WQ0041320_Application_20191201

State of North Carolina
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: �Uti rl�oj� (to be completed byDWR) I\!Ov J 9� ?ray
AR items must be completed or the aoolication will be returned
INOROS
I. APPLICANT INFORMATION: MOORESVILLE REGIONAL OFFICE
1. Applicant's name: Pappas Midtown Berkeley Partners 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: Mark Furlan per 15A NCAC 02T 0106(b)
Title: Managing Director of Healthcare Development
4. Applicant's mailing address: 4777 Sharon Road, Suite 550
City: Charlotte State: NC Zip: 28210
5. Applicant's contact information:
Phone number: [phone] Email Address: mfurlanapappasproperties.com
II. PROJECT INFORMATION:
1. Project name: Kenilworth Medical Office Building I
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: WQ00_
3. County where project is located: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.209936' Longitude:-80.838004'
5. Parcel ID (if applicable): 12520223
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Jonathan Allen License Number: 25497
Firm: NV5/CALYX ENGINEERS
Mailing address: 6750 Tryon Road
City: Cary State: NC Zip: 27518
Phone number: ffl9) 858-1831 Email Address: jonathan.allen(i�nv5.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Sugar Creek Wastewater Treatment Plant Permit Number: NCO024937
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ 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 ®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 Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ❑N/A
4. Origin of wastewater: (check all that apply):
❑ 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: _% Domestic/Commercial 100 % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20)1
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ® No
➢ If Yes, arovide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,"
No. of Units
Flow
Medical Office
250 gal/physician
70
17,500 GPD
gall
GPD
gal/
GPD
gal/
GPD
gall
GPD
gall
GPD
Total
17,500 GPD
a See 15A NCAC 02T .0114(b). (d). (c)(I) 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-41.
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: 17500 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

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
34
DI
8
144
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 (Puma 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)
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 3 of 5

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) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be orovided for sewer systems:
® Yes ❑ No
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 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
➢ 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 webpage
➢ If noncompliance with 02T.0305(f) 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 02B .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 Permitting 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

X. CERTIFICATIONS:
1. 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 nrlor to submittal of the Fast Track Anplleation and sunnortine documents
2. Professional Engineer's Certification:
name from Application Item 111.1.)
that this application for
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.
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. �tpIpNHNYpjj Ai
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required pails 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 pails 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.
Date: II I11
It I
FORM: FTA 04-16 Page 5 of 5

X. CERTIFICATIONS:
1. 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 Engineer's Certification:
attest that this application for
(Professional Engineer's name from Application Item III.1.)
has been reviewed by me and is accurate, complete and consistent with the infonnation 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 potions 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 143-215.613, 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:
Applicant's Certification per 15A NCAC 02T .0106(b):
that this application for
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.
Date:
'd D/NCDENR/DWR
NOV 3 5 2019
WOROS
MOORESVILLE REGIONAL OFFICE
FORM: FTA 04-16 Page 5 of 5

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Limited Liability Company
Legal Name
Pappas Midtown Berkeley Partners, LLC
Information
Sosld: 1822653
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 3/25/2019
Registered Agent: Pappas, Peter A.
Addresses
Mailing Principal Office Reg Office
4777 Sharon Rd Ste 550 4777 Sharon Rd Ste 550 4777 Sharon Rd Ste 550
Charlotte, NC 28210 Charlotte, NC 28210 Charlotte, NC 28210
Reg Mailing
4777 Sharon Rd Ste 550
Charlotte, NC 28210
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.

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Name: CENTER CITY MEDICAL OFFICE BUILDING Location: 035° 12' 34.9607" N, 080° 50' 17.2834" W
Date: 11/21/19
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t(ti7) R n Capacity Assurance Program Application Flow Analysis
,t It lill11111 ,,.
ID:
20181590
Customer Name:
Jonathan Allen,
CALYX Engineers +
Consultants
Submittal Date:
11/15/2018
Reviewer:
Jon Beam
Project Name:
Pearl Park Way Mixed Use
Service Address:
1201 Greenwood Cliff Rd
Service City:
Charlotte
Service State:
NC
Service ZIP:
28204
Tax Parcel Number:
12520141
Approval Type: Conditional
Flow Tracking Status: Inactive - Condition
Connection Type: Major
Certification Date: 12/18/2018
Project Type:: Non Exempt
Basin:: Sugar Creek
Requested Average Daily Flow (gpd): 120,505
Peaking Factor: 2.5
Percent of Flow Applied: 100
Surcharges or Downstream SSO's: No
Nodes and Flows Affected by this Application (Values shown for flow/capacity are in gallons per day)
Node Name Requested —Flow— iBaseline_Capacity Available —Capacity
Remaining_Capacity_
Percent_Remaining
21 301,263 ',63,000,000 112,678,355
1307,283�26,000,000
12,375,092
97.6
30 33,736
267,525
792.9
Sugar Creek 136,171 '6,100,000 11,046,014
I
I
i909,844
�87.
I
i
Requested peak flow and available capacities for pumping stations and flow monitors are reported as peak flow. Requested
peak flow and available capacities for WWTPs are reported as maximum month flow. The available capacities presented for
W WfPs are approximate and for informational purposes only; consult Technical Memorandum 15 — Guidelines for Evaluating
Treatment Capacity for more Information.
Comments: After an analysis of the sanitary sewer system associated with proposed design of project 20181590, Pearl
Park Way Mixed Use, it was determined that there is currently sufficient capacity to accommodate the
proposed average daily flow of 120,505 gallons per day at the connection point(s) indicated on the submitted
utility plan.

CHARLOTTE
W4,ITER
CAPACITY ASSURANCE REVIEW APPLICATION
(FLOW ACCEPTANCE & WILLINGNESS TO SERVE)
All requests require a utility drawing Indicating the proposed waterlsewer connection point(s) and sizes.
c Jonathan Allen A CALYX Engineers + Consultants
W First Name Last Name MI Company (If applicable)
w, 7500 East Independence Blvd, Suite 100 [e-mail]
m Address a -mall
Charlotte NC 28227 919-858-1831
City State Zip Phone
Pearl Park Way Mixed Use
F- 2 Project Name
w �°— 1W1 . Greenwood Cliff Road
a U Site Address
a. Cl Charlotte NC 28204. 12520141
City State Zip Tax Parcel Number
Complete the following: (✓ Will this project have a pool? S3 W Y• ❑ N
1. Project is: ® new, ❑ modification 'Or., veermeathaveearnchdarnline P.
2. Type of development? (15A NCAC 02T 0114 wastewater oas�gn Flow Rates) 4. Will this project have a private sewer lift station?
a. Residential, apartment -Its ❑ Y ® N
b. Residential, townhome/condominlum N/A units
p c. Amenity Center (all or Pool (people) ••�:
5. Total wastewater flow requested (average navy row at epd
_._ snow caKvraoons) A 7 _ _ / 1,
U. d. Residential, single-family N/A lots
0 i. Public Roads? ❑ Y U N 6. Commercial only: Peak wastewater flow requested
e. Restaurant WA seats(( (peek hourly now in GPH) A2 r S 5Z v / (P
(L Retail or Retail with food prep - 2s1GOO 857{ 1 C rnbt ��
Cg Office 26,$Jt .r13w; f4 X i.531 mp/shift 7. Average Daily Water Demand: 120, 5ZJ
It. Warehouse NIA #loading bays 8. Peak Water Demand (GPM): 26 9 - 2,
Hotel or Suites JZO Fjrwv. )C 160_ rooms 8• Does this project include a 6-inch or larger private
J. School G N/A students sewer line providing service to multiple buildings?
1. Cafeteria ❑ Y ❑ N ❑Y M N
il. Gym/Locker rooms O Y O NN 10. Does this project Include a 2-inch or larger private water
940 line providing service to multiple buildings?
© Other (provide flow calculation(s) Medial Of,c (40a physicians o 250 gpd) Y ® N
W CLTWater Trackingif: 20101 5 0 Map #: L
Lu� V
V 2 Does the flow transmit through a CLTWater lift station? O Y' N If yes, which station? fA/ /A -n
OW WTF: McAlpine I McDowell I Irwin Sugar Mallard / Rocky River Flow amount (gpd): -i 2 D v SO S C�PD
Basin: U ler L r •PI�e U .W GMI K/�P7rJSJh
Mall, deliver or fax this application to: C E I y E
CHARLOTTE WATER
5100 Brookshire Blvd NOV 1 4 2018
Charlotte, NC 28216
rr--e-mail: bgross®chariotlenc.gov o
ZSj� fy K i00 9?J L0005f : cs�%� BYh -_ "'." "__." Updated February2017
2,S31 eta/iills 10'fi1C 2 �Pa[4­4A3 4:C3/*2g5 Pd
1.0 rooms 7c iZO�qlraaa» : S9,7p0gpd
40 traa.4 2 St7 g I fs (iR,. ft = 3S, 000 aPd
3 Pa. C5" .10 QCC t perg 530,9()-

North Carolina Secretary ol'State Scarch Results
Page l oI, I
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
Pappas Midtown Berkeley Partners, LLC
Information
Sosld: 1822653
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 3/25/2019
Registered Agent: Pappas, Peter A.
Addresses
Mailing
4777 Sharon Rd Ste 550
Charlotte, NC 28210
Reg Mailing
4777 Sharon Rd Ste 550
Charlotte, NC 28210
Company Officials
Principal Office
4777 Sharon Rd Ste 550
Charlotte, NC; 28210
Reg Office
4777 Sharon Rd Ste 550
Charlotte, NC 28210
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
https://www.sosne.�,)ov/online services/search/Busincss Registration Results 11/22/2019

1GIVEWNC FNRIDWR State of North Carolina
XA 2 201yepartment of Environmental Quality
GEC — Division of Water Resources
Dlvlslon of Water Resources IL}M Sewer Extension FTSEAppli10-18)
MOORESVILLEtit ����� (FTSE 10-18)
Entity Requesting Allocation: Pappas Midtown Berkeley Partners LLC
Project Name for which flow is being requested: Kenilworth Medical Office Building 1
More than one FTSE may be 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: McAlpine Creek, Irwin Creek, Sugar Creek
b. WWTP Facility Permit #: NC0024970, NC0024945, NCO024937
All flows are in MGD
c. WWTP facility's permitted.flow 99.0
d. Estimated obligated flow not yet tributary to the WWTP 13.057
e. WWTP facility's actual avg. flow 74.983
f. Total flow for this specific request 0.0175
g. Total actual and obligated flows to the facility 88.057
h. Percent of permitted flow used 89.0
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 / pf, , Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MOD MOD Flow Capacity***
* 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): Unknown
Downstream Permit Number: Unknown
Page 1 of 6
FTSE 10-18

III. Certification Statement:
Keri Cantrell
certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to cause any
capacity related sanitary sewer overflows or overburden any downstream pump station en route to the
receiving treatment plant under normal circumstances, given the implementation of the planned
improvements identified in the planning assessment where applicable. This analysis has been performed
in accordance with local established policies and procedures using the best available data. This
certification applies to those items listed above in Sections I and II plus all attached planning assessment
addendums for which I am the responsible party. Signature of this form certifies that the receiving
collection system or treatment works has adequate capacity to transport and treat the proposed new
wastewater.
Signing Official Signature
Chief Engineer
Title of Signing Official
12/2/2019
Date
AECEIVEDINCDENRIDWR
QFr - 2 HJ19
WQROS
MOORESVILLE REGIONAL OFFICE
Page 2 of 6
FTSE 10-18

N V 5 ENGINEERS CALYX
CONSULTANTS
November 21, 2019
NCDEQ— Division of Water Resources
Mooresville Regional Office
ATTN: ORI TUVIA
610 E. Center Avenue
Mooresville, North Carolina 28115
Re: Kenilworth Medical Office Building
Fast Track Sewer System Extension Application
Dear Mr. Tuvia:
RECENED/NCDENR/DWR
NOV 2 2 Z01.9
WQROS
MOORESVILLE REGIONAL OFFICE
Per our telephone conversation on Thursday, November 21, please accept this Fast Track Sewer System
Extension submittal package for the Kenilworth Medical Office Building. As discussed, this permit is
needed as quickly as possible as the Contractor is on -site and ready to install this sewer line. With other
City, County and Charlotte Water permits in place, the permitting of this small section of line with
NCDEQ was an oversight.
This submittal package includes the following:
- Fast Track Sewer System Extension Application (the applicant will be mailing the original Applicant
Signature page to you separately)
- NC Secretary of State Corporation Documentation
- $480 application fee
- Site maps (LISGS map and Aerial map)
- Capacity Assurance Letter from Charlotte Water*
*The Flow Tracking/Acceptance Form (FTSE 04-16) has been sent to Charlotte Water for completion. It
will be forwarded to you as soon as possible. In the meantime, I have provided the original Capacity
Assurance acceptance letter from Charlotte Water.
Please let me know if there is any additional information you need. Thank you for your efforts to
expedite the review of this permit application. It is greatly appreciated.
Sincerely,
nathan A. Allen, PE
Project Manager
6750 Tryon Road, Cary NC 27518 1919.836.4800
CALYXengineers.com I NVS.com

N V 5 CALYX ENGINEERS CONSULTANTS
LETTER OF TRANSMITTAL
To: NC DEQ— Division of Water Resources Date:
Mooresville Reqional Office
610 E. Center Avenue
Mooresville, NC 28115
ATTN: ORI TUVIA
Re: Kenilworth Medical Office
I am sending you the following item(s):
6750 Tryon Road
Cary, NC 27518
P: 919.836.4800
F: 919.851.1918
RECENEDINCDENRIDWR
NOV 2 2 2019
WOROS
MOORESVILLF REGIONAL OFFICE
November 21.2019
** HAND DELIVER **
Job No.: 2015057.01
COPIES
DATE
NO.
DESCRIPTION
2
Fast Track Sewer System Extension Application
(Original and 1 copy)
1
NC Secretary of State Corporation Documentation
1
$480 application fee .+ COV69 LEfMt
2
Site Maps (USGS Map and Aerial Map)
1
Capacity Assurance Letter
These are transmitted as checked below:
❑ As requested ❑ For your use
® For approval ❑ For Signatures
❑ For review and comment
Remarks:
PLEASE DELIVER THIS PACKAGE TO OR[ TRUVIA UPON RECEIPT PER MY TELEPHONE
CONVERSATION WITH HIM ON THURSDAY, NOVEMBER 21.
On, Please contact me at lonathan.allenDnv5.com or [phone] if you have any questions,
comments or concerns.
Copy to: File Signed: Jonathan Allen

Central Files: APS _ SWP _
12/2/2019
Permit Number WQ0041320
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
ori.tuvia
Coastal SWRule
Permitted Flow
17,500
Facility
Facility Name
Kenilworth Medical Office Building 1
Location Address
Owner
Owner Name
Pappas Midtown Berkeley Partners LLC
Dates/Events
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
A
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Mooresville
County
Mecklenburg
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Mark Furlan
4777 Sharon Rd
Charlotte NC 28210
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
12/3/2019 11 /22/2019 12/3/2019 12/3/2019
Regulated Activities Requested /Received Events
Office Additional information requested 11/22/19
Wastewater collection Additional information received 12/2/19
Outfall
Waterbody Name Streamindex Number Current Class Subbasin