WQ0045199_Midway_at_Archdale_Apartments_Private_20240320

State of North Carolina
Department of Environmental Quality
, y Division of Water Resources
/ l FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
01 Rip / FTA Z9 3 & SUPP�IRTIN DOCUMENTATION
/VAN 77u M5 t2ef kv av_ 114'e-�� t crrft`� 3/2d Z2o 2 �L
Application Number: (to be completed by DWR)
T
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Midway at Archdale. LLC. (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ®.Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Barry D. Hackett per 15A NCAC OZT .0106(b)
Title: President/
4. Applicant's mailing address: 1175 Revolution Mill Dr., Suite 8
City: Greensboro State: NC ' Zip: 27405-5080
5. Applicant's contact information:
Phone number: [phone] Email Address: bhackett(&hackettproperties.tAm
II. PROJECf'INFORMATION:
1. Project name: Midway at Archd
"r
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date: ,
❑ 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 located uilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.922182' Longitude:-79.932543'
5. Parcel ID (if applicable): 7729422260 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Vince C. Townsend. PE, PLS License Number: 23951
Firm: Green Mountain Engineering, PLLC.
Mailing address: IA Wendy Court
City: Greensboro State: NC Zip: 27409-
Phone number: [phone] Email Address: winceagreenmountainenigneering.com /
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside Treatment Plant Permit Number: NCO024210'
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. PermitNumber(s): WQ N/A ,
2. Downstream (Receiving) Sewer Information: 21 inch ® Gravity ❑ Force Main
3. System Wide Collection System PermitNumber(s) (if applicable): WQCS 00312
Owner Name(s): _)5�z 4-4
FORM: FTA 10-23
Pagel of 5

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,
(828) 2964500
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
226 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]
Stanty, 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,
(919) 7914200
Northampton, Orange, Person, Vance, Wake,
(919) 5714718 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
Alamance, Allegheny, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 3 of 3

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes [-]No N 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 N 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 N N/A -
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ® Swimming Pool/Clubhouse'
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
i
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 .01 14(f)? ❑ Yes N No
If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see OZT.0114(f))
Daily Design Flow • ^
No. of Units
Flow
Residentional 1 Bedroom
75 gal/day
84 .
6,300 GPD
Residentional 2 Bedroom -
150 gal/day
84-
12,600 GPD
Office
25 gal/person/day
1
25 GPD
Pool
10 gal/person/day
50
500 GPD'
gal/
GPD
gal/
GPD
Totat
19,425 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 I SA 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: 19,425 GPD (per I5A NCAC 02T .0114 and G.S. 143-215.11
➢ 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 10-23
Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
2,471
PVC
➢ Section II & 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
VIH. 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 2.0IC. l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCAC 02T .0305(h)t1):
❑ Standby power source or ❑ Standby pump
D Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(13):
➢ 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

IX. 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) & (S)^: ® Yes [—]No
15A NCAC 02T.0305(t) contains minimum separations that shall be otovided 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 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (a). see Section X.1 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 weboage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
i
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Cape Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02009 ® Yes LINO
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
i
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)l6) (additional permits/certifications)? ® Yes ❑ No
Per I5A 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 I5A 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 10-23 Page 4 of 5

X. CERTfFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Punig Stations
and Force Mains (latest version). and the Gravity Sewer Minimum Design Criteria ilatest version) as applicable)
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Altemative 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 nrciects reauirine 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:
1, Vincent C. Townsend, PE, PLS , attest that this application for Midway at Archdale
(Professional Engineer's tome Pimp Application item 111.1.) (Project Name from Application Imp IL 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 Pennitfi ng
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 boy -A III r.tr n r « n,n t
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1. !U N lk(LB f , attest that this application for The Midway at Archdale.
(Signature .4uth ry Name girom pp"` licafiion Item U.) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 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: 7 `� 1�4Date: _ I— J q— 4t3
FORM: ETA 06-21 Page 5 of 5

31
R
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FFSE 10-23)
Entity Requesting Allocation: Midway at Archdale, LLC.
Project Name for which flow is being requested: The Midway at Archdale Y, _ . 4 ,
More than one FTSE may be requiredfor a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit
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
0.019
Il. 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 Q
(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***
Checker Road
0.144 '
0.058
0.003
0.019
0.022
0.036
* The Firm Capacity (design now) of any pump station is defined as the maximum pumped Bow 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): High Point Eastside Treatment Plant
Downstream Permit Number: NC 0024210
Page 1 of 8
FTSE 10-23

III. Certification Statement:
I Z G% >7PIt� 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.
Title
Page 2 of 8
FTSE 10-23

State of North Carolina
Departm✓�_ f'"
ent of Environmental Quality
qaf::::� Division of Water Resources
Flow Tucking for Sewer Ertemion Applications
AMSIO6 - O ISE 10-23)MaW(9Vn,
Entity Requesting A➢ocation: The City of Archdale
Project Name for which flow is being requested: The Midway at Archdale
Abre than one ME nuD, be regtoredfor a single project if the owner of the WW7P is not respo ns ib lefor all pump stottons along the
route of the proposed wastewater flow
L Complete this section only ifyou are the owner of the wastewater tneahneot plant.
a. WWI? Facility name: Eastside WWIP
b. W WIP Facility Pemti #: NC0024210
c. W WTP facility's Pernwed flow
All flaws arein AIGD
MY
d. Fsti r ated obligated flow not yet tributaryto the W WTP 4.5712 '
e. W WTP facility's actual average flow 14.92
f Total flow fir this specific request 0.019 ,
g. Total actual and obligated flows to the fteilty 19.5102
h Percent ofpemYted flow used 75.04°/n '
IL Couplete this section for each pump station your are responsble br along the route oftlrs proposed wastewater flow
List pump station located between the project commoDn pout and the W WTP.
(A) (B) (C) (D)=BtC) P=(A-D)
Pip Design Approx Obligated Total Current
pimp
Station Station Firm Aweraw Daily Curren Not Yet Flow PlusAvailable
(Name or Pemit Capacity, • Flow** Avg Daily Tributary Obligated Capacity***
Number) No. MGD (Fumpl) Flow Daily Flow Flow MGD
MGD MGD MGD MGD
* The Firm Capacity of am prmq station is defined as the maximm pumped flow that can be
achieved with the largest punp taken out of service.
** Design Average Daily Flow is the fumcapacity of the pimp station divided by a peaking factor (pt)
not less than 2.5, per Section 2.02(A)(4)(c) of the Minintu n Design Criteria
*** A Planning Assessment Addendmn shall be attached for each pump station located between the
project connection point and the W WfP where the Available Capacity is <0.
DownstrearnFaciliyNatre(Sewer): EastsideWWIP
Dowtshoam PemY Numiier (Sewer): NC0024210
Page 1 of 8
FrSE 10-23

E01. Certification Smterren t
L Derrick Boone certify to the best of my kncwkdge that the addition of the warn of
wastewater to be petmlted in the project has been evaisted abng the route to the receiving wastewater
treamrert fact iy and that the flow fromihs project is not an bcipated to cause any capacity related sanitary
sewer overflows or omba-den arty dowrstreampurT station m route to the receiving trealnetf plant
viler moral cacvrstances, given the in>pkrtetitation of the planted inprovements identified in the
planning assessment where applicable. This aml ss has been perfomed in accordance with local
establshed policies and procedures using the best avaaabk data Tuts cert&aWn applies to those @errs
listed above in Sections I and B phs all attached plamn assessrreut adderdvts br which I am the
responsible party. Sigreture of this font idicates acceptance ofths wastewater fbw.
P"AZC.E Q.See9.0
S"ring Official Swat re
3/20/24
Page 2 of 8
FfSE 10-23

DWR
Division of Water Resources
k e c_p,�Ue S :3/4/;6A�
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: A"- W l R 9 (to be completed by DWR)
All items must be completed or the application will be returned
i, APPLICANT INFORMATION:
1. Applicant's name: Midway at Archdale. LLC. (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal 19 Other
3. Signature authority's name: Barry D. Hackett per 15A NCAC 02T .0106(b)
Title: President[�
i
4. Applicant's mailing address: 1175 Revolution Mill Dr., Suite 8
City: Greensboro State: NC Zip: 27405-5080
5. Applicant's contact information:/
Phone number: [phone] Email Address: bhackett(ahacket[properties.com
11. PROJECT INFORMATION:
1. Project name: Midway at. Archdale
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: WQ00_ and issued date: _,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Guilford'
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.922182`v Longitude:-79.9325436_�
5. Parcel ID (if applicable): 7729422260 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
Professional Engineer: Vince C. Townssend. PE, PLS� License Number: 23951
Firm: Green Mountain Engineering, PLLC�
Mailing address: IA Wendy Court
City: Greensboro State: NC Zip: 27409
Phone number: [phone]/ Email Address: vince@ureenmountamemaneering com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside Treatment Planter Permit Number: NCO024210'
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ_
2. Downstream (Receiving) Sewer Information: _ inch ❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): _
FORM: FTA 10-23
Page 1 of 5

VI. GENERAL REQUIREMENTS
1. if the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No 0 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 19 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 0 N/A I
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential (Leased) *" ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ® Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic _% Commercial _ % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes[—] No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ❑ No
➢ 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 ..s
No. of Units
Flow
Residentional 1 Bedroom
120 gal/day {
84
10,080 GPD
Residentional 2 Bedroom
240 gal/day
84
20,160 GPD
Office
25 gal/person/day
1 1
25 GPD
Pool
10 gallperson/day
50/
500 GPD
gal/
GPD
gal/
GPD
Total
30,765 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. 42A-4).
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: 30765"GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ 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 10-23 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 l
2,471
PVC
➢ Section H & 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
Vlfl. 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.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

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/altematives found in 15A NCAC 02T.0305(f) & (a)?
15A NCAC 02T.0305(t) contains minimum separations that shall be Drovided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water 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 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
"Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
*"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (a). see Section X.I of this application
"I SA NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check `yes"
above if these alternatives are used and provide narrative information to explain.
"Stream classifications can be identified using the Division's NC Surface Water Classifications webpaae
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC I8C.0906(f) for documentation requirements and submit a separate document,
signed/scaled by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes [:]No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Cape Fear El 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 El 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 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 10-23 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply v
and Force Mains ( latest version), and
❑ Yes ❑ No
as applicable?
If no, for projects requiring a sing) ariancc, complete ii�[ mit the Variance/Altemativc Design Request application
(VADC 10-14) and supporting docume r._reviawT the Central Office. Aoaroval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to limiter
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 Engineers Certification:
1, Vincent C. Townsend, PE, PIS attest that this application for Midway at Archdale/
(Processional 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 Desien 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 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 $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 boe•a r11 Wre r cA nini s
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
i
1. ltit Ql! ft.� 106.( Ls � ,attest that this application for The Midway at Archdai�
(Signature Auth ity Name from Application Item 1.3.) (Project Name from Application Item IL 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. 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 S 10,000 as well as civil penalties up to S25,000 per violation.
Signature: �� "1 ¢—'� CC //V(�f Date:
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Midway at Archdale, LLC.
Project Name for which flow is being requested: The Midway at Archdale
More than one FTSE maybe required for a single project if lire owner of the WWTP is not responsible for all pump
stations along the route of Nee 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 #:
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
0.031
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 / pi),
Avg. Daily
Number)
No.
MGD
MGD
Flow, MGD
Checker
o_-J
0.144
0.058 '
0.003 `
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity***
0.031
0.034'
0.024 /
* 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 (pi) 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): High Point Eastside Treatment Plant
Downstream Permit Number: NC O024210
Page 1 of 8
FTgF ttl-?;

III. Certification Statement:
I 2 b;Z, 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
Title
Page 2 of 8
FTSE 10-23

iliviiml i,! n. :'.tn r Ife .niur r .
State of Notth Carolina
Department of Environmental Quality
Division of Water Resources
FlowT meking for Sewer Extension Applicatiom
(ME 10-23)
FiuityucgwstutgAlbcatiom f igtiPo riNC `
Project Nanc for which lbw is being requested: The Midwayat Aichdak,
Adom than one FUSE ivalr be requiredfora single project if the omier ojthe WWFP is no/ rerpo)uiblefor all psmp slatioms along fire
male of the proposed wasiemvrterflary
1. Cotplete this section only fl you ale the owner ofthe wastewater heahncnt plant.
a. W WIP Facility natim: Eastside W W] P
b. WMP Facility Pem$ #: NC0024210
All flows are in MCD
c. W VTP fteMys Pemilted flow
26,
d. Fstunnted obligated flow not yet tributary to the W WIP
4.5712
e. W WIP faciLt' ys actual average flow
14.92
f Total flow for this speck request
0.031-
g Total actual and obligated flows to the facility,
19.5222/
It Percent of permitted flow used
75.09% /
H. Conplete this section f m each pump station your are responsible for along the route ofthb proposed wastewater lbw
List pump station located between the project connection point and the W WiP.
(A) (B) (C) (D) M C) (L"A D)
Pmnp Pump Design Approx Obligated Total Current
Station Staten Fum Average Daly Cu nent Not Yet Flow Pis Available
(Nanr or Perrin Capacity'* Flow** Avg Daily Tributary Obligated Capacity"*'
Nurber) No. MOD (Fimn(pt) Flow DalyFbw Flow MOD
MOD MGD MGD MGD
*'De Firer Capacity of any punp station is defined as the naxinaun pumped flow that can be
achieved with the largest punp taken out of service.
**llesign Average Daily Flow is the fi m capacity of the pump station divided by a peaking factor (l)t)
not less than 2.5, per Section 2.02(A)(4)(c) of the Mini nurn Design Criteria.
*** A Planning Assessment Addendum shall be attached foreach pump station located behieen the
project connection point and the \WVM where the Available Capacity is <0.
DovwsheamFacilityNanr(Sewer): EastsideWW1P'
Dowrstieani Pemit Nwrber(Sewer): NC0024210 /
Page 1 of 0
FTSE10-23

111. Certification �atenrnt
1, Iknick Boothe, certify to the best of my knowledge that Or addition ofthe wktre of
wastewater to be pemtitted in this project has been evaluated along the route to die receiving wastewater
heatirenl facility and Oat the flow from this project is not anticipated to cause any capacity related sanitary
sewer overibws or medpuden any downshxampunp station en route to One receiving aeatnent plant
under normal cireurnstances, given One implementation of the planned inprovemants identified in One
planning assessment where applicable. This analysis has been perforted in accordance with local
established policies and procedures using Or best available data. This certification applies to those items
listed above in Sections I and it phis all attached planning assessment adderduns for which 1 am the
responsible patty. Sigatue of this form indicates acceptance of this wastewater flow.
J
kb
Td c of Sigwg official
�fss� Pa,bUt. Srivkc.r 1�.Y«ibi
1,R4 a 3
Date
Page 2 of 8
FTSE10-23

Transmittal
Green Mountain Engineering, PLLC
Civil Engineering Consultants
Land Surveyors
MAR 0 4 2024
To: NCDEQ — Public Water Supply Section Winston-Salem
Address: 450 W. Hanes Mill Rd. -Suite 300., Winston-Salem, NC 27105 Regional Office
From: Vincent C. Townsend, PE, Green Mountain Engineering, PLLC.
Date: January 31, 2024
Re: Midway at Archdale
Messages
Attached, please find the application packages for sewer extension off NC HWY
62W, near Modlin Grove Rd, to serve the residential housing proposed by Midway at
Archdale Apartments. Included are one (1) copy of the Application Package.
Please let us know if you have any questions or require additional information. I can be
reached via email vince(&Preenmountaineni+ineers.com or by phone [phone] at
your convenience.
Best Regards,
I
Vincent C. Townsend, P.E.
I Wendy Court - Greensboro, NC 27409 - [phone]
Page 1 of 1

Green Mountain Engineering, PLLC
Civil Engineering Consultants
Land Surveyors
Project Narrative For
Midway at Archdale Apartments
Located in Archdale, NC
January 31, 2024
To Whom it May Concern:
Midway at Archdale is a proposed 7-24 unit apartment complex with a club house,
pool and pool house. The proposed sewer system serving Midway at Archdale will tie
into an existing 21 sewer main located in Modlin Grove Rd. right of way.
Approximately 2,471 linear feet of new 8 inch sewer mains with new services will
connect to the existing 21 ". A total of 168 new units are planned for this complex.
The design and plan review was done in accordance with NCDEQ's Gravity Sewer
Minimum Design Criteria and the City of Graham's standards and specifications.
Work on the sewer installation is planned to begin once the permit has been obtained.
Please contact me if you require additional information. You can reach me via email
vineAp,reenmountaineneineers.com or by telephone [phone] at your
convenience.
Respectfully submitted, ��`�oQ(O E s o0�%
0 ti9 :9
SEAL
s i • Gt 2Q� •�'S�:
Vincent C. Townsend .E.�2oE
Green Mountain Engineering, PLC i I lift � Vm0"°��`l``
1A Wendy Court - Greensboro, NC 27409 - [phone]
Page 1 of 1

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 & Pumn 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.
➢ 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 11.1. 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 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.
INSTRUCTIONS FOR FORM: ETA 10-23 & SUPPORTING DOCUMENTATION Page] 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 I -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)
Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0I 15(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
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 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: DEW
For more information, visit the Division's collection ,systems svehsite
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]
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 Qualitv 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 10-23 & SUPPORTING DOCUMENTATION Page 3 of 3

— UNITY • LOYALTY
le
PROGRESS —
307 BALFOUR DRIVE
P.O. BOX 14068
ARCHDALE, NORTH CAROLINA 27263
PHONE: [phone] FAX: [phone]
12/8/2023
Project: The Midway at Archdale
Private Sewer
Applicant: Hackett Properties, Inc.
Greensboro, NC
NC Department of Environmental Quality
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Dear Sir or Madam:
This is to acknowledge that the City of Archdale will accept wastewater flow from the
above referenced project in the amount of 31,000 GPD, which will then be discharged to
facilities operated and maintained by the City of High Point for treatment in the Eastside
Treatment Plant.
If further information is needed, please let us know.
Yours very truly,
City of Archdale
Zeb Holden
City Manager
City of Archdale
[phone]
zholden(aDarchdale-nc.gov

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North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings • Print a Pre -
Populated Annual Report form • Print an Amended a Annual Report form
Limited Liability Company
Legal Name
Midway at Archdale LLC
Information
Sosld:2761329
Status: Current -Active O
Date Formed: 12/29/2023
Citizenship: Domestic
Annual Report Due Date: April 15th
Currentpnnual Report Status:
Registered Agent: Stewart, Barbara L
Addresses
Reg Office
1175 Revolution Mill Drive, Suite 8
Greensboro, NC 27405-5080
Company Officials
Reg Mailing
1175 Revolution Mill Drive, Suite 8
Greensboro, NC 27405-5080
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
https://www.sosnc.gov/online_ services/search/Business-Registration-Results
1/1

•._ __ _.___ _._ _ _) State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
_Dhdslon of Water R�sources� 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 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 (MDCi 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 may be 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.
D 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 11.1. of the application).
C. Application Fee (All New and Modification Application Packages):
N 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.I.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State I,
® If the Applicant Type in Item I.2 is a partnership ord/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name jn Item II.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 ofthis application and form FTSE indicates that owner has adequate capacity and will hot 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 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
D 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.
D This alternative is only available for average daily flows less than 15,000 gallons per day
D 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)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0I 15(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
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 15A NCAC 02T .0115(c). submit the properly executed Operational Agreement (FORM: BOA).
❑ 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: DEW
For more information, visit the Division's collection systems ivebsite
FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 2 of 3