WQ0042112_Application (FTSE)_20201117

State of North Carolina
nWR
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T A300 -- FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: C t rof Burlington (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
Federal ❑ State/County ® Municipal
3. Signature authority's name: Hardin Watkins per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 425 South Lexington Avenue
City: Burton State. NC Zip: 27215-
5. Applicant's contact information:
Phone number: 336 222-5050 Email Address: Engineering(cici.burlvngton.nc.us
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Brassfield Meadows Subdivision —Phases 3 4 5B
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: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1248° Longitude:-79.4345"
5. Parcel ID (if applicable): 170825
(or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
1. Professional Engineer: Chuck Trubv License Number: NC 14984
Firm; CPT Engineering and Surveying, Inc.
Mailing address: 4400 Tuning Street
City: High Point State: NC Zip. 27265-
Phone number: 336 822-8800 Email Address: chuckt(ajkcptengineerinP com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. facility Name. East Burlington. Wastewater Plant Permit Number: NCO023868
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. PermitNumber(s): WQ0039634
System Wide Collection System Permit Number(s) (if applicable): WQCS00008
Owner Name(s): City of Burlington
FORM: FTA 04-16 Pagel of5

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 Owners' Association has an Operational. Agreement FORM:11OA 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: 100 % Domestic/Commercial °/a Commercial
% Industrial (See 15A NCAC 02T_0103(20))
4 Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ❑ No
If as, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow a,n
No. of Units
Flow
Single Family Residences
360 gal/day
84
30,240 GPD
gal/day
GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
GPD
Total
30,240 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: 30,240 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):
Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
3,118
SDR-21
8
60
DIP
Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Section Ill contains information related to minimum slopes for gravity sewer(s)
Oversiziag Braes to meet minimum slope requirement is not allowed and a violation of the MDC
VHI. 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 number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: 0 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 (TD14)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
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 pump, including travel timeframes, shall be provided in
the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

1X. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(1)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (a) ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations flint shall he nrnuirlPri fnr.cParPr evct.-mv-
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
IS 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 I or
Class 1T 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 elevatian and wetlands see item IX2
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
Drains e systems and interce for 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 webpaae
If noncompliance with 02T.0305(fl or Ll 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 permits 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 b , 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 Iine, 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 -Wade 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 GravitySewer 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 reauest is re uired prior to submittal of the Fast Track Application and supportina
documents.
2. Professional Engineer's Certification:
1 Charles P. Truby, Jr. attest that this application for
Brassfield Meadows Phases 3, 4, & 5B
(Professional Engineer's name from Application Item Ill.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. 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):
(Signature Authority's n
& title frWm Application Item I.3.)
18VI
attest 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 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 $ I0,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date: lea - Z 0 - Zo
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
DW Division of Water Resources
,,R
i7hvNIon of Water itescstirce•. 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 Ph3,4, 5A
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.
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 #: NC 0023868
All flows are in MGD
c. WWTP facility's pennitted flow 12.00
d. Estimated obligated flow not yet tributary to the WWTP 1.910073
e. WWTP facility's actual avg. flow 5.0740
f. Total flow for this specific request 0.030240
g. Total actual and obligated flows to the facility 7,014313
h. Percent of permitted flow used 58.5%
H. 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 Plus
Pump Station Capacity, * Flow** Daily Flow, Daily Flow, Obligated Available
Name GPD (FirmlpD, 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 WWTP where the Available Capacity s 0.
Downstream Facility Name (Sewer)
Downstream Permit Number:
Nat Known
Not Known
Page 1 of 2
FTSE 10-18

Certification Statement:
1, 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 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.
Signing Official Signature
City Engineer
Title of Signing Official
11-1v-Z-0w
.Date
Page 2 of 2 FTSE 10-18

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NARRATIVE
FOR
Brassfield Meadows Subdivision
Phases 3-5-5B
ALAMANCE COUNTY
BURLINGTON, NORTH CAROLINA
November 11, 2020
OWNER / DEVELOPER:
Keystone Group, Inc.
3708 Alliance Drive
Greensboro, NC 27407
[phone]
ENGINEER:
CPT Engineering and Surveying, Inc.
4400 Tyning Street High Point, NC 27265
Phone [phone] • Fax [phone]

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 3,4, and 513 of
Brassfield Meadows Subdivision. Phase 3, 4, and 5B will include 84 new single family
houses. These will be the final phases of the project and so the certification at completion
will be the final certification for the project.
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.