20191671 Ver 1_PCN Form Submission_20191206

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Change only if needed.
BIMS # Assigned
20191671
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Reviewing Office *
Raleigh Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Granville Athletic Park - Phase 3
1a. Who is the Primary Contact?*
Chad Abbott
1b. Primary Contact Email:*
[e-mail]
Date Submitted
12/6/2019
Nearest Body of Water
Boulding Creek 28-9-1
Basin
Tar -Pamlico
Water Classification
C;NSW
Site Coordinates
Latitude: Longitude:
36.264318-78.619295
A. Processing Information
County (or Counties) where the project is located:
Granville
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?
* Nationwide Permit (NWP)
* Regional General Permit (RGP)
7 Standard (IP)
Version#*
1
What amout is owed?*
IT $240.00
r $570.00
Select Project Reviewer*
Stephanie Goss:eads\szgoss
1c. Primary Contact Phone:*
[phone]
V

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
39 - Commercial/Institutional Developments
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
F 401 Water Quality Certification - E)press
F Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. lathe project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r Owner W Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
County of Granville
2b. Deed book and page no.:
1494/767
2c. Responsible party:
County of Granville
2d.Address
Street Address
141 Williamsboro Street
Address Lim 2
City
Oxford
Postal / Zip Cate
27565
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
State / Province / Region
NC
Country
USA
2f. Fax Number:
r Yes r No
r Yes r No
3a. Name:
Chad Abbott

3b. Business Name:
C3 Design & Engineering, PLLC
3c.Address
Street Address
2537 E Lyon Station Rd
Address tine 2
Suite 102
City
Creedmoor
Postal / Zip Code
27522
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Chad Abbott
4b. Business Name:
C3 Design & Engineering, PLLC
4c.Address
Street Address
2537 E Lyon Station Rd
Address tine 2
Suite 102
City
Creedmoor
Postal / Zip Code
27522
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
AGENT AUTHORIZATION FORM.pdf
State / Province / legion
NC
Country
USA
3e. Fax Number:
State / Province / legion
NC
Country
USA
4e. Fax Number:
18.88KB
C. Project Information and Prior Project History C^U
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Oxford, NC
2. Project Identification
2a. Property Identification Number:
2b. Property size:
1911-25-2207
11.86
2c. Project Address
Street Address
4615 Belltown Road
Address tine 2
City
State / Province / legion
Oxford
NC
Postal / Zip Code
Country
27565
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Boulding Creek 28-9-1

3b. Water Resources Classification of nearest receiving water:*
C, NSW
3c. What river basin(s) is your project located in?*
Tar -Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
030201010106
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinityof the project at the time of this application:*
Existing conditions onsite consist of timbered land. There are no streams, but there are two headwater wetlands within the project area. General land use in the vicinity of the project
area consists of forested and agricultural land, with athletic fields directly to the west and Interstate 85 to the south. This is currently a separate parcel that has been purchased by the
county to be developed as an addition to the existing park system located to the west and on the opposite side of Jonesland Drive.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes (- No r Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
2019-01-16 Quadrangle Map.pdf 24.68MB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
D - 2019-08-29 Archived Soil Survey Map.pdf 695.34KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.052 AC
4g. List the total estimated linear feet of all existing streams on the property:
0 LF
4h. Explain the purpose of the proposed project:*
The purpose of the proposed project is to construct a public park which will access the site across a 3' linear wetland.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The proposed project is an independent phase of the existing park facilities on a separate parcel off of Jonesland Drive in Granville County Planning Jurisdiction. The project consists of
disturbing approximately 6.73 acres of the 11.86 acre tract for the development of a 6 court tennis facility, ±2,000 sf pavilion and picnic area, playground, horse shoe pits, volleyball
court, 1/4 mile walking trial, and 74 parking spaces with associated drive aisles. Specifically, there will be one impact resulting from construction of a road crossing. Equipment typically
used for construction and earthwork such as backhoes, bulldozers, excavators, graders, pavers, etc. will be utilized for this project. All erosion and sediment control measures have
been approved by NCDENR and have taken special consideration in the protection of the wetland.
4j. Please upload project drawings for the proposed project.
2019-10-08 GAP COMPLETE COMPILED SET OF DRAWINGS THROUGH BID AWARD.pdf 30.46MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No O Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
SAW-2018-01953
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Steven Ball
Agency/Consultant Company: Soil & Environmental Consultants, PA
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made bythe Corps or DWR
Site confirmed by Ross Sullivan of the USACE on November 28, 2018.
5d1. Jurisdictional determination upload
Post USACE and NCDWR sketch.pdf 359.84KB
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed projector related activity?

There are currently no funds or plans for future a)pansion, however, the project has been designed such that expansions could extend to the north/northwest and south. However, due
to current impact, the park could a)pand to these areas without requiring additional impacts.
D. Proposed Impacts Inventory U
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
W Wetlands f Streams -tributaries ❑ Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
2a1 Reason (?) 2b. Impact type * (?) �2c. Type of W. 2d. W. name * 2e. Forested * 2f. Type of Impact
Jurisdicition*(?)]2g.
area*
Road Crossing P Headwater Forest �W2 Yes Both 0.005
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.005
2h. Comments:
This is a linear project for access over a 3' wide linear wetland.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.005
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The project has been designed to avoid the wetlands as much as practically possible. All of the site improvements requirement larger mass graded
areas such as the parking lot and tennis courts were located above the head of the wetland to avoid impacts. The proposed impact will provide access
to the rest of the site beyond the tennis courts as well as to the rest of the usable property on the other side of the linear wetland, thereby minimizing
current and any possible future impacts to the wetlands.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Site specific construction sequences have been provided for the contractor in general for working around the wetland including a construction
sequence specific to the wetland. The wetland specific sequence requires the use of dams, pump arounds and since this is a linear wetland, the base
flow or groundwater will still be allowed to be conveyed and connected to the wetland on either side of the impact. Standard construction equipment
will be used and since this is a road crossing, all equipment and associated disturbances will be bound by the silt fence limits shown on the plans.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The cumulative impacts are less than 1/10th acre (4,356 SF).
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
There are no protected buffers onsite requiring diffuse flow. Fbwever, we have designed/proposed that all pipe discharges outlet to an earthen level spreader and plunge pool.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
This project is not in a water supply watershed that requires compliance with the low/high density regulations, however being a park in nature, this project and property alone is
considered to be low density with the use of vegetated conveyances and the total BUA at ±26%. We have met low density requirements, however, not required to per local stormwater
rules. Low density supplement form filled out as best as possible, but much is N/A. No swales specifically designed to convey stormwater. All BUA either sheet flows to adjacent pervious
areas or into vegetated conveyance that is graded as sumped area or existing roadside swale.

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the requirements of the National or State (North Carolina)
Environmental Policy Act (NEPAUSEPA)?*
r Yes r No
Comments:*
None that we know of being required.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 21-1.0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
Although no plans have been made for future development or phases on this parcel, the existing roads have been stubbed to the remnants of the
parcel to allow for such at a time it is desired. The proposed impact would get the necessary access beyond the linear wetland, thereby omitting the
need for future impacts.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
North Carolina Natural Heritage Program, 2019. Geographic Information System (GIS) data, NCDENR, Raleigh, NC. Available at http://www.ncnhp.org/.
(Accessed: December 4, 2019).
Consultation Documentation Upload
2019-12-054 Biodiversity & Wildlife Habitat.pdf 150.92KB
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*

The NOAA Habitat Conservation/Habitat Protection: National Marine Fish Service; Essential Fish Habitat Mapper website was reference. No essential
Fish Habitat was identified near the project.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
The NC State Historic Preservation Office HPOWEB GIS Service was referenced on November 26, 2019. No historic listings, study list entries, or
determined eligible listings were identified within the property.
7c. Historic or Prehistoric Information Upload
2019-11-26 Historic Preservation.pdf 435.93KB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-yearfloodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
The NC floodplain Mapping Program's Flood Risk Information System was referenced.
Miscellaneous
Comments
-NCDEMLR Erosion Control approval attached.
-Low Density Supplement Form attached.
Miscellaneous attachments not previously requested.
GRAW-2019-015 LOA 20190903 revised.pdf
2019-12-06 Low Density Supplement Form.pdf
55.91 KB
1.26MB
Signature C")
W By checking the box and signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Chad E Abbott
Signature
&rfa1e,S�
Date
12/6/2019

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO,
PARCEL ID: 191101252207
STREET ADDRESS: 4615 Belltown Rd, Oxford, NC 27565
Please print:<
Property owner: County of Granville
Property Owner:
The undersigned, registered properly owners of the above noted property, do hereby authorize
Chad E. Abbott
(Contractor / Agent)
of C3 Design &Engineering, PLLC
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
141 Williamsboro St, Oxford. NC 27565
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: ) Z�/6/T
Authorized Signature
Date:

Imagery................................................NAIP, January 2010Roads..............................................©2006-2010 Tele AtlasNames...............................................................GNIS, 2010Hydrography.................National Hydrography Dataset, 2010Contours............................National Elevation Dataset, 2010
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NORTHCAROLINA
QUADRANGLE LOCATION
OXFORD QUADRANGLENORTH CAROLINA7.5-MINUTE SERIES
OXFORD, NC
2016
Expressway Local Connector
ROAD CLASSIFICATION
Ramp 4WD
Secondary Hwy Local Road
Interstate Route State RouteUS RouteWX./H
OXFORD, NC
2016
ROAD CLASSIFICATION
Check with local Forest Service unitfor current travel conditions and restrictions.
FS Primary Route FS High Clearance RouteFS PassengerRouteª«­▬Interstate Route State RouteUS RouteWX./H
Expressway Local Connector
Ramp 4WD
Secondary Hwy Local Road
U.S. DEPARTMENT OF THE INTERIOR U.S. GEOLOGICAL SURVEY

1 Satterwhite
8 Kittrell
2 Stovall3 Townsville4 Berea5 Henderson6 Stem7 Wilton
ADJOINING QUADRANGLES
1 2 3
4 5
6 7 8
This map was produced to conform with the National Geospatial Program US Topo Product Standard, 2011.A metadata file associated with this product is draft version 0.6.19
CONTOUR INTERVAL 10 FEETNORTH AMERICAN VERTICAL DATUM OF 1988
SCALE 1:24 000
1000 500 0 METERS 1000 2000
21KILOMETERS00.51
1 0.5 0
MILES
1
1000 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
FEET
Imagery..................................................NAIP, June 2014Roads................................ U.S. Census Bureau, 2015 - 2016Names..........................................................GNIS, 2016Hydrography....................National Hydrography Dataset, 2014Contours............................National Elevation Dataset, 2008Boundaries............Multiple sources; see metadata file 1972 - 2016
Wetlands.........FWS National Wetlands Inventory 1977 - 2014
North American Datum of 1983 (NAD83)World Geodetic System of 1984 (WGS84). Projection and1 000-meter grid: Universal Transverse Mercator, Zone 17S
Produced by the United States Geological Survey
10 000-foot ticks: North Carolina Coordinate System of 1983
This map is not a legal document. Boundaries may begeneralized for this map scale. Private lands within governmentreservations may not be shown. Obtain permission beforeentering private lands.
North American Datum of 1983 (NAD83)World Geodetic System of 1984 (WGS84). Projection and1 000-meter grid: Universal Transverse Mercator, Zone 17S
Produced by the United States Geological Survey
10 000-foot ticks: North Carolina Coordinate System of 1983
This map is not a legal document. Boundaries may begeneralized for this map scale. Private lands within governmentreservations may not be shown. Obtain permission beforeentering private lands.
Imagery<IMG_LEADER><IMG_CITATION>Roads<TRANS_LEADER> U.S. Census Bureau, 2015 - 2016Roads within US Forest Service Lands.............FSTopo Data with limited Forest Service updates, 2012 - 2016Names...............................................................GNIS, 2016Hydrography<HYDRO_LEADER>National Hydrography Dataset, <HYDRO_DATE>Contours<HYPSO_LEADER><HYPSO_CITATION>Boundaries............Multiple sources; see metadata file 1972 - 2016<OPTIONAL_CITATIONS>Wetlands.........FWS National Wetlands Inventory 1977 - 2014
U.S. National Grid
100,000-m Square ID
Grid Zone Designation
QA
17S
^
ØMN
GN
UTM GRID AND 2016 MAGNETIC NORTHDECLINATION AT CENTER OF SHEET
1° 27´26 MILS
9° 20´166 MILS
*7643016379075*NSN.7643016379075NGA REF NO.USGSX24K33778
U.S, DEPARTMENT OF AGRICULTURE
S03L CONSERVATION SERVICE
SHEET NO, 10
SOIL SURVEY OF GRANVILLE COUNTY, NORTH CAROLINA
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SHEET NO.10 OF 16

NOTE: Parcel boundary shown is based on a georeferenced image fromthe Granville Co. GIS mapping website, aligned based on NCDOT roadsGIS layer. As such, all calculated areas shown herein are approximateand subject to change based on new or better information.!?0917 TT 01 Start LW18 TT 29Wetland OffsiteLWW1.....W2!?!?DP1DP2SB01 Start LW flagI 85BELLTOWN RDI 85NC Center for Geographic Information & Analysis!?0917 TT 01 Start LW18 TT 29Wetland OffsiteLWW1.....W2!?!?DP1DP2SB01 Start LW flagI 85BELLTOWN RDI 85NC Center for Geographic Information & AnalysisμWetland Sketch MapGAP Phase III ExpansionGranville County, NCProject No.13597.W1Project Mgr.:SBScale:1" = 200'11/28/180 400 800200FeetSite confirmed by Ross Sullivan of the USACE on 11/28/18
NCHPO HPOWEB
Sources: Esri, HERE, Garmin, USGS, Intermap, INCREMENT P,
NRCan, Esri Japan, METI, Esri China (Hong Kong), Esri Korea, Esri
(Thailand), NGCC, (c) OpenStreetMap contributors, and the GIS
User Community
Local districts & boundaries
Local individual resources & centerpoints
Local Landmark
Local Landmark, Gone
Local HD Center Point
Surveyed Only individual resources & centerpoints
Surveyed Only
Surveyed in NRHD
Surveyed Only, Gone
Surveyed in NRHD, Gone
Blockface- Multiple properties
Blockface in NRHD
Surveyed Area, No designation
Surveyed Area in NHRD
DOE districts & boundaries
Determined Eligible Boundary
Both DOE and Study List Boundary
DOE individual resources & centerpoints
Determined Eligible
DOE, Gone
SL and DOE
SL and DOE, Gone
DOEHD Center Point
SLDOEHD Center Point
SL districts & boundaries
Study List Boundary
Both SL and Determined Eligible Boundary
SL individual resources & centerpoints
SL Individual Entry
SL and DOE entry
Study List Entry, Gone
SL and DOE, Gone
SLHD Center Point
SLDOEHD Center Point
11/26/2019, 2:08:43 PM
0 0.7 1.40.35 mi
0 1 20.5 km
1:36,112
North Carolina State Historic Preservation Office
Granville County, State of North Carolina DOT, Esri, HERE, Garmin, INCREMENT P, NGA, USGS |
Permit No.
(to be provided by DEMLR)
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
LOW DENSITY SUPPLEMENT
This form may be photocopied for use as an original
A low density project is one that meets the appropriate criteria for built upon area and transports stormwater
runoff primarily through vegetated conveyances. Low density projects should not have a discrete stormwater
collection system as defined by 15A NCAC 2H .1002(18). Low density requirements and density factors can be
found in Session Law 2008-211, 15A NCAC 2H .1000, Session Law 2006-246 and the State of North Carolina
Stormwater Best Management Practice Manual. Curb and gutter systems are allowed provided they meet the
requirements in 15A NCAC 2H .1008(g).
I. PROJECT INFORMATION
Project Name
Granville Athletic Park Phase III
Contact Person: Chad Abbott Phone Number: ( 919 )625-7368
Number of Lots:1 Allowable Built Upon Area (BUA) Per Lot*:36% of Project Site
Number of Dwelling Units Per Acre**:N/A
Low Density Development (check one): ® without curb & gutter ❑ with curb & gutter, outlets to (check one):
❑ Swales ❑ Vegetated Area
*If lot sizes are not uniform, attach a table indicating the number of lots, lot sizes and allowable built upon area for each lot.
The attachment must include the project name, phase, page numbers and provide area subtotals and totals. BUA shall be
shown in units of square feet.
**(Phase II Post -Construction [non-SAl only)
II. BUILT UPON AREA
Refer to DEMLR's forms and applications website for specific language that must be recorded in the deed
restrictions for all subdivided projects. (http://portal.ncdenr.ora/web/lr/state-stonnwater-fonns_docs)
Complete the following calculation in the space provided below where:
• SA Site Area - the total project area above Mean High Water.
• DF Density Factor - the appropriate percent built upon area divided by 100.
• RA Road Area - the total impervious surface occupied by roadways.
• OA Other Area - the total area of impervious surfaces such as clubhouses, tennis courts, sidewalks, etc.
• No. of Lots - the total number of lots in the subdivision.
• BUA per Lot - the computed allowable built upon area for each lot including driveways and impervious
surfaces located between the front lot line and the edge of pavement.
• Total allowable lot BUA - the computed allowable built upon area for all lots combined.
• Total BUA from lot listing - the sum of built upon area allocated for each lot on the list of non -uniform lots.
Calculation:
Form SW401-Low Density-Rev.3-2/10/09 Page 1 of 4

For uniform lot sizes:
(SA: 517,297 ft2 x DF: 0.36) — (RA: 35,063 ft2) — (OA: 84,781 ft2) = BUA per Lot = 66,382.92 ft2
(No of Lots: 1)
For non -uniform lot sizes:
a. (SA: ft2 x DF: ) — (RA: ft2) (OA: ft2) = Total allowable lot BUA =
b. Total BUA from lot listing: sf, b must be < a
III. DESIGN INFORMATION
ft2
Complete the following table. If additional space is needed the information should be provided in the same
format as Table 1 and attached to this form. Rainfall intensity data can be found in Appendix 8.03 of the State
of North Carolina Erosion and Sediment Control Planning and Design Manual or at
http://hdsc.nws.noaa.gov/hdsc/pfds/
Table 1. Swale design information based on the 10-vear storm.
Swale No.
Drainage
Area ac
Impervious
Area ac
Grassed
Area (ac)
C
Q
cfs
Slope
%
Vallow
s
Vactual
s
Flow
Depth ft
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
IV. REQUIRED ITEMS CHECKLIST
Form SW401-Low Density-Rev.3-2/10/09 Page 2 of 4

CEA
CEA
CEA
CEA
CEA
V. SWALE SYSTEM MAINTENANCE REQUIREMENTS
1. Mowing will be accomplished as needed according to the season. Grass height will not exceed six inches at
any time; and grass will not be mowed too close to the ground or "scalped".
2. Swales will be inspected monthly or after every runoff producing rainfall event for sediment build-up,
erosion, and trash accumulation.
3. Accumulated sediment and trash will be removed as necessary. Swales will be reseeded or sodded
following sediment removal.
4. Eroded areas of the swales will be repaired and reseeded. Swales will be revegetated as needed and in a
timely manner based on the monthly inspections. Side slopes must be maintained at the permitted slope.
Catch basins, curb cuts, velocity reduction devices, and piping will be inspected monthly or after every
significant runoff producing rainfall event. Trash and debris will be cleared away from grates, curb cuts,
velocity reduction devices and piping.
6. Swales will not be altered, piped, or filled in without approval from NCDENR Division of Energy, Mineral
and Land Resources.
I acknowledge and agree by my signature below that I am responsible for the performance of the six
maintenance procedures listed above. I agree to notify DEMLR of any problems with the system or prior to any
changes to the system or responsible party.
Print Name and Title:N/A
Address:
Phone: Date:
Signature:
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 , County of
do hereby certify that
personally appeared before me this _
day of , and acknowledge the due execution of the forgoing swale maintenance requirements.
Witness my hand and official seal,
Notary signature
SEAL My commission
Form SW401-Low Dcnsity-Rcv.3-2/10/09 Page 4 of 4

ROY COOPER
Governor
MICHAEL S. REGAN
-Secretary
S. DANIEL SMITH
Director
NORTH CAROUNA
Environmental Quality
September 3, 2019
LETTER OF APPROVAL
County of Granville
ATTN: Michael S. Felts, County Manager
141 Williamsboro Street
Oxford, NC 27522
RE: Project Name: GAP PH III
Project ID: GRANV-2019-015
Acres Approved: 7.0
County: Granville, City: Oxford, Address: Belltown Road
River Basin: Neuse, Stream Classification: Falls Lake Watershed
Submitted By: C3 Design & Engineering, PLLC
Date Received by LQS: August 20, 2019
Plan Type: Revised
Dear Mr. Felts:
This office has reviewed the subject erosion and sedimentation control plan. We find the plan to be
acceptable and hereby issue this Letter of Approval. The enclosed Certificate of Approval must be
posted at the job site. This plan approval shall expire three (3) years following the date of approval,
if no land -disturbing activity has been undertaken, as is required by Title 15A NCAC 413.0129.
As of April 1, 2019, all new construction activities are required to complete and submit an electronic
Notice of Intent (N01) form requesting a Certificate of Coverage (COC) under the NCGO10000
Construction Stormwater General Permit. This form MUST be submitted prior to the commencement
of any land disturbing activity on the above named project. The N01 form may be accessed at
deq.nc.gov/NCG01. Please direct questions about the N01 form to Annette Lucas at
Annette.lucas(@ncdenr.gov or Paul Clark at Paul.clark(@ncdenr.gov. Afteryou submita complete and
correct N01 form, a CPOC will be emailed to you within three business days. Initially, DEMLR will
not charge a fee for the coverage under the NCG01 permit. However, on or after June 1, 2019, a $100
fee will be charged annually. This fee is to be sent to the DEMLR Stormwater Central Office staff in
Raleigh.
TM D_EQ��
North Carolina Department of Environmental Quality ' Division of Energy. M'neral and Land Resources
Raleigh Regional Office 1628 Mail Service Center 3800 Barrett Drive Raleigh. North Carolina 27609
919,791.4200

Letter of Approval
County of Oxford
September 3, 2019
Page 2 of 2
Title 15A NCAC 413.0118(a) and the NCG01 permit require that the following documentation be kept
on file at the job site:
1. The approved E&SC plan as well as any approved deviation.
2. The NCGO1 permit and the COC, once it is received.
3. Records of inspection made during the previous 30 days.
Also, this letter gives the notice required by G.S. 113A-61.1(a) of our right of periodic inspection to
insure compliance with the approved plan.
North Carolina's Sedimentation Pollution Control Act is performance -oriented, requiring protection of
existing natural resources and adjoining properties. If, following the commencement of this project, the
erosion and sedimentation control plan is inadequate to meet the requirements of the Sedimentation
Pollution Control Act of 1973 (North Carolina General Statute 113A-51 through 66), this office may require
revisions to the plan and implementation of the revisions to insure compliance with the Act.
Acceptance and approval of this plan is conditioned upon your compliance with Federal and State water
quality laws, regulations, and rules. In addition, local city or county ordinances or rules may also apply to
this land -disturbing activity. This approval does not supersede any other permit or approval.
Please note that this approval is based in part on the accuracy of the information provided in the
Financial Responsibility Form, which you provided. You are requested to file an amended form if
there is any change in the information included on the form. In addition, it would be helpful if you
notify this office of the proposed starting date for this project. Please notify us if you plan to have a
preconstruction conference.
Your cooperation is appreciated.
Sincerely,
Sally Castle, El
Regional Engineering Associate
DEMLR
Enclosures: Certificate of Approval
NCGO1 Fact Sheet
cc: Chad E. Abbott, PE (chad0c3designengElectronic Copy
DEMLR - Raleigh Regional Office File

Biod iversi ty/Wil dli fe H abi ta t - GAP PH III
Sou rce s: Esri, HERE, Ga rmin, Int ermap, increment P Corp., G EBCO, USGS ,FAO , NPS, NRCA N, Ge oBa se, IGN, K adaster NL, O rdna nce Su rve y, Esri
9-1 0 (M ax imum)
8
7
6
5
2-4
1 (Mo der ate )
0 (U nr ated )
Imp er vio us su rf ace >20 %
No rth C aro lina Bo un dar y
De ce mbe r 4, 20 19 0 0.25 0.50.1 25 mi
0 0.4 0.80.2 km
1:14,5 95