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HomeMy WebLinkAboutSW4160801_CURRENT PERMIT_20160816STORMWATER DIVISION CODING SHEET POST -CONSTRUCTION PERMITS PERMIT NO. SW 1,11 ak2 DOC TYPE CURRENT PERMIT APPROVED PLANS ❑ HISTORICAL FILE ❑. COMPLIANCE EVALUATION INSPECTION DOC DATE YYYYMMDD Energy. Mineral and Land Resources ENVIRONMENTAL QUALITY Mr. George T. Barnes, Jr. Glandon Forest Equity, LLC 3825 Barrett Drive Suite 100 Raleigh, North Carolina 27609 PAT MCCRORY c„ret,Iet DONALD R. VAN DER VAART S"'tu'l. TRACY DAVIS NC Department of Environmental Quality Received August 16, 2016 AUG 18 2016 Winston-Salem Regional Office Subject: Stormwater Permit No. SW4160801 Dollar General #17591 in Graham NC, Alamance County Dear Mr. Barnes: The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater Management Permit Application for the subject project on August 15, 2016. Staff review of the plans and specifications has determined that the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A Section NCAC 2H.1000. We are forwarding Permit No. SW4160801, dated August 16, 2016, for the construction, operation and maintenance of the subject project and the stormwater system. This permit shall be effective from the date of issuance until August 15, 2024, or until rescinded and shall be subject to the conditions and limitations as specified therein, and does not supersede any other agency permit that may be required. 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. Per NCGS 143-215(e) the petition 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 Winston-Salem Regional Office. If you have any questions, or need additional information concerning this matter, please contact Mike Randall at (919) 807-6374; or mike.randall@ncdenr.gov. Sincere fa Tracy E. Davis, PE, CPM, Director cc: SW4160801 File, Winston-Salem Regional Office cc: Matt Lowder, PE Triangle Site Design State ol'North Carolina I Environmental Quality I Energy, Mineral and IAnd Resources 1612 Mail Service Center I Raleigh, North Carolina 27699-1612 919-807-6375 State Stormwater Permit Permit No. SW4160801 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT QUALITY STATE STORMWATER MANAGEMENT PERMIT 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 Mr. George T. Barnes, Jr. Glandon Forest Equity, LLC Dollar General #17591 in Graham NC, Alamance County FOR THE construction, operation and maintenance of the bio retention cell in compliance with the provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and the approved stormwater management plans and specifications and other supporting data as attached and on file with and approved by the State and considered a part of this permit. This permit shall be effective from the date of issuance until August 14, 2024, and shall be subject to the following specified conditions and limitations: 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. The bio retention cell is approved for the management of stormwater runoff as described in the application documents and as shown on the approved plans. 3. All stormwater collection and treatment systems must be located in either dedicated common areas or recorded easements. The final plats for the project will be recorded showing all such required easements, in accordance with the approved plans. 4. The runoff from all built -upon area within the permitted drainage area of this project must be directed into,the bio retention. 5. The built -upon areas associated with this project shall be located at least 30 feet landward of all perennial and intermittent surface waters. Page 1 of 4 State Stormwater Permit Permit No. SW4160801 II. SCHEDULE OF COMPLIANCE During construction, erosion shall be kept to a minimum and any eroded areas of the system will be repaired immediately. 2. The permittee shall at all time provide the operation and maintenance necessary to assure permitted bio retention cell permitted functions at optimum efficiency. 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 filter strip. d. Immediate repair of eroded areas. e. Maintenance of all slopes in accordance with approved plans. f. Debris removal and unclogging of all drainage structures, level spreader, filter media, planting media, underdrains, catch basins and piping. Cl. Access to the cell and outlet structure must be available at all times. 3. Records of maintenance activities must be kept for the bio retention. The reports will indicate the date, activity, name of person performing the work and what actions were taken. 4. The permittee shall submit an annual summary report of the maintenance and inspection records for the bio retention. The report shall summarize the inspection dates, results of the inspections, and the maintenance work performed at each inspection. 5. The bio retention cell shall be constructed in accordance with the approved plans and specifications, the conditions of this permit, and with other supporting data. 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 bio retention cell 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. 7. If the stormwater system was used as an Erosion Control device, it must be restored to design condition prior to operation as a stormwater treatment device, and prior to occupancy of the facility. 8. The permittee shall submit to the Director and shall have received approval for revised plans, specifications, and calculations prior to construction, for any modification to the approved plans, including, but not limited to, those listed below: a. Any revision to any item shown on the approved plans, including the stormwater management measures, built -upon area, details, etc. b. Project name change. C. Transfer of ownership. d. Redesign or addition to the approved amount of built -upon area or to the drainage area. e. Further subdivision, acquisition, lease or sale of all or part of the project area. The project area is defined as all property owned by the permittee, for which Sedimentation and Erosion Control Plan approval was sought. f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan. Page 2 of 4 State Stormwater Permit Permit No. SW4160801 9. A copy of the approved plans and specifications shall be maintained on file by the Permittee for a minimum of eight years from the date of the completion of construction. 10. The Director may notify the permittee when the permitted site does not meet one or more of the minimum requirements of the permit. Within the time frame specified in the notice, the permittee shall submit a written time schedule to the Director for modifying the site to meet minimum requirements. The permittee shall provide copies of revised plans and certification in writing to the Director that the changes have been made. III. GENERAL CONDITIONS This permit is not transferable except after notice to and approval by the Director. In the event of a change of ownership, or a name change, the _ permittee must submit a completed Name/Ownership Change form signed'tiy`both parties; to the State, accompanied by the supporting documentation. The approval of this request will be considered on its merits and may or may not be approved. 2. The permittee is responsible for compliance with all permit conditions until such time as the Division approves a request to transfer the permit. 3. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee to enforcement action by the State, in accordance with North Carolina General Statute 143-215.6A to 143-215.6C. 4. The issuance of this permit does not preclude the Permittee from complying with any and all statutes, rules, regulations, or ordinances, which may be imposed by other government agencies (local, state, and federal) having jurisdiction. 5. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the Permittee shall take immediate corrective action, including those as may be required by this Division, such as the construction of additional or replacement stormwater management systems. 6. The permittee grants DEQ Staff permission to enter the property during normal business hours for the purpose of inspecting all components of the permitted stormwater management facility. The permit issued shall continue in force and effect until revoked or terminated. The permit may be modified, revoked and reissued or terminated for cause. The filing of a request for a permit modification, revocation and re -issuance or termination does not stay any permit condition. 8. Unless specified elsewhere, permanent seeding requirements for the stormwater control must follow the guidelines established in the North Carolina Erosion and Sediment Control Planning and Design Manual. 9. Approved plans and specifications for this project are incorporated by reference and are enforceable parts of the permit. Page 3 of 4 State Stormwater Permit Permit No. SW4160801 10. 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 as allowed by the laws, rules and regulations contained in Session Law 2006-246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al. 11. The permittee shall notify the Division in writing of any name, ownership or mailing address changes at least 30 days prior to making such changes. 12. The permittee shall submit a renewal request with all required forms and documentation at least 180 days prior to the expiration date of this permit. Permit issued this the 16t" day of August, 2016. y ., Director Division of Energy, Mineral, and Land Resources Page 4 of 4 State Stormwater Permit Permit No. SW4160801 Mr. George T. Barnes, Jr. Glandon Forest Equity, LLC Dollar General #17591 in Graham NC, Alamance County Designer's Certification I, , as a duly registered in the State of North Carolina, having been authorized to observe (periodically/ weekly/ full time) the construction of the project, (Project Name) for (Project Owner) hereby state that, to the best of my abilities, due care and diligence was used in the observation of the project construction such that the construction was observed to be built within substantial compliance and intent of the approved plans and specifications. , Noted deviations from approved plans and specification: Signature Registration Number Date 61:F_1I cc: NCDEQ-DEMLR Regional Office Page 1 of 1 Date USE ONLY Paid -- Applicable Rules: El Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph 11 - Post Construction (select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Slormwaler Management Plan ❑ Other WQ Mgmt Plan: State of North Carolina NC Department of Department of Environment and Natural Resources Environmental Quality ReceiDivision of Water Quality AUG 18 2016 STORMWATER MANAGEMENT PERMIT APPLICATION FORM This form may be photocopied for use as an original inston-Sa -m Regional Of: I. GENERAL INFORMATION 1. Project Name (subdivision, facility, or establishment name - should be consistent with project r7¢l6 on plans, specifications, letters, operation and maintenance agreements, etc.): /� (�0 Dollar General # 17591 � t r {', 0�a.-ri�= 2. Location of Project (street address): City:Gra ha m Cou nly: A la m ance bto w CA 3. Directions to project (from nearest major htLersection): hSW- Southeast intersection of Southern High School Rd. and S. NC 87 Hwy. 4. Latitude:36' 00' 20" N T►y Longitude:79' 23' 34" W of the main entrance to the project. II. PERMIT INFORMATION: 1.a.Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificabont tRenewals with modifications also regWres SWU-702 - Renewal Application Form b.lf this application is being submitted as the result of a modification to an existing permit, list the existing permit number , its issue date (if known) , and the status of construction: ❑Not Started ❑Partially Completed* ❑ Completed* "provide a designer's certification 2. Specify the type of project (check one): ❑Low Density ®High Density ❑Drains to an Offsile Stormwater System ❑Other 3. if this application is being submitted as the result of a previously returned application or a letter from DWQ requesting a state stormwater management permit application, list the stormwater project number, if assigned, and the previous name of the project, if different than currently proposed, 4.a.Additional Project Requirements (check applicable blanks; itdormation on required state permits can be obtained by contacting the Customer Service Center at "1-877-623-6748): ❑CAMA Major ❑NPDES Industrial Stonnwaler ®Sedimentation/Erosion Control: 2.6 ac of Disturbed Area ❑404/401 Permit: Proposed Impacts b.lf any of these permits have already been acquired please provide the Project Name, Project/Permit Number, issue date and the type of each permit.: 5. Is the project located within 5 miles of a public airport? ❑No ®Yes If yes, see S.L. 2012-200, Part VI: )JlI2://t)ortil.iicdenr.or6 wcblwq/ws/su/stitesw/rules laws Form SWU-101 Version 06Aug20I2 Page I of 6 III. CONTACT INFORMATION 1.a. Print Applicant / Signing Official's name and title (specifically the developer, properly owner, lessee, designated government official, individual, etc. who owns the pro Applicant/Organiration:Glandon Forest Equity LLC Signing Official & Title:George T. Barnes, Jr. - member/manager b.Conlact information for person listed in item la above: Street Address:3825 Barrett Drive Suite 100 City:Raleigh State:NC Zip:27609 Mailing Address (if City: Phone: (919 ) 459-2601 Erna il: gbarnes@vangu and pg.com Sla Zi Fax: (919 ) 459-2604 c. Please check the appropriate box. The applicant listed above is: ® The property owner (Skip to Contact Infonnation, item 3a) ❑ Lessee' (Attach a copy of the lease agreement and complete Contact Infonnation, item 2a and 2b below) ❑ Purchaser' (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and 2b below) ❑ Developer" (Complete Contact Information, item 2a and 2b below.) 2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the person who owns the property that the project is located on): Property Owner/Organization: Signing Official & Title: b.Contact information for person listed in item 2a above: Street Address: City: State: Mailing Address (if applicable): City: State: Phone: ( ) Fax: ( ) Email: . a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other person who can answer questions about the project: Other Contact Person/Organization:Glandon Forest Equity, LLC Signing Official & Title:Ceort,e T. Barnes, Ir. -member/manager b.Contact information for person listed in item 3a above: Mailing Address:3825 Barrett Drive Suite 100 City:Raleigh Stale:NC Zip:27609 Phone: (919 ) 459-2601 Email:gba rues@vanguard pg.com 4. Local jurisdiction for building pennies: Fax: (919 ) 459-2604 Point of ContacL-Gene Foxworth Phone #: (252 ) 728-8545 Form SWU-101 Vcrsion 06Aug2012 Page 2 of 7 IV. PROJECT INFORMATION 1. In the space provided below, briefly summarize how the stormwaler runoff will be treated. Stonnwater runoff from the developed areas of the site will be treated in a wet pond that is designed to treat the 1.0" storm event for 85%TSS 2. a.If claiming vested rights, identify the supporting documents provided and the dale they were approved: ❑ Approval of a Site Specific Development Plan or PUD Approval Date: ❑ Valid Building Permit Issued Date: ❑ Other: Date: b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with: ❑ Coastal SW -1995 ❑ Ph 11 - Post Construction 3. Stormwater runoff from this project drains to the 4. Total Property Area: 1.49 acres River hasin. 5. Total Coastal Wetlands Area: 0 acres 6. Total Surface Water Area: 0 acres 7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project Area':1.49 acres * Total project area shall be calculated to exclude the folloeoing the normal pool of impounded structures, the area between the banks of streams and rivers, the area beloto the Normal High Water (NHW) line or Mean High Water (MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant prefect area is used to calculate overall percent built upon area (BLIA). Non -coastal wetlands landurard of the NHW (or MHb�q line may be included in the total project area. 8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 57.0 % 9. How many drainage areas does the project have?l (For high densihj, count 1 for each proposed engineered stormwater BMP. For loin densihj and other projects, use 1 for the tolrole properhj area) 10. Complete the following information for each drainage area identified in Project Information item 9. If there are more than four drainage areas in the project, attach an additional sheet with the information for each area provided in the same format as below. Basin Information Drainage Area 1 Drainage Area Drainage Area Drainage Area Receiving Stream Name Big Alamance Creek Stream Class * WS-V; NSW Stream Index Number * 16-19-(4.5) Total Drainage Area (sf) _ 47916 On -site Drainage Area (so 47916 Off -site Drainage Area (so 0 posed Impervious Area** (sn E 34848 % Impervious Area' (total) 72.7% hn ervious 'Surface Area Drainage Area 7 Drainage Area _ -Draina ge Area _ Drainage Area On -site Buildings/Lots (so 9010 On -site Streets (so 0 On -site Parking (so 23953 On -site Sidewalks (so 1885 Other on -site (so 0 Future (sf) 0 Off -site (SO 0 Existing BUA*** (sf) 0 Total (so: 34848 Stream Class and Index Number can be determined at: hffla://porfril.ncdrnr.org tneb/aoq(ps/csu/elassifications Imppervious area is defined as the built upon area including, brit not limited to, buildings, roads, parking areas, sidcualks, gravel areas, etc. Form SWU-101 Version 06Aug2012 Page 3 of 7 11. How was the off -site impervious area listed above determined? Provide documentation. Design drawings 1'ro4eets in Union County: Contact DWQ Central Office sta(fto check if the project is located within a Threatened &c Endangered Species watershed that map he subject to more stringeni srornnrater requirements as per 15A NCAC 02B .0600. V. SUPPLEMENT AND O&M FORMS The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded from http://portal.iicdenr.org/web/wq/ws/su/bop-manual. VI. SUBMITTAL REQUIREMENTS Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ). A complete package includes all of the items listed below. A detailed application instruction sheet and BMP checklists are available from littp://portal.ncdeiir.org/web/wq/ws/sti/statesw/fornis—docs. The complete application package should be submitted to the appropriate DWQ Office. (The appropriate office may be found by locating project on the interactive online map at http://portal.iicdenr.org/web/wq/ws/su/maps.) Please indicate that the following required information have been provided by initialing in the space provided for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions for each submitted application package from http://portal.ncdeiir.org/web/wq/ws/su/statesw/forms-docs. 1. Original and one copy of the Stormwater Management Permit Application Form. 2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants Form. (if required as per Part Vll below) 3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M agreement(s) for each BMP. 4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to http://www.eiivlielp.org/pages/onestoDexpress.litml for information on the Express program and the associated fees. Contact the appropriate regional office Express Permit Coordinator for additional information and to schedule the required application meeting.) 5. A detailed narrative (one to two pages) describing the stormwater treatment/nnanagennentfor the project. This is required in addition to the brief summary provided in the Project Information, item 1. 6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2 mile radius on the map. 7. Sealed, signed and dated calculations (one copy). 8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: a. Development/Project name. b. Engineer and firm. C. Location map with named streets and NCSR numbers. d. Legend. e. North arrow. I. Scale. g. Revision number and dates. h. Identify all surface waters on the plans by delineating the normal pool elevation of impounded structures, the banks of streams and rivers, the MI-IW or NHW line of tidal waters, and any coastal wetlands landward of the MHW or NI-IW lines. • Delineate the vegetated buffer landward from the normal pool elevation of impounded structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters. i. Dimensioned property/project boundary with bearings & distances. j. Site Layout with all BUA identified and dimensioned. k. Existing contours, proposed contours, spot elevations, finished floor elevations. 1. Details of roads, drainage features, collection systems, and stormwater control measures. in. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a qualified person. Provide documentation of qualifications and identify the person who made the determination on the plans. n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations. o. Drainage areas delineated (included in the main set of plans, not as a separate document). p. Vegetated buffers (where required). A�&11/ A L - IcS) Form SWU-101 Version 06Aug2012 Page 4 of 6 in. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a qualified person. Provide documentation of qualifications and identify the person who made the determination on the plans. n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations. o. Drainage areas delineated (included in the main set of plans, not as a separate document). p. Vegetated buffers (where required). 9. Copy of any applicable soils report with the associated SH WT elevations (Please identify, Ku. C'4 6 elevations in addition to depths) as well as a map of the boring locations with the existing elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the project area clearly delineated. For projects with infiltration BMPs, the report should also include the soil type, expected infiltration rate, and the method of determining the infiltration rate. (Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verifij the SHWT prior to submittal, (910) 796-7378.) 10. A copy of the most current property deed. Deed book: 0229 Page No: 0058 11. For corporations and limited liability corporations (LLC): Provide documentation from the NC _ Secretary of State or other official documentation, which supports the titles and positions held by the persons listed in Contact Information, item la, 2a, and/or 3a per 15A NCAC 21-1.1003(e). The corporation or LLC must be listed as an active corporation in good standing with the NC Secretary of State, otherwise the application will be returned. http:/ /www.secretary.sLaLe.nc.us/Corporations/`CSearcii.aspx VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS For all subdivisions, oulparcels, and future development, the appropriate property restrictions and protective covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and protective covenants forms can be downloaded from hlln://nurtal.ncdonr.orrt/web/wa/ws/su/slalesw/forms_daw. Download the latest versions for each submittal In the instances where the applicant is different than the property owner, it is the responsibility of the properly owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring that the deed restrictions are recorded. By the notarized signature(s) below, the permit holders) certify that the recorded property restrictions and protective covenants for this project, if required, shall include all the items required in the permit and listed on the forms available on the website, that the covenants will be binding on all parties and persons claiming under them, that they will run with the land, that the required covenants cannot be changed or deleted without concurrence from the NC DWQ, and that they will be recorded prior to the sale of any lot. VILL CONSULTANT INFORMATION AND AUTHORIZATION Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as addressing requests for additional information). Consulting Engineer:Malt Lowder, PE Consulting Firm: Triangle Site Design, PLLC Mailing Address:4004 Barrett Drive, Suite 101 Phone: (919 ) 553-6570 Email:nrlowder@trimiglesitedesigncom State:NC Zip:27609 Fax: ( ) Form S WU-101 Version O6Aug2012 Page 5 of 7 As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment facility without valid permit. 1 understand that the operation of a stormwater treatment facility without valid permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6. Signatu a Notary Public for the State of , County of do hereby certify that personally appeared before me this _ day of and acknowledge the due execution of the application for a stormwater permit. Witness my hand and official seal, SEAL My commission X. APPLICANT'S CERTIFICATION I, (print or type nave of person listed in Contact Information, item In) George T. Barnes Jr. (Glandon Forest Equitll, LLC), certify that the information included on this permit application form is, to the best of my knowledge, correct and that the project will be constructed in conformance with the approved plans, that the required deed restrictions and protective covenants will be recorded, and that the proposed project complies with the requirements of the applicable stormwater rundSA NCAC 2] I .1000 and any other applicable state stormwater requirements. I, Q '/f1/F�2//�7V/f / V a Notary Public for the Stale of �/L County of W/q//E c rereby certify that (I, (rRP.0 �� /1/A- ,/' personally appeared before me this May of '— u V A16 . and acknowledge the due execution of the application for a stormwater permit. Witness my hand and official seal, ,V///U .{( C((,4�41. r/Z -A6,/) �-10,NN ty 0 A4 NOTARY PUBLIC _ WAKE CO. MY COMM. EXP. 03-m-2021 Oi TH CARO\-�%% #ties%% SEAL My commission expires )oil Fonn SWU-101 Version 06Aug2012 Page 6 of t� As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to me, the property owner. As the proper ner, it is my responsibility to notify DWQ immed lately and submit a completed Name/Ownership ge rm ith n 30 days; otherwise I will be operating a stormwater treatment facility without a vali . I u rstand at the operation of a stormwater treatment facility without a valid permit is o Statue 3-215.1 and may result in appropriate enforcement action including the assessment o e of up to 5,000 per day, pursuant to NCGGS 143-215.6. c,....,... ... /1---' .d,._oC�(•�jf,y 1 itarP- ��ll L 1, '64�-4) If .M('1,.�( t" II i1 a Notary Public for the State of NC. . County of +�y� -T- -�-P31 \ ry:b4t;n , do hereby certify that V1e00e}h d ILRq a�Anwmg_ personally appeared before me this 4„day of -�U>,I1. an n/5/�'w'l'edge tJre du execufion Qf the application for a stormwater permit Witness my hand and official seal, W j- -- ASHLEY MCLAURIN NOTARY PUBLIC JOHNSTON COUNTY STATE OF NORTH CAROLINA X. APPLICANT'S CERTIFICATION SEAL My commission expires 5 rl / j I, (print or hype name of person listed in Contact Information, item Ia) Geor5ze T. Barnes, fr. (Glandon Forest Equihy, LLC), certify that the information included on this permit application form is, to the best of my knowledge, correct and that the project will be constructed in conformance with the approved plans, that the required deed restrictions and protective covenants will be recorded, and that the proposed project complies with the requirements of the applicable stormwater ru)e9T ndr,15A NCAC 2I-I .1000 and any other applicable state stormwater requirements. M/ V ` /> I , a Notary Public for the State of -1County of iVr%1(1- cuerebycertifythat i�;ti(>ili'c= /�iF�,�ii/i=5 t k personally appeared /N before me this / I day of , ki / . / '/. and acknowledge the due execution of the application for // 7 a stormwater permit Witness my hand and official seal, ; /r (! ' L (%r Jl %FUANN NyF��i � 9 .O� i NOTARYPUBLIC WAKE CO. MY COMM. EXP. 03-15-2021 �r+ i i iO r %`�,,, SEA I: My commission expires ---,If Fo1mSWU-101 Version06Aug20I2 Page 6 of 6 •.�. f�� u cif-.�✓1 .�. 1 ♦ � J• - /: �..I '..• �r I111 . A _ n rr :4 1145( NORTH STATE BANK GLANDON FOREST EQUITY, LLC RALEIGH, NC 27609 . 3825 BARRETT DRIVE, SUITE 100 66-1235/531 . RALEIGH, NC 27609 6/24/2016 " PAY TO THE NCDEQ ORDER OF - $ _� 505.00 Five Hundred Five and 00/100===»=_»_;._.... «.;_»_,_...._.»..;».___«__:.__«....»»_.«__»_,_...,_,.»«„»»» ........:....:.««, DOLLARS . NCDEQ V 1_j 1 4R41�1 V.. MEMO If AUTHORIZED R SIGNATURE Graham (stormwater) r^�r^+�' - r -,a. Irammr�>�.rml�'mr�rx�,'r�irlmdrn�rl>�.' e II'011450i1° 1:0531123561: 05200591,9iI' Permit No'. (to be assigned by DWQ) IIL REQUIRED ITEMS CHECKLIST Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a requirement has not been met, attach justification. Pagel Plan fiIs S et No. W 61O Mitt tit (�S EM Plans (1' - 50' or larger) of the entire site showing: - Design at ultimate build -out, - Off -site drainage (if applicable), - Delineated drainage basins (include Rational C coefficient per basin), - Cell dimensions, - Pretreatment system, - High flow bypass system, - Maintenance access, - Recorded drainage easement and public right of way (ROW), - Clean out pipe locations, - Overflow device, and - Boundaries of drainage easement. 2. Plan details IV = 30' or larger) for the bioretention cell showing: - Cell dimensions - Pretreatment system, High flow bypass system, - Maintenance access, - Recorded drainage easement and public right of way (ROW), - Design at ultimate build -out, - Off -site drainage (if applicable), - Clean out pipe locations, - Overflow device, and - Boundaries of drainage easement. - Indicate the P-Index between 10 and 30 3. Section view of the bioretention cell (V = 20' or larger) showing: - Side slopes, 3:1 or lower - Underdrain system (if applicable), and - Bioretention cell layers [ground level and slope, pre-treatment, pone ing depth, mulch depth, fill media depth, washed sand, filter fabric (or choking stone if applicable), #57 stone, underdrains (if applicable), SHWT level(s), and overflow structure] 4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The results of the soils report must be verified in the field by DWQ, by completing & submitting the soils investigation request form. County soil maps are not an acceptable source of soils information. All elevations shall be in feet mean sea level (fmsl). Results of soils tests of both the planting soil and the in situ soil must include: - Soil permeability, - Soil composition (%sand, %fines, %organic), and P-index. 5. A detailed planting plan IV = 20' or larger) prepared by a qualified individual showing: - A variety of suitable species, - Sizes, spacing and locations of plantings, - Total quantity of each type of plant specified, - A planting detail, - The source nursery for the plants, and - Fertilizer and watering requirements to establish vegetation. 6. A construction sequence that shows how the Bioretention cell will be protected from sediment until the entire drainage area is stabilized. 7. The supporting calculations (including underdrain calculations, if applicable). 8. A copy of the signed and notarized inspection and maintenance (I&M) agreement. 9. A copy of the deed restriction. Form SW401-Bioretention-Rev.7 Part III, Page 1 of 1 � /�� /l � h l C-�� Y ly �: �� '-- L, � � � � t/ j Vf � i �' �� C �; ! - �i�, �J ti� ...__ __ _ �_ �r _-.. Galt 4 Permit Number: (to be provided by DIIIQ) Drainage Area Number: Bioretention Operation and Maintenance Agreement I will keep a maintenance record on this BMP. This maintenance record will be kept in a log in a known set location. Any deficient BMP elements noted in the inspection will be corrected, repaired or replaced immediately. These deficiencies can affect the integrity of structures, safety of the public, and the removal efficiency of the BMP. Important operation and maintenance procedures: — Immediately after the bioretention cell is established, the plants will be watered twice weekly if needed until the plants become established (commonly six weeks). — Snow, mulch or any other material will NEVER be piled on the surface of the bioretention cell. — Heavy equipment will NEVER be driven over the bioretention cell. — Special care will be taken to prevent sediment from entering the bioretention cell. — Once a year, a soil test of the soil media will be conducted. After the bioretention cell is established, I will inspect it once a month and within 24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and maintenance will be kept in a known set location and will be available upon request. Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately. BMP element: Potentialproblems: Flow I will remediate theproblem: 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 bioretention cell erosive gullies have formed. remove the gully, and then plant a ground cover and water until it is established. Provide lime and a one-time fertilizer application. The inlet device: pipe, The pipe is clogged (if Unclog the pipe. Dispose of the stone verge or Swale applicable). sediment off -site. The pipe is cracked or Replace the pipe. otherwise damaged (if applicable). Erosion is occurring in the Regrade the Swale if necessary to swale (if applicable). smooth it over and provide erosion control devices such as reinforced turf matting or riprap to avoid future problems with erosion. Stone verge is clogged or Remove sediment and clogged covered in sediment (if stone and replace with clean stone. applicable). Form S W401-13ioretenlion O&M-Rev.3 Page I of 4 if BMP element: The pretreatment area n cell: vegetation soils and mulch Plow is bypassing pretreatment area and/or gullies have formed. Sediment has accumulated to a depth greater than three inches. Erosion has occurred Weeds are present. Best professional practices show that pruning is needed to maintain optimal plant health. Plants are dead, diseased or dying. 'free stakes/wires are present six months after planting. Mulch is breaking down or has floated away. Sorts ana/ or mulch are clogged with sediment. An annual soil test shows that pH has dropped or heavy metals have accumulated in the soil media. How I will remediate the problem: Regrade if necessary to route all flow to the pretreatment area. Restabilize the area after grading. Search for the source of the sediment and remedy the problem if possible. Remove the sediment and restabilize the pretreatment area. Provide additional erosion protection such as reinforced turf matting or riprap if needed to prevent future erosion problems. Remove the weeds, preferably by hand. Prune according to best professional practices. Determine the source of the problem: soils, hydrology, disease, etc. Remedy the problem and replace plants. Provide a one-time fertilizer application to establish the ground cover if a soil test indicates it is necessary. Remove tree stake/wires (which can kill the tree if not removed). Spot mulch if there are only random void areas. Replace whole mulch layer if necessary. Remove the remaining much and replace with triple shredded hard wood mulch at a maximum depth of three inches. Determine the extent of the clogging - remove and replace either just the top layers or the entire media as needed. Dispose of the spoil in an appropriate off -site location. Use triple shredded hard wood mulch at a maximum depth of three inches. Search for the source of the sediment and remedy the problem if possible. Dolomitic lime shall be applied as recommended per the soil test and toxic soils shall be removed, disposed of properly and replaced with new planting media. Form SW401-Bioreteution O&M-Rev.3 Pagc2 of4 BMP element: Potential problems: Flow I will remediate theproblem: The underdrain system Clogging has occurred. Wash out the underdrain system. if applicable) The drop inlet Clogging has occurred. Clean out the drop inlet. Dispose of the sediment off -site. the drop inlet is damaged Repair or replace the drop inlet. The receiving water Erosion or other signs of Contact the NC Division of Water damage have occurred at the Quality 401 Oversight Unit at 919- outlet. 733-1786. Form SW401-13ioretention O&M-Rev.3 Page 3 of 4 I'ennit Number: (to be provided b>> DNVQ) acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior to any changes to the system or responsible party. Project name:Dollar General - NC Highway 87 - 13111-linpton - Graham l3MP drainage area number: Print name:George T. Barnes, Jr. - Glandon Forest Equity, LLC Ti tie: in ember -manager Address:3825 Barrett Drive, Suite 100 Ralcigh, NC 27609 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. .5 , a Notary Public for the Slate of /VL ,County of /52/(C- , do hereby certify that (oFf)2GC- % �/�211 //I personally appeared bcl'ore me this a) 1pw day of ACGST and acknowledge the due execution of the forgoing bioretention maintenance requirements. Witness my hand and official seal, ekP NN N Cj A0 � NOTARY PUBLIC WAKE C.O. MY COMM. EXP. 03-15-2021 Z "4P4R%N CAR00%%% � S LA I., My commission expires J� -"20dl A(G<�CY/YaZ f 7� , ('/(1/2-1;1 Form SW401-Bioretention I&M-Rev.2 Page4 ol'4