SW1160501_CURRENT PERMIT_20160527

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

Energy, Mineral
and Land Resources
ENVIRONMENTAL OUALITV
May 27, 2016
Mr. Bob Broadway
Managing Member
The Broadway Group, LLC
216 West Side Square
Huntsville, AL 35801
PAT MCCRORY
Gnrenmr
DONALD R. VAN DER VAART
Subject: Stormwater Permit No. SW 1160501
New Retail Store, Sapphire NC in Transylvania County
Dear Mr. Broadway:
.5""na-e
TRACY DAVIS
The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater
Management Permit Application for the subject project on May 25, 2016. 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 Section NCAC 2H.1000. We are forwarding Permit No. SW 1 160501, dated May
27, 2016, for the construction, operation and maintenance of the subject project and the stormwater
system. This permit shall be effective from the date of issuance until May 26, 2024, or until rescinded and
shall be subject to the conditions and limitations as specified therein, and does not supersede any other
agency permit that may be required.
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. Per
NCGS 143-215(e) the petition must be filed with the OAH within thirty (30) days of receipt of this
permit. You should contact the OAI-I with all questions regarding the filing fee (if a filing fee is required)
and/or the details of the filing process at 6714 Mail Service Center, Raleigh, NC 27699-6714, or via
telephone at 919-431-3000, or visit their website at www.NCOAH.com. Unless such demands are made
this permit shall be final and binding.
This project will be kept on file at the Asheville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Mike Randall at [phone]; or
[e-mail].
Sincerely, Received
r
forforTrw3s,PE/for JUN 13 2016
cc: SW 1160501 File, Asheville Regional Office Land Quality Section
ec: Mellissa Ballard, The Broadway Group Asheville
Derek Westfall, EDT, Inc.
State of North Carolina I Environmental Quality I Energy. Mineral and land Resources
1612 Mail Service Center I Raleigh. North Carolina 27699-1612
919-807-6375

State Stormwater Permit
Permit No. SW 1160501
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT QUALITY
STATE STORMWATER MANAGEMENT PERMIT
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
The Broadway Group, LLC
New Retail Store, Sapphire NC in Transylvania County
FOR THE
construction, operation and maintenance of an infiltration basin in compliance with the
provisions of 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 State and considered a part of this permit.
This permit shall be effective from the date of issuance until May 26, 2024, and shall be
subject to the following specified conditions and limitations:
1. 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. The infiltration basin is approved for the management of stormwater runoff as
described in the application documents and as shown on the approved plans.
3. 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.
4. The runoff from all built -upon area within the permitted drainage area of this project
must be directed into the infiltration basin.
5. 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 4

State Stormwater Permit
Permit No. SW 1160501
11. SCHEDULE OF COMPLIANCE
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
The permittee shall at all time provide the operation and maintenance necessary to
assure the permitted infiltration basin 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.
G. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader, filter
media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
Records of maintenance activities must be kept for the permitted infiltration basis.
The reports will indicate the date, activity, name of person performing the work and
what actions were taken.
4. The permittee shall submit an annual summary report of the maintenance and
inspection records for the infiltration basin. The report shall summarize the
inspection dates, results of the inspections, and the maintenance work performed at
each inspection.
5. The infiltration basin shall be constructed in accordance with the approved plans
and specifications, the conditions of this permit, and with other supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received from
an appropriate designer for the infiltration basin certifying that the permitted facility
has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A modification
may be required for those deviations.
7. If the stormwater system was used as an Erosion Control device, it must be restored
to design condition prior to operation as a stormwater treatment device, and prior to
occupancy of the facility.
8. 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.
Page 2 of 4

State Stormwater Permit
Permit No. SW 1160501
A copy of the approved plans and specifications shall be maintained on file by the
Permittee for a minimum of eight years from the date of the completion of
construction.
10. The Director may notify the permittee when the permitted site does not meet one or
more of the minimum requirements of the permit. Within the time frame specified in
the notice, the permittee shall submit a written time schedule to the Director for
modifying the site to meet minimum requirements. The permittee shall provide
copies of revised plans and certification in writing to the Director that the changes
have been made.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director. In
the event of a change of ownership, or a name change, the permittee must submit a
completed Name/Ownership Change form signed by both parties, to the State,
accompanied by the supporting documentation. The,appiroval'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 State, 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 DEQ 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.
Page 3 of 4

®State Stormwater Permit
Permit No. SW 1160501
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit as
allowed by the laws, rules and regulations contained in Session Law 2006-246, Title
15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division in writing of any name, ownership or mailing
address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 27th day of May, 2016.
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

State Stormwater Permit
Permit No. SW 1160501
The Broadway Group, LLC
New Retail Store, Sapphire NC in Transylvania County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
(Project Name)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
cc: NCQ-DEMLR Regional Office
SEAL
Page 1 of 1

II Date Received I Fee Paid I — , .Permit Number . II
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph 11 - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
State of North Carolina
Department of Environment and Natural Resources RFr'=l\XD
Division of Energy, Mineral and Land Resources
MAY 25 2�116
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This fora may be photocopied far use as an original QEMR-IA ND QUALITY
STORMWA1'ER pERYM ING
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.): R@CeIV2d
New Retail Store - Sapphire, NC
2. Location of Project (street address):
Southwest intersection of US Hiehwav 64 and State Road 1152
City:Sapi2hire County:Transylvania La„;iQua9
3. Directions to project (from nearest major intersection): Asheville
Drive 8.9 miles east on US Highway 64 from State Road 107 toward the intersection of Upper Whitewater
Road. The site is located at the southwest corner of that intersection.
35. It&l 82" 9817 i1Qvi
4. Latitude:35° 6' 58" N Longitude:82° 58' 54" W of the main entrance to the project.
ll. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modification'
tRenetuals with modifications also requires SWU-702 - Renewal Application Fonn
b.lf this application is being submitted as the result of a modification to an existing permit list the existing
permit number , its issue date (if known) and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* `provide a designer's certification
2. Specify the type of project (check one):
®Low Density ❑High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR 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 ®Sedimentation/Erosion Control: 1.23 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
5. Is the project located within 5 miles of a public airport? 5]No ❑Yes
If yes, see S.L. 2012-200, Part VI: http://oortal.ncdenr.org/web/Ir/rules-and-regulations
Form SWU-101 Version Oct.31, 2013 Pagel of6

Ill. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:The Broadway Group, LLC
Signing Official & Title:Bob Broadway - Managing Member
b.Contact information for person listed in item 1a above:
Street Address:216 West Side Square
City:Huntsville State:AL Zip:35801
Mailing Address (if applicable): V�.O (�cu Vq(„ R
City: i�tn �}cy;11Z
Phone: (256 ) 533-7287
Email:[e-mail]
State: At_ Zip: 2,Sgoq-
Fax: [phone]
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization-V-Vl2 Ry-oaJW 4.H Groxw.0u LLG
Signing Official & Title: Tu" ,r+ M . 1� Yp0.d t, C I 1 W kGiE-6
b.Contact information for person listed in item 2a above:
Street Address: '7_1 L W.tSi- SIcl2SA.IxA-r'C-
v
city: State: Zip:
Mailing Address (ifapplicable): i . D . 6D+G ��6q(ng
City: I {uv��SV t�1P , State:Zip: �,S�04
Phone: (2'-1 1 533-')aB7 Fax: (aSb ) �33-7a3e
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
Signing Official &
b. Contact information for person listed in item 3a above:
Mailing Add
City:
Phone: (
4. Local jurisdiction for building permits: ra VA5
Point of Contact: 2�Q1(r IA Mice,
Zi
Fax:
Phone#: (�ag�) Wq-:5Q09
Form S W U-101 Version Oct. 31, 2013 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff will be collected from the proposed building and parking lot area via stormwater inlets.
Stormwater will then be conveyed into a Stormtech Underground Chamber infiltration system where it will
infiltrate into the ground. The Stormtech Underground Chamber system will provide treatement with an
isolator row which will collect the first 1" of runoff in a filter lined chamber row which will capture sediment
and debris while allowing stormwater to filter into the remaining chambers prior to infiltrating into the
ground. Larger storm events will bypass the isolator row and flow directly into the Stormtech chambers which
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 11 - Post Construction
3. Stormwater runoff from this project drains to the
4. Total Property Area: 4.11 acres
River basin.
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— 0 acres
Total project area shall be calctdated to exclude thefollowing: the normal pool of intppounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NO9 line or Mean High Water
(MFIW) line, and coastal Wetlands landeoard from the NHW (or MHVV) title. The resultant project area is used to
caletdate overall percent built upon area (BUA). Notx-coastal roetlands laudzoard of the NHW (or MHVUJ line map
be included in the total project area.
S. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 16.3
9. How many drainage areas does the project have?7 (For high density, count I for each proposed engineered
stormwmter BMP. For loty 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.
Form SWU-101 Version Oct. 31, 2013 Page 3 of

Basin Information
Drainage Area 1
Drainage Area
Drainage Area _
Drainage Area _
Receiving Stream Name
UT to
Horsepastur
e River
n, t
t,Gw
Stream Class
Stream Index Number *
4-13-(0.5)
Total Drainage Area (so
179729
On -site Drainage Area (so
177266
Off -site Drainage Area (so
2463
Proposed Impervious Area** (so
29229
% Impervious Area** total
"16.3
Impervious- Surface Area
Draina e Area 1
Draina e Area _
Draina e Area
Draina e Area
On -site Buildings/Lots (so
9,100
On -site Streets (so
0
On -site Parking (so
17816
On -site Sidewalks (so
1640
Other on -site (so
673
Future (so
0
Off -site (so
0
Existing BUA*** (so
0
Total (so:
29229
" Stream Class and Index Number can be determined at: http://portaLnedenr.org aeb/rog[ps/esu/classifications
*` bnp�emious 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 rennin after developinent. Do not report any existing BUA that
is to be rentoved and which will be replaced by net) BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Conlact DG. l R Central Office slafj to check if the project is located within a Threatened &
Endangered Species watershed that may he subject to Hare .stringent slorinwater requirements as per 1511 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 http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does. The complete application package should be
submitted to the appropriate DEMLR 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 required information have been provided by initialin¢ 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 does.
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 Vll Mine)
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.envhel12.org/pages/onestopexpress.litml for information on the Express program
Form S WU-101 Version Oct. 31, 2013 Page 4 of 7

and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy)._
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.
I. 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).
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 boring locations with the existing
elevations and boring logs. Include an 8.5"xl1" 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 DEMLR to verify the SHWT prior
to submittal, [phone].)�
10. A copy of the most current property deed. Deed book:_yW 741 Page No:599, I S2
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 15A NCAC 2F1.1003(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.
h ttp: / /www.secretary.state.nc.us/­Corporations/CSearch.aspx
Form SWU-101 Version Oct. 31, 2013 Page 5 of 7

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/Ir/state-stormwater-
forms does. 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 DEMLR, and that they will be recorded prior to the sale of any lot.
Vlll. 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:Derek Westfall, P.E.
Consulting
Mailing Address:1705 Enterprise Way Suite 200
City:Marietta State:GA 7_ip:30067
Phone: [phone] Fax: (770 ) 988-0300
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section) --�1 � Oi�
I, (print or type narne of person listed in Contact Information, itenn 2a) 'h r+ Ma w aS1) 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, itern la)� SNCA, with (print or type name of organization listed in
Contact Information, item la)`I Psrtaa.�t,nrt.nGngr,p, LIC, to develop the project as currently proposed. A copy of
the lease agreement or pending property - a es contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
ge f3w\ke-L-A
�gII1550.. �allcv-d �,.(�r-oadwc�y.gra`'P'--.n
Form SWU-101 Version Oct. 31, 2013 Page 6 of 7

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 DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR 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.
Date: 5�a3� Iln
I, MELISSA 3AL L r4Rb , a Notary Public for the State of N0.6a, ti, , County of
M4c�nso_do hereby certify that-.ob.Cr � M. (Sroarj ,.tr\ personally appeared
before me this a day of %' & ;ipI6 " and acknowledge the due execution of the application for
a stormwater permit.. Witness my hand and official seal, �'�4.p i,,.ra. l`W 00..L¢.0.. &
D r ,
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0L�G (? y p 3�IS�1�1 ' 9�'• Q M commission expires
STATE
X. APPLICANT'S CERTIFICATION Rd� +ty\, firwmlwan, a Mq U,gL' u�
1, (print or type nann: of person listed in Contact Infonmation, item 1a) I m j� roa,tw.MGn2L.,n, Lt e-
certify that the information included on this permit application form is, to the bes of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Date- '51a5lu
1, /YW-LIS5A 1- 7SkA A4b a Notary Public for the State of A4CJ- .A yy\a , County of
MA�tSoyx . do hereby certify that i2okaUrt M. personally appeared
before me this ay of Mn� , , rA. , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,. 4.Qi�Lavq.
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My commission expires 3 11 Q I'l
Form SWU-101 Version Oct. 31, 2013 Page 7 of 7

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Permi, ,umber:
(to be provided by DWQ)
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 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
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 remediate 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
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.
Form SW401-Infiltration Basin O&M-Rev.3 Page I of 3

BMP element:
Potentialproblem:
How I will remediate theproblem:
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
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
A visible layer of sediment
Search for the source of the
has accumulated.
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. Replace any media that
was removed in the process.
Revegetate disturbed areas
immediately.
Water is standing more than
Replace the top few inches of filter
5 days after a storm event.
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.
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).
The embankment
Shrubs or trees have started
Remove shrubs or trees
to grow on the embankment.
immediately.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair.
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.
733-1756.
Form SW401-Infiltration Basin O&M-Rev.3 Page 2 of 3

Permit Number.
(m he 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:New Retail Store - Sapphire, NC
BMP drainage area number:I
Print name:The Broadway Group, LLC
Title:Robert M. Broadway, "z.1en+be& IV1n.,kai
Address:216 West Side Square, Huntsville, AL 35801
Date: '51 a all 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' F-Ll55R 7)_ 6ALLAO-6 , a Notary Public for the State of
IQNjp ,,,e County of mo tSov. do hereby certify that
P-Onoe+ (In personally appeared before me this ��
day of MA.H colt. , and acknowledge the due execution of the
forgoing infiltration basin maintenance requirements. Witness my hand and official seal,
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My commission expires 3 t5�r1
Form SW40 I -Infiltration Basin O&M-Rev.3 Page 3 of 3