WQ0034432_Regional Office Historical File Pre 2018

4
A VA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
November 3, 2009
Mr. Dee -Dee Harris, President
CMH-DWH Ballantyne, LLC
6400 Fairview Road
Charlotte, NC 28210
Subject: Permit No. WQ0034432
Providence Road West Walgreens
Tax Parcel #223-134-85, 97
C-MU Tracking # 600-08-673
Wastewater Collection System Extension
Mecklenburg County, North Carolina
Dear Mr. Harris:
In accordance with your complete application received on October 30, 2009, we are forwarding
herewith Permit No. WQ0034432, dated November 3, 2009, to CMH-DWH Ballantyne, LLC, for the
construction and operation of the subject wastewater collection system extension. This permit shall be
effective from the date of issuance until rescinded, and shall be subject to the conditions and limitations
as specified therein. This cover letter shall be considered a part of this permit and is therefore
incorporated therein by reference.
Please pay particular attention to Permit Condition 3, which requires that the wastewater
collection facilities be properly operated and maintained in accordance with 15A NCAC 2T .0403 or any
individual system -wide collection system permit issued to the Permittee.
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 1) 15A NCAC 2T; 2) the Division of Water Quality's (Division) Gravity Sewer Minimum Design
Criteria adopted February 12, 1996, as applicable; 3) and the Division's Minimum Design Criteria for the
Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000, as applicable, unless
specifically mentioned herein. Division approval is based on acceptance of the certification provided by a
North Carolina -licensed Professional Engineer in the application. It shall be the Permittee's responsibility
to ensure that the as -constructed project meets the appropriate design criteria and rules. Failure to
comply may result in penalties in accordance with North Carolina General Statute §143-205.6A through
§143-205.6C, construction of additional or replacement wastewater collection facilities, and/or referral of
the North Carolina -licensed Professional Engineer to the licensing board.
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer— 50% Recycled/10% Post Consumer paper
No�rthCarohna
Natural!!!

Mr. Dee -Dee Harr
Page 2
November 3, 2009
In accordance with the provisions of Article 20 of Chapter 143, General Statutes of North Carolina
as amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted for the
construction and operation of approximately 110 linear feet of 4-inch gravity sewer and 970 linear feet of
8-inch gravity sewer and the discharge of 1,748 gallons per day of collected domestic wastewater into
the Charlotte Mecklenburg Utilities existing sewerage system in conformity with 15A NCAC 2T; the
Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
adopted June 1, 2000, as applicable; and other supporting data subsequently filed and approved by the
Department of Environment and Natural Resources and considered a part of this permit.
The sewage and wastewater collected by this system shall be treated in the McAlpine Creek
VWVTP (NPDES No, NC0024970) prior to being discharged into the receiving stream.
Assessing subsequent impacts to the downstream collection system is the complete
responsibility of Charlotte Mecklenburg Utilities, Charlotte Mecklenburg Utilities must utilize whatever
tracking tools necessary for planning additions of sewer flow in order to maintain compliance with the
VVQCS00001 permit requirements.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this matter, please contact Mr. Michael Parker at
[phone]
Electronic copies.
Cc:
Sincerely,
for Co een H. Sullins
Meredith Moore, Mecklenburg County Development of Water Quality
Barbara Gross, CMU
Philip Edwards, Mecklenburg County
Kristopher W. Rowe, P.E , LandDesign, Inc.
Mooresville Regional Office, Collection System Permit File
Surface Water Protection Central Files
PERCS

•
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
1. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2T; the Division of Water Quality's
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000, as applicable; and other supporting materials unless specifically
mentioned herein.
2. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
3. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2T .0403. If an individual
permit is not required, the following performance criteria shall be met as provided in 15A NCAC 2T
.0403:
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L .0200 or the surface water standards in 15A NCAC 2B .0200.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan shall be developed and implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e.
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week.
e. High -priority sewer lines shall be inspected at least once per every six-month period of time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years.
h. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required by
North Carolina General Statute §143-205.1C.
4

4. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be
considered on its merits and may or may not be approved.
5. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State.
6. Per 15A NCAC 2T ,0116, upon completion of construction and prior to operation of these
permitted facilities, the completed Engineering Certification form attached to this permit shall be
submitted with the required supporting documents to the address provided on the form. A complete
certification is one where the form is fully executed and the supporting documents are provided as
applicable.
7. A copy of the construction drawings shall be maintained on file by the Permittee for the life of the
wastewater collection facilities.
Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2T; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-
205.6A through §143-205.6C.
In the event that the wastewater collection facilities fall to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including
those as may be required by this Division, such as the construction of additional or replacement
facilities.
10. The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies
(local, state and federal) which have jurisdiction, including but not limited to applicable river buffer
rules in 15A NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Ch. 4
and under the Division's General Permit NCG010000, and any requirements pertaining to wetlands
under 15A NCAC 2B ,0200 and 15A NCAC 2H .0500,
11. Noncompliance Notification:
The Permittee shall verbally report to a Division of Water Quality employee at the Mooresville
Regional Office, telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day, following the occurrence or first knowledge of the occurrence
of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or

b. Arty failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.
Voice mail messages or faxed information is permissible, but shall not be considered as the
initial verbal report. Overflows and spills occurring outside normal business hours may also be
reported to the Division of Emergency Management at telephone number [phone] or
[phone]. Persons reporting any of the above occurrences shall file a spill report by
completing Part I of Form CS-SSO (or the most current Division approved form), within five days
following first knowledge of the occurrence. This report shall outline the actions taken or
proposed to ensure that the problem does not recur. Part 11 of Form CS-SSO (or the most
current Division approved form) can also be completed to show that the SSO was beyond
control.
Permit issued this the 3rd day of November, 2009.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0034432

Permit No. WQ0034432
June 10, 2009
Owner/WQCS
Dee -Dee Harris
6400 Fairview Road
Charlotte, NC 28210
PE
Kris Rowe, P. E,
LandDesign, Inc.
223 North Graham Street
Charlotte, NC 28202
WQCSI WWTP
Barbara Gross
CMU
5100 Brookshire Blvd
Charlotte, NC 28206
Complete and submit this form to the permit issuing regional office with the following:
• One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• Supporting design calculations (selected pumps, system curve, operating point, available storage if
portable generator(s) or storage greater than longest past three year outage reliability option selected)
for any pump stations permitted as part of this project
• Changes to the project should be clearly identified on the record drawings or in written summary form.
Permit modifications are re uired for any than es resultin in non-com Hance with this ermit
requlations or minimum design criteria.
This project shall not be considered complete nor allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division. Therefore, it is highly
recommended that this certification be sent in a manner that provides proof of receipt by the
Division°
ENGINEER'S CERTIFICATION
D Partial ] Final
I, , as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (❑ periodically, ❑ weekly, ❑ full time) the construction of Providence
Road West Walgreens, a Mecklenburg County project for the Permittee, hereby state that, to the best of my
abilities, due care and diligence was used in the observation of the construction such that the construction
was observed to be built within substantial compliance of this permit; 15A NCAC 2T„ the Division of Water
Quality's (Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's seal,, signature, and date:
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received, Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions.
4

OF NORThf CAROLINA.
COUNTV'OF MECKLENBURG Permit No,
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (di) and entered into this
29th
day of
October 2009 , by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
a corporation/general partnership registeredflicensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
CMH-DWH BALLANT'YNE, LLC
l . The DEVELOPER is the owner of the certain lands lying in MECKLENBURG.rmm. County, upon
which it is erecting and will erect dwelling units and other improvements, said development to be known
ROAD WEST WALGR ENS
as (hereinafter the Development).
PROVIDENCE
The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to
serve the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to aS. 143-
215.1 to construct, maintain, and operate the Disposal System.
4, The DEVELOPER has created or shall create unit ownership in said dwellings units., other improvements
and lands through fling of a. Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, the Providence Road Retail Associati«r (hereinafte'r
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the
State of North Carolina, for the purpose, among others, of handling the property, affairs and business of
the Development; of operating, maintaining, re -constructing and repairing the common elements of the
lands and improvements subject to unit ownership, including the Disposal System; and of collecting dues
and assessments to provide funds for such operation, maintenance, re -construction and repair.
6. The COMMISSION desires to assure that the Disposal. System of the Development is properly
constructed, maintained and operated in accordance with law and permit provisions in order to protect the
quality of the waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each c fthe parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and.
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions and law.
The DEVELOPER shall not transfer ownership and'or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Quality has inspected and approved of the facilities. In order to change the name of
the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws and Declaration.
The DEVELOPER shall not. transfer, convey, assign or otherwise relinquish or release its respon
for the operation and maintenance of its Disposal System until a permit has been reissued to the
DEVELOPER's successor.
sibility
FORM: DEV 02/03 Page 1 of

The DEVELOPER shall provide in the. Declaration and Association Bylaws that the Disposal. System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
' operated in conformity with law and the provisions of the permit for construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes and insurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses.. In order to assure that there shall be funds readily available
to repair, maintain or construct the Disposal. System, beyond the routine operation and maintenance
expenses, the Declaration and Association Bylaws shall provide that a fund be created out of the common
expenses. Such fund shall be separate from the routine maintenance funds allocated for the facility and.
shall be part of the yearly budget.
ti. in the event the common expense: allocation and separate fund are not adequate for the construction,
repair, and maintenance of the Disposal System, the Declaration and Association Bylaws shal➢ provide for
special assessments to cover such necessary costs. There shall be no limit on the amount of such
assessments, and the Declaration and Bylaws shall provide that such special assessments can be made as
necessary at any time.
7. If a wastewater collection system and wastewater treatment andlor disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall h.ereinafier become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental.
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit may require as condition of accepting the Development's wastewater.
Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the
continued proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall
provide in the AssociationBylaws that the Association shall not enter into voluntary dissolution without
first having transferred its said system and facilities to some person, corporation or other entity acceptable
to and approved by the COMMISSION by the issuance of a. permit.
The agreements set forth in numbered. paragraphs 1, 2, 3, 4,. 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
lt). A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the 'Declaration
is filed and in the offices of the Secretary of State ol'North Carolina with the Articles of Incorporation of
the Association.
IN WITNESS WI~IER.EOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL
MA GEMENT COMMISSION
Co ccn H. Sullins, Director
Division of Water Quality
(Date)
CMH-DWH BALLANTYNE,
Name of DEVELOPER
By:
(Signature)
DEE-DEE HARRIS, PRESIDENT
Print. Name and Title
o a? o
(Date)
FORM: DEV
Page 2 o

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Owner/Permittee:
1 a. CMH-DWH Ballantyne, LLC
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. Dee -Dee Harris - President
Application Number:
(to be completed by DWQ
�41
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing official
The legal entity who will own this system is:
❑ Individual El Federal ❑ Municipality ❑ State/County ❑ Private Partnership 1
• 1d. 6400 Fairview Road
LL Mailing Address
• 1f. North Carolina
State
Q 1 h. 704-364-4957
Telephone
Project (Facility) Information:
2a. Providence Road West Walgreens
1 i. 704-364-5014
Facsimile
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. Kris Rowe — LandDesign, Inc
1 e. Charlotte
Corporation ❑ Other (specify):
City
lg. 28210
Zip Code
cmoonha rrisland.com1!
E-mail
2b. Mecklenburg
County Where Project is Located `.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b, 704-376-7777
Phone Number
1. Project is 1 New ❑ Modification
0
3c. kroweClanddesign,com
E-mail
an existing permit) If Modification, Permit No.:
2. Owner is ❑ Public (skip to Item 8(3))
2a. If private, applicant will be:
Retaining Ownership (i.e. store, church, single office, etc.) or
Leasing units (lots, townhomes, etc. - skip to Item B(3))
Selling units (lots, townhomes, etc. - go to item B(2b))
3. Charlotte Mecklenburg Utilities
® Private
go to Item 2(a))
2b. If sold, facilities owned by a (must choose one
❑ Public Utility (Instruction C)
Homeowner Assoc./Developer (Instruction D)
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. McAlpine Creek Treatment Plant
Name of WWTF
5a. Charlotte Mecklenburg Util, 5b. 8"'
4b_ NC0024970
Gravity 5c.
Owner of Downstream Sewer Receiving Sewer Size !El Force Main
6. The origin of this wastewater is (check al
Residential Subdivision
El Apartments/Condominiums
Mobile Horne Park
❑ School
El Restaurant
❑ Office
that apply):
WWTF Permit No,
Permit # of Downstream Sewer (Instru
® Retail (Stores, shopping centers)
0 Institution
❑ Hospital
Church
❑ Nursing Home
❑ Other (specify):
100 % Domestic/Commercial
Industrial (attach
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
7, Volume of wastewater to be allocated or permitted for this particular project: 1,748 gallons per day
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
El Pump Station, Outtall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
0 Flow has already been allocated in Permit No.
0 Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
FTA 12/07

r.Providethe wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for liFiv-
the Value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
120 gpd / 1,000 sf of retail. Building is 14,570 sf. 100 * (14,570 / 1000) = 1,748
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
New Gravity or Additional
Force Main
8"
970
Gravity
4"
110
Gravity
G
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
W
M
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Z
Z
0
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
V
B. PERMIT INFORMATION
Pump Station Location ID
(self chosen -
as shown on plans/map
for reference)
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow
(MGD)
Operational Point
GPM @TDH1
Power Reliability Option
- permanent generator w/ATS;
2,- portable generator w/MTS
Force Main Size
Force Main Length
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
0 Yes ® No If Yes, permit number of 2nd treatment facility
(RO — if "yes" to B,12 please contact the Central Office PERCS Unit) .
13. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
applicable?
® Yes ❑ No If No, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
FTA12/07

e the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401Certification? 0 Yes fl No N/A
Sedimentation and Erosion Control Plan? El Yes 0 No Li N/A
Stormwater? Yes El No 0 N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T ,0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: 0 and provide details
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Narne)
I, Dee -Dee Harris, attest that this application for Providence Road West Walgreens has been reviewed by me and is
accurate and complete to the best of my knowledge. 1 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. Note: In accordance with North Carolina 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.
1a. *
Signing Official Signature Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMIT`r
TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
0
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, Kristopher Rowe, attest that this application for Providence Road West Walgreens has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, 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
adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance, Although other
professionals may have developed certain portions of this submittal package, inclusion of these materials under my
signature and seal signifies that 1 have reviewed this material and have judged it to be consistent with the proposed design.
Note: In accordance with NC General Statutes 143-215.6A and 143-215.68, 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.
2a. Kristopher W. Rowe
Professional Engineer Name
2b, LandDesign, Inc
Engineering Firm
2c. 223 N. Graham St
Mailing Address
2d, Charlotte 2e, NC
2f, 28202
City State Zip
' 2g. 704.376.7777 2h, 704.332.3246 2i. [e-mail]
Telephone Facsimile E-mail
NC PE Seal, Signature & Date
HER 1'
Moo"'
it°
FTAI 2/07

CHARLOTTE-M E CKL EN BU RG
UTILITIES
October 30, 2008
Mr. Matt McLaren
LandDesign, Inc,
223 N Graham Street
Charlotte, NC 28202
SUBJECT: WATER AND SEWER FLOW ACCEPTANCE
PROVIDENCE ROAD WEST RETAIL CENTER
TAX PARCEL# 223-134-85, 97
C-MU TRACKING #600-08-673
In response to your request, a flow acceptance study of the subject site has been completed and the
following has been determined:
Charlotte -Mecklenburg Utilities agrees to accept the gravity sewage flow of 13,669 gallons per day
(105,148 ft2 retail with food service x 130 gpd11,000 ft2) from this project for transmission to the McAlpine
Creek Wastewater Treatment Plant; NPDES permit number NC0024970, for treatment. This acceptance
of flow is based on the existing capacity of the designated publicly owned treatments works. Please see
attached basin map and flow tracking form.
Charlotte -Mecklenburg Utilities agrees to furnish water to the subject project, The water quality to the
subject project is regulated by the State Drinking Water Act Amendments of 1986, and The Water Supply
Management Plan, dated October 2005, (WSMP # 05-01702 & PWS ID # 0160010), on file with the
Public Water Supply Section of NCDENR. However, Charlotte -Mecklenburg Utilities cannot guarantee a
constant pressure or quality of flow.
Due to the involvement of other agencies and continuing growth of the water and sewer system, the
ability to provide service for future projects cannot be guaranteed nor reserved. Connection to the
Charlotte -Mecklenburg Utilities system is accepted on a first come, first served basis.
The applicant should understand that this letter is not authorization to construct private water or sewer
systems, as the appropriate local or State permits are required prior to construction. /f the appropriate
authorization to Construct permits are not obtained and construction has not stared within one (1) vear of
issuance of this flow acce tan a this flow acce Lance a royal shall be rescinded and a new flow
acceptance fetl est rrrust be made, If you have any questions, you may contact me at [phone].
Barbara Gross
Engineering Assistant
New Services Section
CHARLOTTE-MECKLENBURG UTILITIES
Customer Service Division • New Services Section
www.crnutillties.corn
00 Brookshire Boulevard
Charlotte, INC 28216
Ph: 704/399-2221
Fax: [phone]

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 10/07)
Project Applicant Name: andDesign, Inc.
Project Name for which flow is being requested: Providence Road West Retail Center
More than one FTSE-10/07 may be required for a single project if the owner of the WWTP is not responsible for all
pump stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: McAlpine Creek, Irwin Creek, Sugar Creek WWTP
b. WWTP Facility Permit #:
NC0024970, NC0024945, NC0024937
All flows are in MGD
c. WWTP facility's permitted flow 99.0
d. Estimated obligated flow not yet tributary to the WWTP 14.83
e. WWTP facility's actual avg. flow 66.8
f. Total flow for this specific request 0.013669
g. Total actual and obligated flows to the facility 81.69
h. Percent of permitted flow used
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
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
111. 'on Statempt.
5 kcal , certify that, to the best of my knowledge, the addition of the
volume of tewater 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. 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 for which I am the responsible party. Signature of this form indicates
acc tance of astewater flow,
Signing Official Signature
Date

Weddi
can, NC --- SC Quadrangle
5080-A7-TF-024
Revised 1988

Street Level Map Showing Approximate Connection to Existing Sewer Line

pplIV
Permit Number WQ0034432
Program Category
Non -discharge
Permit Type Fast Track
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
Extensions
Primary Reviewer
michael.parker
Coastal SW Rule
Permitted Flow
1748
Facility
Facility Name
Providence Road West Walgreens
Location Address
Owner
Central Files: APS. SWP_
11/03/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
MajorlMinor
Minor
Region
Mooresville
County
Mecklenburg
Facility Contact Affiliation
Owner Name
Cmh-Dwh Ballanytne LLC
Dates/Events
Orig Issue
11/03/09
App Received
10/30/09
Regulated Activities
Retail
Wastewater collection
Outfall NULL
Draft Initiated
Scheduled
Issuance
Owner Type
Non -Government
Owner Affiliation
Dee -Dee Harris
6400 Fairview Rd
Charlotte
Public Notice Issue
11/03/09
Requested/Received Events
Additional information received
Additional information requested
NC 28210
Effective Expiration
11/03/09
Waterbody Name Stream Index Number Current Class Subbasin

Page 1 of 1
TRANSMITTAL
223 North Graham Street, Charlotte, NC 28202
V: 704.333.0325 F: 704.332.3246
DATE: 10/29/2009
PROJECT NAME: 1008092 PROVIDENCE WEST RETAIL CENTER
TO: DWQ - Mooresville
610 E. Center Avenue
Mooresville, NC 28115
[e-mail]
FROM:
CC:
Kris Rowe
LandDesign, Inc.
223 North Graham Street
Charlotte, NC 28202
krowe @ landdesign,corn
PROJECT 4: 1t?08092
WE ARE SENDING: Providence Road West `v4°algreens
VIA: Overnight
PURPOSE: For your review and comment
Quantity
Dated
Description
Copies of Application Form
$480.00 Application Fee (##3570)
Copies of Operational Agreements
1
NOTES:
Copy of Charlotte -Mecklenburg Utilities Flow Acceptance
Color Map
it #tds tlacemmeerti was deiii seed via FAX, the accompanying transmission curtains confidential Mama.. kilanded stay for the use at the individual of the entity named above. tt you are not the intender) recipient you are
hereby notified that eery ducks epre, copying, d ateibiAon or the Weing of any action in reliance pre the contents of F A facsimile iniedmXIion tls sleety prohibiited_ if pop have received this FAX tlt 6Troe', please isernea a leie statist`
us by telephone to arrange ter disc, sAon or return of the dect+nleflde flo us.
Charlotte NC
Washington DC Tampa FL Asheville NC Pinehurst NC Charlotte NC Nashville TN Beijing PRC
about:blank
10/29/2009

LandDesign. urban design planning civil engineering branding landscape architecture
DATE: September 25, 2009
PROJECT NAME: Providence Road West Walgreens
TO: NCDENR
FROM: LandDesign, Inc
RE: Private Sewer Fast Track Project Narrative
PROJECT #: 1008092
This project will consist of the construction of a private sewer main to serve a retail building of approximately
14,570 SF. The project will tie to an existing public CMUD line. Future phases of development will tie to this
private trunk line. Currently, flow is being permitted for the first building only, but the flow acceptance includes
the projected flows for the entire development (+1- 105,000 SF). As additional buildings and connections are
permitted, additional flow will be added.
PO Box 36959 Charlotte, NC 28236-6959 223 North Graham Street Charlotte. NC 28202 V: 704.333.0325 F: 704.376.8235
FILE PATH: N:1_20081100809210ocs1Permit Forms1NCDENR Private Utiiities\Sewer Project Narritive.doc

North Carolina Secretary of State
Page 1 of 1
North Carolina
Elaine F. Marshall DEPARTMENT OF THE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh, NO 27626-0622 [phone]
CORPORATIONS
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Corporation Names
Name
NC CMH-DWH
BALLANTYNE, LLC
NC CMH BALLANTYNE, LLC
Limited Liability Company
Name Type
Legal
Prev Legal
Information
SOSID:
Status:
Date Formed:
Citizenship:
State of Inc.:
Duration:
Registered Agent
0366663
Current -Active
3/30/1995
Domestic
NC
DEC 2030
Agent Name:
Registered Office Address:
Registered Mailing
Address:
Principal Office Address:
Principal Mailing Address:
Swindell, Gary W
227 West Trade Street, Ste 2030
Charlotte NC 28202
227 West Trade Street, Ste 2030
Charlotte NC 28202
6400 Fairview Road
Charlotte NC 28210
6400 Fairview Rd
Charlotte NC 28210
http://www.secretary.state.nc.us/corporations/Corp.aspx?PitemId=4763388 11/2/2009

Permit No, W©0034432
June 10, 2009
Owner/WOCS PE
Dee -Dee Harris Kris Rowe, RE.
6400 Fairview Road LandDesign, Inc.
Charlotte, NC 28210 223 North Graham Street
Charlotte, NC 28202
WQCSJWWTP
Barbara Gross
CMU
5100 Brookshire Blvd
Charlotte, NC 28206
Complete and submit this form to the permit issuing regional office with the following:
One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
Supporting design calculations (selected pumps, system curve, operating point, available storage if
portable generator(s) or storage greater than longest past three year outage reliability option selected)
for any pump stations permitted as part of this project
Changes to the project should be clearly identified on the record drawings or in written summary form.
Permit modifications are required for any changes resulting in non-compliance with this permit,
regulations or minimum design criteria.
This project shall not be considered complete nor allowed to operate until thus Engineer's Certification and all
required supporting documentation have been received by the Division, Therefore, it is highly
recommended that this certification be sent in a manner that provides proof of receipt by the
Division,
ENGINEER'S CERTIFICATION
L, Partial Final
I, Kristopher W. Rowe , as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe ( periodically, 0 weekly, El full time) the construction of Providence
Road West Walgreens, a Mecklenburg County project for the Permittee, hereby state that, to the best of my
abilities, due care and diligence was used in the observation of the construction such that the construction
was observed to be built within substantial compliance of this permit; 15A NCAC 2T; the Division of Water
Quality's (Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the
Division's Minimum Design Criteria for the Fast -Track, Permitting of Pump Stations and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's seal, signature, and date:
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions.
4

Page 1. of 1.
n design planning civil engineering branding landscape architecture
TRANSMITTAL
223 North Graham Street, Charlotte, NC 28202
V: 704.333,0325 F: 704,332.3246
DATE: 9/21/2010
PROJECT NAME: 1008092 PROVIDENCE WEST RETAIL CENTER
TO: DWQ - Mooresville Regional Office
Surface Water Protection
610 East Center Avenue, Suite 3,31
Mooresville, NC 28115
none1@none .corn
FROM:
CC:
Kris Rowe
LandDesign, Inc,
223 North Graham Street
Chadotte, NC 28202
krowe@landdesign,com
PROJECT #: 1008092
RECEIVED
DIVISION OF WATER QUALITY
SEP 2 3 2010
SWP SECTION
MOORESVILLE 1EGONAL OFFICE
WE ARE SENDING: Final Sewor Certiflcation
VIA: Mail
PURPOSE: For your use and distribution
Quantity
Dated
Description
1
Engineer's Certification
1
Set of Field Testing Reports
1
NO :
Set of Sanitary Sewer As-Builts
if lies AYAXAMOIX VMS OXYXACIXIw E.X. the otterneemetog tranenession coptitientee tefoonation .0,174,d orey for the flee .0 the indendluel of tee emely mooed above, 41' yeel ere .no.4 tee attended movere, ream
eeteby reeefied GAYA arty dieeloauft, wfrein9., testaibteeen e, the Itakiel dr any aeben. eelemee eie ...les &this fweekenee ekemeekee meaty prOAXNAYA UyOU ArryA XXXX,Ati ees FAX 414 ewe. Own., eemeehaUey e.tey
es by Member. lo sosenge fee emee.eien .eumof the dee...et to tkv.
Charlotte NC
Washington DC Tampa FL Asheville NC Pinehurst NC Charlotte NC Nashville TN Beijing PRC
about:blank 9/21/2010

P/11117arndDesign. urban design planning civil engineering landscape architecture
FIELD
REPORT
Project: Fifth Third Bank
Weather: Clear 90°
Location: Providence Road and Johnston Road
Present Ray Graham, LandDesign
at Site: Dean Winesett, C.S Clark
David Glover Pioneer Utilities
Date: Wednesday August 11, 2010
LandDesign PN: 1008367
Contractor: Cloningers Inc.
Pioneer Utilities and Plumbing
Total 8 hours
Time:
CC: Kris Rowe
Comments:
The waterline for the bank site was tested today. Both the domestic water and the fire lines were tested at 200PSI for two
hours. There was no loss of pressure during the test period and the lines were deemed to be acceptable for the pressure
test. I informed the contractor that the chlorination test still needs to be performed. After the lines are chlorinated,
sampled, and tested the test results will have to be received in our office prior to certification.
The sanitary sewer lines were also tested today. Each segment was tested for five minutes under four pounds of
pressure. All of the runs passed the pressure test. No vacuum or exfiltration test was performed on the manholes. The
contractor was informed that this test would be required prior to certification.
Other activities on the site this date was the hauling of stockpiled material and backfilling the retention pond to its final
size. The backfill was being tested by S&ME. There was some discussion about the material being used. There was some
contaminated dirt with root vegetation that was rejected by S&ME. The contractor removed and replaced this material.
NOTE: The work on the slope for erosion purposes has not begun.
I also reviewed the erosion control devices and found everything to be acceptable.
Signed:
**See attached pictures.
-1•10'4".?
Ray Graham
LandDesign, Inc.
PO Box 36959 Charlotte, NC 28236-6959 223 North Graham Street Charlotte, NC 28202 V:704.333.0325 F: 704.376.8235
14' ) C1 10'7',t76'"rnraiLchor, ,M1Cm:r f,e;tl R pnir�701P.; .,IL '�$ 14 -nccld Re,10,1 G3 11 1G.4n,

Images
Image # 1
Placing fill
Image # 2
Loading from stockpile
P© Box 36959 Charlotte, NC 28236.6959 223 North Graham Street Charlotte, NC 28202 V: 704333.0325 F 704,376,6235

Image # 3
Compacted fill
Image # 4
Compacting fill material
PO Oox 36959 Charlotte. NC 28236-6959 223 North Graham Street Charlotte, NC 28202 V: 704,3310325 F: 704.376.8235

urban design plan
civil enr
Lrc.
Image # 5
Excavating material from stockpile
PO Box 36959 Charlotte, NC 28236-6959 '223 North Graham Street Charlotte, NC 28202 V: 704,333,0325 F:704.376.8235

LandDesign.. urban design planning civil engineering landscape architecture
FIELD
REPORT
Project: Fifth Third Bank
Weather: Clear 89°
Location: Providence Road and Johnston Road
Present Ray Graham, LandDesign
at Site: Dean Winesett, C.S Clark
Don Johnson, Pioneer Utilities
Date: Thursday September 9, 2010
LandDesign PN: 1008367
Contractor: Pioneer Utilities
Total 8 hours
Time:
CC: Kris Rowe
Comments:
Pioneer Utilities:
The contractor is performing vacuum testing of the manholes and deflection test of the sewer lines today. Vacuum test
were performed on sanitary sewer manholes #8 and #9. Tests were performed at 10 in of mercury for 2 minutes. Both
tests were successful after seams between the sections of manholes were grouted with non -shrink grout.
The mandrel for deflection test was performed between manholes; 9&7, 8&7, 7&6, 6&5, 5&4, 4&3, 3&2, and 2&1. All lines
were clear and the tests were accepted.
Signed:
**See attached pictures.
Ray Graham
LandDesign, Inc.
PO Box 36959 Charlotte, NC 28236-6959 223 North Graham Street Charlotte, NC 28202 V:704.333.0325 F: 704,376,8235
N :COn IX8367,Cordn.-tior Adm'r,Fi Reportv 2C ICri CIO Oi iSeptl Fisld Repert 01.09 10 dor

,. rci ;iP E,':t tune
mages
Image # 1
Vacuum testing
Image # 2
Vacuum tester
P© Sox 36959 Charlotte, NC 28236.6959 223 North Graham Street Charlotte, NC 28202 V7 204.333,0325 P, 704.376,8235

Image # 3
Gauge on apparatus
Image 4
Seating apparatus to manhole
PO Box 36959 Charlotte, NC 28236.6959 223 North Graham Street Charlotte. NC 28202 V: 704.333.032S F:704,376.8235