WQ0040463_Application (FTSE)_20181130

ColeJenest
& Stone
200 South Tryon Street, Suite 1400 Charlotte, NC 28202
p+7043761555 4704 376 7851 url+ www.colejeneststonc.mm
The Pines at Davidson Project
Charlotte
Raleigh
The proposed Pines at Davidson project is located on a 12 acre
Shaping the Environment site at the intersection of Avinger Lane and Avinger Lane in Davidson,
s' Realizing the Possibilities NC. The site is currently developed. The proposed private sanitary sewer
includes the development of one (1) healthcare building and two (2) villas
for the continuing care retirement community with thirty-eight (38)
apartment units, which will generate a design wastewater flow of 15,975
GPD.
A proposed private 6" sanitary sewer system is to be constructed
within the new property and will outfall at one location via an existing 8"
public sanitary sewer main located southwest of the project. The
Land Planning proposed private sanitary sewer system, to be permitted with the
+ enclosed application, will be owned and maintained by The Pines at
Landscape Architecture Davidson.
+
Civil Engineering
+ Attached Items:
Urban Design 1. Fast Track Application
2. Nonprofit Corporation Documentation
3. Application Fee of $480.00
4. USGS Topographic Map
5. Street Aerial Map
6. Flow Tracking/Acceptance Form

DW State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T.0300, Division Policies and good engineering prattle".
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in I5A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303
Projects not eligible for review via the fast track process (must be submitted for full technical review):
D Projects that require an environmental assessment in accordance with I5A NCAC IC .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Departn ent of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
If necessary for clarity or due to space restrictions, attachments to the application may be made.
® If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application 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).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page I of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
• Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5 -inch x I1 -inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T,0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T.01 15(a)(1) provide 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 sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Prooerty Owners' Associations
❑ Per 15A NCAC 02T.01 15(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T.01 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T.01 15(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCILDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 26115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bartle, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(m be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: The Pines at Davidson (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ® Other - NONPROFIT
3. Signature authority's name: David Rainey per 15A NCAC 02T .0106(b)
Title: Property Owner
4. Applicant's mailing address: 400 Avineer Lane
City: Davidson State: NC Zip: 28036-8894
5. Applicant's contact information:
Phone number: (LO4) 896-1100 Email Address: draingy[rrlthepinesatdavidson.org
II. PROJECT INFORMATION:
1. Project name: The Pines at Davidson - Villas & Healthcare Exoansion
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: 35.48845° Longitude: -80.843633°
5. Parcel ID (if applicable): 00703127
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Casey P. Wemer, PE
Firm: ColeJenest & Stone
License Number: 043906
Mailing address: 200 South Tryon Street, Suite 1400
City: Charlotte State: NC Zip: 28206 -
Phone number: (ZU4 9714507 Email Address: c_weme coMeneststone.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Rocky River Wastewater Treatment Plant Permit Number: NCO036269
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (ifdifferentthan WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): _
FORM: FTA 04-16 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/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 lies an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential Leased Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / 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: 35%Domestic/Commercial 65 % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes ® No
D If ves. Provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01 14(f)
Daily Design Flow a."
No. of Units
Flow
Villas (Multi -Family Residential)
135 gal/unit
38
5130 GPD
Cottages
200 gal/unit
3
600 GPD
Exercise/Fitness Center
50 gal/100 sf
2250 sf
1125 GPD
Banquet/Dining Hall
30 gal/seat
144 seats
4320 GPD
Nursing Home
120 galibed
40
4800 GPD
gal/
GPD
Total
15975 GPD
a See 15A NCAC 02T 0114(b) (d) le)( I ) 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.01 14(c), design flow rates for establishments not identified [in table I SA NCAC 02T.01 I shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 15975 GPD (per 15A NCAC 02T.01 14)
➢ 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
6 740 PVC
➢ Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T.0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
3. Design flow of the pump station: _ millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): _ gallons per minute at _ feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 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(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g) ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
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 lI impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS -I or WS -V), B, SA, ORW, HQW, or SB from normal
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
Top sloe 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
Y 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(t) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboaae
➢ if noncompliance with 02T.0305(f) or (g). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes [:]No ®N/A
➢ 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
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 023.0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0 105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(cN6). 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 ❑ N/A
➢ 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 1.5A 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, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is reouired Prior to submittal of the Fast Track Application and supportine documents
2. Professional Engineer's Certification:
P. Werner, PE attest that this application for
(Professional Engineer's name from AnDlication Item 111.1.1
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, 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 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date: 01 CAR..
SEAL
043906
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1 Vt C e / -'S i d ell- attest that this application for
Authdrify'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 143-215.68. 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: Qd/Z.tt Date: i% /(o IO
FORM: FTA 04-16 Page 5 of 5

CHARLOTTE
W )TER
March 13, 2018
Mr. Robert Hayes
ColeJenest & Stone, PA
200 South Tryon Street
Suite 1400
Charlotte, NC 28202
SUBJECT: WATER AND SEWER FLOW ACCEPTANCE
THE PINES AT DAVIDSON
400 AVINGER LANE, DAVIDSON NC
CLTWATER TRACKING # 2018216
After analysis of the sanitary sewer associated with the proposed design of project The Pines at
Davidson, it was determined that there is sufficient capacity to accommodate the proposed sewer
flow of 15,975 gallons per day (38 apartment units x 135 gpd/unit; 3 cottages x 200 gpd/cottage;
2,250 ft2 Fitness Center x 50 gpd/100 ftp; 144 seat Dining Hall x 30 gpd/seat; 40 bed Nursing Home x
120 gpd/bed) at the connection point(s) indicated on the submitted utility plan for transmission to the
Rocky River Wastewater Treatment Plant; NPDES permit numberNC0036269, located in Cabarrus
County, for treatment. This acceptance of flow is based on the existing capacity of the designated
publicly owned treatments works. Please see the attached NCDEQ FTSE forms.
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 NCDEQ. 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 or extend private
water or sewer systems, as the appropriate local or State permits are required prior to construction.
If you
have any questions, please do not hesitate to contact me at [phone].
Sincerely,
Barbara Gross
Engineering Assistant
Charlotte Water 5100 Brookshire Blvd, Charlotte, NC 28216 charlottewater.org
® Operated by the City of Charlotte

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
(JURISDICTION USE ONLY)
Jurisdiction Reqnesting Flow Acceptance for Collection System:
❑City of Concord []City ofKannapolis ❑Town of Harrisburg ❑Town of Mt. Pleasant
®Charlotte Water
Project Title, Description, and Number of LotstUnit:
Project Title: The Pines at Davidson. Project # 20182
Description: The The Pines at Davidson eneineerir
wastewater discharge of 15.975 GPD.
What is the quantity of flow that will be discharged? 15975 GPD
Flow type:
® Domestic 35 % ® Commercial 65 % ❑ Industrial %
Section I - List the Jurisdiction's pump stations located between the project connection point and the WSACC
hiterce for connection point.
Section H. Jurisdiction's Certification Statement:
I, Cxlr I WI1�191'certify that, to the best of my knowledge, the addition of the volume of wastewater to be permitted in this
project has been evaluated along the route to the receiving WSACC interceptor, and the flow from this project is not
anticipated to cause any capacity related sanitary sewer overflows or overburden on any downstream pump station in route to
the receiving WSACC interceptor 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 Section I plus all attached
planningsessment addendums for which, to the best of my knowledge, will not adversely affect the downstream sewer
capacity. hgnajure of this form indicates acceptance of this wastewater flow.
Official Signature
Revision Date: 08/09/13
a
(A)
B)
(C)
(D)=B+�)F
1c:!
�A-D)
Pump Station
Fiml Capacity
Deai a Average Deily Flow ""
Appmx currant
Obligated, Not Yet
Total Flow
e fable
(Name or Numhef)
MGD
(F -./Pi)
Average only Flow
Tributary Deily Flow
Plus Obligated FlaweciU'me"
MGD
MGD
MGD
MGD
GD
The Firm Capacity of any pump station k defined es 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 not less than 2.5.
'"AP]avnlot, Assessment Addendum shag beattached for each pump station located between the project connection point and the wwT where Available Capacity Is< 0.
Section H. Jurisdiction's Certification Statement:
I, Cxlr I WI1�191'certify that, to the best of my knowledge, the addition of the volume of wastewater to be permitted in this
project has been evaluated along the route to the receiving WSACC interceptor, and the flow from this project is not
anticipated to cause any capacity related sanitary sewer overflows or overburden on any downstream pump station in route to
the receiving WSACC interceptor 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 Section I plus all attached
planningsessment addendums for which, to the best of my knowledge, will not adversely affect the downstream sewer
capacity. hgnajure of this form indicates acceptance of this wastewater flow.
Official Signature
Revision Date: 08/09/13

WSACC
11014001:801 • NCNa Pdk5sls • QNSAS 1901INT
Ms. Barbara Gross
Engineering Assistant
Charlotte Water
5100 Brookshire Blvd
Charlotte, NC 28216
March 1. 2018
Subject: Flow Acceptance Request
The Pines at Davidson
Charlotte Water Tracking Number 2018216
Dear Ms. Gross:
WATER & SEWER AUTHORITY
OF CABARRUS COUNTY
232 Davidson Hwy.
Concord, NC 28027
704.786.1783 ♦ 704.795.1564 Fax
www.wsacc.org
This is an approval of the flow acceptance request received by the Water and Sewer Authority of
Cabarrus County (WSACC) from Charlotte Water on February 27, 2018.
WSACC has or will have capacity at the Rocky River Regional Wastewater Treatment Plant and
appropriate sewer interceptors to transport and treat the domestic wastewater from the proposed
The Pines at Davidson project. This project will include providing sewer service to 38 apartment
units, 3 cottages, a 2,250 square -foot fitness center, a 144 -seat dining hall, and a 40 -bed nursing
facility. As requested by Charlotte Water, WSACC agrees to accept 15,975 gallons per day (gpd)
of wastewater from this project. The wastewater generated by this project will be conveyed
through the proposed 8 -inch and 6 -inch gravity lines, through the existing gravity system, and
then enter WSACC's system at the existing 36 -inch Rocky River Interceptor.
Please note that if construction of this project is not started within two (2) years of the date of
this approval, the approval is rescinded and a second request and approval will be required.
Please notify WSACC in writing when construction of this project is initiated.
If you have any questions, please call me at [phone], extension 228.
Sincerely,
J. Thomas Hahn, PE
Utility Systems Engineer
cc: Carl Wilson, PE/CMU
Michael Wilson
Tim Kiser, PE
Mark Lomax
Chad VonCannon, PE

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Permit Applications
Division of Water Resources (FTSE -01/14)
(WSACC USE ONLY) The Pines at Davidson (Charlotte Water #2018216)
Section I. Name of wastewater treatment facility (W WTF) receiving wastewater:
® Rocky River Wastewater Treatment Facility — Permit #NC0036269
❑ Muddy Creek Wastewater Treatment Facility — Permit #NC0081621
WWTP facility's permitted flow, MGD 26.500
Estimated obligated flow not yet tributary to the WWTP, MGD 1.891
WWTP facility's actual avg. daily flow, MGD 17.040 (64.30% of permit)
Total flow for this specific request MGD 0.016
Total actual and obligated flows to the facility, MGD 18 .947
Percent of permitted flow used 71.50%
Section II. Pump stations along the route from the Jurisdiction's connection point to the WWTP.
Section III. WSACC Certification Statement:
t, J. Thomas Hahn. PE, certify that, to the best of my knowledge, the addition of the volume of wastewater to be permitted
in this project has been evaluated along the route from the connection to the interceptor to the receiving wastewater
treatment facility; and the flow from this project is not anticipated to cause any capacity related sanitary sewer overflows
or overburden on any downstream pump station in 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 Section I and Section 11 plus all attached planning assessment
addendums for which, to the best of my knowledge, will not adversely affect the downstream sewer capacity. Signature
of this form indicates acceptance of this wastewater flow.
CC's Signing Official Signature
Revision Date: 08/09/13
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Pump Station
Firm Capacity •
Design Average Daily Flow a.
Approx. Current
Obligated, Not Yet
Total Current Flow
Name or Number
( )
MGD
(Finn/pn
Average Daily Flow
Tributary Daily Flow
Plus Obligated Flow
Capacity le
apaiity
MCD
MGD
MCD
MGD
MGD
Lower Rocky River PS
37.000
14.800
8.290
1.493
9.783
5.017
"The Firm Capacity of any pump station is defined as the maximum pumped now 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 not less than 2.5.
•••A Planning Assessment Addendum shall be attached for each pump station located behveen the project connection paint and the WWTP where Available Capacity is <0.
Section III. WSACC Certification Statement:
t, J. Thomas Hahn. PE, certify that, to the best of my knowledge, the addition of the volume of wastewater to be permitted
in this project has been evaluated along the route from the connection to the interceptor to the receiving wastewater
treatment facility; and the flow from this project is not anticipated to cause any capacity related sanitary sewer overflows
or overburden on any downstream pump station in 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 Section I and Section 11 plus all attached planning assessment
addendums for which, to the best of my knowledge, will not adversely affect the downstream sewer capacity. Signature
of this form indicates acceptance of this wastewater flow.
CC's Signing Official Signature
Revision Date: 08/09/13

SOSID: 0038976
Date Filed: 6/6/2001 12:58 PM
Elaine F. Marshall
North Carolina Secretary of State
State of North Carolina
2 1 1 5 7 9038 Department of the Secretary of State
ARTICLES OF AMENDMENT
NONPROFIT CORPORATION
Pursuant to §55A-10-05 of the General Statutes of North Carolina, the undersigned corporation
hereby submits the following Articles of Amendment for the parpose of amending its Articles of
Incorporation.
1, The name of the corporation is: Davidson Retirement Community Inc
2. The text of each amendment adopted is as follows (state below or attach):
a. Section 1 of the Articles of Incorporation is amended to read as follows:
1. The name of the corporation is The Pines at Davidson, Inc.
b. The .Articles of Incorporation are amended by adding at the end thereof a new Section 10
to read as follows:
10. To the fullest extent from time to time permitted by law, no person
who is serving or who has served as a director of the corporation shall be
personally Iiable for monetary damages arising out of an action whether by
or in the right of the corporation or otherwise for breach of any duty as a
director.
3. The date of adoption of each amendment was as follows:
June 5, 2001.
4. The amendment was approved by a sufficient vote of the board of directors, and member
approval was not required because there are no members.
5. These articles will be effective upon filing, unless a date and/or time is specified:
This ibe 5`h day of June, 2001.
Aevlsed 1a1}o$r'y 2000
'1QQR,QOKATIONS DTVTSiON
DAVIDSON RETMEMENTCOMMUNITY, INC_
Name of Corporation
3y: eL�at,til �' /�a�.wey Vice Pfc,a+enf
P, 0.13OX 29622
Form N-02
RAUTOH, NC 27626-0622

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Central Files: APS _ SWP _
11 /30/2018
Permit Number WQ0040463
Permit Tracking Slip
Program Category
Status
Project Type
Non -discharge
Active
New Project
Permit Type
Version
Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
1.00
Individual
Primary Reviewer
Permit Contact
Affiliation
barry.love
Coastal SWRuIe
Permitted Flow
15,975
Facility
Facility Name
Major/Minor
Region
The Pines at Davidson -Villas & Healthcare Expansion
Minor
Mooresville
Location Address
County
Mecklenburg
Facility Contact Affiliation
Owner
Owner Name
Owner Type
The Pines At Davidson
Non -Government
Owner Affiliation
David Rainey
Finance dir of
400 Avinger Ln
Dates/Events
Davidson
NC 28036
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue Effective Expiration
11 /30/2018 11 /20/2018
11 /30/2018 11 /30/2018
Regulated Activities
Requested /Received Events
Food preparation, other
Additional information requested
Nursing Home
Additional information received
Wastewater collection
Outfall
Waterbody Name Streamindex Number Current Class Subbasin