WQ0043472_Application (FTSE)_20220511

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: WQ W 4 5 q 12 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1.
Applicant's name: 1158 Place Owners' Association, Inc. (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation
❑ Federal ❑ State. County
❑ General Partnership
❑ Municipal
3. Signature authority's name: Jennifer D. Scott, Esqx per 15A NCAC 02T .0106(b)
Title: Incorporator
4. Applicant's mailing address: 575 Military Cutoff Road, Ste. 106
City: Wilmington State: NC Zip: 28405-
5. Applicant's contact information:
Phone number: [phone] Email Address:
II. PROJECT INFORMATION:
1. Project name: 1158 Place Phase I & II Private Sewer Extension
2. Application/Project status: ® Proposed (New Permit)
❑ Privately -Owned Public Utility
❑ Other
NC Dept of Environmental Quality
MAY .4.1 suti,
Raleigh Regional Office
❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00N,A and issued date: N/A,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00NA
3. County where project is located: Wilson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.745' Longitude:-77.972'
5. Parcel ID (if applicable): 3702-47-7219, 3702-47-9494 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Robert S. Bartlett, PE
Firm: Bartlett Engineering & Surveying, PC
Mailing address: 1906 Nash Street N.
City: Wilson State: NC Zip: 27893-
Phone number: [phone] Email Address: robert(a,bartletteng.com
License Number: 20106
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hominy Creek Water Reclamation Facility Permit Number: NC0023906
Owner Name: City of Wilson
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0041572
2. Downstream (Receiving) Sewer Information: 12 inch
CO Gravity - Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS.
Owner Name(s):
FORM: FTA 06-21
Page I of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑Yes No ®N.A
2. If the Applicant is a Developer of lots to be sold, has a Develotitr's Operational Agreement (FORM: DEN') been attached?
®Yes ❑No ❑N/A
3. If the Applicant is a Home:Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA1 and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
®Yes ❑No ❑NA
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned)
O Residential (Leased)
O School preschool ? day care
O Food and drink facilities
O Businesses : offices . factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical ? dental veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool Clubhouse
❑ Swimming Pool. Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0I03j0))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under 1 A. NCAC 02T .0114111? ❑ Yes ❑ No
➢ If yes., provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
Single Family Townhomes
360 gaUday
43
15,480 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
1
Total
15,480 GPD
a See 1 SA_ NCAC 02T .01 14[bk (d), (e)(1) and (0(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4),
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T,01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 15,480 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
O Flow has already been allocated in Permit Number: Issuance Date:
O Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain): __
FORM: FTA 06-21
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
527
PVC
8
172
DIP
1
➢ Section 11 & 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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - _
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s); gallons per minute (GPM) at
5. Summarize the force main to be permitted (for this Pump Station):
feet total dynamic head (TDH)
Size (inches)
Length (feet)
Material
If any portion of the force main is less than 4-inches in diameter, please identify the me hod of solids reduction per
MDCPSFM Section 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _...
6. Power reliability in accordance with J 5A NCAC 02T _03050)( I ):
❑ Standby power source or ❑ Standby pump
➢ Must have 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 and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separationsaltematives found in 15A NCAC 02T .03051Q & ;}?
15A NCAC 02T,0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, 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 impounded reservoirs used as a source of drinking water, and associated wetlands.
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 associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(0 or (g), see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpase
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ MA
> If no, please refer to I5A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N. A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft_separation requirements for situations where separation cannot be met.
> No variance is required lithe alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B _0200? ❑ Yes ❑ No
> This includes Trout Buffered Streams per 15A NCAC 2B_0202
5. Does the project require coverage,authorization under a 404 Nationwide individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number.•permitting status in the cover letter if coverage authorization is required.
6. Does project comply with I5A NCAC 02T.0105jc)(i) (additional permits'certifications)? ® Yes ❑ No
Per 15A NCAC 02T.01051c)(6), directly related environmental permits or certification applications must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 021.,0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
> 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 permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting. of Pimp Stations
and Fierce Mains (latest version), and the Gravity Sewer Minimum Design Criteria ( latest version) as applicable?
®Yes ❑No
If no, for projects requiring a single variance, complete and submit the VarianceiAltemative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, Robert S. Bartlett, PE, attest that this application for 1158 Place Phase I & II Private Sewer Extension
(Professional Engineer's name from Application Item I11,1) (Project Name from Application Item 11.1)
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,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pumo 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 143-215.6B, 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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
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3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Jennifer D. Scott, Esqx., attest that this application for 1 158 Place Phase I & II Private Sewer Extension
(Signature Authority Name from Application Item I.3.) (Project Namc from Application Item 11.1)
attest that this application 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 I43-215.6A and 143-2I5.6B, 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.
Date: /474771)22
Page 5 of 5

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: 1158 Place Owners' Association, Inc.
Project Name for which flow is being requested: 1158 Place - Phase 1 & II (Private)
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for alpump
stations along the route of the proposed wastewater flow.
I.
Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Hominey Creek Water Reclamation Facility
b. WWTP Facility Permit #: NC0023906
c. WWTP facility's permitted flow
Allflows are in MGD
14.00
d. Estimated obligated flow not yet tributary to the WWTP 0.375
e. WWTP facility's actual avg. flow 9.700
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
0.01548
10.09
h. Percent of permitted flow used 72.07
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:
Pump Station
(Name or
Number)
Contentnea
(A) (B) (C) (D)—(B+C) (E)—(A-D)
Design
Average Approx. Obligated, Total
Pump Daily Current Not Yet Current Flow
Station Firm Flow** Avg. Daily Tributary Plus
Permit Capacity, * (Firm! pf), Flow, Daily Flow, Obligated
No. MGD MGD MGD MGD Flow
#36001 4.320 1.728 1.06 0.211 1.286
Southside
#36000 6.264 2.506 1.73 0.211
Available
Capacity***
0.442
1.956 0.549
* 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): City of Wilson
Downstream Permit Number: WQCS00021
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Kyle F. Manning, 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 Official Signature
CrV. ti n ineQ[
Title of Signing Official
Page 2 of 6
Date
FTSE 10-18

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Wilson County Parcel Report
PIN: 3702-47-7219.000
Parcel Number: 3702477219.000
Current Owner ID:
Physical Address.
Owner & Address:
Date Sold: 1619136000000
Deed Reference. 2892 - 263
Deed Year: 2021
Plat Reference: 43 8
Deed Acres:
Actual Year Built:
Effective Year Built:
Main Improvement
Finished Area:
Tax Year:
Assessed Current
Land Value: $0
Assessed Current
Improvement Value. $0
Total Assessed
Current Value: $0
Current Land Use
Yes or No: $0
Current Land Use Value. $0
Current Land
Fair Market Value. $0
Current Improvement
Fair Market Value: $0
Current Total
Fair Market Value: $0
Grantor:
Previous ParcelNumber:
Previous Deed Reference.
Plat Book/Page: 43-8
Legal Description:
Sales Amount: $875.000
Sales Instrument:
Sales Instrument Descript-on:
Sales Disqualifaction Code.
Sales Disqualifaction Code Description
Date Sold: 20210423
Vacant Improved Code:
Land Current Usage Code.
Land Rate:
Fair Market Value
Land Rate Code:
Parcel Description Code 1
Parcel Description Code 2
Multiple Land Segments.
GIS Calculated Acres
41.08
of Selected Polygon.
Quantity:
Road Frontage:
i

Current Use Code Main Improvement:
Main Improvement Decription Code:
Main Improvement Description:
Construction Quality Grade Decription Code
Depreciation Table
Number of Bedrooms:
Number of Full Bathrooms:
Number of Half Bathrooms:
HVAC:
Fireplace Yes or No
Basement Yes or No:
Attached Garage Yes or No
Percent of Construction Complete
Number of Improvements:
Neighborhood Code
City:
Tax District:
Township:
Area:
Vicinity Map
- SF
aka
Orthophotography Map

Wilson County Parcel Report
PIN: 3702-47-9494.000
Parcel Number: 3702479494.01
Current Owner ID: 1104864
Physical Address: AIRPORT BLVD W
DOCREYN LLC
Owner & Address: ATTN: REYNOLDS WILLIAMS
248 W EVANS ST
Date Sold:
Deed Reference: 2743 - 461
Deed Year: 2021
Plat Reference: -
Deed Acres: 1.46
Actual Year Built:
Effective Year Built:
Main Improvement
Finished Area:
Tax Year: 2021
Assessed Current
Land Value: $107,460
Assessed Current $0
Improvement Value:
Total Assessed
Current Value: $107,460
Current Land Use
Yes or No:
Current Land Use Value: $107,460
Current Land $107,460
Fair Market Value:
Current Improvement
Fair Market Value: $0
Current Total
Fair Market Value: $107,460
Grantor:
Previous ParcelNumber: 3702479494.000
Previous Deed Reference:
Plat Book/Page: 43-8
Legal Description: AIRPORT BLVD W
1.46AC=CITY TOTAL=59.75AC
Sales Amount: $0
Sales Instrument:
Sales Instrument Description:
Sales Disqualifaction Code:
Sales Disqualifaction Code Description:
Date Sold:
Vacant Improved Code:
Land Current Usage Code:
Land Rate: AC - ACRES
Fair Market Value
Land Rate Code: 0700
Parcel Description Code 1: 10 - COMMERICAL
Parcel Description Code 2: 00 - VACANT
Multiple Land Segments:

GIS Calculated Acres
of Selected Polygon:
Quantity:
Road Frontage:
Current Use Code Main Improvement:
Main Improvement Decription Code:
Main Improvement Description:
Construction Quality Grade Decription Code:
Depreciation Table:
Number of Bedrooms:
Number of Full Bathrooms:
Number of Half Bathrooms:
HVAC:
Fireplace Yes or No:
Basement Yes or No:
Attached Garage Yes or No:
Percent of Construction Complete:
Number of Improvements:
Neighborhood Code:
City:
Tax District:
Township:
Area:
Vicinity Map
Orthophotography Map
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1.46
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BARTLETT
ENGINEERING & SURVEYING, PC
1906 Nash Street North Wilson, NC 27893-1726
Phone: [phone] Fax: [phone]
www.bartlett.us.com
May 9, 2022
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality d
Raleigh Regional Office P,oe
3800 Barrett Drive °�
Raleigh, North Carolina 27609 9� ,y�°*4,1
Reference: Fast Track Application for Gravity Sewers
Private Sewer Extension fro
�i P4`�/
1158 Place r�
Airport Blvd. �f0r
Wilson, North Carolina ce
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
• Engineering Report
• Flow Tracking / Acceptance Form
• USGS Topographic Map
• Feature Report
• GIS Aerial Location Map
• HOA Articles of Incorporation
• Developer's Operational Agreement
• HOA Operational Agreement
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.
Project Manager
Enclosures
P' PROJECT 1ILFS' 1158 P1ace'.Permuts,Sewer DEQ\Pnvatc521-007 NCDEiNR Pnv Sew Cover Letter doc

NORTH CAROLINA
Department of the Secretary of State
To all whom these presents shall come, Greetings:
I, ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do hereby
certify the following and hereto attached to be a true copy of
ARTICLES OF INCORPORATION
OF
1158 PLACE OWNERS' ASSOCIATION, INC.
the original of which was filed in this office on the 14th day of July, 2021.
S. `{i -•
?;
Scan to verify online.
IN WITNESS WHEREOF, I have hereunto set my
hand and affixed my official seal at the City of
Raleigh, this 14th day of July, 2021.
d7,40,t, J
Certification C202119402098-1 Reference# C202119402098-1 Page: 1 of 4
Verify this certificate online at https://www.sosnc.govlverification
Secretary of State

State of North Carolina
Department of the Secretary of State
ARTICLES OF INCORPORATION
NONPROFIT CORPORATION
SOSID: 2232407
Date Filed: 7/14/2021 8:19:00 AM
Elaine F. Marshall
North Carolina Secretary of State
C2021 194 02098
Pursuant to §55A 2-02 of the General Statutes of North Carolina, the undersigned corporation does hereby submit these Articles of
Incorporation for the purpose of forming a nonprofit corporation.
1. The name of the nonprofit corporation is: 1158 Place Owners' Association, Inc.
2.0 (Check only ifapplicable.) The corporation is a charitable or religious corporation as defined in NCGS
§55A- I -40(4).
3. The name of the initial registered agent is:
Pinnacle Resource Group, Inc.
4. The street address and county of the initial registered agent's office of the corporation is:
Number and Street:
1300 Hodges St.
City: Raleigh State: NC Zip Code: 27609 County: Wake
The mailing address if different from the street address of the initial registered agent's office is:
Number and Street or PO Box:
PO Box 859
City: Wake Forest State:. NC Zip Code: 27588 County: Wake
5. The name and address of each incorporator is as follows:
Name
Jennifer D. Scott, Esqx.
Address
575 Military Cutoff Rd. Ste. 106 Wilmington NC 28405
6_ (Check either "a" or "b" below.)
apfhe corporation will have members.
b 0 he corporation will not have members.
7. Attached are provisions regarding the distribution of the corporation's assets upon its dissolution.
8, Any other provisions which the corporation elects to include are attached.
BUSINESS REGISTRATION DIVISION
P. O. BOX 29622 RALEIGH, NC 27626.0622
(Revised August. 2017) Form N-01
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9. The street address and county of the principal office of the corporation is:
10. (
Principal Office Telephone Number:
919.874.5050
Number and Street: 1300 Hodges St.
City: Raleigh State: NC Zip Code: 27609 County: Wake
The mailing address if different from the street address of the principal office is:
Number and Street or PO Box: PO Box 859
City: Wake Forest State: NC Zip Code: 27588 County: Wake
Optional): Listing of Officers (See instructions for why this is important)
Name
Address
Title
11. (Optional): Please provide a business e-mail address
The Secretary of State's Office wilt e-mail the business automatically at the address provided at no charge
when a document is filed. The e-mail provided will not be viewable on the website. For more information
on why this service is being offered, please see the instructions for this document.
Privacy Redaction
12. These articles will be effective upon fling, unless a future time and/or date is specified:
This is the / 3th day ofJ u ly ,202
1.
1158 Place owners' Association, Inc.
4 / rydb
;nnife(
/7 ,
for Business Entity Name
azure ofIncorporator
cott, Esqx., Incorporator
Type or print Incorporator's name and title, ifany
NOTES:
1. Filing fee is $60. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P. O. BOX 29622
(Revised August, 2017)
RALEIGH, NC 27626-0622
Form N-01
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Attachment to
Articles of Incorporation of
1158 Place Owners' Association, Inc.
The Association may be dissolved only upon the signed written assent of members
entitled to at least eighty percent (80%) of the votes of the Association. Upon dissolution,
other than incident to a merger or consolidation, the assets of the Association shall be
dedicated to an appropriate public agency to be used for purposes of similar to those for
which the Association was created. In the event that such dedication is not accepted, such
assets shall be granted, conveyed and assigned to any non-profit corporation, association,
trust or other organization devoted to similar purposes. Notwithstanding anything herein
to the contrary, the Common Property shall be preserved to the perpetual benefit of the
owners of Lots within the subdivision and shall not be conveyed except to the County of
Wilson or to any other non-profit corporation organized for similar purposes.
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STATE OF NORTH CAROLINA
COUNTY OF Permit No.
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (di) 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
RBV 1158, LLC
, a corporationigeneral 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 be known
as 1158 Place - Phase I & II (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, 1158 Place Owners' Association, Inc. (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re -constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance, re -construction and repair.
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 DEVELOPER 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 systems and facilities in accordance with applicable permit provisions and law.
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 andDeclaration.
3. The 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.
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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 for 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 yearly budget.
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 andlor 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
proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution without first having
transferred its said system and facilities to some person, corporation or other entity acceptable to and
approved by the COMMISSION by the issuance of 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 offices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL RBV 1158, LLC
MANAGEMENT COMMISSION
S. Daniel Smith
Director, Division of Water Resources
Name of DEVELOPER
(Signature)
Rex Vick Jr. - President
(Date)
Print Name and Title
N5AfrZ2.
(Date)
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STATE OF NORTH CAROLINA
COUNTY OF Permit No.
HOME/PROPERTY OWNERS' OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (di) 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
1158 Place Owners' Association, Inc. , a non-profit corporation organized
and existing under and by virtue of the laws of the State of North Carolina, hereinafter known as the
ASSOCIATION.
WITNESSETH:
1. The ASSOCIATION was formed for the purpose, among others, of handling the property, affairs and
business of the development known as 1158 Place - Phase I & II
(hereinafter the Development); of operating, maintaining, re -constructing and repairing the common
elements of the lands and improvements subject to unit ownership, including the wastewater collection
system with pumps, wastewater treatment works, and/or disposal facilities (hereinafter Disposal System);
and of collecting dues and assessment to provide funds for such operation, maintenance, re -construction and
repair.
2. The ASSOCIATION desires, to construct and/or operate a Disposal System to provide sanitary sewage
disposal to serve the Development on said lands.
3. The ASSOCIATION has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and/or operate the Disposal System.
4. The Development was created subject to unit ownership in the dwellings units, other improvements and
lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter47C
or 47F of the North Carolina General Statutes.
5. 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 ASSOCIATION do hereby mutually agree as follows:
1. The ASSOCIATION shall construct the Disposal System and/or make any additions or modifications to the
Disposal System in accordance with the permit and plans and specifications hereafter issued and approved
by the COMMISSION, and shall thereafter properly operate and maintain such systems and facilities in
accordance with applicable permit provisions and law.
2 The ASSOCIATION 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 for 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.
FORM: HOA 03-19 Page 1 of 2

3. The ASSOCIATION 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 fund allocated for the facility and shall be part of
the yearly budget.
4. In the event the common expense allocation and separate fund(s) 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 be provided such that special assessments can be made
as necessary at any time.
5. 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 ASSOCIATION 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.
6. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the ASSOCIATION to enter into voluntary dissolution without having made adequate provision for the
continued proper maintenance, repair and operation of its Disposal System, the ASSOCIATION shall
provide in the ASSOCIATION Bylaws that the ASSOCIATION shall not enter into voluntary dissolution
without first having transferred its said system and facilities to some person, corporation or other entity
acceptable to and approved by the COMMISSION by the issuance of a permit.
7. The ASSOCIATION 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
ASSOCIATION'S successor.
8. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, and 7 above shall be conditions of any
permit issued by the COMMISSION to the ASSOCIATION for the construction, maintenance, repair and
operation of the Disposal System.
9. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration is
filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL 1158 Place Owners' Association, Inc.
MANAGEMENT COMMISSION
Nam
B
S. Daniel Smith (Si
Director, Division of Water Resources
(Date)
CIATION
nnifer D. Scott, Esqx. - Incorporator
Print Name and Title
FORM: HOA 03-19 Page 2 of 2
(Date)