WQ0045217_Hillsdale_Ridge_Townhomes_FTSSE_App_20240308

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 10-23 & SUPPORTING DOCUMENTATION
7 .(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Davie County -(company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ® State/County ❑ Municipal
3. Signature authority's name: Johnny Lambertper 15A NCAC 02T .0106(b)
Title: Director
4. Applicant's mailing address: 298 East hepot Street. Suite 200
City: Mocksville State: NC* Zip: 27028
5. Applicant's contact information:
•
Phone number: 3( 36) 753-6090 Email Address: [e-mail]
H. PROJECT INFORMATION:
1. Project namajjillsdale Ridee Townho }gI
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00_ and issued date:
❑ Privately -Owned Public Utility
❑ Other
❑ ARPA funded
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 locatelm-
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.9962s Longitude:-80.4509°•
5. Parcel ID (if applicable): 5872006737 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Alex Carter, PL• License Number: 038574
Firm: Beeson & Carter PA •
Mailing address: 4510 Reidsville Road
City: Winston Salem State: NC Zip: 27101-_
Phone number: (IM) 148-0071• Email Address: acarterAbc-ene.com a
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Muddy Creek • Permit Number: NCO050342 •
Owner Name: Winston Salem •
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): W00013390*
•
2. Downstream (Receiving) Sewer Information: 8 inch* ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS Pt7l6,4
Owner Name(s): Davie County
FORM: FTA 10-23 Page I of 5

VL
GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No M N/A"
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No M N/A'
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No M N/A
4. Origin of wastewater: (check all that apply):
M Residential (Individually Owned) ❑ Retail (stores, centers, malls)
❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service
❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities
❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church
❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home
❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(1)? ❑ Yes M No
➢ If yes, 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 tis
No. of Units
Flow
4 bedroom residential; '
75 gal/bedroom '
37
11,100 GPD
Session Law 2023-137
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
700 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e. 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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 11 100 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ Do not include future flows or previously permitted allocations
If permitted now is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: ETA 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
582
SDR35 PVC'
➢ 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
VHL 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
I. Pump station number or name: N/A
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. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)'
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

}
DL SETBACKS & SEPARATIONS - (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & (g)? ® Yes ❑ No
15A 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
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (g). see Section X.l of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
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.
i
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 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ®-No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes [-]No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permtttee 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 10-23 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 requirine 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:
attest that this application for 4JJ,4 ,d kdr /Zt odip� 7ri✓�✓�w..65
(Professional Engineer's name from Application Item M.l.) (Project Name from Application Item H.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 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
, ` i
I,-�—+s.J L av� 6wt- ko- attest that this application for a`cr�i &A Ta .1�.. t
(Signature AuthoriName from Application Item 1.3 J(Project Name rI om Apphc. on Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE - In accordance with General Statutes 143-215.6A and 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: — 2 2-C)F: (
FORM: FTA 10-23 Page 5 of 5

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Davie County
Project Name for which flow is being requested: Hillsdale Ridge Townhomes
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
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
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:
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Approx.
Obligated,
Total
Pump
Pump
Average
Current
Not Yet
Current Flow
Station
Station
Firm
Daily Flow**
Avg. Daily
Tributary
Plus
(Name or
Permit
Capacity, *
(Firm / pf),
Flow,
Daily Flow,
Obligated
Available
Number)
No.
MGD
MGD
MGD
MGD
Flow
Capacity***
East
'
WQ0039884
5.33
2.0
.33
0
.33
1.67
* 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 he attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Davie County
Downstream Permit Number: WQ0039884
Page 1 of 6
FTSE 10-23

III. Certification Statement:
I Johnny Lambert 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.
of Signing Official
Page 2 of 6
FTSF, 10-23

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
D vision of Water Resoura.es Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Davie County
Project Name for which flow is being requested: Hillsdale Ridge Townhomes
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for al! pump
stations along the route of the proposed wastewaterJlow.
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
All flows are in MGD
c. WWTP facility's permitted flow 21.000000
d. Estimated obligated flow not yet tributary to the W WTP 3.1074440
e. WWTP facility's actual avg. flow 13.684444,
f. Total flow for this specific request 0.0111000
g. Total actual and obligated flows to the facility 16.802988,
h. Percent of permitted flow used 80.0
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) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
Idols Rd 5.90000 2.360000 " 0.576579 0.025514 � 0.602093 ` 1.757907
* 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 10-23

III. Certification Statement:
I 141C-#AJ i-/. VrO POe t 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.
Signing Ojjrtcial Signature
o I/C 6"'f—
Title of Signing
POTa
i
Page 2 of 6
FTSE 10-23

t
nstal
USalem /Forsyth County
t1�1t1eS
Wmr •Wastewater • SdtA Wash
Administration, P.O. Box 2511, Winston-Salem, NC 27102
0: 336-727-8000, F: 336-727-8432, wsfcutilities.org
February 21, 2024
Mr. Johnny Lambert
298 E. Depot St.
Suite 200
Mocksville, NC 27028
In Re: Hillsdale Ridge Townhomes Flow Acceptance
Dear Mr. Lambert:
This letter is to confirm that the City/County Utility Commission will accept the sewerage from The
Hillsdale Ridge Townhomes.
We are currently treating 576,336 gallons per day. Our contract with Davie County has a maximum
discharge of 5,000,000 gallons per day; therefore, we should encounter no problems in treating an
additional 11,100 gallons per day. This sewerage will be treated at our Muddy Creek Wastewater
Treatment Plant (NC0050342). The wastewater collection system serving this area is properly sized and
maintained for this service.
If you have any questions concerning this subject, please give me a call at [phone].
Sincerely,
UTILITIES ADMINISTRATION
Todd Lewis
Senior Civil Engineer
Winston-Salem/Forsyth County Utilities
CRY Courufl: Mayar Mlin Joines; Denise D. Adams, Mayor Pro Tempona, North Wad; BarWra Hanes Burke, Nodhean Wad; Rnlan C.Clark, Wen Ward;
John C.Lawn,Sound Wad; Jeff Macintosh, NDrthwert Wahl; Kevin Mundy, Saulhwrst Ward; Anne. ScJ,pm,Fan Wad; lamesTW10 J1, Southeast Wad;
Cry Maurer: iAe D. W o*,
County CommYMnneen David R. Plylen Chair; Don Mahn, Vice Chair, Fbmiq El -Amin; red Kaplan; Rmhad V. Dmille; Tony. M.D.del; Gbda D. WhiuMunt
Call 311 or 336-727-8000 Cnudy Manater Dudldy Wate Jr.
ci linka�clt otws.of W"""hSNan/ForWs County UN" Commimmn: Finnish 5. Tunb,Chair, L Wearies Cards, Jr., Vke Chair, Hamm E. Day; Harold Euslache; Tom GdRn;
tY L Y 9 rvonne H.Hines;Due.Long; Hugh W.Jernigan; Chris Parker, Charles Wllmn; Allan muger

REESOR BCRRT@R, PR.
CIVIL EN6INEERB LAND tN11VEYORB
LAID PLANNING
PO Box 669, Walkertown, NC 27051
Phone [phone] Fax [phone]
www.bc-eng.com
TRANSMITTAL
MAR 0 8 2024
TO: FAST TRACK SEWER APPLICATION ` Winston-Salem
NCDENR- DWR Regional Office
450 HANES MILL ROAD, SUITE 300, WINSTON SALEM, NC 27105
RE: Fast Track Sewer Application - Hillsdale Ridge Townhomes
We are sending you: Attached
COPIES
DATE
DESCRIPTION
ACTION
2
3/7/2024 Fta 10-23 Application and Docs
As requested
1
3/7/2024 Engineering Plans
j For your use
1
3/7/2024 Digital Docs and Plans on USB
For your use
1
3/7/2024 Fee Chk- $600
As requested
Remarks:
Please find enclosed the Fast Track Application for Sewer along with plans and documents
required. The USB drive contains PDF files of the same hard copy Application, plans and
Thank you,
Alex
CC To:
Sinned:
Alex T. Carter, PE

BEES00 8 COOTEO, P0,
CIVIL ENGINEERS LAND SURVEYORS
LAND PLANNING
March 7, 2024
North Carolina Division of Water Resources
Water Quality Section
450 W. Hanes Mill Road, Suite 300
Winston Salem, NC 27105
E;;t
h_ "t"d J,Ity
MAR 0 g 2024
Winston-Salem
Regional C,tce
RE: Fast Track Sewer Extension Application — Hillsdale Ridge Townhomes, Davie County, NC
NC DEQ Reviewer:
Please find the following items and documents in the application package:
• Cover letter with description of project
• Fee check for $600.00
• Fast Track Application FTA 10-23, completed and signed
• FTSE 10-23, completed and signed by Davie County Director of Public Utilties
• FTSE 10-23 Winston Salem (WWTP), completed and signed by Deputy Utilities Director
• USGS annotated map and GIS location map of project site
• Sealed engineering plans and details
PROJECT BACKGROUND
The proposed project is an undeveloped tract of land that was originally planned for commercial
use. It was recently re -zoned for mixed use and townhomes are planned for un-development
portions of the site. The site is situated with existing nearby residential and commercial
development. There are existing public water and gravity sewer facilities on the site. The site
has been approved by the Bermuda Run planning board for development into 153 townhome
residential units. This submittal is for the first phase of construction for 37 units to connect to
the existing gravity sewer located near US Hwy 158 to support this proposed residential
development. The remainder of the site will flow to the East to an existing sewer outfall located
along Smith Creek.
The Davie County Utilities staff have reviewed the site and approved engineering plans enclosed
for the purpose of connecting to existing public sewer lines. The existing gravity sewer lines
flow to the East Davie (WQ0039884) pump station where effluent is pumped for treatment into
the City of Winston Salem system. All details have been provided via the included FTSE 10-23
forms.
PO Box 669 Walkertown, NC 27051 336-748-0071

BEESOR BCRRTER, PR.
CIVILENGINEERS LANDSURVEYORS
LAND PLANNING
PROJECT SUMMARY
The proposed public sewer system will consist of approximately 582 LF of 8" SDR35 PVC
connecting into existing sewer manholes located on site near US Hwy 158 as shown in the
enclosed plans. The site is expected to be developed into thirty-seven (37) units/lots with a
maximum of four (4) bedroom residential homes for a total volume of 11,100 gal/day. All
proposed sewer main, manholes and appurtenances are proposed to meet the Davie County
Utility specifications.
CA .1111,
Best Regards, `,��4 N •••• • o�
Alex Carter, PE a 2
%J?9 "/ 4
9• :�NGINEEP' �
„FX•r..CP�
PO Box 669 Walkertown, NC 27051 336-748-0071

MUSGS
SITE
1
Fi
i
t > �
F' v
s �..

Hillsdale Ridge Townhomes
arch 9, 2023
Ej Parcels City Limit BERMUDA RUN
Watershed Structure MOCKSVILLE L S County Line
COOLEEMEE
1:14,081
0 0.1 01 0.4 mi
0 0.175 0.35 0.7 km
Sm,nes. Esn, HERE, Garmn, USGS. IntwMW INCREMENT P NRCar, I
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State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
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 oractices.
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. Pd C f c, rtrC ! �{
Projects that are deemed permitted do not require a permit from the Division are explained in 15A NCAC 02 T 0303. ta' Quality
1 P ( qu P ) P r.'
Projects not eligible for review via the fast track process (must be submitted for full technical review): MAN Q $ ? ?>f
➢ 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); 1
➢ 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
R 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.
➢ If the project is funded by American Rescue Plan Act (ARPA) funds, please include the ARPA project number in the cover
letter and in parentheses under Project Name (Section D.1. of the application).
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $600.00, 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 10-23):
® 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 D.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.
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 1 of 3

® 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).
E. Flow Tracking/Acceptance Form (Form: FTSE 10-23) (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 I 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 02T .0305(h)(1), 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 .0115(a)(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
fora 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/ProMM Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .01 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .01 15(b), submit the properly executed Operational Agreement (FORM: DEV).
For more iVbrmation, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 10-23 & 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, Hamett, 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]
Staniy, 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, Bartle, 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, Suny, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 3 of 3