SW8981020_CURRENT PERMIT_20230328

STORMWATER DIVISION CODING SHEET
POST-CONSTRUCTION PERMITS
PERMIT NO. SW8 �8 ►p2U
DOC TYPE © CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE 2 o z3 032 g
YYYYMMDD

a�`5TA7Eo
ROY COOPER
Governor
ELIZABETH S.BISER
Secretary a'^"
DOUGLAS R.ANSEL NORTH CAROLINA
lntedm Dlrecmr Environmental Quality
March 28, 2023
ZP No. 76, LLC
Attn: Jeffery L. Zimmer, President
P.O. Box 2628
Wilmington,NC 28401
Subject: Permit Renewal
Post-Construction Stormwater Management Permit No. SW8981020
CVS Pharmacy Sneads Ferry
Onslow County
Dear Mr. Zimmer:
Effective August 1, 2013 the Post-Construction Stormwater Management Program has been transferred from the
Division of Water Quality ("DWQ")to the Division of Energy, Mineral and Land Resources ("DEMLR"). All
previous references to DWQ will remain in older permits issued prior to August 1,2013 until they are modified.
Please note that this permit will now reference DEMLR as the Division responsible for enforcement of the permit.
On August 5, 2009, the Governor signed Session Law 2009-406. This law impacted any development approval
issued by the former Division of Water Quality under Article 21 of Chapter 143 of the General Statutes, which
was current and valid at any point between January 1, 2008, and December 31, 2010. The law extended the
effective period of any permit that was set to expire during this time frame to three(3)years from its current
expiration date. On August 2, 2010,the Governor signed Session Law 2010-177, which granted an extra year for
a total of four(4)years extension.
The Division of Energy, Mineral and Land Resources received a complete 8-year Permit Renewal Application for
the subject permit on March 24, 2023. The Division is hereby notifying you that permit SW8981020 has been
renewed, updated, and re-issued on March 28, 2023, as attached. Please be aware that the renewal and re-
issuance of this stormwater permit does not imply that the site is currently in compliance.
This permit shall be effective until March 10,2031, which includes all available extensions, and does not
supersede any other agency permit that may be required. The project shall be subject to the conditions and
limitations as specified therein. This permit does not impose new or increased stormwater control requirements; it
clarifies the rules and requirements of this program to provide you with a better understanding of your obligations
under this permit. Failure to comply with these requirements will result in future compliance problems. Please
note that this permit is not transferable except after notice to and approval by the Division.
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 and 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 9197431-3000,or visit their website at www.NCOAH.com. Unless
such demands are made this permit shall be final and binding.
If you have any questions concerning this permit, please contact Aisia Freeman in the Wilmington Regional
Office, at phone [phone] or [e-mail].
Sincerely,
Cl �40
Douglas R. Ansel, Interim Director
Division of Energy, Mineral and Land Resources
®rk 0%J� North Carolina Department of Environmental Quality I Division of Energy,Mineral and Land Resources
Wilmington Regional Office 1 127 Cardinal Drive Extension I Wilmington,North Carolina 2&405
aomHcewuNn
910.796.7215

State Stormwater Permit No. SW8 981020
Page 2 of 2
Enclosures: Attachment C—Permitting History
Copy of the Renewal Application Documents
DES/af: \\\Stormwater\Permits&Projects\1998\981020 HD\2023 03 permit 981020
CC' Wilmington Regional Office Stormwater File
North Carolina Department of Environmental Quality I Division of Energy.Mineral and Land Resources
Wilmington Regional Office 1 127 Cardinal Drive Extension I Wilmington,North Carolina 28405
rva mw
910.796.7215

+' Post Construction Stormwater Management
Permit No. SW8981020
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
POST-CONSTRUCTION STORMWATER MANAGEMENT PERMIT
HIGH DENSITY COMMERCIAL 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
Mr. Jeffrey Zimmer and ZP No. 76, LLC
CVS Pharmacy— Sneads Ferry
1309 Highway 210, Sneads Ferry, Onslow County
FOR THE
operation and maintenance of a wet detention pond in compliance with the provisions of 15A NCAC 2H .1000
(hereafter referred to as the "stormwater rules') as outlined in the application, approved stormwater
management plans, supplement, calculations, operation and maintenance agreement, recorded documents,
specifications, and other supporting data (the "approved plans and specifications") as attached and/or on file
with and approved by the Division of Energy, Mineral and Land Resources (the "Division" or"DEMLR"). The
project shall be constructed, operated and maintained in accordance with these approved plans and
specifications. The approved plans and specifications are incorporated by reference and are enforceable part
of this permit.
This permit shall be effective from the date of issuance until March 10, 2031 and shall be subject to the
following specified conditions and limitations. The permit issued shall continue in force and effect until the
permittee files a request with the Division for a permit modification, transfer, renewal, or rescission; however,
these actions do not stay any condition. 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 for cause as
allowed by the laws, rules, and regulations contained in Title 15A NCAC 2H.1000 and NCGS 143-215.1 et.al.
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater described in the
application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as described in
Section 1.6 on page 2 of this permit. The stormwater control has been designed to handle the runoff
from 50,900 square feet of impervious area.
3. The tract will be limited to the amount of built-upon area indicated on page 3 of this permit, and per
approved plans. The built-upon area for the future development is limited to 0 square feet.
4. 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.
5. The runoff from all built-upon area within the permitted drainage area(s) of this project must be directed
into the permitted stormwater control system.
Page 1 of 4

Post Construction Stormwater Management
Permit No. SW8981020
6. The following design criteria have been provided in the wet detention pond and must be maintained at
design condition:
a. Drainage Area, acres: 1.72
Onsite, ft2: 75,090
Offsite, ft2: 0
b. Total Impervious Surfaces, ft2: 50,900
C. Design Storm, inches: 1
d. Pond Design Depth, feet: 5
e. TSS removal efficiency: 90%
f. Permanent Pool Elevation, FMSL: 27.18
g. Permanent Pool Surface Area, ft2: 3,800
h. Permitted Storage Volume, ft3: 4,785
i. Temporary Storage Elevation, FMSL: 28.28
J. Controlling Orifice: 1"OJ pipe
k. Permitted Forebay Volume, ft3: 2,190
I. Receiving Stream/River Basin: Mill Creek/Cape Fear
M. Stream Index Number: 18-87-14
n. Classification of Water Body: "SA" (23 ppm chlorides)
II. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in its entirety, vegetated and operational for
its intended use prior to the construction of any built-upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of the system will be
repaired immediately.
3. The permittee shall at all time provide the operation and maintenance necessary to assure the
permitted stormwater system functions at design condition. 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 vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow spreader, catch basins
and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon request to authorized
personnel of division. The records will indicate the date, activity, name of person performing the work
and what actions were taken.
5. The facilities shall be constructed, operated and maintained in accordance with the provisions of this
permit, the approved plans and specifications, and the supporting documents attached to this permit
and on file with the Division.
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.
Page 2 of 4

Post Construction Stormwater Management
Permit No. SW8981020
8. Access to the stormwater facilities for inspection and maintenance shall be maintained via appropriate
recorded easements at all times.
9. 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.
10. No person or entity, including the permittee, shall alter any component shown in the approved plans
and specifications. Prior to the construction of any modification to the approved plans, the permittee
shall submit to the Director, and shall have received approval for modified plans, specifications, and
calculations including, but not limited to, those listed below. For changes to the project or SCM that
impact the certifications, a new or updated certifi cation(s), as applicable, will be required and a copy
must be submitted to the appropriate DEQ regional office upon completion of the modification.
a. Any modification to the approved plans and specifications, regardless of size including the
'SCM(s), BUA, details, etc.
b. Redesign or addition to the approved amount of BUA or to the drainage area.
C. Further development, subdivision, acquisition, lease or sale of any, all or part of the project and/or
property area as reported in the approved plans and specifications.
d. Altering, modifying, removing, relocating, redirecting, regrading, or resizing of any component of
the approved SCM(s), the stormwater collection system and/or vegetative conveyance shown on
the approved plan.
e. The construction of any allocated future BUA.
f. The construction of any permeable pavement, #57 stone area, public trails, or landscaping
material to be considered a permeable surface that were not included in the approved plans and
specifications.
g. Other modifications as determined by the Director.
III. GENERAL CONDITIONS
1. CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the permittee shall
take immediate corrective actions. This includes actions required by this Division and the stormwater
rules such as the construction of additional or replacement on-site stormwater systems. These
additional or replacement measures shall receive a permit from the Division prior to construction.
2. PERMIT RENEWAL. A permit renewal request must be submitted at least 180 days prior to the
expiration date of this permit. The renewal request must include the appropriate application,
documentation and the processing fee as outlined in Title 15A NCAC 02H.1045(3).
3. CHANGES TO THE PROJECT NAME, PERMITTEE NAME OR CONTACT INFORMATION. The
permittee shall submit a completed Permit Information Update Application Form to the Division within
30 days to making any one of these changes.
4. TRANSFER. This permit is not transferable to any person or entity except after notice to and approval
by the Director. Neither the sale of the project and/or property, in whole or in part, nor the conveyance
of common area to a third party constitutes an approved transfer of the permit.
a. TRANSFER REQUEST. The transfer request must include the appropriate application,
documentation and the processing fee as outlined in 15A NCAC 02H.1045(2). This request must
be submitted within 90 days of the permit holder meeting one or more of the following:
i. A natural person who is deceased;
ii. A partnership, limited liability corporation, corporation, or any other business association that
has been dissolved;
iii. A person or entity who has been lawfully and finally divested of title to the property on which
the permitted activity is occurring or will occur through foreclosure, bankruptcy, or other legal
proceeding.
iv. A person or entity who has sold the property, in whole or in part, on which the permitted
activity is occurring or will occur,
V. The assignment of declarant rights to another individual or entity;
vi. The sale or conveyance of the common areas to a Homeowner's or Property Owner's
Association, subject to the requirements of NCGS 143-214.7(c2);
Page 3 of 4

Post Construction Stormwater Management
Permit No. SW8981020
b. TRANSFER INSPECTION. Prior to transfer of the permit, a file review and site inspection will be
conducted by Division personnel to ensure the permit conditions have been met and that the project
and the on-site stormwater system complies with the permit conditions. Records of maintenance
activities performed to date may be requested. Projects not in compliance with the permit will not be
transferred until all permit and/or general statute conditions are met.
5. COMPLIANCE. The permittee is responsible for compliance with the terms and conditions of this
permit until the Division approves the transfer request.
a. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved plans,
application, supplement, operation and maintenance agreement, all applicable recorded
documents, and specifications shall be maintained on file by the permittee at all times.
b. DIVISION ACCESS. The permittee grants Division Staff permission to enter the property during
normal business hours to inspect all components of the permitted project.
c. ENFORCEMENT. Any individual or entity found to be in noncompliance with the provisions of a
stormwater management permit or the requirements of the stormwater rules is subject to
enforcement procedures as set forth in NCGS 143 Article 21. .
d. ANNUAL CERTIFICATION. The permittee shall electronically submit to the Division an annual
certification completed by either the permittee or their designee confirming the projects
conformance with permit conditions
e. OBTAINING COMPLIANCE. 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
modified plans and certification in writing to the Director that the changes have been made.
f. OTHER PERMITS. The issuance of this permit does not preclude the permittee from complying
with and obtaining any other permits or approvals that are required for this development to take
place, as required by any statutes, rules, regulations, or ordinances, which may be imposed by
any other Local, State or Federal government agency having jurisdiction. Any activities
undertaken at this site that cause a water quality violation or undertaken prior to receipt of the
necessary permits or approvals to do so are considered violations of NCGS 143-215.1, and
subject to enforcement procedures pursuant to NCGS 143-215.6.
Permit renewed, updated and reissued this the 280 day of March 2023,
NORTH CAROLIIN/A ENVIRONMENTAL MANAGEMENT COMMISSION
f74
7.Douglas R. Ansel, Interim Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 4 of 4

Attachment C-Permitting History
CVS Pharmacy Sneads Ferry
Permit No.SW8 981020
Approval Pcrmit Action RIMS Description of the Changes Modified Plan Sheets
Date Version
High Density Stormwater Project-construction,operation and maintenance of a
3/10/1999 Original 1 0 detention pond in compliance with the provisions of 15A NCAC 2H.1000.The I-5(of5)
Approval stormwater control has been designed to handle the runoff from 50,900 square feet of
impervious area.
High Density Commercial Project-operation and maintenance of a wet detention
7/27/2009 Renewal 2.0 pond in compliance with the provisions of 15A NCAC 2H.1000.The storm eater
control has been designed to handle the runoff from 50,900 square feet of impervious
area.
3/28/2023 Renewal 2.0 New Expiration Date 3/10/2031
Page 1 of 1

1 C11111L 1VQ.
S �'Y
4# (to be
n provided
y.QW
State of North Carolina
y.e '
.` Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form may be photocopied for rose as an original
DWQ Stormwater Management Plan Review:
A complete stormwater management plan—submittal includes a wet detention basin supplement for each basin,
design calculations, plans and specifications showing all basin and outlet structure details, and a signed and
notarized operation and maintenance agreement.
I. PROJECT INFORMATION (please complete the following information):
Project Name : CVS Pharmacy
Contact Person: John L. Pierce Phone Number: ( gin) 346-9800
For projects with multiple basins, specify which basin this worksheet applies to:
Basin Bottom Elevation 22, 18 fL (average elevation of the floor of the basin)
Permanent Pool Elevation 27 1 S ft. (elevation of the orifice)
Temporary Pool Elevation 28.28 ft. (elevation of the discharge structure overflow)
Permanent Pool Surface Area 3800 sq. fL (water surface area at the orifice elevation)
Drainage Area 1 .64• ac. ' (on-site and off-site drainage to the basin)
Impervious Area 1 .17 ac. (on-site and off-site drainage to the basin)
?ermanent Pool Volume 9702 cu. ft. (combined volume of main basin and forebay)
Temporary Pool Volume 4580 cu. ft. (volume detained above the permanent pool)
Forebay Volume 2190 CIL fL
SA/DAl used 5. 14% (surface area to drainage area ratio) `
Diameter of Orifice t in.
Design TSS Removal 90% %o (85% TSS removal required, see item k below)
I. REQUIRED ITEMS CHECKLIST
me following checklist outlines design requirements per the Stormwater Best Management Practices manual
'4_C. Department of Environment, Health and Natural Resources, November 1995) and Administrative Code
ectiom 15 A NCAC 2H .1008.
:Aial in the space provided to indicate the following design requirements have been met and supporting
Dcumentation is attached. If the applicant has designated an agent in the Stomwarer Management Permit
pplication Form, the agent may initial below. If a requirement has not been met, attach justification.
an SWU-102 Rev 1/August1998 Page I of 3

Applicants•Inriiais" .
`Tlie'temporary pool controls runoff from the I inch storm event.
1L < b. The basin length to width ratio is greater than 3:3 . .
The basin side slopes above the permanent pool are no steeper than 3:I.
d. A submerged and vegetated perimeter shelf at less than 6:1 is provided (show detail).
ice---• e._.Vegetation above the permanent pool elevation is specified.
f. An emergency drain is provided T..rr_. to empty the basin. (PORTABLE PUMP AVAILABLE)
%g. The permanent pool depth is between 3 and 6 feet (required minimum of 3 feet).
SL h. The temporary pool draws down in 2 to 5 days.
}t i. A trash rack is provided for both the overflow and orifice.
j. The forebay volume is approximately equal to 20% of the total basin volume.
k. Sediment storage is provided in the permanent pool.
I. A 30400t vegetative filter is provided at the outlet2 (include erosive flow calculations)
J2, in. Recorded drainage.easement for each basin including access to nearest right-of-way.
_-�- n. A site specific operation and maintenance (0&M)plan is provided.
3 - o. A vegetation management/mowing schedule is provided in the O&M plan.
JL
P. Semi-annual inspections are specified'in the O&M plan.
S? q. A debris check to be performed after every storm event is specified in the O&M plan.
r. Specific clean-out benchmarks are specified in the 0&M plan (elevation or depth).
s. A legally responsible party is designated in the O&M p�an3 (include name and title).
If the basin is used for sediment and erosion control during construction, clean out of the
basin is specified to be performed prior to use as a wet detention basin.
i
Footnotes:
1 When using the Division SA/DA tables,the correct SA/DA ratio for permanent pool sizing should be computed based upon the
actual % nd permanent pool depth. Linear interpolation should be employed to determine the correct v
sta alue for non-
standard table entries.
�.
- The requirement for a vegetative filter may be waived if the wet detention basin is designed to meet 90%TSS removal.
3 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
FI. WET DETENTION BASL 1 OPERATION.AND MAP41ENANCE AGREEMENT
the wet detention basin system is defined as the wet detention basin, forebay, non-integrated pretreatment
Ystems (pretreatment other than forebays); and the vegetated filter if one is provided.
'his system (check one) ❑ does XXdoes not incorporate a vegetated filter.
'his system (check one) ❑ does KXdoes not incorporate non-integrated pretreatment.
(aintenance activities shall be performs as follows:
After every significant runoff producing rainfall event and at least monthly:
:711 SWU-102 Rev l/August 1998
Page 2 of 3

a! Inspect the wet detention basin system for sediment accumulation, erosion, trash accumulation, grass
cover, and general condition.
b. Check and clear the orifice of any obstructions such that drawdown of the temporary pool occurs within
2 to 5 days.
2. Repair eroded areas immediately, re-seed as necessary to maintain good vegetative cover, mow vegetative
cover to maintain a maximum height of six inches, and remove trash as needed.
3. Inspect and repair the collection system (i.e. catch basins, piping, swales, riprap, etc.) quarterly to maintain
proper functioning.
4. Remove accumulated sediment from the wet detention basin system semi-annually or when depth is
reduced to 75% of the original design depth. Removed sediment shall be disposed of in an appropriate
manner and shall not be handled in a manner that will adversely impact water quality (i.e. stockpiling near a
wet detention basin or stream, etc.).
The original design depth is: 5.0
The sediment removal benchmark depth is: 3.75
5. Remove cattails and other indigenous wetland plants when they cover 75% of the basin surface. These
plants shall be encouraged to grow along the basin perimeter.
6. If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through
the emergency drain shall be minimized to the maximum extent practical.
7. All components of the wet detention basin system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the above
maintenance procedures. I agree to notify DWQ of any problems with the system or changes in the name of the
project,responsible party, or address.
Printname: Jeffrey L. Zimmer, LLC Adminstrator/ZP No. 76,LLC
Address: P.O. Box 2628, Wilmington, NC 28402
Phone: (910) 763-4669
Title: LC Adminstrator
Signature:
Date: October 14 11998
I, 1� \�\Ct VY- a Notary Public for the State of
County of do hereby certify that
personally appeared before me this I—day of DC k-k:�Pl 119 and acknowledge the
due execution of the forgoing infiltration system maintenance requirements. Witness my hand and official seal,
My commission expires My Co ssiom Expires September 24 �00Y ; U n� r �ss?s o 'e =
y°o �.NiWe eI d cig
Form SWU-102 Rev 1/August 1998 Page 3 of 3 y9y011ER Cold •r

DEMLR USE ONLY
Date ecei ed Fee Pai Permit Number
JG(J P ( jDaCl
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: Su g I p
S l om
2. Project name: CVs ?harmacel SnGQ s Ferry
3. Project street address: 1309 H W 0-10
City: Sh e-a oKS Perrtl County: ons:low zip : a Mpo
4. What, if any, changes have been made to the project as permitted? N/OA)e.
If the project has changed from the original approved plans, please complete SWU-101 fora Major
Modification or Minor Modification Application form available at:httl)s:Hdeg.nc.gov/about/divisions/energv-
mi neral-land-resou rces/energy-m i ne ral-land-ru les/stormwater-prog ram/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/energy-mineral-land-rules/stormwater-program/post-construction. State Stormwater Permits do not
automatically transfer with the sale of the property.
1. Current Permit Holder's Company Name/Organization: ZP A)0' 7(pr LLC
2. Signing Official's Name: J Z�i 2 L . Zi mrne r
3. Signing Official's Title: S 1 e
rrL-
4. Mailing Address: r, 0• boy- <94as
City: 1 I M l n n State: C ZIP :a (4Oa
5. Street Address: It P1'/)1CeFX S" eef-
City: ll I m ln� n State:: AZC- ZIP : (Mq0/
6. Phone: ( /0 ),-)Ya- '7&39 Email: . roPeI hY1nzPP/J�(,;1 zdI .caa
ECEIVE
MAR 2 4 2023
By--
Stormwater Permit Renewal Form Page 1 of 3 May 11, 2018

D. PERMITTEE'S CERTIFICATION /qAn� o er Z� No �� Mcrnbcr, T ne '
I, �) 2-�re� L• Zf rnmer, ,, the person legally responsible for the permit, certify that I have
a copy of the Permit and O&M Agreement on site (or I will obtain a copy and it will be kept on site), that I am
responsible for the performance of the maintenance procedures, and the site has been and will be maintained
according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs
or built-upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the
project, SCMs, or ownership All information provided on this permit renewal application is, to the best of my
knowledge, correct and c et .
Signature: Date: 0��
NOTARIZATION::
I, 6QIrr_rr' a Notary Public for the State of
Nor H CGrolrhq County of NrV I+uHoye.Y` do hereby certify
that 3t grey L. '?,wwrer,Ac,NacSlr of 2P No, -76 Ar,&,Av , SYrG personally appeared before me
tlij�lAL %0, day of /°1Q�`( I , 202, and acknowledge the due
HEM i�
ittIntt tyre Jy�going instrument. Witness my hand and official seal,
p,� Vty 2 S
< Nofry Se#)
P%Ov
&My commission expires A&tyy64 31, 2026
ECEIVE
MAR 2 4 2023
BY:
Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

State Stormwater Management Sysiems
Permit No. SW8 981020
CVS Pharmacy-Sneads Ferry
Stormwater Permit No. SW8 981020
OuSlow County
Engineer's Certification
1, Z�LCz X y -d as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe(periodically/weekly/full time) the construction of the project,
F "1`7 (Project)
for ZE A.16.�f- [_[_[/ (Project Owner) hereby state that, to the best of my abilities, due care and
diligence was used in t e 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:
ry„
SEAT.
Signature =
'•. ;
RegisuationNumber
IV
Date
f
MAY 1"1 2009
BY:
6