WQ0030318_Application (FTSE)_20190716

Permit Number WQ0030318
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
dean.hunkele
Coastal SW Rule
Permitted Flow
425,287
Facility
Central Files. APS _ SWP _
6/13/2019
Permit Tracking Slip
Status
Project Type
In review
Major modification
Version
Permit Classification
C
Individual
Permit Contact Affiliation
Facility Name MajorlMinor Region
Autumn Hall Private Sewer Minor Wilmington
Location Address County
New Hanover
Owner
Owner Name
Autumn Hall Master Organization Inc
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Paul Derek Jarrett
C O Premier Management Company
Dates/Events Wilmington NC 28405
Scheduled
Ong Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
6/30/2006 6/12/2019
Regulated Activities Requested /Received Events
Commercial or industrial, other Additional information requested
Condominium Additional information received

NORMS & TUNSTALL
CONSULTING ENGINEERS P.C.
1900 Eastwood Road, Suite 11
Wilmington, NC 28403
[phone]
[phone] Fax
John S. Tunstall, P.E.
T. Jason Clark, P.E.
June 11, 2019
NC DEQ
Division of Water Resources
Water Quality Regional Operations Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Re: Gravity Sewer Extension Fast -Track Permit Revision
Autumn Hall Commercial PHI
Revision to Autumn Hall #WQ0030318 (Issued 08-06-09)
Wilmington, NC
N&T Project No. 18128
Dear Sir or Madam:
1429 Ash -Little River Road
,ash, NC 28420
[phone]
[phone] Fax
J. Phillip Norris, P.E.
Thomas J. Scheetz, E.I.
RECEIVED/NCDENR/DWR
JUN 12 2019
Water Quality Regional
Operations Section
Wilmington Renional Office
Enclosed is one (1) original application form with one (1) copy, two (2) copies of the Sewer
Narrative, one (1) original Flow Tracking / Acceptance Form (FTSE 10-18) from the Cape Fear
Public Utility Authority with one (1) copy, two (2) 8'/z x 11 color USGS Topographic Maps, two
(2) site plans (ledger size) and a $480.00 check for the processing fee. Please note enclosed
is a copy of the required HOA-POA Operational Agreement. The one (1) original and two (2)
copies of the HOA-POA Operational Agreement will be submitted to you under separate cover.
Please review this information for approval and contact us with any questions or comments you
may have. Thank you for your assistance on this project.
Sincerely,
NORRIS & TUNSTALL
CONSULTING ENGINEERS, P.C.
T. Jaso Clark, P.E.
TJC/asn
18128 (05150-1) 06-11-19-s-swr-revision-Itr
Enclosures
NCBELS License C-3641

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:
(to be completed by DWR)
All items must be completed or the apmlication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Autumn Hall Master Organization. Inc. (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ® Other
3. Signature authority's name: Raiford G. Trask, III per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 1051 Military Cutoff Road, Suite 200
City: Wilmington
State: NC Zip: 28405-_
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Autumnn Hall Commercial PHI
2. Application/Project status: ❑Proposed (New ®Existing Permit/Project
If a modification, provide the existing permit nu m er. W00030318 d issued date: 08-06-09
If new construction but part of a master plan, provide xtsting permit number: W000_
3. County where project is located: New Hanover
4. Approximate Coordinates (Decimal Degrees): Latitude: 16.4. Longitude: -44.50
5. Parcel ID (if applicable): R0500-004-147-000
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: John S. Tunstall License Number: 19851 NC
Firm: Norris & Tunstall Consulting Engineers, P.C.
Mailing address: 1900 Eastwood Road, Suite 11
City: Wilmington State: NC Zip: 28403
Phone number: 910 343-9653 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: M'Kean Maffitt (Southside W WTP) Permit Number: NC 0023973
Owner Name: Cape Fear Public Utility Authority
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
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 ®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 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: 100 % Domestic/Commercial % 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 .0114(f)? ❑ Yes ❑ No
➢ If yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow a,b
No. of Units
Flow
Office (16,015 SF)
100 gal/1,000 SF
16,015 SF
1,602 GPD
Restaurant
40 gal/Seat
100
4,000 GPD
Coffee Shop
50 gal/100 SF
2,237 SF
1,119 GPD
Residential (1 & 2 Bedroom)
240 gal/Unit
116
27,840 GPD
Retail
100 gal/1,000 SF
23,873 SF
2,387 GPD
gal/
GPD
Total
36,948 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: 36948 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" 1,547 PVC
➢ Section lI & 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: 0Longitude: - °
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)(I):
❑ 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)
➢ 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-I waters of Class I or
Class II 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 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
➢ 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 webnage
➢ If noncompliance with 02T.0305(for (2). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes [:]No
➢ 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 all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes [:]No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ 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
➢ 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 02T, the Mit imnm Dcsign Criteria for the Permitting of Purnp 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/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the reauest is required prior to submittal of the Fast TrackAnnlicalion and sunnorting documents
2. Professional Engineer's Certification:
name from Application Item 111.1.)
that this application for
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 tiny signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
3. Aj
stion for
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 understated 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. 1 will make no claim against the Division of Water Resources should a condition
of this permit be violated. 1 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.G11, 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:
FORM: FTA 04-16 Page 5 of 5

h-T i� m�l
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Autumn Hall, Inc.
Project Name for which flow is being requested: Autumn Hall Commercial Phase 1
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: James A. Loughlin (Northside) WWTP
b. WWTP Facility Permit #: NPDES NC O023965
All,flows are in MGD
c. WWTP facility's permitted flow 16.000
d. Estimated obligated flow not yet tributary to the WWTP 3.362
e. WWTP facility's actual avg. flow 10.661
£ Total flow for this specific request 0.036948
g. Total actual and obligated flows to the facility 14.059
h. Percent of permitted flow used 87.9%
11. 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)
Design
Pump
Pump
Average
Station
Station
Finn
Daily Flow**
(Name or
Permit
Capacity, *
(Firm / po,
Number)
No.
MGD
MGD
35
N/A
9.100
3.309
(B)
(C)
(D)-(B+C)
(E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current
Tributary
Flow Plus
Avg. Daily
Daily Flow,
Obligated
Available
Flow, MGD
MGD
Flow
Capacity***
2.217
0.457
2.674
0.635
* The Firm Capacity (design flow) 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
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** 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): Cape Fear Public Utility Authority
Downstream Permit Number: Not Available
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Matthew Tribett, CFPUA Eng. Mgr 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 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 the proposed new wastewater.
CF?-U w >v
Title of Signing
Page 2 of 6
FTSE 10-18

SOSID:1029057
Date Filed: 5/6/2019 3:10:00 PM
Elaine F. Marshall
North Carolina Secretary of State
C2019 115 02321
STATE OF NORTH CAROLINA
DEPARTMENT OF THE SECRETARY OF
STATE
DESIGNATION AND/OR STATEMENT OF CHANGE OF REGISTERED OFFICE,
REGISTERED AGENT NAME OR PRINCIPAL OFFICE
Pursuant to §55D-31, §55-1-22(26), §55A-16-23(b), §57D-1-22(29), of the General Statutes of North Carolina, the
undersigned entity submits the following for the purpose of changing its registered office address, registered agent name, and/or
principal office addresses for the State of North Carolina.
INFORMATION CURRENTLY ON FILE
1. The exact name of the entity as listed on the business registry is:
Autumn Hall MasterCircianization. Inc.
Entity Type: eDomesticCorporation, [:]Foreign Corporation, F, Nonprofit Corporation
Domestic Limited Liability Company, ❑ Foreign Limited Liability Company
2. (Check only if applicable) -fa -The registered agent name and/or address is not currently on file with the Secretary of State.
3. (Check only if applicable) -=The principal office address is not currently on file with the Secretary of State.
Registered Agent Information (complete this section ifthere is a registered agent name and address on file with the Secretary of
State)
4. The name of the current registered agent is: Paul Derek Jarrett
S. The street address and county of the entity's registered agent office address currently on file is:
Number and Street: 2018 Eastwood Road
City: Wilmi
NC Zip:28403 County: New Hanover
The mailing address if different from the street address of the registered agent office address currently on file is:
Number and Street or PO Box: PO Box 12051
City Wilmington
NC Zip:28405 County: New Hanover
Principal Office Information (complete this section only ifthere is a principal office on file with the Secretary of State)
6. The street address and county of the entity's principal office address currently on file is:
Number and Street: 2018 Eastwood Road
Wilmington
NC 7,,,.28403
New Hanover
The mailing address if different from the street address ofthe principal office address currently on file is:
Number and Street or PO Box: PO Box 12051
Wilmington
NC 7;-.28405
New Hanover
BUSINESS REGISTRATION DIVISION PO Box 29622 Raleigh, NC 27626-0622
(Revised July, 2017) (Form BE-17)

NEW INFORMATION
Registered Agent Information (complete this section ifthe registered agent name and address is being changed on the business
registry)
1. The street address and county of the entity's new registered agent office address is:
Number and Street: 1985 Eastwood Road Ste 202
City: Wilmington
NC Zip: 28403 County: New Hanover
2. The mailing address if different from the street address of the new registered agent office address is:
Number and Street or PO Box: PO Box 12051
Wilmington
NC Zip:28405 County,, New Hanover
3. The name of the new registered agent and the new agent's consent to appointme ew:
Paul Derek Jarrett
Type or Print Name of New Registered Agent tature & Title
4. The address of the entity's registered office and the address of the business office of its registered agent, as changed, is the
same location.
Principal Office Information (complete this section only ifthere is a principal office on file with the Secretary of State)
The street address and county of the new principal office address is:
Number and Street: 1985 Eastwood Road Ste 202
Wilmington
NC 7:...28403
6. The mailing address if different from the street address of the new principal office address:
Number and Street or PO Box: PO Box 12051
Wilmington
NC 7;...28405
7. This statement wilt be effective upon filing, unless a date and/or time is specified:
This the 1-4 day of AAAW S,
20 101
New Hanover
New Hanover
Autumn Hall Master
Entity Name
Signature
Type or Print Name and Title
Note: Filing fee is $10,00. This document must be filed with the NC Secretary of State
-Instead of signing here, the new registered agent may sign a separate written consent to the appointment, which must be attached to this document
upon submission for filing.
BUSINESS REGISTRATION DIVISION PO Box 29622 Raleigh, NC 27626-0622
(Revised July, 2017) (Form BE-17)

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Non -Profit Corporation
Legal Name
Autumn Hall Master Organization, Inc.
Information
Sosld: 1029057
Status: Current -Active
Annual Report Status: Not Applicable
Citizenship: Domestic
Date Formed: 2/21/2008
Registered Agent: Jarrett, Paul Derek
Addresses
Principal Office Reg Office Reg Mailing
1985 Eastwood Road Ste 202 1985 Eastwood Road Ste 202 P.O. Box 12051
Wilmington, NC 28403 Wilmington, NC 28403 Wilmington, NC 28405
Mailing
P.O. Box 12051
Wilmington, NC 28405

SEWER NARRATIVE
AUTUMN HALL COMMERCIAL PHI
Wilmington, North Carolina
For
Autumn Hall, Inc.
6336 Oleander Drive, Suite 1
Wilmington, NC 28403
[phone]
Cl
May 2019
Prepared by:
NORRIS & TUNSTALL CONSULTING ENGINEERS, P.C.
1900 Eastwood Road, Suite 11
Wilmington, North Carolina 28403
[phone]
[phone] (Fax)
License # C-3641
N&T Project #16110

NARRATIVE
SEWER SYSTEM:
This private gravity system for Autumn Hall Commercial Phase I will be extended
from existing gravity sewer to serve the mixed -use development. A total of 1,547 LF of
8-inch C900 DR18 PVC sewer line will be extended from the existing gravity sewer
outfall.
This system will be served by the Cape Fear Public Utility Authority.

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