SW1100201_CURRENT PERMIT_20110106

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
?9cURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
"Nl�
YYYYMMDD

W 0
7
NC®ENR.
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullinsc,vN:, ���;.�,-�;. Dee Freeman
Governor Director Secretary
January 3, 2011
Mr. Gregory Driver, PE, Director i TJ
State Construction Office ij'.'l t- J01 b 2011
1307 Mail Service Center
Raleigh, NC 27699
Subject: Stormwater Permit No. SW1100201 Modification
DOAIVA Nursing Home
High Density Wet Pond & Bioretention Cell Project -- --------------_...:---
Buncombe County
Dear Mr. Driver:
The Stormwater Permitting Unit received a complete Stormwater Management Permit
Application for modification of DOA/VA Nursing Home on November 15, 2010; with additional
information received December 28, 2010. 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 modified Permit No.
SW 1100201, dated January 3, 2011, for the construction, operation and maintenance of the
subject project and the stormwater BMPs. The modification includes a new access drive and two
bioretention cells.
This permit shall be effective from the date of issuance until February 12, 2020, and shall be
subject to the conditions and limitations as specified therein. Please pay special attention to the
Operation and Maintenance requirements in this permit. Failure to establish an adequate system
for inspection and maintenance of the sto, mwater management system will result in future
compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within thirty (30) days following
receipt of this permit. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative
Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands are made this
permit shall be final and binding.
This project will be kept on file at the Asheville Regional Office. If you have any questions, or
need additional information concerning this matter, please contact Robert Patterson at (919)
807-6375; or [e-mail].
Sincerely,
))�� � X24'�V
fo►- Coleen H. Sullins
Wetlands and Stormwater Branch One
1617 Mail Service center, Raleigh, North Carolina 27699-1617 Nortl l Carof I na
Location: 512 N. Salisbury St Raleigh, North Carolina 27604 ��rtlrr�rll�
Phone: [phone] FAX: [phone], Customer Service: 1-877-623-6748
Internet: www.nmaterquality.org
An Equal Opportunity V Affrmative Action Employer

Mr. Gregory Driver, YE
SW 1) 00201 MOD — DOANA Bing Home
January 3, 2011
cc: Asheville Regional Office
SW 1100201 File
ec: Mr. Chris Day, PE — Civil Design Concepts, PA
Page 2 of 2

�J
0 State Stormwater Permit
rmit No.SW1 100201 MOD
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
State of North Carolina
DOA / VA Nursing Home
35 Camp Road, Swannanoa, Buncombe Count}l
FOR THE
construction, operation and maintenance of a wet detention pond and two bioretention
cells in compliance with the provisions of 15A NCAC 2H .1000 and S.L. 2006-246
(hereafter referred to as the "stormwater rules') and the approved stormwater
management plans and specifications and other supporting data as attached and on file
with and approved by the Division of Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until February 12, 2020, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.6 of this permit. The stormwater control has been
designed to handle the runoff from 262,483 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in 1.6 and 1.7 of
this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
Page 1 of 7

Y
*State Stormwater Permit
rmit No.SW 1100201 MOD
6. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition;',
a. Drainage Area, acres: 9.66
Onsite, ft : 420,638
Offsite, ft2: 0
7
I01
C.
d.
e.
f.
9.
h.
i.
1•
k.
1.
n.
o.
Total Impervious Surfaces, ft2:
Buildings ft
Roads/Parking, ft2:
Other, ft2•
Offsite, ft2:
Average Pond Depth, feet:
TSS removal efficiency:
Design Storm, in.:
Permanent Pool Elevation, FMSJ�
Permitted Surface Area @PP ft
Permitted Storage Volume, ft
Storage Elevation, FMSL:
Controlling Orifice:
Permanent Pool Volume, ft3
Forebay Volume, ft3:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
242,943
124,100
88,804
30,039 (sidewalks)
0
4.0
90%
1.0
2305.00
11,986
23,082 at temporary pool
2,306.60
2.0" O pipe
29,290
6,055
UT to Swannanoa R. / French Broad
6-78
„C�l
The following design criteria have been provided in the bioretention cells and
must be maintained at design condition:
i
c.
d.
e.
f.
h.
i.
J•
k.
I.
m
n.
o.
p-
q-
r.
S.
Drainage Area, acres:
Onsite, ft :
Offsite, ft2:
Total Impervious Surfaces, ft2:
Roads/Perking, ft
Offsite, ft
Design Storm, inches:
Max. Ponded Depth, inches:
Seasonal High Water Table, fmsl:
Planting Media Depth, feet:
Cell Dimensions, feet:
Planting Elevation, fmsl-
Bottom Surface Area, ft2:
Permitted Storage Volume, ft3:
Bypass / Storage Elevation, fmsl:
Predevelopment 1 year 24 hour:
Post development 1 year 24 hour:
Drawdown Time, hours:
Underdrain Diameter, inches:
Total number of plants provided -
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
Cell 1
Cell 2
0.41
0.31
17,775
13,430 - "
0
0
14,007
5,533
14,007
5,533
0
0
1.0
1..0 -
12.0
12.0
2,300.0
2308
2.0
2.0
60x37
56x12
2,304.7
2315.3
1,365
664
1,365
664 '
2,305.7
2316.5
1.4 cfs
0.5 cfs
0.2 cfs
0.1 cfs
24
24
4.0
4.0
grass sod
grass sod
UT to Swannanoa R.•1 French Broad
6-78
=,C„
The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
Page 2 of 7

11
rState Stormwater Permit
mit No.SW1100201 MOD
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired imrnediateiy.
3. The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must be followed in
its entirety and maintenance must occur at the scheduled intervals including, but
not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated areas.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, catch
basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with
the conditions of this permit, the approved plans and specifications, and 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 system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
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. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
9. 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 or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
Page 3 of 7

State Stormwater Permit
O rmit No.SW 1100201 MOD
10.. The permittee shall submit final site layout and grading plans for any. permitted
future areas shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction. -
12. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements.. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form, to the Division of -Water
Quality, signed by both parties, and accompanied by supporting documentation
as listed on page 2 of the form. The project must be in good standing with the
Division. 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 the transfer request.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
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 4 of 7

E
0 State Stormwater Permit
mit No.SIN1100201 MOD
10.Y he 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 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 3rd day of January, 2011.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Jor uoieen Yi. 5uiiins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5 of 7

o
DOA / VA Nursing Home
Stormwater Permit No. SW1100201
Buncombe County
Designer's Certification
9 State Stormwater Permit '
rmit No.SW 1100201 MOD
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)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications..
The checklist of items on page 2 of this form is included in the. Certification.
Noted deviations from approved plans and specification: ,
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Permit
mit No.SW1100201 MOD
Certification Requirements:
.1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
.3. All the built -upon area associated with the project is graded such that the
runoff drains to the system
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
.7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
_10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
.13. All required design depths are provided.
_14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
_15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to
Asheville Regional Office
Surface Water Protection
2090 US Highway 70
Swannanoa, NC 28778
Page 7 of 7

iSE ONT Y' •...r,".k ,•,,. ,�y� 1"3
Elpte RVeived
Pee Paid
Permit Number
ry ,o
S 14/1 119 oZ o f
Applicabldi Rulek ❑ Coastal SW -1995 ❑ Coastal SW - 2008 Ph 11 - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resourc
s JAN 2 7 2010
Division of Water Quality
D NR - WATER WALFFY
STORMWATER MANAGEMENT PERMIT APPLICATI
Branch
This forty airy be photocopied for use as rrrr original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
DOA vA Nursing Home - Buncombe County _
2. Location of Project (street address):
35 Carl u Road
City:Swannanoa County:13uncombe Zip:28778
3. Directions to project (from nearest major intersection):
Main entrance to project is located approx. 755 LF northeast of the intersection_ of Woodland Drive (SR 2460)
and Eastwood Avenue (SR 2461)
4. Latitude:35° 36' 58" N Longitude:-82° 22' 48" W of the train entrance to the project.
11. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New []Modification
b. If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *Provide o designer's cerlifrcatiorr
2. Specify the type of project (check one):
❑Low Density ®I-ligh Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control: 13.1 ac of Disturbed Area
❑NPE)ES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b. If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
Form SWU-101 Version 07July2009 Page I of 6

Ill. 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/OrganizatiomState of North Carolina
Signing Official &'Fitle:Gre or Driver P.E. Director State Construction Office
b.Contact information for person listed in item 1a above:
Street Address:]307 Mail Service Center
City; Ra leigh State:NC Zip:27699
Mailing; Address (if applicable):same as above
City:_ State: Zip:
Phone: t19 _ ) 807-4100 _ Fax:
Errtail:Gre [e-mail]
Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, iten 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. (Phis is the
person who owns the property that the project is located on):
Properly Owner/Organization:
Signin€; Official & Title:
b.Contac information for person listed in item 2a above:
Street Address:
City:— State: Zip:
Mailing; Address (if applicable):
City:
Phone: f )
Email:
State: Zip:
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 & Tide:
b.Contac: information for person listed in item 3a above:
Mailing Add
City:_
Phone: ( }
Email;
State:
Fax: }
4. Local jurisdiction for building permits: State of North Carolina
Point oF, Contact: Phone #:
Form SWU-101 Version 07Ju1y2009 Page 2 of 6
Zip:

0
IV. PRO(ECT INFORMATION
•
1. In the space provided below, briefly summarize how the storrnwater runoff will be treated.
The storrnwater runoff will be treated with the utilization of a wet detention basin.
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.Identify 1 he regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ® Ph II - Post Construction
3. Storrnwater runoff from this project drains to the French Broad River basin.
4. Total Property Area: 20.6 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
Area4:2C.6 acres
+ Total project area shall be calculated to exclude the following the normal pool of impounded structures, the area
betweear the banks of streams and rivers, the area below the Normal High Water (NHW) line or Memo High Water
(MHVV) litre, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calcxlrrte ouerall percent brtilt upon areal (BUA). No) i-coastat zuetlan cis landward of the NHW (or MHW) line may
be iuclnded in the total project area.
8. Project p.-3rcent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 30.0 %
9. How ma:.iy drainage areas does the project have?l (For high density, count 1 for each proposed engineered
storrnwater 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'Iriformation
,.: ,
Drama e Ari?a 1,.
-:
;Drama e Areal':;,f�
�Draiiia e 7lrca'.
�� -, P
DTalna e'Area i
Receiving Stream Name
Trib. to
Trib. 28 to
Swannanoa
River
Stream Class
C
Stream ]Index Number *
6-78
Total Drainage Area (so
420638
On -site Drainage Area (so
420638
Off -site Drainage Area (so
0
Pro used Impervious Area (so
242943
[m ek:vious Area** total
57.8%
Ili er,.vious" 5iiiface;�Aiea ," E,, „�1
� Drama e Area ls�
sDraii�a e'-Area
Ora`ina `e'Area A}
?D'rairia eWA 6,
On -site Buildings/Lots (so
124100
On -site Streets (so
0
On -site Parking (so
88804
On-site'5idewalks (so
30039
Other on -site (so
0
Future (so
0
Off -site (sf)
n/a
I-Existin BUA*** (sf)
n/a
Total (so:
242943
Streams Class and Index Number can be determined at: ltttU://h2o,e)ir.state.rrc.ns/binns/reports/rel.rortsWB.litrnl
Fonn S1VU-101 Version 07July2009 Page 3 of

•
•
*" "I'l}lervious area is defined as the built upon area including, brit not Iinrited to, buildings, roads, parking areas,
sirleivalks, gravel areas, etc.
*** Report only that arnount of existing BUA that will rearain after developrrrerrt. Do not report airy existing BUA that
is to be reuroved and which Will be replaced by rreur BUA.
11. I -low was the off -site impervious area listed above determined? Provide documentation. N A
Proiects in Union Cuunty: Contact DINQ Central Office staff to check if the project is located within a I hreatened &
Endangered Species watershed that nrcry be subject to more s-triagent stornnvcder requirements as per NCIIC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The apphc'able 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 tl!p..I/li2o.ejir.state.iic.us/su/­biiii) forms.lntm.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from littp://li2o.eiir.state.nc.us/su/bmL,- forms.htm. The complete application
package should be submitted to the appropriate DWQ Office. (The appropriate office may be found by
locating project on the interactive online map at littp://li2o.enr.state.nc,us/su/msi_maps.htm.)
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 httl2://l12o.etir.state.iic.us/sii/biiiL)—foriiis.11ttii.
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and orre colry of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VIl beloto)
3. Original of the applicable Supplement Forms) (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
htta.ZZwww.envlielp.org/12ages/onestopexpress.litiiii 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
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'/2 mile of the site boundary, include the'/2
mile radius on the map.
7. Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Loc�rtion map with narned streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scal-:.
g. Revision number and dates.
h. Ider.tify 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
,tructures, 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 13UA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finishes{ floor elevations.
I. Details of roads, drainage features, collection systems, and stormwater coritrol measures.
in. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
Form SWU-101 Version 07July2009 Page 4 of 6
Initials
P—LA
Cr�>
CC->
for C'Z>

o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a trap of the boring locations with the existing
elevations and boring logs. Include an 8.5"xl'l" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO. Schedule a site visit for DWQ to verify file SHWTprior
to sulnttittal, [phone].)
10. A copy of the most current property deed. Deed book: 946 Page No: 527
11, For corporations and limited liability corporations (LLC): Provide documentation from the NC �r
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 21-1.1003(e). The
corporation or LLC must be listed as an active corporation in goof{ standing with the NC
Secretary of State, otherwise the application will be returned.
htt www.secretar .state.nc.us Corporations Z CSearch.as x
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
htt ://h2o,ennstate.nc.uslsu/bmp forms.htm#deed „restrictions. 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 theni, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ, and that they will be recorded prior to the sale of any lot.
Vlll. 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:C. Chris Day, P.E.
Consulting Firm: Civil Design Concepts, PA
Mailing Address:200 Swannanoa River Road
City:AshevJle State:NC Zip:28805
Phone: L3 } 252-5388 Fax: (828 ) 252-5365
Email:c�layi-civildesi ng concepts.com
IX. PROPERTY OWNER AUTHORIZATION (if Contact Infornration, item 2 has been filled out, cotuplete this
sect ion r
1, (print or ttrpe nacre of person listed in Contact Inforwatiott, iteta 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed ire Contact Information, item 1a) with (print or type rrante of organization listed ire
Contact Information, item 11Y) 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 07July2009 Page 5 of 6

L
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 agree.:-nent, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signa to re:
a Notary Public for the State of
do hereby certify that
before me this _ day of ,
Date:
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEA],
My commission expires
X. APPUCANT'S CERTIFICATION
1, (print or tape arrive of person lister( in Contact Information, itew 2) Grego?-V Driver, P.E., Director, State Coatstruction
Office
certify that the information included on this permit application form is, to the best of nay 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, SL 2006-246 (Ph. 11- Post Construction) or SL 2008-211.
* Signature:`
Date: 1-14-W(0
l H , a Notary Public for the State of W- tua , County of
_ A►-Kre•�1 do hereby certify that 1;'FJ✓F� personally appeared
before me this 1{ Mday of -NUA�t 2"ty and ackno (i V tht d e execution of the application for
i
a stormwater permit. Witness my hand and official seal,
=JELEN1
EAL
rth Carolina
ckson
IEWSKI
my Gi7Ptif &, - t.orp
SEA L
My commission expi
- 18 - Zc,10
Norm SWU-101 Versio❑ 07July2009 Page 6 of 6

W /O b zo
Permit Number;
(to be provided by DWQ)
Drainage Area Number: _ e Z
Bioretention Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
Iog in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
Important operation and maintenance procedures:
— Immediately after the bioretention cell is established, the plants will be watered
twice weekly if needed until the plants become established (commonly six
weeks).
— Snow, mulch or any other material will NEVER be piled on the surface of the
bioretention cell.
— Heavy equipment will NEVER be driven over the bioretention cell.
— Special care will be taken to prevent sediment from entering the bioretention cell.
— Once a year, a soil test of the soil media will be conducted.
After the bioretention cell is established, I will inspect it once a month and within 24
hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of operation and maintenance will be kept in a known set location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblems:
How I will remediate the roblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
bioretention cell
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide time and a
one-time fertilizer application.
The inlet device: pipe,
The pipe is clogged (if
Unclog the pipe. Dispose of the
stone verge or swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
a licable).
Erosion is occurring in the
Regrade the Swale if necessary to
Swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
Form SW401-Bioretention O&M-Rev.3
Page I of 4

BMP element:
Potentialproblems:
How I will remediate theproblem:
The pretreatment area
Flow is bypassing
Regrade if necessary to route all
pretreatment area and/or
flow to the pretreatment area.
gullies have formed.
Restabilize the area after grading.
Sediment has accumulated to
Search for the source of the
a depth greater than three
sediment and remedy the problem if
inches.
possible. Remove the sediment and
restabilize the Rretreatment area.
Erosion has occurred.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
revent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand.
The bioretention cell:
Best professional practices
Prune according to best professional
vegetation
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.
Tree stakes/wires are present
Remove tree stake/wires (which
six months after planting.
can kill the tree if not removed).
The bioretention cell:
Mulch is breaking down or
Spot mulch if there are only random
soils and mulch
has floated away.
void areas. Replace whole mulch
layer if necessary. Remove the
remaining much and replace with
triple shredded hard wood mulch at
a maximum depth of three inches.
Soils and/or mulch are
Determine the extent of the clogging
clogged with sediment.
- remove and replace either just the
top layers or the entire media as
needed. Dispose of the spoil in ail
appropriate off -site location. Use
triple shredded hard wood mulch at
a maximum depth of three inches.
Search for the source of the
sediment and remedy the problem if
possible.
An annual soil test shows that
Dolomitic lime shall be applied as
pH has dropped or heavy
recommended per the soil test and
metals have accumulated in
toxic soils shall be removed,
the soil media.
disposed of properly and replaced
with new planting media.
Form SW401-Bioretention O&M-Rev.3 Page of 4

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

0
Permit Number.
W1l6bLot
(to be provided by DIVQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. 1 agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:DOAIVA Nursinf_Home-Buncombe County
BMP drainage area number:DA I & DA 2
Print name:Grea Driver. P.E.
Title : Director- State Construction Office
Address:1307 Mail Service Center
Phon
Sign
Date
Note: The legally responsible parry 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.
1, J 11� t.r! IrGi ��' _ , a Notary Public for the State of
County of -3-0 6 Skyy--� , do hereby certify that
—5—e'do1 r personally appeared before me this AV
day of and acknowledge the due execution of the
forgoing bioretention maintenance requirements. Witness my hand and official seal,
JENNIFER BRALEY
NOTARY PUBLIC
JOHNSTON COUN N.C.
My Commission Expires. U? tl
SEAL
My commission expires
Form SW401-Bioretention I&M-Rev.2 Page of

Permit Number: S K/l 1 d 0 Z 0 I
(to be provided by I)IVQ)
Drainage Area Nuinber: t
Wet Detention Basin Operation and Maintenance Agreement
I will keep a maintenance record on this 13MP. 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 loan 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
rnaximuni extent practical.
— Once a year, a dam safety expert should inspect the embankment.
After d1e 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
Iocation and must be available upon request.
Inspection activities shall be performed'as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potential roblem:
How I will rernediate 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 covet' 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.
approxin atel six inches.
Forni SW401-Wet Detention Basin 0&M-Rev.4
Page 1 of 4

Permit Nutiiber: 'SWI j O oZ of
(to be proviclecl by DIVO)
Drainage Area Number:
BMP element:
Potentialproblem:
How 1 will remediate theproblem:
The inlet device: pipe or
'File 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
twill 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 lants ratl}er 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 necessar ,
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
sedinien: 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 causc,impacts to streams or
the BMP.
Algal growth covers over
Consult a professional to remove
50% of file 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
r
r

EIF
i
Permit Nuinber: -5i✓1 /O pZd 1
(to be provided br DII'Q)
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 2305.0 feet in the main pond, the
sediment shall be removed.
When the permanent pool depth reads 2305.0 feet in the forebay, the sediment
shall be removed.
BASIN DIAGRAM
(rill in the blanks)
Permanent Pool Elevation 2305.0
Sediment Removal E' . 2302.0 _ D 1 Pe manen Pool
-------------- Volume Sediment Removal Elevation 2301.0 Volume
--
Bottoln Elevatiol 2301.0 -ft Min.
Sediment Bottom Elevation 2300.0 ]-ft N ui.
Storage Sediment
Storage
FOR RAV MAIN POND
Form SW401-Wet Detention Basin O&M-Rev.4
!'age 3 of'4

r1l
Pcrmit Number: s i OZO
(to be provided by 1)fVQ)
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 iiame:DOANA Nursinf,, Home - Buncombe County
BAV chrcrrrr We crr•ect mmiber•: I
Print name:Gregory Driver, P.E.
Title:Director, State Construction Office
Address:1307 Mail Service Center, Raleigh. NC 27699
Date: 1 -1 `1-ZA10
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, -:TzqiJ Ll-I.1tEwSr�l a Notary Public for the State of
1-46m-1 , County of do hereby certify that
�aC�EC7nK �l~?l personally appeared before me this
day of 0 ►- , and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
OFFICIAL St AL
Notary Pubic, North Carolina
Courty of.I2Ckson
JOHN �l;LENIEWSKI
My Commission E*ites _ I _Z�'�—
SEAL
My commission expires
9- 15.- ZGIo
Form SW401-Wet Detention Basin O&M-Rev.4 Page 4 of 4

LA. 1
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
September 11, 2014
Mr. Gregory Driver, P.E.
State Construction Office
1307 Mail Service Center
Raleigh, INC 27699
SUBJECT: NPDES Stormwater Permit Compliance Inspection
DOAIVA Nursing Home
Permit No: SW1100201
Buncombe County
Dear Mr, Driver;
This letter is in follow-up to the NPDES Stormwater Permit Compliance Inspection conducted on August 28,
2014 at the VA Nursing Home in Buncombe County. The facility was found to be in compliance with permit
SW1100201 (for post -construction stormwater BMPS).
Enclosed is a copy of the Compliance Inspection Report, which contains additional observations and
comments for your reference. Please note some of the minor maintenance activities that should be
performed on the BMPs to ensure their long term viability. These include addressing the bank erosion on
the wet detention pond, and removing the cattails in the wet detention pond.
If I can be of any further assistance, please contact me at [phone].
Sincerely,
aura C. Herbert, PE
Regional Engineer
Land Quality Section
Enclosure: Compliance Inspection Report
cc: Mr. George Digges; 62 Lake Eden Road; Black Mountain, NC; 28711-8706
Central Files
Asheville Files
Division of Energy, Mineral, and Land Resources
Asheville Regional Office, 2090 US Highway 70, Swannanoa, North Carolina, 28778-8211
Telephone [phone] Fax [phone] One
httpalportal.ncdenr.org/web/ir/land-quality NorthCarolina
An Equal Opportunity 1 Affirmative Action Employer Naturally

Compliance Inspection Report
Permit: SW1100201 Effective:01103/11 Expiration: 02/08/21
Project: DOANA Nursing Home -Buncombe County
Owner: State of North Carolina
County: Buncombe Adress: 35 Camp Rd
Region: Asheville
Contact Person: Gregory Driver
Directions to Project:
Title:
City[State/Zip: Swannanoa NC 28778
Type of Project: State Stormwater - HD - Bioretention State Stormwater - HD - Detention Pond
Drain Areas: 001 - (Swannanoa River) (04.03-02 ) ( C)
002 - (Swannanoa River) (04-03-02) ( C)
003 - (Swannanoa River) (04-03-02) (C)
On -Site Representative(s):
Related Permits:
Inspection Date: 08128/2014 Entry Time: 11:00AM
Prlmary Inspector: Fred Walker
Secondary Inspector(s):
Laura C Herbert
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: 0 Compliant ❑ Not Compliant
Question Areas:
Other
(See attachment summary)
Phone: [phone]
Exit Time: 11:30AM
Phone: [phone]
Inspection Type: Compliance Evaluation
page: i

� It
Permit: SW1100201 Owner - Project: State of North Carolina
Inspection Oats: 08/28/2014 inspection Type Compliance Evaluation Reason for Visit: Routine
inspection Summary:
In compliant. A few maintenance items need addressing as follows:
Bank erosion at the wet detention pond (access road side)
Cattails need removing/thinning at wet detention pond.
Send copy of letter/inspection to
Mr. George Digges
Dept of VA
62 Lake Eden Road
Black Mountain, NC 28711-8706
Other
Comment:
Yes No NA NE
page: 2

0 0
Compliance Inspection Report
Permit: SW1100201 Effective:01103111 Expiration: 02/08/21
Project: DOANA Nursing Home -Buncombe County
Owner: State of North Carolina
County: Buncombe Adress: 35 Camp Rd
Region: Asheville
Contact Person: Gregory Driver
Directions to Project:
Title:
City/State/Zip: Swannanoa NC 28778
Type of Project: State Stormwater - HD - Bioretention State Stormwater - HD - Detention Pond
Drain Areas: 001 - (Swannanoa River) (04-03-02) { C)
002 - (Swannanoa River) (04-03-02) ( C)
003 - (Swannanoa River) (04-03-02) { C)
On -Site Representative(s):
Related Permits:
Inspection Date: 08/28/2014 Entry Time: 11:OOAM
Primary Inspector: Fred Walker
Secondary Inspector(s):
Laura C Herbert
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: Compliant ❑ Not Compliant
Question Areas:
Other
(See attachment summary)
Phone: [phone]
Exit Time: 11:30AM
Phone: [phone]
Inspection Type: Compliance Evaluation
page: 1

permit; SW1100201 Owner - Project: State of North Carolina
Inspection Date: 08/28/2014 Inspection Type Compliance Evaluation
Inspection Summary:
In compliant. A few maintenance items need addressing as follows:
Bank erosion at the wet detention pond (access road side)
Cattails need removing/thinning at wet detention pond.
Send copy of letter/inspection to
Mr. George Digges
Dept of VA
62 Lake Eden Road
Black Mountain, NC 28711-8706
Other
Comment:
Reason for Visit: Routine
Yes No NA NE
page: 2

E
F
11
a
tivaaVA.
ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S. REGAN
Secretary
January 16, 2019
State of North Carolina
Attention: Cecil Holt
1307 Mail Service Center
Raleigh, North Carolina 27699
Subject: Compliance Evaluation Inspection
Permit: SW11.00201
Buncombe County, North Carolina
Dear Mr. Holt:
Enclosed please find a copy of the Compliance Evaluation Inspection Report for the
inspection i conducted at the subject facility on January 9, 2019.
The report should be self-explanatory; however, should you have any questions
concerning this report, please do not hesitate to contact me at [phone] or by email
at lsaiah.reed@ncdenr,gov.
Enclosure: Inspection Report
Sincer i
Isaiah Reed, PSCI, MS4CEC
Environmental Specialist
Land Quality Section
.puemn� AY ROVMi�Gail�
North Carolina Department of Environmental Quality I Divislon of Energy, Mineral and Land Resources
Asheville Regional Office 12090 U.S. Highway 7U I Swannanaa, North Carolina 28778
828.296.4500

I
0 0
Compliance Inspection Report
Permit: SW1100201 Effective:01103111 Expiration: 02/08121
Project: DOANA Nursing Home -Buncombe County
Owner: Sato of North Carolina
County: Buncombe Adress: 35 Camp Rd
Region: Asheville
Contact Person: Gregory Driver
Directions to Project:
Type of Project: State Stormwater - HD - Bioretention
Drain Areas: 001 - (Swannanoa River) (04-03-02 ) ( C)
002 - (Swannanoa River) (04-03-02 ) ( C)
003 - (Swannanoa River) (04-03-02 ) ( C)
On -Site Representative(s):
Related Permits:
CitylStatelZip: Swannanoa NC 18778
Title: Phone: [phone]
State Stormwater - H D - Detention Pond
Inspection Date: 01/0912019 Entry Time: 10:OOAM
Primary Inspector: Isaiah L Reed
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: ❑ Compliant ® Not Compliant
Question Areas:
■ State Stormwater
(See attachment summary)
Exit Time: 11:OOAM
Phone: [phone]
Inspection Type: Compliance Evaluation
page: 1

1
Permit: Sw1100201 Owner - Project: State of North Carolina
Inspoction Date: 01/09/2019 Inspection Type Compliance Evaluation Reason for Visit; Routine
Inspection Summary:
On January 9, 2019, Mike Smith and myself inspected this facility for complaince. During the inspection, the following
items were noted:
1) The Inlet apron of the Bioretention pond designated on the plans as "C2" Is covered by grit and other debris from the
road. The permittee is directed to maintain that apron to ensure that it is functional by removing and disposing of the
accumulated waste.
2) The wet pond designated as "Cl " was observed to have an amount of vagltation growing in the pond without being
maintained. While this vegitalion does not appear to be causing an issue now; if left unchecked, it could result in loss of
stormwater storage volume reducing the effectiveness of the pond.
During the file review, the following items were noted:
A signed certification which certifies that the permitted facility has been installed in accordance with the permit has not
been submitted to this office. The permittee is dierected to submit that certification the Asheville Regional Office,
including any supporting documentation. Any deviation from the approved plans and specifications must be noted on the
certification.
If you have any questions, please contact this office at [phone]
File Review Yes No NAB
Is the permit active? 0 ❑ ❑ ❑
Signed copy of the Engineer's certification is In the file? ❑ E ❑ ❑
Signed copy of the Operation & Maintenance Agreement is In the file? ■ ❑ ❑ ❑
Copy of the recorded deed restrictions is in the file? E ❑ ❑ ❑
Comment: See summary for more Information.
SW Measures Yes No NA NE
Are the SW measures constructed as per the approved plans? ■ ❑ ❑ ❑
Are the inlets located per the approved plans? ❑ ❑ ❑
Are the outlet structures located per the approved plans? E ❑ ❑ ❑
Comment:
Operation and Maintenance Yes No NA NE
Are the SW measures being maintained and operated as per the permit requirements? 0 ❑ ❑ ❑
Are the SW BMP inspection and maintenance records complete and available for review or provided to ❑ ❑ ❑
DWQ upon request?
Comment:
page: 2

Compliance Inspection Report
Permit:
SW1100201 Effective:01/03/11
Project:
DOANA Nursing Home -Buncombe County
Owner:
State of North Carolina
County:
Buncombe
Region:
Asheville
Contact Person: Gregory Driver
Directions to Project:
Expiration: 02/08/21
Adress: 35 Camp Rd
City/State/Zip: Swannanoa NC 28778
Title: Phone: [phone]
Type of Project: State Stormwater - HID - Bioretenlion State Stormwater - HD - Detention Pond
Drain Areas: 001 - (Swannanoa River) (04-03-02 ) ( C)
002 - (Swannanoa River) (04-03-02 ) ( C)
003 - (Swannanoa River) (04-03-02 ) ( C)
On -Site Re prosentative(s):
Related Permits:
Inspection Date: 01/09/2019 Entry Time: 10:00AM
Primary Inspector: Isaiah L Reed
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: ❑ Compliant Not Compliant
Question Areas:
State Stormwater
(See attachment summary)
Exit Time: 11:OOAM
Phone: [phone]
Inspection Type: Compliance Evaluation
page: 1

a a
Permit: SW1100201 Owner - Project: State of North Carolina
Inspection hate: 0110912019 Inspection Type Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
On January 9, 2019, Mike Smith and myself inspected this facility for complaince. During the inspection, the following
items were noted:
1) The inlet apron of the Bioretention pond designated on the plans as "C2" is covered by grit and other debris from the
road. The permittee is directed to maintain that apron to ensure that it is functional by removing and disposing of the
accumulated waste.
2) The wet pond designated as "C1" was observed to have an amount of vagitation growing in the pond without being
maintained. While this vegitation does not appear to be causing an issue now; if left unchecked, it could result in loss of
stormwater storage volume reducing the effectiveness of the pond.
During the file review, the following items were noted:
A signed certification which certifies that the permitted facility has been installed in accordance with the permit has not
been submitted to this office. The permittee is dierected to submit that certification the Asheville Regional Office,
including any supporting documentation. Any deviation from the approved plans and specifications must be noted on the
certification.
If you have any questions, please contact this office at [phone]
File Review
Yes
No NA NE
Is the permit active?
M
❑ ❑ ❑
Signed copy of the Engineer's certification is in the file?
❑
E ❑ ❑
Signed copy of the Operation & Maintenance Agreement is in the file?
■
❑ ❑ ❑
Copy of the recorded deed restrictions is in the file?
■
❑ ❑ ❑
Comment: See summary for more information.
5W Measures Yes No NA NE
Are the SW measures constructed as per the approved plans? ■ ❑ ❑ ❑
Are the inlets located per the approved plans? ■ ❑ ❑ ❑
Are the outlet structures located per the approved plans? © ❑ ❑ ❑
Comment:
Operation and Maintenance Yes No NA NE
Are the SW measures being maintained and operated as per the permit requirements? ® ❑ ❑ ❑
Are the SW BMP inspection and maintenance records complete and available for review or provided to ❑ ❑ ❑
DWQ upon request?
Comment:
page: 2

0 •
State Stormwater Inspection Report
General
Project Name: DO /VA AlvlwfN'�r- //omE
Permit No: SW 11 tb 2b1
Expiration Date: -2 1 Z%Z47n
Contact Person: I41 G k"l &G-)G7 000 Z eti i
Phone Number:
Inspection Type:
Inspection Date: 91 Z0/ 2-0 J
Time in: f I '. Do
Time Out: 1 I : 30
Current Weather: L% El'ar
Recent Rain (Date)? A/0
Rain — in
Location
Facility Address / Location: ` j, Cklotl 120G d t" O % No 0d /0/4
City: S w u/'iv ""gf Zip: Z$-7J79 County: adnl Lat: i"N Long: - 0 4"W
Permit Information
Rule Subject to (circle one): 1988 Coastal Rule 1995 Coastal Rule
Goose Creek High Quality Water,
Density (circle one): {igh (iID) Low (LD)
Stormwater Best Management Practices (BMPs) (inserl number of each):
! Wet Ponds Infiltration Basins Infiltration Trenches
Dry Ponds __�Z—Bioretention Permeable Pavement
Cistern Level Spreader/Filter Strip Other (specifi):
File Review
Phases
2008 Coastal Rule Session Law 2006-246
Outstanding Resource Waters
LD Swales Stormwater Wetlands
Sand filters (circle one) Open Closed
Yes No NIA N/E
1. Is the permit active?
2. Signed Engineer's Certification on file?
3. Signed Operation and Maintenance agreement on file?
4. Recorded Deed Restrictions on file?
Site Visit- guilt Unnn Arpa IRUAI 1// 5 t 1e0/-J cfr5 Yes No NIA NIE
5. BUA is constructed and consistent with the permit requirements?
6. BUA aspermitted) is graded such that the runoff drains to the system? (high density only)/
7. Drainage area is consistent withpermit? i.e. no un ermitted drainage to the SW BMPs
/
8. Drainage area is stabilized? to reduce risk of sedimentation to the SW BMPs
/
Site Visit: Stormwater SMPs
v o llaly ',,.s
Yes No NIA NIE
9. Stormwater BMPs are located per the approvedplans?
/
10. Stormwater BMPs have dimensions (e . length, width, area) matching the approvedplans?
/
11. Stormwater BMPs are constructed per the approvedplans?
/
Site Visit: Operation and Maintenance
Yes No NIA NIE
12. Access oints to the site are clear and well maintained'?
13. Trash has been removed as needed?
14. Excessive landscape debris (grass clippings, leaves, etc) is controlled?
15. Stormwater BMPs being operated and maintained as per the permit requirements?
i
16, Inspection and Maintenance records are available for inspection? (high density only, 1995 — present only)
Site Visit: Other Permit Conditions Yes No NIA NIE
17. Is the site compliant with other conditions of thepermit?
Site Visit: Other Water Quality Issues Yes No NIA NIE
18. Is the site compliant with other water quality issues as noted during the inspection?
State Stormwater Inspection Report, Version 3.0 Page 1 of 2

0 0
State Stormwater inspection Report
comments
mod. f end _ /�.� �!s � �.� ar bu�K s-l� /, 1, �� n/ir<i /via ►' � cce� f �-
InS ection Pictures (some of the pictures taken during the site visit)
Compliance Status 2--l" Compliant E Non -Compliant
Letter Sent (circle one): es No Letter type: CEI NOV NOVRE Other
Date Sent: Reference Number:
Inspector Name and Signature: a Date: a/ z"/24�
State Stormwater Inspection Report, Version 3.0 Page 2 ot'2

fStormwater Ins ection Re 0te
General
Project Name: ���} fy Na u,la5 t�o
Permit No: SW 1 00201
Expiration Date: 2/1 Z 12v
Contact Person: --
Phone Number:
Inspection Type: C&I
i
Inspection Date: L� 13c,/i3
Time In: — 4 : [}p P^-
Time Out: - SO�"�
Current Weather: Ct,&-9--
Recent Rain (Date)? ,jcy
Rain — ? in
.- -- 1 L..% 7'/
Location
Facility Address / Location: /L,? (01:I�7 CL-e.IZ�,Z LN
City: Cjz P s�arrv-(k Lip: 2J3'77't3 County: ��lcr1tL3c Lat: ° "N Long: "W
Permit Information ���
Rule Subject to (circle one): 1988 Coastal Rule 1995 Coastal Rule 2008 Coastal Rule Cesion Law 2006-246
�Goose Creek High Quality Waters Outstanding Resource Waters
Density (circle one): High (HD} Low (LD)
Stormwater Best Management Practices (BM Ps) (insert number of each). -
Wet Ponds Infiltration Basins infiltration Trenches
Dry Ponds 2 Bioretention Permeable Pavement
Cistern Level Spreader/Filter Strip Other (specify):
File Review
LD Swales Stormwater Wetlands
Sand filters (circle one) Open Closed
Yes No NIA NIE
1. Is the permit active?
2. Signed Engineer's Certification on file? N-T 10 44—
3. Signed Operation and Maintenance agreement on file?
4. Recorded Deed Restrictions on file?
Site Visit: Built Union Area 113UA1 / qt 5V-4-"q ` 7rs ) Yes No NIA N/E
5. BUA is constructed and consistent with the permit requirements?
6. BUA aspermitted) is graded such that the runoff drains to the system? hi h density only)
7. Drainage area is consistent withpermit? i.e. no un ermitted draina e to the SW BMPs
8. Drainage area is stabilized? to reduce risk oi'sedimentation to the SW BMPs
Site Visit: Stormwater BMPs (V '4i�5 ) Yes No N/A NIE
9. Stormwater BMPs are located per the approvedplans?
10, Stormwater BMPs have dimensions (e�. len th, width, area) matching the approvedplans?
"
11. Stormwater BMPs are constructed per the approvedplans?
L
Site Visit: Operation and Maintenance
Yes No NIA NIE
12. Access points to the site are clear and well maintained?
13. Trash has been removed as needed? (5.,- w �,G-r J2,, N
14. Excessive landscape debris (grass clippings, leaves, etc) is controlled?
15. Stormwater BMPs being operated and maintained as per the permit requirements?
16. Inspection and Maintenance records are available for inspection? (high density only, 1995 —present only)✓
Site Visit: Other Permit Conditions Yes No NIA NIE
17. Is the site compliant with other conditions of thepermit?
Site Visit: Other Water Quality Issues Yes No NIA NIE
18. Is the site compliant with other water quality issues as noted during the inspection? ,/
State Stormwater Inspection Report, Version 3.0 Page I of 2

State Stormwater o Inspection Re ft
p Rep
oft
roAj fl� _C1�►k N!� ,4GCiScj—
' ^1 cc 12aFrD — ?j6W'5 7v S7 r Lid .
�J.. tt a 7 [�'1 i�(N 5i� �3M P
fS5"wJ -� -- ND Vv F42A.1
on F'ICLUMS (some of the pictures taken during the site
5' DiU4G F1 L_c
Compliance Status G'-� Compliant ❑ Non -Compliant
Letter Sent (circle one): Yes No Letter type CEI NOV NOVRE Other
Date Sent: S k5 '-j Reference Number:
Inspector Name and Signature: zd�Date:
State Stormwater Inspection Report, Version 3.0 Page 2 of 2

Permit No.. -5wit-ouzo/
� 0 (fo be provided by DWD)
NCDENR p Y
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 (Part 111) must be printed, filled out and submitted along with all of the required information.
Project name DOANA%Y
Contact person C: Chris Day, -
Phone number
Date
Drainage area number 1'ti�_',r.f;v; ♦rh<k� ter.
IBOESIGN.INEORMATION&Wr
4,74
[MF '✓�. S&$q. �r�:. tti,,,p'4;'1.
Site Characteristics
Drainage area ' < '`420,63$: ft2
Impervious area, post -development 242.943` ft'
% impervious 57.76 %
a; nrx
Design rainfall depth ":,t���: ��.� rLO, in
Storage Volume: Non -SA Waters
Minimum volume required
V,',:ume provided
Storage Volume: SA Waters
1_5' runoff volume
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Minimum volume required
Volume provided
Peak Flow Calculations
Is the prefpost control of the 1yr 24hr storm peak flow required?
1-yr, 24-hr rainfall depth
Rational C, pre -development
Rational C, post -development
Rainfall intensity: 1-yr, 24-hr storm
Pre -development 1-yr, 24-hr peak flow
Post -development 1-yr, 24-hr peak flow
Pre;Post 1-yr, 24-hr peak Flow control
Elevations
Temporary pool elevation
Permanent pool elevation
HWT elevation (approx. at the perm, pool elevation)
Top u! 1 Oft vegetated shelf elevation
Bott^nt of 1Oft vegetated shelf elevation
Sediment cleanout, top elevation (bottom of pond)
Sediment cleanout, bottom elevation
Sediment storage provided
Is there additional volume stored above the state -required temp, pool?
Elevation of the top of the additional volume
OK
082 It
OK, volume provided is equal to or in excess of volume required.
::�a�,;^',.'2'ts"'•�2u� ft3
ft3
(Y or N)
.2.9 in
"_�q !' `435:(unilless)
'- 0.66(unilless)
ti o.13' in/hr OK
6,29 ft3lsec
6.16 ft3rsec
-0.13 63fsec
t, rw-ti�2306.60 fmsl
e,.°n�4Va;2305.00 fmsl
5,
r..6-2305.5O' fmsI
«;i ' �. 2304.50, fmsl Data not needed for calculation option #1, but OK if provided.
's ��",�2301'MO,fmsl
`X � 2300.00 tmsl Data not needed for calculation option #1, but OK if provided.
1,00 It
kt N t (Y or N)
?' fmsl
Form SW401-Wet Detention Basin-Rev.9.9J17f09 Parts I. & II, Design Summary, Page 1 of 2

0
Permit No. --5 N I f O O Z O f 1
{to be provided by DK ) ' ,7 a
+ a R.' r ❑s YJ'"- .-s•°f ".}Y y",! s±r_ u ' .3 s �. E'd'�a, i' 2 of -r "�"
�_`� .,�� ,_��� �r���.�,4��.�;�
Surface Areas
Area. temporary pool
` 16,146, ft2
Area REQUIRED, permanent pool
11,525 it
SAIDA ratio
2.7T (unitless)
Area PROVIDED, permanent pool, Ap,n,,
- 1106 it
OK
Area, bottom of 10ft vegetated shelf, Abot Shen
.5,982. ft`
Area, sediment cleanout, top elevation (bottom of pond), A6o1-p
ka.+. ' -; = 1,610, it`
Volumes
Volume, temporary pool
" 23,082 ft
OK
Volume, permanent pool,V,,,,,Pwl
t:`o _4;'- ti29,290.ft3
Volume, forebay (sum of forebays if more than one forebay)
f; i.' `' 6,055. ft3
Forebay % of permanent pool volume
20.7% %
OK
SAIDA Table Data
Design TSS removal
''"'''•` "�90 %
Coastal SAIDA Table Used?
e `;,',s, N" "' (Y or N)
MountairJPiedmont SAIDA Table Used?
„-:".:Y. ", ;•, :."(Y or N)
SAIDA ratio
2.74 (unitless)
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 10-2b)
Volume, permanent pool, Vp--Po 1
29,290 ft'
Area provided, permanent pool, A,._p d
11,986 ft'
Average depth calculated
"'^ "F:4`'4,00, ft
OK
Average depth used in SA1DA, d. (Round to nearest 0.5ft)>
��,> 4.0 ft
OK
Calculation option 2 used? (See Figure 10-2b)
=.'rt , N •' (Y or N)
Area provided, permanent pool, ApBf _PC.1
11,986 ft!
Area, bottom of 10ft vegetated shelf, Ael ,"11
5,982 ft'
Area, sediment cleanout, top elevation (bottom of pond), Awl-p-d
1,610 ftz
"Depth" (distance b/w bottom of 10ft shelf and top of sediment)
3.50 ft
Average depth calculated
,,>',4.OQ ft
OK
Average depth used in SAIDA, d, (Round to nearest 0.5ft)
<frT,::.:;'4.0, ft
OK
Drawdown Calculations
Drawdown through orifice?
Diameter of orifice (if circular)
Area of orifice (if -non -circular) -
CoefGcient of discharge (CD)
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)
Storage volume drawdown time
Additional Information
Vegetated side slopes
Vegetated shelf slope
Vegetated shelf width
Length of flowpath to width ratio
Length 10 width ratio
Trash rack for overflow 8 orifce?
Freeboard provided
Vegetated filter provided?
Recorded drainage easement provided?
Capures all runoff at ultimate build -out?
Drain mechanism for maintenance or emergencies is:
(Y or N)
<`�,2.00 in
;i in
0.60 (unitless) tt jjl
r O.53ft L�rC1�
:fir , N`!;a ati (Y or N)
(unitless)
>^ ;a (unitless)
t
L.3+1.z�4 i,S4
F:<uF OK, draws down in 2-5 days.
3 48 days
.. .,
OK
,10.0.ft
OK
OK
:1
OK
Y ,a°" (Y or N)
OK
�K
OK
a.. ;'`V '•`(YorN)
OK
OK
8" GATE VALVE TO DRAIN POND OPERATED VIA HANDLE
Form SW401-Wel Detention Basin�Rev.8-9117109 Parts I. & II. Design Summary, Page 2 of 2

•
El
Permit No. 5V 110000%
(to be provided by DWQ)
[I II RE0UIRE D`ITEM5CHECKL{V r° ,, � ;��E�a ti� � '�=� i, . r',', �•.`
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
—G9
Sheet No.
1. Plans 0" - 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,
Nigh flow bypass system,
Maintenance access,
Proposed drainage easement and public right of way (ROW),
Overflow device, and
Boundaries of drainage easement.
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.
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,
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,
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for forebay,
Gl�
to verify volume provided.
from
_
6. A construction sequence that shows how the wet detention basin will be protected sediment until the
entire drainage area is stabilized.'
-r
7. The supporting calculations.
8. A copy of the signed and notarized operation and maintenance (O&M) agreement.
9. A copy of the deed restrictions (if required).
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 5W401-Wet Detention Basin-Rev.8-9117I09 Part 111. Required Items Checklist, Page 1 of 1