WQ0044707_Application (FTSE)_20230901

Pce�ve_j 14—
State of North Carolina
DWR 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: QQ0 ( -Xq (W he completed by Quit)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Archdale (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Zeb Holden per I5A NCAC 02T-010(>(b)
Title: City Manager
4. Applicant's mailing address: P.O. Box 14068
City: Archdale State: NC Zip: -27263
5. Applicant's contact information:
Phone number: 336-434-7346 Email Address: zholden@archdale-nc.�_-ov
If. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
I. Project name: Logan White Sewer Extension
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: 35.890405' Longitude:-79.934711'
5. Parcel ID (if applicable): 7728301206 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
1. Professional Engineer: H. Mack Summey Jr. PE License Number: 26447
Firm: Summey Enginccrim� Associates PLLC
Mailing address: PO Box 968
City: Asheboro State: NC Zip: 27204-1 106
Phone number: [phone] Email Address: mack.rt summeyen,,inecring com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: I-Ii-gh Point Eastside Treatment Plant Permit Number: NC 0024210
Owner Name: City of I-ii:;h Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0029787
2. Downstream (Receiving) Sewer Information: 12 inch N Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): City of Archdale
FORM: FTA 06-21 Page I 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 Agreemeni (FORtiI: DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an 1-10A. 10- A Operational A,reemem (FORM: 1 K)A) 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):
❑ 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: 0 % Domestic 100 % Commercial 0 % Industrial (See 15A NCAC 0' F .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 0'T .01 I-Iffl? ❑ Yes ® No
If ves, provide a cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow I,b
No. of Units
Flow
Retail (stores, centers, malls)
100 gal/ 1000 SF
11,800 SF
1,180 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
I ,180 GPD
a See 15A NCAC 02T .01 14(b)(d). (e)( I ) and (e)(21 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 02-r.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: 1,180 GPD (per 15A NCAC 02T .01 I4)
Do not include future flows or previously permitted allocations
1f 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 PaLre 2 of 5

V11. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & i�9DC (Gravity Sewers):
I . Summarize gravity sewer to be permitted:
Size (incites) Length (feet) Material
8 290 SDR 26
Y Section 11 & ill of the MDC for Permitting of Gravity Sewers contains information related to design criteria
v Section 111 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
Vlll. PUMP STATION DESIGN CRITERIA (if Applicable) — 02T .0305 & MDC (Puntp Stations/Force Ylains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I . 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 2.01 C. I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(I ):
❑ Standby power source or ❑ Standby pump
> Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B);
1.
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 papa I of S

IX. SETBACKS & SEPARATIONS —(02B .0200 & 15A NCAC 02T ,0305(l)):
I. Does the project comply with all separations/alternatives found in I5A" NCAC 02 .0305(I)N,y? ® Yes ❑ No
15A NCAC 02T.030id) contains minimum ;tmararions that shall be provide f fur sa...- --cm-
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 1 or
Class 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
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 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
tr noncompliance with 02 r.o305(f) or ( see Section X.I of this application
* 15A NCAC 02T.0305(al contains alternatives where separations in 02T.0305(t) cannot be achieved. Please check
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 weboage
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? ® Yes Basin name: Randleman Lake ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0300? ® 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/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with I iA NCAC 021-.010itc) 6 (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6l, 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 02"1'.0-102, "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 Pave 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with I5A NCAC 03T, the iMininitim Design C'riteria lip• the Perniittine.ul•purnp Stations
alid Force Mains_( latest vet-iunj, and the C;ra� itv Sewer iMininunn Design Criteria laic~) erniuni as applicable?
® Yes ❑ No
If no, for projects requiting 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
con_current(y with the approval of the permit and projects requiring it variance approval In av 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
ssi2nificanl portion of the project the full technical review is required
2. Professional Engineer's Certification:
I, J_W_ S� MMi� r . , P ri attest that this application fore,( ��c •� �j`c ti
J
fs sional Gnginccr's name I'ronApplica[ion Item IILI,1 (I°fgjcet 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. 1 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 iklinimum Design Criteria Im the Cast -Track Permitting
of Punta 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 ofthe application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
g g d. (21 N,
the North Carolina -licensed Professional Engineer to referral to the licensing boar CA
ii ,,5\A lgi North Carolina Professional Engineers seal, signature, and date: -- SS/V
Z, QQO ti<
L.
26447
IN
Ile
:................................................... ............ .........................
Applicant's Certification per 15A NCAC 02T .0106(b):
attest that this application for 451� ��tr-tom
(Signature Authority Name from Application Item 1.3.) (roject 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.
1 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 143-215.6B, 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:
FORM: FTA 06-21 Paee 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 Archdale
Project Name for which flow is being requested: Logan White Sewer Extensom
More than one FTSE may be required for a single project if the o►vner 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 #:
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 0.0011
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:
Pump
Station
(Name or
Number)
Weant
Pump
Station
Permit
No.
WQ0029787
Firm
Capacity,
MGD
5.760
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Average
Approx.
Obligated,
Daily
Current
Not Yet
Total Current
Flow**
Avg. Daily
Tributary
Flow Plus
(Firm / pf),
Flow,
Daily Flow,
Obligated
Available
MGD
MGD
MGD
Flow
Capacity***
2.304
1.098
0.041
1.139
1.16.5
* 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 Zeb Holden 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.
Signer Official Signature
Title of Si ing Official
MA
Page 2 of 6
FTSE 10-18

State of North Carolina
Department of 1! nviimmnental Quality
Division of Water Resources
hlowMuching for Seiier &tension Applications
C)Ivi :ir,ru ui 1 r.�tc r' itt in►ite r ; (ME
Entity Requesting Allocation: IligiiPointNC
Project Name for which flow is being requested: Logan White Sewer Extension (Revised)
More than one ME ntay be t egttit edfor a single project if the owner of the WWTP is nol responsible for allptovp stations along the
rattle of theproposed wastewater flow
I. Complete this section only ifyou are the owner of the wastewater h'eahr ent plant.
a. WWTP Facilitynanre; Tastside WMI?
b. WWTP FacilityPemit#:NQ024210
A11 flows are in MGD
c. WWTP facility's Penn itted flow
26
d. Estir ated obligated flow notyet h7butaryto the WWTP
3.05
e. WWTP facRys actual average flow
14.92
f Total Ilow for this specific request
0,0011
g. Total actual and obligated flows to One facility
17.9711
h Percent ofpertnitted How used
69.12%
If. Con}rlete this section for each ptarp station your are responsible for along Ore route offlris proposed wastewater flow
List pump station located between Ore project connection point and Ore WWTP.
(A) (B) (C) (DY(B+C) (LH=(A D)
Pwnp Pump Design Approx Obligated Total Current
Station Station Funr Aver Daffy
Current Not Yet Flow Pius Available
(Maur. or Penrit Capacity, * Flow** Avg Daily Tributary Obligated Capacity***
Number) No. MGD (Fimypf) Flow Daily Flow Flow MGD
MGD MGD MGD MGD
Archdale Z 5 2.5 0,9992 5 8 2_5 0
*Ire Brni Capacity of any pump station is defined as the raximunr pun aped flow that can be
achieved `rith the largest pump taken out of service.
** Design Average Daily howls the firm capacity of the pwrip station divided by a peaking factor (pf)
not less than 2.5, per'Section 2.02(A)(4)(c) of the Minkmwn Design Criteria.
*** A Planning Assessment Addendwn shall be attached for each pwnp station located betMen the
project correction point mid the W WTP «here the Available Capacity is < 0.
Downst'eamFacilityNane (Sewer): Tastside WWIP
DownstearnPenrit Nunber (Sewer): NC0024210
Page 1 of 6
FTSE 10-18

III, Certification Statenent
1, Den•ick 0. Doone, certify to the best ofnry knowledge that the addition of the vokue of
wastewater to be pern>itted bi this project has been evaluated along the route to the receiving wastewater
treahzent facility and that the flow from this project is not anticipated to cause any capacity related sanitary
sewer overflows or ove►bu►•den any downstream puzp station en route to the receiving treahzent plant
under nonml cueurstances, given the inpicnentation of the planned uzprovenents identified in the
pla► ning assessment where applicable, This analysis has been pe►4onzed in accordance with local
establishedpolicies and procedures using the best available data. This certification applies to those iters
listed above in Sections 1 and R plus all attached planningassessizent addenduns for which 1 am (lie
responsible party. Signature of this fbnn indicates acceptance of this wastewater flow,
Ofticial
kb
Title of S4ping Official Assistant Public Services Director
Date
8/24/23
Page 2 of 6
FTSE 10-18

Project Narrative
For
The City of Archdale
8" Sewer Line Extension
For
Logan White
The purpose of this sewer line extension is to provide an existing retail center with an
adequate sewage disposal source and to meet the current needs of this facility. The
existing retail center is located across from Tom Hill Road at the intersection of Tom Hill
Rd and Hwy 311 in Archdale NC.
There will be an 8" sewer line connected to an existing 12" Sanitary Sewer line running
on Mose Road to the Northwest of the retail store. There will be a total of 290 LF of 8"
sewer main extension with this project. The City of Archdale and Highpoint waste water
treatment Systems have the capacity to serve this facility. The only other alternative for
this development would be pump and haul the sewer from this facility and this would not
be feasible due to cost and environmental harm 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: Logan White Sewer Extension

Summey Engineering Associates, PLLC
Engineering • Land Planning • Consulting
PO Box 968 Asheboro, NC 27204
[phone] / Fax: [phone] / [e-mail]
NC Dti�cnt oI
TRANSMITTAL Enviro Repc�receivedQuality
Date: July 20, 2022
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
Winston-Salem
Logan Whig ieerlEx;Y.rlsion
Randolph County, NC
Sanitary Sewer Extension
Sea Job No. E-8682
❑ Copy of Letter
❑ Other
# Co ies
Drawing #
I 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(c)-summeyengineering.com
336-328-0902