WQ0037397_Regional Office Historical File Pre 2018

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AVA L
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, Ili
Governor Secretary
October 21, 2014
Mr. John Dibernardo, Real Estate Project Manager
Quik Trip Corporation
P.O. Box 3475
Tulsa, Oklahoma 74101
Subject: Permit No. WQ0037397
Quik Trip No. 1028
Wastewater Collection System Extension
Mecklenburg County, NC
Dear Mr. Dibernardo:
In accordance with your complete application received October 20, 2014, we are forwarding herewith
Permit No. WQ0037397, dated October 21, 2014, to Quik Trip Corporation 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date of issuance until rescinded, and shall be subject to the conditions and limitations as specified therein.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 and supplement shall be considered a part of this permit and are therefore incorporated
therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition II.4: 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.
It shall be responsibility of the Quik Trip Corporation 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 §143-215.6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to
the licensing board.
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.
2317 Mail Service Center, Raleigh, North Carolina 27699-2317
Location: 512 N. Salisbury S1. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: www.ncwaterResources.orq
An Equal Opportunity 4Affirmative Action Employer

Mr. John Dibernardo
October 21, 2014
Page Two
If you need additional information concerning this matter, please contact Barry Love at [phone] or
via e-mail at barry.love@a ncdenr.gov.
for Thomas A. Reeder
Division of Water Resources
by Michael L. Parker, Regional Supervisor
Water Quality Regional. Operations Section
Mooresville Regional Office
Electronic copy: Brian D. Smith, P.E.
Mooresville Regional Office, Surface Water Protection Section
Water Resources Central Files
PERCS (e- copy)
Barbara Gross (e-copy)
Tommy Rowland (e-copy)

ATA
iThENR
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
Quik Trip Corporation
for the construction and operation of approximately 428 Iinear feet of 8-inch gravity sewer to serve the
Quik Trip No. 1028, and the discharge of 3,515 gallons per day of collected domestic wastewater into the
McAlpine Creek WWTF existing sewerage system, pursuant to the complete application received
October 20, 2014, and 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 apart of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
specified conditions and limitations contained therein.
emit issued this the 21 st day of October, 2014.
for Thomas A. Reeder
Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ 003 7397

SUPPLEMENT TO PERMIT COVER SHEET
Quik Trip Corporation is hereby authorized to:
Construct, and thenoperate upon certification the aforementioned wastewater collection extension. The
sewage and wastewater collected by this system shall be treated in the McAlpine Creek Wastewater
Treatment Facility prior to being discharged into the receiving stream.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 2T; the Division of Water Resources (Division) Gravity Sewer Minimum. Design Criteria
adopted February 12, 1996 as applicable; and the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June I, 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 Perrnittee's responsibility to
ensure that the as -constructed project meets the appropriate design criteria and rules.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special.
Conditions identified below.
SPECIAL CONDITIONS
1. If, at any time, the additional wastewater flow volume made tributary to this sev
exceed the value permitted herein, a modification shall be requested for this permit
Resources to properly allocate the subject wastewater flow.
xtension is believed to
the Division of Water
No flow in excess of the quantity permitted herein, 3,515 GPD, shall be made tributary to the subject sewer
system until an applicationfor permit modification for an increase in flow has been submitted to and approved
by the Division of Water Resources,
II. STANDARD CONDITIONS
This permit is not 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.
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 Resources (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,
This permit shall be effective only with respect to the nature and volume of wastes described in the application
and other supporting data.
4. 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 2r .0403;

a. The sewer system shall be effectively maintained and operated at all times to prevent discharge to land or
surface waters, and to prevent any contravention of groundwater standards or surface water standards.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan including pump station inspection frequency, preventative maintenance
schedule, spare parts inventory and overflow response has been 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 Ieast once per every six -months and inspections are
documented.
E A general observation of the entire sewer system shall be conducted at least once per year.
g•
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
§ 143-215.1 C.
h. A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least biannual
distribution of educational materials for both commercial and residential users and the legal means to
require grease interceptors at existing establishments. The plan shall also include legal means for
inspections of the grease interceptors, enforcement for violators and the legal means to control grease
entering the system from other public and private satellite sewer systems.
2. For privately owned collection systems, the Grease Control Program shall include at least bi-annual
distribution of grease education materials to users of the collection system by the permittee or its
representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and (2) of this
Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and equipment
accessibility.
Documentation shall be kept for Subparagraphs (a) through (i) of this Rule for a minimum of three years
with exception of the map, which shall be maintained for the life of the system.
5. Noncompliance Notification:
The Permittee shall report by telephone to a Water Resources staff member 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. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water

Voice nail messages or faxed information is permissible, but this 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 and submitting Part I of Form CS-SSO (or the most
current Division approved form) within five days following first knowledge of the occurrence. This report must
outline the actions taken or proposed to be taken 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.
6. 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.
7, Per 15A NCAC 21-.0123, 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. 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,
if the permit is issued to a private entity with an Operational Agreement, then a copy of the Articles of
Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately filed with
the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are provided as
applicable. Supporting documentation shall include the following:
One copy of the project construction record drawings (plan & profile views of sewer lines & force mains)
of the wastewater collection system extension. Final record drawings should be clear on the plans or on
digital media (CD or DVD disk) and are defined as the design drawings that are marked up or annotated
with after construction information and show required buffers, separation distances, material changes, etc.
b. One copy of the supporting pump station design calculations (selected pumps, system curve, operating
point, buoyancy calculations, 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 that do not result in non-compliance with this permit, regulations, or the Minimum
Design. Criteria should be clearly identified on the record drawings, on the certification in the space
provided, or in written summary form.
Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting in non-
compliance with this permit (including pipe length increases of 10% or greater, increased flow, pump station
design capacity design increases of 5% or greater, and increases in the number/type of connections),
regulations, or the Minimum Design Criteria. Requested modifications or variances to the Minimum Design
Criteria will be reviewed on a case -by -case basis and each on its own merit. Please note that variances to the
Minimum Design Criteria should be requested and approved during the permitting process prior to construction.
After -construction requests are discouraged by the Division and may not be approved, thus requiring
replacement or repair prior to certification & activation.
8. A copy of the construction record drawings shall be maintained on file by the Permittee for the life of the
wastewater collection facilities.

l
9. 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 § 143-215.6A through §143-215.6C, construction of additional or
replacement wastewater collection facilities, and/or referral of the North Carolina -licensed Professional
Engineer to the licensing board.
10. In the event that the wastewater collection facilities fail 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.
11. 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 NCGO10000,
and any requirements pertaining to wetlands under 15A NCAC 2B .0200 and 15A NCAC 2H .0500.

FAST TRACK ENGINEERING CERTIFICATION
Permittee. Quik Trip Corporation Permit No. WQ0037397
Project: Quik Trip No. 1028 - Mecklenburg County Issue Date: 10/21/2014
Complete and submit this form to the permit issuing regional office with the following:
One copy of the project record drawings (plan & profile views and detail drawings of sewer lines) of the wastewater
collection system extension. Final record drawings should be clear on the plans or on digital media (CD or DVD
disk) in pdf format. Record drawings should indicate the design and the marked up changes during construction.
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. Modifications should be submitted prior to certification.
This project shall not be considered complete nor allowed to operate until the Division has received this Engineer's
Certification and all required supporting documentation. Therefore, it is highly recommended that this certification
be sent in a manner that provides proof of receipt by the Division.
PERMITTEE'S CERTIFICATION
, the undersigned agent for the Permittee, hereby state that this project has
been constructed pursuant to the applicable standards & requirements, the Professional Engineer below has
provided applicable design/construction information to the Permittee, and the Permittee is prepared to operate &
maintain the wastewater collection system permitted herein or portions thereof,
Printed Name, Title
Signature Date
ENGINEER'S CERTIFICATION
-1 Partial Ell Final
as a duly registered Professional Engineer in the State of North Carolina,.
having been authorized to observe (LJ periodically, El weekly, (I full time) the construction of the subject 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 02T; the Division of Water Resources (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
SURFACE WATER PROTECTION SUPERVISOR
MOORESVILLE REGIONAL OFFICE
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.
DM) Use Only:
Flow Crow this prof cl

IIP
STATE QF' NORTH CAROLINA
COUNTY OF Mecklenburg
E:
Mecklenbur
Tijs AGREEMENT aanad
October
Commission, an agency of the
1r`v°uIkinson Holdurngs !, LLC
Permit No,
OPER'S OPERATIONAL AGREEMENT
pursuant to G.S. 143-215.1 (d l) and entered into this 6th day of
2014 , by and between the North. Carolina Environmental Management
State of North Carolina, hereinafter known as the COMMISSION"; and
a corporationlgeneral partnersh
business in the State of North Carolina, hereinafter known as the DEVELOPER..
WEINESSETH:
The DEVELOPER is the owner of the Ce
which it is erecting and will erect dwellin
as QT 1028
.nits cat
ying in
other i.nat>rov
The DEVELOPER desires, to construct a wastewate
works, and/or disposal facilities (hereinafter Disposal
the .Development on said lands,
istere(.?`licensed to do
Mecklenburg County, upon
raerais, said development to be known
(hereinafter th.e Development),
collection system. with pumps, wastewater treatment
System) to provide sanitary sewage disposal to serve
The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
The DEVELOPER. has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General. Statutes.
The DEVELOPER has caused. to be formed or will cause to be f:orrned at the time of fiiine of the
Declaration, the (Unit Owners' Association)
Association), a non-profit corporation organized and existing under and by th
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, naainta.ined 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,
(hereinafter
laws of th.e
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal Systert ire 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.
2. 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.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility
for the operation and maintenance of its Disposal System until a permit has been reissued. 'to the
DEVELOPER.'s successor.
FORM: DEV 1.2/ 12 Page 1 of 2

FOR THE ENVIRONMENTAL
AQEMENT COMMISSION
60. Chuck Walcild, Director )`henrys ,k& y
Division of Water•Qtrahty Re. sowl2C'r.s
(Date)
Z./Z-40/K
• 4. The'D,EVELOPER 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.
6. 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 shall 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 and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter 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.
8. 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 Association Bylaws that the Association shall not enter into voluntary dissolution without
fast 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.
9. 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.
10. 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 of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, 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:
k-TF;RF)
Name of DWVEL OPE
PICA
By:
(Signature)
U-Tr— M; &et ES' 4 ,�.p�
Print Name and Title U
/a - 7-- IL/
(Date)
FORM: DEV 12/12 Page 2 of 2

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number:
(to be completed by DWR)
Owner/Permittee:
la. QukTrip Corporation
Full Legal Name (company, municipality, HOA, utility, et
1b. John Dibernardo, Real Estate Project Manager
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing o
"lc. The legal entity who will own this system is:
❑ Individual ❑� Federal ❑ Municipality ❑ State/County ❑ Private Partnership [] C
PO Box 3475
Mailing Address
OK
State
1h. 704-559-8015
Telephone 'W
Project (Faci
2a, QuikTrip No. 1028
Facsimile
Ion:
Brief Project Name (permit will refer to this name
Contact Person:
Brian D. Smith, Project Engineer
City
74101
Zip Code
............ ....
[e-mail]
E-mail
rpor
2b. Mecklenburg
County Where Pro
Name and Affiliation of Someone Who Can Answer Questions About this Application
704-334-3303 ext 102
Phone Number _. W
Project i New
Owner is IJ Public (skip to iI
a. If
private, applicant will be:
Retaining Ownership (i.e. store, church, single office, etc
❑ Leasing units (lots, townhomes, etc. - skip to item B(3))
❑ Selling units (lots, townhornes, etc, - go to Item B(2b))
Charlotte -Mecklenburg Utilities
Owner of Wastewater Treatment Facility (WINTF) Treating Wastewater From This Project
McAlpine Creek 4b. NC0024945
Private
Name of WWTF WWTF Permit No,
Charlott
Owner o
lecklenbuU b. 8`" Gravity
ownstream Sewer Receiving Sewer Size ❑ Force Main
The origin of t
wastewater is (check all that apply)
• Residential Subdivision
❑ Apartments/Condominiums
[❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
Permit I# of Downs re
Retail ( Stores„ shopping centers)
❑ institution
(] Hospital
Church
[] Nursing Home
❑ Other (specify):
Volume of wastewater to be allocated or permitted for this particular project
"Do not include future flows or previously permitted allocations
he permitted flow is zero, indicate why
5
3c. brian@urbandesignpartners,com
E-mail
Modification, Permit No.:
rn 2(a))
2b. If sold, facilities owned by a (must choose one)
or ❑ Public Utility (Instruction D)
Homeowner Assoc./Developer (Instructs
Sewer
100% Domestic/Commercial
% Industrial
(Attach Description)
E)
% Other
(Attach aescripti
gallons per day
❑ Pump Station, Outfall or Interceptor Line where flow wilt be permitted in subsequent permits tha
Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected
(see ,15A NCAC 02T .0303 to determine if a permit is required)
o th
ine
FTA 08-13 APPLICATION
Page 3 o€(

. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
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).
Parcel 1: 5,858 sf * 60 gpd1100 sf = 3,515 gpd
Parcel 2: 0 gpd at this time
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
New Gravity or Additional
Force Main
8"
428
gravity
w
m
z
p
11. Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
Z
0
Pump Station Location ID: (self chosen - as shown on plans/map for reference)
0
Longitude: Latitude:
Z
0
Q
E
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w1ATS;
2 - portable generator w!MTS
Force Main Size
Force Main Length
CC
0
LL
Z
Pump Station Location ID: (self chosen - as shown on planslmap for reference)
1-
5
Longitude: Latitude:
ce
LLi
a.
CO
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w1ATS;
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?
• 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 Permitting of Pump Stations and Force Mains
(latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as applicable?
1"14
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
FTA 08-I3 APPLICATION
Page 4 of 6

Fp,
14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification? II Yes © No ® N/A
Sedimentation and Erosion Control Plan?
Trout Buffer Waiver?
Stormwater?
Yes No © NIA
© Yes LI No ® N/A
® Yes ©No © NIA
15. Does this project include any high priority lines (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: [Q and provide details:
Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, John Dibernardo , attest that this application for QuikTrip No. 1028
_ has been reviewed by me and is accurate and complete to the best of my knowledge. t 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.
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THiS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
V) TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
Z
Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, Brian D. Smith ,attest that this application for QuikTrip No, 1028
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. 1 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 siignifies 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 143-215.6B, 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 tine not to exceed $10,000 as well as civil penalties up to $25,000 per
2a. Brian D, Smith, PE
Professional Engineer Name
2b, Urban Design Partners, PLLC
Engineering Firm
2c, 1318 Central Avenue, Suite E6
Mailing. Address
2d. Charlotte
City
2e, NC 2f, 28205
State Zip
2g. 704-334-3303 2h. 704-334-3305 2i. [e-mail]
Telephone
Facsimile
E-mail
NC PE Seal, Signature Date
FTA 08-13 APPLICATION
Page 5 of 6

TRANSMITTAL
URBAN
DESIGN
PARTNERS
1318 e-6 central avenue P 704.334,3303
charlotte. nc 28205 F 704.334,3305
To: NCDENR - Sewer Date: 10/7/2014
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC
Phone:
Fax:
Project Name: QuikTrip No. 1028
Project No: 13-040
Transmitted Via:
❑ Overnight
® Courier
❑ Hand
❑ Mail
❑ Fax
Action::
For Approval
For Your Use
0 As Requested
Q For Review & Comment
For Signature
Number
2
Date Description
fast track application (1 original & 1 copy)
2
operation agreement (1 original & 1 copy)
check - $480
flow acceptance letter
quad map
street map
copies of utility plan
Comments
Attached is the submittal package for the fast track application to the above
referenced project. Please feel free to contact me if you have any
questions/comments.
Brian Smith
Cc:

1j3.1.8-e6..pentra ave.. P
charibtte.„..nc:282Q5: P • 794:..334.4339:5:
ufbandosignNethr&torh
,411%bo,
Date: October 7, 2014
To: NCDENR
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Re: QuikTrip No, 1028
Project No: 13-040
To whom it may concern,
Attached is the submittal package for a private sewer extension in Matthews, Mecklenburg
County to serve the above referenced project, The site contains 2 lots for development. The
front parcel will be a convenience store with gas sales. The rear lot will be sold and developed
in the future, No flow is accounted for that rear parcel at this tirne, The permit will be updated
once a final use is known,
The private sewer will connect to a public main along Monroe Road (SR 1009) just outside of the
parcel boundary, The private extension includes 428-linear feet of 8-inch PVC to provide sewer
services to the proposed site and future development projects. The design flow is calculated in
accordance with 15A NCAC 2T .0114 as 3,515-dim:I,
Should you have any questions about the sewer or supporting documentation please contact
me.
Brian U. Smith, P.E.
Partner
Urban Design Partners

Central Files: APS SWP
10/21/2014
Permit Number WQ0037397 Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
michael.parker
Coastal SWRute
Permitted Flow
3,515
Facility
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
Facility Name Major/Minor Region
Quik Trip No. 1028 Minor Mooresville
Location Address
Facility Contact Affiliation
Owner
County
Mecklenburg
Owner Name
Quik Trip Corporation
Dates/Events
Owner Type
Non-Govemment
Owner Affiliation
Matt Miller
PO Box 3475
Tulsa
OK 74101
Orlg Issue
10/21/2014
App Received Draft Initiated
10/8/2014
Scheduled
Issuance Public Notice Issue Effective
10/21/2014 10/21/2014
Regulated Activities Requested /Received Events
Retail
Wastewater collection
Outfall
Expiration
Additional information requested
Additional information received
Waterbody Name
Streamlndex Number Current Class Subbasln

ARI .J.
CHARLOTTE-MECKLENBURG
UTILITY DEPARTMENT
September 25, 2014
Mr, Brian Smith
Urban Design Partners
1316 Central Ave.
Suite E-6
SUBJECT: WATER AND SEWER FLOW ACCEPTANCE
QUIK TRIP #1028
PARCEL ID# 193-211-40
C-MUD TRACKING# 600-14-625
A flow acceptance study of the subject site has been completed and the following has been determined:
Charlotte -Mecklenburg Utility Department agrees to accept the gravity sewage flow of 3,515 gallons per
day (5,858 fta convenience store x 60 gpd/100 ft?) from this protect 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
FTSE form.
Charlotte -Mecklenburg Utility Department 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, PWS ID # 0160010, on file with the Public Water Supply Section of NCDENR,
However, Charlotte -Mecklenburg Utility Department 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 Utility Department 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. If the appropriate
authorization to construct permits are not obtained and construction has not started within tape 1 ear rst
issuance of this flow acceptance letter, and payment for any service connection(s) has not been received
within (1) year of the issuance of this flow acceptance letter, this flow acceptance approval shall be
rescinded and a new flow acceptance study must be made. If you have any questions, you may contact
me at [phone]..
Sincerely,
Barbara Gross
Engineering Assistant
CHARLOTTE-MECKLENBURG UTILITY DEPARTMENT
Engineering Division • Installation & Development Services
www.cmutilities.com
700 North Tryon Street
Charlotte, NC 28202
Ph; 704/432-5801
Fax. [phone]

Department of Fnvir
Flow Tracking/Acce
,ance for Se
State of North Carolina.
e'ut and Natural Resources
ivision of Water Resources
r Extension Applications
(FTSE 08-13)
l'rcaject Applicant Name: urban Design partners
Project Name for which flow is being requested:
More than one VISE may be required for ca single project r"
secalitatas along the route of the proposed Wcr ie water
ak Trip
/ihe WWTP is no/ responsible rfi r at pump
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: McAlpine Creek
in Creek, Sugar Creek WWTP
b. WWTP Facility Permit T: NC0024 '7 . NC0024445, NC002493'7
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e., WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
Al/fiows are in MGDD
9 787
053
315
"79. 841
Complete this section for each purup station you are responsible fo
proposed wastewater flow.
ist pump stations located between the project connection point and the WWTP:
Pump
Station
(Name or
Number)
t� tam
Capacity,
MGD
(A)
Design
Average Daily
Flow°/b
(Firm / pf).
MGD
(H)
Approx.
Current Avg,
Daily Flow,
MGt)
along the route of this
(C) (D)=(B+C) (F)=(A-D)
Obligated,
Not Yet Total Current
Tributary Flow Plus
Daily Flow, Obligated
MGD Flow
* The Firth Capacity of any pump station is defined a the
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pure
factor (pf) not Less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station loc
between the project connection point and the WWTP where the Available Capacity
file
m�axltrnurn pumped flow that
station divided by a peaking
Page lof6

Certiflcation Statement:
certify to the best of my knowledge that the addition of
the volttxt 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 1 and 11
plus all attached planning assessment addendums for which l am the responsible party.
Signature off orm indicates acceptance of this wastewater flow..
Signing
ignafure
Page 2 of 6
FTSE 08-13

523 1 480 000FEET
Produced by the United States Geological Survey
Jorth American Datum of 1983 (NAD83)
Nortd Geodetic System of 1984 (WGS84). Projection and
1 000-meter grid: Universal Transverse Mercator, Zone 175
7*
11

.Polaris 3G Map - Mecklenburg County, North Carolina
Date Printed: 10/6/2014 12:19:37 PM
i m p or raper prepare+ car a tt ventory o real propertywriihin Mecklenburg County and is compiled irom recorded deeds, plats, tax maps, sur
planimetr c maps, and other public records end data, Users of this ms p or report are hereby notified that the aforementioned public primary information sources
lshoutd be consulted for verification, Mecklenburg County and its mapping contractors assume no legal responsibility for the information contained herein,

Cerporations Division Page 1 of 3
North Carolina
Elaine F. Marshall DEPARTMENT OF THE
Secretary SECRETARY OF STATE
PO Box 29822 Raleigh, NC 27628-0822 [phone]
Click Here To:
Account
Login
Register
View Document Filings File an Annual Report Print a Pre -Populated Annual Report form
Amend a Previous Annual Report
Corporate Names
Legal: QuikTrip Corporation
Business Corporation Information
Sosld:
Status:
Annual Report Status:
Citizenship:
Date Formed:
Fiscal Month:
State of Incorporation:
Registered Agent:
Corporate Addresses
1203209
Current -Active
Current
Foreign
5/11/2011
April
OK
CT Corporation System
. Reg Office:
Reg Mailing:
Mailing:
Principal Office:
Officers
150 Fayetteville St., Box 1011
Raleigh, NC 27601-2957
150 Fayetteville St., Box 1011
Raleigh, NC 27601-2957
4705 South 129th East Avenue
Tulsa, OK 74134-7005
4705 South 129th East Avenue
Tulsa, OK 74134-7005
Assistant Secretary:
Assistant Secretary:
Assistant Secretary:
Assistant Secretary:
Assistant Secretary:
Assistant Secretary:
Assistant Secretary:
Larry Dale Dickerson
4705 S 129th E Ave
Tulsa OK 74134
Avery Allyson Simoens
4705 S 129th E Ave
Tulsa OK 74134
Beth Ellen Smith
4705 S 129th E Ave
Tulsa OK 74134
Lora Louise Zumwalt
4705 S 129th E Ave
Tulsa OK 74134
Mark Branham
4705 S 129th E Ave
Tulsa OK 74134
Craig Donovan Williams
4705 S 129th E Ave
Tulsa OK 74134
httn://www.secretarv.state.nc.us/Search/nrofcnrn/9755971
10/9/2014

it/ ODFN
FAST TRACK ENGINEERING CERTIFICATION
i,
Permittee: Quik Trip Corporation Permit No, WQ0037397
Project: Quik Trip No. 1028 — Mecklenburg County WVOROS Issue Date: 10/21/2014
MOORk5ViLLE REGIONAL, OFFICE
Complete and submit this form to the permit issuing regional office with the following:
+ One copy of the project record drawings (plan & profile views and detail drawings of sewer lines) of the wastewater
collection system extension, Final record drawings should be clear on the plans or on digital media (CD or DVD
disk) in pdf format, Record drawings should indicate the design and the marked up changes during construction.
• 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. Modifications should be submitted prior to certification.
This project shall not be considered complete nor allowed to operate until the Division has received this Engineer's
Certification and all required supporting documentation. Therefore, it is highly recommended that this certification
be sent in a manner that provides proof of receipt by the Division.
PERMITTEE'S CERTIFICATION
I, John Dibernardo , the undersigned agent for the Permittee, hereby state that this project has
been constructed pursuant to the applicable standards & requirements, the Professional Engineer below has
provided applicable design/construction information to the Permittee, and the Permittee is prepared to operate &
maintain the wastewater collection system permitted herein or portions thereof.
John Dibernardo, Real Estate Project Manager
Printed Name, Title Signature
ENGINEER'S CERTIFICATION
Date
111 Partial Final
, Brian D. Smith _ as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (Ei, periodically, E weekly, Q full time) the construction of the subject 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 02T; the Division of Water Resources (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:
11JI/,
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
SURFACE WATER PROTECTION SUPERVISOR
MOORESVILLE REGIONAL OFFICE
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.
D W t,) t.l t Onl

TRANSMITTAL
URBAN
DESIGN
PARTNERS
1318 a-6 central avenue P 704.334.3303
charlotte, nc 28205 F 704.334.3305
To: NCDENR - Sewer Date: 3/27/2015
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC
Phone:
Fax:
Project Name: QuikTrip No. 1028
Project No: 13-040
Transmitted Via: Action:
Overnight ® For Approval
Courier 0 For Your Use
Hand ❑ As Requested
Mail 0 For Review & Comment
D Fax LJ For Signature
Number
Date
Description
2
asbuilt plans
documentation
Comments
MOO E VILLE ONAL °r j l
Attached is the submittal asbuilt package for the above referenced project. Please
feel free to contact me if you have any questions/comments.
Brian Smith
Cc: