WQ0045197_River_Village_Phases_2_&_3_20240403

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State of Carolina
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Division of Water Resources
�-- _--oinumomp— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 At SUPPORTING DOCUMENTATION
Application Number: A94 0 f -5117 (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
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 02T .0106t4)
Title: City Manaaer
4. Applicant's mailing address: P.O. Box 1358
City: Burlington State: NC Zip: 27216-
5. Applicant's contact information:
Phone number: [phone] Email Address: chonevcutt(a),burlinetonnc.gov
11. PROJECT INFORMATION:
1. Project name: River Village Phase 2 & 3
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ 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: Al
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1317' Longitude:-79.43330
5. Parcel m (if applicable): 8876281883 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Donald Sever License Number: NCO023868
Firm: Summit Design and Engineering Services
Mailing address: 3301 Benson Dr Suite 400
City: Raleigh State: NC Zip: 27609-
Phone number: [phone] Email Address: don.severyAummitdc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: East Burlington W WTP Permit Number: NCO023869
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. PermitNumber(s): W00012009
2. Downstream (Receiving) Sewer Information: 8 inch 0 Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s)(if applicable):WQCS_
OwnerName(s): City of Burlington
FORM: FTA 10-23 Page 1 of 5

V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No x❑ 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 x❑ N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.01 I5(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. Has a flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes n No
➢ 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))
Daily Design Flow q°
No. of Units
Flow
single family dwelling - 3br
225 gal/home
110
24750 GPD
single family dwelling - 4 br
300 gal/home
29
8700 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
33450 GPD
a See 15A NCAC 02T .0I 14(b). (d). (el(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: 33450 GPD (per 15A NCAC 02T .0114)
D 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) - 02T-.0305 & MDC (Gravity' Sewers)e
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
LL 6118 -
.....PVC
8
244
DIP
I
➢ Section II & 11I 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
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable)-02T.0305 &,MDC.(Pumn Stations/Force Mains):
.PROVIDE A. SEPARATE COPY OF _THIS PAGE FOR EACH PUMP STATION INCLUDED INTHIS PROJECT_,
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:-0 - - - - - - -- -- —
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) perpump(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 2.0IC. I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I SA_NCAC 02T .030500111
❑ 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 timef-ames, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: PTA 10-23 Page 3 of 5

IX. SETBACKS& SEPARATIONS —(02B.0200& 15ANCACO2T.0305(f)):
1. Does the project comply with all separations/altematives found in 15A NCAC 02T .0305t6 & t el? ® Yes ❑ No
15A NCAC 02T,0305 contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
IS 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, W S-I waters of Class I or
Class 11 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 IX.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.l of this application
*15A NCAC 02T.0305w). 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 webr>aa
2. Does this project comply with the minimum separation requirements for water mains? Z Yes ❑ No ❑ NIA
➢ If no, please refer to 15A NCAC I SC.0406(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 x❑ NiA
➢ 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.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: CameFar ❑ No
If yes, does the project comply with setbacks found in the riverbasin rules per .15A.NCAC 02B .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per I5ANCAC 213.0202
5. Does the project require coverageiauthorization under a 404 Nationwide/individual permits ® Yes ❑ No
or 401 Water Quality Certifications?
➢ Please provide the permit numben'permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(cx6) (additional petmits/certifications)? ®Yes ❑ No
Per 15A NCAC 0210) 05,NHL 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, stotmwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A 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 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 10-23 Page 4 of 5

X. CERTIFICATIONS:
Does the submitted system comply with J 5A-NCAC 02T. the Minimum Desicn Criteria for the F
and -Force Mains (latest version), and the Gravitv Sewer Minimum Desicn Criteria flateit version)
® 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. ,Aonroval of the request will be issued
2. Professional Engineer's Certification:
Donald _ attest that this application for A. Sever River Village Phase 2 and 3
_ _— _— - _ „-
(Professtor.iFai ircer s uamefrom Application Item III.1.) - (Project Name from Application Item 11.1)
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,
, Minimum-Desicn Criteria -for Gravity Sewers [latest version . and the Minimum Desicn Criteria for the Fast -Track Permittine
of_ Pumr Stations and Force Mains (latest versions: Although other professionals may have developed certain portions of this
submittal -package,- inclusion of these materials under my signature and sea] 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
--` in`cluile 6 fine not to exceed-$10,000, as well as -civil penalties up to S25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design noncompliance 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 ���N,1CgR0�''•,,� _
isssl
SEAL I y
24627/�
3. Applicant's Certification per 15A NCAC 02T.0106(b):
Craig Honeycutt River Village Phase 2 and 3
I,. _ __ __ . -.-r_ - ..-- -. , attest that this application for ._. . . -
(signature Authority Name from Application Item 1.3.) (Project Name from Application Item IL 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. 1 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 143-215.613. 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 m civil penalties up to $25,000 per violation.
nnre• D 1 it
FORM: FTA 10-23 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
NYston of WAref Resources Flow Tracking/Acceptance for Sewer Extension Permit Applications
Enity Requesting Allocation City of Burlington
Project Name for which flow is being requested: River Village Phases 2 & 3
More than one ME maybe required for a single project ifthe 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:
b. WWTP Facility Permit #:
WWTP
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not.yet tributary to the WWTP '
e. WWTP facility's actual avg. flow
E Total flow for this specific request ^-
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
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 : 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 (Firmlpf), 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 W WTP where the Available Capacity s 0.
Downstream Facility Name (Sewer)::: Fuji Foods Sewer Extension _
Downstream Permit Number: — - -
W00012009
Page 1 of 2 FTSE 10-18 f
ji

Certification Statement:
I, W. Todd Lambert, P.E. . certify to the best of my knowledge that the addition of the
volume of wastewater to Fe —pemutted 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 parry. 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
7711e of Signing Official
Page 2 of 2 FTSE 10-18

LETTER OF TRANSMITTAL
TO: Winston Salem Regional Office
450 W. Hanes Mill Road Suite 300
Winston Salem, NC 27105
ATTN: Water Quality Section
WE ARE SENDING YOU
Prints
Copy of Letter
■ Attached
COPIES
1
1
1
TRANSMITTED
For Approval
COMMENTS:
COPY TO:
Reproducible
Change Order
Under Separate Cover
DRAWING DATE
1/31/2024
1/29/2024
As Requested
C Department of
iro ReceiveQua
ualrty
MAR 0 4 2024
Winston-Salem
DATE:02/28/24 Fteg%bjt-20-0252.010
RE: River Village Phase 2 and 3 Subdivision
Specifications
❑ Other
Shop Drawings
Transmitted Via
DESCRIPTION
FTSA 10-23 form
cover letter
check for $600
site map, aerial map
❑ For Your Use
SIGNATURE:
Don Sever
❑ For Review and Comment
Raleigh Office
3301 Benson Drive, Suite 400, Raleigh, NC 27609
919.322.0115 // www.summitde.com

Winston Salem Regional Office March 28, 2024
Water Quality Section
450 W. Hanes Mill Rd Suite 300
Winston-Salem, NC 27105
River Village Fast Track Sewer System Extension FTA 10-23
City of Burlington
A new residential subdivision with a total of 139 lots in the second and third phase is proposed off W. Old Glencoe
Road in Burlington, NC. A total flow of 33,450 Gallons per day is allocated for the project. This projects connects
into the River Village subdivision approved last year. A pump station with 350 GPM at 135 feet dynamic head is
provided with that project. The receiving downstream sewer is an existing 8" line maintained by the City of
Burlington.
Sincerely,
Dan Swen
Senior Project Manager
Raleigh Office
3301 Benson Drive, Suite 400. Raleigh, NC 27609
919.322.0115 // wwwsummitdo.com

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Project Name: River Village
Owner / Developer: LGI Homes
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Burlington /Alamance
Tax PIN(s): 140418
Figure 4: USGS Topo Quad
Coordinates:
Scale:
Date:
Lat: 36.13614 Long:-79.43258
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10/12/20

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CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd Lambert, P.E.
City Engineer
July 1, 2020
As approved and published by The City of Burlington City Council on December 3,
2019 in the 2020 Fees and Charges Schedules, the Infrastructure Plan Review and
Inspections Fees are required for all Infrastructure / Construction Plans submitted for
initial review after July 1, 2020. The published Infrastructure Plan Review and
Inspections Fee Schedule shall be placed on the cover sheet of all Infrastructure /
Construction Plans submitted for review. The Schedule shall be published on the City
of Burlington's Engineering website and is attached for reference.
In summary:
The Infrastructure Plan Review and Inspections Fee shall include initial plan review,
follow-up review for revised plans based on Engineering redlines and comments,
inspections of all public infrastructure and fire lines by the City of Burlington
Engineering staff, and Certifications for public water and sewer permits. The review
fee for each submittal after the 2nd review shall be 25% of the initial Plan Review and
Inspection Fee.
The entire Plan Review and Inspection Fee shall be paid for all public infrastructure
and fire lines shown on the approved plan at the time of plan approval.
Contractors / Developers shall be responsible for all testing, including but not limited to
testing equipment and labor to perform required test. The COB Engineering Staff shall
witness and approve all testing procedures and results.
Contractor / Developer shall be responsible to supply the Engineering Department with
record drawings / as-builts for approval for all public infrastructure.
Following acceptance of record drawings / as-builts the Engineering Department shall
submit permit certifications for public water and sewer permits along with record
drawings / as-builts for permit satisfaction.
Contractor / Developer shall be responsible for all construction inspection, testing and
certifications of private water, sewer, and storm drain systems.
The Infrastructure Plan Checklist for Plan Review, 9th Revision has been revised to
include UDO references and other Plan requirements. The revised checklist shall be
published on the Engineering website and is attached for reference.
.MAILING ADDRESS: TELEPHONE: [phone]
425 S. LEXINGTON AVE. FAX [phone]
BURLINGTON, NC 27215 VM WBURLINGTONNC.GOV

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd Lambert, P.E.
City- Engineer
Revisions to the City of Burlington Engineering Specifications and Standard Details as
follows -
The City of Burlington will allow PVC sewer collection pipe to be installed in areas that
only serve residential property. PVC sewer may be used in residential developments
where no offsite drainage can or could connect to the line. PVC shall have a minimum
of 4' cover. PVC sewer shall have Class B bedding in accordance with SS-2
Trenching — Bedding — Backfill for PVC Sewer. PVC sewer shall be SDR-21 pipe with
elastometric gasket, push -on type. All PVC sewer locations shall be approved by the
City Engineer.
ADD the following Details:
SS-2 Trenching — Bedding — Backfill for PVC Sewer
PVC SEWER SPECIFICATIONS
PART 1GENERAL
1.01 SCOPE
A. This specification section includes all materials, equipment, labor, and incidentals
required for the supply and installation of polyvinyl chloride (PVC) pipe and fittings,
solid wall 8-inch diameter to 12-in diameter for use in non -pressure sewer applications.
1.02 RELATED SECTIONS
A. City of Burlington Engineering Specifications and Standard Details Section A —
Materials
B. City of Burlington Engineering Specifications and Standard Details Section B.2 —
Sanitary Sewer
1.03 REFERENCES
The Contractor and/or Pipe Manufacturer shall follow the standards listed below, except as
otherwise specified herein. The latest revision or edition in effect at the time of bid opening
shall be utilized.
A. American Society for Testing and Materials (ASTM)
1. D1784 —Standard Specification for Rigid Poly(Vinyl Chloride) (PVC)
Compounds and Chlorinated Poly(Vinyl Chloride) (CPVC) Compounds
MAILING ADDRESS:
425 S. LEXINGTON AVE.
BURLINGTON, NC 27215
TELEPHONE: [phone]
FAX: [phone]
WW'W'.BURLINGTONNC.GO V

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
\t'. Todd lambert, P.E.
Cim Engineer
2. D2321 — Practice for Underground Installation of Thermoplastic Pipe for Sewer
and Other Gravity -Flow Applications
3. D3034 — Type PSM Poly(Vinyl Chloride) (PVC) Sewer Pipe and Fittings
4. D3212 — Joints for Drain and Sewer Plastic Pipes Using Flexible Elastomeric
Seals
5. F477 — Elastomeric Seals (Gaskets) for Joining Plastic Pipe
6. F679 — Polyvinyl Chloride (PVC) Large -Diameter Plastic Gravity Sewer Pipe
and Fittings
7. F1417 — Test Method for Installation Acceptance of Plastic Gravity Sewer Lines
Using Low -Pressure Air
B. American Water Works Association (AWWA)
1. M23 — PVC Pipe — Design and Installation
C. Uni-Bell PVC Pipe Association
1. UNI-B-6 — Recommended Practice for Low -Pressure Air Testing of Installed
Sewer Pipe
2. UNI-B-1 - Recommended Specification for Thermoplastic Pipe Joints, Pressure
and Non -Pressure Applications
3. UNI-PUB-6 — Installation Guide for PVC Solid -Wall Sewer Pipe (4 - 48 in.)
4. UNI-TR-3 — Maintenance of PVC Sewer Pipe
5. Handbook of PVC Pipe Design and Construction
1.04 QUALIFICATIONS
A. The Pipe Manufacturer shall be a member of the Uni-Bell PVC Pipe Association.
B. The pipe and fittings shall be designed, manufactured, and installed in accordance
with industry standards and shall comply with the specification requirements herein.
1.05 SUBMITTALS
A. Conform to the requirements of the City of Burlington Engineering Department.
B. Submit product data on pipe, fittings, gaskets and appurtenances as required to
ensure products meet the requirements of this specification.
1.06 DELIVERY, STORAGE, AND HANDLING
A. Pipe shall be shipped so as to not bend, dent, or otherwise damage the pipe during
transport.
B. Contractor shall take all necessary precautions to prevent damage to pipe and fittings
during delivery and unloading.
C. Owner shall observe and inspect unloading of pipe to ensure proper unloading
procedures are followed.
D. Under no circumstances will pipe be allowed to be rolled, pushed, or dropped off from
any height for delivery, storage, or installation. Any pipe found to have been damaged
MAILING ADDRESS: TELEPHONE: (336) 222-SOSO
425 S. LEXINGTON AVE. FAX: [phone]
BURLINGTON, NC 27215 %X'C( W.BURLINGTONNC.GOV

n
^''Swb�„5r'�
's i p State of North rolina
R Dr%� Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Won of Water ft wces VIA 10-23 At SUPPORTING DOCUMENTATION
Application Number: Ald ll e f s' % % (to be completed by MR)
All items must be completed or the anolication will be returned
I. APPLICANT INFORMATION:
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 02T .01061b1
Title: Ciiv Manawr
4, Applicant's mailing address: P.O. Box 1358
City: Burlington State: 1C Zip: 27216-
5. Applicant's contact information:
Phone number. [phone] Email Address: choneycutt burlingtonnc.gov
11. PROJECT INFORMATION:
1. Project name: River Village Phase 2 & 3
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Pennit/Project
If a modification, provide the existing permit number: W000_ 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: 1�4 amance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1317Longitude:-79.4333'
5. Parcel m (if applicable): 8876, 281983 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Donald Sever License Number: NCO023868
Firm: Summit Design and Engineering Services
Mailing address: 3301 Benson Dr Suite 400
City: Raleigh State: NC Zip: 27609-
Phone number: [phone] Email Address: donseverukummitde.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: East Burlington W WTP Permit Number: NCO023868
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): W00012009
2. Downstream (Receiving) Sewer Information: $ inch M Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS_
OwnerName(s): City of Burlington
FORM: FTA 10-23 Page I of 5

V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No 0 N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV I been attached?
❑ Yes ❑ No x❑ N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOAI 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 (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes ❑x No
➢ 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))
Daily Design Flow' °
No. of Units
Flow
single family dwelling - 3br
225 gaVhome
110
24750 GPD
single family dwelling - 4 br
300 gal/home
29
9700 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
33450 GPD
a See 15A NCAC 02T .0114(b). (d). (eX l) 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: GPD (per 15A NCAC 02T .0114)
➢ 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 0211-0305 & MDC,(GravitS Sewers);
1. 'Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
�; 4 6118` a _
PVC_
— 8
_ 244
DIP
- -
ilt
-- -
➢ 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)
D Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicab le) -. 02T MDC (Pump Stations/Force Mains':
TROVIDE A -SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT_,
I. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump stationr0 - - - - - - • • - - -- -----
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):
Sire (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.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with) A4NCAC 02T -0305th)1 Ili
❑ Standby power source or ❑ Standby pump
D 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 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS —(02B .0200 & 15A NCAC 02T .0305(Q):
1. Does the project comply with all separations/altematives found in 15A NCAC 02T .0305t t) R i e r? 2 Yes ❑ No
15.A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems-.
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 11 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, 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(t) or (e). see Section X.] of this application
* 15A NCAC 02T.0305tet 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 webaaee
2. Does this project comply with the minimum separation requirements for water mains? N Yes ❑ No ❑ NIA
➢ 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 Q NiA
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation reouirements 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? N Yes Basin name: Cast Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? N Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require eoverageiauthorization under a 404 Nationwide/individual permits ® Yes ❑ No
or 401 Water Quality Certifications?
➢ Please provide the permit numbetipermitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0I051c116) (additional permits/certifications)? N Yes [:]No
Per 15A NCAC 02T.0I05lcX6i, 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 N No
Per 15A 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 interferencetconflict 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 10-23 Page 4 of 5

X. CERTIFICATIONS:
Does the submitted system comply with a 5A-NCAC 02T, the Minimum Design Criteria for ti
,and Force Mains ilatest version I' and the Gravity Sewer Minim_ _um Desicn Criteria (latest versi
® 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..Npnroval of the request will be issued
2. Professional Engineer's Certification:
Donald A. Sever ttest that this application for River Village Phase 2 and 3
I,- - - __ .,- - -
(Prof`essmnal-Engineer s reme from`Application Item Ill. I.)a(Project Name Gom Application Item 11.1)
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,
,Minimum Desicn Criteria -for Gravity Sewers Ilatest 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 consistelt 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.$] 0,000, as well as -civil penalties up to $25,000 pei violation. Misrepresentation of the application
information, including failure to disclose any design noncompliance 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 dale: .`` "yN CA/>'0�''�., _t
f OFESS/0N9 �'L- ''..
`SEAL a I 1
GIN
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I Craig Honeycutt ,attest that this application for _ River Village Phase 2• and 3
-_-._. - ,
(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 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. -
Signature: Date:
FORM: FTA 10-23 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
a=Y Division of Water Resources
D►vislon of water Resources Flow Trucking/Acceptance for Sewer Extension Permit Applications
Allocation City of Burlington
Project Name for which flow is being requested: River Village Phases 2 & 3
More than one ME may be required for a single project if the owner of the WWTP is not responsiblefor al1 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:
b. WWTP Facility Permit #:
All flows are in MGD
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
11. 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 (FimVpf), 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. ZZ
••' 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),, Fuji Foods Sewer Extension
Downstream Permit Number:
-,
W00012009
Page 1 of 2 FTSE 10-18

n
Certification Statement:
I, W. Todd Lambert, P.E_. certify to the best of my knowledge that the addition of the
- volume- o wastewater to be —pitted 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.
Signing Official Signature
Cit Y Engineer
Title of Signing Official
Date
Page 2 of 2 FTSE 10-18

LETTER OF TRANSMITTAL
TO: Winston Salem Regional Office
450 W. Hanes Mill Road Suite 300
Winston Salem, NC 27105
ATTN: Water Quality Section
WE ARE SENDING YOU
Prints Reproducible
Copy of Letter Change Order
0 Attached I Under Separate Cover
MAR 0 4 2024
Winston-Salem
DATE:02/28/24 Reg%ay%.f20-0252.010
RE: River Village Phase 2 and 3 Subdivision
Specifications Other
Shop Drawings
Transmitted Via
COPIES
DRAWING
DATE
1/31/2024
1/29/2024
DESCRIPTION
2
1
IFTSA 10-23 form
cover letter
1
1
check for $600
site map, aerial map
TRANSMITTED
For Approval _] As Requested For Your Use
COMMENTS:
COPY TO: SIGNATURE:
Don Sever
1 For Review and Comment
Raleigh Office
3301 Benson Drive, Suite 400, Raleigh, NC 21609
919.322.0115 // www.summitde.com

Winston Salem Regional Office March 28, 2024
Water Quality Section
450 W. Banes Mill Rd Suite 300
Winston-Salem, NC 27105
River Village Fast Track Sewer System Extension FTA 10-23
City of Burlington
A new residential subdivision with a total of 139 lots in the second and third phase is proposed off W. Old Glencoe
Road in Burlington, NC. A total flow of 33,450 Gallons per day is allocated for the project. This projects connects
into the River Village subdivision approved last year. A pump station with 350 GPM at 135 feet dynamic head is
provided with that project. The receiving downstream sewer is an existing 8" line maintained by the City of
Burlington.
Sincerely,
Senior Project Manager
Raleigh Office
3301 Benson Drive, Suite 400, Raleigh, NC 27609
919.322.0115 !! wwwsummitde.coni

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Tax PIN(s): 140418
Figure 4: USGS Topo Quad Coordinates: Scale: Date:
Lat: 36.13614 Long:-79.43258 graphic 10/12/20

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CITY OF BURLINGTON
ENGINEERING DEPARTMENT
July 1, 2020
W. Todd Lambert, P.E.
City Engineer
As approved and published by The City of Burlington City Council on December 3,
2019 in the 2020 Fees and Charges Schedules, the Infrastructure Plan Review and
Inspections Fees are required for all Infrastructure / Construction Plans submitted for
initial review after July 1, 2020. The published Infrastructure Plan Review and
Inspections Fee Schedule shall be placed on the cover sheet of all Infrastructure /
Construction Plans submitted for review. The Schedule shall be published on the City
of Burlington's Engineering website and is attached for reference.
In summary:
The Infrastructure Plan Review and Inspections Fee shall include initial plan review,
follow-up review for revised plans based on Engineering redlines and comments,
inspections of all public infrastructure and fire lines by the City of Burlington
Engineering staff, and Certifications for public water and sewer permits. The review
fee for each submittal after the 2"' review shall be 25% of the initial Plan Review and
Inspection Fee.
The entire Plan Review and Inspection Fee shall be paid for all public infrastructure
and fire lines shown on the approved plan at the time of plan approval.
Contractors / Developers shall be responsible for all testing, including but not limited to
testing equipment and labor to perform required test. The COB Engineering Staff shall
witness and approve all testing procedures and results.
Contractor / Developer shall be responsible to supply the Engineering Department with
record drawings / as-builts for approval for all public infrastructure.
Following acceptance of record drawings / as-builts the Engineering Department shall
submit permit certifications for public water and sewer permits along with record
drawings / as-builts for permit satisfaction.
Contractor / Developer shall be responsible for all construction inspection, testing and
certifications of private water, sewer, and storm drain systems.
The Infrastructure Plan Checklist for Plan Review, 91h Revision has been revised to
include UDO references and other Plan requirements. The revised checklist shall be
published on the Engineering website and is attached for reference.
MAILING ADDRESS: TELEPHONE: [phone]
425 S. LEX7NGTON AVE. FAX: [phone]
BURLINGTON, NC 27215 WWW.BURLINGTONNCGOV

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd lambert, P.E.
City Engineer
Revisions to the City of Burlington Engineering Specifications and Standard Details as
follows:
The City of Burlington will allow PVC sewer collection pipe to be installed in areas that
only serve residential property. PVC sewer may be used in residential developments
where no offsite drainage can or could connect to the line. PVC shall have a minimum
of 4' cover. PVC sewer shall have Class B bedding in accordance with SS-2
Trenching — Bedding — Backfill for PVC Sewer. PVC sewer shall be SDR-21 pipe with
elastometric gasket, push -on type. All PVC sewer locations shall be approved by the
City Engineer.
ADD the following Details:
SS-2 Trenching — Bedding — Backfill for PVC Sewer
PVC SEWER SPECIFICATIONS
PART 1 GENERAL
1.01 SCOPE
A. This specification section includes all materials, equipment, labor, and incidentals
required for the supply and installation of polyvinyl chloride (PVC) pipe and fittings,
solid wall 8-inch diameter to 12-in diameter for use in non -pressure sewer applications.
1.02 RELATED SECTIONS
A. City of Burlington Engineering Specifications and Standard Details Section A —
Materials
B. City of Burlington Engineering Specifications and Standard Details Section B.2 —
Sanitary Sewer
1.03 REFERENCES
The Contractor and/or Pipe Manufacturer shall follow the standards listed below, except as
otherwise specified herein. The latest revision or edition in effect at the time of bid opening
shall be utilized.
A. American Society for Testing and Materials (ASTM)
1. D1784 —Standard Specification for Rigid Poly(Vinyl Chloride) (PVC)
Compounds and Chlorinated Poly(Vinyl Chloride) (CPVC) Compounds
MAILING ADDRESS: "TELEPHONE: [phone]
425 S. LEXINGTON AVE. FAX [phone]
BURLINGTON,NC 27215 WV'W'BLRUNGTONNC.GOV

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd lambert, P.E.
Cim Engineer
2. D2321 — Practice for Underground Installation of Thermoplastic Pipe for Sewer
and Other Gravity -Flow Applications
3. D3034 — Type PSM Poly(Vinyl Chloride) (PVC) Sewer Pipe and Fittings
4. D3212 — Joints for Drain and Sewer Plastic Pipes Using Flexible Elastomeric
Seals
5. F477 — Elastomeric Seals (Gaskets) for Joining Plastic Pipe
6. F679 — Polyvinyl Chloride (PVC) Large -Diameter Plastic Gravity Sewer Pipe
and Fittings
7. F1417 — Test Method for Installation Acceptance of Plastic Gravity Sewer Lines
Using Low -Pressure Air
B. American Water Works Association (AWWA)
1. M23 — PVC Pipe — Design and Installation
C. Uni-Bell PVC Pipe Association
1. UNI-B-6 — Recommended Practice for Low -Pressure Air Testing of Installed
Sewer Pipe
2. UNI-B-1 - Recommended Specification for Thermoplastic Pipe Joints, Pressure
and Non -Pressure Applications
3. UNI-PUB-6 — Installation Guide for PVC Solid -Wall Sewer Pipe (4 - 48 in.)
4. UNI-TR-3 — Maintenance of PVC Sewer Pipe
5. Handbook of PVC Pipe Design and Construction
1.04 QUALIFICATIONS
A. The Pipe Manufacturer shall be a member of the Uni-Bell PVC Pipe Association.
B. The pipe and fittings shall be designed, manufactured, and installed in accordance
with industry standards and shall comply with the specification requirements herein.
1.05 SUBMITTALS
A. Conform to the requirements of the City of Burlington Engineering Department.
B. Submit product data on pipe, fittings, gaskets and appurtenances as required to
ensure products meet the requirements of this specification.
1.06 DELIVERY, STORAGE, AND HANDLING
A. Pipe shall be shipped so as to not bend, dent, or otherwise damage the pipe during
transport.
B. Contractor shall take all necessary precautions to prevent damage to pipe and fittings
during delivery and unloading.
C. Owner shall observe and inspect unloading of pipe to ensure proper unloading
procedures are followed.
D. Under no circumstances will pipe be allowed to be rolled, pushed, or dropped off from
any height for delivery, storage, or installation. Any pipe found to have been damaged
`1AILING ADDRESS:
425 S. LEXINGTON AVE.
BURLINGTON, NC 27215
"TELEPHONE: [phone]
FAX: [phone]
W lL'WJ31iRUNGTONNC.GO V

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd Lambert, P.E.
City Engineer
due to improper handling procedures truck will be immediately marked for identification
and removed from the jobsite at the Contractor's expense.
E. Stacking of pipe shall be performed in accordance with Pipe Manufacturer's
recommendations.
F. Once pipe has been unloaded, it shall be stored as near to its point of installation as
possible. Contractor shall limit moving or restacking of pipe prior to installation.
G. Where necessary, because of ground conditions, store pipe on wooden sleepers,
spaced suitably and of such widths as not to allow deformation of pipe at point of
contact with sleeper or between supports.
H. Pipe shall not be stored close to heat sources or hot objects such as heaters, boilers,
steam lines, and engine exhaust.
I. If pipe is to be exposed to direct sunlight for extended periods (in excess of two years
from the date of manufacture), then Contractor shall cover/shade pipe utilizing canvas
or other opaque materials. Black plastic will not be acceptable as a shading material.
J. Gaskets shall be protected from exposure to excessive heat, prolonged direct sunlight,
and oil and grease.
K. Material storage shall be performed in accordance with Pipe Manufacturer's
recommendations.
PART 2 PRODUCTS
2.01 PIPE
A. Pipe shall be manufactured and supplied in accordance with ASTM D3034 (4-Inch to
15-Inch).
B. Pipe shall have lay lengths between 12 and 22 feet unless otherwise specified by the
Owner.
C. The pipe shall be made of PVC compound having a cell classification of 12454 or
12364 in accordance with ASTM D1784.
D. Pipe shall be homogenous throughout, free of voids, cracks, inclusions, and other
defects.
E. Pipe shall have markings at intervals of 5ft or less including:
1. Manufacturer's name or trademark and code
2. Nominal pipe size
3. PVC cell classification
4. Legend (" SDR-21 PVC Sewer Pipe")
5. ASTM Designation
6. Gasketed pipe shall be marked with an insertion depth mark on the spigot end
F. Pipe for wastewater uses shall be green or white in color.
G. Pipe outside diameters shall be equal to those of cast iron unless otherwise specified
by the Owner.
:NAILING ADDRESS: TELEPHONE: [phone]
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BURLINGTON, NC 27215 WWWBURLINGTONNC.GOV

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd Lambert, P.E.
Cite Engineer
2.02 PIPE DESIGN
A. Pipe shall be supplied to meet the external loading requirements of the project as
follows
1. Maximum calculated deflection of 5%
2. Live loads as calculated per AWWA M23 based on the profile shown on the
plans
3. Depth of cover as shown on the plans
4. Trench width as shown on the plans
5. Modulus of soil reaction (E'), bedding constant (K), and soil density (y) shall be
based on design and site conditions.
2.03 FITTINGS
A. Fittings shall be manufactured and supplied in accordance with ASTM D3034 (8-Inch
to 12-Inch). Molded and fabricated fittings may be supplied in accordance with ASTM
F1336.
B. Fittings shall be made of PVC compound having a cell classification of 12454 or 13343
in accordance with ASTM D1784.
C. Pipe used in fabricated fittings shall have a wall thickness equal to or greater than the
wall thickness of the pipes to which the fitting (or that part of the fitting) will be joined.
D. Molded and fabricated fittings shall have markings including:
1. Manufacturer's name or trademark
2. Nominal size
3. Material designation (e.g. "PVC")
4. ASTM Designation
E. Fittings may also be supplied as ductile iron fittings in accordance with AWWA C110
and/or C153.
2.04 PIPE JOINTS
A. Joints shall be gasketed push -on type conforming to ASTM D3212.
B. Gasket materials shall meet requirements of ASTM F477.
C. Joint lubricant shall be approved by the Pipe Manufacturer and shall have no
detrimental effect on the gasket or pipe.
PART 3 EXECUTION
3.01 GENERAL
A. Install pipe, fittings, specials, and appurtenances in accordance with ASTM D2321,
UNI-PUB-6 and/or in accordance with the Pipe Manufacturer's recommendations.
B. Lay pipe to the lines and grades as indicated on the Plans.
3.02 PIPE HANDLING
A. Handle pipe and piping materials with care to avoid damage.
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425 S. LEXINGTON AVE. FAX: [phone]
BURUNGTON, NC 27215 WlL'W.BURLINGTONNC.GOV

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd Lambert, P.E.
Cite Engineer
B. Prior to installation, each pipe length shall be carefully inspected for damage.
C. All pipe, fittings, and appurtenances shall be thoroughly cleaned before installation and
shall be kept clean until installation and backfilling has completed.
D. Use only nylon ropes, slings, or other lifting devices that will not damage the surface of
the pipe.
E. Keep the pipe clean and free of debris, dirt, animals, and trash during and after laying
operations.
F. At the close of each operating day, seal the open end of the pipe using a gasketed
night cap.
G. Before, during, and after installation, plastic pipe and fittings shall be protected from
exposure to sunlight and any environment that would result in damage to or
deterioration of the material. Pipe shall be covered with opaque plastic film. Solvents,
solvent compounds, lubricants and any similar materials required to install the plastic
pipe shall be stored in accordance with the manufacturer's recommendations and shall
be discarded if the storage period exceeds the recommended shelf life.
3.03 PIPE INSTALLATION
A. Do not drag pipe over gravel or rock. Avoid striking rocks or hard objects when
lowering pipe into the trench.
B. Placement of pipe and fittings into the trench should be done with ropes and skids,
slings on a backhoe bucket, or by hand.
C. Pipe or fittings shall not be thrown into the trench and no part of the pipe shall be
allowed to take an unrestrained fall onto the trench bottom.
D. Joint sockets shall be carefully cleaned before pipes are lowered into trenches.
E. Pipe trenches and excavation shall be kept free of water during pipe laying operations
and other related work. If high groundwater levels are expected or encountered,
Contractor is to ensure that a minimum depth of cover of 1.5 times the pipe diameter
will be maintained over the pipe once it has been installed or provide other methods
approved by the Owner and Pipe Manufacturer of preventing flotation of the pipe.
F. Where the subgrade is found to be unstable or to include ashes, cinders, refuse,
organic material, or other unsuitable material, such material shall be removed to a
minimum of 3-inches, or to the depth ordered by the Engineer, and replaced with a
foundation and bedding of crushed stone, suitably graded, and acting as an
impervious mat into which the unstable soil or unsuitable material will not penetrate.
The depth of crushed stone used for foundation and bedding shall depend upon the
severity of the condition of the trench bottom soil or material. The amount of crushed
stone to be used by the Contractor shall, in all cases, be designated by the Engineer.
Carefully prepare bedding so that the pipe after installation will be true to line and
grade. Surface grade the bedding stone beneath the pipe to provide a uniform and
MAILING ADDRESS: TELEPHONE: [phone]
425 S. LEXINGTON AVE. FAX: [phone]
BURLINGTON, NC 27215 WWW'BURI.INGTONNC.GOV

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd Lamben, P.E.
City- Engineer
continuous support beneath the pipe at all points between bell holes or pipe joints.
Densify bedding stone beneath the pipe. After each pipe has been brought to grade,
aligned, and placed in final position, deposit and densify sufficient bedding material
under the pipe haunches and on each side of the pipe to hold the pipe in proper
position during subsequent pipe jointing, bedding, and backflling operations. Bedding
material shall be uniformly and simultaneously deposited on each side of the pipe to
prevent lateral displacement.
G. Sewer laterals shall connect to the main with a sewer pipe wye. Saddles shall not be
allowed on new installations.
3.04 JOINT MAKING
A. Install push -on joints in accordance with Pipe and Fittings Manufacturer's
recommendations.
B. Inspect the gasket, pipe spigot bevel, gasket groove, and sealing surfaces for damage
or deformation. In cases when gaskets are supplied separately from pipe, Contractor
is to ensure that gaskets supplied are designed for the pipe in use.
C. Clean the gasket of all extraneous matter.
D. Apply a thin film of joint lubricant to the inside of the gasket and the outside of the
spigot prior to entering the spigot into the bell. Lubricated spigots ends shall not come
in contact with soil or backfill material.
E. Insert the spigot end of the pipe carefully into the bell until the reference mark on the
spigot is flush with the bell. If two reference marks are present, the mark closest to the
spigot end shall be considered the minimum insertion mark, and the second mark shall
be considered the maximum insertion mark. Under no circumstances will the spigot
be inserted into the bell past the reference mark or maximum insertion mark.
F. For small diameter pipe, use the bar -and -block method for joint assembly or other
method approved for use by the Owner and Pipe Manufacturer.
G. For large diameter pipe, use mechanical assistance such as hydraulic pipe pullers,
jacks, pulleys, come-alongs, or a backhoe bucket. Observation by a spotter will be
required when assembling joints for large diameter pipe to prevent over -insertion.
H. When using a field cut plain end piece of pipe, bevel the end with a beveling tool,
wood rasp, or power sander to the same angle and length as provided on the factory -
finished pipe. Redraw the insertion line on the spigot using a factory -marked spigot as
a guide.
I. Angular changes in pipe alignment shall be achieved by either fittings, joint deflection,
or longitudinal bending of the pipe.
J. Joint deflection shall not exceed the Pipe Manufacturer's recommendation.
K. Field assembly of pipe fittings shall follow the Pipe Fittings Manufacturer's
recommendations.
NL1lldNG ADDRESS: TELEPHONE: [phone]
425 S. LEXINGTON AVE. FAX: [phone]
BURLINGTON, NC 27215 WWWBUMNGTONNC.GOV

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
l\'. Todd Lambert, P.E.
Cite Engineer
L. Mechanical joints shall be assembled per the Pipe and/or Fittings Manufacturer's
recommendations as well as the recommendations of the mechanical joint supplier.
3.05 LONGITUDINAL PIPE BENDING
A. Longitudinal pipe bending is not allowed. Pipe shall be installed in a direct, straight
line from manhole to manhole.
3.06 FIELD TESTING
A. After pipe has been installed and backfilled, deflection testing shall be performed in
accordance with ASTM D3034 and/or F679, PVC Pipe Handbook, and the
specifications herein. Deflection testing shall utilize a "go/no-go" rigid ball or mandrel
for measurement of pipe deflection. The test shall be conducted after the final backfill
has been in place at least 30 days to permit stabilization of the soil -pipe system. As
an alternative to waiting 30 days to permit stabilization of the soil -pipe system, the
Division will accept certification from a soil testing firm verifying that the backfill of the
trench has been compacted to at least 95% maximum density. No pipe shall exceed a
deflection of 5 percent. If deflection exceeds 5 percent, replacement or correction
shall be accomplished in accordance with requirements in the approved specifications.
The rigid ball or mandrel used for the deflection test shall have a diameter not less
than 95 percent of the base inside diameter or average inside diameter of the pipe
depending on which is specified in the ASTM Specification, to which the pipe is
manufactured. The pipe shall be measured in compliance with ASTM D 2122
Standard Test Method of Determining Dimensions of Thermoplastic Pipe and Fittings.
The test shall be performed without mechanical pulling devices.
B. All finished installations for non -pressure applications shall be tested via low-pressure
air testing in accordance with ASTM F1417, UNI-B-6, and the specifications herein.
All planned services shall be installed prior to testing.
C. Isolate the section of non -pressure sewer line to be air tested by inflatable stoppers or
other suitable test plugs/caps.
D. Ends of all branches, laterals, tees, wyes, and/or stubs in the test section shall be
plugged or capped to prevent air leakage. One of the plugs/caps shall have an inlet
tap or other method for connecting the air hose to an air control source.
E. Test ends should be restrained and/or braced during air testing.
F. Add air slowly to the test section until the pressure reaches 4.0 psi. After the test
pressure is obtained, regulate the air supply so that the pressure is maintained
between 3.5 and 4.0 psi for at least 2 minutes until the air temperature stabilizes and is
in equilibrium with the temperature of the pipe walls.
G. After equilibrium is achieved, determine the rate of air pressure loss by either the
constant pressure method or the time -pressure drop method as outlined in ASTM
F1417.
MAILING ADDRESS: "TELEPHONE: [phone]
425 S. LEXINGTON AVE. FAX [phone]
BURLINGTON, NC 27215 W'WW.BI.aLINGTONNC.GOV

CITY OF BURLINGTON
ENGINEERING DEPARTMENT
W. Todd Lambert, P.E.
City Engineer
H. Upon completion of the test, open the bleeder valve and allow all air to escape.
Caps/plugs shall not be removed until all air pressure in the test section has been
reduced to atmospheric pressure.
I. The contractor will be responsible for performing a video inspection of the sewer line
once it is completed and cleaned. Television inspection information will be provided to
the City of Burlington Engineering Department for all public mains and connecting
services. The Engineering Department shall be provided a report with each section
identified and linked to either a DVD disc or digital media file with all inspection footage
included for each section. Quality of video inspection will be to industry acceptable
standards clearly showing any potential defects. Sewer lines under proposed
pavement are not considered ready for TV until any required pavement binder is in
place and manhole rims are adjusted to grade with the sewer lines cleaned out. Every
foot of main shall be recorded with zero beginning at the first manhole and ending with
next manhole. Video taping of mains shall be done after any cleaning or jetting
operation is complete and immediately after water has been introduced into the main.
In the event that repairs are required, affected segment or segments of line will need
to be retested and reinspected by means of the video inspection process for final
approval. The camera should have pan and tilt capabilities to viewing the pipe at 360
degrees with on screen print out of data. A report form for every segment of line shall
be submitted, this should include the firm submitting the report, date, project, upstream
and downstream invert elevations, manhole depths, length between manholes, pipe
diameter and material type. Any video inspection report that doesn't clearly show the
line and connecting service laterals and not meet the above requirements will be
rejected.
MAILING ADDRESS: TELEPHONE: [phone]
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BURLINGTON, NC 27215 W W W.BURLINGTONNC.GOV

FINAL
BACKFlLL
UNDISTRUBED SOIL)
+ + + + + + + + + + +
+ + + + + + + + + +
+ + + + + + + + + +
+ + + + 4 + t + + + +
2. + + + 4 + + + + + +
+ + + } + + + + + + + INITIAL
+ + + + + + + + + + BACKFlLL
:[.�+ + + + + + + + + + +
SDR-21 PVC SEWER + + + + + + + + + +
+ + + + + + + + + t +
+ + + + + + + + + +
BEDDING STONE
#57 OR S67 BEDDING
SUITABLE, UNDISTURBED TRENCH
DD PIPE + 1' EACH SIDE
AS MINIMUM TRENCH WIDTH
4" MIN
NOTES:
1. BEDDING SHALL BE THE FULL WIDTH OF THE TRENCH WHERE SHORING AND BRACING IS
REQUIRED.
2. ALL BACKFlLL SHALL BE FREE AND CLEAR OF STONES GREATER THAN 2".
3. ALL BACKFlLL MATERIAL SHALL BE SUITABLE, NATIVE MATERIAL APPROVED BY CITY OF
BURLINGTON.
4. BACKFlLL SHALL BE PLACED AND COMPACTED IN 6" LIFTS.
5. DEFLECTION TESTING SHALL TAKE PLACE 30 DAYS AFTER BACKFlLL OPERATIONS ARE
COMPLETE. IN LIEU OF WAITING 30 DAYS, COMPACTIONS TESTING MAY BE COMPLETED
SHOWING 95% TRENCH COMPACTION.
6. UNSUITABLE TRENCH BOTTOM MATERIAL SHALL BE REPLACED WITH FOUNDATION MATERIAL TO
THE SATISFACTION OF THE CITY ENGINEER.
7. INITIAL BACKFlLL SHALL BE HAND WORKED AND TAMPED.
UXIL RCVIJCU JUMLL UCIWL ("� - (1
07/01/20 NOT TO SCALE J L
TRENCHING, BEDDING, AND BACKFlLL REQUIREMENTS FOR PVC SEWER
CITY OF BURLINGTON, NORTH CAROLINA
ENGINEERING DEPARTMENT

• Section 1098
1 Furnish single mode fiber that does not exceed attenuation ratings of 0.25 dB/km at
2 1550 nm and 0.35 dB/krrl at 1310 nm and complies with ITU G.652D and
3 IEC 60793-2-50 Type B.1.3 industry standards for low water peak, single mode fiber.
4 Provide fibers that are useable and with a surface, sufficiently free of imperfections and
5 inclusions to meet optical, mechanical and environmental requirements.
6 Ensure the core central strength member is a dielectric glass reinforced rod and that the
7 completed cable assembly has a maximum pulling rating of 600 lbf during installation
8 (short term) and 180 lbf long term installed.
9 Construct buffer tubes (nominal size of 2.5 mm) manufactured from a polypropylene
10 copolymer material to provide good kink resistance and allows the buffer tube to
11 maintain flexibility in cold temperature over the expected lifetime of the cable. Ensure
12 that buffers tubes contain no more than 12 fibers per buffer tube unless specified
13 otherwise, and that all buffer tubes are filled with a water blocking gel or water swellable
14 material. Construct the cable such that the buffer tubes are stranded around the central
15 strength member in a reverse oscillating arrangement to allow for mid -span entry.
16 Distinguish each buffer tube from others by color coding that meets EIA/TIA-598. Use
17 filler tubes to maintain a circular cross-section of the cable. Ensure the filler tubes are the
18 same nominal size as the buffer tubes of 2.5 mm. Apply binders (water swellable yarn,
19 kevlar, etc.) with sufficient tension to secure buffer tubes and filler tubes to the central
20 member without crushing the buffer tubes. Ensure that binding material is
21 non -hygroscopic, non -wicking and dielectric with low shrinkage. Ensure the binders are
22 of a high tensile strength that is helically stranded evenly around cable core.
23 Ensure the cable core is protected from the ingress of moisture by a water swellable
24 material or that is filled with a water blocking compound that is non-conductive. Ensure
25 the water swellable material (when activated) or the water blocking compound is free
26 from dirt and foreign matter and is removable with conventional nontoxic solvents.
27 Furnish at least one ripcord to aid in the process of removing the outer jacket. Furnish
28 the outer jacket constructed of a medium -density polyethylene material to provide
29 reduced friction and enhanced durability. Ensure the polyethylene material contains
30 carbon black to provide UV protection and does not promote the growth of fungus.
31 Ensure the cable jacket is free of slits, holes or blisters and the nominal outer jacket
32 thickness is > 0.050".
33 Ensure the completed cable assembly contains identification markings printed along the
34 outside cover of the jacket every 2 feet. Ensure the character height of the markings is
35 approximately 0.10 inch. Provide length markings in sequential feet and within 1% of
36 actual cable length.
37 Mark each cable with the following:
38
(1)
Sequential length marks in feet as specified
39
(2)
The name of the manufacturer
40
(3)
"OPTICAL CABLE"
41
(4)
Month/year of manufacture
42
(5)
Number(s) of and type(s) of fibers
43
(6)
Cable ID Number for product traceability
44 (B) Drop Cable
45 Furnish drop cable meeting the material requirements listed in Subarticle 1098-IO(A)
46 with the exceptions herein to provide communications links between splice enclosures
47 and through interconnect centers. Furnish drop cable containing at least 6 individual
48 fibers.
49 Furnish drop cable that complies with RUS-CFR 1755.900 and is RUS listed. Ensure
50 each drop cables has the same operating characteristics as the SMFO cable it is to be
51 coupled with.
10-217

I&etive.S
DWR
Division of Water Resources
( State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: ;(0'I<S 4 7 Ito be completed by
All items must be completed or the application will be returned MAR 0 4 2024
1. APPLICANT INFORMATION:
1. 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
Honeycutt per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: P.O. Box 1358
City: Burlington�State: NC
Zip: 27216-_
5. Applicant's contact information:
Phone number: 3( L6) 222-5000'
Email Address: chonevcutt(&.burlinetonnc.gov
It. PROJECT INFORMATION:
Winston-Salem
Regional Office
❑ Privately -Owned Public Utility
❑ Other
1. Project name: River Village Phase 2 & 3
2. Application/Project status: © Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ 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: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1317' Longitude: - 97 4333°�
5. Parcel ID (if applicable): 8876281883 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Donald Sever License Number: NCO023868
Firm: Summit Design and Engineering Services'
Mailing address: 3301 Benson Dr Suite 400
City: Raleigh' State: NC' Zip: 27609
Phone number: [phone]— Email Address: [e-mail]'
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: East Burlington W WTP ' Permit Number: NC0023868
Owner Name: City of Burlington '
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): W00012009 -
2. Downstream (Receiving) Sewer Information: 8 inch 0 Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS�> s
Owner Name(s): City of Burlington
FORM: FTA 10-23 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 Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ®N/A'
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) 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 (See 15A NCAC 02T .0103(201)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ® No
➢ 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))
Daily Design Flow a,b
No. of Units
Flow
single family dwelling - 3 br'
225 gal/day'
I10
24750 GPD
single family dwelling - 4 br
300 gal/day
29
33450 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
58200 GPD
a See 15A NCAC 02T .0114(b). (d), (e)(1) and (e)(2) 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 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: 58200'GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ 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

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
6118
PVC
8
244
DIP
➢ Section 11 & 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) — 02T .0305 & MDC (Pump Stations/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: 0
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. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCAC 02T .0305(hl(1):
❑ Standby power source or ❑ Standby pump
)0 Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(I)(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(hx1)(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 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
i
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (e)? ® Yes []No
15A NCAC 02T.0305(fl contains minimum separations that shall be nrovided for sewer systems:
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 II 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 IX.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 (2). see Section X.1 of this application
*15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(fl 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 weboaee
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.
➢ Seethe 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: Cape Fear []No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02009 ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
n
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.
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6. 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 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 an sewer collection lines that are deemed "high -priority?" J p I yEl ®No
Per 15A NCAC 02T.04021 "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:
L 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?
® Yeg ❑ 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 rearrest will be issued
2. Professional Engineer's Certification:
1 Donald A. Sever ' attest that this application for River Village Phase 2 and 3 '
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item ❑.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,
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. 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: , /� ,``��� 11""•�,,
g �OCs29
SEAL `all y
24627 r �;
2 •••F'1'GINECe.•'
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1 Craig Honeycutt , attest that this application for River Village Phase 2 and 3'
(Signature Authority Name from Application Item 13.) (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 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.
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Signature: C Date: I ra
FORM: FTA 10-23 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
t r Division of Water Resources
`Dlviston 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: River Village Phases 2 & 3 '
More than one FTSE may be required for a single project ifthe mvner 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: East
b. WWTP Facility Permit #: NC-(
WWTP _ /
I
All flows are in MGD
c. WWTP facility's permitted flow 12.00{
d. Estimated obligated flow not yet tributary to the WWTP _ _ _1.754324. '
e. WWTP facility's actual avg. flow =_ = 3.8360,
f. Total flow for this specific request 0.058200 -�
g. Total actual and obligated flows to the facility 5.648524 -
h. Percent of permitted flow used 47.1%-
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: None
(A)
(B)
(C)
(D)=(B+C)
Obligated,
Total
Design
Approx.
Not Yet
Current Flow
Firm Average Daily
Current Avg.
Tributary
Plus
Pump Station Capacity, * Flow"
Daily Flow,
Daily Flow,
Obligated
Name GPD (Firm/pf), GPD
GPD
GPD
Flow
(E)=(A-D)
Available
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 5 0.
Downstream Facility Name (Sewer) :: Fuji Foods Sewer Extension
Downstream Permit Number:
WQ0012009
Page 1 of 2 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 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. 012-
, 2-
Signing Official Signature Date
City Engineer
Title of Signing Official
Page 2 of 2 FTSE 10-18

Winston Salem Regional Office January 29, 2024
Water Quality Section
450 W. Hanes Mill Rd Suite 300
Winston-Salem, NC 27105
River Village Fast Track Sewer System Extension FTA 10-23
City of Burlington
A new residential subdivision with a total of 139 lots in the second and third phase is proposed off W. Old Glencoe
Road in Burlington, NC. A total flow of 58,200 Gallons per day is allocated for the project. This projects connects
into the River Village subdivision approved last year. A pump station with 350 GPM at 135 feet dynamic head is
provided with that project. The receiving downstream sewer is an existing 8" line maintained by the City of
Burlington.
Sincerely,
Dan SUWA
Senior Project Manager
Raleigh Office
3301 Benson Drive, Suite 400, Raleigh, NC 27609
919.322.0115 // wwwsummitdo.com