WQ0045499_Kinsley_-_Sanitary_Sewer_Outfall_FTSSE_Permit_App_20240626

ceer'sad�7/Zozef-
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: L(!7 / r (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Jamestown (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: Matthew Johnso$ per 15A NCAC 02T .0106(b)
Title: Town Manager
4. Applicant's mailing address: 301 E. Main St
City: Jamestown State: NOS Zip: 27282-�
5. Applicant's contact information:
Phone number: 336) 454-1138 iEmail Address: mjohnsonAl'amestown-nc.go✓
II. PROJECT INFORMATION:
1. Project name: Kinsley - Sanitary Sewer Outfall
2. Application/Project status: ® Aroposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: W000_ and issued date: _,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Guilfo
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.01207f Longitude:-79.919509d/
5. Parcel ID (if applicable): 7822-84-6667, 7822-64-5676, 7822-66-2393, 7822-76-1411, 7822-77-3282 (or Parcel ID to closest
downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Clay Oliver License Number: 027400
Firm: Timmons Group /
Mailing address: 5410 Trinity Rd, Suite 102�
City: Ralei h / State: NCB Zip: 27607-
Phone number: [phone] ' Email Address: clay.oliver(a),timmons.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside Wastewater Treatment Facility Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): WQS00314
2. Downstream (Receiving) Sewer Information: 18 inch � ® Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSS00314 i
FORM: FTA 10-23 Paget of 5

VL GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes []No ®N/A l
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(20I)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa 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'"
No. of Units
Flow
n/a
n/a gal/n/a
n/a
0 GPD
gal/
GPD
gav
GPD
gal/
GPD
gall
GPD
gal/
GPD
Total
0 GPD l
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: O'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 3 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewersl:
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
3068
SDR-26 PVC '
8
2524
DIP '
➢ 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:
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: - °
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)(IXB).
➢ 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 4 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in I.SA NCAC 02T .0305(fl & (a)?
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes []No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-1 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(fl or (g), see Section X.1 of this application
* 15A NCAC 02T.0305(a) 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 webpaee
2. Does this project comply with the minimum separation requirements for water mains? ® Yes [:]No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ 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: Cape Fear- Randleman Lake
❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02002 ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0 1 05(c)(6) (additional permits/certifications)? ® Ves ❑ No
Per 15A NCAC 02T.01051 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/con0ict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
FORM: FTA 10-23 Page 5 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 027, the Minimum Design Criteria for the Permiuing of Putno Stations
and Force Mains (latest versions, and the GravilN Sewer Minimum Design Criteria (latest version as applicable?
® Yes' ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Aonroval of the request will be issued
2. Professional Engineer's Certification:
r
I, ��lts 1//,�l1�IVCf attest that this application for
(Prot'essional G ginger's name from Application Item 11I.1.) (Project a Crom Appli ion Item li.l )
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. 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 Gravin Sewers (latest version h and the Minimum Design Criteria for the Fast -Track Permittine,
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 noncompliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
_. `ttitl..l. ITIt
North Carolina Professional Engineer's seal, signature, and date: ` 1 { CAR /,/,
ESS'0�����
b 7400
C'•.. GINE..�pp .�
rev
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, 1E±nl JJ tb"O attest that this application for F—tN5(E f — Shvrzrrw Swot o Lr]L
(Signature Authority name from Application Item 1.3.) (Project Nam from Application It m
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 ell required supporting information and attachments are nor 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 persofi 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.
Date: �O ,i
FORM- FTA 10-?l paae. 7 of S

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Town of Jamestown
Project Name for which flow is being requested: Kinsley -Sanitary Sewer Outfall
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: High Point Eastside WWTP
b. WWTP Facility Permit #: NC0024210 '
All flows arein MGD
c. WWTP facility's permitted flow 2.0000 MGD
d. Estimated obligated flow not yet tributary to the WWTP 0.0522 MGD '
e. WWTP facility's actual avg. flow 1.1523 MGD .
f. Total flow for this specific request 0.0000 MGD -
g. Total actual and obligated flows to the facility 1.2045 MGD
h. Percent of permitted flow used 60.2%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(B'i C) (E)=(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, * (Firm / pi),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No.
MGD MGD
Flow, MGD
MGD
Flow Capacity***
* The Firm Capacity (design Ilow) of any pump station is defined as the maximum pumped flaw that can be
achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) not
less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Town of Jamestown Collection System "
Downstream Permit Number: W C�314
Page 1 of 8
FTSE 10-23

III. Certification Statement:
I Paul R. Blanchard, Public Services certify to the best of my knowledge that the addition of
Director
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment 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.
Page 2 of 8
FTSE 10-23

(,axrb eta 611 *t
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FlowTracking for Sevier Extension Applications
(FfSE 10-23)
Entity Requesting Allocation: HighPomtNC
Project Nacre for which flow is being txgoested: Kitsley- Sanitary Sewer OutfJI
More than one F7SE may be required for a single project if the owner of the WWi'P is not rerponsiblefor all pitnip stations along the
route of the proposed waslewaterflow
1. Complete this section only if you are the owner of Ore wastewater treatment plant.
a. WWTPFacTtynane:Easiside VAM
b. W V PFacilityPermitMNC0024210
c. W WTP faciligrs Pematted flow
All f(otin are in MGD
26 '
d. Estumted obligated flow not yet tributary to the W WTP 4.412
e. WWTP faclit/s actual average flow 14.92 '
f. Total flow for this specific request 0
g Total actual and obligated flows to the facility 19.332
h Percent ofperaitted flow used 74.35% "
It. Conplete this section for each ptnp station yow ate responsible for along the mute of this proposed wastewater fbw
List pump station located between the project correction point and the W WTP.
(A) (B) (C) PhTI-C) (E)=(AD)
Poop Prntp Design Approx Obligated
Total Current
Ru
Station Station n Average Daily Cunent Not Yet FlowPhs Available
(Nana or Permit Capacity, * Flow** Avg Daily Tnbu Lary Obligated Capacity***
Number) No. MGD (F�pO Flow Daily Flow Flow MGD
MGD MGD MGD MGD
Riverdale M000852 30,0887 11.4842 ,390_1 1,2567 9,64468 1,8374
* The FlrmCapaeity of any pump station Is defined as the maximumpurrgred flow 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 (pt)
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 behueen the
project connection point and the WWPP where the Available Capacity is 5 0.
DowstreamFacRyNaue(Sewer): EastsideWW1P
DownsueamPer itNumber(Sewer):NC0024210
Page 1 of 8
FTSE 10-23

•
ba.•
0 1,000 2,000 `Ni ` tyJ�, ;Hun
Feet d'
Legend
Proposed Sanitary Sewer Outfall
-- Proposed Sanitary Sewer"
- Existing Sanitary Sewer
^�•^- Streams & Creeks
Kinsley Project Boundary
Road
�--- Railroad
Preliminary design and subject to change.
To be permitted separately.
Resources: NCDEQ Surface Water GIS Data, ESRI Base
Map - USA Topo Maps, Timmons Group Design Data
KINSLEY - SANITARY SEWER OUTFALL
USGS TOPO MAP
JAMESTOWN, GUILFORD COUNTY, NC
KE
•� ""°
V�
TIMMONS GROUP
June 5, 2024

DocuSign Envelope ID: 4CC42E94-2907-4B37-89A2-9E81128745BF
i
W �I
Y W W Y W W
W W W W W W
W W V
go := _ A
111
I111
_o
- IIQII�11 WW♦�
MEMO
0 MEMO
11
UF
MUM
\ / V
I�
F
/
I N-/,
I �
o O
1 O o °
O °
— O ° O
° Io ° ° oo\
I O O O 0 0 0 8 0 0 00 C\
0 0 0
8 8 0 ° 0 0\ �80
®e I o ° g/
oo/
o �
o °
o O Q'1 O
'19
o O
O /O O
/
ow,lei
ow NOW
I r/�► �, -__ � �,►� sue.. .
oil
NOWIN
. r► ,,�
OR
INIP
ro 0♦ ♦♦ PAZ
..� ....� WIA
.. fo
I!/'oF still
00
WIM
�y+ 1. e �*,� ►�T
I F�yI •
FREEDOM
20' HORTON
DRH EXPRESS/E
5050' 20'
20'
F F
117' I I I 117' I I
93' 1 —52' I 52' 193' 100' 1�62' I 62'I 100'
5 I 15' �I 5'
20, 20' 20'
CA pEHOU SE l4NE
DETACHED REAR
LOADED
— Li20'
42'
1 05' I I 1 15'
08 8 0--
O O O no i
\ \\ \ o i O \
o ��,�� ° � - PHASE 3 '
\ \ \ \\\\\ / o ,yW - ° ° \
/ \ W
Ne °
W APARTMENTS
° ° ° WW DESIGN BY OTHERS
O \
0
° � \;\\ \'� W W one ie' ° \ \
l o y� W \
I — 0 O ° O� ° 0\\
>� 0 �`� ,A 0 A VAAVA
o \
° IN,
I I / °
OO 0 oN'
/ \\ °jheFOF
JP p \
\o �0 41
I \\\\\\ ^\
0
0 ftyN" IA�
O 0
O
o
0 /
J o
26' REAR LOADED
----ME ___ ____
26'
20' 31'
95, I 195,
I I I I I
5'
10,
22' TOWNHOME 27'
22'
20'
I90, I I I I 90'
I I I I 5'1 I
26' TOWNHOME
26' 20' 31'
I
I 100' I I I 11
I I I I I
5-
-- — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — - — -
TYPICAL LOT LAYOUTS
TOTAL LOTS- PHASE 1
# OF LOTS
DETACHED READ LOAD
0
58
HORTON
8
DRH EXPRESS/E
63
FREEDOM
0
71
26' TOWNHOME
26
22' TOWNHOME
0
0
26' RL TOWNHOME
O
0
AREA PER PHAS
PH 1:
73.59 AC
PH 2:
144.12 AC
PH 4:
39.02 AC
PH 5:
20.81 AC
PH 6:
76.83 AC
TOTAL: 354.37 AC
SEE APARTMENT PLANS FOR PH 3 AREA
Q ROf •••r'��
`U
3 512944A...
SEAL s
055961
WAID
11111 it 4/15/2024
DO NOT USE FOR
CONSTRUCTION
0
C�
O C
o
�E
N
U
w z ;,
Q Z
Lu U N
c�
aC
z
N M
0
(D a)
z UJ M
J X
-
�
Ln
W
Lj O
L T )n
Z
I- L l6
O
W
L�
J
W
Ln
0
cD
0
cr-
W
>
W
0
Q
z
0
DATE
cn
>
0411512024
0
r
DRAWN BY
331
•
DESIGNED BY
•
331
•
CHECKED BY
•
JR W
• •
SCALE
•
1 " = 300'
•
•
N Q
z
J
0
U w a
U
O =
z � �
Lu Qo
z
z=Q
_u
J vo W
I)
z o Q
'� w _
Q V1 z
uzo
Lu
G
O Q
z
ALL CONSTRUCTION TO BE IN ACCORDANCE WITH
THE TOWN OF JAMESTOWN, NCDEO, AND NCDOT -
STANDARDS, SPECIFICATIONS, AND DETAILS.
—11111111 poll JOB NO.
! 48502
SHEET NO.
C2.01
0
c
Z'
.N
U
C
N
0
0
a
a
a
70
0
cu
tn
7o
M
If
cu
a
a
3
�a
�O
2 cD
0-Z
O
og
T �
(6 O
a �
c 0
(0 N
0-o
z co
O�
D_
X
H o
CD
o E-
� 5
m 0
a-r-
o .3
a
Y
�o
d U
i
d in
� O
E a
� m
.2-0
Tz
0
0 c
N o
W
N U
-a
u 0
C O
m
0-
o
� .E
L

TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
NC Department I
Environmental Qua
s Received
JUN 0 7 2024
PROJECT NARRATIVE ? Winston-Salem
Project Name: Kinsley -Sanitary Sewer Outfall Regional Office
Location: 2207 Guilford College Road, Jamestown, Guilford County, NC
Owners: D.R. Horton, Inc.
2000 Aerial Center Parkway, Suite 110
Morrisville, NC 27560
Developer: DHI Communities, A D.R. Horton Company
2000 Aerial Center Parkway, Suite 110
Morrisville, NC 27560
Consultant: Timmons Group
5410 Trinity Road, Suite 102
Raleigh NC 27607
Phone: [phone]
PROJECT DESCRIPTION AND NARRATNE:
The proposed project is inside the Town of Jamestown and is located on the north and east
sides of Guilford College Road south of Mackay Road. The scope of this project will include the
construction of a total of 5,592 linear feet of 8" gravity sewer (3,068 LF of 8" PVC and 2,524 LF
of 8" DIP). The project is being permitted for zero flow. The flow will be included in
subsequent permit(s) for the Kinsley residential subdivision that will be submitted for review
and approval later this year (2024).
The proposed system will connect to an existing Town of Jamestown 18" gravity sewer line in
two locations - one along the eastern project boundary and one at the southern boundary. The
Town of Jamestown sewer eventually flows into a City of High Point sewer system.
The proposed sanitary sewer outfall is expected to temporarily impact a total of 0.195 acres of
wetlands, which is determined to be a non -reporting activity authorized by Nationwide Permit
58 and NCDEQ-DWR WQC 4276.
The gravity sanitary sewer outfall will be owned, operated, and maintained by the Town of
Jamestown
ITEMS INCLUDED IN THIS APPLICATION PACKAGE:
• FTA Application
• Application Fee of $600
• Flow Tracking/Acceptance Form (Jamestown)
• Flow Tracking/ Acceptance Form (High Point)
• Project Description and Narrative
• Aerial Vicinity Map
• USGS Topographic Map
0
v
E
0
N
0
O
E
E
3
3
3

Received 6-26-2024
Kinsley — Sanitary Sewer Outfall
Project Narrative
06/26/2024
The Town of Jamestown is applying for a sewer permit to allow for the installation of 5,592
linear feet of sanitary sewer outfall. The outfall is needed to serve the first phase of the Kinsley
development as well as other phases at a later date. The requested permit will be for the
outfall only. No flow will be generated from this portion of the project. Subsequent permits
will be submitted for each of the 6 phases of development as shown on the attached plan.
These permits will include the sewer lines within the roads of those phases and will allocate the
flow for each phase that will be received by the outfall.
For example, Phase 1 will be the first phase served. The plans are still under review, but Phase 1
will have approximately an additional 13,000 liner feet of sanitary sewer with an anticipated
flow allocation of approximately 68,000 gallons per day. The intention is to allow for the
construction of the outfall while the interior plans are being finalized. No installation of lines
will be allowed beyond the limits of the outfall and no flow will be generated until the
subsequent phases are permitted and constructed.

Kinsley — Sanitary Sewer Outfall
Project Narrative
06/26/2024
The Town of Jamestown is applying for a sewer permit to allow for the installation of 5,592
linear feet of sanitary sewer outfall. The outfall is needed to serve the first phase of the Kinsley
development as well as other phases at a later date. The requested permit will be for the
outfall only. No flow will be generated from this portion of the project. Subsequent permits
will be submitted for each of the 6 phases of development as shown on the attached plan.
These permits will include the sewer lines within the roads of those phases and will allocate the
flow for each phase that will be received by the outfall.
For example, Phase 1 will be the first phase served. The plans are still under review, but Phase 1
will have approximately an additional 13,000 liner feet of sanitary sewer with an anticipated
flow allocation of approximately 68,000 gallons per day. The intention is to allow for the
construction of the outfall while the interior plans are being finalized. No installation of lines
will be allowed beyond the limits of the outfall and no flow will be generated until the
subsequent phases are permitted and constructed.

State of North Carolina
" `' I I Department of Environmental Quality
o
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 (Gravii 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 (downstreanVupstream)
➢ 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 IL 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):
ID 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.
❑ 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 I1.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
ID 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 Pagel 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 11-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 .0305thx 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)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15.A _NCAC 02T .0I I5(all 1l 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 Optional Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
p Developers of lots to be sold
❑ Per 15A NCAC 02T .01151b), submit the properly executed Operational Agreement (FORM: DEV ).
For more information, visit the Division's collection systems webrite
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:
E
ADDRESS
COUNTIES SERVED
al Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
tion
ffFavefteville
Swannanoa, North Carolina 2877"211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
nal 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
Cunituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Realonal Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[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