WQ0031404_Regional Office Historical File Pre 2018

Michael F fr.asley Governor
William G. Ross Jr,, Secretary
North Carolina Department of Environment and Natural Resources
lan W. Klimek, P.F. Director
Dovision ot" 'Water Quality
March 8, 2007
Mr, Bill Cramer, President
Cypress Glenn,LIC
5821 Falls of Neuse Road
Raleigh, NC 27615
Subject: Permit No, WQ0031404
Cypress Glen Senior Apartments
Wastewater Collection System
Cleveland County, North Carolina
Dear Mr„ Cramer
In accordance with your application received on March 6, 2007, we are forwarding herewith
Permit No. WQ0031404 dated March 8, 2007, for the construction and operation of the subject
wastewater collection system extension. This permit shall be effective from the date of issuance until
rescinded, and shall be subject to the conditions and limitations as specified therein, This cover letter
shall be considered a part of this permit and is therefore incorporated therein by reference.
Please pay particular attention to Permit Condition 3 which requires that the wastewater
collection facilities be properly operated and maintained in accordance with 15A NCAC 2T ,0403 or any
individual system -wide collection system permit issued to the Permittee
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 1) 15A NCAC 2T; 2) the Division of Water Quality's (Division) Gravity Sewer Minimum Design
Criteria adopted February 12, 1996, as applicable: 3) and the Division's Minimum Design Criteria for
the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000, as applicable,
unless specifically mentioned herein, Division approval is based on acceptance of the certification
provided by a North Carolina -licensed Professional Engineer in the application. It shall be the
Permittee's responsibility to ensure that the as -constructed project meets the appropriate design criteria
and rules. Failure to comply may result in penalties in accordance with North Carolina General Statute
§143-215.6A through §143-215.6C, construction of additional or replacement wastewater collection
facilities. and/or referral of the North Carolina -licensed Professional Engineer to the licensing board.
Mooresviile .Regional Office 610 East Center AveSuite 301 Mooresville, NC 281.15
Internet : onwe .nemwatercrAlity,org Customer Serviee„1-877-623-6748
An Equal OpportunitylAffirmative Action Employer - 500 Recycled/10% Posl Consumer Paper
Phone:. [phone] Fax: [phone]
?tiCaroltna
aturally

Mr. Howell
Page 2
March 8, 2007
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable Laws, Rules, and Regulations, permission is hereby
granted to the Cypress Glenn, LLC for the construction and operation of approximately 1,048 linear feet
of 8-inch gravity sewer and the discharge of 11,040 gallons per day of collected domestic wastewater
into the City of Shelby's existing sewerage system, pursuant to the application received March 8, 2007,
and in conformity with 15A NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted
February 12, 1996, as applicable: the Division's Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains adopted June 1, 2000, as applicable; and other supporting data
subsequently filed and approved by the Department of Environment and Natural Resources and
considered a part of this permit
The sewage and wastewater collected by this system shall be treated in the City of Shelby's
WWTP (NPDES No, NC0024538) prior to being discharged into the receiving stream,
The Operational Agreement between the Permittee and the Environmental Management
Commission is incorporated herein by reference and shall be a condition of this permit, Noncompliance
with the terms of the Operational Agreement shall subject the Permittee to all sanctions provided by
North Carolina General Statutes 143-215.6A to 143-215.6C for violation of or failure to act in
accordance with the terms and conditions of this permit.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding,
If you need additional information concerning this matter, please contact Dee Browder at (704)
663-1699.
Sincerely,
r Alan W. Klimek, RE,,:
cc: Mooresville Regional Office, Collection System Permit Files
David Koss, KCI Associates of NC
Surface Water Protection Central Files
PERCS

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
1. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2T; the Division of Water Quality's
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000, as applicable; and other supporting materials unless specifically
mentioned herein
2. This permit shall be effective only with respect o the nature and volume of wastes described in the
application and other supporting data.
The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2T ,0403. If an individual
permit is not required, the following performance criteria shall be met as provided in 15A NCAC 2T
.0403:
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L .0200 or the surface water standards in 15A NCAC 2B .0200.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan shall be developed and implemented,
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e.
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week,
e. High -priority sewer lines shall be inspected at least once per every six-month period of time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years.
h. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required by
North Carolina General Statute §143-215 1C,

4, This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be
considered on its merits and may or may not be approved.
5. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State.
Per 15A NCAC 2T .0116, upon completion of construction and prior to operation of these
permitted facilities, the completed Engineering Certification form attached to this permit shall be
submitted with the required supporting documents to the address provided on the form A complete
certification is one where the form is fully executed and the supporting documents are provided as
applicable,
7. A copy of the construction record drawings shall be maintained on fie by the Permittee for the life
of the wastewater collection facilities.
8. Failure to abide by the conditions and limitations contained in this permit, 15A NCAC 2T; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-
215,6A through §143-215.6C.
In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including
those as may be required by this Division, such as the construction of additional or replacement
facilities.
10. The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies
(local, state and federal) which have jurisdiction, including but not limited to applicable river buffer
rules in 15A NCAC 2B ,0200, erosion and sedimentation control requirements in 15A NCAC Ch. 4
and under the Division's General Permit NCG010000, and any requirements pertaining to wetlands
under 15A NCAC 2B ,0200 and 15A NCAC 2H ,0500,
11. Noncompliance Notification:
The Permittee shall verbally report to a Division of Water Quality employee at the Mooresville
Regional Office, telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day, following the occurrence or first knowledge of the occurrence
of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc,; or
b. Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.

Voice marl messages or faxed information is permissible, but shall not be considered as the
initial verbal report, Overflows and spills occurring outside normal business hours may also be
reported to the Division of Emergency Management at telephone number [phone] or
[phone], Persons reporting any of the above occurrences shall file a spill report by
completing Part I of Form CS-SSO (or the most current Division approved form), within five days
following first knowledge of the occurrence, This report shall outline the actions taken or
proposed to ensure that the problem does not recur. Part II of Form CS-SSO (or the most
current Division approved form) can also be completed to show that the SSO was beyond
control.
Permit issued this the 8th day of March 2007.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Jr), Alan W. Klimek, P E Director)
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number W00031404

Fast Track Engineering Certification
Permit No, WQ6031404
March 8, 2007
Mr., Sill Cramer, President
Cypress Glenn, LLC
5821 Falls of Neuse Road
Raleigh, NC 27615
Complete and submit this form to the permit issuing regional office with the following:
+» One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
Supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
+ Changes to the project should be clearly identified on the record drawings or in written summary form. Permit
modificationsare re aired for an chap es resultin in non -co m fiance with this permit, regulations or
minimum design criteria
This project shall not be considered complete nor allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division, Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
ENGINEER'S CERTIFICATION
El Partial
Final
as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe (0 periodically, 0 weekly, ❑ full time) the construction of Cypress Glen Senior Apartments, a
Cleveland County project for the Permittee, hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance of this permit; 15A NCAC 2T; the Division of Water Quality's (Division) Gravity Sewer Minimum Design
Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's
seal, signature, and date,
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received, Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions,

EOF NORTH NA
Permit No.
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to. G.S. 143-215.1 (di
and enteredinto this 9th. day of
February, 2007, by and between the North Carolina Environmental Management Commission, an agency of the
State of North Carolina, hereinafter known as the COMMISSION; and Cypress Glenn_LI.0 , a
corporation/general partnership registeredllicensed to do business in the State of North Carolina, hereinafter
known as the :DEVELOPER.
WITNESSETH:
1 The DEVELOPER is the owner of the certain lands lying in Cleveland County, upon which it is erecting
and will erect dwelling units and other improvements, said development to be known
as Cypress Glenn Apartments. (hereinafter the Development).
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 iS. 143-
215.1 to construct, maintain, and operate the Disposal Sy -stem.
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, the Cypress Glenn, LLC. a LLC organized and existing under and by the virtue of the laws of
the State of:North Carolina, for the purpose, among others, ofhandling 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 and repair.
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 and law,
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 Quality has inspected and approved of the facilities. In order to change the name of
the permit holder, the DEVELOPER must request that the permit he reissued to the Association. The
request must include a copy of the Association Bylaws and Declaration,
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.
4 F IV1 /IA"?

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 highest priority for
expenditures by the Association except for Federal, State, and local taxes and insurance.
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 funds 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 fund be created out of the common
expenses. Such fund shall be separate from the routine maintenance funds allocated for the facility and
shall be part of the yearly budget.
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 he 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 DEVELOP.ER. shall take such action as is necessary to cause the
existing and .future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as muchof the Disposal System and such necessary easements as the
governmental unit may require as condition of accepting the Development's wastewater.
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 a permit.
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 Itc LL.
MANAGEMENT COMMISSION Nan f DEVE.
W. Klimek, P.E., Director'„
vision of Water Quality
(SignaH
-int Name and Title
7
cr--1. VET rv-,

Ce Fites AP
Permit Number,
003"1404
Permit TrackMg Slip
3108/ 7
Program Category
Sian -discharge
Permit Typo
Gravity Sew r
Extensions
Primary Nettle er
deahrowder
Permitted Flew
11040
Facility:
Extension, Pump Stations, Pressure Sewer
Facility Name
Cypress Elan Senior Apartments
Location Address
Owner"
Owner Name
Cypress Glenn LLC
5/Events
Orin
ue
App Received
03/05/07
ul t d Activities
Apartment complex
Condominium
Wastewater callectaes
Outran atil..L
Status Project Type
in reviewer New Project
Version
A
Permit Classific
inl ividu l
Permit Contact Affiliation
Region
toorsvil
County
Cleveland
F cifpty Contact Af iiiadon
d
Owner Type
Non -Government
Owner Affiliation
Bill Cramer
5821 Falls Of Neese d
Raleigh NC 27615
Public Not
ue
Effective Expiration
Reauestedi ceiv9d Eyen s
Additional information requested
Additional information received
Waterbody Name
stream Index Number Curr
nt 1
Subbasin

CYPRESS GLENN, LLC
5821 FALLS OF NEUSE RD., SUITE A
RALEIGH, NO 27609
1(919127,-0177
PAY TO THE
ORDER OF NC DENR
CAOOUNA BANK
66-7401'531
21 /2007
Four Hundred en i t '400.00
NC DENR
MEMO;
Sew
ypress Glenn
u'OO l©a4 1:05 3
1084
DOLLARS

1F/ ST-TRACK APPI.,, ".!A "ION For GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
1. Owner:
la. CYPRESS GLENN, LLC
Full Legal Name (company, municipality, HOA, utility, etc.)
Applicalion Number:
(to be completed by OWQ)
O lb. BILL CRAMER - PRESIDENT
I— Signing Official Name and Title (Please reviewrevew iSA NCAC 2H , 06(b) for authorizedsigning officials!)
ct
2 lc The legal entity who will own this system is:
CC I] Individual 0 Federal 0 Municipality Ej State/County Et Private Partnership Corporation El Other (specify);
O id. 5821 FALLS OF NEUSE ROAD
LL Mailing Address
z
0
11. NORTH CAROLINA
Slate
1h, [phone]
li. 0180
Telephone Facsimile
2. Project (Facility) Information:
2a, CYPRESS GLEN SENIOR APARTMENTS
Brief Project Name (permit will refer to this name) County Where Project is
3. Contact Person:
3a, KCI ASSOCIATES OF NC, DAVE M. KOSS, PE — ENGINEERING DIRECTOR
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. -9214 EXT. 160 . DKOSS@KCI,COM
hone Number
E-mail
1 Project is 0 New 0 Modification (of an existing permit) If Modification, Permit No,:
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
phase, changing line sizeflength, etc.). Only include the modified information in this permit application - do not
duplicate project information in B(7) and B(1O-1'l) that has already been included in the original permit.
2. Owner Is Public (skip to Item B(3))
2a, If private, applicant will be:
le. RALEIGH
City
lg. 27615
hip Code
E-mail
2b, CLEVELAND
2b. if sold, facilities owned by a (must choose one)
0 Retaining Ownership (i.e store, church, single office, etc.) or El Public Utility (Instruction III)
Z Leasing units (lots, lownhornes, etc: - skip to Item B(3)) CI Homeowner Assoc./Developer (Instruction IV)
0 El Selling units (tots, townhomes, etc: - go to Item B(2b))
17— ▪ 3. CITY OF SHELBY
itC
2
CC 4a, CITY OF SHELBY
Name of WWTF
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater
0
1.1.. 5 . CITY OF SHELBY lSb, FT' Gravity
Z Owner of Downstream Sewer /Receiving Sewer Si 0 Force Main
6, The origin of ths wastewater is (check all that apply):
om This Pr '
4b. NC002453
Ej Residential Subdivision
O Apartments/Condominiums
0 Mobile Home Park
O School
• Restaurant
E Office
Car Wash
o
o Institution
Hospital
EI Church
0 Nursing Home
El Other (specify):
5c.
WWTF Permit No,
Permit NumIer af Dowristream Sewer (if known)
100 % DomesticiCommencial
% Industrial
% Other (specify):
7 Volume of wastewater to be allocated for this particular project: 11 040 gallonsper day
'Do not include previously permitted allocations
8. If the permitted flow is zero, indicate why:
O Interceptor Line - Flow will be permitted in subsequent permits that connect to this line
O Flow has already been allocated in Permit No.
LI Rehabilitation or replacement of existing sewer with no new flow expected
PTA inm

ST-TR K APPLI A'I',ION for GRAVITY EWER„
ION,, AN'I) FORCE # MAINS
AICI: 4
z
z
0
FORMATION
9. Provide the wastewater flow ca#culations used In determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design fl w for Ilne or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(l)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(1)(3).
11,040 GPD
10. Summery of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8" DUC1'I1 E IRON PIPE
PVC, SLR 35
4' DIAMETER MANHOL S
ENTER TOTAL LINE LENGTH IN
Length (feet) Gravity or Force Main
(use the pull down menu)
157'
GRAVITY
901' GRAVITY
5 EA. GRAVITY
ES 1067' = 0.20 miles.
umtTtary of Pump Stations to be Pe fled (attach additional sheets as necessary)
Location IUD Power Reliability Option
(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
plans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetry; 4-wet well storage)
12, Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
J Yes D No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13. Have the following permits/cerlif#oati ns been
d for aooroval
Wetland/Stream Crossings - General Permit or 401 Ceriif#catlon? ■' Yes C) No El N/A
Sedimentation and Erosion Control Plan? D Yes 0 No © N/A
Storrnwater? 0 Yes © No 0 N/A
14. Does this project involve aerial lines or siphons? Check it yes: d
These I4nes will be considered hioh priority and must be checked once every six months
ff 15. Does this project have gravity sewer lines designed at minimum slopes?
Bs aware that the Division will not accept installed lines mean than D% batter than the minimum slope Lines Installed oulslde this ts�lananee shouki her
corrected prior to submitting the final engineering coNficetton..
t T'A fl'a1n

FAST -TRACK APPLICATION ti
PLJr °I P STATi )NS, AND FORCE i °I SINS
PAGE5
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA t121
(FAST -TRACK SEWER SYSTEMS)` to collect and record the stream classification data below (attach additional sheets e
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND,
A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
option for any pump station near a Class C down slope waterbody,
Location ID on Map
(sell chosen - as shown ©n Name of Waterbody Stream Waterbody
map for cross-reference) Waterbody County River Basin Index Classfflcation
UT HICKORYCREEK CLEVELAND BROAD 9-50-30
Submit the 8.5" x 11 °° COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
Applicant's CertiKi ation:
1, BILL CRAMEA - PRESIDENT, attest that this application tor CYPRESS GLEN SENIOR APARTMENTS
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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. Note. In accordance with North Carolina
General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, c
certilc/tion in !!cation shall be guilty of a Class 2 misdemeanor which may include a fine nol to exceed' $10,000
as w I as ci !Darla tees up to $25,000 per violation.
Signing Official Signature
2. Professional Engineer's Certification:
Date
! attest that this application for CYPRESS GLEN SENIOR APARTMENTS has been
reviewed by me and is accurate, complete and consistent with the information in the engineering plans, calculations, and
ail 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 adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
Although certain portions of this submittal package may have been developed by other professionals, 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 NC General Statutes 143-215,6A and 143-215,6B, any person who
knowingly makes any false statement, representation, or certification in any application 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 S25,000 per violation.
2a. DAVID M. KOSS, PE
Professional Engineer Name
2b. KCI ASSOCIATES OF NORTH CAROLINA
Engineering Firm
2c, 4601 SIX FORKS ROAD, LANDMARK CENTER il, STE. 220
Mailing Address
2d. RALEIGH
City
2e. NC 2f. 27609
State Zip
2g. [phone] 2h. [phone] 2i, DKOSSKCt,COM
Telephone
Facsimile
E-mail
Seal,
- Rry nst1 l�

arch 7,
Audrey Burnette,PE
I CI Technologies, Inc
01 Six Forks Tirlt
Landmark Center II, Suite 2,20
Raleigh, NC 27609
Re: '+,aseate r or Cypress Glenn
Dear Ma,
This letter is to con fl that Alt' City of Shelby rastet
11,040 gild of w ater generated from the proposed
l
Glenn. Please feel free to contact ine ifyou have y quest
incerely,
Be 'l arb ro
City o Shelby nglll ertng
try etlt'faillt
uni dretaa en
Illl r " riernl
PO Box 207 824 W. Grauer St. - SI t NC 28151-020.7
Visit Ins at

ASSOCIATES OF NC

CYPRESS GLEN
SENIOR APARTMENTS
SHELBY, NC
WASTEWATER DESIGN VOLUMES
15A NCAC 02T,0114
WASTEWATER CALCULATIONS
1BR UNIT - 240 GPD
2BR UNIT - 240 CPU
AVERAGE DAILY FLOW RATE
AVERAGE DAILY FLOW RATE
BUILDING
DESCRIPTION NO, OF UNITS FLOWRATE
1BR UNIT - 32 7680 GPO
2BR UNIT - 14 3360 GPD
TOTAL
11040 CRC)
KCI ASSOCIATES OF NC
4601 SIX FORKS ROAD
EARMARK CNTR II, STE., 220
RALEIGH, NC 27'609

North Carolina Secretary of State Page l of I
Elaine F. Ma
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Date: 3/5/2007
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Corporation Names
Name
NC Cypress Glenn, LLC
Name Type
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Limited Liability Company Information
SOSID:
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Duration:
Registered Agent
0854832
Current -Active
7/3/2006
Domestic
NC
Perpetual
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Registered Office Address:
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Principal Mailing Address:
Integra Investment Holdin!
5821 Falls of Neuse Rd. S.
Raleigh NC 27609
5821 Falls of Neuse Rd, S..
Raleigh NC 27609
No Address
No Address
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3/5/2007

Michael F Easley, Governor
A 7- 6PQ
0 G,
WHam G. Ross Jr, Secretary
North Carolina Department of Environment and Natural Resources
Coieen Sullins, Director
Division of Water Quality
January 22, 2008
Bill Cramer, President
Cypress Glen, LL.0
5821 Falls of Neuse Road
Raleigh, North Carolina 27615
SUBJECT: Cypress Glen Senior Apartments
Permit No, WQ0031404
Wastewater Collection System Extension
Final Engineering Certification
Dear Permittee:
The Division received a final engineering certification for the subject project on December 5, 2007.
A full review of the certification materials may or may not be conducted. It is assumed that receipt
of this certification indicates compliance with all regulations, designcriteria and the permit. Please
be reminded that the Permittee is responsible for keeping a copy of the final record drawings for
the life of the project. If you have not received a copy, please contact your consultant
immediately to obtain a copy,
You are receiving this letter because the Division has you listed as the responsible party. If this
permitted system is no longer owned by you, please complete Form PNOCF-S as this permit is not
automatically transferable. Form PNOCF-S can be downloaded from
http://n2o.enr.state.nc,usindpufna uopps.html#Sewer,
If you have any questions concerning this document or the completionof Form PNOCFTS (if
necessary), please contact Ms. Dee Browder at the letterhead address or via E-mail at
dee,browder@nc,mail.net
Sincerely,
abed Krebs
Surface Water Protection Regional Supervisor
Enclosure
Cc Dovid Koss
Surface Water Protection Section Central Files(certtication page only)
Please forward to Engineer
One
North Caroim
7aturally
Pretreatment, Emergency Response and Collection Systems Unit Internet httplfh2o.enr. nc,state,usindpu
1617 Mail Service Center, Raleigh, NC 27699-1617 An Equal Opportunity Action Employer
Telephone [phone] Fax [phone]% recycled/10% post -consumer paper

Fast Track Engineering Certification
Permit No, WQ0031404
March 8, 2007
Mr, Bill Cramer, President
Cypress Glenn, LLC
5821 Falls of Neuse Road
Raleigh, NC 27615
NC EENR MR0
DWQ-Surface Water Protection
Complete and submit this form to the permit issuing regional office wth the foUowng:
One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• Supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
Changes to the project should be clearly identified on the record drawings or in written summary form.. Permit
modifications are required for any changes resulting in non-compliance with thissermit, regulations or
minimum design criteria.
This project shall not be considered complete nor allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division: Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
ENGINEER'S CERTIFICATION
Partial Xi Final
I. PAO° Aft. k.s as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe periodically, LI weekly, full time) the construction of Cypress Glen Senior Apartments, a
Cleveland County project for the Permittee, hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance of this permit: 15A NCAC 21-, the Division of Water Quality's (Division) Gravity Sewer Minimum Design
Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable: and other supporting materials.
North Carolina Professional Engineers
seal, signature, and date:
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
-
01
MOORESVILLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee iSeriErponsible for tracking all partial certtfications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineers Certification shall be considered a violation of the ,permit and shall subject the Permittee to appropriate
enforcement actions.