SW7061002_CURRENT PERMIT_20070803

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
4
YYYYMMDD

war w"Ro
��F F9p Michael F. Easley, Governor
G William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Colecn H. Sullins, Director
Division of Water Quality
August
Attn.: Bill Bedsole
628 East I Street
Washington, NC 27889
Subject: Stormwater Review SW7061002 MOD
Beaufort County Hospital -Surgery Expansion .
Beaufort County
Dear Mr. Bedsole:
The Washington Regional Office received a completed Stormwater Application for the subject project on
June 5, 2006. 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 21-1.1000. We are forwarding Permit No. SW7061002
MOD dated August 03, 2007 to Beaufort County Hospital for the construction and operation of an infiltration basin to
serve the Beaufort County Hospital -Surgery Expansion located at 628 East 1 e Street, Washington, NC.
This permit shall be effective from the date of issuance until February 27, 2017, and shall be subject to the
conditions and limitations as specked therein. Please pay special attention to the Operation and Maintenance
requirements in this permit. Failure to establish an adequate system for operation and maintenance of the stormwater
management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit This
request must be in the forth of a written petition, conforming to Chapter 150E of the North Carolina General Statutes,
and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. Unless such
demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please contact Ernest Odei-
Larbi or me at [phone].
Si
ncerely,
HL_d� a tonal Su ervisor
99 P
Surface Water Protection Section
Washington Regional Office
AH/sd J:\WPDATA\WQS\Ernest- State SW\Permits - Infiltration
cc: Michelle Clements -The East group
BBe�aaufort County Building Inspections Department
t/Washington Regional Office
. Central Files
North Carolina Division of Water Quality Internet: itc.m
943 Washington Square Mall Phone [phone]
Washington, NC 27889 Fax [phone]
None
rthCarolina
Naturally
An Equal OpportunitylAf8rmatIve Action Employer— 50% Recyded110% Post Consumer Paper

State Stormwater Management Systems
Permit No. SW7061002 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
Beaufort County Hospital
Beaufort County
FOR THE
construction, operation and maintenance of stormwater management systems in compliance with the provisions of
15A NCAC 2H.1000 (hereafter referred to as the "stormwater rulesl 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 for an infiltration basin to serve the Beaufort County Hospital -Surgery
Expansion located at 628 East 12" Streeet, Washington, NC.
This permit shall be effective from the date of issuance until February 27, 2017 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 88,496 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area indicated on page 3 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.
6. The following design criteria have been provided in the infiltration basins and must be maintained at design
condition.

e
State Stormwater Management Systems
Permit No. SW7061002 MOD
DIVISION OF WATER QUALITY
PROJECT DATA
Project Name:
Beaufort County Hospital -Surgery Expansion
Permit Number:
SW7061002 MOD
Location:-__..
__Beaufort -County—..__
Applicant:
Beaufort County Hospital
Mailing Address:
628 East 12 m Street, Washington, NC 27889
Receiving Stream:
Runyon Creek
Classification of Water Body:
C: NSW
Total Site Area:
15.21 ac
Design Storm, inches:
2.0
Drainage area to Basin:
2.90 ac
Impervious area in drainage basin:
88,495 sf
Infiltration Basin Depth:
2.0 ft
Basin bottom elevation, FMSL:
16.50
Bypass Overflow Elevation, FMSL:
21.0
Type of Soil:
Craven clay loam
Provided Storage Volume:
14,752 cf
Time to Draw Down:
0.79 days
Expected Infiltration Rate, in/hr: 5
3

State Stormwater Management Systems
Permit No. SV 7061002 MOD
II. SCHEDULE OF COMPLIANCE
The permittee will comply with the following schedule for construction and maintenance of the stormwater
management system.
a. 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 surfaces except roads.
b. During construction, erosion shall be kept to a minimum and any eroded areas of the system will be
repaired immediately.
2. The facilities must be properly maintained and operated at all times. The approved Operation and
Maintenance Plan must be followed in its entirety and maintenance must occur at the scheduled intervals.
3. The permittee shall at all times provide the operation and maintenance necessary to assure the permitted
stormwater system functions at optimum efficiency including, but not limited to:
a. Semiannual scheduled inspections (every 6 months)
b. Sediment removal
C. Mowing and revegetation of side slopes
d. Immediate repair of eroded areas
e. Maintenance of side slopes in accordance with approved plans and specifications
f. Debris removal and unclogging of outlet structure, orifice device and catch basins and piping.
g. A clear access path to the bypass 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. 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 complefion of construction 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. Mail the Certification to the Washington
Regional Office, 943 Washington Square Mall, Washington, North Carolina, 27889, attention Division of
Water Quality.
7. A copy of the approved plans and specifications shall be maintained on file by the Permittee for the life of the
project
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

State Stormwater Management Systems
Permit No. SW7061002 MOD
Filling in, altering, or piping of any vegetative conveyance shown on the approved plan.
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.
11. The permittee shall submit final site layout and grading plans for any permitted future areas shown on the
approved plans, prior to construction.
12. The stormwater systems shall not be used as Erosion Control devices. They must be kept off line and
free from sediment until the project is complete and the entire site has been stabilized.
13. This permit shall be effective from the date of issuance until February 27, 2017. Application for permit
renewal shall be submitted 180 days prior to the expiration date of this permit and must be accompanied
by the processing fee.
Ill. GENERAL CONDITIONS
1. This permit is not transferable. In the event there is a desire for the facilities to change ownership, or there is
a name change of the Permittee, a formal permit request must be submitted to the Division of Water Quality
accompanied by an application fee, documentation from the parties involved, and other supporting materials
as maybe appropriate. The approval of this request will be considered on its merits and mayor may not be
approved. The permittee is responsible for compliance with all permit conditions until such time as the
Division approves the transfer request.
2. 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-
215.6(a) to 143-215.6(c).
3. 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),
which have jurisdiction.
4. 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.
5. The permttee 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
6. The permit may be modified, revoked and reissued or terminated for cause. The filing of a request for a
permit modification, revocation and reissuance or termination does not stay any permit condition.
7. 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.
8. Approved plans and specifications for this project are incorporated by reference and are enforceable
parts of the permit.
9. The permittee shall notify the Division of any name, ownership or mailing address changes within 30
days.

State Storrnwater Management Systems
Permit No. SW7061002 MOD
Permit issued this the 3rd day of August 2007.
CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
;trColeen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Beaufort County Hospital -Surgery Expansion

State Stormwater Management Systems
Permit No. SVV7061002 MOD
Designer's Certification
as a duly
registered Professional Engineer in the State of North Carolina, having been authorized to observe
(pedodically/weekly/full time)
the construction of the 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.
Signature
Registration Number
Date
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/bypass 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. All required design depths are provided.
13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.
7

...OFFICE USE ONLY.. ... .............. ......
Date Received
Fee Paid
Permit Number
MAi 31 aoo 1
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E State of North Carolina
lo�y5 `off Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
Thisform may be photocopier( for use as an original
GENERAL INFORMATION
Applicants name (specify the name of the corporation, individual, etc. who owns the project)
Beaufort County Hospital
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
Bill Bedsole, CEO Beaufort County Hospital
3. Mailing Address for person listed in item 2 above:
628 East 121s Street
City: Washington State: NC Zip; 27889
Telephone Number: ( 252 ) 975-4100
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
Beaufort County Hospital — Surgery Expansion
5. Location of Project (street address):
628 East 12ib Street
City: Washington, NC County: Beaufort
6. Directions to project (from nearest major intersection):
From the intersection of US 264 and I lighland Drive, go northeast I block on Highland Boulevard to the intersection with
East 12i° Street, turn left (west) onto East 12" Street, the Hospital entrance is the first driveway on the right-hand side
7. Latitude: 35032'56"N Longitude: 77002' 18"W of project
8. Contact person who can answer questions about the project:
Name: Michelle Clements — The last Group Telephone Number: ( 252 ) 758-3746
it. PERMIT INFORMATION:
1. Specify whether project is (check one): New Renewal X Modification
Form SWU-101 Version 3.99 Pagel of4

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number SW7061002 and its issue date (if known) 02/27/2007
3. Specify the type of project (check one): ,
Low Density X High Density _Redevelop X General Permit Other
4. Additional Project Requirements (check applicable blanks):
CAMA Major X Sedimentation/ Erosion Control _ 404/401 Permit _ NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748.
Ill. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project.
Stormwater runoff from the impervious areas will be be collected and piped to an infiltration basin located onsite. Grassed
lawn areas will sheet flow to the existing storm sewer system in the surrounding streets as it does now. All drainage flows to
the Runyon Creek and then to the Pamlico River. **Total project area is the total site of the Hospital complex.**
2. Stormwater runoff from this project drains to the Tar- Pamlico
3. Total Project Area: 15.21 acres
5. How many drainage areas does the project have?
River basin.
4. Project Built Upon Area: 54.6
6. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as below.
Basin Information
Drainage Area 1 -Total Site
Drainage Area 2 - Infiltr. Basin
Receiving Stream Name
Runyon Creek
Runyon Creek
Receiving Stream Class
C:NSW
C:NSW
Drainage Area
662,695 sf 15.21 ac
126,142 sf 2.90 ac
Existing Impervious* Area
356,502 sf 8.18 ac
82 446 sf 1.90 ac
Proposed Im ervious*Area
361 5 33 sf 8.30 ac
88,495 sf 2.03 ac
% Impervious* Area (total)
54.6,0
70.2 %
Impervious* Surface Area
Drainage Area I
Drainage Area 2
On -site Buildings
118,677 sf
2.72 ac
49,770 sf
1.14 ac
On -site Streets
0 sf
0.00 ac
0 sf
0.00 ac
On -site Parking
239,910 sf
5.51 ac
37,187 sf
0.85 ac
On -site Sidewalks
0 sf
0.00 ac
0 sf
0.00 ac
Other on -site
2,916 sf
0.07 ac
1,538 sf
0.04 ac
0 sf
0.00 ac
0 sf
0.00 ac
Total: 361,503
sf (8.30 ac)
Total: 88,495
sf (2.03 ac)
* 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 3.99 Page 2 of 4

Using the 10-year, 6 hour rainfall event, the pre -construction rate of runoff for the entire
15.21 acre site is calculated as 46.78 cfs and the post -construction rate of runoff is
calculated as 39.25 cfs.
Using the 1-year, 24 hour rainfall event, the pre -construction rate of runoff for the entire
15.21 acre site is calculated as 33.28 cfs and the post -construction rate of runoff is
calculated as 26.56 cfs. This is a decrease in flow. The City of Washington Stormwater
Management Program allows for an exemption from the peak flow requires as long as the
increase in flow is less than 10 percent for the 1-year, 24-hour rainfall event. Therefore there
is no need to undertake any peak flow attenuation measures in this project. However, the
storm sewer system in the street experiences periods of being overwhelmed during large
rainfall events. Installing an infiltration basin should help to alleviate this situation.
At this time it is not feasible to install BMPs to meet the requirement of reducing the nitrogen
loading by 30 percent and the requirement of no increase in the phosphorus loading relative
to the previous development. The nitrogen loading is less than 10 pounds/acre/year and
qualifies for the offset payment program. It is proposed to utilize the offset payment program
to meet the nutrient reduction requirements.
The predominant soil types obtained from Soil Survey for Beaufort County, North Carolina,
are:
CrA — Craven fine sandy loam, 0 to 1 percent slopes
CsC2 — Craven clay loam, 4 to 12 percent slopes, eroded
Craven fine sandy loam, 0 to 1 percent slopes soil is moderately well drained. The seasonal
high water table is 2 to 3 feet below the surface. The available water capacity is moderate,
permeability is slow, and the shrink swell potential is moderate.
Craven clay loam, 4 to 12 percent slopes, eroded soil is moderately well drained. The
seasonal high water table is 2 to 3 feet below the surface. The available water capacity is
moderate, permeability is slow, and the shrink swell potential is moderate.
Beaufort County Hospital Surgery Expansion Page 3
October 4, 2006 (Rev 07/10/07)

cI How was the off -site impervious area listed above derived? N/A
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
The following italicized deed restrictions and protective covenants are required to be recorded for all
subdivisions, outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a
table listing each lot number, size and the allowable built -upon area for each lot must be provided as an
attachment.
1. The following covenants are intended to ensure ongoing compliance with state stormwater management permit number
as issued by the Division of Water Quality. These covenants may
not be changed or deleted without the consent of the State.
2. No more than Square feet of any lot shall be covered by structures or impervious materials.
Impervious materials include asphalt, gravel, concrete, brick, stone, slate or similar material but do not include wood
decking or the water surface of swimming pools.
3. Swales shall not be filled in, pipet, or altered except as necessary to provide driveway crossings.
4. Built -upon area in excess of the permitted amount requires a state stormwater management permit modification prior to
construction.
5. All permitted runoff from oulparcels or future development shall be directed into the permitted stormwater control
system. These connections to the stormwater control system shall be performed in a manner that maintains the
integrity and performance of the system as permitted.
By your signature below, you certify that the recorded deed restrictions and protective covenants for this project
shall include all the applicable items required above, 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 State, and that they will be recorded prior to the sale of any lot,
V. SUPPLEMENT FORMS "Infiltration Basin Supplement attached"
The applicable state stormwater management permit supplement form(s) listed below must be submitted for
each BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the
status and availability of these forms.
Form SWU-102
Wet Detention Basin Supplement
Form SWU-103
Infiltration Basin Supplement
Form SWU-104
Low Density Supplement
Form SWU-105
Curb Outlet System Supplement
Form SWU-106
Off -Site System Supplement
Form SWU-107
Underground Infiltration Trench Supplement
Form SWU-108
Neuse River Basin Supplement
Form SWU-109
Innovative Best Management Practice
Form SWU-101 Version 3.99
Page 3 of 4

VI. SUBMITTAL REQUIREMENTS
c�
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. The complete application package should be
submitted to the appropriate DWQ Regional Office.
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
• Original and one copy of the Stormwater Management Permit Application Form
• One copy of the applicable Supplement Form(s) for each BMP
• Permit application processing fee of $420 (payable to NCDENR)
• Detailed narrative description of stormwater treatment /management
• Two copies of plans and specifications, including:
- Development/ Project name
- Engineer and firm
- Legend
-North arrow
- Scale
- Revision number & date
- Mean high water line
- Dimensioned property/project
- Location map with named streets or NCSR numbers
- Original contours, proposed contours, spot elevations, finished floor elevations
- Details of roads, drainage features, collection systems, and stormwater control measures
- Wetlands delineated, or a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
- Drainage areas delineated
- Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section.
Designated agent (individual or firm): The East Group, PA
Mailing Address: PO Box 7305
City: Greenville
Phone: ( 252 )758-3746
VIII. APPLICANT'S CERTIFICATION
NC
Zip:27835-7305
Fax: ( 252 )830-3954
I, (print or type name ofperson listed in General Information, item 2) Bill Bedsole, CEO Beaufort County Hospital
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 m 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 15A
NCAC 2H.1000.If A
Signature:
Date: J O
Form SWU-101 Version 3.99 Page 4 of 4

Permit
(to be provided by DWO
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality 0" ECEI tP/ ED
STORMWATER MANAGEMENT PERMIT APPLICATION FORM MAY 3 12007
INFILTRATION BASIN SUPPLEMENT
This fornn may be photocopied for use as an original DWQ-WARY
DWO Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, an
infiltration basin supplement for each system, design calculations, soils report, and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : Beaufort County Hospital — Surgery Expansion
Contact Person: Michelle Clements Phone Number: ( 252 ) 758-3746
This worksheet applies to: Basin No.
(as identified on plans)
in Drainage Area
(from Form SWU-101)
II. DESIGN INFORMATION - Attach supporting calculations/documentation. The soils report must be
based upon an actual field investigation and soil borings. County soil maps are not an acceptable source
of soils information. All elevations shall be in feet mean,sea level (fms f .
Soils Report Summary
Soil Type
Craven clay loam, 4 to 12 percent slopes
Infiltration Rate
5
ER or cf/hr/sf (circle appropriate units)
SHWT Elevation
14.50
fmsl (Seasonal High Water Table elevation)
Basin Design Parameters
Design Storm
2.0
inch event (1.5 itch event for se waters, 1 inch event for others)
Design Volume
14,326
c.f.
Drawdown Time
0.79
days
Basin Dimensions
Basin Size
25.3
ft. x 71.0 ft. = 1796 sq.ft. (bottom dimensions)
Basin Volume Provided
14,752
c.f.
Basin Elevations
Bottom Elevation
16.50
fmsl
Storage Elevation
21.00
fmsl
Top Elevation
22.00
fmsl
Form SWU-103 Rev 3.99
Page 1 of

III. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, November 1995) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Permit
Application Form, the agent may initial below. Attach justification if a requirement has not been met.
a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
b. System is located at least 100 feet from water supply wells.
c. Bottom of system is at least 2 feet above the seasonal high water table.
d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
e. System is not sited on or in fill material or DWQ approval has been obtained.
u1b
k.
I.
Yu� in.
N/A n.
System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
Drainage area for the device is less than 5 acres.
Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
System captures and infiltrates the runoff from the first 1.0 inch of rainfall (1.5 inch event for
areas draining to SA waters). Design volume and infiltration calculations are attached.
System is sized to take into account the runoff at the ultimate built -out potential from all
surfaces draining to the system, including any off -site drainage. Calculations attached.
All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale, or
sediment trap is provided.
Bottom of the device is covered with a layer of clean sand to an average depth of 4 inches or
dense vegetative cover is provided.
Vegetated filter is provided for overflow and detail is shown on plans (Required minimum
length is 50 feet for SA waters, 30 feet for other waters).
Flow distribution mechanism within the basin is provided.
A benchmark is provided to determine the sediment accumulation in the pretreatment device.
Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days. A soils report and all
pertinent draw -down calculations are attached.
Plans ensure that the installed system will meet design specifications (constructed or
restored) upon initial operation once the project is complete and the entire drainage area is
stabilized.
Form SWU-I03 Rev 3.99 Page 2 of 3

�L
IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the infiltration system for erosion,
trash accumulation, vegetative cover, and general condition.
2. Repair eroded areas immediately, re -seed as necessary to maintain adequate vegetative cover, mow
vegetated cover to maintain a maximum height of six inches, and remove trash as needed.
3. After every runoff producing rainfall event and at least monthly inspect the bypass, inflow and overflow
structures for blockage and deterioration. Remove any blockage and repair the structure to approved design
specifications.
4. Remove accumulated sediment from the pretreatment system and infiltration basin annually or when depth
in the pretreatment system is reduced to 75% of the original design depth. The system shall be restored to the
original design depth without over -excavating. Over -excavating may cause the required water table
separation to be reduced and may compromise the ability of the system to perform as designed. Removed
sediment shall be disposed of in an appropriate manner and shall not be handled in a manner that will
adversely impact water quality (i.e. stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the pretreatment unit. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the design depth reads 6.50 feet in the pretreatment unit, the sediment shall be
removed from both the pretreatment unit and the infiltration basin. (Design depth of6.5 equals
Elevation 16.50feet MSL)
5. If the Division determines that the system is failing, the system will immediately be repaired or replaced to
original design specifications. If the system cannot be repaired to perform its design function, other stormwater
control devices as allowed by NCAC 21-I .1000 must be designed, approved and constructed.
I acknowledge and agree by my signature below that I am responsible for the performance of the five
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.
Print Name and Title: Bill Bedsole, CEO Beaufort County Hospital
Note.: The legally responsible party should not be a homeowners association unless more than 50%of the lots have been sold and a
resident ofdte subdivision
n has been named the president, - 1 A''� /1
1, I �. �V)A t , attN�otary Public for the State of iV64 i ll!/ 4ACtt, County of
rL , do hereby certify that C,L /( &II501Ce personally appeared before me this a5
day offnIUA Zb �7 ...,and acknowledge the due execution of the forgoing infiltration basin maintenance requirements.
Witness m 'o d and official seal,
SEAU'`-7r,,. •° � °•�d�;' Mycommissionexpires 3j o�U%
Form SWU,-103� Rev 3.99• ' r � Page 3 of 3

Justification for Required Items Checklist
Infiltration Basin Supplement Form
Beaufort County Hospital Surgery Expansion
Washington, North Carolina
f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
The Beaufort County Hospital is an institution, where all land and buildings are
owned by the same entity. Since there is only one owner, there should be no need for
easements.
n. Vegetated filter is provided for overflow and detail is shown on plans (Required
minimum length is 50 feet for SA waters, 30 feet for other waters).
Stormwater from the site is discharged to the storm sewer system of the surrounding
streets. The layout and elevations of the site do not make it feasible to utilize a filter
strip at the discharge end of the overflow outlet. Therefore the overflow discharge
continues the existing practice and is piped to the existing storm sewer system.

Permit No. Sw ?-0(, / '�7a2
REGEO�rt�
VE® State of North Carolina (to be provided by DWQ)
Department of Environment and Natural Resources
JAN 3 0 2007 Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM O
DWQ-WARD
UNDERGROUND INFILTRATION TRENCH SUPPLEMENT
This form may be photocopied for use as an original
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, an
underground infiltration trench supplement for each system, design calculations, and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : Beaufort County Hospital — Surgery Expansion
Contact Person: Michelle Clements Phone Number: ( 252 ) 758-3746
For projects with multiple infiltration systems, a supplement form must be completed for each system. This
worksheet applies to: Trench 1 in Drainage Area I
(from plans) (from Form SIVU-101)
II. DESIGN INFORMATION (attach supporting calculations/documentation):
Soils Report Summary (based upon an actual field investigation and soil borings)
Soil Type Craven clay loam, 4 to 12 percent slopes, eroded
Infiltration Rate 5 n/h or cf/hr/sf (circle appropriate units)
SHWT Elevation 14.50 fmsl (Seasonal High Water Table elevation)
Trench Design Parameters
Design Volume
15,300
c.f.
Design Storm
cfb)
inch event (1.5 inch event for SA waters, dzinch.event for. -others)
Drawdown Time
0.34
days
Perforated Pipe Size
48
inch diameter
Perforated Pipe Length
664
ft.
No. Observation Wells
Use CB & JB
(may be required on a case -by -case basis)
Stone Type (if used)
#57(washed)
Stone Void Ratio
40%
Trench Elevations (infect mean sea level)
Bottom Elevation 17.00 frisl
Storage/Overflow Elevation 22.00 frisl
Form S W U-107 Rev 3 I9 Page I of 4

�t
Trench Dimensions
Height
Width
5.0 ft.
50.0 ft.
III. REQUIRED ITEMS CHECKLIST
Length
Volume Provided
90.0 ft.
15,758 cu.ft.
The following checklist outlines design requirements per the Stormwater Best Management Practices manual (N.C.
Department of Environment, Health and Natural Resources, November 1995) and Administrative Code Section: 15
A NCAC 2H .1008.
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Permit
Application Form, the agent may initial below. Attach justification if a requirement has not been met.
Applicants Initials
`WY-:> C- a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
NV1SL b. System is located at least 100 feet from water supply wells.
`1M S L C. Bottom of system is at least 2 feet above the seasonal high water table.
INt L d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
e. Off-line system, runoff in excess of the design volume bypasses the system (bypass detail
provided).
5 L f. System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days based upon infiltration
through the bottom only (a hydrogeologic evaluation may be required).
YV1SL g. Soils have a minimum hydraulic conductivity of 0.52 inches per hour.
"WISE h. System is not sited on or in fill material or D WQ approval has been obtained.
YY1�C i. Plans ensure that the installed system will meet design specifications (constricted or
restored) upon initial operation once the project is complete and the entire drainage area is
stabilized.
1n/\S L j. System is sized to take into account the runoff at the ultimate built -out potential from all
surfaces draining to the system, including any off -site drainage.
N/A k. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
V`_1SC I. System captures and infiltrates the runoff from the first LO inch of rainfall (1.5 inch event
for areas draining to SA waters ).
_."S C_
in. Drainage area for the device is less than 5 acres.
N/A n. A pretreatment device ( filter strip, grassed swale, sediment trap, etc.) is provided.
-'Wl `S L o. Trench bottom is covered with a layer of clean sand to an average depth of 4 inches.
Y� 1SC p. Sides of the infiltration trench are lined with geotextile fabric.
VAS C q. Rock used is free of fines (washed stone) and has a large void ratio.
4 V\°-, C_ r. Side to bottom area ratio is less than 4:1.
Form SWU-107 Rev 3.99
Page 2 of 4

c(
N/A s. Observation well(s) are provided (case -by -case basis).
N/A t. Vegetated filter is provided for overflow (50 feet for SA waters, 30 feet for other
waters) and detail is shown on plans.
`-IV\--> C u. A benchmark for checking sediment accumulation is provided.
IV. UNDERGROUND INFILTRATION TRENCH OPERATION AND MAINTENANCE AGREEMENT
l . After every runoff producing rainfall event and at least monthly inspect the bypass/overflow stricture for
blockage and deterioration and the infiltration system for erosion, trash accumulation, grass cover, and general
condition.
2. Repair eroded areas immediately, re -seed as necessary to maintain adequate vegetative cover, mow vegetative
cover to maintain a maximum height of six inches, and remove trash and blockages as needed to maintain
system performance.
3. Remove accumulated sediment annually or when depth is reduced to 75% of the original design depth. Restore
depth to original design depth without over -excavating. Over -excavating may cause the required water table
separation to be reduced and may compromise the ability of the system to perform as designed.
4. The water level in any monitoring wells will be recorded after a l inch rainfall event and at least once a month.
Chronic high water table elevations (within l foot of the bottom of the system for a period of three months)
shall be reported to DWQ immediately.
5. If DWQ determines that the system is failing, the system will immediately be repaired or replaced to original
design specifications. If the system cannot be repaired to perform its design function, other stormwater control
devices as allowed by NCAC 2H .1000 must be designed, approved and constricted.
6. Remove accumulated sediment from the infiltration system annually or when depth in the unit is reduced to
75% of the original design depth. The system shall be restored to the original design depth without over -
excavating. Over -excavating may cause the required water table separation to be reduced and may
compromise the ability of the system to perforni as designed. Removed sediment shall be disposed of in an
appropriate manner and shall not be handled in a manner that will adversely impact water quality (i.e.
stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the infiltration system. The benchmark will document the original design
depth so that accurate sediment accumulation readings can be taken. The measuring device used to determine
the depth at the benchmark shall be such that it will give an accurate depth reading and not readily penetrate
into accumulated sediments.
When the depth at the benchmark reads 3.75' the accumulated sediment shall be removed
from the system.
Form SWU-107 Rev 3.99 Page 3 of 4

I acknowledge and agree by my signature below that I am responsible for maintaining the stormwater
collection system in accordance with the six 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.
Print Name and Title: Bill Bedsole, CEO Beaufort County Hospital
Address: 628 East 12th Str et Washington, NC 27889
Phone: [phone] Date:
Signature:
Or
Note: The legally responsible party should not be a homeowners association unless more than 50%of the lots have been sold and a
resident ojthe subdivision has been named the president.
day
'•R SEAL'-p•``';
r� , a Notary Public forthe State of kk4l (-e Oi,Uq, County of
�li�r
do hereby certify that c (st (pf personally appeared before me this
and acknowledge the due execution of the forgoing infiltration basin maintenance
my hand and official seal,
My commission expires
a't—t4 Ac',
Form S W U-107 Rev 3.99 Page 4 of 4

('t
Justification for Required Items Checklist
Underground Infiltration Trench Supplement Form
Beaufort County Hospital Surgery Expansion
Washington, North Carolina
k. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
The Beaufort County Hospital is an institution, where all land and buildings are
owned by the same entity. Since there is only one owner, there should be no need for
easements.
n. A pretreatment device (filter strip, grassed swale, sediment trap, etc.) is provided.
This system collects the stormwater runoff directly from the building addition and the
parking areas and does not have any pretreatment measure. Therefore it is sized to
capture and infiltrate the first 2.0 inches of rainfall.
s. Observation well(s) are provided (case -by -case basis).
The junction boxes, catch basins, and drop inlets will be used for observation of the
system.
t. Vegetated filter is provider! for overflow (50 feet for SA waters, 30 feet for other
waters) and detail is shown on plans.
Stormwater from the site is discharged to the storm sewer system of the surrounding
streets. The layout and elevations of the site do not make it feasible to utilize a filter
strip at the discharge end of the overflow outlet. Therefore the overflow discharge
continues the existing practice and is piped to the existing storm sewer system.