SW7061115_CURRENT PERMIT_20070718

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
27/9�
YYYYMMDD

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen 1i, Sullins, Director
Division of Water Quality
July 18, 2007
Mr. C. Brantley Tillman, Member
Weeksville Crossing, LLC
1648 North Market Street, Suite E
Raleigh, NC 27609
Subject: Stormwater Permit No. SW7061115MOD
Weeksville Crossing Shopping Center
Redevelopment Stormwater Permit
Pasquotank County
Dear Mr. Tillman:
The Washington Regional Office received a complete Stormwater Management Permit
Application for the modification of Weeksville Crossing Shopping Center on May 8, 2007.
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. We are
forwarding Permit No. SW7061115MOD dated July 18, 2007, for the construction of the
subject project. The stormwater permit issued for this project on December 8, 2006 is hereby
rescinded and is replaced by this permit.
This permit shall be effective from the date of issuance until December 8, 2016, 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 operation 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 sixty (60) days
following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150E of the North Carolina General Statutes, and filed with the Office
of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such
demands are made this permit shall be final and binding:
If you have any questions, or need additional information concerning this matter, please
contact Scott Vinson, or me at [phone].
Sincerely,
AAlocr
Regional Supervisor
Surface Water Protection Section
AH/sav: C:ISTORMWATERIPERMIT1SW7061115MOD
cc: Andy Dee[, PE, Quible & Associates
Elizabeth City Building Inspections
Jasquotank County Building Inspections
'Washington Regional Office
Central Files N°nc
'Carolina
atur"I'm
North Carolina Division of Water Quality Washington Regional Office Phone [phone] FAX [phone] Customer Service
intemet: www.ncwaterqualitv�.ort 943 Washington Square Mall, Washington, NC 27889 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer — 50% Recycledll0% Pcst Consumer Paper

State Stormwater Management Systems
Permit No. SW7061115MOD
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
REDEVELOPMENT
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
Weeksville Crossing, LLC
Weeksville Crossing Shopping Center
Pasquotank County
FOR THE
construction, operation and maintenance of one wet detention basin and nine bioretention
areas in compliance with the provisions of 15A NCAC 2H .1000 (hereafter referred to as the
"stormwater rules') and the approved stormwater management plans and specifications- and
other supporting data as attached and on file with and approved by the Division of Water
Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until December 8, 2016, 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, 1.7 and 1.8 on pages 3 and 4 of this permit. The
stormwater controls have been designed to handle the runoff from 165,99 square feet
of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in the application,
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 areas of this project
must be directed into the permitted stormwater control system.
Page 2 of 8

State Stormwater Management Systems
Permit No. SW7061115MOD
6. The following design criteria have been provided in the wet detention pond and must
be maintained at design condition:
Drainage Area #1
a.
Drainage Area, acres:
3.24
b.
Total Impervious Surfaces, acres:2.88
(125,668 ftz )
C.
Design Storm, inches:
1.0
d.
Pond Depth, feet:
3.00
e.
Permanent Pool Elevation, FMSL:
5.00
f.
Permanent Pool Surface Area, ft2:
4,551
g.
Permanent Storage Volume, ft3:
4,886
h.
Permitted Forebay Volume, ft3:
1,167
i.
Temporary Storage Elevation, FMSL:
7.00
j.
Temporary Storage Volume, ft3:
13,430
k.
Controlling Orifice:
1.50" pipe
I.
Receiving Stream/River Basin:
Charles Creek 1 Pasquotank
M.
Stream Index Number:
30-3-11
n.
Classification of Water Body:
"C; Sw"
7. The
following design criteria have been provided in the bioretention areas and must be
maintained at design condition:
DA2,3&4 DA5,6&7
a.
Drainage Area, acres:
0.06 0.06
b.
Total Impervious Surfaces, ftz:
2,322 1,854
C.
TSS removal efficiency:
856/0 85%
d.
Bioretention Depth, inches:
9.0 9.0
e.
Temporary Ponded Depth Elevation, FMSL:
11.40 9.70
f.
Bioretention Planting Elevation, FMSL:
10.65 8.95
g.
Bioretention Surface Area, ft2:
528 432
h.
Permitted Storage Volume, ft3:
264 213
i.'
Minimum Required Volume, ft3:
264 213
j.
Receiving Stream/River Basin:
Charles Creek 1 Pasquotank
k.
Stream Index Number:
30-3-11
I.
Classification of Water Body:
"C; Sw"
Page 3 of 8

State Stormwater Management Systems.
Permit No. SW7061115MOD
8. The following design criteria have been provided in the bioretention areas and must be
maintained at design condition:
DA 8
DA 9
DA 10
a.
Drainage Area, acres:
0.37
0.38
0.329
b.
Total Impervious Surfaces, ft2:
12,743
12,040
11,372
C.
TSS removal efficiency:
85%
85%,
85%
- d.
Bioretention Depth, inches:
9.0
9.0
9.0
e.
Temporary Ponded Depth Elevation, FMSL:
10.50
9,40
8.90
f.
Bioretention Planting Elevation, FMSL:
9.75
8.65
8.15
g.
Bioretention Surface Area, ft2:
1,823
1,331
1,222
h.
Permitted Storage Volume, ft3:
1,594
1,374
1,208
i.
Minimum Required Volume, ft3:
1,143
1,116
1,194
j.
Receiving Stream/River Basin:
Charles Creek
1 Pasquotank
k.
Stream Index Number:
30-3-11
1.
Classification of Water Body:
"C; Sw"
II. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in its entirety, vegetated
and operational for its intended use prior to the construction of any built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately.
3. The permittee shall at all times provide 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 (at least 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, flow spreader, catch basins
and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept 'and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
Page 4 of 8

State Stormwater Management Systems
Permit No. SV 7061115MOD
5. 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.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and
prior to operation of this permitted facility, a certification must be received from an
appropriate designer for the system installed certifying that the permitted. facility has
been installed in accordance with this permit, the approved plans and specifications,
and other supporting documentation. Any deviations from the approved plans and
specifications must he noted on the Certification. A modification may be required for
those deviations.
7. 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.
8. Access to the stormwater facilities shall be maintained via appropriate easements at
all times.
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.
13. This permit shall be effective from the date of issuance until December 8, 2016.
Application for permit renewal shall be submitted 180 days prior to the expiration date
of this permit and must be accompanied by the processing fee.
Page 5 of 8

State Stormwater Management Systems
Permit No. SW7061115MOD
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
formal permit transfer request to the Division of Water Quality, accompanied by a
completed name/ownership change form, documentation from the parties involved,
and other supporting materials as may be appropriate. The approval of this request
will be considered on its merits and may or ma not be approved. The permittee is
responsible for compliance with all permit conditions until such time as the Division
approves the transfer request.
2. 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.
3. '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.
4. 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.
5. 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.
6. The permit may be modified, revoked and reissued or terminated for cause. The filing
of a request for a permit modification, revocation and reissuance or termination does
not stay any permit condition.
7. 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.
8. Approved plans and specifications for this project are incorporated by reference and
are enforceable parts of the permit.
9. The permittee shall notify the Division any name, ownership or mailing address
changes within 30 days.
Permit issued this the 18th day of July, 2007.
NORTH CAROLINA ENVIRONMENTAL. MANAGEMENT COMMISSION
for
Coleeullins, irector
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. SW7061115MOD'
Page 6 of 8

' - State Stormwater Management Systems
Permit No. SW7061115MOD
Weeksville Crossing Shopping Center
Stormwater Permit No. SW7061115MOD
Pas uotank Count
Designer's Certification
l , 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 7 of 8

State Stormwater Management Systems
Permit No. SV 7061115MOD
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.
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
Pasquotank County Building Inspections
Elizabeth City Building Inspections
Page 8of8

rom:00MMER0iAL PROPERTIES 9199548859 03/09/2011 12:21 #009 P.002/005
IRECEIVEP
APR 1.5 2011
DWQ NCDENR
PROD # Ne4h earciina uepMtment of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
1. CURRENT PERMIT INFORMATION
1. Stormwater Management Permit Number: T5W D(P 1ixs_
2. Project Name:4R.V1j�1P CIro�S�'r�S�QP�_�n
3. Current Permit Holder's Company Name/Organization:iCSVI
4. Signing Official's Name: C • a 1 t itft]yyj ] Title:
5. Mailing Address: 100 1n�ce T:VY(-" -
Citv: - Cp: �17C0U4
State: N- Z
6. Phone: L V0J-- l i5']-�. � �� Fax: ct !9 q Z Mq1
Ill. PROPOSED PERMITTEE / OWNER / PROJECT / ADDRESS INFORMATION
This request is for. (please check all that apply)
❑ Name change of the owner (Please complete Items 1, 2 and 3 below)
[] Name change of project (Please complete Item 5 below) r
ART'hange, in ownership of the property/company (Please complete Items 1, 2, 3, and 4 below)
❑ Mailing address / phone number change. (Please complete Item 4 below)
0 Other (please explain):
1. Proposed permittee's company name/organizati Ar �
2. Proposed permittee's signing offici l's name:
3. Proposed permittee's tide:
4. Mailing City:• /. - ►•
Phone:• r i
5. New Project Name to be placed on permit:
Please check the appropriate box. The proposed permittee listed above is:
❑ HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA in #1 above and provide name of HOA/POA's authorized representative in #2 above)
The property owner
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
❑ Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner information on page 4)
SSW N/O Change Rev15Feb2011 Page 1 of 4

zrom:COhf1ERCIAL PROPERTIES 9199548859 03/09/2011 12:21 #009 P.003/005
Ili. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may result in processing delays or denial of the transfer.
1. This completed and signed form. This certification must be completed and signed by'both the
current permit„holder and the new applicant if this is a change of ownership.
2. Legal docurneritation of the property transfer to a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4. The designer's certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional office), if required by the permit and if not already submitted to DWQ.
5. If the proposed permittee is a firm, partnership, association, insfibAon, corporation, limited liability
company, or other corporate entity, provide documentation showing the authority of the named
representative to act on behalf of the proposed permittee.
6. The $40.00 processing fee. If this is an initial transfer from the original permittee the processing
fee is not required_ Subsequent ownership transfers will require the $40.00 processing fee.
IV. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fi11 out the certification below that statement_
❑ Check here if the current permittee is only changing his/her/its name, the project name, or mailing
address, but will retain the permit. I, the current
permittee, hereby notify the DWQ that I am changing my name and/or I am changing my mailing
address and/or I am changing the name of the permitted project. 1 further attest that this application
for a name/ownership change is accurate and complete to the best of my knowledge. I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments listed above are not included, this application package will be returned as
incomplete.
Check here if current permittee is transferring the property to a new owner and will not retain
ownersho of the permit.
I, �lt.ili�ilG C �1] I laWthe current permittee, am submitting this application
for a transfer of own rship for permit SW-70U \t!5 . 1 hereby notify DWQ of the sale or
other legal transfer of the storrnwater system associated with this permit. I have provided a copy of
the most recent permit, the designees certification for each BMP, any recorded deed restrictions,
covenants, or easements, the Dfi11Q approved plans and/or approved as -built plans, the approved
operation and maintenance agreement, past maintenance records, and the most recent DWQ
stormwater inspection report to the proposed peiYrAtee named in Sections ll and V of this form. 1 .
further attest that this application for a na;melownership change is accurate and complete to the best
of my knowledge. I understand that if all required Parts of this application are not completed or if all
required supporting Information and attachments listed above are not included, this application
package will be returned as incomplete. I assign all rights apd obligations as permittee to the
proms prendttee n in ions II and V of this form. 1 understand that this transfer of
ownership cannot be approv b the DWQ unless and until the facility is in compliance with the
permit. (--,) , n
Signature:
,�, lk- I \
I, -�LA ;SCJy� .`�� I 0L.C-rY-,3`n , a Notary Public for the State of
n Cs t' G-C a. _ --,County of do hereby certify that
ryQL� personally appeared before me this the
day of _gyp l C- 20-�L. and acknowledge the 03" on of the
forgoing instrument. Witness my hand and official seal,
oho tary Signaturd
Kiy Commission Expires 10-19-2011.
SSW N/O Change Rev15Feb2011. . Page 2 of 4
to
VO
��, Gg 0
►pN E
COV,..""

\l

From:COMMERCIAL PROPERTIES 9199548859 03/09/2011 12:21 #009 P.004/005
V. PROPOSED PERIMIIITTEE CERTIFICATION: (This section must be completed by the
Proposed Permittee for all transfers of ownership)
I, X-w " Z , hereby notify the DWQ that I have acquired
through sale, lease or legal transfer, the res nsibility for operating and maintaining the permitted
stormwater management system, and, if applicable, constructing the permitted system. I
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
❑ the most recent permit
❑ the designer's certification for each BMP
❑ any recorded deed restrictions, covenants, or easements
❑ the. DWQ-approved plans and/or approved as -built plans
the approved operation and maintenance agreement
epast maintenance records from the previous permittee (where required)
DWQ stormwater inspection report showing compliance within 90 days prior to this transfer
I have reviewed the permit, approved plans and other documents listed above, and I will comply with
the terms and conditions of the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to the requirements listed in the permit and in the
operation and maintenance agreement. I further attest that this application for a name/ownership
change is accurate an lete to the best of my knowledge. I understand that if all required parts
of this application g n mpl ted or if all required supporting information and attachments listed
above are not in d is lication package will be returned as incomplete
Signature: r Date: 3
I, _ a Notary Public for the State of
County of bna"o. , do hereby certify that
aml, Ile nyns Jr. personally appeared before me this the
day of _ _ Mja-tcy, , 20 1 l , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
c9 (Notary Sea])
Notary Signature CHRIVINA M. LOCKWOOD
Notary pubiic, state of New York
Quai. in Onondaga Co. No. 4968959
Commssion Expires 07/091j3h*q
Additional copies of the original permit and the approved Operation and Maintenance agreement can
be obtained from the appropriate Regional Office of the Division of Water Quality.
This completed form, including all supporting documents and processing fee frf required), should be
sent to the appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources, Drvrsion of Water Qualify, as shown on the attached map.
Please note that if the Proposed Permgttee listed above is not the prooppeerty owner, the property owner
must complete and sign page 4 of this document. Both the lessee / dove oper and the property
owner will appear on the permit as permittees.
SSW N/O Change Rev15Feb2011 Page 3 of 4

I
Y.
.0

r .. �rom:COMMERCIAL PROPERTIES 9199548859 03/09/2011 12:21 #009 P.005/005
VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections 11 and V of this form is not the Property Owner, the
Property Owner must provide hislher Contact Information below and sign this form:
Printed Name:
Organization:
Title within the Organization:
Street Address:
City:
Mailing Address:
City:
State:
(if different from street address)
State:
Phone: Fax:
Email:
Zip:
Zip:
I certify that 1 own the property identified in this permit transfer document and have given permission
to the Proposed Permsttee listed in Sections 11 and V to develop and/or, lease the property. A copy
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and l wnll therefore share responsibility for
comppliance with the DWGZ Storrrnvater permit. As the property owner, it is my respons�bilit�r to notify
DWQ by submitting a completed Name/ownership Change Form within 30 days of proceunng a
developer, lessee or purchaser for the property. I understand that failure to operate and maintain the
stormwater treatment facility m accordance with the permit is a violation of NC General Statute
(NCGS) 143-215.1, and may result in appropriate enforcement action including the assessment of
civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature of the property owner
I
County of
Date:
a Notary Public for the State of
do hereby certify that
personally appeared before me this the
day of , 20 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signature
SSW N/O Change Rev15Feb2011 Page 4 of 4

State Stormwater Management Systems
Permit No. SW7061115MOD
Weeksville Crossing Shopping Center
Stormwater Permit No. SW7061115MOD
Pasquotank County
Designer's Certification
I, Sean_C. Robey___, as a duly registered professional engineer in the State of North
Carolina, having been authorized to observe („eFiediGallyr l1 11 ' fll time) the construction
of the project, (upon completion)
Weeksville Crossing Shopping Center - stormwater BMP's
(Project)
for Brookline Development Company LLC_(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:
\1UIN1111&A
Signatur \\00 CAgo�i'�''�.
� .�pFESS�p 4,9 �
Registratio `v°SSd
SEAL
Date
II
Page 7 of 8

State Stormwater Management Systems
Permit No. SW7061115MOD
Certification Requirements:
X 1. The drainage area to the system contains approximately the permitted acreage.
X 2. The drainage area to the system contains no more than the permitted amount
of built -upon area.
X 3. All the built -upon area associated with the project is graded such that the runoff
drains to the system.
X 4. All roof drains are located such that the runoff is directed into the system.
X 5. The outlet/bypass structure elevations are per the approved plan.
X 6. The outlet structure is located per the approved plans.
X 7. Trash rack is provided on the outlet/bypass structure.
X 8. All slopes are grassed with permanent vegetation.
X 9. Vegetated slopes are no steeper than 3:1.
X 10. The inlets are located per the approved plans and do not cause short-circuiting
of the system.
X 11. The permitted amounts of surface area and/or volume have been provided.
X 12. Required drawdown devices are correctly sized per the approved plans.
X 13. All required design depths are provided.
X 14. All required parts of the system are provided, such as a vegetated shelf, and a
forebay.
X 15. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Pasquotank County Building Inspections
Elizabeth City Building Inspections
Page 8 of 8

.�.,+4"7'
`OFFiCE'USE�ONLY-
Date Received
Fee Paid
Permit Number
-MAY -- S 200
s IN Ar 6 6 11 j.r
W -WARO State of North Carolina s w4CK � `416 %
®' Department of Environment and Natural Resources t
Division of Water Quality 7 r
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
3. Mailing Address for person listed in item 2 above:
164NnA1i_i�a�
City: ' ,- la k State: NIL Zip: P
Telephone Number: _( cl 19 g U- 5 7
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
5. Location of Project (street address):
City: aza&& Gi County:
6. Directions to project (from nearest major intersection):
• • • �•• . ,, TMI I
7. Latitude:_-36 0 /6 Al., 17"N _ Longitude: 76 ° f Z' A4 . q' W-- _ of project
8. Contact person who can answer questions about the project:
Name: IVirl A. Oeeji P. E. Telephone Number: ( Z SZ ) 26 /- 3300
II. PERMIT INFORMATION:
1. Specify whether project is (check one)
New
Renewal X Modification
Form SWU-101 Version 3.99 Page 1 of 4

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number .S LA %(Z(�-S and its issue date (if known)
3. Specify the type of project (check one):
Low Density High Density _Redevelop General Permit Other
4. Additional Project Requirements (check applicable blanks):
CAMA Major X Sedimentation/Erosion Control �404/401 Permit NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748.
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
!(lone to two pages) describing stormwater management for the project
) 011.wckki2,' iS Fr
-S10rkn Sewe I- G%l&e�an Onfl CQ,YdV mole
2. Stormwater runoff from this project drains to the paS�uo�ur� - - River basin.
3. Total Project Area: q , A4 acres
5. How many drainage areas does the project have?_ !D
4. Project Built Upon Area: 60,4 %
6. 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.
'Basin lnformation � �. a �a
;iffi4WY^;.u. ,:gL1N5f:,7„�,wd iasnKllffl { �3„7C:
II F '
A 3�a �Dr [J A a: z a
-.
.� u D aina e Area 2
Receiving Stream Name
Receiving Stream Class
Drainage Area
Existing Impervious* Area
--
-
Proposed Impervious*Area
% Impervious* Area (total)
tImpe�vious_5urfaceAre�.r�r..rx:ov
Draina e`A'pUDrai��a
e Aiea 2r z ,,
g.
On -site Buildings
On -site Streets
On -site Parking
On -site Sidewalks
Other on -site
Off -site
Total:
Total:
* Impervious area is defined as the built Upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version 3.99 Page 2 of

I
Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
Receiving Stream Name
Pasquotank River /
Charles Creek
Pasquotank River
/ Charles Creek
Pasquotank River /
Charles Creek
Pasquotank River /
Charles Creek
Receiving Stream Class
Sc
SC
Sc
SC
Drainage Area
3.24 Ac.
0.02 Ac.
0.02 Ac.
0.02 Ac.
Existing Impervious* Area
2.36 Ac.
0.02 Ac.
0.02 Ac.
0.02 Ac.
Proposed Impervious*Area
2.88 Ac.
0.02 Ac.
0.02 Ac.
0.02 Ac.
% Impervious* Area (total)
89.0%
73.3%
73.3%
73.3%
Impervious* Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
On -site Buildings
32,787 sf
-
-
-
On -site Streets & Parking
86,731 sf
774 sf
774 sf
774 sf
On -site Sidewalks
4,064 sf
-
-
-
Other on -site
2,086 sf
-
-
-
Off -site
-
-
-
-
Total:125,668 sf
Total: 774 sf
Total: 774 sf
Total: 774 sf

Basin Information
Drainage Area 5
Drainage Area 6
Drainage Area 7
Drainage Area 8
Receiving Stream Name
Pasquotank River /
Charles Creek
Pasquotank River
/ Charles Creek
Pasquotank River /
Charles Creek
Pasquotank River /
Charles Creek
Receiving Stream Class
SC
SC
SC
SC
Drainage Area
0.02 Ac.
0.02 Ac.
0.02 Ac.
0.37 Ac.
Existing Impervious* Area
0.014 Ac.
0.014 Ac.
0.014 Ac,
0.31 Ac.
Proposed Impervious*Area
0.014 Ac.
0.014 Ac.
0.014 Ac.
0.29 Ac.
% Impervious* Area (total)
72.5%
72.5%
72.5%
78.4%
Impervious* Surface Area
Drainage Area 5
Drainage Area 6
Drainage Area 7
Drainage Area 8
On -site Buildings
-
-
-
-
On -site Streets & Parking
618 sf
618 sf
618 sf
12,743 sf
On -site Sidewalks
-
-
-
-
Other on -site
-
-
-
-
Off -site
-
-
-
-
Total: 618 sf
Total: 618 sf
Total: 618 sf
Total:12,743 sf

Basin Information
Drainage Area 9
Drainage Area 10
Receiving Stream Name
Pasquotank River /
Charles Creek
Pasquotank River
/ Charles Creek
Receiving Stream Class
SC
SC
Drainage Area
0.38 Ac.
0.329 Ac.
Existing Impervious* Area
0.38 Ac.
0.097 Ac.
Proposed Impervious*Area
0.28 Ac,
0.26 Ac.
% Impervious* Area (total)
72.7%
79.4%
Impervious* Surface Area
Drainage Area 9
Drainage Area 10
On -site Buildings
1,175 sf
6,995 sf
On -site Streets
-
-
On -site Parking
10,155 sf
3,811 sf
On -site Sidewalks
710 sf
-
Other on -site
-
566 sf
Off -site
-
-
Total: 12,040 sf
Total: 11,372 sf
/L.S�"7

7. How was the off -site impervious area listed above derived? Av �o GAD Area KoQ 1,,L
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
The following italicized deed 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.
1. The following covenants are intended to ensure ongoing compliance with state stormwater management permit number
as issued by the Division of Water Quality. These covenants may not be
changed or deleted without the consent of the State.
2. No more than square feet of any lot shall be covered by structures or impervious materials.
Impervious materials include asphalt, gravel, concrete, brick, stone, slate or similar material but do not include wood
decking or the water surface of swimming pools.
3. Swales shall not be filled in, piped, or altered except as necessary to provide driveway. crossings.
4. Built -upon area in excess of the permitted amount requires a state stormwater management permit modification prior to
construction.
5. All permitted runoff from outparcels or future development shall be directed into the permitted stormwater control
system. These connections to the stormwater control system shall be performed in a manner that maintains the integrity
and performance of the system as permitted.
By your signature below, you certify that the recorded deed restrictions and protective covenants for this project
shall include all the applicable items required above, that the covenants will be binding on all parties and persons
claiming under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the State, and that they will be recorded prior to the sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement forms) listed below must be submitted for each
BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the status
and availability of these forms.
Form SWU-102
Wet Detention Basin Supplement
Form SWU-103
Infiltration Basin Supplement
Form SWU-104
Low Density Supplement
Form SWU-105
Curb Outlet System Supplement
Form SWU-106
Off -Site System Supplement
Form SWU-107
Underground Infiltration Trench Supplement
Form SWU-108
Neuse River Basin Supplement
Form SWU-109
Innovative Best Management Practice Supplement
Form SWU-101 Version 3.99 Page 3 of

VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. The complete application package should be
submitted to the appropriate DWQ Regional Office.
1. 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
• One copy.of the applicable Supplement Form(s) for each BMP 70
• Permit application processing fee of $420 (payable to NCDENR)
• Detailed narrative description of stormwater treatment/management
• Two copies of plans and specifications, including:
- Development/Project name
- Engineer and firm
-Legend
- North arrow
- Scale
- Revision number & date
- Mean high water line
- Dimensioned property/project boundary
- Location map with named streets or NCSR numbers
- Original contours, proposed contours, spot elevations, finished floor elevations
- Details of roads, drainage features, collection systems, and stormwater control measures
- Wetlands delineated, or a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
- Drainage areas delineated
- Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section.
Designated agent (individual or firm):___Guble -t RssocicJc_:sf p C,_,
Mailing Address: A _0. jJraut t- 8 ZO
City: L1(y 8 au)L State: N C Zip: 2 7949'
Phone: ( Z32 } 261- 3300 Fax: ( 2 52 } 261 - /-Zen
VIII. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in General Information, item 2)
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 e recorded, and that the proposed project complies with the requirements of 15A
NCAC 2H .1000. ^ —.
Signatu
Date.. 5-. 3 - v'7
Form SWU-101 Version 3.99 Page 4 of 4

Permit Number:�c9e, /I / S
(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, -"RK ``❑L_9 V Z.L
pretreatment including forebays and the vegetated filter if one is provided.
AUG 1 1 2011
This system (check one):
❑ does ❑ does not . incorporate a vegetated filter at the outlet.1,N-W A`'
This system (check one):
❑ does ❑ does not 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 the roblem:
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 time 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

FM
Permit Number:
(to be provided by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate 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 eroblems 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 one-time
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 SW40I-Wet Detention Basin O&M-Rev.4 Page 2 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
BMP element:
Potential problem.
How l wiIl 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 repair. if applicable) ,
The_ outlet -device
Clogging has occurred.
Clean out the outlet device. Dispose
' of the sediment off -site.
The outlet device is damaged
Repair 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 33. �S feet in the main pond, the
sediment shall be removed.
When the permanent pool depth reads 3, A5 feet in the forebay, the sediment
shall be removed.
BASIN DIAGRAM
Ull in the blanks)
Permanent Piiol Elevation - (O i t7
Sediment Removal ZT!r Pe anen Pool
- - - - - - - - - - - - - - - - Volume Sediment Removal Elevation 47S volume
Bottom Elevatio �� -ft Min.
-------------------------------------------- ------
Sediment Bottom Elevation 2,O 1-ft n.
Storage Sediment
Storage
FOREBAY MAIN POND
Form SW401-Wet Detention Basin O&M-Rev.4 Page 3 of 4
l

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:
BMP drainage area number:
Print name: W V UcAr
Title: onaew
Address: r —F. e f+e.
Phone: ),5- 1
Signature ©: r
Date: O 1 � � 1 A
0
3w
Note: The legally responsible` arty hould not be a homeowners association unless more than 50% of
the lots have been sold an a esident of the subdivision has been named the president.
I, /�I , a Notary Public for the State of
�A-e(rJ , County of , do hereby certify that
�A /1 6, & 4M r: pers r nally appeared before me this 1P�
day of , 2� 11 , and acknowledge the due execution of the
forgoing wet ietention basin maintenance requirements. Witness my hand and official
seal,
BETH A. ARNOLD
(Votary Public, State of New York
No. 01 AR5050677
Oualified in Onondaga County
Commission Expires October 16, 20
SEAL
My commission expires_
132fI1
Form SW401-Wet Detention Basin O&M-Rev.4 Page 4 of 4

'w
Permit Number: 5 W 7 C& 11 157%7) 0,)1)
(to be provided by DWQ)
Drainage Area Number � — � ( r,, ,,Q &A.,,
Bioretention Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
Important operation and maintenance procedures:
-- Immediately after the bioretention cell is established, the plants will be watered
twice weekly if needed until the plants become established (commonly six
weeks).
— Snow, mulch or any other material will NEVER be piled on the surface of the
bioretention'cell.
— Heavy equipment will NEVER be driven over the bioretention cell.
Special care will be taken to prevent sediment from entering the bioretention cell.
Once a year, a soil test of the soil media will be conducted.
After the bioretention cell is established, I will inspect it once a month and within 24
hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of operation and maintenance will be kept in a known set location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblems:
How I will remediate 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 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
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
Form SW401-Bioretention O&M-Rev.3
Page 1 of 4

IW
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.
flies 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. 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 Iime 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.
Form SW401-Bioretention O&M-Rev.3 Page 2 of 4

BMP element:
Potentialproblems:
How 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
i
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 SW401-Bioretention O&M-Rev.3 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: &KL d SPO C-e
BMP drainage area number:
Print name:W/l l 1 1 an--) is:
Titre: dGI r
Address
JM ��S'j Fzi�4e
Phone: `
Signature: 11
Date: &// o/ I 1
Sr.
el, SW SL4 (AC O w l 30 2
Note: The legally responsible pa� should not be a homeowners association unless more than 50% of
the lots have been sold an resident of the subdivision has been named the president.
a Notary Public for the State of
County of , do hereby certify that
Ar�o sr- personally appeared before me this Id
day of ,, and acknowledge the due execution of the
forgoing bioretention maintenance requirements. Witness my hand and official seal,
13ETH A. ARNOLD
Notary Public, State of New York
No, 01 AR5050677
Qualified in Onondaga County
Commission Expires October 16, 20 1
SEAL
My commission expires 1611414 I l I _
Form S W40 I -B ioretention I&M-Rev. 2 Page 4 of 4

F.,
Permit No. `> W�Z DW I I S-A 101)
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
RECEIVED
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
MAY — 8 2007
WET DETENTION BASIN SUPPLEMENT
This form may be photocopied for use as an original DWQ ARO
DWQ_Stormwater Management Plan Review:
A complete stonnwater management plan submittal includes an application form, a wet detention basin
supplement for each basin, design calculations, and plans and specifications showing all basin and outlet
structure details.
I. PROJECT INFORMATION
Project Name: WP,eltsui Z 1e Croi-,is� S �plej Ce„ ker
Contact Person: David A . Deelr A. C. Phone Number: (7,6;)261-- Uo0
For projects with multiple basins, specify which basin this worksheet applies to:
elevations
Basin Bottom Elevation �2. q ft. (floor of the basin)
Permanent Pool Elevation 3. O ft. (elevation of the orifice)
Temporary Pool Elevation z n ft. , (elevation of the discharge structure overflow)
areas
Permanent Pool Surface Area 4,,SS1 sq. ft.
Drainage Area
Impervious Area
volumes
Permanent Pool Volume
Temporary Pool Volume
Forebay Volume
Other parameters
SA/DAI
Diameter of Orifice
Design Rainfall
Design TSS Removal Z
3. 2i` ac.
(water surface area at the orifice elevation)
(on -site and off -site drainage to the basin)
(on -site and off -site drainage to the basin)
40,99A cu. ft. (combined volume of main basin and forebay)
_._3 o cu. ft. (volume detained above the permanent pool)
6 cu. ft. (approximately 20% of total volume)
-0, valw accouiNIs lot ex, i,,p. ore, 4o bd re-oved. 5ee il&ef 3 01;
Ga ic3 .
r719q (surface area to drainage area ratio from DWQ table)
in. (2 to 5 day temporary pool draw -down required)
1 in.
g0 % (minimum 85% required)
Form SWU-102 Rev 399 Page 1 of 4

Footnotes:
' When using the Division SA/DA tables, the correct SA/DA ratio for permanent pool sizing should be computed based upon the
actual impervious % and permanent pool depth. Linear interpolation should be employed to determine the correct value for non-
standard table entries.
2 In the 20 coastal counties, the requirement for a vegetative filter may be waived if the wet detention basin is designed to provide
90% TSS removal. The NCDENR BMP manual provides design tables for both 85% TSS removal and 90% TSS removal.
II. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Permit
Application Form, the agent may initial below. If a requirement has not been met, attach justification.
Applicants Initials
,p f) a.
Q.A b.
[A - C.
9AD d.
NA e.
SAD f
dfflD g.
LA D h.
DAD i.
SAG J.
N./a k.
1"1
The permanent pool depth is between 3 and 6 feet (required minimum of 3 feet).
The forebay volume is approximately equal to 20% of the basin volume.
The temporary pool controls runoff from the design storm event.
The temporary pool draws down in 2 to 5 days.
If required, a 30-foot vegetative filter is provided at the outlet (include non -erosive flow
calculations) - 9490 T55 CalcS can 61gd 3 e; Gulc(AlaiioH1
The basin length to width ratio is greater than 3:1.
The basin side slopes above the permanent pool are no steeper than 3:1.
A submerged and vegetated perimeter shelf with a slope of 6:1 or less (show detail).
Vegetative cover above the permanent pool elevation is specified.
A trash rack or similar device is provided for both the overflow and orifice.
A recorded drainage easement is provided for each basin including access to nearest right-
of-way. ' Pr)v,}ey awned *11,a1n�nl+�G°d sple,,, )oecdecl v„ pr'ivcde pro�e 1
If the basin is used for sediment and erosion control during construction, clean out of the
basin is specified prior to use as a wet detention basin.
NMI- m. A mechanism is specified 99
which will drain the basin for maintenance or an emergency.
"�JiI, tqvi"e pwy-Dt&. (41Ae TO QY4Vnc[tua{ei. e1Pva�la .
Ill. WET DETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
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) 0 does q does not incorporate a vegetated filter at the outlet.
This system (check one) 0 does A does not incorporate pretreatment other than a forebay.
Form SWU-102 Rev 3.99 Page 2 of 4

Maintenance activities shall be performed as follows:
After every significant runoff producing rainfall event and at least monthly:
a. Inspect the wet detention basin system for sediment accumulation, erosion, trash accumulation,
vegetated cover, and general condition.
b. Check and clear the orifice of any obstructions such that drawdown of the temporary pool occurs within
2 to 5 days as designed.
2. Repair eroded areas immediately, re -seed as necessary to maintain good vegetative cover, mow vegetative
cover to maintain a maximum height of six inches, and remove trash as needed.
3. Inspect and repair the collection system (i.e. catch basins, piping, swales, riprap, etc.) quarterly to maintain
proper functioning.
4. Remove accumulated sediment from the wet detention basin system semi-annually or when depth is
reduced to 75% of the original design depth (see diagram below). Removed sediment shall be disposed of
in an appropriate manner and shall be handled in a manner that will not adversely impact water quality (i.e.
stockpiling near a wet detention basin or stream, etc.).
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 :2 . 2S feet in the main pond, the sediment shall be removed.
When the penmanent pool depth reads ;2._2 r
feet in the forebay, the sediment shall be removed.
BASIN DIAGRAM
(fill in the blanks)
Permanent Pool Elevation 6.0
Sediment Re oval El. �. 7,1 75 0
-------------- - Sediment Removal Elevation Z.75 75/0
_ a
BottomEle ation A.a 3 % --------------------------------------------- -------
FOREBAY
Bottom Elevation ;2.0 ♦ 25%
MAIN POND
5. Remove cattails and other indigenous wetland plants when they cover 50% of the basin surface. These
plants shall be encouraged to grow along the vegetated shelf and forebay berm.
6. If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through
the emergency drain shall be minimized to the maximum extent practical.
Form S WU- 102 Rev 3.99 Page 3 of 4

7. All components of the wet detention basin system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the seven
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.
Print name:_ C.. Ti llt-,j,y,, _
Title: Mo�,bef., Ulkk:�vijle Crorji,m4. LLC
Address:_ 169$_Naefk Wo,,Leff-.irel__Suitfp E _
Note: The legally responsible party should not be a homeowners association unless more than 50% of the lots have been sold and a
resident of the subdivision has been named the president.
1,V,SC1x1 _�('i C�,�� , a Notary Public for the State of
County of g -- c,SAny:N do hereby certify that
personally appeared before me this day of _ , Zoo's , and acknowledge the due
execution of the forgoing wet detention basin maintenance requirements. Witness my hand and official seal,
�a M. BLgc
OTAR`�.�y
oy 4$AUE30 Kk -"
+pQN COS,.•'
SEAL
My commission expires MYCOt1SSb11 EON VMD-2011.
a -
Form SWU-102 Rev 3.99 Page 4 of 4

P
A
rr- `�� Lfv L�
Permit No, IN 706 ft 1,5'
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
NOV 16 2006 STORMWATER MANAGEMENT PERMIT APPLICATION FORM
BIORETENTION BASIN SUPPLEMENT
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, sealed design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name:
Contact Person:
Phone Number: (2,2) 24 j • 3,�,n _
For projects with multiple basins, specify which basin this worksheet applies to:
(must match the DA # on the application)
II, DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. ,All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil Type N -
In -Situ Soil Infiltration Rate _1, 0[2 -0,5Z, in./hr. (the most restrictive soil layer)
SHWT Elevation 6,0 _ ft. (Seasonal High Water Table elevation)
Planting Soil Texture (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate p in./hr. (estimated)
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Minimum # of plantings
Total #of plantings provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
lA sq.ft. (on -site and off -site drainage to the basin)
�5q sq.ft. (on -site and off -site drainage to the basin)
inch (1.5 inch event for SA waters, 1 inch event for others)
PA e.f. (storage volume required)
_ 0, 59 fps
17,3 hours
2� ft. x _ �'3ft. _ 6 q. ft. (surface area at basin-boltorrr)
E3F3 c.f. paanlrna Medret
¢ stems (1000 stems per acre of bioretention area)
7 Trees _a_ Shrubs_ (must be at least 3 shrubs for each tree)
� � �re� pf�� 3 skru.bs ���3 YvvnlmuM
� U14)
I_fmsl (elevation of the bypassloutlet structure)
IQ_ h fmsl (elevation of the ground surface bottom)
a, 1 S fmsl (elevation of the bottom of the planting media)
Pagel of 3

III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
fl a. No vertical sand bed is proposed.
b. The bioretention area is at least 40 feet by 15 feet.
DAD c. Sheet flow is provided at the inlet.
DAD d. A grass buffer strip is provided at the inlet.
DAD c. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
DAD f. Ponding depth of 6-12" is provided.
- N/A g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
* i7 h3aW Rrogk }i,e imirdlaljati ol• an uMejdral� a� boj(01.1 o�- P1un41A3 T 6l ?'a
D_ h. An in-depth soils report is provided.
O i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
j. The planting soil meets minimum soil specifications per the latest version of the NCDENR Stormwater
Best Management Practices Manual.
_ k. The ponded area will draw down in less than 5 days. (calculations attached)
nb 1. A planting plan and schedule with species and densities is provided on the plans.
—F)RD _ m. Mulch layer and depth is specified on plans.
____E.� p_ n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
DAI) o. Plan details for the inlet and outlet are provided.
_, L p. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) 1A does 0 does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

It-08-2006 06:d5pn Froir-�IUIBLEIKASSOCIATES 2522611260 T-1�2 P.002/002 F-M
3. Remove accumulated seditnent and old mrilch a_s needed to maintain good infiltration. Replace, or add additional
mulch as needed. Removal of the old mulch layer before applying the new layer is recommended every 3 to 3 yetu-s.
4, Prune !fees and shrubs and remove debris on an annual basis. Grassed vegeration should not exceed 6 inches in hei£hi.
5. Treat all diseased trees and shrubs whenever needed. Remove and replace all dead and diseased vegetation considered
beyond treatment every 6 months.
6. Replace suppon stakes yearly (in the Spring). Replace deficient stakes or wires whenever needed.
7. Soil testing shall be conducted annually to determine pIi and any accumulation of toxins ir. the planting rnedia. Limy
or other alkaline substances shall be applied as recommended per the soil toss and Toxic soils shall be removed.
disposed of properly Aid replaced with new plantin; media.
S. All components of the bioretentien area system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the eight muintenance
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.
Print name; G • CQ,b 1{Pj�.:�,r9
Title: Member, !( JL C ojA ��. L
A: ddxt s:
Phone
S io a
Date:
Note: The legally responsible party should net be a homeowners association rnlesa more that: 53% of tea Intl have been sold anG A rrsid,n, of the
�j subdivision has b`o"on�na=d the president. I. _ 1 .�Cj% •��y • u 3 eD 4 , a Notary Public for the State of l/��
Vd r-I k Corp , yr ,
County of -&v do hereby certify that C . -Z("A Yl
personally appeared before rna this day of aY- _ fRi �o , and acknowledge the due +!xecurion
of the forgo �g Wwj;teetion basin mairtenance requirernezts. Viimtns my hand and official seal,
My commission expires 0 v— 0 3 -a OV I
G?atu�� 'Z� CVM�
Page 3 of 3

r%
Permit No. S 70c r S—
((o be provided by DWQ)
r�„�'� State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
NOV 1 & 2H6
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
rUJ'VVQ-VVAR0 BIORETENTION BASIN SUPPLEMENT
DWQ Stormwater Management Plan Review:_
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, sealed design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name:
Contact Person:
Phone Number: ( )241.3300
For projects with multiple basins, specify which basin this worksheet applies to:
(must match the DA # on the application)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil Type
In -Situ Soil Infiltration Rate 0, Db D..SZ in./hr. (the most restrictive soil layer)
SHWT Elevation ft. (Seasonal High Water Table elevation)
Planting Soil Texture (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate 1, in./hr. (estimated)
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Minimum # of plantings
Total #of plantings provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
jn 5; sq.ft. (on -site and off site drainage to the basin)
�5 q sq.ft. (on -site and off -site drainage to the basin)
inch (1.5 inch event for S,4 waters, 1 inch event for others)
c.f. (storage volume required)
0, S 9 fps
7.1 hours
3 3 , z ft. x 6,Z_,� ft. = __ 176 sq, ft. (surface area at bast+�torn)
RS c.f. Piax4mg rn'24ia
Q stems (1000 stems per acre ofbioretention area)
7 Trees 2 Shrubs r, _ (must be at least 3 shrubs for each tree)
fi (I W6 pfus 3 4tub.5 weeb
(kiJ%l tr+u*1 A4)
(l,+ _ fmsl (elevation of the bypass/outlet structure)
10 6 5_ fmsl (elevation of the ground surface bottom)
. �.L,`i_� fmsl (elevation of the bottom of the planting media)
Pagel of 3

III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
FA a. No vertical sand bed is proposed.
b. The bioretention area is at least 40 feet by 15 feet.
DAD c. Sheet flow is provided at the inlet.
. A) d. A grass buffer strip is provided at the inlet.
DAD e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
—DAQ_ f. Ponding depth of 6-12" is provided.
g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
* Miltg«led Krowjk Ile insialLdivk% o� ar% LcMetdrol, all W (o►, o � RcmliA5 Me.c is
h. An in-depth soils report is provided.
MID i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
)R�) j. The planting soil meets minimum soil specifications per the latest version of the NCDENR Stormwater
Best Management Practices Manual.
_. )A D k. The ponded area will draw down in less than 5 days. (calculations attached)
—)A 1)_ 1. A planting plan and schedule with species and densities is provided on the plans.
f) — in. Mulch layer and depth is specified on plans.
F_A n — n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
o. Plan details for the inlet and outlet are provided.
�}fl p. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) 14 does ❑ does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

11-OB-2006 05:45pn From-GUIBLELASSOCIATES
2522611260 7-155 P.002/002 F-773
3.-Remove accumulated sediment and old mulch as needed to maintain good infiltration. Replace, or add additional
mulch as needed. Removal of the old mulch layer before applying the new layer is recommended every 2 to 3 years.
4. Prune trees and shrubs and remove debris on v annual basis. Grassed vegetation should not exceed 6 inches in hoight.
5. Treat tall diseased trees and shrubs whenever needed. Remove and replace all dead and diseased vegetation considered
beyond treatment every 6 months.
6. Replace suppon stakes yearly (in the Spring). Replace deficient stakes or wires whenever needed.
7. Soil testing shall beconducted annually to determine pli and any accumulation of toxins in the planting media. Lime
or other alkaline substances shall be applied as recommended per the soil tout and toxic soils shall be rt;rnoved.
disposed of properly and replaced with new planting media.
S. All components of the bioretentian area system shal be maintained in good working order.
I acknowledge and agree by my signature below that 1 am responsible for the performance of the eight maintenance
procedures listed above. I agree to notify DWQ of any problems with the system or prior to any changes to the systern or
responsiblo parry.
Print name:
Title: Member, OA A U1I11C CM*,.SA&T
1 _ O
Phone
Signal
Date:
!Vote: The legally responsible putt' should not be n homcowmYs association unlese more than. 50TO of the lot., have been sold and a recidw, of the
subdivision hac boon named the president. y/
a Notary Public for the State of &O"O d "zj
County of �� T , do hereby certify that
personally appeared before rnz* this day of i/di� o� , and acknowledge the due execution
of the forgoing bioretention basin rnaintenwice requirements. Vlitness my hand and official seal,
My commission expires
C))a't �- C6 C V T -�
Page 3 of 3

n
Permit No. S'W 794,
(to be provided by DWQ)
State of North Carolina
[REGF.HEED Department of Environment and Natural Resources
Division of Water Quality
NOV 16 ' 2006TORMWATER MANAGEMENT PERMIT APPLICATION FORM
QWQ-WARO BIORETENTION BASIN SUPPLEMENT
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, sealed design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name:
Contact Person:
Phone Number: (� ?_ L- 3.342a
For projects with multiple basins, specify which basin this worksheet applies to:
(must match the DA # on the application)
11. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil Type _P
In -Situ Soil Infiltration Rate D, Ob D, S� in./hr. (the most restrictive soil layer)
SHWT Elevation 5 D ft. (Seasonal High Water Table elevation)
Planting Soil Texture 5°p2 (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate 1, p in./hr, (estimated)
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Minimum # of plantings
Total #of plantings provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
t, DA6 sq.ft. (on -site and off -site drainage to the basin)
7,59 sq.ft. (on -site and of -site drainage to the basin)
j inch (1.5 inch event for SA waters, I inch event for others)
8B c.f. (storage volume required)
Q•,�_ fps
17. 3 hours
3 3 . ft. x _ 5 , ft. — 176 �sq. ft. (surface area at basin -bottom)
�l3 c.f. plod,, r eMkx
¢ stems (1000 stems per acre of bioretention area)
7 Trees -),— Shrubs (must be at least 3 shrubs for each tree)
T-�l }tee plus 3'kr'6_5
Am r'1nurK 9,61q, 4)
fmsl (elevation of the bypassloutlet structure)
fmsl (elevation of the ground surface bottom)
A. 1,5 fmsl (elevation of the bottom of the planting media)
Pagel of3

III. REQUIr ED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not heen met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
ON)� a. No vertical sand bed is proposed.
b. The bioretention area is at least 40 feet by 15 feet.
�a n c. Sheet flow is provided at the inlet.
d. A grass buffer strip is provided at the inlet.
e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
j� f. Ponding depth of 6-12" is provided.
--'=ZA g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
MJJJ J«fed {-�Mgk µe insiQ11CLEf41H of ar► u.nc{erdrai� a� bol(o). o � PIC I1.3 Mec{ia
DD _ h. An in-depth soils report is provided.
Q Q i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
Qom. j. The planting soil meets minimum soil specifications per the Iatest version of the NCDENR Stonrmwater
Best Management Practices Manual.
k. The ponded area will draw down in less than 5 days. (calculations attached)
1. A planting plan and schedule with species and densities is provided on the plans.
D� D_ in. Mulch layer and depth is specified on plans.
�EJgj_ n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
DAB o. Plan details for the inlet and outlet are provided.
�A'D p. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) X does ❑ does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

It-06-2006 05:45pn From-QUIBLEiASSOCIAT6S
2522611260 T-155 P-002/002 F-TTa
3. Remove accumulated scditnent and old mulch as needed to maintain good infiltration. Replace, or add additional
mulch as needed. Removal of the old mulch layer (afore applying the new layer is recommended every 3 to 3 years.
4, Prune trees and shrubs and remove debris on an annual basis. Grassed vegetation should not exceed 6 inches in h6sht.
5. Treat all diseased trees and shrubs whenever needed. Remove and replace all dt:,ad and diseased vegetation considered
beyond treatment every 6 months.
6. Replace support stakes yearly (in the Spring). Replace deficient stakes or wires whenever needed.
7. Soil testing shall be conducted annually to determine pI-I and any accumulation of toxins in the planting media. Lime
or other alkaline substances shall be applied as recommended per the soil tas. and toxic soils shall be removed,
disposed of properly and replaced with new planting media.
8. All components of the bioretention area system shall be maintained ill good working order.
I acknowledge and agree by my signaturre below that I am responsible for the performance of the eight maintenance
procedUML listed abovo. 1 agree to notify DWQ of any problems with the system or prior to any changes to the system or
responsible party.
Print name: man
Title; ember-, �C! h-i-olle Cra A-c�. 1.L[
MeIrk*4
Phone
Signal
Date:
Note: The legally responsible party should not be n homeowners associarion unlest more thar. 50% of the tote have bom sold :Ind a re6d.n: of tnz
subdivision hae been named the president. /j%
1.�4+-krti G� Q._ �q 4IP *" , a Notary Public for the SiAte of 1 r cI r j± CG ry I,
ri 4.,
County of _ 6a&u :SV Y-4 do hereby certify that L... rJ ra X+ IQ�C1- 1 _ !- M
personally appeared before rn:: this day IUClI rn b4? , and acknowledge the due execution
of the forgoing bioreiention basin maintenance regniremk rtc, Witness my hand and official seal,
c09%1%
My commission expiresy 3,0 3• L� d(A
Page 3 of 1

Permit No. / 0
(to be provided by DWQ)
State of North Carolina
�Department of Environment and Natural Resources
Division of Water Quality
NOV 15 2006 STORMWATER MANAGEMENT PERMIT APPLICATION FORM
DWQ'VVAR0 BIORETENTION BASIN SUPPLEMENT
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, sealed design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I, PROJECT INFORMATION
Project Name.
Contact Person:
Phone Number: (25,2�) 261. 3300
For projects with multiple basins, specify which basin this worksheet applies to: _ ^j
(must match the DA # on the application)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil Type
In -Situ Soil Infiltration Rate
SHWT Elevation
Planting Soil Texture
Planting Soil Infiltration Rate
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Minimum # of plantings
Total #of plantings provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
_Pb_
D, Q( in./hr. (the most restrictive soil layer)
D� 52
_S, 0 $. (Seasonal High Water Table elevation)
SGnrT (must be a sandy loam, loamy sand, or loam texture)
in,/hr. (estimated)
P J-1 sq.ft. (on -site and off -site drainage to the basin)
bo (I sq.ft. (on -site and off -site drainage to the basin)
inch (I. S inch event for SA waters, 1 inch event for others)
71 c.£ (storage volume required)
D, SAS fps
hours
�_ 7. z� ft. x — 5 3 -_ _ ft. = _ I q 4- sq, ft. (surface area at ha4*4& tewr)
71 c.f. plaOi„1 n.edin
stems (1000 stems per acre of bioretention area)
Trees _ Shrubs__ (must be at least 3 shrubs for each tree)
iW P65 3ikraK5 refs
MY A.
3.7 fmsl (elevation of the bypass/outlet structure)
g. 9 fmsl (elevation of the ground surface bottom)
f ?,�7_— fmsl (elevation of the bottom of the planting media)
Page 1 of 3

III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
a. No vertical sand bed is proposed.
b. The bioretention area is at least 40 feet by 15 feet.
DA 0 c. Sheet flow is provided at the inlet.
_._ ')_ d. A grass buffer strip is provided at the inlet.
DAD e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
D_ f: Ponding depth of 6-12" is provided.
N-/A� g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
0 hi.led Krowit, tke 'rnsi411aitdr~ 0; an "MeldrGl, a4 win", o �_ PlanI1"5 media
h. An in-depth soils report is provided.
DA�3 i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
QR� j. The planting soil meets minimum soil specifications per the latest version of the NCDENR Stormwater
Best Management Practices Manual.
^DAD_ k. The ponded area will draw down in less than 5 days. (calculations attached)
)b Q I. A planting plan and schedule with species and densities is provided on the plans.
DU_ in. Mulch layer and depth is specified on plans.
—�J A 1) — n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
o. Plan details for the inlet and outlet are provided.
p. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) 'g does ❑ does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

11-08-2006 05:46pn From-WREOSSOCIATES
2522611260 T-M P-002/002 F-TT3
3. Remove accumulated sediment and old mulch as needed to maintain good infiltration. Replace, or add additional
mulch as needed. Removal of the old mulch layer before applying the new layer is recommended every 3 to 3 years.
4. Prune trees and shrubs and remove debris on an annual basic, Grassed vegetation should not exceed 6 inches in hcirht.
5. Treat ali diseased trees and shrubs whenever needed. Remove and replace all dead and diseased vegetation considered
beyond treatment every 6 months.
6. Replace support strikes yearly {in the Spring}. Replace deficient stakes or wires whenever needed.
7. Soil testing shall be conducted annually to determine pH and any accumulation of toxins in the planting rnedia, Lime
or other alkaline substances shall be applied as recommended per the soil tesi, and toxic soils shall be removed,
disposed of properly and replaced with new planting media.
S. All components of the bioretention area system shall be, maintained in good working order.
I acknowledge: and agree by my signature below that 1 am responsible for the perfonnance of the eight 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.
Print name: _ A, R Tl
Title; Membec, ffilpkst Ile Cro
F
Phone:
Sie atu
Date: _ - /I- 1-06
Note: The legally responsible party should not be it homrowners association unle%n niure than. 50% orthc to(,; have been sold anci a resident of uic
subdivision hac been named the president, f/
f, AiCG d-taJ ��2 a Notary Public for thl3 State of �dp—// {�v�
County of o t , do hereby certify that
personally appeared before rue, this day of � 9 07�46 and acknowledge the due execution
of the forgoing bioretention basin maintenance requirerrtarts, Witne.s my hand and official seal,
Nlbwilo
My commission expires d3 a�0
Page 3 of 3

J
Permit No.
(to be provided by DWQ)
State of North Carolina
REGENIED Department of Environment and Natural Resources
Division of Water Quality
NOV 15 2006STORMWATER MANAGEMENT PERMIT APPLICATION FORM
� Q'l�R� BIORETENTION BASIN SUPPLEMENT
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, scaled design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name:
Contact Person:
Phone Number: (Z53)261. 3_3r7o
For projects with multiple basins, specify which basin this worksheet applies to:
(must match the DA # on the application)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil Type - Pb
In -Situ Soil Infiltration Rate O, 06 -0,S2, in./hr. (the most restrictive soil layer)
Sf WT Elevation 6 p ft. (Seasonal High Water Table elevation)
Planting Soil Texture --suraiv loam. (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate I p _ in./hr. (estimated)
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Minimum # of plantings
Total #of plantings provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
sq.ft. (on -site and off -site drainage to the basin)
6O6 sq.ft. (on -site and off -site drainage to the basin)
inch (1.5 inch event far SA waters, 1 inch event for others)
c.f. (storage volume required)
0, 55 fps
hours
27 1 ft. x 5 , 3 ft. = _ 144 sq. ft, (surface area at bEa&04 �)
71 c.f. ploAli�g Media
¢ _ stems (1000 stems per acre of bioretention area)
Trees Z Shrubs S (must be at least 3 shrubs for each tree)
( i free Oaf, 3 skrubS m-'A-1
min. tez'P-o
9,7 _ fmsl (elevation of the bypass/outlet structure)
f?. 9S fmsl (elevation of the ground surface bottom)
15 w fmsl (elevation of the bottom of the planting media)
Page 1 of 3

III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
proj ect.
Applicants Initials
M a. No vertical sand bed is proposed.
b. `lTbe bioretention area is at least 40 feet by 15 feet.
DA D— c. Sheet flow is provided at the inlet.
AND d. A grass buffer strip is provided at the inlet.
UAD e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
AD f. Ponding depth of 6-12" is provided.
N Z A" g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
* V hpl ed l•1"t"k W 'rnsiu11a11on o� an uMetd raj^ aV b4o'. o � Plo"11-3 Media
-� h. An in-depth soils report is provided,
i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
QA� j. The planting soil meets minimum soil specifications per the latest version of the NCDENR Stormwater
Best Management Practices Manual.
k. The ponded area will draw down in less than 5 days. (calculations attached)
DJ)__ 1. A planting plan and schedule with species and densities is provided on the plans.
nR y) _ m. Mulch layer and depth is specified on plans.
LAD_ n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
DAIl o. Plan details for the inlet and outlet are provided.
p. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) 1A does ❑ does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

11-08-2006 0 OPM From-QUIBLE&ASSOCIATES
2522611260 T-151 P.002/002 F-TT3
3. Remove accumulated sediment and old rruArh as needed to maintain good infiltration. Replace, or add additional
mulch a_a needed. Removal of the old match layer before applying the new layer is recommended every 3 to 3 yeas.
4. Prune trees and shrubs and remove debris on an annual basi.e. Grassed vegetation should not exceed 6 'inches in height.
5. Treat all diseased trees and shrubs whenever needed. Remove and replace all dead and diseased vegetation considered
beyond treatment every 6 months.
6. Replace support stakes yearly Lin the Spring). Replace deficient stakes or wires whenever needed.
7, Soil resting shall be conducted annually to determine pl-I and any accumulation of toxins in the planting media, lime
or other alkaline. substances shall be applied as recommended per the soil tcs,, and toxic soils shall be removed,
disposed of properly and replaced with new planting media,
8. All components of the bioretention area system shall be maintained ilr good working order.
I acknowledge and agree by my signature below that I am responsible for the perforiirance of the eight maintenance
procedures listed above. I agree to notify DWQ of any problems with the system or prior to any changes 10 the system or
responsible. party.
Print name: C - Rr A 1. y Tt 11 M A4 — — ----
Tide: i j44.;_I'L'r F�
Phone:
Sie atu
Mote: The legally responsible party should not be it homeowners association unless more than, 50% of the loss have been sold ;ind a retidJt[ or tlic
subdivision has been narrr-d the president.
I, �� Q•y • J �,p __, a Not&ry Public for the State of / r_ _O -1-h _ CO LA tL. ,
County of Q , do hereby certify that _ ✓� t`� A 4—J 2. u if -11 n a
personally appeared before me this day uP dt! a �r��h e!'and acknowledge the due execution
of the forgoing bioretention basin maintenance regnirerm:rtc, Witness my hand and official seal,
•
0U IBb.�
rfrAT GOVI
ILj
SEAL
My commission expires Q -0 3, dc,)()%
Page 3 of 3

_ .
. �
4
f' ^ ..
� � � 1

R . I
b,
Permit No. '5j„ 2� 9,e ll 1 C
(to be provided by DWQ)
State of North Carolina
R71"E I INSIED Department of Environment and Natural Resources
Division of Water Quality
NOV 15 2006STORMWATER MANAGEMENT PERMIT APPLICATION FORM
DWQ-WARC) BIORETENTION BASIN SUPPLEMENT
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, sealed design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name :
Contact Person:
Phone Number: (z 261 3M
For projects with multiple basins, specify which basin this worksheet applies to: 7
(must match the DA # on the application)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil Type
In -Situ Soil Infiltration Rate 0, 06 - o..52 in./hr. (the most restrictive soil layer)
S14WT Elevation S.O ft. (Seasonal High Water Table elevation)
Planting Soil Texture SQntiT (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate 1, n in./hr. (estimated)
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Minimum # of plantings
Total #of plantings provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
ate` sq.ft. (on -site and off -site drainage to the basin)
606 sq.ft. (on -site and off -site drainage to the basin)
_J_. — inch (1.5 inch event for SA waters, I inch event for others)
71 _ c.f. (storage volume required)
6. 64 fps
I7. �, hours
2 T Z ft. x S, 3 144 sq. ft. (surface area atsiw-bettent)
71 c.f. plonlln j ri'64( I
Q stems (1000 stems per acre of bioretention area)
7 µ _ Trees �_ Shrubs (mast be at least 3 shrubs for each tree)
0 ime Plus 3.Afal'3
.Min. 1`(Y P6 f
,c i fmsl (elevation of the bypass/outlet structure)
fmsl (elevation of the ground surface bottom)
frost (elevation of the bottom of the planting media)
Page] of 3

III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
pAD - a. No vertical sand bed is proposed.
b. The bioretention area is at least 40 feet by 15 feet.
DA 0 c. Sheet flow is provided at the inlet.
d. A grass buffer strip is provided at the inlet.
p�J) e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
_DAD f. Ponding depth of 6-12" is provided.
NA' g. to -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
* lrif l j-led fkt014Jk 41,e 'rns4«1a]1on of an LILMe%(i'a1, a� bof{or„ o � PlawfJAS Media
�D h. An in-depth soils report is provided.
i, The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
A� j. The planting soil meets minimum soil specifications per the latest version of the NCDENR Stormwater
Best Management Practices Manual.
A D k. The ponded area will draw down in less than 5 days. (calculations attached)
__ DA f� .� 1. A planting plan and schedule with species and densities is provided on the plans.
n � m. Mulch layer and depth is specified on plans.
E A D- n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
DAi_ o. Plan details for the inlet and outlet are provided.
A) P. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) X does ❑ does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

II-08-2006 05:45pn Fram-QUIBLEASSOCIAiES
2522611260 i-151 P-002/002 F-73
3. Remove accumulated sediment and old mulch as needed to maintain good infiltration. Replace, or add additicnal
mulch as needed. Removal of the old mulch layer before applying the new layer is recommended every 3 to 3 years,
4. Prune trees and shrubs and remove debris on an annual basis. Grassed vegetation should nor exceed 6 inches in height.
5. Treat all diseased trees and shrubs whenever needed. Remove and replace all dead and diseas�:d vegetation considered
beyond treatment every 6 months.
6. Replace support stakes yearly (in the Spring). Replace deficient stakes or wires whenever needed.
7. Soil testing shall be conducted annually to determine pli and any accumuiation of toxin> in the planting media. Lime
or other alkaline substances shall be applied as recommended per the soil tcs, and roxic soils stiail be removed,
disposed of properly and replaced with new planting media.
S. All components of the bioretention area system shall be maintained in good working order,
I acknowledge and agree by my signature below that I am responsible for the performance of the eight 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.
Print name: G. Rren%'rill - �T
Title; er, W" slJ) d . n2� 45 a LLIC
/{:ld.t',s.5:._-J_��`.� ..1Y�r_tk m�r.lrr.►%-��`+�� ��. ��u���tr..!�c._..azl�o�
Phone
Sio a�
Date:
Note: The legally responsible party should nat be n homeowners associarion unlcae more than 50% oC the tots have been sold -,inc n residdn, of t.ic
xa0divisiori has boen named the president.
I, Af 2J J f , a Notary Public for the State of
County of �i✓ , do hereby certify that �• A Est_ JQ/V
personally appeared before me this day of _A/D c/ }�+e7�� Q _ a•Ode , and acknowledge the due execution
of the forgoing bioretention basin maintenwice requiremer:ts. VJitress my hand and official seal,
.snsoossi...
SEAT.
My commission expires �'4
Pagr 3 oP 3

8
Permit No. SW 7 c6 (I l r "o
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality me-F%IUMev ED
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
BIORETENTION BASIN SUPPLEMENT
MAY - 8 2007
DWO Stormwater Management Plan Review: DWMARO
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, sealed design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name :
Contact Person:
Phone Number: 261- 33442
For projects with multiple basins, specify which basin this worksheet applies to: Q
(must match the DA # on the application)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil 'Type
In -Situ Soil Infiltration Rate 0,06- 0, SA in (the most restrictive soil layer)
SHWT Elevation �, Q ft. (Seasonal High Water Table elevation)
Planting Soil Texture �50 (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate _ 1� in./hr. (estimated)
Basin Design Parameters
Drainage Area
1.5 20 sq.ft. (on -site and off -site drainage to the basin)
Impervious Area
12,743 sq.ft. (on -site and off site drainage to the basin)
Design Storm
/ _ inch (1. S inch event for SA waters, I inch event for others)
Design Volume
!, f 43_ c.f. (storage volume required)
Inlet Velocity
1, QJ fps
Drawdown Time
1 7, _3 hours
Basin Dimensions
Basin Size g 5 ft. x 2/A" ft. _ -1, U 3 -sq. ft. (surface area at basin bottom)
Basin Volume Provided _ f! Syr c.f. wAv&t je -
Minimum # of plantings 4-2 stems (1000 stems per acre of bioretention area)
Total #of plantings provided 43 Trees 1� Shrubs 30' (must be at least 3 shrubs for each tree)
Basin Elevations
Temporary Pool Elevation `1{Z` fmsl (elevation of the bypass/outlet structure)
Planting Elevation 9 , ]S fmsl (elevation of the ground surface bottom)
Bottom Elevation �6, 75 ftnsl (elevation of the bottom of the planting media)
LN
Page 1 of 3

III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
Ap fj _— a. No vertical sand bed is proposed.
f)A j_ b. The bioretention area is at least 40 feet by 15 feet.
DAD— c. Sheet flow is provided at the inlet.
DA �— d. A grass buffer strip is provided at the inlet,
a�__ e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
Nt_ f. Ponding depth of 6-12" is provided.
f A g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
* m'i V}gated -ii,raVck 4-� in31411a}lah o; (1H WMdert(rain of baflar. ot• plawl1'3 M'Mict
DAD- h. An in-depth soils report is provided.
-DAD i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
DAD f . The planting soil meets minimum soil specifications per the latest version of the NCDENR Stormwater
Best Management Practices Manual.,
J)A J k. The ponded area will draw down in less than 5 days. (calculations attached)
I. A planting plan and schedule with species and densities is provided on the plans.
m. Mulch layer and depth is specified on plans.
g� n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
DAD o. Plan details for the inlet and outlet are provided.
DA D P. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) �J does ❑ does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

3. Remove accumulated sediment and old mulch as needed to maintain good infiltration. Replace, or add additional
mulch as needed. Removal of the old mulch layer before applying the new layer is recommended every 2 to 3 years.
4. Prune trees and shrubs and remove debris on an annual basis. Grassed vegetation should not exceed 6 inches in height.
5. Treat all diseased trees and shrubs whenever needed. Remove and replace all dead and diseased vegetation considered
beyond treatment every 6 months.
6. Replace support stakes yearly (in the Spring). Replace deficient stakes or wires whenever needed.
7. Soil testing shall be conducted annually to determine pH and any accumulation of toxins in the planting media. Lime
or other alkaline substances shall be applied as recommended per the soil test and toxic soils shall be removed,
disposed of properly and replaced with new planting media.
8. All components of the bioretention area system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the eight 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.
Print name: Cn
Title: m e n-, ber, Wd-1ki V i l[E Cros!5ing; I_ L G
Address: AMa4 Aio(jk �or� S5� c_ gale/gh N(-,27667 _
Phone:
Signatu
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.
I 1� e1r1 M'6k O-CC% , a Notary Public for the State
County of , do hereby certify that G _ 22rQ;-CI-V-U �,A 1\ rV,,QC�
personally appeared before me this day of I;)-NdA`i , and acknowledge the due execution
of the forgoing bioretention basin maintenance requirements. Witness my hand and official seal,
4 4
�J��aTAR��'9y
`kL9311�pjv CO
SEAL
Oftn" lEOU10.1mil.
My commission expires
Page 3 of 3

Permit No. Jj W 7 04, 1 10A
(to be provided by DwQ
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality RECEIVED
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
MAY - 8 2007
BIORETENTION BASIN SUPPLEMENT
DWO Stormwater Mana,-Bement Plan Review: DWgWAR0
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, sealed design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : [11fe5yi JJg Cro :5,,,a 5koppl,R GPn1eir
Contact Person: avid la. Deel , �? E. Phone Number: (tea}, �zE I�3�300
For projects with multiple basins, specify which basin this worksheet applies to: 1 y•�r
(must match the DA # on the application)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
in -Situ Soil Type Pb
In -Situ Soil Infiltration Rate �, Dh - o, 52 in./hr. (the most restrictive soil layer)
SHWT Elevation 5, Q ft. (Seasonal High Water Table elevation)
Planting Soil Texture 5a logpi (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate J, p in./hr. (estimated)
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Minimum # of plantings
Total #of plantings provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
sq.ft. (on -site and off -site drainage to the basin)
sq.ft. (on -site and off -site drainage to the basin)
4. n inch (1.5 inch event for SA waters, 1 inch event for others)
1, 1 1(, c.f. (storage volume required)
I, 17 fps
I Z-3 _ hours
1 1?0 ft. x _ 7p ft. = _j, 3 3) _sq. ft. (surface area at basin bottom)
1,374 c.f. `LAvi. Wtdf}
3 J stems (1000 stems per acre of bioretention area)
3.J Trees _ 10 Shrubs_2,_ (must be at least 3 shrubs for each tree)
Q , ¢ frisl (elevation of the bypassloutlet structure)
fmsl (elevation of the ground surface bottom)
fmsl (elevation of the bottom of the planting media)
Pagel of 3

v
III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
IV) _ a. No vertical sand bed is proposed.
Ng{_ b. The bioretention area is at least 40 feet by 15 feet.
V MA alold by Ike Facf JKckf t� a redeveleprAenf site
c. Sheet is provided at the inlet.
M— d. A grass buffer strip is provided at the inlet.
_ DA D e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
nRD f. Ponding depth of 6-12" is provided.
g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
'K n)JI'laW 4rolk ll,Q J^51 l40i of a�, U"d* ra11 OJ of
_ M h. An in-depth soils report is provided.
JA� i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
j. The planting soil meets minimum soil specifications per the latest version of the NCDENR Stormwater
Best Management Practices Manual.'
k. The ponded area will draw down in less than 5 days. (calculations attached)
1. A planting plan and schedule with species and densities is provided on the plans.
m. Mulch layer and depth is specified on plans.
n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
�) o. Plan details for the inlet and outlet are provided.
�Ap. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) A does ❑ does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

3. Remove accumulated sediment and old mulch as needed to maintain good infiltration. Replace, or add additional
mulch as needed. Removal of the old mulch layer before applying the new layer is recommended every 2 to 3 years.
4. Prune trees and shrubs and remove debris on an annual basis. Grassed vegetation should not exceed 6 inches in height.
5. Treat all diseased trees and shrubs whenever needed. Remove and replace all dead and diseased vegetation considered
beyond treatment every 6 months.
6. Replace support stakes yearly (in the Spring). Replace deficient stakes or wires whenever needed.
7. Soil testing shall be conducted annually to determine pH and any accumulation of toxins in the planting media. Lime
or other alkaline substances shall be applied as recommended per the soil test and toxic soils shall be removed,
disposed of properly and replaced with new planting media.
8. All components of the bioretention area system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the eight 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.
Phone:
Signatu
Date: h -y 1
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, `jU SQLr-\ S GL(.XX\kOr \ , a Notary Public for the State of 24 or J C C�Qs ,
County of���-pt -� , do hereby certify that _ [.. �[}-� s � l l tnr•�_ _ram
personally appeared before me this day ofNdpA , Z�-O -, and acknowledge the due execution
of the forgoing bioretention basin maintenance requirements. Witness my hand and official seal,
oyy,pV BI.�GA
�N Cod
SEAL
Icy Co bh Expires 10-19-2011.
My commission expires
Page 3 of 3

4
Permit No. `S " Y 70t / K
(to be provid d by DWQ)
State of North Carolina
� EX; ENIM Department of Environment and Natural Resources
Division of Water Quality
NOV 16 2000STORMWATER MANAGEMENT PERMIT APPLICATION FORM
DWOMR0 BIORETENTION BASIN SUPPLEMENT
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, a bioretention
area supplement for each proposed system, sealed design calculations, soils report and 2 sets of plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name:
Contact Person:
Phone Number: (ZS2) 2(,/ - 3.3r(J
For projects with multiple basins, specify which basin this worksheet applies to: 6
(must match the DA # on the application)
II. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil Type P
In -Situ Soil Infiltration Rate in./hr. (the most restrictive soil layer)
SI-1WT Elevation S Q $. (Seasonal High Water Table elevation)
Planting Soil Texture __�ca.L 16a (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate _ 1,�_ _ in./hr. (estimated)
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Minimum # of plantings
Total #of plantings provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
1+a 3 3-1� sq.ft. (on -site and off -site drainage to the basin)
11, 3 7 �_ sq.ft. (on -site and off -site drainage to the basin)
I inch (I.5 inch event for Sit waters, 1 inch event far others)
c.f. (storage volume required)
fps
hours
157 ft- x _ 7 1; ft. _ ! 2_2,z_sq. ft. (surface area at basin bottom)
1 -2y8 c.£ '� Avg. wtd14,
A stems (1000 stems per acre of bioretention area)
2. Trees 0� Shrubs_ ,ZZ_ (must be at least 3 shrubs for each tree)
. 9 fmsl (elevation of the bypass/outlet structure)
_q .1 5: _ fmsl (elevation of the ground surface bottom)
.�), IS fmsl (elevation of the bottom of the planting media)
Pagel of 3

III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not heen met, attach written justification. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
nA�] a. No vertical sand bed is proposed.
b. The bioretention area is at least 40 feet by 15 feet.
DAD c. Sheet flow is provided at the inlet.
DAfl d. A grass buffer strip is provided at the inlet.
DAD e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
f. Ponding depth of 6-12" is provided.
N/A'_ g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
* Mil•) Jaled &f0Lgk }ire insAUllaJIah of an uMetd rain aV boflop, of PlumliA5 Media
li. An in-depth soils report is provided.
(� [] i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour and the type is noted
on plans.
`pg) j. The planting soil meets minimum soil specifications per the latest version of the NCDENR Stormwater
Best Management Practices Manual.
— FAD _ k. The ponded area will draw down in less than 5 days. (calculations attached)
na ti 1. A planting plan and schedule with species and densities is provided on the plans.
n � D _ in. Mulch layer and depth is specified on plans.
T1 A D_ n. Plan and section details for the bioretention area are provided. (including dimensions and elevations)
DAD — o. Plan details for the inlet and outlet are provided.
. �� p. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) X does Q does not incorporate the use of an under -drain.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed and re -mulch as necessary to maintain good vegetative and mulch cover.
Page 2 of 3

11-08-2006 05:45pn From-0U1BLUASSOCiATES 2522611260 T-11S P.002/002 F-773
3. - Remove accumulated sediment and old mulch as needed to maintain good infiltration. Replace, or add additional
mulch as needed. Removal of the old mulch layer before applying the new layer is recommended every 3 to 3 years.
-4, Prune trees and shrubs and remove debris on an annual basis. Grassed vegetation should not exceed 6 inches in height.
5. Treat all diseased tries and shrubs whenever needed. Remove and replace all dead and diseased vegetation considered
beyond treatment every 6 months.
6. Replace support stakes yearly (in the Spring). Replace deficient stakes or wires whenever needed.
7. Soil testing shall be conducted annually to determine pH and any accumulation of toxins in the planting media. Lime
or other alkaline substances shall be applied as recommended per the soil tas! and toxic soils shall be removed.
disposed of properly and replaced with new planting media.
8. All corapdnents of the bioretontion sxrt;a system shall be maintained in good working order.
I acknowledge. and Agree by my signature below that I am responsible for the performance of the eight =intena nce
procedures listed above. I agree to notify DWQ of any problems with the system or prior to any changes to the systern or
responsible party.
Print name; G.
Title: Member, WeeklMle Cmi2iog-
.A lit-ex;n, .__� � �� car J� :(��! �{:': , _..�tti#e �_r t�r_is}�t,_.!�f
Phone:
Sig atu
o »■Rsw��
Note: The legally responsible party should not be it hamcowntrs association unl4:sa more Char. 50% cCthe loco have been sold and Areciden; of the
subdivision has boon named the president
a Notary Public for the State of /_�_ (:�L��/„aLlr
County of do hereby certify that �- 7f -e"
personally appeared before me this day of g 0' 6 and a: knowlcdgy the due Execution
of the forgo�U bioretention basin maintenance requirerrle:r.ts. Wines,; my hand and official sea],
OzMO
My commission expires (93- 03, C� aejr
Qv�
Page 3 of 3