SW8121102_CURRENT PERMIT_20121108

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW ,/. //OA
DOC TYPE
URRENT PERMIT
rAPPROVED
PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
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YYWMMDD

r NCDEE R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
November 8, 2012
Jimmy McCotter, President
Triangle Plaza, Inc.
Post Office Box 12951
New Bern, NC 28561
Subject; State Stormwater Management Permit No. SW8121102
Traifwood Section IV
Low Density Subdivision Permit
Onslow County
Dear Mr. McCotter:
The Wilmington Regional Office received a complete Stormwater Management Permit Application for
TrailWood Section N on November. Staff review of the plans and specifications has determined that the
project, as proposed, will comply with the Stormwater Regulations set forth in Session Law 2008-211 and
Title 15A NCAC 2H.1000. We are forwarding Permit No. SW8121102, dated November 8, 2012, for the
construction of the built -upon area associated with the subject project.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
conditions and limitations as specified therein, and does not supersede any other agency permit that may
be required. Please pay special attention to the conditions listed in this permit regarding the Operation and
Maintenance of the BMP(s), recordation of deed restrictions, certification of the project, procedures for
changes of ownership, and transferring the permit. Failure to establish an adequate system for operation
and maintenance of the stormwater management system, to record deed restrictions, to certify the project
or to transfer the permit in a timely manner, 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 adtudicatory hearing by filing a written petition with the Office of Administrative Hearings (OAH).
The written petition must conform to Chapter 150B of the North Carolina General Statutes, and must be
filed with the OAH within thirty (30 dayys of receipt of this ermit. You should contact the OAH with all
questions regarding the filing fee (if a tiling fee is requireclMd/or the details of the filing process at 6714
Mail Service Center, Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at
www.NCOAH.com. Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please contact Chris
Baker at [phone].
Sincerely,
/-For Charles''Wakild, P. E., Director
Division of Water Quality
GDSlcsb; S -\WWSto rmwater\Perm its & Projects120121121102 LD12012 11 permit 121102
cc: Athan Parker, E. I., Parker & Associates, Inc.
Onslow County Building Inspections
Wilmington Regional Office Stormwater File
Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405 T�TOne
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 NO hCarolina
Internet: www.ncwaterquality.org Natural!
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State Stormwater Management Systems
Permit No.SW8 121102
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
LOW 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
PERMISSION IS HEREBY GRANTED TO
Triangle Plaza, Inc.
Trailwoods Section IV
Lee Rogers Road, Hubert, Onclow County
FOR THE
construction, operation and maintenance of a 12% low density subdivision in compliance
with the provisions of Session Law 2008-211 and 15A NCAC 2H .1000 (hereafter
collectively and separately 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.
The Permit shall be effective from the date of issuance until rescinded and shall be subject
to the following specific conditions and limitations:
I. DESIGN STANDARDS
Each of the 5 lots is limited to a maximum of 3,382 square feet of built -upon area
(BUA), as indicated in the application and shown on the approved plans
2. The overall tract built -upon area percentage for the project is limited to a maximum
of 12% per the requirements of the stormwater rules. This permit covers the
construction of a total of 20,768 square feet of built -upon area, square feet of BUA.
3. Approved plans and specifications for projects covered by this permit are
incorporated by reference and are enforceable parts of the permit.
4. Projects covered by this permit will maintain a minimum 50-foot-wide vegetated buffer
adjacent surface waters, measured horizontally from and perpendicular to the normal
pool of impounded structures, the top of bank of each side of streams and rivers, and
the mean high water line of tidal waters.
5. All runoff directed into and through the vegetative buffer must flow through the buffer
in a diffuse manner. All runoff directed into wetlands shall flow into and through the
wetlands at a non -erosive velocity of 2 feet per second or less.
6. The only runoff conveyance systems allowed will be vegetated conveyances such as
swales with minimum side slopes of 3:1 (H:V) as defined in the stormwater rules and
approved by the Division.
Page 2 of 5

State Stormwater Management Systems
Permit No.SW8 121102
II. SCHEDULE OF COMPLIANCE
1. Swales and other vegetated conveyances shall be constructed in their entirety,
vegetated, and be operational for their 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
swales or other vegetated conveyances will be repaired immediately.
3. The permittee shall at all times provide and perform the necessary operation and
maintenance as specified in the signed Operation and Maintenance Agreement, such
that the permitted stormwater management system functions as designed and
permitted.
4. 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 of the items shown on the approved plans, including the
stormwater management system, design concept, built -upon area, details, etc.
b. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
C. Further subdivision, acquisition, or selling of the project area.
d. Filling in, altering or piping any vegetative conveyance shown on the approved
plan.
e. Construction of any future development area on the plan with a BUA
allocation.
5. The permittee shall submit all information requested by the Director or his
representative within the time frame specified in the written information request.
6. No piping shall be allowed except that minimum amount necessary to direct runoff
beneath an impervious surface such as a road and that minimum amount needed
under driveways to provide access to lots.
7. The permittee is responsible for verifying that the proposed built -upon area does not
exceed the allowable built -upon area. Once the lot transfer is complete, the
maximum allocated built -upon area for the lot may not be revised without approval
from the Division of Water Quality. If the allocated maximum built -upon area on the
lot is exceeded without approval of the permittee and the Division, the lot owner is
subject to enforcement action by the Division of Water Quality.
8. Within 30 days of completion of the project, the permittee must certify in writing that
the project's stormwater controls, and impervious surfaces have been constructed
within substantial intent of the approved plans and specifications. Any deviation from
the approved plans must be noted on the Certification.
9. If the permittee sets up an Architectural Review Committee or Board to review new
lot plans and subsequent modifications for compliance with the restrictions, the plans
reviewed must include all built -upon area (BUA) and piping. Any approvals given by
the Committee or Board on behalf of the permittee do not relieve the lot owner or the
permittee of the responsibility to maintain compliance with the permitted lot BUA limit.
Page 3 of 5

State Stormwater Management Systems
Permit No.SW8 121102
10. Deed restrictions are incorporated into this permit by reference and must be recorded
with the Office of the Register of Deeds prior to the sale of any lot. Recorded deed
restrictions must include, as a minimum, the following statements related to
stormwater management:
a. The following covenants are intended to ensure ongoing compliance with State
Stormwater Management Permit Number SW8 121102, as issued by the
Division of Water Quality under NCAC 2H.1000.
b. The State of North Carolina is made a beneficiary of these covenants to the
extent necessary to maintain compliance with the Stormwater Management
Permit.
C. These covenants are to run with the land and be binding on all persons and
parties claiming under them.
d. The covenants pertaining to stormwater may not be altered or rescinded
without the express written consent of the State of North Carolina, Division of
Water Quality.
e. Alteration of the drainage as shown on the approved lans may not take place
without the concurrence of the Division of Water Quality.
f. The maximum built -upon area per lot is 3,382 square feet. This allotted
amount includes any built -upon area constructed within the lot property
boundaries, and that portion of the right-of-way between the front lot line and
the edge of the pavement. Built upon area includes, but is not limited to,
structures, asphalt, concrete, gravel, brick, stone, slate, and coquina, but does
not include raised, open wood decking, or the water surface of swimming
pools.
g. Filling in or piping of any vegetative conveyances (ditches, swales, etc.)
associated with the development except for average driveway crossings, is
strictly prohibited by any persons.
h. For those lots adjacent to surface waters, each lot will maintain a minimum 50
foot wide vegetated buffer adjacent surface waters.
i. All roof drains shall terminate at least 50 feet from surface waters.
11. The permittee shall submit a copy of the recorded deed restrictions, which contain all
of the above statements, within 30 days of the date of recording.
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. All stormwater conveyances will be located in either a dedicated right-of-way (public
or private), recorded common areas or recorded drainage easements. The final plats
for the project will be recorded showing all such required rights -of -way, common
areas and easements, in accordance with the approved plans.
III. GENERAL CONDITIONS
Failure to abide by the conditions and limitations contained in this permit may subject
the Permittee to an enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statutes 143-215.6A to 143-215.6C.
2. The permit issued shall continue in force and effect until modified, revoked or
terminated.
3. The permit may be modified, revoked and reissued or terminated for cause. The filing
of a request for a permit modification, revocation and re -issuance, or termination
does not stay any permit condition.
Page 4 of 5

State Stormwater Management Systems
Permit No.SW8 121102
-- ' 4. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit as
allowed by the laws, rules, and regulations contained in Title 15A of the North
Carolina Administrative Code, Subchapter 2H.1000; and North Carolina General
Statute 143-215.1 et. al.
5. The permit is not transferable to any person or entity except after notice to and
approval by the Director. The Director may require modification or revocation and re -
issuance of the permit to change the name and incorporate such other requirements
as may be necessary. At least 30 days prior to a change of ownership, or a name
change of the permitte or of the project, or a mailing address change, the permittee
shall submit a completed and signed Name/Ownership Change Form to the Division
of Water Quality accompanied by the supporting documentation as listed on the form.
The approval of this request will be considered on its merits, and may or may not be
approved.
6. The permittee is responsible for compliance with all permit conditions until such time
as the Division approves the permit transfer request. Neither the sale of the project
nor the conveyance of common area to a third party constitutes an approved transfer
of the stormwater permit.
7. 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. If any of
those permits result in revisions to the plans, a permit modification must be
submitted.
8. The permittee grants permission to DENR Staff to enter the property during business
hours for the purposes of inspecting the stormwater management system and its
components.
9. Unless specified elsewhere, permanent seeding requirements for the swales must
follow the guidelines established in the North Carolina Erosion and Sediment Control
Planning and Design Manual.
Permit issued this the 8th day of November, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
` ------------- _ - --------------------
for Charles Wakild, P. E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5 of 5

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
Z
Applicable Rules: ❑ Coastal SW —1 95 ❑ Coastal SW -- 2008 ❑ Ph R - Post Construction
(select all thatapply)❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
Trailwoods Section IV
2. Location of Project (street address):
202 Lee Rogers Rd.
City: Hubert County:Onslow
Zip:28539
3. Directions to project (from nearest major intersection):
Headine West from Swansboro on NC Hwv 24 towards Iacksonville, turn right onto Hubert Boulevard.
Go 0.71 miles, turn right onto Parkertown Road, go 0.61 miles, turn left onto Lee Rogers Road, project
entrance is approximatly 0.5 miles on the right,
4. Latitude:34° 43' 56" N Longitude:77° 13' 20" W of the main entrance to the project.
H. PERMIT INFORMATION:
1.a.Specify whether project is (check one): ®New ❑Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* 'provide a designer's
certification
2. Specify the type of project (check one):
®Low Density []High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the Stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a.Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major
®Sedimentation/Erosion Control: 2.92 ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit
Number, issue date and the type of each permit:
Form SWU-101 Version 07Jun2010
RECEI 7—E
NOV 0 5 2012
Page 1 of 6
BY:

III. CONTACT MORMATION
I. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization.-Triangle Plaza Inc.
Signing Official & Title:limmy McCotter, President
b.Contact information for person listed in item 1a above:
Street Address:4503 West Fairwav Drive
City:New Bern State:NC Zip:28562
Mailing Address (if applicable): P. 0. Box 12951
City:New Bern State:NC Zip:28561
Phone: (252 ) 671-3333 _ Fax: (252 ) 638-3989
Email:
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a
and 2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
City:
State:
State:
Phone: ( ) Fax:
Email:
Zip:
Zip:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
Email:
4. Local jurisdiction for building permits:
Point of Contact:
State:
Fax:
Phone #:
Zip:
5
Form SWU-101 Version 07Jun2010 Page 2 of 7
NOV U 5 2012

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater treatment is provided under the low densitv option of the Coastal Stormwater Rules for "Other
Coastal Development". The project does not exceed the allowable 12% impervious area and stormwater
runoff is transported by roadside ditches that outlet to an existing road side ditch on Lee Rogers Rd.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW —1995 ❑ Ph II — Post Construction
3. Stormwater runoff from this project drains to the White Oak
4. Total Property Area: 3.97 acres
River basin.
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) —Total Coastal Wetlands Area (5) —Total Surface Water Area (6) = Total Project
Area*:3.97 acres
Total project area shall be calculated to exclude the following,- the normal pool of impounded structures,
the area between the banks of streams and rivers, the area below the Normal High Water (NHW) line or
Mean High Water (MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The
resultant pro1ectarea is used to calculate overall percent built upon area (BUA). Non -coastal wetlands
landward of the NNW (or MHW) line may be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 12 Y�
9. How many drainage areas does the project have? 1 (For high density, count I for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each
area provided in the same format as below.
ED
NOV a 5 2012
Form SWU-101 Version Mun2010 Page 3 of 7

Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
Receiving Stream Name
UT to Queens
Creek
Stream Class *
SA; HQW
Stream Index Number *
19-41-16
Total Drainage Area (sf)
173,096
On -site Drainage Area (sf)
173,096
Off -site Drainage Area (sf)
0
Proposed Impervious Area**
(sf)
20,768
% Impervious Area** (total)
12
Impervious" Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
On -site Buildings/Lots (so
16,910
On -site Streets (so
3,858
On -site Parking (sf)
On -site Sidewalks (so
Other on -site (so
Future (so
Off -site (so
Existing BUA*** (so
Total (sf):
20,768
Stream Class and Index Number can be determined a t:
http://portalncdet7r.orb/web/n zps/cstr/classificaLions
�* Impervious area is defined as the built upon area mchtding, but not limited to, buildings, roads, parking
areas, side walks, gra vel areas, etc.
***Report only thatamottnt of existing BUA that will remain after development Do not report arty existing
BUA that is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation.
Projects in Union Coun : Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent slo mwuter requirements us per NC4C 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUMEMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ). A
complete package includes all of the items listed below. A detailed application instruction sheet and BUT
checklists are available from http://portaI.ncdenr.org/web/wq/ws/su/statesw/forms_docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be found
by locating project on the interactive online map at http://L)ortil.ncdciir.org/web/­wq/­ws/­su/­­mips.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.iicdenr.org/web/wq/WS/SLI/St-,ltesw/­"fornis docs,
Ini 'al
1. Original and one copy of the Stormwater Management Permit Application Form,
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated)-and.O&M
agreement(s) for each BMP. kice'' C-EI E13
NOV D 5 Z012
Form SWU-101 Version 071un2010 Page 4 of 7
BY:

4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://www.envhelp.org/pages/onestopexpress.htmI for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary include the'/z
mile radius on the map.
T Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 3642 Page No: 837
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC _
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 2H.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http://www.secretary.state.nc.ti,,;/Corporations/CSearch.aspx
Form SWU-101 Version 07.1un2010 Page 5 of 7
--R
NOV 0 5 2012
BY:

V11. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from
littp://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. Download the latest versions for each
submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed on
the forms available on the website, that the covenants will be binding on all parties and persons claiming under
them, that they will run with the land, that the required covenants cannot be changed or deleted without
concurrence from the NC DWQ, and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Athan M. Parker EI
Consulting Firm: Parker & Associates, Inc.
Mailing Address:306 New Bridge Street
Cityaacksonville State:NC Zip:28540
Phone: (910 ) 455-2414 Fax: (910 ) 455-3441
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item la) with (print or type name of organization listed
in Contact Information, item la) to develop the project as currently proposed. A copy
of the lease agreement or pending property sales contract has been provided with the submittal, which indicates
the party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version 07Jun2010 Page 6 of 7
RECEIVED
NOV U 5 2012
BY:

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my
designated agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or
defaults on their lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater
permit reverts back to me, the property owner. As the property owner, it is my responsibility to notify DWQ
immediately and submit a completed Name/Ownership Change Form within 30 days; otherwise I will be
operating a stormwater treatment facility without a valid permit. I understand that the operation of a
stormwater treatment facility without a valid permit is a violation of NC General Statue 143-215.1 and may
result in appropriate enforcement action including the assessment of ciru it penalties of up to $25,000 per day,
pursuant to NCGS 143-215.6.
Signature:__._ - _ Date:
I, , a Notary Public for the State of . County of
do hereby certify that
before me this _ day of
personally appeared
. and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of peurson listed in Contact Information, item 1a) Kathy Carter
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000, SL 2006-246 (Ph. II — Post Construction) or SL 2008-211.
Date:/._z
M TV.,"' ulr a [Votary Public for the State of AA -k41 C l-rvl, All , County of
+-A ✓ P do hereby certify that K �1rlVUw I C6 k4Uf- personally appeared
before me this day of Q C h he, and i7wled e the due execution /,of the application for
a stormwater permit_ Witness my hand and official seal, ""`'�1
N MY �r
COMMISSION EXPIRES
1124/2017
=rn AUBL�G w�
SEAL
My commission expires
form SWU-101 Version 07Jun2010 Page 7 of 7
/)"�—'c/ /.,Pl 0)
�±-L CEIVED
NOV U 5 2012
l-Y: