20060002 Ver 4_Check Returned_20120203

06 R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Waklld P E Dee Freeman
Governor Director Secretary
February 3 2012
DWQ Project # EXP 05 2062 V2
Lee County
DWQ Project # 06 0002 V4
Wake County
Suburban Asset Management
Ann G Gurnee
999 Waterside Drive Ste 2220
Norfolk Virginia 23510
Subject Property Sandford Retail Investments LLC
Holly Springs Retail Investment LLC
Fees Returned
Dear Ms Gurnee
On January 30 2012 the Division of Water Quality (DWQ) received the enclosed checks to be processed
as a part of the requested change in ownership of the property/company The two projects noted above
were Division of Water Quality (DWQ) 401 Water Quality Certifications and as such do not require a fee
for a change in ownership
Checks # 15007 and 15012 each for $40 are enclosed
Please contact me at [phone] or Ian McMillan at [phone] if you have any questions
KAIV�d
Enclosures Checks #15007 and 15012
cc File Copy + check copies
Wetlands Buffers Stormwater Compliance and Permitting Unit (WeBSCaPe)
1650 Mail Service Center Raleigh North Carolina 27699 1650
Location 512 N Salisbury St Fl 9 Raleigh NC 27604 1170
Phone [phone] FAX 919 - 807 -6494
Web www ncwaterquality org
An Equal Opportunity 1 Affirmative Action Employer
Sincerely
�3"
Karen A Higgins Supervisor
Wetlands Buffers Stormwater Compliance and
Permitting Unit (WeBSCaPe)
Filename 020002V4_ Exp052062V20wnershrpChg (LeeWake)ChecksRetu
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NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H Sullins Dee Freeman
Governor Director Secretary
STATE STORMWATER PERMIT NAME /OWNERSHIP CHANGE FORM
I CURRENT PERMIT INFORMATION
1 Stormwater Management Permit Number DW nlo.
2 Project Name Holly Suigs "Real ztueszrnc,a'z I.L.C.
3 Current Permit Holder s Company Name /Organization uo11y Sa�e,,u, s -ItA,L Sr�ussK+p., T1e,c
4 Signing Officials Name S�e�4,e,a �A,�1erz_ Title
(person legally responsible for permit)
5 Mailing Address Scn uj x ak.L e,� 3\ y-k -S e %0(,
city M-J 'P-1easAtrc— State -Sc- Zip 29 4 e4
6 Phone ( &�S) ASS I - S& 4 u3o1 Fax ( 843 ) $ 81 335 5
II PROPOSED PERMITTEE / OWNER / PROJECT / ADDRESS INFORMATION
This request is for (please check all that apply)
❑ Name change of the owner (Please complete Items 1 2 and 3 below)
❑ me 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 :SA /71 4ol l� Sao &ot-yi � S , L L, C
2 Proposed permittee s signing officials name S C)iA, s1 oo))e e
3 Proposed permittee s Title lQ tea 9 e
4 MailingAd�d � Lk ress ! Gil A.�� fl%n4 ctiienf
Y1 , 9yy (,��tfers de be �� 4e 2-12 -
City r I State VA Zip of 35l o
Phone (151) (off I (iou, K 3y4) Fax b, l 7Y7-7
5 New Project Name to be placed on permit SAAl S�fin2s, LLC
Please check the appropriate box The proposed permittee listed above is
❑ HOA or POA (Attach a copy of the deed transferring ownership of all common areas Print Name
HOA or POA in #1 above and provide name of HOA(POA) president m #2 above)
EP-fhe 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 and complete Property Owner
Information on page 4)
❑ Developer (Complete Property Owner Information on page 4)
SSW N/0 Change Rev16Nov2009 Page 1 of 4

III REQUIRED ITEMS
This application package will not be accepted by the Division of Water Quality unless all of the
applicable required items listed below are included with the submittal
1 This completed and signed form
2 Legal documentation of the transfer of ownership (For Permit Transfers Complete Current permittee
and Proposed Permittee Sections)
3 A copy of the recorded deed restrictions if required by the permit
4 The designers certification if required by the permit and if not already submitted to DWQ
5 If the Proposed Permittee is a corporation LLC or General Partnership provide documentation from
the Secretary of State office which supports the named president vice president member manager
or General Partner
6 The $40 00 processing fee If this is an initial transfer from the original permittee to the property owner
or other responsible party such as an HOA 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
❑ Check here if the Current Owner ►s only changing the owner name company name or project
name or the mailing address and will retain ownership of the permit
the current owner hereby notify the Division of
Water Quality that I am changing my name or company 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 and that if all required supporting
information and attachments as outlined above are not included this application package will be
returned as incomplete
Check here If Current Owner ►s transferring (selling) the property to a new owner and will not
retain ownership of the permit
I _ �� ��e,✓ ISAi.✓ef2 the current owner am submitting this application for a transfer of
owners ip for permit # O(v -000z g + I hereby notify DWQ of the sale or other legal transfer
of the stormwater system associated with this permit I further acknowledge and attest that I have
transmitted a copy of the most recent permit a copy of the Designers Certification a copy of the
DWQ approved plans and /or approved as built plans a copy of the approved Operation and
Maintenance agreement and copies of past maintenance records to the Proposed Permittee named
in Sections II and V of this form at the mailing address listed in Section II of this form I further attest
that I assign all rights and obligations as permittee to the Proposed Permittee named in Section V of
this form I understand that this transfer of ownership cannot be approved by the Division of Water
Quality unless and until the facility is in compliance with the permit and the Proposed Permittee signs
this form I understand that in the event the facility is not in compliance or the Proposed Permittee
does not sign this form the responsibility to bring the facility into compliance and to comply with the
terms and conditions of the permit remains with me until such time as the Proposed Permittee signs
this form and the Division approves it
Signature .- / �•u— Date AID 17 2011
a Notary Public for the State of
5t, &I County of do hereby certify that
- _,/ personally appeared before me this the
/,77M day of i✓aiem!xc 20/ / and acknowledge the due execution of the
forgoing instrument Witness my hand and official seal (Notary Seal)
tary Signature
SSW N/0 Change Rev16Nov2009 Page 2 of 4