WQ0043526_Owner (Name Change)_20240130

Boulevard
Real Estate Advisors
DATE: 1/29/24
TO: NCDEQ-DWR
512 N. Salisbury St. suite 925
Raleigh, NC 27604
We are sending you:
Via:
❑ Mail ® FedEx ❑ FedEx PON
Copies Date Description
2 1/29/24
2 1/29/24
2 1/29/24
For your:
TRANSMITTAL
RECEIVED
JAN 3 0 2024
NCDEQ/DWR/NPDES
❑ Messenger ❑
NWR Sewer System Permit Ownership Change Application
Most Recently Issued Permit and Certification
Deed / Proof of Ownership
❑Review and Comment ❑ Review ® Use
REMARKS:
Signed: L744CAZX�
Amy Denmark
END.
❑ See Remarks ❑
2100 Hastings Dr Charlotte, NC 28207 [e-mail]

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permittee" references the
existing permit holder, and that "Applicant" references the entity applying for the ownership/name change. RREF ;;FF F
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the sLnjimpThtSD
form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting's website: JAN 3 U 2024
A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All ApplicatiNODEWWR/WDES
® Submit an original completed and appropriately executed application (PNOCF 01-16).
® The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
® The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0I06(b).
B. Existing Permit (All Applications):
® Submit a copy of the most recently issued permit and certification.
C. Property Ownership Documentation (All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities:
® Legal documentation of ownership (i.e., GIS, deed, article of incorporation, or contract), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be
sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .O1 15(b), submit an original of the properly executed Operational Agreement (FORM: DE)).
F. Package Submitted in Duplicate
® Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ - DWR
Water Quality Permitting Section
PERCS Unit
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1636 SUITE 925
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

DWR
Division of Water Resources
I. EXISTING PERMITTEE INFORMATION:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM: PNOCF 01-16
1. Permittee's name: Boulevard at 4920 S. Tryon, LLC
2. Signature authority's name: Chris Branch per 15A NCAC 02T .0106(b)
3. Signature authority's title: Manager
4. Permittee's mailing address: 2100 Hastings Dr.
City: Charlotte State: NC Zip: 28207-
5. Permittee's contact information: Phone number. 7( 04) 604-5357 Fax Number
Email Address: accountingAblvdrea.com
IL APPLICANT INFORMATION:
1. Applicant's name: AHC Cama I, LLC
2. Signature authority's name: Tom Zabor per 15A NCAC 02T .0106(b)
3. Signature authority's title: Authorized Signatory
4. Applicant's mailing address: 1603 Orrington Ave., suite 990
City: Evanston State: IL Zip: 60201-
5. Applicant's contact information: Phone number: 847) 733-2235 Fax Number
Email Address: tzabor e,ahcfunds.com
6. Representative's name: Daniel A. Broderick
7. Representative's title:
8. Representative's contact information Phone number: 9( 19) 423-9777 Fax Number (_)
Email Address: dbroderickna.ahcfunds.com
III. PERMIT INFORMATION:
1. Existing permit number: W00043526 and most recent issuance date: 6/14/2022
2. Reason for the permit application: Change of Ownership If other, attach detailed explanation
3. Has the facility been constructed? ® Yes or ❑ No
4. Has the facility been certified per 15A NCAC 02T .0116? ® Yes or ❑ No
FORM: PNOCF 01-16 Page 1 of 2

IV. CERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T .0106(b):
I, Chris Branch, Manager attest that this application
(Signature Authority's name & title from Application Item L2 & 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition ofthe existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included, this application will be returned to me 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 $10,000 as well as V
nalties up to $25,000 per violation.
Signature: Date: 1-29-24
Applicant's Certification per 15A NCAC 02T .0106(b):
I, Daniel A. Broderick, Authorized Signatory attest that this application
(Signature Authority's name & title from Application Item IL2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non -
discharge system to surface waters or the land may result in an 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 ofthis 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: Z�'aw+-W A. 94e44u Date: 1/17/2024
FORM: PNOCF 01-16 Page 2 of 2

B36900 - P 821
For Registration
Fredrick Smith
Register of Deeds
Mecklenburg County, NC
Electronically Recorded
2021 Dec 22 12:36 PM RE Excise Tax: $ 0.00
Book: 36900 Page: 821 - 825 Fee: $ 26.00
Instrument Number: 2021240831
�ftk-
NORTH CAROLINA NON -WARRANTY DEED
Excise Tax: $0.00 (Taxes paid on earlier Special Warranty Deed)
Parcel Identifier No. 149-025-03
Verified by County on the day of 2021. By:
Mail to: Grantee, 1603 Orrington Avenue, Suite 990, Evanston, IL 60201
This instrument was prepared by: Jon Mendi,u, a validly licensed NC Attorney, without opinion on tax or title examination.
[ ] Property conveyed includes Grantors primary home, if checked.
THIS DEED made this ,>21 $-' day of December 2021, by and between
GRANTOR
Larry Thomas Hagler and wife,
Brenda Gregory Hagler, and
Carl William Gregory, Jr. and wife,
Sophia Gregory, and
Donna Gregory Ward, unmarried
Mailing Address:
5640 Sharon Road
Charlotte, NC 28210
GRANTEE
AHC Cama I, LLC
a NC limited liability company
1603 Orrington Avenue, Suite 990
Evanston, IL 60201
Property Address:
4029 S Tryon Street
Charlotte, NC 28217
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall
include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain
lot or parcel of land situated in the City of Charlotte, _Township, Mecklenburg County, North Carolina and more
particularly described as follows:
SEE EXHIBIT `A'
submitted electronically by "Bishop Dulaney ]oyner & Abner, P.A."
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Mecklenburg county Register of Deeds.

B36900 - P 822
The property hereinabove described was acquired by Grantor by instrument recorded in Deed Book _ page
See Estate of Carl W. Gregory, Sr. 10-E-3790, Mecklenburg CSC.
A trap showing the above -described property is recorded in Map Book 5 page 392.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to
the Grantee in fee simple.
The Grantor makes no warranty, express or implied, as to tick to the property hereinabove described.
M WITNESS WHEREOF, the Grantor has caused this instrument to be duly executed and delivered.
Lam A- -�
Brenda Gregory Hagle
State of o f!.'/�— —iIIZD �t�-- , COItnty of
a Notary Public for the County and State aforesaid, do hereby certify that
Larry Thomas Flag r and Brenda Gregory Hagler personally appeared before me this day and acknowledged the due
execution of the foregoing instrument. "P Hu�,11"
Witness my hand and official seal thiss day of D etzmb eR - 2021. ?c'
IOTA*),
Notary Public (print) 4/3 c-- Wg' t t/%
My commission expires: /vp ve n6 dw-- /1 r aoa 3

B36900 - P 823
IN WITNESS W MEOP, the Grantor has caused this insutument to be duly executed and delivered.
State of 9 tw 0 A-)(— . County of t� Q -Q Q lam=
•f- btLL4S i a Notary Public far the County and State aforesaid, do hereby certify that
Cad Wil"atn Gregoly, Jr. and Sophia H. Gcogory Personally appeared before me this day and acknowkdged the due
execution of the foregoing instnunent.
Wetness my hand and official seat this. day of t%C ern b er`_ OiA) AAS1
NASSTATE �AK
COMM. EXP C, # OIpE 3704
Notary Public (print) VAILY "CL A T•.: ^e-a S L
f'. My commis Stoa expires:

B36900 - P 824
IN WITNESS WHEREOF, the Grantor has caused this instrument to be &* executed and delivered.
AS
a Rotary Public for the County and State aforesaid, do hereby certify that
Donna Gregory Ward personally appeared before me this day and acknowledged the due execution of the foregoing
instrument.
Whncss m hand and official scat this 4t1 y
y �„ der of, �P � b� .2021.
My commission expires: 10 _ � I , 203 t

B36900 - P 825
EXHIBIT'A'
TAX PARCEL 1
That certain tract or parcel of land situated, lying and being In the City of Charlotte, County of Mecklenburg,
State of North Carolina and being more particularly described as follows:
BEGINNING at a new 1/2 inch iron rod on the southeasterly right-of-way margin of South Tryon Street
(variable width Public R/W), said iron being the northwest corner of Lot A, Boundary and Subdivision Plat of
4101 South Tryon Street, as recorded In Map Book 41, Page 525 in the Mecklenburg County Public Registry
(the "Registry"); Thence with and along aforesaid southeasterly right-of-way margin of South Tryon Street N
34°06'18" E a distance of 75.00 feet to a new 1/2 inch iron rod, said iron being the southwest corner of the
property of Clanton Presbyterian Church (now or formerly) as described in Deed Book 13955, Page 797 in
said Registry, Thence with and along the southwesterly boundary of aforesaid property of Clanton Presbyterian
Church S 5r13151" E (passing an existing 1 inch iron rod at 189.69 feet) a total distance of 190.00 feet to a
point on the northwesterly boundary of the property of Charles Jonas Highway Properties LLC (now or
formerly) as described in Deed Book 33630, Page 377 in said Registry; Thence with and along aforesaid
northwesterly boundary of the property of Charles Jonas Highway Properties LLC S 34°06'18" W a distance
of 75.12 feet to a new 1/2 inch iron rod; Thence with and along the northwesterly boundary of Lot B if extended
and continuing with the northwesterly boundary Lot A, Boundary and Subdivision Plat of 4101 South Tryon
Street, as recorded In Map Book 41, Page 525 in said Registry N 57*11138" W (passing an existing 1/2 inch
iron rod at 1.63 feet and at I W61 feet) a total distance of 190.00 feet to the point of BEGINNING;
Having an area of 14,258 square feet or 0.3273 acre, as shown on a survey prepared by R. B. Pharr &
Associates, P.A. dated November 11, 2019 (job no. 90737).

ROY COOPER
(,overnor'
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Mr. Chris Branch
Boulevard at 4029 S. Tryon, LLC
2100 Hastings Drive
Charlotte, NC 28207
NORTH CAROLINA
Environmental Quality
June 14, 2022
Subject: Permit No. WQ0043526
Boulevard at 4029 S. Tryon, LLC
East Cama Townhomes
Wastewater Collection System Extension Permit
Mecklenburg County
Dear Mr. Branch,
In accordance with your application received June 10, 2022, we are forwarding herewith Permit No.
WQ0043526 dated June 14, 2022, to Boulevard at 4029 S. Tryon, LLC (Permittee) for the construction and
operation upon certification of the subject wastewater collection system extension. This permit shall be
effective from the date of issuance until rescinded and shall be subject to the conditions and limitations
as specified therein. This cover letter shall be considered a part of this permit and is therefore
incorporated therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11.4: Requires that the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 2T .0403 or any individual system -wide collection system
permit issued to the Permittee.
Condition 11.7: Upon completion of construction and prior to operation of these permitted facilities, the
completed Engineering Certification form with checklist attached to this permit shall be
submitted with the required supporting documents to the address provided on the form.
Permit modifications are required for any changes resulting in non-compliance with
this permit, regulations, or the Minimum Design Criteria. [15A NCAC 02T.0116j
It shall be 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
,-D E Q North Carolina DepartmeW of Environ"K"ad Qua ty P Dhitslon of Water Re�urces
Mooresville Regional Office bto East Center Avenfie, Suite 301 { Moorewdle, North Carolina 2811'.

Boulevard at 4029 S. Tryon, LLC
Permit No. WQ0043526
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 150E 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.
If you need additional information concerning this matter, please contact Barry Love at [phone]
or via e-mail at [e-mail].
Sincerely,
DocuSigned by:
A14CC681AF27425...
for Richard E. Rogers, Jr.
Director, Division of Water Resources
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
cc: R. Allen McDowell, P.E. (electronic copy)
Charlotte Water (electronic copy)
Tommy Rowland (electronic copy)
Water Resources Central Files (electronic copy)
Regional Office Files
Page 2 of 8

NORTH CAROLINA
Environmental Quality
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
Boulevard at 4029 S. Tryon, LLC
Mecklenburg County
for the construction and operation of approximately 301 linear feet of 6-inch gravity sewer as part of the
East Cama Townhomes project, and the discharge of 3,040 gallons per day of collected domestic
wastewater into the Charlotte Water existing sewerage system, pursuant to the application received June
10, 2022 and in conformity with 15A NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria
adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting
data subsequently filed and approved by the Department of Environmental Quality and considered a part
of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the specified
conditions and limitations contained therein.
DocuSigned by:
A14CC681AF27425...
for Richard E. Rogers, Jr.
Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0043526
Permit Issued: June 14, 2022
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
Boulevard at 4029 S. Tryon, LLC 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 Irwin Creek
Wastewater Treatment Facility in accordance with Permit Number NC0024945.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A 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.
I��;7X�IT ��LiI►1]rrL�L`��
1. This permit shall become voidable unless the agreement between Boulevard at 4029 S. Tryon, LLC and
Charlotte Water for the collection and final treatment of wastewater is in full force and effect. [15A
NCAC 02T.0304(h)]
2. No flow in excess of the quantity permitted herein, 3,040 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. [15A NCAC 02T.0304(b)]
II. STANDARD CONDITIONS
1. This permit shall not be 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 143-215.1(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]
3. 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.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. Documentation shall be kept for Subparagraphs (a) through (i) of this Rule 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
hours, following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Page 5 of 8

Voice mail messages or faxed information is permissible, but this shall not be considered as the initial
verbal report. Overflows and spills occurring outside normal business hours may also be reported to
the Division of Emergency Management at telephone number [phone] or [phone].
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence. This report must outline the actions taken or proposed to be taken to
ensure that the problem does not recur. Part II of Form CS-SSO (or the most current Division approved
form) can also be completed to show that the SSO was beyond control. [G.S. 143-215.1C(a1)]
6. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State. [15A NCAC 02T.0108(b)]
7. Upon completion of construction and prior to operation of these permitted facilities, the completed
Engineering Certification form with checklist attached to this permit shall be submitted with the
required supporting documents to the address provided on the form. A complete certification is one
where the form is fully executed and the supporting documents are provided as applicable. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Engineer's Certification shall be considered a violation of the permit and shall subject the
Permittee to appropriate enforcement actions.
If the permit is issued to a private entity with an Operational Agreement, then a copy of the Articles
of Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately
filed with the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are
provided as applicable. Supporting documentation shall include the following:
a. One copy of the project construction record drawings (plan & profile views of sewer lines & force
mains) of the wastewater collection system extension. Final record drawings should be clear on
the plans or on digital media (CD or DVD disk) and are defined as the design drawings that are
marked up or annotated with after construction information and show required buffers,
separation distances, material changes, etc.
b. One copy of the supporting applicable design calculations including pipe and pump sizing, velocity,
pump cycle times, and level control settings, pump station buoyancy, wet well storage, surge
protection, detention time in the wet well, and force main, ability to flush low points in force
mains with a pump cycle, and downstream sewer capacity analysis. If a portable power source or
pump is dedicated to multiple stations, an evaluation of all the pump stations' storage capacities
and the rotation schedule of the portable power source or pump, include travel timeframes, shall
be provided.
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 changes of 10% or greater, increased flow,
pump station design capacity design increases of 5% or greater, and increases in the number/type
Page 6 of 8

of connections), regulations, or the Minimum Design Criteria. Requested modifications or variances
to the Minimum Design Criteria will be reviewed on a case -by -case basis and each on its own merit.
Please note that variances to the Minimum Design Criteria should be requested and approved during
the permitting process prior to construction. After -construction requests are discouraged by the
Division and may not be approved, thus requiring replacement or repair prior to certification &
activation. [15A NCAC 02T .0116]
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)]
A copy of the construction record drawings shall be maintained on file by the Permittee for the life of
the wastewater collection facilities. [15A NCAC 02T .0116]
10. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2T; the Division's
Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted June 1, 2000 as
applicable; and other supporting materials may subject the Permittee to an enforcement action by
the Division, in accordance with North Carolina General Statutes §143-215.6A through §143-215.6C,
construction of additional or replacement wastewater collection facilities, and/or referral of the North
Carolina -licensed Professional Engineer to the licensing board. [15A NCAC 02T .0104; 15A NCAC 02T
.0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including those
as may be required by this Division, such as the construction of additional or replacement facilities.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12. The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by the Division any other Federal, State, or Local
government agencies which have jurisdiction or obtaining other permits which may be required by
the Division or any other Federal, State, of Local government agencies. [G.S. 143-215.1(b)]
Page 7 of 8

CERTIFICATION CHECKLIST
To be completed by the certifying engineer prior to operation of the permitted sewers, per 15A NCAC 02T.0116.
Certifying Engineer:
Certification Review Date:
Project Name:
WQ00
Project County:
1) Has permittee information changed since the permit was issued (or last modified): change of mailing address,
change of ownership, transfer from developer to HOA/POA, etc. ❑ Yes ❑ No
• If yes, please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the HOA/POA must occur with the first certification.
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? ❑ Yes ❑ No
3) Final Engineering certification? ❑ Yes ❑ No
• If Partial Engineering certification, provide detailed narrative including what is being certified in the current
phase, what was previously certified (if applicable), and what is left to be certified.
4) Adequate information related to sewer lines: ❑ Yes ❑ No ❑ N/A
• Three feet minimum cover has been provided for all sewers unless ferrous pipe was installed.
• Minimum diameters for gravity sewers are 8-inches for public lines and 6-inches for private lines.
• Manholes have been 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 shall be 4 feet (48-inches).
5) Adequate information related to pump stations: ❑ Yes ❑ No ❑ N/A
• Ensure power reliability option was selected per 15A NCAC 02T.0305(h).
6) Was project construction completed in accordance with all of the following: ❑ Yes ❑ No ❑ N/A
• 15A NCAC 02T, Minimum Design Criteria (MDC) for the permitting of Gravity Sewers (latest version), and !':_71?i:
for the Permitting of Pump Stations and Force Mains (latest version)?
If not, a variance approval is required in accordance with 15A NCAC 02T.0105(b), prior to certification and operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must submit two copies of the variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy).
• The central office will review the variance request, and if approvable, specific language regarding the variance
will be incorporated into the permit, either via a special condition or a supplementary letter. A copy of the
reissued permit with variance language or the variance letter must be maintained with the original documents.
7) Does the project contains high priority lines (15A NCAC 02T .0402(2))? ❑ Yes ❑ No
• If yes, ensure that the permit already contains the necessary condition related to high priority lines 15A NCAC
02T.0403 (a)(5). If the permit does not include this language, the Fast Track reviewer will reissue the permit with
the appropriate language.
8) Are Permit modifications are required for any changes resulting in non-compliance with this permit (including pipe
length difference of 10% or greater, change in flow, pump station design capacity design change of 5% or greater, and
change in the number/type of connections)? ❑ Yes ❑ No
• If yes, a permit modification request must be submitted to the appropriate Regional Office, and a modified
permit with revised certification must be issued prior to certification and operation.
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office Phone: [phone] FAX: [phone]

PERMITTEE: Boulevard at 4029 S. Tryon, LLC
PERMIT #: WQ0043526
PROJECT: East Cama Townhomes
ISSUE DATE: June 14, 2022
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.
Printed Name, Title Signature Date
ENGINEERS CERTIFICATION
I, , as a duI registered Professional En Ineer in the State of North Carolina,
having been authorized to observe (n periodically, ❑ weekly, full time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the best of
my abilities, due care and diligence was used in the observation of the following construction:
approximately 301 linear feet of 6-inch gravity sewer; 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:
❑ Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
North Carolina Department of Environmental Quality I Division of Water Resources
Mooresville Regional Office 1 601 East Center Avenue, Suite 301 1 Mooresville, NC 28115
D 704.663.1699