WQ0045100_Application (FTSE)_20240112

�Gcciveco
DWR
Division of Water Resources
Application Number:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
(to be completed by DWR)
All items must be completed or the avolication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Jamestown (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Matthew Johnson per 15A NCAC 02T .0106(b)
Title: Town Manager l
4. Applicant's mailing address: 301 E. Main Street
City: Jamestown/State: NC � Zip: 27282-
5. Applicant's contact information:
Phone number: (336) 454-I 138 iEmail Address: miohnson(�jamestown-na.go✓
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Oakdale Forest Phase 1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ 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: W000
3. County where project is located: Guilford/
i
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.986355 Longitude:-79.917963.
5. Parcel ID (if applicable): 223271 (or Parcel ID to closest downstream sewer)
IIL CONSULTANT INFORMATION:
1. Professional Engineer: Thomas R. Glover, Jr. License Number: 027465
Firm: Glover Engineering,PLLC
Mailing address: 7021 Endotrail Road
City: Greensboro State: NC Zip: 27409-_
Phone number: (336) 2024163 Email Address: rich(ilglovereng.com�_
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside Wastewater Treatment Plant � Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): WQC500314 -�
2. Downstream (Receiving) Sewer Information: 10 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00314 �
Owner Name(s): Town of Jamestown -�
FORM: FTA 06-21 Pagel of 5

VI.
GENERAL REQUIREMENTS
If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[I Yes ❑ No ❑ N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV I been attached?
❑ Yes ❑ No ❑ N/A
3. the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
pplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ❑ N/A
4. Origin of wastewater: (check all that apply):
® Ikesidential (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 El No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ETNo
➢ 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'•"
No. of Units
Flow
Townhomes (50 @ 3 bedroom)
120 gaVbedroonr-'
150
18,000 GPD
GPD
gaV
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
18,000 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(l l 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. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.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: 18,000 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):
I. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
g"
2,750
SDR-26/13I'
➢ Section 11 & 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
Vill. 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:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): _ gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.l .b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(hXIXB).
➢ 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(hx I XQ:
❑ 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(i)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(fl & (s)? 91Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
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 11 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 (g), see Section X.I of this application
"15A NCAC 02T.0305(e) 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 weboaage
2. Does this project comply with the minimum separation requirements for water mains? ®Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC I8C.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? ®7es ❑ 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 an State buffer rules? ❑ p .1 � y ® es Basin name: Randleman No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02009 ®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 ®
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.0I05(cl(6) (additional permits/certifications)? Eyes ❑ No
Per 15A NCAC 02T.0 I 05(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.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.
➢ 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(ax5) 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 projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, Thomas R. Glover, Jr., , attest that this application for Oakdale Forest Phase 1 i
(Professional Engineer's name from Application Item 111.1.) (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
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, Matthew Johnson, Town Manager ' , attest that this application for Oakdale Forest Phase 1
(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 he 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: 11 /Zed he z�
FORM: FTA 06-21 Page 5 of 5

DW11R
Dlvlslon of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town of Jamestown
Project Name for which flow is being requested: Oakdale Forest Phase I
More than one FTSE may be required for a single project # the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewaterflow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: High Point Eastside Wastewater Treatmwent Plant
b. WWTP Facility Permit #: NCO024210
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
2.0000 MGD
.0288 MGD l
1.1523 MGD
0.0180 MGD
1.1991 MGD
60.0%/
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
Design
Pump
Pump
Average
Approx.
Station
Station
Firm Daily Flow"
Current
(Name or
Permit
Capacity,(Firm / pf),
Avg. Daily
Number)
No.
MGD MGD
Flow, MGD
(C)
(D)=(B+C)
(E)-(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
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): Town of Jamestown Collection System
Downstream Permit Number: WQCS00314
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Paul R. Blanchard, Public Services certify to the best of my knowledge that the addition of
Director
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 addendmns for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing Official rignciitwe Date
'?JO` % G Jmr,6 c-es 1)I Ye-c-+c \—
Title of Signing Official
Page 2 of 6
FTSE 10-18

cSnn/ad i752
AiMOWN
NORTH CAROLINA
December 18, 2023
NC DEQ - Division of Water Resources
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
RE: Oakdale Forest Sewer Extension
Harvey Road, Jamestown, NC
Dear Sir,
The Oakdale Forest project in Jamestown will discharge wastewater through the Town of
Jamestown wastewater system (WQCS 00314) to its final destination at High Point's
Eastside Wastewater Treatment Facility (NC 0024210).
The downstream sewer for this project was installed in 1962, so the permit number is
unknown. The Town of Jamestown will accept wastewater from this project. The design
flow for this project is 18,000 gpd.
The permitted versus allocated flows for the overall project are summarized below:
Town of Jamestown Permitted Flow: 2,000,000 gpd
Actual Average Flow (last 12 months): 1,152,300 gpd
Obligated Flow Not Yet Tributary: 28,800 gpd
Total Flow for this Project: 18,000 gpd
Total Actual and Obligated Flow:
1,199,100 gpd
Please feel free to contact me at 336 454-1138 with any questions regarding this project.
Respectfully,
Paul R. Blanchard, PE
Public Services Director
C: Rich Glover, PE, Glover Engineering, PLLC
file
P.O. Box 848 Tel:[phone]
Jamestown, NC 27282 www.jamestown-nc.gov Fax:[phone]

State of North Carolina
Division of Water Resources
Department of Eirvin nmental Quality
Division of Water Resources
AowT rackinrg for Sevier Extension Applications
(FFSE 10-23)
Billy Requesting Allocation frighPorINC /
Project Nane for w[rich flow is being requested: Oakdale Forest Pb 1 /
Mbre than one F ISE may be required for a single project ij'the owner of the WWFP is not rerponrnblefor all pump stations along the
route of the proposed wartewater,/low
L Complete this section only ff'you are the owT ofthe wastewater treatment plant.
a. INVTP Facility rare:Eastside WWIP
b. W WIP Fachly Perth #: NC0024210/
All flows are in MGD
c. W WTP fachys Pertained flow
26
d. Estimated obligated flow not yet tributary to the W WIP
4.551
e. W W[P Eckys actual average flow
14.92
f Total lbw for this speck request
0.018
g Total actual and obligated Lbws to the facility
19.489
It Percent: ofpemYted fbw used
74.96%
H. Complete this section br each pump station your are responsible for along the route ofths proposed wastewater flow
List pimp station located between the project correction pout and the W WTP.
Pu np
PUMP
Station
Station
(Nam or
PemaR
Nutrber)
No.
(A)
(B)
Design
Approx
Fain
Average Daily
Current
Capacty, *
Flow**
Avg. Daly
MGD
(Fariano
Flow
MGD /
MGD
30,0887
11,4.842
8,3901
(C)
(Dp(D+(:)
ft) A D)
Obligated
Total Current
Not Yet
Flow Plus
Available
Tributary
Obligated
Capacity***
Daly Flow
Flow
MGD
MGD
1,6055
MGD
9.9956
/
1,4886
* The Firm Capacity of any puurQ station is defined as the maxhnan pu tuped flow that can be
achieved With the largest purtnp taken out of service.
** Design Average Daffy Flowis the firmcapacity of the puunp station divided by a peaking factor(pf)
not less than 2.5, per Section 2.02(A)(4)(c) of the Minnimun Design Criteria
*** A Planting Assessment Addendu rn shall be attached for each pump station located between the
project connection pond and the W WIP vifiere the Available Capacity is < 0.
DownsbearnFacday Nam (Sewer): Iastside WWIP
DownstreatraPemit Nuniber (Sewer): NC0024210
Page 1 of 8
FTSE 10-23

M. Certifrca , S9�e 7
t
L Derrick }3oone.'Fzltdy to the best ofmy knowledge ttet the addition of the wine of
wastewater to be pen»Ated in this project has been evaluated along the roue to the receiving wastewater
treattrert facility and that the flow from this project is not anticipated to cause any capacity related san fary
sewer overflows or overbuaden arty downstreamptnp station en route to the reccAn treatment plant
under wnml circunswrres, gnen the topierrentation ofthe plumed nprovenents identified m the
plarring assesstrent where applicable. T tis analysis has been perfomed in accordance with local
established policies and procedures using the best available data. This certification applies to those items
listed above an Sections I and n plus all attached planning assessment addetdurnx for wtnirh I am the
responsible party. Signahre ofth is fonnirdicates acceptance ofthds wastewater flow.
Atli
T�d/k of Sig(ning Official
/1 4 r 1461,G-<Cm-cer ameC-Jm
/Z127 Z3 /
Date
Page 2 of 8
FfSE 1423

PUBLIC SERVICES
Derrick Boone
Public Services Assistant Director
January 4, 2024
NCDENR
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
Project:
C I T Y O F
hi!ah
point,
Oakdale Forest Ph. 1 and Partial Ph. 2
Applicant: Rich Glover
Greensboro, NC
Dear Sir or Madam:
This is to acknowledge that the City of High Point will accept for treatment in the
Eastside Wastewater Treatment Plant (Permit #NC0024210), wasterwater flow from the
above referenced project in the amount of 18,000 GPD, which will be discharged to
facilities operated and maintained by the City of High Point.
If further information is needed, please let me know.
Sincerely,
Derrick Q. Boone
Assistant Public Services Director
DQB/tab
9 211 South Hamilton St. High Point, NC 27260 ` 336.883.3111 14NI HighPointNC.gov

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GLOVER
ENGINEERING
LAND -WATER -INFRASTRUCTURE
January 4, 2024
Re: Sewer Line Extensions
Servicing Oakdale Forest Subdivision Phase 1
Town of Jamestown
Guilford County
GE File No. 22-13
Division of Water Quality
NC Department of Environment and Natural Resources
450 W. Hanes Mill Road, Suite 300
Winston-Salem. NC 27105
To whom it may concern:
N C Department of
Environmental Quality
Received
IAN 112 2024
Winston-Salem
Regional Office
With regards to the referenced project, and on behalf of the Town of Jamestown, we have
enclosed one original and one copy of the following for your review:
- Fa k Sewer Application
- implication Fee
- Form FTSE completed by the Town of Jamestown
- Form FTSE completed by the City of High Point
- Letter of Flow Acceptance
- 8.5" X 11" color USGS topographic map
- Street level map
Sewer service to Phase 1 of the Oakdale Forest Subdivision includes 50 residential townhomes
(18,000 gpd) located along Oakdale Forest Avenue, Oakdale Forest Court, Goldberry Lane, and
Creekhollow Court. Flow allocations are included in the attached FTSE form for the 50 residential
lots. Phase 2 will be permitted at a later time and will contain an additional 45 lots. Upon
completion of the sewer line installation and testing, the system will be maintained by the Town
of Jamestown. The downstream sewer system is owned by the Town of Jamestown and the
treatment facility is owned by the City of High Point.
If there are any questions or additional information required, please call.
Sincerely,
Glover Engineering, PLLC
omas R. (Rich) Glover, Jr., PE
GLOVER ENGINEERING, PLLC
7021 ENDOTRAIL ROAD GREENSBORO, NC 27409
[e-mail] 336.202.4163

NC Department of
Environmental Quality Received State of North Carolina
DWR
Department of Environmental Quality
JAN 12 1024 Division of Water Resources
Winston-�p FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTR TONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
Reglona� ce
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 the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump Stations/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A 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 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (MDC) documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ 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 boxes 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 submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy maybe digital) of Application and Supporting Documents
® Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, Flow allocation required, etc.
➢ Include the permit number/status of any other required sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $480.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item 11.1 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 be signed, sealed 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
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Pagel of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one year
prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x l 1-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application form itself should include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
❑ The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 021' .0305(h)( I ), submit documentation of power reliability for pumping stations.
This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated 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(b)) or proposed contractor,
stating that "the portable power generation unit or portable, independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump 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 in the case of a multiple station power outage. (Required at time of certification)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .01 15(a 1(I 1 provide the Certificate of Public Convenience and Necessity from 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 Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15:\ \CAC 021 .01 15(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b). submit the properly executed Operational Agreement (FORM: DEV ).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 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 Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Glover Engineering, PLLC
Attn: Thomas R. Glover, Jr.
7021 Endotrail Road
Greensboro, NC 27409
NORTH CAROLINA
Environmental Quality
January 17, 2024
SUBJECT: INCORRECT FAST TRACK SEWER SYSTEM EXTENSION APPLICATION PERMIT FEE
& OTHER ADDITIONAL APPLICATION ERRORS
Project: Oakdale Forest Phase I
Guilford County
Dear Mr. Glover:
The Winston-Salem Regional Office has received your Fast Track Sewer System Extension
Application for the subject project on January 121, 2024. However, North Carolina's 2023
Appropriations Act. Session Law 2023-134 (effective July 1, 2023) included an increase for fast -
track sewer extension permit fees from $480 to $600.
We are returning your check for $480 for the subject project but withholding the application
documents. Please resubmit payment 'of the new permit fee of'$600 for this project as soon as
possible so we may complete processing of your permit application.
In addition, please correct the following mistakes on the application you submitted and resubmit
the corrected application with the new check:
1. _ Please answer questions 1-3 in section VI of the application;
2. In section IX of the application, you answered yes to question #5 but did not provide the
required 404 information. Please provide the requested information with your
resubmittal;
3. Please use the newest fast track application, version FTA 10-23 revised Oct 2023, which
you can download here:
https://www. deg.nc.gov/a bout/divisions/water-resources/permitting/mu n icipa I-npdes-
pretreatment-and-col lecti on-system/co I lection-sVstems/sewer-extension-permitting
4. Please use the newest flow tracking for sewer extension form, version FTSE 10-23, for
both the Jamestown and High Point flows, which you may also find at the above website.
—.n - DEQ�
North Carolina Department ofEmvoruntental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 W. Hanes Mill Rd Suite 30D I Winston-Salem, Noah Carolina 27105
336.776,9800

We will hold your application in abeyance until all the above requested information is received.
Please contact me by phone at 336.776.9690 or by email at [e-mail] if you have
any questions.
Sincerely,
Ctwnusgnea tn:
�ons.lsl Bao..o
B20f8DD5P2X34M_.
Ronald C. Boone, Environmental Program Consultant
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
ff Noah Carolina Deparmteat of Environmental Quality I Division of Water Resources
Wmrtan-Salem Regional Office 1450 W. Hanes Mill Rd Suite 3001 Winston-Salem, North Carolina 27105
336.776.9800
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