WQ0044180_Application (FTSE)_20230505

Wilson, Susan A
From:
Blake Hall <[e-mail]>
Sent:
Friday, April 14, 2023 2:12 PM
To:
Wilson, Susan A
Cc:
Trevor Morrison
Subject: [External] RE: Holly Springs/Oakview Mixed Use Fast Track app WQ0044180
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I will try to answer your questions below. Also attached an image that may be helpful.
Thank you,
Blake Hall
919-316-0126
From: Wilson, Susan A <[e-mail]>
Sent: Friday, April 14, 2023 11:52 AM
To: Blake Hall <[e-mail]>
Subject: Holly Springs/Oakview Mixed Use Fast Track app WQ0044180
CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the
sender and know the content is safe.
Hi Blake —
I'm fairly new to the fast track process — so if you'll bear with me on these questions as I'm reviewing the application for
this project (and excuse my ignorance if these are obvious from other approvals re. this project).
1. If I'm understanding this correctly (and I really wish we would just ask for a simple schematic/flow diagram as
part of the application!) this line ties in to WQ0043006 (also zero flow allocation) and then to WQ0042872 (appx
0.767 MGD flow allocation)? This should do directly to WQ0042872, WQ0043006 was a separate project that
ties into the same downstream manhole that this application ties to.
2. Is this project part of what was originally planned/allocated through WQ0042872? And outlined in that
application? Yes, that is correct
3. What is the estimated timeline on build out for this project? Construction is planned to start later this month,
sewer would follow 2 to 3 months later.

DocuSign Envelope ID: 47BC4503-470D-43F2-9B60487 32BOBQt
N(; ept of Environmental Quality State oi' North C ar•ohim
Department of Environmental Quality
DWR MAR 2 2023 Division of Water Resour-ces
W inns r Tltnc I< SEWERSvsrF�M rr r'I;Ns10N r�PPl.I(-ATION
Division of Water Resources I. 1'A 416-21 & SUPPORTING DOCIIME'NTATION
��. Ralei Re�iotl�, Office ,. ,.
A pplication Number: WQOD q4(Qa (tipheiomplciedlvvDW10
All itertrs roust be cum leted or the aimlication will be returned
1. APPLICANT iNFORMATION:
I. Applicant's name: Town ol' Ho)Iy Springs
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public tatilily
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Kendra D. Parrish. PI.; per UA NCAC 02T —.OUAW
Title: Executive Director of' Utilities & Infrastructure Service
4. Applicant's mailing address: 128 South Main Street PO Box K
City: Holly SL)rinbs Statc: NC Zip: 27540
5. Applicant's contact intbrmation:
Phone number: (90) 577-3150 Ismail Address: Kendra.pat-i•ish(rrlhollysprutgsne.gov
11. PROJE. l' INFORMATION:
I. Project name: Oakview Mixed Use
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
if a modification, provide the existing permit number: WQOO and issued date: _-.-- .-
For modifications, also attach a detailed narrative description as described in Rent G of the checklist.
ifncw construction, but hart ofa master plan, provide the existing permit number: WQOO - .
3. County where project is located: Wake _ .
4. Approximate Coordinates (Decimal Degrees): Latitude:35-658671" I-ongitude:-78.868177
5. Parcel 11) (if applicable) : -„T (or Parcel 11) to closest domvitream sewer)
111. CONSULTANT iNFORMATION:
I. Professional 1'ngincer: Make I Tall. PE Licentie Number: 038616
Firm: Timmons Group _
Mailing address: 5410 Trinity Rd Suite 102
City: Raleigh State: NC Zip: 27607
Phone number: [phone] Finail Address. ; 131aka llall(u),7 imnum* com
W. WAS'1'1sWA'TI;:R'1'R1s'A'I'11'IF:Nl' l A('11.1'1'V (WW'I-l{) INFORMATION:
I. Facility Namc: Uticy Crock Water Reclamation Facility Permit Number: NC'O00j096-----
Owner Nome. Town of Holly Springs
V. REWEAVING DOWNSTRKAM SMER iNFORMATION:
1. Permit Number(s): WQOO43006 -�
2. Downstream (Receiving) Sewer Inlbrmation: 8° inch 0 Gravity 'I Force Main
3. System Wide Collection System Permit Number(s) (iFapplicablc): W{ C5{)(}192 .
Owncr Name(s): To%t-n of Hol ly Sprin gy.-
FORM: FTA 06-21 Page I o1,5

DocuSign Envelope ID: 478C4503-47OD-43F2-9B66-967E32BOE091
\'I. � CI:iVI:IL\E. R[:QEilltl.1171:N'I'S
1 _ Irtltc Applicant is a Privately -Owned Public Utility, has a Ccrtificsttc ol•Public Convenience and Nceessity hccn ul4tchcd''
❑ Yes [—]No ®N?A
2. If' Ilie Applicant is a Developer of lots to be sold, has a Dcvcloper's OperatioingI Agreement (FORM: DEV) been allaclacd?
❑ Yes ❑ No 0 N?A
i, 1I'Ihc Applicant is a HomelProperty Owners' Association, has an J4O�O ,GatSrational Ar_reeancot (FORME: i110A1 and
supplementary documentation as required by 15A NCAC 02T.(11 15(c) been attached?
[:]Yes []No ®N/A
4. Origin ofwastcwater: (check all that apply):
❑ Residential (Individually Owned) X Retail (stores, centers, malls) ❑ Car Wnsh
❑ Residential (Leased) M Retail with Ibod preparation/service ❑ 1 lotel andlor Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swinntting Pool;Clubhotasc
❑ food and drink facilities ❑ Churclt ❑ Swimming Pool.Tilter llackwash
❑ Businesses / offices / factories ❑ Nursing Honk ❑ Other (Explain in Allachmenl )
5. Nature of wastewater: % Domestic 100 % Commercial 'Vo Industrial ( cc 15A NCAC 027` . I03(20t)
If Industrial, is there a Pretreatment Program in effect? ❑X YcR❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14M? ❑ Yes ❑ No
:- Ef 1'cs, provide a cnnv atf 11oty e•cdtaCtion annroval letter with this ati'ttlirsttion
7. Summarize wastewater generated by project:
Establishment Type (sec 02T.01 14(f))
Daily Design Flow ° t'
No. of Cnits
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal!
GPi.)
gal!
G PD
gal/
GPI:)
ToIa1
0 GPD
la Sec 15A NCAC 02T .01 14(bik (d). (e)(11 and c 2 For caveals to wastewater design flow rates (i.e., minimum flow per
dwclhng: proposed unknown non-residential development uses; public access facilities located near bigh public use greats;
and residential property located south or cast ofthe Atlantic Intracoastal Waterway to be used Its vacation renInIs a* defined
m (i S. 42,AA).
b Per 15A NCAC 02-1' .O1 14(c), design flow rates Ior establishments not identified J'in lablc 15A NCAC 02T_01 141 shall he
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured (taka,
Wastewater generated by project: 0 GPD (per 15A&NCAC 02T ,01 14)
Do not include FIRLI •c 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 it) Ihi; line.
Please provide supplementary information indicatintt the approximate timcfriuttc for permitting upstream Sewers with [low.
❑ Flow has already been allocated in Permit Number: W00043006 Issuance Date: 12/10/2021
❑ Rehabilitation or replacctnentofexisting;;ewert with no new flow expectod
❑ Other (Fxplaim)'
FOI2 M- F1•A fills-? 1 Psagc 2 akl`5

DocuSign Envelope ID: 478C4503;47OD43F2-9B66-967E32BOE091
Vll. C:RAVITY tit?WEA DESIGN CRITFRIA (if Applicable) -02T.0305 & RJDC (Gravity Sewers}:
Vill
1. Suinmariie gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
—974
PVC
Section 11 & III of the MDC for Permitting ot'Ciravity Scwers contains information related (o design crrlcria
Section III contains information related to minimum Slopes for gravity sewer(s)
Oversizing lines to meet minimum slope requirements is not allowed and it violation of the MDC
PUMP STATION 1)1;SI(;N CRITERIA (if Applicahle) — 02T .030g & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE, COPY OF THIS PAGE FOR I.ACI I PUMP STATION INCLUDED IN THIS I'ItQ&I C if
Punlp'slation number or name:
2. approximate Coordinates (Decimal Degrees). Latitude: �` Longilude: —
3. Total numbet of pumps at the pump Station:
3. DCStgn ]low of (he pump station: millions gallons per day (firm capacity)
%- This should reflect Ilie total GI'M for the pump station wilIt the largest pump out of service.
4- Operational point(s) per pump(s): gallons per minute (GPM) at: icel lotal dynanllc head ( I'DI1)
5_ SLl1111nari7.0 the Bare plain I0 be permitted (lbr this Pump Station):
Size (inches) Length (feet) Material
Ifany portion ofthe force main is Ics_s (han 4-inches in diameter, please identify the method ol'Solids reduction pet-
MDCPSFM Section 2 01C. Lb. ❑ Grinder Pump ❑ Wchanical Bar Screen ❑ Other (please specify)
h. Power reliability in accordance with 15A NCAC 02T .0305(hlf I,.):
❑ Standhy power source or ❑ Slandby pump
e Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(13):
Required Ibr all pump stations with an average daily flow greater than or equal 10 15.000 gallons per day
Mits t be permanent to facility and may not be portable
Or if the pump Station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick-conncclion receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump c0nncction and Iclemelry:
Y Include documentation Ihat the portable source is owned or contracted by the applicant and is compatible with the .~(atom.
If file portable power'source or pump is dedicated to multiple pump stations, an evaluation of all the ptlnlP slatio ns' �tofdgc
capacities and the rotation schedule of the portable power source or plullp, including travel limcframcr, ~hall be provided
as part of this permit application in the case of a multiple station power oulage.
row: I','rA 06-21 Page I of, 5

DocuSign Envelope ID: 478C4503-47OD-43F2-9B66-967E32BOE091
IX. SI:TRACKN & S1IPARATIONS — (02111.0200 & 15A NCAC 02T .0305(f)):
I . Does the project comply with all separationviallernaLives found in 15A NCAC 02T .0305(n Ik W? ❑x Yes ❑ No
15A NCAC 02T-0305(1) contains minimum sc
Setback Parameter"
Storm sewers and other utilitics not listed below (vertical)
'Water mains (vertical - water over sewer preferred, inclui
-Water mains {horizontal)
Reclaimed water lines (vertical - reclaimed over sewer)
Reclaimed water- lincs (horizontal - reclaimed over sewer)
thal zhal l be pmvidcd Inv sewer systems:
in benched trcnchm)
**Any private or public water supply sourec, including tiny wells, WS-I water, of Class I or
Class II impounded reservoirs used as a s ource ol'drinking water, and associated wellands-
"Waters classified WS (except WS-1 or WS-v), 13, SA. 012 W, flQW, or SB 1rom normal
high water (or tide elevation) and wctlands astiociatcd with these water,, (sec item IX-2)
**Any other stream. hike, impoundment, or ground water lowering and surface draunagc
ditchcs, as well as %vellands associated with these waters or classified its WL
Any building foundation (horizontal)
Any hascnncni (horizontal)
Top slope of embankment or cuts of 2 feet or morc vertical height
and intcrmpior drains
Any swimming,
Final earth ttrud
Separation Required
— -- 18 inches - - -
--- lye inches
10 lect
18 inches
2 feet
100 Icct
50 feet
l0 feet
5lcel'
110 feet
10 1'cct
5 Icci
10 I'm
36 inches
if noncompliance with 02T.0305ff1f orftl, sec Section X.1 of this application
*I JA NCAC 02T,9305(g contains alternatives where separations in 02T.0305(A cannot be achieved. Please check "yes"
above if these alternalivcs are used and provide narrative inliirmation to explain,
"Stream clasxifications can be identified using the Division's NC Surfas Water C. assifications wcb�iayc
(vertical)
1 noes this project comply with tic minimum separation requirements For waver mains? ® Yes ❑ No ❑ NIA
P, Ifno, please refer to 15A NCAC. I9C.090G(1) for documentation requirements and siihmit a,,Cparate document,
signed/scaled by an NC licensed PI::, verifying the criteria outlined in that RUIC.
.3. Does the pr04CCI comply with .separation requirements for wetlands? MY es ❑ No ❑ WA
i- Pictise provide supplementary information identifying the aretis of noii-confornisuice.
Sec the Division's draft sS afton requirements for situations where separation cannot be met.
.� No variance is required iFtlic alternative design criteria spccified is utilized in design and construction.
4. Is the prajcct located in a river hasin subject to any Stme buffer rule~? ® Yes Basin panic:Ca�car L] No
If yes, does the project comply with setbacks found nr the river basin rules per I A CAC 02f3 02 ® Yes ❑ No
This includes Trout Buffered Streunvs per ISA NCAC. B2 0202
5. Does the project require coveragciarithorization under a 404 Nationwidelirid ividual permits ❑ Yes ® No
or 401 W,iter Quality Certifications'?
Please provide the permit nunnberipermitting status in the cover letter if coverage/author•iiati(in is reduired-
6. Does project comply with I5A NCAC )2 T.()105>!c)({+) (,additional permitslcertificat ions)? ® Yes ❑ No
Per lSA HCAC U2T.Q105 c , 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
ann(I sedinnentation control plans, stormwater management plans, etc-).
7. Docs this project includc any sewer collection lines that are deerncd "high -priority?" ❑Yeti ® No
Per ISA UCA 02T�04Q2, "high -priority sewer" means any ncriiil sewer, ~ewer contacting surlier waters,
siphon. or •~ewers positioned pni•allel to titreambanks that arc snhject to erasion that undcrmincs or deteriorates the xcwcr
Siphons and sewers suspended through interference/conflict boars require a variance approval.
If yes. include an attachment with details for each line, including type (aerial line, sire, im)(C6111, and lociuinn).
fligh priority liars shall be inspected by the permittee or its representative at least once every six-month~ and
inspections documented per ISA NCAC 02T.0403(a)(5) ur the per•inittec's individunf System -Wide Collection permit.
P-alum. n--rn nr, 1i Page 4 of

DocuSign Envelope ID: 478C4503-470DA3F2-9B66-967E32BOE091
X. CEIR'I'IFICATIONS:
I . Doc-, the submitted system comply wills 15A NI, A . r, the Minimum Design Criteria for the Pear !(ir u vl'uin Slatio
tint! Force ai s flptgt vcrsia .Intl the Gravity Sewe�M. i um_Dcsi�pn.Criteria [latest versjonl as, )pli(nblc''
® Yes ❑ No
11' too, for projects requiring a single variance, complete and submit the Variance/Alternulive Design Requesl applicaalion
(VADC 10-14) and supporting documents for review to the Central Office. Approval of (lie rettnest will be issued
concurrently with the approval of the a -mit and ro'ects requiring it variance anproval may be subled to Ion per
review tinges. For pr•o'ccts requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the Fiiro4ect, the full technical review is required.
2, Professional Cngincer's Certification:
f3lakc Hall, PI , oticsl that this application for Oakview Mixed Use
Wrofcssinmll languleer's name t1mm3 Application Item III.1.) (Project Name from Application Item 11. I l
has been reviewed by me and is accurate, complete }end consistent with (he information supplied in the plan~.
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 hits been prepared in accordance with the applicable regulations,
Mipjijitn DcsigA Criteria for GMyi.ty Sewers f latest, version - and file ,MiniMMM DcsilEn Criteria for the Nast- rack NmVj4L1L1.,
of rymg Stations and FCce• aigs.flafest version}. Allhough other professionals may have developed certain portions of this
submittal package, inclusion of these materials sunder lily signature and seal signifies that i have reviewed this material and
have judged it to be con.sistent with the proposed design-
NOTF: in accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any I€else
statement. representation, or certification in any application package shall be guilty of a Class 2 misdemeanor. which may
include a line not to exceed $10,000. as well as civil penalties tip to $25,000 per violation. Misrepresentation of the application
infilrmation, including failure to disclose any design non-compliance with the applicable Rules and design criteria, piny subject
the North Carolina -licensed Professional Engineer to referral to the licensing hoard. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date: ,,•.:l1,t,
Applicant's Certification per 15A NCAC: 02-l' .0106(b):
957A22C54A91#612 wit
lie
DoeuSigned Bv:-Slaki all
EAL
2/21/2023 038616
0 IN
,'��rlailllltll�,
1. Kendra D. Parrish, PF. , attest that this application for Oakvicw Mixed Use _
(Signature Aulliorily Nnmc from Allp'leattitill (lem 1.3.1 (Project Numc from Application hem 11. 0
attest that this Application hats been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if lull required parts of this application are not completed and that if all required supporting documentation
and allacltrncatls arc na[ included, this aplplication 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 all immediate enloreellicill
action that may include civil penalties, injunclivc relief, an(1101- criminal prosecution. I will make no claim against the Division
of Witter Resources should a condition elf this permit be violate([. I also understand that ifail required parts ol'Ihis alppliclllion
package are not completed and that if all required supporting ittlirrmalion and attachments are no( included, this application
package will be returned to nix as inccmiplete.
NOTE -- Ili accordance with General Statutes W-215AA and 143-�IS,{r�,3, any person who knowingly makes any false
statement. representation, or certification in any application package shall be guilty of a Class 2 nrisdenicanor, which 111.1Y
include a fine not to exceed $10,000 as well as civil penalties lip to $25,000 per violation.
! J,O,�ocuSigned 6y:
�`°`Vm— 2/21/2023
Signature: D;atc;
FORM: FTA 06-21 Pave 5 01'5

DocuSign envelope ID: 47SC4503-4700-43F2-9866-967E32BOE091
T HE TO W N OF
February 7, 2023
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
3800 Barrett Drive
Raleigh, NC 27609
,9/7o'Ily c prings
Re: Application for Sewer Extension Permit
Project: Oakview Mixed -Use
Dear Sir or Madam:
NC Dept of Enviraimental Quality
Raleigh Regional Office
Please find enclosed the following items in application for a sewer extension permit to the Town
of Holly Springs existing sewer distribution system:
0 One original and one copy cover letter including a project narrative
o A check in the amount of $480.00
0 One original and one copy of the State of North Carolina Fast Track Sewer System
Extension Application (FTA 04-16)
0 Two copies of FTSE 04-16 Flow Tracking/Acceptance Form
0 Two color copies of a 8.5-inch by 11-inch portion of a 7.5 minute USGS Topographic
Map showing project area
0 Two copies of a street level map showing all relevant project areas
0 One copy of the locally -required Design and Application Certification
Feel free to contact me at 919-577-3150 should you have any questions or need additional
information in order to process this application.
Sincerely,
E
uSpriea by:
7
CJaNO
Kendra D. Parrish, P.E., CFM
Executive Director of Utilities and Infrastructure
KP/ek
cc: Project Consultant Engineer, Chris Glass, PE
Rachel Ingham, Engineering Manager
Drew Johnson, Development Construction Manager
Emily Koncz, Utility Permitting Specialist
Project filelCorrespondence 442046
Rachel Ingham
Engineering Manager - utilities
3002
04.17.2018
Utilities and .Infrastructure Services
P.O. Box 8 9 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc.gov

DocuSign Envelope ID: 478C4503-47OD-43F2-9B66-967E32BOE091
TIMMONS GROUP
Oakview Mixed Use
Date: 12-28-22 Job #: 48803
Items included in package:
5410 Tnnity Road P 919.866,4951
Suite 102 F 919,859.5663
Raleigh, NC 27607 wwwOmmomcom
NC Dept of Environmental Quality
MAR 2 2023
Raleigh Regional Office
COPIES
DATE
NUMBER
Di=SCRIPTION
1
Full Size Civil Plan Set
1
Fast Track Sewer System Extension Application
1
Sewer Design Certification
1
$480.00 Check NCDEQ
1
$200.00 Check Town of Holly Springs)
1
USGS Topographic Ma
1
Street Level Ma(vicinity map shown on C0.0
Cover Letter:
The proposed project is in Town of Holly Springs, located at the intersection of New Hill Holly Springs
Road and Green Oaks Pkwy. The scope of the project will include the construction of one Town of Holly
Springs access road, a water main, reclaimed water main and sanitary sewer main. The proposed
sanitary sewer system will serve the surrounding properties and connect to an existing main on the
southwest side of the site along Helix Place, to ultimately connect to the Town's existing pump station.
The new gravity sanitary sewer system will be owned, operated, and maintained by the Town of Holly
Springs. The sanitary sewer main is made up of:
Size (inches] Length (feet) Material
8 -974 PVC
401/404 permits are not required for this project.
ENGINEERING I DESIGN TECHNOLOGY

DocuSign Envelope ID: 47BC4503-47OD-43F2-9B66-967E32BOE091
DO NOT SUBMIT SEWER EXTENSION APPLICATIONS UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BY STAFF!
Sewer Design and Application Certif cation C Dept of Environmental uualit
Note: This form must be submitted with the Fast Tract Application for extension to the Town of
I lolly Springs Sewer System MAR 2 No' -
Project.
Design Engineer:
oakview mixed -use
Timmons Group, Blake Hall, PE
R*eeital Office
Address:
5410 Trinity Rd. Ste 102, Raleigh, NC 27607
Phone Number: r019) 866-4933 [e-mail]
Email:
Date Complete Application Package Received by Town:
ue na
Date Approved: _ �z _ (by RI) { '
2/21/2023
(by KDP) 6 (by DJ)
As design engineer for this project, I certify the following [please check (x) each applicable box]:
® That the design of the project is in conformance with the Town of Holly Springs
Engineering Design and Construction Standards and NC DEQ Sanitary Sewer Design
Regulations;
® That each of the following items arc complete and have been digitally submitted to the
Town via CityView for a sewer extension permit:
Rl One cover letter (includes a project narrative)
W One State of North Carolina form FTA 06-21 Fast Tract Sewer System
Extension Application
1� One FTSE 10-18 Flow Tracking for Sewer Extension Applications
Q One color copy of an 8.5-inch by 11-inch portion of a 7.5-minute USGS
Topographic Map showing project area
® One copy of a street level map showing project components
® One copy of the Iocally-required Design and Application Certification (this
form)
® That each of the following items have been submitted to the Town for a sewer extension
permit:
IN A check in the amount of $480.00 to NC DEQ
® A check in the amount of $200.00 to the Town of Holly Springs
Design Engineer's Signature FL�k`"ll Date 2/21/2023
Please contact rmily Koncz at [phone] or [e-mail] ifyou
have any questions.
2003 Sewer Design Application Certification
10.26.22
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • holly Springs, NC 27540 - wpvw.hollyspringsnagov

one
olio

Certificate Of Completion
Envelope Id: 478C4503470D43F29B66967E32BOE091
Subject: Oakview Mixed Use Sewer
Source Envelope:
Document Pages: 12 Signatures: 4
Certificate Pages: 5 Initials: 4
AutoNaw Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
Record Tracking
Status: Original
2/20/2023 10:50:29 AM
Signer Events
Rachel Ingham
[e-mail]
Engineering Manager - Utilities
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 11/162020 9:41:26 AM
ID: Oc7f672d-8bab-496f-91 f1-115266328d46
Company Name: Town of Holly Springs
Blake Hall
[e-mail]
5/26/2020
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 2/21/2023 8:13:15 AM
ID:11b20ed6-6bea-4b0e-9d6l-940bacd647b2
Company Name: Town of Holly Springs
Drew Johnson
[e-mail]
Development Construction Manager
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 2/21/2023 8:19:46 AM
ID:11860b4c-lad5-4d09-b645-776b00528aid
Company Name: Town of Holly Springs
Kendra Parrish
[e-mail]
Exec Director of Utilities and Infrastructure
Holly Springs
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Holder: Emily Koncz
[e-mail]
Signature
os
Signature Adoption: Pre -selected Style
Using IP Address: 75.189.128.27
957A2204A914812
l &4e "Ad
DocuSignd By: Blak• Hall
Signature Adoption_ Pre -selected Style
Using IP Address: 104.15.28.241
C�'Jl
Signature Adoption: Pre -selected Stye
Using IP Address: 204.84.166.2
o«uabmd ey.
e5assvwaaao
Signature Adoption. Drawn on Device
Using IP Address: 204.84.166.2
DocuSign
Status: Completed
Envelope Originator.
Emily Koncz
PO Box 8
Holly Springs, NC 27540
[e-mail]
IP Address: 204.84.166.2
Location: DocuSign
Timestamp
Sent: 2/20/2023 11:02:32 AM
Resent: 2/21/2023 8:02:46 AM
Viewed: 2/21/2023 8.11.25 AM
Signed: 2121 /2023 8-12-42 AM
Sent: 2/21/2023 8:12:46 AM
Viewed: 2/21/2023 8:13.15 AM
Signed: 2/21/2023 8:15.59 AM
Sent: 2/21/2023 8:16:03 AM
Viewed: 2/21/2023 8:19:46 AM
Signed: 2/21/2023 8:19:56 AM
Sent: 2/21/2023 8:19:59 AM
Viewed: 2/21/2023 2:48:47 PM
Signed: 2/21/2023 2:48:55 PM

Signer Events
Signature
Timestamp
Accepted: 4/6/2021 7-18 46 PM
10: 6cbf2406-2f8d-06a2-8e81-c6f600daf744
Company Name Town of Holly Springs
In Person Signer Events
Signature
Timestamp
Editor Delivery Events
Status
Timestamp
Agent Delivery Events
Status
Timestamp
Intermediary Delivery Events
Status
Timestamp
Certified Delivery Events
Status
Timestamp
Carbon Copy Events
Status
Timestamp
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed; Encrypted
2/2012023 11:02:32 AM
Envelope Updated
Security Checked
2/20/2023 4:41:22 PM
Envelope Updated
Security Checked
2/20/2023 4:41:22 PM
Envelope Updated
Security Checked
2/20/2023 4:41:23 PM
Envelope Updated
Security Checked
2/20/2023 4:41:23 PM
Envelope Updated
Security Checked
2/21/2023 8:02:32 AM
Envelope Updated
Security Checked
2/21/2023 8:02:32 AM
Envelope Updated
Security Checked
2/21/2023 8:02 32 AM
Certified Delivered
Security Checked
2/21/2023 2:48 47 PM
Signing Complete
Security Checked
2/21/2023 2:48 55 PM
Completed
Security Checked
2/21/2023 2:48 55 PM
Payment Events
Status
Timestamps
Electronic Record and Signature Disclosure

Electronic Record and Signature Disclosure created on: 11/12/2020 9:42:57 PM
Parties agreed to: Rachel Ingham, Blake Hall, Drew Johnson, Kendra Parrish
r i
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, Town of Holly Springs (we, us or Company) may be required by law to
provide to you certain written notices or disclosures. Described below are the terms and
conditions for providing to you such notices and disclosures electronically through the DocuSign
system. Please read the information below carefully and thoroughly, and if you can access this
information electronically to your satisfaction and agree to this Electronic Record and Signature
Disclosure (ERSD), please confirm your agreement by selecting the check -box next to `I agree to
use electronic records and signatures' before clicking `CONTINUE' within the DocuSign
system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per -page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to
receive required notices and consents electronically from us or to sign electronically documents
from us.
All notices and disclosures will be sent to you electronically

Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or made
available to you during the course of our relationship with you. To reduce the chance of you
inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact Town of Holly Springs:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: [e-mail]
To advise Town of Holly Springs of your new email address
To let us know of a change in your email address where we should send notices and disclosures
electronically to you, you must send an email message to us at [e-mail]
and in the body of such request you must state: your previous email address, your new email
address. We do not require any other information from you to change your email address.
If you created a DocuSign account, you may update it with your new email address through your
account preferences.
To request paper copies from Town of Holly Springs
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an email to [e-mail] and in
the body of such request you must state your email address, full name, mailing address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Town of Holly Springs
To inform us that you no longer wish to receive future notices and disclosures in electronic
fonnat you may:

i. decline to sign a document from within your signing session, and on the subsequent page,
select the check -box indicating you wish to withdraw your consent, or you may;
ii, send us an email to [e-mail] hollyspringsnc.us and in the body of such request you must
state your email, full name, mailing address, and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: https:::`support.docusi nuides `sig ier-guide-
signing -system -requirements.
Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm that you have
read this hRSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further,
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check -box next to `I agree to use electronic records and signatures' before
clicking `CONTINUE' within the DocuSign system.
By selecting the check -box next to `I agree to use electronic records and signatures', you confirm
that:
You can access and read this Electronic Record and Signature Disclosure; and
You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
Until or unless you notify Town of I lolly Springs as described above, you consent to
receive exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to you by Town of Holly Springs during the course of your relationship with
Town of I lolly Springs.