SW7960208_CURRENT PERMIT_20060908

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW %1Z(60o�D�
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYMMDD

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P,E. Director
Division of Water Quality
DIVISION OF WATER QUALITY
September 8, 2006
Perry Family Limited Partnership
Attn: Mr. Wayne M. Perry
PO Box 1607
Elizabeth City, NC 27906
Subject: Stormwater Permit No. SW7960208
Carolina Chrysler
High Density Stormwater Project
Pasquotank County
Dear Mr. Perry:
The Washington Regional Office received your request to renew
Stormwater Permit SW7960208 on June 26, 2006. After conducting a
site visit on August 23, 2006 and reviewing your request, it has
been determined that the project, as proposed, will comply with
the Stormwater Regulations set forth in Title 15A NCAC 2H.1000.
We are forwarding Permit SW7960208 dated September 8, 2006 to
Perry Family Limited Partnership for the continued operation of a
wet detention pond to serve the Carolina Chrysler Dealership
located at Elizabeth City, NC.
This permit replaces all previous State stormwater permits
for this site, and shall be effective from the date of issuance
until September 8, 2016, and shall be subject to the conditions
and limitations as specified therein. Please pay special attention
to the Operation and Maintenance requirements in this permit.
Failure to establish an adequate system for operation and
maintenance of the stormwater management system will result in
future compliance problems.
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 150B of the
North Carolina General Statutes, and filed with the Office of
Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-
7447. Unless such demands are made this permit shall be final and
binding.
North Carolina Division of Water Quality Intemet: h2o.enr.stale.nc.us
943 Washington Square Mall Phone: [phone]
Washington, NC 27889 FAX [phone]
An Equal OpportunitylAtfirmative Action Employer— 50% Recycledl10% Post Consumer Paper
Nne
orthCarolina
Naturally

Perry Family Limited Partnership
September 8, 2006
Page Two
If you have 'any questions, or need additional information
concerning this matter, please contact Bill Moore at (252) 948-
3919.
Sincerely,
Al Hodg egi nal Supervisor
Surface Water Protection Section
Washington Regional Office
cc: Elizabeth City Planning/Inspections
Washington Regional Office
Central Files

State Stormwater Management Systems
Permit No..SW7960208
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143,
General Statutes of North Carolina as amended, and other
applicable Laws, Rules, and Regulations
PERMISSICN IS HEREBY GRANTED TO
Perry Family Limited Partnership
Pasquotank County
FOR THE
construction, operation and maintenance of stormwater management
systems 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 Water Quality and considered a part of this permit for
a wet detention pond to serve Carolina Chrysler Dealership located
at Elizabeth City, NC.
This permit replaces all previous State stormwater permits for
this site, and shall be effective from the date of issuance until
September 8, 2016, 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 on page 4 of this permit,
the Project Data Sheet.
3. Approved plans and specifications for this project are
incorporated by reference and are enforceable parts of the
permit.
3

DIVISION OF WATER QUALITY
PROJECT DATA
Project Name: Carolina Chrysler Dealership
Permit Number: SW7960208
Location: Pasquotank County
Applicant: Perry Family Limited Partnership
Mailing Address: PO Box 1607
Elizabeth City, NC 27906
Requested Permit: 06/26/2006
Transfer
Receiving Stream:
Stream Classification:
Total Site Area:
Total Impervious:
Area Allowed
Pond Depth:
Required Storage Volume
Provided Storage Volume:
Required Surface Area:
Provided Surface Area:
UT-Knobbs Creek
C
3.75 acres
2.89 acres
5.0 ft
10, 630 of
10,754 cf
6616 sf
10,000 sf
Controlling Orifice: 1.75-inch orifice at elev. 8.56
4

4. No homeowner/lot owner/developer shall be allowed to fill in,
alter, or pipe any vegetative practices (such as swales)
shown on the approved plans as part of the stormwater
management system without submitting a revision to the permit
and receiving approval from the Division.
5. The following items will require a modification to the
permit:
a. Any revision to the approved plans, regardless of size
b. Project name change
C. Transfer of ownership
d. Redesign or addition to the approved amount of built -
upon area
e. Further subdivision of the project area.
In addition, the Director may determine that other revisions
to the project should require a modification to the permit.
6. 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.
II. SCHEDULE OF COMPLIANCE
1. The permittee will comply with the following schedule for
construction and maintenance of the stormwater management
system.
a. 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 surfaces except roads.
b. During construction, erosion shall be kept to a minimum
and any eroded areas of the system will be repaired
immediately.
2. The facilities must be properly maintained and operated at
all times. The approved Operation and Maintenance Plan must
be followed in its entirety and maintenance must occur at the
scheduled intervals.
3. The permittee shall at all times provide the operation and
maintenance necessary to assure the permitted stormwater
system functions at optimum efficiency including, but not
limited to:
5

n
a. Semiannual scheduled inspections (every 6 months)
b. Sediment removal
C. Mowing and revegetation of side slopes
d. Immediate repair of eroded -areas'
e. Maintenance of side slopes in accordance with approved
plans and specifications
f. Debris removal and unclogging of outlet structure,
orifice device and catch basins and piping.
4. Records of maintenance activities must be kept and made
available upon request to authorized personnel of DWQ. The
records will .indicate the date, activity, name of person
performing the work and what actions were taken.
5. 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 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. Mail•the
Certification to the Washington Regional Office, 943
Washington Square Mall, Washington, North Carolina, 27889,
attention Division of Water Quality.
7. A copy of the approved plans and specifications shall be
maintained on file by the Permittee for a minimum of five
years from the date of the completion of construction.
III. GENERAL, CONDITIONS
1. This permit is not transferable. In the event there is a
desire for the facilities to change ownership, or there is a
name change of the Permittee, a formal permit request must be
submitted to the Division of Water Quality accompanied by an
application fee, 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.
2. Failure to abide by the conditions and limitations contained
in this permit may subject the Permittee to enforcement
action by the Division of Water Quality, in accordance with
North Carolina General Statute 143-215.6(a) to 143-215.6(c).
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) which have jurisdiction.
6

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 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.
6. At least six months prior to the expiration date, the
permittee must submit a written request for permit renewal
tc the Division of Water Quality, Washington Regional
Office.
Permit issued this the 8 th day of September, 2006.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Alan W. Klimek, P.E.-Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number SW7960208
11

J u r[ 1 4 U b L 1. U' i d
Project Name i� G i f CJYlGounty
UO
Stprmwater PC �iNo S'JY7,9
i-
REGEM .D
Designer's Certification JUN 2 7 2006
as a duly W WAp
Registered Professional Engineer in the State of North Carolina, having been authorized to observe
(periodically/weekly/full time)
the construction of the project, _l j� t1t 1G�- bl�u5k�r
(Project)
for (l (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.
Sign
Reg
Date
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ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
BRIAN WRENN
Acting Director
Perry Family Limited Partnership
Attention: Mr. Wayne M. Perry
1005 W Ehringhaus St.
Elizabeth City, NC 27909
Dear Mr. Perry:
NORTH CAROLINA
Environmental Quality
February 5, 2020
Subject: Stormwater Permit No. SW7960208 Renewal
Carolina Chrysler — Elizabeth City, NC
High Density Stormwater Project
Pasquotank County
h1A�d
A Division of Energy, Mineral, and Land Resources file review has determined that
Stormwater Permit SW7960208 for a stormwater treatment system consisting of a wet
detention pond to serve Carolina Chrysler located at 1001 Halstead Blvd. in Elizabeth
City, NC expires on September 8, 2020. This is a reminder that permit renewal
applications are due 180 days prior to expiration. We do not have airecord of receiving
a renewal application.
To keep this permit active please submit a completed permit renewal application along
with a $505.00 fee for permit renewal. Permit application forms for renewal can be found
on our website at:
htt s: de .nc. ova out divisions ener -mineral-land-r sources ener - ine al-land-
rules/stormwater-programost-construction. North Carolina General Statutes and the
Coastal Stormwater rules require that this property be covered under a stormwater
permit.
If you have questions, please feel free to contact me at [phone]. 1 will be glad to
discuss this by phone or meet with you. If you would like, I can e-mail you a copy of the
application forms. You can request a copy by e-mailing me at [e-mail]..
Sincerely,
c
ARo'gZrK. Tho p �~
Environmental Engineer
North Carolina Department of Environmental Quality I Division of Energy. Mineral and land Resources
Washington Regional Office 1 943 Washington Square Mail I Washington. North Carolina 27889
vomH c�cr:ru
�� a ��� ft 252.946.6481

Carolina Chrysler, Plymouth, Dodge, Jeep, I agle, Inc.
Detention Pond Maintenance Agreement
I. Operation and maintenance ofthe detention pond shall be the responsibility ofthe owner.
2. Operation ol_the system is automatic upon the occurrence of a rainfall event, however, there are several
maintenance items that must he attended to. First of al I, there must be a lawn maintenance program where the grass
around the pond will be kept mowed during the growing season of the year. It is recommended for aesthetic reasons
that the grass be mowed on at least a bi-weekly basis unless actual growing conditions indicate otherwise, in which
case the mowing frequency should be modified to suit site conditions.
3. The outlet structure must be inspected periodically for obstructions and trash build-up. This inspection should be
done approximately once every th►•ee months to include inspection ol'the orifice in (lie drawdown device to check for
algae or other trash plugging the orifice, inspection of the rip -rap filter around the riser section for trash, cut weeds or
grasses which may tend to plug the filter, inspection ofthe trash rack for the same type of obstructions as with the
rip -rap filter and an inspection of the barrel section for any obstructions such as limbs or anything else that may have
passed the trash rack and pose it plugging problem. Any obstructions found shall be removed and hauled away from
the pond.
4. The forebay area must be checked for sediment deposits, especially during the first year of operat'son. The
frequency of the forebay inspections should be Inotithly until all disturbed areas have been stabilized or for a
minimum of 6 months, whichever is longer. Thereafter, inspect forebay area every three months. To perform this
inspection elevations should be taken along the perimeter of the rip -rap Flow distribution/velocity dissipation pad.
The bottom Shortld approximately 2' to 2-1/2' below the permanent pool elevation. Ifthis is not the case the rip -rap
pad will need to be removed, the sediments excavated to the levels indicated in the details and the rip -rap pads
replaced.
5. It should be noted chat in addition to the inspection frequencies recommenced above, the pond and its
appurtenances should be inspected after any 131,11jor storm event that may transport large amounts of dCbt'iS to the
pond.
By our signature below, we, as owner/operator/manager/administrator ofthe proposed facility do hereby agree to
perform the above mentioned items and maintain the proposed facility in proper operating condition.
Printed Name Printed Dame
Signature Signature
Printed Name Printed Name
Signature Signature

AW A T ;-- Michael F. Easley, Governor
Off' G William G. Ross, Jr., Secretary
j r .jUN North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
DWQ-WARODivision of Water Quality
SURFACE WATER PROTECTION SECTION
COASTAL STORMWATER PERMIT RENEWAL APPLICATION FORM
I. CURRENT PERMIT INFORMATION:
1. Stormwater Management Permit Number:
2. Permit Holder's name:
3. Signing official's name: tl�„
(person legally responsible for rmit)
4. Mailing address: a City..
State:, ZipCode: a?Phone:, - $•.�� � �a r,�.��— J J
(Are �qd�d tV ber} (Are Code and umber}
5. Project Name:!! �y
6. Location of Project: (street address) pp/ V,, 4 67 f0JI
7. Directions to Project (from nearest major intersection) y�eS /:�, l�i--'- f 140
91. 1 1-1%1V9I I I1191 %01%1WIr,I I I.
I . Specify the type of stormwater treatment (wet pond, infiltration, etc.):
�. List any changes (from project that was originally approved, attach additional pages if needed) 51
3. Do you have a copy of the original Operation and Maintenance Agreement? Yes —No ✓
Applicant's Certification:
I (Print) j4VWEc/14/)EkQ certify that the information included on this
permit renewal 13pplicatibn is .to the b t of my knowledge, correct and complete.
Signature: Date: crp^
Submit this com eted form along with an application fee of $420.00 and a copy of the
designer's certification to the address listed below.
North Carolina Division of Water Quality 943 Washington Square Mali Phone [phone] Customer Service 1-877-623-6748
Washington Regional Office Washington, NC 27889 FAX [phone] Internet: h2o.enrstate.nc.us One (� ,.
Na hCarrQnna
An Equa4 Opportunity/Affirmative Action Employer - 50% Recycied110% Post Consumer Paper ;uturally

66-1224 CHECK# 53215
Carolina Chrysler -Dodge -jeep 531 53215
P.O. Box 1607 • 1001 Halstead Blvd. "Z(/!uu t!u custa«cc� rilcuays eotisea �Gxat "
Elizabeth City, NC 27906-1607
[phone]
PAY FOUR HUNDRED TWENTY DOLLARS AND 00/100*
TO THE
ORDER NC DIVISION OF WATER QUALITY
943 WASHINGTON SQUARE MALL
OF WASHINGTON NC 27889
�.nfevJav Bank
& —1 C.,
DATE AMOUNT
06/02/06 $420.00
Va
rohna Chrysler -Dodd ep
VOID AFTER 90 DAY
AUTHORIZED

NAME NUMBER DATE
NC DIVISION OF WATER QUALITY 06/02/06
NC DIVISION OF WATER QUALITY/PERMIT RENEWAL--
STORMWATER PERMIT NO SW 7960208/CAROLINA CHRYSLER/PASQUOTANK
06/02/06 2220 420.00 1199 STORMWATER PERM-SW7960208
REMITTANCE ADVICE Carolina Chrysler-Dad„� Jeep CHECK NO. NET
DETACH AND RETAIN P.C. BOX 1607
ELIZABETH CITY, N.C. 27906-1607 53215 AMOUNT $420.00
PRECISION PRINTING - ELIZABETH CITY, NC 252.338-2450

Jun 14 06 11:07a
P - 2
Project Name Y i�• l i{X.'•1
�o&Lc JET le I �1-fr1�
Stormwater P No. Still,%•
t` b4Y1�t— County
0 8FXF-0 4ifri
Designer's Certification ,JUN 2 6 2006
1, &On G. b!� as a duty
Registered Professional Engineer in the Skate of Forth Carolina, having been authorized to obsery `_ „R0
(periodicaliyMeekiytfull time) f
the construction of the project, a Chi-q:S r-
b Wg—Dw"Ae PM2 EfQ It (Project)
for 01 I n Q_ t om' l� (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.
OOQ,SN CA%/
SlgilatU �•.QpE851p; .y'1
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2
Regist rL lR,�_ , _ — SEAL
18550
Date
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Carolina Chrysler
401 S. Griffin St
Elizabeth City, NC 27909
Subject PERMIT RENEWAL
Storwater Permit No. SW 7960208
Carolina Chrysler
Pasquotank
Dear Carolina Chrysler,
Miidnel F. P:s1-y, Go-ernor
William G. Ron Jr Secrdavy
North Caroiira Depmtmco1 of Favomment and Nrtnral Resources
Alan W. K imrk, P.i< Dineclor
Division of Wna Quality
The Division of Water Quality issued a Coastal Stormwater Management Permit, Number SW 7960208
to Carolina Chrysler for Carolina Chrysler on 420/1996. This permit expires on 5/1/2006. Section
.1003(h) of 15 A NCAC 2H .1000 (the stom water rules) requires that applications for permit renewals
shall be submitted 180 days prior to the expiration of a permit and must be accompanied by a
processing fee, which is currently set at $420.00. However, if your permit has already expired, you
need to send in your application for renewal as soon as possible_ If this is still an active project please
complete and submit the enclosed renewal application in a timely manner. If this project has not been
constructed and a permit is no longer needed, please submit a request to have the permit rescinded. If
you have sold the project, or are no longer the permittee, please provide the name, mailing address
and phone number of the person or entity that is now responsible for this permit Enclosed is a form for
change of ownership, which should be completed and submitted if the property has changed hands.
Your permit requires that upon completion of construction and prior to operation of the permitted
treatment units a certification of completion be submitted to the Division from an appropriate designer
for the system installed. This is to certify that the permitted facility has been installed in accordance with
the permit, the approved plans, specifications and supporting documentation. Please include a copy of
the certification with your permit renewal request and processing fee. Enclosed is a copy of a sample
certification.
You should be aware that failure to provide the Designer's Certification and the operation of a
stormwater treatment facility without a valid permit are violations of NC General Statute 143-215.1 and
may result in appropriate enforcement action including the assessment of civil penalties of up to
$10,000 per day.
If you have any questions, please feel free to contact me or a member of the coastal stormwater staff with
DWQ at 252-946-6481.
Si cerely,
AI Hodge, Regional Supervisor
Surface Water Protection Section
Washington Regional Office
Enclosures
cc: Consulting Engineer
Washington Regional Office
North Carolina Di%ision of Water Quality Internet: One
943 Washington Sguue Mall Phone [phone] or C a
( 9
Waslington, NC 27n9 Fax [phone] Ql *�

May 15, 2006
Carolina Chrysler
1001 Halstead Blvd
PO Box 1607
Elizabeth City, NC 27909
Subject PERMIT RENEWAL
Stonnwater Permit No_ SW 7960208
Carolina Chrysler
Pasquotank
Dear Carolina Chrysler,
Michael F. FAslcy, Governor
Wittiam G. Ross Jr., Secretary
North Carolina Departrac d of Environment and Natural Resources
Alan W_ Klimdc, P_E Director
Division of Water Quality
RECEIVED
.TUNA-'5 2006
DWQ-WARO
The Division of Water Quality issued a Coastal Stonrnvater Management Permit, Number SW 7960208
to Carolina Chrysler for Carolina Chrysler on 412011996. This permit expires on 5/1/2006. Section
_1003(h) of 15 A NCAC 2H _1000 (the stormwater rules) requires that applications for permit renewals
shall be submitted 180 days prior to the expiration of a permit and must be accompanied by a
processing fee, which is currently set at $420.00. However, if your permit has already expired, you
need to send in your application for renewal as soon as possible. If this is still an active project please
complete and submit the enclosed renewal application in a timely manner. If this project has not been
constructed and a permit is no longer needed, please submit a request to have the permit rescinded. If
you have sold the project, or are no longer the permittee, please provide the name, mailing address
and phone number of the person or entity that is now responsible for this permit. Enclosed is a form for
change of ownership, which should be completed and submitted if the property has changed hands.
Your permit requires that upon completion of construction and prior to operation of the permitted
treatment units a certification of completion be submitted to the Division from an appropriate designer
for the system installed. This is to certify that the permitted facility has been installed in accordance with
the permit, the approved plans, specifications and supporting documentation. Please include a copy of
the certification with your permit renewal request and processing fee. Enclosed is a copy of a sample
certification.
You should be aware that failure to provide the Designer's Certification and the operation of a
stormwater treatment facility without a valid permit, are violations of NC General Statute 143-215.1 and
may result in appropriate enforcement action including the assessment of civil penalties of up to
$10,000 per day.
If you have any questions, please feel free to contact me or a member of the coastal stormwater staff with
DWQ at 252-946-Wl .
Si •erely,
AI Hodge, o 4Lvisor
Surface Water Protection Section
Washington Regional Office
cc: Consulting Engineer
Washington Regional Office
North Carolina Division of Water Quality Internet_ www.newate[quality.org One
943 Washington Square Mail Phone (252) 94G (r48I No Caolina
Washington, NC 27M Fax [phone] awra!!y

W A TF9p Michael F. Easley, Governor
ti William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
p Alan W. Klimek, P.E. Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
COASTAL STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
1. Stormwater Management Permit Number:
2. Permit Holder's name:
3
Signing official's name:
(person legally responsible for permit)
Title:
4. Mailing address: City:
State: ZipCode: Phone: FAX:
(Area Code and Number) (Area Code and Number)
II. NEW OWNER 1 PROJECT 1 ADDRESS INFORMATION
1. This request is for: (please check all that apply)
a. Change in ownership of the property/company (Please complete Items #2,
#3, and #4 below)
b. Name change of project (Please complete Item #5 below)
C. Mailing address change. (Please complete Item #4 below)
d. Other (please explain):
2. New owner's name to be put on permit: _
3. New owner's signing official's name and title:
(Title)
4. New Mailing Address: City:
State: ZipCode:_ Phone:_ _ _FAX:
(Area Code and Number) (Area Code and Number)
5. New Project Name to be placed on permit:
Page 1 of 2
North Carolina Division of Water Quaiity Internet: Nvivw One
943 Washington Square Mall Phone [phone] NorthCarolina
Washington, NC 27889 Fax [phone] % atutall y

PERMIT NAME/OWNERSHIP CHANGE FORM
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY .THE DIVISION OF WATER
QUALITY UNLESS ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED
WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed form.
2. Legal documentation of the transfer of ownership.
3. A copy of the.recorded deed restrictions, if required by the permit.
4. The designer's certification, if required by the permit.
5. A signed Operation and Maintenance plan, if a system that requires maintenance will
change ownership.
6. Maintenance records.
CERTIFICATION MUST BE COMPLETED AND SIGNED BY BOTH THE CURRENT PERMIT
HOLDER AND THE NEW APPLICANT IN THE CASE OF A CHANGE OF OWNERSHIP.
FOR NAME CHANGES, COMPLETE AND SIGN ONLY THE CURRENT PERMITTEE'S
CERTIFICATION.
Current Permittee's Certification:
I, , attest that this. application for a name/ownership
change has been reviewed 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 information and attachments are not included, this application package will be
returned as incomplete.
Signature:
Date:
New Applicant's Certification: (Must be completed for all transfers of ownership)
1, , attest that this application for an ownership
change has been reviewed 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 information and attachments are not included, this application package will be
returned as incomplete.
Signature:
Date:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION AND MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
North Carolina Department of Environment and Natural Resources
Division of Water Quality, SWP
943 Washinton Square Mall
Washington, NC 27889
Page 2 of 2