WQ0044234_Application (FTSE)_20230317

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: �`1� 23`( (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
I. Applicant's name: City of Lexington (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: Roger Jones per 15A NCAC 02T ..010bLW
Title: Public Services Managcr
4. Applicant's mailing address: 28 W Center St
City: Lexin,ton State: NC Zip: 27292-
5. Applicant's contact information:
Phone number: [phone] Email Address: rdjonesLilPlexingtonnc.gov
Ill. PROJECT INFORMATION:
I . Project name: Glen Oaks Subdivision Ph. 5
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Davidson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.819030° Longitude: -80 276704'
5. Parcel ID (if applicable): 6725-01-05-5477
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: H. Mack Summey, Jr., PE License Number: 26447
Firm: Summey Engineering Associates, PLLC
Mailing address: PO Box 968
City: Asheboro State: NC Zip: 27204-1 106
Phone number: [phone] Email Address: niackf�6suIll neyengineering.cont
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Lexington Regional Wastewater Treatment Plant Permit Number: NCO055786
Owner Name: City of Lexington
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ
Downstream (Receiving) Sewer Size: inch
S?_st m_Wide Coiection System Permit Numher[__fifa )lic b-le): WQCS
Owner Name(s):

V1. GENERAL REQUIREMENTS
I . 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 Develoner's Op rational Agreement (FORM; DEV) been attached?
[—]Yes [:]No ®N/A
3. If the Applicant is a Home/Property Owners' Association has. an C) erational Agreemptit 1=0R : jQA) been attached?
[—]Yes [:]No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential 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 0 % Commercial
0 % Industrial (See 15A NCAC 02T .0103(20))
Its there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 021' .01 14(t)? ❑ Yes ® No
if yes, provide a copy of flo rcduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow °b
No. of Units
Flow
Single Family Residential
360 gal/day
18
6,480 GPD
gal/
GPD
gal/
G P D
gal/
GPD
gal/
GPD
gal/
GPD
Total
6,480 GPD
a See 15A NCAC 02'r .01 14N., (d). (e)(1) and a (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.01 Ill] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 6,480 GPD (per 15A NCAC 02T .01 14)
y Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
0 Other (Explain):

kyll
Vill.
GRAVITY SEWER DESIGN CRITERIA (If Applicable) - t121* .03t)5 & NII)(' ((;ra%ih ScN�crs):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 I 860 SDR 26
:= Section 11 & 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 requirement is not allowed and a violation of the MDC
PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design now of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) FLength (feet) Material
6. Power reliability in accordance with I �A NCAC 0- 1_.030 (IjKl):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(I )(13)_
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
v Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
►- It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
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 in the case of a multiple station power outage.

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NUA('_0 10.j05 ftj_���g) ®Yes [:]No
15A NCAC 02T.0305() contains minimum separations that shall be irovided for sewer vstems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains vertical -water over sewer including in benched trenches)
18 inches
Water 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 11 impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation) and wetlands (see item IX.2)
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top sloe 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
w I SA NC AC 02T.0305(g) contains alternatives where separations in 02T.0305(fl cannot be achieved.
"Stream classifications can be identified using the Division's NC Surface Water Classifications web aAge
If noncompliance with 02T.0305(f) or NO, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ N; A
See the Division's draft separation requirements for situations where separation cannot be meet
w No variance is required if the alternative design criteria specified is utilized in design and construction
As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 0 B .0200? ® Yes ❑ No ❑ N/A
w This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
w Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with I5A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC_U21'.0 j_L6j, directly related environmental permits or certification applications are 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,).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 1 5A NCAC 02 f.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
w 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 permitee's individual System -Wide Collection permit.

X. CERTIFICATIONS:
I. Does the submitted system comply with 1_51 NC'.\( 0211, the Minini(till Doign C iueria lor the Permiltin�ul'Pump sl pion:
and Force %lain's (latest version and the G ivm_tic\acr,lininium Dcsi�i C'I'IICriFI tI itrst_Vu tiiun) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
r-
P
____.attest that this application for
(Professional l:gineer s name from Application Item II I.I.)
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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force 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 1 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 143-215.613, 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.
North Carolina Professional Engineer's seal, signature, and date: o��'��t G%a?0'll
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26447 i
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3. Applicant's Certification per 15A NCAC 02T .0I06(b):
I, Roger Jones Public Services Manager attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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. l 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_2215.6A and 1 t3-215.013, 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.
Oigitatly signed 6y Roger lopes
R o g e r J o n e s DN cn=Roger Jones, o=Gry of Lexington, ou=Water
Resources, email=RDlOnesr?LexingtonNC gov, -US
Signature: _ Date: 202303.1018:19:19 05'00Date: 3/1 0/2023
FORM- FTA nLI-16 0., r - c

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: City of Lexington
Project Name for which flow is being requested: Glen Oaks Ph. 5 Subdivision
More than one FTSE may be 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: Lexington Regionl WWTF
b. WWTP Facility Permit #: NCO055786
All flows are in MGD
c. WWTP facility's permitted flow 6.5
d. Estimated obligated flow not yet tributary to the WWTP .2092
e. WWTP facility's actual avg. flow 2.8
f. Total flow for this specific request .0085
g. Total actual and obligated flows to the facility 3.02
h. Percent of permitted flow used 46.42
11. 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:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / p fl, Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
Brown St 5.91 2.36 1.5 .229 1.73 .631
* The Firm Capacity 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.
*** 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): N/A
Downstream Permit Number: N/A
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Roger Jones 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 indicates acceptance of this wastewater flow.
Oigi[ally signed by Roger Jones
R o g e r J o n e s DN urcRogerJones, Ones of Lexington,.gm,-er
Resources, email=RDJOnes@Lexing[onNC.gov, -US
Date: 2023.03.10 18:04:16 -05'00'
Signing Official Signature
3/10/2023
Date
Page 2 of 6
FTSE 04-16

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Summey Engineering Associates, PLLC
Engineering • Land Planning • Consulting
W.40& PO Box 968 — Asheboro, NC 27204 NC Department of
[phone] / Fax: [phone] / Mack',& surnmeyeVhalpgeeoni Quality
Received
TRANSMITTAL MAR 17 ?n?!i
Date: March 16 2023
To:
Jenny Graznak
NCDEQ-DWR
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
We are sending you attached the following items:
❑
Shop Drawings
❑
Samples
❑
Prints
❑
Specifications
M
Plans
❑
Disk
Winston-Salem
Regional Ofi ice
Glen Oaks Subdivision Ph.5
Davidson County, NC
Sanitary Sewer Extension
Sea Job No. E-7790
❑ Copy of Letter
❑ Other
# Copies I
Drawing #
Description
Disposition
1
$480.00 Application Fee
1
Cover Letter
2
Fast Track Sewer Application
(1 original & 1 copy)
2
Flow Tracking Acceptance Form
(1 original & 1 copy)
1
USGS Topo Map
1
Aerial Photo
Remarks: I Jenny,
We have enclosed the information for your review. Please let us know if you have any
questions, concerns or need any additional information from us.
Thank you,
Christian Vestal
Christian(a-)-summeyengineerin.g.com
336-328-0902

Project Narrative
For
The City of Lexington
8" Sewer Line Extension
For the
Glen Oaks Subdivision Phase 5
h an
The purpose of this sewer line extension is future needs of these residents Thetnew
adequate sewage disposal source and to meet the ture
subdivision is located at the end of Glenwood Drive in Lexington NC.
There will be one 8" sewer line connected to an existing 8" Sanitary Sewer outfall line
running along the west side of the property. There will be a total of 860 LF of 8" sewer
main extension with this project. The City of Lexington waste water treatment System
has the capacity to serve this new development and many other residences. The only
other alternative for this development would be individual septic systems on each lot
which would not be feasible due to unfavorable site conditions when compared to the
advantages provided by this proposed extension.
Prepared By: H. Mack Summey, Jr., P.E.
Address: P.O. Box 968 Asheboro, NC 27204
Phone: [phone]
Project: Glen Oaks Ph. 5
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