SW3161001_CURRENT PERMIT_20161024

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO. SW ,�110��BBl
DOC TYPE CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

PAT MCCRORY
C., en,.
DONALD R. VAN DER VAART
Energy, Mineral
and Land Resources
ENVIRONMENTAL OUALITV 11 f ,1 019 101����'a
October 24, 2016
Pastor Richard Wilson
Threshold Church
3127 Weddington Road
Matthews, North Carolina 28105
Subject: Stormwater Permit No. SW31601001
Threshold Church, Union County
Dear Pastor:
Secrernm
TRACY DAVIS
"ecF
OCT /��®
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ova
M° e `aP 1, S�<�
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co
The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater
Management Permit Application for the subject project on October 21, 2016. 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 Section NCAC 2H.1000. We are forwarding Permit No. SW3161001,
dated October 24, 2016, for the construction, operation and maintenance of the subject project and the
stormwater system. This permit shall be effective from the date of issuance until October 23, 2024, or
until rescinded and shall be subject to the conditions and limitations as specified therein, and does not
supersede any other agency permit that may be required.
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 Mooresville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Mike Randall at [phone]; or
[e-mail].
Sincerely,
for Tracy E. Davis, PE, CPM, Director
cc: SW3161001 File, Mooresville Regional Office
ec: James P. Magennis, Construction Materials Engineering & Consulting PC
State ol-North Carolina I Environmental Quality I Energy, Mineral and land Resources
1612 Mail Service Center I Raleigh, North Carolina 27699-1612
919-807-6375
)

State Stormwater Permit
Permit No. SW3161001
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT 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
Threshold Church o r'
00
Weddington, Union CountyCr
� o
FOR THE
construction, operation and maintenance of the Dry Detention Basin in c&npliance 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 State and considered a part of this permit.
This permit shall be effective from the date of issuance until October 23, 2024, and shall be
subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. The Dry Detention Basin is 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 Dry Detention Basin.
5. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 4

State Stormwater Permit
Permit No. SW3161001
It. SCHEDULE OF COMPLIANCE
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
2. The permittee shall at all time provide the operation and maintenance necessary to
assure the Dry Detention Basin 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 the Dry Detention Basin. The
reports will indicate the date, activity, name of person performing the work and what
actions were taken.
4. The permittee shall submit an annual summary report of the maintenance and
inspection records for each of the Dry Detention Basin. The report shall summarize
the inspection dates, results of the inspections, and the maintenance work
performed at each inspection.
The Dry Detention Basin shall be constructed in accordance with the approved
plans and specifications, the conditions of this permit, and with other supporting
data.
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 Dry Detention Basin certifying that it 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.
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.
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 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. SW3161001
9. A copy of the approved plans and specifications shall be maintained on file by the
Permittee for a minimum of eight years from the date of the completion of
construction.
10. 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 sighed by both parties, to the State,
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.
Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the State, 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 DEQ 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.
Page 3 of 4

State Stormwater Permit
Permit No. SW3161001
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 2H.1000, and NCGS 143-215.1 et.al.
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 24'h day of October, 2016.
EM
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

State Stormwater Permit
Permit No. SW3161001
Threshold Church
Weddington, Union 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: NCDEQ-DEMLR Regional Office
Page 1 of 1

DEMLR USE ONLY
Date Received
Fee P
Permit tuber
i
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan: 1.6
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Psi o- F2 �•
STORMWATER MANAGEMENT PERMIT APPLICATION F�bF� �0�� 10
77tis form may be photocopied for use as an original Lyp_ <o
I. GENERAL INFORMATION �"�/�
1. Project Name (subdivision, facility, or establishment name -should be consistent with4lCdje` t h ron plans,
specifications, letters, operation and maintenance agreements, etc.): _ dl;Atn .. o
2. Location of
City:
(street address):
County: UNION Zip: Z0104
3. Directions to project (from nearest major intersection):
201
10 50Q;Y0a M71pp06RC4, M. -Go 4UTN�pOti —RI 70 5L7�mN L�r.
4. Latitude: 3Jt' 0 02 'S!. /" N Longitude: �U ° 165 f L " W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ❑New Modification ❑ Renewal w/ Modificationt
tRenewals with me ifications also requires SWU-102 — Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
5W3
permit numberi5e2o3 , its issue date (if known) —/5 and the status of
construction: ❑Not Started ❑Partially Completed* Completed* *provide a designer's certification
2. Specify the type of pr ject (check one):
❑Low Density r-ligh 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
DEMLR requestin a state stormwater management permit application, list the stormwater project number,
if assigned, — and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Se ice Center at 1-877-623-6748):
❑CAMA Major dimentation/Erosion Control: 5.7 ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 Permit: Proposed Impacts
b.If any of these permits have already been
issue date and the type of each permit:_
please provide the Project Name, Project/Permit Number,
5. Is the project located within 5 miles of a public airport? No
If yes, see S.L. 2012-200, Part Vl: http:/(portal.ncdenr.org/web/I /rule a
Form SWU-101 Version Oct. 31, 2013 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):
Signing Official & Title: A(dmo W ywi 0kgz 17yr.- P4oup7je
b.Contact information for person listed in item la above:
Street Address: 312,/wI%lill mbi r2c> n
City: Ml�irr►' tw6 State: N6 Zip: ZDlO5
Mailing Address (if applicable): SMO
Phone: p7o Z77— 5 Fax: ( ) NONE
Email: lelCHA9P, W11,S tS A 491 HVM- care
cXleecheck the appropriate box. The applicant listed above is:
he property owner (Skip to Contact Information, item 3a)
essee* (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 Owners 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/Organization:
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:
City:
State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: f ) Fax:
Email:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can al,,,,,r 0— r ;ter
Other Contact
Signing Offick
b.Contact information for person listed in item 3a above: ��
Mailing Address:
� �37I /b pleoill t%L�IiE F4A0 �• � ^
City: VV g; �r T/v r'��^ State: %� L Zip: 4 1 %�
Phone: Q O ZC/ Fax:
Email: ik-iln AQ a YyyiGti♦P.>f'lm, li✓ A►'d Hpl 60M
4. Local jurisdiction for building permits: W imdlNyinl�9�— 1-1P2 AqA*
Point of Contact: 'fr Y [alel (--Pl N Phone #: ( 7011 )
UNION &ulv7Y- W1W1Jv1Y PV):?,N1V
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
a)� Ex -ray 21MMnigm FyM b
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 PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: 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 CA'rJ+W rJr'tQQ,� River basin.
4. Total Property Area:_acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Proper Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area': acres
Total project area shall be calculated to exclude the following the normal pool of imppou�nded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Mean High Water
W) (MHline, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHWp (or MHW) line may
be included in the total project area. 1' , d A(//q• p,4/i 1a0
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = "'26. 5 T.
9. How many drainage areas does the project have? f (For high density, count 1 for each proposed engineered
stornwater BMP. 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 /
Drainage Area
Drainage Area
Drainage Area _
Receiving Stream Name
ALE
'= wig2f GC
Stream Class *
Stream Index Number
Total Drainage Area (sf)
On -site Drainage Area (sf)
/
Off -site Drainage Area (so
Proposed Impervious Area** so
G
% Impervious Area** total
Impervious' Surface Area
Drainage Area /
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/ Lots (so
Z7—LW0
On -site Streets (so
On -site Parking (so
©Q
On -site Sidewalks (so
/
Other on -site (so
Future (so
Off -site (so
�—
Existing BUA*** (sf)
%rQ�
Total (sf):
* Stream Class and Index Number can be determined at: http://portal.ncdenr.or hay ebAoq/ps/csu/classifications
** Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
'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 replaced by new BUA.
Form SWU-101 Version Oct. 31, 2013 Page 3 of

11. How was the off -site impervious area listed above determined? Provide documentation.
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that maybe subject to more stringent stormwater requirements as per 15A 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 BMP specified for this project. The latest versions of the forms can be downloaded
from httv://Portal.ncdeiir.ori!/web/wo/ws/su/bmD-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://Rortal.ncdenr.org/web/wq/ws/su/statesw/forms does. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map athttp://portal.ncdennorg 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.ncdenr.org/web/wq/ws/su/statesw/forms dots.
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) Q/tfT7 ar7 //y4t-UJ7LW
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/onestoRexpress.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/managementfor
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 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
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.
f. Scale.
g. Revision number and dates.
It. 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.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
J4<
Ja
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where required). A/
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify J
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"x1l" copy of the NRCS County Soils map with the W/T,` /l `
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.
AWAI
to submittal, [phone].)
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to venfij the SHWI prior
� 10. A copy of the most current property deed. Deed book: 60M� Page No: / vJ%z j�'4
11. 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 15A 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.
hft:lZwww.secretLr_y.state.nc.us/Corp—orations/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./, 2ortal.ncdenr.org/webZlrlstate-storMwatpr-forms dots. 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 DEMLR, and that they will be recorded prior to the sale of any lot.
Vill. 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: Jmor7 P /ylAOA5"V/s
Consulting Firm: IV67L�{/GTIO/U M/i japL E //�//yI2J/i�� v le �cli/ 77A(� r%(j
Mailing Address:�Cj 1-kP7'bA) R n
City: State: Zip:-.. 0,6 21
Phone:
Fax: ( 1 Ns/ligr
Fin ail- IYY17/1G Nil IL /1 n.n
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or We mmne of Person listed in Contact Information, item 2a)
certify that
own the property identified in this permit application, and thus give permission to (pr nt or hjpe name of person
listed in Contact Information, item la) with (print or hjpe narne of organization listed in
Contact Information, iten la) 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 Versi9n Oct. 31, 2013 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 DEMLR Stormwater permft!Teverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR 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 up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date: I
a Notary Public for the State of lCounty of
do hereby certify that
before me this _ day of
and acknowledge the due execution of the
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
appeared
plication for
K APPLICANT'S CERTIFICATION V�2')4'H 19 lt-'9100)
I, (print or type nante of person listed in Contact Inforntation, item 1a) PAW X INCEW~ ✓r 0
certify that the information included on this permit application form is, to the best of my knowledge', correct ani
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 propo ed project complies with the requirements of the
applicable stormwater E _ ndeE,15A 15;As 2H .1000,any Ay other applicable state stormwater reguiremenl
I, Rol 0( -' to n 1 CL S (a4" a Notary Public for the State of _N � C ! County of
f do hereb certify that . i� ko-f J 1 '�, o r\ personally appeared
before me this -L day of C 26and acknowledge the due execution of the application for
a stormwater permit Witness my hand and official seal,
Hama Nodah
NOTARY PUBLIC
Medlenburg Cou111g NO
My Commission Expires December 16, 2018
SEAL
My commission
Form S WU-101 Version Oct. 31, 2013 Page 6 of 6

4Paj
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Permit Number:
(to be provided by DWQ)
Drainage Area Number: 7
Dry Extended Detention Basin
Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
The dry extended detention basin system is defined as the dry detention basin, outlet
structure, pretreatment including forebays and the vegetated filter if one is provided.
This system eck one): o
❑ does [ooes not incorporate a vegetated filter at the outlet. ? 40 Z
N
This system ( eck one): z
❑ does Ydoes not incorporate pretreatment other than a forebayy
Q
fi
Important maintenance procedures:
— The drainage area will be managed to reduce the sediment load to the dry
extended detention basin.
— Immediately after the dry extended detention basin is established, the vegetation
will be watered twice weekly if needed until the plants become established
(commonly six weeks).
— No portion of the dry extended detention pond will be fertilized after the first
initial fertilization that is required to establish the vegetation.
— I will maintain the vegetation in and around the basin at a height of
approximately six inches.
— Once a year, a dam safety expert will inspect the embankment.
After the dry extended detention basin is established, it will be inspected once a quarter
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:
The entire BMP
Trash debris is present.
Remove the trash debris.
The perimeter of the dry
Areas of bare soil and/or
Regrade the soil if necessary to
extended detention
erosive gullies have formed.
remove the gully, and then plant a
basin
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
Form SW401-Dry Detention O&M-Rev.3 Page 1 of 4

BMP element:
Potentialproblem:
How I will remediate theproblem:
The inlet device: pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
Swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the Swale if necessary to
Swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
'r'''=
Sediment has accumulated
Search for the source of the
�A
and reduced the depth to 7 %
of the original design de
sediment and remedy the pro m if
possible. Remove the sedi nt and
(see diagram below).
dispose of it in a location here it
will not cause impacts streams or
the BMP.
Erosion has occu ed or
Provide additional rosion
riprap is displ ed.
protection such reinforced turf
matting or rip p if needed to
reventfu erosion problems.
Weeds az present.
Remove weeds, preferably by
hand. I pesticides are used, wipe
them n the plants rather than
s r in .
The main treatment area
Sediment has accumulated
Se ch for the source of the
and reduced the depth to 75%
sediment and remedy the problem if
of the original design depth
possible. Remove the sediment and
(see diagram below).
dispose of it in a location where it
will not cause impacts to streams or
the BMP. Revegetate disturbed
areas immediately with sod
(preferred) or seed protected with
securely staked erosion mat.
Water is standing more than
Check outlet structure for clogging.
5 days after a storm event.
If it is a design issue, consult an
appropriate rofessional.
Weeds and noxious plants are
Remove the plants by hand or by
growing in the main
wiping them with pesticide (do not
treatment area.
spray).
Form SW401-Dry Detention O&D1-Rev.3 Page 2 of 4

BMP element:
Potentialproblem:
How I will remediate theproblem:
The embankment
Shrubs or trees have started
Remove shrubs or trees
to grow on the embankment.
immediately.
Grass cover is unhealthy or
Restore the health of the grass cover
eroding.
- consult a professional if necessary.
Signs of seepage on the
Consult a professional.
downstream face.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair.
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
outlet.
733-1786.
The measuring device used to determine the sediment elevation shall be such that it will
give an accurate depth reading and not readily penetrate into accumulated sediments.
When the basin depth reads I feet in the main pond, the sediment shall be removed.
When the basin depth reads I feet in the forebay, the sediment shall be removed.
Sediment Removal
Bottom
N/A
BASIN DIAGRAM
(fill in the blanks)
Sediment
Storage
Temporary Pool Elevation Awe
Pool em orar
�J P
Sediment Removal Elevation _/ Volumi
Bottom Elevation VOW 4, 25%
MAIN POND
Form SW401-Dry Detention O&M-Rev.3 Page 3 of 4

Permit Number: .
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:
BMP drainage area number:
Print name: / ` t C f/A / i L S- /J
Title: L Xg c u ,—) v(; PASTo, t
Z)C.l C<(yitCt4 lC� O)Atr,�-onJ NC eZ.7/0q
-2 0cf-�27-)-3/5_-)
Signature:
Date:
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
K6 (AAA CA.CO` i nt , County of Met GC (" do hereby certify that
ter, personally appeared before me this 5+
day of Or �o b er DAot (o , and acknowledge the due execution of the
forgoing dry detention basin maintenance requirements. Witness my hand and official
seal,
We Nasrallah
NOTARY PUBLIC
Medde tq Cowty, NC -
My Commission E)ires December 16, 2018
SEAL
My commission expires l� C_< ��t
Form SW401-Dry Detention O&M-Rev.3 Page 4 of 4

r !sCA c^:fl
0' r A YPATCi

Permit No.
(to be provided by DWq)
®�� Gov wATf-, c
STORMWATER MANAGEMENT PERMIT APPLICATION FORM o
WDENR 401 CERTIFICATION APPLICATION FORM
DRY EXTENDED DETENTION BASIN 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.
I. PROJECT INFORMATION
Project name Threshold Church Site Plan Phase 2
Contact person
Phone number
Date
Drainage area number
Jim Magennis
704-323-7334
II. DESIGN INFORMATION
She Characteristics
Drainage area
265,946.00 (t'
Impervious area
115,DD0.00 ft
% Impervious
0.43
Design rainfall depth
1.00 in
Peak Flow Calculations
1-yr, 24-hr rainfall depth
Rational C, pre -development
Rational C, post -development
Rainfall intensity: 1-yr, 24-hr storm
Pre -development 1-yr, 24-hr peak flow
Post -development 1-yr, 24-hr peak flow
Pre/Post 1-yr, 24-hr peak control
Storage Volume: Non -SA Waters
Minimum required volume
Provided volume
Sediment storage volume provided
Storage Volume: SA Waters
1.5' runoff volume
Pre -development 1-yr, 24-hr runoff volume
Post -development 1-yr, 24-hr runoff volume
Minimum required volume
Provided volume
Sediment storage volume provided
Basin Design Parameters
Drawdown time
SHWT elevation
Basin bottom elevation
Storage elevation
Basin side slopes
Top elevation
Freeboard provided
Basin Bottom Dimensions
Basin length
Basin width
Length to width ratio
2.93
in
0.40
(unitless)
0.60
(unidess)
0.12
inmr
0.29
ft'/sec
0.44
ft'/sec
0.15
ft3/sec
13,927.00 ft'
69.426.00 ft' OK
17,357.00 ft' OK
ft3
ft3
ft3
ft3
ft3
ft3
3.00
days
OK
fast
666.00
fmsl
OK
667.56
fmsl
3.0
:1
OK
672.00
fmsl
OK
1.00
It
OK
140.00 ft
70,00 It
2.D0 :1 OK
Form SW401-Dry Extended Detention Basin-Rev.3
Parts I. 411. Design Summary, Page 1 of 2

Permit No.
(to be provded by DWQ)
Additional Information
Total runoff volume captured by basin
6.22
ac-in
Forebay is not required
Forebay provided
N
(Y or N)
Is basin in a recorded drainage easement?
Y
(Y or N)
OK
Does basin capture all runoff at ultimate build -out?
Y
(Y or N)
OK
Is a sediment depth indicator included?
Y
(Y or N)
OK
Does the basin include a drain?
Y
(Y or N)
OK
Forth SW401-Dry Extended Detention Basin-Ray.3 Parts I. a 11. Design Summary. Page 2 of 2

Permit
III. REQUIRED ITEMS CHECKLIST
(to be provided by DWQ)
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.
Pagel Plan
Initials Sheet
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),
- Basin dimensions,
- Pretreatment system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
2. Plan details (1" = 30' or larger) for the bioretenfion cell showing:
- Basin dimensions
- Pretreatment system,
- Maintenance access,
- Outlet structure,
- Overflow device,
- Flow distribution detail for basin inflow, and
- Vegetation specifications.
3. Section view of the basin (1" = 20' or larger) showing:
- Side slopes, 3:1 or lower,
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
6. A construction sequence that shows how the dry detention basin will be protected from sediment unfil the
entire drainage area is stabilized.
7. The supporting calculations.
/
✓
8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
V/
9. A copy of the deed restrictions (if required). fw:7, atol 111a tv
j �
10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. County
soil maps are not an acceptable source of soils information.
Aftr- AN iNtiar4nav Pftffil
Form SW401-Dry Extended Detention Basin-Rev.3 Part III. Required Items Checklist, Page 1 of 1