SW4160801_CURRENT PERMIT_20160816

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO. SW 1,11 ak2
DOC TYPE CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑. COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

Energy. Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. George T. Barnes, Jr.
Glandon Forest Equity, LLC
3825 Barrett Drive Suite 100
Raleigh, North Carolina 27609
PAT MCCRORY
c„ret,Iet
DONALD R. VAN DER VAART
S"'tu'l.
TRACY DAVIS
NC Department of
Environmental Quality
Received
August 16, 2016 AUG 18 2016
Winston-Salem
Regional Office
Subject: Stormwater Permit No. SW4160801
Dollar General #17591 in Graham NC, Alamance County
Dear Mr. Barnes:
The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater
Management Permit Application for the subject project on August 15, 2016. Staff review of the plans and
specifications has determined that the project, as proposed, will comply with the Stormwater Regulations
set forth in Title 15A Section NCAC 2H.1000. We are forwarding Permit No. SW4160801, dated August
16, 2016, for the construction, operation and maintenance of the subject project and the stormwater
system. This permit shall be effective from the date of issuance until August 15, 2024, or until rescinded
and shall be subject to the conditions and limitations as specified therein, and does not supersede any
other agency permit that may be required.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings
(OAH). The written petition must conform to Chapter 150B of the North Carolina. General Statutes. Per
NCGS 143-215(e) the petition must be filed with the OAH within thirty (30) days of receipt of this
permit. You should contact the 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.
This project will be kept on file at the Winston-Salem Regional Office. If you have any questions, or
need additional information concerning this matter, please contact Mike Randall at [phone]; or
[e-mail].
Sincere
fa Tracy E. Davis, PE, CPM, Director
cc: SW4160801 File, Winston-Salem Regional Office
cc: Matt Lowder, PE Triangle Site Design
State ol'North Carolina I Environmental Quality I Energy, Mineral and IAnd Resources
1612 Mail Service Center I Raleigh, North Carolina 27699-1612
919-807-6375

State Stormwater Permit
Permit No. SW4160801
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
Mr. George T. Barnes, Jr.
Glandon Forest Equity, LLC
Dollar General #17591 in Graham NC, Alamance County
FOR THE
construction, operation and maintenance of the bio retention cell in compliance with the
provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and the
approved stormwater management plans and specifications and other supporting data as
attached and on file with and approved by the State and considered a part of this permit.
This permit shall be effective from the date of issuance until August 14, 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.
The bio retention cell is approved for the management of stormwater runoff as
described in the application documents and as shown on the approved plans.
3. All stormwater collection and treatment systems must be located in either dedicated
common areas or recorded easements. The final plats for the project will be
recorded showing all such required easements, in accordance with the approved
plans.
4. The runoff from all built -upon area within the permitted drainage area of this project
must be directed into,the bio retention.
5. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 4

State Stormwater Permit
Permit No. SW4160801
II. SCHEDULE OF COMPLIANCE
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
2. The permittee shall at all time provide the operation and maintenance necessary to
assure permitted bio retention cell permitted 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.
Cl. Access to the cell and outlet structure must be available at all times.
3. Records of maintenance activities must be kept for the bio retention. The reports will
indicate the date, activity, name of person performing the work and what actions
were taken.
4. The permittee shall submit an annual summary report of the maintenance and
inspection records for the bio retention. The report shall summarize the inspection
dates, results of the inspections, and the maintenance work performed at each
inspection.
5. The bio retention cell shall be constructed in accordance with the approved plans
and specifications, the conditions of this permit, and with other supporting data.
Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received from
an appropriate designer for the bio retention cell certifying that the permitted facility
has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A modification
may be required for those deviations.
7. If the stormwater system was used as an Erosion Control device, it must be restored
to design condition prior to operation as a stormwater treatment device, and prior to
occupancy of the facility.
8. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project area.
The project area is defined as all property owned by the permittee, for which
Sedimentation and Erosion Control Plan approval was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
Page 2 of 4

State Stormwater Permit
Permit No. SW4160801
9. A copy of the approved plans and specifications shall be maintained on file by the
Permittee for a minimum of eight years from the date of the completion of
construction.
10. The Director may notify the permittee when the permitted site does not meet one or
more of the minimum requirements of the permit. Within the time frame specified in
the notice, the permittee shall submit a written time schedule to the Director for
modifying the site to meet minimum requirements. The permittee shall provide
copies of revised plans and certification in writing to the Director that the changes
have been made.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director. In
the event of a change of ownership, or a name change, the _ permittee must submit a
completed Name/Ownership Change form signed'tiy`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 such time
as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the State, in accordance with North
Carolina General Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action, including
those as may be required by this Division, such as the construction of additional or
replacement stormwater management systems.
6. The permittee grants DEQ Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
The permit issued shall continue in force and effect until revoked or terminated. The
permit may be modified, revoked and reissued or terminated for cause. The filing of
a request for a permit modification, revocation and re -issuance or termination does
not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference and
are enforceable parts of the permit.
Page 3 of 4

State Stormwater Permit
Permit No. SW4160801
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 16t" day of August, 2016.
y .,
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

State Stormwater Permit
Permit No. SW4160801
Mr. George T. Barnes, Jr.
Glandon Forest Equity, LLC
Dollar General #17591 in Graham NC, Alamance County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
(Project Name)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications. ,
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
61:F_1I
cc: NCDEQ-DEMLR Regional Office
Page 1 of 1

Date
USE ONLY
Paid --
Applicable Rules: El Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph 11 - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Slormwaler Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina NC Department of
Department of Environment and Natural Resources Environmental Quality
ReceiDivision of Water Quality AUG 18 2016
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original inston-Sa -m
Regional Of:
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project r7¢l6 on
plans, specifications, letters, operation and maintenance agreements, etc.): /� (�0
Dollar General # 17591 � t r {', 0�a.-ri�=
2. Location of Project (street address):
City:Gra ha m Cou nly: A la m ance
bto w
CA
3. Directions to project (from nearest major htLersection): hSW-
Southeast intersection of Southern High School Rd. and S. NC 87 Hwy.
4. Latitude:36' 00' 20" N T►y Longitude:79' 23' 34" W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificabont
tRenewals with modifications also regWres SWU-702 - Renewal Application Form
b.lf this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* "provide a designer's
certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsile Stormwater System ❑Other
3. if this application is being submitted as the result of a previously returned application or a letter from
DWQ requesting a state stormwater management permit application, list the stormwater project number,
if assigned, and the previous name of the project, if different than currently
proposed,
4.a.Additional Project Requirements (check applicable blanks; itdormation on required state permits can be
obtained by contacting the Customer Service Center at "1-877-623-6748):
❑CAMA Major
❑NPDES Industrial Stonnwaler
®Sedimentation/Erosion Control: 2.6 ac of Disturbed Area
❑404/401 Permit: Proposed Impacts
b.lf any of these permits have already been acquired please provide the Project Name, Project/Permit
Number, issue date and the type of each permit.:
5. Is the project located within 5 miles of a public airport? ❑No ®Yes
If yes, see S.L. 2012-200, Part VI: )JlI2://t)ortil.iicdenr.or6 wcblwq/ws/su/stitesw/rules laws
Form SWU-101 Version 06Aug20I2 Page I of 6

III. CONTACT INFORMATION
1.a. Print Applicant / Signing Official's name and title (specifically the developer, properly owner, lessee,
designated government official, individual, etc. who owns the pro
Applicant/Organiration:Glandon Forest Equity LLC
Signing Official & Title:George T. Barnes, Jr. - member/manager
b.Conlact information for person listed in item la above:
Street Address:3825 Barrett Drive Suite 100
City:Raleigh State:NC Zip:27609
Mailing Address (if
City:
Phone: (919 ) 459-2601
Erna il: gbarnes@vangu and pg.com
Sla
Zi
Fax: (919 ) 459-2604
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Infonnation, item 3a)
❑ Lessee' (Attach a copy of the lease agreement and complete Contact Infonnation, 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 & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City: State:
Mailing Address (if applicable):
City: State:
Phone: ( ) Fax: ( )
Email: .
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:Glandon Forest Equity, LLC
Signing Official & Title:Ceort,e T. Barnes, Ir. -member/manager
b.Contact information for person listed in item 3a above:
Mailing Address:3825 Barrett Drive Suite 100
City:Raleigh Stale:NC Zip:27609
Phone: (919 ) 459-2601
Email:gba rues@vanguard pg.com
4. Local jurisdiction for building pennies:
Fax: (919 ) 459-2604
Point of ContacL-Gene Foxworth Phone #: (252 ) 728-8545
Form SWU-101 Vcrsion 06Aug2012 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwaler runoff will be treated.
Stonnwater runoff from the developed areas of the site will be treated in a wet pond that
is designed to treat the 1.0" storm event for 85%TSS
2. a.If claiming vested rights, identify the supporting documents provided and the dale they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph 11 - Post Construction
3. Stormwater runoff from this project drains to the
4. Total Property Area: 1.49 acres
River hasin.
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area':1.49 acres
* Total project area shall be calculated to exclude the folloeoing the normal pool of impounded structures, the area
between the banks of streams and rivers, the area beloto the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant prefect area is used to
calculate overall percent built upon area (BLIA). Non -coastal wetlands landurard of the NHW (or MHb�q line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 57.0 %
9. How many drainage areas does the project have?l (For high densihj, count 1 for each proposed engineered
stormwater BMP. For loin densihj and other projects, use 1 for the tolrole properhj area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each
area provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area
Drainage Area
Drainage Area
Receiving Stream Name
Big Alamance
Creek
Stream Class *
WS-V; NSW
Stream Index Number *
16-19-(4.5)
Total Drainage Area (sf) _
47916
On -site Drainage Area (so
47916
Off -site Drainage Area (so
0
posed Impervious Area**
(sn
E
34848
% Impervious Area' (total)
72.7%
hn ervious 'Surface Area
Drainage Area 7
Drainage Area _
-Draina ge Area _
Drainage Area
On -site Buildings/Lots (so
9010
On -site Streets (so
0
On -site Parking (so
23953
On -site Sidewalks (so
1885
Other on -site (so
0
Future (sf)
0
Off -site (SO
0
Existing BUA*** (sf)
0
Total (so:
34848
Stream Class and Index Number can be determined at: hffla://porfril.ncdrnr.org tneb/aoq(ps/csu/elassifications
Imppervious area is defined as the built upon area including, brit not limited to, buildings, roads, parking areas,
sidcualks, gravel areas, etc.
Form SWU-101 Version 06Aug2012 Page 3 of 7

11. How was the off -site impervious area listed above determined? Provide documentation. Design drawings
1'ro4eets in Union County: Contact DWQ Central Office sta(fto check if the project is located within a Threatened &c
Endangered Species watershed that map he subject to more stringeni srornnrater 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 http://portal.iicdenr.org/web/wq/ws/su/bop-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from littp://portal.ncdeiir.org/web/wq/ws/sti/statesw/fornis—docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://portal.iicdenr.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.ncdeiir.org/web/wq/ws/su/statesw/forms-docs.
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part Vll 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.eiivlielp.org/pages/onestoDexpress.litml 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/nnanagennentfor
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.
I. 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 MI-IW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NI-IW 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 a separate document).
p. Vegetated buffers (where required).
A�&11/
A L - IcS)
Form SWU-101 Version 06Aug2012 Page 4 of 6

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 a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SH WT elevations (Please identify, Ku. C'4 6
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 0229 Page No: 0058
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.secretary.sLaLe.nc.us/Corporations/`CSearcii.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, oulparcels, 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
hlln://nurtal.ncdonr.orrt/web/wa/ws/su/slalesw/forms_daw. 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 properly
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 holders) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ, and that they will be recorded prior to the sale of any lot.
VILL CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Malt Lowder, PE
Consulting Firm: Triangle Site Design, PLLC
Mailing Address:4004 Barrett Drive, Suite 101
Phone: (919 ) 553-6570
Email:nrlowder@trimiglesitedesigncom
State:NC Zip:27609
Fax: ( )
Form S WU-101 Version O6Aug2012 Page 5 of 7

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without valid permit. 1 understand that the operation of a stormwater treatment facility without 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.
Signatu
a Notary Public for the State of , County of
do hereby certify that personally appeared
before me this _ day of
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 nave of person listed in Contact Information, item In) George T. Barnes Jr. (Glandon Forest Equitll, LLC),
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 rundSA NCAC 2] I .1000 and any other applicable state stormwater requirements.
I, Q '/f1/F�2//�7V/f / V a Notary Public for the Stale of �/L County of
W/q//E c rereby certify that (I, (rRP.0 �� /1/A- ,/' personally appeared
before me this May of '— u V A16 . and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, ,V///U .{( C((,4�41. r/Z -A6,/)
�-10,NN ty
0 A4
NOTARY PUBLIC
_ WAKE CO.
MY COMM. EXP.
03-m-2021
Oi TH CARO\-�%%
#ties%%
SEAL
My commission expires )oil
Fonn SWU-101 Version 06Aug2012 Page 6 of

t�
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 DWQ Stormwater permit reverts back to
me, the property owner. As the proper ner, it is my responsibility to notify DWQ immed lately and submit a
completed Name/Ownership ge rm ith n 30 days; otherwise I will be operating a stormwater treatment
facility without a vali . I u rstand at the operation of a stormwater treatment facility without a valid
permit is o Statue 3-215.1 and may result in appropriate enforcement action including
the assessment o e of up to 5,000 per day, pursuant to NCGGS 143-215.6.
c,....,... ... /1---' .d,._oC�(•�jf,y 1 itarP- ��ll L
1, '64�-4) If .M('1,.�( t" II i1 a Notary Public for the State of NC. . County of
+�y� -T-
-�-P31 \ ry:b4t;n , do hereby certify that V1e00e}h d ILRq a�Anwmg_ personally appeared
before me this 4„day of -�U>,I1. an n/5/�'w'l'edge tJre du execufion Qf the application for
a stormwater permit Witness my hand and official seal, W j- --
ASHLEY MCLAURIN
NOTARY PUBLIC
JOHNSTON COUNTY
STATE OF NORTH CAROLINA
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires 5 rl / j
I, (print or hype name of person listed in Contact Information, item Ia) Geor5ze T. Barnes, fr. (Glandon Forest Equihy, LLC),
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 ru)e9T ndr,15A NCAC 2I-I .1000 and any other applicable state stormwater requirements.
M/ V ` /> I , a Notary Public for the State of -1County of
iVr%1(1- cuerebycertifythat i�;ti(>ili'c= /�iF�,�ii/i=5 t k personally appeared
/N
before me this / I day of , ki / . / '/. and acknowledge the due execution of the application for
// 7
a stormwater permit Witness my hand and official seal, ; /r (! ' L (%r Jl
%FUANN NyF��i
� 9 .O� i
NOTARYPUBLIC
WAKE CO.
MY COMM. EXP.
03-15-2021
�r+ i i iO r %`�,,,
SEA I:
My commission expires ---,If
Fo1mSWU-101 Version06Aug20I2
Page 6 of 6

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1145(
NORTH STATE BANK
GLANDON FOREST EQUITY, LLC
RALEIGH, NC 27609
. 3825 BARRETT DRIVE, SUITE 100
66-1235/531
. RALEIGH, NC 27609
6/24/2016 "
PAY TO THE NCDEQ
ORDER OF
-
$
_�
505.00
Five Hundred Five and 00/100===»=_»_;._.... «.;_»_,_...._.»..;».___«__:.__«....»»_.«__»_,_...,_,.»«„»»»
........:....:.««,
DOLLARS .
NCDEQ
V 1_j
1
4R41�1
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MEMO If
AUTHORIZED
R SIGNATURE
Graham (stormwater)
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e
II'011450i1° 1:0531123561:
05200591,9iI'

Permit No'.
(to be assigned by DWQ)
IIL REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package
will result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided
to indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Pagel Plan
fiIs S et No.
W 61O
Mitt tit (�S
EM
Plans (1' - 50' or larger) of the entire site showing:
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Delineated drainage basins (include Rational C coefficient per basin),
- Cell dimensions,
- Pretreatment system,
- High flow bypass system,
- Maintenance access,
- Recorded drainage easement and public right of way (ROW),
- Clean out pipe locations,
- Overflow device, and
- Boundaries of drainage easement.
2. Plan details IV = 30' or larger) for the bioretention cell showing:
- Cell dimensions
- Pretreatment system,
High flow bypass system,
- Maintenance access,
- Recorded drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Clean out pipe locations,
- Overflow device, and
- Boundaries of drainage easement.
- Indicate the P-Index between 10 and 30
3. Section view of the bioretention cell (V = 20' or larger) showing:
- Side slopes, 3:1 or lower
- Underdrain system (if applicable), and
- Bioretention cell layers [ground level and slope, pre-treatment, pone ing depth, mulch depth, fill media
depth, washed sand, filter fabric (or choking stone if applicable), #57 stone, underdrains (if applicable),
SHWT level(s), and overflow structure]
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.
5. A detailed planting plan IV = 20' or larger) prepared by a qualified individual showing:
- A variety of suitable species,
- Sizes, spacing and locations of plantings,
- Total quantity of each type of plant specified,
- A planting detail,
- The source nursery for the plants, and
- Fertilizer and watering requirements to establish vegetation.
6. A construction sequence that shows how the Bioretention cell will be protected from sediment until the
entire drainage area is stabilized.
7. The supporting calculations (including underdrain calculations, if applicable).
8. A copy of the signed and notarized inspection and maintenance (I&M) agreement.
9. A copy of the deed restriction.
Form SW401-Bioretention-Rev.7 Part III, Page 1 of 1

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Galt
4 Permit Number:
(to be provided by DIIIQ)
Drainage Area Number:
Bioretention Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
Important operation and maintenance procedures:
— Immediately after the bioretention cell is established, the plants will be watered
twice weekly if needed until the plants become established (commonly six
weeks).
— Snow, mulch or any other material will NEVER be piled on the surface of the
bioretention cell.
— Heavy equipment will NEVER be driven over the bioretention cell.
— Special care will be taken to prevent sediment from entering the bioretention cell.
— Once a year, a soil test of the soil media will be conducted.
After the bioretention cell is established, I will inspect it once a month and within 24
hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of operation and maintenance will be kept in a known set location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblems:
Flow I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
bioretention cell
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
The inlet device: pipe,
The pipe is clogged (if
Unclog the pipe. Dispose of the
stone verge or Swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the Swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
Form S W401-13ioretenlion O&M-Rev.3
Page I of 4

if
BMP element:
The pretreatment area
n cell:
vegetation
soils and mulch
Plow is bypassing
pretreatment area and/or
gullies have formed.
Sediment has accumulated to
a depth greater than three
inches.
Erosion has occurred
Weeds are present.
Best professional practices
show that pruning is needed
to maintain optimal plant
health.
Plants are dead, diseased or
dying.
'free stakes/wires are present
six months after planting.
Mulch is breaking down or
has floated away.
Sorts ana/ or mulch are
clogged with sediment.
An annual soil test shows that
pH has dropped or heavy
metals have accumulated in
the soil media.
How I will remediate the problem:
Regrade if necessary to route all
flow to the pretreatment area.
Restabilize the area after grading.
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
restabilize the pretreatment area.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Remove the weeds, preferably by
hand.
Prune according to best professional
practices.
Determine the source of the
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Remove tree stake/wires (which
can kill the tree if not removed).
Spot mulch if there are only random
void areas. Replace whole mulch
layer if necessary. Remove the
remaining much and replace with
triple shredded hard wood mulch at
a maximum depth of three inches.
Determine the extent of the clogging
- remove and replace either just the
top layers or the entire media as
needed. Dispose of the spoil in an
appropriate off -site location. Use
triple shredded hard wood mulch at
a maximum depth of three inches.
Search for the source of the
sediment and remedy the problem if
possible.
Dolomitic lime shall be applied as
recommended per the soil test and
toxic soils shall be removed,
disposed of properly and replaced
with new planting media.
Form SW401-Bioreteution O&M-Rev.3
Pagc2 of4

BMP element:
Potential problems:
Flow I will remediate theproblem:
The underdrain system
Clogging has occurred.
Wash out the underdrain system.
if applicable)
The drop inlet
Clogging has occurred.
Clean out the drop inlet. Dispose of
the sediment off -site.
the drop inlet is damaged
Repair or replace the drop inlet.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
outlet.
733-1786.
Form SW401-13ioretention O&M-Rev.3 Page 3 of 4

I'ennit Number:
(to be provided b>> DNVQ)
acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:Dollar General - NC Highway 87 - 13111-linpton - Graham
l3MP drainage area number:
Print name:George T. Barnes, Jr. - Glandon Forest Equity, LLC
Ti tie: in ember -manager
Address:3825 Barrett Drive, Suite 100 Ralcigh, NC 27609
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
.5 , a Notary Public for the Slate of
/VL ,County of /52/(C- , do hereby certify that
(oFf)2GC- % �/�211 //I personally appeared bcl'ore me this a)
1pw
day of ACGST and acknowledge the due execution of the
forgoing bioretention maintenance requirements. Witness my hand and official seal,
ekP NN N
Cj A0
�
NOTARY PUBLIC
WAKE C.O.
MY COMM. EXP.
03-15-2021 Z
"4P4R%N CAR00%%% �
S LA I.,
My commission expires J� -"20dl
A(G<�CY/YaZ f 7� , ('/(1/2-1;1
Form SW401-Bioretention I&M-Rev.2 Page4 ol'4