SW3140903_Application Form_20210809 (2)

Date Received
Fee Paid
Permit Number
STATE STORMWATER:
PERMIT TRANSFER APPLICATION FORM
Pursuant to 15A NCAQ 02H.1045 and other applicable statues as reference within
Only complete applications packages will be accepted and reviewed. This form and the required items (with
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at: htto:tldeq.nc.gov/contactrrecrional-offices.
After this application is accepted, DEMLR will conduct a compliance inspection and report any deficiencies to the
current permittee andlor the proposed permittee. Per the state stormwater rules and the state stormwater permit
conditions, the permit shall not be transferred until:
1. the current permittee resolves all non-compliance issues identified in the inspection report,
2. the current permittee negotiates a resolution with the proposed permittee (in writing and signed by both
entities. The negotiated resolution must identify the necessary actions, the responsible party(ies), and the
timelines to correct the deficiencies. The site must either be found in compliance or a copy of the
negotiated resolution must be submitted prior to the transfer of the permit.); or
3. in the case where a transfer falls under G. S. 143-214,7(c2) (see also SL 2011-256), the proposed
permittee resolves a// non-compliance issues upon acquiring the permit.
Signature requirements for the named signing official (for current and proposed permittee) must meet the following:
® Corporation - a principal executive officer of at least the level of vice-president;
• Limited Liability Company (LLC) - the designated manager; (Documentation from the NC Secretary of
State or other official documentation must be provided that states the titles and positions held by the
person who signed the application (pursuant to 02H. 1040) that shows they have legal authority to sign for
the LLC)
® Municipality - a ranking official or duly authorized employee;
® Partnership or limited partnership - the general partner;
• Sole proprietor;
The signature of the consultant or other agent shall be accepted on this permit transfer application only if
accompanied by a letter of authorization signed by one of the signatories noted in a-e above, as
applicable.
A. GENERAL INFORMATION
1. State Stormwater Permit Number: SW3140903
2. Project name: Oak Grove Estates - Is this an updated project name from the current permit? R Yes No
1 Reason for the permit transfer request:
Developer is transferring common open space management, including BMP maintenance, to the Property
Owner's Association.
Stormv,vater Perrnit Transfer Noplication Form Page 1 of 7 April 27, 2018

B. PERSON(S) WHO HAVE SIGNED THIS FORM (select only one response below)
1. Both the current and proposed peond±mms
[l 2. Only the current permittee of a condominium or planned community (skip Part F & G).
/haccordance with (see also SL2011-258).this type oftransfer /sallowed only
when all ofthe following items can betruthfully checked:
F� Any common areas related to the operation and maintenance of the stormwater management
system have been conveyed to the unit owners' association or owners' association in
accordance with the dac|enation�
.
[] The declarant has conveyed etleast fifty percent (5U96)ofthe units nrlots tnowners other than
a declarant (provide documentation per submittal requirements below);
The sborrnvvabarmanagement system is in compliance with the atormvvabarpermit.
NOTE: If subdivision was built prior to 1999, the Declarant's Attorney can make a determination that
the elements of the Planned Community Act (see §47F) have been met by the Declarant for the
subdivision. If the Declarant chooses to use this type of transfer, the determination must be in
writing, signed by the attorney, and submitted to DEMLR with this form.
3. Only the proposed perrnittee(skip Part Dbo/ow).
/naccordance with.(see also GL20/3-Y2f)'this type oftransfer /oallowed only
when all ofthe following items can betruthfully checked:
Fl a. The proposed pormibeeiseither (select one ofthe /o0owin01:
F7 The successor -owner who holds title to the property on which the permitted activity is
occurring urwill occur;
Fl The successor -owner who is the sole claimant of the right to engage in the permitted
M k The cunentpennittee is (select at least one ofthe following, but all that apply):
n /\ natural person who isdeceased.
El A partnership. Limited Liability Corpnnation, oorponatinn, or any other business
association that has been dissolved
�l Aperson who has been lawfully and finally divested oftitle tothe property onwhich the
permitted activity iaoccurring orwill occur.
Fl A person who has au|d the property on which the permitted activity is occurring or will
occur.
El Other (please explain):
Fl c The proposed permittee agrees to the following requirements (all must be selected):
�l There will bennsubstantial change inthe permitted activity.
�] The permit holder shall comply with all terms and conditions of the permit until such
time aethe permit istransferred.
�l The successor -owner shall comply with all terms and conditions of the permit once the
permit has been transferred.
SiormwaterPexndTnansferApplication Form Page 2oi7 April 27.2O18

C. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark 'X"Jpreviously provided. Ifnot
applicable ornot available, please mark k&4.:
y 1. Aprocessing fee offive hundred and five dollars (85O5.UO)per .
y 2. Two hard copies (with original signatures) and one electronic copy of this completed form and the
required items.
y 3. For proposed permittees that are corporations or LLC's, documentation from the NC Secretary of
State demonstrating that the proposed pernnittee in o legal and viable entity able to conduct
business inNorth Carolina.
y 4. |fPart 8.Items 1or3ofthis form isselected, the signed and notarized
from the proposed permittee,earequired bythe permit.
Y 5. Legal documentation that the property has transferred to the proposed permittee (such as a
recorded deed for the property, uncompleted development and/or common areas) or legal
documentation demonstrating that the proposed permittee is the sole claimant of the right to
engage inthe permitted activity.
y G. If required by the permit and if the project has been built, a signed, sealed and dated certification
document from a licensed professional stating that the sturnnvvmtormanagement system has been
inspected and that ithas been built and maintained inaccordance with the approved plans.
`f 7. A copy of the recorded covenants and deed raetriutiVna, if required by the permit. If the project has
been built, documentation that the maximum allowed per lot built -upon area or the maximum
o||ovved total built -upon area has not been exceeded. If the project has not been bui|t, the new
owner shall provide asigned agreement tosubmit final recorded deed restrictions and protective
covenants.
N/A 8. If transferring under <l*.' pe/f£[ Item 2o/this form /000lecbeo0.
documentation verifying that 50% or more of the lots have been conveyed to individuals (not
builders). Copies of the deeds ofconveyance orochart listing the lot number, lot address,
owner's name, conveyance date and deed book and page number are acceptable.
N/A 9. If transferring under (le.' PadE\ Item 3ufthis form /mne/erbeo). provide legal
documentation supporting the dissolution of the corporation ordocumentation supporting the
current permitteewas lawfully and finally divested oftitle ofthe property.
N/A 1O�Acopy ofthe lease agreement ifthe proposed permitteeinthe lessee.
N/A 11. A copy of the pending sales agreement if the proposed permittee is the purchaser.
N/A 12. A copy of the development agreement if the proposed permittee is the developer.
8tonnwaUarPermit Transfer Application Fonn Page 3of7 April 27.2018

D. CURRENT PERMITTEE INFORMATION AND CERTIFICATION Please be sure to provide Email.
1. Current Permit Holder's Company Nonle/0rganizaUon:
2. Signing Official's Name: William DeForest
3. Signing Official's Title: Land Development Manager
4. Mailing Address: 6701 Carmel Road, Ste. 425
City: p: 28226
5. Street Address: 6701 Carmel Road, Ste. 425
City: p: 28C226
G� Phone (704) :
[ the current pennittee.amsubmitting this
application for atransfer ofownership for the above listed stonnmmterpermit under the General Statute and
Session Law identified on Page 1 of this application. I hereby notify DEMLR of the sale or other legal transfer of
the property/project and/orthestonnvvatersystemassociatedwiththispermit. | have provided acopy ofthe
following documents to the proposed permittee named in this application form: (select all that apply)
F1 the most recent permit;
the designer's oertificobnnforeaohSCW1;
any recorded deed restrictions, covenants, common areas, drainage easements or plats;
the approved plans and/or approved as -built plans;
F-1 the approved operation and maintenance agreement;
past maintenance records from the previous perrnibee(where n*quirod);
�7 acopy ofthe most recent inspection report;
| further attest that this application and request for apermit transfer ieaccurate and complete tnthe best of my
knowledge. I attest that I have provided all of the required items per the law to transfer this permit. |understond
that if all required parts of this request are not completed or if all required supporting information and attachments
listed above are not included, this request package willb td as incomplete I i U rights and
obligations as permittee to the pr sed permittee named below. I understand that this request to transfer the
permit may not b --approve h DBVILR unless and until the facility is in compliance with the permit.
a Notary Public for the State of
' ��
� ount of dohereby certify
\_O�_s personally appeared before me
and acknowledge the due
Vt%O
execut* rg 1 ftstrument. Witness my hand and official seal,
Nota
/u`»^»p'My commission expires �5 q—
|
SNrmwaterPennhTransfer AppUcadonForm Page 4of7 8ph{27.2O18

E. PROPOSED PERMIT TEE INFORMATION
1. The proposed permittee is the:
Fj Property owner (Also complete Part F.)
Horne Owners Association (HOA), Property Owners Association (POA)j or Unit Owner Association
(UOA) (Also complete Part F.)
F] Lessee - Attach a copy of the lease agreement. Both the lessee and the property owner will appear on
the permit as co-permittees. If the lease is terminated, responsibility for the permit reverts to the property
owner. (Also complete Parts F & G.)
❑ Purchaser - Attach a copy of the pending sales agreement The permit will require submission of a copy
of the recorded deed after the purchase has taken place. If the purchase agreement is cancelled the
permit reverts to the property owner. (Also complete Parts F & G.)
❑ Developer - Attach a copy of the development agreement. Both the developer and the property owner
will appear on the permit as co-permittees. If the development agreement is terminated, responsibility for
the permit reverts to the property owner. (Also complete Parts F & G.)
2. Proposed permittee name (check one of the following and provide the name):
❑ Corporation, LLC, Partnership, Municipality name:
HOA / POA / UOA name: Oak Grove Estates Owners Association, Inc.
F] Sole Proprietor
3. Proposed permittee contact information:
Please be sure to provide Email.
a. Signing Official's Name: Justin Demers
b. Signing Official's Title: Board President
c. Mailing Address: 5127 Oak Grove Place
City: Waxhaw State: NC ZIP: 28173
Street Address: same
City: State: ZIP:
Phone: [phone] Email: [e-mail]
4. If there is a Management Entity that manages the property for an HOA, PDA or UOA, please provide:
Please be sure to provide Email.
a. Management Company or Business name: Cedar Management Group
b. Contact Name: Aubry Larkin Title: Area Manager
c. Mailing Address: 9500 Statesville Road
d. City: Charlotte State: NC ZIP: 28269
e. Phone: [phone] Email: alarkin(a)mycmq.com
Stormwaier Permit Transler Application Fort-ri ppCe ��f 7
0
AL01 27, Z 18

F. PROPOSED PERMITTEE CERTIFICATION
1, Justin Demers, on behalf of Oak Grove Estates Owners Association, Inc. , hereby notify the DEMLR that I
have acquired through sale, lease, development agreement, or other legal transfer, the project/property covered
by the stormwater management permit and/or the responsibility for constructing and/or operating and maintaining
the permitted stormwater management system. I acknowledge and attest that I liave- received 'a c"`lJ'«bf
that apply):
Z the most recent permit;
Z the designer's certification for each SCK8;
Z any recorded deed restrictions, covenants, common areas, drainage easements or plats;
Z the approved plans and/or approved as -built plans;
Z the approved operation and maintenance agreement;
F-1 past maintenance records from the previous pernoittee(where naquired);
F-1 acopy ofthe most recent inspection report;
[� Check here if the proposed pernittemagrees to1mthe entity responsible for addressing any compliance
issues outlined in the Compliance Inspection Report. If checked, the proposed permittee must provide a
written document statement, with a "plan of action and schedule" addressed to this office stating that they will
bring the project into compliance upon receipt ofthe transferred permit. This written "plan o[action and
schedule" must be received by the Division before the Division will transfer the permit.
| have reviewed the it, approved plans and other documents listed above, and | acknowledge that |will
approved plans; and I will {construc , perate and maintain the approved stormwater management system
pursuant to the rT-quirement li i ermit and in the operation and maintenance agreement.
Signature: Date:
�ka�lOIL) L-2livi a Notary Public for the S
l late of
County ion �do hereby certify that J b(_5-Hrl T_:�& WUU--�S
Notary
-...' /
Mycommission expires
StonrmvaterPennUTransfer Application Form Page 8of7 April 27.2O10

G. PROPERTY OWNER{NFORK8ATiON AND CERTIFICATION
Fill out this section only if the property owner is different from the proposed permittee. The permit will revert to
the property owner if the purchase agreement, development agreement or lease expires or is terminated.
CompanyName/Organization:
Signing Official's Printed Name: Justin Demers
Signing Official's Title: Board President
Mailing Address:
City: Waxhaw State: p: 28173
|
, Justin Demers on behalf of Oak Grove Estates Owners Association, Inc , hereby certify that I currently own
the property identified in this permit transfer document and acknowledge that the Proposed Permittee listed in
Part F will be purchasing the property, developing the property on my behalf, and/or leasing the property from me.
A copy of the purchase agreement, development agreement or the lease agreement, which names the party
responsible for the construction and/or operation and maintenance of the stormwater system, has been provided
with the permit transfer request.
bagree tonotify DEKALRwithin 30days if there are any changes to the purchase,developer orlease agreements
and will submit the applicable completedand signed Pennit!nfonnoUonUpdoteFonn.orPennitTronsfer
Application Form toaddress these changes. As the legal property owner, | ocknow|edge, undenatand, and agree
by my signature below, that the permit will revert to me and I will be responsible for complying with the DEMLR
Stormwater permit if the property purchase, lease or developer agreement/contract is cancelled or defaults. I
understand that any individual urentity found tobein,liance withth i i of the bo bo
management permit or the stormwaler_, n as set forth in NC General Statute
Signature of the property owner
T, a Notary Public for the State of
County 1,4-AJI)n —,do hereby certify that
V1_ personally appeared before me this the day of
"prid acknowledge the due execution of the forgoing instrument. Witness
Alp
my hand and official dear,
(Notary Seal)
LIC
Notary Signature J01.1
My commission expires
SkonnsaterPermit Transfer Application Form Page 7cif 7 Aph|27.2O18