WQ0040884_Application (FTSE)_20220321

March 21, 2022
N.C. Department of Environmental Quality
Division of Water Resources
Winston-Salem Regional Office
450 West Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Re: Guilford/Randolph Megasite
Phase IV Sandy Creek Lift Station
15A NCAC 02T .0300 — Sewer Extension Application
HDR Project Number 10328292
On behalf of the City of Greensboro, enclosed please find the following permit application and
supporting documents for the Guilford/Randolph Megasite Phase IV Sandy Creek Lift Station
Project for your review and approval:
1. One original and one copy of the Fast Track Sewer System Extension Application
2. $480 Application Fee
3. Two (2) Copies of USGS Site Map
4. Two (2) Copies of Aerial Map
5. Tw0 (2) Copies of FTSE10-18
6. Two (2) Copies of previous permit issued.
Proposed project is Phase IV of five phases. This fourth phase contains 14,200 LF of 16" ductile
iron force main and a lift station. The lift station will take flow from the Phase V gravity sewer. The
end of this force main will tie into the terminus of the Phase III force main on Julian Airport Rd.
Should you have any questions or need additional information, please do not hesitate to contact
me.
Sincerely,
HDR Engjneeri, Inc., of the Carolinas
Matthew Watt, PE
Water/Wastewater Engineer
440 S Church Street, Suites 800, 900 & 1000, Charlotte, NC 28202-2075
[phone]

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will he returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Greensboro Water Resources (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: Michael Borchers per 15A NCAC 02T .0106(b)
Title: Director of Water Resources
4. Applicant's mailing address: 2602 S. Elm -Eugene Street
City: Greensboro State: NC Zip: 27406-
5. Applicant's contact information:
Phone number: [phone] Email Address: Michael.Borcherstu" 7,gr'eensboro-nc.>"ov
II. PROJECT INFORMATION:
1. Project name: Phase IV Sandy Creek Lift Station
2. Application/Project status:
❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0040884 and issued date: 5/20/2019,
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: WQ00
3. County where project is located: Randolph
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.87° Longitude: -79.62°
5. Parcel ID (if applicable): 8718520081 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Matthew Watt License Number: 037518
Firm: HDR Engineering Inc. of the Carolinas
Mailing address: 440 S. Church St.. Suite 1200
City: Charlotte State: NC Zip: 28202-2075
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: T. Z. Osborne Water Reclamation Facility Permit Number: NC0047384
Owner Name: City of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQCS00006
2. Downstream (Receiving) Sewer Information: 18 inch El Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00006
Owner Name(s): City of Greensboro
FORM: FTA 06-21
Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls)
❑ Residential (Leased) ❑ Retail with food preparation/service
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities ❑ Church
® Businesses / offices / factories ❑ Nursing Home
El Car Wash
El Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic 100 % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 I4(1)? ❑ Yes ® No
➢ if ves, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow a,b
No. of Units
Flow
Factory excluding industrial waste
25 gal/Per employee per shift
1.33M GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 GPD
a See 15A NCAC 02T .01 14(b). (di. (e)(1) and (c)(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-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1.8M GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
Page 2 of 5

1
I
1

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
18
51
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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump StationslForce Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Sandy Creek Lift Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.8662° Longitude: -79.6209°
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 1_8 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): 1,250 gallons per minute (GPM) at 272 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
16
14,200
DIP
8
75
DIP
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® Standby power source or ❑ Standby pump
> Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(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)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
> Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of 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 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .Q305(fa & (g)?
15A NCAC 02T.0305(lj 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)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water mains (horizontal)
1 10 feet
Reclaimed water lines (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, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, 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
➢ If noncompliance with 02T.0305f fl or (g), see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ❑ Yes ❑ No ® N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 0213 .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 1SA NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ® Yes ❑ No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting 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 -priority?" ❑ Yes ® No
Per I5A 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 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and proiects requiring a variance approval may be subject to longer
review times. For proiects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the vroiect. the full technical review is required.
2. Professional Engineer's Certification:
I, Matthew Watt , attest that this application for Phase IV Sandy Creek Lift Station
(Professional Engineer's name from Application Item III.1.) (Project Name from Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest versionj. 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 143-215.6B, 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. 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:
SEAL
037518
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Michael M. Borchers , attest that this application for Phase IV Sandy Creek Lift Station
(Signature Authority Name from Application Item 1.3.)
(Project Name from Application Item II.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/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 143-215.6B, 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:
Date: 3) 3 /zca_
FORM: FTA 06-21 Page 5 of 5

F THE
USGS U.S. DEUSRGEOLOGDICAL SURVEY
EIUOR
ago
CLIMAX QUADRANGLE
NORTH CAROUNA
9.5JMNUIE SERIES
fl
TO
aro
75
li1:IiNM OR(1.:
rwt.W..•••
6
Mlnl 00
Rt
It
Li
14
•
n•, A+
d!
07 rvtu 11
yroeuce4 by tM Unlbd StM Gecop.N Suety
4.e5” .i M�iN MS.411.•1. ue
0.oa..n urAarW frw�m.eweMin site,
e..n ma u....
li
-13-
n rotor xt�rq ..e•.W iwt w
as
1E
SrA1 E 1:24000
191.11.1.16
19
mum
1.
too
NM
•m s�N�e�a�e n,musT �ts.�n �i.taa.n
POW 1.11
renewate
21
-- - -_ 4URU yn
• F
Conneclloe to
Nov? 111 FM
Phase IV FM
84
79
TE
- !9
76
7)
17
_____ _ ••71'_N
n See ('days Chapel MgC,R.00
e0.9 tt.S10CATgx
.1e1a. Local
CLIMAX, NC
2019

T
MVVGV U.S. DE US. GEOLOG1CAL SURIVETYERIOR
rhn/raamp. *1
•.: US Topo
GRAYS CHAPEL QUADRANGLE
NORTH CAROLINA- RANDOLPH COUNTY
2.5-IRNUTE SERIES
i1.Per
dam
.100911
0
IA
49
05
64
Al
W-
lA
M
F
Proluc dby.Ilnllhd stalls Dmolaylul survey
comet S,Lnn ION wp Prealel
wayn mata urn aa...wu ea.m
N 1T
j 1
17
E if
lT
SCALE 1:24 000
mac
26
COO
Ong
DOD
P..rI e.a•.
COWAN
SeetCllmax Map
Phase IV FM
4
4
70.1
NAW.Va.Ira*p
Sar.nrnLou: Ore
GRAYS CHAPEL, NC
69
MA
12
lµ
1j~
47
N

- WGS U.S. DEPARTMENT OF THE INTERIOR
U.S. GEOLOGICAL SURVEY
9.6er.669y149.8
LIBERTY QUADRANGLE
NORTH CAROLINA
7.1.MINUTE SERIES
II SS 5750 .11 • .. • L .� ,e .. M I. 11
m
UI r
P roduced by 1:10. United 6107779 07101a91ul 5O75.4
Claw 7. al ,w•U
• ttnxir SFaw a �Hu MS...n.mi .a
c.n PH:9.nmulTr. Wn.., vx in
.
• etsue., m.nl dlan
39 n 29
30 31
SCALE 1:24 000
969
ONO
0�0
33 µ
r_3 n
__� iire11lAi co
.w9Eu55nuTi9x
..p. d
-
4 99/
Y rf
LIBERTY, NC
2019
39
49
68
TKO

1
n

i

DW R
i)hl.lon of Waitrr ReSutircts
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 Greensboro
Project Name for which flow is being requested: Sandy Creek Sewer Lift Station
More than one FTSE may 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 wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: T.Z. Osborne Water Reclamation Facility
b. WWTP Facility Permit #: NC 0047384
All flows are in MGD
c. WWTP facility's permitted flow 56.0
d. Estimated obligated flow not yet tributary to the WWTP 0.3100
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
33.93
1.8
37.46
66.90
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
Average Approx. Obligated, Total
Pump Pump Daily Current Not Yet Current Flow
Station Station Finn Flow** Avg. Daily Tributary Plus
(Name or Permit Capacity, * (Firm / pt), Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
Big 1.207 0.274 0.062 0.000 0.062 0.212
tninnn..o
Stewart keiill WQ0038555 10.224 4.626 1.52 0.058 1.516 3.110
v.t_
* 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.
*** 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): City of Greensboro T.Z.Osborne
Downstream Permit Number: NC0047384
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Wendy Messer 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.
r01'iS• k'� )
Signing Official S gnature
0'. r
Title Sighing Official
1)401/ *..001 W.rt0Y Waiter
OM: FIS,
Wendy Messer
O.. ba.n.h4. CA -Wendy Mmaer
a0220S.0714.26.OG0500.
Date
Page 2 of 6
FTSE 10-1 8

ROY COOPER
Governor
ELIZABETH S. BISER
Secretory
S. DANIEL SMITH
NORTH CAROLINA
Director Environmental Quality
March 3, 2022
Michael Borchers, Director of Water Resources
City of Greensboro
2602 S. Elm -Eugene St.
Greensboro, NC 27406
Subject: Permit No. WQ0040884 Modification
City of Greensboro Water Resources
Liberty Road Sewer Force Main Improvements Phase III (Construction Only)
Wastewater Collection System Extension Permit
Guilford/Randolph County
Dear Mr. Borchers;
In accordance with your application received February 23, 2022, and additional information received on
February 28, 2022, we are forwarding herewith Permit No. WQ0040884 Modification dated March 3,
2022, to the City of Greensboro (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, shall void permit number WQ0040884 issued May 20, 2019, 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 1.1:
This permit shall be for the construction of the wastewater collection facilities only. No
flow shall be made tributary to the subject facilities until a permit modification
application is submitted (with the appropriate fee), a modified permit is issued, and the
Engineer's Certification is received and approved by the Division. [15A NCAC 02T.0116]
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11.4:
Requires that the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 02T .0403 or any individual system -wide collection
system permit issued to the Permittee.
Condition 11.7: Upon completion of construction and prior to operation of these permitted facilities,
the completed Engineering Certification form with checklist attached to this permit
shall be submitted with the required supporting documents to the address provided on
the form. Permit modifications are required for any changes resulting in non-
compliance with this permit, regulations, or the Minimum Design Criteria. [15A NCAC
02T.0116]
�QE
tt
• r. ... , �,irmrnMM llii N
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336,776.9800

City of Greensboro Water Resources
Permit No. WQ0040884 Modification
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.
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 Alex Lowe at [phone]
or via e-mail at [e-mail].
Sincerely,
Dow/Signed by:
nfi►, . ,%)^.Clyn.a,k.
0D2a3CE3F1B7468
for S. Daniel Smith
Director, Division of Water Resources
by Jennifer F. Graznak, Assistant Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
cc: Matthew Watt, PE ([e-mail])
Wendy Messer ([e-mail])
DWR Laserfiche Files
Page 2 of 8

NORTH CAROLINA
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 Greensboro
Guilford/Randolph County
for the construction and operation of approximately 107 linear feet of 18-inch gravity sewer and
approximately 29,404 linear feet of 16-inch DIP force main to serve a future industrial site as part of the
Liberty Road Sewer Force Main Improvements Phase III project, and the discharge of zero (0) gallons per
day of collected wastewater (Construction Only Permit) into the City of Greensboro's existing sewerage
system, pursuant to the application received February 23, 2022, and additional information received on
February 28, 2022 and in conformity with 15A NCAC 02T; 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.
Permit Modification History
The purpose of this modification is to account for the next phase of construction in a multi -stage project.
The original permit, issued May 20, 2019, contained the following description: "...approximately 107
linear feet of 18-inch gravity sewer and 14,300 linear feet of 16-inch force main to serve a future
industrial site as part of the Liberty Road Sewer Force Main Improvement Phase 1 project, and the
discharge of 0 gallons per day of collected wastewater (Construction Only Permit) into the City of
Greensboro's existing sewerage system, pursuant to the application received May 16, 2019...". The north
end of the force main permitted in this modification connects to the force main permitted in the original
permit, for a total of approximately 29,404 linear feet of force main accounted under 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.
f—OocuSEgned by:
'-002D3CE3F1B7456.
forS. Daniel Smith
Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number:
Permit Issued:
WQ0040884 Modification
March 3, 2022
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
City of Greensboro is hereby authorized to:
Construct, and then operate upon certification the aforementioned wastewater collection extension.
The sewage and wastewater collected by this system shall be treated in the City of Greensboro's T.Z.
Osborne Water Reclamation Facility in accordance with Permit Number NC0047384.
Permitting of this project does not constitute an acceptance of any part of the project that does not
meet 15A NCAC 02T; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996
as applicable; and the Division's 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 Permittee'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 and any Special
Conditions identified below.
I. SPECIAL CONDITIONS
1. This permit shall be for the construction of the wastewater collection facilities only. No flow shall be
made tributary to the subject facilities until a permit modification application is submitted (with the
appropriate fee), a modified permit is issued, and the Engineer's Certification is received and
approved by the Division. [15A NCAC 02T.0116]
2. No flow in excess of the quantity permitted herein, zero (0) GPD, shall be made tributary to the
subject sewer system until an application for permit modification for an increase in flow has been
submitted to and approved by the Division. [15A NCAC 02T.0304(b)]
II. 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 Permittee, 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.0116; 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 02T; 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 materials unless specifically mentioned herein. [15A NCAC 02T.0110]
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 8

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 02T .0403. If an individual
permit is not required, the following performance criteria shall be met:
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:
1. 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.
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
Page 5 of 8

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 [phone] or (919)
733-3300. 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 II 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(a1)]
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 with checklist 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:
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 but not limited to pipe length changes 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 -
Page 6 of 8

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
Division's 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 individual permit and 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 02T; 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 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 .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 7 of 8

CERTIFICATION CHECKLIST
To be completed by the certifying engineer prior to operation of the permitted sewers, per 15A NCAC 02T.0116.
Certifying Engineer:
Certification Review Date:
Project: Liberty Road Sewer Force Main Improvements Phase III (Construction Only)
Permit No. WQ0040884 Modification Project County: Guilford/Randolph County
1) Has permittee information changed since the permit was issued (or last modified): change of mailing address,
change of ownership, transfer from developer to HOA/POA, etc. ❑ Yes ❑ No
• If yes, please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the HOA/POA must occur with the first certification.
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? ❑ Yes ❑ No
3) Final Engineering certification? ❑ Yes ❑ No
• If Partial Engineering certification, provide detailed narrative including what is being certified in the current
phase, what was previously certified (if applicable), and what is left to be certified.
4) Adequate information related to sewer lines: ❑ Yes ❑ No ❑ N/A
• Three feet minimum cover has been provided for all sewers unless ferrous pipe was installed.
• Minimum diameters for gravity sewers are 8-inches for public lines and 6-inches for private lines.
• Manholes have been installed: At the end of each line, at all changes in grade, size, or alignment, at all
intersections, and at distances not greater than 425 feet; minimum diameter shall be 4 feet (48-inches).
5) Adequate information related to pump stations: ❑ Yes ❑ No ❑ N/A
• Ensure power reliability option was selected per 15A NCAC 02T.0305(h).
6) Was project construction completed in accordance with all of the following: ❑ Yes ❑ No ❑ N/A
• 15A NCAC 02T, Minimum Design Criteria (MDC) for the permitting of Gravity Sewers (latest version), and MDC
for the Permitting of Pump Stations and Force Mains (latest version)?
If not, a variance approval is required in accordance with 15A NCAC 02T.0105(b), prior to certification and operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must submit two copies of the variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy).
• The central office will review the variance request, and if approvable, specific language regarding the variance
will be incorporated into the permit, either via a special condition or a supplementary letter. A copy of the
reissued permit with variance language or the variance letter must be maintained with the original documents.
7) Does the project contains high priority lines (15A NCAC 02T .0402(2))? ❑ Yes ❑ No
• If yes, ensure that the permit already contains the necessary condition related to high priority lines 15A NCAC
02T.0403 (a)(5). If the permit does not include this language, the Fast Track reviewer will reissue the permit with
the appropriate language.
8) Are Permit modifications are required for any changes resulting in non-compliance with this permit (including but not
limited to pipe length changes of 10% or greater, change in flow, pump station design capacity design change of 5% or
greater, and/or change in the number/type of connections)? ❑ Yes ❑ No
• If yes, a permit modification request must be submitted to the appropriate Regional Office, and a modified
permit with revised certification must be issued prior to certification and operation.
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]

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: City of Greensboro
PERMIT #: WQ0040884 Modification
PROJECT: Liberty Road Sewer Force Main Improvements Phase III (Construction Only)
ISSUE DATE: March 3, 2022
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 to 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
ENGINEER'S CERTIFICATION
I, as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (❑ periodically, ❑ weekly, j full time) the construction of the
project referenced above for the above Permittee, and hereby state that, to the best of my abilities, due
care and diligence was used in the observation of the following construction:
approximately 107 linear feet of 18-inch gravity sewer and approximately 29,404 linear feet of 16-inch
DIP force main to serve a future industrial site as part of the Liberty Road Sewer Force Main
Improvements Phase III project, and the discharge of zero (0) gallons per day of collected wastewater
(Construction Only Permit) into the City of Greensboro's existing sewerage system, pursuant to the
application received February 23, 2022, and additional information received on February 28, 2022
; 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 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 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]