SW6140202_Renewal Application_20220623

Mr. Mike Lawyer, CPSWQ
NCDENR - Division of Energy,
Mineral & Land Resources
Land Quality Section
225 Green Street, Suite 714
Fayetteville, NC 28301
Re: Bedford Subdivision Section One
Permit Renewal Application
State Stormwater Permit Number: SW6140202
Dear Mike,
Enclosed are the following items associated with the permit renewal packet for Bedford
Subdivision Section One:
1. Check for $505.00
2. 1 original of the Permit Renewal Form with Secretary of State Document Attached
3. 1 copy of the Permit Renewal Form with Secretary of State Document Attached
4. 1 digital copy of the Permit Renewal Form with Secretary of State Document Attached
Please let me know if you have any questions or need any further information.
Respectfully Submitted,
Moorman, Kizer & Reitzel, Inc.
Cynthia M. Smith
JUN 2 3 2022
DEMLR
t r'

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
W23 Lee aasp
02© 2
NC DEQ Division of Energy, Mineral and Land Resources
In accordance with 15A NCAC 2H.1045(3). the current permit holder shall renew their hi h density permit 180 days
rior to its ex iration. Renewed ermits are valid fora eriod of 8 ears er Session L . �1 3 ,/ 8 �4 78t1 ­
Section 60. (c). This application form is for permit renewals only.
JUN 2 3 2022
A. PROJECT INFORMATION 2 I. j.2 pA,
1. State Stormwater Permit Number:
sW61402OZ DEPAYETTEVILLE RtIONALOFRC
2
Project name: Bedford - Section One
3. Project street address: 7951 Fayetteville Road
City: Raeford County: Hoke Zip ; 28376
4. What, if any, changes have been made to the project as permitted? None
If the project has changed from the original approved plans, please complete SWU-101 for a Major
Modification or Minor Modification Application form available at.* https://deg.nc.gov/about/divisions/energy-
mineral-land-resources/energy-mineral-land-rules/stormwater-program/post-construction.
i L � T
if changes to the permittee or project name have been made, please complete either the Permit Update form
or the Permit Transfer form available at. https://deg.nc.gov/about/divisions/energy-mineral-land-
resources/energy-mineral-land-rules/stormwater-program/post-construction. State Stormwater Permits do not
automatically transfer with the sale of the property.
1. Current Permit Holder's Company Name/Organization: Breezewood of Fayetteville, LLC.
2. Signing Official's Name: D. Ralph Huff, III
3. Signing Official's Title: Member
4. Mailing Address: 2919 Breezewood Avenue, Suite 100
City: Fayetteville State: NC Zip: 28303
5. Street Address: 2919 Breezewood Avenue, Suite 100
City: Fayetteville State: NC Zip: 28303
6. Phone: (910 ) 302-3608 Email: [e-mail]
Stormwater Permit Renewal Form Page 1 of 3 May 11, 2018

C. SUBMITTAL. REQUIREMENTS
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORV10. Only applications packages that
include all required items listed below will be accepted and reviewed.
Initial each item below to indicate that the required information is provided in the application package:
DRH 1. A permit application processing fee of $505.00 payable to NCDEQ.
DRH 2. One original signed hard copy and one electronic copy of this completed form. The signing official
named on this application to represent the current permittee must meet one of the following:
a. Corporation — a principle executive officer of at least the level of vice-president;
b. Limited Liability Company (LLC) — a manager or company official as those terms are defined
in G.S. 57D "North Carolina Limited Liability Company Act;"
c. Public Entity — a principal executive officer, ranking official, or other duly authorized employee;
d. Partnership or limited partnership — the general partner;
e. Sole proprietor; or
f. Letter of authorization signed by one of the signatories noted in a — e above authorizing the
signature of another entity.
DRH 3. One hard copy and one electronic copy of recorded documents required by the original permit that
have not yet been received by DEMLR, including: deed restrictions, protective covenants,
condominium/planned community declaration and easements. If the project has been built, include
documentation that the maximum BUA per lot or maximum total BUA has not been exceeded. If
the project has not been built, include a signed agreement that the final recorded deed restrictions
and protective covenants will be submitted at a later date.
DRH 4. O&M Agreements, Please select one:
[� I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to
keep this on file with the permit; or
❑ 1 do not have a copy of the current recorded O&M Agreement for all SCMs and am
requesting a copy be sent to me. I agree to keep this on file with the permit.
DRH 5. Designer Certifications, Please select one:
❑ A copy of the certification(s) confirming that the project was built in accordance with the
approved plans have been previously provided to the Division; or
❑ A copy of the certification(s) confirming that the project was built in accordance with the
approved plans are enclosed; or
0 The project has not yet been built. (Pond has not been converted/completed)
N/A 6. [IF APPLICABLE] If the project has been built, one original hard copy and one electronic copy of a
signed, sealed, and dated letter from a licensed professional stating that the SCMs have been
inspected, and that they have been built and maintained in accordance with the permit.
DRH 7. [IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC):
Provide one hard copy and one electronic copy of documentation from the NC Secretary of State,
or other official documentation, which supports the titles and positions held by the persons listed in
Section C.2 per 15A NCAC 2H. 1043(3)(b).
https://www.sosne.gov/online services/search/by title/ Business Registration
Stormwater Permit Renewal Application Form Page 2 of 3 May 11, 2018

D. PERMITTEE'S CERTIFICATION
D. Ralph Huff, III , the person legally responsible for the permit, certify that I have
a copy of the Permit and O&M Agreement on site (or I will obtain a copy and it will be kept on site), that I am
responsible for the performance of the maintenance procedures, and the site has been and will be maintained
according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs
or built -upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the
project, SCMs, or ownership. All information provided on this permit renewal application is, to the best of my
knowledge, co st nd c plete.
Signature: Date:
NOTARIZATION:
I, A rnu 0 m
County of
that
1
this the 'aLUi day of
execution of the forgoing instrument. Witness my hand and official seal,
a Notary Public for the State of
do hereby certify
personally appeared before me
20 D � , and acknowledge the due
(Notary Seal)
• M
Cumbed•� 1
• i . CaroftNotary Signature: M C�ommll
My commission expires--1
Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

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Limited Liability Company
Legal Name
Breezewood of Fayetteville, LLC
Information
Sosid: 0707287
Status: Current -Active
Date Formed: 1/20/2004
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Caviness, Watson G.
Addresses
Mailing principal Office Reg Office Reg Mailing
639 Executive Place Suite 400 639 Executive Place Suite 400 639 Executive Place Suite 400 639 Executive Place Suite 400
Fayetteville, NC 28305-5489 Fayetteville, NC 28305-5489 Fayetteville, NC 28305-5489 Fayetteville, NC 28305-5489
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Member Member Member
Christopher E. Cates Watson G. Caviness Denver Ralph Huff
639 Executive Place, Suite 400 639 Executive Place, Suite 400 2919 Breezewood Avenue Suite 400
Fayetteville NC 28305 Fayetteville NC 28305 Fayetteville NC 28303