WQ0045700_Wilkes_County_Rural_Community_Wastewater_Extension_FTSSE_Permit_Application_Final_Submission_20240815

DWR,
Division of Water Resources
EnvirU Received e; li:ai
��State of North Carolina
e
1'024 Department of Environmental Quality
AUG I LDivision of Water Resources
Winston-Salem FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Regional FTA 10-23 &SUPPORTING DOCUMENTATION
Grfice
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: North Wilkesboro (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: Holly
Minton per 15A NCAC 02T .0106(b)
Title: Town Manager
4. Applicant's mailing address: P.O. Box 218
City: North Wilkesboro
State: NC Zip: 28659-
5. Applicant's contact information:
Phone number: [phone]
Email Address: townmanagerknorthwilkesboronc.gov
II. PROJECT INFORMATION:
1. Project name: Wilkes County Rural Community Wastewater Extension
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
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: Wilkes
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.14366' Longitude:-81.0899'
5. Parcel ID (if applicable): 2200990 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Ryan Hager,_ PE License Number: 031444
Firm: W.K.Dickson & Co., Inc.
Mailing address: 401 4`h Street, SW
City: Hickory State: NC Zip: 28602-
Phone number: [phone] Email Address: rwhagergwkdickson.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Thurman Street Wastewater Treatment Plant Permit Number: NCO020761
Owner Name: North Wilkesboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ Unknown
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00093
Owner Name(s): Town of North Wilkesboro
FORM: FTA 10-23 Page I of 5

L11 V;.-O Z1: 1 _'.:rl::.ii
L IL
Received
VI. GENERAL REQUIREMENTS AUG 13 2 012 h
1. If the Applicant is a Privately -Owned Public Utili , has,a Ce�tific� of Public Convenience and Necessity been attached?
�IVinsion,-Jett
PQbsn P t C0 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: % Domestic 100 % Commercial % Industrial (See 15A NCAC 02T .0103(201)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ®No
➢ If Yes, provide a cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
Stadium
5 gal/seat
20,000
100,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
100,000 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(22) 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: 100,000 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
4,135
PVC
8
670
DIP
41
VL"r�°7s�
Rega%em
�ona1 Gffioe
➢ 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 (Puma Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED M THIS PROJECT
1. Pump station number or name: Fishing Creek Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.14366' Longitude:-81.0899'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.3024 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): 210 gallons per minute (GPM) at 122 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
6
3,725
PVC
6
385
DIP
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(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

{4 C DC p r .m,cn', o
Environmenial Quality
Received
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)): AUG 13 2024
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(fA&•( Won_SaA Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be Provided forRcwtr nsw,stgMW.4. rA
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
ZWater mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
ZWater mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
"Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (g), see Section X.1 of this application
*15A 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 webpage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the 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

DWR
Division of Water Resources
NC Department of State of North Carolina
Environmental Quality Department of Environmental Quality
Received p Q tY
Division of Water Resources
k 2 2 ST TRACK SEWER SYSTEM EXTENSION APPLICATION
Winston-SalemFTA 10-23 & SUPPORTING DOCUMENTATION
Regiona
Application Number: J4
ce
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
i
I . Applicant's name: North Wilkesboro (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Holly Minton per 15A NCAC 02T .0106(b)
Title: Town Manager
4. Applicant's mailing address: P.O. Box 218
City: North Wilkesboro / State: NC Zip: 28659-
5. Applicant's contact information:
Phone number: 336) 667-7129 / Email Address: [e-mail]
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Wilkes County Rural Community Wastewater Extension
2. Application/Project status: ®Proposed (New Permit) ❑ Existing Pennit/Project
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: Wilkes '
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.143660 Longitude:-81.0899'
5. Parcel ID (if applicable): 2200990 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Ryan Hager, PEA License Number: 031444
Firm: W.K.Dickson & Co., Inc.,,
Mailing address: 401 4th Street, SW /
City: Hickory ' State: NC
Phone number: 828) 327-6911
O
Zip: 28602-
Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Thurman Street Wastewater Treatment Plant Permit Number: NCO020761
Owner Name: North Wilkesboro.
V. RECEIVING DOWNSTREAM SEWE INFO) MATION:
1. Permit Numbe Cs)-WQCS00093
2. Downstream (Receiving) Sewer Information: 8 inch ❑x Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00093
Owner Name(s): Town of North Wilkesboro
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 ® 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.0I 15(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: % Domestic 100 % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(1)? ❑ Yes ®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))
F Daily Design Flow a°b
No. of Units
Flow
Stadium
5 gal/seat
20,000
100,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
100,000 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.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 100,000 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
4,135-
PVC
8 `
670
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: Fishing Creek Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.14366' Longitude:-81.0899'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.1 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): 210 gallons per minute (GPM) at 122 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
6
3,725
PVC
6
385
DIP
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
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/alternatives found in 15A NCAC 02T.0305(f) & (g)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
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 II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (g), see Section X.1 of this application
*15A NCAC 02T.0305(Q) 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? ® Yves [-]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? ® �es [—]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: ® 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.
r
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:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes � ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
Professional Engineer's Certification:
I, y�l✓� /k5 e ✓ , attest that this application for
(Profe sional Engineer's name from Application Item III.1.)
WtLK155 C.o4wrY 0KAL CNA W✓;VT W1.,/ C,<-j
(Project Name from Application Item II.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification per 15A NCAC
AN
(02T.0106(b):
I, Alt t 6�}`-- attest that this application for WZLK �S
(Signature Au ority Name from Application Item I.3.) (Project Name from Application Item II.1)
GouuT'/ INCAL GOMnoWZTY WV1 6XT,
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 exce d $10,000 as well as civil penalties up to $25,000 per violation.
i
Signature: Date: M 6?Z62
FORM: FTA 10-23 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: North Wilkesboro
Project Name for which flow is being requested: Wilkes County Rural Comm WW Ext
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: Thurman Street Wastewater Treatment Plant
b. WWTP Facility Permit #: NCO020761 '
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
2.0-�
0%
1.1 '
0.1 -
1.2 '
60%
I1. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B) (C) (D)=(B+C) (E)=(A-D)
Design
Obligated,
Pump Pump Average
Approx. Not Yet Total Current
Station Station Firm Daily Flow**
Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf),
Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD
Flow, MGD MGD Flow Capacity***
Speedway 0.216 0.086 0.045 0.1 0.145� -0.059
VFW 0.576 0.23 0.072 ( 0.1 0.172 0.058(
* 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): Thurman Street WWTP
Downstream Permit Number: NCO020761
Page 1 of 6
FTSE 10-23

III. Certification Statement:
AA1)1--
I certify to the best of my knowledge that the addition of
the volu e f 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.
ial
Date
Page 2 of 6
FTSE 10-23

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available Capacity is < 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
170 % and -0.059 MGD of the Available Capacity (E) in Pump Station
Speedway ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
0.1 MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
NCDOT Hwy 115 Widening (R-5759) is in design or under construction with
planned completion in late 2026 ; and/or
d. The following applies:
An upgrade of the Speedway Rd pump station is currently under design as part of NCDOT's
project R-5759. The Speedway Rd pump station upgrade will increase the firm capacity of
the pump station to 0.504 MGD (350 gpm), and 0.202 MGD design average daily flow,
will be constructed concurrently with the time in which the proposed project begins to
receive wastewater flow. Thus providing an available capcity of 0.057 MGD at the
Speedway Pump Station, after the proposed project and the R-5759 project are complete,
insuring that the required downstream capacity will be available.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
26
Date
Page 3 of 6
FTSE 10-23

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DICI<SOICI
community Infrastructure consultants
August 7, 2024
NCDEQ Division of Water Resources
Winston-Salem Regional Office
450 West Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
RE: Wilkes County Rural Community Wastewater Extension
FTA 10-23 Fast Track Application for Approval
North Wilkesboro, North Carolina
WK Dickson # 20220842.00.CL
NC Department of
Environmental Quai .
4,1 Received
AU6 , n
Winston-Salem
Regional office
Enclosed is a Fast -Track Application submittal and supporting documentation for the above
referenced project, for the Division's review and comment. This project consists of the construction
of a gravity sewer line, new wastewater pump station and associated force main serving the North
Wilkesboro Speedway and surrounding area in Wilkes County.
The project includes construction of 4,800 linear feet of 8-inch gravity sewer, a new 210 gpm duplex
submersible wastewater pump station, and approximately 4,100 linear feet of 6-inch force main to
transfer wastewater from the North Wilkesboro Speedway property to the nearest gravity
wastewater collection system owned and operated by the Town of North Wilkesboro. Based upon
the design flow rates provided in 15A NCAC 02T .0114 for Stadium facilities, a daily design flow of
100,000 gallons per day is anticipated from the Speedway.
The proposed 6-inch force main will discharge into an existing manhole located near the intersection
of Speedway Road and NC Hwy 115. The downstream sewer from this location is to be upgraded as
part of NCDOT's project R-5759 that will widen NC Hwy 115. The extent of the downstream
wastewater collection system upgrades and remainder of the downstream sewer is shown in the
included General Project Area map.
This package has been prepared in accordance with 15A NCAC 02T and the "Fast Track Sewer
System Extension Application." The following is included herein:
• Application Form FTA 10-23 (1 original, 1 copy)
• Flow Tracking/Acceptance Form FTSE 10-23 (1 original,1 copy)
Site Maps (2 copies)
Application Fee of $600.00
401 4"' Street, SW
Suite 201
Hickory, NC 28601
Tel. [phone]
www.wkdickson.com Aviation • Water Resources • Land Development • Energy

August 7, 2024
Page 2
Pursuant to FTA 10-23, engineering design documents including drawings, technical specifications,
and calculations were completed prior to submittal of this package and are available to the Division
upon request. Please advise if there are any questions or comments.
Sincerely,
W. K. Dickson & Co., Inc.
Jordan Isenhour, PE
Senior Project Engineer
Enclosures
cc: Holly Minton — North Wilkesboro Town Manager