SW7091203_CURRENT PERMIT_20100201

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO. I SW 70g1j//(%
DOC TYPE CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

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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
February 1, 2010
Ms. JoKay Smith, General Manager
Beaufort County ABC Board
750 Carolina Avenue
Washington, NC 27889
Subject: State Stormwater Permit No. SW7091203
Beaufort County ABC Chocowinity Store
High Density Commercial Bio-Retention Project
Beaufort County
Dear Ms. Smith:
The Washington Regional Office received a complete Stormwater Management Permit
Application for Beaufort County ABC Chocowinity Store on December 7, 2009. Staff review of
the plans and specifications has determined that the project, as proposed, will comply with the
Stormwater Regulations set forth in Session Law 2008-211 and Title 15A NCAC 2H.1000. We
are forwarding Permit No. SW7091203 dated February 1, 2010, for the construction of the
subject project.
This permit shall be effective from the date of issuance until February 1, 2020, 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 Samir Dumpor, or me at [phone].
ncerel
L"I►L.
Al Hodge
Regional Supervisor
Surface Water Protection Section
AH/ sd: K:\WQS\STORMWATER\PERMIT\SW7091203
cc: Scott Farmer, PE, Rivers and Associates, Inc.
Beaufort County Building Inspections
L.�Washington Regional Office
Central Files
North Carolina Division of Water Quality Internet: w,Nw.ncwa1eruualitr.ore
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] L ortth{Carollina
An Equal Opportunity/Afhnnative Action Employer -50%Recycled110% Post Consumer Paper N{�{`{ZmI&

State Stormwater Management Systems
Permit No. SW7091203
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
Beaufort County ABC Board
Beaufort County ABC Chocowinity Store
Beaufort County
FOR THE
construction, operation and maintenance of two bioretention basins in compliance with
the provisions of Session Law 2008-211 and 15A NCAC 2H .1000 (hereafter referred to
as the "stormwater rules') and the approved stormwater management plans and
specifications and other supporting data as attached and on file with and approved by
the Division of Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until February 1, 2020, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from total of 18,039 square feet
of impervious area.
3. The tract will be limited to the amount of built -upon area as indicated in Section
1.7 of this permit, and per the application documents and as shown on the
approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 50 feet
landward of all perennial and intermittent surface waters.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7091203
The following design criteria have been provided in the bioretention basin and
must be maintained at design condition:
a.
b.
Drainage Area, ftz:
Total Impervious Surfaces, ftZ:
Design Storm, inches:
Max. Ponded Depth, feet:
Seasonal High Water Table, fmsl:
Planting Media Depth, feet:
Basin Dimensions, feet:
Bottom Elevation, f9sl:
Top Surface Area, ft
Permitted Storage Volume, ft3:
Bypass / Storage Elevation, fmsl:
Predevelopment 1 year 24 hour:
Post development 1 year 24 hour:
Drawdown Time, hours:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
BASIN #1
BASIN #2
22,351
12,030
11,596
6,443
1.5
1.5
0.75
0.75
21.0
21.0
2' (grass cell)
2' (grass cell)
20'x80'
25'x50'
26.25
26.25
2,758
1,427
1,855
921.0
27.0
27.0
0.851
0.467
1.238
0.643
20
20
Crawford Creek / Tar -Pam River Basin
29-6-2
"SC; NSW"
1. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted stormwater system functions at optimum efficiency. The
approved Operation and Maintenance Plan must be followed in its entirety and
maintenance must occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the basin and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The permittee shall submit to the Division of Water Quality an annual summary
report of the maintenance and inspection records for each BMP. The report
shall summarize the inspection dates, results of the inspections, and the
maintenance work performed at each inspection.
6. The facilities shall be constructed as shown on the approved plans. This permit
shall become void unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW7091203
7. 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.
8. 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.
9. Access to the stormwater facilities shall be maintained via appropriate recorded
easements at all times.
10. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. 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 completed Name/Ownership Change form signed by both parties, to the
Division of Water Quality, accompanied by the supporting documentation as
listed on page 2 of the form. The approval of this request will be considered on
its merits and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
Pace 4 of 7

State Stormwater Management Systems
Permit No. SW7091203
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.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2008-
211, Title 15A NCAC 21-1.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
12. This permit shall be effective from the date of issuance until February 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 the 1 st day of February, 2010.
NA ENVIRONMENTAL MANAGEMENT COMMISSION
c,
O b for
Coleen 'ullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. SW7091203
Page 5 of 7

I
DWQUSE ONLY ...... r
Date Received
Fee Paid
Permit Number
c2
5
Applicable ules: ❑ Coastal SW -1995 D Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non-Coastal.SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan: 6WAC
State of North Carolina
Department of Environment and Natural Resources DEC 0 7 2009
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM'-,°+ l
This form may be photocopied for use as at original
1. 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.):
Beaufort County AI3C Cliocowinity Store
2. Location of Project (street address):
Intersection of US H WY 17 and SR 1142 (Bragaw Lane)
City:Chocowinity County:NC Zip:27817
3. Directions to project (from nearest major intersection):
Protect is located on North side of US 17 appoximately 100 ft east of it's intersection with NCSR 1142 (Bragaw)
4. Latitude:350 31' 11" N Longitude:77° 05' 33" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density . ❑Drains, to en Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements_(check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control:1.25 ac of Disturbed Area
❑NPDES Industrial Stormwater 7404/401 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 permitNone Aquired, SEC Submitted.
0
FonnSWU-101 Version07July2009
Page 1 of 6

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization: Beaufort County ABC Board
Signing Official & Title:JoKay Smith, General Manager
b.Contact information for person listed in item la above:
Street Address:750 Carolina Avenue
City:Washington State:NC Zip:27889
Mailing Address (if applicable):PO Box 2552
City:Washington State:NC Zip:27889
Phone: (252 ) 946-2551 Fax: (252 ) 946-7658
Email:[e-mail]
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/1
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City:
Phone: f )
State:NC
Fax: (252 )
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: Rivers and Associates
Signing Official & Title:I Scott Farmer, PE, Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:107 E Second St
City:Greenville State:NC Zip:27858
Phone: (252 ) 752-4135
Email:[e-mail]
Fax: (252 ) 752-3974
4. Local jurisdiction for building permits: Mid -East Commision
Point of Contact:Bryant Buck Phone #: (252 ) 974-1844
Form SWU-101 Version 07July2009 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will sheet flow across parking lots and gravel pre-treatment into a bioretention cell where it will
infiltrate into the sand media for treatment. Post treatment discharge will be released into an unnamed
tributary of Crawford Creek.
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.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 Tar -Pamlico River basin.
4. Total Property Area:1.26 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area+:1.26 acres
Total project area shall be calculated to exclude the following the normal pool of impounded structures, the area
between the batiks of streams and rivers, the area below the Normal High Water (NM litre or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHI� 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.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 32.8 %
9. How many drainage areas does the project have? 3 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Iiifor`mation, ', ,-': ;' , ' _ 1
.?Drama e'Area.1,
I)'
'� rainage� rea 2"
Draina (Miea'3
Draihii e Area'.l
_
Receiving Stream Name
Crawford Creek
Crawford Creek
Crawford Creek
Stream Class *
SC; NSW
SC; NSW
SC; NSW
Stream Index Number *
29-6-2
29-6-2
29-6-2
Total Drainage Area (so
22,351
12,030
20,583
On -site Drainage Area (so
22,351
12,030
20,583
Off -site Drainage Area (sf)
0
0
0
Proposed Impervious Area** (so
11,596
6,443
0
Impervious Area** total
51.8
53.6
0
1Im`ervious tSurface:Area
_ _
Drauia'e1"Areal#;:Drama
e�Arear2'
_.
Drama e-Area3`�aDrairia
_
OAreal.'
On -site Buildings/Lots (so
1,584
1,461
0
On -site Streets (so
0
0
0
On -site Parking (so
6,620
3,681
0
On -site Sidewalks (so
648
415
0
Other on -site (so
0
0
0
Future (so
2,744
1 886
1 0
Off -site (so
0
0
0
Existing BUA*** (so
0
0
0
Total (so:
11,596
6,443
0
* Streauu Class and Index Number can be determined at: ham://h2o.enr.state.tic.us/binis/reports/reportsWB.lutttil
** 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.
Form SWU-101 Version 07July2009 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation. Site is graded such
that no offsite drainage onto site occours.
Projects in Union Countv: Contact DWQ Central Office staffto check if the project is located within a Threatened &
Endangered Species watershed that may be 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 littp://h2o.enr.state.nc.Us/su/bmp forms.htm.
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 http://h2o.enr.state.nc.us/su/bmp forms.htm. The complete application
package should be submitted to the appropriate DWQ Office. (The appropriate office may be found by locating
project on the interactive online map at http://h2o.enr.state.iic.us/su/msi ma sp htm.)
Please indicate that the following required information have been provided by initialing in the space provided for
each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions for
each submitted application package from http://h2o.eiir.state.nc.us/su/bmp forms.htnr.
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://www.enviielp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
I. 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.
in. 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).
It 'als
N//f
"WE
Fomr SWU-101 Version 07July2009 Page 4 of 6

9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
A copy of the most current property deed. Deed book:1686 Page No: 727
For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item Ia, 2a, and/or 3a per NCAC 2H.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http:/ /www.secretary.state.nc.us/Corporations/CSearch.asi2x
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit far DWQ to verifij the SNWT prior
to submittal, [phone].)
Al
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://h2o.enr.state.nc.us/su[bml2 forms.htmadeed restrictions. 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:l. Scott Farmer, PE
Consulting Firm: Rivers and Associates, Inc
Mailing Address:107 E Second St
City:Greenville State:NC Zip:27858
Phone: (252 ) 7524135
Email:[e-mail]
Fax: (252 ) 752-
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 hjpe name of person
listed in Contact Information, itent la) with (print or hjpe name of organization listed in
Contact Information, item lb) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version 07July2009 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signatu
a Notary Public for the State of
do hereby certify that
before me this _ day of
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
X. APPLICANT'S CERTIFICATION cc
I, (print or type name of person listed in Contact Information, item 2)
certify that the information included on this permit application form is, to the best -of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater ryoes undek 15A NCAC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
certify that
before m6/this I day
a stormwater permit. Witness my hand and official seal,
c J-Y.t C ti
SEA L
Date: �� \�\U'�
for e State 1 County of
personally appeared
.knowledge the due execpfbn of theiapplication for
My commission expires—�
Form SWU-101 Version 07July2009 Page 6 of 6

Permit
(to be provided by DWQ)
AT
or1/o^✓P WA/rlTPg\r\1pc
yV [
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL 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
Beaufort County ABC
Contact name
J. Scott Farmer, PE
Phone number
(252) 7524135
Date
November 11, 2009
Drainage area number
1
II: iDESIGNfINF.ORMATION
Site Characteristics
Drainage area 22,351 ft2
Impervious area 11,596 ft
Percent impervious 51.9% %
Design rainfall depth 1.5 inch
JAN 2 G Zld IU
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak flow required?
Y (Y or N)
1-yr, 24-hr runoff depth
3.5 in
-,
1-yr, 24-hr intensity
0.12 in/hr
Pre -development 1-yr, 24-hr peak flow
0.851 rya/sec
Post -development 1-yr, 24-hr peak flow
1.238 ft3/sec
Pre/Post 1-yr, 24-hr peak control
0.387 ft3/sec
Storage Volume: Non-SAWaters
Minimum volume required
1,493.0 b3
Volume provided
1,855.0 ft3
OK
Storage Volume: SAWaters
1.5' runoff volume
ft3
Pre -development 1-yr, 24-hr runoff
ft3
Post -development 1-yr, 24-hr runoff
ft3
Minimum volume required
0 ff 3
Volume provided
ft3
Cell Dimensions
Fording depth of water
9 inches
OK
Pending depth of water
0.75 ft
Surface area of the top of the bioretention cell
2,758.0 ft2
OK
Length:
- 80 ft
OK
Width:
20 ft
OK
-or-Radius
10ft
OK
Media and Soils Summary
Drawdown time, ponded volume
6 hr
OK
Drawdown time, to 24 inches below surface
14 hr
OK
Drawdown time, total:
20 hr
In -situ soil:
Soil permeability
1.50 in/hr
OK
Planting media soil:
Soil permeability
1.50 in/hr
OK
Soil composition
% Sand (by weight)
86%
OK
% Fines (by weight)
10%
OK
% Organic (by weight)
4%
OK
Total: 100%
Phosphorus Index (P-Index) of media
18 (unitless)
OK
Form SW401-Biaretention-Rev.8
July 30, 2009
Parts I and 11. Design Summary, Page 1 of 2

Permit Number:
(to be provided by DWQ)
Basin Elevations
Temporary pool elevation
27.00 fmsl
Type of bioretention cell (answer 'Y" to only one of the two
following questions):
Is this a grassed cell?
Y (Y or N) OK
Is this a cell with trees/shrubs?
N (Y or N)
Planting elevation (top of the mulch or grass sod layer)
26.25 fmsl
Depth of mulch
0 inches Insufficient mulch depth, unless installing grassed cell.
Bottom of the planting media soil
24.25 fmsl
Planting media depth
2 fl
Depth of washed sand below planting media soil
0.16 If
Are underdrains being installed?
Y (Y or N)
How many clean out pipes are being installed?
3
OK
What factor of safely is used for sizing the underdrains? (See
10
OK
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
1 ft
the bottom of the cell to account for underdrains
Bottom of the cell required
23.09 fmsl
SHWT elevation
21 fmsl
Distance from bottom to SHWT
2.09 fl
OK
Internal Water Storage Zone (IWS)
Does the design include IWS
N (Y or N)
Elevation of the top of the upturned elbow
fmsl
Separation of IWS and Surface
26.25 It
Planting Plan
Number of tree species
0
Number of shrub species
0
Number of herbaceous groundcover species
0
Recommend more species.
Additional Information
Does volume in excess of the design volume bypass the
Y (Y or N)
OK
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
(Y or N)
through a vegetated filter?
What is the length of the vegetated filter?
It
Does the design use a level spreader to evenly distribute flow?
(Y or N)
Is the BMP located at least 30 feet from surface waters (50 feet if
Y
(Y or N)
OK
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Y
(Y or N)
OK
Are the vegetated side slopes equal to or less than 3:1?
Y
(Y or N)
OK
Is the BMP located in a proposed drainage easement with access
Y
(Y or N)
OK
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
ft/sec
Is the area surrounding the cell likely to undergo development in
N
(Y or N)
OK
the future?
Are the slopes draining to the bioretention cell greater than 20%?
N
(Y or N)
OK
Is the drainage area permanently stabilized?
Y
(Y or N)
OK
Pretreatment Used
(Indicate Type Used with an "X" in the shaded cell)
Gravel and grass
(8 inches gravel followed by 3-5 It of grass)
Y
Grassed Swale
Y
Forebay
N
Other
Form SW401-Bioretenlion-Rev.8
July 30, 2009 Parts I and II. Design Summary, Page 2 of 2

A�
NCDENR
Permit Number:
(to be provided by DWQ)
o�of
V ATFgOL
> C
O T
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Pad 111) must be printed, filled out and submitted along with all of the required information.
11. PROJECT INFORMATION
INFORMATION
Project name
Beaufort County ABC
Contact name
J. Scott Farmer, PE
Phone number
(252) 7524135
Dale
November 11, 2009
Drainage area number
2
IL IDESIGNINFORMATION
Site Characteristics
Drainage area
12,030 ft2
Impervious area
6,443 ft2
Percent impervious
53.6% %
Design rainfall depth
1.5 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak Flow required?
Y (Y or N)
1-yr, 24-hr runoff depth
3.5 in
1-yr, 24-hr intensity
0.12 in/hr
Pre -development 1-yr, 24-hr peak flow
0.467 ft3/sec
Post -development 1-yr, 24-hr peak flow
0.643 ft3/sec
Pre/Post 1-yr, 24-hr peak control
0.176 ft3/sec
Storage Volume: Non -SA Waters
Minimum volume required
820.0 h3
Volume provided
921.0 h3
OK
Storage Volume: SA Waters
1.5" runoff volume
It
Pre -development 1-yr, 24-hr runoff
rya
Post -development 1-yr, 24-hr runoff
113
Minimum volume required
0 ft3
Volume provided
to
Cell Dimensions
Fording depth of water
9 inches
OK
Ponding depth of water
0.75 ft
Surface area of the top of the biorelention cell
1,427.0 ft2
OK
Length:
50 ft
OK
Width:
25 ft
OK
-or- Radius
10 ft
OK
Media and Soils Summary
Drawdown time, ponded volume
6 hr
OK
Drawdown time, to 24 inches below surface
14 hr
OK
Drawdown time, total:
20 hr
In -situ soil:
Soil permeability
1.50 in/hr
OK
Planting media soil:
Soil permeability
1.50 in/hr
OK
Soil composition
% Sand (by weight)
86%
OK
% Fines (by weight)
10%
OK
% Organic (by weight)
4%
OK
Total: 100%
Phosphorus Index (P-Index) of media 18 (unitless) OK
Form SW407-Bioretention-Rev.e
July 30. 2009
Parts I and II. Design Summary, Page 1 of 2

Permit Number:
(to be provided by D WQ)
Basin Elevations
Temporary pool elevation
27.00 fmsl
Type of bioretention cell (answer 'Y" to only one of the two
following questions):
Is this a grassed cell?
Y (Y or N) OK
Is this a cell with trees/shrubs?
N (Y or N)
Planting elevation (top of the mulch or grass sod layer)
26.25 fmsl
Depth of mulch
0 inches Insufficient mulch depth, unless installing grassed cell.
Bottom of the planting media soil
24.25 fmsl
Planting media depth
2 it
Depth of washed sand below planting media soil
0.161t
Are underdrains being installed?
Y (Y or N)
How many clean out pipes are being installed?
2 OK
What factor of safely is used for sizing the underdrains? (See
BMP Manual Section 12.3.6)
10 OK
Additional distance between the bottom of the planting media and
1 ft
the bottom of the cell to account for underdrains
Bottom of the cell required _
23.09 fmsl
SHWT elevation
21 fmsl
Distance from bottom toSHWT
2.09ft OK
Internal Water Storage Zone (IWS)
Does the design include IWS N (Y or N)
Elevation of the tap of the upturned elbow fmsl
Separation of IWS and Surface 26.25 It
Planting Plan
Number of tree species 0
Number of shrub species 0
Number of herbaceous groundcover species 0 Recommend more species.
Additional Information
Does volume in excess of the design volume bypass the Y (Y or N) OK
bioretention cell?
Does volume in excess of the design volume flaw evenly distributed (Y or N)
through a vegetated filter?
What is the length of the vegetated filter? it
Does the design use a level spreader to evenly distribute Flow? (Y or N)
Is the BMP located at least 30 feet from surface waters (50 feet if
Y
(Y or N)
OK
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Y
(Y or N)
OK
Are the vegetated side slopes equal to or less than 3:1?
Y
(Y or N)
OK
Is the BMP located in a proposed drainage easement with access
Y
(Y or N)
OK
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
fvsec
Is the area surrounding the cell likely to undergo development in
N
(Y or N)
OK
the future?
Are the slopes draining to the bioretention cell greater than 20%?
N
(Y or N)
OK
Is the drainage area permanently stabilized?
Y
(Y or N)
OK
Pretreatment Used
(Indicate Type Used with an "X' in the shaded cell)
Gravel and grass
(flinches gravel followed by 3-5 ft of grass)
Y
Grassed swale
N
Forebay
N
Other
Form SW401-13ioretention-Rev.8
July 30, 2009 Parts I and II. Design Summary, Page 2 of 2

Permit No:
(to be assigned by DWQ)
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
I ip tials, Sheet No.
1. Plans (1' - 50' or larger) of the entire site showing
` '-) 9 - Design at ultimate build -out,
4 -Off-site drainage (it applicable), N/A
`t - Delineated drainage basins (include Rational C coefficient per basin), r r
y - Cell dimensions,
3,11 -Pretreatment system, &zdv Hr, C7- m
7, 4 - High Pow bypass system,
z,14 -Maintenance access, 43vz5 ,Zu'J
(- Recorded drainage easement and public right ofway (ROW),
-2 - Clean out pipe locations,
z, 3 - Overflow device, and
- Boundaries of drainage easement.
2. Plan details (1" = 30' or larger) for the biorelenlion cell showing:
°/ -Cell dimensions
z- - Pretreatment system,
2, 3 - High flow bypass system,
'I - Maintenance access,
- Recorded drainage easement and public right of way (ROW),
Design at ultimate build -out,
y - Off -site drainage (if applicable),
z - Clean out pipe locations,
Z, 3 - Overflow device, and
- Boundaries of drainage easement.
- Indicate the P-Index between 10 and 30 Svpp /c.•-<-... F
3. Section view of the biorelenlion cell (1" = 20' or larger) showing:
3 - Side slopes, 3:1 or lower
3 - Underdrain system (if applicable), and
3 - Bioretention cell layers [ground level and slope, pre-treatment, ponding depth, mulch depth, fill media
depth, washed sand, filter fabric (or choking stone if applicable), #57 stone, underdrains (if applicable),
SH Wi level(s), and overflow structure]
4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified In the field by DWQ, by completing & submitfing the soils
investigation request form. County soil maps are not an acceptable source of soils information. All
elevations shall be in feet mean sea level (fmsl). Results of soils tests of both the planting soil and the in
situ soil must include:
pna ca�las
- Soil permeability,
- Soil composition (% sand, % fines, % organic), and
SG (7 •
index.
A d
5. A detailed planting plan (1" = 20' or larger) prepared by a qualified individual showing:
-A variety of suitable species,
- Sizes, spacing and locations of plantings,
- Total quantity of each type of plant specified,
-A planting detail,
- The source nursery for the plants, and
- Fertilizer and watering requirements to establish vegetation.
6. An assurance that the installed system will meet design specifications upon initial operation once the
project is complete and the entire drainage area is stabilized.
A YY(
2
7. A construction sequence that shows how the hioretention cell will be protected from sediment until the
l
entire drainage area is stabilized.
8✓b
&. The supporting calculations (including underdrain calculations, if applicable).
Su b.ntil"-r Lt
9. A copy of the signed and notarized inspection and maintenance (I&M) agreement.
� J
10. A copy of the deed restriction.
Form SW401-eioretentlon-Rev.7 Pan IN, Page 1 of 7

Permit Number: SW �G�j 12V3
(to be provided by DWQ)
Drainage Area Number:
Bioretention 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 integrityn
of structures, safety of the public, and the removal efficiency of the BMP.
Important operation and maintenance procedures:
DEC 0 7 2009
— Immediately after the bioretention cell is established, the plants will be watered
twice weekly if needed until the plants become established (commonly six
weeks).
— Snow, mulch or any other material will NEVER be piled on the surface of the
bioretention cell.
— Heavy equipment will NEVER be driven over the bioretention cell.
— Special care will be taken to prevent sediment from entering the bioretention cell.
— Once a year, a soil test of the soil media will be conducted.
After the bioretention cell is established, I will inspect it once a month and within 24
hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of operation and maintenance 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:
Potentialproblems:
How I 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
bioretention cell
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,
The pipe is clogged (if
Unclog the pipe. Dispose of the
stone verge or 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.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
Form SW401-Bioretention O&M-Rev.3
Page 1 of 4

BMP element:
Potentialproblems:
How I will remediate theproblem:
The pretreatment area
Flow is bypassing
Regrade if necessary to route all
pretreatment area and/or
flow to the pretreatment area.
gullies have formed.
Restabilize the area after grading.
Sediment has accumulated to
Search for the source of the
a depth greater than three
sediment and remedy the problem if
inches.
possible. Remove the sediment and
restabilize the pretreatment area.
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.
The bioretention cell:
Best professional practices
Prune according to best professional
vegetation
show that pruning is needed
practices.
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the
dying.
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Tree stakes/wires are present
Remove tree stake/wires (which
six months after planting.
can kill the tree if not removed).
The bioretention cell:
Mulch is breaking down or
Spot mulch if there are only random
soils and mulch
has floated away.
void areas. Replace whole mulch
layer if necessary. Remove the
remaining much and replace with
triple shredded hard wood mulch at
a maximum depth of three inches.
Soils and/or mulch are
Determine the extent of the clogging
clogged with sediment.
- remove and replace either just the
top layers or the entire media as
needed. Dispose of the spoil in an
appropriate off -site location. Use
triple shredded hard wood mulch at
a maximum depth of three inches.
Search for the source of the
sediment and remedy the problem if
possible.
An annual soil test shows that
Dolomitic lime shall be applied as
pH has dropped or heavy
recommended per the soil test and
metals have accumulated in
toxic soils shall be removed,
the soil media.
disposed of properly and replaced
with new planting media.
Form SW401-Bioretention O&M-Rev.3 Page 2 of 4

BMP element:
Potentialproblems:
How I will remediate theproblem:
The underdrain system
Clogging has occurred.
Wash out the underdrain system.
if applicable)
The drop inlet
Clogging has occurred.
Clean out the drop inlet. Dispose of
the sediment off -site.
The drop inlet is damaged
Repair or replace the drop inlet.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
outlet.
733-1786.
Form SW401-Bioretention O&M-Rev.3 Page 3 of 4

Permit Number:
(to be provider! by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:Beau fort County ABC - Chocowinity Store
BMP drainage area number:
Print
Title: ( -,-c—
Address:PO Box 2552, 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, C✓-a� , a Notary Public for the State of
Q i Co thty of /, � do hereby certify that
personally appeared before me this
day f and acknowledge the due execution of the
forgoing bioretention maintenance requirements. itness�m(gy� hand and offi tal seal
pWat1111!q„� �, )�l //I /// 0
SEAL
My commission expires
Form SW401-Bioretention I&M-Rev. 2 1 Page 4 of 4

FINANCIAL RESPONSIB ITY /OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate a land -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land Quality
Section, NC Department of Environment, and Natural Resources. (Please type or print and, if question is not .,
applicable, place N/ A in the blank).
Part A.
DEC 0 9 2009
1. Project Name Beaufort County ABC
2 Location of land -disturbing activity: County Beaufort City or Township Chocowinity
Highway/Street SR 1147 and US 17. Latitude 35031'11'IN Longitude 77005'33"W
3. Approximate date land -disturbing activity will be commenced: January 2010
4. Purpose of development (residential, commercial, industrial, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.3 Ac
6. Amount of fee enclosed $ 130.00 The application fee of $65.00 per acre
(rounded up to the next acres) is assessed without a ceiling amount.
7 Has an erosion and sedimentation control plan been filed? Yes X No
Enclosed X
8. Person to contact should sediment control issues arise during land -disturbing activity.
Name J. Scott Farmer, PE Telephone [phone] Email sfarmerna riversandassociates com
9. Landowner(s) of Record (Use blank page to list additional owners):
Beaufort County ABC
Name(s)
PO Box 2552
Current Mailing Address
Washington NC 27889
City State Zip
10. Recorded in Deed Book No. 1686
Part B.
Tel: [phone] Fax:[phone]
750 Carolina Avenue
Current Street Address
Washington NC 27889
City State Zip
Page No. 727
Person(s) or firm(s) who are financially responsible for this land -disturbing activity (Use a blank page to list
additional persons or firms):
Beaufort County ABC
Name of Person(s) or Firms)
PO Box 2552
Current Mailing Address
Washington NC 27889
City State Zip
Telephone: [phone]
abcwashP,embargmail com
Email Address
750 Carolina Avenue
Current Stree s T
Washington NC 27889
City State �f., zip ^. 'i i,
Fax: [phone] LAN".) '
CIABHiNGTON RE i 1NF.wrr:6E

2 (a) If the Financially Responsible Party is not a resident of North Carolina give name and street address of a
North Carolina Agent.
Name
o .
Mailing Address
City State zip
Telephone
Email Address
Street Address
City State Zip
Telephone
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the certificate of assumed name. If the Financially Responsible Party is a
Corporation give name and street address of the Registered Agent.
Beaufort County ABC
Name of Registered Agent
PO Box 2552
Mailing Address
Washington NC 27889
City State Zip
Telephone [phone]
abcwash(rD,embargmai I.com
Email Address
750 Carolina Avenue
Street Address
Washington NC 27889
City State Zip
Fax [phone]
The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath. (This form must be signed by the financially responsible person if an individual or his attorney -
in -fact or if not an individual by an officer, director, partner, or registered agent with authority to execute
instruments for the financially responsible person). I agree to provide corrected information should there be
any change in the information provided herein.
J� t m41 9�>
Type or prin na Title or Authority
SignaturA Date
I, �� I
, �C Q/ya Notary Public of the County of
State of North Carolina, hereby certify tha Ca L "t Zf_appeared personally before me this day
and being duly sworn acknowledged that the ve foriA was executed by him.
Witness my hand.and notarial seal, this day �(? , 2009
l
Seal` Not
My commission expire C�d

avers
&Associates,lnc.
Since1918
September 14, 2010
Mr. Al Hodge
NC Department of Environment, Health and Natural Resources
Division of Water Quality
943 Washington Square Mall
Washington, North Carolina 27889
Subject: Beaufort County ABC Chocowinity Store
Chocowinity, Beaufort County, North Carolina
Storrnwater Management Permit No. SW7091203
Dear Mr. Hodge:
Engineers
Planners
Surveyors
Please find enclosed the required Professional Engineer's Certification for the referenced project.
Do not hesitate to call if you have any questions or need any additional information at this time.
With best regards,
Rivers Ad Ass ciat I
F. Durward Ty on, Jr., P.E.
Project Manager
Enclosure
cc: Beaufort County ABC Board
Beaufort County Inspections Department
SEP 15 2010
107 East Second Street. Greenville. NC 2785S • Post Office Box 929 • Greenville. NC 27835 • (252) 752-41.35 • FAX [phone]
E-mail: [e-mail]

Ili! S
ciat —
Since1918
Project Name:
Beaufort County ABC Chocowinity Store
Chocowinity, Beaufort County, North Carolina
Stormwater Management Permit No. S W7091203
Engineers / Planners / Surveyors
Rivers and Associates, Inc. provided periodic inspection during the construction of the
referenced project.
As a duly registered Professional Engineer in the State of North Carolina, I hereby state that to
the best of my knowledge and belief, due care and diligence was used in the observation of the
project construction such that the construction was observed to have been built within substantial
compliance and intent with the approved plans and specifications.
Rivers and Associates, Inc.
License No. F-0334
/� 101"
F. Durward Tyson, Jr., P.E. CAiy
Registration No. 17376 ��.• Q,tH RD
�'�x*eSsioA ti9
SEAL ?
.n 17376 s ?
' G :I'QINE�,r• ��•
'a 9y; ••....... 0 x
119
SEP 15 2010
® Q-t1YVARC)