SW6140403_CURRENT PERMIT_20140908

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

NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
September 8, 2014
Lumbee Land Development, Inc.
Attn: Bosco Locklear, Director of Housing
6984 NC Highway 711
Pembroke, NC 28372
Subject: Stormwater Management Permit SW6140403
Pembroke Senior Village
High Density Project
Robeson County
Dear Mr. Locklear:
John E. Skvarla, III
Secretary
The Fayetteville Regional Office of the Division of Energy, Mineral and Land Resources, Land Quality Section
received a complete Stormwater Management Permit Application for the Pembroke Senior Village project on
August20, 2014. 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. Therefore, we are forwarding
herewith Stormwater Management Permit SW6140403, dated September 8, 2014, for the construction, operation
and maintenance of the subject project and associated BMPs.
This permit shall be effective from the date of issuance until September 7, 2022 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 could 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 by filing a written petition with the Office of Administrative Hearings (OAH). The written
petition must conform to Chapter 150E of the North Carolina General Statutes. Per NCGS 143-215(e), the petition
must be filed with OAH within thirty (30) days of receipt of this permit. You should contact the OAH with all
questions regarding the filing fee (if a filing fee is required) and/or the details of the filing process at 6714 Mail .
Service Center, Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at
www.ncoah.com. Unless such demands are made, this permit shall be final and binding.
If you have any questions or concerns, please contact Mike Lawyer or myself at [phone].
Sincerely,
Brad Cole, PE
Regional Engineer
Land Quality Section
BC/ml
cc: Juan A. Blue, PMP - Locklear, Locklear, & Jacobs (via e-mail) V
FRO - Land Quality Section, State Stormwater Files, SW6140403
Division of Energy, Mineral and Land Resources
Land Quality Section
Fayetteville Regional Office, 225 Green Street - Suite 714, Fayetteville, North Carolina 28301
Phone: [phone] / FAX: [phone] / Internet: hnp:#portal.ncdenr.org/web/ir/
An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
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
Lumbee Land Development, Inc.
Pembroke Senior Village
893 Candy Park Road, Pembroke, Robeson County
FOR THE
construction, operation and maintenance of two wet detention basins in compliance with the provisions
of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and the approved stormwater
management plans and specifications and other supporting data as attached and on file with and
approved by the Division of Energy, Mineral and Land Resources and considered a part of this permit.
This permit shall be effective from the date of issuance until September 7, 2022 and shall be subject to
the following specified conditions and limitations:
I. DESIGN STANDARDS
2.
43
5.
91
This permit is effective only with respect to the nature and volume of stormwater described in
the application and other supporting data.
This stormwater system has been approved for the management of stormwater runoff as
described in Section 1.6 of this permit. The stormwater controls have been designed to handle
the runoff from 136,343 square feet of total built -upon area.
The tract will be limited to the amount of built -upon area as indicated in Section 1.6 of this permit
and per approved plans.
All stormwater collection and treatment systems must be located in either dedicated common
areas or recorded easements. The final plats for the project will be recorded showing all such
required easements, in accordance with the approved plans.
The runoff from all built -upon area within the permitted drainage area of this project must be
directed into the permitted stormwater control system.
The following design criteria have been provided in the wet detention basins and must be
maintained at design condition:
Wet Pond #1 Wet Pond #2
Drainage Area, acres: 4.94 4.22
Onsite, ftz: 215,187 183,823
Offsite, ft2: 0 0

Q
Total Impervious Surfaces, ft2:
Buildings, ft2:
Streets, ft2:
Parking, ft2:
Sidewalks, ft2:
Other, ft2:
Future, ft2:
Offsite, ft2:
Design Storm, inches:
Pond Depth, feet:
TSS removal efficiency:
Permanent Pool Elevation, FMSL:
Permanent Pool Surface Area, ft2:
Permitted Storage Volume, ft3:
Temporary Storage Elevation, FMSL:
Controlling Orifice:
Permitted Forebay Volume, ft3:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
75,359
60,984
26,140
12,192
25,856
27,188
10,730
6,525
11,110
14,719
1,523
360
0
0
0
0
1.0
1.0
4.00
4.00
90% .
90%
153.50
153.50
4,743
8,915
15,822
26,538
154.49
154.07
3.00" 0 pipe
3.00" 0 pipe
4,475
5,343
Lumber River /
Lumber
14-(7)
"WS-IV,B;Sw,HQW"
1. The stormwater management system shall be constructed in its entirety, vegetated and
operational for its intended use prior to the construction of any built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of the system will
be repaired immediately.
3. The permittee shall, at all times, provide the operation and maintenance necessary to assure
the permitted stormwater system functions at optimum efficiency. The approved Operation and
Maintenance Plan must be followed in its entirety and maintenance must occur at the scheduled
intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow spreader, catch
basins and piping.
q. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon request to authorized
personnel of DENR. The records will indicate the date, activity, name of person performing the -
work and what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit shall become
voidable unless the facilities are constructed in accordance with the conditions of this permit, the
approved plans and specifications, and other supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and
prior to operation of this permitted facility, a certification must be received from an
appropriate designer for the system installed certifying that the permitted facility has
been installed in accordance with this permit, the approved plans and specifications, and
other supporting documentation. Any deviations from the approved plans and
specifications must be noted on the Certification. A modification may be required for
those deviations.

7. 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.
9. 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 for
a minimum of ten years from the date of the completion of construction.
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 Energy, Mineral and Land Resources accompanied by a completed
name/ownership change form, documentation from the parties involved, and other supporting
materials as may be appropriate. The approval of this request will be considered on its merits
and may or may not be approved. The permittee is responsible for compliance with all permit
conditions until such time as the Division approves the transfer request.
2. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to enforcement action by the Division of Energy, Mineral and Land Resources 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.
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.
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 (if the permit. A copy of the approved plans and specifications shall be
maintained on file by the Permittee at all times.
9. The permittee shall submit a permit renewal application and processing fee at least 180 days
prior to the expiration date of this permit.
Permit issued this the eighth day of September 2014.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Arlracy E. Davis, PE, CPM, Director
Division of Energy, Mineral and Land Resources
by Authority of the Environmental Management Commission
Stormwater Management Permit SW6140403

Pembroke Senior Village Page 1 of 2
Stormwater Management Permit SW6140403
Robeson 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 Name)
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 a part of this Certification.
Noted deviations from approved plans and specification:
SEAL
Signature
Registration Number
Date

Certification Requirements: Page 2 of 2
1. The drainage area to the system contains approximately the permitted acreage.
2. The drainage area to the system contains no more than the permitted amount of built -
upon area.
3. All the built -upon area associated with the project is graded such that the runoff drains to
the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
T . Trash rack is provided on the outlet/bypass structure.
8. All slopes are.grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1 with vegetated shelf at 10:1.
10. The inlets are located per the approved plans and do not cause short-circuiting of the
system.
11. The permitted amounts of surface area and/or volume have been provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf, and a forebay.
15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: NCDENR Fayetteville Regional Office
Division of Energy, Mineral -and Land Resources
Land Quality Section
225 Green Street, Suite 714
Fayetteville, NC 28301

t...; DWQ USE ONLY
' - _ �,
Date Received
Fee Paid
Permit Number
Sa.S
I SW&II416LI63
Applicable Rules:
❑ Coastal SW -1995
❑ Coastal SW - 2008
❑ Ph II - Post Construction
(select all that apply)
❑ Non -Coastal
SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M
mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. 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.):
PEMBROKE SENIOR VILLAGE
2. Location of Project (street address):
893 CANDY PARK ROAD
City:PEMBROKE County:ROBESON Zip:28372
3. Directions to project (from nearest major intersection):
West side of Candy Park Rd.(RR1553)1900 ft south of the intersection of NC 711 and Candy Park
4. Latitude:W W 47" N Longitude:79* 10' 44" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tReneu,als With modifications also requires SWU-102 - Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System []Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑LAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 9.0 ac of Disturbed Area
❑404/401 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:
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
ffyes, see S.L. 2012-200, Part Vl: http://portal.ncdent.org/web/wq/ws/su/statesw/rules laws
Form SWU-101 Version06Aug2012 Page I of

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:Lumbee Land Development, Inc.
Signing Official & Title:Bosco Locklear - Director of Housing
b. Contact information for person listed in item la above:
Street Address:6984 NC HWY 711
City:Pembroke
Mailing Address (if applicable):
City:
Phone: ( )
State:NC Zip:28372
State:
Fax: ( )
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:Venture Properties Group, LLC
Signing Official & Title:Greg_ory S. Bryant - Manager
b. Contact information for person listed in item 2a above:
Street Address:763 Comtech Dr.
City:Pembroke State:NC Zip:28372
Mailing Address (if opplicable):Post Office Box 1359
City:Pembroke State:NC Zip:28372
Phone: (910 ) 736-4105 Fax:
Email:[e-mail]
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: Locklear, Locklear, & lacobs PLLC
Signing Official & Title:luan A Blue - Director of Land Development
b. Contact information for person listed in item 3a above:
Mailing Address:Post Office Box 3110
City:Pembroke State:NC Zip:28372
Phone: (910 ) 774-9306
Email:[e-mail]
Fax: (866 ) 649-7235
4. Local jurisdiction for building permits: Robeson County Dept. of Building Safety and Code Enforcement
Point of Contact:Wayland Townsend Phone #: (910 ) 272-6540
Form SWU-101. Version 06Aug2012 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff from each rain event will be conveyed, via a combination of surface, piped, and channeled
flow, to two wet retention ponds for detention and treatment thin the pond's natural physical, bilogical and
chemical process due to the pond shape and presents of the proper plant selection and planting location.
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 Lumber (03-07-51 sub) River basin.
4. Total Property Area: 12 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area*: acres
Total project area shall be calculated to exclude the followin the normal pool of impounded struchires, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Mean Nigh Water
(MHW) line, and coastal wetlands landward frorn the NHW (or MHIN) line. Thie resultad project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) lira may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 30 %
9. How many drainage areas does the project have?2 (For high densihit, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole properly/ 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.
Form SWU-101 Version 06Aug2012 Page 3 of 7

Basin Information -
Drainage Areas '
Drainage Area_
Drains e Area_
Drains e Area
Receiving Stream Name
UT Lumber
River
1TF Lumber
River
Stream Class *
WS-IV,Sw,HQW
WS-IV,Sw,HQW
Stream Index Number *
14-(7)
14-(7)
Total Drainage Area (so
162,914
152,460
On -site Drainage Area (so
162,914
152,460
Off -site Drainage Area (sf)
0
0
Pro osed Impervious Area** s
88,434
61,532
7,Im ervious Area** total
54
40
Im ervrous Surface Area;, �)'�.
-Drama e AreaAss
.Drains e•Area;'_'
Drairia e Area,..«'
:Drains e'Area s
On -site Buildings/Lots (so
26,140
12,192
On -site Streets (sf)
40,082
27,188
On -site Parking (so
13,050
6,525
On -site Sidewalks (so
6,622
15,267
Other on -site (so
2540
360
Future (sf)
Off -site (so
Existing BUA*** (sf)
Total (so:
88,434
61,532
* Stream Class and Index Number tali be determined at: http.&ortal.ncdenr.or oebAv/ps/csu/classflcnHons
* 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 ally 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 15A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from httV://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from h_ptt ://portal.ncdenr.org/web/wq/ws/su/statesw/forms dots. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at httn:/ /portal.nedenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms dots.
Initial
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.envheip.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.)
Form SWU-101 Version 06Aug2012 Page 4 of 7

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'/z mile of the site boundary, include the 1/1,
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
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.
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"xll" copy of the NRCS County Soils map with the '
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type; expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book:1687 Page No: 157-159
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
ht�p://www.secretiry.state.nc.us/Corporations/CSearch.aspx
/www.secretary.state.nc.us/Corporations/CSearch.aspx/ /www.secretary.state.nc.us/Corporations/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http:/http://portalmcdennorg/web/wq/ws/su/statesw/forms does/web/wq/ws/su/statesw/forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
Form SWU-101 Version 06Aug2012 Page 5 of 7

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:Tonathan E. Locklear, P.E.
Consulting Firm: Locklear, Locklear, & Tacobs, PLLC
Mailing Address:Post Office Box 3110
City:Pembroke
Phone: (910 ) 774-9306
Email:[e-mail]
State:NC Zip:28372
Fax: (866 ) 649-7235
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, itern 2 has been filled ont, complete this
section)
I, (print or hjpe name of person listed in Contact Information, item 2a) Grevont S. Bn1ant , certify that I
own the property identified in this permit application, and thus give permission to (print or hjpe name of person
listed in Contact Information, item 1a) Bosco Locklear with (print or type name of organization listed in
Contact Information, item la) Lumbee Land Development, Inc. to develop the project as currently proposed. A
copy of the lease agreement or pending property sales contract has been provided with the submittal, which
indicates the party responsible for the operation and maintenance of the stormwater system.
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 ycivil penalties of u� to $25,000 perms, pursuant to NCGS 143-215.6.
a Notary Public for the State of
, do hereby certify that
before me this _ day of
Date: Z �'
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
Form SWU-101 Version 06Aug2012 Page 6 of

X. APPLICANT'S CERTIFICATION
I, (print or hjpe name of person listed in Contact Information, item 1a) Bosco Locklear
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 rules undg 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Date: '
I, 441 /Eia � tp> er . a Notary Public for the State of A C'. 14-.. . County of
r(o LeoA , do hereby certify that /i•rto �-Jkk. personally appeared
before me this -a day of A rit 2el`i , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, �� I� T—
glHlllllllllllhp
°P o Ate y
�OTAR),
My Commission=
Expires
c P 11/11/201B 2 z
-;��Fs PUB0ONS
SEAL
My commission expires
Form SWU-101 Version 06Aug2012 Page 7 of 7

Date Received Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph 11- Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on I
specifications, letters, operation and maintenance agreements, etc.): i 1 —1
2. Location of Project (street address):
City:PEMBROKE County:ROBESON
3. Directions to project (from nearest major intersection):
I �
Zip:28372
West side of Candy Park Rd. (RR1 553) 1900 It south of the intersection of NC 711 and Candy Park
Rd.(RR1553)
4. Latitude:34° 39' 47" N Longitude:79° 10' 44" W of the main entrance to the project.
11. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SV✓U-702 - Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* 'provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 4.0 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: Pembroke Senior Village ROBES-2014-017 5/30/2014
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: http://12ortal.ncdenr.org/web/wq/ws/su/statesw/rules laws
Form SWU-101 Version 06Aug2012 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 proiec
Applicant/Organization:Lumbee Land Development, Inc.
Signing Official & Title:Bosco Locklear - Director of Housing
b. Contact information for person listed in item la above:
Street Address:6984 NC HWY 711
City:Pembroke State:NC Zip:28372
Mailing Address (i f applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/OrganizationNenture Properties Group, LLC
Signing Official & Title:Gregory S. Bryant - Manager
b. Contact information for person listed in item 2a above
Street Address:763 Comtech Dr.
City:Pembroke State:NC Zip:28372
Mailing Address (if applicable):Post Office Box 1359
City:Pembroke State:NC Zip:28372
Phone: (910 ) 7364105 Fax: ( )
Emad:[e-mail]
3. a. (Optional) Print the name and title of another contact such as the projects construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:Locklear Locklear, & Jacobs. PLLC
Signing Official & Title:ivan A. Blue - Director of Land Development
b. Contact information for person listed in item 3a above:
Mailing Address:Post Office Box 3110
City:Pembroke State:NC Zip:28372
Phone: (910 ) 774-9306 Fax: (866 ) 649-7235
Email:[e-mail]
4. Local jurisdiction for building permits: Robeson County Dept. of Building Safety and Code Enforcement
Point of Contact: Wayland Townsend Phone #: (910 ) 272-6540
Form SWU-101 Version 06Aug2012 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff from each rain event will be conveyed, via a combination of surface, piped, and
channeled Flow, to two wet retention ponds for detention and treatment thru the pond's natural physical,
bilogical and chemical process due to the pond shape and presents of the proper plant selection and planting
location.
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 Lumber (03-07-51 sub) River basin.
4. Total Property Area:12 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area*:12 acres
* Total project area shall be calculated to exclude thefollowing. the nornml pool of inu unded structures, the area
behveen the banks of stremns and rivers, the area below the Nonnal Hi h Water (NM line or Mean High Water
(MHW) line, and coastal Wetlands lwudrvanl 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 = 30 %
9. How many drainage areas does the project have? 2 (For high density, count 1 for each proposed engineered
stornrrvater BMP. For lore 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.
Form SWU-101 Version 06Aug2012 Page 3 of

Basin Information ,-,-", ...Draina
e,Area l ,
Drainage Area 2
Draina e.Area ..
Drainage Area _
Receiving Stream Name
UT Lumber
River
UT Lumber
River
Stream Class *
WS-IV,Sw,HQW
WS-IV,Sw,HQW
Stream Index Number *
14-(7)
14-(7)
Total Drainage Area (so
215,187
183,823
On -site Drainage Area (so
215,187
183,823
Off -site Drainage Area (so
0
0
Proposed Impervious Area*' (so
75,359
60,984
Impervious Area*` total
35.02
33.18
'ani ervious"' Surface Area IDraina
e-Area "I
'_Draina e'Area 2
Draina e7Area
Draina e Area.
On -site Buildings/Lots (so
26,140
12,192
On -site Streets (so
25,856
27,188
On -site Parkin (so
10,730
6,525
On -site Sidewalks (so
11,110
14,719
Other on -site (so
1,523
360
Future (so
Off -site (so
Existing BUA*** (so
Total (so:
75,359
60,984
* Stream Class and Index Number can be determined at: Idty://portal.ncde)ir.org/ruebhaq/ps/csu/classifications
'* Lngqervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sitletoalks, gravel areas, etc.
'*"Report only that anmunt of existing BUA that will rennin 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
Proiects in Union Countv: Contact DWO Central Office staff to check if the project is located}vithin a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per I5A 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
fromhttp://portal.ncdenr.org/web/wq/ws/suZbrnl2-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://portal.nccienr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. JAB
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants JAB
Form. (if required as per Part VII beloev)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M ,JAB
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to JAB
h!!p:/ /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.) _
Form SWU-101 Version 06Aug2012 Page 4 of 7

5.
A detailed narrative (one to two pages) describing the stormwater treatment/management for
JAI
6.
A USGS map identifying the site location. If the receiving stream is reported as class SA or the
JAB
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 (one copy).
JAB
8.
Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
JAB
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
JAB
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"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 DebiF�s submitted to WiRO: Schedule a site visit for DWQ to verifij the SH VT prior
to subnzittdt),(910)v796-7378.)
10.
A copy of the most curre t property deed. Deed book: 1687 Page No� 157-159
I JAQ
11.
For corporations and'I mi d Iiability corporations (LLC): Provide documentation from the NC] y W AJAR
Secretary of State or other officio�] documentatio_n;,which�supports the titles and positions held-(,r,�,,r1
by the persons listed in Contact Information, item la, 2a, and/or 3a per 15A NCAC 2H.1003te).
The corporation or LLC must be listed as an active corporatior}In good staridfrig,with the NC �! I
Secretary of State\otherwise the appplication- "'Il be returned.
hwww..secra.statnc.u/Cotoraons/CSearch.aWxp/
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
htto://oortal.ncdenr.otd/web/wei/ws/su/statesw/forms does. Download the latest versions for each
submittal
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
Form SWU-101 Version 06Aug2012 Page 5 of 7

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:lonathan E. Locklear, P.E.
Consulting Firm: Locklear, Locklear, & Tacobs, PLLC
Mailing Address:Post Office Box 3110
City:Pembroke
Phone: (910 ) 774-9306
Email:[e-mail]
State:NC Zip:28372
Fax: (866 ) 649-7235
IX. PROPERTY OWNER AUTHORIZATION (if Contact Infortnation, item 2 has been filled out, complete this
section)
I, (print or hjpe name of person listed in Contact Information, item 2a) Gregont S. Bntant , certify that I
own the property identified in this permit application, and thus give permission to (print or hype name of person
listed in Contact Infornmtion, item 1n) Bosco Locklear with (print or hype name of organization listed in
Contact Infornation, item 1a) Lumbee Land Development, Inc. to develop the project as currently proposed. A
copy of the lease agreement or pending property sales contract has been provided with the submittal, which
indicates the party responsible for the operation and maintenance of the stormwater system.
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 D WQ 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 stonnwater 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.
Signature: Date: 1(o
1 I
1, 1 a Notary Public for the State of !V � County of
b e601'1 , do hereby certify that V O Yeqan! V OxAL personally appeared
before me this �l day of Sul 1{_ _, a��Tand acknowledge the due exe ution o e application for
a stormwater permit. Witness my hand and official seal, jL\)
NAOTARy
70
OAF PUBLIC 2U
SEAL
My commission expires IJa 0 —161 &/
Form SWU-101 Version 06An2012 Page 6 of 7

X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Infornmtion, item 1a) Bosco Locklear
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 Z"M
1000 and any other applicable state stormwater requirements.
Signature: fnl�------ Date: G
_ r i
I JCL 'S. Y ,,er-J a Notary Public for the State of 144 &tphnow, Countyof
�SUt do hereby certify thatoS C o Loe�C I e�i• personally appeared
before me this d1 day of MA � an nowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, AQJJ
SEAL
My commission expires I Z 13 I o1-0 j
FormSWU-101 VersionOGAug2012 Page 7of7

PEMBROKE SENIOR VILLAGE
PEMBROKE, NORTH CAROLINA
WET POND #1
AUG 1 5 2014 it

Permit No.
(to be provided by DIVQ)
IN AT Fq0
NCDENR
t
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form mustbe filledouf, printedandsubmetted.
The Required liems Checklist (Pad uq must be printed filled ourand5ubmitted along with all olthe required information.
I:.IPROJECT!INFORMATION ,�rr1'57,1;"11 ,.:"3,^sSM":W^nKs-w.v°�".rcou'ra'�°. �°."�:'S�.ss�'ftntr#
Project name
PEMBROKE SENIOR VILLAGE
Contact person
JUAN A. BLUE
Phone number
704-578-0737
Date
17-Ax-14
Drainage area number
1 '
II (DESIGN INFORMATIONt„ ---:Y 9Yg$1
Site Characteristics
Drainage area
215,187. (lz
Impervious area, post -development
75,359.fe
%imper4ous
35.02 %
Design rainfall depth
8.9in
Storage Volume: Nan -SA Waters
Minimum volume required
6,614 W
Volume provided
15,822 rye
OK, volume provided's equal to or in excess of volume required.
Storage Volume: SA Waters
1.5'runoffvolume
file
Pre -development 1-yr, 24-hr runoff
It,
Post -development l-yr, 24-hr runoff
to
Minimum volume required
file
Volume provided
R'
Peak Flow Calculations
Is the prelpoest control of the lyr 24hr stone peak flow required?
N # or N)
1-yr, 24-hr rainfall depth
in
Rational C, pre -development
(unidess)
Rational C, post -development
(unitless)
Rainfall intensity: l-yr, 24-hr storm
! in/hr
Pre -development 1-yr, 24-hr peak flow
felsec
Post -development 1-yr, 24-hr peak flow
folsec
PrelPosl 1-yr, 24-hr peak flow control
felsec
Elevations
Temporary pool elevation
154.49 f ni
Permanent pool elevation -
153.50 fmsl
SRVVF elevation (approx. at the perm, pod elevation)
154.00111
Top of tat vegetated shelf elevation
154.00 find
Bottom of toff vegetated shelf elevation
153.00 fmsl
Sediment cleanout, top elevation (bottom of pond)
151.25'fmsl
Sediment cleanod, bottom elevation
149 00fmsl
Sediment storage provided
2.25 It
Is there additional volume stored above the state -required temp. pod?
N (Y or N)
Elevation of the top of the additional volume
fins!
Form SW401-Wet Detention Basini W12 Parts I. a It. Design Summary,
Page 24

Permit No.
(to De provided by DN•D)
II: :DESIGN INFORMATION ,+' p1LJt1?;ywY"'"�"^•*•^ri' :.
Surface Areas
Area, temporary pool
5,227 fe
Area REQUIRED, permanent pool
4,497 fe
SAIDA ratio
2.09 (unitless)
Area PROVIDED, permanent pool, A,,,,,,,
4,743 le OK
Area, bottom of loft vegetated shed, A� ,
4,228.ft
Area, sediment cleanout, top elevation (bottom of pond), A.
2,600 ft
Volumes
Volume, temporary pool
15,822 d" OK
Volume, permanent pool, V, _,,
15,8220
Volume, forebay(sum of forebays if more than one foreli
4,475,fe
Forebay% of permanent pool volume
28.3%% Insufficient forebay volume.
SAIDA Table Data
Design TSS removal
Coastal SAIDA Table Used?
Mountain/Piedmont SAIDA Table Used?
SAIDA ratio
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 10-2b)
Volume, permanent pool, V..
Area provided, permanent pool, A,,, _cat,
Average depth calculated
Average depth used in SAIDA, d„, (Round to nearest 0.5ft)
Calculation option 2 used? (See Figure 10-2b)
Area provided, permanent pool, A,„,,,y
Area, bodom of 10ft vegetated shed, A,, y
Area, sediment cleanout, lop elevation (bottom of pond), A._,,
"Depth' (distance b/w bottom of 1 Oft shed and top of sediment)
Average depth calculated
Average depth used in SAIDA, d„, (Round to down to nearest 0.5ft)
Drawdown Calculations
Drawdown through orifice?
Diameter of orifice (if circular)
Area of orifice (if -non -circular)
Coefficient of discharge (Co)
Driving head (H,)
Drawdown through weir?
Weir type
Coefficient of discharge (C,.)
Length ofweir (L)
Driving head (H)
Pre -development 1-yr, 24-hr peak flow
Past -development l-yr, 24-hr peakflow
Storage volume discharge rate (through discharge orifice or weir)
Storage volume drawdavn time
Additional Information
Vegetated side slopes
Vegetated shelf slope
Vegetated shelf width
Length of flowpath to width ratio
Length to width ratio
Trash rack for overflow 8 orifice?
Freeboard provided
Vegetated filter provided?
Recorded drainage easement prodded?
Captures all moot( at ultimate build -out?
Drain mechanism for maintenance or emergendes is:
90
N (Y or N)
Y (Y or N)
2.09 (unitess)
N (Y or N)
15,822 ft
4,743 ft
3.25•ft
OK
3.0ft
OK
Y (Y or N)
4,743 ft
4,228 ft
2,600 fe
1.75 ft
4.00 ft
OK
4.0ft
OK
Y (Y or N)
3.00 in
in'
0.60,(unidess)
1.23 ft
N (Y or N)
-(unidess)
(unifiess)
ft
It
ft sec
ftelsec
ft,/Sec
3.00 days
3':1
10 :1
10.0 It
10':1
2.0 1
OK, draws down in 2-5 days.
OK
OK
OK
OK
OK
AUG 1 5 2014
Y (Y or N)
OK
1.Oft
OK
N '(Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
POND WILL REQUIRE PUMPING
Form SW401-Wet Detention Basin-Rov.- le112 Parts I. 811. Design Summary,
Page 25

CONCRETE ANCHOR BOUANCY CALCULATION
Height of riser = 2.75 ft.
Width of riser = 4 ft.
Vol. of riser = 44 ft'
Wt. of H2O displaced = 2,746 Ib/ft'
Conic. pad thicknes = 8 in.
Conic. pad width/length = 8 ft.
Vol. of conc. pad = 42.67 ft'
W. of H2O displaced = 2,662 Ib/ft'
M. of H2O displaced = 5,408
Unit wt. of concrete = 150 lb/ft'
Wt. of conc. pad = 6,400 lb.
Factor of safety = wt. Conc. Pad
wt. Of H2O displaced
F.S.= 1.18
Anchor Size
L
(ft.)
W
(ft.)
D
(in.)
8
8
8
Page 26

PEM13ROKE SENIOR VILLAGE
PEMBROKE, NORTH CAROLINA
WET POND #2
AUG 15 2014

Permit No.
(to be provided by DWD)
nF `N A 7F9
AATA
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This term must be filled out panted and submitted
The Required Items Checklist (Part fill must be printed filled out and submitted along with all of the required information.
Project name
Contact person
Phone number
Date
Drainage area number
JUAN A. BLUE
704-578 0737
17-Apr-14
2
Ik',I)ESIGN INFORM ATION
�!,�'9
Site Characteristics
Drainage area
183,823 Nis
Impervious area, post -development
60,984 ft'
%impervous
33.18 %
Desgn rainfall depth
8.9 in
Storage Volume: Non -SA Waters
Minimum volume required
5,340 ft'
Volume provided
26,538 ft
OK, volume provided is equal to or in excess of volume required.
Storage Volume: SA Waters
1.5' mnoff volume
ft'
Pre -development 1-yr, 24-hr with
It'
Post -development 1-yr, 24hr mnc f
ft'
Minimum volume required
_ ff'
Volume provided ft'
Peak Flow Calculations
Is the prelpost control of the lyr 24hr stomt peak flow required?
N (Y or N)
1-yr, 24-hr rainfall depth
in
Rational C, pre -development
-(ur ifless)
Rational C, post -development
Uri
Rainfall intensity: l-yr, 24-hr storm
'irVhr
Pre -development 1-yr, 24-hr peak flow
ft'Isec
Post -development 1-yr, 24hr peak flax
f Isec
Prellaost 1-yr, 24-hr peak flow control
fl'lsec
Elevations
Temporary pool elevation
154.07 dmsl
Permanent pool elevation
153.50 fmsl
SHWF elevation (approx. at the perm. pool elevation)
154.00 f nii
Top of 10ft vegetated shelf elevation
154.00 first
Bottom of 1 Oft vegetated shelf elevation
153.00 fmsl
Sediment cleanout, top elevation (bottom of pond)
151.25'first
Sediment cleanout, bottom elevation
149.00 fmsl
Sediment storage provided
2.25 ft
Is there additionai volume stored above the state -required temp. pod?
N (Y or N)
Elevation of the top of the additional volume
fmsl
Form SW401-Wet Detention Basin -Rev .9 /18112 Paris I, a 11, Design Summary,
Page 27

Permit No.
(to be pd tied by DWD)
Surface Areas
Area, temporary pool
Area REQUIRED, permanent pool
SAIDA ratio
Area PROVIDED, permanent pool, A,,,,,_,,
Area, bottom of 1011 vegetated shelf, A.,,
Area, sediment cleanout, top elevation (bottom of pond), A�P�
Volumes
Volume, temporary pool
Volume, permanent pool, V.,,,
Volume, forebay (sum of forebays if more than one forebay)
Foregay %of permanent pod volume
SAIDA Table Data
Design TSS removal
Coastal SAIDA Table Used?
Mountan/Piedmont SAIDA Table Used?
SAIDA ratio
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 102b)
Volume, permanent pool, V,,,,,.
Area provided, permanent pi
Average depth calculated
Average depth used in SAIDA, d„, (Round to nearest 0.58)
Calculation option 2 used? (See Figure 102b)
Area provided, permanent pool, A,.
Area, bottom of 10ft vegetated shelf, A.
Area, sediment cleanoul, top elevation (bottom of pond), Ate. „b
'Depth' (distance b/w bottom of 10ft shelf and top of sediment)
Average depth calculated
Average depth used in SAIDA, d,,, (Round to down to nearest 0.5h)
Drawdown Calculations
Drawdown through orifice?
Diameter of odfice (if circular)
Area of odfice (f-noocircular)
Coefficient of discharge (Co)
Driving head (HU
Drawdovm through weir!
Weir type
Coefficient of discharge (C,)
Length of weir (L)
Driving head (H)
Pre -development 1-yr, 24hr peak flow
Post -development 1-yr, 24hr peak flow
Storage volume discharge rate (through discharge orifice or weir)
Storage volume draMoisn lime
Additional Information
Vegetated side slopes
Vegetated shelf slope
Vegetated shelf Wdth
Length of flowpath to width ratio
Length to width ratio
Trash rack for overflow 8 orifice?
Freeboard provided
Vegetated filter provided?
Recorded drainage easement provided?
Capures all mnoff at ultimate build -out?
Drain mechanism for maintenance or emegendes is:
3,309 fe
.1.80.(unidess)
8,915 fl OK
7,130,ft'
3,658'fl
26,538 ft' OK
26,538 ft'
5,343 ft'
20.1%% OK
N (Y or N)
Y (Y or N)
1,80 (unibess)
-N..__ .(Y or N)
26,538
8,915 h
3.98It OK
4.0It OK
Y (Y or N)
8,915 8?
7,130 fit'
3,658 e
1.75 ft
3.98 It
4.0 ft
Y (Y orN)
3.00 in
in'
3.00 (uni8ess)
0.21 It
N (Y or N)
(unidess)
ft
ft
ft'Isec
fl'Isec
ft'Isec
4.00 days
OK
OK
OK, draws dam in 2-5 days.
3 :1
OK
10:1
OK
10.0 It
OK
10 :1
OK
2.0 :1
OK
Y (Y or N)
OK
1.01t
OK
Y (Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
'POND WILL REQUIRE PUMPING
AUG 15 2014
I
I
I
I
- I
Form SW401-Wet Detention Basin-Re¢9-0lia/12 Pans I. E II. Design Summary,
Page 28

CONCRETE ANCHOR BOUANCY CALCULATION
Height of riser = 2.75 ft.
Width of riser = 4 ft.
Vol. of riser = 44 ft,
Wt. of H2O displaced = 2,746 Ib/ft'
Conc. pad thicknes = 8 in.
Conc. pad width/length = 8 ft.
Vol. of conc. pad = 42.67 ft'
Wt. of H2O displaced = 2,662 Ib/ft'
W. of H2O displaced = 5,408
Unit wt. of concrete = 150 lb/ft'
Wt. of conc. pad = 6,400 lb.
Factor of safety = wt. Conc. Pad
wt. Of H2O displaced
F.S.= 1.18
Anchor Size
L
ft.
W
ft.
D
in.
8
8
8
Page 29

PEMBROKE SENIOR VILLAGE
PEMBROKE, NORTH CAROLINA
EI' S ` ►° JIM
AUG 15 2014
V

Development Name: Pembroke Senior Village
I",MA *91i•Fei��
Wet Detention Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a log in a
known set location. Any deficient BMP elements noted in the inspections will be corrected, repaired
or replaced immediately. These deficiencies can affect the integrity of structures, safety of the
public, and the removal efficiency of the BMP.
The wet detention basin system is defined as a wet detention basin, pretreatment including
forebays and the vegetated filter is one is provided.
This system (check one):
❑ does ❑s does not incorporate a vegetated filter at the outlet.
This system (check one): AUG 1 5 2014
❑ does IN does not incorporate pretreatment other than a forebay.
Important operation and maintenance procedures:
— Immediately after the wet detention basin is established, the plants on the vegetated shelf
and perimeter of the basin should be watered twice weekly if needed, until the plants
become established (commonly six weeks).
— No portion of the wet detention pond should be fertilized after the first initial fertilization
that is required to establish the plants on the vegetated shelf.
— Stable groundcover should be maintained in the drainage area to reduce the sediment load
to the wet detention basin.
— If the basin must be drained for an emergency or to perform maintenance, the flushing of
sediment through the emergency drain should be minimized to the maximum extent
practical.
After the wet detention pond is established, it should be insepected once a month and within 24
hours after every storm event greater than 1.0 inches. 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 1 will remediate theproblem:
The entire BMP
rash debris is present
Remove the trash debris
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to remove
et detention basin
erosive gullies have formed.
the gullies, and then plant a ground
cover and water until it is established.
Provide lime and a one-time fertilizer
application.
Vegetation is too short or too
Maintain vegetation at a height of
lonapproximately
six inches.
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 1 of 4

BMP element:
Potentialproblems:
How I will remediate theproblem:
The inlet device: pipe
The pipe is clogged.
Unclog the pipe. Dispose of the
or Swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to
wale.
smooth it over and provide erosion
control devices such as reinforced turf
matting or riprap to avoid further
problems with erosion.
The forebay
Sediment has accumulated
Search for the source of the sediment
o a depth greater than the
and remedy the problem if possible.
original design depth for
Remove the sediment and dispose of it
sediment storage.
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
iprap if needed to prevent future
erosion problems.
Weeds are present.
Remove the weeds, preferably by hand.
If pesticide is used, wipe it on the
plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional
how that pruning is needed
ractices.
o maintain optimal plant
health.
Plants are dead or diseased
Determine the source of the problem:
or dying.
soils, hydrology, disease, etc. Remedy
he problem and replace plants.
Provide a one-time fertilizer
application to establish the ground
cover if a soil test indicates it is
necessary.
Weeds are present.
Remove the weeds, preferably by hand.
If pesticide is used, wipe it on the
plants rather than spraying.
The main treatment
Sediment has accumulated
Search for the source of the sediment
area
to a depth greater than the
and remedy the problem if possible.
original design depth for
Remove the sediment and dispose of it
sediment storage.
in a location where it will not cause
impacts to streams or the BMP.
Algal growth covers over
Consult a professional to remove and
50% of the area.
control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them with
invasive plants cover 50% of
pesticide (do not spray).
he basin surface.
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 2 of 4

MP element:—Potentialproblems:
Flow I will remediate theproblem:
The embankment
Shrubs have started to grow
lemove shrubs immediately.
n the embankment.
Evidence of muskrat, beaver,
lease consult a professional to remove
r rodent activity is present.
nuskrats, beaver, and rodents.
tree has started to grow on
onsult a dam safely specialist to
he embankment.
-emove the tree.
n annual inspection by an
Make all needed repairs.
appropriate professional
bows that the embankment
needs repair. if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of
he sediment off -site.
The outlet device is damaged.
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Repair and stabilize erosion at pond
damage have occurred at the
outlet. Ensure work does not encroach
outlet
into the 50 foot stream buffer (if
applicable). 'Please contact the City of
High Point Stormwater Division at 336-
83-3455 with any gfiestions.
The measuring device used to determine the sediment elevation shall be such that it will give an
accurate depth reading and readily penetrate into accumulated sediments.
When the permanent pool depth reads 151.25 feet in the main pond, the sediment shall be
removed.
When the permanent pool depth reads 151.75 feet in the forebay, the sediment shall be removed:'.
Basin Diagram AUG I5 Z01�'
(fill in the blanks)
Sediment Removal El
Permanent Pool Elevation 153.50
IPermanent Pool Volume
Sediment Removal Elevation 15125 Volume
151.75--------------------- -- —
1-ft. Min. Sediment Storage
1-ft. Min. Sediment Storage
Bottom Elevation 150.00
Bottom Elevation 149.00
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 3 of 4

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 the City of High Point Stormwater Division of
any problems with the system or prior to any changes to the system or responsible party.
Development Name: Lumbee Land Development
Print Nmmp• Bosco LOckiear
Title: Housing Director
Address: 6984 NC HWY 711 Pembroke, North Carolina 28372
Phom
Signa
Date:
Note: The legally responsible party should not be a homeowners association unless more than 50%
of�pts have been sold and a resident of the subdivision has been named the president.
he do hereby
ww /
certify that /Jo!;?o "r-41en — personally appeared before me this
1 day of G< 2-- / V . and acknowledge the due
execution of the forgoing bioretenttiio/n maintenance requirements. Witness my hand and official
seal, C?Ati1%y 42. � m�
(// // r
SEAL !/
My commission expires: d
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 4 of 4

Development Name:
BASIN # 1
Pembroke Senior Village
Wet Detention Basin Operation and Maintenance Agreement
1 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 inspections will be corrected, repaired
or replaced immediately. These deficiencies can affect the integrity of structures, safety of the
public, and the removal efficiency of the BMP.
The wet detention basin system is defined as a wet detention basin, pretreatment including
forebays and the vegetated filter is one is provided.
This system (check one):
❑ does 0 does not incorporate a vegetated filter at the outlet.
This system (check one): AUG 15 2014
❑ does ❑o does not incorporate pretreatment other than a forebay.
Important operation and maintenance procedures:
Immediately after the wet detention basin is established, the plants on the vegetated shelf
and perimeter of the basin should be watered twice weekly if needed, until the plants
become established (commonly six weeks).
No portion of the wet detention pond should be fertilized after the first initial fertilization
that is required to establish the plants on the vegetated shelf.
Stable groundcover should be maintained in the drainage area to reduce the sediment load
to the wet detention basin.
If the basin must be drained for an emergency or to perform maintenance, the flushing of
sediment through the emergency drain should be minimized to the maximum extent
practical.
After the wet detention pond is established, it should be insepected once a month and within 24
hours after every storm event greater than 1.0 inches. 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 1 will remediate theproblem:
The entire BMP
rash debris is present
Remove the trash debris
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to remove
et detention basin
erosive gullies have formed.
the gullies, and then plant a ground
over and water until it is established.
Provide lime and a one-time fertilizer
application.
egetation is too short or too
Maintain vegetation at a height of
long.
lapproximatelysix inches.
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 1 of 4

BMP element:
Potentialproblems:
How 1 will remediate theproblem:
The inlet device: pipe
The pipe is clogged.
Unclog the pipe. Dispose of the
or Swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to
wale.
smooth it over and provide erosion
control devices such as reinforced turf
matting or riprap to avoid further
problems with erosion.
The forebay
Sediment has accumulated
Search for the source of the sediment
o a depth greater than the
and remedy the problem if possible.
original design depth for
Remove the sediment and dispose of it
sediment storage.
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
iprap if needed to prevent future
erosion problems.
Weeds are present.
Remove the weeds, preferably by hand.
If pesticide is used, wipe it on the
plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional
show that pruning is needed
practices.
o maintain optimal plant
health.
Plants are dead or diseased
Determine the source of the problem:
or dying.
soils, hydrology, disease, etc. Remedy
he problem and replace plants.
Provide a one-time fertilizer
application to establish the ground
cover if a soil test indicates it is
necessary.
Weeds are present.
Remove the weeds, preferably by hand.
If pesticide is used, wipe it on the
plants rather than spraying.
The main treatment
Sediment has accumulated
Search for the source of the sediment
area
to a depth greater than the
original design depth for
and remedy the problem if possible.
Remove the sediment and dispose of it
sediment storage.
in a location where it will not cause
impacts to streams or the BMP.
Algal growth covers over
Consult a professional to remove and
50% of the area.
control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them with
invasive plants cover SO% of
pesticide (do not spray).
the basin surface.
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 2 of 4

MP element:—Potentialproblems:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
n the embankment.
Evidence of muskrat, beaver,
Please consult a professional to remove
r rodent activity is present.
muskrats, beaver, and rodents.
tree has started to grow on
Consult a dam safely specialist to
he embankment.
remove the tree.
n annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. if a licable
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of
he sediment off -site.
The outlet device is damaged.
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Repair and stabilize erosion at pond
amage have occurred at the
outlet. Ensure work does not encroach
utlet.
into the 50 foot stream buffer (if
applicable): Please contact the City of
High Point Stormwater Division at 336-
83-3455 with any questions.
The measuring device used to determine the sediment elevation shall be such that it will give an
accurate depth reading and readily penetrate into accumulated sediments.
When the permanent pool depth reads 151.25 feet in the main pond, the sediment shall be
removed.
When the permanent pool depth reads 151.75 feet in the forebay, the sediment shall be removed.
Basin Diagram
ill in the blanks) AUG 5 2014 `
Permanent Pool
151.75
Sediment Removal El. 1-ft. Min.
Bottom Elevation 150.00
Permanent Pool Elevation 153.50
Volume
Sediment Removal Elevation 151.25 Volume
- __-- -- -- /
Sediment Storage
1-ft. Min. Sediment Storage
Bottom Elevation 149.00
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 3 of 4

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 the City of High Point Stormwater Division of
any problems with the system or prior to any changes to the system or responsible party.
Development Name:
Lumbee Land Development
Print Name: Bosco Locklear
Title: Housing Director
Address: 6984 NC HWY 711 Pembroke, North Carolina 28372
Phom
Signa
Date:
Note: The legally responsible party should not be a homeowners association unless more than 50%
off the lots have been sold and a resident of the subdivision has been named the president.
1, I/LIUnvl 5 %,AWtror-nalS a Notary Public for the State of
no ✓ yal i.to County of Roixsrri, do hereby
certify th''a//t � 50� uekJ,90t-� personally appeared before me this
^T day of a v and acknowledge the due
execution of the forgoing bioretentio-n_m�amt�e aance requirements. Witness my hand and official
seal,
SEAL
My commission expires:
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
14' Page 4 of 4

High Density Residential Subdivisions
Deed Restrictions & Protective Covenances
In accordance with Title 15 NCAC 2H.1000 and S.L. 2006-246, the Stormwater Management Regulations,
deed restrictions and protective covenants are required for High Density Residential Subdivisions where
lots will be subdivided and sold and runoff will be treated in an engineered stormwater control facility. Deed
restrictions and protective covenants are necessary to ensure that the development maintains a "built -upon"
area consistent with the design criteria used to size the stormwater control facility.
I, Bosco Locklear , acknowledge, affirm and agree by my signature below, that I will cause the
following deed restrictions and covenants to be recorded prior to the sale of any lot:
1. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number as is sued by the'Division of Water Quality under the
Stormwater Management Regulations.
2. The State of North Carolina is made a beneficiary of these covenants to the extent n ecessary to
maintain compliance with the stormwater management permit.
3. These covenants are to run with the land and be binding on all persons a nd parties claiming under
them.
4. The covenants pertaining to stormw ater may not be altered or rescinded without the express written
consent of the State of North Carolina, Division of Water Quality.
5. Altcration,nf the drainage as shown on the approved plan may not take place without the concurrence
of the Division of Water Quality.
6.; The iriaximum allowable built -upon area is 444,312 (85%) square feet. This allotted
amount includes any built -upon area constructed within the lot property boundaries, and that portion of
the right-of-'ivay between the front lot line and the edge of the pavement. Built upon area includes, but is
:.,not limited,to, structures, asphalt, concrete, gravel, brick, stone; slate, coquina and parking areas, but
doe5'not'include raised, open wood decking, or the water surface of swimming pools.
OR, if the proposed built -upon areas per lot will vary, please REPLACE #6 above with the following:
6. The maximum built -upon area per lot, in square feet, is as listed below:
Lot # BUA Lot # BUA Lot # BUA Lot # BOA AUG 15 2014
This allotted amount includes any built -upon area constructed within the lot property boundaries, and
that portion of the right-of-way between the front lot line and the edge of the pavement. Built upon area
includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate, coquina and
parking areas, but does not include raised, open wood decking, or the water surface of swimming
pools.
7. Each lot will maintain a 30"foot wide vegetated buffer between all impervious areas and surface
waters.
**50 foot forprojects located in the 20 coastal counties.
8. All runoff from the built -upon areas on the lot must drain into the permitted system. This may be
accomplished through a variety of means including roof drain gutters w hich drain to the street, grading
the lot to drain toward the street, or grading perimeter swales to collect the lot runoff and directing them
into a component of the storm water collection system. Lots that will naturally drain into the system are
not required to provide these additional measures.
Form DRPC-3 Rev.2 05Nov2009 Page 1 of 2

High Density Residential Subdivisions
Deed Restrictions & Protective Covenances
Signature: Date:__
_, a Notary Public in the
Stateof '700-W [Offbtta County of 1Cob2S6TY -
do hereby certify thatSCn �CLr perso nally appeared
before me this the ILI day of _, 20 , and acknowledge,
jedue execution of the foregoing instrument. Witness my hand and official seal, , o
SEAL -
atur6l
Commission expires L dl `
Form DRPC-3 Rev.2 05Nov2009 Page 2 of 2

This certifies that PIN: 1416-01-001
has been verified; the legal description
therein matches the PIN and is free of any
delinquent ad valorem tax liens charged
tgoh;e be County �x Collector.
i� �rYt'il 9/5/08
ff sig ure Date tKG81QS3NIa)l18131
2008009234
ROBESON CO, NC FEE $20.00
STATE OF NC REAL ESTATE EM
$1497.00
INilD D a lccW !
09-05-20D8 02:20:42 PM
s VICKI L LOCKLEAR
S cDD]lice W Dcum
® BY: FRANKIE BRITT
A9lISSM
BK:D 1687
PG:157-159
PIN: jL4 Ao "-0) - 0-tb I Revenue Stamps:$1,497.00
Mail after recording to: Locklear, Jacobs & Hunt, P.O. Box 999, Pembroke, NC 28372
THIS INSTRUMENT WAS PREPARED BY ATTORNEY ARLIE JACOBS/smh
NORTH CAROLINA GENERAL WARRANTY DEED AUG 1 5 2014
ROBESON COUNTY
THIS DEED, made this the 24* day of July, 2008 by and between Pates Supply Company, Inc., hereinafter
termed "Grantor'; and Venture Properties Group, LLC whose address is PO Box 1359, Pembroke, NC 28372
hereinafter termed "Grantee."
WITNESSETH:
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns,
and shall include singular, plural, masculine, feminine or neuter as required by context.
That the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged,
has and by these presents does grant, bargain, sell and convey unto the Grantee, in the manner and form as described
below, all that certain lot or parcel of land situated in Pembroke Township, Robeson County, North Carolina, and more
particularly described as follows:
All that certain tract or parcel of land lying about l '/4 miles southeast of the center of Pembroke, NC, adjacent to
and on the northwest side of SR 1553, Candy Park Road, about 0.3 miles southwest of NC Highway 711, adjacent
to and on the southeast side of SR 1583, Jaycee Hut Road and adjoining the lands of Ruth Dial Woods (561/528),
Allen Griffin Dial (561/531), Grover Oxendine (506/49), Marvin Oxendine (890/101), Welton Jacobs, Sr. (18�7/49
and 17-D/189), Willette F. Carter (1589/126), Gary B. Sampson (16-K/568), Geneva Locklear (1085/306), Ruby
Neal Hunt (494/111), Terry Dale Pate (13-R/428), June L. Sampson (413/100), Thedis Wilkins (17-B/232), Ruby
Carter (15-C/390), Patricia Lowery (737/350), Bernice D. Reimer (492/313), Daisy Locklear (16-Q/35), Wade C.
Hunt (16-D/251) on the northeast, Dwayne Locklear (838/613), Wade C. Hunt (632/465), Jaycees of Pembroke, Inc.
(17-11/134), Armando L. Matos (477/193), Simeon Sampson (764/239), Cathy Marie Lowery (733/917), Ricky
Ransom (433/66), Della R. Brewer and Ricky Ransom (821/586), Malcolm Keith Long (8211113), Ellen Chavis
(810/74), Jeffery Leon Oxendine (1460/406), Joyce Chavis (1527/817), Susan Baker Locklear (17-Z/211), Mary Jane
Scott Locklear (1444/754), Mark A. Scott (768/581), Chester Chavis (1636/01) and Jefffery, Kendall Brooks (454/44)
on the southwest and being more particularly described as follows:
BEGINNING at a mag nail set in the center of SR 1583, Jaycee Hut Road, the north corner of Dwayne Locklear
(838/613), having NC Grid Coordinates, N=334,169.372 and E=1,942,974.74, (NAD 83, from GPS Observation,
horizontal distance) and runs thence from said beginning mag nail near the center of but southeast of SR 1583,

J
Jaycee Hut Road and beyond, North 57 degrees 31 minutes 24 seconds East 837.30 feet to a concrete monument
found, said concrete monument having NC Grid Coordinates N=334,618.961 and E=1,943,680.820 (NC Grid
Coordinates, NAD 83, from GPS Observation, horizontal distance); thence with the southwest line of Ruth Dial
Woods (561/528), South 41 degrees 06 minutes 58 seconds East 321.41 feet to a concrete monument found, having
NC Grid Coordinates N=334,376.920 and E=1,943,892.178; thence with the southwest line of Allen Griffin Dial
(561/531), South 40 degrees 57 minutes 30 seconds East 500.44 feet to a concrete monument found, a corner with
Dial and Grover 'Oxendine 9506/49); thence with Oxendine's southwest line South 40 degrees 57 minutes 38
seconds East 747.90 feet to a concrete monument found; thence continuing with Oxendine's southeast line North 50
degrees 42 minutes 22 seconds East 231.0 feet to a concrete monument found, a corner with said Oxendine and
Marvin Oxendine (890/101); thence with Marvin Oxendine's southwest line South 48 degrees 45 minutes 02
seconds East 212.71 feet to a concrete monument found, a corner with Oxendine and Welton Jacobs, Sr. (18-J/49);
thence to and with a ditch South 46 degrees 57 minutes 48 seconds East 1396.32 feet to a iron pipe found in said
ditch; thence continuing with said ditch and beyond South 47 degrees 16 minutes 26 seconds East 139.11 feet to a
pk nail found in the center of SR 1553, Candy Park Road, at its intersection with said ditch (this pk nail being
located South 41 degrees 19 minutes 34 seconds West 1672.21 feet from a nail and cap found in the intersection of
SR 1553 with NC highway 711); thence from said pk nail with the center of SR 1553, Candy Park Road, South 41
degrees 20 minutes 34 seconds West 1509.69 feet to a nail and cap found in the center of SR 1553, Candy Park
Road at its intersection with a ditch, if extended; thence with said ditch, North 36 degrees 58 minutes 48 seconds
West 515.66 feet to a iron rod set in said ditch; thence continuing with the center of said ditch North 37 degrees 39
minutes 03 seconds West 232.24 feet to a iron rod set in said ditch; thence continuing with said ditch North 37
degrees 11 minutes 19 seconds West 473.51 feet to a iron rod set in said ditch; thence continuing with said ditch
North 38 degrees 09 minutes 54 seconds West 322.08 feet to a iron rod set in said ditch; thence continuing with said
ditch North 37 degrees 51 minutes 39 seconds West 641.72 feet to a iron rod set at a bend in said ditch; thence with
the northeast line of the Jaycees of Pembroke, Inc. (17-11/134), North 39 degrees 31 minutes 39 seconds West
1131.54 feet to a iron pipe found, a corner with said Jaycees and Wade C. Hunt (632/456); thence with Hunt's
northeast line, North 39 degrees 57 minutes 34 seconds West 124.17 feet to a iron pipe found, a corner with
Dwayne Locklear (838/613); thence with Locklear's southeast line North 58 degrees 19 minutes 18 seconds East
208.80 feet to a iron rod set, Locklear's east corner; thence with Locklear's northeast line North 39 degrees 24
minutes 37 seconds West passing through a iron pipe found at 208.75 feet continuing for a total distance of 253.12
feet to the beginning containing 10136 acres, less 1.57 acres in the right of ways of SR 1553 and SR 1583, leaving a
net of 99.79 acres more or less.
And being all or part of those certain lands conveyed by D.H. Harris and wife Sarah Jane Hareris to Pates Supply
Company, Incorporated by deed dated 31 October 1944 and recorded in Deed Book 9-R, page 625, Robeson
County Registry.
Bearings referenced to NC Grid, NAD 83, from GPS Observation, horizontal distance.
This is a survey of existing parcel or parcels of land.
The seller shall be responsible for the 2008 county taxes.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto
belonging to Grantee in the following manner: FORK
And the Grantors covenant with the Grantees, that Grantors are seized of the premises in fee simple, have the
right to convey the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantors
will warrant and defend the title against the lawful claims of all persons whomsoever.
Title to the property hereinafter described is conveyed subject to the following exceptions:
1. All such easements and restrictions that might appear of record or view of the site.

WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this
instrument to be signed in its corporate name by its duly authorized officers and its seal to be hereunto affixed by
authority of its Board of Directors, the day and year first above written.
P7AS SUPPLYPA S SUPPLY OMPANY, INC.
--,-4SEAL}
. Livermore, III/President
NORTH CAROLINA
ROBESON COUNTY
1, JgjLtjNotary Public, do hereby certify that R. H. Livermore, III came before me this day and
acknowledged that be is President of Pates Supply Company, Inc., and that he, as President being authorized to do so,
executed the foregoing on the behalf of the corporation.
WITNESS my hagd and seal this `ogthday of ClactU4, 2008.
%(1
• ` ''.0 '
My Commission EtUirep &C8
��Notary Public

PEMBROKE SENIOR VILLAGE
ROBESON COUNTY, NORTH CAROLINA
WET POND #1
APR 2 2 2014

Permit No.
(to be provided by DWQ)
® �
1a
o2oF WATgS,
NCDENR
o Y
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted along with all of the required information.
j I PEMBROKE SENIOR VILLAGE y,.'J Pro ect name �, ?;.� , .. "....
Contact person I ` 'I"� Y" JUAN Ai BLUE 1 'c'J
Phone number 1704-578 0737 , i
Date 117-Apr-14 .;nt r ..a,:"ip1? i ;�lul t
Drainage area number j2 ; , �.. �� tr',.
n l
11.1 DESIGNII NF.ORMATION
Site Characteristics
Drainage area
Impervious area, post -development
%impervious
Design rainfall depth
Storage Volume: Non-SAWaters
Minimum volume required
Volume provided
Storage Volume: SAWaters
1.5' runoff volume
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Minimum volume required
Volume provided
Peak Flow Calculations
Is the pre/post control of the lyr 24hr storm peak Flow required?
1-yr, 24-hr rainfall depth
Rational C, pre -development
Rational C, post -development
Rainfall intensity: 1-yr, 24-hrstorm
Pre -development 1-yr, 24-hr peak Flow
Post -development 1-yr, 24-hr peak flow
Pre/Post 1-yr, 24-hr peak flow control
Elevations
Temporary pool elevation
Permanent pool elevation
SHWT elevation (approx. at the perm. pool elevation)
Top of 1Off vegetated shelf elevation
Bottom of 1 Oft vegetated shelf elevation
Sediment cleanout, top elevation (bottom of pond)
Sediment deanout, bottom elevation
Sediment storage provided
Is there additional volume stored above the state -required temp. pool?
Elevation of the top of the additional volume
162,914 f?
88;434', ft
54.28 %
67r in
1`77'.'i,"''c 7,213. n'
24,3941 ft'
OK, volume provided is equal to or in excess of volume required.
.',I.
I Ift'
IIr'w:i •'.d'.:Ift'
ft3
to
(•^''N (Y or N)
'0.30:(unitless)
I 0.65 (unibess)
I•' 102 in/hr OK
3.38 ft'Isec
6.76 ft'Isec
3.38 ft'/sec
I 154.73 fmsl
153.50 fmsl
h' 154.00 fmsl
., 153.50 fmsl
I 152.50 fmsl Data not needed for cmculabon option #1, but OK if provided.
I. r •r - 151.25 fmsl
I 0.00 fmsl Data not needed for calmlation option #1, but OK if provided.
151.25 it
-N ,.(Y or N)
!fmsl
Form SW401-Wet Detention Basin-Rev.g /18/12 Parts 1. a 11. Design Summary, Page 1 of 2

Permit No.
(to be provided by DWQ)
I01DESIGNII N F,ORMATION
Surface Areas
Area, temporary pool
Area REQUIRED, permanent pool
SAIDA ratio
Area PROVIDED, permanent pool, %,,,-pw
Area, bottom of 1 Oft vegetated shelf, Al .epn
Area, sediment cleanout, top elevation (bottom of pond), 6,_„a
Volumes
Volume, temporary pool
Volume, permanent pool, V,,,, pw
Volume, forebay (sum of forebays if more than one forebay)
Forebay %of permanent pool volume
SAIDA Table Data
Design TSS removal
Coastal SAIDA Table Used?
Mountain/Piedmont SAIDA Table Used?
SAIDA ratio
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 10-2b)
Volume, permanent pool,m�d
Area provided, permanent pool, P*,,,_,,
Average depth calculated
Average depth used in SAIDA, ¢., (Round to nearest 0.5ft)
Calculation option 2 used? (See Figure 10-2b)
Area provided, permanent pool, Fd,p,.
Area, bottom of 1 Oft vegetated shelf, lip, men
Area, sediment cleanout, tap elevation (bottom of pond), 4,.,
"Depth" (distance bfw bottom of 10ft shelf and top of sediment)
Average depth calculated
Average depth used in SAIDA, 4„ (Round to down to nearest 0 5ft)
Drawdown Calculations
Drawdown through orifice?
Diameter of orifice (if circular)
Area of orifice (if-non-dreular)
Coefficient of discharge (Co)
Driving head (K)
DrawdDwn through weir?
Weir type
Coefficient of discharge (C„)
Length of weir (L)
Driving head (H)
Pre -development 1-yr, 24-hr peak Flow
Post -development 1-yr, 24-hr peak Flow
Storage volume discharge rate (through discharge orifice or weir)
Storage volume dmwdown time
Additional Information
Vegetated side slopes
Vegetated shelf slope
Vegetated shelf width
Length of flowpath to width ratio
Length to width ratio
Trash rack for overflow & orifice?
Freeboard provided
Vegetated filler provided?
Recorded drainage easement provided?
Capures all runoff at ultimate build -out?
Drain mechanism for maintenance or emergencies is:
,7,213, He
3,405 fe
12.09, (uni0ess)
4,74Sfr OK
OK
Insufficient forebay volume.
k N• :1 (Y or N)
g t,. •ri, N jjAqj(Y or N)
2.09 funidem
.r:,g;,;;;.YC, '(Y or N)
15,410 it'
4,743 fr
( 3.25',ft OK
:,3.0;1 OK
4,743
3,859 ft
2,009 fe
1.25 it
h ,att
Y: , I(Y or N)
•i ':1.3.00 in
t in'
.0.60. (unitles:
:1.23 ft
�s.,•: N,... I(Yor N)
Broad I(unides:
3 1(unitles:
.. 5 `..:Ift
0.2 '` [it
. 3.38. ft'/sec
,..6.76 ft'/spc
days OK, draws down in 2-5 days.
' .;. 3':1
OK
-10:1
OK
". 10.:1
OK
;.2.0:1
OK
'Y, ;.' I(Y or N)
OK
" 10,,I1t
OK
Y 1(Yor N)
OK
Y l(Yor N)
OK
Y1(Y or N)
OK
Form SW401-Wet Detention Basin -Rev 9</18112 Parts I. & 11, Design Summary, Page 2 of 2

Permit
(to be provided 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.
Page/ Plan
Initials Sheet No.
1. Plans (i" - 50' or larger) of the entire site showing:
Design at ultimate build -out,
Off -site drainage (if applicable),
Delineated drainage basins (include Rational C coefficient per basin),
Basin dimensions,
Pretreatment system,
High flow bypass system,
Maintenance access,
Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
2. Partial plan (1"= 30' or larger) and details for the wet detention basin showing: -
- Outlet structure with trash rack or similar,
- Maintenance access,
- Permanent pool dimensions,
- Forebay and main pond with hardened emergency spillway,
- Basin cross-section,
- Vegetation specification for planting shelf, and
- Filter strip. APR 2 2 2014
aL
3. Section view of the wet detention basin (1" = 20' or larger) showing:
- Side slopes, 3:1 or lower,
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
4. If the basin is used for sediment and erosion control during construction, clean out of the basin is specified
on the plans prior to use as a wet detention basin.
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for forebay,
to verify volume provided.
A
6. A construction sequence that shows how the wet detention basin will be protected from sediment until the
entire drainage area is stabilized.
7. The supporting calculations.
8. A copy of the signed and notarized operation and maintenance (08M) agreement.
9. A the deed
copy of restrictions (if required).
10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. County
soil maps are not an acceptable source of soils information.
Form SW401-Wet Detention Basin-Rev.9-4/18/12 Part III. Required Items Checklist, Page 1 of 1

PEMBROKE SENIOR VILLAGE
ROBESON COUNTY, NORTH CAROLINA
WET POND #2

Permit No.
fie be faev wby D4V0)
®��
�2op W A 7F9
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted along with all of the required information.
Project name
1 -'"'!' ! 411 !`""It 7"u;P.EMBROKE
SENIOR VILLAGE „^=krt t'",wk"Ix:%n
Contact person
!:
r JUAN A: BLUE'.
Phone number
1704-5760737 ,,,,1"
Date
117-Apr-14
Drainage area number
12,,.:::
Site Characteristics
Drainage area
Impervious area, post -development
%impervious
Design rainfall depth
Storage Volume: Non -SA Waters
Minimum volume required
Volume provided
Storage Volume: SA Waters
1.5' runoff volume
Pre -development 1-yr, 24-hr mnoff
Post -development 1-yr, 24-hr runoff
Minimum volume required
Volume provided
Peak Flow Calculations
Is the prelpost control of the lyr 24hr storm peak flow required?
1-yr, 24-hr rainfall depth
Rational C, pre -development
Rational C, post -development
Rainfall intensity: 1-yr, 24-hr storm
Pre -development 1-yr, 24-hr peak flow
Post -development l-yr, 24-hr peak flow
Pre/Post 1-yr, 24-hr peak flow control
Elevations
Temporary pool elevation
Permanent pool elevation
SHWT elevation (approx. at the perm. pool elevation)
Top of 10n vegetated shelf elevation
Bottom of 10n vegetated shelf elevation
Sediment cleanout, top elevation (bottom of pond)
Sediment cleanout, bottom elevation
Sediment storage provided
Is there additional volume stored above the state -required temp. pool?
Elevation of the top of the additional volume
152,460 e
61,532 ft'
40,36 %
1.•:- .:6.7, in
f l n'
25,199 ft'
I OK, volume provided is equal to or in excess of volume required.
F-77—F-71 (Y or N)
1 3.0', In
I 0.30, (unifless)
0.65'(unitless)
1 3.02 in/hr OK
3.39 n'Isec
6.76 n3lsec
3.37 n3lsec
154.15 fmsl
+453.50 fmsl
154.00 first
154.00 fmsl
I .. 153.50 fmsl Data not needed for calculation option #1, but OK if provided.
151.25 fmsl
'149.00 fmsl Data not needed for calculation option #1, but OK if provided.
2.25 If
,,,.. N`', ,',ia(Y or N)
I.,L ='Ifmsl
Fonn SW401-Wet Detention Basin-Rev.9-0118112 Parts 1. & 11. Design Summary, Page 1 or 2

Permit No.
(to be oaavdetl by DIO)
II IDES IGNI IN FORMATION
Surface Areas
Area, temporary pool
F
'„-' 7,215, f?
Area REQUIRED, permanent pool
2,927 fl"
SAIDA ratio
b.;:_s' -;a
kt 1.92 (unifless)
Area PROVIDED, permanent pool, yf -_rae
',,,.; ,,;�.,; 7;130,ft` OK
Area, bottom of 10ft vegetated shelf, A,-y,d,
Area, sediment cleanout top elevation (bottom of pond), @,
(:` .' -"
i'I 5,89!i
Volumes
Volume, temporary pool
r. ,r
1., 29,691tfe Insufficient. Volume does not agree with data previously entered.
Volume, permanent pool, V..,-
'1
j._ 25,199 n`
Volume, forebay (sum of forebays if more than one forebay)
a i";`:,,';;�.5,243,
fts
Forebay %of permanent pool volume
20.8% % OK
SAIDA Table Data
Design TSS removal
�C',<:_' 855 %
Coastal SAIDA Table Used?
h!..I(Yor N)
MountainlPiedmont SAIDA Table Used?
I';:"'"';:^.'N;i. ?,A(Y or N)
SAIDA ratio
1.92 (unittess)
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 10-2b)
'at•I'."'. Yk'.' :. (Y or N)
Volume, permanent pool, \4,,,_�u
25,199 ft'
Area provided, permanent pool, Fri,,,,
7,130 111
Average depth calculated
h" 3.53 It
OK
Average depth used in SAIDA, 4,(Round to nearest 0.5ft)
„3,51ft
OK
Calculation option 2 used? (See Figure 10-2b)
I ^:' N 1,. '(I (Y or N)
Area provided, permanent pool, P*.aom
7,130 ft`
Area, bottom of 10ft vegetated shelf, Aa u,w
3,859 fe
Area, sediment cleanoul. top elevation (bottom of pond), 4,.m
5,895 fe
'Depth' (distance blw bottom of 1 Oft shelf and top of sediment)
2.25 It
Average depth calculated
{::'"' ..M' •'3.40 It
OK
Average depth used in SAIDA, (k, (Round to down to nearest 0.5ft)
{ ' 3.5' It
OK
Drawdown Calculations
Drawdown through orifice?
F , Y '-�; (Y or N)
Diameter of orifice (it circular)
{;; .: : , 3.00 in
Area of entice (if -non -circular)
I '". Iin'
Coefficient of discharge (CO)
[::. . 3.00. (umOess)
Driving head (H,)
Est"• ...,; ( 0.65 ft
Drawdown through weir?
I',. N''-.' 1(Y or N)
Weir type
I Broad 1(unitess)
Coefficient of discharge (C,.)
)Ul ;:' ." .3 i a , 4" 1(unitless)
Length of weir(L)
F'--12 —,Ift
Driving head (H)
b e... 02,=. n rift
Pre -development 1-yr, 24-hr peak flow
3.39 ft'/sec
Post -development 1-yr, 24-hr peak flow
6:76. ft'/sec
Storage volume discharge rate (through discharge orifice orweir)
�,?>`-_'�.; - .','�' 2174 ftllsec
Storage volume drawdown time
� {. : .,.q.00� days
OK, draws down in 2-5 days.
Additional Information
Vegetated side slopes
."3n;:1
OK
Vegetated shelf slope
IidL`, •,..,, _, .10':1
OK
Vegetated shelf width
10.0 ft
OK
Length of Oowpath to width ratio
I ,.... ' <. r 10.:1
OK
Length to width ratio
Iw,.,`' ��"`i,2.O,:l
OK
Trash rack for overflow 8 orifice?
I Y I(Y or N)
OK
Freeboard provided
I .�.10;ft
OK
Vegetated filter provided?
N `i, :' I(Y or N)
Insufficient. Vegetated filler required.
Recorded drainage easement provided?
I. '. IN I (Y or N)
Insufficient. Recorded drainage easement required.
Capures all runoff at ultimate build -out?
I., Y '' I (Y or N)
OK
Drain mechanism for maintenance or emergencies is:
!8 INCH PONDORAIN WITH SLUICE GATE ATTACHE0.T0 RAISER77'
Fonn SW401-Wet Detention Basin -Rev -111 B/12 Pans I. & 11, Design Summary, Page 2 of 2

Development Name:
Pembroke Senior Village
Wet Detention Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a log in a
known set location. Any deficient BMP elements noted in the inspections will be corrected, repaired
or replaced immediately. These deficiencies can affect the integrity of structures, safety of the
public, and the removal efficiency of the BMP.
The wet detention basin system is defined as a wet detention basin, pretreatment including
forebays and the vegetated filter is one is provided.
This system (check one):
❑ does ❑® does not incorporate a vegetated filter at the outlet.
This system (check one):
❑ does ❑e does not incorporate pretreatment other than a forebay.
Important operation and maintenance procedures:
— Immediately after the wet detention basin is established, the plants on the vegetated shelf
and perimeter of the basin should be watered twice weekly if needed, until the plants
become established (commonly six weeks).
— No portion of the wet detention pond should be fertilized after the first initial fertilization
that is required to establish the plants on the vegetated shelf.
— Stable groundcover should be maintained in the drainage area to reduce the sediment load
to the wet detention basin.
— If the basin must be drained for an emergency or to perform maintenance, the flushing of
sediment through the emergency drain should be minimized to the maximum extent
practical.
After the wet detention pond is established, it should be insepected once a month and within 24
hours after every storm event greater than 1.0 inches. 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
rash debris is present
Remove the trash debris
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to remove
et detention basin
erosive gullies have formed.
the gullies, and then plant a ground
over and water until it is established.
Provide lime and a one-time fertilizer
application.
Vegetation is too short or too
Maintain vegetation at a height of
Ilong.
japproximatelysix inches.
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Pagel of 4

0'
BMP element:
Potentialproblems:
How I will remediate theproblem:
The inlet device: pipe
The pipe is clogged.
Unclog the pipe. Dispose of the
or Swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to
wale.
smooth it over and provide erosion
control devices such as reinforced turf
matting or riprap to avoid further
problems with erosion.
The forebay
Sediment has accumulated
Search for the source of the sediment
o a depth greater than the
and remedy the problem if possible.
original design depth for
Remove the sediment and dispose of it
sediment storage.
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
iprap if needed to prevent future
erosion problems.
Weeds are present.
Remove the weeds, preferably by hand.
If pesticide is used, wipe it on the
plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional
how that pruning is needed
practices.
o maintain optimal plant
health.
Plants are dead or diseased
Determine the source of the problem:
or dying.
soils, hydrology, disease, etc. Remedy
he problem and replace plants.
Provide a one-time fertilizer
application to establish the ground
cover if a soil test indicates it is
necessary.
Weeds are present
Remove the weeds, preferably by hand.
If pesticide is used, wipe it on the
plants rather than spraying.
The main treatment
Sediment has accumulated
Search for the source of the sediment
area
to a depth greater than the
original design depth for
and remedy the problem if possible.
Remove the sediment and dispose of it
sediment storage.
in a location where it will not cause
impacts to streams or the BMP.
Algal growth covers over
Consult a professional to remove and
50% of the area.
control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them with
invasive plants cover 50% of
esticide (do not spray).
he basin surface.
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 2 of 4

MP element:—Potentialproblems:
How 1 will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
n the embankment.
Evidence of muskrat, beaver,
Please consult a professional to remove
r rodent activity is present.
muskrats, beaver, and rodents.
tree has started to grow on
Consult a dam safely specialist to
he embankment.
remove the tree.
n annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of
he sediment off -site.
The outlet device is damaged.
Repair or replace the outlet devi&
The receiving water
Erosion or other signs of
lepair and stabilize erosion at pond
damage have occurred at the
utlet. Ensure work does not encroach
outlet.
nto the 50 foot stream buffer (if
pplicable). Please'eonfact the City of."
igh Point Stormwater Division at 336-
83-3455 with any clu 'iions. V
The measuring device used to determine,the sediment elevation shall be such that it will give an,
accurate depth reading and readily penetrate into accumulated sediments.
When the permanent pool depth reads 151.25 feet in the main pond, the sediment shall be
removed.
When the permanent pool depth reads 151.75 feet in the forebay, the sediment shall be removed.
Basin Diagram `I '
ill in the blanks) "
Permanent Pool
151.75
Sediment Removal El. 1-11. Min.
Bottom Elevation 150.00
Permanent Pool Elevation 153.50
Volume
Sediment Removal Elevation 151.25
Sediment Storage
1-ft. M
Bottom Elevation 149.00
Volume
in. Sediment Storage
Operation and Maintenance Agreement adopted from NCDENR, Division of Water quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 3 of 4

I acknowledge and agree by my signature below that 1 am responsible for the performance of the
maintenance procedures listed above. I agree to notify the City of High Point Stormwater Division of
any problems with the system or prior to any changes to the system or responsible party.
Development Name: Lumbee Land Development
Print Name: Bosco Locklear
Title: Housing Director
Address: 6984 NC HWY 711 Pembroke, North Carolina 28372
Phone: [phone] z
Signature:
Date: i —/ / —
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, 414) a'r NAel% a Notary Public for the State of
N �6 [wre fart Countyof AIAso- do hereby
certify that Pwsca 4"Icaz personally appeared before me this
day of 44,-d Zolq and acknowledge the due
execution of the forgoing bioretention maintenance requirements. Witness my hand and official
seal,
4V a TAR),
MY commission 0
A Expires
O 11/11/2018 U
VBIIG
0,y2
'_ , "i"-i't
My commission expires: // At Lair
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 4 of 4

Development Name:
Pembroke Senior Village
Wet Detention Basin Operation and Maintenance Agreement
1 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 inspections will be corrected, repaired
or replaced immediately. These deficiencies can affect the integrity of structures, safety of the
public, and the removal efficiency of the BMP.
The wet detention basin system is defined as a wet detention basin, pretreatment including
forebays and the vegetated filter is one is provided.
This system (check one):
❑ does 0 does not incorporate a vegetated filter at the outlet
This system (check one):
❑ does 0 does not incorporate pretreatment other than a forebay.
Important operation and maintenance procedures:
— Immediately after the wet detention basin is established, the plants on the vegetated shelf
and perimeter of the basin should be watered twice weekly if needed, until the plants
become established (commonly six weeks).
— No portion of the wet detention pond should be fertilized after the first initial fertilization
that is required to establish the plants on the vegetated shelf.
— Stable groundcover should be maintained in the drainage area to reduce the sediment load
to the wet detention basin.
— If the basin must be drained for an emergency or to perform maintenance, the flushing of
sediment through the emergency drain should be minimized to the maximum extent
practical.
After the wet detention pond is established, it should be insepected once a month and within 24
hours after every storm event greater than 1.0 inches. 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 1 will remediate theproblem:
The entire BMP
rash debris is present
Remove the trash debris
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to remove
et detention basin
erosive gullies have formed.
the gullies, and then plant a ground
cover and water until it is established.
Provide lime and a one-time fertilizer
application.
Vegetation is too short or too
Maintain vegetation at a height of
lonlapproximately
six inches.
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 1 of 4

e N
MP element:
Potentialproblems:
How 1 will remediate theproblem:
The inlet device: pipe
The pipe is clogged.
Unclog the pipe. Dispose of the
or Swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the Swale if necessary to
wale.
smooth it over and provide erosion
control devices such as reinforced turf
matting or riprap to avoid further
problems with erosion.
The forebay
Sediment has accumulated
Search for the source of the sediment
to a depth greater than the
and remedy the problem if possible.
original design depth for
Remove the sediment and dispose of it
sediment storage.
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
iprap if needed to prevent future
erosion problems.
Weeds are present.
Remove the weeds, preferably by hand.
If pesticide is used, wipe it on the
plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional
how that pruning is needed
practices.
o maintain optimal plant
health.
Plants are dead or diseased
Determine the source of the problem:
or dying.
soils, hydrology, disease, etc. Remedy
he problem and replace plants.
Provide a one-time fertilizer
application to establish the ground
cover if a soil test indicates it is
necessary.
Weeds are present.
Remove the weeds, preferably by hand.
If pesticide is used, wipe it on the
plants rather than spraying.
The main treatment
Sediment has accumulated
Search for the source of the sediment
area
to a depth greater than the
original design depth for
and remedy the problem if possible.
Remove the sediment and dispose of it
sediment storage.
in a location where it will not cause
impacts to streams or the BMP.
Algal growth covers over
Consult a professional to remove and
50% of the area.
control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them with
invasive plants cover 50% of
pesticide (do not spray).
he basin surface.
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 2 of 4

MP element:—Potentialproblems:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
n the embankment.
Evidence of muskrat, beaver,
Please consult a professional to remove
r rodent activity is present.
muskrats, beaver, and rodents,
tree has started to grow on
Consult a dam safely specialist to
he embankment.
remove the tree.
n annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair.(if applicable)
The outlet device
Clogging has occurred.
lean out the outlet device: Dispose of
he sediment off -site.
The outlet device is damaged.
lepair or replace the outlet device.
The receiving water
Erosion or other signs of
epair and stabilize erosion at pond
damage have occurred at the
utlet. Ensure work does not encroach
outlet.
nto the 50 foot stream buffer (if
pplicable). Pleasecontactthe City 6f
High Point Stormwater Division at 336;
83-3455 with an uestions.
The measuring device used to determine'the sediment elevation shall be such that it will give an'
accurate depth reading and readily penetrate into accumulated sediments.
When the permanent pool depth reads 151.25 feet in the main pond, the sediment shall be
removed.
When the permanent pool depth reads 151.75 feet in the forebay, the sediment shall be removed.
Basin Diagram
(fill in the blanks)
Permanent Pool Elevation 153.50
Permanent Pool Volume
Sediment Removal Elevation 15125 Volume/
Sediment Removal El.
151.75--------------------- -- --
Min. ediment Storage
1-11. Min. Sediment Storage
Bottom Elevation 150.00
Bottom Elevation 149.00
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 3 of 4

I acknowledge and agree by my signature below that 1 am responsible for the performance of the
maintenance procedures listed above. I agree to notify the City of High Point Stormwater Division of
any problems with the system or prior to any changes to the system or responsible party.
Development Name: Lumbee Land Development
Print Name: Bosco Locklear
Title: Housing Director
Address: 6984 NC HWY 711 Pembroke, North Carolina 28372
Phoni
Signa
Date:
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, 44! %4r- lip*. a Notary Public for the State of
Aj.-A ( I'",L County of )&Lr�-' . do hereby
certify that R—gyro &CA/ personally appeared before me this.
AN day of J np it ?ui&/ . and acknowledge the due
execution of the forgoing bioretention maintenance requirements. Witness my hand and official
seal,
yS NOrARyy9
My c"mission
Expir*s
11/17/2018 V
O �/BLIG J=�
°�C
SEAL
My commission expires: ll.b,116
Operation and Maintenance Agreement adopted from NCDENR, Division of Water Quality, Stormwater
Best management Practices Manual, July 2007, Revised June 2009.
Page 4 of 4

High Density Residential Subdivisions
Deed Restrictions & Protective Covenances
In accordance with Title 15 NCAC 2H.1000 and S.L. 2006-246, the Stormwater Management Regulations,
deed restrictions and protective covenants are required for High Density Residential Subdivisions where
lots will be subdivided and sold and runoff will be treated in an engineered stormwater control facility. Deed
restrictions and protective covenants are necessary to ensure that the development maintains a "built -upon"
area consistent with the design criteria used to size the stormwater control facility
I, Bosco Locklear , acknowledge, affirm and agree by my signature below, that I will cause the
following deed restrictions and covenants to be recorded prior to the sale of any lot:
1. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number as issued by the Division of Water Quality under the
Stormwater Management Regulations.
2. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to
maintain compliance with the stormwater management permit.
3. These covenants are to run with the land and be binding on all persons and parties claiming under
them. '
4. The covenants pertaining to stormwater may not be altered or rescinded without the express written
consent of the State of North Carolina, Division of Water Quality.
5. Alteration of the drainage as shown on the approved plan may not take place without the concurrence
of the Division of Water Quality.
6. The maximum allowable built -upon area is 444,312 (85%) square feet. This allotted
amount includes any built -upon area constructed within the lot property boundaries, and that portion of
the right-of-way between the front lot line and the edge of the pavement. Built upon area includes, but is
not limited to; structures,. asphalt, concrete, gravel, brick, stone, slate, coquina and parking areas, but
does not include raised„ open wood decking, or the water surface of swimming pools.
OR, if the proposed ;built -upon areas per lot will vary, please REPLACE #6 above with the following:
6. The maximum built -upon area per lot, in square feet, is as listed below:
Lot # BUA Lot # BUA Lot # BUA Lot # BUA
This allotted amount includes any built -upon area constructed within the lot property boundaries, and
that portion of the right-of-way between the front lot line and the edge of the pavement. Built upon area
includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate, coquina and
parking areas, but does not include raised, open wood decking, or the water surface of swimming
pools.
Each lot will maintain a 30** foot wide vegetated buffer between all impervious areas and surface
waters.
**50 foot for projects located in the 20 coastal counties.
8. All runoff from the built -upon areas on the lot must drain into the permitted system. This may be
accomplished through a variety of means including roof drain gutters which drain to the street, grading
the lot to drain toward the street, or grading perimeter swales to collect the lot runoff and directing them
into a component of the stormwater collection system. Lots that will naturally drain into the system are
not required to provide these additional measures.
Form DRPC-3 Rev.2 05Nov2009 Page t of 2

High Density Residential Subdivisions
Deed Restrictions & Protective Covenances
Signature:
I, L„real A , a Notary Public in the
State of Aj,,, lk P r, County of ,10 e(,n
do hereby certify that 9&<c,, Ljl�, personally appeared
before me this the /71-` day of ap,; I , 20)�/ , and acknowledge
the due execution of the foregoing instrument. Witness my hand and official seal,
SEAL
� :� 1 -�
SignatLte ooannnmm�,nnpoo
My Commission expires /!/i �,Y � ADA/R�y
--k V&OTAR y S phi;
3 My Commission
N
Expires
isAO 11/11/2018 2
N C o00
Form DRPC-3 Rev.2 05Nov2009 Page 2 of 2