WQ0041191_Application (FTSE)_20190919

State of North Carolina
Department of Environmental Quality
DWR 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 engineerina Practices.
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 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division. R
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Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T. //VCJ)"
Projects not eligible for review via the fast track process (must be submitted for full technical review): S,�P wh
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100; 19 2
➢ Projects that do not meet any part of the minimum design criteria (MDC) document; 01y
Wire
➢ Projects that involve a variance from the requirements of 15A NCAC 2T; Up®rQpaz.
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumwy4l o ry 0171 ty �egi, a/
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems. a/ pffloe
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 Department 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 I.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 1 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 11-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 showing general project area.
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 .0115(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/PrgRerty Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEW
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 INCLDING 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 Reaional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
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, Bertie, 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, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources VIA 04-16 & SUPPORTING DOCUMENTATION
Application Number: t (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Carolina Quality Foods, 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: Sam Nekhaila per 15A NCAC 02T .0106(b)
Title: President
4. Applicant's mailing address: 125 Milano Drive
City: Islamorado State: FL Zip: 33036-3311
5. Applicant's contact information:
Phone number: 305) 394-0315 Email Address: snekhailana.msn.com
II. PROJECT INFORMATION:
1. Project name: Wend 's—MMo.
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Currituck
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.5230290 Longitude:-76.176571 °
5. Parcel ID (if applicable): 014B00000520000
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Cathleen M. Saunders, P.E. License Number: 043652
Firm: Ouible & Associates. P.C.
Mailing address: P.O. Drawer 870
City: Kitty Hawk State: North Carolina Zip: 27949-
Phone number: 252) 491-8147 Email Address: csaunders(a)guible.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Mo ockRegional WWTP High -Rate Infiltration System Permit Number: W00035706
Owner Name: Currituck County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than 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 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: % Domestic/Commercial 100 % Commercial
0 % Industrial (See 15A NCAC 02T .0103MO
Its 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 copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a.e
No. of Units
Flow
Restaurant seats
40 gal/Seat
59
2,360 GPD
Drive-Thru spaces
50 gal/Space
9
450 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
2,81D
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: 2.810 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
6
117
SCH 40 PVC
6
123
SCH 40 PVC
➢ 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 requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Puma Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Sanitary Sewer Pump Station #1
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.523' Longitude:-76.17651
3. Design flow of the pump station: 0.00281 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 30 gallons per minute at 21.8 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
147
HDPE
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(fl):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(fl & (g)
➢ 15A NCAC 02T.0305 contains minimum separations that shall be rovided for sewers stems•
® 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(fl cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnaae
➢ If noncompliance with 02T.0305(fl or (g), 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

Toppen, Sarah A
From: Cathleen Saunders <[e-mail]>
Sent: Thursday, September 19, 2019 3:45 PM
To: Toppen, Sarah A Y
Cc: Michael Strader
Subject: [External] P18081 - Wendy's Moyock, NC
Attachments: P1 8081 -Base-WW1 -2019-09-19.pdf, P18081 FTA 04-16_Rev 2019-09-19.pdf, P18081 -
Pump Operating Curve - GRP19-3.pdf
• xternal Wbon r open attacmw unless you verify. Send all suspicious email as an attachment to
Sarah —
Good afternoon. Please find the attached updated 04-16 form that reflects the changes we discussed. The
kitchen waste lateral and bathroom waste are separated out on the form and both have been updated to reflect
6" PVC. The gpm and TDH have also been added to the application.
In addition, I'm providing the supporting information for your review. The attached plan sheet references the
gravity layout and the attached cut sheet is for the proposed grinder pump. Please let us know if you require
anything additional for your review.
Thank you,
Cathleen M. Saunders, P.E.
Project Manager
Quible & Associates, P.C.
8466 Caratoke Highway, Bldg 400
Powells Point, NC 27966
P.O. Drawer 870
Kitty Hawk, NC 27949
t 252.491.8147
f 252.491.8146
m 252.202.7112
www.guible.com
LEGAL DISCLAIMER
The information transmitted is intended solely for the individual or entity to which it is addressed and may
contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of or
taking action in reliance upon this information by persons or entities other than the intended recipient is
prohibited. If you have received this email in error please contact the sender and delete the material from any
computer.

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Motor Construction Installations
Motor Type:
Enclosed submersible
NEMA Insulation Code:
Class F
Service Factor: 1.15
NEMA Design Type: B
Standard Cable Length:
33 ft
Available Motor Voltages:
1 Phase: 115 V, 200 V, 230 V
3 Phase: 200 V, 230 V, 380 V
460 V. 575 V
Optional Explosion Proof construction:
Factory Mutual approved for Class I,
Div. 1, Group C & D.
Materials
Wet pit with autocoupling
Dimensions (inches) (Tolerance +/-1/4")
Motor housing, volute and Impeller Autocoupling (with optional check valve)
Cast Iron ASTM A 48, Class 40B
Cutter
55 HRC hardened stainless steel
Mechanical seals — Imoeller side
Silicon Carbide vs. Silicon Carbide
Shaft seal — Motor side
Lip Seal (Nitrite Rubber)
O-Rings:
Nitrile Rubber
Upper Bearing:
Deep groove Ball Bearing
Lower Bearing:
Double row angular ball bearing
Power cable sheathing:
Nitrile Rubber
Shaft:
AISI 430 F
Fasteners:
AISI 304 SS
Basestand
Basestand:
19
Anchor bolt 51/4 1 M
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Pump Type
Rated
Phase Voltage
Full Load
Speed
Weight
NEMA
B.H.P.
(V)
Amps
(rpm)
(LBS)
code
GRP 19/ 1
2.0
1 230
8.3
3450
57
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GRP 19/3
2.0
3 230/ 380 / 460
5.8 / 3.5 / 2.9
3450
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1.2
1 230
5.2
3450
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1.2
3 230/ 380 / 460
3.6 / 2.2 / 1.8
3450
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P U M P T E C H N O L O G Y

Quible
Quible & Associates, P.C. P.O. Drawer 870
Kitty Hawk, NC 27949
ENGINEERING - ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING Phone: [phone]
SINCE 1959 Fax: [phone]
Web: quible.com
August 16, 2019 c�i2�1-
Robert Tankard q
NCDEQ Water Quality l✓�
Washington Regional Office �a pr 2I
943 Washington Square Mall
ton, NC 27889 �fO� °�sLA
Washington,
Re: Fast Track Sewer System Extension Application (FTA 04-16)
Wendy's - Moyock'eo
548 Caratoke Highway
Moyock, Currituck County, NC
Dear Mr. Tankard,
On behalf of Carolina Quality Foods, Inc., Quible & Associates, P.C. hereby submits, for your review
and approval, a Fast Track Sewer System Extension Application package for the above referenced
project. The applicant is proposing to develop a 2,405 sq. ft. restaurant located in Moyock, Currituck
County, North Carolina. A collection system has been designed in accordance with 15A NCAC 02T,
the Minimum Design Criteria for the Permitting of Pump Stations and Force Mains, and the Gravity
Sewer Minimum Design Criteria. The proposed system will collect all proposed wastewater onsite at
a pump station and connect via a 2" force main to an existing forcemain within Caratoke Highway
(U.S. 168).
The wastewater flow from the proposed restaurant will be conveyed to an existing Moyock Regional
WWTP owned and operated by Currituck County. The proposed wastewater flow generated by the
proposed restaurant is calculated to be 2,810 GPD.
The following is attached and shall be considered part of this package:
1. Review fee check in the amount of $480.00 made payable to NCDEQ;
2. One (1) original and one (1) copy of the Fast Track Application (FTA 04-16);
3. One (1) copy of the North Carolina Secretary of State Corporation Information;
4. One (1) original and one (1) copy of the Flow Tracking/Acceptance for Sewer Extension
Applications (FTSE 04-16);
5. Two (2) copies of the USGS Topographic Map with project area identified;
6. Two (2) copies of the power reliability plan and power outage data for the area;
7. One (1) original and one (1) copy of the Watershed Classification Attachment (WSCAS 08-
13 );
Please do not hesitate to contact Michael W. Strader, Jr., P.E. or myself at 252.491.8147 should you
have any questions and/or concerns. Thank you for your attention to this project.
Sincerely,
Quible & Associates, P.C.
Cathleen M. Saunders, P.E.
Encl: as stated
Cc: Sam Nekhaila, Carolina Quality Foods, Inc.

NDMR 12 Month Calculated Monthly Average
PERMIT NUMBER: W00035706
FACILITY NAME: Currituck County - Moyock Regional WWTP
00940 - Chloride
(as CI) - mg/I
50050 - Flow, in
conduit or thru
treatment plant -
gpd
70300 - Solids,
Total Dissolved -
180 Deg.0 - mg/I
1-18
40817.935484
2-18
33558.214286
3-18
190
31174.677419
565
4-18
33284.633333
5-18
19009.354839
y
'fI
6-18
10939.533333
7-18
-0.096774
8-18
38874.516129
9-18
32006.466667
10-18
35499.096774
11-18
148
36394.066667
407
12-18
33424.645161
POINT PRIOR:
COUNTY:
,.� 42 02-I
U Ctj
DATE: 9/12/2019
001 PERIOD ENDING MONTH: 12 2018
Currituck REGION: Washington

NDMR 12 Month Calculated Monthly Average
DATE: 9/12/2019
PERMIT NUMBER: WQ0035706
FACILITY NAME: Currituck County - Moyock Regional WWTP
POINT PRIOR: 001
COUNTY: Currituck
PERIOD ENDING MONTH:
12 - 2018
REGION: Washington
00310 - BOD,
5-Day (20 Deg. C)
- mg/I
00400 - pH - su
00530 - Solids,
Total Suspended -
mg/I
00600 - Nitrogen,
Total (as N) - mg/I
00610 - Nitrogen,
Ammonia Total
(as N) - mg/I
00620 - Nitrogen,
Nitrate Total (as N)
mg/1
00625 - Nitrogen,
Kjeldahl, Total (as
N) - mg/I
00665 -
Phosphorus, Total
(as P) - mg/I
1-18
69
7.05
68.5
32.1
24.8
0.015
32.05
3.53
2-18
98
7.052632
17.15
56
29.45
0.02
55.9
1.41
3-18
26.5
7.147619
15.05
41.9
37.7
0
41.9
1.61
4-18
48.5
7.385714
27
53.05
61.6
0.055
52.95
1
5-18
21
7.23
30.85
36.05
33.15
0.045
36.1
0.515
6-18
53.5
85
66.1
34.35
0.085
65.9
1.54
7-18
134
7.250476
134
28.1
26.8
0.03
28.1
6
8-18
70.5
7.205
70.45
43.15
36.85
1.635
40.6
2.81
9-18
5.5
6.994444
21.5
10.3
1.65
4.91
4.25
0.8
10-18
5.333333
7
14.8
13.733333
1.1
11.153333
2.533333
0.416667
11-18
6.5
7.247368
12.9
12
6.6
4.92
7.05
0.32
12-18
10
7.361111
16.85
36.15
17.4
8.68
26.25
13.315

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 - FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: "i l ( (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Carolina Quality Foods, 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: Sam Nekhaila per 15A NCAC 02T .0106(b)
Title: President
4. Applicant's mailing address: 125 Milano Drive
City: Islamorado State: FL Zip: 33036-3311
5. Applicant's contact information:
Phone number: [phone] Email Address: snekhaila(cbmsn.com
II. PROJECT INFORMATION:
1. Project name: Wendy's - Movock
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Currituck
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.523029' Longitude:-76.176571 °
5. Parcel ID (if applicable): 014B00000520000
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Cathleen M. Saunders, P.E. License Number: 043652
Firm: Quible & Associates, P.C.
Mailing address: P.O. Drawer 870
City: Kitty Hawk State: North Carolina Zip: 27949- ^ o-a — �7 i
Phone number: [phone] Email Address: csaundersaguible.com — SD o� 1
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Moyock Regional WWTP High -Rate Infiltration System Permit Number: W00035706
Owner Name: Currituck County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than 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/PropeM 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: % Domestic/Commercial 100 % Commercial
0 % Industrial (See 15A NCAC 02T .0103(20))
1Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(fl? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0I 14JW
Daily Design Flow ° b
No. of Units
Flow
Restaurant seats
40 gal/Seat
59
2,360 GPD
Drive-Thru spaces
50 gal/Space
9
450 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
dotal
2,810 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: 2,810 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
4 ' 240 SCH 40 PVC
➢ 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 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: Sanitary Sewer Pump Station #1
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.5230 Longitude:-76.1765'
3. Design flow of the pump station: 0.00 1 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): allons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station): "••�J/
Size (inches)
Length (feet)
Material
2
147
HDPE
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

I
State of North Carolina
Department of Environmental Quality
DWR 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 combinatiohl at has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and th%vision's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared ac��� nce �15A
NCAC 02T, 15A NCAC 02T .0300, Division policies and eood eneineerine practices.
a� 2 �9I®
While no upfront engineering design documents are required for submittal, in accordance with 15A W,0 .03t�5 design'
documents must be prepared prior to submittal of a fast track permit application to the Division. This w&,de p�il�' design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum,-rteria. These
documents shall be available upon request by the Division. Jio�06o'o��f
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303 0*oa
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC I .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 Department 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.
p If the Applicant Type in Item I.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 En igineer.
® 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 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
E 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):
E Submit an 8.5-inch x 11-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
E Include a street level map showing general project area.
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):
E 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 .0115(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/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(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 INCLDING 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
Favetteville 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 28115
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, Bertie, 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, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

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 contains minimum separations that shall be provided for sewers stems:
® 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(e) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpa¢e
➢ If noncompliance with 02T.0305(fl or (g), 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 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 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 sumortine documents.
2. Professional Engineer's Certification:
I, CkN LC6N M. SALND6:VS IF.E . attest that this application for
(Professional Engineer's name from Application Item III.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 143-215.613, 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.
CA,f
North Carolina Professional Engineers seal, signature, and date: �� 'CN.... RO
p�00
ti.7�
Q SEAL `
4 5 2Y/16,; rz
M.
////11111110
Applicant's Certification per 15A NCAC 02T .0106(b):
ST
11�[.Clh'it t A� C0 •-k%A-r-t 0N611\A6 r Z_
(Signature Authority's name & title from Application Item I.3.)
attest that this application for
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: Date: �— 1/ —19,

State of North Caroling-i,,
Department of Environmental Quality
t k Division of Water es o' es
,t §,
oi0slon of Water Rvsourrcys Flow Tracking/Acceptance for Sewer Extensionation��
9: o .'o
Entity Requesting Allocation: Carolina QualityFoods, Inc.
°
Project Name for which flow is being requested: Wendy's - Moyock °m
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.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moyock Regional WWTP High -Rate Infiltration System
b. WWTP Facility Permit #: WQ0035706
All flows are in MGD
c. WWTP facility's permitted flow 0.099
d. Estimated obligated flow not yet tributary to the WWTP 0.16469
e. WWTP facility's actual avg. flow 0.04058
f. Total flow for this specific request 0.00281
g. Total actual and obligated flows to the facility 0.20809 . c�05;0
,
h. Percent of permitted flow used 211 % �Z � l
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)
Design
Pump
Average Daily
Station
Firm Flow**
(Name or
Capacity, * (Firm / pf),
Number)
MGD MGD
(B)
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current Avg.
Tributary
Flow Plus
Daily Flow,
Daily Flow,
Obligated Available
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):
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I �� 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 indicates acceptance of this wastewater flow.
Signing Official Signature Date
Page 2 of 6
FTSE 04-16

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available
Capacity is < 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to
allow this flow to be permitted, without a significant likelihood of over -allocating capacity in the
system infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste
disposal system.
Signing Official Signature
Date
Page 3 of 6
FTSE 04-16

Instructions for Flow Tracking/Acceptance form (FTSE) and Planning Assessment Addendum (PAA)
Section I
a. WWTP Facili , Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility's permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP, MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for information on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years
and reconciled their flow records, to the best of their ability, so it is known how much flow has been
obligated and is not yet been made tributary to the WWTP, in accordance with local policies and
procedures employed by the reporting entity.
e. WWTP facility's actual avg. flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g., Total actual and obligated flows to the facility, MGD Equals [d + e + fJ
h. Percent of permitted flow used: Equals [(g / c)* 100]
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD. There is a proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
£ = 0.015 MGD
g. = 3.215 MGD
h. = 53.6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c. = 6.0 MGD
d. = 0.515 MGD
e. = 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 04-16

Section II
List the pump station name or number and approximate pump station firm capacity, approximate design
average daily flow (A) approximate current average daily flow (B), and the obligated, not yet tributary flow
through the pump station (C) for each pump station that will be impacted by the proposed sewer extension
project. Calculate the total current flow plus obligated flow (D=B+C) and the available capacity (E=A-D).
Include the proposed flow for this project with other obligated flows that have been approved for the pump
station but are not yet tributary (C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as
per the Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of not
less than 2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump
station if the system has future specific plans related to capacity that should be considered in the permitting
process.
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Design
Approx.
Not Yet
Total Current
Firm
Average
Current Avg.
Tributary
Flow Plus
Pump Station
Capacity
Daily Flow
Daily Flow,
Daily Flow,
Obligated
Available
(Name or Number)
MGD
(Firm / pf)
MGD
MGD
Flow
Capacity*
Kaw Creek PS
0.800
0.320
0.252
0.080
0.332
-0.012
Valley Road PS
1.895
0.758
0.472
0.135
0.607
0.151
Page 5 of 6
FTSE 04-16

Plannine Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section I1 where available capacity
is < 0.
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether
there is significant likelihood that needed improvements or reductions in obligated flows will be in place
prior to activating the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to
manage the flow without capacity related sanitary overflows and must take all steps necessary to complete
the project or control the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned
project in the future not yet funded but in a formal plan adopted by the system. The system should carefully
weigh the certainty of successful timely project completion for any expansion, flow management diversion
or infiltration and inflow elimination projects that are the foundation of a planned solution to capacity
tracking and acceptance compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080
MGD of the committed flow in Pump Station Kaw Creek, and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.01
MGD per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
The master plan and ten year pital plan contain recommended scope and funding for a capital project
entitled Kaw Creek Pump Station upgrade with funding planned in July 2014. This project is planned to
add 0.100 MGD to the firm capacity of the pump station by October 2015. Inclusion of this proposed
capital project as a condition of this Flow Tracking/Acceptance for Sewer Extension Permit Application
elevates this project's priority for funding and construction to be implemented ahead of the activation of
obligated, not yet tributary flows in amounts that exceed the firm pump station capacities identified in
Section 11 above.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
Page 6 of 6
FTSE 04-16

State of North Carolina
DWP
Department of Environment and Natural Resources
Division of Water Resources
Division of water Resources Watershed Classification Attachment (WSCAS 0$1
The Division of Water Resources (Division) will not consider this attacilt' 'ht forr�gl� t be
complete unless all the instructions are followed. Failure to follow the in'ttructions dir to
submit all of the required items will lead to additional application process!hg an d„rev1d*
time.w�;
°>c%p0
0:
For more information or for an electronic version of this form, visit our web site at:
http:// portal. ncdenr.org/web/wq/swp/ps/cs/ext
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ If the sewer system project area is a minimum of 100 feet from any surface water or wetlands, this
classification is NOT necessary. If any portion of the sewer system project is within 100 feet of any
surface water or wetlands, this form must be completed if there are proposed design conflicts with
setbacks or buffers as listed in 2T .0305 (f)..
✓ Do not submit this attachment form for review without a corresponding permit application (Form
FTA 08-13) unless requested by the Division.
✓ Any changes to this attachment form will result in the application package being returned.
B. Prepare the attachment form with the requested information for each portion or location of the
sewer system that is in conflict with a waterbody or wetlands.
✓ Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS
FOR FORM WSCAS 08-13 (SEWER SYSTEMS)" to collect the stream classification data. This
document is available from our web site at the address shown above or by contacting the
appropriate Division of Water Resources regional office.
✓ The same Professional Engineer who certified the permit application form should seal this form.
Different Professional Engineering seals may be accepted from engineers within the same firm.
✓ Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to
identify the entire project area and the closest surface waters. Each map or maps must show the
location of the sewer line and pump stations and be of reproducible quality. For instance, the
project involves 4 miles of interceptor sewer that traverses over or near several different
waterbodies (or counties, basins, etc.). The map should have location ID's for each different
waterbody (where the sewer line is within the setback/buffer) and corresponding classifications
should be recorded.
C. Include the attachment form and the map portions with the permit application for submittal to
the appropriate regional office.
✓ A list of the Division's regional offices, their county coverage, and their contact information may be
downloaded from the web site at: http://portal.ncdenr.orra/web/wq/home/ro
***THESE INSTRUCTIONS DO NOT NEED TO BE SUBMITTED***
INSTRUCTIONS FOR FORM: WSCAS 08-13

FORM WSCAS 08-13
WATERSHED CLASSIFICATION ATTACHMENT
FOR SEWER SYSTEMS
Applicant Name
Project Name
Carolina QualityFoods, Inc.
Wendy's - Moyock
Professional Engineer Name
Engineering Firm Name
Cathleen M. Saunders, P.E.Quible
& Associates, P.C.
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody Stream
Index No.
Waterbody
Classification
1',
Moyoc =F u,
Cur(n uck
Pasquotan
0 4.= - 2=
....
' If unnamed, indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary joins.
I certify that as a Registered Professional Engineer in the State of
North Carolina that l have diligently followed the Division's instructions
for classifying waterbodies and that the above classifications are
inclusive of the stated project, complete and correct to the best of my
knowledge and belief.
PE Seal, Signature and Date
*** END OF FORM WSCAS 08-13 ***
FORM: WSCAS 08-13 Page 1 of 1

STATE OF NORTH CAROLINA
OPERATION
COUNTY OF CURRITUCK AGREEMENT
This agreement entered into by and between Carolina Quality Foods, Inc (Owoiw) and
Enviro-Tech (Operator) is for the operation and maintenance of the pump statiod�e�g
Wendy's located in Moyock, NC.�r��'9
0 of. o
Section I: Price 0.
S
During the contract period Owner agrees to pay Enviro-Tech, for services performed, the
sum of Two Thousand Eight hundred Eighty dollars per year ($2880.00) plus
reimbursement for all goods and services purchased on behalf of Owner necessary for proper
operation and maintenance of the pump station and a twenty percent material/service
procurement fee for materials/services purchased on behalf of Owner. Payment for
operational services shall be made prior to and no later than the tenth day of the service
month. Reimbursement for necessary goods shall be submitted at the end of each service
month.
Section II: Obligations of Enviro-Tech
For the above compensation, Enviro-Tech agrees to provide for the Owner an Operator in
Responsible Charge (ORC) for the pump station. Any additional staff needed to perform
routine operations and maintenance services, preventative maintenance, proper record
keeping and procurement of supplies necessary for proper operation of the pump station will
be provided within the scope of this contract.
Under this contract the scope of work includes the following:
1. The pump station shall be inspected weekly:
a) confirming that control panel, float switches, pumps and alarms are
operational and functioning correctly
2. The following will be performed as needed:
a) respond to all system alarms within a 4 hour time period. Enviro-Tech will not
be held liable for any malfunction, damage or loss of income if response time
cannot be met. Operator shall display a contact phone number on the control
panel. Alarm calls will be billed a minimum of (1) one hour in accordance
with the attached "Time and Material Rates"
b) portable power generation will be billed at $150.00 for mobilization and
$40.00/hour run time. Any additional man hours will be billed as per the time
and material rates
If any malfunction, damage or loss of equipment to any part of the Wastewater System
should occur or be caused by matters not addressed in this contract, Enviro-Tech will take
immediate corrective action. Where such action is required at times other than normal
inspection, Enviro-Tech shall be reimbursed in accordance with the attached Time and
Material Rates. Estimated costs for such action shall be limited to Five hundred Dollars
($500.00) without prior verbal approval by Owner. Every effort will be made to gain pre-

approval for all work; however, the operator may proceed with repairs if public health or
safety is at risk.
Section III: Other Fees
Pumping of tanks and/or the removal of solids will be billed as a reimbursement.
Failure of equipment for any other reason than improper or lack of maintenance will be
replaced or repaired and billed separately.
Section IV: Indemnification
To the extent permitted by North Carolina Law, Owner shall hold Enviro-Tech harmless
from all liabilities, obligations, claims, damages, actions, suits, proceedings, costs and
expenses including attorney's fees that arise in tort, contract or under US Code 1983 due to
any act or omission of Owner or its agents, employees or independent contractors.
Enviro-Tech is a contractor and nothing in this agreement shall be construed to create the
relationship of employer and employee between Owner and Enviro-Tech.
Enviro-Tech and Owner agree that Enviro-Tech is not responsible for damage or destruction
of the facility by an act of God, which includes but is not limited to hurricane, lightning,
floodwaters or wind.
Section V: Maintenance of Insurance
In addition to and without limiting Enviro-Tech's obligations under Section IV above,
Enviro-Tech will provide Owner with certificates of insurance as evidence of insurance for
workers compensation and employers liability.
Section VI: Nondiscrimination
Enviro-Tech agrees that in performance of this contract, Enviro-Tech will not discriminate
against any employee or applicant because of race, color, creed, national origin or ancestry.
Section VII: Default
All terms and conditions of this agreement are considered material and failure to perform any
of the terms and conditions on the part of either party is considered a breach of this
agreement. Should Enviro-Tech or Owner fail to perform any of the terms or conditions the
complaining party has the right to terminate the agreement only after thirty (30) days notice
in writing to the breaching party. The breaching party will have thirty (30) days to remedy
said violations. If (owner) defaults due to non payment William G. Freed Inc. reserves the
right to collect all legal fees associated with collecting outstanding receivables associated
with this contract.

Section VIII: Overdue fees
Past due accounts bear interest at the lesser of 1.5% per month or maximum rate permitted
by applicable law, and continuing after (operator) obtains a judgment against (owner).
Section IX: Term
This contract shall be in force for a period of three (3) years. The (owner) obtains the right to
terminate this agreement after (30) days of written notice is given to the (Operator).The
Operator may impose a cost of living increase of 3% annually on the anniversary date of this
agreement.
Section X: Copies of this agreement
This agreement shall be executed by Enviro-Tech and Owner. Enviro-Tech shall retain one
copy and Owner shall retain one copy. Each copy is an original of the agreement.
This contract is approved as written this
Carolina Quality Foods, Inc
Attn: Sam Nekhaila
125 Milano Drive
Islamorada, FL 33036
305.394.0315
snekhailaLcvmsn.com
Attachments: Time and Rates
day of )2019.
Enviro-Tech
Harbinger, NC 27941
252.491.5277
accounting(tienv irotechn.com

Cathleen Saunders
From: Randall Wright <[e-mail]>
Sent: Wednesday, January 09, 2019 11:43 AM
To: Cathleen Saunders
Subject: RE: 548 Caratoke Highway - Moyock, Currituck County, NC
Cathleen —
I received the following info today from our Operations Department :
07/13/2016 54 minutes. An error occurred during routine circuit switching.
07/15/2016 <momentary> lightning strike
09/01/2016 <momentary> lightning strike
10/09/2016 16+ hour, trees on line: Hurricane Matthew
05/05/2017 <momentary> lightning strike
01/04/2018 2-hour, 23min. transmission line outage
07/17/2018 <momentary> lightning strike
(Note: the lightning strikes were at various locations on the circuit -- not 548 Caratoke — but service
at 548 would have seen the lights blink as a result of the strike)
)Zxnc kvtt wrijkt
Coordinator - Electric Distribution Design
Dominion Energy North Carolina
Elizabeth City Office
Office 252-33 1 -61 08
Cell 757-375-6476
Fax [phone]
om
OR
,0.0 Dominion
Energy
From: Cathleen Saunders [mailto:[e-mail]]
Sent: Wednesday, January 09, 2019 9:57 AM
To: Randall Wright (PowerDelivery - 1)
Subject: [External] RE: 548 Caratoke Highway - Moyock, Currituck County, NC
Hi Randall —
Just following up on this email. As an example, I'm attaching what we have received on other projects. Let me
know if you need any additional information from us in order to provide this.
Thank you,

Cathlben M. Saunders, P.E.
Project Manager
Quible & Associates, P.C.
8466 Caratoke Highway, Bldg 400
Powells Point, NC 27966
P.O. Drawer 870
Kitty Hawk, NC 27949
t 252.491.8147
f 252.491.8146
m 252.202.7112
www.guible.com
LEGAL DISCLAIMER
The information transmitted is intended solely for the individual or entity to which it is addressed and may
contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of or
taking action in reliance upon this information by persons or entities other than the intended recipient is
prohibited. If you have received this email in error please contact the sender and delete the material from any
computer.
From: Cathleen Saunders
Sent: Thursday, January 03, 2019 3:52 PM
To: Randall Wright <[e-mail]>
Subject: Re: 548 Caratoke Highway - Moyock, Currituck County, NC
Hi Randall,
Hoping to determine any known outages at adjacent properties or in the general area. Whatever information you may
have.
Thank you,
Cathleen
-------- Original message --------
From: Randall Wright<[e-mail]>
Date: 1/3/19 1:56 PM (GMT-05:00)
To: Cathleen Saunders <[e-mail]>
Subject: RE: 548 Caratoke Highway - Moyock, Currituck County, NC
Hello Cathleen —
I will check to see if we are able to supply the information you are requesting. What specific area are you referring to?
Thanks
Rana Itt wrilrt
Coordinator - Electric Distribution Design
Dominion Energy North Carolina
Elizabeth City Office
Office 252-33 1 -G 108
Cell 757-375-G47G

, Fax 252-33 1 -G 122
' Dominion
Energy,
From: Cathleen Saunders [mailto:csaundersC uible.com]
Sent: Thursday, January 03, 2019 8:08 AM
To: Randall Wright (PowerDelivery - 1)
Subject: [External] FW: 548 Caratoke Highway - Moyock, Currituck County, NC
Good morning Randall,
Can you address the request below?
Good afternoon, we are currently designing an onsite pump station for a private development located at 548 Caratoke
Highway in Moyock, Currituck County, NC. Could you please provide us with the past three years of power outage data
for this area? Feel free to call if you have any questions.
Thank you,
Cathleen M. Saunders, P.E.
Project Manager
Quible & Associates, P.C.
8466 Caratoke Highway, Bldg 400
Powells Point, NC 27966
P.O. Drawer 870
Kitty Hawk, NC 27949
t 252.491.8147
f 252.491.8146
m 252.202.7112
www.guible.com
LEGAL DISCLAIMER
The information transmitted is intended solely for the individual or entity to which it is addressed and may
contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of or
taking action in reliance upon this information by persons or entities other than the intended recipient is
prohibited. If you have received this email in error please contact the sender and delete the material from any
computer.
From: Harold R Parker<harold.r.oarker(@dominionenerev.com>
Sent: Thursday, January 3, 2019 6:33 AM
To: Cathleen Saunders <[e-mail]>; William I Bruce<wiIlia m.i.bruce@dominion energy.com>
Cc: Michael Strader <[e-mail]>
Subject: RE: 548 Caratoke Highway - Moyock, Currituck County, NC
Good morning Cathleen

10/23,Q018
North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online -
Add Entity to My Email Notification List • View Filings • Print an Amended a Annual Report form • Print a
Pre -Populated Annual Report form
Business Corporation
Legal Name
CAROLINA QUALITY FOODS INC.
Information
Sosld: 1177569
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 11 /30/2010
Fiscal Month: December
Registered Agent: Nekhaila, Sam
Addresses
Mailing Principal Office Reg Office
125 Milano Dr 304 Remele Ct 304 Remele Ct
Islamorada, FL 33036-3311 Kill Devil Hills, NC 27948-9380 Kill Devil Hills, NC 27948-9380
Reg Mailing
304 Remele Ct
Kill Devil Hills, NC 27948-9380
Officers
Vice President
Dorothy Nekhaila
125 Milano Drive
Islamorada FL 33036
President
Sam Nekhaila
125 Milano Drive
Islamorada FL 33036
Stock
https://www.sosnc.gov/online_services/search/Business_Registration_ResuIts
11M

10/23„2,01'8
North Carolina Secretary of State Search Results
Class: Common
Shares: 1500
Par Value 0.01
https://www.sosne.gov/online_services/search/Business_Registration_Results 2/2