SW7061104_CURRENT PERMIT_20070411

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW 7��)=�
DOGTYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

tc W A TF90 Michael F. Easley, Governor
�O (i William G. Ross Jr., Secretary
rNorth Carolina Department of Environment and Natural Resources
p Y Alan W. Klimek, P.E. Director
Division of Water Quality
April 11, 2007.
Mr. Ron Alford
OBX I, LLC
P.O. Box 1070
Worthington, OH 43085
Subject: Permit No. SW7061104
OBXI
High Density Stormwater Project
Dare County
Dear Mr. Alford:
The Washington Regional Office received acompleted Stormwater Application for the subject project on
February 1, 2007. 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. We are forwarding Permit No.
SW7061104 dated April 11, 2007 to OBX I, LLC for the construction and operation of 7 infiltration swales to serve six
houses located at 3616 Virginia Dare Trail in Nags Head, NC.
This permit shall be effective from the date of issuance until April 11, 2017 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 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 form 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 Roger
Thorpe or me at [phone].
Si cerel ,
AI odge, Regional Supervisor
Surface Water Protection Section
Washington Regional Office
cc: MM Design & Engineering, PC
Town of Nags Head Inspections
✓Washington Regional Office
Central Files
North Carolina Division of Water Quality Internet: mN\r.nc%vateraualirv.or_ One
943 Washington Square Mall' Phone [phone] NO Carolina
Washington, NC 27889 Fax [phone] /�/iff/iHif"J/
An Equal Opportunity/Affmna6ve Action Employer —50%Recycled110% Post Consumer Paper fy PKrK`K �/

State Stormwater Management Systems
Permit No. SW7061104
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
OBXI,LLC
Dare 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 nitesl 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 senen filtration swales to serve six houses located at 3616 Virginia
Dare Trail in Nags Head, NC.,
This permit shall be effective from the date of issuance until April 11, 2017 and shall be subject to the following
specified conditions and limitations:
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 on page
2 of this permit, the Project Data Sheet.
3. A maximum of 18,029 square feet of built upon area is allowed on this 1.38 acre site.
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 approved plans.
5. Approved plans and specifications for this project are incorporated by reference and are enforceable parts of
the permit.

DIVISION OF WATER QUALITY
PROJECT DATA
Project Name:
OBX1, LLC
Permit Number:
SW7061104
Location:
Dare County
Applicant:
OBX I, LLC
Mailing Address:
P.O. Box 1070
Worthington, OH 43085
Application Date:
1116/2006 (original)
Receiving Stream:
UT to Roanoke Sound
Classification of Water Body:
SA
Total Site Area:
1.38 ac
Total Impervious:
18,029 sf
Swale #
1& 7 2
3
4 5 6
Drainage Area (square feet):
5,000 10,000
10,000
10,000 10,000 10,000
Impervious Area (square feet):
1,555 2,820
3,175
2,840 .3,085 2,999.,
Infiltration Swale Depth (inches):
12 12.5
12.5
12.5 12.5 12.5
Required Storage Volume (cubic feet):
18.5 336
379
338 368 357
Provided Storage Volume (cubic feet):
300 460
460
460 460 460
Bypass Overflow Elevation 8.0 feet in all swales

6. No homeowner/lot owner/developer shalt be allowed to fill in, alter, or pipe any .vegetative practices (such as
swales) shown on the approved plans as partof the stormwater management system without submitting a
revision to the permit and receiving approval from the Division.
7. The following items will require a modification to the permit:
a. Any revision to the approved plans, regardless of size
b. Project name change .
C. Transfer of ownership
d.. Redesign.or addition to the approved amount of built -upon area
e. Further subdivision of the project area.
In addition, the Director may determine that other revisions to the project should require a modification to the
permit.
B. 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. SCHEDULE OF COMPLIANCE
1. 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.
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 completion 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. Mail the Certification to the Washington Regional Office, 943 Washington Square Mall,
Washington, North Carolina, 27889, attention Division of Water Quality.
A copy of the approved plans and specifications shall be maintained on file by the Permittee for a minimum of
five years from the date of the completion of construction.
III. 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 may be appropriate. The approval of this request will be considered on its merits and may or may not be
approved.
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 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.
6. The Permittee, at least six (6) months prior to the expiration of this permit, shall submit in writing a request for
an extension along with appropriate application fee.
Permit issued this the 11 th day of April, 2007
CAROLINA ENVIRONMENTAL MANAGEMENT
.rv. Alan W. Klimek, P.E. Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number SW7061104

OBX I, LLC - Dare County
Stormwater Permit No. SW7061104
Designer's Certification
I, , 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)
(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 structure is located per the approved plans.
7. All slopes are grassed with permanent vegetation.
_8. Vegetated slopes are no steeper than 3:1.
9. The permitted amounts of surface area and/or volume have been provided.
_10. All required design depths are provided.
_11. All required parts of the system are provided including any vegetated filter.
_12. The required system dimensions are provided per the approved plans.

®WQ-WAR® State of North Carolina S WACK 11/110417
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
m Em ��
3. Mailing Address for person listed in item 2 above:
__no Box /b7o
City:_, WCRrfLJN4TON State: DFl 4M85
-- � Zip: Telephone Number: LAIC ) 499 _. 3881
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
5. Location of Project (street address):
31016 A DARE TRAIL
city: NAB$ IJEAD County: DARE
6. Directions to project (from nearest major intersection):
50vrl4 ON
S. LROATAN 4wY (U5150) LEPTON E
146LLOWELL
ST
Rik;47- ON
5 VIRGINIA DARE T-RL (NC 14 f'RDTEGT
iS ON Rt1'7l{7-
7. Latitude: 35 tl 57' 46" Longitude: 75-4V 37' .dg" of project
8. Contact person who can answer questions about the project:
Name: MEUSSA MeALL-tSTEK Telephone Number: ( 242 ) z4ol-871¢
U. PERMIT INFORMATION:
1. Specify whether project is (check one): New __-__Rehewal Modification
Form SWU-101 Version 3.99 Page I of

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number /t//A- and its issue date (if known)
3. Specify the type of project (check one):
Low Density ✓ High Density _Redevelop _General Permit Other
4. Additional Project Requirements (check applicable blanks):
_CAMA Major V 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.
III. 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.
CONTROL SY5rr-1S WL44_Ae vfe,ETAT_/V6_,/t,Tsk 3772/PS FS(Om�_Dy /xFiaT,tAnait
TWA Ai;5. THE VE44TA71YE F/LTG7QS ARE l*5ED A$ NO STaNC7t9CAL IIIETNOD4OF PROV/D/V!
ADDITIONAL /WF/A/ FltTegwt OFOOcm~5 6 MiA11AI/e// * SMmMWA7a:te 611PAcy^
2. Stormwater runoff from this project drains to the
Pg54'D/%TAMAIK
River basin.
3. Total Project Area: 1.38 acres
4. Project Built Upon Area:
30 %
5. How many drainage areas does the project have? %
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.
-Y * AUb1T/AMAl
A7'rAcNE'D7E-/VW -X-*
Basin Information
Drainage Area 1
Drainage Area 2
Receiving Stream Name
jtoAt40KE SOOND
ROANOKE SooWD
Receiving Stream Class
5A
Drainage Area
�p
Existing Impervious` Area
�y
Proposedlmpervious#Area
/SAS s.%
26z.o $•
% Impervious* Area (total)
3/. / 2
Z8. Z%
Impervious' Surface Area
Drainage Area 1
Drainage Area 2
On -site Buildings
1, (.40 S
On -site Streets
d
On -site Parking
74
O G.
On -site Sidewalks
�1
Other on -site
61
Off -site
6i
,9-
Total: 1 S-J S
Total: 262.0 g -
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

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7. How was the off -site impervious area listed above derived?
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. Swa/es shall not be filled in, piped, 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 outparcels 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
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 Supplement
Form SWU-101 Version 3.99 Page 3 of 4

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. The complete application package should be
submitted to the appropriate DWQ Regional Office.
Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• Original and one copy of the Slormwater 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. boundary
- 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): Me Lt Ss A c A LI STER
Mailing Address: I?. D, a0x 1470
City: K 1'PT i 14xwK State: 1`14C Zip: 27918
Phone: ,(_252 ) 21a1 • 8714 Fax: 1-7470
VIII. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in General Information, item 2) Aw'Q2 , 4
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covens ill be recorded, and that the proposed project complies with the requirements of 15A
NCAC 21-1.1000. /
Signature: _. _ Date:
Form SWU-101 Version 3.99 Page 4 of 4

Permit No.
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORIvIL, Cl dVFE)
INFILTRATION BASIN SUPPLEMENT NOV - 6 2006
This form may be photocopied for use as an original
DWO Stormwater Management Plan Review: D Q-WARO
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 : e9ey l LL 0-
Contact Person: MfuSSA Ml—AtISTER Phone Number: (25z) 2te(-87A
This worksheet applies to: Basin No. in Drainage Area 5, r'm S.Y.
(av identified on plans) (fmm 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 (f nsl).
Soils Report Summary
Soil Type m o C
Infiltration Rate 7 ZO in/h or cf/hr/sf (circle appropriate units)
SHWT Elevation Jr.A f nSI (Seavonal High Water Table elevation)
Basin Design Parameters
Design Storm 1.5 inch (1.5 inch event for SA waters, I inch event for others)
Design Volume (SO c.f.
Drawdown Time / days
Basin Dimensions 5 W M LE
Basin Size /o r7 ft. x l ft. _ / 0 sq. ft. (bottom dimensions)
Basin Volume Provided 31 a c.f.
Basin Elevations 5 W ALi=
Bottom Elevation 7 d fmsl
Storage Elevation 9.0 frisl
Top Elevation 9.0 fmsl
Form SWU-103 Rev 3.99 Page 1 of 3

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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, February 1999) 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
AW a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
IMOA b. System is located at least 100 feet from water supply wells.
4410 c. Bottom of system is at least 2 feet above the seasonal high water table.
MAI d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
Mi.�in e. System is not sited on or in fill material or DWQ approval has been obtained.
MWI f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access casements to the nearest public right-of-way.
h g. Drainage area for the device is less than 5 acres.
fO W h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
i. 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 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.
k.
All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
r(L�
1.
A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
AM
m.
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.
��
14 IP n.
�T
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).
o.
Flow distribution mechanism within the basin is provided.
J_ p.
A benchmark is provided to determine the sediment accumulation in the pretreatment device.
q.
Runoff in excess of the design volume bypasses of -line systems (bypass detail provided).
r.
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.
s.
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

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IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
I. 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 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 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 feet in the pretreatment unit, the sediment shall be.
removed from both the pretreatment unit and.the infiltration basin.
5. If the Division determines that the system is failing, the system will immediately be repaired to original
design specifications. If the system cannot be repaired to perform its design function; other stormwater
control devices as allowed byNCAC2H .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•notifyDWQ of any problems with the system or prior to any
changes to the system or responsible party.
Print Name and Title: /KD {t/ /424ORZ SALE /1/2A,�)/q-& nJ 6 IV sr B E�L
Address: D, bqe /o % 1i)Dk7,7'11UGre,AJ
Phone: Date, /0
Note: The legally responsihle party sho&Knot he a homeowners association unless more than 50% of the lots have peen .sold and a
r
esident of the sabd�iv/i/soon has been named the president.
1, �C.��� �� / + �% a Notgu Public
/nfor c State of � �t County of
>-\, do hereby certify that �12't (, 7-2 personally appeared before me this �/ eT
day of �� �(, and acknowledge the due execution of the forgoing infiltration basin maintenance requirements. J
Witness my hand and official seal,
SEAL
Form SWU-103 Rev 3.99
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Permit No.
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied for use as an original
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 : 675X t . LL 0-
Contact Person: M tj%ik M�AL.Lt TIER Phone Number: [phone]
This worksheet applies to: Basin No. Z in Drainage Area
(ac identified on plane) (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 (fmsl).
Soils Report Summary
Soil Type Flo C
Infiltration Rate 7 ZD in/hr or cf/hr/sf (circle appropriate units)
SHWT Elevation 5 fmSI(SeasonalllighWater Table elevation)
Basin Design Parameters
Design Storm 1 .5 inch (1.5 inch event, for SA waters, 1 inch event for others)
Design Volume 33Le c.f.
Drawdown Time Am days
Basin Dimensions SwALE
Basin Size /6(p ft. x ( ft. = la(^ sq. ft. (bottom dimensions)
Basin Volume Provided 3IA c.f.
Basin Elevations SwokLE
Bottom Elevation
Storage Elevation
Top Elevation
-7•0 fmsl
8.0 fmsl
9 .O fmsl
Form SWU-103 Rev 3.99 Page l of 3

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, February 1999) 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
MW 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.
�Wl _ c.
Bottom of system is at least 2 feet above the seasonal high water table.
_,AA I_ d.
Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
Wl ►M e.
System is not sited on or in fill material or DWQ approval has been obtained.
__ NA in __ 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.
w1 g.
Drainage area for the device is less than 5 acres.
l It.
Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
MA IM i.
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 attached.
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. Calculations attached.
k.
All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
lU JA4 1.
A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
1*ANA m.
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.
6n.
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).
l JA o.
Flow distribution mechanism within the basin is provided.
a Lr uIM p.
A benchmark is provided to determine the sediment accumulation in the pretreatment device.
h ru� q.
Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
VA$A r.
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.
KAIA,8 s.
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-103 Rev 3.99
Page 2 of 3

I

IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
I. 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 rriaintain a maximumtieight 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.' Removeany blockage and rep
specifications. air the structure to approved design
4. Remove accumulated sediment from the pretreatmenUsystem.and infiltration basin annually when,depth
in the pretreatment,unit'is reduced'to'75e/u'qf the original desigp depth. The system shall be restored to the
original design depth, without over-eznvatmg. Over-excavafing may cause the regitired water,talile`
separation to:be reduced and may compromise the ability of the system to, perform asAcsigned. 'Removed
sediment shall be disposed of in an appropriate mariner and shall not be handled in a manner that wlll
adversel imp ct water,"
Y a quahty;(i.e stockpiling near.a stormwater treatment device. orstream,-etc.). .
A benchmarkshall be established in the pretreatment unit The benchmark "will document the original
design depth so that accurate sediment,accumulatton readings can be takers The measuring device used to,
determine the'depth at the benchmark shall be such that it wdl 'give an accurate depth reading and not -°
rcadil enetrate into accumulated'sedirtients.
y,p
When the design depth reads feet m the prctrcafinent unit; the sediment shall be
removed from both"the pretreatment unit and the inTiltrattoni',basm.
5. If the Dtvtstonsdetermines that the'system is failing, the, system will immediately be repaired, to ongmah
design specifications. If the system cannot be repaired`to perform its destgw unctton;:other stormwater `
control device's as allowed by NCAC 2H A000 must be'deslgned .Yapproved and=cohstructed.
I acknowledge and agree by4ry signattire below that I am'Tesponstble:=for the performanee:of the five-
mamtenancc procedures hste'd above , I agree to-n;ottfy DWQ of anyproblerims with the system'or prior,to any.; -
changes'to the'system orresponsiblc party.
Print Name and .Title: 20 v /4L G0 S o �I At�ff—C��l /YIi�1 B E�
Address: (0.7 0 DA27,3)(IA)6 All ° 6) IY7
Phone:
Signature:,
Note The legally, recp �Iepaierso�allot, un ecs •more than'SO'/o-of the lots have beer,cold and a
resident of the.subdivisionhas been imnied the president. "
lof.
a.Notar Public for t1hneState of 6C ✓`/ C� County of
f�do hereby certify that Aon %I'-(('' (`�/����/'�/�, - i�'ipersonally appeared before meand acknowledge the due execution•of the forgoing infiltration. basin maintenance requirements.
and and official seal,
SEAL My commission expires
Form SWU-103 Rev 3.99 Page 3 of 3 `� 1,- ;� , DEBRA M. HARPER
; irlary Public, Stateof Ohio
Iviy Commission Expires
/i December 18. 2010

Permit No.
(to he provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied for use as an original
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 : e9,5y t ILL C
Contact Person: Me'tj%A M�Ar.Lt57-fR Phone Number: (25z) 7(,(-8714
This worksheet applies to: Basin No. 3 in Drainage Area /0, coo S.T.
(av identified on plans) (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 (fmsl).
Soils Report Summary
Soil Type
Infiltration Rate
SHWT Elevation
Basin Design Parameters
Design Storm
Design Volume
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Basin Elevations
Bottom Elevation
Storage Elevation
Top Elevation
KvC
7 ZD in/hr or cf/hr/sf (circle appropriate units)
5-6 fmSl (Seasonal High Water Table elevation)
1.5 inch (1.5 inch event for SA waters, I inch event for others)
379 c.f.
0.13 days
/e(e ft. x / ft. = Iote sq. ft. (bottom dimensions)
3t8 c.f.
7.0 fmsl
8.0 fmsl
9 •O fmsl
Form SWU-103 Rev 3.99 Page 1 of 3

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, February 1999) 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
WW a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
994 b. System is located at least 100 feet from water supply wells.
�Attl 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.
IU lU e. System is not sited on or in fill material or DWQ approval has been obtained.
IV_ f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access casements to the nearest public right-of-way.
M10 g. Drainage area for the device is less than 5 acres.
dA W h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
i. 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 attached.
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. Calculations attached.
1 k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
-� 1.
A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
in.
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.
99UJAL6 W 4( 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).
o.
Flow distribution mechanism within the basin is provided.
�VIIEL>
RAO p.
A benchmark is provided to determine the sediment accumulation in the pretreatment device.
!_l�u�_ q.
Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
. r.
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.
s.
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-103 Rev 3.99 Page 2 of 3

f-

v
rv: INFILTRATION"BASINOPERATION AND.MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the infiltrationsystem for erosion,
trash accumulation, vegetative cover, and'general condition.
2. Repair eroded areas immediately, re -seed as necessary, to,maintain adeguate:vegetative cover, mow
vegetated cover to maintain a maximum height,of six inches, and remove trash as needed.
3. After everyrunoff producing rainfall eventand at least monthly inspect the bypass; inflow And overflow
structures for blockage and•deterioration. Remove anyblockage.and repair th
specifications. e.structure to approved design
4. Remove accumulated sediment from the pretreatment'system and infiltration basin annually orwhen depth
in the pretreatment unit reduced to 75% of the original design, depth Thq system'shall be restore&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 m an appropriate manner and shall not be handled in,a:manncrahat,will' i
adversely impact waterquahty(i:e, stockpiling near a stoimwatcr treatment device -or stream, etc.).
Ai.benchmark shallf be established in the pretreatment unit The benchmark;wdl document the original
design depth so that accurate sediment accumulation readings can be taken, The measuring device used to'
determinethe;depth at the benchmark shall be such drat it will give an accurate dept}i reading and not
7eadily penetrate into.accumulated scdiments.
When the design deptFi,reads feet m the;pretreatment unit;,the,sediment slialFbe
removed from boWthe;pretreatment unikand the infiltraho ' Ili, m11
5. If the Division -determines that the,system is failing the.system will immediately be repaired to ongmal
design specifications If:thc system, cannofbe repaired 4o performlits*s-ignf i'' '"n; other sit Water
control devices as allowed by NCAC 2H 1'000 must be-designed;approved';and constructed
I acknowledge andagree by.my signature below that I am respon
gib le,forthe Performance;of the five;
maintenance procedures listed above.., l agree to.notify DWQof any problems with the system or prior to any
changes`to the systemIor responsible party.`
Print Name and Title: ' 2{�
Address: P O ..Li-�x /J 2 a waGt�`zN G7a N 0 /d70
Phone: Date: 103/10 6
r
Signature:
Note: The lega!(y recpotzr' le party should hot a l:onieowners ar.tocivtioty unlekc mar than 50% of tlie, lots have heeti.mld a"rid a
rreevidentt thesuhdivision.has heen named die president. - In
I,a A It I' , }�i� Diary Public Tor the State'of r I i C� , County of a
do. hereby certify that Q /o. - AL-�� . personally appeared before me this v
day of 0, and acknowledge: the due exccution'if the forgoing infiltration basin maintenance requirements.
Witness my hand and official seal, t
SEAL My commission expire, Fk P
C
` DEBRA M. HARPER
Notary Public, state of Ohio
Form SWU-103 Rev 399 Page 3 of 3 My Commission Expires
`• f December 18, 2010

Permit No.
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied for use as an original
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 : Dl3X t LL e-
Contact Person: AELI%A M�AwtSTER Phone Number: (Z52) 26(-8714
This worksheet applies to: Basin No. 4 in Drainage Area /o. WO 5•4�
(av identified on plans) (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 (f nsl).
Soils Report Summary
Soil Type
Infiltration Rate
SHWT Elevation
Basin Design Parameters .
7 ZD in/hr or ef/hr/sf (circle appropriate units)
9 frisl (Seasonal High Water Table elevation)
Design Storm 1.5 inch
Design Volume 338 c.f.
Drawdown Time 0.2 days
Basin Dimensions 5WALE
Basin Size
Basin Volume Provided
Basin Elevations SwAi-E
Bottom Elevation
Storage Elevation
Top Elevation
10C. ft. x
318 c.f.
T.O fmsl
g.o fmsl
9.0 fmsl
(1.5 inch event for SA waters, 1 inch event for others)
Form SWU-103 Rev 3.99 Page I of 3
ft. = l o to sq. ft. (bottom dimension)

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, February 1999) 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
Khq a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
Wgf b. System.is located at least 100 feet from water supply wells.
M 0 c. Bottom of system is at least 2 feet above the seasonal high water table.
14A 1 d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
WJA e. System is not sited on or in fill material or DWQ approval has been obtained.
OAI f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access casements to the nearest public right-of-way.
IM g. Drainage area for the device is less than 5 acres.
PA N( It, Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
i. 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 attached.
_ A 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. Calculations attached.
VK A4 k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H: V).
11+) A4 1. A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
M Of m. 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.
14 A 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). 5WALE
V ( o. Flow distribution mechanism within the basin is provided. SwALE
k p. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
A q. Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
r. 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.
I� s. 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

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 ofsix inches; and remove trash`as needed.
3. After every runoff producing rainfall evettrand aHeast 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 infiltration basin annually or when depth
in the pretreatment unit is red
ucedao 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 tor. - reduced and rt ay.co, P' q , `se the;ability oftheaystem to'iierform'ae decivned ° tiP A i
- u•• uioVyaou yr lu uu appropriare manner and shall':not be handled in a"manner that will
adversely impact water>quality (i_e stockpiling nears stormwater treatment devlce•oi stream;%etc.).
A:benehmark`shall be.established in the pretreatment umt The;benchmark,w111 document the anginal
design depth,so that accurate sediment accumulation4cadings can betaken' The measuring device used to
determine the'depth at the benchmark shall be such that it will give an accurate depth,readmg and not'
readily
penetrate mto accumulated{sediments:
When the'desrgn depth. reads ; 'feet m the pretreatment'unitahe sediment shallbe
removed from both th'e,pretreatment unit and the i'n5ltratiori'.basm. .
5. If the Dtvtsion[determiges that the system'is failmg,.the system will immediately be repatred4o'orlginal
design specifications: , If,the system cannot be repaired'to perform its de§igh fns utton, other stormwaten
control devices as allowed by NCAC 2H :1000 must be`designed'appr'0 e 'and;constructed:
I acknowledge endagree by,imy signature below that I am responsible?for the performance,of the.five.-
maintenance procedures listed above Pagree to notify DWQ of any problems'with'the`system orprionto any
changes o,the system or, reppsponsible paa//rty.
Print Name and Title:
Address: �n; O'%4. /-6,1 Jb�N, d &7D
Phone Date
Signature:
Note.' The lega]!y: resp txrrble party should o! he a homeowners association unless more than'50% ofthe lots have been sold and a.
resident of the subdivi io&h\as been named the president. - -
I+ -1 �I �l' 'a
llotsfy Public for the State of � I C� , County of
do hereby certify that '/,on. %�-I��/ %��—"
.personally appeared before me th' _
day of nr� , and acknowledgc'the due execution of the forgoinginfiltration basin maintenance requirements.
Witness my hand and official seal, • I t
SEAL My commission expires
DEBRA M. HARPER
�. btnry Public, State of Ohio
Porrn SWU-103 Rcv 3.99 Page 3 of 3 un9 r.r,mmission Expires
Cioceinher 18, 2010 _

Permit No.
(to he provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied for use as an original
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 : 015X l . L.L t^
Contact Person: MEU-SSA tAJ-I-Lktg -ER Phone Number. (Z52) 2tel-8714
This worksheet applies to: Basin No. s in Drainage Area /0• 000 s -.
(av identified on plane) (fmm 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 (fmsl).
Soils Report Summary
Soil Type Ko C
Infiltration Rate 7 ZO in/hr or cf/hr/sf (circle appropriate units)
SHWT Elevation 5 fm$I (Seavonal High Water Table elevation)
Basin Design Parameters
Design Storm 1.5 inch (1.5 inch event for SA waters, 1 inch event for others)
Design Volume 368 c.f.
Drawdown Time 0.13 days
Basin Dimensions S"LE
Basin Size
Basin Volume Provided
Basin Elevations 5 W A LE
Bottom Elevation
Storage Elevation
Top Elevation
101, ft. x
31A c.f.
-?.0 fmsl
8.0 fmsl
9.6 fmsl
Form SWU-103 Rev 3.99 Page I of 3
ft. = 1 o L sq. ft. (bottom dimensions)

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, February 1999) 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
/Yl� a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
XW b. System is located at least 100 feet from water supply wells.
6LW c. Bottom of system is at least 2 feet above the seasonal high water table.
11144 d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
NM e. System is not sited on or in fill material or DWQ approval has been obtained.
{Y M 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.
Y4(►f1 g. Drainage area for the device is less than 5 acres.
It. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
A/W i. 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 attached.
GY1�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. Calculations attached.
Y11/IQ k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H: V).
IIMAQ 1.
A pretreatment device such as a catch basin, grease trap, filter strip, grassed Swale or
sediment trap is provided.
Aim in.
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.
WM 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).
u tA o.
Flow distribution mechanism within the basin is provided. S WpL-6
NIA P.
A benchmark is provided to determine the sediment accumulation in the pretreatment device.
q.
Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
Me4 r.
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.
yJdp7� s.
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

I

IV. INFILTRATION BASIN OPERATION AND:MAINTENANCE AGREEMENT
1. After every tunoff:producing rainfall event and at least monthly inspect.the infiltration system for erosion,
tra
sh accumulation, ;vegetative"cover, and:general.cohdition:
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 iand dete ioration:'.Remove'any, blockage and -repair the structure to appio-1ed`design
specifications.
4. Re'move"accumulated sediment .from the pretreatment system. and infiltration basin annually or when depth
in the pretreatment unitas reduced to 75% ofthe original design'depth. The system, shall-be'restor'ed`tojhe
original design depth'without oyes excavating Ovcr-excavatmg;may cause the required watertable
separation to be reduced and may.comprom se the ability o£the system to perform asAesigned. Removed
sediment shall be disposed of m an appropriate manner and shalfiiIot be handled in a manner thatmill .
adversely impact waterquahty(i c. stockpiling nearv`a°stormwatcrtreatment dcviceorstream etc.).
A benchmark`shall be established,m the pretreatment unit The benchmark;will document the ongmal
design depth so that`accurate sediment accumulation readings can be taken:' The mcasunng'device used:{o .
determme;thedepth at,the benchmark shall.l a such that it will give an accuiatc depth'rcading.and not
readdy,penetrate into aecumulated,sediments: .
Whciithe'design depth reads feet m the pretreatment unit; the sediment sball'be,
removed, from both"We pretreatment unit'and the infiltrahonkbasin..
5 If the Divisiott'determines that thesystem is failing, the system will immediately, be repaired to.original
design specifications. If the system cannof be repaired to perform its design fungi lion„other"sformwater
"control 'devices asallowed by.NCAC 2H .1000 must be'designed; approvedand'constrvcted.
I acknowledge and agree by'my signature below that I am'responsible for the performance of the five
maintenance procedures hsted above I'agrce to notify DWQ of any problems withtthe system orprior to any
changes to;the system or: responsible party.. -- ((11
Pnnt Naiue and Title: AI
Address:_ �C7:, -Q®X /0,70 772)N 13p �34fSi
Phone:Eel..
Date: Aa/3 i p
1
Signature:
Note: The legally re3poizst !e prttyshoiildnoi b a hameowners'association unless more thou 50% of Nre lots have been sold and d
r
es
i
d
ent'pf theruhdivisiiotn has been named the president.-
`t-�w��Yr`Q-� , a Notary Public for the Stat ;of 9hl 0 County of
do Hereby certify that _ ���� .personally appeared
before me this
daybf and ackaowtedge the due execution of the forgoing infiltration basin maintenance requirements.
Witness my hand and official seal,
SEAL My conunissio
DEBRA M.HARPER
%»ryPublic, State of Ohlo
Form S W U-103 Rev 3.99 Page 3 # : - t '. i:nmmission Exp(res
� ,�; ;..•. r D�)cemher 18, 2010"'"

Permit No.
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality \
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied for use as an original
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 : aox t .LL C
Contact Person: Met]%A M�Awtg-rER Phone Number: (252) 2.(,1-8714
This workshcet applies to: Basin No. in Drainage Area /OsCCO S.-P
(as idemified on plans) (fmm Farm 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 (fmsl).
Soils Report Summary
Soil Type
Infiltration Rate
SHWT Elevation
Basin Design Parameters
Design Storm
Design Volume
Drawdown Time
Basin Dimensions SwAt..F
Basin Size
Basin Volume Provided
Basin Elevations 5Wp,t_E
Bottom Elevation
Storage Elevation
Top Elevation
KvC
% ZD in/hr or of/hr/sf (circle appropriate units)
4.8 fmS] (Seasonal High Water Table elevation)
1.5 inch (1.5 inch event for SA waters, 1 inch event for others)
357 c.f.
4.13 days
1 Ab ft. x I R. = l 06 sq. ft. (bottom dimensions)
3t8 af.
7.0 fmsl
8.0 frisl
9.O fmsl
Form SWU-I03 Rev 3.99 Page I of 3

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, February 1999) 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
MWl a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
19M b. System is located at least 100 feet from water supply wells.
LkI W� 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.
A e. System is not sited on or in fill material or DWQ approval has been obtained.
rdA l�l 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.
MAW g. Drainage area for the device is less than 5 acres.
IM h. Soils have, a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
i. 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 attached.
IMM 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. Calculations attached.
uA lA k.
All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
Nl1 I.
A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
in.
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.
Nd OA 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).
WIkl E'tillit o.
Flow distribution mechanism within the basin is provided.
E r4JA p.
A benchmark is provided to determine the sediment accumulation in the pretreatment device.
fuA u NZa q.
Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
SIM r.
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.
WIA_ s.
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-103 Rev 3.99 Page 2 of 3

•.,.:;
;, ..;
�:!'�i
;� �•,
:,, , .
. ,,;

W. 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.11
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 pro ducing.rainfill eventand at least monthly inspect the bypass, inflow and overflow
structures -forblockage,and deterioration. ,Remove any.blockage and repair th
specifications. e structure to:approved design
a
A,. enchmi
desgn;dep
determine;`
Wh
rein
5. ,'Ifth
desi
bhshed m the pretreatment unit The benchmark will document the anginal
ate sediment accuinulatiowreadmgs can be taken. The measuring device used to
benchmark shall be such that it will give an accurate deptfireading-aid not
mutated sedirrients: , -
cads feet m the:pretreatment unit; the sediment shall:be
retreats lent unit and the inTiltrati I". .si'L '
n.
that the system is, failing the system will immediately be repaired tq;onginal
e system cannot/ e repaired' "to perform its design function, other stormwater
byNCQC 2H 1,000 must<be•designed''Tapprove&ah ,constructed.
I acknowledge and±agree by my signature below that I am responstble'forthc performance of the,five
maintenance procedures hsted above ' Iagrce to notify DWQ of any Probl`erils .with the'system or'prior to•any
changes'to the'system,br responsible party.
Print Name and Title:
Address: �O. QO� /.07D . GtJD it/. 7-0/✓,.'
Phone:
Dale-4
Note: The legally, recporrc' le partyshould not a homeowners association unless more than 50% of the lots have heeii sold and a
resident,o the subdivision has been named the presitte'
I+ �Af
2ereby certif that _j'� "personally appearedbefore me this/'
day of acfcnowledge the due execution"of the forgoing infiltration basin maintenance requirements.
Witness myhand and official se I, � �
SEAL My commission expires
-BRA M. HARPER
y Public, State of Ohio
Form S WU-103 Rev 3.99 .Page 3 of 3 r, , Gnmmisslon Expires
Docamber 18, 2010

Permit No.
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied for use as an original
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.
1. PROJECT INFORMATION
Project Name : aox t _L i
Contact Person: MEU%A M�Ai-Ltg-rER Phone Number. (252) 7(0(-8714
This worksheet applies to: Basin No. % in Drainage Area S o00
(av identified on plans) (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 (fmsl).
Soils Report Summary
Soil Type 14a C
Infiltration Rate 7 ZO in/hr or cf/hr/sf (circle appropriate units)
SHWT Elevation 4.4 fmSI (Seavonal High Water Table elevation)
Basin Design Parameters
Design Storm 1 • inch (1.5 inch event for SA waters, I inch eventfor others)
Design Volume IS5 c.f.
Drawdown Time 0.13 days
Basin Dimensions 5WALE
Basin Size
Basin Volume Provided
Basin Elevations 5 W ALE
Bottom Elevation
Storage Elevation
Top Elevation
1o(G ft.x
31f+, c.f.
7.0 fmsl
8•D fmsl
9.O • fmsl
Form SWU-103 Rev 3.99 Page I of 3
ft. = 1011 sq. ft. (bottom dimensions)

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, February 1999) 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
/� N— a.
System is located 50 feet from class SA waters and 30 feet from other surface waters.
IM M _ b.
System is located at least 100 feet from water supply wells.
_ lyA( c.
Bottom of system is at least 2 feet above the seasonal high water table.
IIU_ d.
Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
Im( e.
System is not sited on or in fill material or DWQ approval has been obtained.
f.
System is located in a recorded drainage casement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
g.
Drainage area for the device is less than 5 acres.
_ M W h.
Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
i.
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 attached.
g 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. Calculations attached.
k.
All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
II.
A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
M
m.
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.
�WALE- M 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).
50114 o.
Flow distribution mechanism within the basin is provided.
l,k p.
A benchmark is provided to determine the sediment accumulation in the pretreatment device.
5(u txK q.
Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
YA& r.
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.
PIA s.
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-103 Rev 3.99
Page 2 of 3

F L�, c_
Y. ��• •� Y
� `1

IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
1. After,every, runoff.producing rainfall event and of least- monthly inspect the infiltration system for erosion,
trash accumulation; vegetative cover, and generalcondition.
2. Repair eroded areas;immediatcly, re -seed as necessaryto 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 dctcrioration Remove any'blockagc and r
specifications. epair the structure to approved design
4.
design depth`so that accurate sediment acm cuu
determine the'=depth atthe benchmark shffbe',
readtly,penetrate into ab6tmid atedsedtments '
When the design depth reads fc
removed'froin both the pretreatment.unit'an
5. Ifthe Drvisiop determines that the, system is'fai
design specifications. If the; system,
cannot lie n
control dc4ices as allowed by NCAC 2H'i 100;
I acknnwiPdoe andPa oraP h.;,.h :;'... r, r .a:':rt!'.
Print Name ati Title l!C vim !7Z
Address: 4 tJ
Phone: Cl/
Signature:
VO(&' .The legally msp sihle party should not a
4of
�� rtary Public for the Stat of Y (/ (] County of�i doby certify that /" )1)A lq r personally appeared.. before me this d-acknowledge the due execution of the forgoing infiltration basin maintenance requirements.
Witness my hand and official seat,
SEAL
My commission
Form SWU-I03 Rev 3.99 Page 3
:EBRA M.HARPER
Notary Public, State of Ohio
My Commission Expires
December 18, 2010