SW8140102_CURRENT PERMIT_20220715

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8 14 Ol a
DOC TYPE
M7CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
2022 07 15
YYYYMMDD

ROY COOPER
Governor
ELIZABETH S. BISER
secretary
BRIAN WRENN
Director
July 15', 2022
Sampson Bladen Oil Company, Incorporated
Attn: Haddon M. Clark, III, President
PO Box 469
Clinton, NC 28329
NORTH CAROLINA
Environmental Quality
Subject: Permit Renewal
Post -Construction Stormwater Management Permit No. SW8 140102
Han -Dee Hugo's #39 (Rocky Point)
Pender County
Dear Mr. Clark:
The Division of Energy, Mineral and Land Resources received a complete 8-year Permit Renewal Application for
the subject permit on July 15', 2022. The Division is hereby notifying you that permit SW8 140102 has been
renewed, updated, and re -issued on July 15', 2022, as attached. Please be aware that the renewal and re -issuance
of this stormwater permit does not imply that the site is currently in compliance.
This permit shall be effective until January 10t6, 2030 and does not supersede any other agency permit that may
be required. The project shall be subject to the conditions and limitations as specified therein. This permit does
not impose new or increased stormwater control requirements; it clarifies the rules and requirements of this
program to provide you with a better understanding of your obligations under this permit. Failure to comply with
these requirements will result in future compliance problems. Please note that this permit is not transferable
except after notice to and approval by the Division.
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 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.
This project will be kept on file at the Wilmington Regional Office. If you have any questions concerning this
permit, please contact Dylan McPeake in the Wilmington Regional Office, at [phone] or
[e-mail].
Sincerely,
zv-
Brian Wren , Director
Division of Energy, Mineral and Land Resources
Enclosures: Attachment C — Permitting History
Renewal Application Documents
DES/DM: \\\Stormwater\Permits & Projects\2014\140102 HD\2022 07 permit 140102
cc: Wilmington Regional Office Stormwater File
r�rnw t QZ� North Carolina Departmental Environmental Quality I Division of Energy, Mineral and Land Resources
Wilmington ReglonalOmce 1127 Cardinal Drive Extension I Wilmington, North Carolina 28405
910.796.7215

Post -Construction Stormwater Management
Permit No. SW8 140102
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
POST -CONSTRUCTION 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
Sampson-Bladen Oil Company, Inc.
Han -Dee Hugo #39 (Rocky Point)
11795 US Highway 117 South, Rocky Point, Pander County
FOR THE
construction, operation and maintenance of a constructed wetlands in compliance with Session
Law 2008-211 and the provisions of 15A NCAC 2H .1000 (hereafter collectively referred to as
the "stormwater rules') and as outlined in the application, approved stormwater management
plans, supplement, calculations, operation and maintenance agreement, recorded documents,
specifications, and other supporting data (the "approved plans and specifications") as attached
and/or on file with and approved by the Division of Energy, Mineral and Land Resources (the
"Division" or "DEMLR"). The project shall be constructed, operated and maintained in
accordance with these approved plans and specifications. The approved plans and
specifications are incorporated by reference and are enforceable part of this permit.
This permit shall be effective from the date of issuance until January 101, 2030 and shall be
subject to the following specified conditions and limitations. 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 condition. 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.
1. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as
described in Section 1.7 of this permit.
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.
Page 1 of 6

Post -Construction Stormwater Management
Permit No. SW8 140102
4. The project shall maintain a 50' wide vegetated buffer adjacent all surface waters,
measured horizontally from and perpendicular to the normal pool of impounded
structures, the top of bank of each side of rivers and streams and the mean high-water
line of tidal waters.
5. All runoff being directed into wetlands shall flow into and through those wetlands at a
non -erosive velocity of 2 fps or less.
6. The following design elements have been approved for this constructed wetlands
stormwater facility, and must be provided in the system at all times:
a. Drainage Area, acres:
Onsite, ft2:
Offsite, ft2:
b. Total Impervious Surfaces, ft2:
Onsite, ft2:
Offsite, ft2:
c. Plant Depth, feet:
d. TSS removal eff., %:
e. Design Storm, inches:
f. Permanent Pool Elevation, FMSL:
g. Permitted Wetland Surface Area, ft2:
In. Shallow Land Area, ft2:
i. Shallow Water Area, ft2:
j. Deep Pool Area, ft2:
k. Permitted Temporary Storage Volume, ft3
I. Temporary Storage Elevation, FMSL:
m. Controlling Orifice O":
n. Nos..Plants (Shallow Land);
o. Nos. Plants (Shallow Land)
p. Receiving Stream / River Basin:
q. Stream Index Number:
r. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
1.74
75,871
N/A
57,437
57,437
N/A
12
90
1.5
21
7,624
2,842
3,180
1.602
7,100
22
1.5
800
752
Northeast Cape Fear / Cape Fear
18-74-(47.5)
B;Sw
1. The permittee is responsible for verifying that the proposed built -upon area for the entire
project does not exceed the allowable built -upon area.
2. 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.
3. Records of maintenance activities must be kept and made available upon request to
authorized personnel of DEMLR. The records will indicate the date, activity, name of
person performing the work and what actions were taken.
Page 2 of 6

Post -Construction Stormwater Management
Permit No. SW8 140102
Upon completion of construction, prior to issuance of a Certificate of Occupancy, and
prior to operation of this permitted facility, the permittee shall cause a certification from
an appropriate designer for the system installed to be submitted, 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.
5. The permittee shall at all times provide the operation and maintenance necessary to
assure that all components of the permitted stormwater system function 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:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of side slopes.
d. Maintenance of the wetlands plants and replacement of dead plants.
e. Immediate repair of eroded areas.
f. Maintenance of side slopes in accordance with approved plans and
specifications.
g. Trash and debris removal and unclogging of the wetlands, outlet structure,
orifice, catch basins and piping.
h. Access to all components of the system must be available at all times.
6. 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 project 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
project 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.
7. Prior to transfer of the permit, the stormwater facilities will be inspected by DEMLR
personnel. The facility must be in compliance with all permit conditions. Any items not in
compliance must be repaired or replaced to design condition prior to the transfer.
Records of maintenance activities performed to date will be required.
8. 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.
Page 3 of 6

Post -Construction Stormwater Management
Permit No. SW8 140102
9. 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.
10. 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.
11. During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately. Infiltration systems should not be used as erosion
control devices, due to the potential clogging. 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.
III. GENERAL CONDITIONS
1. CORRECTIVE ACTIONS REQUIRED. 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.
2. PERMIT RENEWAL. 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. 1 045(3).
3. CHANGES TO THE PROJECT NAME, PERMITTEE NAME OR CONTACT
INFORMATION. The permittee shall submit a completed Permit Information Update
Application Form to the Division within 30 days to making any one of these changes.
4. TRANSFER. This permit is not transferable to any person or entity except after notice to
and approval by the Director. Neither the sale of the project and/or property, in whole or
in part, nor the conveyance of common area to a third party constitutes an approved
transfer of the permit.
a. TRANSFER REQUEST. The transfer request must include the appropriate
application, documentation and the processing fee as outlined in 15A NCAC
02H.1045(2). This request must be submitted within 90 days of the permit holder
meeting one or more of the following:
i. A natural person who is deceased;
ii. A partnership, limited liability corporation, corporation, or any other business
association that has been dissolved;
iii. A person or entity who has been lawfully and finally divested of title to the
property on which the permitted activity is occurring or will occur through
foreclosure, bankruptcy, or other legal proceeding.
iv. A person or entity who has sold the property, in whole or in part, on which the
permitted activity is occurring or will occur;
V. The assignment of declarant rights to another individual or entity;
vi. The sale or conveyance of the common areas to a Homeowner's or Property
Owner's Association, subject to the requirements of NCGS 143-214.7(c2),
Page 4 of 6

Post -Construction Stormwater Management
Permit No. SW8 140102
b. TRANSFER INSPECTION. 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 project and the on -site stormwater system complies
with the permit conditions. Records of maintenance activities performed to date
may be requested. Projects not in compliance with the permit will not be
transferred until all permit and/or general statute conditions are met.
5. COMPLIANCE. The permittee is responsible for compliance with the terms and
conditions of this permit until the Division approves the transfer request.
a. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved
plans, application, supplement, operation and maintenance agreement, all
applicable recorded documents, and specifications shall be maintained on file by
the permittee at all times.
b. DIVISION ACCESS. The permittee grants Division Staff permission to enter the
property during normal business hours to inspect all components of the permitted
project.
C. ENFORCEMENT. 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.
ANNUAL CERTIFICATION. The permittee shall electronically submit to the
Division an annual certification completed by either the permittee or their designee
confirming the projects conformance with permit conditions
OBTAINING COMPLIANCE. 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 modified plans and certification
in writing to the Director that the changes have been made.
OTHER PERMITS. 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.
Page 5 of 6

Post -Construction Stormwater Management
Permit No. SW8 140102
Permit modified and reissued this the 151" day of July, 2022.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
A,bnan Wrenn, UWZGW
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 6 of 6

Attachment C - Permitting History
Han -Dee Hugo's #39 (Rocky Point)
Permit No. SW8 140102
Approval
Permit
131MS
Description of the Changes
Date
Action
Version
1/10/2014
Original
10
Approval
The revisions include configuring the previosuly approved
building and parking layout to accommodate a Little
4/21/2016
Plan
1.1
Caesar's Pizza restraunt, and the revisions to the runoff
Revision
collection system along the west property line to address
offsite drainage
7/15/2022
Renewal
2.0
Expires 1/10/2030

Permit Number
(robe provided by DIVQ)
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 LO 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.
BMI%1ement:—=`---;Potentiate;
mblem
How_Lwillaemediatethe- robl; r
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 or 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.
if applicable).
-damaged
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.
JAN 0 G 2011
Form SW401-Wetland O&M-Rev.4 BY. Page I of 3

Permit Number: 5�fq 9 (40/0 Z
(to be prodded by DIVQ)
BMP_'elemenh �= _.___
=Potentral, roblem.=_�-,�, �
=13ow.1 wrllremediate#he rollem. —_
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 pool 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
4 KUv �i htt.J 't at 919-733-1786.
JP4 0 G 294:1 !I
2 f
Form SW40] Wetland O&M Rev.4 BY; PageO 3

Permit Number: :5W I -f—()1O L
(to be provided by Dn'Q)
1 acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Project naine:Han-Dee Hugo
BMP drainage area number:
Print name:Sampson-Bladen Oil Company, Inc.
Title:_ H QdclCr) M7 -brY) -=L Pre r-,'Ae ,-i
Address:3309 Drake Circle Raleigh, NC 27607
Date: I )- i J.-2 0 13
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, e,,+h)
n R
• Lor rsn
, a Notary Public for the State of
or\ h
CGra\: r(i
, Countyof
W 0. KC. , do hereby certify that
personally appeared before me this 3. 0b day of
�Zce. rK r eiol� , and acknowledge the due execution of the forgoing stormwater wetland
maintenance requirements. Witness my hand and official seal, ,
�`fOo
My commission expires I / ao I AU 15
ECE-RVE
JAI 0 6 2014
BY:
Form SW401-Wetland O&M-Rev.4 Page 3 of 3

r
!' ', .

U MLK ubt: UNLr
et Received
Fee Pak
Pe it Number
02z
2 So5
w O
oz
NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
In accordance with 15A NCAC 21-1.1045M). the current permit holder shall renew their high density permit 180 days
prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011-398 (SB 781)
Section W (c). This application form is for permit renewals only.
A. PROJECT INFORMATION
1. State Stormwater Permit Number: SW8 990406
2. Project name: Han -Dee Hugo's #39 (Rocky Point)
3. Project street address: 11795 Hwy 117 South
City: Ro C4 Pomn-i- CountyZIP: '91W
4. What, if any, changes have been made.to the project as permitted? /Voh _
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://deg.nc.gov/about/divisions/eneroy-
minera I -Ian d-resources/energy-mineral-land-ru ieststormwater-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 fifths://deg.nc.gov/abouttdivisionsfenergy-minerat-land-
resources/eneroy-mineral-land-rules/storrnwater-program/post-construction. State Stormwater Permits do not
automaticaltytransfer with the sale of the property.
1. Current Permit Holder's
2. Signing Official's Name:
3. Signing Official's Title: .
4. Mailing Address: _
City:
5. Street Address:
City:
6. Phone: t 9( y )
Sim
Email:
ECEIVE
Jul. 15 2R2
;k 8,)21
Stomwater Permit Renewal Form Page 1 of 3 May 11, 2018

n ,
ULMLN UJt UNLT
Date R ceiv d
Fee Paid.
Permit Number
a
say=
SuwFs Ito 7
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
prior 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 is for permit renewals only.
A. PROJECT INFORMATION 1y01O2.
1. State Stormwater Permit Number: SW8 990406
2. Project name: Flan -Dee Hugo's #39 (Rocky Point)
3. Project street address: 11795 Hwy 117 South
City: RD(,I
4 porA+ County:
Penier ZIP:
�W7
4. What, if any,
changes have been made to the project as permitted?
No h t-
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://deg.nc.gov/about/divisions/energv-
m ineral-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://deg.nc.gov/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 oroperty.
1. Current Permit Holder's
2. Signing Official's Name
3. Signing Official's Title:
4. Mailing Address:
City:
5. Street Address:
City:
6. Phone: (-?(y )
ti
Email:
0/ / A-1
•r
State: Nr" zip: .Z�
O[E( EOVE
ZIP: W21
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:
✓t1M 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
Pit „rt,
signature of another entity.
jar k 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.
OEM Agreements, Please select one:
I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to
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 to me. I agree to keep this on file with the permit.
_ " 5. Designer Certifications, Please select one:
[✓j 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.
_VJY/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
„ y 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
JUL 14 2022 `
BY: -
Stormwater Permit Renewal Application Form Page 2 of 3 May 11, 2018

D. PERMITT�EE'S CERTIFICATION
I, g'f�dri M. Ctar V J' 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, co ec nd m lete. /�/� I �7
Signature: (v t' c0.,,✓I. CL f ± Date: / -c� Z
NOTARIZATION:
this the \ \ 1h5 day of
execution of the forgoing instrument. Witness my hand and official seal,
l I ao I aaa5
a Notary Public for the State of
, do hereby certify
personally appeared before me
:, and acknowledge the due
iiaa=to as �f_
JUL 14 2022
BY:—
Slormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

/,
0
,

AT
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WETLAND SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted along with all the required information.
o�OF W A Tf9'q
y
o �
ILYROJECT'INFORMATION '''` `:: I I `.t :Wt ;, r:... —J: . ,_tx
Project name Han•Dee Hugo::" " + _
Contact name Sampson-Bladen 0l Company,^.Inc
Phone number 9191;:" 785 K -:1* r1904 ',
Date 'De6embeF.9; 20131`
s r t
Drainage area number i rT.YL
Site Charactedstics
Drainage area
i tn(: ;i7587.ti00 ilz
Impervious area
r:r'. „'.;
. ,.....
5T437,00 ft'
Percent impervious
75.7% %
Design rainfall depth
r ;%`' '.: 1-50Inch
Peak Flow Calculations
1-yr, 24-hr rainfall depth
3.65 ;in
1-yr, 24-hr intensity
0.15 ."`P `in/hr
Pre -development l-yr, 24-hr runoff
0.09 >. ft/sec
Post -development 1 -yr, 24-hr runoff
•0.18- ' lft'/sec
Pre/Post 1-yr, 24-hr peak control
0.09 ft'/sec
Storage Volume: Non -SA Waters
Minimum required volume 6,936'00 ft'
Volume provided (temporary pool volume) 7,100.00 ft' OK
Storage Volume: SA Waters Parameters
1.5" runoff volume
-ft'
Pre -development l-yr, 24-hr runoff volume
Post -development 1-yr, 24-hr runoff volume
ft'
Minimum volume required
it
Volume provided
ft'
Outlet Design
Depth of temporary pool/ponding depth (Dpi.)
12.00 in OK
Drawdown time
2.43 days OK
Diameter of orifice
1.50 in OK
Coefficient of discharge (Ce) used in orifice diameter
0.60 (uni8ess)
calculation
Driving head (Hj used in the orifice diameter calculation 0.33 ft OK
Forth SW401-We9and-Rev.e-11/16109 Parts I and 11. Pmlect Design Summary, Page 1 or 3

Surface Areas of Welland Zones
Surface Area of Entire Welland
Shallow Land
The shallow land percentage is:
Shallow Water
The shallow water percentage is:
Deep Pool
Forebay portion of deep pool (pretreatment)
The'forebaysurface area percentage is:
Non-forebay portion of deep pool
The non-forebay deep pool surface area percentage is:
Total of wetland zone areas
Add or subtract the following area from the zones
Topographic Zone Elevations
Temporary Pool Elevation (TPE)
Shallow Land (top)
Permanent Pool Elevation (PPE)
Shallow Water/Deep Pool (top)
Shallow Water bottom
Most shallow point of deep pool's bottom
Deepest point of deep pool's bottom
Design must meet one of the following two options:
This design meets Option #1,
Top of PPE is within 6' of SHWT, If yes:
SHWT (Seasonally High Water Table)
This design meets Option #2,
Wetland has liner with permeability < 0.01 in/hr, If yes:
Depth of topsoil above impermeable liner
Topographic Zone Depths
Temporary Pool
Shallow Land
Permanent Pool
Shallow Water
Deep Pool (shallowest)
Deep Pool (deepest)
Planting Plan
Are cattails included In the planting plan?
Number of Plants recommended in Shallow Water Area:
Herbaceous (4'cubic-inch container)
Number of Plants recommended in Shallow Land Area:
Herbaceous (4'cubic-Inch container), OR
Shrubs (1 gallon or larger), OR
Trees (3 gallon or larger) and Herbaceous (4+ cubic -inch)
Number of Plants provided in Shallow Water Area:
Herbaceous (Ccubic-inch container)
Number of Plants provided in Shallow Land Area:
Herbaceous (4'cubic-inch container)
Shrubs (1 gallon or larger)
Trees (3 gallon or larger) and
Grass -like Herbaceous (4+ cubic -inch)
7,624.00 fh
2,842.06 ftr
37% %
3,180 00 it,
42% %
h 777.44, ftr
10%%
$A; 6 ft'
11%%
7,624.00 fe
0.00 fe
t�22.00ftamsl
{ ;21c00 ft amsl
b '20160ftamsl
9:00 ft amsl
ft amsl
OK
OK
OK
OK
OK
OK
OK
OK
12.00 in
OK
6.00 in
OK
24.00 in
OK
24.00 in
OK
N; (Y or N)
OK
800
750
120
15 and
600
800
OK
752
OK
Form SW401-Wetland-Rev.6-11116109 Parts I and II. Project Design Summary, Page 2 of 3

Additional Information
Can the design volume be contained?
Does project drain to SA waters? If yes,
What is the length of the vegetated filter?
Are calculations for supporting the design volume provided in the
application?
Is BMP sized to handle all runoff from ultimate build -out?
Is the BMP located in a recorded drainage easement with a
recorded access easement to a public Right of Way (ROW)?
The length to width ratio is:
Approximate wetland length
Approximate wetland width
Approximate surface area using length and width provided
Will the wetland be stabilized within 14 days of construction?
Y (Y or N)
OK
N (Y or N)
OK
N/A it
Y (Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
5.00 :1
OK
202.00 It
37.80 It
7,624.00 ft'
This approx. surface area is within this number of square feet
of the entire wetland surface area reported above:
Y (Y or N)
OK
Form SW401-Wetland-Rev.6-11/16/09 Parts I and II. Project Design Summary, Page 3 of 3

.V�
01-10-'14 16:55 FROM- T-466 P0007/0008 F-818
Han -Dee Hugo
Stormwater Permit No. SW8 140102
Pender County
Designer's Certification
.. .....1y. ..J...
/SW8 140102
l/ Page 1 of 2
"V
1„ i z /( /V� ?
, as a duly registered ��/,6zr-
the State of North Carolina, having been authorized to observe (periodically/weekly/full
time) the construction of the project,
&64'
(Project)
for 51 - 4Z�ewc4;Ki C9� �D rL7(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 are a part of this Certification.
Noted deviations from approved plans and specifications:
Signatur
Registration Number
Date
NOV 2 5 2015
BY,.
Page 6 of 7

01-10-'14 16:55 FROM- T-466 P0006/0008 F-818
Permit No. SW8 140102
Certification Requirements: Page 2 of 2
%jLt,r A, The drainage area to the system contains approximately the permitted
acreage.
P(
The drainage area to the system contains no more than the permitted
amount of built -upon area.
2/�3.
All the built -upon area associated with the project is graded such that the
runoff drains to the system.
A.
All roof drains are located such that the runoff is directed into the system.
{ M 5.
The wetland zone elevations are per the approved plan.
/ 2— -
The wetland is located per the approved plans.
aZ7.
A trash rack is provided on the outlet structure.
�L8.
All slopes are grassed with permanent vegetation.
)2 0.
Vegetated slopes are no steeper than 3:1.
j10.
The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11.
The permitted amounts of wetland zone surface area and volume have
been provided.
�12.
Required drawdown devices are correctly sized and located per the
approved plans.
3. All required design depths are provided.
4. All required parts of the system are provided.
1 115. The required number of wetlands plantings have been provided.
cc: NCDENR-DEMLR Regional Office
Pender County Building Inspections
v,5
Page 7 of 1

ecut cd the forogdigg AS of the dey and year fiiat!66ove wnttan �.t