SW8130113_HISTORICAL FILE_20211119

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO
SW8 1301 13
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
20 21 11 1 q
YYYYMMDD

Smith, Ashley M
From
Debbie Juliano <debbiejuliano@saberhealth com>
Sent
Thursday, November 18, 2021 4 57 PM
To
Smith, Ashley M
Cc
Peter Holmes
Subject
[External] RE State Stormwater Permit #SW8 130113
Attachments
Update Page 1 of Stormwater Permit for Autumn Corporattion 11 18 2021 pdf
Follow Up Flag Follow up
Flag Status Completed
CAUTION External email Do not click Inks or open attachments unless you verify Send all suspicious email as an attachment to
Reo�rtSpam
Hello Ashley,
I left you a voice message in regards to this email and I am following up on your request for an updated page 1 of the
permit documentation
Please see updated page 1 of the Stormwater Permit with correction to section B 1 as requested And, if you need
anything else, please let me know and we will respond to you request as quickly as possible
Thank you & Kindest Regards,
SPECIAL NOTE Our business address has changed Please be sure to update your records with our new address listed
below O
rl)ebbw Ptham
Project and Procurement Administrator
Saber, Community Support and Development
23700 Commerce Park
Beachwood OH 44122
216 292 5706 phone ext 100183
216 292 5709 fax
This email and any files transmitted with it are confidential and intended solely for the use of the individual or
entity to whom they are addressed It you have received this email in error please notify the system manager
1 his message contains confidential information and is intended only for the individual named If you are not the
named addressee you should not disseminate distribute or copy this e-mail
From Smith, Ashley M [mailto ashleym smith@ncdenr gov]
Sent Thursday, November 18, 20212 40 PM
To Debbie Juliano <debbie Juliano@saberhealth com>, Peter Holmes <peter holmes@saberhealth com>
Subject State Stormwater Permit #SW8 130113
Hello,
I just want to start off by saying apologies I did not catch this before Ms Debbie thank you for completing the renewal
application and getting the operating agreement sent to me I really appreciate it

I have been Informed that we need matching Information based on the previous Issued permit, the renewal application,
and the next Issued renewal for our database On the original application, I noted that Brunswick Health & Rehab were
owned by Autumn Corporation Since the permit Itself is going to be addressed and Issued to Autumn Corporation, this
needs to be reflected on the application as well If I could receive an updated page one of the application listing Autumn
Corporation as the current permittee, then I can Issue the permit
I appreciate your help on getting this permit back Into compliance as an active status Thank youl
Ashley Smith
Renewal Specialist
Division of Energy, Mineral and Land Resources, Wilmington Regional Office
NC Department of Environmental Quality
Phone [phone]
Email ashleym smith@ncdenr gov
127 Cardinal Drive Ext
Wilmington, NC 28405
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
NOTICE This email may contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it
is addressed If you are not the intended recipient of this email you are hereby notified that any unauthorized use dissemination or copying of this
email or the information contained in it or attached to it is strictly prohibited You maybe subject to penalties under law for any improper use or
further disclosure of any Protected Health Information in this email If you have received this email in error, please delete it and immediately notify
the sender of this email by reply mail Thank you

Burd, Tina J
From Burd, Tina 1
Sent Thursday, November 18, 2021 2 32 PM
To peter holmes@saberhealth com'
Subject SW8 130113 - Autumn Care of Brunswick County
The Wilmington Regional Office of the Division of Energy, Mineral and Land Resources (Stormwater Section) accepted
the Stormwater Permit Renewal Application and $505 00 fee for the subject project on November 12, 2021 The project
has been assigned to Ashley Smith and you will be notified if additional information is needed
Best Regards,
Tina Burd
Administrative Associate II
Wilmington Regional Office
Division of Environmental Assistance & Customer Service
Phone [phone]
NCDEQ
Wilmington Regional Office
127 Cardinal Drive Ext
Wilmington, NC 28405
Email correspondence to and from this addiess is subject to the
North Carolina Public Records taw and may be disclosed to third parties
Website htto //deo nc Qov/about/divisions/enerav mineral -land resources/stormwater
Based on the current guidance to minimize the spread of COVID-ig, the Department of Environmental Quality has adjusted
operations to protect the health ind safety of the staff and public Many employees are working remotely or are on staggered
shifts To accommodate these staffing changes, all DEQoffice locations are limiting public access to appointments only Please
check with the appropuate staff befoie visiting our offices, as we may be able to handle your requests by phone or email We
appreciate vour patience as we continue to serve the public during this challenging time

Non -Transfer Application Completeness Review Checklist
Project Name Ao-r4>rv%,4 CA&E, 154zJIJsLN1c,k cp,*Ty
Project County/Location 75QAJ1`Z*LZ1CX—
Permit Action New New Permit #2
Permit Type
Development Type
Subdivide&
Rule(s) r
Date Delivered to WIRO
I l h2j ZD 7- (
BIMS Received/Accepted Date
)1A 2 Z
Date Gwen to Admin
/ !
BIMS Acknowledged Datet
Not located in the ETJ of the following delegated
and functioning programs
NHC Carolina Beach / Kure Beach / Wilmington / Wrightsville Beach
Bruns Leland / Navassa (2) / Oak Island
Cart Emerald Isle Onsl Jacksonville Pend Surf City
Major Mod / Minor Mod enewal ®Existing Permit #
❑Applicant & Permittee are the sari Expiration Date'
HD LD / LID Overall / HD &LD Combo
General Permit / Offsite / Exempt + Redevelopment
me Residential / Other
Subdivision or 4MIRTFLo
Coastal
-I
Permittee Type & Documents Needed
®Property Owner(s) I C
Coastal 1:11995 Coastal
.rsaI F11988 Coastal
S4..) B ! 30 l 13
mCHfsite to SWS
ElIsOffsite Lot approved in Master Permit2s
OLessee [:]HOA
QViable2 QViable2
Agmt QLease FiElection Minutes
IIPaperwork
�Application
Fee ©$505 (within 6mo) Check#(s) t->& 38r7No Fee
FlSupplement2(1 newform orforolderforms I origmolper SCM)
DO&M2
F—Isoils Report (Infil or PP)
Calculations (signed/sealed)
Deed Restrictions if subdivided
Project Narrative
r-1USGS Map (or on fije2) Subject to SA? Y / N Subject to ORW2 Y / N
Plans (2 Sets)
NOTES
Enter BIMS Acknowledged Date on this Sheet
rFor New Projects Enter New Permit # on Supplements & Deed Restriction Templates
3If permittee is different STOP Needs to be transferred first
°If w/in 6 months and they are requesting a mod STOP Needs a renewal first
slf Lot not approved in master permit, STOP Master permit needs mod
EMAILED ENGINEER DATE Comments
REVIEWER NAME fi c 46 i
Developer
EDViable2
G WQ\\\Reference Libra ry\Procedures\Checkiats\Completeness Review Ch eckiist 202109 08

r,'p4r LIMITED LIABILITY COMPANY ANNUAL REPORT
razou
NAME OF LIMITED LIABILITY COMPANY
Health & Rehab Center. LLC
SECRETARY OF STATE ID NUMBER 1612032 STATE OF FORMATION NC
REPORT FOR THE CALENDAR YEAR 2021
SECTION A REGISTERED AGENT'S INFORMATION
1 NAME OF REGISTERED AGENT CT Corporation System
2 SIGNATURE OF THE NEW REGISTERED AGENT
- Filed Annual
1612032
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3 REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4 REGISTERED AGENT OFFICE MAILING ADDRESS
160 Mine Lake Ct Ste 200
160 Mine Lake Ct Ste 200
Raleigh, NC 27615 Wake County Raleigh, NC 27615
SECTION B
1 DESCRIPTION OF NATURE OF BUSINESS Nursing Home Operations
2 PRINCIPAL OFFICE PHONE NUMBER [phone] 3 PRINCIPAL OFFICE EMAIL Privacy Redaction
4 PRINCIPAL OFFICE STREET ADDRESS 5 PRINCIPAL OFFICE MAILING ADDRESS
23700 Commerce Park 23700 Commerce Park
Beachwood, OH 44122 Beachwood, OH 44122
6 Select one of the following If applicable (Optional see Instructions)
❑ The company is a veteran -owned small business^—
tL`Lo�p W tL_, ,
❑ The company is a service -disabled veteran -owned small business NOV 12
2021
SECTION C COMPANY OFFICIALS (Enter additional company officials in Section E) BY
NAME Saber Governance, LLC NAME NAME
TITLE Manager TITLE TITLE
ADDRESS ADDRESS ADDRESS
23700 Commerce Park
Beachwood, OH 44122
SECTION D CERTIFICATION OF ANNUAL REPORT Section D must be completed in its entirety by a person/business entity
Saber Governance, LLC, by William I Weisberg President 4/6/2021
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This tone
Saber Governance, LLC, by William I Weisberg President Manager
Print or Type Name of Company Official Print or Type Tide of Company Official
This Annual Report has been filed electronically
MAIL TO Secretary of State Business Registration Dwisiun Post Office Box 29525 Raleigh NC 27626-0525

ROY COOPER
Governor
ELIZABETH S BISER
Secretory
BRIAN WRENN
Director
October 13, 2021
Autumn Corporation
Attic William I Weisberg, President
23700 Commerce Park
Beachwood, OH 44122
NORTH CAROLINA
Environmental QuaQty
Subject Stormwater Permit Renewal Request and Transfer -Request
State Stormwater Management Permit No. SW8 130113 �—
Autumn Care
Brunswick County
Dear Mr Weisberg
State Stormwater Management Permit 4SW8 130113 for the subject project expired on April 5, 2021 This is a
reminder that permit renewal applications are due 180 days prior to their expiration per 15A NCAC 2H 1045(3)
North Carolina General Statutes and the Coastal Stormwater niles require that this property be covered under a
stormwater permit Failure to maintain a permit subjects the owner to assessment of civil penalties More
information about the Post -Construction state stormwater program can be found on the following websrte
deg nL�P_oV/SW
Please submit a complete permit renewal form along with a $505 00 fee and other submittal requirements within
30 days The permit renewal form can be found under the Post -Construction section of this webste or at
Permits are not automatically transferred when the property ownership changes If this property has had an
ownership change, a permit transfer application form along with the submittal requirements will also need to be
submitted This form can also be found on the websrte provided above
If you have any questions regarding this matter, please contact Ashley Smith at [phone] or
ashleym smith@ncdenr gov
Sincerely,
Ck
4 Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
DES/ams \\\Stormwater\Permits & Projects\2013\130113 HD\2021 10 req_ren 130113
cc CT Corporation System, Registered Agent, Autumn Corporation, 160 Mine Lake Ct Ste 200, Raleigh, NC 27615
-0H1=Asset (NC-).Hallsboro, LP, New Property Owner, 303 International Circle Suite 200, Hunt Valley, MD 21030
CT Corporation System, Registered Agent for New Property Owner, 160 Mine Lake Ct Ste 200, Raleigh, NC
27615
Wilmington Regional Office File
Mn Wft'_
North Carolina Department of Environmental Quality I Division of Energy Mineral and Land Resources
Wilmington Regional Office 1 127 Cardinal Dnve Extension I Wilmington. North Carolina 28605
rwn. rsnouw,
9107967215

GurYENGINEERINGL
TRANSMITTAL FORM
TO Ms Georgette Scott
Environmental Program
Supervisor II (Stormwater]
127 Cardlnat Drive Ext
Wilmington NC 28405
910-796 7339
georgette scottfdncdenr gov RECEIVED
SUBJECT Autumn Care Brunswick DATE April 26 2018 APR 2 7 018
Brunswick County NC SENT BY Ed Loeffler
Nii
CURRY PROJECT NO 2011 048 WILMINGTON RO
We are sending you the following items
I COPIES I ITEM I DESCRIPTION
1 _ Certification Designer s Certification for Stormwater Permit No SW8 130113
1 Drawing Stormwater Wetland Details — As built Drawing dated 4/26/2018
I nese are transfTllLtea as Cl1eCKe0 of
_ For Information _ Approved as Noted —Revise and Resubmit
_ As Requested _ Not Approved— Revise and Resubmit
_ For Review and Comments _ For Record and File
_ For Revision _ submittal
x For Approval _ For Recording
Approved For Signature then return to
REMARKS
Enclosed are the Stormwater Designers Certification and As built drawing for approval Please contact me with
any questions Thank you
T 1919) 552 0849 205 5 Fuquay Avenue
F 19191 552 2043 Fuquay-Manna NC 27526
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