SW7070715_CURRENT PERMIT_20090223

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT. NO.
SW jj (% // ;
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
2. gUoZo`� 3
YYYYM M DD

WaRO
MCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Reverend David Waterfield, President
Light Assembly of God, Inc.
PO Box 459
Buxton. NC 27920
Dear Rev. Waterfield:
Division of Water Quality
Coleen H. Sullins
Director
February 23, 2009
Subject: Stormwater Permit No. SW7070715 Modification
Lighthouse Assembly of God Church of Buxton
High Density Project
Dare County
Dee Freeman
Secretary
The Washington Regional Office received a complete Stormwater Management Permit Application for the
modification of Lighthouse Assembly of God, Church of Buxton on December 17, 2008. Staff review of the
plans and specifications has determined that the project, as proposed, will comply with the Stormwater
Regulations set forth in Title 15A NCAC 2H.1000. We are forwarding Permit No. SW7070715MOD dated
February 23, 2009, for the construction of the subject project. The stormwater permit issued for this project on
August 3, 2007 is hereby rescinded and is replaced by this permit.
This permit shall be effective from the date of issuance until August 3, 2017, 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, 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].
Efincerely,
AHodge
Regional Supervisor
Surface Water Protection Section
AH/sav: C:\STORMWAT\PERMIT\SW7070715MOD
cc: Robert Stewart, Jr., PE
D_�cre County Building Inspections
, .-Washington Regional Office
Central Files
North Carolina Division of Water Quality
943 Washington Square Mall
Washington, NC 27889
An Fn„al Onnnnnn!W 1 Arfrmalivn Action Fninlover
Internet: www.nmaterquality.org
Phone: [phone] \ FAX: [phone]
FAX: [phone]
NorthCarolina
Naturally

State Stormwater Management Systems
Permit No. SW7070715MOD
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
Lighthouse Assembly of God Church of Buxton
Light Assembly of God, Inc.
Dare County
FOR THE
construction, operation and maintenance of four (4) infiltration basins, connected by a
level pipe system, in compliance with the provisions of 15A NCAC 2H .1000 (hereafter
referred to as the "stormwater rules') and the approved stormwater management plans
and specifications and other supporting data as attached and on file with and approved by
the Division of Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until August 3, 2017, 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 1.6 on page 3 of this permit. The stormwater control
has been designed to handle the runoff from 38,971 square feet of impervious
area.
The tract will be limited to the amount of built -upon area indicated on page 3 of this
permit, and per approved plans.
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.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7070715MOD
A
The following design criteria have been provided in the infiltration basin and must
be maintained at design condition:
a. Site Area, acres:
b. Total Drainage Area to Basins, ft2:
b. Total Impervious Surfaces, ft2:
C. Design Storm, inches:
d. Basins Depth, feet:
e. Bottom Elevation, FMSL:
f. Bottom Surface Area, ft2:
g. Bypass Overflow Elevation, FMSL:
h. Permitted Storage Volume, ft3:
i. Type of Soil:
j. Expected Infiltration Rate, in/hr:
k. Seasonal High Water Table, FMSL:
I. Receiving Stream/River Basin:
M. Stream Index Number:
n. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
4.38
62,729
38,971
1.50
1.00
3.50
4,337 (all 4 basins combined)
4.50
5,426
Fripp, Ousley & Currituck
6.00
1.50
Peters Ditch to Pamlico Sound /
Pasquotank
30-22-23
"SA; HQW'
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 times provide the operation and maintenance necessary
to assure the permitted stormwater system functions at optimum efficiency. The
approved Operation and Maintenance Plan must be followed in its entirety and
maintenance must occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of bypass structure, infiltration media, flow
spreader, catch basins, piping and vegetated filter.
g. A clear access path to the bypass structure must be available at all times.
Page 3 of 7

State Stormwater Management Systems
Permit No. SV 7070715MOD
4. Records of maintenance activities must be kept and made available upon request
to authorized personnel of DWQ. The records will indicate the date, activity, name
of person performing the work and what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received from
an appropriate designer for the system installed certifying that the permitted facility
has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
7. The stormwater systems shall not be used as Erosion Control devices. They must
be kept off line and free from sediment until the project is complete and the entire
site has been stabilized.
Access to the stormwater facilities shall be maintained via appropriate easements
at all times.
The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee, for
which Sedimentation and Erosion Control Plan approval or a CAMA Major
permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by the
Permittee at all times.
12. The Director may notify the permittee when the permitted site does not meet one or
more of the minimum requirements of the permit. Within the time frame specified in
the notice, the permittee shall submit a written time schedule to the Director for
modifying the site to meet minimum requirements. The permittee shall provide
copies of revised plans and certification in writing to the Director that the changes
have been made.
13. This permit shall be effective from the date of issuance until August 3, 2017.
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.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7070715MOD
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 formal permit transfer request to the Division of Water Quality, accompanied by a
completed name/ownership change form, documentation from the parties involved,
and other supporting materials as may be appropriate. The approval of this request
will be considered on its merits and may or may not be approved. The permittee is
responsible for compliance with all permit conditions until such time as the Division
approves the transfer request.
2. 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.
3. 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.
4. 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.
5. 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.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
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.
Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
The permittee shall notify the Division of any name, ownership or mailing address
changes within 30 days.
Permit issued this the 23rd day of February, 2009.
LINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. SW7070715 Modification
Page 5 of 7

State Stormwater Management Systems
Permit No. SW7070715MOD
Lighthouse Assembly of God, Church of Buxton
Stormwater Permit No. SW7070715 Modification
Dare 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. SW7070715MOD
Certification Requirements:
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The bypass structure weir elevation is per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
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. All required design depths are provided.
13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Washington Regional Office
Dare Building Inspections
Page 7 of 7

Ur�f
,7)W� C41
DWQ USE ONLY
Dat Received
Fee Paid
Permit Number
5 W Inde
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION A-eCB11,z.1)Thisform may be photocopiedfor use as an originalDFCI?2008
I. GENERAL INFORMATION PRO✓# Dk'Q
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
Light Assembly of God, Inc.
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
Reverend David Waterfield, president
3. Mailing Address for person listed in item 2 above:
Phone: (252 ) 995-5696
Email:[e-mail]
State:NC Zip:27920
Fax: (252 ) 995-5221
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Lighthouse Assembly of God Church of Buxton
5. Location of Project (street address):
NC Hwy 12
City:Buxton County:Dare Zip:27920
6. Directions to project (from nearest major intersection):
Property is located on the south side of NC 12, approximately 920' west of the intersection of NC 12 and SR
1232, a.k.a. Buxton Back Road
7. Latitude:350 15' 47" N Longitude:75° 33' 12" W of project
8. Contact person who can answer questions about the project:
Name:Robert 1. Stewart, Jr., P.E. Telephone Number: (252 ) 491-8354
Email: [e-mail]
II. PERMIT INFORMATION:
Form SWU-101 Version 03.27.08 Pagel of4

1. Specify whether project is (check one): ❑New ❑Renewal ®Modification
2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number SW7070715 and its issue date (if known)Aug. 3, 2007
3. Specify the type of project (check one):
❑Low Density ®High Density ❑Redevelop []General Permit ❑Universal SMP []Other
4. 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 ®Sedimentation/Erosion Control 2404/401 Permit ❑NPDES Stormwater
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project.
Stormwater run-off will be conveyed via sheet flow across lawn areas, concrete and gravel vehicular areas,
sidewalks and roof tops to four dry infiltration basins hydraulically connected for equalization. Treament will
result from detention in the basins and infiltration into the soil below
2. Stormwater runoff from this project drains to the Pasquotank River basin.
IYo,-mif (;'of")
3. Total Property Area: 4.38 acres 4. Total Wetlands Area: 0.53 acres
5. 100' Wide Strip of Wetland Area: acres (not applicable if no wetlands exist on site)
I zij S3r( f
6. Total Project Area":2.88 acres 7. Project Built Upon Area:34 %
8. How many, drainage areas does the project have?1
9. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as below.
For high density projects, complete the table with one drainage area for each engineered stormwater device.
Basin Information
Drainage Area 1
Drainage Area 2
Receiving Stream Name
Peter's Ditch
Stream Class & Index No.
SA
Total Drainage Area (sf)
62729
On -site Drainage Area (so
61465
Off -site Drainage Area (sf)
1264
Existing Impervious' Area (so
Proposed Impervious*Area (sf)
38971
% Impervious` Area (total)
62.3
Impervious* Surface Area
Drainage Area 1
Drainage Area 2
On -site Buildings (so
12500
On -site Streets (so
On -site Parking (so
21079
On -site Sidewalks (so
4128
Other on -site (so
Off -site (so
1264
Total (so:
38971 0,45 fe"
Form SWU-101 Version 03.27.08 Page 2 of

* Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
**Total project area shall be calculated based on the current policy regarding inclusion of wetlands in the built upon area
percentage calculation. This is the area used to calculate percent project built upon area (BUA).
10. How was the off -site impervious area listed above derived?Off-site BUA consists of portion of entrance rand
and curb located within access easement
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
One of the following deed restrictions and protective covenants are required to be recorded for all subdivisions,
outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table listing each lot
number, size and the allowable -built -upon area for each lot must be provided as an attachment. Forms can be
downloaded from htto:Hli2o.enr.state.nc.us/su/bmp forms.htm - deed restrictions.
Form DRPC-1
High Density Commercial Subdivisions
Form DRPC-2
High Density Developments with Outparcels
Form DRPC-3
High Density Residential Subdivisions
Form DRPC4
Low Density Commercial Subdivisions
Form DRPC-5
Low Density Residential Subdivisions
Form DRPC-6
Low Density Residential Subdivisions with Curb Outlets
By your signature below, you certify that the recorded deed restrictions and protective covenants for this
project shall include all the applicable items required in the above form, 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 State, and that they will be recorded prior to the
sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each
BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the status
and availability of these forms. Forms can be downloaded from http://h2o.enr.state.nc.us/su/bmp forms.htm.
Form SW401-Low Density
Form SW401-Curb Outlet System
Form SW401-Off-Site System
Form SW401-Wet Detention Basin
Form SW401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-1-evel Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Form SW401-Permeable Pavement
Low Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
Permeable Pavement Supplement
Form SWU-101 Version 03.27.08 Page 3 of

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09/24/2003 02:12 2524915112 PERFORMANCE ENG PAGE 05
V1. 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. The complete application package should be
submitted to the appropriate DWQ Office. (Appropriate office may be found by locating project on the
interactive online nap at niaps.htm)
Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
• Original and one copy of the Stormwater Management Permit Application Form
• Original and one copy of the Deed Restrictions & Protective Covenants Form (if
required as per Part IV above)
• Original of the applicable Supplement Form(s) and O&M agreement(s) for esgb BMP
• Permit application processing fee of $305 (Express: $4,000 for HD, $2,000 for LD)
payable to NCDENR
• Calculations & detailed narrative description of stormwater treatment/management
• Copy of any applicable soils report
• Two copies of plans and specifications (sealed, signed & dated), including:
Development/ Project no
Engineer and firm
Legend
North arrow
Scale
Revision number & date
Mean high water line
Dimensioned property/ project boundary
Location map with tamed streets or NCSR nambers
Original contours, proposed contours, spot elevations, finished floor elevations
Details of roads, drainage feahLres, collection systems, grid stormwater control measures
Wetlands delineated, or a note on plans that none exist
Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
Drainage areas delineated
Vegetated buffers (where required)
Vll. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section. (ex. designing engineer or firm)
Designated agent (individual or firm):itobert I. cftwarr Jr., P B ciba Performance Engineering
Mailing Address:8604 Caratoke was _
City:PoweUs point State:NC Zip:27966
Phone: t252 ) 491.8354
Email:bohye93
Ayaboo.com
V11L APPLICANTS CERTIFICATION
Fax: 25( 2 ) 4915112
1, (print or type name of person listed in General Infvmnation, item 2) Rev. Datid Waferfirld
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 plaits, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of 15A
NCAC 211 .1000.
/kignature: Gf Rate:
Form SWU-101 Version 03.27.08 Page 4 of

Permit No. ,9 / mot/
(to be provided by WQ)
TA{, STORMWATER MANAGEMENT PERMIT APPLICATION FORM
NCDENR 401 CERTIFICATION APPLICATION FORM
INFILTRATION 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. PROJECT INFORMATION
Project Name LIGHTHOUSE ASSEMBLY OF GOD CHURCH OF BU)(TON
Contact Person ROBERT STEWART
Phone Number
Date
Drainage Area Number
II. DESIGN INFORMATION
Site Characteristics
Drainage area
Impervious area
Percent impervious
Design rainfall depth
Peak Flow Calculations
1-yr, 24-hr runoff depth
1-yr, 24-hr intensity
Pre -development 1-yr, 24-hr runoff volume
Post -development 1-yr, 24-hr runoff volume
Pre/Post 1-yr, 24-hr peak flow control
Storage Volume: Non -SR Waters
Minimum design volume required
Design volume provided
Storage Volume: SR Waters
1-yr, 24-hr rainfall depth
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Minimum volume'required
Volume provided
Soils Report Summary
Soil type
Infiltration rate
SHWT elevation
Basin Design Parameters
Drawdowntime
Basin side slopes
Basin bottom elevation
Storage elevation
Storage SA
Top elevation
Basin Bottom Dimensions
Basin length
Basin width
Bottom SA
12114Y2008
/r F Vl^^A,r,TFg,,\ ,,\NIrE
Olqiii�I
62,729.00 f?
38,971.00 fh
0.62 %
2.00 in
4.38 in .VD
0.18 inthr
0.04 ft'/sec p ; 17 2308
0.12 Wisec
0.08 ft'/sec DV)Z
s PROJ # O r,1J
na fit OK for non -SR waters
4.38 in
2,976.00 ft'
13,712.00 ft'
1a�3sao— ft3 �8-21J
5,426.00 ft3 y-eS-0tA. z,a
OuB & FrD
6.00 inlhr
1.50 fmsl
0.09
days OK
3.00
:1 OK
3.50
fmsl OK
4.50
first
6,510.00
flz
5.50
fmsl
VARIES ft
VARIES ft
4,337.00 ft
Form SW401-Infiltration Basin-Rev.2 Parts I. a II. Design Summary, Page 1 of 2

Permit No.
(to be provided by DWQ)
Additional Information
Total runoff volume captured by basin
1.49
ac-in
Length of vegetative filter for overflow
50.00
ft
Distance to structure
8.75
ft
Distance from surface waters
254.00
ft
Distance from water supply well(s)
It
Separation from impervious soil layer
2.00
ft
Naturally occuring soil above shwt
2.00
ft
Bottom covered with 4-in of clean sand?
NO
(Y or N)
Proposed drainage easement provided?
NO
(Y or N)
Capures all runoff at ultimate build -out?
Y
(Y or N)
Bypass provided for larger storms?
NO
(Y or N)
Pretreatment device provided
NO
OK
OK
Too close to structure, must be minimum of 15-ft downgradient
OK
OK
OK
OK
OK
OK
OK
7.1 z
Form SW401-Infarction Basin-Rev.2 Parts 1. & 11. Design Summary, Page 2 of 2

Permit No. `e W 7070
(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.
ATS oL 1 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,
t4l,4 - Pretreatment system,
,/Maintenance access,
NIA- Proposed drainage easement and public right of way (ROW),
,Overflow device, and
uIA - Boundaries of drainage easement.
RSS _L6L 2. Plan details (1" = 30' or larger) for the bioretention cell showing:
;/Basin dimensions
Nlg- Pretreatment system,
/Maintenance access,
,/Outlet structure,
t/overflow device,
Nlra - Flow distribution detail for basin inflow, and
- Vegetation specifications.
RAT 3. Section view of the dry detention basin (1" = 20' or larger) showing:
v-/Side slopes, 3:1 or lower,
N 10 Pretreatment and treatment areas, and
Inlet and outlet structures.
'LIE—_EV
SEP 3 0 2000
6. A construction sequence that shows how the dry detention basin will be protected from sediment until the
fUUI entire drainage area is stabilized.
AJii(I oo5 7. The supporting calculations.
5CP8 MT
florum 1" 6. A copy of the signed and notarized operation and maintenance (0&M) agreement.
R,iS _WA__ 9. A copy of the deed restrictions (if required).
41? S(Phi Lr1 10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. County
0 oru#70ur soil maps are not an acceptable source of soils information.
Form SW401-Dry Extended Detention Basin-Rev.2 Part III. Required Items Checklist, Page 1 of 1

Permit Number:
(to be provided by D1YQ)
Drainage Area Number:
Infiltration 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.
Important maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the
infiltration basin.
— Immediately after the infiltration basin is established, the vegetation will be
watered twice weekly if needed until the plants become established (commonly
six weeks).
— No portion of the infiltration basin will be fertilized after the initial fertilization
that is required to establish the vegetation.
— The vegetation in and around the basin will be maintained at a height of
approximately six inches.
After the infiltration basin is established, it will be inspected once a quarter 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:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
infiltration 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.
The inlet device: pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
SEP 3 0 2008
Form S W401-Infiltration Basin O&M-Rev.3 " !' �J `rl 'J1'+" + r Page 1 of 3

BMP
The main treatment area
The embankment
The
The receiving water
Potential problem:
Sediment has accumulated
and reduced the depth to 75%
of the original design depth.
Erosion has occurred or
riprap is displaced.
Weeds are present.
A visible layer of sediment
has accumulated.
Water is standing more than
5 days after a storm event.
Weeds and noxious plants are
growing in the main
treatment area.
Shrubs or trees have started
to grow on the embankment.
An annual inspection by an
appropriate professional
shows that the embankment
needs repair.
occurred
The outlet device is damaged
Erosion or other signs of
damage have occurred at the
outlet.
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 problems.
Remove the weeds, preferably by
hand. If pesticides are used, wipe
them on the plants rather than
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. Replace any media that
was removed in the process.
Revegetate disturbed areas
Replace the top few inches of filter
media and see if this corrects the
standing water problem. If so,
revegetate immediately. If not,
consult an appropriate professional
for a more extensive repair.
Remove the plants by hand or by
wiping them with pesticide (do not
Remove shrubs or trees
Make all needed repairs.
Clean out the outlet device. Dispose
of the sediment off -site.
Repair or replace the outlet device.
Contact the NC Division of Water
Quality 401 Oversight Unit at 919-
733-1786.
Form SW401-Infiltration Basin O&M-Rev.3 Page 2 of 3

09/24/2008 02:12 2524915112 PERFORMANCE ENIG FAGE 04
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.
Projeci name: 4&&LNou L
HAW drainage area number:.
Print name: 17 aU lei bk M o t' �
Title:—Lu-11d2�-/rn4�{nuso Q�SOY�1h�tTTY1C.
Address: P0.90X 4s9 A11lifdr tLC 0
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,yra d . , lZ rA, a Notary Public for the State of
�liir{T County of 0 rc. ✓ 5e- do hereby certify that
_j)ay , d LA/bt e, (A _ personally appeared before me this 2P_e
day of_�_, and acknowledge the due execution of the
forgoing infiltration basin maintenance requirements. Witness my hand and official seal,
BARRETT BOD"OR
NOTARY PUBLIC
ORANGE COUNTY, NC
'•...f Mr Commission Espires 8-10-20 0
SEAL
My commission expires —1 U -2—O D_
Fmm SW401-1nftlrration Amin 0&M-Rcv.1 page 3 of 3

MA
ACDERi
North Carolina Department of Environment and Natural Resources
Request for Express Permit Review
FILL-IN all information below and CHECK required Permit(s). Fax or email this completed form along with a narrative
and vicinity map of the project location to the appropriate One -Stop Coordinator:
• Fayetteville or Raleigh Region -David Lee 919-791-4203; david.leeAncmail.net
• Mooresville & Asheville Region -Patrick Grogan 704-663-3772 or patrick.aroaanna ncmail.netnC Lnn
• Washington Region -Lyn Hardison 252-946-9215 or Ivn.hardison(ancmail.net
• Wilmington Region -Cameron Weaver 910-350-2004 or cameron.weavetfDricmafLnet JUL 18 2007
Project application received after 12 noon will be stamped in the following work day.
APPLICANT Nam
-Company
PROJECT
PROJECT
P (� -ssp
-
oie 454 -
595- 64; %- Faxes
TRIBUTARY T0,'Pawill r.
7-& 1. —
WATER CLASSIFICA
2-lZGI_lZ_&0
State or National Environmental'Polfcy Act (SEPA NEPA) - EA or EIS Required Yes El No
STREAM ORIGIN
STORMWATER
mmination: of Stream calls; Stream Name
❑Low Density ❑ High Density -Detention Pond
❑ Low Density -Curb & Gutter JM High Density -Infiltration
WETLANDS MUST BE ADDRESSED BELOW
❑ High Density -Other
❑ Off Site
fr
❑ COASTAL
❑ Excavation & Fill .. ;
❑ Bridges & Culverts
g
❑ Structures Information '
MANAGEMENT
❑ Upland Develop ment
Marina Development
� ❑Urban Waterfront
LAND QUALITY70 tccc
Erosion and Sedimentation Control Plan with �Zacres to be disturbed.(CK # ' kc (for DENR use))
❑ WETLANDS (401): Check all that appl 7 Isolated wetland on Property ❑ Yes ❑ No
Wetlands on Site ❑ Yes ❑ No / Buffer Impacts: ❑ No ❑ YES: acre(s)
Wetlands Delineation has been completed: ❑ Yes ❑ No / Minor Variance: ❑ No ❑ YES
Major General Variance ❑ No ❑ YES
US ACOE Approval of Delineation completed: ❑ Yes ❑ No 401 Application required: ❑Yes ❑ No If YES, ❑ Regular
404 Application in Process w/ US ACOE: ❑ Yes ❑ No / Permit Received from US ACOE ❑ Yes ❑ No
Perennial, Blue line stream, etc on site ❑ yes ❑ No
The legislation allows additional fees, not to exceed 50% of the original Express Review permit application fee, to be
charged for subsequent reviews due to the insufficiency of the permit applications.
For DENR use only 1
Fee Split for multiple permits: (Check # 1-1 D9 ) Total Fee Amount $ _Icclo
SUBMITTAL
Fee
SUBMITTAL DATES
Fee
DATES
CAMA
Variance 7 Ma'; El Min
SW H—D .77
- t
r555' .35 10
401:
LQS
(-t -p
Stream Deter,_