WQ0040693_Application (FTSE)_20190411

7
Central Files- APS sw_
L;
Permit Nu er WQO-040693
Permit Tracking Slip
Program Category
MM,
Status Project Type
Non -discharge
In review New Project
Permit Type
Version Permit Classification:
Gravity Sewer Extension.. Pump Stations, & Pressure Sewer Extensions
A Individual
Primary Reviewer
Permit Contact Affiliation
dean.hunkele
Coastal SWRulle
Permitted Flow
Facility
Owner
Owner Name Owner Type
Brunswick Al Properties LLC Non -Government
Owner Affiliation
Carrol Saunders Roberson Jr.
3124 Zebulon Rd
Dates/Events Rocky Mount NC 27804
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
3/6/2019
.Regulated Activities Requested /Received Events
Additional information requested

Letter of Transmittal
Date: 03/05/19
Geomatics, Surveying & Engineering, Inc.
PO Box 16110
Wilmington, NC 28408
To: DEQ- Water Quality
ATTN: Dean Hunkele
10MATICS
s : fGE
SURVEYING & ENGNEEM, G INC.
RE: Brunswick Community Assisted Living Facility
Private E2M Station and Forc main
Permitting Submittal
job# I 0-16
COPIES
DATE
DESCRIPTION
1
May-18
Set of Plans (5 total sheets)
1
Jan-19
Cover Letter to Dean Hunkele
1
Mar-19
Permit �RLlication Fee (Check #1227 ; $480.00
1
May-18
Pump Station Specifications
1
May-18
Com leted Fast Track A lication (IncludingBrunswick Coun Documentation)
Bruswick County indicated the FTSE for WQ0040083 shall be applicable to this
permit submittal. Further, a request to rescind WQ0040083 will be made b
Brunswick Count upon a royal of this current 2pplciation.
These are transmitted as checked below:
t"
��,y t�i �'; �>:f �•st uzHN� �5 `a �.-'�' `'� �r.�; i' :i `3i. �r! ���i 1. .
X. For Approval
For Your Use MAR `' f;
For Review and Comment
As Requested Wa e
Returned for Correction ,, ,J
�~
'•':`f�f?1 fir{
Remarks: Dean: As discussed, this a re nest fora royal of a private RME station and forcemain for the 2reviously
reviewed site- Brunswick Assisted Livin Facility. As noted above, the previous FTSE is still valid and BrunsCo
will request a recission of W 0040083 upon a royal of this ap2lication. If you have any questions, 2lease call.
Hoe ou're doin well. -Comer
CC: file
Professional Firm# C-3796
Signed:
Comer Lyons
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V'gyi:
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Phone: [phone]

i
GEOMATICS
January 25, 2019
SURVEYING & ENGINEERING INC.
Dean Hunkele
P.J. Box 16110
Senior Environmental Specialist
Wilmington, NC 28408
Division of Water Resources- DEQ
Tel: [phone]
127 Cardinal Drive Extension
Email: [e-mail]
Wilmington, NC 28405
Professional Firm# C-3796
Re: Brunswick Community Assisted Living Facility
Private Pump Station & WetWell
Fast Track Sewer Application
Dean. -
On behalf of Brunswick AL Properties, LLC, please accept this application for sewer extension (specifically the pump
station and forcemain) at the subject site. Understand these items are intended to be privately owned and operated by
Brunswick County.
Enclosed for your review are the completed FTA 04-16 and the FTSE, as provided by Brunswick County.
Project Summary:
The Brunswick Community Assisted Living Facility is to be a 110 unit (single bedrooms) building with possible
expansion to 154 units in the future. Wetwell and Forcemain design is based on the future tributary flow condition;
however, permitted flow is only based on the 110 unit layout and the current forcemain tie -pressures provided by
Brunswick County.
The project developer have been consulted on this scenario and they understand future flows will be subject to further
permitting, in accordance with Brunswick County and NCDEQ requirements.
General/ Commercial laundry and kitchen facilities will be provided in centralized locations with no individual facilities
within bedroom units.
Wastewater will be collected via an onsite gravity system and flow to the 5-foot collector manhole outside of the pump
station, in accordance with Brunswick County Standards.
The Pump Station will collect flows and pump into Brunswick County's 24-inch forcemain along Highway 17, where
flows will continue to the Brunswick County treatment facility.
Anticipated Wastewater Flows:
110 Units x 120 gpdpu = 13,200 GPD- Average
Items Included in Submittal:
• Cover Letter
• Fast Track Application
• FTSE
Please let me know if you have any questions or concerns.
Sincerely,
i
Comer Lyo , PE
for GS&E, C.
w/ enclosures
cc: Aspect Engineering & Inspections

Hunkele, Dean
From: Comer Lyons <[e-mail]>
Sent: Wednesday, March 6, 2019 9:32 AM
To: Hunkele, Dean
Cc: Amy Aycock
Subject: [External] Submittal this morning: Brunswick Assisted Living
Attachments: 2018-0521_FTSE_BALF.pdf
Dean:
I dropped off an application for a private pump station and forcemain at the subject site this morning.
Brunswick has reviewed the project and given me the go ahead for submittal to you (Amy Aycock is copied on
this email). Please note that Amy indicated the original FTSE remains current for this change to private so, I did
not include a paper copy of the FTSE with the package this morning. I have attached a'pdf copy to this email.
Lastly, I understand BrunsCo prefers to leave the 'public' permit (WQ0040083) active until this private
application is approved. Once that happens, they will forward a request to rescind.
Let me know if you have any questions. Thanks,
Comer
GS&E, Inc.

State of North Carolina
Department of Environmental Quality
D.W..R Division of Water Resources
15A NCAC 02T .0300 -- FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
DIvIslon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
ppW&(k40613 (to be completed by DWR)
All items must be completed or the application will be returned
rrr�— irrnrry.r...rr.r�r■rr���r�r.�
I. APPLICANT INFORMATION:
1. Applicant's name: Brunswick AL Properties, LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
El Federal ❑ State/County ❑ Municipal El Other
3. Signature authority's name: Stan Figlewski per 15A NCAC 02T .0106(b)
Title: Administrative Member
4. Applicant's mailing address: 3124 Zebulon Road
City: Rocky Mount State: NC Zip: 27804-
5. Applicant's contact information:
Phone number: (252 314-5837 Email Address: [e-mail]
H. PROJECT INFORMATION:
I. Project name: Brunswick Community Assisted Living Facility
2. Application/Project status: Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Brunswick
4. Approximate Coordinates (Decimal Degrees): Latitude: 33.95711 ° Longitude:-78.43780'
5. Parcel ID (if applicable): 21200011
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Comer Lyons, PE License Number: 30�963_
Firm: GS&E, Inc.
Mailing address: PO Box 16110
City: Wilmington
Phone number: 910) 742-3 860
State: NC Zip: 28408-
Email Address: clYons(a pandeinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: West Brunswick Permit Number: M Q0023693
Owner Name: Brunswick County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
l . Permit Number(s): WQ0023693 Downstream (Receiving) Sewer Size: 24 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00284
Owner Name(s): Brunswick County
FORM: FTA 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 NN/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 [ON/A
3. If the Applicant is a Home/Proverkv Owners' Association has an Operational Agreement (FORM: H0.4) been attached?
❑ Yes FINo ZN/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned E3Retail (stores, centers, malls) ❑Car Wash
❑ Residential Leased ❑Retail with food preparation/service EJ Hotel and/or Motels
❑ School / preschool J day care ❑Medical /dental /veterinary facilities ❑Swimming Pool /Clubhouse
❑ Food and drink facilities ❑Church ❑Swimming Pool/Filter Backwash
❑ Businesses / offices J 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. Hasa flow reduction been approved under 15A NCAC 02T .0114 ? E]Yes ®No
➢ If yes, provide, a copy of flow reduction apprrov_ al letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0I 14(j))
Daily Design Flow a9b
No. of Units
Flow
Assisted Living Facility
120 gal/Day
110
13,200 GPD
gal/
GPD
gall
GPD
gall
GPI)
gal/
GPD
gal/
GPD
Total
13,200 GPD
a See 15A NCAC 02T .0114(b),d), (e)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 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: GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
El 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:
El 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 (GravitySewe s):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 50 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
VUL PUMP STATION DESIGN CRITERIA (If Applicable) -- 02T .0305 & MDC (Pumg Stations/Force
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 33.95711 ° Longitude:-78.43780'
3. Design flow of the pump station: 0.0132 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 40 gallons per minute at 158 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
700
PVC
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
Z 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) & (,g) ® Yes ❑ No
15A NrAC. (Y)'`I`' 01firVA rnritaine m;nimi rm earmara#inrr +Um+ olk Al 1,,m base nt%vv7r%-. nv.,,4-
Setback Parameter*
Se aration 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-I 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
An buildin foundation
5 feet
Any basement
10 feet
T2p slope of embankment or cuts of 2 feet or more vertical Mot
10 feet
Drainage systems and interce for drains
5 feet
An swimming pools
10 feet
Final earth gade (vertical)
36 inches
➢ 15A NCAC 02T.0305W contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 42T.0305( or, (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) [:]Yes [:]No 10 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 N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401. & Buffer Permitting, Branch
5. Does project comply with 1.5A NCAC 02T.0105(c)(6) (additional permits/certifications)? ED 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 `thigh -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 [D 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 -Vide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X.. CERTIFICATIONS:
1. Does the submitted system connply.with l 5A NCAC 02T, the Minimum D si n Criteriafor the Permittin of Pu Stations
a d_lrorce Mains (latest v_ers�o_n), and the gravity Sewer Minimumgesi„ vn,Criteria {latest version) as applicable?
0 Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. AgIlpyal At thg reau t is M2gired rior to subgftt of the F 9t Tra+eic A li�ca on and su o a
docncaents.
2. Professional Engineer's Certification:
L"foN.-S;
(Professional Engineer's name from Application item ill.1.)
that this application for
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 pie, inclusion of these materials under my signature and seal signifies that I have reviewed this
material and have judged it tar 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 certif cation 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 S25,000 per violation.
North Carolina Professional Engineer's seat, signature, and date:
3. Applicant's Certification per l SA NCAC 02T .0106(b):
it Is4an Ifq F1*J-1CWS ki 100 Adfnitl4rdikd z.�- attest that this application for
(Signature Authority's name 8c title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. l understand that if all required parts of
this application are not completed and that if all regwred supporting documentation and attachments are not included, this
application paclPage 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. 1 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 B.-, any person who knowingly snakes any false
statement, representation, or certification ' application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as w 1 as ivil penalties up to $23,000 per violation.
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of water Resources
Flow Tracking for Sewer Extension. Applications
t o ns
(FTSE 10-18)
Entity Requesting Allocation: Brunswick AL Properties, LLC
Project Name for ,which flog is being requested: Brunswick Co munity .Assisted Liv*
More than oneFTSE may he regadired for a singrle profeet if the owner of the WWTP is not responsible for all pump
stations along the route of the propose' wastewater fl-04.
i. Complete this section only if you axe the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit #
WEST BRUNSWICK wRF
WQ 0023693
All floe are in MGD
c.
WWTP facility's permitted flow
600
d.
Estimated obligated flow not yet tributary to the WWTP
0.651.
e.
WWTP facility's actual avg. flow
2.998
f.
Total flow for.th.is specific request
0.01320
g.
Total actual and obligated flows to the facility
3.66
h.
Percent of permitted flow used
61.0%
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) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm. Daily Flow" Current Tributary Flow Plus
(Name or Permit Capacity, ` (Firm / pf), Avg. Daily Daily Flow, obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity's**
The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(Pt) 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): West Brunswick Regional FM
Downstream Permit Number: WQ0023693 �~
Page 1 of 6

111. Certification Statement:
l William L. Pinnix, RE. certify to the best of .nay 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 receivin.cy
treatment plant under n.orrnal 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 11 plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
1 6 r-
z V. av- P— T
Title of Signing Uff cial
T-.r\,C\ T-r-\
3 \5-
Date
Page 2 of 6
18

North Carolina Secretary of State Search Results
https://www.sosnc.gov/online services/search/Business Registration Re...
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Limited Liability Company
Legal Name
Brunswick Al Properties, LLC
Information
SOSid: 1463420
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 8/12/2015
Registered Agent: Rozier, Sonya A
Addresses
Mailing
3124 Zebulon Rd
Rocky Mount, NC 27804-2425
Reg Mailing
3124 Zebulon Rd
Rocky Mount, NC 27804-2425
Company Officials
Principal Office
3124 Zebulon Rd
Rocky Mount, NC 27804-2425
Reg Office
3124 Zebulon Rd
Rocky Mount, NC 27804-2425
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Administrative Member Manager
Stanley A. Figlewski Carrot Saunders Roberson , Jr
3124 Zebulon Rd 3124 Zebulon Rd
Rocky Mount NC 27804 Rocky Mount NC 27804
1 of 1 1/25/2019, 9:06 AM

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5220 Ocean Hwy W, Shallotte, NC 28470