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TABLE OF CONTENTS
I. INTRODUCTION AND PURPOSE...... I
IL STORMWATER AND
WATERSHED REGULATION ............ I
III. STORMWATER BEST
MANAGEMENT PRACTICES
(BMPs) MANUAL ........................... 1
IV. WATERSHED / STORMWATER
PERMIT PROCESS
A. Purpose and Application .....................2
B. Watershed/Stormwater Permitting
Process
1. Planning, Preliminary Design, and
Concept Plan .................................... 3
2. Final Stormwater Management Plan,
Construction Drawing Review, and
Permitting ........................................ 4
3. Construction, Construction Inspections
of Stormwater Control Structures-BMP(s). 8
V. STORMWATER CONTROL
STRUCTURES (BMPs) INSPECTION
PROGRAM ..................................... 9
APPENDICES
1. Stormwater Concept Plan - Preliminary Site
Plan Requirements Submittal Checklist .... I I
2. Stormwater Management System Concept
Plan Review Submittal Process...............13
3. Watershed/Stormwater Permit Application
Forms
3.a. High Density Permit Application.............14
3.b. Low Density Permit Application .......... 16
3.c. Low Density Permit Application -
Impervious Reduction .........................18
4. Watershed/Stormwater Permit Submittal
Checklists
4.a. High Density Watershed/Stormwater
Permit Submittal Checklist...................20
4.b. Stormwater Design Construction Plans
Submittal Checklist ...........................21
5. Guidelines for Surety Posting................23
6. No Practical Alternatives Riparian Buffer
Authorization Form ...........................25
7. Variance Request Form........................28
8. BMP(s) Operation and Maintenance
Agreement Models
8.a. Operation and Maintenance
Agreement for Private Ownership ...........34
8.b. Operation and Maintenance
Agreement for Homeowners and Other
Associations...................................38
9. Deed of Easement Model......................44
Watershed and Stormwater Administrative Manual i Revised 2020-02-01

10. Operation and Maintenance Plan Models
10.a. Wet Pond Operation and Maintenance
Plan...........................................48
10.b. Bioretention Area Operation and
Maintenance Plan ............................60
11. Maintenance Escrow Agreement
Model.........................................72
12. Watershed/Stormwater Management
Permit Application Process...................7970
13. Stormwater Management Construction
and Construction Inspection Process.....801
14. Engineer's Certificate of Stormwater
Control Completion Model.................81
15. Town of Kernersville Local Watershed
Map........................................... 823
16. Town of Kernersville Watershed Bond
Performance Bond Template...............834
Watershed and Stormwater Administrative Manual ii Revised 2020-02-01

I. INTRODUCTION AND PURPOSE
The Town of Kernersville Watershed and
Stormwater Administrative Manual, referred to
hereafter as Administrative Manual, has been
developed for the purpose of providing guidance
and clarity for implementation of the Town of
Kernersville Stormwater and Watershed
Regulations including Stormwater Post -
Construction Controls, Buffer Rules and Water
Supply Watershed Protection Regulations within
the Town of Kernersville and its Extra -territorial
Jurisdiction (ETJ). The Administrative Manual
includes application requirements and forms,
submission schedules, fee schedules,
maintenance agreements, variances forms and
information on where to obtain copies of the
Town of Kernersville Stormwater Ordinances
and information about the North Carolina
Stormwater Best Management Practice Manual.
A digital copy of the Administrative Manual is
available at the Town of Kernersville Website
under the following link:
Town of Kernersville - Permits, Ordinances, &
Specs.
IL STORMWATER AND
WATERSHED REGULATIONS
The Town of Kernersville Stormwater and
Watershed regulations (Stormwater Post -
Construction Controls, Buffer Rules and Water
Supply Watershed Protection Regulations) are
designed to control stormwater pollutants as
well as increased stormwater volume and
velocity from new development and
redevelopment so that water quality is protected
and downstream flooding is reduced; those
regulations are included in the Town of
Kernersville Unified Development Ordinance
UDO within the Chapter C "Environmental
Ordinance" as following:
• Watershed Protection Ordinance —
Unified Development Ordinance
Chapter C Article III. The effective
date of this Ordinance was July 1, 1993
• Stormwater Runoff - Unified
Development Ordinance Chapter C
Article IV - Section 3- Post -
Construction Runoff. The effective
date of this Ordinance was October 1,
2007.
• Riparian Buffer Protection Ordinance
for Lands within the Jordan
Watershed - Unified Development
Ordinance Chapter C Article V. The
effective date of this Ordinance was July
1, 2011.
Riparian Buffer Protection Ordinance
for Lands within the Randleman
Lake Watershed - Unified
Development Ordinance Chapter C
Article VI. The effective date of this
Ordinance was July 1, 2011.
Copy of the Town of Kernersville Unified
Development Ordinance UDO, including
Chapter C, Articles III, IV, V and VI can be
found at the Town of Kernersville Web -site
under the following link:
http://toknc.com/documents/files/Table`/`20of`/`
20Contents.pdf.
Also, copy of the Town of Kernersville Local
Watershed Map is available in Appendix 15
"Town of Kernersville Watershed Map" of this
document and at the Town of Kernersville Web -
site under the following link:
Town of Kernersville - Permits,Ordinances, &
Specs.
III. STORMWATER BEST
MANAGEMENT PRACTICES
(BMPs) MANUAL
The Watershed Administrator (Town of
Kernersville staff, located at the Community
Development Department -Engineering Division,
in charge of the issue of the Town
Watershed/Stormwater Permit) and Stormwater
Administrator (Town of Kernersville staff,
located at the Public Services Department-
Stormwater Division, in charge of the Town of
Watershed and Stormwater Administrative Manual 1 Revised 2020-02-01

Kemersville BMP(s) Inspection Program) shall
use the policies, criteria, and information,
including technical specifications and standards,
in the most current revision of the North
Carolina Stormwater Best Management Practice
Manual; and for publicly funded linear
transportation projects, the North Carolina
Department of Transportation Stormwater Best
Management Practices Toolbox; as the basis for
decisions about Watershed/Stormwater permits
and about the design, implementation and
performance and maintenance of structural and
non-structural stormwater BMPs.
The North Carolina Stormwater Best
Management Practices Manual includes a list of
acceptable stormwater treatment practices,
BMP(s), including the specific design criteria for
each stormwater practice. Stormwater treatment
practices that are designed, constructed, and
maintained in accordance with these design and
sizing criteria will be presumed to meet the
minimum water quality performance standards
of the Town of Kemersville Stormwater and
Watershed regulations.
The Town of Kemersville Design and
Construction Specifications document is also a
useful reference for designers and developers.
This manual was approved by the Board of
Alderman as a Town ordinance and contains
information pertinent to other stormwater
infrastructure designs.
If the standards, specifications, guidelines,
policies, criteria, or other information in the
North Carolina Stormwater Best management
Practices Manual and in North Carolina
Department of Transportation Stormwater Best
Management Practices Toolbox are amended
subsequent to the submittal of an application for
approval pursuant to the Town of Kemersville
Stormwater/Watershed regulations but prior to
approval, the new information shall control and
shall be utilized in reviewing the application and
in implementing the Town of Kemersville
Stormwater/Watershed regulations with regard
to the application. The most current version of
the North Carolina Stormwater Best
management Practices Manual and the North
Carolina Department of Transportation
Stormwater Best Management Practices
Toolbox shall apply regarding the date of
submittal of a new application.
A digital copy of The North Carolina
Stormwater Best Management Practices Manual
is available at the North Carolina Department of
Environment and Natural Resources (NCDENR)
website; Division of Energy, Mineral and Land
Resources; Land Quality Section under the
following link:
NCDENR - Stormwater BMP Manual
A digital copy of The North Carolina
Department of Transportation Stormwater Best
Management Practices Toolbox is available at
the North Carolina Department of
Transportation website; Programs;
Environmental Programs; Environmental
Excellence; Environmental Hot Topics;
Stormwater Program; NPDES Permit under the
following link:
https:Hconnect.ncdot.gov/resources/hydro/Storm
water%20Resources/Stormwater%2OBe st%20M
anagement%20Practice s%2OToolbox%20-
%20March%202008.Ddf
A digital copy of The Town of Kemersville
Design and Construction Specifications
document is available at the Town of
Kemersville Website under the following link:
Town of Kemersville — Business Information -
Permits, Ordinances, &
http://toknc.com/documents/files/SpecBook.pdf
IV. WATERSHED / STORMWATER
PERMIT PROCESS
A. Purpose and Application
The purpose of the Watershed and Stormwater
Permit Process is to provide a mechanism for the
review, approval, and inspection of the approach
to be used for the management and control of
Stormwater for a development or redevelopment
site consistent with the requirements of the
Town of Kernersville's UDO, whether the
approach consists of structural BMPs or other
techniques such as low -impact or low -density
design. Compliance after project construction is
Watershed and Stormwater Administrative Manual 2 Revised 2020-02-01

assured by the maintenance provisions of the
Town of Kernersville Stormwater and
Watershed Ordinances.
A Watershed/Stormwater Permit is required for
all development and redevelopment unless
exempt pursuant to the Town of Kernersville
Stormwater and Watershed Ordinances. No
building or built -upon area shall be erected or
expanded, nor shall any building or zoning
permit be issued until a Watershed/Stormwater
Permit has been issued by the Watershed
Administrator or Town Manager's designee.
A properly submitted packet (plans, calculation,
legal documents, etc.), as well as a reviewed and
approved Watershed/Stormwater Permit
Application, are required for the issuance of a
Watershed/Stormwater Permit. All plans
submitted with the application shall be prepared
by a registered North Carolina professional
engineer or landscape architect. The engineer or
landscape architect shall perform services only
in their area of competence and shall verify that
the design of all stormwater management
facilities and practices meets the submittal
requirements for complete applications; that the
designs and plans are sufficient to comply with
applicable standards and policies found in the
North Carolina Stormwater Best Management
Practices Manual, and the North Carolina
Department of Transportation Stormwater Best
Management Practices Toolbox if it is a linear
transportation project; and that the designs and
plans ensure compliance with the Town of
Kernersville Stormwater and Watershed
Ordinances.
B. Watershed/Stormwater Permitting
Process
1. Planning, Preliminary Design, and
Concept Plan
Before plans will be reviewed and approved
for construction, preliminary site plans must
be reviewed by the Watershed Administrator
through the Community Development
department review process.
Based upon the review of existing
conditions and site analysis, the designer
should develop a concept site layout plan for
the project. During the concept plan stage
the site designer will perform most of the
layout of the site including the preliminary
stormwater management system design and
layout. The stormwater concept plan allows
the design engineer to propose a potential
site layout and gives the developer and local
review staff preliminary information
regarding the stormwater management
system for the proposed development.
The following steps should be followed in
developing the stormwater concept plan:
a. Use appropriate site design approaches
(see the North Carolina Stormwater Best
Management Practices Manual) as
applicable to develop the site layout,
including:
• Preserving the natural feature
conservation areas defined in the
site analysis.
• Fitting the development to the
terrain and minimizing land
disturbance.
• Reducing impervious surface area
through various techniques.
• Preserving and utilizing the natural
drainage system wherever possible.
b. Calculate preliminary estimates of the
The Watershed/Stormwater Permitting Process
stormwater sizing criteria requirements
can be separated into three phases of stages:
for water quality, channel protection,
Planning, Preliminary Design, and Concept
overbank flooding protection and
Plan; Final Stormwater Management Plan,
extreme flood protection based on the
Construction Drawing Review and Permitting;
concept plan site layout.
and Construction and Construction Inspections
of Stormwater Control Structures-BMP(s).
c. Perform screening and preliminary
selection of appropriate structural
Watershed and Stormwater Administrative Manual 3 Revised 2020-02-01

stormwater controls and identification of
potential sitting locations.
It is extremely important at this stage
that stormwater design is integrated into
the overall site design concept in order
to best reduce the impacts of the
development as well as provide for the
most cost-effective and environmentally
sensitive approach. The goal of
maintaining natural hydrologic
conditions as a site is developed, to the
extent possible, can reduce the
economic costs of stormwater
management and minimize the negative
environmental impacts associated with
development.
It is recommended that prior to the
preparation of the Final Stormwater
Plan; the owner or developer shall
request a consultation meeting with the
Watershed Administrator on a concept
plan for the post -construction
stormwater management system to be
utilized in the proposed development
project. This consultation meeting shall
take place at the time of the preliminary
plan of subdivision or other early step in
the development process. The purpose
of this meeting is to discuss the post -
construction stormwater management
measures necessary for the proposed
project, as well as to discuss and assess
constraints, opportunities and potential
approaches to stormwater management
designs before formal site design
engineering is commenced. The
development process will typically
proceed much faster and smoother if the
concept meeting is conducted very early
in the process.
Appendix 01 "Stormwater Concept Plan
- Preliminary Site Plan Requirements
Submittal Checklist" contains the list of
the items that should be submitted to the
Watershed Administrator for review
purposes prior to the preparation and
submittal of the Final Stormwater
Management Plan and Construction
Plans.
The Stormwater Management System
Concept Plan is only a portion of the
preliminary submittal through the
Community Development Department
review process. The Community
Development Department must approve
the proposed preliminary site plan with
respect to City ordinances and policies
relating to all components of the
development plan (e.g., zoning,
subdivision, utility, landscape, etc.) in
addition to the Stormwater Management
System Concept Plan before the
developer may submit an application
and construction plans for the
Watershed/Stormwater Permit.
The "Planning, Preliminary Design, and
Concept Plan" phase is outlined in
Appendix 02 "Stormwater Management
System Concept Plan Review Submittal
Process"
2. Final Stormwater Management Plan,
Construction Drawing Review, and
Permitting
The final Stormwater Management Plan
ensures that requirements and criteria are
being complied with and that opportunities
are being taken to minimize adverse impacts
from the development. The Final
Stormwater Management Plan should
consist of plans; narrative and supporting
design calculations (hydrologic and
hydraulic); proper documentation and
adequate financial assurance for the
proposed stormwater management system.
For review purposes, the final stormwater
management plan should include the
following elements:
a. Existing Conditions Hydrologic
Analysis: Provide an existing condition
hydrologic analysis for stormwater
runoff rates, volumes, and velocities,
which includes:
Watershed and Stormwater Administrative Manual 4 Revised 2020-02-01

• A topographic map of existing site
• Methodologies, assumptions, site
conditions (minimum 2-foot contour
parameters and supporting design
interval recommended) with the
calculations used in analyzing the
basin boundaries indicated.
existing and proposed conditions
• Acreage, soil types and land cover
site hydrology.
of areas for each sub basin affected
by the project.
c. Stormwater Management System:
• All perennial and intermittent
Provide drawings, design calculations
streams and other surface water
and specifications for the proposed
features.
stormwater management system,
• All existing stormwater
including:
conveyances and structural control
• A drawing of the stormwater
facilities.
management system including the
• Delineation of on -site and off -site
location of nonstructural site design
drainage areas including number of
features and the placement of
acres.
existing and proposed structural
• Direction of flow and exits from the
stormwater controls. This drawing
site.
should show design water surface
• Analysis of runoff from off -site
elevations, storage volumes
areas upstream of the project site.
available from zero to maximum
• Methodologies, assumptions, site
head, location of inlets and outlets,
parameters and supporting design
location of bypass and discharge
calculations used in analyzing the
systems, and all orifice/restrictor
existing conditions site hydrology.
sizes.
• Narrative describing selection
b. Post -Development Hydrologic
process for appropriate and effective
Analysis: Provide a post -development
structural stormwater controls.
hydrologic analysis for stormwater
• Plan view, Cross -sections and
runoff rates, volumes, and velocities,
profile drawings and design details
which includes:
for each of the structural stormwater
• A topographic map of developed
controls (BMPs) in the system. This
site conditions (minimum 2-foot
should include supporting
contour interval recommended) with
calculations to show that the
the post -development basin
structure is designed according to
boundaries indicated.
the applicable design criteria and the
• Location of proposed roads,
North Carolina Best Management
building, parking lots, etc.
Practices Manual.
• Total area of post -development
. Hydrologic and hydraulic analysis
impervious surfaces and other land
of the Stormwater management
cover areas for each sub basin
system for all applicable design
affected by the project.
storms (should include stage -storage
• Unified stormwater sizing criteria
or outlet rating curves, and inflow
runoff calculations for water quality,
and outflow hydrographs).
channel protection, overbank
• Drawings, design calculations and
flooding protection and extreme
elevations for all existing and
flood protection for each sub -basin.
proposed stormwater conveyance
• Location and boundaries of
elements including stormwater
proposed natural feature protection
drains, pipes, culverts, catch basins,
and conservation areas.
channels, swales and areas designed
for overland flow.
Watershed and Stormwater Administrative Manual 5 Revised 2020-02-01

restore a stormwater control
d. Erosion and Sedimentation Control
structure to design specifications in
Plan: All projects which disturb more
the event of failure. Include in this
than one acre within the Town of
plan an annual budget for the
Kernersville and its Extraterritorial
maintenance and control of the wet
Jurisdictional (ETJ) must have an
detention basin. The approved
approved Erosion and Sedimentation
Operation and Maintenance plan
Control Permit from NC DENR. The
should be signed and notarized and
developer shall submit one copy of the
submitted to the Town of
approved Erosion and Sedimentation
Kernersville Engineering Division.
Control Plans to the Watershed
• Draft of the Operation and
Administrator.
Maintenance Agreement for the
BMPs (if applicable) meeting both
e. Proper Documentation and adequate
Watershed Protection and Storm
Financial Assurance for the Proposed
water Runoff Ordinances. The
Stormwater management system
purpose of this agreement is to
In addition to an approval for design
ensure that each BMP receives
construction plans for the proposed
adequate maintenance so that it can
Stormwater Management System, and
satisfactorily perform its pollutant
prior to obtaining a Watershed and
removal function, and meet the
Stormwater permit, the developer and/or
Town of Kernersville Watershed
property owner shall comply with others
and Stormwater runoff regulations.
Watershed Protection and Storm water
The agreement also designates the
Runoff Ordinances requirements, which
responsible party who shall be in
require as part of the permitting process
charge of maintaining the BMP. It
the submittal of the following
serves as a legal document to ensure
documents for review and approval by
maintenance and also outlines the
the Watershed Administrator and/or
routine maintenance schedule for
Watershed Review Committee:
each BMP. The approved Operation
• Complete Watershed and
and Maintenance Agreement shall
Stormwater Permit Application
be recorded in the office of the
and payment of Stormwater Site
Register of Deeds and submitted to
Plan Review fees. The Watershed
the Town of Kernersville
and Stormwater Permit Application
Engineering Division.
fee must be paid with the submittal
• Deed of Easement. For a
of the Permit Application in order
development that involves any
for the application to be considered
stormwater control structure, the
complete for review. The Town of
applicant shall convey unto the
Kernersville Schedule of Fees and
Town of Kernersville or its
Charges is in the approved current
successors or assigns an easement
fiscal year Budget document
and right-of-way establishing the
available online at:
right to ingress, egress, and regress
Town of Kernersville - Finance
over the property for the purpose of
• Draft of an Operation and
inspection, repair, or maintenance of
Maintenance Plan for each BMP
the stormwater control structure(s).
(if applicable). Such plan shall
A description of the area containing
specify all operation and
the storm water control structure(s)
maintenance work necessary for the
within a drainage easement shall be
stormwater control structure(s) and
contained within the deed filed with
methods to be used to maintain or
the Register of Deed together with
any dedication necessary for access
Watershed and Stormwater Administrative Manual 6 Revised 2020-02-01

to and from the stormwater control
replacement, major repair, or
structure(s) and a public street. The
reconstruction of the structural
approved deed of easement shall be
BMPs.
recorded in the office of the Register
• Town of Kernersville No Practical
of Deeds and submitted to the Town
Alternatives - Riparian Buffer
of Kernersville Engineering
Authorization Application Form
Division.
(If applicable). Persons who wish
• Submit a Construction
to undertake uses designated as
Performance Surety to the Town
allowable or allowable with
of Kernersville for the amount
mitigation (as per the Table of Uses
equal to one hundred percent
of the Jordan and Randleman Buffer
twenty (120%) of the total cost of
Rules) shall submit a request for a
the storm water control structure
"No practical alternatives"
(If applicable). Performance
determination to the Town of
Sureties may be in the form of
Kernersville. A Buffer
Standby Letters of Credit,
Authorization may be issued by the
Performance Bonds, and Cash.
Town of Kernersville. Please refer
Please submit unit cost information
to the Town's UDO buffer rules and
pertaining to all storm water control
watershed regulations (Chapter C
structures and /or bids from the
Articles III, V, and VI).
contractor hired to perform the work
• Town of Kernersville Variance
and any change orders related
Request Application Form (If
thereto as a method to determine the
applicable) for the UDO Chapter C
basis for cost of the work for the
Articles III, V and VI. The Town
construction of the BMP. The
may issue a Minor Variance, upon
Engineering Division will review
request from the developer or
and approve the total cost estimation
developer's representative. A Major
for the construction of the BMP.
Variance request will be processed
• Covenants and Restrictions (If
through the Town of Kernersville,
applicable). For those
but shall be issued by the North
developments having a permanent
Carolina Environmental
stormwater control structure,
Management Commission and
(Homeowner's / Property Owner's)
requires extensive reporting and a
Association Covenants, Conditions
local Watershed Review Committee
and Restrictions and Articles of
hearing and report.
Incorporation shall be reviewed and
• Copy of any required
approved by the Watershed Review
environmental permit by
Committee prior to recordation of a
NCDENR Division of Water
plat.
Resources (NCDWR) and the US
• Maintenance Escrow Agreement
Army Corps of Engineers
(If applicable). For all structural
(USAGE) (Stream and/or
BMPs that are to be or are owned
Jurisdictional Wetland Impacts -
and maintained by an owners'
404 general or Individual Permit &
association, the Town of
401 Water Quality Certification;
Kernersville Stormwater Runoff
Isolated Wetland Impacts; Stream
Ordinance requires the
Determinations; Buffer
establishment of an escrow account
authorizations; etc.)
for the long term maintenance of the
BMP(s); which can be spent solely
See appendix 03 for the High Density
for sediment removal, structural,
and Low Density Watershed/Stormwater
biological or vegetative
Permit Applications; appendix 04 for the
Watershed and Stormwater Administrative Manual 7 Revised 2020-02-01

Checklists of the items that should be
submitted to the Watershed
Administrator for review and approval
prior to the issuance of a
Watershed/Stormwater Permit; and
appendix 05 "Guidelines for Surety
Posting" for information about the
performance Sureties.
Appendices 06 to 11 contain templates
of most of the documents mentioned
above for the convenience and use of
developers and property owners.
Electronic copy of this model
documents can be found at the Town of
Kernersville Web -site under the
following link: Town of Kernersville
- Applications and Forms
Additionally, the "Final Stormwater
Management Plan, Construction
Drawing Review, and Permitting" phase
is outlined in Appendix 12
"Watershed/Stormwater Management
Permit Application Process" Flow
Chart.
Construction and Construction
Inspections of Stormwater Control
Structures-BMP(s)
The Construction and Construction
Inspections of Stormwater Control
Structures-BMP(s) Phase is outlined on
Appendix 13, titled "Stormwater
Management Construction and Construction
Inspection Process."
Once the Watershed/Stormwater Permit is
issued, construction may begin, provided all
other environmental permits have been
obtained, or are in the process of being
obtained, and all requirements of the Town
of Kernersville Community Development
Department have been satisfied. During
construction, Town staff may conduct
periodic construction inspections of
Stormwater BMP(s), however the designer
is ultimately responsible to certify that any
structural BMPs meet the requirements of
the ordinance and Stormwater Permit.
Certain BMP(s) (as Bio-retention Areas)
should not be constructed until the drainage
area to that BMP has been stabilized.
Should a BMP be constructed prior to
adequate ground stabilization provisions
being implemented, the responsibility of
reconstruction, replanting or replacement of
any contaminated soils is the responsibility
of the owner
Upon completion of a project, and before a
certificate of occupancy shall be granted, the
applicant shall certify that the completed
project is in accordance with the approved
Stormwater Management Plan and design,
and shall submit "as built" plans for all
BMPs after final construction is completed
to the Watershed Administrator. The plans
shall show the final design specifications for
all stormwater management facilities and
practices and the field location, size, depth,
and planted vegetation of all measures,
controls, and devices, as installed.
The designer of the stormwater management
measures and plans shall also certify, under
seal, that the as -built stormwater measures,
controls, and devices are in compliance with
the approved stormwater plans and designs
and with the requirements of the Town of
Kemersville's applicable ordinances.
Appendix 14 "Engineer's Certificate of
Stormwater Control Completion" contains a
model that the Town of Kernersville has
available for the convenience and use of
designers.
After review and approval by the Watershed
Administrator of the BPM(s) As -built plans
and Engineer's Certificate of Stormwater
Control Completion, and any other pending
requirements; the owner may request
release of fifty percent (50%) of the
performance surety. Upon request by the
owner, the Stormwater Division shall
inspect the stormwater control structure(s) to
determine that the stormwater control(s)
have been constructed and maintained as
required by the Town of Kemersville's
Stormwater and Watershed Ordinances.
Watershed and Stormwater Administrative Manual 8 Revised 2020-02-01

The Stormwater Administrator, upon
determining that the stormwater control(s)
have been installed in conformity with the
Town of Kernersville's Stormwater and
Watershed Ordinances and maintained
properly, shall release fifty percent (50%) of
the performance surety.
No sooner than one year after the
completion of the Stormwater control
structure, BMP(s), the owner may request
release of the remainder of the performance
surety. Upon request by the owner, the
Stormwater Division shall inspect the
stormwater control structure(s) to determine
that the stormwater control(s) are
performing as required by the Town of
Kemersville's Stormwater and Watershed
Ordinances.
If the plantings or other features cannot be
viewed due to time of year, plant dormancy
or leaf cover, then the inspection may be
delayed until such time as the inspection
may be performed.
The Stormwater Administrator, upon
determining that the stormwater control(s)
are performing as required by the Town of
Kemersville's Stormwater and Watershed
Ordinances, and after any needed repairs to
the stormwater control structure(s) are made
by the owner, shall release the remaining
performance surety.
Upon default of the owner to construct,
maintain, repair and, if necessary,
reconstruct any structural BMP in
accordance with the applicable permit or
operation and maintenance agreement, the
Town of Kernersville may use all or any
portion of the performance surety to make
necessary improvements based on an
engineering estimate or bids.
Such expenditure of funds shall only be
made after requesting the owner to comply
with the permit or maintenance agreement.
In the event of a default triggering the use of
installation performance surety, the Town of
Kernersville shall not return any of the
unused performance surety, which shall be
retained for maintenance. If the Town of
Kernersville takes action upon such failure
by the applicant or owner, the Town of
Kernersville may collect from the applicant
or owner for the difference should the
amount of the reasonable cost of such action
exceed the amount of the performance
surety held.
V. STORMWATER CONTROL
STRUCTURES (BMPs)
INSPECTION PROGRAM
Inspections and inspection programs by the
Town of Kernersville may be conducted or
established on any reasonable basis, including
but not limited to routine inspections; random
inspections; inspections based upon complaints
or other notice of possible violations; and joint
inspections with other agencies inspecting under
environmental regulations. Inspections may
include, but are not limited to, reviewing
maintenance and repair records; sampling
discharges, surface water, groundwater, and
material or water in BMPs; and evaluating the
condition of BMPs.
If the owner or occupant of any property refuses
to permit such inspection, the Stormwater
Administrator shall proceed to obtain an
administrative search warrant pursuant to G.S.
15-27.2 or its successor. No person shall
obstruct, hamper or interfere with the
Stormwater Administrator while carrying out his
or her official duties.
The Stormwater Administrator may notify the
owner of any repair or reconstruction necessary
to meet the requirements of the Town of
Kemersville's Stormwater and Watershed
Ordinance All repair or reconstruction shall be
in accordance with the approved plans and
specifications for the stormwater control
structure and the operation and maintenance
plan and shall be completed within ninety (90)
days after notification by the Stormwater
Administrator. Upon request by the owner, the
Watershed and Stormwater Administrative Manual 9 Revised 2020-02-01

Stormwater Administrator shall inspect and
approve the completed repairs.
Annual Maintenance Inspection and Reports
by the Owner of the BMP(s)
All stormwater control structures shall be
inspected at least on an annual basis to
determine that the controls are performing as
required by the Town of Kernersville's
Stormwater and Watershed Ordinances. For
stormwater control structures completed and
approved by the Town of Kernersville after
October 2007, the owner or person responsible
for maintenance shall submit to the Stormwater
Administrator an inspection report from a
qualified registered North Carolina professional
engineer, surveyor, soil scientist or landscape
architect performing services only in their area
of competence. The inspection report shall
contain all of the following:
• The name and address of the land
owner;
• The recorded book and page number of
the lot of each structural BMP;
• A statement that an inspection was made
of all structural BMPs;
• The date the inspection was made;
• A statement that all inspected structural
BMP(s) are performing properly and are
In compliance with the terms and
conditions of the approved maintenance
agreement required by the Town of
Kernersville regulations.
• The original signature and seal of an
engineer, surveyor, soil scientist or
landscape architect who either has
adequate training in BMP maintenance
or has been certified to maintain BMPs.
• Homeowner's and other associations
required entering into an operation and
maintenance agreement shall include a
financial statement certifying
compliance with the escrow account
long term maintenance requirement.
An original inspection report shall be provided
to the Stormwater Administrator beginning one
year from the date of as -built certification and
each year thereafter on or before the date of the
as -built certification.
Watershed and Stormwater Administrative Manual 10 Revised 2020-02-01

APPENDIX 1
Town of Kernersville
P.O. Box 728
Kernersville, NC 27285-0728
`�y�,� QF Kf9yF9
TOWN OF KERNERSVILLE
1�
ORATE
134 East Mountain Street
Telephone [phone]
Fax [phone]
STORMWATER CONCEPT PLAN - PRELIMINARY SITE PLAN REQUIREMENTS
SUBMITTAL CHECKLIST
Site plan at a scale of not less than one (1) inch equals 100 feet.
Property lines with bearings and distances of the land to be developed; names of the
owners of all adjacent land.
Topographic contours at an interval of four (2) feet, showing existing and proposed
contours.
Location of existing structures and other impervious areas
Watershed Site Data Block
• Watershed Name & Classification
• Total Site Acreage = "A"
• Existing Impervious Areas Built prior to 1993 = "B"
• Existing Impervious Areas Built after 1993 = "C"
• Total Undeveloped Acreage under regulations = "D" (D = A-B)
• New acreage of Impervious Area Proposed = "E"
• Percentage of Impervious area proposed = "P" {P = [(C+E) / (D)] * 100}
Delineation of on -site and off -site drainage areas including number of acres
Direction of stormwater flow and exits from the site
Plan view of the proposed stormwater drainage system
• Preliminary Location of inlets, manholes, pipe lines, and other storm drainage
structures.
Watershed and Stormwater Administrative Manual 11 Revised 2020-02-01

Location of existing and proposed conveyance systems such as grass channels, swales,
natural vegetated conveyance, level spreaders, etc.
Existing Ditches, swales, pipes, and drainage easements which are adjacent to the
proposed project
Preliminary Drainage Calculations
Preliminary grading plan that should include finish grading for the residential unit in case
of subdivision and other developments.
Delineation of Predominant Soil Types (from soil surveys if available)
Delineation of Existing Predominant Vegetation
Location and boundaries of other natural feature protection and conservation
areas such as wetlands, lakes, ponds, 100 year floodplain, stream buffer and features
used in designing buffers and meeting any applicable buffer requirements. Other
setbacks(e.g drinking water well setbacks, septic setbacks, etc).
Preliminary selection, size, calculations and location of proposed structural
stormwater controls (BMP's). Low -impact design elements if applicable.
All proposed right-of-ways, easements, parks, playgrounds and other areas proposed
to be dedicated to public or common use.
Proposed lot lines, dimensions of lots. Lot number and total number of lots, and
proposed use of land.
Location of right-of-way widths of all existing and proposed streets; water and sewer
lines.
Vicinity map at a scale of not less than one (1) inch to 1000 feet showing the relation
of the property to adjoining property and to all streets, roads, and existing drainage
ways within 200 feet of any part of the property to be developed.
The legend of the preliminary site plan shall contain the name of the owner(s) of the
property and of the authorized agent, if any; the name of the engineer or landscape
architect with registration seal, responsible for the plan; north arrow; scale; date; total
area, stated in acres, of the land to be developed.
Note: The items listed above should be submitted to the Watershed Administrator for review
prior to the preparation and submittal of the Final Stormwater Management plan and
Construction plans.
Watershed and Stormwater Administrative Manual 12 Revised 2020-02-01

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Town of Kernersville
i APPENDIX 3. a Planning & Engineering Division
}
134 East Mountain Street
'r 4� [phone]
f*r1 10-0
Watershed/Stormwater Permit - High Density Application
Date Submitted:
Project Name:
Property Address:
Project Description:
Stormwater Control Measures Description:
Property Owner
Name:
Name of Signing Official and Title (if applicable):
Address:
Phone: Email:
Property Owner Signature Date
***By signing, the owner certifies that the applicant listed below has full permission to act on the owner's behalf
for the purposes of securing a permit for the development described in this application. ***
Applicant (if different from Property Owner)
Name:
Company:
Address:
Phone:
Responsible Design Professional
Name:
Company:
Address:
Phone:
Email:
Email:
Watershed and Stormwater Administrative Manual 14
Revised 2020-02-01

R-S /r
4
Town of Kernersville
Planning & Engineering Division
134 East Mountain Street
[phone]
(Optional) Other contact such as the project manager who is designated to answer questions about the project
Name:
Company:
Address:
Phone:
SITE DATA
Email:
A.
Total site area
(sq.
ft.)
B.
Proposed disturbed area
(sq.
ft.)
C.
Existing impervious surface area
(sq.
ft.)
D.
Existing impervious surface area built before 1993
(sq.
ft.)
E.
Total regulated undeveloped site area: (A-D)
(sq.
ft.)
F.
Total proposed impervious surface area
(sq.
ft.)
G.
Regulated impervious surface area: (F-D)
(sq.
ft.)
H.
Proposed impervious surface area percentage: (F/A)*100
%
I.
Regulated impervious surface area percentage: (G/E)*100
%
J. If residential, units per acre
Note: Filing this application form gives the Town permission to enter property for inspections.
OFFICE USE
Watershed:
Pin(s)#:
APPROVAL:
Watershed Administrator
Date
Watershed and Stormwater Administrative Manual 15 Revised 2020-02-01

R-S /r
Town of Kernersville
r APPENDIX 3. b Planning & Engineering Division
}
134 East Mountain Street
[phone]
Watershed/Stormwater Permit - Low Density Application
Date Submitted:
Project Name:
Property Address: _
Project Description:
Property Owner
Name:
Name of Signing Official and Title (if applicable):
Address:
Phone: Email:
Property Owner Signature Date
***By signing, the owner certifies that the applicant listed below has full permission to act on the owner's behalf
for the purposes of securing a permit for the development described in this application. ***
Applicant (if different from Property Owner)
Name:
Company:
Address:
Phone:
Responsible Design Professional
Name:
Company:
Address:
Phone:
Email:
Email:
Watershed and Stormwater Administrative Manual 16
Revised 2020-02-01

Town of Kernersville
Planning & Engineering Division
134 East Mountain Street
[phone]
SITE DATA
A. Total site Area (sq. ft.
B. Proposed disturbed area (sq. ft.
C. Existing impervious surface area (sq. ft.
D. Existing impervious surface area built before 1993 (sq. ft.
E. Total regulated undeveloped site area: (A-D) (sq. ft.
F. Total proposed impervious surface area (sq. ft.
G. Regulated impervious surface area: (F-D) (sq. ft.
H. Proposed impervious surface area percentage: (F/A)*100 %
I. Regulated impervious surface area percentage: (G/E)*100 %
J. If residential, units per acre
Note: Filing this application gives the Town permission to enter property for inspections.
OFFICE USE
Watershed:
Pin#:
Watershed Administrator
Date
Watershed and Stormwater Administrative Manual 17 Revised 2020-02-01

,O::LRS rr
Town of Kernersville
i APPENDIX 3. c Planning & Engineering Division
}
134 East Mountain Street
'r 4� [phone]
f*r1 10-0
Watershed/Stormwater Permit - Low Density Application — Impervious Reduction
Date Submitted:
Project Name:
Property Address:
Project Description:
Property Owner
Name:
Name of Signing Official and Title (if applicable):
Address:
Phone: Email:
Property Owner Signature Date
***By signing, the owner certifies that the applicant listed below has full permission to act on the owner's behalf
for the purposes of securing a permit for the development described in this application. ***
Applicant (if different from Property Owner)
Name:
Company:
Address:
Phone:
Responsible Design Professional
Name:
Company:
Address:
Phone:
Email:
Email:
Watershed and Stormwater Administrative Manual 18 Revised 2020-02-01

SITE DATA
A. Total site area
B. Proposed disturbed area
C. Existing impervious surface Area
D. Existing impervious surface area built before 1993
E. Total regulated undeveloped site area: (A-D)
F. Total proposed impervious surface area
G. Regulated impervious surface area: (F-D)
H. Proposed impervious surface area percentage: (F/A)*100
I. Regulated impervious surface area percentage: (G/E)*100
J. If residential, units per acre
Town of Kernersville
Planning & Engineering Division
134 East Mountain Street
[phone]
(sq. ft.
(sq. ft.
(sq. ft.
(sq. ft.
(sq. ft.
(sq. ft.
(sq. ft.
Note: Filing this application form gives the Town permission to enter property for inspections.
OFFICE USE
Watershed:
Pin#:
Watershed Administrator
Date
Watershed and Stormwater Administrative Manual 19 Revised 2020-02-01

APPENDIX 4 a
Project Name:
Submitted By:
Date:
SUBMITTAL CHECKLIST
HIGH DENSITY WATERSHED/STORMWATER
PERMIT TOWN OF KERNERSVILLE
YES
1. COMPLETED HIGH DENSITY
WATERSHED PERMIT APPLICATION
REVIEWERS
NO INITIALS
E]
2.
TWO (2) COPIES OF STORMWATER DESIGN
CONSTRUCTION PLANS AND
CALCULATIONS FOR INITIAL REVIEW
3.
OPERATION AND MANTENANCE
AGREEMENT
4.
DEED OF EASEMENT
F-1
F1
5.
OPERATION AND MAINTENANCE PLAN
6.
COVENANTS AND RESTRICTIONS
(IF APPLICABLE*)
7.
CONTRACTOR'S ESTIMATED COST
FOR CONSTRUCTION OF BMP(s)
8.
PERFORMANCE SURETY FOR BMP(s)
F]
9.
MAINTENANCE ESCROW AGREEMENT
(IF APPLICABLE)
10.
COMPLETE RIPARIAN BUFFER AUTHORIZATION
r
APPLICATION FORM (IF APPLICABLE)
11.
COMPLETE VARIANCE REQUEST APPLICATION
FORM (IF APPLICABLE)
12.
COPIES OF REQUIRED ENVIRONMENTAL PERMITS
FROM NCDWR AND/OR USACE (IF APPLICABLE)
Date Reviewed:
*If owner's association is to own the best management practice(s), BMPs, the association covenants
and restrictions must be reviewed and approved prior to recordation of a plat.
Note: Items listed above shall be submitted, reviewed and approved prior to issuance of a High
Density Watershed/Stormwater Permit.
Watershed and Stormwater Administrative Manual 20 Revised 2020-02-01

APPENDIX 4. b
Town of Kernersville
P.O. Box 728
Kernersville, NC 27285-0728
��`�y�,� QF Kfyyf9s
b
TOWN OF KERNERSVILLE
ORATE
134 East Mountain Street
Telephone [phone]
Fax [phone]
STORMWATER DESIGN CONSTRUCTION PLANS - SUBMITTAL CHECKLIST
Vicinity map at a scale of not less than one (1) inch to 1000 feet showing the relation
of the property to adjoining property and to all streets, roads, and existing drainage
ways within 200 feet of any part of the property to be developed.
Site plan at a scale of not less than one (1) inch equals 100 feet.
The legend of the development plat shall contain the name of the owner(s) of the
property and of the authorized agent, if any; the name of the engineer or landscape
architect with registration seal, responsible for the plan; north arrow; scale; date; total
area, stated in acres, of the land to be developed.
Property lines with bearings and distances of the land to be developed; names of the
owners of all adjacent land.
Topographic contours at an interval of four (2) feet, showing existing and proposed
Contours lines.
Location of existing structures and other impervious areas
All existing right-of-ways, drainage easements or other dedication to the use of public or
others with widths.
All proposed right-of-ways, easements, parks, playgrounds and other areas proposed
to be dedicated to public or common use, or designed for such use.
Location of right-of-way widths of all existing and proposed streets; water and sewer lines.
Proposed lot lines, dimensions of lots. Lot number and total number of lots, and
proposed use of land.
Watershed Site Data Block
• Watershed Name & Classification
Total Site Acreage = "A"
Existing Impervious Areas Built prior to 1993 = `B"
Watershed and Stormwater Administrative Manual 21 Revised 2020-02-01

• Existing Impervious Areas Built after 1993 = "C"
• Total Undeveloped Acreage under regulations = "D" (D = A-B)
• New acreage of Impervious Area Proposed = "E"
• Percentage of Impervious area proposed = "P" {P = [(C+E) / (D)] * 100 )
Delineation of on -site and off -site drainage areas including number of acres
_ Detailed proposed grading plan (should include finish grading for the residential unit in
case of subdivision and other developments), stormwater flow paths and exits from the site
_ Delineation of Predominant Soil Types (from soil surveys if available)
_ Delineation of Existing Predominant Vegetation
_Where the plan for subdivision includes a lake or pond of one (1) acre or more in size, existing or
proposed, the plan shall show the location of dams, spillways or other structures and the location
and extent of inundation at full reservoir. The plan shall be accompanied by a profile of the
proposed dam structure(s) including all appurtenances thereto.
Proposed stormwater drainage system, including location, dimensions, and calculations.
• Inlets, manholes, pipe lines, and other storm drainage structures. Provide pipe and structures design charts
• Existing and proposed conveyance systems such as grass channels, swales, natural vegetated conveyance,
etc.
• Existing Ditches, swales, pipes, and drainage easements which are adjacent to the proposed project
Location and boundaries of other natural feature protection and conservation
areas such as wetlands, lakes, ponds, 100 year floodplain, stream buffer and features
used in designing buffers and meeting any applicable buffer requirements. Other
setbacks (e.g drinking water well setbacks, septic setbacks, etc).
If applicable, selection, size, calculations and location of proposed Engineered Stormwater
Control Structures (BMP's) and Low -impact design elements. Including:
• Total stormwater runoff calculations from design storm, both for pre -development and post -development
conditions.
• Location, dimensions, and calculations for open channels and storm drainage
system, including channel linings for design storm.
• Plans, including plan view and profiles; calculations; and specifications for Best Management Practices
(wet detention ponds, bio-retention areas, sand filters, etc.) proposed.
_If applicable, complete Town of Kernersville Riparian Buffer Authorization Application Form.
_If applicable, complete Town of Kernersville Variance Request Application Form.
_If applicable, copies of required Environmental Permits from NCDWR and/or USACE.
Note: The items listed above should be submitted to the Watershed Administrator for review and approval prior to
the issuance of a Watershed/Stormwater Permit.
Watershed and Stormwater Administrative Manual 22 Revised 2020-02-01

APPENDIX 5
GUIDELINES FOR SURETY POSTING:
Performance Bond
A) Entity issuing the Performance Surety must be licensed to do business in the State of North
Carolina and state its preferred correspondence address within the Performance Surety.
B) The Performance Surety must be issued in favor of the Town of Kernersville (obligee) for the
specified amount.
C) The Performance Surety shall clearly indicate the obligation within the document.
D) The Performance Surety shall clearly indicate principal's full intent to perform.
E) The Performance Surety shall state the surety shall stay in full force and effect until obligee
notifies principal that all obligations stated within the Performance Surety have been satisfied in
their entirety.
Standby Letter of Credit (SBLC)
A) Entity issuing the SBLC must be licensed to do business in the State of North Carolina and
state its preferred correspondence address within the SBLC.
B) The SBLC must be issued in favor of the Town of Kernersville (beneficiary) for a specified
amount and state the customer (account party).
C) The SBLC must clearly state it is an irrevocable Standby Letter of Credit.
D) The SBLC shall clearly indicate the obligation within the SBLC is for the payment of money
in lieu of performance.
E) The SBLC must state the beneficiary has the right to draw on the SBLC from time to time
upon written demand by the beneficiary indicating account parties failure to meet their
obligations.
F) The SBLC shall state draws will be processed within a reasonable time period once
beneficiary demands a draw.
G) The SBLC shall state the original amount may be reduced from time to time only upon
written notice by the beneficiary to do so.
H) The SBLC shall state the obligation shall be in full effect up to 5:00 pm on the date of
expiration as indicated within the SBLC and if said date falls on a holiday, weekend, or other day
in which the beneficiary or issuer are closed for business, the expiration day shall be the
following day that both beneficiary and issuer are open for business.
Watershed and Stormwater Administrative Manual 23 Revised 2020-02-01

I) The SBLC shall state the SBLC shall be automatically extended, without any formal
amendment or notice to the effect, from year to year, for successive periods of one (1) year each
from the present or any future expiration date hereof, unless the issuer notifies the beneficiary
60-days prior to such expiration date in writing, via certified mail, return receipt requested that
issuer has elected not to renew the SBLC and beneficiary has until 5:00 pm on or before the
expiration date to draw the full amount hereunder.
Cash
Cash, or check made payable to the Town Kernersville.
Delivery of Surety
Surety shall be delivered in person to 134 E. Mountain Street, Kernersville or it can be delivered
by certified mail to Town of Kernersville, Engineering Division, PO Box 728, Kernersville, NC
27285
Watershed and Stormwater Administrative Manual 24 Revised 2020-02-01

APPENDIX 6
Town of Kernersville
P.O. Box 728
Kernersville, N.C. 27285-0728
TOWN OF KERNERSVILLE
134 East Mountain Street
Telephone [phone]
Fax [phone]
NO PRACTICAL ALTERNATIVES - RIPARIAN BUFFER AUTHORIZATION FORM
Date Submitted: Enter here
1. Project Information
Name of Project: Enter herE
Address of Project or Property: Enter here
Riparian Buffer rules applied to the Project: Enter here.
2. Owner Information
Name(s) of Property Owner:
Address: Enter here
Phone: Enter here
E-mail address: Enter here
3. Applicant Information (if different from owner)
Applicant is: ❑ Agent
Name(s): Enter here
Business name (if applicable):
Address: Enter here.
Phone: Enter here
E-mail address: Enter here.
❑ Other, Specifiy
Enter here.
4. Project Information and Prior Project History
Property Identification No. (Tax PIN or Parcel ID): Enter here
Property size: :nter here sf Enter here Acres
Name of Local watershed to proposed project: Enter here
Water Quality Classification of watershed: =nter here
River Basin: Enter here.
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Explain the purpose of the proposed project:
5. Jurisdictional Determination
Watershed and Stormwater Administrative Manual 25 Revised 2020-02-01

Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this
property/project (including all prior phases) in the past?
❑ Yes ❑ No ❑ Unknown
If yes, who delineated the jurisdictional areas? Name (if known): Enter here
Agency/Consultant Company:
Other: Enter here
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
6. Project History
Have permits or certification been requested or obtained for this project (including all prior phases) in the past?
❑ Yes ❑ No ❑ Unknown
If yes, explain in detail:
7.
Future Project Plans
Is this a phased project?
If yes, explain:
❑ Yes ❑
No
8.
Proposed Buffer Impacts
Inventory
Individually list all buffer impacts below. If any impacts
require mitigation, then
you
must fill out the "Buffer
Mitigation"
section.
Buffer Impact Number
Reason for Impact
Buffer Mitigation Required?
Zone 1 Impact
Zone 2 Impact
Perm. (P) Temp.(T)
(square feet)
(square feet)
(Select one)
(Select one)
131
❑ P ❑ T
Enter here
❑ Yes
❑
No
Enter here
Enter here
132
❑ P ❑ T
Enter here
❑ Yes
❑
No
Enter here
Enter here
133
❑ P ❑ T
Enter here
❑ Yes
❑
No
Enter here
Enter here
134
❑ P ❑ T
Enter here
❑ Yes
❑
No
Enter here
Enter here
135
❑ P ❑ T
Enter here
❑ Yes
❑
No
Enter here
Enter here
136
❑ P ❑ T
Enter here
❑ Yes
❑
No
Enter here
Enter here
137
❑ P ❑ T
Enter here
❑ Yes
❑
No
Enter here
Enter here
Comments:
9. Impact Justification
Watershed and Stormwater Administrative Manual 26 Revised 2020-02-01

Specifically describe measures taken to avoid or minimize the proposed impacts in designing project:
Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques:
10. Buffer Mitigation
Will the project result in an impact within a protected riparian buffer that requires buffer mitigation?
❑ Yes ❑ No
If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation.
Calculate the amount of mitigation required.
Zone Reason for Impact Total Impact Multiplier Require Mitigation
(square feet) (square feet)
Zone 1 L ter here 3
Zone 2 Enter he I he- 1.5
If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment of a
compensatory mitigation fee to the Riparian Buffer Restoration Fund or to a private mitigation bank,
donation or real property, or restoration or enhancement of a non -forested riparian buffer).
Comments:
11. Diffuse Flow Plan
Does the project include or is it adjacent to protected riparian buffers identified within one of the Town of
Kernersville Buffer Protection Rules?
❑ Yes ❑ No
All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment.
Include a plan that fully documents how diffuse flow will be maintained. If a Level Spreader is proposed,
attach a Level Spreader Supplement Form.
If due to site constraints, a BMP other than a level spreader is proposed, please provide a plan for
stormwater treatment as outlined the NC Stormwater BMP Manual and attach a BMP Supplement Form.
Comments:
Applicant/Agent's Printed Name Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided)
Date
Watershed and Stormwater Administrative Manual 27 Revised 2020-02-01

APPENDIX 7
TOWN OF KE RN ERSVILLE
Town of Kernersville
Engineering Division
P.O. Box 728
Kernersville, N.C. 27285-0728
Variance Request Form
(For Major and Minor Variances)
Protection and Maintenance of Riparian Areas Rules
❑ Check the appropriate box below:
❑ Major Variance
❑ Minor Variance
134 East Mountain Street
Telephone [phone]
Fax [phone]
❑ Town of Kernersville Unified Development Ordinance (UDO) - Chapter C, Article VI
Riparian Buffer Protection Ordinance For Lands Within The Randleman Lake Watershed
❑ Town of Kernersville Unified Development Ordinance (UDO) - Chapter C, Article V
Riparian Buffer Protection Ordinance For Lands Within The Jordan Watershed
❑ Town of Kernersville Unified Development Ordinance (UDO) - Chapter C, Article IV
Stormwater Runoff
❑ Town of Kernersville Unified Development Ordinance (UDO) - Chapter C, Article III
Watershed Protection
Part 1: General Information
(Please include attachments if the room provided is insufficient)
1. Applicant's name (the corporation, individual, etc. who owns the property):
Watershed and Stormwater Administrative Manual 28 Revised 2020-02-01

2. Print owner/Signing official (person legally responsible for the property and its compliance)
Name:
Title:
Street address:
City, State, Zip:
Telephone: O_
Fax: ( )
3. Contact person who can answer questions about the proposed project:
Name:
Telephone
Fax: ( )
Email:
4. Project name (Subdivision, facility, or establishment name - consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
5. Project location:
Street address:
City, State, Zip:
County:
Latitude/longitude:
6. Date property was purchased:
7. Stream to be impacted by the proposed activity:
Stream name (for unnamed streams label as "UT" to the nearest named stream):
8. Which of the following permits/approvals will be required or have been received already for this project?
(If permit received, submit copy with this request).
Required: Received: Date received:
Permit Type:
401 Certification/404 Permit
Stormwater/Wastewater Permit
NPDES Permit
Non -discharge Permit
Stormwater/Watershed Variance
Erosion/Sedimentation Control
Others (specify)
Watershed and Stormwater Administrative Manual
29
Revised 2020-02-01

Part 2: Proposed Activity
(Please include attachments if the room provided is insufficient.)
1. Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat map or site plan
in Adobe (pdf) format) to accurately delineate the boundaries of the land to be utilized in carrying out the
activity, the location and dimension of any disturbance in the riparian buffers associated with the activity, and
the extent of riparian buffers on the land.
2. Fill in the table below to identify the square footage of impact to Zones 1 & 2 in the protected riparian buffers
and the required mitigation. (Fill in the impact portion of the table, even if mitigation is not required):
Buffer Impact
Zone of
Impact in
Number
Purpose for
Required
Impact
Square Feet
(indicate on
The Impact
Multiplier
Mitigation
Plan Sheet)
(From tables)
Zone 1
3
Zone 2
1.5
Total
*Zone 1 extends out 30 feet perpendicular from the most landward limit of the top of bank or the rooted herbaceous vegetation; Zone
2 extends an additional 20 feet from the landward edge of Zone 1.
3. State reasons why this plan for the proposed activity cannot be practically accomplished, reduced or
reconfigured to better minimize or eliminate disturbance to the riparian buffers:
4. Description of any best management practices to be used to control impacts associated with the proposed
activity (i.e., control of runoff from impervious surfaces to provide diffuse flow, re -planting vegetation or
enhancement of existing vegetation, etc.):
Watershed and Stormwater Administrative Manual 30 Revised 2020-02-01

5. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this Rule.
(6) How these difficulties or hardships result from conditions that are unique to the property involved.
(7) If economic hardship is the major consideration, then include a specific explanation of the economic
hardships and the proportion of the hardship to the entire value of the project.
Part 3: Stormwater
1. Provide all the Stormwater Management System Concept Plan documentation including a description of best
management practices (BMPs) that will be used to control nutrients and sedimentation impacts associated with
the proposed activity. Please ensure to include all applicable operation & maintenance agreements and
worksheets drafts for the proposed BMPs. Also, include the BMPs on your plan sheets.
2. Attach a description of how diffuse flow will be maintained through the protected riparian buffers. Please
ensure to include all applicable operation & maintenance agreements and worksheets drafts for the proposed
diffuse flow measure(s). Also, include the diffuse flow measure(s) on your plan sheets.
Part 4: Proposed Impacts and Mitigation
Provide a description of how mitigation will be achieved at your site pursuant to Town of Kernersville Riparian
Buffer Protection Rules for the corresponding Watershed.
Watershed and Stormwater Administrative Manual 31 Revised 2020-02-01

If buffer restoration is the method you are requesting, be sure to include a detailed planting plan to include plant
type, date of plantings, the date of the one-time fertilization in the protected riparian buffers and a plan sheet
showing the proposed location of the plantings.
If payment into a buffer restoration fund is how you plan to achieve your mitigation requirement, then include
an acceptance letter from the mitigation bank you propose to use stating they have the mitigation credits
available for the mitigation requested.
Part 5: Deed Restrictions
By your signature in Part 6 of this application, you certify that all structural stormwater BMPs required by this
variance shall be located in recorded stormwater easements, that the easements will run with the land, that the
easements cannot be changed or deleted without concurrence from the Town of Kernersville, and that the
easements will be recorded prior to the sale of any lot.
Part 6: Applicant's Certification
I, (print or type name of person listed in Part I, Item
2), certify that the information included on this permit application form is correct, that the project will be
constructed in conformance with the approved plans and that the deed restrictions in accordance with Part 5 of
this form will be recorded with all required permit conditions.
Signature:
Date
Title
Part 7: Plan Sheets
Be sure to include a copy of all of your completed application form, plan sheets and maps in Adobe (pdf)
format on a CD or floppy disk.
Part 8: Checklist
A complete application submittal consists of the following components. Incomplete submittals will be returned
to the applicant. Initial below to indicate that the necessary information has been provided.
Watershed and Stormwater Administrative Manual 32 Revised 2020-02-01

Applicant's Item
Initial
• Original and two copies of the Variance Request Form and the attachments listed below.
• A vicinity map of the project (see Part 1, Item 5)
• Narrative demonstration of the need for a variance (see Part 2).
• A detailed narrative or graphic description of the Stormwater Management Concept Plan
(see Part 3).
• Calculations and references supporting nutrient removal from proposed BMPs (see Part 3).
• Location and details for all proposed structural stormwater BMPs (see Part 3).
• Drafts of the applicable Supplement Form(s) and O&M Form(s) for each BMP and/or
narrative for each innovative BMP (see Part 3).
• Three copies of plans and specification, including:
- Development/Project name
- Engineer and firm
- Legend and north arrow
- Scale (1"=50' is preferred)
- Revision number & date
- Mean high water line (if applicable)
- Dimensioned property/project boundary
- Location map with named streets
- Original contours, proposed contours, spot elevations, finished floor elevations.
- Details of roads, parking, cul-de-sacs, sidewalks, and curb and gutter
- Footprint of any proposed building or other structures
- Wetlands delineated, or a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
- Drainage basins delineated
- Perennial and intermittent streams, ponds, lakes, rivers and estuaries
- location of forest vegetation along the streams, ponds, lakes, rivers and estuaries
Watershed and Stormwater Administrative Manual 33 Revised 2020-02-01

APPENDIX 8. a
STATE OF NORTH CAROLINA
COUNTY OF
OPERATION AND MAINTENANCE AGREEMENT
THIS AGREEMENT made pursuant to Town of Kernersville Watershed Protection and
Stormwater Ordinances and entered into this day of , 20 , by and
between the TOWN OF KERNERSVILLE, a North Carolina Municipal Corporation, Party of the First
Part, hereinafter referred to as "TOWN'; and and
Parties of the Second Part, here -in after referred to as "PROPERTY
OWNER".
WITNESSETH:
1. The PROPERTY OWNER is the owner of certain lands as described in Deed Book , Page
in the Office of the Register of Deeds of Forsyth County, North Carolina upon which it is
erecting and will make improvements, said development to be known as
(hereinafter the "PROPERTY").
2. The Property Owner desires to build engineered Stormwater Control Measures (hereinafter SCMs) to
provide storage and treatment of stormwater runoff to serve the development on said Property, as
required by the Kernersville Watershed Protection and Stormwater Ordinances (hereinafter the
"ORDINANCES").
3. The PROPERTY OWNER has applied to the TOWN for the issuance of a High -Density Watershed
Permit (hereinafter "PERMIT") to construct, maintain and operate the SCMs consistent with the
approved plans and specifications and the attached Operation and Maintenance Plan (Attachment A)
and to develop lands within the Watershed.
4. The PROPERTY OWNER has conveyed unto the TOWN, or its successors or assigns an easement
from a public right-of-way establishing the right of ingress, egress and regress over the property for the
purpose of inspection, repair, or maintenance of the SCMs. A description of the easement is contained
within the Deed of Easement filed with the Register of Deeds together with all dedication(s) necessary
for access to and from the SCMs. The SCM system, including components such as the side slopes,
Watershed and Stormwater Administrative Manual 34 Revised 2020-02-01

forebay, riser structure, SCM device and inlets, dam embankments, outlet, and emergency spillway and
sufficient area to perform inspections, maintenance, repairs and reconstruction together with all
easements and right-of-way applying thereto has been described in the Deed of Easement.
The TOWN desires to assure that the SCMs on the PROPERTY are properly constructed, maintained
and operated in accordance with law, the ORDINANCES, and PERMIT provisions in order to protect
the quality of the waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of
the parties hereto, the TOWN and PROPERTY OWNER do hereby mutually agree as follows:
The PROPERTY OWNER shall construct the SCMs in accordance with the ORDINANCES, PERMIT
and approved plans and specifications hereafter issued and approved by the TOWN; and shall thereafter
properly operate and maintain such systems and facilities in accordance with the ORDINANCES,
applicable PERMIT provisions, approved plans and specifications of the SCMs, Operation and
Maintenance Plan and Agreement, and State Law.
2. The PROPERTY OWNER shall not transfer ownership and/or control of any lots until construction of
the SCMs have been completed in accordance with the PERMIT and approved plans, and the
Kernersville Watershed Administrator has inspected the SCMs and the Town's Watershed Review
Committee has determined the SCMs were constructed and are functioning as designed and approved.
In order to change the name of the permit holder, the PROPERTY OWNER must request that the permit
be reissued to the subsequent property owner(s).
3. The PROPERTY OWNER shall provide an Operation and Maintenance Plan (ATTACHMENT A) that
specifies all necessary operation and maintenance procedures and that the SCMs, appurtenances and
access easements thereto shall thereafter be properly maintained and operated in conformity with
provisions of the ORDINANCES and PERMIT.
4. The agreements set forth in numbered Therefore paragraphs 1, 2, and 3, above shall be conditions of
any PERMIT issued by the TOWN to the PROPERTY OWNER for the construction, maintenance,
repair and operation of the SCMs.
5. A copy of this Operation and Maintenance Agreement shall be filed at the Forsyth County Register of
Deeds and in the office of the Watershed Administrator.
IN WITNESS WHEREOF, the parties have hereto set their hands and seals, this day of
.20
{SIGNATURES APPEAR ON THE FOLLOWING PAGES{
Watershed and Stormwater Administrative Manual 35 Revised 2020-02-01

PARTY OF THE FIRST PART:
TOWN OF KERNERSVILLE
I0
ATTESTED TO:
Keith Hooker, Town Clerk
STATE OF NORTH CAROLINA
COUNTY OF FORSYTH
Dawn H. Morgan, Mayor
I, , a Notary Public of Forsyth County, North
Carolina, do hereby certify that personally came before me this
day and acknowledged that she is the Town Clerk of the Town of Kemersville, a North Carolina municipal
corporation, and that by authority duly given as the act of the Town of Kernersville, the foregoing
instrument was signed in its name by its Mayor, sealed with its corporate seal and attested by her as its
Town Clerk.
Witness my hand and official seal, this the day of 120
Notary Public
Print/Type Name:
My Commission Expires:
(SEAL)
Watershed and Stormwater Administrative Manual 36 Revised 2020-02-01

PARTY OF THE SECOND PART:
(SEAL)
STATE OF NORTH CAROLINA
COUNTY OF
I, , a Notary Public of County,
North Carolina, do hereby certify that , the
of personally
came before me this day and acknowledged the execution and sealing of the foregoing instrument as
on behalf of and as the act of the company referred to in
this acknowledgment.
Witness my hand and notarial seal, this the day of 120
Print/Type Name:
My Commission Expires:
(or, if individual owner)
STATE OF NORTH CAROLINA
COUNTY OF
Notary Public
I, , a Notary Public in and for said County and State,
do hereby certify that personally appeared before
me this day and acknowledged the execution of the foregoing Deed of Easement.
Witness my hand and notarial seal, this the day of
Print/Type Name:
My Commission Expires:
Notary Public
20
Watershed and Stormwater Administrative Manual 37 Revised 2020-02-01

APPENDIX 8. b
STATE OF NORTH CAROLINA
COUNTY OF FORSYTH
Permit No.
HOMEOWNERS (or other) ASSOCIATION OPERATION AND MAINTENANCE AGREEMENT
THIS AGREEMENT made pursuant to Town of Kemersville Watershed Protection and Stormwater
Ordinances and entered into this day of , 20_, by and between the TOWN OF KERNERSVILLE,
a North Carolina Municipal Corporation, Party of the First Part, hereinafter referred to as "TOWN'; and
here -in after referred to as "DEVELOPER", and here -in after referred to as the "ASSOCIATION",
Parties of the Second Part.
WITNESSETH:
1. The TOWN under various state and federal laws, is required to regulate the maintenance of
engineered Stormwater Control Measures and related structures (hereinafter referred to as "SCMs") constructed to
serve new or re -development within both the corporate limits of the TOWN and within the extra territorial zoning
jurisdiction of the TOWN to ensure that, following initial construction, the SCMs are operated, maintained, and to
the extent necessary, repaired in accordance with applicable state and federal laws.
2. The TOWN has determined that, to maintain the Town's compliance under applicable state and
federal regulations, certain obligations are to be met by the DEVELOPER and subsequent owners of the SCMs.
3. The DEVELOPER is the owner of certain lands as described in Deed Book , Page
in the Office of the Register of Deeds of Forsyth County, North Carolina upon which it is erecting and will
make improvements, said development to be known as
(hereinafter referred to as the "PROPERTY').
4. The DEVELOPER desires to build SCMs to provide storage and treatment of stormwater runoff to
serve the development on said PROPERTY, as required by the Kernersville Watershed Protection and Stormwater
Ordinances (hereinafter referred to as "ORDINANCES").
5. The DEVELOPER has applied to the TOWN for the issuance of a high density watershed/stormwater
permit (hereinafter referred to as "PERMIT") to construct, maintain and operate the SCMs consistent with the
approved plans and specifications on file at the office of the Watershed Administrator and the Operation and
Maintenance Plan (ATTACHMENT A).
6. The DEVELOPER has conveyed unto the TOWN, or its successors or assigns, an Easement and
Right -of -Way establishing the right of ingress, egress and regress over the PROPERTY for the purpose of inspection,
repair, or maintenance of the SCMs. The Easement and Right -of -Way for the SCMs are described in Deed Book ,
Page , which is recorded in the Office of the Register of Deeds of Forsyth (or Guilford, if applicable) County,
North Carolina.
7. The TOWN desires to assure that the SCMs on the PROPERTY are properly constructed,
maintained and operated in accordance with law, the ORDINANCES, and PERMIT provisions in order to protect the
quality of the waters of the State and the public interest therein.
Watershed and Stormwater Administrative Manual 38 Revised 2020-02-01

8. These SCMs are required to comply with the ORDINANCES and that failure to maintain the SCMs
is a violation of the ORDINANCES potentially subjecting each lot owner of the PROPERTY to significant daily civil
penalties and other enforcement actions.
9. After the completion of construction of the SCMs, the DEVELOPER may convey the SCMs to the
ASSOCIATION.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the TOWN, the DEVELOPER and the ASSOCIATION do hereby mutually agree as follows:
l . The DEVELOPER shall construct the SCMs in accordance with the ORDINANCES, PERMIT and
plans and specifications hereafter issued and approved by the TOWN; and that DEVELOPER and ASSOCIATION
assume specific maintenance, replacement, reconstruction and repair, responsibilities set forth in the ORDINANCES
and with respect to the SCMs.
2. Construction and Maintenance of the SCMs: The DEVELOPER shall be responsible for the
construction of the SCMs; and prior to conveying control of the SCMs, the DEVELOPER will be responsible for
maintenance, repair, reconstruction, and replacement thereof. Following conveyance of the SCMs, the
ASSOCIATION and its members will be responsible for maintaining the SCMs, their appurtenances and vegetation
in the manner specified herein and in strict compliance with the ORDINANCES. At all times, the SCMs shall perform
as designed and shall at all times comply with all applicable laws, ordinances, regulations, rules and directives of
governmental authorities.
3. Ownership and/or Transfer of PROPERTY: Upon completion of the SCMs, the DEVELOPER has
the option to convey that portion of the PROPERTY on which the SCMs are located to an Association to be formed
for the purpose of administrating the provisions of a declaration of covenants to be imposed upon the PROPERTY,
which declaration shall fully comply with all requirements of this contract as well as all applicable laws. The
Declaration of Covenants, Conditions and Restrictions for PROPERTY, in reference to this contract and all applicable
stormwater and watershed laws, shall be subject to review and approval by the Town of Kemersville Attorney.
The DEVELOPER agrees that it shall not transfer ownership and/or control of the SCMs until construction has been
completed in accordance with the PERMIT and approved plans and specifications; and as defined in the
ORDINANCES, the TOWN has inspected and approved the SCMs. In addition, the DEVELOPER and
ASSOCIATION and any new Owner must request that the PERMIT for the SCMs be re -issued to any subsequent
Owner.
The DEVELOPER and ASSOCIATION agree not to transfer, convey, assign or otherwise relinquish or release its
responsibility for the operation and maintenance of its SCMs until a PERMIT has been re -issued to DEVELOPER
and ASSOCIATION's successor, or new owner at which time DEVELOPER and ASSOCIATION shall be released
from any obligations hereunder arising from events or circumstances occurring after the date the SCMs are transferred
and the PERMIT is reissued to the new Owner of the PROPERTY.
4. Cost Estimates for Construction of the SCMs: The DEVELOPER's Engineer shall submit an
estimate of construction costs for review and approval by the TOWN in accordance and regulations with the
ORDINANCES. This cost estimate will be used to establish the level to which the escrow account shall be funded.
5. Establishment of an Escrow Account: For the purpose of insuring the availability of funds for the
long term maintenance and/or replacement/reconstruction of the SCMs, an escrow account must be established, which
can be spent solely for that purpose. Maintenance activities include, but are not limited to, sediment removal, and
structural, biological or vegetative replacement, major repairs, or reconstruction. If the SCMs are not performing
adequately or as intended or are not properly maintained, the TOWN in its sole discretion, may remedy the situation,
and in such instances, the TOWN shall be fully reimbursed from the escrow account.
Escrowed funds may be spent by the DEVELOPER, ASSOCIATION or ASSOCIATIONS's successor for allowable
expenses, provided that the TOWN shall first consent to the expenditure. Escrowed funds shall not be spent for routine
landscaping maintenance items such as mowing.
The escrow account will be funded initially by a lump sum contribution of the DEVELOPER (the "Initial Payment"),
and thereafter by annual sinking funds paid by the ASSOCIATION, if it has taken ownership or by the DEVELOPER
if it still retains ownership of the SCMs. The DEVELOPER shall deposit the Initial Payment in the escrow account
and show proof of such payment:
(i) Prior to plat recordation of the PROPERTY; or
(ii) Before the issuance of building permits for the construction of improvements on the PROPERTY.
Whichever occurs first.
Watershed and Stormwater Administrative Manual 39 Revised 2020-02-01

The Initial Payment shall be equal to $ dollars (which is equal to fifteen percent (15%) of the initial
construction costs of the SCMs).
The total sinking fund budget is defined as the amount required for the initial construction cost of the SCMs. The
ASSOCIATION shall deposit funds at least annually in equal installments into the escrow account such that at least
two-thirds (2/3) of the total amount of the sinking fund budget, as set in the ORDINANCES, shall be deposited into
the escrow account within the first five (5) years and the full amount shall be deposited within ten (10) years following
initial construction of the SCMs. A portion of the annual assessments of the ASSOCIATION shall include an
allocation into the escrow account. Any funds drawn down from the escrow account shall be replaced in accordance
with the schedule of anticipated work used to create the sinking fund budget.
6. The DEVELOPER shall provide in an Operation and Maintenance Plan (ATTACHEMENT A) that
specifies all necessary operation and maintenance procedures and that the SCMs, appurtenances and access easements
thereto shall thereafter be properly maintained and operated in conformity with ORDINANCES and the provisions of
the PERMIT.
7. The DEVELOPER and its successors shall grant to the TOWN a right of entry to inspect, monitor,
maintain, repair, and reconstruct SCMs.
8. The DEVELOPER and its successor hereby authorize the TOWN to recover from the DEVELOPER
or ASSOCIATION and its members, whichever is the responsible party, any and all costs the TOWN expends to
maintain or repair the SCMs or to correct any operational deficiencies. Failure to pay the TOWN all of its expended
costs, after forty-five days written notice, shall constitute a breach of the agreement. The TOWN shall thereafter be
entitled to bring an action against the responsible party to pay, or foreclose upon the lien hereby authorized by the
agreement against the PROPERTY, or both, in case of a deficiency. Interest, collection costs, and attorney fees shall
be added to the recovery.
9. This Agreement shall not obligate the TOWN to maintain or repair any SCMs, and the TOWN shall
not be liable to any person, firm, partnership, company, corporation, governmental agency, Association or entity for
the condition or operation of SCMs.
10. This agreement shall not in any way diminish, limit, or restrict the right of the TOWN to enforce
any of its ordinances as authorized by law.
11. Indemnification: Owners, DEVELOPER and/or ASSOCIATION agree to protect, defend,
indemnify and hold the TOWN, its officers, employees and agents free and harmless from and against any losses,
penalties, damages, settlements, costs, charges, professional fees or other expenses or liabilities in connection with or
arising out of this Agreement and/or related to the SCMs, unless the TOWN has agreed in writing to assume the
maintenance responsibility for the SCMs and has accepted dedication of any and all rights necessary to carry out that
maintenance.
12. A copy of this Operation and Maintenance Agreement shall be filed at the Forsyth (or Guilford, if
applicable) County Register of Deeds and in the office of the Watershed Administrator.
IN WITNESS WHEREOF, the parties have hereto set their hands and seals, this day of
, 20`
{SIGNATURES APPEAR ON THE FOLLOWING PAGES}
Watershed and Stormwater Administrative Manual 40 Revised 2020-02-01

PARTY OF THE FIRST PART:
TOWN OF KERNERSVILLE
M.
ATTESTED TO:
Keith Hooker, Town Clerk
STATE OF NORTH CAROLINA )
COUNTY OF
Dawn H. Morgan, Mayor
I, , a Notary Public of Forsyth County, North Carolina, do hereby certify
that personally came before me this day and acknowledged that he is the
Town Clerk of the Town of Kemersville, a North Carolina municipal corporation, and that by authority duly given as
the act of the Town of Kemersville, the foregoing instrument was signed in its name by its Mayor, sealed with its
corporate seal and attested by him/her as its Town Clerk.
Witness my hand and official seal, this the day of 120
Notary Public
Print/Type Name:
My Commission Expires:
Watershed and Stormwater Administrative Manual 41 Revised 2020-02-01

PARTY OF THE SECOND PART:
DEVELOPER:
By:
Name:
Its:
ATTESTED TO:
STATE OF NORTH CAROLINA )
COUNTY OF )
(Title)
DEVELOPER
ACKNOWLEDGEMENT
I, , a Notary Public of County, North
Carolina, do hereby certify that , the of
personally came before me this day and acknowledged the execution
and sealing of the foregoing instrument as on behalf of and as the act of the
company referred to in this acknowledgment.
Witness my hand and notarial seal, this the day of 120
My Commission Expires:
Notary Public
(SEAL)
Watershed and Stormwater Administrative Manual 42 Revised 2020-02-01

PARTY OF THE SECOND PART:
ASSOCIATION:
By:
Name:
Its:
ATTESTED TO:
STATE OF NORTH CAROLINA )
COUNTY OF )
(Title)
ASSOCIATION
ACKNOWLEDGEMENT
I, , a Notary Public of County, North
Carolina, do hereby certify that I the
of personally came before
me this day and acknowledged the execution and sealing of the foregoing instrument as
President on behalf of and as the act of the company referred to in this
acknowledgment.
Witness my hand and notarial seat, this the day of 120
My Commission Expires:
Notary Public
(SEAL)
Watershed and Stormwater Administrative Manual 43 Revised 2020-02-01

APPENDIX 9
NORTH CAROLINA )
DEED OF EASEMENT
FORSYTH COUNTY )
THIS DEED OF EASEMENT made this the day of , 20 , by and between,
hereinafter referred to as "Party of the First Part", and the TOWN OF KERNERSVILLE,
hereinafter referred to as "Party of the SecondPart' ;
(Note: revise to "Parties of the First Part" if multiple owners)
WITNESSETH:
WHEREAS, the Party of the First Part is owner of certain real property located in Kernersville
Township, Forsyth County, North Carolina; and whereas, the said Party of the First Part now desires to
convey an access easement to the Party of the Second Part in accordance with the requirements of the
Watershed Protection and Stormwater Ordinances of the Town of Kernersville hereinafter referred to as
"Ordinances", and
WHEREAS, the Party of the First Part is owner of a certain tract of property lying and being in Forsyth
County, North Carolina and said property is more particularly described in a Deed as recorded in Deed Book
Page_, Forsyth County Registry, hereinafter referred to as "Property";
WHEREAS, the purpose of the easement is to provide the Party of the Second Part with access from a
public right-of-way to and around all Stormwater Control Measures, hereinafter referred to as SCMs, which
includes components such as the side slopes, forebay, riser structure, SCM device and inlets, dam embankments,
outlet, and emergency spillway and sufficient area to perform inspections, maintenance, repairs and
reconstruction located on the Property of the Party of the First Part;
WHEREAS, pursuant to the Town's Watershed Protection and Stormwater Ordinances (hereinafter
referred to as "Stormwater Ordinances"), easements are needed for the benefit of the Party of the Second Part
for the construction, inspection, maintenance, repair, and operation of the SCMs located upon the Property of
the Party of the First Part;
NOW, THEREFORE, the said Party of the First Part for and in consideration of the sum of Ten Dollars
and other valuable considerations to them paid including the agreement contained herein, do hereby give, grant
and convey unto the Party of the Second Part, their successors and assigns, a perpetual right and easement for
the purpose of ingress and egress over the Property more particularly described as follows:
Easement not less than twenty feet (20') in width over that property as described in Deed Boob
, Page of the Forsyth County Registry and which description is
attached hereto.
TO HAVE and to hold said right and easement to them, the said Party of the Second Part, their
successors and assigns forever; it being agreed that the right and easement hereby granted is appurtenant to
and runs with the Property now owned by the Party of the First Part and hereinabove referred to and the Party
of the First Part is hereby bound, together with all heirs, executors, administrators, or successors, to warrant
and forever defend the easement granted herein unto the Party of the Second Part, its successors and assigns.
It is the intent of the Party of the First that the access easement herein granted from the public right of
way be confined to that area designated and intended for vehicular traffic to and from the SCMs to and from
(insert name of public street or highway), that being the public road that currently provides access to the
property, and further to provide an easement not less than twenty feet (20') in width surrounding the SCMs.
Notwithstanding the foregoing, all easements given herein shall be subject to the provisions of the Stormwater
Ordinances and shall allow the Party of the Second the access needed to perform its duties pursuant to the
Stormwater Ordinances. The Party of the First acknowledges that the Party of the Second shall have no
obligation to repair, replace or maintain any portion of the Property subject to the easement or to repair any
Watershed and Stormwater Administrative Manual 44 Revised 2020-02-01

damage occasioned by its exercise of this grant of easement. The Party of the First shall hold the Party of the
Second safe and harmless and shall indemnify the Party of the Second against any and all claims for damages
arising from this grant of easement or occurring on said easement.
This agreement between the parties shall be binding upon the heirs, assigns and successors of all
parties hereto.
IN TESTIMONY WHEREOF, the said Party of the First Part have hereunto set their hands and seals
the day first above written.
PARTY(IES) OF THE FIRST PART:
By: (SEAL)
(SEAL)
(SEAL)
(SEAL)
STATE OF NORTH CAROLINA
COUNTY OF.
I, , a Notary Public of County,
North Carolina, do hereby certify that (insert name of authorized signer) . the
(insert title) of (insert entity name) personally came
before me this day and acknowledged the execution and sealing of the foregoing instrument as
_(insert title) on behalf of and as the act of the company referred to in this
acknowledgement.
Witness my hand and notarial seal, this the day of , 20_
My Commission Expires:
Notary Public
Watershed and Stormwater Administrative Manual 45 Revised 2020-02-01

(or, if individual owner)
NORTH CAROLINA
FORSYTH
COUNTY
I, , a Notary Public in and for said County and State, do
hereby certify that personally appearedbefore me
this day and acknowledged the execution of the foregoing Deed of Easement.
Witness my hand and notarial seal, this the day of , 20_
My CommissionExpires:
Notary Public
Watershed and Stormwater Administrative Manual 46 Revised 2020-02-01

EXHIBIT A PROPERTY
DESCRIPTION
(PER DEED)
Watershed and Stormwater Administrative Manual 47 Revised 2020-02-01

APPENDIX 10. a
Operation and Maintenance Plan:
"Name of the Pond or development": Wet Detention Pond
Dam Safety
Preserving the structural integrity of the wet detention pond's dam is important in protecting
downstream life and property. There are at least four aspects of the dam that require specific
attention: (1) assessment ofhazard potential due to changes in downstream development; (2)
leakage and seepage, (3) dam material problems; and (4) vegetation growth on the dam
embankments.
Assessment of Hazard Potential
Before any dam is constructed, the design engineer is responsible for notifying the NC State
Dam Safety Office of the proposed dam. If the dam falls under State Dam Safety jurisdiction,
the dam must be constructed, maintained, and operated according to their design and
construction guidelines. Even if the dam does not fall under the NC Dam Safety Office's
jurisdiction, the dam should be designed and constructed in accordance with current proper
engineering practices. The City has requirements concerning the maintenance of dams
associated with required wet detention ponds. As new development occurs downstream of the
pond, the chance of significant property damage or danger to human life may increase if
catastrophic failure of the dam occurs. Although the dam may be initially exempt from
regulation by the State, the owner is responsible for reporting to the State Dam Safety Office
downstream development that may affect the hazard classification of the dam.
Leakage and Seepage
The downstream side of the dam should be inspected regularly for evidence of significant
leakage or seepage. Seepage can emerge anywhere below the normal pool elevation, including
the downstream slope of earth dams, areas beyond the toe of the dam, and around the spillway or
pond outlet conduit. Indications of significant seepage include areas where the soil is saturated
or where there is a flowing "spring" or leak. If "sinkholes" in the dam embankment are noticed,
or if constant flowing water is noticed on the downstream side of the dam, then seepage has
become excessive and professional engineering advice should be sought immediately to avert a
major structural problem or a catastrophic failure of the dam.
Dam Material Problems
For earthen dams, pronounced cracks on the embankment surface indicate the first stages of
potential dam failure. Transverse cracks (running perpendicular to the embankment face)
generally indicating differential settlement of the dam, can provide pathways for excessive
seepage. Longitudinal cracks (running parallel to the embankment face) may be due to
inadequate compaction of the dam during construction or shrinkage of the clay (desiccation) in
the top of the embankment during prolonged dry conditions. These cracks may eventually lead
to slope failure, such as sliding or sloughing. For reinforced concrete dams, the concrete should
be checked for pronounced cracking, leakage from the joints, and displacement (noticeable
Watershed and Stormwater Administrative Manual 48 Revised 2020-02-01

leaning or bulging). Also, excessive seepage, leakage, or springs just downstream of the
concrete dam could be indicative of potential seepage -related "piping" problems under the dam.
If such problems or other structural problems are observed, professional engineering advice
should be sought.
Vegetative Growth
Trees and other woody vegetation are not permitted on the top, slopes, or embankments of
earthen dams. Large root systems from woody vegetation can weaken the dam structure and
provide seepage pathways. Thick vegetative cover can also provide a haven for burrowing
animals such as groundhogs and muskrats. These animals can create a network of burrows in the
dam embankments that can significantly weaken the dam, by creating seepage paths, which may
eventually lead to dam failure. Mowing of the dam embankments should occur, at a
minimum, once every 6 months to prevent woody vegetation from becoming established.
Pollution Prevention Activities
To assist the wet detention pond in improving the quality of stormwater runoff, every effort
should be made to reduce the pollutant load entering the pond system. The following onsite
efforts should be made to reduce pollutants from entering the pond:
• Outside trash dumpsters should be kept covered, and the area around the dumpster should be
kept neat and clean.
• Chemicals, petroleum products, and other pollution sources (such as machinery) should be
stored in a covered area away from possible stormwater contact. Spent chemicals are to be
properly disposed or recycled.
• Fertilizers and pesticides should be used conservatively on the property grounds. Excessive
amounts of these chemicals can be washed away with stormwater runoff, increasing the nutrient
load to the pond.
• Chemicals such as copper sulfate used to inhibit algal growth in the pond degrade water
quality. Since the pond's main function is to enhance water quality, these chemicals should not
be used. Rather, reducing the amount of fertilizer application and ensuring that the pond outlets
are properly functioning so the pool is flushed periodically will help to deter algal growth.
• Trash and vegetative floatables (grass clippings, leaves, limbs, etc.) should be cleaned from
the pond surface and surroundings periodically to promote a healthy, aesthetically pleasing
environment, and to prevent blockage of the pond outlets. Studies have shown that people are
less likely to litter ponds that are aesthetically pleasing and support wildlife.
Stabilization of Wet Detention Pond Drainage Area
The area draining to the wet detention pond should remain stabilized to prevent excessive
sediment from entering the pond. When bare soil is directly exposed to precipitation, the
sediment concentration in runoff is much higher than for soil that is covered and stabilized. A
stabilized area is covered by impervious surfaces (pavement, buildings), grass cover, landscaping
(mulch, pine straw), etc. It is in the best interest of the pond owner to reduce onsite sediment
runoff to the pond, as this will reduce the life span of the pond and result in the need for more
periodic, expensive dredging.
Embankments
If pond embankments are not kept well vegetated with grasses, erosion may occur. Erosion can
be repaired by filling the small channels and gullies with suitable soil, compacting, and seeding.
It may be necessary to install temporary erosion control (such as hay bales) along heavily eroded
areas to allow the repaired areas to stabilize. It is especially important to inspect for and
Watershed and Stormwater Administrative Manual 49 Revised 2020-02-01

immediately repair any erosion on the dam embankments.
Pipe Inlet and Outlet areas
Where erosion causes the undercutting of the downstream end of pipe, the undercut should be
stabilized immediately to prevent the end pipe section from "breaking" off. Eroded areas should
be filled with good compactable soil and covered with geotextile fabric and rip -rap.
Open Channel Flow
Eroded areas should be seeded/sodded and protected with temporary velocity dissipation (such as
excelsior matting, straw bales, etc.). If erosion continues, a more robust lining should be used.
Blockage of Outlets
Wet detention ponds are designed for the water to exit the pond through the low flow orifice(s),
the principal spillway, and the emergency spillway.
It is important to check all three outlets for blockage that would impair the pond's water quality
and hydraulic functionality.
Low Flow Orifice(s)
Unless an inverted orifice is used, some type of trash guard is to be maintained over the low flow
orifice(s) to prevent clogging. When the orifice becomes clogged the water level rises to the
principal spillway elevation and the benefits associated with temporary storage and its gradual
release are lost. To preserve "extended detention" the low flow orifice should be inspected for
blockage monthly, or after every runoff -producing rainfall event.
Principal and Emergency Spillway
Principal and emergency spillways are designed to safely convey one -inch rainfall events, and
those larger storms that produce runoff which exceed the water quality volume of the wet
detention pond. If these spillways are blocked so they do not operate at full capacity, the risk of
dam overtopping or other uncontrolled releases may result. To ensure the hydraulic capacity of
the spillways, the spillways should be inspected for blockage monthly, or after every
runoffproducing rainfall event.
If a riser/barrel is used for the principal spillway, a trash rack is to be maintained on the riser.
Vegetative growth in the riser should be removed promptly so that the design capacity of the
spillway is maintained. The emergency spillway and outlet area where the barrel projects from
the fill slope should be clear of woody vegetation, tree limbs, sediment accumulation, etc.
Sediment Accumulation
To preserve the wet detention pond's pollutant removal capability, sediment must be removed in
areas where the capacity of the design sediment storage volume has been exceeded. The pond
forebay helps to improve the removal efficiency of the pond system by trapping the majority of
coarser suspended solids behind a rock baffle. When sediment deposition in the forebay exceeds
the designed sediment storage capacity for the forebay, the forebay must be dredged. Typically,
forebays will need to be dredged every 5 to 10 years. Depth measurements relative to the normal
surface elevation (bottom of water quality orifice) should be taken at several locations around the
pond. The sediment is to be removed when the measured depth is less than the design permanent
water depth. Most wet detention ponds are designed for a three to four foot permanent water
depth. As sediment accumulates in the pond, the permanent water depth is reduced along with
the pond's ability to treat pollutants in the runoff. If a forebay is used at the inlet area of the pond
Watershed and Stormwater Administrative Manual 50 Revised 2020-02-01

and is regularly dredged, the frequency of dredging the entire pond could be greatly reduced.
Check water depth at various points in the pond semi-annually. If depth is reduced to 75 % of
the original design depth, sediment must be removed to at least the original design depth.
Sediment from most sources is usually not hazardous or contaminated, however, it is very
"soupy" and is difficult to manage. It is good idea to provide a storage area near the wet
detention pond to place sediment once it is dredged to allow it to dry. If desired, sediment may
be land applied and seeded, while following all pertinent soil and erosion control regulations. If
land applied on -site, it should be within the drainage area to the pond so sediment that runs off
can be recaptured.
Wet Detention Pond Maintenance
Routine Maintenance
Routine maintenance shall include minor upkeep such as mowing; trash and debris removal;
minor slope repair and stabilization; periodic structural inspections of the valves, gates, dam,
etc.; and tree and brush removal from the dam, spillway, inlet(s), and outlet. These maintenance
items may be performed by the owner without review of a Professional Engineer.
Non -Routine Maintenance
Non -routine maintenance shall include such items as sediment clean -out (dredging); channel
stabilization; and problems regarding the principal spillway conduits, emergency spillway, dam
failure, and seepage. These items require a Registered Professional Engineer to prepare a plan
and/or details and to certify completion of the maintenance. All revisions and repairs to
permanent runoff control structures shall be done in accordance with Town of Kernersville
guidelines and specifications.
Maintenance Schedule: (estimated schedule - certain ponds may require more or less frequent
Attention).
L Monthly, or after every runoff -producing rainfall event.
A. Remove trash and debris from the trash rack.
B. Check and clear the orifice of any obstructions.
C. Check the pond side slopes for erosion and remove trash from around the pond.
D. Inspect principal and emergency spillways for blockage.
IL Quarterly, or after major storm events (more than 2 inches of rain).
A. Inspect the collection system (e.g. catch basins, piping, grassed swales) for proper
functioning. Clear accumulated trash from basin grates and basin bottoms, and check
piping for obstructions.
B. Check pond inlet pipes for undercutting, replace rip -rap that is choked with sediment,
and repair broken pipes.
C. Check the operation of the gate valve. All valves should be operated from the fully
closed to the fully open position.
D. Remove woody vegetation (trees and brush) from dam embankment surfaces and
spillway(s).
III. Semi -Annually
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A. Remove accumulated sediment from the bottom of the outlet structure.
B. Check for presence of rip -rap at inlet pipes and replace if necessary.
C. Check pond depth at various points in the pond. If mean depth is reduced to 75 % of
the original design depth, sediment will be removed to at least the original design depth.
D. Check riser and barrel for improper alignment, elongation and displacement of joints,
cracks, leaks, loss of protective coating, corrosion, and blockage - repair as necessary.
IV. General
A. Mow side slopes according to the season. Maximum grass height should be nine (9)
inches.
B. Riparian and aquatic vegetation (willows, alders, cattails, etc.) are encouraged along
the perimeter of the pond at the water's edge. However, the dam, emergency spillway,
inlet(s), and water control structure should be kept clear of all woody vegetation.
C. In case the ownership of the pond should change, the current owner should, within
thirty (30) days of transfer of ownership, notify the Town of Kernersville, Stormwater
Division of such ownership transfer.
D. Excessive plant growth, algae blooms, odors, discoloration, perceived animal pests,
etc. should be addressed with the Stormwater Division on an as -needed basis.
Solutions to these problems should be non -chemical and deemed safe to our drinking
water supply.
Any and all amendments to this Operation and Maintenance Plan shall first be submitted to and
approved by Town of Kernersville Stormwater Division.
Watershed and Stormwater Administrative Manual 52 Revised 2020-02-01

Town of Kernersville Wet Pond Inspection Form
Report Date: Inspection Date:
SCM Name/Location:
PASS 0 FAIL 0
Note: Items included in this inspection checklist are not an exhaustive list for any particular facility. As each facility is
different, the Town looks to the professional inspecting the facility to perform a comprehensive inspection prior to
certification.
Code Key:
MN = Maintenance Needed M = Monitor (potential for future problem)
OK = No Maintenance Needed NA = Not Applicable
Assessment I Code I Comments
SCM and Easement Area
Trash or debris present
Inflow & Inlet(s)
Obstruction: vegetation/debris/sediment
Erosion or undercutting
Displacement of fabric, rip -rap, aprons, etc.
Pipe condition: clogged, damaged
Other (describe)
Forebay(s)
Sediment (>50%)/debris accumulation
Side slope erosion or bare soil
Invasive vegetation
Other (describe)
Main Pool & Vegetative Shelf
Sediment and debris accumulation
Bare soils or erosive gullies
Visible pollution or high turbidity
Plants are dead, diseased or dying
Vegetation height and density
Invasive vegetation*
Temporary pool drained (< 5 days after storm)
Other (describe)
* Invasive vegetation should be no more than 50% of the water surface area. Approval from Stormwater Division is required before
any chemical application.
Watershed and Stormwater Administrative Manual 53 Revised 2020-02-01

Code Key
MN = Maintenance Needed M = Monitor (potential for future problem)
OK = No Maintenance Needed NA = Not Applicable
Assessment I Code I Comments
Embankment*
Bare soil, erosion, loss of dam material
Side slopes maintained (correct height, ground
cover)
Shrubs or trees present*
Animal burrows
Slope stability (cracks, sliding, soft or boggy)
Emergency spillway
Invasive vegetation
Other (describe)
* The Town of Kernersville recommends that a dam specialist be consulted about established trees (6" diameter, 5' height) growing
on the dam. The Town of Kernersville accepts no liability in the event of the stormwater SCM failure. Approval from the Stormwater
Division is required before any chemical application.
Outlet Device
Obstruction of pipe, trash rack & drawdown
devise - vegetation, debris, sediment
Erosion or undercutting
Structural condition
Pipe condition
Orifice condition
High -flow bypass
Other (describe)
Note: The Town of Kernersville recommends that the pond maintenance & emergency drains be exercised twice per year to prevent
seizing.
Miscellaneous
Fence condition
Signage
Access
Vandalism
Fish or wildlife observations
Public hazards
Other (describe)
Other (describe)
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Photo 1: Overall View
Photo 2:
Photo 3:
Photo 4:
Actions Needed:
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Photo 5:
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Photo 8:
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Additional Comments:
Inspector
Inspector Signature
C
Date
Certification
(Only completed when SCM is fully functional and has no outstanding repair or maintenance issues)
as a duly registered Professional in the State of North Carolina, hereby attest that I conducted a thorough
inspection and that the stormwater control measure is fully functioning and operating as designed and
intended.
(Seal)
Watershed and Stormwater Administrative Manual 57 Revised 2020-02-01

ANNUAL WET POND INSPECTION CHECKLIST
Date:
Time:
(Project Name): Wet Retention Pond # ,
Kernersville, NC
ANNUAL BUDGET AND REPLACEMENT FUND
Item
Yearly Cost
Budget
Actual
Mowing
Seeding
Fertilizer/Lime
Embankment Repair
Trash Removal
Sediment Removal
Outlet Structure Maintenance
includes Rip Rap)
Pest Control
Deposit in Capital Reserve Fund
Inspector Fee
Total Annual Budget
Date:
Bank:
Report Prepared By:
Capital Reserve Fund
Balance in Capital Reserve Fund:
Deposit in
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IN WITNESS WHEREOF, the Grantor has hereunto set their hands and seals,
this the day and year first above written.
Grantor:
(Seal)
"Development Name" Owners Association
By:
(Seal)
North Carolina, _ County
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for
the purpose stated therein and the capacity indicated:
Date: , 2014. Place notary seal
below this line:
Notary Public
Print/Type Name:
My Commission Expires:
North Carolina, _ County
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for
the purpose stated therein and the capacity indicated: ( ), President of
"'Owner Association or private owner of BMP"
Date: , 2014. Place notary seal
below this line:
Notary Public
Print/Type Name:
My Commission Expires:
Watershed and Stormwater Administrative Manual 59 Revised 2020-02-01

APPENDIX 10. b
(Name of the Bio-Cell) BIORETENTION AREA
OPERATION AND MAINTENANCE PLAN
The goals of this O&M Plan for a BMP structure is to specify all operation and
maintenance work necessary for the storm water control structure(s) and to provide
guidance to the current and any subsequent property owner on the requirements for
BMP inspection and maintenance. Also provide an estimation of the Annual Budget and
Replacement Fund necessary for the annual operation, inspection and maintenance
activities for the BMP.
Effective long-term operation of infiltration practices requires a dedicated and routine
maintenance inspection schedule with clear guidelines and schedules, as shown later
in this Plan. Where possible, facility maintenance should be integrated into routine
landscaping maintenance tasks.
The filter media and surface cover are the two most important elements of a
Bioretention facility in terms of long-term performance.
Common Maintenance Issues
Bioretention facilities require plant, soil, mulch, and under -drain maintenance to ensure
optimal infiltration, storage, and pollutant removal capabilities. Bioretention
maintenance requirements are typical landscape care procedures and include:
1. Watering: Plants should be selected to be tolerant of the bioretention facility's
particular conditions. Watering should not be required after establishment
(about 2 to 3 years). However, watering may be required during prolonged dry
periods after plants are established.
2. Erosion Control: Inspect flow entrances, ponding area, and surface overflow areas
periodically. Replace soil, plant material, and/or mulch in areas where erosion
has occurred. Erosion problems should not occur with proper design except
during extreme weather events. If erosion problems do occur, the following
issues should be re -assessed: flow volumes from the contributing drainage area
and bioretention size; flow velocities and gradients within the bioretention
facility; flow dissipation and erosion protection methods in the pretreatment and in -flow
areas. If sediment is deposited in the bioretention facility, immediately
determine the source, remove excess deposits, and correct the problem.
3. Plant Material: Depending on plants selected and aesthetic requirements,
occasional pruning and removal of dead plant material may be necessary.
Watershed and Stormwater Administrative Manual 60 Revised 2020-02-01

Replace all dead plants. However, if specific plants consistently have a high
mortality rate, assess the cause and replace with appropriate species. Periodic
weeding is necessary until groundcover plants are established. Weeding should
become less frequent if an appropriate plant density has been used.
4. Nutrients and Pesticides: The soil media and plant material should have been
selected for optimum fertility, plant establishment, and growth within the
particular conditions of each bioretention facility. Nutrient and pesticide inputs
should NOT be required and will degrade the pollutant processing capability of
the bioretention facility, as well as contribute to additional pollutant loading to
receiving waters. By design, bioretention facililities are typically specified in
watersheds where phosphorous and nitrogen levels are often elevated.
Therefore, these should not be limiting nutrients with regard to plant health. If
in question, have the soil analyzed for fertility.
5. Mulch: Bioretention areas should be mulched once the planting of trees and shrubs
has occurred. Replace mulch annually in Bioretention facilities where heavy metal
deposition is likely (e.g., drainage areas that include commercial/industrial uses,
parking lots, or roads). In residential or other settings where metal deposition is
not a concern, replace or add mulch as needed to maintain a 2 to 4 inch depth at
least once every two years.
6. Soil media: Soil mixes for bioretention facilities are design to maintain long-term
fertility and pollutant processing capability. Estimates from metal attenuation
research indicates that metal accumulation should not present a toxicity concern
for at least 20 years in bioretention facilities (USEPA 2000). Further, replacing
mulch where heavy metal deposition is likely provides an additional factor of
safety for prolonged bioretention performance. If in question, have soil analyzed
for fertility and pollutant levels.
With soil testing the accumulation of toxins and heavy metals can be detected or
prevented. Over a period of time, heavy metals and other toxic substances will tend to
accumulate in the soil and the plants. Data from other environs such as forest buffers
and grass swales suggest accumulation of toxins and heavy metals within five years of
installation. However, there is no methodology to estimate the level of toxic materials in
the bioretention areas since runoff, soil, and plant characteristics will vary from site to
site.
As the toxic substances accumulate, the plant biologic functions may become impaired,
and the plant may experience dwarfed growth followed by mortality. The biota within the
soil can also become void and the natural soil chemistry may be altered. The
preventative measures would include the removal of the contaminated soil. In some
cases, removal and disposal of the entire soil base as well as the plant material may be
required.
When the filtering capacity diminishes substantially (e.g., when water ponds on the
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surface for more than 12 hours), remedial actions must be taken. One possible problem
is that underdrain pipe systems can become clogged. Annual flushing through pipe
cleanouts is recommended to facilitate unclogging of the pipes without disturbing the
bioretention areas. If the water still ponds for more than 12 hours, the top few inches of
material should be removed and replaced with fresh material. The removed sediments
should be disposed of in an acceptable manner (e.g., landfill). If that does not solve the
problem, more extensive rebuilding is required.
Examples of When to Perform Maintenance
• Replace gravel when it has become clogged with sediment.
• Remove top layer of fill media when the pool does not drain quickly. The pool is
normally designed to drain within 12 hours.
Sample Operation and Maintenance Provisions
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, 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 will be kept in a known set location and
will be available upon request.
Ongoing monitoring and maintenance is vital to the overall success of bioretention
areas. Annual maintenance will be required for plant material, mulch layer, and soil
layer. Inspection activities shall be performed as follows. Any problems that are found
shall be repaired immediately.
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Table Sample Operation and Maintenance Provisions for Bioretention Areas
NCDENR Stormwater BMP Manual
Reference from: N.C. Division of Water Quality BMP Manual
BMP element:
Potentialproblems:
How to remediate the problem
The entire BMP
Trash/ debris is present.
Remove the trash/ debris.
The perimeter of the
Areas of bare soil and / or
Regrade soil if necessary to remove the gully,
bioretention cell
erosive gullies have formed.
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 sediment off -
stone verge or swale
applicable).
Site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable)
Erosion is occurring in the
Regrade the swale if necessary to smooth it over
swale (if applicable).
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 stone and replace
covered in sediment (if
with clean stone.
applicable)
The pretreatment area
Flow is bypassing
Regrade if necessary to route all flow to the
pretreatment area and / or
pretreatment area. Restabilize the area after
gullies have formed.
grading.
Sediment has accumulated to a
Search for the source of the sediment and
depth greater than three
remedy the problem if possible. Remove the
inches.
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 practices.
vegetation
show that pruning is needed to
maintain optimal plant health.
Plants are dead, diseased or
Determine the source of the problem: soils,
dying.
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. If sod was used,
check to see that it was not grown on clay or
impermeable soils. Replace sod if necessary.
Tree stakes/wires are present
Remove tree stake/wires (which can kill the tree
six months after planting
if not removed).
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Table continued
Sample Operation and Maintenance Provisions for Bioretention Areas
Reference from: N. C Division of Water Quality BMP Manual
BMP element:
Potentialproblems:
How to remediate the problem
The bioretention cell: soils
Mulch is breaking down or has
Spot mulch if there are only random void areas.
and mulch
floated away.
Replace whole mulch layer if necessary. Remove
the remaining mulch 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 — remove
clogged with sediment.
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 lime shall be applied as recommended
pH has dropped or heavy
per the soil test and toxic soils shall be removed,
metals have accumulated in
disposed of properly and replaced with new
the soil media.
planting media.
The underdrain system (if
Clogging has occurred.
Wash out the underdrain system.
applicable)
The drop inlet
Clogging has occurred.
Clean out the drop inlet. Dispose of the
sediment off -site.
The drop inlet is damaged.
Repair or replace the drop inlet.
The receiving water
Erosion or other signs of
Contact the NC Division of Water Quality 401
damage have occurred at the
Oversight Unit at 919-733-1786.
outlet.
Watershed and Stormwater Administrative Manual 64 Revised 2020-02-01

Town of Kernersville Bioretention Inspection Form
Report Date: Inspection Date:
SCM Name/Location
PASS 0 FAIL 0
Note: Items included in this inspection checklist are not an exhaustive list for any particular facility. As each facility is
different, the Town looks to the professional inspecting the facility to perform a comprehensive inspection prior to
certification.
Code Key
MN = Maintenance Needed M = Monitor (potential for future problem)
OK = No Maintenance Needed NA = Not Applicable
Assessment I Code I Comments
SCM and Easement Area
Trash or debris present
Perimeter
Bare soil or erosion on side slopes
Sediment or debris accumulation
Side slope vegetation maintained
Invasive vegetation
Other (describe)
Inflow & Inlet(s)
Obstruction: vegetation/debris/sediment
Erosion or undercutting
Dissipators: Rip -rap, fabric, etc.
Structural condition: Pipes, weirs, etc.
Other (describe)
Pretreatment Area(s)
Sediment or debris accumulation
Bare soils or erosion
Flow bypassing pretreatment
Invasive vegetation
Other (describe)
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Code Key:
MN = Maintenance Needed M = Monitor (potential for future problem)
OK = No Maintenance Needed NA = Not Applicable
Assessment I Code I Comments
Bioretention Cell
Overgrown or invasive vegetation
Vegetative health (diseased, dead, dying, etc.)
Mulch is decomposed or displaced
Soils or mulch clogged with sediment
Ponding depth (indicate design and existing
depths in comments)
Ponding duration (ponding > 12 hours)
Underdrain system
Bare soil or erosion on side slopes or in
grassed cell
Other (describe)
Outlet Device
Obstruction: vegetation/debris/sediment
Erosion or undercutting
Structural condition (riser, pipes, dissipator)
High -flow bypass
Other (describe)
Miscellaneous
Fence condition
Signage
Access
Vandalism
Other (describe)
Other (describe)
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Photo 1: Overall View
Photo 2:
Photo 3:
Photo 4:
Actions Needed:
Watershed and Stormwater Administrative Manual 67 Revised 2020-02-01

Photo 5:
Photo 6:
Photo 7:
Photo 8:
Actions Needed:
Watershed and Stormwater Administrative Manual 68 Revised 2020-02-01

Additional Comments:
Inspector
Inspector Signature
Date
Certification
(Only completed when SCM is fully functional and has no outstanding repair or maintenance issues)
as a duly registered Professional in the State of North Carolina, hereby attest that I conducted a thorough
inspection and that the stormwater control measure is fully functioning and operating as designed and
intended.
(Seal)
Watershed and Stormwater Administrative Manual 69 Revised 2020-02-01

NAME OF BIO-CELL
Date:
Time:
(Project Name):
Kernersville, NC
Bio-retention Area #
ANNUAL BUDGET AND REPLACEMENT FUND
Item
Yearly
Cost
Budget
Actual
Mowing and/or pruning
Seeding
Fertilizer/Lime
Replacement of plants
Trash Removal
Sediment Removal
Inlet Structure Maintenance
Stone verge, pipes and/or Rip Rap)
Media soil replacement
Outlet Structure Maintenance
overflow structure and/or Rip Rap)
Pest Control
Deposit in Capital Reserve Fund
Inspector Fee
Other cost
Total Annual Budget
Date:
Bank:
Report Prepared By:
Capital Reserve Fund
Balance in Capital Reserve Fund:
Deposit in
Watershed and Stormwater Administrative Manual 70 Revised 2020-02-01

IN WITNESS WHEREOF, the Grantor has hereunto set their hands and seals,
this the day and year first above written.
Grantor:
By:
(Seal)
Name of Owner or Owners Association
(Seal)
North Carolina, County
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for
the purpose stated therein and the capacity indicated:
Date: _ , 2014. Place notary seal
below this line:
Notary Public
Print/Type Name:
My Commission Expires:
North Carolina, _ County
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for
the purpose stated therein and the capacity indicated: ( ), President of
..
0101
Date: , 2014. Place notary seal
below this line:
Notary Public
Print/Type Name:
My Commission Expires:
Watershed and Stormwater Administrative Manual 71 Revised 2020-02-01

APPENDIX 11
MAINTENANCE ESCROW AGREEMENT
For [Insert SCMnames and Development Name)
Account #
THIS AGREEMENT made pursuant to Town of Kernersville Watershed Protection and Stormwater
Ordinances, and entered into this day of , 20 , by and between The TOWN OF
KERNERSVILLE, a North Carolina municipal corporation, party of the first part (hereinafter referred to as "Town";
and fInsert Name ofDeveloperl (hereinafter
referred to as "Developer"), and [Insert Homeowners or Associationnamel
(hereinafter referred to as the "Association") parties of the second part, hereby employ [Insert Name of the Escrow
Officer of [Insert Name of the Bank], as Escrow Agent party of the third part (hereinafter referred to as "Escrow
Agent"), with its principal place of business at [Insert Full Address of Escrow Officer office], and in connection with
the Stormwater Control Measures of [Insert Name of the Development or project] project at [Insert Full Address of
Proiect or Development] .
WITNESSETH:
WHEREAS, the Town's Watershed Protection and Stormwater Ordinances (hereinafter referred to as
"Stormwater Ordinances"), requires the establishment of an escrow account to ensure that adequate funds are available
to provide for the long-term maintenance, and/or replacement/reconstruction of the Stormwater Control Measures
(hereinafter referred to as "SCMs") (maintenance activities include, but are not limited to, sediment removal and
structural, biological or vegetative replacement, repairs, or reconstruction).
WHEREAS, the Stormwater Ordinances, requires both an initial payment by the Developer and either annual
sinking fund payments by the Association (if it has taken ownership of the SCMs) or by the Developer (if it still retains
ownership of the SCMs) to fund the escrow account.
WHEREAS, the Stormwater Ordinances requires the Developer to pay into the escrow account an initial
payment equal to fifteen percent (15%) of the initial construction cost of the SCMs prior to plat recordation or issuance
of construction permits, whichever occurs first.
Watershed and Stormwater Administrative Manual 72 Revised 2020-02-01

WHEREAS, the Stormwater Ordinances requires the Association (if it has taken ownership of the SCMS) or
the Developer (if it still retains ownership of the SCMS) to pay into the escrow account the total amount of sinking
fund budget (corresponding to eighty-five percent (85%) of the initial construction cost of the SCMS according to the
following schedule: two-thirds (2/3) of the amount shall be deposited into the escrow account within the first five (5)
years and the full amount shall be deposited within ten (10) years following initial construction of the SCMS.
WHEREAS, the Developer is developing a [Insert type of Project] known as [Insert Name of the Project], to
be maintained by a home owners association, a property owners association or similar entity, and desires to provide
the Town a financial guarantee to assure that adequate funds are available to provide for the long-term maintenance,
and/or replacement/reconstruction of the SCMS at [Insert Name of the Project] and has established an Escrow Account
for such purpose.
WHEREAS, the parties have agreed that the Escrow Agent is acceptable to all parties to act in such capacity;
NOW, THEREFORE, in consideration of the foregoing premises, it is hereby agreed:
The Developer has deposited in escrow the sum of
dollars ($ ) with the Escrow Agent, to guarantee that adequate funds are available to provide
for the long-term maintenance and/or replacement/reconstruction of the SCMS as required by the Stormwater
Ordinances and in accordance with approved construction plans and specifications.
2. The Association (if it has taken ownership of the SCMS) or Developer (if it still retains ownership of the
SCMS) shall pay the sum of dollars ($ ) to the Escrow Agent within ten
(10) years following initial construction of the SCMS (funds shall be deposited each year into the escrow account) to
guarantee that adequate funds are available to provide for the long-term maintenance and/or replacement/reconstruction
of the SCMS as required by the Stormwater Ordinances and in accordance with approved construction plans and
specifications.
3. The Escrow Agent agrees to hold said funds and to pay out said funds only upon receipt of "Proper
Authorization" as hereinafter defined. "Proper Authorization" shall mean authority in written form from the Town
stating that a disbursement is authorized either:
(a) To the Association, or to any party designated in writing by the Association, upon delivery of "Proper
Authorization" from the Town authorizing such payment. The Town, through the Town's Stormwater Division, shall
issue such "Proper Authorization" upon approval of the expenditure.
(b) To the Town upon delivery of a "Proper Authorization" from the Town's Stormwater Division, upon its
determination that the SCMS are not performing adequately or as intended or are not properly maintained in accordance
with the Stormwater Ordinances and the Town has determined that pursuant to the Stormwater Ordinances it must
perform any such uncompleted maintenance and/or replacement/reconstruction activities and use the escrow funds on
deposit with the Escrow Agent for such purposes.
Watershed and Stormwater Administrative Manual 73 Revised 2020-02-01

4. The Developer or the Association, whichever is responsible, agrees to comply with the requirement of the
Stormwater Ordinances that any funds drawn down from the escrow account shall be replaced in accordance with the
schedule of anticipated work used to create the sinking fund budget.
5. The Escrow Agent hereby acknowledges that it will hold the funds referred to in Items 1 and 2 above and
represents that it has no obligation whatsoever to any of the parties hereto except to release said funds within ten (10)
calendar days upon delivery of "Proper Authorization" from the Town, and the Developer or Association does hereby
release and hold the Escrow Agent harmless from any and all claims whatsoever by it against the Escrow Agent for
releasing such funds to the Town in accordance with the terms of this Agreement.
6. In the event that this escrow agreement should fail for any reason to cover the costs of maintenance or
repair, including any deficiency as to form or execution, then Developer and the Association, and their successors,
transferees, or assigns, acknowledge that whichever party is deemed responsible by the Town is subject to being
charged for the costs of such maintenance and/or replacement/reconstruction; and such costs shall be enforced in the
nature of a debt as provided by the applicable Ordinances and State laws.
IN WITNESS WHEREOF, the parties have hereto set their hands and seals, this day of
20
{SIGNATURES APPEAR ON THE FOLLOWING PAGES{
Watershed and Stormwater Administrative Manual 74 Revised 2020-02-01

PARTY OF THE FIRST PART:
U 11VATWE110:4 91 1"VILM441T 1m
By:
Dawn H. Morgan, Mayor
ATTESTED TO:
Keith Hooker, Town Clerk
STATE OF NORTH CAROLINA
COUNTY OF
I, , a Notary Public of Forsyth County, North Carolina, do hereby certify
that personally came before me this day and acknowledged that she is the
Town Clerk of the Town of Kernersville, a North Carolina municipal corporation, and that by authority duly given as
the act of the Town of Kernersville, the foregoing instrument was signed in its name by its Mayor, sealed with its
corporate seal and attested by her as its Town Clerk.
Witness my hand and official seal, this the day of 120
Notary
Print/Type Name:
My Commission Expires:
(SEAL)
Watershed and Stormwater Administrative Manual 75 Revised 2020-02-01

STATE OF NORTH CAROLINA )
COUNTY OF )
PARTY OF THE SECOND PART:
DEVELOPER:
By: (SEAL)
Name:
Its: (Title)
DEVELOPER
ACKNOWLEDGEMENT
I, , a Notary Public of County, North
Carolina, do hereby certify that , the of
personally came before me this day and acknowledged the execution and
sealing of the foregoing instrument as on behalf of and as the act of
the company referred to in this acknowledgment.
Witness my hand and notarial seal, this the day of
Notary
Print/Type Name:
My Commission Expires:
(SEAL)
20
Watershed and Stormwater Administrative Manual 76 Revised 2020-02-01

STATE OF NORTH CAROLINA )
COUNTY OF )
PARTY OF THE SECOND PART:
ASSOCIATION:
By: (SEAL)
Name:
Its: (Title)
ASSOCIATION
ACKNOWLEDGEMENT
I, , a Notary Public of County, North
Carolina, do hereby certify that , the
of personally came before
me this day and acknowledged the execution and sealing of the foregoing instrument as
on behalf of and as the act of the company referred to in this
acknowledgment.
Witness my hand and notarial seal, this the
Notary Public
Print/Type Name:
My Commission Expires:
(SEAL)
day of
20
Watershed and Stormwater Administrative Manual 77 Revised 2020-02-01

PARTY OF THE THIRD PART:
NAME OF BANK:
ESCROW AGENT:
By:
Name:
Its:
STATE OF NORTH CAROLINA )
COUNTY OF )
(Title)
ESCROW AGENT
ACKNOWLEDGEMENT
I, , a Notary Public of County, North
Carolina, do hereby certify that , the
of personally came before
me this day and acknowledged the execution and sealing of the foregoing instrument as
on behalf of and as the act of the company referred to in this
acknowledgment.
Witness my hand and notarial seal, this the
Notary Public
Print/Type Name:
My Commission Expires:
(SEAL)
day of 120
Watershed and Stormwater Administrative Manual 78 Revised 2020-02-01

APPENDIX 12
Stormwater/Watershed Permit Process
WATERSHED/STORM WATER MANAGEMENT PERMIT APPLICATION PROCESS
Obtain 000roval of "Stormwater Management Svstem Conceot Plan"
See Appendix 02 "Stormwater Management System
Conceot Plan Review Submittal".
Does the project comply with the Development Standards for the Low Density
Option in accordance with the Town of Kernersville regulations?
NO
A High Density Watershed/Stormwater
Permit is required for a project exceeding
the requirements of the Low Density option.
See Appendix 03
"Watershed /S torm w o ter
Permit Application Forms"
and Appendices 04—a and
04—b "Stormwater Design
Construction Plans
Submittal Checklist" and
"High Density
Wo tersh ed /Storm wo ter
Permit Submittal Checklist"
The project is required to
implement Engineered Stormwat
Control devices (BMPs) to treat
Stormwater runoff.
Submit the following items to the Watershed
Administrator or Designee for review:
—High Density Watershed/Stormwater Application
with corresponding Watershed—Stormwater Fees
—Stormwater Design Construction Plans (including
design of BMPs)
—Draft of the 0&M Agreement for the BMPs
—Draft of the 0&M Plan for the BMPs
—Contractor's estimated cost for construction of BMP(s)
—Draft of Deed of Easement document
—Any additional applicable documentation required for
the project.
ee Appendices 08 "BMPs 0&M Agreement
odels", 09 "Deed of Easement Model", and
ppendix 10 "O&M Plan Models"
YES
Submit Stormwater Design Construction
Plans, any additional applicable
documentation, and Low Density
Watershed/Stormwater Application with
corresponding Watershed/Stormwater
Permit Fees for review by Watershed
Administrator or Designee.
See Appendix 03
"Watershed /Stormwater
Permit Appication
Forms" and Appendix
04—a "Stormwater
Design Construction
Plans Submittal
Checklist"
N i
c
O
N
y N
a N
� U
N N
c
Review of Stormwater Design Construction
m
Plans, Watershed/Stormwater Application
_n
N •a T
and any additional required documentation
W 5 o
by Watershed Administrator or Designee.
of E
Will the BMPs structures be owned and
NO
N T maintained by a homeowner's assoclar iation,
c o property
O N
owners' association, or simientity?
:� ut
o °
L U
N N
YES
u v
Submit a copy of the draft document
m .�
for Association Covenants, Conditions and
See Appendix 11
w 5 0
Restrictions and a copy of the draft
"Maintenance
:2 E
document for the Maintenance Escrow
Escrow Agreement
Agreement for review by the Watershed
Model"
Administrator or designee.
Review of Stormwater Design Construction Plans,
Watershed/Stormwater Application and any additional required
submitted documentation by Watershed Administrator or
Designee and the Watershed Review Committee.
Disapproved
Approved
Disapproved
Review Comments
issued to developer or
designer based on
Watershed
Administrator or
Designee reviews.
Review Comments
Submit a performance surety for BMPs, recorded
issued to developer
Operation and Maintenance Agreement, recorded Deed
See Appendix
or designer based
of Easement and signed and notarized Operation and
05 "Guidelines
on Watershed
Maintenance Plan. Also, submit recorded Association
for Surety
Administrator or
Covenants, Conditions and Restrictions and recorded
Posting"
Designee reviews.
Maintenance Escrow Agreement if applicable.
Watershed/Stormwater permit issued.
Construction may proceed. (see Appendix 13
"Stormwater Management Construction and Construction
Inspection Process"). Watershed/Stormwater permit is
REV. APR/L 2014
valid for twelve (12) months.
Watershed and Stmrawater Administrative
Manual 79
Approved
Watershed/Stormwater
permit issued.
Construction may
proceed. (see Appendix
13 Stormwater
Management
Construction and
Construction Inspection
Process).
Revised 2020-02-01

APPENDIX 13
APPENDIX 13
STORMWATER MANAGEMENT CONSTRUCTION AND CONSTRUCTION INSPECTION PROCESS
Obtain "Watershed/Stormwater Permit".
itenance activities to
ite the BMP(s), the
w/or developer can
est re —inspection of
BMP(s).
Manaqement Permit Application Process.
Construct project per
to constructing field changes.
Construction Phase
Town staff may conduct periodic construction inspections,
owner and/or contractor responsible for inspection and
maintenance of E&SC measures and BMPs.
tenance
ments issued to NO
w or developer
d on
mwater Division
inspection of
BMP(s).
the project require the construction of Engineered NO As determined by the Watershec
water Control devices (BMPs) to treat Stormwater runoff? Administrator As —Built Drawings
YES may be required.
Engineered stormwater control devices
(BMPs) construction complete.
Design professional submits to the Watershed
Administrator for review and approval "As built plans"
for BMPs and "Engineer's Certificate of Stormwater
Control Completion" for each BMP.
Approoved
1
owner may request release of fifty
gent (507) of the performance surety to
Town's Engineering Division.
Stormwater Division staff shall perform
inspection of the BMP(s).
the BMP(s) constructed and
ied as required by the Town of
Mlle Watershed/Stormwater Ordinances?
Denied
eloper or designer based
Watershed Administrator
Designee reviews.
The Stormwater Administrator shall release fifty
percent (507) of the performance surety.
No sooner than one year after the
completion of the BMP(s), the owner may
request release of the remaining fifty
percent (507) of the performance surety to
the Town of Kernersville Engineering Division.
I the Stormwater Division staff shall pertorm
Ian inspection of the BMP(s).
After the repair
and/or epair and/or
maintenance activities to
aintenance comments
Lissued to owner of
NO s (are) the BMP(s) maintained and performin
update the BMP(s), the
owner can request
rat--ias
MP(s) based on
required by the Town of Kernersville
atershed/Stormwater Ordinances?
re —inspection of the BMP(s).
tormwater Division staff
spection of the BMP(s).
fr
YES
e owner or person responsible for maintenance of the BMP(s) shall
The Stormwater Administrator
shall
bmit to the Stormwater Administrator an annual inspection report of
"Engineer's
— .release the remaining fifty percent
e BMP(s) beginning one year from the date of the
(507) of the performance surety.
.rtificate of Stormwater Control Completion" of the BMP(s).
R V. MAY M14
Watershed and Stormwater Administrative Manual 80 Revised 2020-02-01

APPENDIX 14
Town of Kernersville
P.O. Box 728
Kernersville, NC 27285-0728
r
TOWN OF KERNERSVILLE
yew ,
ryC�RPORATC9 lg
134 East Mountain Street
Telephone [phone]
Fax [phone]
ENGINEER'S CERTIFICATE OF STORMWATER CONTROL COMPLETION
I , certify that, pursuant to generally accepted
engineering standards in the community, it is my professional opinion that the storm water
control structure(s) labeled as and located on this plat (or
on name of plat ) as recorded in PB ,PG in the Office of
County Register of Deeds has been completed in conformance with the approved
plans and specifications meeting all requirements of Kernersville Watershed Ordinance, has its
full design volume available, and is functioning as designed.
Witness my hand and seal this day of , 20
Engineer or Landscape Architect
Notice: This property is located in a Watershed WS------ public Water Supply Watershed.
Development restrictions apply. This property is subject to restrictive covenants and contractual
lien requiring maintenance and annual inspection of a storm water control structure.
Watershed and Stormwater Administrative Manual 81 Revised 2020-02-01

e to
Belews Creek%,,i'
150
Kerner66
sville;Lake;CA
' 6eaJei
Martin Mill Belews Creek, East Belews
-Cr'eek( Kernersville ake �_ Creek l
•\� M// r ek
eek
s 8
Kerner Mill
Creek Reedy1Fork e F
Creek
Fishers
Branch Smith West'Fork �Il
Creek _ Deep River
N 66 /
Abbotts
a Creek
I `°sue
or O
eo
Fjd ers
r
eeK%Lower./
cr
reek
s ht3tl �• !'4i
66
Cq
i//eras
�h
APPENDIX 15
N 20140205
Map Not To Scale TOWN OF KERNERSVILLE
WATERSHED MAP
Abbotts Creek WS III - BW East Belews Creek C Reedy Fork Creek WS III - BW
Lower Abbotts Creek WS III - BW - Fishers Branch WS III - BW Smith Creek WS III - BW
Belews Creek Kernersville Lake WS IV - BW Kerner Mill Creek WS III - BW West Fork Deep River WS IV - BW
Belews Creek Kernersville Lake WS IV - CA Martin Mill Creek WS III - BW
'Note: The critical area idetified on themap in the Belews Creek watershed is symbolic. All cases should be evaluated on a site
specific basiV��o d t r i e if the r,�o,ppert is thi the one-half cr' cal area. This map is subject to revisio atan� t'rpg heck with
the Communitya evveopmpen�"�epaa?imen t`or a �ost current watershed boundaries. �evised 2U2b-112-b

APPENDIX 16
NORTH CAROLINA
FORSYTH COUNTY
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS, That as Principal, and
as Surety, are hold and firmly bound unto the Town of Kernersville in the sum of
dollars ($ ) for the payment of which sum the Principal and Surety
do hereby bind themselves, their heirs, executors, administrators and assigns, jointly and severally, firmly
by theses presents.
WHEREAS, the said Principal, as owner of that certain development known as
, as shown on plat dated , prepared by ,
which owner proposes to improve and develop: all of said improvements to be fully installed and said work
to be completed in accordance with the approved construction plans and the Town of Kernersville standards
and specifications; and
WHEREAS, the Principal has contracted and agreed to install said improvements in a manner acceptable
to the Town Manager as being within the standards and specifications of the Town of Kernersville as a
condition for the Watershed Permit of said development as aforesaid;
NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION IS SUCH that if the said Principal (i)
shall well and truly perform and complete his or its agreement with the Town of Kernersville, (ii) shall fully
install and construct all of said improvements in a manner within the standards and specifications of the Town
of Kernersville, (111) shall pay as they become due all just claims for work or labor performed and materials
furnished in connection with said improvements and (iv) shall defend, indemnify and save harmless the Town
of Kernersville against any and all liens, encumbrances, damages, claims, demands, expenses, costs and
charges of every kind, arising out of or in relation to the performance of said work, then this obligation shall
be null and void; otherwise the same shall remain in full force and effect.
It is understood and agreed that the terms of the bond shall give the Town of Kernersville the unqualified
right, after default, to receive any part of the bond which is necessary to complete the promised
performance or to repair any inadequate performance.
It is understood and agreed that the Town of Kernersville may institute suit on this bond, if the principals
fails to perform he or its agreement as above mentioned in all respects.
IN WITNESS WHEREOF, the Principal and Surety has signed and sealed this instrument, this
day of , 20.
BY
Principal
BY
Surety
(SEAL)
(SEAL)
Watershed and Stormwater Administrative Manual 83 Revised 2020-02-01