WQ0038728_Regional Office Historical File Pre 2018

PAT MCCRORY
D N°ALD R. VAN DER VAART"
.ce-crefary
S. JAY ZIMMERMAN
Water Resources
ENVIRONMENTAL QUALITY
September 19, 2016
Suzanne Pugh, President & CEO
Ai'dersgate United Methodist Retirement Community, Inc.
3800 Shamrock Drive
Charlotte, NC 28215
Subject: Permit No, WQ0038728
Aldersgate United Methodist Retirement
Community, Inc.
Independent Living Apartments - Aldersgate
United Methodist Retirement Community
Wastewater Collection System Extension Permit
Mecklenburg County
Dear Ms. Pugh:
In accordance with your application received September 12, 2016, we are forwarding herewith Permit No.
WQ0038728 dated September 19, 2016, to Aldersgate United Methodist Retirement Community, 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 This permit shall be effective from the date of issuance until rescinded and shall be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 additiiional 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 1508 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 I Water Quality Regional Operations
Mooresville Regional Office' 610 East Center Avenue, Suite 301 I Mooresville, North Carolina 28115
704 663 1699

If you need additional information concerning this matter, please contact. Barry Love at
or via e-mail at [e-mail].
Sincerely,
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
cc: Steven S. Wilson, P.E. (e-copy)
Barbara Gross (e-copy)
Tommy Rowland (e-copy)
Regional Office Files
Water Resources Central Files
PERCS (e-copy)
2
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 -
Aldersgate United Methodist Retirement Community, Inc.
Mecklenburg County
for the construction and operation of approximately 0 linear feet of gravity sewer (only laterals from three
buildings to existing 8-inch sewer) to serve 62 apartment units as part of the Independent Living
Apartments - Aldersgate United Methodist Retirement Community project, and the discharge of 8370
gallons per day of collected domestic wastewater into the Charlotte Water existing sewerage system,
pursuant to the application received September 12, 2016, 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 considered a part 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..
by W. Corey Ba inger, Regiona Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of•Water Resources, NCDEQ
Permit Number: WQ0038728
Permit Issued: September 19, 2016
Page 3 of 8

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Aldersgate United Methodist Retirement Community, Inc. is hereby authorized
Construct, and then operate upon certification the aforementioned wastewater collection extension. The
sewage and wastewater collected by this system shall be treated in the Charlotte Water Sugar Creek
Wastewater Treatment Plant in accordance with Permit Number NCO024937.
Permitting of this project does not constitute an acceptance of any part of the projectthatdoesnntmeat
15A N[ACZT; the Dk/ishor/u Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as
applicable; and the Division's Minimum Des,ign Criteria for the Fast -Track Permitting of Pump Stations and
Force Mains adopted June 1, 2QQO,asapplicable, unless specifically mentioned herein. Division approval
is based on acceptance of the certification provided by a North Carolina -licensed Professional Engineer in
the application. It shall be the Permittee's responsibility to ensure that the as -constructed projectrneets
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. No flow in excess of the quantity permitted herein, 8,37OGPDshall be made tributary to the subject
sewer system until an application for permit modification for an increase in flow has been submitted
1pand approved bVthe Division. |lS4M[A[QZT.U]O4(b)l
2. This permit shall become voidable unless the agreement between Aldersgmte United Methodist
Retirement Community, Inc. and Charlotte Water for the collection and final treatment of wastewater
is in full force and effect. (15A NCAC 02T.0304(h)]
11. STANDARD CONDITIONS
1. This pmrrob 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 asmay beappropriate. The approval mfthis request shall beconsidered onits
merits and may o,may not beapproved, [l5ANCACOIT.O1O4;G.S14]-215.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 IT; 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 materials unless specifically mentioned herein. [15A NCAC 02T.0110]
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
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: [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.
. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e. 365
days per year). Pump stations that are connected to a telemetry system shall be inspected at
least once per week.
e. High -priority sewer lines shall be inspected at least once per every six -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 to the appropriate Division regional office in accordance
with 15A NCAC 28 .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 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.
J•
Documentation shall be kept for Subparagraphs (a) through (i) of this Rule fora 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 rendersthe 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 (919) 733-33€ 0.
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))
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 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:
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 $

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. 115A 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 S
PERMW0TEE:
PERMIT #:
PROJECT,
ISSUE DATE:
ENGINEERING CERTIFICATION
AldersgaUeUnited Methodist Retirement Community, Inc.
Independent Living Apartment Alders0ateUnited Methodist Retirement Community
September 19,2O16
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 besubmitted inamanner 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 Permbtee to
appropriate enforcement actions. The Permni\tee is responsible for tracking all partial certifications up
until afinal certification isreceived. AFinal Certification shall beacomplete set nyrecord drawings and
design calculations regardless of whether partials have been submitted,
PERw|T7EE'S CERTIFICATION
Lthe undersigned agent for thoPermittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information tothe Permittee,and the Permhteeisprepared to operate &maimtain
the wastewater collection system permitted herein or portions thereof,
Printed Name, Title
Signature Date
ENGINEER'S CERTIFICATION
i _ _1 ,asaduly |mthe State ofNorth Carolina,
having been authorized to observe ( | periodically, | | weekly, | | 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 O%T; 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 1,2OOO,asapplicable; and other supporting materials.
North Carolina Professional Engineer's Sea|w/signature &date:
Pimm| /_F� /PartiaA description)
Certification if necessary):
State mrm°rtb c=.lbi°|Environmental Quality | Water o°so°=es|Water qua�ky R°gi,=ucm°rauati,
Mooresville Regi=maoflice|moFast Center a.emie,Suite m1|Mnor=rote,North cmmlioauxu5

State of North Carolina
nt of Environmental Quailt
Division of Water Resources
15, NCAC 02T .0300 -- FAST TRA. 7.K. SEWER SYSTEM EXTENSION 1.PPL ICA"ilON
Ds ETA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
All items must be completed or the application will be returned
APPLICANT INFORMATION:
i.Applicant's name: t'�Idersgate United Methodist Retirement C:'omniunit
(to he completed h' D\1 F-
pany„ municipality, NC)A� utility, ete.j
Applicant type: lrrtdividual Corporation 0 General Partners Ftil Privately-U vned PuF lic utility
MEDI
0federal ElState/county 0 Municipal Other
Signature attthori 's :narne: 'Simone Pugh, per 15A 'N(' AC' 02T .O10(i h ` -'
'Fide: President CL()
4, Applicant's mailing address: 380(1 Shamrock Drive
City: Charlotte State: NC Zip: 28,715-
Applicant's contact information:
Phone number: [phone] Email Address. suzarine alders tigcct
PROJECT INFORMATION:
1, Project name: independent Living Apartments _ A1dersgate C Inited M hodis't Retirement Community, Inc
?. Application/Project status: Proposed (ltiew Permit) Existing Permit/Project
If a modification, provide the existing permit number: AWOO and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Mecklenburg
4. Approximate Coordinates (Decimal l egrees): Latitude: 35 2314' Longitude:-80.7677
5. Parcel ID (if applicable): 10102101
(or Parcel 11) to closest downstream sewer)
ILL CONSUL'1ANT INFORMATION:
1, Professional Engineer: Steven 5 Wilson. L ieensc Number: 15497
lwirm: Landworks Design Grortp
Mailing address: 7621 Little Avenue
City: (:,'h,arlotte State: NC. Zip: 28226
Phone number: (704) 841 16051 Email Address swil ottcilapdtverrkspa.com
WAS`I`'EWA"h'F'.R TREATMENT T FACILITY :I`t Y (%VWTF) INFORMATION
1, Facility Name: Su'^ tr Creek 1\ \k' 1"bP Permit Number; N(002m49937
Owner Nance: Charlotte Water
R.ECEIVING 1)O\ NSTRIEA.M SEWER INF`ORMr TION (if different than WWTF):
1. Permit'Number(s): W(1600 14 ?4 L)t wrrstretiam (Receiving) Sewer Size: 12 inch
System Wide Collection System Permit Number O (il"applicable): 1(CS
Owner Name(s): Charlotte Water
FORM: ETA 04-16

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Pubi
y, has a Certificate of Public Conveni
❑ Yes ❑No N/A
If the Applicant is a Developer of lots to be sold, has a Developer's Operational
Applicant is a. HomelPro_perbtc,
4. Origin ofwa5
(check a
hat apply):
❑ Residential Owned
Residential Leased
❑ School/ preschool / day care
❑ Food and drink facilities
0 Businesses / offices / factories
en
❑ Yes ❑No ll;N/A
ciation, has an Operational^regiment (CORM: H.
Ej Yes ❑No ItN//A
❑ Retail (stores, centers, malls)
❑ Retail with food preparation,/service
LI Medical .II dental veterinary facilities
Church
Nursing Home
Nature of wastewater : 100 (1/0 Domestic/Commercial
% Industrial (See l5A NCAC
L--GIs there a Pretreatment Pr
6. Has a flow reduction been approved under 1.5A NCAC 02T .01 1 4
If yes., provide a copy of flow reduction approval letter
7, Summarize wastewater generated by project:
stablirshrnent Type (see 02T.0114(tl)
in effi
? ❑Yes
ly Design Flow
d?
been attached?
ED Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
Yes ] No
No
No. o
Aparments
gaiiunit/day
62
7
gal/
gal/
gal
gal/
gal/
GPI)
GPD
GPD
GPD
GPD
Total
8370 GPD
a See I SA NCAC 02"I" .01 I41b) (d). (,e)LI 1 and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals a.s defined
in G,$. 42A-4).
b Per 15A NCAC 02T .01.14(c), designflow rates for est'ablishm.ents not identified [in table 15A NCAC 02T.01 1 4] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data,
Wastewater generated by project: 3370 GPD (per 15A NCAC. C02T A114)
Y Do not include future flows or previously permitted allocations
If permitted Tow is zero, indicate why:
13 Pump Station or Gravity Sewer where flow will be pert
d in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
© Other (Expiai
FORM: FTA 04-16
Page 2 of 5

GRAVE
Summarize
EWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC it;
o be perm
Length (feet)
ion 1l & 111 ofthe 1DC"'for Permitting cafGravity Sewers contains inform atirtn related tea design alter
Section 111 contains information rehated to rninimatraa slopes
Oversizirtg lines to meet minimum slope require tnettt is toot allowed and a violation of the MDC.
PUMP STATION DESIGN CRITERIA (If Applica
027E .0305 & MDC (Pump Sta.tions/For
COMPLETE FOR EACH PUMP ST/V:10N INCL UD.E1 IN THIS PROJECT
1, Pump station rttrtnber e>r rta
2, Approximate Coordinates (Decimal Degrees): Latitude: Longitude: --_
Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at
5, Summarize the force ma
be permitted (for this Pump Station
l dynamic head (TDH)
6. Power reliability in accordance with 15 1NCA,C i02T 0305_ h)(I ?:
Standby power source or pump with automatic activation and telemetry - 15A. NCr\.0 02`r ,0305(h)(1)(E1)m
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Must be permanent to facility
ter if the pump station has an average daily flow less than l 5,000 gallon
�] Portable power source with manual activation, quick -connection rece
_0:305(h)(1)(C)
or
Portable pumping
d telemetry - 15A NCC 02'f
° pump connection a.tad telemetry 15A NCAC (12`➢° .0305U)
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agrecment)
and is compatible with the station,
If the portable power source or pump is dedicated to multiple pump stations, an evaluation ofall the pump stations storage
capacities and the rotation schedule of the portable power source or pump, ineluding travel titnetra.mes, shall be pro led
in the case of a multiple station power outage.
FORM: FTA. 04- 16 Page .1 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 021 .0305(0):
I. Does the project comply with all separations found in 15A NCAC 02! ,0305(0 & (g„)
• 15A NCAC 02T.0305(t) contains minimum separations that shall be 1)vided for sewe s
Setback Parameter*
Storm sewers and other utilities not listed below (vertical)
Water mains 'cal -water over sewer including in benched trenches)
Vater s hor„ontal)
Reclaimed vat e r lines (vertical reclaimed over sewer)
fainted water lines (horizontal - reclaimed over sewer)
**Any private or public water supply source, including any wells, WS-1 waters of Class 1 or
lass II impounded reservoirs used as a source of drinking water
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW,I-ION.V, or SB from normal
high water Or tide elevation) and wetlands (see item IX.2)
**Any other stream, lake, impoundment, or ground water lowering and. surface drainage
ditches
An buildim, foundation
Any basement
Top sLape of e
ikrinet
ts ot 2 feet
Drainage systems and interceptor drains
swiraming_pools
Final earthrgrade (vertical)
"cal height
M. Yes EP
Se mration Required
24 inches,
18 inches
10 feet
18 inches
2 feet
-100 fee
50 feet
'eet
5 feet
10 feet
(0 feet
5 feet
1.0 feet
36 inches
.15A NCAC.02T,0305(g) contains alternatives where separations in 02T.0305(1) cannot be achieved.
classifications. can be identified using the Division's NC Surface Water Classifications webpage
lf noncompliance with 02T,03051florIgl, see Section X of this application
2, Does the project comply withseparation requirements for wetlands? (50 feet of separation) M Yes
7:" See the Division's draft separation requirements for situations where separation cannot he meet
No variance is required if the alternative design criteria specified is utilized in design and construction
• As built documents should reference the location of areas effected
3. Does the project comply with ail setbacks found in the river basin rules per 15A NCAC
=- This vo u d include 'From Buffered Streams per 15A NCAC, 21.t0:292
'?
No
4. Does the, project comply with an individual 404 Permit or any 401 Certifications? Yes No
Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands Or surface waters
• Information can be obtained from the 401 & Buffer Permitting Branch
5, Does project comply with 15A NCAC 02T.01.05(c)(6) (additional permits/certifications)? NI 'Yes fl No
Per 15A NCAC 021-,0105(e)(61, directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained, Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stonnwater management plans, etc.),
.Does this project include any sewer collection lines that are deemed "high -priority'?"
'Per 15.A 'NC:AC.: 021,040.2, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters„ siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer,
LIJYcs No
If yes, include an attachmentwith details for each line, including type ( aerial line, size, matei tri and location
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per ISA NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
1ORM: 1r A 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. [)oes the submitted system comply with 15A ,NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force jjistalestv rsion , and the Gravity Sewer Minimum„Design Criteria (latest as applicable?
Z Yes No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supportint documents,
Professional Engineer's Certification:
is Steven. S Wilson, PE
(Professional Engineer's name from Application Hem 111.1.)
attest .his application for
has been reviewed by me and is accurate, complete and c..onsistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge, I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design,
NOTE In accordance with General Statutes 143-215,6A and 143-215.6B, 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 S10,000, as well as civil penalties up to $25,000 per violation,
North Carolina Professional Engineer's seal, signature, and date:
3, Applicant's Certification per I.5A NCAC 021 .01060):
i, Suzanne Pugh, President & CEO attest that this application
(Signature Authority's name & title from Application Item.1
has been reviewed by me and is accurate and complete to the hest of my knoledge 1 understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of w.astewater from this non -
discharge system to surface: waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. 1 will make no claim against the Division of Water Resources should a condition
of this permit be violated, 1 also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included. this application package will be returned to me as
incomplete,
NOTE In accordance with General Statutes 143-215,6A and 143-2 5.6B, any person who knowingly makes any false
statement, representation, or certification in any 'application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $1.0.000 as well as civil penalties up to $25.000 per violation,
Signature:
Date:1
FORM: 1TA 04-16 Page 5 of 5

,
Aldersgate United Methodist Retirement Community - Independent Living Apartments - Area Map
NOTES t Data available from U 5 Geological Survey, National Geospalial Program,
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Open in The National Map Viewer
I
8/11/16 4:25 PM

Independent Living Apartments Alders ate United Methodist Retirement Community
Site Map
NOTES: Data available from U,S, Geological Survey, National Geospatial Program.
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Open on The National Map Viewer
8/12116 10:16 AM

Aldersgate United Methodist. Retire
nt Community —Street Level
pr.

CHARLOTTE
WLTER
August 9, 2016
Mr. Steve Wilson
Landworks Design Group
7621 Little Av
Suite 111
Charlotte, NC 28226
SUBJECT: WATER AND SANITARY SEWER FLOW ACCEPTANCE
ALDERSGATE RETIREMENT COMMUNITY — INDEPENDENT
3800 SHAMROCK DRIVE, CHARLOTTE NC
CLTWATER TRACKING# 2016804
WORM
REC
VING APARTMENTS
A flow acceptance study of the subject site has been completed and the following has been determined:
This review has been set to conditional due to capacity concerns at Permanent Flow Monitoring Sites 24
& 25. These capacity concerns should be addressed with the completion of the Briar Creek Relief Sewer
project. All other associated sanitary sewer infrastructure was found to have sufficient capacity to
accommodate the proposed sewer flow of 8,370 gallons per day (62 apartment units x 135 gpd/unit) from
this project for transmission to the Sugar Creek Wastewater Treatment Plant, NPDES permit number
NC0024937, for treatment. This acceptance of flow is based on the existing capacity of the designated
publicly owned treatments works. Please see attached NC DEQ flow tracking form,
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 lD # 0160010 on file with the Public Water Supply Section of NC DENR. 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 sewers stem is acce ted 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) have not been received
within (1) year of issuance of this flow acceptance, this flow acceptance approval shall be rescinded and
a new flow acre tance re nest must be made. If you have any questions, please do not hesitate to
contact me at [phone], or Alan Gaines (704)-391-4689.
Sincerely,
Barbara Gross
Engineering Assistant
Charlotte y aaer 1i7 Brookshire Blvd, Charlotte, NC 28216 charlcat:tev ater°.org
Operated by the City of Charlotte

State of North Caro lina
tiiwllinent of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Landworks Desirgn croup
Project Name for which flow is being requested: Aideregat:e Retirement Community - Independent Living
r, cmexa�
More than one FTSE may be required for ti single project i tgreaowner of'the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: McAlpine Creek, Irwin Creek, Sugar Creek
b. WWTP Facility Permit #: Nc0024970, NCoo24945, t CCQ24937
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
All flaws are in 1 CGD
99.0
.038
71.263
0.0084
82.309
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (13) (G) (D)=(B+C) (E) A-D)
Design Obligated,
Pump Average Daily Approx.. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm 1 pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
* The Firm Capacity of any pump station is defined as the maximu
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pf) not less than 2.5.
*** A Planning Assessment .Addendumshall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < O.
pumped flow that
Downstream Facility Name (Sewer): 15-inch Sanitary Sewer Replacement
Downstream Permit Number: Y+ G0ta0280
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Carl Wilson certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer overflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation
of the planned improvements identified in the planning assessment where applicable. This
analysis has been performed in accordance with local established policies and procedures using
the best available data. This certification applies to those items listed above in Sections I and II
plus all attached planning assessment addendums for which I am the responsible party.
Signature of thrm indicates acceptance of this wastewater flow.
Signing Of
et6itA.'
.Signature
Page 2of6
6 aiDffilfr
Date
FTSE 04-16

Lanz forks Design Group, P.A.
1621 little Avenue, Suite 111
Charlotte, NC 28226
Memorandum
Date September 12, 2016
To: NCDEQ — Mooresville Regional Office
610 E. Center Ave,
Mooresville, NC 28115
From: Landworks Design Group. PA
Steven S. Wilson, PE
Telephone: [phone]
Facsimile: 104-841-1604
Project: Independent Living Apartments — Aldersgate United Methodist Retirement Community, Inc
Job#: 14040—IL
Re: Independent Living Apartments Private Sanitary Sewer
On behalf of Aldersgate United Methodist Retirement Community, Inc, we are submitting Fast -Track
Application (FTA) for gravity sewers for the construction of "Independent Living Apartments" private
sanitary sewer and related appurtenances.
(2) Copies of completed application FTA, Project Narrative, Flow Acceptance letter and form
FTSE, and Site Maps. Appropriate forms have been signed by the proper representatives.
(1) Review Fee
We look forward
any questions or
your favorable review and approval of the proposed construction. Should you have
we may aid in your review, please feel free to contact me at 704,841.1604.
Regards,
Landworks Design Group, PA,
Steven S. Wilson, PE
P:12014 Jobs414040 - Aldersgate Expansion COslPermit SubmittalsVLlLJtility 1L1Private4Sanitary Sewert1_ 14©4© lL - NCDEQ Private Sewer
Submittal Menlo. docx

Landworks Design Group, P.A.
7621 Little Avenue, Suite 111
Charlotte, NC 28226
Project Narrative
Date: September 12, 2016
To: NCDEQ
From: Landworks Design Group, PA
Steven S. Wilson, PE
Telephone: 704-41'104
Facsimile: 704841-1604
Project: Independent Living Apartments — Aldersgate United 14 Methodist Retirement Community, Inc
Job #: 14040 - lL
Re: Independent Living Apartments Private Sanitary S
e
Narrative
The proposed Independent Living Apartments is a planned development serving 62 apartments units.
This project will consist of no proposed sewer, all 3 proposed building will lateral into the existing
private 8" gravity sewer system located on parcel 10102101.
The estimated sewage flow from this project is 8370 gpd based on the following calculations: 62 units x
135 god/unit = 8370 gallons per day.
Regards
LandworksDesign Group, P.A.
Steven S. Wilson, PE
P:12O14 Jobs114t740 - Aldersgate Expansion COslPerrnit Subrnfttafs/LlUtffity ILlPrivate4Sanitary Seweri2 14040 IL - DWQ - Fast Track
Narrative:.docx

Central Files: APS SWP _
9/1 g/2016
Permit Number WQ0038728 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
8,370
Facility
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
Facility Name
Independent Living Apartments - Aldersgate United Methodist Retirement Community
Location Address
Owner
Major/Minor Region
Minor Mooresville
County
Mecklenburg
Facility Contact Affiliation
Owner Name
Aldersgate United Methodist Retirement Community Inc
Dates/Events
Owner Type
Non-Govemment
Owner Affiliation
Suzanne Pugh
& CEO President
3800 Shamrock Dr
Charlotte
NC 28215
Orig Issue
9/19/2016
App Received Draft initiated
9/12/2016
Scheduled
Issuance Public Notice Issue Effective Expiration
9/19/2016 9/19/2016
Regulated Activities Requested /Received Events
Apartment complex
Wastewater collection
O utfal I
Additional information requested
Additional information received
Waterbody Name Streamindex Number Current Class Subbasin

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: Aldersgate United Methodist Retirement Community, Inc,
PERMIT #: WQ0038728
PROJECT: Independent Living Apartments - Aldersgate United Methodist R
ISSUE DATE: September 19, 2016
R Flo c"). N OFT R,„7:E
eme
Community
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 Permittee to
appropriate enforcement actions, The Permittee is responsible for tracking all partial certifications up
until a final certification is received, A Final Certification shall be a complete set of record drawings and
design calculations regardless of whether partials have been submitted°
PERMFrTEES CERTIFICATION
I, the undersigned agent for the Perrnittee, hereby state that this project has been constructed pursuant
to the applicabie 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 he,ein or portions thf,
Suzanne Pugh, President & CEO
Printed Name, Title
gnatu e
ENGINEER'S CERTIFICATION
Date
1, Steven S. Wilson , as a dul registered Professional En neer in the State of North Carolina,
having been authorized to observe l periodically, Li weekly, full time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the best of
rny 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 Ca olina Professional Engineer's Seal w/signature & date:
F
Partial (include description)
Certifkation Cornments/Qualifiers (attach if necessary):
Slate of Noah Caroline Enviroomontal Quality 1 Water Reiunrc.es Watar Quality Roszoital Opc.ratiors
Moottamtle Rogional Med 6(0 East Coot*. Avonite, Suite 301 1 Ntoopos,ilta, North. Carolina 28111
'704 663 1699

arid arks Design Group, P.A.
7621 Littte Avenue, Suite 111
Charlotte, NC 28226
July 2 , 2019
Barry Love
NCDENR Division of Water Quality
610 E. Center Avenue
Suite 301
Mooresville, NC 28115
Aldersgate United Methodist Retirerrte t Com
Mecklenburg County, NC
andworks Project No, 1440
Permit No, WQ0038728
Final As —Built Certification
Dear Mr. Love:
u
Tel: [phone]
Fax [phone]
independent Living Apartments
Please find enclosed the Engineer's Certification and one set of as -built drawings for the subject project. "h
certification covers the private sewer within the boundaries of this project. Please do not hesitate to contact me
you have any further questions or concerns:
Sincerely,,
Landworks e
grt Group, P.A.
Steven S.Wilson P.E.
4040Alders ato xpwnsiora Ds 4s-bui kSowe n€ofn ers r€a c, ttean Cover Leti