WQ0041769_Application (FTSE)_20200623

To
,
WORO
Alfred Benesch &Company
2320West Morehead Street
Charlotte, NC 28208
www.henesch.com
P 04-521- 880
' 704-521-8955
NCDEQ— Water Quality Section Date: 06-22-20 lob No. 17000237.00
Mooresville Regional Office Subject: Gallery at Royal Park PH2
Attn: Debbie Luckman Fast Track Sewer System Extension Application
610 East Center Ave. Suite 301
Mooresville, NC 28115
❑ Mail ❑ Messenger ❑ Next Day Delivery
WE ARE SENDING YOU: ❑Attached
COPIES DATE DESCRIPTION
® UPS Ground ❑ Other:
❑ Under separate cover:
1
04/28/20
Cover Letter — Fast Track Sewer Application
1
04/29/20
Fast Track Sewer System Extension Application (FTA 04-16)
1
09/27/18
Charlotte Water Capacity Assurance Letter
1
05/04/20
Flow Tracking for Sewer Extension Application (FTSE 10-18)
1
05/13/19
Review Fee Check — Check #227379 ($480.00)
1
N/A
USGS Topo —Site Map
1
N/A
Aerial Project Location
THESE ARE TRANSMITTED as checked below:
® For approval ❑ Approved as submitted ❑Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑Return corrected prints
❑ For review and comment
Remarks: Hello Debbie,
Enclosed are Fast Track Sewer System Extension Application (FTA 04-16) and the corresponding
documents for the Gallery at Royal Park — PH2 in Matthews, NC including the wet ink signatures
you requested. Please let us know if you need anything else.
Thanks.
cc: Kevin Gorman, PLA.
Signature: Matt Blackmon, PE
PS01-0998-06 form

Alfred Benesch & Company
2359 Perimeter Pointe Parkway, Suite 350
Charlotte, NC 28208
www.benesch.com
P 704-521-9880
F 704-521-8955
Date: 04/28/2020
4_s
M(,0R-,SXJ1iLLl
Department of Environmental Quality- Division of Water Resources
Mooresville Regional Office - Water Quality Section
610 E. Center A venue
Mooresville, NC 28115
Subject: Gallery at Royal Park PH2 - Fast Track Sewer System Extension Application
To whom it may concern:
Enclosed for your review is the Fast Track Sewer System Extension Application (FTA 04-16) for the
Gallery at Royal Park PH2 Project located in Matthews, NC. This project involves the construction of a
Senior Independent Care Facility. Included in this project are approximately 20 independent living
residences and a Multifamily facility with approximately 180 living units.
This project is located at 4341 Glenloch Circle, south of the intersection of Matthews -Mint Hill Road
and Moore Road, in Mecklenburg County. The property is owned by the Liberty Healthcare Properties
of North Carolina (PID# 2510206) and is approximately 36.0 acres. In addition to the primary structures,
this project involves the construction of surrounding parking lots and underground utilities to serve the
proposed buildings.
The private sewer portion of this project includes approximately 3,206 linear feet of 8-inch PVC sewer
pipe, 15 manholes and the associated appurtenances. Flows for this project were calculated as per the
15A NCAC 02T .0114- Wastewater Design Flow Rates. Included with this application are the Flow
Acceptance Letter and Flow Tracking for Sewer Extension (FTSE 10-18) from Charlotte Water.
Matt Blackmon, P.E. j Project Engineer I
Alfred Benesch & Company

State of North Carolina
li/S t t t ll( 4*
Department of Environmental Quality
1
Division of Water Resources
DW,R
15A NCAC 02T {.0300 — FAST TRACT{ SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources
VgrQ',ios FTA 04-16 &SUPPORTING DOCUMENTATION
Application Number:
61 C (to be completed by DWR)
All items must be completed or the aDDlication will be returned
I. APPLICANT INFORMATION:
WQROS
MOORESVILL_E- REC;IONAL OF
1. Applicant's name: Liberty Healthcare Properties of North Carolina 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: Mathew Bork per 15A NCAC 02T .0106(b)
Title: VP of Finance
4. Applicant's mailing address: 2550 S. 411t Street
City: Wilmington State: NC Zip: 28403-
5. Applicant's contact information:
Phone number: 910) 332-1967 Email Address: [e-mail]
IL PROJECT INFORMATION:
1. Project name: The Gallery at Royal Park Senior_I_ndependent Living Communi
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: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.1147' Longitude:-80.690
5. Parcel ID (if applicable): 21510206
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Matthew Blackmon License Number:
Firm: Alfred Benesch & Company
Mailing address: 2359 Permieter Pointe Parkway, Suite 350
City: Charlotte State: NC Zip: 28208-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: McAlpine Creek Wastewater Treatment Plant Permit Number: NCO024970
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page I of 5

V1. 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/Pr0 ee ty Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No RN/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. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow 1,b
No. of Units
Flow
Residential - Multifamily
135 gal/day/bedroom
180
24300 GPD
Residential - Single Family
190 gal/day/bedroom
20
3800 GPD
Pool
10 gal/person
40
400 GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
28,500 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.0114] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project:28,500 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" 3,206 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: 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);
➢ 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)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
►4 •
Setback Parameter*
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-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
Any building foundation
5 feet
Any basement
10 feet
ToR 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(a) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpaee
➢ If noncompliance with 02T.0305(f) or Lg), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ 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 all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ 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 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 ® No
➢ 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.
FORMT : FTA 04-16 Page 4 of 5

K. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC. 02T. the N inimurn Design Criteria, for the Permitting of Pump Stations
and force Tvlains (latest version), and the Crat itv Sewer Minimum Design Criteria (latest version} as applicable?
M Yes El No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Apnroval of the request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
E VA7UN&Z K (6tC1 • f- - attest that this application for
(Professional Engineer's naive from Application Item III.).)
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 rimy 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 sea! 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.
.••ffafnfago�,' ............ ....... ............
G A RQ#J' %North Carolina Professional Engineer's seal, signature, and date: `,at,•`ke�+ft9ffff,�,r�',p
a SEAL
00014. V/ B\� P� ve Y/Zr/Z*7,o
Ply
'.3"J oXp" plreant's Certification per I5A NCAC 02T .0106(b): j'+tu14 i' 000
I,
0
(Signature Authority's name & title from Application Item I.3.)
attest that this application for
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 none
discharge systemtosurface 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 attaclunents 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.
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Signature: Date:
FORM: FTA 04-16 Page 5 of 5

September 27, 2018
Mr. David Gusty
Benesch
2359 Perimeter Pointe Parkway Ste. 350
Charlotte, NC 28208
SUBJECT: CAPACITY ASSURANCE REVIEW
ROYAL PARK PH2
2036 MOORE ROAD, CHARLOTTE NC
CLTWATER TRACKING# 20181239
MAY 1 P 1010
WQ 0
A Capacity Assurance Review of the subject site has been completed and the following has been
determined:
After an analysis of the sanitary sewer associated with the proposed design of project 20181239, Royal
Park Ph 2 it was determined that there is sufficient capacity to accommodate the proposed sewer flow of
28,500 gallons per day (180 units x 135gal/unit; 40person x 10gal/person; 20 lots x 190gal/lot) from this
project for transmission to the McAlpine Creek Wastewater Treatment Plant; NPDES permit number
NC0024970, for treatment. This acceptance of flow is based upon the existing capacity of the designated
publicly owned treatments works.
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.
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 or sewer
systems, as the appropriate local or State permits are required prior to construction. ff the appropriate
authorization to construct permits are not obtained and construction has not started within two (2) years of
issuance of this Capacity Assurance Review, and payment for any service connections) has not been
received within (2) years of issuance of this Capacity Assurance Review letter. this approval shall be
rescinded and a new Capacity Assurance Review must be made. If you have any questions, you may
contact me at [phone].
Sincerely,
rZwendo yn -banner
Gwendolyn Banner
Engineering Assistant
Charlotte Water 5100 Brookshire Blvd, Charlotte, NC 28216 charlottewater.org
v operated by the City of Charlotte

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Trackin for Sewer Extension A lications
Division of VVetter Resources QROS g pp
OOPESVILLE REGIONAL OFr`l > - (FTSE 10-18)
Entity Requesting Allocation: Benesch
Project Name for which flow is being requested: Royal Park Phase 2 (Residential)
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
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: McAlpine Creek, Irwin Creek, Sugar Creek
b. WWTP Facility Permit #: NC0024970, NC0024945, NCO024937
All flows are in MGD
c. WWTP facility's permitted flow 99.00
d. Estimated obligated flow not yet tributary to the WWTP 10.651
e. WWTP facility's actual avg. flow 72.158
f. Total flow for this specific request 0.0285
g. Total actual and obligated flows to the facility 82.838
h. Percent of permitted flow used 82.81%
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 / pfl,
Avg. Daily
Daily Flow,
Obligated Available
Number) No.
MGD MGD
Flow, MGD
MGD
Flow Capacity***
Crooked Creek
* 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
(pi) 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): Unknown
Downstream Permit Number: Unknown
Page 1 of 6
FTSE 10-18

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North Carolina Secretary of State Search Results
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I Ulm Me 14 R. $11MWISE•.
Legal Name
Liberty Healthcare Properties of North Carolina, LLC
Sosld: 0643724
Status: Current -Active
Date Formed: 8/28/2002
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Balter, Yoel
WN - -
Mailing
2334 S. 41 st St.
Wilmington, NC 28403-5502
Reg Mailing
2334 S. 41 st St.
Wilmington, NC 28403-5502
Principal Office
233.4 S. 41 st St.
Wilmington, NC 28403-5502
Reg Office
2334 S. 41 st St.
Wilmington, NC 28403-5502
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Liberty Real Properties, LLC
2334 S. 41 st Street
Wilmington NC 28403-5502
https://www.sosne.gov/online_serviees/search/Business_Registration Results 6/25/2020