20050732 Ver 16_More Info Received_20100425

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North Carolina Department of Environment and Natural Resources
Division Of Water QUality
401 WATER QUALITY CERTIFICATION AND/OR STORMWATER
MANAGEMENT PLAN NAME/OWNERSHIP CHANGE FORM
i. CURRENT PERMIT/CERTIFICATION/SMP INFORMATION
1. Project Name: Briar Chapel
2. DWQ Project Number (Include applicable version(s)): 05-0732
3. Certification/SMP Approval Issued To: Newland Communities
4. Signing Officials Name: Mr. Mitch Barron
(Person legally responsible for permit)
5. Mailing Address: Street 5850 Fayetteville Road, Suite 201
City: Durham
Phone:
State: NC_ Zip: 27713
Fax:
U. NEW PROJECT NAME/OWNER INFORMATION
1. This request is for : (please check all that apply)
a. ? Change in ownership of property/company
b. ? Change of project/company name
c. Z Mailing address change
d. ® Other (please explain - this may include change in the responsibility of an aspect
of the project such as Stormwater BMP Management): Change in owner name (same
owner, just name change), signing officials name, & owner address
2. New owner's name to be put on the 401 Certification/SMP approval: NNP - Briar Chapel,
LLC
3. New owner's signing official's name and title: Mr, William Mumford PE
(Person legally responsible for permit)
4. New mailing address (where applicable): Street 16 Windy Knoll Circle
City: Chapel Hill
Phone: [phone]
State: NC _ Zip: 27516
Fax: [phone]
5. New project/company name to be placed on approval (if applicable):
III. REQUIRED ITEMS FOR 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):
Initials
1. This completed form;
2. Legal documentation of the transfer of ownership;
3. A copy of the recorded deed restrictions, if required by permit/certification/approval;
4. The designer's certification/certificate of completion
(for all work requiring the supervision of a professional engineer, landscape architect or surveyor, please
have the certified professional complete the last section of the Certificate of Completion);
5. A signed Operation and Maintenance Plan, if a stormwater management plan (SMP)
system that requires maintenance will change ownership.
6. Applicable maintenance records.
IV. CERTIFICATION
Complete only item 1 below where only a name change is involved. All transfer of
ownership applications must complete both items.
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1. Current Owner's/ Permittee's Certification:
/'--17-0 , attest that this application for a name/ownership change has been reviewed and
k.?rw? S is accurate and complete to the best of my knowledge. I understand that if all required
MOMI:6tpparts of this application are not completed and that if all required supporting information
and attachments are not included, this application will be returned as incomplete.
Signature: / Llw- _ Date: 4-zr,"? Q
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2. New Owner's/Permittee's Certification:
1, , 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 will be returned as
incomplete.
Signature: Date:
The entire application package should be mailed to:
NCDENR Division of Water Quality
401 Wetlands/Express Permitting Unit
2321 Crabtree Blvd, Suite 250
Raleigh, NC 27604