WQ0039834_I85_US_Hwy_64_Interchange_Sewer_Improvements_NOC_20241024

OK
October 22nd, 2024
alley, Williams, carmen & king, Inc.
ENGINEERING • ARCHITECTURE • SURVEYING
North Carolina Department of Environmental Quality
Division of Water Resources
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Subject: Sewer System Permit Ownership/Name Change
WQ0039834-1-85/US Hwy 64 Interchange Sewer Improvements
AWCK Project No. 23042
Review Team:
NC Department of
Environmental - al;�
Rer�i „—r -y
OCT 2 4 2024
Winston-Salem
Regional Office
On behalf of Davidson County, please find enclosed for your review and approval the following:
1. Original and one (1) copy of Sewer System Permit Ownership/Name Change Application.
2. Existing Permit and Certification — WQ0039834 (2 copies)
3. Property Ownership Documentation —Right of Way Easement (2 copies)
Davidson County is requesting to change the Permittee's name on the existing sewer permit number
WQ0039834. The original project was constructed by Davidson County, with easements acquired by the
County, but operated and maintained by the City of Lexington. As part of the regional system
improvements that are being made in this area, this system is being turned back over to Davidson
County, to be operated and maintained by County personnel. Because the actual ownership of the
station and associated site was never deeded to the City, the request only pertains to the permittee
name, not a physical change of ownership, as shown on the attached Right of Way Easement.
Should you have any questions or need any additional information, please feel free to contact me.
With Best Regards,
Alley, Williams, Carmen and King, Inc.
J. "Clay" Phillips, P.E.
cc: Casey Smith, Davidson County
740 Chapel Hill Road, Burlington, North Carolina P.O. Box 1179 (27216)
Tel. [phone] Fax [phone] awck.com

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permittee" references the
existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This
form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting's website:
A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All Applications):
® Submit an original completed and appropriately executed application (PNOCF 01-16).
® The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106 c , an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
® The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0106(b).
B. Existing Permit (All Applications):
® Submit a copy of the most recently issued permit and certification.
C. Property Ownership Documentation (All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities:
® Legal documentation of ownership (i.e., GIS, deed, article of incorporation, or contract), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be
sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement (FORM: DEV).
F. Package Submitted in Duplicate
® Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ - DWR
Water Quality Permitting Section
PERCS Unit
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1636 SUITE 925
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

State of North Carolina
DW Department Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM: PNOCF 01-16
Division of Water Resources
I.
1. Permittee's name: City of Lexington
2. Signature authority's name: Johnnie Tavlor per 15A NCAC 02T .0106(b)
3. Signature authority's title: City Manager
4. Permittee's mailing address: 28 West Center Street
City: Lexington State: NC Zip: 27292-
5. Permittee's contact information: Phone number: [phone] Fax Number (_)
Email Address: i8aylor , lexingtonnc.gov
11. APPLICANT INFORMATION:
1. Applicant's name: Davidson County
2. Signature authority's name: Casey Smith per 15A NCAC 02T .0106(b)
3. Signature authority's title: County Manager
4. Applicant's mailing address: 913 North Greensboro Street
City: Lexington State: NC Zip: 27292-
5. Applicant's contact information: Phone number: 336) 242-2000 Fax Number
Email Address: Casey.Smith(t�DavidsonCountyNC.gov
6. Representative's name:
7. Representative's title:
8. Representative's contact information Phone number: (_) _-_ Fax Number (_)
Email Address:
IH. PERMIT INFORMATION:
1. Existing permit number: W00039834 and most recent issuance date: February 28, 2018
2. Reason for the permit application: Name Change If other, attach detailed explanation
3. Has the facility been constructed? ® Yes or ❑ No
4. Has the facility been certified per 15A NCAC 02T .0116? ® Yes or ❑ No
FORM: PNOCF 01-16 Page 1 of

11A110)11074111al [17:VI1[11)M
Existing Permittee's Certification per 15A NCAC 02T .0106(b):
I, �tm4tt=i I i CrH '' MAGa — attest that this application
(Signature Authority's name & title from Application Item 1.2 & 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. 1 will also make no claim against the Division of Water Resources should a condition of the existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included, this application 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 p to $25,000 per violation.
Signature. 1SDate:
Applicant's Certification per 15A NCAC 02T .0106(b):
1, cmFq smpm , CVU 047-q MMKIM attest that this application
(Signature Authority's name & title from Application Item II.2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non -
discharge system to surface waters or the land may result in an 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 w as civil penalties
0 5,000 per violation. �j /)�
Signature: f�" Date: /
FORM: PNOCF 01-16 Page 2 of 2

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permtttee" references the
existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This
form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting's website:
A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All Applications):
® Submit an original completed and appropriately executed application (PNOCF 01-16).
® The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
® The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0106(b).
B. Existing Permit (All Applications):
® Submit a copy of the most recently issued permit and certification.
C. Property Ownership Documentation (All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities:
® Legal documentation of ownership (i.e., GIS deed, article of incorporation, or contract), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be
sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement (FORM: DEV).
F. Package Submitted in Duplicate
® Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ-DWR
Water Quality Permitting Section
PERCS Unit
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1636 SUITE 925
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

State of North Carolina
�, �� Department of Environmental Quality
Division of Water Resources
� V ! _ ® SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
I. EXISTING PERMITTEE INFORMATION:
1. Permittee's name: City of Lexington
2. Signature authority's name: Johnnie Taylor per 15A NCAC 02T .0106(b)
3. Signature authority's title: City Manager
4. Permittee's mailing address: 28 West Center Street
City: Lexington State: NC Zip: 27292-
5. Permittee's contact information: Phone number: 336) 243-2489 Fax Number C__)
Email Address: Maylor(a lexingtonnc.gov
II. APPLICANT INFORMATION:
1. Applicant's name: Davidson County
2. Signature authority's name: Casey Smith per 15A NCAC 02T .0106(bl
3. Signature authority's title: County Manager
4. Applicant's mailing address: 913 North Greensboro Street
City: Lexington State: NC Zip: 27292-
5. Applicant's contact information: Phone number: Q 36) 242-2000 Fax Number (_) _
Email Address: Casey. [e-mail]
6. Representative's name:
7. Representative's title:
8. Representative's contact information Phone number: (_) _-
Email Address:
Fax Number (_)
1. Existing permit number: W00039834 and most recent issuance date: February 28, 2018
2. Reason for the permit application: Name Change If other, attach detailed explanation
3. Has the facility been constructed? ® Yes or ❑ No
4. Has the facility been certified per 15A NCAC 02T .0116? ® Yes or ❑ No
FORM: PNOCF 01-16 Pagel of2

IV. CERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T .0106(b):
I, �bN/1/�GE Tki t ors C-rH ' *yc — attest that this application
(Signature Authority's name & title from Application Item I.2 & 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included, this application will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature. (/' 5 / / Date:
Applicant's Certification per 15A NCAC 02T .0106(b):
I, CPMCA SPIPM , LU t Wq M*Jh6M attest that this application
(Signature Authority's name & title from Application Item I1.2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non -
discharge system to surface waters or the land may result in an 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 143-215.613, 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 w as civil penalties o 5,000 per violation. � )
Signature: Date: /
FORM: PNOCF O1-16 Page 2 of 2

Water Resources
ENVIRONMENTAL QUALITY
February 28, 2018
Roger Jones, Public Services Manager
City of Lexington
28 West Center Street
Lexington, NC 27292
Subject: Permit No. WQ0039834
City of Lexington
I-85/US Hwy 64 Interchange Sewer Improvements
Wastewater Collection System Extension Permit
Davidson County
Dear Mr. Jones:
ROY COOPER
'Governor
AGCHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interiin Director
In accordance with your application received February 26, 2018, we are forwarding herewith
Permit No. WQ0039834 dated February 28, 2018, to the City of Lexington (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, 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.
PIease pay particular attention to the following conditions contained within this permit:
Condition IIA: This permit shall not be automatically,transferable; a request must be made and
.approved.
Condition IIk 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 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 150B of
North Carolina General 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.
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone] \ Internet: www.ncwaterauality.org
State of North Carolina I Environmental. Quality I Water Resources

City of Lexington
Permit No. WQ0039834
If you need additional information concerning this matter, please contact Jenny Graznak at (336)
776-9695 or via e-mail at ienny.graznakPncdenr gov.
Sincerely,
for Linda Culpepper
Interim Director, Division of Water Resources
by Sherri V. Knight, P.E., Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
cc: Benjamin A. Palmer, P.E. - Davis -Martin -Powell ([e-mail])
Christyn Fertenbaugh - PERCS (christyn.fertenbaughCa ncdenr.gov)
Winston-Salem Regional Office Files
Water Resources Central Files
Page 2 of 8

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
City of Lexington
Davidson County
for the construction and operation of approximately 175 linear feet of 8-inch gravity sewer; 40
linear feet of 12-inch gravity sewer; a 200-gallon per minute pump station with duplex pumps, on -
site audible and visual high water alarms, telemetry, and a permanent generator with automatic
transfer switch; as well as approximately 3,150 Iinear feet of 6-inch force main to serve the I-85./US
Hwy 64 Interchange Sewer Improvements project, and the discharge of "0" gallons per day of
collected wastewater into the City of 'Lexington's existing sewerage system, pursuant to 'the
application received February 26, 2018 and in conformity with 15A NCAC 2T; the Division's Gravity
Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1,
2000 as applicable; and other supporting data subsequently filed and approved by the Department
of Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
specified conditions and limitations contained therein.
*Permitted flow is zero because flow will be permitted in subsequent permits that connect to this line.
for Linda Culpepper
Interim Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0039934
Permit Issued: February 28, 2018
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SKEET
Cky of Lexington 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 City of Lexington's
Regional Wastewater Treatment Plant in accordance with Permit Number NC0055786
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 as applicable; and the Division's Minimum Design Criteria for the Fast -Track Permitting of
Pump Stations and Force Mains adopted June 1, 2000 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
1. No flow in excess of the quantity permitted herein, "0" GPD, shall be made tributary to the
subject sewer system until an application for permit modification for an increase in flow has
been submitted to and approved by the Division. [15A NCAC 02T.0304(b)]
2. Each pump station shall be clearly and conspicuously posted using a weatherproof sign with a
pump station identifying name/number, 24-Hour Emergency telephone number, and name of
'the owner/operator of the sewer system/pump station and instructions to call the number in
the event of alarm activation or other emergency. Simplex pump stations or vacuum sewer pits
serving a single-family residence may have a placard or sticker on the control panel in lieu of a
sign. [15A NCAC 02T .0305(h)(2)]
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 Permiee, 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; 15A NCAC 2T; the Division's Gravity Sewer
Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1,
2000 as applicable; and other supporting 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 .0110]
Page 4 of 8

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)]:
a. 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:
1. 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 Iegal 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.
L 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 for a minimum
of three years with exception of the map, which shall be maintained for the life of the
system.
Page 5 of 8

5. The Permittee shall report by telephone to a water resources staff member at the Winston-
Salem 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:
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 I 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 II 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 to appropriate enforcement actions.
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:
a. 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, include 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 106/o 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 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains
adopted June 1, 2000 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 maybe required by the Division or any other Federal, State, of Local government
agencies. [G.S.143-215.1(b)]
Page 7 of 8

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: City of Lexington
PERMIT #: WQ0039834
PROJECT: I-85/US Hwy 64 Interchange Sewer Improvements
ISSUE DATE: February 28, 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
ENGINEERS CERTIFICATION
I, as a duly re istered Professional Engineer in the State of North Carolina,
having been authorized to observe (5 periodically, ❑ weekly, ❑ 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 as applicable; the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other
supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
❑ Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR - Water Quality Regional Operatlons'Section 450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Winston-Salem Regional Office Phone: [phone] FAX: [phone]

i--
Water.Resources
ENVIRONMENTAL QUALITY
February 28, 2018
Roger Jones, Public Services Manager
City of Lexington
28 West Center Street
Lexington, NC 27292
Subject: Permit No. WQ0039834
City of Lexington
I-85/IIS Hwy 64 Interchange Sewer Improvements
Wastewater Collection System Extension Permit
Davidson County
Dear Mr. Jones:
ROY COOPER
Governor
MICHAEL S. REGAN
secretary
LINDA CULPEPPER
Interim Director
In accordance with your application received February 26, 2018, we are forwarding herewith
Permit No. WQ0039834 dated February 28, 2018, to the City of Lexington (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, 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.
Please pay particular attention to the following conditions contained within this permit:
Condition II.1: This permit shall not be automaticallytransferable; a request must be made and
.approved.
Condition IIk 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 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 150B of
North Carolina General 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.
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone] \ Internet: www.ncwateroualitv.orl;
State of North Carolina f Environmental Quality I Water Resources

I
I
City of Lexington
Permit No. WQ0039834
If you need additional information concerning this matter, please contact Jenny Graznak at (336)
776-9695 or via e-mail at [e-mail]
Sincerely,
for Linda Culpepper
Interim Director, Division of Water Resources
by Sherri V. Knight, P.E., Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
cc: Benjamin A. Palmer, P.E. - Davis -Martin -Powell ([e-mail])
Christyn Fertenbaugh - PERCS(christyn.fertenbaugh@ncdenngov)
Winston-Salem Regional Office Files
Water Resources Central Files
Page 2 of 8

'A
1
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
City of Lexington
Davidson County
for the construction and operation of approximately 175 Iinear feet of 8-inch gravity sewer; 40
linear feet of 12-inch gravity sewer, a 200-gallon per minute pump station with duplex pumps, on -
site audible and visual high water alarms, telemetry, and a permanent generator with automatic
transfer switch; as well as approximately 3,150 Iinear feet of 6-inch force main to serve the I-8S./US
Hwy 64 Interchange Sewer Improvements project, and the discharge of "0" gallons per day of
collected wastewater into the City of Lexington's existing sewerage system, pursuant to the
application received February 26, 2018 and in conformity with 1SA NCAC 2T; the Division's Gravity
Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1,
2000 as applicable, and other supporting data subsequently filed and approved by the Department
of Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
specified conditions and limitations contained therein.
*Permitted flow is zero because flow will be permitted in subsequent permits that connect to this line.
for Linda Culpepper
Interim Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: " WQ0039834
Permit Issued: February 28, 2018
Page 3 of 8

Ji
SUPPLEMENT TO PERMIT COVER SHEET
City of Lexington 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 City of Lexington's
Regional Wastewater Treatment Plant in accordance with Permit Number NC0055786
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 as applicable; and the Division's Minimum Design Criteria for the Fast -Track Permitting of
Pump Stations and Force Mains adopted June 1, 2000 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
1. No flow in excess of the quantity permitted herein, "0" GPD, shall be made tributary to the
subject sewer system until an application for permit modification for an increase in flow has
been submitted to and approved by the Division. [15A NCAC 02T.0304(b)]
2. Each pump station shall be clearly and conspicuously posted using a weatherproof sign with a
pump station identifying name/number, 24-Hour Emergency telephone number, and name of
the owner/operator of the sewer system/pump station and instructions to call the number in
the event of alarm activation or other emergency. Simplex pump stations or vacuum sewer pits
serving a single-family residence may have a placard or sticker on the control panel in lieu of a
sign. [15A NCAC 02T .0305(h)(2)]
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; 15A NCAC 2T; the Division's Gravity Sewer
Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1,
2000 as applicable; and other supporting 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 .011Q]
Page 4 of 8

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)]:
a. 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:
1. 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.
i. 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 for a minimum
of three years with exception of the map, which shall be maintained for the life of the
system.
Page 5 of 8

5. The Permittee shall report by telephone to a water resources staff member at the Winston-
Salem 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:
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 I 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 II 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 to appropriate enforcement actions.
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:
a. 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, include 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 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains
adopted June 1, 2000 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 Permitted 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 OZT .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 maybe required by the Division or any other Federal, State, of Local government
agencies. [G.S.143-215.1(b)]
Page 7 of 8

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: City of Lexington
PERMIT #: WQ0039834
PROJECT: I-8S/US Hwy 64 Interchange Sewer Improvements
ISSUE DATE: February 28, 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
I, 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
I, . as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (E] periodically, ❑ weekly, [] 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 as applicable; the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other
supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
❑ Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR - Water Quality Regional Operations -Section 450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Winston-Salem Regional Office Phone: [phone] FAX: [phone]

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE:
City of Lexington
PERMIT #:
WQ0039834
PROJECT:
1-85/US Hwy 64 Interchange Sewer Improvements
ISSUE DATE:
February 28, 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
to 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 shg be a complete set of record drawings and
design calculations regardless of whether partials have been submitted.
IW13j,tv
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 h in or portio thereof.
R06ER
P06uc 5fFA iM S
SoNES MMA6CIt_ _ 14 Zo
Printed Name, Title Signature at
ENGINEER'S CERTIFICATION
1, Beniamin A. Palmer as a duI registered Professional engineer in the State of North Carolina,
having been authorized to observe (ff periodically, ® weekly, ❑ 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 2T; the Division of
Water Resources' (Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as
applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and
Force Mains adopted June 1, 2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
® Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
� ,jN1CARp.
�QQ0.pFE55l �p,..�L%i_
/ 25496
- (— ll-202�:•
NC DWR — Water Quality Regional Operations Section 450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Winston-Salem Regional Office Phone: [phone] Fax: [phone]

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE:
City of Lexington
PERMIT #:
WQ0039834
PROJECT:
1-85/US Hwy 64 Interchange Sewer Improvements
ISSUE DATE:
February 28, 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
to 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 Sh" be a complete set of record drawings and
design calculations regardless of whether partials have been submitted.
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 h m or portio thereof.
PUBLIC SBRVirc S
R06ER log-s ~A6E1L
Printed Name, Title Signature ate
ENGINEER'S CERTIFICATION
1, Beniamin A. Palmer as a duty registered Professional en neer in the State of North Carolina,
having been authorized to observe ( periodically, ® weekly, [] 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 2T; the Division of
Water Resources' (Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as
applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and
Force Mains adopted June 1, 2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
® Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
J ��QppF ESSi ••,C� •���
25496
�i�F�'•Fir %EEP
",,,gMiry q 9P�
NC DWR — Water Quality Regional Operations Section 450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Winston-Salem Regional Office Phone: [phone] Fax: [phone]

4 FILED DAVIDSON COUNTY, NC DAVID T. RICKARD, REGISTER OF DEEDS 9/21/2018
12:11:57 PM BOOK 2331 PAGE 373 377 INSTRUMENT #2018000019431
Recording:$26.00 Excise Tax:$0.00 Deputy: TWARD
Prepared By: Charles E. Frye III, Davidson County Attorney
Mail To: Office of the Davidson County Attorney
Post Office Box 1067
Lexington, NC 27293-1067
RIGHT OF WAY EASEMENT
This Right of Way Easement is made this 3" day of
2018, by and between WILLIAM RANDOLPH GRIMES and
wife, LINDA SIMPSON GRIMES; SAM R. HARRIS and wife, EVELYN L.
HARRIS; and THOMAS A. HARRIS and wife, MARCI W. HARRIS, herein
referred to as Grantor, to DAVIDSON COUNTY, a Body Politic and Corporate of
the State of North Carolina, herein referred to as Grantee:
The designation Grantor and Grantee as used herein shall include said
parties, their heirs, successors and assigns, and shall include singular, plural,
masculine, feminine or neuter as required by context.
WITNESSETH, that Grantor, for a valuable consideration, paid by
Grantee, receipt of which is hereby acknowledged, has and by these presents
does grant, bargain, sell and convey unto Grantee, its successors and assigns, a
perpetual right of way easement to construct, install, operate, repair, maintain,
replace and remove sewer lines and a water drainage system over, across and
through land in Conrad Hill Township, Davidson County, North Carolina,
described as follows:
BEGINNING at the northwest corner of Grantor (DB 654, PG 463),
said point being an existing '/2' iron rod; thence along the northern
property line of said Grantor, the southern right-of-way of New
Bowers Road (NCSR 2227), North 60028'20" East 61.17 feet to a

BK: 2331 PG: 374
point, said point being northeast corner of the easement boundary;
thence with the boundary of said Easement South 5°38'47" West
386.30 feet to a point; thence with the boundary of said Easement
South 84°21'13" East 32.30 feet to a point; thence with the
boundary of said Easement South 5038'47" West 65.43 feet to a
point; thence with the boundary of said Easement South 56°18'00"
East 28.07 feet to a point; thence with the boundary of said
Easement South 33042'00" West 20.00 feet to a point; thence with
the boundary of said Easement North 56'18'00" West 37.54 feet to
a point; thence with the boundary of said Easement North
84021'13" West 62.24 feet to a point in the western line of the
Grantor; thence with the western property line of said Grantor North
1051'06" East 34.74 feet to a 1" iron pipe; thence with the western
property line of said Grantor North 5°38'47" East 395.02 feet to the
point and place of the BEGINNING.
Containing 25,404.25 ± S.F
TO HAVE AND TO HOLD, the aforesaid Right of Way Easement and all
privileges and appurtenances thereto belonging to the Grantee.
And the Grantor covenants with the Grantee, that Grantor is seized of the
premises in fee simple, has the right to convey the Right of Way Easement, that
title is marketable and free and clear of all encumbrances, and that Grantor will
warrant and defend the title against the lawful claims of all persons whomsoever.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as
of the date and year first above written.
[The remainder of this page left intentionally blank]
2

BK: 2331 PG: 375
!f% (SEAL)
WILLIAM FWOLPH GRIMES
- r
A SEAL)
INDA SIMPS N GRIMES
Z� 6��- (SEAL)
AM R. HARRIS
1
(SEAL)
EVELYN L HARRIS
(SEAL)
THOMAS A. HARRIS
w"`,� (SEAL)
MARCI W. HARRIS
3

I
BK: 2331 PG: 376
NORTH CAROLINA
DAVIDSON COUNTY
I , I,KhorLJ� 5, ./✓cs , a Notary Public of said County and
State, do hereby certify that WILLIAM RANDOLPH GRIMES and LINDA
SIMPSON GRIMES personally appeared before me this day and acknowledged
the execution of the foregoing instrument.
Witness my hand and notarial seal this day of
2018.
Notary Public
My Commission Expires: 3 - f3 1,0'�-o pEe�a�`H
a
s�Gs �6LIG w
NORTH CAROLINA
DAVIDSON COUNTY
I, ( �J, VIIf , a Notary Public of said County and
State, do hereby certify that SAM R. HARRIS and EVERLYN L. HARRIS
personally appeared before me this day and acknowledged the execution of the
foregoing instrument.
Witness my hand and notarial seal this 3 day of
2018.
Notary Public
My Commission Expires: 3 S W2.0 A AN r.11I
� t40TAlly �✓
?U
4

BK: 2331 PG: 377
it
8
STATE OF ARIZ A
COUNTY OF '
1, - , a Notary Public of said County and
State, do hereby certify that AOMAS A. HARRIS and MARCI W. HARRIS
personally appeared before me this day and acknowledged the execution of the
foregoing instrument.
Witne s my hand and notarial seal this day of
S , 2018.
Notary Public
My Commission Expires: LISA K. HAGANS
.Y' NOTARY PUBLIC - ARIZONA
Maricopa County
My Commission Expires
March 3, 2019'
5

FILED DAVIDSON COUNTY, NC DAVID T. RICKARD, REGISTER OF DEEDS 9/21/2018
12:11:57 PM BOOK 2331 PAGE 373 - 377 INSTRUMENT #2018000019431
Recording:$26.00 Excise Tax:$0.00 Deputy: TWARD
Prepared By: Charles E. Frye III, Davidson County Attorney
Mail To: Office of the Davidson County Attorney
Post Office Box 1067
Lexington, NC 27293-1067
RIGHT OF WAY EASEMENT
This Right of Way Easement is made this 3" day of
2018, by and between WILLIAM RANDOLPH GRIMES and
wife, LINDA SIMPSON GRIMES; SAM R. HARRIS and wife, EVELYN L.
HARRIS; and THOMAS A. HARRIS and wife, MARCI W. HARRIS, herein
referred to as Grantor, to DAVIDSON COUNTY, a Body Politic and Corporate of
the State of North Carolina, herein referred to as Grantee:
The designation Grantor and Grantee as used herein shall include said
parties, their heirs, successors and assigns, and shall include singular, plural,
masculine, feminine or neuter as required by context.
WITNESSETH, that Grantor, for a valuable consideration, paid by
Grantee, receipt of which is hereby acknowledged, has and by these presents
does grant, bargain, sell and convey unto Grantee, its successors and assigns, a
perpetual right of way easement to construct, install, operate, repair, maintain,
replace and remove sewer lines and a water drainage system over, across and
through land in Conrad Hill Township, Davidson County, North Carolina,
described as follows:
BEGINNING at the northwest corner of Grantor (DB 654, PG 463),
said point being an existing %" iron rod; thence along the northern
property line of said Grantor, the southern right-of-way of New
Bowers Road (NCSR 2227), North 60028'20" East 61.17 feet to a

i BK: 2331 PG: 374
P
point, said point being northeast corner of the easement boundary;
thence with the boundary of said Easement South 5°38'47" West
386.30 feet to a point; thence with the boundary of said Easement
South 84°21'13" East 32.30 feet to a point; thence with the
boundary of said Easement South 5038'47" West 65.43 feet to a
point; thence with the boundary of said Easement South 56°18'00"
East 28.07 feet to a point; thence with the boundary of said
Easement South 33°42'00" West 20.00 feet to a point; thence with
the boundary of said Easement North 56'18'00" West 37.54 feet to
a point; thence with the boundary of said Easement North
84021'13" West 62.24 feet to a point in the western line of the
Grantor; thence with the western property line of said Grantor North
1°51'06" East 34.74 feet to a 1" iron pipe; thence with the western
property line of said Grantor North 5038'47" East 395.02 feet to the
point and place of the BEGINNING.
Containing 26,404.25 ± S.F.
TO HAVE AND TO HOLD, the aforesaid Right of Way Easement and all
privileges and appurtenances thereto belonging to the Grantee.
And the Grantor covenants with the Grantee, that Grantor is seized of the
premises in fee simple, has the right to convey the Right of Way Easement, that
title is marketable and free and clear of all encumbrances, and that Grantor will
warrant and defend the title against the lawful claims of all persons whomsoever.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as
of the date and year first above written.
[The remainder of this page left intentionally blank]
2

BK: 2331 PG: 375
<s (SEAL)
WILLIAM OLPH GRIMES
ti A SEAL)
INDA SIMPS N GRIMES
6��- (SEAL)
AM R. HARRIS
�U2aM QJ1(*0) (SEAL)
EVELYN 11. HARRIS
(SEAL)
THOMAS A. HARRIS
L"d, (SEAL)
MARCI W. HARRIS

A
i
BK: 2331 PG: 376
NORTH CAROLINA
DAVIDSON
COUNTY
a Notary Public of said County and
State, do hereby certify that WILLIAM RANDOLPH GRIMES and LINDA
SIMPSON GRIMES personally appeared before me this day and acknowledged
the execution of the foregoing instrument.
Witness my hand and notarial seal this �' day of
lhl./ , 2018.
Notary Public
My Commission Expires: 3- 8• -;O-Lo eoQAH i, y
o
NORTH CAROLINA
DAVIDSON COUNTY
I, T & I-, a Notary Public of said County and
State, do hereby certify that SAM R. HARRIS and EVERLYN L. HARRIS
personally appeared before me this day and acknowledged the execution of the
foregoing instrument.
Witness my hand and notarial seal this 3 day of
2018.
Notary Public -
My Commission Expires: 9- G. kow
4
tOTAny
zaH co�,�,

BK: 2331 PG: 377
STATE OF ARIZ A
COUNTY OF
RL}!L 15 a Notary Public of said County and
State, do hereby certify t a:t OI HARRIS and MARCI W. HARRIS
personally appeared before me this day and acknowledged the execution of the
foregoing instrument.
Witne s my hand and notarial seal this day of
US , 2018.
r
Notary Public
My Commission Expires:
IISA K. HAGANS
NOTARY PUBLIC ARIZONA
Maricopa County
-ai'+' My Commission Expires
March 3, 2019