20081155 Ver 3_Initial Interest_20090929

®® A C Form Version 6.2
,,. x, g •• 115 5 v 3 June 29, 2009
NCDEW P
INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
WITHIN THE 401 OVERSIGHT/EXPRESS PERMITTING UNIT
A. Applicant Information
1. Processing
401 Water Quality Certification (List NW(s) or GP# verified by Corps: )
? Non-404 Jurisdictional Permit
? Riparian Buffer Authorization
1 a. Type(s) of actions ? Riparian Buffer Minor Variance
requested: ? Coastal General "Major" Variance
(Check all that apply) ? Stream Determination: # Streams
? Non-404 Wetland Determination: # Wetlands
0 Stormwater Management Plan Review (fee not additive if combined with 401):
1 # of Drainage Areas/Project Site
2. Project Information
2a. Name of project: Integra Springs at Kellswater
2b. County: Cabarrus
2c. Latitude/Longitude: Lat: 35.4695*N Long: 80.6670*W
2d. River Basin: Yadkin
2e. Tax PIN or Parcel ID: 5602 4969 060000
2f. Nearest Named Stream: Irish Buffalo Creek
2g. Water Quality Classification of Nearest Named Stream: C
2h. Total project acreage (Stream or wetland determinations may omit this item): 24.05 (acres)
2i. Total Built Out Imperviousness (Stream or wetland determinations may omit this item): 58%
2j. Provide a brief description of this project (attach a site plan):
This Is a proposed modification to SWM/BMP Pond # 1. Pond # 1 was previous approved under DWQ EXP #
08-1155v2 via letter dated July 24, 2009. The Integra Springs project proposes the development of a multi-family and
commercial out parcels with associate road systems and infrastructure. See drainage zone # 1 on the overall site plan
(Sheet C200).
2k. Provide directions from the nearest named town, Including street names and/or highway numbers:
Travel east on HWY 3 from the City of Kannapolis. Turn left onto the Kannapolis Parkway. Turn left onto Rogers Lake
Road. The project site is located on the right hand side of Rogers Lake Road approximately a quarter mile from the
intersection with Kannapolis Parkway. See attached vicinity map.
Please attach a map of the site location using USGS 1:24,000 topographic map and a copy of the latest bound
and published County soil survey with the project/site boundaries delineated. A site plan should also be Included
for all projects other than stream and wetland determinations.
Initial Interest Form v6.2 Cont.
3. Applicant Information
3a. Applicant is: ?X Owner ? Agent ? Other:
3b. Name: David G. McDaniel
3c. Business name (if applicable): Integra Land Company, LLC
3d. Street address: 1525 International Parkway - Suite 2001
3e. City, State, zip: Lake Mary, FL 32746
3f. Telephone no.: [phone] 3g. Fax no.: [phone]
3h. Email address: [e-mail]
4. Agent/Consultant In formation (if applicable)
4a. Contact Name: Adam M. Nowocin, P.E.
4b. Company Name: N-Focus Design, Inc.
4c. Street address: 5405 Kellswater Bridge Boulevard - Suite B
4d. City, State, zip: Kannapolis, NC 28081
4e. Telephone no.: [phone] 4f. Fax no.. [phone]
4g. Email address: [e-mail]
5. Proposed Impacts (include both temporary and permanent) [Determination requests may omit this item]
5a. Total 404/401 wetland impacts: (acres) 5b. Total non-404/401 wetland impacts: (acres)
6c. Total 404 stream impacts: Intermittent: (linear feet) Perennial: (linear feet)
5d. Total non-404 stream impacts: Intermittent: (linear feet) Perennial: (linear feet)
5e. Total riparian buffer impacts: Zone 1: (sq. feet) Zone 2: (sq. feet)
6. Project History and Additional Information
6a. Has any DWQ staff visited the site? ?x Yes ? No
If yes, provide staff name: Alan Johnson and date of visit: March 20, 2008
6b. Does this project require a Stormwater Management Plan (SMP)? X? Yes ? No ? Unknown

6c. Who will be responsible for the review of the SMP? ? Certified Local Gov't:
? DWQ Stormwater Program
® DWQ 401 /Express Review Unit
6d. Does this project require approval under SEPA or NEPA? ? Yes 0 No ? Unknown
6e. Is this project an after-the-fact application or has a DWQ notice of violation been issued? ? Yes 0 No
6f. Does this project include buffer impacts that are "prohibited" in the DWQ "Red Rule Book"? ? Yes ?X No
6g. If you are aware of any local controversy concerning this project, provide details in a cover letter. Describe the
controversy and any measures that have been taken with respect to public involvement.
This form must be submitted via email (c/o Lla.M.Gllleski _ncdenr.gov). faxed (919-733-6893), or hand-delivered to:
Parkview Building, 2321 Crabtree Blvd. Suite 250, Raleigh, NC 27604. Applicants who are selected to participate in the
Express Review Program will be notified via email or fax. Successful applicants will then be instructed regarding detailed
procedures for full application (Note: Submittals of the review packages on Friday after 12:00 pm will be stamped as
received on the next business day).
Please contact Lia Myott Gilleski or Joseph Gyamfi at 919-733-1786 if you have any questions regarding this form.
2
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NC®FNR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
July 24, 2009
DWQ EXP #. 08-1155x2
Cabarnis County
Mr. James Merrifield
Merrifield Partners, LLC
125 Scaleybark Rd.
Charlotte, NC 28209
Subject Property: Kellswater Commons Development
APPROVAL OF STORMWATER MANAGEMENT PLAN (SMP)
Deal- Mr. Merrifield,
On August lit 2008, the Division of Water Quality (DWQ) issued a 401 Water Quality Certification to
Mr, Edwin Thomas and Merrifield .Partners, file. to place fill within or otherwise impact 702 linear feet of
unnamed tributaries to Irish Buffalo Creek for the purpose of constructing the subject development in
Cabarrus County,
On July 22, 2009, the 401 Oversight/Express Review Permitting Unit of the Division of Water Quality
(DWQ) received your stolmwater management plan (SMP) application dated July 20, 2009, along with
supporting information including stormwater management plan sheets dated July 22, 2009 (Engineer's
Seal), design calculations and operation and maintenance (0 & M) agreements from Mr. Adam Nowocin,
PE of N-Focus.Design, inc. for the purpose of meeting Condition 3 of the 401 Certification for this
project. On July 24, 2009, the DWQ received additional information including revised SMP dated July
23, 2009 and 0 &M agreements. After careful reviewing the. information, the DWQ approves the revised
SNIP to satisfy the stormwater condition required by the Water Quality Certification. You are required to
meet the following conditions;
The stormwater management system consisting of three (3) wet detention ponds and all
associated appurtenances, stormwater conveyances, and the grading and drainage patterns
depicted on the plaits dated July 23, 2009, as approved by this office must be maintained In
perpelully, No changes to the structural stormwater practices shall be made without written
authorization from the Division of Water Quality. The storm.water management structures shall
have maintenance access and at least a 10-foot drainage easement on each side to allow for the
ability to maintain the structures, and to perform corrective actions..The stormwater easements
shall be recorded to provide protection of the structures from potential alterations by future
property owners.
2. Stormwater inlet pipes to ponds 2 and 3 shall be installed such that they discharge directly into
their respective forebays to prevent short circuiting of flows. At the time of this approval, the
storm drain layouts for drainage areas 2 and 3 have not been completed.
401 Civersight/Ezpress Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699.1650
Location; 2321 Crabtree Blvd., Raleigh, North Carolina 27504
Phone: [phone] FAX: [phone]
Internet: htip:l/h2o.encslate.nc.uslncwetlands!
One
N -thCarolina
Naturally
An Equal Oppalunily'. Alf rmalive Action Employer
Kellswater Commons Qevelopment
James Merrifield
Page 2 oft
July 24,. 2009
3. You must submit three Q) copies of an executed Declaration of Deed Restrictions and Protective
Covenants within thirty (30) days of recording with the Register of Deeds, .Caharrus County,.
North Carolina. The recorded' deed shall include the language in the DWQ 40I/)express
Permitting Unit's Sample DEED RESTRICTIONS AND PROTECTIVE COVENANTS signed
and notarized on July 20, 2009 and received with your applicoti'oh an July 22;, 2009. These shall
include, but:not limited to, the maximum built upon areas of 70%, 75% and 70% for any
development on any lot or parcel of land In drainage areas. 1, 2 and 3 respectively, draining to the
stormwater best management practices (BMPs),
4. All operation and maintenance activities shall be followed as stipulated in the Operation and
Maintenance Agreements signed and notarized on July 20, 2009 received in our office on July 24,
2009..
5. Notification of Construction: Tile applicant and/or authorized agent shall contact the DWQ
Express Review Program in writing at file letterhead address within ten (10) days of the
commencement of construction.
This letter completes tine review of,your application by the Division of Water Quality under Section 401
of the Clean Water Act. If you have any questions, please contact Joseph Gyamfi or Lia M. G'illeski at
919-733-1786.
Sincerely, a44?wa
Cyndi Karoly, Supervisor-
401 Oversight/Express Review Program
CBK/Jg
ec: File copy
USACE Asheville Regulatory Field Office
Alan Johnson, DWQ Mooresville Regional Office
Adam M. Nowocin, PE, N-Focus Design, Inc., 5405 Kellswater Bridge Boulevard, Kannapolis,
NC 28081
FILED
CABARRUS COUNTY NC
LINDA F. MCABEE
REGISTER OF DEEDS
FILED Aug 19, 2009
AT 10:06 am
BOOK 08868
START PAGE 0265
END PAGE 0271
INSTRUMENT # 21807
EXCISE TAX $0.00
STATE OF NORTH CAROLINA
COVENANTS AND RESTRICTIONS REGARDING
COUNTY OF CABARRUS STORMWATER MANAGEMENT PLAN
THIS DECLARATION OF COVENANTS AND RESTRICTIONS REGARDING
STORMWATER MANAGEMENT PLAN ("Declaration" or "covenants and restrictions") is made
as of the t*06 day of August, 2009, by KELLSWATER COMMONS II, LLC, a North
Carolina limited liability company ("Declarant').
STATEMENT OF PURPOSE
Declarant is the permitee under that North Carolina Department of Environment and
Natural Resources, Division of Water Quality, Stormwater Management Plan permit number
08-1155v2 ("Permit'), which permits the discharge of stormwater into unnamed tributaries of Irish
Buffalo Creek for the development of the Kellswater Commons commercial mixed-use
development upon the terms and conditions set forth in the Permit and in the stormwater
management plan ("SMP") submitted by Declarant in connection therewith. As a condition of
issuance of the Permit, Declarant is required to record restrictions upon any real property covered
by the Permit which is to be conveyed to third parties in order to ensure that all future owners,
developers and occupants of the real property covered by the Permit comply with the Permit in the
future development of such real property. Declarant anticipates conveying the real property
described on Exhibit A (the "Property") attached hereto to Integra Springs, LLC, a Florida limited
liability company ("Integra"), and therefore hereby records these covenants and restrictions upon
the Property in accordance with the Permit.
NOW, THEREFORE, in consideration of the covenants and mutual benefits and duties
herein contained, Declarant hereby declares that the Property shall be held, developed, improved,
leased, sold, transferred, conveyed and occupied subject to the following covenants and
restrictions, all of which are for the purpose of protecting the value and desirability of, and which
shall be appurtenant to and run with title to the Property and shall be binding on all parties having
Blanco Tackabe Page 1 of 2 Drawn by and rneWta:
ry Zachary M. Moretz
P.O. BOX 25008 Moretz & Skufca, PLLC
Winston Salem, NC 27114 37 Union Street South, Suite B
Concord, North Carolina 28025
I?j/ ORLDOCS 11592109 4
a right, title or interest therein now or in the future, along with their heirs, successors and assigns,
and which shall inure to the benefit of each owner thereof:
1. These covenants and restrictions are intended to ensure ongoing compliance with the state
Riparian Buffer Authorization and/or Water Quality General Certification number 08-1155 as issued by
the North Carolina Department of Environment and Natural Resources, Division of Water Quality
for the project known as Kellswater Commons. The Property is a portion of Kellswater Commons
and is a portion of the real property covered by the Permit.
2. The real property burdened by these covenants and restrictions is all that real property
described on Exhibit A attached hereto.
3. The State of North Carolina is made a beneficiary of these covenants and restrictions to the
extent necessary to maintain compliance with the Riparian Buffer Authorization and/or Water Quality
General Certification. These covenants and restrictions, therefore, may not be altered, rescinded or
deleted without the written consent of the State of North Carolina, Department of Environment and
Natural Resources, Division of Water Quality.
4. The Property constitutes a substantial portion of the real property in Drainage Zone #1
pursuant to the Permit. The maximum allowable impervious area for each Drainage Zone is as follows:
DRAINAGE DRAINAGE DRAINAGE ALLOWABLE ALLOWABLE
ZONE AREA AC AREA (Sq. Ft.) IMPERVIOUS (%) IMPERVIOUS (SF)
#1 20.06 AC 873,813.60 SF 70% 611,669.52 SF
#2 55.30 AC 2,408,868.00 SF 75% 1,806,651.00 SF
#3 1124 AC 489.614.40 SF 70% 342,730.08 SF
Total Allowable Impervious = 2,761,050.60 SF
Total Project Area = 3,855,423.38 SF
Total Built-Out Impervious = 71.61%
Impervious materials include asphalt, gravel, concrete, brick, stone, slate or similar material but
do not include wood decking or the water surface of swimming pools.
5. Swales shall not be filled in, piped, or altered except as necessary to provide driveway
crossings.
6. Impervious area in excess of the permitted amount requires a modified water quality
certification prior to construction.
7. All permitted runoff from outparcels or future development shall be directed into the
permitted stormwater control system. For the Property subject hereto, all permitted runoff shall be
directed into stormwater pond #1. All connections to the stormwater control system shall be performed
in a manner that maintains the integrity and performance of the system as permitted.
8. The approved stormwater treatment facilities, stormwater easements and drainage patterns
must be maintained in perpetuity. Alteration of the drainage system as depicted on the approved Permit
may not take place without the concurrence of the State of North Carolina, Department of
Environment and Natural Resources, Division of Water Quality.
Page 2 of 6
ORLDOCS 11592109 4
9. The terms and provisions of these covenants and restrictions shall be appurtenant to,
and shall run with and bind title to, the Property and shall be binding upon and inure to the benefit
of all owners and occupants of the Property and their respective heirs, executors, legal
representatives, successors and assigns, and all other parties hereafter having an interest in any
portion of the Property and all parties claiming by, through or under them, forever.
10. Each future owner or developer of all or any portion of the Property shall be
considered to be the person legally responsible for compliance with the Permit as to stormwater
pond #1. Delcarant is the person legally responsible for compliance with the Perimit as to
stormwater pond #2 and stormwater pond #3. Stormwater ponds #1, #2, and #3 and the
corresponding drainage zones are depicted on the Stormwater Management Plan attached hereto as
Exhibit B.
11. In the event of any litigation arising from or concerning this Declaration, the
prevailing party shall have the right to recover reasonable attorneys' fees, costs and expenses as
awarded by a court of competent jurisdiction, whether such attorneys' fees, costs and expenses
were incurred before, during or after trial, or upon any appellate level, or in any administrative
proceeding, arbitration, mediation, or any proceeding in bankruptcy or insolvency.
SIGNATURE IS ON THE FOLLOWING PAGE.
Page 3 of 6
ORLDOCS 11592109 4
IN WITNESS WHEREOF, the Declarant has caused these covenants and restrictions to be
duly executed as of the day and year first above written.
KELLSWATER COMMONS II, LLC,
a North Carolina limited liability company
By: Crosland Kellswater II, LLC, a North Carolina
limited liability company, its Manager
By: Crosland, LLC, a North Carolina
liability c an::M
By 4.
ames E. Merrifield,
Vice President
SEAL-STAMP NORTH CAROLINA, `YYJ?r ,(e?, COUNTY.
I, the undersigned Notary Public of the County and State aforesaid, certify that
James E. Merrifield personally came before me this day and acknowledged that he
is the Vice President of Crosland, LLC, a North Carolina limited liability
company, the Manager of Crosland Kellswater, LLC, a North Carolina limited
liability company, the Manager of Kellswater Commons ii, LLC, a North Carolina
limited liability company, and that he, being authorized to do so, voluntarily
executed the foregoing on behalf of the said company. Witness my hand and
notarial stamp or seal, this 13 day of August, 2009.
Commission Expires:
T w iv L_ ? -l* "
Notary Public
Printed name:
FRANCES M. ClOM
NOTARY PUBLIC
IrSW County. North Car **
M Commltslon ExptrN "''??°
Page 4 of 6
ORLDOCS 11592109 4

Legal Description
20.139 acres, more or less, from Kellswater Commons II, LLC to Integra Springs, LLC
BEING all those lots or parcels of land situated in the City of Kannapolis, No. 4 Township,
Cabarrus County, North Carolina and more particularly described as Tracts E, F and G as shown
on that plat entitled "Major Subdivision Plat Of. Kellswater Commons Apartment Site" and
recorded in the Cabarrus County Registry at Map Book 57, Pages 88-89, to which reference is
hereby made for a more particular description.
AND BEING THE SAME REAL PROPERTY DESCRIBED BY METES AND BOUNDS AS
FOLLOWS:
BEGINNING at a set concrete monument which is located 586-14-39E 96.30 feet from an
existing #5 rebar located near the southern right-of-way margin of Rogers Lake Road Extension,
said set concrete monument also being located S13-00-34E 51.32 feet from a set #5 rebar in the
southern right-of-way margin of Rogers Lake Road Extension; thence from said set concrete
monument S86-14-39E a total distance of 1006.67 feet, passing a set concrete monument at
921.63 feet, to the centerline of an unnamed tributary; thence with the centerline of the unnamed
tributary the following courses and distances: 531-48-40E 38.11 feet; thence S04-32-41E 37.20
feet; thence 527-26-59E 101.68 feet; thence 511-44-04E 119.40 feet; thence S03-45-12-W 57.75
feet; thence S13-06-50E 54.83 feet; thence S06-28-59W 38.26 feet; thence S13-15-15E 23.97
feet; thence S13-15-15E 86.53 feet; thence S47-14-18W 22.11 feet; thence S38-19-37E 34.95
feet; thence S05-27-35E 58.02 feet; thence S19-24-15E 60.07 feet; thence S13-06-21W 66.79
feet; thence 521-17-15E 94.91 feet, to the centerline intersection with an unnamed creek; thence
with the centerline of the unnamed creek the following courses and distances, 572-14-39W
213.49 feet; thence S81-41-IOW 101.20 feet; thence 573-11-OOW 73.43 feet; thence N66-52-
38W 108.84 feet; thence leaving the centerline of the unnamed creek and running with the old
property line N66-52-38W 85.32 feet thence with the centerline of the unnamed creek the
following courses and distances, N25-44-OIE 12.61 feet; thence N49-37-28E 13.33 feet; thence
N43-25-14W 34.44 feet; thence N43-25-14W 16.98 feet; thence 583-29-02W 17.93 feet; thence
N50-27-35W 22.18 feet; thence N71-09-45W 55.38 feet; thence 570-29-05W 49.23 feet; thence
N64-25-34W 26.09 feet; thence N03-27-21W 12.92 feet; thence S76-03-05W 26.22 feet; thence
549-24-47W 4.56 feet; thence S49-24-47W 38.16 feet; thence S85-19-51W 29.66 feet; thence
S69-03-01 W 79.64 feet; thence leaving the centerline of the unnamed creek, a new line N14-13-
50W a total distance of 510.02 feet, crossing a set #5 rebar at 127.22 feet, to a set 45 rebar;
thence a new line 589-22-19W 348. 58 feet to a set #5 rebar; thence a new curve, arcing to the
left and having a chord bearing of N00-40-58W, a chord distance of 99.00 feet, and a radius of
89.00 feet, to a set #5 rebar; thence a new line N89-22-19E 260.45 feet to a set #5 rebar; thence a
new line N13-00-34W, 320.00 feet, to the POINT AND PLACE OF BEGINNING, containing
20.139 acres, more or less, according to an survey entitled "ALTA/ACSM LAND TITLE
SURVEY FOR: INTEGRA SPRINGS APARTMENT SITE", surveyed by N-Focus Land
Surveying, Inc., dated November 10, 2008, to which reference is hereby made for a more
complete description.
EXHIBIT B
Drainage Zones
[Attached.]
Page 6 of 6
ORLDOCS 11592109 4
EXHIBIT `B"

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OVERALL WTE PLAN "°- Uk"M -1 1
AND DRAMAGE ZOWA - of- N F® C U S
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`"'W""AN/0B"W"A" This map is not a certified survey and has not been
reviewed by a local government agency for
compliance with any applicable land and
development regulations.
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I.
1.
CURRENT PERMIT INFORMATION:
Stormwater Management Permit Number:,
2. Permit Holder's
3.
4.
1.
2.
3.
4.
5.
Signing official's Name:
?i??i???//LYrl
Mailing Address: _.4.2?"' do, City: G'J?f?Lt>7T?' State: Zip: 9900-.2
Phone: Qe Fax: -Ok vV,92,607
?O
NEW OWNER / PROJECT / ADDRESS INFORMATION:
This request is for: (please check all that apply)
a. Change in ownership of the property/company (Please complete Items #2,
#3, and #4 below)
b. Name change of project (Please complete Item #5 below)
C. Mailing address change. (Please complete Item #4 below)
?d. Other (please explain):4&,? SLV?7'!?? di ,3
New owner's name to be put on permit:
New owner's signing official's name and title:
Title:
New Mailing Address:
City: State: Zip:
Phone;,ow Fax:
New Project Name to be placed on permit:
Ownershlp/Name Change-022309 Page 1 of 3
A 1111111 Lliell;al;l i t e t
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 SUBMITTAL.
REQUIRED ITEMS:
1. 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 designer's certification, if required by the permit.
5. A signed Operation and Maintenance plan, If a system that requires maintenance will
change ownership.
6. Maintenance records.
CERTIFICATIONMUST BE COMPLETED AND SIGNED BY &M THE CURRENT PERMIT
HOLDER AND THE NEW APPLICANT IN THE CASE OF A CHANGE OF OWNERSHIP.
FOR NAME CHANGES, COMPLETE AND SIGN ONLY THE CURRENT PERMITTEE'S
CERTIFICATION.
Current Permittee's Certification:
I, lamei 4r. A e lot , attest that this application for a name/ownership
change has been reviewed an 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 in matlon and a chments re n cluded, this application package will be
f f I
returned as I pieta.
r
Signature: 11, k DDate:7/3Z62
New Applicant'o Certification: (Must be corlpialed for d transfers of ownership)
I, Ubvia( . /'7 , attest that this application for an ownership
change as been reviewed an 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 IncomDlete.
Signature: "i wo/ 4l"mf "Za-m y Date:
Mail the entire package to: NCDENR Division of Water Quality
Surface Water Protection Section - Stormwater
at the Appropriate Contact Address (see the following page)
ownership/Name Change-022309 Page 2 of 3
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
I.
1.
2.
3.
4.
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Stormwater Management Permit Number:
Permit Holder's Name: .0?
Signing official's Name: le:
Mailing Address: / (per?onl2gWiy respond rpermit) !%go
City: Zf 19 LmTT? State: 4?
Phone: C9W o%ti1 ? Fax: rdW "13-1 01y?
NEW OWNER / PROJECT / ADDRESS INFORMATION:
1. This request is for: (please check all that apply)
a. Change in ownership of the property/company (Please complete Items #2,
#3, and #4 below)
k -b. Name change of project (Please complete Item #5 below)
c. Mailing address change. (Please complete Item #4 below)
.? d. Other (please explain): ?it/LY ;,??L?/l7?°?i?l?? /s
2. New owner's name to be put on permit:
3. New owner's signing official's name and title: 2iQ 1.1-lb 45;:.?
Title:
4. New
5.
City: State:_ Zip:
Phone:-6t-99 Fax: "-tr
New Project Name to be placed on perm
44,
Ownership/Name Change-022309 Page 1 of 3
PERMIT 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 SUBMITTAL.
REQUIRED ITEMS:
1. 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 designer's certification, if required by the permit.
5. A signed Operation and Maintenance plan, if a system that requires maintenance will
change ownership.
6. Maintenance records.
CERTIFICATION MUAJ COMPLETED AND SIGNED BY BOTH THE CURRENT PERMIT
HOLDER AND THENEW APPLICANT IN THE CASE OF A CHANGE OF OWNERSHIP.
FOR NAME CHANGES, COMPLETE AND SIGN ONLY THE CURRENT PERMITTEE'S
CERTIFICATION.
Current Permittee's Certification:
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 anZfthments are T include thi application package will be
returned as incomplete. r
Signature:_____ ata, ^7/2, Dal
New Applicant's Certiflcati#n: (Moat be completed for all transfers of ownemtvp)
I,E. attest that this application for an 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 d attachments are not clue this applicatio package will be
returned as incomplete ?f
Signature: C? Date:
Mail the entire package to: NCDENR Division of Water Quality
Surface Water Protection Section - Stormwater
at the Appropriate Contact Address (see the following page)
OwnemhiptName Change-022309 Page 2 of 3
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Permit Number: DWQ EXP #08-1155v2
(to be provided by DWQ)
Drainage Area Number: X
Wet Detention Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
The wet detention basin system is defined as the wet detention basin,
pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
? does 0 does not incorporate a vegetated filter at the outlet.
This system (check one):
? does [-does not incorporate pretreatment other than a forebay.
Important maintenance procedures:
Immediately after the wet detention basin is established, the plants on the
vegetated shelf and perimeter of the basin should be watered twice weekly if
needed, until the plants become established (commonly six weeks).
No portion of the wet detention pond should be fertilized after the first initial
fertilization that is required to establish the plants on the vegetated shelf.
Stable groundcover should be maintained in the drainage area to reduce the
sediment load to the wet detention basin.
- If the basin must be drained for an emergency or to perform maintenance, the
flushing of sediment through the emergency drain should be minimized to the
maximum extent practical.
- Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month and
within 24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a
Coastal County). Records of operation and maintenance should be kept in a known set
location and must be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element: Potential problem: How I will rernediate the problem:
The entire BMP Trash/debris is resent. Remove the trash/debris.
The perimeter of the wet Areas of bare soil and/or Regrade the soil if necessary to
detention basin erosive gullies have formed. remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
Vegetation is too short or too Maintain vegetation at a height of
long. approximately six inches.
Form SW401-Wet Detention Basin O&M-Rev.4 Page I of 4
Permit Number: DWQ E%P 108-1155v2
(to be proved by DWQ)
Drainage Area Number:
BMP element: Potential problem: How I will remediate the problem:
The inlet device: pipe or The pipe is clogged. Unclog the pipe. Dispose of the
Swale sediment off-site.
The pipe is cracked or Replace the pipe.
otherwise damaged.
Erosion is occurring in the Regrade the swale if necessary to
swale. smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
The forebay Sediment has accumulated to Search for the source of the
a depth greater than the sediment and remedy the problem if
original design depth for possible. Remove the sediment and
sediment storage. dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Erosion has occurred. Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Weeds are present. Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf Best professional practices Prune according to best professional
show that pruning is needed practices
to maintain optimal plant
health.
Plants are dead, diseased or Determine the source of the
dying. problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Weeds are present. Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The main treatment area Sediment has accumulated to Search for the source of the
a depth greater than the sediment and remedy the problem if
original design sediment possible. Remove the sediment and
storage depth. dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Algal growth covers over Consult a professional to remove
50% of the area. and control the algal growth.
Cattails, phragmites or other Remove the plants by wiping them
invasive plants cover 50% of with pesticide (do not spray).
the basin surface.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 2 of 4
Permit Number: DWQ E%P 108-1155v2
(to be provided by DWQ)
Drainage Area Number:
BMP element: Potential problem: How I will remediate the problem:
The embankment Shrubs have started to grow Remove shrubs immediately.
on the embankment.
Evidence of muskrat or Use traps to remove muskrats and
beaver activity is present. consult a professional to remove
beavers.
A tree has started to grow on Consult a dam safety specialist to
the embankment. remove the tree.
An annual inspection by an Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. if applicable)
The outlet device Clogging has occurred. Clean out the outlet device. Dispose
of the sediment off-site.
The outlet device is damaged Repair or replace the outlet device.
The receiving water Erosion or other signs of Contact the local NC Division of
damage have occurred at the Water Quality Regional Office, or
outlet. the 401 Oversight Unit at 919-733-
1786.
The measuring device used to determine the sediment elevation shall be such
that it will give an accurate depth reading and not readily penetrate into
accumulated sediments.
When the permanent pool depth reads feet in the main pond, the
sediment shall be removed.
When the permanent pool depth reads feet in the forebay, the sediment
shall be removed.
BASIN DIAGRAM
(fill in the blanks)
Permanent Pool Elevation
Sediment Removal Pe nen Pool
-------------- -- Volume Sediment Removal Elevation Volume
otto ------------------------ ------
Bottom Elevatio -ft Min. ---------!!?------- ----
Sediment Bottom Elevation 1-ft r.
Storage Se imej
Storage
FOREBAY MAIN POND
Form SW401-Wet Detention Basin O&M-Rev.4 Page 3 of 4
Permit Number: DWQ E%P #08-1155v2
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
INTEGRA SPRINGS-AT- KELLSWATER BRIDGE
Project name:
BMP drainage area number: I
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
Aky'WW,0?B?a Notary Public for the State of
Florida , County of orange , do hereby certify that
David G. McDaniel personally appeared before me this
day of August , 2009 , and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
NOTARY PUBLIC-STATE OF FLORIDA
111cheie 141. Champion
i jiC0mmi81i0n#nfj692479
?, ,,,,•? 84res: AUG. 24, 2011
119ND p THRU ATL TIC aUti06Y8 CO., INC.
SEAL

My commission expires
Form SW401-Wet Detention Basin O&M-Rev.4
Page 4 of 4

Print name: INTEGRA SPRINGS, LLC
Title: N/A
Address: 1525 International Parkway, Suite.2001, Lake Mary, Fl. 32746
Integra Springs, LLC
1525 International Parkway
Suite 2001
Lake Mary, Florida 32746
407-833-3927
August 13, 2009
Mr. Joseph Gyamfi
NCDENR - Division of Water Quality
2321 Crabtree Boulevard
Suite 250
Raleigh, NC 27604
Re: State Stormwater Permit Name/Ownership Change Form
Dear Mr. Gyamfi,
Please accept this letter in lieu of items four (4) and six (6) on page 2 of 3 of the required items
checklist per the State Stormwater Permit Name/Ownership Change Form. The designer's
certification will be provided to NCDENR upon completion of SWM/BMP Pond # 1 as required per the
DWQ 401 Water Quality Certification. After completion of SWM/BMP Pond # 1 the maintenance
records will be kept in a log in a known set location as required per the Wet Detention Basin
Operation and Maintenance Agreement.
Sincerely,

David G. McDaniel
Managing Member