SW6121005_HISTORICAL FILE_20121031

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
DOC DATE
&%I%S/
YYYYMMDD

Permit Number: 5t✓6 1 Z 10 OS -
(to be provided by DWQ)
Drainage Area Number: _ f
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.
- Special care will betaken to prevent sediment from entering the bioretention cell.
- Once a year, a soil test of the soil media will be conducted.
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
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DENR - EQUAD ;} i
Wetlands 4 ShZM&tar &a:. 'Page 1 of 4

BMP element:
Potentialproblems:
How I will remediate theproblem:
The pretreatment area
Flow is bypassing
Regrade if necessary to route all
pretreatment area and/or
flow to the pretreatment area.
_gullies have formed.
Restabilize the area after grading.
Sediment has accumulated to
Search for the source of the
a depth greater than three
sediment and remedy the problem if
inches.
possible. Remove the sediment and
restabilize the pretreatment area.
Erosion has occurred.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand.
The bioretention cell:
Best professional practices
Prune according to best professional
vegetation
show that pruning is needed
practices.
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the
dying.
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.
Tree stakes/wires are present
Remove tree stake/wires (which
six months after planting.
can kill the tree if not removed).
The bioretention cell:
Mulch is breaking down or
Spot mulch if there are only random
soils and mulch
has floated away.
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.
Soils and/or mulch are
Determine the extent of the clogging
clogged with sediment.
- remove and replace either just the
top layers or the entire media 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.
An annual soil test shows that
Dolomitic lime shall be applied as
pH has dropped or heavy
recommended per the soil test and
metals have accumulated in
toxic soils shall be removed,
the soil media.
disposed of properly and replaced
with new planting media.
Form SW401=Bioretention O&M-Rev3 Page 2 Of 4

BMP element:
Potentialproblems:
How I will remediate the roblem:
The underdrain system
Clogging 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

Permit Number: -S LA 1 Z 1405
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:Rainbow Pediatrics
BMP drainage area number:#1
Print name:Taner Esensoy T
Title:Manager/Member - Purdue Drive Investments, LL C
Address:304 Summertime Road; Fayetteville, NC 28303
Phon
Signz
Date:
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
I, � x _ou CiCisV J U . j V it fy',ha f I , a Notary Public for the State of
of( „by& ��, do hereby certify that /,� /1
personally appeared before me this C��
day of �(�¢p— �, and acknowledge the due execution of the
forgoing; bioreteUl;m,m4intenance requirements. Witness my hand and official seal,
NOTARY !r
_c) PUBLIC
ZliQ`AIVD C0�`;`�`��,`
i�trirllttitti►
SEAL
My commission expiresD2,166 Lao /;
Form SW401-Bioretention I&M-Rev. 2 Page 4 Of 4

CALL SIGN
E N G I N E E R S
October 30, 2012
NCDENR, Division of Water Quality
Attn: Stormwater Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Rainbow Pediatrics
Hoke County, NC
Dear Sirs:
Attached is information pertaining to an application for a Stormwater Management
Permit for the above referenced project. Attached to this package is a list of items that
are included in the package.
Should you have any questions or require additional information, please do not hesitate
to contact either me at 910.486.0700.
Sincerely,
CALL SIGN ENGINEERS
C. Heath Wadsworth, PE, LEED AP
n('r :j 1 2012
104 GILLESPIE STREET I FAYETTEVILLE I . NORTH CAROLINA 1 28301 1 910.486.0700 I CALLS IGN ENG I N EERS.COM
SERviLE 0i9�s�.EO VE 111 OWNen SMALL BUSIN—
I

North Carolina Secretary of State
Page I of 2
North Carolina
Elaine F. Marshall DEPARTMENTOF THE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh, NC 27626-0622 [phone]
Date: 10/26/2012
Click here to:
View Document Filings I File an Annual Report I
J Print a Pre -populated Annual Report Fillable PDF Form I Amended A Previous Annual Report I
Corporation Names
Name Name Type
NC PURDUE DRIVE INVESTMENTS, LEGAL
LLC
Limited Liability Company Information
SOSID:
0745281
Status:
Current -Active
Effective Date:
9/27/2004
Annual Report Due Date:
Citizenship:
DOMESTIC
State of Inc.:
NC
Duration:
PERPETUAL
Annual Report Status:
CURRENT
Registered Agent
Agent Name:
ESENSOY, TANER
Office Address:
304 SUMMERTIME ROAD
FAYETTEVILLE NC 28303
Mailing Address: 3G4 SUMMERTIME ROAD
FAYETTEVILLE NC 28303
Principal Office
Office Address: 612 RAVENCROFT COURT
FAYETTEVILLE NC 28314
Mailing Address:
Officers
Title:
Name:
Business Address:
Title:
Name:
Business Address:
NO ADDRESS
MANAGERIMEMBER
TANER ESENSOY
612 RAVENCROFT COURT
FAYETTEVILLE NC 28314
MANAGER/MEMBER
GLORIA ESENSOY
612 RAVENCROFT COURT
FAYETTEVILLE NC 28314
This website is provided to the public as a part of the Secretary of State Knowledge Base (SOSKB) system. Version:
3588
http://www.secretary.state.nc..us/corporations/Corp.aspx?Pitemld=6531864 10/26/2012

CALL SIGN
E N G I N E E R S
Date: October 30, 2012
Re: Stormwater Management Permit Package Contents
Rainbow Pediatrics
Hoke County, NC
Package Contents:
1. Check for $505
2. Original - SWU-101 Permit Application Form
3. Copy - SWU-101 Permit Application Form
4. S.O.S Documentation showing Perdue Drive Investments, LLC
5. Deed of Purdue Drive Investments, LLC Property
6. Required Items Checklist
7. Original - Signed and Executed O&M Agreement
8. Copy - Signed and Executed O&M Agreement
9. Stormwater Management Plan and Computations (Contains
Supplemental Forms, supporting calculations, soils report, etc.)
10. 2 sets of full-sized sets of construction drawings
If you need additional information, or have any questions, please contact me
([e-mail]; 910-486-0700)
Thanks,
r
Heath Wadsworth, PE, LEED AP
104 GILLESPIE.STREET 1 FAYETTEVILLE I NORTH CAROUNA I 2B301 1 910.486.0700 1 CALLSIGNENGINEERS.COM
S-C, D-511-n-111n-Oww GO 511LL BIG ICSS

Application Completeness Review
First Submittal ❑ Re -submittal Date Received: / 3 -j-Date
Development/Project Name: Ped
Receiving stream name _ sfeJ,�R�-s C r2JLg-.Y
Reviewed.2 &7- By Bill Diuguidk
Classification: IV r_
Liver Basin: C „-- r.� -g-
For post-constructioii requirements, a program will be deemed compliant for the areas where it is
implementing any of the following programs: WS-I, WS-II, WS-III, WS-IV, HQW, ORW, Neuse River Basin
NSW, Tar -Pamlico River Basin NSW, and the Randleman Lake Water Supply Watershed Nutrient
Management Strategy.
High Density Projects that require a 401/404 within an NSW require 85% TSS, 30% TN and 30% TP removal.
T&E Species (Goose Creek, Waxhaw Creek or Six Mile Creek Water Sheds):
Latitude and Longitude: 3S o/ 59A1 06 30 y,/ Jurisdiction .rq
Project Address: lq-2 -
Engineer name and firm: C.11" flt �,jP d s ur. g , �• � . tea/ .J lT.�a
Phone: 07a6 Email:
Is the project confirmed to be in the State MSI Stormwater Permit jurisdiction? Ek"Yes or ❑ No
❑ Low Density (no curb and gutter) ❑ Low Density with curb and gutter outlets E -Kigh Density ❑ Other
-a-401/404 impacts to surface waters, wetlands, and buffers (add language to cover letter and/or add info letter)
p- B U A 446; 7 2,
ca/ Check for $505.00 included
@r"' Original signature (not photocopy) on application Sn
Legal signature (Corporation-VP/higher, Partnership -General Partner/higher, LC-member/manse Agent).
Check spelling, capitalization, punctuation: littp://www.secretary.state.nc.us/corporations/thepage.aspx
If an agent signs the application, a signed letter of authorization from the applicant must be provided which
includes the name, title, mailing address and phone number of the person signing the letter.
❑ �r subdivided projects, a signed and notarized deed restriction statement
t/ ealed, signed & dated calculations
Correc:Bioretention
plement and O&M provided for each BMP on site (check all that were provided & number of each)
�( ❑ RooftoP 9 Runoff Mana ement
-w""Dry Detention Basin
❑
Filter Strip
❑
Grass Swale
❑
Infiltration Basin
❑
Infiltration Trench
❑
Level Spreader
❑
Permeable Pavement
❑
Restored Riparian Buffer
❑ Sand Filter
❑ Stormwater Wetland
❑ Wet Detention Basin
❑ Low Density
❑ Curb Outlet
❑ Off -Site
❑ NCDOT Linear Road
r� wo sets of sealed, signed & dated layout & finish grading plans with appropriate details
Narrative Description of stormwater management provided
r� Soils report, geotech information provided
4a-- Wetlands delineated or a note on the plans or in the accompanying documents that none exist on site and/or
/ adjacent property
�d Details for the roads, parking area, cul-de-sac radii, sidewalk widths, curb and gutter;
e�/Dimensions & slopes provided
rs� Drainage areas delineated ❑ Pervious and impervious reported for each ❑ Areas of high density
MP operation and maintenance agreements provided
r,Y Application complete ❑ Application Incomplete Returned: (Date)
Comments PR43-,*42 c hm'd �
, r.� J6.J .7f C-A-L
Oct 29 2012 Revision, Bill Diuguid

0972
0308
8K:00972 PG:0308
FILED
HOKE COUNTY NC
ONNIE B. DUDLEY
FILED
Jan 23, 2012
TIME
10:19:57 am
BOOK
00972
START PAGE
0308
END PAGE
0310
INSTRUMENT # 00434
RECORDING
$26.00
EXCISE TAX
$770.00
ELB
NORTH CAROLINA GENERAL WARRANTY DEED
Mai after recordin ww
rvwjeachv, Hudson cC Zuravel, 555 Executive PI., Fayetteville, NC 28305
Excise Tax: -v, di3
Phis instrument was re ared by
Donald C. Hudson File fr39557
Brief description for the Index
HIS DEED made this
19 day o1
Janua �
2012 by and between
GRANTOR
GRANTEE
Paraclete Real Estate Holdings, LLC
Mailing Address:925 Doc Brown Road
Raeford, NC 28376
Purdue Drive Investments. LLC
Mailing Address: 1327 Robeson Street
Fayetteville, NC 28305
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and
shall include singular, plural, masculine, feminine or netiter as required by context.
wITNESSETH. that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
r cknowiedged, has and by these presents does grant, bar gain, sell and convey tin to the Grantee in tee sine Ie, all that
,certain lot or parcel of land situated in the City of Raeford McLaughlin Townshi �,
Hoke— rotinty. ti'oith Carolina and more PaMiCLIIarll, descrihed as follows:
Being all of Lot I as shown on a plat entitled "SUBDIVISION FOR PARACLETE~ REAL ESTATE HOLDINGS. I,LC"
la ccording to a plat duly recorded in Plat Cabinet 3. Slide 3-56, Nlap 002. Hoke County Registry.
leis ro erty DOES NOT include the Grantor's primary residence.
I'he property hereinabove described was ac aired by Grantor by instrument recorded in
Book 742, Pa e ,138
Hoke County, North Carolina Re gistry
rnap showing the above described pro erty is recorded in
Plat Cabinet 3, Slide 3-56 iNla 3 002
�ttyY�D Poe' R'ECORUIto�l
ny►y
X� WIMVI 0R coj
nrT �Ut2
11

0972
0309
BK:00972 PG:0309
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging
the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey
the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and
defend the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hercinabove described is subject to the following exceptions:
Restrictions, easements and rights -of -way of record.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this instrument
to be signed in its corporate name by its duly authorized officers and its seat to be hereunto affixed by authority of its
Board of Directors, the day and year first above written.
Paraclete Real Esta Holdings, LLC
(SPAL)
Timothy B. IW,*Knur&6, Mg. Member
(SEAL)
NOTARY: PLEASE DO NOT ACKNOWLEDGE ON THIS PAGE]
[ACKNOWLEDGMENTS ARE ON THE FOLLOWING PAGE]

0972
0310
SPATE OF: Aj (_
1 BK:00972 PG:0310
COUNTY OF- —CO M ��''rt6hr) dL
I. I� d,2 t 111 . (� [ Fs T a Notary Public of the aforesaid State
and County, certify that Timothy B. D'Annunzio personally appeared berbre me and acknowledged that he is
Nlgr.IMeniber of Paraclete Real Estate Holdings, LLC, a North Carolina Limited Liability Company and that by the
authority did), given and as an let of'the Entity, has signed the foregoing instrument in its name and on its behalf as its act
and deed.
Witness my hand and official stamp or seal. this 6:26 day of January, 2012.
ADELL M. COLUER 1`fC�� ?1 C.t� �.Ifi�: (SEAL)
Notary Public. North CatoHna Notary Public
Cumt]erland County
My Commission Expires
februa 24,20ta
My conunissiort expires: c� aY � of