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HomeMy WebLinkAboutSW8070671_Current Permit_20130712A �i A CDEhIR North Carolina Department of Environment and Natural Resources Division of Water Quality Pat McCrory Thomas A. Reeder Governor Acting Director July 12, 2013 Mr. Craig Briner, Manager AF-Middle Sound LLC 1330 Sunday Drive, Suite 105 Raleigh, NC 27607 Subject: ' Modification, Name/Ownemhip Transfer, and Expiration Date Extension Stormwater Management Permit No. SW8 070671 Middle Sound Village High Density Infiltration Basin Project New Hanover County Dear Mr. Briner: John E. Skvarla, III Secretary The Wilmington Regional Office received a complete State Stormwater Management Permit Application for Middle Sound Village on July 11, 2013. Modification: 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 21-1.1000, effective September 1,1995 (the 1995 Rule). We are forwarding Permit No. SW8 070671 dated July 12, 2013, for the construction, operation and maintenance of the BMP's and built -upon area associated with the subject project. Modifications include: 1.) This project has two infiltration basins. Both basins will continue to be permitted under the 1995 Rule. a. Basin #1: The impervious, drainage area, bottom surface area, and required volume have all decreased. b. Basin #2: The impervious and the required volume have decreased. Though the bottom surface area has increased, the increase is not a result of a requirement to contain a larger volume. 2.) Deed Restrictions: The previous permit which was issued on January 25, 2008 required deed restrictions: However, this townhome community will be sold to homeowners without land associated with the building footprints. Therefore, the deed restriction requirements have been removed. 3.) Pervious Pavement: Pervious pavement appears on the plans, but is not covered by this permit because it is not being used for impervious area credit. Transfer. On May 3, 2013, the Division of Water Quality (DWQ) received a permit Name/Ownership Change Form, from Wilshire Management Group, LLC. A file review and site inspection was performed on June 25, 2013 by DWQ and as noted in the enclosed inspection report, the site is currently in compliance with the terms and conditions of the current state stormwater permit because it has not been constructed. The Division is hereby notifying you that permit SW8 070671 has been transferred on June 25, 2013. For your records, please find enclosed a copy of the inspection report, and a copy of the Name/Ownership Change form submitted on May 3, 2013. 1617 Mail Service center, Raleigh, North Carolina 27699-1617 Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 Phone: 919-807-63001 FAX: 919-807-64921 DENR Assistance:1-877-623-6748 Internet: www.nwatemualihr.om N�nCarolina. An Equal Opportun4l Affirmative Action Employer SW8 070671 July 12, 2013 Page 2 of 2 Expiration Date Extension: On August 5, 2009, the Governor signed Session Law 2009-406. This law impacts any development approval issued by the Division of Water Quality under Article 21 of Chapter 143 of the General Statutes, which is current and valid at any point between January 1, 2008, and December 31, 2010. The law extends the effective period of any stormwater permit that was set to expire during this time frame up to three (3) years from its current expiration date. On August 2, 2010, the Governor signed Session Law 2010-177, which granted an extra year for an extension of up to four (4) years. This permit shall be effective from the date of issuance until December 31, 2021, and shall be subject to the conditions and limitations as specified therein. 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 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, and 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. If you have any questions, or need additional information concerning this matter, please contact Kelly Johnson, at (910) 796-7215. Sin rely, 7.n Thom Reeder Division of Water Quality GDS/kpj: S:1WQS1StormwaterlPermits & Projects120071070671 HD12013 07 permit 070671 enc: Inspection Report Name/Ownership Change Form, May 3, 2013. cc: Charles D. Cazier, PE Patrick Bradley Southerland, Wilshire Management Group, LLC (previous permittee) PO Box 3366, Wilmington NC 28406 Inspector, New Hanover County Building Inspections Beth E. Wetherill, New Hanover County Engineering Division of Coastal Management Wilmington Regional Office Stormwater File State Stormwater Management Systems Permit No. SW8 070671 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 AF-Middle Sound LLC Middle Sound Village 611 Middle Sound Loop Rd, Wilmington, New Hanover County FOR THE construction, operation and maintenance of 2 infiltration basins in compliance with the provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater ruiesl 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 December 31, 2021 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. 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 subdivision is permitted for 161,338 square feet of built -upon area. Basin #1 has been designed to treat 85,926 square feet of impervious area. Basin #2 has been designed to treat 75,412 square feet of impervious area. Neither basin has future area allocation available. Approved plans and specifications for this project are incorporated by reference and are enforceable parts of the permit. 4. The basin must be operated with a 50ft vegetated filter. Neither of the vegetated filter designs, which incorporate scour holes, has changed since the previous permit issued on January 25, 2008. The walking path at the northeast side of the property has two wooden footbridges. One is over Swale 7, and the other is over the vegetated area between the outlet of basin #2 and its scour hole. These bridges must be constructed such that they do not impede water flow in the areas that they cross. 5. All stormwater collection and treatment systems must be located in either 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. Page 3 of 8 State Stormwater Management Systems Permit No. SW8 070671 6. The following design elements have been approved for this infiltration basin stormwater facility, and must be provided in the system at all times. a Drainage Area, acres: Onsite, ft2: Offsite, ft2: b Total Impervious Surfaces, ft2: Buildings ft2: Streets, ft2: Parking, ft2: Sidewalks, ft2: Offsite, ft2: c Basin Depth, feet: d Design Storm: e Bottom Elevation, FMSL: f Permitted Surface Area at Bottom, ft2: g Permitted Storage Volume, W: h Storage/Bypass Elevation, FMSL: i Type of Soil: j Expected Infiltration Rate, in/hr: k Time to Draw Down, hours: I Receiving Stream / River Basin: m Stream Index Number: n Classification of Water Body: II. SCHEDULE OF COMPLIANCE Basin 1 Basin 2 4.02 4.24 174,894 184,677 0 0 85,926 75,412 52,000 38,000 12,581 22,893 18,940 8,421 2,405 6,098 0 0 3.00 3.00 1.50 1.50 16.50 16.50 6,122 5,682 21,869 19,392 19.50 19.50 Yellow Medium Sand 3.70 3.70 9.70 9.70 Pages Creek / Cape Fear 18-87-22 SA; HQW 1. No homeowner/lot owner/developer shall fill in, alter, or pipe any drainage feature (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. 2. The permittee is responsible for verifying that the proposed built -upon area for the entire lot, including driveways and sidewalks, does not exceed the allowable built -upon area. Once the lot transfer is complete, the built -upon area may not be revised without approval from the Division of Water Quality, and responsibility for meeting the built -upon area limit is transferred to the individual property owner. 3. 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. 4. Deed restrictions are not required because this townhome community will be sold to homeowners without land associated with the building footprints. If at a later date, it is determined to sell land with the townhomes, a modification is required to incorporate deed restrictions prior to the sale. Page 4 of 8 State Stormwater Management Systems Permit No. SW8 070671 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 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, acquisition, 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 or a CAMA Major permit was sought. f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan. 6. The Director may determine that other revisions to the project should require a modification to the permit. 7. 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 surface. During construction, erosion shall be kept to a minimum and any eroded areas of the system will be repaired immediately. Infiltration systems should not be used as erosion control devices, due to the potential clogging. If the stormwater system was used as an Erosion Control device, it must be restored to design condition prior to operation as a stormwater treatment device, and prior to occupancy of the facility. 8. 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 system installed certifying that the permitted facility 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. 10. The permittee shall at all times provide the operation and maintenance necessary to assure that all components of the permitted stormwater system function 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 revegetation of side slopes. d. Immediate repair of eroded areas. e. Maintenance of side slopes in accordance with approved plans and specifications. f. Debris removal and unclogging of structures, orifice, catch basins and piping. g. Access to all components of the system must be available at all times. 11. Records of maintenance activities must be kept and made available upon request to authorized personnel of DWQ. The records will indicate the date, activity, name of person performing the work and what actions were taken. 12. Permanent seeding requirements for the stormwater control must follow the guidelines established in the North Carolina Erosion and Sediment Control Planning and Design Manual. 13. Prior transfer of the permit, the stormwater facilities will be inspected by DWQ personnel. The facility must be in compliance with all permit conditions. Any items not in compliance must be repaired or replaced to design condition prior to the transfer. Records of maintenance activities performed to date will be required. 14. 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. 15. Built upon area includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate, coquina and parking areas, but does not include raised, open wood decking, or the water surface of swimming pools. Page 5 of 8 State Stormwater Management Systems Permit No. SW8 070671 III. GENERAL CONDITIONS This permit is not transferable to any person or entity except after notice to and approval by the Director. In the event there is either a desire for the facilities to change ownership, or there is a name change of the Permittee, a "Name/Ownership Change Form" must be submitted to the Division of Water Quality signed by both parties involved, accompanied by the appropriate documentation as listed on page 2 of the form. The project must be in good standing with DWQ. 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 of the terms and conditions of this permit until such time as the Director approves the transfer request. 3. Neither the sale of the project area, nor transfer of ownership of the common areas constitutes an approved transfer of the permit. 4. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee to enforcement action by the Division of Water Quality, in accordance with North Carolina General Statute 143- 215.6A to 143-215.6C. 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. 6. 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. 7. 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. 8. Permittee grants permission to staff of the DWQ to access the property for the purposes of inspecting the stormwater facilities during normal business hours. 10. 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. 11. A copy of the approved plans and specifications shall be maintained on file by the Permittee for a minimum of ten years from the date of the completion of construction. 12. The permittee shall submit a permit renewal application at least 180 days prior to the expiration date of this permit. The renewal application shall include the appropriate application fee and documentation. Permit issued this the 12th day of July 2013. NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION homas A eeder, Acting Director Division of Water Quality By Authority of the Environmental Management Commission Page 6 of 8 State Stormwater Management Systems Permit No. SW8 070671 Middle Sound Village Stormwater Permit No. SW8 070671 New Hanover Countv Designer's Certification Page 1 of 2 I, as a duly registered in the State of North Carolina, having been authorized to observe (periodically/weekly/full time) the construction of the project, (Project) 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 was 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 are a part of this Certification. Noted deviations from approved plans and specifications: Signature Registration Number Date SEAL Page 7 of 8 State Stormwater Management Systems Permit No. SW8 070671 Certification Requirements: Page 2 of 2 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. 3. All the built -upon area associated with the project is graded such that the runoff drains to the system. 4. 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. 6. The outlet structure is located per the approved plans. 7. Trash rack is provided on the outlet/bypass structure. 8. All slopes are grassed with permanent vegetation. 9. Vegetated slopes are no steeper than 2:1. (As shown on the permitted plan, 2:1 side slopes were originally permitted in 2008, and this design as re -permitted in 2013.) 10. 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. 12. Required drawdown devices are correctly sized per the approved plans. 13. All required design depths are provided. 14. All required parts of the system are provided, such as a vegetated shelf, a forebay, and the vegetated filter. 15. The required dimensions of the system are provided, per the approved plan. cc: NCDENR-DWQ Regional Office Inspector, New Hanover County Building Inspections Page 8 of 8 o 7Ao" '7J Applicable Mules: U Coastal SW —1995 ❑ Coastal SW — 2008 ❑ Ph II - Post Construction (select all that apply) ❑ Non -Coastal SW- HQW /ORW Waters ❑ Universal Stormwater Management Plan ❑ Other WQ Mjzmt Plan: State of North Carolina Department of Environment and Natural Resources Division of Water Quality STORMWATER MANAGEMENT PERMIT APPLICATION FORM This form may be photocopied for use as an original I. 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.): Middle Sound Villaze 2. Location of Project (street address): 611 Middle Sound Loop Road City:Wilmington County:New Hanover Zip:28411 3. Directions to project (from nearest major intersection): From Market Street (US 17) headed NE toward Ogden turn right on to Middle Sound Loop Road Continue 0.98 miles to entrance to site on left. 4. Latitude:34° 16' 4" N _... Longitude:77° 48' 16" W of the main entrance to the project. II. PERMIT INFORMATION: 1. a. Specify whether project is (check one): ❑New ®Modification b.If this application is being submitted as the result of a modification to an existing permit, list the existing permit numberSW8-070671 , its issue date (if known)1-25-08 and the status of construction: NNot Started ❑Partially Completed* ❑ Completed* *provide a designer's certification Specify the type of project (check one): ❑Low Density NHigh 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 DWQ requesting a state stormwater management permit application, list the stormwater 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 ❑NPDES Industrial Stormwater NSedimentation/ Erosion Control: 10.01 ac of Disturbed Area 0404/401. Permit: Proposed Impacts 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 permit:N/A RV: MAY 0 3 2013 Form SWU-101 Version 07Jun2010 Page 1 of 6 III. 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:AF-Middle Sound LLC Signing Official & Title:Craig Briner - Manager b. Contact information for person listed in item 1a above: Street Address:1330 Sunday Drive Suite 105 City:Raleigh State:NC Zip:27607 Mailing Address (if applicable): City: State: Zip: Phone: (919 ) 861-2910 Fax: ( ) Email:cbriner@greenhawkcorp.com 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.N/A Signing Official & Ti b. Contact information for person listed in item 2a above: Street Address: City:, State: Zip: Mailing Address (if applicable): City: State: Zip: Phone: Email: Fax: ( ) 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:N/A Signing Official & Title: b. Contact information for person listed in item 3a above: Mailing Address: City: State: Zip: Phone: 4. Local jurisdiction for building permits: New Hanover County Point of Contact:Linda Painter Phone # Fax: ( ) (910 ) 798-7068 ECEIVE;' MAY 0 3 2013 ' Form SW-101 Version 07Jun2010 Page 2 of 6 IV. PROJECT INFORMATION 1. In the space provided below, briefly summarize how the stormwater runoff will be treated. Stormwater runoff will be treated by means of Infiltration Ponds 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: N/A Date: b.If claiming vested rights, identify the regulation(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 Cape Fear River basin. 4. Total Property Area: 9.93 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`: 9.93 acres Total project area shall be calculated to exclude the following: the normal pool of impounded 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 wetlands landward from the NHW (or MHW) line. The resultant project area is used to calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may be included in the total project area. 8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 37.2 % 9. How many drainage areas does the project have?2 (For high density, count 1 for each proposed engineered stormwater BMP. For low density and other projects, use 1 for the whole property area) 10. Complete the following information for each drainage area identified in Project Information item 9. If there 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 Drainage Area 1 Drainage Area 2 Drainage Area _ Drainage Area Receiving Stream Name Pages Creek Pages Creek Stream Class * SA;HQW SA;HQW Stream Index Number * 18-87-22 18-87-22 Total Drainage Area (sf) 174894 184677 On -site Drainage Area (sf) 174894 184677 Off -site Drainage Area (sf) 0 0 Proposed Impervious Area** (sf) 85926 75412 % Impervious Area** (total) 49.1% 41% bn ervious' Surface Area Drainage Area 1 Drainage Area 2 Drainage Area _ Drainage Area _ On -site Buildings/Lots (sf) 52000 38000 On -site Streets (sf) 12581 22893 0 0 On -site Parking (sf) 18940 8421 0 0 On -site Sidewalks (sf) 2405 6098 0 0 Other on -site (sf) 0 0 0 0 Future (sf) 0 0 0 0 Off -site (sf) 0 0 0 0 Existing BUA*** (sf) 0 0 0 0 Total (sf): 85926 75412 * Stream Class and Index Number can be determined at: http://portal.ncdenr.org/zveb/zvglps/csu/classifications ** Imperviousrea is defined as the built upon area including, but not limited to, buildings o rl g er � sidewalks, ravel areas, etc. *** Report only that amount of existing BUA that will remain after development. Do not r any existing BUA th this to be removed and which will be replaced by new BUA. JUL 112013 a.. Form SWU-101 Version 07Jun2010 Page 3 of 6 BY: 11. How was the off -site impervious area listed above determined? Provide documentation. N/A Projects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened & Endangered Species watershed that may be subject to more stringent stormwater requirements as per 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 htt ortalmcdennorg / web / wo / ws / su /bmv-manual. VI. SUBMITTAL REQUIREMENTS Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ). A complete package includes all of the items listed below. A detailed application instruction sheet and BMP checklists are available from http:/ /12ortal.ncdenr.org/web/wq/ws/su/statesw/forms does. The complete application package should be submitted to the appropriate DWQ Office. (The appropriate office may be found by locating project on the interactive online map at http:/ /portal.nedenr.org/web/wq/ws/su/maps.) 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:/ /12ortal.ncdenr.org/web/wq/ws/su/statesw/forms does. Ir 'tials 1. Original and one copy of the Stormwater Management Permit Application Form. m 2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants AA Form. (if required as per Part VII below) 3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M agreement(s) for each BMP. 4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to http:/ Iwww.envhelp.ore/pages/onestopexpress.html 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 stormwater treatment/management for 6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the receiving stream drains to class SA waters within % mile of the site boundary, include the 1h mile radius on the map. 7. Sealed, signed and dated calculations. _ 8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:_ 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. 1. Details of roads, drainage features, collection systems, and stormwater control measures. m. 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 separatrMAY IV _ ' p. Vegetated buffers (where required). 3 2013 xa�• Form SW-101 Version 07Jun2010 Page 4 of 6 9. Copy of any applicable soils report with the associated SHWT elevations (Please identify W veao^ L— elevations in addition to depths) as well as a map of the boring locations with the existing Ful elevations and boring logs. Include an 8.5"x11" 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 DWQ to verify the SHWT prior to submittal, (910) 796-7378.) 10. A copy of the most current property deed. Deed book:.-811 b & Page No: _ WV L emc._ 11. For corporations and limited liability corporations (LLC): Provide documentation from the NC nn�' Secretary of State or other official documentation, which supports the titles and positions held by the persons listed in Contact Information, item 1a, 2a, and/or 3a per 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.state.nc.us/Corporations/CSearch.aspx 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: / / portal.ncdenr.org / web / wq I ws / su / statesw / forms docs. 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 covenants 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 DWQ, and that they will be recorded prior to the sale of any lot. VIII. 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 Engineer:Charles D. Cagier Consulting Firm: Intracoastal En ing eering Mailing Address:91 Pelican Point City:Wilmington State:NC Zip:28409 Phone: (910 ) 409-3567 Email:Charlie@intracoastalengineering.com eering.com Fax: ( ) N / A IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this section) I, (print or type name of person listed in Contact Information, item 2a) NIA , 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 stornnxvater system. ECEIVE MAY 032013 4 d ICY_ --- Form SWU-101 Version 07Jun2010 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 DWQ Stormwater permit reverts back to me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a completed Name/Ownership Change Form within 30 days; otherwise I 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. Signature: Date: I, a Notary Public for the State of County of , do hereby certify that personally appeared before me this _ day of I and acknowledge the due execution of the application for a stormwater permit. Witness my hand and official seal, SEAL My commission X. APPLICANT'S CERTIFICATION I, (print or type name of person listed in Contact Information, item 1a) Craig Briner - Manager of AF-Middle Sound LLC 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 stormwater rules under 15A NCAC 21-1.1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211. Date: �VX% L.:i.� I, - f� .1M� a Notary Public for the State of County of -Tt do hereby certify that personally appeared before me this day of &qtx c- , o1b I *�-) , and acknowledge the due execution of the application for a stormwater permit. Witness my hand and official BU � �i••..••••.°yq��oi �Q7ARy ';92 ° ° °V USL _.10 Is 4,h� COVN.r�� SEAL seal, My commission expires 0- `� �5 Form SWU-101 Version 07Jun2010 Page 6 of 6 Permit No. W2 w 0(0-1' (to be provided by DWQ) OaOF W ATFgpG STORMWATER MANAGEMENT PERMIT APPLICATION FORM 401 E NCDENR C RTIFICATION APPLICATION FORM INFILTRATION BASIN SUPPLEMENT This form must be filled out, printed and submitted. The Required Items Checklist (Part Ill) must be printed, filled out and submitted along with all of the required information. PROJECT 14FORMATION Project Name Middle Sound Village Contact Person Craig Briner Phone Number 919-210-1996 Date Drainage Area Number N. DESIGN INFORMATION Site Characteristics 2/8/2013 2 Drainage area 184,677.00 f Impervious area 75,412.00 ft2 Percent impervious 40.83 % Design rainfall depth 1.50 in Peak Flow Calculations 1-yr, 24-hr rainfall depth in 1-yr, 24-hr intensity in/hr Pre -development 1-yr, 24-hr discharge ft3/sec Post -development 1-yr, 24-hr discharge ft3/sec Pre/Post 1-yr, 24-hr peak flow control ft3/sec Storage Volume: Non -SA Waters Minimum design volume required ft3 Design volume provided ft3 Storage Volume: SA Waters 1.5" runoff volume 9465.00 ft3 Pre -development 1-yr, 24-hr runoff volume 0.00 ft3 Post -development 1-yr, 24-hr runoff volume 0.00 ft3 Minimum required volume 9465.00 ft3 Volume provided _ 19,392.00 ft3 Solis Report Summary Soil type Yellow Med Sand Infiltration rate 3.70 in/hr SHWT elevation 14.50 fmsl Basin Design Parameters Drawdown time 0.41 days Basin side slopes 2.00 :1 Basin bottom elevation 16.50 fmsl Storage elevation 19.50 fmsl Storage Surface Area 7,895.00 ft2 Top elevation 20.50 fmsl Basin Bottom Dimensions Basin length 100.00 ft Basin width 45.00 ft Bottom Surface Area 5,682.00 ft2 OK OK Side Slopes are too steep, maximUrn 3:1 OK 9=V11-t1fi0 J IECEIVE 111 1 1 2113 BY: Form SW401-Infiltration Basin-Rev.5 11Apr2011 Parts I. & II. Design Summary, Page 1 of 2 Permit No. (to be provided by DWG) Additional Information =U105ci r"O f C Maximum runoff to each inlet to the basin? 2.61 ac-in Maximum of 2 acre -inches allowed 1"r� fie e-. miLAR—Yt7 LLA(E Length of vegetative filter for overflow 50.00 ft OK Distance to structure na ft OK Distance from surface waters 200.00 ft OK Distance from water supply well(s) na ft OK Separation from impervious soil layer na ft OK Naturally occuring soil above shwt 2.00 ft OK Bottom covered with 4-in of clean sand? y (Y or N) OK Proposed drainage easement provided? y (Y or N) OK Capures all runoff at ultimate build -out? y (Y or N) OK Bypass provided for larger storms? y (Y or N) OK Pretreatment device provided y Grassed Swale ECEINVIC-0 MAY 0 31013 BV: Forth SW401-Infiltration Basin-Rev.5 11Apr2011 Parts 1. & II. Design Summary, Page 2 of 2 Permit No. (to be provided by DWQ) III. REQUIRED ITEMS CHECKLIST Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a requirement has not been met, attach justification. Pagel Plan Initials heet N lans (1' - 50' or larger) of the entire site showing: - Design at ultimate build -out, - Off -site drainage (if applicable), - Delineated drainage basins (include Rational C coefficient per basin), Basin dimensions, - Pretreatment system, - High flow bypass system, Maintenance access, - Proposed drainage easement and public right of way (ROW), - Overflow device, and a��� �,,,�� Boundaries of drainage easement. �r t (� ��';�. partial plan (1' = 30' or larger) and details for the infiltration basin showing: - Bypass structure, - Maintenance access, Basin bottom dimensions, Basin cross-section with benchmark for sediment cleanout, - Flow distribution detail for inflow, Vegetated filter, and Pretreatment device. lt1�CL7 3. Section view of the infiltration basin (1" 20' or larger) showing: - Pretreatment and treatment areas, and A, �- Inlet and outlet structures. ►14� table of elevations, areas, incremental volumes & accumulated volumes to verify the volume provided. ftto MUN�AL5. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The results of the soils report must be verified in the field by DWQ, by completing & submitting the soils investigation request form. County soil maps are not an acceptable source of soils information. 6. A construction sequence that shows how the infitiration basin will be protected from sediment until the entire drainage area is stabilized. 7. The supporting calculations. 6A _)4j1CjACft. A copy of the signed and notarized operation and maintenance (O&M) agreement. d9. A copy of the deed restrictions (if required). Form SW401-Infiltration Basin-Rev.4 MAY 0 3 2013 By. image—"i oft— jFCE VEj APR 2 2013 m: Part III. Required Items /Uhecklist, Page 1 of 1 Permit No. 0'70 (to be provided by D Q) W AT�cR o�pG STORMWATER MANAGEMENT PERMIT APPLICATION FORM oE, ems. NCDENR 401 CERTIFICATION APPLICATION FORM INFILTRATION BASIN SUPPLEMENT This form must be filled out, printed and submitted. The Required Items Checklist (Part lit) must be printed, filled out and submitted along with all of the required information. !. PROJECT INFORMATION Project Name Middle Sound Village Contact Person Craig Briner Phone Number 919-210-1996 Date 2/8/2013 Drainage Area Number t ll. DESIGN INFORMATION Site Characteristics Drainage area 174,894.00 f? Impervious area 85,926.00 ff2 Percent impervious 49.13 % Design rainfall depth 1.50 in Peak Flow Calculations 1-yr, 24-hr rainfall depth in 1-yr, 24-hr intensity in/hr Pre -development 1-yr, 24-hr discharge ft/sec Post -development 1-yr, 24-hr discharge ff3/sec Pre/Post 1-yr, 24-hr peak flow control ft3/sec Storage Volume: Non -SA Waters Minimum design volume required ft, Design volume provided ff3 Storage Volume: SA Waters 1.5" runoff volume 10734.00 ff3 Pre -development 1-yr, 24-hr runoff volume 0.00 ff3 Post -development 1-yr, 24-hr runoff volume 0.00 ft3 Minimum required volume 10734.00 ff3 Volume provided P1,869.00 ft3 Soils Report Summary Soil type Yellow Med Sand Infiltration rate 3.70 in/hr SHWT elevation 14.50 fmsl Basin Design Parameters Drawdown time 0.41 days Basin side slopes 2.00 :1 Basin bottom elevation 16.50 fmsl Storage elevation 19.50 fmsl Storage Surface Area 8,457.00 fe Top elevation 2050 fmsl Basin Bottom Dimensions Basin length 95.00 ft Basin width 55.00 ft Bottom Surface Area 6,122.00 fe OK OK Side Slopes are too steep, maximum 3:1 OK 9L,,q �'C�6S7 ' 11 �Itiz1�3 CEIVE JUL 112013 l:- Form SW401-Infiltration Basin-Rev.5 11Apr2011 Parts I. & II. Design Summary, Page 1 of 2 Permit No. (to be provided by DWQ) Additional Information f &T Maximum runoff to each inlet to the basin? Length of vegetative filter for overflow 2.95 ac-in 50.00 ft Maximum of 2 OK '?P acre -inches allowed` Distance to structure na ft OK� Distance from surface waters 200.00 ft OK Distance from water supply well(s) na ft OK Separation from impervious soi! layer na ft OK Naturally occuring soil above shwt 2.00 ft OK Bottom covered with 4-in of clean sand? y (Y or N) OK Proposed drainage easement provided? y (Y or N) OK Capures all runoff at ultimate build -out? y (Y or N) OK Bypass provided for larger stones? y (Y or N) OK Pretreatment device provided y Grassed Swale EVEIV� APR 2 2 2013 ra�r: Forth SW401-Irfiitration Basin-Rev.5 11Apr2011 Parts I. & II. Design Summary, Page 2 of 2 Permit No. (to be provided by DWQ) III. REQUIRED ITEMS CHECKLIST Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. 9 a requirement has not been met, attach justification. Page/ Plan Initials A ,S �_ 1 w� IL 51. Plans (1" - 50' or larger) of the entire site showing: - Design at ultimate build -out, - Off -site drainage (if applicable), - Delineated drainage basins (include Rational C coefficient per basin), - Basin dimensions, - Pretreatment system, - High flow bypass system, Maintenance access, - Proposed drainage easement and public right of way (ROW), Overflow device, and Boundaries of drainage easement. Partial plan (1' = 30' or larger) and details for the infiltration basin showing: - Bypass structure, - Maintenance access, Basin bottom dimensions, Basin cross-section with benchmark for sediment cleanout, Flow distribution detail for inflow, Vegetated filter, and Pretreatment device. _Nik,46 3. Section view of the infiltration basin 0' = 20' or larger) showing: - Pretreatment and treatment areas, and - inlet and outlet structures. Cffiwmalll A table of elevations, areas, incremental volumes & accumulated volumes to verify the volume provided. 6W AL 5. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The results of the soils report must be verified in the field by DWQ, by completing & submitting the soils investigation request form. County soil maps are not an acceptable source of soils information. 6. A construction sequence that shows how the infitration basin will be protected from sediment until the �i entire drainage area is stabilized. CAUtS 7. The supporting calculations. .CAX AIN00 8. A copy of the signed and notarized operation and maintenance (O&M) agreement. 9. A copy of the deed restrictions (if required). p�ECENED 16APR 2z2013 g�. Form SW4o1-Infiltration Basin-Rev.4 Page 1 of 1 Part III. Required Items Checklist, Page 1 of 1 S`�8'O 7&'6 71 Permit Number: (to be provided by DWQ) Drainage Area Number: Infiltration Basin 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: - The drainage area will be carefully managed to reduce the sediment load to the infiltration basin. - Immediately after the infiltration basin is established, the vegetation will be watered twice weekly if needed until the plants become established (commonly six weeks). - No portion of the infiltration basin will be fertilized after the initial fertilization that is required to establish the vegetation. - The vegetation in and around the basin will be maintained at a height of approximately six inches. After the infiltration basin is established, it will be inspected once a quarter 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: The entire BMP Trash/ debris is present Remove the trash/ debris. The perimeter of the Areas of bare soil and/or Regrade the soil if necessary to infiltration basin erosive gullies have formed. remove the gully, and then plant a ground cover and water until it is established. Provide lime and a one-time fertilizer application. The inlet device: pipe or The pipe is clogged (if Unclog the pipe. Dispose of the swale applicable). sediment off -site. The pipe is cracked or Replace the pipe. otherwise damaged (if applicable). Erosion is occurring in the Regrade the swale if necessary to swage (if applicable). smooth it over and provide erosion control devices such as reinforced turf matting or riprap to avoid future problems with erosion. 'm► � ems'* 4� t#� � MAY 0 3 262 Form SW401-Infiltration Basin O&M-Rev.3 BY. of 3 BMP element: Potential problem: How I will remediate theproblem: The forebay Sediment has accumulated Search for the source of the and reduced the depth to 75% sediment and remedy the problem if of the original design depth. possible. Remove the sediment and dispose of it in a location where it will not cause impacts to streams or the BMP. Erosion has occurred or Provide additional erosion riprap is displaced. 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 pesticides are used, wipe them on the plants rather than The main treatment area A visible layer of sediment -spraying. Search for the source of the has accumulated. sediment and remedy the problem if possible. Remove the sediment and dispose of it in a location where it will not cause impacts to streams or the BMP. Replace any media that was removed in the process. Revegetate disturbed areas immediately. Water is standing more than Replace the top few inches of filter 5 days after a storm event. media and see if this corrects the standing water problem. If so, revegetate immediately. If not, consult an appropriate professional for a more extensive repair. Weeds and noxious plants are Remove the plants by hand or by growing in the main wiping them with pesticide (do not treatment area. spray). The embankment Shrubs or trees have started Remove shrubs or trees to grow on the embankment. immediately. An annual inspection by an Make all needed repairs. appropriate professional shows that the embankment needs repair. The 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. The receiving water Erosion or other signs of Contact the NC Division of Water damage have occurred at the Quality 401 Oversight Unit at 919- oulet. 1 733-1786. Form SW401-Infiltration Basin O&M-Rev.3 Page 2 of 3 Permit Number: (to be provided by DWQ) 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:Middle Sound Village BMP drainage area numberA7. Print name:Craig Briner Title:Manaizer of AF-Middle Sound LLC Address:1330 Sunday Drive Suite 105, Raleigh NC 27607 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, ESSC - L L ,�Ar.) , a Notary Public for the State of NCAQ_6L�ux , County of -rz , do hereby certify that ca4-y' A, ,+" dZ personally appeared before me thisX s�'� day of H , 201`3 , and acknowledg a the due execution of the forgoing infiltration basin maintenance requirements. Witness my hand and official seal, ��`���j�G�:•S U C�'9 yz,��i jt/ i�i�i` ••••R� ,� t7T�R 9 � e y tt s SEAL My commission expires Form SW401-Infiltration Basin O&M-Rev.3 Page 3 of 3 State of. North Carolina Department of Environment and Natural Resources Division of Water Quality STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM I. CURRENT PERMIT INFORMATION 1. Stormwater Management Permit Number: SW8070671 2. Project Name: Middle Sound 3. Current Permit Holder's Company Name/Organization: Wilshire Management Group, LLC 4. Signing Official's Name: Patrick Bradley Southerland 5. Mailing Address: P.O. Box 3366 City: Wilmington 6. Phone: 910 264-9977 Title: Member Manager State: NC Zip: 28406 Fax: �) 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) x❑ 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: AF-Middle Sound LLC 2. Proposed permittee's signing official's name: Craig Briner 3. Proposed permittee's title: Manager 4. Mailing Address: '1330 Sunday Drive Suite 105 City: Raleigh State: NC Phone: (.919_ ) 861-2910 Fax: ( 919 ) 861-2901 5. New Project Name to be placed on permit: NA Zip: 27607 Please check the appropriate box. The proposed permittee listed above is: ❑ HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a recorded easement for all areas that contain stormwater system features. Print name of HOA or POA in #1 above and provide name of HOA/POA's authorized representative in #2 above) x❑ The property owner ❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on page 4) 1=1 Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be granted upon receipt of a copy of the recorded deed) ❑ Developer (Complete Property Owner Information on page 4) ECEIVE MAY 0 3 2013 SSW N/O Change Rev24Sept2012 Page 1 of 4 6Y. III. REQUIRED ITEMS A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all of the applicable required items listed below are included with the submittal. Failure to provide the listed items may result in processing delays or denial of the transfer. 1. This completed and signed form. This certification must be completed and signed by both the current permit holder and the new applicant if this is a change of ownership. 2. Legal documentation of the property transfer to a new owner. NA 3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit. NA 4. The designer's certification (DWQ Engineer and Designer Certification Forms are available from each DWQ Regional office), if required by the permit and if not already submitted to DWQ. 5. If the proposed permittee is a firm, partnership, association, institution, corporation, limited liability company, or other corporate entity, provide documentation showing the authority of the named representative to act on behalf of the proposed permittee. 6. The $40.00 processing fee. If this is an initial transfer from the original permittee the processing fee is not required. Subsequent ownership transfers will require the $40.00 processing fee. IV. CURRENT PERMITTEE'S CERTIFICATION Please check one of the following statements and fill out the certification below that statement: ❑ Check here if the current permittee is only changing his/her/its name, the project name, or mailing address, but will retain the permit. I, , the current permittee, hereby notify the DWQ that I am changing my name and/or I am changing my mailing address and/or I am changing the name of the permitted project. I further attest that this application for a name/ownership change is accurate and complete to the best of my knowledge. I understand that if all required parts of this application are not completed or if all required supporting information and attachments listed above are not included, this application package will be returned as incomplete. ® Check here if current permittee is transferring the property to a new owner and will not retain ownership of the permit. I, Patrick Bradley Southerland , the current permittee, am submitting this application for a transfer of ownership for permit # Sws 070671 . I hereby notify DWQ of the sale or other legal transfer of the stormwater system associated with this permit. I have provided a copy of the most recent permit, the designer's certification for each BMP, any recorded deed restrictions, covenants, or easements, the DWQ approved plans and/or approved as -built plans, the approved operation and maintenance agreement, past maintenance records, and the most recent DWQ stormwater inspection report to the proposed permittee named in Sections 11 and V of this form. I further attest that this application for a name/ownership change is accurate and complete to the best of my knowledge. I understand that if all required parts of this application are not completed or if all required supporting information and attachments listed above are not included, this application package will be returned as incomplete. I assign all rights and obligations as permittee to the proposed permittee named in Sections II and V of this form. I understand that this transfer of ownership cannot be approved by the DWQ unless and until the facility is in compliance with the permit. ---I Signature: Date: I, Joa-rime E Me; se�-�. 1J onk+% C a�ol r;� , County of .2;"oA a Notary Public for the State of do hereby certify that personally appeared before me this the day of , 20 13, and acknowledge the due execution of the forgoing instrument. Witness my hand and official seal, Nbotty Signature (Notary Seal) MAY 0 3 2013 F D� SSW N/Q Change Rev24Sept2012 Page 2 of 4 V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the Proposed Permittee for all transfers of ownership) I, Craig Briner , hereby notify the DWQ that I have acquired through sale, lease or legal transfer, the responsibility for operating and maintaining the permitted stormwater management system, and, if applicable, constructing the permitted system. acknowledge and attest that I have received a copy of: (check all that apply to this permit) xethe most recent permit the designer's certification for each BMP ❑ any recorded deed restrictions, covenants, or easements x❑ the DWQ approved plans and/or approved as -built plans x❑ the approved operation and maintenance agreement ®past maintenance records from the previous permittee (where required) DWQ stormwater inspection report showing compliance within 90 days prior to this transfer I have reviewed the permit, approved plans and other documents listed above, and I will comply with the terms and conditions of the permit and approved plans. I acknowledge and agree that I will operate and maintain the system pursuant to the requirements listed in the permit and in the operation and maintenance agreement. I further attest that this application for a name/ownership change is accurate and complete to the best of my knowledge. I understand that if all required parts of this application are not completed or if all required supporting information and attachments listed above are not included, this application package will be returned as incomplete. Signature: Date: NP*RNL. ' S J�LO13 �T , a Notary Public for the State of cxNA- , County ofA4zM6_--7-r , do hereby certify that C-►Z�'�c,_ f-\ �Z�Z personally appeared before me this the v27 day of A:;;5� , 2013 , and acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,\•''I o Buy ° e 9 a (Notary Seal?:° �pTARy `•2 ° otary Signature ° 0 ••ae°°°pONN ;p�� Additional copies of the original permit and the approved Operation and Maintenance agreement can be obtained from the appropriate Regional Office of the Division of Water Quality. This completed form, including all supporting documents and processing fee (if required), 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 rote that if the Proposed Pennittee 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 property owner will appear on the permit as permittees. t= C; t--1G MAY 0 3 2013 SSW N/O Change Rev24Sept2012 Page 3 of 4 VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION If the Proposed Permittee listed in Sections l/ and V of this form is not the Property Owner, the Property Owner must provide his/her Contact Information below and sign this form: Printed Name: Organization: Title within the Organization: Street Address: City: Mailing Address: City: Phone: Email: State: (if different from street address) State: Fax: Zip: Zip: I certify that I own the property identified in this permit transfer document and have given permission to the Proposed Permittee listed in Sections II and V to develop and/or, lease the property. A copy of the lease agreement or other contract, which indicates the party responsible for the construction and/or operation and maintenance of the stormwater system, has been provided with the submittal. 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 I will therefore share responsibility for compliance with the DWQ Stormwater permit. 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 Statute (NCGS) 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. Signature of the property owner Date: County of a Notary Public for the State of do hereby certify that personally appeared before me this the day of , 20 , and acknowledge the due execution of the forgoing instrument. Witness my hand and official seal, Notary Signature (Notary Seal) EGEIV'ff-- MAY 0 3 2013 SSW N/O Change Rev24Sept2012 Page 4 of 4