WQ0041702_Application (FTSE)_20200518

State of North Carolina
Department of Environmental Quality
rs...
Division of Water Resources
15A NCAC 02T .0300 W FAST 'TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources ETA 04-16 & SUPPORTING DOCUMENTATION
Application Number: _ _ (to be completed by DWR)
All items trust be completed or the apRilcation wifl.by returned
I. APPLICANT INFORMATION:
.
Applicant's name: CiLy of B lit on (company, municipality, HOA, utility, etc.)
2.
Applicant type: [a Individual ❑ Corporation ❑ General Partnership Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3.
Signature authority's name: Hardin Watkins per 15A NCAC 02T .0l0 ffb1
Title: Manage
4.
Applicant's mailing address: 425 South Iexin ton A enue
U: �arrtr�ent t;F
City:Burlington State: NC Zip:27215-
Environmental Quality
Received
5.
Applicant's contact information:
Phone number. 3( 3¢) 2�• 050 ]email Address: Enuineerintr�ci.burlington.iic pet
Sri l►/
8 ��L�
H. PROJECT INFORMATION:
Winston-Salem
I.
Project name: Brassfield Meadow A
Regional Office
2.
Application/Project status: 0 Proposed (New Permit) Existing Permit/Project
If a modification, provide the existing permit number: WQ00_ and issued date: -,,,,,,_,,,,_
If new construction but part of a master plan, provide the existing pennit number: WQ00
3.
County where project is located: Alamance
4.
Approximate Coordinates (Decimal Degrees): Latitude: 16.124V Longitude: -79.4 4
5.
Parcel ID (if applicable): 170825
(or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
1. Professional Engineer: Quck.Tru License Number: C1449T84
Firm: CPT Engilleering aW S11nmLm&
Mailing address: 4400 T eet
City: High Point State: NC .Zip: 27
Phone number: [phone] Email Address: chucktAmlengineering.com
IV. WASTEWATER TREATMENT FACILITY (MVTF) INFORMATION:
1. Facility Name: East.Burlington Wastewater P1a Permit Number: N092280
Owner Name: CiM of Budington
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than NVWTF):
1. Permit Number(s): WQQQ34534 Downstream (Receiving) Sewer Size: 8 inch
teni i e ollec io s Pe it N tuber s licable : WQCS00008
Owner Narne(s): City of Bur ' ton
FORM: FTA 04-16 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 ONo ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational A regiment rQp _QII VD been attached?
® Yes []No ❑NIA
3. If the Applicant is a Home/Pro afty Owners'Association, has an Operational Agreement FORM JIOA} been attached?
❑ Yes ❑No ®NIA
4. Origin of wastewater: (check all that apply):
® Residential Owned] Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool I 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: % Domosdc/Cornmercial % Commercial
% Industrial (Se_ 010320))wT1
�Js there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under I5A NCAC 02T .0114(f) ❑ Yes ❑ No
➢ IfLesp_rovideacoRyofflo)IUAW[onqgRrovalkttLr
7. Summarize wastewater generated by project:
Establishment Type, (see 01LU1A(fl)
Daily Design Flow
No. of Units
Flow
360 gall
49
17,640 GPD
gall
GPD
Sail
GPD
gal/
GPD
gall
GPD
gall
GPD
Total
17,640 GPD
a See 15A NCAC 02T .0114(b). (di, (e}(li and [e)Q) for caveats to wastewater design flow rates (io., minimuni 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 021114) shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 17,64.0 GPD (per lSA—NNCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
[] Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number.-
0 Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - Z.0 T .03fl.5 & 3VIl)C (Gravity �ekvers
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1,967 VCP
Section H & 13I of the MDC for Permittufg of Gravity Sewers contains information related to design criteria
A Section III contains information related to minimum slopes for gravity sewer(s)
9 Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) —_02T ,0305 & MDC Pun Stations/Force Moins
COMI'I,1TF. POI2 >aACff I'pMP STATION INCLln1 IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decvnal Degrees): latitude: Longitude. - °
3. Design flow of the pump station millions gallons per day (firm capacity)
4. Operational point(a) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NC .03 5 )(1l:
❑ Standby power source or pump with automatic activation and telemetry -15A NCAC 02T .0305(h)(1)(B)l
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
D Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry -15A NCAC 02T .0305(h)(1)(C):
D It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
D 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 timefirames, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS -- (02B .0200 & 15A NCAC 02T .0305(l)):
1. Does the project comply with all separations found in 1 SA NCAC 02T .0 05 & ❑ Yes [] No
A 15A NCAC 02T.03051ft eontains minimum senarations that shall he provided for sewer systems:
Setback Parameter*
Separation Rqqwlired
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains horizontal
10 feet
Reclaimed water lines 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 11 im ounded reservoirs used as a source of drinking water
100 feet
*"Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
To2 slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage s stems and interceptor drains
5 feet
An swimming 018
10 feet
Final earth grade vertical
36 inches
D 15A NCAC 02 contains alternatives where separations in 3 S cannot be achieved.
D **Stream classifications can be identified using the Division's NC Surface Water Classifications webnase
➢ If noncompliance with 02T.0305 (f) or fs). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) 0 Yes ❑ No ❑ NIA
D Seethe Division's draft separation requirements for situations where separation cannot be meet
D No variance is required if the alternative design criteria specified is utilized in design and construction
D As built documents should reference the location of areas effocted
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02 07 [D Yes ❑ No [] NIA
➢ This would include Trout Buffered Streams per l SA N
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes 0 No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 &Buffer Pertn�Wing I31Attch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ❑ Yes ID No
Per 15A. NCAQ 02-0.1.05(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02'r 0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes 0 No ❑ NIA
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or Its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's Individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1, Does the submitted system comply with 15A_NCAC 02T, the Minimum Design Criteria far the Pennitting_of Puit�Slalions
and Force _Mains (latest ti crsipn), and the Gra�Jty Sewer Minimum Design Criteria (latest version as applicable?
❑ Yes Q No
If No, complete and submit the VariancelAlternative Design Request application (VADC 10.14) and supporting documents for
review. Approval of the request Is required orior to submittal of the Fast Track Application and sunnorting documents.
2. Professional Engineer's Certification,
0
(Professional Engineer's nattfe fYom Application Item I11,1)
attest that this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. ........
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
& title from Application Item 1.3.)
5
that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that nnay 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 pails 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. A and !4_ 3-215 B, 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: tl" 1.1 toa er _ _ Date: i
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
r h f iE.+is of Ut 4,tlMa 1.1" 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: Brassfield Meadows Phase 5A
More than one FTSE maybe required far a single project if the owner of the WWTP is no! responsible for at! pump stations along
the route ofthe proposed wastewaterflow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: East Burlington WWTP
b. WWTP Facility Permit M NC 0023868
A11 flows are in MGD
c. WWTP facility's permitted flow 12.00
d, Estimated obligated flow not yet tributary to the WWTP 1.892433
e. WWTP facility's actual avg. flow 5.0740
f. Total flow for this specific request 0.017640
g. Total actual and obligated flows to the facility 6.984073
h. Percent of permitted flow used 58.2%
11, 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) (E)=(A-D)
Obligated,
Total
Design
Approx.
Not Yet
Current Flow
Firm Average Daily
Current Avg.
Tributary
Pius
Pump Station Capacity, * Flow"
Daily Flow,
Daily Flow,
Obligated Available
Name GPD (Firmlpt , GPD
GPD
GPD
Flow Capacity`
NONE
* 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 WViffP where the Available Capacitys 0.
Downstream Facility Name (Sewer) :
Downstream Permit Number:
Servis Creek Outfall
Not Known
Page 1 of 2 FTSE 10-18

Certification Statement:
1, W. Todd Lambert, F.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 1 and 11 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. ;L:;,
Signing Official Signature
Cily En ineer
Title of Signing Ogcial
Date
Page 2 of 2 FiSE 1 a-18

PROJECT DESCRIPTION
The project is located on an approximately 71.51 acre tract in Alamance County,
Burlington, NC. The purpose of the project is to construct Phases 2 & 5A of Brassfield
Meadows Subdivision. Phase 2 will include 26 new single family houses with public
roads, water and sewer. 25 of these houses are included in the subdivision project. 1 of
the houses is a Habitat for Humanity home that the developer is helping with. The project
shares a common property line with the Habitat For humanity home. Phase 5 will include
23 new single family houses with public roads, water and sewer.
SITE DESCRIPTION
The site consists of 71.51 acres more or less and is currently field/wooded and vacant.
ADJACENT PROPERTY
Land use in the vicinity is single family residential. The site will access the public street
network by extending Plains Drive.
SOILS INFORMATION
The soil in the project area is mapped as HeC - Helena Sandy Loam, Heb -- Helena Sandy
loam, and Wd-Worsham Sandy Loam per USDA Natural Resources Conservation
Service Web Soil Survey. Soils are in hydrologic group "B". The existing site slopes are
approximately 2 to 10.0% average slope.
OWNERSHIP
Keystone Group Incorporated currently owns the entire 71.51 acre tract. There are no
plans to sell off phases current or future at the present time.

m
*Bras Sfield Meadows
a
A'U'�
Hook er-!St
CD
V)
n
lowarcl-St—'
OL
ILI
-'WsAer-St
IFF,

Ihp NaUcpp! Map
US Topo
BURLINGTON QUADR0
NORTH CAROLINA - ALAMANCE
7.5-MINUTE SERIES
39 40 41 42 \ 43 44 45
MAPLE AWE OR
ARRlAGE.[00P 1�
- E)� �pOSs ..rf 1
pedale/. lywDi
L
Morgant
412
80
F,4p4ss ,
K
r dOR E Nq�rthlairncem St�leyCrr
f _ ' y 1 'CEO �d� 1 � � �'a� �''^{ - e•�rP ' ' � � ' I �a ��1
SFT —�i-
'RQR �~-
700
t;�«-�_�'�"
v asr J PIC
I
F 2 RAiNE7 SI
y -DP fiytff ; bi HAWS
�l� �I AQO} St �n u_Oid.3HOMp AVf r- 1 .- r•
' 4Apo �i.. ,� -�G1D .. ESW00D ST pEDj[pN WA7 z A iU '
w Qa
aw
. Ls•Ub OR I AA
4Ce