SW4080101_CURRENT PERMIT_20120316

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW��& Zy/
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
�(231�
YYYYMMDD

Ai12=
NCDENR
North Carolina Department of Environment and Natural Reso
Beverly Eaves Perdue
Governor
Mr. W. L. Hardin, Jr.
Hardin, LLC
P.O. Box 400
Liberty, NC 27298
Subject: Ownership Change
Stormwater Permit No
Dollar General
Stokes County
Dear Mr. Hardin:
Division of Water Quality
C hades War;ild, P.E.
Director
January 13, 2012
kifiTL•11Fs1111V l
N.C.DePt. of ENR
Winston-Salem
Dee Freeman
Secretary
On March 13, 2012, the Stormwater Permitting Unit received a request for transfer of ownership of the
Stormwater Management Permit for the subject project. Staff of the Division of Water Quality have inspected
the project, determined that the documentation is in order, and the project is in compliance with the
Stormwater permit requirements. By acknowledging receipt of the permit, and by signing the
Name/Ownership Transfer form, you have accepted the responsibility for complying with the terms and
conditions outlined in this permit. If you need additional copies of the permit, or copies of the approved plans,
please contact the Division or Water Quality in the Winston-Salem Regional Office at [phone]. For your
records, please find enclosed a copy of the updated permit, a copy of the original permit issued on September 5,
2008, and a copy of the Name/Ownership Change form submitted.
Please be aware that the project's built -upon area and stormwater controls must be built and maintained in
compliance with the permit documents and the approved plans. Maintenance of the approved system shall
be performed in accordance with the signed Operation and Maintenance agreement. Any modifications to
this project must be submitted to the Division of Water Quality and approved prior to construction. The
issuance of this approval does not preclude you from complying with all other applicable statutes, rules,
regulations or ordinances, which may have jurisdiction over the proposed activity, and obtaining a permit
or approval prior to construction.
If you have any questions, or need additional information concerning this matter, please contact Robert
Patterson at [phone]; or [e-mail].
Sincerely,
for Charles Wakild, P.E.
cc: Sue Homewood _ Winston-Salem Regional Office (SW4080101 File)
T. Cooper James - Columbia Development, LLC
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1517
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: www.newalerquality.org
An Equal Opportunity 4 AHirmalive Action Employer
NorthCarohna
Naturally

State Stormwater Permit
Permit No.SW4080101
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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
Hardin, L.L.C.
Dollar General
Mountain View Road, King, Stokes County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with
the provisions of 15A NCAC 2H .1000 and S.L. 2006-246 (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 September 4, 2018, 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 1.6 on page 2 of this permit. The stormwater
control has been designed to handle the runoff from 43,560 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area indicated on page 2 of
this permit, and per approved plans.
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. This includes the attached recorded deed agreement dated
June 25, 2008, between COLUMBIA DEVELOPMENT, LLC and BBID
Properties, LLC for the part of the wet pond located on BBID's property.
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.
Page 1 of 6
11

State Stormwater Permit
Permit No.SW4080101
6. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a. Drainage Area, ayes: 2.07
Onsite, ft : 314,175
Offsite, ft2: 0
1:7
Total Impervioys Surfaces, ft2:
Buildings ft
Roads/Parking, ft2:
Other, ft2
2
Offsite, ft
Pond Depth, feet:
TSS removal efficiency:
Design Storm:
Permanent Pool Elevation, FMS�:
Permitted Surface Area @a PP ft
Permitted Storage Volume, ft
Storage Elevation, FMSL:
Controlling Orifice:
Permanent Pool Volume, W :
Forebay Volume, W:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
43,560
9,147
19,167
0
15,246 (offsite roadway)
3.0
90%
1.0 inch
476.50
4,230
3,908 at temporary pool
477.20
1.0"0 pipe
12,603
2,404
Muddy Creek 1 Yadkin Pee -Dee
12-94-(0.5)
„C„
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 times 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 revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
Page 2 of 6

State Stormwater Permit
Permit No. SW4080101
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with
the conditions of this permit, the approved plans and specifications, and other
supporting data.
6. Upon compietion 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.
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. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
9. 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.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. 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.
12. 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'tinie 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, to the Division of Water
Quality, signed by both parties, and accompanied by supporting documentation
as listed on page 2 of the form. The project must be in good standing with the
Division. The approval of this request will be considered on its merits and may or
may not be approved.
Page 3 of 6
�I

State Stormwater Permit
Permit No. SW4080101
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
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 of any name, ownership or mailing
address changes at least 30 days prior to making such changes.
Permit issued this the 151h day of March, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
i9f 40 �
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No.SW4080101
King, Dollar General
Stormwater Permit No. SW408010'1i
Stokes Countv
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)
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 _
�I

State Stormwater Permit
Permit No.SW4080101
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.
6. 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.
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.
Please submit this Designer's Certification to: Wintson-Salem Regional Office
Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Page 6 of 6

RECEIVED
N,C,Dept. or ENR
MAR 12 2012
NCDENR
Winston-Salem
North Carolina Department of Environment and Natural Resources
Re Tonal ortce
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Dee Freeman
Governor Director
Secretary
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION
1. Stormwater Management Permit Number: J LU a0301 D t _
2. Project Name: boiiw Genel' (
3. Current Permit Holder's Company Name/organization: GU(Urnh;t,_l!e,Vefo,0f►1e(Lf, LLL
4. Signing Official's Name: T CyA) r Onme-s _ _ Title: f_Wnr�se;
5. Mailing Address:
City: G-r ce- or U State: NJ L Zip: ^ ` D y b L
6. Phone: (3"36) 43 5 - 5 - - 5 Fax: ( ) �s 54 - 53 f b
IL PROPOSED PERMITTEE I OWNER / PROJECT 1 ADDRESS INFORMATION
This request is for: (please check all that apply)
❑ Name change of the owner (Please complete Items 1, 2 and 3 below)
❑ N me 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 / phone number change. (Please complete Item 4 below)
❑ Other (please explain):
1. Proposed permittee's company name/organization:yAa.fa+"\ , ILL
2. Proposed permittee's signing official's name: _ U) 14CAirl ✓� , �r
3. Proposed permittee's title: I G 661 _ e_ 0-
4. Mailing Address: U 61 �k L)b
City: L eir f-i State: C_ Zip: _ 7y
Phone: {336) 6 24- i i,5U T� Fax: ( L
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 ##1 above and provide name of HOAIPOA's authorized representative in ##2 above)
❑ The property owner
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
[age 4)
Purchaser (Attach a copy 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 N/O Change Rev15Feb2011 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. This certification must. be completed and signed by both the
current permit:holder and the new.applicant'if-this is a.change of.owhdrship.
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 designer's certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional office), if required by the permit and if not already submitted to DWQ.
5. If 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 fee.
IV, CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fill out the certification below that statement:
❑ Check here if the current permittee is only changing his/herlifs name, the project name, or mailing
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 I 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.
We'Check here if current permittee is transferring the property to a new owner and will not retain
ownership of the permit.
I, T• ' v Cc , the current permittee, am submitting this application
for a transfer of ownership for permit # S(Aj.qo t)i 01 _ _ . I hereby notify DWQ of 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 li 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 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. I assign all rights and obligations as permittee to the
proposed permittee named in Sections II and V of this form. I understand that this transfer of
ownership cannot be approved by the DWQ unless and until the facility is in compliance with the
permit.
Signature: 1 ..
I, c�t3 ►� �� II, a Notary Public for the State of
�2o5- _, County of do hereby certify that
T�Loo,"- r , CAYACS personally appeared before me this the
__'•7 day of abr , 20_J2, and acknowledge the due execution of the
forgoin instrum . Wit :Sszhan and official seal, (Notary Seal)
N r Sig
SSW N/0 Change Rev15Feb2011 Page 2 of 4

V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed
/Permaittee, for all transfers of ownership)
1,-l/• //�'� ^'y ` _ , 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 recent permit
the designer's certification for each BMP
fany recorded deed restrictions, covenants, or easements
[] the DWQ approved plans and/or approved as -built plans
g1he 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 fora 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 complete or if all required supporting information and attachments listed
above are not included, this pI' do pack e will be returned as incomplete.
Signature: Date: -I
i,-_w> C _ a Notary Public for the State of
__ ry M C, _, County of �4., _ do hereby certify that
L ACLCL& i e) _ personally appeared boforc me this the
- -- ] -41, day of --�lx u_ � t�,�,� �l
20, and acknowle cq'1ied'rfIf3 ecution of the
hi
forgoing instrument. Witness my hand and official seal, ti,° O Vasa*°�.%-9�,f'�yf
(Nofarr e4... j` o s
Nota Signature �e
"a
AUCL1G�a$
+'''•,�pM CQ13N �aa
Additional copies of the original permit and the approved Operation and Ili' f►fAmwtt 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), shouid 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/Q Change Rev15Feb2011 Page 3 of 4

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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 street address)
City: State: Zip:
Phone:
Email:
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 submitting a completed Name/Ownership Change Form within 30 days of procuring a
developer, lessee or purchaser for the property. I understand that failure to operate and maintain the
stormwater treatment facility in accordance with the permit is as violation of .NC General Statute
(NCGS) 143-215.1, and may result in appropriate enforcement action including the assessment of
civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature of the property owner
County of
day of
Date:
a Notary Public for the State of
, do hereby certify that
personally appeared before me this the
20 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signature
SSW N/O Change Rev15Feb2011 Page 4 of 4

0604
1243 APPROVED BY 6W
STOKES COUNTY ASSESSOR
'A—keN (;qr„h 03-02-2010
?\ )RT11 CARoum, —
Rap Fatytc
Ekciu To, Sty
BK:00604 M 1243
FILED
STOKES COUNTY
KATHY YOUNG
REGISTER OF DEEDS
FILED Mar 02, 2010
AT 09:02 am
BOOK 00604
START PAGE 1243
END PAGE 1246
INSTRUMENT # 00896
NORTH CAROLINA SPECIAL WARRANTY DEED
Qcise Tax: ,$ 1620.00
Parcel Identifier No. Verified by County on the _ day of _ _ 20,-,_
Mail/Boxto: William H. Flowe, Jr., P. 0, Box 1315, Liberty, NC 27298-1,115
This instrument was prepared by: Paul M. Dennis Jr. w f P W' a Ex nati
Brief description for the Index:
THIS DEED made this L day ofMA&ck_, 2010, by and between
GRANTOR. I GRANTEE
COLUMBIA DEVELOPMENT, LLC
a North Carolina limited liability company
Grantor's Address:
PO Box 10325
Greensboro, NC 27404
HARDIN, LLC
a North Carolina limited liability company
Grantee's Address:
9V It Bemraet venae P. 0. Box 400
Liberty, NC 27298
Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.g. corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt ofwhich is hereby acknowledged, has and
by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in the
Yadkin Township, Stokes County, North Carolina and more particularly described as follows:
SEE EXHIBIT A ATTACHED HERETO AND INCORPORATED HEREIN BY RERFERENCE.
The property hereinabove described was acquired by Grantor by instruments recorded in Book 576 page 1878, Book 576, Page 1880,
and Book 576, Page 1882.
(00O 462.DOC)NC Bar Association Form No. 6 O 1977, 2002
Printed by Ageemenp with the NC Bar Association - 1991

ON BK:00604 P13:1244
1244
TO HAVE AND TO HOLD 1he aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee, that Grantor has done nothing to impair such title as Grantor received, and Grantor will
warrant and defend the title against the lawful claims of all persons claiming by, under or through Grantor, other than the following
exceptions: (i) easements, restrictions and rights of way of record; (ii) ad valorem taxes for 2010 and subsequent years; and (iii)
unrecorded lease with Doigencorp,Inc.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
COLUMBIA DEVELOPMENT, LLC
By: \ 'Z:�
Title: kia ager
State of North Carolina - County of
1, the undersigned Notary Public of the County and State aforesaid, certify that
personally appeared before me this day and acknowledged the due
execution of the foregoing instrument for the purposes therein expressed. Witness my hand and Notarial stamp or seal this _day of
, 20_.
My Commission Expires:
Notary Public
State of North Carolina -County of
1, the undersigned Notary Public of the County and State aforesaid, certify that T. Cooper )amcs personally came before me
this day and acknowledged that he is the Manager ofCOLUMBIA DEVELOPMENT, LLC, a North Carolina limited liability company,
and that by authority duly given and as the act of such entity, he signed the fore ing instrument in its name on its behalfas its act and
deed. Witness my hand and Notarial stamp or seal, thisg#'K day ofyf�. u, 2010.
My Commission Expires: .4-77/41
State of North Carolina - County of Vol " r, '
4�
I, the undersigned Notary Public ofth d State afar
My Commission Expires:
ridCnd No or seal, this
C"
Public
day of 120,
Notary Public
The foregoing Certificate(s) of istare
certified to be correct. This instrument and this certificate are duly registered at the date and time and in the Book and Page shown on the
fast page hereof.
Register of Deeds for County
By: Deputy/Assistant - Register of Deeds
J00054462.dOCINC Hsr Associuion Form No. 6 D 1977, 2002
Printed by Ag emma with ftfe NC tier Aumistion - 1991

0664
1245
EXHIBIT A BK:00604 PG:1245
In Yadkin Township, Stokes County, North Carolina:
Tract 1:
BEGINNING at a point in the eastern right of way line of Mountain View Road (SR
1132) said point being North 35 degrees 53 minutes 35 seconds East 36.74 feet
from a set Iron pipe in the eastern line of J. Coy Lawson, DB 499, PG 44, Stokes
County Registry; thence from said Beginning point along the eastern right of way
of Mountain View Road on a curve to the right (R=674.08' & Arc=255.20') North 48
degrees 14 minutes 58 seconds East a chord distance of 253.11 feet to a set iron
pipe; thence leaving Mountain View Road on a new line, South 28 degrees 41
minutes 28 seconds East 242.82 feet to a set iron pipe; thence on a new line South
47 degrees 33 minutes 53 seconds West 185.10 feet to a point; thence North 44
degrees 54 minutes 16 seconds West 239.11 feet to the point and place of
Beginning, containing 1.250 Acres; and being shown as Tract 1 on a survey
prepared by Eric L. Craver, Land Surveyor for Columbia Development, LLC. dated
June 15, 2007 and revised December 5, 2007, and further revised December 11,
2007, known as Job/Dwg. No. 0747-2.
Tract 2:
BEGINNING at a set Iron pipe in the eastern right of way line of Mountain View
Road (SR 1132) said pipe being in the eastern line of J. Coy Lawson, DB 499, PG
44, Stokes County Registry; thence from said Beginning point along said right of
way of Mountain View Road (SR 1132), North 35 degrees 53 minutes 35 seconds
East 36.74 feet to a point; thence leaving said right of way of Mountain View Road
(SR 1132) and running with the line of Tract 1 as described In Deed recorded in
Book 576, Page 1878, Stokes County Registry, South 44 degrees 54 minutes 16
seconds East 239.11 feet to a point; thence on a new line South 47 degrees 33
minutes 53 seconds West 140.42 feet to a set iron pipe In the eastern line of J.
Coy Lawson, DB 499, PG 44; thence along Lawson's eastern line the following
three (3) courses and distances: 1) North 09 degrees 11 minutes 17 seconds West
121 A7 feet to an existing iron; 2) North 29 degrees 19 minutes 13 seconds West
58.00 feet to an existing Iron; and 3) North 31 degrees 20 minutes 46 seconds
West 74.78 feet to the point and place of Beginning, containing 0.403 Acres; and
being shown as Tract 2 on a survey prepared by Eric L. Craver, Land Surveyor, for
Columbia Development, LLC dated June 15, 2007 and revised December 5, 2007;
and further revised December 11, 2007, and known as JoblDwg. No. 0747-2.
Tract 3:
BEGINNING at a set Iron pipe in the eastern right of way line of Mountain View
Road (SR 1132), said iron pipe being located in the eastern line of J. Coy Lawson,
DB 499, PG 44, Stokes County Registry; thence North 31 degrees 20 minutes 46
seconds West 32.62 feet to a point in the centerline of Mountain View Road (SR
1132); thence along the centerline of Mountain View Road North 36 degrees 04
minutes 55 seconds East 24.08 feet to a point; thence on a curve to the right
(R=604.08' & Arc=268.56') North 48 degrees 15 minutes 53 seconds East a chord
distance of 266.35 feet to a point; thence leaving the centerline of Mountain View
1000}4462.DOC}NC Bw AssocVtion Form No. 6 O 1977, 2002
printed by Ayscment with the NC Au Association • 1931

0604 BK:00604 PG:1246
1246
Road, South 28 degrees 41 minutes 28 seconds East 30.01 feet to a set iron pipe
in the eastern right of way of Mountain View Road, said iron pipe being located at
the northernmost corner of "Tract 1" described in Deed in Book 576, Page 1878,
Stokes County Registry; thence along the northwest line of said "Tract 1" and
with the eastern right of way margin of Mountain View Road on a curve to the left
(R=574.08' & Arc=255.20') South 48 degrees 14 minutes 58 seconds West a chord
distance of 253.11 feet to a point, said point being located at the northernmost
corner of "Tract 2" described in Deed in Book 576, Page 1880, Stokes County
Registry; running thence with the northwest line of said "Tract 2" and with the
eastern right of way margin of Mountain View Road South 35 degrees 53 minutes
35 seconds West 36.74 feet to the place of Beginning; all in accordance with a
survey by Eric L. Craver, Land Surveyor, for Columbia Development, LLC dated
June 15, 2007; revised December 5, 2007 and further revised December 11, 2007,
and known as Job/Dwg. No. 0747-2.
TOGETHER WITH all right title and interest in and to, those certain Easements appurtenant to
the above described property which are more particularly described In Book 576, Page 1884
and in Book 598, Page 381.
(0005W2.D0C)NC Su Association Forth No. 6 a 1977, 2002
Rinsed by Agrxmem with the NC Har Association - 1931

Compliance Inspection Report
Permit: SW4080101 Effective: 09/05/08 Expiration: 09/04/18 Owner: Columbia Development LLC
Project: King Dollar General
County: Stokes Mountain View Rd
Region: Winston-Salem
King NC 27021
Contact Person: Jason Layne Title: Phone: [phone]
Directions to Project:
Highway 52 North of Winston-Salem to exit 122 (Moore -RJR Drive), Left on Moore -RJR Dr. Go approx. 4 miles and site is on right just
before NC 66.
Type of Project: State Stormwater - HD - Detention Pond
Drain Areas: 001 - (Muddy Creek) (03-07-04 ) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 01/26/2012 Entry Time: 01:00 PM
Primary Inspector: Sue L Homewood
Secondary Inspector(s):
Reason for Inspection: Follow-up
Permit Inspection Type: State Stormwater
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
E State Stormwater
(See attachment summary)
Exit Time: 01:15 PM
Phone: [phone]
Inspection Type: Compliance Evaluation
Page: 1

Permit: 5W4080101 Owner - Project: Columbia Development LLC
Inspection Date: 01/26/2012 Inspection Type: Compliance Evaluation Reason for Visit: Follow-up
Inspection Summary:
Followup visit to inspect repair/restoration of wet detention basin in accordance with approved plan. Site has been
restored as proposed, side slopes laid back, matting installed, forebay berm re -graded and stable outlet installed. Pond
still not holding water to permanent water level but determined to be sufficient per Stormwater Unit review. Site is now in
compliance provided permanent vegetation stabilizes repaired areas.
Page: 2

Permit No. S�� qyi;-CI O%
(Io be provided by DWQ}
, ova r�RO
all
NCDENR a
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form must be titled out, printed and submitted.
The Required Items Checklist (Part 1/0 must be printed, filled out and submitted atong with all of the required information.
Project name King; DallarGetteral• ;-
Contact person Jasori Layne . '
Phone number 704-663-7738'
Date 61212008
Drainage area number 1
IVII)ESIGNIINFORMATION-R, j;'-OZ
Site Characteristics
Drainage area 90;170 ft,
Impervious area 43,560 ' . ft2
% impervious 48-30915852 %
Design rainfall depth 1.0, in
Storage Volume: Non -SR Waters
Minimum volume required
3,643
ft3
Volume provided
31907
ft3
Storage Volume: SR Waters
1-yr. 24-hr runoff depth
in
Pro -development 1-yr, 24-hr runoff
ft3
Post -development 1-yr, 24-hr runoff
ft3
Minimum volume required
ft3
Volume provided
ft3
Peak Flow Calculations
Is prelpost control of the 1-yr 24-hr peak flour required?
N ,
(Y or N)
1-yr, 24-hr rainfall depth
2.8 ., .. in
Rational C, pre -development
0.6•.. _
(unities)
Rational C, post -development
.0:7.
c(unitless)
Rainfall intensity: 1-yr, 24-hr storm
0.1
.infhr
Pre -development 1-yr, 24-hr peak flow
0.1
ft3/sec
Post -development 1-yr, 24-hr peak flow
0.2
ft'/sec
Pre/Post 1-yr, 24-hr peak flow control
0.0
ft3/sec
Basin Elevations
Basin bottom elevation
468.50
ft
Sediment cleanout elevation
469.50
It
Bottom of shelf elevation
476,00"
, ft
Permanent pool elevation
476.50,
ft
Top of shelf elevation
477.001 .
, ft
Temporary pool elevation
477:20 ..
ft
Volume and Surface Area Calculations
SAVA ratio
", '-" .
3,00 :. '•,
f' (unitless)
Surface area at the bottom of shelf
•' '. 2960.0W1 : ft'
Volume at the bottom of shelf
2731.00 `-.-
;ft3
Permanent pool, surface area required
2,705 ' ..,
ft,
Permanent pool, surface area provided
4,230"
It
Permanent pool volume
12,603.,-
ft3
Average depth for SAIDA tables
2,979432624
ft
Surface area at the top of shelf
:5700 ft2
Volume at the top of shelf
2473 :
ft3
OK
Minimum of 3 ft required, Increase depth
Form SW40t-VJet Detention Basin-Rev.3
Parts J. & II. Design Summary, Page 1 of 2

tr R
Permit No. s �✓L� ��
(to be provided by DWQ)
lttDESIGf3iINF,ORMAT10Ng.'br� i>�,"�s, v
Forebay volume
2,384.
ft'
Forebay % of permanent pool volume
19
%
OK
Temporary pool, surface area provided
7,3W
ft2
Drawdown Calculations
Treatment volume drawdown time
3.56
days
OK
Treatment volume discharge rate
0.01'
ft31s
Pre-development'l-yr, 24-hr discharge
, 4.80, ' :
" n"Is
OK
Post -development 1-yr, 24-hrdischarge
2.07
fills
OK
Additional Information
Diameter of orifice
1.00
in
Design TSS removal
90
%
Basin side slopes
3
:1
OK
Vegetated shelf slope
10.
:1
OK
Vegetated shelf width
10
ft
OK
Length of flowpath to width ratio
5
:1
OK
Length to width ratio
2 ' ; " •.
:1
OK
Trash rack for overflow & orifice?
'" Y
(Y or N)
OK
Freeboard provided
:1185' ;"
ft
OK
Vegetated filter provided?
'' N `..
(Y or N)
Design must be based on 90% TSS removal
Recorded drainage easement provided?
Y"', 0%
-(Y or N)
OK
Capures all runoff at ultimate build -out?
:.Y. ..
(Y or N)
OK
Drain mechanism for maintenance or emergencies
Y
Form SW4o1-Wet Detention Basin-Rev.3 Parts I. & II. Design Summary, Page 2 of 2

Permit No, S G 1
(to be provided by DWQ)
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.
Page/ Plan
Initials Sheet No.
JEL SP-2
1. 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),
- Basin dimensions,
- Pretreatment system,
- High flow bypass system,
- Maintenance access,
- Recorded drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
JEL SP-2
2. Partial plan (1" = 30' or larger) and details for the wet detention basin showing:
Outlet structure with trash rack or similar,
Maintenance access,
- Permanent pool dimensions,
Forebay and main pond with hardened emergency spillway,
Basin cross-section,—. - - - - - -
Vegetation specification for planting shelf, and
Filter strip.
JEL SP-3
3, Section view of the dry detention basin (1" = 20' or larger) showing:
- Side slopes, 3:1 or lower,
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
NA NA
4. If the basin is used for sediment and erosion control during construction, clean out of the basin is specified
on the plans prior to use as a wet detention basin.
JEL SP-3
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for forebay,
to verify, volume provided.
NA NA
6. An assurance that the installed system will meet design specifications upon initial operation once the
project is complete and the entire drainage area is stabilized.
NA NA
7. A construction sequence that shows how the wet detention basin will be protected from sediment until the
entire drainage area is stabilized.
JEL Attached
8. The supporting calculations.
JEL Attached
9. A copy of the signed and notarized inspection and maintenance (I&M) agreement.
10. A copy of the deed restriction.
Form 5W401-Wet Detention Basin-Rev.1
Part III. Required Items Checklist. Page 1 of 1

DWQ USE ONLY
Date Received Fee Paid Permit Number
Stv4 coo) 0
State of North Carolina
Department of Environment and Natural Resources -
Division of Water Quality E
STORMWATER MANAGEMENT PERMIT APPLICATION F R JUL j 8 2008
This form may be photocopied for use as nit original
DENR - WATE14 QUALI
Wee ands & Stormwater Branch
I. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
COLUMBIA LLC Z. C 1.4M6S� IYIArJ!'rC�-C�
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
-T.C. 3!}MES MAA+RtAJ_'-R c-aL.Unki3%R- LLC
3. Mailing Address for person listed in item 2 above:
00 %0 x
City: G Beni ►-� $00-0
Phone: ( 331 ) 1351S 55SS
Email: 1r_,\­+550CCC* tips, CD vCO-,Cv to►%A
State: r-'C Zip: 7-_)4.0LA
Fax: 33 $5L(- S'31.G
4. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
King Dollar General Store
5. Location of Project (street address):
Mountain View Road
City: King County: Stokes
6. Directions to project (from nearest major intersection):
Hwy 52 North of Winston Salem to exit 122(Moore-RJR Dr.) Left on Moore -RJR Dr. Drive
approximately 4 miles and site is on night jest before NC 66.
7. Latitude: 36.30153 k Longitude:-80.32951.
8. Contact person who can answer questions about the project:
Name: Jason Layne . Telephone Number: (?04
Email: infoodardeneng. com .
II. PERMIT INFORMATION:
1. Specify whether project is (check one): QNew ❑Renewal
Form SWU-101 Version 8.07
Paget of 4
of project
663-'7738
❑Modification

0
2. If this application is being submitted is the result of a renewal or modification to an existing permit, list the
existing permit number N • A • and its issue date (if known)
3. Specify the type of project (check one):
❑Low Density OHigh Density []Redevelop ❑General Permit ❑Universal SMP ❑Other
4. Additional Project Requirements (check applicable blanks):
❑CAMA Major x❑Sedimentation/Erosion Control 0404/401 Permit ❑NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748.
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project.
Stormwater will sheet flow from Mt. View Rd. Some Runnoff will go into catch basins and other
will sheet flow into the wetpond. Pipes from basins will take collected stormwater to the
new 90% efficient wet pond. wet pond will drain to an existing swale.
2. Stormwater runoff from this project drains to the Yadkin River basin.
3. Total Site Area: 1.65 acres 4. Total Wetlands Area: 0 acres
5. 100' Wide Strip of Wetland Area: N. A. acres (not applicable if 110 wetlands exist on site)
6. Total Project Area**: 1 q, JVQ acres 7. Project Built Upon Area: 40 "Y�t
8. How many drainage areas does the project have? 1
9. Complete the following information for each drainage area. If there are more than two 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 2
Receiving Stream Name
Muddy creek
Stream Class & Index No.
class c
Drainage Area (so
9o, 169.6
Existing Impervious* Area (sf)
15,246.0 -14
Proposed Impervious*Area (so
28,314.1
% Impervious* Area (total)
50$
Impervious*. Surface Area
Drainage Area 1
Drainage Area 2
On -site Buildings (so
9,147
On -site Streets (so
N . A.
On -site Parking (so
19,167
On -site Sidewalks (so
N.A.
Other on -site (so
N.A.
Off -site (so
15,246.1
Total (so:
43,560.1
" Impervious area is defined as llle built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SW U-101 Version 8.07 Page 2 of 4

**TotaI project area shall be calculated based on the current policy regarding inclusion of wetlands in the built upon area
percentage calculation.
10. I -low was the off -site impervious area Listed above derived? A survey was taken then the project
was drawn using Auto CAD.
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
One of the following deed restrictions and protective covenants are required to be recorded for all subdivisions,
outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table listing each
lot number, size and the allowable built -upon area for each lot must be provided as an attachment.
Form DRPC-1
High Density Commercial Subdivisions
Form DRPC-2
High Density Developments with Outparcels
Form DRPC-3
High Density Residential Subdivisions
Form DRPC-4.
Low Density Commercial Subdivisions
Form DRPC-5
Low Density Residential Subdivisions
Form DRPC-6
Low Density Residential Subdivisions with Curb Outlets
By your signature below, you certify that the recorded deed restrictions and protective covenants for this
project shall include all the applicable items required in the above form, 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 State, and that they will be recorded prior to the
sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for
each BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the
status and availability of these forms.
Form SW401-I,ow Density
Form SW401-Curb Outlet System
Form SW401-Off-Site System
Form SW401-Wet Detention Basin
Form SW401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-Isevel Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Low Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
Form SWU-101 Version 8.07 Page 3 of 4

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. The complete application package should be
submitted to the appropriate DWQ Office. (Appropriate office may be found by Iocating project on the
interactive online map at http://112o.cnr.sta(e.ne.us/su/rnsi maps.litrn)
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• Original and one copy of the Stormwater Management Permit Application Form _dv
• Original and one copy of the Deed Restrictions & Protective Covenants Form
• Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP
• Permit application processing fee of $505 ($4,000 for Express) payable to NCDENR
• Calculations & detailed narrative description of stormwater treatment/management
• Copy of any applicable soil report _ .—
• Three copies of plans and specifications (sealed, signed & dated), including: C
- Development/Project name
- Engineer and firm
-Legend
- North arrow
- Scale
- Revision number & date
- Mean high water line
- Dimensioned property/project boundary
- Location map with named streets or NCSR numbers
- Original contours, proposed contours, spot elevations, finished floor elevations
- Details of roads, drainage features, collection systems, and stormwater control measures
- Wetlands delineated, or a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
- Drainage areas delineated
- Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section.
Designated agent (individual or firm):
Mailing Address:
City:
Phone: ---
Email:
VIII. APPLICANT'S CERTIFICATION
State: Zip:
Fax: ( i
I, (print or type name of person listed in General Information, item 2) T c. sA/Yk S
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 15A
NCAC 21-1.1000.
Signa
Form SWU-101 Version 8.07 Page 4 of
Date: (0" aS -0 S

North Carolina Secretary of State .
http:/lwww.secretary.state.nc.us/corporations/Corp.aspx?Pitemld=85...
Elaine F. Marshall
Secretary
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Date: 7/21/2008
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Corporation Names
Name Name Type
- NC—BBID
Properties, LLC
Limited Liability Company Information
SOSID: 0999622
Status: Current -Active
Date Formed: 9/6/2007
Citizenship: Domestic
State of Inc.:
NC
Duration:
Perpetual
Registered Agent
Agent Name:
Browder, J Tyrone
Registered
153 A Jefferson Church
Office Address:
Road
King NC 27021
Registered
P.O. Box 550
Mailing
King NC 27021
Address:
Principal Office
153 a Jefferson Church
Address:
Road r
King NC 27021
Principal
P.O. Box 550
Mailing
King INC 27021
Address:
of 1 7/21/2008 1:06 PM

�f.PAR 7IV��T 1-606-7986969
6�
LIMITED LIABILITY COMPANY
4 ANNUAL REPORT
9`
NAME OF LIMITED LIABILITY COMPANY: COLUMBIA DEVELOPMENT, LLC
STATE OF INCORPORATION: NC
SECRETARY OF STATE L.L.C. ID NUMBER: 0849745
NATURE OF BUSINESS: Commercial Real Estate Development
REGISTERED AGENT: Dennis, Paul Jr.
REGISTERED OFFICE MAILING ADDRESS: 100 N. Greene Street, Suite 600
Greensboro, NC 27401
REGISTERED OFFICE STREET ADDRESS: 305 Pisgah Church Rd Ste. 2c
Greensboro, NC 27455 Guilford County
SIGNATURE OF THE NEW REGISTERED AGENT:
PRINCIPAL OFFICE TELEPHONE NUMBER: [phone]
PRINCIPAL OFFICE MAILING ADDRESS:
PRINCIPAL OFFICE STREET ADDRESS:
MANAGERS/MEMBERS/ORGANIZERS:
Name: T. Cooper James
Title: managing member
Address:
P.O. Box 10325
Greensboro, NC 27404
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
P.O. Box 10325
Greensboro, ArC 27404
600 Green Valley Road, Suite 202
Greensboro, NC 27408
CERTIFICATION OF ANNUAL REPORT MUST BE COMPLETED BY ALL LIMITED LIABILITY COMPANIES
FORM MUST BE SIGNED BY A MANAGER/MEMBER
DATE
TYPE OR PRINT NAME TYPE OR PRINT TITLE
ANNUAL REPORT FEE: $200 MAIL TO: Secretary of State • Corporations Division • Post Office Box 29525 • Raleigh, NC 27626-0525

/9-�_
p�pF W A TF/? Michael F. Easley, Governor
William G. Ross Jr„ Secretary
North Carolina Department of Environment mid Natural Resources
0 Y Coleen H. Sullins, Director
Division of Water Quality
August 13, 2008
CERTIFIED MAIL #7003 2260 0005 5381 1214
RETURN RECEIPT REOUESTED
T.C. James - Manager
Colombia Development, LLC
P.O. Box 10325
Greensboro, NC 27404
Dear Sirs:
CERTIFIED MAIL. #7003 2260 0005 5381 1207
RETURN RECEIPT REOUESTED
Allen M. Brawley
Brawley Construction Company
P.O. Box 1067
Mooresville. NC 28115
Subject: NOTICE OF VIOLATION
NOV-2008-CV-0013
Incident No. 200802076
King, Dollar General
Failure to Obtain State Stormwater Permit
Stokes County
FRECEIVED
N.C. lot
. of ENR
AUG 5 MOB
Winston-$alem
Regional p+.fice
On November 21, 2007, NC Division of Land Resources issued an approval for an erosion and
sedimentation control plan for 1.8 acres of land disturbance for the construction of a Dollar General in
King, Stokes County, NC. According to North Carolina General Statute 143-214.7 and Session -Law
2006-246, Senate Bill 1566, the subject site is required to obtain a State Stormwater Management permit
for post -construction stormwater. This permit is to be secured prior to installation or construction of
impervious surfaces on the site.
On January 31, 2008, the Division of Water Quality (DWQ) Stormwater Permitting Unit received an
application for a permit for the Dollar General site. Subsequent requests from DWQ for additional
information were sent on February 1, 2008, April 14, 2008 and July 21, 2008. To date, all of the
requested information has not been received. The DWQ Winston-Salem Regional Office conducted a site
visit of the Dollar General in King and observed that the building and parking lot had been constructed.
DWQ file review revealed that a State Stormwater Management permit for Post -Construction stormwater
has not been issued for the site.
As a result of the site inspection and a file review, the following violations are noted: Failure to Obtain
State Stormwater Permit according to Session -Law 2006-246, Senate Bill 1566.
Required Response
Accordingly, you are directed to respond to this letter in writing within 30 calendar days of receipt of
this Notice. Your response should include the following:
1. Explain when the construction started and why proper permits were not obtained.
2. Develop and submit the required information to the DWQ Stormwater Permitting Unit in order
for the permit to be issued and a plan to achieve compliance for DWQ approval.
a. This plan must include a timetable for compliance including dates.
3. It is imperative that you respond to the DWQ Stormwater Permitting Unit with the required
information in order for the permit to be issued.
On NhCarolin
�Nakra!!ll
Wellands and Stormwater Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone]
Internet: h2o.enr.state.nc.us 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equa! OpportunitylAffirmative Action Employer — 50% Recycledlt 0% Post Consumer Paper

Page 2 of 2
Dollar General, King NC
Stokes County
a. Send the required information to: Robert Patterson, DWQ Stormwater Permitting Unit,
1617 Mail Service Center, Raleigh, NC 27604, phone [phone].
4. Once the permit is issued, you must construct and install the approved stormwater control
measures within 120 days of approval.
Thank you for your attention to this matter. This office requires that the violations, as detailed above,
be properly resolved. These violations and any future violations are subject to a civil penalty
assessment of up to $25,000.00 per day for each violation. Should you have any questions regarding
these matters, please contact Robert Patterson at [phone] or myself at [phone],
cc:
Sincerely,
�44&01
Bradley Bennett
Stormwater Permitting Unit
Steve Tedder - WSRO SWQ - Surface.Water Supervisor
John Hennessy — DWQ NPS-ACO Unit Supervisor
Robert Patterson - SW Permitting Unit - File Copy
Mike Randall —SW Permitting Unit
DWQ Central Files
Division of Land Resources - WSRO

O�O� Vd A T k:RpG
1 A
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
August 13, 2008
CERTIFIED MAIL N7003 2260 0005 5381 1214
RETURN RECEIPT REQUESTED
T.C. James - Manager
Colombia Development, LLC
P.O. Box 10325
Greensboro, NC 27404
Dear Sirs:
Coleen H. Sullins, Director
Division of Water Quality
CERTIFIED MAIL 97003 2260 0005 5381 1207
RETURN RECEIPT REQUESTED
Allen M. BrawIey
BrawIey Construction Company
P.O. Box 1067
Mooresville, NC 28115
Subject: NOTICE OF VIOLATION
NOV-2008-CV-0013
Incident No. 200802076
King, Dollar General
Failure to Obtain State Stormwater Permit
Stokes County
On November 21, 2007, NC Division of Land Resources issued an approval for an erosion and
sedimentation control plan for 1.8 acres of land disturbance for the construction of a Dollar General in
King, Stokes County, NC. According to North Carolina General Statute I43-214.7 and Session -Law
2006-246, Senate Bill 1566, the subject site is required to obtain a State Stormwater Management permit
for post -construction stormwater. This permit is to be secured prior to installation or construction of
impervious surfaces on the site.
On January 31, 2008, the Division of Water Quality (DWQ) Stormwater Permitting Unit received an
application fora permit for the Dollar General site. Subsequent requests from DWQ for additional
information were sent on February 1, 2008, April 14, 2008 and July 21, 2008. To date, all of the
requested information has, not been received. The DWQ Winston-Salem Regional Office conducted a site
visit of the Dollar General in King and observed that the building and parking lot had been constructed.
DWQ file review revealed that a State Stormwater Management permit for Post -Construction stormwater
has not been issued.for the site.
As a result of the site inspection and a file review, the following violations are noted: Failure to Obtain
State Stormwater Permit according to Session -Law 2006-246, Senate Bill 1566.
Required Response
Accordingly, you are.directed to respond to this letter in writing within 30 calendar days of receipt of
this Notice. Your response should include the following:
1. Explain when the construction started and why proper permits were not obtained.
2. Develop and submit the required information to the DWQ_Stormwater Permitting Unit in order
for the permit to be issued and a plan to. achieve compliance for DWQ approval.
a. This'plan must include a timetable for compliance including dates.
3. It is imperative that you respond to the DWQ Stormwater Permitting Unit with the required
informationin order for the permit to be issued.
o t NhCarolin
Wetlands and Stormwater Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone]
Internet h2o.enrstate.nc.us 512 N. Salisbury St, Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recyded110% Post Consumer Paper

Page 2 of 2
Dollar General, King NC
Stokes County
a. Send the required information to: Robert Patterson, DWQ Stormwater Permitting Unit,
16I7 Mail Service Center, Raleigh, NC 27604, phone [phone].
4. Once the permit is issued, you must construct'and install the approved stormwater control
measures within 120 days of approval.
Thank you for your attention to this matter. This office requires that the violations, as detailed above,
be properly resolved. These violations and any future violations are subject to a civil penalty
assessment of up to $25,000.00 per day for each violation. _Should you have any questions regarding
these matters, please contact Robert Patterson at [phone] or myself at [phone].
Sincerely, '
Bradley Bennett .
Stormwater-Permitting Unit
cc:
Steve Tedder - WSRO SWQ - Surface Water Supervisor:
John Hennessy — DWQ NPS-ACO Unit,Supervtsor -
Robert Patterson - SW Permitting.Unii -File-COPY
Mike Randall —SW Permitting Unit
DWQ Central Files
Division of Land Resources - WSRO

Compliance Inspection Report
Permit: SW4080101 Effective: 09/05/08 Expiration: 09/04/18 Owner: Columbia Development LLC
Project: King Dollar General
County: Stokes Mountain View Rd
Region: Winston-Salem
King NC 27021
Contact Person: Jason Layne Title: Phone: [phone]
Directions to Project:
Highway 52 North of Winston-Salem to exit 122 (Moore -RJR Drive). Left on Moore -RJR Dr. Go approx. 4 miles and site is on right just
before NC 66.
Type of Project: State Stormwater - HD - Detention Pond
Drain Areas: 001 - (Muddy Creek) (03-07-04) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 08124/2011 Entry Time: 03:00 PM
Primary Inspector: Sue L Homewood
Secondary Inspector(s):
Reason for inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: ❑ Compliant ■ Not Compliant
Question Areas:
® State Stormwater
(See attachment summary)
Exit Time: 03:30 PM
Phone: [phone]
Inspection Type: Compliance Evaluation
Page: 1

Permit: SW4080101 Owner - Project: Columbia Development LLC
Inspection Date: 08/24/2011 Inspection Type: Compliance Evaluation
Reason for Visit: Routine
Inspection Summary:
File Review
Yes No
NA
NE
Is the permit active?
■ n
n
n
Signed copy of the Engineer's certification is in the file?
■ n
n
n
Signed copy of the Operation & Maintenance Agreement is in the fife?
M n
n
n
Copy of the recorded deed restrictions is in the file?
■ n
n
n
Comment:
Built Upon Area
Yes
No
NA
NE
Is the site BUA constructed as per the permit and approval plans?
■
n
n
n
Is the drainage area as per the permit and approved plans?
®
n
n
n
Is the BUA (as permitted) graded such that the runoff drains to the system?
■
n
n
n
Comment:
SW Measures
Yes
No
NA
NE
Are the SW measures constructed as per the approved plans?
RODO
Are the inlets located per the approved plans?
e
n
n
n
Are the outlet structures located per the approved plans?
■
n
n
n
Comment:
Operation and Maintenance
Yes
No
NA
NE
Are the SW measures being maintained and operated as per the permit requirements?
n
■
o
o
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ
n
n
n
■
upon request?
Comment: vegetation is not properly maintained. Water level in pond insufficient.
Other Permit Conditions
Yes
No
NA
NE
Is the site compliant with other conditions of the permit?
■
n
n
n
Comment:
Other WQ Issues Yes No NA NE
Is the site compliant with other water quality issues as noted during the inspection? ■ n n n
Comment:
Page: 2

State Stormwater Permit
Permit No.SW4080101
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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
T. Cooper James 1 COLUMBIA DEVELOPMENT, LLC
Dollar General
Mountain View Road, King, Stokes County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with
the provisions of 15A NCAC 2H .1000 and S.L. 2006-246 (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 September 4, 2018, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
I . This permit is effective only with respect to the nature and volume of stormwater
described in the applicationand other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in. Section 1.6 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from 43,560 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area indicated on page 3 of
this permit, and per approved plans.
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. This includes the attached recorded deed agreement dated
,tune 25, 2008, between COLUMBIA DEVELOPMENT, LLC and BBID
Properties, LLC for the part of the wet pond located on BBID's property.
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.
Page 1 of 6

State Stormwater Permit
Permit No.5W4080101
6. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a. Drainage Area, antes: 2.07
Onsite, ft': 314,176
Offsite, ftz: 0
0
C.
d.
e.
f.
h.
i.
J•
k.
1.
n.
o.
Total Impervioys Surfaces, ft2:
Buildings ft :
RoadslParking, ftZ:
Other, ft .
Offsite, ft�:
Pond, Dept h,.feet:
TSS removal efficiency:
Design Storm:
Permanent Pool Elevation;. FMS�:
Permitted- Surface Area @PP ft
Permitted Storage Volume, ft�:
Storage Elevation, l=MSL:
Controlling Orifice:
Permanent Pool Volume, ft3.:
Forebay Volume, ft3: ,
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
11. SCHEDULE OF COMPLIANCE
43,560
9,147
19,167
0
15,246 (offsite roadway)
3.0
90%
1.0 inch
476.50
4,230
3,908 at temporary pool
477.20
1.0"0 pipe
12,603
2,404
Muddy Creek 1 Yadkin Pee -Dee
12-94-(0.5) .
11c"
The stdrmwater 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 times. 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 inspeciions (every 6 months).
b. Sediment removal.-
C. Mowing and revegetation of slopes and the vegetated filter,
d. immediate repair of eroded areas.
e. Maintenance of all slopes In accordance with approved .plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of ❑WQ.- The records will indicate the date,
activity, .name of person performing the work and what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in -accordance with
Page 2 of 6

State Stormwater Permit
Permit No.5W4080101
the conditions of this permit, the approved plans and specifications, and other
supporting data.
6. 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.
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. Access to the stormwater facilities shall be maintained via appropriate
easements at all -times.
9, The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
madification.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.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. 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.
12. The Director may notify the permittee when the permitted site does not meet one
or moreof 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.
Ill. 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, to the Division of Water
Quality, signed by both parties, and accompanied by supporting documentation
as listed on page 2 of the form. The project must be in good standing with the
Division. 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.SW4080101
time as the Division approves the transfer request.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permiltee to enforcement action by the Division -of Water Quality, in
accordance with Noah 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 Pprmittee 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 DEN 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 to Session Law 2006-
246, Title 15A NCAC 21-1.1000, and NCGS 143-215.1 et.al.
11.The permittee shall notify the Division of -any name; ownership or mailing .
address changes at least 30 days prior to making such changes.
Permit issued this the 51h day of September 2006.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
or 061eleh H. SdIlins, Director
Division of Water -Quality
By Authority of the Environmental Management Commission
Page'4 of 6

IVGi)
MAR 0 G 2.11E€9
i
King, Dollar General
Stormwater Permit No. SW4080101
Stokes County
Designer's Certification
State Stormwater Permit /
Permit No.SW4080101
1, 6 V1+\ MY ev` ^, as a duly registered etl (At N+-tom F—
in the State of North Carolina, raving been authorized to observe (periodically/ weekly/
full time) the construction of the project,
P0116'r (-c e.►n�y 1 �Cs"v� �; -- `�fvl�e s C� �.,�-t
(Project).
for idp v1evttLL- (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:
SEAL
SignatureU.
11,,,,.
Registration Number Z S
;:'•v .; t! J -.
Date 5 - q c) r�
'^1!lII III1,I51Vi
Page-5 of 6

State Stormwater Permit
Permit No.SW4080101
Certification Requirements:
��. The drainage'area to the system contains approximately the permitted
acreage.
tf2. 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.
r/6. The outlet structure is located per the approved plans.
r/4. Trash rack is provided on the outlet/bypass structure.
Alt;. All slopes are grassed with permanent vegetation.
Vegetated slopes are no.steeper than 3:1.
r/ 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.
x/12. Required drawdown devices are correctly sized per -the approved.plans.
13. All required design depths are provided.
ti%14. All required parts -of the system are provided, such as a vegetated shelf,
and a forebay:
�5. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Wintson-Salem Regional Office
Surface Water Protection
585 Waugghtown Street
Winston-Salem, NC 27107
Cc: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Page 6of6