SW3150902_CURRENT PERMIT_20160318

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
DOC TYPE F70 CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE l�
YYYYMMDD

Ji e,*1,44 - Cok,
Pat McCrory
Governor
North Carolina Department of Environmental Quality C/aart
Donald R. van der
Mr. Shea Davis, Member Manager
Venture Properties VII, LLC
126 Executive Drive — Suite 200
Wilkesboro, North Carolina 28697
Dear Mr. Davis:
September 22, 2015
Secretary
RECEIVED
MAR 8 2016
PENP-00,110
L-no ,tu oity Section
Mooresville Regional Office
Subject: Stormwater Pierm,it No. SW3150902
Dollar Gener 1-5 atesville
High Density Bioretention Project
Statesville, Iredell County
The Stormwater Permitting Unit received a complete package for the Dollar Gene al -Statesville
project on September 10, 2015. Staff review of the plans and specifications has de ermined 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 this Stormwater Management Permit No.
SW3150902, issued September 22, 2015, 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 September 22, 2023, and shall be
subject to the conditions and limitations as specified therein, and does not supersede any other
agency permit that may be required. Please pay special attention to the conditions listed in this
permit regarding the Operation and Maintenance of the BMP(s), recordation of deed restrictions,
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 follow the procedures for transfer of 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. 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 OAH 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.
1601 Mail Service Center, Raleigh, North Carolina 27699-1601
Phone: [phone] Internet: www,nodenr.gov
An Equal Oppommily IAffunative Action Employer — Made in pan by recycled paper

After thirty days from the date of this letter, this project will be kept on file at the NCDENR Division
of Energy, Mineral and Land Resources, Land Quality Section, Mooresville Regional Office. If you
have questions after that time, please contact Zahid Khan, [e-mail], of that office.
Until that time, if you have any questions or need additional information concerning this permit,
please contact Bill Diuguid at [phone]; or [e-mail].
Sincerely,
William H. Diuguid, AICP, Plans Reviewer
for Tracy E. Davis, P.E., CPM
Director, Division of Energy,
Mineral and Land Resources
cc: NCDENR DEMLR Mooresville Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments

State Stormwater Permit
Permit No. SW3150902
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
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
Venture Properties VII, LLC
for Dollar General -- Statesville
Salisbury Road (U.S. Hwy 70), Statesville, Iredell County
FOR THE
construction, operation and maintenance of one bioretention cell 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 Energy, Mineral and Land Resources, Land Quality Section, and
considered a part of this permit. �l ,q —_,
This permit shall be effective from the date of issuance untKM_6rsh-23,i 2023, 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 shown on the approved site plan for this project, the stormwater
application and all supporting data as referenced in Section 1.7 of this permit.
The stormwater control has been designed to handle the runoff from 31,377
square feet of impervious area.
3. The tract will be limited to the amount of built -upon area as indicated in Section
1.2 of this permit, and per the application documents and as shown on the
approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
Page 1 of 6

State Stormwater Permit
Permit No. SW3150902
6. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
7. The design criteria for the three bioretention cells and related grass swales can
be found on the approved, stamped and signed site plan for this project and it is
incorporated into this permit by reference and the project stormwater
management system must be maintained at design condition as shown on the
approved site plan.
II. SCHEDULE OF COMPLIANCE
The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the completion of the
construction of any built -upon surface and the issuance of any certificate of
occupancy.
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 stormwater system functions at optimum efficiency. The
approved Operation and Maintenance Plan must be followed in its entirety and
maintenance must occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The permittee shall submit to the Division of Energy, Mineral and Land
Resources, Land Quality Section, 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.
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.
Page 2 of 6

State Stormwater Permit
Permit No. SW3150902
8. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
9. Access to the stormwater facilities shall be maintained via appropriate recorded
easements at all times.
10. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form signed by both parties, to the
Division of Energy, Mineral and Land Resources, Land Quality Section,
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.
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 Energy, Mineral
and Land Resources, Land Quality Section, in accordance with North Carolina
General Statute 143-215.6A to 143-215.6C.
Page 3 of 6

State Stormwater Permit
Permit No. SW3150902
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.
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 22nd day of September, 2015.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Original Signed by William H. Diuguid
William H. Diuguid, AICP, Plans Reviewer
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 4 of 6 -

State Stormwater Permit
Permit No. SW3150902
Dollar General — Statesville, Iredell County
Stormwater Permit No. SW3150902
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,
Dollar General — Statesville, Iredelll County
(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 andpecifications.
The checklist of items on page6 of this 1Frf is inbluded in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 5 of 6

State Stormwater Permit
Permit No. SW3150902
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. Trash rack is provided on the outlet/bypass structure.
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/or 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 vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
cc: Zahid Khan, Land Quality Section
NCDEQ-DEMLR, Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Page 6 of 6

State Stormwater Permit
Permit No. SW3150902
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. Trash rack is provided on the outlet/bypass structure.
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 approvedplans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or 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 vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
cc: Zahid Khan, Land Quality Section
NCDEQ-DEMLR, Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Page 6 of 6

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
Bioretention 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 operation and maintenance procedures:
— Immediately after the bioretention cell is established, the plants will be watered
twice weekly if needed until the plants become established (commonly six
weeks).
— Snow, mulch or any other material will NEVER be piled on the surface of the
bioretention cell.
— Heavy equipment will NEVER be driven over the bioretention cell.
— Special care will betaken to prevent sediment from entering the bioretention cell.
— Once a year, a soil test of the soil media will be conducted.
After the bioretention cell is established, I will inspect it once a month 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:
Potentialproblems:
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
bioretention cell
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,
The pipe is clogged (if
Unclog the pipe. Dispose of the
stone verge or 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.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
Form SW401-Bioretention O&M-Rev.3 Page 1 of 4

BMP element:
The pretreatment area
The bioretention cell:
vegetation
The bioretention cell:
soils and mulch
Potential problems:
Flow is bypassing
pretreatment area and/or
gullies have formed.
Sediment has accumulated to
a depth greater than three
inches.
Erosion has occurred.
Weeds are present.
Best professional practices
show that pruning is needed
to maintain optimal plant
health.
Plants are dead, diseased or
dying.
Tree stakes/wires are present
six months after planting.
Mulch is breaking down or
has floated away.
Soils and/or mulch are
clogged with sediment.
An annual soil test shows that
pH has dropped or heavy
metals have accumulated in
the soil media.
How I will remediate the problem:
Regrade if necessary to route all
flow to the pretreatment area.
Restabilize the area after grading.
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
restabilize the pretreatment area.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Remove the weeds, preferably by
hand.
Prune according to best professional
practices.
Determine the source of the
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Remove tree stake/wires (which
can kill the tree if not removed).
Spot mulch if there are only random
void areas. Replace whole mulch
layer if necessary. Remove the
remaining much and replace with
triple shredded hard wood mulch at
a maximum depth of three inches.
Determine the extent of the clogging
- remove and replace either just the
top layers or the entire media as
needed. Dispose of the spoil in an
appropriate off -site location. Use
triple shredded hard wood mulch at
a maximum depth of three inches.
Search for the source of the
sediment and remedy the problem if
Dolomitic lime shall be applied as
recommended per the soil test and
toxic soils shall be removed,
disposed of properly and replaced
with new planting media.
Form SW401-Bioretention O&M-Rev.3 Page 2 of 4

BMP element: .
Potentialproblems:
How I will remediate theproblem:
The underdrain system
Clogging has occurred.
Wash out the underdrain system.
if applicable)
The drop inlet
Clogging has occurred.
Clean out the drop inlet. Dispose of
the sediment off -site.
The drop inlet is damaged
Repair or replace the drop inlet.
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.
Form SW401-Bioretention O&M-Rev.3 Page 3 of 4

Permit Number:
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name
BMP drainage area number:
Print name:
Phone:
Signature:
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,
County of
a Notary Public for the State of
do hereby certify that
personally appeared before me this
day of and acknowledge the due execution of the
forgoing bioretention maintenance requirements. Witness my hand and official seal,
SEAL
My commission
Form SW401-Bioretention I&M-Rev. 2 Page 4 of 4

F�
DEMLR USE ONLY
Date Received
Fee Paid
Per it Nu ber
/ O — 2 D /5
SOS 3
Applicable 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 Energy, Mineral and Land Resources MAR 4 8 .2C16
STORMWATER MANAGEMENT PERMIT APPLICATION FORM OFfvP-O f',lI,
This form may be photocopied for use as an original Liao QuOit'�t Sectson
89aaresmdle Regional Office
�eit�Lxt?/:lllt►fgi t] iul,•1IYZiP►I
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
2. Location of Project (street address): V L-LJ
Salisbury Road SEP 1 a ?Qlq
City:Sta tesville Countya redel I Zip _2867Z�^
3. Directions to project (from nearest major intersection): STORMWATER PERMITTING
Take Interstate 77 towards Statesville, take exit 49A for Hwy 70 (G Bagnal Blvd).
Turn right onto Hwy 70 travel 1.80 miles. Site will be on your right.
4. Latitude: 35' 45' 38.50" N Longitude:80° 50' .61" W of the main entrance to the project.
It. PERMIT INFORMATION:
1.a.Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationf
tRenetoals With modifications also requires SIAU-102 - Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberN/A , 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, N/A and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑LAMA Major
❑NPDES Industrial Stormwater
®Sedimen tation/Erosion Control: 1.91 ac of Disturbed Area
❑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:Iredell County Erosion Control Permit ID: STVLE-2016-012
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: htti2:Hportal.ncdenr.org/web/Ir/rules-and-regulations
Form SWU-101 Version Oct. 31, 2013 Page I of

hL CONTACT INFORMATION
I. 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:Venture Properties VII LLC
Signing Official & Title:Shea Davis - Member Manager
b.Contact information for person listed in item la above:
Street Address:126 Executive Drive - Suite 200
City:Wilkesboro State:NC
Zip:28697
Mailing Address (ifapplicable):PO Box 843
City:Wilkesboro State:NC
Zip:28697
Phone: (336 ) 667-8000 Fax: (336
) 667-8001
Email:[e-mail]
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:Prisci Ilia Detal White ETAL
Signing Official & Title:Stepen Dellinger
b.Contact information for person listed in item 2a above:
Street Address:3236 Smith Farm Road
City:Matthews State:NC Zip:28104
Mailing Address (if applicable):
City: State: Zip:
Phone: ( _ ) Fax: ( )
3. a. (Optional) Print the name and title of another contact such as the projects construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:13REC, PA
Signing Official & Title:lustin C. Church - Principal Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:126 Executive Drive - Suite 220
City:Wilkesboro State:NC Zip:28697
Phone: (336 ) 844-4088 Fax: (336 ) 609-7726
Em a il:i us tini©b rec. bi z
4. Local jurisdiction for building permits:
Point of Contact:
Phone #:
Form SWU-101 Version Oct. 31, 2013
Page 2 of 6

IV. PROJECT INFORMATION
J. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Runoff from newly constructed impervious surfaces will be routed through a bio-retention cell.
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 Yadkin Pee -Dee River basin.
4. Total Property Area: 2.52 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area': acres
Total project area shall be calculated to exclude the following the nornml pool of impounded structures, the area
between the batiks of streanns and rivers, the area below the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward fran the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Nan -coastal zetlands landward of flue NHW (or MHW) line nzay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 28.73 %
9. How many drainage areas does the project have? 1 (For high density, count 1 for each proposed engineered
stornnoater BMP. For loco density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
Receiving Stream Name
Third Creek
Stream Class *
C
Stream Index Number *
12-108-204
Total Drainage Area (sf)
2.52 k. 14
_% D 97 1
On -site Drainage Area (so
2.52
s o 9 7
Off -site Drainage Area (so
0
Pro osed Impervious Area** (so
31,377
Impervious Area** total
28. 73
Impervious** Surface Area
Drainage Area 7
Drainage Area _
Drainage Area
Drainage Area
On -site Buildings/Lots (so
9,100
On -site Streets (so
0
On -site Parking (so
20,219
On -site Sidewalks (so
2,058
Other on -site (so
0
Future (so
0
Off -site (so
0
Existing BUA*** (so
0
Total (so:
31,377
* Stream Class and Index Number can be determined at: http://portal.ucdeizr.org/webfwq[ps/csu/classificatious
Innpervious 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 reuain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

il. How was the off -site impervious area listed above determined? Provide documentation. Field Survey
Proieets in Union County: Contact DEMLR Central Office stcffto check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A 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 htty://uortal.ncdenr.ore/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.ncdennorg/web/wg/ws/su/statesw/forms does. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office maybe found by locating project on the
interactive online map at http://portal.ncdennorg/web/wq/ws/so/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.ncdeiir.org/web/wq/ws/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. ) D,t
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part Vll below)
3. Original of the applicable Supplement Fonn(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.enviielp.org/12ages/onestopexl2ress.htnnl for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 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.
L 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).
-OE
,S7->F
3PC-
JAc
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where required).
9. Cony of any applicable soils report with the associated SHWT elevations (Please identify JDE
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"x1l" 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 verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 04E Page No: 532
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC J Pe
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 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http://www.secretary.state.iic.us/Corporatioiis/CSearch.aspx
VIL 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 htto://12ortal.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.
Vill. 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 Engineerjustin C. Church
Consulting
Mailing Address:126 Executive Drive - Suite 220
City:Wilkesboro State:NC Zip:28697
Phone: (336 ) 844-4088
Lmail:[e-mail]
Fax: (336 ) 609-7726
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or hype name of person listed in Contact Information, item 2a) Stephen Dellinger , certify that I
own the property identified in this permit application, and thus give permission to (print or t(pe name of person
listed in Contact Information, item la) Shen Davis with (print or hjpe nmrne of organization listed in
Contact Information, iteuu 1a) Venture Properties V11, 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.
Form SWU-101 Version Oct. 31, 2013 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
'lease agreement, or pending sale, responsibility for compliance with the 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 assessmeq�Lgf civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Date: y /l T
I, Lll i L1-:.4 M W R E U I- E a Notary Public for the State of A(0&/( (}Attp44ik, County of
Lf AilOAI , do hereby certify that St EPAOAt VC41. i nJ4 ER personally appeared
before me this 14 day of A tL G�5 20 1 , and acknowledge the
/Jdue execution of the application for
a stormwater permit. Witness my hand and official seal, t,J,e.Q .,� -H, Aa AP t—
SEAL [:Nffl
My commission expires
X. APPLICANT'S CERTIFICATION
1, (print or hjpe name of person listed in Contact Information, item 1a) Venture Properties Vll, LLC- Shea Davis
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater
rules
under
/1I A NCAC 21-1 .1000 and any other applicable state stormwater requirements.
SianahrrP/ �✓ IY��•/. /_ llaYa
I, ` )tQy �i�ii��1 l • V I C� a Notary Public for the State of County of
doereby certify that OX personally appeared
t
before me thislay of +,Q�.�, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seat CtAA-,0-
�Py Pp1NA Rb�/�
yp Ce
c Notary Public
Wilkes County
=My Commission Elpiresiz
07/29/2019
ZO �Q \
o rN Ci00\-
SEAL
My commission expires 07 °.—q - 10 19
Form S WU-101 Version Oct. 31, 2013 Page 6 of 6

0

PATHE
THE
ORDER OF
...................... ....................
BREC
EeuPA
126 EX TIVE DRIVE
SUITE22G
WILKESBORO, NC 28697
DATE
BRANCH 6ANHING ANOTRUSTCOMPMy BBTc
FOR
00000 56 70ifs 1:0 S 3 10 11 2 0:000 IS 20 L806 7 C3
I

Permit Number:
(to be provided by DWQ)
NCDENR
`
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items
Checklist (Part 111) must be printed, filled out and submitted along with all of the required information.
I. PROJECT INFORMATION
Project name
Dollar General Statesville
Contact name
Justin Church
Phone number
336-8444088
Dale
September 8, 2015
Drainage area number
1
II. DESIGN INFORMATION
Site Characteristics
Drainage area
39,440 h2
Impervious area
31,377 ft2
Percent impervious
79.6% %
Design rainfall depth
1.0 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak Flow required?
Y (Y or N)
1-yr, 24-hr runoff depth
2.81 in
1-yr, 24-hr intensity
0.12 inlhr
Pre -development 1-yr, 24-hr peak flow
2.280 ft'/sec
Post -development 1-yr, 24-hr peak flow
2.110 fli
Pre/Past 1-yr, 24-hr peak control
-0.170 ft'/sec
Storage Volume: Non-SAWaters
Minimum volume required
2,518.0 ft'
Volume provided
2,890.0 ft' OK
Storage Volume: SA Waters
1.5' runoff volume
ft'
Pre -development 1-yr, 24-hr runoff
ft'
Post -development 1-yr, 24-hr runoff
ft'
Minimum volume required
0 fl'
Volume provided
ft'
Cell Dimensions
/
Pending depth of water
12 inches
OK
✓
Pending depth of water
1.00 ft
Surface area of the top of the biorelention cell
3,220.0 flz
OK
Length:
87 ft
OK
Width:
39 ft
OK
-or- Radius
ft
Media and Soils Summary
Drawdown time, ponded volume
7.5 hr
OK
Drawdown time, to 24 inches below surface
19.5 hr
OK
Drawdown time, total:
27 hr
In -situ soil:
Soil permeability
0.00 in/hr
Insufficient.
Increase infiltration rate or include underdrains.
Planting media soil:
Soil permeability
2.00 in/hr
OK
Soil composition
% Sand (by volume)
85%
OK
% Fines (by volume)
10%
OK
% Organic (by volume)
5%
OK
Total: 100%
Phosphorus Index (P-Index) of media
10 (unitless)
OK
Form SW401-Bioretention-Rev.8
June 25, 2010
Parts I and II. Design Summary, Page 1 of 2

Permit Number:
(to be provided by DWQ)
Basin Elevations
Temporary pool elevation
885.50 fmsl
Type of bioretention cell (answer'Y' to only one of the two
following questions):
Is this a grassed cell?
Y (Y or N) OK
Is this a cell with trees/shrubs?
N (Y or N)
Planting elevation (top of the mulch or grass sod layer)
884.5 fmsl
Depth of mulch
0 inches Insufficient mulch depth, unless installing grassed cell.
Bottom of the planting media soil
882.5 fmsl
Planting media depth
2 ft
Depth of washed sand below planting media soil
0 It
Are underdrains being installed?
Y (Y or N)
How many clean out pipes are being installed?
4
OK
What factor of safety is used for sizing the underdrains? (See
2
OK
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
1 it
the bottom of the cell to account for underdrains
/
Bottom of the cell required
881.5 fmsl
v
SHWT elevation
868 fmsl
Distance from bottom to SHWT
13.5 fl
OK
Internal Water Storage Zone (IWS)
Does the design include IWS
Y
(Y or N)
Elevation of the top of the upturned elbow
fmsl
Separation of IWS and Surface
884.5 it
Planting Plan
Number of tree species
0
Number of shrub species
0
Number of herbaceous groundcover species
0
Recommend more species.
Additional Information
Does volume in excess of the design volume bypass the
y
(Y or N)
OK
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
y
(Y or N)
OK
through a vegetated filter?
What is the length of the vegetated filter?
190 it
Does the design use a level spreader to evenly distribute flow?
N
(Y or N)
Show how flow is evenly distributed.
Is the BMP located at least 30 feet from surface waters (50 feet if
Y
(Y or N)
OK
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Y
(Y or N)
OK
Are the vegetated side slopes equal to or less than 3:19
Y
(Y or N)
OK
Is the BMP located in a proposed drainage easement with access
Y
(Y or N)
OK
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
0.64 ft/sec
OK
Is the area surrounding the cell likely to undergo development in
N
(Y or N)
OK
the future?
Are the slopes draining to the bioretention cell greater than 20%?
N
(Y or N)
OK
Is the drainage area permanently stabilized?
Y
(Y or N)
OK
Pretreatment Used
(Indicate Type Used with an'X' in the shaded cell)
Gravel and grass
(81inches gravel followed by 3-5 it of grass)
Grassed swale
#VALUE!
Forebay
Other
X
Form SW401-Bioretention-Rev.8
June 25, 2010 Parts I and 11. Design Summary, Page 2 of 2

(to be assigned 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.
Pagel Plan
Initials Sheet No.
D& Z"'
Jii (q01 C eL
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),
- Cell dimensions,
- Pretreatment system,
High flow bypass system,
- Maintenance access,
- Recorded drainage easement and public right of way (ROW),
- Clean out pipe locations,
- Overflow device, and
- Boundaries of drainage easement.
2. Plan details (1' = 30' or larger) for the bioretention cell showing:
- Cell dimensions
- Pretreatment system,
- High Flow bypass system,
- Maintenance access,
- Recorded drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Clean out pipe locations,
- Overflow device, and
- Boundaries of drainage easement.
- Indicate the P-Index between 10 and 30
JD(' 02 3. Section view of the bioretention cell (1' = 20' or larger) showing:
- Side slopes, 3:1 or lower
- Underdrain system (If applicable), and
- Biorelention cell layers [ground level and slope, pre-treatment, ponding depth, mulch depth, fill media
depth, washed sand, filter fabric (or choking stone if applicable), 957 stone, underdrains (if applicable),
SHWT level(s), and overflow structure)
kS )(— nc!o • a 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. All
elevations shall be in feet mean sea level thirst). Results of soils tests of both the planting soil and the in
situ soil must include:
- Soil permeability,
- Soil composition (%sand, %fines, % organic), and
P-index.
5. A detailed planting plan IV = 20' or larger) prepared by a qualified individual showing:
A variety of suitable species,
- Sizes, spacing and locations of plantings,
- Total quantity of each type of plant specified,
- A planting detail,
- The source nursery for the plants, and
- Fertilizer and watering requirements to establish vegetation.
,)Lr S o0W 6. A construction sequence that shows how the bioretention cell will be protected from sediment until the
entire drainage area is stabilized.
Al c to r ll,ce 7. The supporting calculations (including uncertain calculations, if applicable).
)hc— + tL"� 8. A copy of the signed and notarized inspection and maintenance (10) agreement.
�_ 9. A copy of the deed restriction.
Forth SW401-Bioretenton-Rev.7 Pan III, Page 1 of 1