WQ0042683_Application (FTSE)_20210714

Frigincers
Planners
-- Surveyors
t 7_', 7
Borum, Wade and Associates, P.A.
July 13, 2021
N.C.D.E.Q.
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road (Suite 300)
Winston-Salem, NC 27105
Regarding: Forestdale Meadows Apartments
Access off of Forestdale Drive
Burlington, NC
FTA 04-16 for Gravity Sewer (Private)
Dear Sir or Madam:
Forestdale Meadows, LLC proposes to develop the above noted 80 unit apartment
complex. In conjunction with this development, a new private gravity sanitary sewer line
owned by the Forestdale Meadows, LLC will be installed. The entrance to this project is
located off the Forestdale Drive in Burlington, North Carolina. The proposed private
sanitary sewer line will tie in to the City of Burlington's proposed gravity sanitary sewer
outfall running down the proposed drive.
Please find the following attached information for review for processing a Gravity Sewer
Permit for the above mentioned project. Included in this package are the following.
1. One original and one copy of the Fast Track Application.
2. One check for $480
3. One original and one copy of the Downstream Sewer Flow Tracking/Acceptance.
4. One original and on color copy USGS Topographic Map and one street level map.
Please call if you have any other questions.
Best Regards, nn 11
W JV,
Jonat n Wade
621 Eugene Court, Suite 100, Greensboro, NC 27401-2711 • PO Box 21B62, Greensboro, NC 27420-1882
Phone [phone] • Fax [phone]
Website: www.borum-wade.com

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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
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
I, APPLICANT INFORMATION:
1. Applicant's name: Forestdale Meadows, LLC (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: Stephen D Bro per 15A NCAC 02T .0106(b)
Title: Managing Member - Forestdale Meadows, LLC
4. Applicant's mailing address: PO Box 787
City: Arnold State: MD Zip: 21012
5. Applicant's contact information:
Phone number: 336 813-3697 Email Address: stephennubrockvi.com
H. PROJECT INFORMATION:
1. Project name: Forestdale Meadows Apartments
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.076944° Longitude:-79.494167'
5. Parcel ID (if applicable): 173292
(or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
1. Professional Engineer: T. Eugene Mustin License Number: 20709
Firm: Borum, Wade & Associates, P.A.
Mailing address: 621 Eugene Court - Suite 100
City: Greensboro State: NC Zip: 27401-
Phone number: 336) 275-0471 Email Address: jwadena borum-wade.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: South Burlington W WTP Permit Number: NCO023876
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. PermitNumber(s): WQ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): _
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 0 % Commercial
0 % 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(f) ❑ Yes ® No
➢ If yes. Provide a coov of flow reduction aooroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow ° s
No. of Units
Flow
1 or 2 Bdmi Units
240 gal/day
54
12,960 GPD
3 Bdrm Units
360 gal/day
26
9,360 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
TO
22,320 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.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 22,320 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
8
427.42
D.I.P.
8
102.77
P.V.C.(SDR-35)
➢ 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
VIIL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Puma 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)(I):
❑ 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(f) & (g)
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
5/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-1 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.0305(c) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboaue
➢ If noncompliance with 02T.0305M or W, 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 02B .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 Permittin Be ranch
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 ® 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 system comply with 15A NCAC 02T the
and Force Mains (latest version), and the Gravity Sewer Minin
as applicable?
SrYes ❑ 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 required Prior to submittal of the Fast Track Application and suoportine documents
2. Professional Engineer's Certification:
3.
T. Eugene Mustin attest that this application for
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 143-215.6B, 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.
North Carolina Professional Engineer's seal, signature, ai
2trL1
Applicant's Certification per 15A NCAC 02T .0106(b): '
Stephen D. Brock
I, Managing Member Forestdale Meadows LLC 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, 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: I Date: D
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
� 1
#` V�
Department of Environment and Natural Resources
Division of Water Resources
tDiviston of 1Nater resources plow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 10-18)
Entity Requesting Allocation City of Burlington
Project Name for which flow is being requested: Forestdale Meadows Apartments
More than one FTSE may be requiredfor a single project if the owner of the WWTP is not responsible for all pump stations
along the roate of the proposed wastewaterflow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: South Burlington W WTP
b. WWTP Facility Permit #: NCO023876
Affflows tare In MGD
c. WWTP facility's permitted flow
12.00
d. Estimated obligated flow not yet tributary to the WWTP
1.804009
e. WWTP facility's actual avg. flow
8.752000
f. Total flow for this specific request
0,022320
g. Total actual and obligated flows to the facility
10.578329
h. Percent of permitted flow used
$8.15%
U. Complete this section for each pump station you are responsible for along the routs of this
proposed wastewater flow.
List pump stations located between the project connection point
and the WWTP
(A)
(8)
(C) (D)=(B+C) (E)=(A-D)
Design
Obligated,
Average Daily
Approx.
Not Yet Total Current
Pump Station Firm Flow"
Current Avg.
Tributary Flaw Plus
(Name or Capacity, * (Firmfpl),
Daily Flow,
Daily Flow, Obligated Available
Number) GPD GPD
GPD
GPD Flow Capacity*"
.m
"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 lose than 2.8.
*** 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) : Gunn Creek Outfall
Downstream Permit Number:
1 of a FTSE 10-18

tfl. 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 asseessment 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 addendum$ for which 1 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
(,-a-
Date
2 of 6 FTSE 10-18