WQ0041873_Sewer Extension, original_20200730

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Transmittal
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JUL 3 0 2020
WQROS
FAYETT9:1111 117 PPPlONALOFFICE
Date: July 23, 2020 Job Number: 009016
Project Name: Starbucks — Raeford Rd
To: NCDEQ — Fayetteville Regional Office Water Quality Section
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
We are sending these by
❑ U.S. Mail
❑ Other
/1 '
❑ Hand Delivery
We are sending you
❑ Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints/Plans ❑ Samples ❑ Specifications ❑ Change Orders
® Other This document serves as the cover letter listing everything included in this submittal package
nntn ATn n0(`/'N77'f i7/l Yl
1
Fast Track Sewer System Extension Application - original
l
Fast Track Sewer System Extension Application — copy
1
Application fee - $480
l
LLC Certificate — documentation showing registered business with the NC
Secretaryof State
1
Flow tracking/acceptance form
1
Topo Map
1
Street Level Map
1
Pump Station Reliability Statement
These are transmitted as checked below:
❑ For your use ❑ Approved as submitted ❑ Resubmit ❑ Copies for approval
❑ As requested ❑ Approved as noted ❑ Submit ❑ Copies for distribution
® For review and comment ❑ Returned for corrections ❑ Return ❑ Corrected prints
Remarks:
Requesting review of the stormwater application for a force main that will west run from the Starbucks
site under Strickland Bridge Rd and connect to the PWC sewer system. This will serve just the
Starbucks site and will contain a grinder pump.
J'
Copy to: Signed:
Ross Godwin

State of North Carolina
Department of, Environmental Quality
d, Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T .0300, Division policies and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed perniitted (do not require a pennit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an enviromnental assessment in accordance with 15A NCAC 1C .0100;
➢ Projects that do not meet any part of the minimum design criteria (NIDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains):
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attaclunents to the application may be made.
® If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item IL 1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 1.5A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to pennnit issuance and must be dated less than one
year prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67 a .
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and pennit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing pen -nit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e.. permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
® Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alterative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Propeny, Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEW
For more information, visit the Divisions collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
.[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's naive: Raeford Rd Fayetteville 2019, 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: Collins Hartzog per 15A NCAC 02T .0106(b)
Title: Member/manager
4. Applicant's mailing address: 109 Still Wild Ln
City: Elgin State: SC Zip: 29045-
5. Applicant's contact information:
Phone number: [phone] Email Address: collinshartzog_ggnnail.com
H. PROJECT INFORMATION:
1. Project name: Starbucks - Raeford Rd
2. Application/Project status: ® Proposed (New Pen -nit) ❑ Existing Pennit/Prcject
If a modification, provide the existing pennit 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: Cumberland
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.039458' Longitude:-79.000301°
5. Parcel ID (if applicable): 9496-99-9355
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
l . Professional Engineer: Matt Lowder License Number: 24434
Finn: Triangle Site Design
Mailing address: 4004 Barrett Dr, Suite 101
City: Raleigh State: NC Zip: 27609-
Phone number: [phone] Email Address: nflowderAtrianglesitedesi sign. com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Rockfish WWTF Permit Number: NPDES NC0050105
Owner Name: Fayetteville Public Works Commission
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Pennit Number(s): PWC2013-SO11 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00007
Owner Name(s): Fayetteville Public Works Conunission
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 ®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' Associatiom 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/ser0ce
❑ Hotel and/or Motels
❑ School / preschool / day care
❑ Medical / dental / veterinary facilities
❑ Swinuning Pool /Clubhouse
® Food and drink facilities
❑ Church
❑ Swinuning Pool/Filter Backwash
❑ Businesses / offices / factories
❑ Nursing Home
❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Conunercial
Industrial (See 15A NCAC 02T .0103(20))
I I- Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 021.0114(f)? ®Yes ❑ No
➢ If _yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow',b
No. of Units
Flow
Restaraunt
25 gal/seat
75
1,875 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
1,875 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
detennined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1,875 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 pennitted in subsequent pen -nits 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
➢ Section II & III of the MDC for Pennitting of Gravity Sewers contains information related to design criteria
Section III contains information related to ininimum slopes for gravity sewer(s)
Y 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: Pentair Myers VRS20A-21
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.039458' Longitude:-79.000301'
3. Design flow of the pump station: 0.0019 mullions gallons per day (fine capacity)
4. Operational point(s) of the pump(s): 6.5 gallons per minute at 20 feet total dynamic head (TDH)
5. Summarize the force main to be pennitted (for this Pump Station):
Size (inches)
Length (feet)
Material
1.5
222
PVC
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(ln)(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(ln)(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 timefrunes, 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 NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
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 nonnal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
**Any other stream, lake, impounchnent, 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(g) 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 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 ® 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 pennits or 401 Water Quality Certifications?
➢ 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 enviromnental pennits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this pen -nit 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 streannbanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® 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 1.5A 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?
2
® 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.
I,
Certification:
(Professional Engineer's name from Application Item III.1.)
attest 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 Pennitting
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 143-215.6B, 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. His
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification per 15A NCAC 02T .0106(b):
I,
(Signature Authori 's name &title from
n 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 attaclunents are not included, thus
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 tlus permit be violated. I also understand that if all required parts of tlus application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: 0
FORM: FTA 04-16 Page 5 of 5

S
SOSID: 1922394
Date Filed: 12/2/2019 11:19:00 AM
State of North Carolina Elaine F. Marshall
North Carolina Secretary oi' State
Department ofthe Secr•etarh of��State
C2019 330 01106
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR LIMITED LIABILITY COMPANY
Pursuant to'§57D-7-03 of the General Statutes of North Carolina, the undersigned limited liability company hereby applies for a
Certificate of ALIthority to transact business in the State of North Carolina, and for that purpose submits the following:
1. The name of the limited liability company is Raeford Rd. Fayetteville 2019, LLC ;
and if the limited liability company name is unavailable f'or use in the State of North Carolina, the name the limited
liability company wishes to use is T
2. The state or country under whose laws the limited liability company was formed is South Carolina
I Principal office information: (Select either a or b.)
a. X❑ The limited liability company has a principal office.
The principal office telephone number: 803-233-3825
The street address and county of the principal office of the limited liability company is
Number and Street: 109 Still Wild Lane
City: Elgin State: SC Zip Code: 29045 County: Richland
The mailing address, if different from the street address, of the principal office of the corporation is:
Number and Street:
City:
State: Zip Code: _ County:
b. ❑ The limited liability company does not have a principal office.
4. The name of the registered agent in the State of North Carolina is: Elizabeth W. Voltz
5. The street address and county of the registered agent's office in the State of North Carolina is:
Number and Street: 3700 Glenwood Avenue, Suite 250
City: Raleigh State: NC Zip Code: 27612 County: Wake
6. The North Carolina mailing address, if different from the street address, of the registered agent's office in the State of North
Carolina is:
Number and Street:
City:
State: NC
Zip Code:____ County:
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July 2017) (Pbrin L-09)

APPLICATION FOR CERTIFICATE OF AUTHORITY
Page 2
7. The names, titles, and usual business addresses of the current company officials of the limited liability company are:
(use attachment if necessai)�) (This document must be signed by a person listed in item 7.)
Name and Title
Business Address
Hartzog Holdings LLC Sole Member - 109 Still Wild Lane Elgin SC 29045 -
8. Attached is a certificate of existence (or document of similar import), duly authenticated by the secretary of state or other official
having custody of limited liability company records in the state or country of formation. The Certificate of Existence must be
less than six months old. A photocopy of the certification cannot be accepted.
9. If the limited liability company is required to use a fictitious name in order to transact business in this State, a copy of the
resolution of its managers adopting the fictitious name is attached.
10. (Optional): PIease provide a business e-mail address:
The Secretary of State's Office will e-mail the business automatically at the address provided above at no cost when a document
is filed. The e-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.
11. This application will be effective upon filing, unless a delayed date and/or time is specified:
'this the '72 day of November , 2019
Raeford Rd. Fayetteville 2019, LLC, a South Carolina LLC
Name of Limited Liability Company
-- --- Signature onrpatry Official
By: Hartzog Holdings, C, a South Carolina LLC, its Sole Member
By: W. Collins Hartzog, President
Type or Print Name and Title
Notes:
1. Filing fee is $250. This document must be filed with the.Secretary of State.
BUSINESS REGISTRALTION DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July 2017) (Form L-09)

The State of South Carolina
Office of Secretary of State Mark Hammond
Certificate of Existence
1, Mark Hammond, Secretary of State of South Carolina Hereby Certify that:
Raeford Rd. Fayetteville 2019, LLC, a limited liability company duly organized under
the laws of the State of South Carolina on November 12th, 2019, with a duration that
is at will, has as of this date filed all reports due this office, paid all fees, taxes and
penalties owed to the State, that the Secretary of State has not mailed notice to the
company that it is subject to being dissolved by administrative action pursuant to S.C.
Code Ann. §33-44-809, and that the company has not filed articles of termination as of
the date hereof.
Given under my Hand -and the Great Seal
of the State of South--`Carpjlna this 12th day
of November, 2019,
Mark Fla ninon l-�ec a y of State

State of North Carolina
Department of Environmental Quality
Division of Water Resources
...fgs� of M,r.�ter Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Raeford Rd Fayetteville 2019, LLC
Project Naive for which flow is being requested: Starbucks - Raeford Rd
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all ptimp
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: Rockfish Wastewater Treatment Facility
b. WWTP Facility Permit #: NPDES NCO050105
All f Zows are in MGD
c. WWTP facility's permitted flow 21.0
d. Estimated obligated flow not yet tributary to the WWTP 3.4667
e. WWTP facility's actual avg. flow 15.6
f. Total flow for this specific request 0.0019
g. Total actual and obligated flows to the facility 19.0686
h. Percent of permitted flow used 90.80
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 / pf), Avg. Daily Daily Flow, 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): PWC/Fayetteville Collection System
Downstream Permit Number: PWC2013 -SO 11
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Joseph E. Glass, P.E. 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 certifies that the receiving
collection system or treatment works has adequate capacity to transport and treat the proposed new
wastewater.
r. NAew'.- ov
Siting Official Signature Date
[.:: "(MI HCEr2.NG d/V#4rYr4 6AF4
Title of Signing Official
Page 2 of 6
FTSE 10-18

DARSWEIL L. ROGERS, COMMISSIONER
WADE R. FOWLER, 1R., COMMISSIONER
EVELYN 0. SHAW, COMMISSIONER
D. RALPH HUFF, 111, COMMISSIONER
DAVID W. TREGO, CEO/GENERAL MANAGER
te�
• ) FAYETTEVILLE PUBLIC WORKS COMMISSION
C 955 OLD WILMINGTON RD
J P.O. BOX 1089
H ME OWN UTILITY FAYETTEVILLE, NORTH CAROLINA 28302-1089
TELEPHONE [phone]
WWW.FAYPWC.COM
July 27, 2020
TO WHOM IT MAY CONCERN:
SUBJECT: Flow Acceptance — Starbucks — Raeford Road
920 Strickland Bridge Road
This letter is in response to the inquiry regarding the availability of sanitary sewer to
serve the proposed Starbucks — Raeford Rd project located at 920 Strickland Bridge Road
in the City of Fayetteville, Cumberland County NC.
Raeford Rd Favetteville 2019, LLC has submitted a permit application for a private pump
station and force main on this project. The Fayetteville Public Works Commission does
not have an operation and maintenance agreement with Raeford Rd Fayetteville 2019,
LLC, but has agreed to accept and treat sanitary sewer from this project. The sewage and
wastewater collected by this system shall be treated in the Fayetteville Public Works
Commission Rockfish Creek Wastewater Treatment Facility (NPDES Permit No.
NC0050105) prior to being discharged into the receiving stream. The projected flow for
this development is 1,875 gallons per day. The Rockfish Facility has the capacity to
accept the flow generated by this project.
If you have any questions concerning this letter, please call me at [phone].
Very truly yours,
F YETTEVILLE PUBLIC WORKS COMMISSION
a r. AVV
oseph E. Glass, P.E.
Water Resources Engineering Manager
cc: Project File
BUILDING COMMUNITY CONNECTIONS SINCE 1905
AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER

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PUMP STATION RELIABILITY STATEMENT
Pump Station Address:
Owner Information:
24 HR Emergency Contact
(In case of power outage or equipment failure)
Pump Station Installer:
Starbucks
920 Strickland Bridge Rd
Fayetteville, NC 28304
Hartzog Holdings, LLC
109 Still Wild Lane
Elgin, SC 29045
Collins Hartzog 803-361-6718
Jordan Williamson 901-740-5552
Heath Grading & Utilities

State of North Carolina
Department of Environmental Quality
Division of Water Resources
? R
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Nurnber: (to be completed by Dwx)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's naive: Raeford Rd Fayetteville 2019, LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Muiucipal ❑ Other
3. Signature authority's name: Collins Hartzog per I5A NCAC 02T .0106(b)
Title: Member/manager
4. Applicant's mailing address: 109 Still Wild Ln
City: Elgin State: SC Zip- 29045-
5. Applicant's contact information:
Phone number: [phone] Email Address: collinshartzog�%cmail.com
II. PROJECT INFORMATION:
1. Project name: Starbucks - Raeford Rd
2. Application/Project status: - -
If a modification, provide t TRIANGLE SITE DESIGN PLLC 3215
4004 BARRETT DR STE 101 66-1121531
If new construction but par RALEIGH, NC 27609
3. County where project is hoc
4. Approximate Coordinates i Pay to the /C Jc �� Cc� � d c"o
Order
5. Parcel ID (if applicable): D t F - Sphoto
ee
(or Parcel ID to closest do` Q r.'t ©ottars ® Dep
Deposit
Cetoits ort 6.uk
III. CONSULTANT INFORMA7 BRANCH BANKING AND TRUST COMPANY
f F � 1-800-BANK BBT BBT.com
1. Professional Engineer: Ma
NP
Finn- Triangle Site Design
For
Mailing address: 4004 Bar
City: Raleigh State: NG
Phone number: (919) 553-6..
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Rockfish WWTF Permit Number: NPDES NCO050105
Owner Name- Fayetteville Public Works Conunission
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): PWC2013-S011 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection Systenn Permit Number(s) (if applicable): WQCS00007
Owner Name(s): Fayetteville Public Works Conunission
FORM: FTA 04-16 Page 1 of 5