WQ0039726_Regional Office Historical File Pre 2018

Water Resources
Environmental Quality
January 22, 2018
Ms. Maria Ruiz, Managing Member
Mi Pueblo HP, LLC
P.O. Box 367
Clemmons, NC 27012
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
Subject: Permit No. WQ0039726
Mi Pueblo HP, LLC
Mi Pueblo Restaurant - Belgate A-5
Wastewater Collection System Extension Permit
Mecklenburg County
Dear Ms. Ruiz:
In accordance with your application received January 8, 2018 and additional information received January
19, 2018, we are forwarding herewith Permit No. WQ0039726 dated January 22, 2018, to Mi Pueblo HP,
LLC (Permittee) for the construction and operation upon certification 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 This permit shall be effective from the date of issuance until rescinded, and shall be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 the following conditions contained within this permit:
Conditions l.1 & 1.2: Alternative designs are granted relative to the minimum slope of the sanitary sewer
and minimum separation distance from wetlands, per 15A NCAC 02T.0105(n). Please see
Conditions 1.1 and 1.2 for more details.
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11.4:
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.
It shall be the responsibility of the Permittee 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.
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
�' Nothing Compares,
State or North Carolina I Environmental Quality I Water Resources 1 Water Quality Regional Operations
Mooresville Regional Office 1610 East Center Avenue, Suite 301 1 Mooresville, North Carolina 28115
704-663-1699

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 Barry Love at [phone]
or via e-mail at [e-mail].
Sincerely,
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
cc: Michael Newman, P.E. (e-copy)
Barbara Gross (e-copy)
Tommy Rowland (e-copy)
Regional Office Files
Water Resources Central Files
PERCS (e-copy)

L9
it
Environmental
Quality
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
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
Mi Pueblo HP, LLC
Mecklenburg County
for the construction and operation of approximately 26 linear feet of 6-inch gravity sewer to serve the Mi
Pueblo Restaurant - Belgate A-5 project, and the discharge of 11,000 gallons per day of collected domestic
wastewater into the Charlotte Water existing sewerage system, pursuant to the application received
January 8, 2018 and additional information received January 19, 2018, 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 Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the specified
conditions and limitations contained therein.
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
Permit Number: WQ0039726
Permit Issued: January 22, 2018

SUPPLEMENT TO PERMIT COVER SHEET
Mi Pueblo HP, LLC is hereby authorized to:
Construct, and then operate upon certification the aforementioned wastewater collection extension, The
sewage and wastewater collected by this system shall be treated in the Charlotte Water Mallard Creek
Wastewater Treatment Plant in accordance with Permit Number NCO030210,
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCA[ 2T; the Division's Gravity Sewer Mm|nnunn Design Criteria adopted February 12, 1996' as
applicable; and the Division's Minimum Design Criteria for the Fast -Track Permitting mfPump Stations and
Force Mains adopted June 1, 2000, as applicable, unless opcci5caflymentioned herein. Division approval
is based on acceptance of the certification provided by Worth 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.
Construction and operation iscontingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
1. SPECIAL CONDITIONS
1 Nmflow inexcess of the quantity permitted herein, 11,000 gallons per day, shall be made tributary to
the subject sewer system until an application for permit modification for an increase in flow has been
submitted to and approved by the Division, [15A WCA[02z.V304(b)] .
2� This permit shall become voidable unless the agreement between K4i Pueblo Hp' LL[and Charlotte
Water for the collection and final treatment mfwastewater is in full force and effect. [15A NCA[
11I. STANDARD CONDITIONS
l This permit is not transferable. in the event there is a desire for the wastewater collection facilities
to change ownership, orthere is a name change of the Perrnittee, a fgmna| 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 urmay not he approved, [1S/\N[A[02T.UlO4;G.Sl4J-Il5.I(d3))
1 This permit shall become voidable unless the wastewater collection hsd|itmo are constructed in
accordance with the conditions mfthis permit; lSA NCA[ 2T; the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1996, as applicable; the Division's Minimum D*o�gn Criteria for
thcFast-TrnckPennittin8ofPunmpStatimnsandForceMa|nsadnpted)unm]L2O0O,asapp|icab|e�and
other supporting materials unless specifically mentioned herein, [15A NCAC 02T.0110]

3. This permit shall be effective only with respect to the nature and volume of wastes described in the •
application and other supporting data. [15A NCAC 02T .0110]
4. 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: [15A NCAC 02T .0108(b)]:
a. The sewer system shall be effectively maintained and operated at all times to prevent discharge
to land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been 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 -months and inspections are
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. 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.
h. A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential users and
the legal means to require grease interceptors at existing establishments. The plan shall also
include legal means for inspections of the grease interceptors, enforcement for violators and
the legal means to control grease entering the system from other public and private satellite
sewer systems.
2. For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.

Documentation shall be kept for Subparagraphs (a) through (i) of this Rule fora minimum of three
years with exception of the map, which shall be maintained for the life of the system.
The Permittee shall report by telephone to a water resources staff member at the Mooresville
Regional Office, telephone number [phone], as soon as possible, but in no case more than 24
hours, 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 55O and/or spill over 1,000 gallons; or
c. Any 55O and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this 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 and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence. This report must outline the actions taken or proposed to be taken 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, [G.S, 143-215.1C(ai.)1
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, [15A NCAC 02T.0.108(b)]
7. 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. 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.
if the permit is issued to a private entity with an Operational Agreement, then a copy of the Articles
of Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately
filed with the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are
provided as applicable. Supporting documentation shall include the following:
a. One copy of the project construction record drawings (plan & profile views of sewer lines & force
mains) of the wastewater collection system extension, Final record drawings should be clear on
the plans or on digital media (CD or DVD disk) and are defined as the design drawings that are
marked up or annotated with after construction information and show required buffers,
separation distances, material changes, etc.

b. One copy of the supporting applicable design calculations including pipe and pump sizing,
velocity, pump cycle times, and level control settings, pump station buoyancy, wet well storage,
surge protection,,detention time in the wet well, and force main, ability to flush low points in
force mains with a pump cycle, and downstream sewer capacity analysis. If a portable power
source or pump is dedicated to multiple stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, include travel
timeframes, shall be provided.
c. Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the certification
in the space provided, or in written summary form.
Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting in
non-compliance with this permit (including pipe length increases of 10% or greater, increased flow,
pump station design capacity design increases of 5% or greater, and increases in the number/type of
connections), regulations, or the Minimum Design Criteria. Requested modifications or variances to
the Minimum Design Criteria will be reviewed on a case -by -case basis and each on its own merit.
Please note that variances to the Minimum Design Criteria should be requested and approved during
the permitting process prior to construction. After -construction requests are discouraged by the
Division and may not be approved, thus requiring replacement or repair prior to certification &
activation. [15A NCAC 02T .0116]
8. Gravity sewers installed greaterthan ten percent below the minimum required slope per the Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case -by -case basis. Resolution of such request shall be evident prior to completing and submitting
the construction certification. [ 15A NCAC 02T.0105(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for the life of
the wastewater collection facilities. [15A NCAC 02T .0116]
10. 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,
construction of additional or replacement wastewater collection facilities, and/or referral of the North
Carolina -licensed Professional Engineer to the licensing board. [15A NCAC 02T .0104; 15A NCAC 02T
.0108(b-c)]
11. 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.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]

12. 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 the Division any other Federal, State, or
Local government agencies which have jurisdiction or obtaining other permits which may be
required by the Division or any other Federal, State, of Local government agencies. [G.S. 143-
215.1(b)]

I
•
FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE:
PERMIT #:
PROJECT:
ISSUE DATE:
Mi Pueblo HP, LLC
WQ0039726
Mi Pueblo Restaurant - Belgate A-5
January 22, 2018
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of
this permit until the Division has received this Certification and all required supporting documentation. It
should be submitted in a manner that documents the Division's receipt. Send the required documentation
the Regional Supervisor, Water Quality Regional Operations Section at the address at the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial certifications up
until a final certification is received. A Final Certification shall be a complete set of record drawings and
design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information to the Permittee, and the Permittee is prepared to operate & maintain
the wastewater collection system permitted herein or portions thereof.
Printed Name, Title
Signature - Date
ENGINEER'S CERTIFICATION
1, , as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (❑ periodically, ❑ weekly, ❑ full time) the construction of the
project name and location as referenced above for the above 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 02T; the
Division of Water Resources' (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 w/signature & date:
❑ Final n Partial (include description)
Certification Comments/Qualifiers (attach if necessary:
State of North Carolina I Environmental Ouality I Water Resources l Water Quality Regional, Operations

on of Water Resources
Stale of North Carolina
Department of Environmental. Quality
Division of Water Resources
15A NCAC () T 9 tlll — FAST' TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-I6 & SUPPORTING DOCUMENTATION
Applic:rt.icrrt Number
pie by )1 R r
AU items must be completed or the application will be returned
APPLICANT INFORMATION:
l , Applicant's name: Mi Pueblo Hl'• 1 LC". (company, municipality I10A, u
Applicant type: J Individual ❑ Corporation
[I State/County
t. Signature authcyrit's name: IFIataltRuizw.
Title: Mara Cc:n2hcr & Secretary
4. Applicant'~ nrttiling address: PO Box__:�fi7
City: Clemmtrns State: NC Zip: 27t)12
5, Applicant's contact information:
Phone number. [phone] Entail Address: druiz,ri i„ppeb
© Federal
PROJECT INFORMATION:
I, Project name: MI Pueblo Restaurant - Be.lgate A-5
Application/Project status:
If modification, provide the ex
^lunicipa
per15.\ NC°\C.
Proposed (New Pe rmiti ❑ :Existing Per rtiiliproject
permit number: WQOO___ _ and issued date:
If new c onstructitin but part of a master plan, provide the existing permit number: WQ0O
County where project is located: Meckicnbur
4. Approximate Coordinates (Decimal Degrees). Longitude C7fi51
5, Parcel II) (if applicable): 047461 17
(or Parcel IL) to closest downstream scwcc)
CONSULTANT INFORMATION:
I, Professional Engirtccr: Michael Newman I...icense Number ?5274
Firm:.MDV Engincc_r nr, PLLC
Mailing address: 215 Johnston ST
City: Roc:k.H=ill, State. SC '.ip: 297:30-
Phone number: [phone] Email Address: ttic;bac](.n)rtrc
WASTEWATER TREATMENT FACILITY (WWTFD INFORMATION:
1. Facility .Name: Mallard Creek \VW"I'F Permit Number: NC0030211)
C)wncr- Name: C.harlouc Water
V. RECEIVING DOWNSTREAM SEWI R INFORM^IAT1C)N (if different than W WTF'):
Permit. Number(s): WQ
Owner Name(s);
Downstream (Reccivin D S over Size: inch
Numbcr(s) if applic r) Ic). yti'QC'S
eel Public Utility
WQRUS
1 A 04-

pry-
. NERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ENo ®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 DNo ®N/A
•
4. Origin of wastewater: (check all that apply):
❑ Residential Owned
❑ Residential Leased
❑ School / preschool / day care
® Food and drink facilities
❑ Businesses / offices / factories
5. Nature of wastewater :
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
% Domestic/Commercial
100 % Commercial
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
% Industrial (See 15A NCAC 02T .0103(20))
)Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes ® No
> If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a'b
No. of Units
Flow
Restaurant, FuJI Service
40 gal/seat
275
11,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
11,000 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(I) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-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: 11,000 GPD (per 15A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
D 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
6
26
PVC
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: . Longitude: -
3. Design flow of the pump station:
4. Operational point(s) of the pump(s):
millions gallons per day (firm capacity)
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
D. Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
E 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):
D. 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

PPF
SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(0 & (g)
➢ 15A NCAC 02T.0305(fl 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(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
❑ Yes ® No
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 Iine, 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

CERTIFICATIONS:
I. Does the submitted system comply with I A—.NCAC 02"T, 'thu & Iiafirttuinl)esu n C.aat lla)cra the ? lraaitting of Puncp Sun'
and. Force Mains at . version and the ir,avuy Sewer rlinirtatarar 1)csi n C riter'ia ltatcst versicata as applicable'?
If No, complete and submit th.e Variar
for review. Approval of the reques
documents.
Professional Engineer's Certification;
C rvEw#414,1J
Yes
LJ No
Ave Design Request application (VADC 10=14) and supporting documents
required prior to submittal of the Fast Track Application and supporting
(Professional Engineer's name from Application Item III.I.)
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 hest 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 far 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 I43-215,6A and 143-215,6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall he guilty of a Class 2. misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification per 1 SA NCAC 02T .0106(b):
I, /NA L' 2,v
(Signature Authority's name title from Application Item
_attest that this application for
has been reviewed by rite and is a.ecurate and complete to the best of iffy 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. 1 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,
inurtctive 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 1 13�15.t1 , 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 tine not to exceed $10,000 as well as civil penalties up to $2:5,000 per violation.
Signature
'TA 04- 16
Page 5 of 5

State of North Carolina
parts ent of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocati.om Fairwood Construction
Project Name for which flow is being requested: Mi Pueblo Mexican
rt'lure than one FTSE may berequired for a single project if the owner of the W 'TP is not responsible,for' ail pump
stations along the route of the proposed wastewater flow
Complete this section only if you are the owner of the wastewater treatt plant.
a. WWTP Facility Name: Mallard Creek WWTP
b. WWTP Facility Permit 4: NC00:30210
c. WWTP facility's permuted flow
All a` t w are 'D
12,000
d. Estimated obligated flow not yet tributary to the WWTP 0.650
c. 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
9.581
0.011
10.242
85.4%
Complete this section f` r 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:
Pump
Station
(Name or
Number)
Firm
Capacity,
MGD
(A) (B) (C) (D)=(JJ+C) ()=(A-D)
Design Obligated,
Average Daily Approx. Not Yet Total Current
Flow** Current Avg, Tributary Flow Plus
(lairm 1 pf), Daily Flow, Daily Flow, Obligated Available
MGD MOOD MGD Plow Capacity***
* The Fir m Capacity 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 (pi) not Tess than 2.5.
*** 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): Sanitary Sewer serving Ikea Blvd (2008)
Downstream Permit Number: 208-542
Page 1, of 6
04-1 la

111. Certification Statement:
I Carl Wilson 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 1 and II
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
fZe
Date
Page 2 of 6
ErsE 04-16

SEWER SYSTEM COVER LETTER
Project: Mi Pueblo Restaurant - Belgate A-5
Date: December 28, 2017
Sewer System: Private
List of Items included in this application package:
1. Cover Letter.
2. $480 Application Fee (Check #1147)
3. Signed Fast -Track Application (1 original & I Copy)
4. Documentation from NC Secretary of State applicant
5. USGS Site Map
6. Street Level Site Map
7. Charlotte Water Capacity Assurance Review Letter
8. Utility Plan Sheet (with sewer highlighted)
PECEEEETERAE tit LEEN AtLEIVR
itti E ;:„J
WQR OS
MOORESVILLE EG NAt„. OFFICE
Los
Protect Narrative: The site is located near the intersection of 'UniversityCity Boulevard
and IKEA Boulevard in Charlotte, NC. The proposed private gravity sewer system will
serve a 9,000 square foot (SF), 275 seat Mexican Restaurant development
Project Description: Private gravity sanitary sewer service to serve the proposed.
restaurant.
Sanitary Sewer System Description: Connection to existing sanitary sewer system
manhole and extension of approximately 26 LF of 6- PVC sanitary sewer line.
appurtenances.
Prepared By:
Prepared For:
MDV Engineering, PLLC
Michael Newman P.E.
215 'Johnston Street C-14
Rock Hill, SC 29730
704,400.1044
Mi Pueblo HP, LLC
PO Box 367
Clerrimon.s, NC 27012
336.-778:8883
2016-1.03
Mi Pueblo Restaurant. Page .1. of 2

SEWER SYSTEM DESIGN CALCULATIONS
1. Find: Design Flow
Given: Restaurant, full Service 40 gallseat
Restaurant, full Service number of seats 275
Solution: Design Flow = (275 seats) (40 gallseat)
Design Flow = 11,000 gpd
2016-103
Mi Pueblo Restaurant Page 2 of 2

1/5/2018 North Carolina Secretary of State Search Results
• Upload a PDF Filing • Order a Documents Online • Add Entity to My Email Notification List
• View Filings • File an Annual Report/Amend an Annual Report
• Print an Amended a Annual Report form • Print a Pre -Populated Annual Report form
Limited Liability Company
Legal Name
MI PUEBLO HP LLC
Information
Sosld: 0407023
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 9/27/1996
Fiscal Month: December
Registered Agent: Ruiz, Jesus
Addresses
Principal Office Reg Office Mailing
2421 Lewisville Clemmons Rd 9800 Styers Ferry Rd PO Box 367
Clemmons, NC 27012 Lewisville, NC 27023 Clemmons, NC 27012
Reg Mailing
PO Box 367
Clemmons, NC 27012
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Managing Member Managing Member
Jesus Ruiz Maria Ruiz
150 Almont Forest Dr 9800 Styers Ferry Rf
Clemmons NC 27012 Lewisville NC 27023
ht:1/wv.sosnc.gov/online_services/search/Business„ Registration_Results 1/2

North Carolina Secretary of State Search Results
Page 1 of 2
• Upload a PDF Filing • Order a Documents Online • Add Entity to My Email Notification List • View Filir
• File an Annual Report/Amend an Annual
Report • Print an Amended a Annual Report form • Print a Pre -Populated Annual Report form
Limited Liability Company
Legal Name
MI PUEBLO HP LLC
Information
Sos ld: 0407023
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 9/27/1996
Fiscal Month: December
Registered Agent: Ruiz, Jesus
Addresses
Principal Office Reg Office Mailing
2421 Lewisville Clemmons Rd 9800 Styers Ferry Rd PO Box 367
Clemmons, NC 27012 Lewisville, NC 27023 Clemmons, NC 27012
Reg Mailing
PO Box 367
Clemmons, NC 27012
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Managing Member Managing Member
Jesus Ruiz Maria Ruiz
150 Almont Forest Dr 9800 Styers Ferry Rf
Clemmons NC 27012 Lewisville NC 27023
https://www.sosnc.gov/online_services/search/BusinessRegistration Results 1/8/2018

North Carolina
Date Printed;
5/2018 1:04:47 PM
Polaris 3G Map Mecklenburg Conn
III PUEBLO
MI PUEBLO SITE
report rs prepared for the irtventary of rent property within # e lenhu County and is corrrprksd from recorded deeds, p# t , tax maps, surveys, p9enimetrc maps, and other public record
Users of this crrapr r report are hereby notified that tkre aforementioned pu lic primary information sources should he consulted for venficabon Mecklenburg County and its mapping contactors assume no legal
nsibihty for the information contained herein

CHARLOTTE
W TER
October 31, 2017
Mr. Brannon Everidge
Fairwood Constuction
114 Fairwood Ave.
Charlotte, NC 28203
SUBJECT: CAPACITY ASSURANCE REVIEW
MI PUEBLO MEXICAN GRILL
7003 UNIVERSITY CITY BLVD, CHARLOTTE NC
CLTWATER TRACKING# 20171372
After an analysis of the sanitary sewer associated with the proposed design of project 20171372, Mi
Pueblo Mexican Grill, it was determined that there is sufficient capacity to accommodate the
proposed sewer flow of 11,000 gallons per day (412 restaurant seats x 40 gpdfseat) at the
connection point(s) indicated on the submitted utility plan for transmission to the Mallard Creek
Wastewater Treatment Plant NPDES permit number NC0030210, for treatment. This acceptance of
flow is based upon the existing capacity of the designated publicly owned treatments works.
CLTWater 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, PWS ID # 0160010, on file with the Public Water Supply Section of NCDENR.
However, CLTWater cannot guarantee a constant pressure or quality of flow.
Due to the involvement of other agencies and the continuing growth of the water and sewer system,
the ability to provide service for future projects cannot be guaranteed nor reserved. Connection to
the CLTWater and sewer system is accepted on a first come, first served basis.
The applicant should understand that this letter is not authorization to construct or extend private
water or sewer systems, as the appropriate local or State permits are required prior to construction.
If the appropriate authorization to construct permits are not obtained and construction has not
started within one (1) year of issuance of this capacity assurance review, and payment for any
service connection(s) has not been received within (1) year of issuance of this capacity assurance
review letter, this approval shall be rescinded and a new capacity assurance review must be made.
If you have any questions, you may contact me at [phone].
Sincerely,
9�/eadoeva Vaue
Gwendolyn Banner
Engineering Assistant
Charlotte Water 5100 Brookshire Blvd, Charlotte, NC 28216 charlottewater.org
Operated by the City of Charlotte

Central Files: APS — SWP _
1/22/2018
Permit Number WQ0039726 Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
barry.love
Coastal SWRuIe
Permitted Flow
11,000
Facility
Version Permit Classification
1.00 individual
Permit Contact Affiliation
Facility Name
MI Pueblo Restaurant-Belgate A-5
Location Address
Owner
Major/Minor Region
Minor Mooresville
County
Mecklenburg
Facility Contact Affiliation
Owner Name
Mi Pueblo Hp LLC
Dates/Events
Owner Type
Non-Govemment
Owner Affiliation
Maria Ruiz
PO Box 367
Clemmons
NC 27012
Orig Issue
1/22/2018
Scheduled
App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
1/8/2018 1 /22/2018 1/22/2018
Regulated Activities Requested /Received Events
Food and kindred products manufacture
Food preparation, other
Wastewater collection
Outfarl
Additional information requested 1/8/18
Additional information received 1/19118
Waterbody Name Streamindex Number Current Class Subbasin

Water Resources
nrattt7ttatttal Quality
May 1,
Ms. Maria Ruiz, Managing Member
Mi Pueblo HP, LLC
P,O. Box 367
Clenunons, NC 27012
SUBJECT: Final Engineering Certif cation Acknowledgement
Project: Mi Pueblo Restaurant --- Belgate A-5
Permit No, WQ0039726
Perntittee: Mi Pueblo HP, LI..0
County: Mecklenburg
Dear Ms. Ruiz:
MICHAEL S. REGAN
Secre wry
LINDA CI.ILPEPPFR
irrrr�m im Director
The Division of Water Resource- s Mooresville Regional Office received the final engineering
certification with rec+ rd drawings for the subject sewer extension project on April 30, 2018.
Enclosed is a certification page for your records. 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, design criteria and the permit. However, if a full technical review is conducted,
you will be notified of any items of non-compliance.
Please be reminded that the Per mittee is responsible for keeping a copy of the final record drawings
for the life of the project. If you have not received such copy from your consultant, please contact
tl ern immediately to obtain :r copy,
Lastly, 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 or your company, please complete Form PNOCF
since the permit is not automatically transferable. Form PNOCF can he downloaded from
htt :/,/porrtal.ncdenr.ort 'wc. tL$' w pr psr^`csx°'pnoe from the Collection Systems ,Applications page.
Should you have any questions, please do not hesitate to contact me at [phone].
Sirncerely,
Environmental. Specialist
cc: Michael D. Newman, I ,E., (MD " Engineering, 215 Johnston Si,, Rock Hill , SC 29730)
Central Files
'IRO
Beak of North Carolina j [nvoronme:rvtttl Quality 1 Vier Resources C Water £:
Mooresville Rc6;ional i"7E'li« hRU Fast t'=enter Avow, Hsu
704-6 ..a-- i 6,9Y
to
y Rgonna

EAST TRACK SE
PERMITTEE:
PERMIT R:
PROJECT:
ISSUE DATE.
R ENGINEERING CERTIFICATION
Mi Pueblo HP, LLC
WW00039726
Mi Pueblo Restaurant , &gate A-5
January 22, 2018
IONA, orr!C'E
This project shall not be considered complete nor allowed to operate ;in accordance with Condition 7 of
this permit until the Division has received this Certification and all required supporting documentation. It
should be submitted in a manner that documents the Division's receipt. Send the required documentation
the Regional Supervisor. Water Quality Regional Operations Section at the address at the bottorn,
Any wastewater flow made tributary to the wastewater collection system extension prior to corapletion
of this Certbication shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions: The Permittee is responsible for tracking all partial certifications up
until a final certification is received. A Final Certification shall be a complete set of record drawings and
design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTWICATION
I, the undersigned agent for the Perrittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information to the Perrnittee, and the Permittee is prepared to operate & maintain
the wastewater collection systern permitted herein or portions thereof.
a ,r. . sa R u z Man a g
Printed Name, Title
M mb e r
�wW
gnature
ENGINEER'''S CERTIFICATION
l � 4 WF ?IV e as a dui. registered Professional En Ine+er irr the State of North Carolina,
having been authorized to observe periodically, Ej weekly, full time) the construction of the
project name and location as referenced above for the above 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 02T; the
Division of water Resources' (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 w/signature & date:
Final Partial (include description)
Certification Comments/Qualifiers (attach if inecessarp: