SW8070801_Current Permit_20220829

ROY COOPER , �j
Governor
.Fro,
ELIZABETH S.BISER
Secretary
BRIAN WRENN NORTH CAROLINA
Director Environmental Quality
August 29,2022
Bald Head Island Club
Attn:.David F. Sawyer,CEO
P.O.Box 3070
Bald Head Island,NC 28461
Subject: Permit Transfer
Post-Construction Stormwater Management Permit No. SW8 070801
Swan's Quarter
Brunswick County
Dear Mr. Sawyer:
The Division of Energy,Mineral and Land Resources received a complete Permit Transfer Application on August
25, 2022 requesting to transfer ownership of the subject permit under the provisions of 15A NCAC
02H.1045(1)(a). Additionally,the proposed permittee selected the option in Section F of the application form,
agreeing to be responsible for addressing any compliance issues. Staff inspected the project on January 26,2022,
reviewed the available documentation,and determined that the project is currently not in compliance with the
terms and conditions of the state stormwater permit.To bring this project into compliance with the regulations
and requirements of this permit,these deviations will be corrected within the proposed schedule of compliance as
documented in Attachment D.By signing the Permit Transfer Application,the Operation and Maintenance
Agreement, and providing the schedule of compliance to correction of the deficiencies outlined in the enclosed
inspection report,you have accepted the responsibility for complying with the terms and conditions outlined in
this permit. The Division is hereby notifying you that permit SW8 070801 has been transferred,updated, and re-
issued on August 29,2022,as attached.
This permit remains effective until September 21,2029 and does not supersede any other agency permit that may
be required. The project shall be subject to the conditions and limitations as specified therein,which includes a
condition to bring this project into compliance as described in Attachment D. This permit does not impose
new or increased stormwater control requirements or design standards; it clarifies the rules and requirements of
this program to provide you with a better understanding of your obligations under this permit. Failure to comply
with these requirements will result in future compliance problems. Please note that this permit is not transferable
except after notice to and approval by the Division.
If any parts,requirements,or limitations contained in this permit are unacceptable,you have the right to request
an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings(OAH). The
written petition must conform to Chapter 150B of the North Carolina General Statutes,and must be filed with the
OAH within thirty(30)days of receipt of this permit. You should contact the OAH with all questions regarding
the filing fee(if a filing fee is required)and/or the details of the filing process at 6714 Mail Service Center,
Raleigh,NC 27699-6714,or via telephone at 919-431-3000,or visit their website at www_NCOAH.com_Unless
such demands are made this permit shall be final and binding.
If you have any questions concerning this permit,please contact Garrett Zorda in the Wilmington Regional
Office,at(910)796-7215 or [e-mail].
Sincerely,
() tL )IaQ
Brian Wrenn,Director
Division of Energy,Mineral and Land Resources
Enclosures: Attachment A—Designer's Certification Form
Attachment C-Permitting History
Attachment D—Schedule of Compliance
copy of the Transfer Application documents including Transfer Application Form and Operation&Maintenance Agreement
copy of the latest compliance inspection report
North Carolina Department of Environmental.Quality I Division of Energy,Mineral and Land Resources
trP;alir Er Wilmington.Regional Office 1127 Cardinal Drive Extension I Wilmington,North Carolina 28405
NORTH O.FQUNq
°a'°°'a°'u"'°°"'"t"'"°'oa 910.796.7215

State Stormwater Permit No. SW8 070801
Page 2 of 2
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cc: Charles A.Paul,III,Manager,Bald Head Island Limited,LLC;previous permittee
Bruce Marelc,PE
Wilmington Regional Office Stormwater File
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North Carolina Department of Environmental Quality I Division of Energy,Mineral and Land Resources
_.1)E -) Wilmington Regional Office 1127 Cardinal Drive Extension I Wilmington,North Carolina 28405
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State Stormwater Management
Permit No. SW8 070801
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
POST-CONSTRUCTION STORMWATER MANAGEMENT PERMIT
HIGH DENSITY 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 (1995 Rules) as
amended on January 1, 2017 (2017 Rules) (collectively, the "stormwater rules"),
PERMISSION IS HEREBY GRANTED TO
Bald Head Island Club
Swan's Quarter
281 South Bald Head Wynd, Bald Head Island, Brunswick County
FOR THE
construction, management, operation and maintenance of built-upon area (BUA) draining to six (6)
infiltration basins ("stormwater control measures" or"SCMs") proposed for the initial site layout,
Phase 1, and eight (8) infiltration basins proposed for the final site layout, Phase 2, 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 September 21, 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 CORRECTIONS NEEDED and SCHEDULE OF COMPLIANCE. To bring this project into
compliance with the Stormwater Regulations and design criteria, these deviations will be corrected
within the proposed schedule of compliance as documented in Attachment D. The schedule must
be adhered to unless an extension or revised plan of action is submitted and approved by the
Division.
2. APPLICABLE RULES (Phase 1). The drainage areas and/or SCMs identified as Drainage Area
#1, Drainage Area#2, Drainage Area#6, Drainage Area #7 and Drainage Area #8 are subject to
the 1995 Rules specific conditions listed herein. The SCM identified as Infiltration Basin 3-4-5
Interconnected is subject to the 2017 Rules specific conditions listed herein.
3. APPLICABLE RULES (Phase 2). The drainage areas and/or SCMs identified as Drainage Area
#1, Drainage Area#2, Drainage Area#3, Drainage Area#4, Drainage Area #5, Drainage Area
#6, Drainage Area#7 and Drainage Area#8 are subject to the 1995 Rules specific conditions
listed herein.
Page 1 of 7

State Stormwater Management
Permit No. SW8 070801
4 PROJECT PHASES. This project is approved to be developed in two phases, Phase 1 and Phase
2, as described throughout this permit. At such time that the permittee desires to transition from
Phase 1 to Phase 2, as previously approved on September 21, 2007, a minor modification shall
be submitted.
5. BUA REQUIREMENTS. The maximum amount of BUA allowed for the entire project is 61,156
square feet. The runoff from all BUA within the permitted drainage areas of this project must be
directed into the permitted SCMs. The BUA requirements and allocations for this project are as
follows:
a. SCM BUA LIMITS (Phase 1). The SCMs labeled Infiltration Basin #1, Infiltration Basin #2,
Infiltration Basin 3-4-5 Interconnected, Infiltration Basin #6, Infiltration Basin #7, and
Infiltration Basin #8 have been designed using the runoff treatment method to handle the
runoff from 8,768 square feet, 8,371 square feet, 24,467 square feet, 5,953 square feet,
13,021 square feet and 576 square feet of BUA, respectively, within the delineated drainage
areas. The BUA for future development within the drainage areas to the SCMs labeled
Infiltration Basin 3-4-5 Interconnected is limited to 11,119 square feet. This permit does not
provide any allocation of BUA for future development within the delineated drainage areas
labeled Infiltration Basin#1, Infiltration Basin #2, Infiltration Basin#6, Infiltration Basin #7,
and Infiltration Basin #8.
b. SCM BUA LIMITS (Phase 2). The SCMs labeled Infiltration Basin #1, Infiltration Basin #2,
Infiltration Basin 3, Infiltration Basin #4, Infiltration Basin #5, Infiltration Basin #6, Infiltration
Basin #7, and Infiltration Basin #8 have been designed using the runoff treatment method to
handle the runoff from 8,768 square feet, 8,371 square feet, 10,142 square feet, 4,776
square feet, 9,549 square feet, 5,953 square feet, 13,021 square feet and 576 square feet of
BUA, respectively, within the delineated drainage areas. This permit does not provide any
allocation of BUA for future development within the delineated drainage area(s).
6. 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.
7. SCM REQUIREMENTS. The SCM requirements for this project are as follows:
a. SCM DESIGN (2017 Rules). The SCM labeled Infiltration Basin 3-4-5 Interconnected
(Phase 1) 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.
Page 2 of 7

State Stormwater Management
Permit No. SW8 070801
b. SCM DESIGN (1995 Rules). The SCMs labeled Infiltration Basin #1, Infiltration Basin #2,
Infiltration Basin 3 (Phase 2), Infiltration Basin#4 (Phase 2), Infiltration Basin#5 (Phase 2),
Infiltration Basin #6, Infiltration Basin #7, and Infiltration Basin #8 are permitted based on the
following design criteria and as shown in the approved plans and specifications. These
SCMs must be provided and maintained at the design condition.
Basin 1 Basin 2 Basin 3 Basin 4 Basin 5 i Basin 6 Basin 7 Basin 8
a. Drainage Area, ac: 0.55 0.309 0.60 0.279 0.461 0.324 0.614 0.118
(1) Onsite, ft2: 23,761 13,452 26,156 12,161 20,086 14,135 26,755 5,131
(2) Offsite, ft2: 0 0 0 0 0 0 0 0
b. Total Impervious
Surfaces, ft2: 8,768 8,371 10,142 4,776 9,549 5,953 13,021 576
(1) Buildings ft2: 5,023 0 9,038 4,447 4,591 4,447 9,038 576
(2) Roads/Parking, ft2: 3,745 8,371 1,104 329 4,958 1,506 3,983 0
c. Design Storm, inches: 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5
d. Basin Depth, feet: 1 1 1 1 1 1 1 1
e. Bottom Elevation, FMSL: 4.5 4.5 4.5 4.5 4.5 4.5 4.5 4.5
f. Permitted Surface Area at 1,295 1,188 1,500 576 1,086 936 2,000 128
Bottom, ft2:
g. Permitted Storage 1,551 1,407 1,725 786 1,518 1,133 2,150 176
Volume, ft3: '
h. Storage/Bypass N/A* N/A* N/A* N/A* N/A* N/A* N/A* N/A*
Elevation, FMSL:
i. Type of Soil: Fine Fine Fine Fine Fine Fine Fine Fine
Sand Sand Sand Sand Sand Sand Sand Sand
j. Expected Infiltration Rate, 20 20 20 20 20 20 20 20
in/hr:
k. Seasonal High Water 2.43 2.45 2.47 2.20 2.17 2.00 2.10 2.50
Table, FMSL:
I. Time to Draw Down, 0.439 0.518 0.522 0.639 0.663 0.486 0.489 0.454
hours:
m. Receiving Stream/River Atlantic Atlantic Atlantic Atlantic Atlantic Atlantic Atlantic Atlantic
Basin: Ocean/ Ocean/ Ocean/ Ocean/ Ocean/ Ocean/ Ocean/ Ocean/
Cape Cape Cape Cape Cape Cape Cape Cape
Fear Fear Fear Fear Fear Fear Fear Fear
n. Stream Index Number: 99-(3) 99-(3) 99-(3) 99-(3) 99-(3) 99-(3) 99-(3) 99-(3)
o. Classification of Water SB SB SB SB SB SB SB SB
Body:
*Non-discharging infiltration basin.
c. PRETREATMENT. The following pretreatment device(s) has (have) been provided to
prevent clogging in the infiltraion SCMs: gravel verges.
8. STORMWATER OUTLETS. This project does not propose any discharge points and therefore will
not have the opportunity to cause erosion during the 10-year storm event.
Page 3 of 7

State Stormwater Management
Permit No. SW8 070801
9. 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.
10. RECORDED DOCUMENT REQUIREMENTS. The stormwater rules require the following
documents to be recorded with the Office of the Register of Deed.
a. EASEMENTS. All SCMs, stormwater collection systems, vegetated conveyances, and
maintenance access located on property owned by other persons or entities must be located
in permanent recorded easements or drainage easements as shown on the approved plans.
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. DEEDS. 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.
11. 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.
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State Stormwater Management
Permit No. SW8 070801
12. 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 to be considered a permeable surface that were not included in the approved plans
and specifications.
g. Other modifications as determined by the Director.
13. 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.
14. 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.
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.
15. 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).
16. CHANGES TO THE PROJECT NAME, PERMITTEE NAME OR CONTACT INFORMATION. The
permittee shall submit a completed Permit Information Update Application Form to the Division
within 30 days to making any one of these changes.
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State Stormwater Management
Permit No. SW8 070801
17. TRANSFER. This permit is not transferable to any person or entity except after notice to and
approval by the Director. Neither the sale of the project and/or property, in whole or in part, nor
the conveyance of common area to a third party constitutes an approved transfer of the permit.
a. TRANSFER REQUEST. The transfer request must include the appropriate application,
documentation and the processing fee as outlined in 15A NCAC 02H.1045(2). This request
must be submitted within 90 days of the permit holder meeting one or more of the following:
i. A natural person who is deceased;
ii. A partnership, limited liability corporation, corporation, or any other business
association that has been dissolved;
iii. A person or entity who has been lawfully and finally divested of title to the property
on which the permitted activity is occurring or will occur through foreclosure,
bankruptcy, or other legal proceeding.
iv. A person or entity who has sold the property, in whole or in part, on which the
permitted activity is occurring or will occur;
v. The assignment of declarant rights to another individual or entity;
vi. The sale or conveyance of the common areas to a Homeowner's or Property
Owner's Association, subject to the requirements of NCGS 143-214.7(c2);
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.
18. 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.
a. REVIEWING AND MONITORING FOR COMPLIANCE. The permittee is responsible for
verifying that the proposed BUA within each drainage area and for the entire project does
not exceed the maximum amount allowed by this permit. The permittee shall review and
routinely monitor the project to ensure continued compliance with the conditions of the
permit, the approved plans and specifications.
b. 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.
c. MAINTENANCE ACCESS. SCMs, stormwater collection systems, and vegetated
conveyances must be accessible for inspection, operation, maintenance and repair as
shown on the approved plans.
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. ANNUAL CERTIFICATION. The permittee shall electronically submit to the Division an
annual certification completed by either the permittee or their designee confirming the
projects conformance with permit conditions.
g. 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.
Page 6 of 7

State Stormwater Management
Permit No. SW8 070801
h. 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 transferred, updated and reissued this the 22"d day of August 2022.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT CAly*,,,(1-/A
Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 070801
Page 7 of 7

State Stormwater Management
Permit No. SW8 070801
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 Infiltration 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 070801
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
Perrnittee's Certificates NCAC 1042(4) Completed/ N/A
Provided
A. DEED RESTRICTIONS I 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
D. SINGLE FAMILY RESIDENTIAL LOTS -Plats for residential lots that Y or N
have an SCM include the following.
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. OPERATION AND MAINTENANCE PLAN—maintenance records are
long kept it a known set braticn for each SCM and are available for Y or N
review.
G. DESIGNER'S CERTIFICATION FOI -has bawl provided to The
[3inrision. Y or N
Page 1 of 6

State Stormwater Management
Permit No. SW8 070801
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.
Page 2 of 6

State Stormwater Management
Permit No. SW8 070801
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
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 stormwater rules
H
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:
O Circle N if the as-built value differs from the Plan. If N is circled, provide an explanation on Page 2.
OO N/E = not evaluated (provide explanation on page 2) ON/A= not applicable to this SCM or project.
Consultant's Certification NCAC .1003((3) &General MDC ®As-built OWE 0)N/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.
Page 3 of 6

State Stormwater Management
Permit No. SW8 070801
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.
®Ash OWE 3N/A
C.: STORMVVATER OUTLETS —the outlet handles the peak Y or- N
flow 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 equal or better protection of surface waters.
E. COMPUANCE WITH OTHER REGULATORY PROGRAMS Y or N
. has been met.
F. SIZING volume of the SCM takes the rur:off from ail
surfaces into account and is sufficient to handle the required Y or N
storm depth.
G . CONTAMINATED SOILS— infiltrating SCM's are not Y or N
located in or on areas with contaminated soils.
H. SIDE SLOPES
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:1V(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 FLOWS An overflow/ bypass has been Y or N
provided. .
14. DEWATERING—A method to drawdown standing water has Y or N
been provided to facilitate maintenance and inspection.
L. CLEANOUT AFTER CONSTRUCTION—the SCM has been Y ox N
cleaned out and converted to its approved deer state.
M. MAINTENANCE ACCESS
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. DESIGNER QUALIFICATIONS(FAST-TRACK PERMIT)—
The designer is licensed under Chapters 89A, 89C, 89E, or . . Y or N
89F of the General Statutes.
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 070801
AS-BUILT DESIGNER'S CERTIFICATION FOR INFILTRATION 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.1051 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
H
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(4).
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. If N is circled, provide an explanation on Page 2.
ON/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
Consultant's Certification (MDC .1051) OAs-built ONCE ®N/A
A. Inlets/ Pretreatment/ Design Depths/Elevations
1. Inlets are located per the approved plans. Y or N
2. Pretreatment measures are provided? (Rooftop runoff Y or N
does not require pre-treatment.)
3. BASIN only—the area and depth of the basin is consistent
with the approved plans
4. TRENCH only-the provided width, length and height of the
trench are consistent with the approved plan.
5. TRENCH only- the provided length and size of the
perforated pipe is consistent with the approved plan.
6. The bottom elevation of the basin /trench is consistent
with the approved plans.
7. The bypass elevation is consistent with the approved plan.
8. The overflow elevation is consistent with the approved
plan.
B. Soils/SHWT I Subgrade
1. The hydraulic properties of the insitu soils are in Y or N
accordance with the soils report.
2. The lowest point of the infiltration system is a minimum of Y or N
2 feet above the SHWT.
3. If separation to the SHWT is less than 1 foot, the water Y or N
table draws down to its pre-storm level within 72 hours.
4. The slope of the soil subgrade is <= 2%. Y or N
C. Drawdown Time
Page 5 of 6

State Stormwater Management
Permit No. SW8 070801
1. The system dewaters within 72 hours? Y or N
2. The Insitu soils were removed and replaced with suitable Y or N
infiltration media to achieve the 72 hour drawdown.
DAs-built ®N/E 'NIA
D. Observation Port for underground systems, a rnintiran at Y or N
one motion part has been providad.
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

Post-Construction Stormwater Management
Permit No. SW8 070801
Attachment C- Permitting History
Swan's Quarter
Permit No.SW8 070801
Approval Permit BIMS Description of the Changes
Date Action Version
Original Approved a total of eight(8)infiltration basins to
9/21/2007 Approval 1.0 treat the runoff from a total of 61,156 square feet of
BUA.
7/19/2017 Renewal 2.0 Renewed the permit with a new expiration date of
September 21,2029.No changes proposed.
Modified the permit to include two(2) "phases" in
order to include a temporary cart parking area.
Phase 1 includes the temporary parking area and
interconnects Infiltration Basins#3,4 and 5 to act
8/6/2020 Major 1 as a single infiltration basin. The other Infiltration
Modification basins remain unchanged. Phase 2 reverts the
project back to the September 21,2007 approved
design. Once it is desired to transition to Phase 2,a
minor modification will need to be submitted to
document the phase transition.
•
8/29/2022 Transfer 2.2 Transferred the permit from Bald Head Island
Limited,LLC to Bald Head Island Club.
Page 1 of 1

Post-Construction Stormwater Management
Permit No. SW8 070801
Attachment D
Schedule of Compliance
Bald Head Island Club has applied for a State Stormwater Permit Transfer for SW8 070801 for Swan's
Quarter. The compliance inspection by the Division of Energy, Mineral, and Land Resources
(DEMLR) on January 26, 2022 identified the following non-compliant items. As the incoming
permittee, and by checking the box in Section F of the Permit Transfer application form accepting
responsibility for resolving any compliance issues,you understand and have accepted that you will be
transferred a non-compliant permit and agree to resolve these items to bring the project into
compliance by September 16, 2022.
Non-Compliant Items:
1. Permit Condition 12 and 15A NCAC 02H.1042(4)(a) effective January 1, 2017: A copy of the
certification for the most recent version of the permit could not be found in the file,however
part of the project has been constructed. Any incomplete SCMs can be completed and certified
by the new owner.
2. Permit Condition 9.b and 15A NCAC 02H.1050(11): A copy of the recorded operation and
maintenance agreement has not been submitted.
3. Permit Condition 4.a, 6.a, 11: Infiltration Basin 3-4-5 Interconnected has not been constructed
in its entirety, as shown on the approved plans. Only the DA4 portion of the system has been
constructed at this time,however, BUA approved to drain to the DA3 and DA5 portions of the
system has been built. A modification has not been submitted showing that the DA4 portion of
the system receives the runoff from the entire parking lot and is able to handle that runoff as a
standalone system.
Page 1 of 1

DEMLR USE ONLY
Date 11c21
eive Fee Pal Permit Number
i ia4 I Ie5 . 5t1 -
.V StL R- 070X 0I
NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT TRANSFER APPLICATION FORM
Pursuant to 15A NCAC 02H.1045 and other applicable statues as reference within
Only complete applications packages will be accepted and reviewed. This form and the required items(with
original signatures)must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at:http://dea.nc.gov/contact/reoional-offices.
After this application is accepted, DEMLR will conduct a compliance inspection and report any deficiencies to the
current permittee and/or the proposed permittee. Per the state stormwater rules and the state stormwater permit
conditions, the permit shall not be transferred until:
1. the current permittee resolves all non-compliance issues identified in the inspection report;
2. the current permittee negotiates a resolution with the proposed permittee(in writing and signed by both
entities. The negotiated resolution must identify the necessary actions, the responsible party(ies), and the
timelines to correct the deficiencies. The site must either be found in compliance or a copy of the
negotiated resolution must be submitted prior to the transfer of the permit.);or
3. in the case where a transfer falls under G.S. 143-214.7(c2) (see also SL 2011-256), the proposed
permittee resolves all non-compliance issues upon acquiring the permit.
Signature requirements for the named signing official(for current and proposed permittee)must meet the following:
• Corporation-a principal executive officer of at least the level of vice-president;
• Limited Liability Company(LLC)-the designated manager; (Documentation from the NC Secretary of
State or other official documentation must be provided that states the titles and positions held by the
person who signed the application(pursuant to 02H.1040)that shows they have legal authority to sign for
the LLC)
• Municipality-a ranking official or duly authorized employee;
• Partnership or limited partnership- the general partner;
• Sole proprietor;
• The signature of the consultant or other agent shall be accepted on this permit transfer application only if
accompanied by a letter of authorization signed by one of the signatories noted in a-e above, as
applicable.
A. GENERAL INFORMATION
1. State Stormwater Permit Number: SW8-070801
2. Project name: Swans Quarter
Is this an updated project name from the current permit? El Yes X❑ No
3. Reason for the permit transfer request:
Chancre of Ownership. The Bald Head Island Club purchased the 3.25 acre Swans Quarter from
Bald Head Island Limited LLC on August 30, 2021
8 EcEi
4�..{'�R_.
NOV 2 4 2o2f
BY
Stormwater Permit Transfer Application Form Page 1 of 7 April 27,2018

B. PERSON(S)WHO HAVE SIGNED THIS FORM (select only one response below)
X❑ 1. Both the current and proposed permiftees
❑ 2. Only the current permittee of a condominium or planned community (skip Part F&G).
In accordance with G.S. 143-214.7(c2) (see also SL 2011-256), this type of transfer is allowed only
when all of the following items can be truthfully checked:
❑ Any common areas related to the operation and maintenance of the stormwater management
system have been conveyed to the unit owners' association or owners' association in
accordance with the declaration;
El The declarant has conveyed at least fifty percent(50%) of the units or lots to owners other than
a declarant(provide documentation per submittal requirements below);
❑ The stormwater management system is in compliance with the stormwater permit.
NOTE: If subdivision was built prior to 1999, the Declarant's Attorney can make a determination that
the elements of the Planned Community Act(see§47F) have been met by the Declarant for the
subdivision. If the Declarant chooses to use this type of transfer, the determination must be in
writing, signed by the attorney, and submitted to DEMLR with this form.
❑ 3. Only the proposed permittee (skip Part D below).
In accordance with G.S. 143-214.7(c5) (see also SL 2013-121), this type of transfer is allowed only
when all of the following items can be truthfully checked:
❑ a. The proposed permittee is either(select one of the following):
❑ The successor-owner who holds title to the property on which the permitted activity is
occurring or will occur;
❑ The successor-owner who is the sole claimant of the right to engage in the permitted
activity.
❑ b. The current permittee is(select at least one of the following, but all that apply):
❑ A natural person who is deceased.
❑ A partnership, Limited Liability Corporation, corporation, or any other business
association that has been dissolved
El A person who has been lawfully and finally divested of title to the property on which the
permitted activity is occurring or will occur.
❑ A person who has sold the property on which the permitted activity is occurring or will
occur.
❑ Other(please explain):
❑ c. The proposed permittee agrees to the following requirements (all must be selected):
❑ There will be no substantial change in the permitted activity.
❑ The permit holder shall comply with all terms and conditions of the permit until such
time as the permit is transferred.
❑ The successor-owner shall comply with all terms and conditions of the permit once the
permit has been transferred.
Be Wie,I V .1
NOV 2 4 2021
By:
Stormwater Permit Transfer Application Form Page 2 of 7 pril 27,2018

r' SUBMITTAL REQUIREMENTS
Please mark NY"to confirm the items are included with this form. Please mark"X"if previously provided. If not
applicable or not available,please mark N/A.:
Y 1. A processing fee of five hundred and five dollars($505.00)per G.S. 143-215.3D(e)(2).
Y 2. Two hard copies (with original signatures) and one electronic copy of this completed form and the
required items.
Y 3. For proposed permittees that are corporations or LLC's, documentation from the NC Secretary of
State demonstrating that the proposed permittee is a legal and viable entity able to conduct
business in North Carolina.
N/A 4. If Part B, Items 1 or 3 of this form is selected, the signed and notarized
applicable O&M aoreement(s)from the proposed permittee, as required by the permit.
Y 5. Legal documentation that the property has transferred to the proposed permittee(such as a
recorded deed for the property, uncompleted development and/or common areas) or legal
documentation demonstrating that the proposed permittee is the sole claimant of the right to
engage in the permitted activity.
N/A 6. If required by the permit and if the project has been built, a signed, sealed and dated certification
document from a licensed professional stating that the stormwater management system has been
inspected and that it has been built and maintained in accordance with the approved plans.
N/A 7. A copy of the recorded covenants and deed restrictions, if required by the permit. If the project has
been built, documentation that the maximum allowed per lot built-upon area or the maximum
allowed total built-upon area has not been exceeded. If the project has not been built, the new
owner shall provide a signed agreement to submit final recorded deed restrictions and protective
covenants.
N/A 8. If transferring under G.S. 143-214.7(c2) (i.e., Part B, Item 2 of this form is selected),
documentation verifying that 50%or more of the lots have been conveyed to individuals (not
builders). Copies of the deeds of conveyance or a chart listing the lot number, lot address,
owners name, conveyance date and deed book and page number are acceptable.
N/A 9. If transferring under G.S. 143-214.7(c5)(i.e., Part B, Item 3 of this form is selected), provide legal
documentation supporting the dissolution of the corporation or documentation supporting the
current permittee was lawfully and finally divested of title of the property.
N/A 10. A copy of the lease agreement if the proposed permittee is the lessee.
N/A 11. A copy of the pending sales agreement if the proposed permittee is the purchaser.
N/A 12. A copy of the development agreement if the proposed permittee is the developer.
2021
Nov 2 4
BY
Stormwater Permit Transfer Application Form Page 3 of 7 April 27,2018

D. CURRENT PERMITTEE INFORMATION AND CERTIFICATION Please be sure to provide Email.
1. Current Permit Holder's Company Name/Organization: Bald Head Island Limited LLC
2. Signing Official's Name: Charles A. Paul, Ill
3. Signing Official's Title: CEO/Registered Agent/Manager
4. Mailing Address: P.O. Box 3069
City: Bald Head Island State: NC ZIP : 28461
5. Street Address: 6 Marina Wind
City: Bald Head Island State: NC ZIP : 28461
6. Phone: [phone] Email: cpaul cnr.bhisland.com
I, Charles A. Paul. III , the current permittee, am submitting this application for a
transfer of ownership for the above listed stormwater permit under the General Statute and Session Law identified
on Page 1 of this application. I hereby notify DEMLR of the sale or other legal transfer of the property/project
and/or the stormwater system associated with this permit. I have provided a copy of the following documents to
the proposed permittee named in this application form: (select all that apply)
X❑ the most recent permit;
N/A❑ the designer's certification for each SCM; Project mostly a vacant lot
X❑ any recorded deed restrictions, covenants, common areas, drainage easements or plats;
X❑ the approved plans and/or approved as-built plans;
N/A❑ the approved operation and maintenance agreement;
N/A❑ past maintenance records from the previous permittee(where required);
N/A❑ a copy of the most recent inspection report;
I further attest that this application and request for a permit transfer is accurate and complete to the best of my
knowledge. I attest that I have provided all of the required items per the law to transfer this permit. I understand
that if all required parts of this request are not completed or if all required supporting information and attachments
listed above are not included, this request package will be returned as incomplete I assign all rights and
obligations as permittee to the proposed permittee named below. I understand that this request to transfer the
permit may not be a the DEMLR unless and until the facility is in compliance with the permit.
Signature: .s Date: %t• 7.2•Z%
.,,'/a,r1P 5f4.hs , a Notary Public for the State of
/(VA , County of Guts Gtl,"�J , do hereby certify
that C r(tS A- Prt w/ `ZC personally appeared before me
this tte.`°'""`p"°0 ' day of A004'h.b4e , 20 ..Z/ , and acknowledge the due
eltEs4tion of theTarcoito instrument. Witness my hand and official seal,
NOT,
rItaryjSeal)
411
NoraiptirgettitO „ze 441A
0000000000000
My commission expires /,2/
NOV 2 4 2021
BY
Stomiwater Permit Transfer Application Form Page 4 of 7 April 27,2018

E. PROPOSED PERMITTEE INFORMATION
1. The proposed permittee is the:
X❑ Property owner(Also complete Part F.)
❑ Home Owners Association (HOA), Property Owners Association (POA), or Unit Owner Association
(UOA)(Also complete Part F.)
0 Lessee-Attach a copy of the lease agreement. Both the lessee and the property owner will appear on
the permit as co-permlttees. If the lease is terminated, responsibility for the permit reverts to the property
owner. (Also complete Parts F& G.)
El Purchaser-Attach a copy of the pending sales agreement. The permit will require submission of a copy
of the recorded deed after the purchase has taken place. If the purchase agreement is cancelled the
permit reverts to the property owner. (Also complete Parts F&G.)
❑ Developer-Attach a copy of the development agreement. Both the developer and the property owner
will appear on the permit as co-permittees. If the development agreement is terminated, responsibility for
the permit reverts to the property owner. (Also complete Parts F&G.)
2. Proposed permittee name (check one of the following and provide the name):
X❑ Corporation, LLC, Partnership, Municipality name: Bald Head Island Club
❑ HOA/POA/UOA name:
❑ Sole Proprietor
3. Proposed permittee contact information:
Please be sure to provide Email.
a. Signing Official's Name: David F. Sawyer
b. Signing Official's Title: CEO
c. Mailing Address: P.O. Box 3070 (per BrunsCo Parcel I.D. P.O. Box 3073: Club uses both)
City: Bald Head Island State: NC ZIP : 28461
d. Street Address: 303 South Bald Head Wvnd
City: Bald Head Island State: NC ZIP : 28461
e. Phone: [phone] ext 5007 Email: dsawyerabhiclub.net
4. If there is a Management Entity that manages the property for an HOA, POA or UOA, please provide:
Please be sure to provide Email.
a. Management Company or Business name: N/A
b. Contact Name: Title:
c. Mailing Address:
d. City: State: ZIP:
e. Phone: (_) Email:
8�
ILO g it .
NOV 2 4 2021
BY:
Stormwater Permit Transfer Application Form Page 5 of 7 pri127,2018

F. PROPOSED PERMITTEE CERTIFICATION
I, David F. Sawyer , hereby notify the DEMLR that I have acquired through sale, lease,
development agreement, or other legal transfer,the project/property covered by the stormwater management
permit and/or the responsibility for constructing and/or operating and maintaining the permitted stormwater
management system. I acknowledge and attest that I have received a copy of: (select all that apply):
X❑ the most recent permit;
N/A❑ the designer's certification for each SCM;
XLI any recorded deed restrictions, covenants, common areas, drainage easements or plats;
X❑ the approved plans and/or approved as-built plans;
NIA❑ the approved operation and maintenance agreement;
N/A❑ past maintenance records from the previous permittee(where required);
N/A❑ a copy of the most recent inspection report;
X❑ Check here if the proposed permittee agrees to be the entity responsible for addressing any compliance
issues outlined in the Compliance Inspection Report. If checked, the proposed permittee must provide a
written document statement, with a "plan of action and schedule"addressed to this office stating that they will
bring the project into compliance upon receipt of the transferred permit. This written "plan of action and
schedule"must be received by the Division before the Division will transfer the permit.
I have reviewed the permit, approved plans and other documents listed above, and I acknowledge that I will
comply with the terms and con.'.ons of the permit. I will construct the project's built-upon area as shown on the
approved plans; and I will{con-Tuct}, operate and maintain the approved stormwater management system
pursuant to the r:• - --nts li ed in the permit and in the operation and maintenance agreement.
Signature: Date:
IP doe
> Z,
I, _ , a Notary Public for the��State of 716 A-C� �aGr/Zo-Qi�✓t�V
County of L , do hereby certify that �IXQwALcL Zeit-ae Ph)
mt
personally appeared before me this the a 3 day of 711OLia it , 20 a.///, and
acknowledge the due execution of the forgoing instrument.Witness my hand and official seal,
(Notary Seal)
gnumx�nyw,_
Notary r.�"'.. E L�
My co imispi �'fcpire§R -le -i c2O,2d.
,: PUBLIC
00- RiEc
if; �
Nov 24 2021
Stormwater Permit Transfer Application Form Page 6 of 7 April 27,2018

G. PROPERTY OWNER INFORMATION AND CERTIFICATION
Fill out this section only if the property owner is different from the proposed permittee. The permit will revert to
the property owner if the purchase agreement, development agreement or lease expires or is terminated.
Company Name/Organization: N/A
Signing Official's Printed Name:
Signing Official's Title:
Mailing Address:
City: State: ZIP :
Phone: ( ) Email:
I, N/A , hereby certify that I currently own the property identified in
this permit transfer document and acknowledge that the Proposed Permittee listed in Part F will be purchasing the
property, developing the property on my behalf, and/or leasing the property from me. A copy of the purchase
agreement, development agreement or the lease agreement, which names the party responsible for the
construction and/or operation and maintenance of the stormwater system, has been provided with the permit
transfer request.
I agree to notify DEMLR within 30 days if there are any changes to the purchase, developer or lease agreements
and will submit the applicable completed and signed Permit Information Update Form, or Permit Transfer
Application Form to address these changes. As the legal property owner, I acknowledge, understand, and agree
by my signature below, that the permit will revert to me and I will be responsible for complying with the DEMLR
Stormwater permit if the property purchase, lease or developer agreement/contract is cancelled or defaults. I
understand that any individual or entity found to be in noncompliance with the provisions of the stormwater
management permit or the stormwater rules, is subject to enforcement action as set forth in NC General Statute
(NCGS) 143,Article 21.
Signature of the property owner Date:
I, , a Notary Public for the State of
, County of , do hereby certify that
personally appeared before me this the day of
, 20 , and acknowledge the due execution of the forgoing instrument. Witness
my hand and official seal,
(Notary Seal)
Notary Signature
My commission expires
8 NOV 24 2021 •
BY:
Stormwater Permit Transfer Application Form Page 7 of 7 April 27,2018

I32vcF_ , Al2g/L ye
_ 95-
f
10. --61
-- --
x,.ilt;,.
..N N/S E : .F2`6IIIIIIIIIiIIII IIIIII ! B99 P1019 454 24?0ROI II � I Register of Deeds page 1 of 3
Operation & Maintenance Agreement 111111
Project Name: (Bald Head Island Club) Swans Quarter SW8-070801
Project Location: South Bald Head Wynd, Bald Head Island, NC 28461
.__ -- `r
Cover Pa. — T- m
0
Maintenance records shall be kept on the following SCM(s). This maintenance record shall be kept in a log in a known set location. p m
Any deficient SCM elements noted in the inspection will be corrected,repaired,or replaced immediately. These deficiencies can ccs
affect the integrity of structures,safety of the public,and the pollutant removal efficiency of the SCM(s). r., In
o 0
N
The SCM(s)on this project include(check all that apply&corresponding O&M sheets will be added automatically):
iv
O pP Y P 9 Y)�
Infiltration Basin Quantity: 8 Location(s): Throughout Site.
Infiltration Trench Quantity: Location(s):
Bioretention Cell Quantity: Location(s):
Wet Pond Quantity: _ Location(s):
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 Type:
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each SCM above,and attached O&M tables. I agree to notify NCDEQ of any problems with the system or prior to any changes to
the system or responsible party.
Responsible Party: David Sawyer
Title&Organization: CEO,Bald Head Island Club
Street address: P.O.Box 3070
City,state,zip: Bald Head Island,NC 28461
Phone number : 910-457-7300
E :i f [e-mail]
Signature: ' Al Date: (9(I-2'
I, Gewt / , 40.71 - ,a Notary Public for the State of Wore.-ti i:4611e/,
County of 8 E,(/N c.k ,do hereby certify that 4#V a el ..5,444.)7 e/2
personally appeared before me this day of Seirte.m be .46 2.2 and
acknowledge the due execution of the perations and Maintenance Ace reeme
Witness my hand and official seal, ,
I `' Gene E Odle
qt- NOTARY PUBLIC
Brunswick Courty,NC
My Commission Expires September 03,2027
Seal My commission expires 6 7 /076.7 -
STORM-EZ 9/8/2022
Version 1.5 O&M Agreement Page 1 of 1

11111111111 111111111111 11111111 ill III Plea 1311079 m ons:242 ROP
Brunswick County, NC Register of Deeds page 2 of 3
AITXtfAielifr
Infiltration Basin Maintenance Requirements
Important operation and maintenance procedures:
-The drainage area will be carefully managed to reduce the sediment load to the infiltration basin.
No portion of the infiltration basin will be fertilized after the initial fertilization that is required to establish
-the vegetation. Lime may be allowed if vegetation is planted on the surface of the infiltration basin and a
soil test shows that it is needed.
-The vegetation in and around the basin will be maintained at a height of four to six inches.
After the infiltration basin is established, it will be inspected quarterly 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 shall be kept in a
known set location and shall be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
SCM element: Potential problem: How to remediate the problem:
The entire infiltration Trash/debris is present. Remove the trash/debris.
basin
Areas of bare soil and/or Regrade the soil if necessary to remove the gully, plant ground
erosive gullies have cover and water until it is established. Provide lime and a one-
The grass filter strip or formed. time fertilizer application.
other pretreatment area Sediment has accumulated Search for the source of the sediment and remedy the problem if
to a depth of greater than possible. Remove the sediment and dispose of it in a location
three inches. where it will not cause impacts to streams or the SCM.
The structure is Dogged. Unclog the conveyance and dispose of any sediment in a location
The flow diversion where it will not cause impacts to streams or the SCM.
structure(if applicable) Make any necessary repairs or replace if damage is too much for
The structure is damaged. repair.
The inlet pipe is clogged(if Unclog the pipe and dispose of any sediment in a location where
applicable). it will not cause impacts to streams or the SCM.
The inlet pipe is cracked or
otherwise damaged(if Repair or replace the pipe.
applicable).
The inlet device Erosion is occurring in the Regrade the swale if necessary and provide erosion control
Erosion
(if applicable). devices such as reinforced turf matting or riprap to avoid future
swaleerosion problems.
Stone verge is clogged or Remove sediment and clogged stone and replace with clean
covered in sediment(if stone.
applicable).
More than four inches of Search for the source of the sediment and remedy the problem if
sediment has accumulated. possible. Remove the sediment and dispose of it in a location
where it will not cause impacts to streams or the SCM.
Erosion of the basin
The basin Provide additional erosion protection such as reinforced turf
surface has occurred or matting or riprap if needed to prevent future erosion problems.
riprap is displaced.
Water is standing more Replace the top few inches of soil to see if this corrects the
than three days after a standing water problem. If not,consult an appropriate
storm event. professional for a more extensive repair.

IiiIIIIIII I II II I I ii III 11II1111111 III B49�g P18@ m4 ns-24.0
Brunswick County, NC Register of Deeds page 3 of 3
kdiitratic n Basin Maintenance Requirements(continued)
SCM element: Potential problem: How to remediate the problem:
Shrubs or trees are
growing on the Remove shrubs and trees immediately.
embankment.
The embankment An annual inspection by an
appropriate professional Make needed repairs immediately.
shows that the
embankment needs repair.
Clogging has occurred. Clean out the outlet device and dispose of sediment in a location
gg g where it will not cause impacts to streams or the SCM.
The outlet device
The outlet device is Repair or replace the outlet device.
damaged
Erosion or other signs of
damage have occurred at Repair the damage and improve the flow dissipation structure.
the outlet.
The receiving water Discharges from the
infiltration basin are
causing erosion or Contact the local NCDEQ Regional Office.
sedimentation in the
receiving water.

Permit No. 5U YO7 O D1
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
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
infiltration basin supplement for each system, design calculations, soils report and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : swan's Quarter
Contact Person: Donald (Jim) Henry Phone Number: (910 ) 457-7463
This worksheet applies to: Basin No. 1 in Drainage Area 3-
(as identified on plans) (from Form SWU-101)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. The soils report must be
based upon an actual field investigation and soil borings. County soil maps are not an acceptable source
of soils information. All elevations shall be in feet mean sea level(fins!).
Soils Report Summary
Soil Type Fine Sand
Infiltration Rate 2 o in/hr or cf/hr/sf (circle appropriate units)
SHWT Elevation 2.43 fmsl (Seasonal High Water Table elevation)
Basin Design Parameters
Design Stonn 1.5 inch (1.5 inch event for SA waters,1 inch event for others)
Design Volume 1134 c.f.
Drawdown Time 0.439 hours days
Basin Dimensions IRREGULAR BASIN. INVERT CONTOUR AREA = 1295 SQFT; TOP CONTOUR AREA = 1806 SQFT
Basin Size ft.x ft. = 1295 sq. ft. (bottom dimensions)
Basin Volume Provided 1551 c.f.
Basin Elevations
Bottom Elevation 4.50 fmsl
Storage Elevation 5.21 finsl
Top Elevation 5.5 o fmsl
Form SWU-103 Rev 3.99 Page 1 of 3

III. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate that the following design 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. Attach justification if a requirement has not been met.
Applicants Initials
a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
b. System is located at least 100 feet from water supply wells.
c. Bottom of system is at least 2 feet above the seasonal high water table.
d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
60 e. System is not sited on or in fill material or DWQ approval has been obtained.
f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
g. Drainage area for the device is less than 5 acres.
h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
i. System captures and infiltrates the runoff from the first 1.0 inch of rainfall(1.5 inch event for
areas draining to SA waters). Design volume and infiltration calculations attached.
j. System is sized to take into account the runoff at the ultimate built-out potential from all
surfaces draining to the system,including any off-site drainage. Calculations attached.
k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
1. A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
m. Bottom of the device is covered with a layer of clean sand to an average depth of 4 inches or
dense vegetative cover is provided.
N/A n. Vegetated filter is provided for overflow and detail is shown on plans (Required minimuni
length is 50 feet for SA waters, 30 feet for other waters). — Lty,—dj SCXi jny SjS h?
o. Flow distribution mechanism within the basin is provided.
p. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
N/A _ q. Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
Mani Sher i+l system.
r. System is esIgned�to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days. A soils report and all
pertinent draw-down calculations are attached.
401r. s. Plans ensure that the installed system will meet design specifications(constructed or
restored)upon initial operation once the project is complete and the entire drainage area is
stabilized.
Form SWU-103 Rev 3.99 Page 2 of 3

IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the infiltration system for erosion,
trash accumulation,vegetative cover, and general condition.
2. Repair eroded areas immediately,re-seed as necessary to maintain adequate vegetative cover,mow
vegetated cover to maintain a maximum height of six inches, and remove trash as needed.
3. After every runoff producing rainfall event and at least monthly inspect the bypass,inflow and overflow
structures for blockage and deterioration. Remove any blockage and repair the structure to approved design
specifications.
4. Remove accumulated sediment from the pretreatment system and infiltration basin annually or when depth
in the pretreatment unit is reduced to 75%of the original design depth. The system shall be restored to the
original design depth without over-excavating. Over-excavating may cause the required water table
separation to be reduced and may compromise the ability of the system to perform as designed. Removed
sediment shall be disposed of in an appropriate manner and shall not be handled in a manner that will
adversely impact water quality(i.e. stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the pretreatment unit. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the design depth reads<= 10 inches feet-in the pretreatment unit,the sediment shall be
removed from both the pretreatment unit and the infiltration basin.
5. If the Division determines that the system is failing,the system will immediately be repaired to original
design specifications. If the system cannot be repaired to perform its design function, other stormwater
control devices as allowed by NCAC 2H .1000 must be designed, approved and constructed.
I acknowledge and agree by my signature below that I am responsible for the performance of 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: Stephen O. Robertson, C.U.O. (Chief Operating Officer)
Address: P.O. Box 3069; Bald Head Island, NC 28461
Phone: (910) 457-7268 /
�� Date: f /o 7
Signature: . /i446.
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, "S.V, r AxJ ,a Notary Public for the State of ]u (' . ,County of (�
'PO usw,r_Q ,do hereby certify that • ytp j L&rtL)S personally appeared before me this/`3 -
day of r ,o?ev y ,and acknowledge the due execution of the forgoing infiltration basin maintenance requirements.
Witness my hand and official seal,
°PRit{. �.i
SEAL - , P11 .Ni My com ' sion ex ires -Vire),4
� '. wry op saumsalelit
B.J.GORMAN
My - •
Form SWU-103 Rev 3.99 Page 3 of 3

Permit No. 5\4$ O-70-j01
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
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
infiltration basin supplement for each system, design calculations, soils report and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : Swan's Quarter
Contact Person: Donald (Jim) Henry Phone Number: (910 ) 457-7463
This worksheet applies to: Basin No. 2 in Drainage Area 2
(as identifled on plans) (from Form SWU-101)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. The soils report must be
based upon an actual field investigation and soil borings. County soil maps are not an acceptable source
of soils information. All elevations shall be in feet mean sea level(fmsl).
Soils Report Summary
Soil Type Fine Sand
Infiltration Rate 20 in/hr or cf/hr/sf (circle appropriate units)
SHWT Elevation 2.45 fmsl (Seasonal High Water Table elevation)
Basin Design Parameters
Design Storm 1.5 inch (1.5 inch event for SA waters,1 inch event for others)
Design Volume 1025 c.f.
Drawdown Time 0.518 hours days
Basin Dimensions IRREGULAR BASIN. INVERT CONTOUR AREA = 1188 SQFT; TOP CONTOUR AREA = 1626 SQFT
Basin Size ft.x ft. = 1188 sq. ft. (bottom dimensions)
Basin Volume Provided 1407 c.f.
Basin Elevations
Bottom Elevation 4.50 fmsl
Storage Elevation 5.26 fmsl
Top Elevation 5.50 fmsl
Form SWU-103 Rev 3.99 Page 1 of 3

III. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate that the following design 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. Attach justification if a requirement has not been met.
Applicants Initials
a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
b. System is located at least 100 feet from water supply wells.
c. Bottom of system is at least 2 feet above the seasonal high water table.
d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
ee. System is not sited on or in fill material or DWQ approval has been obtained.
f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
g. Drainage area for the device is less than 5 acres.
CO h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
g _ i. System captures and infiltrates the runoff from the first 1.0 inch of rainfall(1.5 inch event for
areas draining to SA waters). Design volume and infiltration calculations attached.
j. System is sized to take into account the runoff at the ultimate built-out potential from all
surfaces draining to the system, including any off-site drainage. Calculations attached.
k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
1. A pretreatment device such as a catch basin, grease trap, filter strip,grassed swale or
sediment trap is provided.
m. Bottom of the device is covered with a layer of clean sand to an average depth of 4 inches or
dense vegetative cover is provided.
N/A n. Vegetated filter is provided for overflow and detail is shown on plans(Required minimum
length is 50 feet for SA waters, 30 feet for other waters).
4;) o. Flow distribution mechanism within the basin is provided.
p. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
.4( N/A q. Runoff in excess of the design volume bypasses off-line systems(bypass detail provided).
4i) r. System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days. A soils report and all
pertinent draw-down calculations are attached.
s. Plans ensure that the installed system will meet design specifications(constructed or
restored)upon initial operation once the project is complete and the entire drainage area is
stabilized.
-r n0h-c SCh r5i.iy Sys°-ern
Form SWU-103 Rev 3.99 Page 2 of 3

IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the infiltration system for erosion,
trash accumulation,vegetative cover, and general condition.
2. Repair eroded areas immediately,re-seed as necessary to maintain adequate vegetative cover,mow
vegetated cover to maintain a maximum height of six inches, and remove trash as needed.
3. After every runoff producing rainfall event and at least monthly inspect the bypass, inflow and overflow
structures for blockage and deterioration. Remove any blockage and repair the structure to approved design
specifications.
4. Remove accumulated sediment from the pretreatment system and infiltration basin annually or when depth
in the pretreatment unit is reduced to 75%of the original design depth. The system shall be restored to the
original design depth without over-excavating. Over-excavating may cause the required water table
separation to be reduced and may compromise the ability of the system to perform as designed. Removed
sediment shall be disposed of in an appropriate manner and shall not be handled in a manner that will
adversely impact water quality (i.e. stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the pretreatment unit. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the design depth reads<= 10 inches feet-in the pretreatment unit,the sediment shall be
removed from both the pretreatment unit and the infiltration basin.
5. If the Division determines that the system is failing,the system will immediately be repaired to original
design specifications. If the system cannot be repaired to perform its design function,other stormwater
control devices as allowed by NCAC 2H .1000 must be designed, approved and constructed.
I acknowledge and agree by my signature below that I am responsible for the performance of 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: Stephen O. Robertson, C.O.O. (Chief Operating Officer)
Address: P.O. Box 3069; Bald Head Island, NC 28461
Phone: (910) 457-7268 Date: 9r/2f/U7
Signature: ,� . �.
Note: The legally responsible party should not be a homeowners association unless more than 50%of the lots have been sold and a
resident//I of the subdivision has been named the president.
I, E.J. (7Y?P 07,7 LI -,a Notary Public for the State of A). County of
/gI v dlScv;e_ ,do hereby certify that ni-e & 11424-.50 k) personally appeared before me this-3
day of , Q9'f ,and acknowledge the due execution the forgoing infiltration basin maintenance requirements.
Witness my hand and official seal, c.
OFFICIAL BEAL Notary PutiVe.Noah Omen My co issio expires 3`/L?SEAL rs'"`= couPa v OF BMJli
B..J.(BAN
My Commission Expkes
Form SWU-103 Rev 3.99 Page 3 of 3

Permit No. (J\-41 0-7 0/01
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
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
infiltration basin supplement for each system, design calculations, soils report and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : Swan's Quarter
Contact Person: Donald (Jim) Henry Phone Number: (910 ) 457-7463
This worksheet applies to: Basin No. 6 in Drainage Area 6
(as identified on plans) (from Form SWU-lo1)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. The soils report must be
based upon an actual field investigation and soil borings. County soil maps are not an acceptable source
of soils information. All elevations shall be in feet mean sea level(fmsl).
Soils Report Summary
Soil Type Fine Sand
Infiltration Rate 2 o in/hr or cf/hr/sf (circle appropriate units)
SHWT Elevation 2.00 fmsl (Seasonal High Water Table elevation)
Basin Design Parameters
Design Storm 1.5 inch (1.5 inch event for SA waters,1 inch event for others)
Design Volume 758 c.f.
Drawdown Time 0.486 hours days
Basin Dimensions
IRREGULAR BASIN. INVERT CONTOUR AREA = 936 SQFT; TOP CONTOUR AREA = 1329 SQFT
Basin Size ft. x ft. = 936 sq. ft. (bottom dimensions)
Basin Volume Provided 1133 c.f.
Basin Elevations
Bottom Elevation 4.50 fmsl
Storage Elevation 5.21 fmsl
Top Elevation 5.50 fmsl
Form SWU-103 Rev 3.99 Page 1 of 3

III. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate that the following design 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. Attach justification if a requirement has not been met.
Applicants Initials
a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
b. System is located at least 100 feet from water supply wells.
c. Bottom of system is at least 2 feet above the seasonal high water table.
Oli d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
01/9 e. System is not sited on or in fill material or DWQ approval has been obtained.
fM f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
g. Drainage area for the device is less than 5 acres.
qi° h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
i. System captures and infiltrates the runoff from the first 1.0 inch of rainfall(1.5 inch event for
areas draining to SA waters). Design volume and infiltration calculations attached.
- j. System is sized to take into account the runoff at the ultimate built-out potential from all
surfaces draining to the system,including any off-site drainage. Calculations attached.
k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
1. A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
m. Bottom of the device is covered with a layer of clean sand to an average depth of 4 inches or
dense vegetative cover is provided.
tif N/A n. Vegetated filter is provided for overflow and detail is shown on plans(Required minimum
length is 50 feet for SA waters, 30 feet for other waters).
o. Flow distribution mechanism within the basin is provided.
p. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
N/A q. Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
r. System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days. A soils report and all
pertinent draw-down calculations are attached.
(:;&
s. Plans ensure that the installed system will meet design specifications (constructed or
restored)upon initial operation once the project is complete and the entire drainage area is
stabilized.
$6 hc�h„d�'sch ar0 r 43 s�5 fe iti
Form SWU-103 Rev 3.99 Page 2 of 3

IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the infiltration system for erosion,
trash accumulation,vegetative cover, and general condition.
2. Repair eroded areas immediately,re-seed as necessary to maintain adequate vegetative cover,mow
vegetated cover to maintain a maximum height of six inches, and remove trash as needed.
3. After every runoff producing rainfall event and at least monthly inspect the bypass, inflow and overflow
structures for blockage and deterioration. Remove any blockage and repair the structure to approved design
specifications.
4. Remove accumulated sediment from the pretreatment system and infiltration basin annually or when depth
in the pretreatment unit is reduced to 75%of the original design depth. The system shall be restored to the
original design depth without over-excavating. Over-excavating may cause the required water table
separation to be reduced and may compromise the ability of the system to perform as designed. Removed
sediment shall be disposed of in an appropriate manner and shall not be handled in a manner that will
adversely impact water quality(i.e. stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the pretreatment unit. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the design depth reads<= 10 inches feet-in the pretreatment unit,the sediment shall be
removed from both the pretreatment unit and the infiltration basin.
5. If the Division determines that the system is failing,the system will immediately be repaired to original
design specifications. If the system cannot be repaired to perform its design function,other stormwater
control devices as allowed by NCAC 2H .1000 must be designed, approved and constructed.
I acknowledge and agree by my signature below that I am responsible for the performance of 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: Stephen 0. Robertson, C.O.O. (Chief Operating Officer)
Address: P.O. Box 3069; Bald Head Island, NC 28461
Phone: (910) 457-7268 Date: 9/(3/
Signature:
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, /�.L.) ,a Notary Public for the State of 10 C.. ,County of
v.v s:a; ,do hereby certify that S'etp ,u 0,kg�- ,pp� personally appeared before me this
day of Ea' ,?y ,and acknowledge the due execution of the forgoing infiltration basin maintenance requirements.
Witness or liaiid and of
®MA6.Vic#.
trt,4 McCoy Pubac.Not*Waft
SEAL CORMy commiommiion exres3 /Y l
SA Cif
My CORMISSIOn EXPien _
Form SWU-103 Rev 3.99 Page 3 of 3

Permit No. -)\AN07 0701
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied for use as an original
DWO Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, an
infiltration basin supplement for each system, design calculations, soils report and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : swan's Quarter
Contact Person: Donald (Jim) Henry Phone Number: (910 ) 457-7463
This worksheet applies to: Basin No. 7 in Drainage Area 7
(as identified on plans) (from Form SWU-101)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. The soils report must be
based upon an actual field investigation and soil borings. County soil maps are not an acceptable source
of soils information. All elevations shall be in feet mean sea level(fmsl).
Soils Report Summary
Soil Type Fine Sand
Infiltration Rate 20 in/hr or cf/hr/sf (circle appropriate units)
SHWT Elevation 2.10 fmsl (Seasonal High Water Table elevation)
Basin Design Parameters
Design Storm 1.5 inch (1.5 inch event for SA waters,1 inch event for others)
Design Volume 1631 c.£
Drawdown Time 0.489 hours days
Basin Dimensions
Basin Size 40 ft.X 50 ft. — 2000 sq. ft. (bottom dimensions)
Basin Volume Provided 2150 c.i
Basin Elevations
Bottom Elevation 4.50 frnsl
Storage Elevation 5.25 fmsl
Top Elevation 5.50 fmsl
Form SWU-103 Rev 3.99 Page 1 of 3

III. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate that the following design 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. Attach justification if a requirement has not been met.
Applicants Initials
a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
b. System is located at least 100 feet from water supply wells.
V'' c. Bottom of system is at least 2 feet above the seasonal high water table.
d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
e. System is not sited on or in fill material or DWQ approval has been obtained.
f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
g. Drainage area for the device is less than 5 acres.
(4 h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
-(4 i. System captures and infiltrates the runoff from the first 1.0 inch of rainfall(1.5 inch event for
areas draining to SA waters). Design volume and infiltration calculations attached.
q-1-1 j. System is sized to take into account the runoff at the ultimate built-out potential from all
surfaces draining to the system, including any off-site drainage. Calculations attached.
a6 k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
1. A pretreatment device such as a catch basin,grease trap, filter strip,grassed swale or
sediment trap is provided.
m. Bottom of the device is covered with a layer of clean sand to an average depth of 4 inches or
dense vegetative cover is provided.
ik N/A n. Vegetated filter is provided for overflow and detail is shown on plans (Required minimum
length is 50 feet for SA waters, 30 feet for other waters).
((3 o. Flow distribution mechanism within the basin is provided.
p. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
N/A q. Runoff in excess of the design volume bypasses off-line systems(bypass detail provided).
Cam- r. System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days. A soils report and all
pertinent draw-down calculations are attached.
s. Plans ensure that the installed system will meet design specifications (constructed or
restored)upon initial operation once the project is complete and the entire drainage area is
stabilized.
4( Y)ori-clisGl, zr' ,. sivm
Form SWU-103 Rev 3.99 Page 2 of 3

IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the infiltration system for erosion,
trash accumulation,vegetative cover, and general condition.
2. Repair eroded areas immediately,re-seed as necessary to maintain adequate vegetative cover,mow
vegetated cover to maintain a maximum height of six inches, and remove trash as needed.
3. After every runoff producing rainfall event and at least monthly inspect the bypass,inflow and overflow
structures for blockage and deterioration. Remove any blockage and repair the structure to approved design
specifications.
4. Remove accumulated sediment from the pretreatment system and infiltration basin annually or when depth
in the pretreatment unit is reduced to 75%of the original design depth. The system shall be restored to the
original design depth without over-excavating. Over-excavating may cause the required water table
separation to be reduced and may compromise the ability of the system to perform as designed. Removed
sediment shall be disposed of in an appropriate manner and shall not be handled in a manner that will
adversely impact water quality(i.e. stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the pretreatment unit. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the design depth reads<= io inches tin the pretreatment unit,the sediment shall be
removed from both the pretreatment unit and the infiltration basin.
5. If the Division determines that the system is failing,the system will immediately be repaired to original
design specifications. If the system cannot be repaired to perform its design function,other stormwater
control devices as allowed by NCAC 2H .1000 must be designed,approved and constructed.
I acknowledge and agree by my signature below that I am responsible for the performance of 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: Stephen O. Robertson, C.O.O. (Chief Operating Officer)
Address: P.O. Box 3069; Bald Head Island, NC 28461
Phone: (910) 457-7268 Date: gnf7 7
Signature: .
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, g-a r v. A*..) ,a Notary Public for the State of .a ,County of
'�1 f V N S I..4 c ,do hereby certify that S eP r,e.l.J �,rfi5o h1 _personally appeared before me this 3
day of +, , 7 ,and acknowledge the due execution of the f. •. infiltration basin maintenance requirements.
Witness my hand and official seal,
Air
CZ.SEAL {���'�.. CL.l My commission a
�'1 ires a fO D"
•' Notary Pottle.Nor*Carman
B.J.GORMAN
My Commission Expifes
Form SWU-103 Rev 3.99 Page 3 of 3

Permit No. ✓ 4 C. -1 JTO)
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
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
infiltration basin supplement for each system, design calculations, soils report and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : Swan's Quarter
Contact Person: Donald (Jim) Henry Phone Number: (910 ) 457-7463
This worksheet applies to: Basin No. 8 in Drainage Area 8
(as identified on plans) (from Form SWU-l01)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. The soils report must be
based upon an actual field investigation and soil borings. County soil maps are not an acceptable source
of soils information. All elevations shall be in feet mean sea level(fmsl).
Soils Report Summary
Soil Type Fine Sand
Infiltration Rate 20 in/hr or cf/hr/sf (circle appropriate units)
SHWT Elevation 2.50 fmsl (Seasonal High Water Table elevation)
Basin Design Parameters
Design Storm 1.5 inch (1.5 inch event for SA waters, 1 inch event for others)
Design Volume 97 c.f.
Drawdown Time 0.454 hours days
Basin Dimensions
Basin Size 8 ft. x 16 ft. = 128 sq. ft. (bottom dimensions)
Basin Volume Provided 176 c.f
Basin Elevations
Bottom Elevation 4.50 fmsl
Storage Elevation 4.94 fmsl
Top Elevation 5.50 finsl
Form SWU-103 Rev 3.99 Page 1 of 3

III. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate that the following design 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. Attach justification if a requirement has not been met.
Applicants Initials
a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
b. System is located at least 100 feet from water supply wells.
,....,ciii°
c. Bottom of system is at least 2 feet above the seasonal high water table.
W. d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
e. System is not sited on or in fill material or DWQ approval has been obtained.
f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
g. Drainage area for the device is less than 5 acres.
h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
i. System captures and infiltrates the runoff from the first 1.0 inch of rainfall(1.5 inch event for
areas draining to SA waters). Design volume and infiltration calculations attached.
Pj. System is sized to take into account the runoff at the ultimate built-out potential from all
surfaces draining to the system, including any off-site drainage. Calculations attached.
.4t) k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
1. A pretreatment device such as a catch basin, grease trap, filter strip,grassed swale or
sediment trap is provided.
-P' m. Bottom of the device is covered with a layer of clean sand to an average depth of 4 inches or
'! dense vegetative cover is provided.
4/ N/A n. Vegetated filter is provided for overflow and detail is shown on plans(Required minimum
++IIT" length is 50 feet for SA waters, 30 feet for other waters).
o. Flow distribution mechanism within the basin is provided.
p. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
lt N/A q. Runoff in excess of the design volume bypasses off-line systems(bypass detail provided).
/ , r. System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days. A soils report and all
pertinent draw-down calculations are attached.
s. Plans ensure that the installed system will meet design specifications(constructed or
restored)upon initial operation once the project is complete and the entire drainage area is
stabilized.
hoi - C 5c1 2r5in3c sjsfe -
Form SWU-103 Rev 3.99 Page 2 of 3

IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the infiltration system for erosion,
trash accumulation,vegetative cover, and general condition.
2. Repair eroded areas immediately,re-seed as necessary to maintain adequate vegetative cover, mow
vegetated cover to maintain a maximum height of six inches, and remove trash as needed.
3. After every runoff producing rainfall event and at least monthly inspect the bypass, inflow and overflow
structures for blockage and deterioration. Remove any blockage and repair the structure to approved design
specifications.
4. Remove accumulated sediment from the pretreatment system and infiltration basin annually or when depth
in the pretreatment unit is reduced to 75%of the original design depth. The system shall be restored to the
original design depth without over-excavating. Over-excavating may cause the required water table
separation to be reduced and may compromise the ability of the system to perform as designed. Removed
sediment shall be disposed of in an appropriate manner and shall not be handled in a manner that will
adversely impact water quality(i.e. stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the pretreatment unit. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the design depth reads<= 10 inchesfeetin the pretreatment unit,the sediment shall be
removed from both the pretreatment unit and the infiltration basin.
5. If the Division determines that the system is failing,the system will immediately be repaired to original
design specifications. If the system cannot be repaired to perform its design function, other stormwater
control devices as allowed by NCAC 2H .1000 must be designed, approved and constructed.
I acknowledge and agree by my signature below that I am responsible for the performance of 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: Stephen O. Robertson, C.O.O. (Chief Operating Officer)
Address: P.O. Box 3069; Bald Head Island, NC 28461
Phone: (910) 457-7268 Date: fiX:J/0.7
Signature:
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.
1, -U d-.„.xJ ,a Notary Public for the State of 11.1,(, ,County of
3T UNSio;d.k ,do hereby certify that /69 personally appeared before me this
day of`< ,and acknowledge the due execution of the forgoing infiltration basin maintenance requirements.
Witness my hand and official seal,
OFFICIAL sem.
3//d , -
d
SEAL ,e NorthEms My co fission expires
sf t COWITY OF SFILICIPACK
s y' B.J.
Caramboion Swim
Form SWU-103 Rev 3.99 Page 3 of 3

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Operation & Maintenance Agreement
Project Name: (Bald Head Island Limited, LLC) Swans Quarter SW8-070801
Project Location: South Bald Head Wynd, Bald Head Island, NC 28461
Cover Pa!e — —
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 immediatei 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):
Bioretention Cell Quantity: Location(s):
Dry Detention Basin Quantity: Location(s):
Grassed Swale Quantity: Location(s):
Green Roof Quantity: Location(s):
Infiltration Basin Quantity: 1 Location(s): DA4 IB#4Single Basin Change frm 2007
Infiltration Trench Quantity: Location(s):
Level SpreaderNFS Quantity: Location(s):
Permeable Pavement Quantity: Location(s):
Proprietary System Quantity: Location(s):
Rainwater Harvesting Quantity: Location(s):
Sand Filter Quantity: Location(s):
Stormwater Wetland Quantity: Location(s):
Wet Detention Basin Quantity: 0 Location(s):
Disconnected Impervious Area Present: No Location(s):
User Defined BMP Present: No Location(s):
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: Charles A. Paul,ill
Title&Organization: CEO/Managing Member, Bald Head Island Limited,LLC
Street address: P.O.Box 3069
City, state,zip: Bald Head Island, NC 28461
Phone number(s): 910-457-5000
Email: cpaul(phisland.com
Signature:� /L Date: I�p•VI•
I, k3.tQ✓fne f3. IAJLSCOfe , a Notary Public for the State of NOr'`f h CC.1.10.1/Gl
County of NQU 1-IttrIOvtr , do hearby certify that Chad. A. fku f III
personally appeared before me this I.T41 day of J unp 2020 and
acknowledge the due execution of the Operations andMaintenance��Aggr�eement
Witness my hand and official seal, liCl��
t`0°,t1ne 8 Wt.,
c
etotiry r
i0fobtzc
2U;
.
5TO %III11it • My commission expires M�M� r, wZ5 6/17/2020
Version 1.4 O&M mel Page 1 of 4

Seal My commission expires
STORM-EZ 6/17/2020
Version 1.4 O&M Manual Page 2 of 4

Infiltration System Maintenance Requirements
Important maintenance procedures:
- The drainage area will be carefully managed to reduce The sediment load to The infiltration basin.
Immediately after the infiltration basin is established, the vegetation will be watered twice weekly if needed until-
the plants become established(commonly six weeks).
No portion of the infiltration basin will be fertilized after the initial fertilization that is required to establish the
- vegetation.
- The vegetation in and around the basin will be maintained at a height of approximately six inches.
After the infiltration basin is established, it shall be inspected once a quarter 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 shall be kept in a known
set location and shall 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 to remediate the problem:
The entire BMP Trash/debris is present. Remove the trash/debris.
The perimeter of the Areas of bare soil and/or Regrade the soil if necessary to remove the gully, and then plant a
infiltration basin erosive gullies have formed. ground cover and water until it is established. Provide lime and a one-
time fertilizer application.
The inlet device: pipe or The pipe is clogged(if Unclog the pipe. Dispose of the sediment off-site.
swale applicable).
The pipe is cracked or Replace the pipe.
otherwise damaged(if
applicable).
Erosion is occurring in the Regrade the swale if necessary to smooth it over and provide erosion
swale(if applicable). control devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
The forebay Sediment has accumulated Search for the source of the sediment and remedy the problem if
and reduced the depth to 75% possible. Remove the sediment and dispose of it in a location where it
of the original design depth. will not cause impacts to streams or the BMP.
Erosion has occurred or Provide additional erosion protection such as reinforced turf matting or
riprap is displaced. riprap if needed to prevent future erosion problems.
Weeds are present. Remove the weeds, preferably by hand. If pesticides are used,wipe
them on the plants rather than spraying.
The main treatment area A visible layer of sediment Search for the source of the sediment and remedy the problem if
has accumulated. possible. Remove the sediment and dispose of it in a location where it
will not cause impacts to streams or the BMP. Replace any media
that was removed in the process. Revegetate disturbed areas
immediately.
Water is standing more than Replace the top few inches of filter media and see if this corrects the
5 days after a storm event. standing water problem. If so, revegetate immediately. If not, consult
an appropriate professional for a more extensive repair.
Weeds and noxious plants Remove the plants by hand or by wiping them with pesticide(do not
are growing in the main spray).
treatment area.
The embankment Shrubs or trees have started Remove shrubs or trees immediately.
`to grow on the embankment.
An annual inspection by an Make all needed repairs.
appropriate professional
shows that the embankment
needs repair.
The outlet device Clogging has occurred. Clean out the outlet device. Dispose of the sediment off-site.
The outlet device is damaged Repair or replace the outlet device.
STORM-EZ 6/17/2020
Version 1.4 O&M Manual Page 3 of 4

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.
STORM-EZ 6/17/2020
Version 1.4 O&M Manual Page 4 of 4

State Stormwater Management
Permit No. SW8 070801
AS-BUILT DESIGNER'S CERTIFICATION GENERAL MDC RECEIVED
I hereby state that I am a licensed professional and I certify by my signature and seal belowAhfat A
have observed the construction of the project named above to the best of my abilities with alr 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 ttm,,,,,,;,;v;v RO
Division, except as noted on the "AS-BUILT" drawings, such that the intent of the stormwater rules
and statutes has been preserved.
PHAsr ail if : [S 3,�-14-l®re
Check here if this is a partial certification. Section/phase/SCM#? f c I# 6
_ 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 �J
Name 155xvrAc� ,Gl //bil, SignatureAek,0,,Airielgiehei.
NCRegistration /K,� Date /q /g ya 2_
Number 15
l®
SEAL: .„ Consultant's Mailing Address:
CARD
o'q, s►o/i;••q '= 6-4gq �. 15.7-Wi,v� 161
` _:¢� sEAL q `l 2'2- City/State/ZIP WI 11/1fi r L ) Lk a2ef a2
5684 _ Phone Number We ?q4,2 fc C&L fly "�
�1�FiE90 Consultant's Email address:
04dkt ek y4 e�8_C,d' y', CaM
Q Circle N if the as-built value differs from the Plan. If N is circled, provide an explanation on Page 2.
©N/E = not evaluated (provide explanation on page 2) ©N/A= not applicable to this SCM or project.
Consultant's Certification NCAC .1004(43) &General MIX Q - t OWE Qf+l i4
.1050
A. TREATMENT REQUIREMENTS _
1. The SCM achieves runoff treatment. or N
2. The SCM achieves runoff volume match. r N
3. Runoff from offsite areas and/or existing BUA is Y or N
bypassed. OY
4. Runoff from offsite areas and/or existing BUA is directed 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 CY or N
has been accounted for at the appropriate design storm
level.
7. The SCM(s) meets all the specific minimum design OY 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 V
rivers or streams. /
2. The vegetated setback is maintained in grass or other Y or N r,//
vegetation. _
3. BUA that meets the requirements of NCGS 143-214.7E Y or N
(b2)(2) is located in the setback.
Page 3 of 6

State Stormwater Management
Permit No. SW8 070801
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.
C • t STO 1NATER`OUTLETS— outfit handles the peak =b t E � q
flow from the:10, storm with no dam erosion:
tc
Y or N CeM4 G
D. VARIATIONS
1. A variation (alternative) from the stormwater rule Y or
provisions has been implemented.
2. The variation provides equal or better stormwater control Y or
61
and equal or better protection of surface waters.
E. COMPLIANCE WITH OTHER REGULATORY PROGRAM
has been met 1r. N
F. :SIZING 4he volume of the SCM takes the runoff from WI
surfaces into account and is sufficient to handle the required or NG.
storm
CONtAdMdepthtNATED SOILS—tnfkrating SCM's are not 6 or N
located in or on areas with:contaminated soils.
H. SIDE SLOPES
1. Vegetated side slopes are no steeper than 3H:1V. Y or N
2. Side slopes include retaining walls, gabion walls, or Y or CN
other surfaces that are steeper than 3H:1V. ^
3. Vegetated side slopes are steeper than 3H:1V (provide Y or`(Jnd
supporting documents for soils and vegetation).
!. EROSION PROTECTION
1. The inlets do not cause erosion in the SCM. or N
2. The outlet does not cause erosion downslope of the or N
discharge point during the peak flow from the 10 year AAA d geoptat
storm.
J. EXCESS FLOWS An overflow/bypass has been
lo #ed. Y or N 1 .
K. DE WATERING—A method to drawdawn standing water has v or N
been provided to facilitate maintenanoe and inspection
L CLEANOUT AFTER CONSTRUCTION--the SCM has been or .rat
cleaned out and converted to its approved design state
M. MAINTENANCE ACCESS
1. The SCM is accessible for maintenance and repair. Y or N
2. The access does not include lateral or incline slopes or N
>3:1.
N. DESIGNER QUALIFICATIONS(FAST-TRACK PERMIT)
The designer is licensed under Chapters 89A, 89C, 89E, or Y or .N
89F of the General Statutes.
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 070801
AS-BUILT DESIGNER'S CERTIFICATION FOR INFILTRATION PROJECT
I hereby state that I am a licensed professional and I certify by my signature and seal below, that
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.1051 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. /,ram
PNr�sv / % 16 3, Its,5^ccyvaocrb�
_ Check here if this is a partial certification. Section/phase/SCM #? idGcIS
_ Check here if this is a part of a Fast-Track As-Built Package Submittal per.1044(4).
_ 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 j
'Ji�f�
� V/4'/Gl, 14-44'-4 Signature g./..e,4e.z....frii )1/ittial-
NC Registration Number bc-6e Date ?(-9/ 6.
"`11",,,, Consultant's Mailing Address:
SEAL: CAROB,
s o`z�'Fsioi�;�; 'T - 5"ift CA-S r-rvI,.J 4 AA
•Q - City/State/ZIP R //60 /�S p,#(J /V C ;ego. 2SEA � �- C7 J
5684 .t�_ Phone Number q/(? " l ?/ -?.24.-' 6,--Li. 1!O'2, -,25fg
J, J
-•.,1' ••FNr;;;\Y 'Y �� Consultant's Email address:
/w,y(n/
1
mtiA ....ky , c 1-1.14, cavil
%,,,
CD Circle N if the as-built value differs from the Plan. If N is circled, provide an explanation on Page 2.
®N/E = not evaluated (provide explanation on page 2) ®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
_
Consultant's Certification (MDC .11051) ®As-built OWE ON/A
A. Inlets!Pretreatment!Design Depths!Elevahon
_ 1. Inlets are located per the approved plans. ffl or N
2. Pretreatment measures are provided? (Rooftop runoff Y or N ' ,
does not require pre-treatment.)
3. BASIN only—the area and depth of the basin is consistent
with the approved plans
4. TRENCH only-the provided width, length and height of the
trench are consistent with the approved plan.
5. TRENCH only-the provided length and size of the
perforated pipe is consistent with the approved plan.
6. The bottom elevation of the basin/trench is consistent , /
• with the approved plans. (/,
7. The bypass elevation is consistent with the approved plan.
8. The overflow elevation is consistent with the approved , /
plan. !�
B. Soils!SI!'•1MT/SUNOS&
1. The hydraulic properties of the insitu soils are in g or N
accordance with the soils report.
2. The lowest point of the infiltration system is a minimum of or N
2 feet above the SHWT.
3. If separation to the SHWT is less than 1 foot, the water Y or N
table draws down to its pre-storm level within 72 hours.
4. The slope of the soil subgrade is <=2%. Jor N
C. Dre vdown Time
Page 5 of 6

State Stormwater Management
Permit No. SW8 070801
1. The system dewaters within 72 hours? 62 or N
2. The Insitu soils were removed and replaced with suitable Y or N
infiltration media to achieve the 72 hour drawdown. kTiVdShNe
4As-bui OWE eN/A
D. Observation on Port—for uncierground stems,a mFnimun of Y or !
one inspection port has been id . F
Provide an explanation for every MDC that was not met, and for every item marked "NIA" or"N/E",
below. Attach additional pages as needed:
Page 6 of 6