SW8070671_Current Permit_20130712

A
�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: [phone] FAX: [phone] 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
[phone].
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:[e-mail]
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization.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, [phone].)
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:[e-mail]
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: [phone]
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