WQ0039251_Final Permit_20180131

MIC4IAEL S. REGAN
5. Cretan
LINDA CULPEPPER
hien iPr rlirectur
Water Resources
ENVIRONMENTAL QUALITY
January 31, 2018
Michael J. Myers, President
Old North State Water Company, LLC
4700 Homewood Court, Suite 108
Raleigh, NC 27609
Subject: Permit No. WQ0039251 Modification
Old North State Water Company, LLC
Briar Chapel —SD East
Wastewater Collection System Extension Permit
Chatham County
Dear Mr. Myers:
In accordance with your application received December 22, 2017, we are forwarding herewith Permit No.
WQ0039251 Modification dated January 31, 2018, to the Old North State Water Company, 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 This permit shall be effective from the date of issuance until rescinded, shall void Permit No.
WQ0039251 issued June 2, 2017, 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.
This modification allows for the addition of a 115 bed assisted living center and 13,800 gpd of flow.
Please pay particular attention to the following conditions contained within this permit:
Condition IIA: This permit shall not be automatically transferable; a permit modification request for a
name change must first be approved by this office.
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.
It shall be the 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
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
Division of Water Resources, Raleigh RCgtt nal O1fICC, Waicr Quality Operxtions Secti0V www.nmaterquality.org
1628 Nlail Sen ice Center, Raleigh, NC 27699-1628 Phone: [phone]
1 ov;ition- ISM) Nitwit Drive Ralciuh NC ?7609 Fna- 4919) US-7159

Old North State Water Company, LLC
Permit No. WQ00 5 Modification
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 Ted Cashion at [phone]
or via e-mail at [e-mail].
Sincerely,
for Linda Culpepper
Interim Director, Division of Water Resources
by S. Daniel Smith, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
cc: Gareth Avant, P.E., McKim & Creed, Inc. (via email: [e-mail])
Chatham County Health Department
Raleigh Regional Office Files
Water Resources Central Files
Page 2 of 8

North Carolina Department of Environmental Quality
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF 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
Old North State Water Company, LLC
Chatham County
for the construction and operation of approximately 1,894 linear feet of 8-inch gravity sewer to serve a
115 bed assisted living center and future commercial development as part of the Briar Chapel -- SD East
project, and the discharge of 13,800 gallons per day of collected domestic wastewater into the Old North
State Water Company, LLC's existing sewerage system, pursuant to the application received December
22, 2017, and in conformity with 15A NCAC 2T; 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 and updated
March 2008, 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 fitil rescinded and shall be subject to the specified
conditions and limtat ons contain d terein.
Linda Culpepper
Interim Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0039251 Modification
Permit Issued: January 31, 2018
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
Old North State Water Company, 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 Briar Chapel Utilities Wastewater
Treatment Facility Phases A and B in accordance with Permit Number WQ0028552.
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 and
updated March 2008, as applicable; and the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 and updated March 2008, 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. SPECIAL CONDITIONS
NONE
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; 1SA NCAC 2T; the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 and updated 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 and updated March 2008, 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 .01101
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
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)):
Page 4 of 8

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:
I. 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.
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 fora minimum of three
years with exception of the map, which shall be maintained for the life of the system.
S. The Permittee shall report by telephone to a water resources staff member at the Raleigh 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:
Page 5 of 8

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
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 l 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 It 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 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 tc
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:
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, including travel timeframes,
shall be provided.
Page 6 of 8

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 increases of 10% or greater, increased flow,
pump station design capacity design increases of 5% or greater, and increases in the number/type 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]
8. 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)]
9. 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 and updated March 2008,
as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Station
and Force Mains adopted June 1, 2000 and updated March 2008 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

PERMITTEE: Old North State Water Company, LLC
PERMIT #: WQ0039251 Modification
PROJECT: Briar Chapel — SD East
ISSUE DATE: January 31, 2018
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
1, 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
ENGINEER'S CERTIFICATION
1, , as a duly registered Professional En sneer in the State of North Carolina,
having been authorized to observe (❑ periodically, ❑ weekly, n 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 construction 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
and updated March 2008, as applicable; the Div;sion's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 and updated March 2008, 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):
Division of Water Resources, Raleigh Regional Office, Water QuahtV Operatjan� Section www.ncwateri}uality.org
1628 Mail Ser icc Center, Raleigh, NC 27699-1628 Phouc: [phone]
t „� ,c,,, • ��nn t�.,,,,,,, n� ,: n�t,•,,,t, n`i"17A no r,. � ,a1n, �e_7 i sq

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: fi Q _ Ito ba completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Old North State Water Company, LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Michael J. Myers per 15A NCAC 02T .0106(b)
Title: President
4. Applicant's mailing address: 4700 Homewood Court, Suite 108
City: Raleigh State: NC Zip: 27609
5. Applicant's contact information:
Phone number: [phone] Email Address: mmyersC@,envirolinkinc.com
II. PROJECT INFORMATION:
. Project name: Briar Chapel - SD East
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Perm it.Troject
If a modification, provide the existing permit number: WQ0039251 and issued date: June 2, 2017
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: 35.8086- Longitude:-79.0904
5. Parcel ID (if applicable): 0018911
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
. Professional Engineer: Gareth Avant License Number: 036348
Firm: McKim & Creed, Inc.
Mailing address: 1730 Varsity Drive, Suite 500
City: Raleigh State: NC Zip: 27606-_
Phone number: [phone] Email Address: gavant0mckintcreed.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Briar Chapel Utilities Wastewater Treatment Facility Phases A and B Permit Number: W00028552
Owner Name: Old North State Water Company, LLC
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ0029867 (Pump Station "A")
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Old North State Water Company, LLC
FORM: FTA 04-16 Pagel of5

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Realionak Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleliah Regional Office
1628 Mail Service Center
Chatham, Durham, Edgeoombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilminaton Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mil, Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

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 Home/Property Owners' Association, has an Operational Agreement (FORM: I-IOA] been attached?
❑ Ycs ®No ®N."A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation service ❑ Hotel and/or Motels
❑ School ? preschool I day care ❑ Medical! dental ; veterinary facilities ❑ Swimming Pool ;Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses!' offices I factories ® Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0 10320 )
o Is there a Pretreatment Program in effect? [:]Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14(fl? ® Yes ❑ No
v If Yes, provide a ropy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.0I 14(fl)
Daily Design Flow "b
No. of Units
Flow
Assisted Living
120 gall Bed
115
13,800 GPD
gal?
GPD
gal?
GPD
gal.,
GPD
gait
GPD
gale
GPD
Total
13,800 GPD
cl
a See 15A NCAC 02T .0114(b). (d). (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; 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: 13,800 GPD (per 15A NCAC 02T .0114)
Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new now expected
❑ Other (Explain):
FORM: FTA 04-16 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
1462
PVC
8
432
DIP
f�
➢ Section it & 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 requirement is not allowed and a violation of the MDC
Vill. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & NIDC (Pump Stations?Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: „
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with ISA NCAC 02T .0305(h)(1):
❑ Standby power source or pump with 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
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
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 in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
I. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (R)
> 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewers stems:
® Yes [—]No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer 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 11 impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
hi h water (or tide elevation) and wetlands (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
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
> 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(fi cannot be achieved.
> *'"Stream classifications can be identified using the Division's NC Surface Water Classifications webMe
> If noncompliance with 02T.0305(f) or(.--), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes [-]No
> See the Division's draft separation requirements for situations where separation cannot be meet
z No variance is required if the alternative design criteria specified is utilized in design and construction
> As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
> This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ®Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
> Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15.A NCAC 02T.0105 c 6 , directly related environmental permits or certification applications are 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.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No
➢ 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 permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with I gA N(%\(' 021, the NImsimmmr I)cscs= ( r,tesre t•sr the Lot mntsne ot I'unsts
:fnc1IJris Mainstlatesty.rsium).and the PL1 ittSci%4r,Minimum11,;si:ut'eites'i.s Jlalc,t%,:rsikugasapplicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review_ A t troval of Cite ref next is ref aired prior w sui=rnitl:d of the Fast Track :%polication and supporting
documents.
2 Professional Engineer's Certification:
1 4 '4Vg r< _ _ attest that this application for
(Professional Engineer's name from Application Item lit •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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track
Permitting of Pump 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 $10,000. as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date: ��"�� Ck
03634$
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1• Michael.r.MY-em-President _ _attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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. l 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, andtor 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 1_0-215_6A and !-I 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: _ CG� _ _ . Date:
FORM: PTA 04-16 Page 5 of 5

State of North Carolina
r Department of Environmental Quality
r' . �`s Division of Water Resources
Divi5l<211 of Water 4' Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Old North State Water Company, LLC
Project Name for which flow is being requested: Liberty Senior Living
More than one FTSE may be required for a single project if the owner of the WWTP is not responsiblefor all pump
stations along the route of the proposed waste+vater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Briar Chapel Utilities Wastewater Facility Phases A and B
b. WWTP Facility Permit #: W 0028552
All flows are in GD w,
c. WWTP facility's permitted flow 0.330 �� O
d. Estimated obligated flow not yet tributary to the WWTP 0.177 • r,�
e. WWTP facility's actual avg. flow �0.116�
f. Total flow for this specific request 0.006
g. Total actual and obligated flows to the facility 0.299 0 �A
� c
h. Percent of permitted flow used 90.6%
11. Complete this section for each pump station you are responsible for along the route of thit
proposed wastewater flow. v
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(8+C)
(E)=(A-D)
Design
Obligated,
Pump
Average Daily
Appmx.
Not Yet
Total Current
Station
Firm
Flow**
Current Avg.
Tributary
Flow Plus
(Name or
Capacity, *
(Firm / pf),
Daily Flow,
Daily Flow,
Obligated
Available
Number)
MGD
MGD
MGD
MGD
Flow
Capacity***
LS A
0.983
0.28
0.10
0.049
0.149
0.131
SD East 0.288 0.115 0.006 0.000 0.006 0.109
* The Firm Capacity 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.
*** 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): SD East Lift Station
Downstream Permit Number: WQ0039608
Page I of 6
FTSE 04-16

0 mom
ti. _
i � 710 ,
• 0 T 7...
rill
r' r-ME
.,0 • 7 _l . Jim it T
11111
1 .ti �.

II1. Certification Statement:
I Michael Myers (President) 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 I1
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Signing Official
Date
Page 2 of 6
FI`SF 04-16

STATE OF NORTH CAROLINA
UTILITIES COMMISSION
RALEIGH
DOCKET NO. W-1300, SUB 9
DOCKET NO. W-1230, SUB 1
BEFORE THE NORTH CAROLINA UTILITIES COMMISSION
aaU,f0 iVuor�a�t 1plaing
if 0Z Z Z 330
Sigvna 1P3uaLUU0J1nug Jo ada(I Z)M
In the Matter of
Application by Old North State Water Company, }
LLC, and Briar Chapel Utilities, LLC, for Authority to } ORDER ALLOWING
Transfer Sewer Utility Franchise in Briar Chapel ) RECOMMENDED
Subdivision in Chatham County, North Carolina, to ) ORDER TO BECOME
Old North State Water Company, LLC, and for ) EFFECTIVE AND FINAL
Approval of Rates )
BY THE COMMISSION, On April 20, 2015, Hearing Examiner Ronald D. Brown
issued in the above -captioned docket a Recommended Order Approving Transfer,
Granting Franchise, Approving Rates, and Requiring Customer Notice. The parties have
jointly requested that the Commission adopt the Recommended Order as a Final Order.
Based upon the foregoing, the Commission is of the opinion that the request that
the Recommended Order be adopted as the Final Order should be granted.
IT IS, THEREFORE, ORDERED that the Recommended Order entered in this
docket on April 20, 2015, is hereby adopted as the Final Order of the Commission.
ISSUED BY ORDER OF THE COMMISSION.
This the 20'' day of April , 2015.
NORTH CAROLINA UTILITIES COMMISSION
AC6L �-Moum*
Gail L. Mount, Chief Clerk
Commissioners Susan W. Rabon and ToNola D. Brown -Bland did not participate.

i r
'
iwNJ
KILL
..0
.'
1 No •i%�T
-
Am
1
.
1
A
1 �
Elm III
wm
ME
0
v0
om
Elm
.. • IR7
Ir
d.ti'
' 1
IN
0
III
. a r
IN ...r - .. IN

STATE OF NORTH CAROLINA
UTILITIES COMMISSION
RALEIGH
APPENDIX A
DOCKET NO. W-1300, SUB 9
BEFORE THE NORTH CAROLINA UTILITIES COMMISSION
OLD NORTH STATE WATER COMPANY. LLC
is granted this
CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
to provide sewer utility service
r,
BRIAR CHAPEL SUBDIVISION SERVICE AREA
(including HERNDON WOODS SUBDIVISION)
Chatham County, North Carolina
subject to any orders, rules, regulations,
and conditions nor or hereafter lawfully made
by the North Carolina Utilities Commission
ISSUED BY ORDER OF THE COMMISSION.
This the 20'h day of _April , 2015.
NORTH CAROLINA UTILITIES COMMISSION
A6 L l - Moum*
Gail L. Mount, Chief Clerk

FAST TRACK SEWER APPLICATION NARRATIVE
Liberty Senior Living
Chatham County, North Carolina
December 12, 2017
Prepared for:
Liberty Senior Living
2334 S. 41 St Street
Wilmington, North Carolina 28403
0 9 r
AL -
- 036348 -
12/21/2017
Prepared By:
v MCM4&CREED
v
1730 Varsity Drive, Suite 500
Raleigh, North Carolina 27606
Phone: [phone]
Fax: [phone]
M&C Project No. 07246-0001

Liberty Senior Living
December 12, 2017
PROJECT NARRATIVE
The purpose of the project is to construct basic utility infrastructure to support
the proposed Liberty Senior Living facility in Chatham County, NC. The
improvements planned in this phase are internal to the Liberty Senior Living
parcel and will connect to previously designed infrastructure for SD East
(WQ0039251, WQ0038847). All flows in the system will ultimately tie to an
existing pump station that was approved through previous permits (WQ0033227).
SD East was permitted based on uncertain future outparcels and tenants.
Preliminary modeling was provided to appropriately size the gravity sewer to
serve the overall SD East development of which the Liberty Senior Living facility is
a part. A table calculating the future expected flows was included with the SD East
permit. Based on the original future flow estimation, 6,720 gpd were assigned to
the Assisted Living facility and this was based on a 120 bed facility. The proposed
Liberty Senior Living facility has a total of 115 beds which requires 6,440 gpd. The
system will gravity to a future pump station located onsite. This pump station will
be designed and permitted at a later date by others.
The sewage and wastewater collected by this system will be treated in the on -site
wastewater treatment facility:
WWTP Facility Name: Briar Chapel Utilities, LLC
WWTP Facility Permit #WQ0028552

Summary of future anticipated sewer flaws to be permitted:
Briar Chapel — SD East
Anticipated Sewer Flows
Per 15A NCAC 02T.0114 Guidelines
Anticipated Tenant
Daily Flow
Rate
Anticipated
Multiplier
Anticipated Flows
Office Building
0.15 GSF
50,000 SF
7,500 GPD
Out -Parcel
4,000 GPD
2 parcels
8,000 GPD
Skilled Nursing
120 allda
120 beds
14,400 GPD
Liberty Senior Living
56 gallday
116 beds
6,440 GPD
Total Anticipated Flows:
36,620 GPD