SW7080808_CURRENT PERMIT_20101201

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
%CURRENT PERMIT
C❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
Q2Q�(J
YYYYMMDD

may-
NC®' , i�#X I�0
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North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 1, 2010
Mr. Vimal Kolappa, Manager
Havelock Hospitality Group, LLC
719 West 151 Street, Suite 11
Washington, NC 27889
Subject: Stormwater Permit No. SW7080808 Modification
Holiday Inn Express - Havelock
High Density Project
Craven County
Dear Mr. Kolappa:
The Washington Regional Office received a complete Stormwater Management Permit
Modification Application for Holiday Inn Express - Havelock on November 12, 2010. 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. SW7080808 Modification dated December 1, 2010, for the construction
of the subject project. 1yf5 f Ix4
This permit shall be effective from the date of issuance until December 1 ,2020, shall void
permit Sw708O8O8 issued on August 28, 2008 and shall be subject to the conditions and
limitations as specified therein. Please pay special attention to the Operation and
Maintenance requirements in this permit. Failure to establish an adequate system for operation
and maintenance of the stormwater management system will result in future compliance
problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have
the right to request an adjudicatory hearing upon written request within thirty (30) days
following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150E of the North Carolina General Statutes, and filed with the Office of
Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. Unless such
demands are made this permit shall be final and binding.
If you have any questions, or need additional information con ruing this matter, please
contact Samir Dumpor, or me at [phone]. A it
L
I Supervisbr�
Water Protection Section
AH/sd: K:\SD\Permits—Sand Filters\SW7080808
cc: Larissa Coles, PE (1157 E. Marion Street, Suite 4, Shelby, NC 28150)
Havelock Building Inspections
,/ Washington Regional Office
North Carolina Division of Water Quality Internet: wwv`.ncwaterggLahty org
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] NOrthCarolina
An Equal Opportunity/Affirmative Action Employer- 50%Recycledll0% Post Consumer Paper Natu {{l&

State 5tormwater management z5ystems
Permit No. SW7080808 Modification
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
Havelock Hospitality Group, LLC
Holiday Inn Express - Havelock
Craven County
FOR THE
construction, operation and maintenance of four sand filters in compliance with the
provisions of 15A NCAC 2H A000 (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 December 1, 2020, 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.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.6 on page 3 of this permit. The stormwater
controls have been designed to handle the runoff from 84,398 square feet of
new impervious area.
3. The tract will be limited to the amount of built -upon area indicated on page 3 of
this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
Page 2 of 7

Permit No. SW7080808 Modification
6. The
following design criteria have been
provided in the sand filters and must be
maintained at design condition:
Area 1
Area 2 Area 3
Area 4
a.
Drainage Area, ft2:
25,757
34,440 36,222
15925
b.
Total Impervious Surfaces, ft2:
20,083
29,218 25,614
9,483
C.
Design Storm, inches:
1.0
1.0 1.0
1.0
d.
Sediment Chamber Area, ft2:
1,561
1,011 313
1,000
e.
Sand Chamber Area, ft2:
304
351 233
190
f.
Water Quality Volume adj., ft3:
1,210
1,752 1,554
584
g.
Sand Filter Volume Provided, ft3:
1,613
2,336 2,072
778
h.
Top/Bypass Elevations, FMSL:
18.75
18.20 17.40
19.25
i.
Invert Out Elevations, FMSL:
14.30
14.00 13.40
15.33
j.
Receiving Stream/River Basin:
Slocum Creek / Neuse
k.
Stream Index Number:
27 — 112
I.
Classification of Water Body:
"SC; Sw, NSW"
II. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in its entirety, and
operational for its intended use prior to the construction of any built -upon
surface.
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.
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
Page 3 of 7

State 5tormwater management zDystems
Permit No. SW7080808 Modification
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. 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.
8. 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.
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.
Page 4 of 7

Permit No. SW7080808 Modification
16
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.
6. The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
7. 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.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The permittee shall notify the Division any name, ownership or mailing address
changes within 30 days.
10. This permit shall be effective from the date of issuance until December 1, 2020.
Application for permit renewal shall be submitted 180 days prior to the expiration
date of this permit and must be accompanied by the processing fee.
Permit issued this) t e 1st day of December, 2010.
NORTH CI R LINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. SW7080808 Modification
Page 5 of 7

state stormwater Management aystems
Permit No. SW7080808 Modification
Holiday Inn Express - Havelock
Stormwater Permit No. SW7080808 Modification
Craven County
Designer's Certification
I, , as a duly registered
in the State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 6 of 7

Permit No. SW7080808 Modification
Holiday Inn Express - Havelock
Stormwater Permit No. SW7080808 Modification
Craven County
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 Regional Office
Craven County Building Inspections
Page 7 of 7

r-ermn rvo. ovvivovovo rvwumcduun
Holiday Inn Express - Havelock
Stormwater Permit No. SW7080808 Modification
Craven County
Designer's Certification
I. L S e'u_es , as a duly registered C�NkGl,iegg—
in the State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
t%I.iby tart —t�rly�loc�
(Project)
for �A,Iz,LCCIL, 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
v
Registration Number OEg
Date
Page 6 of 7

1-V111114 IVV. JVV I VUVUVU IVIVUI II.OUV11
Holiday Inn Express - Havelock
Stormwater Permit No. SW7080808 Modification
Craven County
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.
V4. All roof drains are located such that the runoff is directed into the system.
-1/-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.
t/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
ltyfl [pYovid'e�t� <,
`All required design depths are provided.
✓13.~ All required parts of the system are provided.
✓1,14 ',The.requited system dimensions are provided per the approved plans.
I t:
cc: NCDENR=DWQ Regional Office
Craven County Building Inspections
Page 7 of 7

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
ll aI
5 030
Applicable Rules:
(select all that apply)
❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
1.
❑ Other WQ M mt Plan: S
/Io
State of North Carolina „:c
Department of Environment and Natural Resources '"` ,LI A W M
Division of Water Quality NOV 12 2w
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original %;,, _i1,• ,I 7f-�
L GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Holiday Inn Express, Havelock
2. Location of Project (street address):
Lots A & D on Branchside Drive
City:Havelock County:Craven Zip:28532
3. Directions to project (from nearest major intersection):
Approximately 375' from the intersection of Tourist Center Drive and US Highway 70
4. Latitude:76° 55' 33" N Longitude:34* 53' 37" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ❑New ®Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberSW7080808 , its issue date (if known)August 28, 2008 , 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, N/A and the previous name of the project, if different than currently
proposed, N/A
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: 2.9 ac of Disturbed Area
0404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:Erosion & Sediment Control Plan No. Crave-2009-009

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WASHINGTON, NC 27889 - -' imm e.nldng ma T n O mpmy, - -
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NCDENR-Public Water Supply
Stormwater Manaeament.
Permit Application Form
131
11/11/2010
1963
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NOV 122010

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.0214-.0216) or the 401 Water Quality Certification rules (15A NCAC 2H .0500),
or both of them.
Where a Covered Airport Project is not subject to the requirements of the "No
Practical Alternatives" test under the Water Supply Rule or the 401 Rules, such
project is hereby deemed to meet the No Practicable Alternatives Provisions of
the buffer rules, and an authorization certificate for buffer rule approval will be
issued for those projects if conditions 4 through 8 of this GMV are met. If only
buffer rule approval is required, then DWQ may not add additional conditions to
the authorization certificate other than those required to comply with Conditions
4 through 8.
4. Compensatory buffer mitigation will be performed as required by the buffer rules
for Covered Airport Projects. This compensatory mitigation shall not be required
to be done at the Airport Facility, but shall (to the extent practicable) be
performed at locations as close as feasible to the Airport Facility. On -site
mitigation shall, notwithstanding the foregoing, be required only to the extent
allowed by FAA Requirements (as defined below) or other applicable federal
statutes or rules. Mitigation plans must be approved in writing by the DWQ prior
to construction of the mitigation and no later than one year after the date of the
approval of the project under this GMV.
5. Any Covered Airport Project for which a 401 Water Quality Certification is not
required must be designed by the applicant to minimize any adverse impacts to
Zone 1 of an affected buffer to the greatest extent practicable, consistent with
FAA Requirements.
6. Any Covered Airport Project for which a 401 Water Quality Certification is not
required must be designed by the applicant to include on -site stormwater
management controls; 'to'the extent required by the Buffer Rules and are
other.wise,practicable; consistent with the FAA Requirements. Before any new
additional impervious surface associated with the Covered Airport Project is
utilized after construction,, the stormwater management facilities shown in the
FAA filing"must be constructed and'operationafand ih"e approved stormwater
management plan implemented. If the applicant is required to obtain a
Sedimentation and Erosion Control Permit or a CAMA"Major Permit; then a
Stormwater Permit may be required from the DWQ.
7. , The, requirements of Conditions 5 and 6 are satisfied if the applicant, in any
appropriate applications seeking FAA approval or review of the Covered Airport
Project; includes a reference;to the application to this GMV and;the relevant .
buffer rules. In addition, the applicant must include a certification and
explanation that the applicant,, in designing the Covered Airport Project, has
sought to comply with those requirements to the greatest extent practicable,
consistently with FAA Requirements.

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
\ 2 owner �{�—L
Signing Official & Title:Vimal Kolappa, Manager
b. Contact information for person listed in item la above:
Street Address:719 West 15th Street, Suite 11
City:Washington State:NC Zip:27889
Mailing Address (if applicable):Same As Above
City:
Phone: (252 ) 974-0439
Email:[e-mail]
Zip:
Fax: (252 ) 974-1164
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. (Phis is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
b. Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:larissa M. Coles PE
Signing Official & Title:Larissa Coles PE
b. Contact information for person listed in item 3a above:
Mailing Address:1157 E. Marion Street Suite 4
City:Shelby Slate:NC Zip:28150
Phone: (704 ) 482-7883
Fax: (704 ) 487-6088
Email:[e-mail]

4. Local jurisdiction for building permits: City of Havelock
Point of ContactScott Chase
IV. PROJECT INFORMATION
Phone #: (252 ) 444-6411
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater for the proiect will be detained & treated in four different areas. The stormwater will sheetflow
to four different sandfilter basins. The sandfilter basins will treat the stormwater run-off and will be
equipped with overflow basins The overflow basins are piped into existing Craven County stormwater
drainaee systems
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the Neuse River basin.
4. Total Property Area: 2.64 V acres 5. Total Coastal Wetlands Area: N/A acres
6. Total Surface Water Area: N/A acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:2.64 it acres
Total project area shall be calculated to exclude the followin : the normal pool of imyounded structures, the area
between the banks of streams and rivers, the area below the Normal Hi h Water (NM line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or X x line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area. n
8. Project percent of impervious area: (Total ImpervjQus Area / Total Project Area) X 100 = 69 %
9. How many drainage areas does the project have?4 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other prcje4su4 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.

Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
Receiving Stream Name
Slocum Creek
Slocum Creek
Slocum Creek
Slocum Creek
Stream Class *
SC,Sw,NSW
SC,Sw,NSW
SC,Sw,NSW
SC,Sw,NSW
Stream Index Number *
27-112
27-112
27-112
27-112
Total Drainage Area (so
25,757
34,440
36,222
15,925
On -site Drainage Area (so
Off -site Drainage Area (so
Proposed Impervious Area s
20,083
29,218
25,614
9,483
% Impervious Area** total
78
85
71
60
Impervious— Surface Area
Drainage Area
Drainage Area
Drainage Area
Drainage Area
On -site Buildings/Lots (so
8,500
4,200
4235
0
On -site Streets (so
0
0
0
0
OWsite Parking (so
10,332
16,718
21,379
7,887
On -site Sidewalks (so
0
0
0
0
Other on -site (so
1,251
8,300
0
1,596
Future(so
0
0
0
0
Off -site (so
0
0
0
0
Existing BUA*** (so
0
0
0
0
Total (so:
20,083
29,218
25,614
9,483
* Stream Class and Index Number can be detennined at:
** Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
*** Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DWQ Central -Office staff to check if the project is located within a Threatened &
Endangered Species watershed that maybe subject to more stringent stormwater requirements as per NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from . The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at I)
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
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. V.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants LM�
Form. (if required as per Part VII below) � f -
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M t�
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to _ C/
http://www.envhelp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)

5. A detailed narrative (one to two pages) describing the stormwater treatment/ managementfor w�
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the /L
receiving stream drains to class SA waters within 1/z mile of the site boundary, include the r/2
mile radius on the map. ` qQ,
7. Sealed, signed and dated calculations. U "
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: LVA�
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.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
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"x1l" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to venfy the SHWT prior
to submittal, [phone].) , n �'
10. A copy of the most current property deed. Deed book: 2790 Page No: 0230 —U ,
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC lit lY
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 21-1.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http://www.secretarv.state.nc.us/Corporations/CSearch.asDx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.

VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: Larissa Coles, PE
Consulting Firm: Larissa M. Coles, PE
Mailing Address: 1157-4 East Marion Street
Phone: (704 ) 482-7883
Email: [e-mail]
State: NC Zip: 28150
Fax: (704 ) 487-6088
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item la) with (print or type name of organization listed in
Contact Information, item la) 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.
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 tq $25,000 per day, pursuant to NCGS 143-215.6.
Signature: p Date: / /a /0
I, LOCI iruski ns a Notary Public for the State of Al or4h CCtvoliria . County of
�jeauio i+ —do hereby certify that V )WA I personally appeared
before me this 12 day of Nnye YnV).ey' Zo I n and acknowledgle� the due execution of the application for
a stormwater permit. Witness my hand and official seal, I
•�Op I EGA$ 0io,
0prn,q`
y °I+e0, 2:
Co
f.9XIN
My commission expires I— I2-- Zu) 3

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X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item la) Vimal Kolappa
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormw�ter rules under 15A NCAC 21-1.1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Date: 2 O
I, "c't G-cx5b i n S a Notary Public for the State of Nnr1h Coro l*� new . County of
6MUJu or+ do hereby certify that Virrw-1 KkmoLr- VNcA(x2p4 personally appeared
before me this Ja day of NoV Pmber U IU and ahknowle¢ge the due execution of the application for
a stormwater permit. Witness my hand and official seal, (,/U1yi i FJA QSKI v ✓�
�A
y0" g����
s
#0TA.9
OD
SEAL
My commission expires H-z - Z 01 3

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Permit No.
(to be provided by DWO)
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 Page/ Plan
Sheet No.
Vv"C/ C 1. Plans (1' - 50' or larger) of the entire site with labeled drainage area boundaries
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
Flow splitting device,
Proposed drainage easement and public right of way (ROW),
Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Boundaries of drainage easement.
(�^ ` 2. Plan details (1' = 30' or larger) for the sand filter showing:
C( -System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
I� chamber,
Maintenance access,
- Flow splitting device,
- Vegetative filter strip dimensions and slope (if SA waters),
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Boundaries of drainage easement.
/��
l 0 3. Section view of the sand filter (1' = 20' or larger) showing:
- Depth(s) of the sedimentation chamber and sand filter chamber,
- Depth of sand filter media,
- Connection between the sedimentation chamber and the sand filter chamber and weir elevation,
- SHIRT elevation,
- Outlet pipe, and
- Clearance from the surface of the sand filter to the bottom of the roof of the underground structure (if
�C applicable).
� (-�4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the sails report must be verified in the field by DWO, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
& 5. Supporting calculations (including drainage calculations)
�✓C�i 6. Signed and notarized operation and maintenance (0&M) agreement
pn Ci _ 7. A copy of the deed restrictions (if required).
Form SW401-Sand Filter-Rev.52009Sept17 Part III, Page 1 of 1

NJV 12 2010
Permit Number.
(,a be pro, ided h, D If
Drainage Area Number:
Sand Filter 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 13MP 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 sand filter.
— The sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds
six inches.
— Once a year, sand media will be skimmed.
— The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter will be inspected quarterly 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
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.
%ment:` - - _ + 4, =; ��
BMP ele
iabl
Potentl proem -__ . -: �'�
t`How I will remediate the problem . _
Entire HMP
Trash)debris is present.
Remove the trash/debris.
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as
applicable)
pavement surface.
possible -
Perimeter of sand filter
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 -lime fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height.
Flow diversion structure
The structure is cloggcd.
Unclog the conveyance and dispose of any
sediment offsite.
The structure is damaged.
Make arw necessary repairs or replace if
damage is too large for repair.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or dispose of it
in a location where it will not cause
impacts to streams or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
problems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than s raving_
Form SN401-Sand Filter 0KM-Rev.4 2009Sept 17 Paye I of 3

BMP element
'=.Potential ioblem:
'.How.d:will:reinediate the roblem:: -
Filler bed and underdrain
Water is ponding on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm.
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace. If water still
ponds, then consult an expert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment offsite.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage
have occurred at the outlet.
Contact the NC Division of Water Quality
401 Oversight Unit at 919-733-1786.
Form SW401-Sand Filter ORM-12ev.4 2009Sept 17 Page 2 of 3

Permit Number:
tw be p, o, ided h, D It Q)
acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Projec! name: Holiday Inn Express Havelock
BAfP drainage area number:
Print name:Vimal Kolappa - Havelock Hospitality Group, LLC
Address:719 West 151h Street, Suite 11, Washington, NC 27889
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, Lpr 1 5a i n5 , a Notary Public for the State of
NUi 4h �rt)�i tl L� , Cowuy of 13f& _6' - , do hereby certify that
Dime 111 �iumor h K�Ir� personally appeared before me this Z day of
�DiCYf1C3P✓ OI U, and acknowledge the due execution of the forgoing sand filter
maintenance requirements. Witness my hand and official seal, Q l
AKl.��
GAS�i�,''i
2 TAq
L
' G
OT COv;
OttiI l l y, t �
SEAL
My commission expires H Z-aD 13
III
Form SW401-Sand Filter OXM-Rex:4 2009Sept 17 Paee 3 of

NOV 12 2010
Pennu Number
rn, ba pruided br D wo
f ZDrainage Area Number -
Sand Filter 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 sand filter.
- The sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds
six inches-
- Once a year, sand media will be skimmed-
- The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter will be inspected quarterly 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.
- ---T7-� �_—
BMP. e_lem_en_t_:;,._>_,�'•. 's{.-.;w:u
�1 u
-- ----- --
°Potential'pmblem: __.___--- c __{_`_ __`. j_How I will remed Tale the.problem_�_'-___�
Trash/debris is resent. Remove tile trash/debris.
Entire BMP
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as
applicable)
pavement surface.
possible.
Perimeter of sand filter
Areas of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed.
guliv, 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.
Flow diversion structure
The structure is clogged.
Unclog the conveyance and dispose of any
sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if
damage is too large for repair.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or dispose of it
in a location where it will not cause
impacts to streams or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
problems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than s ravin ,_
FormSW401-Sand FilterO&M-Rev.42009Sept17 Paee I of

BMP element"
Pot'entiah iobleiiiE?,' ; - -
How 1 wilhremediate the roblem: -
Filter bed and underdrain
Water is pond ing on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm-
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace If water still
ponds, then consult an expert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment offsite.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage
Contact the NC Division of Water Quality
have occurred at the outlet.
401 Oversight Unit at 919-733-1786.
Form SW401-Sand FilterO&M-Rev.4 2009Sept17
Page 2 of 3

,.4.
Permit Number:
as be provided b, D tl Ql
1 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: holiday Inn Express Havelock
BMP drainage area nianber:
Print name:Vitnal Kolappa- Havelock Hospitality Group, LLC
Title:
Address:719 West 15'h Street, Suite 11, Washington, NC 27889
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, LoC 1 &0'51�Ins a Notary Public for the State of
NDr b Caro I i rl4 , County of , do hereby certify that
Ui M0.\ 1 )Uj pf P. Y-V)j0Lpi4 personally appeared before me this\'+
NpVCXYtloer ao 10 , and acknowledge the due execution of the forgoing sand
maintenance requirements. Witness my hand and official seal,
PX GASICI�Io.
�� s'
%XOT'4r
" 9G
042,� 7- CO\)
SEAL
My commission expires l — I ;k — Jib �3
Form SW401-Sand Filter 0&%I-Rec.4 2009Septl7
10)1 Ki,-V�
day of
filter
face 3 of 3

NOV 12 2010 Permit Number
'Al be p,urided fn Dt1'Q/
Drainage Area Number
Sand Filter 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 sand filter.
— The sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds
six inches.
— Once a year, sand media will be skimmed.
— The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter will be inspected quarterly 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.
;BMf';element_
i_Potential'problem _ ___._;_ ?- How I will remediate the problem:.. _•'_`,`s'i
Trash/debris is present. Remove the trash/debris.
Entire BMIP
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as
applicable)
pavement surface.
possible.
Perimeter of sand filter
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.
Flow diversion structure
The structure is clogged.
Unclog the conveyance and dispose of any
sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if
damage is too large for repair.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or 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 malting or riprap if
needed to prevent future erosion
problems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
Form SW401-Sand Filter O&M-ReN A 2009Sept 17
Paee I of

',BMP-element
_'Potential; 'robl
Hosv,Fivill remediate theproblem:
Filler bed and underdrain
Water is pond ing on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm.
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace. If grater still
ponds, then consult an expert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment offsite.
The outlet device is damn ed
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage
Contact the NC Division of Water Quality
have occurred at the outlet
401 Oversi sht Unit at 919-T_,3-1756.
Form SW401-Sand Filter O&M-Rev.4 2009Sept 17
Pace 2 of 3

Permit Number:
in, br pm, rded h, IjHQ)
1 acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Projec! name: Holiday Inn Express Havelock
BMP c6-ainage area number:
Print name:Vimal Kolappa - Havelock I lospitality Group, LLC
Tit
Address:719 West 151h Street, Suite 11, Washington, NC 27889
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 - Lur t G66'K i n S (� , a Notary Public for the State of
�O4- 1 (kVtAiv) � County of �e(,_t.� ]- , do hereby certify that
V MCJ UM(AlV T, ilo IC n�� personally appeared before me this —L4- day of
1&4tm��cr Ol l) , and acknowledge the due execution of the forgoing sand filter
maintenance requirements. Witness my hand and official seal, �m 1 Aacd L ,
e�PTA qk
• G.cs
OJ`�`,``
SEAL
My commission expires 1-12' Zo ) 3
Form SW401-Sand Filter O&M -Rev 4 2009Sept U
Page 3 of 3

yasl,.
ti.
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wr
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to 'I
NOV 1 ? 2010 Permit Number:
nu he p,u,,drd b, J)1VQI
�r
. t,., _ 1• �: a ; j1, Drainage Area Number
Sand Filter 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 sand filter.
- The sedimentation chamber or Forebay will be cleaned out whenever sediment depth exceeds
six inches.
- Once a year, sand media will be skimmed.
- The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter will be inspected quarterly 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.
_P.otential pro blem::al_;'z_.;, �,�,.
Entire BMI' Trash/debris is resent.
How [ w_ill remediate the problem: --:- -----
Remove the trash/debris.
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as
applicable)
pavement surface.
possible.
Perimeter of sand filter
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.
Flow diversion structure
The structure is clogged.
Unclog the convevance and dispose of any
sediment offsite.
The structure is damaged.
Make anv necessary repairs or replace if
damage is too large for repair.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or dispose of it
in a location where it will not cause
impacts to streams or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
problems -
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
Form SW401-Sand Filter O&M-Rev.4 2009Sept 17 Pace I of 3

Potential roblemE%•v= `._:`-. ' •� ,
'How I will remediate the roblem:
Filter bed and underdrain
Water is pending on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm.
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace. If water still
ends, then consult an expert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment offsite.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage
Contact the NC Division of Water Quality
have occurred at the outlet.
401 Oversight Unit at 919-733-1786.
Form SW401-Sand Filter O&M-Rev.4 2009Sept 17 Pace 2 of-3

Permit
Ho he Prvuded hr LIM 01
I acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. t agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Project name: Holiday Inn Express Havelock
6AIP drainage area number:
Print name:Vimal Kolappa- havelock Hospitality Group, LLC
Address:719 West 15`h Street Suite 11, Washington NC 27889
Note: The legally responsible party should not be a homeowners association unless more than 50% of the lots ha%e been
sold and a resident of the subdivision has been named the president.
I, Low 1 ca:2k`it nS a Notary Public for the State of
Nor+h C XOI i ,1County of (� t�pr-} , do hereby certify that
llcrr�r SL`l7(Q D(:jL personally appeared before me this _IQ day of
N�CmbCr Io to , and acknowledge the due execution of the forgoing sand filter
maintenance requirements. Witness my hand and official seal,
• \4pTAq`
SEAL
My commission expires '-12-2-c) ( 3
AVDK.�
Form SW401-Sand Filter O&M-Rev.4 2009Sept 17 Page 3 of 3