SW8200818_Current Permit_20210420

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ROY COOPER
Governorto'
DIONNE DELLI-GATTI
Secretary *� "` `
BRIAN WRENN NORTH CAROLINA
Director EnviretrmentalQua►ity
April 20,2021
Live Oak NC,LLC
Attn:.Dean Scarafoni,Manager
5 Allen Avenue
Manchester,MA 01944
Subject: State Stormwater Management Permit No.SW8 200818
Crossroads at Carolina Shores
High Density Subdivision Project
Brunswick County
Dear Mr. Scarafoni:
The Wilmington Regional Office received a complete State Stormwater Management Permit Application for the
subject project on August 31, 2020 with final additional information received on April 12,2021. Staff review of
the plans and specifications has determined that the project,as proposed, complies with the Stormwater
Regulations set forth in Title 15A NCAC 02H.1000 amended on January 1,2017(2017 Rules). We are hereby
forwarding Permit No. SW8 200818 dated April 20,2021,for the construction of the built-upon areas(BUA)and
stormwater control measures(SCMs)associated with the subject project.
This permit shall be effective from the date of issuance until April 20,2029 and the project shall be subject to the
conditions and limitations as specified therein and does not supers any other agency permit that may be
required. Failure to comply with these requirements will result in futureue compliance problems.Please note that
this permit is not transferable except after notice to and approval by the Division.
This cover letter,attachments,and all documents on file with DEMLR shall be considered part of this permit and
is herein incorporated by reference.
If any parts,requirements,or limitations contained in this permit are nninceptable,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 concerning this permit,please contact Steve Pusey in the Wilmington Regional Office,
at(910)796-7215 or [e-mail].
Sincerely,
al;1.131. , 4.1.-Q
.gQ Brian Wrenn,Director
Division of Energy,Mineral and Land Resources
Enclosures: Attachment A—Designer's Certification Form
Attachment B—Built-Upon Area Allocation
Application Documents
DES/sgp: \1\Stormwater\Permits&Proj.ects12020\200818 HD12021 04 permit 200818
cc: Gary S.Pape,PE—GSP Consulting,PLLC
Brunswick County Engineering Department
NCDOT District Engineer
Wilmington Regional Office Stormwater File
E ..
North Carolina Department of Environmental Quality I Division of Energy,Mineral and Land Resources
Wilmington Regional Office 1127 Cardinal Drive Extension I Wilmington,North Carolina 28405
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State Stormwater Management
Permit No. SWB 200818
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY SUBDIVISION DEVELOPMENT
In compliance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations promulgated and adopted by the North
Carolina Environmental Management Commission, including 15A NCAC 02H.1000 amended on
January 1, 2017 (2017 Rules) (the "stormwater rules"),
PERMISSION IS HEREBY GRANTED TO
Live Oak NC, LLC
Crossroads at Carolina Shores
Intersection of US Hwy 17& Calabash Road, Brunswick County
FOR THE
construction, management, operation and maintenance of built-upon area (BUA) draining to one (1)
wet detention pond ("stormwater control measures" or"SCMs") 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 April 20, 2029 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. BUA REQUIREMENTS. The maximum amount of BUA allowed for the entire project is 115,700
square feet. The runoff from all BUA within the permitted drainage area of this project must be
directed into the permitted SCM. The BUA requirements and allocations for this project are as
follows:
a. SCM BUA LIMITS. The SCM has been designed using the runoff treatment method to
handle the runoff from 115,700 square feet of BUA within the delineated drainage area for
the existing CVS Pharmacy, "Outparcel # 1", and onsite roads and driveways. This permit
dues riot provide any allocation of BUA for future development within the delineated
drainage area(s). This permit approves some onsite drainage area without BUA on Lot
numbers 2, 3, 4, and 5 to bypass the system. Prior to development of these lots, separate
offsite permits must be obtained for them, and a permit modification will be required for this
"master" permit.
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State Stormwater Management
Permit No. SW8 200818
b. BUA FOR INDIVIDUAL LOTS. The CVS Pharmacy lot, "Outparcel #1", and Lot#s 2, 3, 4,
and 5 are limited to a maximum amount of BUA as indicated in Attachment B of this permit
and as indicated in the approved plans and specifications. The maximum BUA assigned to
each lot via this permit and the recorded deed restrictions and protective covenants
may not be increased or decreased by either the individual lot owner or the permittee
unless and until the permittee notifies the Division and obtains written approval from
the Division.
2. PERVIOUS AREA IMPROVEMENTS. At this time, none of the pervious area improvements
listed in G.S. 143-214.7(b2) or the Stormwater Design Manual have been proposed for this
project. Pervious area improvements will be allowed in this project if documentation is provided
demonstrating those improvements meet the requirements of the stormwater rule.
3. OFFSITE LOT REQUIREMENTS. Each non-residential lot whose ownership is not retained by
the permittee shall submit a separate off-site stormwater permit application to the Division and
receive approval prior to construction. Prior to the discharge of stormwater runoff from any lot
into the approved stormwater system, the permittee shall ensure that the owner of the non-
residential lot has obtained the separate off-site stormwater management permit.
4. SCM REQUIREMENTS. The SCM requirements for this project are as follows:
a. SCM DESIGN. The SCM is permitted based on the design criteria presented in the sealed,
signed and dated supplement and as shown in the approved plans and specifications. This
SCM must be provided and maintained at the design condition.
b. PLANTING PLAN. The SCM landscape planting plan shown in the approved plans shall be
followed in its entirety during construction. After the plants are established, the operation
and maintenance agreement must be followed.
c. FOUNTAINS. At this time, a decorative spray fountain has not been proposed within the wet
pond. Decorative spray fountains will be allowed in the wet pond if documentation is
provided demonstrating that the proposed fountain will not cause resuspension of sediment
within the pond or cause erosion of the pond side slopes.
d. IRRIGATION. If the wet pond is to be used for irrigation, it is recommended that some water
be maintained in the permanent pool, the vegetated shelf is planted with appropriate species
that can handle fluctuating conditions, and human health issues are addressed.
e. PRETREATMENT. The following pretreatment device(s) has (have) been provided to
prevent clogging: grassed swales, forebays for pretreatment.
5. STORMWATER OUTLETS. The peak flow from the 10-year storm event shall not cause
erosion downslope of the discharge point.
6. VEGETATED SETBACKS. A 50-foot wide vegetative setback must be provided and maintained
in grass or other vegetation adjacent to all surface waters as shown on the approved plans. The
setback is measured horizontally from the normal pool elevation of impounded structures, from
the top of bank of each side of streams or rivers, and from the mean high waterline of tidal
waters, perpendicular to the shoreline.
a. BUA IN THE VEGETATED SETBACK. BUA may not be added to the vegetated setback
except as shown on the approved plans.
b. RELEASE OF STORMWATER NOT TREATED IN AN SCM. Stormwater that is not treated
in an SCM must be released at the edge of the vegetated setback and allowed to flow
through the setback as dispersed flow.
7. RECORDED DOCUMENT REQUIREMENTS. The stormwater rules require the following
documents to be recorded with the Office of the Register of Deeds prior to the sale of individual
lots or groups of lots:
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State Stormwater Management
Permit No. SW8 200818
a. ACCESS AND/OR EASEMENTS. The entire stormwater conveyance system, including any
SCMs, and maintenance accesses must be located in public rights-of-way, dedicated
common areas that extend to the nearest public right-of-way, and/or permanent recorded
easements that extend to the nearest public right-of-way for the purpose of inspection,
operation, maintenance, and repair.
b. OPERATION AND MAINTENANCE AGREEMENT. The operation and maintenance
agreement must be recorded with the Office of the Register of Deeds.
c. FINAL PLATS. The final recorded plats must reference the operation and maintenance
agreement and must also show all public rights-of-way, dedicated common areas, and/or
permanent drainage easements, in accordance with the approved plans.
d. DEED RESTRICTIONS AND PROTECTIVE COVENANTS. Recorded deed restrictions and
protective covenants must include, at a minimum, the following statements related to
stormwater management:
i. The following covenants are intended to ensure ongoing compliance with State
Stormwater Management Permit Number SW8 200818, as issued by the Division of
Energy, Mineral and Land Resources (the "Division") under 15A NCAC 02H.1000,
effective January 1, 2017.
ii. The State of North Carolina is made a beneficiary of these covenants to the extent
necessary to maintain compliance with the Stormwater Management Permit.
iii. These covenants are to run with the land and be binding on all persons and parties
claiming under them.
iv. The covenants pertaining to stormwater may not be altered or rescinded without
the express written consent of the Division.
v. Alteration of the drainage as shown on the approved plans may not take place
without the concurrence of the Division.
vi. The maximum built-upon area (BUA) per lot is as shown in Attachment B. This
allotted amount includes any BUA 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 not shown on the approved plans. BUA has the same meaning as G.S.
143-214.7, as amended.
vii. The maximum allowable BUA shall not be exceeded on any lot until the permit is
modified to ensure compliance with the stormwater rules, permit, and the approved
plans and specifications.
viii. All runoff from the BUA on the lot must drain into the permitted system. This may
be accomplished via grading, a stormwater collection system and/or a vegetated
conveyance.
ix. A 50-foot wide vegetative setback must be provided and maintained adjacent to all
surface waters in accordance with 15A NCAC 02H.1003(4) and the approved
plans.
x. 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.
xi. Each non-residential lot within the subdivision whose ownership is not retained by
the permittee, must apply for and receive a separate offsite stormwater
management permit from the Division prior to construction.
xii. If permeable pavement BUA credit is requested, the property owner must submit a
request, with supporting documentation, to the permittee and receive approval prior
to construction.
e. DEEDS FOR INDIVIDUAL LOTS. The permittee shall record deed restrictions and
protective covenants prior to the issuance of a certificate of occupancy to ensure the permit
conditions and the approved plans and specifications are maintained in perpetuity.
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State Stormwater Management
Permit No. SW8 200818
8. CONSTRUCTION. During construction, erosion shall be kept to a minimum and any eroded
areas of the on-site stormwater system will be repaired immediately.
a. PROJECT CONSTRUCTION, OPERATION AND MAINTENANCE. During construction, all
operation and maintenance for the project shall follow the Erosion Control Plan requirements
until the Sediment-Erosion Control devices are converted to SCMs or no longer needed.
Once the device is converted to a SCM, the permittee shall provide and perform the
operation and maintenance as outlined in the applicable section below.
b. SCM RESTORATION. If one or more of the SCMs are used as an Erosion Control device
and/or removed or destroyed during construction, it must be restored to the approved state
stormwater design condition prior to close-out of the erosion control plan and/or project
completion and/or transfer of the state stormwater permit. Upon restoration, a new or
updated certification will be required for the SCM(s) and a copy must be submitted to the
appropriate DEQ regional office.
9. MODIFICATIONS. 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), 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 within the common areas to be considered a permeable surface that were not
included in the approved plans and specifications.
g. Other modifications as determined by the Director.
10. DESIGNER'S CERTIFICATION. Upon completion of the project, the permittee shall determine if
the project is in compliance with the approved plans and take the necessary following actions:
a. If the permittee determines that the project is in compliance with the approved plans, then
within 45 days of completion, the permittee shall submit to the Division one hard copy and
one electronic copy of the following:
i. The completed and signed Designer's Certification provided in Attachment A
noting any deviations from the approved plans and specifications. Deviations
may require approval from the Division;
ii. A copy of the recorded operation and maintenance agreement;
iii. Unless already provided, a copy of the recorded deed restrictions and
protective covenants; and
iv. A copy of the recorded plat delineating the public rights-of-way, dedicated
common areas and/or permanent recorded easements, when applicable.
b. If the permittee determines that the project is not in compliance with the approved plans, the
permittee shall submit an application to modify the permit within 30 days of completion of the
project or provide a plan of action, with a timeline, to bring the site into compliance.
11. OPERATION AND MAINTENANCE. The permittee shall provide and perform the operation and
maintenance necessary, as listed in the signed operation and maintenance agreement, to
assure that all components of the permitted on-site stormwater system are maintained at the
approved design condition. The approved operation and maintenance agreement must be
followed in its entirety and maintenance must occur at the scheduled intervals.
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State Stormwater Management
Permit No. SW8 200818
a. CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the
permittee shall take immediate corrective actions. This includes actions required by the
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.
b. MAINTENANCE RECORDS. Records of maintenance activities must be kept and made
available upon request to authorized personnel of the Division. The records will indicate the
date, activity, name of person performing the work and what actions were taken.
12. 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 15A NCAC 02H.1045(3).
13. CURRENT PERMITTEE NAME OR ADDRESS CHANGES. The permittee shall submit a
completed Permit Information Update Application Form to the Division within 30 days to making
any one or more of the following changes:
a. A name change of the current permittee;
b. A name change of the project;
c. A mailing address change of the permittee.
14. 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) and must be
submitted upon occurrence of any one or more of the following events:
i. The sale or conveyance of the project and/or property area in whole or in part,
except in the case of an individual residential lot sale that is made subject to the
recorded deed restrictions and protective covenants;
ii. The assignment of declarant rights to another individual or entity;
iii. 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);
iv. Dissolution of the partnership, corporate, or LLC entity, subject to NCGS 55-14-05
or NCGS 57D-6-07 and 08;
v. Bankruptcy;
vi. Foreclosure, subject to the requirements of Session Law 2013-121;
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.
15. COMPLIANCE. The permittee is responsible for complying with the terms and conditions of this
permit and the approved plans and specifications until the Division approves the transfer
request.
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State Stormwater Management
Permit No. SW8 200818
a. REVIEWING AND MONITORING EACH LOT FOR COMPLIANCE. The permittee is
responsible for verifying that the proposed BUA on each individual lot, within each drainage
area and for the entire project does not exceed the maximum amount allowed by this permit.
The permittee shall review all individual lot plans for new construction and all subsequent
modifications and additions for compliance. The plans reviewed must include all proposed
BUA, grading, and driveway pipe placement. The permittee shall not approve any lot plans
where the maximum allowed BUA limit has been exceeded or where modifications are
proposed to the grading and/or to the stormwater collection system and/or to the vegetated
conveyance unless and until a permit modification has been approved by the Division. The
permittee shall review and routinely monitor the project and each lot to ensure continued
compliance with the conditions of the permit, the approved plans and specifications, and the
recorded deed restrictions and protective covenants. The permittee shall notify any lot
owner that is found to be in noncompliance with the conditions of this permit in writing and
shall require timely resolution.
b. ARCHITECTURAL REVIEW BOARD (ARB) OR COMMITTEE (ARC). The permittee may
establish an ARB or ARC to conduct individual lot reviews. However, any approval given by
the ARB or ARC on behalf of the permittee does not relieve the permittee of the
responsibility to maintain compliance with the conditions of the permit and the approved
plans and specifications.
c. 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.
d. DIVISION ACCESS. The permittee grants Division Staff permission to enter the property
during normal business hours to inspect all components of the permitted project.
e. 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.
f. 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.
g. OTHER PERMITS. The issuance of this permit does not preclude the permittee from
obtaining and complying with any and all other permits or approvals that are required for this
development to take place, as required by any statutes, rules, regulations, or ordinances,
which are 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.
Permit issued this the 20th day of April 2021.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
C1414atiA;4 4
Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 200818
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State Stormwater Management
Permit No. SW8 200818
Attachment A
Certification Forms
The following blank Designer Certification forms are included and specific for this project:
• As-Built Permittee Certification
• As-Built Designer's Certification General MDC
• As-Built Designer's Certification for Wet Detention Pond Project
A separate certification is required for each SCM. These blank certification forms may be copied and
used, as needed, for each SCM and/or as a partial certification to address a section or phase of the
project.
Page 1 of 1

State Stormwater Management
Permit No. SW8 200818
AS-BUILT PERMITTEE CERTIFICATION
I hereby state that I am the current permittee for the project named above, and I certify by my
signature below, that the project meets the below listed Final Submittal Requirements found in NCAC
02H.1042(4) and the terms, conditions and provisions listed in the permit documents, plans and
specifications on file with or provided to the Division.
Check here if this is a partial certification. Section/phase/SCM #?
_ Check here if this is part of a Fast Track As-built Package Submittal.
Printed Name Signature
, a Notary Public in the State of
County of , do hereby certify that
personally appeared before me this day of , 20
and acknowledge the due execution of this as-built certification. (SEAL)
Witness my hand and official seal
My commission expires
Peer mittee s Certification NCAC .1042(4) Ca ' ed/ N/A
Provided
A. DEED RESTRICTIONS/BUA RECORDS
1. The deed restrictions and protective covenants have been recorded Y or N
and contain the necessary language to ensure that the project is
maintained consistent with the stormwater regulations and with the
permit conditions.
2. A copy of the recorded deed restrictions and protective covenants Y or N
has been provided to the Division.
3. Records which track the BUA on each lot are being kept. (See Note Y or N
1)
B. MAINTENANCE ACCESS
1. The SCMs are accessible for inspection, maintenance and repair. Y or N
2. The access is a minimum of 10 feet wide. Y or N
3. The access extends to the nearest public right-of-way. Y or N
C. EASEMENTS
1. The SCMs and the components of the runoff collection /conveyance Y or N
system are located in recorded drainage easements.
2. A copy of the recorded plat(s) is provided. Y or N
®. SII 3LE FAPPLY RESIDENTIAL LOTS -Plats for resident4ots that Y or N
have an SCM include the foiinwii;a:
1. The specific location of the SCM on the lot. Y or N
2. A typical detail for the SCM. Y or N
3. A note that the SCM is required to meet stormwater regulations and
that the lot owner is subject to enforcement action as set forth in Y or N
NCGS 143 Article 21 if the SCM is removed, relocated or altered
without prior approval.
E. OPERATION AND MAINTENANCE AGREEMENT Y or N
1. The O&M Agreement is referenced on the final recorded plat. Y or N
2. The O&M Agreement is recorded with the Register of Deeds and Y or N
appears in the chain of title.
F. OPEK4 OJ AND MAINTENANCE PLAN — mdir ienarie records tire
being kept in a known set location for each SCM and are available for Y or N
Page 1 of 6

State Stormwater Management
Permit No. SW8 200818
G. OIESIGNER'S CERTIFICATKIN F iRIA tas been provided to the Y or
Cikfi ion.
Note 1-Acceptable records include ARC approvals, as-built surveys, and county tax records.
Provide an explanation for every requirement that was not met, and for every "N/A" below. Attach
additional sheets as needed.
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State Stormwater Management
Permit No. SW8 200818
AS-BUILT DESIGNER'S CERTIFICATION GENERAL MDC
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I
have observed the construction of the project named above to the best of my abilities with all due care
and diligence, and that the project meets the below listed General MDC found in NCAC 02H.1050 in
accordance with the permit documents, plans and specifications on file with or provided to the
Division, except as noted on the "AS-BUILT" drawings, such that the intent of the storrnwater rules
and statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
_ Check here if this is a part of a Fast-Track As-Built Package Submittal per .1044(3).
_ Check here if the designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed
Name Signature
NC Registration
Number Date
Consultant's Mailing Address:
SEAL:
City/State/ZIP
Phone Number
Consultant's Email address:
iD Circle N if the as-built value differs from the Plan. If N is circled, provide an explanation on Page 2.
ON/E = not evaluated (provide explanation on page 2) ©N/A= not applicable to this SCM or project.
7—C nnit nt's Certification NCAC .1003{03) &General "ADC ©As-bunt ©N/E I JN/A
.1050
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment. Y or N
2. The SCM achieves runoff volume match. Y or N
3. Runoff from offsite areas and/or existing BUA is Y or N
bypassed.
4. Runoff from offsite areas and/or existing BUA is directed Y or N
into the permitted SCM and is accounted for at the full
build-out potential.
5. The project controls runoff through an offsite permitted Y or N
SCM that meets the requirements of the MDC.
6. The net area of new BUA increase for an existing project Y or N
has been accounted for at the appropriate design storm
level.
7. The SCM(s) meets all the specific minimum design Y or N
criteria.
B. VEGETATED SETBACKS/BUA
1. The width of the vegetated setback has been measured Y or N
from the normal pool of impounded waters, the MHW
line of tidal waters, or the top of bank of each side of
rivers or streams.
2. The vegetated setback is maintained in grass or other Y or N
vegetation.
3. BUA that meets the requirements of NCGS 143-214.7 Y or N
(b2)(2) is located in the setback.
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State Stormwater Management
Permit No. SW8 200818
4. BUA that does not meet the requirements of NCGS 143- Y or N
214.7 (b2)(2) is located within the setback and is limited
to:
a. Publicly funded linear projects (road, greenway
sidewalk)
b. Water-dependent structures
c. Minimal footprint uses (utility poles, signs, security
lighting and appurtenances)
5. Stormwater that is not treated in an SCM is released at Y or N
the edge of the setback and allowed to flow through the
setback as dispersed flow.
i �IJA -bunt ci)N/ ON/A
C. STNalIWATER OUTLETS—the outlet handles the peak Y or N
low from the 10 year storm with no downslope erosion.
D. VARIATIONS
1. A variation (alternative) from the stormwater rule Y or N
provisions has been implemented.
2_ The variation provides equal or better stormwater control Y or N
and a ual or better protection of surface waters.
E. COMPLIANCE r TFH OTTER REGULATORY PROGRAMS Y or N
has been met.
F. WING-the volume of the,SCM takes the runoff from
surfaces into account and is sufficient to lundle the required Y or N
storm depth. _
G. CONTA INATEbtbO1LS—infiltratihg SCIM's are not Y or N
located in or on areas with contaminated sow.
H. SIDE ELOPES }
1. Vegetated side slopes are no steeper than 3H:1 V. Y or N
2. Side slopes include retaining walls, gabion walls, or Y or N
other surfaces that are steeper than 3H:1 V.
3. Vegetated side slopes are steeper than 3H:1 V(provide Y or N
supporting documents for soils and vegetation).
I. EROSION PROTECTION
1. The inlets do not cause erosion in the SCM. Y or N
2. The outlet does not cause erosion downslope of the Y or N
discharge point during the peak flow from the 10 year
storm.
J. EXCESS FL( S-An oveMov;; bypass has been
provided. Y or N
K. DE WATERING—A method to drawdown standing water has Y or N
been provided to facilitate maintenance and ins ction.
L CLEANC JT AFTER CONDUCTION —the SCM has been t Y or N
cleaned out and converted to its approved design state..
M. MAINTENANCE ACCESS I
1. The SCM is accessible for maintenance and repair. Y or N
2. The access does not include lateral or incline slopes Y or N
>3:1.
N. t ESIGNER OUAUP NS (FAST-TRACK .4E —
The designer is licensed under Chapters 89A, 89C, 69E. or Y or N
89F of the Genera! Statue.
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or"N/E",
below. Attach additional pages as needed:
Page 4 of 6

State Stormwater Management
Permit No. SW8 200818
AS-BUILT DESIGNER'S CERTIFICATION FOR WET DETENTION POND PROJECT
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I
have observed the construction of the project named above to the best of my abilities with all due care
and diligence, and that the project meets all of the MDC found in NCAC 02H.1053, in accordance with
the permit documents, plans and specifications on file with or provided to the Division, except as
noted on the "AS-BUILT" drawings, such that the intent of the stormwater rules and the general
statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
_ Check here if this is part of a Fast-Track As-Built Package Submittal per .1044(3).
_ Check here if the Designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed
Name Signature
NC Registration Number Date
Consultant's Mailing Address:
SEAL:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as-built value differs from the Plan/permit. If N is circled, provide an explanation on
page 2
©N/E = not evaluated (provide explanation on page 2) OO N/A= not applicable to this project or SCM.
This Certification must be completed in conjunction with the General MDC certification under NCAC
02H.1050
C��ee iufta et (MDC .1053) ©As-buit ; v N:E GMVA
A. Forebay/Depths/Fob"'
1. The available Sediment storage is consistent with the Y or N
approved plan and is a minimum of 6 in.
2. Water flow over the forebay berm into the main pond Y or N
occurs at a non-erosive velocity.
3. The provided Forebay Volume is 15%-20% of the main Y or N
pool volume.
4. The Forebay entrance elevation is deeper than the exit Y or N
elevation into the pond.
5. The Average Design Depth of the main pond below the
permanent pool elevation is consistent with the permitted Y or N
value?
6. Fountain documentation is provided. Y or N
B. Side slopes/Banks I Vegetated Shelf
1. The width of the Vegetated Shelf is consistent with the Y or N
approved plans and is a minimum of 6 feet.
2. The slope of the Vegetated Shelf is consistent with the Y or N
approved plans and is no steeper than 6:1.
w
C. As-built Tain Fool I Area's i!ioiurnes/Elevations
1. The permanent pool surface area provided is consistent Y or N
with the permitted value.
2. The Temporary Pool Volume provided is consistent with Y or N
the permitted value.
Page 5 of 6

State Stormwater Management
Permit No. SW8 200818
3. The permanent pool elevation is consistent with the Y or N
permitted value.
4. The temporary pool elevation is consistent with the Y or N
permitted value.
CDAs-but N1F
D.
+Outlet t i Dr wdow
Y. inletsi Wawa i at��a�w�rn
1. The design volume draws down in 2-5 days. Y or N
2. The size of the Orifice is consistent with the permitted Y or N
value.
3. A trash rack is provided on the outlet structure. Y or N
4. Hydrologic impacts to the receiving channel are minimized Y or N
from the 1 yr 24 hr storm discharge?
5. The inlets and the outlet location are situated per the Y or N
approved plan and avoid short-circuiting.
E. Vegetation
1. The vegetated shelf has been planted with a minimum of 3 Y or N
diverse species.
2. The vegetated shelf plant density is consistent with the
approved plans and is no less than 50 plants per 200 sf or Y or N
no less than 24 inches on center.
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or"N/E"
below. Attach additional pages as needed:
Page 6 of 6

State Stormwater Management
Permit No. SW8 200818
Attachment B
Built-upon Area (BUA)Allocations
Crossroads at Carolina Shores
Permit No. SW8 200818
Lot# Offsite Offsite Drains
from Date Allocated Proposed
Permit Project to Pond
Master No Issued Name # BUA BUA
Permit
CVS This 4/20/2021 NA 1 55268 55268
Pharmacy permit
This
1 4/20/2021 NA 1 28202 28202
permit
2 TBD
3 TBD
4 TBD
5 TBD
TBD = To be determined
Page 1 of 1

____ Operation & Maintenance A.-reement
Project Name: Crossroads at Carolina Shores
Project Location: Intersection of US Hwy 17 &Calabash Road
�. Cove r am P .._ -.�.
Maintenance records shall be kept on the following BMP(s). This maintenance record shall 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 pollutant removal efficiency of the BMP(s).
The BMP(s)on this project include(check all that apply&corresponding O&M tables will be added automatically):
Infiltration Basin Quantity: Location(s): I
Infiltration Trench Quantity: Location(s):
Bioretention Cell Quantity: Location(s):
Wet Pond Quantity: 1 Location(s): Eastern Side of Site
Stormwater Wetland Quantity: Location(s):
Permeable Pavement Quantity: Location(s):
Sand Filter Quantity: Location(s):
Rainwater Harvesting Quantity: Location(s):
Green Roof Quantity: Location(s):
Level Spreader-Filter Strip Quantity: Location(s):
Proprietary System Quantity: Location(s):
Treatment Swale Quantity: Location(s):
Dry Pond Quantity: - Location(s):
Disconnected Impervious Surface Present: No_ Location(s):
User Defined SCM Present: No Location(s):
Low Density Present: No I nrafinnkl•
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for each BMP
above,and attached O&M tables. I agree to notify NCDENR of any problems with the system or prior to any changes to the system or
responsible party.
*Responsible Party: Dean Scarafoni
Title&Organization: Manager-Live Oak NC,LLC
Street address: 5 •Ilen Avenue
Cit ate,zi, a chester,MA 01944
Phon ber( : 91 538-5855
0
Err:il: • [e-mail]
Signature: 1 / Virl Date: 5-—.ids'^ ®
I, Garry S. ape ,a Notary Public for the State of North Carolina
County of ew Hanover �_y�, ,do hearby rtify tha Dean Scarafoni
personally appeared before me this '5";/ day of 3 47. and
acknowledge the due execution of the •perations an. ,:intenance Agreement.
Witness my hgRO cial seal, _1 i .
eT�ee. ti,
.Ltd
"i• n
40.
..)
Seal . • - ," My commission expires: April 13,2025
1,.,c,ep d, St ^, f
AUG 3 I4 1
,
BY

Wet Detention Pond Maintenance i equ rements
The wet detention basin system is defined as the wet detention basin,pretreatment including forebays and the vegetated filter if one is
provided.
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 drain 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
1.0 inches(or 1.5 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 BMP Areas of bare soil and/or Regrade the soil if necessary to remove the gully,and then plant a
erosive gullies have formed. 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 approximately six inches.
long.
The Inlet device The pipe is clogged. Unclog the pipe. Dispose of the sediment off-site. _ _ ,
The pipe is cracked or Replace the pipe.
otherwise damaged.
Erosion is occurring in the Regrade the swale if necessary to smooth it over and provide erosion
swale. control devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
Stone verge is clogged or Remove sediment and replace with clean stone.
covered in sediment(if
applicable).
The forebay Sediment has accumulated to Search for the source of the sediment and remedy the problem if
a depth greater than the possible. Remove the sediment and dispose of it in a location where it
original design depth for will not cause impacts to streams or the BMP.
sediment storage.
Erosion has occurred. Provide additional erosion protection such as reinforced turf matting or
jprap 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 practices
show that pruning is needed
to maintain optimal plant
health.
Plants are dead,diseased or Determine the source of the problem: soils,hydrology,disease,etc.
dying. Remedy the problem and replace plants. Provide a one-time fertilizer
application to establish the ground cover if a soil test indicates it is
necessary.
Weeds are present. Remove the weeds,preferably by hand. If pesticide is used,wipe it on
the plants rather than spraying.
AL 31Z
BY

Wet Detention Pond Maintenance Requirements(Continued)
The main treatment area Sediment has accumulated to Search for the source of the sediment and remedy the problem if
a depth greater than the possible. Remove the sediment and dispose of it in a location where it
original design sediment will not cause impacts to streams or the BMP.
storage depth.
Algal growth covers over 50% Consult a professional to remove and control the algal growth.
of the area.
Cattails,phragmites or other Remove the plants by wiping them with pesticide(do not spray).
invasive plants cover 50%of
the basin surface.
The embankment Shrubs have started to grow Remove shrubs immediately.
on the embankment.
Evidence of muskrat or Use traps to remove muskrats and consult a professional to remove
beaver activity is present. beavers.
A tree has started to grow on Consult a dam safety specialist to remove the tree.
the embankment.
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 Department of Environment and Natural
damage have occurred at the Resources Regional Office.
outlet.
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.
Wet mention Pond Design Summary ___
WET POND ID FOREBAY MAIN POND
1 Permanent Pool El. 40.0 Permanent Pool El. 40.0
Temporary Pool El: 41.25 Temporary Pool El: 41.25
Pretreatment other No Clean Out Depth: 8.0 Clean Out Depth: 3.0
than forebay? Sediment Removal El: 32.0 Sediment Removal El: 37.0
Has Veg.Filter? I No Bottom Elevation. 31.0 Bottom Elevation: 36.0 I I
fi,,:e. Am',"A.A.. 1 ,.........
7.`onle"Ii. O.yv ,.
AUG 3 12C2
Br

DEMLR USE ONLY
Date ec ived Fee Paid Permit Number
8 31 a©90 �103 5Q5 �SU- . 00893
-
Applicable Rule . ❑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 Energy,Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name(subdivision,facility,or establishment name-should be consistent with project name on plans,
specifications,letters,operation and maintenance agreements,etc.):
Crossroads at Carolina Shores
2. Location of Project(street address):
Intersection of US Hwy 17&Calabash Road
City:Carolina Shores County:Brunswick Zip: Oil If,7
3. Directions to project(from nearest major intersection):
Site is located at the ntersection of US Hwy 17&Calabash Road
4. Latitude:33°54'30"N Longitude:78°35'09"W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is(check one): New ['Modification ❑Renewal w/ Modification
tRenewals with modifications also requires SWU-102-Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit,list the existing
permit number ,its issue date(if known) ,and the status of
construction: ❑Not Started DPartially Completed* ❑Completed* *provide a designer's certification
2. Specify the type of project(check one):
❑Low Density ®High Density ['Drains to an Offsite Stormwater System ['Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application,list the stormwater project number,
if assigned, and the previous name of the project,if different than currently
proposed, .
4.a.Additional Project Requirements(check applicable blanks;information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑LAMA Major ®Sedimentation/Erosion Control:4.12 ac of Disturbed Area
DNPDES Industrial Stormwater 0404/401 Permit:Proposed Impacts
b.If any of these permit have already been acquired please provide the Project Name,Project/Permit Number,
issue date and the type of each permit
5. Is the project located within 5 miles of a public airport? /1 No ['Yes
If yes, see S.L.2012-200,Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations Sr!"1"rota ,ft,,
ill
Form SWU-101 Version Oct.31,2013 Page 1 of 6 BY

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:Live Oak NC, LLC
Signing Official&Title:Dean Scarafoni-Manager
b.Contact information for person listed in item la above:
Street Address:5 Allen Avenue
City:Manchester State:MA Zip:01944
Mailing Address(if applicable):
City: State: Zip:
Phone: (910 ) 538-5855 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: Zip:
Phone: ( ) Fax: ( )
Email:
3.a. (Optional)Print the name and title of another contact such as the projects construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official&Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
4. Local jurisdiction for building permits:Brunswick .... P, ,
4+ tom'
Point of Contact: Phone#:
Form SWU-101 Version Oct. 31,2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
The storm water for this project will be treated by a wet detention basin
2.a.If claiming vested rights,identify the supporting documents provided and the date they were approved:
❑Approval of a Site Specific Development Plan or PUD Approval Date:
❑Valid Building Permit Issued Date:
❑Other: Date:
b.If claiming vested rights,identify the regulation(s)the project has been designed in accordance with:
❑Coastal SW-1995 ❑Ph II-Post Construction
3. Stormwater runoff from this project drains to the Lumber River basin.
4. Total Property Area:17.15 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+: 17.15 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
W�(MH line,and coastal wetlands landward from the NHW(or MHW>J line. The resultant project area is used to
calculate overall percent built upon area(KM). 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 = 15.5 %
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 Drainage Area 1 Drainage Area_ Drainage Area_ Drainage Area_
Receiving Stream Name Persimmon
Swamp
Stream Class * 15-23-2-1
Stream Index Number* C;Sw DECEIVE":
Total Drainage Area(sf) 186,232 t
11
On-site Drainage Area (sf) 72,871 FFR 1 6 2E121 I)
Off-site Drainage Area(sf) 113,361
Proposed Impervious Area (sf) 115,700 BY
%Impervious Area** (total) 62.1
Impervious`Surface Area Drainage Area 1 ; Drainage Area_ Drainage Area_ Drainage Area_
On-site Buildings/Lots(sf)
On-site Streets (sf)
On-site Parking (sf) 32,230
On-site Sidewalks (sf)
Other on-site (sf)
Future(sf)
Off-site (sf) 83,470
Existing BUA***(sf)
Total (sf): 115,700
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
** Impervious area is defined as the built upon area including,but not limited to, buildings,roads,parking areas,
sidewalks,gravel areas,etc.
Form SWU-101 Version Oct.31,2013 Page 3 of 6

***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.Offsite BUA is
28,202 sf for Out-Parcel#1 and 55,268 sf for the Existing CVS Store.
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened&
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B.0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M)forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy,Mineral and
Land Resources(DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at http://portal.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://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs.
nitials
1. Original and one copy of the Stormwater Management Permit Application Form. r Qs?
2. Original and one copy of the signed and notarized Deed Restrictions&Protective Covenants ✓
Form. (if required as per Part VII below) /
3. Original of the applicable Supplement Form(s) (sealed,signed and dated)and O&M F/
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/management for
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the tWA
receiving stream drains to class SA waters within 1/2 mile of the site boundary,include the'/z
mile radius on the map. /
7. Sealed,signed and dated calculations (one copy). ✓
8. Two sets of plans folded to 8.5"x 14" (sealed,signed,&dated),including:
a. Development/Project name. �� ���
b. Engineer and firm.
0
c. Location map with named streets and NCSR numbers.
d. Legend. (•'E I
e. North arrow.
f. Scale.
g. Revision number and dates. BY:
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures,the banks of streams and rivers,the MHW or NHW line of tidal
waters,and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures,the banks of streams or rivers,and the MHW(or NHW)of tidal waters.
i. Dimensioned property/project boundary with bearings&distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours,proposed contours,spot elevations,finished floor elevations.
1. Details of roads,drainage features,collection systems,and stormwater control measures.
m.Wetlands delineated,or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage(including off-site),drainage easements,pipe sizes,runoff calculations.
o. Drainage areas delineated(included in the main set of plans,not as a separate document).
Form SWU-l.01 Version Oct.31,2013 Page 4 of 6

p. Vegetated buffers(where required).
9. Copy of any applicable soils report with the associated SHWT elevations(Please identify _ALE
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 DEMLR to verify the SHWT prior
to submittal, [phone].) "
10. A copy of the most current property deed.Deed book:2012 Page No: 73 +�
11. For corporations and limited liability corporations(LLC):Provide documentation from the NC
Secretary of State or other official documentation,which supports the titles and positions held
by the persons listed in Contact Information,item 1a,2a,and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State,otherwise the application will be returned.
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/lr/state-
stormwater-forms docs.Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner,it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below,the permit holder(s)certify that the recorded property restrictions and
protective covenants for this project,if required,shall include all the items required in the permit and listed
on the forms available on the website,that the covenants will be binding on all parties and persons claiming
under them,that they will run with the land,that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR,and that they will be recorded prior to the sale of any lot.
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:Garry S.Pape,P.E.
Consulting Firm:GSP Consulting,PLLC
Mailing Address:6626 Gordon Road,Unit C
City:Wilmington State:NC Zip:28411
Phone: (910 ) 442-7870 Fax: (910 ) 799-6659
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information,item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) ,certify that I
own the property identified in this permit application,and thus give permission to (print or type name of person
listed in Contact Information, item 1a) with(print or type name of organization listed in
Contact Information, item 1a) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal,which indicates the
party responsible for the operation and maintenance of the stormwater system.
R E:....—A:7.4 44 :'4,4.-
AUG 3 1 2C Li
BY
Form SWU-101 Version Oct.31,2013 Page 5 of 6

As the legal property owner I acknowledge,understand,and agree by my signature below,that if my designated
agent(entity listed in Contact Information,item 1)dissolves their company and/or cancels or defaults on their
lease agreement,or pending sale,responsibility for compliance with the DEMLR Stormwater permit reverts back
to me,the property owner.As the property owner,it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change Form within 30 days;otherwise I will be operating a stormwater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may result 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 la)Dean Scarafoni ,
certify that the information included on this permit application form is,to the best of my knowledge,correct and
that the project will be co 1.truc :: conformance with the approved plans,that the required deed restrictions
and protectiv ovenan. ill b: irded,and that the proposed project complies with the requirements of the
applicable r water r -s un• - 5A NCAC 2H.1000 and any other applicable state stormwater requirements.
Signa 41..). Date: C',2.5.--2420
I, l< + a Notary Public for the State of 41+r V' Ifki,County of
Is)E.A,1 /I .a ,do hereby certify that /L'6+...+ j8 + e..-.i personally appeared
before me this ay of &k , 7"'X,and .cknowledg the due execution of the application for
a stormwater permit. Witness my hand and official seal, Pi
` aa, . SEAL
�,OTAFt pr
.(
°� .2�2,
kp,,,,,,,t,,.,. �` My commission expires
AUG 312
BY:
1j
Form SWU-101 Version Oct.31,2013 Page 6 of 6
Di:

SUPPLEMENT-EZ COVER PAGE
n, ( FORMS LOADED I
kPROJECT INFORMATION x �-# s 1
1 Project Name Crossroads at Caro lina Shores_ —-
2 Project Area(ac) : �. _..._ 5.72
�.__.. ,
1 3 Coastal Wetland Area(ac) I. 0
4 Surface Water Area(ac) 0--__.�_._._
5 Is this project High or Low Density? I __._ . - ._ Hr9h.__.-__.. - _,_I r
6 Does this project use an off-site SCM? Yes
YrrL
,CSMPUANCE WITh OZH.1003(4)
7 Width of vegetated setbacks provided(feet) N/A _ �'•
8 Will the vegetated setback remain vegetated? _ N!A _M _ ...._ _5
9 If BUA is proposed in the setback,does it meet NCAC 02H.1003(4)(c-d)? ~N/A _._^ - __
10 Is streambank stabilization proposed on this project? N/A
/NUMBER AND TYPE OF SCMs:
j 11 Infiltration System
112 Bioretention Cell ;
a 13 Wet Pond �__ __._ ---____--�:.----•---•- __.___—
1 14 Stormwater Wetland I
15 Permeable Pavement
16 Sand Filter
17 Rainwater Harvesting(RWH) _
18 Green Roof .___-- —_.. __ .___.._.._... ._.._....:..)
19 Level Spreader-Filter Strip(LS-FS) E _......__..._- ...._. —T._....__.._.._.....1
20 Disconnected Impervious Surface(DIS) _ —_ _ _ _
21 Treatment Swale I
22 Dry Pond
_ :__,_..,._-- .._.
23 StormFilter .._..-... -..._-,_..._.__....______,_..........._.-__ __ .._
24 Silva Cell
25 Bayfilter
26 Filterra
FORMS LOADED
DESIGNER CERTIFICATION
27 Name and Title. _ _.. ....-._. Garry„S_Pape PE _.._.,
28 Organization: f r_ GSP_Consuitingw PLLC_
29 Street address: -, 6626-C Gordon Road i
30 City,State,Zip: Wilmington:NC 28411 - 4
31 Phone number(s): 910,442 7870_
1 32 Email: `� — _ -gpape@gsp-consulting com z-..
Certification Statement
I certify,under penalty of law that this.Supplement E Z fo ni and aI supportng information ware prepared under my direction or supervision,that the
information provided in the form is.to the best of my knowledge and belief,true,accurate:and complete:and that the engineering plans:
specifications,operation and maintenance agreements and other supporting information are consistent with the rnformatron.provided here.
Deslaner
\'IIu! 0
'os
4 9 . 11 r
• Signature of D= u. ' �!
' 1ir,.
: 031313 :• By, 3
tic A -r..'. .1 0 C/731.702e-.;d•
Date

DRAINAGE AREAS
1 Is this a high density project? Yes ...___,
I2 If so,number of drainage aeas/SCMs 3_
t 3 Does this pipject have low density areas? ' �No^ _
'/�_4 If so,number of low density drainage areas i 0 i
i S Is all/part of this project subject to previous rule _` N ,
,
versions.? !.._.._._.....:_-.._-._._..r.-..r
FORMS LOADED
DRAINAGE AREA INFORMATION 4 3 Entire Site , 1 2 3
-71Trp ;_.1C - -----------'—'1"—
f - wa—_� :^ ' 9—WiIle t Pond ._ On S'rNeP ''ExsTng CVi O=uP1; er.#1-
S Total drainage area(sq ft) 186232 72871 71151 42210 ;
6 Onsite drainage area(sq ft) 72871 F 72871
is 7 Offsite drainage area(sq ft) 1-.
-_ ___ r 1133fi? 71151 422rQ
a 8 Total BUA in project(sq ft)_ 115700 sf 32230 sf 55268sf • 28202 sf _r
New BUA on subdivided lots(subject to permitting)
i 9 s ft 32230 sf 32230 sf ,
10 New BUA not on subdivided lots(subject to _ ^—
Pi
y,_ permitting)(sf)
C 11 Offsite BUA(sq ft) 83470 sf 55268 sf 28202 sf�
[ 12 Breakdown of new BUA not on subdivided lots: Total On Site Existing CVS Out Parcel#1
!! 1
Parking(sq ft) 1 92809 sf 32230 sf 38631 sf 21948 sf
Sidewalk(sq ft) _ - 6724 sf W 4 2863 sf � 3862 sf
Roof(sq ft) 1616ti_sf� _ P_.._ wF 13774 sf i 2392 sf i
111 -Roadway(sq ft) ; _.
-Future(sq ft) _.._._..._w_)_..._.. ..__._... m ...� ...y
-Other,please specify in the comment box
below(sq ft)
New infiltrating permeable pavement on
13 subdivided lots(sq ft)
14 New infiltrating permeable pavement not on
subdivided lots(sq ft)
15 Existing BUA that will remain(not subject to
permitting)
sq ft)
dy
ted
17 Exi t ng BUA(
U(A that will bea emov dt(sg ft)4 ft) ..._ { r... 55268 sf
1,
18 Percent BUA .• 82% 44% 78% 67%
19 Design storm(inches) ._ 1.5 in 1.5 in y_ i 5 in 15 in
20 Design volume of SCM(cu ft) 14180 cf
21 Calculation method for design volume : A DA
ADDITIONAL INFORMATION F ��•
Please use this space to provide any additional information about the
22 drains a aea(s
The drainage areas are broken up for the Total going to the Wet Pond.the on"
site drive aisles:the Existing CVS that was permitted with SW8070824 and •'
YOut-Parcel#1.
h
BY:

WET POND
} ` '11 Drainage area number L _` _i_
[. 2 Minimum required treatmentRvolu�me(Cu ft i 14180 cf
t�E �D4 Fitl UZ�t0.50_ _
.a..�x�.c.-y _. .. ._:r.-a-�-o.ars�.nr•-.y�zas> .rkry+v
3 Is the SCM sized to treat the SW from all surfaces at build-out? ! Yes
i 4 Is the SCM located away from contaminated soils? I Yes
i 5 What are the side slopes of the SCM(H:V)? 3:f ,;
6 Does the SCM have retaining walls,gabion walls or other engineered No 1
i side slopes?
I 7 Are the inlets,outlets,and receiving stream protected from erosion "Yes E
(10-year storm)? 4. .
I;
Is there an overflow or bypass for inflow volume in excess of the
t. 8 design volume? Yes
9 What is the method for dewatering the SCM for maintenance? Pump(preferred) ,:
10 If applicable,will the SCM be cleaned out after construction? Yes
11 Does the maintenance access comply with General MDC(8)? Yes
12 Does the drainage easement comply with General MDC(9)? Yes
r 13 If the SCM is on a single family lot,does(will?)the plat comply with L N/A
General MDC(10)? •) ...._ ._...:._.._ ,_.__
7 14 Is there an O&M Agreement that complies with General MDC(11)? 1 Yes' s
15 Is there an O&M Plan that complies with General MDC(12)? _ Yes
S 16lDoes the SCM follow the device specific MDC? Yes
j 17 Was the SCM designed by an NC licensed professional?
Yesue.. i
18 Sizing method used • SA/DA_
19 Has a stage/storage table been provided in the calculations? _Yes
Elevation of the excavated main pool depth(bottom of sediment
20 31.00
is removal)(fmsl)
21 Elevation of the main pool bottom(top of sediment removal)(fmsl) 32.00
22 Elevation of the bottom of the vegetated shelf(fmsl) ; 39.50
235Elevation of the permanent pool(fmsl) r 40.00 ^;a
24 Elevation of the top of the vegetated shelf(fmsl) _ 40.50 _ j
1
25 Elevation of the temporary pool(fmsl) i 41.25
26 Surface area of the main permanent pool(square feet) 7088
}27 Volume of the main permanent pool(cubic feet) r 23002 cf
28 Average depth of the main pool(feet) i 3.97 ft
29 Average depth equation used Equation.3 .11
30 If using equation 3,main pool perimeter(feet) 472.0 ft
31 If using equation 3,width of submerged veg.shelf(feet) 3,0 ft• !.
32 Volume of the forebay(cubic feet) 3445 cf V.
33 Is this 15-20%of the volume in the main pool? Yes
34 Clean-out depth for forebay(inches) 36 in —
35 Design volume of SCM(cu ft) 14394 cf .40
36 Is the outlet an orifice or a weir? Orifice
37 If orifice,orifice diameter(inches) 2 in 4
38 If weir,weir height(inches)
39 If weir,weir length(inches)
40 Drawdown time for the temporary pool(days) 2.46 6
Are the inlet(s)and outlet located in a manner that avoids short- ii
41 Yes
circuiting? I
42 Are berms or baffles provided to improve the flow path? No
�43 Depth of forebay at entrance(inches) 36 in '<
f44 Depth of forebay at exit(inches) l _24 in
45 Does water flow out of the forebay in a non-erosive manner? _ Yes_ _
46 Width of the vegetated shelf(feet) 6 ft
47 Slope of vegetated shelf(H:V) 6 1 ^�
Does the orifice drawdown from below the top surface of the
E 48 permanent pool? Yes ,
49 Does the pond minimize impacts to the receiving channel from the 1- , Yes
yr,24-hr storm?
1—50 Are fountains proposed?(If Y,please provide documentation that ! No •v
I MDC(9)is met.) -4
51 Is a trash rack or other device provided to protect the outlet system? Yes
1 52 Are the dam and embankment planted in non-clumping turf grass? Yes I
..
i 53 Species of turf that will be used on the dam and embankment Centipede ,,, ° -
I 54I Hasa planting plan been provided for the vegetated shelf? Yes yAflOITIONAONFORMAYION 1 G
orn
55 Please use this space to provide any additional information about the dQj4a
�__..., wet pond(s): -. - •—--- 8r
1
1
L
Wet Pond 1 7:05 AM 8/28/2020

OFF-SITE SCM
THE DRAINAGE AREA -
1 (Drainage area number for this project Existing CVS
2 iMaster permit number i
• 3 'Drainage area number from the masterpermit _ �� �_.. Existing
,gCV ._rN.
; Existing CVS
M 'Lot or out parcel number1
.....,4 p 1 Existing CVS
5 j BUA allocated by Master Permit I 55268 sf
INFORMATION ABOUT THE OFF-SITE SCM
6 'Type of off-site SCM Wet Pond
7 ;Available treatment capacity in the off-site SCM (cu ft) _ _ ~{ N/A
8 Have deed restrictions limiting the BUA on the site been recorded'? No
9 Has an Engineers Certification for the off-site SCM been submitted to DEQ? R-�~ No __ ~
10 'Are there any Notices of Violation for the off-site system? ' No
s
11 1Has the off-site SCM been maintained in accordance with its O&M Plan? ' No
12iWill the collection system be maintained in its design state and kept clean? ` Yes
ADDITIONAL INFORMATION
13 [Please use this space to provide any additional information about the off site SCM(s):
Existing BUA is being allocated to this Permit .��'. T_ ._ _____
___
zr,...7,..,,,., _____ _.
„...........,_ ..:_..,,. 14:., .
•
AUG 3 1 ;.:
BY•

OFF-SITE SCM
M
THE DRAINAGE AREA
-
1 i Drainage area number for this project i Out-Parcel#1
2 'Master permit number ^ t
3 IDrainage area number from the master permit l Out-Parcel#1
4 ILot or outparcel number ' 'Out-Parcel#1
5 BUA allocated by Master Permit 2.8y20Li-,? #�49-sf.
i1ORMATION ABOUT THE OFF-SITE SCM_
6 'Type of off-site SCM i Wet Pond
7 [Available treatment capacity in the off-site SCM (cu ft) N/A •
8 Have deed restrictions limiting the BUA on the site been recorded? i No
9 Has an Engineer's Certification for the off-site SCM been submitted to DEQ? 1'-.._.,,..Nw..,..rNo,•..e_.._�
10 lAre there any Notices of Violation for the off-site system? , No
_ 11 JHas the off-site SCM been maintained in accordance with its O&M Plan'? ; No
J.
121Will the collection system be maintained in its design state and kept clean? 1 Yes
ADDITIONAL.INFORMATION
� ..,
_13 jPlease use this space to provide any additional information about the off-site SCM(s):
The propodsed BUA for Out-Parcel#1 is being allocated with this Permit *��' r K" ~'# �'� "j
illco,3 f

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, Dean Scarafoni , 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..564 zoOS f$ , as issued by the Division of Energy, Mineral
and Land Resources 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 Energy, Mineral and Land Resources.
5. Alteration of the drainage as shown on the approved plan may not take place without the
concurrence of the Division of Energy, Mineral and Land Resources.
6. The maximum built-upon area for the outparcel(s) shown on the approved plans is as follows:
Outparcel# BUA Outparcel# BUA
Existing CVS 55.258 sf Out-Parcel#1 28.202 sf
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 Energy, Mineral and Land Resources 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 project s I cated i� the 20 coastal counties.
Signature: 4 M L - Date: of—g. -
EC
•
Form DRPC-2 Rev.2 05Nov2009 Page 1 of 2 . AUG 3 1 Z�
BY:

Hiqh Density Developments with Outparcels
?peed Restrictions & Protective Covenances
I, 6a fr S? le_ , a Notary Public in the
State of Po v log list__ , County of !Uf" llaring,--- ,
do hereby certify that �J�arc.-i, personally appeared
before me this the day of �og-�— , 20 , and acknowledge
r
the due execution o he foregoing instrument. Witness my hand and official seal,
eolert
Signs w- �
My Co fission expires r• 3 � � t,OTAy.
r
ECA+ra:xa
1
AUG 31 2023
Br
Form DRPC-2 Rev.2 05Nov2009 Page 2 of 2