SW4111001_CURRENT PERMIT_20120213

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
01CS-0�
YYYYMMDD

Afi�j'A
NC®ENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. William J. Trogdon
Triangle Investors Company
150 W. Kivett Streit
Asheboro, NC 27203
Division of Water Quality
Charles Wakild, P. E.
Director
January 9, 2011
Subject: Stormwater Permit No. SW41l1001
Verizon Wireless & Retail Space
High Density Commercial Sand Filter Project
Randolph County
Dear Mr. Trogdon:
Dee Freeman
N.C.geat. of ENR
FEB 13 201112
winston-salern
Regional Office
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for
Verizon Wireless & Retail Space on January 6, 2012. Staff review of the plans and specifications has
determined that the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A
NCAC 2H.1000 and Session Law 2006-246. We are forwarding Permit No. SW4111001, dated January 9,
2012, 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 January 8, 2020, and shall be subject to the
conditions and limitations as specified therein. Please pay special attention to the Operation and
Maintenance requirements in this permit. Failure to establish an adequate system for inspection and
maintenance of the stormwater management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit.
This request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC
27611-7447. Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the 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 Chuck Wakild, P.E.
cc: Regional Office
SW4111001 File
ec: H. Mack Summey, Jr., PE — Summey Engineering Associates, PLLC
Wetlands and Storrnwaler Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location, 512 N. Salisbury St Raleigh, North Carolina 27604
Phone [phone] FAX: [phone]
Inlemet www.ncwaterquality cry
An Equai Opportunity \Affirmative Action Employer
No�rthCarolina
Natumllty

State Stormwater Permit
Permit No. SW4111001
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
Triangle In vestors Company
Verizon Wireless & Retail Space
E. Dixie Drive in front of Walmart Shopping Center, Asheboro, Randolph County
FOR THE
construction, operation and maintenance of two (2) sand filters in compliance with
the provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter referred
to as the "storm water 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 January 8, 2020, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of
stormwater described in the application and other supporting data.
2. This stormwater system has been approved for the management of
stormwater runoff as described in Section 1.7 of this permit. The stormwater
control has been designed to handle the runoff from 61,419 square feet of
impervious area.
3. The tract will be limited to the amount of new 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. SW4111001
7. The following design criteria have been provided in the sand filter and must
be
maintained at design condition:
a.
Drainage Area, acres:
1.34
0.71
Onsite, ftZ:
58,370
30,926
Offsite, ft2:
0
0
b.
Total Impervious Surfaces, ftZ:
37,461
23,958
Onsite, ft2:
37,461
23,958
Offsite, ft2:
0
0
C.
Design Storm, inches:
1.0
1.0
d.
Sediment Chamber Bottom Elev., fmsl:
765.0
761.0
d.
Top of Sand Elevation, fmsl:
765.0
761.0
e.
Seasonal High Water Table, fmsl:
756.0
756.0
f.
Sand Depth, feet:
2.0
2.0
h.
Bottom of Sand Elevation, fmsl:
763.0
759.0
i.
Sediment Chamber SA, ft2:
201.0
528.0
i.
Sand Chamber SA, ftZ:
349.0
225.0
j.
Permitted Storage Volume, ft3:
7,653
4,331.5
k.
Bypass / Storage Elevation, fmsl:
768.0
763.0
n.
Drawdown Time, hours:
40
40
o.
Underdrain Diameter, inches:
4"
4"
q.
Receiving Stream/River Basin:
UT to Vestal / Cape Fear
r.
Stream Index Number:
17-22-4
S.
Classification of Water Body:
"C"
II. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded
areas of the system will be repaired immediately.
3. The permittee shall at all time provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must be followed in
its entirety and maintenance must occur at the scheduled intervals including,
but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
c. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level
spreader, filter media, planting media, underdrains, catch basins and
piping.
g. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work
and what actions were taken.
5. The permittee shall submit to the Division of Water Quality an annual
summary report of the maintenance and inspection records for each BMP.
The report shall summarize the inspection dates, results of the inspections,
and the maintenance work performed at each inspection.
Page 2 of 6

State Stormwater Permit
Permit No. SW4111001
6. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with
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
was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on
the approved plan.
11. The permittee shall submit final site layout and grading plans for any
permitted future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. The Director may notify the permittee when the permitted site does not meet
one or more of the minimum requirements of the permit. Within the time
frame specified in the notice, the permittee shall submit a written time
schedule to the Director for modifying the site to meet minimum
requirements. The permittee shall provide copies of revised plans and
certification in writing to the Director that the changes have been made.
III. GENERAL CONDITIONS
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.
Page 3 of 6

State Stormwater Permit
Permit No. SW4111001
2. The permittee is responsible for compliance with all permit conditions until
such time as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the 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 9t" day of January, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
D�
forChuck Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No. SW4111001
Verizon Wireless & Retail Space
Stormwater Permit No. SW4111001
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. SW4111001
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. Under drains are located per the approved plans.
8. All slopes are grassed with permanent vegetation, per the vegetation
plan.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and 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 sediment
chambers, sand chambers, under drains, and outlets.
15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Winston Salem Regional Office
Surface Water Protection
585 Waughtown Drive
Winston Salem, NC 27107
City of Asheboro
Building Inspections
Page 6 of 6

WDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. William J. Trogdon
Triangle Investors Company
150 W. Kivett Strett
Asheboro, NC 27203
Division of Water Quality
Charles Wakild, P. E.
Director
January 9, 2011
Subject: Stormwater Permit No. SW4111001
Verizon Wireless & Retail Space
High Density Commercial Sand Filter Project
Randolph County
Dear Mr. Trogdon:
Dee Freeman
Secretary
RECEIVED
N.C.Dept. of ENR
,BAN 12 2012
Winston-Salem
Regional Office
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for
Verizon Wireless & Retail Space on January 6, 2012. Staff review of the plans and specifications has
determined that the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A
NCAC 2H.1000 and Session Law 2006-246. We are forwarding Permit No. SW4111001, dated January 9,
2012, 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 January 8, 2020, and shall be subject to the
conditions and limitations as specified therein. Please pay special attention to the Operation and
Maintenance requirements in this permit. Failure to establish an adequate system for inspection and
maintenance of the stormwater management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit.
This request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC
27611-7447. Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the 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,
v �
for Chuck Wakild, P.E.
CC' !Regional Office.
SW4111001 File
ec: H. Mack Summey, Jr., PE — Summey Engineering Associates, PLLC
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699.1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: www wwaterquahty.org
An Equal Opportunity 1 Affirmative Action Employer
None
rthCarolina
Natmrall#

11
State Stormwater Permit
Permit No. SW4111001
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
Triangle In vestors Company
Verizon Wireless & Retail Space
E. Dixie Drive in front of Walmart Shopping Center, Asheboro, Randolph County
FOR THE
construction, operation and maintenance of two (2) sand filters 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 January 8, 2020, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of
stormwater described in the application and other supporting data.
This stormwater system has been approved for the management of
stormwater runoff as described in Section 1.7 of this permit. The stormwater
control has been designed to handle the runoff from 61,419 square feet of
impervious area.
3. The tract will be limited to the amount of new 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 difected 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. SW4111001
7. The following design criteria have been provided in the sand filter and must
be maintained at design condition:
a. Drainage Area, acres:
1.34
0.71
Onsite, ft2:
58,370
30,926
Offsite, ft2:
0
0
b. Total Impervious Surfaces, ft2:
37,461
23,958
Onsite, ft2:
37,461
23,958
Offsite, ft2:
0
0
c. Design Storm, inches:
1.0
1.0
d. Sediment Chamber Bottom Elev., fmsl:
765.0
761.0
d. Top of Sand Elevation, fmsl:
765.0
761.0
e. Seasonal High Water Table, fmsl:
756.0
756.0
f. Sand Depth, feet:
2.0
2.0
h. Bottom of Sand Elevation, fmsl:
763.0
759.0
i. Sediment Chamber SA, ft2:
201.0
528.0
i. Sand Chamber SA, ft2:
349.0
225.0
j. Permitted Storage Volume, ft3:
7,653
4,331.5
k. Bypass 1 Storage Elevation, fmsl:
768.0
763.0
n. Drawdown Time, hours:
40
40
o. Underdrain Diameter, inches:
4"
4"
q. Receiving Stream/River Basin:
UT to Vestal / Cape Fear
r. Stream Index Number:
17-22-4
S. Classification of Water Body:
"C"
11. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in its
entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to
a minimum and any eroded
areas of the system will be repaired immediately.
3. The permittee shall at all time provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must be followed in
its entirety and maintenance must occur at the scheduled intervals including,
but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level
spreader, filter media, planting media, underdrains, catch basins and
piping.
g. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work
and what actions were taken.
5. The permittee shall submit to the Division of Water Quality an annual
summary report of the maintenance and inspection records for each BMP.
The report shall summarize the inspection dates, results of the inspections,
and the maintenance work performed at each inspection.
Page 2 of 6

State Stormwater Permit
Permit No. SW4111001
6. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with
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.
B. 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
was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on
the approved plan.
11. The permittee shall submit final site layout and grading plans for any
permitted future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. The Director may notify the permittee when the permitted site does not meet
one or more of the minimum requirements of the permit. Within the time
frame specified in the notice, the permittee shall submit a written time
schedule to the Director for modifying the site to meet minimum
requirements. The permittee shall provide copies of revised plans and
certification in writing to the Director that the changes have been made.
III. GENERAL CONDITIONS
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.
Page 3 of 6

State Stormwater Permit ;
Permit No. SW4111001
2. The permittee is responsible for compliance with all permit conditions until
such time as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the 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.-
i
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 91h day of January, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
forChuck Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4of6

16
State Stormwater Permit
Permit No. SW4111001
Verizon Wireless & Retail Space
Stormwater Permit No. SW4111001
Randolph County
Designer's Certification
I, , as a duly registered in the State of
North Carolina, having been authorized to observe (❑periodically 1 ❑weekly 1
❑full time) the construction of the project,
(Project Name)
for (Project Dinner) 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. SW4111001 s
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. Under drains are located per the approved plans.
_8. All slopes are grassed with permanent vegetation, per the vegetation
plan.
.9. Vegetated slopes are no steeper than 3:1.
.10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and 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 sediment
chambers, sand chambers, under drains, and outlets.
15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Winston Salem Regional Office
Surface Water Protection
585 Waughtown Drive
Winston Salem, NC 27107
City of Asheboro
Building Inspections
Page 6 of 6

Homewood, Sue
From: Mack Summey [[e-mail]]
Sent: Friday, April 27, 2012 1:57 PM
To: Clay Parkes; Clay Parkes
Cc: Homewood, Sue; Patterson, Robert; 'Dumont Bunker'; [e-mail]
Subject: Verizon Wireless & Retail - SWP SW 4111001
Attachments: VER!ZON STORMWATER CERTIFICATION.pdf
Hi Sue
Here is the certification for the Verizon site.
Thank you very much!
Mack
Robert— I hear the other day that Randolph County was no longer going to be "Tipped" into the Phase 2 requirements.
If we have a project that has been permitted but not built, can we modify it?
Thanks!
Mack
H, Mack Summey, Jr., PE
Summey Engineering Associates, PLLC
Engineering - Land Planning - Consulting
P.O. Box 968
Asheboro, NC 27204
Office - 336-328-0902
Fax - 336-328-0922
Email: mack asheboro.com

State Stormwater Permit
Permit No. SW4111001
Verizon Wireless Ft Retail Space
Stormwater Permit No. SW4111001
Randolph County
Designer's Certification
I, 0,ky 's6imly2e,4
T, as a duly registered „ c: r in the State of
North Carolina, having 6een authorized to observe (Dqperiodically I❑ weekly I
❑full time) the construction of the project,
Nen zyr�
(Project Name)
FA
for 2D6 401A0z)-1, L l.�:- (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:
'9Signature d,
Registration dumber . ��-7—
Date -
Page 5 of 6
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State Stormwater Permit
Permit No. SW4111001
Certification Requirements:
✓ 1. The drainage area to the system contains approximately the permitted acreage.
1. 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,
f 6. The outlet structure is located per the approved plans.
7. Under drains are located per the approved plans.
8. All slopes are grassed with permanent vegetation, per the vegetation plan.
✓ 9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-circuiting
of the system.
11. The permitted amounts of surface area and 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 sediment chambers,
sand chambers, under drains, and outlets.
15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Winston Salem Regional Office
Surface Water Protection
585 Waughtown Drive
Winston Salem, NC 27107
lY
City of Asheboro
Building Inspections
Page 6 of 6

High Density Commercial Subdivisions
Deed Restrictions & Protective Convenances
In accordance with Title 15 NCAC 2H.1000 and S.L. 2006-246, the Management Regulations, deed
restrictions and protective covenants are required for High Density Commercial Subdivisions where
lots will be subdivided and sold and runoff will be treated in an engineered stormwater control facility.
Deed restrictions and protective covenants are necessary to ensure that the development maintains a
built -upon area consistent with the design criteria used to size the stormwater control facility.
I, Mr. William Trogdon , acknowledge, affirm and agree by my signature below, that I will
cause the following deed restrictions and covenants to be recorded prior to the sale of any lot within the
project known as Retail User & Restaurant
1. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number _SW 4111001 as issued by the Division of Water Quality
under the Stormwater Management Regulations.
2. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to
maintain compliance with the stormwater management permit.
3. These covenants are to run with the land and be binding on all persons and parties claiming
under them.
4. The covenants pertaining to stormwater may not be altered or rescinded without the express
written consent of the State of North Carolina, Division of Water Quality.
5. Alteration of the drainage as shown on the approved plan may not take place without the
concurrence of the Division of Water Quality.
6. The maximum built -upon area per lot, in square feet, is as listed below. -
Lot # BUA Lot # BUA Lot # BUA
1 29,649 sf 2 65,097 sf 3 55,104 _sf
This allotted amount includes any built -upon area constructed within the lot property boundaries,
and that portion of the right-of-way between the front lot line and the edge of the pavement. Built
upon area includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate,
coquina and parking areas, but does not include raised, open wood decking, or the water
surface of swimming pools.
7. All runoff from the built -upon areas on the lot must drain into the permitted system. This may be
accomplished through a variety of means including roof drain gutters which drain to the street,
grading the lot to drain toward the street, or grading perimeter swales to collect the lot runoff
and directing them into a component of the stormwater collection system. Lots that will naturally
drain into the system are not required to provide these additional measures.
8. The owner of each lot, whose ownership is not retained by the permittee, is required to submit a
separate stormwater permit application to the Division of Water Quality and receive a permit
prior to construction.
9. The project and each lot will maintain a 30** foot wide vegetated buffer between all impervious
areas and surface waters.
**50 foot for projects located in the 20 coastal counties.
DEC z 2 2011 L�J
""I • WATER QUALITY
K'ETLAt4" AND "ORMWATER BP,ANCH
Form DRPC-1 Rev-2 05Nov2009 Page I ol' 2

High Density Commercial Subdivisions
Deed Restrictions & Protective Convenances
Signature: Date: /
�U�1,� a! Notary Public in the
State of n� L_ GL� �LIL-ems- County of Ro -+�U 4 „Q -
do hereby certify that c.YX.ca-m CQC"'D personally appeared
before me this the +h day of , 20 I) , and acknowledge
the due execution of the foregoing instrument. Witness my hand and official seal,
f SEAL`` PQ&
Sign tur
My Commission expires 7 , 02014
_ 6d q YY q
Form DRPC-1 Rev2 05Nov2009 Page 2 of 2

Form SW401-Sand Filter O&M-Rev.4 2009Septi7 Page I of 3
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:
Potentials problem:
How I will remediate the problem:'
Entire BMP
Trash/debris is resent.
Remove the trash/debris.
Adjacent pavement (if
Sediment is present on the pavement
Sweep or vacuum the sediment as soon as
applicable)
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 depth
Search for the source of the sediment and
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.
BMP element:
Potentialproblem:
How 1 will remediate theproblem:
Filter bed and underdrain
Water is ponding on the surface for
Check to see if the collector system is clogged
collection system
more than 24 hours after a storm.
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 have
occurred at the outlet.
Contact the NC Division of Water Quality 401
Oversight Unit at 919-733-1786.
�I

Permit Number:
(to be provided by DWQ)
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.
Project name: Retail & Restaurant User
BMP drainage area number:
Print name: Mr. William Tro don
Title:_ Managing Partner
Address: 150 West Kivett Street Asheboro NC 27203
Date:
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, • l �A-u- , a Notary Public for the State of
North Carolina , County of 'Randolph , do hereby certify that
William J. Trocrdon _ personally appeared before me this 78t.h day of
November , 2011 , and acknowledge the due execution of the forgoing sand filter
maintenance requirements. Witness my hand and official seal,
SEAL
My commission expires_ 07-27-2014

DWQ USE ONLY
Date Received Fee Paid
Permit Number
S it ciiq�3
11
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph Il - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Pian
❑ 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 fornr ?nay be photocopied for rise as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, Ietters, operation and maintenance agreements, etc.):
Verizon Wireless & Retail Space
2. Location of Project (street address):
E. Dixie Drive in front of Walmart Shopping Center _
City:Asheboro County:Randolph Zip:27203
3. Directions to project (from nearest major intersection):
From intersection of NC Hwy 42 and US Hwy 64 go West 1 mile. Site is on left
4. Latitude:35"69' 70' N Longitude:79-78`94" W of the main entrance to the project.
,7 , 7-/ 7rZi°r
[I. 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):
❑Law 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,
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: 4.5 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: Land Disturbance Permit has been applied for.
OCT 1 8 2011
WETIMOS AND STORMWATER BRANGII
Form SWU-101 Version 07July2009 Page l of 6
(00 910kL

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who ovens the project):
Applicant/Organization: Triangle Investors Company
Signing Official & Title:Mr. William T. Trogdon
b.Contact information for person listed in item 1a above:
Street Address:150 W. Kivett Street
City:Asheboro
Mailing Address (if applicable):150 W. Kivett Street
City:Asheboro
Phone: [phone]
Email:[e-mail]
State:NC
Zip:27203
State:NC Zip:27203
Fax: (336 ) 626-1554 _
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/ Organ ization:Trian le Investors Cam an
Signing Official & Title:Mr. William T Trogdon
b.Contact information for person listed in item 2a above:
Street Add ress:150 W. Kivett Street
City:Asheboro State:NC
Mailing Address (if applicable):Same
Zip:27203
City: State: Zip:
Phone: ( } Fax: ( )
Email:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
Email:
State:
Fax: ( }
Zip:
4. Local jurisdiction for building permits: City of Asheboro
Point of Contact: Mr. Larr Trotter Phone #: (336 ) 626-1204x231 _
Form SWU-101 Version 07July2009 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
All BUA surface area runoff will be directed to two(2) Sand Filters as shown on the plans. BMP's are
designed to capture the first inch of runoff from the entire 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: 4.905 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) = Total Project
Area':4.905 acres
Total project area shall be calculated to exclude the following the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal Hi h Water (NSW, line or Mean High Wafer
(MHW) line, and coastal wetlands landward from the NHW (or MM line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (ar MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 71.28 %
9. How many drainage areas does the project have? 2 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area _
Drainage Area _
Receiving Stream Name I
UT to Vestal
Creek
UT to Vestal
Creek
Stream Class *
C
C
Stream Index Number *
17-22-4
17-22-4
Total Drainage Area (so
58,370
30,927
On -site Drainage Area (sf)
58370
30,926
Off -site Drainage Area (so
0
0
Proposed Impervious Area** (so
37,461
23,958
Impervious Area** total
64.05
77.46
Impervious— Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area
Drainage Area _
On -site Buildings/Lots (so
4,746
9,704
On -site Streets (so
21,170
8,846
On -site Parking (so
8,367
4,425
On -site Sidewalks (so
3,178
983
Other on -site (so
0
0
Future (so
0
0
Off -site (so
0
0
Existing BUA*** (so
0
0
Total (so:
37,461
23,958
Stream Class and Index Number can be determined at: http.Vlh2o.enr.state.nc.us/bims reports/re12ortsW73.htmI
Form SWU-101 Version 07July2009 Page 3 of 7

�* lttiperutor+s area is defined as the built upon area including, but trot limited to, buildings, roads, parking areas,
sidfivalks, gravel areas, etc.
*** Report only that amount of existing BLIA that will remain after development. Do not report airy existing BLIA that
is to be removed and rultich will be replaced by new BLIA.
11. I -low was the off -site impervious area listed above determined? Provide documentation. There was no off -site
Impervious Area listed above, there is none going thru site.
Proieets in Union County: Contact UH'Q Central Officestaff to check if the project is located +t,ithin a Threatened d-
Endangered Species watershed that may be suf jeci to more stringent stormwater requirements as per NGIC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://h2o.enr.state.nc.us/su/bmp_forms.htm.
Vt. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from http://h2o.enr,state.nc.Us/su/bmp_forms,htm. The complete application
package should be submitted to the appropriate DWQ Office. (The appropriate office may be found by locating
project on the interactive online map at ht#i2:1/h2o.enr.state.nc.us/su/msi maps.htm.)
Please indicate that the following required information have been provided by initialing in the space provided for
each item. All original documents MUSTbe signed and initiated in blue ink. Download the Iatest versions for
each submitted application package from http:/Zh2o.etir.state.nc.us/su/bmp forms.htm.
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part V11 below)
3. Original of the applicable Supplement Form(s) (sealed_, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://ww_w.envhelp.org/pages/onesLopexpress.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.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the'/z
mile radius on the map.
7. Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
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, Ixisting contours, proposed contours, spot elevations, finished floor elevations.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
Initials
�kms.a
1Ams .
Nmt4S)
1Aw,S�
"VAS)
w%.S
�kmSJ
Form SWU-101 Version 07July2009 Page 4 of 7

m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify T!1
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WIRO: Schedule a site: visit for DWQ to verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 2022 Page No: 2960 HYK&J
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC _ }{Ky
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 21-1.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http://www.secretary.state,iic.us/Corporations/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built-u pon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http:J(h2o.enr.state. nc.uslsulbmp forms.htm#deed restrictions. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
VIIL CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: H. Mack Summey, Jr., PE
Consulting Firm: Summey Engineering Associates, PLI_C
Mailing Address: P.O. Box 968
City:Asheboro
Phone: (336 ) 328-0902
Email: [e-mail]
Sta te:NC Zi p:27204
Fax: (336 ) 328-0922
Form SWU-101 Version 07July2009 Page 5 of 7

IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has beet! filled ont, complete this
section)
I, (print or type name 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 (f person
listed in Cori tact Information, item Ia) with (print or type name of organization listed in
Contact Information, item Ib) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
As the legal property owner 1 acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signatu re: Date:
I, , a Notary Public for the State of , County of
do hereby certify that
personally appeared
before me this _ day of , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Form SWU-101 Version 07July2009 Page 6 of 7

X. APPLICANT'S CERTIFICATION
I, (print or type natne of person listed in Contact Information, item 2) William 1. Trogdon
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 15A NCAC 21-1 .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
r
Signature: Date:
1, 5 1/3r •L2 a Notary Public for the State of GA,, County of
�CIIL�-ietfp�try do hereby certify that ���.t.�cQm� �1arr�(.4rt personally appeared
before me this ��day of L. g oy A a 1 , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
'iM'.��t31�i4
v
SEAL
My commission expires M&4c- u /5, 02 0
Form SWU-101 Version 07July2009 Page 7 oi'7

Land Quality Section: s85
,(3k) 771c5000
County: 9A00oLN Project:
Person financially responsible: T`Pa"3 k6A h14rvAcceL
Project 8 (?A&0o - Zdlt" odG
Address: &5oly `tJI 14CI' atw I APc 2?rt0rf
;tlrJr;rJtrCe9C'0.1IfmJfsi111l'
' 1, Project location: b'{1 -15Jvdl&t•o
Pictures: No: I- Yes: ❑ Prints: ❑ Slides: ❑ 'Video_: El' Digital: D
2. Weather and soil conditions: S�,sN Sd` coat ,t ice 5"'t Initial inspection: Yes: ❑ No; Q r
3. Is site currently under notice of violation? Yes: ❑ No: M
4. Is the site in compliance with S.P.C.A, and rules? Yes: ❑ No, 13
If no, check violations below:
S. Violations::
❑ a. No approved plan, C.S. I f 3A-57 (4) and 15A N.C.A.0 4B.0107(c)
❑ g. Inadequate bufrer zone, O.S. I I3A-57(i)
b. Failure to follow approved plan, G.S. 113A-57(5)
® h, Graded slopes and'tills too steep, J
❑ c. Failure to submit revised plan, G.S. 113A754.1(b) and
G.S. 113A-57(2) or 15A N.CA.C. 413.0124(d)
15A N.C.A.C. 4M 118(a)
❑ i. Unprotected exposed slopes, G.S. 113A•57(2)
❑ d. Failure to provide adequate groundcovet, G.S..I 13A-57(3) and
0 j, Failure to maintain measures, 15A N.C.A.C. 4B.0113
15A N.CA.C. 4B.0107(b) or l5A N.C.A.C. 4B.0124(e),
❑k. Failure to self -inspect G.S. I.13A-54.1(e) and
❑ e• Insufficient measures to retain sediment on site, G.S. 113A-57(3)
15A N.C.A.C. 413.0131
M f. Failure to take all reasonable measures, I5A N.C.A.C. 4B.0105
❑ 1. Other (describe)
6. Potential NPDES Permit Violation? Yes: ® No: ❑ Describe:
' Afarr-G..Prr'A.+rc' u & PON
7, Elassedimentafiondamage oecurredsincelost inspection? Yes: ❑Ifyes,wlJe� rt?(checkallthatapply) No:® r5rr
Lakrinatural watercourse on the tract: ❑ Lakduatural watercourse off
the tract: ❑ - Other property: ❑ '
Description:
Degree of damage: slight: ❑ moderate: ❑ severe: ❑
8, Contact name : ,'�La;c.rp 4
.made with ( } ^ ". 4, 4xmkt�k Title:,,_,_
Inspection report given:[] or sent; ®to person fwattciatlp responsible'. Date,i ed et
9. Corrective actions needed:
❑ Submit an adequate sedimentation and erosion control plan for approval, covering all areas, disturbed or to be disturbed.. r , t.
❑ Install_ all sedimentation and erosion control measures nsven shaon the approved plaq including the following locations;
❑ Submit a revised sedimentation and erosion coutrol'plan for approval for & fallowing areas:
❑ Provide adequate permantnt ground cover on all-areas,where development has been completed for 15 working or 90 calendar days,
whichever is shorter (15 working or 60 calendar days, whichever is shorter, in High Quality Waters). ,
❑Install erosion and scdtiiienl'control devices sufficient to retain sediment on the tract
t
sti r--=-a+a_.-�^ac.x •+c- e•.a-.:•.-, .-..w.-«. 1-s m - ., i%; 'i • . " . ".,, . �! _ . y t
❑Install temporary sediment traps, basins and Took dams and associated'diversions Jos shown on the approved plan;- including the following
locations: lr' - � ..� • " , ,., , ` . ,
❑ Install adequate drop inlet protection as shown on the approved plan,• including the following locations:
❑ Provide ao adequate stream buffer zone of sufficientwidth to confine visible sedimentation within the 25 % of the buffer nearer the land
Aittubance using natural or artificial means (minimum'25-foot width in Trout Waters) including the following areas:
❑ Reduce the angle of graded slopes to an angle on which vegetative ground cover may be established including the following locations:
0 Provide adequate temporary or permanent ground cover.on all graded slopes where rough or fine grading has been completed for 21
calendar days, including the following areas:
❑ Maintain all sedimentation and. erosion control measures as specified in the approved plan and as required to prevent sedimentation
damage includingj+Wollowing loelfjons
Report by: ( �u Others present:
Date Of inspection; +>< j t 2(!L Time arriving on site: 1l .'{ 7 4— Time leaving site:
ce: Trt %' X614P : OC14A&rc'R @ Adf , con, , 644C uc1t-t s Jfc�t;t,1 G J rAAG-rdw P, rrt.,: 7,rf,� Page I of Z
Revision Date 12052010

"nd.Quality,5ecfiou '4'. ,'t�.� E:. nss,Er°
County :tAN+3dCpc( Project: t/elk -taKr Project# AANOa-• "ZOIZ.-006
Stretch andtor measurements: ,
• r 1 F
9. Corrective actions needed(contiiaued): Tr�1Tgl.C- S�i'x►u�n �ertP `2 , [••1LLaarNb SIAIII't6,
�4rt .}PIO(O c'9 AAMS Q CJs Ienl.c ► 41det r3 r w T-kAP 9 3�-re
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knS'rccant A!cc 5 19.(, ` c-u.� racM'�S; ©.1nifsit4 La1CfT P d7VC•rr'oJ Fay 4w r,,tcr73
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Report U; -. ..� Date of inspection: Y 12 (•.� '.Page 7— of Z