20091082 Ver 1_401 Application_20091009

pplied Keoource Management, F.G.
October 12, 2009
NCDENR, Division of Water Quality
401 Wetlands Unit
Attn: Mr. Ian McMillian
2321 Crabtree Boulevard
Raleigh, NC 27604-2260
RE: Isolated Fill Impact PCN Permit Application
Surf City Promenade
Highway 210 and Highway 50
Surf City, Pender County, North Carolina
Dear Mr. McMillian,
Enclosed are six copy of the following documents for your review;
Pre Construction Notification (PCN)
PAID
Figure 1 Site Vicinity Map
Figure 2 Pender County GIS 2003 Ortho Photo, NCDOT 2' Contour, And SCS
Soils Map
Wetland Survey for Henry Allen Sullivan and Richard Ray Sullivan Prepared by
Stroud Engineering, P.A.
Surf City Promenade Site Plan Prepared By Michael Gallant, P.E., P.A.
Blow Up Of Impact Area Prepared By Michael Gallant, P.E., P.A.
Copy Of USACE Notice Of No Jurisdiction
Agent Authorization With Supporting Deeds
Copy Of NCDENR Stromwater Management Permit Application Form
Check Number 12091 For $240.00 For Application Fee
I will also forward one copy of this correspondence to Joanne Steenhuis in the Wilmington
PO. Box 882
Hampstead, NC 28443
1 910.270.2919
FAX [phone]
09 1082
ulg@lmy/9i
0("T 1 3 2099
DENR - WATER QUALITY
IVETMUDS AND sTORMA%TER BRANCH
October 12, 2009
Regional Office for her review. If you have any questions, or need any additional
information please do not hesitate to contact me at [phone].
Sincerely,
Ellen F. Comette, R.S.
Wetlands Specialist/Project Geologist
Enclosures
CC' Mo Afify, w/enclosures
Promenade at Surf City, LLC
13480 Highway 210
Surf City, NC 28445
Ms. Joanne Steenhuis w/enclosures
NCDENR, WiRO, DWQ
127 Cardinal Drive Extension
Wilmington, NC 28405
2
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
El Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: or General Permit (GP) number: IWGP 100000
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
? 401 Water Quality Certification - Regular ® Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
® Yes ? No For the record only for Corps Permit:

® Yes ? No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ® Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Surf City Promenade
2b. County: Pender p
2c. Nearest municipality / town: Surf City
2d. Subdivision name: NA 0 C T
2e. NCDOT only, T.I.P. or state
project no: NA DENR•WATER QUALITY
NTUMIS AND TORW ATERBRANCH
3. Owner Information
3a. Name(s) on Recorded Deed: Promenade at Surf City, LLC
3b. Deed Book and Page No. 3682/190
3c. Responsible Party (for LLC if
applicable): Mo Afify, Member Manager
3d. Street address: 13480 Highway 210
3e. City, state, zip: Surf City, NC 28445
3f. Telephone no.: 910-328-9800
3g. Fax no.:
3h. Email address:
Page I of 11
PCN Form -Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ® Agent ? Other, specify:
4b. Name: Ellen Corvette
4c. Business name
(if applicable): Applied Resource Management, P.C.
4d. Street address: P.O. Box 882 (Shipping: 257 Transfer Station Road)
4e. City, state, zip: Hampstead
4f. Telephone no.: 910-270-2919
4g. Fax no.: 910-270-2988
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 4235-27-5218-000 & 4235-37-0590-000
1 b. Site coordinates (in decimal degrees): Latitude: 34.44868 Longitude: - 77.56629
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 22.7 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Becky's Creek (2,700 ft to NW,W, & SW)
proposed project:
2b. Water Quality Classification of nearest receiving water: SA, HQW
2c. River basin: Cape Fear
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The site is currently undeveloped and wooded with one delapidated structure on site to be removed. Based on interviews
with the former owner the site was used as a residence and the property was farmed. The farmed areas on the property
were then excavated as borrow pits for the development of Camp Davis and preparation of roads by NCDOT. The
surrounding properties are utilized a residential, commercial and undeveloped.
3b. List the total estimated acreage of all existing wetlands on the property:
1.7 acres of Isolated Wetlands
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
0
3d. Explain the purpose of the proposed project:
Development as a commercial property, for the purpose of providing residents of Surf City and Northern Pender County
access to service and entertainment facilities. The proposed development is a movie theater, bowling allye, arcade,
pharmacy, and outparcels for future businesses to be developed.
3e. Describe the overall project in detail, including the type of equipment to be used:
The site will be developed as a commercial development with, but not limited to, retail and service businesses, offices,
parking and stormwater devices. Equipment will be as follows (but not limited to): Grading equipment, rubber tired and/or
track mounted backhoes, excavators, bush hogs, trackhoe, drum trucks, and other consruction equipment as necessary.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes ? No ? Unknown
project (including all prior phases) in the past?
Comments: USACE found the site to be non-jurisdictional
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ®Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Applied Resource

Name (if known): Ronnie Smith Management, P.C., Ellen Corvette
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
September 24, 2009, USACE Action ID: SAW-2009-00881
5. Project History
5a. Have permits or certifications been requested or obtained for ? Yes ® No ? Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 11
PCN Form - Version 1.3 December 10, 2008 Version
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
The site will be prepared for future development at the onset of construction.
Page 4 of 11
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ? Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ®T Fill/Excavation Isolated ® Yes
? No ? Corps
® DWQ 0.98
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0.98
2h. Comments: It was initially proposed to utilize the entire pond for storm water infiltration; however, that option was turned
down by the Storm Water Section of NCDENR. Then the impact was proposed at 0.99 acres, and then the impact was
reduced an additional 0.01 of an acre to 0.98 acres.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ? P ? T ? PER ? Corps
? INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts
3i. Comments: Not applicable, no streams onsite.
Page 5 of 11
PCN Form -Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments: Not applicable
5. Pond or Lake Construction
If and or lake construction proposed , then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments: Not applicable
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, the n complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse
? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
61 ?P?T ?Yes
? No
B2 ? P ? T ? Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments: Not applicable
Page 6 of 11
PCN Form -Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The area proposed to be impacted is the lowest point for flow for storm water control. Upon site visit with WIRO, DWQ,
401/Wetland Section personel it was proposed to utilize the natural lay of the land and the islolated wetland for storm water
infiltration in its natural state to preserve the isolated wetland area. This option was proposed to the NCDENR, DWQ,
Stormwater Section and the option was declined; therefore, the engineer located the pond in the area of minimal impact and
proposed preservation of the undisturbed wetlands. The actual pond bottom will be excavated below the existing surface and
the berm in the storm water pond will propogate vegetation found in a flooded environment. The berm fill will be place around
the pool elevation to prevent flooding and overflow, the berm will be sloped to stabilize the berm. The area outside of the
pond will receive fill to grade for roadway and right of way. It is proposed to place the 0.72 acres of isolated wetlands into
preservation to prevent any additional impacts on the site. Also by placing the pond near the isolated wetlands will allow
surface water to flow in the direction of the wetland to prevent from them becoming dry in the future.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The isolated wetland area will be silt fenced and isolated so that no vehicular traffic or sediment can enter the area during
construction.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ? Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps
? Mitigation bank
2c. If yes, which mitigation option will be used for this
El Payment to in-lieu fee program
project?
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form -Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 70%
2b. Does this project require a Stormwater Management Plan? ® Yes ? No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
"The project will be served by one wet detention basin with vegetated filter and forebay. Storm water will be collected by
curb inlet and catch basins and directed to the proposed basins by as discrete piping system to be permitted through
NCDENR Division of Water Quality". As designated by Michael Gallant, P.E. for the project.
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ® DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
® Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply):
? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ® No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
? Yes ? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Wastewater will be supported by a 8" gravity sewer to an existing manhole and collected by the Town of Surf City.
Page 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat? ? Yes ? No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts? ? Yes ® No

5c. If yes, indicate the USFWS Field Office you have contacted. ?
Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ? No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
? Yes ? No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? Pender County GIS Flood Panels, October 8, 2009
Ellen Comette 10/08/09
Applicant/Agent's Printed Name Applicant/Agen s Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.) Date
Page 11 of 11
PCN Form - Version 1.3 December 10, 2008 Version

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18

4C1 • E
U.S. ARMY CORPS OF ENGINEERS 2002
WILMINGTON DISTRICT
Action Id. SAW-2009-00881 County: Pender U.S.G.S. Quad: Holly Ridge
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner/Agent: Mr. Mohamad Afify Ms. Ellen Cornette
Address: A'n'A Builders Applied Resource Management, PC
13480 Highway 50-210 Post Office 882
Surf City, NC 28445 Hampstead, NC 28443
Telephone No.: 910-329-9819 910-270-2919
Property description:
Size (acres) 25 Nearest Town Surf City
Nearest Waterway Becky's Creek River Basin AIWW
USGS HUC 030203020405 Coordinates N 35.1278 W -78.1894
Location description: The site is located at the intersection of N.C Highway 210 and N.C. Highway 50, west of Belt
Road, in Surf City, Pender County, North Carolina
Indicate Which of the Following Apply:
A. Preliminary Determination
_ Based on preliminary information, there may be wetlands on the above described property. We strongly suggest you have
this property inspected to determine the extent of Department of the Army (DA) jurisdiction. To be considered final, a
jurisdictional determination must be verified by the Corps. This preliminary determination is not an appealable action
under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part 331).
B. Approved Determination
_ There are Navigable Waters of the United States within the above described property subject to the permit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or
our published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
There are waters of the U.S. including wetlands on the above described property subject to the permit requirements of
Section 404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
_ We strongly suggest you have the wetlands on your property delineated. Due to the size of your property and/or our
present workload, the Corps may not be able to accomplish this wetland delineation in a timely manner. For a more timely
delineation, you may wish to obtain a consultant. To be considered final, any delineation must be verified by the Corps.
_ The waters of the U.S. including wetland on your property have been delineated and the delineation has been verified by
the Corps. We strongly suggest you have this delineation surveyed. Upon completion, this survey should be reviewed and
verified by the Corps. Once verified, this survey will provide an accurate depiction of all areas subject to CWA
jurisdiction on your property which, provided there is no change in the law or our published regulations, may be relied
upon for a period not to exceed five years.
_ The wetlands have been delineated and surveyed and are accurately depicted on the plat signed by the Corps
Regulatory Official identified below on . Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
X There are no waters of the U.S. to include wetlands resent on the above described ro'ect area which are subject
to the permit requirements of Section 404 of the Clean Water Act (33 USC 1344) Unless there is a change in the
law or our published regulations this determination may be rehed upon for a period not to exceed five years from
the date of this notification.
The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act
(CAMA). You should contact the Division of Coastal Management in Washington, NC, at [phone] to determine
their requirements.
Page 1 of 2
Placement of dredged or fill material within waters of the US and/or wetlands without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). If you have any questions regarding this
determination and/or the Corps regulatory program, please contact Ronnie Smith at 910-251-4829.
C. Basis For Determination
This site exhibits wetland criteria as described in the 1987 Corps Wetland Delineation Manual However, the wetlands
are isolated and are not adiacent to a water of the United States
D. Remarks
Isolated wetlands are subiect to regulation by the state of North Carolina Prior to starting work you should contact
Ms. Joanne Steenhuis with the North Carolina Division of Water Ouality. Their address is as follows: NCDENR
NCDWO, 127 Cardinal Drive Extension Wilmington North Carolina 28405
E. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in
B. above)
This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA form to the following address:
District Engineer, Wilmington Regulatory Division
Attn: Ronnie Smith, Project Manager,
Wilmington Regulatory Field Office
PO Box 1890
Wilmington, North Carolina 28402
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for
appeal under 33 CFR part 331.5, and that it has been received by the District Office within 60 days of the date of the NAP.
Should you decide to submit an RFA form, it must be received at the above address by November, 23 2009.
**It is not necessary to submit an RFA form to the District Office if you do not object to the determination in this
correspondence.
Corps Regulatory Official:
Date: September 24, 2009 Expiration Date: September 24, 2009
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to
do so, please complete the Customer Satisfaction Survey located at our website at http://re ug latory.usacesurvey.com/ to
complete the survey online.
Copy Furnished:
Ms. Joanne Steenhuis
NCDENR-DWQ
127 Cardinal Drive Extension
Wilmington, NC 28405
Page 2 of 2
'NOTIFICATION QF ADNIJNISTRATIVE APPEAL OPTIONS AND PROCESS ;AND
REQUEST FOR APPEAL
Applicant: AWA Builders File Number: SAW-2009- Date: September 24, 2009
00881
Attached is: See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of A
permission)
PROFFERED PERMIT (Standard Permit or Letter of permission) B
PERMIT DENIAL C
APPROVED JURISDICTIONAL DETERMINATION D
PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I - The folloNving identifies your rights and options regarding an admir istrative appeal of the above
decision. Additional information may be found at 11th !;'?ti?z?i.l?sace.arnw mill'inetlfunctions/cwlcecwohe or
Corps regulations at 33 CFR Part331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the
permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request that the
permit be modified accordingly. You must complete Section II of this form and return the form to the district engineer. Your
objections must be received by the district engineer within 60 days of the date of this notice, or you will forfeit your right to appeal
the permit in the future. Upon receipt of your letter, the district engineer will evaluate your objections and may: (a) modify the
permit to address all of your concerns, (b) modify the permit to address some of your objections, or (c) not modify the permit
having determined that the permit should be issued as previously written. After evaluating your objections, the district engineer
will send you a proffered permit for your reconsideration, as indicated in Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the
permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein, you
may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of this form
and sending the form to the division engineer. This form must be received by the division engineer within 60 days of the date of
this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division engineer
within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or
provide new information.
ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the date of
this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers Administrative
Appeal Process by completing Section II of this form and sending the form to the district engineer. This form must be received by
the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps
regarding the preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved
JD (which may be appealed), by contacting the Corps district for further instruction. Also you may provide new
information for further consideration by the Corps to reevaluate the JD.
SECTION lI - REQUEST FOR APPE,,%L or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your
objections to an initial proffered permit in clear concise statements. You may attach additional information to
this form to clarify where your reasons or objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps
memorandum for the record of the appeal conference or meeting, and any supplemental information that the
review officer has determined is needed to clarify the administrative record. Neither the appellant nor the Corps
may add new information or analyses to the record. However, you may provide additional information to clarify
the location of information that is already in the administrative record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision If you only have questions regarding the appeal process you
and/or the appeal process you may contact: may also contact:
Ronnie Smith Mr. Mike Bell, Administrative Appeal Review Officer
USAED-RG CESAD-ET-CO-R
PO Box 1809 U.S. Army Corps of Engineers, South Atlantic Division
Wilmington, NC 28402 60 Forsyth Street, Room 9M15
Atlanta, Georgia 30303-8801
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any
government consultants, to conduct investigations of the project site during the course of the appeal process. You
will be provided a 15 day notice of any site investigation, and will have the opportunity to participate in all site
investigations.
Date: Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits and approved Jurisdictional Determinations send this
form to:
District Engineer, Wilmington Regulatory Division, Attn:Ronnie Smith, Project Manager,
Wilmington Regulatory Field Office, PO Box 1890, Wilmington, North Carolina 28402
For Permit denials and Proffered Permits send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Mike Bell,
Administrative Appeal Officer, CESAD-ET-CO-R, 60 Forsyth Street, Room 9M15, Atlanta,
Georgia 30303-8801
1
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Page 9
10/11/2009 18:22 9103299908 ACCESS_REALTY__ PAGE 01/01
October 8, 2009
NCDENR, Division Of Water Quality
Wilmington Regional Office
Attn: Joanne Steenhuis
127 Cardinal Drive Extension
Wilmington, NC 28405
RE: Isolated Fill Impact PCN Permit Application
Surf City Promenade
Highway 210 and Highway 50
Suit City, Pender County, North Carolina
Dear Ms. Steenhuis,
Mr. Mo Afify, member-manager of the Promenade at Surf City, LhC has authorized Applied
Resource Management, PC, and Ellen Corvette to act as the agent for the wetland
determination/delineation and permitting process for the above referenced property.
If you have any questions please do not hesitate t6 contact Ellen Cornette at (910) 270-
2919 or email at [e-mail].
Sincerely,
Mo Afify, Member-Man er
Promenade at Surf City, LLC
09-15-2009
IIIIIIIillllllllllllllll IIIII IIIIIIII aasaz eachey Fevatte000
Pander County, NC Register of Deeds page 1 of 7
?cu}off ya35-a?'31o3-oaoc?
y a35 5y Faye Teaohey Prevatte Register of Deeds
09-15-2009 12:01:03.000 Pander County, NC
PIN OP35-37-ilo??Cx?ap NC REVENUE STAMP: $4400.00 (#3162)
DATE OQ I ?O°l INTO
/
Excise axParcel Ide 'Lumber:
Instrument Prepared By: Moore & Kenan Attorneys at Law; PO Box 957; Burgaw, NC 28425
Return To: Weatherspoon & Voltz LLP; PO Box 10324 Raleigh, North Carolina 27605
STATE OF NORTH CAROLINA
COUNTY OF PENDER
GENERAL WARRANTY DEED
This Deed is made and entered into this the 1" day of September, 2009, by and between
Richard Ray Sullivan and wife, Bonnie Jean Sullivan and Henry Allen Sullivan and wife,
Cynthia Cooper Sullivan ("Grantors") to Promenade at Surf City, LLC, a North Carolina limited
liability company ("Grantee") whose mailing address is 13480 NC Highway No. 50/210, Surf
City, North Carolina 28445..
WITNESSETH:
That Grantors for valuable consideration paid by Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto Grantee in fee
simple, all of that certain tract or parcel of real property located in Topsail Township, County of
Pender, State of North Carolina and being more fully described as follows:
Being that certain tract of land consisting of 22.68 acres as shown on a survey map entitled "Map
of Recombination for Henry Allen Sullivan & Richard Ray Sullivan" prepared by Stroud
Engineering, P.A. dated August 26, 2009 and recorded in Map Book 49, at Page 102 in the
Office of the Pender County Register of Deeds, State of North Carolina, reference to which is
hereby made for a more complete and accurate description.
I
1 09-15-2009
2 01 03.000
Pander County, NC Register of Deeds page 2 of 7
TO HAVE AND TO HOLD the above-described tract of real property and all rights,
privileges and appurtenances thereto belonging to the Grantee in fee simple.
And Grantors covenant with the Grantee that Grantors are seized of the above-described
tract of real property in fee simple, have the right to convey the same in fee simple, that title is
marketable and free and clear of all encumbrances, and that Grantors will warrant and defend the
title against the lawful claims of all persons whomsoever, except for the Exceptions hereinafter
stated.
Title to the real property is subject to the Title Exceptions that are listed within Exhibit A
attached hereto and incorporated herein by reference.
IN TESTIMONY WHEREOF, the said Grantors, have each set their respective hands and
seals to this General Warranty Deed on the day and year first above written.
[GRANTORS' SIGNATURES FOLLOW ON SUCCEEDING PAGES]
2
9-15-2009
2; 0 tte moo
II I II I I II I III III I I I I III I Jill 111111111 B3sa;eP0len p
Ponder ounty, NC moister of Deeds page 3 of 7
--> (SEAL)
Richard Ray Sulli n
STATE OF VIRGINIA
CITY/COUNTY OF
I, \IQr1PSSr`,, a Notary Public of the aforesaid City/County
and State do hereby certify that Richard Ray Sullivan (the "Signatory") personally appeared
before me this day and acknowledged the execution of the foregoing instrument.
I certify that the Signatory personally appeared before me this day and (check one of the
following and mark through all blank lines or spaces in the certificate)
I have personal knowledge of the identity of the Signatory; or
.... 1,-Yhave seen satisfactory evidence of the Signatory's identity, by a current state or federal
identification with the Signatory's photograph in the form of. (check one of the following):
_4,,-'a driver's license; or
in the form of
or
a credible witness has sworn to the identity of the Signatory.
The Signatory acknowledged to me that he/she voluntarily signed the foregoing
instrument for the purpose stated and in the capacity indicated.
n s my hand and official stamp or seal this thejlj day of September, 2009.
ojkU?Q X? (WA 7 n A <I
Notary Public
Print Name: \/ANrsSA 6QN--z Ate ?
(Notary Public must sign exactly as on notary seal)
(NOTARY SEAL)
y?
44 .? ion Expires: n 3? l?c?
.y
g .......
Jill 1111111111111111BII1111111111111 Fay. Teaehey Prevatte 9
3,,,? 4Pander County. NC aClater of eels age 4 :JAL) Pace of 7
Bonnie Jean ullivan
STATE OF VIRGINIA
CITY/COUNTY OF?oI,
I, lar c ? GOA-inl Pl' , a Notary Public of the aforesaid City/County
and State do hereby certify that Bonnie Jean Sullivan (the "Signatory") personally appeared
before me this day and acknowledged the execution of the foregoing instrument.
I certify that the Signatory personally appeared before me this day and (check one of the
following and mark through all blank lines or spaces in the certificate)
I have personal knowledge of the identity of the Signatory; or
I have seen satisfactory evidence of the Signatory's identity, by a current state or federal
identification with the Signatory's photograph in the form of. (check one of the following):
? a driver's license; or
in the form of ; or
a credible witness has sworn to the identity of the Signatory.
The Signatory acknowledged to me that he/she voluntarily signed the foregoing
instrument for the purpose stated and in the capacity indicated.
W' ess my hand and official stamp or seal this the Xlw?:- day of September, 2009.
NCWL?AC,
Notary Public'
Print Name: V(1?leS.SGza???
(Notary Public must sign exactly as on notary seal) j ?',
(NOTARY SEAI d4 ??s
My Commission Expires: Q 4 ?Nl , k. K,
;A..rto +erto .. :l'
09-16 2009
IIIIIIIIII?III III 1111111 I IIII IIIIi 111 B3sseaOChey Prevatt.900
Ponder ounty, NC egister of Deeds page S of 7
,(SEAL)
Henry Alle ul?
STATE OF NORTH CAROLINA
COUNTY OF G
I, ?o?P ?2 ?A?c? , a Notary Public of the aforesaid County and State do hereby
certify that Henry Allen Sullivan (the "Signatory") personally appeared before me this day and acknowledged
the execution of the foregoing instrument.
I certify that the Signatory personally appeared before me this day and (check one of the following and mark
throug,h all blank lines or spaces in the certificate)
? I have personal knowledge of the identity of the Signatory; or
1-<:::T have seen satisfactory evidence of the Signatory's identity, by a current state or federal identification
with the Signatory's photograph in the form of (check one of the following):
a driver's license; or
--==in the form of ; or
credible witness has sworn to the identity of the Signatory.
The Signatory acknowledged to me that he/she voluntarily signed the foregoing instrument for the
purpose stated and in the capacity indicated.
Witness my hand and official stamp or seal this the 2- day of September, 2009.
Notary Pu lic I
Print Name: ` ? p i?c ccdry,
(Notary Public must sign exactly as on notary seal) ?Mf?'%
(NOTARY SEAL a • '"'"""'?'•.1d ':
My Commission Expires: ?' q 2U 10 '?j 17 : _
III III IIIIIJill 1111111111111111111111 J3 8;eteheP X1- 15-2009
01.03 000
Pender County, NC Register of Deeds page B of 7
w-4$EAL)
Cy thia Cooper Sullivan
STATE OF NORTH CAROLINA
COUNTY OF A
I, `Le , 0 • Cct4e - , a Notary Public of the aforesaid County and
State do hereby certify that Cynthia Cooper Sullivan (the "Signatory') personally appeared
before me this day and acknowledged the execution of the foregoing instrument.
I certify that the Signatory personally appeared before me this day and (check one of the
following and mark through all blank lines or spaces in the certificate)
I have personal knowledge of the identity of the Signatory; or
I have seen satisfactory evidence of the Signatory's identity, by a current state or federal
identificationy.th the Signatory's photograph in the form of: (check one ofthefollowing):
a driver's license; or
X in the form of ; or
" - credible witness has sworn to the identity of the Signatory.
The Signatory acknowledged to me that he/she voluntarily signed the foregoing
instrument for the purpose stated and in the capacity indicated.
Cotary Witness my hand and official stamp or seal this the Z day of September, 2009.
Pub C
Print Name: D[O }-
(Notary Public must sign exactly as on notary seal)
My Commission Expires: l9. Zot
(NOTARY

" 5-2009
tie 000
II I lillll 11111 it l 1111111 tit l ll 111111 ;36 2 P0196 P e0
Pander County, NC egister of Deeds page 7 of 7
EXHIBIT A
(Title Exceptions)
1. Pender County real property taxes for the year 2010 and subsequent years.
2. Town of Surf City real property taxes for the year 2010 and subsequent years.
3. Permit granted to Carolina Telephone and Telegraph Company, Inc. recorded in Deed Book
276, at Page 188 of the Pender County Registry.
4. Right-of-way easement in favor of Tide Water Power Company recorded in Deed Book
276, at Page 405 of the Pender County Registry.
5. Deed of Easement in favor of the Town of Surf City, a North Carolina municipal
corporation, recorded in Deed Book 3328, at Page 283 of the Pender County Registry.
6. Right-of-way easement in favor of Tide Water Power Company recorded in Deed Book
226, at Page 497 in the Office of the Pender County Register of Deeds.
7. Deed of Easement in favor of the Town of Surf City, a North Carolina municipal
corporation, recorded in Deed Book 3328, at Page 292 of the Pender County Registry.
7
DWQ USE ONLY
Date Received Fee Paid Permit Number

Applicable Rules: ? Coastal SW -1995 ? Coastal SW - 2008 ? Ph II - Post Construction
(select all that apply) ? Non-Coastal SW- HQW/ORW Waters ? Universal Stormwater Management Plan
? Other WQ M t Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Surf City Promenade
2. Location of Project (street address):
Corner of Hwy 210/ 50
City:Surf City County:Pender Zip:28445
3. Directions to project (from nearest major intersection):
Project is on the south east corner of the Tunction of Hwy 210 and Hwy 50 adjacent to the Food Lion site
directly across the street from Gateway Plaza
4. Latitude: " N Longitude: " W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ?Modification
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* ? Completed* *provide a designer's certification
2. Specify the type of project (check one):
?Low Density ®High Density ?Drains to an Offsite Stormwater System ?Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, 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):
?CAMA Major ®Sedimentation/Erosion Control: 22 ac of Disturbed Area
?NPDES Industrial Stormwater ®404/401 Permit: Proposed Impacts Less than 1 acre (isolated
wetlands)
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:
III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/ Organization: Promenade at Surf City, LLC
Signing Official & Title:Mo Afify, Member Manager
b. Contact information for person listed in item 1a above:
Street Address:13480 Hwy 210/50
City:Surf City State:NC Zip:28445
Mailing Address (if applicable):same
City:
State:
Phone: (910 ) 3289800 Fax:
Email:
State: Zip:
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:Promenade at Surf City, LLC
Signing Official & Title:same as above
b. Contact information for person listed in item 2a above:
Street Address:same as above
City: State: Zip:
Mailing Address (if applicable):
City:
Phone:
Email:
Fax: ( )
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/ Organization:
Signing Official & Title:
b. Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone: ( )
Email:
State:
Zip:
Zip:
Fax: ( )
4. Local jurisdiction for building permits: Town of Surf City
Point of Contact:Gene Casey Phone #: (910 ) 3284131
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Discrete collection_ystem and pipe network. All runoff directed to a wet detention basin and vegetated filter.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
? Approval of a Site Specific Development Plan or PUD Approval Date:
? Valid Building Permit Issued Date:
Other: Date:
b. 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 Cape Fear River basin.
4. Total Property Area: 22.7 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+:22.7 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 (NHW) line or Mean High Water
(MH[M line, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non-coastal wetlands landward of the 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 = 70

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 _ Drainage Area _ Drainage Area _ Drainage Area _
Receiving Stream Name Becky Creek
Stream Class * SA;HQW
Stream Index Number * 18-87-8
Total Drainage Area (so 988,137
On-site Drainage Area (so 988,137
Off-site Drainage Area (so 0
Proposed Impervious Area** s 691,696
% Impervious Area** total 70
Impervious' Surface Area Drainage Area _ Drainage Area _ Drainage Area _ Drainage Area _
On-site Buildings/Lots (so 60,099
On-site Streets (so 219,410
On-site Parking (so
On-site Sidewalks (sf) 18,842
Other on-site (so 393,345 (out parcels)
Future (so
Off-site (so 0
Existing BUA*** (so 0
Total (so: 691,696
* Stream Class and Index Number can be determined at: http.Ilh2o.enr.state.nc.us/bims/reports/reportsWB.html
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
'Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new B UA.
11. How was the off-site impervious area listed above determined? Provide documentation. NA
Projects in Union County: Contact DWQ 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 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 hgp://h2o.enr.state.nc.us/su/bmp forms.htm.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from http://h2o.enr.state.nc.us/su/bmp_forms.htm. The complete application
package should be submitted to the appropriate DWQ Office. (The appropriate office may be found by locating
project on the interactive online map athttp://h2o.enr.state.nc.us/su/msi maps.htm.)
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://h2o.enr.state.nc.us/su/bmp_forms.htm.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
hgp://www.envhelp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/ Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/ project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off-site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).

9. Copy of any applicable soils report with the associated SHWT elevations (Please identify _
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"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 DWQ to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: Page No: _
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC _
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 21-1.1003(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.
hW2://www.secretaiy.state.nc.us/Corporations/CSearch.awx
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://h2o.enr.state.nc.us/su/bmp forms.htm#deed restrictions. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
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:Michael C. Gallant PE
Consulting Firm: Michael C. Gallant, PE, PA
Mailing Address:PO Box 4039
City:Surf City State:NC Zip:28445
Phone: (910 ) 3282188 Fax: ( )
Email: gallantmc2yahoo.com
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) , 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 1a) with (print or type name of organization listed in
Contact Information, item 1b) 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.

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/ Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date:
I, , a Notary Public for the State of County of
do hereby certify that
before me this _ day of
personally appeared
, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires
I, (print or type name of person listed in Contact Information, item 2)
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Signature: Date:
I,
do hereby certify that
a Notary Public for the State of
County of
personally appeared
before me this _ day of and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires