SW3210401_Cover Letter & Permit_20211004

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
BRIAN WRENN
Director
October 4, 2021
Providence Commons, LLC
Attn: Stephen Rosenburgh, Manager
5925 Carnegie Boulevard, Suite 200
Charlotte, NC 28209
NORTH CAROLINA
Environmental Quality
Subject: State Stormwater Management Permit No. SW3210401
Providence Commons — Caliber Collison
High Density Project
Union County
Dear Mr. Rosenburgh:
The Division of Energy, Mineral and Land Resources (DEMLR) received a complete, State Stormwater
Management Permit Application for the subject project on September 30, 2021. Staff review of the plans
and specifications has determined that the project, as proposed, complies with the Stormwater
Regulations set forth in Title 15A NCAC 02H.1000 amended on January 1, 2017 (2017 Rules). We are
hereby forwarding Permit No. SW3210401 dated October 4, 2021, for the construction of the built -upon
areas (BUA) and stormwater control measures (SCMs) associated with the subject project.
This permit shall be effective from the date of issuance until October 4, 2029 and the project shall be
subject to the conditions and limitations as specified therein and does not supersede any other agency
permit that may be required. 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.
This cover letter, attachments, and all documents on file with DEMLR shall be considered part of this
permit and is herein incorporated by reference.
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 OAH 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 Jim Farkas
in the Central Office, at [phone] [e-mail].
Sincerely,
zw-
, Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
Enclosures: Attachment A — Designer's Certification Form
Application Documents
DES/jf: \\WaterResources\DEMLR - Stormwater\SW Permits\SW3210401
D E Q�� North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
512 North Salisbury Street 11612 Mail Service Center I Raleigh, North Carolina 27699-1612
NORTH CAROLINA _
nevareaeatwEnwim eemioamiry 919.707.9200

State Stormwater Management Systems
Permit No. SW3210401
cc: Marc Momsen, PE — Consulting Engineer
Mark Griffin — Union County Building Code Enforcement
Lee Jenson — Union County Engineering
Lee Ainsworth, III, PE — NCDOT District Engineer
Mooresville Regional Office Stormwater File
Page 2of2

State Stormwater Management
Permit No. SW3210401
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In compliance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations promulgated and adopted by the North
Carolina Environmental Management Commission, including 15A NCAC 02H.1000 amended on
January 1, 2017 (2017 Rules) (the "stormwater rules"),
PERMISSION IS HEREBY GRANTED TO
Providence Commons, LLC
Providence Commons — Caliber Collison
3621 S. Providence Road, Waxhaw, Union County
FOR THE
construction, management, operation and maintenance of built -upon area (BUA) for one (1) area of
redevelopment (the "redevelopment area") as well as BUA draining to one (1) wet pond ("stormwater
control measures" or "SCMs") 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 October 4, 2029 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.
BUA REQUIREMENTS. The maximum amount of BUA allowed for the entire project is 374,984
square feet. The runoff from all BUA within the permitted drainage area of this project must be
directed into the permitted SCM. The BUA requirements and allocations for this project are as
follows:
a. SCM BUA LIMITS. The SCM has been designed using the runoff treatment method to
handle the runoff from 469,403 square feet of BUA within the delineated drainage area. The
BUA for the future development is limited to 282,122 square feet.
2. PERVIOUS AREA IMPROVEMENTS. At this time, none of the pervious area improvements
listed in G.S. 143-214.7(b2) or the Stormwater Design Manual have been proposed for this
project. Pervious area improvements will be allowed in this project if documentation is provided
demonstrating those improvements meet the requirements of the stormwater rule.
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State Stormwater Management
Permit No. SW3210401
3. SCM REQUIREMENTS. The SCM requirements for this project are as follows:
a. SCM DESIGN. The SCM is permitted based on the design criteria presented in the sealed,
signed and dated supplement and as shown in the approved plans and specifications. This
SCM must be provided and maintained at the design condition.
b. PLANTING PLAN. The SCM landscape planting plan shown in the approved plans shall be
followed in its entirety during construction. After the plants are established, the operation
and maintenance agreement must be followed.
c. FOUNTAINS. At this time, a decorative spray fountain has not been proposed within the wet
pond. Decorative spray fountains will be allowed in the wet pond if documentation is
provided demonstrating that the proposed fountain will not cause resuspension of sediment
within the pond or cause erosion of the pond side slopes.
d. IRRIGATION. If the wet pond is to be used for irrigation, it is recommended that some water
be maintained in the permanent pool, the vegetated shelf is planted with appropriate species
that can handle fluctuating conditions, and human health issues are addressed.
4. STORMWATER OUTLETS. The peak flow from the 10-year storm event shall not cause
erosion downslope of the discharge point.
5. VEGETATED SETBACKS. A 30-foot wide vegetative setback must be provided and maintained
in grass or other vegetation adjacent to all surface waters as shown on the approved plans. The
setback is measured horizontally from the normal pool elevation of impounded structures, from
the top of bank of each side of streams or rivers, and from the mean high waterline of tidal
waters, perpendicular to the shoreline.
a. BUA IN THE VEGETATED SETBACK. BUA may not be added to the vegetated setback
except as shown on the approved plans
b. RELEASE OF STORMWATER NOT TREATED IN AN SCM. Stormwater that is not treated
in an SCM must be released at the edge of the vegetated setback and allowed to flow
through the setback as dispersed flow.
6. RECORDED DOCUMENT REQUIREMENTS. The stormwater rules require the following
documents to be recorded with the Office of the Register of Deeds:
a. ACCESS AND/OR EASEMENTS. The entire stormwater conveyance system, including any
SCMs, and maintenance accesses must be located in public rights -of -way, dedicated
common areas that extend to the nearest public right-of-way, and/or permanent recorded
easements that extend to the nearest public right-of-way for the purpose of inspection,
operation, maintenance, and repair.
b. OPERATION AND MAINTENANCE AGREEMENT. The operation and maintenance
agreement must be recorded with the Office of the Register of Deeds.
c. FINAL PLATS. The final recorded plats_must reference the operation and maintenance
agreement and must also show all public rights -of -way, dedicated common areas, and/or
permanent drainage easements, in accordance with the approved plans.
7. CONSTRUCTION. During construction, erosion shall be kept to a minimum and any eroded
areas of the on -site stormwater system will be repaired immediately.
a. PROJECT CONSTRUCTION, OPERATION AND MAINTENANCE. During construction, all
operation and maintenance for the project shall follow the Erosion Control Plan requirements
until the Sediment -Erosion Control devices are converted to SCMs or no longer needed.
Once the device is converted to a SCM, the permittee shall provide and perform the
operation and maintenance as outlined in the applicable section below.
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State Stormwater Management
Permit No. SW3210401
b. SCM RESTORATION. If one or more of the SCMs are used as an Erosion Control device
and/or removed or destroyed during construction, it must be restored to the approved state
stormwater design condition prior to close-out of the erosion control plan and/or project
completion and/or transfer of the state stormwater permit. Upon restoration, a new or
updated certification will be required for the SCM(s) and a copy must be submitted to the
appropriate DEQ regional office.
8. MODIFICATIONS. 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), 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.
9. DESIGNER'S CERTIFICATION. Upon completion of the project, the permittee shall determine if
the project is in compliance with the approved plans and take the necessary following actions:
a. If the permittee determines that the project is in compliance with the approved plans, then
within 45 days of completion, the permittee shall submit to the Division one hard copy and
one electronic copy of the following:
i. The completed and signed Designer's Certification provided in Attachment A
noting any deviations from the approved plans and specifications. Deviations
may require approval from the Division;
ii. A copy of the recorded operation and maintenance agreement;
iii. Unless already provided, a copy of the recorded deed restrictions and
protective covenants; and
iv. A copy of the recorded plat delineating the public rights -of -way, dedicated
common areas and/or permanent recorded easements, when applicable.
b. If the permittee determines that the project is not in compliance with the approved plans, the
permittee shall submit an application to modify the permit within 30 days of completion of the
project or provide a plan of action, with a timeline, to bring the site into compliance.
10. OPERATION AND MAINTENANCE. The permittee shall provide and perform the operation and
maintenance necessary, as listed in the signed operation and maintenance agreement, to
assure that all components of the permitted on -site stormwater system are maintained at the
approved design condition. The approved operation and maintenance agreement must be
followed in its entirety and maintenance must occur at the scheduled intervals.
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State Stormwater Management
Permit No. SW3210401
a. CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the
permittee shall take immediate corrective actions. This includes actions required by the
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.
b. MAINTENANCE RECORDS. Records of maintenance activities must be kept and made
available upon request to authorized personnel of the Division. The records will indicate the
date, activity, name of person performing the work and what actions were taken.
11. 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 15A NCAC 02H.1045(3).
12. CURRENT PERMITTEE NAME OR ADDRESS CHANGES. The permittee shall submit a
completed Permit Information Update Application Form to the Division within 30 days to making
any one or more of the following changes:
a. A name change of the current permittee;
b. A name change of the project;
c. A mailing address change of the permittee.
13. 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.
a. TRANSFER REQUEST. The transfer request must include the appropriate application,
documentation and the processing fee as outlined in 15A NCAC 02H.1045(2) and must be
submitted within 90 days upon occurrence of any one or more of the following events:
i. A natural person who is deceased;
ii. A partnership, limited liability corporation, corporation, or any other business
association that has been dissolved, has completed the winding up of the
business as required by law or equity, and does not have a successor -in -
interest to the permit;
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;
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.
14. COMPLIANCE. The permittee is responsible for complying with the terms and conditions of this
permit and the approved plans and specifications until the Division approves the transfer
request.
a. REVIEWING AND MONITORING FOR COMPLIANCE. The permittee is responsible for
verifying that the proposed BUA within each drainage area and for the entire project does
not exceed the maximum amount allowed by this permit. The permittee shall review and
routinely monitor the project to ensure continued compliance with the conditions of the
permit, the approved plans and specifications.
b. 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.
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State Stormwater Management
Permit No. SW3210401
c. DIVISION ACCESS. The permittee grants Division Staff permission to enter the property
during normal business hours to inspect all components of the permitted project.
d. 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.
e. 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
obtaining and complying with any and all other permits or approvals that are required for this
development to take place, as required by any statutes, rules, regulations, or ordinances,
which are 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.
g. 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.
Permit issued this the 4t" day of October 2021.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
6w.uce a"a 4,07"&w
Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW3210401
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State Stormwater Management
Permit No. SW3210401
Attachment A
Certification Forms
The following blank Designer Certification forms are included and specific for this project:
• As -Built Permittee Certification
• As -Built Designer's Certification General MDC
• As -Built Designer's Certification for Wet Detention Pond Project
A separate certification is required for each SCM. These blank certification forms may be copied and
used, as needed, for each SCM and/or as a partial certification to address a section or phase of the
project.
Page 1 of 1

State Stormwater Management
Permit No. SW3210401
AS -BUILT PERMITTEE CERTIFICATION
I hereby state that I am the current permittee for the project named above, and I certify by my
signature below, that the project meets the below listed Final Submittal Requirements found in NCAC
02H.1042(4) and the terms, conditions and provisions listed in the permit documents, plans and
specifications on file with or provided to the Division.
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is part of a Fast Track As -built Package Submittal.
Printed Name
County of
personally appeared before me this
Signature
a Notary Public in the State of
do hereby certify that
day of
and acknowledge the due execution of this as -built certification. (SEAL)
Witness my hand and official seal
My commission expires
20
Permittee's Certification NCAC .1042(4)
Completed /
Provided
N/A
A. DEED RESTRICTIONS / BUA RECORDS
1. The deed restrictions and protective covenants have been recorded
Y or N
and contain the necessary language to ensure that the project is
maintained consistent with the stormwater regulations and with the
permit conditions.
2. A copy of the recorded deed restrictions and protective covenants
Y or N
has been provided to the Division.
3. Records which track the BUA on each lot are being kept. (See Note
Y or N
1
B. MAINTENANCE ACCESS
1. The SCMs are accessible for inspection, maintenance and repair.
Y or N
2. The access is a minimum of 10 feet wide.
Y or N
3. The access extends to the nearest public right-of-way.
Y or N
C. EASEMENTS
1. The SCMs and the components of the runoff collection / conveyance
Y N
system are located in recorded drainage easements.
or
2. A copy of the recorded plat(s) is provided.
Y or N
D. SINGLE FAMILY RESIDENTIAL LOTS - Plats for residential lots that
Y N
have an SCM include the following:
or
1. The specific location of the SCM on the lot.
Y or N
2. A typical detail for the SCM.
Y or N
3. A note that the SCM is required to meet stormwater regulations and
that the lot owner is subject to enforcement action as set forth in
Y N
NCGS 143 Article 21 if the SCM is removed, relocated or altered
or
without prior approval.
E. OPERATION AND MAINTENANCE AGREEMENT
Y or N
1. The O&M Agreement is referenced on the final recorded plat.
Y or N
2. The O&M Agreement is recorded with the Register of Deeds and
Y N
appears in the chain of title.
or
F. OPERATION AND MAINTENANCE PLAN — maintenance records are
being kept in a known set location for each SCM and are available for
Y or N
review.
G. DESIGNER'S CERTIFICATION FORM — has been provided to the
Y N
Division.
or
Page 1 of 6

State Stormwater Management
Permit No. SW3210401
Note 1- Acceptable records include ARC approvals, as -built surveys, and county tax records.
Provide an explanation for every requirement that was not met, and for every "N/A" below. Attach
additional sheets as needed.
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State Stormwater Management
Permit No. SW3210401
AS -BUILT DESIGNER'S CERTIFICATION GENERAL MDC
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I
have observed the construction of the project named above to the best of my abilities with all due care
and diligence, and that the project meets the below listed General MDC found in NCAC 02H.1050 in
accordance with the permit documents, plans and specifications on file with or provided to the
Division, except as noted on the "AS -BUILT" drawings, such that the intent of the stormwater rules
and statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is a part of a Fast -Track As -Built Package Submittal per .1044(3).
Check here if the designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed
Name
NC Registration
Number Date
SEAL:
Signature
Consultant's Mailing Address:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan. If N is circled, provide an explanation on Page 2.
ON/E = not evaluated (provide explanation on page 2) ON/A = not applicable to this SCM or project.
Consultant's Certification NCAC .1003((3) & General MDC
OAs-built
ON/E
ON/A
.1050
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment.
Y or N
2. The SCM achieves runoff volume match.
Y or N
3. Runoff from offsite areas and/or existing BUA is
Y or N
bypassed.
4. Runoff from offsite areas and/or existing BUA is directed
Y or N
into the permitted SCM and is accounted for at the full
build -out potential.
5. The project controls runoff through an offsite permitted
Y or N
SCM that meets the requirements of the MDC.
6. The net area of new BUA increase for an existing project
Y or N
has been accounted for at the appropriate design storm
level.
7. The SCM(s) meets all the specific minimum design
Y or N
criteria.
B. VEGETATED SETBACKS / BUA
1. The width of the vegetated setback has been measured
Y or N
from the normal pool of impounded waters, the MHW
line of tidal waters, or the top of bank of each side of
rivers or streams.
2. The vegetated setback is maintained in grass or other
Y or N
vegetation.
3. BUA that meets the requirements of NCGS 143-214.7
Y or N
b2 2 is located in the setback.
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State Stormwater Management
Permit No. SW3210401
4. BUA that does not meet the requirements of NCGS 143-
Y or N
214.7 (b2)(2) is located within the setback and is limited
to:
a. Publicly funded linear projects (road, greenway
sidewalk)
b. Water -dependent structures
c. Minimal footprint uses (utility poles, signs, security
lighting and appurtenances)
5. Stormwater that is not treated in an SCM is released at
Y or N
the edge of the setback and allowed to flow through the
setback as dispersed flow.
OAs-built
ON/EON/A
C. STORMWATER OUTLETS — the outlet handles the peak
Y N
flow from the 10 year storm with no downslope erosion.
or
D. VARIATIONS
1. A variation (alternative) from the stormwater rule
Y N
provisions has been implemented.
or
2. The variation provides equal or better stormwater control
Y N
and equal or better protection of surface waters.
or
E. COMPLIANCE WITH OTHER REGULATORY PROGRAMS
Y N
has been met.
or
F. SIZING -the volume of the SCM takes the runoff from all
surfaces into account and is sufficient to handle the required
Y or N
storm depth.
G. CONTAMINATED SOILS — infiltrating SCM's are not
Y or N
located in or on areas with contaminated soils.
H. SIDE SLOPES
1. Vegetated side slopes are no steeper than 3H:1 V.
Y or N
2. Side slopes include retaining walls, gabion walls, or
Y or N
other surfaces that are steeper than 3H:1 V.
3. Vegetated side slopes are steeper than 3H:1 V (provide
Y or N
supporting documents for soils and vegetation).
I. EROSION PROTECTION
1. The inlets do not cause erosion in the SCM.
Y or N
2. The outlet does not cause erosion downslope of the
Y or N
discharge point during the peak flow from the 10 year
storm.
J. EXCESS FLOWS — An overflow / bypass has been
Y N
provided.
or
K. DEWATERING — A method to drawdown standing water has
Y or N
been provided to facilitate maintenance and inspection.
L. CLEANOUT AFTER CONSTRUCTION — the SCM has been
Y or N
cleaned out and converted to its approved design state.
M. MAINTENANCE ACCESS
1. The SCM is accessible for maintenance and repair.
Y or N
2. The access does not include lateral or incline slopes
Y or N
>3:1.
N. DESIGNER QUALIFICATIONS (FAST -TRACK PERMIT) —
The designer is licensed under Chapters 89A, 89C, 89E, or
Y or N
89F of the General Statutes.
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or "WE",
below. Attach additional pages as needed:
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State Stormwater Management
Permit No. SW3210401
AS -BUILT DESIGNER'S CERTIFICATION FOR WET DETENTION POND PROJECT
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I
have observed the construction of the project named above to the best of my abilities with all due care
and diligence, and that the project meets all of the MDC found in NCAC 02H.1053, in accordance with
the permit documents, plans and specifications on file with or provided to the Division, except as
noted on the "AS -BUILT" drawings, such that the intent of the stormwater rules and the general
statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is part of a Fast -Track As -Built Package Submittal per .1044(3).
Check here if the Designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed
Name
NC Registration Number.
SEAL:
Signature
Consultant's Mailing Address:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan/permit. If N is circled, provide an explanation on
page 2
ON/E = not evaluated (provide explanation on page 2) ON/A = not applicable to this project or SCM.
This Certification must be completed in conjunction with the General MDC certification under NCAC
02H.1050
Consultant's Certification (MDC .1053)
OAs-built
ON/E
ON/A
A. Forebay / Depths / Fountain
1. The available Sediment storage is consistent with the
Y N
approved plan and is a minimum of 6 in.
or
2. Water flow over the forebay berm into the main pond
Y N
occurs at a non -erosive velocity.
or
3. The provided Forebay Volume is 15%-20% of the main
Y N
pool volume.
or
4. The Forebay entrance elevation is deeper than the exit
Y N
elevation into the pond.
or
5. The Average Design Depth of the main pond below the
permanent pool elevation is consistent with the permitted
Y or N
value?
6. Fountain documentation is provided.
Y or N
B. Side slopes / Banks / Vegetated Shelf
1. The width of the Vegetated Shelf is consistent with the
Y N
approved plans and is a minimum of 6 feet.
or
2. The slope of the Vegetated Shelf is consistent with the
Y N
approved plans and is no steeper than 6:1.
or
C. As -built Main Pool / Areas / Volumes / Elevations
1. The permanent pool surface area provided is consistent
Y N
with the permitted value.
or
2. The Temporary Pool Volume provided is consistent with
Y N
the permitted value.
or
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State Stormwater Management
Permit No. SW3210401
3.
The permanent pool elevation is consistent with the
Y
N
permitted value.
or
4.
The temporary pool elevation is consistent with the
Y
N
permitted value.
or
OAs-built
ON/EON/A
D. Inlets / Outlet / Drawdown
1.
The design volume draws down in 2-5 days.
Y
or
N
2.
The size of the Orifice is consistent with the permitted
Y
N
value.
or
3.
A trash rack is provided on the outlet structure.
Y
or
N
4.
Hydrologic impacts to the receiving channel are minimized
Y
N
from the 1 yr 24 hr storm discharge?
or
5.
The inlets and the outlet location are situated per the
Y
N
approved plan and avoid short-circuiting.
or
E. Vegetation
1.
The vegetated shelf has been planted with a minimum of 3
Y
N
diverse species.
or
2.
The vegetated shelf plant density is consistent with the
approved plans and is no less than 50 plants per 200 sf or
Y
or
N
no less than 24 inches on center.
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or "N/E"
below. Attach additional pages as needed:
Page 6of6