SW7060812_HISTORICAL FILE_20200224

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
DOC DATE�}a
YYYYMMDD

Thorpe, Roger
From: Thorpe, Roger
Sent: Monday, February 24, 2020 8:27 AM
To: Jason Schwartz
Subject: RE: [External] Stormwater Permit Renewal (no. SW7060312)
Jason
This is to let you know that there is another stormwater permit that also needs to be renewed. Permit SW7060812 for
ACADEMI — Dining Facility expires on September 20, 2020,
Thanks
Roger
From: Jason Schwartz<[e-mail]>
Sent: Friday, January 10, 2020 6:10 PM
To: Thorpe, Roger <[e-mail]>
Cc: Lucas, Annette <[e-mail]>; Katherine McKenzie -Veal <[e-mail]>; Gearoid
Moore <[e-mail]>
Subject: [External) Stormwater Permit Renewal (no. SW7060312)
Hi Roger,
I understand that you have been working with Kate McKenzie -Veal of ACADEMI (copied here) to grant extensions for the
deadline to submit the permit renewal application related to state stormwater permit number SW7060312, and she
asked me to connect with you in connection with a request to further extend the application deadline. The permit was
recently placed in the name of Stonebriar Commercial Finance LLC, which is a commercial finance company that leases
back the property to the prior permit holder but otherwise has no involvement in the operation of the project or the
performance of the tasks set forth in the renewal application. To that end, no employee of Stonebriar is able to deliver
the certification requested in Section D. of the application.
With that in mind, I've been working with Annette Lucas of your agency (also copied here) to identify the appropriate
way to deliver the renewal application - e.g., possibly authorizing us to grant authority to the appropriate officer of our
lessee (the actual operator of the project) to sign the certification on our behalf or to otherwise deliver the required
certification. I know that Annette is diligently tracking down the answer to this question, but understand that there is
not yet a clear solution.
I hope this context helps support one more extension to the renewal application deadline and look forward to ensuring
the application is submitted soon. Please let me know if I can provide any additional details or help in any other way.
Thank you — have a nice weekend,
-Jason
Jason Schwartz
Vice President & Assistant General Counsel
3bmEMkrrC=mvetdefl Ramal�
Granite Park Three

5601 Granite Parkway, Suite 1350
Piano. TX 75024
D: 469.609.8518
SUNEBR

R/z Ao
Ploy COOPER
Governor
MICHAEL S_ REGAN
secretary
S. DANIEL SMITH
Inrerim Director
NORTH CAROLINA
Environmental Qualify
May 8, 2019
ACADEMI Real Estate Holdings, LLC
ACADEMI, LLC, Manager
Attention: Ms. Katherine F. McKenzie -Veal
850 Puddin Ridge Road
Moyock, NC 27958-8679
Subject: Stormwater Permit No. SW7060812 Name Change
Academi — Dining Facility
High Density Stormwater Project
Camden County
Dear Ms. McKenzie -Veal. -
The Washington Regional Office received a Stormwater Management Permit
Application for name change for the subject project on March 27, 2019. Staff review of
the application has determined that the permit can be reissued. We are forwarding
Permit No. SW7060812 dated May 8, 2019, for the continued operation of the subject
project.
This permit, upon its effective date, will replace all previous State Stormw_ater permits for
this project. This permit shall be effective from the date of issuance until September 20,
2020 and shall be subject to the conditions and limitations as specified therein, and does
not supersede any other agency permit that may be required. Please pay special attention
to the Operation and Maintenance requirements in this permit. Failure to establish an
adequate system for operation and maintenance of the stormwater management system
will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you
have the right to request an adjudicatory hearing upon written request within thirty (30)
days following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150E of the North Carolina General Statutes, and filed with the
Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714.
Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please
contact me at [phone].
Sincerely,
Roger K. Thorpe
Environmental Engineer
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
e:��D_EQ> Washington Regional Ofrice 1443 Washinglor Square Mall I Washington, North Carolina 27889
.wxn+cnrmx:run
252 946.6481

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
ACADEMI Real Estate Holdings, L.L.C.
ACADEMI — Dining Facility located at 850 Puddin Ridge Road, Moyock, NC
Camden County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with the
provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and
the approved stormwater management plans and specifications and other supporting
data as attached and on file with and approved by the Division of Energy, Mineral, and
Land Resources (Division) and considered a part of this permit.
This permit shall be effective from the date of issuance until September 20, 2020, and
shall be subject to the following specified conditions and limitations:
1. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.6 of this permit. The stormwater control has
been designed to handle the runoff from 5.55 acres of impervious area over the
8.30 acres of drainage area for this project.
3. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.

1.
J
4. The runoff from all built -upon area within the permitted drainage area of this project
must be directed into the permitted stormwater control system per approved plans.
5. Plans for the future 3.30 acres of impervious area on this site must be submitted to
the. Division and approved prior to the construction
of the additional impervious area.
6. The following design criteria have been provided
in the wet detention pond and must
be maintained at design condition:
a. Drainage Area, acres:
8.30
b. Total impervious Surfaces, acres:
5.55 (including 3.30ac. future)
C. Design Storm, inches:
1.0
d. Pond Depth, feet:
5.00
e. TSS removal efficiency:
90%
f. Permanent Pool Elevation, FMSL:
9.50
g. Permanent Pool Surface Area, ft2.
17,838
h. Permanent Storage Volume, ft3:
46,154
i. Permitted Forebay Volume, ft3:
9,110
i. Temporary Storage Elevation, FMSL:
10.55
j. Temporary Storage Volume, ft3:
52,349
k. Controlling Orifice:
3.0° � pipe
I. Receiving Stream/River Basin:
Tull Creek 1 Pasquotank
M. Stream Index Number:
30-1-2-2-5-1-1
n. Classification of Water Body:
"B; Sw"
Il. SCHEDULE OF COMPLIANCE
1: The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.

3. The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must be followed in its
entirety and maintenance must occur at the scheduled intervals including, but not
limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris.removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of Division. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the .Certification. A
modification may be required for those deviations.
7. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
8. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
9. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.

d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on. the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
12. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
Ill. GENERAL. CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a formal permit transfer request to the Division, accompanied by a
completed name/ownership change form, documentation from the parties
involved, and other supporting materials as may be appropriate. The approval of
this request will be considered on its merits and may or may not be approved.
The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division, in accordance with
North Carolina General Statute 143-215.6A to 143-215.6C.
3. The issuance of this permit does not preclude the permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
4. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.

5. The permittee grants DEQ Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
6. The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
7. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The permittee shall notify the Division of any name, ownership or mailing
address changes within 30 days.
10. This permit shall be effective from the date of issuance until September 20,
2020, Application for permit renewal shall be submitted 180 days prior to the
expiration date of this permit and must be accompanied by the processing fee.
Permit issued this the 8th day of May, 2019.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
S. Daniel Smith, Interim Director
Division of Energy, Mineral, and Land Resources
By Authority of the Environmental Management Commission
Permit No. SW7060812

ACADEMI — Dining Facility
Stormwater Permit No, SW7060812
Camden County
Designer's Certification
I, , as a duly registered
in the State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
SEAL
Signature
Registration Number
Date

In
Certification Requirements:
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 11.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.

Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P,E, Director
Division of Water Quality
September 20, 2006
Mr. Gary Jackson, President
E & J Holding, LLC
PO Box 1029
Moyock, INC 27958
Subject: Stormwater Permit No. SW7060812
Blackwater USA — Dining Facility
High Density Project
Camden County
Dear Mr. Jackson:
The Washington Regional Office received a complete Stormwater Management Permit
Application for Blackwater USA — Dining Facility on September 13, 2006. Staff review
of the plans and specifications has determined that the project, as proposed, will comply
with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000. We are
forwarding Permit No. SW7060812 dated September 20, 2006, for the construction of
the subject project.
This permit shall be effective from the date of issuance until September 20, 2016, and
shall be subject to the conditions and limitations as specified therein. Please pay
special attention to the Operation and Maintenance requirements in this permit. Failure
to establish an adequate system for operation and maintenance of the stormwater
management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you
have the right to request an adjudicatory hearing upon written request within thirty (30)
days following receipt of this permit. This request must be in the form of a written
petition, conforming to Chapter 150B of the North Carolina General Statutes, and filed
with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-
7447. Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please
contact Scott Vinson, or me at [phone].
Sincerely,
Al Hodge
Regional Supervisor
Surface Water Protection Section
AHlsav: C:ISTORMWATERIPERMIT1SW7060812
cc: Jonathan Allen, PE = ARCADIS
Camden County Building Inspections
Washington Regional Office
Central Files
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North Carolina Division of Water Quality Washington Regional Office Phone [phone] FAX [phone] Customer Service
Internet: www,ncwaterquality,om 943 Washington Square Mall, Washington, NC 27889 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper

State Stormwater Management Systems
Permit No. SW7060812
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
E & J Holding, LLC
Blackwater USA — Dining Facility
Camden County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with the
provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and
the approved stormwater management plans and specifications and other supporting
data as attached and on file with and approved by the Division of Water Quality and
considered a part of this permit.
This permit shall be effective from the date of issuance until September 20, 2016, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.6 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from 5.55 acres of impervious
area over the 8.30 acres of drainage area for this project.
3. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
4. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system per
approved plans.
5. Plans for the future 3.30 acres of impervious area on this site must be submitted
to the Division and approved prior to the construction of the additional impervious
area.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7060812
6. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a.
Drainage Area, acres:
8.30
b.
Total Impervious Surfaces, acres:
5.55 (including 3.30ac. future)
C.
Design Storm, inches:
1.0
d.
Pond Depth, feet:
5.00
e.
TSS removal efficiency:
90%
f.
Permanent Pool Elevation, FMSL:
9.50
g.
Permanent Pool Surface Area, ftz:
17,838
h.
Permanent Storage Volume, ft3:
46,154
i.
Permitted Forebay Volume, ft3:
9,110
i.
Temporary Storage Elevation, FMSL:
10.55
j.
Temporary Storage Volume, ft3:
52,349
k.
Controlling Orifice:
3.0" � pipe
I.
Receiving Stream/River Basin:
Tull Creek 1 Pasquotank
M.
Stream Index Number:
30-1-2-2-5-1-1
n.
Classification of Water Body:
"B; Sw"
11. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation, and Maintenance Plan must be followed in its
entirety and maintenance must occur at the scheduled intervals including, but not
limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowin.9 and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW7060812
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
7. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
8. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
9. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Ma'or permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
12. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
13. This permit shall be effective from the date of issuance until September 20,
2016. Application for permit renewal shall be submitted 180 days prior to the
expiration date of this permit and must be accompanied by the processing fee.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7060812
III. GENERAL CONDITIONS
1. This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a formal permit transfer request to the Division of Water Quality,
accompanied by a completed name/ownership change form, documentation from
the parties involved, and other supporting materials as may be appropriate. The
approval of this request will be considered on its merits and may or may not be
approved. The permittee is responsible for compliance with all permit conditions
until such time as the Division approves the transfer request.
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
3. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
4. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
5. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
6. The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
7. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The permittee shall notify the Division of any name, ownership or mailing
address.changes within 30 days.
Permit issued this the 20t" day of September, 2006.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5of7

State Stormwater Management Systems
Permit No, SW7060812
Blackwater USA — Diningg Facility
Stormwater Permit No. SW7060812
Camden County
Designer's Certification
I, , as a duly registered
in the State of North Carolina, having been authorized to observe (periodically/ weekly/
.full time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Management Systems
Permit No. SW706Q812
Certification Requirements:
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved -plans.
cc: NCDENR-DWQ Regional Office
Camden County Building Inspections
Page 7 of 7

p�pF WArF,9QG Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Q Alan W. Klimek, P.E. Director
Division of Water Quality
September 6, 2006
Mr. Gary Jackson, President
E & J Holding, LLC
PO Box 1029
Moyock, NC 27958
Subject: Stormwater Review SW7060812
Blackwater USA — Dining Facility
Camden County
Dear Mr. Jackson:
This office received a Coastal Stormwater permit application and plans for the subject project on
August 18, 2006. A preliminary review of the project indicates that before a State Stormwater permit can
be issued the following additional information is needed.
➢ Please provide a vicinity map with the project site shown.
➢ Please provide a cross sectional detail of the swales.
➢ Please provide a temporary and permanent seeding schedule for proposed vegetated areas.
➢ Please provide energy dissipaters (including cross sectional details) at the pipe and Swale outlets
that lead into the pond forebays.
Please verify that the temporary pool elevation for this wet pond will be 10.55 ftnsl and not 10.25
fmsl as noted on the Wet Detention Basin Supplement form.
The above requested information must be received in this office prior to September 14, 2006 or
your application will be returned as incomplete. The return of this project will necessitate resubtnittal of
all required items including the application fee. If you need. additional time to submit the required
information, please mail or fax your request for time extension to this office at the Letterhead
address.
You should also be aware that the Stormwater Rules require that the permit be issued prior to any
development activity. Construction without a permit is a violation of 15A NCAC 2H.1000 and North
Carolina General Statute 143-215.1 and may result in civil penalties of up to $10,000 per day.
Please reference the Stormwater Project Number above on all correspondence. If you have
questions, please feel free to contact me at [phone].
S' cerely,
Scott Vinson
Environmental Engineer
Washington Regional Office
cc: Jonathan Allen, PE ARCADIS
V41ashington Regional Office o°`
NCaro
-lVatuml
North Carolina Division of Water Quality Washington Regional Office Phone [phone] FAX [phone] Customer Service
Internet: h2o.enr.state.nc.us 943 Washington Square Mall, Washington, NC 27989 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper

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NCDENR
North Carolina Department of Environment and Natural Resources
943 Washington Square Mall, Washington NC 27889 [phone] FAX [phone]
Request for Express Permit Review AUG 1 ` 2006
FILL-IN all information below and CHECK required Permit(s).
Please include this with the application package upon submittal. Project application received -after 12 noon.will be
stamped in the following workday. Thank youl Lyn Hardison lvn.hardison(a7ncmail.net
APPLICANT Name-TouY V&ZNcni
Company E'- 3 Ko+..0(u -S
P.O. 13ax 102
Phone_(_Z5L.) 435-2jS6 F
City/State Ma'(OCK— , A} C_ Zip 2 715'a
2,!�Z) w35- 63 bai Frnail --b,0WJ0 9L-4UcLJATP,204A .ca
PROJECT Name U LACV-U) --r&tZ - D%hi+u 6 rAc-t t_j L Y----..,, County
PROJECT LOCATION (ADDRESS) 85'0 _ NDD(10 'P_I0GE- P.oh0
ENGINEER/CONSULTANT _ _ -56�jAT,4 tn1 ALi-LA1
Company AkcA s
Address 8c,1 GaeP. ceuTee Dk- 5ui� 3ooCitylState elf wt, A1C— Zip 276 a']
Phone (glci) 6S I -t 2.6 Z Fax 691q) 8S4 -S'q qf� - -- Email _ ,4cL& /u a h2cADi5 -us. �o Ai -
State or National Environmental Policy Act (SEPA, NEPA) — EA or EIS Required ❑Yes ❑ No
❑ STREAM ORIGIN Determination; # of Stream calls; Stream Name
------- ------------------------------------------------------------------------------_-------------------- -----------------------------------------------
�TORMWATER ❑ Low Density [ �Igh Density -Detention Pond ❑ Nigh Density -Other
❑ Low Density -Curb & Gutter ❑ High Density -Infiltration ❑ Off Site
PROJECT SYSTEM(S) TRIBUNARY TO i u� ce iz, STREAM NAME r,4-SQu0TAN+c_RIVER BASIN
❑ COASTAL ❑ Excavation .& Fill ❑ Bridges & Culverts ❑ Structures Information
MANAGEMENT ❑ Upland Development ❑ Marina Development ❑ Urban Waterfront
❑ LAND QUALITY ❑ Erosion and Sedimentation Control Plan with acres to be disturbed. CK #
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------
❑ WETLANDS (401) ❑ No Wetlands on Site (letter from COE) ❑Wetlands Delineated/No JD
❑ Greater than 0.1 AC Wetlands Impacted ❑Jurisdictional Determination has been done
❑ Less than 0.1 AC Wetlands Impacted ❑Greater than 0.5 AC Wetlands Impacted
CIRCLE YIN: 401 Application ❑Yes ❑ No 404 Application in Process w/USCOE Des ❑ No
The legislation allows additional fees, not to exceed 50% of the original Express Review permit application
fee, to be charged for subsequent reviews due to the insufficiency of the permit applications.
CHECK # I D�5 5 For DENR use only
SUBMITTAL DATES: Fee Split for multiple permits:
SW_�� c� $ t
CAMA $
LQS $
401 $
Total Fee Amount $ a�
:'I

REGM EID
14, ARCADIS
Infrastructure, environment, buildings
TRANSMITTAL LETTER
To:
Scott Vinson
NCDENR — Div. of Water Quality
943 Washington Square Mall
Washington, NC 27889
Phone No.: [phone]
From:
Jonathan Allen
Subject:
Blackwater USA — Warehouse
We are sending you:
® Attached
❑ Shop Drawings
❑ Prints
❑ Other:
AUG 18 2006
DWQ-WARQ
Copies:
Jim Dehart
850 Puddin Ridge Road
Moyock, NC 27958
Date
11 August 2006
ARCADIS Project No.:
NC406018.0000.00007
❑ Under Separate Cover Via the Following Items:
❑ Plans ❑ Specifications
❑ Samples ❑ Copy of Letter
ARCADIS G&M of
North Carolina, Inc.
801 Corporate Center Drive
Suite 300
Raleigh,
North Carolina 27607.6073
Tel [phone]
Fax [phone]
LAND RE5QURCES
❑ Change Order
❑ Reports
Copies
Date
Drawing No.
Rev.
Description
Action*
2
C1.03,C1.04
Warehouse — Site Drawings
2
Stormwater Management Permit Application Form (Original + 1
copy)
1
Wet Detention Basin Supplement (Original)
1
Request for Express Permit Review form
1
$4,000.00 Application Fee
l
Stormwater Narrative with supplemental information
l
Overall Blackwater Property Layout
Action*
❑ A Approved
❑ AN Approved As Noted
❑ AS As Requested
❑ Other:
Mailing Method
❑ U.S. Postal Service,ls` Class
❑ CertifiedlReg6fiii'ed'Mail
#fir. •.
El Other:
❑ CR Correct and Resubmit
❑ F File
❑ FA For Approval
❑ Courier/Hand Delivery ® FedEx Priority Overnight
❑ United Parcel Service (UPS) ❑ FedEx Standard Overnight
❑ Resubmit Copies
❑ Return Copies
❑ Review and Comment
❑ FedEx 2-Day Delivery
❑ FedEx Economy
comments: _Scott, Please accept this package for Stormwater Express Permit review for the Dining Facility at the Blackwater
site. Per Lyn's request last week, I have also included with this package an overall'Blackwater Property layout. Please let me
know if you have any questions. 'Thanks, Jonathan
gN ' VAW 16VMwnol ham l l aup06.du
Page:
1/1

1i : A
OFFICE USE ONLY
Date Received
Fee Paid
Perna u rb 26
rr � State of North Carolina
SL ACK %/S�0(,
Department of Environment and Natural Resources.
AUG 18 2006
Division of Water Quality
'
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
DWYANAR0 This form may be photocopied for use as an original
GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
E� � T—.--4oL v11q4_. L-LC.
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
C?, RY .11hS.KSi21�i 09--C-dJ E1117'
3. Mailing Address for person listed in item 2 above:
PD. t3esr 11)2$
City: M- 0Y CeK stare: NC, zip: t-7 $
Telephone Number: LZs2�.5_Z.+Jf1
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, le(ters, operation and maintenance agreements, etc.):
Bbkk-wh-TE - bi Ki 1 iu 6 Fq4-,tu-rY
5. Location of Project (street address):
SS-0 N>DW X)yt,E ,soap
City: JA6YOr County:_(!' g_pe7j
B. Directions to project (from nearest major intersection):
��_. _ G, ►�W1Y. __ l G.f�,_� Q__Soul �v�SI" .__�(_P u.t2Q1 .._ J 104 O PLoAP, • Tl l-�'�(I¢?G+ i�
Bu4ut. l id Acr aO oK Pi4ppi Kjor-a RyAD.
7. Latitude: 36 ° U& t 30" Longitude: 7L ° 1I S lief of project
8. Contact person who can answer questions about the project:
Name: IpNY as1 Telephone Number: �2$2� �3S oozo
II. PERMIT INFORMATION: /
1. Specify whether project is (check one): ✓ New Renewal Modification
Form SWU-101 Version 3.99 Page 1 of

'VIT 1 '.1,

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number_ __ 14-JA and its issue date (if known)
3. Specify the type of project (c ck one):
Low Density High Density Redevelop Ceneral Permit Other
4. Additional Project Requirements (check applicable blanks):
_CAMA Major ✓Sedimentation/Erosion Control _404/401 Permit _NPDES Storrnwater
(I1PFfuvC15)
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748.
III. PROJECT INFORMATION
I. 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 .
2. Stormwater runoff from this project drains to the ?"Q LW VA _ River basin.
3. Total Project Area: 9.30 acres 4. Project Built Upon Area: _. 6a % %
5. Flow many drainage areas does the project have? I
6. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as belo��� .
( D1 t4 oq c. F>1c� w ry) � C-Ugka7 it N-r UAe Dtu'
C.uRzeAT DevewmeAr 61MAL, W/a0e"T
Basin Information
Drainage Area 1
Drainage Area 2
Receiving Strearn Name
-rL4" C41ea4-
-ruw C&grK
Receiving Stream Class
Drainage Area
3'
30
Existing Impervious* Area
O
0
Proposed Impervious*Area
2. S
J5.5
% Impervious* Area (total)
S7. $
(8; °7o
Impervious*'SurfaceArea''
D`r`ainage'Aiea h
Drainage Area 2
On -site Buildings
On -site Streets
On -site Parking
On-sitc Sidewalks
O.Og
0. r6
Other on -site
p, p�
.a
e �� &I'D-OI4r
--
3. 3 0
Total:
Impervious area is defined as the built upon area includin,
sidewalks, gravel areas, etc.
Form SWU-101 Version 3.99
Page 2
parking areas,
'va-

LL\,
7. I -low was the off -site impervious area listed above derived? ApclrA—pRl�t��q
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
The following italicized deed restrictions and protective covenants are required to be recorded for all
subdivisions, outparcels and future development prior to the sale of any lot. if lot sizes vary significantly, a table
listing each lot number, size and the allowable built -upon area for each lot must be provided as an attachment.
1. Tire following covenants are intended to ensure ongoing compliance with state stormwater management permit number
as issued by the Division of Water Quality. These covenants may not be
changed or, deleted without tire consent of tire. State..
2. No more than square feet of any lot shall be covered by structures or impervious materials.
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.
3. Swales shall not be filled in, piped, or altered except as necessary to provide driveway crossings.
4. Built -upon area in excess of the Permit red amount requires a state stormwater management permit modification prior to
corutruction.
5. All permitted runoff from outparcels or future development shall be directed into the permitted stormwater control
systern. These connections to the stormwater control system shall be performed in a manner that maintains the integrity
and performance, of the system as permitted.
By your signature below, you certify that the recorded deed restrictions and protective covenants for this project
shall include all the applicable items required above, 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 State, and that they will be recorded prior to the sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each
BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the status
and availability of these forms.
Form SWU-102
Wet Detention Basin Supplement
Form SWU-103
Infiltration Basin Supplement
Form SWU-104
Low Density Supplement
Form SWU-105
Curb Outlet System Supplement
Forth SWU-106
Off -Site System Supplement
Form SWU-107
Underground Infiltration Trench Supplement
Form SWU-108
Neuse River Basin Supplement
Form SWU-109
Innovative Best Management Practice Supplement
Form SWU-101 Version 3.99
Page 3 of 4

VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. The complete application package should be
submitted to the appropriate DWQ Regional Office.
Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• Original and one copy of the Stormwater Management Permit Application Form 01,
• One copy of the applicable Supplement Form(s) for each BMP
• Permit application processing fee of S,420'1'payable to NCDENR) $4,00-u
• Detailed narrative description of stormwater treatment/management
• Two copies of plans and specifications, including:
Development/Project name
Engineer and firm
-Legend
North arrow
Scale
Revision number & date
Mean high water line
Dimensioned property/project boundary
Location map with named streets or NCSR numbers
Original contours, proposed contours, spot elevations, finished floor elevations
Details of roads, drainage features, collection systems, and stormwater control measures
Wetlands delineated, or a note on plans that none exist
Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
Drainage areas delineated
Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section.
Designated agent (individual or firm): ARICAR IS
Mailing Address: 601 Coaepk= cdrArim A wC— , ITr5 3m
City:
Phone:
VIII. APPLICANT'S CERTIFICATION
State: N c- Zip: 2-hpa7
Fax: ],I e6 — S
1, (print or type name of person listed in General Information, item 2) _ G AXy
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 15A
NCAC 2H .1000ri J/I
Signa
Fonn SWU-101 Version 3,99 Page 4 of 4

Permit No. 15�1 7J6 Dnz
(10 be provided btu DPYQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM AUG I LI 20C, 7
WET DETENTION BASIN SUPPLEMENT
This form may be photocopied for use as arr original
DWQ Stormwater Management Plan Review:
A complete stormwater management plan subtmittai includes an application form, a wet detention basin
supplement for each basin, design calculations, and plans and specifications showing all basin and outiet
structure details.
1. PROJECT INFORMATION
Project Name: _91-AC C WAI-159 — PJAf IN G
Contact Person: f-64Y inzat'Al Phone Number: 252 3 - o02q
For projects with multiple basins, specify which basin this worksheet applies to:
elevations
Basin Bottom Elevation 4. S6 ft. (floor of the basin)
Permanent Pool Elevation q._5D ft. (elevation of the orifice)
Temporary Pool Elevation �0$S' f . (elevation of the discharge structure oveifloiv)
areas
Permanent Pool Surface Area i i sq. ft
Drainage Area $. �t7 ac.
Impervious Area t.4 ac.
volumes
Permanent Pool Volume 4 4., 1 s-74 Cu. ft
Temporary Pool Volume g2,,344 cu. ft
Forebay Volume
Other parameters
SA/DA t
Diameter of Orifice
Design Rainfall
Design TSS Removal 2
91 l 0 cu. ft
(watersuyface area al the orifice elevation)
(on -site and off -site drainage to the basin)
(on -sire and off -site drainage to the basin)
(combined volume of maim basin and forebay)
(volume detained above the permanent pool)
(approximately 20% of total volume)
(surface area to drainage area ratio fi-om D PVQ table)
(2 to 5 day temporary pool draw -down required)
(minimum 85% required)
Form SWU-102 Rev 3.99 Page l of 4

Footnotes:
L When using the Division SAIDA tables, the correct SA/DA ratio for permanent pool sizing should be computed based upon the
actual impervious % and permanent pool depth. Linear interpolation should be employed to determine the correct value for non-
standard table entries.
2 In the 20 coastal counties, the requirement for a vegetative filter may be waived if the wet detention basin is designed to provide
90% TSS removal. The NCDENR 13MP manual provides design tables for both 85% TSS removal and 90% TSS removal.
II. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stornwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Permit
Application Form, the agent may initial below. if a requirement has not been met, attach justification.
Applicants Initials
a. The permanent pool depth is between 3 and 6 feet (required minimum of 3 feet).
b. The forebay volume is approximately equal to 20% of the basin volume.
c. The temporary pool controls runoff from the design storm event.
d. The temporary pool draws down in 2 to 5 days.
— A #/A e. If required, a 30-foot vegetative filter is provided at the outlet (include non -erosive flow
calculations)
f. The basin length to width ratio is greater than 3:1. (ApPox. Z$J)
g. The basin side slopes above the permanent pool are no steeper than 3:1.
h. A submerged and vegetated perimeter shelf with a slope of 6:1 or less (show detail).
i. Vegetative cover above the permanent pool elevation is specified.
j. A trash rack or similar device is provided for both the overflow and orifice.
k. A recorded drainage easement is provided for each basin including access to nearest right-
of-way.
1. I f the basin is used for sediment and erosion control during constriction, clean out of the
basin is specified prior to use as a wet detention basin.
m. A mechanism is specified which will drain the basin for maintenance or an emergency.
III. WET DETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
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) 0 does Xdoesnot incorporate a vegetated filter at the outlet.
This system (check one) 0 does Xdoesnot incorporate pretreatment other than a forebay.
Form SWU-102 Rev 3.99 Page 2 of 4

Maintenance activities shall be performed as follows:
I . After every significant runoff producing rainfall event and at least monthly:
a. Inspect the wet detention basin system for sediment accumulation, erosion, trash accumulation,
vegetated cover, and general condition.
b. Check and clear the orifice of any obstructions such that drawdown of the temporary pool occurs within
2 to 5 days as designed.
2. Repair eroded areas immediately, re -seed as necessary to maintain good vegetative cover, snow vegetative
cover to maintain a maximum height of six inches, and remove trash as needed.
3. Inspect and repair the collection system (i.e. catch basins, piping, swales, riprap, etc.) quarterly to maintain
proper functioning.
4. Remove accumulated sediment from the wet detention basin system semi-annually or when depth is
reduced to 75% of the original design depth (see diagram below). Removed sediment shall be disposed of
in an appropriate manner and shall be handled in a manner that will not adversely impact water quality (Le.
stockpiling near a wet detention basin or stream, etc.).
The measuring device used to detenninc the sediment elevation shall be such that it will give an accurate
depth reading and not readily penetrate into accumulated sediments.
_� A '
When the permanent pool depth reads �� feet in the main pond, the sediment shall be removed.
When the permanent pool depth reads 3, 75 feet in the forcbay, the sediment shall be removed.
Sediment Re'
oval El. 5.75 175'
-------------- -
Bottom Ele ation
FOREBAY
BASIN DIAGRAM
(fill in the blanks)
Permanent Pool Elevation I -SO
-------------------------
Sediment Removal Elevation S 75
Bottom Elevation ¢,5o
MAIN 1'OND
75%
25°/o
5. Remove cattails and other indigenous wetland plants when they cover 50% of the basin surface. These
plants shall be encouraged to grow along the vegetated shelf and forebay berm.
6. If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through
the emergency drain shall be minimized to the maximum extent practical.
Form SWU-102 Rev 3.99 Page 3 ot-4

7. All components of the wet detention basin system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the seven
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.
Print name: GARN C- AAC K5o
Title:
Address: $So pupp iN zijo(5;1� xoAp, Mokloci<,kl (� ___ B's 6
Phone: 43�-- 249-
Signature:
Date: 4
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.
a Notary Public for the State of ,
County of C 3 w N-J do hereby certify that - i'.3 A-e k S o
personally appeared before me this 16T'+ day of )rV ^�� , J&04 , and acknowledge the due
execution of the forgoing wet detention basin maintenance requirements. Witness my hand and official seal,
SEAL
My commission expires � --e (� k aejo
Form S WU- 102 Rev 3.99 Page 4 of 4

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION
5V
Yr? r-� G� 17. 0 D
W P
RECEIVED MAR 2 7 2019
1. Stormwater Management Permit Number: SW7060812
2. Project Name: Blackwater USA - DINING FACILITY
3. Current Permit Holder's Company Name/Organization:
4. Signing Official's Name: ACADEMI LLC
5. Mailing Address: 850
City: Moyock
Puddin Ridge Road
6. Phone: ( 252 ) 435-2488
E&J Holdings, L.L_C.
Title: Manager
State: NC Zip: 27958-8679
Fax: ()
II. PROPOSED PERMITTEE 1 OWNER 1 PROJECT 1 ADDRESS INFORMATION
This request is for: (please check all that apply)
0 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)
❑ Mailing address / phone number change. (Please complete Item 4 below)
❑ Other (please explain):
1. Proposed permittee's company name/organization: ACADEMI Real Estate Holdings, L.L.C.
2. Proposed permittee's signing official's name: ACADEMI LLC
3. Proposed permittee's title: Manager
4. Mailing Address:
City:
Phone:(_)
5. New Project Name to be placed on permit:
State: Zip:
Fax: ( }
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)
The property owner
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
❑ Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner Information on page 4)
SSW N/O Change Rev24Sept2012 Page 1 of 4

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, i n45 , 1- L . , the current
permittee, hereby notify the DWQ that I am changing my Harrie 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
ownership of the permit.
I, , the current permittee, am submitting this application
for a transfer of ownership for permit # . 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 ll 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.
t- rqSignature.AcAt- V;P.�e'-� -ST- 56C. Date: 3- 00
,p(-Mt LL4 naQ
1, AmAOyik 9. �Mi---:\l , a Notary Public for the State of
County of C4WDE lJ , do hereby certify that
*r personally appeared before me this the
day of C , 20A9., and acknowledge the due execution of the
forgoing instrument. Wit ess my hand and official seal, R"ti•,,�� (Notary Seal)
Nota Signature pIARY -
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SSW N/O Change Rev24Sept2012 Page 2 of a,9•.
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V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed Permittee for all transfers of ownership)
I, , 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)
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
F] the approved operation and maintenance agreement
❑past 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 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.
Signature:
County of
Date:
a Notary Public for the State 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
Additional copies of the original permit and the approved Operation and Maintenance agreement can
be obtained from the appropriate Regional Office of the Division of Water Quality.
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.
SSW N/O Change Rev24Sept2012 Page 3 of 4

VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections 11 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:
Mailing Address:
City:
Phone:
Email:
State:
(if different from street address)
State:
Fax:
9*3
Zip:
I certify that 1 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
I
, County of
Date:
a Notary Public for the State 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
SSW N/O Change Rev24Sept2012 Page 4 of 4