WQ0041145_Application (FTSE)_20190821

Fleming Engilneerilng9 Inc,
C.onaulFing LI_q neerings &Laid Surveymrs
Transmittal Memo
To: Justin Henderson From: Brent Sievers,P.E.
Subject: Breckenridge Ph.8 Sewer Ext. Date: 8/19/2019
This is the Submittal package for the sewer main extension for Breckenridge phase 8. This is the zero-
flow project we discussed two weeks ago. Thanks, and please feel free to call with any questions.
Thanks
Brent Sievers, P.E.
Office: 544-6432
I
I�
NC Department of
Environmental Quality
Received
AUG 21 2019 j
i
Winston-Salem
Regional Office
P.O. 11nx 8774 1 (Imenslmm,N.C. 27419 1 Phnnrt:"-J'16-852 9797 1 I'nx: :316 852-9766

i
Project Narrative
Breckenridge
Phase 8
The proposed project phase consists of a 8.64 acre parcel extending Freemont Drive in Thomasville, North
Carolina. The development will consist of 21 single family lots with supporting detention pond, public
streets and utilities. Utility installation will involve;sanitary sewer lines,water lines and storm sewer lines.
At this time this application will be permitted for zero flow. When the town of Thomasville ahs completed
the receiving sewer outfall improvements flow for this section will be requested.
Consult plan sheets for further details and specifications.

�� � 22 d�l/� State of North Carolina
l_1/
R t_s�� V/ Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300-FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
PDIon&of Water Resources �} FTA 04-16&SUPPORTING DOCUMENTATION
Application Number: UD I (to be completed by DWR)
All items must be completed or the aoalication will be returned
L APPLICANT INFORMATION:
1. Applicant's name: Greene Group of North Carolina,LLC(company,municipality,HOA,utility,etc.)
2. Applicant type: ❑ Individual ❑Corporation ®General Partnership ❑Privately-Owned Public Utility
❑Federal ❑ State/County ❑Municipal ❑ Other
3. Signature authority's name: Ronnie Parker per 15A NCAC 02T.0106(b)
Title: Manager
4. Applicant's mailing address:502 Hickory Ridge DR
City: High Point State:NC Zip: 27262-
5. Applicant's contact information:
Phone number: 842)241-0018 Email Address:
II. PROJECT INFORMATION:
I. Project name: Breckenridge Ph. 8
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: Randolph
4. Approximate Coordinates(Decimal Degrees): Latitude: 33.573714' Longitude: -85.552222'
5. Parcel ID(if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Brent Sievers License Number:NC 27339
Firm: Fleming Engineering,Inc.
Mailing address: 8518 Triad Drive
City: Colfax State:NC Zip:27235-
Phone number:[phone] Email Address: [e-mail]
W. WASTEWATER TREATMENT FACILITY(WWTF)INFORMATION:
1. Facility Name: Hamby Creek Permit Number:NC 00024112
Owner Name:City of Thomasville
V. RECEIVING DOWNSTREAM SEWER INFORMATION(if different than WWTF):
1. Permit Number(s): WQ38485 Downstream(Receiving)Sewer Size: 8 inch
System Wide Collection System Permit Number(s)(if applicable): WQCS
Owner Name(s):
FORM:FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately-Owned Public Utility,has a Certificate of Public Convenience and Necessity been attached?
❑❑Yes❑ [—]No ❑MN/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 MN/A
3. If the Applicant is a Home/Proyerty Owners'Association,has an Operational Agreement(FORM:HOA)been attached?
❑❑Yes❑ [-]No ❑MN/A
4. Origin of wastewater:(check all that apply):
M❑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
%Industrial(See 15A NCAC 02T.0103(20))
3.Is there a Pretreatment Program in effect? ❑❑❑Yes ❑❑No
6. Hasa flow reduction been approved under 15A NCAC 02T.0114(fl? ❑❑Yes ❑M No
➢ If yes,provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type(see 021.0114(1)) Daily Design Flow•b No.of Units Flow
Residential gall GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
Total GPD
a See 15A NCAC 02T.0114(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 i 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.0114] shall
be determined using available flow data,water using fixtures,occupancy or operation patterns,and other measured data.
8. Wastewater generated by project:0 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
M❑Other(Explain): Will request flow acceptance at the time down stream sewer construction is complete.
FORM: FTA 04-16 Page 5 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
8 521 PVC
➢ Section II&III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA(If Applicable)—02T.0305&MDC(Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. 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) i
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)(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
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- 15A 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:FTA 04-16 Page 6 of 5

12ev��� �
IX. SETBACKS&SEPARATIONS—(02B.0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f)&(a) ® Yes ❑No
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below vertical 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 s inming pools 10 feet
Final earth grade vertical 36inches
➢ 15A NCAC 02T.0305(g)contains alternatives where separations in 02T.0305(f)cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboage
➢ If noncompliance with 02T.0305(t)or(g),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 0213 .0200? ®Yes ❑No ❑N/A
➢ This would include Trout Buffered Streams per 15A 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 Pennitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(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

➢ 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.
X.
FORM: FTA 04-16 Page 8 of 5

CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T,the Minimum Design Criteria for the Pemmitting of 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 Engineer's Certification: �^ y—
I, tl�2�.J V — LEY C r J I GV S attest that this application for
(Professional Engineer's name from Application Item 111.1.)
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, Gravity Sewer
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.
I
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, 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.
North Carolina Professional Engineer's seal,signature,and date: ..........."'....„f..4111'rA�rl'i'i�r..."""""""""'
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3. Applicant's Certification per 15A NCAC 02T.010n6n(b):
1, /Connel S rum�e� T' . attestthatthis application for
(Signature Authority's name&title from Application Item I.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 as well as civil penalties up to$25,000 per violation.
Signature: 1411 y Date:
FORM:FTA 04-16 Page 9 of 5

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STATE OF NORTH CAROLINA l 1 ff jj
COUNTY OF Ran 1pli Permit No.1.,) G 6 " l 1 -1 S
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (dl)and enteredinto this 04 day of
September 2019 by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina,hereinafter(mown as the COMMISSION;and
Greene Group of North Carolina,LLC ,a corporation/general partnership registered/licensed to do
business in the State of North Carolina,hereinafter known as theDEVELOPER.
WTTNESSETH:
1. -The DEVELOPER is the owner of the certain lands lying in Randolph County, upon
which it is erecting and will erect dwelling units and other improvements,said development to beknown
as Breckenridge Phase 8 (hereinafter the Development).
2. The DEVELOPER desires,to construct a wastewater collection system with pumps,wastewater treatment
works, and/or disposal facilities(hereinafter Disposal System)to provide sanitary sewage disposal to serve
the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct,maintain,and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership(hereinafter Declaration),pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, Breckenridge Phase 8 Home Owners Association (hereinafter
Association),a non-profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re-constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance,re-construction andrepair.
6. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interest therein.
NOW,THEREFORE,in consideration of the promises and the benefits to be derived by each of the parties
hereto,the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions andlaw.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws andDeelaration.
3. The DEVELOPER shall not transfer,convey,assign or otherwise relinquish or release its responsibility for
the operation and maintenance of its Disposal System until a permit has been reissued to the DEVELOPER's
successor.
FORM: DEV 03-19 Page I oft

4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of the permit for construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highestpriority for
expenditures by the Association except for Federal,State, and local taxes andinsutance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses.In order to assure that there shall be fiords readily available to
repair,maintain or construct the Disposal System,beyond the routine operation and maintenance expenses,
the Declaration and Association Bylaws shall provide that a fiord be created out of the common expenses.
Such fund shall be separate from the routine maintenance fiords allocated for the facility and shall be part
of the yearlybudget.
6. In the event the common expense allocation and separate fund are not adequate for the construction,repair,
and maintenance of the Disposal System,the Declaration and Association Bylaws shall provide for special
assessments to cover such necessary costs_There shall be no limit on the amount of such assessments, and
the Declaration and Bylaws shall provide that such special assessments can be made as necessary at any
time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town,village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and fixture wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit mayrequire as condition of accepting the Developments wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health .safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the continued
proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution without first having
transferred its said system and facilities to some person, corporation or other entity acceptable to and
approved by the COMMISSION by the issuance of apermit.
9. The agreements set forth in numbered paragraphs 1, 2,3,4, 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies)where the Declaration is
filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF,this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL Greene Group of North Carolina,LLC
MANAGEMENT COMMISSION Name of I�E��R
By LV�y�t/
Linda Culpepper (Signature)
Director,Division of Water Resources
Ronnie Parker, Jr. -Nla n..s c.�'
Print Name and Title
4I N /.2or)
(Date) (Date)
FORM: DEV 03-19 Page 2 of 2