WQ0038799_Regional Office Historical File Pre 2018

Water Resources
ENVIRONMENTAL QUALITY
October 12, 2016
Max Baumgartner, Chief Operating Officer
Forest Hill Church
7224 Park Road
Charlotte, NC 28210
PAT MCCRORY
GO ern'or
DDONALD R. VAN DER VAART
i craor
S. JAY ZIMMERMAN
Lb! lector
Subject: Permit No. WQ0038799
Forest Hill Church
Forest Hill Church - South Blvd, Campus
Wastewater Collection System Extension Permit
Mecklenburg County
Dear Mr. Baumgartner:
In accordance with your application received October 10, 2016, we are forwarding herewith Permit No.
WQ0038799 dated October 12, 2016, to Forest Hill Church (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from the date of issuance until rescinded and shall be subject to the conditions and limitations as specified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 IL4:
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 1 Envisxrnruental Quality I Water Resources 1 Water Quality Regional Operations
Mooresville Regional ©ffiael 610 East Center Avenue, Suite 301 l Mooresville, North Carolina 281.15
704 663 1699

if you need additional information concerning this matter, please contact Barry Love at [phone]
or via e-mail at barry.love@ncdenr%gov.
Sincerely,
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
cc: Jeffery C. Orsborn, P.E. (e-copy)
Barbara Gross (e-copy)
Tommy Rowland (e-copy)
Regional Office Files
Water Resources Central Files
PERCS (e-copy)
Page 2 of 8

Environnienta1
Quality
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143,IGeneral Statutes of North Carolina. as
amended, and other applicable Laws -,.Rules, and Regulations, permission is hereby granted to -
Forest Hill Church
Mecklenburg County
for the construction and operation of approximately 493 linear feet of 8-inch gravity sewer to serve the
Forest Hill Church - South Blvd. Campus project, and the discharge of 2,170 gallons per day of collected
domestic wastewater into the Charlotte Water existing sewerage system, pursuant to _the application
received October 10, 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 datasubsequently 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.
byW. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
1 Permit Number: WQ0038799
Permit Issued: October 12, 2016
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
Forest Hill Church is hereby authorized to:
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 McAlpine Creek
Wastewater Treatment Plant in accordance with Permit Number NC0024970.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
1,5A NCAC 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 Mains adopted June 1, 2000,.as applicable, unless specifically mentioned herein. Division approval
is based on acceptance of the certification provided by a North. Carolina -licensed Professional Engineer in
the application. It shall be the Permittee's responsibility to ensure that the as -constructed project meets
the appropriate design criteria and rules.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
SPECIAL CONDITIONS
No flow in excess of the quantity permitted herein, 2,170 GPD shall be made tributary to the subject
sewer system until an application for permit modification for an increase in flow has been submitted
to and approved by the Division. 115A NCAC 02T.0304(b)]
2. This permit shall become voidable unless the agreement between Forest Hill Church and Charlotte
Water for the collection and final treatment of wastewater is in full force and effect. [15A NCAC
02T.0304(h)]
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. [15A NCAC 02T.0104; G.S 1.43-215.1(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 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 .0110)
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
Page 4 of 8

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 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 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 more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
1. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
J•
Documentation shall be keptfor 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 toknown orunknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage orbreakage, etc.; or
b. Any SSOand/or spill over 1,O0]gallons; or
m. Any S5Oand/or spill, regardless nfvolume, 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/8O8\ 858-0368 or [phone].
Persons reporting any ofthe above occurrences shall file aspill report bYcompleting and submitting
Part | of Form [S'5SQ (or the most current Division approved form) within five days following first
knowledge ofthe occurrence. This report must outline the actions taken o,proposed tmbetaken to
ensure that the problem does not recur. Part ||ofForm [S'SG{](orthemost current Division approved
form) can also be completed to show that the S5C) was beyond control. [G.5. 143'215.1[(a1)]
Construction of the gravity sewers, pump stations, and force mains d`a|| be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
tothe surface waters ofthe State, [I5ANC4[Q2T.01U8(b)l
7. Upon completion ofconstruction and prior tooperation ofthese permitted facilities, the completed
Engineering Certification form attached tothis permit shall be submitted with the required supporting
documents tothe address provided on the form. A complete certification is one where the form is
fully executed and the supporting documents are provided asapplicable. 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.
Ifthe permit Wmissued tma pf ivate entity with anOperational Agreement, then acopy mfthe 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.
Acomplete certification ioone where the form isfully 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) ofthe wastewater collection system extension. Final record drawings should beclear nm
the plans mron digital media (CD orDVD disk) and are defined asthe 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 rnwio, 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
Page 6 of 8

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 notethat 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. 115A 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 ENGINEERIN
PERMNTEE;
PERkND[#;
PROJECT:
ISSUE DATE:
CERTIFICATION
Forest Hill Church
WO0038799
Forest Hill Church - South Blvd. Campus
October 1Z,201G
°
This project shall not be considered complete nor allowed to operate in accordance with Condition 7of
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 wastewate�rflow made tributary to the wastewater collection system extension prior to completion
ofthis Certification shall be considered a violation of the permit and shall subject the Permitteetn
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 nfrecord drawings and
design calculations regardless of whether partials have been submitted.
PEnmirTEE'S CERTIFICATION
|, the undersigned agemtfnrthePennhtee,herebvstatethatthisprnjecthasbeemcPnstroc1edpuounnt
tothe 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 orportions thereof.
Printed Name, Title
Signature Date
ENGINEER'S CERTIFICATION
L as duly rE!giste/ed Professional rint�������mU�
having been authorized to observe M—] periodically,} y, weekly,
eeWy �l full time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the bestof
my abilities, due cape and diligence was used in the observation of the construction such that the
construction was observed tn be built within substantial compliance nfthis perrnit;.l5A N[A[02T, the
Division of Water Resources" (Division) Gravity Sewer Minimum Design Criteria adopted February 12,
1996,asapplicable; the Division's Minimum Design Criteria for the Fast -Track Permitting ofPump Stations
and Force Mains adopted June 1, 2000, as applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/xignatureO^date:
R Final F] Partial (include description)
Certification Comments/Qualifiers. (attach if
State mxNorth Carolina |lin,ir*omevtalQuality |Wuternesmum|Water Quality m�-.ionalOperations
Mooresville Regional Officel 610 East Center Averum, Stiite 3011 Mooresville, North Carolina 28115
rm663«wv

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .(r. 0 FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Applicati iber:
(to be compi et c'd by 1.)111Z)
All items must beeo.mpleted or the application will be returned
I. APPLICANT INFORMATION.
1, Applicant's name: Forest Hill Churchty.mumcipah1. HOA, utility, etc.)
2. Applicant type: El Individual fl Corporation
0 Federal Ej state/county
Lil General Partnership E'PeiVately-OWned Public IT
LJ Municipal El Other
3. Signature authority's name: Max Baumgartner per 15A NCAC 02T .0106(b)
Title: Chief °Denning Officer (COO)
4. Applicant's mailing address: 7224 Park Road
Citv: Charlotte State: NC Zip: 2821°-
5, Applicart(s contact information:
Phone number: [phone] Email Address: Avabcrkelevitemail.com
II. PROJECT INFORMATION:
1, Project name: Forest Hill Church -South Blvd, Campus
2. Application/Project status: L Proposed (New Permit)
E. Existing Permit/Project
If a modification. provide the existing 'permit number: WOO° and issued date:
If new construction butlxirt, of a master plan. provide the existing permit number: WOO°
3, County where project is located: Mecklenburg
4, Approximate Coordinates (Decimal Degrees). .Lat nude. 35A 5541.3 Longitude: -80,878 08'
5.Parcel ID (if applicable): 16916101
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFO,RMATION:
1. Professional Engineer: Jeffery C Orsborn .Licmse Numbcr: 0.28786
Firm: Orsborn En ineerin Grou
Mailing address: 610 E, Morehead Street Suite 106
City: Charlotte State: NC Zip: 28202-
Phone number (704) 749-1.432 Email Address: `o sbo 'i,4,orsborn-e,
IV, WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1, Facilit-y Name: McAlpine Creek WW1? Permit 'Ntnber: NC0024970
°Wrier 'Name: Charlotte .Mecklenburg Utility Department (CMUD)
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
L Permit Number(s): WQ Unknown Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System .Permit Number(s) (if applicable): 'WOCS
Owner NalTIOS): Charlotte Mecklenburg Utility Department (CMUD)
FORM: FTA 04-16 Page 1 of 5

GENERAL GREQUIREMENTS
If the Applicant is a Privately -Owned Public Utility. has a Certificate of Public Convei knee uiid Necess : been attached?
E Yes ON° N/A
2, If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached
Eli Ycs DNo ENIA
the Applicant ts a Home/Propertv Qsncrsociati
4, Origin of Wastewater: .'check all that apply),
.Residential Owned
0 'Residential Leased
0 School / preschool .7 dav care
D Food and drink facilities
Businesses / offices / factories
Iraf
0 'Yes 0No EN/A
0 Retail (stores, centers, malls)
Li Retail with food preparationlservice
El Medical / dental veterinary 'facilities
El Church
JI Nursing HOLM
Nature of Wastewater 100 °A) Domestic/Commercial % Commercial
% industrial (cl5A_NCA(,,Ij)10320
-n attached?
0 Car Wash
D Hotel and/or Motels
0 Swimming Pool /Clubhouse
0 Swimming Pool/Filter Backwash
D. Other (E.xplain in Atta.chment)
Is there a .Pretreatmeni Progiam in effect'? Ej Yes 0 No
Has a flow reduction been approved under 15A NCAC 02T 01 l4jf LI Yes No
If yes, provide a copy of flow reduction approval letter
7. Summarize Wastewater generated by project:
Establishment Type (see 0217,0114(
Daily Design Flow
No. of Units
Flow
5 gal./seat
434
2170 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Tom/ 2170 GPD
See 15A NCAC 02T .0114(b)., (e)(1) and (0(2) for caveats to wastewater design flow rates (Le., 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 oldie Atlantic Intracoastal Waterway to be used as ication rentals
as defined in GS: 4.2.A-4).
b Per 15A. NCAC 02T .0114(c), design flow rates for establishments not identified lin. table j,ACO2T.0114J shall
be determined using available flaw data, water using fixtures, occupancy or operationpatterns, and othersilted data_
8. Wastewater generated by project: 2170 GPD (per 15A NCAC 02T .0114)
Do not include future flows or previously permitted allocations
LI-permitted flow is zero, indicate why,
0 Pump Station or Gravity Sewer where flow will be .pennitted in subsequent permits that connect to this line
0 Flow has al.rady been allocated in :Penni! Number
LI Rehabilitation or replacementof existing sewer with no new flow expected
Other (Explain):
FORM: FTA 04-16 Page 2 of 5

GRAVITY S.
1. Summarize gm
'ERDESIGN CRITERIA (tf Applicable) -
er to be permitted:
Section 11 & 11I of the MDC for Permitting of Gravity Sewers coma
Section Tat contains information related to minimum. slopes for gray
Os=ersizing lures to meet minimum slope requirement is not atkr
MDC (Gra
ormalion related to design criicria
d and a violation of the MDC
PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mai l):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrce.$): Latitude:
Design flow` of the pump station.: millions gallons per day (firm capa
4. Operational point(s) of the purnp(s): ,allon.s per minute at foe
5. Sunannarize the force main to be pernulled (for this Pump Station):
Power reliabilit y in accordance with .15A NCAC 02T .0305(1i)( )
El Standby power source or pump w ith automatic activation
Long
de: -
dynamic head (TDId
ISA NCAC (12T .03050a)(1)(B):
Required for all pump stations with an average daily flow greater Than or equal to 13,000 pitons per day,.
Must be permanent to facility
Or if the pump station has an average daily flow less than 15..000 gallons per dav:
(J Portable power source with manual aactivatican,. quick -connection receptacle and telemetry - 15A NCAC 02T
,03(15(1»(1)(C)
or
] Portable pumping
wed emerge' cy,° pump connection and telemetry - 15A NCAC 02T ,(]:1p5(h)(1)(C'):
It shall be demonstrated to the Division that the portable source is owned or cont acted by the applicant (draafft. agreement)
and is compatible with the station.
tf"ttac portable power source or pinup is dedicated to multiple pump stationspump stations'
storage capacities and the rotation schedule of the portable power source or puratp. includi,nl travet °tinneframtes, shall be
provided in the case of a multiple station power outage.
FORM: FTA 04-16
,t of 5

SETBACKS SP.PARATIO S-- ({t2B .020tt &. 15A NCAC 02T .0305(i')),
Does the project ecuattp1 w itlr all separations fotmd. in 1 S A NCAC 02T .03tt5(f) k g
t 5A NCAC (12T.tl305(f) cont,,atns rrunirnurn separaatiotns tlaart shall be pro ided for se��er
Setback. Parameter*
Recta
Reclaimed w
fisted below (vcrtica
r including in benched trenches)
ed over se
irtt.eel
® Yes LI No
Any; private or public water supply source_ including any wells, WS-I waters of Class I or
,lass 1i impounded resew,oirs used as a source of drinking water
Waters classified \VS (except WVS-1 or 1 S-V). B. SA. ORGV. HOW_ or Ski from uonnal
aigln rr°tiler (or tide elevation) and Wetlands (see item LX..2)
**Any other stream, lake, impoundment, (
ditches
Any buildin fouradatio
nd water lowering and surface dr
18 i.utch.es
e
10(1 feet
ec
Da
Fina
n
s and interceptor.
tdc (vertical)
36 inches
I5A NCAC 02T.0:305(g) contains alternative s n -ltcrc scparalioans in 02T.0305(f) cannot be achiaMr'ed.
**Stream classifications can be identified using; the Division's NC Surface Water Classiticatirnns t ebpag,e
aoncomphancc with 02T.0305(f) or (g). see Section X (Willis application
Does the project comply 'saki separation rawquircments for wetlands? (.50 feet of separation)
r See, the Division's draft separation re luiretuents for situations where separation cannot be meet
No variance is required .if the alternati e design criteria specified is utilized in design and constriction
As built documents should reference the location of areas effected
Does the project coanply with
setbacks found in the river basin rules per . 5A NCAC 02B 0200
This would include Trout Buffered Streams per 1,SA NCAC 213 0.
Does the project comply sN
individual 404 Pernut or any 401 Certifications`,'
0 Yes d No
[D, No
Yes LI No
'vfietl tnd-related permits sh:.;all Ire, requested, obtained, and adhered to for projects that impact wetlands or surface
lrnfornraation can be obtained from the 401 it Buffer Permitting Branch
Does project comply with 15A NCAC 02T 0105(c)(6) (addl.tiotntnl pennitslcertilic
Per 15A NCAC 02T.01.05(c)(6), directly related environmental pernuts or certifi
been applied for, or have been obtained. Issuance of this penanit is contingent on
sedimentation control plans. stormwater management plans. etc.).
Does this project include an
e
ollection lianas that are deemed "high -priority?
15ANCAC 02T0402, "high-pnority sewer" n
'on.
E! Yes C No
tion applica+vans are being prepared, have
suatace of dependent. permits (erosion and
ial surer. seWcr contacting surface waters. siphon_ or sewer
pcasitiorted parallel to streambanks that is subject to erosion thaat tundcrmines or deteriorates the sewer.
YesNo
1 f inc de an attachment s itleach line, including type (aerial liter. sire. rr atenal, and location
High priority lines shall be inspected by the permiltee or its representative at (east once el°et s -months and
inspections documented per '15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide C"oUl Lion permit.
FORM: FT.A 04-1(
Page 4 of 5

VKT
Il°CATiONSoes the submitted. system comply v
d l oreL:Mains (lamest 1a^ram ?t� s, anc
If No, complete and subs
for review, A.pprovat,t'
documents.
Yes
No
tfte. Variance/Alternative Design Request application (VAI:){w° 10-14) and support
required prior to submittal.of the Fast Track Ap>ip)tication a
'rt
has hcen reviewed by me and i„
engins.et'ir,g calt:;ttl,ttitut,s, and all other su
of my knowledge the proposed design
Minin:unt Design Criteria for Gravity
Permitting of Pump Stations and 1°orce. Mains
Jeffrey C. Orsborn, P.E.
gineer's name from Application pent 1
that this application list
sistent with the information supplied itr tltc plans, specifications,
documentation to the befit of my knowledge. I further attest that to the best
prepared in accordance with the applicable regetlal.ie tas, f)ra <ity= Sewer
ut. ersion), and the Minuntun Design Criteria fiar the 4=ast 'l'raek
t version). Although other professionals may have developed Cerra
portions of this submittal package, inclusion of these materials under my signature and seal sign if
material and have judged it to be consistent with the proposed design,
iewed this
NO"l1 — Its accordance with General Statutes 143-215,6A and 143-21.5.613, any person who knowingly makes any false
statement, represe station, or certification in any application package ;hall he guilty of <a ..."lass 2 rniscit tnctmcar, 'Mich may
include. a fine not to exceed St0,000, as vv°ell as civil penalties up to S25,000 per violation.
North Carolina Professional Engineer's seal, signatter , anti date;
Applicant's
A NCAC 02'1.0106(
w Author
Max egartner
�aurr�
tttatne & title from Applicat
attest that this apphcatpa
ved by me and is <tcc.ttrate attd ctstttplcte to the hest eat"rant' knowl;dge. 1 understand that Wall required parts of
are not completed aatad' that if all required supporting documentatie rt and attachments are not included, this
aickage is subject to being returned as incomplete. 1 'understand that any discharge of wastewater from this non-
-) surface waters or eland will result in an immediate eat forcement action that may include civil penalties,
jttrtcti e relief; atrtd{`car erintitaal pre>secution. I will make no claim against the Division of Water Resources should a
condition ofthis permit be vicalated, l also t,an.derstand that if all required parts of this application package are not completed
and that if all required supporti g urfia ttaatitan and attachments. are not included, this application packaage will he returned to
me as incotnp
NOTE — In accordance with (ienerttl Statutes 143µ 215.ia \ and 143-12 15.t>li aarry per.
statement, representation, or certification in any application package shall he guilty of a
include a line not to exceed S10,000 as well as civil penalties up to S25,000
ature:
nisden
,stakes a
,nor. \vh
'11
FORM: I FA 04-16

Forest Hill Church South I ., Ca pus
Charlotte, North Carolina
Project derrive
August 26, 2016
The property for the proposed Forest HIll Church South vd. Campus irrpry
currently developed, The property is located at 6210 Old Pineville Road on
approximately 6.32 acres, The project consists of the renovation of the multi -purpose
budding, expansion of existing buildings, expansion of the parking lot, and sidewalk
provem
All buildings wi19 be served by ar private sanitary sewer collection system that
connect to an existing CMU public sewer running along Old Pineville Road,
s 6s

JOB # 60T
Ea ATE. 0 f J 0
SCALD:" = 0
DRAWN Y: RAO
APPROVED BY: JCO
EXH. A
PROPOSED PRIVATE
SANITARY SEWER
USGS QUAD MAP EXHIBIT
FOR
FOREST HILL CHURCH - SOUTH BLVD. CAMPUS
6210 OLD PINEVILLE ROAD
CHARLOTTE, NORTH CAROLINA
EXISTING PLJBC
SANITARY SE`W' .R
ORSBORN ENGINEER4NG GROUP
(1i© EAST MMOREHEAD STREET, SUITE 1.06
CHARLOTTE, NC 28202
Pj 704,749 1432 . H..704-749-.1433

10/7/2916 Corporations Division
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View Document Filings
Corporate Names
Legal:
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Prev Legal:
North Carolina
Elaine F Marshall DEPARTMENT OF THE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh), NC .27h 26,0622 (919),807-"2000
Forest Hill Church
Forest Hill Presbyterian Church, Charlotte, North Carolina, Presbyterian Church (U,S,A.)
Forest Hill, an Evangelical Presbyterian Church
Non -Profit Corporation Information
Sosld:
Status:
Annual Report Status:
Citizenship:
Date Formed:
State of Incorporation:
Registered Agent:
Corporate Addresses
0193558
Current -Active
Not Applicable
Domestic
8/ 12/ 1986
NC
Chadwick, Did E
Reg Mailing: 1040 Woodlawn Rd
Charlotte, NC 28209
Mailing: 72''24 Park Rd
Charlotte, NC 28210
Principal Office: 7224 Park Rd
Charlotte, NC 28210
Reg Office: 7224 Park Rd
Charlotte, NC 28210
Account
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nc sror#8t arct-Vprofcorp/497254'7 111

pry
September 27, 2016
Mr. Will Berkeley
Forest Hill Church
7224 Park Rd
Charlotte, NC 28210
CHARLOTTE
TER
SUBJECT: WATER AND SEWER FLOW ACCEPTANCE
FOREST HILL CHURCH SOUTH BOULEVARD CAMPUS
6210 OLD PINEVILLE ROAD, CHARLOTTE NC
CLTWATER TRACKING# 20161035
A flow acceptance study of the subject site has been completed and the following has been determined:
This project has been approved to discharge into the Charlotte Water sanitary sewer system in
accordance with the site plans submitted with the application. It should be noted that this project has
been set to major/conditional due to capacity concerns at Permanent Flow Monitoring Site 8, It is
expected that these capacity concerns will be alleviated with the completion/relocation of the Steele
Creek Pump Station Force Main project, All other associated sanitary sewer infrastructure was found to
have sufficient capacity to accommodate the proposed sewer flow of 2,170 gallons per day (434 seat
church x 5 gpd/seat) from this project for transmission to the McAlpine Creek Wastewater Treatment
Plant, NPDES permit number NC0024970, for treatment, This acceptance of flow is based upon the
existing capacity of the designated publicly owned treatments works. Please see attached NC DEQ FTSE
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 ID # 0160010, on file with the Public Water Supply Section of NCDENR, However, CLTWater
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
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 f`1) year of
issuance of this flow acceptance study, and payment for any service connection(s) has not been received
within (1) year of issuance of this flow acceptance letter, this 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 Assi
Charlotte Water 51 no Brookshire Nvd, ChaHotre, NC 28716 charlrrteware;r,org
Operated by the City of "I r(otte

r:fr1)-\lk
Division of Water Re -sources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Forest Hill Church
Project Name for which flow is being requested: Forest Hill Church - South By Campus
More than one F15E may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: McAlpine Creek, Irwin Creek, Sugar Creek
b. WWTP Facility Permit #: NC0024970, NC0024945, NCo024937
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 flows are in MGD
99.0
11.529
71.262
0.002
82.793
83.6%
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) (B) (C) (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 / pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD FIow Capacity***
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
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 Addendum shall be attacked for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): 1974 Annexation, Area 1, Main 11 U-1
Downstream Permit Number: Unknown
Page 1 of 6
FTSE 04-16

Vtfficati0n
Statement:
arl 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 this form indicates acceptance of this wastewater flow.
Signing Off
t gna 51'\---
Page 2 of 6
FTSE 04-16

CRSBORN ..NIGNEERING GROUP
610 EAST MOREHEAD STREFT, SURE 106 Project: 16011
Forest Hill Church - South Blvd,. Campus
CHARLOTTE, NORTH CAROB 28202
PHONE [phone]
FAx 704i. 749..1433
To: East Track Permitting Date: 10/07/2016
NCDENR
610 E. Center Ave. Sent Via: FedEx
!Mooresville, NC 28115
[phone]
For Approval
For Your Use
El As Requested
Copied To:
Description
Applications (1 OrigMal, 1 Copy)
Fee 8480
Flow Acceptance
USGS Quad Map
Cover Letter
NC Secretary of State Documentation of Business
E3 For Review and Comment
Approved as Submitted
TJ Approved as Noted
Returned for Corrections
r Returned After Review
El Resubmit for Approval
Signed:

10/712016
Corporations Division
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View Document Filings
Corporate Names
North Carolina
Elaine F Marshall DEPARTMENT OF THE
Secretary SECRETARY OF STATE
PO Box 29622 R.sleith, NC 27626-0622 (919%807-2000
Legal: Forest, Hill Church
Prev Legal: Forest Hill Presbyterian Church, Charlotte, North Carolina, Presbyterian Church (U.S.A.)
Prey Legal: Forest Hill, an Evangelical Presbyterian Church
Non -Profit Corporation Information
Sosld:
Status:.
Annual Report Status:
Citizenship:
Date Formed:
State of Incorporation:
Registered Agent:
Corporate Addresses
Reg Mailing:
Mailing:
Principal Office:
Reg Office:
0193558
Current -Active
Not Applicable
Domestic
8/ 12f 1986
NC
Chadwick, David E
1040 1Noodlawn Rd
Charlotte, NC 28209
7224 Park Rd
Charlotte, NC 28210
7224 Park Rd
Charlotte, NC 28210
7224 Park Rd
Charlotte, NC 28210
Account
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cosna .q¢avSettdp ofc
4972547
1/1

Permit Number WQ0038799
Central Files: APS ^ SWP _
10/12/2016
Permit Tracking Slip
Program Category
Non -discharge
Permit Type .
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
barry.love
Coastal SWRule
Permitted Flow
2,170
Facility
Status
Active
Project Type
New Project
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
Facility Name
Forest Hill Church -South Blvd. Campus
Location Address'
Owner
Major/Minor
Minor
Facility Contact Affiliation
Region
Mooresville
County
Mecklenburg
Owner Name
Forest Hill Church
Dates/Events
Owner Type
Non-Govemment
Owner Affiliation
Max Baumgartner
7224 Park Rd
Charlotte
NC 28210
Orig Issue App Received
10/12/2016 10/10/2016
Regulated Activities
Draft Initiated
Scheduled
Issuance
Church
Wastewater collection
Outfall
Public Notice Issue
10/12/2016
Requested /Received Events
Effective
10/12/2016
Expiration
Additional information requested
Additional information received
Waterbody Name
Streamlndex Number Current Class
Subbastn

ROY COOPER
Governor
MICHAEL S. R.ECAN
S:ecretary
S. JAY ZIMMERMAN
Director
August 9, 2017
Max Baumgartner, Chief Operating Officer
Forest Hill Church
7224 Park Road
Charlotte, NC 28210
SUBJECT: Final Engineering Certification Acknowledgement
Project: Forest Hill Church South. Blvd. Campus
Permit No. WQ0038799
Permittee: Forest Hill Church
County: Mecklenburg
Dear Mr. Baumgartner:
The Division of Water Resource's Mooresville Regional Office received the final engineering
certification with record drawings for the subject sewer extension project on August 7, 2017.
Enclosed is a certification page for your records. A full review of the certification materials may
or may not be conducted. It is assumed that receipt of this certification indicates compliance with
all regulations, design criteria and the permit. However, if a full technical review is conducted,
you will, be notified of any items of non-compliance.
Please be reminded that the Permitt.ee is responsible for keeping a copy of the final record drawings
for the life of the project. If you have not received such copy from your consultant, please contact
them immediately to obtain a copy.
Lastly, you are receiving this letter because the Division has you listed as the responsible party. If
this permitted system is no longer owned by you or your company, please complete Form PNOCF
since the permit is not automatically transferable. Form PNOCF can be downloaded from
http://portal.ncdenr.org/web/wq/swp/ps/cs/pnoc from the Collection Systems Applications page.
Should you have any questions, please do not hesitate to contact me at [phone].
cc: Jeffery C. Orsborn, P.F., (Orsbom
Charlotte, NC 28202)
Central Files
MRO
Sincerely,
Barry Love
Environmental Specialist
eering Group, 610 East Morehead Sttreet, Suite 106,
State of North Carolina p Environmental (dual
peratinns
Mooresville Regional Office 1610 East Center Avenue, Suite 3011 Mooresville, North Carolgna 28115
704-663-1699

PIIPP
FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: Forest Hill Church
PERMIT #: WQ0038799
PROJECT: Forest Hill Church South Blvd. Campus
ISSUE DATE: October 12, 2016
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.
PERMITTEE'S CERTIFICATION
I, 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,
iy
Printed Name, Title
Lure
ENGINEERS CERTIFICATION
i, e C-C So , as a duly registered Professional En sneer in the State of North Carolina,
having been authorized to observe ` aerit dically, [1 weekly, j 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, 2000, as applicable; and other supporting materials,
North Carolina Professional Engineer's Seal w/signature & date:
1 Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
State of North Carolina I E�vironmeatal Quality! Wafer Resources I Watenr Qualify Regional Opttrations
Mooresville ltegi o M Ousel 610 East Center Avenue, Suite 301 Moores -vale„ .North Cnrnhoa 28115
704 663 1699

PIC
Water Resources
Environmental Quality
As built check list (reference 2T .0300)
Reviewed By: Barry Love
Review Date: 8/09/2017
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
Project Name: Forest Hill Church — South Blvd. Campus
WQ#: WQ0038799
County: Mecklenburg
1) As -built has been signed, sealed, and dated by an N.C. PE ® Yes ❑ No
2) Adequate information related to sewer lines :
Note that per the 2T and MDC, there is a minimum 8" for public gravity or minimum 6" for
private gravity, Three (3) feet minimum cover shall be provided for all sewers unless ferrous
material pipe is specified. Manholes shall be installed: at the end of each line, at all changes in
grade, size, or alignment, at all intersections, and at distances not greater than 425 feet, minimum
diameter of manholes shall be 4 feet (48 inches). ® Yes in No n N/A
3) Adequate information related to pump stations:
Ensure power reliability option is selected (15A NCAC 02T.0305(h)). ❑ Yes ❑ No ® N/A
4) Is Project design is in accordance with (see section B.13 of FTA 12-12)
15A NCAC 02T Gravity Sewer Minimum Design Criteria (latest version), Minimum Design
Criteria for Permitting of Pump Stations and Force Mains (latest version). ® Yes ❑ No ❑ N/A
If no, a variance approval is required per the requirements of 15A NCAC 02T.0105(b)
❑ Applicant must submit TWO copies of the plans, specifications, and calculations
❑ Contact the Central Office to discuss the variance request to determine a course of action.
The central office will review the variance request, and if approvable, specific language
regarding the variance will be forwarded to the Regional Office reviewer to incorporate into the
permit. A copy of the variance letter (or email correspondence) should be kept with the
application file.
5) Project contains high priority lines (15A NCAC 02T .0402(2)) ❑ Yes ® No
If Yes, insure that the permit contains the necessary condition related to high priority lines 15A
NCAC 02T.0403 (a)(5)
6) Is the Sewer As -built length within 10% of the fast track applied Length?
( Original length of pipe — As built Iength I / Original Iength) < 10%. ® Yes ❑ No
If no application need to be modified
i�iotiting Compares.
State of North Carolina I Environmental Quality I Water Resources I Water Quality Regional .Operations
Mooresville Regional Office j 610 East Center Avenue, Suite 30 j Mooresville, North Carolina 28115
704-663-1699