WQ0045515_Emerson_Point_Apartments_FTSSE_App_2nd_Submission_20240619

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Division of Water Resources
9lslon oI Water 'Resources,
FASTTRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: A.)&0)e1ss7S_ (tobewmpietedby DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Emerson Point. LLC (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: Dennis H. Euliss per 15A NCAC 02T.0106(b)
Title: Registered Agent
4. Applicant's mailing address: 524-A W. Elm St.
City: Graham State: NC
5. Applicant's contact htformation:
Phone number: 336 350-8090
Zip: 27253-21_58
Email Address: denniseuliss(a)vmail.com
II. PROJECT INFORMATION:
1. Project name: Emerson Point Apartments
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. W000_
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.110169 Longitude:-79.477749'
5. Parcel ID (if applicable): 116609 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Aden R. Stotzfas License Number: 026461
Firm: Stoltzfus Engineering, Inc.
Mailing address: 683 Gmlin St.
City: Kemersville State: NC 27320 Zip: 27284-3457
Phone number: 3( 36j 904-0207 Email Address: adenQscieneineering com
1V. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: South Burlington WWTF Permit Number:NCO023876
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WONot Known
2. Downstream (Receiving) Sewer Information: 8 inch s2l Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 00008
Owner Name(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 ® 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 El 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 %d Commercial _ % Industrial (See I5A NCAC 02T .0103(20)).
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01141t1? []Yes ❑ No
p If ves, provide a coon of flow reduction approval letter with this applieation
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow au
No. of Units
Flow
2-Bedroom Residential Dwelling
150 gal/dwelling
48
7,200 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Tot",
7,200 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 Waterwav to be used as vacation rentals as defined in G.S. 42A-4).
b Per 15A NCAC OTT .DI 14(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.
S. Wastewater generated by project: 7 200 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 Paget of

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T e0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to,be permitted:
Size (inches) Length (feet) Material
6" 65 SDR-35 PVC
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains' information related to design criteria
➢ Section III contains: information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) —02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATECOPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Emerson Point Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.063579' Longitude:-79.284000°
3. Total number of pumps ahthe pump station: 2
3. Design flow of the pump station: 0.02304 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): 16 gallons per minute (GPM) at 34.9 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
1.5
432
SCHD 40PVC
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 (pleasespecify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(l):
❑ Standby power source or ❑ Standby pump
Most 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
D Must be permanent to facility and may not be portable
Or if the pump station has anaverage 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 dociunentation that the portable source is owncd or contracted by the applicant andis compatible with the station.
9 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 scheduleof the portable power source or pump, including travel timeframes, shall beprovided
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(i)):
1. Does the project comply with all separationstalternatives found in 15A NCAC 02T .0305(f) & (0? ® Yes[I No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches �
rti(ater 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
Glass 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 strewn, 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
Anybasement (horizontal)
10 feet
Top slope of embmtkment or eats 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
f ifYtoncwmpliance with 02T.0305(f) or (a), see Section XI of this application
* 15A NCAC 02T.0305(e) contains alternatives where separations in 02T.030Sf 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 webnaee
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(I) for documentation requirements and submit a separate document,
signed/scaled 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
Y Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's drall senaration requirements for situations where separation cannot be met.
Y No variance is required if the alternative design criteria specifiedis utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ,® Yes Basin name: Jordan Lake ❑ No
If yes, does the project. comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
i- This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or401 Water Quality Certifications?
�, Please provide the permit number,'permitting status in the cover letter if coveragelauthorization is required.
6. Does project comply with PSA NCAC 021'.0I05 c 6) (additional permitsicertifications)'? ® Yes [:]No
Per ISA NCAC 02T.0105(c)f6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer' means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambwtks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
i 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:
1. Does the submitted system comply with I SA 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?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will
2. Professional Engineer's Certification:
1, Aden R. Stoltzfus, PE attest that this application for Emerson Point Apartments
(Professional Engineer's name from Application Item 111,1.) (Pmjeci Name from Application Itetntl.l)
has been reviewed by me and is'accuratei 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 lies been prepared in accordance with the applicable regulations.
Minimum Desimx Criteria for Gravity Sewers (latest version), and the Mhtimunt Design Criteria for die Fast -Track Perm�'tti n
of Pamn 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 suit signifies that I havo reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — in accordance with General Statutes 143-215.6A and 143215.6B, 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 NCAC56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1 Dennis H. Eu)iss , attest that this application for Emerson Point Apartments
(Si6munue Authority 3.amc from Application Item 1:3:) (Project Name front Application Item ❑. t)
attest that this application, has been reviewed by we 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. f 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. t will make no claim against the Division
of water Resources should a condition of this permit be violated. I also understand that if all requiredparts of this application
package are not completed and that if all required supporting infannation 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 SI0,000 as well as civil penalties up to S25,000 per violation.
Signature: 1 JP n _ .^ Date: a 1aCa (-.
PORN: FTA 10 23 � � Page 5 of 5

1�QLa 1'LFC /Zo 2�
State of North Carolina
Department of Environmental Quality
DWRON' Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
L Applicant's name: Emerson Point. LLC (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: Dennis H. Euliss per 15A NCAC 02T .0106(b)
Title: Reeistered Agent
4. Applicant's mailing address: 524-A W. Elm St.
City: Graham r State: NCB Zip: 27253-2158
5. Applicant's contact information:
i
Phone number: 336 350-8090 Email Address: denniseuliss(rr)ymail.com !
II. PROJECT INFORMATION:
1. Project name: Emerson Point Apanarhnents !
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: W000_
3. County where project is located: Alamance -
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1 I0169' Longitude:-79.477749'
5. Parcel ID (if applicable): 116608 (or Parcel 1D to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Aden R. StotzfusLicense Number: 026461
Firm: Stoltzfus Engineering, Inc:'
Mailing address: 683 Gralin St/
City: Kemersville ' State: NC 27320 Zip: 27284-3457
Phone number: [phone] Email Address: aden(d),seien ing Bering com /
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
i
1. Facility Name: South Burlington WWTF Permit Number: NCO023876
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQNot Known
2. Downstream (Receiving) Sewer Information: 8 inch N Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSE09Y9t6* Ai —
Owner Name(s): City of Burlington pile (XICOF
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 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?
i
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential (Leased) i ❑ 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 ISA 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 .0114(t)? ❑ Yes ❑ No
➢ If yes, provide a cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a°
No. of Units
Flow
2-Bedroom Residential Dwelling
150 gal/dwelling
48
7,200 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
Total
7,200 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.0114] shall be
determined using available flow data water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 7 200 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: ETA 10-23 Page 2 of 5

,•, .• .r � .. .

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
6" 1
65
SDR-35 PVC
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIIL 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
I. Pump station number or name: Emerson Point Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.063579' Longitude:-79.284000'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.018 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): 16 gallons per minute (GPM) at 34.9 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
1.5
432
SCHD 40 PVC
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.0I C. Lb. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® 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 I3A 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

IV SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & W
15A NCAC O2T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes [—]No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
mains (horizontal)
10 feet
-'Water
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-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(f) or (g), see Section X.1 of this application
*15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can he identified using the Division's NC Surface Water Classifications weboaee
2. Does this project comply with the minimum separation requirements for water mains? ® )(es ❑ No ❑ N/A
➢ If no, please refer to l5A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No �] N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Jordan Lake No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? 20'es []No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0I05(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(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 any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per I5A 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.
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?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrentiv with the approval of the permit, and oroiects requiring a variance approval may be subject to longer
review times. For oroiects reguirine two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification.
1, Aden R. Stoltzfus, PE attest that this application for Emerson Point Apartments
(Professional Engineer's name from Application Item Ill.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. 1 further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of 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 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1 Dennis H. Euliss I , attest that this application for Emerson Point Apartments
(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. 1 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.
� l
Signature: �1 A Date:
FORM: FTA 10-23 Page 5 of 5

State of North Carolina
Department of Environment and Natural Resources
: 1.ilil- ,,, ;:,z.-. ,. .,,„,,, 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: Emerson Point'
More than one PINE may be required for a single project if the owner of the WWI Y is not responsible for all
pump stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. W WTP Facility Permit #:
South Burlington WWTP'
NC0023876
A11 flows are in MGD
c. W WTP facility's permitted flow
12.00
d. Estimated obligated flow not yet tributary to the W WTP
1.506664"
e. WWTP facility's actual avg. flow
6.922000,
f. Total flow for this specific request
0,007200'
g. Total actual and obligated flows to the facility
8.435864
h. Percent of permitted flow used
70.30% '
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 W WTP
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Average
Approx.
Obligated,
Total
Pump
Daily
Current
Not Yet
Current
Station
Pump Firm Flow'*
Avg. Daily
Tributary
Flow Plus
Available
(Name or
Station Capacity, • (Firm/pf),
Flow,
Daily
Obligated
Capacity**
Number)
Permit No. GPD GPD
GPD
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 W WTP where the Available Capacity < 0.
Downstream Facility Name (Sewer) :
Downstream Permit Number:
Page I of 6
FTSE 10-23

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
Signing Official Signature Date
-City Engineer _
'Title of Signing Official
Page 2 of 6
FTSE 10-23

LIMITED LIABILITY COMPANY ANNUAL REPORT
rfsnon
NAME OF LIMITED LIABILITY COMPANY: EMERSON POINT, LLC
SECRETARY OF STATE ID NUMBER: 2742614
REPORT FOR THE CALENDAR YEAR: 2024
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: EU
STATE OF FORMATION: NC
DENNIS H
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
2742614
CA202410405533
4/13/2024 05:02
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
W. Elm Street
524 W. Elm Street
Graham, NC 27253-2158 Alamance County Graham, NC 27253-2158
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS:
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
524 W. Elm Street 524 W. Elm Street
Graham, NC 27253-2158 Graham, NC 27253-2158
6. Select one of the following if applicable. (Optional see. Instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Dennis H EuliSs
TITLE: Managing Member
ADDRESS:
524-A West Elm Street
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
GRAHAM, NC 27253
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a personibusiness entity.
Dennis H Euliss 4/13/2024
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Dennis H Euliss Managing Member
Print or Type Name of Company Official Prot or Type TNe of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

Owner Name: HUGHES SHANNON H
May 15, 2024
GP I N: 8855897349
PID: 3-7-11
1:2,400
0 0.025 0.05 mi
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Intl ustrial Developm ant Applicants
Streets
— 393-TRAIL
O
APPLIED FOR PERMIT
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Owner Name: HUGHES SHANNON H May 17, 2024 0 0.05 0.1 mi
GPIN: b855897349
PI D: 3-7-11
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Stoltzfus Engineering, Inc.
TRANSMITTAL MEMO
To: Winston Regional Office
Water Quality Section
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
[phone]
From: Aden Stoltzfus, PE
122
JUN 10 2024
Date: 06/10/2QZ4
R ston-Salem
Subject: Emerson Poi lq l s
Sewer Permit Extension
City of Burlington, NC
Alamance County
Attached is the FTA, FTSE and supporting documents for a proposed private gravity sanitary
sewer, lift station and force main to serve Emerson Point Apartments. The project consists of 48 2-
bedroom apartment homes with flow allocation of 7,200 GPD. The project will tie into an existing
8 inch sanitary sewer line that runs in Park Road Extension along the frontage of the property.
Please call me at [phone] with any questions or comments. Your help in this matter is
appreciated.
683 Gralin Street ♦ Kernersville, NC 27284 ♦ [phone]

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump Stations/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300, Division policies, and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in I5A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
De artment of
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NC ntal Quality
Received
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (MDC) documents; JUG# 1
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPS) or simplex grinder pumltNinston-Salem
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains); Regional Office
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may be digital) of Application and Supporting Documents
® Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ Include the permit number/status of any other required sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
➢ If the project is funded by American Rescue Plan Act (ARPA) funds, please include the ARPA project number in the cover
letter and in parentheses under Project Name (Section II.1. of the application).
C. Application Fee (AII New and Modification Application Packages):
® Submit a check or money order in the amount of $600.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 10-23):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
® If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item IL1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional En ig neer.
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page I of 3

® The Applicant's Certification on.Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .Ol'06(c), an alternate person maybe designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
E. Flow TrackinglAcceptance Form (Form: FTSE 10-13) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility. ,
➢' Multiple forms maybe, equired where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance;indicated in form FTSE must not expire prior to permit issuance and must be dated less than one, year-
. prior to the application date. -
.Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-215.67(a).
➢ .Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE. '
F. Site Maps (All Application Packages):
®' Submit an 8.5-inch x 11-inch color'copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface,waters.
➢ General location of theproject components (gravity sewer, pump stations,-& force main) ,
'Downstream connection, points and permit number (if known) for the receiving sewer
® Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can•easilylocate itinthe field. _ .. -
G. Existing Permit,(Application Packages for Modifications to an Existing Permit): ,
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptiveand clear narrative identifying the previously permitted items to remain in -the permit, items to be
added, and/or itemsto be modified (the.application form itself should include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
❑. 'The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit. `
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ .Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only, available for average daily flows less than 15000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the.applicant and is compatible with
the station. The Divisionwill accept a letter signed by the applicant (see 15A NCAC. 02T .0106(b)) or proposed contractor,
stating that "the portable power generation unit or portable, independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump 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 in the case of a multiple station power outage. (Required' attime of certification).
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served bythe sewer
extension, or
❑. Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise approval
•is expected. -
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' .Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per,15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws. -
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more infprmation, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION, Paget of 3