WQ0045336_Application (FTSE)_20240425

sae 6L :.J.�SL'
< _ ; , t State of North Carolina
DWR epartment of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: (to>be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Reidsville (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Josh Beck. PE per 15A NCAC 02T .0106(b)
Title: Reidsville Director of Public Works
4. Applicant's mailing address: 230 W. Morehead Street
City: Reidsville State: NC Zip: 27320-_
5. Applicant's contact information:
Phone number: [phone] Email Address: jbeckAci.reidsville.nc.us
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Poidsville Splash Pad 1
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: ockin ham
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.33200 Longitude:-79.6663'
5. Parcel ID (if applicable): 890418306269 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Christopher N. Huff License Number: 024420
Firm: WithersRavenel, Inc.
Mailing address: 115 MacKenan Drive
City: Cary State: NC Zip: 27511
Phone number: (9(9) 469-3340 Email Address: chuff(a).withersravenel.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Reidsville W WTP Permit Number: NCO024881
Owner Name: City of Reidsville
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): W00034013
2. Downstream (Receiving) Sewer Information: 10 inch 0 Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00049
Owner Name(s): City of Reidsville
FORM: FTA 10-23
Page I of 5

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: A fed 3Z G (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
I. Applicant's name: City of Reidsville (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: Josh Beck. PE per 15A NCAC 02T .0106(b)
Title: Reidsville Director of Public Works
4. Applicant's mailing address: 230 W. Morehead Street'
City: Reidsvillf State: NC ' Zip: 27320-
5. Applicant's contact information:
Phone number: [phone]' Email Address: jbeck 7oci.reidsville.nc.us
II. PROJECT INFORMATION:
I. Project name: Reidsville Splash Pad
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: WQ00_
3. County where project is located: Rockingham '
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.3320Longitude:-79.6663'
5. Parcel ID (if applicable): 890418306269 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Christopher N. Huff ' License Number: 024420
Firm: WithersRavenel.Inc.
Mailing address: 115 MacKenan Drive
City: Cary State: NC - Zip: 27511-_
Phone number: [phone] 11 Email Address: chuff(dwithersravenel.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Reidsville WWTP ' Permit Number: NCO024881
Owner Name: City of Reidsville-
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): W%034013
i
2. Downstream (Receiving) Sewer Information: 10 inch ' ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSMVU 17
Owner Name(s): City of Reidsville
FORM: FTA 10-23 Page I 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 ® 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/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/A -
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
® Food and drink facilities � ❑ Church ® Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : 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(t)? ❑ 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.0I14(f))
Daily Design Flow
No. of Units
Flow
Parks with restroom facilities
250 gal/plumbing fixture
20
5,000 GPD
Filter Backwash
280 gal/filter
2
560 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
5,560 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(I) 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 I5A 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: 5 56tiGPD (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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Reidsville Splash Pad
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.3320' Longitude:-79.6663°
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.036 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): 25 gallons per minute (GPM) at 63 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
1.25
260
PVC
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 ISA 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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
V1H. 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: Reidsville Splash Pad
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.3320' Longitude:-79.6663'
3. Total number of pumps at the pumps
3. Design flow of the pump station 056 dlions gallons per day (firm capacity)
.00
➢ This should reflect the total M for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 25 gallons per minute (GPM) at 63 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
1.25
260
PVC
ry1f6
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C.I.b. ® Grinder Pump' ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(I ):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
➢ 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)):
f
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & (g)? ® Yes ❑ No
I5A 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
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'-Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"*Any private or public water supply source, including any wells, WS-1 waters of Class I or
Class If 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 (e). see Section X.I of this application
"15A NCAC 02T.0305(e) 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 weboaee
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? ErYes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ Seethe 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: Jordan Lake ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ 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 permitter 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 with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Puma Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes r ❑ 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
2. Professional Engineer's Certification:
1, C ri—_"¢r rt , `�.7tT attest that this application for e_ A\ N
(Professional Eng eer's name from Application Item Ill. I.) (Project Name from Applicatioill Item11.1
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. 1 further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the 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 tinder 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 snakes 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 NCAq,56,9.701)
North Carolina Professional Engineer's seal, signature, and date: Q S
SEAL t
n 02A420 ILL
3. Applicant's Certification per I5A NCAC 02T .0106(b): /n► -�,^^ 11 e
11 J oAy. $ &dL , attest that this application for
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item It.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. 1 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 the 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 tip to $25,000 per violation.
Signature: a5 1�_ i _ Date: If 71- -f

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: City of Reidsville r
Project Name for which flow is being requested: Reidsville Splash Pad --
More than one FTSE maybe required for a single project if lite owner of the WWTP is not responsible for all pump
stations along the route of Cite proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: City of Reidsville Wastewater Treatment Plant
b. WWTP Facility Permit #: NC0024881
Allflows are in MGD
c. WWTP facility's permitted flow 7.500�
d. Estimated obligated flow not yet tributary to the WWTP 1.050
e. WWTP facility's actual avg. flow 2.204 i
f. Total flow for this specific request 0.0056
g. Total actual and obligated flows to the facility 3.260 ,,
h. Percent of permitted flow used 43.47
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 W WTP:
(A)
(B) i
' CG)
(D)=(B+C) (E)=(A-D)
Design
Obliated,
Pump
Pump
Average
Apprgx. `
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***
* 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):
Page I of 7
FTSE 10-23

Downstream Permit Number:
III. Certification Statement:
I Steve Moran, PE / 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 of Signing Official
17 ( Z ±"
Date
Page 2 of 7
FTSE 10-23

1
Environmenta,ent of
WithersRavenel
,�
ReceivedQ�aiity
Our People. Your Success.
APR 15 1024
To:
North Carolina Department of Environmental Quality -
eRWinston-Salem
DV08"101fsRer Resources
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Attn: Fast Track Sewer Extension Applications Review
CC:
Josh Beck, PE - Public Works Director, City of Reidsville
tom:
Christopher N. Huff, PE
Date:
April 24, 2024
Project:
City of Reidsville - Splash Pad
Project Number: WR # 02201113.01
Subject:
Fast Track Sewer Extension Application
To whom it may concern,
The City of Reidsville is developing improvements to the existing Jaycee Park at 2010 S. Scales Street in
Reidsville, INC. The project includes the construction of a small duplex submersible sewage pump station,
1.25" force main to serve a splash pad complex. The complex consists of the splash pad and two buildings,
a mechanical building with electrical and mechanical controls for the splash pad and a concession/restroom
building. The complex will have an average daily flow of 5,560 gpd. The downstream sewer being connected
is an existing 10 VCP owned by the City of Reidsville.
A permit is requested for the following:
Pipeline
Type
Size
Length
Material
Force Main
1.25-inch
235
PVC
Pump Station
Pump Station
Pumping Rate
Total Dynamic Head
Splash Pad
28-gpm
63-feet
The permitted flow will be 5,560 gpd.
This Fast Track Application Package includes the following items:
• Fast Track Application (Form FTA 10-23)
• Flow Tracking/Acceptance Form (Form FTSE 10-23)
• Site Maps
• Power Reliability Letter
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008 1 www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh I Southern Pines I Wilmington

1%WithersRavenet
Our People. Your Success.
Please do not hesitate to contact me at 919-469-3340 or [e-mail] should you have any
questions or concerns.
Sincerely,
WithersRavenel
rist er N. I , 1
Senior Project Engineer

City of Reidsville 1100 Vance Street, Reidsville, North Carolina 27320
Phone: [phone]
Email: [e-mail]
THE CITY OE
Reidsville
NORTH CaN01.1-11% public Works Department
TO: NCDEQ Division of Water Resources
ADDRESS: 450 W Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
RE: Reidsville Splashpad — Fast Track Sewer System Extension Application
DATE: April 24, 2024
The City of Reidsville is developing improvements to the existing Jaycee Park at 2010 S. Scales
Street in Reidsville, NC. The project includes the construction of a small duplex submersible
sewage pump station to serve a splash pad complex producing an average daily flow of 5,560
gpd. The pump station will incorporate a manual transfer switch and generator connection so
that the pump station can be operated in case of power failure. The portable power generation
unit, associated appurtenances, and personnel are available for distribution and operation of
this pump station.
Sincerely,
Joshua Beck, PE
Public Works Director
City of Reidsville

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State of North Carolina
DW APR 2 5 2024 Department of Environmental Quality
Division of Water Resources
Winston-Salem 'FASTTRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources Rqs@fl6%S 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 (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 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.
➢ 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: FTA 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(bl. 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 I SA 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 adde&rnodified). 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)(I ), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed contractor,
stating that "the portable power generation unit or portable, independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump station."
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall
be provided in the case of a multiple station power outage. (Required at time of certification)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .01 15(a)(1) 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 .01 15(cj, submit the properly executed Operational Agreement (FORM: HOA).
❑ Per I SA 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 Otierational Agreement ( FORM: DEW
For more information, visit the Divisions collection .ststems 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, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
(7(34) 663-1699
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Fender
[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 I0-23 & SUPPORTING DOCUMENTATION Page 3 of 3

Boone, Ron
From:
Huff, Chris <[e-mail]>
Sent:
Tuesday, April 30, 2024 8:37 AM
To:
Boone, Ron;[e-mail]
Cc:
Graznak, Jenny, Boecker, Chuck
Subject:
[External] RE: Fast Track Sewer System Extension Permit No. W00045336, City of
Reidsville, Reidsville Splash Pad, Rockingham County, Additional Information Request
Attachments:
Revised FTA sheets 1 and 3.pdf
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
Mr. Boone,
As requested, here are revised sheets 1 and 3 of the Fast Track Sewer System Extension application
for permit number WQ00453361
Please let me know if you have lany additional questions.
Have a good day,
Christopher Huff, PE
SENIOR PROJECT ENGINEER G u n v a
t 919.469.3340 d: 919.795.0401 1 Cary, NC WITHERSRAVENEL.COM
From: Boone, Ron <[e-mail]>
Sent: Friday, April 26, 2024 8:38 AM
To: [e-mail]; Huff, Chris <[e-mail]>
Cc: Boone, Ron <[e-mail]>; Graznak, Jenny <[e-mail]>
Subject: [EXTERNAL] Fast Track Sewe ', System Extension Permit No. WQ0045336, City of Reidsville, Reidsville Splash Pad,
Rockingham County, Additional Information Request
CAUTION: This email originated from outside of WithersRavenel. _Do not click links_or open attachments unless you
recognize the'sender and know the_content is safe.
Good Morning,
We have received your Fast Track Sewer System Extension application for the subject project and
assigned it permit number WQ0045336. However, we cannot finish processing your application until
the following corrections are made to the application:
1. Please enter the City of Reidsville's System Wide Collection System Operation and
Maintenance permit number in Question #3 in Section V, as requested.
2. Your answer to the second Question #3 of Section VIII indicates the pump station's firm
capacity is 0.0056 million gallons per day (MGD), but your answers to the first question #3 and
question #4 indicate the pump station will have two 25 gallon per minute (GPM) pumps. Since
the firm capacity of the pump station is "...the total GPM for the pump station with the
largest pump out of service.", as indicated in the bulleted note below the second question

#3, then one pump * 25 GPM per pump * 1,440 minutes per day = 36,000 gallons per day
(GPD) or 0.036 MGD. Please verify this information and update your answers in Section VIII
accordingly.
Because the pages that require correction do not require signature, you may correct them and send
them to me via email if you so choose.
We will hold your application in abeyance until all corrections have been made and additional
information provided as requested above.
Thank you in advance for your cooperation.
Best Regards,
Rona.CdC. Boone, Environmenta(Program ConsuCtant
North Carolina Department of Environmental Quality
Division of Water Resources, Winston-Salem Regional Office
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Office: [phone] t Cell: [phone]
ron.booneI@a)deq.nc.gov
NORrH CAIOL.IN � l'
Department of Envrronmetrtel quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.