WQ0043767_Application (FTSE)_20220914

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: WQD45iwmbecompletedbyDwR)
All items must be comoleted or the aonlication will be returned
L APPLICANT INFORMATION:
1. Applicant's name: Hawthorne -Midway Brightwood Farm. 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: Phil Pavonk per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 806 Green Valley Road, Suite 311
City: Greensboro State: NC Zip: 27408
5. Applicant's contact information:
Phone number: [phone] Email Address: pmavonk�a,hpliving com
H. PROJECT INFORMATION:
1. Project name: Hawthorne at Brightwood Farm
2. Application/Project status: ® Proposed (New Permit) . ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date: _,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.070984' Longitude:-79.584771 °
5. Parcel ID (if applicable): 8824751391 or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Nolan Franz License Number: 050507
Firm: Hagen Engineering, PA
Mailing address: 3859 Battleground Avenue, Suite 300
City: Greensboro State: NC Zip: 27410
Phone number: 3( 36) 286-3350 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: TZ Osborne Permit Number: NCO047384
Owner Name: City of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): W00022153
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): C of Burlington
FORM: FTA 06-21 Page I 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 HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually 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: LOIZ%Domestic _%Commercial _ %Industrial (See 15A NCAC 02T .0103(20))
If Industrial, 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 cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow ",b
No. of Units
Flow
Multifamily Dwelling— I Bedroom
240 gal/day
30
7200 GPD
Multifamily Dwelling — 2 Bedroom
240 gal/day
36
8640 GPD
Multifamily Dwelling — 3 Bedroom
360 gal/day
6
2160 GPD
0 GPD
0 GPD
GPD
Total
1 18000 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 .01 L 4(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: 18000 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timefmme for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain): _
FORM: FTA 06-21 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" 534' PVC
➢ 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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
3. Total number of pumps at the pump station:
3. Design flow of the pump station: _ millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): _ gallons per minute (GPM) at _ feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have 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 and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day I SA NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

M. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & (a)? ® 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)
18 inches
'Water mains (vertical - water over sewer preferred, 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 impounded reservoirs used as a source of drinking water, and associated wetlands.
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 associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
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
➢ If noncompliance with 02T.0305(f) or (g), see Section X.1 of this application
*15A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(t) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webr aye
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ®Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ Seethe Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Cape Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per I SA NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. 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 must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" []Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ 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 permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 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, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance anoroval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is reouired.
2. Professional Engineer's Certification:
I, F(0.J1 :� , attest that this application for Hawthorne at Brightwood Farm
(Professional Engineer's name from Application Item III.1.) (Project Name from Application Item II.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,
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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
I no-L
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, ph " 1 P 6- V Ur k , attest that this application for H el 414hyQ7 C C4 Brr A/ Lewd
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item I1.1) FG✓ rt
attest that this application 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: V & ` k Date:
6-9-2022
FORM: FTA 06-21 Page 5 of 5

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7/22/22, 4:41 PM
GIS Data Viewer
Parcel Number 106269 Total Out Building Value 0
PIN 8824751391 Total Land Value 1064500
Owner HAWTHORNE-MIDWAY BRIGHTWOOD FARM LLC ! Total Deferred Value 0
Owner History Card Image .. ''. Bldg Card .
Mad Address
806 GREEN VALLEY RD STE 311
Appraisal Model Code
Mail City
GREENSBORO
!.. Deed Data
12/28/2021
Mail State
NC
'.. Neighborhood
8824A02
Mail Zip
27408
! Property Type
RESIDENTIAL
Property Address
613 BRIGHTWOOD FARM PKWY
Structure Size
Legal Description
BRIGHTWOOD FARM PL208-34-
Lot Size
21.29
Deed-008560-01603
Year Built
Plat.
208-34
!Bedrooms....... _.
Condo
:. Bathrooms
Total Assessed
1064500
Grade
Total Building Value
0 _..
..... _.
Disclaimer.. While every effort is made to keep information provided over the internet accurate and
up-to-date, Guilford County does not certify the authenticity or accuracy of such information. No
warranties, express or implied, are provided for the records and/or mapping data herein, or for their
use or interpretation by the User.
Map Scale
1 Inch = 500 feet
7/22/2022
https:l/gisdv,gulifordcountync.gov/guiifbrdt 1/1

State of North Carolina
t.. F a r Sri i Department of Environment and Natural Resources
TO
& Division of Water Resources
UR4latnn eef 1Ndle•t'Rr>,ouracs 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: Hawthorne @ Brightwood Farm - Private
More than one MA-10107 may be required for a single project ifthe owner of the WWTP is not responsible for al/pump stations
along the route of the proposed wastewater flow.
Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: City of Burlington Collection System
b. WWTP Facility Permit #: WOCS00008
All flows are in GPD
c. WWTP facility's permitted flow Allocation from Greensboro 900,000
d. Estimated obligated flow not yet tributary to the WWTP 164,688
e. WWTP facility's actual avg. flow 341,622
f. Total flow for this specific request 54,000
g. Total actual and obligated flows to the facility 560,310
h. Percent of permitted flow used 62.3%
1I. Complete this section for each pump station you are responsible for along the route of this
List pump stations located between the project connection point and the WWTP : None
(A)
(B)
(C)
(D)=(B+C)
Obligated,
Total
Design
Approx.
Not Yet
Current Flow
Firm Average Daily
Current Avg.
Tributary
Plus
Pump Station Capacity, ` Flow"
Daily Flow,
Daily Flow,
Obligated
Name GPD (Firm/pf1, GPD
GPD
GPD
Flow
None
(E)=(A-D)
Available
Capacity...
" The Firm Capacity of any pump station fa deflned 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 lase 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) : Brightwood Farms Phase4, Section I
Downstream Permit Number: WQ0030417
Page 1 of 2 FTSE 10-18

Certification Statement:
I, 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 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
Signing Offlclal Signature
City Engineer
Title of Signing Official
'7i7,/
Date
Page 2 of 2 FTSE 10-18

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Olvlslon of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Burlington
Project Name for which flow is being requested: Hawthorne 6c7 Brightwood Farm - Private_
More than one FTSE may be required for a single project tithe owner of the WWTP is not responsiblefor 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: T.Z. Osborne
b. WWTP Facility Permit #: NCO047384
All flows are in MGD
c. WWTP facility's permitted flow
56.0
d. Estimated obligated flow not yet tributary to the WWTP
0.7237
e. WWTP facility's actual avg. flow
34.7800
f. Total flow for this specific request
0.0180
g. Total actual and obligated flows to the facility
36.9237
h. Percent of permitted flow used
65.9%
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:
(A)
Design
Pump
Pump
Average
Station
Station
Firm
Daily Flow**
(Name or
Permit
Capacity, *
(Firm / pf),
Number)
No.
MGD
MGD
Rock
37034
4.32
2.057
(R)
(C)
(D)=(B+C)
(D')=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current
Tributary
Flow Plus
Avg. Daily
Daily Flow,
Obligated
Available
Flow, MGD
MOD
Flow
Capacity***
1.257
0.4108
1.6679
0.3892
Stewart, 38555 10.224 4.963 1.796 0.2924 2.0885 2.8746
A' 1
* 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
(pl) 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): City of Greensboro T.Z. Osborne
Downstream Permit Number: NCO047384
Page 1 of 6
FTSE 1()-18

III. Certification Statement:
I Wendy Messer 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.
Date
D�anany eianea nywaaav Maser
DN G(IB
Wendy MesserGCryMGreenabwo CN We ay Mmee a'a04
Dab. 204.09.1314:05I 00
Page 2 of 6
FTSE 10-18

HAGEN 3859 Battleground Ave, Suite 300
ENGINEERING, PA Greensboro, NC 27410
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road Suite 300
Winston-Salem, North Carolina 27105
[phone]
RE: Hawthorne at Brightwood Farm
Private Sewer Permit
Cover Letter
t NC DepartmentnP
Envircnrncrital (-,ualwv
Received
�FP 14 2G22
1
Winston-Salem
Regional Office
Phofie:[phone]
www.hagen-eng.com
September 2, 2022
The purpose of this cover letter is to outline the contents of this Private Sewer Permit
application package as well as to provide of a summary of the project to which is pertains. The
overall Hawthorne at Brightwood Farm development is a 312 unit multifamily complex. This
Private Sewer permit will require an estimated peak flow of 18000 GPD for utility consumption,
due to a majority of the peak flow for the project being allocated for the Public Sewer permit
being applied for the same project. This portion of the project will be comprised of 534 LF of 8"
PVC private gravity sewer main. Within this submittal package you will find the following items:
1) $480 check for the Private Sewer Permit
2) One completed DWR Fast Track Sewer System Extension application
3) One executed FTSE 04-16
4) One 8.5" x 11" USGS Topo Map
5) One street level map (aerial)
6) One copy of application and supporting documents
Thank you,
K. Bryce Morrison
Hagen Engineering, PA
336-286-3350