SW5121101_HISTORICAL FILE_20130103

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

WITHERS & RAVEN EL
ENGINEERS I PLANNERS I SURVEYORS
111 MacKenan Drive
CARY, NORTH CAROLINA, 27511
[phone]
FAX [phone]
TO: NCDWQ
512 N Salisbury St.
9"' Floor
Raleigh, NC 27604
WE ARE SENDING YOU ® Attached via
❑ Shop Drawings ® Prints
❑ Copy of Letter ❑ Change order
LI Plans
❑ Diskette
LEVUER of VEAA NWMAL
DATE 1 1.19.12 1 108 No- 2090553
ATTENTION Mike Randall
PRONE#
RE:
Town of Bailey Community Park
_ the following items:
❑ Samples ❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
2
Stormwater Management Plans
2
Permit Application (1 original & 1 copy)
1
Permit Fee Check $505.00
1
Wet Detention Basin Supplement
1
0 & M Agreement
1
Stormwater Management Report
THESE ARE TRANSMITTED as checked below:
® For approval ❑ Approved as submitted
❑ For your use ❑ Approved as noted
❑ As requested ❑ Returned for corrections
❑ For review and comment ❑
❑ Resubmit
❑ Submit
❑ Return
copies for approval
copies for distribution
corrected prints
❑ FOR BIDS DUE 20 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS:
COPY TO: File SIGNED: Amy McDonald
if enclosures are not as noted, kindly notify as at once.

DWQ USE ONI.Y
Date Received Fee Paid
Perrnit Number
l
Applicable Rules: ❑ Coastal SW - -1995 ❑ Coastal SW - 2008 ❑ I'll 11- Post Construction
(select all thal apply) ❑ Non -Coastal SW- I-IQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Ni mt Plan:
State of North Carolina f a
Department of Environment and Natural Resources!.:'
Division of Water Quality //1 /J[ "" E ~ NVP
STORMWATER MANAGEMENT PERMIT APPLICATI0�ff Q§t C� ,
This forth utay he photocopier! for use as an original �/jj
GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plat,
specifications, letters, operation and maintenance agreements, etc.): /
Bailey Community Park
2. Location of Project (street address):
Stonev ]-Till Church Road
City: Bailey County: Nash 7ip:27807
3. Directions to project (from nearest major intersection):
From Hwy 264 exit at NC Flwy 23"1 towards Middlesex. 'burn North on NC 231. `!'urn East on Stoney Hill
Church Road. Travel 2.6 mi
4. Latitude:35° 48' 24" N Longitude:780 08' 38" W of the main entrance to the project.
3S . t 0C9'7 17 6
11. 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):
❑ how 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):
❑CAME] Major ®Sedimentation/Erosion Control: 32.77 ac of Disturbed Area
❑NPDES Industrial Stormivater ❑404/401 Permit: Proposed Impacts
b.If any of these.pertilits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:Bailey Community Park - Phase -1, Nash - 2011-013, July -14, 2011, Land
turbance Permit
N 0 V 2 0 2012 I
l=onn SWU-101 Version 07Jun2010 Page 1 of 6

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III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc, who owns the project):
Applicant/Organization:"I'own of Bane
Signing Official & Title:Owen Strickland, Mayor of Bai
b.Contact information for person listed in item I above:
Street Address:6260 Main Street
City:13a iley
Mailing Address (if applicable):
City:
Phone: (252 ) 235-4977
Email:`I'own of [e-mail]
State:
Zip:27807
State: lip:
Fax: (252 } 235-5762
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, itern 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 narne 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/Organi
Signing Official &'Title:
b.Contact information for person listed in itern 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
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:Withers & Itavenel
Signing Official & Title:Loftee Smith, Project
b.Contact information for person listed in item 3a above:
Mailing Address:111 MacKenan Drive
City:Ca ry State: NC Z i p:2751'1
Form 5WU-101 Version 07Jun2010 Page 2 of 7

Phone: (919 ) 469-3340 Fax: (919 ) 467-6008
LmaiI:Ismlth©withersravene1.coin
4. Local jurisdiction for building permits: Nash County
Point of Contact:Nancv Nixon
IV. PROJECT INFORMATION
Phone #: (252 ) 459-12"10
1. In the space provided below, briefl summarize how the stormwater runoff will be treated.
The project will be treated with a wet pond and level spreader.
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. Storimwater runoff from this project drains to the Neuse River basin.
4. Total Property Area: 65.46 acres 5. Total Coastal Wetlands Area: 0 acres
6. 'Total Surface Water Area: 2.2$ acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area*:63.18 acres
Total project area shall be calculated to exclude the followiag the normal pool of irmpormded struchires, Nie area
between the banks of streams and rivers, the area below Me Normal Higli Water (NHM line or Mean High Water
(MFIM line, and coastal wetlands landwardfrom the NNW (or MHW) lime. '['lie resultant project area is rased to
calculate overall percent built upon area (BI..IA). Nori-coastal zoetlaids laiidzoard of the NNW (or MHW) lute ))nay
be included in [lie total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 11.5 %
9. How many drainage areas does the project have?7 (For high density, count I for each proposed engineered
stornrzoater BMP. For low density and other projects, use 1 for the 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.
Form SWU-101 Version 07Jun2010 Page 3 of 7

Basin Information
Drains e Area 1
Draina Te Area._
Drainage Area _
Drainage Area _
Receiving Stream Name
Big Branch of
`fu rke =Creek
Stream Class
C; NSW
Stream Index Nu tuber
27-86-3-6
`total Drainage Area (so
784,080
On -site Drainage Area (so
784,080
Off -site Drainage Area (so
0
Proposed Im el'Viptls Area** s
-196,020
% Impervious Area** total
25%
Impervious— Surface Area
Drainage Area _
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (st)
1500
On -site Streets (sf)
24,787
On -site Parking (so
56,002
On -site Sidewalks (sf)
29,225
Other on -site (so
0.0
Future (so
84,506
Off -site (sf)
0.0
Existing BUA*** (so
0.0
Total (sf):
"196,020
* Stream Class and Index Number can be determined at: ltttf7://l3ortal.rrcrfe?rr.org weblztygZ /csrr/classi rcatiorfs
* ltn )ervious area is defined as lire built upon area including, birt not lituited to, buildings, roads, parking areas,
sNewalks, gravel areas, etc.
** Report only that autorurt of existing BUA that will retnain after developtitent. Do not report any existing BZIA that
is to be retuoved and which will be replaced by 11e71 BLIA.
11. I -low was the off -site impervious area listed above determined? Provide documentation. Autocad - Map
Enclosed
Projects in Union County: Contact DWQ Central Office staffto check it'the project is located i>>ithin a Threatened &
Endangered .Species inatershed that rnai, be subject to nrore stringent starnnvcaer requirements as per NC'11C 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 http//portal.ncdenr.org/+veb/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items Iisted below. A detailed application instruction sheet and BMP
checklists are available from http//portal.nc(ienr.org/web/wq/%vs/sti/statesw/forms dots. 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 htt//portal.ncdenr.org/Nveb/tvq/ws/su/mat.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/%veb/wq/ws/su/statesw/forms_docs.
Initials
1. Original and one copy of the Storniwater Management Permit Application Form. i 1< W
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if rerltrired as per Part V11 below)
3. 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 1'9W
htEp://www.enviielp.org/pages/onestopexpress.html for information on the Express program
Form SWU-101 Version 07Jun2010 Page 4 of 7

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/ managententfor
the project. This is required in addition to the brief summary provided in the Project
!reformation, item 1'
�Y�"
G. 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'/z
mile radius on the map.
7. Sealed, signed and dated calculations.
T
& Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
'V•-
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MI-IW or NHW line of tidal
waters, and any coastal wetlands landward of the Ml-IW 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.
ni. 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 retain set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify ` W
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"xT1 " copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit fir DWQ to verify the SHWT prior
to subniittal, (970) 79£-7378.)
10. A copy of the most current property deed. Deed book: 2500 Page No: 533 �)
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 1a, 2a, and/or 3a per NCAC 2I-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/CSearcli.aspx
Form SWU-101 Version 07lun2010 Page 5 of

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://portal.ncdenr.org/web/wqf ws/su/statesw/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 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.
VI11. 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:Loftec Smith
Consulting Firm: Withers & Ravenei
Mailing Address:111 MacKenan Drive
City:Cary
Phone: (919 ) 469-3340
Erna i1:Ism ith [e-mail]
S to te:NC Zi p:275"l 1
Far: (919 ) 467-6008
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 hos heeii filled rent, conplete this
section)
1, (print or type name of person lister[ 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 :In) with (print or type name of organization listed in
Contact Information, item In) 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.
Dorm SWU-101 Version 07Jun2010 Page 6 of 7

X. APPLICANT'S CERTIFICATION
1, (print or hype IUD Ile of hcrsan Iistcrt itt COI IMd 1ttfUt'l)In ialt, WI It 1n) Owc+t Strickland
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 und�e..r'15A N(CAC2I-1 1000, SL 2006-246 (Ph. 1I - Post ConshRuction) or SL 2008-277.
Signature:_-d,C,.,— .J / Date: 9- ') D ! �-
I, ebr ` • (`J �� � a Notary Public for the State of N��l'`t-G-) � U.yO1- VV County of
do hereby certify that lJ x+1 J 1 ; C 0 l "-'( personally appeared
before me thisq�lay of 1)r q0b,-and a knowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,i���
CLo
AV
Afiy.
i':'C"�
SEAL
My comillission expires
Form SWU-101 Version 07Jun2010 Page 7 of 7