SW1190801_SuppEZ Form_5/12/2020

SUPPLEMENT-EZ COVER PAGE
FORMS LOADED
1 Project Name Leicester Volunteer Fire Department
2 Project Area (ac)10.68
3 Coastal Wetland Area (ac) 0
4 Surface Water Area (ac) 0
5 Is this project High or Low Density? High
6 Does this project use an off-site SCM? No
7 Width of vegetated setbacks provided (feet) N/A
8 Will the vegetated setback remain vegetated? No
9 Is BUA other that as listed in .1003(4)(c-d) out of the setback? No
10 Is streambank stabilization proposed on this project? No
11 Infiltration System 0
12 Bioretention Cell 2
13 Wet Pond 0
14 Stormwater Wetland 0
15 Permeable Pavement 0
16 Sand Filter 0
17 Rainwater Harvesting (RWH) 0
18 Green Roof 0
19 Level Spreader-Filter Strip (LS-FS) 0
20 Disconnected Impervious Surface (DIS) 0
21 Treatment Swale 0
22 Dry Pond 0
23 StormFilter 0
24 Silva Cell 0
25 Bayfilter 0
26 Filterra 0
FORMS LOADED
27 Name and Title: Jacob D. Grieb
28 Organization:Mattern & Craig
29 Street address: 403 E. Market Street
30 City, State, Zip: Johnson City, TN, 37601
31 Phone number(s): 423-979-2220
32 Email:[e-mail]
Certification Statement:

Designer
______________________________________________
Signature of Designer
______________________________________________
Date

I certify, under penalty of law that this Supplement-EZ form and all supporting information were prepared under my direction or
supervision; that the information provided in the form is, to the best of my knowledge and belief, true, accurate, and complete; and
that the engineering plans, specifications, operation and maintenance agreements and other supporting information are consistent
with the information provided here.
PROJECT INFORMATION
NUMBER AND TYPE OF SCMs:
DESIGNER CERTIFICATION
COMPLIANCE WITH 02H .1003(4)
Seal
BIORETENTION CELL
1 Drainage area number 1 2
2 Design volume of SCM (cu ft)3405 cf 3989 cf
3 Is the SCM sized to treat the SW from all surfaces at build-out?Yes Yes
4 Is the SCM located away from contaminated soils?Yes Yes
5 What are the side slopes of the SCM (H:V)?3:1 3:1
6
Does the SCM have retaining walls, gabion walls or other engineered side
slopes? No No
7
Are the inlets, outlets, and receiving stream protected from erosion (10-year
storm)?Yes Yes
8
Is there an overflow or bypass for inflow volume in excess of the design
volume?Yes Yes
9 What is the method for dewatering the SCM for maintenance?Other Other
10 If applicable, will the SCM be cleaned out after construction?Yes Yes
11 Does the maintenance access comply with General MDC (8)?Yes Yes
12 Does the drainage easement comply with General MDC (9)?Yes Yes
13
If the SCM is on a single family lot, does (will?) the plat comply with General
MDC (10)?
14 Is there an O&M Agreement that complies with General MDC (11)?Yes Yes
15 Is there an O&M Plan that complies with General MDC (12)?Yes Yes
16 Does the SCM follow the device specific MDC?Yes Yes
17 Was the SCM designed by an NC licensed professional?Yes Yes
18 SHWT elevation (fmsl)< 2161.00 < 2149.00
19 Bottom of the bioretention cell (fmsl)2163.50 2151.50
20 Ponding depth of the design storm (inches)12 in 12 in
21 Surface area of the bioretention cell (square feet)3757 sf 4045 sf
22 Design volume of the bioretention cell (cubic feet)3405 cf 3989 cf
23 Is the bioretention cell used for peak attenuation?Yes Yes
24 Depth of peak attenuation over planting surface (in)24 in 24 in
25 Height of peak attenuation outlet above the planting surface (in)18 in 18 in
26 Infiltration rate of the in situ soil (inch/hour)N/A N/A
27 Diameter of the underdrain pipes (if applicable)4"4"
28 Does the design include Internal Water Storage (IWS)?Yes Yes
29 if so, elevation of the top of the IWS (fmsl)2165.5 2153.5
30 Elevation of the planting surface (fmsl)2167 2155
31 What type of vegetation will be planted? (grass, trees/shrubs, other)?Other Other
32 Media depth (inches)30 in 30 in
33 Percentage of medium to coarse washed sand by volume 75-80%75-80%
34 Percentage of fines (silt and clay) by volume 8-10%8-10%
35 Percentage of organic matter by volume 5-10%5-10%
36 Type of organic material ie: pine bark
ie: pine
bark
37 Phosphorus Index (P-Index) of media (unitless) <50 <50
38 Will compaction be avoided during construction?Yes Yes
39 Will cell be maintained to a one inch/hour standard?Yes Yes
40 Depth of mulch, if applicable (inches)N/A N/A
41 Type of mulch, if applicable N/A N/A
42 How many clean out pipes are being installed?2 2
43 Type of pretreatment that will be used:N/A N/A
44
Please use this space to provide any additional information about the
bioretention cell(s):
BIORETENTION CELL MDC FROM 02H .1052
GENERAL MDC FROM 02H .1050
ADDITIONAL INFORMATION
31. Sod
Bioretention 1 11:55 AM 4/29/2020
DRAINAGE AREAS
1 Is this a high density project?Yes
2 If so, number of drainage areas/SCMs 2
3
Is all/part of this project subject to previous rule
versions?No
FORMS LOADED
Entire Site 1 2
4 Type of SCM Bioretention Cell Bioretention Cell Bioretention Cell
5 Total BUA in project (sq ft)74199 sf 42254 sf 31945 sf
6
New BUA on subdivided lots (subject to permitting)
(sq ft)0 sf 0 sf 0 sf
7
New BUA outside of subdivided lots (subject to
permitting) (sf)74199 sf 42254 sf 31945 sf
8 Offsite - total area (sq ft)89569 sf 44845 sf 44742 sf
9 Offsite BUA (sq ft)0 sf 0 sf 15100 sf
10 Breakdown of new BUA outside subdivided lots:
- Parking (sq ft)16396 sf 6156 sf 10240 sf
- Sidewalk (sq ft)1663 sf 0 sf 1663 sf
- Roof (sq ft)24640 sf 21184 sf 3456 sf
- Roadway (sq ft)31500 sf 14914 sf 16586 sf
- Future (sq ft)0 sf 0 sf 0 sf

- Other, please specify in the comment box
below (sq ft) 0 sf 0 sf 0 sf
11
New infiltrating permeable pavement on
subdivided lots (sq ft)0 sf 0 sf 0 sf
12
New infiltrating permeable pavement outside of
subdivided lots (sq ft)0 sf 0 sf 0 sf
13
Exisitng BUA that will remain (not subject to
permitting) (sq ft)0 sf 0 sf 0 sf
14 Existing BUA that is already permitted (sq ft)0 sf 0 sf 0 sf
15 Existing BUA that will be removed (sq ft)0 sf 0 sf 0 sf
16 Percent BUA 19%17%24%
17 Design storm (inches)1 in 1 in 1 in
18 Design volume of SCM (cu ft)7394 cf 3405 cf 3989 cf
19 Calculation method for design volume Simple Method Simple Method Simple Method
20
DRAINAGE AREA INFORMATION
ADDITIONAL INFORMATION
Please use this space to provide any additional information about the
drainage area(s):