SW7070305_CURRENT PERMIT_20070719

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW7Z DZNM75
DOC TYPE
00F CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATEQ7�a/
YYYYMMDD

\O�OF \N A r�9
Y
C) r
July 19, 2007
Blue Sun Development, LLC
Attn.: Jeremy Peang-Meth
626 West Main Street
Washington, NC 27889
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Subject: Permit No. SW7070305
Cedar Shores Subdivision, Phase 2
High Density Stormwater Project
Washington County
Dear Mr. Peang-Meth:
Coleen H. Sullins, Director
Division of Water Quality
The Washington Regional Office received a completed Stormwater Application for the subject project on
June 27. 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. We are forwarding Permit No. SV 7070305
dated July 19, 2007 to Blue Sun Development, LLC for the construction and operation of an infiltration basin to serve
the Cedar Shores Subdivision, Phase 2 development located along the NCSR 1315 — Breezy Banks Road in
Skinnersville Township, Washington County, NC.
This permit shall be effective from the date of issuance until July 19, 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 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, 6714 Mail Service Center, Raleigh, NC 27699.6714. 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 me or Samir
Dumpor at [phone].
Si cerely,
Al Hodge, Regional Supervisor
Surface Water Protection Section
Washington Regional Office
AH/sd J:\WPDATA\WQS\Samir- State SW\Permits - Infiltration
cc: Mifhael Tolson, PE, H.C. Harris, Jr. Engineering & Surveying, P.A.
Washington County Building Inspections Department
-'Washington Regional Office
Central Files
North Carolina Division of Water Quality Internet: �e�c�r.nc��utcruuolitc.nro_ One
943 Washington Square Mall Phone [phone] NorthCarolina
Washington, NC 27889 Fax [phone] Nahurally
An Equal Opportunity/Affirmative Action Employer - 50% Recyded110% Post Consumer Paper

State Stormwater Management Systems
Permit No. SW7070305
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
Blue Sun Development, LLC
Cedar Shores Subdivision, Phase 2
Washington County
FOR THE
construction, operation and maintenance of stormwater management systems 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 for an infiltration basin to serve the Cedar Shores Subdivision, Phase 2
development located along the NCSR 1315 — Breezy Banks Road in Skinnersville Township, Washington County,
NC.
This permit shall be effective from the date of issuance until July 19, 2017 and shall be subject to the following
specified conditions and limitations:
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 in *Section 1.6
of this permit. The stormwater control has been designed to handle the runoff from 313,771 square feet of
impervious area.
3. Each of the 29 lots in this 19.70 acres residential development is limited to a maximum of (see attachment)
square feet of built -upon area, as defined by the stormwater rules, and as indicated in the 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 must be directed into the
permitted stormwater control system.
6. The following design criteria have been provided in the infiltration basins and must be maintained at design
condition:

DIVISION OF WATER QUALITY
PROJECT DATA
Project Name:
Cedar Shores Subdivision, Phase 2
Permit Number:
SW7070305
Location:
Washington County
Applicant:
Blue Sun Development, LLC
Mailing Address:
626 West Main Street, Washington, NC 27889
Receiving Stream and index No.:
LIT to Big Swamp
Classification of Water Body:
SB
Total Site Area:
19.70 ac
Design Storm, inches:
1.0
Drainage area to Basin:
19.70 ac
Impervious area in drainage basin:
313,771 sf
Infiltration Basin Depth:
2.3 ft
Basin bottom elevation, FMSL:
7.70
Bypass Overflow Elevation, FMSL:
10.00
Type of Soil:
Tarboro
Provided Storage Volume:
28,774 cf
Time to Draw Down:
0.25 days
Expected Infiltration Rate, in/hr:
0.8

The following items will require a modification to the permit:
a. Any revision to the approved plans, regardless of size
b. Project name change
C. Transfer of ownership
d. Redesign or addition to the approved amount of built -upon area
e. Further subdivision of the project area.
In addition, the Director may determine that other revisions to the project should require a modification to the
permit.
8. 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.
SCHEDULE OF COMPLIANCE
The permittee will comply with the following schedule for construction and maintenance of the stormwater
management system.
a. 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 surfaces except roads.
b. During construction, erosion shall be kept to a minimum and any eroded areas of the system will be
repaired immediately.
2. The facilities must be properly maintained and operated at all times. The approved Operation and
Maintenance Plan must be followed in its entirety and maintenance must occur at the scheduled intervals.
3. The permittee shall at all times provide the operation and maintenance necessary to assure the permitted
stormwater system functions at optimum efficiency including, but not limited to:
a. Semiannual scheduled inspections (every 6 months)
b. Sediment removal
C. Mowing and revegetation of side slopes
d. Immediate repair of eroded areas
e. Maintenance of side slopes in accordance with approved plans and specifications
f. Debris removal and unclogging of outlet structure, orifice device and catch basins and piping.
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. 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.
6. Upon completion of construction 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. Mail the Certification to the Washington Regional Office, 943 Washington Square Mall,
Washington, North Carolina, 27889, attention Division of Water Quality.
7. A copy of the approved plans and specifications shall be maintained on file by the Permittee for the life of the
project.
8. Deed restrictions are incorporated into this permit by reference and must be recorded with the Office of
the Register of Deeds prior to the sale of any lot.

Recorded deed restrictions must include, at a minimum, the following statements related to
stormwater management:
a. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number SW7070305, as issued by the Division of Water Quality under
NCAC 2H.1000.
b. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to
maintain compliance with the Stormwater Management Permit.
C. These covenants are to run with the land and be binding on all persons and parties claiming
under them.
d. The covenants pertaining to stormwater may not be altered or rescinded without the express
written consent of the State of North Carolina, Division of Water Quality.
e. Alteration of the drainage as shown on the approved plans may not take place without the
concurrence of the Division of Water Quality.
f. The maximum built -upon area per lot is (see attachment ) square feet. This allotted amount
includes any built -upon area constructed within the lot property boundaries, and that portion of
the right-of-way between the front lot line and the edge of the pavement. Built upon area includes,
but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate, coquina, driveways,
and parking areas, but does not include raised, open wood decking, or the water surface of
swimming pools.
g. Filling in, piping or altering any 3:1 vegetated conveyances (ditches, swales, etc.) associated with
the development except for average driveway crossings, is prohibited by any persons.
h. Filling in, piping or altering any vegetated area associated with the development is prohibited by
any persons.
A 30' vegetated buffer must be maintained between all built -upon area and the Mean High Water
line of surface waters.
All roof drains shall terminate at least 30' from the Mean High Water mark.
10. The permittee must submit a copy of the recorded deed restrictions within 30 days of the date of
recording.
11. 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.
12. Prior to transfer of ownership, the swales must be inspected and determined to be in compliance with the
permit. Any deficiencies will be repaired or replaced prior to the transfer.

16. The final plats for the project will be recorded showing all required swale easements and common areas,
in accordance with the approved plans.
III. GENERAL CONDITIONS
1. This permit is not transferable. In the event there is a desire for the facilities to change ownership, or there is
a name change of the Permittee, a formal permit request must be submitted to the Division of Water Quality
accompanied by an application fee, 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.
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-
215.6(a) to 143-215.6(c).
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 permitee 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. An application for permit renewal must be submitted at least 180 days prior the expiration of this permit along
with the appropriate processing fee.
Permit issued this the 19th day of July, 2007.
CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
,,?a- Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number SW7070305

Blue Sun Development, LLC — Cedar Shores Subdivision, Phase 2
Stormwater Permit No. SW7070305
Designer's Certification
1, , as a duly
registered Professional Engineer in the State of North Carolina, having been authorized to observe
(periodically/weekly/full time)
the construction of the project,
for
Project)
(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.
Signature
Registration Number
Date
Certification Requirements:
1
_2.
3.
The drainage area to the system contains approximately the permitted acreage.
The drainage area to the system contains no more than the permitted amount of built -upon area.
All the built -upon area associated with the project is graded such that the runoff drains to the
system.
All roof drains are located such that the runoff is directed into the system.
The outlet/bypass structure elevations are per the approved plan.
The outlet/bypass structure is located per the approved plans.
Trash rack is provided on the outlet/bypass structure.
All slopes are grassed with permanent vegetation.
Vegetated slopes are no steeper than 3:1.
The inlets are located per the approved plans and do not cause short-circuiting of the system.
The permitted amounts of surface area and/or volume have been provided.
All required design depths are provided.
All required parts of the system are provided.
The required system dimensions are provided per the approved plans.

Lot Number
Area
19
27,806
sf
0.64 ac
8,342
sf
:tu.uuiu
20
25,632
sf
0.59 ac
7,690
sf
30.00%
21
31,803
sf
0.73 ac
9,541
sf
30.00%
22
30,009
sf
0.69 ac
9,003
sf
30.00%
23
30,624
sf
0.70 ac
9,187
sf
30.00%
24
29,756
sf
0.68 ac
8,927
sf
30.00%
25
27,046
sf
0.62 ac
8,114
sf
30.00%
26
25,734
sf
0.59 ac
7,720
sf
30.00%
27
20,107
sf
0.46 ac
6,032
sf
30.00%
28
19,996
sf
0.46 ac
5,999
sf
30,00%
29 ....26,719
sf
0.61 ac
8,016
sf
30.00%
30
26,557
sf
0.69 ac
7,967
sf
30.00%
31
23,490
sf
0.54 ac
7,047
sf
30.00%
32
20,042
sf
0.46 ac
6.013
sf
30.00%
33
23,527
sf
0.54 ac
7,058
sf
30.00%
34
27,290
sf
0.63 ac
8,187
sf
30.00%
35
36,188
sf
0.83 ac
10,856
sf
30.00%
36
24.711
sf
0.57 ac
7,413
sf
30.00%
37
23,313
sf
0.54 ac
6,994
sf
30,00%
4,000 sf per lot
38.
7,858
sf
0.18 ac
4,000
sf
50,91%
39
6,438
sf
0.15 ac
4,000
sf
62.13%
40
6,438
sf
0.15 ac
4,000
sf
62.13%
41
6,545
sf
0.15 ac
4,000
sf
61.12%
42
6,525
sf
0.15 ac
4,000
sf
61.30%
43
7,483
sf
0.17 ac
4,000
sf
53.45%
44
6,459
sf
0.15 ac
4,000
sf
61.93%
45
6,534
sf
0.15 ac
4,000
sf
61.22%
46
7,308
sf
0.17 ac
4,000
sf
54.73%
47
7,379
sf
0.17 ac
4,000
sf
54.21%
.% Impervious Varies
Lot 3847 common area / septic
32,025
sf
0.74 ac
0 sf
0.00%
Club House
55.352
sf
1.27 ac
38,746.40 sf
70.00%
Trailer Storage Common Area
39,742
sf
0.91 ac
27,819.40 sf
70.00%
Right of Way Area
161,798
sf
3.71 ac
57 100.00 sf
35,29%
Total Area 858,234.11 sf 19.70 ac 313.770.80 sf
Total Proposed Impervious Area 313 770.80 sf 36.56%

OFFICE USE .ONLY
Date Received
Fee Paid
Permit Number
5vJ-Io-Ic-)305
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
1. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
13L-U (��UN w LOP wLELy_T LL G
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
SEZEwty �CqQ/ r� - �FT1i1 14 nia A CZ
3. Mailing Address for person listed in item 2 above:
_(oZfo WG4--r IMaiN Sr¢E� r
City: \A)ASHip(b_-r State:
Zip:�$$9
Telephone Number: ( 2'3 Z ) gA45 - 99715
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.): wV1 - 1111°
PNA7E
C C=0A2 SHORES t3D-uts10N - Z
5. Location of Project (street address):
City: S-Y— fZ_SwtIL E '[ownlSaIP County: VYASHtN6Tor4
6. Directions to project (from nearest major intersection):
i 7?D M U $ 1, M 4 N L 32 %9_`� N_LEG�t oiy t�AvE - NoR7Ef_oiV NL 3z y�
iaRN 0J& T wq 591;&5 - 8ANAS 206D . 51iE wlt-�6 c—QN LEFT tD�oF RogD,
7. Latitude: 35 • 951 j 2 Longitude: -7(o • `(1595 of project
8. Contact person who can answer questions about the project:
Name: cNAEt,�> Tp� £. TelephoneNumbec ('5Z ) 3Zt - 5G07
It. PERMIT INFORMATION:
1. Specify whether project is (check one): New Renewal Modification
Form SWU-101 Version 3.99 Page I of4

�.-r.OFFICE',USF.ONLY
eceived
Date Received
Fee Paid
Permit Number
S 3
State of North Carolina
SWAC-K 6/�L7/07
Department of Environment and Natural Resources
.. Va. Division of Water Quality
Jv, -e / 2� fffORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original \
,'A
1. GEA�®INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
17L�-��ulY T�EtiFC.oD�yENT LL L -
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
�EIZEµty �raQ/ l� - WI F_TLi� /t'l EN1F3� n1 k/YB_f�-E-e
3. Mailing Address for person listed in item 2 above:
_(o��WEs-r tMa1N SrrzEf-r
City: u%[t$h-L/V1-LN State: IV L Zip: 278R9
Telephone Number: (213 7-
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
GEDat3___SHoRES Sy_6Dtu si!onL - �Fr�uosY
5. Location of Project (street address):
_C,,- PAZ—SHot7�Es_PP-1Jt: ' "
City:SiLINNIC9_SU-I WI-rown/l III County_yvrtsHw(.-ron/
6. Directions to project (from nearest major intersection):
FEou4 U5 c q 4- NC, i_2�4'J / 7E25tL7torly T?puEL No¢74' o/V NG 32/9
TORN QLG_N�N'Ib 5913/5- 896C2�8ANk5 2ogp 5/TE w1�4—DEAN—LEFT 5t2c of Rohp.
7. Latitude: 35 • 151 j 2 Longitude: 1(o • ' 1593 of project
8. Contact person who can answer questions about the project:
Name: LNAE Toy 0 -F,t• Telephone Number: (257 ) 3ZI - 5467
II. PERMIT INFORMATION:
1. Specify whether project is (check one): New Renewal Modification
Form SWU-101 Version 3.99 Pagel of4

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):
X—Low Density _High Density _Redevelop General Permit Other
4. Additional Project Requirements (check applicable blanks):
_CAMA'Major _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) describing stormwater management for the project .
S'r09MWA-rEC Wtr-t_ BS COMUt:YE_VAA 9mmipE SwA LEs "ro A eeZOA2_r-
�Nfj-TRA-7rOK SwA E_L.cA TE r7 f{t.aIY�MF EA�rE2rY ?t2or'ERTr c/N t' AL
7{JC[_I2EAR Of r_OT4 Zi - Z'i AND THE 'Ct? rG 2 STORA4F com»&VAj(F,�4.
2. Stormwater runoff from this project drains to the PA S Q u OTA N L River basin.
3. Total Project Area: 19 , -7O acres
5. How many drainage areas does the project have? 1
4. Project Built Upon Area _-54. to tp %
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.
Basin'Informattod-: 3-
Drainage Area 1 �:;
- ;_ ,'DramageArea 2 -Sr
Receiving Stream Name
UT of Bzr' 5 t%P
Receiving Stream Class
�j K 1 4 of
Drainage Area
0
Existing Impervious" Area
Proposed Impervious*Area
315,-27 1 Z$O e
% Impervious` Area (total)
Impervious' Surface Area '%
"' Drainage Area L; -
:Draniage ' rea 2
On -site Buildings
On -site Streets
(.Sol G
On -site Parking
3. y e ( (,
On -site Sidewalks
0-09 AL
Other on -site
Off -site
0 A G
Total: -1,2-0 C,
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 Slate, 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 must 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.
Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• 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 & dale
- 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)EE21N6 C- SLM0EY1Nra F. A
r-
MailingAddress: 'L((o IbA) s(EEEJ
City: State:- N C Zip:_Z859O
Phone: j 25 2 1 32 1 - 5ln 0 -1 Fax: ( 7e 5 Z ) 3Z ( - (o 2 0 $
Vlll. APPLICANT'S CERTIFICATION
I, (print or type name ofperson listed in General Information, item 2) SE RE w i Fa N (o - N%IE T"
certify that the information included on this permit application form is, to the best of my knowledge, correct and
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.
Date: iP ` 4 "0�-
Form SWU-101 Version 3.99 Page 4 of

Permit No. S W l 0-1 c�395-
(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
DWO Stormwater Manayement 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
919`1 - la l07
PAASC
Project Name: CEDAP SHoa65 5ubpi a 51brl SEE'141 l
Contact Person: SE¢Eund PCANr-w1ErH Phone Number. (257 Sys-g975
This worksheet applies to: Basin No. 1—
(as identified on plans)
in Drainage Area A
Urom Form SWU-101)
❑. 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 I';,Qsore.
infiltration Rate 0.(bCO n/hr r cf/hr/sf (circle appropriate units)
SH WT Elevation q.8 frost (Seasonal High Water Table elevation)
Basin Design Parameters
Design Storm
Design Volume
Drawdown 'rime
Basin Dimensions
Basin Size
Basin Volume Provided
Basin Elevations
Bottom Elevation
Storage Elevation
Top Elevation
inch (1.5 inch event far SA waters, I inch event for others)
21, 0011_ c.f.
0.15 days
ft. x�'-- ft. _ — sq. ft.
c.f.
-1.10 frosl
9.99- fmsl
10• 00 fmsl
(bottom dimensions)
Form SWU-103 Rev 3.99 Page l of 3

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
MB1 a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
�lffl b. System is located at least 100 feet from water supply wells.
�u jj c. Bottom of system is at least 2 feet above the seasonal high water table.
W d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
JJA97 e. System is not sited on or in fill material or DWQ approval has been obtained.
A7 f. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access casements to the nearest public right-of-way.
un4i�l g. Drainage area for the device is less than 5 acres.
h. Soils have a minimum hydraulic conductivity of 0.52 inches per hour and soils report is
attached.
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.
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.
Ail k. All side slopes stabilized with vegetated cover are no steeper than 3:1 (H:V).
I. A pretreatment device such as a catch basin, grease trap, filter strip, grassed swale or
sediment trap is provided.
DA3�1 in. 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.
_i,g� n. 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).
h o. Flow distribution mechanism within the basin is provided.
— p. A benchmark is provided to determine the sediment accumulation in the pretreatment device.
► q. Runoff in excess of the design volume bypasses off-line systems (bypass detail provided).
I — 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 enure 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

IV. 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 producingrainfall 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 establilslied 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.
I
When the design depth reads feet in the pretreatment unit, the sediment shall be
removed from both the pretreatment unit and the infiltration basin.
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.
I acknowledge and agree by my signature below that I am responsible for the 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: -56REMI IPE/.rur.- tMFTN - u1cut6E2ImAtM4EIZ
Address: (oZ& W ST MAtia STREET. WA5NIN6ToN N( Z?A89
Phone: 252- 946-g4"I57 Date:(, Z('10-1
i T
Note: The legally esponsiAlparty shoulYAot he a homeowners association unless more than 50% of the lots have been sold and a
resident of t e subdivision has been named the president.
I, _AjcC j c'L f). ToLgort , a Notary Public for the State of_Nor-TH CA¢e11Nq , County of 27
Ep(,6eomgE , do hereby certify that PEAM, - imVT14 personally appeared before me thisiftrii
day of --5uN_ c- , Z�'1 , and
Witness my hand and officiigwoatpnp,,-
SEAL
D. TpZ'9'
''•. 4,
N0-fARy ti
— • -- s
pUBUS ?_
the due execution of the forgoing infiltration basin maintenance requirements.
commission expires 11
Form SWU-103 Rj%•..... .....� Page 3 of 3