WQ0040556_Application (FTSE)_20200306

Kent E. Barney, PE
1420 Double Creek Drive
Lewisville, NC 27023
336-577-5079
March 6, 2020
NCDEQ-Public Water Supply
450 West Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Attn: Justin L. Henderson
Re: WQ0040556 Modification (Rutherford Court, Winston-Salem)
Dear Justin,
Enclosed please find:
• FTA 04-16 — Fast Track Sewer System Extension Application (and copy)
• Assumed Business Name Certification
• Existing Permit WQ0040556
• Articles of Organization
• Site Maps (USGS Topographic map and Aerial location map)
• Power Reliability Letter from Owner
• Developer's Operational Agreement
• Application fee of $480.00
NC Department of
Environmental Quality
Received
MAR 0 6 2020
Winston-Salem
Regional Office
The above is for the modification of the previously approved WQ0040556 permit. During the final
design it was determined that the pump station only required a 36 gpm capacity down from the
permitted 50 gpm. This provided the most economical system and still complied with the MDC for Pump
Stations and Force Mains.
Please review and contact me if you have any questions.
Sincerely
Kent E. Barney, PE
e,

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Clayton Home Properties dba Shugart Homes (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: Brian D. Shugart, per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 221 Jonestown Road
City: Winston-Salem State: NC Zip: 27104-
5. Applicant's contact information:
Phone number: [phone] Email Address:
II. PROJECT INFORMATION:
1. Project name: Rutherford Court
N C Department of
Environmental Quality
Received
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: W00040556 and issued date: 1-4-2019
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Forsyth
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.15294' Longitude:-80.32495°
5. Parcel ID (if applicable): 6807-86-8842
(or Parcel ID to closest downstream sewer)
I IWIIIW6ilj B l0a 810 T1]'06 EN11101\R
1. Professional Engineer: Kent E. Barney License Number: 19275
Firm:
Mailing address: 1420 Double Creek Drive
City: Lewisville State: NC Zip: 27023-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: Lower Muddy Creek Permit Number: NCO050342
Owner Name: Winston-Salem/Forsyth County Utility Commision
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
L Permit Number(s): WQCS00003 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00003
Owner Name(s): Winston-Salem/Forsyth County Utility Commision
MAR 0 6 2020
Winston-Salem
Regional Office
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/Pronerty 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. Has a 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(t1)
Daily Design Flow'"
No. of Units
Flow
Dwelling Unit
240 gal/day
1s
4,320 GPD
gal/day
GPD
gaU
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
4,320 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.0114) shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 4 320 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 650 PVC
➢ Section 11 & Ill of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) —02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: # 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.15150' Longitude:-80.32436°
3. Design flow of the pump station:.008 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 36 gallons per minute at 68 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
720
PVC
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
® Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(0):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(fl & (a)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
❑ Yes ❑ No
Setback Parameter*
Separation Required
Stone 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 sloe of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(fl cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpaee
➢ 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) 0 Yes ❑ No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or [-]Yes Z No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer PermittingBranch
ranch
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 ® N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 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
IfNo, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
I, Kart i 45.
(Professional Engineer's Aarne from Application Item III.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 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 143-215.6E, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
CARP
P. SSJ�,
.
:4
SEAL
19275
/r�'FNGINE
NT E. BPS ,
6 -2o2
I Christopher S. Barrett, Assistant Secretary signing for Brian Shugart attest that this application for
(Signature Authority's name & title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6E 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:
03.06.2020
FORM: FTA 04-16 Page 5 of 5

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USGS Topo Map
Rutherford Court, Winston-Salem, NC
(3668 Yadkinville Road)
The National May
►At I I C T., n.,
RURAL HALL QUADRANGLE
NORTH CAROL INA-FORSYTH CO.
7.5-MINUTE SERIES

SHUGART
HOMES
December 17, 2018
RE: Rutherford/3708 Yadkinville Road
To whom it may concern:
Please be advised Shugart Enterprises, LLC will be developing a private sewer pump station for
the new development located at 3708 Yadkinville Road, also known as Rutherford. The
maintenance company that will be providing maintenance to the pump station owns several
portable power generators and will utilize them as a source of back power for the Rutherford
project, should it be needed.
Thank You,
Greg Garrett
VP of Land
Shugart Enterprises, LLC
buyshugartcom I 221 Jonestown Roctd. Winston-Salem. NC 27104

Phyllis Lee Crisp, Register
Blount County Tennessee
Roo #: 507322
Rec'd: 5.00 Instrument #: 786737
State: 0.00
Clerk: 0.00 Recorded
Other: 2.00 2/1/2017 at 9:50 AM �1
Total: 7.00 in
Record Book 2473 Pgs 2953-2954
ARTICLES OF AMENDMENT TO THE CHARTER FOR -PROFIT CORPORATION (ssa421)
For Office Use Only
.......
Business Services Division
•..
� xvr ?�'•. Tre Hargett, Secretary of State
to*•: State of Tennessee AnmCU aR la 1 312 Rosa L. Parks Ave , 61h FI
_
Nashville, TN 37243
•• `3'' f�+r • [phone]
... .. Filing Fee: $20.00
Pursuant to the provisions of T.C.A. § 48-24-106 the undersigned corporation adopts the following articles of
amendment to its charter:
1. Please insert the name of the corporation as it appears on record: Clayton Properties, Inc.
If Changing the name, insert the new name: Clayton Properties Group, Inc.
Secretary of State control number (If known): 206909
2. If the document is not to be effective upon filing by the Secretary of State, the delayed effective dale and time is:
(Not to exceed 90 days) Effective Dale: _i_i_ Time:
uum sr
3. Please insert any changes that apply:
A. Principal StreelAddress:
City: State: TN Zip Code: County:
B. Registered Agent:
C. Registered Address:
4. Other Provisions:
5. The amendment was duly adopted on: 1 , 20 , 2011
ii M ab v.
The incorporators without shareholder action, as such was not required.
The board of directors without shareholder action, as such was not required.
Q The shareholders.
Note: Pursuant to T.C.A. § 10.7-603 all Information on this form Is public record.
(i..
01I20I2017 (. r'`'�J�"`.�'1
Signature Date Signature f
Director Linda Ponce
Signer's Capacity (if other than individual capacity) Name (printed or typed)
SS-4421 (Rev. 6113) RDA 1678

Tre Hargett
Secretary of State
Clayton Properties Group, Inc.
PO BOX 4098
MARYVILLE, TN 378024098
Division of Business Services
Department of State
State of Tennessee
312 Rosa L. Parks AVE, 6th FL
Nashville TN 37243-1102
Filing Acknowledgment
January 23, 2017
Please review the filing information below and notify our office immediately of any discrepancies.
Control # : 206909 Status: Active
Filing Type: For -profit Corporation - Domestic
Document Receipt
Receipt # : 003060808 Filing Fee: $20.00
Payment-Check/MO - CFS-1, NASHVILLE, TN $20.00
Amendment Type: Articles of Amendment Image # : B0301-9496
Filed Date: 01/23/2017 11:36 AM
This will acknowledge the filing of the attached articles of amendment with an effective date as indicated
above. When corresponding with this office or submitting documents for filing, please refer to the control
number given above.
You must also file this document in the office of the Register of Deeds in the county where the entity has
its principal office if such principal office is in Tennessee.
I�
Processed By: Alex Maxfield Tre Hargett
Secretary of State
Field Name Changed From Changed To
Filing Name Clayton Properties, Inc. Clayton Properties Group, Inc.
Phone [phone] * Fax [phone] * Website: http!//tnbear.tn.gov/

The signer(s) of this application certify, verify, and guarantee(s) the truth and accuracy of all statements and of all answers
given.
INVe understand that I/we am/are signing this document under oath and that I/we, once licensed, will be subject to discipline
if fraudulent information is contained herein. The Board may conduct criminal records verifications on responsible managing
employees, officers and members of the personnel of the applicant.
I/We understand that giving false or forged evidence of any kind in this document or any other document submitted to the
Board constitutes a misdemeanor punishable by a fine of not less than $500.00 or imprisonment of up to three months, or
both.
INVe understand that I/we may contract only in the exact name to which the license is granted. INVe understand that a
formal name change approved by the Board is required in order to contract under any name other than that on the application
for any project exceeding $30,000.00 in cost.
Me certify that the examinee(s) listed in this application is/are responsible managing employee(s), officer(s) and/or
member(s) of the personnel of the applicant and will be required to sign annual renewal forms and/or other forms as required
by the North Carolina Licensing Board for General Contractors (authority N.C.G.S. §87, Article 1, and 21 NCAC 12).
Clayton Properties Group, Inc dba Shugart Homes
Print Name of Applicant for Licensure (Full name of applicant including legal name and DBA name if applicable)
I affirm that I am authorized to act on behalf of the applicant and that all information provided is
truthful and correct. I understand that failure to provide truthful information to the Board may subject
the licensee and qualifier(s) to disciplinary action pursuant to N.C.G.S. 87-11 and 87-13. Further, I
understand that a violation of N.C.G.S. 87.13 is a Class 2 misdemeanor and may subject me to criminal
sanctions. ram,
Signature of Applicant:
Print/Type name and Title of Signatory:
Brian D Shugart Market President
Tax Identification Number of Applicant: 62-1
On behalf of the applicant/licensee, I certify that I have read and understand the "public notice statement' maintained by
the N.C. Industrial Commission, Employee Classification Section on their website.
Further, the applicant/licens 7has 4has not X been investigated for employee misclassification within the past
twelve (12)
Signature
Ken Capron VP of Production
Print Name and title
September 23, 2019
Date
The public statement notice referenced can be viewed at the following web address.
littp://www.ic.iic.gov/EmployeeClassificatioiiSection.litml
A7

Original To: �IYY\ t ar6aa
it►it►ititti►titt►itiitii►►iiiitui►ti►
2019037594 00145
FORSY I H CO, NC FEE $26.00
PRESENE_O S RECORDED.
09-20-2019 01:37:26 PM
LYNNE JOHNSON
R' WSTER OF DEEDS
BY EVELYN R. DIXON
OPTY
BK: RE 3483
PG: 357-357
ASSUMED BUSINESS NAME CERTIFICATE (NCGS §66-71.5)
Please print legibly.
1. The assumed business name is:
Shugart Homes
(You may include no more than five (5) assumed business names on this form.)
The real name of the person or entity engaging in business under the assumed business name is:
Clayton Properties Group, Inc. SOSID# 0296674
(Corporations, LLC's, limited partnerships must provide the exact name registered with the NC Secretary of State's office and
the SOSID number assigned at the time of formation. Go to www.sosnc.aov/br/search to look up your information.)
3. The nature/type of the business is: Single Family Residential Homebuilder & Land Developer
4. The street address of the principal place of business is: (PO Boxes are not acceptable)
221 Jonestown Road Winston-Salem NC 27104
5. The mailing address, if different from the street address, is:
441 Western Lane Irmo, SC 29063
6. The counties where the assumed business name will be used to engage in business are:
M All 100 North Carolina counties
This certificate is signed by the owner/legal representative of the person or entity named above,
this 18 day of
Signature:
Printed/Typed Name: Brian Shugart v
2019
Title: Market President
(See instructions for who must sign for various business entity types.)
Assumed Business Name Certificate 10.03.17

STATE OF NORTH CAROLINA
COUNTY OFPermit No. W �� "I©5Jf b "I11tX+i�i cc�ri
T
DEVELOPER'S OPERATIONAL AGREEMENT `
Thi AGREEMENT made pursuant to G.S. 143-215.1 (d 1) and entered into this �3�^ day of
(.eyn Ir by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
S%1A-QL+ *f)-rp6ses . L LG a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
The DEVELOPER is the owner of the certain lands lying in Fo- rs'A� County upon
which it is ere c mg
as2� -r oc
will erect dwelling units and other improvements, said development to beknown
the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to serve
the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a pen -nit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or w�``
iill±l causeforrued be foued at the time of filing of the
Declaration, the (Unit Owners' Association)RAt'r ROA1 1+i1C+, (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re -constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance, re -construction and repair.
G. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interesttherein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
I. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions andlaw.
2. The DEVELOPER shall not transfer ownership anti/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. "file
request must include a copy of the Association Bylaws and Declaration.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility for
the operation and maintenance ofits Disposal System until a permit has been reissued to the DEVELOPER's
Successor.
DORM: DEV 11-17 Page I ol2

4. "file DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in confomity with law and the provisions of the permit fo' construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes and insurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses. In order to assure that there shall be funds readily available to
repair, maintain or construct the Disposal System, beyond the routine operation and maintenance expenses,
the Declaration and Association Bylaws shall provide that a fund be created out of the common expenses.
Such fund shall be separate from the routine maintenance funds allocated for the facility and shall be part
of the yearlybudget.
6. In the event the common expense allocation and separate fund are not adequate for the construction, repair,
and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for special
assessments to cover such necessary costs. There shall be no limit on the amount of such assessments, and
the Declaration and Bylaws shall provide that such special assessments can be made as necessary at any
time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit mayrequire as condition of accepting the Development's wastewater.
9. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the continued
proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution without first having
transferred its said system and facilities to some person, corporation or other entity acceptable to and
approved by the COMMISSION by the issuance of apenmit.
9. The agreements set forth in numbered paragraphs I, 2, 3, 4, 5, 6, 7, and 3 above shall be conditions ofany
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration is
filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the clay and year written as indicated by each of the parties named below:
FOR E NVIRONMENTAL
AN IE T COMMISSION
5 VC'.r\k-j Sr,'1'+1�
Director, Division of Water Resources
6RbVCR / ay'
Print Name and Title
(Date) -- — (Date)
FORM: DEV I I-17 Page 2 of