SW6090701_Application_20090708

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. . GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
?14IA/:1..,... T
3. Mailing Address for person listed in item 2 above:. '
City:Fayetteville State:NC
Zip:28306
Phone: (TO) 678 2565 Fax: (910 ) 678-6242
Email:[e-mail]2 nc us
4. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
5. Location of Project (street address):
City:Hove Mills County:Cumberland
6. Directions to project (from nearest major intersection):
7. Latitude:340 55' 17" N sS`L� Z)4 q p0
�_ Longitude:780
54' Ol" W /f6 , of project
--i f
8. Contact person who can answer questions about the project:
Name:Timothv Hess Telephone Number: (919. ) 954-8200
Emad:[e-mail]
IL PERMIT INFORMATION:
1. Specify whether project is (check one): ®New Renewal
❑ ❑Modification
Form SWU-101 Version 09.25.08 Pagel of4

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number and its issue date (if known)
3. Specify the type of project (check one):
®Low Density ❑High Density ❑Redevelop []General Permit ❑Universal SMP ❑Other
4. 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):
❑LAMA Major . ®Sedimentation/Erosion Control ❑404/40l Permit ❑NPDES Industrial Stormwater
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.
Storm Water is Piped to a common wet basin and treated as detailed m the attached documentation
2. Stormwater runoff from this project drains to the Cape Fear River basin.
3. Total Property Area: 40.52 acres 4. Total Coastal Wetlands Area: 0 acres
5. Total -Property Area (3) - Total Coastal Wetlands Area (4) = Total Project Area":40.52 acres
6. (Total Impervious Area / Total Project Area) X 100 = Project Built Upon Area (BUA):28 %
7. How many drainage areas does the project have140.52
8. 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.
For hi¢h density Proiectq. rmmnteEn tho t M_ ...:a ,__:---- _
rmation
area
Drainage Area 1
tor each stwater devi7Total
Stream Name
Gray's Creek
ass & Index No.
B-18-35-(1)
a7a2
nage Area (so
2,265,883
ainage Area (so
2,265,883
Off -site Drainage Area (so
0
Existing Impervious* Area (so
0
Proposed Impervious*Area (so
493,237
% Impervious" Area (total)
28
Impervious" Surface Area
On -site Buildings (sf)
Drainage Area 1
128,741
Drainage Area 2
On -site Streets (st)
335,500
On -site Parking (so
0
On -site Sidewalks (so
28,996
Other on -site (so
Off -site (so
Total (so:
'I
493,1237
mpervuous area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
Sidewalks, gravel areas, etc.
"Total project area shall be calculated to exclude Coastal Wetlands from use when calculating the built upon area
percentage calculation. This is the area used to calculate overall percent project built upon area (BUA).
ce.
Form SWU-101 Version 09.25.08 Page 2 of

9. How was the off -site impervious area listed above derived7There are no offsite impervious areas draining
Projects in Union County: Contact the DWQ Central Office staff to check to see ifyou project is located
within a Threatened & Endangered Species watershed that may be subject to more stringent stormwater
requirements.
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
One of the following property 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 sighificantiy, a table
listing each lot number, size and the allowable built -upon area for each lot must be provided as an attachment.
Forms can be downloaded from http://h2o.enr state nc usZsuibml2 forms htm -deed restrictions.
Form DRPC-1
High Density Commercial Subdivisions
Form DRPC-2
High Density Developments with Outparcels
Form DRPC-3
High Density Residential Subdivisions
Form DRPC4
Low Density Commercial Subdivisions
Form DRPC-5
Low Density Residential Subdivisions
Form DRPC-6
Low Density Residential Subdivisions with Curb Outlets
By your signature below, you certify that the recorded property restrictions and protective covenants for this
project shall include all the applicable items required in the above form, 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.
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 Stormwater Permitting Unit at [phone] for the status and
availability of these forms. Forms can be downloaded from htto://h2o.enr state nc us/sulbmp forms htm.
Form SW401-Low Density
Form SW401-Curb Outlet System
Form SW401-Off-Site System
Form SW401-Wet Detention Basin
Form SW401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-Level Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Form SW401-Permeable Pavement
Form SW401-Cistern
Low Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
Permeable Pavement Supplement
Cistern Supplement
Form SWU-101 Version 09.25.08 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 Office. (Appropriate office may be found by locating project on the
interactive online map at http://h2o.enr.state.nc.us/su/nisi maps hun)
1. Please indicate that you have provided the following required information by initiating in the space provided
next to each item.
Initials
• Original and one copy of the Stormwater Management Permit Application Form
• Original and one copy of the Deed Restrictions & Protective Covenants Form (if u/a
required as per Part IV above)
• Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP w raw
• Permit application processing fee of $505 (Express: $4,000 for HD, $2,000 for LD)
payable to NCDENR &ir
• Calculations & detailed narrative description of stormwater treatment/management Dyrc
• Copy of any applicable soils report NSA
• Two copies of plans and specifications (sealed, signed & dated), including: fir_
- 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 (such as additional information requests), please complete this section. (ex. designing engineer or firm)
Designated agent (individual or firm):David Kiker/ WK Dickson
Mailing Address:720 Corporate Center Drive
City:Raleieh State:NC Zip:27607
Phone: (919 ) 782-0495
Email:[e-mail]
VIII. APPLICANT'S CERTIFICATION
Fax: (919 ) 782-9672
I, (print or type name of person listed in General Information, item 2) David Kiker
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.�\ /.
Date: -7'7-61
Form SWU-101 Version 09.25.08 Page 4 of