SW6130105_CURRENT PERMIT_20130208

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT. NO.
DOC TYPE
V) CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
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YYYYMMDD

MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P.E.
Governor Director
February 8, 2013
Antonio G. Burgess, Corporate Secretary
Spring Lake Congregation of Jehova's Witnesses
1015 Karen Circle
Spring Lake, North Carolina 28390
Subject: Stormwater Permit No. SW6130105
Spring Lake Kingdom Hall
Dear Mr. Burgess:
John E. Skvarla, III
Secretary
RECEIVED
MAR 1 1 2013
DENR-FAVETTEV"LEREGIONAL OFFlCE
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for Spring
Lake Kingdom Hall on January 22, 2013. 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 02H.1000. We
are forwarding Permit No. SW6130105, dated February 8, 2013, for the construction, operation and
maintenance of the subject project and the stormwater BMPs.
This permit shall be effective from the date of issuance until February 7, 2021, 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 conditions listed in this permit regarding the Operation and
Maintenance of the BMP(s), recordation of deed restrictions, procedures for changes of ownership,
transferring the permit, and renewing the permit. Failure to establish an adequate system for operation and
maintenance of the stormwater management system, to record deed restrictions, to follow the procedures for
transfer of the permit, or to renew the permit, 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 by filing a written petition with the Office of Administrative Hearings (OAH).
The written petition must conform to Chapter 150B of the North Carolina General Statutes. Per NCGS 143-
215(e) the petition must be filed with the OAH within thirty (30) days of receipt of this permit. You should
contact the OAH with all questions regarding the filing fee (if a filing fee is required) and/or the details of the
filing process at 6714 Mail Service Center, Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit
their website at www.NCOAH.com. Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the Raleigh Regional Office. If you have any questions, or need additional
information concerning this matter, please contact Mike Randall at [phone]; or
[e-mail].
Sincerely,
��.� .—�
J2 u/,moo cc:
for Charles Wakild, PE, Director
Wetlands and Stc,nnater Sra,H)
1617 Mz,l Seiaice Cencei, R,:eigh, Iiodh C'amohna 27699 1617
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SW6130105
Verne L. Thoren, Project Manager
Fayetteville Regional Office
NorthCarolina

Stpte Stormwater Permit
Permit No. SW6130105
i
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
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
Antonio G. Burgess, Corporate Secretary
Spring Lake Kingdom Hall
Spring Lake, North Carolina
Harnett County
FOR THE
construction, operation and maintenance of one wetland in compliance with the
provisions of Session Law 2006-246 and 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 February 7, 2021, 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 application documents and as shown on the approved
plans.
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.
5. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
II. SCHEDULE OF COMPLIANCE
1. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
Page 1 of 4

State Stormwater Permit
Permit No. SW6130105
2. The permittee shall at all time 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 re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
3. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
4. The permittee shall submit to the Division of Water Quality an annual summary
report of the maintenance and inspection records for each BMP. The report
shall summarize the inspection dates, results of the inspections, and the
maintenance work performed at each inspection.
5. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with 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. 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.
Page 2 of 4

State Stormwater Permit
Permit No. SW6130105
9. The permittee shall submit final site layout and grading plans for any permitted
future areas shown' on the approved plans, prior to construction.
10. 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.
11. 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.
III. 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 completed Name/Ownership Change form signed by both parties, to the
Division of Water Quality, accompanied by the supporting documentation. The
approval of this request will be considered on its merits and may or may not be
approved.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves a request to transfer the permit.
3. 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.
4. 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.
5. 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.
6. 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.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. 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.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 21-1.1000, and NCGS 143-215.1 et.al.
Page 3 of 4

State Stormwater Permit
Permit No. SW6130105
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 8th day of February, 2013.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
By Authority of the Environmental Management Commission
Page 4 of 4

State Stormwater Permit
Permit No: SW6130105
Spring Lake Kingdom Hall
Spring Lake, North Carolina
Harnett 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 Name)
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.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
cc: NCDENR-DWQ Regional Office
Page 1 of 1

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
v 0
1St vCv I O 10
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(selectall that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
RECEIVED State of North Carolina
MAR 1 1 2013 Department of Environment and Natural Resources
Division of Water Quality
DENR-FAYETTEMLLE RECU®F9WATER MANAGEMENT PERMTT APPLICATION FORM
This fOrm may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Spring Lake Kingdom Hall
2. Location of Project (street address):
City: Spring Lake County: Harnett -v 1 Zip: 28390
3. Directions to project (from nearest major intersection): rl�
From Intersection of Front (US421) and Main St(US 401/210) South on NC 21013 miles to Raynor Rd (SR
2052)- Left (West) on Raynor 600 Feet - Property on Left
4. Latitude:35° 14' 22" N. Longitude:-78° 55' 47" W of the main entrance to the project.
11. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification
b.lf this application is being submitted as the result of a modification to an existing permit, list the existing
permit number N/A , its issue date (if known)NZA and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* 'provide a designer's
certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, N/A and the previous name of the project, if different than currently
proposed, N/A
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑LAMA Major ®Sedimentation/Erosion Control: 16 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name,
issue date and the type of each permitIn Process
ForinSWU-101 VersionW.ftm2010
Page I of 6

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:Spring Lake Congregation Of Jehova's Witnesses, Spring Lake, North Carolina, Inc
Signing Official & Title:Antonio G. Burgess, Corporate Secretary
b.Contact information for person listed in item la above:
Street Address: 1015 Karen Circle
City: Spring Lake State: NC Zip: 28390
Mailing Address (if applicable): 1015 Karen Circle
City: Spring Lake State: NC Zip: 28390
Phone: (910 ) 885-2571 Fax: (910 ) 496-1896
Email:[e-mail]
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/1
Signing Official &
b. Contact information for person listed in item 2a above:
Street Address:
Mailing Address (if
City:
Phone: ( )
Fax:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization: NC Regional Building Committee #2
Signing Official & Title: Verne L. Thoren, Project Manager
b.Contact information for person listed in item 3a above:
Mailing Address: 1201 Green Branch Lane
Phone: (919 ) 661-8151
Email:vernetl)[e-mail]
4. Local jurisdiction for building permits: Harnett Couny
State: NC Zip: 27603
Fax: (919 ) 803-1944
Point of Contact: Jay Sikes Phone #: (910 ) 893-7525 Ext 4
FormSWU-101 Version 07Jun2010 Page 2of6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Runoff collected by combination of inlet and swales directed to
Stormwater Wetlands with Forebay sized to mitigate 1 2 10 and 100 Yr peak increases.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUDApproval Date:
❑ Valid Building Permit Issued Date:
❑ Other: N/A Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW - 1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the
River basin.
4. Total Property Area: 2.11 Ac acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project Area':
2.11 acres
Total pro/'ectarea shall be calculated to exclude the following: the normal pool of impounded structures,
the area between the banks ofstreams and rivers, the area below the Nonnal High Water (NHW) line or
Mean High Water (MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The
resultant protect area is used to caladate overall percent built upon area (BUA). Non -coastal wetlands
Ian d ward of the NHW (or MHW) line may be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 31.0 U/l
9. How many drainage areas does the project have? 1 (For high density, count I for each proposed engineered
storm water BMF. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area _
Drainage Area
Drainage Area
Receiving Stream Name
U/T-Little River
Stream Class *
C
Stream Index Number *
18-23-(24)
Total Drainage Area (sf)
100,611
On -site Drainage Area (sf)
49794
Off -site Drainage Area (sf)
50,817
Proposed Impervious Area** (sf)
27,147
% Im ervious Area** (total)
1 27.0
Impervious" Surface Area
Drainage Area _
Drainage Area _
Drainage Area _
Drainage Area
On -site Buildings/Lots (sf)
4,610
_
On -site Streets (sf)
0
On -site Parking (sf)
21,197
On -site Sidewalks (sf)
1340
Other on -site (sf)
0
Future (sf)
0
Off -site (sf)
0
Existing BUA*** (sf)
0
Total (sf):
27,147
" Stream Class and Index Number can be determined at:
http://portalncdeur. orv/web/wg/t7s/csu/classifications
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking
areas, sidewalks, grovel areas, etc.
Form SWU-101 Version 07.1un2010 Page 3 of 6

'Report only that amount of existing BUA that will remain after development. Do not report any existing
BUA that is to be removed and which will be rephced bync w BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. Cad Areas
From Autocad Drawing - Back-up Attached
Projects in Union County: Contact DWQ Central OJJice staffm check ifthe project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormmater requirements as per NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BM specified for this project. The latest versions of the forms can be downloaded
from http://portil.ncdenr.org/web/wq/ws/su/bmp-manual.
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. A detailed application instruction sheet and BMP
checklists are available from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be found
by locating project on the interactive online map at http://portal.nctienr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided for
each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions for
each submitted application package from http://portal.ncLienr.org/web/wq/ws/su/statesw/forms does.
ti Is
1. Original and one copy of the Stormwater Management Permit Application Form. �''.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://www.envhelp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within'h mile of the site boundary, include the
mile radius on the map.
7. Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
I. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
Form SWU-101 Version 07Jun2010 Page 4 of 6

o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SH WT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NlZCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verify the SHWT prior
to submittal, [phone]) 2�"
A copy of the most current property deed. Deed book: 964 Page No: 124
For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 2H.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
htt2://www.secretary.state.iic.us/Corporations/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://port,il.nc(ienr.orgZweb/wq/ws/su/statesw/forms_docs. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed on the
forms available on the website, 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 NC DWQ and that they will be recorded prior to the sale of any lot.
VUL CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: David L. Smith, P.E.
Consulting Firm: Rivers And Associates Inc.
Mailing Address:6131 Falls Of Neuse Road, Suite 300
City: Raleigh State:NC Zip:27609
Phone: (919 ) 848-3347 EXT 6257
Email:[e-mail]
Fax: (919 ) 484-0319
IX. PROPERTY OWNER AUTHORIZATION (if Contacthnfornnation, item 2has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) Owner/Applicant , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item la) with (print or type name of organization listed
in Contact Information, item 1 a) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version 07Jun2010 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of,4p to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: X/ Date:
I� d/{ 4 /✓ G✓ Jn S a Nota_Cy Public for the State of ��f�%t�+4rG��
/ ^9 .County of
�n do he by certify that 0 personally appeared
before me thiZAd day of / 14 d , and ocknowl�c the due exe ition of the application for a
stormwater permit. Witness my hand and official s
SEAL
My commission expires l/C44✓ // 20/3
X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Information, item M) Antonio G Burgess
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under J,5A NCAC 2H .1000, SL 2006-246 (Ph. 11- Post Construction) or SL 2008-211.
Signature: /'Date:/Z/ZO/3
I,1,6 13�4'/ a sp a Notasv Pu lfor e Stateoff 40A/% C/✓0%aat , County of
do he by certify that P$S personally appeared
before me thi L
day of 70and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and of ' is sea ,
SEAL
My commission expires
Form SWU-101 Version 07Jun2010 Page 6 of 6

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_ 4A .JehovaWs M'itnesses Inc.
2415 Itoselrill I[oad
I'Seyelleville, NC 211:301
January 3, 2013
CORPORATION RESOLUTION
We the members of the Spring Lake Congregation of Jehovah's Witnesses, Spring Lake, North
Carolina, Inc., give due authority to Antonio G. Burgess and Verne L. Thoren to represent the
Corporation in signing project agreements for the upcoming building project.
resident, James Bethea Jr. Date
Secretary, Antonio G. Burgess Date
Treasurer, Clarence M. Ferguson Date

pfi,57V4-J 4V �206FFf oal
/-Y)tL%-
Application Completeness Review
d First Submittal ❑ Re -submittal Date Received
Development/Project Name: w I
Receiving stream name u/-r--
River Basin: CA -
Date Reviewed: _ By Bill Diuguid
For post-constructidn requirements, a program will be deemed compliant for the areas where it is
implementing any of the following programs: WS-I, WS-II, WS-III, WS-IV, HQW, ORW, Neuse River Basin
NSW, Tar -Pamlico River Basin NSW, and the Randleman Lake Water Supply Watershed Nutrient
High Density Projects that require a 401/404 within an NSW require 85% TSS, 30% TN and 30% TP removal.
T&E Species (Goose Creek, Waxhaw Creek of Six Mile Creek Water Sheds): A r
Latitude and Longitude: 35 /4- 2z A/ -7R 5S 4-9y; Jurisdiction 5 a. -
Project Address: 1 X V Rg�„ra A Ron d
Engineer name and firm: JMv'jis i.. SP;7T"- P.=. iP,✓c,<S and H-Vse ,�a-cr KA/c,a.L Arc Z9Goy
Phone: 4i9- 94 9 _ -4 w4xn r / z So Finai d c,r; J- ii K,✓<A
Is the project confirmed to be in the State MSI Stormwater Permit jurisdiction? 2'Yes or ❑ No
❑ Low Density (no curb and gutter) ❑ Low Density with curb and gutter outlets (D4iigh Density ❑ Other
�/� �--401/404 impacts to surface waters, wetlands, and buffers (add language to cover letter and/or add info letter)
/ /BIJA 3/ °7
�,t Check for $505.00 included
V Original signature (not photocopy) on application
t:f Legal signature (Corporation-VP/higher, Partnership -General Partner/higher, LLC-member/manager, Agent).
v HU.44An Cl2 faf c OKp_ Scr__
Check spelling, capitalization, punctuation: http://www.secretary.state.nc.us/corporations/thepage.aspx
If an agent signs the application, a signed letter of authorization from the applicant must be provided which
includes the name, title, mailing address and phone number of the person signing the letter.
❑ For subdivided projects, a signed and notarized deed restriction statement
ealed, signed & dated calculations
correct supplement and O&M provided for each BMP on site (check all that were provided & number of each)
❑ Bioretention
❑ Rooftop Runoff Management
❑ Dry Detention Basin
❑ S33��d Filter RECEIVED
Filter Strip
Cr3'Stormwater Wetland
❑ Grass Swale
❑ Wet Detention Basin
MAR 1 1 2013
❑ Infiltration Basin
❑ Low Density
❑ Infiltration Trench
❑ Curb Outlet
❑ Level Spreader
❑ Off -Site DENR-FAYETTEVII.LE REGIONAL OFFICE
❑ Permeable Pavement
❑ NCDOT Linear Road
❑ Restored Riparian Buffer
t�Xarrative
wo sets of sealed, signed & dated layout & finish grading plans with appropriate details
Description of stormwater management provided
ry /Soils report, geotech information provided
GY Wetlands delineated or a note on the plans or in the accompanying documents that none exist on site and/or
lacent property
V/Details for the roads, parking area, cul-de-sac radii, sidewalk widths, curb and gutter,
/ Dimensions & slopes provided
o/ Drainage areas delineated ❑ Pervious and impervious reported for each ❑ Areas of high density
d/BMP operation and maintenance agreements provided
o' Application complete ❑ Application Incomplete Returned: (Date)
Comments Lpob r A --
Oct 29 2012 Revision, Bill Diuguid.

t
_ 01c, W A TfgO
NCDENR C
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WETLAND SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part III) must be printed, filled out and submitted along with all the required information.
h,PROJECT,INFORMATION!`
Project name Spring Lake Congregation Kingdom Hall
Contact name Verne L Thoren
Phone number 919-661-8161
Date January 17, 2013
Drainage area number 1
II.':DESIGNIINFORMATION�
Site Characteristics
Drainage area 100,611.00 ff'
Impervious area 27,147.00 ft'iRA
gd
Percent impervious 27 0% %
Design rainfall depth 1.00 inch
Peak Flow Calculations
1-yr, 24-hr rainfall depth
1-yr, 24-hr intensity
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Pre/Post 1-yr, 24-hr peak control
Storage Volume: Non -SA Waters
Minimum required volume
Volume provided (temporary pool volume)
Storage Volume: SA Waters Parameters
1.5" runoff volume
Pre -development 1-yr, 24-hr runoff volume
Post -development 1-yr, 24-hr runoff volume
Minimum volume required
Volume provided
Outlet Design
Depth of temporary pool/ponding depth (Dpi ,J
Drawdown time
Diameter of orifice
3.06
in
0.13
inlhr
3.46
ff3/sec
6.62
ff3/sec
3.16
ff3/sec
►3
2,516.00 ff3
4,101.00 ff3
OK
NIA ff3
ff3
It
ff3
ff3
12.00 in
OK
3.00 days
OK
1.00 in
OK
Coefficient of discharge (Co) used in orifice diameter
0.60 (unitless)
calculation
Driving head (Ho) used in the orifice diameter calculation 0.33 it
RECEIVED
MAR 1 1 1013
DENR—FAYETTEVILLE REGIONAL OFFICE
Provide calculations to support this driving head.
Form SW401-Wetland-Rev.6-11/16/09
Parts I and II. Project Design Summary, Page 1 of 3

Surface Areas of Wetland Zones
Surface Area of Entire Wetland
4,756.00 ft'
OK
Shallow Land
1,310.00 ft'
Insufficient shallow land area.
The shallow land percentage is:
28% %
Shallow Water
1,787.00 ft
Insufficient shallow water area.
The shallow water percentage is:
38% %
Deep Pool
Forebay portion of deep pool (pretreatment)
476.00 f?
OK
The forebay surface area percentage is:
10% %
Non-forebay portion of deep pool
455.00 ft'
OK
The non-forebay deep pool surface area percentage is:
10% %
Total of wetland zone areas
4,028.00 ft2
Enter data into the shaded cells in this section.
Add or subtract the following area from the zones
-728.00 ftZ
Topographic Zone Elevations
Temporary Pool Elevation (TPE)
Shallow Land (top)
215.00 It amsl
Permanent Pool Elevation (PPE)
Shallow Water/Deep Pool (top)
214.00 It amsl
Shallow Water bottom
213.50 ft amsl
Most shallow point of deep pool's bottom
212.00 It amsl
Deepest point of deep pool's bottom
211.50 ft amsl
Design must meet one of the following two options:
This design meets Option #1,
Top of PPE is within 6" of SHWT, If yes:
N (Y or N)
SHWT (Seasonally High Water Table)
213.00 ft amsl
OK
This design meets Option #2,
Y (Y or N)
Wetland has liner with permeability < 0.01 in/hr, If yes:
Depth of topsoil above impermeable liner
4.00 in
OK
Topographic Zone Depths
Temporary Pool
Shallow Land
12.00 in
OK
Permanent Pool
Shallow Water
6.00 in
OK
Deep Pool (shallowest)
24.00 in
OK
Deep Pool (deepest)
30.00 in
OK
Planting Plan
Are cattails included in the planting plan?
N (Y or N)
OK
Number of Plants recommended in Shallow Water Area:
Herbaceous (4'cubic-inch container)
450
Number of Plants recommended in Shallow Land Area:
Herbaceous (4'cubic-inch container), OR
350
Shrubs (1 gallon or larger), OR
56
Trees (3 gallon or larger) and Herbaceous (4+cubic-inch)
7 and
280
Number of Plants provided in Shallow Water Area:
Herbaceous (4'cubic-inch container)
450
OK
Number of Plants provided in Shallow Land Area:
Herbaceous (4'cubic-inch container)
350
OK
Shrubs (1 gallon or larger)
83
OK
Trees (3 gallon or larger) and
Grass -like Herbaceous (4+cubic-inch)
Form SW401-Wetland-Rev.6-11116/09 Parts I and II. Project Design Summary, Page 2 of 3

._
Additional Information
Can the design volume be contained?
Y
(Y or N)
OK
Does project drain to SA waters? If yes,
N
(Y or N)
Excess volume must pass through filter.
What is the length of the vegetated filter?
N/A
ft
Are calculations for supporting the design volume provided in the
Y
(Y or N)
OK
application?
Is BMP sized to handle all runoff from ultimate build -out?
Y
(Y or N)
OK
Is the BMP located in a recorded drainage easement with a
Y
(Y or N)
OK
recorded access easement to a public Right of Way (ROW)?
The length to width ratio is:
7.20 :1
OK
Approximate wetland length
180.00 ft
Approximate wetland width
25.00 ft
Approximate surface area using length and width provided
4,500.00 ft,
This approx. surface area is within this number of square feet
of the entire wetland surface area reported above:
Will the wetland be stabilized within 14 days of construction?
Y
(Y or N)
OK
Form SW401-Welland-Rev.6-11/16/09 Parts I and 11. Project Design Summary, Page 3 of 3

Permit No.
(to be provided by DWQ)
III. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Initials
Pagel Plan
Sheet No.
Z,¢
1. Plans (1" - 50' or larger) of the entire site showing:
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Delineated drainage basins (include Rational C coefficient per basin),
- Wetland dimensions (and length to width ratio),
- Pretreatment system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
J� CL
2. Plan details (1" = 50' or larger) for the wetland showing:
- Wetland dimensions (and length to width ratio)
- Pretreatment system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Overflow device, and
- Boundaries of drainage easement.
ny
,f
3. Section view of the wetland (1" = 20' or larger) showing:
- Side slopes, 3:1 or lower
- Wetland layers
All wetlands: Shallow land depth, shallow water depth, deep pool depth
Option 1, no clay liner: SLWT depth
✓Option 2, clay liner: Depth of topsoil on top of liner, liner specifications
4. A detailed planting plan (1" = 20' or larger) prepared by a qualified individual showing:
- A variety of several suitable species (not including cattails),
- Sizes, spacing and locations of plantings,
- Total quantity of each type of plant specified,
- A planting detail,
- The source nursery for the plants, and
- Fertilizer and watering requirements to establish vegetation.
Z) 4
5. A construction sequence that shows how the wetland will be protected from sediment until the entire
drainage area is stabilized.
6. The supporting calculations (including drawdown calculations).
7. A copy of the signed and notarized operation and maintenance (0&M) agreement.
A1 \
8. A copy of the deed restrictions (if required).
9. A soils report that is based upon an actual field investigation and soil borings. County soil maps are not an
acceptable source of soils information.
SW401-Wetland-Rev.6-11/16/09
Part III, page 1 of 1

Permit Number:
(to be p ouded by DIYQ)
Drainage Area Number:
Stormwater Wetland Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a log in a
known set location. Any deficient BMP elements noted in the inspection will be corrected, repaired or
replaced immediately. These deficiencies can affect the integrity of structures, safety of the public, and
the removal efficiency of the BMP.
Important maintenance procedures:
- Immediately following construction of the stormwater wetland, bi-weekly inspections will be
conducted and wetland plants will be watered bi-weekly until vegetation becomes established
(commonly six weeks).
- No portion of the stormwater wetland will be fertilized after the first initial fertilization that is
required to establish the wetland plants.
- Stable groundcover will be maintained in the drainage area to reduce the sediment load to the
wetland.
- Once a year, a dam safety expert should inspect the embankment.
After the stormwater wetland is established, I will inspect it monthly and within 24 hours after every
storm event greater than 1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and
maintenance will be kept in a known set location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired
immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
Entire BMP
Trash/debris is present.
Remove the trash/debris.
Perimeter of wetland
Areas of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed.
gully, and then plant a ground cover and
water until it is established. Provide lime
and a one-time fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height,
Inlet device: pipe or
The pipe is clogged (if applicable).
Unclog the pipe. Dispose of the sediment
swale
offsite.
The pipe is cracked or otherwise
Replace the pipe.
damaged if applicable).
Erosion is occurring in the swale (if
Regrade the swale if necessary to smooth
applicable).
it over and provide erosion control
devices such as reinforced turf matting or
riprap to avoid future problems with
erosion.
RECEIVED
MAR 1 1 2013
Form SW401-Wetland O&M-Rev.4 DENR-FAYETTDALLEREGIONALOFFICE Page Iof3

J
Permit Number:
(io be provided by DWQ)
BMP element:
Potentialproblem:
How I will remediate theproblem:
Forebay
Sediment has accumulated in the
Search for the source of the sediment and
forebay to a depth that inhibits the
remedy the problem if possible. Remove
forebay from functioning well.
the sediment and dispose of it in a location
where it will not cause impacts to streams
or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
problems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
Deep pool, shallow water
Algal growth covers over 50% of the
Consult a professional to remove and
and shallow land areas
deep pool and shallow water areas.
control the algal growth.
Cattails, phragmites or other invasive
Remove invasives by physical removal or
plants cover 50% of the deep pool and
by wiping them with pesticide (do not
shallow water areas.
spray) - consult a professional.
Shallow land remains Flooded more
Unclog the outlet device immediately.
than 5 days after a storm event.
Plants are dead, diseased or dying.
Determine the source of the problem:
soils, hydrology, disease, etc. Remedy the
problem and replace plants. Provide a
one-time fertilizer application to establish
the ground cover if necessary.
Best professional practices show that
Prune according to best professional
pruning is needed to maintain optimal
practices.
plant health.
Sediment has accumulated and,
Search for the source of the sediment and
reduced the depth to 75% of the
remedy the problem if possible. Remove
original design depth of the deep
the sediment and dispose of it in a location
pools.
where it will not cause impacts to streams
or the BMP.
Embankment
A tree has started to grow on the
Consult a dam safety specialist to remove
embankment.
the tree.
An annual inspection by appropriate
Make all needed repairs.
professional shows that the
embankment needs repair.
Evidence of muskrat or beaver activity
Consult a professional to remove muskrats
is present.
or beavers.
Micropool
Sediment has accumulated and
Search for the source of the sediment and
reduced the depth to 75% of the
remedy the problem if possible. Remove
original design depth.
the sediment and dispose of it in a location
where it will not cause impacts to streams
or the BMP.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment off -site.
The outlet device is damaged
Re air or re lace the outlet device.
Receiving water
Erosion or other signs of damage have
Contact the NC Division of Water Quality
occurred at the outlet.
401 Oversi ht Unit at 919-733-1756.
Form SW40 I -Wetland O&M-Rev.4
Page 2 of 3

If
Permit Number:
provided by Dn'Q)
p.a
1 acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. 1 agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Project name: Spring Lake Kingdom Hall
BMP drainage area number:
Print name:Antonio G Burgess
Title: Registered Agent - Spring Lake Congr. OfJehovah's Witnesses Spring Lake NC Inc
Address:1015 Karen Circle Spring Lake, NC 28390
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.
1-+k
a,Notary Public for the State of
of t!P/ :t7j , do hereby certify that
appeared before me this 2Ad day of
�013 , and acknowledge the due execution of the forgoing stormwater wetland
requirements. Witness my hand and official seal,
SEAL
My commission expires d "T� // U/ 3
Form SW401-Wetland O&M-Rev.4
Page 3 of 3

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