WQ0044211_Application (FTSE)_20230313

State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEiM EXTENSION APPLICATION
FT'A 06-21 & SUPPORTING DOCUMENTATION
Application Number: OQ _q 2-1. -�-- (to be completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFOR�INIATION:
1. Applicant's name: City of Burlington (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Craig Honeycutt per 15A NCAC: 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: PO Box 1358
City: Burlington State: NC Zip: 27216-
5. Applicant's contact information:
Phonc number: [phone] Email Address: clione cutt bburlin ,)to€ unc.
If. PROJECTINFORMATION:
1. Project name: River Village
❑ Privately -Owned Public Utility
❑ Other
2. Application/Project status: ® Proposed (New Permit) ❑ Ixisting Permit/Project
If a modification, provide the cxisting permit number: WQ00 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: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1317' Longitude: 97 4333'
5. farce) ID (if applicable): 8876281883 (or Parcel 11) to closest downstream sewer)
Ill. CONSULTANTINFORMATION:
I . Professional Frigineer: Donald Sever License Number: 24627
Firm: Summit Design & Engineering Set -vices
Mailing address: 320 Executive Court
City: Hillsborough State: NC Zip: 27278-
Phone number: [phone] Ismail Address: don.sever(h).sunmmitde.com
IV. WASTEWATER TREATMENT FACILITY (WW'1'F) INFORMATION:
I . Facility Name: East Burlington W WTP Permit Number: NCO023868
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0012009
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity I I force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): City of Burlington
FORM: FT'A 06-21 Page I of 5

NIL 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.01 15(c) been attached?
❑ Yes ❑ No ❑ N/A
4. Origin of wastewater, (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / clay care ❑ Medical / dental / veterinary facilities ❑ Swimming fool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming fool/filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ 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. Hasa flow reduction been approved under 15A NCAC 02T .01 IMP ❑ Yes ❑ No
Y 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 0
No. of Units
Flow
single family dwelling - 3br
360 gal/liome
126
45360 GPD
single family dwelling - 4 br
480 gal/hontc
33
15840 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
�olal
61200 GPD
a See 15A NCAC 02T .01 14(b). (d). (e)(1) and (e)(22) 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 .01 14(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.
S. Wastewater gencrated by project: 61200 Gill) (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 tintefi-ame 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 cxpcctcd
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

1X. SETBACKS & SEPARATIONS — (0213 .0200 & 15A NCAC 02T .0305(o):
1. Does the project comply with all separations/alternatives found in 15A NCAC 021' .0305(f) & (g)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
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-1 waters of Class l or
Class 11 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 chains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
Y If noncompliance with 02T.0305(f) or (g). see Section X.1 of this application
*I 5A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(0 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 weblage
2. Does this project comply with the minimuni separation requirements for water mains? ® Yes ❑ No ❑ N/A
Y If no, please refer to 15A NCAC 18C'.0906(f) for documentation requirenments and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
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.
Y 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: Cape Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
Y This includes Trout Buffered Streams per 15A NCAC 2B.0202
Does the project require coverage/autlorization under a 404 Nationwide/individual permits ® Yes ❑ No
or 401 Water Quality Certifications?
Y 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 021'.0105(e)(66), 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, stornmwatcr management plans, etc.).
Does this project include any sewer collection lines that are deemed "high -priority?" []Yes ® No
Per 15A NCAC 0210402, "high -priority sewer" nmcans any acrial sewer, sewer contacting surface waters,
siplion, or sewers positioned parallel to streanmbanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
Y If yes, include an attachment with details for each line, including type (acrial line, sic, 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 021'.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

V11. GRAVITV SEWER DESIGN CRITERIA (If' Applicable) - 02T .0305 & MDC (Gravity Sewers):
l . Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
819
DiP
8
7553
PVC
Section li & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Y Section III contains information related to minimum slopes for gravity sewcr(s)
Y Oversizing lines to elect minimmn slope requirements is not allowed and a violation of the MDC
VII1. PUMP STATION DESIGN CRITERIA (if Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: River Village Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitud66.1375° Longitude:-79.4139'
3. Total number of pumps at (lie pump station: 2
3. Design flow of the pump station: 0.1 19 millions gallons per day (firm capacity)
Y This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 350 gallons per minute (GPM) at 135 feet total dynamic head (TDI I)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
6
2680
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 2.01C.l.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
y Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(13);
Itequired for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Y Must be permanent to facility and may not be portable
Or if the pump station has an average daily now less than 15,000 gallons per day 15A NCACO21'.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:
Y Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
y 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 sclicdule of the portable power source or pump, including travel timefranies, 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

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Desinn Criteria for (lie 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 projects requiring a variance approval may be subject to Ionpe_r
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 protect, the full technical review is required.
2. Professional Engineer's Certification:
1, Donald A. Sever , attest that this application for River Villace
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item II.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. 1 further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Desipti Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitlinc
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. 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)
...............`` `,.i�i►Y 1.....r...� ................,
North Carolina Professional Engineer's seal, signature, and date: CAR04''%,
°
°OFE pN•e �'
.--EAL3I
> 0 24627
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..............''''''. .......
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Craig Honeycutt , attest that this application for River Village
(Signature Authority Name from Application Item 1.3.) (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 the 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:
-- --- — - -- -
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 10-18)
Enity Requesting Allocation City of Burlington
Project Name for which flow is being requested: River Village
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:
b. WWTP Facility Permit #
East Burlington WWTP
NC 0023868
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
12.00
1.816524
3.8360
0.061200
5.713724
47.6%
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 : 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
(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 <_ 0.
Downstream Facility Name (Sewer)
Downstream Permit Number:
Fuji Foods Outfall
WQ0012009
Page 1 of 2 FTSE 10-18

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
? -Ll— 2-3,
Date
Page 2 of 2 FTSE 10-18

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WETLANDS
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Figure 4: USGS Topo Quad
ect Name:
River Village
Owner / Developer: LGI Homes
City / County: Burlington / Alamance
Tax PIN(s): 140418
Coordinates: Scale: Date:
Lat: 36.13614 Long:-79.43258 graphic 10/12/20

LETTER OF TRANSMITTAL
TO: Winston Salem Regional Office
450 W. Hanes Mill Road Suite 300
Winston Salem, NC 27105
ATTN: Water Quality Section
WE ARE SENDING YOU
❑ Prints ❑ Reproducible
❑ Copy of Letter ❑ Change Order
❑■ Attached ❑ Under Separate Cover
MAK 1 3 LUL.J
Winston-Salem
DATE: 3/10/23 PROD. NO.: 20-0252.010
RE: River Village Subdivision
❑ Specifications ❑ Other
❑ Shop Drawings
❑ Transmitted Via
COPIES
DRAWING
DATE
DESCRIPTION
2
_
3/8/23
_
FTSA 06-21 form
1
3/10/23
cover letter
1
check for $480
1
site map
1
aerial map
TRANSMITTED
For Approval ❑ As Requested
COMMENTS:
COPY TO:
Raleigh Office
3301 Benson Drive, Suite 400, Raleigh, NC 27609
❑ For Your Use [_] For Review and Comment
SIGNATURE:
Don Sever
919.322.0115 // www.summitde.com

Winston Salem Regional Office March 10, 2023
Water Quality Section
450 W. Hanes Mill Rd Suite 300
Winston-Salem, NC 27105
River Village Fast Track Sewer System Extension FTA 06-21
City of Burlington
A new residential subdivision with a total of 159 lots in the first phase is proposed off W. Old Glencoe Road in
Burlington, NC. A total flow of 61,200 Gallons per day is allocated for the project. A pump station with 350 GPM
at 135 feet dynamic head is provided with the project. The receiving downstream sewer is an existing 8" line
maintained by the City of Burlington.
Sincerely,
Dan Sawn
Senior Project Manager
Raleigh Office
3301 Benson Drive, Suite 400, Raleigh, NC 27609
919.322.0115 // www.summitde.com