WQ0041200_Application (FTSE)_20190923

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ENGINEERING, PLLC : Weston-salea,
PO Box 2116 tRegional oP ce
Jamestown,NC 27282
Phone: [phone]
September 20, 2019
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North Carolina Department of Environmental Quality
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road
Suite 300
Winston-Salem,North Carolina 27105
Re: Tuscan Village West
Non-Discharge Permit Application
Davidson County,North Carolina
Dear Sir:
Enclosed please find: the Fast-Track Sewer System Extension Application; the FTSE Form;
an 8.5 inch by 11 inch copy of the USGS Quad map showing the site; a street level map of
the area; one copy of all forms and documents; and the processing fee in the amount of
$480.00 for the Tuscan Village West sewer extension in Davidson County,North Carolina.
The sewer will be tributary to the City of Lexington's sewer system.
Please feel free to contact me should you have any questions or concerns. Thank you very
much for your time and consideration.
Sincerely,
Q C
Paul R. Blanchard, P.E.
c: file
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State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16&SUPPORTING DOCUMENTATION
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Application Number: O 1 I c)ro (to be completed by DwR)
All items must be completed or the apolication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name`. City of Lexington(company,municipality,HOA,utility,etc.)
2. Applicant type: ❑Individual ❑Corporation ❑General Partnership ❑Privately-Owned Public Utility
❑Federal ❑State/County ®Municipal ❑Other
3. Signature authority's name:Roger D.Jones per 15A NCAC 02T .O1 Oti v {
Title:Public Services Manager N C D e p 7 r t i n e nt of
4. Applicant's mailing address:28 W.Center Street Environmerli:alQualty
Recc;ved
City:Lexington State:NC Zip:27292-_ 19
5. Applicant's contact information:
Phone number: 3 243-2489 Email Address:RDJones(&,LexingtonNC.gov V(ir.ston Salem
36
Regional Office
II. PROJECT INFORMATION:
1. Project name:Tuscan Village West
2. Application/Project status: Proposed(New Permit) ❑Existing Permit/Project
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If a modification,provide the existing permit number:W000_ and issued date:
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: 35.8542' Longitude: -80.2853°
5. Parcel ID(if applicable): 6716-02-98-2330 -
(or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
1. Professional Engineer:Paul Randall Blanchard License Number: 016274
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Firm:Deep River Engineering,PLLC
Mailing address:Po Box 2116
City:Jamestown State:NC Zip:27282-_
Phone number: 336)687-9009 Email Address:deeorivereng-nn northstatemet
IV. WASTEWATER TREATMENT FACILITY(WWTF)INFORMATION:
1. Facility Name:Lexington Regional W WTF Permit Number:NCO055786
Owner Name:City of Lexington
V. RECEIVING DOWNSTREAM SEWER INFORMATION(if different than WWTF):
1. Permit Number(s):WQ_ Downstream(Receiving)Sewer Size: —inch
System wi&CbllcOiou Sy�lcm Permit Numbers)Lifa icabhj:WQCS.
Owner Name(s):
FORM:FTA 04-16 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 Develo pcl i'S Operational Ac,eement j1 ORM DLV]been attached?
❑Yes ❑No ®N/A
3. If the Applicant is a Home/Pro ,Owners m.Assoation Jim anOpeiel �eeiu ionalAent�ORM: 110A)been attached?
❑Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
®Residential 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 ❑Swirurning Pool/Filter Backwash
❑Businesses/offices/factories ❑Nursing Home ❑Other(Explain in Attachment)
5. Nature of wastewater: 100%Domestic/Commercial _%Commercial
I %Industrial(3ee_15A NCAC 02'f 0103(20))
is there a Pretreatment Program in effect? ❑Yes ❑No
6. Hasa flow reduction been approved under 15A NCAC 02T.0114 i ? ❑Yes ®No
➢ If yes,provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type(see 02T.0114(f)) Daily Design Flow a,n No.of Units Flow
Dwelling Units(3 bedroom) 120 gal/day/bedroom 23 8,280 GPD
gall GPD
gal/ GPD
gall GPD
gall GPD
gal/ GPD
Total 8,280 GPD
a See 15A NCAC; 021 A 114(1>), (ct), c 1 and (e)(2) for caveats to wastewater design flow rates(i.e., minimum flow per
dwelling;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 j
inU 5,42A-4).
b Per 15A NCAC 02T.0114(c),design flow rates for establishments not identified[in table 15A NCAC 021'.01141 shall be
determined using available flow data,water using fixtures;occupancy or operation patterns,and other measured data.
8. Wastewater generated by project: 8 280 GPD(per 15A NCAC 021'.0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero,indicate why:
❑Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑Flow has already been allocated in Permit Number:
❑Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other(Explain):
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FORM:FTA 04-16 Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA(If Applicable)-02'f.0305&MDC IGravit% Sewersl:
1. Summarize gravity sewer to be permitted:
t
Size(inches) Length(feet) Material
8 1807 PVC SDR26
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➢ Section II&III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VHL PUMP STATION DESIGN CRITERIA(If Applicable)—02T.0305&MDC(Pum)Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:_
2. Approximate Coordinates(Decimal Degrees):Latitude: Longitude: -
3. Design flow of the pump station: _millions gallons per day(firm capacity)
4. Operational point(s)of the pump(s): gallons per minute at_feet total dynamic head(TDH)
5. Summarize the force main to be permitted(for this Pump Station):
Size(inches) Length(feet) Material
6. Power reliability in accordance with 15A NCAC 02T.,0305(lilll):
❑ Standby power source or pump with 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
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation,quick-connection receptacle and telemetry-15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry- 15A NCAC 02T.0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant(draft agreement)
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
in the case of a multiple station power outage.
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FORM:FTA 04-16 Page 3 of 5
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IX. SETBACKS&SEPARATIONS—(02B.0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in I5A NCAC 0211,.0305W k.._(g) ®Yes ❑No
15A NCAC 02T.0305(o contains minimum separations that shall be provided for sewers stems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below(vertical) 24 inches
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Water mains(vertical-water over sewer including in benched trenches) 18 inches
Water mains(horizontal) 10 feet
Reclaimed waterlines(vertical-reclaimed over sewer) 18 inches
Reclaimed water lines horizontal-reclaimed over sewer 2 feet
**Any private or public water supply source,including any wells,WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water 100 feet
**Waters classified WS(except WS-I orWS-V),B,SA,ORW,HQW,or SB from normal
high water(or tide elevation)and wetlands(see item IX.2) 50 feet
**Any other stream,lake,impoundment,or ground water lowering and surface drainage
ditches 10 feet
Any building foundation 5 feet
Any basement 10 feet j
r
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
➢ 15A NCAC 02T.0305(g)contains alternatives where separations in 02T.0305(1.1 cannot be achieved ,
➢ **Stream classifications can be identified using the Division's NC Surface Wate Classifications weboaee
➢ If noncompliance.with(12T.0305(D- or see Section X of this application
2. Does the project comply with separation requirements for wetlands?(50 feet of separation) ❑Yes ❑No ®N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 0213 .0200? ❑Yes ❑No ®N/A
➢ This would include Trout Buffered Streams per]5A NCAC_2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑Yes ®No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 &.Buffer Petmittuw Branch
5. Does project comply with 15A NCAC 02'P.OlO51c)((i)(additional permits/certifications)? ®Yes [:]No
Per 15A NCAC 02T.0105(e)(6),directly related environmental permits or certification applications are 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.).
6. Does this project include any sewer collection lines that are deemed"high-priority?"
Per 15A NCAC 021.0402, "high-priority sewer"means"any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑Yes ®No ❑N/A
➢ 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 permitee's individual System-Wide Collection permit.
FORM:FTA 04-16 Page 4 of 5

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X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T,the Minimum llesiut Criteria For the Pmmitiine of Rnup Stations
and Fore_e.,Maim, latest version .and the Gravitv See cr Miuinmm Desi Criteria hlu t_versiou)as applicable?
®Yes ❑No
If No,complete and submit the Variance/Alternative Design Request application(VADC 10-14)and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Aaolication and suoportnnt=.documents
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2. Professional Engineer's Certification:
I, Pa 1 1Za ncl h 156nc l, mnJt attest that this application for r
(Professional Engineer's name from Application Item M.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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers(latest version),and the Minimum Design Criteria for the Fast-Track Permitting
of Pump Stations and Force Mains(latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed$10,000,as well as civil penalties up to$25,000 per violation.
.. . ....... 31r .........._....
North Carolina Professional Engineer's seal,signature,and date I �Q��-f.�b4� j
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...... .....
3. Applicant's Certification per 15A NCAC 02T.0106(b):
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1, R0.6ER JDIVES PUBL1G Sr-MICE-5 MANACEE� attest that this application for
(Signature Authority's name&title from Application Item 1.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non-
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief,and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143 215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or 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:_----cr _ -- Date:
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FORM:FTA 04-16 Page 5 of 5

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State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: City of Lexington
Project Name for which flow is being requested: Tuscan Village West
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewaterflow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. W WTP Facility Name: Lexington Regional W WTF
b. W WTP Facility Permit#: NCO055786
All flows are in MGD
F
c. W WTP facility's permitted flow 6.5
d. Estimated obligated flow not yet tributary to the W WTP .241
e. WWTP facility's actual avg. flow 2.8
f Total flow for this specific request .009
g. Total actual and obligated flows to the facility 3.05
It. Percent of permitted flow used 46.9
H. 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 W WTP:
(A) (B) (C) (D)=(B+C) (P')=(A-D)
Design Obligated,
Pump Average Daily Approx, Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity,* (Firm/pf); Daily Flow, Daily Flow, Obligated Available
Number) MGD MOD MGD MGD Flow Capacity***
Brown St 5.91 2.36 1.5 .21 1.71 .65
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*The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
**Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor(pf)not less than 2.5.
***A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the W WTP where the Available Capacity is<0.
Downstream Facility Name(Sewer):
Downstream Permit Number:
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Page 1 of 6
FTSE 04-1

III. Certification Statement:
I EMER TONES 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 I
plus all attached planning assessment addendums for which I am the responsible party.
Signature of th' form indicates eptance of this wastewater flow.
Signing Official Signature Date
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Page 2 of 6
FTSE 04-16

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