WQ0041871_Application (FTSE)_20200803

Sherri Knight, PE
NCDEQ— Division of Water Resources
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Dear Ms. Knight:
DAvis • MARTIN • POWELL dm ENGINEERS & SURVEYORS
July 31, 2020
Re: City of Greensboro, NC
Force Main Relocations as part of
US Highway 70 Widening
NCDOT Project U-2581BA
DMP Project 180212 (BF)
r,:.. uaNartimerit cr
Environmental Quality
Received
3
Winston-Salem
Rep
i7nal G` i^ s
Davis -Martin -Powell is providing utility engineering design services for NCDOT Project U-2581BA, which
involves the widening of US Highway 70 (Burlington Road) from west of Mount Hope Church Road to east of
Birch Creek Road in Guilford County. Two sections of Greensboro's existing 16" Rock Creek Force Main, and a
section of the existing 8" Birch Creek Force Main will have to be relocated due to conflicts with proposed
roadway and storm drainage improvements.
The existing 16" Rock Creek Force Main to the east of Birch Creek Road is being abandoned by others as part of
a separate City of Greensboro project. The new Rock Creek Force Main will convey wastewater from the
existing Rock Creek Lift Station to the new Stewart Mill Lift Station, located to the south of 1-40/85.
The existing 8" Birch Creek Force Main, which conveys wastewater from the Birch Creek Lift Station, ties into
the old 16" Rock Creek Force Main at the intersection of US Highway 70 and Birch Creek Road. The existing 8"
Birch Creek Force Main, a portion of which will be relocated as part of the U-2581BA project, will remain in
service for about four more years. The City of Greensboro is planning to extend a new gravity sewer outfall to
the Birch Creek Lift Station, which will allow this lift station to be abandoned. Since the Birch Creek Lift Station
and Force Main must remain in service for approximately four more years, the existing 16" Rock Creek Force
Main, which runs parallel to US Highway 70 to the west of Birch Creek Road, must also remain in service during
that timeframe. Sections of the existing 16" Rock Creek Force Main that are in conflict with proposed roadway
and storm drainage improvements will be relocated/replaced with sections of 8" force main because they only
have to convey wastewater being pumped from the Birch Creek Lift Station through the 8" Birch Creek Force
Main. Please see the topographic exhibit map that is included with the permit application package for an
illustration of the force main configuration described above.
As part of the U-2581BA project, approximately 652 L.F. of the existing 16" Rock Creek Force Main will be
relocated/replaced with 8" force main, and approximately 385 L.F. of the existing 8" Birch Creek Force Main
will be relocated/replaced with 8" force main. After the Birch Creek Lift Station is abandoned in about 4 years,
the Birch Creek Force Main and the remainder of the existing Rock Creek Force Main can be abandoned.
T: 336-886-4821 • F: 336-886-4458 • License: F-0245
6415 Old Plank Road, High Point, NC 27265 • www.dmp-inc.com

NCDOT Project U-2581BA
Sewer Permit Application Package 713112020 Page 2 of 2
Enclosed are the following items concerning the referenced project, for your review and approval:
• One (1) original and one (1) copy of the executed Fast -Track Sewer System Extension Application
• Two (2) copies of the Flow Tracking/Acceptance Form (FTSE-04-16)
• Two (2) copies of the 8.5"x11" color USGS quad map exhibit
• Two (2) copies of the 8.5"x11" color street -level map exhibit
• Check No. 064847 in the amount of $480.00 for the application fee
We trust this information is complete and will allow you to proceed with your review of enclosed permit
application package. If you have any questions, please do not hesitate to contact our office.
Sincerely,
DAVIS • MARTIN • POWELL & ASSOCIATES, INC
Andrew P. Larrick, PE
c: Jay Guffey, PE —City of Greensboro (enc)
File (enc)
P: 12018k180212�PermitsISewer�DWR-FM Relocotions�U-25818A-DWR Transmittal 2020-07-31.docx

DWR State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
1. Applicant's name: City of Greensboro NC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation rp ❑General Partnership ❑Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Steven D. Drew per 15A NCAC 02T 0106(b)
Title: Director of Water Resources
4. Applicant's mailing address: P.O. Box 3136
City: Greensboro State: NC Zip: 27402-3136
i`t- U'loFJ M 1-1 C: i ll, t:l
knvlrcliniental ili,ltai y
Received
5. Applicant's contact information: 0
Phone number: [phone] Email Address: Steve Drewna greensboro-nc gov
Winston-5al-a:n
II. PROJECT INFORMATION: F rri mai r.;
1: Project name: Force Main Relocation as part ofNCDOT Project U 2581BA
2. Application/Project status: ® 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 permit number: WQ00_
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.084949' Longitude:-79.6678090
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Andrew P. Larrick License Number: 26457
Firm: Davis -Martin -Powell and Associates Inc.
Mailing address: 6415 Old Plank Road
City: High Point State: NC Zip: 27265-3274
Phone number: 336) 886-4821 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: T.Z. Osborne WWTP Permit Number: NCO047384
Owner Name: City of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ unknown / varies
System Wide Collection System Permit Number(s) (if applicable): WQCS00006
Owner Name(s): City of Greensboro
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 ❑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/Pro e�rty Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
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 / 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 % Domestic/Commercial % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow °'"
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 GPD
a See 15A NCAC 02T .0114(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.01141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC 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:
® 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) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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 requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station munber or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) 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
8"
1,037
DIP
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with 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
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):
➢ 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.
➢ 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 ptunp, including travel timeframes, sball 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(f)):
1. Does the project comply with all separations 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)
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 II impounded 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
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainages stems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnage
➢ If noncompliance with 02T.0305( or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related perm is shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. 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 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 02T.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 ® No
➢ 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 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, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast Track Application and suimortine
documents.
2. Professional Engineer's Certification:
Ln,r rr
Engineer's name from Application Item
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: �\ 1 C ARC//ice
`oo i = 26457
9�0�NGINE�q.'�V��
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I attest that this application for
(Signature Authority's name & title from Application Item I.3.)
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, certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to excee4i$10,000 as well as evil penalties up to $25,000 per violation.
Signature:
Date: — c�
U
FORM: FTA 04-16 Page 5 of 5

Division of kVater 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: City of Greensboro
Project Name for which flow is being requested: FM Reloc.- NCDOT PmJ. U-2581BA
Afore than one FTSE nay be regnired for a single project if the owner of the li'WTP is not responsible for rdl pump
stations along lire 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: TZ Osborne W
b. WWTP Facility Permit #: NCO047384
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
40.00
2.6651
29.87
32.5441
81.36
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
Obligated, Total
Pump Pump Daily
Approx.
Not Yet Current
Station Station Firm Flow**
Current Avg.
Tributary Flow Plus
(Name or Permit Capacity, * (Firm / p0,
Daily Flow,
Daily Flow, Obligated
Available
Number) No. MGD MGD
MGD
MGD Flow
Capacity***
Stewart
r Rai .0034 0.00116
0.00018312
0.00002407 0.000207
0.00115
The Firm Capacity (design flow) of any pump station is defined as the maximum pumped Bow
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):
Downstream Permit Number:
Page I of 6

III. Certification Statement:
I �14t1C /t e c,I5,6V 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.
Title of
1zC-)
Page 2 of 6

PROJECT MAP FOR
PROPOSED SEWER IMPROVEMENTS TO BE INSTALLED
AS PART OF NCDOT PROJECT U-2581BA
(WIDENING OF US HIGHWAY 70 FROM
WEST OF MT. HOPE CHURCH ROAD
TO EAST OF BIRCH CREEK ROAD)
SCALE 1.24 ooc'
LEGEND
EXCERPT FROM USGS QUADSHEET:
^•••^•••••• EX. SEWER FORCE MAIN
MCLEANSVILLE, NC
PROPOSED SEWER
FORCE MAIN RELOCATION 2019

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