SW8120501_CURRENT PERMIT_20120511

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW q"N DJ �
DOC TYPE
� CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

A.
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
May 11, 2012
Brian Clodfelter, Member Manager
Par 5 Development Group, LLC
2860-B NC 5 Highway
Aberdeen, NC 28315
Division of Water Quality
Charles Wakild, P. E.
Director
Subject: State Stormwater Management Permit No. SW8120501
Dollar General — Mt. Misery Road
High Density Commercial infiltration Basin Project
Brunswick County
Dear Mr. Clodfelter:
Dee Freeman
Secretary
The Wilmington Regional Office received a complete State Stormwater Management Permit Application for Dollar
General — Mt. Misery Road on May 2, 2012. Staff review of the plans and specifications has determined that the
project, as proposed, will comply with the Stormwater Regulations set forth in Session Law 2008-211 and Title 15A
NCAC 2H.1000. We are forwarding Permit No. SW8120501 dated May 11, 2012, for the construction, operation and
maintenance of the BMP's and built -upon area associated with the subject project.
This permit shall be effective from the date of issuance until May 11, 2020, and shall be subject to the conditions and
limitations as specified therein. Please pay special attention to the conditions listed in this permit regarding the
Operation and Maintenance of the BMP(s), recordation of deed restrictions, certification of the BMP's, procedures for
changes of ownership, transferring the permit, and renewing the permit. Failure to establish an adequate system for
operation and maintenance of the stormwater management system, to record deed restrictions, to certify the BMP's,
to transfer the permit, or to renew the permit, 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 by filing a written petition with the Office of Administrative Hearings (OAH). The written petition
must conform to Chapter 150B of the North Carolina General Statutes, and must be filed with the OAH within thirty
(30) days of receipt of this permit. Unless such demands are made this permit shall be final and binding. You should
contact the OAH with all questions regarding the filing fee and/or the details of the filing process. The mailing
address, telephone and fax numbers for the Office of Administrative Hearings are: 6714 Mail Service Center,
Raleigh, NC 27699-6714. Telephone [phone] or visit their website at www.ncoah.com.
If you have any questions, or need additional information concerning this matter, please contact Chris Baker, at (910)
796-7215.
4Sinc rely, \
For Charles Wakild, P. E., Director
Division of Water Quality
GDS/csb: S:1WQS1StormwaterlPermits & Projectsl20121120501 HD Q012 05 permit 120501
cc: ,tames B. Reed, P. E., Call Sign Engineers
Brunswick County Building Inspections
Brunswick County Engineering
Wilmington Regional Office Stormwater File
Wilmington Regionaf Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405 One
Phone: [phone] FAX: [phone] Customer Service: 1-877-623.6748 North Caro 1 i n a
Internet: w%w.ncwaterquality.org "]fj "
atum ly
An Equal Opportunity 1 Affirmative Action Employer �/

State Stormwater Management Systems
Permit No. SW8 120501
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY COMMERCIAL 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
Par 5 Development Group, LLC
Dollar General Store — Mt Misery Road
Mt. Misery Road, Leland Brunswick County
FOR THE
construction, operation and maintenance of a infiltration basin in compliance with the
provisions of Session Law 2008-211 and 15A NCAC 2H .1000 (hereafter collectively
and separately referred to as the "stormwater rules') and the approved stormwater
management plans and specifications and other supporting data as attached and on file
with and approved by the Division of Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until May 11, 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 1.8 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from 33,541 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.8
on page 3 of this permit, 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 project shall provide a 50' wide vegetated buffer adjacent surface waters,
measured horizontally from and perpendicular to the normal pool of impounded
structures, the top of bank of both sides of streams and rivers, and the mean high
water line of tidal waters.
Page 2of7

State Stormwater Management Systems
Permit No. SW8 120501
R
VA
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 following design criteria have been permitted for the infiltration basin and
must be provided and maintained at design condition:
a.
Drainage Area, acres:
0.98
Onsite, ft :
42,689
Offsite, ft2:
NIA
b.
Total Impervious Surfaces, ft2:
33,541
Onsite, ft :
33,541
Offsite, ft2:
NIA
C.
Design Storm, inches:
1.5
d.
Basin Depth, feet:
1.6
e.
Bottom Elevation, FMSI :
30.5
f.
Bottom Surface Area, ft :
3,880
g.
Bypass Weir Elevation, FMSL:
32.1
h.
Permitted Storage Volume, ft3:
8,690
i.
Predevelopment 1 yr 24 hr peak flow, cfs:
0.45
j.
Post -development 1 yr 24 hr peak flow, cfs:
0.19
k.
Type of Soil:
Loamy Sand
I.
Expected Infiltration Rate, in/hr:
1
M.
Seasonal High Water Table, FMSL:
28.5
n.
Time to Draw Down, hours:
24
a.
Receiving Stream/River Basin:
Baton Branch 1 Cape Fear
P.
Stream Index Number:
18-77-1-1-2
q.
Classification of Water Body:
"C;Sw"
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 times provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must be followed in its
entirety and maintenance must occur at the scheduled intervals including,,but not
limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of bypass structure, infiltration media, flow
spreader, catch basins, piping and vegetated filter.
g. A clear access path to the bypass structure must be available at all times.
4. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
5. 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.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW8 120501
6. 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.
7. 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.
8. 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.
9. Access to the stormwater facilities shall be maintained via appropriate
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 development, subdivision, acquisition, lease or sale of any, all or
part of the project area. The project area is defined as all property owned
by the permittee, for which Sedimentation and Erosion Control Plan
approval or a CAMA Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. 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. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
2. This permit is not transferable to any person or entity except after notice to and
approval by the Director. At least 30 days prior to a change of ownership, or a
name change of the project or of the permittee or a mailing address change, the
permittee shall submit a completed and signed Name/Ownership Change form to
the Division of Water Quality, accompanied by the appropriate documentation as
listed on the form. The approval of this request will be considered on its merits
and may or may not be approved.
Page 4of7

State Stormwater Management Systems
Permit No. SW8 120501
3. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request. Neither the sale of the project
in whole or in part, nor the conveyance of common area to a third party shall
constitute an approved transfer request.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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 reissuance or
termination does not stay any permit condition.
9. Unless specified elsewhere, permanent seeding requirements for the stormwater
controls must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revolting and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2008-
211, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et. al.
11. The permittee shall submit a permit renewal application at least 180 days prior to
the expiration date of this permit. The renewal request must include the
appropriate documentation and the processing fee.
Permit issued this the 11 th day of May, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5 of 7

State Stormwater Management Systems
Permit No. SW8 120501
Dollar General Story — Mt. Misery Roak
Stormwater Permit No. SW8 120501
Brunswick 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)
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 Management Systems
Permit No. SW8 120501
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 bypass structure weir elevation is per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. All required design depths are provided.
13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Brunswick County Building Inspections
Page 7 of 7

DWQ USE ONLY
Date Received
Fee Paid Permit Dumber
Applicab e Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may 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.):
Dollar General Store - Mt. Miser- Road
2. Location of Project (street address):
Mt. Misery Road
City:Leland County:Brunswick Zip:28451
3. Directions to project (from nearest major intersection):
The eroiect site is located on _Mt. Misery_ Road (SR 1426) near its intersection with SR 1479 and SR 1480.
4. Latitude:34° 15' 36" N Longitude:78° 03' 19.08" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®Ne,,,, ❑Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed' ❑ Completed' *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
If this application is being submitted as the result of a previously returned application or a Ietter from DWQ
requesting a state Stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permit`s can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑LAMA Major
®Sedimentation/Erosion Control: 2 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.lf any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
ECEIVE"
MAY 0 2 2012
BY: —
Form SWU-101 Version 07Jun2010 Page I of 6

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:Par 5 Development Group, LLC
Signing Official & Title:Brian Clocifelter, Member Manager
b.Contact information for person listed in item 1a above:
Street Address:2860-B NC 5 Highway
City:Aberdeen State:NC Zip:28315
Mailing Address (if applicable):2860-13 NC 5 Highway
City:Aberdeen State:NC Zip:28315
Phone: (910 } 944-0881 Fax: (910 ) 944-0881
Email: briar©rhetsoncompanies.com
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. ("Phis is the
person who owns the property that the project is located on):
Property Owner/Organization:Charlie M. Skipper
Signing Official & TitIe:Charlie M. Skipper, Owner
b.Contact information for person listed in item 2a above:
Street Address:4924 Woodcrest Drive
City:Caslte Flayne State:NC Zip:28429
Mailing Address (if applicable):4924 Woodcrest Drive
City:Caslte Ha
Phone: ( }
Email:
State:NC Zip:28429
Fax: ( }
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: 1 ! Zip:
BY: —
Fax: ( }
4. Local jurisdiction for building permits: Brunswick County
Point of Contact:Helen Bunch Phone #: (910 ) 253-2050
Form S WU-10l Version 07.1un2010 Page 2 of 6
E OE

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The proposed parking lot and building will be designed so that runoff discharges into and is treated by an
infiltration basin.
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 CaRe Fear River basin.
4. Total Property Area: 1.28 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+:1.28 acres
Total project area shall be calculated to exclude the follawin the normal pool of impounded structures, the area
between the batiks of streams and rivers, the area below the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landzoard front the NHW (or MHW) litre. The resultant project area is used to
calculate overall percent built upon area (B UA). Nau-coastal wetlands landzvard of tlue NHW (or MHM lifie ttiay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 60
9. How many drainage areas does the project have?l (For high density, count I for each proposed engineered
stormwater BMP. For tow density and other projects, use I 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 Areal
Draina e Area _
Drainage Area _
Draina >e Area _
Receiving Stream Name
Banton Branch
Stream Class *
QSW
Stream Index Number *
18-77-1-1-2
Total Drainage Area (so
42,689
On -site Drainage Area (so
42,689
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
33,541
Impervious Area** (total)
79%
Impervious— Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
9,100
On -site Streets (so
0
On -site Parking (so
24,225
On -site Sidewalks (so
0
W_-
Other on -site (so
216
_
,t
Future (so
0
IVIH1 U 4 LV
L
Off -site (sf)
0
i
Existing 13UA*** (so
0
Total (so:
33,541
Stream Class and Index Number can be detertuiued at: littp.aortal.ucdertr.org ebAtpq&s/csu/classifications
* lux pervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
si ewalks, gravel areas, etc.
Norm SWU-101 Version 07Jun2010 Page 3 of 6

'Report only that aniount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which zoill be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DIVQ 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 cis per NCAC 028 .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 httl2:ZZ2ortal.ncdenr.org/wet/",gLws/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 listed below. A detailed application instruction sheet and BMP
checklists are available from http://portil.ncdenr.org/web/wq/ws/su/statesw/forms_docs. 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 htt://_portal.ncdeiir.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
_http://www.envhelp.org/pages/onestopex press. htmI 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 storm water treatment/management
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'/2
mile radius on the map.
7. Sealed, signed and dated calculations.
for
Gam/
`�
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:��C/
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 NI-1W lines. `� E C E IVE
• 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 wae�s. MAY 0 2 2012
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. BY:--
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 Versicm 07Jun2010 Page 4 of 6

9. Copy of any applicable soils report with the associated SHWT elevations (Please identifyj,/ _
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 verify the SI WT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1095 Page No: 0545
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC L✓
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1 a, 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.
htt2://www.secretary.state.tic.uslCorpor-,itioiis/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
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. 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:C. Heath Wadsworth, PE
Consulting Firm: Call Sip_n Engineers, PA
Mailing Address:104 Gillespie Street
City:Fayetteville
Phone: (9-10 ) 486-0700
Email:heath.wadsworth©cailsignengineers.com
State:NC Zip:2830"1
Fax: (91.0 ) 486-8900
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) Charlie M. Skipper , 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) Brian Clodfel ter with (print or type In7me of organization listen in
Contact Information, item 1a) Par 5 Development CrouL) LLC _ 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.
ECEN .
MAY 4 2 2012
BY:
Form SWU-101 Version 07Jun2010 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity fisted 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.
Signature: (_. ifs/.L-�� Date:/,/, ,�_3 - 2
1 L�1•e�I �,►' t I� ✓ ', a Notary Public for the State of �c?` C �rUlrl^0. , County of
NfQW 4CLr"0yf-+r do hereby certify that �-ha-rU e. rn - S k4prx✓ personally appeared
before me this day of ZOI� , and acknowledgethedue execution of the application for
a stormwater permit, Witness my hand and official seal, i( '�t,
� r�oTARy �
PUBLIC :
�tl111��
X. APPLICANT'S CERTIFICATION
SEAL,
My commission expires S�GLk� 2-015
1, (print or type narne of person listen in Contact Information, item 7a) Brian Clod{elter
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 stormwatoellles undX 15A NCB 2I-1 .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Signature:
Date:_` ff— ra11
1, �VbAca- - a Notary Public for
_the
(State of County of
do hereby certify that tC.I1 V, personally appeared
before me this I'S day of h I and J ledge th e cution of the application for
a stormwater permit. Witness my hand and official seal,
P1
441
Notary Publlc ir,_
Moore county ^
�My comm4sston ExpIres-
Ob11912fl 1 bT
ni
SEAL
My commission expires to -- � 9- au I L
FIECEIVE
MAY 0 2 2012
l
Form SWU-101 Version 073Un2010 Page 6 of 6

4.,
Permit No: ' ` U / ZA__52_2/
(to be waded by DM)
� of wnrF9 G
ATA STORMWATER MANAGEMENT PERMIT APPLICATION FORM o
HCDENR 401 CERTIFICATION APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form must be Rkd out, printed and sub =Wed.
The Required Hems Chockfist (Part 110 most be printed, Trtlod out and s1bnfffed along with ap of fire required information.
Projed Name
Contact Person
Ptmarre Number
Date
Drainage Area Number
Site Chamderistics
Dravrape area
Impervious area
Pemant impervious
Design mnla0 depth
peal Flow Calculations
1-1fr. 244u rainfall depth
1-yr. 244mr intensity
Pro -development 1-yr. 244u discharge
Post -development 1-yr, 244u discharge
PrelPos11-yr, 244rr peak flow control
Storage Volume: Non -SA Waters
Mirmnwn design volume required
Design volume Provided
Storage Vohrme: SA Waters
1.5 runoff volume
Pre -development 1-yr. 24-tu rumoff volume
Post4evelopment 1-yr. 24-hr runoff volume
Minimum requaed vokmm
Volune provided
SoiTs Report Summary
Sad type
Infiltration rate
SHWT ckra5or
Basin Design Parmrrueters
Orawdorr time
Baser side slopes
Bashi bottom elevation
Storage elevation
Storage Surface Area
Top elevation
Basin Bottom Dimensions
Basin lerrpth
Basin width
Bottom Surface Area
Dollar General Stare - M1. Misery Road
C. Heath Wads*VrUX PE
910486-0700
4I1912012
DA 1
42.689.00 tlz
33.541.00
78.57 %
1.50 in
3.83
m
NIA
inlhr
045
f1llsec
0.19
llrtsec
-0.26
t lsee
4,WA0 fly
8,6W.00 to
il
f?
to
fe
fe
Loamy Sand
1.00 h1hr
28.50 hsl
OK for non -SA waters
1.00
days OK
3.00
:1 OK
30.50
fmsl OK
32.10
fmsl
6,110.00
f?
32.75
fmsl
96.00 f1
35.00 ft
3 eeo.00 f?
PEG
Form $W4014 riftation 8asln4;ev.5 1 tApM11 Parts L d It Design Swomry. Pape I of 2

ti
Permit No.
fto bepoviaadbr nwnl
Additional Information
Maximum runoff to each inlet to the basin?
2.00
ac-in
OK
Length of vegetaWe filler for overflow
ft
Distance to structure
ft
Distance tarn surface waters
30.00
ft
OK for non -SA waters
Distance firm water supply well(s)
>100
a
OK
Separation from impervious sod layer
200
H
OK
Naturally ooanaug sod above shw1
1.50
it
OK
Bottom covered with 4-in of dean sand?
Y
(Y or N)
OK
Proposed drainage easement provided?
Y
(Y or N)
OK
Capures all runoff at ultimate build -out?
Y
(Y or N)
OK
Bypass provided for larger storrLs?
Y
lY or N)
OK
Pretreatment device provided
Y
Rip Rap basin with 10 fl wide sodded strip
CEf
` MAY 02
Form SW4014r&Qratim B*�-Aer.S 11AprMl l Parts L & li. Design Surnrruuy, Pepe 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.
Page! Plan
Initials Sheet No.
_ZP41 6,1T,-O i 1. Plans (1" 50' or larger) of the entire site showing:
- Design at ultimate build -out,
Off -site drainage (if applicable),
Delineated drainage basins (include Rational C coefficient per basin),
Basin dimensions,
Pretreatment system,
High flow bypass system,
Maintenance access,
Proposed drainage easement and public right of way (ROW),
Overflow device, and
Boundaries of drainage easement.
�r� Z& -O 1 2. Partial plan (1" = 30' or larger) and details for the infiltration basin showing:
- Bypass structure,
Maintenance access,
- Basin bottom dimensions,
Basin cross-section with benchmark for sediment cleanout,
Flow distribution detail for inflow,
Vegetated filter, and
Pretreatment device.
4& -3. Section view of the infiltration basin 0" = 20' or larger) showing:
- Pretreatment and treatment areas, and
Inlet and outlet structures.
4. A table of elevations, areas, incremental volumes & accumulated volumes to verify the volume provided.
* <" 'D Wo PA4c v- pwr w ?-MbVr Ai'PfA41p► Y. (p 6 U, a r 296
!L '1✓ 4` �► 5. 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.
/� / r x /," AR'r*41D1 x OF �¢b 9:T
z k *A 6. A construction sequence that shows how the infitlration basin will be protected from sediment until the
entire drainage area is stabilized.
4 * 4 S-SE N aTIE, i pN -VF-A►^v ► J G- 114 0 - G !r — 01
KEPotr'r 7. The supporting calculations.
GHN AT —MA wD 8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
.zl�v .� 9. A copy of the deed restrictions (if required).
MAY 0 2 2012
Form SW401-Infiltration Basin-Rev.4 Page 1 of 1 Part Ili. Required Items Checklist, Page 1 of 1 -

7
ip
Permit Numbcr45 IZDZ5�/
(to be proi4ded by DIVQ)
Drainage Area Number:
Infiltration 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 Ioccation. 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
infiltration basin.
Immediately after the infiltration basin is established, the vegetation will be
watered twice weekly if needed until the plants become established (commonly
six weeks).
— No portion of the infiltration basin will be fertilized after the initial fertilization
that is required to establish the vegetation.
— The vegetation in and around the basin will be maintained at a height of
approximately six inches.
After the infiltration 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 rernediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
infiltration basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
The inlet device: pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
swale
ae2liLable .
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
l,rosion 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.
-EGEIV
MAY 0 2 2012
Form 5W401-Infiltration Basin O&M-Rev.3 Page I of 3
H' -

BMP element:
The forebay
The main treatment area
The embankment
The outlet device
The receiving water
Potential problem:
Sediment has accumulated
and reduced the depth to 75%
of the original design depth.
Erosion has occurred or
riprap is displaced.
Weeds are present.
A visible layer of sediment
has accumulated.
Water is standing more than
5 days after a storm event.
Weeds and noxious plants are
growing in the main
treatment area.
Shrubs or trees have started
to grow on the embankment.
An annual inspection by an
appropriate professional
shows that the embankment
needs ret)air.
Clogging has occurred.
The outlet device is damages
Erosion or other signs of
damage have occurred at the
outlet.
Form SW401-Infiltration Basin O&M-Rev.3
How I will remediate the problem:
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Remove the weeds, preferably by
hand. if pesticides are used, wipe
them on the plants rather than
spraying.
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMI'. Replace any media that
was removed in the process.
Revegetate disturbed areas
immediately.
Replace the top few inches of filter
media and see if this corrects the
standing water problem. If so,
revegetate immediately. If not,
consult an appropriate professional
for a more extensive repair.
Remove the plants by hand or by
wiping them with pesticide (do not
spray).
Remove shrubs or trees
immediately.
Make all needed repairs.
Clean out the outlet device. Dispose
of the sediment off -site.
Repair or replace the outlet device.
Contact the NC Division of Water
Quality 40"1 Oversight Unit at 919-
733-1786.
EC;E VE
MAY 0 2 2012
BY:—_ pagi; 2 Of 3

e
Permit Number:
(to be provided by DIVQ)
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:Doliar General Store - Mt. Misery Road
BMP drainage area number: l
Print narne:Brian Clodfelter
Title:Member Manager (Par 5 Development Group, LLC)
Address:2860-B NC 5 Highway; Aberdeen, NC 28315
Phone
Signa
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, - Pwc — P1 11Y1't,e , a Notary Public for the State of
County of do hereby certify that
F2- a*— personally appeared before me this 17
day of &nvi 1 1 �—, and acknowledge the due execution of the
forgoing infiltration basin maintenance requirements. Witness my hand and official seal,
GGA4PIrTM���'%
Notary PubliC
Moore Cauniy
;idly Commission Explres=
06/ 1912016
�O
SEAL
My commission expires
Form SW401-Infiltration Basin O&M-Rev.3
1,'Iq - --O [ L
GE D V Ewa,")
i
k` MAY 422012
Y:--Paa- 3 oT 3

05-11-' 12 14:34 rR0t9-DENR Lilaim.ingzim 910-350-2004 'l'-332 P00,97/0008 r-H2
I
Dollar General Story — Mt. Misery Roak
Stormwater Permit No. SW8 120501
Brunswick County
Designer's Certification
State 5tcraiwater Management Systems
Permit No.�,Q 8 12g5Ct1
E
I, C. j4fPerki INft'Ds a Vf , as a duly registered _Fkopfr4Sto�� j„ , ►GI N�€.Z in the
State of North Carolina, having been authorized to observe (periodicallyl weekly/ full
time) the construction of the project,
3�01•�-�'iz __Ci �.N �.i�A"t-, sTD�E - Mr M tS t~i�-Y g-D.�r.-L D Nc
(Project)
for FAg- 5 �Ev9.oer► et4-r �i?wr? 4�-G - _(Project Owner) hereby state that, to the
best of my abilities, clue 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 _ 0 8p ZrsSrp�
Registration Number 26 LtZ_ I - S -
/ 28421
Date JD/ZW ZO�L N� �a
M,
ECE O qY E
OCT 2 9 2012
BY:
_t,

05-11-'12 14:35 FROM-PENE Wilmingtim
9ZC�-35�i-2f7f-�4 T-332 P0008/0008 F-282
Certification Requirements:
State Stormwater Management Systems
Permit No. SW8 120501
_ ✓ 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 bypass structure weir elevation is per the approved plan.
,_✓ 6_ The bypass structure is located per the approved plans.
M44 7. A Trash Rack is provided on the bypass structure.
✓ S. All slopes are grassed with permanent vegetation.
T 9: Vegetated slopes are no steoper than 3:1.
✓^10, The inlets are located per the approved plans and do not cause short-
circuiting of the system,
✓ _11. The permitted amounts of surface area and/or volume have been
provided.
✓ -12. All required design depths are provided.
✓ 13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans,
cc: NCDENR-DWQ Regional Office
Brunswick County Building Inspections
r-, - - - -r _'C