SW8990406_CURRENT PERMIT_20220715

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8 M 04 06
DOC TYPE
F I CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
2 o22 07 IS
YYYYMMDD

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
BRIAN WRENN
Director
July 15", 2022
Sampson Bladen Oil Company, Incorporated
Attn: Haddon M. Clark, III, President
PO Box 469
Clinton, NC 28329
NORTH CAROLINA
Enrlron ntat Quality
Subject: Permit Renewal
Post -Construction Stormwater Management Permit No. SW8 990406
Han -Dee Hugo's #21
Brunswick County
Dear Mr. Clark:
Effective August I, 2013 the Post -Construction Stormwater Management Program has been transferred from the
Division of Water Quality ("DWQ") to the Division of Energy, Mineral and Land Resources ("DEMLR" ). All
previous references to DWQ will remain in older permits issued prior to August 1, 2013 until they are modified.
Please note that this permit will now reference DEMLR as the Division responsible for enforcement of the permit.
On August 5, 2009, the Governor signed Session Law 2009-406. This law impacted any development approval
issued by the former Division of Water Quality under Article 21 of Chapter 143 of the General Statutes, which
was current and valid at any point between January I, 2008, and December 31, 2010. The law extended the
effective period of any permit that was set to expire during this time frame to three (3) years from its current
expiration date. On August 2, 2010, the Governor signed Session Law 2010-177, which granted an extra year for
a total of four (4) years extension.
The Division of Energy, Mineral and Land Resources received a complete 8-year Permit Renewal Application for
the subject permit on July 1516, 2022. The Division is hereby notifying you that permit SW8 990406 has been
renewed, updated, and re -issued on July 15's, 2022, as attached. Please be aware that the renewal and re -issuance
of this stormwater permit does not imply that the site is currently in compliance.
This permit shall be effective until June 24', 2031, which includes all available extensions, and does not
supersede any other agency permit that may be required. The project shall be subject to the conditions and
limitations as specified therein. This permit does not impose new or increased stormwater control requirements; it
clarifies the rules and requirements of this program to provide you with a better understanding of your obligations
under this permit. Failure to comply with these requirements will result in future compliance problems. Please
note that this permit is not transferable except after notice to and approval by the Division.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request
an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings (OAH). The
written petition must confornm to Chapter 150B of the North Carolina General Statutes and must be filed with the
OAH within thirty (30) days of receipt of this permit. You should contact the OAH with all questions regarding
the filing fee (if a filing fee is required) and/or the details of the filing process at 6714 Mail Service Center,
Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at www.NCOAH.com. Unless
such demands are made this permit shall be final and binding.
This project will be kept on file at the Wilmington Regional Office. If you have any questions concerning this
permit, please contact Dylan McPeake in the Wilmington Regional Office, at [phone] or
[e-mail].
Sincerely,
z
5 Bnan Wr nn, Director
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
cfV:R �� —./ Wilmington Regional office 1 127 Cardinal Drive Eztmslon I Wilmington, North Carolina 28405
=�w� / 910.796.7215

N
Enclosures:
DES/DM:
cc:
State Stormwater Permit No. SW8 990406
Page 2 of 2
Attachment C — Permitting History
Renewal Application Documents
\\\Stormwater\Permits & Projects\1999\990406 HD\2022 07 permit 990406
Wilmington Regional Office Stormwater File
pp North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Wilmington Regional Office 1127 Cardinal Drive Extension I Wilmington. North Carolina 28405
910.796.7215

Post -Construction Stormwater Management
Permit No. SW8 990406
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
POST -CONSTRUCTION STORMWATER MANAGEMENT PERMIT
HIGH DENSITY COMMERCIAL DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Sampson-Bladen Oil Company, Incorporated
Han — Dee Hugo's #21
6170 Ocean Hwy, Winnabow, Brunswick County
FOR THE
operation and maintenance of a dry detention basin with a grassed swale in compliance with the
provisions of 15A NCAC 2H .1000 effective September 1, 1995 (hereafter referred to as the
"stormwater rules') and as outlined in the application, approved stormwater management plans,
supplement, calculations, operation and maintenance agreement, recorded documents,
specifications, and other supporting data (the "approved plans and specifications") as attached
and/or on file with and approved by the Division of Energy, Mineral and Land Resources (the
"Division" or "DEMLR"). The project shall be constructed, operated and maintained in
accordance with these approved plans and specifications. The approved plans and
specifications are incorporated by reference and are enforceable part of this permit.
This permit shall be effective from the date of issuance until June 24'", 2031 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.
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as
described in Section 1.6 on page 3 of this permit. The stormwater control has been
designed to handle the runoff from 98,855 square feet of impervious area. This basin
must be operated with a grassed swale.
3. This tract will be limited to the amount of built -upon area indicated on page 2 of this
permit, and per approved plans.
Page 1 of 5

Post -Construction Stormwater Management
Permit No. SW8 990406
4. All stormwater collection and treatment systems must be located in either dedicated
common areas or recorded easements. The final plats for the project will be recorded
showing all such required easements, in accordance with the approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this project must
be directed into the permitted stormwater control system.
6. The following design criteria have been permitted for the dry detention basin and must
be provided and maintained at design condition:
a. Drainage Area, acres:
3.67
Onsite, ftz:
160,000
Offsite, ftz:
0
b. Total Impervious Surfaces, ftz:
98,855
C. Design Storm, inches:
1
d. Basin Depth, feet:
1.35
e. Permanent Pool Elevation, FMSL:
18.15
f. Provided Surface Area, ftz:
8,315 @ elevation 18.15
g. Permitted Storage Volume, ft3:
8,081 (required); 13,852 provided
h. Temporary Storage Elevation, FMSL:
19.5
i. Receiving Stream/River Basin:
Bell Swamp / Cape Fear
j. Stream Index Number:
18-81-6-1-5
k. Classification of Water Body:
"C Sw"
Notes:
The side slopes of the basin must be maintained at 3:1 or flatter.
A small permanent pool is provided at the orifice to reduce clogging.
The seasonal high-water table is located approximately 4.5' below the proposed bottom of the
system.
A 270' grassed swale located at the overflow from the basin has been provided to meet the
required 85% TSS removal.
ll. SCHEDULE OF COMPLIANCE
The stormwater management system shall be constructed in its entirety, vegetated and
operational for its intended use prior to the construction of any built -upon surface.
During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately.
3. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and
prior to operation of this permitted facility, a certification must be received from an
appropriate designer for the system installed certifying that the permitted facility has
been installed in accordance with this permit, the approved plans and specifications, and
other supporting documentation. Any deviations from the approved plans and
specifications must be noted on the Certification. A modification may be required for
those deviations.
4. Records of maintenance activities must be kept and made available upon request to
authorized personnel of DEMLR. The records will indicate the date, activity, name of
person performing the work and what actions were taken.
Page 2 of 5

Post -Construction Stormwater Management
Permit No. SW8 990406
5. The permittee shall at all times provide the operation and maintenance necessary to
assure the permitted stormwater system functions at the design condition. The approved
Operation and Maintenance Plan must be followed in its entirety and maintenance must
occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and specifications.
f. Debris removal and unclogging of bypass structure, infiltration media, flow
spreader, catch basins, piping and vegetated filter.
g. A clear access path to the bypass structure must be available at all times.
The facilities shall be constructed, operated and maintained in accordance with the
provisions of this permit, the approved plans and specifications, and the supporting
documents attached to this permit and on file with the Division.
Access to the stormwater facilities shall be maintained via appropriate recorded
easements at all times.
The Director may notify the permittee when the permitted site does not meet one or
more of the minimum requirements of the permit. Within the time frame specified in the
notice, the permittee shall submit a written time schedule to the Director for modifying
the site to meet minimum requirements. The permittee shall provide copies of revised
plans and certification in writing to the Director that the changes have been made.
9. No person or entity, including the permittee, shall alter any component shown in the
approved plans and specifications. Prior to the construction of any modification to the
approved plans, the permittee shall submit to the Director, and shall have received
approval for modified plans, specifications, and calculations including, but not limited to,
those listed below. For changes to the project or SCM that impact the certifications, a
new or updated certification(s), as applicable, will be required and a copy must be
submitted to the appropriate DEQ regional office upon completion of the modification.
a. Any modification to the approved plans and specifications, regardless of size
including the SCM(s), BUA, details, etc.
b. Redesign or addition to the approved amount of BUA or to the drainage area.
C. Further development, subdivision, acquisition, lease or sale of any, all or part of the
project and/or property area as reported in the approved plans and specifications.
d. Altering, modifying, removing, relocating, redirecting, regrading, or resizing of any
component of the approved SCM(s), the stormwater collection system and/or
vegetative conveyance shown on the approved plan.
e. The construction of any allocated future BUA.
f. The construction of any permeable pavement, #57 stone area, public trails, or
landscaping material to be considered a permeable surface that were not included
in the approved plans and specifications.
g. Other modifications as determined by the Director.
Page 3 of 5

Post -Construction Stormwater Management
Permit No. SW8 990406
III. GENERAL CONDITIONS
CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the
permittee shall take immediate corrective actions. This includes actions required by this
Division and the stormwater rules such as the construction of additional or replacement
on -site stormwater systems. These additional or replacement measures shall receive a
permit from the Division prior to construction.
2. PERMIT RENEWAL. A permit renewal request must be submitted at least 180 days
prior to the expiration date of this permit. The renewal request must include the
appropriate application, documentation and the processing fee as outlined in Title 15A
NCAC 02H.1045(3).
3. CHANGES TO THE PROJECT NAME, PERMITTEE NAME OR CONTACT
INFORMATION. The permittee shall submit a completed Permit Information Update
Application Form to the Division within 30 days to making any one of these changes.
4. TRANSFER. This permit is not transferable to any person or entity except after notice to
and approval by the Director. Neither the sale of the project and/or property, in whole or
in part, nor the conveyance of common area to a third party constitutes an approved
transfer of the permit.
a. TRANSFER REQUEST. The transfer request must include the appropriate
application, documentation and the processing fee as outlined in 15A NCAC
02H.1045(2). This request must be submitted within 90 days of the permit holder
meeting one or more of the following:
i. A natural person who is deceased;
ii. A partnership, limited liability corporation, corporation, or any other business
association that has been dissolved;
iii. A person or entity who has been lawfully and finally divested of title to the
property on which the permitted activity is occurring or will occur through
foreclosure, bankruptcy, or other legal proceeding.
iv. A person or entity who has sold the property, in whole or in part, on which the
permitted activity is occurring or will occur;
V. The assignment of declarant rights to another individual or entity;
vi. The sale or conveyance of the common areas to a Homeowner's or Property
Owner's Association, subject to the requirements of NCGS 143-214.7(c2);
b. TRANSFER INSPECTION. Prior to transfer of the permit, a file review and site
inspection will be conducted by Division personnel to ensure the permit conditions
have been met and that the project and the on -site stormwater system complies
with the permit conditions. Records of maintenance activities performed to date
may be requested. Projects not in compliance with the permit will not be
transferred until all permit and/or general statute conditions are met.
5. COMPLIANCE. The permittee is responsible for compliance with the terms and
conditions of this permit until the Division approves the transfer request.
a. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved
plans, application, supplement, operation and maintenance agreement, all
applicable recorded documents, and specifications shall be maintained on file by
the permittee at all times.
Page 4 of 5

Post -Construction Stormwater Management
Permit No. SW8 990406
b. DIVISION ACCESS. The permittee grants Division Staff permission to enter the
property during normal business hours to inspect all components of the permitted
project.
C. ENFORCEMENT. Any individual or entity found to be in noncompliance with the
provisions of a stormwater management permit or the requirements of the
stormwater rules is subject to enforcement procedures as set forth in NCGS 143
Article 21.
d. 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
e. OBTAINING COMPLIANCE. The Director may notify the permittee when the
permitted site does not meet one or more of the minimum requirements of the
permit. Within the time frame specified in the notice, the permittee shall submit a
written time schedule to the Director for modifying the site to meet minimum
requirements. The permittee shall provide copies of modified plans and certification
in writing to the Director that the changes have been made.
OTHER PERMITS. The issuance of this permit does not preclude the permittee
from complying with and obtaining any other permits or approvals that are required
for this development to take place, as required by any statutes, rules, regulations,
or ordinances, which may be imposed by any other Local, State or Federal
government agency having jurisdiction. Any activities undertaken at this site that
cause a water quality violation or undertaken prior to receipt of the necessary
permits or approvals to do so are considered violations of NCGS 143-215.1, and
subject to enforcement procedures pursuant to NCGS 143-215.6.
Permit modified and reissued this the 151" day of July, 2022.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Brian Wrenn, i
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 5 of 5

Attachment C - Permitting History
Han -Dee Hugo's 421
Permit No. SW8 990406
Approval
Date
Permit
Action
BIMS
Version
Description of the Changes
6/24/1999
Original
Approval
1.0
10/13/2009
Renewal
2.0
Expires 6/24/2023
7/15/2022
Renewal
3.0
Expires 6/24/2031

EXTENDED DRYDETENTIONBASIN & SWALE
MAINTENANCE REQUIREMENTS
Project Name: Proposed Exxon Station, Bolivia, Brunswick County
Project Number: �Lul��rQOs�o�
Responsible Party: Phillips Nursery Inc., David Phillips
Phone Number: [phone]
Address: 1075 Town Creek Road, Leland, NC 28451
I. After construction activity and site is stabilized
1999
666t 9 r add
A. Basins & swales must be cleaned out, graded, and vegetated within 14 days of
the completion of construction. Restore basin & swales to its design
dimensions.
II. Inspect monthly, or after every runoff -producing rainfall event, whichever comes
first
A. Remove debris from inlets and outlets.
B. Check the basin & swale side slopes, remove trash, repair eroded areas before
the next rainfall event.
III. Quarterly
A. Inspect collection system (i.e. drop inlets, piping, grassed swales) for proper
functioning. Clear accumulated trash from inlet grates and inlet bottoms, and
check piping for obstructions. STOM WATER
B. Check pond inlet pipes for undercutting, replace rip rap, and repair broken
pipes. n E C E 1 V E D
III. Twice annually APR 13 1999
A. Reseed grassed swales. Repair eroded areas immediately. PROj a S6u8o90
B. Grassed swales and basins should be mowed. Maximum grass height will be
6".
C. Remove accumulated sediment from the bottom of the outlet structure.
D. Check the basin & swale depth at various points. If depth is reduced to 75%
of original design depth, sediment will be removed to at least original design
depth.

E. Inspect emergency spillway condition. Return it to design standards, if
required.
IV. Annually
A. Remove and replace AASI-ITO #4 rock filter that surrounds riser pipe to
ensure proper functioning.
V. General
A. The orifice is designed to draw down the pond in 2-5 days. If drawdown is
not accomplished in that time, the system may be clogged. The source of the
clogging must be found and eliminated.
B. All components of the detention basin & swale system must be kept in good
working order.
1, DAVID PHILLIPS, hereby acknowledge that I am the financially responsible party for
maintenance of these dry detention basins. I will perform the maintenance as outlined
above, as part of the Certification of Compliance with Storm water Regulations received
for this project.
Date:
I, � -( , a Notary Public for the State of 71,OZ& L.�Q,E.tYL—
County of , do hereby certify that DAVID PHILLIPS personally
appeared before me this /.PYA day of 0,/�, 19�, and acknowledged the
due execution of the foregoing instrument. 'Witness my hand and official seal,
�y 'z)- SEAL
My conimision expires -&-43/ 10d Z_

Da a Received
Fee Paid
Permit Number
5A
teg 7 R 505
'Nq9040L
NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
In accordance with 15A NCAC 2H.1045(3). the current permit holder shall renew their high density permit 180 days
prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011-396 (SB 781)
Section 60.(c). This application form is for permit renewals only.
A. PROJECT INFORMATION
1. State Stormwater Permit Number: SW8 990406
2. Project name: Han -Dee Hugo's #21
3. Project street address: 6170 Ocean Hipbway
City: County BrLAh5WCCK -ZIP: M71
4. What, if any, changes have been, made to the project as permitted? /Vohf
If the project has changed from the original approved plans, please complete SWU-101 fora
Modification or Minor Modification Application form available at; https://dea.nc.cov/aboutfdivi:
B. PERMITTEE INFORMATION
If changes to the permittee orpro/ect name have
orthe Permit Transfer form available at https://d
resources/ -nerdy-mineral-land-rulesistormwater-
automatically transfer with the sale of the properl
1. Current Permit Holder's Company Na e/Oq
2. Signing Official's Name:
3. Signing Official's Title: / n"
4. Mailing Address:
City: cbgtyo
5. Street Address: s/0 �eM
City: I i -,-Forn
6. Phone: LUL — Email
please complete either the Permit Update form
/^ce.McWoo (/® is, eviSdri6/14%. co&,
do not
ECEIVE
JUL 15 2022
BY:
2V41
Stormwater Permit Renewal Form Page 1 of 3 May 11, 2018

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Date Rerived(Fee
Paid
Permit Number
agL
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NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
In accordance with 15A NCAC 2H.1045(3), the current permit holder shall renew their high density permit 180 days
prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011-398 (SB 781)
Section 60. (c). This application form is for permit renewals only.
A. PROJECT INFORMATION
1. State Stormwater Permit Number: SW8 990406
2. Project name: Han -Dee Hugo's #21
3. Project street address: 6170 Ocean Highway
City: innab o % County' ru t ZIP :21 1
4. What, if any, changes have been made to the project as permitted? None-
If the project has changed from the original approved plans, please complete SWU-101 for a Major
Modification or Minor Modification Application form available at: httos://deg.nc.gov/about/divisions/e
B. PERMITTEE INFORMATION
If changes to the permittee or project name have been made, please complete either the Permit Update form
or the Permit Transfer form available at: https //deg nc gov/about/divisions/energy-mineral-land-
automatically transfer with the sale
2.
3.
4.
Current Permit Holder's Company
Signing Official's Name:
Signing Official's Title: _
Mailing Address: _
City:
5. Street Address:
City:
6. Phone: ( I I I_)
State Stormwater Permits do not
property.
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JUL 14 2022
Stormwater Permit Renewal Form
Page 1 of 3
May 11,2018

C. SUBMITTAL REQUIREMENTS
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORW). Only applications packages that
include all required items listed below will be accepted and reviewed.
Initial each item below to indicate that the required information is provided in the application package:
✓), 1 1. A permit application processing fee of $505.00 payable to NCDEQ.
IIZ2 . 2. One original signed hard copy and one electronic copy of this completed form. The signing official
named on this application to represent the current permittee must meet one of the following:
a. Corporation — a principle executive officer of at least the level of vice-president;
b. Limited Liability Company (LLC) — a manager or company official as those terms are defined
in G.S. 57D "North Carolina Limited Liability Company Act;"
c. Public Entity — a principal executive officer, ranking official, or other duly authorized employee,
d. Partnership or limited partnership — the general partner;
e. Sole proprietor; or
f. Letter of authorization signed by one of the signatories noted in a — e above authorizing the
signature of another entity.
One hard copy and one electronic copy of recorded documents required by the original permit that
Atl SN`mi Y have not yet been received by DEMLR, including: deed restrictions, protective covenants,
P,y(, condominium/planned community declaration and easements. If the project has been built, include
r all documentation that the maximum BUA per lot or maximum total BUA has not been exceeded. If
the project has not been built, include a signed agreement that the final recorded deed restrictions
and protective covenants will be submitted at a later date.
Agreements, Please select one:
( I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to
keep this on file with the permit; or
❑ I do not have a copy of the current recorded O&M Agreement for all SCMs and am
requesting a copy be sent to me. I agree to keep this on file with the permit.
o �5. De signer Certifications, Please select one:
Q A copy of the certification(s) confirming that the project was built in accordance with the
approved plans have been previously provided to the Division; or
❑ A copy of the certification(s) confirming that the project was built in accordance with the
approved plans are enclosed; or
❑ The project has not yet been built.
T U 6. [IF APPLICABLE] If the project has been built, one original hard copy and one electronic copy of a
signed, sealed, and dated letter from a licensed professional stating that the SCMs have been
0r" kL inspected, and that they have been built and maintained in accordance with the permit.
7. [IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC):
Provide one hard copy and one electronic copy of documentation from the NC Secretary of State,
or other official documentation, which supports the titles and positions held by the persons listed in
Section C.2 per 15A NCAC 2H. 1043(3)(b).
https://www.sosnc.gov/online services/search/bv title/ Business Registration
Stormwater Permit Renewal Application Form Page 2 of 3 May 11, 2018

D. PERMITTE/E'S CERTIFICATION
I, H a �P(,{On 14. 4 � the person legally responsible for the permit, certify that I have
a copy of the Permit and 0&M Agreement on site (or I will obtain a copy and it will be kept on site), that I am
responsible for the performance of the maintenance procedures, and the site has been and will be maintained
according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs
or built-uponno�rre
and to submit the proper forms to modify or transfer the permit prior to any changes to the
project, SCnership. All information provided on this permit renewal application is, to the best of my
knowledge,I nd cpmplete.
NOTARIZATION:
1, WnVR. LD a Notary Public for the State of
14 o,dw*S")n + , County of �e�1n��c to do hereby certify
that VAI iR C-1 °%('11 ,r personally appeared before me
this the \1 day of ZYLk\ to 20 _, and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,
Z
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expires_
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Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

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Permit No, 3N 0 qqC) 't&
(To be provided by DWQJ
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICA"rION FORM
EXTENDED DRY DETENTION BASIN SUPPLEMENT
This form may be photocopied for use (is an original.
DWO Stormwater Management Plan Review:
A complete storniwater management plan submittal includes a dry detention basin supplement for each basin, design
calculations, plans and specification showing all basin and outlet structure details, and a fully executed operation
and maintenance agreement.
PROJECT INFORMATION (Please complete the following information):
Project Name: X><Cxj U 5/% d h/G S%
ContactPerson:
PhoneNumber:
For projects with multiple basins, specify which basin this worksheet applies to:
Design Storm:
Built -upon Area:
Required Volume:
h
/ (Please choose either the I yr, 24 hr storm, or the 1 "storm)
% 58 F55 square feet
g2d¢ cubic feet
Basin Dimensions:
Bottom Elevation: 16,15 feet, MSL
Storage Elevation:.. feet, MSL
/3DZZ
Detention Volume Provided:cubic feet
�3�44.5
Area: ft long x li wide = ft2
Area: ftlong x ftwide=ftz
o, Sq7
Sediment Storage Provided: 51-52, cubic feet (Equivalent to 20% of the detention volume)
Drawdown Orifice: 15 it (Please indicate size and type of orifice)
Additional BMP to achieve 85% TSS (check one):�Grassed Swale ❑Vegetated Filter ❑Other
IL 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, November, 1995) and Administrative Section 15A
NCAC 21-1.1008.
Initial in the space provided to indicate 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 Forni, the agent may initial below. If a requirement has not been met, attach written justification.
Form SWU-109 Rev. 4.99 Page 1 of 3

Applicants Initials
1_� a.
✓ b
f
c.
t/
d.
✓
e.
✓
f.
g.
i.
j.
k
1.
The basin captures the runoff from the I year, 24 hour storm and releases it over a period of
48 hours
OR the basin captures the runoff from the I inch storm and allows it to draw down over a
period of 2-5 days.
']'lie minimum flow length ratio is 3:1, L:W.
Basin sideslopes are no steeper than 3:1.
A small permanent pool has been provided at the outlet to reduce clogging.
Cleanout access has been provided, sufficient for heavy equipment.
A drain has been provided which will completely empty the basin for cleanout.
Sufficient volume has been provided for any local government peak flow requirements.
I f the basin was used during construction as a sediment basin or trap, it must be cleaned out
to design specifications prior to operation as a dry detention basin.
A vegetation plan has been prepared by a N.C. feensed professional. Consideration must
be given to the grasses specified due to the frequent inundations.
The basin must be stabilized within 14 days of construction.
The design provides for the sediment storage in addition to the detention volume that is equal
to 20% of the detention volume.
Inlet and outlet channels have been protected from scour during high flows from large
storms.
In areas of easily erodible soils, an additional plunge pool at the inlet has been provided, or
riprap is used as an energy dissipator.
A forebay to capture sediment is recommended to make cleanout easier.
The basin is located in uncompacted natural soils.
The seasonal high water table is located at least 1 foot below the bottom of the extended dry
detention basin.
An additional 13MP (such as a swale or vegetated filter) has been designed to operate in
conjunction with this dry detention basin to meet the required minimum 85% TSS removal.
M. EXTENDED DRY DETENTION OPERATION AND MAINTENANCE AGREEMENT
The extended chy detention system is defined as the dry detention basin, forebay, and the required additional 13MP.
This system (check one) I2rdoes ❑ does not incorporate a vegetated filter.
This system (check one) ❑ does Xdoes not incorporate non-integrated pretreatment.
Maintenance activities shall be performed as follows:
I. All grassed areas of the basin shall be mowed at least twice annually.
2. Debris must be removed whenever it accumulates, or at least twice annually.
3. Inspect the basin annually after a rain event to ensure it is functioning properly. The following items must
be inspected:
a. The outlet structure and orifice.
b. Erosion of the side slopes and around the inlets and outlet.
C. Sediment accumulation shall be measured, and removed if it has reduced the available volume to
751/0 of the original depth.
d. The condition of the emergency spillway.
e. Keep woody vegetation off of the banks.
Form SWU-109 Rev. 4.99 Page 2 of 3

4. Any area,,; of the system found to be deficient shall be repaired or replaced to design standards.
5. Written records of the inspections and maintenance activities shall be kept.
1 acknowledge and agree by my signature below that I am responsible for the performance of the above maintenance
procedures. I agree to notify DWQ of any problems with the system or changes in the name of the project,
responsible party, or address.
Phone:
Signature:
I
Title:
County of
Date:
a Notary public for the State of
do hereby certify that personally appeared before me this
day of and acknowledge the due execution of the forgoing
maintenance requirements. Witness my hand and official seal,
SEAL
Signature
My Commission expires
Form SWU-109 Rev 4.99 Page 3 of

State Stormwater Management Systems
Permit No. SW8 990406
Bolivia Exxon Station
Stormwater Permit No. SW8 990406
Brunswick County
Designer's Certification
1, lti1 11r�M E. Fennev Jtz as a duly registered �ro{ass onC\ �narneer
in the State of North Carolina, having been authorized to observe (periodically/weekly/full time) he construction
of the project,
l�o�ty\Cx tx oA S�r�Tr�h r S�runS�J c1< Cc>. (Project)
for M,-, j7o ,, k?l - l ,-S (Project Owner) hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the project construction such that the construction was observed to be
built within substantial compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification: nohe
Signature �---
Registration Number f \ L4 S 8
Date 9�; t -2, � I oc>
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r
�••o��tt CAR0Z1""0,, sEAL
20 OiO %
SEAL ryl =
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1
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State Stormwater Management Systems
Permit No. SW8 990406
Certification Requirements:
\/�I. The drainage area to the system contains approximately the permitted acreage.
2. The drainage area to the system contains no more than the permitted amount of built -upon area.
✓ 3. All the built -upon area associated with the project is graded such that the runoff drains to the system.
4. 'rhe outlet/bypass structure elevations are per the approved plan.
✓5. The outlet structure is located per the approved plans.
6. Trash rack is provided on the outicUbypass structure.
7. All slopes are grassed with permanent vegetation.
✓ 8. Vegetated slopes are no steeper than 3:1.
9. The inlets are located per the approved plans and do not cause short-circuiting of the-gystem _
10. The permitted amounts of surface area and/or volume have been provided.
I. Required drawdown devices are correctly sized and located per the approved plans.
—,L_ 12. All required design depths are provided.
_,,�13. All required parts of the system are provided, such as a vegetated shelf, forebay, or additional BMP's
such as a swale or filter to meet 85% TSS.
IZI 4. The overall dimensions of the system, as shown on the approved plans, are provided.
15. Other
cc: NCDIiNR-DWQ Regional Office
Delaney Aycock, Brunswick County Building Inspector