SW6130201_Application_20130222

Pam"'
DWQ USE ONLY
ate Received
Fee Paid
Permit Number
rr 13
Apphc 1 Rules:
(select all that apply)
❑ Coastal SW -1995 ❑ Coastal SW - 2008 DIPh 11- Post Construction
❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
RECEIVED State of North Carolina
Department of Environment and Natural Resources
FEB 0 6 2013
Division of Water Quality
DENR-FAYETTEVILLE RLSI)PIIUFPI6CtATER MANAGEMENT PERMIT APPLICA
This form may he photocopied for use as an original
L GENERAL INFORMATION I FEA 1 1 2 0 i 3
1. Project Name (subdivision, facility, or establishment name - should be consistent w' t name on plan
specifications, letters, operation and maintenance agreements, etc.): Wee&". a WATER Gwil
2. Location of Project (street address):
Intersection of HWY 401 (17,ayetteville Road) and N. Parker Church Road
County:Hoke Zip:28376
3. Directions to project (from nearest major intersection):
Site is located at the intersection of Hwy 401 and N. Parker Church Road in Hoke County, NC, approximately
6 miles east of the intserction of Hwy 401 and Hwy 211
4. Latitude:35° 01' 40.30" N Longitude:79° 08' 23.86" W of the main entrance to the project.
tl. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-102 - Renewal 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):
❑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, n/a and the previous name of the project, if different than currently
proposed,n/a
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:1.80 ac of Disturbed Area
❑NPDFS Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:n/a
5. Is the project located within 5 miles of a public airport? ❑No ®Yes
If yes, see S.L. 2012-200, Part VI: http://portal.ncdennorg/web/wq/ws/su/statesw/rules laws
Form SWU-lol Version 06Aug2012 Page I of

,r
Ill. 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 proiect):
Applicant/Organization:Durban Development, LLC
Signing Official & Title:William L. Allen, Manager
b.Contact information for person listed in item la above:
Street Address:3735 Beam Road, Suite B
City:Charlotte State:NC Zip:28217
Mailing Address (if applicable):3735 Beam Road Suite B
City:Charlotte State:NC Zip:28217
Phone: (704 ) 357-1220 Fax: (704 ) 357-0018
Emafl:darren.tLtittl@diirbanj,uoup.com
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property
Signing C
b. Contact information for person listed in item 2a above:
Street Address: �23/ 170-1rrr Q-!:r1Zr1
City: State: Ak zip: -� ?OU f
Mailing Address (if applicable): _
Phone: ( ) Fax:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person wino can answer questions about the project
Other Contact Person/Organization:Darren Tuitt
Signing Official & Titie:Director of Developmental Services
b.Contact information for person listed in item 3a above:
Mailing Address:3735 Beam Road Suite B
City:Charlotte State:NC Zip:28217
Phone: (704 ) 496-7190 Fax: (704 ) 357-0037
Email:[e-mail]
4. Local jurisdiction for building permits: Hoke County
Point of ContactCynthia Love _-„__ Phone #: [phone] _
Form SWU-101 Version 06Aug2012 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Water Quality to be treated in a sand filter
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW - 1995 ❑ Ph If - Post Construction
3. Stormwater runoff from this project drains to the
4. Total Property Area: 2.059 acres
River basin.
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:2.059 acres
Total project area shall be calculated to exclude the folloeoing the normal ppool of im/nounded structures, the area
between the bunks of streams and rivers, the area below the Normal High Wntcr (Nl♦W) line or Mean High Water
(MHW) line, and coastal wetlands landward front the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal tetlands landward of the NHW (or MHm line twy
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =
9. How many drainage areas does the project have?l (For high densihj, count ]for each proposed engineered
stornmater BMP. For low densihj and other projects, use 1 for the whole properhj 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.
Basiirl"r6rmation ,....;;,..
Drain e-Area 1
Drainage;Area 2
Draina Area _
Draina e.Area
Receiving Stream Name
Puppy Creek
Stream Class *
C
Stream Index Number *
18-31-19
Total Drainage Area (so
49,658
On -site Drainage Area (so
47,480
Off -site Drainage Area (so
2,178
Proposed Impervious Area** (so
32,000
Impervious Area** total
68.0
Litt er,vious. ;Surface Area„
Draina etArea 1
Drainage. , Area 2
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
8,320
On -site Streets (so
n/a
On -site Parkin (so
23,680
On -site Sidewalks (so
840
Other on -site (so
n/a
Future (so
n/a
Off -site (so
2,178
Existing BUA*** (so
n/a
Total (sf):P—'�
3y` OI
Stream Class and Index Number can be determined at: ldtp://portal.ucdenr.or ho�q[ps/csu/classificatious
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version 06Aug2012 Page 3 of

11. How was the off -site impervious area listed above determined? Provide documentation. square footage of
adjacent parking lot that drains onto the site and ultimately into the BMP's
Projects in Union County: Contact DIVQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A 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 htti)://12ortal.ncdertr.org/web/wq/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 fromht!p://portal.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:/ /pgrtal.ncdenr.orjl/web/wq/ws/su/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://Wrtal.ncdenr.org/web/wn/ws/su/statesw/forms_ does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original anti one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VTl below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M lam
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR, (For an Express review, refer to 6
htto:/Lwww eenvirel .or. ages/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/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the _
receiving stream drains to class SA waters within Y2 mile of the site boundary, include the n/z
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm..
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MI-IW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and lie MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
It. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage casements, 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).
Form S W U-101 Version 06Aug2012 Page 4 of 6

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 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 00697 Page No: 434435 _
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC _
Secretary of Stale 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.
bt!p://www.secretary.state.nc.us/Corporations/CSearch.aspx
VIL 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
htto://oortalmcdennom/web/wa/ws/su/statesw/forms dots. 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 Engureer:Carlton T. Burton, PE 0 1A(,a- N5 K k 1
Consulting Firm: Burton En¢.neering Associates
Mailing Address:5950 Fairview Road Suite 100
City:Charlotte State:NC Zip:2821.0
Phone: (704 ) 553-8881 Fax: (704 ) 553-8860
Email:lukeb®bur tonengineerinlr.com
IX, PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or type name of person listed in Contact Information, item 2a) 14, /v //A Ile rl o/> .) P , certify that 1
own the property identified in this permit application, and thus give�ission to (print name of person
listed in Contact Information, item 1a) with (print or type name of organization listed in
Contact Information, item 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 SWU-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 I will be operating a stormwater treatment
facility without a valid permit I understand that the o eration of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 m result in appropriate enforcement action including
the assessment of it penalties of up to $25,000 per ay so o NCGS 143-215.6.
Signature: Date: I : z0 1-3
. � A t n
Public M pe Statg oft rV T-4- L OWh VN' County of
t- ` A(W IAN V , do her by certify tha v tdZ�- personally appeared
before me this da of VPoG z013 , and acknowledge the d e executi n A/ the application for
Y c Z2 PP
a stormwater permit. Witness my han and official seal,
t>,PN Dl Cc
O �OTAgy �0--
My Comm. Expires
n Novernber11.2015 Z
PUBL1G
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OO .
., <AND 0
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires U� �' /) Z 01,5-
I, (print or hjpe name of person listed in Contact Information, item 1a) William L. Allen
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 the
applicable stormwaterj;ules undgr,,15A NCAC 21I .1000 and any other applicable state stormwater requirements.
Date:
a Notary Public for the State of t Qt� b wt a_ , County of
C do hereby certify that _ UL w.-... 'A personally appeared
before me this Oay of ,ltna ,,. jo _ , _�2011 , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
E* .
SEAL
My commission expires 121 4 I I S
Form SWU-101 Version 06Aug2012 Page 6 of

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. 1 understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 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.
I, a Notary Public for the State of
do hereby certify that
before me this _ day of
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
0W.1II
My commission
X. APPLICANT'S CERTIFICATION
1, (print or hjpe name of person listed in Contact Information, item la) William L. Allen
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 the
applicable stormwaltcr r nder A NCAC 21-I .1000 and any other applicable state stormwater requirements.
Signature: V�/ `— Date: a
(131113
� c
—a Notary Public for the State of 1')44A'qg__, Countyof
(/�S�(p�4 do hereby certify that i 6 1 personally appeared
before me this J3�!day of 4,�,eJ4 rK&An a( 13 and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires 12-k 115
Form SWU-101 Version 06Aug2012 Page 6 of

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