WQ0044429_Application (FTSE)_20230524

State of North Carolina
Department of Environmental Quality
�D W%V R Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Witter Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: (k Oq li _I (to be completed by Dwit)
All items must be completed or the application will be returned
I. 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: Craig Honed<cutt per l5A 1vt At.` U2T, .O I Olaf
Title: City Manager
4. Applicant's mailing address: 425 _S Lexington Ave
City: Burlington State: NC Zip: 27215-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]_ton.nc.us
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Henle)LRidM_Phase 2 & 3
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: 36.0530" Longitude:-79.4189'
5. Parcel ID (if applicable): 176917 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Lee I. Bryant License Number: 53418
Firm: Evans F_Uineerr lnc
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: NC0.023876
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0032053
2. Downstream (Receiving) Sewer Information: 24" inch E Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): City,. of Burlington
FORM: FTA 06-21 Pagel 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 D,4etop'_ t�p�sicane0€lteteFOIRFal been attached?
[:]Yes [:]No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an u, { a0liqrn�E'001 , f I f.1 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 : 100 % Domestic % Commercial % Industrial
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under t 5A jr__,",C �� : q4 t "(,)? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction aplproval letter with this apRlieation
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
360 gal/day
No. of Units
175
Flow
63,000 GPD u
Residential
gall
gal/
GPD
GPD
gall_..._...GPD
gall
~� GPD
gall
GPD
LT Total 1 63,000 GPD l
a See 3A NCAC 02I' .0114tb), tdl,�c`r 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 .0114(c), design flow rates for establishments not identified [in table 5A NcAc tl2r n i t ;] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 63,000 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) & r rr
1. Summarize gravity sewer to be permitted:
Size (inches) I Length (feet) Material
8" 2,703 SDR 21
➢ 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) — tt (p & _E EL F, st fi e i Eti�� , M6 it r :
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: 0Longitude: - _ . °
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 2.01 C. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with kj� (.` i` �2T .03tt l ,:
❑ 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 j&C AQ ��.T Alt)k(1 4AZV Yes ❑ No
15A NCAC 02T.0305(t) contains minimum separations that shall be govided 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)
**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, and associated wetlands.
2 feet
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 item IX.2)
**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)
Any basement (horizontal)
50 feet
10 feet
5 feet
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
Drainage systems and interceptor drains
Any swimming pools
Final earth grade (vertical)
10 feet
5 feet
10 feet
36 inches
➢ If noncompliance with see Section X.1 of this application
k Zi ;'=_(t i; ,` contains alternatives where separations in ;f _)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 N( Surlar , 4'�'ttt t`l s it «calla s G Tpf
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.
➢ See the Division's d, , , , ,s r, > 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: Jordan Lake ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A MAC 02B ,02001? ® Yes ❑ No
➢ This includes Trout Buffered Streams per
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 .1MNCA C (Ir701c 551e'(6) (additional permits/certifications)? ® Yes ❑ No
Per 1,1-)A NIC, a ',0ION 1�J, 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 15A N f Af 0,2 ,the Mj. ittf t _13 ic er Ot t . @gP 6hL .('et r ttiln t� ; tct St ;tines
WWJ'W i `nalt s tla s� E t' rtt=R;,.,, and the gX SewerFeliniinuip tp� C t Mite t.v� ie?si).as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Altemative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Alritroval of the request will be issued
concurrently with the approval of the zermit and proiects requiring a variance a a roval may be subject to lon er
review times. For irroiects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the rtroiect, the full technical review is required
2, Professional Engineer's Certification:
I_ Lee I. Bry attest that this application for HenleA, R d e_Phase 2&3 _
' '
(Professional Engineer's name from Application Item III.1.) (Projecit 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,
and the
Q#�a tiansitdozee_haitts t ltst vaa?zl)• 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: `♦♦♦♦�'LH, A 104z�",
0641 B
5 •q•R3
......................
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Craig Honeycutt , attest that this application for Henley Ridge Phase 2 & 3
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item II.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.
Signature: _ - Date:
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
®tvtslon o 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: Henley Ridge Phases 2 & 3
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 wastewaterflow.
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 M NCO023876
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
12.00
1.283073
6.330000
0.063000
7.676073
63.97%
I1. 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, * (Firm/pf),
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 Capacity 5 0.
Downstream Facility Name (Sewer) : Little Alamance Creek Outfall
Downstream Permit Number
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 ie 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 Date
City Engineer
Title of Signing Official
2 of 6 FTSE 10-18

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p` — Siaacr. 1974 —
Ei*tieers Surveym Flanders
May 23, 2023
NCDEQ
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Re: Henley Ridge Phases 2 & 3
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 175 Townhome units with
a requested flow of 63,000 GPD. With 2,703 if of 8" SDR 21 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

--E ngmeering, Inc,
—Slue 1974—
Eu&eers Surwya m Plaunm
Post Office Box 10285
GREENSBORO, N.C. 27404
Telephone: [phone]
Fax: [phone]
Date: 5-23-23
NC'-- .3 rtment of
Env' :-i .:` 2
Received
�i' "' % 4 2023
,m
0
N C i ep-nrtment f
nvironniental Qu lity
Received
`'��t`it�4�
Winston -Sale
Regional Offi
...............................................................................................
To: Lonnie Snider Subject: Henley Ridge Phase 2 & 3
.................................................................................................................................................................................................
Please process sewer permit package.
neivaea•
1) Application & $480:00 application fee check
................................................................................................................................
1) Flow Tracking..................................................................................................................................................................................................
1) Narrative
................................................................................................................................................................................................................................
(1) USGS Map and Street map & 41� CD's with copies of all paperwork
Please let me know if you have any questions; hanks
...........I...........................................
.................................................................................................................................. Lee Bryant...........................
....................................................... ...............
lease reply ❑ No reply necessary Signed
it