WQ0043768_Application (FTSE)_20220916

DWR
Division of Witter Resources
Application Number:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
(to be completed by DWR)
All items must be completed or the implication will be returned
1. APPLICANT INFORMATION:
I. Applicant's name: City of Burlington (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: David Cheek per 15A NCAC 02'f .OI06(b)
Title: Interim City Manager
4. Applicant's mailing address: 425 S Lexington Ave.
City: Burlington State: NC Zip:27215
5. Applicant's contact information:
Phone number: (336)-222-5050 Email Address: engineering@burlingtomlcgov
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
L 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)
Ill. CONSULTANT INFORMATION:
1. Professional Engineer: Nolan Franz License Number: 050507
Firm: Hagen Engineering, PA
Mailing address: 3859 Batttearound Avenue. Suite 300
City: Greensboro State: NC Zip: 27410
Phone number: (336 286-3350 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: TZ Osborne Permit Number: NCO047384
Owner Name: City of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. Permit Number(s): W00022153
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Numbers) (if applicable): WQCS_
Owner Name(s): City 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?
NUMMEMEOM
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: FICA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® NIA
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: 100 %Domestic _%Commercial _ %Industrial (See 15A NCAC 02T .0103(20))
If Industrial, 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 yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(i))
Daily Design Flow "-"
No. of Units
Flow
Multifamily Dwelling — i Bedroom
240 gal/day
90
21600 GPD
Multifamily Dwelling — 2 Bedroom
240 gal/day
120
28800 GPD
Multifamily Dwelling — 3 Bedroom
360 gal/day
30
10800 GPD
Clubhouse
25 gal/employee/day
4
100 GPD
Pool
10 gal/person/day
50
500 GPD
gal/
GPD
Total
61800 GPD
a See 15A NCAC 02T .0114(b), (dl. (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: 61800 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 40305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
S" 1470' VCP
➢ Section 11 & 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)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
Vill. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Punta Stations/Farce 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 Ingest pump out of service.
4. Operational point(s) per puntp(s): _ gallons per minute (GPM) at _ feet total dynamic head ('I'DH)
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-inclies in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(I):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(E):
➢ Required for all pump stations with an average daily flow greater that or equal to 15,000 gallons per day
➢ Must be perntmuent to facility and may not be portable
Or if the pump station has oil average daily flow less than 15,000 gallons pet -day 15A 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 tintefrantes, shall be provided
as pat of this permit application in the case of a multiple station power outage.
FORM: FTA 06.21 Page 3 of 5

IX. SETBACKS & SEPARATIONS —(02B.0200& 15A NCAC 02T.0305(t)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(fi & (g)? N Yes ❑ No
1 iA Nr'Ar` WT r110Crrn rnntainc minimum crnaratinne that ehall he nrovided fnr sewer Svatenis'
Setback Parameter's
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
z 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 1 a] -
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
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 associated with these waters (see ilea 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 021'0305(f) or (a), see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 021'.0305(0 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 weboase
2. Does this project comply with the minimum separation requirements for water mains? N 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? N Yes ❑ No [:]N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the 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? N Yes Basin name: Cape Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02009 N Yes ❑ No
➢ This includes Trod Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes N 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 N 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 N No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streanbanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and severs suspended through interfe•ence%onflict 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 pe•mittee or its representative at least once every six -months and
inspections documented per 1.5A 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 nroiects requiring a variance anproval may be subject to longer
review times For nroiects requiring two or more variances or where the variance is determined by the Division to be a
significant nortion of the m•oiect, the full technical review is required.
2. Professional Engineer's Certification:
I, t W&%N FAkON I., attest that this application for Hawthome at Brightwood Farm
(Professional Engineer's omne from Application Item I11.1.) (Project Name from Application hem 11.1)
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. 1 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 potions 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:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
....................................................................................... .
9
_ 50
- t/WrL
1, David Cheek , attest that this application for _Hawthorne at BriGhtwood Farm
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item 11.1)
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 an([ 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: C—_ Date:
FORM: FTA 06-21 Page 5 of 5

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7/22n2, 4:41 PM
GIS Data Viewer
Guilford County, NC
Parcel Number
106269
Total Out Building Value
I0
PIN
;8824751391
Total Land Value
1064500
Owner
HAWTHORNE-MIDWAY BRIGHTWOOD FARM LLC
Total Deferred Value
0
Owner History
Card Image -.. __. ....... -
Bldg Card
Mail 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 _... ......
...........
,_,`u� Disclaimer. While everyeffort is made to keep information provided over the Internet accurate and Map Scale
up-to-date, Guilford County does not certify the authenticity oraccuracy of such information. No
�i'} 1 inch = 500 feet
warranties, express or implied, are provided for the records and/or mapping data herein, or for their
�2rsca> use or interpretation by the User. 7/22/2022
https://glsdv.guiifordcountyno,gov/guitford/ 1/1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
O; Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Burlington
Project Name for which flow is being requested: Hawthorne @Brightwood Farms Public
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: T.Z. Osborne
b. W WTP Facility Permit #: NCO047384
All flows are in MGD
c.
W WTP facility's permitted flow
56.0
d.
Estimated obligated flow not yet tributary to the WWTP
0.7057
e.
WWTP facility's actual avg. flow
34.9057
f.
Total flow for this specific request
0.0618
g.
Total actual and obligated flows to the facility
36.9057
It.
Percent of permitted flow used
65.9%
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
Obligated,
Pump Pump Average
Approx. Not Yet Total Current
Station Station Firm Daily Flow*"
Current Tributary Flow Plus
(Name or Permit Capacity, " (Firm / pt),
Avg. Daily Daily Flow, Obligated
Available
Number) No. MGD MGD
Flow, MGD MGD Flow
Capacity"""
Rock 37034 4.32 2.057
1.257 0.4108 1.6679
0.3892
Stewart 38555 10.224 4.963
pe•n —.11_
1,796 0.2924 2.0885
--
— 2.8746
* 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
(pt) 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 10.18

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 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
OlgMally signed! by Wendy Messer
ON C W.
Wendy MesserO.GAyoi Greembeoro, CN=�Weney Messer.g.
Pala 20M.M.13 13: 5:2 OdW
Date
Page 2 of 6
PTSE 10-1*

HAGEN
ENGINEERING, PA
3859 Battleground Ave, Suite 300
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
Public Sewer Permit
Cover Letter
NC r)epar;ir,.,ni. of
Environmcrrtalualit
Recewed y
SOD 14 9
4022
Winston-Salem
RegionalOfi9ce
Phone: [phone]
www.hagen-eng.com
September 2, 2022
The purpose of this cover letter is to outline the contents of this Public Sewer Permit
application package as well as to provide of a summary of the project to which is pertains. This
overall Hawthorne at Brightwood Farm development is a 312 unit multifamily complex. This
Public Sewer Permit will require an estimated peak flow of 61800 GPD for utility consumption.
There is also a Private Sewer permit application for this project which will be responsible for
some of the peak flow of the project. This portion of the project will be comprised of 1470 LF of
8" VCP public gravity sewer main. Within this submittal package you will find the following items:
1) $480 check for the Public Sewer Permit
2) One completed DWR Fast Track Sewer System Extension application
3) One executed USE 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