WQ0042093_Application (FTSE)_20201104

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 — 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: Town of Gibsonville (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Ben Baxley per 15A NCAC 02T .0106(b)
Title: Town Manager
4. Applicant's mailing address: 129 West Main Street
City: Gibsonville State: NC Zip: 27249-
5. Applicant's contact information:
Phone number: [phone] Email Address: bbaxleykgibsonville.net
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Hwy. 61/70 Water & Sewer Extension
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: 36.08' Longitude:-79.55'
5. Parcel ID (if applicable): 104759
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Brent Mills License Number: 048946
Firm: Alley, Williams, Carmen & King Inc.
Mailing address: 740 Chapel Hill Road, P.O. Box 1179
City: Burlin tgton State: NC Zip: 27216-
Phone number: [phone] Email Address: bmills9awck.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: South Burlington Wastewater Treatment Plant Permit Number: NC 0023876
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQN/A Downstream (Receiving) Sewer Size: 16 inch
System Wide Collection System Permit Numbers (applicable): WQCS00349
Owner Name(s): Town of Gibsonville
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/Property 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 N/A % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
4,Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ®No
➢ If Yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
Single Family Home, 3-bedroom
360 gal/day
3
1,080 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
1,080 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: 1,080 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
16
3,862
DIP
8
2,456
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 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 number 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
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

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(D & (g)
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
® Yes ❑ No
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
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305W contains alternatives where separations in 02T.0305(t) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ 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 ❑ N/A
➢ 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 setbacks found in the river basin rules per 15A NCAC 0213.0200? ®Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ® Yes [—]No
individual permits or 401 Water Quality Certifications?
➢ 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.0 I 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 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 ❑ N/A
➢ 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 systeni comply with 15A NCAC 02T. the Minimum Design Criteria for the Permittine of Pumn Stations
anu cuicc ivlaiAla (iaiwi vcwiuii), and tiro Glavii acwcl Nliniguum DrG ii ii C6ictia 1atcai vclaiun' as appii,.�ablc:
® Yes ❑ No
IfNo, 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 supporting documents.
2. Professional Engineer's Certification:
3.
I S. Brent Mills attest that this application for
(Professional Engineer's name from Application Item I11.1.)
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:
Applicant's Certification per 15A NCAC 02T .0106(b):
I, ,gin Baxley , own
(Signature
mouger
& title from Application Item I.3.)
�rSr�1 L
�� � •••• F� 1 NEB • � ��
j,Fiv B.
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. f 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 $10,000 as well as civil penalties up to $25,000 per violation.
"4 Signature: Date: I11,310 Q 2
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
QWR
Division of Water Resources
Entity Requesting Allocation:
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Town of Gibsonville
Project Name for which flow is being requested: Hwy. 61/70 Water & Sewer Extension
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: Town of Gibsonville Collection System
b. WWTP Facility Permit #: WQS 00349
All flows are in MGD
c. WWTP facility's permitted flow .800 - Gib South Allocation
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
£ Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
.011540 - Gib South
.402000 - Gib South
.001080
.413540 - Gib South
51.7% of Gib South Alloc.
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)
Design
Pump
Pump
Average
Approx.
Station
Station
Firm Daily Flow**
Current
(Name or
Permit
Capacity, * (Firm / pf),
Avg. Daily
Number)
No.
MGD MGD
Flow, MGD
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated Available
MGD
Flow Capacity***
* The Firm Capacity (design flow) 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 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): Town of Gibsonville
Downstream Permit Number: WQS00349
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Ben Baxley 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 Il 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
Title of Signing OjJicial
Page 2 of 6
FTSE 10-18

Town of Gibsonville USE - Total
WWTP - FY 19-20 Flows
GPD
Total Flow
660,378
Total Allocation
1,550,000
WWTP - Allocated Flows - Non -Tributary
Project Name GPD
East Plant Total
66,360
South Plant Total
11,540
Total Allocated - Non Tributary Flows
77,900
Proposed Flows
Project Name GPD
HWY 61/70 Water&Sewer Extension
1,080
Total Flows
739,358
Permitted Flows
1,550,000
Percentage of Permitted Flow
47.7%

Town of Gibsonville - East Plant (North) Allocation
East Plant - FY 19-20 Flows
Station Name
GPD
% of Allocation
Gibsonville Flow
258,378
34.5%
East Plant Allocation
750,000
Travis Creek - Calendar Year 2017 Flows
Station Name
GPD
% of Station
Capacity
Travis Creek Pump Station
472,378
59.0%
Total Flow
472,378
Elon Flow
214,000
Manning Meter Flow (GIB to Elon)
18,000
Gibsonville Flow
258,378
WWTP - Allocated Flows - Non -Tributary
Project Name GPD
Joseph's Claim - Phase 2, Section 3 36,480
Manning Crossing Phase 5 15,840
Stone Ridge - Preserve 14,040
Total Allocated - Non Tributary Flows 66,360
Total Allocated - Non Tributary Flows - Elon 37,220
Proposed Flows
Project Name GPD
Total Allocation Flows
338,778
45.2%
Total Pump Station Flows (Elon & Gib)
589,998
73.7%
Situation
GPD
% of Capacity
Peak Capacity of Station - Current
2,000,000
29.5%
Average Daily Flow Capacity - Current
800,000
73.7%

Town of Gibsonville - South Plant Allocation
South Plant - FY 19-20 Flows
Station Name
GPD
Gibsonville Flow
402,000
South Plant Allocation
800,000
South Plant - Calendar Year 2017 Flows
Description
GPD
Total Flow - South
402,000
Gibsonville Flow - Back Creek
328,000
Gibsonville Flow - Westbrook
74,000
WWTP - Allocated Flows - Non -Tributary
Project Name
GPD
Ashley Woods Phase 3 - (1/2)
4,340
Savannah Glen Phase 4 - (Partial)
7,200
Total Allocated - Non Tributary Flows
11,540
Proposed Flows
Project Name
GPD
HWY 61/70 Water&Sewer Extension
1,080
Total Flows to South Plant
414,620
51.8%
Situation
GPD
% of Capacity
Peak Capacity of Station - Current
N/A
Average Daily Flow Capacity - Current
N/A

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Mvi-Jon of Water Resiaciytcz., Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 10-18)
Entity .Requesting Allocation City of Burlington
Project Name for which flow is being requested: Town of Gibsonville
Alare 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 ofthe proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit #:
South Burlington WWTP
NC0023876
All flows are in MGD
c. WWTP facility's permitted flow 12.00
d. Estimated obligated flow not yet tributary to the WWTP 1.783309
e. WWTP facility's actual avg. flow 8,752000
f. Total flow for this specific request .00108 (Gibsonville)
g. Total actual and obligated flows to the facility 10.535309
h. Percent of permitted flow used 87.79%
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
(A)
(B)
(C)
(D)=(B+C) (B)=(A-D)
Design
Obligated,
Average Daily
Approx.
Not Yet
Total Current
Pump Station
Firm Flow**
Current Avg.
Tributary
Flow Plus
(Name or
Capacity, * (Firmlpf),
Daily Flow,
Daily Flow,
Obligated Available
Number)
GPD 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 5 0.
Downstream Facility Name (Sewer)
Downstream Permit Number:
Unknown
1 of 6
FTSE 10-18

III. Certification Statement:
I, W. Todd Lambert, P.E. certify to the best of my knowledge that the addition of the
volume of wastewater to e 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 H 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 Date
City Engineer
Title of Signing Oficial
2 of 6 FTSE 10-18

aW alley, williams, carmen & king, inc®
OKI-ngineering • Architecture • Ltind Sui-vcYing
November 16, 2020
Mr. Justin Henderson
North Carolina Department of Environmental Quality
Division of Water Resources
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Subject: Fast Track Application for Gravity Sewers, Pump Stations & Force Mains
Town of Gibsonville — Hwy. 61/70 Water & Sewer Extension
AWCK Project No. 19016
Dear Mr. Henderson:
On behalf of the Town of Gibsonville please find enclosed for your review and approval the following:
1. One (1) Electronic copy of Fast Track Application with required certification.
2. One (1) Electronic copy of Flow Tracking for Sewer Extension Application.
3. Color USGS map showing project and surrounding areas
4. Street Level Map
The Town of Gibsonville is installing 3,862 LF of 16" DIP sewer main and 2,456 LF of 8" DIP sewer main to
serve future development areas within Town limits. In addition to serving short term developments, the
16" sewer main is sized to be extended to long-term development areas.
Should you have any questions or need any additional information, please feel free to contact me.
With Best Regards,
Alley, Williams, Carmen and King, Inc.
S. Brent Mills, P.E.
cc: Ben Baxley, Town of Gibsonville
740 Chapel Hill Road (27215) • P.O. Box 1179 • Burlington, North Carolina 27216
Tel. - [phone] • Fax - [phone] • awck.com
ESTABLISHED * 1960

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ENGINEERS & ARCHITECTS STREET LEVEL MAP
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ENGINEERS &ARCHITECTS
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740 chapel hill road p.o. box 1179 SCALE: 1 " = 2, 00WDATE:10112120 MAP BY. SBM
burlin ton nc 27216 336 226-5534