WQ0041424_Application_20200117

State of North Carolina
Department of Environmental Quality
DWR 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:/ b VCR— f ? I (to be completed by DWR) ECE-IVED/NC01:NR/t)w�
All items must be completed or the application will be returned JAN 9 7 'gym
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I. APPLICANT INFORMATION: WQROS
1. Applicant's name: ML Austin Village,LLC (company, municipality, HOA, utility, etc.) "(' 0FdE'SVIL1E RE=(310NAI_ OFFICE
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Ryan Lambert per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: P.O. Box 208
City: Indian Trail State: NC Zip: 28079-
5. Applicant's contact information:
Phone number: [phone] Email Address: rlambert(cDcaprockinvest.com
II. PROJECT INFORMATION:
1. Project name: Terraces at Austin Village
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Union
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.070294' Longitude:-80.694956'
5. Parcel ID (if applicable): 07132006
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: David S. Klausman License Number: 35711
Firm: Bloc Design, PLLC
- - Mailing address: 2923 S. Tryon St., Suite 320
City: Charlotte State: NC Zip: 28203-
Phone number: [phone] Email Address: dklausman@bioc-nc,com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Twelve Mile WWTP Permit Number: NCO085359
Owner Name: Union County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ0006421 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Union County
FORM: FTA 04-16 Pagel 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: 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20)
0Is 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
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0I14(f)
Daily Design Flow 0
No. of Units
Flow
Convalescent
120 gal/bed
94
11,280 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
11,280 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 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.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 11,280 GPD (per 15A NCAC 02T .01 1.4)
➢ 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
70
DIP
8
630
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: N/A
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: -
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(0):
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 provided 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(e) 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 213.0202
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 Permitting 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 supportine documents.
2. Pro,[essional Engineer's Certification:
I,
(Professional Engineer's name from Application Item III.1.)
attest 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 143-215.613,
statement, representation, or certification in any application package shall b
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification per 15A NCAC 02T .0106(b):
I,
1Z
any person who knowingly makes any false
ty of a Class 2 r ii demeanop which may
(Signature Authority's name & title from Application Item I.3.)
attest 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.
Signature: Date:
FORM: FTA 04-16 Page 5 of 5

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December 22, 2019
,RECEIV1=OiN('OE NFR1DWP,',
North Carolina Department of Environmental Quality
Division of Water Resources JAN ! '.nJr?0
610 East Center Avenue
Suite 301 WQFIOS
Mooresville, North Carolina 28115 MOORESVILLE REGIONAL OFFICE'
Re: 00588.04 - Terraces at Austin Village (FTA Cover Letter)
To Whom It May Concern,
The referenced project located at 910 Chestnut Lane in Stallings, NC is a proposed senior living facility that will
include seven separate duplex cottage buildings (14 units) and one multi -story building that offers full time assisted
living. The development will be served by an existing public 8-inch gravity sanitary sewer main and proposed
relocated public 8-inch water main. An anticipated flow to the proposed sanitary sewer system will be 11,280
gallons per day.
This package includes the completed FTA 04-16 form, USGS topographic map, aerial, FSTE 10-18 Form and
$480.00 check.
Upon your review of the enclosed information, please feel free to contact me for further discussion.
Regards,
AIJ
ES S f pNO��'�
Qe- qC
SEAL =_
35711
David S. Klausman, PE
Bloc Design, PLLC
NC Firm: P-1007, C-390
803-513-4734
dsk
cc: Mr. W. Larry Lockhart, Jr., PE - BD
Mr. Drew Farnie - BD
CapRock Development Bloc Design
00588.04 - Terraces at Austin Village 2923 South Tryon St, Suite 320
Stallings, North Carolina Charlotte, NC 28203
704.940.2883 www.bloc-nc.com

Union Country Public Works
500 North Main Street
Suite #400
Monroe, NC 28112
T. 704.296.4210
January 14, 2020
Mr. David S. Klausman
Bloc Design
2923 South Tryon Street
Suite 320
Charlotte, NC 28203
Re: Sewer Treatment Capacity
Terraces at Austin Village
Dear Mr. Klausman:
Union County Public Works Department can accept the additional discharge of 11,280 gallons
per day of domestic wastewater from this project for transmission to the Twelve Mile
Wastewater Treatment Plant (NPDES permit number NC0085359) for treatment. This allocation
is intended to serve the above mentioned project.
If you have any questions please don't hesitate to call.
7rys
rely:
al O. Panico, P.E.
New Development Program Manager
COP/pwb

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Union County
Project Name for which flow is being requested: The Terraces at Austin Village (Private)
More than one FTSE may be required for a singleproject if the owner of the WWTP is not responsible for allpump
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: Twelve Mile Creek WWTP
b. WWTP Facility Permit #: NC0085359
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
h. Percent of permitted flow used
All flows are in MGD
6.0* Does not include 3
MGD diversion to 6 Mile
1.7146
4.11
0.0113
5.8359
97.27
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 / p f),
Avg. Daily Daily Flow, Obligated Available
Number) No.
MGD MGD
Flow, MGD MGD Flow Capacity***
N/A
* 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): Twelve Mile Creek WWTP
Downstream Permit Number: WQ0006421
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Crystal O. Panico, PE 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.
Sign
New Development Program Manager
Title of Signing Official
3
Page 2 of 6
FTSE 10-18

North Carolina Secretary of State Search Results
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an Amended a Annual Report form
Limited Liability Company
Legal Name
ML Austin Village, LLC
Information
Sosld: 1778065
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 12/4/2018
Registered Agent: Lambert, Ryan
Addresses
Mailing
Principal Office
Reg Office
Reg Mailing
2410 Dunavang Street
2410 Dunavant Street
2410 Dunavant Street
2410 Dunavant Street
Charlotte, NC 28203
Charlotte, NC 28203
Charlotte, NC 28203
Charlotte, NC 28203
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Member
Ryan Lambert
2410 Dunavant Street
Charlotte NC 28203
https://www.sosnc.gov/online_services/search/Busincss_Registration_Rcsults 1 /21 /2020

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DR 1. SITE DISCHARGES INTO DAVIS MINE CREEK.
2. TOPOGRAPHICAL INFORMATION TAKEN FROM UNITED
STATES GEOLOGICAL SURVEY - STALLINGS, INC, 7.5
MINUTE SERIES QUADRANGLE, DATED 2019.
PROJECT NAME: SHEET TITLE: SHEET:
NXIDIsdoTHE TERRACES AT AUSTIN VILLAGE USGS TOPOGRAPHIC QUAD MAP USGS-1
2923 S. Tryon Street, Suite 320
Charlotte, NC 28203
phone:[phone]
w .bloc-nc.com
OWNER /CLIENT: 3oa No.: oosaa
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CAPROCK CONSTRUCTION
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