WQ0045868_Kendall_Mills_Subdivision_Phase_1_FTSSE_Final_App_20241009

NC Department of
Environmental Quality
Received
State of North Carolina
OCT 0 9 2024 Department of Environmental Quality
DWR Winston-Salem Division of Water Resources
Division of Water Resources Regional Office FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: %c5V � O Ito be completed by Dw2)
All items must be completed or the anlication will he returned
1. APPLICANT INFORMATION:
1. Applicant's name: City of Thomasville (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County 0 Municipal ❑ Other
3. Signature authority's name: Michael Brandt per 15.A.NCAC 02F 0106ibt
Title: City Manager
4. Applicant's mailing address: PO Box 368
City: Thomasville State: jL Zip: 27361-0368
5. Applicant's contact information:
Phone number: (}}6)475-4222 Email Address: michaetbmndt'athomasvige-ncaov
11. PROJECT INFORMATION:
1. Project name: Kendall Mills Subdivision Phase 1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existiagpermit 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: W000_
3. County where project is located: Davidson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.855833° Longitude: -80 093889°
5. Parcel ID (if applicable): 6776-02-68-0300 (or Parcel ID to closest downstream sewer)
1I11. CONSULTANT INFORMATION:
1. Professional Engineer: H. Mack Summe Jr. PE License Number: 26447
Finn: Summev En¢inering Associates, PLLC
Mailing address: P.O. Box 968
City: Asheboro State: NC Zip: 27¢.204.-1.1.06
Phonenumber.UW3328-0902 Email Address: macW4summevengineennecom
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hamby Creek WWTF Permit Number: NCO0241 l2
Owner Name: City of Thomasville
V. RECEFVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ_ This no. does not exist.
2. Downstream (Receiving) Sewer Information: 8 itch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Numbers) (if applicable): WQCS00057
Owner Name(s): City of Thomasville
FORM: FTA 10-23 Pagel 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 ® NIA
2. If the Applicant is a Developer of lots to be sold, has a ;De relobet's•fh o 'tit iaal.t? etia"� nt, tbGR t t l been attached?
❑ Yes ❑ No ® NIA
3. If the Applicant is a Home/Property Owners'Association, has an [lOA/PIA erxtscastl..Art ttnent.tTfali1'• ItOAY and
supplementary documentation as required by 15ANICAC 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 ❑, Swmiming Pou3iClubhouse.
❑ Food and drink facilities ❑ Church ❑= swim in P.{soL'Fslter 'Backwash
❑ Businesses / offices / factories ❑ Nursing Home 0, C7ther'(Explain: nAttachment)
5. Nature of wastewater: 100%Domestic %Commercial %IndustrialtSee1 A'ECACO2'T-ti103("611
If Industrial, is there a Pretreatment Program in effect?' ❑Yes❑ No
6. Has a flow reduction been approved under 15.A `S1CAC 02,T .0.1.14tf}? ❑ Yes [9 No
If Ae , brovide a eoa df floiv rAtiefth annrov it letter with this iggltcati6a
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f)) Daily. Design Flow'' No. of Units Flow
Single Family Residental :(3 bed�oomp. 360 gal/Day 19 6840 GPD
gay
GPD
gay
GPD
gay
GPD
Say
GPD
gay
GPD
Total
6840'GPD
a See I5A NWAC 01T-iOl l- bi (d). (e) l b" and 1 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 15ANCAC 02T .0114(c), design flow rates for establishmentsnot identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation pattems, and other measured data.
8. Wastewater generated by project: 6840 GPD (per 15A z'*nCAC 02T,0114,and GI S:_ 1434.15A
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)- 12t 1' .0305 & y1D£ (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section I'ILcontains 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 (Panip StadouslForee . ns1r:
PRCtV i)E A S-FPAR �' i~ COPY OF TRIS.PA{ tF FC1R EACH -PUMP Si'ATIC)l�& INGI [IDFD::IV TkiIS E!CtO1ECT
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 2.01 C. Lb_ ❑ Grinder. Pump❑ Mechanical Bar Screen ❑ Otherbtease 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)(13):
➢ 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 15ANCACO2T.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 allthepump stations'storage
capacities and the rotation schedule of the portable power source or pump, including traveltimeframes, sha 11 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 15.A Pslf , ;:02T .03t1!( &; _)'? ®Yes ❑ No
15ANCAC 02T p30'5t11 contains minimum separations that shall be orovided for sewer svaems-
Setback Parameter*
Separation Required '
Storm sewer; and other utilities not listed below (vertical)
18 inches
2Watermains (vertical -water over sewer preferred, inchding in benched trenches)
18 inches
2Watermains (horizontal)
10 feet
Reclaimed wa ter line''s" (vertical= reclaimed over sewer)
18. inches
Reclaimed waterlines _ ._,-
(horizontal -reclaimed over sewer)
_. 2 feet
**Any private orpublic watersupply source, including any wells, WS4 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 eleyation) and wetlands associated with these waters (see item IX.2)
50 feet
**An otherstream, lake impoundment, or
y p 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 drams
5 feet
An swimmin g--
Y Pools
.10 feet .
Final earth grade (vertical)
36 inches
If noncompliance with 02T.0305(f) or (&), see Section X.1 of this application
* 15A,NC Q 02T.03054A contains alternatives where separations in 02T.0305ff1 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 Surlagg Watcf Cla iiacatiain swebnade
2. Does this project comply with them inimum separation requirements for water mains? W 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 PI?, 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 c1r, a.6 pa.ration cecLui etrient :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 Iocated in a riverbasin subject to any State buffer rules? ❑ Yes Basin name: I No
If yes, does the project comply with setbacks found in the river basin rules per 1 Sit ivi` 6 .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
or401 Water Quality Certifications?
A Please provide the permit.number/permitting status in the cover letter if coverage/authorization is,required.
6. Does project comply with ISA NCAC 02 T.01.051c1(6)'(additional permits/certifications)? Yes ❑ No
Per .1_a A. NCA(` t}2T.0 65tc)(6?, directly related environmental permits or certification applications must be being prepared,
have been applied for, orhave been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwatermanagement plans, etc.).
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:
I,.. Does the submitted system comply with t5A NCAC 02T, the;itzimurn _C1x�iz�n .Ctcrz lS1F 1� Ps rzlazttii�<:s�t f�zsmn:Statitacts
and Forc eMalnk Elates verszc�ri:l.;and the cavity Sew r.ltifiiztjzirttm l7e zgtz t rzteriti fltttezC=ygz for as applicable?_.
... ..........
21 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. rtaplaval :of the :reguest w li be issued
2. Professional Engineer's Certification:
attest that this application for MAOX.A+i:tii jv ► 1vritQ�l;�Ph..1.
(Ptofe;isionol Eh&in 6r's nnnie. rom•Appticatiiyr lt,: Ill. I.) (ProjectNaine front Application Item 1I.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 accordancewith the applicable regulations,
MinimirmDesiga Criteria fdr( oily Sewtzrs as-t-esty miion and theMztiiiniurn Desim Criteria forthq Fstgt `I'aack Permitting;
of.PUMBStatznnsundFxmt--lylains(atezt°version`t. 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.prhposetidesiga.
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 sotto exceed $10,000, as well as civil penalties up to $25,000 perviolation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, y subject
the North Carolina -licensed` Professional Engineer to referral to the licensing board. (2 i AiAG 56,7r1!1')
North Carolina Professional Engineer's seal, signature, and date:
kTv 264 4-1
111%
3. Applicant's Certification
pper 15A NCAC 02T .0106(b):
attest that this application far,�tit:.J1
(Sig qurP Authority Name from Application Item 1;1) (Project Name from Application Item U.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/orcriminal prosecution. I will makeno 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- 115.6B, 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 civilpenalties up to $25,000 per violation.
Signature:
Date:
FORM: FTA 10-23 Page 5 of 5

NC Department of State of North Carolina
DWR Environmental Quality
Received Department of Environmental Quality
Division of Water Resources
OCT 2 2OZ4 FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources Winston-Salem FFA 10-23 & SUPPORTING DOCUMENTATION
e i�(�WTSO) Z v /1 ZOZ'�ID dS
Application Number. 4 (to be wmpleted by DWR) � is
All items must he completed or the application will he returned i 36 _ 2621 .7
L APPLICANT INFORMATION:
I. Applicant's name: City of Thomasville (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Klunicipal
3. Signature authority's name: MichaelBrandt per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: PO Box 368
C �
City: Thomasville State: NQ Zip: 2 3 1-0368
5. Applicant's contact information
Phone number. (33& 47754222 Email Address: michaelbrandt�a thomasvitle-nc.gov
Il. PROJECT INFORMATION:
1. Project name: Kendall Mills Subdivision Phase 1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permt/Project
❑ Privately -Owned Public Utility
❑ Other
If a modification, provide the existing permit number. W000_ and issued date: ,
❑ ARPA funded
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master planprovide the existing permit number. W000_
3. County where project is located: Davidson
i
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.855833' Longitude:-80.093889°
5. Parcel ID(if applicable): 6776-02-68-0300 (or Parcel ID to closest downstream sewer)
Ili. CONSULTANT INFORMATION:
1. Professional Engineer: H. Mack Summey Jr. PE License Number: 26447
Firm: Summey En inerrmg Associates. PLLC
Mailing address: P.O. Box 968
City: Asheboro State: NL Zip: 27204-1106
Phone number: 336 32 -0,9Q2 Email Address: mack(a),summeven eineerine.com
IV. WASTEWATER TREATMENT FACILIW (WWTF) INFORMATION:
1. Facility Name: Hamby Creek WWTFPemtit Number: NCO024112
Owner Name: City of Thomasville
V. RECEIVING DOWNST SEWER IN ORMAT ✓" ).
1. Permit Number(s): QQQj$1
2. Downstream (Recel wer Informatlon: ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00057
Owner Name(s): City of Thomasville �x
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 15ANCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A /
4. Origin of wastewater. (check all that apply):
i
® Residential (Individualty, 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 PooVFiher Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: ) i %Domestic % Commercial _% Industrial (See 15ANCAC 02T.0103(20)1
If Industrial, is there a Pretreatment Propm in effect? ❑ Yes❑ No
6. Hasa flow reduction been approved under 15ANCAC 02T .0114(f)? ❑ Yes ®No
➢ If provide it copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow 'b
No. of Units
Flow
Single Family Residental
360 gal/Day ,
19
6840 GPD
`i
gal/
GPD
gal/
GPD
ga V
GPD
gall
GPD
gal
GPD
Total
6840 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. 42A4 ,
b Per 15ANCAC 02T.01 14(c), design flow rates forestablishmentsnot identified [m table 15ANCAC 02T.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patters, and othermeasured data.
8. Wastewater generated by project: 6$40 GPD (per I SA 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 timefmme 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
8 650 SDR26
➢ Section II & III of the MDC for Pemnitting 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
VIH. 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 2.01 C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 1 SA NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1xB)_
➢ 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)(l XC):
❑ 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 traveltimeframes, 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 theproject comply with all separations/altematives found in 15A NCAC 02T .0305(t) & (g)? ® Yes ❑ No
15A NCAC 02T.0305() contains in inimpm Sena rn tinna tha t ch a Il he nmvirlPd Fn..P,,.a. -,--
Setback Parameter*
Separation Required
Storm sewers and othermihties not listed below (vertical)
18 inches
2Watermains(vertical -waterover sewer preferred, including inbenched trenches)
18mches
2Watermains (horizontal)
10 feet
Reclaimed waterlines (vertical -reclaimed oversewer)
18 inches
Reclaimed waterlines (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, orground 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 ormore vertical height
10 feet
Drainage systems and interceptor drams
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
y lI noncompliance with U2"1.0305(t) or la). see Section XI of this application
* 15A NCAC 02T.0305(n) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check `yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications weboaee
2. Does this project comply with the minimum separation requirements for water mains? ®Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® 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 t SA 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
or401 Water Quality Certifications?
➢ Please provide the permit number!pemnittvng 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 15ANCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be beingprepared,
have been applied for, or havebeen obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.), j
7. Does this project include any sewer collection Imes 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 ordeteriorates the sewer.
Siphons and sewers suspended through interferencelconflict 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 permince's individual System -Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with I SA NCAC 02T, the Minimum Desirm Criteria for the Permitting of Pump Stations
and Force Mains (latest version). and the Gravity Sewer Minimum Design Criteria (latest version 1 as applicable?
® Yes 1 ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Ahemative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
sienificant portion of the oroiect, the full technical review is required.
2. Professional Engineer's Certification:
WNGy,�r. attest that this application for heAA&a l Mt31 5vbdl vo of , ph. —I
(Professional Engineer's name rom Application Item Ill.1.) (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), andtheMinhnum Design Criteria forthe Fast -Track Permitting
of Pumo 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 a s civil penalties up to $25,000 perviolation. Misrepresentation of the application
information, including failure todiscloseanydesignnon-compliance with theapplicableRules anddesig[criteria, ysubject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC y��,9J01)
North Carolina Professional Engineer's seal, signature, and date:
(VIV- 26447 t
3. Applicant's Certification per 15ANCAC 02T .0106(b): p
I,///,'rL.G / Ix Di....AL( attest that this application forkv..)iY hit'"
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item ❑.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/orcrvnina 1 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 partsof this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be remmed to me as incomplete.
NOTE — to 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: ��J d� ��Q / Date: ZZ�14L-�,p it
FORM: FTA 10-23 Page 5 of 5

Division of Water Resources
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 Thomasville
Project Name for which flow is being requested: Kendall Mills Subdivision Ph.1
More than one FTSE may be required fora 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 astewater treatment plant.
a. WWTP Facility Name: 1
b. WWTP Facility Permit #:
Creek WWTP
NCO0241
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
AUflolows are in MGD
1.1820
2.57
0.00684
3.75884 '
62.65%
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 / pt),
Flow,
Daily Flow,
Obligated
Available
Number)
No.
MOD
MOD
MOD
MOD
Flow
Capacity***
n.East__
WQ0036588
3.168
1.2672 `
.7081 I
.206085 '
0.91418Y
0.35'30
* 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 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 be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Se
Downstream Permit Number: w
Pa elof
FTSE 10-23

III. Certification Statement:
I Morgan Huffman % 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.
Page 2 of 6
FFSE 10-23

Q Summey Engineering Associates, PLLC
Engineering • Land Planning • Consulting
PO Box 968 — Asheboro, NC 27204
[phone] / Fax: [phone] / [e-mail]
NC OepartmFr= f
TRANSMITTAL En vlro ReeeiU`6IC)' JJ'ity
Date: September 12, 2024 SFP 16 2024
To:
Jenny Graznak
NCDEQ-DWR
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
We are sending you attached the following items:
❑ Shop Drawings ❑ Samples
❑ Prints ❑ Specifications
® Plans ❑ Disk
Winston -sal m
Kendall Mill Sub lR(�I Office
Davidson County 1J�
Sanitary Sewer Extension
Sea Job No. E-9049
Recewed'-""y
OCT 01 2024
❑ Copy o*4Wist0n-,,
❑ Other a ..
# Co ies
Drawin #
Description
Disposition
1
pplication Fee
1
Cover Letter
2
Fast Track Sewer Application
(1 original & 1 copy)
2
Flow Tracking Acceptance Form
(1 original & 1 copy)
1
USGS Topo Map
1
Aerial Photo
Remarks:
Jenny,
We have enclosed the information for your review. Please let us know if you have any
questions, concerns or need any additional information from us.
Thank you,
Christian Vestal
Christian(a)summevengineeri no. com

Project Narrative
For
City of Thomasville
8" Sewer Line Extension
For the
Kendall Mill Subdivision
The purpose of this sewer line extension is to provide a new residential development with
an adequate sewage disposal source and to meet their future sewer needs. The new
development is located approx. 550ft SW of the intersection of Koontz Ave and Kendall
Mill road in Thomasville NC.
There will be one 8" sewer line connected to an existing 8" Sanitary Sewer system
located on the north side of the property. There will be a total of 650 LF of 8" sewer main
extension with this project. The City of Thomasville waste water treatment System has
the capacity to serve this new development and many other residences. The only other
alternative for this development would be individual septic systems on each lot which
would not be feasible due to unfavorable site conditions when compared to the
advantages provided by this proposed extension.
Prepared By: H. Mack Summey, Jr., P.E.
Address: P.O. Box 968 Asheboro, NC 27204
Phone: [phone] "
.. Project: Kendall Mills Subdivision

9/12/24. 8.54 AM tv_browse.pl (7366x8837)
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