SW7130704_CURRENT PERMIT_20130715

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT. NO.
SW -7Ad Z
DOGTYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATEl3
�71�
YYYYM M DD

I
CDENR
North Carolina Department of Environment and
Division of Water Quality
Pat McCrory Thomas A. Reeder
Governor Acting Director
Mr. Aruna Swarup, Member/Manager
Washeye, LLC
CT Corporation System
150 Fayetteville Street
Raleigh, INC 27601
Dear Mr. Swarup:
i.RO
Natural Resources
John E. Skvarla, III
Subject: State Stormwater Permit No. SW7130704
Washington Eye Center
High Density Commercial Bio-Retention Project
Beaufort County
The Washington Regional Office received a complete Stormwater Management Permit
Application for Washington Eye Center on July 8, 2013 and additional information on July 12,
2013. Staff review of the plans and specifications has determined that the project, as
proposed, will comply with the Stormwater Regulations set forth in Session Law 2008-211 and
Title 15A NCAC 2H.1000. We are forwarding Permit No. SW7130704 dated July 15, 2013, for
the construction of the subject project.
This permit shall be effective from the date of issuance until July 15, 2021, and shall be subject
to the conditions and limitations as specified therein: Please pay special attention to the
Operation and Maintenance requirements in this permit. Failure to establish an adequate
system for operation and maintenance of the stormwater management system will result in
future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have
the right to request an adjudicatory hearing upon written request within thirty (30) days
following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150E of the North Carolina General Statutes, and filed with the Office of
Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. Unless such
demands are made this permit shall be final and binding.
I
If you have any questions, or need additional information concerning this matter, please
contact Samir Dumpor, at [phone].
Sincerely,
ThomasVA. Reeder
Division of Water Quality
AA/ sd: K:\SD\Permits - Bioretention\SW7130704
cc: Durk Tyson: P.E., Rivers and Associates, Inc. (PO Box 929, Greenville, NC
27835)
Beaufort County Buildin Inspections
✓Washington Regional OWce
North Carolina Division or Water Quality Imemet www.ncwaterquality.ore
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] North Carohna -
An Equal OpportunitylAffirmative Action Employer— 50% Recycled/10% Post Consumer Paper, ;Vatu 1&

State Stormwater Management Systems
Permit No. SW7130704
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
I
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable; Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Washeye, LLC
Washington Eye Center
Beaufort County
FOR THE
construction, operation and maintenance of one 6ioretention basin in compliance with
the provisions of Session Law 2008-211 and 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 July 15, 2013, and shall be
subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
i
i
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 1.7 on page 3 of this permit. The stormwater
control has been designed to handle the runoff from total of 42,950 square feet
of impervious area.
3. The tract will be limited to the amount of built -upon area as indicated in Section
1.7 of this permit, and per the application documents and as shown on the
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.
6. The built -upon areas associated with this project shall be located at least 50 feet
landward of all perennial and intermittent surface waters.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7130704
The following design criteria have been provided in the bioretention basin and
must be maintained at design condition:
a.
Drainage Area, ft2:
BASIN
54,276
b.
Total Impervious Surfaces, ft2:
42,950
C.
Design Storm, inches:
1.5
d.
Max. Ponded Depth, feet:
1.00
e.
Seasonal High Water Table, fmsl:
5.00
f.
Planting Media Depth, feet:
2' (grass cell)
g.
Basin Dimensions, feet:
104'x52'
h.
Bottom Elevation, fgsl:
10.00
i.
Top Surface Area, ft :
5,456
j.
Permitted Storage Volume, ft3:
5,456
k.
Bypass / Storage Elevation, fmsl:
11.00
I.
Predevelopment 1 year 24 hour:
4.10
M.
Post development 1 year 24 hour:
4.30
n.
Drawdown Time, hours:
16
o.
Receiving Stream/River Basin:
Cherry Run/Tar-Pam River Basin
P.
Stream Index Number:
28-103-17
q.
Classification of Water Body:
"C, Sw, NSW"
II. SCHEDULE OF COMPLIANCE
The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
The permittee shall at all time 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 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.
a. Access to the basin and outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become void unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
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
Page 3 of 7

State Stormwater Management Systems
I Permit No. SW7130704
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 belmaintained via appropriate recorded
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.
i
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 signed by both parties, to the
Division of Water Quality, accompanied by the supporting documentation as
listed on page 2 of the form. The approval of this request will be considered on
its merits and may or may not be approved.
The permittee is responsible for compliance with all permit conditions until such
time as the Division approves a request to transfer the permit.
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 and all statutes, rules, regulations, or ordinances, which may be imposed by
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7130704
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.
The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
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 2008-
211, Title 15A NCAC 2H.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. This permit shall be effective from the date of issuance until July 15, 2021.
Application for permit renewal shall be submitted 180 days prior to the expiration
date of this permit and must be accompanied by the processing fee
Permit issued this the 15th day of July, 2013.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
L. 'C-'Y "/ t.-G � '-� -i '✓G��7 for
Thomas A. Reeder, Acting Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. SW7130704
Page 5 of 7

State Stormwater Management Systems
Permit No. SW7130704
Washington Eye Center
Stormwater Permit No. SW7130704
Beaufort County
Designer's Certification
I
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.
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 l

State Stormwater Management Systems
Permit No. SW7130704
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, per the vegetation plan.
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
Beaufort County Building Inspections
Page 7 of 7

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... -,, .DWQ USE ONLY ,.
Date Received
Fee Paid
Permit Number
-
5 5
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW 7 2008 ❑ Ph 11- Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North CaRECEIVED
E �i I` E D
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM JUL - 8 2013
This form nay be photocopied fo%use as an anginal
1. GENERAL INFORMATION D' t% J."— ® O
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans, l�
specifications, letters, operation and maintenance agreements, etc.):
2. Location of Project (street address):
City: Washington County:Beaufort
3. Directions to project (from nearest major intersection):
Zip27889
From HWY 264E (Pactolus Hwv, WSth St) turn right onto Hwv 17 Bus. (Carolina Avenue). Continue north
I
for approximately 0.7 miles. The project will be on the right.'.
4. Latitude:35° 33' 57" N Longitude:-77° 3' 49" W of the main entrance to the project.
If. PERMIT INFORMATION: '
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modifications
t Renenonls roith rnodificatio is also requires StVU-102 - Reuemal Application Form
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): I
[]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
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 2.2 ac of Disturbed Area
❑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: '
5. Is the project located within 5 miles of a public airport? ❑No ®Yes
If ycs, see S.L. 2012-200, Part VI: httl2://portii.ncdenr.org/web/wq/ws/su/statesw/rules laws
Dorm SWU-101 Version 06Aug2012 Page I of

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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:Washeye, LLC
Signing Official & Title:Aruna Swarup, Member / Manayer�
b.Contact information for person listed in item la above:
Street Address:4005 River Park Drive
City:Suffolk State:VA Zip:23435
Mailing Address (if applicable):CT Corporation vstem INC Agent) -150 Fayetteville Street
Phone: (252 ) 946-5175
Email:
State:NC Zip:27601
Fax: (252 ) 946-4943
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.)
i
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: I
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax:
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/Organiza Hon: Rivers and Associates. Inc.
Signing Official & Title:F. Durward Tyson, Jr., P.E. - Project Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:PO Box 929
City:Creenville
Phone: (252 ) 752-4135
Email: d!yson©riversand associates.com
State:NC Zip:27835
Fax: 1(252 ) 752-3974
4. Local jurisdiction for building permits: Beaufort County
Point of Contact: Brandon Hayes Phone #: (252 ) 946-7182
Form SWU-101 Version 06Aug2012 Page 2 of

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IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
i
Stormwater runoff from the building and all asphalt paved areas will sheet Flow to catch basins and drop
inlets. Then will be transmitted through stormwater pipes to a Bioretention pond.
2.1. 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 project drains to the Tar / Pamlico River basin.
4. Total Property Area: 2.16 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area*:2.16 ✓ acres
Total project area shall be calculated to exclude the folloeoin the normal pool of imppounded structures, the area
behoeen khe bmeks of stremns and rivers, the area below the Normal High Water (NE) line or Mean High Water
(MHW) line, and coastal Wetlands landward front the NHW (or MHII line. The rest Itmut project area is used to
calculale overall percent built upon area (BUA). Non -coastal evetlands Inndroard of the NHW (or MHW) line unay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area Total Project Area) X 100 = 63.0
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
slormroater 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 Information
Draina e Area 1.'
Draina ge Area
Draina e Area _
Draina e Area _
Receiving Stream Name
Cherry Run
Stream Class *
N WS, C, Sw
Stream Index Number *
28-103-17
Total Drainage Area (so
94090 ✓
2 • 1'6 a� ✓
a C Sc
On -site Drainage Area (so
94090
Off -site Drainage Area (so
0
Proposed Impervious Area" (so
59242
j
Impervious Area** total
63.0
Impervious** Surface Area
Drainage Area 1
Drainage Area _
Drainage Area -
Drainage Area
On -site Buildings/Lots (so
15023
On -site Streets (sf)
On -site Parkin (so
39650
On -site Sidewalks (so
1277
LJ
Other on -site (so3292
ll
Z
Future (so
Off -site (sf)
Existing BUA*** (so
/
Total (so:
1 59242
" Stream Class and Index Number can be determined at: lutll�portal.itedenr.or vreb{rugfpslcsa/classifications
Irepervious area is defined as the built upon area including, but riot Bruited to, buildings, roads, parking areas,
sidetoalks, gravel areas, etc.
Form SWU-101 Version 06Aug2012 Page 3 of

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***Report only that amount of existing BUA that will remnin after development Do not report any existing BUA that
is to be renmved and which toill be replaced by net, BUA. I
S11. How was the off -site impervious area listed above determined? Provide documentation.
Projects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
EndangeredSpecies watershed that may be subject to more stringent stornnvater requirements as per l SA 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
fronihttp://12ort,il.ncdeT)r.orl,/web/wq/ws/su/bmp-nianual.
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://portil.ncdenr.org/web/wq/ws/su/statesw/forms does. 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.ncdennorg/web/wg/ws/so/maps.)
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/w2/ws/su/statesw/forrm}s does.
✓1. Original and one copy of the Stormwater Management Permit Application Form.
l+��
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✓ 2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants .J.4-
✓/7
✓ 8
Form. (if required as per Part VII below)
Original of the applicable Supplement Form(s) (sealed, 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
http://www.envhelp.org/pages/onestopexpress.htmi 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 1.
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 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
Sealed, signed and dated calculations (one copy).
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 norriial pool elevation of impounded
structures, the banks of streams or rivers, and the MI-IW (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.
I. 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 nd identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
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Fora SW U-101 Version 06Aug2012 Page 4 of 6
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o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5xll" copy of the MRCS 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 verifj the SHWT prior
to submittal, [phone].) i
A copy of the most current property deed. Deed book: 1815, Page No: 260
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 15A NCAC 2H.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.
httD: / /www.secretarv.state.nc.us/Coroorations/CSearch.asl)x
VII. 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 lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot 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.ory/web/wg/ws/su/statesw/forms does. 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. I
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 beirecorded 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:F Durward Tyson, Jr., P.E.
Consulting Firm: Rivers and Associate, Inc. I
Mailing Address:PO Box 929 CeU 2S 2 —71-7 — ZGI 6 O
City:Greenville State:NC Zip:27835
Phone: [phone] Fax: (252 ) 752-3974
Enra il:d tvson©riversa ndassociates.com
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or tyre mane of person listed in Contact Information, item 2a),' , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item 1a) with (print or type narue of organization listed in
Contact Information, iterm la) 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.
Form SW U-101 Version 06Aug2012 Page 5 of 6

•
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 1 will be operating a stormwater treatment
facility without a valid permit. 1 understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 a d may result in appropriate enforcement action 'ncluding
the assessment of civil penalties of ,to $25,000 per �y, pursuant to NCGS 143-215.6.
1
Signature: i Date: 2
1, �at1 n A-Py 2) _)1 1 t JT I , a N {
tar Public for the State of ' C County of
do hereby certify that VV personally appeared
before me this day of ZI L,TL , _, a acknowledge the due ex�e/u�fion of he a placation for
a stormwater permit. Witness my hand and official seat, AA 1 �^
SEA L
My commission expires
PITT
X. APPLICANT'S CERTIFICATION A
1, (print or type name of Verson listed in Contact Information, itern la) I l Y U ga
certify that the information included on this permit application form is, to the best of my knowledg , 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 the
applicable stormwater rules under 15A A, C 2H .1000 an any other applicable state stormwat r requrements.
Signature: 1 ' �D(ate: 2
1, �1 Q1� ` 12) a N(R,t�ary Pu lic for the State of 1 V , County of
do hereby certify that �_` \�..l.i��� �w� personally appeared
before me this2G) day of ��>,.r�.. 1 3�E acknowledge the due exec ion of the ap lication for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Forn1 SWIJ-101 Version 06Aug2012
Page 6 of 6

I �.

Permit Number:
(to be provided by DWQ)
' ®VAo20p wnrFgC
oc
NCDENR °�g
® STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
BIORETENTION CELL SUPPLEMENT
I
This form must be filled out, printed and submitted.
The Required Items Checklist (Part HI) must be printed, filled out and submitted along with all of the required information.
I. PROJECT INFORMATION
Project name Washington Eye Center
Contact name Rivers & Associates - Durk Tyson
Phone number [phone]
Date July 11, 2013
Drainage area number 1
Site Characteristics
i _ /J
Drainage area
54,276 ftzl
Impervious area
42,950
Percent impervious
79.1% %
Design rainfall depth
1.5 inch
Peak Flow Calculations
Is pre/post control of the 1-yr, 24-hr peak flow required?
Y (Yor N)
1-yr, 24-hr runoff depth
3.19 in I
1-yr, 24-hr intensity
0.13 in/hr
Pre -development 1-yr, 24-hr peak Flow
4.100 ft'/sec
Post -development 1-yr, 24-hr peak flow
4.300 ft'/sec
Pre/Post 1-yr, 24-hr peak control
0.200 ft'/sec
Storage Volume: Non -SA Waters
Minimum volume required
ft' 1
Volume provided
ft' '
Storage Volume: SA Waters
n
1.5' runoff volume
4,760 ft3 V
Pre -development 1-yr, 24-hr runoff
16,008 ft'
Post -development 1-yr, 24-hr runoff
17.196 ft'
Minimum volume required
4,760 ft'
Volume provided
5,456 It jN/
OK
Cell Dimensions
V
Ponding depth of water
12 inches
OK
Ponding depth of water
1.00 ft
Surface area of the top of the bioretention cell
5,456.0 ftz
OK
Length:
104 it I
OK
Width:
52 ft �i
OK
-or-Radius
it
Media and Soils Summary
Drawdown time, ponded volume
4 hr
OK
Drawdown time, to 24 inches below surface
12 hr
OK
Drawdown time, total:
16 hr
In -situ soil:
Soil permeability
n/a in/hr
OK
Planting media soil:
1,
Soil permeability
3.00 in/hr
OK
Soil composition
® % Sand (by volume)
86% `
OK
% Fines (by volume)
10%
OK
% Organic (by volume) -
4%
OK
Total:
100%
Phosphorus Index (P-Index) of media
20 (unitless)
OK
Form SW401-Bioretenlion-Rev.8
June 25, 2010
Parts I and II. Design Summary, Page 1 of 2

Permit
Basin Elevations
(to be provided by DWQ)
Temporary pool elevation
12.00 fmsl
Type of bioretention cell (answer 'Y' to only one of the two
following questions):
Is this a grassed cell?
Y
(Y or N)
OK
Is this a cell with trees/shrubs?
nla
(Y or N)
Planting elevation (top of the mulch or grass sod layer)
10 fmsl
Depth of mulch
0 inches
Insufficient mulch depth, unless installing grassed cell.
Bottom of the planting media soil
8 fmsl
Planting media depth
2 it
Depth of washed sand below planting media soil
0 fit
Are underdrains being installed?
Y
(Y or N)
How many clean out pipes are being installed?
6
OK
What factor of safely is used for sizing the underdrains? (See
2
BMP Manual Section 12.3.6)
OK
Additional distance between the bottom of the planting media and
the bottom of the cell to account for underdrains
1 fit
Bottom of the cell required
71msl
SHWT elevation
5 fmsl
Distance from bottom to SHWT
2 ft
OK
Internal Water Storage Zone (IWS) ,;
Does the design include IWS
Y
(Y or N)
Elevation of the top of the upturned elbow
8.5 fmsl
Separation of IWS and Surface
1.5 It
OK
Planting Plan -
Number of tree species
0
Number of shrub species
Number of herbaceous groundcover species
Additional Information
Does volume in excess of the design volume bypass the
Y
Y or N
( )
OK
bioretention cell?
Does volume in excess of the design volume flow evenly distributed
through a vegetated filter?
Y
(Y or N)
OK
What is the length of the vegetated filler?
35 fit
Does the design use a level spreader to evenly distribute Flow?
N
(Y or N)
Show how Flow is evenly distributed.
Is the BMP located at least 30 feet from surface waters (50 feet if
SA waters)?
Is the BMP located at least 100 feel from water supply wells?
Are the vegetated side slopes equal to or less than 3:1?
Is the BMP located in a proposed drainage easement with access
to a public Right of Way (ROW)?
Inlet velocity (from treatment system)
Is the area surrounding the cell likely to undergo development in
the future?
Are the slopes draining to the bloretention cell greater than 20%?
Is the drainage area permanently stabilized?
Pretreatment Used
(Indicate Type Used with an'X' in the shaded cell)
Gravel and grass
(8inches gravel followed by 3-5 It of grass)
Grassed swale
Forebay
Other
Y (Y or N) OK
Y (Y or N) OK
Y (Y or N) OK
Y (Y or N) OK
3.12 fYsec Insufficient inlet velocity unless energy dissipating devices are
being used.
N (Y or N) OK
N (Y or N) OK
Y (YorN) OK
is
Form SW401-Bioretention-Rev.8
June 25, 2010
Parts I and II. Design Summary, Page 2 of 2

Permit No:
(to be assigned by DWQ)
III. REQUIRED ITEMS CHECKLIST
I
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
Ip4jjaJq Sheet No
Ffi�1/L— �a� 1. Plans (1' - 50' or larger) of the entire site showing:
- Design at ultimate build -out,
CA 455 Off -site drainage (if applicable),
- Delineated drainage basins (include Rational C coefficient per basin),
- Cell dimensions,
-
Pretreatmentsystem,
- High flow bypass system,
- Maintenance access,
- Recorded drainage easement and public right of way (ROW),
- Clean out pipe locations,
- Overflow device, and 1
C''i;-
S e'w
M145
JA.
Form SW401-Bioretention-Rev.7
Boundaries of drainage easement.
Plan details (1' = 30' or larger) for the bioretenlion cell showing:
- Cell dimensions
- Pretreatment system, I
- High flow bypass system,
- Maintenance access,
- Recorded drainage easement and public right of way (ROW),
- Design at ultimate build -out,
Off -site drainage (if applicable),
- Clean out pipe locations,
- Overflow device, and
- Boundaries of drainage easement.
- Indicate the P-Index between 10 and 30,
3. Section view of the bioretenlion cell (1' = 20' or larger) showing:
- Side slopes, 3:1 or lower
- Underdrain system (if applicable), and ;
- Bioretention cell layers [ground level and slope, pre-treatment, ponding depth, mulch depth, fill media
depth, washed sand, filler fabric (or choking stone if applicable), #57 stone, underdrains (if applicable),
SHWT level(s), and overflow structure]
4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified in the field by DWO, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information. All
elevations shall be in feet mean sea level (fini Results of soils tests of both the planting soil and the in
situ soil must include:
- Soil permeability,
- Soil composition (% sand, %fines, % organic), and
- P-index. 1
5. A detailed planting plan (1" = 20' or larger); prepared by a qualified individual showing:
- A variety of suitable species, I
- Sizes, spacing and locations of plantings,
- Total quantity of each type of plant specified,
-A planting detail,
- The source nursery for the plants, and
- Fertilizer and watering requirements to establish vegetation.
6. A construction sequence that shows how the Bioretention cell will be protected from sediment until the
entire drainage area is stabilized. I
7. The supporting calculations (including underdrain calculations, if applicable).
8. A copy of the signed and notarized inspection and maintenance (I&M) agreement.
9. A copy of the deed restriction.
Part III, Page 4 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
OBioretention Operation and 1Vlaintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP"elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
Important operation and maintenance procedures:
Immediately after the bioretention cell is established, the plants will be watered
twice weekly if needed until the plants become established (commonly six
weeks). i
Snow, mulch or any other material will NEVER be piled on the surface of the
bioretention cell.
— Heavy equipment will NEVER be driven over the bioretention cell.
— Special care will betaken to prevent sediment from entering the bioretention cell.
— Once a year, a soil test of the soil media will be conducted.
After the bioretention cell is established, I will inspect it 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 will be kept in a known set location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall ®
be repaired immediately.
19
BMP element:
Potentialproblems:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
bioretention cell
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
i
established. Provide lime and a
one-time fertilizer application.
The inlet device: pipe,
The pipe is clogged (if
Unclog the pipe. Dispose of the
stone verge or swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe:
otherwise damaged (if
applicable) .
Erosion is occurring in the
Regracie the swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Stone verge is clogged or
Remove sediment and clogged
covered in sediment (if
stone and replace with clean stone.
applicable).
Form SW401-Bioretention O&M-Rev.3 Page 1 of 4

•
0
BMP element:
Potentialproblems: I
How I will remediate theproblem:
The pretreatment area
Flow is bypassing
Regrade if necessary to route all
pretreatment area and/or
flow to the pretreatment area.
hies have formed.
Restabilize the area after grading.
Sediment has accumulated to
Search for the source of the
a depth greater than three
sediment and remedy the problem if
inches. j
possible. Remove the sediment and
restabilize the pretreatment area.
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.
The bioretention cell:
Best professional practices
Prune according to best professional
vegetation
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.
Tree stakes/wires are present
Remove tree stake/wires (which
six months after planting.
can kill the tree if not removed).
The bioretention cell:
soils and mulch
Mulch is breaking down or
has floated away.
Spot mulch if there are only random
void areas. Replace whole mulch
layer if necessary. Remove the
remaining much and replace with
i
triple shredded hard wood mulch at
a maximum depth of three inches.
Soils and/or mulch are :
Determine the extent of the clogging
clogged with sediment. ;
- remove and replace either just the
top layers or the entire media as
needed. Dispose of the spoil in an
appropriate off -site location. Use
triple shredded hard wood mulch at
a maximum depth of three inches.
Search for the source of the
sediment and remedy the problem if
possible.
An annual soil test shows that
Dolomitic lime shall be applied as
pH has dropped or heavy
recommended per the soil test and
metals have accumulated in
toxic soils shall be removed,
the soil media.
disposed of properly and replaced
with new planting media.
Fonn SW401-13ioretention O&M-Rev.3
Page 2 of 4

�J
s
BMP element:
Potentialproblems:
How I will remediate theproblem:
The underdrain system
(if applicable)
Clogging has occurred.
Wash out the underdrain system.
The drop inlet
Clogging has occurred.,
Clean out the drop inlet. Dispose of
the sediment off -site.
The drop inlet is damaged
Repair or replace the drop inlet.
The receiving water
Erosion or other signs of
damage have occurred at the
outlet.
Contact the NC Division of Water
Quality 401 Oversight Unit at 919-
733-1786.
Form SW401-Bioretention O&M-Rev.3
Page 3 of 4

I Permit Number:
! (to be provided by DWQ)
® i
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.
is
CJ
Project name: Washington Eve Care Center
/3MP drainage area or lot number:
Print
Title:Member / Manager
Address:4005 River Park Drive, Suffolk, VA 23435
Note: The legally responsible party should not be a homeowners association unless more than 50%of
the lots have been sold and a resident of the subdivision has been named the president.
a Notary Public for the State of
NC, County of P do hereby certify that
V I?.nQ s (UYl ,lpersonally appeared before me this
day of 7, � X\� . , and acknowledge the due execution of the
forgoing permeable pavement maintenance requirements. Witness my hand and official
seal,
i
NOTARY _
pUBLIG
My commission expires
Form S W 401-Permeable Pavement O&M-Rev.3
Page 3 of 3