WQ0044592_Application (FTSE)_20230719

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: W4Dogg51 2-(to be completed by DWR)
All items must lie rumt►leted or the a,Lplicaiiotl %+ill be relurned
I. APPLICANT INFORMATION:
Applicant's name: City of Graham (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual
❑ Corporation ❑ General Partnership
❑ Federal
❑ State/County ® Municipal
3. Signature authority's name: Aaron Holland per I SA NC AC (12*l'.0 06 Uh
Title: Assistant City \llsiiagr
4, Applicant's mailing address: PO
Drawer 357
City: Graham State: NC
Zip: 27253
5. Applicant's contact information:
Phone number: [phone]
Email Address: ahollTndt�A�ityuf_.3rtllt_mi,ccuti
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: A-,teadowviyNv Olen Subdivision
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: 36.032458' Longitude:-79.408941°
5. Parcel ID (if applicable): .1-0,117-5 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I. Professional Engineer: T. Eu-gene Mustin License Number: 20709
Firm: J3oi•um 4U;�cic laid r�tisociatcs,_I'_��,
Mailing address: PO Box 21882
City: Greensboro State: NC Zip: 27420-1882
Phone number: [phone] Email Address: jmcginlcy d1borunl-xv.1 le_con,
iV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: South Burlington Waste Water Treatment Facility Permit Number: NC 0023876
Owner Name: City of 1itir1in-
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Ntunber(s): WQ 010 6327
2. Downstream (Receiving) Sewer Itrformation: 42 inch ® Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00349
Owner Name(s): (_i(yof Burlingto"i
FORM: FTA 06-21 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 Develo(Ic_ i`'.5 (aperaGon_il fl*,lcenic�it (I^OR1l: 1)F.V). been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Properly Owners' Association, has an j I-OLVI'Or1 tIo_ rational \ �rec�nent (71ti�1 I1C)A) 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
El Businesses / offices / factories El Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial __ % Industrial (Scq,_1 S/l. N 'cl(" 112 01���))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Hasa flow reduction been approved under 15A NC AC' 02�f ..011 4(f)? ❑ Yes ®No
p If es ovidecony of flow red ctio� a a:oval fetter with this a1112ficati011
7. Summarize wastewater generated by project:
Establishment Type (see 02T.O114(f))
Single Family Home (3br)
Daily Design Flow "''
360 gal/day
No. of Units
28
Flow
10,080 GPD
gal/
GPD
gal/
GPD
gall
� GPD
gal/
GPD
gal/
GPD
Total
10,080 GPD
a See 15A NC:A(: 02`f .01 l4(bi c, (il. (gJ(11_ajd 0(Q 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. 42AA).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 1 AA NCA1t0112`h.Ql J_I] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: I9.08(1 GPD (per 51 �1 NCA ' 02'1' . 14)
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) - 02'1' .0305 & MDC(GrsLvity. Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 947' PVC
➢ Section Il & Ill 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
Vlll. PUMP STATION DESIGN CRITERIA (1rApplicable)— 02`T�0305 & MI)C; (Pratt) 4lations/Force INlains):
PROVIDE A SFPARAT COPY O1 ,11-11S PAGE FOR EACH PUMP STATION INC:L UDED IN `i lJIS IROJECI
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 puntp(s): gallons per minute (GPM) at feet total dynamic head (TDN)
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. I .b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15.A NC A_(jk L._Q 05 I(Lffl1,,):
❑ 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 tinteframes, 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.jIANI A(' 02T .l)3(_)50) & (u)? ® Yes ❑ No
15A NCAC 02T.0305(1) contains minimum senarations that shall he provided fnr sewer systmnw
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-1 waters of Class 1 or
Class Q 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, take, 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 or (e). see Section X.1 of this application
* 1I5A NC'AC02T.03, 05(e) contains alternatives where separations in 021'A305(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 NC% i_fncc 4Vai (, L, sl�ct�li«n5 Nyc1tl}ti �c
2. Does this project comply with the minimum separation requirements for water trains? ®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 d Eat fi 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: Jordan Lake ❑ No
If yes, does the project comply with setbacks found in the river basin rules per i 51\_N('/1C 0213.'02(IU? ®Yes [-]No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
)P, Please provide the pen -nit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with I SA NCA(" 02'f.0I0S�L) (additional permits/certifications)? ® Yes ❑ No
Per 15A NC A(` 02'i'.0 1 U5(cl(6l, 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.0 002, "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 interterence/confllet 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. CEWFIFICATIONS:
1. Does the submitted system comply with 15A_NCAC. 02T. the \Iim u m Uc,ign 0 iterio li,r_lhc l' i1!1 !!1?h al' 'untj� Sty�t_inn
antl i ur4c \•i iin�_ latr�t �ersi,+nT, and the (,i:i\ ilk w\Nci \ii_uinuirl_I) "i4tt trria_ti iLl"I vel-,ionj 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. lmr1 cval of the rccruest will he i.sucd
runrurrentls; with the alinroval of the nermit and m-oicels rcnuirine it variance atrnruval niav he subiect to lunavi-
review tirnt.. Pun uroievis rcuuirillL, Wo ur afore Variruttr" ol. J here llie Variance is tlelerinirted by fire Division to he a
significant liortion of the oroiect, the full technical review is required.
2. Professional Engineer's Certification.
'r. Eugene Mustin Meadowview Subdivision
[, _- _ . _ attest that this application for -- — ---
(Professional Engineer's name porn Application item Itl I) (Project Name from Application item If 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,
klin mum OC,u­n ( titcri,,i lur t ii'.icit% Sewet�.Ilal"I trrsii+n), and the \16-imium I)csign t Iitcii., loi ilie 1 a:11-I,,0, I'cr1)_unu,
I'tu,li tii ti, nti,,pltl i,u � LkLq.st Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1 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: ti;`; a\ -A CA�'f�%i�f
�•C l 1 i( Kit► 7
r
3, Applicant's Certification per iSA NCAC UT .0106(b)=
I, attest that this application for ,��Vlsv�+
(Signature Auth ntt Wa,ar from Application item 13 ) Ihole, I Nance from .\1,1>hc,non Item II 1)
attest that this application has been reviewed by me and is accurate nud complete to the best of my knowledge.
i understand that if all required parts of this application arc 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 walers 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 143-215.0A and I43-215�(yt3, 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: -?11 / LS
FORM; F1'A 06-21 Page 5 of 5

AT A
D-ivision of Water Resouurces
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Graham
Project Name for which flow is being requested: Meadowview Glen
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 wasteivater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: City of Graham Collection System
b. WWTP Facility Permit #: WQCS 00065
All flows are in MGD
c. WWTP facility's permitted flow 0.500 Allocation to COB
d. Estimated obligated flow not yet tributary to the WWTP .1465 to COB
e. WWTP facility's actual avg. flow 0.2102 to COB
f. Total flow for this specific request .0108
g. Total actual and obligated flows to the facility 0.3675 to COB
h. Percent of permitted flow used 73.5%
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 / pfl, Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
* 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
(pf) 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 Burlington -Little Ala Creek OF
Downstream Permit Number: N/A
Page 1 of 6
FTSE 10-18

111. Certification Statement:
I Aaron Holland 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
identmed in the planning assessment where applicable. This analysis has be p 'l' "reed I "fiance
aSJ uu� v�ei� eiw�uwu iii FiccoiA
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.
A444,
Signing Official Signature Date
Xr.raf.,*4 Ci � A*oV
Title nf.Signing
Page 2 of 6
FTSE 10-18

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division oWater 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: Meadowview Glen
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: South Burlington WWTP
b. WWTP Facility Permit #: NCO023876 w
AM lows are in MGD
c. WWTP facility's permitted flow 12.00
d. Estimated obligated flow not yet tributary to the WWTP 1.450169
e. WWTP facility's actual avg. flow 6.330000
f. Total flow for this specific request (0.01008) Graham Allocation
g. Total actual and obligated flows to the facility _ 7.780169
h. Percent of permitted flow used 64.83%
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
Pump Station
(Name or
Number)
None
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Obligated,
Average Daily
Approx.
Not Yet
Total Current
Firm Flow**
Current Avg.
Tributary
Flow Plus
Capacity, ` (Firm/po,
Daily Flow,
Daily Flow,
Obligated
Available
GPD GPD
GPD
GPD
Flow
Capacity"*
* The Finn 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 _< 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
voTume of wastewater tTo-Fe- penmtted 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
ON Engineer
Title of Signing Official
—! 7-Z.c>Z3
Date
2 of 6 USE 10-18

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Borum, Wade and Associates, P.A.
July 18th 2023
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Regarding: Meadowview Glen Subdivision
Meadowview Dr.
Graham, NC 27253
Ron Boone:
NC bometridnt f
environmental Qu01I11y
Received
Winston-Salem
Regional office
Please see our Fast Track Sewer System Extension permit application for the above reference
project [28 single family homes (3br)].
Included in this package are the following:
1. FTA application
2. FTSE-flow acceptance form
3. 8.5inX11 in Topo map
4. Aerial location map
5. Review fee check; $480.00
Please call if you have any questions.
Sincerely,
/., J/"
e+
James McGinley, P.E. (ext. 107: Cell: 336-812-1798)
621 Eugene Court, Suite 100, Greensboro, NC 27401-2711 • PO Box 21882, Greensboro, NC 27420-1882
Phone [phone] Fax [phone]
Website: www.borum- wade.coni
NC License #: C-0868