SW4201101_Final Permit_20210120

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
BRIAN WRENN
Director
NORTH CAROLINA
Environmental Quality
January 20, 2021
Heritage Oaks Holdings, LLC
Attn: Scott Craver, Member -Manager
5426 Heritage Oaks Lane
Winston-Salem, NC 27106
Subject: State Stormwater Management Permit No. SW4201101
Heritage Oaks, Section II — Residential Subdivision
Low Density Subdivision Project
Forsyth County
Dear Mr. Craver:
The Wilmington Regional Office received a complete State Stormwater Management Permit
Application for the subject project on January 5, 2021. Staff review of the plans and
specifications has determined that the project, as proposed, complies with the Stormwater
Regulations set forth in 15A NCAC 2H.1000 amended on January 1, 2017 (2017 Rules). We are
hereby forwarding Permit No. SW4201101, dated January 20, 2020, for the construction of the
built -upon areas (BUA) and vegetated conveyances associated with the subject project.
This permit shall be effective from the date of issuance until rescinded and the project shall be
subject to the conditions and limitations as specified therein and does not supersede any other
agency permit that may be rewired. Failure to comply with these requirements will result in
future compliance problems. Please note that this permit is not transferable except after notice to
and approval by the Division.
This cover letter, attachments, and all documents on file with DEMLR shall be considered part
of this permit and is herein incorporated by reference.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing by filing a written petition with the Office of
Administrative Hearings (OAH). The written petition must conform to Chapter 150B of the
North Carolina General Statutes and must be filed with the OAH within thirty (30) days of
receipt of this permit. You should contact the OAH with all questions regar thirty
the filing fee (if
a filing fee is required) and/or the details of the filing process at 6714 Mail Service Center,
Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at
www.NCOAH.com. Unless such demands are made this permit shall be f1na1 and binding.
If you have an questions concerning thispermit, please contact Corey Anen in the Central DEQ
Office, at [phone] or Corey.Anen ancdenr.gov.
Sincerely,
'W -
Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
D E Q173]�� North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
NORTH CAROLINA �
oepanmem of enmmnmemm Quail� 919.707.9200

Cc: Winston-Salem Regional Office
Alex Carter PE — Beeson & Carter, PA
SW4201101 Stormwater File

State Stormwater Management
Permit No. SW4201101
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
LOW DENSITY SUBDIVISION DEVELOPMENT
In compliance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations promulgated and adopted by the North
Carolina Environmental Management Commission, including 15A NCAC 02H.1000 amended on
January 1, 2017 (2017 Rules) (the "stormwater rules"),
PERMISSION IS HEREBY GRANTED TO
Heritage Oaks Holdings, LLC
Heritage Oaks, Section 11 — Residential Subdivision
5426 Heritage Oaks Lane, Winston-Salem, Forsyth County
FOR THE
construction, management, operation and maintenance of built -upon area (BUA) for a 24% low
density subdivision project (the "low density area as outlined in the application, approved stormwater
management plans, supplements, calculations, operation and maintenance agreement, recorded
documents, specifications, and other supporting data (the "approved plans and specifications") as
attached and/or on file with and approved by the Division of Energy, Mineral and Land Resources (the
"Division" or "DEMLR"). The project shall be constructed, operated and maintained in accordance
with these approved plans and specifications. The approved plans and specifications are
incorporated by reference and are enforceable parts of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations. The permit issued shall continue in force and effect until
the permittee files a request with the Division for a permit modification, transfer, or rescission;
however, these actions do not stay any condition. The issuance of this permit does not prohibit the
Director from reopening and modifying the permit, revoking and reissuing the permit, or terminating
the permit for cause as allowed by the laws, rules, and regulations contained in 15A NCAC 2H.1000
and NCGS 143-215.1 et.al.
BUA REQUIREMENTS. The maximum amount of BUA allowed for the entire project is 150,850
square feet. The BUA requirements and allocations for this project are as follows:
a. LOW DENSITY AREA BUA LIMITS. The low density area must not exceed 24% per the
requirements of the stormwater rules. Within this low density area, this permit approves a
percent BUA of 22.3% and the construction of a total of 0 square feet of future BUA in the
low density area.
b. BUA FOR INDIVIDUAL LOTS. Each of the 27 lots are limited to a maximum of 3800 square
feet of BUA, as indicated in the approved plans and specifications. The maximum BUA
assigned to each lot via this permit and the recorded deed restrictions and protective
covenants may not be increased or decreased by either the individual lot owner or the
permittee unless and until the permittee notifies the Division and obtains written
approval from the Division.
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State Stormwater Management
Permit No. SW4201101
2. PERVIOUS AREA IMPROVEMENTS. At this time, none of the pervious area improvements
listed in G.S. 143-214.7(b2) or the Stormwater Design Manual have been proposed for this
project. Pervious area improvements will be allowed in this project if documentation is provided
demonstrating those improvements meet the requirements of the stormwater rule.
3. LOW DENSITY AREA REQUIREMENTS. The low density area requirements for this project are
as follows:
a. LOW DENSITY AND CONVEYANCE DESIGN. The low density area is permitted based on
the design criteria presented in the sealed, signed and dated supplement and as shown in
the approved plans and specifications. This low density area and conveyances must be
provided and maintained at the design condition.
b. PIPING. Other than the piping shown on the approved plans, only minimal amounts of
piping under driveways and roads is allowed within the low density area when it cannot be
avoided. No additional piping is allowed.
c. DISPERSED FLOW. The low density area has maximized dispersed flow of stormwater
runoff through vegetated areas and minimized the channelization of flow.
d. VEGETATED CONVEYANCES. Stormwater runoff that could not be released as dispersed
flow may be transported by vegetated conveyances with 3:1 (H:V) slopes demonstrated by
engineering calculations and on -site soils investigation to remain stable in perpetuity and
designed to not erode during the peak flow from the 10-year storm event as defined in the
stormwater rules and approved by the Division.
4. STORMWATER OUTLETS. The peak flow from the 10-year storm event shall not cause erosion
downslope of the discharge point.
5. VEGETATED SETBACKS. A 30-foot wide vegetative setback must be provided and maintained
in grass or other vegetation adjacent to all surface waters as shown on the approved plans. The
setback is measured horizontally from the normal pool elevation of impounded structures, from
the top of bank of each side of streams or rivers, and from the mean high waterline of tidal
waters, perpendicular to the shoreline.
6. RECORDED DOCUMENT REQUIREMENTS. The stormwater rules require the following
documents to be recorded with the Office of the Register of Deeds prior to the sale of individual
lots or groups of lots:
a. ACCESS AND/OR EASEMENTS. The entire stormwater conveyance system and
maintenance accesses must be located in public rights -of -way, dedicated common areas
that extend to the nearest public right-of-way, and/or permanent recorded easements that
extend to the nearest public right-of-way for the purpose of inspection, operation,
maintenance, and repair.
b. OPERATION AND MAINTENANCE AGREEMENT. The operation and maintenance
agreement must be recorded with the Office of the Register of Deeds.
c. FINAL PLATS. The final recorded plats_must reference the operation and maintenance
agreement and must also show all public rights -of -way, dedicated common areas, and/or
permanent drainage easements, in accordance with the approved plans.
d. DEED RESTRICTIONS AND PROTECTIVE COVENANTS. Recorded deed restrictions and
protective covenants must include, at a minimum, the following statements related to
stormwater management:
i. The following covenants are intended to ensure ongoing compliance with State
Stormwater Management Permit Number SW4201101, as issued by the Division of
Energy, Mineral and Land Resources (the "Division") under 15A NCAC 02H.1000,
effective January 1, 2017.
ii. The State of North Carolina is made a beneficiary of these covenants to the extent
necessary to maintain compliance with the Stormwater Management Permit.
iii. These covenants are to run with the land and be binding on all persons and parties
claiming under them.
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State Stormwater Management
Permit No. SW4201101
iv. The covenants pertaining to stormwater may not be altered or rescinded without
the express written consent of the Division.
V. Alteration of the drainage as shown on the approved plans may not take place
without the concurrence of the Division.
vi. The maximum built -upon area (BUA) per lot is 3800 square feet.
vii. The maximum allowable BUA shall not be exceeded on any lot until the permit is
modified to ensure compliance with the stormwater rules, permit, and the approved
plans and specifications.
viii. Filling in, piping or altering any vegetated conveyances (ditches, swales, etc.)
associated with the development, except for average driveway crossings, is
prohibited by any persons.
ix. A 30-foot wide vegetative setback must be provided and maintained adjacent to all
surface waters in accordance with 15A NCAC 02H.1003(4) and the approved
plans.
X. All roof drains shall be released no closer than at the edge of the 50-foot wide
vegetated setback and allowed to flow through the setback as dispersed flow. At
no time shall stormwater runoff be piped into or through the setback.
A. Any individual or entity found to be in noncompliance with the provisions of a
stormwater management permit or the requirements of the stormwater rules is
subject to enforcement procedures as set forth in NCGS 143, Article 21.
e. DEEDS FOR INDIVIDUAL LOTS. The permittee shall record deed restrictions and
protective covenants prior to the issuance of a certificate of occupancy to ensure the permit
conditions and the approved plans and specifications are maintained in perpetuity.
7. CONSTRUCTION. During construction, erosion shall be kept to a minimum and any eroded
areas of the on -site stormwater system will be repaired immediately.
a. PROJECT CONSTRUTION, OPERATION AND MAINTNEANCE. During construction, all
operation and maintenance for the project and stormwater system shall follow the Erosion
Control Plan requirements until the Sediment -Erosion Control devices are no longer needed.
b. FINAL GRADING. The vegetated areas and vegetated conveyances shall be entirely
constructed and vegetated. Once the final grading is completed and the site is stabilized, the
permittee shall provide and perform the operation and maintenance as outlined in the
applicable section below.
8. MODIFICATIONS. No person or entity, including the permittee, shall alter any component
shown in the approved plans and specifications, except for minimum driveway crossings. Prior
to the construction of any modification to the approved plans, the permittee shall submit to the
Director, and shall have received approval for modified plans, specifications, and calculations
including, but not limited to, those listed below. For changes to the project that impact the
certifications, a new or updated certification(s), as applicable, will be required and a copy must
be submitted to the appropriate DEQ regional office upon completion of the modification.
a. Any modification to the approved plans and specifications, regardless of size including the
BUA, details, etc.
b. Redesign or addition to the approved amount of BUA.
c. Further development, subdivision, acquisition, lease or sale of any, all or part of the project
and/or property area as reported in the approved plans and specifications.
d. Altering, modifying, removing, relocating, redirecting, regrading, or resizing of any
component of the approved stormwater collection system and/or vegetative conveyance
shown on the approved plan, except for minimum driveway crossings within the low density
area.
e. The construction of any allocated future BUA.
f. Adding the option to use permeable pavement or #57 stone within the lots as a permeable
surface. The request may require a proposed amendment to the deed restrictions and
protective covenants for the subdivision to be submitted and recorded.
g. The construction of any permeable pavement, #57 stone area, public trails, or landscaping
material within the common areas to be considered a permeable surface that were not
included in the approved plans and specifications.
h. Other modifications as determined by the Director.
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State Stormwater Management
Permit No. SW4201101
9. DESIGNER'S CERTIFICATION. Upon completion of the project, the permittee shall determine if
the project is in compliance with the approved plans and take the necessary following actions:
a. If the permittee determines that the project is in compliance with the approved plans, then
within 45 days of completion, the permittee shall submit to the Division one hard copy and
one electronic copy of the following:
i. The completed and signed Designer's Certification provided in Attachment A
noting any deviations from the approved plans and specifications. Deviations
may require approval from the Division;
ii. A copy of the recorded operation and maintenance agreement;
iii. Unless already provided, a copy of the recorded deed restrictions and
protective covenants; and
iv. A copy of the recorded plat delineating the public rights -of -way, dedicated
common areas and/or permanent recorded easements, when applicable.
b. If the permittee determines that the project is not in compliance with the approved plans, the
permittee shall submit an application to modify the permit within 30 days of completion of the
project or provide a plan of action, with a timeline, to bring the site into compliance.
10. OPERATION AND MAINTENANCE. The permittee shall provide and perform the operation and
maintenance necessary, as listed in the signed operation and maintenance agreement and the
Swale System Maintenance Requirements, a part of the Low Density Supplement, to assure that
all components of the permitted on -site stormwater system are maintained at the approved
design condition. The approved operation and maintenance agreement must be followed in its
entirety and maintenance must occur at the scheduled intervals.
a. CORRECTIVE ACTIONS REQUIRED. In the event that the low density area fails to meet
the requirements of low density, the permittee shall take immediate corrective actions. This
includes actions required by the Division and the stormwater rules such as the construction
of additional or replacement on -site stormwater systems. These additional or replacement
measures shall receive a permit from the Division prior to construction.
b. MAINTENANCE RECORDS. Records of maintenance activities must be kept and made
available upon request to authorized personnel of the Division. The records will indicate the
date, activity, name of person performing the work and what actions were taken.
11. CURRENT PERMITTEE NAME OR ADDRESS CHANGES. The permittee shall submit a
completed Permit Information Update Application Form to the Division within 30 days to making
any one or more of the following changes:
a. A name change of the current permittee;
b. A name change of the project;
c. A mailing address change of the permittee.
12. TRANSFER. This permit is not transferable to any person or entity except after notice to and
approval by the Director. Neither the sale of the project and/or property, in whole or in part, nor
the conveyance of common area to a third party constitutes an approved transfer of the permit.
a. TRANSFER REQUEST. The transfer request must include the appropriate application,
documentation and the processing fee as outlined in 15A NCAC 02H.1045(2) and must be
submitted upon occurrence of any one or more of the following events:
i. The sale or conveyance of the project and/or property area in whole or in part,
except in the case of an individual residential lot sale that is made subject to the
recorded deed restrictions and protective covenants;
ii. The assignment of declarant rights to another individual or entity;
iii. The sale or conveyance of the common areas to a Homeowner's or Property
Owner's Association, subject to the requirements of NCGS 143-214.7(c2);
iv. Dissolution of the partnership, corporate, or LLC entity, subject to NCGS 55-14-05
or NCGS 57D-6-07 and 08;
V. Bankruptcy;
vi. Foreclosure, subject to the requirements of Session Law 2013-121;
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State Stormwater Management
Permit No. SW4201101
b. TRANSFER INSPECTION. Prior to transfer of the permit, a file review and site inspection
will be conducted by Division personnel to ensure the permit conditions have been met and
that the project and the on -site stormwater system complies with the permit conditions.
Records of maintenance activities performed to date may be requested. Projects not in
compliance with the permit will not be transferred until all permit and/or general statute
conditions are met.
13. COMPLIANCE. The permittee is responsible for complying with the terms and conditions of this
permit and the approved plans and specifications until the Division approves the transfer
request.
a. REVIEWING AND MONITORING EACH LOT FOR COMPLIANCE. The permittee is
responsible for verifying that the proposed BUA on each individual lot, within each drainage
area and for the entire project does not exceed the maximum amount allowed by this permit.
The permittee shall review all individual lot plans for new construction and all subsequent
modifications and additions for compliance. The plans reviewed must include all proposed
BUA, grading, and driveway pipe placement. The permittee shall not approve any lot plans
where the maximum allowed BUA limit has been exceeded or where modifications are
proposed to the grading and/or to the stormwater collection system and/or to the vegetated
conveyance unless and until a permit modification has been approved by the Division. The
permittee shall review and routinely monitor the project and each lot to ensure continued
compliance with the conditions of the permit, the approved plans and specifications, and the
recorded deed restrictions and protective covenants. The permittee shall notify any lot
owner that is found to be in noncompliance with the conditions of this permit in writing and
shall require timely resolution.
b. ARCHITECTURAL REVIEW BOARD (ARB) OR COMMITTEE (ARC). The permittee may
establish an ARB or ARC to conduct individual lot reviews. However, any approval given by
the ARB or ARC on behalf of the permittee does not relieve the permittee of the
responsibility to maintain compliance with the conditions of the permit and the approved
plans and specifications.
c. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved plans,
application, supplements, operation and maintenance agreement, all applicable recorded
documents, and specifications shall be maintained on file by the permittee at all times.
d. DIVISION ACCESS. The permittee grants Division Staff permission to enter the property
during normal business hours to inspect all components of the permitted project.
e. ENFORCEMENT. Any individual or entity found to be in noncompliance with the provisions
of a stormwater management permit or the requirements of the stormwater rules is subject to
enforcement procedures as set forth in NCGS 143 Article 21.
f. OBTAINING COMPLIANCE. 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 modified plans and certification in writing to the Director that the changes have
been made.
g. OTHER PERMITS. The issuance of this permit does not preclude the permittee from
obtaining and complying with any and all other permits or approvals that are required for this
development to take place, as required by any statutes, rules, regulations, or ordinances,
which are imposed by any other Local, State or Federal government agency having
jurisdiction. Any activities undertaken at this site that cause a water quality violation or
undertaken prior to receipt of the necessary permits or approvals to do so are considered
violations of NCGS 143-215.1, and subject to enforcement procedures pursuant to NCGS
143-215.6.
Page 5 of 6

State Stormwater Management
Permit No. SW4201101
Permit issued this the 20' day of January, 2021.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
T Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW4201101
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State Stormwater Management
Permit No. SW4201101
Attachment A
Certification Forms
The following blank Designer Certification forms are included and specific for this project:
• As -Built Permittee Certification
• As -Built Designer's Certification General MDC
• As -Built Designer's Certification for Low Density Projects
A separate certification is required for each SCM. These blank certification forms may be copied and
used, as needed, for each SCM and/or as a partial certification to address a section or phase of the
project.
Page 1 of 1

State Stormwater Management
Permit No. SW4201101
AS -BUILT PERMITTEE CERTIFICATION
I hereby state that I am the current permittee for the project named above, and I certify by my signature below,
that the project meets the below listed Final Submittal Requirements found in NCAC 02H.1042(4) and the terms,
conditions and provisions listed in the permit documents, plans and specifications on file with or provided to the
Division.
❑ Check here if this is a partial certification. Section/phase/SCM #?
❑ Check here if this is part of a Fast Track As -built Package Submittal.
Printed Name
County of
personally appeared before me this
Signature
a Notary Public in the State of
do hereby certify that
day of
and acknowledge the due execution of this as -built certification. (SEAL)
Witness my hand and official seal
My commission expires
20
Permittee's Certification NCAC .1042(4)
Completed /
Provided
N/A
A. DEED RESTRICTIONS / BUA RECORDS
1. The deed restrictions and protective covenants have been recorded
Y or N
and contain the necessary language to ensure that the project is
maintained consistent with the stormwater regulations and with the
permit conditions.
2. A copy of the recorded deed restrictions and protective covenants
Y or N
has been provided to the Division.
3. Records which track the BUA on each lot are being kept. (See Note
Y or N
1
B. MAINTENANCE ACCESS
1. The SCMs are accessible for inspection, maintenance and repair.
Y or N
2. The access is a minimum of 10 feet wide.
Y or N
3. The access extends to the nearest public right-of-way.
Y or N
C. EASEMENTS
1. The SCMs and the components of the runoff collection / conveyance
Y N
system are located in recorded drainage easements.
or
2. A copy of the recorded plat(s) is provided.
Y or N
D. SINGLE FAMILY RESIDENTIAL LOTS - Plats for residential lots that
Y N
have an SCM include the following:
or
1. The specific location of the SCM on the lot.
Y or N
2. A typical detail for the SCM.
Y or N
3. A note that the SCM is required to meet stormwater regulations and
that the lot owner is subject to enforcement action as set forth in
Y N
NCGS 143 Article 21 if the SCM is removed, relocated or altered
or
without prior approval.
E. OPERATION AND MAINTENANCE AGREEMENT
Y or N
1. The O&M Agreement is referenced on the final recorded plat.
Y or N
2. The O&M Agreement is recorded with the Register of Deeds and
Y N
appears in the chain of title.
or
F. OPERATION AND MAINTENANCE PLAN — maintenance records are
being kept in a known set location for each SCM and are available for
Y or N
review.
G. DESIGNER'S CERTIFICATION FORM — has been provided to the
Y N
Division.
or
Page 1 of 7

State Stormwater Management
Permit No. SW4201101
Note 1- Acceptable records include ARC approvals, as -built surveys, and county tax records.
Provide an explanation for every requirement that was not met, and for every "N/A" below. Attach
additional sheets as needed.
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State Stormwater Management
Permit No. SW4201101
AS -BUILT DESIGNER'S CERTIFICATION GENERAL MDC
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I
have observed the construction of the project named above to the best of my abilities with all due care
and diligence, and that the project meets the below listed General MDC found in NCAC 02H.1050 in
accordance with the permit documents, plans and specifications on file with or provided to the
Division, except as noted on the "AS -BUILT" drawings, such that the intent of the stormwater rules
and statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is a part of a Fast -Track As -Built Package Submittal per .1044(3).
Check here if the designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed Name
NC Registration Number
SEAL:
Signature
Date
Consultant's Mailing Address:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan. If N is circled, provide an explanation on Page 2.
OO N/E = not evaluated (provide explanation on page 2) OO N/A = not applicable to this SCM or project.
Consultant's Certification NCAC .1003((3) & General MDCOAs-built
ON/E
OO N/A
.1050
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment.
Y or N
2. The SCM achieves runoff volume match.
Y or N
3. Runoff from offsite areas and/or existing BUA is
Y or N
bypassed.
4. Runoff from offsite areas and/or existing BUA is directed
Y or N
into the permitted SCM and is accounted for at the full
build -out potential.
5. The project controls runoff through an offsite permitted
Y or N
SCM that meets the requirements of the MDC.
6. The net area of new BUA increase for an existing project
Y or N
has been accounted for at the appropriate design storm
level.
7. The SCM(s) meets all the specific minimum design
Y or N
criteria.
B. VEGETATED SETBACKS / BUA
1. The width of the vegetated setback has been measured
Y or N
from the normal pool of impounded waters, the MHW
line of tidal waters, or the top of bank of each side of
rivers or streams.
2. The vegetated setback is maintained in grass or other
Y or N
vegetation.
3. BUA that meets the requirements of NCGS 143-214.7
Y or N
b2 2 is located in the setback.
4. BUA that does not meet the requirements of NCGS 143-
Y or N
214.7 (b2)(2) is located within the setback and is limited
to:
Page 3 of 7

State Stormwater Management
Permit No. SW4201101
a. Publicly funded linear projects (road, greenway
sidewalk)
b. Water -dependent structures
c. Minimal footprint uses (utility poles, signs, security
lighting and appurtenances)
5. Stormwater that is not treated in an SCM is released at
Y or N
the edge of the setback and allowed to flow through the
setback as dispersed flow.
OAs-built
OO N/E
ON/A
C. STORMWATER OUTLETS — the outlet handles the peak
Y N
flow from the 10 year storm with no downslo e erosion.
or
D. VARIATIONS
1. A variation (alternative) from the stormwater rule
Y N
provisions has been implemented.
or
2. The variation provides equal or better stormwater control
Y N
and equal or better protection of surface waters.
or
E. COMPLIANCE WITH OTHER REGULATORY PROGRAMS
Y N
has been met.
or
F. SIZING -the volume of the SCM takes the runoff from all
surfaces into account and is sufficient to handle the required
Y or N
storm depth.
G. CONTAMINATED SOILS — infiltrating SCM's are not
Y or N
located in or on areas with contaminated soils.
H. SIDE SLOPES
1. Vegetated side slopes are no steeper than 3H:1 V.
Y or N
2. Side slopes include retaining walls, gabion walls, or
Y or N
other surfaces that are steeper than 3H:1 V.
3. Vegetated side slopes are steeper than 3H:1 V (provide
Y or N
supporting documents for soils and vegetation).
I. EROSION PROTECTION
1. The inlets do not cause erosion in the SCM.
Y or N
2. The outlet does not cause erosion downslope of the
Y or N
discharge point during the peak flow from the 10 year
storm.
J. EXCESS FLOWS — An overflow / bypass has been
Y N
provided.
or
K. DEWATERING — A method to drawdown standing water has
Y or N
been provided to facilitate maintenance and inspection.
L. CLEANOUT AFTER CONSTRUCTION — the SCM has been
Y or N
cleaned out and converted to its approved design state.
M. MAINTENANCE ACCESS
1. The SCM is accessible for maintenance and repair.
Y or N
2. The access does not include lateral or incline slopes
Y or N
>3:1.
N. DESIGNER QUALIFICATIONS (FAST -TRACK PERMIT) —
The designer is licensed under Chapters 89A, 89C, 89E, or
Y or N
89F of the General Statutes.
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or "WE",
below. Attach additional pages as needed:
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State Stormwater Management
Permit No. SW4201101
AS -BUILT DESIGNER'S CERTIFICATION FOR LOW DENSITY PROJECTS
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I have
observed the construction of the project named above to the best of my abilities with all due care and diligence,
and that the project meets all of the MDC found in 15A NCAC 02H.1003, in accordance with the permit
documents, plans and specifications on file with or provided to the Division, except as noted on the "AS -BUILT"
drawings, such that the intent of the stormwater rules and the general statutes has been preserved.
❑ Check here if this is a partial certification. Section or phase_
❑ Check here if this is part of a Fast -Track As -Built Package Submittal per 15A NCAC 02H
❑ Check here if the Designer did not observe the construction but is certifying the project.
❑ Check here if pictures of the project are provided.
Printed Name
NC Registration Number
SEAL:
Signature
Date
Consultant's Mailing Address:
1044(3).
City: State: Zip:
Phone:)
Consultant's Email address:
iD Circle N if the as -built value differs from the Plan/permit. If N is circled, provide an explanation on page 3.
O N/E = Not Evaluated (provide explanation on page 2). OO N/A = Not Applicable to this project/plan.
Consultant's Certification (MDC 15A NCAC 02H .1003)
Project Density and Built -Upon AreaOAs-built
ON/E
OO N/A
1. The project has areas of high density based on natural drainage
Y N
area boundaries, variations in land use or construction phasing.
or
2. The project's built -upon area does not exceed the maximum limit
Y or N
specified in the permit.
Dispersed FlowOAs-built
ON/E
OO N/A
1. The project maximizes dispersed flow through vegetated areas
Y or N
and minimizes channelized flow.
Page 5 of 7

State Stormwater Management
Permit No. SW4201101
Vegetated Conveyances
OAs-built
ON/E
G N/A
1. Stormwater that is not released as dispersed flow is transported
Y N
by vegetated conveyances.
or
2. The project has a minimal amount of non -vegetated conveyances
Y N
to reduce erosion.
or
3. Other than minimal piping under driveways and roads, no piping
Y N
has been added beyond what is shown on the approved plans.
or
4. Side slopes are no steeper than 3H:1 V.
Y or N
5. The conveyance does not erode in response to the peak flow from
Y N
the 10-year storm.
or
Curb outlet systems (if applicable)OAs-built
OO N/E
(IN/A
1. The swale or vegetated area can carry the peak flow from the
Y N
10-year storm at a non -erosive velocity.
or
2. The longitudinal slope of the swale or vegetated areas does not
Y N
exceed 5%.
or
3. The swale has a trapezoidal cross-section and a minimum bottom
Y N
width of two feet.
or
4. The minimum length of the swale or vegetated area is 100 feet.
Y or N
5. Side slopes are no steeper than 3H:1 V.
Y or N
6. The project utilizes treatment swales designed per Section .1061
Y N
in lieu of the curb outlet system requirements.
or
Vegetated Setbacks (if applicable)OAs-built
OO N/E
(IN/A
1. The width of the vegetated setback is at least 50'.
Y or N
2. The width of the vegetated setback has been measured from the
normal pool of impounded waters, the MHW line of tidal waters,
Y or N
or the top of bank of each side of rivers or streams.
3. The vegetated setback is maintained in grass or other vegetation.
Y or N
4. BUA that meets the requirements of NCGS 143-214.7(b2)(2) is
Y N
located in the setback.
or
5. BUA that does NOT meet the requirements of NCGS 143-
214.7(b2)(2) is located within the setback and is limited to:
• Publicly -funded linear projects (road, greenway, or sidewalk)
Y N
• Water dependent structures
or
• Minimal footprint uses such as poles, signs, utility
appurtenances, and security lights.
6. The amount of BUA within the setback is minimized, and
Y N
channeling of the runoff from the BUA has been avoided.
or
7. Stormwater is not discharged (via swale or pipe) through a
vegetated setback. Stormwater is released at the edge of the
Y or N
setback and allowed to flow through the setback as dispersed flow.
Page 6 of 7

State Stormwater Management
Permit No. SW4201101
Outlets
OAs-built
ON/E
G N/A
1. Stormwater outlets do not cause erosion downslope of the
Y N
discharge point during the peak flow from the 10-year storm.
or
VariationsOAs-built
OO N/E
(IN/A
1. The project has variations from the MDC that were not previously
Y N
approved. (Modification may be required.)
or
Deed restrictions (if applicable)OAs-built
OO N/E
(IN/A
1. Deed restrictions are recorded and ensure that the project and
the BUA will be maintained in perpetuity consistent with the
Y or N
permit, approved plans, and specifications.
For Subdivisions Only (Residential or Commercial)OAs-built
OO N/E
(IN/A
1. The number of platted lots is consistent with the approved plans.
Y or N
2. The project area is consistent with the approved plans.
Y or N
3. The layout of the lots and streets is consistent with the approved
Y N
plan.
or
4. The width / radius of streets, paved accesses, cul-de-sacs and
Y N
sidewalks is consistent with the approved plan.
or
5. No piping, other than those minimum amounts needed under a
Y N
driveway or under a road, has been added.
or
6. The lot grading, road grading, vegetated conveyances, piping,
Y N
inverts, and elevations are consistent with the approved plans.
or
Provide an explanation below for every MDC that was not met, and for every item marked "N/A" or
"N/E." Attach additional pages as needed.
Page 7 of 7