SW4091202_CURRENT PERMIT_20100406

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW 6�?pQ/
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYMMDD

AJ":A
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Frank Edmondson
Franson, LLC
PO Box 1028
Asheboro, NC 27204
Division of Water Quality
Coleen H. Sullins
Director
March 3, 2010
Subject: Stormwater Permit No. SW4091202
Asheboro Bank I Sheetz
High Density Commercial Sand Filter Project
Randolph County
Dear Mr. Edmondson:
Dee Freeman
Secretary
N,C. DGDt. of ENR
APR 062010
Winston-Salem
Regional Office
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for
Asheboro Bank 1 Sheetz on March 1, 2010. Staff review of the plans and specifications ha'� 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. SW3090203, dated ",•rch 3, 2010,
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 March 2, 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 150E 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 Winston Salem 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: Mr. Jonathan Allen, 801 Corporate Center Drive, Raleigh, INC 27607
Winston Salem Regional Office
Central Files
SPU Files
Weliands and Slormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NorthCat-olina
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1.877-623-6748 ;Vntimally
w Internet: ww.ncwaterquaiily.org :/
An Equal Opponunlfy 1 Affirmative Action Employer

State Stormwater Permit
Permit No. SW4091202
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
STATE
DIVISION OF WATER QUALITY �c+vEo
N Oast. of FNR
STORMWATER MANAGEMENT PERMIT APR O 6 2010
Winston-Salem
Regional Office
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
Franson, LLC
Asheboro Bank / Sheetz
Corner of E. Dixie Dr. (US HWY 64) and Dublin Rd., Asheboro, Randolph County
FOR THE
construction, operation and maintenance of one sand filter 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 March 2, 2020, and shall
be subject to the following specified conditions and limitations:
1. 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 104,801 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.
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. SW4091202
7
The following design criteria have been provided in the sand filter and must be
maintained at design condition:
a.
I
Drainage Area, acres:
Onsite, ft :
Offsite, ft2:
Total impervious Surfaces, ft2:
Onsite, ft :
Offsite, ft2:
Design Storm, inches:
Maximum Head, feet:
Bottom Elevation, fmsl:
Sand Media Depth, feet.
Sed. Chamber Width, feet: 2
Filter Chamber Surface Area, N :
Sed. Chamber Surface Area, ft
Permitted Treatment Volume, ft:
Bypass 1 Storage Elevation, fmsl`
Predevelopment 1 year 24 hour:
Post development 1 year 24 hour:
Drawdown Time, hours:
Underdrain Diameter, inches:
Separation from SHWT, feet:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
4.52
133,581
0
104,801
104,801
0
1.0
3
800.08 (bottom of sand layer)
1.17 (above underdrains)
5
735
1,504
6,717
804.75 (inv of 6" orifice)
5.14 cfs
4.18 cfs
40.0
4.0 (within 9" layer of stone)
1
E.Fork Deep River 1 Cape Fear
11-138
°WS-IV'1
1. The stormwater management system shall be constructed in its entirety and
operational for its intended use immediately after the site is stable.
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, underdrains, catch basins and piping.
g. Access to the sand filter 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.
Page 2 of 6

State Stormwater Permit
Permit No. SW4091202
6. The facilities shall be constructed as shown on the approved plans. This permit
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. 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 time schedule to the
l Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
',that the changes have been made.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to. and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form signed 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. SW4091202
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 P day of March 2010.
NORTH CAROLINA-ENVIRONMENTAL MANAGEMENT COMMISSION
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No. SW4091202
Asheboro Bank 1 Sheetz
Stormwater Permit No. SW4091202
Randolph 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. SW4091202
Certification Requirements:
1. The drainage area to the systern 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. All slopes are grassed with permanent vegetation, per the vegetation plan.
_8. Vegetated slopes are no steeper than 3:1.
_9. The overall sand filter is constructed per the approved plans.
10. The permitted amounts of surface area and/or volume have been
provided.
_11. Required drawdown devices are correctly sized per the approved plans.
12. All required design depths are provided.
13. All required parts of the system are provided, such as a sediment
chamber and sand filter chamber.
14. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Mooresville Regional Office
610 East Center Ave., Ste. 301
Mooresville, NC 28115
NCDENR-DWQ Central Files
1617 Mail Service Center
`. Raleigh, NC 27699-1617
I
Page 6 of 6

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph I1 - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may lie 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.):
ASHEBORO BANK SHEETZ
2. Location of Project (street address):
CORNER OF E.DIXIE DR. US HWY 64 + DUBLIN RD.
City:ASHEBORO County:RANDOLPH Zip:27203
3. Directions to project (from nearest major intersection):
FROM INTERSECTION OF SALISBURY ST. AND S. FAYETTEVILLE ST., HEAD SOUTH ON S.
FAYETEVILLE ST.,
TAKE LEFT ONTO E.DIXIE DR. (US HWY 64), PROJECT SITE WILL BE ON LEF`1' TUST BEFORE DUBLIN
RD. INTERSEcriON.
4. Latitude:35° 41' 38" N Longitude:790 47' 48" 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 number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an 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, N/A and the previous name of the project, if different than currently
proposed, N/A
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: 4.52 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:N A
Form SWU-101 Version 07July20o9 Page 1 of 6

Ill. 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: FRANSON, LLC
Signing Official & Title: FRANK EDMONDSON, MEMBER MANAGER
b.Contact information for person listed in item I above:
Street Address:2423 TOT HILL FARM RD.
City:ASHEBORO State:NC Zip:27205
Mailing Address (if applicable): P.O. BOX 1028
City:ASHEBORO State:NC Zip:27204
Phone: (336 ) 625-6076 Fax: (336 ) 672-1051
Email:FEDMONDSON®SCHWAR7,PROPI?1ZTIES.NE'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: SAME AS PART 1.
Signing Official & Title:
b. Contact information for person Iisted in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
City:
Phone. ( }
Email:
State: Zip.
State:
Fax:
zip:
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:
Phone: {
Email:
4. Local jurisdiction for building permits: CITY OF ASH
State: Zip:
Fax: ( )
Point of Contact:LARRY TROTTER Phone #: [phone] EXT, 231
Form SWU-101 Version 07.1uly2009 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Majority of runoff from site will be treated by an underground sediment chamber and sand filter designed in
series. The remaining runoff is from almost entirely pervious surfaces and will be treated in drainage swales
before leaving the site.
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 II - Post Construction
3. Stormwater runoff from this project drains to the CAPE FEAR River basin.
4. Total Property Area: 4.52 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) W Total Project
Area':4.52 acres
Total project area shall be calculated to exclude the follotoin the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal Hi h Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHiline. The resultant project area is used to
calculate overall percept built upon area (BUA). Nat -coastal -wetlands landward of the NHW (or MHW) lure may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 65.0 %
9. How many drainage areas does the project have?1 (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.
Basin Information
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
Receiving Stream Name
E.Fork Deep
River
E.Fork Deep
River
Stream Class
WS-IV
WS-1V
Strearn Index Number *
17-2-(0.3)
17-2-(0.3)
Total Drainage Area (so
133,581
196,891
On -site Drainage Area (so
1.33,581
196,891
Off -site Drainage Area (so
0
0
Proposed Impervious Area** (so
104,801
128,048
% Impervious Area** total
78.5%
65.0%
Im ervious" Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
8,474
8,474
On -site Streets (so
0
17,870
On -site Parking (so
92,467
92,467
On -site Sidewalks (so
3,860
9,237
Other on -site (so
0
0
Future (so
0
0
Off -site (50
0
0
Existing BUA*** (so
0
0
Total (so:
104,801
128,048
Stream Class and Index Number can be delermined at: littp://lz2o.etrr.state.nc.uslbinrs/re orts/reportsyvB.littnl
In pervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sideivalks, gravel areas, etc,
Form SWU-101 Version 07July2009 Page 3 of 6

'Report only that amount of existing BUA that zoill retain after development. Oo riot 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. N/A
Projects in Union County: Contact D;,YQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent storrwater 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
from httt)://h2o.enr,state.nc.us/su/ban forms.htm.
VI. SUBMITTAL REQUIREMENTS
Only complete a pplication- 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 http://h2o.enr.state.ilc.us/suZbmp_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 athttp://h2o.enr.state.nc.us/su/msi—iiiaps.lit .)
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 bttp:/ /h2o.enr.state.nc.us/su/bmp forms.htm.
3.
4,
5.
6.
7.
Original and one copy of the Stormwater Management Permit Application Form.
Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part V1I belozo)
Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
Permit application processing fee of $505 payable to NCOENR. (For an Express review, refer to
http://www.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.)
A detailed narrative (one to two pages) describing the stormwater treatment/management
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 1/2
mile radius on the map.
Sealed, signed and dated calculations.
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).
Initials
DTP
for
7::y
-3' T
DTP
Form SWU-101 Version 07July2009 Page 4 ofh

9. Copy of any applicable soils report with the associated SHWA' elevations (Please identify N�
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"x11" 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 SHINT prior
to subinittal, [phone].)
10. A copy of the most current property deed. Deed book: 474 Page No: 365 TTP
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC TTP
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.
http://www.secretary.state.iic.uslCorporations/CSearch.asl2
V1I. 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
iZttl2://h2o.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.
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 Iand, 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.
VIII. 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: IONATHAN ALLEN
Consulting Firm: ARCADIS _
Mailing Address:801 CORPORATE CENTER DRIVE
City:RALEIGH State:NC Zip:27607
Phone: (919 ) 854-1282 Fax: (919 ) 854-5448 _
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Cori tact Infornation, (tern 2 has been filled out, complete this
section)
I, (print or type narne of person listed in Contact Information, item 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Infornation, ltent 1 a) with (print or type name of organization listed in
Contact information, item 1b) 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.
Form SWU-101 Version 071uly2009 Page 5 of 6

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 1 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 143-215.6.
Signature:
a Notary Public for the State of
do hereby certify that
Date:
County of
personally appeared
before me this — day of , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listen in Contact Information, item 2) Irc_gnle i �,,n or,�5a,.1 IV
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under) 5A NCAC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Signature:,, ,] 1 -�_ y� 11J Date: 11- 3 0 - Z_003
I, Q iN tilrS a Notary Public ifor the State of County of
do hereby certify that-' CSOK personally appeared
before me this day of and acknowleAge the due e� ecgtion of the application for
a stormwater permit. Witness my hand and official
�OTA�
'�. A (/ $ L
P.'
p T
SEA 4' � A
p'• p .' U
yyo V B L.
O�p� COU���
My cor l ,z?lib
Form SWU-101 Version 07July2009 Page 6 of 6

Perrnit Number:
(to Ire provided by DWO
Drainage Area Number:
Sand Filter Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a log in a
known set location. Any deficient BMP elements noted in the inspection will be corrected, repaired or
replaced immediately. These deficiencies can affect the integrity of structures, safety of the public, and
the removal efficiency of the BMP.
Important maintenance procedures:
-- The drainage area will be carefully managed to reduce the sediment load to the sand filter.
-- The. sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds
six inches.
- Once a year, sand media will be skimmed.
- The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter will be inspected quarterly and within 24 hours after every storm event greater than
1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and maintenance will be kept in
a known set location and will be available upon request.
Inspection activities shall be performed as follows, Any problems that are found shall be repaired
immediately.
BMP element:
i Potential problem_
I will remediate the problem_ _
Entire BMP
_ _ _1
Trash/debris is resent
-How
Remove the trash/debris.
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as
applicable)
pavement surface.possible.
Perimeter of sand filter
Areas.of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed.
gully, and then plant a ground cover and
water until it is established. Provide lime
and a one-time fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height.
Flow diversion structure
The structure is clogged.
Unclog the conveyance and dispose of any
sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if
damage is too large for repair.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or dispose of it
in a location where it,will not cause
impacts to streams or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
problems,
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
Farm SW401-Sand filter O&M-Rev.4 2009Sept17 Page 1 of 3

BMP element:
Potentialproblem:
How I will remediate theproblem:
Filter bed and underdrain
Water is ponding on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm.
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace. If water still
ponds, then consult an expert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the."
sediment offsite.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage
Contact the NC Division of Water Quality
have occurred at the outlet.
401 Oversight Unit at 919-733-1786.
Form SW401-Sand Filter O&M-Rev.4 2009Sept17 Page 2 of 3

Permit Number:
(to be provided by UWQ)
I acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. I agree to notify DWQ of any problems with the_ system or prior
to any changes to the system or responsible party.
Pi-oject nu me:Asheboro Bank/Sheetz Site
BMP cb•aivage area number: I
Print name:Frank Edmondson IV
Title:Member Man
Address:2423 Tot Hill Farm Road Asheboro, North Carolina 27205
Phone:
Signatt
Date: // 3(-) w zoo`s
Note: The legally responsible party should not be a homeowners association unless more than 50% of the lots have been
sold and a resident of the subdivision has been named the president.
I, 1' 1 1' S , a Notary Public for the State of
L , County of is, do hereby certify that
r, Cy1d� Y' personally appeared before me this day of
n
and acknowledge the due execution of the forgoing sand.filter
maintenance requirements. Witness my hand and official seal,
j 0
SEAL
My commission expires 51 i ) I t)
Dorm SW401-Sand Filter 0&M-Rev.4 2009Sept17 Page 3 of 3

Compliance Inspection Report
Permit: SW4091202 Effective: 03/03/10 Expiration: 03/02/20 Owner: Franson LLC
Project: Asheboro Bank/Sheetz
County: Randolph Corner Of E Dixie Drive And Dublin Rd
Region: Winston-Salem
Contact Person: Frank Edmondson Title:
Directions to Project:
Type of Project. State Stormwater - HD - Other
Drain Areas: 001 - (East Fork Deep River) (03-06-08) (WS-IV:*)
002 - (East Fork Deep River) (03-06-08) (WS-IV:*)
On -Site Representative(s):
Related Permits:
Inspection Hate: 07/06/2011 Entry Time: 01:30 PM
Primary Inspector: Sue L Homewood
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: Q Compliant E Not Compliant
Question Areas:
0 State Stormwater
Asheboro NC 27203
Phone: [phone]
Exit Time: 01:40 PM
Phone: [phone]
Inspection Type: Compliance Evaluation
(See attachment summary)
ems TyvJ !
Page: 1

Permit: SW4091202 Owner - Project: Franson LLC
Inspection Date: 07/06/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
File Review
Tes
No
NA
N
Is the permit active?
■
n
n
n
Signed copy of the Engineer's certification is in the file?
❑
■
n
n
Signed copy of the Operation & Maintenance Agreement is in the fife?
■
n
n
n
Copy of the recorded deed restrictions is in the file?
n
n
n
■
Comment: site in operation but no eng. cent. on file.
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: Sheetz constructed and in operation, bank site under construction
SW Measures
Yes
No
NA
NE
Are the SW measures constructed as per the approved plans?
■
n
00
Are the inlets located per the approved plans?
■
n
n
Are the outlet structures located per the approved plans?
■
n
00
Comment:
Operation and Maintenance
Yes
No
NA
NE
Are the SW measures being maintained and operated as per the permit requirements?
n
n
n
■
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ
n
n
n
upon request?
Comment: Underground sand filter, inspector did not access bmp or request records.
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? 0 ❑ n n
Comment:
Page: 2

Permit Number:
(to be provided by DWQ)
A OF wArF9
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be filled out on line, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section lll) and the I&M Agreement (Section IV)
Project name
Contact name
Phone number
Date
Drainage area number
SheetzBank Site
Jonathan Allen
919-854-1282
December 1, 2009
Site Characteristics
Drainage area (AD) 133,581.00 ft2 OK
Impervious area 104,801.00 ft2
% Impervious (IA) 78.5%%a
Design rainfall depth (Ro) 1.00 in
Peak Flow Calculations
1-yr, 24-hr runoff depth
2.20
in
1-yr, 24-hr intensity
0.12
inthr
Pre -development 1-yr, 24-hr runoff
5.14
ft'/sec
Post -development 1-yr, 24-hr runoff
4.18
ft3lscc
Pre/Post 1-yr, 24-hr peak control
-0.96
ft'/sec
Storage Volume
Design volume (WQV)
8,431.00 ft3
Adjusted water quality volume (WQVAdi)
6,323.25 ft' OK
Volume contained in the sedimentation basin and on top of the sand filter
6,717.00
Top of sand filter/grate elevation
801.75 ft amsl
Weir elevation (between chambers)
801.75 ftamsi
Maximum head on the sedimentation basin and sand filter (hMaxFlJter)
3.00 ft OK
Average head on the sedimentation basin and sand filter (hA)
1.50 ft OK
Runoff Coefficient(Rv)
0.76 (unitless)
Type of Sand Filter
Open sand filter?
N Y or N
SHWT elevation
ft amsl
Bottom of the sand filter elevation
ft amsl
Clearance (dsHm)
Closed/pre-cast sand filter?
Y Y or N
SHWT elevation
NIA ft amsl
Bottom of the sand filter elevation
800.08 ft amsl
Clearance (dsHwT)
N/A
_
If this is a closed, underground closed sand filter: The clearance between
T
the surface of the sand filter and the bottom of the roof of the underground
5.00 ft
structure (ds�)
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and II. Project Design Summary, Page 1 of 2
yam_

Permit Number,_
(to be provided by OWQ)
Sedimentation Basin
Surface area of sedimentation basin (As)
Sedimentation basintchamber depth
Sand Filter
Surface area of sand filter (AF)
Top of sand media filter bed elevation
Bottom of sand media filter bed/drain elevation
Depth of the sand media filter bed (dr)
Coefficient of permeability for the sand filter (k)
Outlet diameter
Outlet dischargelflowrate
Time to drain the sand filter (t)
Time to drain the sand filter (t)
Additional Information
Does,volume in excess of the design volume bypass the sand filter?
Is an off-line Flow -splitting device used?
If draining to SA waters: Does volume in excess of the design volume flow
evenly distributed through a vegetated filter'?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the BMP located at least 30ft from surface waters (50ft if SA waters)?
If not a closed bottom, is BMP located at least 100ft from water supply wells?
Are the vegetated side slopes equal to or less than 3:1
Is the BMP located in a recorded drainage easement with a recorded access
easement to a public Right of Way (ROW)?
What is the width of the sedimentation chamberlforebay (Wsd)?
What is the depth of sand over the outlet pipe (dpipe)?
1,504.00 ft2 OK. Meets minimum, but may need to be increased to
5,00 ft
735.00 ft' OK. Meets minimum, but may need to be increased to
801.58 ft amsl
800.08 ft amsl
1.50 ft
3.50 (ftlday)
4.00 in
0.03 ft3lsec
40.00 hours' 4 OK. Submit drainage calculations.
1.87 days
'Y YorN
OK
Y Y or N
OK
YorN
ft
YorN
Y Y or N
OK
YorN
Y or N
YorN
5.00 ft
OK
_1.17 ft
OK
M��sru s,f or rY + SA OF t,R SrRu: r.
1i. 3.5' OF I �3,r7 P NULL. #0 #e5 DRAIA1,U6 7-//W
r, K N FRv/� � • a� SuRi��6 SEA_
swat rloly I
Form SW401-Sand Filter-Rev.5 2009SeptV Parts S and II. Project Design Summary, Page 2 V 2

Permit No.
(to be provided by D WQ)
llf REQWRED;ITEMS!CHTCKLIST . ` i � 3 a • } '
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.
Initials Pagel Plan
Sheet No.
f _ S 1. Plans (1" - 50' or larger) of the entire site with labeled drainage area boundaries
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
Maintenance access,
- Flow splitting device,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
Off -site drainage (if applicable), and
Boundaries of drainage easement.
2. Plan details (1" = 30' or larger) for the sand filter showing:
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
Flow splitting device,
Vegetative filter strip dimensions and slope (if SA waters),
- Proposed drainage easement and public right of way (ROW),
Design at ultimate build -out,
Off -site drainage (if applicable), and
Boundaries of drainage easement.
.f____, Lz 6133. Section view of the sand filter (1" = 20' or larger) showing:
- Depth(s) of the sedimentation chamber and sand filter chamber,
- Depth of sand filter media,
- Connection between the sedimentation chamber and the sand filter chamber and weir elevation,
SHWT elevation,
- Outlet pipe, and
- Clearance from the surface of the sand filter to the bottom of the roof of the underground structure (if
N Pr
applicable).
4• A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified in the field by DWQ, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
5• Supporting calculations (including drainage calculations)
Jf
A
6. Signed and notarized operation and maintenance (0&M) agreement
7. A copy of the deed restrictions (if required).
Form SW401-Sand Filter-Rev.5 2009Sept17
Part III, Page 1 of 1

74
c f: dar "t
Application Completeness Review
❑ First Submittal ❑ Re -submittal Date Received: / /1 " Date Reviewed: B T3.1
Develo ment/Pro'ect Name: /9-s e o' J ul�
p J l�>? 0 20 sh � e.-!�/�/� s.�-�- - -
Receiving stream name r-. Task b— p classification: _ Ws-- IV -
For post -construction requirements, a program will be deemed compliant for the areas where it is
implementing any of the following programs: WS-1, WS-II, WS-III, WS-IV, HOW, ORW, Neuse River Basin
NSW, Tar -Pamlico River Basin NSW, and the Randleman Lake Water Supply Watershed Nutrient
Management Strategy.
High Density Projects that require a 401/404 within an NSW require 85% TSS, 30% TN and 30% TP removal.
T&E Species (Goose Creek; Waxhaw Creek or Six Mile Creek Water Sheds): AI�IA -
Latitude and Longitude: 3f 4i� -� �7� 47 90 Jurisdiction .4sh� 6.2Qr»A�,�or,,� ���•�ry
Project Address: G= c G .Dix Drr 4us AZVV GSA Du le
Engineer name and firm: ��& ����, p ���.e c��,�r 671,7) df arc 001�-' ;Gig
❑ Low Density (no curb and gutter) ❑ Low Density with curb and gutter outlets 2-Hi h Densi ❑ Other
4011404 impacts to surface waters, wetlands, and buffers (add language to cover letter and/or addinfo letter)
L>� BUA �e 5 0
o—Check for $505.00 included
rOriginal.signature .(not photocopy) on application =- ---_:--:- -- _. _.____..--.----.-_-----.-----._.._-----.—___-.--
tY Legal signature (Corporation-VP/higher, Partnership -General Partner/higher, LLC-member/manager, Agent).
Check spelling, capitalization, punctuation: http://www.secretary.state.nc.us/corporations/thepage.aspx
If an agent signs the application, a signed letter of authorization from :11e applicant must be provided which
includes the name, title, mailing address and phone number of the person signing the letter.
{y'R TiL , For subdivided projects, a signed and notarized deed restriction statement
W Sealed, signed & dated calculations
o"'Correct supplement and O&M provided for each BMP on site (check all that were provided & number of each)
❑ Bioretention
❑ Dry Detention Basin
❑ Filter Strip
a Grass Swale
❑ Infiltration Basin
❑ Infiltration Trench
❑ Level Spreader
❑ Permeable Pavement
[i Restored Riparian Buffer.
El P oftop Runoff Management
03"-Sand Filter
❑ Stormwater Wetland
❑ Wet Detention Basin
❑ Low Density
❑ Curb Outlet
❑ Off -Site
❑ NCDOT Linear Road
2"" Two sets of sealed, signed & dated layout & finish grading plans wlin appropriate details
5a' Narrative Description of stormwater management provided
❑ Soils report provided
c3. Wetlands delineated or a note on the plans that none exist on site and/or :adjacent property
&r' Details for the roads; parking area, cul-de-sac radii, sidewalk widths, cure and gutter;
Dimensions & slopes provided
2 Drainage areas delineated ❑ Pervious and impervious reported for each ❑ Areas of high density
Gr' Inspection and maintenance agreements provided
Fw( Application completeCciasQ !]Application Incomplete Returned: (Date)
'S
February 9, 2009 Revision

Sl_ 2006-246 Section 9 Post Construction Requirements for Non -Coastal Counties
Low -density projects
❑ No more than two dwelling units per acre or 24% built -upon area;
❑ Vegetated conveyances to the maximum extent practicable;
❑ Built -upon areas at least 30 feet landward of perennial and.intermittent surface waters;
❑ Deed restrictions, protective covenants, and/or other restrictive language/measures.
Hi4h density pr-__ojects
❑ Control and treat runoff from the first one -inch of rain.
❑f Runoff volume drawdown time must be a minimum of 48 hours, but not more than 120 hours;
❑ Discharge the storage volume at a rate equal to or less than the predevelopment discharge rate for the
one-year, 24-hour storm.
❑ Achieve 85% average annual removal of total suspended solids.
❑ For BMPs that require a separation from the seasonal high-water table (SHWT), the separation shall include
at least 12 inches of naturally occurring soil above the SHWT.
❑ Stormwater management measures must comply with the General Engineering Design Criteria For All
Projects requirements listed in 15A NCAC 2H .1008(c);'
Li All built -upon areas are at least 30 feet landward of perennial and intermittent surface waters;
❑ Deed restrictions, protective covenants, and/or other restrictive language/measures
❑.. Provide. a.mechanism_to_require_long-term_operation.a_nd.maint.enance of Best Management Practices
Goose Creek, Six Mile Creek and Waxhaw Creek Watersheds
Buffer Requirements
❑ Undisturbed riparian buffers within.200 feet of water bodies within the 100-Year Flooz:plain and within 100 feet
of water bodies that are not within the 100-Year Floodplain. Exceptions to the undisturbed buffer
requirements are set forth in 15A NCAC 02B .0607
Stormwater Controls as required b 15A NCAC 02B .0602
❑� Control and treat the difference between the pre -development and post -development conditions for the one-
year, 24-hour storm with structural controls.
❑ Development and redevelopment shall implement stormwater management measures that promote infiltration
of flows and ground water recharge for the purpose of maintaining stream base flow.
❑ 85% average annual removal of total suspended solids.
❑ Draw down the treatment. volume no faster than 48 hours, but no slower than 120 hours, for detention ponds.
o Discharge the storage volume at a rate equal or less than the pre -development discharge rate for the one-
year, 24-hour storm.
❑ Meet design or Stormwater management measures set forth in 15A NCAC 2H .1008.
High Density Projects that require a 4011404 within an NSW
❑ 85% TSS
❑ 30% TN
❑ 30% TP
February 9, 2009 Revision