WQ0044298_Application (FTSE)_20230411

State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: N 2,q% (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Seagrove/Ulah Metro Water District (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: Michael T. Walker per 15A NCAC 02T .0106(b)
Title: Secretary
4. Applicant's mailing address: P.O. Box 370
City: Seagrove State: NC Zip: 27341-
5. Applicant's contact information:
Phone number: 336 873-9055 Email Address: michaelwalker51348p_gmail.com
II. PROJECT INFORMATION:
1. Project name: Villas at Pinewood Townhomes
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 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: WQ00
3. County where project is located: Randolph
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.623588' Longitude:-79.822631'
5. Parcel ID (if applicable): 7658522817 & 7658528849 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Aden R. Stoltzfus, PE License Number: 026461
Firm: Stoltzfus Engineering Inc.
Mailing address: 683 Gralin St
City: Kernersville State: NC Zip: 27284
Phone number: [phone] Email Address: aden@seien ing eering.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Asheboro WWTF Permit Number: NC00026123
Owner Name: City of Asheboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ Not Known
2. Downstream (Receiving) Sewer Information: 8 inch N Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS N/A
Owner Name(s): Seagrove/Ulah Metro Water District
FORM: FTA 06-21 Pagel of 5

VL 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?
❑ Yes ❑ No ® N/A
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.0I 15(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(f) ❑ Yes ® No
➢ If yes provide a copy of flow reduction approval letter with this application
Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow',b
No. of Units
Flow
GPD
3-Bedroom Dwelling
360 gal/day
27
9,720 GPD
2-Bedroom Dwelling
240 gal/day
18
4,320 GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
�14,0#OGPD�
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).
Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 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 Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

VU. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1593 DIP
8 338 SDR-35
➢ 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
VIII. 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:
2. Approximate Coordinates (Decimal Degrees): Latitude: ° Longitude: - °
3. Total number of pumps at the pump station:
3. Design flow of the pump station: 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): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
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.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 021.0305(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(fl & (gl? ®Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for se Se arat on Required
Setback Parameter* p
18 inches
Storm sewers and other utilities not listed below (vertical) 18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches) 10 feet
'Water mains (horizontal) 18 inches
Reclaimed water lines (vertical - reclaimed over sewer) 2 feet
Reclaimed water lines (horizontal - reclaimed over sewer)
**Any private or public water supply source, including any wells, WS-1 waters of Class I or 100 feet
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal 50 feet
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
**Any other stream, lake, impoundment, or ground water lowering and surface drainage 10 feet
ditches, as well as wetlands associated with these waters or classified as WL. 5 feet
Any building foundation (horizontal) 10 feet
Any basement (horizontal) 10 feet
Top slope of embankment or cuts of 2 feet or more vertical height 5 feet
Drainage systems and interceptor drains 10 feet
Any swimming pools 36 inches
Final earth grade (vertical)
➢ If noncompliance with 02T 0305 or , see Section X.1 of this application
* 15A NCAC 02T.0305(l contains alternatives where separations in 02T.0305 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 webpage
2. Does this project comply with the minimum separation requirfor ements
or requirements and submitwater mains? ® eparate❑Yes dNo []ntN/A
➢ If no, please refer to 15A NCAC 18C.090(�
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
Yes El No ❑ N/A
3. Does the project comply with separation requirements for wetlands?
®
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the 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:
® 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
El Yes ®No
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter coverage/authorization is required.
if coverag
6. Does project comply with 15A NCAC 02T.0105(�6_) (additional permits/certifications)?
® Yes [:]No
ions must be being
Per 15A NCAC 02T 0105(cll�, directly related
tIssuance of thisapermitlis contingent ts or tonnssuancetof dependent permitr(eros'o,n
have been applied for, or have been obtained.
and sedimentation control plans, stormwater management plans, etc.).
,> El Yes ®No
7. Does this project include any sewer s Wlines
''means any that are deemed
al sew r, sewers contacting surface waters,
Per 15A NCAC 02T.0402, "high -priority
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).
at least once every six -months and
High priority slues shall be inspected 15CAC 02T.0403(a)(5) or the permit ee se
1 individual System -Wide Collection permit.
inspections documented per
Page 4 of 5
FORM: FTA 06-21

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest 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. Approval of the request will be issued
concurrently with the approval of the permit and projects requiring a variance approval may be subject to longer
review times For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, Aden R. Stoltzfus , attest that this application for Villas at Pinewood Townhomes
(Professional Engineer's name from Application Item III.1.) (Project Name from Application Item II.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 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 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 143-215.613, 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. 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 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Michael T. Walker , attest that this application for _Villas at Pinewood Townhomes
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item II.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 143-215.613, 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.
Date � _�
Signature:
S10"
FORM: FTA 06-21 Page 5 of 5

��
�
Division of Water ResourCC5
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Seagrove-Ulah MWSD
Project Name for which flow is being requested: Villas at Pinewood Townhomes
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: _
b. WWTP Facility Permit ff:
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
II. 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 Pump Average
Approx. Not Yet Total Current
Station Station Firm Daily Flow**
Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / p fl,
Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD
Flow, MGD MGD Flow Capacity***
Uwharrie 0.288 0.115 0.025 0.014 0.039 .076
* 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 Asheboro WWTP
Downstream Permit Number: NC00026123
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Michael T. Walker 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 parry. 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
Title of
Date
Page 2 of 6
I''I'I>I? 10--1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Asheboro
Project Name for which flow is being requested: Villas at Pinewood Townnomes
More than one FTSE maybe 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: City of Asheboro WWTP
b. WWTP Facility Permit #: NC00026123
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
9.0
0.466
3.570
0.014 'Tk-c floe woj 0114c (40 lro
4.050 t, CA 5 ��, ; �,., OA
45.0
II. 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
Average Approx. Obligated, Total
Pump Pump Daily Current Not Yet Current Flow
Station Station Firm Flow** Avg. Daily Tributary Plus
(Name or Permit Capacity, * (Firm / pf), Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
14 WQCS00025 0.345 0.138 0.030 0.025 0.055 _ 0.083
6 WQCS00025 2.59 1.04 0.216 0.080 0.296 0.744
2 WQCS00025 _ 4.75 _ 1.9 0.389 0.099 0.488 _ 1.412
* 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):
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I John N. Ogburn, III 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
Title of Signing
Date
Page 2 of 6
FTSE 10-18

Randolph County, NC

06 07
Villas at
Pinewood Site
Boundary
0
Q
Existing
Sewer Line Proposed
Sewer Line
2842
{ Q
4 840 Z
a
-800—
134
Ao

RINJ Stoltzfus Engineering, Inc.
NC Department ai
r—Rvi_eR4 �ealit
Received
TRANSMITTAL MEMO
To: NCDEQ
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
From: Aden Stoltzfus, PE
Attached are:
APR 11 2023
Date: 04/11/2023 Winston-Salem
Regional Offic-
Subject: Seagrove/Ulah Sewer Main Extension
Villas at Pinewood Townhomes
-One (1) original signed Fast Track Sewer System Extension application.
-One (1) copy of the Fast Track Sewer System Extension application.
-Check made out to NCDEQ for $480.00 for the application fee.
Please call me at [phone] with any questions or comments.
683 Gralin Street ♦ Kernersville, NC 27284 ♦ [phone]