SW8070653_Historical File_20150624

AdirA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald van der Vaart
Governor Secretary
June 24, 2015
Lisa C. Beaman, Manager
Hoosier Daddy, LLC
6025 Tarin Road
Wilmington, NC 28409
Subject: Approved Plan Revision
Oyster Landing Subdivision
Stormwater Permit No. SW8 070653
Onslow County
Dear Ms. Beaman:
On May 8, 2015, the Wilmington Regional Office received final information regarding a request to revise
the approved plans for Stormwater Management Permit Number SW8 070653. The revisions include
lot layout changes and an increase in the BUA for the entrance road of 9,469 square feet. The
previously approved "Future" allocation of 110,000 square feet within DA#1 was reduced to 100,531
square feet to make up for this increase. The overall permitted BUA within DA#1 remains unchanged
at 757,946 square feet. It has been determined that a formal permit modification is not required for the
proposed changes. We are forwarding you an approved copy of the revised plans for your files. Please
add the attached plans to the previously approved plan set and replace page 2 of 4 of the application
with the attached revised page.
Please be aware that all terms and conditions of the permit transferred and issued to you on
October 7, 2014, remain in full force and effect. Please also understand that this revision to the
approved plans or to the permit for the subject State Stormwater project is approved on a case-by-
case basis. Any other changes to this project must be submitted to and approved through this
Office prior to construction. The issuance of this plan revision does not preclude the permittee from
complying with all other applicable statutes, rules, regulations or ordinances which may have
jurisdiction over the proposed activity, and obtaining a permit or approval prior to construction.
If you have any questions concerning this matter, please do not hesitate to call me at [phone].
Sincerely,
Glef'+'7 46"
Linda Lewis, E.I.
Environmental Engineer III
GDS1arl: G:1WQ\Shared\Stormwater\Permits&Projects120071070653 LD\2015 06 permit_pr 070653
cc: Mark Hargrove, P.E., Port City Consulting Engineers
Onslow County Building Inspections
Wilmington Regional Office Stormwater File
Division of Energy,Mineral, and Land Resources
Land Quality Section-Wilmington Regional Office •
127 Cardinal Drive Extension,Wilmington,North Carolina 28405
(910)796-72151 Fax:[phone].Internet:http:llportal.ncdenr.orglwebllrl

L.GLVILA U.7II 1/4/IN L 1. o
Date Received Fee Paid(express only) Permit Number
3-4--Zoi 5 -- 5Gt)g0706953
State of North Carolina
Department of Environment and Natural Resources
Division of Energy,Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT PLAN REVISION APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Stormwater Management Permit Number: SW8 07653
2. Project Name: Oyster Landing Subdivision
ECF.AVEU
3. Permit Holder's name(specify the name of the corporation,individual,etc.):
Hoosier Daddy,LLC MAR 0 4 2015
4. Print Owner/Signing Official's name and title(person legally responsible for permst):
Lisa Beaman-Member
5. Mailing Address for person listed in item 2 above:
6025 Tarin Road
City:Wilmington State:NC Zip:28409
Phone: (910 ) 769-3053 Fax: (
Email:[e-mail]
IL PLAN REVISION INFORMATION
1. Summarize the plan revision proposed(attach additional pages if needed):
The entrance road was modified and Lanyard Drive was added which increased the road impervious area.
Impervious area permitted as future was used for this additional impervious area that was added for the road
III. 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. The complete
application package should be submitted to the DEMLR Office that issued the permit.
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
hi
• Original&1 copy of the Plan Revision Application Form �7N
• Two(2)copies of revised plans(must be revisions of original approved plan sheet(s)) 1,104
If applying for Express review(only available in 20 coastal counties):
• Application fee of$500.00(made payable to NCDENR) A7IA
VI. APPLICANT'S CERTIFICATION
L(print or type name of person Iisted in General Information,item 3) Lisa Beaman
certify that I have authorized these plan revisions and that the information included on this plan revision
application is,to the best of my knowledge,correct and complete.
Signature: Date: 3 /y5
Flan Revision Form�� Rev.Oct.31,2013

3. Specify the type of project(check one):
X Low Density High Density Redevelop General Permit Other
4. Additional Project Requirements(check applicable blanks):
CAMA Major X Sedimentation/Erosion Control X 404/401 Permit NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748
III. PROJECT INFORMATION
1. In the space provided below,summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages)describing stormwater management for the project.
Roadside vegetative swales
2. Stormwater runoff from this project drains to the Cape Fear River Basin.
3. Total Project Area: 319 acres.
4. Project Built Upon Area: 24.4 %.
5. How many drainage areas does the project have? 2
6. Complete the following information for each drainage area. If there are more than two drainage areas in the
project,attach and additional sheet with the information for each area provided in the same format as below.
Basin Information Drainage Area 1 Drainage Area 2
Receiving Stream Name StonesCreek Turkey Creek
Receiving Stream Class SA;HQW SA ;ORW
Drainage Area 3,107,134 sf 9,343,620 sf
Existing Impervious*Area 0 0
Proposed Impervious*Area 757,946 sf 2,039,937
%Impervious*Area(Total) 24.4% 21.8%
Impervious* Surface Area Drainage Area 1 Drainage Area 2
On-Site Buildings 476,000 sf 1,183,000 sf
On-Site Streets 181,415 sf 513,377 sf
On-Site Parking/Pavement 0 0
On-Site Sidewalks 0 43,560 sf
Other On-Site(Future) 100,531 sf 300,000 sf
Off-Site Access Drive 0
I Total: 757,946 sf Total: 2,039,937 sf
*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 3.99 Page 2 of 4 MAY 0 8 2015
BY:S6)10706,53

swa07c 53
Resolution of Hoosier Daddy, LLC
I,Jack Carlisle,certify that I am a Member/Manager of Hoosier Daddy,LLC a limited
liability company organized under the laws of the State of South Carolina, and that the following is a
true and correct copy of a Resolution duly adopted by the Board of Directors o le_day of May,
2015.
OAF
Mr-Or isle
Member/Manager
Resolved by the Board of Directors of Hoosier Daddy,LLC,that Lisa Carlisle Beaman is
appointed as a Manager of Hoosier Daddy,LLC and that as said Manager is authorized for and on
behalf of the company to execute any and all documents related to the business of Hoosier Daddy,
LLC, including among other things,but not limited to,the execution of deeds and other closing
documents for the sale of lots in New Hanover County,NC. Jack Carlisle is authorized to certify a
copy of this resolution.
flECEIVE
MAY 082015
BY:

E-Filed Annual Report
10399465
�' ' LIMITED LIABILITY COMPANY
p • ANNUAL REPORT Do not data enter manually.
NAME OF LIMITED LIABILITY COMPANY: HOOSIER DADDY,LLC
REPORT FOR THE YEAR:2014 STATE OF INCORPORATION: SC
SECRETARY OF STATE L.L.C.ID NUMBER: 1352669
NATURE OF BUSINESS: land development
REGISTERED AGENT: Beaman,Lisa
REGISTERED OFFICE MAILING ADDRESS: 6025 Tarin Road
Wilmington,NC 28409-0006
REGISTERED OFFICE STREET ADDRESS: 6025 Tarin Road
Wilmington,NC 28409-0006 New Hanover County
PRINCIPAL OFFICE TELEPHONE NUMBER: 910-769-3053
PRINCIPAL OFFICE MAILING ADDRESS: 6025 Tarin Road
Wilmington,NC 28409-0006
PRINCIPAL OFFICE STREET ADDRESS: 6025 Tarin Road
Wlrlmington,NC 28409-0006
Company Officials:
Name:Jack Jenkins Carlisle Name:Lisa Carlisle Beaman
Title:Member Title:Member
Address: Address:
109 Willesden Drive 6025 Tarin Road
Cary,NC 27513 Wilmington,NC 28409
CERTIFICATION OF ANNUAL REPORT MUST BE COMPLETED BY ALL LIMITED LIABILITY COMPANIES
Jack Jenkins Carlisle 2/2/2015
FORM MUST BE SIGNED BY A MANAGER/MEMBER DATE
Jack Jenkins Carlisle Member
TYPE OR PRINT NAME TYPE OR PRINT TITLE
ANNUAL REPORT FEE:E-Paid MAIL TO: Secretary of State•Corporations Division•Post Office Box 29525•Raleigh,NC 27626-0525

Lewis,Linda
From: Lewis,Linda
Sent: Tuesday,April 28,2015 5:48 PM
To: 'Mark Hargrove-Old'
Subject: Oyster Landing Subdivision SW8 070653 Plan Revision
Attachments: 2015 04 applicationscan 070653.pdf
Mark:
I am reviewing this proposed plan revision. Unfortunately,you left off the second drainage area from the revised
application page that you submitted. In addition,you left the previously approved condition on there. Remember,this
application page will replace the original page,so you should not have both the previously permitted condition and the
new proposed condition on the same page because then,they would both be considered the permitted condition which
is not correct.That comparison table is best put into the supporting narrative for the plan revision. The approved
project has 2 drainage areas,as shown on the attached pdf of the original application.That application was on the old
1999 version,which was only 4 pages long.The drainage area columns for that version are on page 2.
You can either take the attached original application page and mark it up with the proposed information in the DA 1
column,and resubmit it,or you can combine the 2 drainage areas into one column on the DA column page from the
latest application.The overall density for the project is 25%irrespective of the ORW classification of Turkey Creek. No
portion of the project is within the 575'ORW AEC,so it really doesn't matter if there are 2 columns separated as Turkey
Creek and Stone Creek, or if there is just one column all lumped together.
Also,what do you want to do with the plans? It does not appear that they were intended to replace the approved plan
sheets that Mike Gallant, P.E., originally created,so they will just be marked as additional sheets to those previously
approved plans.
Thanks,
Linda Lewis,E.I.
Environmental Engineer Ill
Division of Energy, Mineral and Land Resources
Wilmington Regional Office
127 Cardinal Drive Ext.
Wilmington,NC 28405
Main Office-910-796-7215
Direct Line-910-796-7343
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third parties.
1

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OYSTER LANDING SUBDIVISION CO/!1 n ,
PERMIT No.SW8 070653
(Previous Submittal) (Revised Submittal)
Basin Information Drainage Area 1 Drainage Area 1
Receiving Stream Name Stone Creek Stone Creek
Stream Class SA;HQW SA; HQW
Stream Index Number 19-30-3 19-30-3
Total Drainage Area(sf) 3,107,134 3,107,134
On-site Drainage Area(sf) 3,107,134 3,107,134
Proposed Impervious Area **(sf) 757,946 757,946
%Impervious Area**(total) 0.24 0.24
Impervious**Surface Area Drainage Area 1 Drainage Area 1
On-site Buildings/Lots(sf) 476,000 476,000
On-site Streets(sf) 171,946 181,415
On-site Parking(sf) 0
On-site Sidewalks(sf) 0
Other on-site(sf)Waste Water Plant 0
Future(sf) 110,000 100,531
Off-site(sf)
Existing BUA**(sf)
Total(sf): 757,946 757,946
flECEIVE
FEB 182015
BY:S 70l o5,3

March 4,2015
Linda Lewis
NC Division of Energy, Mineral and Land Resources
127 Cardinal Drive
Wilmington,North Carolina 28405
RE: Stormwater Permit No. SW8 07653
Permit Revision D�jv�O 3 5((�
Oyster Landing 111
Onslow County I
Dear Ms. Lewis:
Per your request, attached are the signed Revision Application Form and Sheets C-2.1, C-
3.1, C-3.2, C-3.3 & C-3.4 which show the revised plans for the first phase of construction
for the Oyster Landing Subdivision. Lanyard Drive is shown as well as the changes for
where lots 471-474 were changed to lots 1 &2 and 30&31. Sheets C-3.1 —3.4 are the
detail road way plans.
If there is anything else you need,please let me know.
Sincerely,
Ajtitivar
Mark N. Hargrove
Port City Consulting Engineers,PLLC
RECEIVE0
MAR 04 01 - .a °; .o ,.
MAR u 41,►J
BY:
PORT CITY CONSULTING ENGINEERS, PLLC
6 2 1 6 STONEBRIDGE ROAD, WI L M I NO TON , N C 2 13409
P H : ( 9 1 0 ) 5 9 9 - 1 7 4 4

Casmer, Jo
From: Casmer,Jo
Sent: Thursday,April 02,2015 8:24 AM
To: 'e851isaegmail.com; Mark Hargrove
Subject: Oyster Landing Subdivision;Stormwater Permit SW8 070653
The Wilmington Regional Office of the Division of Energy, Mineral, and Land Resources (Stormwater Section)
received the Stormwater Permit Plan Revision application on March 4, 2015. Your project will be assigned to a
staff member and you will be notified if additional information is needed.
Jo Casmer
Administrative Assistant for DEMLR/Stormwater Section
NC Department of Environment&Natural Resources
127 Cardinal Drive Extension
Wilmington,NC 28405
Phone: [phone]
Fax: [phone]
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third
pasties
1

Lewis,Linda
From: Lewis,Linda
Sent: Friday, February 20,2015 11:03 AM
To: 'Mark Hargrove -Old'
Subject: RE:Oyster Landing - SW8 070653
Thanks Mark.These changes do warrant a plan revision,so please submit the completed and signed (by permittee) plan
revision application form,and 2 copies of a revised full-size layout and grading plan sheet showing the road changes, lot
layout changes and lot numbering changes.The smaller sheets you provided in the attachment will not suffice since the
approved plans in the file are full-size.
Thanks and stay warm!
Linda
From: Mark Hargrove- Old [mailto:[e-mail]]
Sent: Wednesday, February 18, 2015 12:05 PM
To: Lewis,Linda
Cc: Lisa Beaman;[e-mail]
Subject: Oyster Landing - SW8 070653
Linda,
Attached is a letter addressing the comments and supporting information.
If you need anything else, please let me know.
Thanks
Mark N. Hargrove, PE
Port City Consulting Engineers, PLLC
910-599-1744
Tills email has been checked for viruses by Avast antivirus software.
www.avast.com
1

February 18,2015 / 3
AO1 Linda Lewis v
NC Division of Energy,Mineral and Land Resources
127 Cardinal Drive
Wilmington,North Carolina 28405 -t
RE: Stormwater Permit No.SW8 07653 FEB 1 $ 201
Permit Transfer/SL 2013-121
Oyster Landing BY:
Onslow County
Dear Ms. Lewis:
The following is in reference to the letter from Georgette Scott dated October 7 2014
requesting information on the Oyster Landing Project: Deficiencies were listed and a
response if provided.
1. Provide documentation that no lot has exceeded the permitted maximum BUA
limit of 4006 square feet.
Response: Attached is a spreadsheet from the homebuilders of the first 64 lots
detailing the size of the houses. Also shown are the sizes of the driveways,patios
and walkways for some of the lots. All the information is not shown for all the lots,
but for the lots that I have all the information,we are well below the BUA limit of
4,006 sf. The most shown for the lots with all the information is 3,326 sf. Figure 3
shows an aerial image take in 2012 with some of the finished lots. The most shown
is 3,807 sf.
2. Submit a plan revision to document the layout change for Lots 471,472,473 &
474.
Response: Attached are Figure 1 and Figure 2 showing the difference in the layout
and the increase in impervious area for the streets. The lot numbers were changed
from the original design. Lots 471—474 are not Lots 1,2,30&31.
3. Account for the BUA additions due to the addition of Lanyard Road and the
expansion of the entrance road off of NC 172.
Response: Attached are Figure 1 and Figure 2 showing the difference in the layout.
The new entrance layout added 9,469 sf. A breakdown of the impervious area is
provided on a separate sheet. The additional impervious area for the change in the
PORT CITY CONSULTING ENGINEERS, PLLC
6216 9TC N EBRIDG E ROAD, WILMINDTO IVt N C 2 9409
P H t (9 1 D 1 5 9 9 - 1 7 4 4

entrance road will be taken from the future impervious area that was previously
permitted.
4. Submit a copy of the recorded deed restrictions prior to selling any more lots.
Response: A copy of the recorded deed restrictions were previously emailed to you
on September 12,2015.
5. Perform the maintenance of those swales that front an undeveloped lot.
I am waiting to hear back if the swales have been cleaned out.
If there is anything else you need,please let me know.
Sincerely,
AdvilAiatAdlem&_
Mark N.Hargrove
Port City Consulting Engineers,PLLC
cc: Jack Carlisle—Hoosier Daddy,LLC
PORT CITY CONEULTI NO ENGINEERS, PLLC _...�
6 2 1 C STONEBRIDGE ROAD, WILMINGTO N , N C 2 9 4 0 9
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OYSTER LANDING SUBDIVISION-NEW DESIGN 1 ENTRANCE ROAD BUA&LANYARD ROAD
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HOOSIER DADDY,LLC
PORTO1YCONSULTING
6216 STONEBRRIDCE EGAD
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ENGIN�RS,PLLC APPROVED Elt DATE: roe Mk
6025 TARIN ROAD
WILMINGTON,NC 28409 kiwi 10/Tslr4
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OYSTER LANDING SUBDIVISION-ORIGINAL DESIGN ENTRANCE ROAD BUA&LANYARD ROAD x 81`• SCALE: MAE NO,
PORT CITY CONSULTING MNH 1'm60' 2
HOOSIER DADDY,LLC ENGINEERS,PLLC
6025 TARIN ROAD 6216 STONIBR �� as s�
RIDGE ROAD
WIUutlNGTON,NC 28409 MNH 11/05lt4
WILMINGTCIN,NC 28409 ,E 916EA.naa LICENSE NO.P.1032 ,

` Impervious Survey OYSTER LANDING
8u114Igg SotIsT
Front 25
Roar 15 7it_rrr�R-1�
81de 8 Onslow 000ily
Comer 20 I
Impervious Area
Lot a Lot Area(AC) L ot7ype HOUSE AREA DRIVE AREA WALK AREA PATia AREA Taro.AREA
1 0.55 INSIDE 1,206 SF
2 0.43 CORNER 1,279 SF 568 SF _ 55 SF 120 SF 2,022 SF
3 0.43 CORNER 2,137 SF
4 0.37 INSIDE 1,946 SF
5 0.37 INSIDE 1,456 SF 861 SF 52 SF 110 SF 2,478 SF
6 0.36 INSIDE 1,255 SF
7 0.36 INSIDE 2,127 SF
8 0.35 INSIDE 1,280 SF 764 SF 42 SF 120 SF 2,206 SF
9 0.38 INSIDE 1,362 SF 762 SF 35 SF 120 SF 2,279 SF
10 0.61 INSIDE 2,475 SF 687 SF 164 SF 3,326 SF
11 0.55 INSIDE 2,197 SF
12 0.42 INSIDE 1,280 SF 823 SF 43 SF 120 SF 2,266 SF
13 0.37 INSIDE 1,199 SF
14 0.31 INSIDE 1,273 SF
15 0.35 INSIDE 1,430 SF
16 0.33 INSIDE 1,287 SF
17 0.31 INSIDE 1,338 SF
18 0.26 INSIDE 1,287 SF 442 SF 56 SF 1,785 SF
19 0.26 INSIDE 2,559 SF 424 SF 149 SF 3,132 SF
20 0.27 INSIDE 1,448 SF 578 SF 47 SF 110 SF 2,181 SF
21 0.26 INSIDE 1,272 SF 581 SF 56 SF 120 SF 2,029 SF
22 , 0.40 INSIDE 1,286 SF 581 SF 56 SF 120 SF 2,043 SF
23 0.38 INSIDE 1,658 SF
24 0.36 INSIDE 1,349 SF
25 0.36 INSIDE 1,204 SF 464 SF 41 SF 110 SF 1,819 SF
26 0.35 INSIDE 1,347 SF 521 SF 47 SF 112 SF 2.027 SF
27 0.34 INSIDE 1,287 SF
28 0.37 INSIDE 1,442 SF
29 0.43 _ CORNER 1,545 SF
30 0.39 CORNER 2,566 SF
31 0.37 INSIDE 1,428 SF 592 SF 58 SF 118 SF 2.196 SF
32 0.33 INSIDE 1,428 SF
33 0.34 INSIDE 1,493 SF 563 SF 18 SF 100 SF 2,174 SF
34 0.39 INSIDE 1,915 SF
35 0.32 INSIDE 2,028 SF 474 SF 60 SF 229 SF 2,791 SF
36 0.31 INSIDE 1,779 SF 462 SF 96 SF 100 SF 2,437 SF
37 0.25 CORNER 1,767 SF
38 0.23 INSIDE 2,028 SF 429 SF 80 SF 229 SF 2,746 SF
39 0.35 INSIDE 1,843 SF
40 '0.24 INSIDE 1,554 SF
41 0.23 INSIDE 1,472 SF
42 0.36 INSIDE 1,752 SF
43 0.35 INSIDE 2.029 SF 464 SF 52 SF 229 SF 2,774 SF
44 0.37 INSIDE 1,394 SF 572 SF 106 SF 100 SF 2,172 SF
45 0.43 INSIDE 1,759 SF 467 SF 108 SF 100 SF 2,434 SF
46 0.45 INSIDE 1,786 SF 578 SF 30 SF 100 SF 2,494 SF
47 0.59 INSIDE 1,855 SF 464 SF 56 SF 130 SF 2,505 SF
48 0.45 INSIDE 1,428 SF 272 SF 114 SF 100 SF 1,914 SF
49 0.36 INSIDE 1,790 SF 612 SF 29 SF 100 SF 2,531 SF
50 0.38 INSIDE 1,775 SF 637 SF 102 SF 100 SF 2,614 SF
51 0.35 INSIDE 1,860 SF 462 SF 52 SF 130 SF 2,504 SF
52 0.35 INSIDE 1,654 SF 528 SF 21 SF 100 SF 2303 SF
53 0.35 INSIDE 1,759 SF 441 SF 115 SF 100 SF 2,415 SF
54 0.33 INSIDE 1,658 SF 494 SF 26 SF 100 SF 2,278 SF
55 0.38 INSIDE 1,843 SF
56 0.36 INSIDE i,635 SF
57 0.39 INSIDE 1,771 SF 441 SF 98 SF 100 SF 2,410 SF
58 0.39 INSIDE 1,936 SF 508 SF 32 SF 2,524 SF
59 0.55 CORNER 1,767 SF 393 SF 114 SF , 100 SF 2,374 SF
60 0.29 INSIDE 2,018 SF 511 SF 56 SF 229 SF 2,814 SF
61 0.29 INSIDE 1,654 SF 579 SF 43 SF 100 SF 2376 SF
62 0.30 INSIDE 1,927 SF 579 SF 100 SF 2,606 SF
63 0.26 INSIDE 1,843 SF
64 0.26 CORNER 1,786 SF 1,031 SF 37 SF 100 SF 2,954 SF
Page 1 OYSTER LANDING Impervios

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OYSTER LANDING SUBDIVISION-NEW DESIGN
BUA AMOUNTS FOR LOTS DO.011'04 S -. AE Ir
PORT CITY CONSULTING MNH 1" .50' 3
HOOSIER DADDY,LLC ENGINEERS,PLLC �
6216 STONEBRRIDGE ROAD FM s"`t'—' F 't"`
6025 TARIN ROAD W/ILMINGTON,NC 2&i09
WILMINGTON,NC 28409 970599-1744 LICENSE NO.F-1032 MNH 112/1/14 ` ,

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATI.ON
1. Stormwater Management Permit Number: Sit/ S a)D 6s3
2. Project Name: d-e.1r1 .L czn '; e y
3. Current Permit Holder's Company Name/Organization: Qy s)-r r- Look : L L
4. Signing Official's Name: 'oft T. Let ce.x.t Title: i'neiv.,h.e.(--
5. Mailing Address: 0 S®8 IA ; I:4-411 cc#`41- ? g4, fu;)i't- 3 v a.
City: G.21 /Jbl Ili 10 rt State: AI& Zip: a-eye3
6. Phone: (I 1V ) as-6 — 01 'i Fax: (q l n ) ?6 OS/.s
II. PROPOSED PERMITTEE/OWNER/PROJECT/ADDRESS INFORMATION
This request is for: (please check all that apply)
® Name change of the owner(Please complete Items 1, 2 and 3 below)
❑ Name change of project (Please complete Item 5 below)
® Change in ownership of the property/company (Please complete Items 1, 2, 3, and 4 below)
[XI Mailing address/phone number change. (Please complete Item 4 below)
El Other(please explain):
1. Proposed permittee's company name/organization: 110 o +tr.r` .06,1dy , L L G
2. Proposed permittee's signing official's name: 3a -M- CaiNkS le
3. Proposed permittee's title: nem. t r- II an egar
4. Mailing Address: 60 Lf 7i -`A a&I
City: i : i m 1+n3 Stvrt State: iv L Zip: o1 'l 0 /
Phone: ( `W O ) 7'44`I' 3('S 3 Fax: ( )
5. New Project Name to be placed on permit:
Please check the appropriate box. The proposed permittee listed above is:
❑ HOA or POA(Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA in#1 above and provide name of HOA/POA's authorized representative in#2 above)
I.The property owner
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
O Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be
granted upon receipt at a copy of the recorded deed)
❑ Developer (Complete Property Owner information on page 4)
AEcEiv
nECEIVE
SSW N/O Change Rev2, "ep1 9 2014 ' ge 1 of 4 AUG 14
I i BY:
BY:

III. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may result in processing delays or denial of the transfer.
1. This completed and signed form. This certification must be completed and signed by both the
current permit holder and the new applicant if this is a change of ownership.
2. Legal documentation of the property transfer to a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4.The designer's certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional office), if required by the permit and if not already submitted to DWQ.
5. If the proposed permittee is a firm, partnership, association, institution, corporation, limited liability
company, or other corporate entity, provide documentation showing the authority of the named
representative to act on behalf of the proposed permittee.
6. The$40.00 processing fee. If this is an initial transfer from the original permittee the processing
fee is not required. Subsequent ownership transfers will require the$40.00 processing fee.
IV. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fill out the certification below that statement:
❑ Check here if the current permittee is only changing his/her/its name, the project name, or mailing
address, but will retain the permit. I, , the current
permittee, hereby notify the DWQ that I am changing my name and/or I am changing my mailing
address and/or I am changing the name of the permitted project. I further attest that this application
for a name/ownership change is accurate and complete to the best of my knowledge. I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments listed above are not included,this application package will be returned as
incomplete.
(Check here if current permittee is transferring the property to a new owner and will not retain
ownersh�ipo of the permit.
I, �n T.V inc ent , the current permittee, am submitting this application
for a transfer of ownership for permit#,Sn)8O1(o53 . I hereby notify DWQ of the sale or
other legal transfer of the stormwater system associated with this permit. I have provided a copy of
the most recent permit,the designer's certification for each BMP, any recorded deed restrictions,
covenants, or easements, the DWQ approved plans and/or approved as-built plans, the approved
operation and maintenance agreement, past maintenance records, and the most recent DWQ
stormwater inspection report to the proposed permittee named in Sections II and V of this form. I
further attest that this application for a name/ownership change is accurate and complete to the best
of my knowledge. I understand that if all required parts of this application are not completed or if all
required supporting information and attachments listed above are not included,this application
package will be returned as incomplete. I assign all rights and obligations as permittee to the
proposed permittee named in Sections II and V of this form. I understand that this transfer of
ownership cannot be approved by the DWQ unless and until the facility is in compliance with the
permit.
iv — 5 ri krO f /rails-Er 5L ZG 13— 121
Signature: p
I, , a Notary Public for the State of
, County of , do hereby certify that
personally appeared before me this the
day of . 20 , and acknowledge the due execution of the
forgoing instrument Witness my hand and official seal, (Notary Seal)
Notary Signature ��ED E
SEP192014
AU 22014
SSW N/O Change Rev24Sept2012 Page 2 of 4 BY
BY:

V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed Permittee for all transfers of ownership)
I, :5 0.G1 _ ear 16 he , hereby notify the DWQ that I have acquired
through sale, lease or legal transfer,the responsibility for operating and maintaining the permitted
stormwater management system, and, if applicable, constructing the permitted system. I
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
?S the most recent permit
the designer's certification for each BMP
❑ any recorded deed restrictions, covenants, or easements
❑ the DWQ approved plans and/or approved as-built plans
❑ the approved operation and maintenance agreement
Bpast maintenance records from the previous permittee (where required)
DWQ stormwater inspection report showing compliance within 90 days prior to this transfer
I have reviewed the permit, approved plans and other documents listed above, and I will comply with
the terms and conditions of the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to the requirements listed in the permit and in the
operation and maintenance agreement. I further attest that this application for a name/ownership
change is accurst- and complete to •e best of my knowledge. I understand that if all required parts
of this applicatio . e n• -•mp - : • • if all required supporting information and attachments listed
above are not int • - •` -�•plii: • ' age will be returned as incomplete.
Signature Date: I/Y
I, 't1 CJDki? ICJC , a Notary Public for the State of
MIL , County of (' E\rf 4-W`ln , do hereby certify that
J�4. at-j'W rtNS aZI-\ 51--i personally appeared before me this the
'C tI1. day of u(---tj ci , 20 l`I , and acknowledge the due execution of the
forgoing instrument.Witness my hand and official seal, ```‘‘�/y�Frecy I
i
--- --L ,--s -Aa • . /_ ,,,
Notary SO nature 4\ r10Tq
7;'›i eclC y ':
ro 016 ���
Additional copies of the original permit and the approved Operation a . W-rranl rt�ment can
be obtained from the appropriate Regional Office of the Division of Wat- o7 1 O '
tla1s)'
This completed form, including all supporting documents and processing fee (if required), should be
sent to the appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources, Division of Water Quality, as shown on the attached map.
Please note that if the Proposed Permittee listed above is not the property owner, the property owner
must complete and sign page 4 of this document. Both the lessee/developer and the property
owner will appear on the permit as permittees.
SEP 19 2014 A 212014 9
SSW N/O Change Rev24Sept2012 Page 3 of 4 .•

VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections II and V of this form is not the Property Owner, the
Property Owner must provide his/her Contact Information below and sign this form:
Printed Name:
Organization:
Title within the Organization:
Street Address:
City: State: Zip:
Mailing Address:
(if different from street address)
City: State: Zip:
Phone: Fax:
Email:
I certify that I own the property identified in this permit transfer document and have given permission
to the Proposed Permittee listed in Sections II and V to develop and/or, lease the property. A copy
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and I will therefore share responsibility for
compliance with the DWQ Stormwater permit. As the property owner, it is my responsibility to notify
DWQ by submitting a completed Name/Ownership Change Form within 30 days of procuring a
developer, lessee or purchaser for the property. I understand that failure to operate and maintain the
stormwater treatment facility in accordance with the permit is a violation of NC General Statute
(NCGS) 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 of the property owner Date:
I, , a Notary Public for the State of
, County of , do hereby certify that
personally appeared before me this the
day of , 20 , and acknowledge the due execution of the
forgoing instrument.Witness my hand and official seal,
(Notary Seal)
Notary Signature
fl€CE&VE
1 , SEP192014 f''
SSW N/O Change Rev24Sept2012 Page 4 of 4 OY:

North Caroriaa Department or the Seeretar r of State hart Pita Class Maim
Corporations Division Us Pbasaaga Paid
PA Box 29525 Pem,it 24N3
Raleigh,NC 27656-0525 RakIati,NC
H !ER DADDY,Ll.0
Lisa Seaman
6025 Tann Road
Wilmington,NC 28409
Notice of GGrounds
NOTICE OF GROUNDS FOR REVOCATION OF
CERTIFICATE OF AUTHORITY
The entity identified on the reverse is delinquent in filing at least one annual report and
consequently,is not in compliance with the North Carolina Limited Liability Act.
The Secretary of State is authorized by N.C.a.S.57D-7-30 to revoke the Certificate of
Authority of a business entity if the grounds for revocation exist. Failure to file the
annual report is grounds for revocation. This Notice is the first step of the revocation
process. In order to prevent revocation,the business entity must file the appropriate
annual report(s),or show to the Corporations Division of the Secretary of State within
sixty(60)days from the date of this Notice that each ground determined does not exist.
A list of your annual reports submitted to date is viewable by clicking the link to the
Corporations Division wcbpagge at vwvw.sosnc.com.The due date for filing a Limited
Liability Company annual report is April IS. One report is required for each year
beginning the year atter the year of creation.
Visit ewm+w.sesne,ccrm for further intbmtatiim.Customer Service is
available at(919)go7-2225 or via entail notices cosnc.con �Pfit. 'r � '
•
North.Carolina.Department of the Secretary of State *.• • ,
Corporations Division -*`► _,
DATE October 29,2014
2- Z -I 5 Celled Mr. Co Lc lb Off'scu is I/S.
LL1 hers e c / 20lir 1 c2// b,e.
T
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Corporations Division Page 1 of 1
NorthCY-r rein
• l c � DEPARTMENT T
(4 , r ,< � � Elm l: marshy" EP' OF THE
. .• Seorataty SECRETARY OF STATE
PO Su rails Raft.NC 27826411 19 07 Ali Account
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Click Here To: Register
View Document Filings File an Annual Report Print a Pre-Populated Annual Report form
Amend a Previous Annual Report
Corporate Names
Legal: HOOSIER DADDY,LLC
Limited Liability Company Information
Sosld: 1352669
Status: Current-Active
Annual Report Status: ADM Pending
Citizenship: Foreign
Date Formed: 12/17/2013
Fiscal Month:
State of Incorporation: SC
Registered Agent: Beaman, Lisa
Corporate Addresses
Mailing: 6025 Tarin Road
Wilmington, NC 28409
Principal Office: 6025 Tarin Road
Wilmington, NC 28409
Reg Office: 6025 Tarin Road
Wilmington, NC 28409
Reg Mailing: 6025 Tarin Road
Wilmington, NC 28409
Company Officials
http://www.secretary.state.nc.us/Search/profcorp/10399465 2/2/2015