WQ0042721_Mod_Application_Revised_(FTA)_20231222

lie i e i 6r4Q I LI22r2D23
Stale of North Carolina
R Department of Plnvi-onmental Quality
Division of Water Resourves
FAST TRACK SEWER SVS'rvm EXTENSION APPLICATION
Division of Water Resources 11'A 06-21 & SUPPORTING DOCUMENTATION
Application Numhor: !' 446 g2Al7.x I (to be completed by DWRI
s All itemmost he colmmleted ell ullcNlmt will be rolurned
APPLICANT INFORMATION:
I. Applicant's name: Front Street WWjbjtt •y. LLC (compony, municipality, I IOA, utility, wo.)
2. Applicant type: ❑ Individual ® Corporation ❑ (Iolerol Nri ership ❑ Privately -Owned Puhlie Utility
❑ Fcdcral ❑ Sttolo/Cuunty ❑ Municipal ❑ O(Iwr
3. Signature authority's not uc: un'I' t per 15A NCAC 02T.0106(b)
'fide: MmiffilidWarluor
0/
4. Applicant's mailing address: 450 North Patterson Avenue. Suite 300
City: Winston-SMlen Slate: K ✓ Zip: 21101-
5. Applicant's contact inlbrn alion:
Phone number. (31, 6) 24g-2600 Final] Address: HobinCnitFontslreeled(>!Ifl{,gqn Nx
f ��d
II. PROJEC`['INFORMATION:
I. Project name: Front Street._ Wallbuty, I.I.0 Wallhurg Read Puma Station
2. Application/Project stanu: ❑ Proposed (New Pennit) ® Fxisling Perink/Project
If it modification, provide the existing permit number: W00042721 and issued date: August 11. 2021.
Far modifications, nlso Minch it detailed narrative description its described In Item G of the chochllst.
If now construction, bill part ol'a nutster plan, provide the existing permit another: W0(a),
3. County whole project is locretod: tgtWh
4. Approximate Coordinates (Dmimal [> Nunes): Lotilutic: 36395 " Longitude: - 0 1 ' 93°
5. Parcel II) (if applicable): 6863.55.342).00 (or Nicol 11) to closest downstream sewer)
lit. CONSULTANT INFORMATION:
I. Professional Engineer; i,jJeal'I'ucker 1'ti LicenstlNunrber:014985
Firm: Stimmol Associates, KA,
Mailing address: 601 N 'Trade Street. Suite 200
City: 3vinston-S4lcm`1 / Slatc: NC Zip: 27101 _
Phone number. (1Z) j;yl• 106Y Email Address: Nlucke slinnncll cc n
IV. WASTRWATERTRRA:1'MF;N'1'FACI1,1'1'V(WWFF)INFORMA'I'ION:
I. Facility Nnme• LalvluddyC Ie /i'orntil Number: NCO0.50342'�
Owner Name: Winston-Solent/Forsvth County Utility Conmissiv)l
V. RECRIVING DOWNSTREAM SBWF.R INFORMATION;
I. Pennit Numher(s): W0C1S00003
2. Downstream (Receiving) Sewer Inlornmtion: IK inch N (Lavi(y I l Forge Main
3. System Wide Collection System Pormil Numbor(s)(ifapplicable): W0CSQQ0D.'�
Owner Nome(s): iV' sot-tia141L1°ersvth ('aunty ffli lfvCoulmissioil
FORM: F"fA 06.21
Page I of 5

VI. GENERAL RRQUIREMENTS'
I. If (lie Applicant is a Privately -Owned Public Utility, has a C'enificate 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 QVsratioml Agreement (FORM; VEVI been nitached'T
[--]Yes ❑ No ® N/A
3. If file Applicant is a Ilomc/Prupeny Owners' Association, has an HOA/POA Operational Agreement (FOR_MLHS2A and
supplementary documentation srs required by 15A NCAC 02T.011.5(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, mails) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparatiotilservice ❑ 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 / oflices / factories ❑ Nursing Home ❑ Otter (lixplain in Attachment)
r/
5. Nature of wastewater: 0 % Domestic IOQ%Cone norcial 0 % Industrial (�eeS )
If Industrial, is there a Pretreatment Program in cffw? LJ Yes ❑ No
6. Has a flow reduction been approved under ISA NCAC 02T.0114(fYl ❑ Yes ® No
)o If ve , provide a cony of Row reduction approval letter with this anolication
7. Summarize wastewater generated by project:
Fatablishment'lype (see 02T.0114(0)
Daily Design How"
No. of Unit
Flow
Warehouse
100 galflooding bay
117
11,700 OPD
gal/
OPD
gal/
OPD
gal/
OPD
gal/
Opt)
gal/
kipD
Two/
11,7000111)
it Sec ISA NCAC 02T 0114(b). (d). (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., mininnun 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 he used as vacation rentals as defined
in 9.S.42A-4.
b per 15A NCAC OTT ,0114(c), design flow rules forestablishumas not identified [in table ISA NCAC 02T.0114i shall be
determined using available flow (late % cr using fixtures, occupancy or operation patterns, and other pleasured data.
8. Wastewater generated by project: 11.70 (✓1111) (per 15A NCAC 021' .0114)
y Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main of Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary infornalion indicating the approximate tinieframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Pemtit Number: _. ___ _ Issuance Date: _
❑ Rehabilitation or replacement of existing sewers with an new flow expected
❑ otter (explain):
FORM: VIA 06.21 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 58 DI
i Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Y Section III contains information related to minimum slopes for gravity sewer(s)
l 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 IN THIS PROJECT
1. Pump station number or name: Wallbure Road — Pump Station ' /
2. Approximate Coordinates (Decimal Degrees): Latitude: 36. 039527' Longitude:-80.1347930
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.148320'millions gallons per day (firm capacity)
i This should reflect the total GPM f Obe pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 103 gallons per minute (GPM) at 66 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
3
1,224
PVC
If any portion of the force main is less than 4-inchpelu diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power liability in accordance with 15A NCAC 02T .0305(hH l ):
® ✓Standby power source or ❑ Standby pump
Y Must have automatic activation and telemetry - 15A NCAC 02T.0305(hxI B).
Y Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Y 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 I5A NCACO2T.0305(hx 1 XQ:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
1 Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
Y 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(0):
1. Does the project comply with all separationsialternatives found in 15A NCAC 02T.0305(f) & (R)? ® Yes ❑ No
I SA NCAC 02T.0305(f) 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
2Water 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-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
➢ If noncompliance with 02T.0305(f) or (R), see Section X. I of this application
* 15A NCAC 02T.0305(R) 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 web a
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to I5A NCAC 111C.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 nonconformance.
➢ 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
5. Does the project require coverage/authorization under a 404 Nationwide individual permits - ( ® Yes ❑ No
or 401 Water Quality Certifications? l
➢ 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
It' no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting docunrems for review to the Central Office. Anoroval of the request will be issued
2. Professional Engineer's Certification:
1, J. Neal Tucker. P.E.. attest that this application for Front Street — WallburIL LLC Waliburg Road - Pump Station
(Professional Engineer's now from Application Item III. I) (Project Name from Application Item Il.l )
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 Minimum Design Criteria for the Fast -Track Permitting
of Pumo Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, 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 S 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 Cer ificatio or 15A NCAC 02T.0106(b):
1, Robin Team , attest that this application for Front Street - Wallburg. LLC Wallburg Road - Pump Station _
(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 accurnte 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 ate not included, this application package is subject to being returned as incomplete. 1 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. 1 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: ��' L • Z3
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
MAUR
Department i Environmental Quality
��---��Division of Water Resources
olvls� Ion of water lt� Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Front Street - Wallburg LLC
Project Name for which flow is being requested: 12522 - FSC Wallburg Road
More than one FTSE may he required for d single project if the owner of the WWTP is not responsible for all pump
stations along the route ofthe proposed wastewater flow.
I. 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
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
All flows are in MGD
21.000000
2.913427
16.790000
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
0.011700
19.715127
93.9%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
r
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 / pi),
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 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): 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.
Signature Date
Capital Projects Engineer
Title of Signing Official
Page 2 of 6
FTSE 10-18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available Capacity is <
0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in
d. The following applies:
; and/or
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
Signing Official Signature
Date
Page 3 of 6
FTSE 10-18

Instructions for Flow Tracking form (FTSE) and Planning Assessment Addendum (PAA)
Section I
a. WWTP Facility Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the W WTP receiving the
wastewater flow.
c. WWTP facility's permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not vet tributary to the WWTP. MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through interlocal
agreements or other contracts not yet contributing flow to the collection system are also included. For POTWs
that implement a pretreatment program, include flows allocated to industrial users who may not be using all of
their flow allocation. Please contact your Pretreatment Coordinator for information on industrial flow tributary
to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years and
reconciled their flow records, to the best of their ability, so it is known how much flow has been obligated and
is not yet been made tributary to the WWTP, in accordance with local policies and procedures employed by the
reporting entity.
e. WWTP facility's actual avg. flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flows to the facility, MGD Equals [d + e + fJ
h. Percent of permitted flow used: Equals [(g / c)* 1,001
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there is 0.5
MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7 MGD. There is a
proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h. = 53.6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c. = 6.0 MGD
d. = 0.515 MGD
e. = 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 10-18

Section II
List the pump station name or number and approximate pump station firm capacity, approximate design average
daily flow (A) approximate current average daily flow (B), and the obligated, not yet tributary flow through the
pump station (C) for each pump station that will be impacted by the proposed sewer extension project. Calculate
the total current flow plus obligated flow (D=B+C) and the available capacity (E=A-D). Include the proposed flow
for this project with other obligated flows that have been approved for the pump station but are not yet tributary
(C)•
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as per the
Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station'divided by a peaking factor (pf) of not less than
2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump station
if the system has future specific plans related to capacity that should be considered in the permitting process.
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Design
Approx.
Not Yet
Total Current
Firm
Average
Current Avg.
Tributary
Flow Plus
Pump Station
Capacity
Daily Flow
Daily Flow,
Daily Flow,
Obligated
Available
(Name or Number)
MGD
(Firm / pf)
MGD
MGD
Flow
Capacity*
Kaw Creek PS
0.800
0.320
0.252
0.080
0.332
' 0.012
Valley Road PS
1.895
0.758
0.472
0.135
0.607
0.151
Page 5 of 6
FTSE 10-18

I'
Planning Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section II where available capacity is < 0.
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether there is
significant likelihood that needed improvements or reductions in obligated flows will be in place prior to activating
the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to manage the
flow without capacity related sanitary overflows and must take all steps necessary to complete the project or control
the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned project in
the future not yet funded but in a formal plan adopted by the system. The system should carefully weigh the
certainty of successful timely project completion for any expansion, flow management diversion or infiltration and
inflow elimination projects that are the foundation of a planned solution to capacity tracking and acceptance
compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080 MGD of the
committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.01 MGD
per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with planned
completion in ; and/or
d. The following applies:
The master plan and ten year capital elan contain recommended scope and funding for a capital proiect entitled
Kaw Creek Pump Station upgrade with funding planned in July 2014. This proiect is planned to add 0.100 MGD
to the firm capacity of the pump station by October 2015. Inclusion of this proposed capital project as a condition
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow this flow
to be permitted, without a significant likelihood of over -allocating capacity in the system infrastructure.
Page 6 of 6
FTSE 10-18

Wallburg Road Pump Station L'
Aerial Site Map
1 FI 'r� 11 f
t
1
Project Location
e
Legend
�,.IR
• 7'
1 y
t. f�
1 �S v
C) 202-1 Gzj6

601 N.
TE
• 7 stimmel WIWNWSSON �ALPEM,NC axom 336!� 3, 11067
December 11, 2023
North Carolina Department of Environmental Quality
Division of Water Resources
450 W. Hanes Mili Road, Suite 300
Winston-Salem. NC 27105
Attn: Mr. Ron Boone
Re: Modification to Permit Number WQ0042721
Front Street — Wallburg Road Pump Station
Forsyth County
Winston-Salem, NC 27106
Dear Mr. Boone:
I am requesting a modification for the above referenced permit due to an
pump station. The above referenced permit includes the following items:
1. 58 linear feet of 8-inch gravity sewer
2. 94-gallon per minute pump station with duplex grinder pumps
3 Onsite audible and visual high water alarms and telemetry
4. Permanent generator with automatic transfer switch
5. 1,224 linear feet of 3-inch force main
6. Discharge of 11.700 gallons per day of wastewater
NC Department of
Environmental Quality
Received
DEC 2 2 2023
Winston-Salem
Regional Office
increase in the pumping rate of the
We request the following items to be modified:
1. The 94-gallon per minute duplex grinder pumping system to be modified to 103 gallons per minute. All
other items remain unchanged from the original permit.
The reason for this change is that the Contractor submitted a different manufacturer's pump than that
specified. The alternate pumps were accepted based on my opinion that the alternate pumps were better
suited for the installation. Calculations were revised using the alternate pump curves and the pump operating
point increased from 94-gallons per minute to 103-gallons per minute.
The final permit should include the following:
1. 58 linear feet of 8-inch gravity sewer
2. 103-gallon per minute pump station with duplex grinder pumps
3. Onsite audible and visual high water alarms and telemetry
4. Permanent generator with automatic transfer switch
5. 1,224 linear feet of 3-inch force main
6. Discharge of 11,700 gallons per day of wastewater
A partial certification was submitted for the pump station on 9128/2022. The certification was partial due to the
permanent standby generator being on back order. Standby power was provided by a leased portable
generator until the permanent generator was delivered and installed. At the time that I submitted the partial
certification I did not realize an increase in pumping capacity of 5% or more required a permit modification, so
this was an oversight on my part.
LANDSCAPE ARCHITECTURE CIVIL ENGINEERING LANDPLANNING

COPstimmel wsa moM 3�11oEt3.O67
Attached you will find the following:
• Fast Track Permit Application (FTA 06-21) - one original and one copy
• Application fee in the amount of $600
• Flow Tracking / Acceptance Form (FTSE 04-16)
• USGS Quad Map
• Google Earth aerial location map
• Existing Permit WO0042721
Let me know if you need any additional information.
Sincerely,
J. Neal Tucker, PE
Stimmel Associates, P.A.
Vice President / Director of Civil Engineering
Attachments
Cc: File
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14985
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LANDSCAPE ARCHITECTURE CIVIL ENGINEERING LAND PLANNING

NC Department of
Environmental Quality
Received
QW11R�
Division of Walter Resources
DEC 2 2 2023
State of North Carolina
Winston-Salem Department of Environmental Quality
Regional Office Division of Witter Resources
FAST'rRACK SEWER SYSTEM EXTENSION APPLICATION
INSTRIXTIONS F'OR FORM: VFA 06-21 & S(IPPOKI'ING DOCIIMI(N'I'A'1'ION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and lite applicant that the project meets the requirements of 15A NCAC 021 and the Division's
Mininuun Design Criteria (Gravity Sewer & Pump Stalions/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with I5A NCAC 02T, 15A NCAC 02T.0300, Division policies, and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02I' .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. 'Ibis world include plans, design
calculations, and Imiject specifications referenced in IAA NCAC 02T .0305 and the applicable minimum design criteria. 'These
documents shall be immediately available upon request by lire Division.
Projects that are deemed permitted (do not require it permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible fir review via the fast track process (must be submitted fbr fill[ technical review):
Y Projccas that do not meet any part of the minimum design criteria (MDC) documents;
➢ Projects that involve more than one variance from the mquirencnus of I SA NCAC 02T;
Y pressure sewer systems utilizing simplex septic tank -effluent pumps (SIT.Ps) or simplex grinder pumps;
Y Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
Y Vacuum sewer systems.
General- When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided loxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall sulanit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may be digital) of Application and Supporting Documents
0 Required unless otherwise noted. Signatures on original nmst be "wet ink" or seams digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
11. Cover I.etter/Narrative Description (Required for All Application Packages):
I@ List all items included in the application package, as well as a briefdescription of the requested permitting action.
➢ fie specific as to the system typo, nunnber of hones served, Flow allocation required, etc.
Y Include the pemlil number/status of any other required sewer permits (downstream/upsream)
Y If necessary for clarity, include attachments to the application form.
C. Application Fee (Alp New and Modification Application Packages): WOOD.
® Submit a check or money order in lime amount o�11gRQ , dated no naac than 90 days prior to application submittal.
Y I4ryablc to North ('arolina Ucpartmemt oil?nvprrnunanal Vmamlity (NCDIiQ)
1). Fasi Track Application (Required for All Application Packages, Form F"1'A 05-21):
® Submit the completed and appropriately executed application.
Y If necessary for clarity or clue to space restrictions, altacluneus to the application may be made.
® If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is rcgislered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a p atinership or d/b/a, enclose a copy of the certificate filed with the Register of feeds in
the county of business.
I@ The project Name in ilea I1,1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall to signed, scaled and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
I SA NCAC 02'T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person win nmcels the criteria in 15A NCAC 02T .0I06(h).
INSTRI1Cr10Ns F'OR FORM: FFA 06.2I & SIIPPORTINO DOCUMIiNTATION Page I of 3

R. l,'low'I'rgieldnyJAcceptnnce harm (Form: VISE 04-14) (If Applicable):
® Submit the completed and executed VI'SF form Irian the owncns of the downstream sewers and Ircateenl facility.
Y Multiple forms maybe required where the downslremu sewer owner and wastewater treatment facility ate different.
Y The flow acceptance indicated in fomn VISE must not expire prior to permit issuance and must be doted less than one year
prior to the upplication (laic.
Y Submi0al of this application and limn FISE indicates that owner has adequaw capacity and will not violate G.S 143-21 S b7(a),
Y Intergovernmental agreements or other ctmbncls will not be accepted in pica ofn project -specific FISH.
F. Site Mops (All Appllca(lan Packages):
N Submit an 9.5-I1reh x 1 I -hock color copy of it DMIS Topographic Mop orsufRdent scale to identity 111e entire project "roll,
including the closest surtbec %voters.
Y (formal location ol'the project ctaniwncnls (gravity sewer, daunp stations, & force main)
Y Downstream Connection points and penuit number (if known) liar lle r ceiving sewer
® include an aerial Iocalion map showing general project area (such as street manes or IntlWde/longitude) so lhgil Division staff
can cosily locate it in the field.
G. Existing Permit (Applicnllon Ihncknµes for Modl0callous to an Existing 11crntip:
by Submit it copy of the most mcenly issrcd existing pennil.
® include n descriptive and clear narrative identifying the previously per•nitied horns to remain In the perndl, Items to be
added, and/or items to be modifled (tile application limn ilsetfshouid include only include items to be nddmUnuuldlied). The
narrative should also include whether any previously permitted items hove been certified.
® The narrative should clearly Identify the requested permlithtg action and accurately describe file sewers fit be listed In
the Wtal permit.
11. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T 0305(hN 1). submit documentation ol'pwwor reliability for pumping stations.
Y 'I'inis alternative is only available for average daily flows loss than 15,000 gallons per day
Y It shnil be dcnronsitoted to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(h)) or proposed contactor,
staling that "tic portable power generation unit or portable, independonlly-powered pumping units, associated appurtenances
and persomcl are available for distribution and olncration of this pump station."
Y if the portable power snare or pump is dedicated to multiple pump stations, all evalun0oa of gill the punga stations'
storage capacities and the roballon schedule of the porinble power source at, punyl, Including travel thme0ronles, shall
Ile provided In the cuso of it nmlliple stallon power outlµe, (Required "1 Woe ol'een•110ca0un)
I. Cor dOctlto of Public Convenience and Necessity (Alp Application Packages for PrivItlely-Owned Public U111111es)t
❑ Per 15A NCAC 029'.0115(a)(I) provide [lie Certificate of Public Convenience and Necessity tom the North Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Stfifjslaling all application
for a fraochiso has Icon received and that the service area is contiguous to an existing franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications front IIOA/POA and Developers for pots to be sold):
❑ l lomdl'ro)NI'ly Oegos' Associ ions
❑ Per I SA NCAC 02'r .01 We , submit the properly executed Operational Agreement (FORM: HOA).
❑ per 15A NCAC 02T,01 I5(c), submit a copy of the Articles of Incorporation, I)cclnrations and Hy -laws.
❑ Dovcloncrs of lots to be sold
❑ Per 15A NCAC 02T .01 15(b). submit the properly exeaned Operational Agreement (FORM: DEV).
Formolt, hifin•mnrion, visit lire Divisions colloolon sysiems• tvebsire
INS'i-RUCTIONS FOR FORM: f•rl'A 05.21 R SUPPORTING DWILIMRNTA'I'ION Pogo 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE. APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional OHice
Water Quality Section
2090 US highway 70
Swannanoa, North Carolina 28778-8211
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Fayetteville Realonal Office
Water Quality Sectlon
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5095
[phone]
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
Water uallt Section
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan.
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham Edgecombe, Franklin,
Water Quali Sectlon
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washinaton Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Curriluck, Dare, Gales, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pill, Tyrrell, Washington, Wayne
W ihninaton Realonal Office
Water Quality Sectlon
Winston-Salem Regional Oflica
Water Quality Sectlon
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
450 W. Hanes Mill Road
Suite 31f0
Winston-Salem, North Carolina 27105
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pander
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davis, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Suny, Watauga, Wilkes, Yadkin
INSTRUCTIONS FOR FORM: IrrA 05.21 & SUPPORTING DOCUMLMI'ATION Page 3 of 3