WQ0043916_Application (FTSE)_20221107

State of North Carolina
Department of Environmental Quality
A4 R Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources MMFTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: cog?) 1p � (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Gannaway, LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Stanhope Johnson per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 348 N. Elm St
City: Greensboro State: NC Zip: 27401
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION: _ ,p �
1. Project name: Suparee Meadows �v
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date: _,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000,
3. County where project is located: Davidson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.8519788' Longitude:-80.0649856°
5. Parcel ID (if applicable): 1634800000026 (or Parcel ID to closest downstream sewer)
III, CONSULTANT INFORMATION:
1. Professional Engineer: Nolan Franz License Number: 050507
Firm: Hagen Engineering
Mailing address: 3859 Battleground Ave. Ste 300
City: Greensboro State: NC Zip: 27410-
Phone number: 336) 286-3350 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hamby Creek WWTPPermit Number: N00024112
Owner Name: City of Thomasville
V. RECEIVING DOWNSTREAM SEWER INFORMATION:p
1. Permit Number(s): WQ_
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00057
Owner Name(s): City of Thomasville
FORM: FTA 06-21 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
TBD. Developer to sell project once all permits acquired. New developer to submit DOA prior to selling lots.
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial _ % Industrial See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ®No
➢ If provide a copv of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a s
No. of Units
Flow
Single Family — 4 bedroom unit
480 gal/day
171
82,080 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
82,080 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114.] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 82,080 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Pennit Number: Issuance Date: _
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
5545
PVC
8
720
DIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VILL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Puma Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.8519788' Longitude:-80.0649856'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.206 millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 143 gallons per minute (GPM) at 69 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
4 1770 PVC
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I5A NCAC 02T .0305(h)(1):
® Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305( & (a)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
"Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(t) or (g), see Section X.1 of this application
* 15A NCAC 02T.0305(a) contains alternatives where separations in 02'r.0305(t) cannot be achieved. Please check "'yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpaee
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ Seethe Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Yadkin —Pee Dee ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ® Yes ❑ No
or 401 Water Quality Certifications?
➢ Please provide the permit number/pennitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Mininunn D=sign Criteria for the Permitting of Puntdr Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria dalcxt version) as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10.14) and supporting documents for review to the Central Office. ,AAuvroval of the renuest will be issued
2. Professional Engineer's Certification:
I, _Nolan Franz attest that this application for _Sugaree Meadows
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. i further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria I'or (iravi)y Scwgis Ilalesl version), and the Minimum Design Ctitcria for the Fast -Track 1'ennittine
of_Pump Stations and Forc4 Mains (latest version . Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCACnS�(>r(ja9ti%, /
tH CAR
North Carolina Professional Engineer's seal, signature, and date:FES$/ O�j�
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, _Stanhope Johnson , attest that this application for _Sugarec Meadows
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6IJ, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not,4n exceed $10,000 as well as civil penalties up to $25,000 per violation.
FORM: FTA 06-21 1 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water ]Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Thomasville
Project Name for which flow is being requested: Sugaree Meadows
More than one FTSE may he required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Hamby Creek WWTP
b. WWTP Facility Permit #: NC0024112
All flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 1 0,9488
e. WWTP facility's actual avg. flow 2.30
f. Total flow for this specific request 0.08208
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
3.33088
55.51%
H. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
Pump
Pump
Station
Station
(Name or
Permit
Number)
No.
(A)
Design
Average
Daily
Firm Flow**
Capacity, * (Firm / pt),
MOD MOD
East
r, • , WQ0036588 3.4128 1.36512
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Approx.
Obligated,
Total
Current
Not Yet
Current Flow
Avg. Daily
Tributary
Plus
Flow,
Daily Flow,
Obligated
Available
MOD
MOD
Flow
Capacity***
0.954
0.00108
0.95508
0.41004
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0..
Downstream Facility Name (Sewer): City of Thomasville
Downstream Permit Number: WQCS00057
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Morgan Huffman certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing
�..�Ni D r/,ec.
Title of Signing Official
z/.X
Date
Page 2 of 6
FCSE 10-18

LIMITED LIABILITY COMPANY ANNUAL REPORT
116/2022
NAME OF LIMITED LIABILITY COMPANY: Gannaway, LLC
SECRETARY OF STATE_ ID NUMBER: 1548570 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2021 AMENDING DOC ID
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: ,Johnson, Stanhope M.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
1548570
CA202206003181
3/1/2022 12:00
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
348 N. Elm Street
Greensboro, NC 27401 Guilford County
SECTION B: PRINCIPAL. OFFICE INFORMATION
348 N. Elm Street
Greensboro, NC 27401
1. DESCRIPTION OF NATURE OF BUSINESS: Real Estate Investment
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
348 N Elm
5. PRINCIPAL OFFICE MAILING ADDRESS
348 N Elm Street
Greensboro, NC 27401 Greensboro, NC 27401
6. Select one of the following If applicable. (Optional see Instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Stanhope Johnson NAME:
TITLE: Member
ADDRESS:
348 N. Elm Street
Greensboro, NC 27401
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Stanhope Johnson
SIGNATURE
Form must be signed by a Company Official listed under Section C of This form.
3/1 /2022
DATE
Stanhope Johnson Member
Print or Type Name of Company Official Print or Type Tille of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

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u IIAGEN
ENGINF,ERING, PA
NC Department of
Environmental Quality
Received
Nov 0 7 2022
TRANSMIV on -Salem i
Regional Office
DATE: 11 /4/2022
TO: Attn: Jenny Graznak
NCDEQ Winston-Salem Regional Office Water Quality Section
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
PROJECT: Sugaree Meadows (Public and Private Sewer)
PLEASE FIND ATTACHED:
ITEM
1 Cover Letter for Private Sewer Permit Application
1 Fast Track Sewer System Extension App. - Private
1 Check for Application Fee - Private Sewer Application
1 Supporting Maps for Private Sewer Permit Application
1 FTSE
1 CD - Digital Copies
1 Cover Letter for Public Sewer Permit Application
1 Fast Track Sewer System Extension App. - Public
1 Check for Application Fee - Public Sewer Application
1 Supporting Maps for Public Sewer Permit Application
1 FTSE
1 CD - Digital Copies
DATED
11 /4/2022
11 /3/2022
11 /4/2022
11 /4/2022
11 /4/2022
11 /3/2022
11 /4/2022
11 /4/2022
Hagen Engineering, PA 3859 Battleground Ave Suite 300 Greensboro, NC 27410
P-336-286-3350 [e-mail]

U j HAGEN
ENGINEERING, PA
City of Thomasville
10 Salem St.
Thomasville, NC 27360
336-475-4210
3859 Battleground Ave, Suite 300 Phone: [phone]
Greensboro, NC 27410 [e-mail]
RE: Sugaree Meadows
Private Sewer Permit Cover Letter
November 4, 2022
The purpose of this cover letter is to outline the contents of this Private Sewer Permit
application package as well as to provide of a summary of the project to which is pertains. This
Sugaree Meadows development is a unit single family subdivision with 171 buildable lots which
will require an estimated peak flow of 82,080 GPD for utility consumption. The project will be
comprised of 5545 LF of 8" PVC private gravity sewer, 720 LF of 8" DIP gravity sewer, a private
pump station, and 1770 LF of 4" PVC private force main. Within this submittal package you will
find the following items:
1) $480 check for the Private Sewer Permit
2) One completed DWR Fast Track Sewer System Extension application
3) One 8.5" x 11" USGS Topo Map
4) One street level map (aerial)
5) Flow Tracking Form
Thank you, ;/�Z
Nolan Franz, PE
Hagen Engineering, PA
336-646-4484