Loading...
HomeMy WebLinkAboutNC0057720_Owner (Name Change)_20210805 State of North Carolina 3.J . Department of Environmental Quality v.DW Division of Water Resources SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16 This form is for ownership changes or name changes of a sewer system permit. Please note that"Permittee"references the existing permit holder,and that"Applicant" references the entity applying for the ownership/name change. Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This form should not be used for permits with NC,NCG,SW or other types of non-sewer permits beginning with WQ. For more information, visit the Division's Water Quality Permitting's website: A. Sewer System Permit Ownership/Name Change(FORM: PNOCF 01-16)Application (All Applications): ❑ Submit an original completed and appropriately executed application(PNOCF 01-16). ❑ The Existing Permittee's Certification 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). ❑ The Applicant's Certification 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). RECEIVED B. Existing Permit(All Applications): ❑ Submit a copy of the most recently issued permit and certification. AUG. d02 C. Property Ownership Documentation (All Applications): • ➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system faciliti [CDEAQU ❑ Legal documentation of ownership(i.e.,GIS,deed,article of incorporation, or contract),or tVVI' W5�PR/NP1DEs ❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map,or ❑ Approved board minutes D. Certificate of Public Convenience and Necessity(All Applications where the Applicant is a Privately-Owned Public Utility): ❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of 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 non-discharge system. E. Operational Agreements (Applications where the Applicant is a Home/Property Owners'Association or Developer of lots to be sold): ➢ Home/Property Owners' Associations 0 Per 15A NCAC 02T.01 15(c),submit an original properly executed Operational Agreement(FORM: HOA). O Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By- laws that contain the language required by the Operational Agreement. ➢ Developers of lots to be sold ❑ Per 15A NCAC 02T.01 15(b),submit an original of the properly executed Operational Agreement(FORM: DEV). F. Package Submitted in Duplicate ❑ Submit a copy of all required documents in Instructions A-E as required THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE TO: NCDEQ-DWR Water Quality Permitting Section PERCS Unit By U.S. Postal Service: By Courier/Special Delivery: 1617 MAIL SERVICE CENTER 512 N. SALISBURY ST. RALEIGH,NORTH CAROLINA 27699-1636 SUITE 925 RALEIGH, NORTH CAROLINA 27604 TELEPHONE NUMBER: (919)807-6300 INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1 State of North Carolina Department of Environmental Quality Division of Water Resources SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE - INSTRUCTIONS FOR FORM: PNOCF 01-16 Division of Water Resources I. EXISTING PERMITTEE INFORMATION: 1. Permittee's name: Apex Bank 2. Signature authority's name: Crystal Pate per 15A NCAC 02T.0106(b) 3. Signature authority's title: Vice President 4. Permittee's mailing address: 430 Montbrook Lane,Suite 207-208 City: Knoxville 5. State: TN Zip: 37919 - Permittee's contact information: Phone number: (865) 531-4170 Fax Number( ) - Email Address: emily.moore(a,apexbank.com II. APPLICANT INFORMATION: 1. Applicant's name: Jones Estates Hidden Lakes LLC 2. Signature authority's name: Kellen Buss per 15A NCAC 02T .0106(b) 3. Signature authority's title: Director of Site Infrastructure 4. Applicant's mailing address: 2310 S.Miami BLVD#238 City: Durham 5. State: NC Zip:27703 - Applicant's contact information: Phone number: (419)357-9091 Fax Number( )_- Email Address: kbussArentstackhouse.com 6. Representative's name: Jon Southern 7. Representative's title: Operator 8. Representative's contact information Phone number: (336)978-9658 Fax Number( ) - Email Address: jmsouthern27@ gmail.com III. PERMIT INFORMATION: 1. Existing permit number: NC0057720 and most recent issuance date: 1 June 2017 2. Reason for the permit application:Transfer of Ownership If other, attach detailed explanation 3. Has the facility been constructed? ❑ Yes or❑ No 4. Has the facility been certified per 15A NCAC 02T.0116? E Yes or❑No FORM: PNOCF 01-16 Page 1 of 2 IV. CERTIFICATIONS: Existing Permittee's Certification per 15A NCAC 02T.0106(1 ): Crystal Pate,Vice President attest that this application (Signature Authority's name& title flout Application Item 1.2& 3) has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit into the Applicant's name, I will continue to he responsible for compliance with the current permit and any discharge of wastewater from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit be violated. l also understand that if all required parts of this application are note completed and that if all required supporting information and attachments arc not included,this application will he returned to me as incomplete. NOTE In accordance with General Statutes 14 3-215.6A and 14 t-21 5.613, any person who knowingly makes any false statement, representation, or certification in any application package shall be guilty of a ('lass 2 misdemeanor, which may include a fine not to exceed S10,000 as well as civil pet ties up to S25,000 per violation. 1 Z- - Signature: —x�':�i ��- Date: 1E. 1Z ='1 Applicant's Certification per I5A NCAC 02T.0106(h): n d .L Itta, 1 t! J re Q�'- Sac nKct ' JcJ. attest that this application (Signature Authority's name& title from Application Item II 2&3.) has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into the Applicant's name, I will he responsible for compliance v,ith the issued permit and any discharge of wastewater from this non- discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief, and/or et iminal prosecution. I will stake 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 143-215.61 and 143-21 L_G13, any person who knowingly makes any false statement, representation, or certification in an application package shall be guilty of a (:lass 2 misdemeanor, which may include a line not to exceed S10,000 as well a' ' 'r allies up to S25,000 per violation. Signature: Date: V°S. E O Z I FORM: PNOCF oI-16 Page 2 of BK 0729 PG 0833 FILED ELECTRONICALLY Approved by Stokes County Tax Administration STOKES COUNTY NC BRANDON HOOKER NCGS 161-31(A) and NCGS 105-303(a2) REGISTER OF DEEDS KA Date 01/25/2021 FILED Jan 25, 2021 AT 11:40 AM BOOK 00729 START PAGE 0833 This instrument prepared by Midtown Property Law, END PAGE 0835 INSTRUMENT # 00371 a licensed North Carolina attorney. EXCISE TAX $0.00 Delinquent taxes, if any, to be paid by the closing attorney to the Tax Collector upon disbursement of closing proceedings per NCGS 160-30(a1) Excise Tax $0.00 REID: 14608 Mail after recording to: Grantee This instrument was prepared by: Midtown Property Law(without title search or opinion) Brief description for the index: 0 Off Slate Road NORTH CAROLINA QUITCLAIM DEED THIS DEED made this 8th day of January,2021, by and between GRANTOR GRANTEE JONES ESTATES LLC JONES ESTATES HIDDEN LAKES LLC a North Carolina limited liability company a North Carolina limited liability company mailing address: mailing address: 2310 S.Miami Blvd, Suite 238 2310 S. Miami Blvd, Suite 238 Durham,NC 27703 Durham,NC 27703 The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,and assigns, and shall include singular,plural,masculine,feminine neuter as required by context. WITNESSETH, that Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged,has remised and released and does hereby remise,release and forever quitclaim unto the Grantee, all those certain lots or parcels of land situated in Stokes County,North Carolina and more particularly described as follows: See attached Exhibit A,incorporated herein by reference. For chain of title see deed recorded in Book 728,Page 1570, Stokes County Registry. TO HAVE AND TO HOLD the aforesaid lots or parcels of land and all privileges and appurtenances thereto belonging to the Grantee in fee simple. Grantor makes no warranty, express or implied, as to title to the property hereinabove described. 1 submitted electronically by "Midtown Property Law" in compliance with North Carolina statutes governing recordable documents and the terms of the submitter agreement with the Stokes county Register of Deeds. BK 0729 PG 0834 IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written. GRANTOR: JONES ESTATES LLC, a North Carolina limited liability company By: DANIELS HOLDINGS LLC, its Manager By: (SEAL) Name: Pt?. n Title: Ltrvt .� NORTH CAROLINA, COUNTY I,the undersigned Notary Public of the County and State aforesaid,certify that 96,1A 0 0 ,ersok the (\ of Daniels Holdings LLC, the Manager of Jones Estates LL , personally came before me this day and acknowledged the due execution of the foregoing instrument in the capacity indicated. ppa�d' Witness my hand and Notarial stamp or seal this CJ day of cv ,2021. SEAL—STAMP Notary ublic My commission expires: .3436' Z'� MELISSA SOLOMON Notary Public, North Carolina • Wake County My Commission Expires r March30,2025 2 BK 0729 PG 0835 EXHIBIT A Legal Description BEGINNING at a placed railroad spike in the center of State Road#1966 (Slate Road) in the corner of Jimmy D. Welborn's line (see Deed Book 229,page 416 of the Stokes County Registry) and runs South 27 degs. 58 min. 39 sec. West 454.22 feet to a placed railroad spike 4 feet East of the center of State Road #1966 (Slate Road); thence South 10 degs. 34 min. 30 sec. West 34.06 feet to an iron placed 16 feet East of the center line of State Road#1966(Slate Road);thence North 72 degs. 36 min. 42 sec. West 629.50 feet (passing over a 3/a" iron found at 50 feet) to a placed iron; thence South 10 degs. 13 min. 47 sec. West 126.65 feet to a 20 inch marked oak tree; thence North 82 degs. 39 min. 49 sec. West 1,486.25 feet to an axle found at a stone; thence North 8 degs. 40 min. 22 sec. East 1,369.81 feet to a found stone 6 feet East of a marked oak tree;thence South 82 degs. 34 min. 27 sec. East 99.89 feet to a found iron stake; thence South 82 degs. 32 min. 58 sec. East 1,380.07 feet to a found iron stake;thence South 5 degs. 36 min. 13 sec.West 485.72 feet to an 18 inch marked oak tree; thence South 80 degs. 09 min. 22 sec. East 893.96 feet(passing over a rebar found at 858.64 feet) to the BEGINNING and containing 60.902 acres. This description taken from the survey plat established by C. Ray Cates bearing the date of October 13th, 1982, See Deed Book 259 at Page 286, Stokes County Registry. SAVE AND EXCEPT: BEGINNING at a point in the West right of line of State Road #1966 (Slate Road), said point being South 27 degs. 30 min. 57 sec. West 270 feet from the Jimmy D.Welborn line (see Deed Book 229 at Page 416 of the Stokes County Registry) and runs thence South 27 degs. 30 min. 57 sec. West 173.24 feet; thence (continuing with the right of way) South 28 degs. 29 min. 53 sec.West 116.76 feet;thence with the North right of way of the proposed road North 72 degs. 04 min. 57 sec.West on a chord 62.73 feet to a point in the North right of way of proposed road;thence North 82 degs. 39 min. 49 sec. West 122 feet to a point;thence North 11 degs. 18 min. 28 sec.East 340 feet to a point;thence South 65 degs. 50 min. 08 sec. East 273.38 feet to the BEGINNING and containing 1.61 acres. This description taken from the survey plat of C. Ray Cates established on March 18th, 1983. SAVE AND EXCEPT the following lots: (1) Lot#1 in the Twin Lakes Subdivision as per deed recorded in Book 290,page 670. (2) Lot#2 in the Twin Lakes Subdivision as per deed recorded in Book 290,page 674. (3) Lot#3 in the Twin Lakes Subdivision as per deed recorded in Book 289,page 770. (4) Lot#4 in the Twin Lakes Subdivision as per deed recorded in Book 298,page 887. REID: 14608 Address: 0 Slate Road,King,NC 27021 3 OPERATING AGREEMENT OF JONES ESTATES HIDDEN LAKES LLC TI-IIS OPERATING AGREEMENT of Jones Estates Hidden Lakes LLC (the "Company"), a limited liability company organized pursuant to the North Carolina Limited Liability Company Act, is executed effective as of December 16, 2020. Jones Estates LLC ("Member") is the sole member of the Company. Solely for federal and state tax purposes and pursuant to Treasury Regulations Section 301.7701, the Member and the Company intend the Company to be disregarded as an entity that is separate from the Member. For all other purposes (including, without limitation, limited liability protection for the Member from Company liabilities), however, the Member and the Company intend the Company to be respected as a separate legal entity that is separate and apart from the Member. ARTICLE I FORMATION OF THE COMPANY 1.1. Formation. The Company was formed on December 16, 2020, upon the filing with the Secretary of State of the Certificate of Formation of the Company. 1.2. Name. The name of the Company is Jones Estates Hidden Lakes LLC. The Member may change the name of the Company from time to time as she deems advisable,provided necessary filings under the Act are made. 1.3. Registered Office and Registered Agent. The Company's registered office within the State of North Carolina and its registered agent at such address shall be as the Managers may from time to time deem necessary or advisable. 1.4. Principal Place of Business. The principal place of business of the Company within or without the State of North Carolina shall be at such place or places as the Member may from time to time deem necessary or advisable. 1.5. Purposes and Powers. (a) The purpose of the Company shall be to engage in any lawful business for which limited liability companies may be organized under the Act. (b) The Company shall have any and all powers which are necessary or desirable to carry out the purposes and business of the Company, to the extent the same may be legally exercised by limited liability companies under the Act. 1.6. Term. The Company shall continue in existence until it is dissolved and its affairs wound up in accordance with the Act or this Agreement. 1.7. Nature of Member's Interest. The interest of the sole Member in the Company shall be personal property for all purposes. The entire membership interest in the Company (the Pagetof7 "Membership Interest") shall consist of 100 units of Membership Interest, held in the name of Jones Estates LLC. Legal title to all Company assets shall be held in the name of the Company. ARTICLE II DEFINITIONS The following terms used in this Agreement shall have the following meanings (unless otherwise expressly provided herein): "Act" means the Delaware Limited Liability Company Act, as the same may be amended from time to time. "Agreement" means this Operating Agreement, as amended from time to time. "Certificate of Formation"means the Certificate of Formation of the Company filed with the Secretary of State, as amended or restated from time to time. "Code" means the Internal Revenue Code of 1986, as amended from time to time (and any corresponding provisions of succeeding law). "Manager" means the Person or Persons designated as manager pursuant to Section 3.2. "Member"means Jones Estates LLC, a North Carolina limited liability company. "Person" means an individual, a trust. an estate, a domestic corporation, a foreign corporation, a professional corporation, a partnership, a limited partnership, a limited liability company, a foreign limited liability company, an unincorporated association, or another entity. "Property" means (i) any and all property acquired by the Company, real and/or personal (including, without limitation, intangible property); and (ii) any and all of the improvements constructed on any real property. "Secretary of State" means the Secretary of State of the State of Delaware. "Treasury Regulations" means the Income Tax Regulations and Temporary Regulations promulgated under the Code, as such regulations may be amended from time to time (including corresponding provisions of succeeding regulations). ARTICLE III MANAGEMENT OF THE COMPANY 3.1. Management. The Company shall be a manager-managed limited liability company and therefore, except as otherwise expressly provided in this Agreement, the Certificate of Formation or the Act, all decisions with respect to the management of the business and affairs of the Company shall be made by the Manager(s). The Manager(s) may execute agreements on Page 2 of 7 behalf of the Company utilizing such title (including, without limitation, "President") as the Manager(s) may elect from time to time. 3.2. Appointment of Manager. The Member, by virtue of his status as the sole Member, shall designate the Manager or Managers of the Company for all purposes. The Member may, but need not, serve as a Manager. The initial Managers of the Company shall be Jonathan Gindes and Peyton Anderson. 3.3. Indemnification of Managers for Management Services. The Company shall indemnify the Manager(s) or their authorized delegate(s) in connection with their services to the Company to the fullest extent permitted or required by the Act, as amended from time to time, and the Company may advance expenses incurred by such person upon the approval of the Manager(s) (or the Member in the event of an advance to the Manager), upon the receipt by the Company of a signed statement agreeing to reimburse the Company for such advance in the event it is ultimately determined that the Manager is not entitled to be indemnified by the Company against such expenses. 3.4. Stakeholders. The Member expressly agrees, that in discharging the duties of the Manager, and in determining what is in the best interests of the Company and its Member, the Manager(s) or their authorized delegate(s) shall not be required to regard any interest, or the interests of any particular group affected by such action, as a dominant or controlling interest or factor. The Manager(s)or their authorized delegate(s)shall give due consideration to the following factors, including, but not limited to,the long-term prospects and interests of the Company and its Member, and the social, economic, legal, or other effects of any action on any current and retired employees, any suppliers and customers of the Company or its any subsidiaries, and the communities and society in which the Company or its subsidiaries operate (collectively, with the Member, the "Stakeholders"), together with the short-term, as well as long-term, interests of its Member and the effect of the Company's operations (and its subsidiaries" operations) on the environment and the economy of the state, the region, and the nation. Nothing in this Section 3.4, express or implied, is intended to create or shall create or grant any right in or for any person or any cause of action by or for any person. Notwithstanding the foregoing, the Manager(s) or their authorized delegate(s) are entitled to rely upon the definition of"best interests" as set forth above in enforcing its rights hereunder and under state law, and such reliance shall not, absent another breach, be construed as a breach of the Manager's fiduciary duty of care. ARTICLE IV RIGHTS AND OBLIGATIONS OF MEMBER 4.1. Removal and Designation of Manager. The Member may by written action, taken at any time for any or no reason,remove a Manager. The Member may replace a Manager due to such Manager's death, dissolution, resignation, removal, or otherwise by written action and the written consent of the successor Manager to serve as such. 4.2. Limited Liability. The Member shall not be required to make any contribution to the capital of the Company, except as set forth on Schedule 1,nor shall the Member in its capacity as such be bound by, or personally liable for, any expense, liability, or obligation of the Company except to the extent of his interest in the Company and the obligation to return distributions made to such Member under certain circumstances as required by the Act. The Member shall be under Page 3of7 no obligation to restore a deficit Capital Account upon the dissolution or liquidation of the Company. ARTICLE V CAPITAL CONTRIBUTIONS The Member has contributed property to the Company as the initial Capital Contribution as set forth on Schedule I attached hereto. ARTICLE VI ALLOCATIONS, ELECTIONS, AND REPORTS All allocations of profit and loss of the Company and all assets and liabilities of the Company shall, solely for state and federal tax purposes, be treated as that of the Member pursuant to Treasury Regulations Section 301.7701, but for no other purpose(including, without limitation, limited liability protection for the Member from Company liabilities). ARTICLE VII DISTRIBUTIONS Distributions of assets shall be made on such basis and at such time as determined by the Manager. ARTICLE VIII DISSOLUTION AND LIQUIDATION OF THE COMPANY 8.1. Dissolution Events. The Company will be dissolved upon the happening of any of the following events: (a) All or substantially all of the assets of the Company are sold, exchanged, or otherwise transferred (unless the Member has elected to continue the business of the Company); (b) The Member signs a document stating his election to dissolve the Company; (c) The entry of a final judgment, order, or decree of a court of competent jurisdiction adjudicating the Company to be bankrupt and the expiration without appeal of the period, if any, allowed by applicable law in which to appeal; or (d) The entry of a decree of j udicial dissolution or the administrative dissolution of the Company as provided in the Act. 8.2. Liquidation. Upon the happening of any of the events specified in Section 8.1 and, if applicable, the failure of the Member to continue the business of the Company. the Member, or any liquidating trustee designated by the Member, will commence as promptly as practicable to wind up the Company's affairs unless the Member or the liquidating trustee (either, the "Liquidator") determines that an immediate liquidation of Company assets would cause undue loss to the Company, in which event the liquidation may be deferred for a time determined by the Liquidator to be appropriate. Assets of the Company may be liquidated or distributed in kind, as Page 4 of 7 the Liquidator determines to be appropriate. The Member will continue to be entitled to Company cash flow and Company profits during the period of liquidation. The proceeds from liquidation of the Company and any Company assets that are not sold in connection with the liquidation will be applied in the following order of priority: (a) To payment of the debts and satisfaction of the other obligations of the Company, including, without limitation, debts and obligations to the Member; (b) To the establishment of any reserves deemed appropriate by the Liquidator for any liabilities or obligations of the Company, which reserves will be held for the purpose of paying liabilities or obligations and,at the expiration of a period the Liquidator deems appropriate, will be distributed as provided in Section 8.2(c); and, thereafter (c) To the Member. 8.3 Articles of Dissolution. Upon the dissolution and commencement of the winding up of the Company, the Member shall cause a Certificate of Dissolution to be executed on behalf of the Company and filed with the Secretary of State,and the Member shall execute,acknowledge, and file any and all other instruments necessary or appropriate to reflect the dissolution of the Company. ARTICLE IX MISCELLANEOUS 9.1. Records. The records of the Company will be maintained at the Company's principal place of business or at any other place the Member selects, provided the Company keeps at its principal place of business the records required by the Act to be maintained there. 9.2. Survival of Rights. Except as provided herein to the contrary, this Agreement shall be binding upon and inure to the benefit of the parties, their successors and assigns. 9.3. Interpretation and Governing Law. When the context in which words are used in this Agreement indicates that such is the intent, words in the singular number shall include the plural and vice versa. The masculine gender shall include the feminine and neuter. The Article and Section headings or titles shall not define, limit, extend, or interpret the scope of this Agreement or any particular Article or Section. This Agreement shall be governed and construed in accordance with the laws of the State of Delaware without giving effect to the conflicts of laws provisions thereof. 9.4. Severability. If any provision, sentence, phrase, or word of this Agreement or the application thereof to any person or circumstance shall be held invalid, the remainder of this Agreement, or the application of such provision, sentence, phrase, or word to Persons or circumstances, other than those as to which it is held invalid, shall not be affected thereby. 9.5. Agreement in Counterparts. This Agreement may be executed in several counterparts, each of which shall be deemed an original, and all of which shall constitute one and the same instrument. Page 5of7 9.6. Creditors Not Benefited. Nothing in this Agreement is intended to benefit any creditor of the Company. No creditor of the Company will be entitled to require the Member to solicit or accept any loan or additional capital contribution for the Company or to enforce any right which the Company may have against a Member, whether arising under this Agreement or otherwise. IN WITNESS WHEREOF, the undersigned,being the sole Member and both Managers of the Company, has caused this Operating Agreement to be duly adopted by the Company as of the date set forth on the cover page hereof. INITIAL MEMBER ANI) MANAGERS: • J athan Gindes, Manager Pey on Anderson, Manager Jones Estates LLC, Member J athan Gindes, It Manager Page 6of7 SCHEDULE 1 Property Contributed to the Company by the Member Name and Address of Member Initial Capital Contribution Membership Interest Jones Estates LLC 100% 2310 S. Miami Blvd, Suite 238 Durham, NC 27703 Page 7 of 7 State of North Carolina Department of Environmental Quality t Division of Water Resources SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16 This form is for ownership changes or name changes of a sewer system permit. Please note that"Permittee" references the existing permit holder,and that"Applicant" references the entity applying for the ownership/name change. Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This form should not be used for permits with NC,NCG,SW or other types of non-sewer permits beginning with WQ. For more information, visit the Division's Water Quality Permitting's website: A. Sewer System Permit Ownership/Name Change(FORM: PNOCF 01-16)Application (All Applications): ❑ Submit an original completed and appropriately executed application (PNOCF 01-16). ❑ The Existing Permittee's Certification shall be signed in accordance with I5A 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). ❑ The Applicant's Certification 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). B. Existing Permit(All Applications): ❑ Submit a copy of the most recently issued permit and certification. C. Property Ownership Documentation (All Applications): ➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities: ❑ Legal documentation of ownership (i.e., GIS,deed, article of incorporation, or contract),or ❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map,or ❑ Approved board minutes D. Certificate of Public Convenience and Necessity(All Applications where the Applicant is a Privately-Owned Public Utility): O Per 15A NCAC 02T .0115(a)(1), provide one copy of 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 non-discharge system. E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be sold): > Home/Property Owners' Associations ❑ Per I5A NCAC 02T.0115(c),submit an original properly executed Operational Agreement(FORM: HOA). ❑ Per I SA NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By- laws that contain the language required by the Operational Agreement. > Developers of lots to be sold ❑ Per 15A NCAC 02T .01 15(b),submit an original of the properly executed Operational Agreement(FORM: DEV). F. Package Submitted in Duplicate ❑ Submit a copy of all required documents in Instructions A-E as required THE COMPLETED APPLICATION,AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE TO: NCDEQ-DWR Water Quality Permitting Section PERCS Unit By U.S. Postal Service: By Courier/Special Delivery: 1617 MAIL SERVICE CENTER 512 N. SALISBURY ST. RALEIGH,NORTH CAROLINA 27699-1636 SUITE 925 RALEIGH, NORTH CAROLINA 27604 TELEPHONE NUMBER: (919)807-6300 INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1 State of North Carolina Department of Environmental Quality „ „ Division of Water Resources SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16 I. EXISTING PERMITTEE INFORMATION: 1. Permittee's name: Apex Bank 2. Signature authority's name: Crystal Pate per 15A NCAC 02T.0106(b) 3. Signature authority's title: Vice President 4. Pennittee's mailing address: 430 Montbrook Lane, Suite 207-208 City: Knoxville 5. State: TN Zip: 37919 - Permittee's contact information: Phone number: (865) 531-4170 Fax Number( )_- Email Address: emily.moore a,apexbank.com II. APPLICANT INFORMATION: 1. Applicant's name: Jones Estates Hidden Lakes LLC 2. Signature authority's name: Kellen Buss per 15A NCAC 02T .0106(b) 3. Signature authority's title: Director of Site Infrastructure 4. Applicant's mailing address: 2310 S. Miami BLVD#238 City: Durham 5, State: NC Zip: 27703 - Applicant's contact information: Phone number: (419)357-9091 Fax Number( ) - Email Address: kbuss a,rentstackhouse.com 6 Representative's name: Jon Southern 7. Representative's title: Operator 8. Representative's contact information Phone number: (336) 978-9658 Fax Number( ) - Email Address: jmsouthern27(a,gmail.com III. PERMIT INFORMATION: 1. Existing permit number: NC0057720 and most recent issuance date: 1 June 2017 2. Reason for the permit application: Transfer of Ownership If other, attach detailed explanation 3. Has the facility been constructed? ❑ Yes or❑ No 4. Has the facility been certified per 15A NCAC 02T.0116? ❑ Yes or❑No FORM: PNOCF 01-16 Page 1 of 2 IV. CERTIFICATIONS: Existing Permittee's Certification per ISA NCAC(12T.(J106(b): Crystal Pate,Vice President attest that this application (Signature Authority's name& title front Application Item 1.2& 3) has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit into the Applicant's name, I will continue to he responsible for compliance ‘s ith the current permit and any discharge of wastewater from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief, and;or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit be violated. I also understand that if all required parts of this application are note completed and that if all required supporting information and attachments arc not included,this application will be returned to me as incomplete. NOTE In accordance with General Statutes 14 3-215 6A and 14 t-215.613. any person who knowingly stakes any false statement. representation, or certification in any application package shall he guilty of a Class 2 misdemeanor, which may include a fine not to exceed S I0,000 as well as civil pet hies up to S25,000 per violation. Signature: C-„&sc),.‘ C)a'—...._ C:L (1 Dale: 1^7 i. -2:i ,I Applicant's Certification per ISA NCAC 02T.0106(h): I, 4!IQ� -7,14 r--- aretIvar Q Sat 7";; ' .ta-nicJ.di-...... attest that this application (Signature Authority's name& title from Application Item 1I.2&3.) has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into the Applicant's name, I will he responsible Iitr compliance with the issued permit and any discharge of wastewater from this non- discharge system to surface waters or the land nnay result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make,no claim against the Division of W,acr Resources should a condition of this permit he violated I also understand that if all required parts of this application package are not completed and that if all required supporting mfbrnrttion and attachments are not included,this application package it ill be returned to me as incomplete NOTE In accordance with General Statutes I-73-2I5.6A and l_41_21=,,(?f3, any person who knowingly makes any false statement, representation, or certification in an application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to , exceed $10,000 as well a• ' 't ' alties up to S25,000 per violation. V°S) Signature: Date: ?2-f FORM: f NOCF01-16 - Page 2 of t 'm •, ROY COOPER Of'id ,, 'y i ,a i , Gnverno fat ;, . 4" G MICHAEL S. REAN Seerercrrn Water Resources S. JAY ZIMMERMAN e NVIRONMENTAL DUALITY NC Department of Director Environmental Quality May 15, 2017 Received Mr.Jon M. Southern .1 i,i1 J 201 9455 Helsabeck Rd Rural Hall,NC 27045 Win iron-Salem Region:II (.Jirlce Subject: Issuance of NPDES Permit NC0057720 a - Hidden Lakes Village WWTP ,- Stokes County Class WW-2 Dear Mr. Southern: Division personnel have reviewed and approved your application for renewal of the subject permit. Accordingly,we are forwarding the attached NPDES discharge permit. This permit is issued pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S.Environmental Protection Agency dated October 15, 2007(or as subsequently amended). This final permit includes no major changes from the draft permit sent to you on February 22, 2017. If any parts,measurement frequencies or sampling requirements contained in this permit are "ultfzf;ceptable to you,you have the right to an adjudicatory hearing upon written request within thirty(30) the following receipt of this letter. This request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina General Statutes,and filed with the Office of Administrative Hearings 371.4 Mail Service Center,Raleigh,North Carolina 27699-6714). Unless such demand is made,this cb cis„on sh hll be final and binding. Please note that this permit is not transferable except after notice to the Division. The Division may regxui c o24-aalification or revocation and'reissuance of the permit. This permit does not affect the legal rr:I.,tci,'en nts to obtain any other Federal,State,or Local governmental permit that may be required. If you haw.'arty questions concerning this permit,please contact Charles H.Weaver at telephone number(919) 54}'f.6'91. e t . ' rly, ,,,,,,A,*/ / -ir'' ' ?)Z /s.Jay Zimmerman, . Director, Division of Water Resources cc: Central Files Winston-Salem Regional Office NPDES files John H.Oakley/2112 Zephyr Rd,Dobson,NC 27017 State of North Carolina I Environmental Quality i Water Resources 1617 Mail Service Center l Raleigh,NC 27699-1617 919 807 6300 919-807-6389 FAX httpsJ/deq.ne.gov/about/divisions/water-resources/water-resources-permits!wastewater-branch/np les-wastewater-permits • • Permit NC0057720 • STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF WATER RESOURCES PERMIT TO DISCHARGE WASTEWATER UNDER THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and regulations promulgated and adopted by the'North Carolina Environmental Management Commission, and the Federal Water Pollution Control Act, as amended, John Henry Oakley is hereby authorized to discharge wastewater from a facility located at the Hidden Lakes Village Mobile Home Park WWTP NCSR 1966 King Stokes County to receiving waters designated as an unnamed tributary to Timmons Creek in subbasin 03- 02-01 of the Roanoke River Basin in accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and 1V hereof. This permit shall become effective June 1, 2017: This permit and authorization to discharge shall expire at midnight on February 28, 2022. Signed this day May 15, 2017 S y Zimmerman, P.G. erector, Division of Water Resources By Authority of the Environmental Management Commission Page 1 of 6 i ermit NC0057720 SUPPLEMENT TO PERMIT COVER SHEET All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked, and as of this issuance, any previously issued permit bearing this number is no longer effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the permit conditions, requirements,terms, and provisions included herein. John Henry Oakley is hereby authorized to: 1. Continue to operate an existing 0.07 MGD wastewater treatment system that includes the following components: ♦ Bar screen [aluminum] ♦ Extended aeration tank • Two blowers for basin air, return sludge, and sludge wasting ® Dual final clarifiers • Sludge holding tank ♦ Tablet chlorine disinfection (2 sets) ♦ Tablet dechlorination (2 sets) ♦ Stevens flow meter The facility is located at the Hidden Lakes Mobile Home Park (NCSR 1966, King) in Stokes County. 2. Discharge from said treatment works via outfall 001, at the location specified on the attached map, into an unnamed tributary to Timmons Creek[Stream Index 22-25-2] which is currently classified C waters in subbasin 03-02-01 [HUC: 0301010302] of the Roanoke River Basin. • Page 2 of 6 • Permit NC0057720 Part I A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS [15A NCAC 02B.0400 et seq.; 15A NCAC 02B.0500 et seq.] Beginning with the effective date of this permit and lasting until expiration, the Permittee is authorized to discharge treated wastewater from Outfall 001. Such discharges shall be limited and monitored' by the Permittee,as specified below: PARAMETER • EFFLUENT LIMITATIONS MONITORING REQUIREMENTS Parameter Code Average Maximum Freque I :Tyt:tcyd 'Sample • .. . .Location Flow 50050 0.02 MGD Continuous Recording Influent or Effluent BOD,5-day,(20°C) .C0310 22.0 mg/L 33.0 mg/L Weekly Grab Effluent Total Suspended Solids C0530 30.0 mg/L 45.0 mg/L • Weekly Grab Effluent NH3 as N-Summer* C0610 2.0 mg/L 10.0 mg/L Weekly Grab Effluent NH3 as N-Winter* C0610 6.4 mg/L 32.0 mg/L Weekly Grab Effluent Dissolved Oxygen 00300 Daily average>6.0 mg/L Weekly Grab Effluent Dissolved Oxygen 00300 Monitor&Report • Weekly Grab Upstream&2 Downstream . Fecal Coliform 31616 200/100 ml 400/100 ml Weekly Grab Effluent (geometric mean) Total Residual Chlorine 3 50060 28 pg/L 2/Week Grab Effluent Temperature(°C) 00010 Monitor&Report Daily Grab Effluent Temperature CC) 00010 Monitor&Report Weekly Grab Upstream&2 Downstream >6.0 and<9.0 standard pH 00400 - units Weekly Grab Effluent *Summer. April 1-October 31 *linter November 1-March 31 Footnotes: 1. The permittee shall submit discharge monitoring reports electronically using the Division's eDMR application system [see A. (2)]. 2. Upstream=at least 100 feet upstream from the outfall. Downstream= 0.2 miles downstream from the outfall. 3. The Division shall consider all effluent TRC values reported below 50 µg/1 to be compliant with the permit. However, the Permittee shall continue to record and submit all values reported by a North Carolina certified laboratory (including field certified), even if these values fall below 50 µg/I. THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS. • Page 3 of 6 ‘115ermit NC0057720 A. (2) ELECTRONIC REPORTING OF MONITORING REPORTS JNCGS 143-215.1 (b)] Federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and program. The final NPDES Electronic Reporting Rule was adopted and became effective on December 21, 2015. NOTE: This special condition supplements or supersedes thefollowing sections within Part II of this permit (Standard Conditions for NPDES Permits): • Section B. (11.) Signatory Requirements • Section D. (2.) Reporting • Section D. (6.) Records Retention • Section E. (5.) Monitoring Reports 1. Reporting Requirements'Supersedes Section D. (2.) and Section E. (5.1 (au The permittee shall report discharge monitoring data electronically using the NC DWR's Electronic Discharge Monitoring Report (eDMR) internet application. Monitoring results obtained during the previous month(s) shall be summarized for each month and submitted electronically using eDMR. The eDMR system allows permitted facilities to enter monitoring data and submit DMRs electronically using the internet. Until such time that the state's eDMR application is compliant with EPA's Cross-Media Electronic Reporting Regulation (CROMERR), permittees will be required to submit all discharge monitoring data to the state electronically using eDMR and will be required to complete the eDMR submission by printing, signing, and submitting one signed original and a copy of the computer printed eDMR to the following address: NC DEQ / Division of Water Resources / Water Quality Permitting Section ATTENTION: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 If a permittee is unable to use the eDMR system due to a demonstrated hardship or due to the facility being physically located in an area where less than 10 percent of the households have broadband access, then a temporary waiver from the NPDES electronic reporting requirements may be granted and discharge monitoring data may be submitted on paper DMR forms (MR 1, 1.1, 2, 3) or alternative forms approved by the Director. Duplicate signed copies shall be submitted to the mailing address above. See "How to Request a Waiver from Electronic Reporting" section below. • Regardless of the,submission method, the first DMR is due on the last day of the month following the issuance of the permit or in the case of a new facility, on the last day of the month following the commencement of discharge. Starting on December 21, 2020, the permittee must electronically report the following compliance monitoring data and reports, when applicable: Page 4 of 6 Permit NC0057720 • Sewer Overflow/Bypass Event Reports; • Pretreatment Program Annual Reports; and • Clean Water Act (CWA) Section 316(b) Annual Reports. The permittee may seek an electronic reporting waiver from the Division (see "How to Request a Waiver from Electronic Reporting" section below). 2. Electronic Submissions .. In accordance with 40 CFR 122.41(1)(9), the permittee must identify the initial recipient at the time of each electronic submission. The permittee should use the EPA's website resources to identify the initial recipient for the electronic submission. Initial recipient of electronic NPDES information from NPDES-regulated facilities means the entity (EPA or the state authorized,by EPA.to implement the NPDES program) that is the designated entity•for receiving electronic NPDES data [see 40 CFR 127.2(b)]. EPA plans to establish a website that will also link to the appropriate electronic reporting tool for each type of electronic submission and for each.state_ Instructions on how to access and use the appropriate electronic reporting tool will be available as well. Information on EPA's NPDES Electronic Reporting Rule is found at:' • http://www2.ena.gov/compliance/final-national-pollutant-discharge-elimination- system-npdes-electronic-reporting-rule. Electronic submissions must start by the dates.listed in the "Reporting Requirements" section above. • 3. How to.Reeuest a Waiver from Electronic Reporting The permittee may seek a temporary electronic reporting waiver from the Division. To obtain an electronic reporting waiver, a permittee must first submit an electronic reporting waiver request to the Division. Requests for temporary electronic reporting waivers must be submitted in writing to the Division for written approval at least sixty (60) days prior to the date the facility would be required under this permit to begin submitting monitoring data and reports. The duration of a temporary waiver shall not exceed 5 years and shall thereupon expire. At such time, monitoring data and reports shall be submitted electronically to the Division unless the permittee re-applies for and is granted a new temporary electronic reporting waiver by the Division. Approved electronic reporting waivers are not transferrable. Only permittees with an approved reporting waiver request may submit monitoring data and reports on paper to the Division for the period that the approved reporting waiver request is effective. Information on eDMR and the application for a temporary electronic reporting waiver are found on the following web page: http://deq.nc.gov/about/divisions/water-resources/edmr 4. Signatory Requirements (Supplements Section B. 111.1 (bl_and Supersedes Section B. (11.) (d)] All eDMRs submitted to the permit issuing authority shall be signed.by a person • described in Part II, Section B. (11.)(a) or by a duly authorized representative of that person as described in Part II, Section B. (11.)(b). A person, and not a position, must be delegated signatory authority for eDMR reporting purposes. Page5of6 Permit NC0057720 For eDMR submissions, the person signing and submitting the DMR must obtain an eDMR user account and login credentials to access the eDMR system. For more information on North Carolina's eDMR system, registering for eDMR and obtaining an eDMR user account, please visit the following web page: http://deq.nc.gov/about/divisions/water-resources/edmr Certification. Any person submitting an electronic DMR using the state's eDMR system shall make the following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF CERTIFICATION WILL BE ACCEPTED: "I certify, under penalty of law, that this document and all attnehments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons'Who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of and imprisonment for knowing violations." 5. Records Retention [Supplements Section D. 16.11 The permittee shall retain records of all Discharge Monitoring Reports, including eDMR submissions. These records or copies shall be maintained for a period of at least 3 years from the date of the report. This period may be extended by request of the Director at any time [40 CFR 122.41]. • Page 6 of 6 • • ref 4 -,LR. -'r- "-- [�Q . iiiiviirf 2, �* ,,N rs• , '+' !'• { /1. r. s r R2J(9 fC ti -i• • i )) 3 -, ✓;�.�,n y�, ,, -'r ,.. ..1•I,`y' i, ,} C> , �;f� -`��y-; 1 ', RR h` ter', L + I 4 ,�. 1 "11 ` //� t I r i(' �� A. 'J fi`': IYl ,,i';v+C<".. � �\11 t' : Nr.:"''" ;!4 l•4 -/•-. 7: r, �� r'S . 90 �- ``i:J 7f = .f t !1}. 4..r. � / r '`•I •1 `Y •1lr r ~�.. ,I : ,5 i ,. r. <;i / �� I 4�tr„ ->•r �-' Y .-1 � °•' a,r fi' 873,. \ � _.,• ' ' r the y } :'`5'.+. ilk ,.b� /�•w,x.;9'-= rw ,�y 1 ,, f(, h.' ,'t �4' �;, 1 �'r� ... -�' L..••_ 'a fl i,,TWA'',',;dn? Xi �/ ,.. "�> I \l ;`,t;..., d .,\- P� fti ;it; '>:v `.` 3 w a" f / ;� • t t. �,�.. .I r :.:! - %, 1 .y AF, y" s+. ., /a'-�.'�` • •.r "i � 1` ; �r �i�r �,\ �5,5��v 1, •\-� , •.�: n nT _ ' (t y f K• ?\. --, v- i' �. S: :,' \ �/ �, qy .;. 'i,:•,,'!:'' ' t ;,7• .,,�5'_.* ,d, ,f, n:a:o,' .g '.l< N ( IA. ➢. • ••l f2•fkti, i; ' , yr'„Ili, v ry ,u-' .4 "I-','> 'rf;;- a'' ,•+;'rL ••^ 1'\a- v ,I:;,4. ., - 1 0 r•✓• Yam, - �,: �% ���y 1 f¢pv-I k +w..4• _ -.�T K1 ,, t ,> t r i '"` Tom' ,=l _ ,ll , 1 J1,� � f7:� y^ S r, -'ate..�s 7r.$ �� ''; j ; r : a{ i7I=e\ .�,� tax 7:: °.n •, ">rs ��,rr ,. - " } "��,: J %, .� a A,J 1 (\ '4c,f•-• :,_•. ,;---7,---;;1,.---Nki-c,' :t1.1;=;:,;7:';',, ,,„ ,-;', .,L......,;i-----,..,,,- '',,•,, , .•-:,- - 1.4 GGG��� JJ .• ' // • C J .. �`F�^i t; I.,.,:\ vs i��4? .ry-. ''!d ,a>� %�l ri �/1%� t'' r• j,z l 'tiv ll`�- ? �Y7 a' � 9. �;iiii�` '' "., ,�,.r I,• 'L. i, +•yam.-1?�'< �R I I t ry �' � � - _'� 1 Y'7�'-- � r ,l t -1:71) � � „. ]J / Fit I _ *I }• 'r;. •o.' tI.•jrl9{ > µ✓ ` O .� r,61'h (4" / l� -' , !.?4' G'-." r.- h 1 r 1 ,. l�' \ `-'' ; ;Y? !�-~ f/ rt, r,� �• ��"/�`'`d>: ,L;,l.r r`4; ,{ r 1;t� .: ../. \,.,,,.. , ,-•, ,;•,,,,. '., _„.,..., ----•-, •,e-1- 7.,-;')/ ..,,,,.„ .,,•,,.:, ..., — '-,, „,, tr. oft r ;^ .9 i /" n, .• / Q I -L:.rY'" .., '. `'t.l',, + _.�``c .. � ' "{�: NC�� South rr �(_�4.3% R1� i L *' 1,0/A ' --44....j, • s'.7" ,,.,b ' �, � ®e au oo� evi -: "- / ,. „... ..,4!..iALSINi 1/4fNtS!14. ..- e.,.yil,,;.")h..1 4,,,,,ft . .. • • i , :_ , t _ .,,, '� . "/ , ,116 .......„...„..„ „ ,,,... .....,, ,,i),,,,, ,, ,., :,. , . l' ' ..#7.7-''''''' ''ir"-' •4 . '', _;;; -.:?';'',\"''' _„\l, 041111) V . . . ,., ..., er.0".41U---- ' ,(,j'N(, A I. 4".ittl -// ,JC r J �• ,\ :ter.- ••� 5' I' ',�' � ' d I .• :ram / ,, ,,J• '„ l j r.11 , , -45 i �1. i,2; t.r�,' I �`' `':,'s.;:.\� i) j +-- 0.-/- 1/i ,• ,�.:U:�, fr r i� f; K7i► . .a ),IL__ r )11, ) 1N:; . • ' 'J -. ^s�Arir G...-� rill i n l� // �s f%: , 1 \,.......---... .-- , ..-: !trio.seliff vi\_,b..,,,,a i• :4*.'\r_.'.. 4'k'' ' ,7,,.'' ,...„---.4.- :---6--e ....„..„.‘"------- - .,g.,,,,, 2,'f a,-:7'5..'...,, , _ '''_ , . , - _ 8,J-,&,..) Y:::-.: 'W''''."----\(,,-n :‘,,.. r,,,,;,<,..,,__.-„. 'i,..-7.%-:4 . ,L.--..---'-',.. _;, : '4111110-, :tq't -:. ,.r.,..-:::: -,7,,c,, ,,.,... - t.....-.1, /-2---- )'-- ',.''''n,i' ''', .. 7..1, r")7.---?..r'-- -:- ' . . . .,(..., , (--' L- ,- -. •,,,, .,•:„...e .. . -_,,.ii ,,,,,rot.,, . c.,:.._) ,.,N r:,- ce4,--&\.4 if„,,- - - .., John Henry Oakley N i,,t °, me •_�i1 Hidden Lakes Mobile Home Park WWTP �'��� -'ii1��4 � � 1 f�PDES Permit 53720 A ,�001:4+���;Ili:Facility Location ���Receiving Stream:Timmons CreekStream Class:C scale not shown Stream Segment:22 25 2 Sub-Basin#:03-02-01 �"j��` River Basin:Roanoke HUC:0301010302 SCALE 36.278611°, -20.302222° County:Stokes 1;24,000 USGS quad:King BK 0729 PG 0833 FILED ELECTRONICALLY Approved by Stokes County Tax Administration STOKES COUNTY NC BRANDON HOOKER NCGS 161-31(A) and NCGS 105-303(a2) REGISTER OF DEEDS KA Date 01/25/2021 FILED Jan 25, 2021 AT ' 11:40 AM BOOK 00729 START PAGE 0833 This instrument prepared by Midtown Property Law, END RAGE 0371 INSTRUMENT # 00371 a licensed North Carolina attorney, EXCISE TAX $0.00 Delinquent taxes, if any, to be paid by the closing attorney to the Tax Collector upon disbursement of closing proceedings per NCGS 160-30(a1) Excise Tax $0.00 REID: 14608 Mail after recording to: Grantee This instrument was prepared by: Midtown Property Law(without title search or opinion) Brief description for the index: 0 Off Slate Road NORTH CAROLINA QUITCLAIM DEED THIS DEED made this 8th day of January,2021, by and between GRANTOR GRANTEE -JONES ESTATES LLC JONES ESTATES HIDDEN LAKES LLC a North Carolina limited liability company a North Carolina limited liability company mailing address: mailing address: 2310 S.Miami Blvd, Suite 238 2310 S. Miami Blvd, Suite 238 Durham,NC 27703 Durham,NC 27703 The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,and assigns, and shall include singular,plural,masculine,feminine neuter as required by context. WITNESSETH, that Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged,has remised and released and does hereby remise,release and forever quitclaim unto the Grantee, all those certain lots or parcels of land situated in Stokes County,North Carolina and more particularly described as follows: See attached Exhibit A, incorporated herein by reference. For chain of title see deed recorded in Book 728,Page 1570, Stokes County Registry. TO HAVE AND TO HOLD the aforesaid lots or parcels of land and all privileges and appurtenances thereto belonging to the Grantee in fee simple. Grantor makes no warranty, express or implied, as to title to the property hereinabove described. 1 submitted electronically by "Midtown Property Law" in compliance with North Carolina statutes governing recordable documents and the terms of the submitter agreement with the stokes County Register of Deeds. BK 0729 PG 0834 IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written. GRANTOR: JONES ESTATES LLC, a North Carolina limited liability company By: DANIELS HOLDINGS LLC, its Manager By: e (SEAL) Name: Ptn Title: Ltnct. NORTH CAROLINA, 1 •D-M COUNTY I,the un, er 961Asigned Notary Public of the County and State aforesaid,certify that 6 r) 2rs the 11V.141 of Daniels Holdings LLC, the Manager of Jones Estates LL , personally came before me this day and acknowledged the due execution of the foregoing instrument in the capacity indicated. tY Witness my hand and Notarial stamp or seal this day of ,2021. SEAL—STAMP Notary ublic My commission expires: .3D"�-�►Z S" MELISSA SOLOMON Notary Public, North Carolina • Wake County My Commission Expires Merch30,2025 2 BK 0729 PG 0835 EXHIBIT A Legal Description BEGINNING at a placed railroad spike in the center of State Road#1966 (Slate Road) in the corner of Jimmy D. Welborn's line (see Deed Book 229, page 416 of the Stokes County Registry) and runs South 27 degs. 58 min. 39 sec. West 454.22 feet to a placed railroad spike 4 feet East of the center of State Road #1966 (Slate Road); thence South 10 degs. 34 min. 30 sec. West 34.06 feet to an iron placed 16 feet East of the center line of State Road#1966(Slate Road);thence North 72 degs. 36 min. 42 sec. West 629.50 feet (passing over a 3/4" iron found at 50 feet) to a placed iron; thence South 10 degs. 13 min. 47 sec. West 126.65 feet to a 20 inch marked oak tree; thence North 82 degs. 39 min. 49 sec. West 1,486.25 feet to an axle found at a stone; thence North 8 degs. 40 min. 22 sec. East 1,369.81 feet to a found stone 6 feet East of a marked oak tree;thence South 82 degs. 34 min. 27 sec. East 99.89 feet to a found iron stake; thence South 82 degs. 32 min. 58 sec. East 1,380.07 feet to a found iron stake;thence South 5 degs. 36 min. 13 sec.West 485.72 feet to an 18 inch marked oak tree; thence South 80 degs. 09 min. 22 sec. East 893.96 feet (passing over a rebar found at 858.64 feet) to the BEGINNING and containing 60.902 acres. This description taken from the survey plat established by C. Ray Cates bearing the date of October 13th, 1982, See Deed Book 259 at Page 286, Stokes County Registry. SAVE AND EXCEPT: BEGINNING at a point in the West right of line of State Road#1966 (Slate Road),said point being South 27 degs. 30 min. 57 sec. West 270 feet from the Jimmy D.Welborn line (see Deed Book 229 at Page 416 of the Stokes County Registry) and runs thence South 27 degs. 30 min. 57 sec. West 173.24 feet; thence (continuing with the right of way) South 28 degs. 29 min. 53 sec.West 116.76 feet;thence with the North right of way of the proposed road North 72 degs. 04 min. 57 sec.West on a chord 62.73 feet to a point in the North right of way of proposed road;thence North 82 degs. 39 min. 49 sec. West 122 feet to a point;thence North 11 degs. 18 min. 28 sec. East 340 feet to a point;thence South 65 degs. 50 min. 08 sec. East 273.38 feet to the BEGINNING and containing 1.61 acres. This description taken from the survey plat of C. Ray Cates established on March 18th, 1983. SAVE AND EXCEPT the following lots: (1) Lot#1 in the Twin Lakes Subdivision as per deed recorded in Book 290, page 670. (2) Lot#2 in the Twin Lakes Subdivision as per deed recorded in Book 290,page 674. (3) Lot#3 in the Twin Lakes Subdivision as per deed recorded in Book 289, page 770. (4) Lot#4 in the Twin Lakes Subdivision as per deed recorded in Book 298,page 887. REID: 14608 Address: 0 Slate Road,King,NC 27021 3 OPERATING AGREEMENT OF JONES ESTATES HIDDEN LAKES LLC THIS OPERATING AGREEMENT of Jones Estates Hidden Lakes LL.0 (the "Company"), a limited liability company organized pursuant to the North Carolina Limited Liability Company Act, is executed effective as of December 16, 2020. Jones Estates LLC ("Member") is the sole member of the Company. Solely for federal and state tax purposes and pursuant-to Treasury Regulations Section 301.7701, the Member and the Company intend the Company to be disregarded as an entity that is separate from the Member. For all other purposes (including, without limitation, limited liability protection for the Member from Company liabilities), however, the Member and the Company intend the Company to be respected as a separate legal entity that is separate and apart from the Member. ARTICLE I FORMATION OF THE COMPANY 1.1. Formation. The Company was formed on December 16, 2020, upon the filing with the Secretary of State of the Certificate of Formation of the Company. 1.2. Name. The name of the Company is Jones Estates Hidden Lakes LLC. *Hie Member may change the name of the Company from time to time as she deems advisable,provided necessary filings under the Act are made. 1.3. Registered Office and Registered Agent. The Company's registered office within the State of North Carolina and its registered agent at such address shall be as the Managers may from time to time deem necessary or advisable. 1.4. Principal Place of Business. The principal place of business of the Company within or without the State of North Carolina shall be at such place or places as the Member may from time to time deem necessary or advisable. 1.5. Purposes and Powers. (a) The purpose of the Company shall be to engage in any lawful business for which limited liability companies may be organized under the Act. (b) The Company shall have any and all powers which are necessary or desirable to carry out the purposes and business of the Company, to the extent the same may be legally exercised by limited liability companies under the Act. 1.6. Term. The Company shall continue in existence until it is dissolved and its affairs wound up in accordance with the Act or this Agreement. 1.7. Nature of Member's Interest. The interest of the sole Member in the Company shall be personal property for all purposes. The entire membership interest in the Company (the Page 1 of 7 "Membership Interest") shall consist of 100 units of Membership Interest, held in the name of Jones Estates LLC. Legal title to all Company assets shall be held in the name of the Company. ARTICLE II DEFINITIONS The following terms used in this Agreement shall have the following meanings (unless otherwise expressly provided herein): "Act" means the Delaware Limited Liability Company Act, as the same may be amended from time to time. "Agreement" means this Operating Agreement, as amended from time to time. "Certificate of Formation" means the Certificate of Formation of the Company filed with the Secretary of State, as amended or restated from time to time. "Code"means the Internal Revenue Code of 1986, as amended from time to time(and any corresponding provisions of succeeding law). "Manager" means the Person or Persons designated as manager pursuant to Section 3.2. "Member"means Jones Estates LLC, a North Carolina limited liability company. "Person" means an individual, a trust, an estate, a domestic corporation, a foreign corporation, a professional corporation, a partnership, a limited partnership, a limited liability company, a foreign limited liability company, an unincorporated association, or another entity. "Property" means (i) any and all property acquired by the Company, real and/or personal (including, without limitation, intangible property); and (ii) any and all of the improvements constructed on any real property. "Secretary of State" means the Secretary of State of the State of Delaware. "Treasury Regulations" means the Income Tax Regulations and Temporary Regulations promulgated under the Code, as such regulations may be amended from time to time (including corresponding provisions of succeeding regulations). ARTICLE III MANAGEMENT OF THE COMPANY 3.1. Management. The Company shall be a manager-managed limited liability company and therefore, except as otherwise expressly provided in this Agreement, the Certificate of Formation or the Act, all decisions with respect to the management of the business and affairs of the Company shall be made by the Manager(s). The Manager(s) may execute agreements on Page 2 of 7 behalf of the Company utilizing such title (including, without limitation, "President") as the Manager(s) may elect from time to time. 3.2. Appointment of Manager. The Member, by virtue of his status as the sole Member, shall designate the Manager or Managers of the Company for all purposes. The Member may, but need not, serve as a Manager. The initial Managers of the Company shall be Jonathan Gindes and Peyton Anderson. 3.3. Indemnification of Managers for Management Services. The Company shall indemnify the Manager(s) or their authorized delegate(s) in connection with their services to the Company to the fullest extent permitted or required by the Act, as amended from time to time, and the Company may advance expenses incurred by such person upon the approval of the Manager(s) (or the Member in the event of an advance to the Manager), upon the receipt by the Company of a signed statement agreeing to reimburse the Company for such advance in the event it is ultimately determined that the Manager is not entitled to be indemnified by the Company against such expenses. 3.4. Stakeholders. The Member expressly agrees, that in discharging the duties of the Manager, and in determining what is in the best interests of the Company and its Member, the Manager(s) or their authorized delegate(s) shall not be required to regard any interest, or the interests of any particular group affected by such action, as a dominant or controlling interest or factor. The Manager(s)or their authorized delegate(s)shall give due consideration to the following factors, including, but not limited to, the long-term prospects and interests of the Company and its Member, and the social, economic, legal, or other effects of any action on any current and retired employees, any suppliers and customers of the Company or its any subsidiaries, and the communities and society in which the Company or its subsidiaries operate (collectively, with the Member, the "Stakeholders"), together with the short-term, as well as long-term, interests of its Member and the effect of the Company's operations (and its subsidiaries' operations) on the environment and the economy of the state,the region, and the nation. Nothing in this Section 3.4, express or implied, is intended to create or shall create or grant any right in or for any person or any cause of action by or for any person. Notwithstanding the foregoing, the Manager(s) or their authorized delegate(s) are entitled to rely upon the definition of"best interests" as set forth above in enforcing its rights hereunder and under state law, and such reliance shall not, absent another breach, be construed as a breach of the Manager's fiduciary duty of care. ARTICLE IV RIGHTS ANI) OBLIGATIONS OF' MEMBER 4.1. Removal and Designation of Manager. The Member may by written action, taken at any time for any or no reason, remove a Manager. The Member may replace a Manager due to such Manager's death, dissolution, resignation, removal, or otherwise by written action and the written consent of the successor Manager to serve as such. 4.2. Limited Liability. The Member shall not be required to make any contribution to the capital of the Company, except as set forth on Schedule 1, nor shall the Member in its capacity as such be bound by, or personally liable for, any expense, liability, or obligation of the Company except to the extent of his interest in the Company and the obligation to return distributions made to such Member under certain circumstances as required by the Act. The Member shall be under Page 3 of 7 no obligation to restore a deficit Capital Account upon the dissolution or liquidation of the Company. ARTICLE V CAPITAL CONTRIBUTIONS The Member has contributed property to the Company as the initial Capital Contribution as set forth on Schedule 1 attached hereto. ARTICLE VI ALLOCATIONS, ELECTIONS, AND REPORTS All allocations of profit and loss of the Company and all assets and liabilities of the Company shall, solely for state and federal tax purposes. be treated as that of the Member pursuant to Treasury Regulations Section 301.7701, but for no other purpose(including, without limitation, limited liability protection for the Member from Company liabilities). ARTICLE VII DISTRIBUTIONS Distributions of assets shall be made on such basis and at such time as determined by the Manager. ARTICLE VIII DISSOLUTION ANI) LIQUIDATION OF THE COMPANY 8.1. Dissolution Events. The Company will be dissolved upon the happening of any of the following events: (a) All or substantially all of the assets of the Company are sold, exchanged, or otherwise transferred (unless the Member has elected to continue the business of the Company); (h) The Member signs a document stating his election to dissolve the Company; (c) The entry of a final judgment, order, or decree of a court of competent jurisdiction adjudicating the Company to be bankrupt and the expiration without appeal of the period, if any, allowed by applicable law in which to appeal; or (d) The entry of a decree of judicial dissolution or the administrative dissolution of the Company as provided in the Act. 8.2. Liquidation. Upon the happening of any of the events specified in Section 8.1 and, if applicable, the failure of the Member to continue the business of the Company. the Member, or any liquidating trustee designated by the Member, will commence as promptly as practicable to wind up the Company's affairs unless the Member or the liquidating trustee (either, the `'Liquidator") determines that an immediate liquidation of Company assets would cause undue loss to the Company, in which event the liquidation may be deferred for a time determined by the Liquidator to be appropriate. Assets of the Company may be liquidated or distributed in kind, as Page 4 of 7 the Liquidator determines to be appropriate. The Member will continue to be entitled to Company cash flow and Company profits during the period of liquidation. The proceeds from liquidation of the Company and any Company assets that are not sold in connection with the liquidation will be applied in the following order of priority: (a) To payment of the debts and satisfaction of the other obligations of the Company, including, without limitation, debts and obligations to the Member; (b) To the establishment of any reserves deemed appropriate by the Liquidator for any liabilities or obligations of the Company, which reserves will be held for the purpose of paying liabilities or obligations and,at the expiration of a period the Liquidator deems appropriate. will be distributed as provided in Section 8.2(c); and, thereafter (c) To the Member. 8.3 Articles of Dissolution. Upon the dissolution and commencement of the winding up of the Company, the Member shall cause a Certificate of Dissolution to be executed on behalf of the Company and filed with the Secretary of State, and the Member shall execute,acknowledge, and tile any and all other instruments necessary or appropriate to reflect the dissolution of the Company. ARTICLE IX MISCELLANEOUS 9.1. Records. The records of the Company will be maintained at the Company's principal place of business or at any other place the Member selects, provided the Company keeps at its principal place of business the records required by the Act to be maintained there. 9.2. Survival of Rights. Except as provided herein to the contrary. this Agreement shall be binding upon and inure to the benefit of the parties, their successors and assigns. 9.3. Interpretation and Governing Law. When the context in which words are used in this Agreement indicates that such is the intent, words in the singular number shall include the plural and vice versa. The masculine gender shall include the feminine and neuter. The Article and Section headings or titles shall not define, limit, extend, or interpret the scope of this Agreement or any particular Article or Section. This Agreement shall be governed and construed in accordance with the laws of the State of Delaware without giving effect to the conflicts of laws provisions thereof. 9.4. Severability. If any provision, sentence, phrase, or word of this Agreement or the application thereof to any person or circumstance shall be held invalid, the remainder of this Agreement, or the application of such provision, sentence, phrase, or word to Persons or circumstances, other than those as to which it is held invalid, shall not be affected thereby. 9.5. Agreement in Counterparts. This Agreement may be executed in several counterparts, each of which shall be deemed an original, and all of which shall constitute one and the same instrument. Page 5of7 9.6. Creditors Not Benefited. Nothing in this Agreement is intended to benefit any creditor of the Company. No creditor of the Company will be entitled to require the Member to solicit or accept any loan or additional capital contribution for the Company or to enforce any right which the Company may have against a Member, whether arising under this Agreement or otherwise. IN WITNESS WHEREOF,the undersigned,being the sole Member and both Managers of the Company,has caused this Operating Agreement to be duly adopted by the Company as of the date set forth on the cover page hereof. INITIAL MEMBER ANI) MANAGERS: 71,11 J athan Gindes, Manager I'ey on Anderson, Manager Jones Estates LLC, Member J Lathan Gindes, It. Manager Page 6 of7 SCHEDULE 1 Property Contributed to the Company by the Member Name and Address of Member Initial Capital Contribution Membership Interest Jones Estates L,L,C 5 100% --------- 2310 S. Miami Blvd, Suite 238 Durham,NC 27703 Page 7 of 7