SW8961234_HISTORICAL FILE_20010924

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8 �1Q123`-4
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
tZ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
2 UOI O cl 2k-{
YYYYMMDD

Michael F. Easley, Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
Wilmington Regional Office
September 24, 2001
Kure Dunes Homeowner's Association, Inc.
Mr. Thomas Cannon, President
637 Fort Fisher Road
Kure Beach, NC 28449
Subject: Permit No. SW8 961234 Modification
Kure Dunes Phase IV
High Density Subdivision Stormwater Project
New Hanover County
Dear Mr. Cannon:
The Wilmington Regional Office received all required information to transfer ownership of the Stormwater
Management Permit Application for Kure Dunes Phase IV on September 11, 2001. Staff review of the plans and
specifications has determined that the project, as proposed, will comply with the Stormwater Regulations set forth
in Titlel5ANCAC2H.1000. We are forwarding Permit No. SW8 961234 Modification, dated September 24,200 1,
for the construction of Kure Dunes Phase IV.
This permit shall be effective from the date of issuance until January 21, 2010, 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. Please obtain a copy of the stamped, approved plans from Kure
Beach Associates as part of the permit conditions.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request an
adjudicatory hearing upon written request within thirty (30) days following receipt of this permit. This request must
be in the form of a written petition, conforming to Chapter 150B of the North Carolina General Statutes, and filed
with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. 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 Linda Lewis, or
me at [phone].
Sincerely,
Rick Shiver
Water Quality Regional Supervisor
RSS/arl: S:\WQS\STORMWAT\PERMIT\961234.SEP
cc: Bill Hanna, Kure Beach Building Inspections
Tony Roberts, New Hanover County Inspections
Linda Lewis
Wilmington Regional Office
Central Files
N.C. Division of Water Quality 127 Cardinal Drive Extension Wilmington, N.C. 28405 [phone] Fax [phone] Customer service
800-623-7748

State Stormwater Management Systems
Permit No. SW8 961234,
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 ofNorth Carolina as amended, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Kure Dunes Homeowner's Association, Inc.
Kure Dunes Phase IV
New Hanover County
FOR THE
construction, operation and maintenance of a detention pond and an underground infiltration trench in compliance
with the provisions of 15A NCAC 2H A000 (hereafter referred to as the "stormwater rules') 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 January 21, 2010 and shall be subject to the following
specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater described in the
application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as described on page
3 of this permit, the Project Data Sheet. The stormwater detention pond has been designed to handle the
runoff from 185,698 ftz, and the infiltration gallery has been designed for 19,563 ft2 of impervious area, and
includes lots, clubhouse area, roads, and parking, as shown on the drainage area map..
3. Approved plans and specifications for this project are incorporated by reference and are enforceable parts
of the permit.
4. The tract will be limited to the amount of built -upon area indicated on page 3 of this permit, and per
approved plans.
Each of the 40 lots in the subdivision is restricted to a maximum amount of built -upon area, as tabulated on
the attachment to the application. See Section II, Part 11 of this Permit for the specific allowable BUA per
lot.

State Stormwater Management Systems
Permit No. SW8 961234
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
Kure Dunes Homeowner's Association, Inc.
Kure Dunes Phase IV
New Hanover County
FOR THE
construction, operation and maintenance of a detention pond and an underground infiltration trench in compliance
with the provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') 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 January 21, 2010 and shall be subject to the following
specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater described in the
application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as described on page
3 of this permit, the Project Data Sheet. The stormwater detention pond has been designed to handle the
runoff from 185,698 ft2, and the infiltration gallery has been designed for 19,563 ft2 of impervious area, and
includes lots, clubhouse area, roads, and parking, as shown on the drainage area map..
3. Approved plans and specifications for this project are incorporated by reference and are enforceable parts
of the permit.
4. The tract will be limited to the amount of built -upon area indicated on page 3 of this permit, and per
approved plans.
5. Each of the 40 lots in the subdivision is restricted to a maximum amount of built -upon area, as tabulated on
the attachment to the application. See Section II, Part 11 of this Permit for the specific allowable BUA per
lot.
2

State Stormwater Management Systems
Permit No. SW8 961234
DIVISION OF WATER QUALITY
PROJECT DATA SHEET
Project Name:
Permit Number:
Location:
Applicant:
Mailing Address:
Application Date:
Water Body Receiving Stormwater Runoff:
Index #/ Classification of Water Body:
Pond Depth:
Permanent Pool/Bottom Elevation, FMSL:
Total Impervious Surfaces Allowed, ftZ:
Offsite Area entering Pond, ft':
Required Surface Area, ftZ:
Provided Surface Area, ft'
Required Storage Volume, ft':
Provided Storage Volume, ft':
Temporary Storage Elevation, FMSL:
Controlling Orifice:
Seasonal High Water Table Elevation, FMSL:
Type of soil:
Reported Hydraulic Conductivity:
Time to drawdown:
*Pond drains to The Keys, SW8 940217.
Kure Dunes Phase IV
SW8 961234 Modification
New Hanover County
Kure Dunes Homeowner's Association, Inc.
Thomas Cannon, President
Kure Dunes Homeowner's Association, Inc.
637 Fort Fisher Boulevard
Kure Beach, NC
28449
January 28, 2000 (Last Modification)
Atlantic Ocean
Cape Fear River
(CFR 99-3) / "SB"
(CFR 18-71) / "SC"
*POND
INFILTRATION TRENCH
6'
10' W x 3' H x 135' L trench with 270
linear feet of 12"tp perforated piping
17
22
185,698
19,563
2-2/3 lots from Phase III
@4,534 each (12,091 total)
10,235
N/A
11,766
N/A
15,367
1,622
16,973
1,747
18.3
24.03
2" pipe
overflow weir set @24.03 FMSL
N/A
18.6
N/A
Beach Sand
N/A
2.75 gal/hour/sq.ft.
2.4 days
3.5 hours
3

State Stormwater Management Systems
Permit No. SW8 961234
II. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in it's entirety, vegetated and operational for it's
intended use prior to the construction of any built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of the system will be repaired
immediately.
3. The permittee is responsible for verifying that the proposed built -upon area does not exceed the allowable
built -upon area.
4. The following items will require a modification to the permit
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 of the project area.
f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan.
The Director may determine that other revisions to the project should require a modification to the permit.
The Director may notify the permittee when the permitted site does not meet one or more of the minimum
requirements ofthe 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.
The permittee shall at all times follow the approved Operation and Maintenance plan to assure the permitted
stormwater system functions at optimum efficiency. 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 oftrenches, outletfbypass structures, orifice, catch basins and piping.
g. Access to the outlet/bypass structure must be available at all times.
It. Annual cleaning/testing of the infiltration trench system.
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.
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.
10. 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.
0

State Stormwater Management Systems
Permit No. SW8 961234
11. Prior to the sale of any lot, deed restrictions must be recorded which limit the built -upon area per lot to the
amount as shown on the Project Data Sheet, per Section I, Part 2. A copy of the recorded deed restrictions,
including the statements below, must be received within 30 days of the date of recording:
a. "The maximum built -upon area per lot is * square feet, and includes that portion of the right-
of-way between the lot line and the edge of pavement; structures, pavement, brick, stone, gravel,
slate, coquina, and parking areas, but does not include raised, open wood decking, or the water
surface of swimming pools."
Lot 1 4,046
Lot 14
6,795
Lot 27
3,106
Lot 2 3,444
Lot 15
3,404
Lot 28
3,896
Lot 3 3,181
Lot 16
3,318
Lot 29
3,012
Lot 4 3,443
Lot 17
4,112
Lot 30
3,000
Lot 5 3,409
Lot 18
4,293
Lot 31
3,000
Lot 6 4,019
Lot 19
4,583
Lot 32
3,000
Lot 7 3,538
Lot 20
4,099
Lot 33
3,000
Lot 8 3,188
Lot 21
5,461
Lot 34
3,000
Lot 9 3,439
Lot 22
3,912
Lot 35
3,000
Lot 10 3,320
Lot 23
3,286
Lot 36
3,123
Lot 11 3,951
Lot 24
4,147
Lot 37
3,111
Lot 12 4,595
Lot 25
3,882
Lot 38
3,029
Lot 13 5,408
Lot 26
4,682
Lot 39
3,258
Lot 40
3,253
*The permittee shall fill in the blank as
provided in the
lot listing above.
b. "The covenants pertaining to stormwater
regulations
may not be changed
or deleted without
concurrence of the State."
C. "Alteration of the drainage
as shown
on the approved plan may not
take place without the
concurrence of the State."
d. "All runoff on the lot must drain into the permitted system. This may be accomplished through
providing roof drain gutters which drain to the street, grading the lot to drain toward the street, or
grading perimeter swales and directing them into the pond or street. Lots that naturally drain into the
system are not required to provide these measures."
12. A copy of the recorded deed restrictions must be sent to the Division within 30 days of the date of recording
13. 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.
14. An access/maintenance easement to the stormwater facilities shall be granted in favor of the permittee for
the operation and maintenance of the facility.
1II. GENERAL CONDITIONS
This permit is not transferable. In the event there is a desire for the facilities to change ownership, or there
is a name change of the Permittee, a formal permit request must be submitted to the Division of Water
Quality accompanied by an application fee, documentation from the parties involved, and other supporting
materials as may be appropriate. The approval of this request will be considered on its merits and may or
may not be approved.

State Stormwater Management Systems
Permit No. SW8 961234
2. 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.
3. 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.
4. 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.
5. The permittee grants DEHNR Staff permission to enter the property for the purpose of inspecting all
components of the permitted stormwater management facility.
6. 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.
7. The permittee shall notify the DWQ of any mailing address changes within 30 days of the change.
Permit issued'this the 24th day of September, 2001.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
r3-,-"C V /� A -J AA=A= 3
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number SW8 961234

Michael F. Easley, Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
Wilmington Regional Office
August 11, 2001
Mr. Thomas Cannon, President
Kure Dunes HOA, Inc.
637 Fort Fisher Boulevard
Kure Beach, NC 28449
Subject: Ownership Transfer
Kure Dunes Phase IV
Stormwater Project No. 961234
New Hanover County
Dear Mr. Cannon:
Enclosed please find two supplement forms, containing the Operation and Maintenance requirements for
the wet detention pond and the infiltration system. The documents you submitted with those requirements have been
replaced by the supplement forms. Please initial, sign, notarize and return as soon as possible to complete the
transfer. Upon receipt of the forms, the permit will be forwarded to you. Thank you for your assistance in this
matter.
If you have any questions, please do not hesitate to call me at [phone].
Sincerely,
Linda Lewis
Environmental Engineer
RSS\arl: S:\WQS\STORMWAT\LETTERS\961234.AUG
cc: Linda Lewis
AWA
IN NR
N.C. Division of Water Quality 127 Cardinal Drive Extension Wilmington, N.C. 28405 [phone] Fax [phone] Customer Service
800-623-7748

r
WK
DICKSON
Engineers •Planners• Surs,eyers
Landscape Architects
July 23, 2001
Ms. Linda Lewis
North Carolina Department of Environment
and Natural Resources
Division of Water Quality Section
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
RE: Kure Dunes Phase IV
New Hanover County
NCDWQ Project Number SW8 961234 Mod
Dear Ms. Lewis:
RECEIVED
JUL 2 5 2001
BY: %(Z3¢
Kure Beach Associates has requested that WK Dickson & Co., Inc. assist them in
submitting the proper information to transfer the maintenance responsibilities for the
detention pond and infiltration trench system to the Kure Dunes Homeowner's
Association, Inc.. Based on a letter from you dated July 26, 1999, the following
items have been addressed.
1) A resident of the subdivision, Thomas Cannon — President of the Home Owner's
Association, has signed the Coastal Stormwater Permit Name/Ownership Change
form.
2) Twenty lots have been sold in Phase IV of Kure Dunes. This meets the 50%
criteria of lots sold to or occupied by persons or entities not associated with the
developer or the company in any way.
3) The stormwater controls have been inspected and found to be in compliance with
the current permit. The drop inlets for the infiltration system were filled with
sediment, but the sediment has been removed.
4) The president of the Home Owner's Association has signed an Operation and
Maintenance Plan for the pond and infiltration system. See attached form.
5) The deed restrictions for the subdivision have been recorded and a copy has been
previously provided to the Division of Water Quality. Another copy is attached.
6) The designer's certification has been previously provided to the Division of Water
Quality.
909 Market Street
Wilmington, North Carolina 28401
Other Offices:
Charlotte, NC
910.762.4200
Asheville, NC
Columbia, SC
Fax [phone]
Atlanta, GA
Hickory, iN'C
www,wkdickson.coni
Roca Raton, FL
Raleigh, NC

Ms. Linda Lewis
July 23, 2001
Page 2 of 2
7) The HOA is financially able to take on the maintenance responsibility.
8) A copy of the written maintenance records as required is attached.
If you need additional information please feel free to call.
Sincerely,
W.K. DICKSON & CO., INC.
Mark N. Hargrove, PE
Enclosure: As noted above
cc: Joe Hearne

BOOK PAGE
26.72 0265
STATE OF NORTH CAROLINA AGREEMENT
1999 NOV 24 PH 2: 56
COUNTY OF NEW HANOVER
Rc�Of10'�G ?'�fi0 Vci':Il=11:D
i•Uu;Y "Ui=_0�� � S
REG131'il' tii- I:iFF.U�
H0199 Kure Dunes Homeowners' Association, Inc., a North Carolina non-profit76i'ptfr6ti661inC0,11C
order to comply with the existing storm water run-off regulations in effect for coastal areas of the
State of North Carolina does hereby agree to abide and comply with the existing regulations and
to that end does hereby agree that the tract set forth an described below will be limited to 13,345
square feet of impervious surface.
Being all of that tract of land labeled "Club House Tract" as shown on final map Phase IV
Kure Dunes as recorded in Map Book 38 Page 261 of the New Hanover County Registry.
This agreement is intended to insure continued compliance with.the storm water run-off
rules adopted by the State of North Carolina and shall be a covenant running with the above
described land and may be enforced by the State of North Carolina through its duly authorized
agencies.
In Witness Whereof Kure Dunes Homeowners' Association, Inc., has caused this
agreement to be signed in its corporate name by its duly authorized officers the day and year first
above written.
ATT
Secretary
KURE DUNES HOMEOWNERS' ASSOCIATION, INC.
By:
Presiders
RECEIVED
JUL 2 5 2001
DWQ
PROJ #

BOOK PAGE
STATE OF NORTH CAROLINA 2 6 7 2. 0 2 6 6
COUNTY OF V .ol)Le°tl
I, a Notary Public of the County and State aforesaid, certify that
�rn7/!D�mm/17 / personally came before me this day and acknowledged that he
is Secretary of KURE DUNES HOMEOWNERS' ASSOCIATION INC., a North
Carolina Corporation, and that by authority duly given and as the act of the corporation, the
foregoing instrument was signed in its name by its President, sealed with its corporate seal
and attested by 27� her/him as its Secretary.
Witness my hand and official stamp or seal, this /% day � /, 1999.
Expires: A-Z- /ry=*1/TocDQ�
Notary Public
STATE OF NORTH CAROLINA
New Hanover County
The Foregoing/ Annexed Certscale(sof.,
0
Notary (Notaries) Public is/ 11 cued
to be correct,
T'bi � day of9
ry e Oofs, Regis of Deeds
b
Deputy AssisFar[t
WTJ/at
T:WAYUAyFilesMg\Rweru esHA_A9.wpd

STORMWATER OPERATION AND MAINTENANCE Pjl ATO 1"EIjD TLC
FOR.
111J L/ V �J 1
JUL 2 5 2001
KURE DUNES HOME OWNER'S ASSOCIATION, INC. DWQ
KURE BEACH, NORTH CAROLINA PROD #
1. The owner will be responsible for the proper operation and maintenance of the
stormwater collection and treatment facilities.
2. The collection system will be inspected monthly by the owner to identify
malfunctioning catch basins and drainage pipes. The collection system will be kept
relatively clear of debris and sediment. The stormwater system shall be kept in good
working order. Any malfunctioning component shall be repaired/replaced per approved
plans as necessary to assure proper operation of the system.
3. The treatment facilities consist of one (1) stormwater pond and outlet control. This
facility will be inspected twice a year by the owner to determine the mean depth of the
pond and identify any malfunctions. The mean depth of the pond, under normal
conditions, shall be 6.0 feet. The owner will remove the sediment from the pond if the
mean depth is determined to be less than 4.5 feet and will correct malfunctions when
necessary.
4. The outlet structure, orifice, and sideslopes will be inspected immediately after every
runoff producing rainfall event. Any debris observed on the orifice and outlet structures
will be removed. Eroded areas will be repaired and reseeded immediately after a rainfall
event.
5. A permanent stand of grass shall be maintained at all times. Mowing during the
growing season will be a as needed, otherwise, the grass height will not exceed 6"
Thomas Cannon, President
Kure Dunes Home Owner's Association, Inc.
P.O. Box 22 .
Kure Beach, NC 28449
," kMARIES
I, a Not ublic o he State
f County of do 3 `yOTA9`
here y certify that personally
appeared before me this,/�day of Jkla�Bo/and 9T5 Z
ackno dges the due execution ofth ore ing instrument. AUB1.�G
Wi s my hand and officialal,
ER GO
My commission expires

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KURE DUNES STORMWATER INSPECTION:
(6 MOS)
DEBRIS
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SIDE SLOOPS
POND
ANNUAL
1/16199
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BASINS
PIPING
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DEPTH
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DATE
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07�19/2001 11:31 9107524201
kK DICKSON PAGE 02
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
WATER QUALITY SECTION
NCDENR
NORTH CAROL)NA OKPr TMeNT of
ENVIRONMG ANp NA RA, RC qurtcem
Stotmwater Management Permit Number: p G.3q
L
I. Perm it Holder's name: kurto I�jeac� ASSOGIa�TeS
2. Pcrrnit's signing official's name and title:
(parson legally raspnnelele for permit)
o
3. Mailing address: 22 City:
State:. N C Zip Cade:U4g9 Phone: I-10- y58 • y Oyb F.AX - D' 0
(Area Code and Number) (Area Code mid Number)
II. NEW OWNER/NAME INFORMATION
This request is for:
�a. Change in ownership of the property/company
�b. Name change of project or company. I
C. Other (please explain):
New owner's name (name to be put on permit): ZUP-L DUA,`4S JlnnE pwmeees ASSoci�T/�+ ZNe
New owner's signing official's name and title: 2!2 oVv 05 C&uNu� /
(Penn Iegally rceponsi ble for permit)
PItE S/ dC,vY
(ride)
Mailing address; 6 37 e!*A T /flwl- vc City: v4-e ISM52y, wC.
State: N! C Zip Code: ! dfV'1 % fye-540e� -,P//y907 �
(Aran Code and Number) (,Area Code and Numb-0

07/19/2001 11:31 9107624201 kK DICKSON PAGE 03
r ,
PEPUMIT NAME/OWNERSHIP CHANGE FORM.
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF WATER QUALITY
UNLESS ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE ST?BMITTAL.
REQUIRED ITEMS:
This completed form.
2. Legal documentation of the transfer of ownership.
3. A copy of the recorded deed restrictions, if required by the permit.
4, The engineer's certification, if required by the permit.
A signed Operation and Maintenance plan, if a system that requires maintenance will change ownership.
CERTIFICATION MUST BE COMPLETED AND SIGNED BY DOM THE CURRENT PERMIT HOLDER AND
THE NEW APPLICANT IN THE CASE OF A CHANGE OF OWNERSH P.
FOR NAME CHANGES, COMPLETE AND SIGN THE CURRENT PERMITTEE'S CERTIFICATION.
Current Permittee's Certification:
1, OS &rl-1 C . f%ARNL ; attest diet this application for a nameJownership change has been reviewed and
is accuse and complete to the best of my knowledge. I understand that if all required parts of this applicadion are not
completed and that if all required supporting information and attachments are not included, this application package will be
returred as incomplete.
Signature: Date: /I v
Applicant's Certification:
1, T/-102XI' nfJNft rt/ , attest that this application for a name/ownership change has been :eYiewed, and
is accurate and complete to the best of my knowledge. 1 understand that if all required parts of this application art not
completed and that if all required supporting information and attachments are not included, this application package will be
Date:-7 /6 a
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
North Carolina Department of Environment and Natural Resources
Division of Water Quality
127 Cardinal Drive Extention
Wilmington,NC 28405
ATTN: Linda Lewis