SW5111201_CURRENT PERMIT_20120213

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW ,42Ila(%
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
, 9(i/��_u z 3
YYYYMMDD

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Charles Wakild, PE
Director
January 10, 2012
Ms. Sara Rudolph
Franklin -Vance -Warren Opportunity, Inc.
P.O. Box 1453
Henderson, NC 27536
Subject: Stormwater Permit No. SW5111201
Franklin -Vance -Warren Opportunity, Inc.
High Density Commercial Bio-Retention Project
Franklin County
Dear Ms. Rudolph:
Dee Freeman
Secretary
FEB 13 2012
ABC DEER
Ra�P.!gh Raci-) al Office
The Stormwater Permitting Unit received a complete Stormwater Management Permit
Application for Franklin -Vance -Warren Opportunity, Inc. on January 10, 2012. Staff review of the
plans and specifications has determined that the project, as proposed, will comply with the
Stormwater Regulations set forth in Title 15A NCAC 2H.1000 and Session Law 2006-246. We
are forwarding Permit No. SW5111201, dated January 10, 2012, for the construction, operation
and maintenance of the subject project and the stormwater BMPs.
This permit is conditional on the submittal of a low density stormwater permit application,
by February 10, 2012; for the adjacent New Birth Apostolic Church, Inc. property and the
shared driveway that will be built along with the Franklin -Vance -Warren Opportunity, Inc.
project. If in the future, the church property goes above the low density BUA threshold
(24/o BUA), all BUA including the shared drive will have to be captured and treated per the
high density requirements at that time. This will be done via a permit modification.
This permit shall be effective from the date of issuance until January 9, 2020 and shall be
subject to the conditions and limitations as specified therein, and does not supersede any other
agency permit that may be required. Please pay special attention to the conditions listed in this
permit regarding the Operation and Maintenance,of the BMP(s), recordation of deed restrictions,
procedures for changes of ownership, transferring the permit, and renewing the permit. Failure to
establish an adequate system for operation and maintenance of the stormwater management
system, to record deed restrictions, to follow the procedures for transfer of the permit, or to
renew the permit, will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within thirty (30) days following
receipt of this permit. This request must be in the form of a written petition, conforming to
Chapter 150E of the North Carolina General Statutes, and filed with the Office of Administrative
Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands are made this
permit shall be final and binding.
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality org
An Equal Oppo to Wy 1 Affirmative Action Employer
One
NorthCarolina
naturally

Ms. Sara Rudolph
SW51 1 1201 — Franklin -Vance -Warren Opportunity, Inc.
January 10, 2012
This project will be kept on file at the Raleigh Regional Office. If you have any questions, or
need additional information concerning this matter, please contact Robert Patterson at (919)
807-6375; or [e-mail].
Sincerely,
/,74-
for Charles Wakild, PE
cc: SW5111201 File
ec: Danny Smith — Raleigh Regional Office
Peter Sokalski, PE — Pond Water Solutions, Inc.
Page 2 of 2

State Stormwater Permit
Permit No. SW5111201
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Franklin -Vance -Warren Opportunity, Inc.
FVW Opportunity, Inc.
417 South Main St., Franklinton, Franklin County
FOR THE
construction, operation and maintenance of a bioretention cell in compliance with the
provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter referred to as
the "stormwater rules') and the approved stormwater management plans and
specifications and other supporting data as attached and on file with and approved by
the Division of Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until January 9, 2020, and shall
be subject to the following specified conditions and limitations:
1. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 of this permit. The stormwater control has been
designed to handle the runoff from 9,283 square feet of impervious area.
3. The tract (Parcel A) will be limited to the amount of built -upon area as indicated
in Section 1.7 of this permit, and per the application documents and as shown on
the approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 6

State Stormwater Permit
Permit No. SW5111201
7. The following design criteria have been provided in the bioretention cell and must
be maintained at design condition:
a. Drainage Area, acres:
Onsite, ft :
Offsite, ft2:
b. Total Impervioug Surfaces, ft2:
Onsite, ft :
Offsite, ft2:
C. Design Storm, inches:
d. Max. Ponded Depth, feet:
e. Seasonal High Water Table, fmsl
f. Planting Media Depth, feet:
g. Cell Dimensions, feet:
h. Planting Elevation, fmsl-
i. Bottom Surface Area, ft�:
j. Permitted Storage Volume, ft3.
k. Bypass 1 Storage Elevation, fmsl:
1. Drawdown Time, hours:
M. Underdrain Diameter, inches:
n. Total number of plants provided:
o. Receiving Stream/River Basin:
p. Stream Index Number:
q. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
0.28
12,341
0
9,283
9,283
0
1.0
0.75
431.00
2.0
90x12
437.00
1,074
910
437.75
21
4.0
grass sod
Franklin Branch 1 Tar - Pamlico
28-29-(2)
"C; NSW"
1. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use immediately upon stabilization of
the drainage area(s).
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted stormwater system functions at optimum efficiency. The
approved Operation and Maintenance Plan must be followed in its entirety and
maintenance must occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, swales, filter
media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The permittee shall submit to the Division of Water Quality Raleigh Regional
Office an annual summary report of the maintenance and inspection records for
each BMP. The report shall summarize the inspection dates, results of the
inspections, and the maintenance work performed at each inspection.
Page 2 of 6

State Stormwater Permit
Permit No. SW5111201
6. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with other
supporting data.
7. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
8. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
9. Access to the stormwater facilities shall be maintained via appropriate recorded
easements at all times.
10. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made. ,
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form signed by both parties, to the
Division of Water Quality, accompanied by the supporting documentation as
listed on page 2 of the form. The approval of this request will be considered on
its merits and may. or may not be approved.
Page 3 of 6

State Stormwater Permit '
Permit No. SVV5111201
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, 'rules,'regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 10th day of January, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Lnuck vvaKiia, v t, uirector
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4of6

State Stormwater Permit
Permit No. SW5111201
Franklin -Vance -Warren Opportunity, Inc.
Stormwater Permit No. SW5111201
Franklin County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
(Project Name)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification;
Signature
Registration Number
Date
SEAL
Page 5 of 6

State Stormwater Permit `
Permit No. SW5111201
Certification Requirements:
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation, per the vegetation plan.
9. Vegetated slopes are no steeper than 11.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as pretreatment,
outlet/bypass, underdrains, and permanent vegetation.
15. The required system dimensions are provided per the approved plans.
Please submit completed form to
Cc..
DWQ - Raleigh Regional Office
Surface Water Protection
3800 Barrett Drive
Raleigh, NC 27609
Henry Gupton, Town of Franklinton Building
Inspections
Page 6 of 6

DWQ USE ONLY
D to Occeived
Fee Paid
Permit Number
/Z-Z 9 I I
I -A� oS 'A)3'oI
�-� tkka-oI
Applicable ules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 rKph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management flan
❑ Other WQ M mt Plan:
State of North Carolina �` � ' �`�� � IS
Department of Environment and Natural Resource
Division of Water Quality l
I�1FEB 132012
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocapied for use as an original
1. 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.):
Franklin -Vance -Warren Opportunity, Inc.
2. Location of Project (street address):
417 South Main Street
City:Franklinton County:Franklin/_ip:27525
3. Directions to project (from nearest major intersection):
Take US-1 N out of Raleigh. From its intersection with 1-540, travel approximately 15.5 mi north toward
Franklinton. Turn right onto S Main St US-1 Alt. and travel approximately 1.5 mi north toward NC 56.
Parcel is on the right just before NC 56. _
4. Latitude:36° 05' 55" N Longitude:78° 27' 32" W of the main entrance to the project.
IL 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, Franklin July 13 2011 and the previous name of the project, if different than currently
proposed, Franklin -Vance -Warren Opportunity, Inc.
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: 1.3 ac of Disturbed Area
❑NPDES 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 perm it: Franklin -Vance -Warren Opportunity, Inc.; T
Permit No. FRANK-2012-001, Date: 8/11/2011; Sedimentation & Erosion Control Permit ^�
Form SWU-101 Version 07Jun2010 Page I of 6

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:Frank] in -Vance -Warren QnpaLLUnity,Inc.
Signing Official & Title:Sara Rudolph - Chief Executive Officer
b.Contact information for person listed in item 1a above:
Street Add ress:180 Beckford Drive
City:Henderson
Mailing Address (if applicable):P.O. Box 1453
City:Henderson
Phone: [phone]
l?mail:srudolph a fvwopp.coni
State:NC
State:NC
Zip:27536
Zip:27536
Fax: (252 ) 492-6250
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. ("Phis is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applIcable):
City:
State:
State:
Phone: ( ) Pax:
Email:
Zip:
Zip:
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/OrganizatiomPo_nd Water Solutions, Inc.
Signing Official & Title:Peter Sokalski, PE
b.Contact information for person listed in item 3a above:
Mailing Address:P.O. Box 8342
CityYocky Mount _ _ _ State:NC Zip:27803
Phone: (252 ) 904 - 8078 Fax: { )
Email:peter@pondwatersolu tions.com
4. Local jurisdiction for building permits: Town of Franklinton
Point of Contact:Henry Gu
Phone #: (919 ) 494 - 2520 _
Form SWU-101 Version 07Jun2010 Page 2 of6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the storniwater runoff will be treated.
The majority of runoff will be treated through the proposed bioretention cell. A small portion of runoff
fromthe proposed project will drain to an existing roadside ditch.
2. a.If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ ApprovaI of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b. If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW - 1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the Tar -Pamlico River basin.
4. Total Property Area: 0.669 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:0.669 acres
Total project area shall be calculated to eiclrule the follou,itrgg the normal pool of impowided structures, the area
between the barks of strew is and rivers, the area below the Norrnal High Water (NHW) line or Mean High Water
(MHW) 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). No)i-coastal wetlatids latrdzttrird of the NNW (or MHW) line tnay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 39.95 %
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stortnwater BMP. For low densihj and other projects, rise I 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
Franklin Branch
Stream Class *
C; NSW
Stream Index Number *
28-29-(2)
Total Drainage Area (so
12,341
On -site Drainage Area (sf)
12,341
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
9,283
% Impervious Area'* total
75.2To
Impervious— Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Draina e Area
On -site Buildings/Lots (so
4,269
On -site Streets (so
0
On -site Parking (so
4,463
On -site Sidewalks (so
551
Other on -site (so
0
Future(so
0
Off -site (SO
0
Existing BUA*** (so
0
Total (so:
9,283
Strearn Class and !rides Nrrtnber can be deterinined at: http.aortal.ncdetrr.org ttebAvq&s/csrr/classi cations
�* Itrrppervious area is defined as the built upon area including, but riot litnited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version 073un2010 Page 3 of 6

'Report only that amount of existing BLIA that will remain after development. Do not report any existing BLIA 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.
Projects in Union County: Contact Dil'Q Central OJfice staff to check if the project is located 11 ithin a 77u errterrerl &
Endangered Species il,atershed that nary he 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 http//portal.ncdennorg/web/wg/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from http:/`portal.ticdenr.org/web/wq/ws/su/statesw/fornis_docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://portal.ncdetir,org/%veb/wows/su/maps.)
Please indicate that the following required information have been provided bV 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 1=t Z/portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs.
-1f ' ' ]s
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 fart Vll 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
http1/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/managenientfor
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
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 MI-IW 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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
in. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
Form SWU-101 Version 07Jun2010 Page 4 of 6
Mi
lr7mlu

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 f rr DWQ to verifij the SHWT' prior
to Submittal, [phone].)
10. A copy of the most current property deed. Deed book: 7� 2 Page No: Ll6b
11. For corporations and limited liability corporations (LI.C): 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 1a, 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.
http://www.secretary.state.iic.us/Corp2ratioiis/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.ncdeiir.org/web/wq/tips/su/statesw/foriiis does. 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:Peter Sokalski, PE
Consulting Firm: Pond Water Solutions, Inc.
Mailing Address:P.O. Box 8342
City:Rocky Mount State:NC Zip:27803
Phone: (252 904 - 8078_ Fax:
Email: peter@pond watersolu tions.com
IX. PROPERTY OWNER AUTHORIZATION (if Cox tact Information, item 2 has been filled out, complete this
section)
1, (print or type rraure of person listed in Corr fact Information, item 2a) certify that I
own the property identified in this permit application, and thus give permission to (print or type rraure (f person
listed in Contact Information, item In) with (print or hype name r f organization listed in
Contact Information, item 1a) OWMnAhna& to develop the project as currently proposed. A copy of
the lease agreement or pending property safe-, contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Dorm SWU-101 Version 07.1un2010 Page 5 of 6

As the legal property owner 1 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 penaltie?lof up t9-V5,000 per„daAursuant to NCGS 143-215.6,
Signature:
Date: Aa -8 1
I, `J V ' , a Notary Public for the State of County of
W 0i114iYti- do hereby certify that -.J 0-4Q S • ltiO personally appeared
before me this Aday of 44 A'411 , and a nowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, 8 t::go H
SEAL
My commission expires A11i -21) ` 1
X. APPLICANT'S CERTIFICATION
1, (17rint or type name of person listed bi Confaet Information, itein 1a) Sara Rudolph _
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 un(pr 15AACAC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Signature:
Date: ! a ` g—[ I
I, o- V _ a Notary Public for the State of �y�'1 QA6-" , County of
do hereby certify that ��R s - personally appeared
before me thisA day of&&hn4h _ , do), , and/knowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, /��`- e I
SEAL
My commission expires Agx� 17, oS e //
Fonn SWU-101 Version 07Jun2010 Pale 6 of 6

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Permit Number: Sh/.S/ j 12O%
(lo he provided by Dlt'Q)
Drainage Area Number: I
Bioretention Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
Important operation and maintenance procedures:
— Immediately after the bioretention cell is established, the plants will be watered
twice weekly if needed until the plants become established (commonly six
weeks).
— Snow, mulch or any other material will NEVER be piled on the surface of the
bioretention cell.
— Heavy equipment will NEVER be driven over the bioretention cell. + LLP -
- Special care will be taken to prevent sediment from entering the bioretention cell: 4,, co
LL
— Once a year, a soil test of the soil media will be conducted. j , g r
After the bioretention cell is established, I will inspect it once a month and within 24
hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal-�
County). Records of operation and maintenance will be kept in a known set location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblems:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
bioretention cell
erosive gullies have formed,
remove the gully, and then plant a
ground cover and water until it is
established. Provide time and a
one-time fertilizer application.
The inlet device: pipe,
The pipe is clogged (if
Unclog the pipe. Dispose of the
stone verge or swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
Form SW401-Bioretention O&M-Rev.3 Page I of 4

BMP element:
The pretreatment area
The bioretention cell:
vegetation
The bioretention cell:
soils and mulch
Potential problems:
Flow is bypassing
pretreatment area and/or
gullies have formed.
Sediment has accumulated to
a depth greater than three
inches.
}-rosion has occurred
Weeds are present.
Best professional practices
show that pruning is needed
to maintain optimal plant
health.
Plants are dead, diseased or
dying.
'free stakes/wires are present
six months after planting.
Mulch is breaking down or
has floated away.
Soils and/or mulch are
clogged with sediment.
An annual soil test shows that
pl-I has dropped or heavy
metals have accumulated in
the soil media.
How I will remediate the problem:
Regrade if necessary to route all
flow to the pretreatment area.
Restabilize the area after grading.
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
restabilize the pretreatment area.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Remove the weeds, preferably by
hand.
Prune according to best professional
practices.
Determine the source of the
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Remove tree stake/wires (which
can kill the tree if not removed).
Spot mulch if there are only random
void areas. Replace whole mulch
layer if necessary. Remove the
remaining much and replace with
triple shredded hard wood mulch at
a maximum depth of three inches.
Determine the extent of the clogging
- remove and replace either just the
top layers or the entire med is as
needed. Dispose of the spoil in an
appropriate off -site location. Use
triple shredded hard wood mulch at
a maximum depth of three inches.
Search for the source of the
sediment and remedy the problem if
possible.
Dolomitic lime shall be applied as
recommended per the soil test and
toxic soils shall be removed,
disposed of properly and replaced
with new planting media.
Donn SW401-Bioretention O&M-Rev.3 Page 2 of 4

BMP element:
Potential roblems:
How I will remediate the problem.
The underdrain system
Ciogging has occurred.
Wash out the underdrain system,
if applicable)
The drop inlet
Clogging has occurred.
Clean out the drop inlet. Dispose of
the sediment off -site.
The drop inlet is damaged
Repair or replace the drop inlet.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
ou tlet.
733-1786.
Form SW401-Bioretention O&M-Rev.3 Page 3 of 4

Pennit Number. 5V5P J zoj
(to he provided by 1)IVQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project nume:Frank] in -Vance -Warren Opportunity, Inc.
BMP drainage QreCI number: I
Print name:Sara Rudolph
Title:Chief Executive Officer
Address:180 Beckford Drive, Henderson, NC 27536
Phone:
Signatt
Date: f
Note: The legally responsible party should not be a homeowners association unless more than 50%, of
the lots have been sold and a resident of the subdivision has been named the president.
I, 6 a-VU,y. eu- Q , a Notary Public for the State of
U C&A , County of UV Qhf1�n , do hereby certify that
A, G. personally appeared before me this SkA
day of I&Q.c Il. ,and acknowledge the due execution of the
forgoing bioretention maintenance requirements. Witness my hand and official seal,
SEAL
My commission expires_Abc� n, as 1(
Fonn SW401-Bioretention I&M-Rev, 2 Page 4 of 4

Permit Number— w5t i) I Lti)
(to be provided by DWQ)
O��f W ATFRQG
ARAr >
NCDENR T
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part Ill) must be printed, filled out and submitted along with all of the required information.
I. PROJECT INFORMATION 71
Project name FVW, Inc
Contact name Peter 5okalski, PE
Phone number [phone]
Date October 18, 2011
Drainage area number 1
11. DESIGN INFORMATION
Site Characteristics
Drainage area
12,341 ft
Impervious area
9,283 ft2
Percent impervious
75.2%
Design rainfall depth
1.0 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak flow required?
Y (Y or N)
1-yr. 24-hr runoff depth
2.88 in
1-yr, 24-hr intensity
0.12 in/hr
Pre -development 1-yr, 24-hr peak flow
0,038 ft'/sec
Post -development 1-yr, 24-hr peak flow
0.595 ft'/sec
Pre/Post 1-yr, 24-hr peak control
0.557 ft'/sec
Storage Volume: Non -SA Waters
Minimum volume required
805.0 ft,
Volume provided
910.0 ft3
Storage Volume: SA Waters
1,5" runoff volume
It
Pre -development 1-yr, 24-hr runoff
ft3
Post -development 1-yr, 24-hr runoff
ft3
Minimum volume required
0 W
Volume provided
W
Cell Dimensions
Ponding depth of water
9 inches
Ponding depth of water
0.75 ft
Surface area of the top of the bioretention cell
1,074.0 ft2
Length:
90 ft
Width:
12 ft
-or- Radius
ft
Media and Soils Summary
Drawdown time, ponded vdume
9 hr
Drawdown time, to 24 inches below surface
12 hr
Drawdown time, total:
21 hr
In -situ soil:
Soil permeability
0,01 in/hr
Planting media soil:
Soil permeability
1,00 in/hr
Soil composition
% Sand (by volume)
85%
% Fines (by volume)
10%
Organic (by vclume)
5%
Total: 100%
OK
T
OK
OK
OK
OK
OK
`5
s [�
1�
I C 8 13 2012
P IPii
Insufficient Increase infiltration rate or include underdrains.
OK
OK
OK
OK
Phosphorus Index (P-Index) of media 20 (unitless) OK
Form SW401-Bioratention-Rev.8
June 25, 2010
Parts I and II. Design Summary, Page 1 of 2

14
Permit Number;
(to be provided by 0WQ)
Basin Elevations
Temporary pool elevation
Type of bioretention cell (answer 'Y" to only one of the two
following questions):
Is this a grassed cell?
Is this a cell with trees/shrubs?
Planting elevation (top of the mulch or grass sod layer)
Depth of mulch
Bottom of the planting media soil
Planting media depth
Depth of washed sand below planting media soil
Are underdrains being installed?
How many clean out pipes are being insta{led?
What factor of safety is used for sizing the underdrains? (See
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
the bottom of the cell to account for underdrains
Bottom of the cell required
SHWT elevation
Distance from bottom to SHWT
Internal Water Storage Zone (IWS)
Does the design include IWS
Elevation of the top of the upturned elbow
Separation of IWS and Surface
Planting Plan
Number of tree species
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
through a vegetated filler?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the BMP located at least 30 feet from surface waters (50 feet if
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Are the vegetated side slopes equal to or less than 3:1?
Is the BMP located in a proposed drainage easement with access
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
Is the area surrounding the cell likely to undergo development in
the future?
Are the slopes draining to the bioretention cell greater than 20%?
Is the drainage area permanently stabilized?
Pretreatment Used
(Indicate Type Used with an "X" in the shaded cell)
Gravel and grass
(flinches gravel followed by 3-5 ft of grass)
Grassed swale
Forebay
Other
437.75 fmsl
Y (YorN) OK
N (Y or N)
437 fmsl
inches
435 fmsl
2 ft
0.25 ft
Y (Y or N)
2 OK
2 OK
1 ft
433.75 fmsl
431 fmsl
2.75 ft OK
N (YorN)
fmsl
437 ft
0
0
0 Recommend more species.
N (Y or N) Excess volume must bypass cell.
N (Y or N) Excess volume must pass through filter.
ft
(Y or N)
Y (Y or N) OK
Y (Y or N) OK
Y (Y or N) OK
Y (Y or N) OK
1 fUsec OK
N (Y or N) OK
N (Y or N) OK
Y (YorN) OK
x
OK
Form SVV401-Bioretention-Rev.8
June 25, 2010
Paris I and II. Oesign Summary, Page 2 of 2

Ap q (0�
SwS1 J I2c/
11131IM9191IN110
Doc 10: 004D98D3D002 TvDf: CRP
Recorded: DB/05/2010 at 01:38:31 PM
Ffa Amt: t22.D0 Peof 1 of 2
Franklin Countv North 'oroltne
Linda N. Stone North
of Deeds
BK 1782 P0468-469
Excise Tax: 50.00 This instrument prepared by:
J. P. Williamson, Jr.
Jolly, Williamson & Williamson
P. O. Box 96
Louisburg, N. C. 27549
PIN M 006902
NORTH CAROLINA
FRANKLIN COUNTY
WARRANTY DEED
THIS DEED, made this 27" dayof July, 2010, by New Birth Apostolic Church, Inc.
"Repairing the Breach Ministries", hereinafter referred to as Grantor, to Franklin -
Vance -Warren Opportunity, Incorporated, of 116 Young Street, Henderson, North
Carolina, 27536, hereinafter referred to as Grantee;
WIT NESSETH:
That said Grantor, in consideration of TEN DOLLARS AND OTHER VALUABLE
CONSIDERATIONS to it paid by the Grantee, the receipt of which is hereby
acknowledged, has bargained and sold, and by these presents does grant, bargain, sell
and convey to said Grantee, its successors and assigns, that certain tract or parcel of land
in Franklinton Township, Franklin County, North Carolina, and more particularly described
as follows:
That certain tract or parcel of land containing 0.699 acre (29,153 square feet) according
to survey by Nathan R. Hymiller, Jr., Professional Land Surveyor, as shown on plat thereof
dated June 16, 2010, and entitled "Division of Land for New Birth Apostolic Church, Inc.,
Franklinton Township, Franklin County, North Carolina", of record in Book 2010, Page 111,
F E B 13 2012
tvc N "R
I?a,!Plgi! r " )lidl '�f'IrQ

r •
q(oq
in the office of the Franklin County Register of Deeds.
All ore portion of the property herein conveyed —includes or x does not include
the primary residence of a Grantor.
TO HAVE AND TO HOLD said lands and all privileges and appurtenances thereto
belonging, to the said Grantee, and its successors and assigns, to their only use and
behoof forever.
And the said Grantor, for itself and its successors and assigns, covenants with said
Grantee, and its successors and assigns, that it is seized of said premises in fee and has
the right to convey in fee simple; that the same are free and clear from all encumbrances
and that it does hereby forever warrant and will forever defend the said title to the same
against the lawful claims of all persons whomsoever.
IN TESTIMONY WHEREOF, the said Grantor has hereunto caused this instrument
to be signed in its name, the day and year first above written.
NEW BIRTH APOSTOLIC CHURCH, INC.,
"REPAIRING HE BR EACO MINISTRIES"
(SEAL)
By: Robert Lockle , President
NORTH CAROLINA,,a,.... COUNTY
I. a Notary Public for said County and State, do hereby certify that Robert Locklear
personally came before me this day and acknowledged that he is the President of NEW
BIRTH APOSTOLIC CHURCH, INC. "REPAIRING THE BREACH MINISTRIES", a
corporation, and that he, as President, being authorized to do so, executed the foregoing
on behalf of the corporation.
;� ijm gqhand and official seal, this the day of _ �u;uo — 2010.
�1I H W J/�'i
i ignature of Notary Public
Judith W. Cox
Cau N0 '\\r``� Printed or Typed Name of Notary Public
My Commission Expires: Y-5-14