WQ0044045_Application (FTSE)_20230112

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: o �. t�% o be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Triad Network Properties (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ® General Partnership
❑ Federal ❑ State/County ❑ Municipal
3. Signature authority's name: John Martin per 15A NCAC 02T .0106(b)
Title: Member and Manager
4. Applicant's mailing address: 400 Bellemeade St, Suite 800
City: Greensboro State: NC Zip: 27410
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Neighbors Bar & BB
❑ Privately -Owned Public Utility
❑ Other
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..1876° Longitude:-79.88'
5. Parcel ID (if applicable): 7864587542
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Randly L McNeill License Number: 10117
Firm: Davis -Martin -Powell and Associates, Inc.
Mailing address: 6415 Old Plank Road
City: High Point State: NC Zip: 27265-3274
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: T.Z. Osborne Water Reclamation Facility Permit Number: NCO047384
Owner Name: City of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ (unknown) Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00006
Owner Name(s): City of Greensboro
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: FICA) 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 % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
,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 cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow 1,V
No. of Units
Flow
Food & Drink - Restaurants, Full Service
40 gal/seat
81
3,240 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
3,240 GPD
a See 15A NCAC 02T .01 14(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: 3,240 GPD (per 15A NCAC 02T .01 14)
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 Servers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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: Neighbors Bar and BBO
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.1876' Longitude:-79.88'
3. Design flow of the pump station: 0.00324 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 38 gallons per minute at 16.0 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
158
PVC
6. Power reliability in accordance with 15A NCAC 02T .03050h1(1 j:
® 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)
Me
❑ 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(o):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(fl & (�-x) ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be Drovided for sewers stems:
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.0305(Q) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications webpatre
➢ If noncompliance with 02T.0305(f) 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. 02B .0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
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 1 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 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, 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:
I Randy McNeill attest that this application for
(Professional Engineer's name from Application Item III.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, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
John Martin, Manager and Member attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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.
-- 2 Z
71/At1__--- Date:
FORM: FTA 04-16 Page 5 of 5

3
9-4
GREENSBORO
Application Number:
Project Applicant Name:
Project Name for which flow is being requested
City of Greensboro
Water Resources Department
Engineering Division
Flow Tracking/Acceptance for Sewer
(COG-FTSE-10/07)
2022-030
John Martin Triad Network Properties LLC
507 Simpson St Neighbors Bar & BBQ
More than one COG-FTSE-10107 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. Flow acceptance is contingent upon City Council approval.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit Number:
c. WWTP facility's permitted flow
d. Estimated obligated flow not ye
e. WWTP facility's actual avg. flow
f. Total flow for this specific reque
g. Total actual and obligated flows
h. Percent of permitted flow used
T.Z. Osborne Water Reclamation Facility
NCO047384
All flows are In MGD
56
CS - 5.4715 SIU - 1.4200
34,7800
0.0032
41.6715
74.4%
II. Complete this section for each pump station you are responsible for along the route of this proposed wastewater flow.
Are there any pump stations affect, No
List pump station (if any) project initially goes t
Pump Station Name
1 None
2 #N/A
3 #N/A
4 #N/A
5 #N/A
III. Certification Statemen
Approx. Capacity, MGD
(Firm/Design)
# N/A
# N/A
#N/A
#N/A
# N/A
If "Yes", starting where upstream?
None
Approx. Design
Current Avg.
Daily Flow, MGD
#N/A
*N/A
#N/A
#N/A
# N/A
I, Wendy Messer certify that, to the best of my knowledge, 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 stations enroute to the receiving treatment
plant. 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 for which I am the responsible party. Signature of this form indicates
acceptance of this wastewater flow,
Pa� 1&1212012022
Wendy Mess�_r Date
Signing Official Signature

Prod— by Ne W Ited Stales G Jool j Survey
w,u Gah,t S/uemaliil�tnv45M1. P,elenW aM t
Weaod°amele, c,;e,wr...,a nr,,...w.os>. xee in
.es Ne amo...x.a �a m,ree —aiwu :a
uNusalav................................— ee.�i nfwa -iem oe ........�,...�...�..a
a.,...... ..... .................................
w
wa..n.............-0s —, K meue,u lee io�iv�. mii ..
ma a
Wawq..................ivn w�Ml WaI,M, Immiuy xot ev.Nae
SCALE 1:24000
a usorsas
sm o sow
)000 ,uu �a000
eoaa rcn
loaf cu5smunox
�
���
�Ms�.use oau,e Qus ea.e Osum farce
s x x wee,w,
6 2 1 iaue.unc.�,ew
b.wmce�e.aW.is e c
GREENSBORO, NC
2022

507 SIMPSON Si
PI L �-� �4• � Mftm
WEST FISHER ST Dowrit°�yn ►- '
Grecnway
wz
UJ
Cn
^ i :• a (�
Y �, i�►�->ti_,zN '. �i �, :�1 i �.f+- .. IS�i, ��+ � � �. E .1 .
is
II
-...der _ _ ,� ,� Y ► Ski i °e ; _ r�!
• t . �. W E,5T $ I z
Is
.:A y 1 4. • r .' w, ��. -� , ��:. � � �� �.�: }�. � � •`��' r i } y ice:
°;"� � - - �' 4 R /�Jy� � �! j� h3 •, ��� ?ti' - _"^r i �•'!o '.�1c1_r -
/*
40
1.:!Y► t� f
1 /3J2023, 2:59.22 PM
— Street Classification
Transportation Projects (Preliminary Design)
Transportation Projects (Consiruetion Design)
Guilford County Clrthophoto 2018
Red: Banrl1
Green: Band-2
Blue: Band 3
1,2,257
0 0.01 0.03 0.06 mi
l. , A. I I I i C�
0 C'.02 0.04 0-O9 krr,
Ply: OPQI.iFr. NC 911 Beard. Grnersoom Planning NrA.
web AppOwider ror Amour,
NC Oo-hlap, NC 911 Board I NC Ok,e ht:sir. NC 911 Board I Gre«m;[: ,f, f7l:wwi i r..—I i

State of North Carolina
Department of Environmental Quality
Winston Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road
Winston-Salem, NC 27105
To Whom it May Concern:
DAMS • MARTIN • POWELAmp ENGINEERS 8 SURVEYOR
January 5, 2023
Re: Neighbors Bar & BBQ
507 Simpson St
Greensboro NC
Fast Track Sewer Extension Application
Job No. 210178(BF)
�IC D 1'frnr'iit ()I
-v
I Regionai uIric
In accordance with the Fast Track Sewer System Extension Application, we have enclosed the following
information for approval.
1. One Original and One Copy of the application.
2. Review fee in the amount of $480
3. Flow Tracking/Acceptance from provided by the City of Greensboro
4. 8.5" x 11" USGS Map showing the project location
5. A street level aerial map of the project location
We appreciate your prompt attention to this project.
If you have any questions or need additional information, please do not hesitate to call.
Sincerely,
ETM/dd
c: File
T: 336-886-4821 • F: 336-886-4458 • License: F-0245
6415 Old Plank Road, High Point, NC 27265 • www.dmp-inc.com
ARTIN • POWELL & ASSOCIATES, INC