SW5090701_CURRENT PERMIT_20100223

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW�O�B�
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
AMU=0�1��
YYYYMMDD

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Mr. Roy Lorenzen, PE
Stewart Engineering, Inc.
421 Fayetteville St., Ste. 400
Raleigh, NC 27601
Dear Mr. Lorenzen:
Coleen H. Sullins
Director
December 14, 2009
Subject: Request for Additional Information
Dee Freeman
Secretary
Stormwater Project No. SW5090701 MOD
Chatham Hospital (Siler City Dialysis Center)
Chatham County
The Division of Water Quality Central Office received a Stormwater Management Permit Application for
the subject project on December 10, 2009. A preliminary review of that information has determined that
the application is not complete. The following information is needed to continue the stormwater review:
1. All items that must be signed by the applicant (Carolina Dialysis, LLC), must be signed by a
member/manager of the LLC. Alternatively, a member/manager of the LLC may submit an
original signed letter giving signature authority to Mr. Benjamin Gilbert.
2. A soils report must be submitted. that provides information on the seasonal high water table
(SHWT). This needs to be provided based on soil boring within the footprint of the proposed
BMP.
3. The drainage area values are not consistent between SWU-101, the supplement form, plans, and
calculations. Please correct these so all these items show the same values.
4. The impervious areas were all left blank in Section IV.10. of SWU-101. Please complete the
application fully.
5. Please show any wetlands on the plans or add a note stating there are not any.
6. The future expansion needs to be shown on the plans, calculations, and in the drainage area
table on SWU-101.
7. Underdrain calculations need to be provided. These calculations must show that the treatment
volume discharge rate < pre -development 1-yr, 24-hr storm discharge rate.
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699.1617 North Carol i t� a
Location: 512 N. Salisbury St. Rafeigh, North Carolina 27604 Phone: [phone] FAX: [phone] Customer Service: 1-877-623.6748 Naturally
Internet: www.ncwatergualit .org
An Equal Opportunityl Affirmative klion Employer

Mr. Roy Lorenzen, PE
SW5090701 MOD — Chatham Hospital
December 14, 2009
S. Please provide velocity information for the bioretention inlet swale feature at the west corner of
the parking lot. Inlet velocities into the bioretention cell should be < 1 fps.
9. The bioretention plan shows a single underdrain line on the cast side of the cell. It is highly
recommended that some redundancy is provided in the underdrains in case one of the lines
becomes clogged.
10. The outlet invert shown on the-bioretention area detail appears to be incorrect.
Please note that this request for additional information is in response to a preliminary review. The
requested information should be received by this Office prior to January 15, 2010, or the application will
be returned as incomplete. The return of a project will necessitate resubmittal of all required items,
including the application fee.
If you need additional time to submit the infonmation, please mail or fax your request for a time extension
to the Division at the address and fax number at the bottom of this letter. The request must indicate the date
by which you expect to submit the required information. The Division is allowed 90 days from the
receipt of a completed application to issue the permit. .
The construction of any impervious surfaces, other than a construction entrance under an approved
Sedimentation Erosion Control Plan, is a violation of NCGS 143-215.1 and is subject to enforcement
action pursuant to NCGS 143-215.6A.
Please reference the State.assigned project number SW5090701 on all correspondence. All original
documents must be returned or new originals must be provided. Copies are not acceptable. If you have
any questions concerting this matter please feel free to call me at [phone].
Sincerely,
obert D. Patterson, P.E.
Environmental Engineer
Stormwater Pennitting Unit
cc: Mr. Benjamin 01bert, Carolina Dialysis, LLC,.UNC Hospitals, Medical School Wing E, 4`h Floor,
Chapel Hill, NC 27514.
Ms. Carol Straight, Chatham Hospital, Inc., POfBox 649, Siler City, NC 27517
Raleigh Regional U." ice
DWQ Central Files.
Stormwater P--rmitting Unit Files
Page 2of2

q.
A , '9
d44
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Benjamin Gilbert
Division of Water Quality
Coleen H, Sullins
Director
January 5, 2010
Dee Freeman
Secretary
Carolina Dialysis, LLC i� E3 2 3 2010
101 Manning Drive
Chapel Hill, NC 27514 --- _ - i
Subject: Stormwater Permit No. SW5090701 Modification
Chatham Hospital (Siler City Dialysis Center #3375)
High Density Commercial Wet Pond & Bioretention Project
Chatham County
Dear Mr. Gilbert:
The Stormwater Permitting Unit received a complete Stormwater Management Permit
Application for modifying the Chatham Hospital permit on December 10, 2009, with additional
information received on December 23, 2009 and January 4, 2010. 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
modified Permit No. SW5090701, dated January 5, 2010, for the construction, operation and
maintenance of the subject project and the stormwater BMPs.
This permit shall be effective from the date of issuance until August 21, 2019, and shall be
subject to the conditions and limitations as specified therein. Please pay special attention to the
Operation and Maintenance requirements in this permit. Failure to establish an adequate system
for inspection and maintenance of the stormwater management system will result in future
compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within thirty (30) days following
receipt of this permit. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative
Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands are made this
permit shall be final anu binding.
This project will be kept on file at the Raleigh Regional Office. If you have any questions, or
need additional information concerning this matter, please contact Robert Patterson at (919)
807-6375; or [e-mail].
Sincerely,
far Coleen H. Sullins
Wetiands and Stormwaler Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 North C aro 1 i n a
Location: 512 N. Salisbury St Raleigh, North Carolina 27604 ,y ���1�3'����
Phone: [phone] FAX: [phone] L Customer Service: 1-877-623-6748 NI/�Y/
Internet: vAvw.ncwa*rqua:ity.or9
An Equal Opportunity 1 Affirmative Aclion Employer

Mr. Benjamin Gilbert
SW5090701 MOD — Chatham Hospital (Siler City Dialysis Center)
January 5, 2010
cc: Ms. Carol Straight - Chatham Hospital, Inc.
Raleigh Regional Office
Central Files
zSPU Fifes
ec: Mr. Adam Pike, PE, Stewart Engineering
Page 2 of 2

State Stormwater Permit
Permit No.SW5090701
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
Chatham Hospital, Inc.
Chatham Hospital (M.O.B. & Siler City Dialysis Center)
475 Progress Blvd., Siler City, Chatham County
FOR THE
construction, operation and maintenance of a wet detention pond and bioretention cell
in compliance with the provisions of 15A NCAC 2H .1000 and S.L. 2006-246 (hereafter
referred to as the "stormwater rules') and the approved stormwater management plans
and specifications and other supporting data as attached and on file with and approved
by the Division of Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until August 21, 2019, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.6 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from 51,449 square feet of
impervious area. This includes the 2,826 square feet of future impervious area.
3. The tract will be limited to the amount of built -upon area indicated on page 3 of
this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 7

State Stormwater Permit
Permit No.SW5090701
7. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a. Drainage Area, acres: 3.88
Onsite, ft : 169,013
Offsite, ft2: 0
b. Total Imperviops Surfaces, ft2:
Buildings ft :
Roads/Parking, ft2:
Other, ft2.
Offsite, ft:
c. Average Pond Depth, feet:
d. TSS removal efficiency:
e. Design Storm (in.):
f. Permanent Pool Elevation, FMS�
g. Permitted Surface Area @PP ft
h. Permitted Storage Volume, ftl:
i. Storage Elevation, FMSL:
j. Controlling Orifice:
k. Permanent Pool Volume, ft3
I. Forebay Volume, ft3:
m. Receiving Stream/River Basin:
n. Stream Index Number:
o. Classification of Water Body:
93,218
15,158
77,390
670 (sidewalks)
4.72
90%
1.0
569.0
4,814
7,817 at temporary pool
570.3
1.5" O pipe
13,295
2,558
Rocky River/ Cape Fear
17-43-(8 )
F,Ctl
8. The following design criteria have been provided in the bioretention cell and must
be maintained at design condition:
a.
Drainage Area, 9cres:
59,340
Onsite, ft :
59,340
Offsite, ft2:
0
b.
Total Imperviou? Surfaces, ft2:
41,769
Onsite, ft.:
41,769
Offsite, ft2:
0
C.
Design Storm, inches:
1.0
d.
Max. Ponded Depth, feet:
1.0
e.
Seasonal High Water Table:
> 2' below bottom
f.
Planting Media Depth, feet:
3.17
g.
Cell Dimensions, feet:
20 x 126
h.
Bottom Elevation, fmsl:
573.03
i.
Bottom Surface Area, ft2:
3,908
j.
Permitted Storage Volume, ft3:
3,425
k.
Bypass 1 Storage Elevation, fmsl:
577.2
I.
Predevelopment 1 year 24 hour:
0.73 cfs
M.
Post development 1 year 24 hour:
0.73 cfs
n.
Drawdown Time, hours:
36
o.
Underdrain Diameter, inches:
6
P.
Totai number of plants provided:
188
q.
Receiving Stream/River Basin:
Rocky River 1 Cape
r.
Stream Index Number:
17-43-(8)
S.
Classification of Water Body:
"C"
Fear
Page 2 of 7

State Stormwater Permit
Permit No.SW5090701
SCHEDULE OF COMPLIANCE
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.
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
The permittee shall at all times 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 revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, planting media, underdrains, catch basins.and piping.
g. Access to the outlet structure must be available at all times.
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 constructed in accordance with
the conditions of this permit, the approved plans and specifications, and other
supporting data.
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.
Page 3 of 7

State Stormwater Permit
Permit No.SW5090701
9. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or.sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
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 specifications 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
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 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.
Page 4 of 7

State Stormwater Permit
Permit No.SW5090701
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 requestfor a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10.The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11.The permittee shall notify the Division 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 5�h day of January, 2010.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION -
for uoleen H. Sullins, uirector
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5of7

State Stormwater Permit
Permit No.SW5090701
Chatham Hospital (Siler City Dialysis Center #3375)
Stormwater Permit No. SW5090701 MOD
Chatham County
Designer's Certification
I, , as a duly registered
in the State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
(Project)
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.SW5090701
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.
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.
'I4. All required parts of the system are provided, such as a plants,
underdrains, planting media, and a forebay.
_15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Raleigh Regional Office
Surface Water Protection
3800 Barrett Drive
Raleigh, NC 27609
-� and:
DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Page 7 of 7

State Stormwater Permit
Permit No.SW5090701
Chatham M.O.B.
Stormwater Permit No. SVV5090701
Chatham Countv
Designer's Certification
J 1EV Ei Y E0
FEB - 3 2011
AIC DENH
Raiefgh Regional Office
1
�. Y �}
I, A�q� t� , as a duly registered rh t�
in the State of North Carolina, having been authorized to observe eriodicall weekly/
full time) the construction of the project,
(U 4o, M141 Wu -
(Project)
for CF14%A It5p ital Ikc,
(Project Owner) hereby state that, to the
best of my abilities, due c re 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 o 36 Z-31
Date -41/11
SEAL
"otii�
2-Q SEAL
036231�/�
Page 5 of 6

State Stormwater Permit
Permit No.SW5090701
Certification Requirements:
A(P 1.
The drainage area to the system contains approximately the permitted
acreage.
_kP_2.
The drainage area to the system contains no more than the permitted
amount of built -upon area.
A(P 3.
All the built -upon area associated with the project is graded such that the
runoff drains to the system. .
A4.
All roof drains are located such that the runoff is directed into the system.
m5.
The outlet/bypass structure elevations are per the approved plan.
6.
The outlet structure is located per the approved plans.
SC;�s
rf%--i 7.
Trash rack is provided on the outlet/bypass structure.
8.
All slopes are grassed with permanent vegetation.
W*n.
`` 11
QNd
9.
Vegetated slopes are no steeper than 11.
5 G e�
10.
The inlets are located per the approved plans and do not cause short-
circuiting of the system.
0T
AAd�.i'MG
11.
The permitted amounts of surface area and/or volume have been
vs i�
provided.
12.
Required drawdown devices are correctly sized per the approved plans.
n
r 13.
All required design depths are provided.
V14.
All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
U 15_ The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Raleigh Regional Office
Surface Water Protection
3800 Barrett Drive
Raleigh, NC 27609
and:
DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Page 6 of 6

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
March 24, 2011
CERTIFIED MAIL ##7008 1300 0000 1109 4949
RETURN RECEIPT REQUESTED
Ms. Carol Straight, President
Chatham Hospital, Inc.
PO Box 649
Siler City, NC 27517
Subject: NOTICE OF INSPECTION
Chatham Medical Office Building & Siler City Dialysis Center
Permit No. SW5090701
Chatham County
Dear Ms. Straight:
On February 3, 2011, Natalie Landry and Lauren Witherspoon of the Raleigh Regional Office of the
Division of Water Quality (DWQ) inspected the Chatham Medical Office Building & Siler City Dialysis
Center in Chatham County to determine compliance with Stormwater Management Permit Number
SW5090701 issued on February 19, 2010. DWQ file review and site inspection revealed that the site had
some deficiencies with the terms and conditions of this permit. These are listed below, Please address
these deficiencies, describe your actions in writing and, in addition, submit your operation and
maintenance records to the DWQ Raleigh Regional Office. Please find a copy of the completed form
entitled "Stormwater Inspection Report" attached to this letter.
Chatham Medical Office Building (Wet Pond)
1. The berm between the forebay and the basin has one area of erosion with rills on the slope.
2. The dissipater pad on the inlet of the forebay is inadequate.
3. Groundcover has not been established.
4. The riser outlet dissipater pad is inadequate (too small and not built per the plan as the outlet pipe is
too short).
5. The silt fence should be removed from areas of concentrated flow (please refer to the Approved
Erosion and Sedimentation Control Plan).
Siler City Dialysis Center (Bioretention)
1. The deepest area of the forebay is not where the stormwater enters the lorebay as shown on the
plans.
2. The riser outlet dissipater pad is inadequate per the plans (not long enough).
3. Several of the clean outs could not be found. They were either not present or buried.
4. Ground covers shown on the plans near the inlet were not found (Coreopisis rosea and Lobia
cardinais).
Please be advised that you are required to comply with the terms, conditions and limitations of your
Stormwater Management Permit under 'Title 15A North Carolina Administrative Code 21-1 .1003 ARd
NorthCarolina
Naturally
North Carolina Division of Water duality Raleigh Regional Office Surface Water Protection Phone [phone] Customer Service
Internet, www.ncwaterquality.org 1628 Mail Service Center Raleigh, NC 27699-1628 FAX [phone]
An Equal OpportunitylAffirmative Action Employer — 50% Recycfed110% Past Consumer Paper

Chatham Medical•Office Building &�Siler City Dialysis Center
March 24, 201�,�
Page 2
North Carolina General Statute 143-214.7, including operation and maintenance of your permitted
stormwater system.
If the project has changed name, ownership or mailing address, a formal change of name/ownership form
must be submitted to DWQ within 30 calendar days detailing the change. Please provide the name,
mailing.address and phone number of the person or entity that is now responsible for this permit.
Thank you for your assistance and cooperation in responding to these items. Please be advised that
violations of the Stormwater Management Permit may be subject to a civil penalty assessment of up to
$25,000.00 per day for each violation. If you have any questions, comments, or need assistance with
understanding any aspect of your permit, please do not hesitate to contact me at [phone].
Sincerely,
Natalie Landry
Environmental Specialist
Enclosure: Stormwater Inspection Report
cc: Niki Maher — WBS Compliance & Permits Unit
IRRO Files
DWQ Central Files
Adam Pike, Stewart, 421 Fayetteville Street, Suite 400, Raleigh, NC 27601

Compliance Inspection Report
Permit: SW5090701 Effective: 01/05/10 Expiration: 08/21/19 Owner: Chatham Hospital Inc
Project: Chatham MOB
County: Chatham
475 Progress Blvd
Region: Raleigh
Chapel Hill NC 27517
Contact Person: Roy Paul Lorenzen Title: Phone: [phone]
Directions to Project:
Type of Project: State Stormwater - HD - Bioretention
Drain Areas: 001 - (Rocky River) (03-06-12 ) ( C)
002 - (Rocky River) (03-06-12 ) ( C)
On -Site Representative(s):
Related Permits:
Inspection Date: 02/03/2011 Entry Time: 03:15 PM
Primary Inspector: Natalie Landry
Secondary Inspector(s):
Lauren M Witherspoon
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: Q Compliant ■ Not Compliant
Question Areas:
E State Stormwater
(See attachment summary)
State Stormwater - HD - Detention Pond
Exit Time: 03:55 PM
Phone: [phone]
Phone:
Inspection Type: Compliance Evaluation
Page: 1

Permit: SW5090701 Owner - Project: Chatham Hospital Inc
Inspection Date: 02/03/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page: 2

Permit: SW5090701
Inspection Date: 02/0312011
Owner - Project: Chatham Hospital Inc
Inspection Type: Compliance Evaluation
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?
Reason for Visit: Routine
Comment: This permit covers two parcels: Siler City Dialysis Center and Chatham
Hospital Medical Office Building. The Dialysis Center has a Bioretention device and the
MOB has a Wet Pond to treat stormwater.
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 ftAaaauraa
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: The Bioretention device was not constructed as per the approved plans.
Deficiencies identified: the deepest area of the forebay is not where the stormwater
enters the forebay as shown on the plans, the riser outlet dissipator pad is inadequate
(not long enough), several clean outs not found, ground covers not found near inlet
(Coreopisis rosea and Lobia cardinais).
Operation and Maintenance
Are the SW measures being maintained and operated as per the permit requirements?
Yes No NA NE
■ ❑ ❑ ❑
■ ❑ ❑ ❑
■ ❑ ❑ ❑
Yes No NA NE
❑■❑❑
■ ❑ ❑'❑
■ ❑ ❑ ❑
Yes No NA NE
❑ ■ ❑ ❑
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ ❑ ❑ ❑ ■
upon request?
Comment: The O&M of the Wet Pond had several deficiencies identified and they are:
the berm between the forebay and basin has one area of erosion with rills on the slope,
the dissipator pad on the inlet of the forebay is inadequate, groundcover was not
observed, riser outlet dissipator pad is inadequate (too small and not built per the plan
as the outlet pipe is too short). Silt fence should be removed from areas of
concentrated flow and site needs groundcover over all. Request records.
Other Permit Conditions
Is the site compliant with other conditions of the permit?
Comment:
Other WQ Issues
Yes No NA NE
■ ❑ ❑ ❑
Yes No NA NE
Page: 3

Permit: SW5090701 Owner - Project: Chatham Hospital Inc
Inspection Date: 02/03/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Is the site compliant with other water quality issues as noted during the inspection? ■ ❑ 0
Comment:
Page: 4

High Density Developments with Outparcels
Deed Restrictions & Protective Covenances
In accordance with Title 15 NCAC 2H.1000 and S.L. 2006-246, the Stormwater Management
Regulations, deed restrictions and protective covenants are required for High Density Developments
with Outparcels where outparcel lots will be subdivided from the main tract and sold. Deed restrictions
and protective covenants are necessary to ensure that the development maintains a "built -upon" area
consistent with the design criteria used to size the stormwater control facility.
I, Carol Straight, as President of Chatham Hospital Incorporated, acknowledge, affirm and agree by my
signature below, that I will cause the following deed restrictions and covenants to be recorded prior to
the sale of any outparcel or future development area:
1. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number SW5090701 , as issued by the Division of Water Quality under
the Stormwater Management Regulations.
2. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to
maintain compliance with the stormwater management permit.
3. . `"These covenants are to run with the land and be binding on all persons and parties claiming
under them.
4. The covenants pertaining to stormwater may not be altered or rescinded without the express
written consent of the State of North Carolina, Division of Water Quality.
5. Alteration of the drainage as shown on the approved plan may not take place without the
concurrence of the Division of Water Quality.
6. The maximum built -upon area for the outparcel(s) shown on the approved plans is as follows:
Outparcel # BUA Outparcel # BUA
1 41,769 ft2
These allotted amounts include any built -upon area constructed within the property boundaries,
and that portion of the right-of-way between the lot lines and the edge of the pavement. Built
upon area includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate,
coquina and parking areas, but does not include raised, open wood decking, or the water
surface of swimming pools.
7. The runoff from all built -upon area within the outparcel or future development area must be
directed into the permitted stormwater control system.
8. Built -upon area in excess of the permitted amount will require a permit modification.
9. The connection from the outparcel's collection system into the stormwater control shall be made
such that short-circuiting of the system does not occur.
10. For those outparcels or future development areas whose ownership is not retained by the
permittee, the new owner shall submit a separate offsite stormwater permit application to the
Division of Water Quality and receive a permit prior to construction.
11. The project and each outparcel will maintain a 30** foot wide vegetated buffer between all
impervious areas and surface waters.
**50 foot for projects located in the 20 coastal counties.
Form DRPC-2 Rev.2 05Nov2009 Page 1 of 2

High Density Developments with Outparcels
Deed Restrictions & Protective Covenances
Signature: &1,tt ,( a r�.� _ Date:February J, 2010
Carol
Straight' President of Chatham Hospital Incorporated
a Notary Public in the
State of _J} Uu -Yk County of IP /�
do hereby certify that Carol Straight, President of Chath m Hospital Incorporated personally
appeared before me this the /y day of , 20--LO and
acknowledged the due execution of the foregoing instrument. Witness my hand and official seal,
P
Signature
My Commission expires
SEAL
Form DRPC-2 Rev.2 05Nov2009 Page 2 of 2
WCSR 4310486v2

V.
t
.ti
Permit Number:V O O 1U
(to be provided by DWO)
o� W A rgR 1t'! c7 rD
AGLA
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted along with ail of the required information.
I: PROJECT,lNF:ORMATION': ..,:A ,"f, 5' .^r} r4.i�.°"^.,j`: a'M,as Via. 'u r '� ' �Iro , a, r ;;�, r.' �`, i '-.r:ai'., riw3:� t
_ F._. `�l ,.. ,_. i
Project name Siler City Dialysis Center
Contact name Roy Lorenzen
Phone number 919 380 8750
bate December 22, 2009
Drainage area number 2
.a
II. DESIGN INFORMATION: r� � , ...v ..;;� ,e � :s, �y'�a :i� M,,, ,,,, 7x .FrtJ�s,� b �', w' � � �i�t w,�., � I' q i";. �a., .t-,''.,•
N- �.'7 .!j .f �. Ln .l JNr: . I ti � uJ f .♦<r. i . f � I
Site Characteristics
Drainage area 59,340 ft2
Impervious area 41,769 ft2
Percent impervious 70.4% %
Design rainfall depth 1.0 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak flow required?
N (Y or N)
1-yr, 24-hr runoff depth
N/A in
1-yr. 24-hr intensity
NIA in/hr
Pre -development 1-yr, 24-hr peak flow
N/A ft'Isec
Post -development 1-yr, 24-hr peak flow
N/A ft3/sec
Pre/Post 1-yr, 24-hr peak control
#VALUE! ft3/sec
Storage Volume: Nora -SA Waters
Minimum volume required
3,380.0 ft3
Volume provided
3,425.0 ft3
Storage Volume: SA Waters
1.5" runoff volume
NIA ft3
Pre -development 1-yr, 24-hr runoff
N/A ft3
Post -development 1-yr, 24-hr runoff
N/A ft3
Minimum volume required
#VALUE! ft3
Volume provided
NIA ft3
Cell Dimensions
No
Ponding depth of water
12 inches
OK
Ponding depth of water
1.00 ft
Surface area of the top of the bioretention cell
3,908.0 ft2
OK
Length:
126 ft
OK
Width:
20 ft
OK
-or- Radius
ft
Media and Soils Summary
Drawdown time, ponded volume
12 hr
OK
Drawdown time, to 24 inches below surface
24 hr
OK
Drawdown time, total:
36 hr
In -situ soil:
Soil permeability
0.52 in/hr
OK
Planting media soil:
Soil permeability
1.00 Whr
OK
Soil composition
% Sand (by weight)
85%
OK
% Fines (by weight)
12%
OK
#VALUE!
Form SW401-Bioretention-Rev.8
Juty 30, 2009
Paris ! and II. Design Summary, Page 1 of 3

r'
Peimit Number;
(to 6e provided by DWQ)
% Organic (by weight) 3% OK
Total: 100%
Phosphorus Index (P-Index) of media 15 (unitless) OK
Forth SW401-Bioretention-Rev.8
July 30, 2009 Parts I and II. Design Summary, Page 2 of 3

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 sett with trees/shrubs?
Planting elevation (top of the mulch or grass sod layer).
Depth of mulch
Bottom of the planting media soil
Planting media depth
Depth of washed sand below planting media soil
Are underdrains being installed?
How many clean out pipes are being installed?
What factor of safety is used for sizing the underdrains? (See
BMP Manual Section 12,3.6)
Additional distance between the bottom of the planting media and
the bottom of the cell to account for underdrains
Bottom of the cell required
SHWT elevation
Distance from bottom to SHWT
Internal Water Storage Zone (IWS)
Does the design include IWS
Elevation of the top of the upturned elbow
Separation of IWS and Surface
Planting Plan
Number of tree species
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
through a vegetated filter?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the BMP located a1 least 30 feet from surface waters (50 feet if
SA waters)?
is the BMP located at Ieast.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
(81inches gravel followed by 3-5 ft of grass)
Grassed swale
Forebay
Other
577.20 fmsi
N (Y or N)
Y (Y or N) OK media depth
576.2 fmsl
2 inches OK
573.03 fmsl
3.17 ft
0.333 ft
Y (Y or N)
11
10
1 ft
571.697 fmsl
NIA fmsl
#VALUE? ft
Y (Y or N)
fmsl
576.2 ft
Q
0
0
OK
OK
OK
Permit Number: 5 `' d� a�
(to be provided by DWO)
rt Ld
#VALUE!
N (Y or N) Excess volume must bypass cell.
N (Y or N) Excess volume must pass through filter.
NIA ft
NIA (Y or N) Enter Data
Y (Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
Y (Y or N)
OK
3.7 ft/sec
Insufficient inlet velocity unless energy dissipating devices are being
used.
N (Y or N)
OK
N (YorN) OK
Y (Y or N) OK
X
OK
X
Form SW401-Bioretention-Rev.8
July 30, 2009
Parts I and II. Design Summary, Page 3 of 3

Permit Number: .S AJ 5 O`;1C7? O /
(to be provided by DWQ)
Drainage Area Number: 2
Bioretention Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
Iog 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 theproblem:
The entire BMP
Trash/debris is present.
Remove the trasl!Z 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 -sine.
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
c
turf matting or riprap to avoid i
future problems with erosion.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
If�ilJi� ._•�
Lk
Form SW401-Bioretention 0&M-Rev.3
Page I of 4

BMP element:
Potentialproblems:
How I will remediate theproblem:
The pretreatment area
plow is bypassing
Regrade if necessary to route all
pretreatment area and/or
flow to the pretreatment area.
gullies have formed.
Restabilize the area after grading.
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. Reprove 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
possible.
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 elanting media.
Form SW40I-Bioretention O&M-Rev.3 Page 2 of 4

BMP element:
Potentialproblems:
now I will remediate theproblem:
The underdrain system
Clogging has occurred.
Wash out the underdrain system.
if applicable)
The drop inlet
Clogging has occurred.
Clean out the drop inlet. Dispose of
the sediment off -site.
The drop inlet is damaged
Repair or replace the drop inlet.
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,
Form SW40 I -Bioretention O&M-Rev.3 Page 3 of 4

r
Permit Number: 5 LV 5 01 Cif% 0 /
(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 party.
Project name.Carolina Dialysis, LLC- Siler City #3375
BMP drainage area number:
Print name: �044 f" e h 6,
Title:
Address
10 AOMhl-'tAi
Phone:
Signature:
W U, 1V C, Z- S (
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,,, ! U/QAe S , a Notary Public for the State of
N ►' l ' , County of do hereby certify that
l'�"'Ic1M1 h in �-tll personally appeared before me this sj
day of,L(1y,� �e,/ 2Uy7 , and acknowledge the due execution of the
forgoing bioretention maintenance requirements. Witness my hand and official seal,
Diane Owens
Notary Public
Durham County
North Carolin
My Commission Expires ` 2
SEAL
My commission expires '-f -" Z - /�t-
Form SW401-Bioretention I&M-Rev. 2 Page 4 of 4

t�
2 AMC11 I A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor
Ms. Carol Straight, President
Chatham Hospital, Inc.
PO Box 649
Siler City, NC 27517
Dear Ms. Straight:
Director
July 13, 2009
Subject: Request for Additional Information
Stormwater Project No. SW5090701
Chatham M.O.B.
Chatham County
Secretary
The Division of Water Quality Central Office received a Stormwater Management Permit Application for
the subject project on July 1, 2009. A"preliminary review of that information has determined that the
application is not complete: The following information is needed to continue the stormwater review:
The plans must show the entire property area and BUA (new and existing). The permit will be
written for the entire property area, not just a portion of it as proposed. The existing BUA does
not need to be treated, only the new BUA. This information will be reflected in part III of
SWU-101. Any future changes anywhere on the property will require a permit modification
and/or plan.revision regardless of how much land is disturbed.
2. A soils report must be submitted that provides information on the seasonal high water table
(SHWT). This needs to be provided based on soil boring within the footprint of the proposed
BMP.
3. The incorrect.SA/DA ratio was used for the wet pond design. The average depth (as calculated
by one of two options in the Manual) must be used, not the maximum depth as shown in the
calculations.
4. The impervious area is not consistent between SWU-101, the supplement form, and the
calculations. Please -correct these so that the same impervious area is shown on all documents.
5. The table in the calculations showing contour areas and volumes should be continued up
through the 1" treatment volume storage elevation.
6. The head used in the orifice drawdown calculations must use 1-1/3 as per the BMP Manual.
Wetlands and Stormwater Branch
1647 Mail Service Center, Raleigh, North Carolina 27699-1617 One
Location: 512 N. Salisbury St, Raleigh, North Carolina 27604 NorthCarollriina
Phone: [phone] FAX: 919�07-64941 Customer Service: 1-877-623-6748 AahiralJ/ L
Internet: www.ncwaterquahty,org ;/
An Equal Opportunity 1 Affirmative Action Employer

Ms. Carol Straight, President
SW5090701 —Chatham M.O.B.
July 13, 2009
7. The pond cross-section on C600 shows the bottom at elevation 261, the text above it says it is at
260. The calculations and forms all show it at 259.5. Please make consistent.
8. The planting plan shows trees on the embankment, one tree in the middle of the emergency
spillway, and at least one tree on the vegetated shelf. No trees should be planted on the pond
embankment, spillway, or vegetated shelf. All trees should be outside of the pond proper.
Please revise. It may be helpful to show the major pond contours (berm, shelf, etc) on the
planting plan.
Please note that this request for additional information is in response to a preliminary review. The
requested information should be received by this Office prior to August 14, 2009, or the application will be
returned as incomplete. The return of a project will necessitate resubmittal of all required items, including
the application fee.
If you need additional time to submit the information, please mail or fax your request for time extension
to the Division at the address and fax number at the bottom of this letter. The request must indicate the date
by which you expect to submit the'required information. The Division is allowed 90'days from the'
receipt of a completed application to issue the permit.
The construction of any impervious surfaces, other than a construction entrance under an -approved
Sedimentation Erosion Control Plan, is a violation of NCGS 143-215.1 and is subject to enforcement
action pursuant to NCGS 143-215.6A.
Please reference the State assigned project number SW5090701 on.a11 correspondence. All original
documents must be returned or new originals must be provided. Copies are not acceptable. If you have
any questions concerning this matter please feel free to call me at (919) 8077-6375. .
cc: Raleigh Regional Office
D WQ Central Files
Stormwater Permitting Unit Files
Sincerely,
Robert D. Patterson, P.E.
Environmental Engineer
Stormwater Permitting Unit
Page 2 of 2

i F
3DW.Q USE�ONLYw..��„1��,'�'A���.n?t,.sz{.�.:�.��.;�,.•,:��°�;�:��_��,�s��:f:�,,#.�;
Dat Received Fee Paid Permit Number
r o aC a S+✓ OGl 3 o
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This farm may be photocopied for use as an original
1. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
Chatham Hospital, Inc.
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
Carol Straight, President
3. Mailing Address for person listed in item 2 above:
City:Siler City _ State:NC Zip:27517
Phone: (919 . ) 799-4001 Fax: (919 } 799-4011
Email:[e-mail]_
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Chatham MOB
5. Location of Project (street address):
475 Progress Blvd
City:Siler City County:Wake Zip:
6. Directions to project (from nearest major intersection):
64W heading from Raleigh, make a left on Progress Blvd. Make a left on Campus Blvd. Site will be on the
7. Latitude:35° 43' 26" N Longitude:79° 25' 00" W of project
8. Contact person who can answer questions about the project:
Name:Roy Lorenzen _ Telephone Number: (919 ),-866-4813
Email:[e-mail]
II. PERMIT INFORMATION:
1. Specify whether project is (check one)
►1 -
❑Renewal ❑Modification
Form SWU-101 Version 09.25.08 Page 1 of 4

1. Specify whether project is (check one): ZNery ❑Renewal }i,4ociificat!on
2. If this application is being submitted as the result of a renewal or modification to an existint; permit, list the.
existing permit numbern/a and its issue date i_i' know..)ii la
3. Specify the type of project (check one):
❑1_ow Density XHigh Density [:]Redevelop I Permit fr[U:tivc rsal S\i.P ❑Other
4. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-674 ):
❑CAMA Major ®Sedimentation/Eros ion Control ❑404/401 Perii-dt []NPDES Industrial ~✓LONAA alter
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be Healed. Also attach i, detailed narrative
(one to two pages) describing stormwater management for the project.
Stormwater for the proposed improvements will involve runoff bein r capture 1) , proposed storm drainage
and stormwater swales that will route the runoff to a proposed i of detention basin at the eastern portion of the
project. The wet detention basin will then capture and detain the first flush of runoff and release the first flush
volume over a period of 4 days.
2. Stormwater runoff from this project drains to the Cape Fear _ River basin.
3. Total Property Area: 30.3$ acres 4. Total Coastal Wetlands Area: N/A __ acres
5. Total Property Area (3) - Total Coastal Wetlands Area (4) = Total Project Area" 30.38 acres
6. (Total Impervious Area / Total Project Area) X 100 = Project Built Upon Area (BUA):26 io
7. How many drainage areas does the project have?]
8. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as below.
For high density uroiects. conrnlete the table with one drainage area for each engineered stormwater device.
Basin Information
Drainage Area 1
Drainage Area 2
Receiving Stream Name
Rocky River
Stream Class & Index No.
C 17--43-(8)
Total Drainage Area (sf)
169013
On -site Drainage Area (so
169013
Off -site Drainage Area (so
0
Existing Impervious* Area (so
0
Proposed Impervious*Area (so
93218
Impervious* Area (total)
55
Impervious* Surface Area
Drainage Area 1
Drainage Area 2
On -site Buildings (so
15158
On -site Streets (so
5050
On -site Parking (sf)
72340
On -site Sidewalks (so
670
Other on -site (so
0
Off -site (so
0
Forin SWU-101 Version 09.25.08 Page 2 of 4

Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
**Total project area shall be calculated to exclude Coastal Wetlands from use when calculating the built upon area
Percentage calculation. This is the area used to calculate overall percent project built upon area (BUA).
9. How was the off -site impervious area listed above derived?N/A
Projects in Union County: Contact the DWQ Central Office staff to check to see if you project is located
within a Threatened & Endangered Species watershed that may be subject to more stringent stormwater
requirements.
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
One of the following property restrictions and protective covenants are required to be recorded for all
subdivisions, outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table
listing each lot number, size and the allowable built -upon area for each lot must be provided as an attachment.
Forms can be downloaded from littp://h2o.enr.State.nc.us/su/bmp forms.htm - deed restrictions.
Form DRPC-1
High Density Commercial Subdivisions
Form DRPC-2
High Density Developments with Outparcels
Form DRPC-3
High Density Residential Subdivisions
Form DRPC-4
Low Density Commercial Subdivisions
Form DRPC-5
Low Density Residential Subdivisions
Form DRPC-6
Low Density Residential Subdivisions with Curb Outlets
By your signature below, you certify that the recorded property restrictions and protective covenants for this
project shall include all the applicable items required in the above form, that the covenants will be binding on
all parties and persons clairping under them, that they will run with the land, that the required covenants
cannot be changed or deleted without concurrence from the NC DWQ, and that they will be recorded prior to
the sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each
BMP specified for this project. Contact the Stormwater Permitting Unit at [phone] for the status and
availability of these forms. Forms can be downloaded from http://l12o.enr.state.nC.Lls/su/bmp. forms.ltm.
Form SW401-Low Density
Form SW401-Curb Outlet System
Form SW401-Off-Site System
Form SW401-Wet Detention Basin
Form SW401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-Level Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Form SW401-Permeable Pavement
Form SW401-Cistern
Low Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
Permeable Pavement Supplement
Cistern Supplement
Form SWU-101 Version 09.25.08 Page 3 of 4

VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. The complete application package should be
submitted to the appropriate DWQ Office. (Appropriate office may be found by locating project on the
interactive online map at http://h2o.enr.state.ne.us/so/msi maps.htm)
I. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• Original and one copy of the Stormwater Management Permit Application Form ff
• Original and one copy of the Deed Restrictions & Protective Covenants Form (if
required as per Part IV above)
• Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP Atp
• Permit application processing fee of $505 (Express: $4,000 for HD, $2,000 for LD)
payable to NCOENR AlP
• Calculations & detailed narrative description of stormwater treatment/management Ali+
• Copy of any applicable soils report hl/F
■ Two copies of plans and specifications (sealed, signed & dated), including: fir_
- Development/Project name
- Engineer and firm
-Legend
- North arrow
- Scale
- Revision number & date
- Mean high water line
- Dimensioned property/project boundary
- Location map with named streets or NCSR numbers
- Original contours, proposed contours, spot elevations, finished floor elevations
- Details of roads, drainage features, collection systems, and stormwater control measures
- Wetlands delineated, or a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
- Drainage areas delineated
- Vegetated buffers (where required)
VIL AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf (such as additional information requests), please complete this section. (ex. designing engineer or firm)
Designated agent (individual or firm):
Mailing Address:
City: State: Zip:
Phone: { } Fax: ( )
Email:
VIII. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in General Information, item 2) Carol Striaght
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 15A
NCAC 2H .100 .
� '(7 , /cy
Signature: Date: -?
Form SWU-101 Version 09.25.08 Page 4 of 4

Permit Namber:L W .S O?a 1}�/
(to be provided by DWQ)
Drainage Area Number: _
Wet Detention Basin 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.
The wet detention basin system is defined as the wet detention basin,
pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
❑ does ®does not
This system (check one):
❑ does ®does not
incorporate a vegetated filter at the outlet.
incorporate pretreatment other than a forebay.
Important maintenance procedures:
— Immediately after the wet detention basin is established, the plants on the
vegetated shelf and perimeter of the basin should be watered twice weekly if
needed, until the plants become established (commonly six weeks).
— No portion of the wet detention pond should be fertilized after the first initial
fertilization that is required to establish the plants on the vegetated shelf.
— Stable groundcover should be maintained in the drainage area to reduce the
sediment load to the wet detention basin.
— If the basin must be drained for an emergency or to perform maintenance, the
flushing of sediment through the emergency drain should be minimized to the
maximum extent practical.
- ._Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected 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 should be kept in a known set
location and must be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the wet
Areas of bare soil and/or
Regrade the soil if necessary to
detention basin
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.
Vegetation is too short or too
Maintain vegetation at a height of
long.
approximately six inches.
Form SW401-Wet Detention Basin O&M-Rev.4
Page 1 of 4

Permit Number: 1'V51e�`iG�
(to be Provided by DWQ)
Drainage Area Number: I
BMP element:
Potential roblem:
How I will rernediate theproblem:
The inlet device: pipe or
The pipe is clogged.
Unclog the pipe. Dispose of the
swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the Swale if necessary to
Swale.
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
The forebay
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design depth for
possible. Remove the sediment and
sediment storage.
dispose of it in a location where it
will not cause impacts to streams or
the-BMP.
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., If pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional
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 on
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The main treatment area
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design sediment
possible. Remove the sediment and
storage depth.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Algal growth covers over
Consult a professional to remove
50% of the area.
and control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them
invasive plants cover 50% of
.with pesticide (do not spray).
the basin surface.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 2 of 4

Permit Number: cSt►Qa C) ?G/
(to be provided by DIVQ)
Drainage Area Number: /
BMP element:
Potentialproblem:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
A tree has started to grow on
Consult a dam safety specialist to
the embankment.
remove the tree.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs re air. (i€ applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged___
Re air or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the local NC Division of
damage have occurred at the
Water Quality Regional Office, or
outlet.
the 401 Oversight Unit at 919-733-
1786.
The measuring device used to determine the sediment elevation shall be such
that it will give an accurate depth reading and not readily penetrate into
accumulated sediments.
When -the permanent pool depth reads 9.5 feet in the main pond, the sediment
shall be removed.
When the permanent pool depth reads 5 feet in the forebay, the sediment shall
be removed.
Sediment Removal 165 1
Bottom Elevaticx 564
FOREBAY
BASIN DIAGRAM
(fill in the blanks)
Volume
ft Min.
Sediment
Storage
Permanent Pool Elevation 569
Pool
Sediment Removal Elevation 560.5 Volume
Bottom Elevation
MAIN POND
1-ft n.
Sediment
Storage
Form SW401-Wet Detention Basin O&M-Rev.4
Page 3 of' 4

Permit 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 party.
Project name:Chatham Hospital MOB
BMP drainage area number:
Print name -Carol Straight
Title: President
Address:PO Box 649, Siler City, NC 27344 __.,..
Phone:[phone]
Signature:
Date: 4k%may
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, `�r l�a p•r�c SS , a Notary Public for the State of
W , County of "to I I, , do hereby certify that
personally appeared before me this
day of �t cryy_ o �1_ , and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
SEAL
My commission expires o?ol U
Form SW401-Wet Detention Basin O&M-Rev.4 Page of 4