HomeMy WebLinkAboutSW6121104_CURRENT PERMIT_20121231STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW (oL�
11
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYMMDD
DENR-FRO
NCDENR DEC 3 t 2012
North Carolina Department of Environment and Natural ResourW
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
November 28, 2012
Mr. R. Lee Pittman
Par 5 Development Group, L.L.C.
2860-B NC 5 Hwy.
Aberdeen, NC 28315
Subject: Stormwater Permit No. SW6121104
Dollar General Store - Chicken Foot Rd.
High Density Commercial Infiltration Basin Project
Cumberland County
Dear Mr. Pittman:
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for the
subject project on November 20, 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. SW6121104, dated November 28, 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 November 28, 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 BM P(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 by filing a written petition with the Office of Administrative Hearings (OAH).
The written petition must conform to Chapter 150B of the North Carolina General Statutes. Per NCGS 143-
215(e) the petition must be filed with the OAH within thirty (30) days of receipt of this permit. You should
contact the OAH with all questions regarding the filing fee (if a filing fee is required) and/or the details of the
filing process at 6714 Mail Service Center, Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit
their website at www.NCOAH.com. Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the Fayetteville Regional Office. If you have any questions, or need additional
information concerning this matter, please contact Robert Patterson at (919) 807-6375; or
robert.patterson@ncdenr.gov.
Sincerely,
for Charles Wakild, PE, Director
Wetlands and Slormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location 512 N Salisbury St. Raleigh, North Carolina 27604
Phone 919-807-63001 FAX: 919-807-6494
Internet: www,ncwaterquality.org
An Equal Opportunity lAffrmative Action Employer
cc: SW6121104 File,
Alfred R. Pittman - Owner
ec: C. Heath Wadsworth, PE - Call Sign Engineers
Mike Lawyer - Fayetteville Regional Office
One
NorthCarolina
Naturally
State Stormwater Permit
Permit No. SW6121104
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 applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Par 5 Development Group, L.L.C.
Dollar General Store — Chicken Foot Road
Chicken Foot Rd. (SR 2252), Hope Mills, Cumberland County
FOR THE
construction, operation and maintenance of an infiltration basin in compliance with the
provisions of Session Law 2006-246 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 November 28, 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 1.8 of this permit. The stormwater control has been
designed to handle the runoff from 30,633 square feet of impervious area.
3. The infiltration basin is designed, and must be maintained, to capture and
infiltrate the 10-yr, 24-hr storm event in lieu of providing a vegetated filter strip
and bypass.
4. The tract will be limited to the amount of built -upon area indicated in Section 1.8
of this permit, and as shown on the approved plans.
5. 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.
6. 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
Permit No. SW6121104
7. The built -upon areas associated with this projec! shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
8. The following design criteria have been permitted for the infiltration basin and
must be provided and maintained at design condition:
a. Drainage Area, acres:
1.01
Onsite, ft :
43,917
Offsite, ft2:
0
b. Total Impervious Surfaces, ft2:
30,633
Onsite, ft :
30,633
Offsite, ftZ:
0
C. Design Storm, inches:
1.0
d. Basin Depth, feet:
1.1
e. Bottom Elevation, FMS�:
166.0
f. Bottom Surface Area, ft :
4,600
g. Bypass Weir Elevation, FMSy
167.1
h. Permitted Storage Volume, ft :
4,600
i. Type of Soil:
Wagram Loamy Sand
j. Expected Infiltration Rate, inlhr:
2.45
k. Seasonal High Water Table, FMSL:
160.5
I. Time to Draw Down, days:
0.5
M. Receiving Stream/River Basin:
Grays Creek 1 Cape Fear
n. Stream Index Number:
18-35-(1)
o. Classification of Water Body:
"B"
ll. 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 bypass structure, infiltration media, flow
spreader, catch basins, piping and vegetated filter.
g. A clear access path to the bypass 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 permittee shall submit to the DWQ Fayetteville Regional Office an annual
summary report of the maintenance and inspection records for each BMP. The
report shall summarize the inspection dates, results of the inspections, and the
maintenance work performed at each inspection.
Page 2 of 6
State Stormwater Permit
Permit No. SW6121104
6. 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.
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. 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.
9. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
10. 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.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. 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.
13. 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 to any person or entity 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 the
appropriate 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.
Page 3 of 6
State Stormwater Permit
Permit No. SW6121104
2. The permittee is responsible for compliance with all permit.conditions until such
time as the Division approves the transfer request.
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 and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
controls 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 in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 281h day of November, 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for unarleS vvaKIICJ, N.E., uirector
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6
State Stormwater Permit
Permit No. SW6121104
Dollar General Store — Chicken Foot Road
Stormwater Permit No. SW6121104
Cumberland 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 5 of 6
State Stormwater Permit
Permit No. SW6121104
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 overflow structure weir elevation is per the approved plan.
6. The overflow structure is located per the approved plans.
7. The fore bay is constructed per the approved plans.
$. 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 volume have been provided.
12. All required design depths are provided.
13. All required parts of the system are provided.
14. 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 28301-5043
Cc: Cumberland County Building
Inspections
Page 6 of 6
?AJ"fG,250nJ
DWQ USE ONLY
Date Received
Fee Paid
Permit Num cr
h Ze J 2
,�O re1.
Applicable Rules: ❑ Coastal Sw —1995
(select all that apply) ❑ Non -Coastal SW- 1-IQW/ORbV
❑ Other I-VQ M mt Plan:
❑ Coastal SW -- 2008 PT11 11 - Post Construction
Waters ❑ Universal Stormwater Management Plan
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This forin inay he photocopied for use as air original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Dollar General Store - Chicken Foot Road
2. Location of Project (street address):
No address for property; located off Chicken „Foot (SR 2252) near Hope Mills, NC
City:Rockfish Township _ County:Cumberlancl Zip:28451.
3. Directions to project (from nearest major intersection):
The project site is located on Chicken Foot Road SR 2252 near its intersection with Sand Hill Road.
4. Latitude:34* 55' 53.04" N Longitude:78° 54' 57.96" IV of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification
b.lf 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):
❑L,ow 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: 2.5 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.lf any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
@C�d�
_[_NOV 2 0 1012
Form SWU-I01 Version Ohii2010 Page I of 6
M. CONTACT INFORMATION
I.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: Par 5 Development Group, LLC
Signing Official &'I'itle:R. Lee Pittman, Member Manager
b.Contact information for person listed in item I above:
Street Address:2860-B NC 5 1-lighway
City:Aberdeen State:NC Zip:28315
Mailing Address (if applimble):2860-B NC 5 Highway
City:Aberdeen State:NC Zip:28315
Phone: (910 } 944-0881 Fax: (910 ) 944-0881
Email:lee@rlletsoncomyanies.com
c. Please check the appropriate box. The applicant listed alcove 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 ["roperty Owner's name and title below, if you are the lessee, purchaser or developer. ('Phis is the
person who owns the property that the project is located on):
Property Owner/OrganizatiomAlfred R. Pittman
Signing Official & Title:Alfred R. Pittman, Owner
b.Contact information for person listed in item 2a above:
Street Address:2012 Crystal Springs Road
City: Fayetteville State:NC Zip:28306
Mailing Address (if applicable):
City: State: Zip:
Phone: { .._._) - _ �_— Fax: ( }
Email:
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:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( }
Email:
4. Local jurisdiction for building permits: Cumberland County
Point of Contact:Torn Lloyd Phone #: (910 ) 678-7600
1orm SWL1-101 Version 07Jun2010 Pxgc 2 of 6
IV. PROJECT INFORMATION
1. In the space provided belotiv, briefly summarize how the stormwater runoff will be treated.
The proposed parking lot and building will be designed so that runoff discharges into and is treated by an
infiltration basin.
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 PUDApproval 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 11 — Post Construction
3. Stormwater runoff from this project drains to the Cape Fear River basin.
4. Total Property Area: 2.58 acres 5. 'Total Coastal Wetlands Area: 0 acres
6. 'Total Surface Water Area: 0 acres
Total Property Area (4) —Total Coastal Wetlands Area (5) — Total Surface Water Area (6) =Total Project Area':
2.58 acres
Total project area shalt be calculated to exclude the following: the normal pool of ndrpounded structures, the area
1070 edr the banks of streams and rivers, the area below the Normal High Water (NHW) time or Mean High Water
(M 14W) true, and coastal wetlands landward front the NNW (or MHIN) litre. The resultadrt project area is used to
CalCnlate overall percent bait upon area (BLIA). Nord -Coastal wetlands larddWard of the NHW (or R'IHW) tine may
be included in the total project area.
S. Project percent of impervious area: (Total Impervious Area I 'Total Project Area) X 100 = 28.4
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
storinwater BMP. For tout density and other projects, rise 1 for tide 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
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area`_
Receiving Stream Name
Grays Creek
Stream Class *
13
Stream Index Number *
18-35-(1)
Total Drainage Area (sf)
43,917
On -site Drainage Area (sf)
43,917
Off -site Drainage Area (sf)
0
Proposed Impervious Area** (sf)
30,633
"o Impervious Area** (total)
70"�,
impervious*' Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area'
On -site Buildings Lots (sf)
9,100
On -site Streets (sf)
0
On -site Parking sf
21,333
On -site Sidewalks (sf)
0
Other on -site (sf)
200
Future (sf)
0
Off -site (sf)
0
Existing BUA*** (sf)
0
Total (sf):
30,633
* Stream Class and hider Number can be determined at: littp).- Aortal.iiedeur.org/rtieblwrl/ps esulclassifScations
** hrd ervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sia e7valks, gravel areas, etc.
** Report only that amorndt of existing BLIA that will remain after development. Do not report any existing BUA flint
is to be removed and which will be replaced by new BUA.
Form SWU-101 Version 07.111112010 l'aoc 3 oT6
11. Ho%v was the off -site impervious area listed above determined? Provide documentation. NIA
Projects in Union County: Contact DIi,'Q Central Office staff to check if the project is located within a Threatened 4-
Endangered Species watershed that ina-y be subject to more stringent storMiVater 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 htto://vortal.ncdenr.orp/web/tva/ws/su/bmp-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/t1,q/xvsjsu/states A,/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.ncdenr.org/ web / wq / WS / SLI / Isla US.)
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 Storm water Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part hll below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 poyable to NCDENR. (For an Express review, refer to
htti://wtvw.envhelp.org/p,i es/onestopexpress.html 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.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management
6. A USCS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters Within ih mile of the site boundary, include the rh
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 NHYV line of tidal
waters, and any coastal wetlands landward of the MI-1W or NFIW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the Ail-11-NI (or NHIV) 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.
nt. 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).
e'J
for '4/
Forst SW(_I-101 Version 07.1un2010 Pace 4 of 6
9. Copy of any applicable soils report with the associated SI-1W'I' elevations (P[ease identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration 13MPs, 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 0WQ to verifij the SH1N7 prior
to submittal, (910) 796-7378.)
10. A copy of the most current property deed. Deed book: 5634 Page No: 0576 �/
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC Grp,l# _
Secretary of State or other official documentation, which supports the titles and positions held T�'
by the persons listed in Contact Information, item la, 2a, and /or 31 per 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.
http:/ / w%viv.secretary.state.nC.us/Corporations/CSearch.aspx
VI[. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, autparcels, 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.org/webZwq/LNLs/sLi./stateswi 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.
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 EngineenC. Heath Wadsworth, PE
Consulting Firm: Call Sign Engineers, PA
Mailing Address:104 Gillespie Street
City:l;ayettevi I le State:NC Zi p:28301
Phone: (910 ) 486-0700 Fax: (910 ) 486-8900
Email:heath.wads%vorth r+ callsignengineers.com
IX. PROPERTY OWNER AUTHORIZATION (if Contact lnfornration, item 2 has been filled orrt, complete this
section)
[, (print or type name of person listed in Contact lnforruation, item 2a) Alfred R._Pittman certify that [
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) R. Lee Pittrrrau with (print or type name of organization listed in
Contact Information, item .T.a) Par Development Groop, 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.
Form S W IJ-101 Version 07,I un2010 Pa-e 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 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 of NC General Statue 1.43-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature:
Date: /e/— /S / Z
I, Sf i (je-A/ _ _ , a Notary Public fortheState of lV c g O lthsQJ1� (lounty of
(u mkj �ar�do hereby certify that Al Frred 9�-- T s VVY11OI✓1 personally appeared
before me this - day of NOVe-ft0t6Y', 'DOiand ackr owled &�;
e execution of the application for
a stormwater permit. Witness my hand and official seal,
`,J%11111//j"/
ti
Abe L%G :
F
-4ND Gp,,```%
/11111111
X. APPLICANT'S CERTIFICATION
v
SEAL
My commission expires�� VU) �- D 0( S
I, (print or type name of Person listed in Contact Information, item 1a) K. Lee Pittman
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 covenan will be record that the proposed project complies with the requirements of the
applicable s water ri s under A NCA 21-1 .1000, SL 2006-246 (Ph. 1I - Post Construction) or SL 2008-211.
Signature. / Date: 77/ / z
1, a Wary 11P��u��bhc for the State ofA(f)&R'PA&"County of
do hereby certify #hat i_t.l� PL�1 personally appeared
before me tlhisA.�ay of and ac ow ledge rdix xecution of the application for
s
a stormwater permit. Witness my hand and official seal,
(�t1 i sCIle
Notary Public
Moore County
My Com 1s i EXPires
?Py
�r�r�rrrrttntttrs���
SEAL
My commission expires d a� b �/ '2� /q
Form SWII-101 Vcrsion 07.1un2010 Pabc 6 of 6
SATO
/,
l� Irifliiii�'L
Permit Number:.W Cal?, I 10q
(to be provided by DWQ)
Drainage Area Number: f
Infiltration 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 13MP.
Important maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the
infiltration basin.
— Immediately after the infiltration basin is established, the vegetation Will be
watered twice weekly if needed until the plants become established (commonly
six weeks).
— No portion of the infiltration basin will be fertilized after the initial fertilization
that is required to establish the vegetation.
— The vegetation in and around the basin will be maintained at a height of
approximately six inches.
After the infiltration basin is established, it will be inspected once a quarter and within
24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of 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.
BMP element:
Potential roblem:
How l 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
infiltration basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
The inlet device. pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade 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. _rolile7ms rvig erosion-
u=
E WV 2 0
DENR-_WATLR DUAL" ►,
Form SW401-Inliltration Basin O&M-Rev.3
Page 1 Of 3
BMP element:
The forebay
The main treatment area
The embankment
The outlet device
The receiving water
Potential problem:
Sediment has accumulated
and reduced the depth to 75%
of the original design depth.
Erosion has occurred or
riprap is displaced.
Weeds are present.
A visible layer of sediment
has accumulated.
Water is standing more than
5 days after a storm event.
Weeds and noxious plants are
growing in the main
treatment area.
Shrubs or trees have started
to grow on the embankment.
An annual inspection by an
appropriate professional
shows that the embankment
needs repair.
Clogging has occurred.
The outlet device is damaged
Ivrosion or other signs of
damage have occurred at the
outlet.
How 1 will remediate the problem:
Search for the source of the
sedimentand remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Remove the weeds, preferably by
hand. If pesticides are used, wipe
them on the plants rather than
spraying.
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP. Replace any media that
was removed in the process.
Revegetate disturbed areas
immediately.
Replace the top few inches of filter
media and see if this corrects the
standing water problem. If so,
revegetate immediately. If not,
consult an appropriate professional
for a more extensive repair. _
Remove the plants by hand or by
wiping them with pesticide (do not
spray).
Remove shrubs or trees
immediately.
Make all needed repairs. M
Clean out the outlet device. Dispose
of the sediment off -site.
Repair or replace the outlet device.
Contact the NC Division of Water
Quality 401 Oversight Unit at 919-
733-1786.
Form SW401-Infiltration Basin ORM-Rev.3 11,we 2 of")
Pennit Number: .SW61 Z 110 !f
(to he provided b� DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name: Dollar General Store - Chicken Foot Road
BMP drainage area number: I
Print name:R. Lee Pittman
'I'itle:Member Manager War 5 Development Group, LIC)
Address:2860-B NC 5 Highway-, Aberdeen. NC 28315 _
Phone
Signat
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.
I, a Notary Public for the State of
5
A&&, County of 01ADAt do hereby certify that
61 personally appeared before me this j
day of A)O?)041-4�, Zf,, and acknowledge the due execution of the
forgoing infiltration basin maintenance requirements. Witness my hand and official sea]
ii
Notary Public
Moore County
=My Com ISSI n EXes'
O?
!!!llfll n441555
SISAL
My commission expires Oal I S lao 11
Form SW401-Infiltration Basin O&M-Rev.3 Page 3 of 3
ti ', :�'
., ,. , ,-
Permit No. 5w61Z1 f 0`f
(to be provided by DWQ)
Ill. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Pagel Plan
Initials Sheet No.
C —n
1. Plans (1" 50' or larger) of the entire site showing:
Design at ultimate build -out,
G(y �OZ
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.
i�J G&- oL 2. Partial plan (1" = 30' or larger) and details for the infiltration basin showing;
Bypass structure, D j
- Maintenance access, i. @
- Basin bottom dimensions,
- Basin cross-section with benchmark for sediment cleanout,
Flow distribution detail for inflow,
Vegetated filter, and
DENR - WA bu �B[laneh
Pretreatment device. Wettanda.
LLB-o L
3. Section view of the infiltration basin (1" = 20' or larger) showing:
Pretreatment and treatment areas, and
Inlet and outlet structures.
4. A table of elevations, areas, incremental volumes & accumulated volumes to verify the volume provided.
F 7�1
�//1/
114
5. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified in the field by DWO, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
6. A construction sequence that shows how the infitlration basin will be protected from sediment until the
C(Y'oz.
entire drainage area is stabilized.
7, The supporting calculations.
ti7� 8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
G 9. A copy of the deed restrictions (if required).
Form SW401-Infiltration Basin-Rev.4 Page 1 of 1 Part III. Required Items Checklist, Page 1 of 1