WQ0045892_Application_20241007

25226 US Highway 17, Hampstead, NC 28443
Phone: [phone] Fax: [phone] a ail: Admin@RSCEn inaeri g ng,com
DWR — Division of Water Resources
127 Cardinal Drive Extension
Wilmington, NC28405
Re: Hampstead Station Expansion Project —Cover Letter
RE0
EIVED/NC45KBM52024
OCT 0 7 2024
Water Quest, Regional
Operations Section
Wilmington Renionel Oaice
The JayTees Properties IV, LLC is requesting approval to tie into an existing force main (Pluris) located on
US Hwy 17 in Hampstead. There is a new commercial development located on approximately 7.61 acres
that will be comprised of 4 individual buildings that will be occupied by a mix of office space, retail space
and restaurants that is proposed to deliver 484 gpd total flow. A private lift station will be located on
the parcel and pump via 2" force main to the proposed connection. The 2" force main will be 180' in
length from the duplex lift station to the easement in which the existing Pluris force main is located. As
required by Pluris, there is an application to cover the private portion of the extension. There is also an
application fee attached.
Please see attached for the following:
• Application fee ($600)
• Fast Track Application (FTA 06-21)
• Flow Tracking (FTSE 10-18)
• Site Map
• Secretary of State documentation
If you should have questions regarding this submittal, please feel free to contact me. I appreciate your
review of the project and look forward to hearing back from you.
Sincerely,
Anthony C. Braam, PE

DWR State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 &SUPPORTING DOCUMENTATION
Application Number:
- (to be completed by DWR)
All items must be comi2leted or the application will be returned
I• APPLICANT INFORMATION:
1. Applicant's name: The JavTees Properties IV LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: El Individual
❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County® Privately -Owned Public Utility
3. Signature authority's ❑ Municipal ® Other
name: Jeff W. Tu in Sr per 15A NCAC 02T .0106 b Title: ManagingMember
4. Applicant's mailing address: 105 Island
City Wilmington State: NC
5. Applicant's contact information: Zip: 28480-_
Phone number: 910 619-7941 Email Address: 'efftur in [e-mail]
maiLcom
It. PROJECT INFORMATION:
1 • Project name: Hampstead Station Expansion Project
2. Application/Project status;
® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W 00_ s ARPA funded
d issuedate:
For modifications, also attach a detailed narrative escriptions described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Pender _
4• Approximate Coordinates (Decimal Degrees): Latitude: 34.36400 Longitude:-77.7116o
5. Parcel ID (if applicable): 3282-86� gg 1 (or parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Anthony License Number: 23044
Firm: RSC Engineerin_g, PLLC
Mailing address: 15226 US Hwy 17
City: Ham stead State: NC Zip: 28443-_
Phone number: 919) 219-2543 Email Address: cliff(a�rsceneineer__ �na�om
IV. WASTEWATER TREATMENT FACILITY (WWTF)INFOR
1. Facility Name: Pluris Ham stead WWTF permit Number: W p 372g7v Owner Name: Pluris
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
L PermitNumber(s): WQ0037324
2. Downstream (Receiving) Sewer Information: 8 inch
3. System Wide Collection System Permit Number(s) (if applicable): WQCS Gravity ®Force Main
Owner Name(s):
FORM; FTA 10-23
Page. I of �

VI. GENERAL REQUIREMENTS
L If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM- DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM- HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes [:)No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ® Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ® 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
® 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 O114(fl? ElYes ® 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(I))
Mixed Commercial Use
Daily Design Flow 0
880 gal/day/Acre
No. of Units
0.55
Flow
484 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
484 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 .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T 01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 484 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:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date: _
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 10-23
Page 2 of 5

VIL 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
1. Pump station number or name: I
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.37480' Longitude:-77.703840
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.000484 millions gallons per day (fine 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): 20 gallons per minute (GPM) at 127 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
180
Sch 40
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
® Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible ��/��/with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the putations' storage
capacities and the rotation schedule of the portable power source or pump, including travel time -.!s shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/altematives found in 15A NCAC 02T 0305(i) & (g)? ® Yes [:)No
15A NCAC 02T.0305 contains minimum separations that shall be rovided for sewer s stems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below (vertical)
ZWater mains (vertical - water over sewer preferred, including in benched trenches)
'Water
18 inches
mains (horizontal)
18 inches
Reclaimed water lines (vertical - reclaimed over sewer)
10 feet
Reclaimed water lines (horizontal - reclaimed over sewer)
l8 inches
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class 11 impounded reservoirs used
2 feet
as a source of drinking water, and associated wetlands.
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from
high
100 feet
normal
water (or tide elevation) and wetlands associated with these waters (see item IX.2)
**Any
other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated
50 feet
with these waters or classified as WL.
Any building foundation (horizontal)
10 feet
Any basement (horizontal)
5 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
10 feet
Any swimming pools
5 feet
Final earth grade 1. eP i,.n
10 feet
➢ If noncompliance with 02T 0305(f) or (g), see Section X.l of this application 36 inches
* 15A NCAC 02T.030 5(� contains alternatives where separations in 02T 0305(f) 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 Webrnule
2. Does this project comply with the minimum separation requirements for water mains? ➢ No
If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a❑s parateYes❑docum ®N/A
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands?
➢ Please provide supplementary information identifying the areas of non-conformance. ❑Yes ❑ No ®N/A
➢ See the Division's draft separation reouirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: _
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .020®No
0?
➢ This includes Trout Buffered Streams per 15A NCAC 2B4O202 ❑Yes ❑ No
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits
or 401 Water Quality Certifications? ❑ Yes ® No
➢ 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/certificatiol Per 15A NCAC 02T 0105(c)(6) directly related environmental permits or certification applications must bebein es ❑ No
epared
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" Per 15A NCAC NCB 02 "high -priority sewer" means any aerial sewer, sewer contacting surface waters, ❑Yes ®No
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, /locationHigh priority lines shall be inspected by the permittee or its representative at least once every siinspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System-Wermit.
FORM: FTA 10-23
ge 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting 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
2. Professional Engineer's Certification:
I, Anthony C. Braam , attest that this application for Hampstead Station Expansion Project
(Professional Engineer's name from Application Item 111.I.) (Project Name from Application Item IL 1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum 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 143-215.6B, 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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Jeff W. Turpin, Sr. attest that this application for Hampstead Station Expansion Project
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item IL 1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
1 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.
Signature: �— Date: G
l7
FORM: FTA 10-23 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DwR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
L Applicant's name: The Jaylees Properties IV LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ corporation rP El General Partnership ®Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ® Other
3. Signature authority's name: Jeff W. Turpin Sr per 15A NCAC 02"I O I Q6(1>)
Title: Managing Member
4. Applicant's mailing address: 105 Island Drive
City: Wilmington
5. Applicant's contact information:
State: NC Zip: 28480-_
Phone number: 910 619-1941 Email Address: jeffturyinI95SAamail com
II. PROJECT INFORMATION:
I. Project name: Hampstead Station Expansion Project
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00ElARPA funded
_ and issued date: _
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00_
3. County where project is located: Pender
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.3640' Longitude:-77.71160
5. Parcel ID (if applicable): 3282,86-8819-0000 (or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
L Professional Engineer: Anthony C. Braam License Number: 23044
Firm: RSC Engineering, PLLC
Mailing address: 15226 US Hwy 17
City: —Hampstead State: NC Zip: 28443-_
Phone number: 919 219-2543 Email Address: Cliff@
ncenizineering.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Plurjs Hampstead W WTF Permit Number: M0037287
Owner Name: Pluris
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
Permit Number(s): W 0037324
2. Downstream (Receiving) Sewer Information: 8 inch
❑ Gravity
3. System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): _
® Force Main
FORM: FTA 10-23
Page 1 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 N N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement FORNj..DEV) been attached?
❑ Yes ❑ No N N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0I15(c) been attached?
[:)Yes [-]No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ® Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ® 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
® Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic 100 % Commercial % Industrial See 15A JNCAC 02T .0103L20�
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 140f ? ❑ Yes N 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'•"
No. of Units
Flow
Mixed Commercial Use
880 gal/day/Acre
0.55
484 GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
GPD
gal/
GPD
Total
484 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 .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T,01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 484 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:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02' .0305 & MPE fGrgyE[y Secaers
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 MC
VUL PUMP STATION DESIGN CRITERIA (If Applicable) -7 02T .0305 & MDC Pnm Sfatlons(Force Elaars):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.37480° Longitude:-77.703840
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.000484 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): 20 gallons per minute (GPM) at 127 feet total dynamic head (TDII)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
2 180 Sch 40
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.0IC. 1.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T.0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Most be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
® Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, sh 11 be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

M. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/altematives found in 15A NCAC 02T .0305(f) & Lg�? ® Yes ❑ No
15A NCAC 02T.0305 contains minimum se arations that shall be rovided for sewer [
Setback Parameter*
Sys ems.
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-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
"Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
r If noncompuance with g� t .0 iu , t) or (QL see Section X.1 of this application
*I SA NCAC 02T.0305(g) contains alternatives where separations in 02T.030M 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 Nveboaee
2. Does this project comply with the minimum separation requirements for water mains? ❑ Yes ❑ No ® N/A
D If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No ® N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ Seethe 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.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: _ ® No
If yes, does the project comply with setbacks found in the river basin rules per liA NCAC 02B .0200? ❑ Yes ❑ No
D This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(cZ(6) (additional permits/certifications)? ® Yes ElNo
Per 15A NCAC 02T.0 I 05(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 ® 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 undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months nd
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Colle ion permit.
FORM: FTA 10-23
Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with.] SA NCAC 02T, the Minimum Design Criteria for the Permittin_�of Pu>nu Stations
and Force Mains iatest versionj and the Gravity Sewer L1irimum 1�esisn Criteria latest version as applicable?
N 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 vroiects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, Anthony C. Braam , attest that this application for Hampstead Station Expansion Project
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item it.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers latest version), and the Minimum Design( riteria.ior the Fang,"" aCic " �rillifflnv
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 143-215.6B, 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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Jeff W. Turpin, Sr. attest that this application for Hampstead Station Expansion Project
(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.
Sign
FORM: FTA
Date: —a ^ k.
Page 5 of 5

State Of North
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
Entity Requesting Allocation:
LLC
Project Name for which flow is being requested: Hampstead Station Ex
More than one FUNpansion Project
n+aY be attlons along theglepreject (f the owner of the route of to proposed wastewareerf w. P Is not rerponsiblejor all pump
•' `-umptete uus section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Pluris Hampstead WWTF
b. W WTp Facility Permit # WMIT)4�
c. VIM? facility's permitted flow
d. Estimated obligated flow not yet tributary to the W WTI
e. W WTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
are in
96.36 —
II. Complete this section for each pump station
wastewater now. you are responsible for along the route of this proposed
List pump
stations located between
the project connection point and the W WTP:
P
Pump�1$°
(A)
B)
(L)
(Dl�� (Eh(A-(A
(Name or Station
Station Finn
PNo.rt
De ►y Flow** Average
Approx.
current
Not yet
Total Current
Number)
Capacity,•
MOD
(Firm/Pt),
M(}D
Avg Dai IY
Tributary
Daily Flow,
Flow Plus
Obligated
Flow, MGD
MGD
Available
Flow Capacity***
* The Firm Capacity (design owtl ) of any p p tton is fd ne rimed as the i umeam m pumped flow that can achieved with the largest pump taken out of service,
es Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
less than 2.5, per Section 2.02(A)(q)(c) of the (pt) not
Minimum Design Criteria.
*** A Planning Assessment Addendum shalt be attached for each pump station located
Project connection point and the W WTP where the Available Capacity is < p, between the
Downstream Facility Name (Sewer): Pluri Hampstead LLC
Downstream Permit Number:
W(�0037324
Page I of 6
! 'I M: I Q-?.;

III. Certification Statement:
I � r, S k „�� certify to the best of my knowledge that the addition of
the volume of wastewater to a permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat_!hc_proposed new wastewater.
Signing Official Signature
Page 2 of 6

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• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
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an Amended a Annual Report form
Limited Liability Company
Legal Name
TheJayTees Properties III, LLC
Information
Sosid: 1545280
Status: Current -Active O
Date Formed: 9/22/2016
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Turpin, Jeffery Wayne, SR
Addresses
Malting
105 Island Drive
Wrightsville Beach, NC 28480-1922
Reg Office
105 Island Drive
Wrightsville Beach, NC 28480-1922
Company Officials
Principal Office
105 Island Drive
Wrightsville Beach, NC 28480-1922
Reg Mailing
105 Island Drive
Wrightsville Beach, NC 28480-1922
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Managing Member
Jeffery W Trupin , SR
105 Island Drive
wrightsville Beach NC 28480