SW8120712_Current Permit_20120920

AA
WoENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
September 20, 2012
Ms. Robin Strickland, Manager
BBS of ENC, LLC
2113-A South Glen Burnie
New Bern, NC 28562
Subject: Stormwater Management Permit No. SW8 120712
Family Tire
Project served by an Offsite System
Onslow County
Dear Ms. Strickland:
The Wilmington Regional Office of the Division of Water Quality received a complete
Stormwater Management Permit Application for Family Tire on September 13, 2012. Staff
review of the plans and specifications has determined that the project, as proposed, will
comply with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000. We are
forwarding Permit No. SW8 120712, dated September 20, 2012, for the construction of the
built-upon areas and the runoff conveyance/collection system associated with the subject
project.
This permit shall be effective from the date of issuance until rescinded and shall be subject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 runoff
conveyance/ collection system on the lot, the maximum built-upon area limits, and the
procedures for changes of ownership and transferring the permit. Failure to establish an
adequate system for operation and maintenance of the runoff conveyance/ collection
system, to limit the built-upon area, or to transfer the permit in a timely manner, 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 filing fee (if a filing fee
is required) and/or the details of the filing process at 6714 Mail Service Center, Raleigh, NC
27699-6714, or via telephone at 919-431-3000, or visit their website at www.NCOAH.com.
Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please
contact Christine Nelson at [phone].
Sincerely,
oit
harle Wakild, P.E., Director
Division of Water Quality
GDS/can: S:1WQS\Stormwater\Permits& Projects120121120712 Offsite12012 09 permit 120712
cc: Susan Sayger, KSMJ Engineering, PLLC
Onslow County Building Inspections
Christopher Bailey, President, Bailey and Associates, Inc.
Wilmington Regional Office Stormwater File
Wilmington Regional Office
127 Cardinal Drive Extension,Wilmington,North Carolina 28405 One
Phone:[phone] FAX:[phone] DENR Assistance:1-877-623-6748 NorthCarolina
Internet www.ncwaterquality.org Naturally
An Euual Opportunity 1 Affirmative Action Employer �/ "✓U

State Stormwater Management Systems
Permit Number SW8 120712
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
SERVED BY AN OFF-SITE PERMITTED STORMWATER BMP
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
BBS of ENC, LLC
Family,Tire
204 Yopp Road, Jacksonville, Onslow County
FOR THE
construction of impervious areas with runoff to be treated in an offsite permitted stormwater
facility, in compliance with the provisions of SL 2008-211 and Title 15A NCAC 2H .1000
(hereafter collectively referred to as the `°stormwater rules") and the approved stormwater
management plans, application, supplement, specifications and other supporting data as
attached and on file with and approved by the Division of Water Quality and considered a
part of this permit. The stormwater runoff from the site will be routed to the wet detention
pond operated and maintained by Bailey and Associates, Inc. under the terms and
conditions set forth in the latest version of Permit No. SW8 060718.
This permit shall be effective from the date of issuance until rescinded, and shall be subject
to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. The runoff associated with this project has been approved to be discharged into a
stormwater management system permitted under the latest version of SW8 060718.
2. The built-upon area allocated to this development by Stormwater Management Permit
No. SW8 060718, is 66,646 square feet. This project proposes 47,532 square feet.
The amount available for future development is 19,114 square feet.
3. All stormwater conveyance and collection systems must be located in dedicated
common areas or recorded easements. The final plats for the project will be recorded
showing all required public rights-of-way, common areas and easements, in
accordance with the approved plans.
4. The runoff from the permitted built-upon area of this project must be collected and
conveyed to the permitted offsite stormwater BMP.
Page 2 of 6

State Stormwater Management Systems
Permit Number SW8 120712
II. SCHEDULE OF COMPLIANCE
1. This permit is issued contingent on the construction of the permitted offsite stormwater
BMP being complete and in compliance with the conditions of permit number SW8
060718, issued to Bailey and Associates, Inc. on September 13, 2010, as
subsequently revised, modified, or renewed. Prior to the construction of any built-
upon area associated with this permit, the offsite permittee shall have constructed,
operated, maintained, and certified the offsite stormwater management system in
compliance with SW8 060718.
2. The permittee shall construct and maintain the proposed stormwater runoff
conveyance and collection system and the built-upon areas to the dimensions,
elevations and grades as shown on the approved plans.
3. This lot is limited to the amount of built-upon area specified in Section 1.2 of this
permit, and as reported on the application, the supporting calculations and as shown
on the approved plans. The project must maintain a built-upon area less than or equal
to the amount permitted under Stormwater Permit No. SW8 060718. A total built-upon
area in excess of the maximum allowed amount will require a modification to SW8
060718 prior to construction.
4. During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately. After construction the permittee shall maintain
the grassed areas, slopes and vegetated runoff conveyances on the lot in a densely
vegetated state.
5. The permittee is responsible for keeping the stormwater collection system within the
lot property boundaries clear of trash, debris and sediment, and must control the
sediment on the lot in accordance with the requirements of the NC Erosion and
Sediment Control Design Manual. The permittee shall follow the minimum
maintenance procedures and intervals for the lot's built-upon areas and its stormwater
collection /conveyance system as indicated in the Operation and Maintenance
agreement.
6. The permittee shall maintain and repair or replace any of the components of the lot's
stormwater collection and conveyance system such that the lot's runoff is captured
and adequately conveyed to the BMP.
7. Upon completion of the permitted construction on this lot, and prior to occupancy of
the facility, the permittee shall submit to the Division the completed Designer's
Certification accompanied by an as-built survey of the project's built-upon areas and
stormwater collection /conveyance system.
8. The permittee shall submit to the Director and shall have received approval for revised
plans, specifications, and calculations prior to construction, for any modification to the
approved plans, including, but not limited to, those listed below:
a. Any revision to the approved plans, regardless of size.
b. Redesign of or addition to the maximum approved amount of built-upon area.
c. Further development, subdivision, acquisition or sale of any, all or part of the
project area covered by this permit.
d. The construction of built-upon area within any future development area noted on
the approved plan.
e. Alteration of any component of the approved stormwater conveyance/collection
system shown on the approved plan.
Page 3 of 6

State Stormwater Management Systems
Permit Number SW8 120712
9. The Director may determine that other revisions to the project should require a
modification to the permit.
10. This permit shall become void unless the stormwater collection system and built-upon
areas of the lot are constructed and maintained in accordance with the conditions of
this permit and per the supporting documents that are enforceable parts of this permit.
11. The Director may notify the permittee when the permitted site does not meet one or
more of the minimum requirements of the permit. Within the time frame specified in
the notice, the permittee shall submit a written time schedule to the Director for
modifying the site to meet minimum requirements. The permittee shall provide copies
of revised plans and certification in writing to the Director that the changes have been
made.
III. GENERAL CONDITIONS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application, supplement, and other supporting data. Any other
activities undertaken at this site prior to receipt of the necessary permits or approvals
to do so from any local, state or federal government agency having jurisdiction, are
considered violations of NCGS 143-215.1, and subject to the enforcement procedures
pursuant to NCGS 143-215.6.
2. 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 Name/Ownership
Change Form, accompanied by the supporting documentation as listed on the form, to the
Division of Water Quality at least 60 days prior to any one or more of the following events:
a. Further subdivision, sale or conveyance of this lot. The project must be in
compliance with the permit, as determined by a DWQ inspection.
b. Bankruptcy or foreclosure;
c. Dissolution of the corporate entity or partnership;
d. A name change of the permittee;
e. A name change of the project;
f. A mailing address change of the permittee;
3. The approval of a permit transfer request will be considered on its merits and may or
may not be approved.
4. The permittee is responsible for compliance with all terms and conditions of this permit
until such time as the Director approves the permit transfer. Neither the sale of the
project nor the conveyance of common area to a third party shall be considered as an
approved transfer of the permit.
5. Any person or entity found to be in noncompliance with the terms and conditions of
this stormwater management permit or the stormwater rules is subject to enforcement
procedures in accordance with North Carolina General Statute 143 Article 21.
6. The permittee grants permission for DENR Staff to enter the property for the purpose
of inspecting all components of the permitted stormwater management facility.
7. The permit may be modified, revoked and reissued or terminated for cause. The filing
of a request for a permit modification, revocation and reissuance or termination does
not stay any permit condition.
Page 4 of 6

State Stormwater Management Systems
Permit Number SW8 120712
8. Approved plans, application, supplement forms, calculations and specifications for this
project are incorporated by reference and are enforceable parts of the permit. A copy
of this permit, the approved plans and supporting documents shall be maintained on
file by the Permittee for the life of the project.
9. None of the development activities associated with the construction of this project
shall cause a wetland standard violation, a stream standard violation, or other water
quality violation. These violations are subject to civil penalties of up to $25,000.00 per
violation per day pursuant NCGS 143-215.6.
Permit issued this the 20th day of September 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
EC-49d
harles akild, P.E., Director
Division o Water Quality
By Authority of the Environmental Management Commission
Page 5of6

State Stormwater Management Systems
Permit Number SW8 120712
Stormwater Project Number SW8 120712
Family Tire
Onslow County
Designer's Certification — Offsite Lot
I, , as a duly registered in the State of
North Carolina, having been authorized to observe (periodically/weekly/full time) the
construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
Required Items to be checked for this certification to be considered complete are on page 2
of this form.
Noted deviations from approved plans and specifications:
SEAL
Signature
Registration Number
Date
Certification Requirements:
1. The lot contains no more than the maximum permitted amount of built-upon
area.
2. All the built-upon area associated with this permit is graded such that the
runoff drains to the permitted offsite BMP.
3. The lot has been stabilized with permanent vegetation to prevent erosion.
4. Vegetated slopes are no steeper than 3:1.
5. Roof drains are located such that building runoff drains into the system.
6. The inlet from this project into the approved offsite BMP is located per the
approved plans and does not cause short-circuiting.
7. The stormwater conveyance/ collection system on the lot adequately
conveys the design storm runoff to the system and has not been altered from
its permitted condition.
cc: NCDENR-DWQ
Onlsow County Building Inspections
Page 6 of 6

DWO USE ONLY
Dap Rec ived Fee Paid Psrmit Number
Applicable Rules: ❑Coastal SW-1995 ❑Coastal SW-2008 ❑Ph II-Post Construction
(select all that apply) ❑Non-Coastal SW-HQW/ORW Waters ❑Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION 'I- EWE
This form may be photocopied for use as an original
I. GENERAL INFORMATION JUL 2 O 2012
1. Project Name(subdivision,facility,or establishment name-should be consistent with alert name on ar&,
specifications,letters,operation and maintenance agreements,etc.):
Family Tire
2. Location of Project(street address):
204 Yopp Road
City:Jacksonville County:Onslow,NC Zip:28541
3. Directions to project(from nearest major intersection):
Headed south on Highway 17(in Jacksonville),turn right(westerly)onto Highway 258.
Continue approximately 0.85 miles and turn left onto to Yopp Road.Continue approximately 0.5 miles to site.
4. Latitude:34°45'3"N Longitude:77°27'34"W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is(check one): New ['Modification
b.If this application is being submitted as the result of a modification to an existing permit,list the existing
permit number. ,its issue date(if known) ,and the status of
construction: ®Not Started ['Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project(check one):
['Low Density ['High Density ®Drains to an Offsite Stormwater System ['Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application,list the stormwater project number,if
assigned, and the previous name of the project,if different than currently
proposed,
4.a.Additional Project Requirements (check applicable blanks;information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control:1.55 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit:Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name,Project/Permit Number,
issue date and the type of each permit:Sediment/Erosion permit per City of Jacksonville
Form SWU-I01 Version 07Jun20I0 Page 1 of 6 •3

III. CONTACT INFORMATION
1.a.Print Applicant/ Signing Official's name and title(specifically the developer,property owner,lessee,
designated government official,individual,etc.who owns the project):
Applicant/Organization:Robin Strickland-BBS of ENC, .C.
Signing Official&Title:Robin Strickland / Manager
b.Contact information for person listed in item la above:
Street Address:2113-A South Glen Burnie
City:New Bern State:NC Zip:28562
Mailing Address (if applicable):SAA
City: State: Zip:
Phone: ( ) Fax: ( )
Email:[e-mail]
c.Please check the appropriate box.The applicant listed above is:
®The property owner(Skip to Contact Information,item 3a)
❑Lessee*(Attach a copy of the lease agreement and complete Contact Information,item 2a and 2b below)
❑Purchaser*(Attach a copy of the pending sales agreement and complete Contact Information,item 2a and
2b below)
❑Developer*(Complete Contact Information,item 2a and 2b below.)
2.a.Print Property Owner's name and title below,if you are the lessee,purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official&Title:
b.Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address(if applicable): "
City: State: ip:
Phone: ( ) Fax: f JUL Z 0 2012
Email: BY:
3.a. (Optional)Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:Mitchell Brydge-Brydge and Lee
Signing Official &Title:Mitchell Brydge-Developer
b.Contact information for person listed in item 3a above:
Mailing Address:2113-A South Glen Burnie
City:New Bern State:nc Zip:28562 _
Phone: (252 ) 633-1999 Fax: ( )
Email:[e-mail]
4. Local jurisdiction for building permits:Jacksonville
Point of Contact:Aldon Cox Phone#: (910 ) 938-6547
Form SWU-I01 Version 07Jun2010 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
This is a 1.5 acre site located within the City of Jacksonville. A commercial tire retail store and parking are
proposed. All runoff drains to catch basins and into the existing wetpond,in keeping with permit.,
2.a.If claiming vested rights,identify the supporting documents provided and the date they were approved:
❑Approval of a Site Specific Development Plan or PUD Approval Date:
❑Valid Building Permit Issued Date:
❑Other: Date:
b.If claiming vested rights,identify the regulation(s)the project has been designed in accordance with:
❑Coastal SW-1995 ❑Ph II-Post Construction
3. Stormwater runoff from this project drains to the White Oak River basin.
4. Total Property Area:1.53 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area:0 acres
7. Total Property Area(4)-Total Coastal Wetlands Area(5)-Total Surface Water Area(6)=Total Project
Area+:1.53 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded� structures, the area
between the banks of streams and rivers, the area below the Normal High Water(NHW)line or Mean High Water
(MHVV)line,and coastal wetlands landward from the NHW(or MHVV)line. The resultant project area is used to
calculate overall percent built upon area(BL A). Non-coastal wetlands landward of the NHW(or MHW)line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area/ Total Project Area)X 100 =71 %
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project,attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information Drams' . Area Drainage Area Drainage Area Drainage Area
Receiving Stream Name Blue Creek
Stream Class * SC,NSW
Stream Index Number* 19-8
Total Drainage Area(sf) 66646
On-site Drainage Area(sf) 66646
Off-site Drainage Area(sf)
Proposed Impervious Area**(sf) 47532
%Impervious Area**(total) 71.3
Impervious Surface Area Drainage Area Drainage Area Drainage Area.,_. Drainage Area
On-site Buildings/Lots(sf) 11140
On-site Streets (sf) C EIVE,
On-site Parking (sf) 35792
On-site Sidewalks (sf) 600 - l ---- SEr 1 3 2012
Other on-site (sf)
Future(sf) 19114 BY
Off-site (sf)
Existing BUA***(sf)
Total (sf): 66646
* Stream Class and Index Number can be determined at: http://portaLncdenr.org/web/wq/ps/csu/classifications
Form SWU-101 Version 07Jun20 10 Page 3 of 6

* Impervious area is defined as the built upon area including, but not limited to,buildings, roads,parking areas,
sidewalks,gravel areas, etc.
***Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off-site impervious area listed above determined?Provide documentation.
Projects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened&
Endangered Species watershed that may be subject to more stringent stormwater requirements as per NCAC 02B.0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance(O&M)forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality(DWQ).
A complete package includes all of the items Iisted below. A detailed application instruction sheet and BMP
checklists are available from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map athitp://portal.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item.All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http:/I portai.ncdenr.org/web/wq/ws/su/stateswjforms docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions&Protective Covenants IV ri
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s)(sealed,signed and dated)and O&M
agreement(s)for each BMP.
4. Permit application processing fee of$505 payable to NCDENR. (For an Express review,refer to
http://www.envhelp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative(one to two pages)describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information,item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary,include the 1 �•/
mile radius on the map.
7. Sealed,signed and dated calculations. ILA
8. Two sets of plans folded to 8.5"x 14" (sealed,signed, &dated),including:
a. Development/Project'`name.
b. EnginOand fi it.
c. LocationinOrwith named stVts and NCSR nwfibers.
d. Legend.
e. North rroy4
f. Scaler
g. Revision number and dates. A 0 rEIVEt
h. Identify all surface waters on the plans by delineating the no�minal pool elevaimpounded structures,the banks of streams and rivers,the MHW or NHW l2 0 2012
waters,and any coastal wetlands landward of the MHW or NHW lines.• Delineate the vegetated buffer landward from the normal pool elevationded
structures,the banks of streams or rivers,and the MHW(or NHW)of tidaB�0aters:---- J
i. Dimensioned property/project b undary with bearings&distances.
j. Site Layout with all BUA ide ied and dimensioned.
k. Existing contours,proposed contours,spot elevations,finished floor elevations.
1. Details of roads,drainage features,collection systems,and stormwater control measures.
Form SWU-10I Version 07Jun2010 Page 4 of 6

• m.Wetlands delineated,or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage(including off-site),drainage easements,pipe sizes,runoff calculations.
o. Drainage areas delineated(included in the main set of plans,not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations(Please identify 16 4
elevations in addition to depths)as well as a map of the boring locations with the existing
elevations and boring logs.Include an 8.5"x11"copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs,the report should also
include the soil type,expected infiltration rate,and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO:Schedule a site visit for DWQ to verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed.Deed book:3656 Page No:842
11. For corporations and limited liability corporations(LLC):Provide documentation from the NC
Secretary of State or other official documentation,which supports the titles and positions held
by the persons listed in Contact Information,item 1a,2a,and/or 3a per NCAC 2H.1003(e).The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State,otherwise the application will be returned.
http://www.secretary.state.nc.us/Corporations/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions,outparcels,and future development,the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary,a table listing each lot number,lot size,and the allowable built-upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does.Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner,it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s)below,the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project,if required,shall include all the items required in the permit and listed
on the forms available on the website,that the covenants will be binding on all parties and persons claiming
under them,that they will run with the land,that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm)so that they may provide information on your behalf for this project(such as
addressing requests for additional information).
Consulting Engineer:Susan Sayger,P.E.
Consulting Firm:KSMT Egineering,pllc
Mailing Address:388 McCotter Blvd.
City:Havelock State:NC Zip:28532
Phone: (252 ) 444-5765 Fax: (252 ) 444-5765
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION(if Contact Information,item 2 has been filled out, complete this
section) COVE
I, (print or type name of person listed in Contact Information, item 2a) at I
own the property identified in this permit application,and thus give permission to inj a p s n
listed in Contact Information, item 1a) with(print or typ me of organization li in
Contact Information, item 1a) to develop the project as c ;en lv nr sed--24ropy of
the lease agreement or pending property sales contract has been provided with the submittal,which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-l01 Version 07Jun2010 Page 5 of 6

1• • • , •
As the legal property owner I acknowledge,understand,and agree by my signature below,that if my designated
agent(entity listed in Contact Information,item 1)dissolves their company and/or cancels or defaults on their
lease agreement,or pending sale,responsibility for compliance with the DWQ Stormwater permit reverts back to
me,the property owner.As the property owner,it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days;otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to$25,000 per day,pursuant to NCGS 143-215.6.
Signature: Date:
I, ,a Notary Public for the State of ,County of
,do hereby certify that personally appeared
before me this day of ,and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 1a)Robin Strickland ,
certify that the information included on this permit application form is,to the best of my knowledge,correct and
that the project will be constructed in conformance with the approved plans,that the required deed restrictions
and protective covenants will be recorded,and that the proposed project complies with the requirements of the
applicable s m/water r es under 15A NCAC 2H.1000,SL 2006-246(Ph.II-Post Construction)or SL 2008-211.
Signature: 11Lt1 r"l teAt 4-y.IL Date: f® /.Y
I, 1--1 3Ct LE fr-l/LL/ ,a tary Public for the State of ILL ,County of
0._(a d-e,ri ,do hereby certify that e 1. Try 1C k.-I personally appeared
before me this r t) day of_•iLt(t- , 2.0(Zan ckno edge the due execution of the application for
a stormwater permit. Witness my hand and official seal, GA— ?-21....1-4.--1.--- 6j....
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JUL 20 2012
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Form SWU-1 0 l Version 07Jun2010 Page 6 of 6 1

Permit No. �4.1 /�� 7/
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
OFF-SITE SYSTEM SUPPLEMENT
FOR DEVELOPMENT DRAINING TO PERMITTED OFF-SITE TREATMENT SYSTEMS
This form may be photocopied for use as an original
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, an
off-site system supplement for each off-site stormwater treatment system, appropriate supplement forms for any
on-site stormwater treatment systems, and plans and specifications showing all stormwater conveyances and
drainage details for the project.
I. PROJECT INFORMATION
Project Name : Family Tire
Contact Person: Mitchell Brydge Phone Number: [phone]
Is all drainage from the project directed to the off-site system? (check one): ►/ Yes ❑No
IL OFF-SITE SYSTEM INFORMATION(please complete the following information for the off-site system
that will treat runoff from your project):
Permit No. SW8060718
Project Name:Freedom Village Shopping Center and Yopp Road Relocation
Type of System(wet pond, infiltration basin, etc.):Wet pond
Lot No. (if part of a subdivision):10
How much built upon area draining to the permitted treatment system has been allocated to this
project?66646 tilECE I V E
JUL 202012
III. REQUIRED ITEMS CHECKLIST
BY:
Prior to issuing an off-site permit, verification of the following information must be provided. Initial in the
space provided to indicate that the following requirements have been met and supporting documentation is
attached. If the applicant has designated an agent in the Stormwater Management Permit Application Form,the
agent may initial below. If a requirement has not been met, attach justification.
Form SW401-Off-Site System-Rev.1 Page 1 of 2

Aptxlicants Initials
7 a. Deed restrictions limiting the built-upon area on the site have been recorded.
b. Engineers certification for the existing off-site system has been submitted to DWQ.
/�f c. There are no outstanding Notices of Violation for the off-site system.
d. Off-site system is in compliance with the issued permit.
IV. STORMWATER COLLECTION SYSTEM MAINTENANCE REQUIREMENTS
1. Mowing will be accomplished as needed according to the season. Grass height will not exceed six inches
at any time.
2. Accumulated sediment and trash will be removed from the collection system as necessary. Swales and
ditches will be reseeded or sodded following sediment removal.
3. Eroded areas of swales and ditches will be repaired and reseeded. Swales and ditches will be revegetated as
needed based on monthly inspections.
4. The collection system,including catch basins, curb cuts, velocity reduction devices, and piping, will be
inspected monthly or after every significant runoff producing rainfall event. Trash and debris will be
cleared away from grates,curb cuts,velocity reduction devices,and piping.
5. The collection system may not be altered in any way without prior approval from NCDENR Division of
Water Quality.
I acknowledge and agree by my signature below that I am responsible for maintaining the stormwater collection
system in accordance with the five 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.
Print Name and Title:Robin Strickland
Address:2113 A S Glenburnie Road
Phone:252-6 - 999 Date:July 10,2012
Signature: 6 kuyt.,
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, 1-1 5 CC I / (a rr e.L L ,a Public f the State of &I` — ,:... o
event
n
(_. 6..(114-'1 ,do hereby certify that 'r'1 , C t personall ";,peared beforeme th
day of /0 , —rti`t.l °i,and acknowledge the due execution of the forgoing docum ,1 ,diciltigh01012wa
collection system maintenance::e ei►�
requirements. Witness my hand and official seal, BY:
,�ti:e
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Form SWU-106 Red, y700 CQ‘?,%%%% Page 2 of 2
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