WQ0035172_Regional Office Historical File Pre 2018

North Carolina De
Beverly Eaves Perdue
Governor
Mr. Gerald Cox
Autumn Corporation.
451 North Winstead Avenue
Rocky Mount, North Carolina 27804
Dear Mr. Cox:
NCDENR
artment of Environment and Natural Resources
Division of Water Quality
Coleen H. S ullir s Dee Freeman
Director Secretary
January 5, 2011
Subject: Permit No. WQ0035172
Autumn Care Cornelius
Wastewater Collection System Extension
Mecklenburg County, North Carolina
In accordance with your complete application received on January 3, 2011, we are forwarding
herewith Permit No. WQ0035172, dated January 5, 2011, to Autumn Corporation 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the date of issuance until rescinded, and shall be subject to the conditions and limitations as specified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.
Mooresville Regional Office
Location: 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer Service: 1-877-623-6748
Internet: http://portal, ncdenr.orgiweb/wq
An Equal Opportunity Affirmative Action Employer — -0% R :ycled/1O% Post Consumer paper
Nne
©thCa olina
�7atiira/I//

. IR Cox
'aviary 5, 2011
P3ga Two
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 for the construction and operation of approximately 159 linear feet of 6-inch gravity sewer, and
the discharge of 0 gallons per day of collected domestic wastewater into the City of Charlotte existing
sewerage system 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 McDowell Creek
WWTP (NPDES No, NC0036277) prior to being discharged into the receiving stream.
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 150E of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Maki 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 Mr, Michael Parker at
(7 04) 663-1699,
Electronic copies:
Cc:
Sincerely,
leen H. Sullins
Erin Hall, Mecklenburg County Development of Water Quality
Philip Edwards, Mecklenburg County
Donald L, Curry, Jr., P.E., The Curry Engineering Group, PLLC
Barbara Gross, CMU
Mooresville Regional Office, Collection System Permit File
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 to the nature and volume of wastes described in the
application and other supporting data.
3. 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 (Le.
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.
t

4. This permit is not 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.
6. 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 drawings shall be maintained on file 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.
9. 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
2

• 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 mail 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 11 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 5th day of January, 2011.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0035172

Permit No. WQ0035172
January 2, 2011
Owner/WQCS
Gerald Cox
Autumn Corporation
451 North Winstead Avenue
Rocky Mount, NC 27804
PE
Donald L. Curry, Jr., P.E.
The Curry Engineering Group, PLLC
133 Spring Avenue
Fuquay-Varina, NC 27526
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 modifications are required for any changes resultinq in non-compliance with this permit,
regulations or minimum design criteria.
This project shalt 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 ❑ Final
f, as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (❑ periodically, ❑ weekly, D full time) the construction of a Autumn
Care Cornelius, a Mecklenburg 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.
4

0
LL.
z
z
z
USE THE TAB KEY TO MOVE FROM FIELD TO FIELDI
Owner/Pertinittee:
a. Autumn Corporation
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Gerald Cox, President
Application Number:
(to be completed by DWQ
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
lc. The legal entity who will own this system is:
❑ Individual ❑ Federal 0 Municipality ❑ State/County ❑ Private Partnership Z Corporation ❑ Oth
ld. 451 N. Winstead Ave. 1e. Rocky Mount DIVISit3
Mailing Address
NC
State
h. 252-4
43-626
Telephone
2. Project (Fac
Autumn
v) Information:
Cornelius
Brief Project Name (permit will refer to this n
3. Contact Person:
a. Donald L. Curry, Jr., PE
City
1 g. 27804
Zip Code
bobdewt autum
TY
s:c,
SW E z 1.tQN..
VILLE: REGIONAL OFFICE
E=mail
2b, Mecklenburg
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b, 919-552-0849
2.
2a. If private, applicant will be:
Phone Number
3c. [e-mail]
E-mail
Project is > New ❑ Modification (of an existing permit) If Modification, Permit No.:
ner is
Public (skip to Item B(3)) Private
go to Item 2(a) )
2b. If sold, facilities owned by a (must choose one
Retaining Ownership (i.e. store, church, single office, etc.) or
Leasing units (lots, townhomes, etc, - skip to Item B(3))
Selling units (lots, townhomes, etc. - go to Item B(2b))
Charlotte -Mecklenburg Utilities
Owner of Wastewater Treatment Facility (WWTF) Treatin
4a. McDowell Creek WWTP
Name of WWTF
Charlotte -Mecklenburg j5b. 8" Gravity i5c.
Owner of Downstream Sewer ;Receiving Sewer Size ❑ Force Main
The origin of this wastewater is (check all that apply):
Residential Subdivision
❑ Apartments/Condominiums
El Mobile Home Park
El School
❑ Restaurant
❑ Office
Public Utility (Instruction C)
❑ Homeowner Assoc./Developer (In
er From This Project
4b. NC0036277
WWTF Permit No.
Perini
❑ Retail (Stores, shopping centers)
0 Institution
0 Hospital
0 Church
Nursing Home
❑ Other (specify):
Volume of wastewater to be allocated or permitted for this particular project:
*Do not include future flows or previously permitted allocations
If the permitted flow is zero, indicate why:
0 Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
0 Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
nstream Sewe
In
uction D)
uction E)
100 % Domestic/Commercial
% Industrial (attach
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
12.240 gallons per day
F TA l 2/07

Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
102 bed nursing home x 120 GPD/bed = 12,240 GPD
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
2"
Length (feet) New Gravity or Additional
Force Main
4,700' Force Main
8" 45'
Gravity
11. Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
;Pump Station Location ID
Proposed Private Lift Station (self chosen - as shown on planslmap for reference)
•
•
•
•
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generatorwlATS;
2 - portable generator w/MTS
0.01224 I 25.5 GPM@61' 1- perm generatorwl ATS
Force Main Size
Force Main Length
4,700'
Pump Station Location ID (self chosen - as shown on planslmap for reference)
Design Flow
(MGD)
Operational Point Power Reliability Option
GPM @TDH 1 - permanent generator w1ATS;
2 - portable generator WRITS
Pump Station Location ID (self chosen
Design Flow
ig Operational Point
(MGD)
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator wIMTS
Force Main Size
Force Main Length
as shown on planslmap for reference)
Force Main Size
Force Main Length
112. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No if Yes, permit number of 2nd treatment facility
'(RO — if "yes" to B,12 please contact the Central Office PERCS Unit)
113. 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 Chapter 2T as
applicable?
® Yes ❑ 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
FTA12/07

0 2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
tu
14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401Certification? Yes 0 No 0 N/A
Sedimentation and Erosion Control Plan? Yes 0 No El NIA
Stormwater? Yes 0 No 0 N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T ,0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be conside d high priority and musj be checked once every six months
Check if Yes: 0 and provide details
Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Gerald Cox •attest that this application for Autumn Care Cornelius 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. Note: In accordance with North Carolina 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 misd peer, which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per
violation,
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY,
TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T ,0305
1, Donald L. Curry, Jr., PE , attest that this application for Autumn Care Cornelius has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, 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
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 other
professionals may have developed certain portions of this submittal package, inclusion of these materials under my
signature and seal signifies that 1 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 $25,000 per violation,
2 . Donald L. Cu PE
Professional Engineer Name
2b, The Cu En ineerin G
Engineering Firm
2c. j33SrinAve.
Mailing Address
2d, Fuquay-Varina
City
2e. NC 2f. 27526
State Zip
2i.
cloncurry@curryengineeringgro
2g. 919-552-0849 2h. 919-552-2043 up.com
Telephone Facsimile E-mail
FTA12/a7

North Carolina Secretary of State Page 1 of 2
North Carolina
Elaine F. Marshall DEPARTMENT OF THE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh, NC 27626-0622 [phone]
Date: 1/4/2011
Click here to:
View Document Filings i Sign Up for E-Notifications i
J Print apre-populated Annual Report Form i File an Annual Report 1
Corporation Names
Name
NC AUTUMN
CORPORATION
NC LYNN HAVEN
CONVALESCENT PREV LEGAL
CENTER, INC.
Business Corporation Information
Name Type
LEGAL
SOSID: 0008051
Status: Current -Active
Effective Date: 2/25/1977
Dissolution Date:
Annual Report Due Date:
Citizenship: DOMESTIC
State of Inc.: NC
Duration: PERPETUAL
Registered Agent
Agent Name:
Office Address:
COX, GERALD P
451 N WINSTEAD AVE
ROCKY MOUNT NC 27804
Mailing Address: P 0 BOX 7728
ROCKY MOUNT NC 27804
Principal Office
Office Address: 451 N WINSTEAD AVE
ROCKY MOUNT NC 27804
Mailing Address: P 0 BOX 7728
ROCKY MOUNT NC 27804
Officers
Title: PRESIDENT
Name: GERALD COX
Business Address: P 0 BOX 7728
ROCKY MOUNT NC 27804
Title: SECRETARY
Name: MELIA COX
Business Address: P 0 BOX 7728
ROCKY MOUNT NC 27804
Title:
Name:
VICE PRESIDENT
SAMUEL MARSH
http://www.secretary.state.nc.us/corporations/Corp.aspx?PitemId=4777734 1/4/2011

CHARLOTTE.
CHARLOTTE-MECKLENBURG
UTILITIES
July 29, 2010
Mr. Donald Curry
The Curry Engineering Group
133 Spring Avenue
Fuquay-Varina, NC 27526
SUBJECT: WATER AND SANITARY SEWER FLOW ACCEPTANCE
AUTUMN CARE AT CORNELIUS
TAX PARCEL# 007-101-11A
C-MU TRACKING# 600-10-566
In response to your request, a flow acceptance study of the subject site has been completed and it has
been determined that:
Charlotte -Mecklenburg Utilities (C-MU) agrees to accept the gravity sewage flow of 12,240 gallons per
day (102 bed nursing care facility x 120 gpdibed) from this project for transmission to the McDowell Creek
Wastewater Treatment Plant; NPDES permit number NC00036277, for treatment. This acceptance of
flow is based on the existing capacity of the designated publicly owned treatments works.
Charlotte -Mecklenburg Utilities agrees to furnish water to the subject project. The water quality to the
subject project is regulated by the State Drinking Water Act Amendments of 1986 and The Water Supply
Management Plan, dated October 2005, (WSMP # 05-01702 & PWS ID # 0160010) on file with the Public
Water Supply Section of NCDENR. However, CMU cannot guarantee a constant pressure or quality of
flow.
Charlotte -Mecklenburg Utilities does not expect any of the above conditions to preclude water or sewer
service to the subject site. However, the applicant should understand that due to the involvement of other
agencies and continuing growth of the water and sewer system, the ability to provide service for future
projects cannot be guaranteed nor reserved. Connection to the C-MU system is accepted on a first come,
first served basis.
The applicant should understand that this letter is not authorization to construct private water or sewer
systems, as the appropriate local or State permits are required prior to construction. !f the appropriate
authorization to construct permits are not obtained and construction has not started within one (1) year of
issuance of this flow acceptance: and payment for service connections have not been received within (1)
year of the issuance of this flow acceptance, this flow acceptance approval shall be rescinded and a new
flow acceptance request must be made. If you have any questions, please do not hesitate to contact me
at [phone].
Sincerely,
Barbara Gross
Engineering Assistant
New Services Section
CHARLOTTE-MECKLENBURG UTILITIES
Customer Service Division • New Services Section
www.cmutilities.com
5100 Brookshire Boulevard
Charlotte, NC 28216
Ph: 704/399-2221
Fax: [phone]

Charlotte-Meckienbur Utilites
P Service Areas with I: asins

State of North Carolina
Department of Environment and natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Se vetr Extension Permit Applications
(FTSL--10/07)
Project Applicant Nance:
Curry Enginee ,ra
Project Marne for which flow is being requested: Auunra Care
Adore than one F7Sf -10/07 may be required rot a single project if the owner of th
pump stations along the route t?f the proposed Wastewater flow.
nelius
`,PUP is not responsible
I. Complete this section
a. WWTP Facility Name:
b. WWTP Facility Permit
y if you are the
ek W
MC0036277
f"the wastewater treatment plant.
All flows are itt MGD
c. WWTP facility's permitted flow — 12.
obligated flow not yettributary to the WWTP 0. 3 4 3
c. WWTP facility's actual avg. flow 4..79
f Total flow for this specific request 0 ,01224
g. Total actual and obligated flows to the fciiity��
h. Percent of permitted flow used 4 2.5%
II. Complete this section for each pump station you are responsible for aiong the route of this
proposed wastewater flow.
List pump stations located between the project connection paint and the WWTP
Pump Station Name
Approx. Capacity, MCID Approx. Current Avg.
(Firm/Design)
Daily Flow, MGD
C r iflcation Statement:
s. ro, , certify that, to the best of myknowledge, the addition of the
volume of`wstewater to be pt rmitt:erl 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
rotated sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances. 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 for which 1 am the responsible party. Signature of this forn.t indicates
acceptance of this, tewater flow,
ing 0 r'itrl Signature
7 / /o
Date

Autumn Corporation
Autumn Care Cornelius
Pump Station Calculations
19330 Old Statesville Rd.
Cornelius. NC 28031
Donald L. Curd,nJr.,
PO Box 2018
133 Spring Ave.
F"uqua}-Varina, NC 27526
d.oncur ,,(4lcur
Phone: 919.552:0849
Fax; 919.552.2043
irteering group.com
www. c ac rr1= e n g i n e e rug ggr o up. c o m.

Pump Station Calculations Worksheet
Project: Autumn Care Cornelius
Location: Cornelius, NC
Design Data:
Date: 12/20/2010
Designer: DLC
Number of Lots: "C,i Lots
Flow Projection: @ 12,240 GPD , 200 GPD
Pump Rate Selection (GPDx3PeakFactor/1,440min/day) Ir 2 60 GPM
Force Main Discharge Elevation (Peak Elevation) `' 823:261 feet
Gravity Influent Elevation ....,-823.25 feet
Ground Elevation at Lift Station 786 00l feet
Bottom of Wetwell " 773.75E feet
Force Main Type and Size 1 7,PVC G 120 W° 3 2 inch
Force Main Length 1 0' feet
Wetwell Diameter feet
Wetwell Surface Area sf
Gallons per vertical foot of Wetwell
Velocity in Force Main (0.409*Flow) 2 613 fps
V — DA2
Total Dynamic Head (See Attached) agh,;; 5t feet
Pump Selected
Pump Capacity
Pump Speed
Pump HP
Voltage
Hertz
Phase
Minimum Solid Size
Pump On Elevation
Pump Off Elevation
Detention Volume (Area x (Pump On - Pump Off) x (7.48 gal/cf)
Total Daily Flow (Q = Flow Projection/(24hours x 60 min.))
Pump On Time (Detention Volume/(Pump Capacity - Q)
Run Time per Day (Pump On time x # of Cycles x 24 hours/day)
Pump Off Time (Detention Volume 1 Q)
Pumping Cycle (Pump On + Pump Off)
Cycles (60 min/hour / Pumping Cycle)
777 20
77fi 00f
feet
feet
gallons
gpm
minutes
minutes
minutes
minutes
cycles/hr

Friction Losses
Static Head
High Point
Pump Off Elevation
Total Static Lift
E°a 47. feet
Friction Losses
Station Loss
2-inch Discharge Line
2-inch Plug Valve
2-inch 90 deg. Bend
2-inch Tee
2-inch Check Valve
Quantity .f
530=
Equivalent
Pipe Length
7
51 =
Total Equivalent Length
f (Friction Loss/100' of pipe)
Head Loss=1.98x(38.5/100)
4
2.05 Hazen -Williams Formula
RF z3,4lfeet
feet
feet
feet
feet
feet
feet
Force Main
Dynamic Head for Existing FM => N/A in this case
- Length of Existing Main (ft)
- Size of Existing Main (in)
- Flow in Existing Main (GPM)
- Total Flow (Exist Main + New Flow)
f (Friction Loss/100' of pipe)
Head Loss =3.72x(1 200/1 00)
Total Dynamic Head (TDH)
= N/AA' k FEHazen-Williams Formula
INAIRRifeet
feet Use
x feet

P1R S2012D 60HZ
Cornelius Nursing Home Pump Station 25.5 GPM @ 61 feet TDH
H[
11
1
n
5'
0_
19
0
<1Z
0 _
1
0
O T
27.2°a
.
Hydr.e
0_
0_
0-
0-
o-
•143
0-
0:
PE
3-
5=
2 _
-
�rD
143
0
I lydr9ul;c efticieicy
_,/"................
jD143
0
0
Ills 1111 1111 1111
5 10 15 20
ilia 1111
25 30
1111 1111
35 40
1111
45
111
50
!Ill
55
1111
60
Ill{
1111 1111 1111
0 NS a.n.m.1
8
6
4
2
1
P2 [h
2.
1.
11[
2
1
Testnorm
Hydraulic Institute
2010-09-28
Operating data specification
Flow
Static head
Shaft power
Fluid
Nature of system
32.3 US g.p.m.
47.3 ft
2.13 hp
Water
Single head pump
Head
Efficiency
NPSH
Temperature
No. of pumps
69.3 ft
26.6%
39 °F
Pump data
Type
Series
N°of vanes
Suction port
PIR S20/2D 6OHZ
PIRANHA
4
Make ABS
Impeller Macerator
Impeller size 5.63 inch
Discharge port G1+/4"
Motor data
Rated voltage 460 V
Rated power P2 2.41 hp
Number of poles 2
Power factor 0.84
Starting current 19.2 A
Starting torque 11.2 Ibf ft
Insulation class F
Frequency 60 Hz
Nominal speed 3395 rpm
Efficiency 74.5 %
Rated current 3.61 A
Rated torque 3.73 Ibf ft
Degree of protection IP68
ABS reserves the right to change any data and dimensions without prior notice and can not be held responsible far the use of
information cantained in this software.
ABSEL PRO 1.7.2 / 2007-02-07

oviiiiiiiiiiwo
bs .
Pump performance curves
PIRANHA S D 60 HZ
Curve number
Reference curve
PIRANHAS D
Cornelius Nursing Home Pump Station 25.5 GPM @ 61 feet TDH
Discharge
G1 t
Frequency
60 Hz
Density
62.428 Ib/ft3
Viscosity
0.000016813 ft2/s
Testnorm
Hydraulic Institute
Rated speed
3395 rpm
Date
2010-12-20
Flow
32.3 US g.p.m.
Head
69.3 ft
Rated power
2.13 hp
Hydraulic efficiency
26.6 %
NPSH
H Ift].
115=
110 =
`S2p/
-
105:
-
'0ti
1
100
95 =
90:
85:
-
80:
.
Hydr.eff
75 :
27.2°.
701
65:
60:
55;
50
45 -
40:
35 =
30:
.143
25:
20 _-_-
:.
15
10:
-
5
P2
[ha*
Ell
3.2
2.8
-
-
2.4 A
-
2
r—.
f
—
—D143
1.6
1.2-
71
30:
Hydrau
is efficiency
25
20:
15
10_
D143
5
Tilt
0 5 10
i r r r
15
I I I L
20
1 r 1 1
25
1 1 1 r
30
1 1 1 1
35
III
40
11 1 1 III
45 50
l i l t
55
r i i r
60
i l r l
65
r r i l
I r
Q [US
$ 1 1.
g.p.m.1
Impeller size
5.63 inch
N°of vanes
4
Impeller
Macerator
Solid size
Revision 2010-09-28
reserves the right to change any data and dimensions without prior notice and can not be held responsible for the use of
Information contained In this software.
ABSEL PRO 1.7.212007-02-07

PIR S20/2D 60HZ
Cornelius Nursing Home Pump Station 25.5 GPM @ 61 feet TDH
Piranha
Sewage pumps with shredding action used for reliable and economical
discharge of effluent under pressure, using small diameter discharge lines
in communal schemes. For effluent removal from houses in rural areas
where high ground must be overcome, or where only small diameter pipework
can be laid, and for example removal from motorway service stations and
camp sites, large construction sites, urban renewal and renovation of buildings.
Pumped medium: sewage and other heavily polluted waste water.
Capacity up to
Head, max.
30 m3/h
75 m
Type: PIR S20/2D 60HZ
Technical data
Delivery rate : 32.3 US g.p.m.
Delivery head : 69.3 ft
Hydr. efficiency : 26.6 %
Shaft power : 2.13 hp
Speed : 3395 rpm
Impeller type : Macerator
Motor output : 2.41 hp
Voltage : 460 V
Frequency : 60 Hz
Discharge outlet : Gi t/4"
ABS reserves the right to change any data and dimensions without prior notice and can not be held responsible for the use of ABSEL PRO 1.7.2 / 2007-02-07
-nfnrmatinn mntainnri in thic cnftwara

Motor performance curve
S20/2D 60HZ
Frequency
60 Hz
Cornelius Nursing Home Pump Station 25.5 GPM @ 61 feet TDH
Rated power
2.41 hp
Service factor
Nominal speed
3395 rpm
Number of poles
2
Rated voltage
460 V
Date
2010-12-20
1,4
1.3
1.2
0.9
0.8
0.7
M/Mn
/in
as
P1
`eff
P2
_111.-Allilr
/
rr
7
r/
7
s
0.6 _
0.5
0.4
0.3
0.2
0.1
0
20
40 60
80
100 120
P21P2n'[%
P [hp]
7
6.5
6
5.5
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
Loading
No load
25%
50%
75%
100%
125%
P1 [hp]
0.4983
1.139
1.822
2.509
3.24
4.345
P2 [hp]
0
0.6035
1.207
1.81
2.414
3.012
I [A]
2.12
2.261
2.548
3.01
3.61
4.257
eff [%]
0
52.98
66.24
72.16
74.5
69.32
cos
0.22
0.4715
0.6693
0.7801
0.84
0.9553
n [rpm]
3584
3543
3496
3448
3395
3327
M [lbf ft]
0
0.8946
1.813
2.758
3.734
4.755
5 [%]
0.4444
1.584
2.879
4.223
5.694
7.583
Tolerance according to VDE 0530 T1 12.84 for rated power
Starting current
19.2 A
Starting torque
11.2 lbf ft
Moment of inertia
ABS reserves the right to change any data and dimensions without prior notice and can not be held responsible for the use of information contained ABSEL PRO 1.7.2 / 2007-02-07
in this software.

ABS Piranha submersible grinder pump 08 - 125
ABS submersible pumps for problem -free pumping of sewage
containing faecal matter in pipe lines from 11/4" (DN 32) in
accordance with EN 12050-1.
Applications
Piranha submersible pumps have been designed for effective and
economic dewatering using discharge lines of small diameter, in
private, municipal and industrial areas.
❑ Sewage removal from living units and houses in remote settle-
ments where the laying of a conventional sewer would be too
expensive, where large ground undulations are present or where
it is only possible to lay pipe lines of small diameter.
❑ Sewage removal from motorway resting sites. communal build-
ings and for renovation of buildings or areas of a city.
❑ For use in slaughter houses, food processing plants, paper
factories, agriculture and similar areas.
o Piranha 08 and 09 are specially designed for private and domes-
tic applications.
❑ Maximum allowable temperature of the medium is 40 °C, or
short term to 60 °C (max. 5 minutes).
Construction
The water pressure -tight, encapsulated fully flood -proof motor
and the pump section form a compact ,robust, unit construction.
Bearings
The stainless steel motor shaft is supported in lubricated -for -life
ball bearings.
Shaft sealing
Piranha 08 - S30: Between motor and hydraulic section by means
of a high quality sealing unit using a silicon carbide mechanical
seal. Seal at motor side is by oil lubricated tip seal.
Piranha PE25/2C - 125/2E: Double mechanical seals, SiC-SiC at
the hydraulic side, SiC-C at the motor.
All seals are independent of direction of rotation and resistant to
temperature shock
Discharge
Piranha 08 and 09: G 11/4" internal thread
Piranha S10 - PE45/2C: DN 32 flange (G 11/4" threaded adaptor
available as accessory)
Piranha PE80/2E - PE125/2E: DN 50 with DIN -flange
Shredding system
Spiral bottom plate and stationary cutter ring combined with
a shredding rotor located before the impeller, for optimum
blockage -free running.
Temperature monitoring
Thermal sensors in the stator to switch off the pump in the case of
overheating and switch on automatically after cooling down.
Seal monitoring
DI system consisting of a sensor in the motor and oil chambers
which signals an inspection alert if there is leakage at the shaft
seals. Not available for Piranha 08 and 09.
Features
❑ Unique ABS Piranha shredding system capable of shredding
items such as cloths and plastic bags.
❑ For the pumping of wastewater containing sewage, offal, organic
and industrial effluent.
❑ Piranha 08 and 09 fitted with MF modular motor; Piranha-S with
A5, Piranha -PE with XFP Premium Efficiency IE3.
❑ Small discharge lines from 11/4" (DN 32).
❑ Installations are possible where large ground undulations are
present.
❑ Standard and Ex -versions (see motor data below).
❑ Piranha 08 and 09 have capacitor in upper lid and do not require
a control box.
o Low installation costs due to small diameter discharge pipe -
work.
Motor
Three-phase 460 V or single-phase 230 V, 50 Hz, 2-pole (3400
r/min) or 4-pole (1750 r/min).
Cooled by amply dimensioned cooling areas.
Piranha 08 & 09: insulation class F, protection type IP 68. non -Ex
only.
Piranha S10 - S30: insulation class F, protection type IP 68, Ex and
non -Ex.
Piranha PE25/2C - PE125/2E: Premium Efficiency IE3 with NEMA
Class A temperature rise, insulation class H, protection type IP 68,
Ex only.
Explosive -proof versions are in accordance with EX d IIB T4 and
ATEX international standards.
Materials
tescriptio
Upper Lid *
. Motor Housing
i8h.o
ater'
Stainless steel 1.4301 (AISI 304)
Cast iron EN-GJL-250
Rotor Shaft
Stainless steel 1.4021 (A151420)
Volute Cast iron EN-GJL-250
Impeller** Cast iron EN-GJL-250
Fasteners Stainless steel 1.4401 (AISI 3161
• Piranha 08 and 09
Poiyamide far Piranha 08

Technical Data
08/2W
G 11/4"
2.15
1.50
9.39
230 1-
3400
SJTOW-A 16/3
18
08/2D
G 11/4" 1.85 1.50
2.87 460 3- 3400 STOW -A 16/4 18
09/2W G 11/4" 2.83 2.25 13.50 230 1- 3400 SJTOW-A 16/3 23
09/2D G 11/6" 2.53 2.00 3.98 460 3- 3400 STOW -A 16/4 23
S10/4W j1 32 G 11/4" 1.48 1.00 6.50 230 1- 1750 SOW -A 14/7 32
510/4D 32 G 11/4" 1.33 1.00 2.60 460 3- 1750 SOW -A 14/7 32
S20/2W 1i 32 G 11/4" 2.45 1.80 11.50 230 1- 3400 SOW -A 14/7 32
520/2D 32 G 11/4" 2.42 1.80 3.61 460 3- 3400 SOW -A 14/7 32
S2612W 1t 32 G 11/4" 3.13 2.60 13.70 230 1- 3400 SOW -A 14/7 40
S30/2D 32 G 11/4" 3.87 3.00 5.50 460 3- 3400 SOW -A 14/7 53
PE25/2W-C 32 G 11/4" 3.74 2.50 16.60 230 1- 3400 SOOW 12/7 85
PE28/2D-C 32 G 11/4" 3.21 2.80 4.72 460 3- 3400 S00W 14/7 85
PE35/2W-C 32 G 11/4" 5.19 3.50 24.00 230 1- 3400 SOOW 10/7 85
PE35/2D-C 32 G 11/4" 3.94 3.50 5.81 460 3- 3400 SOOW 14/7 85
PE45/2W-C 32 G 11/4" 5.60 4.60 7.69 230 1- 3400 AWM 8/4+16/3 85
PE45/2D-C 32 G 11/4" 5.10 4.50 7.40 460 3- 3400 SOOW 12/7 85
PE80/2D-E 50 DIN 8.87 8.00 13.30 460 3- 3400 SOOW 12/7 130
PE100/2D-E 50 DIN
10.80 10.00 17.30 460 3- 3400 SOOW 10/7 145
PE110/2D-E 50 DIN
12.00 11.00 18.60 460 3- 3400 SOOW 10/7 145
PE125/2D-E 50 DIN
13.70 12.50 21.30 460 3- 3400 AWM 8/4+16/3 145
• Piranha S10/4 - PE45/2 with threaded flange adaptor as accessory " Pi = Power at mains; P2= Power at motor shaft
••• Weight with 10 m cable
u Start and Run capacitor to the following specification required in control panel.
Start: 161-193pF for S10/4W & S20/2W, 200pF for S26/2W
Run: 30pF for S10/4W, 20pF for S20/2W, 500F for S26/2W
The recommended start time for the motors is two seconds.
Performance Curves
48
H tml
44
40
36
32
20
24
20
16
12
0 IVO
Un'/ht 0
4
0
0
4
.
Nis?\,.■■■■■■■
s3Q
y{. = max. flow
bSIiiIIII
111■11
1111u■■
.
1I
r►w
1 2 3 4 5 6
25 5 7.5 10 12 5 15 17.5 20 225
H tml 90
80
70
60
50
40
30
20
10
H = Totat Head; Q = Discharge Volume. Curves to ISO 9906 N.B. please use the ABSEL program to validate pump selection.
■■i_22s
2A
s
■.■:.
- Krax. flow
■
111
1I.I
p8t16/2�e,
•
I!••■■■
1
A.
■!._
MI1111I
iC.:711MMIM
_.
111
pE�La
._
■
pfj ""
■■■■■■m11il{
iI
•
vc
WOO
■■■MI■■■
i
1
4
2 3 4 5 6 7 8
12 16 20 24 20
9
32

Dimensions Imml
•
40
Piranha 08 & 09
100
40
14
o W
1W_ (7
-14
Bp
512
392
A
c
0110 /////)ii/
Piranha PE25/2C - PE45/2C
y
- '
,fir
//////ice / /22/1//////// i/1/71
rr 18
wrilik
NOM
I �. f
lull w
65
Piranha;k
S10/4 & S20/2
526/2 & S30/2
PE80/2E
PE100/2E - PE125/2E
347 .414
360 427
774
843
368
374
40
14
0
�»
Piranha 510/4 - S30/2
18
65J L
Piranha PE8O/2E - PE125/2E
Piranha 06 - PE125/2E: Minimum sump opening 0625 mm
Pedestal base secured using M10 masonry anchor bolts, drill hate size 14 mm
• Lowest switch -off paint for automatic operation
Piranha PE80/2E - PE125/2E: Discharge line connection with threaded flange ON 50/2- PN16
Discharge elbow supplied by customer
" Hexagon head wood screw 10 x 70 DIN 571 and dowel size 12

•
•
Accessories
Mggg
I fi.6
86
4,7
��r�inhs
Fixed installation . Pedestal (EN-GJL-250)
with pedestal
90° cast bend
90° cast bend with built-in
non -return valve
without bend
Threaded Adaptor
hexagon double nipple
Guide Rail (galvanized steel)
Chain Kit (galvanized steel)
including shackle
Chain Kit (stainless steel)
including shackle
G 11/4" 62325007
G 11/4" 62320674
G 11" 62320676
08 & 09
S10/4-530/2,
PE25/2C-45/2C
G 11" 62320536 510/4-530/2
G 11/4" 62320538 PE25/2C-45/2C
DN 50/G2" 62320660 PE80/2E-125/2E
G 11"
13770011 08 & 09
11/4" x 1 m 31380007 08-PE125/2E
11/4"x2m 31380008
11" x 3 m 31380009
1 Y4" x 4 m 31380010
' 11/4" x 5 m 31380011
3m
4m
6m
7m
61265065
61265093
61265069
61265096
3 m 61265081
4 m 61265099
6 m 61265085
7 m 61265102
08-PE125/2E
08-PE125/2E
Transportable Threaded Flange Kit (EN-GJL-250) G 11/4" 61180512 S10/4-PE45/2C
applications including discharge piece, gasket and bolts
Ground Support Stand (St. 37) 61900013 S10/4-530/2
with fixing bolts 61900007 PE25/2C-125/2E
Fixed Coupling (brass) GEKA G 11/4" 15020003 S10/4-PE45/2C
with external thread
Hose Coupling G 11" 15020018 S10/4-PE45/2C
with nozzle, outer dia. 34 mm
Horizontal Pump DN 150/PN 16
(tank connection) with built-in flange on suction side to DIN 2633
Head Support (EN-GJL-250)
with vibration damping
0n request 510/4-PE125/2E
62665103 510/4-530/2
General Non -return Valve (EN-GJL-250) G11" 61400525 08-PE125/2E
ball valve with internal thread G1'/2" 61400526
G2" 61400527
Shut-off Valve (brass) G11/4" 14040005 08-PE125/2E
with internal thread G11/2" 14040006
G2" 14040007
u)
m
E
0
0
m
n
a
V
0
V
0
0)
0
0
0
u
m
a
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(0
0
u,
L
01
0)
w
m
V1
L.
m
n
m
co
w
cci
N
OD
0
E
a
0
L
US
L
°G1
z
0
(o
U)

d States Geological Survey
drIc methods Mann imagery dated 1,965
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ROM) CLASSIFICATION
Parnery 114h6ey, 1411 duty 666, twri
hard %wine ruistrtvoul surface
Secoodome highway,
hard ustioute sous,— UrtAptcheld road o u ue. u
tuteritate 6481te 9S Route t Slate Routo
40A0it.4,1r, AlCA' mAti
PeelerollU skteru 41 manic camaIled tadtenr.C.II unIF
North Carolina Department or Envewnment, lieotth and
Natural Resources hum enagory dated 3993 and other sources
Map added 1966
IniermoTtun ahoy,o le matte muy n17 root( tISC/S content
standards ahe may cork) with previously mopped contours
CORNELIUS, NC
35080.87,TE024
1993
ISMA 4ASe 166 44SEPOSS V042
rem
-•=r,-OF 35'2230"
90`45'
Z -66

•
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9 990
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NJ. PROPOSED SENAGE SIVAL COAPLy rrni TOP.
OF °MINORU WC CI4AM41D
D. NI pRoposul cot LE1400 sNAft CO•PLY tfll
Tom or commas Lae DEER. 7.5 ONEROR
U210.0
3. ALL PSCPCSED Seee AND DRIORDE SWILL MeV
WIN SOW OF 000113.1.6 POST CONSFRUCTION
STORIPIATER OFIDAANCE.
4. ALL PROPOSED LANDSCAPING WE A. 0.2.02.
SHALL CORKY WM TOWN OF COMIELII0
1 YOUNT/NY TORN AraN£01101 CF PRDPEMY 0001
NU STEEN FRED SEPARATELY.
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OVERALL S1TENT1LITY DEVELOPMENT PLAN
C-03

The Curry Engin
Group, PLL,C
AUTY
LETTER OF TRANSMITTA OOREs"i� _L R O OFFICE
To: NCDENR Mooresville Regional t)fce
610 E. Center Ave.
Mooresville, NC 26'116
Phone:
04-663-1699 Overnight
YSX
ding you the following:
❑ EC Plans
0 Contracts
0 Prints/Plans
X Permit Applications
These are transmitted as checked below:
Job No. 2010-007
Job Name: AC Cornelius
Cornelius, NC
Date: December 23, 2010
Sent By: Don Curry, PE
O Construction Plat 0 Site Plan Drawings
0 Comtauter Disk
• Site Work Calculations 0
X For Approval 0 As Discussed 0 For Your File
O For Your Signature, there retum to:
0 For Review and Comment
pie
Date
1
0 As Requested 0 For Your Use
Description
Dec 23, 2010 1 origl1 copy Autumn Care Cornelius Fast -Track SearerApplrcation
Dec 23, 2010 $480 Application Fee
Remarks
Please contact me wwittt and^ questions.
Thanks, Don
Copies To: file
The Corry Engineering Croup,. 11,1,C
PO Box 2018
133 Spring Ave.
Fuquay-Variva, NC 27526
il000irri c1yeu rrb Pngmt➢,enriflggL"8➢13
919.552.0849 (0)
919.552.2043 (F)
919.880.9857 (C)

Permit Number W00035172
Central Files: APSl, SWP_
01/04/11
Permit Tracking Slip
Program Category
Non -discharge
Permit Type Fast Track
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
Extensions
Primary Reviewer
michael.parker
Coastal SW Rule
Permitted Flow
12240
Facility
Status Project Type
In review New Project
Version
A
Permit Classification
Individual
Permit Contact Affiliation
Facility Name
Autumn Care
Location Address
Owner
Major/Minor
Minor
Region
Mooresville
County
Mecklenburg
Facility Contact Affiliation
Owner Name
Autumn Corporation
Dates/Events
Orig Issue
D 1 /05/11
Owner Type
Non -Government
Owner Affiliation
Gerald Cox
President
PO Box 7728
Rocky Mount
NC 27804
App Received Draft Initiated
01/03/11
Regulated Activities
Nursing Home
Wastewater collection
Outfall NULL
Scheduled
Issuance
Public Notice Issue
01/05/11
Requested/Received Events
Additional information requested
Additional information received
Effective
01 /05/11
Expiration
Waterbody Name Stream Index Number CurrentClass Subbasin

Pef`fy t rNo, rr1CQOC
January 2, 20
Owner/WQCS
r 4d Cox
Corporator.
,ttf: t ,North',iV"instead Avenue'
ck' •ount. 3° C :27804
ep et. artd 7ULra'a�'�i th foram to the per
One copy el the project record drawrn is (plan t
system extension
Supporting design ealeutatie;'rs (seier trod pumps, system curve, ererratirrg port°wt, t
pie rtable gelrerator(s) or storage great ar than longest past three year outage reliabi
f r any pump :stations permitted as part of this project
d be clearly identified, on the record drawings or n written summary form,
-cone oii
PE
Donald L Curry, Ir ,
The Curry En reer ng Grp up
133 Scrnno avenue
.uqusv_Varinn, NC 27525
recommended that tl
m de.
It [s 3t0
��n chanusres
is
ntoatien have beenrecr0ve s" 1. y
,,v th the
of sewer 1in esl of the wastewater collection
ifie; on be sent in a manner that o
, asad
having been at. hi ze'd too serrve
Care Cornelius, a Mecklenburg Cour
due care and diligence was used in
observed to be built withiln 'rfu tstar?tia
Quality's (Division} Gravity Sewer Mir
Drwsion's Minimum De'stgn Criteria fo
ENGINEER'S CenTINCATIoN
d'r
s permit,
tiF'cation and
T hetr it re, it is highly
video proof of receipt by the
istersd Profess ara al Enthe State of North Carolna,
`e pe,riodic�ally, ^ekly, LJ full tiny l tfr= c�r�struraoon of a Autumn
project for the Perrnittoe, hereby state that. to the best of my ab lIttec,
ervc Lion of the construction such that the construction was
compliance of this permit; 1 5A NCAC 2"d the Division of Water
mum Design Criteria adopted Eet ruary 12, 1 i96 as applicable, the
the Fast -Track Permitting of Pump Stations and Force Mains atohted
Jure 1, 200C, as applicable; fond other supporting materials
Una Nrofessio
seal, signature, and date.
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
SURFACE VVATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28'11 fa
onstble for tracking all partial cerrtiriratita s up un
wastewater flow made trttaclt Icy to the wastewater collection system exte
Engineer's Certification shall be cons dered a violation of the pernarit and she
appropriate, enforcement actions,
ration is r" c ived_ Any
for to completion of this
ect the Permittee try

-Envy-
TRANSMITTAL FORM
TO: Michael Parker
NCDENR Mooresville Regional Office
610 East Center Avenue
Suite 301
Mooresville, NC 28115
704-663-1699
SUBJECT: Autumn Care Cornelius DATE: Nov 19, 2014.
CURRY PROJECT NO: 2010-007 SENT BY: Don Curry
We are sending you the following items:
COPIES
1
ITEM DESCRIPTION
Certification Final Sewer Certification from Engineer
Sewer Shops As -Built Sewer Shops
Plans As -Built. Utility Plans
These are transmitted as checked below:
For Information Approved as Noted - Revise and Resuhmit
As Requested Not Approved - Revise and Resubmit
For Review and Comments For Record and File
For Revision Submittal
For Approval For Recording
Approved For Signature, then return to:__
REMARKS:
Please find the enclosed as -built cei-tilir.utson for the Autumn Care of Corrrehos:
` i E.S' Y r 3 >r