SW8051243_CURRENT PERMIT_20061025

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW�CJlO`C"�
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

Michael F. Easley, Governor
WiIIiam G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.C. Director
Division of Water Quality
October 25, 2006
Mr. Mike Kelley, Member/Manager
Kelley Austin Properties, LLC
1076 W. 4 Street, Suite 200
Winston-Salem, NC 27101
Subject: Stormwater Permit No. SW8 051243
Walgreen's Swansboro
High Density Project
Onslow County
Dear Mr. Kelley:
The Wilmington Regional Office received a complete Stormwater Management Permit
Application for Walgreen's Swansboro on September 20, 2006. 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. SW8 051243
dated October 25, 2006, for the construction of the subject project.
This permit shall be effective from the date of issuance until October 25, 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 150B of the North Carolina General Statutes, and filed with the Office of
Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands
are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please
contact Linda Lewis, or me at [phone].
Sinc e yl" ,
Edward Beck
Regional Supervisor
Surface Water Protection Section
ENB/arl: S:1WQSISTORMWATIPERMIT1051243.oct06
cc: Don Gibbs, P.E., Greenhorne & O'Mara
Town of Swansboro Building Inspections
Linda Lewis
Wilmington Regional Office
Central Files
North Carolina Division of Water Quality 127 Cardinal Drive Extension Wilmington, NC 28405 Phone [phone]
Wilmington Regional Office Internet: www.newatcryualily;ort Fax [phone]
No �hCaro[ina
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State Stormwater Management Systems
Permit No. SW8 051243
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Michael Kelley & Kelley Austin Properties, LLC
Walgreen's Swansboro
Hwy 24 & NCSR 1512 (Old Hammock Road), Swansboro, Onslow County
174]Cira4
construction, operation and maintenance of sand filter in compliance with the provisions
of 15A NCAC 2H A 000 {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 October 25, 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 1.7 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from 62,920 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area indicated on page 3 of
this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. This is an after -the -fact permit. The stormwater facilities covered by this permit
must be fully constructed and operational prior to January 25, 2007.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW8 051243
7. The following design criteria have been provided in the sand filter and must be
maintained at design condition:
a.
Drainage 2Area, acres:
Onsite, ft
Offsite, ft2:
b.
Total Impervious Surfaces, ft2:
C.
Filter Depth, feet:
d.
TSS removal efficiency:
e.
Bottom Elevation, FMS.. :
f.
Bottom Surface Area, ft :
g.
Permitted Storage Volume, W:
h.
Bypass Elevation, FMSL:
i.
Controlling Orifice:
j.
Receiving Stream/River Basin:
k.
Stream Index Number:
1.
Classification of Water Body:
il. SCHEDULE OF COMPLIANCE
1.44
62920
0
62,920
3.0
90%
26.42
520 (each chamber)
3,120 (both chambers)
29.42
6"0 pipe
White Oak River (ICWW)
WOK01 20-18
"SA"
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 (every 6 months).
b. Sediment removal.
C. Mowin.9 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 sand filter structure, orifices, catch
basins and piping.
g. When the infiltration capacity of the sand filter has been reduced such
that the 1" runoff bypasses the system without infiltrating, the sand must
be removed and replaced.
h. Access to the sand filter structure must be available for inspection and
routine maintenance.
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.
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.
Page 3of7

State Stormwater Management Systems
Permit No. SW8 051243
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
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.
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 may not
be approved. The permittee is responsible for compliance with all permit
conditions until such time as the Division approves the transfer request.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW8 051243
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 e 25th day of October 2006.
NOR CAROLINA,CNViR3 MENTAL MANAGEMENT COMMISSION
G
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5 of 7

State Stormwater Management Systems
Permit No. SW8 051243
Walgreen's Swansboro
Stormwater Permit No. SW8 051243
Onslow County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/ full
time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Management Systems
Permit No. SW8 051243
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
Town of Swansboro County Building Inspections
Page 7 of 7

~�r12/1-34210.05 17:09
J� •
9158518393
GREENHORNE & O'MARA
PAGE 06/09
i]atc Received
Fee Paid
Permit Number
fo 2 200
5 l J 17
B 05 l Z-y 3
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality '
STORNIWATER MANAGEMENT PERMIT APPLICATI - ��®
This form maybe photocopied ,for use as an original
JUN 2 9 2006
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 (r;erson legaUy .responsible for facility and compliance):
3. Mailing Address for person listed in item 2 above:
City:.. Z2 .v `7, r INn State:_ All Zip: I0
Telephone Number: 336 -- /
4-. Project Name (subdivision• facility, or establishment name - should be consistent with project name on plans,
specifications. letters, operation and maintenaneeeements, etc.):
,t in re e
5. Location of Project (street address):
2- -��_ Ord �� .� rt, mac_ 'e 'ed
City:
,J.5 Leo :-r-)
6. Directions to project (fro
nearest major intersection):
0'., y 2 q _Y_
County:------ &1.2LLIJ --
CD /J
w
r,
7. Latitude: ^ "_� _ j5 �`� longitude: 7 ! �' of protect
B. Contact person who can answer Questions about the project:
` D i'r Telephone Number: ( �(�
Name: :C' 1V C � I !� � 3 `J �' rj 5 � — �
II. PERMIT INFORMATION:
1. Specify whether project is (check one): New Renewal Modification
Form SW '-101 Vcrsion 3.99 PsL- 1 cf4

12/13/2005 17:09 9198518393 GREENHORNE & O'MARA PAGE 07/09
2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number . 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, lvlajar Y Sedimentation/Erosion Control _404/40I Permit �NPDES St❑rmwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-•6748.
IIZ, PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
��''1r(one to twoj pages) describing stormwater management for the project.
mac .-.H►+!�
_ :�r�;y:.J�1_•G.t !� �r�� �ti f� D S F �c';e- ✓� �.,�s �z.r �� t%:,�
2. 5tormwat+vr runoff from this ,prroject drains to the
1rCRiver basin.
3. Total Project Area: i 1 `7 acres 4. Project Built Upon Area: _96
5. Mow many drainage areas does the project have?_
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.
:�--rrez fe d rI Sznd
F'
er
•B2s..�rrinforraation ;,,
..e . IC;; �i•'
�:�:� - :: 'raSna e Area:i?.;;
...r�C�cTJ,�r.a3i-nAAre:a.
,rwa'=-� ,
.Imperviaus,.$urface Area.'.:
Drainage -Area 1 ;•:.;.;::., .:
:..::: 3�rainage;Arta 2.= '. ,'.:."
On -site 5ui1dings
j 4Glij
On -site Streets
On -site Parking
r 4
On -site Sidewalks
$J
Other on -site
Off -site
Total: 7}"7 sF
Total: 6Z 920 {
Impervious arra is defined as the built upon area Including, but not 11mired to, buildings, roads, parking areas,
sidewalks, gravel areas, etc, f-ut'weJ (017S FC4—
Drai y- Area.
Form S w Li-1 Q I V vrs ion 3.99 Page 2 of 4

12/13/2005 17:09 9198518393 GREENHORNE & O'MARA - PAGE 08109
7. How was the off -site impervious area listed above derived?
N. DEED RESTRICTIONS AND FROTECTrVE COVENANT'S
File following itallcized deed restrictions and protective covenants are required to be recorded for all
subdivisions, outparcels and future development prior to the sale of any lot, U 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.
J. 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 he flied in. piped, or altered except as necessary to provide driveway crossings.
4. Bunt -upon area in excess of the permitted amount requires a state stormwater management permit modflcation prior to
construction.
5. All permitted runoff from ourparcels or future development shall be directed into the permitted stormwater control
system- These connections to the stormwater control system shall he performed in a manner that maintains the integrity
and performance of the systc.m 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 tot.
V. SUPPLEMENT FORMS
The applicable state storrnwater management permit supplement form(s) listed below must be submitted for each
BMF 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 SWU405
Curb Outlet System Supplement
Form SWU-106
Off -Site System Supplement
Form SWU•107
Underground Infiltration Trench Supplement
Form SWU-108
Neuse River Basin Supplemem
Form SWU-109
Innovative Best Management Practice Supplement
Form SWU-101 Version 3.99 Page 3 of 4

VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. The complete application package should be
submitted to the appropriate DWQ 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 ✓
• 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):.
Mailing Address:
City:
Phone:
VIII. APPLICANT'S CERTIFICATION
State:
Fax:
Zip:
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 be recorded, and that the proposed project complies with the requirements of 15A
NCAC 2H .1000.
Date: 9 7-Q,(,'
Form SWU-101 Version 3.99 Page 4 of

RECEIVED
SEP 2 0 2006
Permit No. !Gv X SI Z43
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
DwQ
-'RoJ # STORMWATER MANAGEMENT PERMIT APPLICATION FORM
SAND FILTER SUPPLEMENT
This form may be photocopier) for use as an original.
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a Sand Filter supplement for each proposed sand filter,
design calculations, plans and specifications showing all sand filter details, and a fully executed operation and
maintenance agreement.
1. PROJECT INFORiMATION (Please complete the following information):
Project Name: S Sw 7q�S a HIV C'_ 57-P C # 10 �31�
Contact Person:_ L,)D,,j Gi n-s S _ Phone Number: - Z -3 /2
For projects with multiple basins, specify which basin this worksheet applies to: NIA
Elevations
Bottom:
Top of Sand:
Weir:
Grate:
Areas
Drainage Area:
Bottom Area:
Design Storage Area:
Volumes
Sediment Chamber
Z(,. 4'2-fmsl
N/A
7,9. Yz fmsl
3 /. a0 fmsl
.197,0 ft2
5Za ft2
_ :ZA9 ft2
Sand Chamber
fmsl
Z9.�f2fmsl
Z9. 4-7- fmsI
3/. 06 fmsl
(floor of the sand f lter)
(min. 18"above bottom)
(weir into the sand chamber)
(top of the grate)
5Ze:, ft2 (ruin. 360 ft2 per acre of drainage area)
SZo ft2 (at the weir elevation of the sand filter)
Required Volume: -750 ft3 -7 0 W (Min. 540 ft3 per acre of drainage area)
Volume Provided: /eft' /, Sift' (volume provided at the weir elevation)
Total Volume Provided (both chambers) 3ft3
Other Parameters
Drawdown Orifice Size: (o r� (maximum 6" diameter)
Orifice Invert Elevation: fmsl (usually the floor of the sand filter)
Time to drawdown: hours (must be :52=t hours)
If. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the latest version of the Stormwater Best Management
Practices Manual (N.C. Department of Environment and Natural Resources) and Administrative Section 15A
NCAC 21-1.1008.
Initial in the blank space provided in front of each item 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, please attach written
justification.
Form SWU-
Page 1 of 3

Permit No. <Lw) ;F G S 12- +3
(Applicant or authorized agent- Please initial in the appropriate blanks or mark the blank NIA if it does not
apply)
sEC�C#l� a. Each chamber (sediment and sand chamber) of the sand filter provides a minimum surface area of 360
square feet per acre of drainage area.
395 b Each chamber (sediment and sand chamber) of the sand filter provides a minimum volume of 540 cubic
feet per acre of drainage area.
wS c. A minimum of 18" of sand is provided in the sand chamber.
d. Positive drainage to the sand filter has been provided either in conduit or surface drainage.
e. The sediment chamber has no other outlet except to the sand chamber.
O tj 5 f. The outlet from the sediment chamber to the sand chamber results in a sheet flow condition.
a� 5 g. An outlet drain has been provided in the sand chamber which will completely empty the sand chamber
within 24 hours.
h. No single outlet pipe is sized greater than 6", to maintain a minimum of 12" of sand depth above the
orifice.
V5 i. The drainage area to the sand filter does not exceed 50 acres.
j. Where stormwater quantity control is required by local ordinance, runoff that will flow over the sand
filter has been considered in addition to the runoff flowing from the normal outlet of the sand filter.
d k. Methods to capture trash have been provided at each inlet to prevent premature failure.
III. SAND FILTER OPERATION AND MAINTENANCE AGREEMENT
Regular maintenance is essential to the long-term performance and durability of the sand filter, as it is with all
stormwater BMP's. The Sand Filter system is defined as the sediment chamber, the sand chamber, and the flow
regulator or outlet device.
This system (check one) ❑.does does not incorporate a vegetated filter.
This system (check one) ❑ does idoes not incorporate non-integrated pretreatment.
At a minimum, the follo«ing maintenance activities shall be performed:
1. Depending on the types of activities occurring within the drainage area, most sand filters will show a
decreased capacity for filtration after a few years. At least once a year, each filter must be inspected after a
1" design storm event to determine if the filter bed is passing the runoff within 24 hours.
2. if the filter is not passing the runoff completely within 24 hours, -the first 2"-3" of discolored sand must be
removed and replaced with new sand. The removed sand must be dewatered and disposed of properly.
3. At the same time that maintenance is performed on the sand chamber, the sediment chamber shall be
pumped and cleaned. Remove accumulated sediment when it reaches a height of 6" in the sediment
chamber. The removed sediment should be dewatered and disposed of properly.
4. At least once every quarter, check that the drawdown orifice is clear of obstruction.
5. Vegetation within an open sand filter must be mowed regularly to limit the height to 12". Vegetation within
a closed sand filter must be removed.
6. Direct access to the sand and sediment chambers must be provided for maintenance and inspection.
Form SWU-
Page 2 of 3

Permit No.�
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance
procedures Iisted above. I agree to notify DWQ of any problems with the system and prior to making any changes to
the system or to the responsible party.
Print name and title:
Mailing Address:
Phone: ~ / i= -
• � V"�� 7 ? Fax:
Signature i Date
Note: The legally responsible party shall not be a homeowners association unless the developer no longer holds a
majority interest and a resident of the subdivision has been named the president, or a performance bond has been
accepted by the Division.
I V 1, ej<-, e �0 t,�eN s
-- —,a Notary Public for the State of Alavth, 0,ayp' Ci%
County of (5-IV )?eS
do hereby certify that T,' 1n,' Ck,,g l Ke /J e
personally appeared before me this the _ p� 7 day of ,T(4 n e 200(10`, and acknowledge the
due execution of the foregoing sand filter maintenance requirements. Witness my hand and official seal,
I/t��. S ow-c.d
My commission expires
SEAL
OFFICUIL SEAL
MoM Carolina • Stokes Count'
10 VICKiE S. OWENS
NOTARY PUBLIC
W Commission b#es 6 1VQ� y
Form SWU-
Page 3 of 3