WQ0044428_Application (FTSE)_20230524

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number"_ 1 �1 1 (to be completed by DWR)
All items must be completed or the a ) lication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Citof Burlington (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: Cram Honeycutt per
Title: City Manager
4. Applicant's mailing address: 425 S_Lexinyton Ave
City: Burlington State: NC Zip: 27215-
5. Applicant's contact information:
Phone number: 3t 36) 222-5050 Email Address: en ineerin tci.burlington.nc.us
II. PROJECT INFORMATION:
1. Project name: Mackintosh on the Lake Parcel I -Section I-2
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 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: WQ00
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.053480' Longitude:-79.536151'
5. Parcel ID (if applicable): 174146 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Lee 1. Bryant License Number: 53418
Firm: Evans Engineering, Inc
Mailing address: 4609_Dundas Drive
City: Greensboro State: NC Zip: 27407-
Phone number: 336 279-7451 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: South Burlington Permit Number: NC0023876
Owner Name: Cit , of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0032053
2. Downstream (Receiving) Sewer Information: 8" inch 0 Gravity 0 Force Main
3. System Wide Collection System Permit Numbers) (if applicable): WQCS
Owner Name(s): Cil\_of Burlington
FORM: FTA 06-21 Paget 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 l c cl is r tiar�tll tgcs ra eta lk ';h ; k l� ,),been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an tjj&PC s t.Ita t er �rl Car erxt (FORM: lE -' and
supplementary documentation as required by 15A NCAC 02T.0I 15(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: 100 % Domestic % Commercial % Industrial
If Industrial, is there a Pretreatment Program in effect? ❑ Yes Cl No
6. Has a flow reduction been approved under _t A! � ❑ 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(f))
l Daily Design Flow ° °
No. of Units
Flow
p
120 gal/bedroom
15
7,200 GPD
gall
gal/
GPD
GPD
T
gall
GPD
gal/
GPD
_ ._._...
gal/
GPD
Total
7,200 GPD
a See ,1 Av 0rr ;rl t rc g,�, r�{� f t 1 E: 341 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 }.
b Per 15A NCAC 02T .0I 14(c), design flow rates for establishments not identified [in table i shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 7,200 GPD (per
➢ 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 timeframe 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) -
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 597 VCP
t. _. .__
➢ 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)
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)�vl 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 _ NQ 2 _ 0-4k_!LL, -
❑ 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 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 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

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in c (r'; o rf F , ,_ ? ® Yes ❑ No
15A NCAC 02T.0305(t) contains minimum se )arations that shall be provided for sewer systems:
Setback Parameter*
Storm sewers and other utilities not listed below (vertical)
'Water mains (vertical water over sewer preferred, including in benched trenches)
'Water mains (horizontal)
Reclaimed water lines (vertical - reclaimed over sewer)
Separation Required
18 inches
18 inches
10 feet
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, mWS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
**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 item IX.2)
100 feet
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.
Any building foundation (horizontal)
10 feet
5 feet
10 feet
Any basement (horizontal)
Top slope of embankment or cuts of 2 feet or more vertical height
Drainage systems and interceptor drains
10 feet
5 feet
Any swimming pools
Final earth grade (vertical)
10 feet
36 inches
➢ If noncompliance with see Section X.1 of this application
wt j ! ,r�t.`w i� F, contains alternatives where separations in `; 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 �111rit a�€t tarsicticwc
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(t) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
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 .. ;; for situations where separation cannot be met.
4-=
➢ 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: Jordan Lake ❑ No
If yes, does the project comply with setbacks found in the river basin rules per h t AC 0�13 ,tltFt ° ® Yes ❑ No
➢ This includes Trout Buffered Streams per ) j
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 1.5A NCAC tcj f) (additional permits/certifications)? ® Yes ❑ No
Per 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.).
Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per "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 M M fit. �1��', the dinimunl Desiteria for t@ts Eps r� �►f Eurttl� �r�xiti.rt:.
t�a_� aic;, and the 3 ;<, Segnil�tum �?esl c r(tei;t ter st ver;,lc1ti as applicable?
.�wL pp �
® 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 approval may be subject to loner
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 required.
2. Professional Engineer's Certification:
I Lee I. Bryant , attest that this application for Mackintosh on the Lake Parcel I - Section I-2
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item I1.1)
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,
itrilteitti uni Design Cdteda I'm a myitV (iaic&� u.`
P� p.i Fairce_Ma n ;vto 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 $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:CARO
S ON`fyp
'$ 053418
-�-A3
................ r%yli'iil�i ffiP \\\\\............
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, _Graj,g Honeycutt attest that this application for Mackintosh on the Lake Parcel I -Section I-2
(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 and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes ' , -, and ; 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.
� J -
Signature: Date:
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 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: MOTL Parcel I, Sec 1-2
More than one FTSE maybe 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: South Burlington WWTP
b. WWTP Facility Permit #: NCO023876
All flows are
in MGD
c. WWTP facility's permitted flow
12.00
d. Estimated obligated flow not yet tributary to the WWTP
1.283073
e. WWTP facility's actual avg. flow
6.330000
f. Total flow for this specific request
0.007200
g. Total actual and obligated flows to the facility
7.620273
h. Percent of permitted flow used
63.50%
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,
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 Capacity5 0.
Downstream Facility Name (Sewer) MOTL parcel I - Sewer Outfall
Downstream Permit Number: WQ0039076
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 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 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 Official Signature
City Engineer
Title of Signing Off cial
Date
2 of 6 FTSE 1 D-18

OV
6-7TE
Y.
Zoom, 16
Scale: 9028,
F-70 �ft�

ir41
•
eat
JYy K•
.
^ `' •,
IU)
s t ri
- •� �
r�
r•
to
tl a
'A
�J
.
n
M
f t �
ti rt
a r
.ti
7

ans
ngincerin , Inc.
—Since 1974
Ettglneers Surveyors Planners
May 23, 2023
NCDEQ
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Re: Mackintosh on the Lake Parcel I- Section I-2
To Whom it May Concern:
Please find attached the complete Permit Application Package for this project along with
the fee check and flow tracking form. The project consists of 15 single family homes with
a requested flow of 7,200 GPD. With 5971f of 8" VCP pipe to be installed as part of this
project.
Sincerely,
Lee Bryant
Vice President of Operations
4609 Dundas Drive
Greensboro, NC 27407
Phone [phone]
Fax [phone]
License #C-0168

+_` ngineering, Inc.
—Since 1974—
Engineers Surwyors Plannsn
Post Office Box 10285
GREENSBORO, N.C. 27404
Telephone: [phone]
Fax: [phone]
NC Department Of
Environmental �-Lia+ity
MAY 2 4 023
Winston-S lem
ional I
ffice
Date: 5-23-23
...................................................................
To: Lonnie Snider Subject: Mackintosh on the Lake
......................................................................................................................................................................
Parcel I- Section 1-2
...................................................................................................................................................................................................
Letter
Please process sewer permit package.
.....................................................................................................................................................................................................................................
Included-
.. �..........................................................................................................................................................................................................
(1) Application & $480.00 application fee check
..................................................................................................................
�1) Flow Trackin...........................................................
..................................... ........................................................... ...........................
(1) Narrative
Q.) USGS Map and Street map & (1) CD's with copies of ally aperwork
Please let me know if you have any questions. Thanks
..............................................................................................
............................ ................................................................................ -...................................................... ............................
Lee Bryant
.......��lease
.............................................................................................................................................................................. ..............................
reply ❑ No reply necessary Signed