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Home My WebLink AboutSW6130703_Renewal Application_20210818DEMLR USE ONLY D to Re eived Fee Paid Permit Number NC DEQ Division of Energy, Mineral and Land Resources STATE • PERMIT RE • •' DL-'Q-FAY1:1TEV1I_LE IZE� iOi�IAL01=FiC� In accordance with 15A NCAC 2H.1045(3), the current permit holder shall renew their high density permit 180 days prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011-398 (SB 781) Section 60. (c). This application form is for permit renewals only. A. PROJECT INFORMATION 1. State Stormwater Permit Number: SW6130703 2. Project name: Peartree West Subdivision (Formerly Camden Glen Subdivision) 3. Project street address: Off Camden Road City: Fayetteville County: NC ZIP: 28306 4. What, if any, changes have been made to the project as permitted? None If the project has changed from the original approved plans, please complete SWU-101 for a Major Modification or Minor Modification Application form available at. https:Hdeg.nc.gov/about/divisions/energy- mineral-land-resources/energy-mineral-land-rules/stormwater-program/post-construction. If changes to the permittee or project name have been made, please complete either the Permit Update form or the Permit Transfer form available at: https://deg.nc.gov/about/divisions/energy-mineral-land- resources/energy-mineral-land-rules/stormwater-program/post-construction. State Stormwater Permits do not automatically transfer with the sale of the property. 1. Current Permit Holder's Company Name/Organization: Camden Glen Development, LLC 2. Signing Official's Name: Harold Kidd 3. Signing Official's Title: Member 4. Mailing Address: 6885 Cliffdale Road City: Fayetteville State: NC ZIP: 28314 5. Street Address: 6885 Cliffdale Road City: 28314 6. Phone: (910) 864-9727 Email: hkiddl947(ogmail.com State: NC ZIP: Stormwater Permit Renewal Form Page 1 of 3 May 11, 2018 C. SUBMITTAL REQUIREMENTS Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORM. Only applications packages that include all required items listed below will be accepted and reviewed. Initial each item below to indicate that the required information is provided in the application package: X 1. A permit application processing fee of $505,00 payable to NCDEQ. X 2. One original signed hard copy and one electronic copy of this completed form. The signing official named on this application to represent the current permittee must meet one of the following: a. Corporation — a principle executive officer of at least the level of vice-president; b. Limited Liability Company (LLC) - a manager or company official as those terms are defined in G.S. 57D "North Carolina Limited Liability Company Act;" c. Public Entity — a principal executive officer, ranking official, or other duly authorized employee; d. Partnership or limited partnership — the general partner; e. Sole proprietor; or f. Letter of authorization signed by one of the signatories noted in a — e above authorizing the signature of another entity. X 3. One hard copy and one electronic copy of recorded documents required by the original.permit that have not yet been received by DEMLR, including: deed restrictions, protective covenants, condominium/planned community declaration and easements. If the project has been built, include documentation that the maximum BUA per lot or maximum total BUA has not been exceeded. If the project has not been built, include a signed agreement that the final recorded deed restrictions and protective covenants will be submitted at a later date. X 4. O&M Agreements, Please select one: ® I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to keep this on file with the permit; or ❑ I do not have a copy of the current recorded O&M Agreement for all SCMs and am requesting a copy be sent to me. I agree to keep this on file with the permit. X 5. Designer Certifications, Please select one: ® A copy of the certifications) confirming that the project was built in accordance with the approved plans have been previously provided to the Division; or ❑ A copy of the certifications) confirming that the project was built in accordance with the approved plans are enclosed; or ❑ The project has not yet been built. X 6. [IF APPLICABLE] If the project has been built, one original hard copy and one electronic copy of a signed, sealed, and dated letter from a licensed professional stating that the SCMs have been inspected, and that they have been built and maintained in accordance with the permit. X 7. [IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC): Provide one hard copy and one electronic copy of documentation from the NC Secretary of State, or other official documentation, which supports the titles and positions held by the persons listed in Section C,2 per 15A NCAC 2H. 1043(3)(b). https://www.sosnc.gov/online services/search/by title/ Business Registration Stormwater Permit Renewal Application Form Page 2 of 3 May 11, 2018 D. PERMITTEE'S CERTIFICATION a(_O�C� \L'�k d A , the person legally responsible for the permit, certify that I have a copy of the Permit and O&M Agreement on site (or I will obtain a copy and it will be kept on site), that I am responsible for the performance of the maintenance procedures, and the site has been and will be maintained according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs or built -upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the project, SCMs, or ownership. All information provided on this permit renewal application is, to the best of my knowledge, correct and complete. 1 A NOTARIZATION: I, �t 1 GIU� - V-�6� �e �" a Notary Public for the State of 0 0,C-0 1 G• County of C-0" e r\ a_.,A , do hereby certify that V_ t d d personally appeared before me this the 7day of AW CA 20 2-- 1 , and acknowledge the due execution of the forgoing instrument. Witness my hand and official seal, (Notary Seal) \�\\\11 t 11111111!ll��i' tar Nota Signature: �Dr�' �7CO�Z1J �___0CtJrnb Pend V ry mberland � w county My commission expires 0 7 y = My Comrn E>< 2Q 10-0)2024 P ��a� +(v� . G�robv e r- � P i�'Y CA R Oyu Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018 l?EMLR USE`ONLY� Fee Paid Permit Number iT—.�, NC DEQ Division of Energy, Mineral and Land Resources -1 a�J a STATE STORMWATER: PERMIT RENEWAL APPLICATION FORM A 1 J 6 113 2'621 � N3 0�:&F,',Y-T-,rVll I-� t 180 daysCowin r In accordance with 15A NCAC 2H.1045(3), the current permit holder shall renew their high density perms prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011-398 (SB 781) Section 60. (c). This application form is for permit renewals only. A. PROJECT INFORMATION 1. State Stormwater Permit Number: SW6130703 2. Project name: Peartree West Subdivision (Formerly Camden Glen Subdivision) 3. Project street address: Off Camden Road City: Fayetteville County: NC ZIP: 28306 4. What, if any, changes have been made to the project as permitted? None If the project has changed from the original approved plans, please complete SWU-101 for a Major Modification or Minor Modification Application form available at. https://deq nc.gov/about/divisions/energy mineral land resources/energy-mineral-land-rules/stormwater-program/post-construction. B. PERMITTEE INFORMATION If changes to the permittee or project name have been made, please complete either the Permit Update form or the Permit Transfer form available at. https•//deq nc qov/about/divisions/energy-mineral-land- resources/energy mineral-land-rules/stormwater-program/post-construction. State Stormwater Permits do not automatically transfer with the sale of the property. 1. Current Permit Holder's Company Name/Organization: Camden Glen Development, LLC 2. Signing Official's Name: Harold Kidd 3. Signing Official's Title: Member 4. Mailing Address: 6885 Cliffdale Road - -- - CAMDEN GLEN DEVELOPMENT 6885 CLIFFDALE ROAD I. FAYErMVILLE, NC 28314 PAY TO THE ��11�i" ORDER OF_ (� SelectP"* Fayeuev" xc 28303 FOR _1466 66-1233/531 I -, C E;K ARMOIr DATE ..