SW7080930_CURRENT PERMIT_20081121

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW zD��
DOC TYPE
CURRENT PERMIT
l
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
Ia/69llo�
YYYYM M DD

CG
Michael F Easley, Governor
William G Ross Jr, Secretary
North Carolina Department of Environment and Natural Resources
November 21, 2008
Ms. Patricia Pledger, President
Pledger Palace Child Development and Educational Center, Inc.
P.O. Box 299
Jarvisburg, NC 27947
Subject: Stormwater Permit No. SW7080930
Pledger Day Care Center
High Density Project
Currituck County
Dear Ms. Pledger.
Coleen H. Sullins, Director
Division of Water Quality
The Washington Regional Office received a complete Stormwater Management Permit Application for the
proposed Pledger Day Care Center on September 23, 2008. 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
21-1.1000. We are forwarding Permit No. SW7080930 dated November 21, 2008, for the construction of the
subject protect.
iZ13d/2t
This permit shall be effective from the date of issuance until November 21, 2018, 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 150E 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 Roger Thorpe, or
me at [phone].
ncerely, I
AI Hodge
Regional Supervisor
Surface Water Protection Section
cc: Quible & Associates, P.C.
Currituck County Building Inspections
Division of Coastal Management— Elizabeth City
-.�ashington Regional Office
Central Files
North Carolina Division of Water Quality Internet wain• ncoaterquahty ore
943 Washington Square Mall Phone [phone]
Washington, NC 27889 Fax [phone]
NorthCarolina

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
Pledger Palace Child Development and Educational Center, Inc.
Pledge Day Care Center
Currituck County
FOR THE
construction, operation and maintenance of an infiltration basin 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 November 21, 2018, and shall be subject to the
following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater described in the
application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as described in
Section 1.6 of this permit. The stormwater controls have been designed to handle the runoff from 29,171
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. The built -upon area for the future development is limited to 29,171 square feet.
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 basin and must be maintained at design
condition:
a.
Drainage Area, fit:
37,613
b.
Total Impervious Surfaces, ft2:
29,171
C.
Design Storm, inches:
1.0
d.
Basin Depth, feet:
3.5
e.
Bottom Elevation, FMSL:
7.0
f.
Bottom Surface Area, ftz:
2,234
g.
Overflow Elevation, FMSL:
10.5
h.
Required Storage Volume W:
2,345
i.
Permitted Storage Volume, W:
12,033
j.
Type of Soil:
Conetoe Loamy Sand
k.
Expected Infiltration Rate, in/hr:
2.0
I.
Seasonal High Water Table, FMSL:
5.0
M.
Time to Draw Down, days:
0.9
n.
Receiving Stream/River Basin:
Currituck Sound/Pasquotank
o.
Classification of Water Body:
SC
If. SCHEDULE OF COMPLIANCE
1
2.
3.
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.
During construction, erosion shall be kept to a minimum and any eroded areas of the system will be
repaired immediately.
The permittee shall at all times provide the operation and maintenance necessary to assure the permitted
stormwater system functions at optimum efficiency. The approved Operation and Maintenance Plan must
be followed in its entirety and maintenance must occur at the scheduled intervals including, but not limited
to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and specifications.

f Debris removal and unclogging of bypass structure, infiltration media, flow spreader, catch
basins, piping and vegetated filter.
g. A clear access path to the bypass structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon request to authorized personnel
of DWO. The records will indicate the date, activity, name of person performing the work and what
actions were taken.
5. 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.
6. 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.
7. If the stormwater system was used as an Erosion Control device, it must be restored to design condition
prior to operation as a stormwater treatment device, and prior to occupancy of the facility.
8. Access to the stormwater facilities shall be maintained via appropriate easements 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 Sedimentation and Erosion Control Plan
approval or a CAMA Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan.
10. The permittee 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 at all times.
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 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.

III. GENERAL CONDITIONS
1. 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.
2. Failure to abide, by the conditions and limitations contained in this permit may subject the Permittee to
enforcement action by the Division of Water Quality, in accordance with North Carolina General Statute
143-215.6A to 143-215.6C.
3. The issuance of this permit does not preclude the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other government agencies (local, state, and
federal) having jurisdiction.
4. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions,
the Permittee shall take immediate corrective action, including those as may be required by this Division,
such as the construction of additional or replacement stormwater management systems.
5. The permittee grants DENR Staff permission to enter the property during normal business hours for the
purpose of inspecting all components of the permitted stormwater management facility.
6. The permit may be modified, revoked and reissued or terminated for cause. The filing of a request for a
permit modification, revocation and reissuance or termination does not stay any permit condition.
7. Unless specified elsewhere, permanent seeding requirements for the stormwater control must follow the
guidelines established in the North Carolina Erosion and Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference and are enforceable
parts of the permit.
9. The permittee shall notify the Division any name, ownership or mailing address changes within 30 days.
10. This permit shall be effective from the date of issuance until November 21, 2018. 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.
Permit issued this the 21 st day of November 2008.
NORTH CARROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
�I
forColeen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. SW7080930

Pledger Day Care Center
Stormwater Permit No. SW7080930
Cunituck County
Designer's Certification
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
Owner) hereby state that, to the best of my abilities, due
care and diligence was used in the observation of the project construction such that the construction was
observed to be built within substantial compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
SEAL
Signature
Registration Number
Date

Certification Requirement's.
_1. The drainage area to the system contains approximately the permitted acreage.
2. The drainage area to the system contains no more than the permitted amount of built -upon area.
_3. All the built -upon area associated with the project is 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 bypass structure weir elevation is per the approved plan.
_6. The bypass structure is located per the approved plans.
_7. A Trash Rack is provided on the bypass structure.
_8. All slopes are grassed with permanent vegetation.
_9. Vegetated slopes are no steeper than 3:1.
_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. All required design depths are provided.
13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.

DWQUSE ONLY ,
Date Received
Fee Paid
Permit Number
bLP r 3 2008
5
S'7 %1-V'A' 'I State of North Carolina SW4� �/�/Og
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):
Pledger Palace Child Development and Educational Center Inc.
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
Patricia Pledger, President
3. Mailing Address for person listed in item 2 above:
City:iarvisburg State:NG Zip:27947
Phone: (252 ) 457-0050 Fax: [phone]
Email: [e-mail]
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Pledger Day Care Center
5. Location of Project (street address):
City:Point Harbor County:Currituck Zip:27964
6. Directions to project (from nearest major intersection):
From the north end of the Wright Memorial Bridge (Dare Co /Currituck Co line) head north on US 158 0.25
miles. Tom right on lames Griggs Rd and drive 01 miles. Turn right onto Helen Ct The project site is
located at the end of Helen Ct.
7. Latitude:36° 04' 59.31" N Longitude:75° 47' 47.38" W of project
8. Contact person who can answer questions about the project:
Name:Derek A. Dail, P.E. Telephone Number: (252 ) 261-3300
Email:[e-mail]
II. PERMIT INFORMATION:
1. Specify whether project is (check one): ®New ❑Renewal ❑Modification
Form SWU-101 Version 03.27.08 Page I of4
-TNF

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit numberNZA and its issue date (if known)
3. Specify the type of project (check one):
❑Low Density ®High Density ❑Redevelop ❑General Permit ❑Universal SMP ❑Other
4. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control 0404/401 Permit ❑NPDES Stormwater
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.
Storwater runoff is directed to a discrete collection system via overland flow and roof drains. The discrete
collection system subsequently conveys the storwater to an infiltration basin located at the rear of the property.
The primary stormwater treatment for the site is via infiltration.
2. Stormwater runoff from this project drains to the Pasauotank River basin.
3. Total Property Area: 1.56 acres 4. Total Wetlands Area: no wetlands on -site acres
5. 100' Wide Strip of Wetland Area: n/a acres (not applicable if no wetlands exist on site)
6. Total Project Area**:1.56 acres 7. Project Built Upon Area:44.80
8. How many drainage areas does the project have?1
9. 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.
For high density projects, com lete the table with one drainage area for each engineered stormwater device.
Basin Information
Drainage Area 1
Drainage Area 2
Receiving Stream Name
Currituck Sound
Stream Class & Index No.
SC
Total Drainage Area (sf)
37,613
On -site Drainage Area (sf)
37,613
Off -site Drainage Area (sf)
Existing Impervious* Area (sf)
Proposed Impervious*Area (sf)
29,171
% Impervious* Area (total)
77.56%
Impervious* Surface Area
Drainage Area 1
Drainage Area 2
On -site Buildings (sf)
12,592
On -site StnerJa (sf) A sp6 4
14,201
On-site-,� (sf)ConcrC+e
2,378
On -site Sidewalks (sf)
Other on -site (sf)
Off -site (sf)
Total (sf):
29,171
* Impervious area is defined as the built upon area including, bill not limited to, buildings, roads, parking areas,
sidearalks, gravel areas, etc.
**Total project area shall be calculated based on file current policy regarding inclusion of wetlands in the built upon area
percentage calculation. This is the area used to calculate percent project built upon area (BUA).
Form SWU-101 Version 03.27 08 Page 2 of 4

10. How was the off -site impervious area listed above
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
One of the following 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. Forms can be
downloaded from ham://h2o.enr.state.nc.us/su/bmp forms.htm - deed restrictions.
Form DRPC-1
High Density Commercial Subdivisions
Form DRPC-2
High Density Developments with Outparcels
Form DRPC-3
High Density Residential Subdivisions
Form DRPC-4
Low Density Commercial Subdivisions
Form DRPC-5
Low Density Residential Subdivisions
Form DRPC-6
Low Density Residential Subdivisions with Curb Outlets
By your signature below, you certify that the recorded deed restrictions and protective covenants for this
project shall include all the applicable items required in the above form, 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 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. Forms can be downloaded from httu://h2o.enr.state.nc.us/su/bml2 forms.htm.
Form SW401-Low Density
Form SW401-Curb Outlet System
Form SW401-Off-Site System
Form SW401-Wet Detention Basin
Form SW401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-Level Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Form SW401-Permeable Pavement
Low Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
Permeable Pavement Supplement
Form SWU-101 Version 03.27.08 Page 3 of4

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 Office. (Appropriate office may be found by locating project on the
interactive online map at httl2://h2o.enr.state.nc.us/su/iiisi-maps.him)
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
A 1
• Original and one copy of the Deed Restrictions & Protective Covenants Form (if
�F n
required as per Part IV above)
• Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP
F�D
• Permit application processing fee of $505 (Express: $4,000 for HD, $2,000 for LD)
payable to NCDENR
• Calculations & detailed narrative description of stormwater treatment/management
'tO A Il
• Copy of any applicable soils report
0 A 6
• Two copies of plans and specifications (sealed, signed & dated), including:
A
- 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. (ex. designing engineer or firm)
Designated agent (individual or firm):Ouible & Associates, P.C.
Mailing Address:PO Drawer 870
City:Kitty Hawk State:NC Zip:27948
Phone: (252 ) 261-3300
EmaiLderekdgquible,com
VIII. APPLICANT'S CERTIFICATION
Fax: (252 ) 261-1260
I, (print or type name of person listed in General Informmtion, item 2) Patricia Pledger, President
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 21-1 100 .
Sig tore:C Date: a—( o1LR
Form SWU-101 Version 03.27.08 Page 4 of 4

a WE'D
Permit Number:
(to be provided by DWQ)
SEP 2 3 2008 Drainage Area Number:
Infiltration Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
Important maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the
infiltration basin.
— Immediately after the infiltration basin is established, the vegetation will be
watered twice weekly if needed until the plants become established (commonly
six weeks).
— No portion of the infiltration basin will be fertilized after the initial fertilization
that is required to establish the vegetation.
— The vegetation in and around the basin will be maintained at a height of
approximately six inches.
After the infiltration basin is established, it will be inspected once a quarter and within
24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of operation and maintenance will be kept in a known set location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
infiltration basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
The inlet device: pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
Swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the Swale if necessary to
Swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Form SW401-Infiltration Basin O&M-Rev3 Page 1 Of I

BMP element:
Potentialproblem:
How I will remediate theproblem:
The forebay
Sediment has accumulated
Search for the source of the
and reduced the depth to 75%
sediment and remedy the problem if
of the original design depth.
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Erosion has occurred or
Provide additional erosion
riprap is displaced.
protection such as reinforced turf
matting or riprap if needed to
revent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticides are used, wipe
them on the plants rather than
spraying.
The main treatment area
A visible layer of sediment
Search for the source of the
has accumulated.
sediment and remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP. Replace any media that
was removed in the process.
Revegetate disturbed areas
immediately.
Water is standing more than
Replace the top few inches of filter
5 days after a storm event.
media and see if this corrects the
standing water problem. If so,
revegetate immediately. If not,
consult an appropriate professional
for a more extensive repair.
Weeds and noxious plants are
Remove the plants by hand or by
growing in the main
wiping them with pesticide (do not
treatment area.
spray).
The embankment
Shrubs or trees have started
Remove shrubs or trees
to grow on the embankment.
immediately.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair.
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
outlet.
733-1786.
Form SW401-Infiltration Basin O&M-Rev.3 - Page of 2

Permit Number:
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the 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.
Project name:Pledger Day Care Center
BMP drainage area number: I of 1
Print name:Patricia M. Pledger
Title:President (Pledger Palace Child Development and Educational Center Inc.)
Address: PO Box 299, Jarvisburg NC 27947
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
a Notary Public for the State of
/�County of �p2� , do hereby certify that
nPLIR > Q I W P W s'f2 personally appeared before me this —ice
day of � ciw� , and acknowledge the due execution of the
forgoing infiltration basin maintenance requirements. Witness my hand and official seal,
ci;T„r ;_c'rt-
NOTARY FU--LIC
DARE COW17y,'40
ri
SEAL
My commission expires a0%�
Form SW401-Infiltration Basin O&M-Rev.3 Page 3 of 3

Pennd No
(Io erVmMeOMDwO)
F. author. a she :4E.'yN r,, CTe-�YJi.E i"S?com {^.L
Plows cone: de the YOM Shaded hems
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This fond must be AW rod, printed and submitted
The Required Items Checkbsl (Fart III) must be printed, filed oul and submitted along with all Of the required information
Project Name
Pleepw Day Cars Gaoler
Contain Person
Derek A D811
Phone Number
252261-KOO
Date
Drainage Area Number
1 of 1
II: DESIGN INFORMATION' 'S: '•"...
„ ,rn'-.•. r:=-
_ - .,... -.
n _ -
Site Chamctarirtim
Drainage arm
37,61300
112
Impervious area
Percent sniper
29,1710m
ft2
Design miNal depth
455
n
Peak Flow Calculations
1yr, 24-hr ruro0 depth
Na
n
1-yr,2velop "artery
Na
rvto
SEP 2 jr 2008
Pow-devlopmem tyr24-0rrmwO volume
Na
III
Postdovebpmem derhad volume
X3'sec
Pre✓Pos11-yr, 24-hr peakftrx cpttml
aVALOE!
L
X3'sEc
tE,l�-,Q-V}
��tl /-Zt1O
Storage Volume: Non -SR Waters
1
Minimum design volume required
264200
43
Design whore provided
t2.033 00
113
OK far rpD$R waters
Storage Volume: SR Waters
1 yr, 24-tu mural depth
Na
n
Predevebprent 1-yr, 24-Ie mreR
Na
X3
Post-covelopment 1 yr, 24-hr which
Na
113
Minimum vu'ume required
#VALUE'
113
Volume prodded
Na
X3
Soils Report Summary
Soil type
CRA
INitlral. rate
200
;-V
SNWT elevation
5W
final
Basin Design Pammnen;
Drawdown time
090
days
OK
Basin side sppes
3 W
1
OK
Basin bottom elevation
700
tmsl
OK
Storage eleaalm
1050
XrN
Storage SA
4,64200
f2
Top elevation
1050
Imsl
Basin Bottom Dlmemberse
Basin length
W20
X
Basin width
3960
X
Bottom SA
223400
h2
Adilbonal Information
Total runoff volume Captured by basin
Length of vege9atdm hider far wedlow
Durance to structure
Distance fran surface emote
Distance from water supply wel(5)
Separation from urpervnua sW by,
Naturally occurs g sot above sW
Bottom covered with bin of clean sand?
Proposed drayage aasemem prodded?
Capores all mnoff at otluwte birth
Bypass provided for larger stoma?
Pretreatment device provided!
321 sic -in
Maamumd2a're-andlesallowed —^
000 ft
RIKis 100 short dug be � 3041 10
18,50 fl
OK
Ism 00 X
OK
10000 X
OK
5Id X
OK
200 h
OK
(Y or N)
OK
y (Y sir N)
OK
y (Y or N)
OK
ri (Y or N)
Mist provide bypass fa layer fbw5
\Lr -
ErCC S_
<A,;fc`- �H. t"r �. CTOir r•� JrZvVr'^_ 13(Av,C Or'
! n•« "r n., iC f�f`D.,. NE ../7;
.r rah JS %jr'
Vrc:, %a s, V� t1iJr�f
3 -
EKCC iS
Crt sYC 1r PfJ �r[b
fSftl•J, dI In 0 YhG
VipG: !rr ac; oEL
Form S W401.imin,.eon Be—
Rw 2
Pero i 6 11 uesipn summary, P.m. , w t

Permit No.
(to be povdedN
III. REQUIREDITEMSCHECKLIST
Please Indicate the page or plan
sheet numbers where the supporting documentation can be found. An incomplete submittal package will
Page/ Plan
Initials Sheet No.
PA-6 of — e 3
1. Plans (1" - 50' or larger) of the entire site showing:
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Delineated drainage basins (include Rational C coefficient per basin),
- Basin dimensions,
- Pretreatment system,
- High flow bypass system, Exc ess srcAA46 e e. rr") PRov,OF 1� SN L. Fv e f
- Maintenance access, 13YPA.s.� s ysr.ht
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
6A D C 2
2. Partial plan (1"= 30' or larger) and details for the infiltration basin showing:
- Bypass structure,
- Maintenance access,
- Basin bottom dimensions,
- Basin cross-section with benchmark for sediment cleanout,
- Flow distribution detail for inflow,
-Vegetatedfilter,andExcrss 5-Tc,vjc.cw.sl "'� PRav%Da6 IAr L'EU av.it) crea
- Pretreatment device.
D A % C 2
3. Section view of the infiltration basin (1' = 20' or larger) showing:
Pretreatment and treatment areas, and
Inlet and outlet structures.
'b A D CA LC 5
4 t+ 7- ;-,
4. A table of elevations, areas, incremental volumes & accumulated volumes to verify the volume provided.
1hJ NA to Anvf :
5. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
S a rLs sFcna,v results of the soils report must be verified in the field by DWO, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
D AI) c 3
6. A construction sequence that shows how the infllration basin will be protected from sediment until the
entire drainage area is stabilized.
DAZ AVA1,4E
7. The supporting calculations.
DAD A rrA'µE.S
6. A copy of the signed and notarized operation and maintenance (O&M) agreement.
_/ti _ MIA
9. A copy of the deed restrictions (if required).
Form SW401-Infiltration Basm-Rev.2 Page 1 of 1 Part III Required Items Checklist, Page 1 of 1

/0-306 'seep
-es W'7a%6g30
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the . ,,I l
Land Quality Section, N.C. Department of Environment and Natural Resources. (Please type or print and, if
the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blankTP 2 / 200S
Part A.
J: �.
1. Project Name Pledger Day Care Center
2. Location of land -disturbing activity: County Currituck City or Township Point Harbor
Highway/Street Helen Ct. Latitude 360 04' 59.31" Longitude 750 47' 47.38"
3. Approximate date land -disturbing activity will commence: November 2008
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.49 ac.
6. Amount of fee enclosed: $ 130 The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Patricia Pledger - E-mai Address [e-mail]
Telephone [phone] Cell #
Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Pledger Palace Child Development and Educational Center Inc 252-457-0050 252-457-6470
Name Telephone Fax Number
PO Box 299 6470 Caratoke Hwv _
Current Mailing Address Current Street Address
Jarvisburg NC 27947 Grandy NC 27939
City State Zip City State Zip
10. Deed Book No. 924 Page No. 124 Provide a copy of the most current deed.
Part B.
Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
Pledger Palace Child Development and Educational Center, Inc [e-mail]
Name E-mail Address
PO Box 299 6470 Caratoke Hwv
Current Mailing Address Current Street Address
Jarvisburg NC 27947 Grandy NC 27939
City State Zip City State Zip
Telephone [phone] Fax Number 252-457-6470

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City
Fax Number
State Zip
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Patricia Pledger
Name of Registered Agent
PO Box 299
Current Mailing Address
pledgerpala [e-mail]
E-mail Address
6470 Caratoke Hwy
Current Street Address
Jarvisburg NC 27947 Grandy NC 27939
City State Zip City State Zip
Telephone [phone] Fax Number 252-457-6470
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any changeinformation provided herein.
\d�tic�Q M.�e oc� t'CeS,1c�(l�
_Ty"_Zt inf na e Title or Authority
G I I(0IC>
Date
y�cyy � a Notary Public of the County of
State of North Carolina, hereby certify that �i f ,2) (! )yg'1�w c Pil appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this /((' day of (�(:iT),P)) L 20
Notary i
Seal _ J )
a`w
My commission expires
Of{gISTINE A. BOYIE
NOTARY pUaLIG
p,4RE COI IrdTY, NO