WQ0041460_Application (FTSE)_20200131

State of North Carolina
DWR m Department Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: N/ d '"( (to be completed byDWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Burlington (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: Hardin Watkins per 15A NCAC 02T .0106(b)
Title: City Manager Envl onent of
m ntlal Quality
4. Applicant's mailing address: 425 S. Lexington Ave. Received
City: Burlington State: NC Zip: 27215-.
5. Applicant's contact information:
Phone number: [phone] Email Address: Engineering (a ci.burlington.nc.us
II. PROJECT INFORMATION:
1. Project name: Brightwood Farms Phase 4A Section 4D
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00_ and issued date: _
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.071876' Longitude:-79.592049'
5. Parcel ID (if applicable): 0106270
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Anthony D. Lester License Number: 19773
Firm: Evans Engineering, Inc.
Mailing address: 4609 Dundas Drive
City: Greensboro State: NC Zip: 27407
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: T.Z. OSBORNE Permit Number: NCO047384
Owner Name: City of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): W00022153 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): City of Burlington
JAN 31 2020
Winston-Salem
Regional Office
FORM: FTA 04-16 Page I of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Pro e�rty Owners' Association, has an Operational Agreement (FORM: FICA) 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 ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 IMP ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow °.b
No. of Units
Flow
Single Family Home (4 Bedrooms)
120 gal/Bedroom
5
2,400 GPD
Twinhomes (4 Bedrooms)
120 gal/Bedroom
42
20,160 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
22,560 GPD
a See 15A NCAC 02T .0114(b),(d), (e)(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
in G.S. 42A-41.
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 22560 GPD (per 15A NCAC 02T .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):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Scwcrs):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8"
1,404 LF
VCP
8"
253
DIP
➢ 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
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. 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(h)(1):
❑ 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.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches)
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vortical - 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 or WS-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
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainages stems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T.0305(s) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnaee
➢ If noncompliance with 02T.0305(f) or (a), 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 02B .0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
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 PermittingBranch
ranch
5. 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 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 02T.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

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permittingof f Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
N 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 Application and supporting documents.
2. Professional Engineer's Certification:
1, ftNT"AA11 ,C/ , L F�$Tf2 attest that this application for
(Professional Engineer's name from Application Item III.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.
North Carolina Professional Engineer's seal, signature, and date: .111\\.Et. CAR (� i
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Hacd�rt
(Signature Authority's name & title frbm Application Went I.3.)
SEAL
19773
6I
that this application for
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 143215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: '/� ` V V G�'V 1 �^ Date:
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Burlington
Project Name for which flow is being requested: Brightwood Farms 4A 4D
More than one FTSE ntay be 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. WWTP Facility Name: T Z Osborne
b. WWTP Facility Permit #: NCO047384
Al[flows are in MGD
c. WWTP facility's permitted flow
40.0
d. Estimated obligated flow not yet tributary to the WWTP
CS 0.552 SIU 2.6099
e. WWTP facility's actual avg. flow
29.87
f. Total flow for this specific request
0,02256
g. Total actual and obligated flows to the facility
32.5577
h. Percent of permitted flow used
81.39
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B)
(C) (D)=(B+C)
(E)=(A-D)
Design
Obligated,
Pump Pump Average Approx.
Not Yet Total Current
Station Station Firm Daily Flow** Current
Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Avg. Daily
Daily Flow, Obligated
Available
Number) No. MOD MGD Flow, MOD
MOD Flow
Capacity***
Rock
0.0384
2.291 0.9164 .538
.34 .878
Stewart 4.896 1.958 0.263 0.034 0.297 1.661
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
*" Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
**x A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page l of 6
FTSE 10-18

III. Certification Statement:
I 'I'm N �% f certify to the best of my knowledge that the addition of
the vdhime 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 plmming 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
Date
Page 2 of 6
FFSE 10-18

State of North Carolina
Department of Environment and Natural Resources
l`X Division of Water Resources
Dwislon of \unto n€solnc cs Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 04-16)
Enity Requesting Allocation City of Burlington
Project Name for which flow is being requested: Brightwood Farm Phase 4A Section 4D
More than one FTSE-10107 nay be required for a single project if the owner of the WYVTP is no( responsible far all pump stations
along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit #:
City of Burlington Collection System
WQCS00008
All flows are in GPD
c. WWTP facility's permitted flow Allocation from Greensboro
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
11. Complete this section for each pump station you are responsible for along the route of this
List pump stations located between the project connection point and the WWTP : None
(A)
(B)
(C)
(D)=(B+C)
Obligated,
Total
Design
Approx.
Not Yet
Current Flow
Firm Average Daily
Current Avg.
Tributary
Plus
Pump Station Capacity, * Flow**
Daily Flow,
Daily Flow,
Obligated
Name GPD (Firm/pf), GPD
GPD
GPD
Flow
None
900,000
164,688
341,622
22,560
528,870
58.8%
(E)=(A-D)
Available
Capacity***
* 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 pumpstation 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 WWTP where the Available Capacity 5 0.
Downstream Facility Name (Sewer) : Brightwood Farms Phase 4A, Section 1 C
Downstream Permit Number: WQ0030417
Page 1 of 2 FTSE 04-16

Certification Statement:
I, W. Todd Lambert, P.E. 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 asssessment 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 Signature
City Engineer
Title of Signing Official
Date
Page 2 of 2 FTSE 04-16

y Printed ft. TOPGI CIOOI Nrtiond G.VVI. H.M6, s (wxn�mpo.com)

—Since 1974—
Surveyors Planners
January 31, 2020
NCDWR
ATTN: Justin Henderson
Winston-Salem Regional Office
Water Quality Section
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
NC Department of
Environmental Quality
Received
JAN 31 2020
Winston-Salem
Regional Office
Re: Fast Track Sewer System Extension Application for Brightwood Farms Phase 4A
Section 413; Guilford County, NC
Justin:
Please find attached the sanitary sewer system extension application package for
Brightwood Farms Phase 4A Section 41).
My submittal package contains the following items:
1. FTA 04-16 Application (One original & One copy)
2. Application Fee Check for $490.00
3. USGS Site Map
4. Street Level Map
FTSE Form from the City of Burlington
FTSE Form from The City of Greensboro
Please process this application for approval. Should there be any questions or comments,
please notify me. Thanks for your help.
Sincerely, 6kg
fi
W
Anthony D. es r, PE, PLS
Vice Preside
Evans Engineering, Inc.
MrFONY/106.8 NCDWR LETTER/I/31/2020

Henderson, Justin L
From: Anthony Lester <[e-mail]>
Sent: Tuesday, February 4, 2020 12:00 PM
To: Henderson, Justin L
Subject: RE: [External] RE: Brightwood Farms Phase 4A
There are 21 duplex units x 8 total bedrooms = 20,160 GPD AND there are 5 regular single family units with 4 bedrooms
each ( 5 x 4 bedrooms = 2400 GPD) = 22,560 GPD Total.
From: Henderson, Justin L<[e-mail]>
Sent: Tuesday, February 04, 2020 11:32 AM
To: Anthony Lester <[e-mail]>
Subject: RE: [External] RE: Brightwood Farms Phase 4A
Thanks. So my follow-up to that is, are there 21 or 42 duplex units?
21 duplex units X 8 total bedrooms=20,160 GPD
42 duplex units x 8 total bedrooms = 40,320 GPD
From: Anthony Lester <[e-mail]>
Sent: Tuesday, February 4, 2020 11:24 AM
To: Henderson, Justin L<[e-mail]>
Subject: [External] RE: Brightwood Farms Phase 4A
These are two units that are attached. Each will have 4 bedrooms.
From: Henderson, Justin L<[e-mail]>
Sent: Tuesday, February 04, 2020 11:18 AM
To: Anthony Lester <[e-mail]>
Subject: Brightwood Farms Phase 4A
Anthony,
Quick questions concerning the subject FTA received by our office:
1) Can you describe what is meant by twinhomes? Is this a duplex that has a total of 4 bedrooms?
Thanks for the clarification.
Justin Henderson
Environmental Specialist II
Winston Salem Regional Office
Division of Water Resources
[phone]