WQ0045812_Renaissance_Church_Office_FTSSE_Final_Permit_App_20241002

DWR
Division of Water Resources
NC Departrnen t of
Environmental Quality
Received
Winston-Salem
Re,7ional Office
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: WQ0045812 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Renaissance Church of the Triad, Inc. (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: Jason Goins per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 3723 Apple Orchard Cove
City: High Point State: NC Zip: 27265-
5. Applicant's contact information:
Phone number: 3( 36) 402-4981 Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Renaissance Church - Office
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0084' Longitude:-79.9011 °
5. Parcel ID (if applicable): 7832436269 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Jacob Moore License Number: 050512
Firm: Timmons Group
Mailing address: 101 Centreport Dr, Suite 245
City: Greensboro State: NC Zip: 27409-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside Wastewater Treatment Plant Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0000929
2. Downstream (Receiving) Sewer Information: 12 inch M Gravity ❑ Force Main
3. System Wide Collection System Permit Numbers) (if applicable): WQCS00010
Owner Name(s): City of High Point
FORM: FTA 10-23 Page 1 of 5

I�cP71ri 1,;,,I State of North Carolina
tr iil, niinientai DWR�.ua ;�'y Department of Environmental Quality
F;e ei,;ed Division of Water Resources
)1' 1 1 �'i.32,4 FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
L'Vins%on-`tilern
Application Number: W 0C �F/ 2 (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
l . Applicant's name: Renaissance Church of the Triad. Inc (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
i
3. Signature authority's name: Jason 'Goins per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 3723 Apple Orchard Cove
i
City: High Point State: NC Zip: 27265-
5. Applicant's contact information:
Phone number: [phone] Email Address: jason oins/ ,rentriad.church
II. PROJECT INFORMATION:
1. Project name: Renaissance Church - Office
2. Application/Project status: ®Proposed (New Permit) ❑Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: WQ00 and issued date:
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Guilford' J
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0084' Longitude:-79.9011 °
5. Parcel ID (if applicable): 7832436269 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Jacob Moore License Number: 050512
Finn: Timmons Group
Mailing address: 101 Centreport Dr, Suite 245
i
City: Greensboro State: NC' Zip: 27409-
Phone number: [phone]� Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside Wastewater Treatment Plant Permit Number: NCO024210
Owner Name: Ci1y of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 12 inch Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): —L
FORM: FTA 10-23 Page 1 of 5

NIC
VI. GENERAL REQUIREMENTS Envjro ,i*nental ; L!2jity
Received
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenie%K and Necessity been attached?
El Yes [:]No ® N/A 2012
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreem�A i (I��kW-'bVM been attached?
Regional Office
❑ 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(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes ®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 1,b
No. of Units
Flow
Office Building
25 gal/employee/shift
98 '
2450 GPD
Church with kichen
5 gal/seat
540
2700 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
5150 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: 515dGPD (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
1077
DIP
8
270
SDR-21 PVC
Er,viru
Receiiled ['y
Winston-Salem
Regional G-ifice
➢ 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.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

C l
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)): ReccIve ~
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .OqI°�®,Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provid�o f% wgr $y tams:
i
Setback Parameter*
�S ration 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)
j 36 inches
➢ If noncompliance with 02T.0305(f) or fgh 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 webaage
2. Does this project comply with the minimum separation requirements for water mains? ® ''es ❑ 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: Jordan ❑ 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 l 0-23 Page 4 of 5

Environii-rental Q,Uak ',%
Received!
X. CERTIFICATIONS:
SLE1 201A
Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for tWRartdrtittin9;QfE. Ffrmp Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest versi bF
�ipabtle?^
® 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 Dermit, and Droiects reauirina a variance aDDroval may be subiect 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 protect, the full technical review is required.
2. Professional Engineer's Certification:
1, Jacob Moore, PE / , attest that this application for Renaissance Church - Office
(Professional Engineer's name from Application Item III.1.) (Project Name from Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum 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: A
SEAL r'
05051
4'G I N
.............. ....................................................................
3. Applicant's Certification per 15A NCAC 02T .0106(b):
L
I Jason Goins , attest that this application for Renaissance Church - Office
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certifica W n in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine 7ceed$10,00 as ell as civil penalties up to $25,000 per violation.
Signature: DLate:
z
FORM: FTA 10-13 / Page 5 of 5

N C Departn-ient of
State of North Carolina Environmental Quality
WMR.z Department of Envirorunental Quality Received
Division of Water Resources I C T o ? 2024
01
Flow Tracking for Seer Extension Applications Winston-Salem
Division of wa-ter Resources WBE10-23) Regional Office
Entity Requesting Allocation: HighPointNC
Project Nam for which flow is being requested: Renaissance Church- Office
More than one FTSE may be required for a single project if the owner of the W6VTP is not responsible, for all pomp stations along the
route of the proposed wastewaterflow
I. Complete this section only if you are the owner of the wastewater treatrrent plant.
a. WWTP Facility name: Eastside WWFP
b. W WTP Facility Permit #: NCO024210
All flows are in MGD
c. WWTP facility's Permitted flow
26
d. Estirmated obligated flow not yet tribigary to the W V P
4.4209
e. W WTP Facility s actual average flow
14.92
f. Total flow for this specific request
0.0052
g. Total actual and obligated flows to the facility
19.346
h. Percent of permitted flow used
74.41 %
11. Complete this section for each pwnp station your are responsible for along the route of this proposed wastewater flow
List pump station located between the project connection point and the W WTP.
(A) (B) (C) (D)=(B+C) (E)—(A-D)
Prune Pump Design Approx Obligated Total Cwrent
Station Station Firm Average Daily Current Not Yet Flow Plus Available
(Naire or Permit Capacity, * Flow** Avg. Daily Tributary Obligated Capacity***
Nrnber) No. MGD (Firnipfl Flow Daily Flow Flow MGD
MGD MGD MGD MGD
Resisters -Creek -Creek W00000929 4_2 1.68 0.5629 0.2137 0.7766 0.9034
*The Fium Capacity of any pump station is defined as the maxin➢ m purnpe d flow that can be
achieved Stith the largest pump taken out of service.
** Design Average Daily Flowis 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 Minimsl_m Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located bet-vwen the
project connection point and the WWTP where the Available Capacity is <_ 0.
Downstream Facility Name (Sewer): EastsideWWTP
Downstream Permit Number (Sewer): NCO024210
Page 1 of 8
FTSE 10-23

M. Certification Statement
I, Denick Boone, 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 Ur receiving wastewater
treatment facility and that the flow flow this project is not anticipated to cause any capacity related sanitary
sewer overflows or overburden any downstreamprunp station en route to the receiving treahn:.nt plant
under normal circumstances, p� en the implennentation of the planned improvements identified in the
planning assessment where applicable. •Iles analysis has been perfonted 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 assessrnt addendturs for which I am the
responsible patty. Sigmahne of this form indicates acceptance of this wastewater flow.
Official
Job
Title of Signing Official
k)ottArtG a^J�'ce 1Jitevi
Page 2 of 8
FTSE 10-23
NC rDenartment cf
Environmcr ntul QLality
Received
2024
Winston-Salem
Regional Office
'f 12Y
Date

State of North Carolina
Department of Environmental Quality
Division of Water Resources
blow'Fracking for Sewer Extension Applications
(ME 10-23)
Er1;.'II'{Jni';r
11/f C�
9,;-„
WI!1siGiii--5Cai m
r -- --- e l i) ,
Entity Requesting Allocation HiglnPointNC l _--_-_ -- ----- ---- - - ,
Project Name for which flow is being requested: 5900 Scotland rd. Sewer Extension
More than one FTSE may be required —for a single project_if_the owner of th—W-W-TP"is not responsible for• all ptimp stations along the
r oute of •the proposed ivasteivater flovv
I. Complete this section only if you are the owner of the wastewater treatment plant
a. WWIP Facility name: Eastside WWTP/
b. WWTP Facility Permit #: NC0024210 _.
All flows are in MGD
c. V✓W IP fackys Pemutted flow
26
d. Fsti rated obligated flow not yet tributary to the W WIP
4.4209
e. WWTP facilit}ts actual average flow
14.92
f. Total flow for this specific request
0.0052
g Total actual and obligated flows to the facility
19.346
h Percent ofpermdted flow used
74.41
H. Connnlete this section for each pump station your are responsible for along the route of this proposed wastewater flow
List pump station located between the project connection point and die WWfP
(A) (B) (C)
(D)=(B+C) (E)---(A-D)
PtnrIP Pump Design Approx Obligated
Total Current
Station Station Fimi Average Daily Current Not Yet
Flow Plus Available
(Name or Pemnit Capacity, * Flow** Avg. Daily Tnbutary
Obligated Capacity***
Nurber•) No. MGD (Finripf) Flow Daily Flow
Flow MGD
MGD MGD, MGD
MGD ,
Resisters -Creek WQ0000929 44. 1.68 0,5629 0.2137
0.7766 0.9034
*'The Firm Capacity of any pmup station is defined as the rrraximuni, 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.
DownstreamFacihtyNati r (Sewer): Eastside WWIP
Downstream Permit Number (Sewer): NC0024210
Page 1 of 8
FTSE 10-23

M. Certification SWerrent
1, Dentk Boone, 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 fheAdy and that the flow fiorn this project is not anticipated to cause any capacity related sanitary
sewer overflows or overburden rden any downstream pump station en route to the receiving treatment plant
under normal circumstances, given the irnplementation of the planned improvements identified in the
planning assessment where applicable. 'Ibis 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 IT plus all attached planning assessr•rmt addendruns for which I am the
responsible party. Signature of this fomr indicates acceptance of this wastewater flow.
Official Signature
M2
Title of Signing Official °
�95-5-f PA6L-G scrj,,,c c
Q� 7 ,
4.
Vtl;ii5%OrI 0 12m
6/-/
Date
Page 2 of 8
FTSE 10-23

NC Department of
Environmental Quality
Received
Winston-Salem State of North Carolina
Regional Office Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Renaissance Church of the triad, Inc
Project Name for which flow is being requested: Ressaissance Church -Office
More than one FTSE may be required for a single project if the owner oJ'the WWTP is not responsible for allpump
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit #:
A11 flows are in MGD
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 0.00515
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
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 Firni Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) not
less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page I of 6
FTSE 10-23

Ira::; De-PPirtri,ent ofi
1 r, irontn e, r1ta1 Q1-1a1'ty
Recei lcu
III. Certification Statement:
\N. +jilston-S IIP- "i
I �I�ICYid Me$s�V 1„t� %V' e best of my knowledge that the addition of
the volume 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.
Signing
Title of `gn 4,1 - Clfficial
01gMy sgnetl by Wently Messer
DN: C=US,
Wendy Messera=wat"Res-es �Pnmac Ducuy m9w'
Greensboro, CN=W..y Messer
Date- 2024.07M 14:1236-NM'
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Date
Page 2 of 6
FTS E 10-23

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TIMMONS GROUP NF'NARAWP0tot
Rmv rommentol Quality
YOUR VISION ACHIEVED THROUGH OURS. Rerlvei
S P 11 2024
Winston-Salem
TRANSMITTAL Regional Office
TO: NCDEQ — Division of Water Quality Date:09/10/2024 Job #: 58261
Winston-Salem Regional Office Project: Renaissance Church - Office
450 W. Hanes Mill Rd, Suite 300 Reference:
Winston-Salem, NC 27105 Copies Sent To:
® ENCLOSED PLEASE FIND:
❑ WE ARE SENDING UNDER SEPARATE COVER: See below
COPIES
DATE
NUMBER
DESCRIPTION
2
Cover Letter
2
Application Form
2
Secretary of State Verification
1
$600 Application Fee
2
Site Aerial Ma
2
Site USGS Ma
2
Flow Tracking/Acceptance Form
2
Sewer Acceptance Letter
THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once.
COMMENTS:
Please find the attached items necessary for permit approval for the public gravity extension for
the Renaissance Church Office project located in Greensboro, NC. Please reach out if any
additional information is needed.
Thank you.
SIGNED:
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TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
September 10, 2024
NCDEQ— Division of Water Quality
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
RE: Renaissance Church — Office
NC Department of
Environmental Quality
Receive
SEA' a 1 02
Winston-Salem
Regional Office
Please find enclosed, the necessary items for Fast -Track Application approval for the above
reference project. This project consists of an office building and parking which includes a public
sewer extension. A future church building is also planned for the site and the flow has been
allocated below.
Sanitary sewer service will be extended to the office and future church by means of an 8" gravity
main to be installed by Renaissance Church of the Triad, Inc, and conveyed to the City of
Greensboro upon completion. All construction shall conform to City of Greensboro and NCDEQ
Standards and Specifications.
The current flow has been calculated as 2,450 GPD per the calculation of 25 gal/employee/shift
per 15A NCAC 02T .0114 and (2) shifts of 49 employees each assumed due to restrictions in
operating hours per zoning conditions, and per number of offices provided in the building plans.
The future church flow has been calculated as 2,700 GPD per the calculation of 5 gal/seat per
15A NCAC 02T .0114, and 540 seats per the building plans.
Total allocated flow shall be the sum of 2,450 GPD + 2,700 GPD = 5,150 GPD.
Feel free to call me at [phone] if you have any questions.
Sincerely,
Jacob Moore, PE
Project Manager
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GREENSBORO
NORTH CAROI�NA
June 10, 2024
NC
+LifO,+i1?etlta( C1Lldl;tli
Received
Winston-Sale,-n
RegIOinJi ojriice
The City of Greensboro Water Resources has reviewed the feasibility for the proposed property at
5900 Scotland Rd. The City of Greensboro does have the ability to service the proposed development
with water and sewer. The development is located in the City of Greensboro's limits will be subject
to all rules and regulations for development.
The proposed development is an office building 13,034 SF assuming 49 employees. A sewer demand
of 2,450gpd was calculated for this development. The City sewer collections system is available and
does have adequate capacity at this point in time. Water is available on Scotland Rd. This project is
in construction review TRC Plan #2023-3408 but will need to be permitted through NC Department
of Environmental Quality since it flows to the City of High Point.
Sincerely,
Wendy Messer
Water Resources- Engineering Division
Capacity Assurance
Attachment- Project Site Map
cc: Mr. Johnnie Hill, Plan Review Supervisor, Engineering
Ms. Jana Stewart, Engineering Manager
Iq
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c;a[;
PO BOX 3136 • GREENSBORO NC 27402 3136 • WWW.GREENSBORO-NC.GOV • 336-373-CITY (2489)

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List - View Filings
Non -Profit Corporation
Legal Name
Renaissance Church of the Triad, Inc.
Prev Legal Name
Renaissance Church - Gate City, Inc.
Prev Legal Name
Renaissance Road, Inc.
Information
Sosld: 1006448
Status: Current -Active O
Date Formed: 10/11 /2007
Citizenship: Domestic
Annual Report Due Date:
Registered Agent: Goins, Jason M
Addresses
Nl of3-1Cn t o
Em iror'iill _'ntal Q.Ualit;/
Received
SET 11 29A
Winston -Salem
Regional Office

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