WQ0042314_Application (FTSE)_20210203

State of North Carolina
Department of Environmental Quality
DW'RDivision of Water Resources
15A NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvftsiwt of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: 1/ 3 (to bt completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
1. Applicant's name: Powell Property Holdings, LLC (company, municipality, HOA, utility, etc.)
2. Applicant Limited Liability
pp type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -owned Public Utility
❑ Federal ❑ state/County ❑ Municipal ❑ Other
3. Signature authority's name: Cara Powell per 15A NCAC 02T .0106(bl
Title: Ma alter
4. Applicant's mailing address: 1931 New Bern Avenue
City: Raleigh State: NC Zip: 27610
5.
Applicant's contact information:
Phone number: [phone] Email Address: ara g f8photostudios.com
II. PROJECT INFORMATION:
v
I.
Project name: The Upchurch Grinder Pump Station Force Main, and Private Sewer Line
O'
2.
Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
O
If a modification, provide the existing permit number: WQ00 and issued date:
a
q
If new construction but part of a master plan, provide the existing permit number: WQ00
Q e r)
t
o
v
3.
County where project is located: Wake
o w
Ali
4.
Approximate Coordinates (Decimal Degrees): Latitude: 35.766°Longitude: -78.8 r
5.
Parcel ID (if applicable): 0733337439
O
U
(or Parcel 1D to closest downstream sewer)
2
III. CONSULTANT INFORMATION:
1. professional Engineer: John F. Phillips. P.E. License Number: 10130
Firm: Dichl & Phillips. P.A.
Mailing address: t 5w Piney Plains Road Sutie 200
City: Cy State: NC Zip: 27518-_
Pbone number; (M!01-M Email Address: ftbillins(albellsouth aet
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Wes= wIU RU W Water Reclam—ation Facility Permit Number.
V. RECYIVING DOWNSl U AM SEWER INFORMATION (if dh7u trt tin WWTF):
I. Pauit Nedra(s)r WQ_ onv noueam (RwWvkW Sewer Sine: i io&
WQCSQQM
Owner Narae(ar TOM Of AM
FORM FTA 04-16 Page 1 of '

VI. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necenity been attached?
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a .pIQner's Ooeratiortal AaMent (FORM: DEV 1 bow attached?
❑ Yes ONO ®N/A
3. If the Applicant is a HMCTmpcnv ion. 11231 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 / 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)
Event Venue, no commercial kitchen,
5. Nature of wastewater: 1QQ 9/o Domestic/Commercial V Commercial only a warming stove for catered foods
% Industrial (Sa 15A NCAC 02T .0103(20)1
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ®No
➢ If yes. Provide a copy of flow reduction approval Jettyr
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f)1
Daily Design Flow'-b
No. of Units
Flow
Wedding & Event Venue
5 gal/guest
200
1,000 GPD
Venue employees
25 gatlemployee
4
100 GPD
gaU
GPD
gav
GPD
gal/
GPD
8av
GPD
Total d7l,7100PD
a See 15A NCAC 02T .0I l4ft (d1(00l and (cX2i 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 cast of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC T.01 41 shall be
determined using available flow data, water using fixtums, occupancy or operation patternz,and other measured data.
8. Wastewater generated by project: 1.100 GPD (per IJA NCAC 021, .0 IJ 4
D 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 cotmect 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: PTA 04-16
Page 2of5

%'II. GRAVITY SEWER DESIGN CRITERIA (if Applicable) - 02T .0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
6 184 PVC
➢ Section II & 111 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
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mainsl:
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
l . Pump station number or name: The Upchurch Grinder Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.766' Longitude:-78.887'
3. Design flow of the pump station: 0.0403 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 28 gallons per minute at 60 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
1,537
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(hXIXB);
➢ 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(hx l )(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry -15A NCAC 02T .0305(hx I XQ:
➢ 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
cape it and the rotation schedule of the portable power source or pump. including travel timef ames, shall be provided
in the oese of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IN. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (2) ® Yes [:]No
D 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-1 waters of Class I or
Class 11 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 a vertical
36 inches
➢ I5A NCAC 02T.0305(k contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ "*Stream classifications can be identified using the Division's NC Surface Water Classifications w6pue
➢ If noncompliance with 02T.0305(f) or (e), 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 coveragetauthorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 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 ❑ 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 ISA NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: PTA 04-16
Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T. the Mimmum Design Criteria fer the Permitting of Pump Stations
and Force Mains flntcst version1 and theGravitySewer 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 Attoroval of the reaunt is rcoulred orior to submittal of the Fast Track ARMication and sunportin4 documents_
2. Professional Engineer's Certification:
1, John F. Phillips P L attest that this application for
(Professional Engineer's name from Application Item W.I -)
The Upchurch Grinder Pump Station, Fora Main, and Private Sewer
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, spedfiatioas,
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 Cavity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
Of Pump Stations and Fora 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. whhich may
include a fine not to exceed $10.000. as well as civil penalties up to S25,000 per violation.
t,unnuuA
North Carnlioa Professional Engineer's seal, signature, and date: �v``�CA Q'''�,
,•9
3 0130
3. Applicant's Certification per ISA NCAC 02T 0106(b):
—t U ► L I fJ4 11t attest that this application for
name dt title Rom Application Item I.3.)
The Upchurch Grinder Pump Station, Force Main, and Private Sewa
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required pmu of
this application are not completed and that if all required supporting documentation and attachments ate not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge rfswm to surface waters or the land will result in an immediate enforcement action that my include civil penalties,
injunctive relief, andlor criminal prosecution. I will make no claim against the Division of Water Resouroas shodd a condition
of this permit be violated. I also understand that if all required parts of this application pttcimme are not completed and that if
all required supporting information and attachments are not included, this Application package will be rettutud to me as
incomplete.
NOTE — In accordance with General Stouin 143-21SAA and 143-215.6 . any pe In who imawiney makes any false
statement, representation. or aniffadoo In any appOadon pecJcage tthall be guilty of a pats 2 misdaneanor, which may
include a fine not to ex000d $10,000 as we11 as civil penalties up to f25,000 per violation
Signature Date:
FORM: FTA 04-16 Page 5 of 5

DIEHL & PHILLIPS, P.A.
( ONS111_I ING ENGINEERS
15($J Piny Plaim Rd., Suitt 200
c ury, Nunh ( aruW» 2731E
1 clephonc 1919141)7-9972 - FU [phone]
February 1, 2021
Water Quality Section
Raleigh Regional Office of NC DEQ
1628 Mail Service Center
Raleigh, NC 27699-1628
Re: Sewer System Extension Application
The Upchurch Event Venue
Apex, NC
Dear Reviewer:
W11J w C- DWL IPAL
J" F. ► B Lam, r.L
AUN L KF1T1 PA
NC mpt of Lnvironmer,w► Vu,1 a
n r.�+1
FEB - 3 7�,
Raleigh Regional Off'"
Please find enclosed one original and one copy of the following documents:
• This cover letter
■ Check no. 15062, in the amount of $480
• Fast Track Form FTA 04-16
• Flow Tracking/Acceptance Form
■ USGS topographic map showing the project location
■ Street level map showing the project location
The sewer system extension application is for a grinder pump station that will serve
two separate buildings on The Upchurch event venue site, and a 2-inch diameter force
main that will discharge into a Town of Apex gravity sewer manhole. The pump station
has been designed with a dedicated standby power generator and a cellular telemetry
system.
Please advise if you require any further information to process this application. Thank
you for your assistance with this matter.
Yours very truly,
Diehl & Phillips, P.A.
John F. Phillips, P.E.
Cc: Mr. Peter Cnossen, P.E.

� Quality
yC neat of Enviroro
State of North Carolina
.1 Department of Environmental Quality
FE8 3 Division of Water Resources
Ce
DMsion of Water Resources Ralclgh R*lowcgIonII ow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Powell Property Holdings, LLC
Project Name for which flow is being requested: The Upchurch
More than one ME Wray be required for a single project tf the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewaterJlow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Western Wake Water Reclamation Facility
b. WWTP Facility Permit #: NC0088846
Alt flows are in MGD
C. WWTP facility's permitted flow 18.0 (6.12 Apex capacity)
d. Estimated obligated flow not yet tributary to the WWTP 2.0e (1.13 Apex)
e. WWTP facility's actual avg. flow 6.7(2 (3.06 Apex)
f. Total flow for this specific request 0.0011
g. Total actual and obligated flows to the facility _ 8.81 (4.19 Apex)
h. Percent of permitted flow used 48.94%
IL 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)
Design
M
(C)
(D)�'K?
(F.)-(A-D)
Pump
PUMP
Average
Daily
Approx.
Current
Obligated,
Not Yet
Total Current
station
(Name or
Station
Permit
Firm
Capacity, •
Flow**
(Firm / pf),
Avg. Daily
Flow,
Tributary
Daily
Flow Plus
Number)
No.
MGD
MGD
MGD
Flow,
MGD
Obligated
plow
Available
Capacity —
Beaver
�1
White
39.4
12.71
6.72
2.09 _
8.81
&9
.._L
WOM37331
2.505
0.867
_ 0,139
0.132
0.271
0.596
• The Firm Capacity (design flout') o -any pump station is defined as the maximum pumped flow
that as be ac)tleved with the largest pump taken out of service.
r• Design Avamp Daily F1mr is the Arm capacity of the pomp station divided by a paNtta9 t
elar
(PI) not iess than 2.5, per Section 2.02(Ax4xc) of the Minimum Design Criteria,
•** A Ph aning Assmsment Addendum shall be attached for sub pump stall" loathed
between the project sonneetioa point and the WWI? Where the Available Capacfty b' p,
Downstream 1" acL* Name ( '): Town of AM
Downssu=m Pamir Number: WQCS000064
PAP I of 6
ME M.11t

111. Certification Statement:
1 Robert Hirt 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.
The Obligated Flow Not Yet butary reDorted in itemsLd and Il.c include the Town of AM
flow~ ceilified ley the Town of Apex below. Signature of this form indicates acceptance of this
wastewater flow.
Signing
of Cary, Lead Agency
Jan. 28.2021
Date
I Michael Deaton certify to the best of my knowledge that the total Estimated Obligated flow from
within the Town of Apex Jurisdiction not yet tributary to the WWRWMF (Item l.d) is l .11_ _ 5 in
and that the total Estimated Obligated flow from within the Town of Apex Jurisdiction not yet
tributary to the BCPS - Item (lLc) is 0.897 Mgd.
fining ?Wt lalSignature - oH_,n o Aperx
Pap 2 of 6
FM 0143

..wr•�•iF.
IV
JI-
��% •f -. fir., "�^ �', '� ��;� .jr i •'� ,+ �.. � r—•' [ ` •v
�^ ,
l ✓%i� I is - .T171 � � — .._ �-� '�
e r' i > • it \', �` ` ` �.1-*"`'�- {
is
of
•.7t , i � � J J-_.• ^t �. _ � J,, • v �"1 l /;� ��� cyr }ram � � . 1 � `� .
�- _ __�~, -may `=�`� ,y"' 'j •, � �� �� }�- i ��_� .,
� 'a:� _ ,try. _ .���!- t•.�,� � -.�. f .� `
, `fiFr. 1 �,,1 ��` .!•r-��. � ,± .�r 1 `f_' .R. �1i� ! �`_• �?� • !J ��� �' L �J � � _�
� , r / � l \� �,.ti "\t�� .�� ,. • a tf •. �f � •ri � � .� � i� V 1; L. � * f / �/ f} 1 � it
GREEN LEVEL QUADRANGLE a (; ,�I�i``'} � " ��� � -_� � , E � ✓�,J/
NORTH CAROIJNA ~r ' t;;T �� 13 �' < ' % 1 nr ►,- it/.
7 ; MINUTE SERIES fCOPOC:RAPHIQ .%^,'' ` j •, i i� - ;�'� .r �� ' h
D f *aQrda C"*W C IMDai.rm Yarastk NF NO ice DOE iISM h —1 lW ft i AWO Dm& W Da. WGM
1

n`
a
Q)
s
I N�Y
`ol4,i Ln
ook Pin* TUai
ow"
V
Turner Creep road &
Etementary
Jack gram
VOW wow
c b%*4 Roc:
r
t �
d1
PROJECT
• SITE z
o Pacr S5
RIDGE ACRE
tr�„� lr � • ro
V
2
Jenks Rd
Walgreens v O
� Or
monks
�� day '� st
fl
cor0
4* J
d
�E Q� 3 Ci'�rro�
[�►. f4 3 sJftcn Ln
d
FamalIn

SOS1D:1940671
Date Filed:1/23/2020 2:11:00 PM
Elaine F. Marshall
State of North Carolina North Carolina Secretary of State
Department of the Secretary of Stat C2020 023 00940
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:
Powell Property Holdings, 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 a member, organizer or both by checldng
all applicable boxes.) Note: This document must be signed by all persons listed
Name Business Address Capacity
Todd A. Jones P.O. Box 20248, Raleigh. NC 27619Member QOrganizer
ElMember OOrganizer
OMember E]Organizer
3. The name of the initial registered agent is: Todd A. Jones
4. The street address and county of the initial registered agent office of the limited liability company is:
Number and Street
421 N. Blount Street
City Raleigh State: NC Zip code: 27601 County:
Wake
5. The mailing address, if different from the street address, of the initial registered agent office is:
Number and Street P.O. Box 20248
City Raleigh State: NQ Zip Code: 21619 County:
6. Principal office information: (Select either a orb.)
a. ❑ The limited liability company has a principal office.
Tire principal office telephone number.
Wake
The street address and county of the principal office of the limited liability company is:
Number and Street:
City. State:
Zip Code:
County:
BUSDIFM REGISTRATION DIVISION P.O. BOX 29622 Raleigh, NC 27626-0622
(Revised August. 2017) Forst L-01

The [nailing address, if different from the street address, of the principal office of the company is:
Number and Street:
City:
State: Zip Code: County.
b. WIThe 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
creation document.
Name
Title
Business Address
Cara Powell
Member Manager
1931 New Bern Ave, Raleigh, NC 27610
Brad Powell
Member Manager
1931 New Bern Ave, Raleigh, NC 27610
9. (Optional): Please provide a business e-mail address. rIVaC a ac Ion
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 17th day of January , 20 20
Powell Prop" Moldings. LLC
Signature
Todd A. Jones. Organu!.er
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.
Signature
Type and Pin ame and Title
Signature
Type and Print Name and Title
NOTE:
1. Filing fee is S125. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P.O. BOX 29622
(Re►ised August. 2017)
Raleigk NC 27626-0622
Form L-01