WI0100345_NOTIFICATION FORM_20150212

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION FOR STORMWATER DRAINAGE WELLS
Stormwater drainage wells are Class S injection wells 'permitted by rule " and do not require an individual
injection well permit when constructed in accordance with the rules of 1 SA NCAC 02C . 0200.
As described in 1 SA NCAC 02C .0227 this applies to rooftop runoff infiltration systems and certain other
stormwater infiltration systems implemented as Best Management Practices designed in accordance with State
stormwater regulations or an approved local government stormwater program. Additional guidance is available
online at httn://portal.ncdenr.org/web/wq/aps/�wnro/injection stormwater
This notification form shall be submitted within 30 days of a change of status as described in Part D below.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: U � 20 PERMIT NO. k/ T_ P/ 3 Y (to be completed by DWQ)
A. STATUS OF WELL OWNER (choose
one)
(1) Single Family Residence
(2) Business/Organization
(3) Government: State Municipal County Federal
B. WELL OWNER — For single family residences list the property owner(s). For all others, list name of the
business, organization, or government n
ent agency and person delegated signature authority:
w i l� l V\ M k1tA,& i A Of �e A ✓VA AV>
Mailing Address: 0 q- 1 2S
City: M Q,-\ k' A_+ State: � � Zip Code: 2-4? 7 S—1
Ph#: 2�? — cr, 5— 3 3 1 EMAIL:
C. WELL FACILITY
(1) Name of Facility:
St
(2) Physical Address: J+ Z 5-_ % T n a1 k fil c-
City: I V ` 6M � rf ti � State: NC Zip Code: 2A? 1 S-'l
(3) Facility Location Identified By (check one):
W'A"'ttached facility site map with property boundaries, or
[ ] Geographic Coordinates: Latitude:
Longitude:
Reference Datum: Position Accuracy:
Method of Data Collection:
D. WELL STATUS — Indic to the status of the well or well system (choose one):
Proposedctive Inactive Temporarily Abandoned Permanently Abandoned
DWn/l J1C Stormwater iniection Nntification Fnrm (Reviaertt 4/'An/?01')l P, I

E. SIGNATURES — The following section is to be completed as required below or by that person's authorized
agent. 15A NCAC 02C .0211(d) requires signatures as follows:
(a) for a corporation: by a responsible corporate officer;
(b) for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
(c) for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
(d) for all others: by the well owner;
(e) for any other person authorized to act on behalf of the applicant: documentation shall be
submitted with the notification" that' clearly id'eritifies -ihe`'persori-� grants them signature
authority, and is signed and dated by the applicant.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false -'information. Lggree to construct, operate, maintain, repair, and if applicable, abandon
the injection well an17 all relaie'd appurten�ances in accordance with the 1 SA NCAC 02C 0200 Rules.
I "
Signature of Property Owner/Applicant
W 1,Ol'A 1M �eAviiao
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full•Name
Submit one copy of the completed notification package to:
DWQ — Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone] Fax: [phone]
DWO/I I1C. RtnrmwatPr IniPrtinn Nntifiratinn Fnrm (Rrvk.-r1 4/10/?01?) P.OP

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j RAIN GARDEN 5 BOULDER WALL
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ITOI(j� ]j ' ILUME CAI .CIILATIONS FOR RAIN GARDEN MAR E MEIHOBI
RUNNOFF COEFFICIENT CALCULATION
Rya 0.051(0.009y8
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RY. 0.95
RUNOFF VOLUME CALCULATION
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A. SB509 (ARE
A OF WATERSHED TO RAW GARDEN)
P.1 INCH
0.95 •3850. (1/12) !
V. 2B7 CF-
' AREA OF TEMPORARY SILT PR FROM EROSION CONTROL MEASURES
SI IN BE CONVERTED TO PREMANENT RAIN GARDEN. SILT PIT V UME
\ N90 CR EXCEEDS REOUIRFO VOLUME TO CAPTURE THE FIRST 1 INCH
FLUSH OF 24 HOUR STORM EVENT, C
VOLUME.I AI*A, 2 �A I X HT
BEGID 970 RAGE: 267 CF
STORAGE PROVIDED FROM OPEN BASIN:
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GRAVEL CELL STORAGE 2 J
NEASHED 057 STONE UNDER RAIN GARGENI
V. CF•P
CF . CUBIC FEET OF STORAGE
P. POROSITY
V.2517.6- X 1.25' (15• AVERAGE DEPTH OF STON
V. 234 CF /
P. TOM I FROM STORMTECH IASSI %GA
V.291I.40. $3.7TOTAL RUNOFF STORAGE FOR RAN: \�
212 OF + 93.7 OF . 305.7 OF
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OWNER
BILL AND ANNE SEAMAN
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APPALACHAIN WAY
MONTREAT, NC 28757
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CONTRACTOR
JIM M.CONNAUGHY
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EWING S WONNAUGHY CONSTRUCTION, INC
3161 Old US 70 ELa1
EIWCk MoudlIM. Nodh CWQWM 20711
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82S-8BMc 9.1133(o.)
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929-231-9767(call)
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CONTACT
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MATTHEW SPROUSE. ASLA
SITEWORK STUDIOS, PH
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362 DEPOT STREET. SUITE 120
ASHEVILLE, PIC 28801
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PROJECT ADDRESS
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PIN:0720-27-3366
ACREAGE OF DEVELOPMENT: 0.315 AC.
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APPALACHIAN WAY
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MONTREAT, NORTH CAROLINA 28757
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y /�9Q�\ GRADING NOTES:
1. VERIFY GRADES, MIIENStONS 5 BLAOWO LOCATION W FIELD. NOTIFY LANDSCAPE ARCAIIEC I OR ARCHITECT F ANY WME
-./. C "LICTS OH AMBIGLMfIES ARISE,
2. CONTRACTOR IS TO MAINTAIN EXISTING ROAD DRAINAGE SYSTEM IN WORKING CONDITION.
SPOT ELEVATIONS AT CURB ARE AT BASE OF CURB UNLESS NOTED OTHERWISE. TO .TOP OF CURB.
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4. MATCH EXISTING GRADES SMOOTHLY WHERE PROPOSED FEATURES MEET EXISTING FEATURES.
5. THE CONTRAOTOR SHALL ENSURE POSITIVE DRA04ME AWAY FROM BUILDING DURING ALL PHASES OF CONSTRICTION.
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B. EROSION CONTROL MEASURES ARE GENERA. IN NATURE. CONTRACTOR 18 RESPONSIBLE FOR ADDITIONAL MEASURES AS REQUBAF(
TO PREVENT 0(4- OR OFF SITE RUNOFF AND EROSION.
7. ALL INL EIS TO HAVE TEMPORAR Y INL ET PROTECTION INSTALLED IMMEDIATELY AFTER INLET HAS BEEN CONSTRUCTED.
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B. CONTRACTOR IS RESPONSIBLE FOR WEEKLY INSPECTION OF ALL EROSION CONTROL AND SEDIMENT PRACDCES. NEEDED REPAIRS
ARE TO BE COMWFTEOM•1MEDIATELY, MAINTAIN SILT FENCE BY CLEARING OUT MEN HA.F FULL.I1_M'EC11ON 13 fECARED MER
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ALL RAIN EVENTS.
9. REMOVE AL TEMPORARY ER0.NIX4 ODNTRMX. MEASURES AFTER DISTURBED AREAS HAVE BEEN BTABR47ED ANO COMPLETED.
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10. ALL PROPOSED INLET STRUCTURES SHALL CONNECT TO M! PAOPOSEO STORM DRAIN LINE8 AND SHALL OUTFAL ON TI IE PROPERTY
WITH ADEOIIATEER05KTN CONTROL MFAURESATTHE OUTFALL.
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11. ALL PROPOSED STOMA DRAIN LINES SHALL HAVE A MINIMUM OF 1M OF COVER.
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12, THE CONTRACTOR SHALL PROVIDE FINISHED GRAMS AS SHOWN ON THE PLAN WITHIN A W TOLERANGE.
13. ALL TREFA AND VEGETATION TO REMAIN SHALL BE PROTECTED FROM INJURY DURING ANY LAND CLEARING AND CONSIKUCTIDN,
14. THE CONTRA770R SHALL NOT PARK VEHICLES, SIOHE MATEREAL8 OR TRENCH WITHIN DRIPL94E OF 7REES 10 REMAIN. GH WITHIN
M O NNIN a M"dIn IM IIIINNNNI�,TECTB40 ANY VEGETATION TO REMAIN.
Ly` ACTOR SHALL NOT CAUSE OR ALLOW THE GLEANFM OF EOWPMENT, STORAGE OR DISPOSAL OF MATERIALS SUCH A8
Ionl gD1N7MMF1t ♦B[QIIL7� 1r0-1 WMA HALT OR CONCRETE, OR ANY MATERIAL THAT CAN DAMAGE THE HEALTH OF VEGETATION WITHIN THE DWLINI
`OOR�IpM1al'lE:�
I ��• /�Y
PO CT 7E STATION.
THIS DOCUMENT IS THE PROPERTY OF SITEWORK STUDIOS, PLLC.
I
IT IS 10 BE USED FOR HIS SPECIFIC PROTECT ONLY AND IS NOI
TO BEU USED OTHERWISE WITHOUT OBTAI•014G WRITTEN CONSBN
FROM SITEWORK 51U0105, PLLC
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REVISIONS
NO.1 REMARKS I DATE—
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DATE:
08,08.2011
SHEET TITIF.
STORMW ATER
MANAGEMENT
PLAN
SHEET N 1.
L-30

LANDSCAPE ARCHITECTURE I 'LAN PLANNING I J;AN DESIGN
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f
Attachment "A"
Bioretention Areas
General
Yes No/
❑ f
Evidence of sedimentation build-up?
C� ❑
Is_ Noreten#ion area draining in. 2-5 days?
10,
Need for pruning of shrubs and trees?
❑ d
Are'there dead trees or shrubs per original plans which need replacement or removal?
0 LJ
Is. trash present which needs removal? (Especially at outlet structure)
❑ ❑
For grass bioretention areas and. basins; is the grass healthy and displaying a dense texture.
and generally free of weeds?
❑ ❑
Are there other.items specifically noted in the O&M. manual not otherwise, listed. here?
If so- describe:
Condition of. Mulch
Yes: No .
❑ N`
Bare spots? .
❑ .
Using Double Shredded Hardwood? (Recommend,.if not)
❑ rrlra ..Evidence_of
old. mulch not having been removed in the past: year?::
❑(
Are: slopes stabilized? Is vegetation established properly? Is sufficient mulch present?
❑ : ...
Evidence:of.under or over -fertilization; of adjacent lawn? (Circle which one).
Embankment (if present) : -
Yes ..: No ..
❑ _: , .. d.
Are there trees;.shrubs, or:woody.growth which require ,removal?.
❑
Seepage, cracks, settlement observed?.
❑ :
Beaver/ Muskrat holes ,present?
❑ . : d _ :.
Presence of weeds/invasive plants
Inlet Conduit:.
=
Yes No
Is.there evidence of undermining .or erosion?
❑ :. , C
Is the irilet conduit clogged, or otherwise ful.l.of sediment which may. restrict the volume?
❑
Are the. rip -rap dissipator pads in good condition and;do they:exhibit properly sculpted. rip -rap:
�.
,below.the. pad?,'
❑
.Is there evidence of cracks, separation, or.align. ment problems with the joints?
Conduit/Outlet
._ .
Yes ; _ 'No'
❑ L—Y/ :
Is there evidence of undermining?
❑ LY
Do joints or, alignments show signs of,atress, separation, or. cracks?
❑ .
Are there any: depressions in the soil surface.over the.pipe?
13' . 11._
Is. the rip -rap dissipator pad c or sized properly to the. original design requirements?
Note: If clean -outs are 'installed,. notify owner that clean=outs MUST be.ffushed within: 60-days 'of inspection: If .
clean -outs are=NOT installed, and surficial soils need replacement down to the_underdirainsystem,'a clean -out.
retrofit to the underdrain
system should be seriously. considered.
PHOTGRAPH8
Import digital photographs
of the. BMP devices and.structures below. If several photos exist.'(that might not fit on this page)
then list them individually as, Figures 1, 2, etc...and add a titles and caption to each: one and list:them below. Attach the
:actual: photographs to the back: of the report if they don't fit here below:
Additional Comments. and Descriptions to Add Regarding the BMP's (use additional paper if necessary)

Rain Garden Attachment —Photographs
1. Inlet from drainage pipes (left) and outlet
(right) are maintained in clear condition
year around.
2. Winter debris are removed by a paid
landscaper, from rain garden and upper
slopes.