WQ0042558_Application (FTSE)_20210519

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 -- FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: W OQ t Z �V — (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Evolve at Heritage, LLC (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: Mike Winstead Sr. per 15 A NCAC 02T .0100(hl
Title: Manage
4. Applicant's mailing address: 2918-A Martinsville Road
City: Greensboro State: NC Zip: 27408-
5. Applicant's contact information:
Phone number: 336 L62-ZM Email Address: mwinstead47 mail.com
H. PROJECT INFORMATION:
1. Project name: Evolve at Heritage -Phase 2 Private
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Existing Permit/Pro ect
2. Application/Projectscatus: ®Proposed (New Permit) ❑ g
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If a modification, provide the existing permit number: WQOONIA and issued date: NA
If new construction but part of a master plan, provide the existing permit number: WQ000
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3. County where project is located: Wilson
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4. Approximate Coordinates (Decimal Degrees): Latitude: 35.747347 Longitude:-77.973835
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5. Parcel ID (if applicable): 3702-59-1073
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(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Robert S. Bartlett License Number: 20106
Firm: Bartlett Engineering & Surveying. PC
Mailing address: 1906 Nash Street N.
City: Wilson State: NC Zip: 27893-1726
Phone number: 2( 52) 399-0704 Email Address: robert bbardetten .com
TV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hominy Creek Water Reclamation Facility Permit Number: NCO 223906
Owner Name: Ci of Wilson
RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): W00041572 Downstream (Receiving) Sewer Size: 12 inch
5+ tem Wide Collection System Permit Numbers if apPlicablJ: WQCS00021
Owner Name(s): City of Wilson
Page 1 of 5
FTA 04-16

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®NIA
3. If the Applicant is a Home -Trope rty Owners' Association. has an Operational Agreement {FORM: HOA) been attached?
❑ Yes [:]No ®N;`A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (Sec 13A NCAC 02T._0103(20})
�"Is there a Pretreatment Program in effect? []Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow "•d
No. of Units
Flow
1-Bedroom Residential Units
240 gal/unit/day
36
8,640 GPD
2-Bedroom Residensial Units
240 gal/unit/day
48
11,520 GPD
3-Bedroom Residential Units
360 gal/unit/day
12
4,320 GPD
gal/
GPD
gall
GPD
gall
GPD
Total
24,480 GPD
a See 15A NCAC 02T .()114(b), (0. (e)( I I and (el(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in GGS. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified (in table 15A NCAC 02T.0114) shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 42.765 GPD (per 15A NCAC AC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
334
PVC
8
132
DI
Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Section ICI contains information related to minimum slopes for gravity sewer(s)
Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. OperationaI point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NCAC 02T _0305 M 1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B):
z Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
z Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
> If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & Ig)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
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-1 waters of Class I or
Class II im ounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage s stems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth rade vertical
36 inches
D 15A NCAC 02T.0305(e,l contains alternatives where separations in 02T.03054f} cannot be achieved.
);,- **Stream classifications can be identified using the Division's NC Surface Water Classifications webpaue
➢ If noncompliance with 02T.0305(1)or }, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ NSA
➢ 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 l5A NCAC 02B .0200? ® Yes ❑ No ❑ NlA
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
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 cue Buffer Permitting, Branch
5. Does project comply with 15A NCAC 02T.010i(cl(6) )(additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ NA
➢ 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 1SA NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04- l 6 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria fix.LW- Permittinf'.of Pump Stations
and Fo a Mains LLatest version}, and the Gravity Sewer Minimum Design Criteria Ilatest version l as applicable?
® Yes ❑ No
If No, complete and submit the Variance."Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required yrior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
attest that this application for
(Professional Engineer's name from Application ltem III.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1 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):
.............
R� Cgrr/1z
SS/p2�.L9
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11 t'lel— �rlsT,s_ , �5�2.�_ attest that this application for
(Signature Authority's name & title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE - In accordance with General Statutes 143-215.6A and 143-215.6B, 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

r-I T� N R -
D[viston nt• Water Resource-,
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Wilson
Project Name for which flow is being requested: Evolve at Heritage
More than one FTSE ►stay be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of floe proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Hominy Swamp Water Relcamation Facility
b. WWTP Facility Permit #: NCO023906
Allflorps are in MGD
c. WWTP facility's permitted flow 14 MGD
d. Estimated obligated flow not yet tributary to the WWTP 1.11586
e. WWTP facility's actual avg. flow 8.86 MGD
f. Total flow for this specific request 0.037
g. Total actual and obligated flows to the facility 9.97856
h. Percent of permitted flow used 71.27
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Average
Approx.
Obligated,
Total
Pump
Pump
Daily
Current
Not Yet
Current Flow
Station
Station
Firm
Flow**
Avg. Daily
Tributary
Plus
(Name or
Permit
Capacity, *
(Firm / pt),
Flow,
Daily Flow,
Obligated
Available
Number)
No.
MGD
MGD
MGD
MGD
Flow
Capacity***
3
W CS00021
4.320
1.728
1.06
0.34957
1.4466
0.2814
4
WQCS00021
6.264
2.506
1.66
0.33725
2.0343
0.4714
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Hominy Swamp Water Reclamation
Downstream Permit Number: NC 0023906
Page 1 of 6
rT[tiY' 1 A 1 0

II1. Certification Statement:
I W.T. Bass IV, PE certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing OjfIcial Signature
lD, ep cabl« 1115.5
Title of Signing Official
Page 2 of 6
rrrnr n 1 0

1906 Nash street North Wilson. NC 27893-1726
Phone: [phone] Fax: [phone]
www.bartlettus.com
May 17, 2021
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Reference: Fast Track Application for Gravity Sewers
Private Sewer Extension
Evolve at Heritage -Phase 2
3761 Raleigh Road Pkwy. W.
Wilson, North Carolina
To Whom It May Concern:
Enclosed for your review and approval are two (2) copies of the following items related to the
above referenced project:
■ Fast Track Application for Gravity Sewers
■ Developer's Operational Agreement
■ Secretary of the State LLC Annual Report
■ Flow Tracking / Acceptance Form
■ Quad/Location Map
■ Aerial Photo
This project consists of approximately 334 L.F. 8" PVC & 132 L.F. 8" DIP Gravity Public Sewer
Extension to serve a proposed Multi -Phase Apartment Complex located at 3761 Raleigh Road
Parkway W. in Wilson, NC. Phase 2 of the proposed complex will consist of 96 residential units. This
private onsite gravity sewer main extension is proposed to discharge into the existing 15" gravity
main sewer line, located to the southwest of the project, via the existing 12" offsite public sewer
extension previously permitted and constructed for this project.
P PROJECT FILFS1Evolve m Iloritageftw 2U'ermitiNvate Sewer'20 559 NCVENR Pnv Sew Cove Left doe

STATE OF NORTH CARO'iL++INA
COUNTYOF w I L_S N
Permit No. k/ Q f10 4 Z-Ssc�
DEVELOPEWS OPERAHO AL AG -EMENT
This AGREEMENT made pursuant to G.S. 143-215A (dl) and entered into this day of
by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
Evolve Companies , a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
1. The DEVELOPER is the owner of the certain lands lying in Wilson County, upon
which it is erecting and will erect dwelling units and other improvements, said development to beknown
Evolve at Herita a (hereinafter the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to serve
the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, Evolve at Heritage (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue ofthe laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re -constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance, re -construction and repair.
6. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPFR do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such sysictns and facilities in uccurdancc vv7th upplicablc permit provisions and low.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws and Declaration.
3. '1 he DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility for
the operation and maintenance of its Disposal System until a permit has been reissued to the DEVELOPER's
successor.

4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of the permit i'or construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes and insurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses. In order to assure that there shall be funds readily available to
repair, maintain or construct the Disposal System, beyond the routine operation and maintenance expenses,
the Declaration and Association Bylaws shall provide that a fund be created out of the common expenses.
Such fund shall be separate from the routine maintenance funds allocated for the facility and shall be part
of the yearlybudget.
6. In the event the common expense allocation and separate fund are not adequate for the construction, repair,
and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for special
assessments to cover such necessary costs. There shall be no limit on the amount of such assessments, and
the Declaration and Bylaws shall provide that such special assessments can be made as necessary at any
time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit mayrequire as condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the continued
pmper maintenance, repair and operation of its Disposal System, the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution without first having
transferred its said system and facilities to some person, corporation or other entity acceptable to and
appmvcd by the COMMISSION by the issuance of apermit.
9. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration is
filed and in the off ices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS W14EREOF, this agreement was executed in duplicate originals by the dull authorized
representative of the parties hereto on the day and year written as indicate each or the parties named below:
FOR THE ENVIRONMENTAL Evolve om10
MANAGEMENT COMMISSION Name fD
Linda Culpepper
Director, Division of Water Resources
(Date)
Mike Winstead JrtPdn
Print Name and Title
(Date)

SOSID: 1898176
Date Filed: 4/5/2021
LIMITED LIABILITY COMPANY ANNUAL H Elaine F. Marshall
s
North Carolina Secretary of'State
1NUIT CA2021 095 04009
NAME OF LIMITED LIABILITY COMPANY: Evolve at Heritage, LLC
SECRETARY OF STATE ID NUMBER: 1898176 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2021moil]
MY JV6&1
SECTION A: REGISTERED AGENT'S INFORMATION WW
W.
1. NAME OF REGISTERED AGENT: Stephen C Pritchard
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS 8 COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
804 Green Valley Rd Ste 200
Greensboro, NC 27408 Guilford
SECTION B; PRINGIPAL OFFIGE INFORMATION
804 Green Valley Rd Ste 200
Greensboro, NC 27408 Guilford
1. DESCRIPTION OF NATURE OF BUSINESS: Multi -Family Apartments
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMA� Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS .
a
2918 Martinsville Ad Ste A ` 2918 Martinsville Rd Ste A
Greensboro, NC 27408-2785 Guilford Greensboro, NC 27408-2785 Guilford
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C. COMPANY OFFICIALS (Enter additional company officials In Section E.)
NAME: Joseph A Mckinne , Jr NAME: Michael P. Winstead , Jr. NAME:
TITLE: Manager TITLE: Manager TITLE:
ADDRESS:
315 Spring Garden KUnit
Greensboro, NC 1 GiilVord
ADDRESS:
2918 Martinhille Rd Ste A
Grix f sbw6, NC 27408-2785 Guilford
ADDRESS:
SECTION a: action D must be completed in its entirely by a personlbusine entll
CA
zl
SIGNATURE DATE
Form must be signed by a Company offixial fisted under Section of This form.
of
Print or Type Name of Company Ogldel 0 Print at Type Title of Company OMdal
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $200
MAUL TO: Secretary of Stale, Business Registration Division, Post Ofte Box 29525, Relalgh, NC 2782"525

UNITED STATES
DEPARTMENT OF THE INTERIOR
GEOLOGICAL SURVEY
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Also enclosed is the $480.00 sewer permit application fee. Should you have any questions or
require further information during your review, please let us know.
Respectfully,
Steve 0 iverio
Project Manager
Enclosures
P JRO&Cf Pi FS'Evolve at Herifte'Phae. 2'Permits' Private Sewer120 359 NCMR Priv Scw Cover Letter.doc