WQ0037048_Application (FTSE)_20220525

r
State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number:--k—M(lo oc coinpleted b%- DWR)
Ali items must be completed or the a— opliication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name- Paliouras Enterprises. LLC (compan), municipalith. 110A, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partner.;hip ❑ Pri,-atcly-Owned Public Utility
❑ Federal ❑ State'County ❑ Municipal ❑ Other
3_ Signature authority's name: James Paliouras per I5A_NI('A(' O-1 1 .0Wt )(h
Title: Managing Member r
4. Applicant's mailing address: PO Box 715 Q -1�1 G w&.Ly PiEr'E 1 o 3rZ3/1
City- Chapel I till Slate: NC 'Lip: 27514-cu��,� �Jtgt� 5 �2 s 12Z
5, Applicant's contact information:
Phone number: {919) 942-5356 Email Address: global travelnaiPyahoo.com
H. PROJECT INFORMATION:
I_ Project name: Paliouras Force Main Relocation
2. Application/Project status: ❑ Proposed (Ncw Permit) ® Existing Perm itlProject
If a modification, provide the existing permit number: WQ0037048 and issued date: March 31, 2014,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan. provide the existing permit number: WQ0037048
3. County where project is located: Orange
4. Approximate Coordinates (Decimal Degree!.): Latitude: 36.056' Longitude:-79.079
5. Parcel ID (il applicable): 9873694294 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I. Professiona; Engineer: Jercm% A. Allen License Number: 034361
Firm; Flightill Infragructure
Mailing address: 2703 Jones Franklin Rd STE 201
Cite: Cary State: NC Zip: 27518-9297
Phone number: (919) 4$I-4342 Email Address: iallen c2hiepc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name. Town Of1-IillSborough WWTP Permit Number: NCO026433
Owner Name. Town o(Ilillborouh
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0037048
2. Downstream (Receiving) Sewer Information: 3 inch Gravity ® Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSN; A
Owner Name(s); James Paliouras - Managing member of PALIOURAS 1:N'I'E:RPRISES LLC
FORM; F TA 06-21
Page I of 5

VI. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility. has a Certificate of Public Convenience and Necessity been attached'?
❑ Yes [—]No ® N.--A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (Doll.M: DI: ) been attached?
❑ Yes ❑ No N WA
3. If the Applicant is a I Lome/Property Owners' Association, has an 1 IOA:POA Operational Agreement d'ORM: I IOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
[:]Yes ❑ No ®N A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individuall)' Owncd) ❑ Retail (stores, centers. malls) ❑ Car 'Aash
❑ Residential (Leased) ® Retail with fixed preparationlservice ❑ hotel and -or Motels
❑ School .-preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool;'Clubhouse
❑ food and drink facilities ❑ Church ❑ Swimming Pool?I--ilter Back++ash
❑ Businesses / offices 1 factories ❑ Nursing home ❑ Other (Explain in Attachment)
5. Nature of ++astewater : 0 % Domestic 100 % Commercial 0 % Industrial (See 15A NCAC 021 .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
G. 1 fas a flow reduction been approved under 15A NCAC 021' A 1140)? ❑ Yes ® No
> If yes, provide a cony of now reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow 4-1
No. of Units
Flow
Aldi Grocery Store without food service
100 gall 1.000sq li
19.209 sq tt
1.921 GPD
gal'
GPD
gal'
GPD
gaV
GPD
gal.'
GPD
gal.'
G13D
Total
1,921 GPD
e �
L+J'
a Sec 15A NCAC 021' .01 I4(b). (d). (Of 1) and (c)(2) for caveats to wastewater design tlaw rates (i.e., minimum fio+% per
dwelling; proposed unkno++n non-residential development uses; public access facilities located near high public use areas;
and residential property located south or cast of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02'f .0114(c), design floc rates for establishments not identified [in table 15A NCAC 02 L01 141 shall be
determined using available flaw data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1,921 GPD (per 15A NCAC 02T .01 14)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station+Force Main or Gravity Sc++cr where flo+v will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement ofexisting sexvers with no new tlon• expected
❑ Other (Explain):
1'ORM: FTA 06-21 Page 2 of 5

V11. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & NIDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 456 PVC
Section 11 & III ofthe MDC for Permitting of Gravity Se%%crs contains information related to design criteria
w Section III contains information related to minimum slopes for graN ity sewer(s)
Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
Vill, PUMP STATION DESIGN CRITERIA (if Applicable) — 02T .0305 & MDC (Pump StationslForce Mainsl:
PROVIDE A SEPARATE', COPY Oh THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name: Palionras PS
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.056' Longitude:-79.079
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.144 millions gallons per day (firm capacity)
> This should reflect the total OPM for the pump station +rith the largest pump out of service.
4. Operational point(s) per pump(s): 100 gallons per minute (GPM) at 82 feet total dynamic head (TDI-I)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
3
729
PVC
If any portion of the force main is less than 4-inches in diameter, please identif} the method of solids reduction per
MDCPSFM Section 2.01C. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ® Other (please specify) Grinder
6. Power reliability in accordance with 15A NCAC 02 f .0305(h)(1):
® Standby power source or ❑ Standby pump
Must have automatic activation and telemetn. - 15A NCAC 02T_0305(h)(1)(B).'
Y Required for all pump stations with an average daily flow greater than or equal to 15.000 gallons per day
Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15.000 gallons per day 15A NCACO21'.0305(h)(1)(C):
❑ Portable power source %rith manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit "ith plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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
as part of this permit application in the case of a multiple station poNver outage.
FORM: FTA 06-21 Page 3 of 5

Ix. SETBACKS & SEPARATIOiNS— (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives round in I5A NCAC 02T .0305(I) & {e}7 ® Yes L No
15A NCAC 021'.0305 I contains minimum separations that shall beprovided for sewer s� stems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
t 8 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
`Water mains (horizontal)
10 leet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supple source, including any wells. WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking ►eater, and associated wetlands.
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 associated with these waters (sec item IX.2)
50 leet
**Any other stream. lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feel
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 ieet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 lect
Final earth grade (vertical)
36 inches
> If noncompliance ++ith ti T.0 05(r) or {g}, see Section X.1 of this application
* 15A NCAC 021..03Q W contains alternatives where separations in 021'.0305(I) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surlace Water Classifications i+eboagc
2. Does this project comply with the minimum separation requirements for water mains? ®Yes [—]No [ J', A
f no, please refer to 15A NCAC 18C.0906(t) fior documentation requirements and submit a separate document.
signedrscaled by an NC licensed PE. verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? , Yes ❑ No ® N A
Please provide supplementary information identifying the areas of non-conformance.
See the Division's draft separation requiremefar situations ++here separation cannot be met, nts
No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules'? ® Yes Basin name: Neuse ❑ No
If � es, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No
'Phis includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
9 Please provide the permit number/permitting status in the cover letter if coverage authorization is required.
6. Does project comply with 15A !NCAC 02 l .0145(c)(6) (additional permitsfcertifications)? ® Yes ❑ No
Per I5A NCAC 02 f.0105(c)(6), directly related environmental permits or certification applications must be 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-).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 021'.0402. "high -priority sewer" means any aerial sec+-er. sewer contacting surface waters.
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the se++cr_
Siphons and sewers suspended through interference?conflict boxes require a variance approval.
Ifyes, include an attachment with details fir each line, including type (aerial line, size, material, and location)_
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A ]NCAC 02T,0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 ol`5

V CEI2•t'IFICAI'll 0NS:
l- Dws the submittal system comply with ' 4 % ',,' , . , the
drxl 1'„tle 111.1;11.r il.ltetit �t:l." tNF'• and the' t. i\i'
Ox Yes ❑ No
If ttu, for projects requiring a single variance. complete and submit the Variance-Alternatr\e Design Request application
(VADC 10-14) and supporting documents for reeiew to the Central Office. Approval of file ruimest_►rill be issued
concurrentiv with the amliruval or the hermit, and proiecls retluirin(i a variance approval mov be subiecl to longer
review Bates. For lro•ects requiring lwo or more variances or where the variance is determined by the Division to he ;1
si mificant portion of the proiect. the full technical review is required.
?. Professional En,+ineer's Certification:
I, Jeremy A. Allen __, attest that this application] fior I :rhnnras Force I! fain Relocation
(Professional I-ngineer' n+rr c from \PiiIiemimt hem III I ) (Project ~'sole (r.m. App tcation [tea' 11 11
has been revie)%ed by me and is accurate, complete and consistent ]►ith the illfornmatiun supplied in the plans,
specifications, engineeritill calculations, and all other supporting documentation to the Hest of my kn(mled�(c. I lilrilter
attwxt that to the hest of in,, knowledge the proposed design has been prep;rrctl in Ut:CLWdarlCC \\tth the applt.ahle regulation.,
and the' I] t I P
:Vihuu�,h other prt]fCssiunals ma% iliac de\ -eloped certain portions of this
suhrrllttal package, inclusion of these materials under my signature and seal sgmitic; [hilt I lm\e rc\'nC\\cd this material pint
llu%t Judged It to be ,onsisiem with the proposed desig,l.
VO'1 L - In ;ICCol.LlU11CC Uifl' Genertl St11tt11CS 1 1.3-21a,6 A and 1 4?-215.613. vm% person who kt1 vmgllimiketi ill% take
statement, representation, (it certillcaiion in a[1\' application package sli,ill bt pillt\ of a Clal s 7 misdoilelllior, which Isla\
include a fine not to Caceud S 10.000, as well as Civil penaltles up to S25,000 rel' \ iulauon Glusrcpresenuttiun of the applicauori
information, irtCludillti iililurc W disclos4 any design non=compliarice Lt nh the applicable Rutz, and &Sign Critcri,l, nla\ subject
the North C arolirm-lieen,ed Protcs5ional Engineer to relcrral w the licensing board. (21 NC AC 50.0701 i
North Carolina Professional Engineer's Seal. si+„ nalkire, and date: Cl11"J �.
` �/
034361
1.
���rlUlrFllitl\L\\\\
Applicant's Certification per I5A NC"AC 0?'1•,0106(h):
1, jams Paliotu as , ;tttes[ that Lkk applic;1lion for Pahouras Force -laid Relocation
(Slgn.uurc A+.Hwm% tian]c from \I,I!;1W1 01; 14V,u I t ) illw1cet ~dine liont Appllc.ltion Iteir. 11 1 1
atlest that this application has been resie►%ed by me and is accul•ale and complete to tie hest of my kno\\'ledge.
1 nndersrtnd tkat if all r4quired parts of this appltcation are not completed and that il' ail iequned supporting LIOCtl11101tati011
and athiChnieilLS are not includod. this applicadon package is suhjw to being returned as mcompletc. I understand that and'
discharge of wastewater from titis nun -discharge sy.stern to surface waters or the land will result in an immediate ci librcenlellt
action that may include civil penalties, injunctive relief, mid'or Criminal proseeution. I \\ ill make nu Claim against the Division
of Water RCS0111-Ccs Should a condition of this permit he violated. I alsal uridt•I;.S(Mltl that If 1tll required parts of this applic'mion
package titre not Completed and that if ail regt[v-ed .,uppurting+ information and aila\'hments are nut included, this applicalu]n
package will he returned to the a, incomplete.
N(1TF — In accordance. With Cienetal Statutes and :.I., an\ IMSun wh+, I:Is+n_111411\ nlltkeS put\• false
statement, represrrltation, OF CCrlilic;nion ill ally ,ippli,:mion package shall be gulh\ ut ,. ('lass ti Ilti;dCl1WMl01-, \\'hick IMIN
include 11 fine not to cxCCCd S10,1100 a: \vCll aS c.\ it pen;J11jes llp to S25,000 per \-i+,huion
Si211i UN: l J Tom, J1 -- -- l).lLc. _
FORM: 171'A Wi-21 Pa"C 5 I l'S

HIGHFILL
May 24, 2022
NCDEQ-DWR
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
RE: Application Submittal
Paliouras Force Main Relocation
HIGHFILL Project No.: GEM2201
Dear Reviewer:
Highfill Infrastructure Engineering, P.C.
2703 Jones Franklin Road, Suite 201
Cary, North Carolina 27518
Tel [phone] NC Firm License No. C-2586
The Paliouras Force Main Relocation project consists of the relocation of a portion of an existing 3-inch
force main to accommodate for the construction of an Aldi Grocery store.
The existing 540 linear feet of 3-inch force main is previously permitted under Permit No. WQ0037048.
This application submittal serves to increase the length of permitted 3-inch force main from 540 linear
feet to 729 linear feet. In addition, 186 linear feet of 8-inch PVC gravity sewer is being added to the
collection system, increasing the total length of 8-inch gravity sewer from 270 to 456 linear feet.
A grinder unit and guiderail system will be installed in the existing wet well to ensure that the pump
station complys with 15A NCAC 2T, Minimum Design Criteria for the Permitting of Pump Stations and
Force Mains.
Finally, 8,100 GPD of wastewater was included under the original permit; however, this include 1,500
GPD for a Pharmacy that was never built. With the addition of the estimated 1,921 GPD for the proposed
Aldi Grocery store and by removing the 1,500 GPD dedicated for the Pharmacy, the revised flow tributary
to the Paliouras PS will be 8521 GPD. The PS will then convey the flow to the existing Town of
Hillsborough's collection system A'. other items listed in the existing permit shall remain.
Please find enclosed two copies of each of the following documents for review and approval:
• Fast -Track Form (FTA 06-21) and supporting documentation.
• Flow Tracking for Sewer Extension App`icat;ons (FTSE 10-18)
Also, please find the following:
• Application fee check in the amount of $480,00
Engineering is our profession. Service is our passion.

NCDEQ-DWR
May 24, 2022
Please contact me at 919-481-4342 or [e-mail] if you have any questions or concerns.
Sincerely,
HIGHFILL INFRASTRUCTURE ENGINEERING, P.C.
1
Jeremy Al en, PE
Project Manager
enclosures
HIGHFILL I Page 2

11%1%lnn of dater Re -sources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: GEMCAP Development
Project Name for which flow is being requested: Paliouras Force Main Relocation
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a.
WWTP Facility Name: Not owner of WWTP
b.
WWTP Facility Permit #: N/A
All flows are in MGD
c.
WWTP facility's permitted flow
NIA
d.
Estimated obligated flow not yet tributary to the WWTP
NIA
e.
WWTP facility's actual avg. flow
NIA
f.
Total flow for this specific request
.0050
g.
Total actual and obligated flows to the facility
NIA
h.
Percent of permitted flow used
NIA
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Average
Approx.
Obligated,
Pump
Pump
Daily
Current
Not Yet
Total Current
Station
Station
Firm
Flow**
Avg. Daily
Tributary
Flow Plus
(Name or
Permit
Capacity, *
(Firm / pf),
Flow,
Daily Flow,
Obligated
Available
Number)
No.
MGD
MGD
MGD
MGD
Flow
Capacity***
Palnc!
bC
WQ0037048
.086
.035
.004
.004
.008
.027
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Town of Hillsbrough
Downstream Permit Number: Unknown
Page l of 6
FTSE 10-18

III.• Certification Statement:
D- ) c �i ��-5 certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signature
/vlon bQ-r PC,I'oLkcrs rn�-er 9-
Title of Signing Df cial
Dale
Page 2 of 6
I=TSE 10-18

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: — GEMCAP Development
Project Name for which flow is being requested: Paliouras Force Main Relocation
More than one FTSE may be required far a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Town of Hillsborough WWTP
b. WWTP Facility Permit #: NC0026433
A11 flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
3.0
0.483
1.083
.0050
1.571
52
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design
Average Approx. Obligated,
Pump Pump Daily Current Not Yet Total Current
Station Station Firm Flow** Avg. Daily Tributary Flow Plus
(Name or Permit Capacity, * (Firm / p fl, Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
E. Brady WQ0035536 1.584 .6336 .340 .1158 .4558 .1778
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): WWTP
Downstream Permit Number: As Above
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I K. Marie Strandwitz, PE certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
3/18/2022
Signing Orcial Signature Date
Utilities Director
Title of Signing Official
Page 2 of 6
FTSE 10-19

rA1
March 23, 2022
NCDEQ-DWR
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
HIGHFILL
RE: Application Submittal
Paliouras Force Main Relocation
HIGHFILL Project No.: GEM2201
Dear Reviewer:
Highfill Infrastructure Engineering, P.C.
2703 Jones Franklin Road, Suite 201
Cary, North Carolina 27518
Tel [phone] NC Firm License No. C-2586
The Paliouras Force Main Relocation project consists of the relocation of a portion of an existing 3-inch
force main to accommodate for the construction of an Aldi Grocery store.
The existing 540 linear feet of 3-inch force main is previously permitted under Permit No. WQ0037048.
This application submittal serves to increase the length of permitted 3-inch force main from 540 linear
feet to 729 linear feet. In addition, 1,921 GPD of wastewater will be discharged from the Aldi Grocery
store to the existing Paliouras collection system which will then be conveyed to the existing Town of
Hillsborough's collection system. All other items listed in the existing permit shall remain.
Please find enclosed two copies of each of the following documents for review and approval:
• Fast -Track Form (FTA 06-21) and supporting documentation. 'Covent Quh11`M1
• Flow Tracking for Sewer Extension Applications (FTSE 10-18) pelt o��nv
G �
Also, please find the following:
• Application fee check in the amount of $480.00 ge$tOP
Please contact me at 919-481-4342 or [e-mail] if you have any que vm)'�oncerns.
Sincerely,
HIGHFILL INFRASTRUCTURE ENGINEERING, P.C.
0, li--
Jeremy Allen, PE
Project Manager
enclosures
Engineering is our profession. Service is our possion.

race r��f-%c L,
mmorpn
71,
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nig"�rlii
. LIMITED LIABILITY COMPANY ANNUAL REPORT
■
;8i7p17
NAME OF LIMITED LIABILITY COMPANY: GEMCAP Development, LLC
SECRETARY OF STATE ID NUMBER. 1444920
REPORT FOR THE CALENDAR YEAR: 2021
SECTION A: REGISTERED AGENT'S INFORMATION
STATE OF FORMATION: NC
1. NAME OF REGISTERED AGENT: Kilpatrick Townsend & Stockton LLP
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
1444920
CA202105501575
2124/2021 10:00
Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
1001 West Fourth Street
1001 West Fourth Street
Winston Salem, NC 27101-1029 Forsyth County Winston Salem, NC 27101-1029
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Commercial Development and Construction
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
418 N. Marshall St #201
Winston Salem, NC 27101
5. PRINCIPAL OFFICE MAILING ADDRESS
418 N. Marshall St #201
Winston Salem, NC 27101
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Paul Gray Williams _ NAME: George V Dunn
TITLE: Vice President TITLE: Managing Member
ADDRESS:
ADDRESS:
418 N. Marshall St #201 418 N. Marshall St #201
Winston-Salem, NC 27101 Winston-Salem, NC 27101
NAME:
TITLE:
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
George V Dunn 2/24/2021
SIGNATURE DATE
Form must be signed by n company Official Ir:ted under Section C of This form.
George V Dunn Managing Member
Print cr Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO: secretary of State, Business Registration Division, Post Offi a Bcx 29525, Raleigh, NC 2762"525

SOSID: 1444920
Date Filed: 5/12/2015 9:11:00 AM
Elaine F. Marshall
State of North Carolina North Carolina Secretary of State
Department of the Secretary of State C2015 126 01007
Limited Liability Company
ARTICLES OF ORGANIZATION
Pursuant to §57D-2-20 of the General Statutes of North Carolina, the undersigned does hereby submit
these Articles of Organization for the purpose of forming a limited liability company.
I . The name of the limited liability company is: GEMCAP Holdings, LLC
2. The name and address of each person executing these articles of organization is as follows:
Kristan D. Bryant, Organizer
100 N. Cherry Street, Suite 600
Winston-Salem, NC 27101
3. The name of the initial registered agent is: George V. Dunn
4. The street address, mailing address and county of the initial registered office of the limited liability
company is:
Number and Street: 210 W. Fourth Street, Suite 200
City, State, Zip Code: Winston-Salem, NC 27101 County: Forsyth
5. The limited liability company has a principal office. The street address, mailing address and county
of the principal office of the limited liability company is:
Number and Street: 210 W. Fourth Street, Suite 200
City, State, Zip Code: Winston-Salem, NC 27101 County: Forsyth
6. These articles will be effective upon filing.
This is the 0 day of May, 2015.
Krastan D. Bryant, Organizer
CORPORATIONS DIVISION P.O. Box 29622 RALEIGH, NC 27626-0622
(Revised January 2014) 1 (Fonn Ir01)
#649868Y2