WQ0045935_Highway_109_Subdivision_FTSSE_Final_App_20241105

QWR State of North Carolina
Department of Entironmental Quality
�0. Dig ision of Water Resources
1;7 FAST TRACK SEW ER S1 STENI EXTENSION APPLIC 1TIO
DN'
Division of Water Resources FT 1 10-23 & SUPPORTING DOCUMENTATION
/l % %J r/�1L
2� Applicatiaiil�ijetber: / tQ(0 /f^f 3 Ito he r DwR) �� J< LCC eVt cP
ZoZ�I(Gi, — nm
All items must be completed or the application Nill be returned
I. APPLICANT INFORMATION:
1. Applicant's name Town. of Denton (company, municipality, HOA. utility, etc i
2. Applicant type ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State Count) ® Municipal
3. Signature authority's name: Angel Jenkins per 15A NCAC 0 T 0106(b)
Title: Town Manager
4. Applicant's mailing address: 201 W. Solisbun Street
City: Denton State: NC Zip: 27239-
5. Applicant's contact information:
Phone number QM) 8L9-4231 Email Address wgelJcnkins n7ownofdcmon i•m
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
I Project name: Highway 109 Subdivision
2 Application Project status ® Proposed (New Permit) ❑ Existing Pemtit/Projecl ❑ ARPA funded
If modification, provide the existing permit number W000 and issued date: _,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan. provide the existing permit number WQOO
3. County where project is located Davidson
4. Approximate ( oordinates (Decimal Degrees) Latitude 35 654479 Longitude .80 101149
5. Parcel ID (if applicable). 667903246701(or Par,el ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
Professional Engineer Brian Cone License Number 36791
Finn: Providence Partners
Mailing address &101 Tower Point Drive Ste 200
City: Charlotte NC State. NC Zip: 28227-
Phone number. [phone] Email Address bcone(@,Pmvidenceparinersine.com
IV. WASTEW ATER TREATMENT FACILITY(M WTF) INFORMATION:
1. Facility Name JEURUA t)z� Permit Number KU24e1or
Owner Name AnylJeA k,ns
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
L PermitNumber(s): WQ0jUZ23
2. Downstream (Receiving) Sewer Information: 8 _ inch Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS DQd.73
OwnerNome(s) ��)C.`nS
FORM: FTA 10-23
Page I of

%C pep; tie ` ^, ci
EnvironmentalQuality
Received
1. GENERAL REQUIREMENTS
I If the Applicant iq a Pmatcly-Owned Public Utility, has a Certificate of Pua(jF;Convenience and Necessit) been attached
❑ Yes ❑ No
2 If the ApphLant is a Developer of lots to be sold, has a Developer's Operuional .4areemem (F_ORM: t)1.YJ been attached
❑ Yes ❑ No ® N A
3 If the Applicant is a Home/Properly Owners' Association, has an HOA/POA and
Onerationnl Aereernent (FORM H041 supplementary documentation as required by 15A NCAC 02T.0115(c) been attached'
El Yes El No ®NA
4 Origin of wastewater. (check all that apply)
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) El Car K ash
❑ 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
❑ Businesses / offices / factories ❑ Other
er (Explain
ain in At a Backwash
❑ Nursing Home ❑Other (Explain in Attachment)
5 Nature of wastewater: 100%Domestic _ooCommercial °olndustrial(see ISAN('ACO2T OIOj[20�)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes [I No
5 Has a Flow reduction been approved under ISA N("AC 02T.0114 f ❑ Yes ❑ No
If ves, nravide n cony of flow reduction approval letter with this.application
7. Summarize wastewater generated by project:
Establishment Type (see 01T.0114(0)
Doily Design Flow I* No. of Units Flow
Single Family Residential (3 bedroom) "
225 gal day 43 '
9675 GPD
gal
GPD
gal
GPD
gal/
GPD
gal/ _
gal
Total
GPD
GPD
9675 GPD
a ace i_s rvt.,vc 011 .01 14(bj, (d1 (el! I ] and le1(2j 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. 4 -4).
b Per 15A NCAC 02T 0114(c), design flow rates for establishments not identified [in table I5A NC,4C 02T.01 I shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
W astewater generated b project 967 vr'D (per t S
g > P J (p �i CAC 02T .0114 and (j.S. 143-215.1.)
I 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 servers 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

N If. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity Sewers):
I Summarize gravity sewer to be permitted
Size (inches) Length (feet) Material
g 2040 ' PVC' NC Dcpart:n:ent of
Environmental quality
g f 521 DIP Received
NOV 0 12024
Winston-Salem
�- Regional Office
Section 11 & 111 of the MD(:: f. r Permitting of Gravity Sewers contains information related to design .:riteria
Section III contains informab n related to minimum slopes for gravity sewers)
Oversizing lines to meel minimum slope requirements is not allowed and a violation of the MDC
VIll. PUMP STATION DESIGN CRITERIA (If Applicable)-02T.03p5 & MDC Tump Stations'Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGC 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 Oow 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 (TDI-I)
5 Summarize the force main to be permitted (for this Pump Station)
Size (inches) I Length (feet) I Material
If an) portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2 01C.I b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6 Power reliability in accordance with I5A NCAC021 0105(h)(I I:
�] 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)(I NC)
❑ 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 awned or contracted by the applicant and is compatible with the station.
If the portable power source or pump is dedicated 10 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

IV SETBACKS Si SEPARATIONS,-(018.0100S:ISANCACO2T.03o5
m)• r 1 214
I Does the project c amply with all separations/altematives found in NCAC 07 ?
15A NCAC 02T.0305(f) contains minimum separations that shall be ided foron J e �
Setback Parameter• a _s
r
Storm sewers and other utilities not listed below (vertical)
'Water mains (vertical - water over sewer preferred, including in benched trenehesl
-Water mains (horizontal)
Reclaimed water lines (vertical - reclaimed over
Reclaimed water lines (horizontal - reclaimed over sewer)
"Any private or public water supply source, including any wells,lYS-( waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
"Waters classified WS (except WS-1 or 1YS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
•'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.
Any building foundation (horizontal)
Any basement (horizontal)
of embankment or cuts of 2 feet or more vertical
ystems and intercentor drains
Final earth
® Yes ❑ No
seams:
at(on Required
18 inches
18inches
10 feel
18 inches
2 feet
100 feet I
50 feet I
10 feet
5 feet
10 feet
10 feet
5 feet
10 feet
36inches
^��•••r••�• �� •r•m MA 1 MU i n or (a)see Section X.I of dtis application
• I SA NCAC 02T.03051 t contains alternatives where separations in 92T.93M 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
i If no, please refer to 15A NCAC 1 SC.0906(f) for documentation requirements and submit a separate document,
signedsealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlonds9 ® 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.
I 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 Stale buffer rules? ❑ Yes Basin name:
If )es, does the project comply with setbacks found in the river basin rules per I SA NCAC 026 0200^ ®No
I This includes Trout Buffered Streams per 15A NCAC 26 0202 P ❑Yes ❑ No
5. Does the project require coverage authorization under a 404 Nationwide individual permits
or 401 11ater Qualit) Certifications? ❑Yes ®No
I Please provide the permit number' permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with ISA NCAC 02T.0105(ck6) (additional permitscertifications)?
No
Per I M NCAC 02T.010 (ctrsi, 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 sireambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
I 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

\. CERTIFICATIONS:
I Does the submitted system comply with j SA NG\(' 02T, the A i[_ligm Desien C iteria for the feminine of p
and Force and the Gravity Seller Alinimum Desien Criteria lalest version as applicable'
® )'es- [ No
It no, for projects requiring a single variance, complete and submit the Variance Alternative Design Request application
iVADC 10-14) and supp,nmg documents for review to the Central Office. Annroval of th, r.,,,,..• ,..:u ,...:_-.._.,
2 Professional Engineers Certification
K. Brain Cone_ H 109 Subdivision
attest that this application for W±
0 mfes50nal lingmcn's name from Application hem III 1) IRo�rd Name fmm Apphrmion hem 11 I)
has been reviewed by me and is accurate, complete and consistent with ill, 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 Desien Criteria for Gravity Sewers (latest vcrs_,on). and the Minimum Dcsian Criterio for the Fast•Tmck Pemvitine
of Pumn.Stations and Force Mains ( latest version) Although other professionals may have developed certain portions of this
submittal packageinclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE In accordance with General Statutes 143-215.6A and 143-215 6B any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed 510.000. as well as civil penalties up to 525.000 perviolation 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: ��0NICg1111Z
`2o�pFESS%py���
a�SES
3871�
!/ C
�INECQ.� `,:
A�J,/RIlAljlil\ `` nog°
Brian
3 Applicant's Certification per 15A NCAC 02T 0106(b)
Cone
1 Q T N me 1, , attest that this application for l� hwdA �Clfa'tr ,tir.Ir) -
(Signal Amhonry Name from Appli-auun Item 1 3 ) 101eet Mme fmm Apphoauon item it I)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
1 understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and or criminal prosecution I will make no claim against the Division
of Water Resources should a condition of this permit be violated 1 also understand that if all required parts of this application
package are not completed and that if 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 S25,000 per violation
Signature Jy Date: (01)(p'a0a14
FORM: FTA 10-23
Page 5 of 5

NC Department of
Environmental Quality
Received State of North Carolina
NOV 0 5 2024 Department of Environmental Quality
PXRMW� Winston-SalemDivision of Water Resources
.
Division of Water Resources Rc O 'Ic :Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Asher Heights LLC '
Project Name for which flow is being requested: Highway 109 Subdivision'
Afore than one FTSE may be required for a single project if the owner of the 11'11'TP is not responsible for all pump
stations along the route of the proposed wmstewaterjfow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Town of Denton WWTP
b. WWTP Facility Permit #: NC0026689
All flows are in MGD
c. WWTP facility's permitted flow 0.800 -
d. Estimated obligated flow not yet tributary to the WWTP 0,051 '
e. WWTP facility's actual avg. flow 0.388 '
f. Total flow for this specific request 0,0097 '
g. Total actual and obligated flows to the facility 0.4487-
h. Percent of permitted flow used 561;o '
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)
Design
Pump
Pump
Average
Station
Station
Firm
Daily Flow**
(Name or
Permit
Capacity, "
(Firm pt),
Number)
No.
MGD
MGD
Gamer
0.0403
0.0161
N. Main
�.
0.403
0.161 -
(B)
(C)
(D)-(B+C)
Obligated,
Approx.
Not Yet
Total Current
Current
Tributary
Flow Plus
Avg. Daily
Daily Flow,
Obligated
Flow, MGD
MGD
Flow
0.0008 "
0.0097
0.0105
0.045
0.0097
0.0547'
(E)-(A-D)
Available
Capacity",
0.0056
0.1063
* The Firm Capacity (design Bow) of any pump station is derrned as the maximum pumped Bow that can he
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): Denton WWTP
Downstream Permit Number: NCO026689
Page I of 6
FTSE 10-23

III. Certification Statement: "',,W 0 5 2024
[ Angel Jenkins 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.
Title of Signing
Page 2 of 6
FTSE 10-23

State of North Carolina
DWR
NOV Q 1 2014 Department of Environmental Qualit}
Division of Water Resources
Winston -Sp.! ,
Division of Water Resources Regional U` Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: _ Asher Heights LLC
Project Name for which flow is being requested: Highway 109 Subdivision
Afore than one FTSE ntap be required for a single project if the owner of the 11'I17P is not responsible jar al/ punip
stations along the route ofthe proposed uwstewaterjlmv.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Town of Denton WWTP
b. WWTP Facility Permit #: NCO026689
All flatus are in MGD
c. WWTP facility's permitted flow 0.800
d. Estimated obligated flow not yet tributary to the WWTP 0.051
e. WWTP facility's actual avg. flow 0.388
f. Total flow for this specific request 0.0097
g. Total actual and obligated flows to the facility 0.459 0, y
h. Percent of permitted flow used 57' o 5-/ % )
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:
Pump
Pump
Station
Station
(Name or
Permit
Number)
No.
Gamer
(A)
(B)
Design
Average
Approx
Firm DailyFlow**
Current
Capacity, * (Firm pf),
Avg Daily
MGD MOD
Flow, MGD
O. 0.0403` 0.0161
N. Main/ 0.403-� 0.161
(C)
Obligated,
Not Yet
Tributary
Daily Flow,
MGD
0.0068 U097
0.045 0.0097
(D) (B+C)
(E) (A-D)
Total Current
Flow Plus
Obligated
Available
Flow
Capacity***
0.0105
0.0056
0.0547
0.1063
• The Firm Capacity (design Bow) 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 Floss 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 benseen the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Denton WWTP
Downstream Permit Number: NCO026689
Page 1 of 6
FTSE 10-23

Ill. Certification Statement: NOV 0 j 2024
Ifi-,c-., -I -
1 Angel Jenkins 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
Title of Signing
Page 2 of 6
FTSE 10-23

FLOOD HAZARD INFORMATION NOIESTOUSERS
maswwmmnmrouwimoxz.xomouwr I �.._.__._�.._
1. xuwoau.s.®a. i.w, Fw
tea,
w�
mwrws.r.
a r
� `, m+M1arxf
® rtiuyN
xe..
wreroic
�xs m..rrm
mi9 wm
—•urawrrwwLrsq
®mr D�..i.roraw
]r-aeomo „m ue.mo
PANEL LOCATOR
6Axwm
w ..
1
F667 CAROLINA
wrefi6]9
W1
w�
INS)
C
8
C
O
Z
arm�r�
Vze/poor

EW`{j�l U.S u.i0.aYFMW'[u EIW A Ii n. NWi..lry ]. S.MI T�MOhQu]D u
�I pUanixtl Tcpo r f.xpurt rw
r.�n�s.'ro.i���n�n� •n r_ m�Y�T w�mnuvv.� � ].5- Xirt["OPo. MC

,OV U t 202�
_ Winston-Salem
?egional Offic,
G9lop, c 4�a
SITE
P
4
VICINITY MAP
NOT TO SCALE

NC of
Ei,. .
r='OV 01 2024
HIGHWAY 109 SUBDIVISION
NCDEQ FAST TRACK SEWER APPLICATION COVER LETTER
PROJECT:
HIGHWAY109 SUBDIVISION
PROJECT LOCATION:
TOWN OF DENTON, NC
DATE:
9/21/2024
PREPARED BY:
BRIAN CONE, PE
PROVIDENCE PARTNERS
8101 TOWER POINT DRIVE, STE 200
CHARLOTTE, NC 28227
704-266-6621
[e-mail]
NC COA: C-4456

September 21, 2024
Angel Jenkins, CMC, NCCMC
Town Manager
201 W. Salisbury Street, Denton, NC 27239
336-859-4231
[e-mail]
RE: Highway 109 Subdivision, Davidson County, North Carolina
Angel,
See attached transmittal for all documents included with this submittal.
This document is written to provide information describing the build -out design of the
sanitary sewer system for the Highway 109 Subdivision.
The final build -out design will consist of approximately 2049 linear feet of 8" PVC and
521 linear feet of DIP gravity sewer to serve 43 homes.
The flow required is: 43, 3 bedroom homes at 225 GPD = 9,675 GPD.
Sincerely,
Brian Cone
Providence Partners
Enc:
Fast Track Sewer Application
Water and Sewer Construction Documents

NC DeP,artr
Environm2nt,il
Receive,
OCT 2 12024
Division ofWaterResources Winston-Salem
R­iuna! Gr" _
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEIVER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
a1Q0D' 59,i'4=R sE,li- 2d2ytid 23-
Application Number: � s ttot+ccnmplemJhyplvR)'
�3e .7 2o2 /it Z#
All items must be camnleted or the annlicntion will be returned
I. APPLICANTINFORMATION:
i
1. Applicant's name: Town of Denton (company, municipalit), HOA, utility, cic.i
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ StateCount),® Municipal ❑ Other
3. Signature authority's name: Angel Jenkins per I SA NCAC 02T .0106(b)
Title: Town Manager �
4. Applicant's mailing address: 201 W. Salisbury Street
City: Denton - State: NC Zip: 27239-
5. Applicant's contact information:
Phone number. (336) 8594231 Email Address. angel.ienkins'rrtownofdefiton.com
It. PROJECT INFORMATION:
1. Project name: Highway 109 Subdivision
i
2. ApplieationTroject status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number. W000_ and issued date: _,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but pan of a master plan, provide the existing permit number. 1V000_
3. County where project is located: Davidson
4. Approximate Coordinates (Decimal Degrees) Latitude. 35.654479� Longitude:-80.101149
5. Parcel ID (if applicable): 667903246701 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
L
I. Professional Engineer: Brian Cote ' License Number: 36791
Firm: Providence Partners
�t1
Mailing address: 8 10 1 Tower Point Drive, Ste 200
City: Charlotte NC 1 State: NE Zip: 28227-_
Phone number. (704) 266- Email Address: bcone na orovidencenartnersinc com
IV. WASTEWATER TREATMENT FACILIT'1' (IVWTF) INFORMATION:
1. Facility Name L4AE>�thrHen Permit Number: "i to /
Owner Name: kbaal JeA k,ns "
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. Permit Number(s): WQja" al '
2. Downstream (Receiving) Sewer Information: _ 8—inch Gravity 0 Force Main
3. System (Vide Collection System
System Permit Number(s) (if applicable): WQCS�a3 —
Owner Name(s):anae 5!nKC A5 -
J
FORM: FTA 10-23
Page I of 5

N'1. GENERAL REQUIREMENTS
I If the Applicant n a Pns ately-Owned Public Utility, has a Certificate of Public Convenience and Necessit) been attached'
❑Yes ❑No ®NA%
2 If the Applicant is a Developer of lots to be sold, has a Developer's Qpemtioiin) aereement {FOR[v1' Dl 't been attached '
❑ Yes ❑ No ® N A '
3 If the Applicant is a Home/Property Owners' Association, has an IQAlPOA Operationa� ement iFORhf HOA I and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached'
❑Yes ❑No ®NA
4 Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Nash
❑ Residential (Leased) ❑ Retail with food preparation service ❑ Hotel and or Motels
❑ School / preschool / day care ❑ Medical dental veterinary facihties ❑ Swinmming 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 _ 9e Industrial (See I SA NCAC 02T .0103U)
If Industrial, is there a P!0rc3rffFc#tTcpgrani in ei%cl? ❑ Yes Q No
6 Has a flow reduction been approved under 15,�� N( AC 02T AI 14 ? []Yes
i If ves. nrnvide a tone nrn.nm rry L�rl inn nnnrnvnt imtov. ;,6 ......1:.v3!
7 Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow •
No. of Units
Flow
Single Family Residential '
360 gal day
43
15,490 GPO
r
gal
GPD
Sal
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
15,480 GPD
a See 15A N(_,AC 02T .01 Ai4). (dl. JO i t and c it 2j 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. 4 A-4).
b Per I SA NCAC 021' 0114(c). design flow rates for establishments not identified [in table 15A NCAC 02T 01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8 R astemvater generated by project I-- GPD (per 19_j_NCAC 02T=0114 and t .5. 14.-_ s.l _ )
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 ttmeGame 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

%H. GRAVITYSEWERDESIGNCRITERIA(if Applicable) -02T.0305&MDC (GravitvSewers):
1 Summarize gravity sewer to be permitted
Size (inches)
Length (feet)
Material
8
2049
PVC
8
521
DIP
2r57c
Section II & 111 of the MDC for Permitting of Gravity Sewers contains inf: mation related to design criteria
Section III ,.:�ntains information related to minimum slopes for eravity sewcr(s)
Oversizing lines to meet minimum slope requirements is not allowed and it violation of the MDC
Vlll. 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
I. 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(;) 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) I Length (feet) l Material
If an) portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2 OIC I b ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
G Power reliability in accordance with 15A NCAC021 0305(h)(11:
❑ 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 ISA NCACO2T.0305(h)(I HC)
❑ 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 — (0211.0200 R ISA NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 1 SA NCAC 02T .0345(p & tel? ®1'es ❑ No
I SA NCAC 02T.0305(n contains minimum se arations that shall be nrovided for sewer
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
Is inches
=Water mains (vertical - water over sewer preferred, including in benched trenches)
Is inches
2Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
IS 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 %%IS (except WS-1 or WS-V), B, SA, ORW, HQW, or SR 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
;w if noncompuance will) u[ t.03u2tt) oriel. see Section X.I of this application
15A NCAC 02T.0305(e) contains alternatives where separations in g2T.0305t1) cannot be achieved Please check "yes"
above if these alternatives nre used and provide narrative information to explain.
"Stream classifications can be identified using the Division's NC Surface Water Classifications webjm&
2. Does this project comply with the minimum separation requirements for water mains? ®Yes ❑ No ❑ N A
e If no, please refer to 15A NCAC I &C.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
r Please provide supplementary information identifying the areas of non-conformance.
See the Division's draft separation reouirements for situations where separation cannot be met.
No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: _ ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? [--]Yes ❑ No
This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require coverage authorization under a 404 Nationwide individual permits ❑ Yes ® No
or 401 U ater Quality Certifications?
Please provide the permit number permining 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-priorityT' ❑ Yes ® No
Per I $A 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. CERTIFIC MONS:
I Does the submitted system comply with ISt1 NCa(_gn1', the A inimum Design Criteria for the Permiitin:, of Pump_Sta ions
and. Force Mains ilatcst ecrsioal, and the G rwih Sewer %finim csSn Criteria lla_test ver5iont as applicable'
®les ❑Nr
If no, for projects requiring a single variance, complete and submit the Variance Alternative Design Request application
IVADC 10-14) and supp,nmg documents for review to the Central Office. Attnraval of the request will be issued
2 PM Iona EngineersCertification
K. Brain Corje , attest that this application for Hwy 109 Subdivision
1`114plessional. lirgtn<cr's nomc from AppLcanon Im:n Its I (Pin; eel Name from Application Item tl I )
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 Gravih Sewers (latest version), and the Alinimum Design Criteria for the Fast -Track Penniffinc
of Portly Stations and Force Mains tlatest version) Although ether profe,sinnals ma} have developed certain portions of This
submittal package, inclusion of these materials under my signature and seal slenifies that 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE In accordance with General Statutes 143-215.6A and 143-215 6B. any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed S 10.000, as well as civil penalties up to S25 000 per violation Misrepresentation of the application
infannation, 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 07011
North Carolina Professional Engineer's seal, signature, and date: Ox, �C3 O /. '
36lilM
xB} �� Z
G �
Brian
3 Applicant's Cerlificatinn per 15A NCAC 02T 0106(h) Cone d 'a
r
I. AI�P Jett me its attest that this application for i ylrjlcet Min �Q�tt�ri'rQ�
(Slgnst Authont} Name from Apple.anon Item 13 ) mtcct Mine from Application Item III )
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
1 understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and or criminal prosecution I will make no claim against the Division
of Water Resources should a condition of this permit be violated 1 also understand that ifall required pans of this application
package are not completed and that if all required supporting infomtation 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 S 10,000 as well as civil penalties up to 525,000 per violation
Signature
Date: 1011(0 lada q
FORM: FTA 10-23 Page 5 of 5

HIGHWAY 109 SUBDIVISION
NCDEQ FAST TRACK SEWER APPLICATION COVER LETTER
NC Department of
PROJECT: tnviro Receved4uality
HIGHWAY 109 SUBDIVISION OCT 2 1 2024
PROJECT LOCATION:
TOWN OF DENTON, NC
DATE:
9/21/2024
PREPARED BY:
BRIAN CONE, PE
PROVIDENCE PARTNERS
8101 TOWER POINT DRIVE, STE 200
CHARLOTTE, NC 28227
704-266-6621
[e-mail]
NC COA: C-4456
Winston-Salem
Regional Office

September 21, 2024
Angel Jenkins, CMC, NCCMC
Town Manager
201 W. Salisbury Street, Denton, NC 27239
336-859-4231
[e-mail]
RE: Highway 109 Subdivision, Davidson County, North Carolina
Angel,
See attached transmittal for all documents included with this submittal.
This document is written to provide information describing the build -out design of the
sanitary sewer system for the Highway 109 Subdivision.
The final ,build -out design will consist of approximately 2049 linear feet of 8" PVC and
521 linear feet of DIP gravity sewer to serve 43 homes.
The flow required is: 43 homes at 360 GPD = 15,480 GPD.
Sincerely,
Brian Cone
Providence Partners
Enc:
Fast Track Sewer Application
Water and Sewer Construction Documents

FLOOD HAZARD INFORMATION
oocm. �rwn]one rux monsurosovrr
mrm�-wmew neeeoe.mee„P�
®'amnnm+n _ �••
�mit...ncna—F� aeA:
� F. aeesauan w �
mix one
s�nuciNrs
s.�br
i.s�ea
.i�o�vuBY�s
iFANMS Me^em�a.mw
NOTES TO USERS
SCALE
ewwo+r ro n,000
PANEL LOCATOR
ox�ruam.nnaon.wwna�ervowi.
to NORTH CAROLINA
WW 2 .x 66]9 �
FAY V 1 �• �
y�jj( C
C
O
O
LL
O
N
Z
MiNd
iJOlfl%W
yYy]Y09

MUSGSu. s. REP ITMENT OF THE INTERIOR ,I }ha National Map E.s,MMurE TORO QJ.OR 4tE
It ccoio�rcu zuam errvaiopo

i
�.