SW3170501_CURRENT PERMIT_20170528

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO. SWJ1
DOC TYPE CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DO DATE
YYYYMMDD

ROY COOPER
Governor
i;
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Energy, Mineral & Director
Land Resources
ENVIRONMENTAL QUALITY
May 28, 2017
Mr. Scott W. Hughes, Manager
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Jones & Hughes Real Estate, LLC
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228 W. Main Street
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Rockwell, North Carolina 28138-8582
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Subject: Stormwater Permit No. SW3170501
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FillTech USA Manufacturing Plant Rockwell, NC, Rowan County
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Dear Mr. Hughes:
The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater
Management Permit Application for the subject project on May 28, 2017. Staff review of the plans and
specifications has determined that the project, as proposed, will comply with the Stormwater Regulations
set forth in Title 15A Section NCAC 21-1.1000. We are forwarding Permit No. SW3170501, dated May
28, 2017, for the construction, operation and maintenance of the subject project and the stormwater
system. This permit shall be effective from the date of issuance until May 27, 2025, or until rescinded and
shall be subject to the conditions and limitations as specified therein, and does not supersede any other
agency permit that may be required.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings
(OAH). The written petition must conform to Chapter 150B of the North Carolina General Statutes. Per
NCGS 143-215(e) the petition must be filed with the OAH within thirty (30) days of receipt of this
permit. You should contact the OA14 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.NCOA14.com. Unless such demands are made
this permit shall be final and binding.
This project will be kept on file at the Mooresville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Mike Randall at [phone]; or
[e-mail].
Sincerely,
for Tracy E. Davis, PE, CPM; Director
cc: SW3170501 File, Mooresville Regional Office
cc: G. Wesley Webb, Alley, Williams, Carmen & King, Inc.
Nothing Compares..,..
SState of North Carolina I Environmental Quality I Energy, Mineral and land Resources
512 N. Salisbury Street 11612 Mail Service Center I Raleigh. North Carolina 276991612
919 707 9200

State Stormwater Permit
Permit No. SW3170501
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT QUALITY
STATE STORMWATER MANAGEMENT PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina
as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
FiIlTech USA Manufacturing Plant
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Jones & Hughes real Estate, LLC
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Rowan County
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FOR THE
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construction, operation and maintenance of the Stormwater Control Measure
(S(/I) in compliance
with the provisions of 15A NCAC 2H .1000 (hereafter referred to as the
"stormw^r rules') and the
approved stormwater management plans, specifications and other supporting data as on file with
and approved by the State and considered a part of this permit.
This permit shall be effective from the date of issuance until May 27, 2025, 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. The SCM is approved for the management of stormwater runoff as described in the
application documents and as shown on the approved plans.
3. All stormwater collection and treatment systems must be located within a dedicated common
areas or recorded easements. The final plats for the project will be recorded showing all
such required easements, in accordance with the approved plans.
4. The runoff from all built -upon area within the permitted drainage area of this project must be
directed into the SCM.
5. The built -upon areas associated with this project shall be located at least 30 feet landward of
all perennial and intermittent surface waters.
6. The inlets SCMs shall be designed to protect the SCM from erosion resulting from
stormwater discharges. The outlets of SCMs shall be designed so that they do not cause
erosion immediately downslope of the discharge point during the peak flow from the 10-year
storm event as shown by engineering calculations.
II. SCHEDULE OF COMPLIANCE
During construction, erosion shall be kept to a minimum and any eroded areas of the system
will be repaired immediately.
SCMs that allow stormwater to infiltrate shall not be located on or in areas with contaminated
soils.
Page 1 of 4

State Stormwater Permit
Permit No. SW3170501 J
3. The permittee shall at all time provide the operation and maintenance necessary to assure
every SCM 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. The SCM shall be maintained in a manner that results in a drawdown of at least two inches
per hour at the sand surface. When the filtering capacity has diminished below this level,
then remedial actions shall be taken.
5. Records of maintenance activities must be kept for the SCM. The reports will indicate the
date, activity, name of person performing the work and what actions were taken. The owner
shall keep maintenance records and these shall be available upon request by the party
responsible for enforcing the stormwater program under which the SCMs were approved.
6. The permittee shall submit an annual summary report of the maintenance and inspection
records for the SCM. The report shall summarize the inspection dates, results of the
inspections, and the maintenance work performed at each inspection.
7. The SCM shall be constructed in accordance with the approved plans and specifications, the
conditions of this permit, and with other supporting data.
8. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and prior to
operation of this permitted facility, a certification must be received from an appropriate
designer for the SCM certifying that it has been installed in accordance with this permit, the
approved plans and specifications, and other supporting documentation. Any deviations
from the approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
9. SCMs impacted by sedimentation and erosion control during the construction phase shall be
cleaned out and converted to its approved design state.
10. The permittee shall submit to the Director and shall have received approval for revised plans,
specifications, and calculations prior to construction, for any modification to the approved
plans, including, but not limited to, those listed below:
a. Any revision to any item shown on the approved plans, including the stormwater
management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the drainage
area.
e. Further subdivision, acquisition, lease or sale of all or part of the project area. The
project area is defined as all property owned by the permittee, for which
Sedimentation and Erosion Control Plan approval was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the approved
plan.
11. A copy of the approved plans and specifications shall be maintained on file by the Permittee
for a minimum of eight years from the date of the completion of construction.
Page 2 of 4

State Stormwater Permit
Permit No. SW3170501
12. The Director may notify the permittee when the permitted site does not meet one or more of
the minimum requirements of the permit. Within the time frame specified in the notice, the
permittee shall submit a written time schedule to the Director for modifying the site to meet
minimum requirements. The permittee shall provide copies of revised plans and certification
in writing to the Director that the changes have been made.
13. All SCMs and associated maintenance accesses on privately owned land shall be located in
permanent recorded easements. The SCM shall be shown and labeled within the easement.
These easements shall be granted in favor of the party responsible for enforcing the
stormwater program under which the SCMs were approved. SCMs must have access and
maintenance easements to provide the legal authority for inspections, maintenance
personnel and equipment. The entire footprint of the SCM system must be included in the
access and maintenance easement, plus an additional ten or more feet around the SCM to
provide enough room to complete maintenance tasks. This SCM system includes the side
slopes, forebay, riser structure, SCM device, and basin outlet, dam embankment, outlet, and
emergency spillway.
14. The O&M Agreement shall be referenced on the final plat and shall be recorded with the
County Register of Deeds upon final plat approval' If no'subdivision plat is recorded for the
site, then the O&M Agreement shall be recorded with the county Register of Deeds so as to
appear in the chain of title of all subsequent purchasers.
III. GENERAL CONDITIONS
1. This permit is not transferable except after notice to and approval by the Director. In the
event of a change of ownership, or a name change, the permittee must submit a completed
Name/Ownership Change form signed by both parties, to the State, accompanied by the
supporting documentation. 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 the Division
approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to enforcement action by the State, in accordance with North Carolina General
Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with 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 to inspect 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.
Page 3 of 4

State Stormwater Permit
Permit No. SW3170501
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 281' day of May, 2017.
for Tracy E. Davis, P.E., CPM
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

State Stormwater Permit
Permit No. SW3170501
FillTech USA Manufacturing Plant
Jones & Hughes Real Estate, LLC
Rowan County
Designer's Certification
I, , as a duly registered
North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
(Project Name)
in the State of
for (Project Owner) hereby state that, to the best of
my abilities, due care and diligence was used in the observation of the project construction such
that the construction was observed to be built within substantial compliance and intent of the
approved plans and specifications.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
cc: NCDEQ-DEMLR Regional Office
SEAL
Page 1 of 1

DEMLR USL ONLY
D Received
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en
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Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - P6st Construction
(select 411 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
b I L)1tMWAI LK MANAULMLN'I PLKMl'1' APPLICA'1'lUN FORM
This form Inay be photocopied for use as an original
L GENERAL INFORMATION �\ p
1. Project Name (subdivision, facility, or establishment name - sbDuld be consistel;th project name on plans, 1
"'MECEIVED� �\
specifications, letters, operation and maintenance agree[,
nillTarh I IrA - Nov., K4a nS.,Forr„Yi..,. PIf �' L' e�1,
2. Location of Project (street address): 9L t; ca
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City: Rockwell
3. Directions to project (from nearest major intersection):
From the intersection of U.S. Hwy. 52 / W. Main Street and Market Street head northeast on Market Street
4. Latitude: 35' 33' 17' N � Longitude: -80' 24' 16" W lk� of the main entrance to the project.
it. PERMIT INFORMA ON:
I. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tReueWals With nmdifications also requires SINU-702 - Renezoal Application Fonn
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 ®I-ligh 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: 50 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: The site is located in Rowan County. The sedimetn and erosion
control plan will be issued by Rowan County Environmental Protection
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/ruies--,ind-regulations
Form SWU-101 Version Oct. 31, 2013 Page I of

III. 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 uroiect):
Applicant/Organization: [ones & Huehes Real Estate LLC
Signing Official & Title: Scott W. Hughes -Manager
b.Contact information for person listed in item I above:
Street Address: 228 W. Main Sreet
City: Rockwell State: NC Zip: 28138-8582
Mailing Address (if applicable): P.O. Box 1209
City: Rockwell State: NC Zip: 28138-1209
Phone: ( 704 ) 279-4300 Fax:
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:
Signing Official &
b.Contact information for person listed in item 2a above
Street Address:
City:
State:
Zip:
Mailing Address (if applicable):
City:
State:
Zip:
Phone: ( )
Fax: ( )
Email:
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: Chad Porterfield
/ CHADCO Builders
Signing Official & Title: Chad Porterfield -Genera I Contractor
b. Contact information for person listed in item 3a above:
Mailing Address: 2004 Anthony Road #B
City: Burlington
State: NC
Zip: 27215-8941
Phone:( 336 ) 227-6585
Fax: ( )
Email: chad©chadcobuilders.com
4. Local jurisdiction for building permits: Rowan County
Point of Contact: Building Inspections Department Phone #: ( 704 ) 216-8619
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stonnwater runoff will be treated.
Stormwater runoff will be collected and conveved through storm drainage inlets and piping into one of two
forebays for pretreatment, and then into a detention pond with a 985 SF Sand Filter BMP
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: 5.03 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': 5.03 acres
Total project area shall be calculated to exclude the folhaVingg the normal pool of impounded structures, the area
between the banks of streants and rivers, the area below the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands Imtdward of the NHW (or MHW) line stay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 60.8
9. How many drainage areas does the project have? 4 (For high density, count 1 for each proposed engineered
stornaoater BMP. For laze density and other projects, use I for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Draina e Area 1
Draina e Area 2
Draina e Area 3
Draina e Area 4
Receiving Stream Name
Second Creek
Second Creek
Second Creek
Second Creek
Stream Class *
C
C
C
C
Stream Index Number *
12-117-2
12-117-2
12-117-2
12-117-2
Total Drainage Area (so
17004
25885
175033
9750
On -site Drainage Area (so
17004
25885
168980
8348
Off -site Drainage Area (sf)
0
0
6053
1 1402
Proposed Impervious Area** s
3611
1936
130680
3121
% Im ervious Area** total
21.2
1 3.6
74.7
32.0
Impervious— Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
On -site Buildings/Lots(sf)
0
0
40,563
0
On -site Streets (so
0
0
0
0
On -site Parking (so
838
0
43603
0
On -site Sidewalks (sf)
39
208
1849
0
Other on -site (so
0
728
1977
0
Future (sf)
0
0
34767
0
Off -site (so
0
0
6053
1 1402
Existing BUA*** (so
2734
0
1868
1 1719
Total (so:
3611
936
130680
1 3121
Stream Class and Index Number can be determined at: Itttp://portal.nedemr.org oebkvq&s/esu/classificatioms
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 neto BUA.
Form SWU-101 Version Oct. 31, 2013 Page of

11. How was the off -site impervious area listed above determined? Provide documentation. From surveyed field
data of existing pavement areas and property lines The property line extends into the Street Right of Way
Projects in Union County: Contact DEMLR Central OjJice staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 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 httril/portal.ncdenr.ore/web/wci/ws/su/bmv-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://portal.ncdenr.org/web/wg/ws/su/statesw/forms dots. 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 ath2R://portal ncdenr org/web/wg/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://Rortal.ncdenr.or$t/web/wq/ws/su/statesw/forms dots.
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/­onestoRexl2ress.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 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
in. 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 separate document).
.L„
G wc</
e- z&,-
6 A". l
61,
Gw�
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where required).
Copy of any applicable soils report with the associated SHWT elevations (Please identify ��✓
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1278 & 1259 Page No: 799 & 135 G(✓�
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per 15A NCAC 21-1.1003(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.secretaKy.state.nc.us/Corporations/CSearch.a.5px
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 http://12ortal.ncdenr.org/web/ir/state-stormwater-
forms docs. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR, and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: G. Wesley Webb
Consulting Firm: Alley, Williams, Carmen & King, Inc.
Mailing Address: P.O. Box 1248
City: Kannapolis
Phone: ( 704 ) 938-1515
Email: wwebb®awck.com
State: NC Zip: 28082-1248
Fax: ( 704 ) 938-6810
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) certify that I
own the property identified in this permit application, and thus give permission to (print or hype name of person
listed in Contact Information, item 1a) with (print or hjpe name of organization listed in
Contact Information, item la) 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 assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
I, a Notary Public for the State of
do hereby certify that
before me this _ day of
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 1a) Scott W. Hughes
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 pryused project complies with the requirements of the
applicable stormwater rulesyndeV5A NCAC 21/!1000 ui any other applicable state stormwater requirements.
Date:_ %
I L'�r-� g l x �Pa Notary Public for the State of I Cc'r� l ihS County of
Ol i 4r do hereby certify that ')( n-i lr �� 1�xf personally appeared
before me this 'day of / /nd ac wlec]ge Pne execution of the application for
a stormwater permit. Witness my hand and official se ��i l \/�\\\ 011aA--IAi
r
SEAL
My commission expires_ (-23 -/%'7 u
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6

ration & Maintenance Agreement
Project Name: I Filltech USA - New Manufacturing
Project Location: 1380 Palmer Road Rockwell NC
Maintenance records shall be kept on the following BMP(S). This maintenance record shall be kept in a log in a known set locati(
Any deficient BMP elements noted in the inspection will be corrected, repaired, or replacedimmediately. These deficiencies can
affect the integrity of structures, safety of the public, and the pollutant removalefficiency of the BMP(s).
The BMP(s) on this project include (check all that apply & corresponding O&M tables will
Bioretention Cell Quantity:
Dry Detention Basin Quantity:
Grassed Swale Quantity:
Green Roof Quantity:
Infiltration Basin Quantity:
Infiltration Trench Quantity:
Level SpreaderNFS Quantity:
Permeable Pavement Quantity:
Proprietary System Quantity:
Rainwater Harvesting Quantity:
Sand Filter Quantity:
Stormwater Wetland Quantity:
Wet Detention Basin Quantity:
Disconnected Impervious Area Present:
User Defined BMP Present:
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
1
0
No
No
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each BMP above, and attached O&M tables. I agree to notify NCDEQ of any problems with the system or prior to any changes to the
system or responsible party.
Signature:
County of
' Responsible Party:
Title & Organization:
Street address:
City, state, zip:
Phone number(s):
Email:
personally appeared before me this
Scott W. Hu hs
Jones & Hughes Real Estate, LLC
228 W Main Street
Rockwell, NC 28138-8582
704-2794300
sco fllltechUsa.COM
Date: 5 OZ
a Notary Public for the State of CEO
do hearby certify that
day of @-Q k and
acknowledge the due execution of theO�per ns and Main na c gIreement
Witness my hand and official seal,, iXreennent
My commission expires Dj-&-I,
3/8/2017 Filltech USA- New Manufacturing Plant

I Sand Filter Maintenance Requirements c
Important maintenance procedures:
- The drainage area will be carefully managed to reduce the sediment load to the sand filter.
- The sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds six inches.
- Once a year, sand media will be skimmed.
- The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter shall be inspected quarterly and within 24 hours after every storm event greater than 1.0 inches 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:
Potential problem:
How to remediate the problem:
Entire BMP
Trash/debris is present.
Remove the trash/debris.
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as possible.
applicable)
pavement surface.
Perimeter of sand filter
Areas of bare soil and/or
Regrade the soil if necessary to remove the gully, and then plant a
erosive gullies have formed.
ground cover and water until it is established. Provide lime and a one-
time fertilizer application.
Vegetation is too short or too
Maintain vegetation at an appropriate height.
long.
Flow diversion structure
The structure is clogged.
Unclog the conveyance and dispose of any sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if damage is too large for repair.
The inlet device
The pipe is clogged.
Unclog the pipe. Dispose of the sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to smooth it over and provide erosion
swale.
control devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
Stone verge is clogged or
Remove sediment and replace with clean stone.
covered in sediment (if
applicable).
Forebay or pretreatment
Sediment has accumulated to
Search for the source of the sediment and remedy the problem if
area
a depth of greater than six
possible. Remove the sediment and stabilize or dispose of it in a
inches.
location where it will not cause impacts to streams or the BMP.
Erosion has occurred.
Provide additional erosion protection such as reinforced turf matting or
riprap if needed to prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by hand. If a pesticide is used, wipe it
on the plants rather than spraying.
Filter bed and underdrain
Water is ponding on the
Check to see if the collector system is clogged and flush if necessary.
collection system
surface for more than 24
If water still ponds, remove the top few inches of filter bed media and
hours after a storm.
replace. If water still ponds, then consult an expert.
The embankment
Shrubs or trees have started
Remove shrubs or trees immediately.
to grow on the embankment.
Grass cover is unhealthy or
Restore the health of the grass cover— consult a professional if
eroding.
necessary.
Signs of seepage on the
Consult a professional.
downstream face.
Evidence of muskrat or beaver
Use traps to remove muskrats and consult a professional to remove
activity is present.
beavers.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair.
3/8/2017
Filltech USA- New Manufacturing Plant

BMP element:
Potential problem:
How to remediate the problem:
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
damage have occurred at the
outlet.
Contact the local NC Department of Environmental Quality Office at
704-663-1699.
3/6/2017 Filltech USA- New Manufacturing Plant