WQ0039992_Application (FTSE)_20180613

State of North Carolina
Department of Environmental Quality
nWR Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:'�+�G��
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Old North State Water Company, LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual i,pn ❑ General Partnership X Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Michael J. Myers per 15A NCAC 02T .0106(b)
Title: President
4. Applicant's mailing address: 4700 Homewood Court, Suite 108
City: Raleigh State: NC Zip: 27609-
5. Applicant's contact information: MAY 10 2018
Phone number: [phone] Email Address: mmvers(@,,envirolinkinc.com
II. PROJECT INFORMATION:
1. Project name: Southside Commons
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W Q00 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Pender
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.3672' Longitude:-77.6972'
5. Parcel ID (if applicable): 3292-27-3539-0000
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Timothy Clinkscales License Number: 028847
Firm: Paramounte Eneineerin , Inc.
Mailing address: 122 Cinema Drive
City: Wilmington State: NC Zip:28403
Phone number: [phone] Email Address: jblair(ril,-paramounte-ene.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Majestic Oaks WWTFPermitNumber: W00030088
Owner Name: Old North State Water Company, LLC
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): W00030883 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Old North State Water Company, LLC
FORM: FTA 04-16
Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No NN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
N Yes ❑No ❑N/A
3. If the Applicant is a Home/Properh, Owners' .Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No NN/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls) N Car Wash
N Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities N Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
- ,gg. %Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes [:]No
6. Has a flowtr�juctiri been approved under 15A NCAC 02T .0114(f)? ❑ Yes N No
'➢' Itves, provid acopv of flow reduction approval letter
7. Summarize wastexler generated by project:
Establishment Type (see 02'F.0114(fl)
Daily Design Flow a"
No. of Units
Flow
Single Family Residences
210 gal/unit
106
22,260 GPD
gal/unit
GPD
gal/person
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
22,260 GPD
a See 15A NCAC 02T .0114(b), (d). (e)(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 ofthe Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation pattems, and other measured data.
8. Wastewater generated by project: 22260 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted 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 (Explain):
FORM: ETA 04-16
Page 2 of 5

-- 1
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewersl:
Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8-inch 6,248 PVC C900 (DR-18)
8-inch 60 DIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable)-02T .0305 & MDC (Pump Stations/Fm-ce Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: PS #1
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.3672° Longitude:-77.6972'
3. Design flow of the pump station: 0.048384 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 84 gallons per minute at 124 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
3 4,645 PVC SDR21
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B):
➢ 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
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - I SA NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5
r�

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g)
➢ 15A NCAC 02T 0305M contains minimum se arations that shall be orovided for sewers stems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches)
18 inches
Water mains horizontal
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02'r.0305(11 contains alternatives where separations in 02T.0305M cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications web me
➢ If noncompliance with 02T.0305 or g , see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes [:]No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02009 ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0I05(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T 0105(c)(6), 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, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "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.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16
Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the c'ravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Altemative 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 supporting documents.
2. Professional
Engineer's name from Application Item III.
this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting 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 be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date: j „°' N ...
•SEAL 9�,•�',
�rP47
p �EQ r �Fv
CL�
3. Applicant's Certification per 15A NCAC 02T .0106(b):
that this application for
name & title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I 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 wastewater 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. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I 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 143-215.6B, 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 $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
Date:
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
�,; AI p A s ;• Department of Environmental Quality
€, 4{ Division of Water Resources
n vislcn cc Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Old North State Water Company, LLC
Project Name for which flow is being requested: Southside Commons
More than one FTSE 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: Majestic Oaks WWTF
b.
WWTP Facility Permit #: W00030088
A/lflows are in MGD
c.
WWTP facility's permitted flow
0.059720
d.
Estimated obligated flow not yet tributary to the WWTP
0.00336
e.
WWTP facility's actual avg. flow
0.027666
f.
Total flow for this specific request
0.02226
g.
Total actual and obligated flows to the facility
0.053286
It.
Percent of permitted flow used
89.2
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 / pt),
Daily Flow, Daily Flow,
Obligated Available
Number) MGD MGD
MGD MGD
Flow Capacity***
#1 0.1498 0.05992 0.027666 0.00336 0.0310 0.0289
—*—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 attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Old North State Water Company, LLC
Downstream Permit Number: W00030883
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Michael J. Myers, President 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 ut the planting 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 ant the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Page 2 of 6
FTSE 04-16

3S
is
r
u
a
F
_
(�jzhpil
tl
1�—
��t
i
i I f i
EiE -
PRWHIMARY DESIGN - NOY REE.EASED FOR CONSTRUCTION
i n
,
OVOW.LSir-F"N
GREY DULLPROPERTY
pRAMOUNT'E
,••�•••A
E N
t
CONDMONAL RELON WO
BENDER COt1N
NORlNCARMA
B��gmapny,yp
Fae,,..wc,.wya
ORE1'BULI, INC
IMIIJ DUMNi RD
31Gt9
w__2stt�m
is
IL
0
0
J
0
iz
LL
0
ti
0
v
N

�`g'^
ro: V I � �
❑ `h y k
h
T 4
1O10
$ k '
i
n
v
o�
y
h�

SMITHMOORE
LEJUHERWOOD
ATTORNEYS AT LAW
September 13, 2017
Ms. Lynn Jarvis
Chief Clerk
North Carolina Utilities Commission
430 N. Salisbury Street
Raleigh, NC 27603
434 Fayetteville Street
Suite 2800
Raleigh, NC 27601
RE: Old North State Water Company, LLC—AmendedCPCN Application
Docket W-1300, Sub 20
Dear Ms. Jarvis:
Please find attached an Amended Application for a Certificate of Public
Convenience and Necessity and for Approval of Rates, filed on behalf of Old North
State Water Company, LLC in the above referenced docket.
If you have any questions concerning this filing, please let us know.
Thank you in advance for your assistance in this matter.
Sincerely,
I "D
"Ak'_-� Pa? .Awit'o
Patricia B. Butler
Enclosures
cc: Mr. David Fort
Patricia B, Butler I Direct: 919 755-8789 1 [e-mail] I www.smithmoorelaw.com
ATLAN TA I CHARLESTON I CHAIlLO ri'E I GREENSBORO I GREENVILLE I RALEIGH I WILMINGTON
RALEIGI'1521344.1
(L
0
U
J
U
u.
LL
0
r
0
N
Cl)
t1
v
IV)

NORTH CAROLINA
PUBLIC STAFF
UTILITIES COMMISSION
October 7, 2015
Mr. Mike Myers
Old North State Water Company, LLC
1620 Chalk Road
Wake Forest, NC 27587
RE: Grey Bull Development
Docket No. W-1300, Sub 20
Application for Certificate of Public Convenience and Necessity (sewer service)
Fender County
TO WHOM IT MAY CONCERN:
The Public Staff has received the application for a certificate of public
convenience and necessity to provide sewer utility service in Grey Bull Development
in Fender County, North Carolina. The Public Staff anticipates that approval will be
granted upon investigation and review of the submitted application.
Please feel free to call if you have any questions or if I can be of further assistance.
Sincerely,
�a6ette �/V(,c�emze
Babette McKemie, Utilities Engineer
Public Staff — Water & Sewer Division
c: Ron Brown
Executive Director
Communications Economic Research Legal
Transportation
733-2435
733-2810 733-2902 733-6110
733-7766
Accounting
Consumer Services Electric Natural Gas
Water
733-4279
733-9277 733-2267 733-4326
733-5610
4326 Mail Service Center • Raleigh, North Carolina 27699-4326 • Fax (919)
715-6704
An Equal Opportunity I Affirmation Action Employer

PENDER COUNTY, NORTH CAROLINA
Prepared for:
KG PLAZA, LLC
8640 River Road
Wilmington, NC 28412
Prepared by:
122 Cinema Drive
Wilmington, NC 28403
Project #15204.PE
May 2018
�rnOJli/2 j t i

PROJECT NARRATIVE
The property served by this proposed sewer extension lies off of Factory Road and Forest Sound
Road in Pender County. This subdivision is a low -density project of the Coastal Stormwater
Program that is in a SA, HQW watershed, Mill Creek (Betts Creek) (18-87-14).
is located at the end of Arrow Wood Road and abuts Hoover and US Hwy 17 in Hampstead NC
and includes Tax Parcel #3293-01-5693. The property drains to Godfrey Creek (C, SW; 18-74-49-1)
— White Oak Basin.
KG Plaza, LLC desires to install a gravity sewer system and an 84 GPM pump station and 3-inch
force main to serve a 106-lot single family subdivision. It is proposed that wastewater from the
residential development, calculated to be 22,260 GPD, be ultimately collected and carried to the
proposed new pump station on the property, where it will then be pumped to the existing Majestic
Oaks pump station across Factory Road at the current Old North State Utilities treatment facility
MIQ0030088 — Old North State Water Company, LLC).
Gravity collection sewer lines carry the flow from the property to a centralized location where the
pump station is sited and designed per NCAC Title 15A.2T.0100 - .1600. The gravitycollection
system is to be owned by Old North State Water Company, LLC. For the permit, it will consist of
6,308 LF of 8" gravity sewer, this represents all the gravity sewer for the entire project. The
operating point for the pump station will be 84 gpm at 124 TDH.
The project contains gravity lines and manholes which are within 50' of wetlands. The plans require
and show pipe materials and testing to meet watermain standards and for manholes to be fully lined
with waterproof material and vacuum tested for these sections.