WQ0045521_Burch_Bridge_Road_Conservation_Subdivision_FTSSE_Permit_App_2nd_&_1st_Submissions_20240624

R
Division of Water Resources
vQ� y/,_//zo2y
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING INN 1ImFNTxTrnw
Application Number IWAW! 5S21 (to bacanpluedbyDWRI
All Items must be completed or the aonlieation wig be returnJJN 2 1 2024
1. APPLICANT INFORMATION: Winston-Salem
1. Applicant's name: City of Burlington (.company, municipality, HOA, utility, etc.) Regional Office
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership El Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Craig Honeycutt per15A V('AC'02T Ulpo,b1
Title: City Manager
4. Applicant's mailing address: 425 S. Lexington Ave
I
City: Burlington State: hK Zip: 27215-_
5. Applicant's contact information:
Phone number: [phone] Email Address: choneycutt(a burlineton tc eov
11. PROJECT INFORMATION:
L Project name: Burch Bridge Road Conservation Subdivision
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
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: WQOO_
3. County where project is located: Alamancef
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1 7' Longitude:-79.453631'
5. Parcel ID (if applicable): 8866-63-5647 (or Parcel ID to closest downstream sewer)
HL CONSULTANT INFORMATION:
Professional Engineer: Matthew Daniels. PE License Number: 049488
Firm: FLM Eneineerine Inc '
Mailing address: PO Box 91727
City: Raleigh State: lam' Zip: 7675-
Phone number: (9) M-2952' Email Address: mdaniels(n)Bmengineering com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Bast Burlington WWTP / Permit Number. NCO023868
Owner Name. City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ(N/Al Installed 1977
2. Downstream (Receiving) Sewer Information: 20 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number s) (if applicable): WQCSfAK
Owner Name(s): City of Burlington
FORM: FTA 10-23 Page 1 of

V1. GENERAL REQUIREMENTS
L If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A �
2, If the Applicant is a Developer of lots to be sold, has a D .% •I roer . Unerutivaal amement (FORM DEV t been attached?
❑ Yes ❑ No ® N/A �
3. If the Applicant is a Home/Property Owners' Association, has an [IQA POA Operational ;'cement (FORNt Ht rA) and
supplementary documentation as required by 15A NCAC 02T.0I 15(c) been attached?
❑ Yes ❑ No ®N/Ai
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned)
❑ Retail (stores, centers, malls)
❑ Residential (Leased)
❑ Retail with food preparation/service
❑ School / preschool / day care
❑ Medical / dental / veterinary facilities
❑ Food and drink facilities
❑ Church
❑ Businesses / offices / factories
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming POOL/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic _% Commercial _ % Industrial (See I5A NCAC 02T 0103120 y
If Industrial, is there a Pretreatment Program in effect? ❑ Yes[] No
6. Has a Flow reduction been approved under I iA N( AC O' T 0 t 141 U? ❑ Yes ❑ No
io If ves. provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow '"
No. of Units
Flow
Single Family - 4 bdrm (75 gaVbdrm) `
300 galiunit
51
15,300 GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
GPD
gaV
GPD
Total
15,300 GPD
a See 15A NCAC 02T .0114(b). (d). (ch 1) and (et(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 (i.S. 42A-4).
b Per I SA NCAC 02T .0114(c), design flow rates for establishments not identified [in table � � NCAC 021 01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 15300 GPD (per I iA NCAC 02T .01 14 and G.S. 143-215.1)
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 10-23 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T_0305 & NIDC tGrasith Sewerst:
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 2,268 DIP
➢ Section If &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 sewers)
D 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 StatiouslForce Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - '
3. Total number of pumps at the pump station:
3. Design flow of the pump station: _ millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational points) per pump(s): _ gallons per minute (GPM) at _ feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A IV('AC 021 010(h)(I1:
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(lxB):
➢ 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(hg 1 pC):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
D 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 Ravel 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 — (028.0200 & 15A NCAC 02T .0305(f)):
I Does the project comply with all separations/alternatives found in 15A NCAC 02T 03U5( t) e 1 e j' ® Yes ❑ No
15A NCAC 02T.0305 contains minimum se ration th t h II k-
Pa
s a s a provtded for sewer
Setback Parameter*
s srems:
Stoma sewers and other utilities not listed below (vertical)
'Water mains (vertical - water over sewer preferred, including in benched trenches)
M18mches
'Water mains (horizontal)
Reclaimed water lines (vertical - reclaimed over sewer)
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"Any private or public water supply source, including any welts, WS-1 waters of Class 1 or
Class II 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
r n&Mpuaucc wruryL l . VJ V 5i r t Or 1 e L see Section A.l OI min. app[ICSUOR
*15A NCAC 02T.0305te) contains alternatives where separations in 02T.03051f1 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 INC Surface Water Classifications webnr"
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 drlit separation regtnremcnts for situations where separation cannot be met.
> No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Jordan ❑ No s
If yes, does the project comply with setbacks found in the river basin rules per 15A NC AC 02B .U_'UO'.. ® Yes ❑ No
> This includes Trout Buffered Streams per 15A NCAC 28.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ® Yes ❑ No
or 401 Water Quality Certifications?
> Please provide the permit number/permitting status in the cover letter if covmgetauthorization is required.
6. Does project comply with 15A NCAC 02101051c i1t51(additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC UZT.0 1051 L ab t. directly related environmental permits or certification applications must be being prepared
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" []Yes ® No
Per ; iA Nl Al 0T.040', "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/cooNet 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 permit[ee 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

V CERTIFICATIONS:
I. Does the submitted system comply with I iA NC AC O_ I, the Mimmum Deslan (-ntcria for the Permuung A P 8 St utuns
and Furce Mains (latest vcntun) and the Cis th Ssn er Minanum Design Criteria (latest verbion as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Altemative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office, Approval of the request will be issued
2. Professional Engineer's Certification:
I• t�t�tu�at.> olC attest that this application for 31irr1,C lJl"�r"�� C ..4r-•- 4h•�t tA�
(Pmfessinnal Engineer's name from Applintion Item 111.I_) (Project Name F m 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,
Mininum Design Cntena for Gravm Sewers (latest v •r,t n), and the Minimum Dcstgn Cnterto for the Fast -Track Permitting
Of Pullin stauum 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. (2I NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
/ J
1, Craig Honeycutt, City Manager attest that this application for Burch Bridge Road Conservation Subdivision
(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. 1 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.OA 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 misdemcanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: L `� _ _-- Date:
FORM: FTA 10-23 Page 5 of 5

f
CAW�A* R
Division of water Resources
gee-elt, trd."o &/iy/z o ziol'
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 (.�((� �jf S,$$ o`« (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 Honevcutt per 15,-� \(.AC 02T.OIOrAbt
Title: City Manager
4. Applicant's mailing address: 425 S. Lexington Ave.
City: Burlington State: NC Zip: 27215-_
5. Applicant's contact information:
Phone number. [phone] Email Address: chone+,cutt(&,burlingtonnc.gov
11. PROJECT INFORMATION:
l . Project name: Burch Bridge Road Conservation Subdivision
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: WQ00_ and issued date: _,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00_
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.120267' Longitude:-79.453631'
5. Parcel ID (if applicable): 8866-63-5647 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
Professional Engineer: Matthew Daniels. PE License Number: 049488
Firm: FLM Engineering, Inc.'
Mailing address: PO Box 91727
City: Raleigh' State: NC Zip: 27675-_
Phone number: [phone]' Email Address: mdanielsi&,f1menstineering.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: East Burlington WWTP ` Permit Number:
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
l . Permit Number(s): WQ(N/A ) Installed 1977
2. Downstream (Receiving) Sewer Information: 20 inch Z Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00008'
Owner Name(s): City of Burlington '
FORM: FTA 10-23 Page I 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 ' )r. LINE-s Omalauadl Agreement it ORMt DEV i 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 (Ltdividually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental i 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 ()'T 01031201
If Industrial, is there a Pretreatment Program in effect? ❑ Yes[] No
b. Has a flow reduction been approved under 15 A .N C 4C o) 1 '/ 1 ! al 1r ❑ Yes ❑ No
➢ If ves. provide a copy of flow redaction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow ^°
lVe. of Units
Flow
Single Family - 4 bdrm (75 gallbdrm)
300 gal/unit
51
15,300 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
15,300 GPD
a See 15A NCAC 02T .0114(b). (d)(ctt I ) and (c)(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 O.S. 4ZA-4 .
b Per ISA 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: 1jJQ0 GPD (per 15A NCAC 02T .01 14 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

47I. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Graviry Sewers):
_ Summanze gravity sewer to be permitted:
Size (inches) Length (feet) Material
S 1,268 DIPS
10 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 alloyed 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
l . Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station: _
3. Design flow of the pump station: _ millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): _ gallons per minute (GPM) at _ feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C. I .b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .03056H 1):
❑ 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(hg 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(f)):
I Does the project comply with all separations/altematives found in � ( A, _ T „, ®Yes ❑ No
15A NCAC 02T 0305t f contains minim • Ilr
UM se attons at shall m provided for sewer
Setback Parameter;
systems:
Separation Required
Storm sewers and other utilities Trot 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 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)
(0 feet
Top slope of embankment or cuts of 2 feet or more vertical height
I0 feet
Drainage systems and interceptor drams
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
C-----
36 inches
u nvnuanpuance wtm v: t u�u�t n or i el see Section X.1 ofthis application
"; SA M-AI 02T 03051 a) contains ahematives where separations in 021.03051 tl cannot be achieved. Please check "yes"
above if these altematives are used and provide narrative information to explain
"Stream classifications can be identified using the Division's NC Surface Water Classifications webriaee
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.
4. Is the project located in a river basin subject to any State buffer ndes? ®Yes Basin name: Jordan ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B 0200" ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 28.0202
r
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ®Yes ❑ No
or 401 Water Quality Certifications?
D Please provide the permit number/permitting status in the cover letter if coveragetauthorization is required.
6. Does project comply with t 5A NCAC 02T.0105(c a6) (additional permits/certifications)? ® Yes ❑ No
Per i 5A NCAC 02T.0I 05f c u 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 any sewer collection lines that are deemed "high -priority?" ❑ Yes ®No
Per : SA NCAC02T,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/cooflict 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 I5A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC ()'I, the Mmlmum Design Cntcna for the Per atmx t Pump S 1
and For,_ 'slams tlatest �enlont and the Gravllti Sewer kbmmum Design Criteria tlatest v er 1 n 1 as applicable?
® Yes' ❑ No
If no, for projects requiring a single variance, complete and submit the VarianceiAlternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Annroval of the rem,nat wilt h, i.....A
2. Professional Engineer's Certification:
I, C W 2a C attest that this application for 1�7t YTIti ,ram H
(Professtonat Engtneefs name from Application Item 111.1.) (Project Name m Appl7i.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 Desism Criteria for Gravity Sewers tlatest versions and the Mmtmutn Destan Criteria for the Fast -Track Pernurtmg
of Pump Stations and Farce Mains (latest version ). 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 143-215.611, any person who knowingly [Hakes 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 nor[ -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)
,\ "W11111111...
North Carolina Professional Engineer's seal, signature, and date: C A RO��''%
6-13-
p, v
11111\��
3. Applicant's Certification per 15A NCAC 02T-0106(b):
1, Craig Honeycutt, City Manager , attest that this application for Burch Bridge Road Conservation Subdivision
(Signature Authority Name from Application Item 1.3.) (Project Name from Appli"tion Item If.])
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. 1 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-' 15.o A, and 14 3 1 i 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: s—I L�
FORA: FTA 10-23 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 10-23)
Entity Requesting Allocation City of Burlington
Project Name for which flow is being requested: Burch Bridge Road Conservation S/D
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump stations along
the route of the proposed wastewaterjlow.
1. 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 12.00'
d. Estimated obligated flow not yet tributary to the WWTP 1.754924'
e. WWTP facility's actual avg. flow 4.0510/
f. Total flow for this specific request 0.015300 '
g. Total actual and obligated flows to the facility 5.821224
h. Percent of permitted flow used 48.5%
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)
uesign Approx.
t oral
Pump Average Current
Current
Station Pump Firm Daily Avg. Daily
Flow Plus
Available
(Name or Station Capacity, * Flow** Flow, Obligated, Not Yet Tributary
Obligated
Capacity**
Number) Permit No. GPD (Firm/pf), GPD Daily Flow, GPD
Flow
* 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<0.
Downstream Facility Name (Sewer) :
Downstream Permit Number:
Page 1 of 2
FTSE 10-23

III`. Certification Statement:
1, W. Todd Lambert. P.E. i 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 asseessment 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 1 am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works equate capacity to transport and treat the proposed new wastewater.
Signing Official Signature
Citv Engineer
Title of Signing Official
Date
Page 2 of 2 FTSE 10-23

FLMENGINEERING
TRANSMITTAL IFNcDepartmentof
Environmental quality
r Received
Date: June 13, 2024 JUN 14 4V4
To: Winston-Salem Regional Office Winston-Salem
450 W. Hanes Mill Road Suite 300 Regional Office
Winston-Salem, North Carolina 27105
Attn: Water Quality Section
Reference: Burch Bridge Road Conservation Subdivision — Fast Track Submittal
We are sending the following items:
Copies
Descri .tion
Date
2
Cover Letters
2024-06-13
1
Application Fee of $600.00
2024-06-13
2
Burch Bridge Rd Conservation S/D - Fast Track Sewer Applications
2024-06-13
2
Burch Brid a Rd Conservation S/D - Tracking / Acceptance Forms
2024-06-13
2
8.5" x 11" USGS Topographic Map
2024-06-13
2
8.5" x 11" Aerial Imagery Map
2024-06-13
2
8.5" x 11" 3' DEM Contour Maps
2024-06-13
These items are transmitted:
❑ For Review & Comment = As Requested ❑ For Your Use
Sincerely,
FILM/ Engineering, Inc.
c h4ew!an/Y6�
Matthew Daniels, Project Engineer
mdaniels(4flmen gineerinacom
® For Approval
© 2024 FILM Engineering, Inc. Page 1 of 1 June 13, 2024
PO Box 91727, Raleigh, NC 27675 p 1919.923.2952

FLMENGINEERING
June 13, 2024
NCDEQ Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road Suite 300
Winston-Salem, North Carolina 27105
Reference: Burch Bridge Road Conservation Subdivision
Fast Track Sewer Extension Application
To Whom It May Concern:
NC Denarfine
EnvlrpRocei"F' Q ality
JUN 14 2024
W/nston-Sa/ern -
Regional Office
This letter is to accompany the submittal package for the Burch Bridge Road Conservation Subdivision
Fast Track Sewer Extension Application (form FTA 10-23).
Burch Bridge Rd Partners, LLC. is proposing to construct 51 single-family residential homes, with an
extension and tie-in to an existing sewer main. The site is located North of Burlington on Burch Bridge
Road on Alamance County Parcel ID No. 8866-63-5647.
Per the 15A NCAC 02T, we have utilized a design flow rate of 75 gallons per day per dwelling bedroom.
Thus, for 51 dwellings, the total wastewater flow generated by this project is expected to be 51
dwellings x 4 bedrooms/dwelling x 75 gallons per day/bedroom = 15,300 gallons per day.
The sewer extension consists of 15 proposed public 4' diameter manholes, and 3 proposed public 5'
diameter manholes, and 2,268 feet of 8-inch DIP.
The proposed gravity sewer system shall connect to the City of Burlington sewer system.
Included with the submittal are the following items:
• Cover Letter,
• FTA,
• FTSE,
• USGS Topographic Map,
• Aerial Location Map, and
• Application Fee of $600.
Please let me know if you have any questions or need any additional information.
Sincerely,
Matthew D. Daniels, PE
Project Engineer
919.923.2952
[e-mail]
© 2024 FLM Engineering, Inc.
Page 1 of 1
PO Box 91727, Raleigh, NC 27675 p 1919.610.1051
June 13, 2024

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