WQ0043999_Application (FTSE)_20221121

RECEWW/NCDENRMM
W01-CDI-I39q J
McCLURE'"
1700 Swift Street, Suite 100
North Kansas City, MO 64116
P 816.756.0444
www.mccIurevisi6n.com
November 17, 2022
0
Division of Water Resources
Washington Regional Office
U943 Washington Square Mall
Washington, NC 27889
Re: Elizabeth City, NC Petco Sanitary Sewer Narrative
Dear Reviewer:
NOV 21 2022
water Qua, ty,
w �Qffme
We are proposing to construct a private pump station and forcemain to serve the property addressed as 117
Tanglewood Drive in Elizabeth City, North Carolina. This will be a duplex pump station with all necessary
controls and alarms and hardware as required by NCDEQ. The forcemain will be a 1 .5" Schedule 80 line that
traverses the adjacent north property along its west side in an existing utility easement. The connection manhole
is at the terminus of Commerce Boulevard along the west side of Tanglewood Shopping Center.
This application package includes this narrative letter, completed application, flow tracking form, site map, and
North Carolina registration for PC -Elizabeth City, NC-1-UT, LLC.
Thanks so much for your help with this project. Please let me know if any additional information is needed to
review our permit application.
uiiuii rciuN
Team Leader

State of North Carolina
NOV 2 1 2022 Department of Environmental Quality
RDivision of Water Resources
D_ W_ R Water CEW TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INS T UM: FTA 06-21 & SUPPORTING DOCUMENTATION.
eglTOa Qryice
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump Stations/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300, Division policies, and good engineering practices.
While no upfront engineering design documents are required for submittal; in accordance with 15A NCAC 02T .0305 ft design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T:0303:
Projects -not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (Iv1DC) documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may be digital) of Application and Supporting Documents
® Required unless otherwise noted. Signatures on original must be "wet ink" or secure -digital signatures.
Please do not submit engineering design plans with the application unless specifically requested,
B. Cover Letter/Narrative Description (Required for All Application Packages):
List all items included in the application package, as well as a brief description, of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation'required, etc.
➢ 'Include the permit number/status of any other required se.wer.p=nits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
�. Submit a check or money order in the amount of $480.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast. Track Application (Required for All Application Packages, Form FTA 05-21):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due td space restrictions, attachments to the application maybe made.
® If,the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secreta orb f-State.
❑ If the Applicant Type in Item L2 is Via. partnership or d/b%a, enclose a copy of the. certificate filed with the Register of Deeds in
the county of business. -
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification'on Page 5 of the application shall be signed in accordance with15A NCAC 02T .0106lb1. Per
15A NCAC 02T .0106(c), as alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria mil NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Pagel of 3

E. Flow Traeking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
The flow acceptance indicated in form FTSE must. not expire prior to permit issuance and must be dated less than one year
prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-215.67(a).
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
❑ Submit an 8.5-inch x. 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
❑ Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G, Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative Identifyiug the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application form itselfshould include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
❑ The narrative should .clearly Identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed contractor,
stating that "the portable power generation unit or portable, independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump 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. (Required at time: of certification)
L Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T..011-5(ak l) provide the Certificate of Public Convenience and Necessity'from the North Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension, or
❑ Provide a letter from the North Carolina Utilities'Commission's Water and Sewer Division Public Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise approval
is expected. -
J. Operational Agreements (Applications from HO kTOA and Developers for lots to be sold}:
❑ Home/Propeit_y Owners' Associations . .
❑ Per 15A NCAC 02T .0115(c) submit the properly executed Operational Agreement (FORM. HOA),
El Per 15A NCAC 02T ,0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per,15A NCAC 02T .0115(b); submit the properly executed Operational Agreement (FORM: DEV).
.For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION- AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Renlonal-Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Sectton
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Realonal Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
(704) 663-16N
Stanly, Union
[phone] Fax
Raleigh RGalonal Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water GlValtly Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washinaton Retjlonal Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office.
127 Cardinal Drive. Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
(910). 796-7215
[phone] Fax
Winston -§slam Realonal Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie; Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
-
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM; FTA 05-21 & SUPPORTING DOCUMENTATION
-Pa&e 3 of 3

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application 9umber: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: PC -Elizabeth City, NC-1-UT, LLC (company, municipality, HOA, utility, etc,)
2. Applicant type: ❑ Individual ®Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Tommy Waters per I5A NCAC:02T .0I06(b)
Title: Vice President
4. Applicant's mailing address: 4747 Williams Ddye.
City: Georgetown State: TX Zip: 78633-
5. Applicant's contact information:
Phone number: 512) 819-4Email Address: twaters(a�embreegroup.eom
It. PROJECT INFORMATION:
1. Project name: Elizabeth City, NC - Petco
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
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: WQ00�
3. County where project is located: Pasquotank
4. Approximate Coordinates (Decimal Degrees): Latitude: 36 2936° LongiWde: - 6� 2991°
5. Parcel ID (if applicable): 7993569601 '(or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I. Professional Engineer: Jason DeWald License Number: 046626
Firm: McClure Engineering Company
Mailing address: 11031 Strang Line Road
City: Lenexa State. KS Zip: 66215-
Phone number;.(2j1) 888-7800 Email Address: jdewald(a�mci urevi�ion.com.
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Rogerson WWTF Permit Number. NCO02591 I
Owner Name: Elizabeth City
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0031 54
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Names} .
El Force Main
FORM: FTA 06-21 Page 1 of 5

Nri. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Udlity, has a Certificate of'Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A
2. If the Applicant is a Developer of tote to be sold, has a Aevelo�Nrational Agre n=t (FORM: DEV) been nttached?
0 Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners` Association, has an HQAlPOA Operational Aor gment (FORM: HOA) 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 (individually Owned) ® Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) El Retail with food preparation/seMce ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical !'dental / veterinary facilities ❑ Swimming PoolIClubhouse
❑ Food and drink facilities ❑ Church ❑ SwimmingPool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 0 % Domestic j-U % Commercial Q % Industrial (See 15A NCAC 02T .0103(201)
If Industrial, is there a Pretreatment Program in ef-ect7 ❑ Yes M No
6. Hasa flow reduction been approved underl5ANCAC 02T .0114(f)? ❑ Yes Z No
> ff ves, provide a copra of Row reduction approval letter with this eyoUc2dou
7. Summarize wastewater generated by project•.
Establishment Type (see 02T.0I14(f))
Daily Design Flow °b
No. of Units
now
Retail Store
I00 gaVl,M0 sf
N/A
1,090 GPD
gaV
GPD
gaV
GPD
gaV
GPD
gaV
GPD
gaV
GPD
Total
GPD
a See 15A NCAC 021.0114(b). (d). (e)(l) and (c)(21 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 rends as defined
in G.S. 42A-4).
b Per 15A NCAC 02T,.0114(c), design Row rates for establishments not identified [in table 15A NCAC 02T,0114] shall be
determined using available How data, water using fixtures, occupancy or operation patterns, and other measured data.
B. Wastewater generated by project: l ,090 GPD (per l 5A NCAC 02T .01 l4)
Y Do not include future flows or previously permitted allocations
If permitted flow is zero, please indkat+e why:
❑ Pump Station/Force Main or Gravity Sewer where flow 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: IssuanceDate:
❑ Rehabilitation or replacement of existing sewers with no new Row expected
❑ Other (Explain):
FORM: FTA 06-2 l Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Se*.ers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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 requirements is not allowed and a violation of the MDC
VM. PUMP STATION DESIGN CRITERIA (If Applicable) -_02T .0305 & MDC. (Pump SCAlons/Force. Mainsl:
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Elizabeth City, NC - Petco
2. Approximate Coordinates (Decimal Degrees): Latitude: 3 .2 Longitude:-76.2991'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.038 mullions gallons per day (firm capacity)
➢ This,should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 21 gallons per minute (GPM) at 63 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
1.5
504
Sch 80 PVC
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C. Lb. ® Grinder Pump ❑ Mechanical liar -Screen ❑ Other (please specify). .
6. Power reliability in accordance with 15A-NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(13)
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Mast 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 I5A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
Portable pumping unit with 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 ofall 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 power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS - (0213.0200 & 15A NCAC 02T .0305(f)):
1. Does theproject comply with all separations/alternatives found in 15A NCACO2T .0305(fl & (a)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum senarstinns that shall he nrnvided fnr sewer systemc-
Setback Parameter*
Separation. Required
Storm sewers and other utilities notlisted below (vertical)
1$ inches
'--Water mains (vertical - water over sewer preferred; 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 H impounded reservoirs used as a source of drinking water, 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 (see item IX.2)
50 feet
**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 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 fbet or more vertical height
10 .feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
i It noncompliance with V-) LWOM or (g), see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) 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 Surface Water Classifications webpag
2. Does this project comply with the minimum separation requirements for water mains? ❑ Yes ❑ No ® N/A
If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed 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 requirements for situations where separation cannot be met.
➢ No variance is required.if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river baser subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ® No
This 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?
Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. 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 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 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the Sewer.
Siphons and sewers suspended through interference/conflict boxes require a .variance approval.
➢. If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every slx-months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permlttee's individual System -Wide Collection permit.
FORM, -FTA 06-2 I Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump' Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Cri(eria (latest version) as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents. for review to the Central Office. Approval of the request will. be Issued
concurrently with -the approval of the permit, and proiects requiring a variance approval may be subiect to I.onQer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be _a
sie►ifficant portion of the project, the full technical review is required.
2. Professional Engineer}s Certification: Eli
( 1
l/e m, l , attest that this application for G l i ��.? (�'[� 6 tV, ��r A 60
(Professional Engineer:a name from Application Item 1111.) (Project Name from App cation Item II: I )
has been reviewed 'by me and Is accurate, complete and consistent with the information supplied in the plans,
speciffeatlonsi engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version). and the Minimum Design Criteria for the -Fast -Track Permitting
of Pump Stations and Forge 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 desig
n.
NOTE --.In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may,
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance: with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
ll Oslo,
North Carolina Professional Engineer's seal, signature, and date:
•'Egg/� •2 ; I
.i
SF�AI- .I
046626
a �
3. 'Applicant's Certification per 15A NCAC 02T .0106(b): f t vs LZ
L PC -Elizabeth City; NC-1-UT, LLC , attest that this application for Elizabeth City, NC - Petco
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item 11.i.)
attest that this application has been reviewed by we 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 mot included, this application package is subject to being returned as.incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief; and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 14 -2 5. S, any person who knowingly' makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,006 as well as civil penalties up to $25,000 perviolation.
PC -Elizabeth City, NC-1-UT, LLC
By: Embree Development Group, In , Member
Signature:; Date: 20Z2
Tommy Vdiers, Vice -President of Real Estate
FORM. FTA 06-21 Page 5 of 5

NOV 212022
Water QuaAtY
Regional Operations Section
Washington Regional Office
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: PC Elizabeth City, NC-1-UT, LLC
Project Name for which flow is being requested: Elizabeth City, NC - Petco
More than one ME 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: Rogerson Wastewater Treatment Facility
b. WWTP Facility Permit #: NCO025911
All flows are in MGD
c. WWTP facility's permitted flow 4.5
d. Estimated obligated flow not yet tributary to the WWTP , 0.940
e. WWTP facility's actual avg. flow 3.36
f. Total flow for this specific request 0.0015
g. Total actual and obligated flows to the facility 3.3615
h. Percent of permitted flow used 74.70%
H. 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:
Pump
Station
(Name or
Number)
Walmart
Knobbs
0-11
(A)
Design
Average Daily
Firm Flow**
Capacity, * (Firm, / pf),
MGD MGD
(B)
Approx.
Current Avg.
Daily Flow,
MGD
1.152 0.4608 0.0843
6.48 2.5920 0.8497
(C)
(D)—(B+C)
(E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity***
0.0109
0.0952
0.3656
0
0.8497
1.7423
* The Firm 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 (pf) not less 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): Walmart
Downstream Permit Number:, WQ0031954
Page l of 6
PTeF nd-1(

III. Certification Statement:
I Montique_McClary______,__ _ _ _ _— _ 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
fowl indicates acceptance of this wastewater flow..
7 J-0 • P,7;�--
Date
Page 2 of 6
PT RF. 04-16

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section Il where Available
Capacity is < 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
and MGD of the Available Capacity (E) in Pump Station
.; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to
allow this flow to be permitted, without a significant likelihood of over -allocating capacity in the
system infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste
disposal system.
' C�
si g'iring 0' Jicial S gnatu
, 2,0 ;2c).2; -
Date
Page 3 of 6
FTSF. 04-1 Fi

Instructions for Flow Tracking/Acceptance form (FTSE) and Planning Assessment Addendum (PAA)
Section I
a WWTP Facilit,LName: Enter the name of the WWTP that will receive the wastewater flow.
b. Vi)W P Facility. Permit 4: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facilif�'s permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not Mt tributary, to the W V P. MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for information on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years
and reconciled their flow records, to the best of their ability, so it is known how much flow has been
obligated and is not yet been made tributary to the WWTP, in accordance with local policies and
procedures employed by the reporting entity.
e. WWTP facility's -actual ay. flow, MGD: Previous 12 month average.
f. Total flow for this_sMific request. MGD: Enter the requested flow volume.
g. Total actual and oblig4jtA flows to the facility; MGD Equals [d + e +
h. Percent of bermitted flow used: Equals [(g / c)* 100]
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD. There is a proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h. = 53.6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c.
= 6.0 MGD
d.
= 0.515 MGD
e.
= 2.73 MGD
f.
= 0.102 MGD
g.
= 3.349 MGD
h.
= 55.8 %
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 04-16

the pump station name or number and approximate pump station firm capacity, approximate design
average daily flow (A) approximate current average daily flow (B), and the obligated, not yet tributaryflow
through the pump station (C) for each pump station that will be impacted by the proposed sewer extension
project. Calculate the total current flow plus obligated flow (D=B+C) and the available capacity (E=A-D).
Include the proposed flow for this project with other obligated flows that have been approved for the pump
station but are not yet tributary (C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as
per the Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of not
less than 2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump
station if the system has future specific plans related to capacity that should be considered in the permitting
process.
(A)
(B) (C) cDr(B+C)
Obligated,
Design
Approx.
Not Yet
Total Current
Firm
Average
Current Avg.
Tributary
Flow Plus
Pump Station Capacity
Daily Flow
Daily Flow,
Daily Flow,
Obligated
(Name or Number) MGD
(Firm / pf)
MGD
MGD
Flow
Kaw Creek PS _ 0.800,_ _,
_0.320
0.252
_ 0.080 _
_ 0.332
Valley,Road_PS _ 1.895 0.758 0.472
(E)—(A-D)
Available
Capacity*
-0.012
0.135 0.607 0.151
Page 5 of 6
FTSF. 04-16

Plannine Assemment Addendum -Instructions.
Submit a planning assessment addendum for each pump station listed in Section II where available capacity
-is <0.
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether
there is significant likelihood that needed improvements or reductions in obligated flows will be in place
prior to activating the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to
manage the flow without capacity related sanitary overflows and must take all steps necessary to complete
the project or control the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned
project in the future not yet funded but in a formal plan adopted by the system. The system should carefully
weigh the certainty of successful timely project completion for any expansion, flow management diversion
or infiltration and inflow elimination projects that are the foundation of a planned solution to capacity
tracking and acceptance compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080
MGD of the committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 001
MGD per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in. ; and/or
d. The following applies:
and fundine for a caoi
entitled
obligted not yet tributa!y flows in amounts that exceed the firm pump- station capacities identifiedin
Section II above. - - _
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
Page 6 of 6
FTRF. 04-16

NORTH CAROLINA
Departmentof the Secretary of StaW
To all, whom these, presents shall. come, Greetings:.
L ELAINE F. MARSHALL, Secretary- of State of the State of North Cdrotina,, do hereby'
certify the following and hereto attached to be a :true copy of
APPLICATION FOR CERTIFICATE OF AUTHORITY
OF
PC-ELIZABETH CITY, NC-1-UT, LLC`
the Original of which was fried in this office on the, 11th day of'July, 2022. - -
o
Ii1' ;•t� f O ' n n
IN WITNESS WHEREOF; I havt hereunto set,my,
hand and affixed my official seal.at the City: of
Raleigh, this IIth-day of.July,.2022.
Certification#, C202218900626-1 Reference# C202218900626-1 Page:r I of
Verify this certificate -online at.httpsJ/www:sosne.gov/verification
Secretary of State

State of North Carolina
Department of the Secretary -of State
SOSID: 2449589
Date Filed: 7/11/202210:12:00 AM
Elaine F-Marshall
North Carolina Secretary, of,State
C2022 1.89- 90626
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR LIMITED' LIABILITY COMPANY
Pursuant to §57D-7-03 of the General Statutes of North Carolina, the undersigned limited liability company hereby applies fcr•a;
Certificate of Authority to transact business in the State of North Carolina, and for that purpose submits the following:
1. The name of the limited liability company is PC -Elizabeth Clly; NC-1-UT, LLC
and if the limited liability company name is unavailable for use in the State of North Carolina, the name the limited
liability company wishes to use is
2. The state or country under whose laws the limited liability company was formed is Utah
3. Principal office information: (Select either a or b.)
a. x The limited liability company has a principal office.
The principal office telephone number. 512-819-4735
The street address and county of the principal office of the limited liability company is:
Number and Street: 4747 Williams Drive
City: Georgetown Stale: TX Zip Code: 78633 County:
The mailing address, If different from die street address, of the principal office of the corporation is:
Number and Street: -
City: State: Zip Code: County:
b. The limited liability company does not have a principal office.
4. The name of the registered agent in the State of North Carolina is: COGENCY GLOBAL INC.
5. The street address and county of the registered agent's office in the State of North Carolina is:
Number and Street: 212 South Ttyon Street, Suite 1000
City; Charlotte State: NC Zip Code: 28281 County: Mecklenburg
6. The North Carolina mailing address, tf different front the street address, of the registered agent's office in the State of North
Carolina is:
Number and Street:
City: State: NC Zip Code: County:
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 RALEIGH, NC 27626=0622
(Revised July 2017) (Form-L-09)
Certification# C202218900626-1 Reference# C202218900626- Page: 2 of 4

4
Do'cusig E velope ID: 3339D175-5921-45DF-AD21-792B3C8731AA
APPLICATION FOR CERTIFICATE OF AUTHORITY
Page 2
7. The names, titles, and usual business addresses of the current company officials of the limited liability company are:
(use attachment if necessary) (This document must be signed by a person listed lit !tent 7.)
Name and Tlrle
Rocky Hardin, CFO
Business Address
4747 Williams Drive Georgetown, TX 78633
8. Attached is a certificate of existence (or document of similar import), duly authenticated by the secretary of state or other bfftcial
having custody of limited liability company records in the state or country of formation. The Certificate of.Existence must be
less than sic months old. A Photocoay of the certification cannot be accented.
9. If the limited liability company is required to use a fictitious name in order to transact business in this State, a copy of the
resolution of its managers adopting the fictitious name is attached.
10. (Optional): Please provide a business e-mail address: Privacy Redacti011
The Secretary of State's Office will a -mail the business automatically at the address provided above at no cost when a document
is filed. The e-mail Provided will not be viewable an the website: For more information on why this service is offered, please see
the instructions for this document.
11. This application will be effective upon filing, unless a delayed date and/or time is specified:
This the 7th day of duty , 20 22
PC -Elizabeth City, NC-1-UT, LLC
0 2$Qwd gypme of Llndied Liability Company
7�
x nantre ojCompatty Official
Rocky Hardin, CFO
Type or Print Maine and Ttlle
Notes:
1. FWng,fee is $250. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION
(Revised July 2017)
P.O. BOX 29622
RALEIGH, NC 27626-0622
_(F6r7n.L=09).
Certlfication# C202218900626-1 Reference# C202218900626- Page: 3 of 4

Utah Department of Commerce
Division of Corporations & Commercial Code.
160 East 300 South, 2nd Floor, PO Box 146705
Salt Lake City, UT 84114-6705
Service Center. (801) 5304849
Tall Free: (877) 526,3994 Utah Residents
Fax:[phone]
Web Site: h1tp:/AYvrW,commermutah.8ov
O'1107L21YI2' _ .: .
12548776-016007072022-324907.6
CERTIFICATE OF EXTSTENCE f.
Registration -Plumber: 12548776-0160
Business Name: PC-ELIZABETH-CITY, NC-1-UT; LLC
Registered Date:. November 02, 2021
Entity Type; LLC - Domestic
Status: Current
The Division of Corporations and Commercial Code'of the State, -of Utah, custodian of -the records of
business registrations, certifies that the business entity on this. certificate -is authorized to transact business -and was
drily registered under -the laws of the. State of Utah. The Division also certifies that this entity has paid .all fees_ and
penalties owed to this state; its Most recent annual report has been filed by the Division (unless Delinquenty,,and,,
that Articles of Dissolution have not been filed. .
Leigh Veillette
Director
Division of Corporations and Commercial'Code
Page,l,Of,l
Certifleation# C202218900626-1 Reference# C202218900626- Page: 4 of 4

.._ r NORTH CAROLINA
0 Department of the Secretary of State
CERTIFICATE OF AUTHORITY
I, ELAINE' F. MARSHALL, Secretary of State of°the State of Forth Carolina, do hereby
certify that
PC-ELIZABETH CITY, NC-1-UT, LLC
having filed on this date an application conforming, to the requirements ;of the General
Statutes of North Carolina,. a, copy of which is hereto attached, is hereby granted
authority to transact business in the: State of -North Carolina.
IN WITNESS, WHEREOF, I have hereunto set.,
my hand and affixed my official seal at the City
of'Raleigh, this I Ith.dny of Jtily,,,2022.
Scan ;to verify online:
Documentld: C202218900626 Secretary of State
Verify this certificate online at'https:/hvtv%v.sosne.gov/verification

ex xxrianesra
......-.,e..._..�
_r. OWSO a uuxx xnroasn SJSII� z��x.u'a.nn nx •wmsve vwnzx aunuazurm vn

00
0
LD
0
0
x
D
(a
CD
a)
r
Em
-0
0
:_
O
(D
"S
°
n
a
a o
N
3
°'
N0
N
p
O
N
N
O
p
O
N
N
O
N
N
Orj
N
N
O
N
N
N
V�
O
CD
h
Q
T
aJ
T_
n
(DD
0O
rr
3
W
fD
Q
(JJ
T_
O
O
�
S
O
N
N
N
A
N
W
N
N
W
A
rt
00
W
0
00
t0
111
In
J
N
00
J
N
00
t0
0)
A
W
Ol
W
x$
MN
CO
m
00)
c14 ov
W
N
W
ID
O
A
W
W
00
F+
(n
A
ul
0)
0)
O
t0
J
A
W
W
lA
00
W
W
W
N
W
00
W
W
J
V
N
W
F+
W
W
W
t0
D
m
v
<
ao
a)
60
'i7
cr
N
S
rr
0
Lri
Z
O
O
N
N
O
N
N