WQ0038679_Regional Office Historical File Pre 2018

Water Resources
ENVIR©NMIEN'TAL.. QUALITY
August 25, 2016
Laura MacFadden, Senior Director of Design and Construction
Novant Health, Inc.
3600 Country Club Road, Suite 201
Winston Salem, NC 27104-3824
Dear Ms. MacFadden:
DOI D R. VAN DER VAART
SeCrOOry
S. JAY ZIMMERMAN
!)recrzrt°
Subject: Permit No. WQ0038679
Novant Health, Inc..
Novant Health Mint Hill Medical Center
Wastewater Collection System Extension Permit
Mecklenburg. County
In accordance with your application received August 16, 2016, we are forwarding herewith Permit No.
WQ0038679 dated August 25, 2016, to Novant Health, Inc. (Permittee) for the construction and operation
upon certification 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from the date of issuance until rescinded and shall be subject to the conditions and limitations as specified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 the following conditions contained within this permit:
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11.4:
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 the responsibility of the Permittee 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.
State of North Carolina I Environmental Quality I Water Resources Water
Mooresville Regional Office' 610 East Center Avenue, Suite 301 I Moores
704 663 1699
it3 Regional Operations
l larth Carolina 28115

If you need additional information concerning this matter, please contact Barry Love
or via e-mail at [e-mail].
Sincerely,
irs''_ by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
cc: Lester Barnes, P.E. (e-copy)
Barbara Gross (e-copy)
Tommy Rowland (e-copy)
Regional Office Files
Water Resources Central Files
PERCS (e-copy)
7
235-2143
Page 2 of 8

Environmental.
• Quality
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 •
Novant Health, lnc...
Mecklenburg • County
for the construction and operation of approximately 730, linear feet of 8-inch gravity sewer to serve a
medical office building as part of the Novant Health Mint Hill Medical Center project, and the discharge
of 14,000 gallons per day of collected domestic wastewater into the Charlotte Water and Water & Sewer
Authority of Cabarrus County existing sewerage systems,pursuant to the application received August 16,
2616,•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 Environmental Quality and considereda part of
this permit.
"Thi permit shall.be"effective from the dateof issuance"until rescinded and shall be subject to the specified
co r lit'. nktatuons contained therein.
R-J y W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
Permit Number:. WQ0038679
Permit Issued: August 25, 2016
•
Page 3 of 8

��KU�������������/������������������U����
~,*�" v��o�"u.v�n u�� PERMIT "�v��u."* ~p,"m�v�o
Novant Health, Inc. is hereby authorized to:
Construct, and then operate upon cerlification the aforementioned wastewater collection extension. The
sewage and wastewater collected bvthis system shall be treated imthe Water & Sewer Authority of
[abarrus County Rocky River Regional Wastewater Treatment Plant in accordance with Permit Number
NC0036Z69.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A N[AC 2T;the Division's 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 K8aimy adopted June l, 20}0, as applicable, unless specifically mentioned herein. Division approval
is based on acceptance of the certification provided by a North Caroiina-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.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
i SPECIAL CONDITIONS
1. No flow in excess of the quantity permitted herein, 14,0006PUshall be made tributary tothe subject
sewer system until an application for permit modification for an increase in flow has been submitted
to and approved by the Division. [15AN[ACO2T.0304(b)]
2. This permit shall become voidable unless the agreement between Novant Health, Inc. and Charlotte
Water and Water 8k Sewer Authority oyCabanus County for the collection and final treatment of
wastewater is in full force and effect. [15A NCAC 02T.0304(h)]
III. STANDARD CONDITIONS
1. This permit isnot transferable. In the evert there is a desire for the wastewater collection facilities
to change ownership, or there is a name change of the Pemmh1e* a fmmna| permit request ohuUU be
submitted to the Division accompanied by documentation from the parties involved, and other
supporting materials aymay beappropriate. The approval ofthis request shall beconsidered onits
merits and may ormay not beapproved. [1SANCACOITD104;G.S14]-2l5.l(d3))
2. 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's Gravity Sewer Minimum
Design Criteria adopted February lI, 1995, as applicable; the Division's Minimum Design Criteria for
the Fast -Track Permitting ofPump Stations and Force Mains adopted June 1, 2808, as applicable,; and
other supporting materials unless specifically mentioned herein. [15A NCAC 02T.0110)
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [15A NCAC 02T .01101
4. The wastewater collection facilities shall be properly maintained and operated at all times. The
Page 4 of 8

I
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: [15A NCAC 02T .0108(b)]:
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 everyday (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 -months and inspections are
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported totheappropriate Division regional officein accordance
with 15A' NCAC 2B .0506(a), and public notice shall be provided as required by North Carolina
• General Statute §143-215.1C.
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 rnore 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
equipmentfaccessibility.
j. 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. 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,
following the occurrence or first knowledge of the occurrence of either of the following:
• Page 5 of 8

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 mail 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 II of Form CS-SSO (or the most current Division approved
form) can also be completed to show that the SSO was beyond control. [G,S. 143-215.1C(a1)1
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. [15A NCAC 02T.0108(b)]
7. 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 C©unty'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:
a. 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 applicable design calculations including pipe and pump sizing,
velocity, pump cycle times, and level control settings, pump station buoyancy, wet well storage,
surge protection, detention time in the wet well, and force main, ability to flush low points in
force mains with a pump cycle, and downstream sewer capacity analysis. if a portable power
source or pump is dedicated to multiple stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, include travel
timeframes, shall be provided.
Page 6 of 8

I
c. 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. [15A NCAC 02T .0116]
8. Gravity sewers installed greater than ten percent below the minimum required slope per the Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case -by -case basis. Resolution of such request shall be evident prior to completing and submitting
the construction certification. [ 15A NCAC 02T.0105(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for the life of
the wastewater collection facilities. [15A NCAC 02T .0116]
10. 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. [15A NCAC 02T .0104; 15A NCAC 02T
.0108(b-c)]
11. 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.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12. 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 the Division any other Federal, State, or
Local government agencies which have jurisdiction or obtaining other permits which may be
required by the Division or any other Federal, State, of Local government agencies. [G.S. 143-
215.1(b)]
Page 7 of 8

FAST TRACK SEWER ENGINEERING CERTIFICATION
NnvantHealth, Inc.
WQ003867
NovantHealth Mint Hill Medical Center
August JS,2O16
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of
this permit until the Division has received this Certification and all required supporting documentation. It
should be submitted in a manner that documents the Division's receipt, Send the required documentation
the Regional Supervisor, Water Quality Regional Operations Section at the address at the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Pemohtee to
appropriate enforcement actions. The pernnhtee is responsible for tracking all partial certifications up
until final certification isreceived. AFinal Certification shall beacomplete set ofrecord drawings and
design calculations regardless ofwhether partials have been submitted.
PERMITTEE'S. CERTIFICATION
1, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards 8, requirements, the Professional Engineer below has provided applicable
design/construction information to the Pernnittee, and the Pennittoe is prepared to operate & maintain
the wastewater collection system permitted herein or portions thereof,
Printed Name, Title
Signature Date
ENGINEER'S CERTIFICATION
|, _ _ , as duly registered Professional Engineer in the State ofNorth Carolina,
having been authorized to observe (F- pehodica1ly,0weekly, full time) the construction of the
project name and location as referenced above for the above 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, 20,00, as applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/dgma1ore&6date:
0 Final Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
State ofNorth Carolina I Envirmmental Quality I Water Resources I Water Quality Regional Operations
Mooresville Regional Office[ mwFast Center Avenue, suite s*1|wm"esville,xwthCarolina m1n
/04ma1mv

Division of Water lesources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
Ali items ust be completed or the application will be returned
APPLICANT INFORMATION:
Applicant's name: Novant Health, Inc.
omt a
Applicant type: individual Cor-porati
Federal ❑ StatefCou
3. Signature authority's name: Laura MacFadden per
Title: Senior Director of Design and Construction
4. Applicant's rnailin.g address: 3600 Country Club Road Ste 201
City. Winston Salem State: North Carolina Zip 27104 3824
5„ Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
u6'
Cr' 11 to be etrletcd by DWR)
PROJECT INFORMATION:
1. Project name: Novant Health Mint Hill ,Medical Center
?. Application/Project status: Proposed (New Permit) -] f:xistit�g Perrr
Ifa modification, provide the ex inn permit number, WQ00 and issued date:
I'hnew construction but part of master plan, provide the existing permit number: WQ00,
3. County where project is located: Mecklernburg
4. Approximate Coordinates 'Decimal Degrees): Latitude: ?2" Longitude: -80.65"
5. Parcel ID (if applicable): ;I 1 l,2fl0..3
(or Parcel ID to closest downstream sewer)
CONSULTANT INFORMATION:
] . Professional En ineer: Iaester Barnes i License Number:: 040973
Firm: Benesch & Company
Mailing address: 2320 West Morehead Street
City: Charlotte State: North Carolina Zip: 28208-.,,.,.,
Phone number:: [phone] Ismail Address: )baniesti benesch.con
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: McAlpine Creek Permit Number NC'0024970
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if d'iffer'en'l than WWTF):
I. Permit yumber(s): Ak Q _
System Wide Collection System PermPer(s) (0'applicable): WQCS
Owner Name(s)r
ity, HOA, utility, etc.)
0 General Partnership Privately -Owned Public Utility.
Municipal 0 Other
r_ ...02l 0106(h)
'Project
Rt;`:'CtOl(AL;;.6i OFFICE-7
FTA 04-I6 Page 1 of 5

Vt. GENERAL REQUIREMENTS
If the Applicant is a Privately -Owned Public Utili
has a Certificate of Public Convenience and Necessity been attached?
❑ Yes
If the Applicant is a Developer of lots to be sold, has a Developer`
0 Yes L1No
If the Applicant is a Horn Prverty: ()wncr,S yoc r�ttat�m,...h�r n r
El Yes :No
4. Origin of wastewater: (check all that apply;):
Residential Owned
Residential Leased
Q School / preschool day care
® Food and drink facilities
businesses / offices / factories
Retail (stores, centers, malls)
Retail with food preparations/service
Medical / dental ,'veterinary facilities
❑ Church
Nursing Home
Nature of wastewater : 1' 00 % Domestic/Commercial. % Commercial
% Industrial (See 15.A, ( (0_' ➢_ 0103(2 )
OIR\1 1)1`) been attached?
K ijc),') been attached?
Car Wash
❑ Hotel anctor Motels.
Q Swimming Pool (Clubhouse
(❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
there a Pretreatment Program in effect? [ Yes © No
) 01. 14(()?
Has a flow reduction been approved under I > A NCAC 02
If vest provide a copy of flow reduction approval letter
2. Summarize wastewater generated by project:
Establishment Type (see 02T.0I1 43(f)
Medical Office Building (Employees)
Rice Building (Med. Pract.)
250 gal/Practitioner
gal/
gal,
Yes Q No
cat/
gal/
'Total
GPD
GPD
GPD
14,000 GPD
a See 1` 0 N(wA( 02 _1)1 14(b),..)A),_l.0).Ll)A0_e 1 :),C.) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling, proposed unknown non-residential development uses; public access facilities located near high public' use areas:
and residential property located youth or east of the Atlantic Intracoastal. Waterway to be used as vacation rentals as defined
in G S.,_
b Per I5A NCAC 02T ,01 14(c), design flow rates for establishrnents not identified [in tab
l4I shall be
deterrnined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
Wastewater generated by project: 14,.000 GPD (per I5�ANck 021 0 d as a)
Y Do not include future (lows or previously permitted allocations
if pennitted flow is zero, indicate why:
0 Pump Station or Gravity Sewer where flow will he permitted in subsequent permits that cone
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement ofe, ting sewer with no new flow expected
0 Other (Explain):
his lin
FORM: FTA 04- l (6
Page 2 of 5

GRAv1T ' SEWER DESIGN CRITERIA (1f Applicable
I . Summarize gravity sewer to be permitted:
Size (inches)
Section II Ill ofthe MDC for Permitting of Gravity Sewers contains information related to design criteria
Section 111 contains information related to minimum slopes for gravity sewer(s)
Oversi ing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VILE PUMP STATION DESIGN CRITERIA (If Applicable) - 2T a030 & MDC" (Pump Stations/Force Mains'):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
Approximate Coordinates (Decimal Degrees): Latitude:
Long
de: -
3. Design flow of the pump station: ____a millions ns per day (firnn capacity)
4. Operational point(s) of the. pump(s): P gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance. with 1 C,
❑ Standby power source or pump
Required fir all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A, NCAC 02T
.0305(h)(1)(C)
or
automatic ac
vation and telemetry - 15A NCAC 02T ,0305(.h)(1)(1E3):,
❑ Portable pumping unit with plugged emergency pump connection and telemetry - I5A NCAC 02T .0305(h)(1)(C):
It shall he demonstrated to the Division that the portable source is owned or contracted by the applicant (dratf agreement)
and is compatible with the station.
If the portable power source or purnp is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timetranr.es, shall be provided
in the case of a multiple station power outage.
FORM: PTA 04-16

IX. SETBACKS & SEPARATIONS — (028 .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in l 5A NC 1C; 07-1 Oalf) &
• 15A NCAC 02T 0305(f) contains minimum se arations that shall provided or sewer systems
Separation Required
4
Storm sewers and of
Water mains t"ve
Reclaimed water lines (vertica
Setback Parameter*
not listed below (vertical)
ewer including in benched trenches)
aimed over s
Reclaimed water lines (horizontal - reclaimed over sewer)
**Any private or public water supply source, including any weds, W=S-i waters of Class I or
- � e d `g water
impounded re�servorrs used as a source. of
Class I lm.—._._. -- -- _ - -- ---
*Waters classified WS (except WS-1 or WS-V), 13, SA, ORW, HOW, or SB from normal
high water (or tide elevation) and wetlands (see item IX,2)
Yes
24 inches
18 inches
10 feet
l8 inches
2 feet
**Any other stream, lake, impoundment, or round water lowering and surface drainage
ditches
Any buildin foundation
Any basement
To sembankment
Draina
rs of 2 feet or more vertical height
s and interceptor drains
Aby swimming pools
Final earth grade (vertical)
1.0 feet
5 feet
1.0 feet
10 feet
5 feet
▪ SA NC AC 021 ontains alternatives where separations in 021
• **Stream classifications can be identified using the Division's NC 4urft
If noncompliance with 021.0.305t1) or (g), see Section X of this application
1.0 feet
36 inches
cannot be achieved,
➢➢assal:l :..:ntionsv ehj age
Does the project comply with separation requirements for vetlands? (50 feet of separation)
See the Division's draft separation requirements for situations where separation cannot be meet
• No variance is required if the alternative design criteria specified is utilized in design and construction
As built documents should reference the location of areas effected
Does the project comply with all setbacks found in the river basin rules per
This would include Trout Buffered Strearn.s per 1,5 1. C A.t_,,,2(I 0,2(,
4. Does the p
e
omply with an individual 404 Permit or any 40I Certifications?
No
No
El Yes ❑ No
▪ Wetland -related. permits shall be requested, obtained, and adhered to for projects that impact wetlands or surfaace waters
Information can be obtained from the 401 & Butter Permitting Bransla
Does project comply w021._t) 05 )(i,) (additional pen mit-Icertifleatiions)?
Yes No
Per � � _N
„ m_ C AC 021010' fc)(0), directly related environments) permits or certification applications are being prepared, have
1 �
been applied for, or have been obtained, Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.),
Does this project include any sewer collection lines that are deemed "high -priority
Per 1 i AAtA
positioned paraiit
high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
o streatnbanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes Z No
If yes, include an attachment with details for each line, including type (aerial line, size, material. and location).
High priority linesshall be inspected by the pernittee or its representative at least once every six -
documented per t5A NCAC 02T.0403(a)(5) or the permitee''s individual System -Wide Collection permit.
hs and inspections
FORM: FTA. 04-I 6 Page 4 of 5

X. CERTIFICATIONS:
Does the submitted system comply with 1...M.,,NciVLIL2T, the Min:maim Design, Criteria tin' the Pciattittnia or Pump
and Force Mains ()atom version), and the Gravity Sewer NI titioil Criteria (lttoistersitio) a.s applicable?
EI Yes Ej No
r No, complete and submit the Variance/Alternative Design .Request application (VADC I 0- ft) and supporting documents for
review. Approvat of the request is required prior to submittal or the Fast Track * st
2. Professional Engineer's Certification:
el Atoes
(Pr —sternal Erigincees name from Applicat
attest that this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting docuinentation to the best of my knowledge„ 1 further attest that to the best
of my knosviedge the proposed design has been prepared in accordance with the applicable regulations, Gravity Seer
Minimum 'Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast:rrack Permitting
of Pump Stations and Force Mains (West version), Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance With General Statutes I 43-215,6A and 143-2156B, any person svho knowingly makes any false.
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a tine not to exceed $ !ONO., as well as civil penalties up to $25,000 per violation,
wttiii/01
North Carolina Professional Engineer's seal, signature, and date: ,;\ C A
S 7,7
„
t:1
3. Applicant's Certification per I 5A NCAC 02 f .0 0 r
i>tc,t-icZ c4 --De5j. Coy6r40,--ri.t,Ittest that this application for
(Signature Authority's name & Idle from Application Item LI)
has been reviewed by me and is accurate and complete to the best of my knossdedgeunderstand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not mclodcd, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface wLiters or the land will result in an immediate enforcement action that may include civil penalties,
.injunctive relief, andior criminal prosecution, I will (mike no claim against. the Division of Water Resources should a ,condition
of this permit he V nt atcd 1also understand that flail required parts of this application package are nut completed and that if
all required supporting information .and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with ()client! Statutes t 43-2 j5.6A and 1 d3-2,J5cill, any person who knowingly makes any false
statement, representation., or certification in any application package shall he guilty of a Class 2 misdemeanor, which may
include a fine not to exceed SlO.,000 as well as civil penalties up to $25,000 per violation.
Signature.:
Date:
FORM: 1 FA 04- 6 Page 5 1)1.5

CHARLOTTE
WTER
August 15, 2016
Mr, David Gusty
Alfred Benesch & Company
2320 'W Morehead St
Charlotte, NC 28208
SUBJECT: WATER AND SEWER FLOW ACCEPTANCE
NOVANT HEALTH MINT HILL MEDICAL CENTER
HEALTH CARE LOOP, MINT HILL NC
CLTWATER TRACKING # 2016655
In response to your request, a flow acceptance study of the subject site has been completed and the
following has been determined:
After analysis of the sanitary sewer associated with the proposed project it was determined that there is
sufficient capacity to accommodate the proposed gravity sewage flow of 14,000 gallons per day (Medical
office with 160 employees x 25 gpd/employees. 40 Medical practitioners x 250 gpd/practitioner) from this
project for transmission to the Rocky River Wastewater Treatment Plant, NPDES permit number
NC0036269, located in Cabarrus County, for treatment, This acceptance of flow is based on the existing
capacity of the designated publicly owned treatments works, Please see the attached FTSE forms.
CLTWater 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, CLTWater
cannot guarantee a constant pressure or quality of flow,
CLTWater does not expect any of the above conditions to preclude water or sewer service to the subject.
site. However, the applicant should understand that 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 CLTWater and sewer 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 one (1) year of
issuance of this flow acceptance, and payment for any service connection(s) has not been received within
one 9' ear cif issuance of this flow acce lance this flow acce tarace a rival shall be rescinded and a
rev flow acceptance request must be made. If you have any questions, please do not hesitate to contact
me at [phone].
Sincerely,
Barbara Gross
Engineering Assistant
Charlotte Water 5f;.i:
y ti
f Charlotte

i
t
F
i
t
of WAF9 • State of North Carolina
` 4� Department of Environment and Natural Resources
q Division of Water Qualityt
i 111[ r i
-c Flow Tracking/Acceptance for -Sewer Extension Permit Applications i
(FTSE —10/07) F
r
k
l
(JURISDICTION USE ONLY)
JurisdictionRequesting Flow Acceptance for Collection System:
['City of Concord ❑City of Kannapolis ❑Town of Harrisburg ❑Town of Mt. Pleasant
®Charlotte Water
Project Title, Description, and Number of hots/Unit:
Project Title: Novant Health Mint Hill Medical Center, 2016655
Description: The Novant Health Min Hill Medical Center engineerintr plans and specifications. as prepared and sealed by
Lester Barnes, NCPE, with Alfred Benesch & Company. for the wastewater collection system extension consisting of
approximately 729.41 feet of 8-inch sanitary sewer with 5 manhole and other appurtenances to serve Novant Health Mint Hill
Medical Center located on Albemarle Road in Charlotte NC, with a wastewater dischar:re of 14000 GPD.
What is the quantity of flow that will be discharged? 14000 GPD
Flow type:
❑ Domestic
% ❑ Commercial 100 % ❑ Industrial
Section I - List the Jurisdiction's pump stations located between the project connection point and the WSACC
Interceptor connection point.
Pump Station
(Name or Number)
Firm Capacity *
MGD
(A)
Design Average Daily Flow "*
(Firm/pi)
MGD
(B)
Approx. Current
Average Daily Flow
MGD
(C)
Obligated, Not Yet
Tributary Davy now
MGD
(D)=(B)
Total Current Flow
Plus Obligated Flow
MGD
(E)=(A-D)
Available
Capacityooe
MGD
* The Firm Capacity of any pump simian is defined as the maximum pumped now thit can be achieved with be Largest pump taken out of service.
*"Design Average Daily Flow is the firm capacity of the pump Station divided by a peaking factor not has than 2.5.
*""A Planning Assessment Addendum shall be attached for each pump atallon located between the project connection point and the WWTP where Available Capacity is <0.
Section II. (Jurisdiction's Certification Statement:
I, CCt.I I tit;lip?%%rtify that, to the best of my knowledge, the addition of the volume of wastewater to be permitted in this
project has been evaluated along the route to the receiving WSACC interceptor; and the flow from this project is not
anticipated to cause any capacity related sanitary sewer overflows or overburden on any downstream pump station in route to
the receiving WSACC interceptor 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 th best available data. This certification applies to those items listed above in Section I plus all attached
planning assess t addendums for which, to the best of my knowledge, will not adversely affect the downstream sewer
capacity. Si r of thi form indicates acceptance of this wastewater flow.
\J D72h6
Jurisdictio S gningtOfficial Signature ate
Revision Date; 08/09/13

Sanitar-
Request
N a antHeahh Min
Charlotte. NI, a mt Tracking 'wither 2#!66.75

Division o liiVa er Resources
C CSC,
• #20166 5j
Name of was(
'Wastewater Treatment Facility
d% ["reek Wastewater Treatment 1Facility !' rs.rrtt i'S 81621
State t,t No t 'aro ina
eparttrtent t,t' Ern irontttdrtttt and Natural Resources
Ifis`isitln „f tN ater Resource:
#cd eptattrw:e f,,r'c crExtension Permit applications
dl :1SF, I,1!_ 14)
I)
t Health -,
-
dicai Center (Charlotte
36269
Section tl Ci. Pump stations tdo
W'48dR�t..F Pb4s€KG49t� rsst. apd',n�.nxti -�, �;.d3
m`sraq. t��=as�ri�a: NItt)
€ pp
`n "`i t„"h ro tdl ttl 1, ..} ",,0)0
Fwa+w iuc'a dit' ��_taxteda arsxta+ta a via^vtaa9 ::� thepan�
idea :6.'�c'a ,1^ G#aaiFw ,^W« �'� the darzn Miwnrcaiv jai �Wz i+atreta
'tannin -1/4J4k rolum .h:ull dry Attach a for cAvh pump stattican Itr<rvakd be04vei
he ,lurisdiction's ctt nnocttrrrl l utrl
last NI( al
ittt kt 4
taken out
SC'l`t1a"r1'
hiec
and the tl
tti4 tl fa €'kii iiPt\ ;tti•vt1stre,'UTi r
e the imple eTittii d4 l'i ?t tl (lt & n @1nprtA4 1Y' entii iile'nu t 1 6r Ih t dimint" a,ssessine°rxt k'e t
tin,' .5. has been nert�urtne t iii uia ci i t<sri e kk rth local otahll hart rafts dt°ti ,ind procedure's using t
This
Acidendurils for baltieh. to the hesi or in
lent:
interceptor to the rec iG inu i,'bwl;riF`wAer
a ut tt11 form indle lte's accephincr ,ai th
ki'tr?wledL

M
M

Go
'» earth feet 10
3
meters

Corporations Division
Page 1 of 1
North Carolina
Elaine E marshal! iDEPARTM ENT OF THE
Secretary SE CRETARY of STATE
PO Bag. 2022 Raleigh, NO 2743264 : 9j0C17.2000
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Account
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View Document Filings
Corporate Names
Legal:
Prev Legal:
Novant Health, Inc.
Presbyterian Health Services Corp.
Non -Profit Corporation Information
Sosld:
Status:
Annual Report Status:
Citizenship:
Date Formed:
State of Incorporation:
Registered Agent:
Corporate Addresses
0116543
Current -Active
Not Applicable
Domestic
4/1/1983
NC
Brunstetter, Peter S
Mailing:
Principal Office:
Reg Office:
Reg Mailing:
200 Hawthorne Lane
Charlotte, NC 28204 •
2085 Frontis Plaza Boulevard
Winston Salem, NC 27103
2085 Frontis Plaza Boulevard
Winston Salem, NC 27103
2085 Frontis Plaza Boulevard
Winston Salem, NC 27103
https://www.sosnc.gov/Search/profcorp/4931559
8/17/2016

benesch
Transmittal Form
To:
Mr. Barry Love - NCDENR
Mooresville Regional Office
610 East Center Ave. Suite 301
Mooresville, NC 28115
RECEIVEDIN
,V i0
MOORE SVII•. L REGIONAL IOP A Orric
Alfred Ben ^sch & Company
^1 yAJNeP f � r twad StfQet
04.521.9 380
w 704521 .8955
7)4
Date: 08-15-16 1 ,Gob No 17.000077
Subject: Novant Health Mint Hill Medical Center -
Hospital
Mail -' Messenger
WE ARE SENDING YOU:
COPIES
DATE
2 08/15/16
1
n/a
n/a
7/22/16
08/15/16
Next Day Delivery Z UPS Ground
Attached
DESCRIPTION
fl
-Track Application (FTA-08-13)
Application Fee - Check No. 22
USGS Topo Site Map
Construction Drawings — Utility Plans (Sheets C 413t3 to C-404)
98
Under separate cover:
4
0.00)
C Other:
Flow Acceptance Letter
THESE ARE TRANSMITTED as checked below:
Z For approval Approved as submitted
L., For your use Approved as noted
[] As requested Returned for corrections
For review and comment
Resubmit copies for approval
Submit copies for distribution
Return corrected prints
r Rem
. g p
arks: Barry,
Novant Health will be constructin a Hospital Buildingwith a private sewer line to serve. The
approximate length of sewer to be installed is 730 LF of 8" PVC.
Please let us know if you need anything else.
cc: Phillip Hobbs / File
Signature: David Gusty, El
PS01-0998-06form

Central Files: APS _ SWP _
8/25/2016
Permit Number WQ0038679 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
barry.love
Coastal SWRule
Permitted Flow
14,000
Facility
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Facility Name
Novant Health Mint Hill Medical Center
Location Address
Owner
Major/Minor Region
Minor Mooresville
County
Mecklenburg
Facility Contact Affiliation
Owner Name Owner Type
Novant Health Inc Non-Govemment
Owner Affiliation
Laura Macfadden
Dates/Events
3600 Country Club Rd
Winston Salem
NC 27104
Orig Issue
8/25/2016
Scheduled
App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
8/16/2016 8/25/2016 8125/2016
Regulated Activities Requested !Received Events
Concessions
Hospital
Office
Wastewater collection
Outfall
Additional information requested
Additional information received
Waterbody Name Streamlndex Number Current Class Subbasin