WQ0041379_Application (FTSE)_20191209

State of North Carolina
Department of Environmental Quality
,WR Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
D vision of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: 0 3 M i (to be completW by DWR) Cj
t
All items must be completed or the apOication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Wineandbeerarewe, LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ Statc,'County ❑ Municipal Other
3. Signature authority's name: Gregory W. Stafford per 15A NCAC 02T .0106(b) �beptofEhviroamental Quality
Title: Member Manager DEC — 9 2019
4. Applicant's mailing address: 901 Jordan Hills Drive
City: Chapel Hill State: NC Zip: 27517- Melgl Regional Office
5. Applicant's contact information:
Phone number: (2L9) 215-8782 Email Address:
11. PROJECT INFORMATION:
1. Project name: Relocation of Private Utilities for 56 Sanford Road
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: Chatham
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.71666' Longitude:-79.16666'
5. Parcel ID (if applicable): 07888
(or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
1. Professional Engineer: Mark P. Ashness License Number. 18894
Firm: CE_Group, Inc.
Mailing address: 301 Glenwood. Avenue, Suite 220
City: Raleigh State: NC Zip: 27603-
Phone number. 919 367-8790 Email Address: mark0a CEGroupinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. FaciIity Name: Town of Pittsboro Wastewater Treatment Facility Permit Number: NCO020354
Owner Name: Town of Pittsboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream pipe under Permit Review at same time Downstream (Receiving) Sewer Size: 8
inch
System Wide Collection System Permit Number{s_(f annlicablel: WQCSNIA
Owner Name(s): Town of Pittsboro
F0PM- PTA 04-1A pqno t ni";

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 ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Aueement (FORM: DEVbeen attached?
❑ Yes [:]No ®NIA
3. If the Applicant is a Tlome Pro ,�ertty Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®NIA
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 1 day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool !Clubhouse
® Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
® Businesses I offices! factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % DomesticlCommercial % Commercial
0 % Industrial (See 15A NCAC 02T .0103(20))
1Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114{f1? ❑ Yes ® No
➢ If Yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see PAT.0 1140
Daily Design Flow "''
No. of Units
Flow
gall
GPD
gal/
GPD
gall
GPD
gaV
GPD
gal/
GPD
gal/
GPD
Total
0 GPD
a See f 5A NCAC 02T.0114(b), (d), (e)(1) and (eX2) 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 Watcr►vay 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: 0 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):
r(ivm- n-rA nn 14 Pnwr 7 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 ,& MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
S 220 DIP
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
VIIl. 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: �Longitude: - "
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):
D Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
i 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):
D 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.
MUM- rT'A n4--t( Page 3 of

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(1)):
1. Does the project comply with all separations found in 15A NCAC 02T .030_&
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Stone sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains (horizontall
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
To 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
15A NCAC 02T.0305(g contains alternatives where separations in 02T.0305(n cannot be achieved.
e **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
9 If noncompliance with 02T.0305ft2r gl, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ NIA
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
Z As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per I SA NCAC 02B .0200? ❑ Yes ❑ No ® NIA
D This would include Trout Buffered Streams per 15A NCAC 2830202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
D Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 03T.01051e, 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 ®No ❑ NIA
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.
V-r "%r. T"rA nA I PnnAAnrS

i
X.
CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the MinimsLNLin Criteria for the Permittin, of PmpuStations
a td Force Mains atest versi and the!Qrqvity,5eFSr 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. Aporoval of the re uest is re uired prior to submittal of the Fast Track AUDUCHHOn and supoorting documents.
2. Professional Engineers c ' cation.
attest that this application for
(Professional Engineer's name from Application Item M.l.)
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 M0,000, as well as civil penalties up to S25,000 per violation. h
North Carolina Professional Engineer's seal, signature, and date:
Y
SEAL.'
l�rrr��tl4�s�t►4ti�t ---
3, Applicant's Certification per I5A NCAC 02'1 .0106(b).
I, . �7404V
� • attest that this application for
ignat T Authority's flame & title from Application Item 13 )
has been reviewed by the and is accurate and complete to the best of my knowledge. I understand that if al; required parts of
this application are not completed and that if all required supportutL documentation and attachments are not included, this
application package is subject to being returned a., incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the lard will result in an i=ncdiate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosccuticn I tvilI make no clsim against the Division of Water Resources should a condition
of this permit be violated. I also understand tha, it all requLmd part.,-, of dus appltcduun package are not completed and that if
all required supporting information and attaL-ltments are net included, this appliLdtion will b._ returned to n,c as
incomplete.
NOTE 1n accordance with Geu=ral Stan:tes 143-215.6A and L43-1 3, any person tvhn knowmgl} makes any false
statement, representation, or certification to anv application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed S 10,00q as well as cn -il penalties up to S25,000 per violation.
Signature: Date. C ��
FORM; FfA C4-16 Page 5 of5

�•
Division of Water Resources
Entity Requesting Allocation:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Town of Pittsboro
Project Name for which flow is being requested:
Relo of Public Util for 56 Sanford Road
More than one FTSE may be required for a single project if the oivner of the IP IVTP is not responsible far all painp
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: _
b. WWTP Facility Permit #:
-T'6wn off' ` 145
NC OO a O
LoWT VP
All floivs are in MGD
c. WWTP facility's permitted flow Q,9150
d. Estimated obligated flow not yet tributary to the WWTP Q , 13 to 1
e. WWTP facility's actual avg. flow , 5O,a 9
f. Total flow for this specific request
g. Total actual and obligated flows to the facility {�, U39 O
h. Percent of permitted flow used B96__ _
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
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, * (Firm ! pt),
Avg. Daily
Daily FIow,
Obligated
Available
Number)
No.
MGD MGD
Flow, MGD
MGD
Flow
Capacity***
* 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
(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): T%%S (D WLCY-r P
Downstream Permit Number: NCOOC90 3 H
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I ���i'�'��-" certify to the best of my knowledge that the addition of
the volume ofwastewater 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 certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
al Signature
-AO4- __
Title of Signing fficial
Date
Page 2 of 6
FTSE 10-18

Public and Private Sewer Relocation 56 Sanford Road, Pittsboro
PROJECT NARRATIVE FOR SEWER EXTENSION
NCDOT is planning a street improvement project for Sanford Road (south of the Courthouse). The
improvements include widening of sidewalks and streetscape plantings. Our client has agreed to
relocate existing sewer connections from the front of the building to a rear location avoiding conflict
with the NCDOT project. A small portion of public sewer will be constructed to just outside the ROW.
The extension of sewer beyond the public section will be private.
This project does not add any new flow and is simply rerouting the sewer to the back of the building.
This is a zero flow request.
Separate Applications are included to cover the public and private portions of the sewer outfall along
with a FTA form noting zero flow contribution.

TO: NCDENR -- DWQ
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
ATTENTION: Permitting
CE GROUP
`r 301 GLENWOOD AVENUE, SUITE 220
RALEIGH, NC 27603
Phone: [phone]
E-Mall: [e-mail]
Transmittal
DATE: 1219119
PROJECT NO: 127
Sewer Relo for 56 Sanford Road NCDOT Project
Pittsboro, NC
Public & Private Extension(s)
Quantity
Drawing No.
Description
2
1 copy/1 original
Fast Track Sewer System Extension Application (Public)
2
1 copy/1 original
Fast Track Sewer System Extension Application (Private)
2
Copy
Project Narrative
2
Checks
$480 Application Fee(s) — Check 10862 (Public) & 10863 (Private)
2
Originals
FTSE
2
Copy
USGS Overall Area Map
2
Copy
Vicinity Location Map
1
Copy
NC Secretary Articles of Incorporation (Private Portion)
NC DeptofEaviron
REMARKS Please let us know if you require any additional information. Raleigh Re2innai 91.�__
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X411-1-', LIMITED LIABILITY COMPANY ANNUAL REPORT
J0/2a17
NAME OF LIMITED LIABILITY COMPANY: WineAndBeerAreWe, LLC
SECRETARY OF STATE ID NUMBER: 1420645 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2419
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Stafford, Gregory W.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
3. REGISTERED OFFICE STREET ADDRESS S COUNTY
901 Jordan Hills Drive
Ring Office Use my
E - Filed Annual Report
1420645
CA201907708242
3/18/2019 09:38
Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
4. REGISTERED OFFICE MAILING ADDRESS
901 Jordan Hills Drive
Chapel Hill, NC 27517-6440 Chatham County Chapel Hill, NC 27517-6440
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Property ownership and rental
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS & COUNTY
901 Jordan Hills Drive
5. PRINCIPAL OFFICE MAILING ADDRESS
901 Jordan Hills Drive
Chapel Hill, NC 27517-6440 Chapel Hill, NC 27517-6440
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: Sweet B's LLC NAME:
TITLE: General Manager TITLE:
ADDRESS:
901 Jordan Hills
Chapel Hill, NC 27517
SECTION D: CERTIFICATION OF ANNUAL REPORT.
ADDRESS:
NAME:
TITLE:
ADDRESS:
Section D must be completed in its entirety by a person/business entity.
Sweet B's LLC, by Gregory W Stafford Member Manager 3/18/2019
SIGNATURE
Forth must be signed by a Company OfSciaJ listed under Section C of This form.
DATE
Sweet B's LLC, by Gregory W Stafford Member Manager General Manager
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed elecimnically.
MAIL TO' Secretary of State. Business Registration Division, Post Office Box 29525, Raleigh. NC 27626-0525

SOSID: 1420645
Date Filed: 1/8/2015 12:27:00 PM
Elaine F. Marshall
North Carolina Secretary of State
State of North Carolina
Department of the Secretary of State C2015 005 00865
Limited Liability Company
ARTICLES OF ORGANIZATION
Pursuant to §57D-2-20 of the General Statutes of North Carolina, the undersigned does hereby submit these
Articles of Organization for the purpose of forming a limited liability company.
The name of the limited liability company is: WineAndBeerkeft LLC
(Sec lien, torthe Instructions for appropriate entity designation)
2. The name and address of each person executing these articles of organization is as follows: (State
whether each person is executing these articles of organization in the capacity of member, organizer
or both. Note: This document must be signed by all persons listed.)
Timothy A. Nordgren, Organizer, 3211 Shannon Road, Suite 620, Durham, NC 27707
3.
4.
The name of the initial registered agent is: Gregory W. Stafford
The street address and county of the initial registered agent office of the limited liability company is:
Number and street 901 Jordan Hills Drive
City.Chapel Hill Slate: NC Zip Code: 27517 County:
Chatham
The mailing address, if different from the street address, of the initial registered agent office is:
Number and Street
State: NC Zip Code: County:
Principal office information: (Select either a or b.)
a. ❑a The limited liability company has a principal office.
The principal office telephone number:
919-215-8782
The street address and county of the principal office of the limited liability company is:
Number and Street 901 Jordan Hills Drive
CityChapel Hill State: NC Zip Code: 27517
County: Chatham
CORPORATIONS DIVISION P.O. Box 29622 RALEIGH. NC 27626-0622
(Revised January 2014) 1 (Form L-0 I )

The mailine address, if different from the street address, of the principal office of the company is:
Number and Street
City State: Zip Code: County:
b. ❑ The limited liability company does not have a principal office.
7. Any other provisions which the limited liability company elects to include (e.g., the purpose of the entity)
are attached.
S. (Optional): Please provide a business e-mail address:
The Secretary of State's Office will a -mail the business automatically at the address provided above at no
cost when a document is filed. The a -mail provided will not be viewable on the website. For more
information on why this service is offered, please see the instructions for this document.
9. These articles will be effective upon filing, unless a future date is specified:
This is the 5th day of January , 20 t5
t -�- k- N
Signature
Timothy A. Nordgren, Organizer
Type or Print Name and Title
The below space to be used if more than one organizer or member is fisted in Item #2 above.
Signature
Type and Print Name and Title
Signature
Type and Print Name and Title
Signature
Type and Print Name and Title
Signature
Type and Print Name and Title
NOTES:
I. Filing fee is $125. This document must be filed with the Secretary of State.
CORPORATIONS DIVISION P.O. Box 29622 RALEIGH, NC 27626-0622
(Revised January 2014) 2 (Form L-01)