SW3141103_CURRENT PERMIT_20141205

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO. SW
DOC TYPE 02CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE CWll
YYYYMMDD

NIFWA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
DcccmbcDi Ijj&4QF LAND RESOURCES
Mr. Alan Lewis
,AND QUALITY SECTION
TKC CXX11, LLC
5935 Carnegie Blvd. Suite 200 DEC 0 9 2014
Charlotte, North Carolina 28209
DEPHnt1�16­1 1� -,.YrnunMENT
Subject: Stormwatcr Permit No. SW3141103 AND NATURALR
Project Marley
Dear Mr. Lewis:
The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater
Management Permit Application for the subject project on November 20, 2014. Staff review of the plans and
specifications has determined that the project, as proposed, will comply with the Stormwatcr Regulations set
forth in Title 15A NCAC 2111000 and Session Law 2006-246. We are forwarding Permit No. SW3141 103,
dated January 5, 2014, 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 December 3, 2022, and shall
be subject to the conditions and (imitations 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). -rhe written petition nttist conform to Chapter 15013 of the North Carolina General Statutes. Per
NCGS 143-215(c) 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.NCOAI-Lcom. Unless such demands are made this permit shall be
final and binding.
]'his project will be kept on file at the Mooresville Regional Office. Ifyou have any questions, or need
additional information concerning this matter, please contact Mike Randall at [phone]; or
[e-mail].
ncdenr.gov.
Sincerely,
fnr Tracy D is, Pl F `CPMv D ector
cc: SW3141 103 File, Mooresville Regional Office
cc: Luke.). Bugenske, PE, Burton Engineering Associates
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://portal.ncdenr.org/web/ir/
An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper

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State Stormwater Permit
Permit No. SW3141103
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statute
North Carolina as amended, and other applicable Laws, Rules, and Regulation-EX,
egulation-E O�
Ilk
PERMISSION IS HEREBY GRANTED TO 'S�'fs Ox ,', ,,
Mr. Alan Lewis
TKC CXXII, LLC
Project Marley
Salisbury North Carolina, Rowan
FOR THE
County
construction, operation and maintenance of three sand filters in compliance with the
provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter referred to as
the "storm water 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 December 3, 2022, 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. The three sand filters are 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 permitted stormwater control system.
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. SW3141103
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 the three permitted sand filters 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.
3. 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.
4. The permittee shall submit an annual summary report of the maintenance and
inspection records for each of the three sand filters. The report shall summarize
the inspection dates, results of the inspections, and the maintenance work
performed at each inspection.
Each of the three sand filters 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 each of the three sand filters 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. SW3141103
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
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 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 DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
Page 3 of 4

State Stormwater Permit
Permit No. SW3141103
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 5`h day of December, 2014.
Tor i racy C. uavis, r.c., k,rivi
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

State Stormwater Permit
Permit No. SW3141103
Project Marley
Salisbury North Carolina. Rowan 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
SEAL
cc: NCDENR-DEMLR Regional Office
Page 1 of 1

DEMLR USE ONLY
Date Received
Fee Paid.._,
Permit Number
Applicable Rules:
(select all that apply)
❑ Cciastal SW - 1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
❑ 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 `spa
STORMWATER MANAGEMENT PERMIT APPLICATIONIZSRM— ,�3�
sop
This form may be photocopied for use as�Q}gyiat e Y
I. GENERAL INFORMATION C�' Nov20 y�4
1 specifications, rct atio s,ame (letters, operation and ma ntivision, facility, or bnanm ag name
`Y YQi 2 consistent fiy}t�pNq��RiipR�MV1/17g1ans,
O\� N�
Project Marley
2. Location of Project (street address):
1010 Corporate Center Drive,A�
City:Salisbury County:R ot�� Zip:
3. Directions to project (from nearest major intersection):
Interstate 85 to Julian Road exit in southern Salisbury. Head east. Turn Right on Summit Park Drive.
4. Latitude:35° 37' 27.31" N Pl' Longitude:80° 29' 22.74" W )- of the main entrance to the project.
II. PERMIT INFORMATION: , J;40" q 3
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modification'
'Renernals With modifications also requires SWU-102—Rene71,al Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's cerlificat ion
2. Specify the type of project (check one):
❑Low Density XHigh Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application, list the stormwater project number,
if assigned, n/a and the previous name of the project, if different than currently
proposed, n/a
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 ®Sedimentation/Erosion Control: 19.5 ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 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:Rowan County Erosion Control Approval -Summit Corporate Center
Tract 4, Approved 08/04/20140. No permit number provided.
5._. Is the project located within 5 miles of a public airport? ❑No ®Yes
If yes, see S.L. 2012-200, Part VI: http://portal.ncdenr.org/web/Ir/rules-and-regulations
wkr_6
Form SWU-101 Version Oct. 31. 2013 Page I of 6

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:TKC CXXII, LLC
Signing Official & Title:Alan Lewis, Development Partner
b. Contact information for person listed in item la above:
Street Address:5935 Carnegie Blvd., Suite 200
City:Charlotte State:NC Zip:28209
Mailing Address (if applicable):Same as above
City:
Phone: (704 ) 365-6000
Email:[e-mail]
Fax: (704 ) 365-0733
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:
Mailing Address (if applicable):
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:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
4. Local jurisdiction for building permits:
Point of Contact:
Fax: ( )
Phone #:
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

'IV. PROJECT INFORMATION
1. ' In the space provided below, briefly summarize how the stormwater runoff will be treated.
There are two separate drainage basins on the project. Water on the west side will be treated by 2 sand filters.
The drainage to the east will be treated by 1 sand filter.
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.lf 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
4. Total Property Area: 32.55 acres
River basin.
5. Total Coastal Wetlands Area: n/a acres
6. Total Surface Water Area: 0 acres
Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area': 32.55 acres
Total project area shell be rnlndated to exclude the follorving the normal pool of imponided structures, the area
between tlic backs of streams and rivers, the area belo v the Nornml High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MH6) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal zvetlalids lalidtvard of the NHW{or MHW) line uiay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =
a�
9. How many drainage areas does the project have? 3 (For high density, count 1 for each proposed engineered
stornnoater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Draina e Area 1 a
Draina ge Area 1b
Draina e Area 2
Draina e Area
Receiving Stream Name
Town Creek
Town Creek
Town Creek
Stream Class *
C
C
C
Stream Index Number *
12-115-3
12-115-3
12-115-3
Total Drainage Area (so
127116
191664
494713
On -site Drainage Area (so
127116
191664
194713
Off -site Drainage Area (so
0
0
0
Proposed Impervious Area**(so
81907
188617
166798
% Impervious Area** total
64.41%
98.41%
85.68%
Impervious** Surface Area
Draina e Area 1a
Draina e Area l b
Drainage Area 2
Draina e Area _
On -site Buildings/Lots (so
0
102060
102060
On -site Streets (so
23963
0
6628
On -site Parking (so
54635
85629
9108
On -site Sidewalks (so
3309
928
1508
Other on -site (so
Future (so
50096
Off -site (so
Existing BUA*** (so
Total (so:
81907
188617
169400
Stream Class and Index Number call be determined at: li�://nortal.ricdenr.or hog ebAi;g&slcsu/classifi'cations
Impervious area is defined as the built upon area including, bill not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Report only that anoint of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Proiects in Union County: Contact DEMLR Central Office 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 htto://12ortai.ncdenr.org/web/wq/ws/su/Limp-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
ham://portal.ncdennorg/web/wq/ws/su/statesw/forms does. 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 at http://portal.ncdenr.org/web/v`-q/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 htto://portal.ncdenr.org/web/wows/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. Q61
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants t`1(A
Form. (if required as per Part VII belout)
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
htto://www.envhelp.org[pages/onestol2express.html 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/management for
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 hk mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where required).
9.. Copy of any applicable soils report with the associated SHWT elevations (Please identify Vc w ci44 (lE(b(LC
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 viiit for DEMLR to verify the SHWT prior
to subrn it t al, [phone].) (ow
(0("j
A copy of the most current property deed. Deed book: 1124 Page No: 120
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 LI-C must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
htto: / /www.secretary.state.nc.us/Corporations/CSearch.aspxx
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:1/12ortaI.ncdetir.org/web/h/state-stormwater-
forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR, and that they will be recorded prior to the sale of any lot.
Vill. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer.Carlton T. Burton
Consulting Firm: Burton Engineering Associates
Mailing Address:5950 Fairview Road Suite 100
City:Charlotte State:NC Zip:28210
Phone: (704 ) 553-8881 Fax: (704 ) 553-8860
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 type name of person
listed in Contact Information, item la) with (print or type name of organization listed in
Contact Information, itent 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 46

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 thent crv' enalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
e asses
Signature: Date: DV d 13 ao(4+
I, L t SG, /J Cr tt Z— , a Nota�r Public for the State of �r7� (� ✓a/ nG� , County of
fetl do hereby certify that /) eal i e iA /\ • iefU-lec/ personally appeared
before me this _ day of Nil✓ e e ✓ 0?01 , and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal,.
3 NotoN Public s
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X. APPLICANT'S CERTIFICATION
SEAL
My commission expires TF-11
1, (print or type nanie of person listed in Contact Information, item 1a)
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater 1 15 CA 2H .1000 and any other applicable state stormwater requirements.
Signature: /D'ate:/�Ai, a dOly
a Notary Public fCfor the State of �/ / �Q�d �ine� . County of
r/&071"do hereby certify that KC�/?eH Of
r✓eklLL/ personally appeared
before me this day of )�G✓tm %i[� . -&/$ and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal, o&Tn— /J et4
NotatV Public c
5 Gosto0 County MV Commission exp lies=
071081201'1
TH CPz0\\o°
SEAL
My commission
-7-g-0
Form SWU-101 Version Oc1.31, 2013
Page 6 of 6

-
241
rKC CXVII; LLC
BRANCH BANKING & TRUST
6869 FAIRVIEW ROAD
5935 CARNEGIE BLVD.. STE. 200
CHARLOTTE, NC 28210
CHARLOTTE. NC 28209
704-365-6000
66-112/531
PAY **** FIVE
HUNDRED FIVE AND
00/100 DOLLARS
_
11/13/2014
$ 505.00*****
TO THE
ORDER OF
NC DENR
1632 MAIL
SERVICE CENTERFpo
RALEIGH,
NC 27699-1646
xv
MEMO: VOID AFTER 90 DAYS

241 TOTAL: $505.00"""`
BANK:117 OPERATING CASH(117ca3h)
PAYEE:NC DENR(ncdl63) MEMO: VOID AFTER 90 DAYS
Invoice - Date Description
Amount
Property Address -Code sas. o0
11/13 /14 - 11/13 /2014 STORMWATER MANAGMENT PERMIT
TKC CXXII, LLC - 122 505.00
�w . 3� q 1103
RZEC+t_.i l..
NUV 20 2014
I-�� crivil'ITINIG

Permit Number:
(to be provided by DWQ)
O2�F WATFgOG
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 18M Agreement (Section IV)
Project name
Contact name
Phone number
Date
Drainage area number
II. DESIGN INFORMATION
Site Characteristics
PE
November 19, 2014
1A
Drainage area (AD)
127,11Coo ft2
OK AL L 5. O
Impervious area
81,907.00!ft2
% Impervious (IA)
64.4% %
Design rainfall depth (Ro)
1.46 in
Peak Flow Calculations
OF L11N� RERCEf
1 -yr, 24-h r runoff depth
2.75 in
L41WQASECTION
1-yr, 24-hr intensity
0.39 in/hr
Pre -development 1-yr, 24-hr runoff
12.38 ft3/sec
DEC
Post -development 1-yr, 24-hr runoff
11.81 ft'/sec
0 9 Z0�4
PrelPost 1-yr, 24-hr peak control
-0.57 ft3/sec
-viavinuNMENT
Storage Volume
�90
Design volume (WQV)
6,704.06 ft3
Adjusted water quality volume (WQVAd;)
5,028.00 ft'
OK
Volume contained in the sedimentation basin and on top of the sand filter
16,325.00 ft'
Top of sand flier/grate elevation
769 ft amsl
Weir elevation (between chambers)
771 ft amsl
Maximum head on the sedimentation basin and sand filter (hMmrilter)
2.00ft
OK
Average head on the sedimentation basin and sand filter (hA)
1.00 ft
OK
Runoff Coefficient (Rv)
0.63(unitless)
Type of Sand Filter
Open sand filter? Y Y or N
SHWT elevation Not EncounC ft amsl <—' NOT 6N "U Q'rt;'ZG
Bottom of the sand filter elevation 767.40'ft amsl Co — tp'5.4Q
Clearance (dsHwT) 2.50
Closed/pre-cast sand filter? N YorN CRUGER R6FuS ►�
SHWT elevation ft amsl
Bottom of the sand filter elevation ft amsl
Clearance (dSHWT)
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 ft
structure (ds,)
Form SW401-Sand Filter-Rev.5 2009Septl7 Parts I and II. Project Design Summary, Page 1 of 3

C;
l
'e"
— 4
Y
� .,
_� i
l F
' ~
_
��
3� �
.e
� :.
t
=:
��c: —
�,� .
�
S45 4
_
�_° �
'—
5

Permit Number:
(to be provided by DWO)
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 (it)
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 flaw -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 (5Oft 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 (Wsed)?
What is the depth of sand over the outlet pipe (dpipe)?
1,600.00. ft,
Vry IVI Mb IIIIIIIIIIUIIII, UUl IIIGy I=U lU UC IIlUltd=U IU
2.00 ft
775.00,ft"
Illuea=DUllawawa.n11Z,Wilt alJulnucaxUlc
769.00 ft amsl
767.40 ft amsl
1.60 ft
3.50 (ft/day)
15.00 in
0.52 ft3/sec
35.81 hours
OK. Submit drainage calculations.
1.49 days
Y
YorN
OK
Y
YorN
OK
YorN
It
YorN
Y
YorN
OK
Y
YorN
OK
Y
YorN
OK
Y
YorN
OK
30.00 ft
OK
1.00'It
OK
Form SW401-Sand Filter-Rev.S 2009Sept17 Parts I and II. Project Design Summary, Page 2 of 3

Permit No.
(to be provided by DWQ)
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.
Initials
Pagel Plan
Sheet No.
v J
I
1. Plans (1" - 50' or larger) of the entire site with labeled drainage area boundaries
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
GN, O
chamber,
- Maintenance access,
- Flow splitting device,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
GW
C� 0
- Boundaries of drainage easement.
2. Plan details (1" = 30' or larger) for the sand filter showing:
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
- Flow splitting device,
- Vegetative filter strip dimensions and slope (if SA waters),
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Boundaries of drainage easement.
COW G4•0 3. Section view of the sand filter (1" = 20' or larger) showing:
- Depth(s) of the sedimentation chamber and sand filter chamber,
- Depth of sand filter media,
- Connection between the sedimentation chamber and the sand filter chamber and weir elevation,
- SHWT elevation,
- Outlet pipe, and
- Clearance from the surface of the sand filter to the bottom of the roof of the underground structure (if
applicable).
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.
6�eL 5. Supporting calculations (including drainage calculations)
6. Signed and notarized operation and maintenance (0&M) agreement
UJ A 7. A copy of the deed restrictions (if required).
A 10:M� CSMg A'3lc,pf_ EX.Pc."Tfal 4 S+twT 9.;-7PG2-T
�c laepelu ace S-bafwwATdt- Mct.1cG�Q%�CJ-r "A w .
Form SW401-Sand Filter-Rev.5 2009Sept17 Part III, Page 3 of 3

- _ to .. [�l ...
__ ' _/ .ye

Permit
(to be provided by DWQ)
0p WATf;9
T&Ayi�j h r
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&M Agreement (Section IV)
Project name
Contact name
Phone number
Date
Drainage area number
Site Characteristics
Drainage area (Au)
Impervious area
% Impervious (IA)
Design rainfall depth (Rp)
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 (WQV)
Adjusted water quality volume (WQVAd;)
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„rifter)
Average head on the sedimentation basin and sand filter bA)
Runoff Coefficient (Rv)
Type of Sand Filter
Open sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (daHWT)
Closed/pre-cast sand filter?
SHWT elevation
Bottom of the sand filter elevation
Clearance (dsav,,r)
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 (ds,)
Greg Welsh, PE
704-553-8881
;November 14, 2014
1B
191,664.00 ft2
188,617.00,ft2
98.4% %
1.45iin
2.75
in
0.39
in/hr
12.38
;ft3/sec
11.81
ft3/sec
-0.57
ft3/sec
14,958.00; ft3
11,218.50 ft'
18,450.00, ft3
789 ft amsl
786 ft amsl
3.00 ft
1.50,ft
0.94 (unitless)
Y YorN
779.00: ft amsl
784.50:ft amsl
5.50'
N YorN
ft amsl
ft amsl
'ft
OK
M
OK
OK
4. 4 Ai 4 !'- a
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and 11. Project Design Summary, Page 1 of 3

Permit
(to be provided by DWO)
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 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 (Ww)?
What is the depth of sand over the outlet pipe (dpipe)?
2,050.00'ft2
vn. rviccra nunuum n, um may neeu w ue umi edaeu ru
3.00 ft
2,050.00,ft2
vn. VXULw unwmuJu, um mdy neeu w ve utuedaeu w
786.00 ft amsl
784.50 It amsl
1.50 ft
3.50 (ftlday)
15.001 in
1.07,ft'/sec
38.831hours
OK. Submit drainage calculations.
1.62 days
Y
YorN
OK
Y
YorN
OK
YorN
ft
YorN
Y
Y or N
OK
Y
YorN
OK
Y
YorN
OK
Y
YorN
OK
32.00 ft
OK
1.00,ft
OK
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and 11. Project Design Summary, Page 2 of 3

Permit No.
(to be provided by DWQ)
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.
Initials
Pagel Plan
Sheet No.
`
�w
1)
1. Plans (1" - 50' or larger) of the entire site with labeled drainage area boundaries
L� t
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
- Flow splitting device,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Boundaries of drainage easement.
r�
2. Plan details (1" = 30' or larger) for the sand filter showing:
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
- Flow splitting device,
- Vegetative filter strip dimensions and slope (if SA waters),
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Boundaries of drainage easement.
3. Section view of the sand filter (1" = 20' or larger) showing:
- Depth(s) of the sedimentation chamber and sand filter chamber,
- Depth of sand filter media,
- Connection between the sedimentation chamber and the sand filter chamber and weir elevation,
- SHWT elevation,
- Outlet pipe, and
- Clearance from the surface of the sand filter to the bottom of the roof of the underground structure (if
applicable).
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.
5. Supporting calculations (including drainage calculations)
00
6. Signed and notarized operation and maintenance (O&M) agreement
a14
a/A
7. A copy of the deed restrictions (if required).
Form SW401-Sand Filter-Rev.5 2009Sept17 Part III, Page 3 of 3

Permit Number:
Ito be provided by DWD)
OF WATF9
y �
NC®ENR
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 IIQ and the I&MAgreement (Section IV)
Project name
Contact name
Phone number
Date
Drainage area number
'Greg Welsh, PE
704-553-8881
November 19, 2014
2
Site Characteristics
Drainage area (AD)
194,713,00:ft2
Impervious area
166,798.001ft2
% Impervious (IA)
85.7% %
Design rainfall depth (Ro)
1.32'in
Peak Flow Calculations
1-yr, 24-hr runoff depth
2.75 in
1 -yr, 24-hr intensity
0.39 in/hr
Pre -development 1-yr, 24-hr runoff
2.70 ft3/sec
Post -development 1-yr, 24-hr runoff
2.25 ft3/sec
Pre/Post 1-yr, 24-hr peak control
-0.45 ft"/sec
Storage Volume
Design volume (WQV)
13,327.00 ft'
Adjusted water quality volume (WQVAa;)
9,995.25 ft3
Volume contained in the sedimentation basin and on top of the sand filter
21,855.00,ft3
Top of sand filter/grate elevation
775.6 ft amsl
Weir elevation (between chambers)
779.2 ft amsl
Maximum head on the sedimentation basin and sand filter (hMa.Fifter)
3.6018
Average head on the sedimentation basin and sand filter (hA)
1.80i11t
Runoff Coefficient (Rv)
0.82 (unitless)
Type of Sand Filter
Open sand filter?
Y Y or N
SHWT elevation
Not Encount. ft amsl
Bottom of the sand filter elevation
774.00 ft amsl
Clearance (dsHwT)
2+
Closed/pre-cast sand filter?
N Y or N
SHWT elevation
ft amsl
Bottom of the sand filter elevation
It amsl
Clearance (dsHwT)
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
ft
structure (ds,,,)
OK
OK
OK
OK
E—� NOT ENC0U.NTGRE1:5
@ -1-7Z
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and II. Project Design Summary, Page 1 of 3

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 (Ar)
Top of sand media filter bed elevation
Bottom of sand media flier bed/drain elevation
Depth of the sand media filter bed (d,)
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 filler?
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 (Ws)?
What is the depth of sand over the outlet pipe (dpipe)?
2,600.00,ft2
Vn. IVIQaW IIIII III nuu1, uul IIlay ueeu lu ue 11 Ul CdbM w
3.50 It
ZocuO ft2
vn. v=U, ninuuiun i, uuu nay nccu ru ue nwieaxu ru
775.60 It amsl
774.00 ft amsl
1.60 ft
3.50 (fVday)
15.00 in
1.04 ft3/sec
35.60.hours
OK. Submit drainage calculations.
1.48 days
Y
YorN
OK
Y
Y or N
OK
YorN
ft
YorN
Y
YorN
OK
Y
YorN
OK
Y
YorN
OK
Y
Y or N
OK
20.09 It
OK
1.00 ft
OK
Form SW401-Sand Filter-Rev.5 2009Sept17 Parts I and II. Project Design Summary, Page 2 of 3

2
Permit No.
(to be provided by DWQ)
IIh,.'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.
Initials Pagel Plan
Sheet No.
C $ 0 1. Plans (1" - 50' or larger) of the entire site with labeled drainage area boundaries
Lr� Z - System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
- Flow splitting device,
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Boundaries of drainage easement.
(Dlnl LL4•Z- 2. Plan details (1" = 30' or larger) for the sand filter showing:
- System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
chamber,
- Maintenance access,
- Flow splitting device,
- Vegetative filter strip dimensions and slope (if SA waters),
- Proposed drainage easement and public right of way (ROW),
- Design at ultimate build -out,
- Off -site drainage (if applicable), and
- Boundaries of drainage easement.
•)Z 3. Section view of the sand filter (1" = 20' or larger) showing:
- Depth(s) of the sedimentation chamber and sand filter chamber,
- Depth of sand filter media,
- Connection between the sedimentation chamber and the sand filter chamber and weir elevation,
- SHWT elevation,
- Outlet pipe, and
- Clearance from the surface of the sand filter to the bottom of the roof of the underground structure (if
6 � applicable).
l' W 4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified in the field by DWO, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
ILICA 5. Supporting calculations (including drainage calculations)
6. Signed and notarized operation and maintenance (0&M) agreement
7. A copy of the deed restrictions (if required).
Form SW401-Sand Filter-Rev.5 2009Sept17 Part III, Page 3 of 3

Operation & Maintenance Agreement
Maintenance records shall be kept on the following BMP(s). This maintenance record shall be kept in a k
Any deficient BMP elements noted in the inspection will be corrected, repaired, or replaced Immediately.
affect the integrity of structures, safety of the public, and the pollutant remov
The BMP(s) on this project include (check all that apply &
Bioretention Cell
Quantity:
Dry Detention Basin
Quantity:
Grassed Swale
Quantity:
Green Roof
Quantity:
Infiltration Basin
Quantity:
Infiltration Trench
Quantity:
Level SpreadefNFS
Quantity:
Permeable Pavement
Quantity:
Proprietary System
Quantity:
Rainwater Harvesting
Quantity:
Sand Filler
Quantity:
Stormwater Wetland
Quantity:
Wet Detention Basin
Quantity:
Disconnected Impervious Area
Present:
Soil Amendments
Present:
These deficiencies can
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 NCDENR of any problems with the system or prior to any
changes to the system or responsible party.
' Responsible Party:
Title & Organization:
Street address:
City, state, zip:
Phone number(s):
Email:
Mr. Derek Sallie
Project Manager, CXXII, LLC
5936 Carnegie Boulevard, Suite 200
Charlotte, North Carolina, 26209
704 365.6000
[e-mail]
Signature: XL 61IV4 Date:IV
I, Li S C' �cr "Z , a Notary Public for the Stale of Aloe fk 6210 kn w
County of IA Q [.-1 Cn bue t do hearby certify that re. K SF 1 r-w
personally appeared before me this 17 day of No ✓eN, be / f e'ZO f and
acknowledge the due execution of the Operations and Maintenance Agreement.
Witness my hand and official seal, Ale
CgUj
NotatV Public
Gostan County M`; Commission expfifes
07/00/201Q Q.
My commission expires r7r$' i7
11/1sa014
You created this PDF from an'application that is not licensed to print to novaPDF printer (http://www.novapdf.com) Page t of

.Sand Filter Maintenance Requirements
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 (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:
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 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
Contact the local NC Department of Environment and Natural
damage have occurred at the
Resources Regional Office.
outlet.
11/1912014
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