WQ0045230_Flora_Avenue_Sewer_Extension_20240314

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dtvlslon of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
F
1. Applicant's name: City of 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: Craig Honeycutt per 15A NCAC 021.0106(b)
Title: City Manager
4. Applicant's mailing address: 425 S Lexington Avenue
City: Burlington State: NC Zip: 27215-
5. Applicant's contact information:
Phone number: (IL6) 222-5050 Email Address: dbowmantaburlingtonnc.gov
IL PROJECT INFORMATION:
1. Project name: 11holAvimue Sewer Exteusion.1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ AR -PA funded
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: W000_
3. County where project is located:
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1156° Longitude: - 97 4699"
5. Parcel ID (if applicable): 8866111639 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Ravindra BissramJ License Number: 27436
Firm: FEI
Mailing address: $518 Triad Drive
City: Colfax State: NC Zip: 27235-_
Phone number: (336) 544-¢ 26' Email Address: rbissramOkfeiconsultiti com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: East Burlington Wastewater Treatment Plant " Permit Number: NCO023868 "
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): W00015195
2. Downstream (Receiving) Sewer Information: $ inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS_aOQ b
Owner Name(s): City of Burlington '
FORM: FTA 10-23 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 At cement (FORM: DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOATOA Operational Agreement (FORM: HOA 1 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 (See 15A NCAC 02T .0103(20 ))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 141 fi I ❑ Yes ®No
D If yes, provide a copy of Flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Dailv Design Flow 0
No. of Units
Flow
Nursing Home Facility '
120 gal/day/br * 5 br '
1 '
600 GPD'
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
CoOO GPD
a See I SA NCAC 02T .0114(b). (d). (c)(1) and (eK2) for caveats to wastewater design flow rates (i.e. 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 he used as vacation rentals as defined in G.S. 42A4 .
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow dgta, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project:00 GPD (per 15A NCAC UZT .0114 and G.S. 143-2I5.1)
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 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T 0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8"
231
VCP
➢ 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
VUL PUMP STATION DESIGN CRITERIA (If Applicable)— 02T .0305 & MDC (Pump Statious/Force 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 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 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCAC 02T .0305(hH l 1:
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - I SA NCAC 02T.0305(h)(l XB).'
➢ 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)(1xC):
❑ 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 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & ISA NCAC 02T.0305(f)):
1. Does the project comply with all separations/altematives found in l5A NCAC 02T .03050) & le)? ® Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
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-I waters of Class I or
Class li 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 item rX.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 02T.0305(f) or (e), see Section X.1 of this application
* I5A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(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 Surface Water Classifications webpage
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 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.
i
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: _ ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ 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?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105tc)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 021010N)46), 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 I SA NCAC 02T.0402, "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 permttee 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 10-23 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 Ilatest version). and the Gravity Sawer Minimum Dcsign Criteria (latest version) 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. Approval of the request will be issued
concurrently with the approval of the permit, and projects reauirine a variance approval may be subject to Ionizer
review times. For projects requirine 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.
_'_ Professional Engineer's Certification:
1 Ravindra Bissrarn , attest that this application for Flora Avenue Sewer Extension
(Professional Engineer's name from Application It= III.1.) (Project Name from Application Item II.I)
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 Punt) 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. 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):
1,ef 1=/7�i�Iora e/? , attest that this application for , /O, /fYe' /` i+r7
(Signamrc Authority . e from Application Item 1.3.) (Project Name front Application Item I1.11
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 143-215.6A and t43-215.6B, 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 Date: Y
FORM: FTA 10-23 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 10-23)
Enity Requesting Allocation City of Burlington
Project Name for which flow is being requested: Flora Avenue Sewer Extension
More than one FTSE mcry be required for a single project if the owner of the fVWTP is not responsible.for all pump .stations along
the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: East Burlington WWTP
b. WWTP Facility Permit #: NC 0023868
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
1.754924
3.8360
0.000600
5.591524
46.6%�
IL 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:
None
(A) (B)
(C)
(D)=(B*C) (E)=(A-D)
Obligated,
Total
Design Approx.
Not Yet
Current Flow
Firm Average Daily Current Avg.
Tributary
Plus
Pump Station Capacity, ' Flow" Daily Flow,
Daily Flow,
Obligated Available
Name GPD (Firm/pf), GPD GPD
GPD
Flow Capacity"'
' 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 s 0.
Downstream Facility Name (Sewer) : Durham Street CDBG - Ph II
Downstream Permit Number:
W00015195
Page 1 of 2 FTSE 10-18

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 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.
1-11
Z-2(-Zq -
Signing Official Signature Date
City Enaineer'
Title of Signing Official
Page 2 of 2 FTSE 10-18

&�a FE
Environmental Quallty,
Received
Fleming Engineering; Ang.
Consulting Engineers & Land Surveyo
TRANSMITTAL MEMO
To: Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road
Suite 300
Winston Salem, NC 27105
[phone]
Project #: 13047.001
Cc:
From: Ravindra Bissram, PE
Date: March 13, 2024
Salem
Cfhce
Re: Flora Avenue Sewer Extension Fast Track Sewer System Extension Application
Urgent For Revicw x Please Comment Please Reply Please Recycle
To Whom it may Concern:
Attached is the submittal package for the Fast Track Application on the Flora Avenue Sewer Extension. The sewer main
will be extended and publicly maintained by the City of Burlington. A single 5 bedroom building will connect onto the
extension; a daily design flow of 120 gal/day/br (or 600 gpd) will be generated from the extension.
For your review is the following:
I. (1) Original Application FTA 04-16
2. (1) Copy for FTA 04-16
3. (1) Application fee of S600
4. (I) Flow Tracking/Acceptance Form
5. (1) USGS Site Map
6. (1) Street level map
Please let me know if there are any questions, concerns or additional information required.
Thanks.
Ravindra Bissram, PE
SP„ ',,. o,��a
FEI
Civil Engineers arW Land Surveyors
as la Triad Drive
CoffaX NC 27235
Phwet(330544-6426
www. FleminaEneineerine.eom
8518 Triad Drive, Colfax, NC 27235 Phone: [phone] Fax: [phone]

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