WQ0044576_Application (FTSE)_20230706

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NC Department of _.1
EnvirQnmen al Quality e�ct 1�r�c, t -ZC eA,
ee .1ved State of North Carolina
JUL 1 9 2023 Department of Environmental Quality
DWRDivision of Water Resources
Winston-Salem: (FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources Regional office FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: W Q IDOL�L1 J1(QobecompletedbyDWR)
All items must he completed or (lie application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: City oflhonmsville (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Michael Brandt per 15A NC'AC 021' .0106tb)
Title: City Manager
4. Applicant's mailing address: PO Box 368
City: Thomasville State: NC Zip: 27361-0368
5. Applicant's contact information:
Phone number: [phone] Email Address: Michael.brandt, iltlionrtsville-nc. gy
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
I. Project name: Fletchers Farm Subdivision
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: Davidson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,850009' Longitude:-80.097701 °
5. Parcel ID (if applicable): 676-01-46-7136 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
1. Professional Engineer: H. Mack Summey Jr. PE License Number: 26447
Firm: Sunuttey Engineering Associates, PLLC
Mailing address: PO Box 968
City: Asheboro State: NC Zip: 27204-1106
Phone number: [phone] Email Address: mack iosummeyen�ineerin_g con
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hamby Creek WWTP Permit Number: NCO024112
Owner Name: City of Thomasville
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ00057
2. Downstream (Receiving) Sewer Information: 8 inch Z Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00057
Owner Name(s): City ol'Thomasville
FORM: FTA 06-21 Page] of 5

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 Developer's Operational Agreement (FORM: 1)1:V1 been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA 11_0A 0peratiunalAgreement (FORM: I10A) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
El 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 0 % Commercial 0 % Industrial (See I5A NCAC 02T.0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under I5A NCAC 021- .01 14(1-)? ❑ Yes ® No
If yes, provide it copy of now reduction approval letter with (his application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow n,b
No. of Units
Flow
Single Family Residential
360 gal/day
24
8640 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
8640 GPD
a See I SA NCAC' O?.1'_ U_1 1 4(bJ_Lt11. _(elt lj ai�d_(c��') 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 I iA NCAC 01_ f.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 8640 GPD (per I SA NC;AC_02:1..01 14)
�- Do not include future flows or previously permitted allocations
If permitted now 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):
I . Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
1 185
Material
8
SDR 26
8
100
DIP
i- Section 11 & Ill of the MDC for Permitting of Gravity Sewers contains information related to design criteria
i Section III contains information related to minimum slopes for gravity sewer(s)
Y Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
V111. PUMP STATION DESIGN CRITERIA (If Applicable) — )2T .0305 & MDC (Pump 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: aLongitude: - °
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.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02 f .0 305_(h)(I1:
❑ Standby power source or ❑ Standby pump
y 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:
i- Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
i 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)):
I. Does the project comply with all separations/alternatives found in 15A NCAC _02T ;0305(0 & ? ® Yes ❑ No
15A NCAC 02T.0305(l) 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-1 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
Y if noncompliance with 02T.0305(t)or see Section X.1 of this application
* 15A NCAC 02T,030 0) contains alternatives where separations in 02T.0305(f) 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 webpaae
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.
Y See the Division's drall 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 0213 .(20(? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per l5A 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 L6) (additional permits/certifications)? ® Yes ❑ No
Per 15r1 NCAC 0?1'.i)105(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 115A NCAC 02T.04021 "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.
y 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:
I. Does the submitted system comply with 15A NCAC 02T, the k1iitimum Design Criteria kli. the Perntitlin", of I'ump Station.
and Force Mains (latest version). and the Gravity Sewer Minimum Desi_n 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 longer
review limes. For projects requiring two ur more variances or where the variance is determined by the Division to be a
significant portion of the proiect, the full technical review is required.
2. Professional Engineer's Certification:
1. H, r�" st w-.on6 4f PF. , attest that this application for �GtG�nGr3 1:7&e^ V o
Pro
tics6mal Engineer's name frn Appli3ttiun Item III. I.) (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 [lie Fast- _1_rack._Permilti
of Pump Stations and Force Mains I 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:
<02,
�
E,� ALq t
2644/ n a
L- a
,
,
1h�,�•�........_............
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Aie, l I�iK-J/attest that this application for /e'�G�� S �etrr✓� �,,.�d i�l t►"tp�
(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 1-1,>-'_ I i.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.
Signature: --�!sG%vim---��ii% �? Date: -7117/oZ02-3
FORM: FTA 06-21 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: Fletchers Farm 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: Hamby Creek WWTP
b. WWTP Facility Permit #: NCO024112
All flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 1.0602
e. WWTP facility's actual avg. flow 2.68
f. Total flow for this specific request 0.00864
g. Total actual and obligated flows to the facility 3.74884
h. Percent of permitted flow used 62.48%
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:
Pump
Station
(Name or
Number)
East
Pump
Station
Permit
No.
WQ0036588
Firm
Capacity,
MGD
3.168
(A)
(B)
(C)
(D)=(B+C)
Design
Average
Obligated,
Total
Daily
Approx.
Not Yet
Current Flow
Flow**
Current
Tributary
Plus
(Firm J pt),
Avg. Daily
Daily Flow,
Obligated
MGD
Flow, MGD
MGD
Flow
1.2672
0.799074
0.151665
0.950739
(E)=(A-D)
Available
Capacity***
0,316461
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

M. Certification Statement:
I Morgan Huffman certify to the best of my knowledge that the addition of
the volume of wastewater to be pennitted 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 H 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.
'et V",
Title of Signing Official
�iY/-2 0`� 3
Page 2 of 6
FTSE 10-18

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Summey Engineering Associates, PLLC
Engineering • Land Planning • Consulting
PO Box 968 — Asheboro, NC 27204
[phone] / Fax: [phone] / MacVIi�,surMpgyengi om
Env:,-- ;:.::, r -ji duality
TRANSMITTAL yxx�eccived
Date: July 5, 2023 Winston-Salem 3
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
® Plans ❑ Disk
Fletchers Farm Subdivision
Davidson County, NC
Sanitary Sewer Extension
Sea Job No. E-7765
❑ Copy of Letter
❑ Other
# Co ies
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)-summeyengineering.com
336-328-0902 / /

Project Narrative
For
City of Thomasville
8" Sewer Line Extension
For the
Fletchers Farm Subdivision
The purpose of this sewer line extension is to provide a new residential development with
an adequate sewage disposal source and to meet their future sewer needs. The new
development is located near the_ intersection of Lake road _and_ _Kendall Mill road in
Thomasville NC.
There will be one 8" sewer line connected to an existing 8" Sanitary Sewer system
located on the north side of the property. There will be a total of 1286 LF of 8" sewer
main extension with this project. The City of Thomasville 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: Fletchers Farm Subdivision