WQ0045488_Caribou_Coffee_&_Slim_Chickens_FTSSE_Permit_App_2nd_Submission_20240626

State of North Carolina
nwR Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dk4Aon of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: JJAW J&YJ % (to be completed by DwR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: Lighthouse Properties. 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: Cannon Cory per 15A NCAC 02T .0106(b)
Title: Owner!
4. Applicant's mailing address: 2504 Mavbank Drive
City: Charlotte State: NCB Zip: 282111
5. Applicant's contact information:
Phone number: [phone] Email Address: cannon(a_)lighthouse-oroos.com
H. PROJECT INFORMATION:
1. Project name: Caribou Coffee & Slim Chickens"
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Prcject
If a modification, provide the existing permit number: W000 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: W000
3. County where project is located: Guliford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.02910' Longitude:-79.9709°/
5. Parcel ID (if applicable): 196569 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Kyle Sharpe License Number: 54209
Firm: Gaskins + LeCraw of NC, PLLC
Mailing address: 3475 Corporate Way, Suite A
City: Duluth � State: GAS Zip: 30096�
Phone number: 678) 546-8100 Email Address: ksharpe(a),gaskinslecrew.conY
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside Treatment Plant' Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): WQ_
2. Downstream (Receiving) Sewer Information: 8 inch -' ® Gravity' ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00010
Owner Name(s): City of High Poim
FORM: FTA 10-23 Page 1 of

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No N N/A'
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes N No N N/A e
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.0115(c) been attached?
❑ Yes ❑ No N 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
N Food and drink facilities i ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic 100 % Commercial l % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes N No
➢ If Yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow ",s
No. of Units
Flow
Restaurant, Full Service
40 gal/seat .
i
92
3,680 ('iPD
Carry Out Only
50 gal/100 sf '
624 `
312 GPD
gal/
GPD,
gal/
GPD
gal/
GPD
gal/
GPD
Total
3,992 GPD
a See 15A NCAC 02T .0I 14(b). (d). (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e. proposed unknown
non-residential development uses; public access facilities located near high public use areas; and residential property
located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 3 992 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ 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 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
6 f
21.33
PVC
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section ID 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
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump StationslForce 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.1.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)(IXC):
❑ 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 timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 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(fl & (g)? ® Yes ❑ No
15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
—'Water
mains (horizontal)
10 feet
—'Water
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-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 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(f) or (g), see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl 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
➢ 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 basin subject to any State buffer rules? ❑ Yes Basin name: ® IYo
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02009 ❑ 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 coveragelauthorization 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 n6t 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, stornwater 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 six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

X. CERTIFICATIONS:
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 Criteria (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 projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, Timothy Kyle Sharpe attest that this application for Caribou Coffee & Slim Chickens
(Professional Engineer's name from Application Item IIL I.) (Project Name from Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the 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 Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-2I5.6B, 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)
North Carolina Professional Engineer's seal, signature, and date: i Af—A H
SEAL -
54209 _
A 2�
'. yYKYLES . 5
_..............i,.r�...1111 tea
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Cannon Cory attest that this application for Caribou Coffee & Slim Chickens
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item II.I )
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. 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 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.
Signature:
Date: 5/31 /24 '
FORM: ETA 10-23 Page 5 of 5

State of North Carolina
" a A a ; ; rl "f Department of Envm ironental Quality
KA
,%
t Division of Water Resources
How1}ackbrg for SemeiEttensiou Applications
Division of Water Resources (ME10-23)
FntityRequesti gAllocation: I`IWohMC
Project Naar. for which flow is being requested: Caribou Coffee & Slmr Chickens
Mbie than one FISE neap be required fora single project if lite owner of tire JPWFP is notrrsponsiblejor all pump stations along the
route of the proposed wastewatet flow
L Completeth'ssectiononlyifyauamtheownerofthewastmatermeamrentplain.
a. W WfP Facitilynane: Fastside'\V%VFP
b. W%V1P Facility Permit M NCO024210
All floras are in jlIGD
c. W WIP facRys Pemilted flow
26
d. Fstirmted obligated flaw triimtaryto the WWIP
4.4153
C. W WIP facrays actrslatetagr flow
14.92
f Total flow for this specific request
0.004
g. Total actual and obligated flows to the Pack
19.3393
h Percent ofpeuretted flow used
74.38%
D. Corplete this section for each poop station}mry are responsible for along the route ofth's proposed vastewaerlbw
Jet pu rp statim located between the project mtmection point and the W VIP.
(A) (B) (C) (D)=(B+C) P=(A D)
Design Approx ObBgited TotalClment
Prop Pmrp F6m AverageDafly Qmerd Not Yet Flow Phis Available
Station Station Capacity, * Flow** Avg Dafly Trbilary Obligated Capacity***
(Name or Penret MGD (Firinpi) Flow D*Flow Flow MGD
Nurber) No. MGD MGD MGD MGD
lake Forest =0014149 1,1 0.72 0,4205 0.004 4.4245 0,2955
Rherdak W00008572 30,0887 11,484 8,3901 1,2641 26542 1.83
* The Eirm Capacity of any pump station Is defined as the naximan pumped flow that can be
achievedwtth the largest pump taken out of service,
** Design Average Daily Flowis the 8nncapacity of the punp station divided by a peaking factor (pl)
not less (ban 2.5, per Section 2.02(A)(4)(e) of the Minimum Design Criteria.
*** A Planning Assessment Addeodmn shall be attached for each poop station located behveen the
project correction point and the \IAM ubene the Available Capacity is _< 0.
DowssheamFaciftyNane (Sewer): Fastside MIrM
DomskeamPemit Nodrer (Sewer): NCO024210
Page 1 of
FFSE 10-23

L� GAS KI N S
3.4 LECRAW
TRANSMITTAL
TO: FROM:
NCDEQ Amy Wilby
Attn: Sewer Review Gaskins+LeCraw
450 W. Hanes Mill Road 3475 Corporate Way, Suite A
Duluth, GA 30096
Winston-Salem, NC 27105
COMPANY: DATE:
NCDEQ 05/14/24
RE: JOB NO.
Slim Chickens/Caribou Coffee — High 359013
Point, NC
❑ URGENT X FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE
NOILS/COMMENTS:
Please find the following documents:
• 1 — Narrative
• 1— Set of revised Civil Plans
• 1 — USB
• 1 — Cover Letter
• 1 —Location Map
• 1— USGS Topo Map
• 1— FTA
• 1 — NC State Secretary of State Results
Please contact me directly at 678-257-1902 or email [e-mail] if you
should have any questions or concerns.
Thank you,
Amy Wilby

� GASKINS
1Ai +LECRAW
May 31, 2024
Lon Snider
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
RE: Fast Track Sewer System Extension Application
Project Name: Caribou Coffee / Slim Chickens
County: Guilford County
Proposed Sanitary Sewer Cover Letter/Narrative
We are submitting this permit application in an effort to provide sanitary sewer service to two proposed quick
service restaurants to be located in the city limits of the City of High Point. The 624 sf Caribou Coffee and
3,171 sf Slim Chickens are being proposed at 2525 East Chester Street.
This application is for 21 LF of 6" PVC to be extended from an existing cleanout to a proposed cleanout in
order to provide sanitary service to both the Caribou Coffee and Slim Chickens properties. Per 15A NCAC 02T
.0114, 3,992 GPD of wastewater will be generated from these two uses: 312 GPD from Caribou Coffee and
3,680 GPD from Slim Chickens. Wastewater from these uses will be gravity fed through the proposed system.
Please feel free to contact me directly should you have any questions or concerns about the information as it has
been presented. My email address is kyle.shaMeAlecraweng com and my direct line is 678.257.1916.
Sincerely,
Kyle Sharpe, PE (GA)
LeCraw Engineering, Inc.
3475 corporate way - Suite a — Duluth. GA 30096 - 678.546.8100
www.lecrawengi neering.com

5/38/24, 4:46 PM
North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Uploads PDF Filing -Order a Document Online
Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form Print
an Amended a Annual. Report form
Limited Liability Company
Legal Name
Lighthouse Properties CT High Point, LLC
Information
Sosld: 2850972
Status: Current -Active (D
Date Formed: 5/28/2024
Citizenship: Domestic
Annual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: Cory,.Cannon
Addresses
Mailing
2504 Maybank Dr
Charlotte, NC 28211-1911
Reg Mailing
2504 Maybank Dr
Charlotte, 'NC 28211-1911
Company Officials
Principal Office .
2504 Maybank Dr
Charlotte, NC 28211-1911
Reg Office
2504 Maybank Dr
Charlotte, NC 28211-1911
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Cannon ,Cory
2504 Maybank Drive '
Charlotte NC 28211-1911
https:/Aw .sosnc.gov/online_services/search/Business Regislration_Resulls, 1N

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LOCATION MAP