SW6121202_HISTORICAL FILE_20121211

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

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post onstruction
(select all that apply) ❑ Non -Coastal SW- HQW /ORW 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 fornt may be photocopied far 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.):
SOF Administrative Annex
2. Location of Project (street address):
Interesection of El Salvador Street and Just Cause Road (building to be between ex. building 3925 and 3622)
City:Fort Bragg County:Cumberland Zip:28307
3. Directions to project (from nearest major intersection):
From Access Control Point #7, Turn west on Gruber Road, turn south on Reilly Rd, turn _west on lust Cause Dr
4. Latitude:35" 06' 41.8" N Longitude:78° 59' 55.4" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenemals with modifications also requires S WU-102 - Renewal Application Forin
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: 2.64 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:
5. Is the project located within 5 miles of a public airport? ®No ❑Y
If yes, see S.L. 20I2-200, Part VI: littp://12ortal.ncdenr.org/web/wq/
Form SWU-101 Version 06Aug2012 Page 1 of 6

Ill. 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: pirectorate of Public Works (DPW Water Management Branch
Signing Official & Title:Mr. David Heins, Environmental Division Chief (DPW)
b.Contact information for person listed in item 1a above:
Street Address:2175 Reilly Road Stop A
City:Fort Bragg State: 1c Zip:28310-5000
Mailing Address (if applicable):2175 Reilly Road Stop A
City:Fort Bragg State:NC Zip:28310-5000
Phone: (910 } 396-8207 Fax: [phone]
Email: david.a.heins.civ©mail.mil
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, 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 & Ti
b. Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
City:
Phone:
Email:
State:NC Zip:28310-5000
Sta
Fax:
Zip:
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. Lee Ward
Signing Official & Title: DPW / Water Management Branch
b.Contact information for person listed in item 3a above:
Mailing Address: Bldg 0-9125, McKellars Road „
City:Fort Bragg _ State:NC Zip:28310-5000
Phone: [phone] Fax: (910 ) 907-2420
Email: lee. p.ward.civ©mail.mil
Form SWU-101 Version 06Aug2012 Page 2 of 7

4. Local jurisdiction for building permits:
Point of Contact:
Phone #:.( _
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be routed through Bio-retention pond for stormwater quality.
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 PUDApproval 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 Cape Fear River basin.
4. Total Property Area: 3.25 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 Area':
3.25 acres
Total project area shall be calculated to exclude thefollowing: the normal pool of imppounded strtichtres, the area
between the banks of streams and rivers, the area below the Normal Higgh Water (NM line or Mean High Water
(MHW) line, and coastal wetlands landzvard front the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built ztpon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may be
included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = Sl%
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stornrzvater BMP. For lore 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 06Aug2012 Page 3 of 7

Basin Information
Drainage Area 1
Drainage Area r
Drainage Area.---
Drainage Area _
Receiving Stream [dame
Big Branch
Stream Class
C
Stream Index Number *
18-31-24-5-1
Total Drainage Area (sf)
78,408
On -site Drainage Area (sf)
78,408
Off -site Drainage Area (sf)
0
Proposed Linpervious Area** (so
43,124
Impervious Area** (total)
55%
Impervious" Surface Area
Drainage Area
Drainage Area _
Drainage Area
Drainage Area
On-site Buildings/Lots (so
9,660
-------------
On -site Streets (so
4,205
On -site Parking (so
21,964
On -site Sidewalks (so
5,006
Other on -site (so
0
Future (sf)
0
Off -site (50
0
Existing BUA*** (sf)
2,289
Total (so:
43,124
* Stream Class and Index Number can be determined at: ltttp://portal.ncdenr.o)g/zileb/rnrl[ps/csrr/classi icatiotts
** Iinppervious area is defined as the brtilt upon area inchrding, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
**` Report only that amount of existing BUA that will rentain after development. Do not report any existing BUA that is
to be removed and which roill be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DWQ Central Office staff to check if the project is located ►vithin a Threatened &
Endangered Species xvatershed that may be subject to more stringent srormFvater requirements as per I SA 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 http://portal.ncdenr.org/web/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 listed below. A detailed application instruction sheet and BMP
checklists are available from http://portal.ncdenr.org/web/wq/wslsu/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 http://portal.ncdenr.org/web/wd/ws/su/maps.)
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/web/wq/ws/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. 41~5
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if regeiired as per Part VII beloro)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M A"S
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to 49
hht-p://www.enyhelp.org/panes/onestopexl2ress.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.)
Form SWU-101 Version 06Aug2012 Page 4 of 7

5. A detailed narrative (one to two pages) describing the stormwater treatment/management for fl E 5
the project. This is required in addition to the brief summary provided in the Project
Information, item I.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the A*
receiving stream drains to class SA waters within'h mile of the site boundary, include the 1h
mile radius on the map.
7. Sealed, signed and dated calculations (one copy). AE-5
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:ft S
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 NI-IW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from 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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
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).
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: 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: Page No:
11. For corporations and limited liability corporations (L,LC): Provide documentation from the NC �+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 15A NCAC 2H.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.aecretary.state.nc.us/Corl2orations/CSearch.aspx
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, 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.nedenr.org/web/wq/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.
Form SWU-101 Version 06Aug2012 Page 5 of 7

VIII. 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:
Consulting Firm: LBYD, Inc.
Mailing Address:716 South 301h Street
City.Birmin ham State:AL Zip:35233
Phone: (205 ) 251-4500
Email:dcoley©lbyd.com
Fax: [phone]
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 1a) with (print or type name of organization listen 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.
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: Date:
I, , a Notary Public for the State of
. do hereby certify that
before me this _ day of
County of
personally appeared
. and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Form SWU•101 Version 06Aug2012 Page 6 of 7

X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Information, item 2a) Mr. David 1-leins
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 rubs yndej 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Date: o D&,o
1, a Notary Public for the State of County of
do hereby certify that
personally appeared
before me this _ day of . and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Form SWU-101 Version 05Aug2012 Page 7 of 7

-"' "GSC CONSTRUCTION, INC. 30125
Check#: 36125 : Data: I Ill612012 Vendor#: ' .1438 NCDENR '
invoice#
Job/Description , -
Balance. Retain Discount
This Check
Stormwater S06
53.8 SOF Adii inistraiio
505.00
505•00
x_ GSC C STRUCTION, iNC WELLS FAacO . ,•
GEORGIA
. f_ . 30125
1727 WRIGHTSBORO ROAD 64.22/610
AUGUSTA` GEORGIA 30944
s
t; [phone] �s {` CHECK NO
CHECK DATE ". VENDOR NO.
F
J ,ap ,� 30i 25 `,
11 /16/2012 .. 1438
u
r EXACTLY ;FIVE HUNDRED FIVE DOLLARS_
'
CHECK AMOUNT
.I
$ *505.00
' TO,THE NEDENR !
ORDER `�1'601 Mal SeNice Center
1
Gsc coNsrAucTlbN, INC.
bF RaleidWNC>27699
V 'y I fI.W,,..Rr .•
- -AUTHORIZED SIGNATURE
'-'....
:... .. _. SECURITY FEATURES �J ES INCLUDED. DETAILS ON BACK. L�J

'r ; u(Z-tJ 70 2�; 0 y d J�) r--Vkk6
Application Completeness Review
❑ First Submittal ❑ Re -submittal
Development/Project Name: SD J
Receiving stream name _ 1% q —
River Basin: C .r -P 24-
6P.,tAf"c '
. l'/
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):�A
Latitude and Longitude: 3S aG �/. 8 �/ —716 S2 5S. Jurisdiction ,
Engineer name and firm: Co4E
Phone: 2a-r, - ZSI - 54-oo mail: dcole a aG
Is the project confirmed to be in the State MSI Stormwater Permit j risdiction? Yes �anor
❑ Low Density (no curb and gutter) ❑ Low Density with curb and gutter outlets❑ Other
-aj4011404 impacts to surface waters, wetlands, and buffers (add language to cover lenfo letter)
Y BUA Si.
,,Check for $505.00 included
riginal signature (not'photocopy) on application
V Legal signature (Corporation-VP/higher, Partnership -General Partner/higher, LLC-member/manager, Agent).
fii i u -rA )e V
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.
�or subdivided projects, a signed and notarized deed restriction statement
sled, signed & dated calculations
Correct supplement and 0&M provided for each BMP on site (check all that were provided & number of each) '~
a v"Bioretentlon
❑ Dry Detention Basin
❑ Filter Strip
❑ Grass Swale
❑ Infiltration Basin
❑ Infiltration Trench
❑ Level Spreader
❑ Permeable Pavement
❑ Restored Riparian Buffer
❑ Rooftop Runoff Management
❑ Sand Filter
❑ Stormwater Wetland
❑ Wet Detention Basin
❑ Low Density
❑ Curb Outlet
❑ Off -Site
❑ NCDOT Linear Road
GY/Two sets of sealed, signed & dated layout & finish grading plans with appropriate details
Vsoils
arrative DescriWeinformation
stormwater management provided
report, eo provided
-2— Wetlands delineated or a note on the plans or in the accompanying documents that none exist on site and/or
djacent property
D tails for the roads, parking area, cui-de-sac radii, sidewalk widths, curb and gutter;
� , ensions & slopes provided
rainage areas delineated ❑ Pervious and impervious reported for each ❑ Areas of high density
BMP operation and maintenance agreements provided
Application complete ❑ Application Incomplete Returned: (Date)
Comments
Oct 29 2012 Revision, Bill Diuguid

,
Civil and Stirucrural Engineers
Date: December 5, 2012
Re: Stormwater Management Permit Package Contents
SOF Administrative Annex LEWD
Fort Bragg, NC
Please find enclosed the following package contents for the Stormwater Management Permit
Submittal for the SOF Administrative Annex at Fort Bragg:
Package Contents:
"'Vf' Check for $505
f Original - SWU-101 Permit Application Form
�. Copy - SWU-101 Permit Application Form
Required Items Checklist
Signed and Executed O&M Agreement (BMP 1)
h. Stormwater Management Plan and Computations (Contains Supplemental Forms,
% supporting calculations, soils report, etc.)
V7. 2 sets of full-sized sets of construction drawings
If you need additional information, or have any questions, please contact me
([e-mail], 205-251-4500)
Thank you,
A"A
David M. Coley, PE
LBYD, Inc. - 716 South 30"' Street - Biimingham. Alabama 35233
Biimingnam Atlanta Huntsnlle
www.lbyd.com
Phone [phone]C
Tampa BCN

Permd No:
(to be assigned oy nwo)
III. REQUIRERITE.KCHECKLIST.. _
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the lollowing design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Page! Plan
Initials Sheet No.
05 C -lab
1. Plans (1' - 50' or larger) of the entire site showing:
C ' 110
- Design at ultimate build -out,
G " f f I
- Off -site drainage (if appifcable),
G " 4W
- Delineated drainage basins (include Rational C coefficient per basin),
e (0Z
Cell dimensions,
Pretreatment system,
High flow bypass system.
Maintenance access,
Recorded drainage easement and public right of way (ROM.
Clean out pipe locations,
Overflow device, and
Boundaries of drainage easement.
Af S & `400
SgVp frwA9 M1
Aft WWI
AES
/t ES
L-foo
L"fol
2. Plan details (1' = 30' or larger) for the bioratention cell showing:
Cell dimensions
Pretreatment system,
High flow bypass system,
Maintenance access,
Recorded drainage easement and public right of way (ROW),
Design at ullimale build•out.
Off-sile drainage (il applicable),
Clean out pipe locations,
Overflow device, and
Boundaries of drainage easement.
Indicate the P-Index between 10 and 30
3. Section view of the bioretention cell (1" = 20' or larger) showing:
Side slopes, 3:1 or lower
Underdrain system (if applicable), and
Bioretention cell layers [ground level and slope, pre-treatment, ponding depth, mulch depth, fill media
depth, washed sand, filter fabric (or choking stone if applicable), 457 stone, underdrains (it applicable),
SHWT level(s), and overflow structure)
4, A sails report that is based upon an actual field investigation, sail borings, and infiltration tests. The
results of the soils report must be verified in the field by DWO, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information. All
elevations shall be in feel mean sea level (imsl). Results of sails tests of both the planting soil and the in
situ soil must include:
Soil permeability,
Soil composition (% sand, % fines, % organic), and
P-index.
5. A detailed planting plan (1' = 20' or larger) prepared by a qualified individual showing:
A variety of suitable species,
Sizes, spacing and locations of plantings,
Total quantity of each type of plant specified,
A planting detail,
The source nursery for the plants, and
Fertilizer and watering requirements to establish vegetation.
6. A construction sequence that shows how the biorelention cell will be protected from sediment until the
51",A a entire drainage area is stabilized.
tit Ff 7. The supporting calculations (including underdrain calculations, if applicable[.
C-108
4•fd'1
A ES P11V
S. A copy of the signed and notarized inspection and maintenance (I&M) agreement.
9. A copy of the deed restriction.
Form SW401•Bioretenlion-Rev.7 Part M. Page i of -1

u fz rJ To g c) y d 3�> ,_ vW-N E
Application Completeness Review
❑ First Submittal ❑ Re -submittal
Development/Project Name: S� 1
Receiving stream name 13,
River Basin: C P --- ,ra.
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): ff�h
Latitude and Longitude: 3S 06 �/, 8 a/ - 7 V 5q 55: 5p / Jurisdiction S
Project Address: r�r t.,� r . El A;4•h -t 3:u._54 C"g u se_ 6:0,kcp
Engineer name and firm: D,R41r`Lp CoL V L 7t YD,.'Live.
Phone: 2v5 dcoleya
Is the project confirmed to be in the State MSI Stormwater Permitj risdiction? Yes or o
❑ Low Density (no curb and gutter) ❑ Low Density with curb and gutter outlets igh DeD
❑ Other
-e-�401/404 impacts to surface waters, wetlands, and buffers (add language to cover letter an ornfo letter)
Y BUA _ S/�,,
�heck for $505.00 included
riginal signature (not photocopy) on application
V Legal signature (Corporation-VP/higher, Partnership -General Partner/higher, LLC-member/manager, Agent).
'm i u -r,# le
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.
-13-7or subdivided projects, a signed and notarized deed restriction statement
"aled, signed & dated calculations
Correct supplement and 0&M provided for each BMP on site (check all that were provided & number of each)
r"Bioretention
❑ Dry Detention Basin
❑ Filter Strip
❑ Grass Swale
❑ Infiltration Basin
❑ Infiltration Trench
❑ Level Spreader
❑ Permeable Pavement
Zi Restored Riparian Buffer
❑ Rooftop Runoff Management
❑ Sand Filter
❑ Stormwater Wetland
❑ Wet Detention Basin
❑ Low Density
❑ Curb Outlet
❑ Off -Site
❑ NCDOT Linear Road
r Two sets of sealed, signed & dated layout & finish grading plans with appropriate details
r� arrative Descrip ' stormwater management provided
Soils report, eo a information provided
-a- Wetlands delineated or a note on the plans or in the accompanying documents that none exist on site and/or
,adjacent property
D tails for the roads, parking area, cul-de-sac radii, sidewalk widths, curb and gutter;
� ensions & slopes provided
rainage areas delineated ❑ Pervious and impervious reported for each ❑ Areas of high density
BMP operation and maintenance agreements provided
Application complete ❑ Application Incomplete Returned: (Date)
Comments
Oct 29 2012 Revision, Bill Diuguid