SW8040706_Current Permit_20110822

A& rA
NCDEE R
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
August 22, 2011
Division of Water Quality
Coleen H. Sullins
Director
Harborside Club at 70 West Community Services Association
C/o Doug Martin, President
4425 Arendell St. Box 64
Morehead City, 28557
Subject: Name Change / Ownership Change
Harborside
Stormwater Permit No. SW8 040706
Carteret County
Dear Mr. Martin:
Dee Freeman
Secretary
On July 20, 2011, the Wilmington Regional Office received a request for the transfer of
ownership of the Stormwater Management Permit for the subject project. Staff of the Division of
Water Quality have inspected the project,. determined that the documentation is in order, and
the project is in compliance with the Stormwater permit requirements. As indicated on the
Name/Ownership Change form, you have acknowledged receipt of a copy of the permit, which
includes the application and supplement forms, a copy of the approved plans and a copy of the
required Operation and Maintenance agreement from the previous permittee. By acknowledging
receipt of the permit, and by signing the Name/Ownership Transfer form, you have accepted the
responsibility for complying with the terms and conditions outlined in this permit. If you need
additional copies of the permit, or copies of the approved plans, please contact the Division of
Water Quality in the Wilmington Regional Office at the phone number below. Please replace the
old second page of the permit with the enclosed updated page.
Please be aware that the project's built -upon area and stormwater controls must be built and
maintained in compliance with the permit documents and the approved plans. Maintenance
of the approved system shall be performed in accordance with the Operation and
Maintenance agreement. Any modifications to this project must be submitted to the Division
of Water Quality and approved prior to construction. The issuance of this approval does not
preclude you from complying with all other applicable statutes, rules, regulations or
ordinances, which may have jurisdiction over the proposed activity, and obtaining a permit
or approval prior to construction.
If you have any questions concerning this matter, please do not hesitate to call David Cox at
[phone].
Sincerely,
Georgette Scott
Stormwater Supervisor
Division of Water Quality
GDS/ c wc: S:lWQS\StormwaterlPermits & Projects 2011 07 permit 040706
cc: Karl Stimpson
Carteret County Building Inspections
Wilmington Regional Office File
Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405 One
Phone: [phone] FAX: [phone] Customer 5ervice:1-877-623-6748 NorthCarolina
Internet: www.ncwaterquality.org N� J�
An Equal Opportunity lAffirmativeAction Employer �atm` `/`/

August 22, 2011
Harborside
Permit # SW8 040706
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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
Harborside Club at 70 WestCommunity Services Association, Inc.
Harborside
Carteret County
FOR T HE
construction, operation and maintenance of 7 sand filters 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 Water Quality and
considered a part of this permit.
This permit shall be effective from the date of issuance until July 16, 2014, and shall be
subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
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 in Section 1.6 on page 3 of this permit. The stormwater controls
have been designed to handle the runoff from the built -upon area within the
specified drainage area, as per Section 1.6 of this permit.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.6 of
this permit, and per the approved plans.
4. The runoff from all built -upon area within the permitted drainage area of this project
must be directed into the permitted stormwater control system.
2

State Stormwater Permit No. 5�-)LTD 4k*
Applies to System No. I
SAND FILTER OPERATION AND MAINTENANCE PLAN
Regular maintenance is essential to the long-term performance and durability of the
sandfilter, as it is with all stormwater BMP's.
1. Depending on the types of activities occurring within the drainage area, most sand
filters will show a decreased capacity for filtration after a few years. At least once a
year, each filter must be inspected after a 1" design storm event to determine if the
filter bed is passing the runoff within 24 hours.
2. If the filter is not passing the runoff completely within 24 hours, the first 2"-3" of
discolored sand must be removed and replaced with new sand. The removed sand
must be dewatered and disposed of properly.
3. At the same time that maintenance is performed on the sand chamber, the sediment
chamber should be pumped and cleaned. The removed sediment should be
dewatered and disposed of properly.
4. At least once every quarter, check that the orifice is clear.
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 and prior to any changes to the system or the responsible party.
Print name and title United Developers of North Carolina LLC c/o Karl Stimpson Member
Address PO Box 26 Pfafftown, NC 27040
Phone: [phone] s Fax: [phone]
Signature - -o _ 4_ - = Date 7 L b (-j
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, Matthew L. Montanve , a Notary Public for the State of
North Carolina , County of Craven do hereby certify that
Karl A. Stimpson personally appeared before me this the ( '*' day of
Wit! 2004 , and acknowledge the due execution of the foregoing
sand filter aintenance requirements. Witness my hand and official seal,
�' •,���tttt111/1//,� SEAL
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State Stormwater Permit No. SW 9 0401069
Applies to System No. 2A
SAND FILTER OPERATION AND MAINTENANCE PLAN
Regular maintenance is essential to the long-term performance and durability of the
sandfilter, as it is with all stormwater BMP's.
1. Depending on the types of activities occurring within the drainage area, most sand
filters will show a decreased capacity for filtration after a few years. At least once a
year, each filter must be inspected after a 1" design storm event to determine if the
filter bed is passing the runoff within 24 hours.
2. If the filter is not passing the runoff completely within 24 hours, the first 2"-3" of
discolored sand must be removed and replaced with new sand. The removed sand
must be dewatered and disposed of properly.
3. At the same time that maintenance is performed on the sand chamber, the sediment
chamber should be pumped and cleaned. The removed sediment should be
dewatered and disposed of properly.
4. At least once every quarter, check that the orifice is clear.
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 and prior to any changes to the system or the responsible party.
Print name and title United Developers of North Carolina, LLC c/o Karl Stimmon, Member
Address PO Box 26 Pfafftown, NC 27040
Phone: [phone] Fax: [phone]
Signature >4�, Date 7 1& 10q
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, Matthew L. Montanve , a Notary Public for the State of
North Carolina , County of Craven do hereby certify that
Karl A. Stimpson personally appeared before me this the day of
2004 , and acknowledge the due execution of the foregoing
sand filte maintenanc requirements. Witness my hand and official seal,
11nu1#180 �I SEAL
My commission expires der. Z9_ eav .�•''
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State Stormwater Permit No. 590407O(0
Applies to System No. ZP_;'
SAND FILTER OPERATION AND MAINTENANCE PLAN
Regular maintenance is essential to the long-term performance and durability of the
sandfilter, as it is with all stormwater BMP`s.
1. Depending on the types of activities occurring within the drainage area, most sand
filters will show a decreased capacity for filtration after a few years. At least once a
year, each filter must be inspected after a 1" design storm event to determine if the
filter bed is passing the runoff within 24 hours.
2. If the filter is not passing the runoff completely within 24 hours, the first 2°-3n of
discolored sand must be removed and replaced with new sand. The removed sand
must be dewatered and disposed of properly.
3. At the same time that maintenance is performed on the sand chamber, the sediment
chamber should be pumped and cleaned. The removed sediment should be
dewatered and disposed of properly.
4. At least once every quarter, check that the orifice is clear.
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 and prior to any changes to the system or the responsible party.
Print name and title United Developers of North Carolina, LLC c% Karl Stimmon Member
Address P® Box 26 Pfafftown, NC 27040
Phone: [phone] Fax: [phone]
Signature _L _ Date 7 b 64
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, Matthew L. Montanye , a Notary Public for the State of
North Carolina , County of Craven do hereby certify that
Karl A. Stimpson personally appeared before me this the 6 7lv day of
2004 , and acknowledge the due execution of the foregoing
sand filter aintenance requir ents. Witness my hand and official seal,
SEAL
My commission expires Ar. o` og <`d`�'�'••M''ONAtr�e
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State Stormwater Permit No. SW,? 040_70(o
Applies to System No. 1zC_
SAND FILTER OPERATION AND MAINTENANCE PLAN
Regular maintenance is essential to the long-term performance and durability of the
sandfilter, as it is with all stormwater BMP's.
Depending on the types of activities occurring within the drainage area, most sand
filters will show a decreased capacity for filtration after a few ;rears. At least once a
year, each filter must be inspected after a 1" design storm event to determine if the
filter bed is passing the runoff within 24 hours.
2. If the filter is not passing the runoff completely within 24 hours, the first 2"-3" of
discolored sand must be removed and replaced with new sand. The removed sand
must be dewatered and disposed of properly.
3. At the same time that maintenance is performed on the sand chamber, the sediment
chamber should be pumped and cleaned. The removed sediment should be
dewatered and disposed of properly.
4. At least once every quarter, check that the orifice is clear.
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 and prior to any changes to the system or the responsible party.
Print name and title United Developers of North Carolina. LLC c% Karl Stimpson Member
Address PO Box 26 Pfafftown, NC 27040
Phone: [phone] Fax: [phone]
Signature Date i a
.o
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, Matthew L. Montanye. , a Notary Public for the State of
North Carolina , County of Craven do hereby certify that
Karl A. Stimgson personally appeared before me this the 6day of
Tu1-Y 2004 , and acknowledge the due execution of the foregoing
sand filt r maintenance requirements. Witness my hand and official seal,
`,,�a�llugq�r�i SEAL
My commission expires QcT o%9. ZDo� �'�.o• `'� •.
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State Stormwater Permit No. L .60 904'7U&
Applies to System No. 3
SAND FILTER OPERATION AND MAINTENANCE PLAN
Regular maintenance is essential to the long-term performance and durability of the
sandfilter, as it is with all stormwater BMP's.
1. Depending on the types of activities occurring within the drainage area, most sand
filters will show a decreased capacity for filtration after a few years. At least once a
year, each filter must be inspected after a 1" design storm event to determine if the
filter bed is passing the runoff within 24 hours.
2. If the filter is not passing the runoff completely within 24 hours, the first 2"-3" of
discolored sand must be removed and replaced with new sand. The removed sand
must be dewatered and disposed of properly.
3. At the same time that maintenance is performed on the sand chamber, the sediment
chamber should be pumped and cleaned. The removed sediment should be
dewatered and disposed of properly.
4. At least once every quarter, check that the orifice is clear.
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 and prior to any changes to the system or the responsible party.
Print name and title United Developers of North Carolina. LLC c/o Karl Stimpson Member
Address PO Box 26 Pfafftown, NC 27040
Phone: [phone] Fax: [phone]
Signature Date -7 . .(. toq
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, Matthew L. Montanve , a Notary Public for the State of
North Carolina , County of Craven do hereby certify that
Karl A. Stimpson personally appeared before me this the day of
_. — 'e/ `i 2004 , and acknowledge the due execution of the foregoing
sand filte aintenance requireme ts. Witness my hand and official seal,
SEAL
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My commission expires ecT 2M ZOd k +,reVdJ.L:.ti1®�,°�.,.
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State Stormwater Permit No. 5w,?04-070(�0
Applies to System No.
SAND FILTER OPERATION AND MAINTENANCE PLAN
Regular maintenance is essential to the long-term performance and durability of the
sandfilter, as it is with all stormwater BMP's.
1. Depending on the types of activities occurring within the drainage area, most sand
filters will show a decreased capacity for filtration after a few years. At least once a
year, each filter must be inspected after a 1" design storm event to determine if the
filter bed is passing the runoff within 24 hours.
2. If the filter is not passing the runoff completely within 24 hours, the first 2"-3" of
discolored sand must be removed and replaced with new sand. The removed sand
must be dewatered and disposed of properly.
3. At the same time that maintenance is performed on the sand chamber, the sediment
chamber should be pumped and cleaned. The removed sediment should be
dewatered and disposed of properly.
4. At least once every quarter, check that the orifice is clear.
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 and prior to any changes to the system or the responsible party.
Print name and title United Developers of North Carolina. LLC c% Karl Stimpson Member
Address PO Box 26 Pfafftown, NC 27040
Phone: [phone] Fax: [phone]
Signature Daie '7 L /64
Note: The legally responsible party should not be a homeowners association unless more than 50°Y of the
lots have been sold and a resident of the subdivision has been named the president
I, Matthew L. Montanve , a Notary Public for the State of
North Carolina , County of Craven do hereby certify that
Karl A. Stimpson personally appeared before me this the d *0 day of
2004 , and acknowledge the due execution of the foregoing
sand filter maintenance require ents. Witness my hand and official seal,
901 0,011112198100 "0
SEAL
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My commission expires &T. �g Zyd 8 �����e,.eje�se..�.,.�,�,A•.��i
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State Stormwater Permit No.(�
Applies to System No.
SAND FILTER OPERATION AND MAINTENANCE PLAN
Regular maintenance is essential to the long-term performance and durability of the
sandfilter, as it is with all stormwater BMP's.
1. Depending on the types of activities occurring within the drainage area, most sand
filters will show a decreased capacity for filtration after a few years. At least once a
year, each filter must be inspected after a 1" design storm event to determine if the
filter bed is passing the runoff within 24 hours.
2. If the filter is not passing the runoff completely within 24 hours, the first 2"-3" of
discolored sand must be removed and replaced with new sand. The removed sand
must be dewatered and disposed of properly.
3. At the same time that maintenance is performed on the sand chamber, the sediment
chamber should be pumped and cleaned. The removed sediment should be
dewatered and disposed of properly.
4. At least once every quarter, check that the orifice is clear.
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 and prior to any changes to the system or the responsible party.
Print name and title United Developers of North Carolina. LLC c/o Karl Stimpson, Member
Address PO Box 26 Pfafftown, NC 27040
Phone: [phone] Fax: [phone]
Signature -- - -�4 - a� Date_ 74
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, Matthew L. Montanye , a Notary Public for the State of
North Carolina , County of Craven do hereby certify that
Karl A. Stimpson personally appeared before me this the &10 day of
TucV 2004 , and acknowledge the due execution of the foregoing
sand filte maintenance requirements. Witness my hand and official seal,
SEAL
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My commission expires f.�T. ZDo� '�`.�• *
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freernan
Govemor Director' Secretary
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION
Stormwater Management Permit Number: SW8040706
2. Project Name: HARBORSIDEJ.
3. Current Permit Holder's Company NamelOrganization: United Developers of North
4. Signing Official's Narfie: Karl Stimpson Title: President Carolina, Inc.
(person legally responsible for permit)
5. Mailing Address: P . 0. Box 189.
City: Pfafftown State: NC Zip: . 27.040 -
6. Phone: ( 336 ) 345-2867 Fax: ( 336 )9,24-0152
II. PROPOSED PERMITTEE / OWNER / PROJECT / ADDRESS INFORMATION
This request is for: (please check all that apply)
❑ Name change of the owner (Please complete Items 1, 2 and 3 below)
❑ Name change of project (Please complete Item 5 below)
® Change in ownership of the property/company (Please complete items 1, 2,'3, and 4 below)
❑ Mailing address / phone number change. (Please complete Item 4 below)
❑ Other (please explain):
1. Proposed permittee's company name/organization: Harborside Club at 70 west community
2. Proposed rmittee's signing official's name: services Association, Inc.
p pe 9 9 . DOUG MARTIN
3. Proposed permittee's Title:. _ Board- -Member
4. !`Mailing Address: 58 1 4 `4 Z_5 jq,re n d'el t S_ 4- , � � x � L4 �
CityState: --V-8F n Zip:
Phone: [phone] Fax: ( re Ph^^{ eaxj-
5. New Project Name to be placed on permit:. N/A - -no change �i� �� �
r-()6 J-�
-Tr-
Please check the appropriate box. The proposed permittee listed above is:
HOA or POA (Attach a copy of the deed transferring ownership of all common areas. Print Name
of HOA or POA in #1 above and provide name of HOA(POA) president in #2 above).
❑ The property owner.
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
❑ Purchaser (Attach a copy of the pending sales agreement and complete Property Owner
Information on page 4)
❑ Developer (Complete Property Owner Information on page 4) RECEIVED
JUL 2 0 2011
SSW N/O Change RevMov2009 Page 1 of 4
BY:

Ill. REQUIRED ITEMS
This application package will not be accepted by the Division of Water Quality unless all of the
applicable required items listed below are included with the submittal.
f : This completed and signed form.
2. Legal documentation of the transfer of ownership. (For Permit Transfers Complete Current Permittee
and Proposed Pennittee Seddons)
3. A copy of the recorded deed restrictions, if required by the permit.
4. The designer's certification, If required by the permit and if not already submitted to DWQ.
5. If the Proposed Permittee is a corporation, LLC or General Partnership, provide documentation from
the Secretp_y of State office, which supports the named president, vice president, member, manager
or General Partner.
6. The $40..00 processing fee. If this is an initial transfer from the original permittee to the property owner
or other responsible party such as an HOA, the processing fee is not required. Subsequent ownership
transfers will require the $40.00 processing fee.
1V. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the' following statements:
❑ Check here if the Current Owner is only changing the owner name, company name or project
name, or the mailing address, and will retain ownership of the permit
I, , the current owner, hereby notify the Div' ' n of
Water Quality that I am changing my name or company name and/or I am changingI g
address and/or 1 am- changing the name of the permitted protect. I further attest th i ppli h
for a name/ownership change is accurate and complete to the best of my kno . I underst
that if all required parts of this application are not completed and that if al' supt Yting
information and attachments as outlined above are not included, this a " ion pagkage will
returned as incomplete.
R1 Check here if Current Owner is transferring (selling) the property to a n' n will not
retain $ nIle p&( thS C c °�'.
I, of North Carolina, Inc,.the current owner, am submitting this application for a transfer -of
ownership for permit # _sW8a o -Qb . I hereby notify DWQ of the sale or other legal transfer
of the stormwater system associated with this permit. I further acknowledge and attest that I have
transmitted a copy of -the most recent permit, a copy of the Designers Certification, a copy of the
DWQ approved plans and/or approved as -built plans, a copy of the approved Operation and
Maintenance agreement and copies. of past maintenance records to the Proposed Permittee named
in Sections 11 and V of this form at the mailing address listed in Section II of this form. I further attest
that I assign all rights and obligations as permittee to the Proposed Permittee named in Section V of
this form. I understand that this transfer of ownership cannot be approved by the Division of Water
Quality unless and until the facility is in compliance with the permit and the Proposed Permittee signs
this form. I understand that in the event the facility is not in compliance or the, Proposed Permittee
does not sign this form, the responsibility to bring the facility into compliance and to comply with the
terms and conditions of the permit remains with me until such time as the Proposed Permittee signs
this form and the Division approves it.
United Da velope North CArolina, Inc.
Signature: By : Date:' (o - Zo ! /
,/President
a Notary Public for the State of
Alrbt< `fed C A r) 41t , County of s � , do hereby certify that
Rare. Stimpson personally appeared before me this the
dayv 11g k . 24 1 1 , and acknowledge the of � g c+�4p y4on ofthe
Witness my hand and official seal,
SSW N/0 Change Revl6Nov2009 Page 2 of 4
Y
NOTARY
PUBLIC
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V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed Permittee for all transfers of ownership)
8arborside Club at 70 West Community
Derv; _P- Asanr+; ��-; �„ r Inc , hereby notify the Division of Water Quality that 1 have
acquired through sate, lease or legal transfer, the responsibility for constructing and/or Operating and
maintaining, the permitted stormwater management system. I have examined the permit and
inspected the permitted facility, and agree to assume the rights and liabilities contained in the permit
and to comply with the terms and conditions of the permit.
I attest that.I have reviewed.this application for an ownership change and it 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 package will be returned as incomplete.
I further acknowledge and attest that in the event the required facility inspection reveals that the
project is not in compliance with the permit, I understand this transfer of ownership will not be
approved until the project is brought into -compliance. I acknowledge and attest that 1 have received a
copy of the most recent permit, a copy of the Designer's Certification, a copy of the DWQ approved
plans and/or approved as -built plans, a copy of the approved Operation and Maintenance agreement
and copies of past maintenance records from the previous permittee. I further acknowledge and
agree that I will construct and/or operate and maintain the system per the requirements listed in the
permit and in the O eration and Maintenance agreement.
Harborside at 70$ Comm nity Services A c' ati , C1
Signature: B V 1 Date, /
OU MART , oard Member
a Notary Public for the State of
L/'C County ofdo hereby certify that
DOUG MARTIN personally appeared before me this the
r s day of cfv�.{ 20 11 and acknowledge the due execution of the
forgoing instrument. Witness hand and official seal,
(Notary Seal)
Notary Signature .
My commission expires: 2a ( DARLIENE R. MOORE
WOTARY PUBLIC
COMMONWEALTH OF %MRGINIA �y
[MY
COMMISSION EXPIRES MAY 31, 201 '
COMMISSION M 346412 "•.,., ,,.`-' '
Additional copies of the original ermit and the a kR
pP approved operation and Maintenance plan#°�a�i`"be
obtained from the appropriate Regional Office of the Division of Water Quality.
This completed form, including all supporting documents and processing fee, should be sent to the
appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources, Division of Water Quality, as shown on the attached map.
Please note that if the Proposed Permittee listed above is not the property owner, the property owner
must complete and sign page 4 of this document: Both the lessee/ developer and the propE, y
owner will appear on the permit as permittees.
'� SUS 2 0 2011
SSW N/0 Change Rev1 6Nov2009 Page 3 of 4

VI. PROPERTY OWNER CONTACT INFORMATION AZJD CERTIFICATION
If the Proposed Permittee listed in Sections ll and V of this form is not the Property Owner, the
Property Owner must provide h1s/her Contact Information below and sign this form:
Printed Name: DOUG MARTIN
Organization: Harborside Club at 70 West Community Services Association, Inc.
Title within the Organization: President
Street -Address: c/o 304 Plummer Drive, ' Chesapeake, VA 23323
City:_
Chesapeake State:
Mailing Address:
City:
(IT amerent trorn street address)
State:
Phone: [phone]
Email: D.MARTIN@cox. net
Fax:
VA
Zip: 23323
Zip:
I cerfy that I own the property identified in this permit transfer document and have given permission
to the Proposed Permittee listed in Sections It and V to develop, lease or purchase the property. A
copy of the lease agreement or pending property sales contract has been provided with the
submittal, which indicates the party responsible for the construction and/or operation and
maintenance of the stormwater system.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and that if the designated Proposed
Permittee dissolves their company and/or cancels or defaults on their lease agreement or pending
sales contract, 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 by submitting a
completed Name/Ownership Change Form within 30 days of procuring a developer, lessee or
purchaser for the property.' I understand that failure to operate and maintain the stormwater
treatment facility in accordance with the 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 143-215.5.
� l
Signature of the property own r Date:,
DOUG MAR
a Notary Public for the State of
DOUG MARTIN
County of , do hereby certify that
personally appeared before me this the
day of - , 20 11 , and acknowledge the due execution of the
forgoing instrument. Witness rn hand and official seal,
otary Sear.
.Notary Signature
My commission expires: S-t zzsf
DARLENE R. MOORE
NOTARY PUBLIC
COMMONWEALTH OF VIRGINIA
MY OOMMISSION EXPIRES MAY 31. 2013
COMMISSION N 340412
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SSW N10 Change Rev1 Mov2009 Page 4 of 4

State Storrnwatr-r Management System
errnit N o...'5 8 0 07(36
Harborside
Stormwater Permit No. SW8 040706
Carteret County
Designer's Certification
i, : RONALD D CULLIPHER , as a duly registered _ ED
in the State of North Carolina, having been authorized to obsery (periodica weeklyl
full time) the construction of the project,
RBORSIDE
(Project)
MR. KARL STIMPSON, MEMBER/ MANAGER
UNITED DEVELOPERS OF NORTH CAROLINA, LLC
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the. construction wa�:observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification
Noted deviations from approved plans and specification:
VE&ETA-T1UC FiLltom. UJiL(- )UEL--P lVJlaJAqenJA,cL
"VC- L s a n)c o (- -n -en t
�UG�(LN I AU 11 ) �-`� F 1 L �_
P 1 ►� 1+11S �o W R fr�� ZePC-ACt�►�� SEAL
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Signature
�''•
Registration Num er Sip •. 2 •.
•
Date 5 2 = :QQ':s
SEq�, r
7 43 *:
RECEIVED
MAY 2 8 2010
BY:
Page 6 of 7

State Stormwc-ter Management Systems
Permit Np._,a 8 Q4(?7U6
Certification Requirements:
WK-1
The drainage area to the system contains approximately the permitted
acreage.
�2.
The drainage area to the system contains no more than the permitted
amount of built -upon area.
L3.
All the built -upon area associated with the project is graded such that the
pp
� �ar,4.
runoff drains to the system.
All roof drains are located such that the runoff is directed into the system.
5.
The outlet/bypass structure elevations are per the approved plan.
A) 6.
The outlet structure is located per the approved plans.
A)l A 7.
Trash rack is provided on the outlet/bypass structure.
8.
All slopes are grassed with pef'manent vegetation.
11 �_9.
Vegetated slopes are no steeper than 3:1.
�D10.
The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11.
The permitted amounts of surface area and/or volume have been
provided.
P�(-12.
Required drawdown devices are correctly sized -per the approved plans.
dZ& 13.
All required design depths are provided.
A)LA 14.
All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15.
The required system dimensions are provided per the approved plans --
cc: NCDENR-DWQ Regional Office
Katrina Marshall, Carteret County Building Inspections
RECEIVED
MAY 2B2010
Page 7 of 7