SW4091201_401 Certification Application_20100216

Permit Number:
(to be provided by DWQ)
tA A
NCDENR
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 Ill) must be printed, filled out and submittod along with all of the required information.
I:}PROJECT INFORMATION. `` ' _.: i' `
�..
Project name Goodw9l Mocksvilie
Contact name Bill Haymore
Phone number 336-724-3625
Date December 11, 2009
Drainage area number 2
I! DESIGN:INF,ORMATION
i. ..:.` •pia...
Site Characteristics
Drainage area 38,768 ft2
Impervious area 28,749 ftz
Percent impervious 74.2% %
Design rainfall depth 1.0 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak flow required?
1-yr. 24-hr runoff depth
1-yr, 24-hr intensity
Pre -development 1-yr, 24-hr peak flow
Post -development 1-yr, 24-hr peak flow
Pre/Post 1-yr. 24-hr peak control
Storage Volume: Non -SA Waters
Minimum volume required
Volume provided -
Storage Volume: SA Waters
N (Y or N)
In
2.98 in/hr
fl'lsec
ft'/sec
ft'Isec
2,328.0 ft'
2,360.0 ft' OK
1.5" runoff volume ft3
Pre -development 1-yr, 24-hr runoff ft'
Post -development 1-yr, 24-hr runoff ft3
Minimum volume required 0 ft3
Volume provided ft3
Cell Dimensions
Ponding depth of water
Ponding depth of water
Surface area of the top of the bioretention cell
Length:
Width:
-or- Radius
Media and Soils Summary
Drawdown time, ponded volume
Drawdown time, to 24 inches below surface
Drawdown time, total:
In -situ soil.,
Soil permeability
Planting media soil:
Soil permeability
Soil composition
% Sand (by weight)
% Fines (by weight)
% Organic (by weight)
Phosphorus Index (P-Index) of media
Form SW401-Bioretention-Rev.3
July 30. 2009
12 inches
OK
1.00 ft
2,328.0 ft'
OK
140 ft
OK
23 ft
OK
ft
6 hr OK
18 hr OK
24 hr
0.13 inlhr Insufficient. Increase infiltration rate.
2.00 in/hr OK
85% OK
10% OK
5% OK
Total: 100%
30 (unitless) OK
Parts I and II. Design Summary, Page 1 of 2

Permit Number:
(ro be provided by QWQ)
Basin Elavations
Temporary pool elevation
Type of bioretention cell (answer "Y" to only one of the two
following questions):
Is this a grassed cell?
Is this a cell with trees/shrubs?
Planting elevation (top of the mulch or grass sod layer)
Depth of mulch
Bottom of the planting media soil
Planting media depth
Depth of washed sand below planting media soil
Are underdrains being installed?
How many clean out pipes are being installed?
What factor of safety is used for sizing the underdrains? (See
BMP Manual Section 12.3.6)
Additional distance between the bottom of the planting media and
the bottom of the cell to account for underdrains
Bottom of the cell required
SHWT elevation
Distance from bottom to SHWT
Internal Water Storage Zone (IWS)
Does the design include IWS
Elevation of the top of the upturned elbow
Separation of IWS and Surface .
Planting Plan
Number of tree species
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
through a vegetated filter?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the BMP located at least 30 feet from surface waters (50 feet if
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Are the vegetated side slopes equal to or less than 3:1?
Is the BMP located in a proposed drainage easement with access
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
Is the area surrounding the cell likely to undergo development in
the future?
Are the slopes draining to the bioretention cell greater,than 20%?
Is the drainage area permanently stabilized?
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
Forebay
Other
828.00 fmsl
Y (Y or N) OK
Y (Y or N) OK media depth
827 fmsl
0 inches Insufficient mulch depth, unless installing grassed cell.
824 fmsl
3ft
0.33 ft
Y (Y or N)
4 OK
10 OK
1 ft
822.67 fmsl
818 fmsl
4.67 ft OK
N (Y or N)
fmsl
827 ft
2
4
4 OK
N (Y or N) Excess volume must bypass cell.
N (Y or N) Excess volume must pass through filter.
ft
N (Y or N) Show how flow is evenly distributed.
Y (Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
0.5 ft/sec:
OK
N (Y or N) OK
N (Y or N) OK
Y (Y or N) OK
X
OK
Form SW401-Bioretention-Rev.8
July 30, 2009 Paris I and 11. Design Summary, Page 2 of 2

Permit Number:
(to be provided by DWQ)
o�'0E wpT �94G
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kv RA r
ti
HCDENR Y
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This form must be titled out, printed and submitted.
The Required Items Checklist (Part Itt) must be printed, filled out and submitted along with all of the required information.
I:, -PROJECT. INF0RMATI0N':r5:�. F��R_r _ W;•�
Project name Goodwill Mocksville
Contact name Bill Haymore
Phone number 336-724-3625
Date December 11, 2009
Drainage area number 1
II'DESIGN INFORMATION:%TL«r°.x_ 4`ti w s'�y_` .'"`.. + `y- iu _'� " r `�'� ":.:_ Awl ' i
Site Characteristics
Drainage area 71,874 ft2
Impervious area 40,946 tt2
Percent impervious 57.0% %
Design rainfall depth 1.0 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak flow required?
N (Y or N)
1-yr, 24-hr runoff depth
in
1-yr, 24-hr intensity
2.98 in/hr
Pre -development 1-yr, 24-hr peak flow
ft'/sec
Post -development 1-yr, 24-hr peak flow
f Isec
Pre/Post 1-yr, 24-hr peak control
ft3lsec
Storage Volume: Non -SA Waters
Minimum volume required
3,383.0 ft3
Volume provided
3,795.0 ft3
OK
Storage Volume., SA Waters
1,5' runoff volume
ft3
Pre -development 1-yr, 24-hr runoff
ft,
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
3,795.0 ft2
OK
Length:
120 ft
OK
Width:
35 ft
OK
-or- Radius
ft
Media and Soils Summary
Drawdown time, ponded volume
6 hr
OK
Drawdown time, to 24 inches below surface
18 hr
OK
Drawdown time, total:
24 hr
In -situ soil.•
Soil permeability
0.13 in/hr
Insufficient. Increase infiltration rate.
Planting media soil.,
Soil permeability
2.00 in/hr
OK
Soil 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 (unitless)
OK
Form $W401-Bioretention-Rev.8
July 30, 2009
Parts I and II. Design Summary, Page 1 of 2

Permit Number:
(to be provided by DWQ)
Basin Elevations
Temporary pool elevation
Type of bioretention cell (answer "Y" to only one of the two
following questions):
Is this a grassed cell?
Is this a cell with trees/shrubs?
Planting elevation (top of the mulch or grass sod layer)
Depth of mulch
Bottom of the planting media soil
Planting media depth
Depth of washed sand below planting media soil
Are underdrains being installed?
How many clean out pipes are being installed?
What factor of safely is used for sizing the underdrains? (See
BMP Manual Section 12.3.6)
Additional distance between the bottom'of the planting media and
the bottom of the cell to account for underdrains
Bottom of the cell required
SHWT elevation
Distance from bottom to SHWT
Internal Water Storage Zone (IWS)
Does the design include IWS
Elevation of the top of the upturned elbow
Separation of IWS and Surface
Planting Plan
Number of tree species
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
through a vegetated filter?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the BMP located at least 30 feet from surface waters (50 feet if
SA waters)?
Is the BMP located at least 100 feet from water supply wells?
Are the vegetated side slopes equal to or less than 3:1?
Is the BMP located in a proposed drainage easement with access
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
Is the area surrounding the cell likely to undergo development in
the future?
Are the slopes draining to the bioretention cell greater than 20%?
Is the drainage area permanently stabilized?
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
Forebay
Other
824.00 fmsl
Y (Y or N) OK
Y (Y or N) OK media depth
823 fmsl
0 inches Insufficient mulch depth, unless installing grassed cell,
820 fmsl
3 ft
0,33 ft
Y (Y or N)
6 OK
10 OK
1ft
818.67 fmsl
813 fmsl
5.67 ft OK
N (YorN)
fmsl
823 ft
2
4
4 OK
N (Y or N) Excess volume must bypass cell.
N (Y or N) Excess volume must pass through filter.
ft
N (Y or N) Show how flow is evenly distributed.
Y (Y or N) OK
Y (Y or N) OK
Y (Y or N) OK
Y (Y or N) OK
0.25 fVsec OK
N (Y or N) OK
N (Y or N) OK
Y (Y or N) OK
X
OK
Form SW401-Sioretention-Rev.8
July 30, 2009 Parts ! and N. Design Summary, Page 2 of 2

Permit No:
(to be assigned by DWQ)
fI IREQUIRED'rrEMS CHECKLIST..
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Pagel Pfan
Initials Sheet No.
/'("�r C — 3 5 1. Plans (1" 50' or larger) of the entire site showing:
Cht1LMIML>) Design at ultimate build -out,
Off -site drainage (if applicable),
Delineated drainage basins (include Rational C coefficient per basin),
Cell dimensions,
Pretreatment system,
High flow bypass system,
Maintenance access,
Recorded drainage easement and public right of way (ROW),••
Clean out pipe locations,
Overflow device, and
Boundaries of drainage easement,.
C-3 C 2. Plan details (1" = 30' or larger) for the bioretention cell showing:
StJ�fnl7t'$D� Dell dimensions
Pretreatment system,
High flow bypass system,
Maintenance access, s
Recorded drainage easement and public right of way (ROW),
Design at ultimate build -out.
Off -site drainage (if applicable),
Clean out pipe locations,
Overflow device, and
Boundaries of drainage easement.
Indicate the P-Index between 10 and 304� __
C ~ 3 G 3. Section view of the bioretention cell (t" = 20' or larger) showing:
C6ki5rAl rpD)- Side slopes, 3:1 or lower
Underdrain system (if applicable), and
Bioretention cell layers [ground level and slope, pre-treatment, ponding depth, mulch depth, fill media
depth, washed sand, fitter fabric (or choking stone if applicable), #57 stone, underdrain_s (if applicable),
SHWT level(s), and overflow structure]
t;EPaRT 4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
STor—tAWATfIZ results of the soils report must be verified in the field by DWO, by completing & submitting the soils
MA NA(q. investigation request form. County soil maps are not an acceptable source of soils information. All
PLA 4 . elevations shall be in feet mean sea level (fmsl). Results of soils tests of both the planting soil and the in
C5J8tM1RiD)situ soil must include:
Soil permeability,
Soil composition (% sand, % fines, % organic), and
- P index.
C- 3D 5. A detailed planting plan (1" = 24' or larger) prepared by a qualified individual showing:
C'5V60I1TfVb) - Avarietyofsuitablespecies,
Sizes, spacing and locations of plantings.
Total quantity of each type of plant specified,
-A planting detail,
The source nursery for the plants, and
Fertilizer and watering requirements to establish vegetation.
SW 0-I01 6. An assurance that the installed system will meet design specifications upon initial operation once the
C-SI aM I TUD) project is complete and the entire drainage area is stabilized.
C —3 C 7, A construction sequence that shows how the bioretention cell will be protected from sediment Lntll the
entire drainage area is stabilized.
8, The supporting calculations (including underdrain calculations, if applicable).
� tI'fTED>
SV5MI
Sy>�iTTEp 9. A copy of the signed and notarized inspection and maintenance (I&M) agreement.
�EPo�T 10. A copy of the deed restriction,
Form SW401-Bioretention-Rev.7 Part III, Page 1 of 1