WQCS00293_Application_20240807

Docusign Envelope ID: 2CFCD12D-BOF9-4B4D-B17B-66FDB1DA047B
I. APPLICANT INFORMATION:
1. Applicant's name (Municipality, Public Utility, etc): Aqua North Carolina, Inc
2. Facility Information: Name: Governor's Club Collection System Permit No.: WQCS00293
3. Applicant type: ❑ Municipal ❑ State ® Privately -Owned Public Utility
❑ County ❑ Other:
4. Signature authority's name: Brent Milliron per 15A NCAC 02T .0106(b) RECEIVED
Title: Environmental Compliance Director
5. Applicant's mailing address: 202 Mackenan Court A U G Q 7 2324
City: Cary State: NC Zip: 27511
6. Applicant's contact information:
Phone number: [phone] Fax number: [phone] Email address: BlWQQCC &a QWQ/N PDES
H. CONTACT/CONSULTANT INFORMATION:
1. Contact Name: Lorraine Sta rg ier
2. Title/Affiliation: Central Area Manager, Aqua North Carolina, Inc
3. Contact's mailing address: 202 Mackenan Court
4. City: Caa State: NC Zip: 27511
5. Contact's information:
Phone number: [phone] Fax number: N/A Email address: LMStagnerA)gguaamerica.com
III. GENERAL REQUIREMENTS:
1. New Permit or Premit Renewal? ❑ New ® Renewal
2. County System is located in: Chatham County
3. Owner & Name of Wastewater Treatment Facility(ies) receiving wastewater from this collection system:
Owner(s) & Name(s): Aqua North Carolina — Governor's Club
4. WWTF Permit Number(s): W0000088
5. What is the wastewater type? 100 % Domestic or % Industrial (See 15A NCAC 02T .0103(201)
Is there a Pretreatment Program in effect? ❑ Yes or ® No
6. Wastewater flow: 0.110 MGD (Current average flow of wastewater generated by collection system)
7. Combined permitted flow of all treatment plants: 0.234 MGD
8. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T .0114 or ® Representative Data
9. Population served by the collection system: 996 Connections
IV. COLLECTION SYSTEM INFORMATION:
1. Line Lengths for Collection System:
Sewer Line Description
Length
Gravity Sewer
0.762 miles
Force Main
21.4 miles
Vacuum Sewer
miles
Pressure Sewer
miles
APPLICATION CSA 04-16 Page 3 of 5

Docusign Envelope ID: 2CFCD12D-BOF9-4B4D-B17B-66FDB1DA047B
AOUA.
4 Essential
August 2, 2024
NCDEQ-DWR
Water Quality Permitting Section
Municipal Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Collection System Permit Renewal Package
Governor's Club Collection System
Permit No. WQCS00293
Chatham County
To whom it may concern:
RECEIVED
Al; U 7 L„24
NCDEQIDWR/NPDES
Please find enclosed our request to renew the collections permit for our Governor's Club
Collection system (WQCS00293).
If you have any questions or require additional information, please do not hesitate to
contact me at [e-mail] or 919-6S3-6999.
Sincerely,
Brent Milliron
Environmental Compliance Director
cc: Lorrie Stagner, Area Manager - Aqua NC
Wesley Bishop, Field Supervisor - Aqua NC
Jennifer King, Compliance Specialist - Aqua NC

Docusign Envelope ID: 2CFCD12D-BOF9-4B4D-B17B-66FDB1DA047B
2. Pump Stations for Collection System:
Pump Station Type
Number
Simplex Pump Stations(Serving Single Building)
784
Simplex Pump Stations(Serving Multiple Buildings)
0
Duplex Pump Stations
8
3. Submit a list of all major (i.e. not simplex pump station serving a single family home) pump stations. Include the following
information:
➢ Pump Station Name
➢ Physical Location
➢ Alarm Type (i.e. audible, visual, telemetry, SCADA)
➢ Pump Reliability (Can convey peak hourly wastewater flow with largest single pump out of service)
➢ Reliability Source (permanent/portable generator, portable pumps)
➢ Capacity of Station (Pump Station Capacity in GPM)
4. Submit a list of all high priority lines according per 15A NCAC 02T .0402(2) known to exist in the collection system. Head
the list with "Attachment A for Condition V(4)" and include the system name.
No high priority lines present.
➢ Use the same line identification regularly used by the applicant
➢ Indicate type of high priority line (i.e. aerial), material and general location
V. COLLECTION SYSTEM ADMINISTRATION:
1. Provide a brief description of the organizational structure that is responsible for management, operation and maintenance of
the collection system.
The operation of the existing Governor's Club Wastewater Collection system is the responsibility of the main ORC. The
main ORC is supervised by a Regional Supervisor who reports to an Area Manager. Operations teams are supported by
internal Engineering, Compliance, and Customer Care managers.
2. Indicate the current designated collection system operators for the collection system per 15A NCAC 08G.0201
Main ORC Name: Ashley Klinger
Certification Number: 1015154
Back -Up ORC Name: Timothy Thomas
Certification Number: 101 1379
See the "WOCS Contacts and ORC Report" for a current listing of the ORC(s) the Division has on file for WQCS permit
3. Approximate annual budget for collection system only: the North Carolina Utilities commission reviews capital expenses
through regular proceedings. Sufficient capital funds are allotted for all Aqua NC wastewater systems.
4. Submit a copy of your current annual budget.
N/A
5. Approximate capital improvement budge for the collection system only: N/A
6. Submit a copy of your current capital improvement plan.
Lift station rehabilitation is planned for all lift stations in Aqua's current 5-year capital improvement plan.
Additionally, funding is set aside for any emergency repairs as needed.
7. Is this collection system currently a satellite system ❑ Yes or ® No
8. Do any satellite systems discharge to this collection system ❑ Yes or ® No (If yes complete table below)
APPLICATION CSA 04-16 Page 4 of 5

Docusign Envelope ID: 2CFCD12D-BOF9-4B4D-B17B-66FDB1DA047B
Satellite System Contact Information Name Address Phone Number
Complete for Satellite Systems that have a flow or capacity greater than 200,000 GPD (Average daily flow)
9. List any agreements or ordinances currently in place to address flows from satellite systems:
VI. COLLECTION SYSTEM COMPLIANCE:
1. Is a Response Action Plan currently in place ® Yes or ❑ No
2. If Yes, submit a copy of the Response Action Plan or see table 6 below.
3. Is a pump station contingency plan currently in place? ® Yes or ❑ No
4. If Yes, submit a copy of the pump station contingency plan or see table 6 below.
5. Is a comprehensive collection system map currently in place? ® Yes or ❑ No
6. Submit a submit a copy of the collection system map (CD or hardcopy) or indicate a schedule for completion
7. Thoroughly read and review the System -Wide Collection System Permit Conditions. Typically compliance schedules
are only offered to NEW permit applicants and NOT permit renewals. Any compliance dates must be included within
the permit prior to issuance or the permit holder will be found in violation upon inspection.
Permit Condition
Current
Compliance?
If no, Indicate a
Compliance
Date
Typical
Compliance
Schedule
I(4) — Grease ordinance with legal authority to inspectlenforce
® Yes ❑ No
12 — 18 mo.
1(5) — Grease inspection and enforcement program
® Yes ❑ No
12 — 18 mo.
I(6) — Three to five year current Capital Improvement Plan.
® Yes ❑ No
12 — 18 mo.
1(8) — Pump station contingency plan
® Yes ❑ No
3 mo.
I(9) — Pump station identification signs.
® Yes ❑ No
3 mo.
I(11) — Functional and conspicuous audible and visual alarms.
® Yes ❑ No
3 — 6 mo.
II(5) — Spare pumps for any station where one pump cannot
handle peak flows alone (in a duplex station, the 21 pump is
the spare if pump reliability is met).
® Yes ❑ No
6 — 9 mo.
II(7) — Accessible right-of-ways and easements.
® Yes ❑ No
6 —12 mo.
II(9) — Response action plan with Items 9 (a — h).
® Yes ❑ No
3 mo.
III(3) — Comprehensive collection system map
® Yes ❑ No
10% per year
For conditions not listed, compliance dates are not typically offered. List any permit conditions that may be difficult for the
applicant to meet (attach clarification if needed):
N/A
VII. APPLICANT'S CERTIFICATION per 15A NCAC 02T .0106(b):
1 Brent Mi l l i ron attest that this application for
(Signature Authority's Name & Title from Item I.4)
Aqua North Carolina, Inc.
(Facility name from Item I.1)
APPLICATION CSA 04-16 Page 5 of 5

Docusign Envelope ID: 2CFCD12D-BOF9-4B4D-B17B-66FDB1DA047B
Governor's Club (WQCS00093) Collection System Pump Stations
L/S #1
Walker Woods
13
27426 Walker
A/V/Scada
Portable Generator
Yes
L/S #2
Glenn Glade
45
39419 Glenn Glade
A/V/Scada
Portable Generator
Yes
L/S #3
South Entrance
198
11600 Morehead
A/V/Scada
Portable Generator
Yes
L/S #4
Vance Villas
59
99501 Gibbs Lane
A/V/Scada
Portable Generator
Yes
L/S #S
East Church
64
56706 Nash
A/V/Scada
Portable Generator
Yes
L/S #6
Davie Street
11
60101 Davie
A/V/Scada
Portable Generator
Yes
#7
Clubhouse
100
11470 Club Drive
A/V/Scada
Portable Generator
Yes
FL/L/S
S #8
Nash Street
17
10340 Nash
A/V/Scada
Portable Generator
Yes

DocuSign
Certificate Of Completion
Envelope Id: 2CFCD12DBOF94B4DB17B66FDBlDA047B
Status: Completed
Subject: Governors Club Collection (WQCS00293) Permit Renewal _2024.08.02.pdf
Source Envelope:
Document Pages: 8
Signatures: 1
Envelope Originator:
Certificate Pages: 1
Initials: 0
Brent Milliron
AutoNav: Enabled
[e-mail]
Envelopeld Stamping: Enabled
IP Address: 144.202.188.252
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
Record Tracking
Status: Original
Holder: Brent Milliron
Location: DocuSign
8/2/2024 4:01:04 PM
[e-mail]
Signer Events
Signature
Timestamp
Brent Milliron
nOOeY3gwd by.
r
�6
Sent: 8/2/2024 4:01:06 PM
[e-mail]
/*� --
lll���„eze,oBBo
Viewed: 8/2/2024 4:01:16 PM
Environmental Compliance Director
EF
Signed: 8/2/2024 4:01:59 PM
Security Level: Email, Account Authentication
Signature Adoption: Uploaded Signature Image
Freeform Signing
(None)
Using IP Address: 144.202.188.252
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events
Signature
Timestamp
Editor Delivery Events
Status
Timestamp
Agent Delivery Events
Status
Timestamp
Intermediary Delivery Events
Status
Timestamp
Certified Delivery Events
Status
Timestamp
Carbon Copy Events
Status
Timestamp
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
8/2/2024 4:01:06 PM
Certified Delivered
Security Checked
8/2/2024 4:01:16 PM
Signing Complete
Security Checked
8/2/2024 4:01:59 PM
Completed
Security Checked
8/2/2024 4:01:59 PM
Payment Events
Status
Timestamps

Docusign Envelope ID: 2CFCD12D-BOF9-4B4D-B17B-66FDB1DA047B
STATE OF NORTH CAROLINA
UTILITIES COMMISSION
RALEIGH
APPENDIX A-14
DOCKET NO. W-218, SUB 341
BEFORE THE NORTH CAROLINA UTILITIES COMMISSION
AQUA NORTH CAROLINA, INC.
is granted this
CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
to provide water utility service in
BEECHWOOD COVE CEDAR TERRACE CHATHAM, HIDDEN VALLEY, POLK'S
LANDING POLK'S TRAIL AND WOODBRIDGE SUBDIVISIONS
AND
to provide sewer utility service in
CAROLINA MEADOWS COUNTY LINE PLAZA GOVERNORS CLUB, GOVERNORS
FOREST GOVERNORS VILLAGE THE LEGACY AT JORDAN LAKE,THE
PRESERVE AT JORDAN LAKE AND WESTFALL SUBDIVISIONS
Chatham County, North Carolina
subject to any orders, rules, regulations,
and conditions now or hereafter lawfully made
by the North Carolina Utilities Commission.
ISSUED BY ORDER OF THE COMMISSION.
This the 291h day of January, 2013.
NORTH CAROLINA UTILITIES COMMISSION
AoiL l . Cif loum*
Gail L. Mount, Chief Clerk

Docusign Envelope ID: 2CFCD12D-BOF9-4B4D-B17B-66FDB1DA047B
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 information and attachments are not included, this application package
will be returned to me as incomplete.
Note: In accordance with NC General Statutes 143-215.6A and 143-215.613 any person who knowingly makes any false statement,
representation, or certification in any application 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.
o«uftfwd by:
Signature: Date: 8/2/2024
1742870BB%MEF ..
APPLICATION CSA 04-16 Page 6 of 5

nr, —i r, F.,—io o In. grFrmgn-RnF9-4R4D-8178-66FD81DA047B
V D ii�
Creek Rcl
` '.d
Governor's Club
J !
•,
1
Wastewater
botrr •
-•- --==�--
Chatham County
♦-
/-w wwwww —.. ...----/
r
North Carolina
9 /
0 !
x
``
�_.�—--- -
WQ000088
n Dr
a €
(Treatment Plant)
a
stem) (Collection S
y
t
,=
Grt�;
C
t5i...
i
1 J
ro l*
/
Legend 00% 1), / { I C,t Feo
Or
4 •,, + • �� 'ptti
ra •
ff ♦ L
/ �� ♦ {�
♦
f
Club WWTP
5 •
,r �VIC,
•
r � �
Q / . AN
!Town of Car„!bt§pf-North Carolina DOT, Esri, HERE, GarminJINCREMENT P, NGA, USGS
fir
Printed: Aug 02, 2024
0 0.1 0.2 0.4
1 inch equals 1,250 ft mi
AQUA �,s
These maps should be used as a reference to me general
location of watelMaste water system information as interpreted
Rom documents submitted to the Engineenng department. Refer
to specific engineering plans for more detailed Intimation.
Report comeclions to AquaGIS mallbax
aquag is@ aquaa menca.com