SW3110402_CURRENT PERMIT_20110930

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
� CURRENT PERMIT
1
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYMMDD

State Stormwater Permit
Pei-mit No. S`+N3110901
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
LINEAR DEVELOPMENT PROJECT
RECEIVED
DIVISION OF WATER QUALITY
SEP 30 2011
SVVP SECTION
MOORESVILLE REGIONAL OFFICE
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
Town of Waxhaw
Waxhaw SRTS sidewalks
Kensington Road, Waxhaw-Monroe Road, Cemetery Drive, Sharon Drive and
Arbor Drive
Town of Waxhaw, Union County
FOR THE
construction, operation and maintenance of a linear sidewalk project in compliance with
the provisions of Session Law 2006-246, 15A NCAC 2B .0600, 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.
The Permit shall be effective from the date of issuance until rescinded and shall be
subject to the following specific conditions and limitations:
I. DESIGN STANDARDS
2.
3.
4.
5.
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
This permit covers the construction of 41,600 square feet of built -upon area.
Approved plans and specifications for projects covered by this permit are
incorporated by reference and are enforceable parts of the permit.
This stormwater system has been approved for the management of stormwater
runoff as described of this permit and approved plans.
No piping is allowed except that minimum amount necessary to direct runoff
beneath an impervious surface such as a road or to provide access.
Page 1 of 3

State Stormwater Permit
Permit No. S'vV3110901
II. SCHEDULE OF COMPLIANCE
1. No one shall fill in, alter, or pipe any drainage feature (such as swales) shown on
the approved plans as part of the stormwater management system without
submitting a revision to the permit and receiving approval from the Division.
2. The permittee is responsible for verifying that the proposed built -upon area for
the entire project does not exceed the maximum allowed by this permit.
3. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
4. 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.
5. 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 the approved plans, regardless of size.
b. Redesign or addition to the approved amount of built -upon area.
C. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
6. During construction, erosion shall be kept to a minimum and any eroded areas
will be repaired immediately.
7. 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.
8. Records of maintenance activities must be kept by the permittee. The records will
indicate the date, activity, name of person performing the work and what actions
were taken.
9. The project shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
Ill. GENERAL CONDITIONS
This permit is not transferable 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 signed by both parties, to the
Division of Water Quality, accompanied by the supporting 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.
2. The permittee is responsible for compliance with all permit conditions until such
tin ie as the Divisi-)n approves a -equest to tranFfer the permit.
Page 2 of 3

State Stormwater Permit
Permit No. SW3110901
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 re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual; and in the NCG010000 NPDES
Stormwater Construction General Permit.
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.
Permit issued this the 22nd day of September, 2011.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Division of Water Quality
By Authority of the Environmental Management Commission
Page 3 of 3

Re ltv le,i f0 M' k e &*'I t- I (
Application Completeness Review
First Submittal ❑ Re -submittal
Development/Project Name: VU
Receiving stream name n/EL1
Date Received: i Date Reviewed: By Bill Diuguid4*7
r d 1_i cage / e!;,J. _ !L r
LZ C
Classification
Liver Basin: CA j hWBA- - b/CANCH
C
For post -construction requirements, a program will be deemed compliant for the areas where it is
implementing any of the following programs: WS-I, WS-II, WS-III, WS-IV, HQW, ORW, Neuse River Basin
NSW, Tar -Pamlico River Basin NSW, and the Randleman Lake Water Supply Watershed Nutrient
Management Strategy.
High Density Projects that require a 401/404 within an NSW require 85% TSS, 30% TN and 30% TP removal.
T&E Species (Goose Creek, Waxhaw Creek or Six Mile Creek Water Sheds): Al /if -- 5&- 1A of- G &o se Curl, wsr
Latitude and Longitude: 54 49 z -90 *& 38 a Jurisdiction 6/"HA W 1Midtn,✓ C4
Project Address: I;gn,s..�,aib.r ,Act ` $� 4� oGWShr
Engineer name and firm: Ggmia/. P.E.0 w.'lbug 5_ "'.'t,_Ass., s�
lfiel.�. DrtnJa
Phone: BO3-759-476z Email: PgIa.•biI1 Q
Is the project confirmed to be in the State MSI Stormwater Permit jurisdiction? Rr Yes or ❑ No
a Low Density (no curb and gutter) ❑ Low Density with curb and gutter outlets ❑ High Density ®'other
❑ 401/404 impacts to surface waters, wetlands, and buffers (add language to cover letter and/or add info letter) 5"'C%*wx
fie' BUA 'Z .3 7
�W �FlJsrrJr
;✓ Check for $505.00 included
t�Original signature (not photocopy) on application
ce Legal signature (Corporation-VP/higher, Partnership -General Partner/higher, LLC-member/manager, Agent).
Check spelling, capitalization, punctuation: http://www.secretary.state.nc.us/corporations/thepage.aspx
If an agent signs the application, a signed letter of authorization from the applicant must be provided which
includes the name, title, mailing address and phone number of the person signing the letter.
NVA--a-
For subdivided projects, a signed and notarized deed restriction statement
-a-
Sealed, signed & dated calculations
-Er
Correct supplement and O&M provided for each BMP on site (check all that were provided & number of each)
6C_4'1/6 r—X ;S7746 A1CDCT
RvAb S;_bC sW*LEs
a Bioretention
❑ Rooftop Runoff Management
❑ Dry Detention Basin
❑ Sand Filter
❑ Filter Strip
❑ Stormwater Wetland
❑ Grass Swale
❑ Wet Detention Basin
❑ infiltration Basin
❑ Low Density
❑ Infiltration Trench
❑ Curb Outlet
❑ Level Spreader
❑ Off -Site
❑ Permeable Pavement
❑ NCDOT Linear Road
ci Restored Riparian Buffer
of Two sets of sealed, signed & dated layout & finish grading plans with appropriate details
Fb� Narrative Description of stormwater management provided
„VIA- -a~ Soils report provided
-a Wetlands delineated or a note on the plans or in the accompanying documents that none exist on site and/or
djacent property
Details for the roads, parking area, cul-de-sac radii, sidewalk widths, curb and gutter-
:Dimensions & slopes provided
a Drainage areas delineated ❑ Pervious and impervious reported for each ❑ Areas of high density
IVIk -Er- BMP operation and maintenance agreements provided
er- Application complete ❑ Application Incomplete Returned: (Date)
Comments
Mc✓ 5, 2011 Rev;.:ion, &u Diuguid

j.
1
r-r �
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DWQ USE ONLY
Date Received
Fee Paid
Permit Number
5.05 # + a -,I Flo
I & J' % 1 0 C% 0 1
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph 11 - Post Construction
(selecl all lhal apply) ❑ Non -Coastal SW- 1-1QW/0RW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form uray be photocopied for use as rnr original
1. 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.):
Waxhaw SRTS Sidewalks
2. Location of Project (street address):
Kensington Road, Waxhaw-Monroe Road, Cemetery Drive, Sharon Drive, Arbor Drive
City: Waxhaw County:Union
3. Directions to project (from nearest major intersection):
Kensington: Approximately 3 miles west of NC 1.6 at SR 1305
Waxhaw: Approximately 0.7 miles southeast of NC 16 at NC 75 _
7_ip:28 l 73
4. Latitude:34° 56' 42" N Longitude:-80° 46' 38" W of the main entrance to the project.
340 55' 06"N -80' 44' 06"W
IL PERMIT INFORMATION:
'I. a. Specify whether project is (check one): ®New ❑Modification
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 if 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, Union 20-12-007 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: 3_l ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 Pernut: Proposed hzlpacts
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 Erosion and sediment control, Union 2012-007, August 12, 2011
o N IN
SEP 1 9 2011
DENR • WATER QUALITY
form SWU-101 Version 07.1un2010 Page I of WE1WDSAND STORmwATEIiWAKH

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:Town of Waxhaw._...
Signing Official & Title:Mr. Michael McLaurin, Town Manager
b.Contact information for person listed in item 1a above:
Street Address: 317 N. Broome Street
City: Waxhaw State: NC Zip: 28-173
Mailing Address (if applicable):
City:
Phone: ( 704 1 843-2195
Email:
State:
Zip:
Fax: ( 704 ) 843-2196
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 Owner/Organization: NQQT
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Add
Citv:
Mailing Ail dress (if applicable):
City:
Phone:
Email:
State: Zip:
State: Zip:
Fax: { )
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: Mr. Greg Mahar
Signing Official & Title:. Director of Planning and Community Development
b.Contact information for person listed in item 3a above:
Mailing Address: 317 N. Broome Street
City: Waxhaw
State: NC
Zip: 28173
Phone: ( 704 ) 843-2195 Fax: ( 704 } 843-2196
Email: �-ymaharOwaxhaw.com
4. Local jurisdiction for building permits: Town of Waxhaw
Point of Contact: Phone #:
Form SWU-101 Version 07Jun2010 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff from sidewalk surfaces (5 ft wide) will be directed to roadside grassed swales (existing)_
on DOT right of way
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 II - Post Construction
3. Stormwater runoff from this project drains to the Twelve Mile Creek River basin.
4. 'Total Property Area: 11.46 acres 5. 'Total Coastal Wetlands Area: 0 acres
(8,320, x 6 0 ' ) 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': 11.46 acres
+ Total project area shall be calculated to exchcde the folloaoin fire normal 001 of Ill! rounded structures, the area
between fire batiks of streanis and rivers, the urea below the Norinal High Water (=\M fine or Meat Hi�lr Water
(M14M litre, and coastal zvetlands landWard fronr the NNW (or MHVO litre. Tire resrtlfant project area is rtsed to
calcrdate overall percent brudt ripon area (BLIA). Nora -coastal wetlands landward of the NHW (or MHM lira: way
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 8.3
(8, 32C' x 51) = 0.96 A8
9. Flow many drainage areas does the project have?2 (For high density, count I for each proposed engincured
stortt17017ter BMP. For loaf) density rand outer projects, use I for tire 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 2
Drainage Area _
Drainage Area _
Receiving Stream Name
Twelve Mile Crk
(Zone Branch
Stream Class *
C
C
Stream Index Number"
11-138
11-138-4
Total Drainage Area (so
805,767
10,729,260
On -site Drainage Area (so
118,020
381,180
Off -site Drainage Area (so
687,747
10,348,080
Proposed Impervious Area''` s
9,835
3.1,765
% Im ervious Area** total
8.3
8.3
Impervious** Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
N/A
N/A
On -site Streets (so
N/A
N/A
On -site Parkin (so
N/A
N/A
On -site Sidewalks (so
9,835
31,765
Other on -site (so
N/A
N/A
Future (so
N/A
N/A
Off -site (so
Existing BUA*** (so
47,208
152,472
Total (so:
1 57,043
184,237
Sfrcatn Class and Index Nirtnber can be determined al: n't/)s cslr clrtss'i rcutic>trs
* Imppervious area is defined as tare built upon area inchiding, but not Ihnited to, buildings, roads, parking areas,
sirierualks, gravel areas, eh:.
Form SWU-101 Version 07Jun2010 Page 3 of 6

Report only that amount of existing BUA that will remrirr after developrrncrrt. Do not report any exisfilrg BUA that
is to be removed r111d vnlrich will be replaced by beta BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. USGS O7uad _
Projects in Union County: Contact DJYQ Central Office shrff to check if the projecl is located ++,ilhiir a Threalened &
Endan�Fered Species' watershed that may he swhjecl to more sirini;ent storm i ater requir•enenis as per A'C,4C 0213.0600.
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 httr)://L)ortal.ncdenr.orL,/web/wci/v%,s/su/bmtrmantra].
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 Iisted below. A detailed application instruction sheet and BMP
checklists are available from htt p: L)irrtal,nccleiir.t)r 7 web w is-s su statesw forms docs. 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://portrll.nrdenr.or;/ia.eb/wq/wsf sir/rna}is.}
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 initiated in blue ink. Download the latest versions
for each submitted application package from http://i)ortal.iicderir.org/web/wq/�vs/su/statesw/foriiis docs.
Initials
I. Original and one copy of the Stormwater Management Permit Application Forni. p w6t
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants N />s�
Form. (if required as per Part V11 helo(r)
3. Original of the applicable Supplement Forni(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
liter://www.envliel12_.org/pages/oiiestol2express.litnil 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 for —F-� c�,
6. A USCS map identifying the site location. If the receiving stream is reported as class SA or the Pk\rfq
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the'/z
mile radius on the map.
7. Sealed, signed and dated calculations. N j J�!'
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: �yv
i a. Development/ Project name.
r b. Engineer and firm.
l 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 MHW or NHW lines.
• Delineate the vegetated buffer landward front the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) 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.
r 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 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).
Form SWU-101 Version 07.lun2010 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"xll" 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: Sclnednde a site Visit for DWQ to verify the SHVVT prior
to submiltal, [phone].)
10. A copy of the most current property deed. I7eed book: Page No: / ✓�
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC Y / A
Secretary of State 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 NCAC 21-1.1003(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.
littl2://www.secretarv.state.nc.u,s/Corporations/CSearcli.,Ispx
VI1. 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
http://statesNv/forms docs. 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 acid 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.
V1II. 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 Engineer: Pat Gambill, P.E.
Consulting Firm: Wilbur Smith Associates
Mailing Address: '1301 Gervais Street
City: Columbia State: SC Zip: 29201
Phone: ( 803 } 758-4762 Fax: ( )
Email: [e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or type irame of persott lister[ in Contact Information, item 2a) , certify that 1
own the property identified in this permit application, and thus give permission to (print or type naive of person
listed in Contact Infornmtion, item 1a) with (print or type name of orgauizatioi) lisled in
Contact Information, item 1a) 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 07Jun2010 Page 5 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. I 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.
Signature: Da
a Notary Public for the State of , County of
do hereby certify that
before me this _ day of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
64WILIN
My commission expi
X. APPLICANT'S CERTIFICATION
1, (print or type naive of person listed in Contact htfor)rtatioli, ile?)l hl) MichUel MCLII[Iriri
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 stormw, r rules under 15A NCAC 21-1.1000, SL 2006-246 (Ph. 11 - Post Construction) or SL 2008-211.
Signature: Date: .S
1, 1A0 `�� c-— 1NQ-AU-%, , a Notary Public for the State of -A 0X*1k C.dAAJ4% County of
do hereby certify that f h4►9��Ouut,�. personally appeared
before me thisi 5 day ofD (L and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, �
Z.
. rF.7F `•
y
SEA L
My commission expires k- • .11 . ay 1 )
form SWU-101 Version 07Jun2010 Page 6 of 6

4272-6
TOWN OF WAXHAW PROVISION FOR THE PAYMENT OF THIS CHECK (OR DRAFT) ! "
GENERAL FUND HAS BEEN MADE., BY AN APPROPRIATION' DULY MADE OR �D��
BONDS OR RATES DULY AUTHORIZED PURSUANT TO THE _ 1]j_J�l
P.O. BOX 6 'PH. 704-843-2195 LOCAL GOVERNMENT BUDGET AND FISCAL CONTROL ACT.
NORTH CAROLINA
WAXHAW, NC 28173 \
J
Five Hui ndred Five Dollars and 00 Cents
~
PAY
TO THE
ORDER __- NCDENR
OF
� ownz-ter
42726
DATE AMOUNT
09/15/2011 $505.00
1 V ID AFTE 120 DAYS
� 8
EE�caTil� Til / �\ AUTHORIZED SIGNATURE
I
11'

Waxhaw SRTS Project
Post Construction Permit Narrative
The Waxhaw Safe Routes To School (SRTS) project consists of installing five feet wide
sidewalks in strategically selected locations to improve and promote safe pedestrian
travel to and from local schools and is funded by an NCDOT grant. As a condition of
grant funding, the project must also provide ADA compliance and serve the public
welfare. The project is almost entirely located within the NCDOT and Town of Waxhaw
street rights -of -way. The right of way width is typically 60 feet but varies in some
locations. For purposes of the permit, 60 feet will be used to compute the property
area. Since the sidewalk runs with the roadway, the length of the sidewalk will be used
to determine the area of the project and impervious area.
The sidewalk will largely be built to match the existing grade and maintain existing
swales and flow patterns. In some cases, offsite runoff enters the right of way, flows
across the sidewalk and into the existing grass swale adjacent to the roadway. In other
cases, the roadway runoff flows across the sidewalk and existing grassed shoulder by
way of sheet flow.
The runoff from the proposed sidewalks discharges to two main streams, an un-named
tributary to Twelve Mile Creek and Rone Branch, both of which flow to Twelve Mile
Creek in the Catawba River basin. The sidewalks grouped together geographically as
Kensington Elementary sidewalks flow to the un-named tributary of Twelve Mile Creek.
The sidewalks grouped together geographically as Waxhaw Elementary sidewalks flow
to Rone Branch through multiple drainageways. Rone Branch discharges to Twelve
Mile Creek. The drainage areas are computed from the USGS map at the most
downstream point of proposed construction.
Because space in the right of way is limited, existing drainage patterns are utilized as
well as existing grassed swales and shoulders. There is little additional room to install
water quality treatment trains or devices between the sidewalk (which is typically
immediately inside the right of way) and the edge of the roadway pavement. For safety,
the shoulder area is reserved for vehicle emergencies and to provide a separation
between pedestrian sidewalk users and automobile traffic. It is also impractical to re-
route flows for treatment due to the linear and limited nature of the right of way and
adjacent property. The most practical method of water quality treatment is to utilize the
existing grassed conveyance.

-974'-)..i O/v

,;&7'1745L,h
®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
May 5, 2011
Mr. Iyore Ojomo
BBC Real Estate, LLC
Childrens Lighthouse Learning Center
9110 Skipaway Lane
Waxhaw, North Carolina 28173
Subject: Stormwater Permit No. SW3110402
Children's Lighthouse Childcare Learning Center
Union County
Dear Mr. Ojomo:
Dee Freeman
Secretary
RECEIVED
DIVISION OF WATER QUALITY
JUN 7 2011
SWP SECTION
MOORESVILLE REGIONAL OFFICE
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application
for Childrens Lighthouse Childcare Learning Center on May 5, 2011. 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. SW3110402, dated May 3, 2011, 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 May 4, 2021, and shall be subject to
the conditions and limitations as specified therein. Please pay special attention to the Operation
and Maintenance requirements in this permit. Failure to establish an adequate system for
inspection and maintenance of the stormwater management system 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 upon written request within thirty (30) days following
receipt of this permit. This request must be in the form of a written petition, conforming to Chapter
150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings,
P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands are made this permit shall be
final and binding.
This project will be kept on file at the Mooresville Regional Office. If you have any questions, or
need additional information concerning this matter, please contact Mike Randall at (919) 807-
6374; or [e-mail].
Sincerely,
for �oleen. Sullins
cc: Mooresville Regional Office
SPU Files
Wetlands and Stormwater Branch . One
1617 Mail Service Center, Raleig# . North Carolina 27699-1617 NorthCaroffina
Location: 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: [phone] FAX[phone] Customer Service: 1-877-623.6746 Naturally
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer

State Stormwater Permit
Permit No. SW3110402
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
lyore Ojomo
BBC Real Estate, LLC
Childrens Lighthouse Childcare Learning Center
Rea Road at Tom Short Road, Union County
FOR THE
construction, operation and maintenance of one infiltration basin(s) in compliance with
the provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter referred to
as the "sforrnwafer 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 May 5, 2021, 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 this permit. The stormwater control has been designed to
handle the runoff from 29,204 square feet of impervious area.
3. 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.
4. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
5. The built -upon areas associated with this project shall be locted at lest 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 4

State Stormwater Permit
Permit No. SW31110402
6. The following design criteria have been permitted for the infiltration basin and
must be provided and maintained at design condition:
a. Drainage Area, acres:
Onsite, ft :
Offsite, ft2:
b. Total Impervious Surfaces, ft2:
Onsite, ft :
Offsite, ft 2.,
C. Design Storm, inches:
d. Depth of sand, feet:
e. Bottom Elevation, FMSL:
f. Surface Area of Sand Filter, ft2:
g. Bypass Weir Elevation, FMSL:
h. Permitted Storage Volume, ft :
i. Predevelopment 1 year 24 hour ft3Nec:
j. Post -development 1 year 24 hour ft Isec
k. Time to Draw Down, hours:
M. Receiving Stream/River Basin:
n. Stream Index Number:
o. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
1.1
48,302
0
29,402
29,402
0
1.98
1.5
591.00
900
594.0
3,703.00
0.83
3.95
40.0
McBride Creek 1 Catawba
11-138-3-3
„C„
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
2. 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 prepare and make available to the Division of Water Quality
upon request 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.
6. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in -accordance with
the conditions of this permit, the approved plans and specifications, and 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.
Page 2 of 4

State Stormwater Permit
Permit No. SW3110402
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
1. 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.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
Page 3 of 4

State Stormwater Permit
Permit No. SW:;110402
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 5th day of May, 2011.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Goleen N. Sumns, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4of4

State Stormwater Permit
Permit No. SW3110402
Childrens Lighthouse. Childcare Learning Center, Union 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,
Childrens Lighthouse Childcare Learning Center
(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 1 of 2

State Stormwater Permit
Permit No. SW_"11040v
Certification Requirements:
cc:
_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 bypass structure weir elevation is per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the bypass structure.
8. 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/or 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.
NCDENR-DWQ Regional Office
Page 2 of 2

North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. lyore Ojomo
BBC Real Estate, LLC
Childrens Lighthouse Learning Center
9110 Skipaway Lane
Waxhaw, NC 28173
Dear Mr. Ojomo,
Division of Water Quality
Coleen H. Sullins
Director
September 20. 2011
Subject: Compliance Evaluation Inspection
Children's Lighthouse Childcare Learning Center
Stormwater Permit No. SW3110402
Union County, NC
Dee Freeman
Secretary
Enclosed is a copy of the Compliance Evaluation Inspection (CEI) report for the inspection conducted
at the subject site on September 15, 2011, by Mr. Samar Bou-Ghazale with the Division of Water'Quality.
No construction was noted during the site visit. Please, familiarize yourself with the requirements of the
Stromwater Permit No. SW3110402 issued to you by the Division of Water Quality on May 5, 2011 prior to
construction.
If you have any questions, comments, or need assistance with understanding any aspect of your
permit, please do not hesitate to contact Mr. Bou-Ghazale at [phone].
Sincerel
Robert B. Krebs
Surface Water Protection Regional Supervisor
Enclosure
cc: Shelton Sullivan — NPSIACO Unit
Mooresville Regional Office
Location: 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Phone: [phone]Fax: [phone] Customer Service'. 1-877-623-6748
internet: http:/IpWa1.nodenr,or/web/wq/home/ro
A— r)--- n :-- c.,.,., i... ,,., r. of o.,.,.,.e„Allnoi n....F r'^„
NorthCarolin.a

Compliance Inspection Report
Permit: SW3110402 Effective: 05/05/11 Expiration: 05/04/21 Owner: Bbc Real Estate LLC
Project: CNldrens Lighthouse Childcare Learning
Center
County: Union Rea Rd At Tom Short Rd
Region: Mooresville
Contact Person: lyore Ojomo Title:
Directions to Project:
Type of Project: State Stormwater -.General Permit
Drain Areas:
On -Site Representative(s):
Related Permits:
Inspection Date: 09115/2011 Entry Time: 01:00 PM
Primary Inspector: Samar E Bou Ghazale
Secondary Inspector(s):
Reason for Inspection: Complaint
Permit Inspection Type: State Stormwater
Facility Status: ® Compliant Q Not Compliant
Question Areas-
® State Stormwater
(See attachment summary)
Waxhaw NC 28173
Phone: [phone]
Exit Time: 01:15 PM
Phone: [phone]
Ext.2199
Inspection Type: Compliance Evaluation
Page: 1

Permit: SM110402 Owner - Project: i Real Estate LLC
Inspection Date: 09/15/2011 Inspection Type: Compliance Evaluation Reason for Visit: Complaint
Inspection Summary:
No construction as of this date.
File Review
Yes
No
NA
NE
Is the permit active?
n
n
n
Signed copy of the Engineer's certification is in the file?
n
®n
n
Signed copy of the Operation & Maintenance Agreement is in the file?
®
n
n
n
Copy of the recorded deed restrictions is in the file?
®
n
❑
n
Comment: No construction as of this date.
Built Upon Area
Yes
No NA
NE
Is the site BUA constructed as per the permit and approval plans?
❑
n ®
n
Is the drainage area as per the permit and approved plans?
n
n n
Is the BUA (as permitted) graded such that the runoff drains to the system?
n
n
n
Comment: No construction as of this date.
Are the SW measures constructed as per the approved plans? n n m n
Are the inlets located per the approved plans? In n m ❑
Are the outlet structures located per the approved plans? n n ® n
Comment: See note above.
Operation and Maintenance Yes No NA NE
Are the SW measures being maintained and operated as per the permit requirements? n n n
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ n n ® n
upon request?
Comment: See note above.
Other Permit Conditions Yes No NA NE
Is the site compliant with other conditions of the permit? n n © ❑
Comment: See note above.
Other WQ Issues Yes No NA NE
Is the site compliant with other water quality issues as noted during the inspection? n n M n
Comment: See note above.
Page: 2

_t]WQ':USE.ONLY,
Date eceived
Fee Paid
Permit Number
Applica6le Rules:
(select all that apply)
❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ 13511 Post Construction
❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M gmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This fonn may be photocopied for use as an 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.):
ChiIdrens Lighthouse Childcare Learning Center
2. Location of Project (street address):
Rea Road at Tom Short Rd
City: Wed din ton County _Union Zip:
3. Directions to project (from nearest major intersection):
From I-485 go south on Rea Rd toward Weddington
Site it on the right just east the Union County line 1,100 ft before the Tom Short Rd intersection
4. Latitude:35° 01' 08" N Longitude:-80° 48' 20.23" W of the main entrance to the project.
Il. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New []Modification
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, 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: 2,11 ac of Disturbed Area
❑NPDES 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:Childrens Lighhouse Day Care, ID: Union-2011-030, March 11, 2011
Erosion & Sedimentation Plan
Form SWU-101 Version 07Jun2010
Page I of 6

III. CONTACT INFORMATION
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:
mdrrauS u 6tr71dv%JSE LInrru1%/C9.
a - -
Signing Official&Title: r017.5— y u 0iAU CsIA](= j% Tl7FlZ
b. Contact information for person listed in item I a above:
Street Address: 9110 S; i ns6t 1 LA V
City: L&)q 4M W State: iy L Zip: Z51 23
Mailing Address (if applicable): 04-AA
City: GtJR byA►J State: M L, Zip: 7, A173
Phone: L:JtJq_ 2 Fax: ( 7 0 1 7iCl6 -9 -7015
Email:�Yun/Lit]In.HOIJJ.IAo - _iL.. am
c. Please check the appropriate box. The applicant Iisted 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)
54,'urchaser* (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 proiect is located on):
Property Owner/Organiza
Signing Official & Title:
to P%A o; e4i .Soy..-` f `,, LLC .
b.Contact information for person listed in item 2a above:
Street Address: _ ffV1__ A __O&M( Ie w 61,Lx Brij er- _
city: - 1-4_%4- State: N C, zip: �173
Mailing Address (if applicable): G,l OL'Ut") CkJ0..11
City:— A �,O h) State:_t C, Zip:
Phone. L-Ing ) -?"5Z.,S Fax: ( 70q 7-57,6
Email:_ 12 t( L✓M45ALIIV GLG, wAf
3. a. (Optional) Pratt the name and title of another contact such as the projeces construction supervisor or other
person who can answer questions about the project: 1 `
Other Contact Person/Organization: 1�. n 1 cL CT,9 l�ih�t�/ull?
Signing Official & Title:-- - 1a►♦ X
b.Contact information for person listed in item 3a abov
e'
.
'
Mailing Address:
City: 'B Q State: i�C. Zip: It)
Phone: {IH )) 2% — C -2 % Fax: { ­7 ad-) _V1 to -011 r7
Email: Zr4w(( @ 61f e- w 121a . 0�m�
4. Local jurisdiction for building permits: Union County _
Point of Contact: i yl 7w„611i Phone #: Clog ) 093 —3491 10
Form SWU-101 Version 07Jun2010 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The stormwater runoff from this project will be directed through a Sand Filter BMP designed in accordance
with Chapter 11 of the NCDENR-DWQ BMP Manual revision date 9 20 2009
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:
bAf 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 Cental Catawba River basin.
4. Total Property Area: 5.55 acres 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
AreW:5.55 acres
' Total project area shall be calculated to exclude the follou�in lire normal pool of ini rounded structures, lire area
bettiven the banks of streauts arid rivers, the area belotrr the Normal High Writer (NHV0 lure or Mean High Witter
(MHW) lure, and coastal wetlands landrrrard froin the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landurard of the NHW (or MF1W) line nifty
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =12.1 %
9. How many drainage areas does the project have? 2 (For high density, count 1 for each proposed engineered
stor)moater BMP. For loth density arid other projects, use 1 for the rrrhole 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 2
Drainage Area
Drainage Area
Receiving Stream Name
McBride Ck
McBride Ck
Stream Class *
C
C
Stream Index Number *
11-138-3-3
11-138-3-3
Total Drainage Area (so
48,302
193,456
On -site Drainage Area (so
48,302
193,456
Off -site Drainage Area (so
0
0
Proposed Impervious Area** (so
29,204
0
Impervious Area** total
60.5
0
Im ervious" Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area _
Draina a Area _
On -site Buildings/Lots (so
13,894
0
On -site Streets (so
0
0
On -site Parking (so
14,429
0
On -site Sidewalks (so
881
0
Other on -site (so
0
0
Future (so
0
0
Off -site (so
0
0
Existing BUA*** (sf}
1 0
1 0
Total (so:
1 29,204
1 0
" Stream Class and 1ude.r Nurrrber can he detenuirred at: lit t ortal.ncderrr.orvet�vg&sjcsti classi cations
*" tut reYt�ious rrrerr is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
si�cwalks, grat)el areas, etc.
**" Report only that amount of existing BUA that will remain after developruerrl. Do not report any existing BUA dial
is to be removed and which will be replaced by ner) BUA.
form SWU-101 Version 07Rtn2010 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation. NZ _
Projects in Union County: Contact DWQ Central Office staff to check if the prafect is located within a Threatened &
Endangered Species watershed that may he subject to more stringent slormwater 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 httn://t)ortal.ncdeiir.ore/web/wo/ws/su/bmo-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 htt : portal.nc(ienr.or web w 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 littp://Voi-tal,ncdeiir.org/,web/wq/ws/su/­miip .)
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 Iatest versions
for each submitted application package from httpl /porLil.iicdeiir.org/web/wq/ws/su/ statesw/formsdocs.
7. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Coven antsr'}�
Form. (if required as per Part VIf below)
1 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 payable to NCDENR. (For an Express review, refer to
ht www.envheII2.org/pages/onestol2express.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 1/2 mile of the site boundary, include the
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:
tea. Development/Project name.
-6. Engineer and firm.
Lt. Location map with named streets and NCSR numbers.
mod. Legend.
North arrow.
f. Scale.
e1. 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 MI-IW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer Iandward from the normal pool elevation of impounded
f structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
JDimensioned property/project boundary with bearings & distances.
. Site Layout with all BUA identified and dimensioned.
A, Existing contours, proposed contours, spot elevations, finished floor elevations.
• . Details of roads, drainage features, collection systems, and stormwater control measures.
4n. 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.
lo. Drainage areas delineated (included in the main set of plans, not as a separate document).
gyp. Vegetated buffers (where required).
Form SWU-101 Version 07.lun2010 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 T
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: 1491,.� Page No: z�
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State 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 NCAC 21-1.1003(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:/ /www.secretary.state.nc.us/Corporations/CSearch.asl2
VII. 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, Iot 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://port2l,ncdenr.org/gb(wd/ws I su/statesWZforms 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 INI:ORMATION 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 Engineer: D. Eric Sutton, PE _
Consulting Firm: William E. Bru e Construction Consultant
Mailing Address:8501-A Tower Pt Dr
City -.Charlotte State:NC _ Zip:28227 _
Phone: [phone] ) ext 2 _
Email:der
zutton-@,windstreammet
4 M 1.2:..
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item ?a) O' OkO with (print or type name of organization listed in
Contact Information, item 7a) to develop the project as currently proposed. A copy of
the lease agreement or pending property sa es contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form S WU-101 Version 071un2010 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 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 ivi penalties uY—
Signature: o $25,000 per day, pursuant to NCGS 143-215.6.
jj L -4 � Date: 20/"�a
I, �JA V1�7 C Sul ✓tit 1 [mot- a Notary Public for the State of +N C County of
no do hereby certify that �S+ea ktq 12. Py Cie —TT personally appeared
before me this day of s20 r 1 , and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal, C a
JANBT C GCigRIDT
"0" Fubft
Un" Couw
14a m Carolina
INV t MMANIM 104M Fab 19,_2413
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires -2 m/'z/'?
I, (print or type name of person listed in Contact Information, item 1a)
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 stormwater rules under 15A NCAC 2H .1000, SL 2006-246 (Ph. 11— Post Construction) or SL 2008-211.
Signature: ad8Ar Date: ZO //
1, "J A.n et C S M; a Notary Public for the State of JQC County of
UA + D ✓% ^ do hereby certify that �r'4 0 W _ i d Mo personally appeared
before me khisqWday of—A� -�OI 1. and knowled e the due ex cutian of the application for a
stormwater permit. Witness my hand and official seal, L
JANET C SCMMOT
Natant► Fubft
Urdon Counly
North Carolina
My Commtaton i XPIM Fop 14, 2013
SEAL
My commission expires 90/-3
Form SWU-101 Version 07Jun2010 Page 6 of 6

-- - - - - - - - - - -
*A Cowwltticw viblLea op 16' 3011
14011y cotalluo
numu CORUIA
"cloth bmwlc
r TOM c ec"Wol
flumv Comm
19040A ~
wimu c SCHMI

AN-9w;
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Michael McLaurin, Town Manager
Town of Waxhaw
317 N. Broome Street
Waxhaw, North Carolina 28173
Division of Water Quality
Coleen H. Sullins
Director
September 22, 2011
Subject: Stormwater Permit No. SW31 10901
Waxhaw SRTS Sidewalks
Linear Project
Union County
Dear Mr. Mclaurin:
Dee Freeman
Secretary
RECEIVED
DIVISION OF 1VATER QUALITY
SEP 3 a 2011
S W P SEr,`-QON
MOORESVILLE REGIONAL OFFICE
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for Lawyers
Road Sidewalk Project on September 19, 2011. 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
02H.1000, Session Law 2006-246, and 15A NCAC 02B .0600. We are forwarding Permit No. SW31 10901,
dated September 22, 2011. 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 rescinded and shall be subject to the conditions
and limitations as specified therein, and does not supercede any other agency permit that may be required.
If any parts, requirements, or limitations contained in this pert -nit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this pertnit.
This request must be in the Form of a written petition, conforming to Chapter 150B of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC
2761 1-7447. Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the Mooresville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Mike Randall at [phone]-, or
[e-mail].
ncdenr.gov.
Sincerely,
for Coleen H. Sullins
cc: Mooresville Regional Office
S W31 10901 File
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St, Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
Natumllty

Permit Number:
(to be provided by DW!2)
Drainage Area Number:
Sand Filter 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 BMP.
Important maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the sand filter.
— The sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds
six inches.
Once a year, sand media will be skimmed.
The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter will be inspected quarterly 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 ,':,,�r�•� �t;,�k;,t �:,
?Potential% roblem �,;��� :,,, �,,,,,. t
� y �
How 1 wiil'remediate;tlic, rolilem ,t�;
Entire BMP
Trash/debris is present.
Remove the trash/debris.
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as
applicable)
pavement surface.
possible.
Perimeter of sand filter
Areas of bare soil and/or erosive I
Regrade the soil if necessary to remove the
gullies have formed,
gully, and then plant a ground cover and
water until it is established. Provide lime
and a one-time fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height.
Flow diversion structure
The structure is clogged.
Unclog the conveyance and dispose of any
sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if
damage is too large for repair.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or dispose of it
in a location where it will not cause
impacts to streams or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
roblems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
Form SW401-Sand Filter O&M-Rev.4 2009Sept17 Page 1 of 3

r}�J.:P,otential;
''io6lem .s� r •
{How L;will;reinediate,the':
Filter bed and underdrain
Water is ponding on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm.
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace. If water still
onds, then consult an ex ert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment offsite.
The outlet device is damaged
Re air or re lace the outlet device.
Receiving water
Erosion or other signs of damage
Contact the NC Division of Water Quality
have occurred at the outlet.
1 401 Oversight Unit at 919-733-1786.
Form SW401-Sand Filter O&M-Rev.4 2009Septl7 Page 2 of 3

Permit Number:
(to be provided by 1)WQ)
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: Childrens Lighthouse Childcare Leaming Center - Rea Rd at Tom_ Short Rd
BMP drainage area number: 1
Print name: IA PIE ()7 ()m 0
Title: HAU4iRIWkr
Address: _ 9110 5k e(u LAC I _(&9J 1tA) J[VC... -
Phone: rIO�{ —�} 7 - (OEX) Z
Signature:
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.
1, 1, "C 5-'k+-Nj4 , a Notary Public for the State of
C- , County of A, ty- , do hereby certify that
&tL e personally appeared before me this � 1714'dayof
ILI p?D i f , and acknowledge the due execution of the forgoing sand ter
maintenance requirements. Witness my hand and official seal,
4
w � .
Now pubft
1iNoR COunM
Noft cafflum
Caffgrjulm Fx= Feb 19. 201 S
SEAL
My commission expires 1-2613
Form SW401-Sand Filter O&M-Rev.4 2009Septl7 Page 3 Of 3

Permit Number:
(lobe provided by DWQ)
Drainage Area Number;
Sand Filter 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 BMP.
Important maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the sand filter.
— The sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds
six inches.
— Once a year, sand media will be skimmed.
— The sand filter media will be replaced whenever it fails to function properly after maintenance.
The sand filter will be inspected quarterly 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_. }a, '�. �1 , - " -"Pateritial}
roblern Fa 3. x�4 � '
How I w_ill'remediate`the. iob_lem ,r tj f" "r`
Entire BMP
Trash/debris is present.
Remove the trash/debris.
Adjacent pavement (if
Sediment is present on the
Sweep or vacuum the sediment as soon as
applicable)
pavement surface.
possible.
Perimeter of sand filter
Areas of bare soil and/or erosive
Regrade the soil if necessary to remove the
gullies have formed.
gully, and then plant a ground cover and
water until it is established. Provide lime
and a one-time fertilizer application.
Vegetation is too short or too long.
Maintain vegetation at an appropriate
height.
Flow diversion structure
The structure is clogged.
Unclog the conveyance and dispose of any
sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if
damage is too large for repair.
Forebay or pretreatment area
Sediment has accumulated to a
Search for the source of the sediment and
depth of greater than six inches.
remedy the problem if possible. Remove
the sediment and stabilize or dispose of it
in a location where it will not cause
impacts to streams or the BMP.
Erosion has occurred.
Provide additional erosion protection such
as reinforced turf matting or riprap if
needed to prevent future erosion
problems.
Weeds are present.
Remove the weeds, preferably by hand. If
a pesticide is used, wipe it on the plants
rather than spraying.
Form SW401-Sand Filter O&M-Rev.4 2009Septl7 Page 1 of 3

V0
{BMP;elemerf:� �� ,�, -,., a•
- . ;_._, - , ,. .:.: s
Potential. rvblem �f�1 n�
` How;I,wili'remediate tfie roblem ,°'�
Filter bed and underdrain
Water is ponding on the surface for
Check to see if the collector system is
collection system
more than 24 hours after a storm.
clogged and flush if necessary. If water
still ponds, remove the top few inches of
filter bed media and replace. If water still
onds, then consult an ex ert.
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the
sediment offsite.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of damage
Contact the NC Division of Water Quality
have occurred at the outlet.
401 Oversight Unit at 919-733-1786.
Form SW401-Sand Filter O&M-Rev.4 2009Septl 7 Page 2 of 3

'4
Permit Number:
(to be provided by 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:. Childrens Lighthouse Childcare Learning Center - Rea Rd at Tom Short Rd__
BMP drainage area number:
Print name: I `FORE 070MO
Title:
Address: 9 j10C..t
Phone: '7014-9 7 5' (oa) t
Signature:
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
County of L� n ; o� , do hereby certify that
bl-c _ personally appeared before me this day of
.90 11 , and acknowledge the due execution of the forgoin sand f ter
maintenance requirements. Witness my hand and official seal, 9'k-(
Fcalw�--'B
CI.
C
my �v 19, zol S
SEAL
My commission expires �U 3
Form SW401-Sand Filter O&M-Rev.4 2009Septl7 Page 3 of 3

Permit Number:
(to be provided by DWQ)
NCDENR a
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
SAND FILTER SUPPLEMENT
This form must be filled out on line, printed and submitted with all of the required information.
Make sure to also fill out and submit the Required Items Checklist (Section 11I) and the I&M Agreement (Section IV)
1 .PROJECTJNFORMATIONO
Project name Childress Lighthouse
Contact name Eric Sutton
Phone number
Date
Drainage area number
704,846,2327
April 12, 2011
tl:r.a. �� R. �:yN: : a ..T a r'I M u mrR . K f. "�] 2' k� ! .r�'74 •b� w
DESIGN INFORMATION'te . � � �
Site Characteristics
Drainage area (AD)
48,302.00 ft'
OK
Impervious area
29,204.00 ft2
% Impervious (IA)
60.5% %
Design rainfall depth (Ro)
0.91 in
Peak Flow Calculations
1-yr, 24-hr runoff depth
1.98 in
1-yr, 24-hr intensity
inlhr
Pre -development 1-yr, 24-hr runoff
0.83 ft3lsec
Post -development 1-yr, 24-hr runoff
3.95 felsec
PrelPost 1-yr, 24-hr peak control
3.12 ft3lsec
Storage Volume
Design volume (WOV)
3,703.00 ft3
Adjusted water quality volume (WOVAdi)
2,777.25 ft'
OK
Volume contained in the sedimentation basin and on top of the sand filter
5,403.00 ft'
Top of sand filter/grate elevation
_ _ _592.5 ft amsl
Weir elevation (between chambers)
ft amsl
Maximum head on the sedimentation basin and sand filter (hMaMFifter)
1153 ft
Insufficient depth,
Average head on the sedimentation basin and sand filter (hA)
0.77 ft
Ensure that the average is half of the max.
Runoff Coefficient (Rv)
0.59 (unitless)
Type of Sand Filter
Open sand filter Y Y or N
SHWT elevation ft amsl
Bottom of the sand filter elevation 590.00 ft amsl 101j;il
Clearance (dSHwr)Closedlpre-cast sand filter? N Yor N ; �
SHWT elevation ft amsl
Bottom of the sand filter elevation ft amsl t A �
Clearance (dsHwr) Y j ] 324
If this is a closed, underground closed sand filter: The clearance between "� Z• f
the surface of the sand filter and the bottom of the roof of the underground ft r.0 O •�•t' 9'��,1�
structure (dam) 1 SO'
'
Form SVfJ401-Sand Filter-Rev.5 2009Sept17 Parts I and II. Project Design Summary, Page 1 of 2

r-e
Sedimentation Basin
Surface area of sedimentation basin (As)
Sedimentation basinlchamber depth
Sand Fitter
Surface area of sand filter (AF)
Top of sand media filter bed elevation
Bottom of sand media filter bed/drain elevation
Depth of the sand media filter bed (dF)
Coefficient of permeability for the sand filter (k)
Outlet diameter
Outlet dischargetflowrate
Time to drain the sand filter (t)
Time to drain the sand filter (1)
Additional Information
Does volume in excess of the design volume bypass the sand filter?
Is an off-line flow -splitting device used?
If draining to SA waters: Does volume in excess of the design volume Bow
evenly distributed through a vegetated filter?
What is the length of the vegetated filter?
Does the design use a level spreader to evenly distribute flow?
Is the BMP located at least 30ft from surface waters (54ft if SA waters)?
If not a closed bottom, is BMP located at least 100ft from water supply wells?
Are the vegetated side slopes equal to or less than 3:1
Is the BMP located in a recorded drainage easement with a recorded access
easement to a public Right of Way (ROW)?
What is the width of the sedimentation chamberlforebay (WSJ)?
What is the depth of sand over the outlet pipe (dpipe)?
Permit Number:
(to be provided by DWQ)
1,474.00 ft2
Vn' IVICCW IIIIIIIIIIUIII, UUL 11Icly IICCU LU UC 111WUk1=U LU
1.00 ft
900.00 ft2
Vn. Iy1CCW IIIU IIIIIUIII, UUL IIIGy IICCU LU UG IIILICa�CU LV
592.50 ft amsl
--
591.00 ft amsl
1.50 ft
3.50 (ft/day)
6.00 in
0.34 ftllsec
40.00 hours
OK. Submit drainage calculations.
1.67 days
Y
Y or N
OK
N
Y or N
Insufficient flow splitter.
YorN
ft
N
Y or N
Show how Bow is evenly distributed.
Y
YorN
OK
YorN
Y
YorN
OK
Y
Y or N
OK
12.00 ft
OK
11.35 ft
OK
Form SW401-Sand Filter-Rev.5 20095ept17 Parts I and 11. Project Design Summary, Page 2 of 2