SW6120103_CURRENT PERMIT_20120320

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STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
k1l�i27
YYYYMMDD

LT X-AA
dam®
NC®ENR
North Carolina Department of Environment and Natura
Beverly Eaves Perdu. -
Governor
Division of Water Quality
Charles Wakild, P. E.
Director
February 17, 2012
Mr. Scott A. Moore
GLM Fayetteville Bunce, LLC
3715 Northside Parkway, Building 200 ; Suite 750
Atlanta, GA 30327
DENR-FRO
MAR 2 0 2012
Resources DWQ
Dee Freelran
Secretary
Subject: Stormwater Permit No. SW6120103
Walgreens Store #15151
High Density Commercial Sand Filter and Dry Detention Project
Cumberland County
Dear Mr. Moore:
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for
Walgreens Store #15151 on January 13, 2012 after requesting additional information on February 7, 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. SW6120103, dated February 15, 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 February 16, 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 Fayetteville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Brian Lowther at [phone]; or -
[e-mail].
Sincerely,
zlo
f,r Charles Wakild, P.E.
` cc: Fayetteville Regional Office
'7`SVV6120106-File
ec: Michael D. Ritch, PE - SDG Engineering
1 Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27599-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet www.ncwalerquality.org
1 An Equal Opportunely 1 AfSrmalive Action Employer
One
NorthCarolina
Naturally

State Stormwater Permit
Permit No. SW6120103
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
GLM Fayetteville Bunce, LLC
Walgreens Store #15151
6330 Raeford Road, Fayetteville, Cumberland County
FOR THE
construction, operation and maintenance of three (3) sand filters and one (1) dry detention
basin 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 February 16, 2020, and shall be
subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
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 57,064 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.
The runoff from all built -upon area within the permitted drainage area of this project
must be directed into the permitted stormwater control system.
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 7

State Stormwater Permit.
Permit No. SW6120103
7.
The following design criteria have been provided in the sand filter and must be
maintained at design condition:
a.
7.1
C.
d.
d.
e.
f.
h.
i.
i.
J•
k.
n.
o.
q•
r.
Drainage Area, acres:
Onsite, ft2:
Offsite, ft2:
Total Impervious Surfaces, ft2:
Onsite, ft2:
Offsite, W:
Design Storm, inches:
Sediment Chamber Bottom Elev.,
Top of Sand Elevation, fmsL•
Seasonal High Water Table, fmsl:
Sand Depth, feet:
Bottom of Sand Elevation fmsl:
Sediment Chamber SA, ft�:
Sand Chamber SA, ft2:
Permitted Storage Volume, ft3:
Bypass / Storage Elevation, fmsL•
Drawdown Time, hours:
Underdrain Diameter, inches:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
SF 1
SF2
SF3
0.33
0.17
0.08
14,375
7,405
3,485
0
0
0
14,375
6,094
3,049
14,375
6,094
3,049
0
0
0
1.0
1.0
1.0
fmsl: 11.5
12.0
12.4
12.5
13.0
13.4
10.33
10.33
10.33
1.0
1.0
1.0
11.5
12.0
12.4
202.5
150.0
90.0
202.5
150.0
90.0
1,215.0
758.0
378.0
14.6
14.2
14.4
40
40
40
4"
4"
4"
UT to Beaver
Creek / Cape
Fear
18-31-24-5
"C„
8. The following design criteria have been provided in the dry detention pond and must
be maintained at design condition:
a. Drainage Area, acres: 0.96
Onsite, ft2: 41,818
Offsite, ft2: 0
L7
C.
d.
e.
f.
g•
h
i.
J•
k.
Total Impervious Surfaces,
Buildings ft2:
Roads/Parking, ft2:
Other, ft2:
Offsite, ft2:
Pond Depth, feet:
Drawdown Time, hours:
Design Storm:
Permitted Storage Volume, ft3:
Storage Elevation, FMSL:
Bottom Elevation, FMSL:
Controlling Orifice:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
ft2:25,265
7,410
17,855
0
0
2.6
48
1.0 inch
2,335
12.6
11.0
2.0" 0 pipe
UT to Beaver Creek / Cape Fear
18-31-24-5
,.C"
The stormwater management system shall be constructed in its entirety, vegetated
and operational for its intended use prior to the construction of any built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately.
3. The permittee shall at all 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
Page 2 of 7

State Stormwater Permit
Permit No. SW6120103
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.
9. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The reports
will indicate the date, activity, name of person performing the work and what actions
were taken.
5. The permittee shall submit to the Division of Water Quality an annual summary report
of the maintenance and inspection records for each BMP. The report shall summarize
the inspection dates, results of the inspections, and the maintenance work performed
at each inspection.
6. The 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.
Page 3 of 7

State Stormwater Permit
Permit No. SW6120103
13. The Director may notify the permittee when the permitted site does not meet one or
more of the minimum requirements of the permit. Within the time frame specified in
the notice, the permittee shall submit a written time schedule to the Director for
modifying the site to meet minimum requirements. The permittee shall provide copies
of revised plans and certification in writing to the Director that the changes have been
made.
III. GENERAL CONDITIONS
1. This permit is not transferable except after notice to and approval by the Director. In
the event of a change of ownership, or a name change, the permittee must submit a
completed Name/Ownership Change form signed by both parties, to the Division of
Water Quality, accompanied by the supporting documentation as listed on page 2 of
the form. The approval of this request will be considered on its merits and may or may
not be approved.
2. The permittee is responsible for compliance with all permit conditions until such 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 21-1.1000, and NCGS 143-215.1 et -at.
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.
Page 4 of 7

State Stormwater Permit
Permit No. SW6120103
Permit issued this the 171" day of February, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
of
.. 7z/q
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5 of 7

State Stormwater Permit,
Permit No. SW6120103
Walgreens Store #15151
Stormwater Permit No. SW6120103
Cumberland County
Designer's Certification
1, , 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 6 of 7

State Stormwater Permit
Permit No. SW6120103
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: Fayetteville Regional Office
Surface Water Protection
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301
Page 7 of 7

Permit Number: SuJ6 1 ZZ)iO 3
(to be provided by DWQ)
Drainage Area Number:
Dry Extended Detention Basin
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.
The dry extended detention basin system is defined as the dry detention basin, outlet
structure, pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
❑ does ® does not incorporate a vegetated filter at the outlet.
This system (check one):
® does ❑ does not incorporate pretreatment other than a forebay.
Important maintenance procedures:
— The drainage area will be managed to reduce the sediment load to the dry
extended detention basin.
— Immediately after the dry extended detention basin is established, the vegetation
will be watered twice weekly if needed until the plants become established
(commonly six weeks).
— No portion of the dry extended detention pond will be fertilized after the first
initial fertilization that is required to establish the vegetation.
— I will maintain the vegetation in and around the basin at a height of
approximately six inches.
— Once a year, a dam safety expert will inspect the embankment.
After the dry extended detention basin is established, it will be inspected once a quarter
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:
Potentialproblem:
How I will remediate the roblem:
The entire BMP
Trash debris is present.
Remove the trash debris.
The perimeter of the dry
Areas of bare soil and/or
Regrade the soil if necessary to
extended detention
erosive gullies have formed,
remove the gully, and then plant a
basin
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
Form 5W401-Dry Detention O&M-Rev.3
Page 1 of 4

BMP element:
Potentialproblem:
How I will remediate theproblem:
The inlet device: pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
Swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the Swale if necessary to
Swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
The forebay
Sediment has accumulated
Search for the source of the
and reduced the depth to 75%
sediment and remedy the problem if
of the original design depth
possible. Remove the sediment and
(see diagram below).
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Erosion has occurred or
Provide additional erosion
riprap is displaced.
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 pesticides are used, wipe
them on the plants rather than
spraying.
The main treatment area
Sediment has accumulated
Search for the source of the
and reduced the depth to 75%
sediment and remedy the problem if
of the original design depth
possible. Remove the sediment and
(see diagram below).
dispose of it in a location where it
will not cause impacts to streams or
the BMP. Revegetate disturbed
areas immediately with sod
(preferred) or seed protected with
securely staked erosion mat.
Water is standing more than
Check outlet structure for clogging.
5 days after a storm event.
If it is a design issue, consult an
appropriate rofessional.
Weeds and noxious plants are
Remove the plants by hand or by
growing in the main
wiping them with pesticide (do not
treatment area,
spray).
Form SW401-Dry Detention O&M-Rev.3 Page 2 of 4

BMP element:
Potentialproblem:
How 1 wiIl remediate theproblem:
The embankment
Shrubs or trees have started
Remove shrubs or trees
to grow on the embankment.
immediately.
Grass cover is unhealthy or
Restore the health of the grass cover
eroding.___
- consult a professional if necessary.
Signs of seepage on the
Consult a professional.
downstream face.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs re air.
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
outlet.
733-1786.
The measuring device used to determine the sediment elevation shall be such that it will
give an accurate depth reading and not readily penetrate into accumulated sediments.
When the basin depth reads 12.1 feet in the main pond, the sediment shall be removed.
When the basin depth reads NLA feet in the forebay, the sediment shall be removed.
Sediment Removal
Bottom Elevati
BASIN DIAGRAM
6611 in the blanks)
--------------=-- olume
NIA 25%
Sediment
Storage
FOREBAY
Temporary Pool Elevation 14.1
Pool
Sediment Removal Elevation 12.1
----------------------------=--------------
Bottom Elevation 11.0
MAIN POND
!mporary
Volume
25% S(ediment
Form SW401-Dry Detention O&M-Rev.3
Page 3 of 4

Permit Number:
(to be provided by DWQ)
1 acknowledge and agree by my signature below that 1 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: W al reens Store # 15151
BMP drainage area number:1.14 Acres
Print name:GLM Fayetteville Bunce LLC
Title:Vice President
Address:3715 Northside Parkway, Building 200, Suite 750, Atlanta, GA 30327
Signature: % SCa7r %i. DDjeE
Date: l�
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.
)1 I V r Gt . /17:6 , a Notary Public for the State of
dr . County of �� , do hereby certify that
JCO i i iA- 00tz personally appeared before me this
day of and acknowledge the due execution of the
forgoing dry detention basin maintenance requirements. Witness my hand and official
seal,
SEAL
My commission expires //� L,7013
Form SW401-Dry Detention O&M-Rev.3 Page 4 of 4

ml I
4A.

Permit Number: S�aC Z b107
(!a be provided by DWQ)
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:
Potentialproblem:
How 1 will remediate theproblem: .
Entire BMP
Trash/debris is present.
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 time
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.
Form SW401-Sand Filter O&M-Rev.4 2009Sept17 Page 1 of 3

J►
BMP element:
Potential robletn:
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
or replace the outlet device.
Receiving water
Erosion or other signs of damage
-Repair
Contact the NC Division of Water Quality
have occurred at the outlet.
401 Oversi ht Unit at 919-733-1786.
Form SW40I-Sand Filter O&M-Rev.4 2009Sept17 Page 2 of 3

Permit Number:
(to be provided by, DJVQ)
I acknowledge and agree by my signature below that 1 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:Walgreens Store #15151 _
BMP drainage area numher:SF-1
Print name:GLM Fayetteville Bunce, LLC
Title:Vice President
Address:3715 Northside Parkway, Building 200, Suite 750, Atlanta, GA 30327
Phone:
Signatt
Date: 11,111411
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.
1, Oitlj'a- ? Str/ (-h , a Notary Public for the State of
(J� County of (�' p , do hereby certify that
SA. bores personally appeared before me this ! day of
AO J a-, and acknowledge the due execution of the forgoing sand filter
maintenance requirements. Witness my hand and official seal,
SEAL
My commission expires 911,3 a'o/'3
Form SW40I-Sand Filter O&M-Rev.4 2004Sept17 Page 3 of 3

Permit Number: 5W 612 0 0 3
(to be provided by D11'Q)
Drainage Area Number:
Sand Filter Operation and Maintenance Agreement
N
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 eleritent:
Potentialproblem-
Howl -will r'emediate:the, roblem:
Entire BMP
Trash/debris is present.
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.
Form SW401-Sand Filter O&M-Rev.4 2009Septl7 Page 1 of 3

BMP element:
Potential.problem:
How I will remediate the roblem:
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 he provided by DIJV)
1 acknowledge and agree by my signature below that l am responsible for the performance of the
maintenance procedures listed above. 1 agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Project name.Walgreens Store #15151
BMP drainage area number:SF-2
Print name:GLM Fayetteville Bunce, LLC
Title:Vice President
Address:3715 Northside Parkway, Buildinp, 200, Suite 750, Atlanta, GA 30327
Phon
Sign;
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.
1, 1Xy 16L a Notary Public for the State of
{ , County of Cobb--., do hereby certify that
(� A . Aoor&- personally appeared before me this `r"1 day of
and acknowledge the due execution of the forgoing sand filter
maintenance requirements
SEAL
Witness my hand and official seal
--I xu�q)
My commission expires
_ 9//,� 4W/A
Form SW401-Sand Filter O&M-Rev.4 2009Sept 17
Page 3 of 3

4
+ • �1� � �
. r �' + i
.A �. �.�v ��;_
f /rrrOlJiiHsis++

r
Permit Number: Sly C I Z01 D 3
(Io be provided by DPVQ)
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:
Potentialproblem:
How I will remediate theproblem:
Entire BMP
Trash/debris is present.
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 aimlicafion.
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,
Form SW401-Sand Filter O&M-Rev.4 2009Septl7
Page I of 3

BMP element:
Potentialproblem:
How I will remediate the roblem:.
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
onds, 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 re lace 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 DA'Q)
1 acknowledge and agree by my signature below that 1 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: Walgreens_Store # 15151
BMP drainage area number:SF-3
Print name:GLM Fayetteville Bunce, LLC
Title:Vice President
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.
a Notary Public for the State of
f `,,County of do hereby certify that
14 lD personally appeared before me this q day of
5�q_2, and acknowledge the due execution of the forgoing sand filter
maintenance requirements.
No,, y
SEAL
Witness my hand and official seal '
My commission expires Vig �Qtl
Form SW401-Sand Filter O&M-Rev.4 2009Septl7 Page 3 of 3

• �
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y'
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ti� �.
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✓f

A*' I A
HCDEHR
Permit No.
fto be provided by DWQ)
a�� W ArF9 G
U O
i?
401 CERTIFICATION APPLICATION FORM Y
DRY EXTENDED DETENTION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part Ill) must be printed, filled out and submitted along with all the required information.
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
I.1P,ROJECTIINF,ORMATION
miiil
Project name
Walgreens Store#15151
Contact person
Michael D. Ritch
Phone number
678-5604161
Date
11912012
Drainage area number
Basin 1
Site Characteristics
Drainage area
41,818.00
ft2
Impervious area
25,265.00
ft2
% Impervious
0.60
Design rainfall depth
1.00
in
Peak Flow Calculations
1-yr, 24-hr rainfall depth
3.10
in
Rational C, pre -development
0.65
(unitless)
Rational C, post -development
0.75
(unitless)
Rainfall intensity: 1-yr, 24-hr storm
0.13
inihr
Pre -development t-yr, 24-hr peak flow
2.95
ft3lsec
Post -development 1-yr, 24-hr peak Flow
2.68
ft'lsec
PrelPosl 1-yr, 24-hr peak control
-0.27
ft'lsec
Storage Volume: Non -SA Waters
Minimum required volume
2,069.00
ft'
Provided volume
2,335.00
ft3
OK
Sediment storage volume provided
2,335.00
ft3
OK
Storage Volume: SA Waters
5' runoff volume
NIA
ft3
Pr development 1 4-hr runoff volume
NIA
ft3
Post 1— t 1-yr, 24-hr runoff volume
NIA
ff3
Minimu uired volume
#VALUE!
ft3
Pr ' ed vo a
NIA
ft3
#VALUE!
ediment storag fume provided
NIA
ft3
#VALUE!
Basin Design Parameters
Drawdown time
2.00
days
OK
SHWT elevation
10.33
fmsl
Basin bottom elevation
11.00
fmsl
Raise basin bottom, Must be at least 2-ft above SHWT
Storage elevation
12.60
fmsl
Basin side slopes
3.0
:1
OK
Top elevation
15.40
fmsl
OK
Freeboard provided
1.30
ft
OK
Basin Bottom Dimensions
Basin length
280.00
ft
Basin width
27.50
ft
Length to width ratio
10.00
:1
OK
Form SW4e1-pry Extended Detention Basin-Rev.3 Parts I. & II. Design Summary, Page 1 of 2

Permit No.
(to be provided by DWQ)
Additional Information
Total runoff volume captured by basin
3.21
ac-in
Forebay is not required
Forebay provided
N
(Y or N)
Is basin in a recorded drainage easement?
Y
JY or N)
OK
Does basin capture all runoff at ultimate build -out?
Y
(Y or N)
OK
Is a sediment depth indicator included?
Y
JY or N)
OK
Does the basin include a drain?
Y
(Y or N)
OK
Form SW401-Dry Extended Detention Basin-Rev.3 Parts I, & 11, Design Summary, Page 2 of 2

Permit No.
(to be provided by DINQ)
111. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met, If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Page/ Plan
I t' s Sheet No.
4A, 4B, 4C, 8C 1. Plans (1" - 50' or larger) of the entire site showing:
- Design at ultimate build -out,
- Off -site drainage (if applicable),
Delineated drainage basins (include Rational C coefficient per basin),
4A, 4B, 4C, 8A
8A
Hydro
Yes
NIA
Yes
- Basin dimensions,
Pretreatment system,
Maintenance access,
Proposed drainage easement and public right of way (ROW),
Overflow device, and
Boundaries of drainage easement.
2. Plan details (1" = 30' or larger) for the bioretention cell showing:
- Basin dimensions
- Pretreatment system,
Maintenance access,
- Outlet structure,
Overflow device,
- Flow distribution detail for basin inflow, and
- Vegetation specifications.
3. Section view of the basin (1" = 20' or larger) showing:
- Side slopes, 3:1 or lower,
Pretreatment and treatment areas, and
- Inlet and outlet structures,
6, A construction sequence that shows how the dry detention basin will be protected from sediment until the
entire drainage area is stabilized.
7. The supporting calculations.
8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
9. A copy of the deed restrictions (if required).
10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests, County
soil maps are not an acceptable source of soils information.
Form SW401-Dry Extended Detention Basin-Rev.3 Part III. Required Items Checklist, Page 1 of 1 .

Permit Number:
(to be provided by DWQ)
X
i
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 td also fill out and submit the Required Items Checklist (Section 111) and the I&M Agreement (Section IV)
Project name
Contact name
Phone number
Date
Drainage area number
Site Characteristics
Drainage area (AD)
Impervious area
% Impervious (IA)
Design rainfall depth (RD)
Peak Flow Calculations
1-yr, 24-hr runoff depth
1-yr, 24-hr intensity
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Pre/Post 1-yr, 24-hr peak control
Storage Volume
Design volume (WQV)
Adjusted water quality volume (WQVAdi)
Volume contained in the sedimentation basin and on top of the sand filter
Top of sand filter/grate elevation
Weir elevation (between chambers)
Maximum head on the sedimentation basin and sand filter (hmrdter)
Average head on the sedimentation basin and sand filter (hA)
Runoff Coefficient (Rv)
Type of Sand Filter
Open sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (dsHwT)
Closedipre-cast sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (dSwwT)
If this is a closed, underground closed sand filter: The clearance between
the surface of the sand filter and the bottom of the roof of the underground
structure (ds.)
Walgreens Store #15151
Michael Ritch
678-5604161
January 9, 2012
Basin 1 (SF-1)
14,375.00It' OK
14,375.00 ft'
100.0% %
1.00 in
3.10
in
0.13
inihr
H5
ft3isec
1.54
ft3lsec
0.69
ft3lsec
1,138.00 ft3
853.50 ft3 OK
1,215.00 ft'
15 ft amsl
14.6 ft amsl
2.10 ft OK
1.05 ft OK
0.95 (unitless)
N YorN
ft amsl
ft amsl
Y YorN
10.33 ft amsl
11.50 ft amsl
1.17
2.40 ft
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and II. Project Design Summary, Page 1 of 2

Permit Number:
(to be provided by DWQ)
Sedimentation Basin
Surface area of sedimentation basin (As)
Sedimentation basin/chamber 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 (dF)
Coefficient of permeability for the sand filter (k)
Outlet diameter
Outlet d ischargelflowrate
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 chambedforebay (WW)?
What is the depth of sand over the outlet pipe (dpipe)?
202.50 f[ "1%. I°I°°" IM111111U111, UUl 111cly imcu W UC'Moccavu lV
3.50 ft
202.50 ft2 #DIVIO!
12.50 ft amsl
11.50 ft amsl
1.00 ft
3.50 (ft/day)
15.00 in
ft'Isec
hours
0.00 days
Y Y or N
OK
YorN
YorN
ft
YorN
Y Y or N
OK
YorN
YorN
Y Y or N
OK
1.50 ft
OK
ft
Form SW401-Sand Filter-Rev,5 2009Sep117 Parts I and II. Project Design Summary, Page 2 of 2

Permit No.
(to be provided by D WQ)
III. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal
package will result in a request for additional information. This will delay final review and approval of the project. Initial
in the space provided to indicate the following design requirements have been met. If the applicant has designated an agent,
the agent may initial below. If a requirement has not been met, attach justification.
Initials Page/ Plan
Sheet No.
2,813 and Hydre 1, Plans (1" - 50' or larger) of the entire site with labeled drainage area boundaries
2188 - 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
- Rnnnriarinc of rlrainano oncomont
8B 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.
8B 3, Section view of the sand filter (11= 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
annlicah1p).
Yes 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 DWO, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
Hydro 5. Supporting calculations (including drainage calculations)
Yes 6. Signed and notarized operation and maintenance (0&M) agreement
NIA 7, A copy of the deed restrictions (if required).
Form SW401-Sand Filter-Rev.5 20095ept17 Part III, Page 1 of 1

r
f - f
Figure 1: Open Sand Filter
SeditiuecrtatioA Wad Filter
G�iilubEr C�Ii; �ttl�El•
(or Fnrebm•) fi -
« it r CrllilEt.
Flow
III -Situ Soil
Figure 2: Closed Sand Filter
Hi hater Tahle
Weir Flow
Overland Flow
Concrete Chamber
Sedimentation Chamber
( Deposition of Heavy sediments,
Wes.
Grates
dsw«.,7lar
...... df
I__-.
Sand Filter Chamber
(Filtration of solids)
EMIR!

Permit Number:
{to be provided by DWQ)
ATA
HCDEHR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be filled out on tine, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section Ill) and the !&M Agreement (Section l�q
Project name
Walgreens Store #15151
Contact name
Michael Ritch
Phone number
678-5604161
Date
January 9, 2012
Drainage area number
Basin 1 (SF-2)
Site Characteristics
Drainage area (AD)
7,405.00 ft' OK
Impervious area
6.094.00 ftz
% Impervious (IA)
82.3% %
Design rainfall depth (Ro)
1.00 in
Peak Flow Calculations
1-yr, 24-hr runoff depth
3.10 in
1-yr, 24-hr intensity
0.13 inlhr
Pre -development 1-yr, 24-hr runoff
0.44 Wisec
Post -development 1-yr, 24-hr runoff
0.79 ft3lsec
Pre/Post 1-yr, 24-hr peak control
0.35 ft3isec
Storage Volume
Design volume (WQV)
488.00 ft'
Adjusted water quality volume (WQVAdi)
366.00 ft3
Volume contained in the sedimentation basin and on top of the sand filter
OK
758.00 ft'
Top of sand filterigrate elevation
15 ft amsl
Weir elevation (between chambers)
14.2 ft amsl
Maximum head on the sedimentation basin and sand filter (hMaxrilter)
1.20 ft Insufficient depth.
Average head on the sedimentation basin and sand filter (hA)
0.60 It OK
Runoff Coefficient (Rv)
0.79 (unitless)
Type of Sand Filter
Open sand filter?
N Y or N
SHWT elevation
it amsl
Bottom of the sand filter elevation
ft amsl
Clearance (dsw)
Closed/pre-cast sand filter?
Y Y or N
SHWT elevation
10.33 ft amsl
Bottom of the sand filter elevation
12.00 ft amsl
Clearance (dsHwr)
1.67
If this is a closed, underground closed sand filter: The clearance between
the surface of the sand filter and the bottom of the roof of the underground
1.90 ft
structure (dso,,e)
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and 11. Project Design Summary, Page 1 of 2

L t
Permit Number:
(to be provided by D WQ)
Sedimentation Basin
Surface area of sedimentation basin (As)
Sedimentation basinlchamber 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 OF)
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 (Ws'd)?
What is the depth of sand over the outlet pipe (dpipe)?
150.00 fi
Vr\. 141CCW IIIIIIIIIIUIII, UUL IIIGY IICCU LV UC 117UVUC CU LV
3.00 ft
150.00 ft
#DIVO
13.00 it amsl
12.00 ft amsl
1.00 ft
3.50 (ft/day)
15.00 in
ft3lsec
hours
0.00 days
Y Y or N
OK
YorN
YorN
It
YorN
Y Y or N
OK
YorN
YorN
Y Y or N
OK
1.50 ft
OK
ft
Form SW401-Sand Filter-Rev.5 2009Sept17
Parts I and It. Project Design Summary, Page 2 of 2

Permit No.
(to be provided by DWQ)
III. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal
package will result in a request for additional information. This will delay final review and approval of the project. Initial
in the space provided to indicate the following design requirements have been met. if the applicant has designated an agent,
the agent may initial below. If a requirement has not been met, attach justification.
Initials Pagel Plan
Sheet No.
8B, Hydrolog 1. Plans (i" - 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,
t d+t"61613 - 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
_ Rniinriariac of drainnna aacamani
8B 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
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.
8B 3. 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,
filter
- 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
annlir:ahla).
Yes 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,
Hydro 5. Supporting calculations (including drainage calculations)
Yes 6. Signed and notarized operation and maintenance (0&M) agreement
NIA 7. A copy of the deed restrictions (if required).
Form SW401-Sand Filter-Rev.5 2009Sept17 Part III, Page 1 of 1

Figure 1: Open Sand Filter
�Se&nentafion Sajid Filier
,01-ebw
Flow 'Otitlet
12+:ft
r,.
III-Siftfsoifl Sensona6i' ): HI A Water Table
.................................
Figure 2. Closed Sand Filter
-7+, ft,
..............
Ispace, hMaxFilter
.........
dPjpe
F
..............
:d
SHWT
..............
Sedimentation Chamber (rorebay) Sand Filter Chamber
(Deposition of Heavy sediments, ftanics, Clebris) (Filtration of solids)
.............
WSed

Permit Number:
(to be provided by DWQ)
ALIMA
TA
MCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be fitted out on tine, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section 111) and the I&M Agreement (Section IV)
Project name
Walgreens Store #15151
Contact name
Michael Ritch
Phone number
678-5604161
Date
January 9, 2012
Drainage area number
Basin 1 (SF-3)
Site Characteristics
Drainage area (AD)
3,485.00 ftZ OK
Impervious area
3,049.00 ftZ
% Impervious (IA)
87.5% %
Design rainfall depth (Ra)
1.00 in
Peak Flow Calculations
1-yr, 24-hr runoff depth
3.10 in
1-yr, 24-hr intensity
0.13 inlhr
Pre -development 1-yr, 24-hr runoff
0.21 ft3lsec
Post -development 1-yr, 24-hr runoff
0.37 ft3lsec
Pre/Post 1-yr, 24-hr peals control
0.16 ft3lsec
Storage Volume
Design volume (WQV)
243.00 ft3
Adjusted water quality volume (WQVAdi)
182.25 ft'
Volume contained in the sedimentation basin and on top of the sand filter
OK
378.00 ft3
Top of sand filterigrate elevation
15 ft amsl
Weir elevation (between chambers)
14.4 ft amsl
Maximum head on the sedimentation basin and sand filter (hM3,FkRer)
1.00 ft Insufficient depth,
Average head on the sedimentation basin and sand filter (hA)
0.50 ft OK
Runoff Coefficient (Rv)
0.84 (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 (dsHwT)
Closed/pre-cast sand filter'?
Y Y or N
SHWT elevation
10.33 ft amsl
Bottom of the sand filter elevation
12.40 ft amsl
Clearance (dsHwT)
2.07
If this is a closed, underground closed sand filter: The clearance between
the surface of the sand filter and the bottom of the roof of the underground
1.50 ft
structure (ds,,,)
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and II. Project Design Summary, Page 1 of 2

Permit Number:
(to be provided by DWQ)
Sedimentation Basin
Surface area of sedimentation basin (As)
90.00 ft2
VIX. 1"`9O" "11HIMUnh "u` 1110Y liuzu tv u` 1116sc°"u `U
Sedimentation basinlchamber depth
2.60 ft
Sand Filter
Surface area of sand filter (Ar)
90.00 ft 2
#DIVI01
Top of sand media filter bed elevation
13.40 ft amsl
Bottom of sand media filter bedldrain elevation
12.40 ft amsl
.Depth of the sand media filter bed (dr)
1.00 It
Coefficient of permeability for the sand filter (k)
3.50 (ft/day)
Outlet diameter
15.00 in
Outlet dischargelftowrate
ft3lsec
Time to drain the sand filter (t)
hours
Time to drain the sand filter (t)
0.00 days
Additional Information
Does volume in excess of time design volume bypass the sand filter?
Y Y or N
OK
Is an off-line flow -splitting device used?
Y or N
If draining to SA waters: Does volume in excess of the design volume flow
evenly distributed through a vegetated filter?
Y or N
What is the length of the vegetated filter?
ft
Does time design use a level spreader to evenly distribute flow?
Y or N
Is the BMP located at least 30ft from surface waters (50ft if SA waters)?
Y Y or N
OK
If not a closed bottom, is BMP located at least 100ft from water supply wells?
Y or N
Are the vegetated side slopes equal to or less than 3:1
Y or N
Is the BMP located in a recorded drainage easement with a recorded access
easement to a public Right of Way (ROW)?
Y Y or N
OK
What is the width of the sedimentation chamberlforebay (Wsd)?
1.50 ft
OK
What is the depth of sand over the outlet pipe (dpipe)?
ft
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and 11. Project Design Summary, Page 2 of 2

Permit No.
(to be provided by OWQ)
III. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal
package will result in a request for additional information. This will delay final review and approval of the project. Initial
in the space provided to indicate the following design requirements have been met. If the applicant has designated an agent,
the agent may initial below. If a requirement has not been met, attach justification.
Initials Page/ Plan
Sheet No.
8B, Hydrolog 1. Plans (1" - 50' or larger) of the entire site with labeled drainage area boundaries
Q - System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
Zr$9 chamber,
- Maintenance access,
g'#01t3 - Flow splitting device,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Pniindnrioc of rlrninnno oncomont
8B 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.
8B 3. 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 filler to the bottom of the roof of the underground structure (if
annlicahlel.
Yes 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.
Hydro 5. Supporting calculations (including drainage calculations)
Yes 6. Signed and notarized operation and maintenance (0&M) agreement
NIA 7. A copy of the deed restrictions (if required).
Form SW401-Sand Filter-Rev.5 2009Sept17 Part III, Page 1 of 1

Figure 1: Open Sand Filter
'Sedimentation S:u►d Filler
Cliuutier c1laillbel..
011fle P
Flow
hi-sitil'soili Seasonabb- Hi Rk Water Table.
.............. ? .........
vyi;. d
Figure 2: Closed Sand Filter
Sedimentation Chamber (Forebay), Sand Filter Chamber
(Deposition of Heavy sediments, Qyrganics, debris} (Filtration of solids)
..............
Med

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
5.05 *s a_[A
to ► .
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph H - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M&Tt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
WALU.CENf ST-t2E. :*_151S 1
2. Location of Project (street address):
03 0 Rases 90Ao CW 40
City: 5' e1%yitL - County: CL.AIB D zip: 2-93-1-LL
3. Directions to project (from nearest major intersection):
FCCl2AEEvRD 2oA D US o ` 1411 tl o
4. Latitude:.39 ° 07- ' 31;.7'" N Longitude: 49 ° 59 ' L3•3 " W of the main entrance to the project.
1I. PERMIT INFORMATION:
1. a. Specify whether project is (check one): [(iew ❑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 26rains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major
❑NPDES Industrial Stormwater
[Sedimentation/Erosion Control: 2 •b(o ac of Disturbed Area
❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the
issue date and the type of each permit N"L.(,4VEWS STARE * 1.3151
%O l o : N c.n EN lL_
Name, Project/Permit Number,
� 7'n: CuoneE - 2oi1- Obi ;
JAN 1 7 2012
Form SW-101 Version 07Jun2010 Page l of 6
DENR- WATER DUALITY
WETLANDS AND STORMATER BRAKVI

i
1
a
t
I . "i • . . .

III. CONTACT INFORMATION
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:
SUW C.G , LLYU
Si Official & Title:
Ong
SGo�I
MOo az�
�.....
%u Qf1 E ]o aqz
T.._.._
b. Contact information for person listed in item 1a above:
Street Ad
.SI
city:-iZA4T--.,_.. State: ��RZip: 3032�
Mailing Address (if applicable): S PiDoilE
City:
State: Zip:
Phone: (4JO ) 511- - 92-0.° .. ,... _.._.. Fax: S l2 - $lobo
Email:
Ple a check the appropriate box. The applicant listed above is:
The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization: RgjE
Signing Official & Title:
b. Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
City:
State:
State:
Phone: ( } Fax:
Email:
Zip:
Zip:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization: " GAS* 3 c-kpr -'F^L
Signing Official & Title: a
b. Contact information for person listed in item 3a above:
Mailing Address: 10 S T ST 150
City: R.oSw ELL State: (h zip: 30o-4 G, . _... _
Phone: ,( 3-40 ) S 18 - 2$ o b Fax: a - U90
Email: e_ a� CF.iaMw tc, aL L f f . C om
4. Local jurisdiction for budding permits: CR bF �
V1 L
Point of Contact:1�OtiA- an'f ' Phone #: ( 910 ) 433 ^ 14i (v
Form SWU-101 Version 07Jun2010 Page 2 of 6

.r , '
i
' � � � .F'„1 ilS ,.y
i• l � r ,
' ,' ' -. '
•�

i?R-v_ - SF l SF2 SJP�2
Baslnllnfclrmalicm _-_'l i,,' 4
Dralna �c Art�i °I .
Dralnit O[ Areli ?
Dr,nna f�;. a 3
DPalnuhe.�
Receiving Stream Nance
Beaver Cr. Trib B
Bt•aver Cr Trih B
Betivc'1• Cr. Trih B
Beaver Cr. Trib B
Stream CI.Iss *
ij>s--ilf'G
vys4ll e
� 11[
11 1fC"c
Streunl Indo-'x Nnnibef
1$-3-q.`1-S
Taal Drainage Areii (A)
11,575•
'14, 375
7,405
3,485
On -site Droirr,l;e Area (so
41181ti-
14,375
7,405
3,455
Off -site Draina.go Aroii (sf)
0 —
()
t!
0
Pro ,[,s,'ti till xer� ions Area (sf)
25,265
1�4,375
0,09.4
3,049
"". ]m 1olvi+,lls Area** (lotal)
fill
100
s23
87.5
1111 )E'I-Vil:iliS­ Snrhlt'l' Area •
Draltla ' ,Arca 1 -
DIaina Te: Arc`a 2
I.71•:11nagt-' Ar'ea 3 _
Drainiq;e-­AI•erl 4
—
On -site Buddings/Lots (sf)
7,410
7,410
I1
[)
On -site Stret'Is (sl)
-17,855
6,965
6,094
3,049
On -site Parking (A)
0
tl
0
0
011-tilt(.' Sill[•+\'inks (Sl)
t)
0
P
0
Other on -silk' (tit)
1)
0
0
0
Fntmv {sf)
0
0
0
0
Off -site (SO
0
t?
0
0
1:; istinI'll BUA' (sf)
I}
1)
If
0
Total (sl):
1 25,265
14,375
6,094
3,049
titretvjr Cla;s air it Nrr!ilber•Cal I he r10cr•Ifrilet Ilit: lrttjl://r7rir'tfil,7lCl/L'Fr7".[71/rt�ch/ertU��/cstr/ctra�srfirrttrr�rrti
III rlIl1�r)Trolfr : arr'rf i; dt fiw'd 11n tin• hlrilt upon wren hwhnli!f,,, but 1101 liruilt'd If hniIrlirr,�ti, r'uctrls, l,arlcilr,�
,�frr['rl'all<.y, ,,raz'4'1 orCrr,;, CIC.
�'�l�t'!n!I'1 !lril[t ff1a1 r}lrlr!fr111 r,fi.litililft,' f�tlA tll,[t il�lll rt'rfflllfl nftr'1'rl['�'['lr!lt}1f1'rfl. lti� 7f�!t r['lk�l"t nfn� C.l'l�tifr�ti I�CIA that
is if) bc' acneneat arrrl Which will be rC11111CC11 hlt fiezt' VC1A.
H. How was the off --site impervious area listed above determined? Provide d(x.ume Citation. n a
Pro'ects in Union County: Contact DIVQ CentralOf ce staff to check if the project is located within a Threatened &
Endangered Species x,atenshed that nlav be subject to more stringent stommater requirements as per NCAC 0213.0600.
V. SUPPLEMENT AND O&M FORMS
The iipplieaWe stint- sttlrnnvater management pernlitsupplenWilt and aheration and maintenance (O&R-l) forms
nrtrst he' suh[niticd for each BAdP specified for this project. Tht' lidesl versions (4the forms can he dowlibladt'd
from htlp://1,011<<!_.nc:denr.orf� web/1vc�(ws/su/bmh-rlZatzual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will he accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items liste&below. A detailed application instruction sheet and BNJP
checklists are available from http://pr,r'lal.nc;derv,org/Zvi:b/lvtl/ws/su/s!alesw/foruls_docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appri+priaty office nuly be
himid by locating project on the interactive online neap at hll�/�,clrlal.ncdenr.clr�[1rf ►vehJlvc)�}ysJstiJnlats-)
Please indicate that the following required information have been provide_ d by initialing in the space provided
fOr each ik'm. All t,riginal liocunlenls A'lUST he signed and initialed in blue ink. Download the latest versions
for each submitted application package front 11tty f Zlit) rlaI-Iwd eur.01'k'/,ych/Wk WS/su JSIalesly/f(1rIIIS_dOCS.
Initials
7. i.)ri,�inal ffildu!rrCOIT'1 [.Il tht-.St0rL11Wi1ter A'Ia EW 41lellt Pormil Applicatit,n Forn1.
2. Orl ,anal and me copy of the signed and notarized Deed RestrlChUr1S & Protective Covenants
Form. (if reglnrefI as per, Part V1I belozo)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agree.rnenl(s) for each BM P.
4. Permit application processing fee of $505 payable to NCOENR. (For an Express review, refer to
http://www.c�nvhta,�c)rye[�,llyes/clneslclpexpress.hlml for information on the Express prograrn
and the associated fees. Contact the appropriate regional office Express Permit Ccx)ydinator for
additional information and to schedule the required application meting,.)
Form SWt]-101 Version 073un2010 Page 4 of 7

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
2V140 So A t \4Q y6went13 ftuJt
S 1 5 D Rmpm M0Z- a 'Or vh0. Wial walept
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. If Claiming vested rights, 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 CgPE FEAT - River basin.
4. Total Property Area: 2-.15(. acres 5. TotaI Coastal Wetlands Area: O acres
6. Total Surface Water Area: O acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area': 2. S to acres
+ Total project area shall be calculated to exclude the following the normal pool of imPpo�u�nded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHK9 Iine or Mean High Water
W)
(MHline, and coastal wetlands landward from the NHW (or MHi? line. The resultant project area is used to
calculate overall percent built upon area (BLIA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = Sj Z S
9. How many drainage areas does the project have? Z (For high density, count T for each proposed engineered
stormwater BMR 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
Drain Area _L
Drainage Area ' Z
Drainage Area
. Drain a Area
Receiving Stream Name
BGwer G n
Stream Class *
13MG
Vis -1 1
Stream Index Number
3k_lk_S
Total Drainage Area (so
1 8C
On-site Drainage Area (so
'3
IPI VLO
Off -site Drainage Area (so
p
0
Proposed Impervious Area** s
0(0
Impervious Area** total
"n
4m ous'"Sutface.A'rea
Drama Area'
Drains e`Area "
Drairia' 'Area'
Drain' Area'"_
On -site Buildin /Lots (sf)
I4 Zo
p
On -site Streets (so
0
p
On -site Parking (so
y Z.4'1
b
On -site Sidewalks (sf)
0 C" u FD
o
Other on -site (so
p
o
Future (sf)
a
Off -site (so
p
C
Existing BUA*** (sf)
0
O
Total (so:
O(o
0
* Stream Class and Index Number can be determined at: lit : ortal.ncdeiir.or eb s cs classi cations
" Imp ous area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
* *Report only that amount of existing BUA that will remain after development. Do not report any existing BCIA that
is to be removed and which will be replaced by new BLIA.
Form SW- 101 Version 07Jun20I0 Page 3 of 6

2

11. How was the off -site impervious area listed above determined? Provide documentation. tO A
Protects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per NCAC 02B . 0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from h4p://PoTtal.ncdenr.orjZ/web/wq/ws/su/bmp-manual,
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items Iisted below. A detailed application instruction sheet and BMP
checklists are available from hqp://portal.ncdenr.ors/web/wq/ws/suZstatesw/forms_docs. The complete
application package should be submitted to the appropriate DWO Office. (The appropriate office may be
found by locating project on the interactive online map at http:/ /portal.ncdenr.org/web/wq/ws/su maps.)
Please indicate that the following re uired information have been lzrovided hy initialen 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 hU:/ /portal.ncdertr.org/web/`­wq/ws/su statesw forms ds.
1. Original and one copy of the Stormwater Management Permit Application Form. f
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP. /
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to ✓
h!W:/ /www,envhelt).org/12aM/onestox ress.htm] 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 u
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.i
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the'/s
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. 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).
Form SWU-101 Version 07Jun2010 Page 4 of 6

r
.1'�
r

9. Copy of any applicable soils report with the associated SHWT elevations (Please identify ,
elevations in addition to depths) as well as a map of the baring locations with the existing
elevations and boring logs. Include an 8.5"01" 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: 13 rage No:
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC ✓
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 2H.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
hqp:/ /www.secretaM.s_tate.nc.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 -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
htt : portai.ncdenr.or web w /ws/su statesw forms flocs. 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.
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: rlcwAEL l).
Consulting Firm:
Mailing Address
City: State: Q-)h Zip: 30ob8
Phone: 8 S(oo- 40b1 Fax: LG, S 1 51.o—L41(,1
Email: a7 S4_- ae%! i-
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or hjpe name of person Iisted in Contact Information, item 2a) �-�Cc} Mc)oM 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 Information, item 1a) , nc.s,U.i. with (print or type name of organization listed in
Contact Information, item 1a)C .,\, � Livv tLx._ 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 07Jun2010 Page 5 of 6

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As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I unders d that the operation of a stormwater treatment facility without a valid
permit is a violatio NC General State 143-215.1 and may result in appropriate enforcement action including
the assessment of�K penal $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date: 119 lZ.
0I
1' 0 0 P a Notary Public for the State of e ,i - County of
l -UrJL)„,. do hereby certify that _ J iZTl- ft , tyl On Y'-P ,_ _personally appeared
before me this 9 day of O r- 67'und acknowledge the due execution f the application for
a stormwater permit. Witness my hand and official seal,
OP— \\AA S"
;� 1SOTgRy.
a��,�UBLIC
C/1, . F,CHkiSy'.nQ�
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION /]/j
I, (print or type name of person listed in Contact Information, item Ta) Ca /r oo
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 cove nts wiII be r ded, and that the proposed project complies with the requirements of the
applicable stormw r rules and r A NCAC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Signature: Date: iL
1,0
1, l,V l a- a Notary Public for the State of 'e0 f Q. County of
�b do hereby certify that Mop r c personally appeared
before me this 6f day of RO and a='9'
the due ex do f the application for
a stormwater permit. Witness my hand and official seal,
.
NOTARY
pUBLtiG ^''
SEAL
My commission expires 9 i3 a o
Form SWU-101 Version 07]un2010
Page 6 of 6