WQ0043049_Application (FTSE)_20240425

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23&SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION: "
1. Applicant's name: (company.municipality,HOA,utility,etc.)
2. Applicant type: ❑Individual ❑Corporation ❑General Partnership ❑Privately-ONxnied Public Utility
❑Federal ❑State/County ®Municipal ❑Other
3. Signature authority's name:Mr.Jimmy Cook.PE per 15A NCAC 02T .0106(b)
Title:Town Engineer
4. Applicant's mailing address: PO Box 278 'ECEn 'Er-'
o•
City: Angier State:NC Zip:27501-
5. Applicant's contact inforniation: A'AR f ���/
Phone number:[phone] Email Address: icook ci=gier.com 7;z,.1-1(?,.,-X
Il. PROJECT INFORMATION: "'-FAYETTEVILLE REGIONAL OFFICE
1. Project name:Modified Kennebec Crossing Subdivision
2. Application/Project status: ❑Proposed(New Permit) ®Existing Permit/Project ❑ARPA funded
If a modification,provide the existing permit number: WQ0043049 and issued date: MARCH 3.2021.
For modifications,also attach a detailed narrative description as described in Item G of the checklist.
If new construction,but part of a master plan,provide the existing permit number:WQ00
3. County where project is located:Franklin
4. Approximate Coordinates(Decimal Degrees):Latitude: 35.5349: Longitude:-78.7543
5. Parcel ID(if applicable): 0675302448.0674390203.0674391027(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer:Brian E.Johnson,PE License Number:045625
Finn:ESP Associates
Mailing address:2200 Gateway Centre Boulevard.Suite 216
City: Morrisville State:NC Zip: 27560-
Phone number:[phone] Email Address:biot hnson(a;espassociates.com
IV. WASTEWATER TREATMENT FACILITY(WWTF)INFORMATION:
1. Facility Name:North Harnett Regional W WTP Permit Number:NC0021636
Owner Name:Harnett County Public Utilities
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s):WQ
2. Downstream(Receiving) Sewer Information: inch x Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s)(if applicable):WQCS00183
Owner Name(s):Town of Angier
FORM:FTA 10-23 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately-Owned Public Utility,has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ®N/A
2. 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 Hotne/Property Owners'Association,has an IIOAJPOA Operational Agreement(FORM:HOA)and
supplementary documentation as required by 15A NCAC 02T.0I 15(c)been attached?
❑Yes ❑ No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential(Individually Owned) ❑ Retail(stores,centers,malls) ❑ Car Wash
❑ Residential(Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School/preschool/day care ❑ Medical/dental/veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities
❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses/offices/factories ❑ Nursing Home ❑ Other(Explain in Attachment)
5. Nature of wastewater: 100%Domestic 0%Commercial 0%Industrial(See 15A NCAC 02T.0103(20))
If Industrial,is there a Pretreatment Program in effect?❑Yes ❑No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ® Yes ❑ No
If yes.provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type(see 02T.0I14(f)) Daily Design Flow a.b No.of Units Flow
3 Bedroom Units 75 gal/bedrooin/day 35 7,875 GPD
4 Bedroom Units 75 gal/bedroom/day 18 5,400 GPD
5 Bedroom Units 75 gal/bedroom/day 23 8,625 GPD
gay GPD
gal/ GPD
gal/ GPD
Toted 21,900 GPD
a See 15A NCAC 02T .01 14(b). (d).mil)and (e)_(2) for caveats to wastewater design flow rates(i.e. proposed unknown
non-residential 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.01 141 shall be
determined using available flow data,water using fixtures,occupancy or operation patterns,and other measured data.
8. Wastewater generated by project:21.900 GPD(per I SA NCAC 02T.0114 and G.S. 143-215.1)
- 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 pennitting 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:FTA 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA(If Applicable)-02T.0305&MDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size(inches) Length(feet) Material
8 3,021 SDR 35 PVC
8 81 DIP
P_ Section II&III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Section III contains information related to of
slopes for gravity sewer(s)
Oversizing lines to meet minimum slope requirements is not allo`ved and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA(If Applicable)—02T.0305&11IDC(Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates(Decimal Degrees):Latitude: Longitude:-
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions-allons 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 method of solids reduction per
MDCPSFM Section 2.01 C.l.b.❑Grinder Pump ❑ Mechanical Bar Screen ❑Other(please specify)
h. Power reliability in accordance with 15A NCAC 021 .0305(h)(1�:
❑ Standby power source or ❑ Standby pump
),w Must have automatic activation and telemetry- 15A NCAC 02T.0305(h)(1)(B):
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
v Must 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-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 applicant and is compatible with the station.
i If the portable power source or pump is dedicated to multiple pump stations,an evaluation of all the pump stations'storage
capacities and the rotation schedule of the portable power source or pump,including travel timeframes,shall be provided
as part of this pennit application in the case of a multiple station power outage.
FORM:FTA 10-23 Page 3 of 5

IX. SETBACKS&SEPARATIONS—(02B.0200& 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 021'.0305(f)&(y)? ®Yes ❑No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below(vertical) 18 inches
2Water mains(vertical-water over sewer preferred,including in benched trenches) 18 inches
'Water mains(horizontal) 10 feet
Reclaimed water Iines(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-1 or WS-V),B,SA,ORW,HQW,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
If noncompliance with 02T.0305M or(e),see Section X.1 of this application
*15A NCAC 02T.0305(t)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.
**Stream classifications can be identified using the Division's NC Surface Water Classifications Nvebnag
2. Does this project comply with the minimum separation requirements for water mains? ®Yes ❑ No ❑N/A
i- If no,please refer to 15A NCAC 18C.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 ❑NIA
y Please provide supplementary information identifying the areas of non-conformance.
Y See the Division's draft separation requirements for situations where separation cannot be met.
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: CAPE FEAR ❑No
If yes,does the project comply with setbacks found in the river basin rules per 15A NCAC 02B.0200? ❑ Yes [—]No
y This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ®Yes ❑No
or 401 Water Quality Certifications'?
S- Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6)(additional permits!certifications)? ®Yes ❑No
Per 15A 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 I5A 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 permittne 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:FTA 10-23 Page 4 of 5

X. - CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T,the Minimum Design Criteria for the Pennitting
of and Force Mains(latest version).and the Gravity Sewer Minimum Design Criteria(latest version)as applicable?inp Stations
®Yes ❑No
If no, 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. Approval of the request will be issued
concurrently with the a roval of the ermit and ro'ects requiring a variance approval may be su.11 bject to Ionizer
review times.For ro'ects re uirin f y or more variances or where the variance is determined by the Division to be a
significant portion of the project the full technical review is required
2. Professional Engineer's Certification:
I, Brian E. Johnson, PE attest that this application for Kennebec Crossing Subdivision
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item Il.l)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications,engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers latest version),and the Minimum Design Criteria for the Fast-Track Permitting
of Puma Stations and Force Mains(latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, 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$l 0,000,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 Engineer to referral to the licensing board. (21 NCAC 56.0701)
..........�``�1t111.411/1y)..�..........
North Carolina Professional Engineer's seal,signature,and date: ♦♦�V-(N CAM
SS
��`� •�Z9 SEAL
i •• i ' .... • 04562
562
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LICENSE NO.: -
F-1407
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�i�,o •'••.........••'��'`♦. :..... /�//lttl►t\U�............
3. Applicant's Certification per 15A NCAC 02T.0106(b)�,,i,,S;Q'I;;``\ \,"-♦ 2024.03.13 17:10:23-04'00'
I, ` attest that this application for �1 �-t Ke",tb e t 6fe.y3 1 V>
llpl.�reVAuthority Name from Application Item I.3.) (Pro-- ject Name from Application Item 11.I)
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. I understand that any
discharge of wastewater from this non-discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties,injunctive relief,and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed$10,000 as well as civil penalties up to$25,000 per violation.
Signature: Date: �y
FORM:FTA 10-23
Page 5 of 5

RECEIVE ["
MAR 1 ( 2024 State of North Carolina
Department of Environmental Quality
®FO-FAYETTEVILLF REGIONAL OFFIC Division of Water Resources
e Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Town of Angier
Project Name for which flow is being requested: Kennebec Crossing Mod(Angier)
More than one FTSE maybe required for a single project if the owner of fire WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Harnett County North Regional WWTP
b. WWTP Facility Permit#: NCO021636
A11 flows are in MGD
c. WWTP facility's permitted flow 7.500
d. Estimated obligated flow not yet tributary to the WWTP 3.224
e. WWTP facility's actual avg. flow 4.431
f. Total flow for this specific request 0.021
g. Total actual and obligated flows to the facility 7.676
h. Percent of permitted flow used 102.35%
H. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated;
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm/pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow,MGD MGD Flow Capacity***
SLS-120 14.4 5.760 3.348 2.328 5.676 0.084
*The Firm Capacity(design flow)of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
**Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor(pf)not
less than 2.5,per Section 2.02(A)(4)(c)of the Minimum Design Criteria.
***A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is<0.
Downstream Facility Name (Sewer): North Harnett Regional WWTP
Downstream Permit Number: NCO021636
Page 1 of 8
FTSE 10-23

III. Certification Statement:
I Steve Ward, Utilities Director certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendurns for which I
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 proposed new wastewater.
Signing Official Signature W Date
Title of Signing Official
Page 2 of 8
FTSE 10-23

DPP
REGE. 1"
. State of North Carolina
2 024 Department of Environmental Quality
Division of Water Resources
DEQ-FAYETTEVILLE F MONU Jog for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Town of Angier
Project Name for which flow is being requested: Modified Kennebec Crossing
Afore than one FTSE may be required for a single project if the owner of the WWTP is not responsible for an punip
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: North Harnett WWTP
b. WWTP Facility Permit#: NCO021636
All flows are in MGD
c. WWTP facility's permitted flow 1.008
d. Estimated obligated flow not yet tributary to the WWTP .733
e. WWTP facility's actual avg. flow .7008
f. Total flow for this specific request .021
g. Total actual and obligated flows to the facility 1.45
h. Percent of permitted flow used 144%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow" Current Tributary Flow Plus
(Name or Permit Capacity, (Firm/pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow,MGD MGD Flow Capacity—
3 .270 .108 .056 .021 .077 .031
Y The Firm Capacity(design flow)of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
xx Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor(pf)not
less than 2.5,per Section 2.02(A)(4)(c)of the Minimum Design Criteria.
xx A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is<0.
Downstream Facility Name (Sewer): Town of Angier, NHRWWTP
Downstream Permit Number: WQCS00183,NC0021636
Page 1 of 8
FTSE 10-23

III. Certification Statement:
I Jimmy Cook certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsi le party. Signature of this form certifies that the receiving collection system or treatment
works has ade ate capacity to transport and treat the proposed new wastewater.
lid - '3- 13 )1-
Si ng If
cial Signature - �
L vt 5 �t-cL`�br Date
We of Signing Official
Page 2 of 8
FTSE 10-23

N
i�
p4,
mcopomloa L'ti
1901
of
Crepe
Town of Angier
www.angier.org
Robert M. Jusnes, Sr. Elizabeth Krige Veronica Hardaway
Mayor Town Manager Town Clerk
March 15, 2024 RECEIV-
E
U
Trent Allen NEAR 1,�a
Division of Water Resources Z�Z�i
Fayetteville Regional Office ®EQ-FAYETTEVILLEREGIONALpFF3�
Water Quality Section
225 Green Street Suite 714
Fayetteville,NC 28301-5095
Reference FTA Permit Modification Request-Kennebec Crossing Subdivision
Mr. Allen,
We respectfully request your consideration to modify Kennebec Crossing Subdivision Permit
No. WQ0043049 issued on March 3, 2022. All items within the permit remain unchanged with
the exception of General Requirements (7) Pursuant to Session Law 2023-55, Senate Bill 673 we
are requesting a reduction in the daily design flow and therefore the total flow from 120 GPD/BR
to 75 GPD/BR.
Please reverence the Engineer's memo that Summarizes the waste water generated by the
project. The original permit had (83) 3BR homes permitted at 29,880 GPD. (7) homes have
become tributary
We are requesting (35) 3BR homes permitted at 7,875GPD and (18) 4BR homes permitted at
5,400 GPD and (23) 5BR homes permitted at 8,625 Total flow request is 21,900 GPD This is a
reduction of 7,980 GPD.
Items included in this package:
1. (1) Check for$600.00
2. (2)Modified Fast Track sewer system extension application
3. (2) Wastewater Collection System Extension Permit No. WQ0042822
4. (2) Memo from Engineer
5. Harnett County FTSE
6. Town of Angier FTSE
If you have any question please let me know.
Jimmy Cook
Town of Angier
Public Works Director
919-331-6708
Post Office Box 278 • Angier,North Carolina 27501-0278 • [phone]

DocuSign Envelope ID:AC84AAAE-3B54-46D5-B892-6CDBF78F8D06
STnr
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
Town of Angier
Wake County
for the construction and operation of approximately 3,102 linear feet of 8-inch gravity sewer to serve 50
four-bedroom and 33 three-bedroom homes as part of the Kennebec Crossing Subdivision project, and
the discharge of 35,800 gallons per day of collected domestic wastewater into the Town of Angier's
existing sewerage system, pursuant to the application received December 3, 2021, and additional
information received on February 9 and March 2, 2022 and in conformity with 15A NCAC 02T; the
Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 and updated in March
2008, 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:
s t 'U�. w
BCDA9D825D4A46D...
for S. Daniel Smith
Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0043049
Permit Issued: March 3, 2022
Page 3 of 9