SW4160101_CURRENT PERMIT_20160129

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW'&616
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ .COMPLIANCE EVALUATION INSPECTION
DOC DATE��QC
YYYYMMDD

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. Shea Davis
PAT MCCRORY
cnre..nn.
DONALD R. VAN DER VAART
Secremn
TRACY DAVIS
RECEIVED
January 27, 2016 N.C. Dept of ENR
JAN 2 9 2016
Venture Properties VII. LLC R NSTO L OFF CE
4700 Weddington Road
Matthews, North Carolina 28104
Subject: Stormwater Permit No. SW4160101
Dollar General — 7291 Sixty Five Hwy, Belews Creek, NC in Forsyth County
Dear Mr. Davis:
The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater
Management Permit Application for the subject project on January 19, 2016. Staff review of the plans
and specifications has determined that the project, as proposed, will comply with the Stormwater
Regulations set forth in Title 15A NCAC 2H.1000 and Session Law 2006-246. We are forwarding Permit
No. SW4160101, dated January 27, 2016, for the construction, operation and maintenance of the subject
project and the stormwater system. This permit shall be effective from the date of issuance until January
26, 2024, or until rescinded and shall be subject to the conditions and limitations as specified therein, and
does not supersede any other agency permit that may be required.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings
(OAH). The written petition must conform to Chapter 150B of the North Carolina General Statutes. Per
NCGS 143-215(e) the petition must be filed with the OAH within thirty (30) days of receipt of this
permit. You should contact the OAH with all questions regarding the filing fee (ifa filing fee is required)
and/or the details of the filing process at 6714 Mail Service Center, Raleigh, NC 27699-6714, or via
telephone at 919-431-3000, or visit their website at www.NCOAH.com. Unless such demands are made
this permit shall be final and binding.
This project will be kept on file at the Winston-Salem Regional Office. If you have any questions, or
need additional information concerning this matter, please contact Mike Randall at [phone]; or
[e-mail].
Sincerely, 0/
for Tracy E. Davis, PE, CPM, Director
cc: SW4160101 File, Winston-Salem Regional Office
cc: Justin Church, BREC, PA
State of Nord) Carolina I Environmental Quality I Energy, Mineral and land Resources
1612 Mail Service Center I Raleigh, Nonh Carolina 27699-1612
919-807-6375

State Stormwater Permit
Permit No. SW4160101
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 Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Venture Properties VII. LLC
Dollar General at 7291 Sixty Five Hwy, Betews Creek, NC in Forsyth County
FOR THE
construction, operation and maintenance of a wet detention basin in compliance with
the provisions of 15A NCAC 2H .1017 (hereafter referred to as the "stormwater rules')
and the approved stormwater management plans and specifications and other
supporting data as attached and on file with and approved by the State and considered
a part of this permit.
This permit shall be effective from the date of issuance until January 26, 2024, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the.application and other supporting data.
2. The wet detention basin is approved for the management of stormwater runoff as
described in the application documents and as shown on the approved plans.
3. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
4. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the 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. SW4160101
II. SCHEDULE OF COMPLIANCE
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted wet detention basin 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 the wet detention basin. The report shall summarize the
inspection dates, results of the inspections, and the maintenance work
performed at each inspection.
5. The wet detention basin shall be constructed in accordance with the approved
plans and specifications, the conditions of this permit, and with other supporting
data.
6. 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 et detention basin 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. SW4160101
9. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of eight years from the date of the completion of
construction.
10. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to,the Director
that the changes have been made.
III. GENERAL CONDITIONS
1. This permit is not transferable except after notice to,and Approval byrthe�Director.
In the event of a change of ownership, or a name chWNge, 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. SW4160101
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 21-1.1000, 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 271h day of January, 2016.
for Tracy E. Davis, P.E., CPM
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

State Stormwater Permit
Permit No. SW4160101
Dollar General
7291 Sixty Five Hwy,
Forsyth Countv
Belews Creek, NC
Designer's Certification
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
t 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
Datc Receiv d
Fee 'd
Permite
Lff(selVtIc',Rules: CoastalSW-1995 ❑ Coastal SW - 2008 ❑ Ph II - Post onstruction
hat apply) ❑ Non -Coastal SW- I-IQW/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
STORMWATER MANAGEMENT PERMIT APPLICATION FORM pod
form may be photocopied for use as an original
I. GENERAL INFORMATION
W/
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.): �o; —a.
RECEIVED F 0
Dollar General - Belews Creek NC N.C. Dept. of ENR
2. Location of Project (street address): JAN 2 9 2016 Z��U
. ' y
7291 Sixty Five Hwy WNSTON-SALEM n�
EU1v1 r.Lvr
City:Belews Creek County:Forsyth Zip:27009
3. Directions to project (from nearest major intersection):
From US Hwy 311 S turn right onto Stokesburg Rd.. Then make an immediate left onto
NC Hwy 65 E, Travel about 3.75 miles and the project site will be on the left across the street from a gas
.�4X O`161
4. Latitude:36° 14' 59.25" N Longitude:80° 05' 45.95" W of the main entrance to the project.
it. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with ruodifications also requires SWLI-102 - Renewal Application Forru
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberN/A , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* "provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ❑High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application, list the stormwater project number,
if assigned, N/A 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
®Sedimentation/Erosion Control: 3.45 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.lf any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:Erosion Control applied for with City of Winston Salem/Forsyth
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: http://12ortal.ncdenr.org/web/ir/rules-and-regulations
Form SWU-101 Version Oct. 31, 2013 Pagel of6

Ili. 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:Venture Properties VII, LLC
Signing Official & Title:Shea Davis - Member Manager
b.Contact information for person listed in item I above:
Street Address:126 Executive Drive - Suite 200
City:Wilkesboro State:NC Zip:28697
Mailing Address (ifapplicable):PO Box 843
City:Wilkesboro
Phone: (336 ) 667-8000
Ema i bsheaOv pd evel op me nt. co m
State:NC Zip:28697
Fax: (336 ) 667-8001
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:Camille Graves & Herman Wayne Martin
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:7291 Sixty Five Hwy
City:Belews Creek State:NC Zip:27009
Mailing Address (if aphlicable):2700 Reynolda Rd
City:Winston-Salem State:NC Zip:27106
Phone: ( ) N/A Fax:
Email:N/A
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:BREC, PA
Signing Official & Title:lustin C. Church - Principal Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:126 Executive Drive - Suite 220
City:Wilkesboro State:NC Zip:28697
Phone: (336 ) 844-4088
Fmail:[e-mail]
Fax: (336 ) 609-7726
4. Local jurisdiction for building permits: City of Winston Salem/Forsyth County
Point of Contact:Brian Matthews Phone #: (704 ) 283-3816
Form SN'U-101 Version Oct. 31. 2013 Page 2 of 6

t IV. . PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
•stormwater runoff will be treated with a wet detention basin with an outlet to an existing wooded area via
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 Roanoke River basin.
4. Total Property Area: 4.31 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:4.31 acres
Total project area shall be calculated to exclude the folloeoiug the normal pool of impounded structures, the area
between the banks of streams and rivers, the area belmo the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHM 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 project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =15.5
9. How many drainage areas does the project have? 1 (For high density, count 1 for each proposed engineered
stormmwater 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
Drainage Area—
Draina e Area _
Draina e Area _
Receiving Stream Name
West BelewsCr.
Stream Class *
C
Stream Index Number *
22-27-9-(3)
Total Drainage Area (so
99,392
On -site Drainage Area (so
99,392
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
29,161
% Impervious Area** total
29.3%
Ira ervious" Surface Area
Drainage Area
Drainage Area
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
9,100
On -site Streets (so
0
On -site Parking (so
20,061
On -site Sidewalks (so
0
Other on -site (so
0
Future (so
0
Off -site (so
0
Existing BUA*** (so
0
Total (so:
29,161
Stream Class and Index Number can be determined at: lnthr//nortal.nedenr.or flog ebfaq[ps/esu/classi cations
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

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. Field Survey
Projects in Union County: Contact DEMLR Cenral 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 http://portal.ncdenr.org/web/wq/ws/su/bap-manual.
Vt. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://portal.ncdennorg web/wq/ws/so/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 atlittp://portal.ncdeiir,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.ncdennorg/web/wq/ws/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. c )
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants Al I
Form. (if required as per Part VII below) 1
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
\ E
http://www.envhelp.org/pages/onestopexpress.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.)
1
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 1h
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 MI-IW 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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
in. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
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
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"x1l" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 512 Page No: 316
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 ]a, 2a, and/or 3a per 15A NCAC 21-1.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
ht!p://www.secretary.state.nc.us/Corl2orations/CSearch.aspx
VII. 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 httn://12ortal.ncdenr.org/weber/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.
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 Engineenjustin C. Church
Consulting Firm: BREC PA
Mailing Address:126 Executive Drive - Suite 220
City:Wilkesboro State:NC Zip:28697
Phone: (336 ) 844-4088
Email:[e-mail]
Fax: (336 ) 609-7726
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or hype ,ante of person listed in Contact Information, item 2a) Camille Graves certify that I
own the property identified in this permit application, and thus give permission to (print or hjpe name of person
listed in Contact Information, item la) Shen Davis with (print or hjpe tame of organization listed in
Contact Information, item ]a) Venture Properties VII, LLC to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version Oct. 31, 2013 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including the assessment oftcwit penaIt' s of up to $25,000 per day, pursuant to NCGS 143-215.6.
V/
Signature: `--Q"7 � p//' iCcz,io/ VDate: a� �D/L✓�-
a Notary Public for the State of �— County of
orScaf ,, do hereby certify thatpersonally appeared
before me this dKday of an d e the due executi f the application for
a stormwater permit. Witness m hand and official seal,
PHILIP E. SEARCY
Notary Public
Forsyth County, NC
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires y-s - d a /
1, (print or hjpe name of person Listed in Contact Information, item la) Venture Properties VII, LLC - Shen Davis
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 2H .1000 and any other applicable state stormwater requirements.
Signature: =c /✓ k---_— ( Date: % - :� el-,,c-
1` be-rri S So u3,�e-r a Notary Public for the State of C6XAlfl0� County of
VV I YC.S do hereby certify that : . S�nea`�004" S personally appeared
before me this 29 day of 01015,and ^acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, �O*.
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Notory Publicilkes z
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Commisslon E
03/08/2020ires_
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My commission expires a3 - 0 8-2q as a
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6

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Permit No.
(to be provided by DWO)
RECEIVED
'
N.C. Dept. of ENR
JAN 2 9 2016
EGIO ON -SAL IC O^F W^ATF9
REGIONAL OFFICE o��a
� C
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Pad III) must be printed, filled out and submitted along with all of the required information.
I.' PROJECT I N F 0 R M A T 10 N Q
litwx<a
Project name
Dollar General Belem Creek
Contact person
Justin Church
Phone number
336-844-4088
Date
1112/2016
Drainage area number
1
II:+=DESIGN IN FORMATION '.- :.:..:'
'e'*tires%3IEXK,'r+ ?«?r;.;.>•.,..
Site Characteristics
Drainage area
99,392 ftz
Impervious area, post -development
29,161 ft2
impervious
29.34
Design rainfall depth
1.0 in
Storage Volume: Non-SAWaters
Minimum volume required
2,601 ft3
Volume provided
7,370 ft3
OK, volume provided is equal to or in excess of volume required.
Storage Volume: SA Waters
1.5" mnoff volume
ft3
Pre -development 1-yr, 24-hr runoff
rya
Post -development 1-yr, 24-hr runoff
ft3
Minimum volume required
ft3
Volume provided
ft3
Peak Flow Calculations
Is the pre/post control of the 1yr 24hr storm peak flow required?
y (Y or N)
1-yr, 24-hr rainfall depth
2.8 in
Rational C, pre -development
(unitless)
Rational C, post -development
(tintless)
Rainfall intensity: 1-yr, 24-hr storm
in/hr
Pre -development 1-yr, 24-hr peak flow
1.76 ft3/sec
Post -development 1-yr, 24-hr peak flow
0.51 ft3/sec
Pre/Post 1-yr, 24-hr peak flow control
-1.25 ft3/sec
Elevations
Temporary pool elevation
766.25 fmsl
Permanent pool elevation
765.50 fmsl
SHWT elevation (approx. at the perm. pool elevation)
765.00 first
Top of 1Oft vegetated shelf elevation
766.00 first
Bottom of 10ft vegetated shelf elevation
765.00 fmsl
Sediment cteanout, top elevation (bottom of pond)
760.00 fmsl
Sediment cleanout, bottom elevation
759.00 first
Sediment storage provided
1.00 it
Is there additional volume stored above the state -required temp. pool?
n (Y or N)
Elevation of the top of the additional volume
fmsl
Form SW401-Wet Dereneon Basin-Rev.9-4/18/12 Parts I. S If. Design Summary, Page 1 of 2

Permit No.
(to be pmWded by DWQ)
I0DESIGN INFORMATION -a >'x.%��a",', ,_ ,fir 'v;"i Y; !°e: <.' tom,"r �n;{a��'SAMR an
Surface Areas
Area, temporary pool
6,567 fl'
Area REQUIRED, permanent pool
1,203 ft
SAIDA ratio
1.21 (unitless)
Area PROVIDED, permanent pool, A._,,
5,072 fit`
Area, bottom of 10ft vegetated shelf, Aye, mbi
2,587 ft`
Area, sediment cleanout, top elevation (bottom of pond), Ayo,yo,u
434 fte
Volumes
Volume, temporary pool
7,370 it'
Volume, permanent pool, V,,M..li
10,753 ft'
Volume, forebay (sum of forebays if more than one forebay)
2,280 ft3
Forebay %of permanent pool volume
21.2% %
SAIDA Table Data
Design TSS removal
Coastal SAIDA Table Used?
MountainlPiedmont SAIDA Table Used?
SAIDA ratio
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 10-2b)
Volume, permanent pool, Vpe,,_m.I
Area provided, permanent pool, A.m.
Average depth calculated
Average depth used in SAIDA, d., (Round to nearest 0.5ft)
Calculation option 2 used? (See Figure 10-2b)
Area provided, permanent pool, A._,,
Area, bottom of 10ft vegetated shelf, Awl s,,
Area, sediment cleanout, top elevation (bottom of pond), A,,,,a
'Depth' (distance b/w bottom of 10ft shelf and top of sediment)
Average depth calculated
Average depth used In SAIDA, d., (Round to down to nearest 0.5ft)
Drawdown Calculations
Drawdown through orifice?
Diameter of orifice (if circular)
Area of orifice (if-noncircular)
Coefficient of discharge (Co)
Driving head (Ho)
Drawdown through weir?
Weir type
Coefficient of discharge (C„.)
Length of weir (L)
Driving head (H)
Pre -development 1-yr, 24-hr peak flow
Post -development 1-yr, 24-hr peak flow
Storage volume discharge rate (through discharge orifice or weir)
85 %
n (Y or N)
y (Y or N)
1.21 (unitless)
n (Y or N)
10,753 ft'
5,072 fte
It
It
y (Y or N)
5,072 It,
2,587 ft'
434 ffz
5.00 it
3.30 It
3.5 It
y (Y or N)
1.50 in
in
0.61 (unitless)
0.94 It
n (Y or N)
(unitless)
(unitless)
It
it
1.76 1
0.51 ftslsec
0.04 ft3/sec
OK
OK
OK
Need 3 ft min.
OK
OK
Storage volume drawdown time
2.00 days
Of, draws down in 2-5 days.
Additional Information
Vegetated side slopes
3 :1
OK
Vegetated shelf slope
10 :1
OK
Vegetated shelf width
10,0 ft
OK
Length of towpath to width ratio
3 :1
OK
Length to width ratio
2.0 :1
OK
Trash rack for overflow 8 orifice?
y (Y or N)
OK
Freeboard provided
1.0 ft
OK
Vegetated filter provided?
y (Y or N)
OK
Recorded drainage easement provided?
y (Y or N)
OK
Capures all runoff at ultimate build -out?
y (Y or N)
OK
Drain mechanism for maintenance or emergencies is'.
PUMP
Form SW4D1-Wet Detention Basin-Rev.94/18/12 Pans I. d II. Design Summary, Page 2 of 2

Permit
(to be provided by DWQ)
III. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Pagel Plan
Initials
Sheet No.
DE
c 2 C)o
1. Plans (1" - 50' or larger) of the entire site showing:
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Delineated drainage basins (include Rational C coefficient per basin),
- Basin dimensions,
- Pretreatment system,
- High Flow bypass system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
1 rF
( 9C0
2. Partial plan (1" = 30' or larger) and details for the wet detention basin showing:
- Outlet structure with trash rack or similar,
- Maintenance access,
- Permanent pool dimensions,
- Forebay and main pond with hardened emergency spillway,
- Basin cross-section,
- Vegetation specification for planting shelf, and
- Filter strip.
1 _iW
3. Section view of the wet detention basin (1" = 20' or larger) showing:
- Side slopes, 3:1 or lower,
- Pretreatment and treatment areas, and
. - Inlet and outlet structures.
C U &L 4. If the basin is used for sediment and erosion control during construction, clean out of the basin is specified
on the plans prior to use as a wet detention basin.
C 5
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for Forebay,
to verify volume provided.
6. A construction sequence that shows how the wet detention basin will be protected from sediment until the
entire drainage area is stabilized.
-�
(
7. The supporting calculations.
-�
8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
QE
9. A copy of the deed restrictions (if required).
r ! 10, A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. County
soil maps are not an acceptable source of soils information.
Form SW401-Wet Detention Basin-Rev.9-4/18/12 Part III. Required Items Checklist, Page 1 of 1

RECEIVED
N.C. Dept. of ENR
,.
JAN 2 9 2016
Permit Number:
(Io be provided by DfVQ)
VVINSTON-SA! ,,,, Drainage Area Number:
,REGl IAL QFvl"
Wet Detention Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
The wet detention basin system is defined as the wet detention basin,
pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
® does ❑ does not incorporate a vegetated filter at the outlet.
This system (check one):
❑ does ® does not incorporate pretreatment other than a forebay.
Important maintenance procedures:
— Immediately after the wet detention basin is established, the plants on the
vegetated shelf and perimeter of the basin should be watered twice weekly if
needed, until the plants become established (commonly six weeks).
— No portion of the wet detention pond should be fertilized after the first initial
fertilization that is required to establish the plants on the vegetated shelf.
— Stable groundcover should be maintained in the drainage area to reduce the
sediment load to the wet detention basin.
— If the basin must be drained for an emergency or to perform maintenance, the
flushing of sediment through the emergency drain should be minimized to the
maximum extent practical.
— Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month and
within 24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a
Coastal County). Records of operation and maintenance should be kept in a known set
location and must 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:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the wet
Areas of bare soil and/or
Regrade the soil if necessary to
detention basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
Vegetation is too short or too
Maintain vegetation at a height of
long.
approximately six inches.
Form SW401-Wet Detention Basin O&M-Rev.4
Page 1 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate theproblem:
The inlet device: pipe or
The pipe is clogged.
Unclog the pipe. Dispose of the
swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to
swale.
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
The forebay
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design depth for
possible. Remove the sediment and
sediment storage.
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 pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional
show that pruning is needed
practices
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the
dying.
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The main treatment area
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design sediment
possible. Remove the sediment and
storage depth.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Algal growth covers over
Consult a professional to remove
50% of the area.
and control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them
invasive plants cover 50% of
with pesticide (do not spray).
the basin surface.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 2 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
A tree has started to grow on
Consult a dam safety specialist to
the embankment.
remove the tree.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. if applicable)
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 Division of
damage have occurred at the
Water Quality Regional Office, or
outlet.
the 401 Oversight Unit at 919-733-
1786.
The measuring device used to determine the sediment elevation shall be such
that it will give an accurate depth reading and not readily penetrate into
accumulated sediments.
When the permanent pool depth reads
sediment shall be removed.
When the permanent pool depth reads
shall be removed.
Sediment Removal
Bottom
feet in the main pond, the
feet in the forebay, the sediment
BASIN DIAGRAM
(fill in the blanks)
764 i Pe manen
-------------- -- Volume
761 -ft Min.
Sediment
Storage
FOREBAY
Permanent Pool Elevation 765.5
Pool
Sediment Removal Lie vation 760 Volume
Bottom Elevation
MAIN POND
1-ft
Storage
Form SW40I-Wet Detention Basin O&M-Rev.4 Page 3 of 4

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.
Project name:Dollar General - Belews Creek
BMP drainage area number:
Print name:
Title:President
Address:126 Executive Drive - Suite 200 - Wilkesboro, NC 28697
Date: 2O I b
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.
I, Sh4XYl'E SptAer a Notary Public for the State of
�0614 �a r0(i na- , County of �K.f_ S , do hereby certify that
(` or+� n --D K oorl personally appeared before me this 14
day of-Q.Pmuc-r- t 201 (,q , and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
.s`��s\tt61SOU/ ,
Notary Public
Wilkes County '-
My Commission Expires_
03/08/2020
SEAL
My commission expires DA'n - o O
Form SW401-Wet Detention Basin O&M-Rev.4 Page 4 of 4