SW7110303_CURRENT PERMIT_20110315

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
Sw _I& z) 5
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE�(D
YYYYMMDD

�, w �
NC®ENR
North Carolina Department of Environment and
Beverly Eaves Perdue
Governor
Mr. Don Palmer
115 Azure Drive
Emerald Isle. NC 28594
Dear Mr. Palmer:
Division of Water Quality
coleen H. Sullins
Director
March 15, 2011
W4xRO
Natural Resources
Dee Freeman
Secretary
Subject: Stormwater Permit No. SW7110303
Kid's World
High Density Commercial Wet Pond Project
Craven County
The Washington Regional Office received a complete Stormwater Management Permit Application for
Kid's World on March 8, 2011. 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 21-1.1000. We are forwarding Permit No. SW7110303 dated March 15, 2011, for
the construction of the subject project.
This permit shall be effective from the date of issuance until March 15, 2021, 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 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer
27447, Raleigh, NC 27611-7447. Unless such demands are made this permit shall be final and
binding.
If you have any questions, or need additional information concerning this matter, please contact Scott
Vinson, or me at [phone].
S cere ,
AI Hod e d `
Regional Supervisor
Surface Water Protection Section
AH/ sv: K:\WQS\STORMWATER\PERMIT\SW7110303
cc: Joseph Avolis, PE
aven County Building Inspections
Washington Regional Office
North Carolina Division of Water Quality Internet: wtivw.ncuaterquality,org 7�TOne y, 1 943 Washington Square Mall Phone: [phone] \ FAX: [phone] Ol�tl I C�II 01 I Ilal
n Equal
Oin, NC 27889 FAX: [phone] Natu Nn ly
An Equal Opponunityl AKnnalive Action Employer LL IDL`

State Stormwater Management Systems
Permit No. SW7110303
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
Don Palmer
Kid's World
at 7430 US. Hwy 70, South of New Bern, Craven County
FOR THE
construction, operation and maintenance of a wet detention pond and grassed swales
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 March 15, 2021, 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 80,665 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section I. of
this permit, and per 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 perennial and intermittent surface waters.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7110303
The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a. Drainage Area, acres:
b. Total Impervious Surfaces, ftZ:
C. Design Storm, inches:
d. Pond Depth, feet:
e. TSS removal efficiency:
f. Permanent Pool Elevation, FMS�:
g. Permanent Pool Surface Areq, ft
h. Permitted Storage Volume, ft :
i. Temporary Storage Elevation, FMSL
j. Predevelopment 1 year 24 hour:
k. Post development 1 year 24 hour:
I. Controlling Orifice:
M. Permitted Forebay Volume, ft3:
n. Fountain Horsepower, HP
o. Receiving Stream/River Basin:
P. Stream Index Number:
q. Classification of Water Body:
It. SCHEDULE OF COMPLIANCE
4.16
80,665
1.50
6.50 (4.00 avg.)
90 %
24.50
7,282
10,095 at temporary pool el
25.60
4.03
1.60
1.50"0 pipe
4,413
0, (too small no fountain allowed)
Tucker Creek / Neuse
27-112-6
"SC; Sw, NSW"
1. 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 time provide the operation and maintenance necessary
to assure the permitted stormwater system functions at optimum efficiency. The
approved Operation and Maintenance Plan must be followed in its entirety and
maintenance must occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the vegetated filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, level
spreader, filter strip, catch basins and piping.
q. Access to the outlet structure must be available at all times.
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. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
6. Decorative spray fountains will not be allowed in the stormwater treatment
system.
7. The facilities shall be constructed as shown on the approved plans. This permit
shall become void 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. SW7110303
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.
9. 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.
10. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. 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.
12. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
13. A copy of the approved plans and specifications shall be maintained on file by
the Permittee at all times.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form, to the Division of Water
Quality, signed by both parties, and accompanied by supporting documentation
as listed on page 2 of the form. The project must be in good standing with the
Division. 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.
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.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7110303
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2008-
211, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division 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 March 15, 2021.
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 15th day of March, 2011.
INA ENVIRONMENTAL MANAGEMENT COMMISSION
for
Division of Water Quality
By Authority of the Environmental Management Commission
Stormwater Permit No. SW7110303
Page 5 of 7

State Stormwater Management Systems
Permit No. SW7110303
Kid's World
Stormwater Permit No. SW7110303
Craven 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
Page 6 of 7

State Stormwater Management Systems
Permit No. SW7110303
Certification Requirements:
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation.
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 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,
and a forebay.
15. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Washington Regional Office
Craven County Building Inspections
Page 7 of 7

IA
a R I u've
Fee Paid end£ , t,54
Permit Number
n.
963000 Mk erso
SvJ—I II D303
Applicable iZu es: -Coastal SW - 1995 ❑ Coasta SW - 2008 ❑ Ph II - Post Construction
(select all thrttrntwlvl. n-Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
9tl ri ILJer WQ M mt Plan:
State of North Carolina 00�U J
Department of Environment and Natural Resources c ,U S
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
L 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:)-
2. Location of Project (street address):
7430 U.S. Highway 70
City:New Bern County:Craven Zip:28560
3. Directions to project (from nearest major intersection):
4. Latitude:34° 56' 36.6" N Longitude:76° 56' 48.5" 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 N/A , 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):
❑LAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 3.9 ac of Disturbed Area
❑404/401 Permit: Proposed Impacts
b.lf any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit: N/A
FonnSWU-101 Version07Jun2010
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: Don Palmer
Signing Official & Title: Developer
b.Contact information for person listed in item la above:
Street Address:115 Azure Drive
City: Emerald Isle State:NC Zip:28594
Mailing Address (if applicable):
City: State:
Phone: ( ) Fax:
Email:
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: Jeffrey Ashford Wynne
Signing Official & Title: leffrey Ashford Wynne, Property Owner
b.Contact information for person listed in item 2a above:
Street Address:7470 Highway 70 East
City:New Bern State:NC Zip:28560
Mailing Address (if
City:
Phone: ( )
Fax: ( )
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:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State:
Phone: ( ) Fax:
4. Local jurisdiction for building permits:
Point of Contact:Shelton Toler Phone #: (252 ) 636-4987
Form S)VU-101 Version 07Jun2010 Page of 6

IV. PROJECT INFORMATION
1. In the space provided below, hriefly summarize how the stormwater runoff will be treated.
Stormwater runoff will be collected in grass lined swales and directed to a wet detention pond for 90% TSS.
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: 4.157 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': 4.157 acres .
Total project area shall be calculated to exclude the followin the norinal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MH1N) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Nano -coastal roetlands landward of tlne NHW (orMHW) lime nnay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 44.6 %
9. How many drainage areas does the project have?7 (For high density, count I for each proposed engineered
stornnoater BMP. For low density and other projects, use I for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area _
Drainage Area
Drainage Area
Receiving Stream Name
Tucker Creek
Stream Class *
SC; Sw, NSW
Stream Index Number *
27-112-6
Total Drainage Area (so
181,059
On -site Drainage Area (sf)
181,059
Off -site Drainage Area (so
0
Proposed Impervious Area** s
80,665
% Impervious Area** total
44.6
Irri ervious.* Surface"Area
aDraina e Area 1
Draina'LieArea
Draina e Area L,
Draina e Area
On -site Buildings/Lots (so
12,919
On -site Streets (so
6,726
On -site Parking (so
6,318
On -site Sidewalks (so
1,608
Other on -site (so
50,224
Future (so
0
Off -site (so
0
Existing BUA*** (so
2,870
Total (so:
1 80,665
* Stream Class and Index Number can be determined at: littp:Uportal.ricdenr.or vebhoq(ps/esu/classifications
* Impervious area is defined as the built upon area including, bat not limited to, buildings, roads, parking areas,
sidezoalks, gravel areas, etc.
*** Report only that anount 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.
Form SWU-101 Version 07Jun2010 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation.
Field Visit and Topographic Survey
Proiects in Union County: Contact DWQ Central Office staff to check ifthe project is located within a Threatener) &
Endangered Species watershed that may be subject to more stringent stonnwater requirements as per NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from httLi://portii.ncdenr.org/web/wq/ws/su/bap-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from httl2:/[porta1.ncdenr.org/web/wq/ws/su/statesw/forms dots. 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/maw.)
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://Vortil.ncdenr.org/web/wq/ws/su/statesw/forms dots.
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 V11 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
http://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/managementfor
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 _Q{�
receiving stream drains to class SA waters within'h mile of the site boundary, include the 1h v
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. �V "—
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.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
Form S WU-101 Version 07Jun2010 Page 4 of 6

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"xl1" 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 SNWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 2653 Page No: 478
11. For corporations and limited liability corporations (I.LC): Provide documentation from the NC NG4
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 21-1.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http://www.secretary.state.nc.us/Corporatioiis/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://portaI.ncdenr.org/web/wq/ws/su/statesw/forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ, and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: Joseph C. Avolis, P.E.
Consulting Firm: Avolis Engineering, P.A.
Mailing Address:P.O. Box 15564
City:New Bern
Phone: (252 ) 633-0068
Email:avolisen my eering©embargmail.com
State:NC Zip:28561
Fax: (252 ) 633-6507
IX. PROPERTY OWNER AUTHORIZATION (if Con tact Information, item 21as been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) Je fret/ Ashford Wttnne , certify that I
own the property identified in this permit application, and thus give permission to (print or hjpe name of person
listed in Contact Information, item la) Don Palmer with (print or hjpe none of organization listed in
Contact Information, item la) Kid's World 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 07Jun2010 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.
2�2q-2o\I
I, t rrvv a Notary Public for the State of NQv� -\o- County of
Q-rowQ - do hereby certify that personally appeared
before me this 24u day of ��f�ruor�.� , 2ot \ ,and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
NOTARY
PUBLIC
q�ENIC���Oxx��
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires Q4 . '22 ?c)\U
I, (print or type nine of person listed in Contact Infornmtion, item 1n) Dan Palmer
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 protectivq covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stq'4�/y)nwater rules Rdi 15A NCAC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SSL 2008-211.
Signature: r &-V*V � Date:
a Notary Public for the State of N - �Nti Countyof
C( do hereby certify that y pb- ° ✓ personally appeared
before me this2 t" day of . `Loi � and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,1\ �k
NOTARY
PUBLIC
SEAL
My commission expiresZotq
Form SWU-101 Version 07Jun2010 Page 6 of 6

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Permit No.
(to W provided by DWD)
W A Tf9O
NCDENR 'o
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part III) must be printed, filled out and submitted along with all of the required information.
I. PROJECTINFORMATION --. - -- -
Project name Kid'sWorld
Contact person Joseph C. Avolis, P.E.
Phone number 252-633*068
Date 24-Feb-11
Drainage area number 1
II. DESIGN INFORMATION
Site Characteristics
Drainage area
181,059i ry�
Impervious area, post -development
80,665'ry2
%impervious
44.55 %
Design rainfall depth
1.5in
Storage Volume: Non-SAWaters
Minimum volume required
Volume provided
Storage Volume: SA Waters
1.5" runoff volume
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Minimum volume required
Volume provided
Peak Flow Calculations
Is the pre/post control of the tyr 24hr stone peak flow required?
1-yr, 24-hr rainfall depth
Rational C, pre -development
Rational C, post -development
Rainfall intensity: 1-yr, 24-hr storm
Pre -development 1-yr, 24-hr peak flow
Post -development 1-yr, 24-hr peak flow
Pre/Post 1-yr, 24-hr peak flow control
Elevations
Temporary pool elevation
Permanent pool elevation
SHWT elevation (approx. at the perm. pool elevation)
Top of 1 Oft vegetated shelf elevation
Bottom of 10ft vegetated shelf elevation
Sediment cleanout, top elevation (bottom of pond)
Sediment cleanout, bottom elevation
Sediment storage provided
Is there additional volume stored above the state -required temp, pool?
Elevation of the top of the additional volume
10,095ry' Insufficient required volume.
10,095,. ft,
OK, volume provided Is equal to or in excess of volume required.
ft
It,
ft1
Its
ry3
Y ;(Y or N)
3.5 in
0.30' (unitless)
0.57 limitless)
0.15'in/hr OK
4.03 fta/sec
6.48 ft'/sec
2.45 aalen,
25.60 fmsl
124.50,fmsl
24.50' fmsl
25.00'.. fmsl
24.00' fmsl
18.00 fmsl
17.00, fmsl .
1.00 ft
N (YorN)
fmsl
Form SW401-Wet Detention Basin -Rev 8-9/17109 Parts 1.8 11. Design Summary. Page 1 of 2

Permit No..
(to be provided by DWQ
Area, temporary pool
10174, ft'
Area REQUIRED, permanent pool
7,007 ft'
SAIDA ratio
3.87- limitless)
Area PROVIDED, permanent pool, Ape,m-p,
.7,282'ft`
OK
Area, bottom of 1 Oft vegetated shelf, Asp, v,eu
5,243 ft`
Area, sediment cleanout, top elevation (bottom of pond), AWId
1 155 ft`
Volumes
Volume, temporary pool
10,095 to
OK
Volume, permanent pool, Vpe,,,, m,i
21,585 ft'
Volume, forebay (sum of forebays if more than one forebay)
4,4131 ft'
Forebay %of permanent pool volume
20.4 % %
OK
SAIDA Table Data
Design TSS removal
_
� 00:
Coastal SAIDA Table Used?
-Y T(Y or N)
Mountain/Piedmont SAIDA Table Used?
"N (Y or N)
SAIDA ratio -
3,87 (unitless)
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 10-2b)
.' N '+(Y or N)
Volume, permanent pool, Vpe,m psi
21,585 ft'
Area provided, permanent pool, Ape,m,W
7,282 ft`
Average depth calculated
ft
Need 3 If min.
Average depth used in SAIDA, d., (Round to nearest 0.5ft)
ft
,
Calculation option 2 used? (See Figure 10-2b)
.' Y i (Y or N)
Area provided, permanent pool, Ape,,,_p
7,282 ft`
Area, bottom of 1Oft vegetated shelf, Ay,t rnat
5,243 ft`
Area, sediment cleanout, top elevation (bottom of pond), Aw_pa,a
1,155 ft'
'Depth" (distance b/w bottom of 10ft shelf and top of sediment)
6.00 It
Average depth calculated
4.09, It
OK
Average depth used in SAIDA, d„, (Round to nearest 0.5ft)
4.0, ft
OK
Drawdown Calculations
Drawdown through orifice?
YI(Y or N)
Diameter of orifice (if circular)
1.50'l in
Area of orifice (if -non -circular)
:; in
Coefficient of discharge (CD)
0.60:'(unitless)
Driving head (H j
` 1.101 ft
Drawdown through weir?
N. ',(Y or N)
Weir type
(unitless)
Coefficient of discharge (C.)
_ (unitless)
Length of weir(L)Ift
Driving head (H)-
i [ft
Pre -development l-yr, 24-hr peak flow
..4.03?ft0Isec
Post -development 1-yr, 24-hr peak flow
1.60'. ft'Isec
Storage volume discharge rate (through discharge orifice or weir)
0.04'. fis/sec
Storage volume drawdown time
3.20I days
OK, draws down in 2-5 days.
Additional Information
Vegetated side slopes
!3i:1
OK
Vegetated shelf slope
10i:1
OK "
Vegetated shelf width
10.0'.ft
OK
Length of flowpath to width ratio
3':1
OK
Length to width ratio
3.0;:1
OK
Trash rack for ovedlow & orifice?
Y- - (Y or N)
OK
Freeboard provided
I1.1ift
OK
Vegetated filter provided?
IN ', (Y or N)
OK
Recorded drainage easement provided?
"Y "'!(Y or N)
OK
Captures all runoff at ultimate build -out?
t... ,,. Y..... '`..((Y or N)
OK
Drain mechanism for maintenance or emergencies is:
Pump
Form SW401-Wet Detention Basin -Rev .8-9117/09 Parts I. & II. Design Summary, Page 2 of 2

Permit No.
(to be provided by DWQ)
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.
Pagel Plan
Initials
Sheet No.
1. Plans (1" - 50' or larger) of the entire site showing:
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Delineated drainage basins (include Rational C coefficient per basin),
- Basin dimensions,
- Pretreatment system,
- High flow bypass system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
AGS
2. Partial plan (1" = 30' or larger) and details for the wet detention basin showing:
- Outlet structure with trash rack or similar,
- Maintenance access,
- Permanent pool dimensions,
- Forebay and main pond with hardened emergency spillway,
- Basin cross-section,
- Vegetation specification for planting shelf, and
- Filter strip.
��.
�c
C
3. Section view of the wet detention basin (1" = 20' or larger) showing:
V
- Side slopes, 3:1 or lower,
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
4. If the basin is used for sediment and erosion control during construction, clean out of the basin is specified
on the plans prior to use as a wet detention basin.
Q
r
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for forebay,
to verify volume provided.
C$
6. A construction sequence that shows how the wet detention basin will be protected from sediment until the
v
entire drainage area is stabilized.
CEO
7. The supporting calculations.
1 Wi?
8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
N/A
9. A copy of the deed restrictions (if required).
10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. County
soil maps are not an acceptable source of soils information.
Form SW401-Wet Detention Basin-Rev.8-9I17I09 Part III. Required Items Checklist, Page 1 of 1

Permit
(to be provided by DWQ)
Drainage Area Number: I
Wet Detention Basin 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.
The wet detention basin system is defined as the wet detention basin,
pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
❑ does ® does not incorporate a vegetated filter at the outlet.
This system (check one):
❑ does ® does not incorporate pretreatment other than a forebay.
Important maintenance procedures:
— Immediately after the wet detention basin is established, the plants on the
vegetated shelf and perimeter of the basin should be watered twice weekly if
needed, until the plants become established (commonly six weeks).
— No portion of the wet detention pond should be fertilized after the first initial
fertilization that is required to establish the plants on the vegetated shelf.
— Stable groundcover should be maintained in the drainage area to reduce the
sediment load to the wet detention basin.
— If the basin must be drained for an emergency or to perform maintenance, the
flushing of sediment through the emergency drain should be minimized to the
maximum extent practical.
— Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month and
within 24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a
Coastal County). Records of operation and maintenance should be kept in a known set
location and must be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash debris.
The perimeter of the wet
Areas of bare soil and/or
Regrade the soil if necessary to
detention basin
erosive gullies have formed.
remove the 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
Maintain vegetation at a height of
long.
approximately six inches.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 1 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number: I
BMP element:
Potentialproblem:
How I will remediate theproblem:
The inlet device: pipe or
The pipe is clogged.
Unclog the pipe. Dispose of the
Swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to
swale.
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
The forebay
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design depth for
possible. Remove the sediment and
sediment storage.
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 problems.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional
show that pruning is needed
practices
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the
dying.
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The main treatment area
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design sediment
possible. Remove the sediment and
storage depth.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Algal growth covers over
Consult a professional to remove
50% of the area.
and control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them
invasive plants cover 50% of
with pesticide (do not spray).
the basin surface.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 2 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
A tree has started to grow on
Consult a dam safety specialist to
the embankment.
remove the tree.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the local NC Division of
damage have occurred at the
Water Quality Regional Office, or
outlet.
the 401 Oversight Unit at 919-733-
1786.
The measuring device used to determine the sediment elevation shall be such
that it will give an accurate depth reading and not readily penetrate into
accumulated sediments.
When the permanent pool depth reads 6.5 feet in the main pond, the sediment
shall be removed.
When the permanent pool depth reads 6.5 feet in the forebay, the sediment
shall be removed.
Sediment Removal
Bottom
BASIN DIAGRAM
(fill in the blanks)
Permanent Pool Elevation 24.5
18.0 1 Pe anen Pool
--------------- -- Volume Sediment Removal Elevation 18.0 Volume
17.0 ft Min.
-------------------------------------------- ------
Sediment Bottom Elevation 17.0 1-fit r
Storage Sedimet
Storage
FOREBAY MAIN POND
Form SW401-Wet Detention Basin O&M-Rev.4 Page 3 of 4

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. 1 agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name
BMP drainage area number:
Print name:Don Palmer
Address:115 Azure Drive, Emerald Isle, NC 28594
Si
Date: `L a L�r L l
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,V �t Mrv� S a Notary Public for the State of
___, County of C r—O O 2 t\ , do hereby certify that
nn
Fes( rr2- personally appeared before me this
day of Cc.� r\.t O1 I , and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
B69WP9q�
aa` aY g�%
S NOTARY
a
PUBLIC
oauao
SEAL
My commission expires lkrl 1 22, 2Ot�1
Form SW401-Wet Detention Basin O&M-Rev.4 Page 4 of 4

Permit
(to be provided by DWO)
Sw. Op W ATEq
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
GRASSED SWALE SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part III) must also be filled out, printed and submitted along with all of the required information.
Project name
Contact name
Phone number
Date
Drainage area number
Joseph C. Avolis, PE
252-633-0068
II.'_DESIGN 'INFORMATION -
Site Characteristics
Drainage area
$81565.06W
Impervious area
28,750.00'ft2
Percent impervious
74.5% %
Design rainfall depth
1.50'inch
Peak Flow Calculations
10-yr storm runoff depth
6.00 in
10-yrstorm intensity
0.25 'inthr
Post -development 10-yr storm peak flow
I 0.17 1ft'/sec
Velocity
Maximum non -erosive velocity (peak 10-year storm)
Soil characteristics (enter "x' below)
Sand/silt (easily erodible)
Clay mix (erosion resistant)
Grass Type (enter "Y" below)
Bermuda
Tall fescue
Bahiagrass
Kentucky bluegrass
Grass -legume mixture
Swale type: Fill out one of the options below:
Option 1: Curb Outlet Swale:
Maximum velocity
Side slopes
Swale length
Option 2: Conveyance Swale, Seekino Pollutant Credit:
Maximum velocity for 10-yr storm
Side slopes
Swale length
6.00 fit/sec
X
N
(YorN)
I
i
1
ft
Y
(Y or N)
1.00
ft/sec OK
5.00
:1 OK
150.00
ft OK
Form SW401-Grassed Swale-Rev.3 Parts I and II. Project Design Summary, Page 1 of 2

Permit Number:
(to be provided by D W0)
Swale Characteristics
Swale Shape: Enter an Y' in the appropriate cell below:
Trapezoidal
Parabolic
V-shaped
Width of the bottom of the swale
Width of the top of the Swale
Additional Information
Is the swale sized for all runoff from ultimate build -out?
Is the BMP located in a proposed drainage easement with a
recorded access easement to a public Right of Way (ROW)?
What is the distance from the bottom of the swale to the SHWT?
What is the ground level elevation?
What is the elevation of the bottom of the swale?
What is the SHWT elevation?
What is the longitudinal slope of the swale?
What is the depth of freeboard?
X
0.00 ft
15.00 ft
Y (Y or N) OK
Y'(YorN) OK
1.00 ft OK
27.00 fmsl
25.70 fmsl
24.70'fmsl
0.X% OK
1.00 It OK
Form SW401-Grassed Swale-Rev.3 Parts I and 11. Project Design Summary, Page 2 of 2

Permit No:
• (to be assigned by DWQ)
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 Pagel Plan
Sheet No.
C3
1. Plans (1" = 50' or larger) of the entire site showing:
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Delineated drainage basins (include Rational C coefficient per basin),
- Swale dimensions (width, length, depth),
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Grass species, and
- Boundaries of drainage easement.
2. Plan details (1" = 50' or larger) for the grassed swale showing:
- Swale dimensions (width, length, depth),
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Grass species,
- Off -site drainage (if applicable),and
- Boundaries of drainage easement.
Cq
3. Section view of the grassed swale (1" = 20' or larger) showing:
- Side slopes,
- Longitudinal slope,
- Freeboard
- Swale dimensions, and
- SHWT level(s)
CEO 4. Supporting calculations (including maximum velocity calculations for applicable storms)
41J'nCff6i9 5. A copy of the signed and notarized operation and maintenance (0&M) agreement.
6. A copy of the deed restrictions (if required).
SW401-Grassed Swale-Rev.3 Part III, Page 1 of 1

Permit Name:
(to be provided by DWQ
Drainage Area Number: J
Grassed Swale 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 of the grassed swale will be carefully managed to reduce the
sediment load to the grassed swale.
— After the first-time fertilization to establish the grass in the swale, fertilizer will
not be applied to the grassed swale.
The grassed swale will be inspected once a quarter. 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:
Potentialproblem:
How I will remediate theproblem:
The entire length of the
Trash/debris is present.
Remove the trash/debris.
swale
Areas of bare soil and/or
Regrade the soil if necessary to
erosive gullies have formed.
remove the gully, and then re -sod
(or plant with other appropriate
species) and water until established.
Provide lime and a one-time
fertilizer application.
Sediment covers the grass at
Remove sediment and dispose in an
the bottom of the Swale.
area that will not impact streams or
BMPs. Re -sod if necessary.
Vegetation is too short or too
Maintain vegetation at a height of
ton
__approximatelysix inches.
The receiving water
Erosion or other signs of
__approxirnately
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
outlet.
733-1786.
Form SW401-Grassed Swale O&M-Rev.3
Page 1 of 2

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.
Projec! name: ICtD'g (A P-L-D
6MP drainage area number:
Print name: 1)(1YUAt-th PAL--"62.
Title: 121EVELD ge P_
Address: 115 ,A2uIkE 'pR.xur £MER44.-7 T C_ /VL' Z8594
Date: 3L3l i t
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
N&A--h.`Q0, ;Xk r\c�_ County of (r (3kjtar- do hereby certify that
1- t e� �Ca rv�y✓ personally appeared before me this '2 L
day of t/\k-o. r 6— 2)0\ , and acknowledge the due execution of the
forgoing grassed swale maintenance requirements. Witness my hand and official seal,
0".. S..... �
M..
r �
NOTARY
j PUBUC j
SEAL
My commission expires h yYXn 1
Form SW401-Grassed Swale O&M-Rev.3 Page 2 of 2