SW6120305_CURRENT PERMIT_20120501

STORMWATER.DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO. SW_4_�1Aa_�DS
DOC TYPE
p CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE I 2aI2OSDi
YYYYMMDD

"'''�`=�
NCDENR
North Carolina Department of Environment and Natura
Beverly Eaves Perdue
Governor
Mr. David Heins
Director of Public Works (DPW)
2175 Reilly Road Stop A
Fort Bragg, NC 28310
Division of Water Quality
Charles Wakild, P.E.
Director
March 29, 2012
Subject: Stormwater Permit No. SW6120305
Ft. Bragg District Superintendent Office (DSO)
High Density Commercial Bio-Retention Project
Cumberland County
Dear Mr. Heins:
f _
r � Q a — t --i
MAY 01'0 1
Resources Dwo
Dee Freeman
Secretary
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for Ft.
Bragg District Superintendent Office (DSO) on March 23, 2012. 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.
SW6120305, dated March 29, 2012, 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 March 28, 2020 and shall be subject to the
conditions and limitations as specified therein, and does not supersede any other agency permit that may
be required. Please pay special attention to the conditions listed in this permit regarding the Operation and
Maintenance of the BMP(s), recordation of deed restrictions, procedures for changes of ownership,
transferring the permit, and renewing the permit. Failure to establish an adequate system for operation and
maintenance of the stormwater management system, to record deed restrictions, to follow the procedures
for transfer of the permit, or to renew the permit, 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 150E 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 Fayetteville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Brian Lowther at [phone]; or
[e-mail].
Sincerely,
for Chuck Wakild, P.E.
cc: Fayetteville Regional Office
SW6120305 File
ec: Stephen L. Mehaffey, P.E. - CEMS
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 North Carolina
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Customer Service. 1-877-623-6748 ;Vattlrally
Internet: www.%waterquality org a/
An Equal Opperlunity 1 Affirmative Action Employer

State Stormwater Permit
Permit No. SW6120305
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
Director of Public Works (DPM
Ft. Bragg Superintendent Office (DSO)
Bastogne Drive, Ft. Bragg, Cumberland County
FOR THE
construction, operation and maintenance of one (1) bioretention cell in compliance with
the provisions of Session Law 2006-246 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.
This permit shall be effective from the date of issuance until March 28, 2020, 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 Section 1.7 of this permit. The stormwater control has been
designed to handle the runoff from 51,401 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area as indicated in Section
1.7 of this permit, and per the application documents and as shown on the
approved plans. The built -upon area for the future development is not allowed in
this permit.
4. 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.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 6

State Stormwater Permit
Permit No. SW6120305
The following design criteria have been provided in the bioretention cell and must
be maintained at design condition:
a
0
Drainage Area, 9,cres:
0nsite, ft :
Offsite, ftz:
Total Impervious Surfaces, ftz:
Onsite, ft 2:
Offsite, ftz:
Design Storm, inches:
Max. Ponded Depth, feet:
Seasonal High Water Table, fmsl:
Planting Media Depth, feet:
Cell Dimensions, feet:
Bottom Elevatiop, fmsl:
Surface Area, ft
Permitted Storage Volume, ft3:
Bypass 1 Storage Elevation, fmsl:
Predevelopment 1 year 24 hour:
Post development 1 year 24 hour:
Drawdown Time, hours:
Underdrain Diameter, inches:
Total number of plants provided:
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body
II. SCHEDULE OF COMPLIANCE
3.83
166,835
0
51,401
51,401
0
1"
91,
288'
3'
153 by 65
290'
9,150
6,526
294.86
1.37
0.94
33
6"
54
Tank Creek (McDuffie
Creek) (McFayden Pond) 1 Cape Fear
18-23-27
„C„
1. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all time 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 re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet 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 submit to the Division of Water Quality 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
Page 2 of 6

State Stormwater Permit
Permit No. SW6120305
maintenance work performed at each inspection.
6. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with other
supporting data.
7. 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.
8. 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.
9. Access to the stormwater facilities shall be maintained via appropriate recorded
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
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
Page 3 of 6

State Stormwater Permit
Permit No. SW6120305
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 a request to transfer the permit.
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.
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 29th day of March 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
,for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No. SW6120305
Ft. Bragg District Superintendent Office (DSO)
Stormwater Permit No. SW6120305
Cumberland 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,
(Project Name)
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 5 of 6

State Stormwater Permit
Permit No. SW6120305
Certification Requirements:
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 outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation, per the vegetation plan.
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. Required drawdown devices are correctly sized per the approved plans.
.13. All required design depths are provided.
.14, All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
.15. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Cumberland County Building Inspections
Page 6 of 6

P .c r I .-P P" A- n n) 11,2 � G I s_
0
r
�J
DWQ USE ONLY
Date Received
Fee Paid
Permit Number
5o t
5 1
Applicable Rules: ❑ Coastal SW - 1995
(select all that apply) ❑ Non -Coastal S1V- I-IQI'V/OIZL,V
❑ Other WQ M rrttt Plan:
❑ Crustal Still - 2008 ❑ I'll Il - Post Construction
LVaters ❑Universal Stornn��rater �Ianagenneni flan
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This f rrin ivarj he photocopiedfor use as an original
1. GENERAL INFORMATION
1. Project Name (subdivision, facility, or L.�titahlislintent naive - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Pt. BraggDistrictSuperintendent Office (I)SO)
2. Location of Project (street address):
City:Ft Bragg w County:Cuntberland I_ip:28307
3. Directions to project (front nearest major intersection):
Approximatle 800't�esi �f tltc: intersection of Normandy
4. Latifude:35° 08' 03" N Longitude:79° 00' 82" W of the main entrance to the project.
014 Z 2"
if. PERMIT INFORMATION:
1.a.Specify whether project is (check rate.): ®New ❑Modification
b.If this application is heing submitted as the result of a modification to an existing perntit, list the existing
permit number its issue date (if known) anri the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *proaide a designers certificabon
2. Specify the type of project (check one):
❑Low Density ®I-ligh Density ❑Drains to an Offsite Siormwater Systeni ❑Other
3. If this application is being submitted as the result of a previously returned application or it letter front DWQ
requesting; a state storntivater inanagenient permit application, list the storni%vater 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 Critter at 1-877-623-6748):
❑CAMA Major ®Se(lictientatiort/I;r'osion Control: 4.66 ac of Disturbed Area
❑NPDI:'S Industrial Storniwater ❑404/401 Permit: Proposed Impacts
b.If any of Illese perinrts have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each perntit:
ILorin SW'U-101 Version 14Ma)r20l0
Page I of 6

III. CON`['ACI' INPORMATION
•
r1
LJ
•
"I. a. Print Applicant / Signing? Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc, who owns the ro'ect):
Applicant/Organization:Directorofl'uhlicWorks DPW
Signing Official & Title:lylr, David Heins, Environmental Division Chief (DPW)
b.Contact information for person listed in item la above:
Street Address:2175 Reill-y [load Stop A
Cit:y:Fort Bra ; - -- State:NC Zip:283'10-5000
Mailing Aridness (ifallplicable):2175 Reilly Road Stop A
CityTort Bragg;
1'11ar,e: (9-10 ) 396-2301
Email:clavid.a.heins.civ©mail.mil
Sta te: NC Z i p:28310-5000
Fax: (910 )_ 907-2420
c. Please check the appropriate box. The applicant listed above is:
®The property owner (Skit? 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:
Signing; Official &'Title:
b.Contact information for person listed in item 2a above:
Street Address:
City:
Mailing; Andress (if a pplimble):
City:
Phone: ( 1
F.maiL
Sta te: Zip:
State: Zip:
Fax:
3. a. (Optional) Print the name and title of another contact such as the p,•oiect's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:Mr. Lee Ward
Signing Official & Title:Dl'1V / Water tManag;ement Branch _
b.Clntact information for person listed in item 3a above:
Mailing Address:Bld > 0-9125 rMcKellars Road
City:Fort Bragg; _ State:NC I.ip:28310-5000 -
Phone: [phone] Fax: (910� ) 90772420
l?mail:lee.p.zvar<I.civr,mail.mil � _.
4. Local jurisdiction for building; permits: N/A
Point of Contact: I'hone #:
Form SWU-101 Version WMay2010 P;sgc 2 of 6

iV. PROJLCI' INFORMA'TION
I. In the space Provided below, brief IV summarize how the stormwater runoff will be treated.
A
s
Runoff generated from the site will be collected and muted through a hioretention area
2. a.If claiming vested rights, identify the supporting documents provided and the elate Ihcy were approved:
❑ Approval of a Site Specific Development Ilan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.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 Cape Fear River basin.
4. 'Total Properh, Area: 4.66 acres
5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. 'Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) _ "Total Project
Area':4.66 acres
Tolal project area shall be calculated to exclude the following: the normal pornl of impounded structures, flit, area
between fire banks of streams and rivers, the area below the Normal High Miter (NHW) lira; or Mean High Witter
(MI -Mg Bare, wain coastal arjetlands Luulcoard frown the NHW (or MHIN) line. '17re resarltant project wares +s itself to
calculate overall perceart built rapon area (BLIA). Non -coastal wellands laard7vard (if the NHW (or MI*V) lime mai/
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / "Total Project Area) X 100 = 3"1 %
9. How many drainage areas does the project have? 1 (For high density, count 1 for each proposed engineered
slormwater BMI'. 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 [lie project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area "I
Drainage Area _
Drainage Area _
Drainage Area
Receiving Stream Name
McDuffie. Creel:
T k e« ( t1
p.,6-1, f n
Q
Stream Class '
C
Stream index Number
18-23-27
Total Drainage Area (so
166,835
On -site Drainage Area (so
166,835
Off -site Drainage Area (so
0
Proposed Impervious Area** s
51,401
T. Impervious Area (total)
1 31
Impervious- Surface Area
Draina e Area _
Draina Te Area _
Draina re Area
Draina e Area
On -site Buildings/Lots (SO
'13,068
On -site Streets (sf)
On -site Parking (si)
22,676
Ora -site Sidewalks (st)
2,000
Other on -site (st)
1 1,043
Future (sf)
Off -site (sf)
1:xistang BUA*** (st)
2,614
Total (st):
51,401
* Stream Class and Index Number can be delerminerl at: hit jnrtal.arcrlerar.or ue°!� net/t>ti/csrr/E:Ir+ssafiiativrt5
r I)1t��?ervirrus area is defined as the br{ili upoat rm•era including, !.jilt not limited to, buildings, rnrarls, parking areas,
siricza�ralks, grrrza'! a virs, etc.
Report only that amn+rnt of existing 13LIA drat Will rennin after development. Do not report anyexisting BLIA Ilan
is to be reaauacel and 7111+0171411 be replaced by new BLIA.
Form SWU-101 Version 14May2010 Page 3 of

11. How was the off -site impervious area listed above determined? Provide documentaition, N/A
Pro'ecIs in Union Couniv: CO fact UIIVQ Central (y1we stc{%f to cluck if the; project is facateil lvithin a Threatener!
Endangered Species ir^cuershed that nrgv he subject to more strip, enf stornnt,wer requirements as per NC:IC oli 0600.
V. SUPPLEMENT AND O&M FORMS
The applicable State stormwater management perllllt Supplement and operation and maintenance (O&fbl) forms
must be submitted for each BNIP specified for this project. The latest versions of the forms call be downloaded
from http://portal.ncdenr.ork;[w6ZNVLf/ws/Ski Ilillp-manual.
V1. SUBMl7"1'AL 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 htttj_/Lportal.nMent',or > web itivq/ws/stt/,statesav/fornls does. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may tie
found by locating project on the interactive online neap at httRII Lortal.ncelenr.or r web w(l/%vs/sLi/rnaILs.)
Please indicate that the following reL111ired 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 front litt(iocs.
Initials
1. Original and one allot of the Stormwater Nianagenient Permit Application Forni.
--'res
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part V11 beloto)
3. Original of the applicable Supplement Forni(s) (sealed signed and dated) and O&NI
'r S
agreement(s) for each U41'.
� S
4, Perinit application processing fee of $505 payable it) NCDENR. (For an Express review, refer to
http://www.envhelp.org/pages/onestopexpress.htnll for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and ill schedL11C the required application meeting.)
5. A detailed narrative (one to 11V0 pages) describing the stormwater ti,e: it!pent/lilailagc'Iilc.iit'f(lr
TES
the project. `]'his is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS neap identifying the site location. if the receiving stream is reported as class SA or tile,
TE S
receiving stream drains to class SA waters within'/2 mile of the site boundary, include the'/z
niile radius oil the neap.
7. Sealed, signed and dated calculations.
T�5
R. TWO sets of plans folded to 85' x 14" (sealed, signed, & dated), including:
TES
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the K'll-1W or NI -RV lines.
• Delineate the vegetated Duffel' landwill'd from the normal 11001 OOVation Of II11pOLInCl.ed
structures, the banks of streams or rivers, and the N41-IVV (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 storlilsvater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
Llualified person. Provide documentation of qualifications and identify the pel'son who
made: the deterinination on the plans.
n. I'.xisting drainage (including oft -site), drainael'. ei15E'.Illei7tS, pipe slL(S, i'Lllloff calculations,
o. Drainage areas delineated (included in till' inain set of plaits, Rotas a separate document:).
p. Vegetated buffers (where required).
Fornl SWU-101 Version 14May2010 Page 4 of6

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9. Copy of any applicable soils report with the associated SI-l>r'1T elevations (Flease identify
elevations in addition to depths) as well as a neap of the boring locations with the existing
elevations and boring logs. Include in 8.5"x-Il" copy of the NRCS County Soils map avith the
project area clearly delineated. For projects with infiltration I3NI1's, the report should also
include the soil type, expected infiltration rate, and the method of determining; the infiltration rate.
(Infiltration Devices submitted to WiRO: SChedfile a sitr' visit for Cal VQ to vertjil the Sl-11 ]"prior
to sxbnuttal, [phone].)
'10. A copy of the most cu rrent property deed. Deed book: Page No: Al M
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC /II/!Q
Secretary of State or other official doClimentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 2H.1003(c). The
corporation or LLC rnttst be lister{ as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
littp:/ /wavw.secrc�tary.state.nc.us/Ciarporziti<ins/`CScrarcli.aslix
VII. DEED JZES'I'lZICI'IONS AND PROTECI"IVE COVI:NAN`I'S
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
13UA 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
hltl7ortal.ncilenr.or ��eb wq ws su/statesw/fornls_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 dead restrictions and protective covenants fora] 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.
Vill. 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 Fngineer:Stephen L Mahaffey,P.li.
Consulting Firm: CEMS
Mailing, Address:3509 Iron Florse Drive
City:Ladson St<ate:SC Zip:29456
Phone: (843 ) 875-3637 lax: (843-875-4509
l mail:siaaahaffey©ceillsc?ngineLrlilg.cciiii
1X. PROPERTY OWNER AUTHORIZATION (if Contract InPrination, itern 2 has been filler! ont, coinplele this
section)
1, (print or type urine of person lister! in Contact Infornratiou, iteirr a) , certify that 1
own the property identified in this permit application, and thus give permission to (pritit or type name cf person
lister? in Cotttnct Ixforination, iteirr Ira) with (print or type iratne of organization listed in
Contact Infortttntion, iteirr 117) to develop the project as currently proposed. A ropy of
the lease agreement or pending, property sides contract has boen provided with the submittal, which indicates the
party responsible for the operation and maintenance of the slorrnwate.r system.
Forin SWU-101 Versioii 14ivlay2010 Page. ol'6

n
LJ
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 anti/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DkVQ Slormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify MVQ immediately and submit a
completed Name/Ownership Change Form within 30 clays; otherwise I will be operating a storntwater treatment
facility without a valid permit. I understand that the operation of a storinwater 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 assessinent of civil penalties of Lip to $25,000 pet' day, pursuant to NCGS "143-215.6.
Signature: Date:
a Notary Public for the State of
do hereby certify that
before me this _ day of
Cou city of
personally appeared
111d acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SIAI.,
MY commission expires
X. Al"PI,ICANT'S CI-RTIFICA'I'ION
1, (pritit or type name of person listed in Contact Information, item 1n) Mr. David Heins
cerltfy that the information inclUded on Ihis permit application form is, to [lie 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 e recorded, and that the proposed project complies with the requirements of the
applicak le on wa r ri es nd 15A NCAC 21-1 .1000, SI. 2006-246 (Ph. It - Post Construction) or SC, 2008-21 1.
Signahire: r'� 7J`..J Date: � A�'�)
a Notary Public for the State of , County of
clo hereby certify that
before me this _ clay of
personally appeared
and acknowledge the clue execution of the application for
a stormwater permit. Witness my hand and official seal,
Sl?Al_
My co in mission e\p
Form SWU-101 Version 14May2010
I'age 6 of 6

` "CEM&ENGINEERING; INC:'
(643)t5575 3637 "s 4
3509 IRON HORSE DRIVE 67-219/539
L.ADSON : C 29456 3I22I2012
PAY TOfHE NCDENR`**SDS.DO
ORDER OF
Five hundred five'and
NCDENR
Wilmington Regional' Office
127 Cardinal Drive Extension
Wilmington; NC 28405 '
MEMO

CEMS ENGINEERING, INC.
NCD6NR LADSON, SC 29456
45041
3/22/2012
4504'1
4So41, .1 ,
s
r
. 8
s
_ DOLLARS
�L
45041
•
3/22/2012 Bill #Storm Water Quality Perm... 505.00 505.00 505.00
117000 CASH : Checking Ace... Storm Water Quality Permitting Fee - #11007 - Ft. 505.00