SW3160701_CURRENT PERMIT_20160725

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

PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Energy, Mineral
and Land Resources
ENVIPONMENTAL OUALITV
July 25, 2016
Chad Bruner, Real Estate Project Manager
Loves Travel Stops and Country Store
10601 North Pennsylvania Avenue
Oklahoma City, OK 73120
Subject: Stormwater Permit No. 3160701
Loves Travel Stops — Newton
Newton, Catawba County
Dear Mr. Bruner:
Secrerury
TRACY DAVIS
RECEIVE®
S LEI G 0 LUIV
DENR-DEMLR
Land Quality Section
Mooresville Regional C"Ce
The Stormwater Permitting Unit received a complete package for the Loves Travel Stops on
July 13, 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 NCAC 21-1.1000 and
Session Law 2006-246. We are forwarding this Stormwater Management Permit No.
SW1160602, issued July 25, 2016, 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 July 25, 2024, 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.
State a( North Carolina I Environmmrml Quality I linergy, Mineral and Land Resources
1612 Mail Serviee Center 1512 North Salisbury Street I Raleigh, NC 27699-1612
919 707 9200 "1'

Chad Bruner, Real Estate Project Manager
State Stormwater Permit SW3160701
Loves Travel Stops and Country Store
Newton, Catawba County
July 25, 2016
Page 2
After thirty days from the date of this letter, this project will be kept on file at the NCDEQ
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 Richard Riddle at [phone];
or [e-mail].
Sincerely,
Original signed by Richard L. Riddle, Jr.
Richard L. Riddle, Jr., Plans Reviewer
for Tracy E. Davis, P.E., CPM
Director, Division of Energy,
Mineral and Land Resources
cc: NCDEQ DEMLR Mooresville Regional Office
Lesley England, Davis -Martin -Powell and Associates
Central Files
Stormwater Permitting Unit Files
Attachments
State of \orih Carolim I Emvnnmennl Qualim,I Energy, Ndneral and Land Remumcs
1612 \Sul Smice Center 1 512 North Salisbuty Stret I Raleigh, \C'_7699d612
919 707 9200 T

State Stormwater Permit
Permit No. SW3160701
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
Loves Travel Stops and Country Store
for Loves Travel Stop - Newton
1760 Southfork Drive
Newton, Catawba County
FOR THE
construction, operation and maintenance of a four (4) bioretention basins 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.
This permit shall be effective from the date of issuance until July 25, 2024, 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(s) 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(s) has been designed to handle the runoff from
353,989 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.
Page 1 of 6

State Stormwater Permit
Permit No. SW3160701
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
7. The design criteria for the a bioretention basin can be found on the approved,
stamped and signed site plan and other related supporting calculations and data
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.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted stormwater system functions at optimum efficiency. The
approved Operation and Maintenance Plan must be followed in its entirety and
maintenance must occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The permittee shall submit to the Division of 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.
7. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
Page 2 of 6

State Stormwater Permit
Permit No. SW3160701
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
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.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Energy, Mineral
Page 3 of 6

State Stormwater Permit
Permit No. SW3160701
and Land Resources, Land Quality Section, 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.
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.
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.
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.
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 25th day of July, 2016.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Original signed by Richard L. Riddle, Jr.
Richard L. Riddle, Jr, 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. SW3160701
Loves Travel Stops
Newton, Catawba County
Stormwater Permit No. SW3160701
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,
Loves Travel Stops - Newton, Catawba 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 and specifications.
The checklist of items on page 2 of this form is included in the Certification
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 5 of 6

State Stormwater Permit
Permit No. SW3160701
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. INC 28115
Page 6 of 6

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
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
❑ Other WQ M mt Plan:
State of North Carolina 9���,'�B8\/
Department of Environment and Natural Resources VIM
Division of Energy, Mineral and Land Resources
SEP '.; 6 1'316
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original DEW-DEMUt
Lana Qua # Section
1. GENERAL INFORMATION mooreSt/illeRegionalOffice
1. Project Name (subdivision, facility, or establishment name -should be consistent witH ppr,Q e) Ana m ejoLL 5�I-
specifications, letters, operation and maintenance agreements, etc.):
Loves Travel Stops & Country Stores - Newton North Carolina JUL 13 2016
2. Location of Project (street address): DENR-LAND QUALITY
1760 & 1761 Southfork Drive STORMWATER PERMITTING
City:Newton County:Catawba Zip:28658
3. Directions to project (from nearest major intersection):
Located in the Northwest quandrant of the intersection of Highway 10 and US Highway 321
4. Latitude:35° 38' 5.75" N Longitude:81° 18' 4.42" W of the main entrance to the project.
❑. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tReneaals with modifications also requires SWU-102 - Renemal Application Form
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
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
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 15.4 ac of Disturbed Area
0404/401 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:Erosion Control Permit from Catawba County -Love's Travel Stop
Permit #CBPR-05-2016-23923 Date: June 7, 2016
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part Vl: httl2://12ortal.ncdenr.org/web/Ir/rules-and-regulations
Form SWU-101 Version Oct. 31, 2013 Page 1 of 6

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Ill. CONTACT INFORMATION
La. 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: Chad Bruner, Loves Travel Stops and Country Store
Signing Official & Title:Real Estate Project Manager
b.Contact information for person listed in item la above:
Street Address:10601 North Pennsylvania Ave
City:Oklahoma City State:OK Zip:73120
Mailing Address (if applicable):
City:
Phone: (405 ) 203-5900
Email:[e-mail]
Fax: (405 ) 463-3646
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:Southfork Properties LLC
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:
City:.
State:NC Zip:
Mailing Address (if applicable): P.O. Box 3404
City:Hickory State:NC Zip:28603-3404
Phone:
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: Lesley England Davis -Martin -Powell and Associates
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing Address:6415 Old Plank Rd
City:High Point State:NC Zip:27265
Phone: ,(336 ) 886-4821
Email:[e-mail]
4. Local jurisdiction for building permits: Catawba County
Fax: (336 ) 886-4458
Point of ContactChris Timberlake Phone #: (828 ) 465-8380
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Network of grass swales and grass lined bioretention areas around the perimeter of the site.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.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 Catawba River basin.
4. Total Property Area: 17.92 acres
5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area`:17.92 acres
Total project area shall be calculated to exclude the follosvin the normal pool of innpounded structures, the area
between tine banks of streams and rivers, the area below the Normal High Water (NM 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). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in tine total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 45.35
9. How many drainage areas does the project have?4 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
Receiving Stream Name
Henry Fork
Henry Fork
Henry Fork
Stork Cat River
Stream Class *
C
C
C
WS-V
Stream Index Number *
11-129-1-(12.5)
11-129-1-(12.5)
11-129-1-(12.5)
11-129-(0.5)
Total Drainage Area (so
211162.8
81134.8
94839.9
98862.5
On -site Drainage Area (sf)
211162.8
81134.8
94839.9
98862.5
Off -site Drainage Area (so
Proposed Impervious Area** (so
142754.4
70530.65
66235.8
74468.5
Impervious Area** total
67.6
186.9
169.8
75.3
Impervious- Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
On -site Buildings/Lots (so
On -site Streets (so
On -site Parking (sf)
On -site Sidewalks (so
Other on -site (so
Future (so
Off -site (sf)
Existing BUA*** (sf)
Total (so:
1 142754.4
70530.65
66235.8
74468.5
Strewn Class and Index Number can be determined at: http://nortal.rnedenr.or vebAt )glps/csu/classi catimts
Impervious area is defined as the built upon area including, but not lintited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Report only that amount of existing BUA that will remain after development. Do not report any existing 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

11. How was the off -site impervious area listed above determined? Provide documentation. Survey by DMP and
Projects in Union County: Contact DEMLR Central Ojjice stafflo check ifthe 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 htto://vortii.ncdenr.orL,/web/wo/ws/su/bmo-mai)ual.
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-docs. 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 athttp://portal.ncdenr.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/wg/ws/su/statesw/forms does.
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/onestopexpress.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 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 1h 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.
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.
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

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 SI IWT 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"x11" 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 SHW7'prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: Page No: _j V
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 1a, 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.nc.us/Corporations/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
BIJA 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 httl2://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.
V Ill. 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:Lesley England, PE
Consulting Firm: Davis -Martin -Powell and Associates
Mailing Address:6415 Old Plank Road
City:Pligh Point State:NC Zip:27265
Phone: (336 ) 886-4821
EmaiCleiiglandQd m p-inccom
Fax: (336 ) 886-4458
IX. PROPERTY.OWNER AUTHORIZATION (if Contact Information, item 2 has been filled ont, complete this
section)
I, (print or type none of person listed in Contact Information, item 2a) Doug Stussi , certify that I
own the property identified in this permit application, and thus give permission to (print or hype name of person
listen in Contact Information, item In) Chad Bremer with (print or type nave of organization listed in
Contact brfmrrnation, item 1n) Loves Travel Stops & Country Stores, Inc. 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

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 stornnvater
treatment facility without a valid perms I mdcrstand that the operation of a stormwater treatment facility
without a valid per of General Statue'143-215.1 and may result in appropriate enforcement
action includinf eeVssessment of ci I penalties of up to $25,000 peLday, pursuant to NCGS'143-215.6.
Signature: Date: DI(O
I, r a Notary Public for the State of o Ki nma , County of
Q ( h }�(�_J do hereby ert✓ tify that �U Q 5�ui51 personally appeared
4A
before me this day of a��6 and i cknowI dd e� the due
execution of the application for
a stormwater permit. Witness my hand and official seal , / IUL o
\pa�mnurrur�r
P` K Q "'G
` ...: �......... F�
#10008677
N ;
EXP. 10/18/18
� �A,: 0
-80
/'4r"rOFml)K�F` "
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires 10 . I g' 18
1, (print or hype name of person listed in Contact Information, item 1a) Chad Bruner
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 NCAC 2I-I .1000 and any other applicable state stormwater requirements.
Signatu
W e-S oQG aNotary
)Public for the State of County of
C -1 2. }�` . _ �� do hereby certify that L�� r/CuAe- I— personally appeared
before me this LO day of Sv t-0 Z016 , and ackn 90 the clue ex ,�cution of the application for
a stormwater permit. Witness my hand and official seal,—
L
FXP 005371
_06/75116, ,i
iry�''i OF �GKLP`N0<<`<<
SEAL
My commission expires 6 --/ 5 /�
Form SWU-101 Version Oct. 31, 2013 Page 6 of

Permit No:
(to be assigned by D WO)
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 fallowing 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. 1 Plans (1' - 50' or larger) of the entire site showing: \�``�'��11 ....... eI
- Design at ultimate build-out,FESS/p''.`T' %
-Off-site drainage (if applicable), _.'� '9
- Delineated drainage basins (include Rational C coefficient per basin), ixSE L y�� � ��yy
-Celldimensions, �/ 0 644i =
- Pretreatment system, 1
- High Flow bypass system, �c9, •f'&GINEev`\�
-Maintenanceaccess,
- Recorded drainage easement and public right of way (ROW), y//// t I t I I I
- Clean out pipe locations,
- Overlow device, and
- Boundaries of drainage easement.
Q tA%% 21 2. Plan details (1" = 30' or larger) for the bioretention cell showing:
-Celldimensions _ RECEIVE®
-Pretreatment system,
- High Flow bypass system,
- Maintenance access, 5 L u `l 2016
- Recorded drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), DENR-DEMLR
- Clean out pipe locations, '� Land Wall Section
- Overflow device, and MV W e$Vlle Regional Office
- Boundaries of drainage easement.
- Indicate the P-Index between 10 and 30
SAS 22 3. Section view of the bioretention cell (1" = 20' or larger) showing:
- Side slopes, 3:1 or lower
- Underdrain system (if applicable), and
- Bioretention cell layers [ground level and slope, pre-treatment, ponding depth, mulch depth, fill media
depth, washed sand, filter fabric (or choking stone if applicable), k57 stone, underdrains (if applicable),
SHWT level(s), and overflow structural
Ak— NIA 4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified in the field by DWQ, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information. All
elevations shall be in feet mean sea level (fmsl). 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.
46 Q 5. A detailed planting plan (1' = 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.
All 6. A construction sequence that shows how the bioretention cell will be protected from sediment until the
entire drainage area is stabilized.
611 /eZTk�%HG 7. The supporting calculations (including underdrain calculations, if applicable).
0*1H60L- 304- . ATV
1V49I 6, A copy of the signed and notarized inspection and maintenance (AM) agreement.
vA A ,1I A 9. A copy of the deed restriction.
Form SW401-81oretention-Rev.7 Part III, Page 1 of 1

t-.) v r 4 ''

Permit Number:
(to be provided by DWDJ
O�e4 WATFgOG
' h r
NCD``ENR
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 Love's Travel Stops - Newton, North Carolina
Contact name Lesley England
Phone number 336.886A821 ext. 274
Dale July 7, 2016
Drainage area number Biocell p1 (DA-1)_
II. DESIGN INFORMATION
Site Characteristics
Drainage area
211,163 ft'
Impervious area
142,754 it
Percent impervious
67.6% %
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
2.97 in
1-yr, 24-hr intensity
0.124 in/hr
Pre -development 1-yr, 24-hr peak Flow
6.697 ft'/sec
Post -development 1-yr, 24-hr peak Flow
14.830 ft'/sec
Pre/Post 1-yr, 24-hr peak control
8.133 ft'/sec
Storage Volume: Non -SA Waters
Minimum volume required
11,586.4 ft'
Volume provided
24,055.0 ft' OK
Storage Volume: SAWaters
1.5' runoff volume
ft'
Pre -development 1-yr, 24-hr runoff
W
Post -development 1-yr, 24-hr runoff
ft'
Minimum volume required
0 ft'
Volume provided
f 3
Cell Dimensions
Pending depth of water
12 inches OK
Pending depth of water
1.00 If
Surface area of the top of the bioretention cell
12,045.6 ft2 OK
Length:
ft
Width:
It
-or- Radius
It
Media and Soils Summary
Drawdown time, ponded volume
5.99 hr
OK
Drawdown time, to 24 inches below surface
7.18 hr
OK
Drawdown time, total:
13.17 hr
In -situ soil:
Soil permeability
N/A in/hr
OK
Planting media soil:
Soil permeability
1.00 inlhr
OK
Soil composition
• Sand (by volume)
85%
OK
• Fines (by volume)
12%
OK
Form SW401-Bioretention-Rev.8
June 25, 2010
Parts I and II. Design Summary, Page 1 of 3

% Organic (by volume)
3% OK
Total: 100%
Permit
(to be provided by DWQ)
Phosphorus Index (P-Index) of media
10 (unitless) OK
Form SW401-Biorelenlion-Rev.e
June 25, 2010 Parts I and 11, Design Summary, Page 2 of 3

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

Permit Number: r::�0d140 W,
(to be provided by DWO)
o�DF WATp, O
ti T
� r
o -mac
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 III) must be printed, filled out and submitted along with all of the required information.
I. PROJECT INFORMATION
Project name Love's Travel Stops - Newton, North Carolina
Contact name Lesley England
Phone number 336.886.4821 ext. 274
Date July 7, 2016
Drainage area number Biocell#2 (DA-2)_
II. DESIGN INFORMATION
Site Characteristics
Drainage area
81,135 ft'
Impervious area
70,531 ftZ
Percent impervious
86.9% %
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
2.97 in
1-yr, 24-hr intensity
0.124 in/hr
Pre -development 1-yr, 24-hr peak flow
2.574 ft'/sec
Post -development 1-yr, 24-hr peak Flow
6.732 ft'Isec
Pre/Post 1-yr, 24-hr peak control
4158 ft'Isec
Storage Volume: Non -SA Waters
Minimum volume required
5,627.9 ft1
Volume provided
14,778.0 ft'
Storage Volume: SAWaters
1.5' runoff volume ft3
Pre -development 1-yr, 24-hr runoff ft'
Post -development 1-yr, 24-hr runoff ft1
Minimum volume required 0 W
Volume provided ft'
Cell Dimensions
K4
Pending depth of water
12 inches OK
Pending depth of water
1.00 ft
Surface area of the top of the bioretention cell
5,670.2 ft' OK
Length:
ft
Width:
ft
-or- Radius
ft
Media and Soils Summary
Drawdown time, ponded volume
5.99 fir
OK
Drawdown time, to 24 inches below surface
7.18 hr
OK
Drawdown time, total:
13.17 fir
In -situ soil:
Soil permeability
NIA inthr
OK
Planting media soil:
Soil permeability
1.00 Whir
OK
Soil composition
• Sand (by volume)
85%
OK
• Fines (by volume)
12%
OK
Form SW401-Biorelenlion-Rev.B
June 25, 2010 Parts I and 11. Design Summary, Page 1 of 3

% Organic (by volume)
3% OK
Total: 100%
Permit NumberJ�4 1T
(to be provided by DWQ)
Phosphorus Index (P-Index) of media
10 (unitless) OK
Form SW401-Bioretention-Rev.8
June 25, 2010 Parts I and II. Design Summary, Page 2 of 3

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

M
NCDENR
Permit Number Sa31%�J
(to be provided by DWQ)
920E WATF9
h y
� r
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 Love's Travel Stops - Newton, North Carolina
Contact name Lesley England
Phone number 336.886.4821 ext. 274
Date July 7, 2016
Drainage area number Biocell 83 (DA-3)_
II. DESIGN INFORMATION
Site Characteristics
Drainage area 94,840 ftr
Impervious area 66,236 ftz
Percent impervious 69.8% %
Design rainfall depth 1.0 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak now required?
Y (Y or N)
1-yr, 24-hr runoff depth
2.97 in
1-yr, 24-hr intensity
0.124 in/hr
Pre -development 1-yr, 24-hr peak flow
3.017 ft3/sec
Post -development 1-yr, 24-hr peak Bow
6.936 ft3/sec
PrelPost 1-yr, 24-hr peak control
3.919 ft3/sec
Storage Volume: Non -SA Waters
Minimum volume required
5,362.9 ft3
Volume provided
11,120.0 ft3 OK
Storage Volume: SA Waters
1.5' runoff volume
ft3
Pre -development 1-yr, 24-hr runoff
ft3
Post -development 1-yr, 24-hr runoff
ft3
Minimum volume required
0 ff3
Volume provided
rya
Cell Dimensions
Fording depth of water
12 inches OK
Fording depth of water
1.00 it
Surface area of the top of the bioretention cell
5,575.0 ft' OK
Length:
it
Width:
it
-or- Radius
it
Media and Soils Summary
Drawdown time, ponded volume
5.99 hr
OK
Drawdown time, to 24 inches below surface
7.18 or
OK
Drawdown time, total:
13.17 hr
In -situ soil:
Soil permeability
N/A in/hr
OK
Planting media soil:
Soil permeability
1.00 in/hr
OK
Soil composition
% Sand (by volume)
85%
OK
% Fines (by volume)
12%
OK
Form SW401-Bioretention-Rev.8
June 25, 2010
Parts I and If. Design Summary, Page 1 of 3

Permit
(to be provided by D WQ)
%Organic (by volume)
Phosphorus Index (P-Index) of media
3% OK
Total: 100%
10 (unitless) OK
Farm SW401-Bioretention-Rev.8
June 25, 2010 Parts I and If. Design Summary, Page 2 of 3

Basin Elevations
Permit Number: ad
w
(to be provided by DWQ)
Temporary pool elevation
852.00 fmsl
Type of bioretention cell (answer "Y" to only one of the two following
questions).
Is this a grassed cell?
Y (Y or N)
Is this a cell with trees/shrubs?
N (Y or N)
Planting elevation (top of the mulch or grass sod layer)
851 fmsl
Depth of mulch
0 inches
Bottom of the planting media soil
848.75 fmsl
Planting media depth
2.25 If
Depth of washed sand below planting media soil
0.33 If
Are underdrains being installed?
How many clean out pipes are being installed?
What factor of safety is used for sizing the underdrains? (See
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
the bottom of the cell to account for underdrains
Bottom of the cell required
SHWT elevation
Distance from bottom to SHWT
Internal Water Storage Zone (IWS)
Does the design include IWS
Elevation of the top of the upturned elbow
Separation of IWS and Surface
Planting Plan
Number of tree species
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
through a vegetated filter?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the BMP located at least 30 feet from surface waters (50 feet if
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Are the vegetated side slopes equal to or less than 3:1?
Is the BMP located in a proposed drainage easement with access
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
Is the area surrounding the cell likely to undergo development in the
future?
Are the slopes draining to the bioretention cell greater than 21
Is the drainage area permanently stabilized?
Pretreatment Used
(Indicate Type Used with an'X' in the shaded cell)
Gravel and grass
(8 mches gravel followed by 3-5 it of grass)
Grassed swale
Forebay
Other
T
Insufficient mulch depth, unless installing grassed cell.
Y (Y or N)
9 OK
2 OK
1 It
847,42 fmsl
fmsl
847.42 it OK
N (Y or N)
fmsl
851 If
0
0
1 Recommend more species.
Y (Y or N) OK
N (Y or N) Excess volume must pass through filter.
ft
N (Y or N) Show how Flow is evenly distributed.
Y (Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
0.5 f /sec
OK
N (Y or N) OK
N (Y or N) OK
Y (Y or N) OK
X OK
Form SW401-Bioretention-Rev.8
June 25, 2010 Parts I and 11. Design Summary, Page 3 of 3

Permit Numbergw 3111L
(to be provided by DWQ)
RM%
NCDENR
40
�I✓W� �
Olqiii�t
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 III) must be printed, filled out and submitted along with all of the required information.
I. PROJECT INFORMATION
Project name Love's Travel Stops - Newton, North Carolina
Contact name Lesley England
Phone number 336,886.4821 ext. 274
Date July 7, 2016
Drainage area number Biocell #4 (DA-4)_
11. DESIGN INFORMATION
Site Characteristics
Drainage area
98,863 ft2
Impervious area
74,468 112
Percent impervious
75.3% %
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
2.97 in
1-yr, 24-hr intensity
0.124 in/hr
Pre -development 1-yr, 24-hr peak Bow
3.141 ft'/sec
Post -development 1-yr, 24-hr peak Bow
7.482 ft'/sec
Pre/Post 1-yr, 24-hr peak control
4.341 ft'/sec
Storage Volume: Nan -SA Waters
Minimum volume required
5,997.1 ft'
Volume provided
12,550.0 ft'
Storage Volume: SA Waters
1.5' runoff volume
ft'
Pre -development 1-yr, 24-hr runoff
rya
Post -development 1-yr, 24-hr runoff
rya
Minimum volume required
0 ff'
Volume provided
ft'
Cell Dimensions
ren
Pending depth of water
12 inches OK
Pending depth of water
1.00 If
Surface area of the lop of the bioretention cell
6,065.0 ft2 OK
Length:
If
Width:
It
-or- Radius
It
Media and Soils Summary
Drawdown time, ponded volume
5.99 m
OK
Drawdown time, to 24 inches below surface
7.18 hr
OK
Drawdown time, total:
13.17 hr
In -situ soil:
Soil permeability
N/A in/hr
OK
Planting media soil:
Soil permeability
1.00 inthr
OK
Soil composition
%Sand (by volume)
85%
OK
% Fines (by volume)
12%
OK
Form SW401-Bioretention-Rev.8
June 25, 2010 Parts I and II. Design Summary, Page 1 of 3

Permit Number:
(to be provided by DWp)
% Organic (by volume) 3% 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 2 of 3

Permit
(to be provided by DWQJ
Basin Elevations
Temporary pool elevation
Type of bioretention cell (answer "Y' to only one of the two following
questions):
Is this a grassed cell?
Is this a cell with trees/shrubs?
Planting elevation (top of the mulch or grass sod layer)
Depth of mulch
Bottom of the planting media soil
Planting media depth
Depth of washed sand below planting media soil
Are underdrains being installed?
How many clean out pipes are being installed?
What factor of safety is used for sizing the underdrains? (See
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
the bottom of the cell to account for underdrains
Bottom of the cell required
SHWT elevation
Distance from bottom to SHWT
Internal Water Storage Zone (IWS)
Does the design include IWS
Elevation of the top of the upturned elbow
Separation of IWS and Surface
Planting Plan
Number of tree species
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
bioretention cell?
Does volume in excess of the design volume Flow evenly distributed
through a vegetated filter?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the BMP located at least 30 feet from surface waters (50 feel if
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Are the vegetated side slopes equal to or less than 3:1?
Is the BMP located in a proposed drainage easement with access
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
Is the area surrounding the cell likely to undergo development in the
future?
852.00 imsl
Y (Y or N) OK
N (Y or N)
851 fmsl
0 inches Insufficient mulch depth, unless installing grassed cell.
848.75 fmsl
2.25 it
0.33 it
Y (Y or N)
8 OK
2 OK
1 fl
847.42 fmsl
fmsl
847.42 it OK
N (Y or N)
fmsl
851 it
0
0
1 Recommend more species.
Y (YorN) OK
N (Y or N) Excess volume must pass through filter.
if
N (Y or N) Show how flow is evenly distributed.
Y (Y or N)
OK
Y (Y or N)
OK
Y (YorN)
OK
Y (Y or N)
OK
0.5 ft/sec
OK
N (Y or N) OK
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 ft of grass)
Grassed swale X OK
Forebay
Other
Form SW401-Bioretention-Rev.8
June 25, 2010 Parts I and II. Design Summary, Page 3 of 3