WQ0044668_Application (FTSE)_20230811

HAGEN
ENGINEERING, PA
TO: Fayetteville Regional Office
Water Quality Section
225 Green Street Suiet 714
Fayetteville NC 28301-5094
910-433-3300
PROJECT: Overlook at Pineridge Apartments
PLEASE FIND ATTACHED:
ITEM
1 Cover Letter
1 Fast Track Applications
1 Flow Tracking Applications
1 Street Level Maps
1 USGS Topo Maps
1 $480 Check
1 Secretary of State Proof Business
1 Set of Design plans
Note:
Tim Shaw
TRANSMITTAL
DATE: 8/10/23
REOFIVED
DEQ-FAYFTTEUILLE REGIONAL OFFICE
DATED
1 /10/2020
1 /10/2020
1 /10/2020
1/10/2020
1 /10/2020
Hagen Engineering, PA PO Box 14851 Greensboro, NC P-336-404-9796 [e-mail]

HAGEN 3859 Battleground Ave, Suite 300 Phone: [phone]
ENGINEERING, PA Greensboro, NC 27410 [e-mail]
Fayetteville Office
Water Quality Section
225 Green Street Suite 714
Fayetteville NC 28301-5094
910-433-3300
RE: Overlook at Pineridge Apartments
NCDEQ Submission
Private Sewer Permit
Cover Letter
August 4, 2023
6�ECEI`�,��
AUG 11 202
3-'a 3 RlZ-/
DEQ-FAYETTEVILLE REGIONAL OFFICE
The purpose of this cover letter is to outline the contents of this Private Sewer Permit
application package as well as to provide of a summary of the project to which is pertains. This
Overlook at Pineridge Apartments development is a 269 unit multifamily complex which will
require an estimated peak flow of 70,000 GPD for utility consumption. The project will be
comprised of private gravity sewer main. In terms of private sewer, this project will be comprised
of 1474 LF of 8" PVC. Within this submittal package you will find the following items:
1) $480 check for the Public Sewer Permit
2) One completed DWR Fast Track Sewer System Extension application
3) One executed FTSE 04-16
4) One 8.5" x 11" USGS Topo Map
5) One street level map (aerial)
6) Secretary of State Proof of Business
7) 1 CD with digital copy of the above items
Thank you,
Tim Shaw, PE
Hagen Engineering, PA
336-286-3350

State of North Carolina
Department of Environmental Quality
D%1V_R Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
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 Ilood enlzineerin$! practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), 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 frill technical review):
r Projects that do not meet any part of the minimum design criteria (MDC) documents;
r Projects that involve more than one variance from the requirements of 15A NCAC 02T;
Y Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
y Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains),
r- 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
p 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):
FxJ List all items included in the application package, as well as a brief description of the requested permitting action.
y Be specific as to the system type, number of homes served, flow allocation required, etc.
r Include the permit number/status of any other required sewer permits (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.
r Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
El Submit the completed and appropriately executed application.
If necessary for clarity or due to space restrictions, attachments to the application may be 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 Secretary of State.
❑ If the Applicant Type in item 1.2 is a 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 with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Page I of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (if Applicable):
F] 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.
r 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).
Intergovermnental 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.
r General location of the project components (gravity sewer, pump stations, & force main)
r Downstream connection points and permit number (if known) for the receiving sewer
[ Include an aerial location snap showing general project area (such as street narnes 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 identifying the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application form itself should 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.
r 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)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity fi-om 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 HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .01 15(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .01 15(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 Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional 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
[phone]
[phone] Fax
Winston-Salem Regional 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 Pabe 3 of 3

State of North Carolina
Application Number: Q00L4LA(D(pg (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
ZP 378 Southern P1nes II, LLC
1. Applicant's name: (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual
❑ Corporation ❑ General Partnership
❑ Federal
❑ State/County ❑ Municipal
Adam
3. Signature authority's name:
Tucker
per 15A NCAC 02T .0106(b)
Title: Principal
4. Applicant's mailing address: ill
Princess St
City: wilmingtonState: NC
Zip: 28401_
5. Applicant's contact information:
Phone nuiltber: ( 91-0)800 _ 9231
Eniall Address: adamtuckerazdc. com
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
I . Project name: Overlook at Pir_eridge Apartmen s
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: Moore
4. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - 79.4153
20220587
5. Parcel ID (if applicable): (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Tim !z. Shaw License Number: 050770
Fit -ill: Hagen Engineering, PA
Malling address: 3859 Battleground Ave, Suite 300
City: Greensoro State: NC Zip: 27410 -
Phone number: (�36 )286 _3350 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Permit Number:
NC0037"D08
Owner Name: Moore County
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ C500034
2. Downstream (Receiving) Sewer Information: H inch E Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 11031
OwtlerNatlle(s): Moore County Utilities
FORM: FTA 06-21 Page 1 of 5

V1. GENERAL REQUIREMENTS
l . if the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No F-71 N/A
2. 1f the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No 0 N/A
3. if the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.01 15(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) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ❑ No
If ves, provide a cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow a,h
No. of Units
Flow
1 or 2 BR unit Apartment
240 gal/
247
59,280 GPD
3 BR Unit Apartment
360 gal/
22
7,920 GPD
Clubhouse
25 gal/
4
100 GPD
Car Wash/Maintenance
1200 gal/
1
1200 GPD
Swimming Pool
10 gal/
50
500 GPD
Cabana
250 gal/
4
1000 GPD
Total
70,000 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(l) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow pet -
dwelling; proposed unlulown 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 .01 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project:70,004D (per 15A NCAC 02T .0114)
y Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate 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: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 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
g
1474
c9C0 PVC
r> Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
y Section III contains information related to minimum slopes for gravity sewer(s)
y Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions 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): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.l.b. ❑ Grinder- Pump ❑ Mechanical Bar 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)(B):
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 NCACO2T.0305(h)(l)(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 of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timefrannes, 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 — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(j) & (g)? El Yes ❑ No
15A NCAC 02T.0305(f) contains minimurn separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 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-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-1 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 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
If noncompliance with 02T.0305( 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 webpage
2. Does this project comply with the minimum separation requirements for water mains? ❑ Yes [:]No ❑ N/A
Y 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
y Please provide supplementary information identifying the areas of non-conformance.
r See the Division's draft separation requirements for situations where separation cannot be met.
Y 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: © 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 F_x1 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)? FlYes ❑ 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 0 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.
y 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 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 of 5

X. CERTIFICATIONS:
1, Does the submitted system comply with 15A NQAQ One Minimair-i ' c-,ii gyn _CTJfU.,;-,6a_ for the Pennitting q iJ'anrn Stations
and Force Mains LILatcst versiorth and the ersion' as applicable?
S Yes [I No
teqh�fcikl rev ew s
_qgfred-
2. Professional Engineer's Certification:
attest that this application for \J ei— (0 e-
(professional Engincer's nee fturn Application It= Ill. I (Pniject Name fmin Application Item
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 Nq,606607P))
CAR 04
North Carolina Professional Engineer's seal, signature, and date:
�,s 10 -
SEAL
050770
3. ApplicanVs Certification per 15A NCAC 02T.0106(b):
1, Adam Tucker attest that this application for Overlook at Pine Ridge
(Signature Authority Name fmm Application Item 1.3.) (Project Name from Application Item 11. 1)
attest that this application has been reviewed by me and Is accurate and complete to the best of my knowleft
I understand that if all tequired parts of this application are not completed and that if all required supporting documentati
and attachments are not included, this application package is subject to being returned as incomplete. I understand that
discharge of wastewater from this non-dischuge system to surface waters or the land will -1
action that may include civil penal6es, injunctive relief, and/or criminal prosecution. 1 will make no claim against the Divisi
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this applicati
package are not completed and that if all required supporting information and attachments are not included, this applicati
package will be returned to me as incomplete. I
NOTE — In accordance with General Statutes 143-215.6A and 143-' 15.6B. any person who knowingly makes any false
statement, representation, or cerfification in any application package shall be guilty of a Class 2 misdemeanor, wWch may
include a fine not to exc�cd $ 1 civil penalties up to $25,000 per violation.
Si gpmn(re: _V 8/10/2`3
f%
DaW
FOP-Tviv FTA 06-1-1 Page 5 of 5

State of North CarolinR,
Department of Environmental Quali
Division of Water Resourc)
Flow Tracking for Sewer Extension Applications
(FTSE 10- 18)
Entity Requesting Allocation: Town of Southern Pines
Project Naine for which flow is beinc, requested: Overlook at Pii
More thaii oize FTSE may be reqtdredfor a sbigle project if the o wizer of the WWTP is itot respoiisiblefior all pump
statioizs aloiig the route of the proposed waste waterflo w,
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b, WWTP Facility Permit #:
AlIflows 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 0.070 MGD
a
b. Total actual and obligated flows to the facility
h. Pet -cent of permitted flow used
11. 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)
Desion
Pump Pump
Average
Station Station
Firm Daily Flowq*
(Name or Permit
Capacity, (Firm / pl),
Number) No.
MGD MGD
(B)
(C)
(D)=(B+C)
(E*(A-D)
Obligated,
Approx,
Not Yet
Total Current
Current
Tributary
Flow Plus
Ava. Daily
Daily Flow,
Obliaated
Available
Flow, MGD
MGD
Flow
CapacIty***-
The Firm Capacity (design flow) of any pump -station isdefinedas the maximum _Pumped -flow
that can be achieved with the largest pump taken out of ser-vice.
** 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 Southern Pines
Downstream Permit Timber: WQCS00309
Paoe I oll 6
Z_"

111. Certification Statement:
t'c k e, 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 Linder normal circumstances, given the implementation of the planned irripl-Lovenlentts)
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 1.1 plus all attached planning, assessment addendums for which .1
any the responsible party. Signature of this form certifies that the receiving collection system or treatment
L- - 0
works has adequate capacity to transport and treat the proposed new wastewater,
Qfticicil Signature Ahe
Tifle oj-'Signing (Vicial
Pa(-,e of 6

Entity Requesting Allocation:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flo%� Tracking for Sewer Extension Applications
(FTSE 10- 18)
Town of Southern Pines
Project Name for which flow is being requested: Overlook at Pineridge Apartments
.41orethan one ,l"TSEtnqv be required fora single project tfthe owner of the if') ITPisnotresponsiblefor all pump
stations along the route of the proposed )wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moore County Water Pollution Control Plant
b. WWTP Facility Permit -NC 0037508
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
All flows tire in IIIGD
10.0000
0-94413
4.96300
0.07000
1�
5.9771-)
59.7713
11. 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)
Design
Pump
Pump
Averaize
Approx.
Station
Station
Firal Daily Flow"
Current
(Name or
Permit
Capacity, (Firm / pl),
Avg. Daily
Number)
- -- ---- ------
No.
MGD MGD
-------
Flow, NIGD
-- ------ ---- — -----------
(C)
(D)=(B+Q
(E)=(A-D)
Obligated,
Not Yet
Total Current
'FribUtal-N!
Flow Plus
Daily Flow,
Oblilgate(l
Available
MGD
Flow
Capacity***
The Firm Capacity (dvsign flow) of any pump station is del'ined as the ma-dn-ttmi pumped flow
that can be achieved with the largest puiup taken out.of service.
Design Averaue DajIv Flow is the fire 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 Mininiuni Dvsign Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the W WTPwhere the Available Capacity is < 0,
Downstream Facility NaMe (SCNVer): Moore County Public Utilities
Downstream Permit Number: WOCS00034
Page I of 6

111. Certification Statement:
I Randy Gould. 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 of 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 perl"ort-ned 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 11 plus all attached planning assessment addendums for which I
any 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.
Page 2 of 6
i, 10- 1 k"

NATIONAL Southern Pines,, NC
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AMENDED LIMITED LIABILITY COMPANY ANNUAL REPORT
Uc/2o22
NAME OF LIMITED LIABILITY COMPANY: ZP 378 SOUTHERN PINES Il. LLC
SECRETARY OF STATE ID NUMBER: 2444323
REPORT FOR THE CALENDAR YEAR:
STATE OF FORMATION: NC
AMENDING DOC ID
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: HPrhPrt .I 7immPr
2. SIGNATURE OF THE NEW REGISTERED AGENT:
r O L
g Office Use
Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
111 Princess Street
Wilmington, NC 28401 New Hanover
Post Office Box 2628
Wilmington, NC 28402 New Hanover
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Ppntal Ronal FctatA
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL:
4. PRINCIPAL OFFICE STREET ADDRESS
111 Princess Street
Wilminaton, NC 28401 New Hanover
5. PRINCIPAL OFFICE MAILING ADDRESS �_
� . 0 ,
Post Office Box 2628
Wilmington, NC 28402 New Hanover
6. Select one of the following if applicable. (Optional see instructions)
1:1 The company is a veteran -owned small business
F-1 The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Jeffrey L Zimmer
TITLE: Mangnpr
NAME: NAME:
TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
111 Princess Street
Wilmington, NC 28401 NEW HANOVER
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
SIGNATURE
Form must be signed by a Company Official listed under Section C of This form.
DATE
Print or Type Name of Company Official Print or Type Title of Company Official
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $10.00
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525
■

SECTION E: ADDITIONAL COMPANY OFFICIALS
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
Name:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:

North Carolina Department of the Secretary of State
Elaine F. Marshall, Secretary
BELOW IS THE CHECK LIST FOR LIMITED LIABILITY COMPANY ANNUAL REPORT. Please take a few minutes and read the
information provided. The Limited Liability Company Annual Report is due by April 15th of each year, with the filing fee of
200.00.
Each Limited Liability Company filing an annual report with the North Carolina Department of Secretary of State must
provide the following information:
1. NAME OF LIMITED LIABILITY COMPANY
2. STATE OF FORMATION
3. ANNUAL REPORT CALENDAR FILING YEAR
4. THE REGISTERED AGENT'S NAME AND SIGNATURE IF CHANGED
5. THE REGISTERED AGENT'S STREET ADDRESS AND MAILING ADDRESS IF DIFFERENT.
6. THE PRINCIPAL OFFICE ADDRESS, COUNTY AND TELEPHONE NUMBER
7. THE NAMES, TITLES AND BUSINESS ADDRESSES OF THE COMPANY OFFICIALS
8. A BRIEF DESCRIPTION OF THE NATURE OF BUSINESS
IF THE INFORMATION REQUIRED TO BE ENTERED IN SECTION A THROUGH SECTION C HAS NOT CHANGED SINCE THE MOST
RECENTLY FILED ANNUAL REPORT, COMPLETE HEADER SECTION AND SECTION D TO CERTIFY THE ANNUAL REPORT.
SECTION A: REGISTERED AGENT'S INFORMATION
1. The name of the registered agent must be typed or printed.
2. If the registered agent has changed, the new registered agent MUST SIGN CONSENT to the appointment in the space provided. If the registered agent's
name has changed due to marriage, or by any other legal means, the limited liability company must indicate such change in the space provided and have the
agent sign consent to the appointment under their new name. If the new registered agent is a business entity, then the appropriate representative of that
entity must sign and print their name and title. The registered agent must reside in North Carolina.
3. if the street address of the registered office has changed, indicate the change. The address of the registered office must be a Street Address and NOT a
Post Office Box Address. The street address of the registered office must be a North Carolina address.
4. If the mailing address of the registered office has changed it should be indicated in this item. The registered office's mailing address may be a Post Office
Box. The registered office mailing address must be a NORTH CAROLINA ADDRESS.
SECTION B: PRINCIPAL OFFICE INFORMATION
1. Provide a brief description of the nature of the LLC's business.
2. Enter the principal office telephone number.
3. Enter the principal office E-mail address.
4. The principal office address should reveal the limited liability company's physical location. The principal office street address must be a street address
and NOT a Post Office Box Address.
5. The principal office mailing address may be a Post Office Box.
6. You may voluntarily report whether the company qualifies as a service -disabled veteran -owned or veteran -owned small business. The annual net receipts
cannot exceed one million dollars ($1 000,000) to report as either veteran -owned small business designation. Choose the designation of a service -disabled
veteran -owned small business if one or more service -disabled veterans owns more than 50% of the business. Choose the designation of veteran -owned small
business if one or more veteran owns more than 50% of the business. For further definitions see N.C.G.S. §55-1-40; §57D-1-03; or §59-32.
SECTION C: COMPANY OFFICIALS
Enter the name, title and business address of each company official. Use Section E or a plain 8 1/2 X I I sheet of paper if more space is needed. A
person listed in this section must sign the annual report and is then authorized to sign on other documents filed with this office.
SECTION D: CERTIFICATION OF ANNUAL REPORT
Check the annual report carefully to ensure all inforination required for Kling has been provided. Only a company official listed on this report or past
completed and filed report may sign. Complete the signature, date, title and typed or printed name in the space provided on the form to certify that the
information is accurate and current. If the company official is another business entity then the appropriate representative of that business entity must certify
the annual report.
SECTION E: ADDITIONAL COMPANY OFFICIALS
Enter the name, title, and business address of each additional company official. A person listed in this section is then authorized to sign on other
documents filed with this office.
Mail the annual report to: Secretary of' State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525. For information or assistance,
please contact the Business Registration Division at [phone] or Toll Free 1-888-246-7636. Web address is http://www.sosnc.gov. (Remised 1012017)

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8/15/2023, 11:19:02 AM 1:9,028
Parcels (Black Lines) 0 0.07 1. 0.15 0.3 mi
Streams 0 0.13 0.25 0.5 km
Esri, NASA, NGA, USGS, FEMA, Esri Community Maps
Contributors, Moore County GIS (NC), State of North
Carolina DOT, © OpenStreetMap, Microsoft, Esri, HERE,
Garmin, SafeGraph, GeoTechnologies, Inc, METUNASA,
Source: TOSP Public Mapping Site
The Town of Southern Pines, its agents and employees make NO warranty as to the correctness or accuracy of the information set forth on this media whether express or implied.

[External] RE: FTSE Application for Overlook at Pineridge Apartments
Tim Shaw <[e-mail]>
Tue 8/15/2023 11:27 AM
To:Moran, Sharon <[e-mail]>
1 2 attachments (844 KB)
GIS Waterbody Screenshot.pdf, 15a ncac 02t .0114.pdf,
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report
Message button located on your Outlook menu bar on the Home tab.
Hi Sharon,
Sorry I missed your call the other day. Please see attached GIS printout as requested.
Regarding the flows, these were obtained through the 15a NCAC 02T.0114 wastewater flow rates document using
the below assumptions:
For the clubhouse we used the "General Business and office facilities" for 25gal/employee/shift. Based on
previous projects, these clubhouses typically have 4 employees so we did 25*4 = 100 gal/day for clubhouse.
For the cabana, this is the main bathroom used by residents at the pool, we used the 250gal/fixture assumption
for "park with restroom facilities", and utilizing 4 total fixtures for a total of 1000 GPD.
Thanks,
From: Moran, Sharon <Sharon.Moran @deq.nc.gov>
Sent: Friday, August 11, 2023 3:49 PM
To: Tim Shaw <[e-mail]>
Subject: FTSE Application for Overlook at Pineridge Apartments
Good Afternoon!
Apologies for emailing so late on a Friday, but I just received your application for Overlook at Pineridge
Apartments and I need some clarification on the daily design flow numbers. I see a listed 25 gal/ for a
clubhouse as well as 250 gal/ for the cabana and would like to know how these numbers were assigned.
Additionally, I do need a color 8.5xI I inch map showing nearby roads and water bodies/streams, such as
an ArcGIS or Google Maps to complete the application as listed in the application checklist letter F.
Look forward to hearing from you. Feel free to call me or to return my email if you'd like to discuss the
matter.
And most importantly, enjoy your weekend!
Best,

Sharon Moran
Division of Water Resources
North Carolina Department of Environmental Quality
Fayetteville Regional Office
Cell: [phone]
[e-mail]
DEQ is updating its email addresses to @deq.nc.gov in phases from May 1st to June 9th.
Employee email addresses may look different, but email performance will not be impacted.
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an
authorized state official.