WQ0042125_Application (FTSE)_20201208

Permit Number WQ0042125
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
dean.hunkele
Coastal SWRuIe
Permitted Flow
Facility
Central Files: APS _ SWP
11 /20/2020
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
A
Individual
Permit Contact Affiliation
Facility Name Major/Minor Region
Surf City Tractor Supply Private Pump Station Minor Wilmington
Location Address County
Pander
Owner
Owner Name
Surf City Development Group LLC
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
11/20/2020
Regulated Activities
Outfall
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Thomas Gavin Melia
155 W New York Ave
Southern Pines NC 28387
Public Notice Issue Effective Expiration
A b-'? � 1 a-�-a�
Requested /Received Events
Additional information requested
Additional information received
Waterbody Name Streamindex Number Current Class Subbasin

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: W 064a o`j (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Surf City Development Grout) 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: Thomas Gavin Melia per 15A NCAC 02T .0106(b)
Title: Member
4. Applicant's mailing address: 155 W. New York Ave. Suite 200
City: Southern Pines State: NC Zip: 28387-_
5. Applicant's contact information:
Phone number: 910 695-3694 Email Address: gavin(@,,baselinedevelopment.com
11. PROJECT INFORMATION:
1. Project name: TSC Surf City
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Pender
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.453°Longitude:-77.614'
5. Parcel ID (if applicable): 4215-78-6561-0000
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Rob Balland License Number: 031591
Firm: Paramounte Engineering, Inc.
Mailing address: 122 Cinema Drive
City: Wilmington State: NC Zip: 28403-_
Phone number: (910 791-6707 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Town of Surf City Wastewater Treatment Plant Permit Number: W00000795
Owner Name: Town of Surf City
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: A.d �W W
I
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): Town of Surf City 1
FORM: FTA 04-16 Pagel of 5

NIL GENERAL REQUIREMENTS
I. 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 t)evelo )er s Oueratioiril Aercencnl Il'OR,%I DES been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home.'Pronetty Otnlers' Associariun, hats an Operational A,�recmem (FORM: I IOA) been attached°
❑ Ycs ❑No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ® Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial '% Commercial
_'%o Industrial (Sec 15A NCA(' 021 .0103(20))
"Is there a Pretreatment Program in effect'? ❑ Yes ❑ No
6. lias a flow reduction been approved under 15A NCAC 02'1 .0114(1)? ❑ Ycs ® No
I If yes, provide a conv of flow reduction annroval letter
7. Summarize wastewater generated by project
Establishment Type (see 02T.0114(f))
Daily Design Flow "J'
No. of Units
Flow
Retail
100 g11/1000 sf
19097
1910 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
1'olnl
1910 GPD
a Sec I5n NCAC 011 .01 14(b), �)��c ( and c (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 oreast of the Atlantic Lm-acoastal Waterway to be usecl as vacation rentals as defined
in G.S. 42A_4).
b Pei 15A NCAC 02T .01 14(c), design flow rates for estabIishnlctits not identified [in table I5A NC AC 011 .01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1910 GIT (per ISA NCAC 021.0114)
Do not include future flows or previously permitted allocations
If permitted flow is zoro, indicate why:
❑ Pun1p 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 oCexisting sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 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
➢ 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 sewers)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIH. 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: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.453' Longitude:-77.614°
3. Design flow of the pump station: .00 191 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 30 gallons per minute at 50 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
375
SDR-21
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:
® Yes ❑ No
Setback Parameter's
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, W S-I waters of Class I or
Class It impounded reservoirs used as a source of drinking water
100 feet
"Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top 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(f) cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications webnage
➢ 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
➢ 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.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supportine documents
2. Professional Engineer's Certification:
name from Application Item III. I.)
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 package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
IJ W\A A
(Signature Authority's name & title from Application Item I.3.)
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 non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6E, 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: I ""' V Date:
FORM: FTA 04-16 Page 5 of 5

SOSID: 1989892
Date Filed: 6/2/2020 3:20:00 PM
State ofNorth Carolina Elaine F. Marshall
Department of the Secretary of Statil North Carolina Secretary of State
C2020 139 00820
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.
1. The name of the limited liability company is: Surf City Development Group, LLC
(See Item Iof the 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 by checking
all applicable boxes.) Note: This document must be signed by all persons listed.
Name Business Address Capacity
Ralph J. Ronalter, Jr. 155 W New York Avenue, Suite 2013, Southern Pines, NC 28387 OMember ❑Organizer
William C. Ronalter 155 W New York Avenue, Suite 200, Southern Pines, NC 28387
❑Member ❑Organizer
Pine Hill Trust dated December 17, 2013 6880 E. Horseshoe Road, Paradise Valley, AZ 85253
o s awn a la a Southern Ines, 11 lember t ❑Organizer
3. The name of the initial registered agent is: Linda Suydam
4. The street address and county of the initial registered agent office of the limited liability company is:
Number and Street 155 W New York Avenue, Suite 200
Ciry Southern Pines State: NC Zip Cede: 28387 County: Moore
5. The mailing address, if different from the street address, of the initial registered agent office is:
Number and Street 155 W New York Avenue, Suite 200
Southern Pines
State: NC Zip Code: 28387 County: Moore
6. Principal office information: (Select either a orb.)
a. 7 The limited liability company has a principal office.
The principal office telephone number: 910-695-3694
The street address and county of the principal office of the limited liability company is:
Number and Street: 155 W New York Avenue, Suite 200
City:
Southern Pines
State: NC Zip Code: 28387 County: Moore
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 Raleigh, NC 27626-0622
(Revised August 2017) Form L-01

The mailing address, if different from the street address, of the principal office of the company is:
Number and Street: same as above
City:
State: Zip Code: County:
b. The limited liability company does not have a principal office.
Any other provisions which the limited liability company elects to include (e.g., the purpose of the entity) are
attached.
(Optional): Listing of Company Officials (See instructions on the importance of listing the company officials in the
9. (Optional): Please provide a business e-mail address Privacy Redaction
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.
10. These articles will be effective upon filing, unless a future date is specified:
This is the 1 Sth day of May 2020 .
Surf City Development Group, LLC
vi'dix"Vx 416,,C�
Signature
William C. Ronalter Member
Type or Print Name and Title
The below space to be used if more than one organizer or member is listed in Item #2 above.
Ci Develop ent Group, LLC Surf CityDevelopment Group,C
_.. Signa��rc
David A. Long (Trustee)lfor Pin Hill Trust dated
Q_ermber 12_2013 Member Ralph J. Ronalter, Jr. Member
I peand'nntNameand mile Type and Print Name and Title
Surf City Development Grou , LLC
!VOTE: I . Filing fee is $125. This document must be filed with the Secretary of Stale.%400 S -
gnature
Thomas Gavin Melia Member
Type and Print Name and Title
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 Raleigh, NC 27626.062.2
(Revised August. 2017) Form L01

11/20/2020
North Carolina Secretary of Slate Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
Surf City Development Group, LLC
Information
Sosld: 1989892
Status: Current -Active O
Date Formed: 6/2/2020
Citizenship: Domestic
Annual Report Due Date: April 15th
Registered Agent: Suydam, Linda
Addresses
Mailing
155 W New York Avenue, Suite 200
Southern Pines, NC 28387
Reg Office
155 W New York Avenue. Suite 200
Southern Pines, NC 28387
Company Officials
Principal Office
155 W New York Avenue, Suite 200
Southern Pines, NC 28387
Reg Mailing
155 W New York Avenue, Suite 200
Southern Pines, NC 28387
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
https://ww sosnc.gov/online_services/search/Business_Registration_Resu Its 1/1

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