WQ0040365_Application (FTSE)_20181022

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16&SUPPORTING DOCUMENTATION
J
Application Number: Moo 10 3&D (robe wmpieted by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Caprock.LLC (company,municipality,HOA,utility,etc.)
2. Applicant type: ❑Individual ®Corporation ❑General Partnership ❑Privately-Owned Public Utility
❑Federal ❑State/County ❑Municipal ❑ Other RECEIVED/NCDENRIDWR
3. Signature authority's name:Kyle diPretoro per 15A NCAC 02T.0106(b) .00 T 1 2 ZO�$
Title: yr vp orV+�LoPM�NT " -
4. Applicant's mailing address:PO Box 36884 WOROS
City: Charlotte State:NC Zip:28236-
MOORESVII I c RrMONAL OFFICE
5. Applicant's contact information:
Phone number: 704)816-2203 Email Address: kdipretoroAcaprockinvest com
II. PROJECT INFORMATION:
1. Project name:Greenleaf Townhomes
2. Application/Project status: ®Proposed(New Permit) ❑Existing Permit/Project
If a modification,provide the existing permit number:W000_ and issued date:
If new construction but part of a master plan,provide the existing permit number: W000_
3. County where project is located:Mecklenburg
4. Approximate Coordinates(Decimal Degrees): Latitude: 35,2311° Longitude:-80.8552780
5. Parcel ID(if applicable): 073-221-82,073-221-81 &073-221-98
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Brian D. Smith License Number:27890
Firm:Urban Design Partners
Mailing address: 1318-E6 Central Avenue
City:Charlotte State:NC Zip:28205-
Phone number: 704)334-3303 Email Address:brianAurbandesignpartners.com
IV. WASTEWATER TREATMENT FACILITY(WWTF)INFORMATION:
1. Facility Name:Irwin Creek Wastewater Treatment Plan Permit Number: NCO024945
Owner Name:Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION(if different than WWTF):
1. Permit Number(s): WQ_ Downstream(Receiving)Sewer Size: 8 inch
System Wide Collection System Permit Number(s)(if applicable):WQCS_
Owner Name(s): Charlotte Water
FORM:ETA 04-16 Page 1 of 5

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/A
2. If the Applicant is a Developer of lots to be sold,has a Developer's Operational Agreement(FORM:DEV)been attached?
®Yes ❑No ❑N/A
3. If the Applicant is a Home/Property Owners'Association.has an Operational Agreement(FORM:HOA)been attached?
❑Yes ❑No ®N/A
4. Origin of wastewater:(check all that apply):
®Residential 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: 100%Domestic/Commercial %Commercial
Industrial(See 15A NCAC 02T.0103(20))
"Is there a Pretreatment Program in effect? ❑Yes ❑No
6. Has a flow reduction been approved under 15A NCAC 02T.0114(f)? ®Yes ❑No
➢ If yes,provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type(see 02T.0114(fl) Daily Design Flow•" No.of Units Flow
residential-townhomes 190 gal/unit 4 760 GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
Total 760 GPD
a See 15A NCAC 02T .0114(b). (d), (c)(1)and(e)(2) for caveats to wastewater design flow rates(i.e.,minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S.42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table I SA 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: 760 GPD(per 15A NCAC 02T.0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑Flow has already been allocated in Permit Number:
❑Rehabilitation or replacement of existing sewer with no new flow expected
❑Other(Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA(If Applicable)-02T.0305&MDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size(inches) Length(feet) Material
8 126 PVC
➢ Section II&III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA(If Applicable)—02T.0305&MDC(Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates(Decimal Degrees):Latitude: 0Longitude:-
3. Design flow of the pump station: millions gallons per day(firm capacity)
4. Operational point(s)of the pump(s): gallons per minute at_feet total dynamic head(TDH)
5. Summarize the force main to be permitted(for this Pump Station):
Size(inches) Length(feet) Material
6. Power reliability in accordance with 15A NCAC 02T.0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry- 15A NCAC 02T .0305(h)(1)(B);
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation,quick-connection receptacle and telemetry- 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry- 15A NCAC 02T.0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant(draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' -
storage capacities and the rotation schedule of the portable power source or pump,including travel timeframes, shall be
provided in the case of a multiple station power outage. _
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS&SEPARATIONS—(02B.0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f)&(a) M Yes ❑No
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameters' Separation Required
Storm sewers and other utilities not listed below vertical 24 inches
Water mains vertical-water over sewer including in benched trenches 18 inches
Water mains horizontal 10 feet
Reclaimed water lines vertical-reclaimed over sewer 18 inches
Reclaimed water lines horizontal-reclaimed over sewer 2 feet
"Any private or public water supply source,including any wells,WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking water 100 feet
"Waters classified WS(except WS-I or WS-V),B,SA,ORW,HQW,or SB from normal
high water or tide elevation and wetlands see item IX.2 50 feet
"Any other stream,lake,impoundment,or ground water lowering and surface drainage
ditches 10 feet
Any building foundation 5 feet
Any basement 10 feet
Top sloe of embankment or cuts of 2 feet or more vertical height 10 feet
Drainage systems and interceptor drains 5 feet
Any swimming pools 10 feet
Final earth grade vertical 36 inches
➢ 15A NCAC 02T.0305(Q)contains alternatives where separations in 02T.0305 cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications webnaee
➢ If noncompliance with 02T.0305(f)or(g),see Section X of this application
2. Does the project comply with separation requirements for wetlands?(50 feet of separation) ❑Yes ❑No ®N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑Yes ❑No M N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑Yes M No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 &Buffer Permittine Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6)(additional permits/certifications)? M Yes ❑No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for,or have been obtained. Issuance of this permit is contingent on issuance of dependent permits(erosion and
sedimentation control plans,stormwater management plans,etc.).
6. Does this project include any sewer collection lines that are deemed"high-priority?"
Per 15A NCAC 02T.0402, "high-priority sewer"means"any aerial sewer, sewer contacting surface waters,siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑Yes M No ❑N/A
➢ 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 permitee's individual System-Wide Collection permit.
FORM: FTA 04-16 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 Criteria(latest version)as applicable?
®Yes ❑No
If No, complete and submit the Variance/Alternative Design Request application(VADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:1, A!2A1A�4 P SAAt`,,4 I-� attest that this application for
(Professional Engineer's name from Application Item 111.1.)
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, Gravity Sewer
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 143-215.613, 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.
....................r«„r.r r.r,r.,r......................
North Carolina Professional Engineer's seal,signature,and date:
;�OQOFE§srp•••..9 ;
;•Q
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3. Applicant's Certification per 15A N�CAC 02T.0106(b):
1, 6D►vz���, V 1Cr IPE/�T OFV�(.OP/�E' attest that this application for
(Signature Authority's name&title from Application Item I.3.)
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 a well as civil penalties up to$25,000 per violation.
j
Signature: Date: (/Iwp
FORM: FTA 04-16 Page 5 of 5

1318 e central avenue 704.334.330
charlotte,
F,no 28205 704.334.3305
RECEIVED/NCDENR/DWR
URBAN OCT 1220j8
TRANSMITTAL D E S I G Np g R T N E R 5 WQRO$
MOORESVILLE REGIONAL OFFICE
To: Deborah Luckman Date: 10/11/2018
NCDEQ
610 East Center Ave. Suite 301
Mooresville, NC 28115
Phone: [phone] Project Name: Greenleaf Townhomes
Fax: Project No: 18-014
Transmitted Via: Action:
® Overnight M For Approval
❑ Courier ❑ For Your Use
❑ Hand ❑ As Requested
❑ Mail ❑ For Review &Comment
❑ Fax ❑ For Signature
Number Date Description
1 Fast Track Fee Check ($480)
Comments
Please let me know if you have any questions,
Brian D. Smith, P.E.
Cc:

i STATE OF NORTH CAROLINA
COUNTY OF Mecklenburg Permit No, W Q 00 t-W 365
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (dl)and entered into this day of
October 2018 by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina,hereinafter known as the COMMISSION; and
CapRock,LLC a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
1. The DEVELOPER is the owner of the certain lands lying in Mecklenburg County, upon
which it is erecting and will erect dwelling units and other improvements, said development to be known
as. Greenleaf Townhomes (hereinafter the Development),
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities(hereinafter Disposal System)to provide sanitary sewage disposal to serve
the Development on said lands.
3. _ The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct,maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership(hereinafter Declaration),pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration,the (Unit Owners' Association) Greenleaf Townhome HOA (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re-constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance,re-construction andrepair.
6. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interest therein.
NOW,THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto,the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions andlaw.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans,_and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws andDeclaration.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility for
the operation and maintenance of its Disposal System until a permit has been reissued to the DEVELOPERSs
successor.
FORM: DEV 11-17 Page 1 of

i
4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of-the permit for construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes and insurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses. In order to assure that there shall be funds readily available to
repair,maintain or construct the Disposal System, beyond the routine operation and maintenance expenses,
the Declaration and Association Bylaws shall provide that a fund be created out of the common expenses.
Such fund shall be separate from the routine maintenance funds allocated for the facility and shall be part
of the yearlybudget.
6. In the event the common expense allocation and separate fund are not adequate for the construction, repair,
and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for special
assessments to cover such necessary costs. There shall be no limit on the amount of such assessments, and
the Declaration and Bylaws shall provide that such special assessments can be made as necessary at any
time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit mayrequire as condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the continued
proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution without first having
transferred its said system and facilities to some person, corporation or other entity acceptable to and
approved by the COMMISSION by the issuance of apermit.
9. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration is
filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL CapRock, LLC
MANAGEMENT COMMISSION Name tlfD BIP
Linda Culpepper ( $ fe)
Interim Director, Division of Water Resources
flue L91 o yO U)t:' 6k-VCypMe-rJ "
Print Name and Title
a-Weagse 2 20/ 3
(Date) (Date)
FORM: DEV I1-17 Page 2 of

CHARLOTTE
W4JE R
August 30, 2018
Mr. Brian Smith
Urban Design Partners
1318-e6 Central Avenue
Charlotte, NC 28205
SUBJECT: WATER AND SEWER FLOW ACCEPTANCE
GREENLEAF TOWNHOMES
1000 GREENLEAF AVENUE., CHARLOTTE NC
CLTWATER TRACKING#2018870
After an analysis of the sanitary sewer associated with the proposed design of project 2018870,
Greenleaf Townhomes, it was determined that there is sufficient capacity to accommodate the
proposed sewer flow of760 gallons per day(4 units x 190 gpd/unit)at the connection point(s)
indicated on the submitted utility plan to the Irwin Creek Wastewater Treatment Plant; NPDES
permit number NC0024945, for treatment. This acceptance of flow is based on the existing capacity
of the designated publicly owned treatment works. Please see attached FTSE form.
CLTWater agrees to furnish water to the subject project. The water quality to the subject project is
regulated by the State Drinking Water Act Amendments of 1986, and The Water Supply
Management Plan, PWS ID#0160010, on file with the Public Water Supply Section of NCDEQ.
However, CLTWater cannot guarantee a constant pressure or quality of flow.
CLTWater does not expect any of the above conditions to preclude water or sewer service to the
subject site. However, the applicant should understand that due to the involvement of other agencies
and continuing growth of the water and sewer system, the ability to provide service for future
projects cannot be guaranteed nor reserved. Connection to the CLTWater and sewer system is
accepted on a first come, first served basis.
The applicant should understand that this letter is not authorization to construct private water and
sewer systems, as the appropriate local or State permits are required prior to construction. If the
appropriate authorization to construct permits are not obtained and construction has not started
within one (2) year of issuance of this flow acceptance letter: and moment for any service
connection(s) has not been received within (2) year of issuance of this flow acceptance letter, this
flow acceptance approval shall be rescinded and a new flow acceptance study must be made. If you
have any questions, you may contact me at(704) 336-1006.
Sincerely,
C�rdaZya Sna arel
Gwendolyn Banner
Engineering Assistant
Charlotte Water 5100 Brookshire Blvd,Charlotte,NC 28216 charlottewater.org
6 operated by the City of Charlotte

State of North Carolina
Department of Environmental Quality
DNA Division of Water Resources
Division of water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Urban Design Partners
Project Name for which flow is being requested: Greenleaf Townhomes
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for al!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: McAlpine Creek, Irwin Creek, Sugar Creek
b. WWTP Facility Permit#: Nco024970,Nco024945,N00024937
Al!flows are in MGD
c. WWTP facility's permitted flow 99.0
d. Estimated obligated flow not yet tributary to the WWTP 11.519
e. WWTP facility's actual avg. flow 65.008
f_ Total flow for this specific request 0.00076
g. Total actual and obligated flows to the facility 76.573
It. Percent of permitted flow used 77.4%
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)--(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg, Tributary Flow Plus
(Name or Capacity,* (Firm/pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MOD MGD Flow Capacity***
* 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): Unknown
Downstream Permit Number: Unknown
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Keri Cantrell certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer overflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation
of the planned improvements identified in the planning assessment where applicable. This
analysis has been performed in accordance with local established policies and procedures using
the best available data. This certification applies to those items listed above in Sections I and II
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
8/24/2018
Signing Official Signature Date
Page 2 of 6
FTSE 04-16

LIMITED LIABILITY COMPANY ANNUAL REPORT
1012017
NAME OF LIMITED LIABILITY COMPANY: CapROck, LLC
Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 1425805 STATE OF FORMATION: NC E-Filed Annual Report
1425805
02213
REPORT FOR THE CALENDAR YEAR: 2018 C211201 801:14
3l21/2018 01:14
SECTION A: REGISTERED AGENTS INFORMATION Changes
1. NAME OF REGISTERED AGENT: COX, R. Andrew
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THEAPPOINTMENT
3. REGISTERED OFFICE STREET ADDRESS &COUNTY 4.REGISTERED OFFICE MAILING ADDRESS
2410 Dunavant Street 2410 Dunavant Street
Charlotte, NC 28203 Mecklenburg County Charlotte, NC 28203
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Cap Rock Building Group, LLC
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS&COUNTY 5.PRINCIPAL OFFICE MAILING ADDRESS
2410 Dunavant Street 2410 Dunavant Street
Charlotte, NC 28203 Mecklenburg County Charlotte, NC 28203
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran-owned small business
❑ The company is a service-disabled veteran-owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Nathanael Andrico NAME: Nathanael Andrico NAME: Andrew Glraldo
TITLE: Manager TITLE: Member TITLE: Manager
ADDRESS: ADDRESS: ADDRESS:
2410 Dunavant Street 2410 Dunavant Street 2410 Dunavant St
Charlotte, NC 28203 Charlotte, NC 28203 Charlotte, NC 28203
SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Nathanael Andrico 3/21/2018
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Nathanael Andrico Manager
Print or Type Name of Company Official Print or Type Title of Company Official
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29526,Raleigh,NC 27626-0525

SECTION E: ADDITIONAL COMPANY OFFICIALS
NAME: Andrew Girald0 NAME: Ryan Lambert NAME: Ryan Lambert
TITLE: Member TITLE: Manager TITLE: Member
ADDRESS: ADDRESS: ADDRESS:
2410 Dunavant St 2410 Dunavant Street 2410 Dunavant Street
Charlotte, NC 28203 Charlotte, NC 28203 Charlotte, NC 28203
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE: -
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: Name:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:

Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 10/2/2018 7:42:27 AM
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should be consulted for verification. Mecklenburg County and its mapping contractors assume no legal responsibility forthe information contained herein.

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North Carolina Secretary of State Search Results Page 1 of I
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
Add Entity to My Email Notification List • View Filings • Print an Amended a Annual Report form • Print a
Pre-Populated Annual Report form
Limited Liability Company
Legal Name
CapRock, LLC
Information
Sosld; 1425805
Status: Current-Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 2/3/2015
Registered Agent: Cox, R. Andrew
Addresses
Mailing Principal Office Reg Office Reg Mailing
2410 Dunavant Street 2410 Dunavant Street 2410 Dunavant Street 2410 Dunavant Street
Charlotte, Nr 28203 Charlotte, NC 28203 Charlotte, NC 28203 Charlotte, NC 28203
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager Member Manager Member
Nathanael Andrico Nathanael Andrico Andrew Giraldo Andrew Giraldo
2410 Dunavant Street 2410 Dunavant Street 2410 Dunavant St 2410 Dunavant St
Charlotte NC 28203 Charlotte NC 28203 Charlotte NC 28203 Charlotte NC 28203
Manager Member
Ryan Larrber! Ryan Lambert
2410 Dunavant Street 2410 Dunavant Street
Charlotte NC 28203 Charlotte NC 28203
https://www.sosnc.gov/online_services/search/Business_Registration_Results 10/15/2018

Central Files: APS _ SWP _
10/22/2018
Permit Number WQ0040365
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
barry.love
Coastal SWRuIe
Permitted Flow
760
Facility
Facility Name
Greenleaf Townhomes
Location Address
Owner
Owner Name
Caprock LLC
Dates/Events
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Mooresville
County
Mecklenburg
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Kyle Dipretoro
2410 DunavantSt
Charlotte NC 28203
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
10/22/2018 10/12/2018 10/22/2018 10/22/2018
Regulated Activities Requested /Received Events
Condominium Additional information requested
Wastewater collection Additional information received
Outfall
Waterbody Name Streamindex Number Current Class Subbasin