WQ0040000_Application_20180515

BROOKS
ENGINEERING ASSOCIATES
May 1 st, 2018
NCDEQ
Asheville Regional Office
Division of Water Quality
2090 US Hwy 70
Swannanoa, NC 28778
Attention:
Regarding:
Dear Mr. Heim:
Tim Heim, PE
Planning & Project Management / Civil Engineering
Surveying / Environmental Engineering & Services
17 Arlington Street I Asheville NC 20601
www.hrooksea.com / M232.4700
Golden Valle RV Park
ut erford County
BEA Project No. 461317
FTA 04-16 Application Cover Letter
MAY - 3 2018
Water Oue1Ry RegbW1 f "Minora
P`O� Ck e
On behalf of Northgate Golden Valley, Inc. (owner), we are submitting the enclosed Fast
Track Sewer Extension Application FTA 04-16. The application is for Blue Ridge Crossing
which is an expansion of an existing RV Park in Rutherford County. Wastewater generated
by the project consists of an Event Center with Dining, Cafd, Retail store with employee
shower facilities, a water park, RV and Park Model sites and tent camping sites. The
wastewater generated will be 100% domestic.
The system will consist of a gravity collection system that drains to a pump station. The
pump station will pump to an onsite wastewater treatment plant that is being permitted
separately. For this reason, information on the application discussing receiving treatment
plant has been left blank. There will be one stream crossing that will be crossed with a
horizontal bore and no encroachments on public right of ways.
The enclosed application package is for a single pump station, approximately 1970 IS. of 3"
forcemain and approximately 16,859 feet of 8" PVC Gravity Sewer with manholes. The total
daily design flow to the proposed pump station is .035266 million gallons per day which is
equal to phase 1 for the onsite treatment system.
The additional required submittal items for this application package are enclosed.
%,A 6 a ncr,1�

We appreciate your review of this permit application. Please feel free to call or email to
discuss this submittal.
Sincerely,
Brooks Engineering Associates, P.A.
UAL
n2i.S14
"U
Travis Maxwell, PE
Enclosures: Application Fee Check for $480
Application and checklist for FTA 04-16
USGS Topographic Map of area
Street level map
NC Secretary of State Company Search Results

State of North Carolina
Department of Environmental Quality
Division of Water Resources
"
ISA NCACO2T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Water Resources FTA 04.16 & SUPPORTING DOCUMENTATION
ApplicationNumber:WQ00O" _ (to becmnpletedbyDlVR)
All items must be completed or the anvilcation will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: NORTHGATE GOLDEN VALLEY. EVC (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: ZACHARY BOSSENBROECK per 15A NCAC 021'.0106M
Title: MANAGER
4. Applicant's mailing address: 401 HALL ST, SUITE 385
City: GRAND RAPIDS State: MI Zip: 49503-5098
5. Applicant's contact information:
Phone number: [phone] Email Address: zbossenbroek(rr?northaateholdines,com
II. PROJECT INFORMATION:
1. Project name: GOLDEN VALLY RV PARK
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000` and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: RUTHERFORD
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.499774° Longitude: -81.793431°
5. Parcel 113 (if applicable): 1664-68-5831
(or Parcel ID to closest downstream sewer)
IH, CONSULTANT INFORMATION:
1. Professional Engineer: Travis Maxwell License Number: 025514
Firm: BROOKS ENGINEERING ASSOCIATES
Mailing address: 17 ARLINGTON ST
City: ASHEVILLE State: NC Zip: 28801-2005
Phone number: [phone] Email Address: tmaxwell@brooksea com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: _ Permit Number:
Owner Name:
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1, Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s):
FORM: FTA 04.16 Page 1 of 5

j, 4
We OUNMAli3tFQllll�t�M) NSB,
4, iPEJrdAppllcantisal,�clvatdty;ptv�rditkhtbltoUtitiG�,l�snCd�t}caEeoPku6lto;�tP�nieri�mtdNccassi6ybeanatiaofied�;
OVO []No MWA
2. iPtitaltppfioantiaetUe7rotpparofltfttohdsWd 11110a and pwp2jj gperstional Aigoeftiont (R)W.. DIL V) boojj.oftaohod?
n yes tj"o NNIA
I Ifthe Applicant Is a Hofflftpa& 0%milogg! AMplAqgp, has an Opetallapal An, HQAJ been afloched?
D Vos UNO OVA
4, 04glo, of lvmtovfoov (chock so (bat ppplyy.
❑ Raidenflat Omed Q itetaif(Oluros, Oenten, molls) F1 Pov,Wash
Rciskloat]41 Loosed 4144 avAmdPOpif UWagitoo Hotel findlormutels
khool /pYcaAoatldoy care ties
Food and drh* fholutids Ochurch SivinvAins Poollrilter Daokwaoh
0 Nursing-Hawo J$I Attachment)
A Commercial
—2
I]Ym [IXO
0. WO CQVAIIO? OYos []Ne
)0, Yves Mly1donconi riawrddQAflofl gourn"Mottir
7. id,410"a Jog AA I
a
it
2,11
Ivial
mri
b Per 15A NC4V 02T.11114(01 -403)p flowratos for eslsblbsliwwts Act R1601W P OIOMADAMLL
s,. �Vaarevr4tetgaaer�ted"t+ypraieots�pn�parIsAtoc�Gb2r.atla>Ah�pgj��"�'za'a"'-"�:
toto, billc4to, %01�4
xymp Station or'Ofqvlv$owor'whwbw wilt be vom*w 10 whsequora parmitailivit comeatto'lldi tine
Flow has 011ready book,aftboated In
Rollsibilhalloo or replavetbont of oslothill swe"vith op ONY flowexpoctod
D Qffier5lain)3 ,_
FORM: PTA 04-16
per
M,
ned
The

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC Gravity Sewers);
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 16859 PVC
➢ Section I1 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains);
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I . Pump station number or name: PUMP STATION #1
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.50580 Longitude: -81.7957°
3. Design flow of the pump station: .035266 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 82.9 gallons per minute at 188 feet total dynamic head (TD1I)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
3
1970
PVC
6. Power reliability in accordance with 15A NCAC 02T.030501)(1):
® Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B);
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B.0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T 0305 t &, e ® Yes ❑ No
ISA NCAC 02T.0305(fl contains minimum senaratinnc rh�r a,�u t,e ,......:sed a.. ,..,...,._
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches)
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS -I waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS -I or WS -V), B, SA, ORW, HOW, 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
An building foundation
5 feet
Any basement
10 feet
To2 slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drains e systems and interce for drains
5 feet
Any swimming pools
10 feet
Final earth rade (vertical)
36 inches
➢ I SA NCAC 02T 0305(n) contains alternatives where separations in 02T.0305(t) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(t) or (c). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or [—]Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Pet mining Branch
5. Does project comply with 15A NCAC 02T.O I05(c)(6) (additional permits/certifications)? ❑ Yes ❑ No
Per I 5 NCAC 01T,0 105(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:
Does the submitted system comply with 15A NCAC 02T the Minimum De`StLCCriteda for tile Penni in, of pump Stations
and Force Mains (latest veraonh and theGravit�Sewer Minimum Desgn Critoria LIAest version as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Aonroval of the renneer is vo.. ;—A ...:....... ....�_,.._. ..-. .. _
2. Professional
name from Application Item Ill. 1.) attest 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 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
�` °' "-`i° " 'll, 9 9 ijr.e�y r -V -.fY J attest that this application for
(Signature Authority's name & title frorn.k pplication 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 1.43--215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
FORM: FTA 04-16
Page 5 of 5

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, HA
NCAC 02T, 15A NCAC 02T 0300, Division uolieies and good enainecrin� ractiees.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in ISA NCAC 02'1' .0305 and the applicable minimuy�design criteria. These
documents shall be available upon request by the Division. /
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NC;
Projects not eligible for review via the fast track process (must be submitted for full technical review : I�h'ae�
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .01 `Ae,
➢ Projects that do not meet any part of the minimum design criteria (MDC) document; of
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder p s. ��18
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General —When submitting an application, please use the following instructions as a checklist in order to ensure all requa it*e/em�
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time d
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
9( Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
C15 List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application forth.
C. Application Fee (All New and Major Modification Application Packages):
Ep Submit a check or money order in the amount of $450.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
C3 Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
l�k If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of S1ate.
❑ If the Applicant Type in Item I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
la, The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
p The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .01 06(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable): 0#J S/ rt= W651C W^�«
❑ Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
715.67(x.
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
N Submit an 8.5 -inch x 11 -inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
❑ Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump station."
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump
stations' storage capacities and the rotation schedule of the portable power source or pump, including travel
timeframes, shall be provided in the case of a multiple station power outage. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(I) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities C'ommission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per I5A NCAC 02'r .01'I5(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T.01 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T.01 15(b), submit the properly executed Operational Agreement (FORM DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

lj
MUGS us.oEPa6Maxcoi WEawnwoa
s:: USTapo
ovsAKWIM QUAOMNCLE
I1.1..e
SC9E 1 74 COD
y.,.
... ...w:...........,
�" e MART uLLE. N[
rti
T—
It
�:} \�
�;, r'�i����t
?n L"!'�
�r�1�r' .�L`�/Zrr
t=��'����,(�a�
4
v, I
�V '
�s�e�-. �
�(�I�r �f.+`•
I"r'14 r �I•f"
��r �+r5f S .�1�(r.
r�
lL`� 1
rl� �I�II tr
t I �
N,r'i
CrL���)✓
r��'�r ��
j
l S��' �U�
J\�'•�
L�� th
��°N�a�I
r1l
J ✓
1
x r
II .�a\IJ
�'
.;�(jf�
n� v
I�
��iiJ�N
i�� v14 �1
IS
-Lh ,y�
�Lh1 rrru
�i I V
J
,
r, �; i
V.
�(��
U
STs
Va \s
hrt, ,>1
��'�
l+l l) :%i/�
1 �P ) ,
r/"
,���,$
, n
, h�
„�
S � ,✓.��.
�, .✓^
r��
��Ji
`r l���
�� L
rl�,(I a�
lrrU
.�'irf�� r�l lr�//I
f �.
c16 '�'� +
,. I l
/
�.SC �
cSV
1S , c
I r����
t.� L �✓
7 1_y rl
t i
� 5��
, 411rL�
r Y�l �F
t1"7�(
)� c
1 1
rhe.
ITCH' f
,l Jill rc.
�
1 S1
�../'i
�h Jl
..�c
mxIr9-
Il.
{},y>�A,i
p�l
"��V���`
iJ�
ri�
z`✓��/'yam
r J
�L"+l i t l
rS t
��`�''�'
t
t?�t
s i
/ �{���a (�
�� 'L
t
�
3_
-
l r�✓ t
l� `
-' �^�/��r°It
4S g ;
�
r� "d
Vls�t �t �r �4
i�\ �� 1'n
l�
1 i
�
,�'��c<i
1�i�i�i,�l<r-1
.� i.
All J�� } t�,
�/j I �
r 2 _
v �'IL(�.
� ✓
J
I r G
ii� L ,✓
.-� 1 �
1��.� }r�L�">�
I � II) I t I�
o �j txr �l.
�' �,✓1
l � !����
Yt,
)� ��:,.�
�
V�"�11
IZ r�`
f U
➢s
`o l' t� JS>(�
lj Q; ((
A � �
hi •.,
)5 �
� F!`'.
l�l''.�\"J
YVl
[i h5
L''31C�
LLTE
„����
:fPI nI i)i
� }r�
J •,��f �'1�
�� ti'Y�
,la,r,
�/� .0
n �� �
`'k�i
`l��
�id\�`
�) i
`H (� L✓✓
�� �� .�
)� ° )14
•i L`S,%f' L�
(.1 �"
Z '.,� �3
r �0 AVAALLI {.� '
���.` �/� T �� oe
1 � •� �
`ra.�)
li ���
111
�,.,.,,�r�`�'� yj
L`�1j r•
)
f�
If ' Cr
' '/3jf
lC 11i ({till -A9�
t{l
lv �?,t
L 6-. 0
,.. /r 2
���. k�u%
, i I
! ' zap! � 1 vA`+
(r,y o l a
i(L
��� I'
r,%`
•• w
Gti? �,
_.
•S �,,^�
�,,-,r'�
y � s
; 5 �� t
(J
l z� �4
)ice " y
J
f��Lr
(�i�St
�
a �I�r
q t>� V�� 7
fit �;'
i 2$ al
��
, I L �
S i
'� � r✓ JA
� �
):,��'))`�:
fir/`-'
''
��L o
Q y y ` ,•. tf
r
� ��
.r
�
�
��
J 5�ti"`"'�
^�'`'
���1. �..
9il P' ��
h�1(�%Z � �,
� '� ;�✓'. �.;
?��11]^ 21
C � ��r ,�
'T��S
r-^- i i����i'�R a,
SC9E 1 74 COD
y.,.
... ...w:...........,
�" e MART uLLE. N[

la
r �
Rd
Gs�
s
0
0
u
n
i
rvE
la
r �
Rd
Gs�
s
0
0
a m
V s�
S
4 �
I Vyl yy
W
0
ni
rr
� 6
I a
Earnmm�°"e^�
u
i
rvE
a m
V s�
S
4 �
I Vyl yy
W
0
ni
rr
� 6
I a
Earnmm�°"e^�

North Carolina Secretary of State Search Results
lit4)s://www.sosnc.gov/online_services/search/Business_Registration—Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
• Add Entity to My Email Notification List • View Filings • Print an Amended a Annual Report form
• Print a Pre -Populated Annual Report form
Limited Liability Company
Legal Name
Northgate Golden Valley, LLC
Information
Sosid: 1583302
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 3/24/2017
Fiscal Month: January
Registered Agent: Registered Agents Inc.
Addresses
Mailing Principal Office Reg Office
401 Hall Street, Suite 385 401 Hall Street, Suite 385 4030 Wake Forest Road, Ste 349
Grand Rapids, MI 49503 Grand Rapids, MI 49503 Raleigh, NC 27609
Reg Mailing
4030 Wake Forest Road, Ste 349
Raleigh, NC 27609
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Zachary Bossenbroek
401 Hall Street Suite 385
Grand Rapids MI 49503
1 of 1 4/30/2018, 3:45 PM