SW6231109_Application Form_20231127

_ DEMLR USE ONLY
Date Received Fee Paid Permit Number
Applicable Rules: E Coastal SW-1995 ❑ Coastal SW-2008 E Ph II-Post Construction
(select all that apply) E Non-Coastal SW-HQW/ORW Waters ❑Universal Stormwater Management Plan
E Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
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.):
Barker Laydown Yard
2. Location of Project(street address):
5556 Braxton Road(0422-39-7835)
City:Hope Mills County:Cumberland Zip:28348
3. Directions to project(from nearest major intersection):
Entrance of site is approximately 800 feet West of the intersection of Chicken Foot Road (SR 2252) and
Braxton Road (SR 2242).
4. Latitude:34° 55'35" N Longitude:78° 54'51" W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is(check one): New ❑Modification ❑Renewal w/ Modificationt
tRenewals with modifications also requires SWLI-102-Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit,list the existing
permit number ,its issue date(if known) ,and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project(check one):
®Low Density ['High 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
DEMLR 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 ®Sedimentation/Erosion Control:9.1 ac of Disturbed Area
❑NPDES Industrial Stormwater 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:
5. Is the project located within 5 miles of a public airport? No ®Yes
If yes,see S.L.2012-200,Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations
Form SWU-101 Version Oct.31,2013 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:Duke Energy Progress,LLC
Signing Official&Title:Nuwan Wijesuriya-Lead Transmission Permitting Manager
b.Contact information for person listed in item la above:
Street Address:411 Fayetteville Street
City:Raleigh State:NC Zip:27601
Mailing Address (if applicable):411 Fayetteville Street
City:Raleigh State:NC Zip:27601
Phone: 919 ) 546-2090 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)
n 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:Kathryn G.Barker-Barker Gallberry Farms LLC
Signing Official&Title:Martha S.Purser-Manager Land Services II (Duke Energy Progress,LLC)
b.Contact information for person listed in item 2a above:
Street Address:5556 Braxton Road
City:Hope Mills State:NC Zip:28348
Mailing Address (if applicable):5556 Braxton Road
City:Hope Mills State:NC Zip:28348
Phone: ( ) Fax: ( )
Email:
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:
Signing Official&Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
4. Local jurisdiction for building permits:
Point of Contact: Phone#: ( )
Form SWU-101 Version Oct. 31,2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
Stormwater runoff from the gravel area will be routed to a proposed yard inlet which will tie-in with an
existing catch basin structure with the application of a temporary diversion ditch.Water will also be allowed
to naturally drain into the ground.The laydown yard will be removed at the end of the lease in three(3)years
and drainage patterns will return to existing conditions at the completion of the project.
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 PUD Approval Date:
n Valid Building Permit Issued Date:
n Other: 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:123.05 acres 5. Total Coastal Wetlands Area:0.0 acres
6. Total Surface Water Area:18.25 acres
7. Total Property Area (4)-Total Coastal Wetlands Area(5) -Total Surface Water Area(6) =Total Project
Area+:104.8 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 MHVV)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 =6.7 %
9. How many drainage areas does the project have?1 (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 A Drainage Area_ Drainage Area_1 Drainage Area
Receiving Stream Name Grays Creek
Stream Class * B
Stream Index Number* 18-35-(1)
Total Drainage Area(sf) 4,565,088
On-site Drainage Area(sf) 4,565,088
Off-site Drainage Area(sf) 0
Proposed Impervious Area**(sf) 306,663
% Impervious Area**(total) 6.7
Impervious**Surface Area Drainage Area A Drainage Area_ Drainage Area_ Drainage Area
On-site Buildings/Lots (sf) 0
On-site Streets (sf) 0
On-site Parking (sf) 0
On-site Sidewalks (sf) 0
Other on-site (sf) 283,140
Future(sf) 0
Off-site (sf) 0
Existing BUA***(sf) 23,523
Total (sf): 306,663
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
** Impervious area is defined as the built upon area including, but not limited to, buildings, roads,parking areas,
sidewalks,gravel areas, etc.
Form SWU-101 Version Oct. 31,2013 Page 3 of 6

***Report only that amount of existing BUA that will remain after development.Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off-site impervious area listed above determined?Provide documentation.N/A
Projects in Union County: Contact DEMLR 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 15A 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 http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy,Mineral and
Land Resources(DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at http://portal.ncdenr.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://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. Z.E
2. Original and one copy of the signed and notarized Deed Restrictions&Protective Covenants NA
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s)(sealed,signed and dated)and O&M ZE
agreement(s)for each BMP.
4. Permit application processing fee of$505 payable to NCDENR. (For an Express review,refer to IE
http://www.envhelp.org/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 ZE
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the Z E
receiving stream drains to class SA waters within 1/2 mile of the site boundary,include the 1/2
mile radius on the map.
7. Sealed,signed and dated calculations(one copy). Z.E.
8. Two sets of plans folded to 8.5"x 14" (sealed,signed,&dated),including: Z E
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 separate document).
Form SWU-101 Version Oct.31,2013 Page 4 of 6

p. Vegetated buffers(where required).
9. Copy of any applicable soils report with the associated SHWT elevations(Please identify 7E
elevations in addition to depths)as well as a map of the boring locations with the existing
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 DEMLR to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed.Deed book:9079 Page No:564 Z E
11. For corporations and limited liability corporations(LLC):Provide documentation from the NC 7
Secretary of State or other official documentation,which supports the titles and positions held
by the persons listed in Contact Information,item la,2a,and/or 3a per 15A 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/lr/state-
stormwater-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 DEMLR,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:Zachary Eulo
Consulting Firm:Dewberry Engineers Inc.
Mailing Address:2610 Wycliff Road,Suite 410
City:Raleigh State:NC Zip:27607
Phone: (919 ) 425-7610 Fax: (
Email:[e-mail]
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)Kathryn G.Barker ,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 la)Nuwan Wijesuriya with(print or type name of organization listed in
Contact Information,item 1a)Duke Energy Progress,LLC 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 stormwater system.
Form SWU-101 Version Oct.31,2013 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 DEMLR Stormwater permit reverts back
to me,the property owner.As the property owner,it is my responsibility to notify DEMLR 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: ID /'
/ L
VA4414 11 S0 ,a Not Publi�he St of �a er€t ,1 C ,County of
[L (c o do hereby certify that PI &AN ea/k ti� personally appeared
4G 19r,/ .fin'w�7
before me this �' day of , ! ,and acknowled a the due execution of the application for
a stormwater permit. Witness my hand and official seal,
•�`°�``, KPH'E ,,,,
'O "'--
�Q• c F Ri+ssio� .tS•�% SEAL
1.1OTARy 1,1
PUBLIC '�
�� 6 o `2? My commission expires ,
I
OI
X. APPLICANT'S CERTIFICATION
I,(print or type name of person listed in Contact Information,item la)Nuwan Wijesuriya
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 2H.1000 and any other applicable state stormwater requirements.
Signature: ��n..� • '. Date: /0 �i y 2(72-3
I, l�/l l./�I! f4c6 ,a Notary Public for the State of I a11/V 'C- - ,County of
f/'r'Ji. &1' I(,h k,do hereby certify that !� /L� Nm ry pe�'sdrra y appeared
before me this I I day of ki(t. , 2 .2 ',and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
�P
0\JAH inissio F� SEAL
.tc,o •� tp
•
p1OTA�Y I
s r 'Ot/BUG V F. /� Z�
17 "I> I My commission expires cbrtAirV1 2
o t
•
Form SWU-101 Version Oct. 31,2013 Page 6 of 6

Permit No.
(to be provided by DEMLR)
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
LOW DENSITY SUPPLEMENT
This form may be photocopied for use as an original
A low density project is one that meets the appropriate criteria for built upon area and transports stormwater
runoff primarily through vegetated conveyances. Low density projects should not have a discrete stormwater
collection system as defined by 15A NCAC 2H .1002(18). Low density requirements and density factors can be
found in Session Law 2008-211, 15A NCAC 2H .1000, Session Law 2006-246 and the State of North Carolina
Stormwater Best Management Practice Manual. Curb and gutter systems are allowed provided they meet the
requirements in 15A NCAC 2H .1008(g).
I. PROJECT INFORMATION
Project Name : Barker Laydown Yard
Contact Person: Nuwan Wijesuriya Phone Number: ( 919 )546-2090
Number of Lots:N/A Allowable Built Upon Area (BUA)Per Lot*:24%
Number of Dwelling Units Per Acre**:N/A
Low Density Development (check one): ® without curb & gutter ❑ with curb & gutter, outlets to (check one):
❑ Swales ❑ Vegetated Area
*If lot sizes are not uniform,attach a table indicating the number of lots,lot sizes and allowable built upon area for each lot.
The attachment must include the project name,phase,page numbers and provide area subtotals and totals. BUA shall be
shown in units of square feet.
**(Phase II Post-Construction [non-SA] only)
II. BUILT UPON AREA
Refer to DEMLR's forms and applications website for specific language that must be recorded in the deed
restrictions for all subdivided projects. (http://portal.ncdenr.org/web/lr/state-stormwater-forms_docs)
Complete the following calculation in the space provided below where:
• SA Site Area-the total project area above Mean High Water.
• DF Density Factor- the appropriate percent built upon area divided by 100.
• RA Road Area-the total impervious surface occupied by roadways.
• OA Other Area-the total area of impervious surfaces such as clubhouses, tennis courts, sidewalks, etc.
• No. of Lots - the total number of lots in the subdivision.
• BUA per Lot- the computed allowable built upon area for each lot including driveways and impervious
surfaces located between the front lot line and the edge of pavement.
• Total allowable lot BUA -the computed allowable built upon area for all lots combined.
• Total BUA from lot listing - the sum of built upon area allocated for each lot on the list of non-uniform lots.
Form SW401-Low Density-Rev.3-2/10/09 Page 1 of 4

Calculation:
For uniform lot sizes:
(SA: ft2 x DF: )—(RA: ft2)—(OA: ft2) =BUA per Lot= ft2
(No of Lots: )
For non-uniform lot sizes:
a. (SA: 4565088 ft2 x DF: 0.24)—(RA: 0 ft2)—(OA: 23523 ft2) =Total allowable lot BUA= 1072098 ft2
b. Total BUA from lot listing: 306,663 sf. b must be< a
III. DESIGN INFORMATION
Complete the following table. If additional space is needed the information should be provided in the same
format as Table 1 and attached to this form. Rainfall intensity data can be found in Appendix 8.03 of the State
of North Carolina Erosion and Sediment Control Planning and Design Manual or at
http://hdsc.nws.noaa.gov/hdsc/pfds/
Table 1. Swale design information based on the 10-year storm.
Swale No. Drainage Impervious Grassed C Q Slope Valiow Vactual Flow
Area (ac) Area(ac) Area (ac) (cfs) (%) (fps) (fps) Depth(ft)
1 3.74 3.10 0.64 0.86 12.58 .01 5.8 2.74 0.59
2 3.00 2.51 0.49 0.86 10.09 .01 5.8 2.55 0.52
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Form SW401-Low Density-Rev.3-2/10/09 Page 2 of 4

IV. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the North Carolina Administrative Code Section 15A
NCAC 2H .1000, NCDENR BMP Manual (2007), Session Law 2006-246, and Session Law 2008-211.
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 that the following requirements
have been met and supporting documentation is provided as necessary. If the applicant has designated an agent
on the Stormwater Management Permit Application Form, the agent may initial below. If any item is not met,
then justification must be attached. Only complete items n through p for projects with curb outlets.
Page/Plan
Initials Sheet No.
_7 E N/A a.tFor projects in the 20 coastal counties: Per NCAC 2H.1005, a 50 foot wide vegetative buffer is
provided adjacent to surface waters. For Redevelopment projects, a 30' wide vegetative
buffer adjacent surface waters is provided.
Z.E. N/A b.tFor HQW or ORW projects outside the 20 coastal counties: A 30 foot wide vegetative buffer is
provided adjacent to surface waters.
Z£ App C c.t For Phase II Post-Construction projects: All built upon area is located at least 30 feet
landward of all perennial and intermittent surface waters.
Z.E N/A d. Deed restriction language as required on form SWU-101 shall be recorded as a restrictive
covenant. A copy of the recorded document shall be provided to DWQ within 30 days of
platting and prior to the sale of any lots.
Z E App E e. Built upon area calculations are provided for the overall project and all lots.
Z E N/A f. Project conforms to low density requirements within the ORW AEC. (if applicable per
15A NCAC 2H .1007)
Z.E. N/A g. Side slopes of swales are no steeper than 3:1; or no steeper than 5:1 for curb outlet swales.
2 E N/A h. Longitudinal slope of swales is no greater than 5%;for non-curb outlet projects, calculations for
shear stress and velocity are provided if slope is greater than 5%.
7 E N/A i. At a minimum, swales are designed to carry the 10 year storm velocity at a non-erosive rate.
7 E N/A j. Swales discharging to wetlands are designed to flow into and through the wetlands at a non-
erosive velocity (for this flow requirement into wetlands, non-erosive is velocity<2 ft/s).
7 E N/A k. Swale detail and permanent vegetation is specified on the plans.
2 E N/A 1. Swale detail provided on plans; includes grass type(s) for permanent vegetative cover.
Z.E N/A m. Swales are located in recorded drainage easements.
7 N/A n.tt Length of swale or vegetated area is at least 100 feet for each curb outlet.
ZE N/A o.tt The system takes into account the run-off at ultimate built-out potential from all surfaces
draining to the system(delineate drainage area for each swale).
Z E N/A p.tt Curb outlets direct flow to a swale or vegetated area.
t Projects in the Neuse,Tar-Pamlico,Catawba River basins,and Randleman Lake may require additional buffers.
tt Only complete these items for projects with curb outlets.
Form SW401-Low Density-Rev.3-2/10/09 Page 3 of 4

V. SWALE SYSTEM MAINTENANCE REQUIREMENTS
1. Mowing will be accomplished as needed according to the season. Grass height will not exceed six inches at
any time; and grass will not be mowed too close to the ground or"scalped".
2. Swales will be inspected monthly or after every runoff producing rainfall event for sediment build-up,
erosion, and trash accumulation.
3. Accumulated sediment and trash will be removed as necessary. Swales will be reseeded or sodded
following sediment removal.
4. Eroded areas of the swales will be repaired and reseeded. Swales will be revegetated as needed and in a
timely manner based on the monthly inspections. Side slopes must be maintained at the permitted slope.
5. Catch basins, curb cuts,velocity reduction devices, and piping will be inspected monthly or after every
significant runoff producing rainfall event. Trash and debris will be cleared away from grates, curb cuts,
velocity reduction devices and piping.
6. Swales will not be altered,piped, or filled in without approval from NCDENR Division of Energy,Mineral
and Land Resources.
I acknowledge and agree by my signature below that I am responsible for the performance of the six
maintenance procedures listed above. I agree to notify DEMLR of any problems with the system or prior to any
changes to the system or responsible party.
Print Name and Title:Nuwan Wijesuriya-Lead Transmission Permitting Manager
Address:411 Fayetteville Street, Raleigh,NC 27601
Phone:[phone] Date: /4 /I 9 /2-0 2_3
Signature: i�wwo•�� Lam- ; �
Note: The legally responsible partyshould not be a homeowners association unless more than 50%ofthe lots have been sold and a
S Y P
resident of the subdivision has been named the president.
I, r ^ ,a Notary Public for the State of a yzi ,County of
d ,d hereby certify that AlleVv4 r\ IAA)eh th n � ©� personally appeared before me this _
day of , ,and acknowledge the due execution of the forgoing swale maintenance requirements.
Witness my hand and official seal,
No
SEAS .:���OT Tn'S9�% My commission expires 4 i'7/I it/II
Form SW401-Low Density-Rev.3-2/10/09 Page 4 of 4