SW8031130_CURRENT PERMIT_20230127

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8 n311�o
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
Zo _L'5 D1 2-1
YYYYMMDD

ROY COOPER
Governor
ELIZABETH S..BISER
secretary
DOUGLAS R. ANSEL
Interim Director
January 27, 2023
Piedmont Recreation, Inc.
Attn: Carl D. Bryant, President
2709 Leader Circle
Wilmington, NC 28412
NORTH CAROLINA
Environmental Quality
Subject: Permit Renewal
Post -Construction Stormwater Management Permit No. SW8 031130
Dollar General Store- Holden Beach
Brunswick County
Dear Mr. Bryant:
The Division of Energy, Mineral and Land Resources received a complete 8-year Permit Renewal Application for
the subject permit on January 26, 2022. The Division is hereby notifying you that permit SW8031130 has been
renewed, updated, and re -issued on January 27, 2023, as attached. As requested, a copy of the current operation
and maintenance agreement is also enclosed. Please be aware that the renewal and re -issuance of this stormwater
permit does not imply that the site is currently in compliance.
This permit shall be effective until April 13, 2026 and does not supersede any other agency permit that may be
required. The project shall be subject to the conditions and limitations as specified therein. This permit does not
impose new or increased stormwater control requirements; it clarifies the rules and requirements of this program
to provide you with a better understanding of your obligations under this permit. Failure to comply with these
requirements will result in future compliance problems. Please note that this permit is not transferable except
after notice to and approval by the Division.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request
an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings (OAH). The
written petition must conform to Chapter 150B of the North Carolina General Statutes and must be filed with the
OAR within thirty (30) days of receipt of this permit. You should contact the OAH with all questions regarding
the filing fee (if a filing fee is required) and/or the details of the filing process at 6714 Mail Service Center,
Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at www.NCOAH.com. Unless
such demands are made this permit shall be final and binding.
If you have any questions concerning this permit, please contact Ashley Smith in the Wilmington Regional Office,
at [phone] or [e-mail].
Sincerely,
Douglas R. Ansel, Interim Director
Division of Energy, Mineral and Land Resources
Enclosures: Attachment C — Permitting History
copy of the Renewal Application Documents
Copy of the current operation and maintenance agreement
DES/ams: \\\Stormwater\Petmits & Projects\2003\031130 HD\2023 01 permit 031130
cc: Wilmington Regional Office Stormwater File
®Ir ��� North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Wilmington Regional Office 1127 Cardinal Drive Extension I Wilmington. North Carolina 28405
910.796.7215
Harm cwourw

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
POST -CONSTRUCTION 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
Piedmont Recreation, Inc.
Dollar General — Holden Beach
3045 Holden Beach Road, Holden Beach, Brunswick County
FOR THE
construction, operation and maintenance of one (1) infiltration basin in compliance with the
provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and as
outlined in the application, approved stormwater management plans, supplement, calculations,
operation and maintenance agreement, recorded documents, specifications, and other
supporting data (the "approved plans and specifications") as attached and/or on file with and
approved by the Division of Energy. Mineral and Land Resources (the "Division" or "DEMLR").
The project shall be constructed, operated and maintained in accordance with these approved
plans and specifications. The approved plans and specifications are incorporated by reference
and are enforceable part of this permit.
This permit shall be effective from the date of issuance until April 13, 2026 and shall be subject
to the following specified conditions and limitations. The permit issued shall continue in force
and effect until the permittee files a request with the Division for a permit modification, transfer,
renewal, or rescission; however, these actions do not stay any condition. The issuance of this
permit does not prohibit the Director from reopening and modifying the permit, revoking and
reissuing the permit, or terminating the permit for cause as allowed by the laws, rules, and
regulations contained in Title 15A NCAC 2H.1000 and NCGS 143-215.1 et.al.
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 24,951 square feet of.impervious area. This basin is designed to
hold the 10 year — 10 minute rainfall event and hold and infiltrate the 25 year — 24 hour
event. No vegetative filter is required.
3. The tract will be limited to the amount of built -upon area indicated in Sections 1.2 and 1.6
of this permit, and per approved plans.
Page 1 of 5

State Stormwater Management
Permit # SW8 031130
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 permitted built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system. A permit
modification must be submitted and approved prior to the addition of drainage area and
prior to the construction of additional built -upon area from outside of the approved
drainage area.
6. The following design criteria have been provided in this alternative design infiltration
basin BMP and must be maintained at design condition:
a. Drainage Area, acres:
Onsite, ftz:
Offsite, ftz:
b. Total Impervious Surfaces, ftz:
c. Basin Depth, feet:
d. Bottom Elevation, fmsl:
e. Bottom Surface Area, ftz:
f. Permitted Storage Volume, ft3:
g. Temporary Storage Elevation, fmsl
h. SHWT Elevation, fmsl:
i. Type of Soil:
j. Expected Infiltration Rate:
k. Time to Draw Down:
I. Receiving Stream/River Basin:
m. Stream Index Number:
n. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
1.1 acres
43,995
3.821
24.951
2.5
26.0
4,393
14,358
28.5
22.0
Sand
24 inches per hour
0.23 hours
ICWW / LBR59
15-25
"SA HQW'
The stormwater management system shall be constructed in its entirety, vegetated and
operational for its intended use prior to the construction of any built -upon surface.
During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately.
The permittee shall at all times provide the operation and maintenance necessary to
assure the permitted stormwater system functions at the design condition. The approved
Operation and Maintenance Plan must be followed in its entirety and maintenance must
occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and specifications.
f. Debris removal and unclogging of bottom infiltration media, collection system
ditches, swales, catch basins and piping.
4. Records of maintenance activities must be kept and made available upon request to
authorized personnel of DEMLR. The records will indicate the date, activity, name of
person performing the work and what actions were taken.
5. The facilities shall be constructed, operated and maintained in accordance with the
provisions of this permit, the approved plans and specifications, and the supporting
documents attached to this permit and on file with the Division.
Page 2 of 5

State Stormwater Management
Permit # SW8 031130
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and
prior to operation of this permitted facility, a certification must be received from an
appropriate designer for the system installed certifying that the permitted facility has
been installed in accordance with this permit, the approved plans and specifications, and
other supporting documentation. Any deviations from the approved plans and
specifications must be noted on the Certification. A modification may be required for
those deviations.
If the stormwater system was used as an Erosion Control device, it must be restored to
design condition prior to operation as a stormwater treatment device, and prior to
occupancy of the facility.
8. At least 30 days prior to the sale or lease of any portion of the property, the permittee
shall notify DEMLR and provide the name, mailing address and phone number of the
purchaser or leasee. An access/maintenance easement to the stormwater facilities shall
be granted in favor of the permittee if access to the stormwater facilities will be restricted
by the sale or lease of any portion of the property.
9. 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.
10. The permittee must maintain the current permitted drainage area. No additional drainage
area and no additional runoff from outside of the permitted drainage area boundary may
enter the permitted stormwater facilities without first applying for and receiving a permit
modification.
11. No person or entity, including the permittee, shall alter any component shown in the
approved plans and specifications. Prior to the construction of any modification to the
approved plans, the permittee shall submit to the Director, and shall have received
approval for modified plans, specifications, and calculations including, but not limited to,
those listed below. For changes to the project or SCM that impact the certifications, a
new or updated certification(s), as applicable, will be required and a copy must be
submitted to the appropriate DEQ regional office upon completion of the modification.
a. Any modification to the approved plans and specifications, regardless of size
including the SCM(s), BUA, details, etc.
b. Redesign or addition to the approved amount of BUA or to the drainage area.
C. Further development, subdivision, acquisition, lease or sale of any, all or part of
the project and/or property area as reported in the approved plans and
specifications.
d. Altering, modifying, removing, relocating, redirecting, regrading, or resizing of any
component of the approved SCM(s), the stormwater collection system and/or
vegetative conveyance shown on the approved plan.
e. The construction of any allocated future BUA.
f. The construction of any permeable pavement, #57 stone area, public trails, or
landscaping material to be considered a permeable surface that were not
included in the approved plans and specifications.
g. Other modifications as determined by the Director.
III. GENERAL CONDITIONS
CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the
permittee shall take immediate corrective actions. This includes actions required by this
Division and the stormwater rules such as the construction of additional or replacement
on -site stormwater systems. These additional or replacement measures shall receive a
permit from the Division prior to construction.
Page 3 of 5

State Stormwater Management
Permit # SW8 031130
2. PERMIT RENEWAL. A permit renewal request must be submitted at least 180 days
prior to the expiration date of this permit. The renewal request must include the
appropriate application, documentation and the processing fee as outlined in Title 15A
NCAC 02H.1045(3).
3. CHANGES TO THE PROJECT NAME, PERMITTEE NAME OR CONTACT
INFORMATION. The permittee shall submit a completed Permit Information Update
Application Form to the Division within 30 days to making any one of these changes.
4. TRANSFER. This permit is not transferable to any person or entity except after notice to
and approval by the Director. Neither the sale of the project and/or property, in whole or
in part, nor the conveyance of common area to a third party constitutes an approved
transfer of the permit.
TRANSFER REQUEST. The transfer request must include the appropriate
application, documentation and the processing fee as outlined in 15A NCAC
02H.1045(2). This request must be submitted within 90 days of the permit holder
meeting one or more of the following:
i. A natural person who is deceased,
ii. A partnership, limited liability corporation, corporation, or any other
business association that has been dissolved,
iii. A person or entity who has been lawfully and finally divested of title to the
property on which the permitted activity is occurring or will occur through
foreclosure, bankruptcy, or other legal proceeding.
iv. A person or entity who has sold the property, in whole or in part, on which
the permitted activity is occurring or will occur,
V. The assignment of declarant rights to another individual or entity;
vi. The sale or conveyance of the common areas to a Homeowner's or
Property Owner's Association, subject to the requirements of NCGS 143-
214.7(c2);
b. TRANSFER INSPECTION. Prior to transfer of the permit, a file review and site
inspection will be conducted by Division personnel to ensure the permit
conditions have been met and that the project and the on -site stormwater system
complies with the permit conditions. Records of maintenance activities performed
to date may be requested. Projects not in compliance with the permit will not be
transferred until all permit and/or general statute conditions are met.
COMPLIANCE. The permittee is responsible for compliance with the terms and
conditions of this permit until the Division approves the transfer request.
a. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved
plans, application, supplement, operation and maintenance agreement, all
applicable recorded documents, and specifications shall be maintained on file by
the permittee at all times.
b. DIVISION ACCESS. The permittee grants Division Staff permission to enter the
property during normal business hours to inspect all components of the permitted
project.
C. ENFORCEMENT. Any individual or entity found to be in noncompliance with the
provisions of a stormwater management permit or the requirements of the
stormwater rules is subject to enforcement procedures as set forth in NCGS 143
Article 21.
d. ANNUAL CERTIFICATION. The permittee shall electronically submit to the
Division an annual certification completed by either the permittee or their
designee confirming the projects conformance with permit conditions
Page 4 of 5

State Stormwater Management
Permit # SW8 031130
OBTAINING COMPLIANCE. 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 modified plans and
certification in writing to the Director that the changes have been made.
OTHER PERMITS. The issuance of this permit does not preclude the permittee
from complying with and obtaining any other permits or approvals that are
required for this development to take place, as required by any statutes, rules,
regulations, or ordinances, which may be imposed by any other Local, State or
Federal government agency having jurisdiction. Any activities undertaken at this
site that cause a water quality violation or undertaken prior to receipt of the
necessary permits or approvals to do so are considered violations of NCGS 143-
215.1, and subject to enforcement procedures pursuant to NCGS 143-215.6.
Permit renewed, updated and reissued this the 27th day of January 2023.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
C.�rya P[,XV
Douglas R. Ansel, Interim Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 031130
Page 5 of 5

Attachment C - Permitting History
Dollar General Store -Holden Beach
Permit No. SWS 031130
Approval
Permit Action
RIMS
Description of the Changes
Modified PIan,Sheets
Date
Version
High Density Stormwater Project -construction, operation
and maintenance of an infiltration basin in compliance
with the provisions of 15A NCAC 2H .1000.
management of stormwater runoff as described on page 3
4/13/2004
Original
1.0
of this permit, the Project Data Sheet. The stormwater
1 2 4 7
Approval
control has been designed to handle the runoff from
24,951 square feet of impervious area. This basin is
designed to hold the 10 year— 10 minute rainfall event
and hold and infiltrate the 25 year -24 hour event. No
vegetative filter is required.
8/7/2014
Minor
1.1
Ownership Transfer
Modification
1/27/2023
Renewal
2.0
Expires April 13, 2026
Page 1 of 1

DEMLR USE ONLY
Date Re eiv Fee Paid Permit Number
as D� Sw� 03(130
STATE STORMWATER:
PERMIT INFORMATION UPDATE APPLICATION FORM
There is NO FEE for updating project name or permittee information.
This form is to only to be used by the current permittee to notify the Division of.
1) changes to the Point of Contact (signing official) for the current permittee (LLC, Corporation, HOA or POA);
2) changes to the mailing address, phone number or email address of the current permittee;
3) changes to the name of the project; and
4) changes to the legal corporate name as documented by a Name Change or Merger filed with the NCSOS.
A. NEW PERMIT INFORMATION
State Stormwater Permit Number: sw8 031130
Are you updating
(check all that apply):
If so, please provide the updated information:
❑ Project name
Dollar General Store -Holden Beach
❑ Corporation Name'
Piedmont Recreation Inc
❑ Permit Contact Name2.3
Carl D Bryant
❑ Permit Contact Title
President
❑ Mailing Address3
Po Box 7884
❑ Phone number
910 297-8195
❑ Email address
douobryantCcDec rr com
VVUUMahlawh such as a Name Change / Merger filed with the NCSOS.
Provide supporting documentation such as NCSOS filing. The permit contact's position must be in accordance
with 15A NCAC 02H 1040(1).
If more than one point of contact or mailing address is being changed, please attach a separate sheet.
B. CERTIFICATION OF PERMITTEE
1, Carl D Bryant , the current permittee, hereby notify DEMLR that I am making the changes
as listed in Section A above. I further attest that this application for an update to the permit information currently on file is
accurate and complete to the best of my knowledge.
Signature: (0 Date:
1,� �Cj G {70V'� a Notary Public for the State of L
County of d \�Y Ctr�}gv�W Lr do hereby certify thaty • py Avg 1
erso � P �� ^�
P g ryGgppeared bl� ;Te this the day of iL -&A� -cr 20 21,and acknowledge the due
exealt' i of the forgoingment. Witness my hand and official seal,
�10Te _
1�L
(No$ Seal
LIO ? 2
NotaryV,40,nc `U 1 l u � ` -Z
n r rrrrr
My Commission expires MY commtsaion Expires March 30, 2024
Stormwater Permit Information Update Form Page 1 of 1
-
i
DEC 0 5 2022
BY.-_________-
May 11, 2017

. .. - .: ;, ..: ... . - _ O(EMLH USE ONLY
Data NaCO M
- Fee Pda
Permit Numt or
NC DEQ Division of Energy, Mineral and LandReso
STATE STORMWATER'
CEIVE
PERMIT RENEWAL APPLICATION7FO V-hC- 05 -Mi
in accordance with 156 NCAC 2Hi 1045rat the current permit holder shall renew lheir high density permit 180 dayi
prior to its e-NOHon. Renewed permits arevalid for a period of 8 years `perSassipri Law 2011-398'(S8 781)
'Section 60.(c).-Thisapplicationformis!orpernit renewals only. ,' • -
.. ..rl
A PRO
JECT-1NFORMATION
d1 A -
1. State stormwater Permit Number. s" 031d 30
2. .Project name:' Dollar General Store -Holden Beach
3. Project street address; 3045 Hoiden Beach Rd SW. .
... City: Hoiden Beach • ...County •. Biu-sw ck. ... `
.ZIP: 28462
4. What- it any, changes have been made to the proieG eipermitted7 N (V f _
If project has changed from the original approved plans,` please complete SWU-JOf /ore MaJor ;
MCdihcatlon or Minor Modification Applicahori form available at: htlos4/deo no dovtabouUdivis ons/energv-
. - -: min eral-larxf{esources/enerov-mineraldand-rule 'stormwatei-oromm%oost-construction: '
B. PERMrrrU INFORMATION'
If changes to (he perm rise ar project name have been made please complete either tbe.Pennit Update'form
_ or the Permit Transfer form available at:htto's:/ldeC.nc goviaboNidivitions/6nemy-ininer'al=16iii-. '
fesources/enerav-mineral-land rules/stormwater-oroaram/Costcons n coon:' Slate'Stormwafar t?emiits do not "
aut0mat 0aW transfer with the sale of the prnperfy.,
I. Current'Permit Holder's Company Namelbrgana'atibm-Piedmont Recreation Inc'
2 Signing Official's Name: Carl D Bryant
3. Signi g OtfioWsTifie: oresidenf;
4. Malling Address: ,N :i7 ' d-F 02E4 C-skc C t
City' wtiminaton State. nC_ZIP:
5. Street Address: 1 c 9• L E A 11 a A C- Z k L C-
City: W -L L M z P- 6 zo si State: Nr.. ZIP: 1E4t1;. ?�
• 8. Phan; 910 297.8196 Email: doucbrvantIi] cm rr com
JAV� 26 2023
sY6
� }r�
l j

i
C. SUBMITTAL REQUIREMENTS
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORW). Only applications packages that
include all required items listed below will be accepted and reviewed.
Initial each item below to indicate that the required information is provided in the application package:
cdb 1. A permit application processing fee of $505.00 payable to NCDEQ.
cdb 2. One original signed hard copy and one electronic copy of this completed form. The signing official
named on this application to represent the current permittee must meet one of the following:
a. Corporation — a principle executive officer of at least the level of vice-president;
b. Limited Liability Company (LLC) — a manager or company official as those terms are defined
in G.S. 57D "North Carolina Limited Liability Company Act;"
c. Public Entity — a principal executive officer, ranking official, or other duly authorized employee;
d. Partnership or limited partnership — the general partner;
e. Sole proprietor; or
f. Letter of authorization signed by one of the signatories noted in a — e above authorizing the
signature of another entity.
cdb 3. One hard copy and one electronic copy of recorded documents required by the original permit that
have not yet been received by DEMLR, including: deed restrictions, protective covenants,
condominium/planned community declaration and easements. If the project has been built, include
documentation that the maximum BUA per lot or maximum total BUA has not been exceeded. If
the project has not been built, include a signed agreement that the final recorded deed restrictions
and protective covenants will be submitted at a later date.
4. O&M Agreements, Please select one:
❑ I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to
keep this on file with the permit; or
® I do not have a copy of the current recorded O&M Agreement for all SCMs and am
requesting a copy be sent tome. I agree to keep this on file with the permit.
cdb 5. Designer Certifications, Please select one:
® A copy of the certification(s) confirming that the project was built in accordance with the
approved plans have been previously provided to the Division, or
® A copy of the certification(s) confirming that the project was built in accordance with the
approved plans are enclosed; or
❑ The project has not yet been built.
cdb 6. (IF APPLICABLE] If the project has been built, one original hard copy and one electronic copy of a
signed, sealed, and dated letter from a licensed professional stating that the SCMs have been
inspected, and that they have been built and maintained in accordance with the permit.
cdb 7. (IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC): Provide
one hard copy and one electronic copy of documentation from the NC Secretary of State, or other
official documentation, which supports the titles and positions held by the persons listed in Section
C.2 per 15A NCAC 2H. 1043(3)(b).
https:/Iwww.sosnc.aov/online services/search/by title/ Business Registration
E0!E0%.,/E
DEC 1 4 2022
BY
Stormwater Permit Renewal Application Form Page 2 of 3 May 11, 2018

I' .
D. PERMITTEE'S CERTIFICATION
the person legally responsible for the permit, certify that I have
a copy of the Permit hnd 0&M Agreement on site (or I will obtain a copy and it will be kept on site), that I am
responsible for the performance of the maintenance procedures, and the site has been and will be maintained
according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs
or built -upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the
project, SCMs, or ownership. All information provided on this permit renewal application is, to the best of my
knowledge, correct and complete.
Signature: ('.h (/ (/ 61—u�= Date: /2-
NOTARIZATION
1, E�&4. C �Ou)�lt , a Notary Public for the State of
L , County of Q,w do hereby certify
that (lw �� { personally appeared before me
this the T M day of Z
, 20 2 and acknowledge the due
exe`rpi� tXe4wr�' xf instrument. Witness my hand and official seal,
1ry Segal) 'q%
"etic
�2
Noi8ry0ature: Ob
C013 A%
My comm111A M�kpires My Commission Expires March 30, 2024
DEC 0 5 2022 G'
BY:_
Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

Permit No. SWS 031130
(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 : fl0t t�.1Z (a Et 1t RAv - i-��x Der-lGk�
Contact Person: V%uGti 1 . e?AV!:7 Phone Number: (1�01433 �f 6xT�
This worksheet applies to: Basin No
(as idewifed on plans)
in Drainage Area
U'om Form SWU-100
11. 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 (finsl).
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
Z—t 'tl/hr or of/hr/sf (circle appropriate omits)
Z Z fmsl (Seasonal High Water Table elevation)
1' S inch (1.5 inch event for SA waters, I inch event for others)
2o6`f c.f.
o.Z3 day,�rs.
70-S ftx 4Z•3 ft= g393 sq.ft. (bottom dimensions)
H 3�c.f.
2 (� fins]
Z8. S fmsl
2 T5.5 fmsl
Form SWU-103 Rev 3.99 Page I of 3

111. 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
a.
b.
C.
d.
e.
f.
System is located 50 feet from class SA waters and 30 feet from other surface waters.
System is located at least 100 feet from water supply wells.
Bottom of system is at least 2 feet above the seasonal high water table.
Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
System is not sited on or in fill material or DWQ approval has been obtained.
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.
g. Drainage area for the device is less than 5 acres.
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.
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.
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.
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).
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

IV. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
l . 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, innow 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 by NCAC 2H A 000 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:fnr�T -r L.
Address:
Date: 4.12 • C>4
Note. The legally responsible party should not be a homeowners association unless more than 50%, of the lots have been sold and a
residentofthe subdivision has been named the president.
% hI, l ( tS 6 %t1 yl� "Cik X, ( `a Notary Public for the State of C, County of
C06 b -,do hereby certify that yappeared
personal) cared before me this 1
day of -IDA and acknowledge the due execution of the forgoing infiltration basin maintenance requirements.
Witness my hand and official seal, Ck"Stc"' � ' I' /".,_ - '
1'Y� .
SEAL ' a,
�
3,:,
M commission expires Notary Pnhli
y p c Cobb County Georgia
My Commission Expires February 24, 2008
a.
Form SR'i�103'.: Rev.�.99:;�_
Page 3 of 3

Project name
County
Stormwater Permit No. SW8 project #
Designer's Certification
I, M49S/71• [.tam{; o as a duly registered in
the State of North Carolina, having been authorized to observe (periodically / weekly /
full time) the construction of the project,
&4-1-A2 (SCMMAL SToiZe Eleuvwl ?AALIA
(Project)
for SaTutrL f6pgYiSES (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.
Required Items to be checked for this certification to be considered complete are on
page 2 of this form.
Noted deviations from approved plans and specifications:
Signature
Registration Number /a'L�v
DateS
SEAL
cc: NCDENR DWQ Regional Office
inspector, county County Building Inspector
Page 1 of 2

Q
Project name
County
Stormwater Permit No. SW8 project #
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.
4N',_A'4. The outlet/bypass structure elevations are per the approved plan.
A�_5. The outlet/bypass structure is located per the approved plans.
4A_6. Trash rack is provided on the outlet/bypass structure.
✓7. All slopes are grassed with permanent vegetation.
✓8. Vegetated slopes are no steeper than 3:1.
9�_9. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
10. The permitted amounts of surface area and/or volume have been
provided.
_WIL11. Required drawdown devices are correctly sized per the approved plans.
�12. All required design depths are provided.
✓13. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
14. The dimensions of the system, as shown on the approved plans, are
provided.
cc: NCDENR-DWQ
inspector, county County Building Inspector
Page 2 of 2