WQCS00227_Renewal (Application)_20210415

rAll Carolina Water Service
Oleg of North Carolina`"
April 9, 2021
NCDEQ-DWR
Water Quality Permitting Section
PERCS Unit
Attention: PERCS Unit Supervisor
Collection System Renewal
1617 Mail Service Center
Raleigh NC 27699-1617
RECEIVED
Re: Fairfield Sapphire Valley Collection System APR 15 MA
Permit# WQCS00227
Renewal Request NCDECIIpWR"'DES
Dear Sir/Madame:
Please find enclosed application and attachments and consider this letter as our official request
to renew the Collection System Permit for the facility referenced above.
If you should have any questions or need any additional information, please do not hesitate to
call me at 704-319-0523 or by email at [e-mail]
Thank you in advance for your attention.
Sincerely,
❑9ia9r s9�b To
NC-U9,ar-ara aOpezmns¢cawuu VvnP.suvi�
Tony Konsul
Date;202104.0909:510.400'
Fo4 RUMomPOF Vasm'.tO.Tt
Tony Konsul
Director, State Operations
Enclosures; (1)CSA 04-16 permit application, (1)CPCN, (1) Pump station list, (1) High Priority list, (1)
Capital improvement plan, (1) Response Action Plan, (1)Contingency Plan, (1)Comprehensive Collection
System Map, (1) Compliance letter
•4944 Parkway Plaza Blvd.Ste 375 •Charlotte, North Carolina 28217 • 800-525-7990

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0400—SYSTEM-WIDE WASTERWATER COLLECTION SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM CSA 04-16&SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T .0100, 15A NC '("- '" " "'", and all relevant
Division Policies. Failure to submit all required items will necessitate additional processing and review time.
For more information, visit the System-wide Collection System Permitting website:
General—When submitting an application to the Pretreatment,Emergency Response,&Collection Systems(PERCS)Unit,
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.
The Applicant shall submit one original and one copy of the application and supporting documentation.
A. Cover Letter
® Submit a cover letter listing all items and attachments included in the permit application package
B. No Application Fee Required
➢ No application fee is necessary. The permittee will be billed an annual fee upon issuance of the permit
> The appropriate annual fee for systemwide wastewater collection system permits may be found at:
➢ Annual Non-Discharge Fees
C. System-Wide Wastewater Collection System (FORM: CSA 04-16)Application:
® Submit the completed and appropriately executed System-wide Wastewater Collection System (FORM: CSA 04-
16) application. Any unauthorized content changes to this form shall result in the application package being
returned. If necessary for clarity or due to space restrictions,attachments to the application may be made,as long
as the attachments are numbered to correspond to the section and item to which they refer.
® If the Applicant Type in Section I.3 is a Privately-Owned Public Utility, provide the Certificate of Public
Convenience and Necessity(CPCN)from the North Carolina Utilities Commission demonstrating the Applicant is
authorized to hold the utility franchise for the area to be served by the wastewater collection system,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.
® If the Applicant Type in Section 1.3 is a corporation or company, provide documentation if it is registered for
business with the North Carolina Secretary of State.
D. General Information:
➢ The Authorized signing official listed in Section I.4 should match with that of the Applicant certification page 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 15A NCAC 02T
.0106(b).
> NOTE - Public Works Director's are not authorized to sign this permit application according to the rule
unless they are delegated.
INSTRUCTIONS FOR APPLICATION CSA 04-16&SUPPORTING DOCUMENTATION Page 1 of 5

E. Summary of Attachments Required:
N Instruction A: Cover Letter
N Instruction C: Application
N Instruction C: Ownership Documentation(i.e.CPCN)(If necessary)
El Instruction D: Delegation Letter(If necessary for signing official) Already on file
N Section IV.3 Pump Station List
N Section IV.4 High Priority Lines List
N Section V.4 Annual Budget for Collection System(Updated and Approved)
N Section V.6 Capital Improvement Plan(Updated and Approved)
N Section VI.2 Response Action Plan
N Section VL4 Contingency Plan
N Section VI.6 Comprehensive Collection System Map
N Section VII Note Any Potential Compliance Issues
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS,SHOULD BE SENT TO:
NCDEQ-DWR
Water Quality Permitting Section
PERCS UNIT
By U.S.Postal Service: By Courier/Special Delivery:
Attn:PERCS Unit Supervisor 512 N.SALISBURY ST.Suite 925
1617 MAIL SERVICE CENTER RALEIGH,NORTH CAROLINA 27604
RALEIGH,NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION CSA 04-16&SUPPORTING DOCUMENTATION Page 2 of 5

I. APPLICANT INFORMATION:
1. Applicant's name(Municipality,Public Utility,etc):Carolina Water Service of North Carolina
2. Facility Information: Name: Fairfield Sapphire Valley Collection System Permit No.:WQCS00227
3. Applicant type: ❑Municipal ❑State ®Privately-Owned Public Utility
❑County ❑Other:
4. Signature authority's name:Tony Konsul per 15A NCAC 02T .0106(b)
Title:Director,State Operations
5. Applicant's mailing address:4944 Parkway Plaza Boulevard,Suite 375
City:Charlotte State:NC Zip:28224-0908
6. Applicant's contact information:
Phone number:[phone] Fax number:( ) - Email address: Tonv.Konsul(2i carolinawaterservicenc.com
II. CONTACT/CONSULTANT INFORMATION:
1. Contact Name: Tony Konsul
2. Title/Affiliation:Director,State Operations
3. Contact's mailing address:4944 Parkway Plaza Blvd
4. City:Charlotte State:NC Zip:28224-0908
5. Contact's information:
Phone number:[phone] Fax number:( ) - Email address:Tony.Konsul(a,carolinawaterservicenc.com
III. GENERAL REQUIREMENTS:
1. New Permit or Premit Renewal? ❑New ®Renewal
2. County System is located in: Jackson County
3. Owner&Name of Wastewater Treatment Facility(ies)receiving wastewater from this collection system:
Owner(s)&Name(s):Carolina Water Service of North Carolina
4. WWTF Permit Number(s): NC0022985
5. What is the wastewater type? 100%Domestic or %Industrial(See 15A NCAC 02T.0103(20))
Li Is there a Pretreatment Program in effect?❑Yes or®No
6. Wastewater flow:0.131 MGD(Current average flow of wastewater generated by collection system)
7. Combined permitted flow of all treatment plants: 0.3 MGD
8. Explain how the wastewater flow was determined:❑ 15A NCAC 02T.0114 or®Representative Data
9. Population served by the collection system: 1950=(780 x 2.5)
IV. COLLECTION SYSTEM INFORMATION:
1. Line Lengths for Collection System:
Sewer Line Description Length
Gravity Sewer 3.0(miles)
Force Main 6.2(miles)
Vacuum Sewer 0(miles)
Pressure Sewer 0(miles)
APPLICATION CSA 04-16 Page 3 of 5

2. Pump Stations for Collection System:
Pump Station Type Number
Simplex Pump Stations(Serving Single Building) 1
Simplex Pump Stations(Serving Multiple Buildings) 0
Duplex Pump Stations 46
3. Submit a list of all major(i.e.not simplex pump station serving a single family home)pump stations. Include the following
information:
➢ Pump Station Name
➢ Physical Location
➢ Alarm Type(i.e. audible,visual,telemetry,SCADA)
➢ Pump Reliability(Can convey peak hourly wastewater flow with largest single pump out of service)
➢ Reliability Source(permanent/portable generator,portable pumps)
➢ Capacity of Station(Pump Station Capacity in GPM)
4. Submit a list of all high priority lines according per 15A N r\C 02T.0402 (2)known to exist in the collection system. Head
the list with"Attachment A for Condition V(4)"and include the system name.
➢ Use the same line identification regularly used by the applicant
➢ Indicate type of high priority line(i.e.aerial),material and general location
V. COLLECTION SYSTEM ADMINISTRATION:
1. Provide a brief description of the organizational structure that is responsible for management,operation and maintenance of
the collection system.
,Director,State Operations,Area Manager,ORC,Lead Operator,Operator
2. Indicate the current designated collection system operators for the collection system per 15A NCAC 08G.0201
Main ORC Name: Leland Flint Plank Certification Number:21884
Back-Up ORC Name:James Stacy Adcock Certification Number: 1000801
See the"WQCS Contacts and ORC Report"for a current listing of the ORC(s)the Division has on file for WQCS permit
3. Approximate annual budget for collection system only: $31K approximately
4. Submit a copy of your current annual budget.
5. Approximate capital improvement budge for the collection system only: $209,921 approximately
6. Submit a copy of your current capital improvement plan.
7. Is this collection system currently a satellite system ❑ Yes or®No
8. Do any satellite systems discharge to this collection system ❑Yes or®No(If yes complete table below)
Satellite System Contact Information(Name,Address,Phone Number)
Complete for Satellite Systems that have a flow or capacity greater than 200,000 GPD(Average daily flow)
9. List any agreements or ordinances currently in place to address flows from satellite systems:
N/A
APPLICATION CSA 04-16 Page 4 of 5

VI. COLLECTION SYSTEM COMPLIANCE:
1. Is a Response Action Plan currently in place®Yes or El No
2. If Yes,submit a copy of the Response Action Plan or see table 6 below.
3. Is a pump station contingency plan currently in place?®Yes or❑No
4. If Yes,submit a copy of the pump station contingency plan or see table 6 below.
5. Is a comprehensive collection system map currently in place? ®Yes or El No
6. Submit a submit a copy of the collection system map(CD or hardcopy)or indicate a schedule for completion
7. Thoroughly read and review the ' stem-Alido (ollection System Permit ('onditions. Typically compliance schedules
are only offered to NEW permit applicants and NOT permit renewals. Any compliance dates must be included within
the permit prior to issuance or the permit holder will be found in violation upon inspection.
Current If no,Indicate a Typical
Permit Condition Compliance Compliance
Compliance? Date Schedule
I(4)—Grease ordinance with legal authority to inspect/enforce El Yes ®No 12—18 mo.
I(5)— Grease inspection and enforcement program ®Yes ❑No 12—18 mo.
I(6)—Three to five year current Capital Improvement Plan. ®Yes ❑No 12—18 mo.
I(8)—Pump station contingency plan ®Yes ❑No 3 mo.
I(9)—Pump station identification signs. ®Yes El No 3 mo.
I(11)—Functional and conspicuous audible and visual alarms. ®Yes El No 3—6 mo.
II(5)—Spare pumps for any station where one pump cannot
handle peak flows alone(in a duplex station,the 2nd pump is ®Yes El No 6—9 mo.
the spare if pump reliability is met).
II(7)—Accessible right-of-ways and easements. ®Yes ❑No 6—12 mo.
H(9)—Response action plan with Items 9(a—h). ®Yes El No 3 mo.
II1(3)—Comprehensive collection system map ®Yes ❑No 10%per year
For conditions not listed,compliance dates are not typically offered. List any permit conditions that may be difficult for the
applicant to meet(attach clarification if needed):
VII. APPLICANT'S CERTIFICATION per 15A NCAC 02T .0106(b):
I,Tony Konsul Director,State Operations attest that this application for Carolina Water Service of North Carolina
(Signature Authority's Name&Title from Item I.4) (Facility name from Item 1.1)
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 information and attachments are not included,this application package
will be returned to me as incomplete.
Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application 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.
Oplavy signed byres,
Tony Konsul R osul
a�� � .Sam.aNC ON r�K
Signature: «Ca 09410400 Date:
APPLICATION CSA 04-16 Page 5 of 5

APPENDIX A-5
STATE OF NORTH CAROLINA
UTILITIES COMMISSION
RALEIGH
Docket No. W-354, Sub 350
Before the North Carolina Utilities Commission
CAROLINA WATER SERVICE, INC. OF NORTH CAROLINA
is granted this
CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
to provide water and sewer utility service in
FAIRFIELD SAPPHIRE VALLEY SERVICE AREA
Jackson and Transylvania Counties, North Carolina
subject to all orders, rules, regulations,
and conditions as are now or may hereafter be lawfully made
by the North Carolina Utilities Commission.
ISSUED BY ORDER OF THE COMMISSION.
This the 17th day of August, 2016.
NORTH CAROLINA UTILITIES COMMISSION
Janice H. Fulmore, Deputy Clerk

"M‘1144k. Carolina Water Service
Vag of North CarolinaTM
Fairfield Sapphire Valley — Pumping Stations
Permit - WQCS00227
Condition I1.6.
• Fairfield Sapphire Valley Pump Station#1- Located at Fairway Hamlets, Sapphire Valley, NC,
28774. Station has(2)5hp pumps with a capacity of 66 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#2- Located at Recreation Building,Sapphire Valley, NC,
28774. Station has(2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#3- Located at Ski Lodge,Sapphire Valley, NC, 28774.
Station has(2) 2hp pumps with a capacity of 37 gallons per minute each.Station equipped with
audio,visual and telemetry alarms. Emergency portable generator is available if needed.
• Fairfield Sapphire Valley Pump Station#4- Located at Mount Laurel 7, Sapphire Valley, NC,
28774.Station has(2)2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#5- Located at Hill Top 24-25, Sapphire Valley, NC,
28774.Station has(2) 15hp pumps with a capacity of 600 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#6- Located at River Chase 1-2, Sapphire Valley, NC,
28774. Station has(2)2hp pumps with a capacity of 37 gallons per minute each.Station
• 4944 Parkway Plaza Blvd.Ste 375 • Charlotte, North Carolina 28217 • 800-525-7990

equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#7- Located at Ridge 15, Sapphire Valley, NC, 28774.
Station has(2) 2hp pumps with a capacity of 37 gallons per minute each.Station equipped with
audio,visual and telemetry alarms. Emergency portable generator is available if needed.
• Fairfield Sapphire Valley Pump Station#8—Located at Chestnut Ridge Bridge,Sapphire Valley,
NC, 28774. Station has (2) 3hp pumps with a capacity of 55 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Stationary generator on site.
• Fairfield Sapphire Valley Pump Station#9- Located at Emerald Crest 14-15, Sapphire Valley,
NC, 28774. Station has (2) 1.5hp pumps with a capacity of 15 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#10—Located at Emerald Crest 16,Sapphire Valley, NC,
28774.Station has(2) 1.5hp pumps with a capacity of 15 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#11- Located at Emerald Crest 17,Sapphire Valley, NC,
28774. Station has(2)2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#12- Located at Emerald Crest 21-22,Sapphire Valley,
NC, 28774.Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#13—Located at Mountain View Villas, Sapphire Valley,
NC, 28774. Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#14—Located at Hampton Glen, Sapphire Valley, NC,
28774.Station has(2) 3hp pumps with a capacity of 55 gallons per minute each.Stationary
generator on site.Station equipped with audio,visual and telemetry alarms.

• Fairfield Sapphire Valley Pump Station#15—Located at Fairway Forest 1, Sapphire Valley, NC,
28774.Station has(2) 1.5hp pumps with a capacity of 15 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#16- Located at Fairway Forest 2-3, Sapphire Valley, NC,
28774. Station has(2)2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#17- Located at Fairway Forest 4-5,Sapphire Valley, NC,
28774.Station has(2)2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#18- Located at Fairway Forest 6,Sapphire Valley, NC,
28774. Station has(2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#19- Located at Fairway Forest 7, Sapphire Valley, NC,
28774. Station has(2) 1.5hp pumps with a capacity of 15 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#20- Located at Fairway Forest 8,Sapphire Valley, NC,
28774. Station has(2) 1.5hp pumps with a capacity of 15 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#21- Located at Fairway Forest 9-10,Sapphire Valley,
NC, 28774.Station has (2) 1.5hp pumps with a capacity of 15 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#22- Located at Fairway Forest 11-12, Sapphire Valley,
NC, 28774. Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.

• Fairfield Sapphire Valley Pump Station#23-Located at Fairway Forest 14-15, Sapphire Valley,
NC, 28774.Station has(2) 1.5hp pumps with a capacity of 15 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#24- Located at Fairway Forest 16,Sapphire Valley, NC,
28774. Station has(2) 1.5hp pumps with a capacity of 15 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#25- Located at Golf Maintenance,Sapphire Valley, NC,
28774. Station has(2) 1.5hp pumps with a capacity of 15 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#26- Located at Fairway Forest 18-19,Sapphire Valley,
NC, 28774. Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#27- Located at Fairway Forest 20-21, Sapphire Valley,
NC, 28774. Station has (2) 2hp pumps with a capacity of 37 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#28- Located at Fairway Forest 22-23,Sapphire Valley,
NC, 28774.Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#29- Located at Fairway Forest 24, Sapphire Valley, NC,
28774.Station has(2)2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#30- Located at Fairway Forest 25-26, Sapphire Valley,
NC, 28774.Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.

• Fairfield Sapphire Valley Pump Station#31- Located at Fairway Forest 28-29, Sapphire Valley,
NC, 28774. Station has (2) 2hp pumps with a capacity of 37 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#32- Located at Woods Building 23,Sapphire Valley, NC,
28774.Station has(2) 7.5hp pumps with a capacity of 425 gallons per minute each. Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#33- Located at Sapphire Brewing Co., Sapphire Valley,
NC, 28774. Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#34- Located at Eagle Ridge Condo, Sapphire Valley, NC,
28774.Station has(2)5hp pumps with a capacity of 85 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#35- Located at Eagle Ridge Lot#95-96,Sapphire Valley,
NC, 28774.Station has (2) 5hp pumps with a capacity of 85 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#36-Located at Eagle Ridge Lot#26,Sapphire Valley, NC,
28774. Station has(2)2hp pumps with a capacity of 37 gallons per minute each.Station
equipped with audio,visual and telemetry alarms. Emergency portable generator is available if
needed.
• Fairfield Sapphire Valley Pump Station#37- Located at Mountain Laurel Building 1-2, Sapphire
Valley, NC, 28774.Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.
Station equipped with audio,visual and telemetry alarms. Emergency portable generator is
available if needed.
• Fairfield Sapphire Valley Pump Station#38- Located at Mountain Laurel Building 3-4, Sapphire
Valley, NC, 28774. Station has (2) 2hp pumps with a capacity of 37 gallons per minute each.
Station equipped with audio,visual and telemetry alarms. Emergency portable generator is
available if needed.

.14
• Fairfield Sapphire Valley Pump Station#39- Located at Mountain Laurel Building 5-6,Sapphire
Valley, NC, 28774.Station has(2)2hp pumps with a capacity of-37 gallons per minute each.
Station equipped with audio,visual and telemetry alarms. Emergency portable generator is
available if needed.
• Fairfield Sapphire Valley Pump Station#40- Located at River Run, Sapphire Valley, NC,28774.
Station has(2) 15hp pumps with a capacity of 240-gallons per minute each.Station equipped
with audio,visual and telemetry alarms. Emergency portable generator is available if needed.
• Fairfield Sapphire Valley Pump Station#41- Located at Woods Entrance,Sapphire Valley, NC,
28774.Station has(2)7.5hp pumps with a capacity of 110 gallons per minute each. Stationary
generator on site.Station equipped with audio,visual and telemetry alarms.
• Fairfield Sapphire Valley Pump Station#42- Located at CWS Office, Sapphire Valley, NC,28774.
Station has(2) 2hp pumps with a capacity of-37 gallons per minute each.Station equipped with
audio,visual and telemetry alarms. Emergency portable generator is available if needed.
•
Fairfield Sapphire Valley Pump Station#43- Located at Mount High Eagle Ridge,Sapphire
Valley, NC, 28774. Station has (2)5hp pumps with a capacity of 85-gallons per minute each.
Station equipped with audio,visual and telemetry alarms. Emergency portable generator is
available if needed.
• Fairfield Sapphire Valley Pump Station#44- Located at Lonesome Valley, Sapphire Valley, NC,
28774. Station has(2) 10hp pumps with a capacity of 525-gallons per minute each. Stationary
generator on site.Station equipped with audio,visual and telemetry alarms.
• Fairfield Sapphire Valley Pump Station#45- Located at Lonesome Valley,Sapphire Valley, NC,
28774.Station has(3) 1.5-hp pumps with a capacity of-15--gallons per minute each.Stationary
generator on site.Station equipped with audio,visual and telemetry alarms.
• Fairfield Sapphire Valley Pump Station #46—Located at Lonesome Valley, Sapphire Valley NC
28774. Station has (2) 2hp pumps with a capacity of 46 gallons per minute each.Stationary
generator on site.Station equipped with audio,visual and telemetry alarms.
• Fairfield Sapphire Valley Pump Station#47—Located at well#8,Sapphire Valley NC 28774.
Station has(1)1.5hp pump with a capacity of 140 gallons per minute. Station equipped with
audio,visual and telemetry alarms. Emergency portable generator is available if needed.

PAPNIA,
Carolina Water Service
of North CarolinaTM
Fairfield Sapphire Valley — High Priority Lines
Permit - WQ CS00227
Attachment"A" for condition V4
• Mountain Laurel—Pump Stations#2,3,4,37,38, &39 to Manhole#44(Creek Crossing)
• Country Club - Manhole#62 through Manhole#63 (Creek Crossing)
• Woods—Manhole#173 through Manhole# 169 (Creek Crossing)
• 4944 Parkway Plaza Blvd.Ste 375 • Charlotte, North Carolina 28217 • 800-525-7990

BUSINESS CORPORATION ANNUAL REPORT
2017
NAME OF BUSINESS CORPORATION: Carolina Water Service, Inc. of North Carolina
0023927 Filing Office Use Only
SECRETARY OF STATE ID NUMBER: STATE OF FORMATION: NC E-Filed Annual Report
0023927
REPORT FOR THE FISCAL YEAR END: 1 2/31/201 9 CA202006903009
3/9/2020 03:00
SECTION A: REGISTERED AGENTS INFORMATION 1111 Changes
1. NAME OF REGISTERED AGENT: Corporation Service Company
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
2626 Glenwood Avenue, 2626 Glenwood Avenue„ Suite 550
Raleigh, NC 27608 Wake County Raleigh, NC 27608
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Water/Sealer Utility
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
500 W.Monroe St.STE 3600 500 W. Monroe St.STE 3600
Chicago, IL 60661 Chicago, IL 60661
6. Select one of the following if applicable. (Optional see instructions)
The company is a veteran-owned small business
The company is a service-disabled veteran-owned small business
SECTION C: OFFICERS(Enter additional officers in Section E.)
NAME: Bryce Mendenhall NAME: Amy Robinson NAME: Allen Wilt
TITLE: Vice President TITLE: Assistant Secretary TITLE: Secretary
ADDRESS: ADDRESS: ADDRESS:
5701 Westpark Drive,Suite 101 2335 Sanders Road 500 W. Monroe St.STE 3600
Charlotte, NC 28217 Northbrook, IL 60062 Chicago, IL 60661
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
enti
Amy Robinson 3/9/2020
SIGNATURE DATE
Form must be signed by an officer listed under Section C of this form.
Amy Robinson Assistant Secretary
Print or Type Name of Officer Pent or Type Title of Officer
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

SECTION E:ADDITIONAL OFFICERS
NAME: Jim Andrejko NAME: Donald Denton NAME:
TITLE: Treasurer TITLE: President TITLE
ADDRESS: ADDRESS: ADDRESS:
500 W. Monroe St STE 3600 5701 Westpark Drive,Suite 101
Chicago, IL 60661 Charlotte, NC 28217
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: Name:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:

Carolina Water Service
11,mai of North Carolina'
Sapphire Valley
Capital Improvement Plan
Sanitary Sewer Collection System Permit WQCS00227
I. Mission Statement
Carolina Water Service Inc.of NC (CWSNC) owns, operates, and maintains the sanitary sewer collection
system serving the Sapphire Valley residential communities outside Cashiers in Jackson County, NC.
CWSNC is an investor-owned public utility and is committed to providing safe, reliable, and cost-
effectives rvi our customers and with the underlying commitment to act with integrity, protect the
service totY,
Y g g
environment and enhance the communities we serve. CWSNC works to maintain the system and meet
customer growth expectations and regulatory requirements in a financially responsible manner. As a
privately owned public utility, CWSNC is regulated through the NC Utilities Commission.
II. Description of Systems
The service area currently is comprised of 780 residential sewer customers. Growth has been somewhat
stagnant in recent years. The system is comprised of approximately 3.0 miles of gravity sewer collection
mains;6.2 miles of pressure force main, (47) duplex pump stations and a 0.3 MGD extended aeration
wastewater treatment plant.
III. Projects
Preventive Maintenance-At least 10%of the gravity collection system mains are pressure washed and
cleaned each year with the intent to clean 100%of the gravity mains in a ten-year period or less. All lift
stations are cleaned at least annually.
CWSNC is financially capable of making all emergency repairs immediately and takes immediate action
any time the system may be compromised to protect the system integrity,the environment and to meet
regulatory requirements.
CWSNC plans for all capital improvement with at least a 3-year plan. The system is assessed each year
by review of operations,visual inspection of manholes,and review of emergency repair history or other
deficiencies identified in state inspections or in review of compliance needs. Any needed improvements
are prioritized for inclusion in future year's budgetary plan.
•4944 Parkway Plaza Blvd. Ste 375 • Charlotte, North Carolina 28217 • 800-525-7990

As of 4/06/2021,the following projects have been identified for 2021 budget or later.
NC-2021-Sapphire Valley-Sewer LS Replacement-#41 Dry Can to Submersible
w/generator 9/30/2021 $635,560
NC-2021-Sapphire Valley-WWCS Improvements(Rehab-Clean,CCTV,CIPP,
Replacement) 12/31/2021 $208,000
NC-2023 -Sapphire Valley-WWCS Improvements(Rehab-Clean,CCTV,CIPP,
Replacement) 6/30/2023 $212,000
NC-2025-Sapphire Valley-WWCS Improvements(Rehab-Clean,CCTV,CIPP,
Replacement) 6/30/2025 $212,000
NC-2025-Sapphire Valley-Sewer LS Improvement-#40 stationary generator _ 9/30/2025 $47,700

ditnrill Carolina Water Service
of North Caroline
SANITARY SEWER OVERFLOW AND SPILL RESPONSE ACTION PLAN
Fairfield Sapphire Valley Sanitary Sewer Collection System
WQCS00227
A Sanitary Sewer Overflow(SSO) can endanger the environment and affect the health of individuals and
wildlife that come in contact. It is the policy of our company that all SSO's be investigated immediately
and actions taken to prevent or minimize all environmental impact.
The public should contact our 24-hour customer service number at 1-800-525-7990 and provide as much
information as possible on the location of the problem. On-call staff will be dispatched immediately for
full investigation. This number will reach our office during normal business hours and then an
emergency call service center after normal business hours. Available and current on-call staff
information is always kept ensuring that appropriate staff can be dispatched immediately.
Any operations employee that comes across an SSO should contact the Operating Manager,Area
Manager or Regional Manager immediately and take immediate action to assess, minimize, prevent, or
mitigate any such event.
The local Operating Manager and ORC of the system will be the primary interface between the company
and the NC Dept. of Environment and Natural Resources, Division of Water Quality(DWQ) and county
health department (if required). The appropriate manager will follow the current and then in place SSO
reporting policy as designated by DWQ(see attached reporting form)or any other regulatory agency
having jurisdiction. As of the writing of this document.
• Report any spill of 1,000 gallons or more; and
• Any spill, regardless of the volume, if any waste reaches the surface waters of the State. Any
conveyances such as drainage ditches or storm sewers are considered waters of the State.
1) Report by telephone to a person (not a fax or voicemail) to the Asheville Regional DWQ Office at
828-296-4500 during normal business hours(Monday through Friday, 8 am to 5 pm) as soon as
•4944 Parkway Plaza Blvd.Ste 375 • Charlotte, North Carolina 28217 • 800-525-7990

possible, but in no case more than 24 hours after the SSO is known or discovered. To report
outside of regular business hours,call [phone].
2) Follow up the verbal report by sending the completed written report using the attached form or
most current within five days.
3) If the discharge involves 1,000 gallons or more AND reaches surface waters, a press release
must be issued within 48 hours of first notification. If the discharge is 15,000 gallons or more, a
public notice must be published within 10 days and proof of publication shall be provided to
DWQ within 30 days.
Containment Procedures
As soon as an employee arrives at the site of the SSO, he/she shall use whatever means necessary to
contain the spill as to prevent it from reaching surface waters. If there is no danger or potential of the
SSO reaching surface waters,the SSO should be contained in as small an area as possible but use of any
means possible such as construction of dams,ditches, checks etc. The sewage contained or collected
shall be returned to the sewer system or taken to the WWTP by pumps, pumper trucks or other
available means.
If possible, a blocked or damaged section of collection main should be bypassed around the problem
area using transfer pumps from an upstream manhole into a downstream manhole. The damaged main
section should be plugged if possible,to prevent waste from entering the problem area.
The area should be sectioned off to prevent any unauthorized person from entering the contaminated
area.
Blockage Correction
Employees should treat a reported blockage with utmost urgency to prevent any spill or backup from
causing environmental or home damage. The first person on site should try to assess the problem and
determine if flow can be maintained or restored using temporary pump bypass or other means,of if the
problem area can be blocked off and the waste transported from a manhole to the WWTP using a pump
or pumper truck. Contractors should be called immediately, and employee should stay on site or within
close distance to assist with emergency work. Containment and bypass equipment and measures shall
remain on site until the blockage is corrected.
Clean up
Remove all debris such as plastic, paper,or other materials from the site, bag or place in a container and
dispose of properly in dumpster at WWTP site.
Clean or wash area thoroughly and return this water to the sewer system or treatment plant. If on soil
or dirt, apply a liberal layer of white hydrated lime to raise the pH and kill pathogenic organisms and to
treat for odor. Apply straw and grass seed if appropriate.
If the SSO reaches surface waters, every effort should be made to contain the spill area by use of dams
near a manhole or area accessible to a pumper truck and mobile equipment. The contained area should
be pumped back into the sewer system. Two employees or one employee and a contractor shall be

present at all time while pump is operated. Backhoe or other equipment should be available to help
maintain earthen dams until cleanup efforts are complete.
If possible, the area should be flushed with potable water and that water also returned to the sewage
system. The operator should try and use a broom or other measures to agitate sludge on the bottom
during the pumping and cleaning efforts to make sure it is all retrieved. Rocks and riprap should be
washed of residue.
If surface waters are used for drinking source or recreation, additional measures must be taken to notify
local health departments.
Water samples to include dissolved oxygen and fecal bacteriological samples should be taken frequently
before clean-up, during and after clean-up. In addition, samples should be taken upstream and
downstream of the affected area.
Spare Parts and Equipment List
p
Portable trailer mounted generator to operate pump stations and/or electrical equipment in the event
of power loss or in remote locations. This will be always kept in good running order at the WWTP
location.
Common parts such as electrical components such as elapsed time meters,voltage phase monitors etc.
are kept in stock at the Sapphire Valley WWTP and can be always accessed by a supervisor.
White hydrated lime will be kept on hand at the WWTP for spill abatement.
Normal hand tools such as shovels, rakes etc.will be kept on the Operator's truck or at the WWTP.
The ORC or Operating Manager must be familiar with all pumping equipment brands and have means to
contact a distributor or representative for expedited parts.

Contractors List and Contact Information
Gopher Utility—704-932-7662
Electrical and equipment repair work
Rain for Rent—704-393-3345
Emergency portable pump rental and pump supplies(hoses etc.)
W&S Maintenance—828-216-8998
Underground repairs,facility and building repairs. Pumper truck/vac truck and main cleaning.
Mikes Septic-828-775-1658
Pumper truck/vac truck.
CU Maintenance—828-776-7947
Underground repairs.
Osteen Lemmons Electrical and Mechanical Services—828-697-7696
Electrical and equipment repair work.

Carolina Water Service
of North CarolinaTM
Sapphire Valley
Lift station Pump Failure Contingency Plan
Sanitary Sewer Collection System Permit WQCS00227
Mission Statement
1. Carolina Water Service Inc. of NC(CWSNC)owns, operates, and maintains the sanitary
sewer collection system serving the Sapphire Valley communities located in Jackson
County, NC. CWSNC is an investor-owned public utility and is committed to providing
safe, reliable, and cost-effective service to our customers and with the underlying
commitment to act with integrity, protect the environment and enhance the
communities we serve. CWSNC works to maintain the system and meet customer
growth expectations and regulatory requirements in a financially responsible manner.
As a privately owned public utility, CWSNC is regulated through the NC Utilities
Commission.
Description of Systems
2. The service area currently is comprised of 780 sewer residential customers.The system
is comprised of approximately 3.0 miles of gravity sewer collection mains; 6.2 miles of
pressure force main, (47) pump stations and a 0.300 MGD extended aeration
wastewater treatment plant.
Objective of Plan
3. To ensure a normal level of service in the event of a lift station pump failure while
protecting the environment. CWSNC is financially capable of making all emergency
repairs immediately and takes immediate action any time the system may be
compromised to protect the system integrity,the environment and to meet regulatory
requirements.
Criteria for Invoking the plan:
4. One or more pump failures or loss of power to any or all lift station

Roles, Responsibilities, and Authority
5. The local Operating Manager/ORC of the system will oversee operating this contingency
plan. If additional personnel are needed, he will contact the appropriate Area Manager
who will then assign more staff if deemed necessary.
Procedures for Invoking Contingency Mode
6. The area operator will monitor the system on an emergency basis until there are no
problems with the operation of the system.The alarm systems for all 47 lift stations
have capabilities so that alarms will still be reported in the event of power loss.
If an employee discovers a problem, he will immediately begin to diagnose to correct
the problem.The employee will also call his immediate supervisor and describe the
nature of the problem (e.g., no electricity, pump failure to one or all lift stations).
Procedures for Operating in Contingency Mode
7. Generators—Some Lift Stations are equipped with generator transfer quick connects
that will enable the operator to hook up available portable generators located in the
system. If all lift stations are without power,the Area Manager will establish a rotation
schedule based upon the capacity in the wet wells and storage in the lines to rotate the
generators between the lift stations.
One Pump Failure—Should one pump fail in the duplex stations; the operator is to
contact the necessary contractor from the contractors list and arrange to have the
pump checked immediately.Should the pump need to be replaced,the operator should
check the spare parts inventory and have installed, should one be available.The other
pump should be sent to a repair facility for a repair cost estimate. The station should be
checked daily until such time the pump can be repaired or replaced.
Dual Pump Failure—Should both pumps fail in the duplex stations,the operator is to
contact the necessary contractors from the contractors list and arrange to have the
pumps checked immediately and/or to rent a portable pump if needed. Should the
pump need to be replaced,the operator should check the spare parts inventory and
have a pump installed, should one be available.The other pumps should be sent to a
repair facility for a repair cost estimate.The station should be checked daily until such
time that both pumps can be repaired and replaced. If needed a vacuum pump truck
should be called from the contractors list to prevent all overflows.
8. Criteria for Returning to normal operation mode:
Electricity returned to all stations and all lift station pumps are operational.
9. Post Contingency Plan:

The Area Manager will meet with personnel who assisted in operating this plan
to evaluate how well it worked. If necessary, changes will be made for any future
emergencies.

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Carolina Water Service
- void of North Carolina"
Potential Compliance Issues
Section VII
Re: Fairfield Sapphire Valley Collection System
Permit# WQCS00227
Renewal Request
Dear Sir/Madame:
There are no known compliance issues within the Sapphire Valley subdivision.
If you should have any questions or need any additional information, please do not hesitate to
call me at 704-319-0523 or by email at a ony.i\onsui(cDcaroiirndwaLer see vicenc.cor,
Thank you in advance for your attention.
•4944 Parkway Plaza Blvd.Ste 375 • Charlotte,North Carolina 28217 • 800-525-7990