SW6140802_CURRENT PERMIT_20140902

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

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
September 2, 2014
Mr. Andrew Taylor, Lead Pastor
Liberty Baptist Church of Spring Lake, Inc.
1625 Ray Road
Spring Lake, North Carolina 28390
Subject: Stormwater Permit No. SW6140802
Liberty Baptist Church — Worship Center Addition_
High Density Stormwater Wetland Project
Harnett County
OCT 1 6 2014
Dear Mr. Taylor:
The Stormwater Permitting Unit received a complete Stormwater-Management Permit
Application for Liberty Baptist Church — Worship Center Addition -on August 1, 20141 .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 02H.1000. We are
forwarding Permit No. SW6140802, dated September 2, 2014, for the construction,
operation and maintenance of the subject project and the stormwater BMPs.
This permit shall be effective from the date of issuance until September 2, 2022, and shall
be subject to the conditions and limitations as specified therein, and does not supersede
any other agency permit that may be required. Please pay special attention to the
conditions listed in this permit regarding the Operation and Maintenance of the BMP(s),
recordation of deed restrictions, procedures for changes of ownership, transferring the
permit, and renewing the permit. Failure to establish an adequate system for operation and
maintenance of the stormwater management system, to record deed restrictions, to follow
the procedures for transfer of the permit, or to renew the permit, will result in future
compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you
have the right to request an adjudicatory hearing 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
the 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.
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone]Internet: www.ncdenr,gov
An Equal Opportunity 1 Af(rmative Action Employer -Made in part by recycled paper

After thirty days from the date of this letter, this project will be kept on file at the NCDENR
Division of Energy, Mineral and Land Resources, Land Quality Section, Fayetteville
xc Regional Office. If you have questions after that time, please contact Brad Cole,
brad. cole(C7ncdenr.goy or Mike Lawyer, [e-mail], of that office. Until
that time, if you have any questions or need additional information concerning this permit,
please contact Bill Diuguid at [phone]; or [e-mail].
Sincerely,
Original Signed by William H. Diuguid
William H. Diuguid, AICP, Plans Reviewer
for Tracy E. Davis, P.E., CPM
Director, Division of Energy,
Mineral and Land Resources
cc: SW6140802 File
ec: NC DENR DEMLR Land Quality Section, Fayetteville Regional Office
Kevin Lindsay, P.E., Crawford Design Company
Stormwater Permitting Unit Files
Attachments

State Stormwater Permit
Permit No.SW6140802
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
Liberty Baptist Church of Spring Lake, Inc.
Liberty Baptist Church — Worship Center Addition
1625 Ray Road, Spring Lake, Harnett County
FOR THE
construction, operation and maintenance of one stormwater wetland in compliance with
the provisions of 15A NCAC 02H .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, Land Quality Section and considered a part of this permit.
This permit shall be effective from the date of issuance until September 2, 2022, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 of this permit. The stormwater control has been
designed to handle the runoff from 74,657 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.7
of this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 6

State Stormwater Permit
Permit No.SW6140802
The following design criteria have been provided in the stormwater wetlands and
wet detention BMPs and must be maintained at design co dition:
Wetland
a
C.
d.
e.
f.
9.
h.
i.
M.
n.
Drainage Area, acres:
Onsite, ft
Offsite, ftz:
Total Imperzious Surfaces, ft
2:
Onsite ft
Offsite, ft2:
Design Storm, inches:
Shallow Land Depth, feet:
Permitted Storage Volume ft3:
Permanent pool Volume, ft�:
Forebay Volume, ft
TSS efficiency:
Elevations, FMSL:
Temporary Pool:
Permanent Pool:
Shallow Water Bottom:
Deep Pool Pttom:
Surface Areas, ft
Total:
Shallow Land:
Shallow Water:
Forebay Deep Pool:
Non-Forebay Deep Pool:
Controlling Orifice:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
IIII&YyCI4Big] 11410]Zole]JdC74/_1.[6y
3.78
146,678
0
74,657
74,657
0
1.0
1.0
10,575.77 at temp.
1099.97
297.50
296.50
296.00
293.50
10575.77
4230.30
4214.87
1099.97
1030.63
2.0" 0 pipe
Jumping Run Creek / Cape Fear
18-23-29
"C
The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the complete of
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.
g. 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 the Division of Energy, Mineral and Land
Resources, Land Quality Section. The records will indicate the date, activity,
Page 2 of 6

State Stormwater Permit
Permit No.SW6140802
name of person performing the work and what actions were taken.
5. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with 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
1. This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form, to the Division of Energy,
Mineral and Land Resources, Land Quality Section, signed by both parties, and
Page 3 of 6

State Stormwater Permit
Permit No.SW6140802
accompanied by supporting documentation as listed on page 2 of the form. The
project must be in good standing with the Division. The approval of this request
will be considered on its merits and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Energy, Mineral
and Land Resources, Land Quality Section, in accordance with North Carolina
General Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the: construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10.The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11.The permittee shall notify the Division of any name, ownership or mailing
address changes at least 30 days prior to making such changes.
12.The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 2"d day of September, 2014.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Original Signed by William H. Diuguid
William H. Diuguid, AICP, Plans Reviewer
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No.SW6140802
Liberty Baptist Church —Worship Center Addition
Stormwater Permit No. SW6140802
Harnett 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,
Liberty Baptist Church —Worship Center Addition
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 5 of 6

State Stormwater Permit
Permit No.SW6140802
Certification Requirements:
_1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than shown on the approved plans.
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 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 deep pools, shallow
water area, shallow land area, forebay, and vegetation.
15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: NCDENR DEMLR Regional Office
Land Quality Section
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
cc: Building Inspections — Harnett County
Page 6 of 6

22-0/5 LQlI S2L- nib I
J V
DJ
619 25S
2r1

State Stormwater Permit
Permit No.SW6140802
Liberty Baptist Church —Worship Center Addition
Stormwater Permit No. SW6140802
Harnett County
Designer's Certification
Kevin S Lindsay , as a duly registered Professional Engineer
in the State of North Carolina, having been authorized to obsery eriodical eekly/
full time) the construction of the project,
Liberty Baptist Church —Worship Center Addition
(Project)
for Liberty Baptist Church (ProjectIOwner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
NOV 2 3 2015
1
�11 541-1: o,
SEAL
027502
SEAL
Signature —_-1
Registration Number 27502
Date 11-10-15
Page 5 of 6

0
0

State Stormwater Permit
Permit No.SW6140802
Certification Requirements:
X 1. The drainage area to the system contains approximately the permitted
acreage.
X 2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
X 3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
X 4. All roof drains are located such that the runoff is directed into the system.
X 5. The outlet/bypass structure elevations are per the approved plan.
X 6. The outlet structure is located per the approved plans.
X 7. Trash rack is provided on the outlet/bypass structure.
X 8. All slopes are grassed with permanent vegetation.
X 9. Vegetated slopes are no steeper than shown on the approved plans.
X 10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
X 11. The permitted amounts of surface area and volume have been provided.
X 12. Required drawdown devices are correctly sized per the approved plans.
X 13. All required design depths are provided.
X 14. All required parts of the system are provided, such as deep pools, shallow
water area, shallow land area, forebay, and vegetation.
X 15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: NCDENR DEMLR Regional Office
Land Quality Section
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
cc: Building Inspections — Harnett County
Page 6 of 6

ixs-"40 g17_1 2-0i4-P
-
1
DEMLR USE ONLY
_;,
Date Received
Fee Paid
Permit Num er
zoi
Sos =
U
Applicable Rules:
❑ Coastal SW -1995
❑ Coastal SW - 2008 h 11- Post Constru lion
(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 Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT
This form ruay be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent wI
specifications, letters, operation and maintenance agreements; etc.): l+
Libertv Baptist Church - Worship Center Addition
2. Location of Project (street address): I
- . OCT 1 6 2014
City: Spring Lake, NC County! Harnett
3. Directions to project (from nearest major intersection):
AUG 0 12014
ject name on plans,
A W- ,.
Zip:28390
Turn onto Ray Road from NC210. Liberty Baptist Church is approximately 1.6 miles on the left.
4. Latitude:35° 13' 53.03" N Longitude:78° 57' 53.80" W of the main entrance to the project.
H. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenemals nvith modifications also requires SWU-102 - Reneenal 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
DEMLR 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: 6 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
If yes, see S.L. 2012-200, Part VI: http://portal.ncdenr.org/web/Ir/rules-and-regulations
Form SWU-101 Version Oct. 31, 2013 Page 1 of

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III: CONTACT INFORMATION
1, a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization: Liberty Baptist Church of Spring Lake, Inc.
Signing Official & Title: Andrew Taylor, Lead Pastor
b.Contact information for person listed in item la above:
Street Address: 1625 Ray Road
City: Spring Lake State: NC Zip: 28390
Mailing Address (if applicable): Same
City: State: Zip:
Phone: ( 910 ) 497-5315
Email: [e-mail]
Fax: ( 910 ) 497-6920
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: See item Ill.l.b above.
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if
City:
Phone: ( ) Fax:
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: Randall Wheeler
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing Address: 1625 Ray Road
City: Spring Lake
Phone: ( 910 ) 497-5315 Cell: [phone]
Email: [e-mail]
4. Local jurisdiction for building permits: Harnett County
State: NC Zip: 28390
Fax: ( 910 ) 497-6920
Point of Contact: Phone #:
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV: PROJECT INFORMATION
r
1. In the space provided below, hriefly summarize how the storm water runoff will be treated.
Stormwater from new worship center shall be treated with a new stormwater wetland.
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 Cape Fear River basin.
4. Total Property Area: 3.37 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area': 3.37 acres
Total project area shall be calculated to exclude the followingR the norral pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward fron the NHW (or MHM 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 stay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 66.10 (50.9% new) %
9. How many drainage areas does the project have? 1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low deusihj and other projects, use I for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area
Drainage Area
Drainage Area
Receiving Stream Name
Jumping Run
Creek
Stream Class *
C
Stream Index Number *
18 - 23 -29
Total Drainage Area (so
146,678
On -site Drainage Area (so
146,678
Off -site Drainage Area (so
0
Pro osed Impervious Area** s
74,657 (new)
Im ervious Area** total
50.9%
Impervious— Surface Area
Drainage Area _
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
On -site Streets (so
On -site Parking (so
On -site Sidewalks (so
Other on -site (so
Future (so
Off -site (sf)
Existing BUA*** (so
Total (so:
Streant Class and Index Number can be determined at: httn://portal.ncdenr.or aeb/wq(ps/csu/classificatioits
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version Oct. 31, 2013 Page 3 of

** Report only that amount of existing BUA that will rentain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). 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/w2/ws/su/statesw/forms does. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at http: / / portal.ncdennorg/ web/ wq / ws / so / 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 andanitialed=in=blue:inkr Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wg/ws/su/statesw/forms dots.
Initials
1. Original and one copy of the Storm water Management Permit Application Form. KS c
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants kA
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M �SL
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to KA-
http://www.envhelp.org/pages/onestopexpress.htnil http://www.envhelp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor ley L
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 KSL
receiving stream drains to class SA waters within lh mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of planstf6ldJd-t5'.85'x-143 (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
It. 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.
KSZ
ZS�.-
Form SWU-101 Version Oct. 31, 2013 Page 4 of

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 KSL
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 DEMLR to verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1036 Page No: 656 KS L
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC J4I L
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
httR://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 htto://porta1.ncdenr.org/web/Ir/state-stormwater-
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 DEMLR, and that they will be recorded prior to the sale of any lot.
VIIL CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:
Consulting Firm: Crawford Design Company
Mailing Address: 116 N. Cool Spring Street
City: Fayetteville State: NC Zip: 28301
Phone: (910 ) 221-0033
Email:—[e-mail]
Fax: (910 ) 221-0035
—t44-IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) I certify that I
own the property identified in this permit application, and thus give permission to (print or hjpe name ofperson
listed in Contact Information, item 1a) with (print or hjpe name of organization listed in
Contact Information, item la) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version Oct. 31, 2013 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, Uem'l) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility, to notify DEMLR 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 inappropriate enforcement
action including the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Da
a Notary Public for the State of County of
do hereby certify that
personally appeared
before me this _ day of and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Information, item 1e) Andrew TaIllor
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 storm ater rules under 15A NCAC 21-1 .1000 and any other applicable state stormwater requirements.
Signature: ^ Date: `>
r
I, l��S �YnLnd_I AV(L;r . a Notary Public for the State of -Al -NIRCounty of
_ p r_y�g=t —,do hereby certify that 8ndr_e_w_Ti_ _y.(a r personally appeared
before me this 3Q day of w L Y , -dDI and ack�wlecige the due exe ution of the application for
a stormwater permit. Witness my hand and official seal, �1wo u/ri�rn�
SEAL
MV commission expires91rZ71oZG/S
Form SWU-101 Version Oct. 31, 2013 Page 6 of

1, UIL"I uo t �uu unr
SOSID: 0323543
Date Filed: 4/6/2010 3:56:00 PM
Elaine F. Marshall
STATE OF NORTH CAROLINA North Carolina Secretary of State
DEPARTMENT OF THE SECRETARY OF STATE C201007500106
STATEMENT OF CHANGE OF REGISTERED
OFFICE AND/OR REGISTERED AGENT
Pursuant to §55D-31 of the General Statutes of North Carolina, the undersigned entity submits the following for the purpose of changing
its registered office and/or registered agent in the State of North Carolina.
MINURIuG YteliYke :7.i UOiG'la1J11114M
The name of the entity is: L ; 6
r, a La
Entity Type: ❑Corporation, ❑Foreign Corporation, p(JNonpro6t Corporation, []Foreign Nonprofit Corporation,
❑Limited Liability Company, ❑Forei Limited Liability Company ❑Limited Partnership, []Foreign Limited Partnership,
[)Limited Liability Partnership, []Foreign Limited Liability Partnership
The street address and county of the entity's registered office currently on file is:
Number and Street: (L.aS Qu PDQd /I''
City, State, Zip Code: S o f- i n c La (�C C. 18390 County: H O r n P
The mailing address if different froln the street address of the registered office currently on file is:
The name of the current registered agent is:
1. The street address and county of the new registered office of the entity is:
(complete this item only if the address of the registered office is being changed)
Number and Street: OCT 1 6 miti.,
City, State, Zip Code:
County:
2. The trailing address if different from the street address of the new registered office is:
(complete this item only if the address of the registered office is being changed)
3. The name of the new registered agent and the new agent's consent to appointment appears below:
(complete this item only iifthe name of the registered agent is being changed)
K. 4n4tr^ew TaU/t,r I r ?-esido,-t—
Type or Print Name ofjYew Agent P Signature & Title
4. The address of the entity's registered office and the address of the business office of its registered agent, as changed,
will be identical.
5. This statement will be effective upon filing, unless a date and/or time is specified:
This is the /0 4day of / t t a r 04 20_LO.
Notes: Filingfee
CORPORATIOT
Revised January 2002
c4 c.,Cl, of s ,gig to
Entin, Name
A—TSignature f`� J -t-
�'�. /+n�rCrr 1 0..,t �urr `('fQSiGren t
Type orPri tName and Title
must be filed with the Secretary of State.
P. O. BOX 29622
RALEIGH, NC 27626-0622
Fort BE-06

7/17/2oia
North Carolina Secretary of State
North Carolina
Elaine F. Marshall DEPARTMENT o1 ,-HE
Secretary SECRETARYOFSTATE
PO Box 29622 Raleigh, NC 27626-0622 [phone]
Date: 7/17/2014
t here to:
v Document Filings i
PLLC, LP and Non -Profit entities are not required to file annual reports.
Corporation Names
Name Name Type
NC LIBERTY BAPTIST CHURCH LEGAL
OF SPRING LAKE
Non -Profit Corporation Information
S OS I D:
0323543
Status:
Current-Acti\e
Effective Date:
4/22/1993
Citizenship:
DOMESTIC
State of Inc.:
NC
Duration:
PERPETUAL
gistered Agent
Agent Name: TAYLOR, K ANDREW
Office Address: 1625 RAY RD
SPRING LAKE NC 28390
Mailing Address: 1625 RAY RD
SPRING LAKE NC 28390
rincipal Office
Office Address: NO ADDRESS
Mailing Address: NO ADDRESS
Icers/COmoanv Officials
This website is promded to the public as a part of the Secretary of State Knowledge Base (SOSKB) system. Version:
3617
http:/Aw .secretary.state.nc.us/corporations/Cup.aspVPitemld=4642090 1/1

ATTACHMENT C :
OPERATIONS & MAINTENANCE
AGREEMENT
WORSHIP CENTER ADDITION
LIBERTY BAPTIST CHURCH
STORMWATER WETLAND
SPRING LAKE, NC
Crawford
est 1CDn kui
'. OCT 1 6 2C1-1
Crawford
es com my

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

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

Permit Number:
(lobe provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Project name: L,iberly Baptist Church_Worship Center Addition
BMP drainage area number:
Print
Title: bead Pastor
Address: 1625 Ray Road, Spring Lake, NC: 28390
Note: 'rhe legally responsible party should not be a homeowners association unless more than 50% of the lots have been
sold and a resident of the subdivision has been named the president.
I, i s A rnu�� _T (y. _. a Notary Public for the State of
County of } c:rtevtl___,do hereby certify that
Personally appeared before me this 36 `day of
__Jki y �7�, and acknowledge the due execution of the forgoing stttoormwater wetland
maintenance requirements. Witness my hand and official seal,
SEAL
My commission expires_.__��
Form SW40i-Wetland O&M-Rev.4
Page 3 of 3