WQ0045663_Providence_Point_FTSSE_Permit_Application_Final_Submittal_20240815

Nt`'_. 7eN3i"tm--z i-! of
Environmental Quality
Received
State of North Carolina
AUG 13 2024 Department of Environmental Quality
DWR Winston-Salem
Division of Water Resources
Regional Oi{;,!FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Divisions of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: 6, (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 Archdale (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 Christian per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: PO Box 14068
City: Archdale State: NC Zip: 27263-
5. Applicant's contact information:
Phone number: [phone] Email Address: mchristianoarchdale-nc.gov
II. PROJECT INFORMATION:
1. Project name: Providence Pointe
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. Randolph
4, Approximate Coordinates (Decimal Degrees): Latitude: 35.8970' Longitude:-79.9165'
5. Parcel ID (if applicable): 7728-82-6865 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I . Professional Engineer: Tyler Cross License Number: 051879
Finn: Timmons Group
Mailing address: 5410 Trinity Road, Suite 102
City: Raleigh State: NC Zip: 27607-
Phone number: 919) 532-3271 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside Treatment Plant Permit Number: NC 0024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1, PermitNumber(s): WQ0029628
2. Downstream (Receiving) Sewer Information: 10 inch O Gravity 21 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00312
Owner Name(s): City of Archdale
FORM: FTA 10-23 Page I of 5

NC Dep9rtr;1ent of
Environmental Quality
Received
AUG 13 2024
VI. GENERAL REQUIREMENTS
Winston-Sa �m
I. If the Applicant is a Privately -Owned Public Utility, has a Cpfftifieate f/jPS7µ�lrc Convenience and Necessity been attached?
1�Cegiona V� lie
❑ 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 .0114(f)? []Yes ®No
A 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 a,n
No. of Units
Flow
Single-family residential (four -bedroom)
300 gal/day/unit
293
87,900 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
87,900 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e. proposed unknown
non-residential development uses: public access facilities located near high public use areas; and residential property
located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 87,900 GPD (per 15A NCAC 02T .011.4 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
14,020
PVC
8
1,080
DIP
8
210
RJDIP
Envir _rnent of
ReceivedQL aj'tV
AUG 13 2024
Winston-Salem
Regional mf ce
➢ Section I1 & 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.1.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 pen -nit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

Environmental Quali-ty
Received
AUG13 2024
IX. SETBACKS & SEPARATIONS —(02B.0200 & 15A NCAC 02T.0305(f)): Winston-Salem
1. Does the project comply with all separations/altematives found in 15A NCAC 02T .03C6M & WPOffice ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'-Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (.a), see Section X.I of this application
* 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpaae
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 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: Randleman 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 I SA 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 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

nCLelvea
,,7 -
Docusign Envelope ID: 9681 OB21 -EOD4-43A9-AFF4-93F7330BAFB2 AUG 13 202�
Winston -Belem
X, CERTIFICATIONS: Regional C°:';,.
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?
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.
2. Professional Engineer's Certification:
I Tyler Cross , attest that this application for Providence Pointe
(Professional Engineer's name from Application Item IIL I) (Project Name from Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. 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 Gravjty 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: ���� -(N CARD
O� .GG�ssin(�
D�,ytlSlgned by�� •, -9
0811512024
C.);
..FNGINe' �0
.............
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1 ���` r`3�is+n , attest that this application for ?P.) J(We_ P 1(4�
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item 1I.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
FORM: FTA 10-23 Page 5 of 5

N- nepartment of
Environmental Quality
�eceiv
AUG 13 2024
Winston-Salem
Regional office
NC Depart;;;.- ,ni_
Envirom eni;-
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 Archdale
Project Name for which flow is being requested: Providence Pointe
More than one FTSE inay be required for a single project if the owner of the fVWTP is not responsible for all pump
stations olong 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 #: NCO024210
AlI lows are in MGD
c. WWTP facility's permitted flow 2.500 (contractural)
d. Estimated obligated flow not yet tributary to the WWTP 0.124
e. WWTP facility's actual avg. flow 1.064
f. Total flow for this specific request 0.088
g. Total actual and obligated flows to the facility 1.276
h. Percent of permitted flow used 51.0%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)—(B+C)
(E)=(A-D)
Design
Approx.
Obligated,
Total
Pump
Pump
Average
Current
Not Yet
Current Flow
Station
Station
Firm
Daily Flow**
Avg. Daily
Tributary
Plus
(Name or
Permit
Capacity, *
(Firm / pf),
Flow,
Daily Flow,
Obligated
Available
Number)
No.
MGD
MGD
MGD
MGD
Flow
Capacity***
Suits
WQ0029628
0.746
0.298
0.009
0.088
0.097
0.201
Weant
WQ0029787
5.760
2.304
1.064
0,193
1.257
1.047M
* 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): High Point Eastside Treatment Plant
Downstream Permit Number: NCO024210
Page I of 8
11-l'St 10-2 3

III. Certification Statement:
I Matthew Christian, City Manager certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving.
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing Official Signature
of SignMg Official
Date
Page 2 of 8
FTSE 10-2 )

NV E)e. � +
t-)�! r nt C,f Environmerital QU�iit
Receiver) Y
PROJECT NARRATIVE 1:€JG e 3 2024
Winston-Salem
Project Name: Providence Pointe Region?l off-._,
Location: City of Archdale, Randolph County, NC `
PIN: 7728-82-2583
Owner: MG Suits, LLC
4030 Wake Forest Road, Suite 349
Raleigh, NC 27609
Developer: MG Suits, LLC
4030 Wake Forest Road, Suite 349
Raleigh, NC 27609
Contact: James Floyd
Consultant: Timmons Group
Clay D. Oliver, PE
5410 Trinity Road, Suite 102
Raleigh, NC 27607
Phone: [phone]
PROJECT DESCRIPTION AND NARRATIVE:
The proposed Providence Pointe project is inside the City of Archdale jurisdictional limits and is located
on the east side of Suits Road, between Tuttle Road to the north and Poole Road to the south. The scope
of the project will include the construction of 293 single-family, four -bedroom homes on 157.22 acres.
The project is anticipated to generate 300 gallons per day (gpd) of wastewater flows per single-family unit
(75 gpd/bedroom) for a total development flow rate of 87,900 gpd.
The proposed Providence Pointe gravity sanitary sewer system will consist of approximately 15,310 LF
of 8" pipe, of which 210' of rigid RJDIP pipe will be suspended from a pedestrian bridge that will span
Muddy Creek between manholes 40C and 40D (see attached plan sheets). This 210' length suspended
from the bridge is considered a "high -priority" line since it is an aerial crossing of Muddy Creek. The
system will connect to the existing City of Archdale Suits Road Pump Station (Permit No. WQ0029628),
which connects to an existing 10" force main.
The proposed project has been authorized under a 404 Nationwide Permit 29 (SAW-2022-02029)
approved for an Individual 401 Water Quality Certification (WQC006483).
The new gravity sanitary sewer system will be owned, operated, and maintained by the City of Archdale.

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: to 51�& (to be completed by DWR)
All items must be completed or the application will he returned
1. APPLICANT INFORMATION:
f
1. Applicant's name: City of Archdale (company, municipality, HOA, utility, etc.)
i
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal State/County ® Municipal ❑ Other
3. Signature authority's name: Susan Swaim per 15A NCAC 02T .0106(b)
Title: Interim CiV Manager
4. Applicant's mailing address: PO Box 1406
1
City: Archdale State: NC Zip: 27263-
5. Applicant's contact information l
Phone number: [phone] Email Address: sswaim(@archdale-nc.gov
II. PROJECT INFORMATION:
1. Project name: Providence Pointe
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: Randolph i
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.8970' Longitude:-79.9165'
5. Parcel ID (if applicable): 7728-82-6865 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
i
1. Professional Engineer: Tyler Cross License Number: 051879
Finn: Timmons Group'
Mailing address: 5410 Trinity Road. Suite 102,
City: Raleieh State: NCB / Zip: 27607-
Phone number: [phone] Email Address: tyler.cross(@timmons.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside Treatment Plant Permit Number: NBC 0024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0029628
2. Downstream (Receiving) Sewer Information: 10 inch ❑ Gravity © Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 10-23 Page 1 of 5

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
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):
®kesidential (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 °l Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ 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 n.b
No. of Units
Flow
Single-family residential (four -bedroom) '
300 gal/day/unit '
293 `'
87,900 GPD
coal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
87,906 GPD
a See _15A NCAC 02T .0114(b) (d) (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e. proposed unknown
non-residential development uses; public access facilities located near high public use areas; and residential property
located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 87.900 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

Vll. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
l . Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8 a
14,020
PVC
8
1,080
DIP
8 J
210
RJDIP
➢ 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
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: Longitude: - °
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.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

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) & (a)? EYes [:]No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems -
Setback Parameter*
Separation Required
Stone 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-1 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 nonnal
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.0406(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: Randlema�Lake ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® I'es ❑ 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 l
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.),
i
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 IMiniMUni Design, Criteria for tlic Permitting of Pta_in Stations
and Force Adains (latest version),and the Gravity Sevre: iviinimum 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 nernit. and proicc(s reouiring a variance anoroval may be subject to longer
review tinier. For projects reouirinia tvvo or more variances or where the variance is determined by the Division to be I
siantficznt portion of the project, the full technical review is required
2. Professional Engineer's Certification: Q
1
C(�S$ attest that this application for �4VI�ENG'✓ �olra77F
(Professional Engineer's name from Application Item I[I.I.) (Project Name from Application Item II.1)
3.
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,
Minitnum Dasian Criteria for Gravitv Scwr-rs (latest vcisiori , and the lvlinimum Design Criteria for the Past -Track pernittin!z
of Pump Stations arid Force 1,Iains (latest v•!rsion� 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: �H CARD
E
SEAL -
051879
-18I?07't� �-'��
........................ _...............:.�,�.
Applicant's Certification per 15A NCAC 02T .0I06(b):
1 /la�i�^s�1 G�r.s� a� attest that this application for
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item It, l )
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
FORM: FTA 10-23
Date: / �Y
Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
MowTracking racking for Sewwr Extension Applications
Oili-:. ... (FFSE 10-23)
Eitily Requesting Allocation: TIr City of Archdale
Project Nann for which flow is being requested: Providence Pointe
More than one FTSE nra3� be required for a single project if the owner of the 14'WTP is not responsible for all pump stations along the
route of theproposed waeteivaterflow
1. Complete this section only if you are the owner of the wastewater treatrrent plant.
a. WWTP Facility name: Eastside VVNVIT
b. W WTP Facility Penr it #: NCOU24210
All flows are in MGD
a WWTP facilit}ts Permitted flow
26 '
d. Esti n ited obligated flow not yet tributary to the W WTP
4.4193
e. WWTP facilitys actual average flow
14.92 %
f. Total flow for this specific request
0.0879
g. Total actual and obligated flows to the facility
19.4272
h Percent ofpelTr&ed flow used
74.72% '
H. Complete this section for each pump station your are responsible for along the route of this proposed wastewater flow
List pnrp station located between the project connection point and the W VFP
(A)
(13)
(C)
(D)=(B+C)
0E} A-D)
Putnp
Punp
Design
Approx
Obligated
Total Current
Station
Station Finn
Average Daily
Cwrent
Not Yet
Flow Pins
Available
(Name or
Pei -nit Capacity, *
Flow**
Avg. Daily
Tnbutary
Obligated
Capacity***
Nturher)
MGD
No.
(FirnYpf)
Flow
Daily Flow
Flow
MGD
MGD
MGD
MGD
MGD
* The Firm Capacity of any pump station is defined as the maximum pumped flow that can be
achieved NSith the largest pump taken out of service.
** Design Average Daily Flowis the firm capacity of the pump station divided by a pealing factor (pf)
not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall he attached for each pump station located bet -,wen the
project connection point and the WWTP where the Available Capacity is < 0.
DowgstreamFacil Nanr.(Sewer): EastsideWWl'P
DounstreaunPeumit Number (Sewer): NC0024210
Page 1 of 8
FTSE 10-23

M. Certification Staten rnt
I, Derrick Boone certify to the best of my knowledge that the addition of the vohm>r of
wastewater to be permitted in this project has been evak sated along the route to the receiving wastewater
treatment facility and that the flow fiom this project is not anticipated to cause any capacity related sanitary
sewer overflows or overburden any downstream punp station en route to the receiving treatrnt plant
under normal circumstances, given the inplennentation of the planned in-proverrents identified in the
planning assessment where applicable. This analysis has been performed in accordance with local
established policies and procedures Cuing the best available data. "This certification applies to those itenm
listed above in Sections I and lI plus all attached planning assessment addcndums for which I am the
responsible party. Signature of this form indicates acceptance of this wastewater flow.
Official Signature
Job
Title of Signing Official
&4. R.W;c- SGrv,ccs
Page 2 of 8
FTSE 10-23
% 72 ZDZq
Date

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 Archdale
Project Name for which flow is being requested: Providence Pointe
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pomp
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: _
b. WWTP Facility Permit #:
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
0.088
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(B+C)
(> )=(A-D)
Design
Approx.
Obligated,
Total
Pump
Pump
Average
Current
Not Yet
Current Flow
Station
Station
Firm
Daily Flow**
Avg. Daily
Tributary
Plus
(Name or
Permit
Capacity, *
(Firm / pf),
Flow,
Daily Flow,
Obligated
Available
Number)
No.
MGD
MGD
MGD
MGD
Flow
Capacity***
Suits
WQ0029628
0.746
0.298
0.009 "
0.088f
0.00
0.20i
Weant WQ0029787 5.760 2.304 1.064 ' 0.212 1.276 1.028
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): High Point Eastside Treatment Plant
Downstream Permit Number: NC0024210
Page 1 of 8
FTSE 10-23

III. Certification Statement:
I /6rA4W cllkr'SI'`^'' 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.
7-/7,2Y
Signing Official Signature
/qr�g��
Title of Sig nin g Official
Date
Page 2 of 8
FTSE 10-23

000000•
•
TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
TRANSMITTAL
TO: NCDEQ DWR — Winston-Salem Regional Office
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
ATTN: SS Fast Track Permitting personnel
® ENCLOSED PLEASE FIND:
❑ WE ARE SENDING UNDER SEPARATE COVER:
NC Department of
Environmental Quality
Received
JUL 31 2024
Winston-Salem
Regional Office
Date: 07/30/2024 Job #: 53431
Project: Providence Pointe
Reference:
Copies Sent To:
COPIES
DATE
NUMBER
DESCRIPTION
1
1
Fast Track Sewer Application (Incl. Flow Acceptance Form/
Certification Statements
1
2
Check for $600 MG SUITS LLC Check No. 1012
1
3
Project Narrative
1
4
Aerial Sewer Plan Sheets and Details
1
5
USGS To o Ma
1
6
1 Aerial Vicinity Ma
THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once.
COMMENTS:
Feel free to contact me with any questions at 984-222-1613 or @ [e-mail]
Thank you,
Clay Oliver, PE
Project Manager
1\
SIGNED:
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PROJECT NARRATIVE
Project Name: Providence Pointe
Location: City of Archdale, Randolph County, NC
PIN: 7728-82-2583
Owner: MG Suits, LLC
4030 Wake Forest Road, Suite 349
Raleigh, NC 27609
Developer: MG Suits, LLC
4030 Wake Forest Road, Suite 349
Raleigh, NC 27609
Contact: James Floyd
Consultant: Timmons Group
Clay D. Oliver, PE
5410 Trinity Road, Suite 102
Raleigh, NC 27607
Phone: [phone]
PROJECT DESCRIPTION AND NARRATIVE:
The proposed Providence Pointe project is inside the City of Archdale jurisdictional limits and is located
on the east side of Suits.Road, between Tuttle Road to the north and Poole Road to the south. The scope
of the project will include the construction of 293 single-family, four -bedroom homes on 157.22 acres.
The project is anticipated to generate 300 gallons per day (gpd) of wastewater flows per single-family unit
(75 gpd/bedroom) for a total development flow rate of 87,900 gpd.
The proposed Providence Pointe gravity sanitary sewer system will consist of approximately 15,310 LF
of 8" pipe, of which 208' will be suspended from a pedestrian bridge that will span a stream (see attached
plan sheets). The system will connect to the existing City of Archdale Suits Road Pump Station (Permit
No. WQ0029628), which connects to an existing 10" force main.
The proposed project has been authorized under a 404 Nationwide Permit 29 (SAW-2022-02029)
approved for an Individual 401 Water Quality Certification (WQC006483).
The new gravity sanitary sewer system will be owned, operated, and maintained by the City of Archdale.

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tia
t h r
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Roads k�»;
-
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Suits Road Pump Station
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0 1,500 3,000Feet
r�'�; , i_'"
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EarGhst r
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0 1,000
2,000 '..pis user
Feet
Group Design Data
9
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PROVIDENCE POINTE
AERIAL VICINITY MAP
TIMMONsoGROUP
ARCHDALE, RANDOLPH COUNTY, NC
July 30, 2024

74