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HomeMy WebLinkAboutSW8950821_COMPLIANCE_20160415STORMWATER DIVISION CODING SHEET POST -CONSTRUCTION PERMITS PERMIT NO. SW8 g50$2t DOC TYPE ❑ CURRENT PERMIT ❑ APPROVED PLANS ❑ HISTORICAL FILE COMPLIANCE EVALUATION INSPECTION DOC DATE 2U1� O'-415 YYYYMMDD STATE OF NORTH CAROLINA Department of Environmental and Natural Resources 127 Cardinal Drive Extension Wilmington, North Carolina 28405 (910) 796-7215 FILE ACCESS RECORD SECTION S iZ� sirf E / TIME/DATE / NAME REPRESENTING ��: 7 E c•/ it 'y S J c" Guidelines for Access: The staff of Wilmington Regional Office is dedicated to making public records in our custody readily available to the public for review and copying. We also have the responsibility to the public to safeguard these records and to carry out our day-to-day program obligations. Please read carefully the following guidelines signing the form 1. Due to the large public demand for file access, we request that you call at least a day in advance to schedule an appointment to review the files. A6poiatments will be scheduled between 9Mam and 3:00pm. Viewing time ends at 4:45pm. Anyone arriving without an appointment may view the files to the extent that time and staff supervision is available. 2. You must specify files you want to review by facility name. The number of files that you may review at one time will be limited to five. 3. You may make copies of a file when the copier is not in use by the staff and if time permits. Cost per copy is $.05 cents. Payment , 2y be made by check money order, or cash at the reception desk Copies totaling $5 00 or more can be invoiced for voar convenience. 4. FILES MUST BE KEPT IN ORDER YOU FOUND THEM. Files may not be taken from the office. To remove, alter, deface, mutilate, or destroy material in one of these files is a misdemeanor for which you can be tined up to $500M. No briefcases large totes, etc. are permitted in the file review area 5. In accordance with General Stame 25-3-512, a $25.00 processing fee will be charged and collected for checks on which payment has been refused. FACILITY NAME 3.e H 2 � J e f�a .. p/ rP/Ld i s ev �n r� �-n /s zvi� ignature. and Name of Fimi/Business Date Time In Please attach a business card to dds form COPIES MADE / 0 PAID 5� INVOICE, S:Admin.file access . COUNTY Time Out Permit: SW8950821 Project: Lumma Station Owner: Lumina Station LLC County: New Hanover Region: Wilmington Compliance Inspection Report Effective: 01/30/08 Expiration: 10/17/19 Adress: 1900 Eastwood Rd City/State/Zip: Wilmington NC 28403 Contact Person: Joel L Tomaselli Title: Manager Directions to Project: From intersection of Eastwood Rd. & Wrightsville Ave, go NW 0 36 miles on US 74 Project is on left. Type of Project: State Stonnwater - HD - Detention Pond Drain Areas: 1 - (Wrightsville Recreational Area (including Lees Cut, Motts Channel and portions of Bai On -Site Representative(s): Related Permits: Inspection Date: 09/04/2015 Entry Time: 09 15AM Primary Inspector: Kelly Johnson Secondary Inspector(s): Reason for Inspection: Routine Permit Inspection Type: State Stonnwater Facility Status: 0 Compliant ❑ Not Compliant Question Areas: State stonnwater (See attachment summary) Phone: 910-256-5566 Exit Time: 09:45AM Phone: 910-796-7331 Inspection Type: Transfer Renewal page 1 permit: SW6950821 Owner - Project Lumina Station LLC Inspection Date: 09/04/2015 Inspection Type Transfer Renewal Reason for visit: Routine File Review Yes No NA NE Is the permit active? 0 ❑ ❑ ❑ Signed copy of the Engineer's certification is in the file? ❑ ❑ ❑ Signed copy oft he Operation & Maintenance Agreement is in the file? ❑ ❑ ❑ Copy of the recorded deed restrictions is in the file? ❑ ❑ E ❑ Comment Built Upon Area Yee No NA NE Is the site BUA constructed as per the permit and approval plans? 0 ❑ ❑ ❑ Is the drainage area as per the permit and approved plans? 1 0 ❑ ❑ ❑ Is the BUA (as permitted) graded such that the runoff drains to the system? 0 ❑ ❑ ❑ Comment: SW Measures Yes No NA NE Are the SW measures constructed as per the approved plans? 0 ❑ ❑ ❑ Are the inlets located per the approved plans? E ❑ ❑ ❑ Are the outlet structures located per the approved plans? 0 ❑ ❑ ❑ Comment Operation and Maintenance Yes No NA NE Are the SW measures being maintained and operated as per the permit requirements? 0 ❑ ❑ ❑ Are the SW BMP Inspection and maintenance records complete and available for review or provided to ❑ ❑ ❑ DWO upon request? Comment: page: 2 Stormwater Inspection Reports ECEIVE AUG 1 12015 BY: f�etentian F'nnc! f5ervicer>. Inc:. Stormwater Maintenance and Inspection Report Customer Name: lumina Station Inspection(Monthty or Annual): Monthly Faclllty It: M1001 Date: 1%6/2015 Water Level (High, Normal, tow): Normal Weather Conditions: &uuny SITE CONDITIONS COMMENTS Yes No N/A Ara IvO1,11nt and/or o,md hasin(s) stdJ' e' d dnd z El ❑ unctimm�g nrope ^ly> A:. Cv .r no tlitrhl lalr auaieFI t .� c•ra ",or � El ❑ t".'Ct o ,I. nf0ne:iy: A',iwrt'a0'f 3"Pd O}e�'OVOn I9fftir'it i 1p" qd ❑ z ❑ .alE.ilsl' DD 'l1 d'nA4 'B(j� '1 vrg.'tdiA4 ❑ 1z El Ist ie hnchay sepa'dm-Isl tcnftsn ng p'operly` ❑ ❑ z Au a apes and hn r.rt.:mst xUnn: ng � � ❑ pro ler y h t i lny sedlmi tt nn arnilai:on m the aonrl w 0 ZI ❑ ulv> the inu re nnY nnosrn=11" t' -1 o'ssurc tnet nrvro m o„ aacn•sseo' Al, ine re any add 1 ona enn,meoh rzg ardnlg toa El❑ s te. MAINTENANCE PERFORMED COMMENTS YES NO N/A A-, pnlo .l'Ce W t-11 Ot t,5n Ana C,n—. I' z ❑ ❑ W"', Tn" g"m L:t In'4d pond Alllaj$I) � ❑ El Are 1 l t mh'euk d 0 d•nw tlowil ripe un Ml ❑ ❑ o"t t .xcx C".11 DOv51nc POeld ared to w, trr„1t"d for ,rq„AY-L ❑ ❑ VegelafiOn aOd�Ur d dAf"' Dirt yoo mnrl.ct an ann.,,tl ae oto :' m ofthe ❑ ❑ 21 OOnO(sI7 Technician Signature: Technician Name (Print): Matthew ,& E 2 Retention Fend 5ervice5, Inc. WORK COMPLETION REPORT Facility Number: Im 1001 Arrival Date: 1/6/2015 Departure Date: 1/6/2015 Facility Name: umina Station Arrival Time: 8:48 AM Total hours worked on Job Departure Time: 9:00 AM site: 12 min Comm ents/Additional Information: Contractor Team Lead Signature: '� Date: 1/6/2015 Team Lead Printed Name: Matthew NetheFCutt Facility Employee Signature: Date: 1/6/2015 Facility Employee Name: Facility Employee Title: STORMWATER COMPLIANCE OPERATIONS WORK COMPLETION REPORT Site Photos t .��LM+MyL •� .y r� r l" s �- Description Description Description �etrsn#:ion Fn rcl `a<.rr'vir,t,e*, Inc. Stormwater Maintenance and Inspection Report Customer Name: lumina Station Facility u: Im1001 Inspection (Morahly or Annual): Monthly Dale: 213'2015 Water Level (High, Normal, tow): Normal Weather Conditions: Sunny SITE CONDITIONS COMMENTS Yes No N/A an,<ediment 111c or pond tla.intsi stapil.rnd a In 1-1 El:nct�on�ng prnperly? m tl drtchl 1 a.�d swab(.) r. b Grind and © El El roaer y .r to yarra 1 r-,v�d z ❑ ealsl. Uo ;:.ny areas -eq u�re re-vegetatoo? ❑ z ❑ Is the foreday separatorlsl funcnoninSproper1y1 ❑ ❑ z nw rd. 11,1tures1,-oning a ❑ ❑ ❑ © ❑ lint 1 Are 1 y onsl ..t' ih•a.r or slurs th At ❑ ❑ nncdt h dtlms5 A,,ih rc any atlrlrt n��comrrent ga d�nst- ❑ © ❑ R• MAINTENANCE PERFORMED COMMENTS YES NO N/A AT. pond area(i) tre, of trash ane dror ' z ❑ ❑ Was the grass cast n a•I ponn a -(' 1, z ❑ ❑ Ar., 1 1 x 11 n—, o•) the ❑ ❑ o,.t t Dor t po. red t" on tr_foI in, aquatic ❑ a ❑ v<:g tatn and/.r.,lgae. biC you contlu[t an annual dr:nth plot rit thr ❑ ❑ Q nndizl , Technidan Signature: Technician Name(Pdm): Matt Facility Number: Arrival Date: Departure Date 1A AIL y Retention Porld 5ervice!�5a Inc;. WORK COMPLETION REPORT Im1001 Facility Name: lumina Station 2/3/2015 Arrival Time: 2:15 PM Total hours worked on job 2/3/2015 Departure Time: 2:20 PM site: 5 min Contractor Team Lead Signature: Team Lead Printed Name: Facility Employee Signature: Facility Employee Name: Facility Employee Title: Matt Date: 2/3/2015 Date: 2/3/2015 Site Photos STORMWATER COMPLIANCE OPERATIONS WORK COMPLETION REPORT 2:18 0 Description Description �etentinn Fond 6:ir:rvice£. Inc. Stormwater Maintenance and Inspection Report Customer Name Lumina Station FadutyR: LM1001 Inspection(MomhN or Annual)! Monthly Date: 3"TS:'2915 Water Level (High, Normal, Low): Normal Weather Conditions: Sunny SITE CONDITIONS COMMENTS Yes No N/A All' ""n basnisl rtim;en ain .:grtpn l&n,np IV: r, El El f .�nrtoa i�` pmpe-.t� Are t Ar-e Any area M r •usiOn AreR`nt S nootl El 0 Ooany arPAS rerj.,le fL'nni ❑ ❑ Is the tors NdY sepa'a[ar(sI tunR=o rg ;'npeiy' 1:1 El An a ipes anr!hn ^ttw,tcrest �mlrmm�ny ❑ ❑ Ill inY srdll,ntmrm»slatilll n rile pone or oatel Pox All tnr'e<nY onnPnrr t, L^sur IS .esth•at nett [n bi iCdrg54d All Tnf -1 a'Yadd•tn ,i ro'^mrm •egad nEI" sar' MAINTENANCE PERFORMED COMMENTS YES NO N/A A,, j}O'iC a9`d(51 f'FC 0{ t n5^i a9C rlebrli El El lMa• the ErSI, Clll rn IF wIr ife�#iYl� ❑ ❑ An' in t + r -a,rc aid d raw tlmvn en< mN I'll - z El El "UT 0 ]ou11,Iri IN,,, tht no Id necr'ts r t rears tarth;abc vcgrtat a ann/ar gtr UI(! ynL III1dOC1,l a,1110m O(P" Plot It VII oOnC(z)? Technician Signature Technician Name (Print) Antonio Oralale5 Retention Poticl 15ervice�, Inc, WORK COMPLETION REPORT Facility Number: LMJOOJ Facility Name: Lumina Station Arrival Date: 3/18/2015 Arrival Time: 1:45 PM Total hours worked on job Departure Date: 3/18/2015 Departure Time: 1:55 PM site: 10 min Comments/Additional information: na Contractor Team Lead Signature: Date: 3/18/2015 Team Lead Printed Name: Antonio clraiLl Facility Employee Signature: Facility Employee Name: Facility Employee Title: na na Date: 3/18/2015 "~^~~, ^~,`."~",.° Site Photos STORMWATER COMPLIANCE OPERATIONS WORK COMPLETION REPORT 18/2015 1:53 Description Description FlbriA lnu, Stormwater Maintenance and Inspection Report customer Name: Lumina Station Facility LM1001 Inspechon (Monthly or Annual): Monthly Date: 4/16;2015 Water Level (High, Normal, Low): Normal _Weather Conditions: cloudy SITE CONDITIONS COMMENTS ye, No N/A AII—e-- And/- pond z t , "t ,, "g i, A, 0, 11, -1, 11, 0, 11 It 1 In 111 1! 111b i en 2 El I i,—t .,,,q ,' An- t--yxri=av Mergsion p,,­1 i, pond F1 z 0 011 any' "en" El Z 0 ho"fi-ev-Y Are E EI p'hpv'V nut ld'110 Are V the, -—1.111it I tell thot F-I z El need 1. he....... r"', -7-7 Ind I d", "I, E z 0 MAINTENANCE PERFORMED COMMENTS YES NO N/A A, pond are l"', pt t," ­1 d,hr' El [I All, In, t.1111 111 — 111. 1-1 , d" on v- [I F 11 i' 11 We, I)— the pond need to he to,o,d to-q-t, F-I z 11 of 1h, Te6nicl.r Signature: Technician Name (Print): Robert Spohn I f— — Facility Number: Arrival Date: Departure Date: .� . 0 Retention fond 15ervice--,, Inc. WORN COMPLETION REPORT LM 1001 Facility Name: 4/16/2015 Arrival Time: 11:15 AM Total hours worked on job 4/16/2015 Departure Time: 11:25 AM site: Contractor Team Lead Signature: Team Lead Printed Name: Facility Employee Signature: Facility Employee Name: Facility Employee Title: Lumina Station 1 Date: 4/16/2015 Robert Spohn 0 Date: 4/16/2015 STORMWATER COMPLIANCE OPERATIONS WORK COMPLETION REPORT Site Photos %it velep tion Id `=r;rvirt°e, Inc Stormwater Maintenance and Inspection Report Customer Name: Lumina Station inspection (Monthly or Annual): Monthly Fadlltyx: LM1001 Date_ 529/2015 Water Level (High, Normal, Low): Low Weather Conditions: Clear SITE CONDITIONS COMMENTS Yes No N/A Are sediment and/or pnnd haan(r) stanlll-rA antiEl D .:ncYmm�y amnrrl¢, An d v nn d tel(s) nc swae(") sl foJ Ved vvl .:nctavny mm�orly/ A,,ttlr`eanV en'a QtFrcnnOn.Jrex•gt in,. -a El © El area(")' On any a'eas reV,�ne re-vegrtanna' El 1-1 Near concrete Slll:vay 11 the tn^oay sepa ntn'Td l.,nm o ng 1'oprayl El 0 Z An qll ore" and nvd r1Vachursf, a9aning El El Escessve leaf Uttar at intake pipe flared end seetloe arzm t, lrfvr any v di ole n mYur AatJni, trio nano nr El 21 El,,t 0. A@ i 11.1k,any nna"ti r fie itv-n (e Sh.;rrLoaf er tlto ne aetlrrwrnI Are let, , a,, acd t n"la : n'tmpnt 'vievd ,le, Lin.s z "tEl MAINTENANCE PERFORMED COMMENTS Are pontl arca(s) tree of trash and de nV,s' YES NO El N/A El Was mr g^ass c.t mar, paod area{s):' ❑ ❑ Q Aft'the t"arl "dCx and d'a, lro ') oinrfli the oqu rlear © El El Oolstx avod nrer 11le t'eatrd in, aqa atr aretal nn aotl/n g a' El Z El n� ye,,, f.t an Ann,aI de Dt:l ('llllt pt f[e- pontiee' ❑ © ❑ Technician Signature: Technician Name (Print) Vida Oblegl0 Peterition Pane 15ervicec, hic, WORK COMPLETION REPORT Facility Number LM1001 Facility Name: Lurnina Station Arrival Date: 5/29/2015 Arrival Time 10:36AM Total houn worked on lob 20 Departure Dato: 5/29/2015 Departure Ti— 10:51 AM site: min5 Comments/Additional Information: Contractor Team Lead Signature: Date: 5/29/2015 Team Lead Primed Name: Vida Obleglo Facility Employee Signature: Facility Employee Name: Facility Employee Title: None Date: 5/29/2015 STORMWATER COMPLIANCE OPERATIONS WORK COMPLETION REPORT Site Photos %% 4 A611kxjk WAI Uw K,te�ntirxi Vb",l tic customer Narav, Lumina station Inspection (Monthly or Annual): Monthly Facility #: M1001 Date: 615/2015 Water Lc -I (Meh, Normal, Low): Normal Weather Conditions: fair SITE CONDITIONS COMMENTS Yes No N/A p11,1, El El ..nttianing properly' Are 1 '1— d 1 11 IVII I [Z El El fx,ct ng —P, -i, Z Ej Is lne fnrebay "P-t (,I i­to, g E] El z Are TII pipes Intl hard truft i�revfunrSinning Z El El po 0 F—I ]EE1 ,, ,-❑ Ar, Ih,,11h,a z 1-c I.b, Ar, cn-- , co—nt—qd ng 11 1 ❑ z o Is t(� MAINTENANCE PERFORMED COMMENTS YES No N/A A, —), -0) f,, of El 1:1 W, grass turn W pond 4",(, A, the 1-1 T',, —,l 1— 1-- ,Ip,, -V"t 11- 1 le.,41, Dees 11, P-e need T') c'. i, —"T ❑ z 0 -d:o, . . . ... . ... ......... ... [M y- 1, Id,,11 , 11 - al d,p, 11 plot M I w El Z El p-d(,,j Technician Signature: Technician Name(Print): Matt C kl; Retention Forld 5eruic t-5, lmc. WORK COMPLETION REPORT Facility Number: Im1001 Facility Name: LUmina Station Arrival Date: 6(5/2015 Arrival Time: 1 :43 PM Total hours worked on job Departure Date: 6J5(2015 Departure Time 1:48 PM site: 5 min imarmanon: Contractor Team Lead Signature: Date: 6(5J2015 Team Lead Printed Name: Matt Facility Employee Signature. Date: 6/5/2015 Facility Employee Name: Facility Employee Title: STORMWATER COMPLIANCE OPERATIONS WORK COMPLETION REPORT Site Photos Description Description Z 312 636 741 1 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. , Do not use for International Mail See reverse Z I Sentto -10 -Tpt'1125Lll1 Strect 8 Number co berr �. Lee Or. Post State, $ ZIP Code ke, VN NL Z8-412- Postage $ 3 Z Certified Fee Special Delivery Fee N Restricted Delivery Fee � Return Receipt Showing ro. Whom & Date Delivemd'(i ° 1 . n Rewm Receipt Showig [a,Whan, Date,BAddresseaigdmessl �Y �Q1 Fe TOTAL POst'age & Feey , i$' 2..). / coo 0 Postmark or Date 10jJ- a I . 1 � f�__First-Class Mail" UNITED STATES POSTAL SERVICE � �, ""�" " Postage &'Fees Paid USPu Permit No: G _10��_ • Print your name, aid rigs, and ZIP Code in this box • NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOUR 127 CARDINAL DRIVE EXTENSION WILMINGTON, N.C. 28405-3845 R Soaz i /wL/ •Complete items t and/or 2 for additional services. •Complete hems 3, 4a, and 4b. tPrim your name and address on the reveres of this torn so that we can return this cak to you. •Attach this form to the from of the mailpiew, or on the back if space does not permit. -Write -Return Receipt Requested' on the mailgece below the article number. •1ho Return Receipt will show to whom the article was delivered and the date delriered 7 A.N..1.• AAA... n....A �...I Ar AA1..1.. Hr. •Toe( Tomaseill LUrrfi,)a St2btui (�rfh?r5 (LC c/o 3(o& kobey+ 6. Lee U- Vvllm nc�+cn KJC 2841Z X PS Forth , December 1994 I also wish to receive the following services (for an extra fee): 1. ❑Addressee's Address uZ 2. ❑ Restricted Delivery H Consult postmaster for fee. n P! 31Z ❑ Registered ❑ Express Mail ❑ Return Receipt at m (O36� 74t E rz(Certifled 0 ❑ Insured m for Merdiandise ❑ COD Da of /Deelliv0 —G6 7 0 T i Addressee's Address (Only ff requested and fee is paid) 102595-97-B-0179 Domestic R( State of North Carolina - Department of Environment and Natural Resources Wilmington Regional Office James B. Hunt, Jr., Governor Wayne McDevitt, Secretary Division of Water Quality November 13. 1997 CERTIFIED MAIL Z 312 636 741 RETURN RECEIPT REQUESTED Mr. Joel Tomaselli Lumina Station Partners, LLC c/o 306 Robert E. Lee Drive Wilmington, NC 28412 NCDENR NORTH CARCUNA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Subject: NOTICE OF VIOLATION Lumina Station Stormwater Permit No. SW8 950821 New Hanover County Dear Mr. Tomaselli: On November 3, 1997, Wilmington Regional Office personnel performed a Compliance Inspection of the project known as Lumina Station, located off Eastwood Road in New Hanover County, North Carolina. The inspection was performed to determine the status of compliance with Stormwater Permit Number SW8 950821, issued to you on October 17, 1996. The project has been found in violation of Stormwater Permit Number SW8 950821, issued pursuant to the requirements of 15A NCAC 2H.1000. The violations found are: 1. Failing to provide the required Engineer's Certification upon completion of construction. Section H, #6 of your permit requires the submittal of this Certificate. 2. Failing to notify this Office of a change of owner name and mailing address. Two letters, enclosed, mailed to the address on the permit application, were returned to this Office. Section I, #5 of your permit requires you to submit a permit modification for a change in ownership. 127 North Cardinal Dr., Wilmington, North Carolina 28405 Telephone 910-395-3900 FAX 910-350-2004 An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper Mr. Tomaselli November 13, 1997 Stormwater Permit No. SW8 950821 To correct these violations you must : 1. Provide a written "Plan of Action" which outlines the actions you will take to correct the violations and a time frame for,completion of those actions, on or before December 13, 1997. 2. Provide the Engineer's Certification. 3. Provide a name/ownership change form. Failure to provide the "Plan of Action" by December 13, 1997, or to correct the violations by the date designated in the "Plan of Action", are considered violations of 15A NCAC 2H.1000, and may result in the initiation of enforcement action which may include recommendations for the assessment of civil and criminal penalties, pursuant to NCGS 143-215.6A. By copy of this letter to the New Hanover County Building Inspector, this Office is requesting that the Building Inspector consider withholding building permits and Certificates of Occupancy for the currently unpermitted expansion of this project until this matter is satisfactorily resolved. If you have any questions concerning this matter, please call Ms. Linda Lewis at (910) 395-3900. Sincerely, S�-,�,v-� -r- Rick Shiver, P.G. Regional Supervisor RSS:\arl S:\WQS\STORMWAT\NOTICE\950821.NOV cc: Phil Tripp, P.E. Tony Roberts, New Hanover County Building Inspections Bradley Bennett Linda Lewis Central Office State of North Carolina Department of Environment, Health and Natural Resources Division of Environmental Management James B. Hunt, Jr., Governor Jonathan B. Howes, -Secretary _ A. Preston Howard, Jr., P.E., Director 1. Permit holder's C)EHNFR WATER QUALITY SECTION PERMIT NAME/OWNERSHIP CHANGE FORM 2. Permit's signing official's time and title: (Person legally responsible for permit) (Title) 3. Mailing address: City: State: Zip Code: Phone: ( 1 II. NEW OWNERINAME INFORMATION 1. This request for a name change is a result of: \' _a. Change in ownership of property/company _b. Name change only _c. Other (please explain): 2. New owner's name (name to be put on permit): 3. New owner's or signing official's name and title: (Person legally responsible for permit) (Title) 4. Mailing State Zip Code- Phone: ( 1 �w"Immalumur • ' U -" --THIS—APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF ENVIRONMENTAL MANAGEMENT UNLESS ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL. 1. This completed application 2. Processing fee of $100.00 (Checks to be made payable to DEHNR) 3. If an ownership change, legal documentation of the transfer of ownership (such as a contract, deed, articles of incorporation) CERTIFICATION MUST BE COMPLETED AND SIGNED BY BOTH THE CURRENT PERMIT HOLDER AND THE NEW APPLICANT IN THE CASE OF CHANGE OF OWNERSHIP. FOR NAME CHANGE ONLY, COMPLETE AND SIGN THE APPLICANT'S CERTIFICATION. Current Permittee's Certification: I, attest that this application for name/ownership change has been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required parts of this application are not completed and that if all required supporting information and attachments are not included, this application package will be returned as incomplete. Signature: Date: Applicant's Certification: I, , attest that this application for a name/ownership change has been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required parts of this application are not completed and that if all required supporting information and attachments are not included, this application package will be returned as incomplete. Signature: Date THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS: North Carolina Division of Environmental Management Water Quality Section Permits and Engineering Unit P.O. Box 29535 Raleigh, North Carolina 27626-0535 Telephone: (919) 733-5083 Fax: (919) 733-0719