SW6070902_CURRENT PERMIT_20071012

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW&y7U��%�
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑. COMPLIANCE EVALUATION INSPECTION
DOC DATE�_
YYYYMMDD
0

F W ATF
` Q - � Michael F. Easley, Governor
e6 William G. Ross Jr.; Secretary
DUCr Nonh Carolina Department of Environment and Natural Resources
1
Q Y Coleco n. Sullins, Director
Division of Water Quality
October 12. 2007
Nic's Pic Kwik, Inc.
Attn: Charles Dean Nichols, Jr., President
PO Box 1209
Laurinburg, NC 28353
Subject: Stormwater Management Permit SNV6070902
Nic's Pic Kwik Convenience Store
High Density Project
Moore County
Dear Mr. Nichols
The Fayetteville Regional Office of the Division of Water Quality received a complete
Stormwater Management Permit Application for the Nic's Pic Kwik Convenience Store project on
October 3, 2007. 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.
Therefore, we are forwarding herewith Stormwater Management Permit SW6070902 dated October 12,
2007, for the construction of the subject project.
This pern3it shall be effective from the date of issuance until October 11, 2017 and shall be
subject to the conditions and limitations as specified therein. Please pay special attention to the
Operation and Maintenance requirements in this pennit. Failure to establish an adequate system for
operation and maintenance of the stornnvater management system will result in future compliance
problems.
o 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) calendar 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
Mike Lawyer, or myself at [phone].
Sincerely,
l�L��� l u�y19'cYv
Belinda S. Henson
Regional Supervisor
Surface Water Protection Section
BSH: ML/ml
cc: Bryan Welborn -Neal Smith Engineering, Inc.
Moore County Planning Department
FRO -Surface Water Protection
Water Quality Central Files
o, e
NorthCarolin❑
'Xallllal�q
Nonh Carolina Division of Water Quality 225 Green Street -Suite 714 Fayetteville, NC 28301 Phone [phone] Customer Service
Intenme www.ncwnteruualitv.ore Fax [phone]
An Equal Opponunily/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper

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
Charles Dean Nichols, Jr.-Nic's Pic Kwik, Inc.
Nic's Pic Kwik Convenience Store
Moore County
FOR THE
construction, operation and maintenance of a bioretention area 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 October 11, 2017 and shall be subject to the
following specified conditions and limitations:
1. DESIGN STANDARDS
l . This permit is effective only with respect to the nature and volume of stormwater described in
the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as
described in Section I.6 of this permit. The stormwater controls have been designed to handle the
runoff from 40,077 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.6 of this permit,
and per approved plans.
4. All stormwater collection and treatment systems must be located in either dedicated common
areas or recorded easements. The final plats'for the project will be recorded showing all such
required easements, in accordance with the approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this project most be
directed into the permitted stormwater control system.

6. The following design criteria have been provided in the bioretention area and must be maintained
at design condition:
a. Drainage Area, acres: 1.76
b. Total Impervious Surfaces, ft2:
C. TSS removal efficiency:
d. Bioretention Depth, inches:
C. Temporary Ponded Depth Elevation, FMSL:
Bioretention Bottom Elevation, FMSL:
f. Bioretention Surface Area, ft2:
g. Permitted Storage Volume, ft3:
Minimum Required Volume, ft3:
h. Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
11. SCHEDULE OF COMPLIANCE
40,077
85'%,
6.0
592.5
588.0
3,130
3,326
3,325
Little River/Cape Pear
18-23-(1)
" %N7S-III;HQW"
I . The stormwater management system shall be constructed in its entirety, vegetated and
operational for its intended use prior to the construction of any built -upon surface.
2. During construction, erosion shall be kept to it minimum and any eroded areas of the system will
be repaired immediately.
3. The permittee shall, at all times, provide the operation and maintenance necessary to assure the
permitted stonnwater 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, 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.
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.
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. . .

If the stormwater system was used as an Erosion Control device, it must be restored to design
conditions prior to operation as a stormwater treatment device, and prior to occupancy of the
facility.
8. Access to the stonnwater facilities shall be maintained via appropriate casements at all times.
9. The permittee shall submit to the Director and shall have received approval for revised plans,
specifications, and calculations prior to construction, for any modification to the approved plans,
including, but not limited to, those listed below:
a. Any revision to any item shown on the approved plans, including the stormwater
management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project area. The project
area is defined as all property owned by the permittee, for which Erosion and
Sedimentation Control Plan approval or a CAMA Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan.
10. The pennittee shall submit final site layout and grading plans for any permitted future areas
shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by the Permittee for
a minimum of ten years from the date of the completion of construction.
12. The Director may notify the permittee when the permitted site does not meet one or more of the
minimum requirements of the permit. Within the time frame specified in the notice, the pennittee
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.
13. This permit shall be effective from the date of issuance Until October 11, 2017. Application for
permit renewal shall be submitted 180 days prior to the expiration date of this permit and must
be accompanied by the processing fee.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director. In the event of
a change of ownership, or a name change, the permittee must submit a formal permit transfer
request to the Division of Water Quality, accompanied by a completed name/ownership change
form, documentation from the parties involved, and other supporting materials as may be
appropriate. The approval of this request will be considered on its merits and may or may not be
approved. The permittee is responsible for compliance with all permit conditions until such time
as the Division approves the transfer request.
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.
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) havingjurisdictiot.
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 stonnwater
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.
Unless specified elsewhere, permanent seeding requirements for the stonnwater 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
thirty (30) calendar days.
Permit issued this the twelfth day of October 2007.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
� Q
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Stormwater Management Permit SNN'6070902

Nic's Pic Kwik Convenience Store
Stormwater Management Permit SW6070902
Moore County
Designer's Certification
Page I of 2 11
1, as a duly registered in the State of
North Carolina, having been authorized to observe (periodically/ weekly/ full time) the construction of
the project,
(Project)
for (Project Owner) hereby state that, to the best of my,
abilities, due care and diligence was used in the observation of the project construction such that the
construction was observed to be built within substantial compliance and intent of the approved plans and
specifications.
The checklist of items on page 2 of this form is a part of this Certification.
Noted deviations from approved plans and specification:
SEAL;
Signature
Registration Number
Date

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

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Land Resources
Jaynes D. Simons, PG, PE Land Quality Section Michael F. Easley, Governor
Director and State Geologist William G. Ross Jr., Secretary
May 4, 2007
LETTER OF APPROVAL WITH MODIFICATIONS
Nic's Pic Kwik, Inc.
Attn: Charles Dean Nichols J, President
P.O. Box 1209
Laurinburg, NC 28353-
RE: Project Name: Nic's Pic Kwik Convenience Store Acres Approved: 1.36
Project ID: Moore-2007-021
County: Moore West End Hwy 211
River Basin: Cape Fear Stream Classification: HQW
Submitted By: Neal Smith Engineering, Inc.
Date Received by LQS: 4/10/2007
Plan Type: New
Dear Charles Dean Nichols J.:
This office has reviewed the subject erosion and sedimentation control plan. We find the
plan to be acceptable with modifications and hereby issue this letter of Approval With
Modifications. The Modifications Required for Approval are listed on the attached page. This
plan approval shall expire three (3) years following the date of approval, if no land -disturbing
activity has been undertaken, as is required by Title 15A NCAC 4B .0129.
Please be advised that Title 15A NCAC 4B .011 &(a) requires that a copy of the approved
erosion control plan be on file at the job site. Also, you should consider this letter to give the
Notice required by G.S. 113A-61.1(a) of our right of periodic inspection to insure compliance
with the approved plan.
North Carolina's Sedimentation Pollution Control Program is performance -oriented,
requiring protection of existing natural resources and adjoining properties. If, following the
commencement of this project, it is determined that the erosion and sedimentation control plan is
inadequate to meet the requirements of the Sedimentation Pollution Control Act of 1973 (North
Carolina General Statute I I3A-51 through 66), this office may require revisions to the plan and
implementation of the revisions to insure compliance with the Act.
Fayetteville Regional Office
225 Green Street — Suite 714, Fayetteville, North Carolina 28301 • Phone: [phone] / FAX: [phone]

Letter of Approval with Modifications
Nic's Pic Kwik. Inc.
May 4, 2007
Page 2 of 3
Acceptance and approval of this plan is conditioned upon your compliance with Federal
and State water quality laws, regulations, and rules. In addition, local city or county ordinances
or rules may also apply to this land -disturbing activity. This approval does not supersede any
other permit or approval.
Please be aware that your project will be covered by the enclosed NPDES General
Stormwater Permit NCGOI 000 (Construction Activities). You should first become familiar with
all of the requirements for compliance with the enclosed general permit.
Please note that this approval is based in part on the accuracy of the information provided
in the Financial Responsibility Form, whi.ch you have provided. You are requested to file an
amended form if there is any change in the information included on the form. In addition, it
would be helpful if you notify this office of the proposed starting date for this project. Please
notify us if you plan to have a preconstruction conference.
Your cooperation is appreciated.
Sincerely,
Jodi Pace, El
Land Quality Section
Enclosures: Certificate of Approval
Modifications Requiredior Approval
NPDES Permit
Cc: Neal Smith Engineering, Inc.
Jonathan S. Thomas, Building Inspector
Belinda Henson, Division of Water Quality
Land Quality Section
t

Letter of Approval with Modifications
Nic's Pic Kwik, Inc.
May 4, 2007
Page 3 of 3
MODIFICATIONS REQUIRED FOR APPROVAL
Project Name: Nic's Pic Kwik Convenience Store
Project ID: Moore-2007-021
County: Moore
1. Silt Fence and Temporary Diversion Berm are shown to be outside the limits of
disturbance. All measures must be within the limits of disturbance. Please modify the
plan and send in two sheets showing the modifications.
The updated version of the N. C. Erosion and Sediment Control Planning & Design
Manual is now posted ea the Land Quality web site at
hitp/otie;w d9r.enr.cta8e.nc.us/haves/nianualsandvideos.ht�n! Revision packets have been
mailed to people who have previously purchased manuals, and returned a postcard
verifying their current address. if you have a manual and did not receive a postcard due to
a change in address, please send an email to Stenhanie.L:inera ncmail.net Include your
name and mailing address and the serial number on the first page of your manual (if
available).

L
STORMWATER MANAGEMENT
Nic's Pic KwIK
NC Hwy 211
WEST END, VIRGINIA
DENR-FRO
SEr 2 81007
DWO
SEPTEMBER 24, 2007
NEAL SMITH ENGINEERING, INC. Project No. 0700502

Table of Contents
Stormwater Management Permit Application Form..............Section 1
And Bioretention Supplement
Project Narrative .......................................................Section 2
Project Map.............................................................Section 3
Special Non -Intensity Allocation Permit...........................Section 4
Soils Report ............................................................Section 5

-OFFICE 'USE ONLY
Date Received
Fee Paid
Permit Number,
S
to '76 o 2—
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc, who owns the project):
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
Charles Dean Nichols. Jr.. President
3. Mailing Address for person listed in item 2 above:
PO Box 1209
City:
Telephone Number: L- 910 ) 280-3120
State: NC Zip:_28353
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Nic's Pic Kwik Convenience Store
5. Location of Project (street address):
119 Pinewood Street
City:_ West End
6. Directions to project (from nearest major intersection):
County: Moore
The project is located 0.22 miles north of the intersection of NC Hwy. 211 and NC Hwy. 73 on the corner of NC Hwy
7. Latitude: 35,14357262 Longitude: 79.34631770 of project
8. Contact person who can answer questions about the project:
Name:_ Charles Dean Nichols, Jr. Telephone Number.
II. PERMIT INFORMATION:
1. Specify whether project is (check one): _ X New Renewal
280-3120
Modification
Form SWU-101 Version 3.99 Page 1 of 4

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number and its issue date (if known)
3. Specify the type of project (check one):
Low Density -X High Density _Redevelop _General Permit _Other
4. Additional Project Reouirements (check applicable blanks):
_CAMA Major .X Sedimentation/Erosion Control 404/401 Permit _NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748.
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describine stormwater mana¢ement for the project .
Stormwater will be collected by grate/curb inlets and curb cuts then conveyed to a Bioretention Cell for infiltration.
2. Stormwater runoff from this project drains to the
River basin.
3. Total Project Area: 1.76 acres 4. Project Built Upon Area: 52.3 %
5. How many drainage areas does the project have?_ 1 _
6. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as below.
Bann I format one y`
r ¢-.�-a:'.c. ,-m -• :.y.^�+.' .Yt 3A 'a�"-3%.
b a Drai age Area 1
"A 4i...
Little River
Dramage Are a 2' F
Receiving Stream Name
Receiving Stream Class
WS-III; HQW
76,665 SF _
3665 SF
40,077 SF_
Drainage Area
Existing Impervious* Area
Proposed Impervious#Area
% impervious` Area (total)
52.3%
n rr"1. + { .� n
Impervtous Surfac_eArea�xrr`
, r: a ��� w,��
r ,�w�ri:. DramageArea 1 ,, 4,rry
3,750 SF
DramageA�ea`2x
� a - -
On -site Buildings
On -site Streets
On -site Parking
35,107 SF
On -site Sidewalks
1,220 SF
Other on -site
Off -site
Total: 40,077 SF
Total:
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version 3.99 Page 2 of 4

7. How was the off -site impervious area listed above
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
The following italicized deed restrictions and protective covenants are required to be recorded for all
subdivisions, outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table
listing each lot number, size and the allowable built -upon area for each lot must be provided as an attachment.
1. The following covenants are intended to ensure ongoing compliance with state stormwater management permit number
as issued by the Division of Water Quality. These covenants may not be
changed or deleted without the consent of the State.
2. No more than square feet of any lot shall be covered by structures or impervious materials.
Impervious materials include asphalt, gravel, concrete, brick, stone, slate or similar material but do not include wood
decking or the water surface of swimming pools.
3. Swales shall not be filled in, piped, or altered except as necessary to provide driveway crossings.
4. Built -upon area in excess of the permitted amount requires a state stormwater management permit modification prior to
construction.
5. All permitted runoff from outparcels or future development shall be directed into the permitted stormwater control
system. These connections to the stormwater control system shall be performed in a manner that maintains the integrity
and performance of the system as permitted.
By your signature below, you certify that the recorded deed restrictions and protective covenants for this project
shall include all the applicable items required above. that the covenants will be binding on all parties and persons
claiming under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the State, and that they will be recorded prior to the sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below mast be submitted for each
BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the status
and availability of these forms.
Form SWU-102
Wet Detention Basin Supplement
Form SWU-103
Infiltration Basin Supplement
Form SWU-104
Low Density Supplement
Form 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-101 Version 3.99 Page 3 of 4

VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. The complete application package should be
submitted to the appropriate DWQ Regional Office.
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Ini
• Original and one copy of the Stormwater Management Permit Application Form
• One copy of the applicable Supplement Form(s) for each BMP
• Permit application processing fee of $420 (payable to NCDENR)
• Detailed narrative description of Stormwater treatment/management
• Two copies of plans and specifications, including:
- Development/Project name
- Engineer and firm
-Legend
- North arrow
- Scale
- Revision number & date
- Mean high water line
- Dimensioned property/project boundary
- Location map with named streets or NCSR numbers
- Original contours, proposed contours, spot elevations, finished floor elevations
- Details of roads, drainage features, collection systems, and Stormwater control measures
- Wetlands delineated, or a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
- Drainage areas delineated
- Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section.
Designated agent (individual or firm): Neal Smith Engineering, Inc.
Mailing Address:_ 139 Pinehurst Avenue Suite C
City:_ Southern Pines _ State:— NC Zip
Phone: ( 910 ) 695-8825 Fax: ( 910 ) 695-8832
VIII. APPLICANT'S CERTIFICATION
28387
1, (print or type name of person listed in General Information, item 2) Charles Dean Nichols, Jr.
certify that the information included on this permit application form is, to the best of my knowledge, correct anc
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of 15A
NCAC 2H .1000. _ ,
Signatu
Date: &g'� �G� %
Form SWU-101 Version 3.99 Page 4 of 4

Permit No.
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
BIORETENTION BASIN SUPPLEMENT
This form may be photocopied for use as an original.
DWO Stormwater Management Plan Review
A complete stormwater management plan submittal includes a Stormwater management permit application, a
bioretendon area supplement for each proposed system, sealed design calculations, a detailed soils report and 2 sets
of plans and specifications showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : Nids Pic Kwik Convenience Store
Contact Person: Charles Dean Nichols, Jr.
Phone Number: ( 910 )_ 280-3120
For projects with multiple basins, specify which basin this worksheet applies to:
(must match the DA N on the application & plans)
II. DESIGN INFORMATION Attach supporting calculations/documentation. Provide a written soils report
based on actual field investigations conducted by a qualified individual. The soils report should include
informational references to the County soils maps when available. All elevations shall be in feet mean sea level
(fmsl).
Soils Report Summary
In -Situ Soil Type Canrinr-Ilrban
In -Situ Soil Infiltration Rate —_ + in./hr. (the most restrictive .soil layer)
SHWT Elevation -_> FR2 ft. (Seasnnal Nigh Water Table elevation)
Planting Soil Texture . San�v loam (must be a sandy loam, loamy sand, or loam texture)
Planting Soil Infiltration Rate —1.0 _ in./hr.
Basin Design Parameters
Drainage Area
_ 76,665 _
sq.ft. (on -site and off -site drainage to the basin)
Impervious Area
_Ann n77__
sq.ft. (on -.site and of -site drainage to the basin)
Design Storm
1 n
inch (1.5 inch eventforSA waters, I inch eventforothers)
Design Volume
Inlet Velocity
__ __
_ 2 325 __
c.f. (storage volume required) // /
— {. d,'rs;PaAw � eh A?aGs'8s,.�s� A SAS
—4_2--fps
nav-
%
DrawdownTime
_48_hours
iv /e'- e asr?M c vsYvo( a
Basin Elevations
jam, -&174e _k All? —� �,Yd. wWs_1..
592.5
�..q
Temporary Pool Elevation
fmsl (elevation of the blpass/oudet structure)
Planting Elevation
__
_ 592.0 _
fmsl (elevation of the ground .surface bottom)
Bottom Elevation
_ 588.0 _
fmsl (elevation of the bottom of the planting media)
Basin Dimensions
Basin Size
__ 15 __
ft. x —208.7 _ ft. = _-3130 sq. ft. (surface area at basin bottom)
Basin Volume Provided
_ 3326 _
c.f.
SWU-108 4.07
Page I of 4

Basin Plantings
Number of plantings required _ 28 ---
stems (400 stemv per acre of biere!ention area is requiredal a minimum)
Total No. of plantings provided —,U— = Trees _ 9 _ + Shrubs_ 23 _ (at least ) tree for every 3 shrubs)
This system (check one) does X does not incorporate the use of an under -drain.
(Under -drains are not allowed for those projects that drain to class SA waters.)
III. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the North Carolina Stormwater Best Management Practice
Manual and Administrative Code Section: 15A NCAC 2H .1000. These requirements are subject to change in
accordance with the manual and rules.
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach written justification. An incomplete
submittal package will result in a request for additional information and will substantially delay final review and
approval of the project.
Applicant's Initials
a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
b. No vertical sand bed is proposed.
c. The bioretention area is at least 15 feet wide by 40 feet long.
See Attached d. A grass buffer strip and sheet flow conditions are provided at the inlet.
_ e. Seasonal High Water table depth is at least 2 feet below the planting elevation surface.
f. Ponding depth of 6-I2" is provided.
100 g. In -situ soils have a minimum hydraulic conductivity of 0.52 inches per hour.
h. An in-depth soils report is provided. (report should include soil types, boring log, map,
y�� suitability for placement of the control system, seasonal high water table, infiltration rate, etc.)
lip i. The planting soil has a minimum hydraulic conductivity of 0.52 inches per hour. The type and
placement specifications of the planting media are noted on the plans.
o� j. The planting soil meets minimum soil specifications per the latest version of the NCDENR
Stormwater Best Management Practices Manual, including a low phosphorus content to
promote phosphorus removal. (P-Index of 20 to 40 is optimal.) Include a soils test, indicating
j P-Index, from a certified lab for those projects draining to Nutrient Sensitive Waters.
k. System is designed to draw down the design storage volume to the proposed bottom elevation
under seasonal high water conditions within 24 hours. Draw down calculations are attached.
!� 1. A detailed planting plan, prepared by a qualified individual, is provided on the plans. This plan
shall indicate a variety of suitable species, location, spacing, soil preparation, fertilizer
requirements, installation procedures, construction schedule, etc..
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Type layer
m.
of mulch and depth is specified on the plans.
!�= n.
Plan and section details for the bioretention area are provided. (including dimensions and
elevations)
o.
Plan details for the inlet and outlet structures are provided. (including dimensions and
elevations)
p.
All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
q.
A benchmark is provided to determine the sediment accumulation in the basin area.
See Attached r. Vegetated filter is provided for overflow and detail is shown on plans (Required minimum
length is 50 feet for SA waters, 30 feet for other waters).
See Attached s. Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
t. 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.
IV. BIORETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
Records of maintenance items to include dates, inspector's name, type of maintenance, etc. shall be kept and made
available to Division staff upon request. Maintenance activities shall be performed as follows:
1. Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after
every significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed, re -plant, and re -mulch as necessary to maintain good vegetative and
mulch cover.
3. Remove accumulated sediment as needed to maintain good infiltration. When the filtering capacity diminishes
substantially (e.g., when water ponds on the surface for more than 24 hours), the top few inches of material must
be removed and replaced with fresh planting soil material. Regardless of infiltration capacity, accumulated
sediment in the bioretention basin shall be removed when the depth 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.).
4. Replace, or add additional mulch as needed. Removal of the old mulch layer before applying the new layer is
recommended every 2 to 3 years.
5. Prune trees and shrubs and remove debris on an annual basis. Grassed vegetation should not exceed 6 inches in
height.
6. Treat all diseased trees and shrubs whenever needed. Remove and replace all dead and diseased vegetation
considered beyond treatment every 6 months.
7. Replace support stakes yearly (in the spring). Replace deficient stakes or wires whenever needed
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8. Soil testing shall be conducted annually to determine pH and any accumulation of toxins in the planting media.
Lime or other alkaline substances shall be applied as recommended per the soil test and toxic soils shall be
removed, disposed of properly and replaced with new planting media.
9. All components of the bioretention area system shall be maintained in good working order.
10. 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 A 000 must be designed, approved and constructed.
I acknowledge and agree by my signature below that I am responsible for the performance of the ten 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 i
Title:
Address: 67& Ale' ,2,,O- r.2
Phone: _'_ai% arf O
Signature: l%n
Date:
Note: The legally responsible party should not be a homeowners association unless more than 50`.t, of the lots have been sold and a
resident of the subdivision has been named the president. �, \
I, Ir • S�n'.,e Sa � A t 5 a Notary Public for the
1 State of 'y c AA— Ce
`
County of k-c� 2 do hereb /
certify that � �Vtn. e S � i CL,.k 5 �..
personally appeared before me this day of (J�e vr^1-y�✓ o r 1 , and acknowledge the
due execution of the forgoing bioretention basin maintenance requirements. Witness my hand and official seal,
SEAL
My commission expires O
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NCDENR-Division of Water Quality
Subject: Exceptions to required items checklist
On Bioretention Basin Supplement
Section III, Item d.
Requirement: A grass buffer strip and sheet flow conditions are provided at the inlet.
Stormwater enters the system via an outlet pipe or curb cut with a velocity dissipater and
a centipede grass strip.
Section III, Item r.
Requirement: Vegetative filter is provided for overflow and detail is shown on plans
(required minimum length is 50 feet for SA waters, 30 feet for other waters).
Overflow enters NC Hwy. 211 right of way through overflow weir. Area immediately
following the overflow weir will have centipede grass sod.
Section III, Item s.
Requirement: Runoff in excess of the design volume bypasses off-line systems (bypass
detail provided).
Runoff in excess of the design volume will overflow in -line through an overflow weir.