SW8220315_Current Permit_20230201

•
STATE
R.OY COOPER ,
Governor > , �
ELIZABETH S.BISER.
Secretary
DOUGLAS It,ANS.EL. NORTH CAROLINA.
Irrter<:m mrector envirgantenNiQuality
February 1,2023
Park City Property Investments,LLC;Developer
Attn:Harold Shipp,Jr.and Karen Shipp;Managing Members
228 S.Elm Street
Swansboro,NC 28584
Subject: Post-Construction Stormwater Management Permit No. SW8 220315
Park City RV Park—Phase 1
Low Density Subdivision Project
Onslow County
Dear Mr.and Ms. Shipp:
The Division of Energy,Mineral and Land Resources received a Post-Construction Stormwater Management
Permit Application and associated documentation for the subject project most recently on November 21,2022.
Staff review of the plans and specifications has determined that the project,as proposed,may be issued as set
forth in Title 15A NCAC 2H.1000 mended on January 1,2017(2017 Rules). We are hereby forwarding Permit
No. SW8 220315 dated February 1,2023,for the construction,operation and maintenance of the built-upon areas
(BUA)and vegetated conveyances or areas associated with the subject project.
Please be aware that this project is receiving approval that includes the requirement,permit condition(s),to
provide the following items within 90 days of the date of this permit or prior to construction,whichever is earlier.
These items are necessary to complete the application documents,as noted by the rule references below. Please
also refer to the Approval Condition section of your attached permit.
a. 15A NCAC 02H.1042 2(g)(iv): The grading plan shows that swales are proposed however the associated
proposed contours have not yet been provided. Please provide the proposed contours and drainage
patterns of the site on the plans as required,including the swales and ditch sections.
This permit shall be effective from the date of issuance until rescinded and does not supersede any other agency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.
These permit conditions address the following: 1)Approval Condition,2)BUA Limits and Requirements, 3)
Pervious Area Improvements,4)Low Density Area Requirements,5)Stormwater Outlets,6)Vegetated Setbacks,
7)Recorded Documents, 8)Construction,9)Modifications, 10)Designer Certification, 11)Operation and
Maintenance, 12)Current Name or Address Changes, 13)Transfer,and 14)Compliance Requirements. Failure to
comply with these requirements will result in future compliance problems that may result in appropriate
enforcement action in accordance with North Carolina General Statute §143-215.6A through§143-215.6C.
Please note that this permit is not transferable except after notice to and approval by the Division.
Please be aware that it is the responsibility of the permit holders,Park City Property Investments,LLC
("Developer")and Harold Shipp,Jr.and Karen Shipp("Property Owners"),to notify the Division of any changes
in ownership and request an ownership/name change for the stormwater permit. However,if the development
agreement between the Developer and the Property Owner is dissolved,cancelled or defaults,and the Division is
not notified by the Developer to transfer the permit,then the responsibility for permit compliance reverts back to
the Property Owner. A complete transfer request must be submitted to the Division within 30 days as described
below otherwise the Developer and Property Owner will be operating a stormwater treatment facility without a
valid permit which is a violation of NC General Statue 143-215.1. Failure to transfer the permit may result in
appropriate enforcement action in accordance with North Carolina General Statute§143 2 15.6A through§143-
215.6C being taken against the Property Owner.
If any parts,requirements,or limitations contained in this permit are nnarceptable,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,
'" North Carolina Department of Environmental Quality I Division of Energy,Mineral and.Land Resources
E ,) Wilmington Regional Office 1127 Cardinal Drive pension I Wilmington,North Carolina 28405
w r 910796.72/5

State Stormwater Permit No. SW8 220315
Page 2 of 2
Raleigh,NC 27699-6714,or via telephone at 919-431-3000,or visit their website at w ww.NCOAH.com.Unless
such demands are made this permit shall be final and binding.
If you have any questions concerning this permit,please contact Thom Edgerton in the Wilmington Regional
Office,at(910)796-7215 or [e-mail].
Sincerely,
CC --I-
X.Douglas R. Ansel,Interim Director
Division of Energy,Mineral and Land Resources
Enclosures. Attachment A-Designer's Certification Form
Application Documents
DES/tae: \\\Stormwater\Permits&Proiects\20221220315 LD\2023 01 permit 220315
cc: Jonathan L McDaniel,PE,Tidewater Associates,Inc.,604-E Cedar Point Boulevard,Cedar Point,NC 28584
Onslow County Building Inspections
Onslow County Planning&Development
Wilmington Regional Office Stormwater File
North Carolina Department of Environmental Quality I Division of Energy.Mneral and Land Resources
` Wilmington Regional Office 1127 Car4inaI Drive Extension I Wilmington,North Carolina 28405
NORTH CAROLINA
ap. mraar 910.796..7215

Post-Construction Stormwater Management
Permit No. SW8 220315
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
POST-CONSTRUCTION STORMWATER MANAGEMENT PERMIT
LOW DENSITY SUBDIVISION DEVELOPMENT
In compliance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations promulgated and adopted by the North
Carolina Environmental Management Commission, including 15A NCAC 02H.1000 amended on
January 1, 2017 (2017 Rules) (the "stormwater rules"),
PERMISSION IS HEREBY GRANTED TO
Park City Property Investments, LLC and Harold Shipp, Jr. and Karen Shipp
Park City RV Park— Phase 1
4100 Freedom Way, Swansboro, Onslow County
FOR THE
construction, management, operation and maintenance of built-upon area (BUA) for a low density
subdivision area (the "low density arc:(s)") discharging to Class SA-HQW as outlined in the
application, approved stormwater management plans, supplements, 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 parts of this permit.
This permit shall be effective from the date of issuance until rescinded 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, 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 15A NCAC 2H.1000
and NCGS 143-215.1 et.al.
1. APPROVAL CONDITION. Within 90 days of the date of this permit or prior to construction,
whichever is earlier, please provide the following items necessary to complete the application
documents.
a. 15A NCAC 02H.1042 2(g)(iv): The grading plan shows that swales are proposed
however the associated proposed contours have yet been provided. Please provide the
proposed contours and drainage patterns of the site on the plans as required, including
the swales and ditch sections.
2. BUA REQUIREMENTS. The maximum amount of BUA allowed for the entire project is 178,728
square feet. The BUA requirements and allocations for this project are as follows:
a. LOW DENSITY AREA BUA LIMITS (DA1). The low density area, also referred to as
Drainage Area DA1 in the approved plans and specifications, must not exceed 12% per the
requirements of the stormwater rules. Within this low density area, this permit approves a
percent BUA of 12% and the construction of a total of 178,728 square feet of BUA, which
includes 70,574 square feet of future BUA.
Page 1 of 6

Post-Construction Stormwater Management
Permit No. SW8 220315
b. BUA FOR INDIVIDUAL LOTS. Each of the 67 lots are limited to a maximum of 800 square
feet of BUA, as indicated in the approved plans and specifications. The maximum BUA
assigned to each lot via this permit and the recorded deed restrictions and protective
covenants may not be increased or decreased by either the individual lot owner or the
permittee unless and until the permittee notifies the Division and obtains written
approval from the Division.
3. PERVIOUS AREA IMPROVEMENTS. The following types of improvements are included in the
project and considered pervious per the stormwater rules:
a. #57 STONE. The project has included the use of#57 stone laid at least four inches thick
over a geotextile fabric as a pervious surface for use on the individual lots. The underlying
soil should not be mechanically compacted prior to installation. The permittee shall review
all applications and uses of#57 stone within the permitted project for compliance with these
requirements. The permittee shall not approve any plans that do not meet these
requirements. The permittee shall retain the individual lot#57 stone applications and a copy
of the written approval on file for the life of the Stormwater Management permit. At the
request of the Division, the permittee shall provide a copy of these documents for any and all
lots approved to install #57 stone within the permitted project. If, in the future, the areas of
#57 stone are no longer found to meet the #57 stone requirements, a permit modification will
be required.
4 LOW DENSITY AREA REQUIREMENTS. The low density area requirements for this project are
as follows:
a. LOW DENSITY AND CONVEYANCE DESIGN. The low density area is permitted based on
the design criteria presented in the sealed, signed and dated supplement and as shown in
the approved plans and specifications. This low density area and conveyances must be
provided and maintained at the design condition.
b. PIPING. Other than the piping shown on the approved plans, only minimal amounts of
piping under driveways and roads is allowed within the low density area when it cannot be
avoided. No additional piping is allowed.
c. DISPERSED FLOW. The low density area has maximized dispersed flow of stormwater
runoff through vegetated areas and minimized the channelization of flow.
d. VEGETATED CONVEYANCES. Stormwater runoff that could not be released as dispersed
flow may be transported by vegetated conveyances with minimum side slopes of 3:1 (H:V)
designed to not erode during the peak flow from the 10-year storm event as defined in the
stormwater rules and approved by the Division.
5. STORMWATER OUTLETS. The peak flow from the 10-year storm event shall not cause erosion
downslope of the discharge point.
6. VEGETATED SETBACKS. A 50-foot wide vegetative setback must be provided and
maintained in grass or other vegetation adjacent to all surface waters as shown on the approved
plans. The setback is measured horizontally from the normal pool elevation of impounded
structures, from the top of bank of each side of streams or rivers, and from the mean high
waterline of tidal waters, perpendicular to the shoreline.
a. BUA IN THE VEGETATED SETBACK. BUA may not be added to the vegetated setback
except as shown on the approved plans or in the following instances where the BUA has
been minimized and channelizing runoff from the BUA is avoided:
i. Water dependent structures; and
ii. Minimal footprint uses such as poles, signs, utility appurtenances, and security
lights that cannot practically be located elsewhere.
b. RELEASE OF STORM WATER NOT TREATED IN A STORMWATER CONTROL
MEASURE (SCM). Stormwater that is not treated in an SCM, such as in this low density
project (including roof drains), must be released at the edge of the vegetated setback and
allowed to flow through the setback as dispersed flow.
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Post-Construction Stormwater Management
Permit No. SW8 220315
7 RECORDED DOCUMENT REQUIREMENTS. The stormwater rules require the following
documents to be recorded with the Office of the Register of Deeds:
a. EASEMENTS. All stormwater collection systems, vegetated conveyances, and maintenance
access located on property owned by other persons or entities must be located in permanent
recorded easements or drainage easements as shown on the approved plans.
b. OPERATION AND MAINTENANCE AGREEMENT. The operation and maintenance
agreement must be recorded with the Office of the Register of Deeds.
c. FINAL PLATS. If a final plat is recorded, it must reference the operation and maintenance
agreement and must also show all public rights-of-way, dedicated common areas, and/or
permanent drainage easements, in accordance with the approved plans.
d. DEED RESTRICTIONS AND PROTECTIVE COVENANTS. The permittee shall record deed
restrictions and protective covenants prior to the issuance of a certificate of occupancy to
ensure the permit conditions and the approved plans and specifications are maintained in
perpetuity.
8. CONSTRUCTION. During construction, erosion shall be kept to a minimum and any eroded
areas of the on-site stormwater system will be repaired immediately.
a. PROJECT CONSTRUCTION, OPERATION AND MAINTENANCE. During construction, all
operation and maintenance for the project and stormwater system shall follow the Erosion
Control Plan requirements until the Sediment-Erosion Control devices are no longer needed.
b. FINAL GRADING. The vegetated areas and vegetated conveyances shall be entirely
constructed and vegetated. Once the final grading is completed and the site is stabilized, the
permittee shall provide and perform the operation and maintenance as outlined in the
applicable section below.
9. MODIFICATIONS. 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 that impact the certifications, a new or updated
certification(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
BUA, details, etc.
b. Redesign or addition to the approved amount of BUA.
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 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 infiltrating permeable pavement, #57 stone area, public trails, or
landscaping material to be considered a pervious surface that were not included in the
approved plans and specifications.
g. Other modifications as determined by the Director.
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Post-Construction Stormwater Management
Permit No. SW8 220315
10. DESIGNER'S CERTIFICATION. Upon completion of the project, the permittee shall determine if
the project is in compliance with the approved plans and take the necessary following actions:
a. If the permittee determines that the project is in compliance with the approved plans, then
within 45 days of completion, the permittee shall submit to the Division one hard copy and
one electronic copy of the following:
i. The completed and signed Designer's Certification provided in Attachment A
noting any deviations from the approved plans and specifications. Deviations
may require approval from the Division;
ii. A copy of the recorded operation and maintenance agreement;
iii. Unless already provided, a copy of the recorded deed restrictions and
protective covenants; and
iv. A copy of the recorded plat delineating the public rights-of-way, dedicated
common areas and/or permanent recorded easements, when applicable.
b. If the permittee determines that the project is not in compliance with the approved plans, the
permittee shall submit an application to modify the permit within 30 days of completion of the
project or provide a plan of action, with a timeline, to bring the site into compliance.
11. OPERATION AND MAINTENANCE. The permittee shall provide and perform the operation and
maintenance necessary, as listed in the signed operation and maintenance agreement, to
assure that all components of the permitted on-site stormwater system are maintained at the
approved design condition. The approved operation and maintenance agreement must be
followed in its entirety and maintenance must occur at the scheduled intervals.
a. CORRECTIVE ACTIONS REQUIRED. In the event that the low density area fails to meet
the requirements of low density, the permittee shall take immediate corrective actions. This
includes actions required by the 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.
b. MAINTENANCE RECORDS. Records of maintenance activities must be kept and made
available upon request to authorized personnel of the Division. The records will indicate the
date, activity, name of person performing the work and what actions were taken.
12. 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.
13. 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. DEVELOPER AGREEMENT. It is the responsibility of the permit holders, Park City Property
Investments, LLC ("Developer") and Harold Shipp, Jr. and Karen Shipp ("Property Owner"),
to notify the Division of any changes in ownership and request an ownership/name change
for the stormwater permit. However, if the development agreement between the Developer
and Property Owner is dissolved, cancelled or defaults, and the Division is not notified by the
Developer to transfer the permit, then the responsibility for permit compliance reverts back to
the Property Owner. A complete transfer request must be submitted to the Division within 30
days as described below otherwise the Developer and Property Owner will be operating a
stormwater treatment facility without a valid permit which is a violation of NC General Statue
143-215.1. Failure to transfer the permit may result in appropriate enforcement action in
accordance with North Carolina General Statute §143-215.6A through §143-215.6C being
taken against the Property Owner.
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Post-Construction Stormwater Management
Permit No. SW8 220315
b. 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);
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.
14. COMPLIANCE. The permittee is responsible for complying with the terms and conditions of this
permit and the approved plans and specifications until the Division approves the transfer
request.
a. REVIEWING AND MONITORING FOR COMPLIANCE. The permittee is responsible for
verifying that the proposed BUA within each drainage area and for the entire project does
not exceed the maximum amount allowed by this permit. The permittee shall review and
routinely monitor the project to ensure continued compliance with the conditions of the
permit, the approved plans and specifications.
b. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved plans,
application, supplements, operation and maintenance agreement, all applicable recorded
documents, and specifications shall be maintained on file by the permittee at all times.
c. MAINTENANCE ACCESS. SCMs, stormwater collection systems, and vegetated
conveyances must be accessible for inspection, operation, maintenance and repair as
shown on the approved plans.
d. DIVISION ACCESS. The permittee grants Division Staff permission to enter the property
during normal business hours to inspect all components of the permitted project.
e. 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.
f. 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.
g. 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.
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Post-Construction Stormwater Management
Permit No. SW8 220315
h. OTHER PERMITS. The issuance of this permit does not preclude the permittee from
obtaining and complying with any and all other permits or approvals that are required for this
development to take place, as required by any statutes, rules, regulations, or ordinances,
which are 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 issued this the 1st day of February 2023.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
r
X,Douglas R. nsel, In erim Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 220315
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Post-Construction Stormwater Management
Permit No. SW8 220315
Attachment A
Certification Forms
The following blank Designer Certification forms are included and specific for this project:
• As-Built Permittee Certification
• As-Built Designer's Certification General MDC
• As-Built Designer's Certification for Low Density Projects
A separate certification is required for each SCM. These blank certification forms may be copied and
used, as needed, for each SCM and/or as a partial certification to address a section or phase of the
project.
Page 1 of 1

Post-Construction Stormwater Management
Permit No. SW8 220315
AS-BUILT PERMITTEE CERTIFICATION
I hereby state that I am the current permittee for the project named above, and I certify by my signature below,
that the project meets the below listed Final Submittal Requirements found in NCAC 02H.1042(4) and the terms,
conditions and provisions listed in the permit documents, plans and specifications on file with or provided to the
Division.
❑ Check here if this is a partial certification. Section/phase/SCM
❑ Check here if this is part of a Fast Track As-built Package Submittal.
Printed Name Signature
I, , a Notary Public in the State of
County of , do hereby certify that
personally appeared before me this day of , 20
and acknowledge the due execution of this as-built certification. (SEAL)
Witness my hand and official seal
My commission expires
Permittee's Certification NCAC .1042(4) I Completed/ i N/A I
Provided l I
I A. DEED RESTRICTIONS/BUA RECORDS r _
1. The deed restrictions and protective covenants have been recorded I y or N
and contain the necessary language to ensure that the project is
maintained consistent with the stormwater regulations and with the
permit conditions.
2. A copy of the recorded deed restrictions and protective covenants Y or N
has been provided to the Division.
3. Records which track the BUA on each lot are being kept. (See Note Y or N
1) _
B. MAINTENANCE ACCESS
1. The SCMs are accessible for inspection, maintenance and repair. Y or N
2. The access is a minimum of 10 feet wide. Y or N
3. The access extends to the nearest public right-of-way. Y or N
C. EASEMENTS
1. The SCMs and the components of the runoff collection /conveyance Y or N
system are located in recorded drainage easements.
2. A copy of the recorded plat(s) is provided. Y or N
D. SINGLE FAMLY RESIDENTIAL LOTS -Puts for residential k is that Y or N
have an SCM include the folloAng:
1. The specific location of the SCM on the lot. Y or N
2. A typical detail for the SCM. Y or N
3. A note that the SCM is required to meet stormwater regulations and
that the lot owner is subject to enforcement action as set forth in Y or N
NCGS 143 Article 21 if the SCM is removed, relocated or altered
without prior approval.
E. OPERATION AND MAINTENANCE AGREEMENT Y or N
1. The O&M Agreement is referenced on the final recorded plat. Y or N
2. The O&M Agreement is recorded with the Register of Deeds and Y or N
appears in the chain of title. _
F. OPERATION AND MAINTENANCE PLAN maintenance records are _ --
being kept in a known set location for each SCM and are available for Y or N
review.
G. DESIGNER'S CERTIFICATION FORD —has been provided to the Y N
Di«,iision.
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Post-Construction Stormwater Management
Permit No. SW8 220315
Note 1-Acceptable records include ARC approvals, as-built surveys, and county tax records.
Provide an explanation for every requirement that was not met, and for every "N/A" below. Attach
additional sheets as needed.
Page 2 of 6

Post-Construction Stormwater Management
Permit No. SW8 220315
AS-BUILT DESIGNER'S CERTIFICATION GENERAL MDC
I hereby state that I am a licensed professional and I certify by my signature and seal below, that
have observed the construction of the project named above to the best of my abilities with all due care
and diligence, and that the project meets the below listed General MDC found in NCAC 02H.1050 in
accordance with the permit documents, plans and specifications on file with or provided to the
Division, except as noted on the "AS-BUILT" drawings, such that the intent of the stormwater rules
and statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM
Check here if this is a part of a Fast-Track As-Built Package Submittal per .1044(3).
Check here if the designer did not observe the construction, but is certifying the project.
LI Check here if pictures of the SCM are provided.
Printed Name Signature
NC Registration Number Date
Consultants Mailing Address:
SEAL:
City/State/ZIP
Phone Number
Consultant's Email address:
U Circle N if the as-built value differs from the Plan. If N is circled, provide an explanation on Page 2.
OO N/E = not evaluated (provide explanation on page 2) 3N/A= not applicable to this SCM or project.
Consuftant's Certification NCAC .1003((3)& General MDC ®As-built ®N/E MNfA
.1050
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment. Y or N
2. The SCM achieves runoff volume match. Y or N
3. Runoff from offsite areas and/or existing BUA is Y or N
bypassed.
4. Runoff from offsite areas and/or existing BUA is directed Y or N
into the permitted SCM and is accounted for at the full
build-out potential.
5. The project controls runoff through an offsite permitted Y or N
SCM that meets the requirements of the MDC.
6. The net area of new BUA increase for an existing project Y or N
has been accounted for at the appropriate design storm
level.
7. The SCM(s) meets all the specific minimum design Y or N
criteria.
B. VEGETATED SETBACKS/ BUA
1. The width of the vegetated setback has been measured Y or N
from the normal pool of impounded waters, the MHW
line of tidal waters, or the top of bank of each side of
rivers or streams.
2. The vegetated setback is maintained in grass or other Y or N
vegetation.
3. BUA that meets the requirements of NCGS 143-214.7 Y or N
(b2)(2) is located in the setback.
4. BUA that does not meet the requirements of NCGS 143- Y or N
214.7 (b2)(2) is located within the setback and is limited
to:
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Post-Construction Stormwater Management
Permit No. SW8 220315
a. Publicly funded linear projects (road, greenway
sidewalk)
b. Water-dependent structures
c. Minimal footprint uses (utility poles, signs, security
lighting and appurtenances)
5. Stormwater that is not treated in an SCM is released at Y or N
the edge of the setback and allowed to flow through the
setback as dispersed flow.
(DAs-butt OWE SN/A
C. VORMWATER OUTLEtS—the outlet hieltiles the peak—
flow or N
flow from the 10 year Eton-; keith.no dot�vnstcpe erosion.
D. VARIATIONS
1. A variation (alternative) from the stormwater rule Y or N
provisions has been implemented.
2. The variation provides equal or better stormwater control Y or N
and e•ual or better protection of surface waters.
. • , : 1 ' 'ITH OTHER REGULATORY PROGRAMS
has beenmet. Y or I
F. SIZING 4t ,volume of the SCM takes the runoff from all -- --��
surfaces into account and is cufficierit to handle the required Y or N
storm depth.
G. CONTAMINATED SOILS —inflitratmg SCM's are not Y or N
located in or on areas with contaminated soils.
H. SIDE SLOPES
1. Vegetated side slopes are no steeper than 3H:1V. Y or N
2. Side slopes include retaining walls, gabion walls, or Y or N
other surfaces that are steeper than 3H:1V.
3. Vegetated side slopes are steeper than 3H:1V(provide Y or N
supporting documents for soils and vegetation).
I. EROSION PROTECTION I
1. The inlets do not cause erosion in the SCM. Y or N
2. The outlet does not cause erosion downslope of the Y or N
discharge point during the peak flow from the 10 year
storm.
J. EXCESS FLOWS —An overflow/bypass has been
provi Y or N
ded.
K. bEWATERI G—A method to drawdown standing water has y or N
been prodded to facilitate mainterkar..e and inspection.
L.. CLEANOUT AFTER CONSTRUCTION —the SCM has been Y or N
cleaned out and converted to its approved design state.
M. MAINTENANCE ACCESS
1. The SCM is accessible for maintenance and repair. Y or N
2. The access does not include lateral or incline slopes Y or N
>3:1.
N. G ALIFICATIONS (FAST RACK PERMIT)— --�
The e1e-gn+nr is licensed under Chapters 89A, 89C, 89E, or Y N
89F of ti•hie General Statutes.
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or"N/E",
below. Attach additional pages as needed:
Page 4 of 6

Post-Construction Stormwater Management
Permit No. SW8 220315
AS-BUILT DESIGNER'S CERTIFICATION FOR LOW DENSITY PROJECTS
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I have
observed the construction of the project named above to the best of my abilities with all due care and diligence,
and that the project meets all of the MDC found in 15A NCAC 02H.1003, in accordance with the permit
documents, plans and specifications on file with or provided to the Division, except as noted on the"AS-BUILT"
drawings, such that the intent of the stormwater rules and the general statutes has been preserved.
❑ Check here if this is a partial certification. Section or phase
❑ Check here if this is part of a Fast-Track As-Built Package Submittal per 15A NCAC 02H .1044(3).
❑ Check here if the Designer did not observe the construction but is certifying the project.
❑ Check here if pictures of the project are provided.
Printed Name Signature
NC Registration Number Date
Consultant's Mailing Address:
SEAL:
City: State: Zip:
Phone:( )
Consultant's Email address:
iD Circle N if the as-built value differs from the Plan/permit. If N is circled, provide an explanation on page 3.
© N/E = Not Evaluated (provide explanation on page 2). ©N/A= Not Applicable to this project/plan.
Consultant's Certification(MDC 15A NCAC 02H .1003)
Project Density and Bulk-Upon Area I (DAs-built I( N/E TN/A
1. The project has areas of high density based on natural drainage Y or N
area boundaries, variations in land use or construction phasing.
2. The project's built-upon area does not exceed the maximum limit Y or N
specified in the permit.
Dispersed Flow DAs-built { P)N/E ®N/A
1. The project maximizes dispersed flow through vegetated areas Y or M
and minimizes channelized flow.
VeDsteted Convayances OAs-uiIt ©N/E ? ON/A
1. Stormwater that is not released as dispersed flow is transported Y or N
by vegetated conveyances.
2. The project has a minimal amount of non-vegetated conveyances Y or N
to reduce erosion.
3. Other than minimal piping under driveways and roads, no piping Y or N
has been added beyond what is shown on the approved plans.
4. Side slopes are no steeper than 3H:1V. Y or N
5. The conveyance does not erode in response to the peak flow from Y or N
the 10-year storm.
Curb outlet systems(If applicable) (DAs-built ©N1E ©N/A
1. The swale or vegetated area can carry the peak flow from the Y or N
10-year storm at a non-erosive velocity.
2. The longitudinal slope of the swale or vegetated areas does not Y or N
exceed 5%.
3. The swale has a trapezoidal cross-section and a minimum bottom Y or N
width of two feet.
4. The minimum length of the swale or vegetated area is 100 feet. Y or N
5. Side slopes are no steeper than 3H:1V. Y or N
Page 5 of 6

Post-Construction Stormwater Management
Permit No. SW8 220315
6. The project utilizes treatment swales designed per Section .1061 Y or N
in lieu of the curb outlet system requirements.
Vegetated Setbacks (If applicable) .. fDAs-bud 2)NJE ON/A
1. The width of the vegetated setback is at least 50'. Y or N
2. The width of the vegetated setback has been measured from the
normal pool of impounded waters, the MHW line of tidal waters, Y or N
or the top of bank of each side of rivers or streams.
3. The vegetated setback is maintained in grass or other vegetation. Y or N
4. BUA that meets the requirements of NCGS 143-214.7(b2)(2) is Y or N
located in the setback.
5. BUA that does NOT meet the requirements of NCGS 143-
214.7(b2)(2) is located within the setback and is limited to:
• Publicly-funded linear projects (road, greenway, or sidewalk) Y or N
• Water dependent structures
• Minimal footprint uses such as poles, signs, utility
appurtenances, and security lights.
6. The amount of BUA within the setback is minimized, and Y or N
channeling of the runoff from the BUA has been avoided.
7. Stormwater is not discharged (via swale or pipe) through a
vegetated setback. Stormwater is released at the edge of the Y or N
setback and allowed to flow through the setback as dispersed flow.
Outlets _ OAs-buttMN/E O ➢/A
1. Stormwater outlets do not cause erosion downslope of the Y or N
discharLe point during the peak flow from the 10-year storm.
Varia ! ®As-built (DN/E MN/A
1. The project has variations from the MDC that were not previously Y or N
approved. (Modification may be required.)
Deed restridbne(If applicable) ®As-built )N/E (3)NIA
1. Deed restrictions are recorded and ensure that the project and
the BUA will be maintained in perpetuity consistent with the Y or N
permit, approved plans, and specifications.
For Subdivisions Only(Residential or Commercial" ' ®As-built N/E COW
1. The number of platted lots is consistent with the approved plans. Y or N
2. The project area is consistent with the approved plans. Y or N
3. The layout of the lots and streets is consistent with the approved Y or N
plan.
4. The width/radius of streets, paved accesses, cul-de-sacs and Y or N
sidewalks is consistent with the approved plan.
5. No piping, other than those minimum amounts needed under a Y or N
driveway or under a road, has been added.
6. The lot grading, road grading, vegetated conveyances, piping, Y or N
inverts, and elevations are consistent with the approved plans.
Provide an explanation below for every MDC that was not met,and for every item marked "N/A" or
"N/E."Attach additional pages as needed.
Page 6 of 6

Operation & Maintenance Agreement
Project Name: Park City RV Park - Phase 1
Project Location: Swansboro 5.4 S 22.410 315
Cover Pa e _
Maintenance records shall be kept on the following SCM(s). This maintenance record shall be kept in a log in a known set location.
Any deficient SCM elements noted in the inspection will be corrected, repaired, or replaced immediately. These deficiencies can
afft the integrity of structures, safety of the public, and the pollutant removal efficiency of the SCM(s).
The SCM(s) on this project include (check all that apply&corresponding O&M sheets will be added automatically):
Infiltration Basin Quantity: I Location(s):
Infiltration Trench Quantity: Location(s):
Bioretention Cell Quantity: Location(s):
Wet Pond Quantity: Location(s):
Stormwater Wetland Quantity: Location(s):
Permeable Pavement Quantity: Location(s):
Sand Filter Quantity: Location(s):
Rainwater Harvesting Quantity: Location(s):
Green Roof Quantity: Location(s):
Level Spreader- Filter Strip Quantity: Location(s):
Proprietary System Quantity: Location(s):
Treatment Swale Quantity: Location(s):
Dry Pond Quantity: Location(s):
Disconnected Impervious Surface Present: No Location(s):
User Defined SCM Present: No Location(s):
Low Density Present: Yes Type: Dispersed flow wart 1 sidt, 'Dily..Lus
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each SCM above, and attached O&M tables. I agree to notify NCDEQ of any problems with the system or prior to any changes to
the system or responsible party.
Responsible Party: Harold L. Shipp,Jr.
Title&Organization: Manager, Park City Property Investments, LLC
Street address: 228 S. Elm Street
City, state, zip: Swansboro, NC 28584
Phone number(s): 252-241-4496
Email: bshipp@ec.r .com
Signature:3:7 ". Date: 7 22-)Z
I b c�l4%. t.& L'a" a a Notary Public for
�- � -Eh � •� ry o the State of IV
County of e of r 4..1 I" t t , do hereby certify that re Id 1- 614 i PP `5 r,
personally appeared before me this AA day of o20 2 Z. and
acknowledge the due execution of the Operations and Maintenance Agre ment .
Witness my hand and official seal, F rl--4 .
' C'�- �' a� flECEIVE'
'. JUL 2 6 2022
'y; ;,�.' Liam l
Seal �'�"` My commission expires 1/q c?
STORM-EZ 7/22/2022
Version 1.5 O&M Agreement Page 1 of 1

Low Density Maintenance Requirements
Important maintenance procedures:
The drainage area to the vegetated conveyance or vegetated receiving area will be carefully managed
to reduce the sediment load to the vegetated conveyance or vegetated receiving area.
After the initial fertilization to establish the grass in the vegetated conveyance or the vegetated receiving
area, fertilizer will not be applied to the vegetated receiving areas.
'The vegetated conveyance or vegetated receiving area will be inspected quarterly. 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.
SCM element: Potential problem: How to remediate the problem:
Vegetation Vegetation is too short or Maintain grassed vegetation such that the swale or vegetated
too long. area does not erode during the peak flow from the 10-year storm
Trash/debris is present. Remove the trash/debris.
—
Areas of bare soil and/or Regrade the soil if necessary to remove the gully, and then re-sod
erosive gullies have (or plant with other appropriate species) and water until
Vegetated receiving areas formed. established. Provide lime and a one-time fertilizer application.
Trees and/or other woody Remove the trees and woody vegetation from the swale, regrade
vegetation are present in the swale if necessary and re-establish grass as shown on the
the swale. approved plans.
Trash/debris is present. Remove the trash/debris.
Areas of bare soil and/or Regrade the soil if necessary to remove the gully, and then re-sod
erosive gullies have (or plant with other appropriate species) and water until
formed. established. Provide lime and a one-time fertilizer application.
Sediment covers the grass Remove sediment and dispose in an area that will not impact
Vegetated conveyances I at the bottom of the swale. streams or SCMs. Re-sod if necessary.
swales/ roadside ditches Regrade the slopes to the permitted configuration per the
(other than curb outlet The side slope is steeper approved plan and reestablish vegetation. If as-built or existing
swales) than the approved conditions do not allow the slopes to be regraded, contact the
configuration. applicable permitting agency.
Grass is dead, diseased or Determine the source of the problem: soils, hydrology, disease,
dying. etc. Remedy the problem and replace plants. Provide a one-time
fertilizer application to establish the ground cover if necessary.
Trees and/or other woody Remove the trees and woody vegetation from the vegetated
vegetation are present in conveyance, regrade the vegetated conveyance if necessary and
the vegetated conveyance. re-establish grass as shown on the approved plans.
flEcFEjj
'
NOV 2 1 2022
BY

Clogging has occurred. Clean out the outlet device. Dispose of the sediment off-site.
The outlet device (if
applicable)
The outlet device is Repair or replace the outlet device.
damaged
Erosion or other signs of
damage have occurred at Repair the damage and improve the flow dissipation structure.
the outlet.
The receiving water Discharges from the site
are causing erosion or Contact the local NCDEQ Regional Office.
sedimentation in the
receiving water.
Rec:elf,.,,,.,
NOV 2 1 2022 tO
BY

DEMLR USE ONLY
Date Rec lived Fee Paid Permit Number
3/VI �2 2 71e ]4- 505e-t- 5v41$ 214,31-
Applicable Rules: ❑Coastal SW-1995 ❑Coastal SW-2008 0 Ph II-Post Construction
(select all that apply) ❑Non-Coastal SW-HQW/ORW Waters ❑Universal Stormwater Management Plan
❑Other WQ Mgmt Plan:
State of North Carolina E C E I V E
Department of Environment and Natural Resources
k 6 21127
Division of Energy,Mineral and Land Resources
S T ORMWATER MANAGEMENT PERMIT APPLICATION E i1 --- -----
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.):
Park City RV Park-Phase 1
2. Location of Project(street address):
4100 Freedom Way (NC Highway 24)
City: Swansboro County: Onslow Zip: 28584
3. Directions to project(from nearest major intersection):
1495 LF West of intersection of Belgrade Swansboro Road(NCSR 1434)and NC Highway 24
4. Latitude: 34°42'17"N Longitude: 77°10'3"W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is(check one): ZNew [Modification ❑Renewal w/ Modificationt
"[Renewals with modifications 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
permit number ,its issue date(if known) ,and the status of
construction: ['Not Started ['Partially Completed* El Completed* *provide a designer's certification
2. Specify the type of project(check one):
®Low Density ❑High Density DDrains to an Offsite Stormwater System Daher
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting 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 Service Center at 1-877-623-6748):
❑LAMA Major ®Sedimentation/Erosion Control:12.2 ac of Disturbed Area
ENPDES Industrial Stormwater 0404/401 Permit:Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name,Project/Permit Number,
issue date and the type of each permit:Erosion Control:ONSLO-2022-026
5. Is the project located within 5 miles of a public airport? No Dyes
If yes,see S.L. 2012-200,Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations
Form SWU-l01 Version Oct.31,2013 Page 1 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): L.C,�-+E
Applicant/Organization: Park City Property Investments,LLC G
Signing Official&Title: Harold Shipp Tr.,Member 1n77 `; ji
b.Contact information for person listed in item la above: BY: _ y
Street Address: 228 S.Elm Street
City: Swansboro State: NC Zip: 28584
Mailing Address(if applicable): same
City: State: Zip:
Phone: (252 ) 241-4496 Fax: ( )
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/Organization: Harol L.Shipp Ir.and Karen L.Shipp
Signing Official&Title: owners
b.Contact information for person listed in item 2a above:
Street Address: 228 S.Elm Street
City: Swansboro State: NC Zip: 28584
Mailing Address(if applicable): same
City: State: Zip:
Phone: (252 ) 241-4496 Fax: ( )
Email:[e-mail]
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:
Signing Official&Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: f )
Email:
4. Local jurisdiction for building permits:Onslow County
Point of Contact Hank Beswetherick Phone#: (910 ) 989-3077
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.
Stormwater treatment provided under low density requirements with no additional impervious area.Runoff
from impervious area is treated via dispersed sheet flow and roadside ditches.
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:
0 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 White Oak River basin.
4. Total Property Area:34.19 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+:34.19 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water(NHV1)line or Mean High Water
(MHW)line,and coastal wetlands landward from the NHW(or MHV line. The resultant project area is used to
calculate overall percent built upon area(B UA). Non-coastal wetlands landward 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 =12 %
9. How many drainage areas does the project have?1 (For high density,count 1 for each proposed engineered
stormwater 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 1 Drainage Area Drainage Area_ Drainage Area—
Receiving Stream Name Queen Creek
Stream Class * SA;HQW
Stream Index Number* 19-41-16
Total Drainage Area(sf) 1,489,397
On-site Drainage Area(sf) 1,489,397
Off-site Drainage Area(sf) 0
Proposed Impervious Area**(sf) 178,728
%Impervious Area**(total) 12
Impervious"'Surface Area Drainage Area 1 Drainage Area_ Drainage Area_ Drainage Area_
On-site Buildings/Lots(sf) 8,434
On-site Streets (sf) 46,120
On-site Parking (sf) 53,600 (+` ®
On-site Sidewalks (sf) 0
Other on-site (sf) 0 Bp 4/0/,/
Future(sf) 70,574
Off-site (sf) 0
Existing BUA***(sf) 0
j Total (sf): 178,728 1 I - -- I `_1
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/`wq/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.
Form SWU-101 Version Oct.31,2013 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 replaced by new BUA.
11. How was the off-site impervious area listed above determined?Provide documentation.N/A
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened&
Endangered Species watershed that may be 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 http://portal.ncdenr.org/web/wq/ws/su/bmp-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://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs. 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 at http://portal.ncdenr.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.ncdenr.org/web/wq/ws/su/statesw/forms docs.
pals
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 94
Form. (if required as per Part VII below)3. Original of the applicable Supplement Form(s)(sealed,signed and dated)and O&M 1/14/
agreement(s)for each BMP. A
4. Permit application processing fee of$505 payable to NCDENR. (For an Express review,refer to /fr
iAl
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.) n
fill5. A detailed narrative(one to two pages)describing the stormwater treatment/management for `J1
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the ,1441
receiving stream drains to class SA waters within 1/2 mile of the site boundary,include the 1
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: 1/
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. LegeNortha ECEI` ,E
e. North arrow. G G `/`
f. Scale.
g. Revision number and dates. JUL 2 6 2022
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 BY:
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).
Form SWU-101 Version Oct.31,2013 Page 4 of 6

p. Vegetated buffers(where required).
9. Copy of any applicable soils report with the associated SHWT elevations(Please identify iti(4
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"x11"copy of the NRCS 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 DEMLR to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed.Deed book:1237 Page No:538
11. For corporations and limited liability corporations(LLC):Provide documentation from the NC 1 -
Secretary of State or other official documentation,which supports the titles and positions held
by the persons listed in Contact Information,item 1a,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.
http://www.secretary.state.nc.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://portal.ncdenr.org/web/lr/state-
stormwater-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 DEMLR,and that they will be recorded prior to the sale of any lot.
VIII. 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: Jonathan L.McDaniel,PE
Consulting Firm: Tidewater Associates,Inc.
Mailing Address: 604-E Cedar Point Boulevard
City: Cedar Point State: NC Zip: 28584
Phone: (252 ) 393-6101 Fax: ( )
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION(if Contact Information,item 2 has been filled out,complete this
section)
I, (print or type name of person listed in Contact Information,item 2a) Harold L. Shipp, Jr. ,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) Harold L. Shipp, Jr. with(print or type name of organization listed in
Contact Information;item la) Park City Property Investments, LLC 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. �,
ECEI `�'®E`:
JUL 2 6 2022
BY:
Form SWU-101 Version 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 permit reverts 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 eneral Statue 143-215.1 and may result in appropriate enforcement
action includin the assessment , civil pe allies of up to$25,000 per day,pursuant to NCGS 143-215.6.
Signature: (2 I / • Date: .7-as a a
r
I, J 1 iz..h.e..+'- r 1. J.= a.c /w ,a Notary Public for the State of 11/4-'C- ,County of
s-Al r-,-t ,do hereby certify that 11 .r o 1 a I- J4,%p p 'Tr. personally appeared
before me this A/day of ,AO(Da,and cknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, L 4.4 ' kA-- g
- -OVA M e.i'‘,� SEAL
,�"i 0.TARY %
'l �Biii;tozr My commission expires /^! 9 d--
X. APPLICANT'S CERTIFICATION
I,(print or type name of person listed in Contact Information,item la) Harold L. Shipp, Ir. ,
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 stor water
rul ` der 5A NCAC 2H.1000 and any other applicable state stormwater requirements.
Signature: - Date: 7 a'2-2 z
I, 1` II Zit. 17-1-0— M. k 4 c 14_ ,a Notary Public for the State of pc_ ,County of
La r e r t 6 ,do hereby certify tha ro l e I- 1 pp 4 r• personally appeared
before me this.?day of o2O7- ,and acknowledge the due executio the application for
a stormwater permit. Witness my and and official seal, (.([.�� AA--
=-_t!T1i'Nl.....k-.....ey 1'1 SEAL
i
i W; %OM). • of
®•® j
. i o
12.3-
1 % �'otizittr �'MA° �`� My commission expires
:\ _-
flECEIVE
JUL 2 6 2022
BY:
Form SWU-101 Version Oct.31,2013 Page 6 of 6

SUPPLEMENT-EZ COVER PAGE
FORMS LOADED
51$.1 8 220 31S
PROJECT INFORMATION
u-=�—�-.r.�:�:.c.s�;+--.d�*+�•�-..—.-�a,a•.zz+aru+asr..�s-aa:��.+ssra.••__"—"-'.-u-s.a�.nYv.r..a;�s..�r-.��aae.yc-a4r-,rr:,�.,d::�..�a;rarzvs:aar +�-nes-crir_
1 Project Name Park City RV Park-Phase 1
2 Project Area(ac) 34,19
3 Coastal Wetland Area(ac) 0
4 Surface Water Area(ac) 0
5 Is this project High or Low Density? Low
6 Does this project use an off-site SCM? Na
COMPLIANCE WITH 02H.1003(1_
7 'Width of vegetated setbacks provided(feet)
8 Will the vegetated setback remain vegetated? N/A
9 If BUA is proposed in the setback,does it meet NCAC 02H.1003(4)(c-d)? N/A
10 Is streambank stabilization proposed on this project? No
NUMBER AND TYPE OF SCMs:11 Infiltration System 0
•
12 Bioretention Cell 0
13 Wet Pond 0
14 Stormwater Wetland 0
15 Permeable Pavement 0
16 Sand Filter 0
17 Rainwater Harvesting(RWH) 0
18 Green Roof 0
19 Level Spreader-Filter Strip(LS-FS) 0
20 Disconnected Impervious Surface(DIS) 0
21 Treatment Swale 0
22 Dry Pond 0
23 StormFilter 0
24 Silva Cell 0
25 Bayfilter 0
26 Filterra 0
FORMS LOADED
DESIGNER CERTIFICATION
27 Name and Title: Jonathan L.McDaniel,PE
28 Organization: Tidewater Associates
29 Street address: 604E Cedar Point Blvd
30 City,State,Zip: Cedar Point,NC 28584
31 Phone number(s): 252-393-6101
32 Email: [e-mail]
Certification Statement:
I certify,under penalty of law that this Supplement-kZ form and all supporting information were prepared under my direction or supervision;that the
information provided in the form is,to the best of my knowledge and belief,true,accurate,and complete;and that the engineering plans,
specifications,operation and maintenance agreements and other supporting information are consistent with the information provided here. N 0�
•
Designer '•OI/ 1�
� SEAL Signature of Designer
37928 •
.* Lt.�auk"—
/
���f 11 i au k"— Date

DRAINAGE AREAS
1 Is this a high density project? No
2 If so,number of drainage areas/SCMs 0
3 Does this project have low density areas? Yes
4 If so,number of low density drainage areas 1
Is all/part of this project subject to previous rule
5 versions? No
FORMS LOADED
DRAINAGE AREA INFORMATION -Entire Site LID 1 --'
's.- T-y�•�-_...r..��-- a -sue . -•—urn. .=•ma c.-_=-- - r. c_-a:�e:=rzti_:szs:
4 e of SCM N/A N/A
5 Total drainage area(sq ft) 1,489,397 i 1,489,397
6 Onsite drainage area(sq ft) 1,489,397 1,489,397
7 Offsite drainage area(sq ft) I; �9 I.
8 Total BUA in project(sq ft) ' 178,728 0! 178,728 I
. New BUA on subdivided lots(subject to permitting)M
9 (sq ft) 1 178,728 y 178,728
New BUA not on subdivided lots(subject to
10 permitting)(sf) i 11 I
. 11 Offsite BUA(sq ft) s 1
1,
12 Breakdown of new BUA not on subdivided lots:
-Parking(sq ft) 53600 sf w 53600 sf .
-Sidewalk(sq ft) npp
-Roof(sq ft) A 8434 sf 8434 sf '
-Roadway(sq ft) A 46120 sf 1 46120 sf y
-Future(sq ft) I 70574 sf 1 70574 sf
-Other,please specify in the comment box ,
below(sq ft)
New infiltrating permeable pavement on 0
13 subdivided lots(sq ft)
New infiltrating permeable pavement not on
14 subdivided lots(sq ft)
Existing BUA that will remain(not subject to
15 permitting)(sq ft) }
16 Existing BUA that is already permitted(sq ft)
17 Existing BUA that will be removed(sq ft)
18 Percent BUA 12% 12%
19 Design storm(inches) • 3.65 in • 3.65 in
20 _ Design volume of SCM(cu ft) N/A N/A
21 Calculation method for design volume N/A N/A
ADDITIONAL INFORMATION
Please use this space to provide any additional information about the
22 drainage area(s):
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4c
/4/01/711,
F

LOW DENSITY
DESIGN REQUIREMENTS FOR LOW DENSITY PROJECTS FROM 02H.1003
1 Is project below density thresholds set forth in the applicable stormwater rule? Yes •
2 Does project maximize dispersed flow and minimize channelization of flow? Yes
3 Has the use of piping been minimized per.1003(2)(c)? Yes M
4 Side slopes of the vegetated conveyances(H:V) 3 sf C
5 Maximum velocity in the vegetated conveyances during the 10-year storm? 1.54
6 Are curb outlet swales proposed? No
7 Maximum longitudinal slope of curb outlet swale(s)(%) N/A
8 Bottom width of curb outlet swale(s)(feet) N/A
9 Maximum side slope of curb outlet swale(s)(H:V) N/A
10 Minimum length of curb outlet swale(s)(feet) N/A i
11 Are treatment swales used Instead of curb outlet swales? No
12 Is stormwater released at the edge of the setback as dispersed flow? Yes
13 Have stormwater outlets been designed to prevent downslope erosion? Yes
Q 14 Are variations to rule.1003 proposed? No '
r'ADDITIONAL INFORMATION __ __ _
15 Please use this space to provide any additional information about this low density project:
Drainage Pervious
Swale BUA Q Slope Va.,„ V. Flow depth
# Area are(ac) � C (cis) CM Its) Its) (it)
1 8.90 4.10 4 80 0.35 28.00 0.23 2.00 1 54 1.77
2
3
4
5
8
7
a
B
10
11 •
^
12
13
14
16
18
17 ��16
19 O� / ,�
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21 ey.
2
22
40,
23
24
26
2s
27
28
29
30