SW8000536_CURRENT PERMIT_20221122

STORMWATER DIVISION CODING SHEET
POST-CONSTRUCTION PERMITS
PERMIT NO. SW8 bw S *-,) cq
DOC TYPE CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE 2,3z2 '1 t Z 2
YYYYMMDD

ROY COOPER
Governor
ELIZABETH S.BISEP ^ .
Secretary
BRIAN WRENN NORTH CAROLINA
Director Environmental Quality
November 22", 2022
ZP No. 73, LLC
Attn: Jeffrey L. Zimmer, Manager
P.O. Box 2628
Wilmington,NC 28402
Subject: Permit Renewal
Post-Construction Stormwater Management Permit No. SW8000536
Long Leaf Mall Renovations
New Hanover County
Dear Mr.Zimmer:
Effective August 1,2013 the Post-Construction Stormwater Management Program has been transferred from the
Division of Water Quality("DWQ")to the Division of Energy, Mineral and Land Resources("DEMLR"). All
previous references to DWQ will remain in older permits issued prior to August 1, 2013 until they are modified.
Please note that this permit will now reference DEMLR as the Division responsible for enforcement of the permit.
The Division of Energy, Mineral and Land Resources received a complete 8-year Permit Renewal Application for
the subject permit on November 141, 2022. The Division is hereby notifying you that permit SW8000536 has
been renewed, updated, and re-issued on November 22', 2022, as attached. Please be aware that the renewal and
re-issuance of this stormwater permit does not imply that the site is currently in compliance.
This permit shall be effective until November 21", 2030 and does not supersede any other agency permit that may
be required. The project shall be subject to the conditions and limitations as specified therein. This permit does
not impose new or increased stormwater control requirements; it clarifies the rules and requirements of this
program to provide you with a better understanding of your obligations under this permit. Failure to comply with
these requirements will result in future compliance problems. Please note that this permit is not transferable
except after notice to and approval by the Division.
If any parts, requirements, or limitations contained in this permit are unacceptable,you have the right to request
an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings (OAH). The
written petition must conform to Chapter 150B of the North Carolina General Statutes and must be filed with the
OAH within thirty(30)days of receipt of this permit. You should contact the OAH with all questions regarding
the filing fee(if a filing fee is required)and/or the details of the filing process at 6714 Mail Service Center,
Raleigh,NC 27699-6714,or via telephone at 919-431-3000, or visit their website at www.NCOAH.com. Unless
such demands are made this permit shall be final and binding.
If you have any questions concerning this permit, please contact Aisia Freeman in the Wilmington Regional
Office, at(910)796-7318 or [e-mail].
Sincerely,
CA4 //4
For Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
Enclosures: Attachment A—Designer's Certification Form
Attachment C—Permitting History
Copy of the Renewal Application Documents
Copy of the current operation and maintenance agreement
DES/af:\\\Stormwater\Permits& Projects\2000\000536 HD\2022 11 permit 000536
cc: Wilmington Regional Office Stormwater File
North Carolina Department of Environmental Quality I Division of Energy.Mineral and Land Resources
Wilmington Regional Office 1127 Cardinal Drive Extension I Wilmington,North Carolina 28405
910.796.7215

Post-Construction Stormwater Management
Permit No. SW8000536
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
POST-CONSTRUCTION STORMWATER MANAGEMENT PERMIT
REDEVELOPMENT 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
Jeffrey L. Zimmer and ZP No. 73, LLC
Long Leaf Mall
4310 Shipyard Blvd, Wilmington, New Hanover County
FOR THE
redevelopment of existing impervious surfaces and treatment of the runoff in five (5) underground infiltration
trenches in compliance with the provisions of 15A NCAC 2H.1000 (hereafter referred to as the "stormwater
rules') as outlined in the application, approved stormwater management plans, supplement, calculations,
operation and maintenance agreement, recorded documents, specifications, and other supporting data (the
"approved plans and specifications") as attached and/or on file with and approved by the Division of Energy.
Mineral and Land Resources (the "Division" or "DEMLR"). The project shall be constructed, operated and
maintained in accordance with these approved plans and specifications. The approved plans and
specifications are incorporated by reference and are enforceable part of this permit.
This permit shall be effective from the date of issuance until November 21 sl, 2030 and shall be subject to the
following specified conditions and limitations. The permit issued shall continue in force and effect until the
permittee files a request with the Division for a permit modification, transfer, renewal, or rescission, however,
these actions do not stay any condition. The issuance of this permit does not prohibit the Director from
reopening and modifying the permit, revoking and reissuing the permit, or terminating the permit for cause as
allowed by the laws, rules, and regulations contained in Title 15A NCAC 2H.1000 and NCGS 143-215.1 et.al.
I. DESIGN STANDARDS
1. The proposed built-upon area is 1,018,323 square feet, which is less than the built-upon area that
previously existed.
2. The facilities shall be constructed, operated and maintained in accordance with the provisions of this
permit, the approved plans and specifications, and the supporting documents attached to this permit
and on file with the Division.
3. This permit is effective only with respect to the nature and volume of stormwater described in the
application and other supporting data.
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.
Page 1 of 5

Post-Construction Stormwater Management
Permit No. SW8000536
5. To the extent practicable, the project has provided stormwater control measures in accordance with the
stormwater rules. The control measures are: five infiltration trenches to treat built-upon area at one
and one-half times greater than the area that is rebuilt since 2000. The building for the relocation of the
Harris Teeter cannot be treated due to existing utility obstructions and safety restraints so alternate
BUA in the parking areas is treated. The stormwater measures as more fully described in Section 1.7 of
this permit.
6. Approved plans and specifications for projects covered by this permit are incorporated by reference and
are enforceable parts of the permit.
7. The runoff from all built-upon area within the permitted drainage areas of this project must be directed
into the permitted stormwater control system.
8. The following design criteria have been provided in the infiltration trenches and must be maintained at
design condition:
Infiltration Trench 2a 2b 2c 3 4
existin existin new new new
2.2
a. Drainage area, acres 1.23 .23 .87 .62
Onsite, ft2: 53,578 10,018 37,897 27,007 95,832
Offsite, ft2: 0 0 0 0 0
b. Total Impervious Surfaces, ft2: 48,941 9,667 31,166 26,527 94,045
c. Design Storm, inches: 1.5 1.5 3 3 3
d. Dimension, L x W x H, ft: 280x5. 150x3. 1308x4. 830x4.3 3980x4.3
48x3.3 9x3.32 32x2.76 2x3.32 2x2.76
2
e. Perforated Pipe, Dia. x L: 24 in 24 in 18 in 24 in 18 in
f. Bottom Elevation, FMSL: 35.34 36.04 38.22 36.9 36.49
g. Overflow Elevation, FMSL: 38.82 39.52 41 40.2 39.25
h. Permitted Storage Volume, ft3 1547 1060 7627 6325 23,208
i. Type of Soil Ba meade
j. Infiltration Rate, in/hr: 20 20 20 20 20
k. Seasonal High Water Table, 33 33 36 34.7 34.49
FMSL:
1. Time to Draw Down, hours: 5 2 2 2 2
m. Receiving Stream/River Basin ICWW/Cape Fear River
n. Stream Index Number: 21-30
o. Classification: Within '/z mile of SA;HWQ
II. SCHEDULE OF COMPLIANCE
1. The permittee shall at all times provide adequate erosion control measures in conformance with the
approved Erosion Control Plan.
2. 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.
3. The permittee shall submit all information requested by the Director or his representative within the time
frame specified in the written information request.
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. Access to the stormwater facilities shall be maintained via appropriate easements at all times.
Page 2 of 5

Post-Construction Stormwater Management
Permit No. SW8000536
6. No person or entity, including the permittee, shall alter any component shown in the approved plans
and specifications. Prior to the construction of any modification to the approved plans, the permittee
shall submit to the Director, and shall have received approval for modified plans, specifications, and
calculations including, but not limited to, those listed below. For changes to the project or SCM that
impact the certifications, a new or updated certification(s), as applicable, will be required and a copy
must be submitted to the appropriate DEQ regional office upon completion of the modification.
a. Any modification to the approved plans and specifications, regardless of size including the
SCM(s), BUA, details, etc.
b. Redesign or addition to the approved amount of BUA or to the drainage area.
C. Further development, subdivision, acquisition, lease or sale of any, all or part of the project and/or
property area as reported in the approved plans and specifications.
d. Altering, modifying, removing, relocating, redirecting, regrading, or resizing of any component of
the approved SCM(s), the stormwater collection system and/or vegetative conveyance shown on
the approved plan.
e. The construction of any allocated future BUA.
f. The construction of any permeable pavement, #57 stone area, public trails, or landscaping
material to be considered a permeable surface that were not included in the approved plans and
specifications.
g. Other modifications as determined by the Director.
7. The permittee shall at all times provide the operation and maintenance necessary to assure the
permitted stormwater system functions at the design condition including, but not limited to:
a. Semi-annual scheduled inspections (every 6 months).
b. Sediment removal.
c. Mowing and re-vegetation of side slopes.
d. Immediate repair of eroded areas.
e. Debris removal and unclogging of outlet structure, orifice device, catch basins and piping.
8. Access to the stormwater facilities shall be maintained via appropriate easements at all times.
9. 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.
10. 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. CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the permittee shall
take immediate corrective actions. This includes actions required by this Division and the stormwater
rules such as the construction of additional or replacement on-site stormwater systems. These
additional or replacement measures shall receive a permit from the Division prior to construction.
2. PERMIT RENEWAL. A permit renewal request must be submitted at least 180 days prior to the
expiration date of this permit. The renewal request must include the appropriate application,
documentation and the processing fee as outlined in Title 15A NCAC 02H.1045(3).
3. CHANGES TO THE PROJECT NAME, PERMITTEE NAME OR CONTACT INFORMATION. The
permittee shall submit a completed Permit Information Update Application Form to the Division within
30 days to making any one of these changes.
Page 3 of 5

Post-Construction Stormwater Management
Permit No. SW8000536
4. TRANSFER. This permit is not transferable to any person or entity except after notice to and approval
by the Director. Neither the sale of the project and/or property, in whole or in part, nor the conveyance
of common area to a third party constitutes an approved transfer of the permit.
a. TRANSFER REQUEST. The transfer request must include the appropriate application,
documentation and the processing fee as outlined in 15A NCAC 02H.1045(2). This request must
be submitted within 90 days of the permit holder meeting one or more of the following:
i. A natural person who is deceased,
ii. A partnership, limited liability corporation, corporation, or any other business association that
has been dissolved;
iii. A person or entity who has been lawfully and finally divested of title to the property on which the
permitted activity is occurring or will occur through foreclosure, bankruptcy, or other legal
proceeding.
iv. A person or entity who has sold the property, in whole or in part, on which the permitted activity
is occurring or will occur,
v. The assignment of declarant rights to another individual or entity,
vi. The sale or conveyance of the common areas to a Homeowner's or Property Owner's
Association, subject to the requirements of NCGS 143-214.7(c2);
b. TRANSFER INSPECTION. Prior to transfer of the permit, a file review and site inspection will be
conducted by Division personnel to ensure the permit conditions have been met and that the project
and the on-site stormwater system complies with the permit conditions. Records of maintenance
activities performed to date may be requested. Projects not in compliance with the permit will not be
transferred until all permit and/or general statute conditions are met.
5. CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the permittee shall
take immediate corrective actions. This includes actions required by this Division and the stormwater
rules such as the construction of additional or replacement on-site stormwater systems. These
additional or replacement measures shall receive a permit from the Division prior to construction.
6. PERMIT RENEWAL. A permit renewal request must be submitted at least 180 days prior to the
expiration date of this permit. The renewal request must include the appropriate application,
documentation and the processing fee as outlined in Title 15A NCAC 02H.1045(3).
7. CHANGES TO THE PROJECT NAME, PERMIT-TEE NAME OR CONTACT INFORMATION. The
permittee shall submit a completed Permit Information Update Application Form to the Division within
30 days to making any one of these changes.
8. COMPLIANCE. The permittee is responsible for compliance with the terms and conditions of this
permit until the Division approves the transfer request.
a. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved plans,
application, supplement, operation and maintenance agreement, all applicable recorded
documents, and specifications shall be maintained on file by the permittee at all times.
b. DIVISION ACCESS. The permittee grants Division Staff permission to enter the property during
normal business hours to inspect all components of the permitted project.
c. ENFORCEMENT. Any individual or entity found to be in noncompliance with the provisions of a
stormwater management permit or the requirements of the stormwater rules is subject to
enforcement procedures as set forth in NCGS 143 Article 21.
d. ANNUAL CERTIFICATION. The permittee shall electronically submit to the Division an annual
certification completed by either the permittee or their designee confirming the projects
conformance with permit conditions
e. OBTAINING COMPLIANCE. The Director may notify the permittee when the permitted site
does not meet one or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the Director for
modifying the site to meet minimum requirements. The permittee shall provide copies of
modified plans and certification in writing to the Director that the changes have been made.
Page 4 of 5

Post-Construction Stormwater Management
Permit No. SW8000536
f. OTHER PERMITS. The issuance of this permit does not preclude the permittee from complying
with and obtaining any other permits or approvals that are required for this development to take
place, as required by any statutes, rules, regulations, or ordinances, which may be imposed by
any other Local, State or Federal government agency having jurisdiction. Any activities
undertaken at this site that cause a water quality violation or undertaken prior to receipt of the
necessary permits or approvals to do so are considered violations of NCGS 143-215.1, and
subject to enforcement procedures pursuant to NCGS 143-215.6.
Permit renewed, updated and reissued this the 22°d day of November 2022.
NORTH CAROLINNA ENVIRONMENTAL MANAGEMENT COMMISSION
l 7r /LI-f
Foror na�nn Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 5 of 5

Attachment C- Permitting History
ZP No. 73, LLC
Permit No. SW8000536
Approval Permit BIMS
Description of the Changes
Date Action Version
construction, operation and maintenance of an underground
infiltration trench in compliance with the provisions of 15A
Original NCAC 2H .1000 (hereafter referred to as the "stormwater
8/3/2000 Approval 1.0 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.
redevelopment of existing impervious surfaces and treatment of
the runoff in five(5) underground infiltration trenches in
compliance with the provisions of 15A NCAC 2H.1000
2/I/2008 Modification 1.1 (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.
11/22/2022 Renewal 2.0 INew Expiration Date 11/21/2030

Pennit'Nbrnber.s�SOWE —3(OW�D
(to be provided by DWQ)
Drainage Area Number:
Infiltration Trench Inspection 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 elementsmoted.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 of the infiltration trench will be carefully managed to reduce
the sediment load to the sand filter.
— The water level in the monitoring wells will be recorded once a month and after
every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal County).
The infiltration trench 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_
inspection 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 grass filter strip or Areas of bare soil and/or Regrade the soil if necessary to
other pretreatment area 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.
Sediment has accumulated to Search for the source of the
a depth of greater than six sediment and remedy the problem if
inches. possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
The flow diversion The structure is clogged. "Unclog the conveyance and dispose
structure (if applicable) of any sediment off-site.
The structure is damaged. Make any necessary repairs or
replace if damage is too large for
repair.
Form SW401-Infiltration Trench IRM-Rev.2 Page I of')

BMP element: Potentialproblem: How I will remediate theproblem:
The trench Water is ponding on the Remove the accumulated sediment
surface for more than 24 from the infiltration system and
hours after a storm. dispose in a location that will not
impact a stream or the BMP.
The depth in the trench is Remove the accumulated sediment
reduced to 75% of the original from the infiltration system and
design depth. dispose in a location that will not
impact a stream or the BMP.
Grass or other plants are Remove the plants, preferably by
growing on the surface of the hand. If pesticide is used;wipe it on
trench. the plants rather than spraying.
The observation well The water table is within one Contact the DWQ Stormwater Unit
foot of the bottom of the immediately at 919-733-5083.
system for a period of three
consecutive months.
The outflow pipe is clogged. Provide additional erosion
protection such as reinforced_turf
matting or riprap if needed to
prevent future erosion problems.
The outflow pipe is damaged. Repair or replace the pipe.
The emergency overflow Erosion or other signs of The emergency overflow berm will
berm damage have occurred at the be repaired or replaced if beyond
outlet. repair.
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 Trench 1&M-Rev.2 Paee 2 of 3

PennitNumber: S IDS ��5361�09
(ro be provided by D1110)
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: Lone Leaf Mall Harris Teeter Renovations and Additions
BA1P drainage area number:2C. 3, and 4
Print name: ZP NO. 73, LLC, By: Jeffrey L. Zimmer
Title: LLC Administrator
Address: 111 Princess Street, Wilmington, NC 28401
Phone: (910) 763-4669
Signature:
Date: 01/30/2008
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.
1, Donna Dickens a Notary Public for the State of
North Carolina , County of New Hanover , do hereby certify that
of ZP NO. 73, LLC,
Jeffrey L. Zimmer, as LLC Administrator6ersonally appeared before me this 30th
day of January , 2008 , and acknowledge the due execution of the
forgoing infiltration trench maintenance requirements. Witness my hand and official
seal, \� �y�V//"�� //� �, /y�
w,�Nww.wntiw � / U' Ift��0�/�..Y/Vy
*0 DICt ,�� Notary Public — Donna Dickens
a NOT�', �y ;
i �
Va
s 'OUBLIC+ i
�-9
�QkER COV��.+i°r
�"rrr«way°�
SEAL
Ir V
My commission expires 06/24/2008 ID�I 1 90�8
BY:_— —i
Form SW401-infiltration Trench I&M-Rev.2 Page 3 of 3

7. _. AEMLR USE ONLY
Date R ej ceivedlFee Paid Permit Number
2 �- � 3 5U5 = 5� • � 3(0
NC DEG Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
In accordance with 15A NCAC 2H.1045(3), the current permit holder shall renew their high density permit 180 days
prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011.398 I SB 781)
Section 60.fc). This application form is for permit renewals only.
A. PROJECT INFORMATION
1. State Stormwater Permit Number: SW g�00rJ3�p
2. Project name:,. L-0" LeA /call RCh ,OV OnS
3. Project.street address: ...J L431.0. ShI OLrd -BIVA
W City:. - 1 IM{1rtA K County: GLJ OVeCziP -' TD3
4. What, if any,changes have been made to the project as permitted? Mone
If the project has changed from the original approved plans,please complete SWU-101 fora Major
Modification or Minor Modification Application form available at:https://deg.nc.gav/about/divisions/enerov-
m i n eral-land-resou rces/e n e rgy-mineral-land-rules/stormwa t er-pro gra m/post-const ruction.
B. PERMITTEE INFORMATION
If changes to the permittee or project name have been made,please complete either the Permit Update form
or the Permit Transfer form available at:https://deo.nc.gov/about/divisions/energv-mineral-land-
resourccees/energv-mineral-land-rules/stormwater-program/post-construction. State Stormwater Permits do not
automatically transfer with the sale of the property.
1. Current Permit Holder's Company�Name/Organization: Z t�' �O . 7 3, 1 -1-C
2. Signing Official's Name: L • Zl myv%u-
3. Signing Official's Title: GfX1 P.1�
4. Mailing Address O •301L $
City: ., h Dll _ State:;�C ZIP :off?y0 a-
5. Street Address: /:1 fhGCTS' S. ee n
City: W 1 1thl h Qbh State ZIP : ayo l
6. Phone: -1(42Email: rD�bn�r�-t,,}inanaaerCe� zdc:"Co7yt
tL►t��� nor �_
NOV 14 2022 ;(
Stormwater Permit Renewal Form Page 1 of 3 Mav 11. 2018

C. SUBMITTAL REQUIREMENTS
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters)or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non-Coastal HQW/ORW). Only applications packages that
include all required items listed below will be accepted and reviewed.
Initial each item below to indicate that the required information is provided in the application package:
1. A permit application processing fee of$505.00 payable to NCDEQ.
2. One original signed hard copy and one electronic copy of this completed form. The signing official
named on this application to represent the current permittee must meet one of the following:
a. Corporation—a principle executive officer of at least the level of vice-president;
b. Limited Liability Company (LLC) —a manager or company official as those terms are defined
in G.S. 57D"North Carolina Limited Liability Company Act;"
c. Public Entity—a principal executive officer, ranking official, or other duly authorized employee;
d. Partnership or limited partnership—the general partner;
e. Sole proprietor; or
f. Letter of authorization signed by one of the signatories noted in a—e above authorizing the
signature of another entity.
'pA 3. One hard copy and one electronic copy of recorded documents required by the original permit that
have not yet been received by DEMLR, including: deed restrictions, protective covenants,
condominium/planned community declaration and easements. If the project has been built, include
documentation that the maximum BUA per lot or maximum total BUA has not been exceeded. If
the project has not been built, include a signed agreement that the final recorded deed restrictions
1 and protective covenants will be submitted at a later date.
on�t l�le 4. O&M Agreements, Please select one:
❑ I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to
keep this on file with the permit; or
0 I do not have a copy of the current recorded O&M Agreement for all SCMs and am
Q 11
requesting a copy be sent to me. I agree to keep this on file with the permit.Fi�C
5. Designer Certifications, Please select one:
tA A copy of the certification(s) confirming that the project was built in accordance with the
approved plans have been previously provided to the Division; or
❑ A copy of the certification(s) confirming that the project was built in accordance with the
approved plans are enclosed; or
❑ The project has not yet been built.
6. [IF APPLICABLE] If the project has been built, one original hard copy and one electronic copy of a
signed, sealed, and dated letter from a licensed professional stating that the SCMs have been
inspected, and that they have been built and maintained in accordance with the permit.
7. [IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC):
Provide one hard copy and one electronic copy of documentation from the NC Secretary of State,
or other official documentation, which supports the titles and positions held by the persons listed in
Section C.2 per 15A NCAC 2H. 1043(3)(b).
https://www.sosnc.gov/online services/search/by title/ Business Registration
CEIVE
Nov 14 2o22 E OCT 2 4 2022
BY.• ���y�il,f
Stormwater Permit Renewal Application Form Page 2 of 3 May 11,2018

D. PERMITTEE'S CERTIFICATION
1,S-e*-4c L. Z i mmer the person legally responsible for the permit, certify that I have
a copy of the Permit and O&M Agreement on site (or I will obtain a copy and it will be kept on site), that I am
responsible for the performance of the maintenance procedures, and the site has been and will be maintained
according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs
or built-upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the
project, SCMs, or ownershi . All information provided on this permit renewal application is, to the best of my
knowledge, correct and c tplate.
Signature: Date: I O
NOTARIZATION:
1, &Qrr �ki�1cN1
a Notary Public for the State of
No✓-N CfsYyU-k?q County of Ni`•U do hereby certify
that 7c�EE!"3; L, Z mryt�r
� personally appeared before me
this the ZI s1 day of 004_D�rr 20 22- , and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,
111111///
(Notary Seal) �0���(�
9 ' 4V 1ict/"t�
Notary Si nature A _
z�
ate f 31
My commission expires Iti6 � �)�
q NOV ER
—,� ECEIVE
NOV 141022 J OCT 2 4 2022
Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

Permit No. %O$
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
UNDERGROUND INFILTRATION TRENCH SUPPLEMENT
This form may he photocopied for use as an original
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, an
underground infiltration trench supplement for each system, design calculations, and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION Am /
Project Name : f. on. a L en Aa e.,tove
Contact Person: Aq y-Ae 47, Ac i^n rove P r'`% Phone Number: (9/y ) 39 d —9i`/cl
For projects with multiple infiltration systems, a supplement form must be completed for each system. This
worksheet applies to: Trench in Drainage Area _
(from plans) (from Form SWU-/0/) �tPPL�1P� 1
- 1r5�.� g13I�0
II. DESIGN INFORMATION (attach supporting calculations/documentation):
\OrM mos>
Soils Report Summary (based upon an actual field investigation and soil borings) �w���Nt�•
Soil Type /3e.
Infiltration Rate dcl. I in r9r cf/hr/sf (circle appropriate units)
SHWT Elevation 6 6elowgtn4 fmsl (Seasonal High Water Table elevation)
oral-3 �D2d/-z tSrli — 32.5
Trench Design Parameters @ 33.n
Design Volume 9 5-0 17,690 c.f.
@ oLlr 3 3v,S
Design Storm /•S inch event(1.5 inch event far SA waters, I inch event for others)
Drawdown Time 8.5 S.3 4.yg kr-3
Perforated Pipe Size 4 inch diameter
Perforated Pipe Length / b 2 80 ft.
No. Observation Wells -- 0— (may be required on a case-by-case basis)
Stone Type (if used) 4�5 7
Stone Void Ratio o n
Trench Elevations (in feet mean sea level)
Bottom Elevation 36,oc 35,34 fmsl
Storage/Overflow Elevation 37,5a/38.8A fmsl
Form SWU-107 Rev 3.99 Page I of 4

Trench Dimensions
Height 3,3 Z 3.3a ft. Length / O / © ft.
Width 3,90/ 98 ft. Volume Provided ?Cal/7o6 cu.ft.
III. 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, November 1995) 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
AIPH a. System is located 50 feet from class SA waters and 30 feet from other surface waters.
Al NN b. System is located at least 100 feet from water supply wells.
M NA C. Bottom of system is at least 2 feet above the seasonal high water table.
01 to 1� d. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
MN#- e. Off-line system, runoff in excess of the design volume bypasses the system (bypass detail
provided).
MN f. System is designed to draw down the design storage volume to the proposed bottom
elevation under seasonal high water conditions within five days based upon infiltration
through the bottom only (a hydrogeologic evaluation may be required).
AA g. Soils have a minimum hydraulic conductivity of 0.52 inches per hour.
M h. System is not sited on or in fill material or DWQ approval has been obtained.
M)Jµ i. 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
,f stabilized.
m SIT 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.
AA k. System is located in a recorded drainage easement for the purposes of operation and
maintenance and has recorded access easements to the nearest public right-of-way.
/y lyll 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 ).
/1110 m. Drainage area for the device is less than 5 acres.
MPH n. A pretreatment device ( filter strip, grassed swale, sediment trap, etc.) is provided.
fnIV9 o. Trench bottom is covered with a layer of clean sand to an average depth of 4 inches.
114N P p. Sides of the infiltration trench are lined with geotextile fabric.
m N q. Rock used is free of tines (washed stone) and has a large void ratio.
III/V8 r. Side to bottom area ratio is less than 4:1.
Form SWU-107 Rev 3.99 Page 2 of 4

s. Observation well(s) are provided (case-by-case basis).
N } t. Vegetated filter is provided for overflow (50 feet for SA waters, 30 feet for other waters)
and detail is shown on plans.
/nN4 u. A benchmark for checking sediment accumulation is provided.
IV. UNDERGROUND INFILTRATION TRENCH OPERATION AND MAINTENANCE AGREEMENT
1. After every runoff producing rainfall event and at least monthly inspect the bypass/overflow structure for
blockage and deterioration and the infiltration system for erosion, trash accumulation, grass cover, and general
condition.
2. Repair eroded areas immediately, re-seed as necessary to maintain adequate vegetative cover, mow vegetative
cover to maintain a maximum height of six inches, and remove trash and blockages as needed to maintain
system performance.
3. Remove accumulated sediment annually or when depth is reduced to 75% of the original design depth. Restore
depth to 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.
4. The water level in any monitoring wells will be recorded after a 1 inch rainfall event and at least once a month.
Chronic high water table elevations (within 1 foot of the bottom of the system for a period of three months)
shall be reported to DWQ immediately.
5. If DWQ determines that the system is failing, the system will immediately be repaired or replaced 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.
6. Remove accumulated sediment from the infiltration system annually or when depth in the unit is reduced to
75% of the original design depth. The system shall be restored to the original design depth without over-
excavating. Over-excavating may cause the required water table separation to be reduced and may ,
compromise the ability of the system to perform as designed. Removed sediment shall be disposed of in an
appropriate manner and shall not be handled in a manner that will adversely impact water quality (i.e.
stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the infiltration system. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
When the depth at the benchmark reads o ) 5 the accumulated sediment shall be removed
from the system.
Form SWU-107 Rev 3.99 Page 3 of 4

I acknowledge and agree by my signature below that I am responsible for maintaining the stormwater
collection system in accordance with the six 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: -Ye C, z7� Mm_er LLc ,¢C4tn ni 5'
Address: //) Pj-ln - 55 e'4 rYr4-, AX� 1q -orl Nt: a84o1
Phone: 9/0 - 763 — t/66y j Date: _TLI a°t XOOb
Signature:
Note: The legally responsible party should not be homeowners association unless more than 50%of the lots have been sold and a
resident of the subdivision has been named the president.
t
1, I 1 ,a Notary Public for the State of LV4CAIM610, ,County of
at&MOA do hereby certify that personally appeared before me this
day of 7,000 ,and acknowledge� ,� 6n,eaacy you of the forgoing infiltration basin maintenance
requirements. Witness my hand and official seal,
V
° gem
Z e U e
9 � sp =:
CCV
SEAL My commission expires KAV 0nmmiaeinn FxniteS Scp(embcr 24,2002
Form SWU-107 Rev 3.99 Page 4 of 4

Permit.No.
(fo be provided by F vVQ
. . o',•jai�A
S T OP,MWATER MANAGE RENT PERMIT APPLICATION FORM '
4010ER IFICATIONAPPLICATIONFORM
iNFILTRATION TRENCH SUPPLEMENT
This form must be filled out,primed and submitted. .
The Required Items Checklist(?art 111)must be printed, filled out and submitted along with all of the required information.
I:,.P_RDJEDT,y h\ a u X y.,p, .+ x t'm.,'( .,..:�Jrxii"'.x•`G. h Cer». b:wi sM-t..r aTt�i^�'tY rS�f,"�'�t`.v.!yii "',�ak.'wkT-,sblri�3G'i
. IF.DRMATION,",�
Project name Long Le2�Mall Narns Ta ter and Retail addlhon _ - _
Contact person S:Shayde Leathers L
Phone number
Date ,
Drainage area number -
'
II.tkDESIGNINEORMATIQN�'��„-_."-`x�> �ru.�"4:�frg• �M:Y, ,.�.n. -.��� .� ..� �... _,2r� ,.i.>r� , ,. �- -..�7»r•.'c;
Site Characteristics
Drainage area t3YNz
Impervious area f
Percent impervious QL Z
Design rainfall depth '? in 17o r;tire r
Peak Flow Calculations Is preipost control of the 1-yr 24-hr peak flow required? ('f or N)
1-yr,24-hr runoff depth -in
1-yr,24-hr intensity �.+.r 'V inR r
"—development 1-yr,24-hr peak flow T c ft3/sec
development 1-yr,24-hr peak flow SLLao fi3lsec _
n e/Pest 1-yr,24-hr peak flow control —C� roo Osec I oti 'r v I`t o.i�
Storage Volume:Non-SR Waters
Minimum volume required G-. ff3
Volume provided "IL
Storage Volume: SR Waters
1-yr,24-hr rainfall depth f75 O r;';in
Pre-development 1-yr,24-hrrunoff -fts
Post-development 1-yr,24-hr runoff :+sr S "'0=.ft
Minimum volume required n!f?- ff3 �y
Volume provided ft3
Soils Report Summary
T=
Soil type
Infiltration rate in/hr
SHWT elevation =?:ram fmsl .
Trench Design Parameters
days l r'„/
Drawdown time f l
Perforated pipe diameter ...._'•I,lg -... f:.in
Perforated pipe length 43 7a rt
Stone type(If used) r v T
S tone void ratio
4D!n. .
Stone is free of fines? - r _ (Y or N)
Trench Elevations
melevation fmsl
age(overlow elevation L f:D 0. fmsl z
Top elevation y D.`'t-%. fmsl
Form.SW401-Inf[ur2Scn Trend,Rev.t Parts I.&IL Design Summary,Pace 1 of 2

Permit No.
(to be provided by DWQ)
Trench Dimensions
cih(Iona dimension) ft
,th(sh ndimension) ?� .�T. fi Haight(depth) ft
Additional Information
Total runoff volume captured by trench 67 ec-ie I'- n
Length of vegetative filter for overflow
Number of observation wells r t✓ a f ',' ,
Distance to structure
Distance from surface waters it
Distance from water supply well(s) ff
r
Separation from impervious soil layer ,... !1,'r r '! it 'o ,�e r 'v^� ✓''
Naturally occuring soil above SHWT
Bottom covered with 4-in of clean sand? (Y or N)
Recorded drainage easement provided? "1 (Y or N) ov v r,
Capures all runoff at ultimate build-out? ;'i(Y or N)
Bypass provided for larger storms? _V (Y or N)
Trench wrapped with eotextile fabric? J (Y or N)
PP 9
,..
Pretreatment device provided c� (� '-'FFC j1, i r�� a +.- p" u, -- � gyp'`
J
,
Form SW401-Infiltration.Trench-Rev.1 Pans I.&II.Design summary,Page 2 of 2
I'

Permit No.
no be provided by DWQ)
III '4EQUI°ED'ITEI1a1S CPc 'NL1 T > f � � _ a o sip rf„ -a .r.-2 w
Please indicate the pace or plan sheet numbers where the supporting documentation can be found.An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant-has designated an agent,.the agent may initial below.If a
requirement has.notbeen,met..attach:justificatio ...
Pagel Plan
Initials Sheet No.
l 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),
-Trench dimensions,
-Pretreatment system,
-High Flow bypass system,
-Maintenance access,
-Recorded drainage easement and public right of way(ROW),
-Overflow device,and
-Boundaries of drainage easement.
2.Partial plan(1"=30'or larger)and details for the infiltration trench showing:
-Bypass structure,
(f J -Maintenance access,
L 'j uJ -Basin bottom dimensions,
-Basin cross-section with benchmark for sediment cleanout,
s`y✓ -Flow distribution detail for inflow,
Vegetated filter,and
�� c t�-Pretreatment device.
3. Section view of the infiltration basin(1"=20'or larger)showing:
- -5 -Pretreatment and treatment areas,and
-Inlet and outlet structures,
;Z 4. A table of elevations,areas,Incremental volumes&accumulated volumes to verity the volume provided.
GZ t7 CZ.I `l
7v C?Z `q 5. A soils report that is based upon an actual field investigation,soil borings,and infiltration tests. The .
C results of the soils report must be verified in the field by DWQ, by completing&submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
�c mF of urancte(thl�the installed system will meet design specifications upon initial operation once the
project is complete and the entire drainage area is stabilized.
—71i/ o�Ci 7. A construction sequence that shows how the infitlration basin will be protected from sediment until the
�e�rytl entire drainage area is stabilized.
t" 9'
8. The supporting calculations.
fa�i'�/n_0>f" A.copy of the signed ano'notanz=d inspection and mairitenance-(I&M)agreement.
A
v / / 10. A copy of the deed restriction.
Form SW401-In iltration Tr-nch-Rev.1 Part III.Required Items Checklist.Page 1 of 1

Permit No.
(to be provided by DWQ)
F W<.iE9
IN LA ,
�CDEI�R STORMWATER MANAGEMENT PERMIT APPLICATION FORM
T
401 CERTIFICATION APPLICATION FORM
INFILTRATION TRENCH SUPPLEMENT
This form must be filled out,printed and submitted.
The Required Items Checklist(Part III)must be printed, filled out and submitted along with all of the required information.
Project name - Long Leaf Mall Harris.Teeter and Retail Addition
Contact person S.Shayne Leathers -
Phone number 919-671l-0035 J
Date
Drainage area number
- t
II;,DESIGN,INFORMAT.ION'
1 hT'y-o t
Site Characteristics
Drainage area 2' r-UO r�r ft'
Impervious area 2 G.5-Z,� ft'
Percent impervious 9S Z to
Design rainfall depth r 53..... 1. in
Peak Flow Calculations
Is prelpost control of the 1-yr 24-hr peak flow required? (Y or N)
1-yr,24-hr runoff depth in
1-yr,24-hr intensity OT GZv ' inmr
development 1-yr,24-hr peak Flow ft3fsec
development 1-yr,24-hr peak flow ft'/sec
HrelPost 1-yr,24-hr peak Flow control 0, 1 ft'/sec
Storage Volume:Non-SR Waters
Minimum volume required t v ft3
Volume provided ft3
`Storage Volume: SR Waters
1-yr,24-hr rainfall depth 3.. ._i'in
Pre-development 1-yr,24-hr runoff 53,1 a ' "ft3
Post-development 1-yr,24-hr runoff 1, - its
Minimum volume required S la 3 Its
Volume provided (;-3 5 its
Soils Report Summary
Soil type SaH'cQ. S ;; — � FPr /I
Infiltration rate .2`i��Z .•''inlhr
SHWT elevation ? {. T fmsl
Trench Design Parameters
Drawdown time
{ ZuI =" stir
Perforated pipe diameter Z_ti in
Perforated pipe length 3 C9 ft
Stone type(if used)
Stone void ratio
Stone is free of fines? a/' ` (Y or N) 4
Trench Elevations
m elevation 3 G.
fmsl
age/overflow elevation q,j, 2_ fmsl
Top elevation )-%+.3. 7 Z fmsl
Form SW401-Infiltration Trench-Rev.1 Parts I.&II.Design Summary,Page 1 of 2

Permit No
(to be provided by DWQ)
Trench Dimensions
�ngth(long dimension) �J it
th(short dimension) ft
ft
height(depth) 3, ]2 ft
Additional Information
Total runoff volume captured by trench G3— aewn t r
Length of vegetative filter for overflow .y1/vr ft' l f✓'�" "'` `
Number of observation wells h -• '' P/v S t `7 J/V4-T .n
Distance to structure
Distance from surface waters '(n -> ft
Distance from water supply well(s) :,ft
Separation from impervious soil layer ft
Naturally occuring soil above SHWT '7 Z ;ft 5A
Bottom covered with 4-in of clean sand? (Y or N)
Recorded drainage easement provided? = �(Y or N) [,eo
Capures all runoff at ultimate build-out? r. , s (Y or N)
Bypass provided for larger storms? ( t:='(Y or N)
Trench wrapped with geotextile fabric? k (Y or N)
Pretreatment device provided
T �
Form SW401-Infiltration Trench-Ray.1 Parts I.&II.Design Summary,Page 2 of 2

Permit No.
(to be provided by DWQ)
III:'REQUIRED.ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found.An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project.Initial in the space provided to
indicate the following design requirements have been met. If the applicant,has designated an agent,the agent may initial below:lba
requirement has not been met,attach justification.
Pagel Plan
Initials Sheet No.
All 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),
-Trench dimensions,
-Pretreatment system,
-High flow bypass system,
-Maintenance access,
-Recorded drainage easement and public right of way(ROW),
-Overflow device,and
-Boundaries of drainage easement.
C-Z 1�Z 2. Partial plan(1"=30'or larger)and details for the infiltration trench showing:
-Bypass structure,
y C/ -Maintenance access,
CJ t -Basin bottom dimensions,
-Basin cross-section with benchmark for sediment cleanout,
-Flow distribution detail for inflow,
Vegetated filter,and
-Pretreatment device.
3. Section view of the infiltration basin(1"=20'or larger)showing:
L 2 (45 -Pretreatment and treatment areas,and
-Inlet and outlet structures.
�/y y C 4. A table of elevations,areas,incremental volumes&accumulated volumes to verify the volume provided.
7/y C?`r y 5. A soils report that is based upon an actual field investigation,soil borings,and infiltration tests. The
(it 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.
55L �ti VLo'da7surancte tha`-tthe installed system will meet design specifications upon initial operation once the
tLgeuut project is complete and the entire drainage area is stabilized.
�[�j PtiGCI� -7. A construction sequence that shows how the infttration basin will be protected from sediment until the
entire drainage area is stabilized.
{ Y�8. The supporting calculations.
Ail—'` / /a f�{,9r A copy of the signed and notarized inspection and maintenance(I&M)agreement.
__/ 1 �0. A copy of the deed restriction.
Form SW401-Infiltration Trench-Rev.1 Part III.Required Items Checklist,Page 1 of 1

Permit No.
io be provided by DWQ)
or
'E STOP.MNIATER NIAN'GEMENT PER APPLICATION FORM > <
401 CERTIFICATION APPLICAT ION FORM
INFILTRATION TRENCH SUPPLEMENT
This form must be filled out;printed and submitted.
The Required Items Checklist(Part III)must be printed, filled out and submitted along with all of the required information.
Long Leaf Mall Horns Te ter and Retail Adddlo,
Project name _
Contact person S.Shayne Leathers -'
Phone number 919-678 0035 - '
Date 11120120071L 1,77ir` ° ' r
Drainage area number ` ` ' ''
{I�aDESIGN,INF,ORMATION�r_n�„r.,,>>„i. �,€�`_. S:.Y,.�'rti,:-1:.:y -- _e5 n._.3+�u',.t2.v.�,.,, a.a,ya sa x..xr�as`.�.�.�,kxx,...,u>.,,�,.-.:3,✓...— .
Site Characteristics - -
Drainage area
Impervious area 9 NftZ
Percent impervious H$r I
Design rainfall depth -in
Peak Flow Calculations
Is pre/post control of the 1-yr 24-hr peak flow required? Tt/ (Y or N)
1-yr,24-hr runoff depth =in
24-hr intensity Oj I Z S ; 'inlhr
development 1-yr,24-hr peak flow d t C7 r' ft3lsec
Post-development 1-yr,24-hr peak flow J ,€[� ft'/sec %3� L�r1^� e_ : ,1 t vt�eiv r o ✓ S
Pre/Post 1-yr,24-hr peak flow control ` D ft3/sec
Storage Volume:Nori Waters
Minimum volume required i' ' g�
Volume provided f 1
Storage.Volume:SR Waters
1-yr,24-hr rainfall depth .4 3 O i =in
Pre-development 1-yr,24-hr runoff ft3
Post-development 1-yr,24-hr runoff a "-ff
Minimum volume required D ft3
Volume provided Z3 " ft'
Soils Report Summary
Soil type
Inflltradon rate 2��S ini
'SHWTelevation �; 4� -+fmsl
Trench Design Parameters _
Drawdown time I>I daTs✓ff�
Perforated pipe diameter .a t:In
Perforated pipe length '�2,gU "lit
Stone Type(If used) S T 11J C 99 T
Stone void.ratio , ;L(7'!r
Stone is free of fines? (Y or N)
itch Elevations
Bottom elevation ( . " `r fmsl
Storage/overflow elevation y t; Z fmsl
Top elevation .7 o fmsl
Form SW401-Infiltration Trench-Reo.1 Pans I.&II.Design Summary,Page 1 of 2

Permlt.No:
(fc be provided by✓WO)
inch Dimensions
Length(long dimension)
Width(snort dimension) `��72 it
Height(depth) .: ''✓+:i.�(''.:: Y
Additional Information
Total runoff)volume captured by trench ac-in �r
Length of vegetative filter for overflow 7l/ d io vt 2 r 0 P7YN u U n
Number of observation wells
Distance to structure 7`U U ft -
Distance from surface seaters S��I '`J h
Distance from water supply well �l jzl it
Separation from impervious soil layer / It
Naturally occuring Boll above ShWT �
it
Bottom covered with"-in of clean sand?
Recorded drainage easement provided? ,( (Y or N)
Capures all runoff at ultimate build-out? J.. ( (Y or N)
Bypass provided for larger storms? — 'iLr _(Y or N)
Trench wrapped with geolextile fabric? -y (Y or N)
Pretreatment device provided
J
• 1
Form SW40 1-Infiltration Trench-Rev.1 Parts I.&IL Design Summary,Page 2 of 2

Permit No.
(to be provided by DWQ)
Ili. PZ-QUIRED ITEMS CHECKLIST
Please indicate the pace or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requiramen`s have been met. If the applicant hasdesgrated an agent,the agent may initial below:If-a,
requirement has not been met,attach justification.
Pagel Plan
Initi-le Sheet No.
J A� 1. Flans(1"-50'or larger)of the entire site showing:
-Design at ultimate build-out,_
011-site drainage(if applicable),
-Delineated drainage basins(include Rational C coefficient per basin),
-Trench dimensions,
-Pretreatment system,
-High Flow bypass system,
-Maintenance access,.
Recorded drainage easement and public right of way(ROW),
-Overflow device, and
-Boundaries of drainage easement.
2.Partial plan(1"=30'or larger)and details for the infiltration trench showing:
-Bypass structure,
J/ -Maintenance access,
Basin botiorftlimensions,
r� -Basin cross-section with benchmark for sediment cleanout,
=flow distribution detail for inflow,
Vegetated filter,and
-Pretreatment device.
—�-� �. 3. Section view of.the infiltration basin(1"=20'or larger)showing:
l r ,5 -Pretreatment and treatment areas,and
-Inlet and outlet structures.
�y C Z taZ 4. A table of elevations,areas,incremental volumes&accumulated volumes to verify the volume provided.
i
GZ.i;7 GZ.Ij
5. A soils report that is based upon an actual field investigation,soil borings,and infiltration tests. The
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.
5l/ �<tG��l a l✓s6jV le 61
�srurrancetha-tthe installed system will meet design specifications upon initial operation once the
j 1 1 project is complete and the entire drainage area is stabilized.
7. A construction sequence that shows how the infiltration basin will be protected from sediment until the
entire drainage area is stabilized.
/g 0C�(YQ8. The supporting calculations.
rl9"A.,copy,ofthe'signed-and notarized inspection and maintenance'(10)agreement.
i9
11 10. copy of the deed restriction.
Form SW401-Infiltration Trench-Rev.1 Part III,Required Items Checklist,Page 1 of 1