SW6110707_CURRENT PERMIT_20110819

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

4
NC®ENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Division of Water Quality
Colleen H. Sullins
Director
August 19, 2011
Mr. Mark Davis
Food Lion, LLC
2940 Arrowhead Rd.
Dunn, NC 28334
Subject: Stormwater Permit No. SW6110707
Food Lion -Tornado Re -Build, Expansion & Plant Renovations
High Density Commercial Sand Filter Project
Harnett County
Dear Mr. Davis:
Dee Freeman
Secretary
The Stormwater Permitting Unit received a complete Stormwater Management Permit
Application for Food Lion - Tornado Re -Build, Expansion & Plant Renovations on August 15,
2011. 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 2H.1000
and Session Law 2006-246. We are forwarding Permit No. SW6110707, dated August 19,
2011, 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 August 18, 2021, and shall be
subject to the conditions and limitations as specified therein. Please pay special attention to
the Operation and Maintenance requirements in this permit. Failure to establish an adequate
system for inspection and maintenance of the stormwater management system 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 upon written request within thirty (30) days
following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150E of the North Carolina General Statutes, and filed with the Office
of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such
demands are made this permit shall be final and binding.
This project will be kept on file at the Fayetteville Regional Office. If you have any questions,
or need additional information concerning this matter, please contact Robert Patterson at
[phone]; or [e-mail].
Sincerely,
AqX
forColeen H. Sullins
Wetlands and Stormwater Branch One 1 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NorthCarolina
IC�LC011lla
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 //
Internet: 9www 7-6300rgFA :91 807-64941 Customer Service: 1-877-623-6748 . Natural! y
An Equal Opportunity \ Affirmative Action Employer ;/

Mr. Mark Davis
SW6110707 - Food Lion -Tornado-Rebuild, Expansion & Plant Renovations
August 19, 2011
cc: SW6110707 File
ec: Fayetteville Regional Office
Mr. Jim Hale - Stellar
Page 2 of 2

State Stormwater Permit
Permit No. SW6110707
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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
Food Lion, LLC
Food Lion - Tornado Re -Build, Expansion & Plant Renovations
2940 Arrowhead Rd., Dunn, Harnett County
FOR THE
construction, operation and maintenance of three (3) sand filters 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 Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until August 18, 2021, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of
stormwater described in the application and other supporting data.
2. This stormwater system has been approved for the management of
stormwater runoff as described in Section 1.7 of this permit. The stormwater
control has been designed to handle the runoff from 62,079 square feet of
impervious area.
3. The tract will be limited to the amount of new built -upon area as indicated in
Section 1.7 of this permit, and per the application documents and as shown on
the approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the
project will be recorded showing all such required easements, in accordance
with the approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. 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 6

State
The following design criteria have been provided in the
Stormwater
Permit No. SW6110707
Permit
sand filters
and must
be maintained at design condition:
DA1
DA2
DA3
a. Drainage Area, acres:
0.53
0.90
0.83
Onsite, ft2:
23,271
39,319
36,146
Offsite, ft2:
0
0
0
b. Total Impervious Surfaces, ftZ:
9,845
28,205
24,029
Onsite, ft2:
9,845
28,205
24,029
Offsite, ft2:
0
0
0
C. Design Storm, inches:
1.0
1.0
1.0
d. Sediment Chamber Bottom Elev., fmsl:
173.50
173.00
173.25
d. Top of Sand Elevation, fmsl:
172.50
172.00
172.25
e. Seasonal High Water Table, fmsl:
168.50
168.50
168.75
f. Sand Depth, feet:
1.5
1.5
1.5
h. Bottom of Sand Elevation, fmsl:
171.00
170.50
170.75
i. Sediment Chamber SA, ft2:
200
585
531
i. Sand Chamber SA, ft2:
200
585
531
j. Permitted Storage Volume, ft3:
750
1,755
1,593
k. Bypass / Storage Elevation, fmsl:
174.75
174.25
170.42
n. Drawdown Time, hours:
30
18
15
o. Underdrain Diameter, inches:
4.0
4.0
4.0
q. Receiving Stream/River Basin:
UT to Black
River / Cape
Fear
r. Stream Index Number:
18-68-12-1
S. Classification of Water Body:
"C; Sw"
II. SCHEDULE OF COMPLIANCE
The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
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.
The permittee shall submit to the Division of Water Quality 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.
Page 2 of 6

State Stormwater Permit
Permit No. SW6110707
6. The facilities shall be constructed as shown on the approved plans. This
permit shall become void unless the facilities are constructed in accordance
with the conditions of this permit, the approved plans and specifications, and
other supporting data.
Upon completion of construction, prior to issuance of a Certificate of
Occupancy, and prior to operation of this permitted facility, a certification
must be received from an appropriate designer for the system installed
certifying that the permitted facility has been installed in accordance with this
permit, the approved plans and specifications, and other supporting
documentation. Any deviations from the approved plans and specifications
must be noted on the Certification. A modification may be required for those
deviations.
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.
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
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 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 Water Quality, 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.
Page 3 of 6

State Stormwater Permit
Permit No. SW6110707
The permittee is responsible for compliance with all permit conditions until
such time as the Division approves a request to transfer the permit.
Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality,
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 DENR 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 19`h day of August, 2011.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
04 ��-
ForColeen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4of6

. , . 4
State Stormwater Permit
Permit No. SW6110707
Food Lion —Tornado Re -Build, Expansion & Plant Renovations
Stormwater Permit No. SW6110707
Harnett County
Designer's Certification
I, , as a duly registered in the State of
North Carolina, haying 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.
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. SW6110707
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. Ali 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. Under drains are located per the approved plans.
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 volurne 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 sediment
chambers, sand chambers, under drains, and outlets.
15. The required system dimensions are provided per the approved plans.
Please, submit this Designer's Certification to: Fayetteville Regional Office
Surface Water Protection
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
i
Justin Harcum - Harnett County
Building Inspections
Page 6 of 6

' DWQ USE ONLY
ate Received
Fee Paid
Permit Number
Z C r
O 4-5'3C0 N9--
6W io 11 O'7 01
Applicable ul s: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 PPh II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Food Lion - Tornado Re -Build, Expansion & Plant Renovations
2. Location of Project (street address):
2940 Arrowhead Road
City:Dunn County:Harnett Zip:28334
3. Directions to project (from nearest major intersection):
I-95 Exit 71 to LongBranch Road (northwest) to US 301 (South) to site
4. Latitude:350 16' 41" N Longitude:78° 3757" W of the main entrance to the project.
11. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification
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 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; 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: 2.37 ac of Disturbed Area
❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
Form SWU-101 Version 07Jun2010 Page I of

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:Food Lion LLC
Signing Official & Title:Mark Davis Regional Facility Manager
b.Contact information for person listed in item la above:
Street Address:2940 Arrowhead Road
City:Dunn State:NC Zip:28334
Mailing Address (if opplicoble):same
Phone: [phone] x 305 ) Fax:
EmaiLjmd avis a foodlion.com
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 & Title:
b. Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
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:Bob Obrzut/Stellar- Superintendent
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing Address:2900 Hartley Road
City:Lacksonville State:FL Zip:32257
Phone: (904- ) 260-2900
Eniail:[e-mail]
Fax: (904 ) 899-9434
4. Local jurisdiction for building permits: Harnett County
Point of Contact:lustin Harcum Phone #: (910 ) 433-3300
Form SWU-101 Version 07Jun2010 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Sand filters will treat stormwater from new roof before being discharged to existing storm system and existing
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 Black River/Cape Fear River basin.
4. Total Property Area: 118.87 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*:
" _4_. 115, Ki acres
Total project area shall be calculated to exclude the following: the normal pool of imppounded structures, the area
between the banks of streams 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 landward of the NHW (or MHW) line may be
�
included in the total prol'ect area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =,(> r > z`f
9. How many drainage areas does the project have?3 (For high density, count 1 for each proposed engineered
stormwater BMP. For low 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 Tnformahon
Dra' a e9 ea l
;Drama e Area c
Drains e Area'3 .
Drama e Area
Receiving Stream Name UT
T Black Ricer (4
T, B ac R ver
r. Black River
Stream Class *
I c sw
c sw
c sw
Stream Index Number
/ 6 q-12 - I
Total Drainage Area (s)
23271
39319
36146
On -site Drainage Area (so
23271
-19319
36146
Off -site Drainage Areas
0
0
Pro osed Impervious Area*" (st)
9845
28205
24029
Impervious Area*" (total)
42.3
71.7
66.5
Sin ervious Surface Ai6a
--l-ots
Drains e Area ,Drainage.
Area;_
Drama e A ea` i
Drama" e Area -'
On -site Buildi(sf)
196
27788
24029
On -site Streets (sf)
0
0
0
On -site Parking (s
0
0
On -site Sidewalks (sf)
9649
0
0
Other on -site (sf)
0
417
0
Future (s)
0
0
0
Off -site (50
0
0
0
Existing BUA*** (s
Total (st):
1 9645
26205
1 24029
* Stream Class and Index Number can be determined at: httv::: ortal.ncdenr.orgJweb&q&s1csu1 CLassiflcations
'* In pervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
swalks, 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.
11. How was the off -site impervious area listed above determined? Provide documentation. From survey
Form SWU-101 Version 07Jun2010 Page 3 of 6

'Report only that anwunt of existing BUA that Will rennin after development. Do not report any existing BUA that
is to be rentoved and which Will be replaced by Hem BUA.
Nlb,
11. How was the off -site impervious area listed above determined? Provide documentation. From survey
Projects in Union County: Contact DLVQ Central Office slrffto check if the project is located within a Threatened &
Endangered Species watershed that tna), be subject to more stringent stornnvater requirements as per NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from htty://i)ortal.ncdenr.oriz/web/wo/ws/su/bmD-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 http://portaI.ncdenr.org/web/wq/ws/su/statesw/forms does. 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.ncdenr.org/web/wq/ws/su/map.)
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.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
��--QYfg}kq�-FNtft-BMBfO if•g€•the-6jg�iQd-alld-µg �Flygd Tlen,i ReStYjCti p,,� k PmfPrfivo Cm,anants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Fonn(s) (sealed, signed and dated) and O&M r�
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/oiiestopexpress.htinI 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'/z
mile radius on the map.
7. Sealed, signed and dated calculations.
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 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 07Jun2010 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 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"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 far DWQ to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 2346 Page No: 132
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 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
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://portal.ncdenr.org/web/wg/ws/so/statesw/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 DWQ 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:Jim Hale
Consulting Firm: Stellar
Mailing Address:2900 Hartley Road
Cityaacksonville State:FL Zip:32257
Phone: (904 ) 899-9434 Fax: [phone]
EmaiLi ha IeOstellar. net
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or hype 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 type name of person
listed in Contact Information, item 1a) with (print or type none of organization listed in
Contact Information, item 1a) 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 07Jun2010 Page 5 of6

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 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.
a Notary Public for the State of . County of
do hereby certify that
before me this _ day 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 la) Mark Davis Regional Facility Manager
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 15A NCAC 2I-I .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
before me
a stormwater permit.
Date: % 'r�S�' QVJ
dCq� a kotary Public for the State of Y) ,C County of
do hereby certify that on, t)-� - personally appeared
(((�
of and a rowledge the dueS.'0 execution of the application for
Witnes my hand and official seal, --� ()CQOy
%
�GGY D (F
sr` 4 A/p
�a6V} F E
U
2
Form SWU-101 Version 07Jun2010 Page 6 of

Perm it N umber:__ It/ 6 1 ( O ) O-)
(lo be provided bj Mflo
Drainage Area Number:
Sand Filter Operation and Maintenance Agreement
—3
I will keep a maintenance record on this BMP. This maintenance record will be kept in a log in a
known set location. Any deficient BMP elements noted in the inspection will be corrected, repaired or
replaced immediately. These deficiencies can affect the integrity of structures, safety of the public, and
the removal efficiency of the BMP.
Important maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the 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 will be inspected quarterly and within 24 hours after every storm event greater than
1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and maintenance will be kept in
a known set location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired
immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
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
applicable)pavement
surface.
possible.
Perimeter of sand filter
Areas of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed.
gully, and then plant a ground cover and
water until it is established. Provide lime
and a one -rime fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height.
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.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or dispose of it
in a 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.
Form SW40I-Sand Filter O&M-Rev.4 2009Sept17 Page 1 of 3

BMP element:
Potential probiem:
How I will remediate theproblem:
Filter bed and underdrain
Water is pending on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm.
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace. If water still
ends, then consult an expert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment offsite.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage
Contact the NC Division of Water Quality
have occurred at the outlet.
401 Oversight Unit at 919-733-1786.
Form SW401-Sand Filter O&M-Rev.4 2009Sept17 Page 2 of 3

Permit Number:
(to be provided by DWQ
I acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior
to any changes to the system or responsible party.
Prqject name:Food Lion Tornado Re -Build, Expansion and Plan Renovations
BMP drainage area number: 1-3 Sand Filters
Print name:Mark Davis
Title:Regional Facility Manaeer
Address:2940 Arrowhead Road
Phone: [phone]
Date: ' 1
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.
a Notary Public for the State of
do hereby certify that
personally appeared before me this��day of
cZUI I , and acknowledge the due execution ofthe forgoing sand filter
requirements. Witness my hand and official seal,
G`( O. �F
.GGI A)? �
U
: IBa'�'
cod
SEAL
My commission expires 3_16.0166
4�1 '0 4, -��ty
Form SW40I-Sand Filter O&M-Rev.4 2009Sept17 Page 3 of 3

(✓��( 01)0)
Permit Number:,]
(to be provided by DWQ)
ATA0p
WATF9
O�
y&5 y
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be filled out on line, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section III) and the I&MAgreement (Section IV)
I: PROJECT INFORMATION
Project name
Food Lion -Tornado Re -Build, Expansion & Plant Renovations
Contact name
Jim Hale
Phone number
904-899-9434
Dale
August 12, 2011
Drainage area number
1 - Office Entrance Area
II. DESIGN INFORMATION
Site Characteristics
Drainage area (Ao)
23,271.00 ft' OK
Impervious area
9,845.00 ft'
% Impervious (IA)
42.3% %
Design rainfall depth (Ro)
1.00 in
Peak Flow Calculations
1-yr, 24-hr runoff depth
1.00
in
1-yr, 24-hr intensity
6.00
in/hr
Pre -development 1-yr, 24-hr runoff
1.12
ft3/sec
Post -development 1-yr, 24-hr runoff
2.35
ft�/sec
Pre/Post 1-yr, 24-hr peak control
1.23
ft3/sec
Storage Volume
Design volume (WQV)
838.05 ft3
Adjusted water quality volume (WQV,,)
628.54 ff3
Volume contained in the sedimentation basin and on top of the sand filter
OK
750.00 ft3
Top of sand filter/grate elevation
172.5 ft amsl
Weir elevation (between chambers)
174.5 ft amsl
Maximum head on the sedimentation basin and sand filter (h,,a,F,,,)
2.00 ft OK
Average head on the sedimentation basin and sand filter (hA)
1.00 It OK
Runoff Coefficient (RV)
0.43 (unitless)
Type of Sand Filter
Open sand filter? y Y or N
SHWT elevation 168.50 ft amsl
Bottom of the sand filter elevation 171.00 ft amsl
Clearance (dsHwr) 2.00
Closed/pre-cast sand filter? n Y or N
SHWT elevation NA It amsl
Bottom of the sand filter elevation NA It amsl
Clearance (dsHwr) NA
If this is a closed, underground closed sand filter: The clearance between
the surface of the sand filter and the bottom of the roof of the underground NA ft
structure (d$,,)
Form SW401-Sand Filter-Rev.5 2009Sep117 Parts I and II. Project Design Summary, Page 1 of 2

Permit Number:
(to be provided by DWQ)
Sedimentation Basin
Surface area of sedimentation basin (As)
Sedimentation basin/chamber depth
Sand Filter
Surface area of sand filter (AF)
Top of sand media filter bed elevation
Bottom of sand media filter bed/drain elevation
Depth of the sand media filter bed (dF)
Coefficient of permeability for the sand filter (k)
Outlet diameter
Outlet discharge/flowrate
Time to drain the sand filter (t)
Time to drain the sand filter (t)
Additional Information
Does volume in excess of the design volume bypass the sand filter?
Is an off-line flow -splitting device used?
If draining to SA waters: 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 30ft from surface waters (50ft if SA waters)?
If not a closed bottom, is BMP located at least 10011from water supply wells?
Are the vegetated side slopes equal to or less than 3:1
Is the BMP located in a recorded drainage easement with a recorded access
easement to a public Right of Way (ROW)?
What is the width of the sedimentation chamber/forebay (Ws,,)?
What is the depth of sand over the outlet pipe (dpipe)?
200.00 it
Urn. rviamb imm11um It, uuundy Ilddu w uc muudbeu w
1.50 it
200.00 ft2
vn. rvroOrb 111111111 IU I I I, Um IIldy IIODU w ue 11161Cdb= lu
172.50 ft amsl
171.00 ft amsl
1.50 it
3.50 (fUday)
4.00 in
0.01 ft'/sec
30.00hours
OK. Submit drainage calculations.
1.25 days
y YorN OK
y YorN OK
NA Y or N Enter Data
NA it
y Y or N
OK
y Y or N
OK
y YorN
OK
y YorN
OK
y YorN
OK
9.50 it
OK
2.00 ft
OK
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and II. Project Design Summary, Page 2 of 2

Permit Number: sWO/o 90
(to be provided by DWQ)
® � 1 W ATFgO
_ h T
NCDENR ��C
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be filled out on line, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section III) and the I&M Agreement (Section IV)
I. PROJECT INFORMATION
Project name Food Lion -Tornado Re -Build, Expansion & Plant Renovations
Contact name Jim Hale
Phone number
Date
Drainage area number
II. DESIGN INFORMATION
Site Characteristics
2-Cooler area
Drainage area (AD) 39,319.00 112 OK
Impervious area 28,205.00 ft'
% Impervious (IA) 71.7% %
Design rainfall depth (Ro) 1.00 in
Peak Flow Calculations
1-yr, 24-hr runoff depth
1.00
in
1-yr, 24-hr intensity
6.00
in/hr
Pre -development 1-yr, 24-hr runoff
1.89
ft3lsec
Post -development 1-yr, 24-hr runoff
4.00
ft3/sec
Pre/Post 1-yr, 24-hr peak control
2.11
ft3/sec
Storage Volume
Design volume (WQV) 2,295A0 ft3
Adjusted water qualityvolume(WQVId) 1,721.25ft3 OK
Volume contained in the sedimentation basin and on top of the sand filter 1,755.00 ft3
Top of sand filter/grate elevation 172 ft amsl
Weir elevation (between chambers) 173 It amsl
Maximum head on the sedimentation basin and sand filter (h,,Fme,) 2.00 ft OK
Average head on the sedimentation basin and sand filter (hA) 1.00 It OK
Runoff Coefficient (Rv) 0.70 (unitless)
Type of Sand Filter
Open sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (ds.)
Closed/pre-cast sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (dsnwr)
If this is a closed, underground closed sand filter: The clearance between
the surface of the sand filter and the bottom of the roof of the underground
structure (dswe)
YorN
168.50 ft amsl
170.50 It amsl
2.00
n YorN
NA It amsl
NA If amsl
NA
NA it
Form SW401-Sand Filter-Rev.5 2009Sept17 Pans I and II. Project Design Summary, Page 1 of 2

r
Permit
(to be provided by DWQ)
Sedimentation Basin
Surface area of sedimentation basin (As)
Sedimentation basin/chamber depth
Sand Filter
Surface area of sand filter (AF)
Top of sand media filter bed elevation
Bottom of sand media filter bed/drain elevation
Depth of the sand media filter bed (dF)
Coefficient of permeability for the sand filter (k)
Outlet diameter
Outlet discharge/flowrate
Time to drain the sand filler (t)
Time to drain the sand filter (t)
Additional Information
Does volume in excess of the design volume bypass the sand filter?
Is an off-line Flow -splitting device used?
If draining to SA waters: 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 30ft from surface waters (50ft if SA waters)?
If not a closed bottom, is BMP located at least 100ft from water supply wells?
Are the vegetated side slopes equal to or less than 3:1
Is the BMP located in a recorded drainage easement with a recorded access
easement to a public Right of Way (ROW)?
What is the width of the sedimentation chamber/forebay (Wsld)?
What is the depth of sand over the outlet pipe (dpipe)?
585.00 ft'
VA. rvnccrb uinmuuni, uuuudy uccu w uu muiudbeu w
1.50 ft
585.00 ft'
VA. rvienm mumuwu, um wdy iiccu w uc niuedbeu w
172.00 ft amsl
170.50 ft artist
1.50 It
3.50 (ftlday)
4.00 in
0.04 ft3/sec
18.00hours
OK. Submit drainage calculations.
0.75 days
y YorN OK
y YorN OK
NA Y or N Enter Data
NA ft
Y
Y or N
OK
Y
Y or N
OK
Y
YorN
OK
Y
YorN
OK
Y
Y or N
OK
9.50 It OK
2.00 it OK
Form SW401-Sand Filter-Rev.5 2009Sept77 Parts I and II. Project Design Summary, Page 2 of 2

l �. •''1 Permit Number: Sl✓,;(li:007
(robe provided by DWQ)
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be filled out on line, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section Ill) and the I&M Agreement (Section IV)
I. PROJECT INFORMATION
Project name Food Lion -Tornado Re -Build, Expansion & Plant Renovations
Contact name Jim Hale
Phone number
Date
Drainage area number
II. DESIGN INFORMATION
Site Characteristics
Drainage area (AD)
Impervious area
% Impervious (IA)
Design rainfall depth (Ro)
Peak Flow Calculations
1-yr, 24-hr runoff depth
1-yr, 24-hr intensity
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Pre/Post 1-yr, 24-hr peak control
Storage Volume
Design volume (WOV)
Adjusted water quality volume (WOVAJ
Volume contained in the sedimentation basin and on top of the sand filter
Top of sand filter/grate elevation
Weir elevation (between chambers)
Maximum head on the sedimentation basin and sand filter (hM,,F;ne,)
Average head on the sedimentation basin and sand filter (hA)
Runoff Coefficient (Rv)
Type of Sand Filter
Open sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (ds.)
Closed/pre-cast sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (ds,r,,)
If this is a closed, underground closed sand filter: The clearance between
the surface of the sand filler and the bottom of the roof of the underground
structure (its,,,)
904-899-9434
August 12, 2011
Area
36,146.00 ft' OK
24,029.00 ftZ
66.5% %
1.00 in
1.00
in
6.00
in/hr
1.74
ft'/sec
3.55
ft3/sec
1.81
ft3/sec
1,958.00 ft,
1,468.50 ft' OK
1,593.00 ft
172.25 It amsl
174.25 It amsl
2.00 It . OK
1.00 ft OK
0.65 (unifless)
y YorN
168.75 ft amsl
170.75 ft amsl
2.00
_ YorN
NA It amsl
NA It amsl
NA
NA ft
032270
1'ttGt
Form SW401-Sand Filter-Rev.5 2009Sep117 Parts I and II. Project Design Summary, Pag 1 of 2

Permit Number:
(to be provided by DWQ)
Sedimentation Basin
Surface area of sedimentation basin (As)
Sedimentation basin/chamber depth
Sand Filter
Surface area of sand filter (AF)
Top of sand media filter bed elevation
Bottom of sand media filter bed/drain elevation
Depth of the sand media filter bed (dF)
Coefficient of permeability for the sand filter (k)
Outlet diameter
Outlet dischargelflowrate
Time to drain the sand filter (t)
Time to drain the sand filter (t)
Additional Information
Does volume in excess of the design volume bypass the sand filter?
Is an off-line flow -splitting device used?
If draining to SA waters: 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 30ff from surface waters (50ft if SA waters)?
If not a closed bottom, is BMP located at least 100ft from water supply wells?
Are the vegetated side slopes equal to or less than 3:1
Is the BMP located in a recorded drainage easement with a recorded access
easement to a public Right of Way (ROW)?
What is the width of the sedimentation chamberlforebay (Wsey)?
What is the depth of sand over the outlet pipe (dpipe)?
531.00 ft'
vn. rvieem uuuw wuy um may iceu w ue wu edbcu m
1.50 ft
531.00 ft'
ItU vdbt butdbd d,ad. i uu Wit dmu uiuedbc me
172.00 ft amsl
170.50 ft amsl
1.50 ft
3.50 (ft/day)
4.00 in
0.03 ft/sec
15.00hours
OK. Submit drainage calculations.
0.63 days
y
YorN
OK
y
YorN
OK
NA
Y or N
Enter Data
NA It
Y
Y or N
OK
Y
Y or N
OK
Y
Y or N
OK
Y
Y or N
OK
Y Y or N OK
9.50 It OK
2.00 It OK
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and 11. Project Design Summary, Page 2 of 2