WQ0038465_Permit (Issuance)_20160520

PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secmary
S. JAY ZIMMERMAN
Director
Water Resources
ENVIRONMENTAL QUALITY
May 20, 2016
Mr. Terry Houk
City of High Point
P.O. Box 230
High Point, NC 27261
Subject: Permit No. WQ0038465
City of High Point
Gravity Sewer to Abandon the Old Thomasville Road Pump Station
Wastewater Collection System Extension Permit
Randolph County
Dear Mr. Houk:
In accordance with your application received May 13, 2016, we are forwarding herewith Permit
No. WQ0038465 dated May 20, 2016, to the City of High Point (Permittee) for the construction
and operation upon certification of the subject wastewater collection system extension. This
permit shall be effective from the date of issuance until rescinded and shall be subject to the
conditions and limitations as specified therein. This cover letter shall be considered a part of this
permit and is therefore incorporated therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition I.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition IA: Requires that the wastewater collection facilities be properly operated and
maintained in accordance with 15A NCAC 2T .0403 or any individual system-
wide collection system permit issued to the Permittee.
It shall be responsibility of the Permittee -to ensure that the as -constructed project meets the
appropriate design criteria and rules. Failure to comply may result in penalties in accordance
with North Carolina General Statute §143-215.6A through §143-215.6C, construction of additional
or replacement wastewater collection facilities, and/or referral of the North Carolina -licensed
Professional Engineer to the licensing board.
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone] \ Internet: www.ncwaterguality.org
State of North Carolina I Environmental Quality I Water Resources

City of High Point
Permit No. WQ0038465
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request must be in the form of a written petition, conforming to Chapter 150B
of North Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714
Mail Service Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall
be final and binding.
If you need additional information concerning this matter, please contact Mike Mickey at (336)
776-9697 or via e-mail at [e-mail].
Sincerely,
for S. Jay Zimmerman, P.G.
Director, Division of Water Resources
by Sherri V. Knight, PE, Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
cc: Randy McNeill, PE (Davis, Martin, Powell & Associates, 6415 Old Plank Rd, High Point, NC 27265)
Winston-Salem Regional Office Files
Water Resources Central Files
PERCS (electronic copy)
Page 2 of 9

STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina
as amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to
the
City of High Point
Randolph County
for the construction and operation of approximately 2,524 linear feet of 8-inch gravity sewer that
will allow the abandonment of an existing pump station as part of the Gravity Sewer to Abandon
the Old Thomasville Road Pump Station project, and the discharge of "0" gallons per day of
newly collected wastewater into the City of High Points existing sewerage system, pursuant to
the application received May 13, 2016, and in conformity with 15A NCAC 2T; the Division's
Gravity Sewer Minimum Design Criteria adopted February 12,1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
adopted June 1, 2000 as applicable; and other supporting data subsequently filed and approved
by the Department of Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
specified conditions and limitations contained therein.
19 _AU,WL�--
for S. Jay Zimmerman, P.G
Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number. WQ0038465
Permit Issued: May 20, 2016
Page 3 of 9

SUPPLEMENT TO PERMIT COVER SHEET
City of High Point is hereby authorized to:
Construct, and then operate qpon certification the aforementioned wastewater collection
extension. The sewage and wastewater collected by this system shall be treated in the Westside
High Point Wastewater Treatment Facility in accordance with Permit Number NC0024228.
Permitting of this project does not constitute an acceptance of any part of the project that does not
meet 15A NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted February
12,1996 as applicable; and the Divisions Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains adopted June 1, 2000 as applicable, unless specifically
mentioned herein. Division approval is based on acceptance of the certification provided by a
North Carolina -licensed Professional Engineer in the application. It shall be the Permiee s
responsibility to ensure that the as -constructed project meets the appropriate design criteria and
rules.
Construction and operation is contingent upon compliance with the Standard Conditions
identified below.
I. STANDARD CONDITIONS
1. This permit shall not be transferable. In the event there is a desire for the wastewater
collection facilities to change ownership, or there is a name change of the Permiee, a formal
permit request shall be submitted to the Division accompanied by documentation from the
parties involved, and other supporting materials as may be appropriate. The approval of this
request shall be considered on its merits and may or may not be approved. [15A NCAC
02T.0104; G.S 143-215.1(d3)]
2. This permit shall become voidable unless the wastewater collection facilities are constructed
in accordance with the conditions of this permit; 15A NCAC 2T; the Division's Gravity Sewer
Minimum Design Criteria adopted February 12, 1996 as applicable; the Divisions Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June
1, 2000 as applicable; and other supporting materials unless specifically mentioned herein.
[15A NCAC 02T.01101
3. This permit shall be effective only with respect to the nature and volume of wastes described
in the application and other supporting data. [15A NCAC 02T .0110]
Page 4 of 9

4. The wastewater collection facilities shall be properly maintained and operated at all times.
The Permittee shall maintain compliance with an individual system -wide collection system
permit for the operation and maintenance of these facilities as required by 15A NCAC 2T
.0403. If an individual permit is not required, the following performance criteria shall be met:
[15A NCAC 02T .0108(b)]:
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and to prevent any contravention of groundwater
standards or surface water standards.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan including pump station inspection frequency,
preventative maintenance schedule, spare parts inventory and overflow response has
been developed and implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day
(i.e. 365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week.
e. High -priority sewer lines shall be inspected at least once per every six -months and
inspections are documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required
by North Carolina General Statute §143-215.1C.
h. A Grease Control Program is in place as follows:
For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential
users and the legal means to require grease interceptors at existing establishments.
The plan shall also include legal means for inspections of the grease interceptors,
enforcement for violators and the legal means to control grease entering the system
from other public and private satellite sewer systems.
2. For privately owned collection systems, the Grease Control Program shall include at
least bi-annual distribution of grease education materials to users of the collection
system by the permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1)
and (2) of this Subparagraph if necessary to prevent grease -related sanitary sewer
overflows.
Page 5 of 9

i. Right-of-ways and easements shall be maintained in the full easement width for personnel
and equipment accessibility.
j. Documentation shall be kept for Subparagraphs (a) through (i) of this Rule for a minimum
of three years with exception of the map, which shall be maintained for the life of the
system.
5. The Permittee shall report by telephone to a water resources staff member at the Winston-
Salem Regional Office, telephone number [phone], as soon as possible, but in no case
more than 24 hours, following the occurrence or first knowledge of the occurrence of either
of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility
incapable of adequate wastewater transport, such as mechanical or electrical failures
of pumps, line blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as
the initial verbal report. Overflows and spills occurring outside normal business hours may
also be reported to the Division of Emergency Management at telephone number (800) 858-
0368 or [phone]. Persons reporting any of the above occurrences shall file a spill report
by completing and submitting Part I of Form CS-SSO (or the most current Division approved
form) within five days following first knowledge of the occurrence. This report must outline
the actions taken or proposed to be taken to ensure that the problem does not recur. Part H
of Form CS-SSO (or the most current Division approved form) can also be completed to show
that the SSO was beyond control. [G.S.143-215.1C(al)]
6. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as
not to interrupt service by the existing utilities nor result in an overflow or bypass discharge
of wastewater to the surface waters of the State. [15A NCAC 02T.0108(b)]
7. Upon completion of construction and prior to operation of these permitted facilities, the
completed Engineering Certification form attached to this permit shall be submitted with the
required supporting documents to the address provided on the form. A complete certification
is one where the form is fully executed and the supporting documents are provided as
applicable. Any wastewater flow made tributary to the wastewater collection system
extension prior to completion of this Engineer's Certification shall be considered a violation
of the permit and shall subject the Permittee to appropriate enforcement actions.
A complete certification is one where the form is fully executed and the supporting
documents are provided as applicable. Supporting documentation shall include the
following:
Page 6 of 9

a. One copy of the project construction record drawings (plan & profile views of sewer lines
&_force mains) of the wastewater collection system extension. Final record drawings
should be clear on the plans or on digital media (CD or DVD disk) and are defined as the
design drawings that are marked up or annotated with after construction information and
show required buffers, separation distances, material changes, etc.
b. One copy of the supporting applicable design calculations including pipe and pump
sizing, velocity, pump cycle times, and level control settings, pump station buoyancy, wet
well storage, surge protection, detention time in the wet well, and force main, ability to
flush low points in force mains with a pump cycle, and downstream sewer capacity
analysis. If a portable power source or pump is dedicated to multiple stations, an
evaluation of all the pump stations' storage capacities and the rotation schedule of the
portable power source or pump, include travel timeframes, shall be provided.
c. Changes to the project that do not result in non-compliance with this permit, regulations;
or the Minimum Design Criteria should be clearly identified on the record drawings, on
the certification in the space provided, or in written summary form.
Prior to Certification (Final or Partial): Permit modifications are required for any changes
resulting in non-compliance with this permit (including pipe length increases of 10% or
greater, increased flow, pump station design capacity design increases of 5% or greater, and
increases in the number/type of connections), regulations, or the Minimum Design Criteria.
Requested modifications or variances to the Minimum Design Criteria will be reviewed on a
case -by -case basis and each on its own merit. Please note that variances to the Minimum
Design Criteria should be requested and approved during the permitting process prior to
construction. After -construction requests are discouraged by the Division and may not be
approved, thus requiring replacement or repair prior to certification & activation. [15A NCAC
02T .0116]
8. Gravity sewers installed greater than ten percent below the minimum required slope per the
Divisions Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be
certified until corrected. If there is an unforeseen obstacle in the field where all viable
solutions have been examined, a slope variance can be requested from the Division with firm
supporting documentation. This shall be done through a permit modification with fee. Such
variance requests will be evaluated on a case -by -case basis. Resolution of such request shall
be evident prior to completing and submitting the construction certification. [ 15A NCAC
02T.0105(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for
the life of the wastewater collection facilities. [15A NCAC 02T .0116]
10. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2T; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force
Mains adopted June 1, 2000 as applicable; and other supporting materials may subject the
Page 7 of 9

Permittee to an enforcement action by the Division, in accordance with North Carolina
General Statutes §143-215.6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional
Engineer to the licensing board. [15A NCAC 02T .0104;15A NCAC 02T .0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of additional or
replacement facilities. [15A NCAC 02T .0110;15A NCAC 02T .0108(b)]
12. The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by the Division any other
Federal, State, or Local government agencies which have jurisdiction or obtaining other
permits which maybe required by the Division or any other Federal, State, of Local
government agencies. [G.S. 143-215.1(b)]
Page 8 of 9

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: City of High Point
PERMIT #: WQ0038465
PROJECT: Gravity Sewer to Abandon the Old Thomasville Road Pump Station
ISSUE DATE: May 20, 2016
This project shall not be considered complete nor allowed to operate in accordance with
Condition 7 of this permit until the Division has received this Certification and all required
supporting documentation. It should be submitted in a manner that documents the Division's
receipt. Send the required documentation the Regional Supervisor, Water Quality Regional Operations
Section at the address at the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to
completion of this Certification shall be considered a violation of the permit and shall subject the
Permittee to appropriate enforcement actions. The Permittee is responsible for tracking all partial
certifications up until a final certification is received. A Final Certification shall be a complete set
of record drawings and design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed
pursuant to the applicable standards & requirements, the Professional Engineer below has
provided applicable design/construction information to the Permittee, and the Permittee is
prepared to operate & maintain the wastewater collection system permitted herein or portions
thereof.
Printed Name, Title Signature Date
ENGINEERS CERTIFICATION
I, , as a duly registered Professional En ineer in the State of North
Carolina, having been authorized to observe (❑ periodically, ff weekly, ❑ full time) the
construction of the project name and location as referenced above for the above Permittee hereby
state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance of
this permit,15A NCAC 02T; the Division of Water Resources' (Division) Gravity Sewer Minimum
Design Criteria adopted February 12,1996 as applicable; the Divisions Minimum Design Criteria
for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as
applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
❑ Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR - Water Quality Regional Operations Section 450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Winston-Salem Regional Office Phone: [phone] FAX: [phone]

I
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD
APPiication Number:
(to be completed by DWR)
1.
Owner/Permittee:
11a.
Ci of -High Point NC
Full Legal Name (company, municipality, HOA, utility, etc.)
Z_._..
1b.
----- -- ---._. --- ------- - -- -- -----------------------------------------
Terry Houk, Director of Public Services
0
Signing Official Name and Title (Please review 15A NCAC 2T 0106 (b) for authorized signing officials)
1 c.
The legal entity who will own this system is
❑ Individual ❑ Federal ® MunicIpality 0 State/County ❑ Private Partners1hjp_0 Corporation ❑ Other_(specify).
0
;1d.
POBox230 Ile. High Point
L LL
!
4..
Mailing Address City
.. ._._._.. .... ._ .._._._... ._._ .._.... ._.._._ _._._._._.. .. ... ... ... ._..___.._.. _ ___. .. ._._.._._. .___..__._.___._._.___.
L
1f.
North Carolina 1g. 27261
Z
State Zip Code
OI-._._....--
_
1h.
---.._.__.._ .___....__.__._ .... .------- .. _..----- ----.__-.._.__ .. ------- ...-----------..-.._... _-------- --------_----._...
336 883-3215 11i. .1j. [e-mail]
QTelephone
L Facsimile E-mail
U
2
Protect (Facility) Information:
J
i2a.
Gravity Sewer to Abandon Old Thomasville Road Pump Station 12b. Randolph
d
Brief Project Name (permit will refer to this name) ( County Where Project is Located
a
___
3.
.. ___----- .---_-__.
Contact Person:
Q
3a.
Randy McNeill, PE Davis -Martin -Powell
Name and Affiliation of Someone Who Can Answer Questions About this Application
13b.
[phone] [3c. [e-mail]
Phone Number E-mail
1.
Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
2.
Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
1
i2a.
If private, applicant will be:
i
2b. If sold, facilities owned by a (must choose one)
❑ Retaining Ownership (i.e. store, church, single office, etc.) or
i
❑ Public Utility (Instruction D)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑Homeowner Assoc./Developer (Instruction E)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
Z
3.
City of High Point, NC
'
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
Q4a.
Westside WWTF
1,4b. NCO024228
'
Name of WWTF
WWTF Permit No.
0
Sa.
Cityof High Point 5b. 8-in ®Gravity Sc.
LL
IOwner
of Downstream Sewer Receiving Sewer Srze ❑ Force Main Permit # of Downstream Sewer (Instruction F)
......_._.__.._- ..__.____.._._.._._..__._
Z
6.
The origin of this wastewater is (check all that apply):-_-- ------------------------
H
!
❑ Residential Subdivision ❑ Retail (Stores, shopping centers) % Domestic/Commercial
❑ Apartments/Condominiums ❑ Institution % Industrial
❑ Mobile Home Park ❑ Hospital
LLU
1
❑ School ❑ Church (Attach Description)
p,
!
❑ Restaurant ❑ Nursing Home ova Other
❑ Office ❑ Other (specify)
m
I.Attacb_Descrintion)....._
I
7.
Volume of wastewater to be allocated or permitted for this particular project: None gallons per day
*Do not include future flows or previously permitted allocations
8.
If the permitted flow is zero, indicate why:
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent pe[m�ts hat connect to this line„
Iv C �epaY[ment of
❑ Flow has already been allocated in Permit No.
ronmenaua
Envitl Quality
Y
® Rehabilitation or replacement of existing sewer with no new flow expected
Received
(see 15A NCAC 02T .0303 to determine if a permit is required) v
FTA 10-14 APPLICATION
MAY 13 LUIb
s*' Winston-Salem
Page 4of6 Regional Office

---__ ________ --- --------------- _______
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
Gravity extension to abandon an existing pump station
i10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Sae (inches) Length (feet) New Gravity or Additional
Force Main
_._ -.__._ __ _--- _ ___ __. _._._._ - --
8 2,524 E New Gravity
--------------
_ _. --_ --. _- -- -- -
- - - --- -- _ -- -
c------ - 1
w- -- - L - - - __ _ --------------------- ------ ---
Z
F, "11_ Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
__... __._._._.._.-..-.-_._. .______._._._ __._..-.__-. _ ___..
Z
O !pump Station Location ID: (self chosen - as shown on plans/map for reference)
0 'I
":Longitude: Latitude:
Z,
Oi ___---------------- ___---------- ----- --- -__._---_----------- ___ _--__.______.
Design Flow Power Reliability Option
Operational Point
Q (MGD) GPM @TDH i 1 - permanent generator w/ATS; Force Main Sae i Force Main Length
1 2 portable generator w/MTS
- - - --. ---- - - --- -- ---
o U. j
i
Z
— ;Pump Station Location ID: (self chosen - as shown on plans/map for reference)
N i
!Longitude: Latitude:
- --- -_ ... ------ --- _._. _._-___ .. _._-. _.._-- .---_.____.._ . .
W
Design Flow Power Reliability Option
a (MGD) Operational Point1 - permanent generator w/ATS; Force Main Sae Force Main Length
m GPM @TDH 2 - portable generator w/MTS
------ — '... .. I
I
I
i12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No If Yes, permit number of 2nd treatment facility
(RO - if "yes" to 13,12 please contact the Central Office PERCS Unit)
113. Does the sewer system comply with the Minimum Design Criteria for the Permitting of Pump Stations and Force Mains
(latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as applicable?
® Yes ❑ No
I
If No, complete and submit the Variance/Alternative Design Request (VADC 10-14) application and supporting
documents for review. Approval of the request is required prior to submittal of the Fast Track Application and
supporting documents.
FTA 10-14 APPLICATION Page 5 of 6

14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
i
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Trout Buffer Waiver? ❑ Yes ❑ No ® N/A
Stormwater? ❑ Yes ❑ No ® N/A
115. Does this project include any high priority lines (15A NCAC 02T .0402 (2)) involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: ❑ and provide details:
11. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
I
/, Terry Houk, attest that this application for Gravity Sewer to Abandon Old Thomasville Road Pump Station has
been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
i 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. Note: In accordance with North Carolina General
Statutes 143-215.6A and 143-215.6E any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000
as well as civil penalties _uprto $25,000 per violation.
�Il a. L
Signing Official ature Date
i
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
to TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
Z
O _____ ____ __-_ --- --_ _____ __.______ ____ --- ______----------- ____________ _--- ___ ___________
_
h--
Q 2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
C) 1,� 7 1/ ' "/� attest that this application for Gravity Sewer to Abandon Old Thomasville
LL Road Pump Station has been reviewed by me and is accurate, complete and consistent with the information in the
engineering plans, calculations, and all other supporting documentation to the best of my knowledge. I further attest that
W to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
V Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria
for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 and the watershed classification in
V accordance with Division guidance. Although other professionals may have developed certain portions of this submittal
package, inclusion of these materials under my signature and seal signifies that / have reviewed this material and have
judged it to be consistent with the proposed design. Note: In accordance with NC General Statutes 143-215.6A and 143-
215.6B any person who knowingly makes any false statement, representation, or certification in any application 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
Professional Engineer Name
Davis -Martin -Powell & Associates, Inc.
Engineering Firm
Mailing Address
Rn--..--. .�.
2d High Point 2e NC 2f 27265s t�,�'�jN��� \
City State Zip
2g. 336-819-5283 2h. 336-886-4458 2i. [e-mail]
Telephone j Facsimile IE-mail INC PE Seal, Signature & Date
FTA 10-14 APPLICATION Page 6 of 6

Mr. Corey Basinger
NCDEQ — DEMLR
450 West Hanes Mill Road, Suite 300
Winston-Salem, North Carolina 27105
Dear Corey:
May 11, 2016
Re: City of High Point, NC
Gravity Sewer to Abandon
Old Thomasville Road
Pump Station
DMP Project 150302 (BF)
NC Department of
4.
n Environmental
Quality
Received
MAY 13 2016
re
+5fj4'S
7 b`La
F.2€=;
Winston-Salem
Regional Office.
Fa
On behalf of the City of High Point and in regards to the referenced project we are enclosing the
following information for your review and approval:
• Two (2) copies of Fast -Track Application for Gravity Sewers, Pump Stations and Forcemains
• Two (2) copies of Watershed Classification Attachment (WSCAS-01-15) with Quad sheet
• Two (2) copies of site map exhibit
• $480 review fee
The proposed project will involve the construction of 2,524 LF of 8-inch gravity sewer main and
associated appurtenances to allow abandonment of an existing sewer pumping station, with no
additional sewer capacity at this time. City staff has talked with your office and determined that a FTSE
form is not required since no new flows are associated with this project.
We trust the enclosed information is complete and will allow for approval to be issued at an early date.
However, should you have any questions or require additional information, please contact our office.
Sincerely,
C: Terry Houk, City of High Point
Tyler Barrier, City of High Point (enc)
File (enc)
T:336-886-4821 1 F:336-8864458 1 www.dmp-inc.com
6415 Old Plank Road, High Point, NC 27265

State of North Carolina
Department of Environment and Natural Resources
PI-13s-40in
Division of Water Resources
of Water Resources Watershed Classification Attachment (WSCAS 01-15)
Along with this form, submit a color copy of a USGS Topographic Map to identify the project area and
waterbodies. Each map or maps must show the location of the sewer system and include location identifiers
where the system traverses over or near waterbodies. The map should have location ID's for each different
waterbody and corresponding classifications should be recorded.
Include the completed form and map portions with the permit application for submittal to the appropriate review
agency. A list of the Division's regional offices, their county coverage, and contact information can be obtained
from: http://Portal.ncdenr.org/web/wa/home/ro
Location ID
Name of Waterbody'
River
Basin
Waterbody
Index No.
Waterbody
Classification
S01
Unnamed Tributary to Kennedy
Mill Creek
Yadkin
Pee -Dee
12-119-7-2
C
I If unnamed, indicate "unnamed tributary to X% where X is the named waterbody to which the unnamed tributary joins.
I certify that as a Registered Professional Engineer in the State of
North Carolina that I have diligently followed the Division's
instructions for classifying waterbodies and that the above
classifications are inclusive of the stated project, complete and
correct to the best of my knowledge and belief.
PE Seal, Signature and Date

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ENGINEERS & SURVEYORS
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Old Thomasville Road Gravity Sewer Extension
Street Site Map
DMP Project No.: 150302

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HANK OF AMERICA as-taisao
yl{ City of High Point CHP,RLOTTE,NC28255
�A Treasury Services Division 652$32
- P.O. Box 230
NORTH GROLINA'S INiF.RNAIIONAL i.IfY High Point, NC 27261 05/0512016
.VOID IF PRESENTED AFTER So DAYS
PAY Four Hundred Eighty and 00/100 Dollars'' $480.00
This Disbursement has been approved as required by
the Local Government Budget and Fiscal Control Act
TO THE NCDEQ (47659)
ORDER OF 450 WEST HANES MILL RD STE 300 1—T—
WINSTON SALEM NC 27105
ill 0652832V 1:0S30001961: 000695to63612110
Description PO # Inv #
OLD TVILLE RD PUMP STA OLD TVILLE
05/02/16 FAST TRACK APP RDPUMP
STA
Total
Amount Description
$480.00
-------------
# Inv# Amount
$480.00
,".
NC Department of
.-q
Environmental Quality
Received
'
MAY i 0 2016
4
Winston-Salem
1'4l��;
a,.
Regional Office
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