SW7130405_CURRENT PERMIT_20130628

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

'fir
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Acting Director Secretary
June 28, 2013
Mr. Barnes Boykin, VP/Secretary
Eastern Pride, Inc.
2405-F Nash Street
Wilson, NC 27896
Subject: Stormwater Permit No. SW7130405
Family Dollar Store - Bath
High Density Commercial - Constructed Wetland
Beaufort County
Dear Mr. Boykin:
The Washington Regional Office received a complete Stormwater Management Permit
Application for Family Dollar Store in Bath on June 7,-2013. 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. SW7130405 dated June 28, 2013, for the construction of the subject
project.
This permit shall be effective from the date of issuance until June 28, 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 150E of the North Carolina General Statutes, and filed with the Office of Administrative
Hearings, P.O. Drawer 27447, Raleigh, INC 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 at [phone].
Sincerely,
Thomas A. Reeder
AH/ sv: K:\WQS\STORMWATER\PERMIT\SW7130405
cc: Marie Peedin, Pamlico Engineering Services, PLLC
Beaufort County Planning
�/(Nashington Regional Office
North Carolina Division of Water Quality
943 Washington Square Mall One
Washington, North Carolina 27889 NOIthCarolina
Phone: [phone] FAX: [phone]n/
Internet: www.nmateualitv.om (/ y %tu`Nal/y
An Equal Opportunity 1 Aff native Action Employer

State Stormwater Management Systems
Permit No. SW7130405
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
Eastern Pride, Inc.
Family Dollar Store - Bath
On NC 92 in Bath, Beaufort County
FOR THE
construction, operation and maintenance of a constructed wetland 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 June 28, 2021, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 of this permit. The stormwater controls have
been designed to handle the runoff from 34,582 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 and specifications.
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. SW7130405
7. The following design criteria have been provided in the constructed wetlands and
must be maintained at design condition:
a.
Drainage Area, ft2:
74,357
b.
Total Impervious Surfaces, ft2:
34,582
C.
Design Storm, inches:
1.50
d.
Permanent Pool (PP)Elevation, FMSL:
8.00
e.
Shallow Water (PP) Surface Area, ft2:
1,927
f.
Temporary Pool (TP) Elevation, FfVJ�SL:
9.00
g.
Shallow Land (TP) Surface �rea, ft :
1,600
h.
Required Storage Volume, N:
4,355
i.
Provided Storage Volume, ft :
4,695
j.
Controlling Orifice:
1.13"0 pipes
k.
Receiving Stream/River Basin:
Back Creek / Tar -Pamlico
I.
Stream Index Number:
29-19-9-(2)
M.
Classification of Water Body:
"SB; NSW"
II. SCHEDULE OF COMPLIANCE
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. Mowin.9 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.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
records will indicate the date, activity, name of person performing the work and
what actions were taken.
5. 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. SW7130405
8. 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 permiittee 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.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7130405
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 June 28, 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 28`h day of June, 2013.
NORT 7CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
,64 i��� �� for
Thotfias A. Re er,-Acting Director
Division of W r Quality
By Authority of the Environmental Management Commission
Stormwater Permit No. SW7130405
Page 5 of 7

State Stormwater Management Systems
Permit No. SW7130405
Family Dollar Store - Bath
Stormwater Permit No. SW7130405
Beaufort County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/ full
time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Management Systems
Permit No. SW7130405
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
Beaufort County Planning / Building Inspections
Page 7 of 7

' �
DWQ USE ONLY
Date Received
Fee Paid
Permit Number
3
3
6'
-
Applicable Rules:
❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply)
❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ MEnt Plan: L
State of North Carolina �p ';�
Department of Environment and Natural Resources C S.� __, ! N,
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORMPR - 3 2013
This form may be photocopied for use as an original y y
I. GENERAL INFORMATION UV�t-c��I�RO
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans, O
specifications, letters, operation and maintenance agreements, etc.): I�
Bath- Family Dollar
2. Location of Project (street address):
NC 92 428' NW of NCSR 1913 and NC 92
City:Bath County:Beaufort Zip:27808
3. Directions to project (from nearest major intersection):
Property is located 428' north west of the intersection of NC 92 and NCSR 1913
4. Latitude:35° 28' 30" N Longitude:76° 48' 24" W of the main entrance to the project.
IL PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-102 - Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ®Not Started ❑Partially Completed* ❑ Completed* "provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System []Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
Proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control:1.70 ac of Disturbed Area
❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired
issue date and the type of each permitTar Pam Bu
provide the Project Name, Project/Permit Number,
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: httl2://12ortal.ncdenr.org/web/wq/ws/su/statesw/`rules laws
Form SWU-101 Version 06Aug2012 Page 1 of
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III.. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the oroiect):
Applicant/Organization:Eastern Pride, Inc.
Signing Official & Title:Barnes Boykin Vice President/ Secretary
b. Contact information for person listed in item 1a above:
Street Address:2405-F Nash Street
City:Wilson State:NC Zip:278%
Mailing Address (if applicable):
State: Zip:
Phone: (252 ) 23040632 Fax:
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization: Margaret A. Midgette
Signing Official & Title: Margaret A. Midgette
b. Contact information for person listed in item 2a above
Street Address:P O Box 154
City:Bath State:NC Zip:27808
Mailing Address (if applicable):
Phone:
State:
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
City:_
Phone:
State:
Fax: ( )
4. Local jurisdiction for building permits: Beaufort co
Point of Contact: Brandon Hayes Phone #: (252 ) 946-7182
Form SWU-101 Version 06Aug2012 Page 2 of

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IV. PROJECT INFORMATION
1. In the space provided below, brift summarize how the stormwaber runoff will be treated.
2. a. If claiming vested rights, identify the supporting documents provided and the date were a Approval of a Site Specific Development Plan or PIID Approval Date:y pproved
Valid Building Permit
❑ Other: Issued Date:
babe:
b.If claiming vested rights, identify the regulation(s) the project has been designed
❑ Coastal SW -1995 El Ph li - Post Construction n� accordancewith
3. Stormwater runoff from this project drains to the Tar Pam
River basin
4. Total Property Area:1.7 acres
5. Total Coastal Wetlands Area: 0
6. Total Surface Water Area: 0 acres
7. Total Pro
Pg= (4)a T�°ta(Coastal Wetlands Area (5) -Total Surface Water Area (6) =Total Project
Area*:1.7
Total project area shall be calerdaw to erdude the
between the banks o streams and Fo ng. the rrornud pool r Haled structures the area
(MHIM fine, and ca sta! ran ��, the area below the Normal Hi h Water (� line or Mean High Water
calculate overall Hands �—aard from the NHW (or MHf� lire. 77re resultant proieet area is used to
be included in the t project � a BLCA). Non -coastal wetlands hrndward of the NHW (or MH[M line may
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 46.51
9. How many drainage areas does the
10.
starmwater BMP. For low densi andProlect have7l (For high density, count 1 for each
ty other projects, use 1 for the whale property area)Complete the lid ��td
are more than four
d ulna oareas ption for each drainage area identified in Project Information item 9. If there
provided in the same format as below. Project, attach an additional sheet with the information for each area
- -, " .' o arc. - - o. _»• ••�....... M, ro, ouuaings roads, Parking areas,
Form SWU-101 Version 06Aug2012
Page 3 of 6

Report only that mnount 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.
Protects in Union County: Contact DWQ Central Office staff to check ifthe project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wq/ws/su/bmp-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
checklistsareavailablefromhttp://portal.ncdenr.org/web/wq/ws/su/`statesw/forms does. Thecomplete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http:/ /portal.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wu/ws/su/statesw/forms doss.
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 —4
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
http://www.envhein org/nages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/ management
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 lh
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW` or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer 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.
I. 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).
for
Form SWU-101 Version 06Aug2012 Page 4 of 6

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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"xll" 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 WiROt Schedule a site visit for DWQ to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 837 Page No: 797
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 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.
ht!p://www.secretaEy.state.nc.us/CoEporations/CSearch.aspx
VIL 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
h2R://gortal.ncdenr.org/web/wg/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.
VIIL CONSULTANT INFORMATION AND AUTHORIZATION
Applicant Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Marie U. Peedin
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:mMdin@pamlicoen%tinecrinjZservices.com
tX PROPERTY OWNER AUTHORIZATION (if Contact information, item 2 has been filled out, complete this
section)
I, (print or hjpe name of person listed in Contact Information, item 2a) Margaret A. Midgette , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item la) Barnes Boykin with (print or type name of organization listed in
Contact Information, item la) Eastern pride, Inc to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version 06Aug2012 Page 5 of

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As, the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the E)wQ Stonnwatu 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 Mrmwater treatment
facility out a valid permit. 1 understand that the operation of a siDrmwater 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�u�p" to$25,O00 perr day, pursuant to NCGS 143-215.6.
Signature: ' V \G ,ra Qn. �Q Y V�>�l a H' l) Dot,.
1
L �v • Kj—
C--O C . a Notary Public for the State of _ ��r L' Ck- 6( ' Cmm of
ty
do hereby certify that h1 l C zA N1 k�uCrhFe personally appeal
before me this day of C m 12UL end Inowledge the de a eraecution of the application for
a stormwater permit Witness my hand and official seal, t 1
AMY W. CORDON
Notary Pu6lie
Beaufort County
North Carolina
Commission Expire$ Jan 28, 2015
x APPLICAWS CEERT'IFICAMM
SEAL
My commiuion enepires .� ��1. a�� , 0IS
L (print or fW name ojperson Listed in Contact Inprrrudiem, item 1aj !lames 1lmrldrt
certify that the information included on this permit application form is, to the best of my know)edge, correct and
Ow t 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 Hiles under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
y� ate: k m13
Pubbttc for . �luf 1LW4h oL ,,_County or
e stormwaaer Permit Witness my hand and official seal,
SEAL
tA,�— — Ply appeared
due emcution of the application for
Im-
My commission exPtres r c2 a G l
Form SWU-101 Version O6Aug2Ol2 Page 6 of6

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As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $75,000 per day, pursuant to NCGS 143-215.6.
a Notary Public for the State of
do hereby certify
County of
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, ,::>' "—
i_-tom✓ �.,.'�
ar;=y
SEAL
APR 1 1 2013
A1-43
My commission expires-
X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Infonnation, item 1a) Barnes Bonkin
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 record d, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15 CAC 2H .1000 and any other applicable state stormwater requirements.
Signature: Date: I
1, 111Q (i Sba S ��5 a Notary Public for the State of kko'Vn. C play. . County of
Wit -'an do hereby certify that IJof n'e5 &'4' ;n personally appeared
before me this L day of Aj%1 2013 . and acknowledge the due
,�execution of the application for
a stormwater permit. Witness my hand and official seal, `�Yl�� SQ' TY
11
SEAL
My commission expires (01 2O11
Form SWU-101 Version 06Aug2012 Page 6 of

®�� y�OF W A TF,9OG
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WETLAND SUPPLEMENT
This form must be tilled out, printed and submitted.
The Required Items Checklist (Part III) must be printed, filled out and submitted along with all the required information.
Project name
Contact name
Phone number
Date
Drainage area number
BATH FAMILY DOLLAR
MARIE U PEEDIN
252-945-2983
April 1, 2013
1
Ill. IDESIGN INFORMATION
Site Charactedstics
Drainage area
74,356.90 itz
Impervious area
34,582.00 it'
F 14` , E D
Percent impervious
46.5% %
`8"
Design rainfall depth
1.50 inch
Peak Flow Calculations
APR - 3 2013
1-yr, 24-hr rainfall depth
3.25 in
1-yr, 24-hr intensity
Pre -development 1-yr, 24-hr runoff
0.14 in/hr
0.05 ft3/sec
'v�e•
�jx�VAR®
Post -development 1-yr, 24-hr runoff
0.09 ft3 /sec
Pre/Post 1-yr, 24-hr peak control
0.04 ft3/sec
Storage Volume: Non -SA Waters
Minimum required volume
4,354.53 ff3
Volume provided (temporary pool volume) 4,695.00 ft3 OK
Storage Volume: SA Waters Parameters
1.5" runoff volume
ft3
Pre -development 1-yr, 24-hr runoff volume
ft3
Post -development 1-yr, 24-hr runoff volume
113
Minimum volume required
ft3
Volume provided
rya
Outlet Design
Depth of temporary pool/ponding depth (DR,,t)
12.00 in OK
Drawdown time
2.00 days OK
Diameter of orifice 1.13 in Drawdown orifice diameter may be insufficient. Please provide
adequate supporting calculations.
Coefficient of discharge (CD) used in orifice diameter
0.60 (unitless)
calculation
Driving head (Ho) used in the orifice diameter calculation 1.50 it OK
Form SW401-Wetland-Rev.6-11116109 Parts I and II. Project Design Summary, Page 1 of 3

- 1
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Surface Areas of Wetland Zones
Surface Area of Entire Wetland
4,695.00 a
OK
Shallow Land
1,600.00 ftz
OK
The shallow land percentage is:
34% %
Shallow Water
1,927.00 ft2
OK
The shallow water percentage is:
41% %
Deep Pool
Forebay portion of deep pool (pretreatment)
588.00 ftz
OK
The forebay surface area percentage is:
13% %
Non-forebay portion of deep pool
580.00 fe
OK
The non-forebay deep pool surface area percentage is:
12% %
Total of wetland zone areas
4,695.00 ftz
OK
Add or subtract the following area from the zones
0.00 ff'
Topographic Zone Elevations
Temporary Pool Elevation (TPE)
Shallow Land (top)
9.00 It amsl
Permanent Pool Elevation (PPE)
Shallow Water/Deep Pool (top)
8.00 it amsl
Shallow Water bottom
7.50 it amsl
Most shallow point of deep pool's bottom
6.00 ft amsl
Deepest point of deep pool's bottom
5.00 ft amsl
Design must meet one of the following two options:
This design meets Option #1,
y (Y or N)
Top of PPE is within 6" of SHWT, If yes:
SHAFT (Seasonally High Water Table)
8.00 ft amst
OK
This design meets Option #2,
n (Y or N)
Wetland has liner with permeability < 0.01 in/hr, If yes:
Depth of topsoil above impermeable liner
in
Topographic Zone Depths
Temporary Pool
Shallow Land
12.00 in
OK
Permanent Pool
Shallow Water
6.00 in
OK
Deep Pool (shallowest)
24.00 in
OK
Deep Pool (deepest)
36.00 in
OK
Planting Plan
Are cattails included in the planting plan?
n (Y or N)
OK
Number of Plants recommended in Shallow Water Area:
Herbaceous Wcubic-inch container)
500
Number of Plants recommended in Shallow Land Area:
Herbaceous Wcubic-inch container), OR
400
Shrubs (1 gallon or larger), OR
64
Trees (3 gallon or larger) and Herbaceous (4+ cubic -inch)
8 and
320
Number of Plants provided in Shallow Water Area:
Herbaceous (4'cubic-inch container)
500
OK
Number of Plants provided in Shallow Land Area:
Herbaceous Wcubic-inch container)
400
OK
Shrubs (1 gallon or larger)
64
OK
Trees (3 gallon or larger) and
0
More required if not planting herb. and/or shrubs.
Grass -like Herbaceous (4+ cubic -inch)
0
More recommended if planting trees.
Form SW401-WeUand-Rev.6-11116109 Parts I and II. Project Design Summary, Page 2 of 3
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Additional Information
Can the design volume be contained?
Does project drain to SA waters? If yes,
What is the length of the vegetated filter?
Are calculations for supporting the design volume provided in the
application?
Is BMP sized to handle all runoff from ultimate build -out?
Is the BMP located in a recorded drainage easement with a
recorded access easement to a public Right of Way (ROW)?
The length to width ratio is:
Approximate wetland length
Approximate wetland width
y (YorN)
n (Y or N)
It
y (YorN)
y (Y or N)
y (Y or N)
11.87 :1
184.00 ft
15.50 ft
Approximate surface area using length and width provided 2,852.00 itz
Will the wetland be stabilized within 14 days of construction? y (Y or N)
OK
Excess volume must pass through filter.
OK
OK
OK
OK
This approx. surface area is within this number of square feet
of the entire wetland surface area reported above:
OK
Forth SW401-Wetland-Rev.6-11116109 Parts I and II. Project Design Summary, Page 3 of 3

LX

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.
Initials
Pagel Plan
^
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),
- Wetland dimensions (and length to width ratio),
- Pretreatment system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
2. Plan details (1" = 50' or larger) for the wetland showing:
Cva v
-Welland dimensions (and length to width ratio)
- Pretreatment system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Overflow device, and
- Boundaries of drainage easement.
Oo
3. Section view of the wetland (1' = 20' or larger) showing:
- Side slopes, 3:1 or lower
- Wetland layers
All wetlands: Shallow land depth, shallow water depth, deep pool depth
Option clay liner: SLWT depth
Option 2, clay liner: Depth of topsoil on top of liner, liner specifications
Gv o
4. A detailed planting plan (1" = 20' or larger) prepared by a qualified individual showing:
- A variety of several suitable species (not including cattails),
- Sizes, spacing and locations of plantings,
- Total quantity of each type of plant specified,
- A planting detail,
- The source nursery for the plants, and
Q° Lf
- Fertilizer and watering requirements to establish vegetation.
5. A construction sequence that shows how the wetland will be protected from sediment until the entire
drainage area is stabilized.
r
6. The supporting calculations (including drawdown calculations),
^�
r
7. A copy of the signed and notarized operation and maintenance (08M) agreement.
A�
B. A copy of the deed restrictions (if required).
v ��1 9. A soils report that is based upon an actual field investigation and soil borings. County soil maps are not
an acceptable source of soils information.
SW401-Wetland-Rev.6-11I16I09 Part III, page 1 of 1

�� �,rL SC'r PL,C 0..;, •�'rr �.�. 4. r. rIi _. .. .i r'..n ..;. :h'�. .. .. ..
_..� '�.. �r,. .if.�`tt 1. �'P•LT r'r •G'.i r. .;'; _•�I ^i,... `41 pp. I1�?'. ;C�si�lt(�' .; ..1�.:
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IF

Permit Number: S141/1 `J o L cC 'S
ito be provided by )W[IJ
Drainage Area Number:
Stormwater Wetland Operation and Maintenance Agreement A
C (le
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:
— Immediately following construction of the stormwater wetland, bi-weekly inspections will be
conducted and wetland plants will be watered bi-weekly until vegetation becomes established
(commonly six weeks).
— No portion of the stormwater wetland will be fertilized after the first initial fertilization that is
required to establish the wetland plants.
— Stable groundcover will be maintained in the drainage area to reduce the sediment load to the
wetland.
— Once a year, a dam safety expert should inspect the embankment.
After the stormwater wetland is established, I will inspect it monthly and within 24 hours after every
storm event greater than 1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and
maintenance will be kept in a known set location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired
immediately.
'BMP,element
Potentialproblem:
How 1 will remediate theproblem:
Entire BMP
Trash debris is present.
Remove the trash debris.
Perimeter of wetland
Areas of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed.
gully, and then plant a ground cover and
water until it is established. Provide lime
and a onetime fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height
Inlet device: pipe or
The pipe is clogged (if applicable).
Unclog the pipe. Dispose of the sediment
swale
offsite.
The pipe is cracked or otherwise
Replace the pipe.
damaged if applicable).
Erosion is occurring in the swale (if
Regrade the Swale if necessary to smooth
applicable).
it over and provide erosion control
devices such as reinforced turf matting or
riprap to avoid future problems with
erosion.
Form S W401-Wetland O&M-Rev.4 Page I of 3

i
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:fig
Sediment has accumulated in the
forebay to a depth that inhibits the
forebay from functioning well.
has occurred.
are present.
Deep pool, shallow water Algal growth covers over 50% of the
and shallow land areas deep pool and shallow water areas.
Cattails, phragmftes or other invasive
plants cover 50% of the deep pool and
Shallow land remains flooded more
than 5 days after a storm event.
Plants are dead, diseased or dying.
Best professional practices show that
pruning is needed to maintain optimal
plant health.
Sediment has accumulated and
reduced the depth to 75% of the
original design depth of the deep
pools.
Embankment A tree has started to grow on the
embankment.
An annual inspection by appropriate
professional shows that the
embankment needs repair.
Evidence of muskrat or beaver activity
is present.
Micropool Sediment has accumulated and
reduced the depth to 75% of the
original design depth.
Permit Number:
(to be provided by DWQ)
How I will remediate the problem:
Search for the source of the sediment and
remedy the problem if possible. Remove
the sediment and dispose of it in a location
where it will not cause impacts to streams
or the BMP.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
Consult a professional to remove and
control the algal growth.
Remove invasives by physical removal or
by wiping them with pesticide (do not
device immediately.
Determine the source of the problem:
soils, hydrology, disease, etc. Remedy the
problem and replace plants. Provide a
one-time fertilizer application to establish
the eround cover if necessary.
Prune according to best professional
practices.
Search for the source of the sediment and
remedy the problem if possible. Remove
the sediment and dispose of it in a location
where it will not cause impacts to streams
or the BMP.
Consult a dam safety specialist to remove
the tree.
Make all needed repairs
Consult a professional to remove muskrats
Search for the source of the sediment and
remedy the problem if possible. Remove
the sediment and dispose of it in a location
where it will not cause impacts to streams
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.
Receiving water Erosion or other signs of damage have Contact the NC Division of Water Quality
occurred at the outlet 401 Oversight Unit at 919-733-1766.
Form SW40I-Wetland O&M-Rev.4 Page 2 of 3

Permit Number:
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. 1 agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Project name:Family Dollar Bath
BMP drainage area number:
Print name:Barnes Boykin
Title:Vice President- Secretary
Address:2405-F Nash Street, Wilson, NC 27896
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.
1, Me.1;Ss4 S gees , a Notary Public for the State of
14orlin. Garoy� County of Le', lswn do hereby certify that
�4rneS�r;n personally appeared before me this �L day of
Ae(,, 2013 and acknowledge the due execution of the forgoing stormwater wetland
maintenance requirements. Witness my hand and official seal,
c :.q
SEAL
4.s$�- 5.9j"'Q-�
My commission expires 4L► tot 2.°t3
APR 1 1 2013
Form SW401-Wetland O&M-Rev.4 Page 3 of 3

;phi'

State Stormwater Management Systems SAAI
Permit No. SW7130405
Family Dollar Store - Bath
Stormwater Permit No. SW7130405
Beaufort County
Designer's Certification
NOV -1 2013
A ,ice. q f�r 171) P'�J
1, NN"i: Q- U- � ee �-v as a duly registered in the
State of North Carolina, having been authorized to observe eriodica /weekly/ full
time) the construction of the project,
�L�•� �c��L:.f --i>f-Tf
(Project)
for e—wrs 7- 1 kN T2r • 3 1r'L (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 2�)'2 J---3
Registration Number �O�I
Date ;2S/r S
�k GARp���i��
OFESSIp�<��/9
k sZ
5 2oz12
�9i '•FNGINE�P•Q�4:
Page 6 of 7

I I !

State Stormwater Management Systems
Permit No. SW7130405
Certification Requirements:
1 The drainage area to the system contains approximately the permitted
acreage.
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 outiet/bypass structure elevations are per the approved plan.
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.
�1. The permitted amounts of surface area and/or volume have been
provided.
--�1-2. Required drawdown devices are correctly sized per the approved plans.
/13. All required design depths are provided.
�4. 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
Beaufort County Planning / Building Inspections
Page 7 of 7

f

', �'F VED
APR - 3 2013
Permit Number:
(to be provided by DWQ)
Drainage Area Number:
Storm jVi e4aA&%gRGn 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:
— Immediately following construction of the stormwater wetland, bi-weekly inspections will be
conducted and wetland plants will be watered bi-weekly until vegetation becomes established
(commonly six weeks).
— No portion of the stormwater wetland will be fertilized after the first initial fertilization that is
required to establish the wetland plants.
— Stable groundcover will be maintained in the drainage area to reduce the sediment load to the
wetland.
— Once a year, a dam safety expert should inspect the embankment.
After the stormwater wetland is established, I will inspect it monthly and within 24 hours after every
storm event greater than 1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and
maintenance will be kept in a known set location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired
immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
Entire BMP
Trash debris is present.
Remove the trash/debris.
Perimeter of wetland
Areas of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed.
gully, and then plant a ground cover and
water until it is established. Provide lime
and a one-time fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height
Inlet device: pipe or
The pipe is clogged (if applicable).
Unclog the pipe. Dispose of the sediment
swale
offsite.
The pipe is cracked or otherwise
Replace the pipe.
-damaged if applicable .
Erosion is occurring in the swale (if
Regrade the swale if necessary to smooth
applicable).
it over and provide erosion control
devices such as reinforced turf matting or
riprap to avoid future problems with
erosion.
Form SW401-Wetland O&M-Rev.4 Page 1 of 3

1 i P7
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Permit Number:
(to be provided by NVQ)
BMP element:
Potentialproblem:
How I will remediate theproblem:
Forebay
Sediment has accumulated in the
Search for the source of the sediment and
forebay to a depth that inhibits the
remedy the problem if possible. Remove
forebay from functioning well.
the sediment and dispose of it in a location
where it will not cause impacts to streams
or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
roblems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
Deep pool, shallow water
and shallow land areas
Algal growth covers over 50% of the
-deep pool and shallow water areas.
Consult a professional to remove and
control the algal growth.
Cattails, phragmites or other invasive
plants cover 50% of the deep pool and
shallow water areas.
Remove invasives by physical removal or
by wiping them with pesticide (do not
s ra - consult a professional.
Shallow land remains Flooded more
than 5 days after a storm event.
Unclog the outlet device immediately.
Plants are dead, diseased or dying.
Determine the source of the problem:
soils, hydrology, disease, etc. Remedy the
problem and replace plants. Provide a
one-time fertilizer application to establish
the ground cover if necessary.
Best professional practices show that
Prune according to best professional
pruning is needed to maintain optimal
practices.
lant health.
Sediment has accumulated and
Search for the source of the sediment and
reduced the depth to 75% of the
remedy the problem if possible. Remove
original design depth of the deep
the sediment and dispose of it in a location
pools.
where it will not cause impacts to streams
or the BMP.
Embankment
A tree has started to grow on the
embankment
Consult a dam safety specialist to remove
the tree.
An annual inspection by appropriate
professional shows that the
Make all needed repairs.
embankment needs repair.
Evidence of muskrat or beaver activity
Consult a professional to remove muskrats
is present.
or beavers.
Micropool
Sediment has accumulated and
Search for the source of the sediment and
reduced the depth to 75% of the
remedy the problem if possible. Remove
original design depth.
the sediment and dispose of it in a location
where it will not cause impacts to streams
or the BMP.
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.
Receiving water
Erosion or other signs of damage have
occurred at the outlet.
Contact the NC Division of Water Quality
401 Oversight Unit at 919-733-1786.
Form SW401-Wetland O&M-Rev.4 Page 2 of 3

: 1
1
1
j
C

Permit Number:
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:Family Dollar Bath
BW drainage area numbed
Print name:BBrns Bo"
Title: Vice President/Secretary - Eastern Pride, Inc.
Address:2405-F Nash Street Wilson, N C
Date: 3— a6— /-3
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
A. ..a County off do hereby certify that
ersonally appeared before me this _c2E
day of `�02p Q� �D 13 • and acknowledge the due execution of the
stormwater wetland maintenance requirements. Witness my hand and official seal,
9'•
SIR
���Illllll/1�
SEAL
My commission expires
Form SW401-Wetland O&M-Rev.4 Page 3 of 3