WQ0041075_Application (FTSE)_20190815

oil Stoltzfus Engineering, Inc .
oa/o Z/l 9 ( e..4)
TRANSMITTAL MEMO Date: .^�'s {� ==
To: NCDENR Winston-Salem Regional Office Subject: Brightwood Farm Phase 5
Water Quality Section
450 West Hanes Mill Road, Suite 300 Gravity Sewer Extension-Public
Guilford C MtynFLW of Burlington
Winston-Salem,NC 27105 - N
C:nvuonmental Quality
Received
From: Aden Stoltzfus, PE
Winston-Salem
Regional Office
Attached is one (1) original and one (1) copy of the completed Fast-Track Application including the Fast
Track Form,Flow Tracking Acceptance Form,and the Site Maps along with Check in the amount of$480.00
for the permit fee for Brightwood Farm Phase 5 Subdivision.
The public gravity sewer extension consists of 4,302 linear feet of gravity sanitary sewer to serve 114 homes
of a new residential development entitled Brightwood Farm Phase 5. Wastewater that will be generated by
this development is estimated to be 54,720 GPD. The downstream sanitary collection system is operated by
the City of Burlington. The flow from this project will be treated by T.Z. Osborne Water Reclamation
Facility owned by the City of Gg ensboro.
Please call me at(336) 904-0207 with any questions.
747 Park Lawn Court ♦ Kernersville, NC 27284 ♦ [phone]

State of North Carolina
M9000� Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300-FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04.16&SUPPORTING DOCUMENTATION
Application Number: WQGO� G�✓ (to be completed byDWR)
All items must be completed or the auplication will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: City of Burlington(company,municipality, HOA,utility,etc.)
2. Applicant type: ❑Individual ❑Corporation ❑General Partnership ❑ Privately-Owned Public Utility
❑Federal ❑State/County ® Municipal ❑ Other
3. Signature authority's name:Hardin Watkins per 15A NCAC 02T.0106(b)
Title: Burlington City Manager
4. Applicant's mailing address:P.O.Box 1358
City: Burlington State:NC Zip:27216
5. Applicant's contact information:
Phone number: 3( 36)222-5022 Email Address:hwatkins@burlin tog nne g_ov
11. PROJECT INFORMATION:
1. Project name: Brightwood Farm Phase 5
2. Application/Project status: ®Proposed(New Permit) ❑ Existing Permit/Project
If a modification,provide the existing permit number: W000_ and issued date:
If new construction but part of a master plan,provide the existing permit number: W000_
3. County where project is located: Guilford
4. Approximate Coordinates(Decimal Degrees): Latitude: 36.070758' Longitude:-79,587952'
5. Parcel ID(if applicable): P/O 106269, 106271, 106272, 106281 & 106284
(or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
I. Professional Engineer: Aden R.Stoltzfus License Number:26461
Firm:Stoltzfus Engineering,Inc.
Mailing address: 747 Park Lawn Court
City: Kernersville State:NC Zip: 27284-_
Phone number:[phone] Email Address:[e-mail]
IV. WASTEWATER TREATMENT FACILITY(W WTF)INFORMATION:
1. Facility Name:T.Z.Osborne Water Reclamation Facility Permit Number: NCOO-47384
I
Owner Name:City of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION(if different than WWTF):
1. Permit Number(s):WQ 003001 Downstream(Receiving)Sewer Size: 8 inch
System Wide Collection System Permit Numbers if applicable): WQCS-"Do
OwnerName(s): 0 U� �ttl'�ll1Y
I
FORM: FTA 04-16 Page 1 of 5

i
VL GENERAL REQUIREMENTS
I
I. If the Applicant is a Privately-Owned Public Utility,has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No NN/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 NN/A
3. If the Applicant is a Home/Property Owners'Association,has an Operational Agreement(FORM: HOA)been attached?
❑ Yes [-]No NN/A
4. Origin of wastewater:(check all that apply):
N Residential 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 %Commercial
_%Industrhd (See 15A NCAC 02T.0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under ISA NCAC 02T.0l 14(f)? [:] Yes ❑No
➢ If ves,provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type(see 02T.0114(f)) Daily Design Flow"b No.of Units Flow
Residentil 4 bedroom houses 480 gal/day 114 54720 GPD
gal/ GPD
gal/ GPD
gal/ GPD
gall GPD
gal/ GPD
Total I 54720 GPD
a See 15A NCAC 02T.0I 14(b).(d). (e)(1)and(e)(2) for caveats to wastewater design flow rates(i.e.,minimum flow per
dwelling;proposed unknown non-residential development uses;public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S.42A-4).
b Per 15A NCAC 02T.0114(c),design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data,water using fixtures,occupancy or operation patterns,and other measured data.
8. Wastewater generated by project: 54720 GPD(per 15A NCAC 02T.0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero,indicate why:
❑Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑Other(Explain):
FORM: FTA 04-16 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 3,833 VCP eu\_119
8 469 DIPX
➢ 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 requirement is not allowed and a violation of the MDC
Vlll. PUMP STATION DESIGN CRITERIA(If Applicable)—02T.0305&MDC (Puma Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name:
2. Approximate Coordinates(Decimal Degrees): Latitude: Longitude:-
3. Design flow of the pump station: _millions gallons per day(firm capacity)
4. Operational point(s)of the pump(s): _gallons per minute at_feet total dynamic head(TDH)
5. Summarize the force main to be permitted(for this Pump Station):
Size(inches) Length(feet) Material
6. Power reliability in accordance with 15A NCAC 02T.0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry- 15A NCAC 02T.0305(h)(I)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation,quick-connection receptacle and telemetry- ISA NCAC 02T �
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry- 15A NCAC 02T.0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant(draft agreement)
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
in the case of a multiple station power outage.
FORM: FPA 04-16 Page 3 of 5

IX. SETBACKS&SEPARATIONS—(02B.0200&15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in I SA NCAC 02T.0305(t)&(g) ® Yes ❑No
I
➢ 15A NCAC 02T.0305(f)contains minimum separations that shall be provided for sewers stems:
Setback Parameter* Separation Required L
Storm sewers and other utilities not listed below(vertical) 24 inches
Water mains vertical-water over sewer 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 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(see item IX.2) 50 feet
**Any other stream,lake,impoundment,or ground water lowering and surface drainage
ditches 10 feet
Any building foundation 5 feet
Any basement 10 feet
Top sloe 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
➢ 15A NCAC 02T.0305(M contains alternatives where separations in 02T.0305(D cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboaee
➢ If noncompliance with 02T.0305(t)or(e),see Section X of this application
2. Does the project comply with separation requirements for wetlands?(50 feet of separation) ® Yes ❑No ❑N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B.0200? ® Yes ❑ No ❑N/A
➢ This would include Trout Buffered Streams per I SA NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ® Yes ❑ No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 &Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(e)(6)(additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6),directly related environmental permits or certification applications are 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.).
6. Does this project include any sewer collection lines that are deemed"high-priority?"
Per 15A NCAC 02T.0402,"high-priority sewer"means"any aerial sewer, sewer contacting surface waters, siphon,or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ 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 permitee's individual System-Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T,the Minimum Design Criteria for the Permittingof f Pump Stations
and Force Mains(latest version),and the Gravity Sewer Minimum Design Criteria(latest version)as applicable?
® Yes ❑ No
If No,complete and submit the Variance/Alternative Design Request application(VADC 10-14)and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineers Certification:
1 Aden R. Stoltzfus attest that this application for
(Professional Engineer's name from Application Item I11.1.)
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 j
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers(latest version),and the Minimum Design Criteria for the Fast-Track Permitting j
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$25,000per violation.
................. rtp�i r
North Carolina Professional Engineer's seal,signature,and date: 0 GAR... �i
?�SSIO
...._..............................................................................
:
3. Applicant's Certification per 15A NCAC 02T.0106(b):
I Hardin Watkins G) - y oex tla!2c:4 — attest that this application for
(Signatur rity's name from Application Item 1.3.)
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 assw well
�ass civil penalties up to$25,000 per violation.
Signature: �� 1 "" Date:
FORM: FCA 04-16 Page 5 of 5

�l
� P VP d g�ll ll� State of North Carolina
Department of Environmental Quality
Division of Water Resources
°n
?� m-11 Flow Tracking for Sewer Extension Applications
VII.Entity Requesting Allocation: City of Burlington
Project Name for which flow is being requested: Brightwood Farms Ph 5
More titan one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: T Z Osborne
b. WWTP Facility Permit#: NCO047384
All flows are in MGD
c. WWTP facility's permitted flow 40.0
d. Estimated obligated flow not yet tributary to the WWTP CS 0.0552 SIU 2.6099
e. WWTP facility's actual avg. flow 29.87
f Total flow for this specific request 0.054
g. Total actual and obligated flows to the facility 32.52
h. Percent of permitted flow used 81.3
H. 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. MGD MGD Flow,MGD MGD Flow Capacity***
Rock 2.52 1.008 0,564 0.168 .732 0.276
* 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):
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I �`?hGn c� �'� e certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning 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.
CI
Si g Official hnditure Date
Title ofSignigg fficial
Page 2 of 6
FTSE 10-18

City of Greensboro
Water Resources Department
Engineering Division
Flow Tracking/Acceptance for Sewer Extension Permit Applications
�96, dj (COG-FTSE-10/07)
GREENSBORO
Permit Number: N/A
Project Applicant Name: City of Burlington
Project Name for which flow is being requested: Brightwood Fauns Phase 5
More than one COG-ME-10107 may be required for a single project if the owner ofthe WWTP is not responsible for all pump stations along the route of the
proposed wastewaterflow.Flow acceptance is contingent upon City Council approval.
The Flow Tracking/Acceptance Permit is valid for a period ofone yearfrom the date ofissuance.Failure to renew the perndt prior to the expiration date,by
submission ofa revised application,will result in relinquishment ofany waste waterflow allacatedfor the project in question.A revised application.rust be
submtued to Water Resources Department ifflow conditions or deve/opmentplans change other than what was stated in the original application.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: T.Z.Osbome Water Reclamation Facility
b. WWTP Facility Permit Number: NCO047384
All flows are in MGD
c. WWTP facility's permitted flow 56.0000
d. Estimated obligated flow not yet tributary to the WWTP CS- 0.0728 SRI- 2.4078
e. WWTP facility's actual avg.flow 20.38
f. Total flow for this specific request 0.054
g. Total actual and obligated flows to the facility 22.9146
It. Percent of permitted flow used 57.29
1I. Complete this section for each pump station you are responsible for along the route of this proposed wastewater flow.
Are there any pump stations affected? Yes
List pump stations located between the project connection point and the WWTP
Pump Station Name Approx.Capacity,MGD Approx.Current Avg.
(Firm/Design) Daily Flow,MGD
Rock Creek 2,5202436 1.023076812
Not Applicable n/a n/a
Not Applicable tJa n/a
Not Applicable n/a n/a
III. Certification Statement:
I,Shane Messer certify that,to the best of my knowledge,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 stations enroute to the receiving treatment plant.This analysis
has been perforated 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 for which I am the responsible party.Signature of this form indicates acceptance of this
wastewater flow.
Skp..e'�wxcc
3/1/IOl9
Signing Official Signature Date

I
State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
Division of water Resources Flow Tracking for Sewer Extension Applications -
(FTSE 10-18)
Entity Requesting Allocation: City of Burlington
Project Name for which flow is being requested: Brightwood Farms Phase 5
More than one FTSE nmy be required for a single project#,the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewaterflow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: T.Z. Osborne
b. WWTP Facility Permit#: NCO047384
All flows are in MGD
c. WWTP facility's permitted flow 56.00
d. Estimated obligated flow not yet tributary to the WWTP CS- 0.0728 SIU- 2.4078
e. WWTP facility's actual avg. flow 20.38
f. Total flow for this specific request 0.054
g. Total actual and obligated flows to the facility 22.9146
It. Percent of permitted flow used 57.29
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(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/pt), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow,MOD MGD Flow Capacity***
Rock
r o�, 2.52 1.008 0.817 0.168 .985 0.023
* 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):
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Shane Messer 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.
�ViAJ�A .3 /
tng Offictal Signature Date
Title of 'gkng Offidial
Page 2 of 6
FTSE 10-18

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 04-16)
Enity Requesting Allocation City of Burlington
Project Name for which flow is being requested: Brightwood Farm Phase 5
More than one FTSE-I0107 may be required for a single project ifthe owner of the IVIVTP is not responsible for all puotp stations
along the route ofthe proposed wastewaterflow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. W WTP Facility Name: City of Burlington Collection System -Greensboro Rock Creek PS
b. W WTP Facility Permit#: WQCS00008
All flows are in GPD
c. W WTP facility's permitted Flow Allocation from Greensboro 900,000
d. Estimated obligated flow not yet tributary to the W WTP 106,848
e. W WTP facility's actual avg. flow 341,622
f. Total flow for this specific request 54,000
g. Total actual and obligated flows to the facility 502,470
h. Percent of permitted flow used 55.8%
II. Complete this section for each pump station you are responsible for along the route of this
List pump stations located between the project connection point and the W WTP : None
(A) (B) (C) (D)=(B*C) (E)=(A-D)
Obligated, Total
Design Approx. Not Yet Current Flow
Firm Average Daily Current Avg. Tributary Plus
Pump Station Capacity, ' Flow" Daily Flow, Daily Flow, Obligated Available
Name GPD (firm/pf),GPD GPD GPD Flow Capacity"'
None
The Firm Capacity of any pump station Is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
" Design Average Daily Flow is the firm capacity of the pumpstation divided by a peaking
factor(pf) not less than 2.6.
""" A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity s 0.
Downstream Facility Name(Sewer) : Brightwood Farms Phase 4, Section 1 C
Downstream Permit Number: WQ0030417
Page 1 of 2 FTSE 04-16

f
III.
I
Certification Statement:
1, W. Todd Lambert, P.E. certify to the best of my knowledge that the addition of the
volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any
capacity related sanitary sewer overflows or overburden any downstream pump station en route to the
receiving treatment plant under normal circumstances, given the implementation of the planned
improvements identified in the planning asssessment where applicable. This analysis has been
performed in accordance with local established policies and procedures using the best available data.
This certification applies to those items listed above in Sections I and II plus all attached planning
assessment addendums for which 1 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.
11, 07 7 3-1111
Signing Official Signature pate
City Engineer
i
Title of Signing Official
l
I
f
Page 2 of 2 USE 04-16

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[e-mail] USGS QUAD MAP
336-904-0207 GIBSONVILLE,NC 2016
747 Park Lawn Court COUNTY: GUILFORD
Kernersville, NC 27284 DATE:01/25/2019
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BRIGHTWOOD FARM PHASE 5 1000' 500' 0' 1000, 2000'
SCALE 1"=1000'
Aden R.Stoltzfus, PE C-3812
[e-mail] USGS QUAD MAP with AERIAL
336-904-0207 GIBSONVILLE,NC 2016
747 Park Lawn Court COUNTY: GUILFORD
to tz us Engineering nc. Kernersville, NC 27284 DATE:01/25/2019
Civil Engi ming Consultants