WQ0045358_Application (FTSE)_20240522

r
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: + ' �O 35(?(to be completed by DWR)
AU items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Carolina Meadows Inc (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County El MunicipalO, ef.,!'v;'e7ia! �t3a�ii f
3. Signature authority's name: Kevin McLeod per 15A NCAC 02T .01061b1
Title: President & CEO
4. Applicant's mailing address: 100 Carolina -Meadows Dr APR 19 2024
City: Chapel Hill State: NC Zip: 21� 17 ;
5. Applicants contact information: Z. 11ce
Phone number: (�19) 942-4014 Email Address: kevin(a)carolinameadows.net
II. PROJECT INFORMATION:
1. Project name: Skilled Nursing Building - Carolina Meadows
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date: ,
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: Chatham
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.8613° Longitude: -7 .022r
5. Parcel ID (if applicable): 20033 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Jamie Powless License Number: 38704
Firm: NV5 Engineers
Mailing address: 3300 Regency Parkway, Suite 100
City: CM State: NC Zip: 27518-
Phone number: 919) 452-7963 Email Address: jamie.powless(@nv5.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Chatham Water Reclamation Facili Permit Number: NC 0056413
Owner Name: Carolina Meadows
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0000866
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Carolina Meadows
FORM: FTA 10-23 Page 1 of 5

Vl. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes [:]No ® NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational been attached?
❑ Yes ❑ No ® NIA
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA QVetatio I Agreement FORM: H(_'fA) and
supplementary documentation as required by t5A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® NIA
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, cbnters, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food prep aration/service ❑ Hotel and/or Motels
❑ School / preschool ? day care ❑ Medical I 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 °'o Domestic _% Commercial % Industrial (See I A CAC 02T .0103(20])
If Industrial, is there a Pretreatment Program in effect? ❑ Yes[—] No
b. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ® No
D If les, provide a copy of flow reduction aporov5d letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow'-b
No. of Units
Flow
Nursing Home
120 gal/bed
90
10800 GPD
gal/
GPD
gall
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
10800 GPD
a See 19A NCAC 02T .0114(b). (d), (e}(1J,a_n feX2] 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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 10800 GPD (per 5,NQAC 02T .0114 and G.S. 143-215.1)
D Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain); _ _
FORM: 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 76 PVC
➢ Section Il & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC.(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 gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at feet total dynamic head (TDH)
S. 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)
6. Power reliability in accordance with 15A NQAQ 02T .0305 h 1):
❑ Standby power source or ❑ Standby pump
➢ 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
➢ 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.
➢ 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 permit 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/altematives found in 15A NCAC 02T .0305f f1 & IRV ® Yes [:]No
15A NCAC 02T.0305(fl contains minimum Renarntinns that shall he nrnvirlerl for sewer euetnme-
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, 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
r it noncompliance wttti uz t.u3UX11 or_= see Section X.l of this application
* 1!,5 NCAC 021305 contains alternatives where separations in 02T.0305 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 Classiftcatinjt� we pggq
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ NIA
➢ If no, please refer to 15A NCAC 18C.0906(0 for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft se aration 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
➢ This includes Trout Buffered Streams per l5A UCAC 2B.02M
5. Does the project require coverage/authorization under a 404 Nationwide/individual pern its ❑ Yes ❑ No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 1$A NCAC92T-010_5_W bj (additional permits/certifications)? ® Yes ❑ No
Per j,5A_NCA002TAI05(cM, 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 li A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: 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 Permitting of Nrrip-Stations
and Force Mains (latest version), and the Graviti Sewer Minimum Design Criteria (latest versionas applicable?
® 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 approval of the permit,, and projects requiring a variance approval may be subject to longer
review times. For nrQjects requiring two 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:
S1C 1 C. t;r0 �lJ{Ji2Sl 1u fi b�U1C D��v�
1, tki L-F1�S , attest that this application for i f. pu-4f 4 _mE AtaAS _
(Professional .ngineer's name from Application Item TH.1.) (Project Name from Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Desigg Criteria f and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest versionl. 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 $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
SKrcc�A /Vc�.jt.5raa� /$u.rr.���'
1, ,�'C� �.S! 'iG�G�D , attest that this application for 64��Pk /"fE rAeWS
(Signature Authority Name from Application Item 13) (Project Name from Application Item 11,1)
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. 1 also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE - In accordance with General Statutes 143-215.6A and 143-215.68, 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: /C/_� Date; W& /7z Z�' —
FORM: FTA 10-23 Page 5 of 5

Docusign Envelope ID: 480EBB93-B5E6-46B7-AC30-1 E917787DC47
NC. Dept ai �i � iiGa;.:%:k,ai Q--
APR 19 2024 State of North Carolina
Department of Environmental Quality
DW.R Rale:gl2 reg:oU, ` Division of Water Resources
Division of Water Resources now Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Carolina Meadows
Project Name for which flow is being requested: Carolina Meadows Skilled Nursing
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Chatham Water Reclamation Facility
b. WWTP Facility Permit #: NC0056413
All flaws are in MGD
c. WWTP facility's permitted flow 0.350
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
0.0181
0.101926
0.0108
0.130826
37.4%
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***
LS-1 Pre1990 uk
0.288 0.1152
0.0342
0.0289 0.0631
0.0521
* 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): Carolina Meadows
Downstream Permit Number: WQ0000866
Page 1 of 8
FTSE 10-23

DocuSign Envelope ID: 480EB893-B5E6-46B7-AC30-1 E91 7787DC47
III. Certification Statement:
I Lauren Raup-Plummer 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 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.
by:
Signature
Engineering Manager
Title of Signing Official
4/17/2024
Date
Page 2 of 8
FTSE 10-23

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• Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings
Non -Profit Corporation
Legal Name
Carolina Meadows, Inc.
Prey Legal Name
Carolina Meadows
Information
Sosld: 0023323
Status: Current -Active O
Date Formed: 9/2/1983
Citizenship: Domestic
Annual Report Due Date:
Registered Agent: McLeod, Kevin A.
Addresses
Mailing
100 Carolina Meadows
Chapel Hill, NC 27517
Officers
Principal Office
100 Carolina Meadows
Chapel Hill, NC 27517
APR 19 2024
Reg Office
100 Carolina Meadows
Chapel Hill, NC 27517
Reg Mailing
100 Carolina Meadows
Chapel Hill, NC 27517

NC Dept of [:nvil-o„ I,tenial Quality NIV15
APR 19 2024
To: NCDEQ DWR Raleigh Regional offiCe
From: Jamie Powless, NV5
Re: Carolina Meadows Skilled Nursing Sanitary Sewer Permitting Cover Letter
Date: April 18, 2024
This project includes the installation of 76 LF of 8" PVC private sanitary sewer pipe and two
manholes for Carolina Meadows Skilled Nursing located at 750 Oak Lane in Chapel Hill, NC. The
proposed building is a 90-bed nursing home facility with a projected daily flow rate of 10,800 GPD.
The following items are enclosed with this permit package.
• Application fee
• Application Fast Track Form FTA 10-23
• North Carolina Secretary of State Registered Business Documentation
• Flow Tracking Acceptance Form FTSE 10-23
• Site Maps
Please contact me at (919) 4S2-7963 or [e-mail] if you have any questions,
comments or concerns.
Sincerely,
Jamie Powless, P.E.
Site/Civil Project Manager
'µHQ IMIItoryq. IV
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04/18/2024
3300 Regency Road, Suite 100 1 Cary, NC 27518 1 www.NVS.com I Office 919.836.4800 I Fax [phone]
CONSTRUCTION QUALiTYASSURANCE - INFRASTRUCTURE ENERGY - PROGRAM MANAGEMENT ENVIRONMENTAL

N V 5
LETTER OF TRANSMITTAL
APR i 9 26el
NC Dept of Ei,
3300 Regency Parky Sutitej100t10'
V tGT:iitCiliil Qiict�;l�/ Cary, NC 27518
P: 919.836.4800
F. 919.851.1918
APR 19 2024 NV5.com
Raleig12 Regio,--QI 0.rnce
To: NCDEQ Date: April 18, 2024
Attn: Water Quality Section
3800 Barrett Drive
Raleigh, NC ** WAND DELIVER **
Re: Carolina Meadows Skilled Nursing
Sanitary Sewer
Job No.: 2022085,00
I am sending you the following item(s):
COPIES DATE NO. I DESCRIPTION
1 I Sanitary Sewer Fast Track Application & Supporting Documents
These are transmitted as checked below:
❑ As requested
® For approval
❑ For review and comment
❑ For your use
071
Remarks:
Please contact me at [phone] orjamie.pow][e-mail] if you have any questions, comments or
concerns.
Copy to
File
Signed: Jamie Powless

NC Dept of Environmental Quality
May 15 2024
Raleigh Regional Office
MORNING AND MAPLE LANE
CHAPEL HILL, NORTH CAROLINA 27517
ECS PROJECT NO. 49:18071
FOR: CONSTRUCTION PRACTICES, LLC
AUGUST 25, 2022

C
ECS Southeast, LLP
"Setting the Standard for Service"
Geotechnical • Construction Materials • Environmental • Facilities
Mr. Stewart Beason
Construction Practices, LLC
1084 West 4th Street
Winston-Salem, North Carolina, 27101
August 25, 2022
ECS Project No. 49:18071
Reference: Waters of the U.S. Delineation Report, Carolina Meadows, Morning and Maple
Lane, Chapel Hill, Chatham County North Carolina
Dear Mr. Beason:
ECS Southeast, LLP (ECS) is pleased submit this report of the Waters of the U.S. (WOUS) services
for the above -referenced site. ECS services were provided in general accordance with ECS Proposal
No. 49:32892 authorized on August 2, 2022 and generally meets the requirements of the 1987 U.S.
Army Corps of Engineers (USACE) Wetlands Delineation Manual and the Regional Supplement to the
Corps of Engineers Wetland Delineation Manual: Eastern Mountains and Piedmont Region, Version
2.0 dated April 2012. Based on our field reconnaissance, potentially jurisdictional WOUS are
not present onsite.
If there are questions regarding this report, or a need for further information, please contact the
undersigned.
ECS Southeast, LLP
Hi44b K'S�
Michelle Measday, CFM, PWS
Environmental Senior Project Manager
[e-mail]
919-861-9910
Brandon Fulton, LSS, PSC, PWS
Environmental Principal
[e-mail]
704-525-5152
5260 Greens Dairy Road, Raleigh, North Carolina 27616 • T: 919-861-9910 • F: 919-861-9911 • ecslimited.com
NC Engineering No. F-1078 NC Geology No. C-553
ECS Florida, LLC • ECS Mid -Atlantic, LLC • ECS Midwest, LLC • ECS Southeast, LLP • ECS Southwest, LLP
ECS Capitol Services, PLLC -An Associate of the ECS Group of Companies

• ECS Southeast, LLP
1.0 INTRODUCTION
This report presents the findings of a wetland delineation conducted by ECS Southeast, LLP (ECS)
for Construction Practices, LLC on a portion of the Carolina Meadows site located at Morning and
Maple Lane, Chapel Hill, Chatham County, North Carolina (35.860349,-79.022365). The project study
area (PSA) consists of approximately one acre within the Carolina Meadows site. Carolina
Meadows consists of an approximately 66.73 acres. According to the Chatham County Geographic
Information System (GIS) website, the Parcel Identification Numbers (PINS) are: 0064734 (40.81 acres)
and 0020033 (25.92 acres) (Total: 66.73 acres acres), as shown on the Site Location Map (Appendix
I, Figure 1). The site currently consists of a retirement community. The purpose of this study was to
identify and delineate jurisdictional Waters of the U.S. (WOUS) within the PSA as part of proposed
improvements and expansions within the development.
Wetlands are defined by the United States Army Corps of Engineers (USACE) and the United States
Environmental Protection Agency (EPA) as "those areas that are inundated or saturated by surface
or groundwater at a frequency and duration sufficient to support, and under normal circumstances,
do support a prevalence of vegetation typically adapted for life in saturated soil conditions." In order
for an area to be classified as wetland, hydrophytic vegetation, hydric soils, and wetland hydrology
indicators must be present described in the 1987 "Corps of Engineers Wetlands Delineation Manual"
and the Appropriate Regional Supplement.
2.0 METHODOLOGY
The findings of the WOUS delineation is based on ECS' professional judgment and application of
the technical criteria presented in the 1987 USACE Wetlands Delineation Manual and the Regional
Supplement to the Corps of Engineers Wetland Delineation Manual: Eastern Mountains and Piedmont
Region, Version 2.0 dated April 2012.
ECS completed the following tasks to identify and delineate potentially jurisdictional WOUS
boundaries onsite:
2.1 Literature Review
ECS reviewed supporting information from publicly -available databases to identify possible ecological
effects the project may have on potential state- and/or federally -jurisdictional water resources.
During the desktop review, ECS documented relevant, site -specific details (e.g., topographic
characteristics, soil composition, recent precipitation, level of disturbance, plant community
structure, etc.) and integrated the obtained information with the onsite delineation effort.
2.2 Methodology for Field Investigation
Wetland boundaries were delineated using the routine onsite determination method described in the
USACE Manual and Regional Supplement, in conjunction with the Eastern Mountains and Piedmont
2020 Regional Wetland Plant List and the USDA Soil Survey.
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• ECS Southeast, LLP
ECS performed onsite wetland delineations as described above. First, site hydrology was observed
and the plant community within the data plot was characterized. The dominant plant species within
each community were then identified, and it was determined whether or not hydrophytic (wetland)
plants dominated the plant community. The USFWS has defined five wetland plant indicator
categories including:
• Obligate wetland (OBL) - has >99% probability of occurring in wetlands
• Facultative wetland (FACW) - has 66% to 99% chance of occurring in wetlands
• Facultative (FAQ - has 33% to 66% chance of occurring in wetlands
• Facultative upland (FACU) - has 1 to 33% chance of occurring in wetlands
• Upland (UPL) - has <1 % chance of occurring in wetlands
• No Indicator (NI) - no wetland indicator for the specified species, considered UPL
Plants identified as OBL, FACW, or FAC are considered wetland plants (or hydrophytes) by USACE.
In areas determined to have hydrophytic vegetation and potential wetland hydrology, an
approximately 16-24 inch hand auger soil boring or shovel test pit was completed to determine if
hydric soils were present. The soil boring was also inspected to determine if indicators of wetland
hydrology (inundation, soil saturation, etc.) were present.
Once an area is determined to be a wetland, further testing was performed to locate the wetland/
upland (non -wetland) boundary. A second soil data point was completed in the upland area to
document non -wetland conditions. Wetland boundaries were marked with consecutively numbered
surveyor's ribbon flags.
Data forms specified in the Regional Supplement were completed for each wetland and non -wetland
soil data point location. The data forms recorded the vegetation, soils, and hydrology observations
used in making the wetland determinations.
2.3 Methodology for Delineating Streams
During the field investigation for wetlands, ECS did not identify streams onsite that would be
considered jurisdictional by state and federal regulatory agencies. ECS used field indicators such as
flow, substrate composition, presence/absence of defined bed and banks, origin of hydrologic source,
presence/absence of vegetation in the stream channel, and composition and relative abundance of
resident benthic macroinvertebrates to classify onsite streams into three stream types: ephemeral,
intermittent, and perennial.
RGL No. OS -OS provides guidance on identifying physical indicators of Ordinary High Water Mark
(OHWM) as defined in 33 CFR Sections 328.3(e) and 329.11(a)(1) and discusses implementation of
other appropriate means that consider the characteristics of the surrounding areas to establish the
lateral limits of jurisdiction over tidal and non -tidal waters. Per RGL No. OS -OS, "the lateral limits of
jurisdiction over non -tidal water bodies extend to the [OHWM], in the absence of adjacent wetlands.
When adjacent wetlands are present, CWAjurisdiction extends beyond the OHWM to the limits of the
adjacent wetlands"
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• ECS Southeast, LLP
3.0 FINDINGS
3.1 Literature Review
ECS professionals reviewed the U.S. Geological Survey (USGS) Topographic Map, U.S. Department
of Agriculture Natural Resource Conservation Service (USDA-NRCS) 2006 published Soil Survey
for Chatham County County, U.S. Department of Agriculture Natural Resource Conservation Service
(USDA-NRCS) Web Soil Survey, the Soil Data Access (SDA) Hydric Soils List, the Federal Emergency
Management Agency (FEMA) Floodplain Mapping Service, U.S. Fish and Wildlife Service (USFWS)
National Wetlands Inventory (NWI) Wetlands Mapper, and available aerial photographs to identify
potentiallyjurisdictional Waters of the U.S. (i.e., streams, wetlands, natural ponds, lakes) and available
watershed information.
3.1.1 Literature Review Summary
The following is a summary of the available desktop information that was reviewed as part of
this study:
• According to the Farrington (North Carolina) USGS Topographic Map Quadrangle dated
1993 (Appendix I, Figure 2) no streams or low-lying areas are depicted within the PSA. The
PSA is located at approximately 290 feet above mean sea level (MSL).
• According to the USDA-NRCS Web Soil Survey (Appendix I, Figure 3), the PSA is comprised of
the following soil map units: CrB - Creedmoor-Green Level complex, 2 to 6 percent slopes
and CrD - Creedmoor-Green Level complex, 10 to 15 percent slopes. The aforementioned
soils) are not listed on the SDA Hydric Soils List for Chatham County, North Carolina.
• The US Fish and Wildlife NWI map (Appendix I, Figure 4) does not identify wetlands on the
PSA.
• The site is located within the Cape Fear watershed and is identified as Hydrologic Unit Code
(HUC) 03030002.
• The FEMA Flood Insurance Rate Maps (FIRMS), Panel 371 0979600L, dated October 19,
2018 (Appendix I, Figure 5) indicates the PSA is located in unshaded Zone X. These areas are
determined to be outside the 0.2% Annual Chance Floodplain.
• ECS reviewed the NOAA LiDAR Elevation Data of the site (Appendix I, Figure 6). Carolina
Meadows elevations range from approximately 305 feet above MSL to approximately
230 feet above MSL. The PSA is located at approximately 290 feet above MSL.
• ECS queried the USACE-developed Antecedent Precipitation Tool (APT) to gain an
understanding of typical moisture conditions in the PSA vicinity. Pre- and post -investigation
reports used to demonstrate typical versus atypical climatic conditions for the Project
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• ECS Southeast, LLP
locale were, then, generated for a comparative analysis of current and historical moisture
conditions. The analysis indicated the investigation was conducted during the Dry Season
and conditions were Drier than Normal for the time of year (Appendix III).
3.2 Field Investigation Findings
ECS personnel conducted the field investigation on August 18, 2022. The last precipitation event prior
to the site reconnaissance was on August 16, 2022 and approximately 0.05 was recorded.
Waters of the U.S. including ponds, streams and wetlands were not observed within the PSA.
3.2.1 Wetland Summary
ECS did not identify wetland areas within the boundaries of the PSA during the site reconnaissance.
3.2.2 Stream Summary
Streams were not identified within the boundaries of the PSA during the site reconnaissance.
4.0 REGULATORY DISCUSSION
After review of the findings in the report and at the client's request, ECS can coordinate with the
USACE, the NC DWR and Chapel Hill to conduct a jurisdictional determination and field visit, if
necessary. The timeline of this process is dependent on the availability of the regulatory agency. ECS
recommends receipt of the formal jurisdictional determination letter from the necessary agencies
prior to conducting any land -disturbance activities.
5.0 WATERSHED CLASSIFICATION/BUFFER REQUIREMENTS
5.1 State Riparian Buffer Requirements
The PSA is located within the NC DWR Jordan Lake Buffer Area. The NC DWR requires maintaining
a vegetated buffer of 50 feet from the top of each bank of perennial and intermittent streams or
normal water level of non -linear water bodies depicted on the most recent published version of
the Chatham County soil survey map or other site specific evidence prepared by the NRCS or the
most recent USGS1:24,000 scale quadrangle topographic map. The 2006 Chatham County Soil Survey
does not depict streams within the PSA boundary or adjacent to the PSA boundary. Therefore, a 50
foot state mandated riparian buffer would not be required from the feature.
5.2 Local Buffer Requirements
Chapel Hill, Town Public Works, Stormwater Management Division is the delegated authority in
making stream determinations. Intermittent and perennial streams are subject to their Resource
Conservation District (RCD) overlay and protection rules. The feature observed on site does not
qualify as either an intermittent or perennial stream. Nor is it mapped on the most recent published
version of the Chatham County soil survey map or other site specific evidence prepared by the NRCS
or the most recent USGS1:24,000 scale quadrangle topographic map. Therefore, the feature would
not be subject to Chapel Hill's RCD protection rules.
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• ECS Southeast, LLP
ECS recommends consultation with a civil engineer to determine if mandatory vegetative buffers and/
or regulated development (impervious surfaces) setbacks are required for the site in addition to those
mentioned above.
6.0 CONCLUSIONS
No potentially jurisdictional wetland areas or potentially jurisdictional streams were identified
or delineated within the PSA.
The findings summarized in this report represent our best professional judgment concerning the
presence or absence of potential jurisdictional aquatic resources in the PSA at the time of the study.
These findings are only to be considered preliminary and are for planning purposes only, as they have
not yet been verified by the regulatory agencies and are, therefore, subject to change pending their
review. ECS cannot guarantee that field conditions will not change over time.
Prior to conducting construction -related activities onsite, ECS recommends requesting a jurisdictional
Determination from the USACE for verification of these results to satisfy the requirements of Section
404 of The Clean Water Act (33 U.S.C. 1344). No earth -disturbing activities should be conducted within
the PSA until a USACE Determination has been issued. In addition, ECS recommends requesting a
stream determination from the Town Public Works, Stormwater Management Division of Chapel Hill
to confirm the findings within this report.
ECS Project # 49:18071
Page 5
C

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August 25, 2022

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August 25, 2022

• ECS Southeast, LLP
9 - Culvert at southern end of rip -rapped ditch.
10 - I M G 4266
ECS Project # 49:18071

August 25, 2022

• ECS Southeast, LLP
13 - I M G 4270
ECS Project # 49:18071

Appendix III: Stream Data
Forms

NC DWQ Stream Identification Form Version 4.11
Date: 8/18/2022
Project/Site: Carolina Meadows
Latitude: 35.860639
Evaluator: M. Measday
County: Chatham
Longitude:-79.022955
Total Points:
12.5
tream rmination (circle one)
Other
Stream is at least intermittent
Ephemeral ntermittent Perennial
e.g. Quad Name:
if>_ 19 or perennial if>_ 30'
A. Geomorphology (Subtotal = b )
Absent
Weak
Moderate
Strong
1 a. Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
O
1
2
3
4. Particle size of stream substrate
0
1
2
3
5. Active/relict floodplain
QO
1
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3
6. Depositional bars or benches
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2
3
7. Recent alluvial deposits
0
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2
3
8. Headcuts
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cip
2
3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
o 00
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hydrology (Subtotal = 2.5 )
12. Presence of Baseflow
0
0
2
3
13. Iron oxidizing bacteria
Q
1
2
3
14. Leaf litter
1.5
1
0
15. Sediment on plants or debris
0
0.5
1
1.5
16. Organic debris lines or piles
0
0.5
1
1 1.5
17. Soil -based evidence of high water table?
No = OD
Yes = 3
C. Biology Subtotal = 4
18. Fibrous roots in streambed
3
20
1
0
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
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1
2
3
22. Fish
Q
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1
1.5
23. Crayfish
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1
1.5
24. Amphibians
Q
0.5
1
1
1 1.5
25. Algae
0
0.5
1
1
1 1.5
26. Wetland plants in streambed
FACW = 0.75; OBL =
1.5 Other = 0
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: StnrmwatPr rnnvPynnre thrnughmit the PSA
through n sPriPs
of rnrnignted Ian star
^ipp rnnrrPtP
rtjlyPrtS
and rip -rap rhannels_
Sketch:

Appendix IV: Antecedent
Precipitation Tool

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From:
Jamie Powless
To:
Wild, Elaine; kevin(d)carolinameadows.net
Subject:
RE: [External] RE: Skilled Nursing Building -Carolina Meadows —Additional Information Request
Date:
Wednesday, May 22, 2024 9:54:18 AM
Attachments:
image003.pno
imaae004.pna
Carolina Meadows Skilled Nursing - FARRINGTON QUAD 12000.pdf
Carolina Meadows Skilled Nursing - Aerial.pdf
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Hi Elaine,
Yes, WQ0000866 is the existing 8" PVC shown on the maps. Please see the attached maps that that
include the permit number.
Thank You,
Jamie Powless, PE I Land Development Senior Project Manager I NV5
3300 Regency Parkway, Suite 100 1 Cary, NC 27518 1 P: 919.858.1842 1 C: 919.452.7963
From: Wild, Elaine <[e-mail]>
Sent: Monday, May 20, 2024 1:23 PM
To: Jamie Powless <[e-mail]>; [e-mail]
Subject: RE: [External] RE: Skilled Nursing Building -Carolina Meadows —Additional Information
Request
Hello Jamie,
Thank you for providing the addition information requested on 05/14/24. Please see my comments
below in blue and provide a response to #4.
Please provide the following information by June 13, 2024, and note that the requested information
must be submitted by the date, or the applicant will be required to submit a new application and
application fee in accordance with 15A NCAC 02T .0107.
Thank you,
Elaine Wild
Environmental Engineer
Division of Water Resources — NPDES Industrial Permitting Unit
North Carolina Department of Environmental Quality
elaine.wildlaDdeq.nc.gov
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Water Quality Permitting I NC DEG
Permitting Process I NC DEQ
From: Jamie Powless <1amie.Powless(c)nv5.com>
Sent: Wednesday, May 15, 2024 8:55 AM
To: Wild, Elaine <elaine.wildCapdeq.nc.gov>; kevinCcbcarolinameadows. net
Subject: [External] RE: Skilled Nursing Building -Carolina Meadows —Additional Information Request
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Good Morning Elaine,
Thank you for the feedback. Please see responses below in red and attached documents for
clarification. Please let me know if the aerial and quad maps are sufficient or if you would like for us
to add any additional information.
Jamie Powless, PE I Land Development Senior Project Manager I NV5
3300 Regency Parkway, Suite 100 1 Cary, NC 27518 1 P: 919.858.1842 1 C: 919.452.7963
From: Wild, Elaine <elaine.wild(@deq.nc.gov>
Sent: Tuesday, May 14, 2024 1:09 PM
To: kevin(@carolinameadows.net; Jamie Powless <iamie.powless(@nv5.com>
Subject: Skilled Nursing Building -Carolina Meadows —Additional Information Request
Hello Kevin and Jamie,
After reviewing the Fast Track Sewer System Extension Application for Skilled Nursing Building -
Carolina Meadows, additional information is required in order to further process the application.
Please provide the following information by June 13, 2024, and note that the requested information
must be submitted within 30 days of this request, or the applicant will be required to submit a new
application and application fee in accordance with 15A NCAC 02T .0107.
1. Is this an ARPA funded project? If so, please include the DWI assigned ARPA project number in
your response. This is not an ARPA funded project. Carolina Meadows is financing the project
with NC Medical Care Commission tax exempt bonds — thank you for the clarification.
2. Carolina Meadows Inc. is listed as Non -Profit Corporation. Is the intention for Carolina
Meadows Inc to maintain ownership of the infrastructure after the completion of the
project? Carolina Meadows is a nonprofit organization and will retain ownership of the
infrastructure and building after the project is completed. — thank you for the clarification.
3. Section IX.S. of the FTA is unmarked but Section IX.3 indicates that the project complies with
wetland separation requirements. Please indicate whether there are any wetlands or streams
located within the project area and if 401/404 authorization is needed. There are no

wetlands or stream buffers within the project boundary. Please see attached determination.
—thank you for the clarification.
4. The topographical and aerial maps submitted were not sufficient. According to Section F of
the Application Instructions, an 8.5-inch x 11-inch color copy of a USGS Topographic Map and
an aerial map should clearly indicate the project area, the closest surface waters, general
location of the gravity sewer, pumpstations, and force mains, and the downstream
connection points for the receiving sewer. Please provide the required maps according to the
application requirements. The additional information has been added to the aerial and USGS
Topographic maps. A campus —thank you for the updated maps. Is Carolina Meadows II,
WQ0000866, the "Ex. 8" PVC SEWER MAIN" indicated in the topo/aerial maps?
15A NCAC 02T .0107 Staff Review and Permit Preparation states:
• "(2) (e) If an application is accepted and later found to be incomplete, the applicant shall be
advised how the application or accompanying supporting information may be modified to
make it complete. The staff shall advise the applicant:
(2) if all required information is not submitted within 30 days, the project will be
returned as incomplete. Any resubmittal of a returned application shall be accompanied
with a new application fee."
Please contact me with any questions that you may have regarding this request.
*Please note that the fee for fast track sewer extension permits has increased to $600 as of
October 3, 2023 [as stipulated in the 2023 House Appropriations Act, House Bill 259, Water
Quality and Storm water Fees, Section 12.14(a)].
Sincerely,
Elaine Wild
Environmental Engineer
Division of Water Resources - Raleigh Regional Office
North Carolina Department of Environmental Quality
919.791.4254 Office
elaine.wild(@deq.nc.gov
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Sewer Extension Permitting I INC DEQ
subchapter t rules.pdf (state.nc.us)

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