SW7060312_CURRENT PERMIT_20191206

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYMMDD

in/ti 12 G
ROy COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
December 6, 2019
Stonebriar Commercial Finance LLC
Attention: Mr. Dirk Stock, Vice President
5601 Granite Parkway, Suite 1350
Plano, TX 75024
Subject: Stormwater Permit No. SW7060312 Ownership Change
ACADEMI Black Bear Inn 2
High Density Stormwater Project
Camden County
Dear Mr. Stock:
The Washington Regional Office received a Stormwater Management Permit
Application for ownership change for the subject project on October 28, 2019. Staff
review of the application has determined that the permit can be reissued. We are
forwarding Permit No. SW7060312 dated December 6, 2019, for the continued
operation of the subject project.
This permit, upon its effective date, will repiace all previous State Stormwater permits for
this project. This permit shall be effective from the date of issuance until June 22, 2020
and shall be subject to the conditions and limitations as specified therein, and does not
supercede any other agency permit that may be required. Please pay special attention to
the Operation and Maintenance requirements in this permit. Please note that this permit
only transfers ownership and it expires on Jane 22, 2020. Renewal applications are due
180 days prior to expiration.
If any parts, requirements, or limitations contained in this permit are unacceptable, you
have the right to request an adjudicatory hearing upon written request within thirty (30)
days following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150E of the North Carolina General Statutes, and filed with the
Office or Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714.
Unless such demands are made this permit shall be final and binding.
If you have any questions, or need aciditionai information concerning this matter, please
contact me at [phone].
Sincerely,
Roger K. Thorpe
E-,:vlronmentai Engineer
EQ7 North Carolina Department of EnOronmentafQuality 1 Division of Energy, Mineral and Land Resources
Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
S V
°+�+ 252 a46.648?

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of _
North Cardlina as amended and other applicable Laws, Rules, and_Regulations
PERMISSION IS HEREBY GRANTED TO
Stonebriar Commercial Finance LLC
ACADEMI — Black Bear Inn 2
Camden County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with the
provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules`) and
the approved stormwater management plans and specifications and other supporting
data as attached and on file with and approved by the Division of Energy, Mineral, and
Land Resources (Division) and considered a part of this permit.
This permit shall be effective from the date of issuance until June 22, 2020, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.6 of this permit and per application and approved
plans. The stormwater control has been designed to handle the runoff from
263,937 square feet of impervious area.
3. The overall tract will be limited to the 310,904 square feet of built -upon area
within the total project area of 29 acres as indicated on the application and per
approved plans in order to remain 25.88% low density overall.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.

f I
5. The runoff from all built -upon area within the permitted drainage area #1 of this
project must be directed into the permitted stormwater control system per
approved plans.
6. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a. Drainage Area, acres: 15.10
b. Total Impervious Surfaces, ftz: 263,937
C. Design Storm, -inches:
1.0
d. Pond Depth, feet:
4.50
e. TSS removal efficiency:
90%
f. Permanent Pool Elevation, FMSL:
10.00
g. Permanent Pool Surface Area, ft2:
75,932
h. Permanent Storage Volume, ft3:
271,236
i. Permitted Forebay Volume, ft3:
46,405
j. Temporary Storage Elevation, FMSL:
10.63
k. Temporary Storage Volume, ft3:
48,580 (28,742 ft3 required)
1. Controlling Orifice:
3.0" � pipe
M. Receiving Stream/River Basin:
Run Swamp Canal 1 Pasquotank
n. Stream Index Number:
30 — 2 — 1 — 1
o. Classification of Water Body:
"C; Sw"
II. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.

3. The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must be followed in its
entirety and maintenance must occur at the scheduled intervals including, but not
limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved -plans and
------.--- -- specifications. --
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of the Division. The records will indicate the
date, activity, name of person performing the work and what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
7. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
8. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
9. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.

e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by
the Pe�rrmittee at all times.
12. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
13. This permit shall be effective from the date of issuance until June 22, 2020.
Application for permit renewal shall be submitted 180 days prior to the expiration
date of this permit and must be accompanied by the processing fee.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a formal permit transfer request to the Division, accompanied by a
completed name/ownership change form, documentation from the parties
involved, and other supporting materials as may be appropriate. The approval of
this request will be considered on its merits and may or may not be approved.
The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division, in accordance with
North Carolina General Statute 143-215.6A to 143-215.6C.
3. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
4. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.

5. The permittee grants DEQ Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
6. The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
7. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
_.- _----Sediment-Corittol-Planning and-Design-Manual:—�W -Y_-
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The permittee shall notify the Division of any name, ownership or mailing
address changes within 30 days.
Permit issued this the 6 t' day of December 2019.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
o
S. Daniel Smith, Director
Division of Energy, Mineral, and Land Resources
By Authority of the Environmental Management Commission
Permit Number: SW7060312

State of North Carolina
Department of Enviromment and Natural Resources
Division of Water Quality
STATE STORMWATER PERMIT NAMEIOWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION #?EQ7vED
1. Stormwater Management Permit Number:
fl�P?060312MOD °�� � � `�1 f
ACADEMI-Black Bear Inn 2
2. Project Name:
3. Current Permit Holder's Company Name/Organizat on: ACADEMI Real Estate Holdings, y. L.. c.
4, Signing Official's Name: ACMEMI UC Title: 4anager
5. Mailing Address: 850 Puddin Ridge Road
City: Hoycck State: NC Zip: 27958-8679
6. Phone: 2t -- ) 435-2488 Fax: i
It. PROPOSED PERMITTEE / OWNER / PROJECT / ADDRESS INFORMATION
This request. Is for: (please check all that apply)
❑ Name change of the owner (Please complete Item:3 1, 2 and 3 below)
❑ Name change of project (Please complete Item 5 telow)
® Change in ownership of the property/company (Please complete Items 1, 2, 3, and 4 below)
❑ Mailing address / phone number change. (Please c*mplete Item 4 below)
❑ Other (please explain):
1. Proposed permittse'S company name/organizabon: _Stonabriar Commercial Finance LLC
2. Proposed permittee's signing official's name: Dirk 'Stock
3. Proposed permittee's title: vice President
4. Mailing Address: 5601 Granite Parkway,Suitc 1350
City: Piano ___ __ t3tate: TX Zip: 75024
Phone: 4{ 69 l 609-8500 Far: ( }
5. New Project Name to be placed on permit:
Please check the appropriate box. The proposed perry ittee listed above is:
❑ HOA or POA (Attach documentation showing that ; he HOA or POA owns, controls, or has a
recorded easement for all areas that contain storm vater system features. Print name of HOA or
POA in #t above and provide name of HOA/POA's authorized rW esentative in #2 abovs)
❑ The property owner
[] Lessee (Attach a copy of the lease agreement and complete Property Ovmer Information on
Page 4)
® Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be
granted upon receipt of a copy of the recorded dee1)
❑ Developer (Complete Property Owner Information an page 4)
SSW N/O Change Rev24Sept2012 Page 1 a: 4

'r' >
111. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may, result in processing delays or denial of the transfer.
1. This completed and signed form. This certification must be completed and signed by both the
current permit holder and the new applicant if this is a change of ownership.
2. Legal documentation of the property transfer to a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4. The designer's certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional office), if required by the permit and if not already submitted to DWQ.
5. If the proposed permittee is a firm, partnership, association, Institution, corporation, limited liability
company; or other corporate entity, provide documentation showing the authority of the -named
representative to act on behalf of the proposed permittee.
6. The $40.00 processing fee. If this Is an initial transfer from the originpl permittee the processing
fee is not required. Subsequent ownership transfers will require the $40.00 processing fee.
IV. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fill out the certification below that statement:
❑ Check here if the current permittee is only changing his/her/its name, the project name, or mailing
address; but will retain the pennit. I, the current
permittee, hereby notify the DWQ that I am c anging my name and/or I am changing my mailing
address and/or I am changing the name of the permitted project. I further attest that this application
for a name/ownership change is accurate and complete to the best of my knowledge. I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments lasted above are not included, this application package will be returned as
incomplete.
0 Check Here if.cu►t~errt.Peri'rrlifiae=4,ftansferring the property to anew owner and will not retain
- o r of the`perirri'
1 Real $scats Holding
. L . L . c the current permittee, am submitting this application
for a trans er o ownership or permit # sw7g60312Mon I hereby notify DWQ of the sale or
other legal transfer of the stormwater system associated with this permit. i have provided a copy of
the most recent permit, the designer's certification for each BIVIP, any recorded deed restrictions,
covenants, or easements, the DW`Q approved plans and/or approved as-bultt plans, the approved
operation and maintenance agreement, past maintenance records; and the most recent DWO
stormwater inspection report to the proposed permittee named in Sections ll and V of this form. I
further attest that this application for a name/ownership change is accurate and complete to the best
of my knowledge. I understand that if all required parts of this application are not completed or if all
required supporting information and attachments listed above are not included, this application
package will be returned as incomplete. I assign all rights and obligations as permittee to the
proposed permittee named in Sections li and V of this form. I understand that this transfer of
ownership cannot be approved by the DWQ unless and until the facility is In compliance with the
permit.
Signature: f - Date:
I,a Notary Public for the State of
1V00VIA 0n- County of { , do hereby certify that
ClV
c -o_,.ent ao C - personally appeared before me this the
day of Sgj:,A ev 6e r , 26_B, and acknowledge thtdtWpecutlon of the
o ing inst m W my hand and official seal,
•' NOTARr
{)tart' ature ' • PUBLIC
n
MY G # $3627 � .
o EXPIRES
5 �
:e�� •'• &3012022
SSW N/O Change Rev24Sept2012 Page 2 of 4 � '�4;

V. PROPOSED PERMITTEE CERTIFICATION: (!'his section must be completed by the
Proposed Permittee for all transfers of ownership)
I, Stonebriar Commercial Pittance LLC (by Dirk 5toek) , hereby notify the DWQ that I have acquired
through sale, lease or legal transfer, the responsibility for operating and maintaining the permitted
stormwater management -system, and, if applicable, constructing the-permhted system. I
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
�( the most recent permit
U the designer's certification for each BMP
❑ any recorded deed restrlctions, covenants, or easements
❑ the DWQ approved plans and/or approved as-tuilt plans
C] the approved operation and maintenance agree+rnent
8 past maintenance records from the previous permittee (where required)
DWQ stormwater inspection report showing compliance within 90 days prior to this transfer
I have reviewed the permit, approved plans and other documents listed above, and I will comply with
the terms and conditions of the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to the requirements listed In the permit and in the
operation and maintenance agreement. I further attest that this application for a name/ownership
change is accurate and complete to the best of my knowledge. I understand that if all required parts
of this application are not completed or if all required supporting information and attachments listed
above are n I included, this application package will b� returned as incomplete.
Signature: for 5ton6riar Commercial Fine ice LLC Date:
i, Carrie Stovall _ , a Notary Public for the State of
Texas , County of Cotlirt , do hereby certify that
Dirk Stock personally appeared before me this the
9th _ _stay of Auxust _ 2019 and acknowledge the due execution of the
forgoing instrumer t. Witness my hand and official seal,
OVALL
Note rgnature °WMItrasaes
My oaamt teslw Eons
"•nay`''
Nmmbcr 8, 2018
Additional copies of the original permit and the approvad Operation and Maintenance agreement can
be obtained from the appropriate Regional Office of tha Division of Water Quality.
This completed form, including all supporting documents and processing fee (if required), should be
sent to the appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources; ©!vision of Water Quality, as shown on the. attached map.
Please note that if the Proposed Permittee listed abovo is not the property. owner, the property owner
must complete and sign page 4 of this document. Both the lessee / developer and the property
owner will appear on the permlt as permittees.
SSW N/Q Change Rev24Sept2012 Page 3 of 4

VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed In Sections 11 and V of this form is not the Property Owner, the
Property Owner must provide his/her Contact Information below and sign this form:
Printed Name:
Organization:
Title within the Organization:
Street Address:
City: State: Zip:
Mailing Address: -
(if different from street address)
City: State:_ Zip:
Phone:
Email
Fax:
I certify that I own the property identified in this permit transfer document and have given permission
to the Proposed Permittee listed in Sections II and V to develop and/or, lease the property. A copy
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and aggree by my signature below, that I will
appear as a permittee along with the lessee/developer and 1 rdrill therefore share responsibility for
compliance with the DWO Stormwater permit. As the propert�_y owner, it is my responsibility to notify
DWQ by submitting a completed Name/Ownership Change Form,within 30 days of procuring a
developer, lessee or purchaser for the property. I understand that failure to operate and maintain the
stormwater treatment facility in accordance with the permit is a violation of NC General Statute
(NCGS) 143-215.1, and may result in appropriate enforcement action including the assessment of
civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature of the property owner Date:
I, , a Notary Public for the State of
County of -- do hereby certify that
personally appeared before me this the
day of , 20 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signature
SSW N/O Change Rev24Sept2012 Page 4 of 4

ACADEMI — Black Bear Inn 2
Stormwater Permit No. SW7060312 Modification
Camden County
Designer's Certification
]R EUIVED OCT Z S 2019
Sean C. Robey, PE , as a duly registered Engineer
in the State of North Carolina, having been authorized to observe (p'e4e4ieatly/ 1ekll /
f+-time) the construction of the project, df%srCW1s/xaCPd�✓
ACADEMI - Black Bear Inn 2 (includes Black Bear Inn 1)
(Project)
for ACADEMI (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number A52- 7V
Date /0,
Page 6 of 7
SEAL

I VI I III IVV. V V V f VVVd 11L1VIlJLJ
Certification Requirements.-
1
The drainage area to the system contains approximately the permitted
acreage.
2.
The drainage area to the system contains no more than the permitted
amount of built -upon area.
3.
All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4.
All roof drains are located such that the runoff is directed into the system.
5.
The outlet/bypass structure elevations are per the approved plan.
6.
The outlet structure is located per the approved plans.
7.
Trash rack is provided on the outlet/bypass structure.
8.
All slopes are grassed with permanent vegetation.
�9.
Vegetated slopes are no steeper than 3:1.
10.
The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11.
The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
:14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
5. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Camden County Planning / Building Inspections
Page 7 of 7

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
5V
�P
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION RECEIVED MAR 2 7 2019
1. Stormwater Management Permit Number: SW7060312
2. Project Name
Blackwater USA - Bunkhouse
3. Current Permit Holder's Company Name/Organization:
4. Signing Official's Name- ACADEMI LLC
5. Mailing Address: 850
City: Moyock
Puddin Ridge Road
6. Phone: ( 252 ) 435-2488
Fax: (
E&J Holdings, L.L.C.
Title: Manager
State: NC
Zip: 27958-8679
11. PROPOSED PERMITTEE 1 OWNER / PROJECT / ADDRESS INFORMATION
This request is for: (please check all that apply)
0 Name change of the owner (Please complete Items 1, 2 and 3 below)
❑ Name change of project (Please complete Item 5 below)
❑ Change in ownership of the property/company (Please complete Items 1, 2, 3, and 4 below)
❑ Mailing address / phone number change. (Please complete Item 4 below)
❑ Other (please explain):
1. Proposed permittee's company name/organization: ACADEMI Real Estate Holdings, L.L.C.
2. Proposed permittee's signing official's name: ACADEMI LLC
3. Proposed permittee's title: Manager
4. Mailing Address:
City:
Phone: ( )
5. New Project Name to be placed on permit:
State: Zip:
Fax:
Please check the appropriate box. The proposed permittee listed above is:
❑ HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA in #1 above and provide name of HOA/POA's authorized representative in #2 above)
0 The property owner
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
❑ Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner Information on page 4)
SSW N/O Change Rev24Sept2012 Page 1 of 4

III. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may result in processing delays or denial of the transfer.
1. This completed and signed form. This certification must be completed and signed by both the
current permit holder and the new applicant if this is a change of ownership.
2. Legal documentation of the property transfer to a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4. The designer's certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional office), if required by the permit and if not already submitted to DWQ.
5. If the proposed permittee is a firm, partnership, association, institution, corporation, limited liability
company, or other corporate entity, provide documentation showing the authority of the named
representative to act on behalf of the proposed permittee.
6. The $40.00 processing fee. If this is an initial transfer from the original permittee the processing
fee is not required. Subsequent ownership transfers will require the $40.00 processing fee.
IV. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fill out the certification below that statement:
® Check here if the current permittee is only changing his/her/its name, the project name, or mailing
address, but will retain the permit. I, E + J kib16 i L . L. C • , the current
permittee, hereby notify the DWQ that I am changing y name and/or I am changing my mailing
address and/or I am changing the name of the permitted project. I further attest that this application
for a name/ownership change is accurate and complete to the best of my knowledge. I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments listed above are not included, this application package will be returned as
incomplete.
❑ Check here if current permittee is transferring the property to a new owner and will not retain
ownership of the permit.
I, , the current permittee, am submitting this application
for a transfer of ownership for permit # . I hereby notify DWQ of the sale or
other legal transfer of the stormwater system associated with this permit. I have provided a copy of
the most recent permit, the designer's certification for each BMP, any recorded deed restrictions,
covenants, or easements, the DWQ approved plans and/or approved as -built plans, the approved
operation and maintenance agreement, past maintenance records, and the most recent DWQ
stormwater inspection report to the proposed permittee named in Sections II and V of this form. I
further attest that this application for a name/ownership change is accurate and complete to the best
of my knowledge. I understand that it all required parts of this application are not completed or if all
required supporting information and attachments listed above are not included, this application
package will be returned as incomplete. I assign all rights and obligations as permittee to the
proposed permittee named in Sections II and V of this form. I understand that this transfer of
ownership cannot be approved by the DWQ unless and until the facility is in compliance with the
permit.
Signature:A1.G - A55T1`:S�C _Date: 3 24 - l q
I ACAVG.YK% LK:� vt00. C'
a Notary Public for the State of
Nor* Caro I inr)L- I , County of C0.nr1CLLA , do hereby certify that
k&AaA r%A F Mc �enii e_- 4to-( personally appeared before me this the
20'01 day of MM arck , 20,9 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
Nota ignatu
M� czmfy�s5ikm AfnI IS, w;t -
SSW N/O Change Rev24Sept2012 Page 2 of 4
H '•� otar
R.� Y Seal)
• .� l
�� • a��` NRY •'• �_
i puo-
�'•�,�FeN co

y�_a as+�j� r
�5
w' :,�' �ry
'��
..�. t�- .
•M1Z
4.�y
•� _ '..
H'
r �
4
` -x
i - '
� _
_
'-

V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed Permittee for all transfers of ownership)
I, , hereby notify the DWQ that I have acquired
through sale, lease or legal transfer, the responsibility for operating and maintaining the permitted
stormwater management system, and, if applicable, constructing the permitted system. I
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
❑the most recent permit
the designer's certification for each BMP
❑ any recorded deed restrictions, covenants, or easements
❑ the DWQ approved plans and/or approved as -built plans
F] the approved operation and maintenance agreement
epast maintenance records from the previous permittee (where required)
DWQ stormwater inspection report showing compliance within 90 days prior to this transfer
I have reviewed the permit, approved plans and other documents listed above, and I will comply with
the terms and conditions of the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to the requirements listed in the permit and in the
operation and maintenance agreement. I further attest that this application for a name/ownership
change is accurate and complete to the best of my knowledge. I understand that if all required parts
of this application are not completed or if all required supporting information and attachments listed
above are not included, this application package will be returned as incomplete.
Signature:
M
County of
Date:
a Notary Public for the State of
do hereby certify that
personally appeared before me this the
day of , 20 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signature
Additional copies of the original permit and the approved Operation and Maintenance agreement can
be obtained from the appropriate Regional Office of the Division of Water Quality.
This completed form, including all supporting documents and processing fee (if required), should be
sent to the appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources, Division of Water Quality, as shown on the attached map.
Please note that if the Proposed Permittee listed above is not the property owner, the property owner
must complete and sign page 4 of this document. Both the lessee / developer and the property
owner will appear on the permit as permittees.
SSW N/O Change Rev24Sept2012 Page 3 of 4

VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections II and V of this form is not the Property Owner, the
Property Owner must provide his/her Contact Information below and sign this form:
Printed Name:
Organization:
Title within the Organization:
Street Address:
City:
Mailing Address:
City:
Phone:
Email:
State:
(if different from street address)
State:
Fax:
Zip:
93
I certify that I own the property identified in this permit transfer document and have given permission
to the Proposed Permittee listed in Sections II and V to develop and/or, lease the property. A copy
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and I will therefore share responsibility for
compliance with the DWQ Stormwater permit. As the property owner, it is my responsibility to notify
DWQ by submitting a completed Name/Ownership Change Form within 30 days of procuring a
developer, lessee or purchaser for the property. I understand that failure to operate and maintain the
stormwater treatment facility in accordance with the permit is a violation of NC General Statute
(NCGS) 143-215.1, and may result in appropriate enforcement action including the assessment of
civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature of the property owner
Date:
I, a Notary Public for the State of
County of , do hereby certify that
personally appeared before me this the
day of , 20 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signature
SSW N/O Change Rev24Sept2012 Page 4 of 4

Permit No. ,!S-,w + 6 03
(to be provided bY D i p)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form may be photocopied for use as an original
DWQ Stornlwater Managementan Review:
A complete stormwater management plan submittal includes an application form, a wet detention basin
supplement for each basin, design calculations, and plans and specifications showing all basin and outlet
structure details.
I. PROJECT INFORMATION
Project Name: gt-At.ILwA-TEQ - 9omK House=
Contact Person: tomy VEeNo,cJ Phone Number: (2SZ) 43.5 -2,V6,S
For projects with multiple basins, specify which basin this worksheet applies to: tit A
elevations
Basin Bottom Elevation S ft. (jlaa• of the basin)
Permanent Pool Elevation 10.0 ft. (elevation of the orifice)
Temporary Pool Elevation 10 •.5- ft. (elevation of the discharge structure overflow)
areas
Permanent Pool Surface Area S 21 VA sq. Ft. (water surface area at the orifice elevation)
Drainage Area lt. 3! ac. (on -site and off -site drainage to the basin)
Impervious Area _ 5.1D _ ac. (on -site and off -site drainage to the basin)
volumes
Permanent Pool Volume
Temporary Pool Volume
F'orebay Volume
Other parameters
SAIDA 1
Diameter of Orifice
Design Rainfall
Design TSS Removal 2
Form SWU-102 Rev 3.99
?_ Z,7 31 cu, ft �- ��'^ j ,� asin and forebay)
IZ4, "95t cu. ft`< r S Cl^�" Verrnanent pool)
'{,1,7+ cu. ftc�.volume)
Iv �
I— �sugace-area-to -ararnage-area ratio from DWQ table)
in. (2 to S day temporary pool draw -down required)
! in.
9y % (minimum 85% required)
Page 1 of 4

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number A,11A and its issue date (if known)
3. Specify the type of project (check one):
Low Density High Density Redevelop General Permit Other
4, Additional Project Requirements (check applicable blanks):
_CAMA Major YuSedimentation/Erosion Control 404/401 Permit NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
I-877-623-6748.
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project .
S'CokAA,w -TE2 kOA)—oFr= FZo A TKr .st-TE tvLLi_ 11 gATED
RIt' 4 LAE-T 0e7Eu _7t0A) gA
2. Stormwater runoff from this project drains to the PA s Qu epI ilNk River basin.
3. Total Project Area: Zv - 7 I acres 4. Project Built Upon Area: Z 2 %
5. How many drainage areas does the project have? I
6. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as below.
1' OSEC-7 srrE
07� P2ose --T ARE,1
Basin Information
Z)fffi trgZrATe L--a
Receiving Stream Name
l vur C EEk
r,j LL, CtfZt
Receiving Stream Class
5
$' Sw
Drainage Area
Existing Impervious* Area
O
D
Proposed Impervious*Area
5.1a
g. Z
% Impervious* Area (total)
Impervious* Surface Area ,
Drainage Area° 1 E 'S,
Drainage Area 2
On -site Buildings
(, E Z
I-IZ 4e-
On-site Strects
. 2 D A.,
qko
On -site Parking
On -site Sidewalks
0.36 Ac
AC
Other on -site 6tLOU . 4 aeA
0,344c
Off -site
p
Total: fj D
Total: �.
* Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Forin SWU-l01 Version 3.99 Page 2 of 4 0IJ

/ f
dVW V-3vV
9 ol9zf 5 m z -,, I
� Z _