SW5171101 DaVita Medical Permit Package

Energy, Mineral
and Land Resources
ENVIRONMENTAL OUALIl'Y
Alex Washburn, Manager
ART Sharpsburg LLC
1910 Fairview Ave East, Suite 200
Seattle, Washington 98102
February 13, 2017
Subject: Stormwater Permit No. SW5170201
DaV ita Medical Office
Sharpsburg, North Carolina in Wilson County
Dear Mr. Washburn:
ROY COOPER
Governor
MICHAEL S. REGAN
secretary
TRACY DAVIS
Uirenor
The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater
Management Permit Application for the subject project on February 01, 2017. 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 rules. We are forwarding Permit No. SW5170201,
dated February 13, 2017, for the construction, operation and maintenance of the subject project and the
stormwater system. This permit shall be effective from the date of issuance and shall be subject to the
conditions and limitations as specified therein, and does not supersede any other agency permit that may
be required.
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. Per
NCGS 143-215(e) the petition 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.
This project will be kept on file at the Mooresville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Richard Riddle at [phone]; or
[e-mail].
Sincerely,
Original Signed by Richard L. Riddle, Jr.
for Tracy E. Davis, PE, CPM, Director
cc: SW5170201 File,
Raleigh Regional Office
cc: Ryan Parker, Kleinfelder
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Smear I Raleigh, NC 27699-1612
919 707 9200 T

State Stormwater Permit
Permit No. SW5170201
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT QUALITY
STATE STORMWATER MANAGEMENT PERMIT
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
DaVita Medical Office
100 SE Railroad Street, Sharpsburg
Wilson County
FOR THE
construction, operation and maintenance of the Stormwater Control Measures (SCM) in
compliance with the provisions of 15A NCAC 2H .1000 (hereafter referred to as the
"stormwater rules') and the approved stormwater management plans, specifications and
other supporting data as on file with and approved by the State and considered a part of
this permit.
This permit shall be effective from the date of issuance until February 13, 2025, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. The SCM is approved for the management of stormwater runoff as described in the
application documents and as shown on the approved plans.
3. 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.
4. The runoff from all built -upon area within the permitted drainage area of this project
must be directed into the SCM.
5. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
II. SCHEDULE OF COMPLIANCE
During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately.
2. The permittee shall at all time provide the operation and maintenance necessary to
assure every SCM 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:
Page 1 of 4

State Stormwater Permit
Permit No. SW5170201
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader, filter
media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
3. Records of maintenance activities must be kept for the SCM. The reports will
indicate the date, activity, name of person performing the work and what actions
were taken.
4. The permittee shall submit an annual summary report of the maintenance and
inspection records for the SCM. The report shall summarize the inspection dates,
results of the inspections, and the maintenance work performed at each inspection.
5. The SCM shall be constructed in accordance with the approved plans and
specifications, the conditions of this permit, and with 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 SCM certifying that it 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. SCMs impacted by sedimentation and erosion control during the construction phase
shall be cleaned out and converted to its approved design state.
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 was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
9. A copy of the approved plans and specifications shall be maintained on file by the
Permittee for a minimum of eight years from the date of the completion of
construction.
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.
Page 2 of 4

State Stormwater Permit
Permit No. SW5170201
11. SCMs that allow stormwater to infiltrate shall not be located on or in areas with
contaminated soils.
12. Plats for residential lots that contain SCMs shall include: the specific location of the
SCM on the lot; a typical detail for SCM to be used; and a note that the SCM on the
property has been required to meet stormwater regulations and that the property
owner may be subject to enforcement procedures as set forth in G.S. 143, Article 21
if the SCM is removed, relocated, or altered without prior approval.
13. The O&M Agreement shall be referenced on the final plat and shall be recorded with
the county Register of Deeds upon final plat approval. If no subdivision plat is
recorded for the site, then the O&M Agreement shall be recorded with the county
Register of Deeds so as to appear in the chain of title of all subsequent purchasers.
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
completed Name/Ownership Change form signed by both parties, to the State,
accompanied by the supporting documentation. The approval of this request will be
considered on its merits and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such time
as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the State, in accordance with North
Carolina General Statute 143-215.6A to 143-215.6C.
4. 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.
5. 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.
6. The permittee grants DEQ Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated. The
permit may be modified, revoked and reissued or terminated for cause. The filing of
a request for a permit modification, revocation and re -issuance or termination does
not stay any permit condition.
8. 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.
9. Approved plans and specifications for this project are incorporated by reference and
are enforceable parts of the permit.
Page 3 of 4

State Stormwater Permit
Permit No. SW5170201
10. 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 as
allowed by the laws, rules and regulations contained in Session Law 2006-246, Title
15A NCAC 21-1.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division in writing of any name, ownership or mailing
address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 13th day of February, 2017.
Original signed by Richard L. Riddle, Jr.
for Tracy E. Davis, P.E., CPM
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

State Stormwater Permit
Permit No. SW5170201
DaVita Medical Office
100 SE Railroad Street, Sharpsburg
Wilson County
Designer's Certification
I, , 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 Name)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
cc: NCDEQ-DEMLR Regional Office
Page 1 of 1

Permit Number—5
(to be provided by DWQ)
Drainage Area Number: I
Wet Detention 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.
The wet detention basin system is defined as the wet detention basin,
pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
❑ does ® does not incorporate a vegetated filter at the outlet.
This system (check one):
❑ does ® does not incorporate pretreatment other than a forebay.
Important maintenance procedures:
— Immediately after the wet detention basin is established, the plants on the
vegetated shelf and perimeter of the basin should be watered twice weekly if
needed, until the plants become established (commonly six weeks).
— No portion of the wet detention pond should be fertilized after the first initial
fertilization that is required to establish the plants on the vegetated shelf.
— Stable groundcover should be maintained in the drainage area to reduce the
sediment load to the wet detention basin.
— If the basin must be drained for an emergency or to perform maintenance, the
flushing of sediment through the emergency drain should be minimized to the
maximum extent practical.
— Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month 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 should be kept in a known set
location and must be available upon request
hispection 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 wet
detention basin
Areas of bare soil and/or
erosive gullies have formed.
Regrade the soil if necessary to
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer a lication.
Vegetation is too short or too
Maintain vegetation at a height of
lon
a roximatel six inches.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 1 of 4

Permit Number: -.IOZA:n70;(0/
(to be provide by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate theproblem:
The inlet device: pipe or
The pipe is clogged.
Unclog the pipe. Dispose of the
swale
sediment off-site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to
swale.
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
The forebay
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design depth for
possible. Remove the sediment and
sediment storage.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Erosion has occurred.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional
show that pruning is needed
practices
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the
dying.
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The main treatment area
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design sediment
possible. Remove the sediment and
storage depth.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Algal growth covers over
Consult a professional to remove
50% of the area.
and control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them
invasive plants cover 50% of
with pesticide (do not spray).
the basin surface.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 2 of 4

Permit Number: :50-577—Na-
(to
50- ! 7—Na/(to be provided by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
A tree has started to grow on
Consult a dam safety specialist to
the embankment.
remove the tree.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off-site.
The outlet device is damaged
Re air or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the local NC Division of
damage have occurred at the
Water Quality Regional Office, or
outlet.
the 401 Oversight Unit at 919-733-
1786.
The measuring device used to determine the sediment elevation shall be such
that it will give an accurate depth reading and not readily penetrate into
accumulated sediments.
When the permanent pool depth reads 5.50 feet in the main pond, the
sediment shall be removed.
When the permanent pool depth reads 2.50 feet in the forebay, the sediment
shall be removed.
Sediment Removal
BASIN DIAGRAM
ill in the blanks)
132.00 Pe men`
----------------- Volume
131.50 -ft Min.
Sediment
Storage
FOREBAY
Permanent Pool Elevation 134.50
Sediment Removal Elevation 129.00
-----------------------------------------
Bottom Elevation
MAIN POND
Form SW401-Wet Detention Basin O&M-Rev.4 Page 3 of 4
1-ft
Storage

Permit Number: �lrJ'S�70��l
(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:Sharpsburg Medical Clinic Building
BMP drainage area number:
Print name:Bill Hardt
Title:Director of Development
Address: 1910 Fairview Avenue East, Suit 200, Seattle, WA 98102
Phone:[phone]
Signature:
Date: 11 111201'1
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.
I, OYy D-A:n, a Notary Public for the State of
(O 0,,%VCmN 47AVv , County of , do hereby certify that
0161 H.o, rJA- personally appeared before me this Z6
day of 3qyxoaorn 2 0 CI , and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
YASAMINE FIROOZI
Notary Public
Slats of Washington
My Appointment Expires Jul 30, 2020
SEAL
My commission expires c),A 30 202-0
Form SW401-Wet Detention Basin O&M-Rev.4 Page 4 of 4