SW4090801_CURRENT PERMIT_20090903

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW�Q���Qz
DOC TYPE
CURRENT PERMIT
C
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
2�`���j
YYYYMMDD

A74i'LA.
RCD NR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. William McDonald
Davie Kidney Center of WFU
1804 King Road
Tifton, GA 31793
Division of Water Quality
Coleen H. Sullins
Director
September 1, 2009
Subject: Stormwater Permit No. SW4090801
Davie Kidney Center
High Density Commercial Bio-Retention Project
Davie County
Dear Mr. McDonald: .
Dee Freeman
Secretary
FRECEIVED
N.C. Moot. of eNM
SEP 0 3.2009
Winston-Salem
Regional Office
The Stormwater Permitting Unit received a complete Stormwater Management Permit
Application for Davie Kidney Center on August 7, 2009, with additional information received on
September 1, 2009. 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
and Session Law 2006-246. We are forwarding Permit No. SW4090801, dated September 1,
2009, for the construction, operation and maintenance of the subject project and the stormwater
BMPs.
This permit shall be effective from the date of issuance until September 1, 2019, 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 inspection 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 150B of the North Carolina General Statutes, and filed with the Office of Administrative
Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands are made this
permit shall be final and binding.
This project will be kept on file at the Winston-Salem Regional Office. If you have any questions,
or need additional information concerning this matter, please contact Robert Patterson at (919)
807-6375; or [e-mail].
S�cerely,
for Coleen H. Sullins
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NorthCarofina
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]N4 Customer Service: 1-877-623.6748 �atl Lrall�
IntemeL www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer

Mr. William McDonald ,
SW4090801 — Davie Kidney Center
September 1, 2009
cc: Winston-Salem Regional Office
Sue Homewood - WSRO
Central Files
SPU Files
ec: Ken Binkley - Stimmel Associates, PA
Page 2 of 2

State Stormwater Permit
Permit No. SW4090801
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
Davie Kidney Center of Wake Forest University
Davie Kidney Center
Dr-; oc svil e; - avre-County=
FOR THE
construction, operation and maintenance of 2 bioretention cells in compliance with the
provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter referred to as
the "stormwater rules') 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.
This permit shall be effective from the date of issuance until September 1, 2019, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
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 1.7 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from 48,449 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area as indicated in Section
1.7 of this permit, and per the application documents and as shown on the
approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 6

State Stormwater Permit '
Permit No. SW4090801
7
The following design criteria have been provided in the bioretention cells and
must be maintained at design condition:
Cell #1
a.
Drainage Area, Acres:
0.98 7
Onsite, ft :
42,842
Offsite, ft2:
0
b.
Total Impervioug Surfaces, ft2:
25,448
Onsite, ft :
25,448
Offsite, ft2:
0
C.
Design Storm, inches:'
1.0
d.
Max. Ponded Depth, inches:
12
e.
Seasonal High Water Table, fmsl-
782
f.
Planting Media Depth, feet:
3.0
g.
Cell Dimensions, feet:
141 x22
h.
Media Elevation, fmsl:
796.0
i.
Bottom Surface Area, ft2:
2,602
j.
Permitted Storage Volume, ft3:
2,165
k.
Bypass 1 Storage Elevation, fmsl:
797.0
I.
Predevelopment 1 year 24 hour:
0.253 cfs
M.
Post development 1 year 24 hour:
0.192 cfs
n.
Drawdown Time, hours:
18 .
o.
Underdrain Diameter, inches:
6..0
p
LL' `Totahnumberof plants provided:---105T
---`-
q.
Receiving Stream/River Basin:
Bear Creek 1 Ya
r.
Stream Index Number:
12-108
S. Classification of Water Body
II. SCHEDULE OF COMPLIANCE
Cell #2
1.02
37,308
7,182
23,001
23,001
0
1.0.
12-
782
3.0
82x37
799.5
2,453
2,159
800.5
0.593 cfs
0.243 cfs
18
dkin-Pee Dee
-18-(1)
'C"
1. 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.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted stormwater system functions at optimum efficiency. 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 re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The permittee shall submit to the Division of Water Quality an annual summary
report of the maintenance and inspection records for each BMP. The report
shall summarize the inspection dates, results of the inspections, and the
maintenance work performed at each inspection.
Page 2 of 6

State Stormwater Permit
Permit No. SW4090801
6. The facilities shall be constructed as shown on the approved plans. This permit
shall become void unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
7. 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.
8. 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.
9. Access to the stormwater facilities shall be maintained via appropriate recorded
easements at all times.
10. The permittee shall submit to the Director and shall have received approval for
revised _plans,_specifi_cations, and calculations prior to construction, for any
�--- modification to the approve-
dplans, including, buf- i&flimited-toy those -listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. 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.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form signed by both parties, to the
Division of Water Quality, accompanied by the supporting documentation as
listed on page 2 of the form. The approval of this request will be considered on
its merits and may or may not be approved:
Page 3 of 6

State Stormwater Permit "
Permit No. SW4090801
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves a request to transfer the permit.
3. 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 143-215.6A to 143-215.6C.
4. 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) having jurisdiction.
5. 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.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated._
_ TI1e permit may lae modified; revoked an-d-reissued-or-terminated-for cause: The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. 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
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the Vt day of September, 2009.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No. SW4090801
Davie Kidney Center
Stormwater Permit No. SW4090801
Davie County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
- :.-:- - — - (P-rojecf_ Nam e):--z._-------
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 5 of 6

State Stormwater Permit
Permit No. SW4090801
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_._ _ Tlie-outletlbypass_structure elevations are --the approved plan: T�
6
7
8
9
The outlet structure is located per the approved plans.
Trash rack is provided on the outlet/bypass structure.
All slopes are grassed with permanent vegetation, per the vegetation plan.
Vegetated slopes are no steeper than 3:1.
The inlets are located per the approved plans and do not cause short-
circuiting of the system.
The permitted amounts of surface area and/or volume have been
provided.
Required drawdown devices are correctly sized per the approved plans.
All required design depths are provided.
All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
The required system dimensions are provided per the approved plans.
M. DV'WQ Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699
Page 6 of 6

th
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. William McDonald
Davie Kidney Center of WFJ.
1804 King Road
Tifton, GA 31793
Division of Water Quality
Coleen H. Sullins
Director
September 1, 2009
Subject: Stormwater Permit No. SW4090801
Davie Kidney Center
High Density Commercial Bio-Retention Project
Davie County
Dear. Mr. McDonald: .. _
Dee Freeman
Secretary
The Stormwater Permitting Unit received a complete Stormwater Management Permit
Application for Davie Kidney Center on August 7, 2009, with additional information received on
September 1, 2009. 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
and Session Law 2006-246. We are forwarding Permit No. SW4090801, dated September 1,
2009, for the construction, operation and maintenance of the subject project and the stormwater
BMPs.
This permit shall be effective from the date of issuance until September 1, 2019, 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 inspection 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, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands are made this
permit shall be final and binding.
This project will be kept on file at the Winston-Salem Regional Office. If you have any questions,
or need additional information concerning this matter, please contact Robert Patterson at (919)
807-6375; or [e-mail].
ply,
for Coleen H. Sullins
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699.1617 1. V �TOl�tl l Ci�rO 1 r� ��
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 �aturall�
Phone: [phone] FAX: [phone] I Customer Service: 1-877-623-6748
Internet: www.ncwaterqualit .org
An Equal Opportunity 1 Atrrma5ve Acton Employer

Mr. William McDonald r
SW4090801 — Davie Kidney Center
September 1, 2009
cc: Winston-Salem Regional Office
Sue Homewood - WSRO
Central Files
SPU Files
ec: Ken Binkley - Stimmel Associates, PA
Page 2 of 2

State Stormwater Permit
Permit No. SW4090801
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
Davie Kidney Center of Wake Forest University
Davie Kidney Center
- = interstate Dr; EVlocksvilfe Davie County---—--
FOR THE
construction, operation and maintenance of 2 bioretention cells in compliance with the
provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter referred to as
the "stormwater rules') 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.
This permit shall be effective from the date of issuance until September 1, 2019, and
shall be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from 48,449 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area as indicated in Section
1.7 of this permit, and per the application documents and as shown on the
approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 6

State Stormwater Permit '
Permit No. SW4090801
7. The following design criteria have been provided in the bioretention
cells and
must be maintained at design condition:
Cell #1
Cell #2
a.
Drainage Area, acres:
0.98 :
1.02
Onsite, ft :
42,842
37,308
Offsite, ft2:
0
7,182
b.
Total Imperviou Surfaces, ft2:
25,448
23,001
Onsite, W:
25,448
23,001
Offsite, ft .
0.
0
C.
Design Storm, inches:
1.0
1.0
d.
Max. Ponded Depth, inches:
12 -
12
e.
Seasonal High Water Table, fmsl:
782
782
f.
Planting Media Depth, feet:
3.0
3.0
g.
Cell Dimensions, feet.-
141 x22
82x37
h.
Media Elevation, fmsl:
796.0
799.5
i.
Bottom Surface Area, ft2:
2,602
2,453
j.
Permitted Storage Volume-, ft3:
2,165
2,159
k.
Bypass 1 Storage Elevation, fmsl:
797..0
800.5
I.
Predevelopment 1 year 24 hour:
0.253 cfs
0.593 cfs
M.
Post development 1 year 24 hour:
0.192 cfs
0.243 cfs
n.
Drawdown Time, hours:
18 .
18
o.
Underdrain Diameter, inches:
6.0
6_0
_--_p r ---
.Total -number -of plantsWp &_ided
5
q.
Receiving Stream/River Basin:
Bear Creek
/ Yadkin
-Pee Dee
r.
Stream Index Number:
12-108-18-(1)
S.
Classification of Water Body:
.
"C"
II. SCHEDULE OF COMPLIANCE
1. 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.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted stormwater system functions at optimum efficiency. 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 re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
4. Records of maintenance activities must, be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The permittee shall submit to the Division of Water Quality an annual summary
report of the maintenance and inspection records for each BMP. The report
shall summarize the inspection dates, results of the inspections, and the
maintenance work performed at each inspection.
Page 2 of 6

State Stormwater Permit
Permit No. SW4090801
6. The facilities shall be constructed as shown on the approved plans. This permit
shall become void unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
7. 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.
B. 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.
9. Access to the stormwater facilities shall be maintained via appropriate recorded
easements at all times.
10. The permittee shall submit to the Director and shall have received approval for
—_---revised plans, specifications, and calculations prior to construction, for any
--" modification to the approved -plans, including;�but not -limited -to; those listed-
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. 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.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form signed by both parties, to the
Division of Water Quality, accompanied by the supporting documentation as
listed 'on page 2 of the form. The approval of this request will be considered on
its merits and may or may not be approved.
Page 3 of 6

State Stormwater Permit
Permit No. SW4090801
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves a request to transfer the permit.
3. 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 143-215.6A to 143-215.6C.
4. 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) having jurisdiction.
5. 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.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.__
--------- = The -permit maybe modified; revoked -and -reissued or -Terminated -for cause: The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. 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
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 1" day of September, 2009.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for uoteen H. 5unins, uirector
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No. SW4090801
Davie Kidney Center
Stormwater Permit No. SW4090801
Davie County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/
fall time) the construction of the project,
--- (P_roject-Name)—=_—�___
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification. -
Signature
Registration Number
Date
SEAL
11
Page 5 of 6

State Stormwater Permit
Permit No. SW4090801
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.
ThefoutEetibypass s6dt ireyeievations are per -the approved plan
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation, per the vegetation plan.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
cc: DWQ Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699
Page 6 of 6

(,At
State Stormwater Permit
Permit No, SW4090801
RECEIVED
N-C, Dent of 5NR
AUG 0 3 2010
Winston-Salem
Regional Crf Ce
Davie Kidney Center
Stormwater Permit No. SW4090801
Davie County
Designer's Certification
I Wilbur E. Christmas , as a duly registered Professional Engineer in the
State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
Davie Kidney Center ; Interstate Drive -, Mocksville, NC
(Project Name)
for Davie Kidney Center of WFU (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.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
-Portions of Entry Side Slopes into the cell are steeper than 3:1
Signature
Registration Number 23552
Date 7/30/10
yea°a lb 4aAROO ..
O�0l09y�9 ,C` �f
�Q�ggSEES/p�.�9 P
S�tL�t'9l
023552
C;
HGINO.�.���:�
Page 5 of 6

*$a
oeafar)oms
State Stormwater Permit
Permit No. SW4090801
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,except portions of Driveway
✓ 4. All roof drains are located such that the runoff is directed into the system.
_ Z 5. The outlet/bypass structure elevations are per the approved plan.
✓ 6. The outlet structure is located per the approved plans.
NIA 7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation, per the vegetation plan.
4( 9. Vegetated slopes are no steeper than 11.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the.:system.
11. The permitted amounts of surface area and/or volume have been
provided.
NIA 12. Required drawdown devices are correctly sized per the approved plans.
✓ 13. All required design depths are provided.
NIA
✓ 14. All required parts of the system are provided, such as a vegetated shelf
and a may. NIA
15. The required system dimensions are provided per the approved plans.
CC' DWQ Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699
Page 6 of 6

Compliance Inspection Report
Permit: SW4090801 Effective: 09/01/09 Expiration: 09/01/19 Owner: Davie Kidney Center of Wake Forest University
Project: Davie Kidney Center
County: Davie Interstate Dr
Region: Winston-Salem
Mocksville NC 27028
Contact Person: Ken Binkley Title: Phone: [phone]
Directions to Project:
Type of Project: State Stormwater - HD - Bioretention
Drain Areas: 001 - (Bear Creek) (03-07-06 ) ( C)
002 - (Bear Creek) (03-07-C6 ) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 03122/2011 Entry Time: 02:00 PM
Primary Inspector: Sue L Homewood
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: ® Compliant 0 Not Compliant
Question Areas:
® State Stormwater
(See attachment summary)
Exit Time: 02:30 PM
Phone: [phone]
Inspection Type: Compliance Evaluation
Page: 1

Permit: SW4090801 Owner - Project: Davie Kidney Center of Wake Forest University
Inspection Date: 03/22/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Built Upon Area Yes No NA NE
Is the site BUA constructed as per the permit and approval plans? ■ In In n
Is the drainage area as per the permit and approved plans? ■ n n n
Is the BUA (as permitted) graded such that the runoff drains to the system? ■ n n n
Comment:
SW Measures
Yes
No
NA
NE
Are the SW measures constructed as per the approved plans?
■
n
n
n
Are the inlets located per the approved plans?
n
n
n
■
Are the outlet structures located per the approved plans?
n
n
❑
■
Comment:
Other Permit Conditions
Yes
No
NA
NE
Is the site compliant with other conditions of the permit?
■
n
In
n
Comment:
Other WQ Issues
Yes
No
NA
NE
Is the site compliant with other water quality issues as noted during the inspection?
■
n
In
n
Comment
Page: 2

Fi 6
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM
Director
October 29, 2013
CERTIFIED MAIL 47013 1710 0002 1865 7614
RETURN RECEIPT .UQUESTED
Mr. William McDonald
Davie Kidney Center of WFU
1804 King Road
Tifton, GA 31793
Subject: NOTICE OF INSPECTION
Davie Kidney Center
Permit No. SW4090801
Davie County
Dear Mr. McDonald:
Pat McCrory, Governor
John E. Skvarla, III, Secretary
On October 29, 2013, Aana Taylor -Smith of the Winston-Salem Regional Office of the Division of Energy,
Mineral, and Land Resources (DEMLR) inspected the Davie Kidney Center site in Davie County to determine
compliance with Stormwater Management Permit Number SW4090801 issued on September 1, 2009. DEMLR
site inspection and subsequent File review revealed that the site is not compliant with the terms and conditions of
this permit. The following items were noted during the inspection and file review:
I . The slopes near both bioretention cells need minor re -seeding to prevent potential erosion into the
treatment area.
2. Grass clippings and other debris should be kept out of the mulch in both bioretention cells. Please remove
grass ciippings that have accumulated in the mulch.
3. In bioretention cell #2, grass clippings are clogging the rip -rap near the inlet pipe. Please remove grass
clippings and other debris from rip -rap.
Please refer to the Sand Filter Operation and Maintenance Agreement and/or NC DENR Stormwater Best
Management Practices (BMP) Manual for guidance. The BMP Manual can be found at the following website:
.http://portal.nedenr.org/, eb/w /q ws/sti/btnp-manual
All necessary repairs should be conducted within 30 days of receiving this letter. DEMLR staff will conduct a
follow-up inspection at that time. Please find a copy of the completed form entitled "Compliance Inspection
Report" attached to this letter.
Please be advised that you are required to comply with the terms, conditions and limitations of your Stortnwater
Management Permit under Title 15A North Carolina Administrative Code 21-1 .1003 and North Carolina General
Statute 143-214.7, including operation and maintenance of your permitted stormwater system.
Winston-Salem Regional Office
585 Waughtown Street, Winston-Salem, NC 27101 . Phone: [phone] FAX: [phone]

Davie Kidney Center
October 29, 2013
Page 2 of 2
If the project has changed name, ownership or mailing address, a formal change of name/ownership form must be
submitted to DEMLR within 30 calendar days detailing the change. Please provide the name, mailing address and
phone number of the person or entity that is now responsible for this permit.
Thank you for your assistance and cooperation during this inspection. Please be advised that violations of the
Stormwater Management Permit may be subject to a civil penalty assessment of up to $25,000.00 per day
for each violation. if you have any questions, comments, or need assistance with understanding any aspect of
Your permit, please do not hesitate to contact Aana Taylor -Smith, Sue White, or me at (336) 77 i-5000.
Enclosure: Compliance Inspection Report
cc: WSRO Files
DWR Central Files
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
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Compliance Inspection Report
Permit: SW4090801 Effective: 09/01/09 Expiration: 12/30/21 Owner: Davie Kidney Center of Wake Forest University
Project: Davie Kidney Center
County: Davie
Interstate Dr
Region: Winston-Salem
Contact Person: Ken Binkley Title:
Directions to Project:
Type of Project: State Stormwater - HD - Bioretention
Drain Areas: 001 - (Bear Creek) (03-07-06 ) ( C)
002 - (Bear Creek) (03-07-06 ) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 1012912013 Entry Time: 09:57 AM
Primary Inspector: Aana Taylor -Smith
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: 0 Compliant ® Not Compliant
Question Areas:
® State Stormwater
(See attachment summary)
Mocksville NC 27028
Phone: [phone]
Exit Time: 10:17 AM
P h one: 336-771-5000
Inspection Type: Compliance Evaluation
Page: 1

Permit: SW4090801 Owner - Project: Davie i<idney Center of Wake Forest University
Inspection Date: 10/29/2013 Inspection Type: Compliance Evaluation Reason for visit: Routine
Inspection Summary:
Please re -seed bare spots on slopes near both cells. Both cells have grass clippings washed into mulch - please remove.
Clean out grass clippings in rip -rap near inlet pipe in cell #2. Otherwise, measures look very good and are
well -maintained.
File Review
Yes
No NA
NE
Is the permit active?
El ❑
❑
Signed copy of the Engineer's certification is in the file?
®❑
❑
❑
Signed copy of the Operation & Maintenance Agreement is in the file?
®❑
❑
❑
Copy of the recorded deed restrictions is in the file?
❑ n
n
Comment:
Built Upon Area Yes No NA NE
Is the site BItA constructed as per the permit and approvaf plans? ®❑ ❑ fl
Is the drainage area as per the permit and approved plans? ❑ ❑ ❑
Is the BUA (as permitted) graded such that the runoff drains to the system? ®❑ rl ❑
Comment:
cteF V.. Mn N❑ NF
Are the SW measures constructed as per the approved plans? ®❑ fl ❑
Are the inlets located per the approved plans? ®❑ ❑ ❑
Are the outlet structures located per the approved plans? IN ❑ ❑
Comment:
Operation and Maintenance Yes No NA NE
Are the SW measures being maintained and operated as per the permit requirements? ❑ Eq 111 ❑
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ ❑ ❑ D EM
upon request?
Comment: Please re -seed bare spots on slopes near both cells. Both cells have grass
clippings washed into mulch - please remove. Clean out grass clippings in rip -rap near
inlet pipe in cell #2. Otherwise, measures look very good and are well -maintained.
Other Permit Conditions
Is the site compliant with other conditions of the permit?
Comment:
Other WQ Issues
Is the site compliant with other water quality issues as noted during the inspection?
Comment:
Yes No NA NE
rM❑❑❑
Yes No NA NE
M 0 0 0
Page: 2

i .q
State Stormwater Inspection Report
General
Project Name: j:>GIVi-e 1Lid �-Enter
ation Date:
Contact Person: In V.t
Phone Number: I LS - t pLo-1
inspection Type: G E t
Inspection Date: 21'► f IS
Time In: C)g 57
Time Out: i o 1 �
Current Weather: 0 g 0,yCnCi-, I Uvj U 0 S
Recent Rain (Date)?
Rain - in
Location
Facility Address 1 Location: n}� S-j-oL D.r.
City: jV1oGtLSVille Zip;o2E'� County: Lat: "N Long: -
"W
y Da v i2
Permit Information
Rule Subject to (circle one): 1989 Coastal Rule 1995 Coastal Rule 2008 Coastal Rule Session Law 2006-246
Goose Creek High Quality Waters Outstanding Resource Waters
Density (circle one): High (H Low (LD)
Stormwater Best Management Practices (I3M Ps) (insert number of ecrcl�):
Wet Ponds infiltration Basins Infiltration Trenches
Dry Ponds Bioretention eelts Permeable Pavement
Cistern Level Spreader/Filter Strip Other (specrfj):
File Review
LD Swales Stormwater Wetlands
Sand filters (circle one) Open Closed
Yes No NIA NIE
1. Is the permit active?
2. Signed f,n,,,ineer's Certification on file?
t/
3. Signed Operation and Maintenance agreement on file?
4. Recorded Deed Restrictions on file?
✓
Site Visit- guilt Unen Area MUM
ttYe�� ►17.Ih_=. UM
5. BUA is constructed and consistent with the permit requirements?
6. BUA (aspermitted) is graded such that the runoff drains to the system? (high density only)
7. Drainage area is consistent withpermit? i.e. no un ermitted drainage to the SW BMPs)
8. Drainage area is stabilized? to reduce risk of sedimentation to the SW BMPs)
t/
Site Visit: Stormwater BMPs
Yes No NIA NIE
9. Stormwater BMPs are located per the approvedplans?
10. Stormwater BMPs have dimensions (e g. length, width, area) matching the approvedplans?
1 I . Stormwater BMPs are constructed pSr the approvedplans?
/
Site Visit: Ooeration and Maintenance
Yes No NIA NIE
12. Access points to the site are clear and well maintained?
13. Trash has been removed as needed?
14, Excessive landscape debris (grass clippings, leaves, etc) is controlled?
15. Stormwater BMPs being operated and maintained as per the permit requirements?
16. Inspection and Maintenance records are available for inspection? (high density only, 1995 - present only)
Site Visit: Other Permit Conditions Yes No NIA NIE
17. Is the site compliant with other conditions of thepert-nit? c/
Site Visit: Other Water Quality Issues Yes No NIA NIE
18. Is the site compliant with other water quality issues as noted during the inspection?
State Stornmvater Inspection Report, Version 3.0_3-09 Page I o1'2

State Stormwater inspection Report
IZe- s-e Ce! +1
CP It # t S C-UPP�ncy' w"1S►1A vvj ih-ry rv"-tAAUrttA av'e"l
C_1e0LA 1 t) LA_t q V_CtSS Ci ! p i S Otis -t > � j Yip - re'_p A_)� ` C0- t i 2
otkeXw i 5 P_ , V - O ate S y� jrZ p_ w-el11 ' YytZL4 tits ZLA Yv A
ctures (some of the pictures taken during the site
Compliance Status Compliant ❑ Non -Compliant
Letter Sent (circle one) No No Letter type'. NOV NOVRE Other
Date Sent: Reference Number:
Inspector Name and Signature: tSgYjQ TGU1Dr Date: jig 129 I 1
State Storniwater Inspection Report, Version 3.0_3-09 Page 2 of 2

BIORETENTION CELL: O & M Inspection Checklist
J_ INLET and PERIMETER
1. Inlet and Perimeter are free of erosive gullies and bare soil areas:
2
❑
❑
❑
2. Inlet device (swale, pipe, stone verge) is free of erosion, damage or clogs:
12"
❑
❑
❑
3. Weir heights appear to match approved plans:
❑'�
❑
❑
❑
PRETREATMENT
4. Flow is entering pretreatment area (not being bypassed):
E(
❑
❑
❑
5. Pretreatment area is free of erosion:
a
❑
❑
❑
6. Pretreatment area is free of excessive sediment or clogs:
a
❑
❑
❑
MAIN TREATMENT AREA
7. Side slopes are 3:1 or less:
❑'
❑
❑
❑
8. The under drain system is free flowing and free of clogs (if applicable):
❑
❑
❑
9. Cleanout(s) and cap is provided for the under drain as per the approved plans:
❑
❑
❑
10. Heavy equipment has not been driven into the cell:
[]�
❑
❑
❑
11. Surface is free of piles of heavy materials (piles of mulch, etc):
[a
❑
❑
❑
12. Ponding depth is 9-12 inches after rain:
❑" r
❑
❑
❑
13. All dimensions are >=10ft.:
12�
❑
❑
❑
SOXL/MULCH and VEGETATION
14. Plants are healthy and being maintained:
[]/
❑
❑
❑
15. The proper amount and type of vegetation is present in the cell:
R
❑
❑
❑
16. Mulch is in good condition (has not broken down or floated/ migrated towards the outlet):
('
❑
❑
❑
17. Surface if free of excessive sediment and clogs:
a
❑
❑
❑
18. Trees are free of stakes/wires > 6 months after planting:
Ea'
❑
❑
❑
19. The annual soil test shows the proper pH and absence of heavy metal accumulation:
❑
❑
0
[�
OUTLET
20. Outlet is free of evidence of improper drainage (no standing water, cattails, etc.):
❑
❑
❑
21. Outlet device (drop inlet, weir, etc.) is free of damage or clogs:
12`
❑
❑
❑
22. Orifice size matches approved plans:
D
❑
❑
❑
23. Outlet is free of damage, clogs, or erosion:
❑`
❑
❑
❑
24. Relative elevations match approved plans:
a
❑
❑
❑
V3.3_09

Permit Number: Sk/109 OglOI
(to be p -ovided by DWQ)
Drainage Area Number: _I Z
Bioretention Operation and Maintenance Manual
Davie Kidney Center
Interstate Rd.
Mocksville, NC
Owner to keep a maintenance record on this BMP. This maintenance record will be kept in
a log in a known set location. Any and all maintenance shall be documented in this log. Any
deficient BMP elements noted in the inspection will be corrected, repaired or replaced
immediately. These deficiencies can affect the integrity of structures, safety of the public,
and the removal efficiency of the BMP. Please keep a copy of this manual with the
maintenance log for reference. Any other problems or general questions about
Bioretention cells can be addressed at NC Division of Water Quality; Winston-Salem
Regional Office [phone].
Important operation and maintenance procedures:
-Immediately after the bioretention cell is established, the vegetation will be
watered twice weekly if needed until the vegetation become established
(commonly sic weeks).
-Snow, mulch or any other material will NEVER be piled on the surface of the
bioretention cell.
-Heavy equipment will NEVER be driven over the bioretention cell.
-Special care will be taken to prevent sediment from entering the bioretention cell.
-Once a year, a soil test of the soil media will be conducted.
After the bioretention cell is established, the owner or owner's representative will
inspect it once a month and within 24 hours after every storm event greater than 1.0
inches (or 1.5 inches if in a Coastal County). Records of operation and maintenance
will be kept in a known set location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately:
BIVLP element:
Potentialproblems:
How I will remediate the
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
bioretention cell
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.

SNIP element:
Potential problems:
How I will remediate the
roblem
The inlet device: pipe.
The pipe is clogged (if
Unclog the pipe. Dispose of the
stone verge or swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
The pretreatment area
Flow is bypassing
Regrade if necessary to route all
pretreatment area and/or
flow to the pretreatment area.
gullies have formed.
Restabilize the area after grading.
Search for the source of the
sediment and remedy the problem
if possible,
Sediment has accumulated to
Remove the sediment and
a depth greater than three
restabilize the pretreatment area.
inches.
Erosion has occurred.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems._
The bioretention cell:
Best professional practices
Prune according to best
vegetation
show that pruning is needed
professional practice
Weeds are Present
Remove the weeds, preferably by
hand
Tree stakes/wires are present
Remove tree stake/ wires
six months after planting.
(which can kill the tree if not
removed).
The bioretention
Mulch is breaking down or
Spot mulch if there are only
cell: soils and
has floated away.
random void areas. Replace whole
mulch
mulch layer if necessary. Remove
the remaining much and replace
with triple shredded hard wood
mulch at a maximum depth of
three inches.
Soils and/or mulch are
Determine the extent of the
clogged with sediment.
clogging - remove and replace
either just the top layers or the
entire media as needed. Dispose of
the spoil in an appropriate off -site
location. Use triple shredded hard
wood mulch at a maximum depth
of three inches. Search for the
source of the sediment and
remedy the problem if possible.

BtNIP element:
Potential Problems:
How I will remediate the problem
The bioretention
An annual soil test shows
Dolomitic lime shall be applied as
cell: soils and mulch
that pH has dropped or
recommended per the soil test and
heavy metals have
toxic soils shall be removed, disposed
accumulated in the soil
of properly and replaced with new
media.
planting media.
The underdrain system
Clogging has occurred.
Wash out the underdrain system.
(if applicable)
The drop inlet
Clogging has occurred.
Clean out the drop inlet. Dispose of
the sediment off -site.
The drop inlet is damaged
Repair or replace the drop inlet.
Contact the NC Division of Water
The receiving water
Erosion or other signs of
damage have occurred at
Quality 401 Oversight Unit at 919-
the outlet.
733-1786

Permit Number: 5KI1'0 )'DTOI
(to be provided by DfVQ)
I acknowledge and agree by my signature below that I am responsible for the performance of
the 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.
Project name: ) ; `L f Y1 C 4"--
BMP drainage area number: 1 Z
Print name: k j�l�" c 1 0
Title: t/ vtn
Address: % C�
Phone: r o
Signature:
Date: � _ ,� / • �
Note: The legally responsible party should not be a homeowners association unless more than 301"a of
the lots have been sold and a resident of the subdivision has been named the president,
Il&(A- fYMdrI CkS , a Notary Public for the State of
County of _ 7do herebv certify that
W 11, ( Y1(C personally appeared before me this SY
day of 13AI Lk -24A , and acknowledge the due execution of
the forgoing bior ention maintenance requirements. Witness my hand and official seal,
SEAL
IMy commission expires C 4 �/

D ONLY
Date 5eceived
Fee Paid
Number
l�Permit
State of North Carolina
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
1. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
Davie Kidnev Center of Wake Forest Universi
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
William McDonald, VP of Research and Development
3. Mailing Address for person listed in item 2 above:
1804 Kin! Rd.
City:`I'ifton State:GA Zip:31793
Phone: (229 ) 386-5505 ext 107 Fax: (229 } 382-6167
Email:william@healths,ystemsinc.com
4. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Davie Kidney Center _
5. Location of Project (street address):
City:Mocksville County:Davie Zip:
6. Directions to project (from nearest major intersection):
Head Northwest on Hwy 601 from Hw,.y 601, Interstate 40 Intersection (exit # 170) , take left on Interstate
drive, property on right about a quarter mile from 601 / Interstae Drive Intersection
7. Latitude:35° 55' 27" N Longitude:80° 35' 53" W of project
8. Contact person who can answer questions about the project:
Name:Ken Binklev Telephone Number: (336 ) 723-1067
Email:kbinkle,,,@stimrnelpa.com
11. PERMIT INFORMATION:
Form SWU-101 'Version 09.25.08 Page I of 4

j 1. Specify whether project is (check one): ®Newv ❑Renewal ❑Modification
2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number and its issue date (if known)
3. Specify the hype of project (check one):
❑Low Density ❑High Density ❑Redevelop ®General Permit ❑Universal SMP ❑Other
4. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ❑Sedimentation/Erosion Control 7404/401 Permit ❑NPDES Industrial Stormwater
ICI. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project.
Stormwater will be treated by wav of two bioretention cells
2. Stormwater runoff from this project drains to the Yadkin River basin.
3. Total Property Area: 2.80 acres 4. Total Coastal Wetlands Area: N/A acres
5. Total Property Area (3) - Total Coastal Wetlands Area (4) = Total Project Area**:2.80 acres
6. (Total Impervious Area / Total Project Area) X 100 = Project Built Upon Area (BUA):42 %
7. How many drainage areas does the project have?2
S. 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.
For high densih, vroiects, complete the table with one drainage area for each engineered stormwater device.
,Basin Itiform' lion L
Drainage`Area 1
Drainage Area
Receiving Stream Name
Bear Creek
Bear Creek
Stream Class & Index No.
C & 12-108-18-(1)
C & 12-108-18-(1)
Total Drainage Area (so
42842
44490
On -site Drainage Area (sf)
42842
37308
Off -site Drainage Area (sf)
0
7182
Existing Impervious* Area (so
0
0
Proposed Impervious*Area (so
25448
23001
% Impervious* Area (total)
59.4
51.7
Impervious Surface.Area
Drainage�Area 1' ,r
�.Drai.naOeArea 2.
On -site Buildings (so
0
13190
On -site Streets (so
0
0
On -site Parking (so
24786
9171
On -site Sidewalks (so
662
640
Other on -site (st)
0
Off -site (so
0
Total (so:
25448
23001
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 09.25.09 Page 2 of

1 **Total project area shall be calculated to exclude Coastal Wetlands from rise when calculating the built upon area
percentage calculation. This is the area used to calculate overall percent project built upon area (BUA).
9. How was the off -site impervious area listed above derived?Autocad Area Function
Projects in Union County: Contact the DIVQ Central Office staff to check to see if you project is located
vvithin a Threatened & Endangered Species watershed that niai- be subject to more stringent storm water
requirements.
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
One of the following property 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.
Forms can be downloaded from littp:j h2o.enr.state.nc.us/su/bmh forms.litm - deed restrictions.
Form DRPC-1 High Density Commercial Subdivisions
Form DRPC-2 High Density Developments with Outparcels
Form DRPC-3 High Density Residential Subdivisions
Form DRPC-4 Low Density Commercial Subdivisions
Form DRPC-5 Low Densitv Residential Subdivisions
Form DRPC-6 Low Density Residential Subdivisions with Curb Outlets
By your signature below, you certify that the recorded property restrictions and protective covenants for this
project shall include all the applicable items required in the above form, 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 NC DWQ, 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 belo%v must be submitted for each
BMP specified for this project. Contact the Stormwater Permitting Unit at [phone] for the status and
availability of these forms. Forms can be downloaded from 1-ittp://h2o.enr.state.nc.us/sLi/bmp f0rm5.h1111.
Form SW401-Low Density
Form S1111401-Curb Outlet Svstem
Form SW401-Off-Site Svstem
Form SW401-Wet Detention Basin
Form S11\1401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-Level Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Form SW401-Permeable Pavement
Form SW401-Cistern
Lowy Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
Permeable Pavement Supplement
Cistern Supplement
Form S11'U-101 Version 09.25.08 Page 3 of

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 Office. (Appropriate office may be found by locating project on the
interactive online map at httl2://l12o,enr.state.nc.us/su/nisi maps.htm)
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 Stormwater Management Permit Application Form
• Original and one copy of the Deed Restrictions & Protective Covenants Form (if
required as per Part IV above)
• Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP
• Permit application processing fee of $505 (Express: $4,000 for HD, $2,000 for LD)
payable to NCDENR
• Calculations & detailed narrative description of stormwater treatment/management
• Copy of any applicable soils report
• Two copies of plans and specifications (sealed, signed & dated), 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)
VIL AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf (such as additional information requests), please complete this section. (ex. designing engineer or firm)
Designated agent (individual or firm):Stimmel Associates, PA
Mailing Address:601 N. Trade St. Suite 200
Citv:Winston-Salem State:NC Zip:27101
Phone: [phone] Fax: [phone]
Email: kbinkley®stimmelpa.com
VIII. APPLICANT'S CERTIFICATION
I, (print or type name of person Iisted in General Information, item 2) William McDonald
certify that the information included on this permit application form is, to the best of my kno,.vledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of 15A
NCAC 21-1.1000. 1 A
Signature:
Date: 7_3/ i2Cfo �
Form SWU-101 Version 09.25.08 Pav-e 4 of 4

Permit Number. 5W-i 0 `0 VJ
(to be pmvrded by pwO)
oaflp WA7FgoG
MEW Y
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted along with all of the required information.
I. PROJECT INFORMATION
Project name Davie Kidney Center
Contact name Ken Binkley
Phone number 336-723-1067
Date July 6, 2009
Drainage area number 1
II. DESIGN INFORMATION
Site Characteristics
Drainage area
42,842 ft2
Impervious area
25,448 ft2
Percent impervious
59.4% %
Design rainfall depth
1.0 inch
Peak Flow Calculations
Is prelpost control of the 1-yr, 24-hr peak flow required?
y (Y or N)
1-yr, 24-hr runoff depth
2.77. in
1-yr, 24-hr intensity
0.12 in/hr
Pre -development 1-yr, 24-hr peak flow
0.253 ft3lsec
Post -development 1-yr, 24-hr peak flow
0.192 ft3lsec
Pre/Post 1-yr, 24-hr peak control
-0.061 ft3/sec
Storage Volume: Non -SA Waters
Minimum volume required
2,098.0 ft3
Volume provided
2,165.0 ft3
OK
Storage Volume: SA Waters
1.5' runoff volume
ft3
Pre -development 1-yr, 24-hr runoff
ft3
Post -development 1-yr, 24-hr runoff
ft3
Minimum volume required
0 ft3
Volume provided
ft3
Cell Dimensions
Ponding depth of water
12 inches
OK
Ponding depth of water
1,00 ft
Surface area of the tap of the bioretention cell
2,602.0 ft'
OK
Length:
141 ft
OK
Width:
22 ft
OK
-or- Radius
ft
Media and Soils Summary
Drawdown time, ponded volume
6 hr
OK
Drawdown time, to 24 inches below surface
12 hr
OK
Drawdown time, total:
18 hr
In -situ soil:
Soil permeability
2,00 inlhr
OK
Planting media soil.
Soil permeability
2.00 in/hr
OK
Soil composition
% Sand (by weight)
85%
OK
% Fines (by weight)
10%
OK
410 Organic (by weight)
5%
OK
Total: 100%
Phosphorus Index (P-Index) of media
30 (unitless)
OK
Form SIN401-Rioretention-Rev.7 Parts I and II. Design Summary, Page 1 of 2

A Permit Number:
(to be provided by DWO)
Basin Elevations
Temporary pool elevation
797,00 fmsl
Type of bioretention cell (answer "Y" to only one of the two
following questions):
Is this a grassed cell?
(Y or N)
Is this a cell with treesishrubs?
y _,(Y or N) OK media depth
Planting elevation (top of the mulch or grass sod layer)
796 fmsl
Depth of mulch
2 inches OK
Bottom of the planting media soil
793 fmsl
Planting media depth
3 It
Depth of washed sand b0ow planting media soil
It
Are underdrains being installed?
y (Y or N)
How many clean out pipes are being installed?
3
OK
What factor of safety is used for sizing the underdrains? (See
10
OK
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
1 ft
the bottom of the cell to account for underdrains
Bottom of the cell required
792 fmsl
SHWT elevation
782 fmsl
Distance from bottom to SHWT
loft
OK
Planting Plan
Number of tree species
10
Number of shrub species
3
Number of herbaceous groundcover species
3 OK
Additional Information
Does volume in excess of the design volume bypass the
y (Y or N}
OK
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
n (Y or N)
Excess volume must pass through filter.
through a vegetated filter?
What is the length of the vegetated filter?
0 ft
Does the design use a level spreader to evenly distribute flow?
n (Y or N)
Show how flow is evenly distributed.
Is the BMP located at least 30 feet from surface waters (50 feet if
y (Y or N)
OK
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
y (Y or N)
T
OK
Are the vegetated side slopes equal to or less than 3:1?
y (Y or N)
OK
Is the BMP located in a proposed drainage easement with access
y (Y or N}
OK
to a public Right of Way (ROW)?
intet velocity (from treatment system)
458 ft/sec
Insufficient inlet velocity untess energy dissipating devices are
being used.
Is the area surrounding the cell likely to undergo development in
n (Y or N)
OK
the future?
Are the slopes draining to the bioretention cell greater than 20%?
n (Y or N)
OK
Is the drainage area permanently stabilized?
y (Y or N)
OK
Pretreatment Used
(Indicate Type Used with an "X" in the shaded cell)
Gravel and grass
(8'lnches gravel followed by 3-5 ft of grass}
Grassed swale
#VALUE!
Forebay
Other
x
Form SVJ461-8ioretention-Rev.7 Parts I and II. Design Summary, Page 2 of 2

Permit Number: LIA `! 0 ! )O Q/
{to be provided by DWQ)
�°� wargRo
HCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted along with all of the required information.
I. PROJECT INFORMATION
Project name Davie Kidney Center
Contact name Ken Binkley
Phone number 336-723.1067
Date July 6, 2009
Drainage area number 2
II. DESIGN INFORMATION
Site Characteristics
Drainage area
44,490 ft'
Impervious area
23.001. ftz
Percent impervious
51.7% %
Design rainfall depth
1.0 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak flow required?
y (Y or N)
1-yr, 24-hr runoff depth
2.77 in
1-yr, 24-hr intensity
0.12 inlhr
Pre -development 1-yr, 24-hr peak Flow
0,593 ft3/sec
Post -development 1-yr, 24-hr peak flow
0.243 ft3lsec
Pre/Post 1-yr, 24-hr peak control
-0,350 Wisec
Storage Volume: Non -SA Waters
Minimum volume required
1,925.0 ft'
Volume provided
2,159.0 ft3
OK
Storage Volume: SA Waters
1.5" runoff volume
It
Pre -development 1-yr, 24-hr runoff
ft3
Post -development 1-yr, 24-hr runoff
ft3
Minimum volume required
0 ft3
Volume provided
ft3
Cell Dimensions
Ponding depth of water
12 inches
OK
Ponding depth of water
1.00 ft
Surface area of the top of the bioretention cell
2,453.0 ft'
OK
Length:
82 ft
OK
Width:
37 ft
OK
-or- Radius
ft
Media and Soils Summary
Drawdown time, ponded volume
6 hr
OK
Drawdown time, to 24 inches below surface
12 hr
OK
Drawdown time, total:
18 hr
In -situ soil,
Soil permeability
2.00 inrhr
OK
Planting media soil:
Soil permeability
2.00 inihr
OK
Soii composition
% Sand (by weight)
85%
OK
% Fines (by weight)
10%
OK
% Organic (by weight)
5%
OK
Total: 100%
Phosphorus Index (P-Index) of media
30 (un&ess)
OK
Form SbV401-Bioretention-Rev.7 Pars I and II. Oesign Summary. Page I of 2

�Permit Number;
(to be provided by DWQ)
Basin Elevations
Temporary pool elevation
800.50 fmsl
Type of bioretention cell (answer "Y" to only one of the two
following questions):
Is this a grassed cell?
(Y or N)
Is this a cell with trees/shrubs?
r y (Y or N) OK media depth
Planting elevation (top of the mulch or grass sod layer)
799.5 fmsl
Depth of mulch
2 inches OK
Bottom of the planting media soil
796,5 fmsl
Planting media depth
3 ft
Depth of washed sand below planting media soil
ft
Are underdrains being installed?
y (Y or N)
How many clean out pipes are being installed?
6
OK
What factor of safety is used for sizing the underdrains? (See
10
OK
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
1 ft
the bottom of the cell to account for underdrains
Bottom of the cell required
795.5 fmsl
SHWT elevation
782 fmsl
Distance from bottom to SHWT
13.5 ft
OK
Planting Plan
Number of tree species
0
Number of shrub species
3
Number of herbaceous groundoover species
3
OK
Additional Information
Does volume in excess of the design volume bypass the
y (Y or N)
OK
bioretention cell?
Does volume in excess of the design volume Flow evenly distributed
n (Y or N)
Excess volume must pass through filter.
through a vegetated filter?
What is the length of the vegetated filter?
0 ft
Does the design use a level spreader to evenly distribute flow?
n (Y or N)
Show how Flow is evenly distributed.
Is the BMP located at least 30 feet from surface waters (50 feet if
, y '(Y or N)
OK
SA waters)?
Is the BMP localed at least 100 feet from water supply wells?
y (Y or N)
Ot<
Are the vegetated side slopes equal to or less than 3:1?
y (Y or N)
OK
Is the BMP located in a proposed drainage easement with access
y (Y or N)
OK
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
4.06 ft/sec
Insufficient inlet velocity unless energy dissipating devices are
being used.
is the area surrounding the cell likely to undergo development in
n (Y or N)
OK
the future?
Are the slopes draining to the bioretention cell greater than 20%? n (Y or N) OK
Is the drainage area permanently stabilized? y (Y or N) OK
Pretreatment Used
(Indicate Type Used with an "X" in the shaded cell)
Gravel and grass
(8inches gravel followed by 3-5 ft of grass)
Grassed swale #VALUE!
Forebay
Other x
Form SW461-8ioretention-Rev.7 Parts I and IL Design Summary. Page 2 of