WQ0045542_Application (FTSE)_20241002

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23& SUPPORTING DOCUMENTATION
Application Number: 061 " (to be completed by DWR) '
All items must be com leted or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Carolina Beach RE LLC(company,municipality, HOA,utility, etc.)
2. Applicant type: ❑ Individual IX Corporation ❑ General Partnership ❑ Privately-Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Rob Tanner per I SA NCAC 02T.0106(b)
Title: Director of Real Estate
4. Applicant's mailing address: 621 NW 531 Street Suite 320
City: Boca Raton State: FL Zip: 33487-
5. Applicant's contact information:
Phone number: (717 891-5168 Email Address:rob(@impeccabledeveloi)mcnt.com
II. PROJECT INFORMATION:
1. Project name: Carolina Beach&Myrtle Grove Wawa
2. Application/Project status: ❑ Proposed(New Permit) ZII Existing Permit/Project ❑ ARPA funded
If a modification,provide the existing permit number: WQ0045542 and issued date: 09/08/2024,
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: WQOON/A
3. County where project is located: New Hanover County
4. Approximate Coordinates(Decimal Degrees): Latitude: 34.0889' Longitude: -77.8970'
5. Parcel ID(if applicable): R08200-001-026-000(or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
1. Professional Engineer: Colin D. Rohr License Number: 056309
Firm: Kimlc -Hom and Associates
Mailing address: 200 S Tryon St Suite 200
City: Charlotte State: NC Zip: 28202-
Phone number: [phone] Email Address:colinxohr a,kimley-horn.com
IV. WASTEWATER TREATMENT FACILITY(W WTF) INFORMATION:
1. Facility'Name: The Cape W WTP Permit Number: NC 0057703
Owner Name: AQUA NC
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQN/A
2. Downstream (Receiving) Sewer Information: 4 inch ❑ Gravity N Force Main
3. System Wide Collection System Permit Number(s)(if applicable): WQCSN/A
Owner Name(s): Aqua Noah Carolina, Inc.
FORM: FTA 10-23 Page I of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately-Owned Public Utility,has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No X1 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 HOA/POA Operational Agreem_ ent(FORM: HOA)and
supplementary documentation as required by 15A NCAC 02T.0115(c)been attached?
❑ Yes ❑ No X N/A
4. Origin of wastewater: (check all that apply): I
❑ Residential(Individually Owned) ❑ Retail(stores,centers,malls) ❑ Car Wash
❑ Residential(Leased) Z Retail with food preparation/service ❑ Hotel and/or Motels
❑ School/preschool/day care ❑ Medical/dental/veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
EI Businesses/offices/factories ❑ Nursing Home ❑ Other(Explain in Attachment)
5. Nature of wastewater: %Domestic 100%Commercial %Industrial(See 15A NCAC 02T .0103(20))
If Industrial,is there a Pretreatment Program in effect?❑ Yes❑ No
6. Has a flow reduction been approved under 15A NCAC 02T.0114(f)? ❑ Yes XI No
➢ If Yes,provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type(see 02T.0114(f)) Daily Design Flow'b No.of Units Flow
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Convenience Store with Food Preparation 60 gal/100 SF 5919 SF 3552 GPD t
gal/ GPD
gal/ GPD
gall GPD
gall GPD
gall GPD
Total 3552 GPD
a See 15A NCAC 02T.0114(b),(d), (e)(1)and(e)(2) for caveats to wastewater design flow rates(i.e. proposed unknown
non-residential development uses; public access facilities located near high public use areas; and residential property
located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S. 42A-4}.
b Per 15A NCAC 02T.0I 14(c),design flow rates for establishments not identified [in table 15A NCAC 02T.0114]shall be
determined using available flow data,water using fixtures,occupancy or operation patterns,and other measured data.
8. Wastewater generated by project:3552 GPD(per 15A NCAC 02T.0114 and G.S. 143-215.1)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero,please indicate why:
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❑ Pump Station/Force Main or Gravity Sc%vcr 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. j
❑ Flow has already been allocated in Permit Number: Issuance Date:
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Rehabilitation or replacement of existing sewers with no new flow expected
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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
➢ Section II&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
l. Pump station number or name:Carolina Beach LS
2. Approximate Coordinates(Decimal Degrees): Latitude: 34.0884' Longitude: -77.8977'
3. Total number of pumps at the pump station:2
3. Design flow of the pump station: 0.0036 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): 36 gallons per minute(GPM)at 55 feet total dynamic head(TDH)
5. Summarize the force main to be permitted(for this Pump Station):
Size(inches) Length(feet) Material
1.25 372 PVC
4 565 PVC
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If any portion of the force main is less than 4-inches in diameter,please identify the method of solids reduction per j
MDCPSFM Section 2.01 C.l.b.® Grinder Pump ❑ Mechanical Bar Screen ❑ Other(please specify)
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6. Power reliability in accordance with 1.5A NCAC 02T.0305(h)(1):
® Standby power source or ❑ Standby pump
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➢ -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:
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➢ Include docurnentation that the portable source is owned or contracted by the applicant and is compatible with the station. j
➢ If the portable power source or pump is dedicated to multiple pump stations,an evaluation of all the purnp 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.
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FORM: FTA 10-23 Page 3 of 5

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IX. SETBACKS&SEPARATIONS—(02B.0200 & 15A NCAC 02T.0305(f)):
I. Does the project comply with all separations/alteratives found in 15A NCAC 02T.0305(f)&(g)? Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Paraineter* 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 I
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Any basement(horizontal) 10 feet j
Top slope of embankment or cuts of 2 feet or more vertical height 10 feet
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Drainage systems and interceptor drains 5 feet
Any swimming pools 10 feet
Final earth grade(vertical) 36 inches
➢ If noncompliance with 02T.0305(f)or(g),see Section X.I of this application
*15A NCAC 02T.0305 contains alternatives where separations in 02T.0305(fl cannot be achieved.Please check"yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webp. e
2. Does this project comply with the minimum separation requirements for water trains? X1 Yes [:] No ❑ N/A
➢ If no,please refer to 15A NCAC 18C.0906(f)for documentation requirements and submit a separate document, j
signed/scaled by an NC licensed PE,verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? 1 11 Yes ❑ No -N N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation re uirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
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4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: 1Z 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 15A NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes X 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 15A NCAC 02T:0105 c 6)(additional permits/certifications)? N Yes ❑ No
Per 15A NCAC 02T.0105(c)(6),directly related environmental permits or certification applications must be being prepared,
have been applied for,or have been obtained. Issuance of this permit is contingent on issuance of dependent permits(erosion
and sedimentation control plans, stormwater management plans,etc.).
7. Does this project include any sewer collection lines that are deemed"high-priority?" [.; Yes Z' No
Per 15A 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 undennincs 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 lure,size, material, and location).
High priority lines shall be inspected by the perrnittee or its representative at least once every six-months and
inspections documented per 15A NCAC 02T.0403(a)(5)or the perrnittee's indi�ridual System-Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

Docusign Envelope ID:02DOE317-AC3F-4240-B6EE-5457EB5OB186
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X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Pennitting of Pump Stations
and Force Mains(latest version),and the Gravity Sewer Minimum Design Criteria(latest version)as 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 projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the proiect,the full technical review is required.
2. Professional Engineer's Certification:
1, Colin Rohr ,attest that this application forCarolina Beach & Myrtle Grove Wawa
(Professional Engineer's name from Application Item 1I1.1.) (Project Name from Application Item 11.I)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications,engineering calculations,and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers(latest version),and the Minimum Design Criteria for the Fast-Track Permitting
of 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.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 NCA.� ���,Q,j{l�
..................... ! ... .... ��%..................:
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North Carolina Professional Engineer's seal,signature,and date: •.•` Q` .............
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3. Applicant's Certification per 15A NCAC 02T.0106(b):
I, Rob Tanner , attest that this application for Carolina Beach & Myrtle Grove Wawa
(Signature Authority Name from Application Item i.3.) (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. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed$10,000 as well as civil penalties up to$25,000 per violation.
DocuSigned by:
Signature: Lr6� Date: 10/1/2024
FORM: FTA 10-23 Page 5 of 5

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October 1, 2024
Richard Davis
North Carolina Department of Environmental Quality (NCDEQ)
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
Re: Project Narrative for
Carolina Beach & Myrtle Grove Wawa
Dear Mr. Davis:
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Kimley-Horn and Associates, Inc. is pleased to submit the Project Narrative for the Wawa-Carolina Beach
& Myrtle Grove Road Project. This is part of the overall submittal for the NCDEQ Sewer System Extension
Application.
The proposed project will incorporate a duplex grinder station and accompanying force main sewer. The
proposed lift station will pump to a proposed force main made of 1.25" Schedule 80 PVC. The force main
ties into to an existing 4" force main that conveys wastewater from the existing Old Cape Lift Station 12 to f
an existing manhole on Saint Vincent Drive. The lift station will be sized to accommodate wastewater
generation from the Wawa.
See below for a table for basic project information.
Project Name: Carolina Beach & Myrtle Grove Wawa
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Parcel Identification R08200-001-026-000, R08200-001-024-000, R08200-
Number (PINs): 001-023-000 '
Overall Project Site Area: 6.47 acres
System Type: Grinder Station & Force Main
Proposed Use to be Wawa (Convenience Store with Gasoline Sales)
Served:
Estimated Daily Flow: 3,551 GPD
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This design package has been prepared in accordance with the applicable state and local sanitary sewer 1
design requirements. Below is a list of the items enclosed in this application package:
• Fast Track Application (Form FTA 10-23)
• LLC Good Standing Form
• Flow Tracking/Acceptance form (Form FTSE 04-16)
• USGS Topographic Site Map
• Lift Station Calculations Package
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SOSID:2623915
Date Filed:5/1/2023 3:57:00 PM
Elaine F.Marshall
State of North Carolina North Carolina Secretary of State
Department of the Secretary of Stat C2023 121 03469
Limited Liability Company
ARTICLES OF ORGANIZATION
Pursuant to§57D-2-20 of the General Statutes of North Carolina,the undersigned does hereby submit these Articles
of Organization for the purpose of forming a limited liability company.
1. The name of the limited liability company is: Carolina Beach RE LLC
(See Item 1 of the Instructions for appropriate entity designation)
2. The name and address of each person executing these articles of organization is as follows:(State whether each
person is executing these articles of organization in the capacity of a member,organizer or both by checking i
all applicable boxes.)Note: This document must be signed by all persons listed.
Name Business Address Capacity.
Robert Tanner 621 NW 53rd St,Suite 320 Boca Raton FL 334( []Member,WOkgari*
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❑Member❑Organizer
[]Member DOrganizer
3. The name of the initial registered agent is: Corporation Service Company
4. The street address.and county of the initial registered agent office of the limited liability company is:
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Number and Street 2626 Glenwood Avenue Suite 550
Raleigh 27608 Wake
City State:NC Zip Code: County:,
5. The mailing address,if different from the street address, of the initial registered agent office is:
Number and Street
City State: fr Zip Code: County:,
6. Principal office information: (Select either a or b.)
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a. ✓R The limited liability company has a principal office.
The principal office telephone number:
The street address and county of the principal office of the limited liability company is:
Number and Street: __ 15� (�0 C'-"01Wa $aV-CAL 6ak
W �w NC8y1a 1(/ Q
City: + lK State: Zip Code: County: eo u wt r
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BUSINESS REGISTRATION DIVISION P.O.BOX 29622 Raleigh,NC 27626-0622
(Revised August, 2017) Form L-01
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The mailing al9dress.if different from the street address, of the principal office of the company is:
Number and Street:
City:. State: Zip Code: County:.
b. ❑The limited liability company does not have a principal office.
7. An other provisions which the limited liability company elects to include e. . the purpose,of the entity)are
Y p tY p Y ( 8� purp ty}
attached.
8. (Optional): Listing of Company Officials(See instructions on the importance of listing the company officials in the
creation document.
Name Title. Business Address
Robert Tanner Manager 621 NW 53rd ST suite 320, Boca.Raton FL 33
9.. (Optional}: Please provide a business e-mail addrej Privacy Redaction
The Secretary of State's Office will e-mail the business automatically at the address provided above at no cost when a
document is filed. The e-mail provided will not be viewable on the website. For more information on why this service is
offered,please see the instructions for this document.
10. These articles will be effective upon filing,unless a future date is specified:
k
This is the 28 day of April ,20 23 .
Signature
Robert Tanner,Manager,Organizer
Type or Print Name and Title,
The below space to be used if more than one organizer or member is listed in Item 92 above.
Signature Signature - -
Type and Print Name and Title Type and Print Name and Title
NOTE:
1. Filing fee is$125. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P.O.SOX 29622 Raleigh,NC 27626-0622
(ReWsed August.2017) Form L-01