WQ0043345_Application (FTSE)_20220401

Summey Engineering Associates, PLLC
Engineering • Land Planning • Consulting
PO Box 968 — Asheboro, NC 27204
[phone] / Fax: [phone] / [e-mail]
TRANSMITTAL
Date: March 31, 2022
To.
Justin Henderson
NCDEQ-DWR
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
We are sending you attached the following items:
❑ Shop Drawings
❑ Prints
® Plans
❑ Samples
❑ Specifications
❑ Disk
Villas on Church St
Guilford County, NC
Sanitary Sewer Extension
Sea Job No. E-5505
❑ Copy of Letter
❑ Other
# Copies
Drawing #
Description
Disposition
NC Department of "
1
$480.00 Application Fee
Environmental Quality
Received ati
1
Narrative and Cover Letter
2
Fast Track Sewer Application
APR d' 2022
(1 original & 1 PDF copy)
Winston-Salem
2
Flow Tracking Acceptance Form
Regional Office
(1 original & 1 PDF copy)
1
USGS Topo Map
1
Aerial Photo
1
Construction Plan Set (1 PDF copy)
1
Calculations and Specifications
Remarks:
Bryan,
We have enclosed the information for your review. Please let us know if you have any
questions, or need any additional information from us.
Thank you,
Christian Vestal
Christian(cilsummeyengineerinq.com
336-328-0902

Project Narrative and Engineering Documents
For
The City of Greensboro
Sewer Extension
For the
Villas on Church St
The purpose of this sewer extension is to provide a new 34 unit townhome complex an
adequate sewage disposal source and to meet the future needs of these residents. The new
dwelling units are located at the intersection of N. Church St and Rivington Way in
Greensboro, NC.
The site will have gravity sewer lines collecting all waste from the proposed development
and taking it to an onsite private pump station. The onsite private pump station will pump
the waste to the city system via a 2 inch line that connects to a manhole on the project
side of the road and a gravity line will connect the new system to an existing city
maintained system. The only other alternative for this development would be individual
septic systems on each lot which would not be feasible due to the density proposed.
Prepared By:
Address:
Phone:
Project:
Included items:
H. Mack Summey, Jr., P.E.
P.O. Box 968 Asheboro, NC 27204
(336)-328-0902
Villas on Church
FTA 06-21
FTSE
Developers Operational Agreement
Acceptance Flow Tracking COG
USGS Topo Map
Aerial
Anti Flotation Calcs
Sewer Specifications
Pump Station Calculations
Pump Specifications
Panel Specifications
$480 Review Check

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 be returned
1. APPLICANT INFORMATION:
1.
Applicant's name: Boulding Corp (company, municipality, HOA, utility, etc.)
Applicant type: ❑ Individual ® Corporation ❑ General Partnership
❑ Federal ❑ State/County ❑ Municipal
3. Signature authority's name: Frank Truskolaski per ISA NCAC 02T .0106(b)
Title: Registered Agent
4. Applicant's mailing address: 2102 Mast Ave
City: High Point State: NC Zip: 27265-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
I1. PROJECT INFORMATION:
1. Project name: The Villas on Church
2. Application/Project status: ® Proposed (New Permit)
If a modification, provide the existing permit number: WQ00
❑ Privately -Owned Public Utility
❑ Other
❑ Existing Permit/Project
and issued date:
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.16167889° Longitude: -79.791138°
5. Parcel ID (if applicable): 7868605962 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
1. Professional Engineer: H. Mack Summey Jr License Number: 26447
Firm: Summey Engineering Associates, PLLC
Mailing address: PO Box 968
City: Asheboro State: NC Zip: 27204-
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:
I. Permit Number(s): 1655
2. Downstream (Receiving) Sewer Information: 8 inch El Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 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
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: 1IOA) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
❑ Yes ❑ No ❑ N/A
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned)
❑ Residential (Leased)
❑ School / preschool / day care
❑ Food and drink facilities
['Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
['Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % 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 .0114(I)? ❑ Yes ® No
> If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
Single family residential
360 gal/day
34
12,240 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
12,240 GPD
a See 1 5A NCAC 02T .0414(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-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T'.01 I -I] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: _ 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
El Other (Explain):
FORM: FTA 06-21
Page 2 of 5

Vll. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
775
DIP
D. 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 (Puma Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Private Pump Station 5208-PS
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.167889° Longitude: --79.791138°
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.01224 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): 45 gallons per minute (GPM) at 52.80 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
270
PVC
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C.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(t)):
1. Does the project comply with all separations/alternatives found in I5A NCAC 02T .0305tF] & lea?
15A NCAC 02T.0305(Il contains minimum seppystems:
arations that shall be rovided for sewer s
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
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.0305(f) or (g), see Section X.1 of this application
*15A NCAC 02T.0305(Q contains alternatives where separations in 02T.0305W 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 weboage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
D. If no, please refer to 15A NCAC 1 8C.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
Y Please provide supplementary information identifying the areas of non-conformance.
D. 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 02B .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A 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)(61, directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
D. 1f 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 I5A 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?
I'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 projects requiring a variance approval may be subtect to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, t-i. M 0.c.. $uttnme. J r, t p E , attest that this application for
(Professional Engineer's name frorit Application Item 111.1.)
he U.U4s on Owed.
(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. ) 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 Pumn Stations and Force Mains 1 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 143-215.6B, 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:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Frank Truskolaski , attest that this application for
(Signature Authority Name from Application Item 1.3.)
The Villas on Church
(Project Name from Application Item 11.1)
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 pence' S up to $25,000 per violation.
Signature:
Date: 01 /17/2022
FORM: FTA 06-21 Page 5 of 5

r
L
GREENSBORO
City of Greensboro
Water Resources Department
Engineering Division
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(COG-FTSE-10/07)
Permit Number: N/A
Project Applicant Name: The Villas on Church
Project Name for which flow is being requested: 5210 N Church St
More than one COG-FTSE-10/07 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. Flow acceptance is contingent upon City Council approval.
The Flow Tracking /Acceptance Permit is valid for a period of one year from the date of issuance. Failure to renew the permit prior to the expiration date, by
submission of a revised application, will result in relinquishment of any waste water flow allocated for the project in question. A revised application must be
submitted to Water Resources Department if flow conditions or development plans change other than what was stated in the original application.
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 Number: NC0047384
c. WWTP facility's permitted flow
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
All flows are in MGD
56.0000
CS - 0.3100 SIU - 1.4223
33.93
0.01632
35.6786
63.71
R. Complete this section for each pump station you are responsible for along the route of this proposed wastewater flow.
Are there any pump stations affected? Yes
List pump stations located between the project connection point and the WWTP
Pump Station Name
McNairy Pointe
Peach Orchard
Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
0.28512 0.01728
2.838863381 0.415520826
Not Applicable
Not Applicable
III. Certification Statement:
n/a n/a
n/a n/a
I, Wendy Messer certify that, to the best of my knowledge, 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 stations enroute to the receiving treatment plant. 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 1 and II for which I am the responsible party. Signature of this form indicates acceptance of
this wastewater flow.
Zau6V 22f7LC2
Signing Official Signature; Date
2/2/2022

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: The Villas on Church
Project Name for which flow is being requested: 5210 N Church St
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 #: NC0047384
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 33.93
f. Total flow for this specific request 0.01632
g. Total actual and obligated flows to the facility 35.6786
h. Percent of permitted flow used 63.71
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,
Pump Pump Daily Current Not Yet Total Current
Station Station Firm Flow** Avg. Daily Tributary Flow Plus
(Name or Permit Capacity, * (Firm / p f), Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
McNairy WQ0030051 0.285 0.107 0.016 0.016 0.033 0.075
Peach WQ0020104 2.839 1.01 0.416 0.024 0.440 0.567
* 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 < O.
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.
1)f/44e/1-J c2
Signing Official/gnature Date
a..)46,4C2/Xex__
cI
Title o igni Official
Page 2 of 6
FTSE 10-18

STATE OF NORTH CAROLINA City of Greensboro
GUILFORD COUNTY Permit No.
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (d1) and entered into this day
of , , by and between the North Carolina Environmental
Management Commission, an agency of the State of North Carolina, hereinafter known as the
COMMISSION; and , a corporation/general partnership
registered/licensed to do business in the State of North Carolina, hereinafter known as the
DEVELOPER.
WITNESSETH:
1. The DEVELOPER is the owner of the certain lands lying in Guilford County, upon which it is
erecting and will erect dwelling units and other improvements, said development to be known as
(hereinafter the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater
treatment works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary
sewage disposal to serve the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S.
143-215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other
improvements and lands through filing of a Declaration of Unit Ownership (hereinafter
Declaration), pursuant to Chapter 47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, the (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue of the laws
of the State of North Carolina, for the purpose, among others, of handling the property, affairs
and business of the Development; of operating, maintaining, re -constructing and repairing the
common elements of the lands and improvements subject to unit ownership, including the
Disposal System; and of collecting dues and assessments to provide funds for such operation,
maintenance, re -construction and repair.
6. The COMMISSION desires to assure that the Disposal System of the Development is properly
constructed, maintained and operated in accordance with law and permit provisions in order to
protect the quality of the waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the
parties hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans
and specifications hereafter issued and approved by the COMMISSION, and shall thereafter
properly operate and maintain such systems and facilities in accordance with applicable permit
provisions and law.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the
Association until construction has been completed in accordance with the permit and approved
plans, and the staff of the Division of Water Quality has inspected and approved of the facilities.
In order to change the name of the permit holder, the DEVELOPER must request that the permit
be reissued to the Association. The request must include a copy of the Association Bylaws and
Declaration.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its
responsibility for the operation and maintenance of its Disposal System until a permit has been
reissued to the DEVELOPER's successor.
COG-DEV 12/07 Page 1 of 2

4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal
System and appurtenances thereto are part of the common elements and shall thereafter be
properly maintained and operated in conformity with law and the provisions of the permit for
construction, operation, repair, and maintenance of the system and facilities. The Declaration
and Bylaws shall identify the entire wastewater treatment, collection and disposal system as a
common element which will receive the highest priority for expenditures by the Association except
for Federal, State, and local taxes and insurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal
System will be maintained out of the common expenses. In order to assure that there shall be
funds readily available to repair, maintain or construct the Disposal System, beyond the routine
operation and maintenance expenses, the Declaration and Association Bylaws shall provide that
a fund be created out of the common expenses. Such fund shall be separate from the routine
maintenance funds allocated for the facility and shall be part of the yearly budget.
6. In the event the common expense allocation and separate fund are not adequate for the
construction, repair, and maintenance of the Disposal System, the Declaration and Association
Bylaws shall provide for special assessments to cover such necessary costs. There shall be no
limit on the amount of such assessments, and the Declaration and Bylaws shall provide that such
special assessments can be made as necessary at any time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by
any city, town, village, county, water and sewer authorities, or other unit of government shall
hereinafter become available to serve the Development, the DEVELOPER shall take such action
as is necessary to cause the existing and future wastewater of the Development to be accepted
and discharged into said governmental system, and shall convey or transfer as much of the
Disposal System and such necessary easements as the governmental unit may require as
condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and
welfare for the Association to enter into voluntary dissolution without having made adequate
provision for the continued proper maintenance, repair and operation of its Disposal System, the
DEVELOPER shall provide in the Association Bylaws that the Association shall not enter into
voluntary dissolution without first having transferred its said system and facilities to some person,
corporation or other entity acceptable to and approved by the COMMISSION by the issuance of a
permit.
9. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 above shall be
conditions of any permit issued by the COMMISSION to the DEVELOPER for the construction,
maintenance, repair and operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in Guilford County where the
Declaration is filed and in the offices of the Secretary of State of North Carolina with the Articles
of Incorporation of the Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties
named below:
FOR THE ENVIRONMENTAL Bouldong Corp
MANAGEMENT COMMISSION
Name of DEVELOPER
B
(Signature) (Signature)
City of Greensboro, a Delegated Authority
Frank J Truskolaski, Secretary
Print Name and Title
01 /17/2022
(Date) (Date)
COG-DEV 12/07 Page 2 of 2

UVVV U.S. DEPARTMENT U.S. GEOLOGICAL GIICAL SURVEY ERIOR
science for a changing worldJ
The National Map
tt US Topo
LAKE BRANDT QUADRANGLE
NORTH CAROLINA
7.5-MINUTE SERIES
-79.8750
OamN
11
10
09
8
07
06
05
60200.E 03 04 05 06
REBECCA DR
Mears Fnrk— .,.
SUM EM RFIELD
Hillsidl\e Lake
Foster Lake
,fBOON RD /
Hllnsnckle
04, Lake
03
02
01
a
00
aV
99
-79.8750°
WI° FARMS 0B 149D
Luke Brandt
OWLS ROOST RD
OSETIMSCRS DR O
02 03
Produced by the United States Geological Survey
North American Datum 0f 1983(NA083)
World Geodetic System of 1984(WG584). Projection and
1 000-meter grid:Universal Transverse Mercator, Zone 175
This map is not a legal document. Boundaries may be
generalized for this map scale. Private lands within government
reservations may not be shown. Obtain permission before
entering private lands.
Imagery NAIP, May 2016 - November 2016
Roads U.S. Census Bureau, 2016
Names GNIS, 1980 - 2016
Hydrography National Hydrography Dataset, 1899 - 2018
Contours National Elevation Dataset, 2008
Boundaries Multiple sources, see metadata file 2017 - 2018
Hillsdale
Richardson
\Lakd
Law
Fon Creet
0
M.
154 MILS
TROUBLES°
12 m LS
CEDAR VIEW DR
SCALESVILLE RD
Britt -
Fishman Lake
CEDAR R/OC
w — \QeedY Fork
Reedy Noi'k�
AIR HARK/
08
GRENHAM RD
CASPIAN L
USTAM£RE ARM RD
50,-ThA ri Harbor
Airport
19, EVELw,,.- . cN0
09F
Richland Lake
BLUFF RUN DR
'� MEADOW
Ilcen_ho;o Coumbty 1 ,
inREE
Bark Lake Five B
PINEBURR-RD
UTM GRID AND 2019 MAGNE IC NORTH
DECLINATION AT CENTER OF SHEET
U.S. Xstional Grid
Imam-m Square ID
PA
.0
PV
05
06
HORE LA
ROBER,..
1 v
North Iiyde-Park
07 08
SCALE 1:24 000
0.5 KILOMETERS
2
1000
500
0.5
METERS
1000 2000
MILES
1000 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
FEET
CONTOUR INTERVAL 10 FEET
NORTH AMERICAN VERTICAL DATUM OF 1988
09 10
NORTN
AROLINA
9UAwuNOLE LOCATION
2
3
4
5
BURTOMFAR.
ARCHERGATER0
1 Ellisboro
2 Bethany
3 Reidsville
4 5ummerfield
5 Browns Summit
6 Guilford
7 Greensboro
8 McLeansviUe
ADJOINING QUADRANGLES
10
Lake
Townsend
Koontzville
CODY AVE
RANHIN RD
-79.7500°
2 36.
11 612000inE
ROAD CLASSIFICATION
Expressway L IC tor
Secondary Hwy Local Road
Ramp 4WD
.Interstate Route 0 US Route O State Route
12
11
10
09
08
07
06
05
04
03
02
01
PA
00
PV
3999000
-79.7500° 36°
Wetlands MS National Wetlands Inventory 1982
This map was produced to conform with the
National Geospatial Program US Topo Product Standard, 2011.
A metadata file associated with this product is draft version 0.6.18
6
7
8
LAKE BRANDT, NC
2019