SW8011006_CURRENT PERMIT_20030609

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPECURRENT
PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
o`ZP.PJ,3(iLBO
YYYYMMDD

Michael F. Easley, Governor
. ocyQF W � rERoG
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Mr. Greg Thorpe, Ph.D., Manager
NCDOT PDEA Branch
1548 Mail Service Center
Raleigh, NC 27699-1548
Dear Mr. Thorpe:
Alan W. Klimek, P.E.,Director
Division of Water Quality
June 9, 2003
Subject: Permit No. SW8 011006 Modification
R-2405A US 17 Bypass
High Density Stormwater Project
Pender County
The Wilmington Regional Office received a complete, modified Stormwater
Management Permit Application for R-2405A US 17 Bypass, on June 9, 2003. Staff
review of the plans and specifications has determined that the project, as proposed, will
comply with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000. We are
forwarding Permit No. SW8 011006 modification dated June 9, 2003, for the
construction of R-2405A US 17 Bypass.
This permit shall be effective from the date of issuance until June 9, 2013, and shall be
subject to the conditions and limitations as specified therein. Please pay special
attention to the Operation and Maintenance requirements in this permit. Failure to
establish an adequate system for operation and maintenance of the stormwater
management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you
have the right to request an adjudicatory hearing upon written request within thirty (30)
days following receipt of this permit. This request must be in the form of a written
petition, conforming to Chapter 150B of the North Carolina General Statutes, and filed
with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-
7447. Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please
contact Linda Lewis, or me at [phone].
Sincerely,
vRick Shiver
Water Quality Regional Supervisor
RSSlarl: S:1WQSISTORMWATIPERMIT1011006.jun03
CC'. Marshall Clawson, NCDOT Hydraulics Unit
Pender County Building Inspections
Division of Coastal Management
Robert Vause, NCDOT, Division 3, District 1
Linda Lewis
Wilmington Regional Office
Central Files
N. C. Division of water Quality 127 Cardinal Drive Extension [phone] Customer Service
Wilmington Regional Office Wilmington, NC 28405 [phone] Fax [phone] NCDEN'R

State Stormwater Management Systems
Permit No. SW8 011006 Modification
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
NCDOT
R-2405A US 17 Bypass
Pender County
FOR THE
construction, operation and maintenance of two infiltration basins in compliance with the
provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and
the approved stormwater management plans and specifications and other supporting
data as attached and on file with and approved by the Division of Water Quality and
considered a part of this permit.
This permit shall be effective from the date of issuance until June 9, 2013, and shall be
subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described on page 3 of this permit, the Project Data Sheet. The
stormwater controls have been designed to' handle the runoff from a limited
amount of built -upon area. Pond 1 will treat runoff from a portion of the new US
Highway 17, and Pond 2 will treat runoff from the future development area at
Scotts Hill Baptist Church.
3. The tract will be limited to the amount of built -upon area indicated on page 3 of
this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage areas of this
project must be directed into the appropriate permitted stormwater control
system.
2

State Stormwater Management Systems
Permit No. SW8 011006 Modification
DIVISION OF WATER QUALITY
PROJECT DESIGN DATA SHEET
Project Name:
Permit Number:
Location:
Applicant:
Mailing Address:
Application Date:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
Basin Number:
Drainage Area, acres:
R2405-A Project, acres:
Scotts Hill Baptist Church, acres
Total Impervious Surfaces, sq. ft.:
Basin Depth, ft:
TSS removal efficiency:
Bottom Elevation, FMSL:
Permitted Bottom Surface Area, sq. ft.
Permitted Storage Volume, cubic ft.:
Temporary Storage Elevation, FMSL:
Drawdown Time, hours:
Seasonal High Water Table Elevation:
Type of Soil:
Expected Infiltration Rate, in/hour:
R-2405A US 17 Bypass
SW8 011006 Modification
Pender County
Greg Thorpe, Ph.D., Manager
NCDOT PDEA Branch
1548 Mail Service Center
Raleigh, NC 27699-1548
June 9, 2003
Futch Creek 1 Cape Fear
CFP24 18-87-19
"SA"
1 (Hwy 17)
15.1
15.1
0
182,952
2.5
2 Church
9.0
0
9.0
392,040
4.0
85%
85%
(a 50' vegetated
filter is required)
13.1
11.5
9,543
9,736
27,242
60,836
15.6
15.6
42.3
41.3
8.2 6.6
Sandy clay loam
0.71 1.14
k 3

State Stormwater Management Systems
Permit No. SW8 011006 Modification
II. SCHEDULE OF COMPLIANCE
The stormwater management system shall be constructed in it's entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee small at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must'be followed in its
entirety and maintenance must occur at the scheduled intervals including, but not
limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
5. Decorative spray fountains will not be allowed in the stormwater treatment
system.
6. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
7. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
8. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
9. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction. If the proposed
BUA exceeds the amount permitted under this permit, a modification to the
permit must be submitted and approved prior to construction.
III

State Stormwater Management Systems
Permit No. SW8 011006 Modification
10. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
11. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
c. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, or sale of all or part of the project area.
The project area is defined as all property owned by the permittee, for
which Sedimentation and Erosion Control Plan approval or a CAMA Major
permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
12. At least 30 days prior to the sale or lease of any portion of the property, the
permittee shall notify DWQ and provide the name, mailing address and phone
number of the purchaser or leasee. An access/maintenance easement to the
stormwater facilities shall be granted in favor of the permittee if access to the
stormwater facilities will be restricted by the sale or lease of any portion of the
property.
13. The permittee must maintain compliance with the proposed built -upon area and
ensure that the runoff from all the built -upon is directed into the permitted -system.
14. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
15. The permittee must maintain the current permitted drainage area. No additional
runoff from outside of the permitted drainage area boundary may enter the
permitted stormwater facilities without first applying for and receiving a permit
modification.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of owership, or a name change, the permittee must
submit a formal permit transfer request to the Division of Water Quality,
accompanied by a completed name/ownership change form, documentation from
the parties involved, and other supporting materials as may be appropriate. The
approval of this request will be considered on its merits and may or may not be
approved. The permittee is responsible for compliance with all permit conditions
until such time as the Division approves the transfer request.
9

State Stormwater Management Systems
Permit No. SW8 011006 Modification
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
3. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances which may be imposed by
other government agencies (local, state, and federal) which have jurisdiction.
4. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
5. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
6. The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
7. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The permittee shall notify the Division. any name, ownership or mailing address
changes within 30 days.
Permit issued this the 9th day of June, 2003.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
2

R-2405A US 17 Bypass
Stormwater Permit No. SW8 011006 Modification
Pender County
Designer's Certification
1, , as a duly registered
in, the State of North Carolina, having been authorized to observe
(period icallylweeklylfull time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
SEAL
Signature
Registration Number
Date

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

1
. II Date Received
OFFICE USE ONLY
Fee Paid
Permit Number
/ z Q3 1 13
o//o o(, IKc b
State of North Carolina l�
Department of Environment and Natural Resources JAN f 2���
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION 1~OIWISION OF HIGHWAYS
HYDRAULICS UNIT
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
LINEAR ROADWAY PROJECT
This form may he photocopied for use as an original.
DWQ Stormwater Management Plan Review:
A complete Stormwater management plan submittal includes this application form, a supplement form for each BMP
proposed (see Section V), design calculations, and plans and specifications showing all road and BMP details.
PROJECT INFORMATION
NCDOT Project Number: Q-2yosA jl County: Iley/ A*)ovE9 sAEA4Pt-�4
Project Name:-lyo3,4 a5 t1��7�roi,n ERS,F of ZYpel�1,%r%�+�><�H /o D,21 km I`lEof SQ/�7
Project Location: 5co*g Rif f ofya
Contact Person: M-ARMALL CI-4 w.So Phone: 9 11 ` I. Q - It) 00 Fax: `I � � - i50 ` 4f 0�
Receiving Stream Name: F14IeA Cree K River Basin: 64 JeB4� Class:
Proposed linear feet of project: Id,ig k.•A _
Proposed Structural BMP and Road Station (attach a list of station and BMP type if more roont is needed):
,Z-i14 fro /Pvn4 S�� .1/f Sa L f - �//r/- .Staffs A1,11 Loop, /W
Type of proposed project: (check all that appl)):
I4 New PqWidening 02 lane* 04 lane* Curb and Gutter ❑Bridge Replacement
❑Other (Describe)
*2 lane and 4 late imply that roarLvide Glitches are used unless Curb and Gutter is also checked.
I1. REQUIRED ITEMS CHECKLIST
Initial in the space provided below to indicate the following design requirements have been met and supporting
documentation is attached. Supporting documentation shall, at a minimum, consist of a brief narrative description
including (1) the scope of the project, (2) how the items below are met, (3) how the proposed best management practices
minimize water quality impacts, and (4) any significant constraints andlor justification for not meeting a, b, c and d to the
maximum extent practicable.
DevigneY s Initials
L )��Z a. The amount of impervious surface has been minimized as much as possible.
4P2 -b. The runoff from the impervious areas has been diverted away from surface waters as much as possible.
LRfZ c.
/-VA d.
Best Management Practices are employed which minimize water quality impacts.
Vegetated roadside ditches are 3:1 slope or flatter.
Form SWU-112 Rev 04.00 Page 1 of 2

III. OPERATION AND MAINTENANCE AGREEMENT
I acknowledge and agree by my initials below that the North Carolina Department of Transportation is responsible for the
implementation of the four maintenance items listed. 1 agree to notify DWQ of any operational problems with the BMP's
that would impact water quality or prior to making any changes to the system or responsible party.
Maintenance Engineer's Initials
a. BMP's shall be inspected and maintained in good working order.
b. Eroded areas shall be repaired and reseeded as needed.
c. Stormwater collection systems, including piping, inlets, and outlets, shall be maintained to insure proper
functioning.
Maintenance Engineer's Name:
Title
IV. APPLICATION CERTIFICATION
I, (pl"nrt ot" type [[an[e} ( o r C— of � Branch,
certify that the information inc d on this per it application form is, to the best of my knowledge, correct and that the
project will be constructed in conformance with the approved plans and that the proposed project complies with the
requirements'of 15A NCAC 214 .1000.
Title:
Addri
Signo
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each BMP
specified for this project. Contact the Stormwater and General Permits Unit at (9 t 9) 733-5083 for the status and
availability of these forms.
Form SWU-102
Wet Detention Basin Supplement
Form SWU-103
Infiltration Basin Supplement
Form SWU-104
Low Density Supplement
Form SWU-105
Curb Outlet System Supplement
Form SWU-106
Off -Site System Supplement
Form SWU-107
Underground Infiltration Trench Supplement
Form SWU-108
Neuse River Basin Supplement
Form SWU-109
Innovative Best Management Practice Supplement
Form SWU-1 10
Extended Dry Detention Basin Supplement
Form SWU-112 Rev 04.00 Page 2 of 2

Permit No. 56u641(00(OHbc
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied far use as an original
DWO Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, an
infiltration basin supplement for each system, design calculations, soils report and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION \\
Project Name : - 7-4 05 A ( uS ?P1
Contact Person: �Phone Number:
This worksheet applies to: Basin No. (yS !% �re�J in Drainage Area
(us ident fed on plans) (from Form SWU-lol)
1I. DESIGN INFORMATION - Attach supporting calculations/documentation. The soils report must be
based upon an actual field investigation and soil borings. County soil maps are not an acceptable source
of soils information. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
Soil Type DZN - �a N ,e- Nit �,_►r L.oAtn
Infiltration Rate a, h or cfllirlsf (circle appropriate units)
SHWT Elevation g,•Z _ fmsl (Seasonal High Water Table elevation) ` /t
Z .� yi�17 �. '.�l'y ti�C/d ►J � x i S �r a� � �O�% Sk rt r•. [. P
Basin Design Parameters
Design Storm 1 . S inch (1.5 inch event for SA waters, 1 inch event for others)
Design Volume -Z.5 S 6 Fs c.f. t` -1 -S z . " "-�)
Drawdown Time �'71'- days (+3R5-J on 0,-71
Basin Dimensions
�p-f- rcc'rc�n �� a�
Basin Size — :t. x
Basin Volume Provided C.: c.f.
Basin Elevations
Bottom Elevation
Storage Elevation
Top Elevation
5 . -r S .•..
5 Li q sq. ft. (bottom dimensions)
Form SWU-103 Rev 3.99 Page 1 of 3

The Following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the' Stormwater Management Permit
Application Form, the agent may initial below. Attach justification if a requirement has not been met.
Applicants Initials
a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
b. System is located at least 100 feet from water supply wells.
LpA2 J c. Bottom of system is at least 2 feet above the seasonal high water table.
x- Ple- d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
I -RA J e. System is not sited on or.in Fill material or DWQ approval has been obtained.
L �� ✓ f.
System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
LOfL / g.
sVZ/f71er B10A res�r.cks 1r.1 krr PA
Drainage area for the device is less than 5 acres. �o a�vrox�.►u�� �.�cr�f
h.
Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
G PA 4 i.
System captures and infiltrates the runoff from the first 1.0 inch of rainfall (1.5 inch event for
areas draining to SA waters ). Design volume and infiltration calculations attached.
L A9A j
System is sized to take into account the runoff at the ultimate built -out potential from all
surfaces draining to the system, including any off -site drainage. Calculations attached.
GOZ k.
All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
C PA I.
A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided. Forefay
Gam_ m.
Bottom of the device is covered with a layer of clean sand to an average depth of 4 inches or
dense vegetative cover is provided.
LaI2 n.
h-[�.r�Pt w1Ti-� NA'CLRi�'l. %j�CaG-TAYio.'l
Vegetated filter is provided for overflow (Required minimum
length is 50 feet for SA waters, 30 feet for other waters).
4-�9Z J o. Flow distribution mechanism within the basin is provided: SPI.i.Lw P4
L07- _ v P. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
o r E LLB V [1T, rJ J of� rGW�Erm^Y
L,0lL J q. Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
G,�ie J r. System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days. A soils report and all
pertinent draw -down calculations are attached.
s. Plans ensure that the installed system will meet design specifications (constructed or
restored) upon initial operation once the project is complete and the entire drainage area is
stabilized.
Form SWU=103 Rev 3.99
Page 2 of 3

F
. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the infiltration system for erosion,
trash accumulation, vegetative cover, and general condition.
2. Repair eroded areas immediately, re -seed as necessary' to maintain adequate vegetative cover, mow
vegetated cover to maintain a maximum height of six inches, and remove trash as needed.
3. After every runoff producing rainfall event and at least monthly inspect the bypass, inflow and overflow
structures for blockage and deterioration. Remove any blockage and repair the structure to approved design
specifications.
4. Remove accumulated sediment from the pretreatment system and infiltration basin annually or when depth
in the pretreatment unit is reduced to 75% of the original design depth. The system shall be restored to the
original design depth without over -excavating. Over -excavating may cause the required water table
separation to be reduced and'may compromise the ability of the system to perform as designed. Removed
sediment shall be disposed of in an appropriate manner and shall not be.handled in a manner that will
adversely impact water quality (i.e. stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the pretreatment unit. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the design depth reads S feet in the pretreatment unit, the sediment shall be
removed from both the pretreatment unit and the infiltration basin.
5. If the Division determines that the system is failing, the system will immediately be repaired to original
design specifications. If the system. cannot be repaired to perform its design function, other stormwater
control devices as allowed by NCAC 2H .1000 must be designed, approved and constructed.
ry "`f JS 31t-M
I acknowledge and agree by my signature below that �n respone performance of the five
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior to any
changes to the system or responsible party.
Print Name and Title:%� t' • %Mf', f�. !'1�y
Address: IZ4 JW61c)4 .fit,— L/It'/U*J &—P1 0 1t11✓ 29411
Pt
Si
Note: The legally responsible parry should not be a homeowners association unless more than 50% of the lots have been sold and a
resident of the subdivision has been named the president.
I, , a Notary Public for the State of l � County of
, do hereby certify that `�yd L 1hhmd 5 S� �- personally appeared before me this �S
day of , 200S , and acknowledge the due execution of the forgoing infiltration basin maintenance requirements.
Witness my hand and official seal,
S r
-Sr.Z'AL
a4'6� P.
2
My commission expires
Form SWli-103 Rev 3.99
Page 3 of 3

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Permit No. SWO 11GO & HU d�
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form may be photocopied for use as an original
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, an
infiltration basin supplement for each system, design calculations, soils report and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : - Zw a S A
Contact Person: Phone Number:
( )
This worksheet applies to: Basin No. Z 4r -G) in Drainage Area
(as identified on plans) (from Form SWU-101)
II. DESIGN INFORMATION - Attach supporting calculations/documentation. The soils report must be
based upon an actual field investigation and soil borings. County soil maps are not an acceptable source
of soils information. All elevations shall ba in feet mean sea level (fmsl).
Soils Report Summary
Soil Type
CKN ` TAr-t
sAND�c , ('L-aY L.oAtwx
Infiltration Rate(nt;.,'-M kr4)
1, < LA
G711kJor
cf/hr/sf (circle appropriate units)
SHWT Elevation
fMSl
(Seasonal Nigh Water Table elevation)
Basin Design Parameters
Design Storm
.S
inch
(1.5 inch event for SA waters, 1 inch event for others)
Design Volume
Li -7 Z $
c.f.
Drawdown Time
a , -7Z
days
Basin Dimensionsa,,�
Basin Size
--
ft. x
ft. _ `0 LA Z sq. ft. (bottom dimensions)
Basin Volume Provided G, 05,ls- c.f.
70
Basin Elevations
Bottom Elevation
Storage Elevation
Top Elevation
)5'�rerye,,cy iZ
Form SWU- 103 Rev 3.99
3. S r.,—frns4—
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Page i of 3
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111. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Permit
Application Form, the agent may initial below. Attach justification if a requirement has not been met.
Applicants Initials
LDIL j a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
LO2 J b. System is located at least 100 feet from water supply wells.
2-429 � .1 c. Bottom of system is at least 2 feet above the seasonal high water table.
2-/2/Z / d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
Lot J e. System is not sited on or in fill material or DWQ approval has been obtained.
L�2 J f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
�/ s111'r- box resr�c,�s. pa;
g. Drainage area for the device is less thanres.pp ,
�oall 7'c (sAtrcl
IRW— J h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
System captures and infiltrates the runoff from the first 1.0 inch of rainfall (1.5 inch event for
areas draining to SA waters ). Design volume and infiltration calculations attached.
L AZ J j. System is sized to take into account the runoff at the ultimate built -out potential from all
surfaces draining to the system, including any off -site drainage. Calculations attached.
L�1L. J k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
1. A pretreatment device such_as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided. }-0a.e 3AY
L,DR J m. Bottom of the device is covered with a layer of clean sand to an average depth of 4 inches or
dense vegetative cover is provided.
Low i_Ytn1Cp P.�EA WvTta N4%TV2AL, V�.C�TP�TIorJ
LRR- J n. Vegetated filter is provided for overflow s (Required minimum
length is 50 feet for SA waters, 30 feet for other waters).
GQJZj o. Flow distribution mechanism within the basin is provided. f_nne R.Ge N S?4�c wR'Y �tti s�
J P. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
iOf* EL'I. VA'rt*vJ OF
LPQJ. q. Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
LOIZ r. System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days. A soils report and all
pertinent draw -down calculations are attached.
�Qie J s. Plans ensure that the installed system will meet design specifications (constructed or
restored) upon initial operation once the project is complete and'the entire drainage area is
stabilized.
Form SNVU 103 Rev 3.99 Page 2 of 3

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V. INFILTRATION BASIN OPERATION AND MAINTENANCE AGREEMENT
I.. After every runoff producing rainfall event and at least monthly inspect the infiltration system for erosion,
trash accumulation, vegetative cover, and general condition.
2. Repair eroded areas immediately, re -seed as necessary' to maintain adequate vegetative cover, mow
vegetated cover to maintain a maximum height of six inches, and remove trash as needed.
3. After every runoff producing rainfall event and at least monthly inspect the bypass, inflow and overflow
structures for blockage and deterioration. Remove any blockage and repair the structure to approved design
specifications.'
4. Remove accumulated sediment from the pretreatment system and infiltration basin annually or when depth
in the pretreatment unit is reduced to 75% of the original design depth. The system shall be restored to the
original design depth without over -excavating. Over -excavating may cause the required water table
separation to be reduced and'may compromise the ability of the system to perform as designed. Removed
sediment shall be disposed of in an appropriate manner and shall not be handled in a manner that will
adversely impact water quality (i.e. stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the -pretreatment unit. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the design depth reads s .S o feet in the pretreatment unit, the sediment shall be
removed from both the pretreatment unit and the infiltration basin.
5. If the Division determines that the system is failing, the system will immediately be repaired to original
design specifications. If the system cannot be repaired to perform its design function, other stormwater
control devices as allowed by NCAC 2H .1000 must be designed, approved and constructed.
1J c..pert MC. I �go
03
I acknowledge and agree by my signature below that �t r spoo ibAa3he performance of the five
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior to any
changes to the system or responsible party.
Print Name and Title:
-jAviD L., s?, Re7/%%�f/t�7�7✓/3�VGCrG��L---
Address:_ /zI .7a'y3 6r/ VVII&A677n) nrG 7,941 �
Phone: Date:
Signature:
Note: The -legally responsible party should not be a homeowners association unless more than 50% of the lots have been sold and a
resident of the subdivision has been named the president.
I, QM PU a Notary Public for the State of aajMazounty of
do hereby certify that Vkj L U O ffli2:�, �f, 26 personally appeared before me this
day of , and acknowledge the due execution of the forgoing infiltration basin maintenance requirements.
Witness my band and official seal, ^ `
SEAL. My commission expires " C26 v�
Form SWU-1V • Rev 3.99
Page 3 of 3

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1

�i�fi� �lii;'Il?\\':S1C1,1'l:ll]:ICCI,I;:lli �\'S1�I11S
PCriZIlt No. S%V8 011006
US 17 NVIdening and Scotts Hill hoop Road R-2405A
Storrim.ater Permit No. SW8 011006
Pender County
Designer's Certification
I, _l a r-r 4*4,e, Sr., as a duly registered ;oraCeS: ii'gx t An•kGe r i.n
the State of Nort Carolina, having been authorized to observe {periodically/weekly/full time} the construction of
the project,
GI S 17 O;d en:,A a-4 Lao 0 f1ZYoS _ (Project)
for IJ60o 7— _ (Project Owner) hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the project construction such that the construction was observed to be
built within substantial compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number 4926 fed O
Date
E.` WI-30
``'J"1r61u4inyi
00
CAR
ESS
• 4 SEAL -
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AS�`�•
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)l::it_ 1,C)ri].LL';;ica" 1,"l;1?7',:��Clll�i7i S\'tilCI17S
Permit No. S\V8 QI 1006
Certification Requirements:
'A�'J2 1.
The drainage area to the system contains approximately the permitted acreage.
Apt 2.
The drainage area to the system contains no more than the permitted amount of built -upon area.
3.
All the built -upon area associated with the project is graded such that the runoff drains to the system.
4.
The outlet/bypass structure elevations are per the approved plan.
5.
The outlet structure is located per the approved plans.
/J/i4-6.
Trash rack'is provided on the outlet bypass structure.
1,PA 7.
All slopes are grassed with permanent vegetation.
S.
Vegetated slopes are no steeper than 3:1.
9.
The inlets are located per the approved plans and do not cause short-circuiting of the system.
10.
The permitted amounts of surface area and/or volume have been provided.
/P/Z .l I.
Required drawdown devices are correctly sized per the approved plans.
X47C I
All required design depths are provided.
X,PIZ- 13.
All required parts of the system are provided, such as a b , and a forebay.
14. The overall dimensions of the system, as shown on the approved plans, are provided.
cc: NCDENR-DWQ Regional Office
Pender County Building Inspections
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