SW1100301_CURRENT PERMIT_20110329

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW/�i%3�)z
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYMMDD

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NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins - „°DeeAF,reemama ;��.
Governor Directory —Secretary�
February 28, 2011
Mr. Matt Wilson = ".
Butler Development Group
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2727 Paces Ferry Road ; Suite 1-255 s x
Atlanta, GA 30339 '
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S b t• St t P t N SW1100301
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Hendersonville Distribution Facility at Blue Rock Commerce Center' '
High Density Commercial Bio-Retention Project
Henderson County
Dear Mr. Wilson:
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application
requesting a permit modification for Hendersonville Distribution Facility at Blue Rock Commerce Center on
February 24, 2010. Staff review of the plans and specifications has determined that the project, as
proposed, will comply with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000 and Session
Law 2006-246. We are forwarding Permit No. SW1100301, dated February 28, 2011, for the construction,
operation and maintenance of the subject project and the stormwater BMPs.
This permit shall be effective from the.date of issuance until May 10, 2020, and shall be subject to the
conditions and limitations as specified therein. Please pay special attention to the Operation and
Maintenance requirements in this permit. Failure to establish an adequate system for inspection and
maintenance of the stormwater management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit.
This request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC
27611-7447. Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the Asheville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Brian Lowther at [phone]; or
[e-mail].
Sincerely,
for Coleen H. Sullins
cc: Asheville Regional Office
Central Files
Jesse Gardner, PE Civil Design Concepts, PA
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 olina
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 9' NorthCart''al�/
li
Phone: [phone] FAX: [phone] Customer Service: 1-877.623-6748 Aatvd
Internet: www.nwaterquality.arg r/
An Equal Opportunity 4 Affirmative Action Employer

State Stormwater Permit
Permit No. SW1100301
STATE OF NORTH CAROLING
DEPARTMENT OF ENVIRONMENT AND NATURALS RESOURCES
DIVISION OF WATER QUALITY'
F t+ MAR 2 9 20N
STATE STORMWATER MANAGEMENT PERMIT __ ?
HIGH DENSITY 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
Butler Development, LLC
Hendersonville Distribution Facility at Blue Rock Commerce Center
McMurray Road, Flat Rock & Henderson County
FOR THE
construction, operation and maintenance of two bioretention cell(s) in compliance with
the provisions of Session Law 2006-246 and 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 Division of Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until May 10, 2020, and shall be
subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. 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 1.7 on page 2 of this permit. The stormwater
control has been designed to handle the runoff from 48,963 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area as indicated in Section
1.7 of this permit, and per the application documents and as shown on the
approved plans. The built -upon area for the future development is limited to
46,363 square feet.
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 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 6

State Stormwater Permit
Permit No. SW1100301
7
The following design criteria have been provided in the bioretention cell and must
be maintained at design condition:
a
L�
C.
d.
e.
f.
h.
m.
n.
o.
P.
9•
r.
Drainage Area, 9cres:
Onsite, ft :
Offsite, ft2:
Total Impervious Surfaces, ft2:
Onsite, ft :
Offsite, ft2:
Design Storm, inches:
Max. Ponded Depth, feet:
Seasonal High Water Table, fmsl:
Planting Media Depth, feet:
Cell Dimensions, feet:
Bottom Elevatiop, fmsl:
Surface Area, ft
Permitted Storage Volume, ft3:
Bypass 1 Storage Elevation, fmsl:
Predevelopment 1 year 24 hour:
Post development 1 year 24 hour:
Drawdown Time, hours:
Underdrain Diameter, inches:
Receiving Stream/River Basin. -
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
1.58
30,544
31,468
1,848
8,798
24,498
24,465
24,498
24,465
0
0
V1
12"
12"
2161
2' (grass)
41' by 54',
102' by 40'
2162
2164
2,004
2,060
2,004
2,060
2,166
2,168
2.64
2.94
1.08
1.32 ft3lsec
24
24
4"
4"
UT to Bat
Fork 1 French Broad
6-55-8-1
IICR
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.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be, repaired immediately.
3. The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted stormwater system 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.
g. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The permittee shall submit to the Division of Water Quality an annual summary
report of the maintenance and inspection records for each BMP. The report
shall summarize the inspection dates, results of the inspections, and the
maintenance work performed at each inspection.
6. The facilities shall be constructed as shown on the approved plans. This permit
Page 2 of 6

State Stormwater Permit
Permit No. SW1100301
shall become void unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
7. 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.
8. 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.
9. Access to the stormwater facilities shall be maintained via appropriate recorded
easements at all times.
10. 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 or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
III. GENERAL CONDITIONS
1. This permit is 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 by both parties, to the
Division of Water Quality, accompanied by the supporting documentation as
listed on page 2 of the form. 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
Page 3 of 6

State Stormwater Permit
Permit No. SW1100301
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 Division of Water Quality, 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 DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. 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.
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 28th day of February 2011.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Uoleen H. Sullins, Uirector
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4of6 '

State Stormwater Permit
Permit No. SW1100301
Henderson Distribution Facility at Blue Rock Commerce Center
Stormwater Permit No. SW1100301
Henderson 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.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 5 of 6

State Stormwater Permit
Permit No. SW1.100301
Certification Requirements:
_1. 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. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
fi. The outlet structure is located per the approved plans.
7. Trash rack. is provided on the outlet/bypass structure.
.8. All slopes are grassed with permanent vegetation, per the vegetation plan.
9. Vegetated slopes are no steeper than 3:1.
10., The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Page 6 of 6

NCDEN R . ! NOV 1 8 2011
North Carolina Department of Environment and Natural Resources
Division of Water Quality va _,t_rr r = r,ov
Beverly Eaves Perdue Coleen H, Sullins A�+---V,Dj: Fi,-r:(Dee Freema_nJ
Governor Director Secretary
, r .,..,... „. .
STATE STORMWA7ER PERMIT NAME/OWNERSHIP CHANGE F.ORM,....�.:
I. CURRENT PERMIT INFORMATION
1. Stormwater Management Permit Number: _S(AJ 1100301
2.Project Name: _ _. ee\Ar sonV►�Jf- 17+Silrti �n � it;i►, a}' 1�1Ue,_Voac �orny++ucc t
3. Current Permit Holder's Company Name/Organization: tAl-or
4. Signing Official's Name: # 1�So'� ____ Title: _ e- kirAeg "
5. Mailing Address: L-? Pat �r JZ' 50t, 1-255
City, A±6State: [r Zip: _�0
6. Phone: L77DJ 93 -�SoO exf. 1q. Pax: { �) �I�?, -Og09
If. PROPOSED PERMITTEE / OWNER / PROJECT / ADDRESS INFORMATION
This request is for: (please check all that apply)
{ Name change of the owner (Please complete Items 1, 2 and 3 below)
❑ Name change of project (Please complete Item 5 below)
❑ Change in ownership of the property/company (Please complete Items 1, 2, 3, and 4 below)
❑ Mailing address 1 phone number change. (Please complete Item 4 below)
❑ Other (please explain):
1. Proposed permittee's company name/organization: a
2. Proposed permittee's signing official's name: «
3. Proposed permittee's title:
4. Mailing Address:
City: ��� ,� iQue.�l _ State:
Phone: (DL)ay� ._,� y7/ Fax: (23
5. New Project Name to be placed on permit:
Please check the appropriate.box. The proposed permittee listed above is:
❑ HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA in /ft above and provide name of HOA/POA's authorized representative in #2 above)
❑ The properly owner
❑ Lessee (Attach a copy of the lease agreement'and complete Property Owner Information on
Page 4)
❑ Purchaser (Attach a cop of the pending sales agreement. Final approval of this transfer will be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner Information on page 4)
SSW NIO Change Revl 5Feb2011 Page 1 of 4

Ill. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may result in processing delays or denial of the transfer.
1. This completed and signed form, iiisicertificatiori must beteomp eted end signed;by both1he
current perhiil: t of'der;antl t ie anew ;applicantFif .this �s a�ctiange.of�owriersh4p:
2. Legal documentation of the property transfer to a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4. The designers certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional offide), if required by{the permit and if not already submitted to DWQ.
5. II the proposed permittee is a firm, partnership, association, institution, corporation, limited liability
company, or other corporate entity, provide documentation showing the authority of the named
representative to act on behalf of the proposed permittee.
6. The $40.00 processing fee. If this is an initial transfer from the original permittee the processing
fee is not required. Subsequent ownership transfers will require the $40.00 processing tee.
IV. CURRENT f ERMITTEE'S CERTIFICATION
Please check one of the following statements and till out the certification below that statement:
❑ Check here if the current permittee is only changing his/her/ils name, the project name, or mailir
address, but will retain the permit, I, , the current
permittee, hereby notify the DWQ that I am changing my name and/or I am changing my mailing
address and/or l am changing the name of the permitted project. I further attest that this application
for a name/ownership change is accurate and complete to the best of my knowledge, I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments listed above are not included, this application package will be returned as
incomplete.
[Check here if current permittee is transferring the property to a new owner and will not retain
ownership of the permit.
I, RuAer Do cp24, LLC - the current permittee, am submitting this application
for a transfer of ow ership for permit # Sub I I oo3o . I hereby notify DWQ o1 the sale or
other legal transfer of the stormwater system associated with this permit. I have provided a copy of
the most recent permit, the designer's certification for each BMP, any recorded deed restrictions,
covenants, or easements, the DWQ approved plans and/or approved as -built plans, the approved
operation and maintenance agreement, past maintenance records, and the most recent DWQ
stormwater inspection report to the proposed permittee named in Sections 11 and V of this form. I
further attest that this application for a name/ownership change is accurate and complete to the best
of my knowledge. I understand that if ail required parts of this application are not completed or if all
required supporting information and attachments listed above are not included, this application
package will be returned as incomplete. I assign all rights and obligations as permittee to the
proposed permittee named in Sections 11 and V of this form. I understand that this transfer of
ownership can of be approved by the DWQ unless and until _the facility is in compliance with the
permit. All i k i d .�
• If I FRI ITI r' R .: ' �, of
a Notary Public for the State of
Qt, , County of do hereby certify that
A personally appeared b�Jgp, me this the
`�ti r'faii
.10 _day of O , 20JL, and acknow� �f��ecution of the
forgoing instrume t. Witness my hand and official seal,=a�°�SI�No fj8��1)
- D C ; =
Notary Sig tore = 2014
111t,111
� RY
SSW N/0 Change Revl 5Feb2011 Page 2 of 4

••r
V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed PPeermiltee for all transfers of ownership)
►{1�A/ , hereby notify the DWQ that I have acquired
through sale, lease or legal transfer, the responsibility for operating and maintaining the permitted
stormwater management system, and, if applicable, constructing the permitted system. I
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
the most recant permit
the designer's certification for each BMP
❑ any recorded deed restrictions, covenants, or -easements
❑ the DWO-approved plans and/or approved as -built plans
❑ the approved operation and maintenance agreement
®past maintenance records from the previous permittee (where required)
DWQ stormwater inspection report showing compliance within 90 days prior to this transfer
I have reviewed the permit, approved plans and other documents listed above, and I will comply with
the terms and conditions of the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to'the requirements listed in the permit and in the
operation and maintenance agreement. I further attest that this application for a name/ownership
change is accurate and complete to the best of my knowledge. I understand that if all required parts
of this application are not completed or if all required supporting Information and attachments listed
above are not irlcl , this application package will be returned as incomplete.
Signature: / iGl �r Date: l
I, e ! S • 'Lode_ , a Notary Public for the State of
Te nr�e sse e , County ofer� , do hereby certify that
Se SS mah_ C - personally appeared before me this the
ti ii11
i day of N 0Vembe_r , 20 t a , and acknowlecf6 e i &,execution of the
forgoing instrument. Witness my hand and official seal, O srgT
q, nn � ••,�cc� r
OF
Notary Signature : I . NorgRy
7.f %<pUBt<1C J�````�
Cp,,C \\
Additional copies of the original permit and the approved Operation and Maintenance agreement can
be obtained from the appropriate Regional Office of the Division of Water Quality.
This completed form, including all supporting documents and processing fee (if required), should be
sent to the appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources, Division of Water Quality, as shown on the attached map.
Please note that if the Proposed Permittee listed above is not the property owner, the property owner
must complete and sign page 4 of this document. Both the lessee / developer and the property
owner will appear on the permit as permittees•
SSW N/O Change Revl5Feb2011 • Page 3 of 4

1
VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections 11 and V of this form is not the Property Owner, the
Property Owner must provide his/her Contact Information below and sign this form:
Printed Name:
Organization:
Title within the Organization:
Street Address:
City: State., Zip:
Mailing Address: _
(if different from scent address)
City: State:_ Zip: -
Phone:
Finail:
Fax:
I certify that I own the property identified in this permit transfer document and have given permission
to the Proposed Permittee listed in Sections 11 and V to develop and/or, lease the property. A copy
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of .the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and I will therefore share responsibility for
compliance with the DWQ Stormwater permit. As the property owner, it is my responsibility to notify
DWQ by submilling a completed Name/Ownership Change Form within 30 days of procuring a
developer, lessee or purch.Aser for the property. I understand that failure to operate and maintain the
stormwater treatment facility in accordance with the permit is a violation of NC General Statute
(NCGS) 143-215.1, and may result in appropriate enforcement action including the assessment of
civil penalties of tap to $25,000 per da ant to- NCGS J 43-215.6.
Signature of the property owner. 2&Date:
1, S . Cep e , a Notary Public for the State of
—Ti ryYesSe e. , County of �c�m, tioler. , do hereby certify that
Se -.s M curd personally appeared before me this the
1-j Ili
clay of _ _ N OVarAbef 20 11 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
\0%11l+f+1/11"
.�` SPA S. C'
Notary Signature
= OF
t
:TENNESSEE
y , NOTARY
. PUBLIC
.�fizeZEN '
GO. S
111111010
SSW NIO Change Revi 5Feb2011 Page 4 of 4

Plant Contact: Danny Channel[ - ESS Coordinator
Phone: [phone]
Fax: 423-586
-3728
jdOV 18 2011
E-Mail: [e-mail]
1-ti. C;7.­'cif ),'

02 1 P
0003173732 OCT 03 2011
iAAfLED FR0;AZfP CODE 28778
ri
ARA*
North Carolina Department of
Environment and Natural Resources
Division of water Quality
Surface water Protection Section
NCDENR 209C U.S. Highway 70, swannanoa. NC 28778
Corporation Service Co., Registered Agent
Flowers Baiting Company of Morristown, LLC
327 Hillsborough Street
Raleigh, NC 27603
..:...IrIr�I1�r��1r�l�1l�li�+rllif�rillf,s��iill„t��rJi��l�rll•• � .�

Wilson, Susan A
From: [e-mail]
Sent: Friday, December 02, 2011 11:40 AM
To: Wilson, Susan A
Cc: [e-mail]
Subject: Bio-Retention Pond Inspection Forms
Susan -
I am the corporate environmental manager for Flowers Foods, Inc. with oversight responsibilities for our new warehouse
at Hendersonville. You recently conducted an inspection of the warehouse and sent us a copy with your
recommendations for correcting a few things.
First I can tell you that all paperwork requesting a change of ownership has been submitted as requested.
Second, we are currently in the process of developing a formal O&M plan for the ponds as well as an inspection
procedure and schedule. We would like to use excerpts from your inspection form(s) as part of the inspection process to
be included in the O&M. All copies we currently have are scanned images and we can't cut & paste or use portions. We
would prefer to not re -invent the wheel so we were wondering if you had a pdf or WORD formatted copy that you could
share with us that would allow us to excerpt and include in the new O&M plan?
Lastly - the actual management responsibility for this warehouse comes out of.our bakery located in Morristown, `
Tennessee. Mr. Danny Channell is the Environment, Safety & Security Director and has direct responsibility for
compliance for this warehouse. You can direct any correspondence to him. His e-mail address is
Danny [e-mail] and his phone number is 423.586.2471
We appreciate your consideration of this request and look forward to hearing from you.
Sincerely,
Jim Johnson, MSM, QEP
Environmental Manager Flowers Foods
2900 Rolling Pin Lane
Suite C
Suwanee, GA 30024
770.932.7927 (Office)
301,606.5846 (Cell)
770.831.9259 (Fax)
lim bhnson(d,)flocorp.com

Wilson, Susan A
From: [e-mail]
Sent: Thursday, May 31, 2012 9:49 AM
To: Wilson, Susan A
Subject: RE: Copy of Permit #SW1100301
No hurry Susan - we were just going through our records making sure they are up-to-date and noticed we didn't have a
copy. If you could just send a copy when you are finished we should be OK.
Between you and me we just announced that in June we are beginning unannounced environmental audits of our plants
so they are all going through their records making sure everything is audit ready and the plant found this and are trying to
get their files complete.
Knowing what you just told me if they get their audit prior to receiving a copy of the permit I'll know what the answer is and
shouldn't mark it against them.
Thank you for following up on this request.
Jim Johnson, MSM, QEP
Environmental Manager Flowers Foods
2900 Rolling Pin Lane
Suite C
Suwanee, GA 30024
770.932.7927 (Office)
301,606.5846 (Cell)
770,831.9259 (Fax)
iimJohnsontc'7.flocorp.com
From. 'Wilson, Susan X <susan.a.% ilson@ncdenr.00v>
To: "Jim Johnson(a)Flocorp.com" <Jim John son(Ciflocorp.com>
Date: 05/29/2012 09:57 AM
Subject: RE: Copy of Permit #SW 1100301
Hi Jim —
I
You know what? I had totally forgotten to do the name/owner change for your permit. Let me get that done and get it back to you
this week. If you need a copy of the old permit now — I can get that to you —just let me know.
I really apologize — I went back through my files and realized I hadn't done the name/owner change.
Thanks,
Susan
Susan A. Wilson - [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Surface Water Protection

2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and therefore may
be disclosed to third parties.
From: Jim Johnson(Nocoro.com [mailto:Jim [e-mail]]
Sent: Thursday, May 24, 2012 9:57 AM
To: Wilson, Susan A
Subject: Copy of Permit #SW1100301
Good Morning Susan
Don't know if you remember me we traded a -mails a while back. I have a request to make of you. We were wondering if
you could send us a copy of the actual permit for our warehouse in Flat Rock, NC. You inspected it last year and we had
to do a change of ownership as well as implement the BMP. We were working on that permit and realized we did not have
an actual copy of the permit. i don't know if Butler had a copy or we had one and it has been misplaced. We tried to find
one on-line but could not find it. Could you scan a copy and e-mail it or if it is on-line point me to the proper URL.
If I need to make a formal request in writing please let me know to whom I need to send the letter and we'll do it
Thank you!
Jim Johnson, MSM, QEP
Environmental Manager Flowers Foods
2900 Rolling Pin Lane
Suite C
Suwanee, GA 30024
770.932.7927 (Office)
301.606.5846 (Cell)
770.831.9259 (Fax)
iim '[e-mail]

MLW"
A
NC®ENR
North Carolina Department of Environment and
Division of water Quality
Beverly Eaves Perdue
Governor
Mr. Jesse Gardner, P.E.
Civil Designs Concepts, PA
P.O. Box 5432
Asheville, NC 28813
Dear Mr. Gardner:
Coleen H. Sullins
Director
March 30, 2010
Natural Resources
L-
Subject: Request for Additional Information
Dee Freeman
Secretary
Stonnwater Project No. SW1100301
Hendersonville Distribution Facility at Blue Rock
Commerce Center
Herderson County
The Division of Water Quality Central Office received a Stormwater Management Pen -nit Application
the subject project on March 19, 2010. A preliminary review of that information has detennined that t
application is not complete. The, following information is needed to continue the stormwater review:
l . Some of the items on the Required Item Checklist have not been included in the application
materials. Missing items are: Cell Dimensions, Recorded Drainage Easement and public right
of way (ROW), and Boundaries of drainage easement.
2. Please provide supporting calculations for the swales and any other entering points to the
bioretention cell in order to show the flow will not cause erosion. Inflow must enter a
bioretention cell via sheet flow at 3.0 ft/sec for grassed cells or alternative energy dissipating
devices must be used. If sheet flow is not attainable, as may be the case with this design, then
the inflow will enter from concentrated sources and need a rip rap lined entrance, a torebay, or
other energy -dissipating device.
3. The cell must be designed to include pretreatment. The supplement has "Gravel and grass"
mark, .d: The pretreatment is not shown on the plan sheets. A grass and gravel combination,
consist of 8 inches of gravel followed by 3 to 5 feet of sod. Please show these details on the
plans or provide another type of pretreatment.
4. The Bic :.tention Cell Supplements are missing necessary inputs: Length and Width —or-
Radius «rid Inlet Velocity.
5. There appe:lrs to be inconsistencies on the supplement forms and plan sheets. Please check all]
elevations to make sure they match. On the supplement form, the temporary pool elevation 1s
2167.00 fins! -out on plan sheet C7 the elevation looks to be at 2166 fins].
6. The site plans show only one underdrain for each bioretention cell. In section 5.7 of the BMP
Manual, it states a minimum of two pipes should be installed to allow for redundancy. We
strongly recommend providing more than one underdrain for each cell.
Wetlands and Sto.7nw:ater Branch 1�TOne
1617 Mail Service Center, FalL-0, Morin Carrlina 27699-1617 1V OI tl l l.ci: loll lac%
Location: 512 N. SalisL-ir; St. Raleigh, North Car.lii}a 27604
Phone: 919-8::7-6300', FAX: �1l+-507-64941 Customer Service: 1.877-623-6748 Naturally
Internet www.ncwa1ergUal4.'r9
An Epual Opportunity 1 Af irmalive Aclicn Employer

Mr. Jesse Gardner
SW l 100301 - Ft. Bragg Green Fuel Facility
March 30, 2010
Please note that this request for additional information is in response to a preliminary review. The
requested information should be received by this Office prior to April 30, 2010, or the application will be
returned as incomplete. The return of a project will necessitate resubmittal of all required items, including
the application fee.
If you need additional time to submit the information, please mail or fax your request for a time extension
to the Division at the address and fax number at the bottom of this letter. The request must indicate the
date by which you expect to submit the required information. The Division is allowed 90 days from the
receipt of a completed application to issue the permit.
If you have any questions concerning this matter please feel free to call me at [phone].
Sincerely,
1 /
vJ
Brian Lowther
Environmental Engineer
cc: .Asheville Regional Office
DWQ Central Files
Stormwater Pennitting Unit Files

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW -- 2008 ❑ Ph II'- Post Construction '
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters' ❑ Universal Storriiv4at6r Management Plan,.. ,.�
❑ Other WQ M mt Plan: r*
State of North Carolina �(�
Department of Environment and Natural Resources `+I ,I ; j i
Division of Water Quality MAR 2 g �011 Jr
STORMWATER MANAGEMENT PERMIT APPLICATIO
This form irray he photocopied far rase as arr original L D . �]
1. GENERAL INFORMATION y^ 1
1. Project Name (subdivision, facility, or establishment name - should be consistent ih 'rJWI nen4 o201.1._ ` a
plans, specifications, letters, operation and maintenance agreements, etc.): '
2. Location of Project (street address):
urr
City:Flat Rock County: Henderson Zip:
3. Directions to project (from nearest major intersection):
The project is located on lot 4 of Blue Rock Commerce Park, which is approximately 3,000 LF south of the
intersection of Tracy Grove Road and McMurray Road in central Henderson County.
4. Latitude:350 18' 26.02" N Longitude:82° 24' 39" W of the main entrance to the project.
11. PERMIT INFORMATION:
1, a. Specify whether project is (check one): []New ®Modification
b. If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number1100301 , its issue date (if known)May 11, 2010 , 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 ®1-iigh Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DWQ requesting a state stormwater management permit application, list the stormwater project number,
if assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ❑Sedimentation/Erosion Control: ac of Disturbed Area
❑NPDES industrial Stormwater ❑404/401 Permit: Proposed Impacts
b. If any of these permits have already been acquired please provide the Project Name, Project/ Permit
Number, issue date and the type of each permit:
Form SWU-10i Version 07July2009 Page I of

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organiza
Signing Official & T
Matt Wilson - Bu
b.Contact information for person listed in item I above:
Street Address:2727 Paces Ferry Rd Suite 1-255 _
City:Atlanta State:GA Zip:30339
Mailing Address (if applieable):Same as ab
City:
Phone: [phone], ex. 19
[e-mail]_
State:
Zi
Fax: {770 ) 433-0909 I
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a
and 2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization: Flowers Baking Co. of Morristown LLC
Signing Official & Ti
b.Contact information for person lifted in item 2a above:
Street Address: / 7Z ItIn � Fvl ` 11,, A. S lsrr
City: A1ii(ftS`h./ J State: Zip: 7W
Mailing Address (if applicable): l / 24C dvesf &. & 4r�4_
City: e Ala a 0.1'S'� Stated % � Zip:4= -7
Phone: Fax: z!/„ 6 ,-
Email:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: { ) Fax:
Email:
4. Local jurisdiction for building permits:
Point of Contact: Phone #:
Form SWU-101 Version 071uly2009 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The projects stormwater will be conveyed primarily through vegetated dictches and directed into one of the
2 planned biorention cells for quantity_ and quality control.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.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 French Broad River basin.
4. Total Property Area: 1.58 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area+:1.58 acres
+ Total project area shall be calculated to exclude the following• the noruual pool of iunpounded strictures, fire area
behoeen the banks of streams and rivers, the area below the Normal High Water (NHW) litre or Mean High Water
(MHW) line, and coastal wetlands landruard front the NHW (or MHW) line. The resultant )project area is used to
calculate overall percent built upon area (BZ_IA). Nowt -coastal Wdlands landward of the NHW (or MHW) titre nuay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 69.7
9. How many drainage areas does the project have?2 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each
area provided in the same format as below.
Form SWU-101 Version 07JLLIy2009 Page 3 of

Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area
Draina e Area I
Receiving Stream Narne
UT to Bat Fork
UT to Bat Fork
Stream Class *
C
C
Stream Index Number *
6-55-8-1
6-55-8-1
Total Drainage Area (so
32,402
40,266
On -site Drainage Area (sf)
30,544
31,468
Off -site Drainage Area (sf)
1,858
8,798
Proposed Impervious Area**
(so
24,498
24,465
I
% Impervious Area** total
75.60
1 60.87
Impervious— Surface Area
Draina e Area
Drainage Area _
Drainage Area
Drainage Area
On -site Buildings/Lots (so
2,940
2,940
On -site Streets (so
16,063
18,724
On -site Parking (so
5,342
2,633
On -site Sidewalks (so
153
168
Other on -site (so
0
0
Future (so
0
0
Off -site (so
0
0
Existing BUA*** (so
0
0
Total (so:
1 24,498
24,465
* Stream Class and Index Number can be determined at: littp.-Mi2o.enr.state.tic.us/Iritus/reports/reportsW$.Ittttt!
Impervious area is defined as the buill upon area including, but not lintited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
*"Report only that amoind of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. i-low was the off -site impervious area listed above determined? Provide documentation. Field Survey
Projects in Union County: Contract DJPQ Central Office staff to check if the project is located within a Threatened &
1;ndangered Species 4ratershed that may be subject to nrore stringent sloriwrater requirements as per NC,4C 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://h2o.enr.state.iic.us/su/bmp__forms.htm.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality
(DWQ). A complete package includes all of the items Iisted below. A detailed application instruction sheet
and BMP checklists are available from httl2://h2o.enr.state.nc.us/su/bmp forms.htm. The complete
application package should be submitted to the appropriate DWQ Office. (hhe appropriate office may be
found by locating project on the interactive online map at http://l12o.enr.state.nc.us/su/msi rnaps.htm.)
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://112o,enr.state.nc.us su/bml2 forms.htm.
In' al
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 VII below)
3. Original of the applicable Supplement Form(s) (sealed signed and dated) and O&M �iC�+•rv�
agree ment(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
httl2://www.envhelp,org/pai;es/onestol2exl2ress.litm]-foi- 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.)
Form SWU-101 Version 073uly2D09 Page 4 of 7

5. A detailed narrative (one to two pages) describing the stormwater treatment/management for
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within'/z mile of the site boundary, include the
mile radius on the map.
7, Sealed, signed and dated calculations.
S. 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.
f. 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 MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
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, [phone].)
10. A copy of the most current property deed. Deed book: Page No: `
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 NCAC 2H.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
httl2://www.secretary.state.tic.us/Corporations/Csearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
Qr�►••.-,fir c+ir►.�
%• If
fj
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table fisting each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from
http:/Ih2o.enr.state.nc.us/sulbmp forms.htm#deed restrictions. Download the latest versions for each
submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded. I
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listec
on the forms available on the website, that the covenants will be binding on all parties and persons claimin
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.
Form SWU-101 Version 07July2009 Page 5 of

VIIL 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:lesse Gardner, P.E.
Consulting Firm: Civil Design Concepts, PA
Mailing Address:P.O. Box 5432
City:Asheville State:NC Zip:28813
Phone: (828 ) 252-5388
1'smail:[e-mail]
Fax: (828 ) 252-5365 _
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, itern 2 has been filled out, complete this
section) /�^
1, (print or type name of person listed in Contact Information, item 2a) �eSS Mapr d certify that I
own the property identified in this permit a plication, and thus give permission to (print or type name of parson
listed in Contact Information, itc 1 Trr) '1Is6' with (print or type name of organization listed in
Contact Irrforuration, item 1b) i t rc 6 Lei to develop the project as currently proposed, A copy
of the lease agreement or pending property sales contract has been provided with the submittal, which indicates
the party responsible for the operation and maintenance of the stormwater system.
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 l will be
operating a stormwater treatment facility without a valid permit. I understand that the operation of a
stormwater treatment facility without a valid permit is a violation of NC General Statue 143-215.1 and may
result in appropriate enforcement action including the assessment of civil penalties of up to $25,000 per day,
pursuant to NCGS lia-215.6.
Date:_ Z-/y -//
1, T't)�-a —,a Notary Public for tjhe State of e r) n e-, 5se e . County of
r"131er, J' do hereby certify that SS AOL Y-8 personally appeared
before me this 1 day of F>✓bY-tAcry v 1 ! and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, _ At" J , OA' _
`\,�ttVllltll���,
09A S c0 ��'•
O 5TA7E
''�
OF
_ :TENNESSEE
NOTARY
PUBLIC .
4
d�tF!llilyll`'
SEAL
My commission expires o2 g
Form SWU-101 Version 07Ju1y2009 Page 6 of 7

R
X. APPLICANT'S CERTIFICATION '�,)i� _1
1, (print or type nawe of person lister! in Contact Information, itefa 2) [' �� WI ���'`� - V P A 'Deve10Q,rw�rl-
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 star a ales under 15 NCC 2E 1 .1000, SL 2006-246 (Ph. If -Post Construction) or SL 2008-211.
Signature:. / Date: .z
In � ..s
Ao do hereby certify that L' A i+ 1' V d Son personally appeared
is day of RM)ekAaY o r t ,and acknowledge the due e ec tion of the application for
- , f
a stormwater permit. Witness my hand and official seal, fZi� ,4 lU i--,)
My commission expiresrG atay'q (J' , 01
Form SWU-101 Version 07July2009 Page 7 of 7

. 1610.
Son
L E 0
cl.

Permit Number:
(to be provided by DWQ)
�
O"0� W A-rtI?
A > y
NCDENR T
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This fora must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, idled out and submitted along with all of the required information.
sr _. rw tir M �e ,t 1
15 PROTECT INFORMATION ' pr' '; '�f fix._ h�M .k & :nv w' ': U :'Q 4;
Project name Hendersonville Distribution Facility at blue Rock Commerce Center I
Contact name Jesse Gardner, RE,
Phone number 828-252-5388
Date February 1, 2011
Drainage area number DA-1 I
II:-,DESIGNi,INF,ORMAT10
Site Characteristics
Drainage area
Impervious area
Percent impervious
Design rainfall depth
Peak Flow Calculations
Is prelpost control of the 1-yr, 24-hr peak flow required?
1-yr, 24-hr runoff depth
1-yr, 24-hr intensity
Pfe-development 1-yr, 24-hr peak flow
Post-developmeht 1-yr, 24-hr peak flow
Pre/Post 1-yr, 24-hr peak control
Storage Volume: Non -SA Waters
Minimum volume required
Volume provided
Storage Volume: SA Waters
1.5" runoff volume
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Minimum volume required
Volume provided
Cell Dimensions
Ponding depth of water
Ponding depth of water
Surface area of the top of the bioretention cell
Length:
Width:
-or- Radius
Media and Soils Summary
Drawdown time, ponded volume
Drawdown time, to 24 inches below surface
Drawdown time, total:
In -situ soil.,
Soil permeability
Planting media soil:
Soil permeability
Soil composition
% Sand (by weight)
% Fines (by weight)
% Organic (by weight)
32,402 ft2
24,498 ft2
75.6% %
1' inch
Y (Y or N)
3.4 in
0.14 in/hr
2,640 ft3/sec
1.080 ft3/sec
-1.560 ft3/sec
1,972.2 ft3
2,004.2 ft3 OK
ft3
ft3
ft3
0 ft3
ft3
12 inches
OK
1.00 ft
2,004.2 ft2
OK
41 ft
OK
54 ft
OK
ft
6 hr OK
18 hr OK
24 hr
2.00 inlhr OK
2.00 in/hr OK
87% OK
8% OK
5% OK
Total: 1001/0
Phosphorus Index (P-Index) of media 10 (unitless) OK
Form SW401-Bioretention-Rev.8
July 30, 2009
MAR 2 9 2011
vdr. ���_� r�_I,�.i_I ry �-•:�c, nc�r•r
Parts I and II. Design Summary, Page 1 of 2

`7
Permit Number.
(to be provided by DWO)
Basin Elevations
Temporary pool elevation
Type of bioretention cell (answer "Y' to only one of the two
following questions):
Is this a grassed cell?
Is this a cell with treesishrubs?
Planting elevation (top of the mulch or grass sod layer)
Depth of mulch
Bottom of the planting media soil
Planting media depth
Depth of washed sand below planting media soil
Are underdrains being installed?
2166.00 fmsl
Y (Y or N)
N (Y or N)
2165 fmsl
0 inches
2163 fmsl
2 ft
Oft
Y (Y or N)
How many dean out pipes are being installed?
4
What factor of safety is used for sizing the underdrains? (See
10
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
1 ft
the bottom of the cell to account for underdrains
Bottom of the cell required
2162 fmsl
SHWT elevation
2161 fmsl
Distance from bottom to SHWT
1 it
Intemal Water Storage Zone (IWS)
Does the design include IWS
N (Y or N)
Elevation of the top of the upturned elbow
fmsl
Separation of IWS and Surface
2165 ft
Planting Plan
Number of tree species
0
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
Y (Y or N)
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
Y (Y or NJ
through a vegetated filter?
What is the length of the vegetated filter?
83 ft
Does the design use a level spreader to evenly distribute flow?
Is the BMP located at least 30 feet from surface waters (50 feet if
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Are the vegetated side slopes equal to or less than 3:1?
Is the BMP located in a proposed drainage easement with access
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
Is the area surrounding the cell likely to undergo development in
the future?
Are the slopes draining to the bioretention cell greater than 20%?
Is the drainage area permanently stabilized?
Pretreatment Used
(Indicate Type Used with an 'X' in the shaded cell)
Gravel and grass
(8inches gravel followed by 3-5 ft of grass)
Grassed swale
Forebay
Other
OK
Insufficient mulch depth, unless installing grassed cell.
C611
X121
Insufficient distance to SHWT.
OK
OK
N (Y or N) Show how flow is evenly distributed.
Y
(Y of N)
Y
(Y or N)
Y
(Y or N)
Y
(Y or N)
2.33/2.77 ft/sec
N
(Y or N)
OK
OK
OK
OK
Insufficient inlet velocity unless energy dissipating
being used.
OK
N (Y or N) OK
Y (Y or N) OK
Y
M
Form SW401-Bioretention-Rev.8
July 30, 2009 Parts I and 11. Design Summary, Page 2 of 2

Permit Number: I
(to be provided DWO)
awn
MCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part /11) must be printed, filled out and submitted along with all of the required information,
litPROJECTsINFORMATION�Vi-
J
Project name Hendersonville Distribution Facility at Blue Rock Commerce Center
Contact name Jesse Gardner, P.E.
Phone number 828-252-5388
Date February 1, 2011
Drainage area number DA-11
t.�- 7"T
"DESIGN 4NEORMAT ION;ram11� �_ 77j 7.
Site Characteristics
Drainage area 32,402 ft2
Impervious area 24,498 ft2
Percent impervious 75.6% _%
Design rainfall depth 1' inch
Peak Flow Calculations N
Is pre/post control of the 1 -yr, 24-hr peak flow required? Y _(YorN)
1-yr, 24-hr runoff depth 3.4 in
1-yr, 24-hr intensity 0.14 in/hr
4
Pre -development 1 -yr, 24-hr peak flow 2,640 ft'/sec
R 9
Post -development 1 -yr, 24-hr peak flow 1.080 ft'/sec MA2 2011
Pre/Post 1 -yr, 24-hr peak control -1-560 fillser
t
Storage Volume: Non -SA Waters
Minimum volume required 1,972.2 ft' L �J C,,j �, UTY --C.- T 10 N
X : —1
CE
Volume provided 2,004.2 ft' OK A' 0'7
Storage Volume: SA Waters
1.5" runoff volume ftJ
Pre -development 1 -yr, 24-hr runoff
Past -development 1 -yr, 24-hr runoff
Minimum volume required 0
Volume provided
Cell Dimensions
Ponding depth of water 12 inches OK
Ponding depth of water 1.00 ft
Surface area of the top of the bioretention cell 2,004.2 fl2 OK
Length: 41 ft OK
Width: 54 ft OK
-or- Radius It
Media and Solis Summary
Drawdown time, ponded volume 6 hr OK
Drawdown time, to 24 inches below surface 18 hr OK
Drawdown time, total: 24 hr
In -situ soil:
Soil permeability 2.00 in/hr OK
Planting media soil:
Soil permeability 2.00 in/hr OK
Soil composition
% Sand (by weight) 87% OK
% Fines (by weight) W./. OK
% Organic (by weight) 5% OK
Total lon.
Phosphorus Index (P-Index) of media 10 (unitless) OK
Form S1V401-Bioretention-Rev.8
July 30, 2009 Parts I and 11. Design Summary, Pagelf of 2

{
Permlt Number:
(to be proWided by DWO)
Basin Elevations
Temporary pool elevation
2166.00 fmsl
Type of bioretention cell (answer 'Y" to only one of the two
following questions):
Is this a grassed cell?
Y
(Y or N)
OK
Is this a cell with treestshrubs?
N
(Y or N)
Planting elevation (top of the mulch or grass sod layer)
2165 fmsI
Depth of mulch
0 inches
Insufficient mulch depth, unless installing grassed cell.
Bottom of the planting media soil
2163 fmsl
Planting media depth
2 ft
Depth of washed sand below planting media soil
0 f l
Are underdrains being installed?
Y
(Y or N)
How many clean out pipes are being installed?
4
OK
What factor of safety is used for sizing the underdrains? (See
10
OK
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
1 It
the bottom of the cell to account for underdrains
Bottom of the cell required
2162 fmsl
SHWT elevation
2161 fmsl
Distance from bottom to SHWT
1 ft
Insufficient distance to SHWT.
Internal Water Storage Zone (IWS)
Does the design include IWS
N
(Y or N)
Elevation of the top of the upturned elbow
fmsl
Separation of IWS and Surface
2165 ft
Planting Plan
Number of tree species
0
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
Y
(Y or N)
OK
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
Y
(Y or N)
OK
through a vegetated filter?
What is the length of the vegetated fitter?
83 ft
Does the design use a level spreader to evenly distribute flow?
N
(Y or N)
Show how flow is evenly distributed.
Is the BMP located at least 30 feet from surface waters (50 feet if
Y
(Y or N)
OK
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Y
(Y or N)
OK
Are the vegetated side slopes equal to or less than 3:1?
Y
(Y of N)
OK
Is the BMP located in a proposed drainage easement with access
Y
(Y or N)
OK
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
2,33/2,77 fUsec
Insufficient inlet velocity unless energy dissipating devices are
being used.
Is the area surrounding the cell likely to undergo development in
N
(Y or N)
OK
the future?
Are the slopes draining to the bioretention cell greater than 20%?
N
(Y or N)
OK
Is the drainage area permanently stabilized?
Y
(Y or N)
OK
Pretreatment Used
(Indicate Type Used with an "X" in the shaded cell)
Gravel and grass
(flinches gravel followed by 3-5 ft of grass)
Grassed swale
OK
Forebay
X
Other
Form SW404-Bloretention-Rev.8
Juty 30, 2009 Parts I and II. Design Summary, Page 2,02

DWQ USE ONLY. ',;` I
Date Received
Fee Paid Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ MgMt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
2. Location of Project (street address):
City:Flat Rock County:Henderson
3. Directions to project (from nearest major intersection):
The project is located on lot 4 of Blue Rock Commerce Park, which is approximately 3,000 LF south of the
intersection of Tracy Grove Road and McMurray Road in central Henderson County_ _
4. Latitude:35° 18' 26.02" N Longitude:82° 24' 39" W of the main entrance to the project.
II. PERMIT INFORMATION:
I - a. Specify whether project is (check one): ❑New ®Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number1100301 , its issue date (if known)May 11, 2010 , and the status of
construction: ❑Not Started ®Partially Completed* ❑ Completed* *provide a designer's
certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a Ietter from
DWQ requesting a state stormwater management permit application, list the stormwater project number,
if assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ❑Sedimentation/Erosion Control: ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts-
b. If any of these permits have already been acquired please provide the
Number, issue date and the type of each permit:
XU; �41'IlI�I f� ff , i� l' 1.i =
;I� MAR 2 9 2911
Form SWU-101 Version 07July2009 Page] of6

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project}:
Applicant/Organization: Matt Wilson- Butler DeveIopment, LLC T ``
Signing Official & Title:Matt Wilson - Vice President of Development I
b.Contact information for person listed in item la above:
Street Add
City:Atlanta State:GA
Mailing Address (if applicable).Same as above I
City: State: Zip:
Phone: [phone] ex. 19 Fax: [phone] V
Email:[e-mail]
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a
and 2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:Flowers Baking Co. of Morristown. LLC _
Signing Official & Titre:
tv
b.Contact information for person lilted in item 2a above:
Street Address: / 7L r Korea+ Fhil 4v?
City: / loyrn, J _-. State: TN Zip: .7
Mailing Address (if applicable). / 1 L1; &, S 1�Xr � rrt
City: n'l8 ►'V j-s U4, .._.. State „ zip:mw
Phone: ( y Z 3 ) _ S-11 G" Z I -7% Fax: { ' f Z_ _) SVla — 3,7,2
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: Fax: ( ]
Email:
4. Local jurisdiction for building permits: _
Point of Contact: Phone #: ( ]
Form SWU-101 Version 07July2009 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The projects stormwater will be conveyed primarily through vegetated dictches and directed into one of the
2 planned biorention cells for quantity and quality control. _
1
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development PIan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.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 French Broad _ River basin.
4. Total Property Area: 1.58 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:1.58 acres
Total project area shall be calculated to exclude thefollowing: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area beloio the Normal Hi h Water (NHM line or Mean High Water
W) (MHline, and coastal wetlands landward from the NHW (or MHX line. The resultant project area ¢s used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 69.7 %
9. How many drainage areas does the project have?2 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each
area provided in the same format as below.
Form S WU-101 Version 07July2009 Page 3 of 7

Basin Information.•
Draina e Area 1
-Draina a Area 2
Draina" e Area 'iDrainage
Area I
Receiving Stream Name
UT to Bat Fork
UT to Bat Fork
Stream CIass *
C
C
Stream Index Number rt
6-55-8-1
6-55-8-1
Total Drainage Area (so
32,402
40,266
On -site Drainage Area (sf)
30,544
31,468
Off -site Drainage Area (sf)
1,858
8,798
Proposed impervious Area*
s
24,498
24,465
1
`
% Impervious Area* total
75.60
60.87
Impervious** Surface Area
Draina e;Area
Drainage Area —
Draina e Area
-Draina e Area .I
On -site Buildings/Lots (so
2,940
2,940
1
On -site Streets (so
16,063
18,724
`
On -site Parking (so
5,342
2,633
On -site Sidewalks (so
153
168
Other on -site (sf)
0
0
Future (so
0
0
Off -site (sf)
0
0
Existing BUA*** (so
0
0
Total (so:
1 24,498
24,465
* Stream Class and Index Number can be determined at: ht 2o.enr.state.nc.us ims re orts r ortsWB.hlml
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
*** Report only that amount of existing BUA that will remain after development, Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. Field Survey
Protects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that maybe subject to more stringent stormwater requirements as per NCAC 02B.0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
fromhttn://h2o.enr,state.nc.us/su/bmn forms.htm.
Vl. 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 ht!p://h2o.enr.state.nc.us/su/bmp- forms.htm. 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://h2o,enr.state.nc.us/su/msi maps.htm.)
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://h2o.enr.state.nc.us/Su/bmp forms.htm.
In' al
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 :�Y5
Form. (if required as per fart VII below)
3. Original of the applicable Supplement Form(s) (sealed sigLied and dated) and O&M A' v-4.^%'
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
httpJLwww.envhelp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
Form SWU-101 Version 07July2009 Page 4 of 7

I
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for pp'�# 04 6,06
6, A USGS map identifying the site location, If the receiving stream is reported as class SA or the �� < <'t
receiving stream drains to class SA waters within'/s mile of the site boundary, include the lh
mile radius on the map.
7. Sealed, signed and dated calculations.
S. 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.
f. 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 MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j, Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
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"xl l" 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 verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: Page No:
11, For corporations and limited liability corporations (LLC): Provide documentation from the NC _
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per NCAC 2H.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
htq2://www.secretary.state.ne.us/CorRorationsZCSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from
httj2:/A22o.enr.state.nc.us/su/bml2 forms,htm#deed restrictions. Download the latest versions for each
submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
Form SWU-101 Version 07July2009 Page 5 of 7

VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as
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:
Consulting Firm: Civ
Mailing Address:P_O
City:Asheville
Phone: (828 ) 252-5388
Email:[e-mail]
State: NC Zip:28813 I
Fax: (828 } 252-5365
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section) p�
I, (print or type name of person listed in Contact Information, item 2a) yeSS /�' `4tfPf d certify that 1
own the property identified in this permit a plication, and thus give permission to (print or type name of person
listed in Contact Information, ite 1a) i u'fst"Al with (print or type name of organization listed in
Contact Information, item Ib) 15 t Yc G C . to develop the project as currently proposed. A copy
of the lease agreement or pending property sales contract has been provided with the submittal, which indicates
the party responsible for the operation and maintenance of the stormwater system.
As the legal property owner I acknowledge, understand, and agree by my signature below, that if my
designated agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or
defaults on their lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater
permit reverts back to me, the property owner. As the property owner, it is my responsibility to notify DWQ
immediately and submit a completed Name/Ownership Change Form within 30 days; otherwise I will be
operating a stormwater treatment facility without a valid permit. I understand that the operation of a
stormwater treatment facility without a valid permit is a violation of NC General Statue 143-215.1 and may
result in appropriate enforcement action including the assessment of civil penalties of up to $25,000 per day,
pursuant to NCGS 1ia-215.6.
Date: z--/Y —//
I, b ra 5. �) t? , a Notary Public for�tghe State of i Q r, e SSe e_ County of
Roamben do hereby certify that J�S5 /�actaay^ personally appeared
before me this i►� day of 6C -usny and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, 4 , C�a�
0 1t11ttt1,,ii
CO
O. STATE 'Ct�
OF
-TENNESSEE•
�,. NCTARY
V, % PU13LIC
SEAL
My commission expires 14±1
1 A $ ! a 01 Y'
Form SWU-101 Version 07July2009 Page 6 of 7

X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 2) 1 � Yi'CL I ��On - V P v-V NV&p�iy/1�
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 stor a les under 15 N C 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211,
c;o„a,,,ro•� �� nap 2-1 i lIii
ran
1, a Notary Public
� for the State of �.. County of
do hereby certify that 0a i V ', I son personally appeared
before me this 0 day of a 1 ,and acknowledge the duee%�tion of the application for
a stormwater permit. Witness my hand and official seal, A, / J
'= FEB
2012�
2 �'.
0�qRr
SEAL
My commission expiresr--eb AKIN U. IN
Form SWU-101 Version 07July2009 Page 7 of 7