SW8121101_CURRENT PERMIT_20121130

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
115�)
YYYYMMDD

MCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
November 30, 2012
Mr. Barnes Boykin, Vice President
Eastern Pride, Inc
2405-F Nash St.
Wilson, NC 27896
t, ■
Division of Water Quality
Charles Wakild, P. E.
Director
Mr. Frederick Mitchell
403 Bay Drive
Sneeds Ferry, NC 28460
Subject: State Stormwater Management Permit No. SW8 121101
Family Dollar - Richlands
High Density Commercial Sand Filter Project
Onslow County
Dear Mr. Boykin and Mr. Mitchell:
Dee Freeman
Secretary
The Wilmington Regional Office received a complete Stormwater Management Permit
Application for Family Dollar - Richlands on November 29, 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. SW8 121101, dated November 30, 2012, for the construction, operation
and maintenance of the BMP's and built -upon area associated with the subject project.
This permit shall be effective from the date of issuance until November 30, 2020, and shall be
subject to the conditions and limitations as specified therein. The designated permit holder,
Eastern Pride, Inc, shall be responsible for meeting the conditions and limitations specified
therein. Please pay special attention to the conditions listed in this permit regarding the
Operation and Maintenance of the BMP(s), recordation of deed restrictions, procedures for
changes of ownership, transferring the permit, and renewing the permit. Failure to establish an
adequate system for operation and maintenance of the stormwater management system, to
record deed restrictions, to transfer the permit, or to renew the permit, will result in future
compliance problems.
Please be aware that it is the responsibility of the permit holder, Eastern Pride, Inc., to notify
DWQ of any changes in ownership and request an ownership/name change for the stormwater
permit. However, please be reminded that if the agreement to purchase the property between
Eastern Price, Inc. and Mr. Frederick Mitchell is dissolved, cancelled or defaults, and DWQ is
not notified by Eastern Pride, Inc. to transfer the permit, then the responsibility for permit
compliance reverts back to the property owner. As the property owner, Mr. Frederick Mitchell
must notify DWQ immediately of the permit ownership change and submit a completed
Name/Ownership form to DWQ within 30days. Otherwise Mr. Frederick Mitchell will be
operating a stormwater treatment facility without a valid permit. This 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, being taken against the property owner,
Mr. Frederick Mitchell.
Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405
Phone: [phone] FAX: [phone] DENR Assistance: 1-877-623-6748
Internet: www,ncwaterqualit .org
A.. C... nl } V6—ti— A'fi— P-1- r
NorthCarolina
vVatur1711Y

State Stormwater Management Systems '
Permit No. SW$ 121101
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing by filing a written petition with the Office of
Administrative Hearings (OAH). The written petition must conform to Chapter 150B of the North
Carolina General Statutes, and must be filed with the OAH within thirty (30) days of receipt of
this permit. You should contact the OAH with all questions regarding the filing fee (if a filing fee
is required) and/or the details of the filing process at 6714 Mail Service Center, Raleigh, NC
27699-6714, or via telephone at 919-431-3000, or visit their website at www.NCOAH.coni.
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
Christine Nelson, at [phone].
Sincerely,
F
Charles . akild, P.E., Director
Division of Water Quality
GDS/can: S:IWQSIStormwater\Permits & Projects120121121101 HD12012 11 permit 121101
cc: Marie Peedin, Pamlico Engineering Services, PLLC
Onslow County Inspections
Wilmington Regional Office Stormwater File
n.-.-- r) _r r)

State Stormwater Management Systems
Permit No. SW8 121101
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY COMMERCIAL 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
Eastern Pride, Inc.
Family Dollar - Richlands
US Hwy 258 and NC 24, Richlands, Onslow County
FOR THE
construction, operation and maintenance of one (1) sand filter in compliance with
Session Law 2008-211 and the provisions of 15A NCAC 2H .1000 (hereafter collectively
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 November 30, 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 1.7 of this permit. The stormwater control has been
designed to handle the runoff from 23,643 square feet of impervious area.
3. A 50' wide vegetative buffer must be provided and maintained adjacent surface
waters, measured horizontally from and perpendicular to the normal pool of
impounded structures, the top of bank of both sides of streams and rivers and the
mean high water line of tidal waters.
4. The tract will be limited to the amount of built -upon area indicated in this permit
and permit per the approved plans. No built -upon area has been allocated for
future development.
5. 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.
Page 3 of 9

State Stormwater Management Systems
Permit No. SW8 121101
All runoff being directed into wetlands shall flow into and through those wetlands
at a non -erosive velocity of 2 fps or less.
The following design elements have been approved for this sand filter stormwater
facility, and must be provided in the system at all times.
a
07
C.
d.
e.
f.
h.
i.
j.
k.
I
m
n.
o.
P.
q-
r.
Drainage Area, acres:
Onsite, ft2.
Offsite, ft2:
Total Impervious Surfaces, ft2:
Onsite, W..
Offsite, ft2:
Design Storm, inches:
Sediment Chamber Depth, feet:
Sand Media Depth, feet:
Sediment Chamber Bottom Elev. fmsl
Sand Chamber Bottom Elev., fmsl:
Sediment Chamber Surface Area, ft2:
Sand Chamber Surface Area, ft2:
Weir Elevation, fmsl:
Maximum Head on Filter, feet:
Permitted Storage Volume, ft3:
Orifice Diameter, inches:
Time to Draw Down, hours:
Seasonal High Water Table, FMSL:
Receiving Stream 1 River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
0.916
39,901
none
23,643
23,643
none
1.5
3.5
2.0
55.0
55.0
550
680
58.5
2.5
2,250
4.0" m
6.2
55.5
UT of the New River I White Oak
19-1
"C, NSW"
No person or other legal entity shall alter the approved stormwater management
system, or fill in, alter, or pipe any drainage feature, including swales, shown on
the approved plans as part of the stormwater management system, unless and
until the permittee submits a modification to the permit and receives approval
from the Division.
2. The permittee is responsible for verifying that the proposed built -upon area for
the entire project does not exceed the allowable built -upon area.
3. It is the responsibility of the permit holder, Eastern Pride, Inc., to notify DWQ of
any changes in ownership and request an ownership/name change for the
stormwater permit. However, please be reminded that if the agreement to
purchase the property between Eastern Price, Inc. and Mr. Frederick Mitchell is
dissolved, cancelled or defaults, and DWQ is not notified by Eastern Pride, Inc. to
transfer the permit, then the responsibility for permit compliance reverts back to
the property owner. As the property owner, Mr. Frederick Mitchell must notify
DWQ immediately of the permit ownership change and submit a completed
Name/Ownership form to DWQ within 30days. Otherwise Mr. Frederick Mitchell
will be operating a stormwater treatment facility without a valid permit. This 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, being taken against the property owner, Mr. Frederick Mitchell.
Page 4of9

State Stormwater Management Systems
Permit No. SW8 121101
4. 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.
5. 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.
6. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately. Infiltration systems should not be used
as erosion control devices, due to the potential clogging. 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.
7. 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. Redesign or addition to the approved amount of built -upon area or
drainage area.
C. Further development, 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.
d. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
8. The Director may determine that other revisions to the project should require a
modification to the permit.
9. 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.
10. The permittee shall at all times provide the operation and maintenance
necessary to assure that all components of the permitted stormwater system
function at optimum efficiency. The signed and approved Operation and
Maintenance Plan must be followed in its entirety and maintenance must occur at
the scheduled intervals.
11. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
12. Permanent seeding requirements for the stormwater control must follow the
guidelines established in the North Carolina Erosion and Sediment Control
Planning and Design Manual.
Page 5of9

State Stormwater Management Systems
Permit No. SW8 121101
13. Prior to transfer of the permit, the stormwater facilities will be inspected by DWQ
personnel. The facility must be in compliance with all permit conditions. Any
items not in compliance must be repaired or replaced to design condition prior to
the transfer. Records of maintenance activities performed to date will be
required.
14. This permit shall become voidable unless the facilities are constructed in
accordance with the conditions of this permit, the application, approved plans
and specifications, and other supporting data.
15. Built upon area includes, but is not limited to, structures, asphalt, concrete,
gravel, brick, stone, slate, coquina and parking areas, but does not include
raised, open wood decking, or the water surface of swimming pools.
III. GENERAL CONDITIONS
This permit is not transferable to any person or entity except after notice to and
approval by the Director. At least 30 days prior to a change of ownership, or a
name change of the Permittee or of the project, or a mailing address change, the
permittee shall submit a completed and signed "Name/Ownership Change Form"
to the Division of Water Quality, accompanied by the appropriate documentation
as listed on the form. The project must be in good standing with DWQ. 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 of the terms and conditions
of this permit until such time as the Director approves the transfer request.
Neither the sale of the project area in whole or in part, nor the conveyance of
common area to a third party, constitutes an approved permit transfer.
3. Any individual or entity found to be in noncompliance with the provisions of this
storrmwater management permit or the requirements of the Stormwater rules is
subject to enforcement procedures as set forth in G.S. 143 Article 21.
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) which have jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The 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.
7. Permittee grants permission to staff of the DWQ to access the property for the
purposes of inspecting all components of the stormwater facilities.
8. The permittee shall submit a permit renewal request at least 180 days prior to the
expiration date of this permit. The renewal must include the appropriate
documentation and processing feel.
Page 6 of 9

State Stormwater Management Systems
Permit No. SW8 121101
9. The application form, supplement forms, approved plans and specifications for
this project are incorporated by reference and are enforceable parts of the
permit. A copy of the approved plans and specifications shall be maintained on
file by the Permittee at all times.
Permit issued this the 30th day of November ,2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Division of Water Quality
By Authority of the Environmental Management Commission
Page 7 of 9

State Stormwater Management Systems
Permit No. SW8 121101
Family Dollar - Richlands
Stormwater Permit No. SW8 121101
Onslow County
Designer's Certification
Page 1 of 2
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 are a part of this Certification.
Noted deviations from approved plans and specifications:
Signature
Registration Number
Date
SEAL
Page 8 of 9

State Stormwater Management Systems
Permit No. SW8 121101
Certification Requirements: Page 2 of 2
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 sand filter elevations are per the approved plan.
6. The sand filter is located per the approved plans.
7. A trash rack is provided on the outlet/bypass structure.
8. For open sand filters, 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.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized and located per the
approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf, a
forebay, and the vegetated filter.
15. The required dimensions of the system are provided, per the approved
plan.
cc: NCDENR-DWQ Regional Office
Onslow County Building Inspections
Page 9 of 9

Family Dollar - Richlands
Stormwater Permit No. SW8 121101
Onslow County
Designer's Certification
State Stor water Management Systems
Permit No. SW8 121101
") Page 1 of 2
Uk rt as a duly registered in
the State of North Carolina, having been authorized to obsery lylweekly/full
time) the construction of the project,
�� �"' 1y -\--> �\\ar ' UA, -�s
(Project)
for �_S TC--� _ �r pie �c _(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 are a part of this Certification.
Noted deviations from approved plans and specifications:
Signaturw'��X�W
Registration Number
Dater_
.I H i C'q R
a. FESS�U.
r SAL r 7 S
r 9 � 20212
r
sf , ,f YL ETI 4 q4A.
RECEIVE
MAY 17 2013 D
BY. —
Page 8 of 9

State Stormwater Management Systems
Permit No. SW8 121101
Certification Requirements: Page 2 of 2
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.
Y 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.
The sand filter elevations are per the approved plan.
6. The sand filter is located per the approved plans.
`Z"'7. A trash rack is provided on the outletlbypass structure.
�. For open sand filters, all slopes are grassed with permanent vegetation.
`""9. Vegetated slopes are no steeper than 3:1.
t/0. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
vl""11. The permitted amounts of surface area and/or volume have been
provided.
t� 12. Required drawdown devices are correctly sized and located per the
approved plans.
13. All required design depths are provided.
✓ 14. All required parts of the system are provided, such as a vegetatiNd-stfet ,
e r.
�15. The required dimensions of the system are provided, per the approved
plan.
cc: NCDENR-DWQ Regional Office
Onslow County Building Inspections
Page 9 of 9

.;Pamlico Engineering Services, PLLC
128 Abbey Lane
WASHINGTON, NC 27889
PHONE [phone]
Rmlico
Enginering
en+ices
To:
Date 5/14/13 Job No. 120 24
NCDEN R - DWQ
Attention : Kelly Johnson
Stormwater
Family Dollar Richlands
i
i
WE ARE SENDING YOU ® Attached ❑ Under separate cover via
the following items:
❑ Shop drawings ❑ Prints ® Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES DATE No DESCRIPTION
i Original Designer's Certification
THESE ARE TRANSMITTED as checked below:
® For approval ❑ Approved as submitted ❑ Resubmit copies for approval
Cl For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FOR BIDS DUE 20_ ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS:
Please call if you have any questions.
Marie U. Peedin, PE.
GGEIVE
MAY 17 2013
BYE _.

9.W�Q USE ONLY
r' Fee raid / i Permit Number
Applicable Kules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph lI - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
1. GENERAL INFORMATION
Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
2. Location of Project (street address):
City:Richlands County:Onslow " Yo'
. Zip: 28574
3. Directions to project (from nearest major intersection):
Approximately 530 if southeast along US 258 from the intersection of US 258 and NCSR 1306 located on the
West
4. Latitude:34° 54' 03" N Longitude:77* 33' 10" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tReneu7als with modifications also requires SWU-102 - Reneroal 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: ❑Nat 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: na ac of Disturbed, Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Proj9WArmit Number,
issue date and the type of each permit:
5. Is the project located within 5 miles of a public airport? ®No
If yes, see S.L. 2612-200, Part VI: http://portal.ncdenr._c
Form SWU-101 Version 06Aug2012 Page I of

II.[. - 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: Eastern Pride Inc.
Signing Official & Title:Barnes Boykin, Wax2mai4knitZ Secretary
b.Contact information for person listed in item 1a above:
Street Address:2405-F Nash Street
City: W i lson State:NC Zip:278%
Mailing Address (if applicable):
City:
Phone: (252 ) 230-0632
Email:
State: Zip:
Fax:
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: Frederick Mitchell
Signing Official & Title: Owner
b. Contact information for person listed in item 2a above:
Street Address:403 Bay Drive
City:Sneeds Ferry _ State:NC Zip:28460
Mailing Address (if applicable):
City: State:
Phone: ( ) Fax: ( )
Email:
3. a. (Optional) Print the name and title of another contact such as the projects construction supervisor or other
person who can answer questions about the project: P-,.
Other Contact Person/
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
Email:
4. Local jurisdiction for building permits:
Point of Contact:George Lacey, Code Administrator
State: Zip:
Fax: ( ) __
[phone] Phone #:
Form SWU-101 Version 06Aug2012 Page 2 of 6
BY:
25 2012

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 through a sand filter prior to overflowing into
an existing draiange system which drains to a tributary t
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 11- Post Construction
3. Stormwater runoff from this project drains to the White Oak River basin.
4. Total Property Area: 0.916 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
Aree:0.916 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NttK9 line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MH1Nj line. The resultant project area is used to
calculate overall percent built upon area (BLIA). 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 = 59.25 %
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area _
Draina a Area
Drainage Area
Receiving Stream Name
UTrib of New
River
Stream Class *
C, NSW
Stream Index Number *
194
Total Drainage Area (so
39901
On -site Drainage Area (sf)
39901
Off -site Drainage Area (so
0
Proposed Impervious Area" (so
1 23643
% Impervious Area** total
59.25
-Impervious" Surface Area
Drainage Area 1
Drainage Area
Drainage Area
Drainage Area _
On -site Buildings/Lots (so
8320
On -site Streets (so
0
On -site Parking (so
13474
On -site Sidewalks (so
1949
� �p
Other on -site (so
0 -
-
Future (sf)
0
y NOV 7 6 7m'
I
Off -site (so
0
Existing BUA*** (so
0
BY.
Total (so:
23643
Strearn Class and Index Number can be determined at: lrtU2.aortal.rrcdearr.org ebluLq ps/csu/classificatiorrs
Form SWU-101 Version 06Aug2012 Page 3 of 6

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*" Iinppervious 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 BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. n1a
Proieets 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
fromhttpl/norm.ncdenT.Or&/web/wq/ws/su/bmp manual.
VL 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 _does. 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:L/portal.ncdenr.org/web/wg/ws/su/maps.)
Please indicate that the following regMired 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 b_ft:/Zportal.ncdenr.org/_Web/wg/ws/su/statesw/­forms-docs.
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one cop, of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) sealed signed and dated and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
ht :/ lwww.envheII2.org/pgyesLQiaestppexMess.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/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'/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. NOV og 2012
g. Revision number and dates. }
h. Identify all surface waters on the plans by delineating the normal pool elev4 'on of
impounded structures, the banks of streams and rivers, the MHW or NHW luie-of tidy
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 w e -,
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned. 2�12
k. Existing contours, proposed contours, spot elevations, finished floor elevations. SEP 2
1. Details of roads, drainage features, collection systems, and stormwater control m res.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated b
qualified person. Provide documentation of qualifications and identify the person o
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
Form SWU-101 Version 06Aug2012 Page 4 of 6

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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 verify the SHWTprior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 871 Page No: 124
11. For corporations and Iimited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 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.
htt�:/ /www.secretary.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
htt ortal.ncdenr.or web w ws su statesw forms does. 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 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.
Vill. CONSULTANT INFORMATION AND AUTHORIZATION EGEOVEn
Applicant: Complete this section if you wish to designate authority to another indiv�u al d/c�r f' uc as a
consulting engineer and/or firm) so that they may provide information on your behal ifo # Rr��ch
addressing requests for additional information). I G
Consulting Engineer:Marie U. Peedin
Consulting Firm: Pamlico Engineering Services, PLLC _.
Mailing Address:128 Abbey Lane
City: Washington State -.NC Zip:27889
Phone: (252 _ ) 945-2983_ Fax: (252_ ) 974-7618
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) Frederick V. Mitchell - , certify that I
own the property identified in this permit application, and thus give permission to (print or hype name of person
listed in Contact Information, item 1a) Barnes Boakin _ with (print or hjpe name of organization listed in
Contact Information, item 1a) Eastern -Pride, hu _ 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.
ECEIVE
SEP 2 5 2012
Form SWU-101 Version 06Aug2012 Page 5 of 6 13Y:

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As llie 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 S6ormwater 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 NCGS 143-215.6_
Date: 11-�2// Z
e, P , T� a Notary
� jPuublic for
do ereby certify that r�.1Y
before me this day Of em < an
a stormwater permit. Witness my hand and official sea
SEAL
the State of! \ V-fT 1
1% ft+- -1-e I
�owledge the due execs
i4Lt:FiM M.
Notuyl
caorranls
MY
County of
Personally appeared
of the application for
My commission expires C 5 r '5 7_ to r
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 2) Barnes B ,
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 21H.1000, SL 2006-246 (Ph. H - Post Construction) or SL 2008-211.
Signature: Date.
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,
�CEDVE
SEAL '
NOV 0 � 2012 a
aY: �� f�%�
My commission expires
SEP 2 5 2012
Form SWU-10l Version 07]uty2009 Page 6 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 tieeir company and/or cancels or defaults on their
lease aunt, 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 efarrement action inhaling
the assessment of civil penalties of up to $225,000 per day, pursuant to NCGS 143-215.6.
Signature: Data}
I, - -- - - - - -- - -- -- . a Notary Public for the State of - - - - -- - - - . Co" 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 IF—0 0%9 E
NOV 012M
X APPLICAN 'S CERTIFICATION
L (print or type name of person listed in Contact Infor►nation, item 2) Barnes AZd m
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. rules under 15A CAC 2H .1000, SL 2006-246 (Ph.11- Pt st Construction) or SL 2008-211.
7-t7,.S /3 �'� q V—/)�
Signature. Date.
I, - �+^► °I a Notary Public for the State; _ L. . County of
1Lshk, do hereby certify that lcxx 1 , O personally appeared
before me this `T day of YNn & G �:a I), , and acknaw e- d execu ' application for
a stormwater permit. Witness my hand and official seal,
CHERYL LOretsNG
Mot"'
Public
1Mlson 9
on �yzoni
W
Form SWU-101 version 07Ju1y2009
-WXAI
My commission expires I a% i -� !,_I i l--
EGF-
SEP 2 5 2012
Page 6 of 6Y: