SW5100602_CURRENT PERMIT_20181107

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW-5/(%(�p(�
DOC TYPE
in CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
//O %
YYYYMMDD
I

ROY COOPER NORTH CAROLINA
Governor Envtronnentat Quality
MICHAEL S. REGAN
Secretary
WILLIAM E. (TOBY) VINSON, JR.
Interim Director
November 7, 2018
Mr. Kevin McGuinness
ABB Inc.
305 Gregson Drive
Cary, NC 27511
Subject: Stormwater Permit No. SW5100602
ABB Inc. Expansion
Edgecombe County
Dear Mr. McGuinness:
The Division of Energy, Mineral and Land Resources (DEMLR), received a complete Stormwater
Management Permit Application for the subject project on October 8, 2018. Staff review of the plans and
specifications has determined that the project, as proposed, will comply with the Stormwater Regulations
set forth in Title 15A NCAC 02H .1000. We are forwarding Permit No. SW5100602, dated November 7,
2018, for the construction, operation and maintenance of the subject project and the stormwater system.
This permit shall be effective from the date of issuance until November 7, 2026, or until rescinded and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.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings
(OAH). The written petition must conform to Chapter 150E of the North Carolina General Statutes. Per
NCGS 143-215(e) the petition must be filed with the OAH within thirty (30) days of receipt of this
permit. You should contact the OAH with all questions regarding the filing fee (if a filing fee is required)
and/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.
After 30 days, this project will be kept on file at the Raleigh Regional Office. If you have any questions,
or need additional information concerning this matter, please contact Corey Anen at [phone]; or
[e-mail].
Sincerely,
da j d deti ted Cry Rldlartad
for William E. Toby Vinson, Jr., PE, CPESC, CPM
cc: SW5100602 File, Raleigh Regional Office
cc: J. Michael Stocks, PE — Stocks Engineering
North Carolina Department of Environments]Quality I Division of Energy. Mineral and Land Resources
512 North Salisbury Street 1 1612 Mall Service Center I Raleigh North Carolina 27699-1612
919.707.9200

State Stormwater Permit
Permit No. SW5100602
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
STATE STORMWATER MANAGEMENT PERMIT
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
ABB Inc.
for
ABB Inc. Expansion
3022 NC Highway 43 N, Pinetops, NC
Edgecombe County
FOR THE
construction, operation and maintenance of the Stormwater Control Measures (SCM) in
compliance with the provisions of 15A NCAC 02H .1000 (hereafter referred to as the
"stormwater rules') and the approved stormwater management plans, specifications and
other supporting data as on file with and approved by the State and considered a part of
this permit.
This permit shall be effective from the date of issuance until November 7, 2026, 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. The SCM is approved for the management of stormwater runoff as described in the
application documents and as shown on the approved plans.
3. All stormwater collection and treatment systems must be located within a dedicated
common areas or recorded easements. The final plats for the project will be
recorded showing all such required easements, in accordance with the approved
plans.
4. The runoff from all built -upon area within the permitted drainage area of this project
must be directed into the SCM.
5. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
II. SCHEDULE OF COMPLIANCE
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
Page 1 of 4

State Stormwater Permit
Permit No. SW5100602
The permittee shall at all time provide the operation and maintenance necessary to assure
every SCM functions at optimum efficiency. The approved Operation and Maintenance
Plan must be followed in its entirety and maintenance must occur at the scheduled
intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader, filter
media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
2. Records of maintenance activities must be kept for the SCM. The reports will
indicate the date, activity, name of person performing the work and what actions
were taken. The owner shall keep maintenance records and these shall be available
upon request by the party responsible for enforcing the stormwater program under
which the SCMs were approved.
3. The permittee shall submit an annual summary report of the maintenance and
inspection records for the SCM. The report shall summarize the inspection dates,
results of the inspections, and the maintenance work performed at each inspection.
4. The SCM shall be constructed in accordance with the approved plans and
specifications, the conditions of this permit, and with other supporting data.
5. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received from
an appropriate designer for the SCM certifying that it has been installed in
accordance with this permit, the approved plans and specifications, and other
supporting documentation. Any deviations from the approved plans and
specifications must be noted on the Certification. A modification may be required for
those deviations.
6. SCMs impacted by sedimentation and erosion control during the construction phase
shall be cleaned out and converted to its approved design state.
7. 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 item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project area.
The project area is defined as all property owned by the permittee, for which
Sedimentation and Erosion Control Plan approval was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
A copy of the approved plans and specifications shall be maintained on file by the
Permittee for a minimum of eight years from the date of the completion of
construction.
Page 2 of 4

State Stormwater Permit
Permit No. SW5100602
9. 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.
10. All SCMs and associated maintenance accesses on privately owned land except for
those located on single family residential lots shall be located in permanent
recorded easements. The SCM shall be shown and labeled within the easement.
These easements shall be granted in favor of the party responsible for enforcing the
stormwater program under which the SCMs were approved. SCMs must have
access and maintenance easements to provide the legal authority for inspections,
maintenance personnel and equipment. The entire footprint of the SCM system
must be included in the access and maintenance easement, plus an additional ten
or more feet around the SCM to provide enough room to complete maintenance
tasks. This SCM system includes the side slopes, forebay, riser structure, SCM
device, and basin outlet, dam embankment, outlet, and emergency spillway.
11. The O&M Agreement shall be referenced on the final plat and shall be recorded with
the County Register of Deeds upon final plat approval. If no subdivision plat is
recorded for the site, then the O&M Agreement shall be recorded with the county
Register of Deeds so as to appear in the chain of title of all subsequent purchasers.
III. GENERAL CONDITIONS
1. This permit is not transferable except after notice to and approval by the Director. In
the event of a change of ownership, or a name change, the permittee must submit a
completed Name/Ownership Change form signed by both parties, to the State,
accompanied by the supporting documentation. The approval of this request will be
considered on its merits and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such time
as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the State, in accordance with North
Carolina General Statute 143-215.6A to 143-215.6C.
4. 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) having jurisdiction.
5. 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.
6. The permittee grants DEQ Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated. 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 3 of 4

State Stormwater Permit
Permit No. SW5100602
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference and
are enforceable parts of the permit.
10. 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 Session Law 2006-246, Title
15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division in writing of any name, ownership or mailing
address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 7'h day of November, 2018.
Ot4,w B 44"� d 4 R[cls"d Z. Redd& 9h,
for William E. Vinson, Jr., P.E., CPESC, CPM
Interim Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

. -
DFMI.A USE ONLY
Dale I2cceivd
Fee Paid
Permit Number
w as
s
w vo6 2 MOD -
Applicable Rules:
(select all that apply)
0 Coastal SW - 1995 ❑ Coastal SW - 2008 ❑ I'll 11 - Post Construction
❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M >mt Plan:
State of North Carolina n � Department of
DeDepartment of Environment and Natural Resources Environmental Quality
P Received
Division of Energy, Mineral and Land Resources OCT U 2
zcss
STORMWATER MANAGEMENT PERMIT APPLICATION FORM Winston-Salem
Uiis fornn may be photocopiedfir use as an original
Regional Office
1. 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.): 9
A1313power T&DCompany Expansion � C_14/pr)
2. Location of Project (street address): GCT 08 &16
3022 NC Hwy 43 N
-, "-mNU
LITy
City:Pinetops County:Edy>ecombe `'1C7ip277864oc�A_
3. Directions to project (from nearest major intersection):
At intersection of NC 1-Iwv 42 and NC Hwy 43, head north on NC Hwy 43 (North 3111 St) for 0.8 miles and
4. Latitude:35' 48' 09.07" N L.ongitude:77' 38' 29.01" W of the main entrance to the project.
IL PERMIT INFORMATION:
1.a.Specify whether project is (check one): ❑New ®Modification ❑ Renewal w/ Modification!
f Renewals With modifications also requires SIIVII-102 - Renewal Application Fonn
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberSW5100602 , its issue date (if known)6-25-2010 , 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
DEMLR requesting a state stormwater management permit application, list the stornnvater 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: _
❑NPD13S Industrial Stormwater ❑404/401 Permit: Proposed Impacts
ac of Disturbed Area
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 permitErosion Control AI3B Power -I'&D Company Expansion, EDGEC-20'19-
003 September 28, 2018
5. Is the project located within 5 miles of a public airport? ®No ❑Ye
If yes, see S.L. 2012-200, Part Vl: httl2://12ortal.ncdenr.org/web/ir/rules-and-regulations
V
Form SWU-101 Version Oct. 31, 2013 Page 1 of 6

Ill. CONTACT INFORMATION
1. 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:ABB Power T & D Co. Inc
Signing Official & Title:Kevin McGuinness, Col', — Indirect Material and Services. SCM
b.Contact information for person listed in item la above:
Street Address:305 Gregson Drive
State:NC Zip:27511
Mailing Address (if
Phone: (252 ) 827-2121 Fax:
L'nnail: kevin. [e-mail]
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: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( 1
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:
Phone: ( ) Fax:
4. Local jurisdiction for building permits: Pmetops
Point of Contact:Natalie Bess Phone #: (252 ) 827-4435
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The existing stormwater pond will not be modified. Only impervious area allotment will be revised to
incorporate the new building addition.
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 PUDApproval Date:
❑ Valid Building Permit Issued Date:
Other: Date:
b.If claiming vested rights, identify the regulatton(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 Tar -Pam River basin.
4. Total Property Area: 26.24 acres 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':
26.24 acres
Total project area shall becalculated to exclude the following the nornnal pool of imppounded 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 zetlands landzoard from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon aica (BUA). Non -coastal wetlands landward of the NNW (or MHW) line may be
included in the total project area. I I'
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =,16.8 %
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stornuvater BMP. For low density and other projects, use 1 for the whole property area) i
10. Complete the following information for each drainage area identified in Project Information item 9. If there r
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.
Basin Information.. ,..-, , - ., -
Drains eArea 1,
I�rsina 'e Aiea_,
DrainseArea
__ .
Drains e,,Area
Receiving Stream Name
UN Trib to
Town_Creek
,
Stream Class
C:NSW
Stream Index Number *
28-83
Total Drainage Area (so
442,572
On -site Drainage'AeeA (so
442,572
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
250,795
Im ervious Area** (total)
21.9%
Im ervious"" Surface Area - , .,
Drainage Area P
_
Drama e,.�Area _
Drains eArea_ t L
Drains e Are_ _a'_
On -site Buildings/Lots (so
57,600
On -site Streets (so
0
On -site Parking (so
57,738
On -site Sidewalks (so
1,115
Other on -site (so
92,654,
Future (so
41,688
Off -site (so
• 0, •
Existing BUA*** (so
0;(Post 1994),.
Total (so:
1 250,795
* Stream Class and Index Nianber can be deteriiiined at: httn://nortaLncden'r.org'/zueb/ziiq/ps/csu/clnssif cations
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidezvalks, gravel areas, etc.
Report only that muount of existing BUA that will remain r fter development. Do not report any existing BUA that is
to be rentoved and which Will be replaced by neza BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stornnvater requirements as per 15A NCAC 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 htto://oortal.ncdenr.ore/web/wo/ws/su/bmo-manual.
Vl. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
httl2://12ortal.iicdenr.org/web/­wq/ws/­su/"statesw/­`forms does. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at http://portaLncdennorg/web/wq/ws/su/maw.)
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.ncdenr.org/web/wghvs/su/statesw/forms.docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
0A
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
VIA
Form. (if required as per Part PH belozv)
3. Original of the applicable Supplement Forms) (sealed, signed and dated) and O&M
A11A
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
ham://www.envhelp.org/pages/onestopexl2ress.litml 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 stormwatei treatment/managementfer
rA
the project. This is required in addition to the brief summary provided in the ]'reject
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
54
receiving stream drains to class SA waters within 1h mile of the site boundary, include the 1h.
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
i IIA
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
E�
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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
Form SWU-101 Version Oct. 31, 2013 Page-4 of 6

in. 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 F4
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"x1l" 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 DEMLR to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 10 45 Page No: 2.7 EA
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 15A 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.st-,ite.nc.Lis/Corporations/CSearch.asi2x
VII. 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 http://12ortal.nedenr.org/web/ir/state-stormwater-
forms does. 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 c6ve't6nts 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 DEMLR, and that they will be recorded prior to the sale of any lot.
Vlll. 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 Engineenf. Michael Stocks
Consulting Firm: Stocks Engineering
Mailing Address:P.O. Box 1108
City:Nashville
Phone: (252 ) 459-8196
Email:[e-mail]
State:NC Zip:27856
Fax: ( )
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (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 1a) with (print or type name of organization listed in
Contact Information, item 1a) 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 Oct. 31, 2013 Page 5 of 6

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 DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change Form within 30 days; otherwise 1 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 civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
a Notary Public for the State of County of
do hereby certify that
before me this _ day of
stormwater permit. Witness my hand and official seal,
SEAL
personally appeared
and acknowledge the due execution of the application for a
My commission
X. APPLICANT'S CERTIFICATION
1, (print or type ❑nine of person listed in Contact Infornmtion, item la) Kevin McGuinness
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 storm (ter rules u� , 5A WC 2H .1000 and any other applicable state stormwater requirements.
Datc: 9r/
i {1 &Et iwoumty of
W(( J�i[ do hereby certify that '7e V� / / ) t- (-,Yu i h 17e5 5 personally appeared
before me this }da 7 y of erne of D I SY, and acknowledge the due executionofthe application for a
stormwater permit. Witness my hand and official seal, �d ,a QK a-�
DO
Q\ Notary Public S
m Wake
County
MY�C' mm. Exp• e
c
.r09TH C1ARpssxxp
SEAL
My commission expires
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6