SW7121010_CURRENT PERMIT_20121102

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW /NO
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
ALY� �`D�
YYYYMMDD

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
NovpmhPr 2 2012.
Mr. Ninad N. Patel, Manager
4-GOVIND, LLC
101 Charles Street
Havelock, NC 28532
Subject: Stormwater Permit No. SW7121010
Expressway #4
High Density StormFilter by Contech Project
Craven County
Dear Mr. Patel:
The Washington Regional Office received a complete Stormwater Management Permit
Application for Expressway #4 project on October 23, 2012. Staff review of the plans and
specifications has determined that the project, as proposed, will comply with the Stormwater
Regulations set forth in Session Law 2008-211 and Title 15A NCAC 2H.1000. We are
forwarding Permit No. SW7121010 dated November 2, 2012, for the construction of the
subject project.
This permit shall be effective from the date of issuance until November 2, 2020, and shall be
subject to the conditions and limitations as specified therein, Please pay special attention to
the Operation and Maintenance requirements in this permit. Failure to establish an adequate
system for operation and maintenance of the stormwater management system 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, 6714 Mail Service Center, Raleigh, NC 27699-6714. Unless such
demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please
contact Samir Dumpor, at [phone].
Sincerely,
ar�oda.tlk
harles Wakild, P.E., Director
Division of Water Quality
AAlsd: K:1SD1Permits - Infiltration1SW7121010
cc: Bobby Billingsley, PE, Thomas Engineering
Craven County Building Inspections
,,,VVashington Regional Office
North Carolina Division of Water Quality Internet: www.ncwalereuatily_,3org
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] NorthCarohna
An Equal CpportunitylAffirmative Action Employer — 50% Recycled110% Post Consumer Paper ;VatutwI&

State Stormwater Management Systems
Permit No. SW7121010
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
4-GOVIND, LLC
Expressway #4
870 Highway 70 West, Havelock, Craven County
FOR THE
construction, operation and maintenance of one StormFilter by Contech system in
compliance with the provisions of Session Law 2008-211 and 15A NCAC 2H .1000
(hereafter referred to as the "storm water 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 November 2, 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 1.6 on page 3 of this permit. The stormwater control
has been designed to handle the runoff from 24,746 square feet of impervious area.
3. 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.
4. The runoff from all built -upon area within the permitted drainage area of this project
must be directed into the permitted stormwater control system.
5. The built -upon areas associated with this project shall be located at least 50 feet
landward of all surface waters.
6. The following design criteria have been provided in the StormFilter by Contech
system and must be maintained at design condition:
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7121010
a. Drainage Area, ft2:
b. Total Impervious Surfaces, ft2:
C. Design Storm, inc�.es:
d. Design Volume, ft :
e. Adjusted Water Quality Volume,
(75% of Design Volume), ft
f. Provided Storage Volume, ft3:
Corrugated Metal Pipe Detention System:
g. 7-30" barells, ft:
h. 1-30"header, ft:
i. Bottom Elevation, FMSL:
j. Bypass Weir Elevation, FMSL
k. Permitted Storage Volume, ft
I. Type of Soil:
StormFilter specs:
M.
Design Volume, ft3:
n.
TSS removal efficiency:
o.
Cartridge Height-
P.
Maximum Cartridge Flow:
q.
Mass Load per Cartridge:
r.
Number of Cartridges Required:
S.
Maximum Treatment Flow rate, cfs:
t.
Receiving Stream/River Basin.-
U.
Stream Index Number;
V.
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
26,841
24,746
1.5
2,952
2,214
2,226
61' long each
26.5 long
26.00
28.50
2,226
Lenoir silt loam
2,226
85%
18"
7.5 gpm
36 Ibs
6
0,10
Sandy Run 1 Neuse River basin
27-112-6-3
"SC; Sw; NSW"
1. The stormwater management system shall be constructed in its entirety and
operational for its intended use prior to the construction of any built -upon surface.
The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
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 necessaryto
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. Replacement of cartridges per manufacturer's recommendation.
d. Immediate repair and clean out of outlet device.
e. Sweep and vacuum the sediment from adjacent pavement.
f. Debris removal and unclogging of bypass structure, filter media, flow
spreader, catch basins and piping.
g. A clear access path to the bypass structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
records will indicate the date, activity, name of person performing the work and what
actions were taken.
5. 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.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW7121010
6. 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.
7. Access to the stormwater facilities shall be maintained via appropriate easements at
all times.
8. 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.
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
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
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.
2. The permittee is responsible for compliance with all permit conditions until such time
as the Division approves the 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.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7121010
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 reissuance 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 forth is 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 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.
12. This permit shall be effective from the date of issuance until November 2, 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 2nd day of November, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
14 Y J 11/d-J for
l Charles Waki, P.., Director
Division of Watbr Quality
By Authority of the Environmental Management Commission
Permit No. SW7121010
Page 5 of 7

State Stormwater Management Systems
_ Permit No. SW7121010
Expressway #4
Stormwater Permit No. SW7121010
Craven County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (period icallylweekly/ 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
Page 6 of 7

State Stormwater Management Systems
Permit No. SW7121010
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 elevations are per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the outlet/bypass structure.
8. A clear access path to the bypass structure and clean -outs provided.
9. .The inlets are located per the approved plans and do not cause short-
circuiting of the system.
10. The permitted amounts of surface area and/or volume have been provided.
11. All required design depths are provided.
12. All required parts of the system are provided.
13. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Craven County Building Inspections
Page 7 of 7

DWQ USE ONLY
I9E& rRTCVt�`1
Fee Paid Ck+#- IR
Permit Number
r r n
1-0nO
I 5W I t Z i c l&
Applicable ides' " 11'taastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that ap 1 ��n-Coastal SW- HQW/ORW Waters 1] Universal Stormwater Management Plan
��// er WQ MgLftt Plan:
State of North Carolina. wc�_R O
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Expressway #4 -
2. Location of Project (street address):
870 Highway 70 West
City:HaveIock County:NC Zip:28532
3. Directions to project (from nearest major intersection):
The project is locate on the service road on the south western corner of the intersection of US Highway 70
and Hickman Hill Road SR 1759). The 12r2ject is directly across US 70 from the Havelock West End
Fire Station
4. Latitude:34° 55' 36" N Longitude:76° 56' 53" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-102 - Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ❑Sedimentation/Erosion Control: _
❑NPDES Industrial Stormwater 0404/401 Permit: Proposed Impacts
ac of Disturbed Area
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:
5. Is the project Iocated within 5 miles of a public airport? ®No []Yes
If yes, see S.L. 2012-200, Part VI: http://portal.ncdenr.orgZweb/wq/ws/su/­statesw/rules laws
Form SWU-101 Version 06Aug2012 Page 1 of 6

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:4-GOVIND, LLC
Signing Official & Title:Ninad N. Patel - Manager
b. Contact information for person listed in item 1a above:
Street Address:101 Charles Street
City:Havelock
Mailing Address (if applicable):
City:
State:NC
State:
Phone: (252 ) 571-0147 Fax: (n/a )
Email:n a
Zip:28532
Zip:
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:
Signing Official &
b. Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City:
State: Zip:
Phone: ( ) Fax:
Email:
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:Thomas Engineering, PA
Signing Official & Title:Bobby Billingsley, PE - Project Engineer
b. Contact information for person listed in item 3a above:
Mailing Address:401 Howell Road
City:New Bern State:NC Zip:28562
Phone: (252 ) 637-2727 Fax: (252 ) 636-2448
Email: bobbybillin_gsley@thomasengineeringpa. com
4. LocaI jurisdiction for building permits: Craven County Inspections Department
Point of Contact:Shelton Toler Phone #: (252 ) 636-6618__
Form SWU-101 Version 06Aug2012 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Sheet flow across narking/driveways to several area drains. Area drains pined to underzround CMP
detention network system. Detention system flow through Contech Stormfilter and offsite through adjacent
propeM pipe. Overflow stormwater byRasses the stormfilter box.
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. 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 Neuse River basin.
4. Total Property Area: A,, %SSA acres 5. Total Coastal Wetlands Area: acres
b. Total Surface Water Area: '~' acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area+:36,655 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal Hi li Water (NHM Iine or Mean High Water
W) (MHline, and coastal wetlands landward from the NHW (or Z; line. Die resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = _ 412.3 % °"o4.
9. How many drainage areas does the project have? l (For high density, count 1 for each proposed engineered AIZM
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 7
Drainage Area _
Drainage Area _
Drainage Area
Receiving Stream Name
Sandy Run
Stream Class *
SC;SW;NSW
Stream Index Number *
27-112-6-3
Total Drainage Area (so
36,655
7 vTAL
On -site Drainage Area (so
26,841
A9
AM
Off -site Drainage Area (so
0
Proposed Impervious Area** s
24,746
Impervious Area** total
92.3%
<--% of PA
Impervious' Surface Area
Draina e Area 7
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (sf)
24,746
On -site Streets (so
The above
On -site Parking (so
amount is
On -site Sidewalks (sf)
the total
Other on -site (so
0
Future (so
0
Off -site (so
0
Existing BUA*** (sf)
Neglected
Total (so:
24,746
* Stream Class and Index Number can be determined at: http/lportal.iicde)zr.ortoeh/ciyg/ps/csu/classi icaffons
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
**'Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new B UA.
Form SWU-101 Version 06Aug2012 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation, n/a
Projects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/­wSl/ws/su/bnip-matival.
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.ncdenr.org/web/wq/ws/su/statesw/forms_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.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. QL-e
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants T
Form. (f required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
le —[-a
http://www.envhelp.or&ZRages/onestopexpress.htmI for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/ managementfor
Q��� / 24,W
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
ry-e-fd, kco
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/z
�—
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
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 Iandward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
Form SWU-101 Version 06Aug2012 Page 4 of 6

�. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verify the SHWF prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 3035 Page No: 765 0e(-0
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC gLd
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http: / / www.secretary. s tote. nc. us/ Corporations/ CSearch. aWx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If Iot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, Iot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC 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:lohn G. Thomas, PE
Consulting Firm: Thomas En 'neerg, PA
Mailing Address:PO Box 1309
City:New Bern State:NC Zip:28563
Phone: (252 637,2727 _ _ Fax: (252 ) 636.2448�
Email.,[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item 1a) with (print or hjpe name of organization listed in
Contact Information, item 1a) to develop the project as currently proposed. A copy of
the Iease 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 06Aug2012 Page 5 of 6

• As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date:
I, a Notary Public for the State of _ County of
do hereby certify that personally appeared
before me this _ day of . and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item In) Ninad N. Patel
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 ru atA 7AC 2H .1000 and any other applicable state stormwater requirements.
Signature: Date: Cl�]P-Z11 2-
I, � C). Q , a Notary Publicfor the State of '7 �� 11��1L'� County of
0t Q.(U &Yt. -do hereby certify that D �l, . personally appeared
before me this day of and ac owled e the due execution of the application for
a stormwater permit. Witness my hand and official sea ,
SEAL
My commission expires I " a t - as ! 'L4
Form SWU-101 Version 06Aug2012
Page 6 of 6

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PRESS
OCT 23 2012
WC DENR
Permit
Number: t-24CIO
(to be provided by DWQ)
Drainage Area
Number:
'Contech StormFilter 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
StormFilter.
- The pretreatment sump will be cleaned out whenever sediment depth exceeds
- six inches.
The StormFilter system will be inspected quarterly. Records of operation and
maintenance will be kept in a known set location and will be available upon
request.
Inspection activities shall be performed as follows. Any problems that are found
shall be repaired immediately.
BMP element: -�
Potential problem: W v
How i will remediate the problem:
Entire BMP
Trash/debris is present.
Remove the trash/debris.
Adjacent pavement (if
applicable)
Sediment is present on the
pavement surface.
Sweep or vacuum the sediment as soon as
possible.
Flow diversion structure (if required)
The structure is clogged.
Unclog the conveyance and dispose of any
sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if
damage is too large for repair.
Page I of 3

BMP element:
Potentialproblem:
How I will remediate theproblem:
Cartridges not performing as
designed — see Contech O&M
document to determine if cartridge
Replace cartridges per manufacturer's
StormFiiter Cartridges
maintenance is required.
recommendations.
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.
Page 2 of 3

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: Expressway #4
BMP drainage area number: l
Print name: Nina' N. Patel
Title: Manager — 4-GOVIND, LLC
Address: 101 Charles Street, Havelock, NC 28532
Phone:[phone]
Sign
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, U a Notary Public for the State of
, County of ram, UAL) do hereby certify that
personally appeared before me this day of
�I IA , : , and acknowledge the due execution of the forgoing
StormFilter maintenance requirements. Witness my hand and official seal, *6�'
woa
.pU13
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.
rr, . Zo•
1'1EN C4 �.�►'�
•• t rwaai���
SEAL
My commission expires_ — Q 1 — QZ21 L4
Page 3 of 3