WQ0045932_Brakebush_Yard_Expansion_FTSSE_Final_App_20241101_20241101

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tua1es-U0JSUIM
State of North Carolina
DWR hZOZ I( U AON Department of Environmental Quality
pania�aa Division of Water Resources
_rilen7) IElUOutUOJIAU3 FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources - `�"'U 'Nj
FTA 10.23 &SUPPORTING DOCUMENTATION
9T-tj Application Number: N4604103_;� (to be completed byDWR)
Ze7_*1 f Cy4 49 All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Brakebush Brothers Inc. (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: Carey Brakebush per 15A NCAC 02T .0106(b)
Title: Vice President
4. Applicant's mailing address: N4993 61b Drive
City: Westfield State: WI Zip: 53964-
5. Applicant's contact information:
Phone number: (8U0) 933-2121 Email Address: cargyb(a)brakebush.com
II. PROJECT INFORMATION:
1. Project name: Brakebush Yard Expansion'
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: Davie County
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.8804050 Longitude:-80.555933'
5. Parcel ID (if applicable): 5737988809 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Catherine W. Underwood License Number: 033470
Firm: Daylight Engineering
Mailing address: PO Box 1804
City: Concord' State: NC Zip: 28026-1804
Phone number: [phone]' Email Address: katena daylighteng.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
/
1. Facility Name:Dutchman's Creek W WTPPernit Number: NCO021491
Owner Name: Town of Mocksville
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): N/A
2. Downstream (Receiving) Sewer Information: 8- inch X Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS CS00156
Owner Name(s): Town of Mocksville
FORM: FTA 10-23 Paget of 5

,4� uepartment of
Environmental Quality
Received
VI. GENERAL REQUIREMENTS NOV O Al 2024
1. If the Applicant is a Privately -Owned Public 0449,SkM E'Vj6frate of Pint Convenience and Necessity been attached?
{ TVis, Cj;No ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A /
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ pod and drink facilities El Church ❑ Swimming Pool/Filter Backwash
® Vusinesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
1
5. Nature of wastewater : % Domestic % Commercial 100 % Industrial (See 15A NCAC 02T .0103(20)
If Industrial, is there a Pretreatment ,P�.roogram in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under I5A NCAC 02T .0114(f)? ElEy Yes No
➢ If yes, provide a copy of flow reduction approval letter with this aoolication
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a•s
No. of Units
Flow
Truck Garage '
25 gal/employee/shift
ern l021 shift
525'GPD
WWTP Employee Bathrooms/
25 gal/employee/shift2
employees'
50'GPD
Wellness Center - Gym
50 gal/100 sf
2,026 sf
1013'GPD
Wellnesss Center - Medical Office
250 gal/practitioner/shift
3 practitioners
7501GPD
Wellness Center - Conference Center
S gal/seat
15 Seats -
75 GPD
gal/
GPD
Total
2413 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(I) 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.
I
Wastewater generated by project: 2 413 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
)0 Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8" !
261.67
PVC
NC Department of
Environmental Quality
Received
NOV 0 4 2024
Winston Salem
Reeional offtce
➢ 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: LiflStation
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.8815' Longitude:-80.5548°
3. Total number of pumps at the pump station: 2
i
3. Design flow of the pump station: 0.04608 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): 32 gallons per minute (GPM) at 57 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
1138.01
SDR 15'
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.Lb. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(D:
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
® Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel 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

NC Dep-)rtment of
Environmen a! Quality
Received
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)): NO"! P 4 71911
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (a)? ® Yes [:)No
15A NCAC 02T.0305(t) contains minimum separations that shall he nmvided fnr sewer cvstemv
Setback Parameter* -
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (a). see Section X.1 of this application
• 15A NCAC 02T.0305(g) 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 webpaae
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.
J
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: Yadkin Pee -Dee ®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(cX6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(e)(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-priorityT' ❑ 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

NC Department or
Environmental Quality
Received
X. CERTIFICATIONS: NOV 0 4 2024
I. Does the submitted system comply with 15A NCAC 02T the Minim m Desi n Criteria for th Permittin of Pum Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Crite 4Fd 'yer35bel'�als applicable?
^7i ri:r .
®Yes � ❑No R._,.r'� �--
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
2. Professional Engineer's Certification:
I, Nick Buysse attest that this application for Brakebush Yard Expansion
(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. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pumo Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per I5A NCAC 02T .0106(b):
11 /04/2024
I, Carey Brakebush attest that this application for Brakebush Yard Expansion
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: L a Y
FORM: FTA 10-23 Page 5 of 5

ReCLivcU,
State of North Carolina
} NOV 0 4 M Department of Environmental Quality
i%I
WinstonSalrn Division of Water Resources
Division of Water Resourccs R.e ienal 0` - Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Brakebush Brothers Inc.
Project Name for which flow is being requested: Brakebush Yard Expansion'
Afore than one FTSE nury be required for a single project if dhe owner of the WIVTP is not responsible for all ponp
stations along the route of the proposed wastewaterflow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. W WTP Facility Name: Dutchman's Creek W WV
b. W WTP Facility Permit H: NCO021491
All flows are In MGD
c. W WTP facility's permitted flow 0.980
d. Estimated obligated flow not yet tributary to the W WTP
0.282
e. W WTP facility's actual avg. flow
0.565
f Total flow for this specific request
0.002 '
g. Total actual and obligated flows to the facility
0.849 '
h. Percent of permitted flow used
87%
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
Obligated,
Pump Pump Average Approx.
Not Yet Total Current
Station Station Firm Daily Flow" Current
Tributary Flow Plus
(Name or Permit Capacity,(Finn / pf), Avg. Daily
Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MOD
MOD Flow Capacity***
* The Firm Capacity (design Dow) 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 (p0 not
less than 2.5, per Section 2.02(A)(4)(e) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the NVWTP where the Available Capacity is <0.
Downstream Facility Narne (Sewer): Town of Mocksville Collection System
Downstream Permit Number: WQCS00156
Page I of 6
FTSE 10-23

NC Dop-if-t.rncnI of
Environmental Qua ity
Received
MOV 0 4 2024
Winston Salem
Ili. Certificatio tatement- ReEionaI Gffic
I �'Gr % 93� 1r44 I certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning 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 1 and 11 plus all attached planning assessment addendums for which l
am the responsible party. S ire of this torm certifies that the receiving collection system or treatment
works has adequate SpoWity to transp9to d treat the proposed new wastewater.
Oricial Signature
Title of Signing Official
Page 2 of 6
Date
FTSF.. 10-23

DAYLIGHT
Ron Boone
NC Dcpartrt c ; ,;; 185 Brumley Ave NE
Environm2ntai Quality Concord, NC 28025
Received
980.234.7500
PiL 0 4 2024 daylighteng.com
Winston-Salem
Regional Office
NCDEQ Division of Water Resources — Winston-Salem Regional Office
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Ron,
Below, you will find the responses to your comments dated 10/25/2024. The responses to the comments are in blue text.
1. The answer to application question V.I. is incorrect. The entered permit number is the wastewater collection system
operation permit number for the Town of Mocksville, but the question is asking for the fast track sewer system extension
(FTSSE) permit number for the specific pipe that the pipe for this project will tie into. Please be aware that there may not
be an FTSSE permit number for this specific section of pipe if its installation precedes the establishment of the FTSSE
permitting program. If this is the case, then the answer to the question would be "N/A".
Response: This has been updated to "N/A" in the FTA 10-23 form per guidance from Town of Mocksville Utility
Engineers (Willis Engineers).
2. The answer to the second application question VIII.3. is incorrect. It's asking for the pump station's firm capacity, which,
as indicated on the application, is the maximum capacity of the pump station with the largest pump out of service, which
according to our calculations would be 0.04608 MGD.
Response: This has been updated in the FTA 10-23 to 0.04608 MGD,
11/4/24 1

NC Or'Pjrtrnent cr
Environn—,ental O,.�.:1'�y
DAYLIGHT Received 165 Brumcord, N Ave NE
25
NOV O 4 concord, NC 28025
980.234.7500
Winston daylighteng.com
egio^
3. The answer to question I.h. of the flow form indicates the percent of permitted flow used at the Dutchman's Creek
WWTP after construction of this project will be 87%. However, pursuant to 15A NCAC 02T .0118 DEMONSTRATION
OF FUTURE WASTEWATER TREATMENT CAPACITIES, no permits for sewer line extensions shall be issued to
wastewater treatment systems owned or operated by municipalities, counties, sanitary districts, or public utilities unless,
prior to exceeding 80 percent of the system's permitted hydraulic capacity (based on the average flow during the last
calendar year), the permittee shall submit an engineering evaluation of their future wastewater treatment, utilization, and
disposal needs. Please provide the information required to answer these concerns.
Response: Per Sydnee S. Potter, PE from Willis Engineers:
"The Town is underway with a new pump station which will redirect approximately 372,000 gallons per day from the
Dutchman's Creek WWTP to the Town of Cooleemee WWTP. This has already been permitted under Permit No.
WQ0043365. The new pump station is still under construction but will be placed in service within the next few weeks.
Attached is the approved permit for reference."
4. Please answer the two questions located at the bottom of the second page of the flow form.
Response: The FTSE 10-23 form has been updated and signed by Town Manager Ken Gamble.
Sincerely,
Hunter Thomas, El
Engineering Intern
M 704.530.6181 1 E hunter(Wdavlightena.com
165 Brumley Ave NE I Concord, NC 28026
DAYLIGHT
11/4/24

ROY COOPER
Governor'
ELIZABETH S. BISER
secretary;
RICHARD E. ROGERS,.JR.
Director
Kenneth Gamble, Town Manager
Town of Mocksville
171 S. Clement St.
Mocksville, NC,27028
NORTH CAROLINA.
Environmental Quality
April 29, 2022
Subject: Permit No. WQ0043365
Town of Mocksville
Utilities to Serve Brakebush Brothers
Wastewater Collection System Extension Permit
Davie County
Dear Mr. Gamble:
In accordance with your application received April 12, 2022, and additional information received April 21,
2022 and April 29, 2022, we are forwarding herewith Permit No. WQ0043365 dated April 29, 2022, to the
Town of Mocksville (Permittee) for the construction and operation upon certification of the subject
wastewater collection system extension. This permit shall be effective from the date of issuance until
rescinded and shall be subject to the conditions and limitations as specified therein. This cover letter shall
be considered a part of this permit and is therefore incorporated therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11.4: Requires that the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 02T .0403 or any individual system -wide collection system
permit issued to the Permittee.
Condition 11.7: Upon completion of construction and prior to operation of these permitted facilities, the
completed Engineering Certification form with checklist attached to this permit shall be
submitted with the required supporting documents to the address provided on the form.
Permit modifications are required for any changes resulting in non-compliance with
this permit, regulations, or the Minimum Design Criteria. [15A NCAC 02T.0116]
It shall be responsibility of the Permittee to ensure that the as -constructed project meets the appropriate
design criteria and rules. Failure to comply may result in penalties in accordance with North Carolina
General Statute §143-215.6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to
the licensing board.

Town of Mocksville
Permit No. WQ0043365
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within 30 days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150B of North Carolina General
Statutes, and filedwith the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC
27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this matter, please contact Alex Lowe at [phone] or
via e-mail at [e-mail].
Sincerely,
DocuSigned by:
OD2D3CE3F1B7456... Cl
for Richard E. Rogers, Jr..
Director, Division of Water Resources
by JenniferF. Graznak, Assistant Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
cc: Sydnee S. Potter, PE ([e-mail])
Todd Lambert, Town of Mocksville ([e-mail])
DWR Laserfiche Files
Page 2 of 7

WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
Town of Mocksville
Davie County
for the construction and operation of approximately 688 linear feet of 8-inch PVC or DIP gravity sewer,
173 linear feet of 12-inch PVC or DIP gravity sewer, and 90 linear feet of 18-inch PVC or DIP gravity "sewer
and the following pump stations; Leonard Creek Pump Station, a 530—gallon per minute pump station
with duplex pumps, on -site audible and visual high water alarms, telemetry, and a permanent generator
with automatic transfer switch; and Bear Creek Pump Station, a 1,150-gallon per minute pump station
with duplex pumps, on -site audible and visual high water alarms, telemetry, and a permanent generator
with automatic transfer switch; as well as approximately 2,592 linear feet of 8-inch RJ DIP force main and
approximately 7,563 linear feet of 8-inch PVC or DIP force main to serve the expanded Brakebush Brothers
chicken processing facility and existing Leonard Creek residential flow as part of the Utilities to Serve
Brakebush Brothers project, and the discharge of 372,000 gallons per day of collected domestic and
industrial wastewater into Town of Mocksville's existing sewerage system, pursuant to the application
received April 12, 2022, and additional information received on April 21, 2022 and April 29, 2022 and in
conformity with 15A NCAC 02T; the Division's Gravity Sewer Minimum Design Criteria adopted February
12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting data subsequently
filed and approved by the Department of Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the specified
conditions and limitations contained therein.
DocuSignedby:�1 u
OD2D3CE3F1B7456... C/
for Richard E. Rogers, Jr.
Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0043365
Permit Issued: April 29, 2022
Page 3 of 7

SUPPLEMENT TO PERMIT COVER SHEET
Town of Mocksville is hereby authorized to:
Construct, and then operate upon certification the aforementioned wastewater collection extension. The
sewage and wastewater collected by this system shall be treated in .the Town of Mocksville Wastewater
Treatment 'Facility in accordance with Permit Number NC0024872.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 02T; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as
applicable; and the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and
Force Mains adopted June 1, 2000 as applicable, unless specifically mentioned herein. Division approval
is based on acceptance of the certification provided by a North Carolina -licensed Professional Engineer in
the application. It shall be the Permittee's responsibility to ensure that the as -constructed project meets
the appropriate design criteria and rules.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
F. SPECIAL CONDITIONS
1. This permit shall become voidable unless the agreement between Town of Mocksville and Davie
County for the collection and final treatment of wastewater is in full force and effect. [15A NCAC
02T.0304(g)]
No flow in excess of the quantity permitted herein, 372,000 GPD, shall be made tributary to the
subject sewer system until an application for permit modification for an increase in flow has.been
submitted to and approved by the Division. [15A NCAC 02T.0304(b)]
3. Each pump station shall be clearly and conspicuously posted using a weatherproof sign with a pump
station identifying name/number, 24-Hour Emergency telephone number, and name of the
owner/operator of the sewer system/pump station and instructions to call the number in the event
of alarm activation or other emergency. Simplex pump stations or vacuum sewer pits serving a single-
family residence may have a placard or sticker on the control panel in lieu of a sign. [15A NCAC 02T
.0305(h)(2)]
4. The abandonment of any existing wastewater facilities including septic systems being replaced by new
sewer infrastructure shall be done in accordance with the applicable agency having compliance
oversight on such facilities. [15A NCAC 02T.0105(c)(6)]
If. STANDARD CONDITIONS
1. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be "submitted to the Division accompanied" by documentation from the parties involved, and
other supporting materials as may be appropriate. The.approval of this request shall be considered
on its merits and may or may not be approved. [15A NCAC 02T.0116; G.S 143-215.1(d3)]
Page 4 of 7

2. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 02T, the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for
the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and
other supporting materials unless specifically mentioned herein. [15A NCAC 02T.0110]
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [15A NCAC 02T .0110]
4. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 02T .0403. If an individual
permit is not required, the following performance criteria shall be met:
a. The sewer system shall be effectively maintained and operated at all times to prevent discharge
to land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e. 365
days per year). Pump stations that are connected to a telemetry system shall be inspected at
least once per week.
e. High -priority sewer lines shall be inspected at least once per every six -months and inspections are
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in accordance
with 15A NCAC 2B .0506(a), and public notice shall be provided as required by North Carolina
General Statute §143-215.1C.
h. A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential. users and
the legal means to require grease interceptors at existing establishments. The plan shall also
include legal means for inspections of the grease interceptors, enforcement for violators and
the legal means to control grease entering the system from other public and private satellite
sewer systems.
2. For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
Page 5 of 7

j. Documentation shall be kept for Subparagraphs (a). through (i) of this Rule for a minimum of three
years with exception of the map, which shall be maintained for the life of the system.
5. 'The Permittee shall report by telephone to a water resources staff member at the Winston-Salem
Regional Office, telephone number [phone], as soon as possible, but in no case more than 24
hours, following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as the initial
verbal report. Overflows and spills occurring outside normal business hours may also be reported to
the Division of Emergency Management at telephone number [phone] or [phone].
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence. This report must outline the actions taken or proposed to be taken to
ensure that the problem does not recur. Part II of Form CS-SSO ('or the most current Division approved
form) can also be completed to show that the SSO was beyond control. [G.S. 143-215.1C(a1)]
6. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State. [15A NCAC 02T.0108(b)]
7. Upon completion of construction and prior to operation of these permitted facilities, the completed
Engineering Certification form with checklist attached to this permit shall be submitted with the
required supporting documents to the address provided on the form. A complete certification is one
where the form is fully executed and the supporting documents are provided as applicable. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Engineer's Certification shall be considered a violation of the permit and shall subject the
Permittee to appropriate enforcement actions. Supporting documentation shall include the following:
a. One_copy of the project construction record drawings (plan & profile views of sewer lines & force
mains) of the wastewater collection system extension. Final record drawings should be clear on
the plans or on digital media (CD or DVD disk) and are defined as the design drawings that are
marked up or annotated with after construction information and show required buffers,
separation distances, material changes, etc.
One copy of the supporting applicable design calculations including pipe and pump sizing, velocity,
pump cycle times, and level control settings, pump station buoyancy, wet well storage, surge
protection, detention time in the wet well, and force main, ability to flush low points in -force
mains with a pump cycle, and downstream sewer capacity analysis. If a portable power source or
pump is dedicated to multiple stations, an evaluation of all the pump stations' storage capacities
and the rotation schedule of the portable power source or pump, include travel timeframes, shall
be provided.
Page 6 of 7

c. Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the certification
in the space provided, or in written summary form.
Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting
in non-compliance with this permit (including but not limited to pipe length changes of 10% or
greater, increased flow, pump station design capacity design increases of 5% or greater, and
increases in the number/type of connections), regulations,. or the Minimum Design Criteria.
Requested modifications or variances to the Minimum Design Criteria will be reviewed on a case -by -
case basis and each on its own merit. Please note that variances to the Minimum Design Criteria
should be requested and approved during the permitting process prior to ' construction. After -
construction requests are discouraged by the Division and may not be approved, thus requiring
replacement or repair prior to certification & activation. [15A NCAC 02T .0116]
8. Gravity sewers installed greaterthan ten percent below the minimum required slope perthe Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions, have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case -by -case basis. Resolution of such request shall be evident prior to completing and submitting
the construction certification. [ 15A NCAC 02T.0105(n)]
9. A copy of the individual permit and construction record drawings shall be maintained on file by the
Permittee for the life of the wastewater collection facilities. [15A NCAC 02T .0116]
10. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 02T; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted June
1, 2000 as applicable; and other supporting materials may subject the Permittee to an enforcement
action by the Division, in accordance with North Carolina General Statutes §143-215.6A through§143-
215.6C, construction of additional or replacement wastewater collection facilities, and/or referral of
the North Carolina -licensed Professional Engineer to the licensing board. [15A NCAC 02T .0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including those
as may be required by this Division, such as the construction of additional or replacement facilities.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12. The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by the Division any other Federal, State, or Local
government agencies which have jurisdiction or obtaining other permits which maybe required by the
Division or any other Federal, State, of Local government agencies. [G.S. 143-215.1(b)]
Page 7 of 7

CERTIFICATION CHECKLIST
To be completed by the certifying engineer prior to operation of the permitted sewers, per 15A NCAC 02T.0116.
Certifying Engineer:
Certification Review Date:
Project: Utilities to Serve Brakebush Brothers
Permit No. WQ0043365 Project County: Davie County
1. Has permittee information changed since the permit was issued (or last modified): change of mailing address,
change of ownership, transfer from developer to HOA/POA, etc. ❑ Yes ❑ No
• If yes, please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the HOA/POA must occur with the first certification.
2. Have the as -built drawings have'been signed, sealed, and dated by an N.C. PE? ❑ Yes ❑ No
3. Final Engineering certification? ❑ Yes ❑ No
• If Partial Engineering certification, provide detailed narrative including what is being certified in the current
phase, what was previously certified (if applicable), and what is left to be certified.
4. Adequate information related to sewer lines: ❑ Yes ❑ No ❑ N/A
• Three feet minimum cover has been provided for all sewers unless ferrous pipe was installed.
• Minimum diameters for gravity sewers -are 8-inches for public lines and 6-inches for private lines.
Manholes have been installed: At the end of each line, at all changes in grade, size, or alignment, at all
intersections, and at distances not greater than 425 feet; minimum diameter shall be 4 feet (48-inches).
5. Adequate information related to pump stations: ❑ Yes ❑ No ❑ N/A
• Ensure power reliability option was selected per 15A NCAC 02T.0305(h).
6. Was project construction completed in accordance with all of the following: ❑ Yes ❑ No ❑ N/A
• 15A NCAC 02T, Minimum Design Criteria (MDC) for the permitting of Gravity Sewers (latest version), and MDC
for the Permitting of Pump Stations and -Force Mains (latest version)?
If not, a variance approval is required in accordance with 15A NCAC 02T.0105(b), prior to certification and operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must submit two copies of the variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy).
• The central office will review the variance request, and if approvable, specific language regarding the variance
will be incorporated into the permit, either via a special condition or a supplementary letter. A copy of the
reissued permit with variance language or the variance letter must be maintained with the original documents.
7. Does the project contains high priority lines (15A NCAC 02T .0402(2))? ❑ Yes ❑ No
• If yes, ensure that the permit already contains the necessary condition related to high priority lines 15A NCAC
02T.0403 (a)(5). If the permit does not' include this language, the Fast Track reviewer will reissue the permit with
the appropriate language.
•" Are Permit modifications are required for any changes resulting in non-compliance with this permit (including but not
limited to pipe length changes of 10% or greater, change in flow, pump station design capacity design change of 5% or
greater, and/or'change in the number/type of connections)? ❑ Yes ❑ No
• If yes, a permit modification request must be submitted to the appropriate Regional Office, and a modified
permit with revised certification must be issued prior to certification and operation.
NC DWR— Water Quality Regional Operations Section 450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Winston-Salem Regional Office Phone: [phone] FAX: [phone]

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: Town of Mocksville PROJECT: Utilities to Serve Brakebush Brothers
ISSUE DATE: April 29, 2022 PERMIT#: WQ004336S
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of
this permit until the Division has received this Certification and all required supporting documentation. It
should be submitted in a manner that documents the Division's receipt. Send the required documentation
to the Regional Supervisor,. Water Quality Regional Operations Section at the address at the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial certifications up
until a final certification is received. A Final Certification shall be a complete set of record drawings and
design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information to the Permittee, and the Permittee is prepared to operate & maintain
the wastewater collection system permitted herein or portions thereof.
Printed Name, Title Signature Date
ENGINEERS CERTIFICATION
I, . as a duly registered Professional En sneer in the. State of North Carolina,
having been authorized to observe (❑ periodically, [:]'weekly, LJ full time) the construction of the
project referenced above for the above Permittee, and hereby state that, to the best of my abilities, due
care and diligence was used in the observation of the following construction:
approximately 688 linear feet of 8-inch PVC or DIP gravity sewer, 173 linear feet of 12-inch PVC or DIP
gravity sewer, and 90 linear feet of 18-inch PVC or DIP gravity sewer and the following pump stations;
Leonard Creek Pump Station, a 530—gallon per minute pump station with duplex pumps, on -site audible
and visual high water alarms, telemetry, and a permanent generator with automatic transfer switch; and
Bear Creek Pump Station, a 1,150-gallon per minute pump station with duplex pumps, on -site audible and
visual high water alarms, telemetry, and a permanent generator with automatic transfer switch; as,well
as approximately 2,592 linear feet of 8-inch RJ DIP forcemain and approximately 7,563 linear:feet of 8-
inch PVC or DIP force main to serve the expanded Brakebush Brothers chicken processing facility and
existing Leonard Creek residential flow as part of the Utilities to Serve Brakebush Brothers project, and
the discharge of 372,000 gallons per day of collected domestic and industrial wastewater into Town of
Mocksville's existing sewerage system, pursuant to the application received April 12, 2022, and additional
information received on April 21, 2022 and April 29, 2022
; such that the construction was observed to be built within substantial compliance of this permit; 15A
NCAC 02T;,the. Division of Water Resources' (Division) Gravity Sewer Minimum. Design Criteria adopted
February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of
Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting materials.
.............................. .
North Carolina Professional Engineer's Seal w/signature & date:
❑ Final ❑ Partial (include description)
NC DWR — Water Quality Regional Operations Section 450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Winston-Salem Regional Office Phone: [phone] FAX: [phone]

NC Department of
Environmental Quality
v . DW R Received
OCT 18 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: N D � 3 Z (to be completed by DWR) /¢ZA Se of 26 440 2S
� 3,0 = Z6Z1 Il Z¢
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Brakebush Brothers Inc. (company, municipality, HOA, utility, etc.)
2. Applicant type: El Individual ®Corporation El General Partnership El Privately -Owned Public Utility
❑ Federal ❑]fState/County El Municipal ❑ Other
3. Signature authority's name: Carey Brakebush per 15A NCAC 02T .0106(b)
Title: Vice President W
4. Applicant's mailing address: N4993 6" Drive
City: Westfield State: WI Zip: 53964-_
5. Applicant's contact information:
Phone number: [phone] Email Address: careybna brakebush.com
II. PROJECT INFORMATION:
I. Project name: Brakebush Yard Expansion
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: Davie County
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.880405' Longitude:-80.555933'
5. Parcel ID (if applicable): 5737988809 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Catherine W. Underwood
Firm: Daylight Engineering
Mailing address: PO Box 1804
City: Concord ' State: NC'
Phone number: [phone]
Zip: 28026-'1804
License Number: 033470
Email Address: kateCa daylightenP com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name:Dutchman's Creek W WfPPermit Number: NCO021491
Owner Name:
V. RECEIVING
1. Permit Num s): WQ QS00156
2. Downstream ( ceiving) Sewer Info tion: 8- inch N Gravity ❑ Force Main
'3. System Wide Collecho ermit Number(s) (if applicable): WQCS CS00156
Owner Name(s): Town of Mocksville '
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 ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities I ❑ Church ❑ Swimming Pool/Filter Backwash
® Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic % Commercial 100 d/o Industrial (See 15A NCAC 02T .0103(20))
if Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .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 0
No. of Units
Flow
Truck Garage
25 gal/employee/shift
em l02ees/shift
525 GPD'.—
WWTP Employee Bathrooms
25 gal/employee/shift
2 employees'
50 GPD
Wellness Center - Gym
50 gal/100 sf
2,026 sf ,
1013 GPD ;
Wellnesss Center - Medical Office
250 gal/practitioner/shift
3 practitioners
750 GPD
Wellness Center - Conference Center
5 gal/seat
15 Seats
75 GPD
gau
GPD
Total
2413 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.
i
8. Wastewater generated by project: 2 413 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

V VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8"
261.67
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
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
I. Pump station number or name: LiftStation
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.8815' Longitude:-80.5548'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station:.002413 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): 32 Qallons per minute (GPM) at 57 feet total dvnamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
1138.01
SDR 15
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C.I.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCAC 02T .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 15A NCACO2T.0305(h)(1)(C):
® Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
I. Does the project comply with all separations/altematives found in 15A NCAC 02T.0305(f) & (g)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, W S-1 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 XI of this application
*15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check `y&'
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 webpaee
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No ® N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ Seethe Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
i
i
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: Yadkin Pee -Dee ®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.
d
6. Does project comply with I5A 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.).
i
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per I SA NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permtttee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T. the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (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
concurrently with the approval of the permit and proiects requiring a variance approval may be subject to longer
review times. For proiects requiring 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:
I, Catherine W. Underwood , attest that this application for Brakebush Yard Expansion
(Professional Engineer's name from Application Item IIL 1.) ('Project Name from Application Item II.I )
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that i have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design noncompliance with the applicable Rules and desi crit 9k may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCFGOf
North Carolina Professional Engineer's seal, signature, and date:
c
033470 0
.F Io.ls'©Q
ti •. ticiNEE. ' Z
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, Carey Brakebush attest that this application for Brakebush Yard Expansion
(Signanue Authority Name from Application Item I.3.) (Project Name from Application Item ILL)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — in accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
ZSignature: - _� Date:
FORM: FTA 10-23 Page 5 of 5

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Brakebush Brothers Inc.
Project Name for which flow is being requested: Brakebush Yard Expansion
Afore titan one FTSE nmy be required for a single project if the owner of the UIVTP 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: Dutchman's Creek WWTP
b. WWTP Facility Permit #: NC0021491
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
It. Percent of permitted flow used
A/l flows are in MGD
0.980e
0.282
0.565
0.002 '
0.849 '
87%
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)
(B)
(C)
(D)-(B+C) (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.
MOD MGD
Flow, MGD
MGD
Flow Capacity***
*The Firm Capacity (design Bow) 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 Poch pump station located between the
project connection point and the WWTP where the a le Capacity is <0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
\ FT E 10-23

III. Certification Statement:
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 adegya e capacit" transport and treat the proposed new wastewater.
Signing Official,S/i�gnature
/"/<{✓/v9 Pam- i
Title of Signing
Date
Page 2 of 6
FTSE 10-23

DAY LIGHT)�j,,
E N G I N E E R I N G
165 Brumley Ave NE
Concord, NC 28025
980.234.7500
daylighteng.com
NC Department of
Environmental Quality
October 16, 2024 Received
Jenny Graznak
OCT 18 2024
NCDEQ Winston-Salem Regional Office Winston-Salem
450 W. Hanes Mill Road Suite 300 Regional Office
Winston-Salem, North Carolina 27105
Subject: Brakebush Private Sewer Extension Application
The submittal package includes the following applications, and supporting documents:
(2) Copies of the Liftstation Calculations, signed and sealed
(2) Copies of the Fast Track Sewer System Extension Application (FTA 10-23), 1 original wet signature and 1 copy signed
and sealed
(2) Copies of the Flow Tracking for Sewer Extension Applications (FTSE 10-23), 1 original wet signature and 1 copy signed
and sealed
(2) Copies of the USGS Quad Map
(2) Copies of the Aerial Location Map
(1) Check made payable to NCDEQ for $600
To whom it may concern,
The proposed project includes extending sanitary sewer services from the existing sanitary sewer manhole structure across
Eaton Rd via directional drilling with the development of 261.67 LF of 8" PVC gravity sewer services, a private sewer lift
station, and 113&01 LF of 2" SDR 15 forcemain to the proposed industrial building. The required flow allocation is 2,413
GPD.
Sincerely
Hunter Thomas, El
Engineering Intern
M 704.530.6181 1 E [e-mail]
165 Brumley Ave NE I Concord, NC 28025
DAYLIGHT ,��'�;
October 16, 2024

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