SWG030055_Application Form_20240312

FOR AGENCY USE ONLY
N.C. DIVISION OF WATER QUALITY Date Received
Year Month Day
SURFACE WATER PROTECTION SECTION
Certificate of Coverage
STATE STORMWATER NOTICE OF INTENT (NOI) S W G 0 3 r
Check# Amount
SWG030000 - GENERAL PERMIT TO CLEAR AND GRADE A PROPOSED Permit Assigned to
DEVELOPMENT SITE
State Stormwater Management Application Notice of Intent for coverage under the General Stormwater
Management Permit to Clear and Grade a proposed development site.
For the clearing and grading only of a proposed development site where the final design is not known.
(Please print or type)
1. Mailing address of owner/developer: (The address to which all permit correspondence will be mailed.)
Owner/Developer Name Fayetteville Public Works Commission
Street Address 955 Old Wilmington Road
City Fayetteville State NC ZIP Code 28301
Telephone No. [phone] Fax ( )
2. Proposed Project Information:
Project Name Rockfish - B4.9 Solar Utility Station -Tree Clearing
Street Address Tracy Hall Road
of the Project
City Fayetteville State NC ZIP Code 28306
County Cumberland
Contact Person David Deschamps _
Mailing Address P.O. Box 1089
City Fayetteville State NC ZIP Code 28302
Telephone No. [phone] Fax ( )
3. Physical Location Information:
Please provide the street address of the project and describe how to get to the project, using street names,
state road numbers, and the distance and direction from the nearest major intersection:
From Raleigh, take 1-40 E to 1-95 S. Take Exit 46A for NC-87 S. Follow NC-87 S for 1.3 miles, turn left onto
Elizabethtown Road, after 0.1 miles, turn right onto Tracy Hall Road. The site will be on your right after 0.3 mi.
4. What is the name of the receiving stream? Rockfish Creek
5. River Basin Cape Fear Receiving Stream Classification C
6. This Certificate of Coverage is being submitted as a result of:
❑✓ New or proposed project ❑ Modification to an existing project
Existing COC or Permit Number:
Date project is scheduled to begin construction 05/27/2024
7. What is the total project area above mean high water? 1,205,500 ftz
8. Will wet detention basins or other ponds be constructed at this site?
❑✓ YES ❑ NO
SWU-115-17FEB2010 Page 1 of 3

9. Please list all proposed piping, ditches, and drainage alterations to be constructed as part of this project:
(attach an additional sheet if needed)
There is to he a culvert installed at the proposed construction entrance. as well as three skimmer basins and
one sediment basin installed for runoff treatment. The clearing of trees may cause minor drainage pattern
alterations, as the site is currently wooded.
10. Is the project within 575' of the Mean High Water line of class ORW waters?
LI YES (Please show the 575'AEC line on plans) ENO
(If yes,total built-upon area must be less than or equal to 25%of the total project area within the AEC above mean high water.)
11. Are there any wetlands on the site? ❑✓ YES(please delineate on the plans) ❑ NO
Name and affiliation of person making this determination: Zach Windham-ECS Southeast, LLP
12. Please list all Best Management Practices employed at this site:
Construction entrance, perimeter measures(silt fence and silt fence outlets), three skimmer basins, and one
sediment basin. Temporary seeding will be used to stabilize the site until the construction of the solar utility
station can begin (a separate permit is to be pursued for the construction of the solar utility station).
13. Certification:
North Carolina General Statute 143-215.6B (i) provides that:
Any person who knowingly makes any false statement, representation,or certification in any application, record, report,plan,
or other document filed or required to be maintained under this Article or a rule implementing this Article;or who knowingly
makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article;or who falsifies,
tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or
maintained under this Article or rules of the Commission implementing this Article shall be guilty of a Class 2 misdemeanor
which may include a fine not to exceed$10,000. (18 U.S.C.Section 1001 provides a punishment by a fine of not more than
$10,000 or imprisonment of not more than 5 years,or both,for a similar offense.)
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit will
constitute the permit requirement for the project and is enforceable in the same manner as an individual permit.
I certify that I am familiar with the information contained in the application and that to the best of my knowledge and
belief such information is true, complete, and accurate.
Printed name of person signing: David Deschamps
Title: Mana f Electri ngineering
c re) e1
(Signature of Appli (Date signed)
9' )
A check or money order must accompany this Notice of Intent for$505.00, made payable to:NCDENR.
Your application will be returned unprocessed unless all of the following items are submitted:
• This completed form
• Two sets of grading plans
❑ A check for$505 00$700.00
ElA USGS map with the project clearly located on it.
Mail the entire package to: NCDENR Division of Water Quality
Surface Water Protection Section—Stormwater
at the Appropriate Contact Address (see the following page)
Note:
The submission of this document does not guarantee the issuance of a Certificate of Coverage under the General
Permit.
SWU-115-17FEB2010 Page 2 of 3

For questions,please contact the DWQ Central Office or Regional Office for your area.
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DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE FAYETTEVILLE REGIONAL OFFICE MOORESVILLE REGIONAL OFFICE
2090 US Highway 70 225 Green Street 610 East Center Avenue/Suite 301
Swannanoa, NC 28778 Systel Building Suite 714 Mooresville, NC 28115
[phone] Fayetteville, NC 28301-5043 [phone]
HOW&ORW Projects in Counties Above [phone] HQW&ORW Projects in Counties Above
HOW&ORW Projects in Counties Above
RALEIGH REGIONAL OFFICE WASHINGTON REGIONAL OFFICE WILMINGTON REGIONAL OFFICE
3800 Barrett Drive 943 Washington Square Mall 127 Cardinal Drive Extension
Raleigh, NC 27609 Washington, NC 27889 Wilmington, NC 28405-2845
[phone] [phone] [phone]
HOW&ORW Projects in Counties Above Coastal Stormwater,HOW&ORW Projects in Counties Coastal Stormwater,HOW&ORW Projects in
Above Counties Above
WINSTON-SALEM REGIONAL CENTRAL OFFICE
OFFICE 1617 Mail Service Center "To preserve, protect
585 Waughtown Street Raleigh, NC 27699-1617
Winston-Salem, NC 27107 [phone] and enhance
North Carolina's;eater:-."
[phone] Phase 2 Post-Construction Projects not covered ----
HOW&ORW Projects in Counties Above by local government
SWU-115-17FEB2010 Page 3 of 3