SW7960806_CURRENT PERMIT_20210503

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

Qapo
ROY COOPER
Governor
DIONNE DELLI-GATTI
Secretary
BRIAN WRENN
Director
NORTH CAROLINA
Envlron tal Quality
May 3, 2021
Pirates Cove Slip Owners Association
Attention: Sharon Aldridge, Property Manager
1 Sailfish Drive
Moyock, NC 27954
Subject: Stormwater Permit No. SW7960806 Renewal/Ownership Change
Pirates Cove Marina Parking Lot
High Density Project
Dare County
Dear Sharon Aldridge:
The Washington Regional Office received a Stormwater Management Permit
Application for renewal and change of ownership of the subject permit on March 30,
2021. Staff review of the application has determined that the permit can be reissued.
We are forwarding Permit No. SW7960806 dated May 3, 2021, for the continued
operation of the existing stormwater system.
This permit, upon its effective date, will replace all previous State Stormwater permits for
this project. This permit shall be effective from the date of issuance until May 2, 2029 and
shall be subject to the conditions and limitations as specified therein, and does not
supercede any other agency permit that may be required. 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 150E of the North Carolina General Statutes, and filed with the
Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699=6714.
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 me at [phone].
Sincerely,
Roger K. Thorpe
Environmental Engineer
Ec Glenn Futrell - [e-mail]
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
252.946.6481
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
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
PERMISSION IS HEREBY GRANTED TO
Pirates Cove Slip Owners Association
Pirates Cove Marina Parking
Located adjacent to US641264 at Washington Baum Bridge, Manteo, NC
Dare County
FOR THE
construction, operation and maintenance of five infiltration basins 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 Energy, Mineral, and
Land Resources (Division) and considered a part of this permit.
This permit shall be effective from the date of issuance until May 2, 2029, 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 below on the Project Data Sheet.
3. Approved plans and specifications for this project are incorporated by reference and
are enforceable parts of the permit.
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
252.946.6481

PROJECT DATA SHEET
Project Name
Permit Number:
Location:
Water Body Receiving Runoff Stormwater
Classification of Water Body:
Total Site Area:
Total Impervious
Surfaces Allowed:
Pirates Cove Marina Parking Lot
SW7960806
Dare County
Roanoke Sound
SA
2.31 acres
25,446 sf conventional asphalt
10,277 sf porous asphalt
Required Provided Provided Storage
Basin Storage Storage Area Depths
A
930 cf
965 cf
960 sf
1.5 ft
C1
624 cf
804 cf
600 sf
2.0 ft
C2
684 cf
844 cf
630 sf
2.0 ft
C3
721 cf
775 cf
578 sf
2.0 ft
D1
731 cf
764 cf
570 sf
2.0 ft
Note: Runoff is routed to infiltration basins by sheet flow and/or vegetated swales. Due to
favorable soil & water table conditions, and very rapid infiltration rates, no outlet structures
are provided. Any overflows that might occur under extreme storm conditions spill over into
adjacent vegetated swales.
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
252.946.6481

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:
North Carolina Department of Environmental Quality I Division of Energy. Mineral and Land Resources
_ Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
252.946.6481

a. Semi-annual scheduled inspections (every 6 months)
b. Sediment removal
C. Mowing and revegetation of side slopes
Cl. 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 the Division. 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 Energy, Mineral, and Land
Resources.
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 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, in accordance with North
Carolina General Statute 143-215.6(a) to 143-215.6(c).
®ER J% North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
252.946.6481

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.
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. This permit shall be effective from the date of issuance until May 2, 2029.
Application for permit renewal shall be submitted 180 days prior to the expiration
date of this permit and must be accompanied by the processing fee.
Permit issued this the 3 rd day of May 2021.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
For
Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW7960806
Ipjft�� North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
252.946.6481

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Date Received
Fee Paid
Permit Number
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NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
In accordance with 15A NCAC 2H.1045(3), the current permit holder shall renew their high density permit 180 days
prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011-398 (SB 781)
Section 60.(c). This application form is for permit renewals only.
A." PROJECT INFORMATION
1. State Stormwater Permit Number:
2. Project name:
3. Project street address: hAm no- FAEKi" 10+-"
City: j� IU.t1-FGO County: Dorf, -ZIP:: %�
4. What, if any, changes have been made to the project as permitted?
If the project has changed from the original approved plans, please complete SWU-101 fora Major
Modification or Minor Modification Application form available at. https://deg.nc.gov/about/divisions/energy-
mineral-land-resou rces/energv-mineral-land-rules/stormwater-grog ram/post-construction.
B. PERMITTEE INFORMATION
If changes to the permittee or project name have been made, please complete either the Permit Update form
or the Permit Transfer form available at: htti)s:Hdeg.nc.gov/about/divisions/energv-mineral-land-
resources/energv-mineral-land-rules/stormwater-program/post-construction. State Stormwater Permits do not
automatically transfer with the sale of the property.
1. Current Permit Holder's Company Name/Organization: R ra+8 Cox, 61;pPwn &r5 A5sc>6 won
2. Signing Official's I
3.
4.
Signing Official's'
Mailing Address:
City: NAM{rp State: A(L ZIP
5. Street Address:
City: IVIk.YIi-G
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6. Phone: (ZF2%%- L) 1 I / fX,' Email:
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ZIP: ;lqs4
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MAR 3 0 2021
Stormwater Permit Renewal Form Page 1 of 3 May 11, 2018

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C. SUBMITTAL REQUIREMENTS
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORW). Only applications packages that
include all required items listed below will be accepted and reviewed.
Initial each item below to indicate that the required information is provided in the application package:
1. A permit application processing fee of $505.00 payable to NCDEQ.
2. One original signed hard copy and one electronic copy of this completed form. The signing official
named on this application to represent the current permittee must meet one of the following:
a. Corporation — a principle executive officer of at least the level of vice-president;
b. Limited Liability Company (LLC) — a manager or company official as those terms are defined
in G.S. 57D "North Carolina Limited Liability Company Act;"
c. Public Entity — a principal executive officer, ranking official, or other duly authorized employee;
d. Partnership or limited partnership — the general partner;
e. Sole proprietor; or
f. Letter of authorization signed by one of the signatories noted in a — e above authorizing the
signature of another entity.
3. One hard copy and one electronic copy of recorded documents required by the original permit that
have not yet been received by DEMLR, including: deed restrictions, protective covenants,
condominium/planned community declaration and easements. If the project has been built, include
documentation that the maximum BUA per lot or maximum total BUA has not been exceeded. If
the project has not been built, include a signed agreement that the final recorded deed restrictions
and protective covenants will be submitted at a later date.
4. O&M Agreements, Please select one:
[� I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to
keep this on file with the permit; or
❑ I do not have a copy of the current recorded O&M Agreement for all SCMs and am
requesting a copy be sent to me. I agree to keep this on file with the permit.
5. Designer Certifications, Please select one:
A copy of the certification(s) confirming that the project was built in accordance with the
approved plans have been previously provided to the Division; or
❑ A copy of the certification(s) confirming that the project was built in accordance with the
approved plans are enclosed; or
❑ The project has not yet been built.
6. [IF APPLICABLE] If the project has been built, one original hard copy and one electronic copy of a
signed, sealed, and dated letter from a licensed professional stating that the SCMs have been
inspected, and that they have been built and maintained in accordance with the permit.
7. [IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC):
Provide one hard copy and one electronic copy of documentation from the NC Secretary of State,
or other official documentation, which supports the titles and positions held by the persons listed in
Section C.2 per 15A NCAC 2H. 1043(3)(b).
httos://www.sosnc.gov/online services/search/by title/ Business Registration
Stormwater Permit Renewal Application Form Page 2 of 3 May 11, 2018

D. PER ITTEE'S CERTIFICATION
1, S2 rD r� 01Lcat 1 6�6 /%e/
son legally responsible for the permit, certify that I have
a copy of the Permit and O&M Agreelment on site (or I will obtain a copy and it will be kept on site), that I am
responsible for the performance of the maintenance procedures, and the site has been and will be maintained
according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs
or built -upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the
project-SCMs, or ownership. All informs i ,ovided on this permit renewal application is, to the best of my
Date:
NOTARIZATION:
a Notary Public for the State of
NOfth C41411Inq V, County of Dare , do hereby certify
that Sharon 1drld Ae, Prop Mgr. personally appeared before me
this the
PUBLIC
My
day of
instrument. Witness my hand and official seal,
20 2 , and acknowledge the due
Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

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Permit Number:
(to be provided by DWQ)
Drainage Area Number:
Stormwater Wetland Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a log in a
known set location. Any deficient BMP elements noted in the inspection will be corrected, repaired or
replaced immediately. These deficiencies can affect the integrity of structures, safety of the public, and
the removal efficiency of the BMP.
Important maintenance procedures:
- Immediately following construction of the stormwater wetland, bi-weekly inspections will be
conducted and wetland plants will be watered bi-weekly until vegetation becomes established
(commonly six weeks).
- No portion of the stormwater wetland will be fertilized after the first initial fertilization that is
required to establish the wetland plants.
- Stable groundcover will be maintained in the drainage area to reduce the sediment load to the
wetland.
- Once a year, a dam safety expert should inspect the embankment.
After the stormwater wetland is established, I will inspect it monthly and within 24 hours after every
storm event greater than 1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and
maintenance will be kept in a known set location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired
immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
Entire BMP
Trash/debris is present.
Remove the trash/debris.
Perimeter of wetland
Areas of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed.
gully, and then plant a ground cover and
water until it is established. Provide lime
and a one-time fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height.
Inlet device: pipe or
The pipe is clogged (if applicable).
Unclog the pipe. Dispose of the sediment
swale
offsite.
The pipe is cracked or otherwise
Replace the pipe.
-damaged if applicable .
Erosion is occurring in the swale (if
Regrade the swale if necessary to smooth
applicable).
it over and provide erosion control
devices such as reinforced turf matting or
riprap to avoid future problems with
erosion.
Form SW40 I -Wetland O&M-Rev.4 Page 1 of 3

Permit Number:
(to be provided by DWQ)
BMP element:
Potentialproblem:
How I will remediate theproblem:
Forebay
Sediment has accumulated in the
Search for the source of the sediment and
forebay to a depth that inhibits the
remedy the problem if possible. Remove
forebay from functioning well.
the sediment and dispose of it in a location
where it will not cause impacts to streams
or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
problems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
Deep pool, shallow water
Algal growth covers over 50% of the
Consult a professional to remove and
and shallow land areas
-deep pool and shallow water areas.
control the algal growth.
Cattails, phragmites or other invasive
Remove invasives by physical removal or
plants cover 50% of the deep pool and
by wiping them with pesticide (do not
shallow water areas.
- consult a professional.
Shallow land remains flooded more
-spray)
Unclog the outlet device immediately.
than 5 days after a storm event.
Plants are dead, diseased or dying.
Determine the source of the problem:
soils, hydrology, disease, etc. Remedy the
problem and replace plants. Provide a
one-time fertilizer application to establish
the ground cover if necessary.
Best professional practices show that
Prune according to best professional
pruning is needed to maintain optimal
practices.
-plant health.
Sediment has accumulated and
Search for the source of the sediment and
reduced the depth to 75% of the
remedy the problem if possible. Remove
original design depth of the deep
the sediment and dispose of it in a location
pools.
where it will not cause impacts to streams
or the BMP.
Embankment
A tree has started to grow on the
Consult a dam safety specialist to remove
embankment.
the tree.
An annual inspection by appropriate
Make all needed repairs.
professional shows that the
embankment needs repair.
Evidence of muskrat or beaver activity
Consult a professional to remove muskrats
is present.
or beavers.
Micropool
Sediment has accumulated and
Search for the source of the sediment and
reduced the depth to 75% of the
remedy the problem if possible. Remove
original design depth.
the sediment and dispose of it in a location
where it will not cause impacts to streams
or the BMP.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage have
Contact the NC Division of Water Quality
1
occurred at the outlet.
401 Oversight Unit at 919-733-1786.
Form SW401-Wetland O&M-Rev.4 Page 2 of 3

Permit Number: SW 19tec)V 9 Lp
(to be provided by DFQ)
I acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Project name:
BMP drainage area number:
1
Date:_ _ 3• %e- Wl
Note: The legally responsible party should not be a homeowners association unless more than 50% of the lots have been
sold and a resident of the subdivision has been named the president.
I, Julian �iher►doe a Notary Public for the State of
_ri0(r11 C U011 YIQ , County of DQ(e do hereby certify that
Sharon Ald rid de , Ptd p. MQ( • personally appeared before me this Z (O day of
Marc H VZI , and acknowledge the due execution of the forgoing stormwater wetland
maintenance requirements. Witness my hand and official seal,
�;0 S0TARy
I —•— I
PUBLIC t
SEAL
My commission expires Q- 22'yZ1
Form SW401-Wetland O&M-Rev.4 Page 3 of 3

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Date Received Fee Paid Permit Number
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NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT TRANSFER APPLICATION FORM
Pursuant to 15A NCAC 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://deg.nc.gov/contact/reoional-offices.
After this application is accepted, DEMLR will conduct a compliance inspection and report any deficiencies to the
current permittee and/or 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 all 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 osit' ns held by the
person w ho signed the application (pursuant to 02H.1040) that shows they Jpffg a rn n or
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 per
accompanied by a letter of authorization signed by one of the signatories nc
applicable.
A. GENERAL INFORMATION
1. State Stormwater Permit Number: GIA IMP 09OLP
2. Project name:
Is this an updated project name from the current permit? ❑ Yes
3. Reason for the permit transfer request:
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MAR 3 0 2021 U
if
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Stormwater Permit Transfer Application Form Page 1 of 7 April 27, 2018

1p—%EM RENEE PARRISH
Administrative Assistant
OFFICE 252-473-4203 EhWE [e-mail]
Fax [phone]
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B. PERSON(S) WHO HAVE SIGNED THIS FORM (select only one response below)
PE
u 1. Both the current and proposed permittees
❑ 2. Only the current permittee of a condominium or planned community (skip Part F & G).
In accordance with G. S. 143-214.7(c2) (see also SL 2011-256), this type of transfer is allowed only
when all of the following items can be truthfully checked:
❑ 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 declaration;
❑ The declarant has conveyed at least fifty percent (50%) of the units or lots to owners other than
a declarant (provide documentation per submittal requirements below),
❑ The stormwater management system is in compliance with the stormwater permit.
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 permittee (skip Part D below).
In accordance with G.S. 143-214.7(c5) (see also SL 2013-121), this type of transfer is allowed only
when all of the following items can be truthfully checked.
❑ a. The proposed permittee is either (select one of the following):
❑ The successor -owner who holds title to the property on which the permitted activity is
occurring or will occur;
❑ The successor -owner who is the sole claimant of the right to engage in the permitted
activity.
❑ b. The current permittee is (select at least one of the following, but all that apply):
❑ A natural person who is deceased.
❑ A partnership, Limited Liability Corporation, corporation, or any other business
association that has been dissolved
❑ A person who has been lawfully and finally divested of title to the property on which the
permitted activity is occurring or will occur.
❑ A person who has sold the property on which the permitted activity is occurring or will
occur.
❑ Other (please explain):
❑ c. The proposed permittee agrees to the following requirements (all must be selected):
❑ There will be no substantial change in the permitted activity.
❑ The permit holder shall comply with all terms and conditions of the permit until such
time as the permit is transferred.
❑ The successor -owner shall comply with all terms and conditions of the permit once the
permit has been transferred.
Stormwater Permit Transfer Application Form Page 2 of 7 April 27, 2018

C. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark W" if previously provided. If not
applicable or not available, please mark N/A.:
Y 1. A processing fee of five hundred and five dollars ($505.00) per G.S. 143-215.3D(e)(2).
2. Two hard copies (with original signatures) and one electronic copy of this completed form and the
required items.
N 3. For proposed permittees that are corporations or LLC's, documentation from the NC Secretary of
State demonstrating that the proposed permittee is a legal and viable entity able to conduct
business in North Carolina.
4. If Part B, Items 1 or 3 of this form is selected, the signed and notarized
applicable O&M agreement(s) from the Proposed permittee, as required by the permit.
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 in the permitted activity.
•/n 6. 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 stormwater management system has been
inspected and that it has been built and maintained in accordance with the approved plans.
7. A copy of the recorded covenants and deed restrictions, if required by the permit. If the project has
been built, documentation that the maximum allowed per lot built -upon area or the maximum
allowed total built -upon area has not been exceeded. If the project has not been built, the new
owner shall provide a signed agreement to submit final recorded deed restrictions and protective
covenants.
N 8. If transferring under G.S. 143-214.7(c2) (i.e., Part B, Item 2 of this form is selected),
documentation verifying that 50% or more of the lots have been conveyed to individuals (not
builders). Copies of the deeds of conveyance or a chart listing the lot number, lot address,
owner's name, conveyance date and deed book and page number are acceptable.
9. If transferring under G.S. 143-214.7(c5) (i.e., Part B, Item 3 of this form is selected), provide legal
documentation supporting the dissolution of the corporation or documentation supporting the
current permittee was lawfully and finally divested of title of the property.
N111he 10. A copy of the lease agreement if the proposed permittee is the lessee.
N_ 11. A copy of the pending sales agreement if the proposed permittee is the purchaser.
T 12. A copy of the development agreement if the proposed permittee is the developer.
Stormwater Permit Transfer Application Form Page 3 of 7 April 27, 2018

D. CURRENT PERMITTEE INFORMATION AND CERTIFICATION Please be sure to provide Email.
1. Current Permit Holder's Company Name/Organization: Pomo►Ct, iFrD
2. Signing Official's Name: bIP.1'1Yt I­-L MJ I
3. Signing Official's Title: �
4. Mailing Address- Vol RQdbr)`7 OW9 2p -
1
City: � 64h State: NL ZIP: �15
5. Street Addressq y' : _07 L 0x4Ur 1.5 I n J'da,� 1PJ
City: - l - State: NC-- ZIP : a7ft(5
6. Phone: (q_) le*, I qL1 Email: _AI P hnE Ful l I prYI+U.Lom
I, the current permittee, am submitting this application for a
transfer of ownership for the above listed stormwater permit 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/or the stormwater system associated with this permit. I have provided a copy of the following documents to
the proposed permittee named in this application form: (select all that apply)
dthe most recent permit;
❑ the designer's certification for each SCM;
❑ any recorded deed restrictions, covenants, common areas, drainage easements or plats;
❑ the approved plans and/or approved as -built plans;
❑ the approved operation and maintenance agreement;
❑ past maintenance records from the previous permittee (where required);
❑ a copy of the most recent inspection report;
I further attest that this application and request for a permit transfer is accurate and complete to the best of my
knowledge. I attest that I have provided all of the required items per the law to transfer this permit. I understand
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 will be returned as incomplete I assign all rights and
obligations as permittee to the proposed permittee amed below. I understand that this request to transfer the
permit may not be appryy.9diothe DEELR�ynle , ggd•ur}tif the facility is in compliance with the permit.
I, S /1a ntn o t1 1P 1) tx 0 ( 1 , a Notary Public for the State of
I\%L County of P, , do hereby certify
that V) FL/. �I. l personally appeared before me
this the I day of ✓ kAV&(&, 202, i , and acknowledge the due
Witness my hand and official seal,
NOTARY PUBLIC
3ry Sea ake County
orth Carolina ;
Commission Expires
Notary Signature: o k G rmll%— 4461—Q.)CV
My commission expires Z.3 ' 20-Z S"
Stormwater Permit Transfer Application Form Page 4 of 7 April 27, 2018

E. PROPOSED PERMITTEE INFORMATION
1. The proposed permittee is the:
❑ Property owner (Also complete Part F.)
Ed Home Owners Association (HOA), Property Owners Association (POA), or Unit Owner Association
(UOA) (Also complete Part 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 I POA I UOA name: PIPY1+G5
❑ Sole Proprietor
3. Proposed permittee contact information:
Please be sure to provide Email.
a. Signir
b. Signir
c. Mailin
City:
d. Street Address: t VLL
City: KAr2A1+W State: iz ZIP: L7g5
e. Phone: [phone]—i1$OD Email: GL arbn& DIIYlviG.5—r"t)VG•IOIYL
4. If there is a Management Entity that manages the property for an HOA, POA or UOA, please provide:
Please be sure to provide Email.
a. Management Company or Business name
b. Contact Name: Shexon Aldr[AAC, Title: Protzr", l 1AtznaaGr'
c. Mailing Address: H UriJt�
d. City: %na.r+eo State: Ni. ZIP: i
e. Phone: (161 LL-12L- 1122 t'16 Email: di{1QAbne nirOt5-Co t-Wrn
Stormwater Permit Transfer Application Form Page 5 of 7 April 27, 2018

F. PROPOSED PERRMITTEECERTIFICATIOyN
I,S harts (1 h!—EG G ��_ mfie by notify the DEMLR that I have acquired through sale, lease,
development agreement, or o he 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 have received a copy of: (select all that apply):
Lyl the most recent permit;
❑ the designer's certification for each SCM,
❑ any recorded deed restrictions, covenants, common areas, drainage easements or plats;
❑ the approved plans and/or approved as -built plans;
❑ the approved operation and maintenance agreement;
❑ past maintenance records from the previous permittee (where required);
❑ a copy of the most recent inspection report;
❑ Check here if the proposed permittee agrees to be the 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 of the transferred permit. This written "plan of action and
schedule" must be received by the Division before the Division will transfer the permit.
I have reviewed the permit, approved plans and other documents listed above, and I acknowledge that I will
comply with the terms and conditions of the permit. I will construct the project's built -upon area as shown on the
approved plans an_ d onstruct), operate and maintain the approved stormwater management system
pursuant -to-the_reguirements-listed the permit and in the operation and maintenance agreement.
Signature:
Date: Ao;zl
I, J 1Ill Q11 Eolen d a Notary Public for the State of uafth C Of dif rt Q
County of bare ,do hereby certify that Aaron 111dridge, Prep• MQ r
personally appeared before me this the Z'q day of M Art h 20 Z4 , and
execution of the forgoing instrument. Witness my hand and official seal,
,,, r
PUB\-�C V
My cdMWf 9ldn expires
Stormwater Permit Transfer Application Form Page 6 of 7 April 27, 2018

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G. PROPERTY OWNER INFORMATION 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.
Company Name/Organization:
Signing Official's Printed Nami
Signing Official's Title:
Mailing Address: I 50i
uh
I, f1GL✓ OY� UT<lSC ht��Q hereby certify that I currently own the property identified in
this permit transfer document and acknowledge that the Proposed Permiftee 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.
I agree to notify DEMLR within 30 days if there are any changes to the purchase, developer or lease agreements
and will submit the applicable completed and signed Permit Information Update Form, or Permit Transfer
Application Form to address these changes. As the legal property owner, I acknowledge, understand, 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 or entity found to be in noncompliance with the provisions of the stormwater
management permit.or-the-stormwater-rules�i +"subject to enforcement action as set forth in NC General Statute
(NCGS) 143, Article.
Signature of the property owner Date:
Date:-©.''L�
I, Jllllayl s-htin d qe a Notary Public for the State of
North ( drol f VIA County of We do hereby certify that
Aaron hld ridge, PirOr. personally appeared before me this the 21 day of
Maa4i 20 7, l , and acknowledge the due execution of the forgoing instrument. Witness
Stormwater Permit Transfer Application Form Page 7 of 7 April 27, 2018