WQ0045688_High_Street_Sewer_Extension_FTSSE_Permit_Application_Final_Submission_20240814

Environni` vQuality
Received Received State of North Carolina
e
Department of Environmental Quality
AUGDWR 13 2024 Division of Water Resources
Winston-Salem FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources Regional O ff_, e FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: lAw (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Burlington (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual
❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal
❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Craig
Honeycutt per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: 425 S. Lexington Ave
City: Burlington State: NC
Zip: 27215-
5. Applicant's contact information:
Phone number: [phone]
Email Address: dbowman(2( burlin tonnc.gov
II. PROJECT INFORMATION:
1. Project name: High Street Sewer Extension
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing 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: 36.093558' Longitude:-79.443915'
5. Parcel ID (if applicable): (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Zachary Gardner, PE License Number: 50747
Firm: Gardner Engineering, PLLC
Mailing address: PO Box 3048
City: Asheboro State: NC Zip: 27204-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: South Burlington WWTP Permit Number: NCO023876
Owner Name: City of Burlinaton
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ(Installed prior to 1950)
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00008
Owner Name(s): City of Burlington
FORM: FTA 10-23 Page 1 of 5

J w h 1 i^S S in ('-t # 2—
Ix. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.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 c^a'
**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.
0
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 i °
**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(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 webpMe
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 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)(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 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.
➢ 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 10-23 Page 4 of 5

?G,rr=�v`i.iif=fit G�
Envircnnry ant-�i "' aUy State of North Carolina
DWRI „c�ei ed Department of Environmental Quality
AUG C 8 2024 Division of Water Resources
VVinscon_Saiem FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources EFTA 10-23 &SUPPORTING DOCUMENTATION
Application Number: d�,��D �r (to be completed by DwR) , ryt A
All items must be com nieted or the application will be returned 12-
1. APPLICANT INFORMATION:
1. Applicant's name: Cit%_ of Burlinton (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: Crai- Hone, cuff per 15h. N(.AC ("ICT .0I06toj
Title: City Manager
4. Applicant's mailing address: 425 S. Lexintton Ave
City: Burlington'State: NCZip:
Zip: 27215!
5. Applicant's contact information:
Phone number: [phone]� Email Address: dbowman a burlin-tonnc. ov
11. PROJECT INFORMATION:
1. Project name: Hi_h Street Sewer Extension
2. Application/Project status: ®'Proposed (New Permit) ❑ Existing Permit/Project ❑ AR -PA funded
If a modification, provide the existing 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: WQOU
3. County where project is located: Alamance'
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.093558' Longitude:-79.44391_5"
5. Parcel ID (if applicable): (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Zachar, _ Gardner,_ PE License Number: 50747
Firm: Gardner En,_ineerin . PLLC
Mailing address: PO_ Box 3048 `
City: Asheboro " State: NC Zip: 27204-
Phone number: 336) 302-4949,,, Email Address: zach a ardndren�;ineering(lllc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: South Burl.in�,ton WWTP Permit Number: VC c, u 2-
Owner Name: City_ of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ ( installed_hrior to 1950
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00008
Owner Name(s): Cit\_ of_Burlinton
FORM: FTA 10-23 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?
i
❑ Yes ❑ No ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement
� ( "' ° "t >? ' been attached?
❑ Yes ❑ No ® N/A,
3. If the Applicant is a Home/Property Owners' Association, has an F' ;lal
A •reement +_F'ORN4: IiOA and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A i
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 / day care ❑ Medical / dental / veterinary facilities
❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church
❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home
❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 °1 Domestic % Commercial % Industrial (S - �)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under i A N,(' A,rl o)) `>! `::-ti t 0 ❑ Yes ❑ No
➢ If ves. provide a cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f)) Daily Design Flow s,n No. of Units Flow
Single Family Home- 3 Bedroom - 225 gal/day 1 225 GPD+
gal/ GPD
gall GPD
..__...........
.._.........t.__--------- — -- +----.T
gal/ — — � GPD
I gal/ GPD
__...__....._.__. ..... ..... .
gal/ _._._. GPD
Total i 225 GPD
a See i 5A NCAC 02T .0114(b), (d), (e)(l)and (eJ(2) for caveats to wastewater design flow rates (i.e. 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, 42A74).
b Per 15A NCAC 02T .4114(c), design flow rates for establishments not identified [in table 4 5A N(7 A%C 011- 0 s A 41 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
i
8. Wastewater generated by project: 225 GPD (per 15 A NCAC 02.T .0114 ap G,S,_ 143-2 i5_ )
➢ Do not include future flows or previously permitted allocations
If permitted now 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 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 42T .0305 & MDC i Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) i Length (feet) Material
8 I 56 I 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 jPum p Stations/Force Mains ):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: ° Longitude:
3. Total number of pumps at the pump station:
3. Design flow of the pump station: 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): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) I Length (feet) Material
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.Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0.305+hit-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 10-23 Page 3 of 5