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HomeMy WebLinkAboutSW8080527_CURRENT PERMIT_20210928STORMWATER DIVISION CODING SHEET POST -CONSTRUCTION PERMITS PERMIT NO I SW8 DOC TYPE I N CURRENT PERMIT ❑ APPROVED PLANS ❑ HISTORICAL FILE ❑ COMPLIANCE EVALUATION INSPECTION DOC DATE I 2 0 21 o g 2 8 YYYYMMDD ROY COOPER Governor ELIZABETH S BISER Seaetmy BRIAN WRENN Director September 28, 2021 BR & JD Leasing, LLC Arm Dr Jon D Ward, Manager 11 Bnerwood Road Shallotte, NC 28470 NORTH CAROLINA Enr4vnmenial Quaf+h Subject Permit Renewal State Stormwater Management Permit No SW8 080527 Family Entertainment of Shallotte Brunswick County Dear Mr Ward Effective August 1, 2013 the State Stormwater program has been transferred from the Division of Water Quality (DWQ) to the Division of Energy, Mineral and Land Resources (DEMLR) All previous references to DWQ will remain in older stormwater permits issued prior to August 1, 2013 until they are modified Please note that this permit will now reference DEMLR as the Division responsible for issuance of the permit On August 5, 2009, the Governor signed Session Law 2009-406 This law impacted any development approval issued by the former Division of Water Quality under Article 21 of Chapter 143 of the General Statutes, which was current and valid at any point between January 1, 2008, and December 31, 2010 The law extended the effective period of any stormwater permit that was set to expire during this time frame to three (3) years from its current expiration date On August 2, 2010, the Governor signed Session Law 2010-177, which granted an extra year for a total of four (4) years extension The Wilmington Regional Office received a complete 8 year Stormwater Management Permit Renewal Application for the subject project on September 24, 2021 The Division is hereby notifying you that permit SW8 080527 has been renewed on September 28, 2021, and shall be effective until June 23, 2028, which includes all available extensions For your records, please find enclosed a renewed, updated, and re -issued permit and a copy of the renewal application As requested, a copy of the current operation and maintenance agreement is enclosed Please keep this permit on file at all tunes Please note that the renewed, updated, and re -issued permit does not impose new or different terms, it merely restates some of the previous terns to provide you with a better understanding of your obligations under the permit The renewal and reissuance of this stormwater permit does not imply that the site is currently in compliance with the terms and conditions of this state stormwater permit The plans originally approved on December 16, 2008 and most recently modified and transferred on June 25, 2010, will remain in full force and effect in accordance with the regulations set forth in Title 15A NCAC 2H 1000 This permit is subject to the conditions and limitations as specified therein 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 transfer 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 150B of the North Carolina General Statutes, and 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 fdmg 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 D E Q North Carolina Department of Environments] Quality I Dmsion of Energy Mineral and Land Resources 512 North Salisbury Street 1 1612 Mad Semce Center I Raleigh North Carolina 27699-1612 State Stormwater Permit No SW8 080527 Page 2 of 2 If you have any questions, need additional copies of the permit or approved plans, please contact Ashley Smith in the Wilmington Regional Office, at (910) 796-7215 or ashleym smith@ncdenr gov Sincerely, l���VlY�v.Q Ili 9�;; Brian Wrenn, Director Division of Energy, Mineral and Land Resources Enclosures Attachment B — Built -Upon Area Allocation Attachment C — Permitting History Renewal Application Documents DES/ams \\\Stormwater\Permits & Projects\2008\080527 HD\2021 09 permit 080527 cc Sabrina B Babson PE East Coast Engineering PC 4918 Main Street Shallotte NC 28459 NCDEQ-DENER Wilirungton Regional Office North Carolina Department of Enwonmentai Quality I Dmsion of Energy Mineral and Land Resources 512 North Salisbury Street I t612 Mail Service Cemer I Raleigh. North Carolina 27699-1612 r��r�� 9197079200 State Stormwater Management Systems Permit No SW8 080527 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF ENERGY, MINERAL AND LAND RESOURCES STATE STORMWATER MANAGEMENT PERMIT HIGH DENSITY COMMERCIAL 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 BR & JD Leasing, LLC Family Entertainment Center of Shallotte 349 Whrtevdle Road — NC Hwy 130, Shallotte, Brunswick County FOR THE Construction, operation and maintenance of one (1) wet detention pond in compliance with the provisions of Session Law 2008-211 and 15A NCAC 2H 1000 (hereafter referred to as the "stormwater rules') and the approved stormwater management plans and specifications and other supporting data as attached and on file with and approved by the Division of Energy, Mineral and Land Resources (the "Division" or "DEMLR") and considered an enforceable part of this permit This permit shall be effective from the date of issuance until June 23, 2028, and shall be subject to the following specified conditions and limitations I DESIGN STANDARDS 1 This stormwater system has been approved for the management of stormwater runoff as described in Section 16 of this permit The stormwater control has been designed to handle the runoff from 345,431 square feet of impervious area, of which 100.000 square feet is for future development and 35 545 square feet is allocated to Outparcel #1 on Permit Number SW8 100603 2 The tract will be limited to the amount of built -upon area indicated in Section 16 on page 2 of this permit, and per approved plans 3 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 4 The runoff from all built -upon area within the permitted drainage area of this project must be directed into the permitted stormwater control system 5 The built -upon areas associated with this project shall be located at least 50 feet landward of all perennial and intermittent surface waters Page 1 of 7 State Stormwater Management Systems Permit No SW8 080527 6 The following design criteria have been provided in the wet detention pond and must be maintained at design condition a Drainage Area, acres 122 Onsite, ft2 284,808 Offsite, ft2 246,624 b Total Impervious Surfaces, ft2 345,431 Buildings, ft2 50,000 Roads/Parking, ft2 159,886 Sidewalk & Concrete ft2 0 Outparcel #1, ft2 35,545 (see SW8 100603) Future, ft2 100,000 c Average Pond Design Depth, feet 50 d TSS removal efficiency 90% e Design Storm, inches 1 5 f Permanent Pool Elevation, FMSL 55 g Permanent Pool Surface Area, ft2 26,889 h Permitted Storage Volume, ft3 45,401 1 Storage Elevation, FMSL 7 t Pre-dev 1 year 24 hour rate, cfs 21 k Controlling Orifice YO pipe I Permanent Pool Volume, ft3 136,905 m Forebay Volume, ft3 26,588 n Maximum Fountain Horsepower /2 HP o Receiving Stream / River Basin Mulberry Branch / Lumber p Stream Index Number 15-25-2-7 q Classification of Water Body "C,SW" II SCHEDULE OF COMPLIANCE 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 During construction, erosion shall be kept to a minimum and any eroded areas of the system will be repaired immediately The permittee shall at all time provide the operation and maintenance necessary to assure the permitted stormwater system functions at the design condition 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 Semiannual scheduled inspections (every 6 months) Sediment removal Mowing and re -vegetation of slopes and the vegetated filter strip Immediate repair of eroded areas Maintenance of all slopes in accordance with approved plans and specifications Debris removal and unclogging of outlet structure, orifice device, level spreader, filter strip, catch basins and piping Access to the outlet structure must be available at all times Records of maintenance activities must be kept for each permitted BMP The records will indicate the date, activity, name of person performing the work and what actions were taken Access to the stormwater facilities for inspection and maintenance shall be maintained via appropriate easements at all times The facilities shall be constructed, operated and maintained in accordance with the provisions of this permit, the approved plans and specifications, and the supporting documents attached to this permit and on file with the Division Page 2 of 7 State Stormwater Management Systems Permit No SW8 080527 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 If the stormwater system was used as an Erosion Control device, it must be restored to design condition prior to operation as a stormwater treatment device, and prior to occupancy of the facility 9 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 10 Records of maintenance activities must be kept by the permittee The records will indicate the date, activity, name of person performing the work and what actions were taken 11 Prior to issuance of an out parcel permit, the stormwater facilities will be inspected by DEMLR personnel The protect and the stormwater facility must be in compliance with all permit conditions Any items not in compliance must be repaired, replaced or restored to design condition prior to issuance of future permits or modifications Records of maintenance activities performed to date will be required 12 No person or entity, including the permittee, shall alter any component shown in the approved plans and specifications Prior to the construction of any modification to the approved plans, the permittee shall submit to the Director, and shall have received approval for modified plans, specifications, and calculations including but not limited to, those listed below For changes to the protect or SCM that impact the certifications, a new or updated certification(s), as applicable, will be required and a copy must be submitted to the appropriate DEQ regional office upon completion of the modification a Any modification to the approved plans and specifications, regardless of size including the SCM(s), BUA, details, etc b Redesign or addition to the approved amount of BUA or to the drainage area c Further development, subdivision, acquisition, lease or sale of any, all or part of the protect and/or property area as reported in the approved plans and specifications d Altering, modifying, removing, relocating, redirecting, regrading, or resizing of any component of the approved SCM(s), the stormwater collection system and/or vegetative conveyance shown on the approved plan e The construction of any allocated future BUA f The construction of any permeable pavement, #57 stone area, public trails, or landscaping material to be considered a permeable surface that were not included in the approved plans and specifications g Other modifications as determined by the Director 13 Prior to transfer of the permit, a file review and site inspection will be conducted by Division personnel to ensure the permit conditions have been met and that the protect and the on -site stormwater system complies with the permit conditions Any items not in compliance must be repaired, replaced restored, or resolved prior to the transfer Records of maintenance activities performed to date may be requested Page 3 of 7 State Stormwater Management Systems Permit No SW8 080527 14 Prior to the sale of any lot, the following deed restrictions must be recorded a The following covenants are intended to ensure ongoing compliance with State Stormwater Management Permit Number SW8 080527, as issued by the Division under NCAC 2H 1000 b The State of North Carolina is made a beneficiary of these covenants to the extent necessary to maintain compliance with the Stormwater Management Permit c These covenants are to run with the land and be binding on all persons and parties claiming under them d The covenants pertaining to stormwater may not be altered or rescinded without the express written consent of the State of North Carolina, DEMLR e Alteration of the drainage as shown on the approved plans may not take place without the concurrence of the Division f The maximum built -upon area is as listed below and as shown on the approved plans Area BUA Onsite Area 209,886 sf Outparcel #1 35,545 sf for Permit No SW8 100603 Future Development 100,000 sf 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 All runoff on the lot must drain into the permitted system This may be accomplished through providing roof drain gutters, which drain to the street, grading the lot to drain toward the street, or grading perimeter swales and directing them into the pond or street Lots that will naturally drain into the system are not required to provide these measures Built -upon area in excess of the permitted amount will require a permit modification Each lot within the subdivision whose ownership is not retained by the permittee, must submit a separate Offsite Stormwater Management Permit application package to the Division and receive a permit prior to any construction on the lot If permeable pavement credit is requested, the property owner must submit a request, with supporting documentation, to the permittee and receive approval from DEMLR prior to construction of BUA 15 A copy of the recorded deed restrictions must be submitted to the Division within 30 days of the date of recording the plat, and prior to selling lots The recorded copy must contain all of the statements above, the signature of the Permittee, the deed book number and page, and the stamp/signature of the Register of Deeds 16 Decorative spray fountains are allowed in the pond, subject to the following criteria a The minimum permanent pool volume is 30,000 cubic feet b The fountain must draw its water from less than 2' below the permanent pool surface c Separated units, where the nozzle, pump and intake are connected by tubing, may be used only if they draw water from the surface in the deepest part of the pond d The fountain may not be placed into the forebay e The falling water from the fountain must be centered in the main pond, away from the shoreline f The maximum horsepower for a fountain in this pond is 1/2 horsepower Page 4 of 7 State Stormwater Management Systems Permit No SW8 080527 III GENERAL CONDITIONS 1 Any individual or entity found to be in noncompliance with the provisions of a stormwater management permit or the requirements of the stormwater rules is subject to enforcement procedures as set forth in NCGS 143 Article 21 2 The issuance of this permit does not preclude the permittee from complying with and obtaining any other permits or approvals that are required for this development to take place, as required by any statutes, rules, regulations, or ordinances, which may be imposed by any other Local, State or Federal government agency having jurisdiction Any activities undertaken at this site that cause a water quality violation or undertaken prior to receipt of the necessary permits or approvals to do so are considered violations of NCGS 143-215 1 and subject to enforcement procedures pursuant to NCGS 143-215 6 3 If the facilities fail to perform satisfactorily, the permittee shall take immediate corrective actions This includes actions required by this Division and the stormwater rules such as the construction of additional or replacement on -site stormwater systems These additional or replacement measures shall receive a permit from the Division prior to construction 4 Permit Transfer This permit is not transferable to any person or entity except after notice to and approval by the Director The permittee shall submit a completed and signed "Permit Transfer Application Form" (available on the Division website) accompanied by the required fee and supporting documentation as listed on the form, to the Division at least 60 days prior to any one or more of the following events a The sale or conveyance of the project area in whole or in part, except in the case of an individual lot sale that is made subject to the recorded deed restrictions and protective covenants, b The assignment or conveyance of declarant rights to another individual or entity, c The sale or conveyance of the common areas to a Homeowners or Property Owner's Association, subject to the requirements of NCGS 143-214 7(c2), d Dissolution of the partnership, corporate, or LLC entity, subject to NCGS 55-14-05 or NCGS 57D-6-07 and 08, e Bankruptcy, f Foreclosure, subject to the requirements of Session Law 2013-121, Current Permittee Name or Address Changes The permittee shall submit a completed "Permit Information Update Application Form" (available on the Division website) to the Division within 30 days to making any one or more of the following changes A name change of the current permittee, A name change of the project, A mailing address change of the permittee, 6 The permittee is responsible for compliance with all terms and conditions of this permit until the Division approves the transfer request Neither the sale of the project, in whole or in part, nor the conveyance of common area to a third party constitutes an approved transfer of the permit 7 The permittee grants Division Staff permission to enter the property during normal business hours to inspect all components of the permitted project 8 The permit issued shall continue in force and effect until the permittee files a request with the Division for a permit modification, transfer, renewal, or rescission, however, these actions do not stay any permit conditions 9 Approved plans, application documents, supplements, calculations, operation and maintenance agreement, and specifications for this project are incorporated by reference and are enforceable parts of the permit A copy of this permit, application, supplements, operation and maintenance agreement, and approved plans and specifications shall be maintained on file by the permittee Page 5 of 7 State Stormwater Management Systems Permit No SW8 080527 10 Unless specified elsewhere, permanent seeding requirements for the on -site stormwater system must follow the guidelines established in the North Carolina Erosion and Sediment Control Planning and Design Manual 11 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 for cause as allowed by the laws, rules, and regulations contained in Title 15A NCAC 2H 1000 and NCGS 143-215 1 et al 12 A permit renewal request must be submitted at least 180 days prior to the expiration date of this permit The renewal request must include the appropriate application, documentation and the processing fee as outlined in Title 15A NCAC 02H 1045(3) Permit renewed, updated and reissued this the 28th day of September 2021 NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION 1�n'an vvrenn, Director Division of Energy, Mineral and Land Resources By Authority of the Environmental Management Commission Page 6 of 7 State Stormwater Management Systems Permit No SW8 080527 Attachment B Master Permit No SW8 080527 Modification Lot# from Master Permit Drains to Pond # Offsite Permit No Date Issued Offsite Project Name Allocated BUA (sf Proposed BUA 1 1 SW8 100603 June 25, 2010 First Bank of Shallotte 35,545 sf 35,545 sf Future 1 Future Future Future 100,000 sf future Page 7 of 7 Attachment C - Permitting History Famil Entertainment Center of Shallotte Permit No SW8080527 Approval Date permit Action RIMS Version Description of the Changes 12/16/2008 Original Approval 10 6/25/2010 Modification/ Transfer l I This modification changes the name of the permittee from East Coast Entertainment to BR & JD Leasing, LLC, corrects the drainage area to include the off -site parcel and future areas, and adds the pond area to the permit area 9/28/2021 Renewal 20 Permit Number SI,v�D�DS.-)imQP (to be provided by DWQ) Drainage Area Number 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 inspection will be corrected, repaired or replaced unmediately 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 the wet detention basin, pretreatment including forebays and the vegetated filter if one is provided This system (check one) ❑ does ® does not incorporate a vegetated filter at the outlet This system (check one) ❑ does ® does not incorporate pretreatment other than a forebay Important 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 trutial 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 muumrzed to the maximum extent practical — Once a year, a dam safety expert should inspect the embankment After the wet detention pond is established, it should be inspected once a month and within 24 hours after every storm event greater than 10 inches (or 15 inches if in a Coastal County) Records of operation and maintenance should be kept in a known set location and must be available upon request Inspection activities shall be performed as follows Any problems that are found shall be repaired immediately BMP element Potential problem How I will remediate the problem The entire BMP Trash debris is present Remove the trash/debris The perimeter of the wet Areas of bare soil and/or Regrade the soil if necessary to detention basin erosive gullies have formed remove the gully, and then plant a ground cover and water until it is established Provide lime and a one-time fertilizer application Vegetation is too short or too Maintain vegetation at a height of long approximately six inches Form SW401-Wet Detention Basin O&M -Rev 4 7Y,�— Cr,-fVF0 8 2010 Page I of 4 Permit Number (to be provided by DWQ) Drainage Area Number BMP element Potential problem How I will remediate the problem The inlet device pipe or The pipe is clogged Unclog the pipe Dispose of the 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 swale smooth it over and provide erosion control devices such as reinforced turf matting or riprap to avoid future problems with erosion The forebay Sediment has accumulated to Search for the source of the a depth greater than the sediment and remedy the problem if original design depth for possible Remove the sediment and sediment storage 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 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 to maintain optimal plant health Plants are dead, diseased or Determine the source of the dying problem soils, hydrology, disease, etc Remedy the problem and replace plants Provide a one-time fertilizer application to establish the ground cover if a sod 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 area Sediment has accumulated to Search for the source of the a depth greater than the sediment and remedy the problem if original design sediment possible Remove the sediment and storage depth dispose of it in a location where it will not cause impacts to streams or the BMP Algal growth covers over Consult a professional to remove 50% of the area and control the algal growth Cattails, phragmites or other Remove the plants by wiping them invasive plants cover 50% of with pesticide (do not spray) the basin surface i CEYVE15 Form SW401-Wet Detention Basin O&M -Rev 4 JUN 0 8 2010 Page 2 of 4 BY Permit Number (to be provided by DWQ) Drainage Area Number BMP element Potential problem How I will remediate the problem The embankment Shrubs have started to grow Remove shrubs immediately on the embankment Evidence of muskrat or Use traps to remove muskrats and beaver activity is present consult a professional to remove beavers A tree has started to grow on Consult a dam safety specialist to the embankment remove the tree An 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 the sediment off -site The outlet device is damaged Repair or replace the outlet device The receiving water Erosion or other signs of Contact the local NC Division of damage have occurred at the Water Quality Regional Office, or outlet the 401 Oversight Unit at 919-733- 1786 The measuring device used to determine the sediment elevation shall be such that it will give an accurate depth reading and not readily penetrate into accumulated sediments When the permanent pool depth reads 6 5 feet in the main pond, the sediment shall be removed When the permanent pool depth reads 6 5 feet in the forebay, the sediment shall be removed Sediment Removal Bottom BASIN DIAGRAM (rill in the blanks) 0 Permanent Pool Elevation 5 5 I Pe manen Pool --------------- -- Volume Sediment Removal Elevation-1 Volume 2 -ft Min ----------------------------- ------------ --- - --- Sediment Bottom Elevation -2 1-ft n Storage Sedimer Storage FOREBAY MAIN POND Form SW401-Wet Detention Basin O&M -Rev 4 CIE, IVED JUN 6 8 2010 Page 3 of 4 BY PermitNumber 5u3O o8D521 moD (to be provided by DWQ) I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed above I agree to notify DWQ of any problems with the system or prior to any changes to the system or responsible party Project name Family Entertainment Center of Shallotte BMP drainage area number SW Pond #1 Print name Title Manager / Member Address 343 Whiteville Road, Shallotte, NC 28549 Phone Signatt 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 I, 14Jcw k4rie.4i d t— a Notary Public for the State of kt l A, r_0D IIhI0.. , &unty of GC, , do hereby certify that h1J T>. WAVI> personally appeared before me this day of WUA, , �plp , and acknowledge the due execution of the forgoing wet etention basin maintenance requirements Witness my hand and official seal, SEAL My commission expires 1I' 1 lak Z 4 20 i7, Form SW401-Wet Detention Basin O&M -Rev 4 1 JUN 0 8 2010 1 Page 4 of 4 ��,y��. ;�l�!(ilrp, r� \' ��f�^ (J^ty�� � j u f �i �'.� r ^� 13 r c. 4� ' �; w '^ ��„`'bUn s� � i Ry ..,,.'"�� ' s Permit Number S�v�oeaa`sa (to be provided by DWQ) Drainage Area Number 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 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 The wet detention basin system is defined as the wet detention basin, pretreatment including forebays and the vegetated filter if one is provided This system (check one) ❑ does ® does not incorporate a vegetated filter at the outlet This system (check one) ❑ does ® does not incorporate pretreatment other than a forebay Important 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 dram should be minimized to the maximum extent practical — Once a year, a dam safety expert should inspect the embankment After the wet detention pond is established, it should be inspected once a month and within 24 hours after every storm event greater than 10 inches (or 15 inches if in a Coastal County) Records of operation and maintenance should be kept in a known set location and must be available upon request Inspection activities shall be performed as follows Any problems that are found shall be repaired immediately BMP element Potential problem How I will remediate the problem The entire BMP Trash/debris is present Remove the trash/debris The perimeter of the wet Areas of bare soil and/or Regrade the sod if necessary to detention basin erosive gullies have formed remove the gully, and then plant a ground cover and water until it is established Provide lime and a one-time fertilizer application Vegetation is too short or too Maintain vegetation at a height of long approximately six inches Fnrtn cwaW _wPr nrtPnt,nn Racm lLCM_PP" 7 Pa 1 of 4 Permit Number 51.✓ S' 0 LO:5" a 7 (to be provided by DWQ) Drainage Area Number / BMP element Potential problem How I will remedrate the problem The inlet device pipe or The pipe is clogged Unclog the pipe Dispose of the 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 swale smooth it over and provide erosion control devices such as reinforced turf matting or riprap to avoid future problems with erosion The forebay Sediment has accumulated to Search for the source of the a depth greater than the sediment and remedy the problem if original design depth for possible Remove the sediment and sediment storage 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 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 to maintain optimal plant health Plants are dead, diseased or Determine the source of the dying problem soils, hydrology, disease, etc Remedy the problem and replace plants Provide a one-time fertilizer application to establish the ground cover if a soil test indicates i 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 area Sediment has accumulated to Search for the source of the a depth greater than the sediment and remedy the problem if original design sediment possible Remove the sediment and storage depth dispose of it in a location where it will not cause impacts to streams or the BMP Algal growth covers over Consult a professional to remove 50% of the area and control the algal growth Cattails, phragmites or other Remove the plants by wiping them invasive plants cover 50% of with pesticide (do not spray) the basin surface Fnrm cwatri_WPt nPtrnfinn Rac,n ORM_RPv i Pann? of 4 Permit Number Sly 7 0 V Vs;c 7 (to be prp OW )_ _ Drainage Area Numbers �j' BMP element Potential problem How I will remediate the problem The embankment Shrubs have started to grow Remove shrubs immediately on the embankment Evidence of muskrat or Use traps to remove muskrats and beaver activity is present consult a professional to remove beavers A tree has started to grow on Consult a dam safety specialist to the embankment remove the tree An annual inspection by an Make all needed repairs appropriate professional shows that the embankment needs repair The outlet device Clogging has occurred Clean out the outlet device Dispose of the sediment off -site Phe outlet device is damaged I Repair or replace the outlet device The receiving water Erosion or other signs of Contact the local NC Division of damage have occurred at the Water Quality Regional Office, or outlet the 401 Oversight Unit at 919-733- 1786 The measuring device used to determine the sediment elevation shall be such that it will give an accurate depth reading and not readily penetrate into accumulated sediments When the permanent pool depth reads 6 5 feet in the main pond, the sediment shall be removed When the permanent pool depth reads 6 5 feet in the forebay, the sediment shall be removed BASIN DIAGRAM ill in the blanks) Permanent Pool Elevation 5 5 Sediment Removal EVo2 Pe anen Pool --------------- olume Sediment Removal Elevation -I Vol Bottom Elevatft Min------------------------------------------- -- �--- -2 jl-ft Storage Storage FOREBAY MAIN POND Fnrt cwnni-wPt DPt>nfinn Racm n q m-Rvv 2 Pao i of 4 Permit Number S vyo g n� (to be provided by DWQ) I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed above I agree to notify DWQ of any problems with the system or prior to any changes to the system or responsible party Project name Family Entertainment Center BMP drainage area number SW Pond #I Print name Brian McCall Title Address 205 8'h Ave N North Myrtle Beach, SC 29582 Phone (843) 249-4562 . , A Signature Dateq�a8 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 11 QrLJ a Notary Public for the State of County of rtwwScJccAc_ do hereby certify that :&ri QV\ to f (t L1I personally appeared before me this aq'o� day of P: , 4co3 , and acknowledge the due execution of the forgoing wet detention basin maintenance requirements Witness my hand and official seal, @�OTA�7�C 1j134�G u COU SEAL My commission expires (0 - t5 a00 9 Fn,m cwani-WPt nrtnnt..n Racm n.CM_RPv'i Pao.4 of 4 DEMLR USE ONLY - Date Received Fee Paid Permit Number 1 J t J 0c//c i-c�! NC DEQ Division of Energy, Mineral and Land Resources STATE STORMWATER PERMIT RENEWAL APPLICATION FORM In accordance with 15A NCAC 2H 1045(3), the current permit holder shall renew their high density permit 180 days pnor to its expiration Renewed permits are valid for a period of 8 years per Session Law 2011-398 (SB 781) Section 60 (c) This application form rs for permit renewals only A PROJECT INFORMATION 1 State Stormwater Permit Number SW8 080527 2 Project name Family Entertainment Center of Shallotte 3 Project street address City Shallotte 349 Whitewlle Road County Brunswick ZIP 28470 4 What, if any changes have been made to the project as permitted? None If the project has changed from the original approved plans, please complete SWU-101 for a Major Modification or Minor Modification Application form available at https //deq nc gov/about/divisions/energv- mineral-land-resources/energy-mineral-land-rules/stormwater-program/post-construction B PERMITTEE INFORMATION If changes to the permittee or project name have been made please complete either the Permit Update form or the Permit Transfer form available at https //deq ncgov/about/divisions/energy-mineral-land- resources/energy-mineral-land-rules/stormwater-program/post-construction State Stormwater Permits do not automatically transfer with the sale of the property 1 Current Permit Holders Company Name/Organization BR & JD Leasing LLC 2 Signing Officials Name Dr John D Ward 3 Signing Official's Title Manager 4 Mailing Address 11 Brierwood Road City Shallotte State NC ZIP 28470 5 Street Address City 6 Phone ( 9�0 ) 754-754-6453 Email jdward@atmc net SEP 2 4 2021 BY_ ZIP Stormwater Permit Renewal Form Page 1 of 3 May 11 2018 C SUBMITTAL REQUIREMENTS Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR Central Office (Urbanizing Areas Ph 2 USMP Non -Coastal HQW/ORW) Only applications packages that include all required items listed below will be accepted and reviewed Initial each item below to indicate that the required information is provided in the application package IaE 1 A permit application processing fee of $505 00 payable to NCDEQ 2 One original signed hard copy and one electronic copy of this completed form The signing official named on this application to represent the current permittee must meet one of the following a Corporation — a principle executive officer of at least the level of vice-president b Limited Liability Company (LLC) — a manager or company official as those terms are defined in G S 57D "North Carolina Limited Liability Company Act c Public Entity — a principal executive officer, ranking official or other duly authorized employee d Partnership or limited partnership — the general partner, e Sole proprietor or f Letter of authorization signed by one of the signatories noted in a — e above authorizing the signature of another entity N/A 3 One hard copy and one electronic copy of recorded documents required by the original permit that have not yet been received by DEMLR, including deed restrictions protective covenants, condominium/planned community declaration and easements If the project has been built, include documentation that the maximum BUA per lot or maximum total BUA has not been exceeded If the project has not been built, include a signed agreement that the final recorded deed restrictions and protective covenants will be submitted at a later date 4 O&M Agreements Please select one ❑ I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to Vr keep this on file with the permit or I do not have a copy of the current recorded O&M Agreement for all SCMs and am requesting a copy be sent tome I agree to keep this on file with the permit 5 Dgsigner Certifications Please select one �f A copy of the certification(s) confirming that the project was built in accordance with the approved plans have been previously provided to the Division or ❑ A copy of the certification(s) confirming that the project was built in accordance with the approved plans are enclosed, or ❑ The project has not yet been built N/A 6 [IF APPLICABLE) If the project has been built, one original hard copy and one electronic copy of a signed sealed and dated letter from a licensed professional stating that the SCMs have been inspected and that they have been built and maintained in accordance with the permit 7 [IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC) Provide one hard copy and one electronic copy of documentation from the NC Secretary of State or other official documentation, which supports the titles and positions held by the persons listed in Section C 2 per 15A NCAC 2H 1043(3)(b) https //www sosnc gov/online services/search/by title/ Business Registration SEP 2 4 2021 BY Stormwater Permit Renewal Application Form Page 2 of 3 May 11 2018 D PERMITTEE'S CERTIFICATION Dr John D Ward, Manager the person legally responsible for the permit, certify that I have a copy of the Permit and O&M Agreement on site (or I will obtain a copy and it will be kept on site) that I am responsible for the performance of the maintenance procedures, and the site has been and will be maintained according to the O&M Agreement and approved plans I agree to notify DEMLR of any problems with the SCMs or built -upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the project SCMs or ownership All information provided on this permit renewal application is to the best of my knowledge correct nd c mpl:2t Signature % > Date NOTARIZATION I, Sabrina B Babson North Carolina County of Brunswick a Notary Public for the State of do hereby certify that Dr John D Ward, Manager personally appeared before me this the 1 st day of September 20 21 and acknowledge the due execution of the forgoing instrument Witness my hand and official seal 0 w My ditf4iMSon @ so U800 'S�/CK COO' .. W.' 110 October27 2023 A^ AC: Via,` r, SEP 2 4 2021 11 BY Stormwater Permit Renewal Application Form Page 3 of 3 May 11 2018 d Permit (to be pmndad by DWO) -pF WATF,SO 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 III) must be printed filled out and submitted along with all of the required information IPROJECT4INFORMATION%.'' ..` ..rAu '` .ee. '4"+`y's".'�"J,.. ` '''k.6 ' =,.' Project name Family Enlenainmenl Center Contact person „ Bnan McCall i Phone number 1843 249-4562 - - - - Date @7 May Off Drainage area number Storm Water Pond #1 _ ` IpxDESIGN`INPORMATION,' ra "fir. " "r'z." —,- `,'. Site Characteristics Drainage area 531 432 fP Impervious area 345431 fP %Impervious 6500003763 % Design rainfall depth 15 in Storage Volume Non SR Waters Minimum volume required 42182 fl3 Volume provided 45401 rya Storage Volume SR Waters 1 yr 24 hr runoff depth NIA in Pre -development 1 yr 24 hr runoff NIA N3 Post development 1 yr 24 hr runoff NIA fl3 Minimum volume required #VALUE' n3 Volume provided NIA rya Peak Flow Calculations Is pre/post control of the 1 yr 24 hr peak flow required9 Y (Y or N) 1 yr 24 hr rainfall depth 3 7 in Rational C pre development 03 (unitless) Rational post -development 07 (unitless) Rainfall intensity 1 yr 24 hrstonn 57 tnlhr Pre -development 1 yr 24 hr peak flow 210 ft3lsec Post -development 1 yr 24 hr peak flow 59 ttalsec Pre/Post 1 yr 24 hr peak flow control 15 1 ft/sec Basin Elevations Basin bottom elevation 200 ft Sediment cleanout elevation 100 it Bottom of shelf elevation 500 it Permanent pool elevation 550 ft Top of shelf elevation 600 It Temporary pool elevation 700 It Volume and Surface Area Calculations SAIDA ratio 465 (unitless) Surface area at the bottom of shelf 2359500 fl2 Volume at the bottom of shelf 124284 00 tt3 Permanent pool surface area required 24 712 11 Permanent pool surface area provided 26 889 g? Permanent pool volume 136905 rya Average depth for SAIDA tables 5091487225 it Surface area at the top of shelf 30 832 1? Volume at the top of shelf 151 335 rya SHW7- = I ro' MSc - Form SW401 Wet Detention Basin Rev 3 y OC` 0��0�8 OF (!W4 Salts mar By MTacof- 51NrM #,A suwrcr. pftm hV4ug-u, zing) Paris 1 a 11 Design Summary Page 1 of 2 1 f 1 t _ _ nn < ) f ♦: �°�` to r • � � ,t E 0 Permit No (to be provided by DWQ) II DESIGN INFORMATION Forebay volume 26 588 rya Forebay %of permanent pool volume 19 % OK Temporary pool surface area provided 33 645 fie Drawdown Calculations Treatment volume drawdown time 249 days OK Treatment volume discharge rate 020 fi3g Pre -development 1 yr 24 hr discharge 2102 fi3(s OK Post -development l yr 24 hr discharge 590 ryals OK Additional Information Diameter of onfice 300 in Design TSS removal 90 % Basin side slopes 3 1 OK Vegetated shelf slope 10 1 OK Vegetated shelf width 10 It OK Length of fiowpath to width ratio 3 1 OK Length to width ratio 25 1 OK Trash rack for overflow & onfice? Y (Y or N) OK Freeboard provided 42 fi OK Vegetated filter provided? N (Y or N) Design must be based on 90%TSS removal Recorded drainage easement provided? Y (Y or N) OK Capures all runoff at ultimate build -out? Y (Y or N) OK Drain mechanism for maintenance or emergencies portable pump 4VALf1Ei Form SW401 Wet Detention Basin Rev 3 Paris I & 11 Design Summary Page 2 of 2 Permit No (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 protect Initial in the space provided to indicate the following design requirements have been met If the applicant has designated an agent the agent may initial below If a requirement has not been met, attach justification Pagel Plan Initials Sheet No 1 Plans (1 50 or larger) of the entire site showing /oG,5� Design at ultimate build out SQVIcgP Off site drainage (if applicable) AWI-7o uW-Delineated drainage basins (include Rational C coefficient per basin) Own` TblPM-Basin dimensions A/A Pretreatment system t oKI 3ors High flow bypass system "i tors Maintenance access /orS Recorded drainage easement and public right of way (ROW) 3er5' Overflow device and t or.5— Boundaries of drainage easement 2 Partial plan (1' = 30' or larger) and details for the wet detention basin showing 3PF5' Outlet structure with trash rack or similar 104- Maintenance access ' 9cFS Permanent pool dimensions 3op5;leF37' Forebay and main pond with hardened emergency spillway 3oFs Basin cross section 3oFs Vegetation specification for planting shelf and tij/A Filter stnp —ilk 3 Section view of the dry detention basin (1 = 20 or larger) showing . I - Side slopes 31 or lower Pretreatment and treatment areas and Inlet and outlet structures 3 of 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 6 An assurance that the installed system will meet design specifications upon initial operation once the project is complete and the entire drainage area is stabilized 7 A construction sequence that shows how the wet detention basin will be protected from sediment until the entire drainage area is stabilized -AM2gAdA 8 The supporting calculations 9 A copy of the signed and notarized inspection and maintenance (I&M) agreement _ 10 A copy of the deed restriction Form SW401 Wet Detention Basin Rev 1 Part III Required Items Checklist Page 1 of 1 State Stormwater Management Systems Permit No SW8080527 Family Entertainment or Shallotte, LLC Stormwater Permit No SW8080527 Brunswick County Designer's Certification 1, JAl R • PAJ5Mf , as a duly registered MF,FtoofAi FJ IW n the State of North Carolina, having been authonzed to ooserve (periodical / weekly/ full time) the construction of the protect, (Protect) for SJIKt AS ABp,/f- (Protect Owner) hereby state that, to the best of my abilities, due care and diligence was used in the observation of the protect 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 Acc MA709r117 t 1>1nIaW5IC J5 , Anlb AtT> &LirJ6 of Fb.4JD .qQg WITH,) NORMAL coNsrnuuzoo( TD A60 >?�Ai .Ji- �7s oK �.IteEE{ , C-V9AJrAfr- Rt4V ,+"V.Js. Signature t"A Registration �i SEP 2 4 202, 11 BY SEAL Page 7 of 8 s State Stcrmwater Management Systems Permit No SW8080527 Certification Requirements The drainage area to the system contains approximately the permitted acreage The drainage area to the system contains no more than the permitted amount of built -upon area All the built -upon area associated with the project is graded such that the runoff drains to the system All roof drams are located such that the runoff is directed into the system The outlet/bypass structure elevations are per the approved plan The outlet structure is located per the approved plans Trash rack is provided on the outlet/bypass structure All slopes are grassed with permanent vegetation Vegetated slopes are no steeper than 3 1 The inlets are located per the approved plans and do not cause short- circurtmg of the system The permitted amounts of surface area and/or volume have been provided Required drawdown devices are correctly sized per the approved plans All required design depths are provided All required parts of the system are provided, such as a vegetated shelf, and a forebay The required system dimensions are provided perthe approved plans cc NCDENR-DWQ Regional Office Brunswick County Budding Inspections SEP 2 4 2021 BY Pace 8 of 8 High Density Developments with Outparcels 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 Developments with Outparcels where outparcel lots will be subdivided from the main tract and sold 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, Dr John D Ward, 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 outparcel or future development area 1 The following covenants are intended to ensure ongoing compliance with State Stormwater Management Permit Number SW8 0805271as 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 built -upon area for the areas listed below and shown on the approved plans is as follows Area BUA Onsite Area 209,886 sf Outparcel #1 35,545 Future Development 100,000 at These allotted amounts include any built -upon area constructed within the property boundaries, and that portion of the right-of-way between the lot lines 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 The runoff from all built -upon area within the outparcel or future development area must be directed Into the permitted stormwater control system 8 Built -upon area in excess of the permitted amount will require a permit modification 9 The connection from the outparcel's collection system Into the stormwater control shall be made such that short-circuiting of the system does not occur 10 For those outparcels or future development areas whose ownership is not retained by the permittee, the new owner shall submit a separate offsite stormwater permit application to the Division of Water Quality and receive a permit prior to construction 11 The project and each outparcel 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 Form DR PC-2 Rev 2 05Nov2009 Page f of 2 :771 ~• High Density Developments with Outplarcels " Deed Restrictions & Protective Covenances I, J 1 '' II -- , a Notary Public in the State of or`-k i�.tr LrIj , County of I4Paa VfrioIeZ, do hereby certify that jwoh►3 D, Vkrd _ personally appeared before me this the IM day of 20 IV and acknowledge the due execution of the foregoing instrument Witness my hand and official seal, At" Signature My Commission expires IYl&rcL.2� 2olL Form DRPC-2 Rev 2 05Nov2009 Page 2 of 2 SEAL 6 OFFICIAL SEAL Notary Public North Carolina NEW HANOVERCOUNTY H SCOTTKENNEDY,JR ��CE' IVEr) JUN 0 8 2010 BY J40P High Density Commercial Subdivisions I Deed Restrictions & Protective Covenances IP�tVccordan ith Title 15 NCAC 2H 1000, the Management Regulations, deed restrictions W pro ve covenants are required for High Density Commercial Subdivisions where lots will ubdivided and sold and runoff will be treated in an engineered stormwater control y Deed restrictions and protective covenants are necessary to ensure that the evelopment maintains a built -upon area consistent with the design criteria used to size the stormwater control facility I, Brian McCall , 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 within the project known as The Family Entertainment Center of Shallotte_ 1 The following covenants are intended to ensure ongoing compliance with State Stormwater Management Permit Number _SW8 08 0527. as Issued by the Division of Water Quality under NCAC 2H 1000 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 per lot is _209,886 square feet Future development to the current drainage area of the permitted pond will be limited to 135,545 sf 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 lmuted 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 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 8 The owner of each lot, whose ownership is not retained by the permittee, is required to submit a separate stormwater permit application to the Division of Water Quality and receive a permit prior to construct) Signature �r' ��= Date State of D k>_Z�-'b trl , a Notary Public in the County of �B c.JLc_L do hereby certify that �-Rr-L,clr-\ A lc Cat personally appeared before me this the day of ���cmi�cv— 20 Did , and acknowledge the due execution of the foregoing instrument Witness my hand and v as Signature z `G My Commission expires aCO5