SW7120701_CURRENT PERMIT_20120822

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
„261n/J���j
YYYYMMDD

ROY COOPER
Governor
MICHAEL S. PECAN
Secretory
S. DANIEL SMITH
Director
Eastern Pride Inc.
Attention: Mr. Bares Boykin
2405-F Nash Street
Wilson, NC 27896
NORTH CAROLINA
Environmental Quality
January 27, 2020
W' �G
Subject: Stormwater Permit No. SW7120701 Renewal
Family Dollar - Belhaven
High Density Stormwater Project
Beaufort County
Dear Mr. Boykin:
A Division of Energy, Mineral, and Land Resources file review has determined that
Stormwater Permit SW7120701 for a stormwater treatment system consisting of two
sand filters serving a Family Dollar Store located on US Hwy 264 in Belhaven, NC
expires on August 22, 2020. This is a reminder that permit renewal applications are due
180 days prior to expiration. We do not have a record of receiving a renewal application.
To keep this permit active please submit a completed permit renewal application along
with a $505.00 fee for permit renewal. Permit application forms for renewal can be found
on our website at:
httW bog tf division f energy-mineral-faed-re�o.lzrces energy -mineral -lam
rules '/stormwater-program 1l2!D�r�structi�o 1. North Carolina General Statutes and the
Coastal Stormwater rules require that this property be covered under a stormwater
permit.
If you have questions, please feel free to contact me at [phone]. 1 will be glad to
discuss this by phone or meet with you. If you would like, I can e-mail you a copy of the
application forms. You can request a copy by e-mailing me at ra er.thorpe@ncdenngQy.
Sincerely,
�—
Roger K. Thorpe
Environmental Engineer
D,_E
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
••/ Washington Regional Office k 943 Washington Square Mall i Washington, North Carolina 27889
/"� 252.946.6481

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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
Eastem Pride Inc.
Belhaven — Family Dollar
US Hwy 264 Belhaven, NC, Beaufort County
FOR THE
construction, operation and maintenance of two open .sand filter(s) in compliance with the provisions
of Session Law 2008-211 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 August 22, 2020, and shall be subject to
the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater described in
the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as
described in Section 1.8 of this permit. The stormwater control has been designed to handle the
runoff from 24,850 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.8 of this permit,
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 50 feet landward of
all surface waters.

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7. The following design criteria have been permitted for the sand filter(s) and must be provided
and maintained at design conditions:
a.
b.
C.
d.
e.
f.
h.
J.
1.
m
n.
Drainage Area, acres:
Total Impervious Surfaces, ft2:
Design Storm, incp.es:
Design Volume, ft
Adjusted Water Quality Volume, ft3:
Provided Storage Volume, ft : 2
Sediment Chamber Surface Area, ft
Sand Chamber Surface Area, ft2:
Top / Bypass Weir Elevation, FMSL:
Bottom of Sand Filter Elevation, FMSL.-
Seasonal High Water Table, FMSL:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
Drainage Area # 1 Drainage Area # 2
23,002
16,768
11,821
13,029
1.5
1.5
1,493
1,571
1,120
1,178
1,125
1,200
390
400
390
400
6.5
6.5
3.0
3.0
1.0
1.0
Shoe Maker Creek/ Tar -Pamlico Basin
29-34-34-6
SC - NSW
The stormwater management system shall be constructed in .its entirety, vegetated and
operational for its intended use prior to the construction of any built -upon surface.
2. During construction, erosion shall be kept to, a minimum and any eroded areas of the system
will be repaired immediately.
3. The permittee shall at all times 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:
4.
5
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowin.9 and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and specifications.
f. Debris removal and unclogging of bypass structure, infiltration media, flow spreader,
catch basins, piping and vegetated filter.
g. A clear access path to the bypass structure must be available at all times.
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.
The facilities shall be constructed as shown on the approved plans. This permit shall become
voidable unless the facilities are constructed in accordance with the conditions of this permit,
the approved plans and specifications, and other supporting data.
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.

i. 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. Access to the stormwater facilities shall be maintained via appropriate easements at all times.
9. 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 or a CAMA Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan.
10. The permittee shall submit final site layout and grading plans for any permitted future areas
shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by the permittee at
all times.
12. 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
1. This permit is not transferable to any person or entity 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 to the Division of Water Quality, signed by both
parties, and accompanied by the appropriate 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.
2. The permittee is responsible for compliance with all. permit conditions until such time as the
Division approves any transfer request.
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.

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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 reissuance or termination does not stay any permit
condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater controls 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 2008-211, Title 15A NCAC 21-1.1000, 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. This permit shall be effective from the date of issuance until August 22, 2020. Application for
permit renewal shall be submitted 180 days prior to the expiration date of this permit and must
be accompanied by the processing fee.
Permit issued this the 22 day of August 2012.
TCAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
L
For CharlesTVak'70,,'P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. SW7120701

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Belhaven — Family Dollar
Stormwater Permit No. SW7120701
Beaufort 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)
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

1
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 bypass structure weir elevation is per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
16. 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. All required design depths are provided.
13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.

Belhaven — Family Dollar
Stormwater Permit No. SW7120701
Beaufort Coun
Designee's Certification
R
NOV - 7 2013
1-GL
S V 7,4
I,���{ (�. �� �d.:... , as a duty registe wee in the State of North
Carolina, having been authorized to obsery edicall / weekly/ full time) the construction of the
project, ___
kle
(Project)
for _ _ c ram' +�'' (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 /° I2 3l3

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-1.
Certification Requirements:
,Z"'ll. The drainage area to the system contains approArnately 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 bypass structure weir elevation is per the approved plan.
6. The bypass structure -is located per the approved plans.
7. A Trash Rack is provided on the bypass structure.
�8. All slopes are grassed with permanent vegetation.
/9. Vegetated slopes are no steeper than 3:1.
---10. The inlets are located per the approved plans and do not cause short-circuiting of the
system.
1 1. The permitted amounts of surface area and/or volume have been provided.
,1 12. All required design depths are provided.
�3, All required parts of the system are provided.
K 14. The required system dimensions are provided per the approved plans.

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
s
Applicable Rules: ❑ Coastal SW --1995 ❑ Coastal SW - 2008 ❑ Ph 11- Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management PIan
❑ Other WQ M mt Plan: SW 3
Rai
State of North Carolina � � � � � �
�/ Department of Environment and Natural Resource
ED
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FO� 6 2012
This form may he photocopied for use as anoriginal j
I. GENERAL INFORMATION D 11 %� it Q— lEe %� 1f AR®
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Belhaven - FamiIy Dollar__
2. Location of Project (street address):
US 264H
City: Belhaven County:Bgr<e �P djjLDr* -� Zip:27810
3. Directions to project (from nearest major intersection):
On 264 By Pass going east the yropgM is a12x 0.35 miles west of the intersectionof W. Pante o St.
The ro r is diagonal from the Food Lion.
4. Latitude:.35 ° 33' 12.62" N Longitude:76 ° 37' 29.04" 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 Storm water 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: 0.913 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 permit:Tar Pam Buffer Determination 12-0402
Form S WU- 101 Version 07July2009 Page I of 6

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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 proiect):
Applicant/Organization: Eastern Pride Inc.
Signing Official & Title:Barnes Boykin
b.Contact information for person listed in item 1a above:
Street Address:2405-F Nash Street
City:Wilson _ _ _ _ State:NC Zip:27896
Mailing Address (if applicable):
City:
Phone: (252 ) 230-0632
Email:
State: Zip:
Fax: ( )
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:Shirley Ann O Neal_
Signing Official & Title:Shirley Ann O'Neal
b.Contact information for person listed in item 2a above:
Street Address: 442 E. Water St.
City:Belhaven NC State: Zip: 27810
Mailing Address (if applicable):
City: —
Phone:
Email:
State: Zip:
Fax: ( 1
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:Seld-en Taylor - Stock and Taylor Construction Co.
Signing Official & Title:Selden Taylor, P.E. President
b.Contact information for person listed in item 3a above:
Mailing Address:1825 Carolina Ave
City:Washingon State:NC Zip:27889
Phone: (252 ) 975-5855 Fax: (-
Email:
4. Local jurisdiction for building permits: Belhaven
Point of Contact -.Dean Burba e Phone #: [phone]
Form SWU-101 Version 07Ju1y2009 Page 2 of

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IV. PROJECT INFORMATION
1. - In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff from the development shall be treated by a sand filters stem prior to drainLnZ in to an
existing ditch
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 - 4995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the Tar Pam River basin.
4. Total Property Area- .0.913 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+:0.913 acres
Total project area shall he 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 (NHIM line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant pprroject area is used to
calculate overall percent built upon area (BUA). Nan -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 = 61.9 %
9. How many drainage areas does the project have?2 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area _
Draina a Area _
Receiving Stream Name
ShoeMaker Crk
ShoeMaker Crk
Stream CIass *
NSW, SC
NSW, SC
Stream Index Number *
29-34-34-6
29-34-34-6
Total Drainage Area (so
23002.00
16768.00
On -site Drainage Area (sf)
23002.00
16768.00
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
11821.21
13029.02
% Impervious Area** total
51.4
77.7
Im rvious"` Surface Area
Drainage Area 7
Draina a Area _
Draina a Area.
Drainage Area _
On -site Buildings/Lots (sf)
3997.5
3997.5
0
On -site Streets (sf)
0
On -site Parkin (so
6946.31
8282.77
On -site Sidewalks (sf)
877.4
748.75
Other on -site (so
0
Future (so
0
0
Off -site (sf)
0
0
Existing BUA*** (sf)
0
Total (so:
11821.21
13029.02
* Stream Class and Index Nnrnber can be determined at: ht i2o.ertr.state.nc.us 'tus rc ports re ortsWB.htntl
Form SWU-101 Version 07July2009 Page 3 of 6

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Impervious area is defined as the built upon area including, but not lintited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
* Report only that amount of existing 8 UA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area Iisted above determined? Provide documentation. NA
Prolects in Union CountY_: Contact DWQ Central Office staf,j'lo check if the project is located within a Threatened &
Endangered .Species watershed that maybe subject to more stringent stormwater requirements as per NCAC 02B .0b00.
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 hn:/Lh2o.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/suZbrnp-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 at http_//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. Ail original documents MUST be signed and initialed in blue ink. Download the latest versions for
each submitted application package from ht!p://h2o.enr.state.nc.us/sulbmp 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 VIl 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
hqp://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/management for
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.
Form SWU-101 Version 07July2004 Page 4 of

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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 verifij the SHV11T prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1127 Page No: 591
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 fisted 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.
httj /www.secretaKy.state.nc.us/`Corporations/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from
httj2.1&2o.enr.state.nc.us/su/bmp forms.htm#deed restrictions. Download the Iatest 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 diming
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:Marie U. Peedin PE
Consulting Firm: Pamlico Engineering Services, PLLC
Mailing Address:128 Abbey Lane
City: Washington
Phone: (252 ) 945-2983
[e-mail]
State:NC Zip:27889
Fax: (252 ) _974-7618
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or hjpe name of person Iisted in Contact Information, item 2a) Shirley Annn O'Neal 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) Barnes Boykin with (print or hype name of organization listed in
Contact Information, item 1b) Eastern Pride Inc. 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.
Form SWU-101 Version 07July2009 Page 5 of 6

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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 assessn)etiif7 f civ+pena#ies of up to $25,000 per,,day, pursuant to NCGS 143-215.6.
before me
a stormwater permit.
Date- S�
a Notary Public for the State of V County of
do hereby certify that.r ply appeal
r of 1 ,and acknowledge the due execution of the application for
Witness my hand and official seal, - Q2," -/" /,..s?1-,
SEAL
My commission expires-3— I `o — `^ O 3
JAL APPL.ICANrS CERTIFICATION
I, (print or type name of person listed in Contact Information, item 2) Barnes Boykin
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 storm ater rules under 15A C 2H .1000, SL 2006-246 (Ph. II- Post Construction) or SL 2008-211.
Signature: � G Late: fz,S'/
I, a Notary Public for the State of _�3 , County of
do hereby certify that 2 PS personally appeared
before me this day of J Ltr�e, _ s�019 , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and
ROBIN A EATMON
NOTARY PUBLIC
MLSON COUNTY. NC
My C,ormrb*M E)*M 11-2-2015
official seal,
SEAL
My commission expiresJL�im�G�. D1 S
Form SWU-101 Version Muly2009 Page 6 of 6

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Permit Number:
(to be provided by OWQ)
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NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be filled out on line, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section Ill) and the I&M Agreement (Section IV)
I. PROJECT INFORMATION
Project name Belhaven Family Dollar
Contact name Marie U Peedin
Phone number
Date
Drainage area number
Il. DESIGN INFORMATION
Site Characteristics
2529452983
July 2, 2012 -
1
Drainage area (Ao) 23,002.00 a OK
Impervious area 11,821.21 fe
% Impervious (IA) 514% %
Design rainfall depth (Ro) 1.50 in
Peak Flow Calculations
1-yr, 24-hr runoff depth 3.33 in RECEIVED
1 -yr, 24-hr intensity 0.14 Whir
Pre -development 1-yr, 24-hr runoff 0.01 ft3lsec
Post -development 1-yr, 24-hr runoff 0.05 ft31sec J U L - G 2012
Pre/Post 1-yr, 24-hr peak control 0,04 ft'/sec
Storage Volume s � l��O
Design volume (WQV) 1,493.00 ft'
�~ V D Q—
Adjusted water quality volume (WQVAd) 1,119.75 ft' ✓ OK
Volume contained in the sedimentation basin and on top of the sand filter 1,125.00 ft'
Top of sand filtedgrate elevation 5 ft amsf
Weir elevation (between chambers) 6.5 ft amsl
Maximum head on the sedimentation basin and sand filter (hm'Fik') 1.50 ft Insufficient depth.
Average head on the sedimentation basin and sand filter (hA) ^ 0,75 ft OK
Runoff Coefficient (Rv) 0.51 (unibess) 1/
Type of Sand Filter
Open sand filter?
y _ Y or N
SHWT elevation
1.00 ft amsl
Bottom of the sand filter elevation
3.00 ft amsl
Clearance (dsiw)
2.00
Closed/pre-cast sand filter?
n Y or N
SHWT elevation
ft amsl
Bottom of the sand filter elevation
ft amsl
Clearance (dsHwT)
If this is a closed, underground closed sand filter: The clearance between
the surface of the sand fitter and the bottom of the roof of the underground
ft
structure (dspa,)
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and rl. Project Design Summary, Page 1 or 2

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Permit Number:
(to be provided by DWQ)
Sedimentation. Basin
Surface area of sedimentation basin (As)
-Sedimentation basinlchamber depth
Sand Filter
Surface area of sand filter (AF)
Top of sand media filter bed elevation
Bottom of sand media filter bedldrain elevation
Depth of the sand media filter bed (dF)
Coefficient of permeability for the sand filter (k)
Outlet diameter
Outlet discharg0owrate
Time to drain the sand filter (t)
Time to drain the sand filter (t)
Additional Information
Does volume in excess of the design volume bypass the sand filter?
Is an off-line flow -splitting device used?
If draining to SA waters: Does volume in excess of the design volume flow
evenly distributed through a vegetated filter?
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 30ft from surface waters (50ft if SA waters)?
If not a closed bottom, is BMP located at least 100ft from water supply wells?
Are the vegetated side slopes equal to or less than 3:1
Is the BMP located in a recorded drainage easement with a recorded access
easement to a public Right of Way (ROW)?
What is the width of the sedimentation chamberlforebay (Wsd)?
What is the depth of sand over the outlet pipe (dpipe)?
390.00 fe OK. Meets minimum, but may need to be increased to
. 2:00 ft
390.00 fe OK. Meets minimum, but may need to be increased to
5.00 It amsl
3.50 ft amsl
1:50 ft
3,50 (ftlday)
6.00 in
2•00 ft3/sec
40.00 hours OK. Submit drainage calculations.
1.67 days
�Y� YorN OK
y YorN OK
n Y or N Excess volume must pass through fitter.
ft
YorN
y YorN OK
Y _ YorN OK
X Y or N OK
y Y or N OK
390.00 ft OK
2.00 it OK
Form SW401-Sand Filler-Rev.5 2009Sept17 Parts I and rl- Project Design Summary, Page 2 or 2

Permit Number:
flo be provided by DWQ)
ATA
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be filled out on line, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section ltl) and the 18M Agreement (Section lVj
I. PROJECT INFORMATION i
Project name Belhaven Family Dollar i
Contact name 'Marie U Peedin
Phone number 2529452983-
Date July 2, 2012 T T
Drainage area number 2
II. DESIGN INFORMATION
Site Characteristics
Drainage area (AD)
16,768,00 f' OK
Impervious area
13,029.02 ft2
% Imperious 0A)
77.7% %
Design rainfall depth (Ro)
1.50 in
Peak Flow Calculations
1-yr, 24-hr runoff depth
3.28 in
1-yr, 24-hr intensity
0.14 inlhr
Pre -development 1-yr, 24-hr runoff
0.01 ft/sec
Post -development 1-yr, 24-hr runoff
0.04 ft3lsec
Pre/Post 1-yr, 24-hr peak control
0.03 ft3lsec
Storage Volume
Design volume (WQV)
1,571.00 ft3
Adjusted water quality volume (WOV,di)
1,178.25 ft3 `�
Volume contained in the sedimentation basin and on top of the sand filter
OK
1,200.00 ft'
Top of sand filter/grate elevation
5 ft amsf
Weir elevation (between chambers)
6.5 ft amsl
Maximum head on the sedimentation basin and sand fitter (hLf )
1,50 ft Insufficient depth.
Average head on the sedimentation basin and sand filter (ha)
0.75 ft OK
Runoff Coefficient (Rv)
0.75 (unitless) V
Type of Sand Filter
Open sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (dsHwT)
Closedlpre-cast sand filter?
SHWT elevation
Bottom of the sand fiifier elevation
Clearance (d513,,,,r)
If this is a closed, underground dosed sand filter: The clearance between
the surface of the sand filter and the bottom of the roof of the underground
structure (dam)
Y_ Y or N
1.00 ft amsl
3.00 ft amsl
2.00
n YorN
ft amsl
It amsf
Form SW401-Sand Fitter-Rev.5 2009SeptV Parts I and If. Project Design Summary, Page 1 of 2

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Permit Number:
(to be provided by DWQ)
Sedimenta$on Basin
Surface area of sedimentation basin (A0
Sedimentation basin/chamber depth
Sand Filter
Surface area of sand filter (AF)
Top of sand media filter bed elevation
Bottom of sand media filter bed/drain elevation
Depth of the sand media filter bed (dF)
Coefficient of permeability for the sand filter (k)
Outlet diameter
Outlet dischargetflowrate
Time to drain the sand filter (t)
Time to drain the sand filter (t)
Additional Information
Does volume in excess of the design volume bypass the sand filter.?
Is an off-line flow -splitting device used?
If draining to SA waters, Does volume in excess of the design volume flow
evenly distributed through a vegetated filter?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the 8MP located at least 30ft from surface water; (50it if SA waters)?
If not a closed bottom, is BMP located at least 100ft from water supply wells?
Are the vegetated side slopes equal to or less than 3,f
Is the 8MP located in a recorded drainage easement with a recorded access
easement to a public Right of Way (ROW)?
What is the width of the sedimentation chamberlforebay (WSW)?
What is the depth of sand over the outlet pipe (dpipe)?
400.00 f{2 OK. Meets minimum, but may need to be increased to
2,00 ft
400.00 f 2 OK. Meets minimum, but may need to be increased to
5,00 ft amsl
3.50 ft amsl
1.50 ft
3.50 (ftlday)
6.00 in
2.00 Osec
40,00 hours OK. Submit drainage calculations.
1.67 days
y Y or N OK
y YorN OK
n YorN Excess volume must pass through filter.
ft
YorN
YorN
OK
y Y or N
OK
_y YorN
OK
y YorN
OK
400.00 ft
OK
2.00 ft
OK
Form SW401-Sand Fitter-Rev.5 2009Sept17 Parts I and II. Project Design Summary, Page 2 of 2

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Permit Number:
(to be provided by DWQ)
Drainage Area Number:
Sand Filter 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 maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the sand filter.
— The sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds
six inches.
— Once a year, sand media will be skimmed.
-- The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter will be inspected quarterly 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:
Potential roblem:
How I will remediate the problem:
Entire BMP
Trash debris is present.
Remove the trash debris.
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as
applicable)
pavement surface,
2ossible.
Perimeter of sand filter
Areas of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed,
gully, and then plant a ground cover and
water until it is established. Provide lime
and a one-time fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height.
Flow diversion structure
The structure is clogged.
Unclog the conveyance and dispose of any
sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if
d"ge is too large for repair.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or dispose of it
in a location where it will not cause
impacts to streams or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
roblems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
RECEIVED
Form SW401-Sand Filter O&M-Rev.4 2009Septl7 J U L - b 2012 Page I of 3
DWQ-WARO

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BMP element:
Potential problem.
How I will remediate theproblem:
Filter bed and underdrain
Water is ponding on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm.
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace. If water still
ponds, then consult an expert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment offsite.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage
Contact the NC Division of Water Quality
have occurred at the outlet.
401 Oversight Unit at 919-733-1786.
Form SW401-Sand Filter O&M-Rev.4 2009Septl7 Page 2 of 3

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Permit Number:
(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:Family Dollar Belhaven
BMP drainage area number: I < 2—
Print name:Bames Boykin �^
Title:Secret,M
Address:2405-F Nash Street Wilson, NC 27896
vat
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.
a Notary Public for the State of
\D&Adc, County of 1�_Dr4 , do hereby certify that
17G121e Scx¢ki n personally appeared before me this �_ day of
_i Cgr12 ,o'�bl Z , and acknowledge the due execution of the forgoing sand filter
maintenance requirements. Witness my hand and official seals
I
ROBIN A EATNION
NOTARY PUBLIC
WILSON COUNTY, NC
W Camttasbn fxpkw t i 2-20t5
SEAL
My commission expires 1 lmerr bet DD Qo)t
Form SW401-Sand Filter O&M-Rev.4 2009Sept17 Page 3 of 3

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Permit No.
(to be provided by 4WQ)
III. REQUIRED ITEMS CHECKLIST -
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal
package will result in a request for additional information. This will delay final review and approval of the project. Initial
in the space provided to indicate the following design requirements have been met. If the applicant has designated an agent,
the agent may initial below, If a requirement has not been met, attach justification.
Initials Page/ Plan
Sheet No.
C. 0 a
1. Plans (1" - 59 or larger) of the entire site with labeled drainage area boundaries
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
- Flow splitting device,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Boundaries of drainage easement.
2. Plan details (1" = 30' or larger) for the sand filter showing.
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
-Flow splitting device, RECEIVED-
Vegetative filter strip dimensions and slope (if SA waters),
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out, J U L — 6 2012
- Off -site drainage (if applicable), and
-Boundaries of drainage easement. Y Y ��O
3. Section view of the sand filter (1" = 20' or larger) showing: DWQ^
- Depth(s) of the sedimentation chamber and sand filter chamber,
- Depth of sand filter media,
- Connection between the sedimentation chamber and the sand filter chamber and weir elevation,
- SHWT elevation,
- Outlet pipe, and
- Clearance from the surface of the sand filter to the bottom of the roof of the underground structure (if
n
applicable).
4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified in the field by DWQ, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
n
5. Supporting calculations (including drainage calculations)
? 6. Signed and notarized operation and maintenance (0&M) agreement
~ 7. A copy of the deed restrictions (if required).
Form SW401-Sand Filter-Rev.5 2009Septl7 Part III, Page 1 of 1