SW4081201_CURRENT PERMIT_20121029

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW 4m '�lO1D/
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYMMDD

��A
NCDENR
North Carolina Department of Environment and Natural Resou
Beverly Eaves Perdue
Governor
Mr. Darrell Walker
Winston-Salem/Forsyth County Schools
1605 Miller Street
Winston-Salem, NC 27103
Division of Water Quality
Charles Wakild, P.E.
Director
October 26, 2012
Subject: Approved Plan Revision
Stormwater Permit No. SW4081201
Rural Hall Elementary School Classroom Addition
Forsyth County
Dear Mr. Walker:
N.V.De;A, Ui EN!
OCT 2 g 2912
Winston -;,aloft
Regional otfico
Dee Freeman
Secretary
The Stormwater Permitting knit received a request for a plan revision for Stormwater Management Permit
Number SW4081201 on October 25, 2012. The plan revision includes revisions to the planting plan for
bioretention cell #1; and does not change the total allowable amount of BUA on the site. It has been
determined that a formal permit modification is not required for the proposed changes. We are forwarding
you an approved copy of the revised plan for your files.
Please be aware that all terms and conditions of the permit issued on March 24, 2009 remain in full force and
effect. Please also understand that the approval of this revision to the approved plans for the subject State
Stormwater Permit is done on a case -by -case basis. Any other changes to this project must he submitted to and
approved through the Division of Water Quality prior to construction. The issuance of this plan revision does
not preclude the permittee from complying with all other applicable statutes, rules, regulations or ordinances
which may have jurisdiction over the proposed activity, and obtaining a permit or approval prior to
construction.
If you have any questions, or need additional information concerning this matter, please contact Robert
Patterson at [phone]; or [e-mail].
Sincerely,
ZED
for Charles Wakild, P.E.
enclosures - approved revised plan
cc: SW4081201 File w/ enclosure
ec: Todd Kneller - WS/FCS Maintenance Division
Sue Homewood - Winston-Salem Regional Office
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location, 512 N. Salisbury St, Raleigh, North Carolina 27604
Phone: [phone] FAX; 919-807-6494
Internet: www.ncwaterquality.org
An Equal OpparlunitylAffirmative Action Employer
NorthCarolina
Naturally

Bryan Fowler
Project Superintendent
Hendrick Construction, Inc.
9144 ArrowPoint Blvd., Suite 150
Charlotte, NC 28273
Office:704-887-0280
Fax:[phone]
Mobile: [phone]
Nextel: i50*286*931
[e-mail]
www.hendrickconstruction.com
o };
Todd E. Kneller
3
••- •
Environmental Coordinator
Maintenance Division
office: (336) 6614999
-ax: (336) 6614971
mobile [phone]
e-mail, teknellc a wsfcs.kIInems
Winston-Satem1Forsyth County Schools - 4897 Lansing D6vc • Winston-Salem, NC 27105
I

October 22, 2012
Robert; Patterson
Stormwat:er Staff Engineer
NC Division of Water Quality
1617 Mail Service Center
Winston Salem/Forsyth Co. Schools
Raleigh, NC 27699-16 l 7
Maintenance Division
4897 Lansing Drive
Winston Salem, NC 27105
RE: Plan Revision for Rural. Hall. Elemen tar. y School.
336.6614999
rax 336.6614971
Dear Mr. Patterson:
As we previousa.y discussed over the telephone and by ema-il., l am working on an
effort; to install vegetation more adapted to our region and more sustainable
to the application in our bio--teal.. We' ve had significant difficulty getting
turf grass to grow well in the bio-cell, and 1 have sought the help of our
local cooperative extension office for a practical solution for a better stand
of vegetation.
Please see the a.t:tached plan revision change. vie items of interest are
encircled in `bubble' denotation.
Our hope is to be allowed to install a variety of perennial grasses from the
list of herbaceous plants .Listed in the State BMP Manual and as per
recommendation of our local cooperative extension. For the Rural. Hall.
setting, the local cooperative extension has suggested muhly grass, river
oats, soft rush (or leathery rush) and/or white sedge. Purple .lovegrass is
another species we world like to include, as this was recommended by the
Mellow Marsh Farm nursery in Siler City, NC. We would like to plant; a
combination of these grasses, as well as add some daylilies in the corners for
aesthetics. Depending on what grasses do well in this application; we would
also like the ability to choose between the herbaceous plants recommended for
bio-cell application in the future if certain species don' t fare well and are
in need of replacement.
Please feet free to contract; me with any questions
consideration in this matter.
Sincerely,
�pZf�
Todd Knel.ler
Environmental Coordinator
WS/FCS Maintenance Division
Thank you for your
t/ lJ� V1�!' tI Rz- 00 it 11
OCT ?, J
CPENR - WATER G7tilSLlfY

JA
fF � "
FA a
NC®ENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor .
Mr. Darrell Walker
Forsyth -County Schools.
1605 Miller Street
Winston-Salem, North Carolina 27103
Division of Water Quality
Coloen H. Sullins
Director
March 24, 2009
Subject:. Stormwater Permit No. SW4081201
Rural Mall Elementary School Classroom Addition
High Density Institutional Bio-Retention Project
Forsyth County
Dear. Mr: Walker:
Dee Freeman
Secretary
The Stormwater Permitting Unit received a complete Stonnwater Management Permit Application for Rural Hall
Eleln�ntary School Classroom Addition on March 13, 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. SW4081201, dated March 24, 2009, for the
construction, operation and maintenance of the subject project and the storinwater BMPs.
This permit shall be effective from the date of issuance until March 24, 2019, and shall be subject to the conditions
and limitations as'spccified therein. Please pay special attention to the Operation and Maintenance requirements in
this pen -nit. Failure to establish an adequate system for inspection and maintenance of the stornwater managcment
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 forth 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 Cory Larsen at [phone]; or cory.larscn a nclnail.nct.
Sincerely,
for Coleen 1-1. Sullins
cc: Winston-Salem Regional Office, Rose Pruitt
DMP, Inc., Jay Guffey
Central Files
SPU Files
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1517
Location: 512 N. Salisbury. St. Raleigh, North Carolina 27604
Phone: [phone] FAX: 919.807-FY1941 Customer Service: 1-B77-623-6748
Internet www.ncwalerquality.org
An EquO Opportunity 1 Afiirmative Action Employer
Ge FIVE �NR
N,C. flap4
YJlturt°n'�°1em
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NorthCarohna

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State Stormwater Permit
Permit No. SW4081201
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
Winston-Salem/Forsyth County Schools
Rural Hall Elementary School Classroom Addition
275 College Street, Rural Hall, Forsyth County
FOR THE
construction, operation and maintenance of one bioretention cell(s) in compliance with
the provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter referred to
as the "stormwaterrules`),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 March 24, 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 in Drainage Area 3 has been approved for the
management of stormwater runoff as described in Section 1.7 on page 2 of this
permit. The stormwater control has been designed to handle the runoff from
32,340 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. The built -upon area for the future development is limited to zero
square feet.
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 7

State Stormwater Permit
Permit No. SW4081201
7
0
The following design criteria have been provided for Drainage Area 3 and the
bioretention cell and must be maintained at design condition:
a.
Drainage Area, acres:
1.19
Onsite, ft :
51,962
Offsite, ft2:
0 '
b.
Total Imperviou� Surfaces, ft2:
32,340
Onsite, ft :
32,340
Offsite, ft2:
0
C.
Design Storm, inches:
1.0
d.
Max. Ponded Depth, feet:
1.0
e.
Seasonal High Water Table, fmsl:
.1002
f.
Planting Media Depth, feet:
2.0
g.
Cell Dimensions, feet:
106 x 21
h.
Bottom Elevation, f9sl:
1004.25
i.
Top Surface Area, ft :
3,338.3
j.
Permitted Storage Volume, W:
2,908.7
k.
Bypass 1 Storage Elevation, fmsl:
1,008.25
1.
Predevelopment 1 year 24 hour, cfs:
2.7
M.
Post development 1 year 24 hour, cfs:
4.4
n.
Drawdown Time, hours:
18.1
o.
Underdrain Diameter, inches:
6.0
p.
Total number of plants provided:
1, grassed
q.
Receiving Stream/River Basin:
Lucy Branch 1 Roanoke
r.
Stream Index Number:
22-25-5-2-1
s.
Classification of Water Body:
C
The following design criteria have been provided for Drainage Area 2 and must
be maintained at design condition:
a. Drainage Area, acres:
Onsite, ft :
Offsite, ft2:
b. Total Impervious Surfaces, ft2
Onsite, ft :
Offsite, ft2:
G. Receiving Stream/River Basin
d. Stream Index Number:
e. Classification of Water Body:
1.01
44,005
0
35,721
35,721
0
Lucy Branch 1 Roanoke
22-25-5-2-1
C
The following design criteria have been provided for Drainage Area 1 and must
be maintained at design condition:
a. Drainage Area, 9cres:
Onsite, ft :
Offsite, ft2:
b. Total Impervious Surfaces, ft2:
Onsite, ft :
Offsite, ft2:
C. Receiving Stream/River Basin:
d. Stream Index Number:
e. Classification of Water Body:
11. SCHEDULE OF COMPLIANCE
6.16
268,537
0
148,324
148,324
0
Lucy Branch 1 Roanoke
22-25-5-2-1
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
Page 2 of 7

State Stormwater Permit
Permit No. SW4081201
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.
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, 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
Page 3 of 7

State Stormwater Permit
Permit No. SW4081201
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.
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
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 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.
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 may 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.
Page 4 of 7

State Stormwater Permit
Permit No. SW4081201
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 241" day of March, 2009.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Rural Hall Elementary School Classroom Addition
Stormwater Permit No. SW4081201
Forsyth Count
Page 5 of 7

State Stormwater Permit
Permit No. SW4081201
Designer's Certification
I, , as a duly registered in the
State of North C8rolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
Rural Hall Elementary School Classroom Addition
(Project 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
Page 6 of 7

State Stormwater Permit
Permit No. SW4081201
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. The outlet/bypass structure elevations 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: NCDENR-DWQ Regional Office
, Forsyth County Building Inspections
Page 7 of 7

Permit Number: AV y 0 � J'2�-61 f
(to be provided br D111'Q)
Drainage Area Number. 0113
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 1 wilI remediate theproblem:
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 Hine 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
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable),
Erasion is occurring uz 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-Bioretention O&M-Rev.3 Page I of 4

BMP element:
Potentialproblems:'
How I will remediate theproblem:
The pretreatment area
Flow is bypassing
Regrade if necessary to route all
pretreatment area and/or
flow to the pretreatment area.
ullies have formed.
Restabdize 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-time
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 planting.
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 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.
An annual soil test shows that
Dolomitic time 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.
horns SW401-Bioretention O&M-Rev.3 Page 2 of 4

BMP element:
Potential roblerns:
How I will remediate theproblem:
The underdrain system
Clogging has occurred.
Wash out the underdrain system.
if a Iicable
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 91.9-
o u tle t.
733-1786.
Form 5W401-Bioretention O&M-Rev.3 Page 3 of 4

Permit Number: 5\d q 0 ? tZ 6
(io be provided by DIVQ)
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:Rural Hall Elementary School Classroom Addition
BMP drainage area number:
Print name:Darrell Walker
Title:Assistant Superintendent
Address:1605 Miller Street, Winston-Salem, NC 27103
Photie:336-727-2816
Signature:
Date:
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.
1, a� e e /e it �, 0, a Notary Public for the State of
CO ro 1 n� , County of Egg,,,/_ j , do hereby certify that
amen personally appeared before me this
day of NrDke p fr ,- � A OOP , and acknowledge the due execution of the
forgoing bioretention maintenance requirements. Witness my hand and official seal,
SEAL
My commission expires
Form SW401-Bioretention I&M-Rev. 2 Page 4 of 4

State Stormwater Permit
Permit No, SW4081201
Designer's Certification
I, A. i. u - , as a duly registered r lm, 6A&J i/we,' in the
State bf North Caroli a, having been authorized to observe perio icall weekly/
full time) the construction of the project,
Rural Hall Elementary School Classroom Addition
(Projecf Name)
for Mtusrar4-'r, —A ��srfH'_ Co.►�oaLs (Pro)ect Owner) hereby state that, to the
best of my abilities, d e car 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:
C��c�-Ihe,i. �oaua ate.. �e�►o� c.r ybp�e�-tip ,� � [ e�sh>���1 +v`
e+ YkL boo aid a M.� �.���►; � +. .� Q,,..Al. 18t ?_010
SEAL 1'
Signature Li*S
S$fp el� ',,
Registratio N ber D33880 - EAt.�9r�'�
Date 33804 :
�.
.F ,,
Page 6 of 7

State Stormwater Kermit
Permit No. SW4081201
Certification Requirements:
The drainage area to the system contains approximately the permitted
acreage.
:394 2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
�+t 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.
S�_5, The outlet/bypass structure elevations are -per the approved plan.
:166. The outlet structure is located per the approved plans.
;50h7. Trash rack is provided on the outietlbypass structure.,
44�_8. All slopes awgrassed -with permanent vegetation, per the vegetation plan.
;'Igh 9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circulting 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.
1►� 13. Alf required design depths are provided.
,196 14. All required parts of the system are provided,,such as a vegetated shelf,
and a forebay. j
.1915. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
, Forsyth County Building Inspections
Page 7 of 7

Taylor -Smith, Aana
From: Sanders, Carlos <[e-mail]>
Sent: Wednesday, August 06, 2014 11:31 AM
To: Taylor -Smith, Aana; Homewood, Sue; White, Sue
Cc: Kneller, Todd E.
Subject: 2014 Rural Hall Yearly Inspection--SW4081201
Attachments: 2014 BMP Yearly Inspection.pdf; 20140731_084203[1].jpg; 20140731_084141.jpg; 20140731
_084147.jpg
To all,
Attached is the yearly inspection for SW4081201 permit, Rural Hall Elementary,
Thanks,
Carlos Sanders
Civil Engineer Apprentice
Maintenance Division
Winston -Sale mlForsyth County Schools
336-748-4000 ext. 44518
336-399-6214 (mobile)
336-661-4971 (fax)
All e-mail correspondence to and from this address is subject to the North Carolina Public Records Law, which
may result in monitoring and disclosure to third parties, including law enforcement. AN EQUAL
OPPOR"I'UNITY/AFI{1RMATIVE ACTION EMPLOYER

State Stormwater Inspection Report
General
Project Name: I 17�I C7(A
Permit No: SW 4 f ()1j jZ 01
Expiration Date:
Contact Person: Gt�
Phone Number:
Inspection Type:
Inspection Date: 7 _3 t _ Z ol4
Time In, /,, /o
Time Out: , Lc-
S
Current Weather: -ys o C�
Recent Rain (Dale)?
Rain — in
Location
Facility Address) Location: Z75y L'uilr G 5{-
City: R.�a� Zip' -��c`5=County.��s g l at: N Long: - "W
Permit Information
Rule Subject to (circle one): 1988 Coastal Rule 1995 Coastal Rule 2008 Coastal Rule Session Law 2006-246
Goose Creek High Quality Waters Outstanding Resource Waters
Density (circle one): High (I -ID) Low (LD)
Stormwater Best Management Practices (BMPs) (insert number of each):
Wet Ponds Infiltration Basins Infiltration Trenches LD 5wales Stormwater Wetlands
__Dry Ponds __)(_Bioretention Permeable Pavement Sand Inters (circle one) Open Closed
Cistern Level Spreader/Filter Strip Othcr (spec):
Files Raview Yes No NIA NIE
1. is the permit active?
X
2. Signed Engineer's Cerfrfication on tile?
3. Signed Operation and Maintenance a reement on life?
_
4, Recorded Deed Restrictions on file?
Sits Vicit• Rnilt tlnnn Araa IRIIAt Yes No NIA NIE
5. BUA is constructed and consistent with the permil, requirements?
6. BUA(as ermitted) is graded such that the runoff drains to the system? (high density on) )
7. Drainage area is consistent withpermit? (i.e. no un errnitted drainage to the SW [BMPs)j(
8. Drainage area is stabilized? (to reduce risk of sedimentation to the SW BMPs) i(
Sites Visit- Stormwater BMPs Yes No NIA NIF
9, Stormwater BMPs are locatcd per the approved laps?
10, Stormwater BMPs have dimensions (e . length, width, area) matching the approved plans?
X
11. Stormwater BMPs are constructed per the_approyed plans?
Site Visit- Oneratinn and Maintenance Yes No NIA NIE
12. Access Dints to the site are clear and well maintained?
X
13.
Trash has been removed as needed?
X
14.
Excessive landscape debris(grass cli pings, leaves, etc) is controlled?
K
I S.
Stormwater BMPs being operated and maintained as per the permIt requirements?
16.
Inspection and Maintenance records are available for inspection? (hi h density only, 1995 —
present only)
Site Visit: Other Permit Conditions Yes No NIA NIE
17. Is the site compliant with other conditions of the permit?
Site Visit: Other Water Quality Issues Yes No NIA NIE
18, Is the site compliant with other watu quality issues as noted during the inspection?
State Stonmvoter Inspection Repon, Version 3.0_3-09 Page I of 2

State Stormwater Inspection Report
k,,Wjmnen tis
f`ir :�55vj?rs
inspection viciures (some of the pictures taken during the site
Compliance Status Ll Compliant U Non -Compliant
Letter Sent (circle one): Yes No Letter type: CEI NOV NOVRE Other
Date Sent: Reference Number:
Inspector Name and Signature. VQOlv3 Jntn&4aS 0,/(�i ale:
t
Stutc Stormwater Inspection Report, Version 3.0_3-09 Page 2 of 2

BIORETENTION CELL: O & M Inspection Checklist
INLET-and=PERIMETEIR:;
1. Inlet and Perimeter are free of erosive gullies and bare soil areas: ❑ ❑ ❑
2. Inlet device (swale, pipe, stone verge) is free of erosion, damage or dogs:
[�
❑
❑
❑
3. Weir heights appear to match approved plans:
❑
❑
❑
k
PRETREATMENT-.,:
4. Flow is entering pretreatment area (not being bypassed):
❑
❑
❑
5. Pretreatment area is free of erosion:
❑
❑
❑
6. Pretreatment area is free of excessive sediment or clogs:
❑
❑
❑
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):
V
El
❑
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):
lj
❑
❑
❑
12. Ponding depth is 9-12 inches after rain:
❑
❑
❑
13. All dimensions are >=10ft.:
❑
❑
❑
:SOIL/MULCFf;and:VEGETATIUN; `.
14. Plants are healthy and being maintained:
❑
❑
❑
15. The proper amount and type of vegetation is present in the cell:
❑
❑
❑
1.6. Mulch is in good condition (has not broken down or floated/migrated towards the outlet):
[
❑
❑
❑
17. Surface if free of excessive sediment and clogs:
❑
❑
❑
18. Trees are free of stakes/wires > 6 months after planting:
❑
❑
❑
19. The annual soil test shows the proper pH and absence of heavy metal accumulation:
❑
❑
❑
-
20.Outlet is free of evidence of improper drainage (no standing water, cattails, etc.):
LN
❑
❑
❑
21. Outlet device (drop inlet, weir, etc.) is free of damage or clogs:
12Q
❑
❑
❑
22. Orifice size matches approved plans:
❑
❑
❑
23. Outlet is free of damage, clogs, or erosion:
IX
❑
❑
❑
24. Relative elevations match approved plans:
X
❑
❑
❑
V3.3 09

Winston-5alemlForsyth County Schools MI 1111111111111111 Printed onPaae 1 of 2
Date Created: 7A/2013 12:0SAM : 7/1912013
Work Order ID 169191
Craft Environmental Services
Completion Date7/19/2013
Description
Monthly - Stormwater System Inspection 504 - Refer to PM schedule
details.
Location
Rural Hall Elementary
Request Date
7 1 2013
-Building
Status
Closed Work Orders
Area
Priority
Medium
Area Number
Pu ose Code
Preventive Maintenance
Equip Item No.
StrmWtrSO4
Bud et Code
Equip. DesC
Bio-Cep
Requester
Wayne Loflin
Assigned To
Kneller, Todd
Requester Phone
336-661-4999
Notes
Labor To Date: h
Purchases To Date: $0.00
Date
Name
Hrs
Date
PD
description
Supplier
Qty
Cost
Each
Inventory To Date: $0.00
Date
Item No
Description
Qty
Pool
Action Taken
Heavy rains earlier this month; several dates In a row with inch -plus rain
events. No issues resulting. System overall looks good. Vegetation trim
on July 8. TK
Tech n icia n/S u pe ryi sor
www.sChooldude.com Ma In tenance Direct
Date Confirmatlon/Accepted By Date
Printed by Todd Knellef

Winsion-SalemlForsyth County Schools 1111111111111111111 Paqe 1 of 2
Date Created: 811/2013 12:07AM -1 r--.m -1 4Ei&Z& Printed on: 8/2812013
Work Order ID 172182
Craft Environmental Services
T
Completion Date8128/2013
Description
Monthly - Stormwater System Inspectlon 504 - Refer to PM schedule
details.
Location
Rural Hall Elementary
Request Date
8 1 2013
Building
Status
Closed Work Orders
Area
Priority
Medium
Area Number
Pur ose Code
Preventive Maintenance
Equip Item No.
StrmWtr504
Budget Code
Equip. Desc
Bio-Cell
Requester
Wayne Loftin
Assigned To
Knellerr Todd
Requester Phone
336-661-4999
Notes
Labor To Date: h
Purchases To Date: $0.00
Date
Name
Hrs
Date
PO
Description
Supplier
Qty
Cost
Each
Inventory To Date: $0.00
Date
Item No
Description
Qty
Pool
Action Taken
No Issues to report, Several rain events totalling 1" or more this month;
_1" on 8/10; —V on 8/13; —1,75" 8/17-19. TK
Tech niclan/Supervisor
www.schooldude,corn MaintenancoUrect
Date Confirmation/Accepted By Date
Printed by Todd Kneller

Winston-Salem/Forsyth County Schools � � I III mill III page 1 of 2
Date Created: 9/2/2013 12:03AM 1714MCP h Printed an: 10/412013
Work Order ID 176916
Craft Environmental Services
Completion Date 10/4/2013
Description
Monthly - Stormwater System inspection 504 - Refer to PM schedule
details.
Location
Rural hall Elementary
Request Date
9 2 2013
Building
Status
Closed Work Orders
Area
PrioritX
Medium
Area Number
Purpose Code
Preventive Maintenance
-Equip Item No.
StrmWtr504
Budget Code
Equip. Desc
Bio-Celt
Requester
Wayne Loflln
Assigned To
Kneller, Todd
Requester Phone
335-661-4999
Notes
Labor To Date: h
Purchases To Date: $0.00
Date
Name
Hrs
Date
PO
Description
Supplier
Qty
Cost
Each
Inventory To Date: $0.00
Date
Item No
Description
Qty
Pool
Action Taken No issues to report. TK
Technician/Supervisor
www.schooldLode.com MaintenanceDlrect
Date Confirmation/Accepted By
Date'
Printed by Todd Kneller

Wrnston-SalenVForsyth County Schools 1111111111111111111 Page 1 of 2
Date Created: 1011/2013 12:07AM -1 B In -1 tsa% Printed on: 1017/2013
Work Order ID 161155
Craft Environmental Services Completion Date 10/7/2013
Description
Monthly - Stormwater System inspection 504 - Refer to PM schedule
details.
Location
Rural Hall Elemeniay
Request Date
10 1 2013
Building
Status
Closed Work Orders
Area
Priori
Medlum
Area Number
Purpose Code
Preventive Maintenance
Equip Item No.
StrmWtr504
Bud et Code
Equip. Desc
Bio-Cell
Requester
Wayne Loflin
Assigned To
Kneller, Todd
Requester Phone
336-661-4999
Notes
Labor To Date: h
Purchases To Date: $0.00
Date
Name
Firs
Date
PO
Description
Suppller
Qty
Cost
Each
Inventory To Date: $0.00
Date
Item No
Description
Qty
Pool
Action Taken
BMP in good condition. Maintenance plantings planned for later in
October. TK
Tech n ici a n/ S u perviso r
www.schooldudc.cam MaintenanceDirect
Date Confirmation/Accepted By Date
Printed by Todd Kneller

PERODIC 13MP SITE INSPECTION OPERATION & MAINTENANCE RECORD
Recorded by Date General Observations or comments
Location: TL,Q, 9+0-tc i-S
A.
Any adverse observations
YES
NCT'
NIA
B.
Plant life compromised or needing attention
YES
*&-
NIA
C.
Irrletloutlet clogged
YES
N$-
NIA
D.
Vegetation growing in rip -rap or emergency spillway
YES
Awe
NIA
E.
Trash accumulation
YES
Ne-
NIA
i
Noxious weeds, invasive vegetation / cattails present
Ytls
NO
N/A
G.
Bare soil erosion observed, slopes or embankments
YI S
N _e
NIA
1-1.
Grasses no less than 6-8" in height (as applies to site)
YES
No
NIA
1.
Animal interference or damage
YES
-No
NIA
J.
Sediment accumulation
YES
-Nk&
NIA
K.
Significant algae growth
YES
-Ne
NIA
L.
In need of mowing or string trimming
F-
NO
NIA
M.
Trees present on dam as applies to site
YES
N101
NIA
N.
Observation Well Levels (Spear ES Only)
A
13
Describe maintenance activities performed or planned for `YES' answers above:
If more than one BMP on site, denote the location of issue:

PERODIC BMP SITE INSPECTION OPEIZATION & MAINTENANCE RECORD
Recorded by Date
�,�( � 12 3 a • ! 3
Location 941.,�
General Observations or comments
A.
Any adverse observations
YES
?tH.
NIA
B.
Plant life compromised or needing attention
YES
N-CL
NIA
C.
Inlet/outlet clogged
YES
144;,
NIA
D.
Vegetation growing in rip -rap or emergency spillway
YES
NQ,
NIA
E.
7"rash accumulation
YES
N6.1
NIA
F.
Noxious weeds, invasive vegetation / cattails present
YES
W
NIA
G.
Bare soil erosion observed, slopes or embankments
YES
T14"
NIA
H.
Grasses no less than 8-12" in height (as applies to site)
YES
NQ
N/A
I.
Animal interference or damage
YES
DxQ
N/A
J.
Sediment accumulation
YES
Nitl
NIA
K.
Significant algae growth
YES
IL0
N/A
L.
In need of mowing or string trimming
Y1`S
Njg�
N/A
M.
Trees present on dam as applies to site
YES
4i9_
NIA
N.
Observation Well bevels (Speas ES Only)
A
B
Describe maintenance activities performed or planned for `YES' answers above:
If more than one BMP on site, denote the location of issue:

PERODIC BMP SITE INSPECTION, OPERATION & MAINTENANCE RECORD
Recorded by Date General Observations or comments
Location: Rural Hall ES
A.
Any adverse observations
YES
NO
NIA
B.
Plant life compromised or needing attention
YES
(D
NIA
C.
Inlet/outlet clogged
YES
(70")
NIA
D.
Vegetation growing in rip -rap or emergency spillway
YES
(R-0")
NIA
E.
Trash accumulation
YES
NO
NIA
F.
Noxious weeds, invasive vegetation / cattails present
YES
NO
NIA
G.
Bare soil erosion observed, slopes or embankments
YES
NO
NIA
H.
Grasses less than 5-12" in height (as applies to site)
YES
O
NIA
1.
Animal interference or damage
YES
NO
N/A
J.
Sediment accumulation
YES
NO
NIA
K.
Significant algae growth
YES
NO
NIA
L.
In need of mowing or string trimming
YES
NO
N/A
M.
Trees present on dam as applies to site
YES
NO
NIA
N.
Observation Well Levels (Speas-ES Only)
A
B
Describe maintenance activities performed or planned for `YES' answers above:
If more than one BMP on site, denote the location of issue:

I
PERODIC BMP SITE INSPECTION, OPERATION & MAINTENANCE RECORll
Recorded by Date General Observations or comments
Location: Rural Hall ES.
A.
Any adverse observations
YES
NO
NIA
B.
Plant life compromised or needing attention
YES
(DO
NIA
C.
Inlet/outlet clogged
YES
NO
NIA
D.
Vegetation growing in rip -rap or emergency spillway
YESED
N/A
E.
Trash accumulation
YES
NO)
NIA
F.
Noxious weeds, invasive vegetation / cattails present
YES
NO
N/A
G.
Bare soil erosion observed, slopes or embankments
YES
NO
NIA
H.
Grasses less than 8-12" in height (as applies to site)
YES
NIA
1.
Animal interference or damage
YES
NO
NIA
J.
Sediment accumulation
YES
NO
N/A
K.
Significant algae growth
YES
NO
N/A
L.
In need of mowing or string trimming
YES
NO
NIA
M.
Trees present on dam as applies to site
YES
NQ
NIA
N,
Observation Well Levels (Specs ES Only)
A
B
Describe maintenance activities performed or planned for `Yl1S' answers above:
If more than one BMP on site, denote the location of issue:

PERODIC BMP SITE INSPECTION, OPERATION & MAINTENANCE RECORD
Recorded by Date General Observations or comments
___T�C 3 z t if � 9,"t __
Location: Rural Hall ES
A.
Any adverse observations
YES
NO
NIA
B.
Plant life compromised or needing attention
YES
NIA
C.
Inlet/outlet clogged
YES
"�"�
NJA
D.
Vegetation growing in rip -rap or emergency spillway
YES
NIA
E.
Trash accumulation
YES
NO
NIA
F.
Noxious weeds, invasive vegetation 1 cattails present
YES
NO
NIA
G.
Bare soil erosion observed, slopes or embankments
YES
NO
NIA
H.
Grasses less than 8 -12" in height (as applies to site)
YES
TO
NIA
I.
Animal interference or damage
YES
NO
N/A
J.
Sediment accumulation
YES
NO
NIA
K.
Significant algae growth
YES
NO
NIA
L.
In need of mowing or string trimming
YES
NO
NIA
M.
Trees present on dam as applies to site
YES
(NO
NIA
N.
Observation Well Levels (Speas ES Only)
A
B
Describe maintenance activities performed or planned for `YES' answers above:
If more than one BMP on site, denote the location of issue:

I
PERODIC BMP SITE INSPECTION OPERATION & MAINTENANCE RECORD
Recorded by Date General Observations or comments
Location: Rural Hall ES
A.
Any adverse observations
YES
CNOO
NIA
13.
Plant life compromised or needing attention
YES
(DO
NIA
C.
Inlet/outlet clogged
YES
NO)
NIA
D.
Vegetation growing in rip -rap or emergency spillway
YES
6TO
NIA
E.
Trash accumulation
YES
NO
NIA
F.
Noxious weeds, invasive vegetation 1 cattails present
YES
NO
NIA
G.
Bare soil erosion observed, slopes or embankments
YES
NOS
NIA
1-1,
Grasses less than 8-12" in height (as applies to site)
YES
NO
NIA
1.
Animal interference or damage
YES
NO
NIA
J.
Sediment accumulation
YES
NO
NIA
K.
Significant algae growth
YES
NO
NIA
L.
In need of mowing or string trimming
YES
NO
NIA
M.
Trees present on darn as applies to site
YES
NO
NIA
N.
Observation Well Levels (Speas ES Only)
A
B
Describe maintenance activities perfonned or planned for `YES' answers above:
If more than one 13MP on site, denote the location of issue:

PERODIC_BMP SITE INSPECTION:. PERATION & MAINTENANCE RECORD
Recorded by Date General Observations or comments
Location: Rural Hall ES
A. Any adverse observations
B. Plant life compromised or needing attention
C. Inlet/outlet clogged
D. Vegetation growing in rip -rap or emergency spillway
E. Trash accumulation
F. Noxious weeds, invasive vegetation / cattails present
G. Bare soil erosion observed, slopes or embankments
H. Grasses less than 8-12" in height (as applies to site)
1. Animal interference or damage
J. Sediment accumulation
K. Significant algae growth
L. In need of mowing or string trimming
M. Trees present on dam as applies to site
N. Observation Well Levels (Spear ES Only)
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
A —
Describe maintenance activities performed or planned for `YES' answers above:
If more than one BMP on site, denote the location of issue:
NO
N
No
D
NO
NO
NO
TO
NO
NO3)
O�O
N DO
NO
B
NIA
NIA
NIA
NIA
NIA
NIA
N/A
N/A
NIA
NIA
NIA
N/A
NIA

PERODIC BMP SITE INSPECTION OPERATION & MAINTENANCE RECORD
Recorded by Date General Observations or comments
-A&. -71,�Olfq
Location: Rural Hall ES
A.
Any adverse observations
YES
NO
NIA
B.
Plant life compromised or needing attention
YES
QQO
NIA
C.
Inlet/outlet clogged
YES
NIA
D.
Vegetation growing in rip -rap or emergency spillway
YES
(IN' �O
NIA
E.
Trash accumulation
YES
NO
NIA
F.
Noxious weeds, invasive vegetation / cattails present
YES
NO
NIA
G.
Bare soil erosion observed; slopes or embankments
YES
NO
NIA
H.
Grasses less than 8-12" in height (as applies to site)
YES
O
NIA
I.
Animal interference or damage
YES
NO
NIA
1,
Sediment accumulation
YES
NO
NIA
K.
Significant algae growth
YES
NO
NIA
L.
In need of mowing or string trimming
YES
NO
NIA
M.
Trees present on dam as applies to site
YES
'ENO
NIA
N.
Observation Well Levels (Speas ES Only)
A
B
Describe maintenance activities performed or planned for `YES' answers above:
If more than one BMP on site, denote the location of issue:

Compliance Inspection Report
Permit: SW40812D1 Effective:03124109 Expiration: 12/30/21
Project: Rural Hall Elementary School Classroom Addition
Owner: Forsyth County Schools
County: Forsyth Adress: 275 College St
Region: Winston-Salem
CitylStatelZip: Rural Hall NC 27045
Contact Person: Darrell Walker Title: Phone: [phone]
Directions to Project:
Type of Project: Slate Stormwater - HD - Other
Drain Areas: 001 - (Lucy Branch) (03-02-01 ) ( C)
002 - (Lucy Branch) (03-02-01 ) ( C)
003 - (Lucy Branch) (03-02-01 ) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 0713112014 Entry Time: 11:00Ab1 Exit Time: 1130AM
Primary Inspector: Aana Taylor -Smith Phone: [phone]DDD
Secondary Inspector(s):
Reason for Inspection: Routine
Permit inspection Type: Slate Stormwater
Facility Status: Compliant ❑ Not Compliant
Question Areas:
State Stormwater
{See attachment summary}
Inspection Type: - Compliance Evaluation
page: 1

Permit: SW4081201 Owner - Project: Forsyth County Schools
Inspection Date: 07131/2014 Inspection Type Compliance Evaluation
Inspection Summary:
Please see report by Carlos Sanders, WS/FC.
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:
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:
SW Measures
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
Are the SW measures being maintained and operated as per the permit requirements?
Are the SW BMP inspection and maintenance records complete and available for review or provided to
DWQ upon request?
Comment:
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:
Reason for Visit: Routine
Yes No NA NE
0 ❑ ❑ ❑
® ❑ ❑ ❑
® ❑ ❑ ❑
Yes No NA NE
■ ❑ ❑ ❑
® ❑ ❑ ❑
Yes No NA NE
❑ ❑ ❑
❑ ❑ ❑
M ❑ ❑ ❑
Yes No NA NE
® ❑ ❑ ❑
®❑❑❑
Yes No NA NE
■ ❑❑❑
Yes No NA NE
® ❑ ❑ ❑
page: 2

Taylor -Smith, Aana
From: Homewood, Sue
Sent: Friday, September 27, 2013 9:42 AM
To: White, Sue; Taylor -Smith, Aana
Subject: FW: Rural Hall 2013 Yearly Inspection SW#4081201
Attachments: Rural Hall 2013 Inspection Report.pdf; Rural Hall 2013 Yearly Inspection Pictures.docx
Sorry, here's the attachments.
Sue Homewood
NC DENR Winston-Salem Regional Office
Division of Water Resources — Water Quality Programs
S85 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Sanders, Carlos[mailto:CSanders@wsfcs,kl2.nc.us]
Sent: Tuesday, September 24, 2013 3:15 PM
To: Homewood, Sue
Cc: Knelier, Todd E.
Subject: Rural Hall 2013 Yearly Inspection SW#4081201
Sue,
Attached is the 2013 yearly inspection report and pictures.
Thanks,
Carlos Sanders
Civil Engineer Apprentice
Maintenance Division
Winston-Salem/Forsyth County Schools
336-748-4000 ext. 44518
336-399-6214 (mobile)
336-661-4971 (fax)
All e-mail correspondence to and from this address is subject to the North Carolina Public Records Law, which
may result in monitoring and disclosure to third parties, including law enforcement. AN EQUAL
OPPORTUNITYIAFFIRMATIVE ACTION EMPLOYER

State Stormwater Inspection Report
General
Project Name: RtAvAA Aml ELAmAn,64J
Permit No: SW4151g12D I
Expiration Date:
Contact Person: �� Jant�¢!S
Phone Number:
Inspection Type:
Inspection Date: 9 _ I $ _ ZJI3
Time In: 11: dJ
Time Out: (1: 79 J -
Current Weather: 73 °
Recent Rain (Date)?
Rain - in
Location
acility Address/ Location: 2-7S e.> r cy F�
Jty: QwR-( 'fit 7_tp' _).Vr County: ge Iat: «N Long: - e �4W
Permit Information
Rule Subject to (circle one): 1988 Coastal Rule 1995 Coastal Rule 2008 Coastal Rule Session Law 2006-246
Goose Creek High Quality Waters Outstanding Resource Waters
Density (circle one): High (HD) Low (LD)
Stormwater Best Management Practices (BMPs) (insert number of each):
Wet Ponds Infiltration Basins Infiltration Trenches LD Swales Stormwater Wetlands
Dry Ponds _—)(-Bioretention Permeable Pavement Sand filters (circle one) Open Closed
Cistern Level Spreader/Filter Strip Other (spec):
File Review Yes No NIA N1E
1. Is the permit active?
2. Signed Engineer's Certification on file?
3. Si ned Optration and Maintenance a reement on file?
4. Recorded deed Restrictions on file?
Site Visit: Rullt Unon Area (BUAI Yes No NIA NIE
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
Sites Visit Stormwater RMPs Yea No NIA NIF
9. Stormwater BMPs are located per the approvedplans?
10. Stormwater BMPs have dimensions e , length, width, area matching the approvedplans?
X
]_ l . Stormwater BMPs are constructed per the approvedplans?
Aifa Visit- flnaratinn and Mainfananra Yea Nn N/A NIF
12. Access 20ints 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 o erased and maintained as per the permit requirements?
X
16, Inspection and Maintenance records are available for inspection? (hip± density only, 1995 - present only)
Site Visit: Other Permit Conditions Yes No NIA NIE
17. Is the site compliant with other conditions of thepermit?
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 Stormwater Inspection Report, Version 3.0_3-09 Page I of 2

Us
y$S64-L
A*
State Stormwater Inspection Report
of the plotures taken during the site
Compliance Status o Compliant - ❑ Non -Compliant
Letter Sent (circle one); Yes No Letter type; CEI NOV NOVRE Other
Date Sent: Reference Number:
Inspector Name and Signature:
State Storrnwater Inspection Report, Version 3.0_3-09
Date:
Page 2 of 2

BIORETENTION CELL: 0 & M inspection Checklist
Inlet and Perimeter are free of erosive gullies and bare soil areas:
2. Inlet device (swale, pipe, stone verge) Is free of erosion, damage or clogs:
Cc
3. Weir heights appear to match approved plans:
'o;r
4. Flow is entering pretreatment area (not being bypassed):
0
El
0
5. Pretreatment area Is free of erosion:
El
El
E]
6. Pretreatment area Is free of excessive sediment or clogs:
El
D
El
7. Side slopes are 3:1 or less:
B. The under drain system is free flowing and free of dogs (if applicable):
9. Cleanout(s) and cap is provided for the under drain as per the approved plans:
El
El
El
10. Heavy equipment has not been driven Into the cell:
D
El
El
11. Surface is free of piles of heavy materials (piles of mulch, etc):
El
El
El
12. Poncling depth is 9-12 Inches after rain:
J
0
El
.11
13. All dimensions are >=10ft.:
El
El
El
14. Plants are healthy and being maintained:
11
15. The proper amount and type of vegetation is present in the cell:
El
El
1:1
16. Mulch Is in good condition (has not broken down or floated/migrated towards the outlet):
E3
El
11
17. Surface If free of excessive sediment and clogs-
El
El
El
18. Trees are free of stakes/wires > 6 months after planting,
19. The annual soil test shows the proper pH and absence of heavy metal accumulation:
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 dogs:
11
El
0
22. Orifice size matches approved plans:
El
0
El
23. Outlet is free of damage, dogs, or erosion:
1:1
El
El
24. Relative elevations match approved plans:
El
El
El
V3.309

Permit: SW4081201
County: Forsyth
Region: Winston-Salem
Compliance Inspection Report
Effective: 03/24/09 Expiration: 12/30/21 Owner: Forsyth County Schools
Project: Rural Hall Elementary School Classroom
Addition
275 College St
Contact Person: Darrell Walker Title:
Directions to Project:
Type of Project: State Stormwater - HD - Other
Drain Areas: 001 - (Lucy Branch) (03-02-01 ) ( C)
002 - (Lucy Branch) (03-02-01 ) ( C)
003 - (Lucy Branch) (03-02-01 ) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 09/1812013 Entry Time: 11:00 AM
Primary Inspector: Aana Taylor -Smith
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
■ State Stormwater
(See attachment summary)
Rural Hall NC 27045
Phone: [phone]
Exit Time: 11:30 AM
Phone: [phone]
Inspection Type. Compliance Evaluation
Page: 1

Permit: SW4081201 Owner - Project: Forsyth County Schools
Inspection Date: 09/18/2013 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Please see report by Carlos Sanders, WSIFC.
File Review Yes No NA NE
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:
Built Upon Area Yes No NA NE
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:
SW Measures
Yes
No
NA
NE
Are the SW measures constructed as per the approved plans?
0011
❑
Are the inlets located per the approved plans?
■
❑
❑
❑
Are the outlet structures located per the approved plans?
■
❑
❑
❑
Comment:
Operation and Maintenance
Yes
No
NA
NE
Are the SW measures being maintained and operated as per the permit requirements?
■
❑
❑
❑
Are the SW BMP inspection and maintenance records complete and available for review or provided
to DWO ■
❑
❑
❑
upon request?
Comment:
Other Permit Conditions
Yes
No
NA
NE
Is the site compliant with other conditions of the permit?
■
❑
❑
❑
Comment:
Other WO Issues
Yes
No
NA
NE
Is the site compliant with other water quality issues as noted during the inspection?
Comment:
Page: 2

Stimmel
601 N, Trade Street
su;la zaa
Winston Salem, NC
Landscape Architecture
27101-2916
Civil Engineering
5timmel Associates, PA Land Planning
P: 336.723.1067
F: 336.723 1069
date: 5/22/2012 job #: 11-178
project: Keen Transport
RECEI ICJ
letter of transmittal N,C.Dept niE'R
attn: NCDENR
to: Winston-Salem Regional Office
Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
MAY 2'3 20112
sent via: ow Atached
wins on -Salem
C' Un er Sep�regver
F U.S. Mail r By Hand
Over Night Service r For Pick -Up
r Fax #
# of pages total =
We are sending you the following items:
r Prints F Calculations F Base Drawings
r- Reproducibles I— Information r Correspondence
r Originals I- Specifications r Change Order/ Addendum
r Diskette 1 CD
r Email with Attachments
r
copies
sheet
dated
description
1
Stormwater Pond Certification of Construction
1
Stormwater Permit
remarks, comments, & details:
To Whom It May Concern:
Attached you will find the above referenced stormwater pond certification of construction. I have
also enclosed the permit that was issued for the project, as it appears it was copied to the
Asheville Regional Office by mistake.
If noted enclosures are not received, please notify us.
copies to: File by: J. Neal Tucker, P.E.

State Stormwater Permit
Permit No.SW4111201
Keen Transport
Stormwater Permit No. SW4111201
Porsy4h_ County
Designer's Certification
N.C.Deat, OFENIR
MAY 2 3 20f2
Winston-Salem
It. — * . �J f`L Tuc*'12r , as a duly registered
in the State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
Keen Transport
(Project)
for K�� TtzAs-�SQr (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 ia'ndspecification:
SEAL
Signature
,,;11IM;;J17
.
Registration Number I $S
��
���SS/Xf ` .
l
Date 1 Z
=.
= 4 SEAL
:.
14986
"11111����s����
Page 5 of 6

. h
c
State Stormwater Permit
Permit No.SW4111201
Certification Requirements:
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 associat;q`;. iflidhe 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. The outlet/bypass structure elevations are per the approved plan.
✓ 6. The outlet structure is located per the approved plans.
i/7. Trash rack is provided on the outlet/bypass structure.
✓ 8. All slopes are grassed with permanent vegetation.
g. Vegetated slopes are no steeper th�'n3` 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 devicesL.are.-c.orr.:ectiy 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.
_pe"' 15_ 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, o of

Compliance inspection Report
Permit: SW4081201 Effective: 03/24/09 Expiration: 03/24/19 Owner: Forsyth County Schools
Project: Rural Hall Elementary School Classroom
Addition
County: Forsyth 275 College St
Region: Winston-Salem
Contact Person: Darrell Walker Title:
Directions to Project:
Type of Project: State Stormwater - HD - Other
Drain Areas: 001 - (Lucy Branch) (03-02-01 ) ( C)
002 - (Lucy Branch) (03-02-01 ) ( C)
003 - (Lucy Branch) (03-02-01 ) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 07111/2011 Entry Time: 01:00 PM
Primary Inspector: Sue L Homewood
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: n Compliant 0 Not Compliant
Question Areas:
■ State Stormwater
(See attachment summary)
Rural Hall NC 27045
Phone: [phone]
Exit Time: 01:15 PM
Phone: [phone]
Inspection Type: Compliance Evaluation
Page: 1

Permit: SW4081201 Owner - Project: Forsyth County Schools
Inspection Date: 07/11/2011 Inspection Type: Compliance Evaluation
Inspection Summary:
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: site complete, no eng. cert. 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:
SW Measures
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: biocell seeded and mulched, permit requires sod.
Reason for Visit: Routine
Yes No NA NE
n®nn
0nnn
®nnQ
Operation and Maintenance Yes No NA NE
Are the SW measures being maintained and operated as per the permit requirements? ■ n Cl n
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ n n n ■
upon request?
Comment:
Other Permit Conditions Yes No NA NE
Is the site compliant with other conditions of the permit? ® n n n
Comment:
Other WQ issues Yes No NA NE
Is the site compliant with other water quality issues as noted during the inspection? ® n n n
Comment:
Page: 2

Compliance Inspection Report
Permit: SW4081201 Effective: 03/24/09 Expiration: 03/24/19 Owner: Forsyth County Schools
Project: Rural Hall Elementary School Classroom
Addition
County: Forsyth 275 College St
Region: Winston-Salem
Contact Person: Darrell Walker Title:
Directions to Project:
Type of Project: State Stormwater - HD - Other
Drain Areas: 001 - (Lucy Branch) (03-02-01) ( C)
002 - (Lucy Branch) (03-02-01) ( C)
003 - (Lucy Branch) (03-02-01) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 08/2412011 Entry Time: 04:00 PM
Primary Inspector: Sue L Homewood
Secondary Inspector(s):
Reason for inspection: Follow-up
Permit Inspection Type: State Stormwater
Facility Status: 0 Compliant ■ Not Compliant
Question Areas:
® State Stormwater
(See attachment summary)
Rural Hall NC 27045
Phone: [phone]
Exit Time: 05:00 PM
Phone: [phone]
Inspection Type: Compliance Evaluation
Page: 1

Permit: SW4081201 Owner - Project: Forsyth County Schools
Inspection date: 08/24/2011 Inspection Type: Compliance Evaluation
Reason for Visit: Follow-up
Inspection Summary:
File Review
Yes
No
NA
NE
Is the permit active?
o
n
n
n
Signed copy of the Engineer's certification is in the file?
®
n
n
n
Signed copy of the Operation & Maintenance Agreement is in the file?
®
n
n
n
Copy of the recorded deed restrictions is in the file?
n
n
®
n
Comment:
Built Upon Area
Yes
No
NA
NE
Is the site BUA constructed as per the permit and approval plans?
dy
n
n
n
Is the drainage area as per the permit and approved plans?
fa
n
n
n
Is the SUA (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? 0 ❑ n n
Are the inlets located per the approved plans? ® n n n
Are the outlet structures located per the approved plans? ® n n n
Comment:
}aeration and Maintenance Yes No NA NE
Are the SW measures being maintained and operated as per the permit requirements? n ®n n
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ nnn
upon request?
Comment: sod replaced by seeded grass. grass coverage more than 50%, weeds
throughout.
Other Permit Conditions Yos 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:
®nnn
® n n n
Page: 2

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