SW4100701_CURRENT PERMIT_20100908

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW o l���l`Jl
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYMMDD

r�
�Ml
NC®ENR
North Carolina Department of Environment and Natural
Beverly Eaves Perdue
Governor
Mr. Di id Coe
1648 R:•..-ebud Road
Walnut Cove, North Carolina 27052
Division of Water Quality
Coleen R Sullins
Director
August 2, 2010
Subject Stormwater Permit No. SW4100701
Lori O. Coe, MD Office Building
High Density Commercial Bioretention Project
Forsyth County
Dear Mr. Coe:
RECEIVED
N.0 Dwry
SEP 0 8 2010
winston'a.
Regional O�lcu
Dee Freeman
Secretary
The ';:c: r. water.PerT13itting Unit received a complete Stormwater Management Permit Application for the Lori 0.
Coe, MD Office Building project on July 29, 2010. Staff review of the plans and specifications has determined `hat
the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000 and
Session L .w 2006-246. We are forwarding Permit No. SW4100701, dated August 2, 2010, for the construction,
operation and maintenance of the subject project and stormwater BMPs.
This permit shall be effective from the date of issuance until August 1, 2020, and shall be subject to the
conditior :::ncl limitations as specified therein. Please pay special attention to the Operation and Maintenance
requirempnts in this permit. Failure to establish an adequate system for inspection and maintenance of the
stormwat,r 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 1506 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 questions or need additional
information concerning this matter, please contact Cory Larsen at [phone] or.cory,[e-mail]..
Sincerely,
w
forColeen H. Sullins
cc: Winston-Salem Regional Office
.Central Files
Mr. Kevin uavie, PE, Allied Design, Inc, 4720 Kester. Mill Road, Winston-Salem, North Carolina 27103.
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1611 NQ] t�lCdi O� ]j]il
Location; 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1.877-623-6748 J/VatI14WIlJ
Internet: www.ncwaterquality.org
An Equal Opportunity 4 Affirmative Action Employer

State Stormwater Permit
Permit No.SW4100701
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
David & Lori Coe (Permittee) .
Lori O. Coe, MD Office Building (Project)
North Ridge Park Drive, Rural Hall, Forsyth County
FOR THE
construction, operation and maintenance of a bioretention cell in compliance with the provisions of
15A NCAC 2H'1000 and S.L. 2006-246 (hereafter referred to as the "storm water 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 August 1, 2020, 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 1.6 of this permit. The-stormwater controls have been designed to handle
runoff from a maximum of 51,014 square feetof impervious area.
3. The tract will be limited to the amount of built -upon area indicated above and per 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. Runoff from all new built -upon area within the permitted drainage areas of this project must be
directed into the permitted stormwater control systems.
6. The following design criteria have been provided and must be maintained at design condition:
a. Bioretention Cell for drainage area #1 as per the attached approved Bioretention Cell
Supplement dated June 24, 2010 and approved August 2, 2010,
Page 1 of 6

State Stormwater Permit
Permit No.SW4100701
b. Receiving Streams/River Basin: Beaver Dam Creek 1 Yadkin - Pee Dee River Basin
Stream Index Numbers: ; - 12-94-2
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 times- provide tho operation and maintenance necessary to assure
the permitted stormwater system functions at optimum efficiency. The approved Operation
and Maintenance Plan must be f6llow(-..,�) in its entirety and maintenance must occur at the
scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and vegetated filter.
d. Immediate repair of eroded ar las.
e. Maintenance of all slopes in accordance with approved plans and specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow spreader, catch
basins and piping.
g. Access to the outlet structure,must be available at all times.
4. Records of maintenance activities must be kept and made available upon request to
authorized personnel of DWQ.. The records will indicate the date, activity, name of person
performing the work and what actions were taken.
The facilities shall be constructed as shown on the approved plans. This permit -shall become
voidable unless the facilities are constn:::ted in accordance with the conditions of this permit,
the approved plans and specifications, and other supporting data.
6.' Upon completion of construction, prior to issuance of a Certificate of Occupancy, and prior to
operation of this permitted facility, a certification must be received from an appropriate
designer for the system installed certifying that the permitted facility has been installed in
accordance with this permit, the -approved plans and specifications, and other supporting
documentation. Any deviations from the approved plans and specifications must be noted on
the Certification. A modification may be required for those deviations.
If the stormwater system was used as an Erosion Control device, it must be restored to design
condition prior to operation as a stormwater treatment device, and prior to occupancy of the
facility.
Access to the stormwater facilities shall be maintained via appropriate easements at all times.
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.
Page 2 of 6 f

State Stormwater Permit
Permit No.SW4100701
Filling in, altering, or piping of any vegetative conveyance shown on the approved
plan.
10. The permittee shall submit final site layout and grading plans for any permitted future areas
shown on the approved plans, prior to construction.
11. A copy,of the approved plans and specification; shall be maintained on file by the Permittee
° for a minimum of ten years from the date of the completion of construction.
12. 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
1. 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, to the Division of Water Quality, signed by both parties, and
accompanied by supporting documentation as listed on page 2 of the form. The project must
be in good standing with the Division. The approval of this request will be considered on its
merits and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such time as the
Division approves the transfer request.
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 hot 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
rra.t be 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.
Page 3 of 6

State Stormwater Permit
Permit No.SW4100701
11. The permittee shall notify the Division 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 211d day of August 2010.
NORTH CAROLINA ENVIRONMENTAL MANAGEMFANT COMMISSION
forColeen H. Sullins, Director
Division of Water' -Quality
By Authority of the Environmental Management Commission
0
i
Page 4 of 6

State Stormwater Permit
Permit No.SW4100701
LORI 0. COE, MD OFFICE BUILDING
Stormwater Permit No. SW4100701
Forsyth Count
Y
1
1
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,
Lori O. Coe, MD Office Building
(Project)
for (Project Owner) hereby state that, to the best of my abilities,
due rare 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
w
IL
SEAL
Page 5 of 6

State Stormwater Permit
Permit No.SW4100701 '
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 built-upcarea associated with the project is graded such that the runoff drains to
the system oc.cording to the approved plans.
4. All roof drains are located such that the runoff is'directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. All slopes are grassed with permanent vegetation.
8. Vegetated slopes are no steeper than 3:1.. .
9. The inlets are located per the approved plans -and do not cause short-circuiting of the
system. ,
10. The permitted amounts of surface area and/or volume have been provided.
11. Required drawdown devices are correctly sized per the approved plans.
12. All required.design depths are provided.
13. All'required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Winston-Salem Regional Office
Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Page 6 of 6

Permit: $W4100701 Owner - Project: David & Lori COE
Inspection Date: 03/2712012 Inspection Type: Compliance Evaluation
Inspection summary: ,
File Review
Is the permit active?
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?
Comment: no certification on file
Built Upon Area
Is the site BUA constructed as per the permit and approval plans?
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?
Comment:
Are the SW measures constructed as per the approved plans?
Are the inlets located per the approved plans?
Are the outlet structures located per the approved plans?
Comment:
Operation and Maintenance
Reason for Visit: Routine
Yes No NA NE
Yes No NA NE
Yes No NA NE
■ ❑ ❑ ❑
■QQQ
■❑❑❑
Are the SW measures being maintained and operated as per the permit requirements? Q ❑ ❑
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ ❑ ❑ ❑ ■
upon request?
Comment: new facility
Other Permit Conditions Yes No NA NE
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
■ ❑ Cl Cl
Page: 2

Compliance Inspection Report
Permit: SW4100701 Effective: 08/02/10 Expiration: 12/30/21 Owner: David & Lori COE
Project: Lori O. Coe - M.D. office Building
County: Forsyth N Rdg Park Dr
Region: Winston-Salem
Contact Person: David COE
Directions to Project:
Title: Owner
Type of Project: State Stormwater - HD - Bioretention
Drain Areas: 001 - (Beaver Dam Creek) (03-07-04) ( C)
On -Site Rep rosentative(s):
Related Permits:
Inspection Date: 03/27/2012 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 ❑ Not Compliant
Question Areas:
0 State Stormwater
(See attachment summary)
Rural Hall NC 27045
Phone:
Exit Time: 02:30 PM
Phone: [phone]
Inspection Type: Compliance Evaluation
Page: 1

X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 2) David Coe
certify that the information included on this permit application form is, to the best of my knowledge, 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 the
applicablq,stormwater rules under 15A NCAC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Signa
Date: �P 17-16
a Notary Public for the State of _r�4��i 1 . County of
C1� ��_ _ — do hereby certify that ("xtJ LL -C[02�_ personally appeared
before me this i q day of d wl e ZQ 1 D and acknow(lledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, f
VICKI J ALDLINATE
NOTARY PUBLIC
FORSYTH COUNTY
STATE OF NORTH CAROLINA
MY COMMISSION EXPIRES 5-1-2012
SEAL
My commission expires
5- 1- 2D f 2_
i
�1
Form SWU-101 Version 07July2009
Page 7 of 7

ARA&
NCDENR
Permit Number: ,Sid i /&d7V f
fro be provided by DWQ)
p��p VJ A reHOL
7 y
U 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 1l1) must be printed, filled out and submitted along with all of the required information.
Site Characteristics
Drainage area 186,195 fl'
Impervious area 51,014 ft2 Approved Stormwater Permit Documents
Percent impervious 27.4% % Construction in accordance with these documents is
w required by the stormwater permit. North Carolina
Design rainfall depth 1.0 inch rules require that the stormwater system designer
Inspect during construction: certify conformity with the
Peak Flow Calculations plans and specs; and certify compliance with the
is pre/post control of the 1-yr, 24-hr peak flow required? y (Y or N) stormwater rules. (15A NCAC 2H A 008 (j) )
1-yr, 24-hr runoff depth 2.83 in Permit # 3 VI+1 oa 701 Date e1L / o
1-yr, 24-hr intensity 0.12 in/hr by C L NC Division of Water Quality
Pre -development 1-yr, 24-hr peals flow 0.179 ft'Isec Sheet #_pPI - Z _Revision Date_sSQ
Post -development 1-yr, 24-hr peak flow 0.264 fl3lsec
Pre/Post 1-yr, 24-hr peak control 0,085 ft'lsec
Storage Volume: Non -SA Waters
Minimum volume required 4,683.0 f1'
Volume provided 4,683.0 f1' OK
Storage Volume: SA Waters ,1�{
1.5" runoff volume
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 11.4 inches OK
Ponding depth of water 0.95 ft
Surface area of the top of the bioretention cell 4,950.0 ft2 OK
Length: 30 ft OK
Width: 165 ft OK
-or- Radius ft
Media and Soils Summary
I Drawdown time, ponded volume 12 hr OK
Drawdown time, to 24 inches below surface 25.26315789 hr OKtoo* 04
R01/,4�.'���
Drawdown time, total: 37.26315789 hr ;
In -situ soil:
Soil permeability FiZBA UPt►s UripsAlt4,4 0.57 in/hr OK = Q
Planting media soit: S?L%. 50iL4 fkiy 4� A r
Soil permeability 0.95 in/hr OK '41
Soil composition �•�.'
% Sand (by weight)
OK
% Fines (by weight) 12%° OK '�0xfrst�It%0"
% Organic (by weight) 3% OK
�L
Total: 100%
Phosphorus Index (P-Index) of media 20 (unitless) OK
Form , 2009 eioretention-Rev.B Parts f and II, Design Summary, Page 1 of 2
July 30, 2009 9 7� 9

,�,
t

Permit Number: aw !tk+floi k +
(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 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
Eiavafion of the top of the upturned elbow
Separation of IWS and Surface
Planting Plan GZA7S CEO
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
(flinches gravel followed by 3-5 ft of grass)
Grassed Swale
Forebay
Other
fmsl
"�' (Y or N) OK
(Y or N)
3 fmsl
finches
l; fmsl
2.ft
lift
(Y or N)
OK
OK (1.35)
1ft
179 fmsl
tE,7fmsl
2ft OK
`ML''23 (Y or N)
"fmsl
o4vm4tl>
(Y or N) OK
(Y or N)
ft
(Y or N)
(Y or N)
(Y or N)
(Y or N)
(Y or N)
Excess volume must pass through filter. AvT 5A r+ `C%X*M
OK
OK
OK
OK Tit-
(Y or N) OK
(Y or N)
(Y or N)
Insufficient slopes for design. SLDRS f*AnC1dtft IM CA CAI
Insufficient stabilization. IT WtLL 'K 'Pie* C04V14A
OK
Form SW401-13iore1ent1on-Rev.8
July 30, 2009
Parts I and II. Design Summary, Page 2 of 2

Permit No:
(to be assigned by D WQ)
t
1
1
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.
Page! Plan
Initials Sheet No.
sw �.
419 !2!�O0
1. Plans (1" - 50' or larger) of the entire site showing:
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.
2. Plan details (1' = 30' or larger) for the bioretention cell showing:
Cell dimensions
Pretreatment system,
High Flow bypass system,
Maintenance access,
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 30
� 3. Section view of the bioretention cell (1" = 20' or larger) showing:
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, filter fabric (or choking stone if applicable), #57 stone, underdrains (if applicable),
SHWT ievel(s), and overflow structure]
U•.in�a,e"�.�5
AJI* n�4Crs•A
W LWC! MC6
IVIA
:11op
WO
5vo'M3'
W�
Form SW401-Bloretention-Rev.7
4. A soils report that is based.upon an actual field investigation, soil borings, and infiltration tests... The .
results of the soils report must be verified in the field by DWO, by completing & submitting the soils
investigation request form. County soi! maps are not an acceptable source of soils information. Ali
elevations shall be in feet mean sea level (fmsI). Results of soils tests of both the planting soil and the in
situ soil must include:
Soil permeability,
Soff composition (% sand, % fines, % organic), and
P-index.
5. A detailed planting plan (1' = 20' or larger) prepared by a qualified individual showing:
A variety of suitable species,
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.
6. An assurance that the installed system will meet design specifications upon initial operation once the
project is complete and the entire drainage area is stabilized.
7. A construction sequence that shows how the bioretention cell will be protected from sediment until the
entire drainage area is stabilized.
8. The supporting calculations (including underdrain calculations, if applicable).
9. A copy of the signed and notarized inspection and maintenance (I&M) agreement
10. A copy of the deed restriction. C n•( -juts 4 !'"V {
Part rlt, Page 1 of 1

Permit Number: S&VY(an 70 1
(to be provided by DWQ)
Drainage Area Number:__ 0%1
Bioretention Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. 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.
Important operation and maintenance procedures:
— Immediately after the bioretention cell is established, the plants will be watered
twice weekly if needed until the plants become established (commonly six
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, I 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.
BMP element:
Potentialproblems:
How I will remediate the roblem:
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.
The inlet device: pipe,
The pipe is clogged (if
Unclog the pipe. Dispose of the
stone verge or swale
a licable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
Form SW401-13ioretention O&M-Rev.3 Page I of 4

BW element:
Potentialproblems:
How 1 will remedi ate the roblem:
The pretreatment area
Flow is bypassing
Regrade if necessary to route all
pretreatment area and/or
flow to the pretreatment area.
llies have formed.
Restabilize the area after grading.
Sediment has accumulated to
Search for the source of the
a depth greater than three
sediment and remedy the problem if
inches.
possible. Remove the sediment and
restabilize the pretreatment area.
Erosion has occurred.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand.
The bioretention cell:
Best professional practices
Prune according to best professional
vegetation
show that pruning is needed
practices,
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the
dying.
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one -tune
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Tree stakes/wires are present
Remove tree stake/wires (which
six months after planqRg.
can kill the tree if not removed).
The bioretention cell:
Mulch is breaking down or
Spot mulch if there are only random
soils and mulch
has floated away.
void areas. Replace whole 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 clogging
clogged with sediment.
- remove and replace either just the
top Iayers 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
ossible.
An annual soil test shows that
Dolomitic lime shall be applied as
pH has dropped or heavy
recommended per the soil test and
metals have accumulated in
toxic soils shall be removed,
the soil media.
disposed of properly and replaced
with new planting media.
IForm SW401-Bioretention 0&M-Rev.3 Page 2 of 4

BMP element:
Potentialproblems:
How I will remediate theproblem:
The underdrain system
CIogging 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.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
outlet.
733-1786.
1 Form SW401-13ioretention O&M-Rev.3 Page 3 of 4

Penn it Number:
(to be provided by DWQ)
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 parry.
Project name:_ I-c2,-( _ eloe rn 2_ affr cc-
BMP drainage area number: I _ T
Print name: D N ti [] Co C
Title: V i te--
Address: ) 61
Signature:
Date:-7- f - Zo 10
Z 2 c5Lr
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
I, &4'86L Vr)4- S _,a Notary Public for the State of
J V WA, / I , County of u4-h , do hereby certify that
ill r�� �� __ personally appeared before me this
day of 9JI&Lj , aD I Q , and acknowledge the due execution of the
forgoing bioretention maintenance requirements. Witness my hand and official seal,
Candace Barnes
Notary Public
Forsyth County, NC
My Commission Expires April 23, 2011
a-k-1-es
SEAL
My commission expires 1
Form SW401-Bioretention I&M-Rev. 2 Page 4 of 4