WQ0043179_More Information (Received)_20220308

Good morning Mr. Huffine:
-"AC, 94-X3 sAst. e/
50nt *iv G.-p tarn, •
I've had a chance to review the FastTrack permit application you submitted on behalf of
the Mebane Street Townhomes project, and I have a few revisions to request from you:
• Page 1, itenj,J4 The legal signatory of the project must be listed. This appears to be Mr. Jay
Gaffney, as his email is provided in the contact information, and he is the signatory on behalf of
Blu Ladder Construction on the Operational Agreement document. If Mr. Gaffney is, in fact, the
le al re res of BI I e th
age , item VI.3: T is is a simple fix; please just check Yes, No, or N A to indicate whether an
HOA will be created for this community, and include ooc nrItion it'yes '.
• Page 2, item VI.8: This should be populated with the total flow listed in the table in item VI.7. 720b
• - Page 4, item IX.1: Again, a simple fix; check 'Yes' to confirm that you have reviewed the
minimum separations listed and that this project complies.
ssie
Page 5, item X.2: Please list your name and the name of the project in their respective blanks,
and sign, date, and seal as you did for the first submission.
• Page 5, item X.3: Here, the signatory listed in item 1.3 will print their name, the name of the
project, and sign and date.
I also noticed that signatures provided on the Operational Agreement form by Mr.
Gaffney and on the FTSE form by Mr. Lambert are not valid signatures. The only
signatures which are legally valid for any of these submission materials (including
form FTA 06-21 [application], form FTSE 10-18 [flow tracking], and form DEV 03-19
[operational agreement]) are original wet -ink signatures or secure digital
signatures, like those applied with a program such as Adobe or
DocuSign. Unfortunately, typed signatures or photocopies/scans of wet -ink signatures
do not carry the legal weight required for our documentation.
While you make these revisions and gather the signatures, I will begin entering your
project into our database with the information provided, and drafting the permit as well
as I can. That way I should have it issued to you soon after I receive these edits.
If you have any questions at all about what is needed from you, please don't hesitate to
call. I'm happy to help clarify our process as best as I can.
Best Regards,
Alex Lowe (he/him)
Environmental Specialist II
Division of Water Resources
Department of Environmental Quality
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Cell: [phone]
Office: [phone]
Ne N1d01%1Q14
EnvIre ntoi ual tY
ecvea
MAR 0 0 2022
Winston-Salem
Regional Office

THE L.E.A.D.S GROUP, P.A.
505 EAST DAVIS STREET
BURLINGTON, NC 27215
NC DENR WINSTON-SALEM REGIONAL OFFICE
ATTN: ALEX LOWE
FAST TRACK SEWER EXTENSION APPLICATION
DIVISION OF WATER RESOURCES
450 WEST HANES MILL ROAD, SUITE 300
WINSTON-SALEM, NC 27105

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEMEXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWIt)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: Blu Ladder Construction (conpany, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual tEl Corporation ❑ General Partnership 0 Privately -Owned Public Utility
Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: _ Mr. Jay Gaffney
Title: Contractor
4. Applicant's mailing address: 108 State Street. Ste. 300
City: Greensboro State: NC Zip: 27408 -
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
blu-ladder.com
11. PROJECT INFORMATION:
1. Project name: Mebane Street Townhomes
2. Application/Project status: Z Proposed (New Permit)
❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
For modifications, also attach adetailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.07749' Longitude:-79.48380'
5. Parcel ID (if applicable): 113780 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Charles D. I-iuffrne License Number: 24924
Firm: The L.E.A.D.S. Group, Pa
Mailing address: 505 East Davis Street
City: Bm9ineton State: NC Zip: 27215-_
Phone number: ( 336 ) 227-8724 Email Address: [e-mail]
IV. WASTEWATER FACTREATMENT (WWTF) INFORMATION:
1. Facility Name:
Owner Name: City of' Burlineton
Permit Number: nectoz3876
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch X Gravity ❑Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): The City of Burlington
FORM: FTA 06-21
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?
0 Yes ®No ❑N/A
If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
® Yes ❑No ❑N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA)and
supplementary documentation as required by 15A NCAC 02T.0I 15(c) been attached?
❑ Yes ❑No 17N/A
7
4. Origin of wastewater: (check all that apply):
®Residential(Individually Owned)
['Residential (Leased)
❑ School / preschool / day care
❑Food and drink facilities
❑ Businesses / offices / factories
❑Retail (stores, centers, malls)
❑Retail with food preparationiservice
❑Medical / dental / veterinary facilities
['Church
['Nursing Home
❑Car Wash
Dilate; ardlor Motels
❑Swimming Pool/Clubhouse
❑Swimming Pool/Filter Backwash
[Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (See I5A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect?❑ Yes ❑ No
6. Has a flow reduction been approved under I5A NCAC 02T .0114(f)? ® Yes ❑ No
Y If ves. provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type'(see 02T.0114(())
Daily Design Flow °„b
No. of Units
Flow
Town home 3 bedroom
120 gal/day/rR
20
7,200 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
nap GPD
a See I 5A NCAC 02T.0114(b). (d). (e)(1) and (e)(2) for caveats to wastewater des'gn flow rates (Le., minimum flow per
dwelling; proposed unknown nonresidential 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
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.0114] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 7.200 GPD (per I5A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):_
FORM: ETA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -02T.0305&)11DC(Gravity Sewers):
I. Summarize gravity sewer to be permitted:.
Y
Y
Size (inches)
Length (feet)
Material
500'
Sdr-35 pvc
Section 11 & 111 of the MDC for Permitting of Gravity Sewers contains information relo ed to design criteria
Section 111 contains information related to minimum slopes for gravity sewer(s)
Oversizing lines to meet minimum slope requirements Is not allowed antra violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable)—02T.0305&MDC (Pump Stations/Force Mains):
PROVIDEA SEPARATE COPY OF THIS PAGEFOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinatest(Decimal Degrees): Latitude:
3. Total number of pumps at the pump station:
3. Design flow of the pump station:
Longitude: - .
millions gallons per day (firm capacity)
This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s):
gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
If any portion of the force main is less than 4-inches in diameter, please identify the me hod of solids reduction per
MDCPSFM Section 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen 0 Other (please specify)_
6. Power reliabilityin accordance with ISANCAC 02T.0305(h)(1):
❑ Standby power source or ❑Standby pump
i
D
Must have automatic activation and telemetry - I5A NCAC 02T.0305(h)(I)(B)1
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Must be permanent to facilityand may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per dayI5A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
> Include documentation that the portable source is owned or contracted by the applicantand is compatible with thestation.
D 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 tinteframes, shall be
provided as part of this permit application in the case ofa multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200&15A NCAC 02T .0305(0):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (ea? I x I Yes ❑ No
I5A NCAC 02T.0305(fl contains minimum senaratimts that shall be provided for sewers sae n
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18inches
2Water mains (vertical -water over sewer preferred, 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, and associated wetlands.
100 feet
"*Waters classified WS (except WS-I or WS-V), B, SA, ORW, HOW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
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
A If noncompliance with 02T.0305(fl or (g) see Section X.1 of this application
*15A NCAC 02T.0305(2) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Streanrclassifications can be identified using the Division's NC Surface Water Classifications webnage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
in If no, please refer to 15A NCAC I8C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No ® N/A
i Please provide supplementary information identifying the areas of non-conformance.
n- See the Division's draft separation requirements for situations where separation cannot be stet.
3 No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? Yes Basin name: JordanD No
If yes, does the project comply with setbacks found in the river basin rules per I5A NCAC 028.0200? ® Yes❑ No
This includes Trout Buffered Streams per 15A NCAC 28.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
inn Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T0105(c)(6) (additional permits/certifications)? ® Yes❑ No
Per I5A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402 "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
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 permittee's individual System -Wide Collection permit.
FORM: ETA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with I5A NCAC 02T the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version) and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
Ifno, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office.Annroval of the reauest will be issued
concurrently with the approval of the permit and projects requiring a variance a taroval may be subject to longer
review times. For protects requiring two or more variances or where the variance is determined by the Division to be
a significant portion of the protect. the full technical review is required.
Professional Engineer's Certification:
Chales D. Hufane, PE
. attest that this application for
(Professional Engineer's name from Application Item 111.1.)
MEBANE STREET TOWNHOMES
(Project Nano from Application Item 11.1) - - --
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.) further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
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 1 have reviewed this
material and have judged it to be consistent with the proposed design.
NOTE— In accordance with General Statutes I43-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, er 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. Misrepresentation of the
application information, including failure to disclose any design non-compliance with the applicable Rules and design
criteria, may subject the North Carolina -licensed Professional Engineerto referral to the licensing board.(21'NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification perl5A NCAC 02T .0106(b):
Mr. Jay Gaffney �ma�yy// // Z L�
attest that this application for /'�c'LirdP irsw
(Signature Authority Name from Application Item 1.3.) (Project Name from Application. Item Itl)
attest that this application 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. 1 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. 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 tome as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, 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 S10,000 as well as civil penalties up to $25,000 per violation.
Signature: —
FORM: FTA 06-21
Date: l — 2 /" 2Z
Page 5 of 5

STATE OF NORT4 CAROLINA
COUNTY OF/ic-t2,t.a,c¢.,, Permit No.
DEVELOPER'S OPERATIONAL AGREEMENT
�( This AGREEMENT made pursuant to G.S. 143-215.1 (dl) and entered into this 3'I s� day of
Jeun.44- - ' 72' , by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
fa 1--Aelete'' � ,, s�n cc I,'o r , a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as theDEVELOPER.
WITNESSETH:
1. The DEVELOPER is the owner of the certain lands lying in County, upon
which it is erecting and will erect dwelling units and other improvements, said development to beknown
as n4c-ttLne- //ram- T ,r j �, (hereinafter the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to serve
the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, WIl ttne 541,---eJ- 7, A &-00e.i'J-; &v (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re -constructing and repairingthe common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance, re -construction andrepair.
6. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions andlaw.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws andDeclaration.
3 The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility for
the operation and maintenance of its Disposal System until a permit has been reissued to the DEVELOPER's
successor.
FORM: DEV 03-19 Page 1 of2

4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of the permit for construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes andinsurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses. In order to assure that there shall be funds readily available to
repair, maintain or construct the Disposal System, beyond the routine operation and maintenance expenses,
the Declaration and Association Bylaws shall provide that a fund be created out of the common expenses.
Such fund shall be separate from the routine maintenance funds allocated for the facility and shall be part
of the yearlybudget.
6. In the event the common expense allocation and separate fund are not adequate for the construction, repair,
and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for special
assessments to cover such necessary costs. There shall be no limit on the amount of such assessments, and
the Declaration and Bylaws shall provide that such special assessments can be made as necessary at any
time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit mayrequire as condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the continued
proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution without first having
transferred its said system and facilities to some person, corporation or other entity acceptable to and
approved by the COMMISSION by the issuance of apermit.
9. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 above shall be conditions of any
pemut issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration is
filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL 234 , C - 2. - rr1,n�.r t"—e
MANAGEMENT COMMISSION Name of DEVELOPER
/sir
Bv:
S. Daniel Smith (Signature
Director, Division of Water Resources
Print Name and Title
/3//2-u2
(Date) (Date)
FORM: DEV 03-19 Page 2 of 2

ri
Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 10-18)
Entity Requesting Allocation City of Burlington
Project Name for which flow is being requested: Mebane Street Townhomes
More than one FTSE may be required for a single project if the owner ojthe If f1TP is not responsible for all pump stations
along the route of the proposed wastewater flow.
F. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: South Burlington WWTP
b. WWTP Facility Permit fl: NC0023876
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
£ 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
12.00
1.763764
8.752000
0.007200
10.522964
87.69%
11. 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,
Average Daily Approx. Nat Yet Total Current
Pump Station Firm FIoW" Currant Avg. Tributary Flow Plus
(Name or Capacity, " (Firm/pf), Daily Flow, Daily Fiow, Obligated Available
Number) GPD GPD GPD GPD Flow Capacity"""
NONE
* 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 pumpatatlon divided by a
peaking factor (pf) not leas 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 s 0.
Downstream Facility Name (Sewer) : City of Buffington
Downstream Permit Number:
1 of 6 FTSE 10-18

11I. Certification Statement:
I, W. Todd Lambert, P.E, 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 asseessment where applicable. This
analysis has been performed in accordance with local established policies and procedures using the
best available data. This certification applies to those items listed above in Sections 1 and II plus
all attached planning assessment addendums for which 1 am the responsible party. Signature
of this form certifies that the receiving collection system or treatment works has adequate capacity to
transport and treat the pro ew wastewater.
1.-•;Z�i-Zl-2Z-
Signing Official Signature
City Engineer
Title of Signing Official
- 2.I -•27—
Date
2 of 6 FTSE.10-18

STATE OF NORTI4 CAROLINA
COUNTY OF 14.tvvot-c-c . Permit No.
DEVELOPER'S OPERATIONAL AGREEMENT
.( This AGREEMENT made pursuant to G.S. 143-215.1 (d1) and entered into this �� -� day of
t A n,vi-v�-� ZL , by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
lu - 6;ns a-n,cc 4c r- , a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
1. The DEVELOPER is the owner of the certain lands lying in'�rae- County, upon
which it is erecting and will erect dwelling units and other improvements, said development to be known
as ,t4 /�<c o� `a%= ref' 7 ,rnS-4 (hereinafter the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to serve
the Development on said lands.
3. The DEVELOPER has:. applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, pt'Lc..txt,m.o- 54r^ey/-- 2k6 S0€.+A 519.•i (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re -constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance, re -construction andrepair,
6. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions andlaw.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws andDeclaration.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility for
the operation and maintenance of its Disposal System until a permit has been reissued to the DEVELOPER's
successor.
FORM: DEV 03-19 Page 1 of 2

4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of the permit for construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes andinsurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses. In order to assure that there shall be funds readily available to
repair, maintain or construct the Disposal System, beyond the routine operation and maintenance expenses,
the Declaration and Association Bylaws shall provide that a fund be created out of the common expenses.
Such fund shall be separate from the routine maintenance funds allocated for the facility and shall be part
of the yearly budget.
6. In the event the common expense allocation and separate fund are not adequate for the construction, repair,
and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for special
assessments to cover such necessary costs. There shall be no limit on the amount of such assessments, and
the Declaration and Bylaws shall provide that such special assessments can be made as necessary at any
time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit mayrequire as condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the continued
proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution without first having
transferred its said system and facilities to some person, corporation or other entity acceptable to and
approved by the COMMISSION by the issuance of apermit.
9. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration is
filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as/
s indicated by each of the parties named below:
FOR THE ENVIRONMENTAL f Yt, ,,def.e✓ (t„As2't coca.
MANAGEMENT COMMISSION Name of DEVELOPER
S. Daniel Smith
Director, Division of Water Resources
(Date)
Bv: 411,
(Si
&Li Can -fc,...1,
Print Name and Title
//�z�zz✓
(Date)
FORM: DEV 03-19 Page 2 of2