WQ0040049_Application_20180607

State of North Carolina
Department of Environmental Quality
Division of Water Resources
P" • -'_: 15A NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application NumberW@C0riO0i1 (m be completed byDwR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Lake City Tractor Supply LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ OtherRECEIVEDINCDENRIDWR
3. Signature authority's name: David Krug per 15A NCAC 02T .0106(6) l U N 5 ,1110
Title: Manager
WORO5
4. Applicant's mailing address: 122 Cherokee Road, Suite 2 MOORESVILLE REGIONAL OFFICE
City: Charlotte State: NC Zip: 28207-
5. Applicant's contact information:
Phone number: [phone] Email Address: david(c�davidrkrug.com
11. PROJECT INFORMATION:
1. Project name: Oakhurst Shopping Center
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.202° Longitude: -80.825'
5. Parcel ID (if applicable): 16104344
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Jeffery C. Orsborn License Number: 028786
Firm: Orsborn Engineering Group, PA
Mailing address: 610 E. Morehead St., Suite 106
City: Charlotte State: NC Zip: 28202-2614
Phone number: [phone] Email Address: iorsborn(tborsborn-eng com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Sugar Creek W WTP Permit Number: NCO024937
Owner Name: CLTWater(CMUD)
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQUnknown Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): CLTWater(CMUD)
FORM: FTA 04-16 Pagel 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 NN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Aereement (FORM: DEV) been attached?
❑ Yes ❑No NN/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Aereement (FORM: HOA) been attached?
❑ Yes []No NN/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned
N Retail (stores, centers, malls)
❑ Car Wash
❑ Residential Leased
N 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: 100 % Domestic/Commercial % Commercial
Industrial (See 15A NCAC 02T.0 103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T.01 14(fl? ❑ Yes N No
➢ If yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow e,b No. of Units
Flow
Shopping Center w/ Food Prep
130 gal/ 1000 sq ft 26,400
3432 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
3432 GPD
a See 15A NCAC 02T .0114(b), (d). (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 3432 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (if Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 230' PVC
➢ Section 11 & Ill of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) —02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - °
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at _ feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B)."
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be
provided in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B.0200 & 15A NCAC 02T.0305(0):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains horizontal
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, WS -1 waters of Class I or
Class 11 impounded reservoirsused as a source of drinking water
100 feet
**Waters classified WS (except WS -I or WS -V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
To slo e of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboage
➢ If noncompliance with 02T.0305(f) or (2), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes [-]No
Y See the Division's draft separation requirements for situations where separation cannot be meet
No variance is required if the alternative design criteria specified is utilized in design and construction
Y As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .02009 ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 26.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
Y Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high-priority?"
Per 15A NCAC 02T.0402, "high-priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No
S- If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02 T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version) and the Gravitv Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
1 bffery C Orsborn, PE attest that this application for
(Professional Engineer's name from Application Item IIm
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain
portions of this submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this
material and have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 sdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
(Signature
David
's name & title from Application Item 1.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. 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:
Pl1TT R. PTA AA 1G
Date: g// 6 fl e

CHARLOTTE
W,, )TE R
May 30, 2018
Mr. Blong Yang
Orsborn Engineering Group, PA
610 East Morehead Street
Suite 102
Charlotte, NC 28202
SUBJECT: WATER AND SANITARY SEWER FLOW ACCEPTANCE
OAKHURST SQUARE SHOPPING CENTER
4701 MONROE ROAD, CHARLOTTE NC
CLTWATER TRACKING# 2018719
After an analysis of the sanitary sewer system associated with the proposed design of, Oakhurst
Square Shopping Center, it was determined that there is sufficient capacity to accommodate the
proposed sewer flow of 3,432 gallons per day (26,400 ft' retail space x 130 gpd/1,000 ft') at the
connection point(s) indicated on the submitted utility plan for transmission to the Sugar Creek
Wastewater Treatment Plant; NPDES permit number NC0024937, for treatment. This acceptance of
flow is based on the existing capacity of the designated publicly owned treatments works. Please
see attached NC DEQ flow tracking form.
CLTWater agrees to furnish water to the subject project. The water quality to the subject project is
regulated by the State Drinking Water Act Amendments of 1986 and The Water Supply Management
Plan, PWS ID # 0160010 on file with the Public Water Supply Section of NC DENR. However,
CLTWater cannot guarantee a constant pressure or quality of flow.
CLTWater does not expect any of the above conditions to preclude water or sewer service to the
subject site. However, the applicant should understand that due to the involvement of other agencies
and continuing growth of the water and sewer system, the ability to provide service for future
projects cannot be guaranteed nor reserved. Connection to the CLTWater and sewer system is
accepted on a first come, first served basis.
The applicant should understand that this letter is not authorization to construct private water or
sewer systems, as the appropriate local or State permits are required prior to construction. If the
you nave any
please do not hesitate to contact Charlotte Water at [phone].
Sincerely,
Barbara Gross
Engineering Assistant
Charlotte Water 5100 Brookshire Blvd, Charlotte, NC 28216 charlottewater.org
6 Operated by the City of Charlotte

State of North Carolina
` Department of Environmental Quality
�X F Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Orsborn Engineering Group, PA
Project Name for which flow is being requested: Oakhurst Square Shopping Center
More than one FTSE may be required for a single project if 1he owner of the 117WTP is not responsiblefor all pmnp
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: McAlpine Creek, Irwin Creek, Sugar Creek
b. WWTP Facility Permit #: NC0024970, NC0024945, NCO024937
All flows are in MGD
c. WWTP facility's permitted flow 99.0
d. Estimated obligated flow not yet tributary to the WWTP 11.29
e. WWTP facility's actual avg. flow 65.0
f Total flow for this specific request 0.003
g. Total actual and obligated flows to the facility 76.29
h. Percent of permitted flow used 77.1%
Il. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pf) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Oakhurst TOWnhomes
Downstream Permit Number: 416-626
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Keri Cantrell certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer overflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation
of the planned improvements identified in the planning assessment where applicable. This
analysis has been performed in accordance with local established policies and procedures using
the best available data. This certification applies to those items listed above in Sections I and 11
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Signing Official Signature
KA', Q�(a 5/24/2018
Date
Page 2 of 6
FTSE 04-16

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JOB # 17019 -
DATE: 05/15/18 USGS QUAD MAP EXHIBIT
SCALE: 1"=300' FOR��
DRAWN BY: MLM Oakhurst Shopping Center s -
APPROVED BY: 1C0 CHARLOTTE, NORTH CAROLINA
A ORSBORN ENGINEERING GROUP
610 EAST MOREHEAD STREET, SUITE 106
CHARLOTTE, NC 28202
P) 704-749-1432. F) 704-749-1433

North Carolina Secretary of State Search Results
Page I of 2
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Limited Liability Company
Legal Name
Lake City Tractor Supply, LLC
Prev LegaL Narnr
2207 EAST 7TH STREET, LLC
Information
Sosld: 0497061
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 6/16/1999
Fiscal Month: December
Registered Ager:: Krug, David R
Addresses
Mailing
122 Cherokee Rd., Suite 2
Charlotte. NC 28207-1962
Reg Mailing
122 Cherokee Rd., Suite 2
Charlotte, NC 28207-1962
Company Officials
Principal Office
122 Cherokee Rd., Suite 2
Charlotte, NC 28207-1962
Reg Office
122 Cherokee Rd., Suite 2
Charlotte. NC 28207-1962
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
https://www.sosnc.gov/online_services/search/Business_Registration_Results 6/5/2018

North Carolina Secretary of State Search Results
Manager
David R Krug
122 Cherokee Rd., Suite 2
Charlotte NC 28207
Page 2 of 2
littps://www.sosnc.gov/online_services/searchlBusiness_Registration_Results 6/5/2018

CD•�•
(010
TRANSMITTAL
ORSBORN ENGINEERING GROUP
610 EAST MOREHEAD STREET, SUITE 106 Project: 17019
CHARLOTTE, NORTH CAROLINA 28202 Oakhurst Shopping Center RECEIVED/NCDENR/DWR
PHONE [phone]
FAx [phone] JUN 5 ?O1R
To: Fast Track PermittingDate: 06/01/2018 WQROS
MOORESVILLE REGIONAL OFFICE
NCDENR
610 E. Center Ave. Sent Via: FedEx
Mooresville, NC 28115
[phone]
Qty. Date
Description
2
Applications
1
Fee $480
1
Flow Acceptance/Flow Tracking
1
USGS Quad Map
1
Cover Letter
® For Approval
❑ For Your Use
❑ As Requested
❑ For Review and Comment
❑ Approved as Submitted
❑ Approved as Noted
❑
Returned for Corrections
❑
Returned After Review
❑
Resubmit for Approval
Copied To: Signe�f:
Mackenzie McCo I, EI

CD•F=-•C
ORSSORN ENGINEERING GROUP
Oakhurst Shopping Center
Charlotte, North Carolina
Project Narrative
May 16, 2018
The overall development includes a new subdivision with new public streets and utility
infrastructure. The public sewer system, maintained by Charlotte Water, will be extended
along Oakhurst Commons Drive up to the lot edge.
Within this development, there is a new 2 acre lot that includes 4 buildings with a total of
26,400 sq. ft. to be used for a shopping center. All buildings drain to a new private S" collection
system which connects to the new public sewer extension.

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