SW7960401_CURRENT PERMIT_20201207

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
sw_l�(��
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYM M D D

ROY COOPER
Governor
MICHAELS.REGAN
Secretory
BRIAN WRENN
Director
NORTH CAROLINA
Environmental Quality
December 7, 2020
Walker Boys Investment Holdings, LLC
Attention: Tara Walker, President
112 Soundshore Drive
Kill Devil Hills. NC 27948
Subject: Stormwater Permit No. SW7960401 Renewal/Ownership Change
Major League Plumbing
High Density Project
Dare County
Dear Tara Walker:
The Washington Regional Office received Stormwater Management Permit Applications
for renewal and Ownership Change of the subject permit on November 12, 2020. Staff
review of the applications has determined that the permit can be reissued. We are
forwarding Permit No. SV 7960401 dated December 7, 2020, for the continued
operation of the subject project.
This permit, upon its effective date, will replace all previous State Stormwater permits for
this project. This permit shall be effective from the date of issuance until March 6, 2029
and shall be subject to the conditions and limitations as specified therein, and does not
supercede 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 150B 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
V — _ North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resom'ces
Washington Regional Office I Q43 Washington Square Mull I Washington. North Carolina 2768o

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
Walker Boys Investment Holdings, LLC
Major League Plumbing
Located at 1064 Colington Road, Kill Devil Hills, NC
Dare County
FOR THE
construction, operation and maintenance of two infiltration basins 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 March 6, 2029, 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 the Project Data Sheet below.
3. Approved plans and specifications for this project are incorporated by reference and
are enforceable parts of the permit.

PROJECT DATA
Project Name: Major League Plumbing
Permit Number: SV 7960401
Location: Dare County
Applicant: Walker Boys Investment Holdings, LLC
Mailing Address: 112 Soundshore Drive
Kill Devil Hills, NC 27948
Water Body Receiving Stormwater
Runoff: Colington Creek
Classification of Water Body: SC
Total Site Area: 2.34 acres
Total Impervious
Surfaces Allowed: 64,731 sf
Basin Depths: 1.50 - Basin A
1.00 - Basin B
Required Storage Volume: 1575 cf - Basin A
3729 cf - Basin B
Provided Storage Volume: 3336 cf - Basin A
8838 cf - Basin B
Provided Surface Area: 1599 sf - Basin A
7272 sf - Basin B
Storage Elevations: 4.3 ft - Basin A
4.1 ft - Basin B

4. No homeowner/lot owner/developer shall be allowed to fill in, alter, or pipe any
vegetative practices (such as swales) shown on the approved plans as part of the
stormwater management system without submitting a revision to the permit and
receiving approval from the Division.
5. The following items will require a modification to the permit:
a. Any revision to the approved plans, regardless of size
b. Project name change
C. Transfer of ownership
d. Redesign or addition to the approved amount of built -upon area
e. Further subdivision of the project area.
In addition, the Director may determine that other revisions to the project should
require a modification to the permit.
6. 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.
II. SCHEDULE OF COMPLIANCE
1. The permittee will comply with the following schedule for construction and
maintenance of the stormwater management system.
a. 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 surfaces except roads.
b. During construction, erosion shall be kept to a minimum and any eroded areas
of the system will be repaired immediately.
2. The facilities must be properly maintained and operated at all times. The approved
Operation and Maintenance Plan must be followed in its entirety and maintenance
must occur at the scheduled intervals.
3. The permittee shall at all times provide the operation and maintenance necessary to
assure the permitted stormwater system functions at optimum efficiency including,
but not limited to:

li
a. Semi-annual scheduled inspections (every 6 months)
b. Sediment removal
C. Mowing and revegetation of side slopes
d. Immediate repair of eroded areas
e. Maintenance of side slopes in accordance with approved plans and
specifications
f. Debris removal and unclogging of outlet structure, orifice device and catch
basins and piping.
4. Records of maintenance activities must be kept and made available upon request to
authorized personnel of the Division. The records will indicate the date, activity,
name of person performing the work and what actions were taken.
5. 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 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. Mail
the Certification to the Washington Regional Office, 943 Washington Square Mall,
Washington, North Carolina, 27889, attention Division of Energy, Mineral, and Land
Resources.
7. A copy of the approved plans and specifications shall be maintained on file by the
Permittee for a minimum of five years from the date of the completion of construction.
III. GENERAL CONDITIONS
1. This permit is not transferable. In the event there is a desire for the facilities to change
ownership, or there is a name change of the Permittee, a formal permit request must
be submitted to the Division accompanied by an application fee, 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.
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 143-215.6(a) to 143-215.6(c).
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) which have 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 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.
6. This permit shall be effective from the date of issuance until March 6, 2029.
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 7th day of December 2020.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
For
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW7960401

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NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
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: SW7960401
2. Project name: colington Speedway
3. Project street address: 1064 colington Road
City: Kill Devil Hills
County: Dare
4. What, if any, changes have been made to the project as permitted?
ZIP : 27948
If the project has changed from the original approved plans, please complete SWU-101 fora Major
Modification or Minor Modification Application form available at: https://deg.nc.gov/about/divisions/energy_
mineral-land-resources/energy-mineral-la nd-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://deg.nc.gov/about/divisions/energy-mineral-land- '
resources/ an ergy-m ioeral-land-rL)Ies/stormwater-program/post-constructi on. State Stormwater Permits do not
automatically transfer with the sale of the property.
1. Current Permit Holder's Company Name/Organization: Jimmie Summerell (Property Sold, see Permit Transfer)
2. Signing Official's Name: Tara walker
3. Signing Official's Title: President
4. Mailing Address: 112 soundshore Drive
City: Kill Devil Klis State: NC ZIP : 27948
5. Street Address: 1064 colington Road
City: Kill Devil Hills State: NC ZIP : 27948
6. Phone: 252 ) 207-2626 Email: tara5705@yahoozom
➢RECEIVED NOV 1 2 2020
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/ORW). Only applications packages that
include all required items listed below will be accepted and reviewed.
Initialeach item below to indicate that the required information is provided in the application package:
VV S 1.
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A permit application processing fee of $505.00 payable to NCDEQ.
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.
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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.
S4.
O&M Agreements, Please select one:
© 1 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
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requesting a copy be sent to me. I agree to keep this on file with the permit.
Designer
5.
Certifications, Please select one:
© A copy of the certification(s) confirming that the project was built in accordance with the
approved plans have been previously provided to the Division; or
❑ A copy of the certification(s) confirming that the project was built in accordance with the
approved plans are enclosed; or
❑ The project has not yet been built.
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.
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
1, Tara walker , 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 andwill 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, SCM , or ownership. All information provided on this permit renewal application is, to the best of my
knowledge, Orrect and complete. A
NOT
that
this the
ON:
Date: D/2gAo
a Notary Public for the State of
County of 1 Yi V/ e , do hereby certify
personally appeared before me
day of UC'*06- �-- , 200,L21 and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,
(Notary Seal)
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Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

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NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT TRANSFER APPLICATION FORM
Pursuant to 15A NCAC 02H.1045 and other applicable statues as reference within
Only complete applications packages will be accepted and reviewed. This form and the required items (with
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at: http://deq.nc.gov/contactlreoiotial-offires.
After this application is accepted, DEMLR will conduct a compliance inspection and report any deficiencies to the
current permittee and/or the proposed permittee. Per the state stormwater rules and the state stormwater permit
conditions, the permit shall not be transferred until:
1. the current permittee resolves all non-compliance issues identified in the inspection report;
2, the current permittee negotiates a resolution with the proposed permittee (in writing and signed by both
entities. The negotiated resolution must identify the necessary actions, the responsible party(ies), and the
timelines to correct the deficiencies. The site must either be found in compliance or a copy of the
negotiated resolution must be submitted prior to the transfer of the permit.); or
3. in the case where a transfer falls under G.S. 143-214.7(c2) (see also SL 2011-256), the proposed
permittee resolves all non-compliance issues upon acquiring the permit.
Signature requirements for the named signing official (for current and proposed permittee) must meet the following:
• Corporation - a principal executive officer of at least the level of vice-president;
• Limited Liability Company (LLC) - the designated manager; (Documentation from the NC Secretary of
State or other official documentation must be provided that states the titles and positions held by the
person who signed the application (pursuant to 02H.1040) that shows they have legal authority to sign for
the LLC)
• Municipality - a ranking official or duly authorized employee;
• Partnership or limited partnership - the general partner;
• Sole proprietor;
• The signature of the consultant or other agent shall be accepted on this permit transfer application only if
accompanied by a letter of authorization signed by one of the signatories noted in a-e above, as
applicable.
A. GENERAL INFORMATION
1. State Stormwater Permit Number: Sw7960401
2. Project name: Major League Plumbing
Is this an updated project name from the current permit? ® Yes ❑ No
3. Reason for the permit transfer request:
Property sold
Stormwater Permit Transfer Application Form Page 1 of 7 April 27, 2018

B. PERSON(S) WHO HAVE SIGNED THIS FORM (select only one response below)
❑ 1. Both the current and proposed permittees
❑ 2. Only the current permittee of a condominium or planned community (skip Part F & G).
In accordance with G.S. 143-214.7(c2) (see also SL 2011-256), this type of transfer is allowed only
when ail of the following items can be truthfully checked:
❑ Any common areas related to the operation and maintenance of the stormwater management
system have been conveyed to the unit owners' association or owners' association in
accordance with the declaration;
❑ The declarant has conveyed at least fifty percent (50%) of the units or lots to owners other than
a declarant (provide documentation per submittal requirements below);
❑ The stormwater management system is in compliance with the stormwater permit.
NOTE: If subdivision was built prior to 1999, the Declarant's Attorney can make a determination that
the elements of the Planned Community Act (see §47F) have been met by the Declarant for the
subdivision. If the Declarant chooses to use this type of transfer, the determination must be in
-writing, signed by the attorney, and submitted to DEMLR with this form.
® 3. Only the proposed permittee (skip Part D below).
In accordance with G.S. 143-214.7(c5) (see also SL 2013-121), this type of transfer is allowed only
when all of the following items can be truthfully checked:
© a. The proposed permittee is either (select one of the following):
© The successor -owner who holds title to the property on which the permitted activity is
occurring or will occur;
© The successor -owner who is the sole claimant of the right to engage in the permitted
activity.
© b. The current permittee is (select at least one of the following, but all that apply):
❑ A natural person who is deceased.
❑ A partnership, Limited Liability Corporation, corporation, or any other business
association that has been dissolved
❑ A person who has been lawfully and finally divested of title to the property on which the
permitted activity is occurring or will occur.
© A person who has sold the property on which the permitted activity is occurring or will
occur.
❑ Other (please explain):
® c. The proposed permittee agrees to the following requirements (all must be selected):
© There will be no substantial change in the permitted activity.
© The permit holder shall comply with all terms and conditions of the permit until such
time as the permit is transferred.
© The successor -owner shall comply with all terms and conditions of the permit once the
permit has been transferred.
Stormwater Permit Transfer Application Form Page 2 of 7 April 27, 2018

C. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark JC" if previously provided. If not
applicable or not available, please mark N/A.:
N/A 1. A processing fee of five hundred and five dollars ($505.00) per G.S. 143-215.3D(e)(2).
Y 2. Two hard copies (with original signatures) and one electronic copy of this completed form and the
required items.
Y 3. For proposed permittees that are corporations or LLC's, documentation from the NC Secretary of
State demonstrating that the proposed permittee is a legal and viable entity able to conduct
business in North Carolina.
NIA 4. If Part B, Items 1 or 3 of this form is selected, the signed and notarized
applicable O&M agreement(s) from the proposed permittee, as required by the permit.
Y_ 5. Legal documentation that the property has transferred to the proposed permittee (such as a
recorded deed for the property, uncompleted development and/or common areas) or legal
documentation demonstrating that the proposed permittee is the sole claimant of the right to
engage in the permitted activity.
NIA 6. If required by the permit and if the project has been built, a signed, sealed and dated certification
document from a licensed professional stating that the stormwater management system has been
inspected and that it has been built and maintained in accordance with the approved plans.
NIA 7. A copy of the recorded covenants and deed restrictions, if required by the permit. If the project has
been built, documentation that the maximum allowed per lot built -upon area or the maximum
allowed total built -upon area has not been exceeded. If the project has not been built, the new
owner shall provide a signed agreement to submit final recorded deed restrictions and protective
covenants.
NIA 8, If transferring under G. S. 143-214.7(c2) (i.e., Part B, Item 2 of this form is selected),
documentation verifying that 50% or more of the lots have been conveyed to individuals (not
builders). Copies of the deeds of conveyance or a chart listing the lot number, lot address,
owner's name, conveyance date and deed book and page number are acceptable.
NIA 9. If transferring under G.S. 143-214.7(c5) (i.e., Part B, Item 3 of this form is selected), provide legal
documentation supporting the dissolution of the corporation or documentation supporting the
current permittee was lawfully and finally divested of title of the property.
NIA 10. A copy of the lease agreement if the proposed permittee is the lessee.
NIA 11. A copy of the pending sales agreement if the proposed permittee is the purchaser.
NIA 12. A copy of the development agreement if the proposed permittee is the developer.
Stormwaler Permit Transfer Application Form Page 3 of 7 April 27, 2018

D. CURRENT PERMITTEE INFORMATION AND CERTIFICATION Please be sure to provide Email.
1. Current Permit Holder's Company Name/Organization:
2. Signing Official's Name:
3. Signing Official's Title:
4. Mailing Address:
City:
5. Street Address:
City:
6. Phone: (_)
ZIP:
ZIP :
I, , the current permittee, am submitting this application for a
transfer of ownership for the above listed stormwater permit under the General Statute and Session Law identified
on Page 1 of this application. I hereby notify DEMLR of the sale or other legal transfer of the property/project
and/or the stormwater system associated with this permit. I have provided a copy of the following documents to
the proposed permittee named in this application form: (select all that apply)
❑ the most recent permit;
❑ the designer's certification for each SCM;
❑ any recorded deed restrictions, covenants, common areas, drainage easements or plats;
❑ the approved plans and/or approved as -built plans;
❑ the approved operation and maintenance agreement;
❑ past maintenance records from the previous permittee (where required);
❑ a copy of the most recent inspection report;
I further attest that this application and request for a permit transfer is accurate and complete to the best of my
knowledge. I attest that I have provided all of the required items per the law to transfer this permit. I understand
that if all required parts of this request are not completed or if all required supporting information and attachments
listed above are not included, this request package will be returned as incomplete I assign all rights and
obligations as permittee to the proposed permittee named below. I understand that this request to transfer the
permit may riot be approved by the DEMt{R unless and until the facility is in compliance with the permit.
Sign
L
that
this the
day of
County of
execution of the forgoing instrument. Witness my hand and official seal,
Y
ureo.. V OLvLP
Date: 1 i2&g / 2Zo /
a Notary Public for the State of
do hereby certify
personally appeared before me
20 2X�) , and acknowledge the due
Slormwater Permit Transfer Application Form Page 4 of 7 April 27, 2018

E. PROPOSED PERMITTEE INFORMATION
1. The proposed permittee is the:
© Property owner (Also complete Part F.)
❑ Home Owners Association (HOA), Property Owners Association (POA), or Unit Owner Association
(UOA) (Also complete Part F.)
❑ Lessee - Attach a copy of the lease agreement. Both the lessee and the property owner will appear on
the permit as co-permittees. if the lease is terminated, responsibility for the permit reverts to the property
owner. (Also complete Parts F & G.)
❑ Purchaser - Attach a copy of the pending sales agreement. The permit will require submission of a copy
of the recorded deed after the purchase has taken place. If the purchase agreement is cancelled the
permit reverts to the property owner. (Also complete Parts F & G.)
❑ Developer - Attach a copy of the development agreement. Both the developer and the property owner
will appear on the permit as co-permittees. If the development agreement is terminated, responsibility for
the permit reverts to the property owner. (Also complete Parts F & G.)
2. Proposed permittee name (check one of the following and provide the name):
© Corporation, LLC, Partnership, Municipality name: walker Boys Investment Holdings LLc
❑ HOA I POA I UOA name:
❑ Sole Proprietor
3. Proposed permittee contact information:
Please be sure to provide Email.
a. Signing Official's Name: Tara walker
b. Signing Official's Title: President
c. Mailing Address: 112 Soundshore Drive
City: Kill Devil Hills State: NC ZIP : 27948
d. Street Address: 10e4 Colmgton Road
City:
e. Phone: ( 252 ) 207-2626
NC ZIP : 27948
4. If there is a Management Entity that manages the property for an HOA, POA or UOA, please provide:
Please be sure to provide Email.
a. Management Company or Business name:
b. Contact Name:
c. Mailing Address:
d. City: State: ZIP:
e. Phone: (_) Email:
Slormwater Permit Transfer Application Form Page 5 of 7 April 27, 2018

F. PROPOSED PERMITTEE CERTIFICATION
I, Tam Walker , hereby notify the DEMLR that I have acquired through sale, lease,
development agreement, or other legal transfer, the project/property covered by the stormwater management
permit and/or the responsibility for constructing and/or operating and maintaining the permitted stormwater
management system. I acknowledge and attest that I have received a copy of: (select all that apply):
© the most recent permit;
❑ the designer's certification for each SCM;
® any recorded deed restrictions, covenants, common areas, drainage easements or plats;
❑ the approved plans and/or approved as -built plans;
❑ the approved operation and maintenance agreement;
❑ past maintenance records from the previous permittee (where required);
❑ a copy of the most recent inspection report;
® Check here if the proposed permittee agrees to be the entity responsible for addressing any compliance
issues outlined in the Compliance Inspection Report. If checked, the proposed permittee must provide a
written document statement, with a 'plan of action and schedule " addressed to this office stating that they will
bring the project into compliance upon receipt of the transferred permit. This written 'plan of action and
schedule " must be received by the Division before the Division will transfer the permit.
I have reviewed the permit, approved plans and other documents listed above, and I acknowledge that I will
comply with the terms and conditions of the permit. I will construct the project's built -upon area as shown on the
approved pla s; and I will (construct), operate and maintain the approved stormwater management system
pursuant to t e requirements listed in th permit and in the operation and maintenance agreement.
�� /
Signature: �� ISv V � Date: 10 / 2 q 2 bi
I, l —1G (` LC^eYLi- a Notary Public for
rtthee State of �
County of �Y� hereby certify that --ram, k2a) kt,—
personally appeared before me this the __2Q�_�day of DC f-pr- , 20->, and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Y
O U ;Z
ARE G•`'
Stormwater Permit Transfer Application Form Page 6 of 7 Apn1 27, 2018

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G. PROPERTY OWNER INFORMATION AND CERTIFICATION
Fill out this section only if the property owner is different from the proposed permittee. The permit will revert to
the property owner if the purchase agreement, development agreement or lease expires or is terminated.
Company Name/Organization:
Signing Official's Printed Name:
Signing Official's Title:
Mailing Address:
City:
Phone: (_) Email:
State: ZIP:
I, , hereby certify that I currently own the property identified in
this permit transfer document and acknowledge that the Proposed Permittee listed in Part F will be purchasing the
property, developing the property on my behalf, and/or leasing the property from me. A copy of the purchase
agreement, development agreement or the lease agreement, which names the party responsible for the
construction and/or operation and maintenance of the stormwater system, has been provided with the permit
transfer request.
I agree to notify DEMLR within 30 days if there are any changes to the purchase, developer or lease agreements
and will submit the applicable completed and signed Permit Information Update Form, or Permit Transfer
Application Form to address these changes. As the legal property owner, I acknowledge, understand, and agree
by my signature below, that the permit will revert to me and I will be responsible for complying with the DEMLR
Stormwater permit if the property purchase, lease or developer agreement/contract is cancelled or defaults. I
understand that any individual or entity found to be in noncompliance with the provisions of the stormwater
management permit or the stormwater rules, is subject to enforcement action as set forth in NC General Statute
(NCGS) 143, Article 21.
Signature of the property owner
my hand and official seal,
(Notary Seal)
Notary Signature
My commission
Date:
a Notary Public for the Stale of
County of , do hereby certify that
personally appeared before me this the day of
20 , and acknowledge the due execution of the forgoing instrument. Witness
Stormwater Permit Transfer Application Form Page 7 of 7 April 27, 2018

,,,ts'"^
AUG 0 9 Z006
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
COASTAL STORMWATER PERMIT RENEWAL APPLICATION FORM
CURRENT PERMIT INFORMATION: SSW% 9 6 O 4® 1
1. Stormwater Management Permit Number: JU 7 —1 qt D n -mot cD) St�lAc j;
2. Permit Holder's name: �) rn,-.ram, F
g/I7�0(o
3. Signing official's name:I I rynrtn, F Vt'ry ry-), LdTitle:
(person legally responsible for permit)
4. Mailing address: 112 Cbt_tr=-rn.) L.n1 City: �Ic�7�( YIL 1r)L1�S
State: klLZipCode: 2.11 q,97P hone: 252'W1IP38 AX: 252 4.P.nie-1 5 --1
(Area Code and Number) (Area Code and Number)
5. Project Name:
6. Location of Project: (street address) 1l7✓ + Cal rwtr Ti�hL R D
x,�►�o.,tl N,�►�,N�t�2�r C),+ I
%. Directions to Project(fromnearest major intersection) �R OY )\5C_� 92 n"�G� S C[>rnl V
W La N6-, T✓ N
n_) e.,-)4-r .
II. PERMIT INFORMATION I
1. Specify the type of stormwater treatment (wet pond, infiltration, etc.):,I� + f -A41 o n
List any changes (from project that was originally approved, attach additional pages if needed) m I nn Y A a v t ;lhi
Do you have a copy o0the original Operation and Maintenance Agreement? Yes.( No_
Applicant's Certification:
, certify that the information included on this
my knowledge, correct and complete.
Signature: 111.--r-,:!)-Y,,-.., � Date: &_&'N0
Submit this completed form along with an application fee of $420.00 and a copy of the
designer's certification to the address listed below.
North Carolina Division of Water Quality 943 Washington Square Mali Phone [phone] Customer Service 1-877-623-6748 One
Washington Regional Office Washington, NC 27889 FAX [phone] Internet: h2o.enrstate.mus ONprthC3roliuc
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