SW6120603_CURRENT PERMIT_20120807

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
L,2Lv7
YYYYMMDD

C - -- • 1
NCDENR
North Carolina Department of Environment and Natural Resources
Division.of Water Quality
Levelly Eaves Perdue C,l ,-Ies bhYanllV, r aL
Governor
Mr. Joe Joseph
Summit Healthcare Group, LLC
390-C South Sf atford Rd.
Winston-Salem, NC 27103
Director
VGG Freeman
Secretary
July 3, 2012 r1%
IIECEIVED
AUG ` l 2012
DENR -EAYErTEWLLE REGIONAL OF
Subject: Stormwater Permit No. S11!!6120603 1_1�k
Harnett Health Medical Office Park
High Density Commercial Wet Detention Basin Project
Harnett County
Dear Mr. Joseph. -
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for
Harnett Health Medical Office Park on June 22, 2012. 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 and Session Law 2006-246. We are forwarding Permit No. SW6120603, dated July 3,
2012, for the construction, operation and maintenance of the subject project and the stormwater BMPs.
This permit shall be effective from the date of issuance until July 2, 2020 and shall be subject to the
conditions and limitations as specified therein, and does not supersede any other agency permit that may
be required. Please pay special attention to the conditions listed in this permit regarding the Operation and
Maintenance of the BMP(s), recordation of deed restrictions, procedures for changes of ownership,
transferring the permit, and renewing the permit. Failure to establish an adequate system for operation and
maintenance of the stormwater management system, to record deed restrictions, to follow the procedures
for transfer of the permit, or to renew the permit, will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit.
This request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC
27611-7447. Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the Fayetteville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Brian Lowther at [phone]; or
[e-mail].
Sincerely,
7 - '
for Charles Wakild, PE
cc: Fayetteville Regional Office
SW6120603
ec: James L. Walters, PE—[e-mail]
Wetlands and Slormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1517
Location: 512 N. Salisbury SI Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: www,ncwaterqualily,org
An Equal Opportunely 4 Affirmative Aclion Employer
NorthCarolina
Natkrall.ff

State Stormwater Permit
Permit NL.SV,1612-;603
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
RECEIVED
STATE STORMWA.TER MANAGEMENT PERMIT AUG - 7 2012
HIGH DENSITY DEVELOPMENT DENR-FAYEfTEOLLEREGIONALOFFICe
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
Summit Healthcare Group. LLC
Harnett Health Medical Office Park
Tilghman Drive, Dunn, Harnett County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with
the provisions of 15A NCAC 2H .1000 and S.L. 2006-246 (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 July 2, 2020, 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 control has been
designed to handle the runoff from 647,211 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated on page 2 of
this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
Page 1 of 6

State Stormwater Permit
Perri it No.S Y y'61206u3
6. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a. Drainage Area, aps: 1.93
Onsite, ft : 84,071
Offsite, ftz: 0
b. Total Impervioys Surfaces, ft2:
Buildings ft :
Roads/Parking, ftz:
Other, ft2.
Offsite, ftz:
C. Pond Depth, feet:
d. TSS removal efficiency:
e. Design Storm:
f. Permanent Pool Elevation, FMS:
g. Permitted Surface Area =DPP ft
h. Permitted Storage Volume, ftz:
i. Storage Elevation, FMSL:
j. Controlling Orifice:
k. Permanent Pool Volume, ft3:
I. Forebay Volume, ft3:
m. Receiving Stream/River Basin:
n. Stream Index Number:
o. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
66,211
19,388
40,137
6,68 (sidewalks and future)
3.09
90%
1.0 inch
95.5
5,2455
6,011 at temporary pool.
96.5
2.0" O pipe
13,040
2,746
Juniper Creek 1 Cape Fear
18-68-12-1-3
"C i Sw"
1. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted 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 outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
5. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with other
supporting data.
Page 2 of 6

State Stormwater Permit
Permit No.S`LN6120803
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 for a minimum of ten years from the date of the completion of
construction.
12. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the 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
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, to the Division of Water
Quality, signed by both parties, and accompanied by supporting documentation
as listed on page 2 of the form. The project must be in good standing with the
Division. 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 the transfer request.
Page 3 of 6

State Stormwater Permit
Permit No.S' 6/120603
3. 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.
4. The issuance of this permit does not preclude the Permittee from complying with
any grid all statutes, rules, regulations, or ordinances, which maybe innposed L
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 giants DENR Staff permission to enter the propel y 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.
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 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division 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 3rd day of July, 2012,
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
w' /16�
j r Charles Wakild, PE, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No.SWo120603
Harnett Health Medical Office Park
Stormwater Permit No. SW6120603
Harnett 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,
Harnett Heaith Medical Office Park
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 5 of 6

State Stormwater Permit
Permit No.SW6120603
Certification Requirements:
.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. Ali the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
.6.- The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 11.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Fayetteville Regional Office
Surface Water Protection
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301
Page 6 of 6

State Stormwater Permit
Permit No. 5W6120603
Harnett Health Medical Office Park
Stormwater Permit No. SW6120603
Harnett (you
Designers Certification
Z'_.__A�&fi (as a duly registered
in the State of North Carolina, having been authorized to observe (periodically/ weekly)
full time) the construction of the project,
Harnett Health Medical Office Park
(Project)
for 4-filA; L L Ci (Project Owner) hereby state that, to the
Lbest 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:
Signature_ --.-
Registration umber L[
DateZ4��
Page 5 of 6
SEAL
c� ,yw
18584
r��+'` � 3d)i494i�3143�9b

State Stormwater Permit
Permit "do.SVV612o603
Certification Requirements:
V 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.
V 3. All t,le built -upon area associated with the project is graded such that the
runoff drains to the system.
i/ 4. All roof drains are located such that the runoff is directed into the system.
// 5, The outlet/bypass structure elevations are per the approved plan.
rl 6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
S. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 11.
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.
y 12. Required drawdown devices are correctly sized per the approved plans.
✓ 13. All required design depths are provided.
114, All required parts of -the system are provided, such as a vegetated shelf,
and a forebay.
_�65_ The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Fayetteville Regional Office
Surface Water Protection
225 Green Street,
Systel Building Suite 714
Fayetteville, NC 28301
Page 6 of 6

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��—'� 3fYtEM LW I/ESE PLAW4 H£REOdVSIRUCIED WfT}W(�SfAM11i
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SU�4►fIT IIEALTC4RE GROUP, LLC
,.HPA
A/EDIGIL OFFICE PARR
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N;f TER OUAI.IR'PL�.�'A&BULLT

NO -
January 31, 2013
Mr. Bruce Fields
Osborne Construction
Re: Laboratory Soil Testing
Permeability
Harnett Health Medical Office Park
Dunn, North Carolina
ECS Project Number 33-2079
Dear Mr. Fields:
As requested, ECS Carolinas, LLP (ECS) has performed the laboratory testing on soil samples
S-1 and S-2 obtained by Shelby Tube from the above referenced project site in Dunn, North
Carolina.
Samples (S-1 and S-2) were tested in accordance with test procedure ASTM D-5084 entitled
"Measurement of Hydraulic Conductivity of Saturated Porous Materials Using a Flexible Wall
Permeameter." For the hydraulic conductivity, two representative samples of the pond soil were
obtained via Shelby Tube by an ECS representative. Both samples tested meet the
requirement of 0.01 inches per hour.
A summary of the ECS laboratory results are listed in the table below:
Sample ID
Test Procedure
Test Result
S-1
Average Hydraulic Conductivity
7.70 x 10 cm/sec
S-2
Average Hydraulic Conductivity
1.10 x 10 cm/sec
We appreciate the opportunity to be of service on this project, if you have any questions, please
contact me at your earliest convenience.
Respectfully,
ECS CAROLINAS, LLP.
Bruce Arnoi� %
Project Manager
' Branch Manager
CA
0�.�1
SEAS..
G37387
I\,-J FT

h
Measurement of Hydraulic Conductivity ASTM D 5084
ECS Carolinas, LLP
4811 Koger Blvd
Greensboro, NC 27407
Phone: [phone]
Fax:[phone]
www.ecslimited.com
JOB INFORMATION SAMPLE INFORMATION
NAME Harnett Health Medical Office Park DESCRIPTION Brown Tan Clayey Fine SAND
NUMBER 09-22321 NUMBER S-1
DATE 1/31/2013 ENGINEER S. Dowell
Sample Dimensions Unit Weight
Diameter (in)
2.836
Dry p (lb/ft3)
Height (in)
4.195
105.0
Area (in2)
6.317
Moisture %
Volume (ft3)
0.015
17.90/a
Confining Pressure (psi) 53.01
Top Burette Pressure 50 12
(psi)
Base Burette Pressure 47.05
(psi)
Permeant Liquid Average Hydraulic Conductivity (cm/sec)
Water 7.7E-06

ECS Carolinas, LLP
4811 Koger Blvd
Greensboro, NC 27407
Phone: [phone]
Fax: [phone]
www.ecslimited.com
Measurement of Hydraulic Conductivity ASTM D 5084
JOB INFORMATION SAMPLE INFORMATION
NAME Harnett Health Medical Office Park DESCRIPTION Brown Tan Clayey Fine SAND
NUMBER 09-22321 NUMBER S-2
DATE 1/31/2013 ENGINEER S. Dowell
Sample Dimensions
Unit Weight
Diameter (in) 2.835
Dry p (lb/ft3)
Height (in) 5.150
105.9
Area (in2) 6.312
Moisture
Volume (ft3) 0.019
17.2%
Confining Pressure (psi) 53.06
Top Burette Pressure 50.04
(Psi)
Base Burette Pressure 46.99
(Psi)
Permeant Liquid Average Hydraulic Conductivity (cm/sec)
Water 1.1E-05

Dunlap Lawn Service, Inc.
P.O. Box 39597
Greensboro, NC 27438
3roiect: Harnett Health Bid.
Location: Dunn, N.C.
ITEM Description
CITY
Unit of
Measure
Materials
Unit
Cost
Total Cost
Labor
Hours
Unit Cost
Labor Cost
Crew Size
Days
Red Maple
15
2 inch
$ -
$ -
$ -
Crape Myrtle
8
6 foot
$ -
$ -
$ -
Juniper
7
3 gal
$ -
$ -
$ -
Indian Hawthorn
175
3 gal
$ -
$ -
$ -
Bio Pond Plantings
White Water Lily
215
2x4 plug
$ -
$ -
$ -
Soft Stem Bulrush
80
2x4 plug
$ -
$ -
$ -
Duck Potato
80
2x4 plug
$ -
$ -
$ -
Pickerel Weed
14
2x4 plug
$ -
$ -
$ -
Arrow Arum
14
2x4 plug
$ -
$ -
$ -
Lizard Tail
14
2x4 plug
$ -
$ -
$ -
Sweet Flag
11
2x4 plug
$ -
$ -
$ -
Virginia Iris
13
2x4 plug
$ -
$ -
$ -
Soft Rush
32
2x4 plug
$ -
$ -
$ -
Swanp Hibiscus
7
2x4 plug
$ =
$ -
$ -
Cardinal Flower
50
2x4 plug
$ -
$ -
$ -
Rose Mallow
50
2x4 plug
$ -
$ -
$ -
Swithch Grass
130
2x4 plug
$ -
$ -
$ -
Broom Sedge
130
2x4 plug
$ -
$ -
$ -

ddy.....p....
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral & Land Resources
Tracy E. Davis, PE, CPM Land Quality Section Pat McCrory, Governor
Director John E. Skvarla, III, Secretary
September 16, 2013
Summit Healthcare Group, LLC
Attn: Joe Joseph
390-C South Stratford Road
Winston-Salem, NC 27103
Subject: Compliance Evaluation Inspection
State Stormwater Management Permit SW6120603
Harnett Health Medical Office Park
Harnett County
Dear Mr. Joseph:
On September '11, 2013, I, Michael Lawyer from the Fayetteville Regional Office of the Division of Energy, Mineral & Land
Resources, conducted a Compliance Evaluation Inspection at the Harnett Health Medical Office Park facility located on
Tilghman Drive in Harnett County, North Carolina. The purpose of the inspection was to ensure compliance with State
Stormwater Management Permit SW6120603 issued on July 3, 2012. A copy of the Compliance Inspection Report is
enclosed for your review. As a result of the inspection and subsequent file review, it has been determined that the facility
is in compliance with the subject permit and approved plans.
Please refer to the enclosed Compliance Inspection Report for additional comments and observations made during the
inspection. It you have any questions, or this office can be of any assistance, please contact me at [phone] or by
e-mail at mike.lawyer®ncdenr.gov.
Sincerely,
4x :�'
Michael Lawyer, CPSWQ
Environmental Specialist
Enclos/Jannes
re
cc: L. Waiters, PE - Latham -Walters Engineering, Inc. (electronic copy)
FRO - Land Quality Section, State Stormwater Files, SW6120603
Fayetteville Regional Office 225 Green Street, Suite 714, Fayetteville, North Carolina 28301-5095 One
Phone: [phone] FAX: [phone] Internet: http://portal.ncdenr.org/webhr/land-quality NorthCarolina
An Equal Opportunity 1 Affirmative Action Employer NWIM711Y

Permit: SW6120603
County: Harnett
Region: Fayetteville
Compliance Inspection Report
Effective: 07/03/12 Expiration: 07/02/20 Owner: Summit Healthcare Group
Project: Harnett Health Medical Office Park
Tilghman Dr
Contact Person: Joe Joseph Title:
Directions to Project:
Type of Project: State Stormwater - HD - Detention Pond
Drain Areas: 001 - (Juniper Creek) (03-06-18) ( C;Sw)
On -Site Representative(s):
Related Permits:
Inspection Date: 0911112013 Entry Time: 01:10 PM
Primary Inspector: Mike Lawyer
Secondary Inspector(s):
Lori H Britt
Reason for Inspection: Routine
Permit Inspection Type: State Stormwater
Facility Status: ® Compliant n Not Compliant
Question Areas:
® State Stormwater
(See attachment summary)
Dunn NC 28334
Phone: [phone]
Exit Time: 01:20 PM
Phone: [phone]
Ext.729
Phone:
Inspection Type: Compliance Evaluation
Page: 1

Permit: SW6120603 Owner - Project: Summit Healthcare Group
Inspection Date: 09/11/2013 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Inspection for compliance with the State Stormwater Management Permit (SW6120603) was conducted in conjunction
with an erosion control inspection. Due to completion of construction and the site being stable with permanent ground
cover, the erosion control plan for the project has been closed out. Observations were made of the built -upon area,
stormwater drainage system and wet detention pond, all of which appeared to be constructed per the approved
stormwater management plans and permit. Future built -upon area as shown on the approved plans has not been
constructed. This office should be notified once construction begins for this future area.
Page: 2

Permit: SW5120603 Owner - Project: Summit Healthcare Group
Inspection Date: 09/11/2013 Inspection Type: Compliance Evaluation Reason for Visit:
Routine
File Review
Yes
No
NA
NE
Is the permit active?
®
n
n
n
Signed copy of the Engineer's certification is in the file?
®
n
n
n
Signed copy of the Operation & Maintenance Agreement is in the file?
®
n
n
n
Copy of the recorded deed restrictions is in the file?
DOE
n
Comment:
Built Upon Area
Yes
No
NA
NE
Is the site BUA constructed as per the permit and approval plans?
®n
n
n
Is the drainage area as per the permit and approved plans?
®
1)
❑
❑
Is the BUA (as permitted) graded such that the runoff drains to the system?
®
n
❑
❑
Comment: At the time of inspection, the future BUA as noted on the approved plans
and already allocated in the permit was not constructed.
SW Measures
Yes
No
NA
NE
Are the SW measures constructed as per the approved plans?
MOOD
Are the inlets iocated per the approved plans?
W
n
n
n
Are the outlet structures located per the approved plans?
®n
n
n
Comment:
Operation and Maintenance
Yes
No
NA
NE
Are the SW measures being maintained and operated as per the permit requirements?
®
n
n
n
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ n
n
n
EM
upon request?
Comment:
Other Permit Conditions
Yes
No
NA
NE
Is the site compliant with other conditions of the permit?
MOD
n
Comment:
Other WQ Issues
Yes
No
NA
NE
Is the site compliant with other water quality issues as noted during the inspection?
®
Cl
n
n
Comment: No issues observed.
Page: 3

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
P S 3-8 lv !u
Lsv LP M -1.0 In 0
Applicable Rules: ❑ Coastal SW -1995 ❑ CoastaI SW - 2008 ❑ Ph it - Post Construction
(select all that apply) .❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
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STORMWATER MANAGEMENT PERMIT APPLICATION FORM
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This form mint be photocopied for use as an original
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1. GENERAL INFORMATION
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1. Project Name (subdivision, facility, or establishment name - should be consistent with project name �i plans,
specifications, letters, operation and maintenance agreements, etc.):
Harnett Health Medical Office Park
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2. Location of Project (street address):
Tilghman Drive
City.Dunn County:Hamett Zip:28334
3. Directions to project (from nearest major intersection):
710' North of intersection of Tilehman Dr. and Susan Tart Rd.. located on rieht
4. Latitude:35° 18' 26.81" N Longitude:780 37 58.95" W of the main entrance to the project.
11. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) and the status of
construction: []Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
[]Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. 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: 2,19 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit Proposed Impacts
b. If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit Erosion Control: HARNE-2012-082 (currently under review)
Uut
12

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III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:loe loseah 1 Summit Healthcare Group, LLC
Signing Official & Title: Toe Joseph, Manager
b. Contact information for person listed in item 1a above:
Street Address:390-C South Stratford Rd.
City:Winston-Salem State:NC Zip:27103
Mailing Address (if applicable):
City:Dunn State:NC Zip:28335
Phone: [phone] Fax: (336 ) 774-9130
Email:boseph®summithg.com
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:Harnett Health System, Inc. (formerly Betsy Johnson Healthcare Systems, Inc.)
Signing Official & Title:Kenneth E. Bryan, President and CEO
b. Contact information for person listed in item 2a above:
Street Address:800 Tilghman Drive
City:Dunn State:N.C. Zip:28335
Mailing Address (if applicable):P.O. Box 1706
City:Dunn State:N.C. Zip:28335
Phone: (910 ) 892-1000 ext. 4106 _..., ..__ Fax: (91.0 ) 892-6,030
Email, k.b an®birh.or
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization: Mike Stewart Summit Healthcare Grout). LC
Signing Official & Title:Director of Project Management
b. Contact information for person listed in item 3a above:
Mailing Address:390-C South Stratford Rd.
City:Winston-Salem State:NC Zip:27103
Phone: (704__ ) 340-0650 Fax: (336 j_ 774-9130
Email_mstewart®summithg.com
4. Local jurisdiction for building permits: Ci of Dunn NC
Point of Contact:Samantha L. Wullenwaber Phone #: (910 L 230-3503 „_ _

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IV. PROJECT INFORMATION
1. In the space provided below, br_ t fly summarize how the stormwater runoff will be treated.
A BMP Wet Pond will treat all storm water runoff for the phase one development. The pond will treat the
first inch of runoff from the site and detain the post developed flows for the 1 year storm to pre developed
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this protect drains to the Cape „Fear _ _ River basin.
4. Total Property Area: 5 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area': 5 acres
Total project area shall be calculated to exclude the following the normal yool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHM line or Mean High Water
(MHW) line, and coastal wetlands landward from the NNW (or M;R line. The resultant project area is used to
calculate overall percent built upon area (BI.IA). Non -coastal wetlands landward of the NHW (orMHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 78.76
9. How many drainage areas does the project have?] (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9, If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin trifor-m-ati'o in
Drainage Area 1
Drainage Area' .
Drama e Area, —Drainage
Area _
Receiving Stream Name
Juniper Creek
Stream Class *
C;Sw
Stream Index Number *
18-68-12-1-3
Total Drainage Area (so
84,071
On -site Drainage Area (so
84,071.
Off -site Drainage Area (sf)
0
Proposed Impervious Area** (so
66,211
% Im ervious Area**(total)_78.76
Impervious' Surface Area
Drainage Area 7
Drainage Area
Drainage Area _
Drainage Area
On -site Buildings/Lots (so
19,388
On -site Streets (so
0
On -site Parking (so
40,137
On -site Sidewalks (so
2,120
Other on -site (so
0
Future (so
4,566
Off -site (SO
0
Existing BUA*** (so
0
Total (so:
66,211
* Stream Class and Index Number can be determined at: littp.&ortal.ncdenr.org oebAoq(ps/csu/classifications
* 11H ervious area is defied as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
*�* Report only that amount of existing BUA that will remain after development. Do not report any existing B UA that
is to be removed and which will be replaced by new BUA.

11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DWQ Central ice staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per NCAC 02B . 0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from httr)://r)ortal.ncdenr.oriz/web/wcl/ws/su/bmv-manual.
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. A detailed application instruction sheet and BMP
checklists are available from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://portal.ncdenr.org/web/wqZwsZsu/mal2s.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
63
4.
5.
Form. (if required as per Part VIl below)
Original of the applicable Supplement Form(s) (seale(,-signed and dated) and O&M
agreement(s) for each BMP.
Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
hU://www.envhelp.org/pages/onestopExRress.hbnl for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 7.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within Y2 mile of the site boundary, include the'/s
mile radius on the map.
7. Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).

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9. Copy of any applicable soils report with the associated SHWT elevations (Please identify W
elevations in addition to depths) as well as a map of the boring Iocations with the existing
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 01644 Page No: 0001
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 21-1.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
littp://www.secretary.state.nc.us/Corporations/CSearch.aspx
V1I. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any Iot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, Iot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, 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 NC DWQ and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: amen L. Walters P.E.
Consulting Firm: Latham -Walters Engineering, Inc.__
Mailing Address:16507-A Northcross Drive
City:Huntersville
Phone: (704 _ ) 89.5-8484
Email:[e-mail]
State:NC Zip:28078
Fax: (704 . 3 237-4362
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) Kenneth E. Bryan I certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
Iisted in Contact Information, item 1a) Joe loseph with (print or type name of organization Iisted in
Contact Information, item la) Summit Healthcare Group, LLC to develop the project as currently proposed. A
copy of the lease agreement or pending property sales contract has been provided with the submittal, which
indicates the party responsible for the operation and maintenance of the stormwater system.

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As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation o C General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment If c' it enalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature:
Date: i0l ► ZO��
I,
��tf- J LaL U a Notary Public for the State of t4041%0 County of
do hereby certify thatLA-1rA*%A& n ,G .-&rmc",. personally appeared
before me this _LL day of , '�,01 z , and acknowledge the dupe execution of the application for
a stormwater permit. Witn A�myy ndand official seal,
ERIDGITTE T. LEE
ACAO'Notary Public, North Carolina
Johnston County
My Co rn sion Expires
1
SEAL
My commission expires_ la T
X. APPLICANT'S CERTIFICATION
I, (print or hjpe nanre of person listed in Contact Iriforrnrttiorr, item Ia) 0e
certify that the information included on this permit application form is, to the best of my kno edge, correct and
that the project willbestr uc in co ormance with the approved plans, that the required deed restrictions
and protective covill record , and that the proposed project complies with the requirements of the
applicable stormws Z15CAC2H .1000, SL 2006-246 (Ph. II -Post Construction)/or L 2008-211.
Signature; _ .. Date: 2—
I1 [1SAa Notary Public for the State of County of
L, liyi.n n> V do hereby certify that _ �OE ¢SaT %._.__._. personally appeared
Jbefore me this e day of U17 C /2- and a wledge hi, d e ution of the application for
a stormwater permit. Witness my hand and official seal,
James L. Walters
Notary Public
Lincoln County
North Carolin
M Commission Ex its 3 �4'b
SEAL
My commission expires A& rt 6 -2o1L
Form SWU-101 Version 07Jun2010 Page 6 of 6

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2866
AQUESTA BANK
L."IfFIAM WALTERS'ENGINEERING INC.
16507 NORTHCROSS DRIVE, SUITE A 66-1271.531
HUNTERSVILLE, NC 28078 x
_01812012 �
0
PAY TO THE
ORDER OF KI ENR _ $ **505.00 $
FIVw'-Hi infi sd EW anfl DOLLARS -
P
vl
NCDENR
8
11Ewi0
Harnett Health Medical Park - DWQ Review.

s 1
RECEIVED
Permit No.
(to be provided by DWr?)
AUG - 7 2012
ADENR -FAYE-FTEVI LLE REGICNAL OFFICE
TA
NCDENR
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form must be fitted out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted along with all of the required information.
o�pF W n reRQ�
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I.'PROJECTINFORMATION :�; ,� Rrp
, .
Project name Harnett Health Medical Park
Contact person JIM WALTERS
Phone number 704-895-8494
Date 4-Jun-12
Drainage area number 1
Ill. -,DESIGN INFORMATION s-.
Site Characteristics _
Drainage area 84,071 fs
Impervious area, post -development 66,211 ff2
% Impervious 78.76 %
Design rainfall depth 3A'in 1 I ,
Storage Volume: Non -SA Waters
Minimum volume required 5,600 fo
Volume provided
6,011 ft3
OK, volume provided is equal to or in excess of volume required.
Storage Volume: SA Waters
1.5" runoff volume
ft3
Pre -development 1-yr, 24-hr runoff
ff3
Post -development 1-yr, 24-hr runoff
ft3
Minimum volume required
ff3
Volume provided
ft3
Peak Flow Calculations
Is the pre/post control of the lyr 24hr stone peak flow required?
Y (Y or N)
t`
1-yr, 24-hrrainiall depth
3.1 in
.°''` f� .."• r+ r�
Rational C, pre -development
68.00 (unitless)
.'y�•+.e
Rational C, post -development
90.00 (unitless)
•i7tfS • ..1 J•
;" '. `��' r
Rainfall intensity: 1- r, 24-hrstorm
3.05 inlhr
OK
Pre -development 1-yr, 24-hr peak flow
2.09 e/sec
v �,
Post -development 1-yr, 24-hr peak flow
1.62 ft3lsec
t
Pre/Post 1-yr, 24-hr peak flow control
-0.47 0sec
Elevations
Temporary pool elevation
96.50 fmsl_
le
�l
Permanent pool elevation
95.50 f nsi
:p .
,� � 1 e�
' Ets
SHWT elevation (approx. at the perm, pool elevation)
95.00 fmsl
. 1;110
Top of 10ft vegetated shelf elevation
96.00 fmsl
Bottom of 10ft vegetated shelf elevation
95.00 tmsl
Sediment cleanoui, top elevation (bottom of pond)
91.50 €msl
Sediment cleanout, bottom elevation
90.50 frnsl
Sediment storage provided
1.00 ft
Is there additional volume stored above the state -required temp. pool?
N (Y or N)
Elevation of the top of the additional volume
96.5 imsl
OK
Form SW401-Wet Detention Basin-Rev.9.4l1&12 Parts I, & II. Design Summary, Page 1 of 2

Rv -1D.d S -k- g ( 7?f %)
d" 7 6
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Surface Areas
Area, temporary pool
Area REQUIRED, permanent pool
SAIDA ratio
Area PROVIDED, permanent pool, Aar,,,
Area, bottom of 10ft vegetated sheaf, Ads $Wl
Area, sediment cleanout, top elevation (bottom of pond), Ab., ,.b
Volumes
Volume, temporary pool
Volume, permanent pool, V, ,,,,,d
Volume, forebay (sum of forebays if more than one forebay)
Forebay % of permanent pool volume
SAIDA Table Data
Design TSS removal
Coastal SAIDA Table Used?
Mountain/Piedmont SAIDA Table Used?
SAIDA ratio
Average depth (used in SAIDA table):
Calculation option t used? (See Figure 10-2b)
Volume, permanent pool, Vary ,,
Area provided, permanent pool, A, ,_p,,,
Average depth calculated
Average depth used in SAIDA, d,,,, {Round to nearest 0.5ft)
Calculation option 2 used? (See Figure 10-2b)
Area provided, permanent pool, Ap r,N
Area, bottom of 10ff vegetated shelf, At,,_"
Area, sediment cleanout, top elevation (bottom of pond), Aya m d
"Depth" (distance btw bottom of 10ft shelf and top of sediment)
Average depth calculated
Average depth used in SAIDA, d., (Round to down to nearest 0.5ft)
Drawdown Calculations
Drawdown through orifice?
Diameter of orifice (if circular)
Area of orifice (if -non -circular)
Coefficient of discharge (Co)
Driving head (Ho)
Drawdown through weir?
Weir type
Coefficient of discharge (Cw)
Length of weir (L)
Driving head (H)
Pre -development 1-yr, 24-hr peak Bow
Post -development 1-yr, 24-hr peak Bow
Storage volume discharge rate (through discharge orifice or weir)
Storage volume drawdown time
Additional Information
Vegetated side slopes
Vegetated shelf slope
Vegetated shelf width
Length of Bowpath to width ratio
Length to width ratio
Trash rack for overflow & orifice?
Freeboard provided
Vegetated filter provided?
Recorded drainage easement provided?
Capures all runoff at ultimate build -out?
Drain mechanism for maintenance or emergencies is
6,777 ft?
3,733 ftz
4.44 (unitless)
5,245 ft` OK
3,871 ft`
1.275 ft`
6,011 ft3 OK
13,040 ft3
2,746 ft3
21.1% % OK
90 %
N (Y or N)
Y (Y or N)
4.44 (unitless)
N (Y or N)
13,040 ft'
5,245 fit`
It Need 3 ft min.
It
Y (Y or N)
5,245 ft°
3,871 ft`
1,275 ft2
3.50 ft
3.09 ft OK
3.0 ft OK
Y (Y or N)
2.00 in
in'
0.60 (unitless)
1,00 it
N (Y or N)
(unitless)
(unitless)
ft
ft
2.09 ft'/sec
1.62 ft3Isec
0.05 ft'/sec
2.24 days OK, draws down in 2-5 days.
3 :1
OK
10 :1
OK
10,0 it
OK
3 :1
Insufficient Bow path to width ratio. Must not short-circuit pond.
2.6 :1
OK
Y
(Y or N)
OK
1.0 ft
OK
N
(Y or N)
OK
Y
(Y or N)
OK
Y
(Y or N)
OK
PUMP OUT
Form SW401-Wet Detention Basin-Rev.9-4118112 Parts I. & It. Design Summary, Page 2 of 2

Permit No.
(to be provided by DWQ)
Ill REQUIRED ITEMS CHEGKI°tST s 4 ' I ',p,
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. If a
requirement has not been met, attach justification.
Pagel Plan
Initials
Sheet No.
-J0
C i' O
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,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
Boundaries of drainage easement.
JuJ
C 1' 0
2. Partial plan (1" = 30' or larger) and details for the wet detention basin showing:
- Outlet structure with trash rack or similar,
- Maintenance access,
- Permanent pool dimensions,
- Forebay and main pond with hardened emergency spillway,
- Basin cross-section,
- Vegetation specification for planting shelf, and
- Filter strip.
3. Section view of the wet'detention basin (1" = 20' or larger) showing:
- Side slopes, 3:1 or lower,
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
W
0- 01C9. 0
4. If the basin is used for sediment and erosion control during construction, clean out of the basin is specified
Q\W0
..
on the plans prior to use as a wet detention basin.
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for forebay,
to verity volume provided.
J(X)—
C 3'
6. A construction sequence that shows how the wet detention basin will be protected from sediment until the
entire drainage area is stabilized.
/
J`1`I
7. The supporting calculations.
/AtCLVD�QD g, A copy of the signed and notarized operation and maintenance (O&M) agreement.
Nr /`� 9. A copy of the deed restrictions (if required).
10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. County
soil maps are not an acceptable source of soils information,
Form SW401-Wet Detention Basin-Rev.9-4118/12 Part III, Required Items Checklist, Page 1 of 1

Permit Number:
(to be provided by 1)WQ)
Drainage Area Number:
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):
0
m
❑ does ® does not incorporate a vegetated filter at the outlet.
y
This system (check one):
jTl
❑ does ® does not incorporate pretreatment other than a forebay.
m
�,
CD p rn
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
m
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.
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 wet
Areas of bare soil and/or
Regrade the soil if necessary to
detention basin
erosive gullies have formed.
remove the gully, and then planta
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
Vegetation is too short or too
Maintain vegetation at a height of
long.
approximately six inches.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 1 of 4

Permit Number:
(to be provided 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 BM P.
l-rosion 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 s ra yin .
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:
(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 re lace 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 92'� feet in the main pond, the
sediment shall be removed.
When the permanent pool depth reads '26 feet in the forebay, the sediment
shall be removed.
BASIN DIAGRAM
ill in the blankc)
Permanent Pool Elevation'
0
Sediment Removal `� L 'S
Pe anen Pool
q S
-----------------
Volume
Sediment Removal Elevation `z
Volume
Bottom Elevatio ��'S
-f3Min._________________________-------------------
Sediment
Bottom Elevation
_ ____
Storage
Sediment
Storage
FOREBAY
MAIN POND
Form SW401-Wet Detention Basin O&M-Rev.4 Page 3 of 4

Permit Number:
(10 be provided by UWQ)
l acknowledge and agree by my signature below that 1 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:Harnett Health Medical Park
BMP drainage area number: I
Print name. -Joe J
Title:
Addri
Phone
Signa
Date:
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, > L a Notary Public for the State of
(;�,r✓� ,County of L,nraLN , do hereby certify that
O_e- t%a rT f/ personally appeared before me this 6,
day of _k/4-4 , 22012_, and acknowledge the due execution of the
forgoing wet detention basin ainte nce requirements. Witness my hand and official
seal, /--z
James L. Walters
Notary Public
Uncoln County
North Carolina :3;a
E mmission Ex Tres
SEAL
My commission expires � <I� 03
Form SW401-Wet Detention Basin O&M-Rev.4
Page 4 of 7