NCS000517_Renewal Application_20210706

Quible
Quible & Associates, P.C.
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING
SINCE 1959
June 30, 2021
Jeanette Powell
MS4 Program Coordinator
North Carolina Department of Environmental Quality
Division of Energy, Mineral, &
Land Resources Stormwater Program
1612 Mail Service Center
Raleigh, NC 27699-1612
P.O. Drawer 870
Kitty Hawk, NC 27949
Phone: [phone]
Fax: [phone]
web: quible.com
FIV F ",E)
JUL 06 2021
DENR-LAND QUALITY
STORMVVATER PECRMITTING
Re: NPDES MS4 Permit Renewal
The Fund for Sandy Point North Carolina,LLC (Permit No. NC000517)
Edenton, Bertie County, North Carolina
Ms. Powell,
On behalf of The Fund for Sandy Point North Carolina, LLC, Quible & Associates, P.C. hereby
submits for your review and approval an NPDES MS4 Permit Renewal Application submittal.
Included with this renewal request is an enclosed, executed NPDES MS4 Permit Renewal
Application Form. As you are aware, the form typically requires supplemental information, such
as a draft copy of the Stormwater Management Plan (SWMP). Since this project is unique and
has not yet begun development that would add any permanent population, we are including this
SWMP letter in place of.
Please note that The Fund for Sandy Point North Carolina, LLC (the Permittee) will notify the
DEQ-DEMLR Stormwater Program and DEQ-DEMLR Washington Regional Office prior to
commencement of any construction that will increase the permanent population of the Sandy
Point project. The Permittee will also comply with the Coastal Counties rules in 15A NCAC 02H
.1019 by implementing a DEQ approved post -construction plan to protect surface waters from
the impact of stormwater runoff from new development. Lastly, the Permittee will submit a draft
SWMP to the DEQ-DEMLR Stormwater Program for review and approval within 120 days of the
Sandy Point estimated population reaching 1,000.
At your earliest convenience, please review and do not hesitate to contact me by phone at (252)
491-8147 or by email at [e-mail] should you have any questions and/or require
additional information. Thank you for your time and attention to this project and we look forward
to hearing back.
Sincerely,
Quible & Associates, P.C.
I L . 1-46 �,—
Dyl L. Tillett, P.E.
Encl.: as stated
Cc: Sam Young, The Fund for Sandy Point North Carolina, LLC

NPDES MS4 Permit Renewal Application Form
National Pollutant Discharge Elimination System (NPDES)
Municipal Separate Storm Sewer System (MS4)
Please complete the information below and submit this form along with the required supplemental information
to the address indicated.
Part I: Permittee Information
Current Permit No.
NCS NC000517
MS4 Name
The Fund for Sandy Point North Carolina, LLC
Owner Name*
Sam Young
Owner Title
President
Street Address
215 Sandy Point Road
City, State, Zip
Edenton, North Carolina, 27932
Phone Number
252 562-3812
E-mail Address
[e-mail]
* The owner must be a principal executive officer or ranking elected official for the city/town/entity that
owns/operates the permitted M54. Any permit enforcement actions will be sent to the owner on record,
Part II: Primary Contact**
Contact Name
Sam Young
Contact Title
President
Employer
Street Address
P.O. Box 789
City, State, Zip
Edenton, North Carolina, 27932
Phone Number
252 562-3812
E-mail Address
[e-mail]
** The primary contact is the responsible party who will oversee the day-to-day permit compliance and
Stormwater Management Program implementation. With the exception of enforcement actions, permit
communications originating from NCDEQ will be sent to the primary contact and will be copied to the other
contacts listed below.
Part III: Other Contacts
Contact Name
E-mail Address
Contact Name
E-mail Address
Part IV: Required Supplemental Information
Submit one (1) hard copy and one (1) electronic copy of a Draft Stormwater Management Plan (SWMP)
with this permit renewal application. The Draft SWMP must be in the current NCDEQ SWMP Template
format and shall include all required information in order for the permit renewal application to be
considered complete.
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Part V: Certification
By my signature below I hereby certify, under penalty of law, that this document and all attachments
were prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of
the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete.
I am aware that there are significant penalties for submitting false information, including the possibility
of fines and imprisonment for knowing violations. I am also aware that incomplete permit renewal
applications, inclusive of the required Draft SWMP, will not be processed and will be returned to the
permittee.
❑ I am a ranking elected official for the permitted MS4.
© I am a principal executive officer for the permitted MS4.
❑ I am a duly authorized representative for the permitted MS4 and have attached the authorization
made in writing by the permit owner listed in Part I of this application, which specifies me as (check
one) :
❑ A specific individual having overall responsibility for the stormwater permit.
❑ A specific position having overall responsibility for the stormwater permit.
Signature:*
Print Name:
Title:
Signed this 4 day of 20 -. 41
* Please note that an original signature is required on this form, any required supplemental information, and any
representative authorization. Photocopies cannot be accepted.
Return this completed form along with the required supplemental information to:
DEQ-DEMUR Stormwater Program
Attn: MS4 Permitting
1612 Mail Service Center
Raleigh, NC 27699-1612
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