WQ0044285_Application (FTSE)_20230410

State of North Carolina
�fuV� Department of Environmental Quality
_DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number:(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of King (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: Scott Barrow per 15A NCAC 02T .0106(b)
Title: City En ig'neer
4. Applicant's mailing address: PO Box 11 W3
City: King State: NC Zip: 27021-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Alexander Apartments PuI"A+ C,
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: Stokes
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.2625' Longitude:-80.3698'
5. Parcel ID (if applicable): 5991-66-0398 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: T. Eugene Muslin License Number: 20709
Firm: Borum, Wade & Associates, P.A
Mailing address: 621 Eugene Court, Suite 100
City: Greensboro State: NC Zip: 27401-
Phone number: [phone] Email Address: mwilliams(&borum-wade.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Lower Muddy Creek Wastewater Treatment Plant Permit Number: NC 0050342
Owner Name: City of Winston-Salem/Forsyth County Utility Commission
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8" inch ❑x Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00350
Owner Name(s): City of King
FORM: FTA 06-21 Pagel 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?
❑ 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.0115(c) been attached?
❑ Yes ❑ No ❑ N/A
4. Origin of wastewater: (check all that apply):
Z 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
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow',b
No, of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 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: 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 470 SDR-26
➢ 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 (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED fN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: - °
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 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(f) & W? ® Yes ❑ No
15A NCAC 02T.0305(fl 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
'Water mains (vertical - water over sewer preferred, 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 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(f) or (a), see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl 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 webpAM
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.
➢ 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? Z Yes Basin name: Muddy Creek ❑ 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 213.0202
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/permitting 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 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 proiects requiring a variance approval may be subject to Langer
review times. For nrolects reaulring two or more variances or where the variance is determined by the Division to be a
danifleant portion of theyroeect, the full technical review is required.
2. Professional Engineer's Certification:
I, T. Eugene Mustin , attest that this application for Alexander Apartments _
(Professional Engineer's name from Application Item III.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 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 143-215.6B, 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 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Scott Barrow . attest that this application for Alexander Apartments
(Signature Authority Name fivm Application Item 1.3.) (Project Name from Application Item li.l )
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 hi 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 143-215.6B, 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.
Signature:
Date: 3 -1 7 ,23
FORM: FTA 06-21 Page 5 of 5

i
400
gq/isloti ' Y {fithbftil + y}
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 King
Project Name for which flow is being requested: Alexander Apartments
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: Muddy Creels
b. WWTP Facility Permit ff: NCO050342
All flows are in MGD
c. WWTP facility's permitted flow 0.97
d. Estimated obligated flow not yet tributary to the WWTP 0.24
e. WWTP facility's actual avg. flow 0.533
f. Total flow for this specific request 0.0000
g. Total actual and obligated flows to the facility 0.7956
h. Percent of permitted flow used 82
IL 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)
Design
Pump Pump
Average
Station Station
Firm
Daily Flow**
(Name or Permit
Capacity, *
(Firm / pf ,
Number) No.
MGD
MGD
The Farm P.S.
2.05
0.82
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current
Tributary
Flow Plus
Avg. Daily
Daily Flow,
Obligated
Available
Flow, MGD
MGD
Flow
Capacity***
0.58
0.124
0.704
0.116
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped now
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 King
Downstream Permit Number: WQCS00350
Page l of 6
FTSE 10-18

III. Certification Statement:
I T. Scott Barrow 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.
Official Signature
Title of Signing Official
- e3
Date
Page 2 of 6
FTSE 10-18

Winston-Salem / Forsyth County
I ti I itioles
Water • Wastewater • Solid Waste
Administration, P.O. Box 2511, Winston-Salem, NC 27102
O: 336-727-8000, F: 336-727-8432, wsfcutilities.org
April 28, 2023
Mr. T. Scott Barrow
P.O. Drawer 1132
King, NC 27021
In Re: Alexander Apartments Flow Acceptance
Dear Mr. Barrow:
This letter is to confirm that the City/County Utility Commission will accept the sewerage from the
proposed Alexander Apartments development.
It has been determined that actual flows and calculated flows are drastically different. For this reason, it
was necessary to reconcile flows that are tracked per our Inter -Local Agreement. The average daily flows
for the last five years are 566,800 gallons per day and we will use this volume in our flow allocation
tabulation.
We are currently treating 566,800 gallons per day. With this estimated demand of an additional 22,560
gallons per day brings the total allocation to 589,360 gallons per day. Our contract with the City of King
has a maximum discharge of 970,000 gallons per day; therefore, we should encounter no problems in
treating the additional flow. The wastewater collection system serving this area is properly sized and
maintained for this service.
If you have any questions concerning this subject, please give me a call at [phone].
Sincerely,
UTILITIES ADMINISTRATION
Todd Lewis, P.E.
Senior Civil Engineer
Winston-Salem/Forsyth County Utilities
City Council: Mayor Allen Joines; Vivian H. Burke, Mayor Pro Tempore, Northeast Ward; Denise D. Adams, North Ward; Dan Besse, Southwest Ward; Robert C. Clark,
West Ward; John C. Larson, South Ward; Jeff Maclntosh, Northwest Ward; Annette Scippio, East Ward; James Taylor, Jr., Southeast Ward; City Manager: Lee D. Garrity
County Commissioners: David R. Plyler, Chair; Don Martin, Vice Chair; Fleming El -Amin; Ted Kaplan; Richard V. Linville; Tonya McDaniel; Gloria D. Whisenhunt; County
Call 311 or 336-727-8000 Manager: Dudley Watts, Jr.
Winston-Salem/Forsyth County Utility Commission: Randall S. Tuttle, Chair; L. Wesley Curtis, Jr., Vice Chair; Harold E. Day; Tom Griffin; Yvonne H. Hines; Duane Long;
[e-mail] HughW.Jernigan; Chris Parker; James Ruffin; Donald R. Stewart; Allan Younger

State of North Carolina
-� Department of Environmental Quality
Division of Water Resources
01vi ton of WM(n tt< -,,,urK, •; Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of King
Project Name for which flow is being requested: Alexander Apartments
More than one FTSE nmv he required for o single project if the owner of the WWTP is aot respmhsible for rill pump
stations along the route of the proposed wastewater flow.
L Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: MUDDY CREEK
b. WWTP Facility Permit #: NC0050342
Allfforvs are in MGD
c. WWTP facility's permitted flow 21.000000
d. Estimated obligated flow not yet tributary to the WWTP 3.1074440
e. WWTP facility's actual avg. flow 13.960000
f. Total flow for this specific request 0,0022560
g. Total actual and obligated flows to the facility 17.069700
It. Percent of permitted flow used 81.3
IL 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 / pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
* 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 pealing 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): Muddy Creek
Downstream Permit Number: WQCS00003
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Courtney Driver, P.E. 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.
�FOV—iy UTIt_i
of Signing Official
/ /2,o?3
Dare
Page 2 of 6
FTSE 10-18

Engineers
Planners
- - - Surveyors
-_:-
Borum, Wade and Associates, P.A.
April 5, 2023
North Carolina Department of Environment Quality
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 28405
Regarding: Alexander Apartments
Newsome Road
King, NC
To Whom It May Concern:
NC N,,prtment of
Enviruril-nerital Quality
Received
APR 10 2023
Winston-Salem
Regional Office
Please find attached fast track application for the gravity sewer line for the above referenced project.
Included in this package are the following:
1. One original and one copy of the Fast Track Application
2. One check for $480
3. One original and one copy of the Downstream Sewer Flow
Tracking/Acceptance Form
4. One original and one copy of the USGS Topographic map and street level map
The proposed public sanitary sewer extension will serve an 80 unit apartment complex — 28 -three
bedroom units, 40 -two bedroom units and 12 -one bedroom units. The project is located off
Newsome Road in King, North Carolina. The flow allocation will need will be permitted in a private
permit. The sewer extension will tie into the existing public 8" sanitary sewer extension owned by
City of King. The extension will consist of 407 linear feet of 8" SDR 26 sanitary sewer line. The
proposed extension will be owned and maintained by the City of King.
Please call if you have any questions.
Very Truly Yours,
A9� IAAIX�
Matt Williams, P.E.
Enclosures
621 Eugene Court, Suite 100, Greensboro, NC 2740 1-27 11 • PO Box 21882, Greensboro, NC 27420-1882
Phone [phone] • Fax [phone]
Website: www.borum-wade.com
NC License #: C-0868