WQ0045398_Encore_at_Bentley_Manor_FTSSE_App_20241023

iV C De ,, State of North Carolina
DWR Erv,ronmental Department of Environmental Quality
Receivecl tY Division of Water Resources
OCT 2 3 2024 FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Regional 011itA06 J5 S Nl O],i
Application Number: hI61 II (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Randleman (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Shain Sexton per I SA NCAC 02T .0106(b)
Title: Interim City Manager
4. Applicant's mailing address: 204 S. Main St.
City: Randleman State: NC Zip: 27317-_
5. Applicant's contact information:
Phone number: 3( 36) 495-7500 Email Address: ssextonlacitvofrandleman.com
❑ Privately -Owned Public Utility
❑ Other
11. PROJECT INFORMATION:
L Project name: Encore at Bentley Manor
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: Randolph
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.820457' Longitude:-79.827613'
5. Parcel ID (if applicable): _ (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Vince C. Townsend, PE, PLS License Number: 23951
Finn: Green Mountain Engineering, PLLC
Mailing address: I Wendy Court
City: Greensboro State: NC Zip: 27409-_
Phone number: 3( 36) 294-9394 Email Address: vinena�greenmountainengineers.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Ctiv of Randleman Wastewater Treatment Plant Permit Number: NCO025445
Owner Name: City of Randleman
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): WQN/A
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00099
Owner Name(s): City of Randleman
FORM: FTA 10-23 Page 1 of 5

VT. GENERAL REQUIREMENTS rCT 23 1 (i
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 Operation i 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(20)
re a Pr)
If Industrial, is theetreatment 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'•"
No. of Units
Flow
Residential (1-bedroom)
75 gal/day
144
10,800 GPD,
Residential (2-bedroom)
150 gal/day
180
27,000 GPD
Residential (3-bedroom)
225 gal/day
24
5,400 GPD
Clubhouse/Office
25 gal/person/day
1
25 GPD
Pool House
10 gal/person
95
950 GPD
Total
44,175 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(l) 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: 44.175 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 4,481 PVC
Er,�rr
➢ 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 SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.817841 ° Longitude:-19.826920'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: O.1368 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): 95 gallons per minute (GPM) at 32 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
4
1146
DIP
NC Departmc
Environmental ,
Receivec
OCT 23 2C' l
Winston -Sal
Regional Oi ;,
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 15A NCAC 02T .0305(h)(1):
® Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)03)_
➢ 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

Department O7
Enlwllonrnental Qualit
Received Y
IX, SETBACKS & SEPARATIONS —(02B.0200 & 15A NCAC 02T.0305(f)): OCT 2 3 0
24
1. Does the project comply with all separations/alternatives found in 15A N AC 02T.0305(f) c ? ® Yes [-]No
15A NCAC 02T.0305(f) contains minimum separations that shall be vrovl ed iiota�w 'Ar&ms:
Setback Parameter* NegIona
WAfttion Required
Storm sewers and other utilities not listed below (vertical)
18 inches
ZWater mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
ZWater 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 (g), see Section X.1 of this application
*15A NCAC 02T.0305(e) 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 weboage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
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 .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes [:)No
Per 15A NCAC 02T.0I05(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 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:
Pd DfP,_?''I ;c^rli of
Er,lronrnental Quafty
Received
��T (,
Does the submitted system comply with 1.5A NCAC 02T, the Minimum Dcsien Cntena r hC `ls'crinity ne of Pumo Stations
and Force Mains flattest version), and the Gravity Sewer Minimum Design Criteria (latest version as applicable?
® Yes ❑ No Regional Oifjce
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. Aooroval of the reauest will be issued
concurrently with the approval of the Permit and orolects reauirine a variance approval may be subject to longer
review times. For orolects reauirine two or more variances or where the variance is determined by the Division to be a
sienificant portion of the oroiect, the full technical review is required
2. Professional Engineer's Certification:
1, Vincent C. Townsend, PE PLS , attest that this application for Encore at Bentley Manor
(Professional Engineer's name from Application Item 111.1.) (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 Permittin¢
of Pump Stations and Force Mains (latest versionl. 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 143-215.68, 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 icon -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, Shain Sexton , attest that this application for Encore at Bentley Manor
(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. 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 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: JJ rr Date. ,A / O'
FORM: FTA 10-23 Page 5 of 5

NC Department of
DWR
Environmental Quality
Received
OCT 14 2024
Division of Water Resources Winston-Salem
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: �161 4631 fry°(m be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFO
1. Applicant's e: Ciri of Ranleman (c mpany, municipality, HOA, utility, etc.)
2. Applicant typ . ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Shain Sexton per 15A NCAC 02T .0106(b)
Title: Interim City Manaeer
4. Applicant's mailing address: 204 5. Main St.
City: Randleman State: NC � Zip: 2�17
5. Applicant's contact information: /
Phone number: [phone] Email Address: ssextonl(Lucitvofiandleman.com
a .1' Vic-
z02 /d i;
❑ Privately -Owned Public Utility
❑ Other
'Aft 1 cat T �/
H. PROJECT INFORMATION: �1s� I f (,p,^l �)
1. Project name: Encore at Bentley Manor Y U VV
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
D
For modifications, also attach a detailed narrative description as described in Item G of the c ec t�t,'.
If new construction, but part of a master plan, provide the existing permit number: W000_ fb r� vPs ors
¢ 5
t��,p
3. County where project is located: Randolph FL '� 7 " 15 bpi
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.820457' Longitude:-79.827613'
5. Parcel ID (if applicable): (or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
Professional Engineer: Vince C. Townsend, PE. PLS License Number: 23951
Firm: Green Mountain Mountain Engineering. PLLCPLLC
Mailing address: IA Wendy Courf!
City: Greensboro State: NC - Zip: 27409 =
Phone number: 3( 36) 294-9394Email Address: vince(aereenmountaineneineers com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Randleman Wastewater Treatment Plant - Permit Number: NCO025445
Owner Name: City of Randleman _1�
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQN/A
2. Downstream (Receiving) Sewer Information: 8 inch ® Gmvity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00099
Owner Name(s): City of Randleman
Fr1RM- FTA 10-71
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Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[]Yes (—]No ® N/Al
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 l
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 at ached?
❑ 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)
i
5. Nature of wastewater: 100 % Domestic % Commercial _ % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? [IYes❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 l41 ? ❑ Yes ®No
➢ If yea 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 now °
No. of Units
Flow
Residential(I-bedroom)
75gal/day"
144
10,800GPD
Residential (2-bedroom) '
150 gal/day
180
27,000 GPD
Residential(3-bedroom)
225gaUday
24
5,406GPD
Clubhouse/Office
25
1 �
25 GPD
Pool House
1 gal/min
1
I,440 GPD
GPD
Total
44,665 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. 42A4).
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: 44665 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):
cnose. rre rn_ot Pave. 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8" l
4,481
PVC
➢ 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
Vlll. 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: I
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.817841 ° Longitude:-79.826920°
3. Total number of pumps at the pump : 1 /
3. Design flow of the pump station: 5 s gallons per day (firm capacity)
➢ This should reflect the total GP the pump station with the largest pump out of service. /
4. Operational point(s) per ptmtp(s): 95 gallons per minute (GPM) at 32 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station): / `3 lr
Size (inches)
Length (feet)
Material
4
1146
DIP
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
EyStandby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B):
D 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 I5A NCACO2T.0305(h)(1xC):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ if the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timefiames, 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)):
1. Does the project comply with all separations/altematives found in 15A NCAC 02T .0305(f) & (g)?
5A NCAC 02T 0305 contains minimum Separations that shall be rovided for sewers stems:
r
® Yes [:]No
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, W S-I waters of Class I or
Class If 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(fl or (g). see Section X.1 of this application
*15A NCAC 02T.0305(g) 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 webnage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes []No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Cane Fe az ❑ Ny
If yes, does the project comply with setbacks found in the river basin rules per I5A NCAC 02B .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes �dNo
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 I5A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes [:]No
Per I5A 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 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

R. CERTIFICATIONS:
Does the submitted system comply with I the
anal I'oi I n , I I_ac,1_ %-zri'ti7ffi and the .... ,.
® Yes
as applicable?
❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Requot apphrmon
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently ,with the aooroval of the permit, and Droiects reaulrine a variance apnroval may be 5ubiect to longer
review times For projects requirine two or more variances or where the variance is determined by the Division to be a
slenificant portion of the t iect, the full technical review is required.
2. Professional Engineer'sCcrtifncauon:
I, Vincent C. Townsend, PE, PLS , attest that this application for _ Encore at Bentev Manor
(Pt.few.mai Enginm a name 6mn Appli,mi,,n hem 111.1 1 (Pmj<ct Nmne from Appiicntiw 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.
\lininkm Ut. m C'ti4ria for G-a :� �_;.a. � .:: !, and the `,mini t �.:t I).,itt r'rita rl tot It t Faellack Pu c
ui PuarLSi o _��t1. i_t - - + ....:, I I LI -( ycr.,..w . 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 14MI5.68, 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 510,000, 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:
L •�' 2
r31N
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, _ Shain Sexton__ , attest that this application for Encore at Bentley Manor _
(Signature Authority Name ftum Application Item 1.3.1 (Project Nmne from Application Item H I
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 Iq;_; and 1_e _`_I j,nli, 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: CAT
_ _____ Date:
FORM: FTA 10-23 Page 5 of 5

NC Department of
Envlronment.al Quality
Received
OCT 2 3 2024 State of North Carolina
Department of Environmental Quality
Winston-Salem Division of Water Resources
Regional Officr Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: City of Randleman
Project Name for which flow is being requested: Encore at Bentley Manor
More than one FTSE may be required jar a single project if the owner of the WWTP is not responsible for aff pump
stations along the route of the proposed waslewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: City of Randleman Wastewater Treatment Plant
b. WWTP Facility Permit #: NCO025445
A!l flows are in MGD
c. WWTP facility's permitted flow 1.745
d. Estimated obligated flow not yet tributary to the WWTP .013
e. WWTP facility's actual avg. flow 454
f. Total flow for this specific request 0.044
g. Total actual and obligated flows to the facility .511
h. Percent of permitted flow used 29.28%
If. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)—(BtC) (E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow•• Current Tributary Flow Plus
(Name or Permit Capacity, • (Firm / pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
Main Ps WOCS00099 2 MGD 0.8 .500 .057 .557 .243
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) not
less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is <0.
Downstream Facility Name (Sewer): City of Randleman
Downstream Permit Number: WQCS00099

h'c of
EnvironM,:rntjl Quality
Received
OCT 2 3 2024
Ill. Certification Statement: Wnston Salem
I Michael Glass 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 assessment 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
Signature
Wastewater Director
Title of Signing Offlcial
5—
Date
FTSE 10-23

Entity Requesting Allocation:
Project Name for which flow is
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
/ /(FTSE 10-23)
Inv Mnnnr It ! . 7 L /
at
More than one FTSE maybe required fora .single project if the owner of the WWTP 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: City of Randleman Wastewater Treatment Plant
b. WWTP Facility Permit #: NCO025445 i
All flows are in MGD
c. WWTP facility's permitted flow 1.745 s
d. Estimated obligated flow not yet tributary to the WWTP .013 e,
e. WWTP facility's actual avg. flow .454
f. Total flow for this specific request 0.044
g. Total actual and obligated flows to the facility .511
h. Percent of permitted flow used 29.28a//
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:
(A)
Design
Pump
Pump
Average
Station
Station
Finn
Daily Flow"
(Name or
Permit
Capacity, *
(Firm / pf),
Number)
No.
MGD
MGD
Main Ps
WQCS00099
2 MGD
0.8
B) (C) (D)=(B+C) (E)=(A-D)
Obligated,
Approx. Not Yet Total Current
Current Tributary Flow Plus
Avg. Daily Daily Flow, Obligated Available
Flow, MGD MGD Flow Capacity***
.500 .057 .557 .243
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) not
less than 2 5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): City of Randleman `
Downstream Permit Number: WOCS00099
T
FTSE. I

III. Certification Statement:
i
I Michael Glass 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
as
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 Use
where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and 11 plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
, ��L
Signing Official Signature
Wastewater Director
Title of Signing Off Fcial
I
i, .
FTS6 10-23

MAYOR
BOARD OF ALDERMEN
Mayor Pro-Tempore
MEL.
NANO r.cr.Jc Otv
KIMMY WILLIAMS
STEVE GROOMS
April 4, 2024
Mr. Brian Tanis
Green Mountain Engineering, PLLC
1A Wendy Court
Greensboro, NC 27409
Dear Mr. Tanis
204 S. MAIN STREET
RANDLEMAN, NC 27317
P: [phone]
F: [phone]
W W W.CITYOFRANDLEMAN.COM
CITY ADMINISTRATION
Interim City Manager/
Chief of Police
Finance Director / HP Specialist
City Clerk, CIVIC, NCCMC
This letter serves to inform you the City of Randleman agrees to serve the Encore at Bently Manor Project, a project
located within the City Limits of Randleman, by providing water to, and accepting sewage from, the above referenced
project. The City system has adequate water supply and sewer capacity to serve the requested flows.
If you have any questions fee free to contact me at [phone] or Elizabeth Sechriest, Finance Director at
[phone].
Shain Sexton
Interim City Manager
Cc via email: Mr. Brian Tanis, Green Mountain Engineering
Mrs. Elizabeth Sechriest, Finance Director—[e-mail]
Mr. Brian Crawford, Public Work Director- [e-mail]
Mr. Michael Glass, WWTP Director—[e-mail]

10/11/23, 8:48 AM
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10/11/23, 8:33 AM
North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings • Print a Pre -
Populated Annual Report form • Print an Amended a Annual Report form
Limited Liability Company
LegaL Name
ENCORE AT BENTLEY MANOR, LLC
Information
Sosld: 2628243
Status: Current -Active O
Date Formed: 5/9/2023
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentgnnuaL Report Status:
Registered Agent: CR Services, LLC
Addresses
Reg Office
235 N. Edgeworth Street
Greensboro, NC 27401-2217
Company Officials
Reg Mailing
235 N. Edgeworth Street
Greensboro, NC 27401-2217
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
https://www.sosnc.gov/online services/search/Business_Reaistration_ResuIts 1 /1

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SITE
' Wendds Meal heals
Hwy 55 Burgers
Shakes &Fries
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Great Clips
L 'Great CIIpsa Salon
• 1 Motion
NC Lumbe r
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Hughes F,..._

Technical Information
AMS434/ 1-170/5,1 T/C
Operating data
Flow
Head
Shaft power P2
Pump efficiency
Required pump NPSH
Pumps type
No. of pumps
Fluid
Pump
Pump Code
Impeller
Impeller size
Solid size
Discharge port
Suction port
Motor
Rated voltage
Frequency
Rated power P2
Rated speed
Number of poles
Efficiency
Rated current
Degree of protection
95 US g.p.m.
32 It
2.74 hp
44 %
Single pump
1
AMS434/1-17015,1T/C
Single channel impeller
6"/1B
31nch
4' ANSI
DN100
230 V
60 Fb
5.1 hp
1750 rpm
4
83 %
21.2 A
IF 68
1-IQNA
P UMi EN MIT SYSTEM
Testnonn: HI Standard Sect 11.6.6.4
[y,] Efficiency 64s34/1-170
40
20
0
[hp] Shaftpower P2 170.
3
2
1
0 50 100 150 200 250 300 350 400 450 [US g.p.m.]
Wet well installation with coupling Idt (T, 140...190)
Dimensons i n mm [inch], I efters we table
Materials
,
Motor housing Lest Imn ASTM A48;G.408
Impeller Cast Imn ASTM A48;0.40B
Pump housing Cast Imn ASTM A46;G.408
Weardng Bronze ASTM B505; C93200
Motorshaft AISI 430 F Stainl am Steel
Bolts AISI 304 Stainless Steel
Elastomeres
NiMle Rubber
F
Mechanical seal on motor side Sic / Sic H
Mechanical seal on medium side Sic / Sic ^
Lower Bearing Double mw angular ball bearing
Upper Bearing Deep Groove Ball Bearing
Table Dimensions
(Inch )
A
26i6/u
Project
Project no.:
Created by:
Page:
Date:
1
4/30/2024

Performance Curve
AMS434/1-170/5,1 T/C
IM1QNfa
P UMPEN MIT SYSTEM
Impeller
Impellertype:
Solid size 0:
Max. 0: Min. 0:
Sel. 0:
Single channel impeller
3 inch
I 61 S'Iz
611Ae'
Operating data
Speed:
Frequency:
Duty point:
Shaft power P2:
Discharge port:
1750 rpm
60 Hz
Q =95 US g.p.m. H =32 ft
2.74 hp
4" ANSI
Power data referred to: Testnorm: HI Standard Sect 11.6.5.4
Water, clean [100%] ; 68'F; 62.322ibfft'; 1.0818E-5ft'/s
[ft]
Head
48
Application range O'
AM I I
�3417.
44
7j0 I i
40
32
Elf.
2
62 1 .80.
I
2
1
12
Efficiency
I%]
MS434/1-17
50
4
30
20
10
nA
[hP]
Shaft power P2
-�170
3.
2.
2
1.
1
0 40 80 120 160 200 240 280 320 360 400 440 460 IUS g.p.m]
Project
Project no.:
Created by:
Page:
Date:
1
2
413012024

Dimensions
AMS434/1-170/5,1 T/C
Wet well installation with coupling lot (i, 140...190)
Dimensions In mm [Inch), letters see table
W "'D-147 A
tk "WbWe
� m
$G Rsel
r�w=en Ri
m
Prl
�e i�eoea
G
� ea
Table Dimensions
A 26'5i,e
IMIQNA
P U M P E N MIT SYSTEM
min level = Minimum fluid level for intermittent operation (53)
Project
Project no.:
Created by:
Page:
Date:
3
4/30/2024

Technical Data
AMS434/1-170/5,1T/C
INIQNA
P U M P E N MIT SYSTEM
Operating data
Flow
95 US g.p.r1US g.p.m.
Head
32 ft ft
Shaft power P2
2.7 hp
Static head
24 ft
Pump efficiency
44.0 %
Required pump NPSH
It
Pumps type
Single pump
No. of pumps
1
Fluid
Wastewater
Temperature
68 T
Density
62.31 lb/ft'
Kin. viscosity
1.077E-5 ft'Is
Pump
Pump Code
AMS434/1-170/5,1T/C
Speed
1750 rpm
Suction port
DN100
Max.
Head
Min.
39.9 ft
Discharge port
4' ANSI
21.3 ft
Impellertype
Single channel impeller
Flow Max.
462.3 t1S g.p.m.
Solid size
3 inch
Pump efficiency max.
62.8 %
ImpellerO
6.69 inch
Required rated power max. P2
4.2 hp
M otor
Motordesign
Submersible motor
Insulation dam
H
Motor name
AM173.6,2T/4/1
Degree of protection
IP 68
Frequency
60 Hz
Temperature dam
T3C
Rated power P1
6.1 hp
NEMA code
Rated power P2
5.1 hp
Explosion protection
Rated speed
Rated voltage
1750 rpm
230 v 1-
100%
Efficiency
at % rated power
50%
83.0 %
%
Rated current
21.2 A
%
Starting current, direct starting
54.9 A
100%
cos phi
at %rated pourer 75%
50%
0.97
Starting current, star -delta
11 A
Starting mode
Directly
Powermble
10G1,5
olcable
Type of pourer cable
H07RN8-F PLUS
cont
Type of control cable
Cable length
32.809 ft
Service factor
1.15
Shaft seal
Mechanical seal on motor side Sic/Sic
Mechanical seal on medium side Sic / Sic
Bearing
Lower Bead ng Double now, angular bal I bearing
Upper Bearing Deep Groove Ball Beading
Remade
Stan-/ Runcapacitor. 100pF / 50pF
Materials / Weight
Motor housing
Cast Iron ASTM A48;CI.40B
Bolts
AISI 304 Stainless Steel
Pump housing
Cast Iron ASTM A48;CI.40B
Elastomeres
Nitdle Rubber
Impeller
Cast Iran ASTM A48;CI.408
Wearring
Bronze ASTM 8505; C9320
Motor shaft
AISI 430 F Stainless Steel
Weight aggregat
265.73 lb
Project
Project no.:
Created by:
Page:
1
Date:
4
4130/2024

PART/PRINT NO. PART DESCRIPTION DATE
--- 4" DUPLEX VALVE BOX 10.5.23
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THIS DRAWING IS FOR SUBMITTAL ONLY
AK INDUSTRIES INC. DRAWN BY: SCALE: REVISION *: SIGNATURE:
2055 PIDCD DR.
PLYMOUTH, IN. 46563
DwnmrW47A% o'xc_aroa A,HARTUNG III
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Green Mountain Engineering, PLLC
Civil Engineering Consultants
NC Deuart.rnent of Lang{ Surveyors
ivironrnental quality _ N p�,mXm
Transmittal
To: NCDEQ - Public Water Su
OCT 14 2024
Winston-Salem
5ws6aigkCe
OCT 10 2024
Winston-Salem
Address: DEQ- PWSSection, 4S'o w. a.ANES Miu. 2t),� 6oryE 7uc)AW-s�jvL.27406
From: Vince C. Townsend, PE, PLS
Date: September 25, 2024
Re: Encore at Bentley Manor
Messages
Attached, please find the application package for the private sewer extension off Old
High Point Street and Commonwealth Road, to serve the residential housing proposed by
Encore at Bentley Manor Apartments. Included are one (1) copy of the amended public
application package.
Please let us know if you have any questions or require additional information. I can be
reached via emailynce(a)greenmountainengineers.com or by phone [phone] at
your convenience.
Best Regards,
14zG:v
Vince C. Townsend, PE, PLS
1A Wendy Court - Greensboro, NC 27409 - [phone]
Page 1 of 1

dC Dc,_;
Environmental Civaliy
Received
OCT 14 2024
Winston-Salem
Regional Office
To Whom It May Concern:
Green Mountain Engineering, PLLC
Civil Engineering Consultants
Land Surveyors
Project Narrative For
Encore at Bentley Manor
Located in Randleman, NC
September 25, 2024
Midway at Archdale is a proposed 348 unit apartment complex with a club house,
pool and pool house. The proposed sewer system serving Encore at Bentley Manor
will tie into an existing 8" sewer main located in Commonwealth Rd. (SR#: 1990)
right of way. Approximately 4,481 linear feet of new 8 inch PVC sewer main with 27
new manholes that will be publicly maintained and will connect to the existing 8 inch
sewer main. This gravity system will be assisted by a pump station and 1,146 linear
feet of 4 inch DIP force main with 1 air release manhole that will tie into a new 8"
sewer main that will being all in part of the aforementioned linear feet of new 8"
sewer main. All new gravity and force sewer main will be publicly maintained.
The design and plan review was done in accordance with NCDEQ's Gravity Sewer
Minimum Design Criteria and the City of Randlemans's standards and specifications.
Work on the sewer installation is planned to begin once the permit has been obtained.
Please contact me if you require additional information. You can reach me via email
wince(a)greenmountainengineers.com or by telephone [phone] at your
convenience.
Respectfully submitted,
U
Vincent C. To end, P.E.
Green Mountain Engineering, PLLC
1A Wendy Court Greensboro, NC 27409 - [phone]
Page 1 of 1