SW7061212_CURRENT PERMIT_20061218

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW 7(i(�l��aj
DOC TYPE
CURRENT PERMIT
C
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYWMMDD

wain
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
December 18, 2006
Mr. Nelson Smith, Superintendent
Tyrrell County School Board of Education
210-North Road Street
Columbia, NC 27925
Subject: Stormwater Permit No. SW7061212
Columbia High School —Middle School Gymnasium
High Density Project
Tyrrell County
Dear Mr. Smith:
The Washington Regional Office received a complete Stormwater Management Permit Application for Columbia
High School -Middle School Gymnasium on December 11, 2006. Staff review of the plans and specifications has
determined that the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A NCAC
2H.1000. We are forwarding Permit No. SW7061212 dated December 18, 2006, for the construction of the
subject project.
This permit shall be effective from the date of issuance until December 18, 2016, and shall be subject to the
conditions and limitations as specified therein. Please pay special attention to the Operation and Maintenance
requirements in this permit. Failure to establish an adequate system for operation and maintenance of the
stormwater-management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request
an adjudicatory hearing upon written request within sixty (60) 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.
If you have any questions, or need additional information concerning this matter, please contact Samir Dumpor, or
me at [phone].
Sincer ly,
v
H
Regional Supervisor
Surface Water Protection Section
AHlsd: J:IWPOATAIWQSISamir - State SWIPermits-Bioretention
cc: Robert Bartlett, PE wl Bartlett Engineering & Surveying, PC
Tyrrell County Building Inspections
Ilashington Regional Office
Central Files
North Carolina Division of Water Quality Internet: +r+++s.n�++atercuialit�'.or� One
943 Washington Square Mall Phone [phone] NorthCarohna
Washington, NC 27889 Fax [phone] naturally
An Equal OpportunitylAffirmadve Action Employer — 50% Recycledl10% Post Consumer Paper

State Stormwater Management Systems
Permit No. SW7061212
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other appiicable Laws, Rules, and Reguiations
PERMISSION IS HEREBY GRANTED TO
Tyrrell County School Board of Education
Columbia High School — Middle School Gymnasium
Tyrrell County
FOR THE
construction, operation and maintenance of a bioretention area in compliance with the
provisions -of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and
the approved stormwater management plans and specifications and other supporting
data as attached and on file with and approved by the Division of Water Quality and
considered a part of this permit.
This permit shall be effective from the date of issuance until December 18, 2016, and
shall be subject to the following specified conditions and limitations:
1. 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 on page 3 of this permit, the Project Data Sheet. The
stormwater control has been designed to handle the runoff from 26,887 square
feet of impervious area. This bioretention area must be operated with a
vegetated filter.
3. The tract will be limited to the amount of built -upon area indicated on page 3 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 2 of 7

State Stormwater Management Systems
Permit No. SW7061212
6. The following design criteria have been provided in the bioretention area and
must be maintained at design condition:
a. Drainage Area, acres: 0.75
b. Total Impervious Suzrfaces, ft2: 26,887
On -site Buildings, ft. 25,970
On -site Sidewalks, t�: 917
C. TSS removal efficiency: 85%
d. Bloretention Depth, inches: 9.0
e. Temporary Ponded Depth Elevation, FMSL: 3.75
Bioretention Bottom Elevation, FMSL: 3.0
f. Bioretention Surface Area, ft2: 3,654
g. Permitted Storage Volume, ft3• 3,034
Minimum Required Volume, ft3: 2,734
h. Receiving Stream: UT to Scuppernong River
River Basin Pasquotank
I. Stream Index Number: 30-14-4-(9)
M. Classification of Water Body: "SC"
II. SCHEDULE OF COMPLIANCE
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, 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.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW7061212
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with
the conditions of this permit, the approved plans and specifications, and other
supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and, priorto 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. Toansfer 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.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7061212
III. GENERAL CONDITIONS
1. This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a formal permit transfer request to the Division of Water Quality,
accompanied by a completed name/ownership change form, documentation
from the parties involved, and other supporting materials as may be appropriate.
The approval of this request will be considered on its merits and may or may not
be approved. The permittee is responsible for compliance with all permit
condi#ions until such time as the Division approves the transfer request.
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
3. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
4. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall'take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
5. The permittee grants DENR Staff permission to enter the property during normal
business hours for the pur ose of inspecting all components of the permitted
stormwater management facility.
6. The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit.condition.
7. Unless specified elsewhere, permanent seeding. requirements for the stormwater
control must follow the guidelines established'in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The permittee shall notify the Division any name, ownership or mailing address
changes within 30 days.
Permit issued this the 18th day of December, 2006.
N RTH tCROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
r
Alan W, KlimeF,- P.Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5of7

State Stormwater Management Systems
Permit No. SW7061212
Columbia High School — Middle School Gymnasium
Stormwater Permit No. SW7061212
Tyrrell 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)
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 6 of 7

State Stormwater Management Systems
Permit No. SW7061212
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. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The 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 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. 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.
cc: NCDENR-DWQ Regional Office
Craven County Building Inspections
Page 7 of 7

El
State of North Carolina
Department of Environment and Natural Resources
�r� i17- C M E M . Division of Water Quality
OFFICE USE ONLY
Date Received Fee Paid Permit Number
s WA Ck is-A1/0�
DEC 1 1 20WORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
D [f tf Q-t11f Aii1O
I. GENERAL INFORMATION
I. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
Tyrrell County School Board of Education
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
Mr. Nelson Smith
3. Mailing Address for person listed in item 2 above:
210 North Road Street
City: Columbia State: NC
Telephone Number: ( 252-796-1121
Zip: 27925
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
-veil County HS/MS Gymnasium Addition
Co %6io,
5. Location of Project (street address):
920 Main St
City: Columbia County: Tyrrell
6. Directions to project (from nearest major intersection):
Approximately 2200 feet (0.42mi) east of the intersection of SR 1209 and US Hwy 64 in Columbia, NC.
7. Latitude: 35.9187 N Longitude: 76.2463 W (WGS841NAD83) of project
8. Contact person who can answer questions about the project:
Name: Jon Meade Telephone Number: ( 252 )-399-0704
IL PERMIT INFORMATION:
1. Specify whether project is (check one): X New Renewal Modification
Form SWU-101 Version 3.99 Page I of

L�7.t, 3 = li�7l��

2. if this application is being submitted as the result of a renewal or modification to an existing permit, list the
' existing permit number N/A and its issue date (if known)
3. Specify the type of project (check one):
Low Density High Density Redevelop General Permit Other
4. Additional Project Requirements (check applicable blanks):
_CAMA Major X Sedimentation/Erosion Control _404/401 Permit X NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748.
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project.
Stormwater will be piped from roof drains to a bioretention area for treatment before being discharged.
2. Stormwater runoff from this project drains to the Pasquotank
3. Total Project Area: 16.19 acres
5. How many drainage areas does the project have? 1
River basin.
4. Project Built Upon Area: unknown
6. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as below.
BIORETENTION AREA
Basin Information
Drainage Area 1
Drainage Area 2
Receiving Stream Name
UT to Scuppernong River
UT to Scuppernong River
Receiving Stream Class
SC
SC
Drainage Area
16.19 acres
0.753 acres
Existing Impervious* Area
unknown
17,197 sq ft/ 0.395 acres (demo)
Proposed Impervious*Area
30,772 sf/ 0.71 acres
26,887 sf/ 0.617 acres
% Impervious* Area (total)
1.92% increase (includes demo)
81.94%
Impervious '-Surface Area
Drainage Area I '
Drainage!Area 2
On -site Buildings
25,968 sq ft
25,969.5 sq ft
On -site Streets
N/A
N/A
On -site Parking
N/A
N/A
On -site Sidewalks
4804 sq ft
917.4 sq ft
Other on-site
-17,197 sq ft (demo old gym)
N/A
Off -site
N/A
N/A
Total: net 13,575 sq ft / 0.31 acres
Total: 26,887 sf/ 0.617 acres
" Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version 3.99 Page 2 of 4

7. How was the off -site impervious area listed above derived? NIA
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
The following italicized deed restrictions and protective covenants are required to be recorded for all
subdivisions, outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table
listing each lot number, size and the allowable built -upon area for each lot must he provided as an attachment.
I. The following covenants are intended to ensure ongoing compliance with state stormwater management permit number
as issued by the Division of Water Quality. These covenants may not be
changed or deleted without the consent of the State.
2. No more than square feet of any lot shall be covered by structures or impervious materials.
Impervious materials include asphalt, gravel, concrete, brick, stone, slate or similar material but do not include wood
decking or the water surface of swimming pools.
3. Swales shall not be filled in, piped, or altered except as necessary to provide driveway crossings.
4. Built -upon area in excess of the permitted amount requires a state stormwater management permit modification prior to
construction.
5. A11 permitted runoff from outparcels or future development shall be directed into the permitted stormwater control
system. These connections to the stormwater control system shall be performed in a manner that maintains the integrity
and performance of the system as permitted.
By your signature below, you certify that the recorded deed restrictions and protective covenants for this project
shall include all the applicable items required above, that the covenants will be binding on all parties and persons
claiming under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the State, and that they will be recorded prior to the sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each
BMP specified for this project. Contact the Storniwater and General Permits Unit at [phone] for the status
and availability of these forms.
Form SWU-102
Wet Detention Basin Supplement
Form SWU-103
Infiltration Basin Supplement
Form SWU-104
Low Density Supplement
Form SWU-105
Curb Outlet System Supplement
Form SWU-106
OffSiteSystem Supplement
Form SWU-107
Underground Infiltration Trench Supplement
Form SWU-108
Neuse River Basin Supplement
Form SWU-109
Innovative Best Management Practice Supplement
Form SWU-101 Version 3.99 Page 3 of

VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. The complete application package should be
submitted to the appropriate DWQ Regional Office.
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item,
• Original and one copy of the Stormwater Management Permit Application Form
• One copy of the applicable Supplement Form(s) for each BMP
• Permit application processing fee of $420 (payable to NCDENR)
• Detailed narrative description of stormwater treatment/management
• Two copies of plans and specifications, including:
- Development/Project name
- Engineer and firm
-Legend
North arrow
- Scale
Revision number & date
Mean high water line
Dimensioned property/project boundary
Location map with named streets or NCSR numbers
Original contours, proposed contours, spot elevations, finished floor elevations
Details of roads, drainage features, collection systems, and stormwater control measures
Wetlands delineated, or a note on plans that none exist
Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
Drainage areas delineated
Vegetated buffers (where required)
VII, AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section.
Designated agent (individual or firm): Bartlett Engineering and Surveying, PC
Mailing Address: 1906 Nash Street North
City: Wilson State: NC Lip: 27893
Phone: ( 252 ) -399-0704 Fax: ( 252 ) -399-0804
VIII. APPLICANT'S CERTIFICATION
1. (print or type name of person listed in General Information, item 2) Mr. Nelson Smith
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of 15A
NCAC 2H .1000. n
Signature:
Form SWU-101 Version 3.99 Page 4 of 4
Date: _t/-U — �—o — .0. 6

Permit No.
(to be provided by DWQ)
State of North Carolina
V Department of Environment and Natural Resources
DEC 1 1 2006 Division of Water Quality
MUC-t YAROSTORMWATER MANAGEMENT PERMIT APPLICATION FORM
BIORETENTION AREA SUPPLEMENT
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes a stormwater management permit application, an
bioretention area supplement for each system, design calculations, soils report and plans and specifications showing all
stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name : _Columbia High School -Middle School Gymnasium
Contact Person: Jon_ Meade Phone Number: (252 ) -399-0704
For projects with multiple basins, specify which basin this worksheet applies to:
II. DESIGN INFORMATION -Attach supporting calculations/documentation. Provide a written soils report based
on actual field investigations conducted by a qualified individual. The soils report should include informational
references to the County soils maps when available. All elevations shall be in feet mean sea level (fmsl).
Soils Report Summary
In -Situ Soil Type
In -Situ Soil Infiltration Rate
SHWT Elevation
Planting Soil Texture
Planting Soil Infiltration Rate
Basin Design Parameters
Drainage Area
Impervious Area
Design Storm
Design Volume
Inlet Velocity
Inlet flow depth
Drawdown Time
Basin Dimensions
Basin Size
Basin Volume Provided
Basin Elevations
Temporary Pool Elevation
Planting Elevation
Bottom Elevation
NIA
N/A in./hr. (the most restrictive soil layer)
N/A _ ft. (Seasonal High Water Table elevation)
loamy (must be a sandy loam, loamy sand, or loam texture)
1.0 in./hr. (estimated)
_32,813 sq.ft. (on -site and off -site drainage to the basin)
_26,887 _ sq,ft. (on -site and off -site drainage to the basin)
1.0 inch (1. S inch event for SA waters, I inch event for others)
2734 c.f. (storage volume required)
2.87 fps
12.0 inch (12" PVC)
0.27-1.0 days
—31 fl. x —118 ft. = 3654 sq. ft. (surface area at basin bottom)
3034 c. f.
3.75 fmsl (elevation of the bypass/outlet structure)
3.0 fmsl (elevation of the ground surface bottom)
1.0 fmsl (elevation of the bottom of the planting media)
Pagel of 3

III. REQUIRED ITEMS CHECKLIST
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If a requirement has not been met, attach an explanation of wiry. An incomplete submittal
package will result in a request for additional information and will substantially delay final review and approval of the
project.
Applicants Initials
a. No vertical sand bed is proposed.
4r, b. The bioretention area is at least 40 feet by 15 feet.
-Alk_ c. Sheet flow is provided at inlet.
d. A grass buffer strip is provided at the inlet of the bioretention area.
e. Seasonal I-ligh Water table depth is at least 2 feet from planting surface.
Q A, f. Ponding depth of 6-9" is provided.
/(A � g. The in -situ soil infiltration rate is greater than 0.52 in/hr.
h. The planting soil infiltration rate is greater than 0.52 in/hr.
i. The ponded area will draw down in less than 5 days. (calculations attached)
j. Planting soil meets minimum soil specifications (NCDENR Stormwater Best
Management Practices Manual, April 1999).
k. A planting schedule with species and densities is provided on plans.
1. Mulch layer and depth is specified on plans.
�frlt, in, Plan details for the bioretention area are provided. (including dimensions and elevations)
n. Plan details for the inlet and outlet are provided.
o. An operation and maintenance agreement signed and notarized by the responsible party is provided.
This system (check one) Vdoes ❑ does not incorporate the use of an under -drain.
IV. 13IORETENTION AREA OPERATION AND MAINTENANCE AGREEMENT
Maintenance activities shall be performed as follows:
l . Inspect the bioretention area system for soil and mulch erosion, vegetated cover, and general condition after every
significant runoff producing rainfall event and at least monthly. Remove trash as needed.
2. Repair eroded areas immediately, re -seed acid re -mulch as necessary to maintain good vegetative and mulch cover.
3. Remove accumulated sediment and old mulch as needed to maintain good infiltration. Replace, or add additional
mulch as needed. Removal of the old mulch layer before applying the new layer is recommended every 2 to 3 years.
Page 2 of 3

4. Prune trees and shrubs and remove debris on an annual basis. Grassed vegetation should not exceed 6 inches in height.
S. Treat all diseased trees and shrubs whenever needed, Remove and replace all dead and diseased vegetation considered
beyond treatment every 6 months.
6. Replace support stakes yearly (in the Spring). Replace deficient stakes or wires whenever needed.
7. Soil testing shall be conducted annually to determine pH and any accumulation of toxins in the planting media. Lime
or other alkaline substances shall be applied as recommended per the soil test and toxic soils shall be removed,
disposed of properly and replaced with new planting media.
8. All components of the bioretention area system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the eight maintenance
procedures listed above. l agree to notify DWQ of any problems with the system or prior to any changes to the system or
responsible party.
Print name: Ale!sc,r. Ili
Address: 2 7 t! a,- rt L L 2-
Phone: x
Signatttre:�_� —
Date:
Note: The legally responsible party should not he a homeowners association unless more than 50% of the lots have been sold and a resident of the
subdivision has been named the president.
�2y rc.lea , a Notary Public for the State of
County of , do hereby certify that
personally appe red before me this day of �nc-� , ���►� , 2pp�, , and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official seal,
SEAL
My commission expires NpX) .'30
Page 3 of 3