SW7060107_CURRENT PERMIT_20060505

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

w ATE9Q Michael F. Easley, Governor���
�O 6 William G. Ross Jr-,, Secretary
CIO
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Dircctor
Division of Water Quality
May 5, 2006
Mr. Ray McCotter
MCDI Properties, LLC
PO Box 12623
New Bern, NC 28561
Subject: Stormwater Permit No. SW7060107
West Cross Roads
High Density Project
Craven County
Dear Mr, McCotter:
The Washington Regional Office received a complete Stormwater Management Permit Application for
West Cross Roads on March 31, 2006. 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. We are forwarding Permit No. SW7060107 dated May 5, 2006, for the construction of the
subject project.
This permit shall be effective from the date of issuance until May 5, 2016, 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 operation 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 150E of the North
Carolina General Statutes, and fled 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.
If you have any questions, or need additional information concerning this matter, please contact Amy
Franklin, or myself at [phone].
Sincerely,
AI odge, RePion upery or^
Surface Water Protection Section
Washington Regional Office
AHlalf
cc: John G. Thomas, PE, Thomas Engineering, PA
Cfaven County Building Inspections
L^ashington Regional Office
Central Files
No`hCarolir
vakrrrrllr
North Carolina Division of Water Quality Washington Regional Office Phone [phone] FAX [phone] Customer Service
Internet: ngwaterauality.orq 943 Washington Square Mall, Washington, NC 27899 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer — 50°% Recyeledfl0°% Post Consumer Paper

State Stormwater Management Systems
Permit No. SW7060107
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
MCDI Properties, LLC
West Cross Roads
Craven County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with the provisions of
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 May 5, 2016, and shall be subject to the
following specified conditions and limitations:
I. DESIGN STANDARDS
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 1.6 on page 3 of this permit. The stormwater control has been designed to
handle the runoff from 348,542 square feet of impervious area listed under drainage area 1. Also
note that each lot is limited to (see attachment) square feet of impervious area. This pond must
be operated with a vegetated filter.
The tract will be limited to the amount of built -upon area indicated on page 3 of this permit, and
per approved plans. Also note that each lot will be limited to the built upon area indicated on the
attachment.
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.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7060107
6. The following design criteria have been provided in the wet detention pond and must be
maintained at design condition:;
Pond 1
a. Drainage Area, acres: 17.43
b. Total Impeivious Surfaces, ft2: 348,542
C. Design Storm, inches: 1.0
d. Pond Depth, feet: 6
e. TSS removal efficiency: 85%
f. Permanent Pool Elevation, FMSL: 12.00
g. Permanent Pool Surface Area, ftz: 14,700
h. Permitted Storage Volume, ft3: 42,375
i. Temporary Storage Elevation, FMSL: 20.5
j. Controlling Orifice: 2.5" 0 pipe
k. Permitted Forebay Volume, ft3: 7,298
I. Receiving Stream/River Basin: Neuse River
m. Stream Index Number: 27-(85)
n. Classification of Water Body: "SC: Sw: NSW"
ll. SCHEDULE OF COMPLIANCE
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 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.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW7060107
f. Debris removal and unclogging of outlet structure, orifice device, flow spreader, catch
basins and piping.
g. Access to the outlet strlacture must be available at all times.
4. Records of maintenance activities must be kept and made available upon request to authorized
personnel of DWQ. The records will indicate the date, activity, name of person performing the
work and what actions were taken.
5. 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.
6. 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.
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.
8. Access to the stormwater facilities shall be maintained via appropriate easements at all times.
9. 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 ail 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.
10. The permittee shall submit final site layout and grading plans for any permitted future areas shown
on the approved plans, prior to construction.
11. 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.
12. 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.
13. This permit shall be effective from the date of issuance until May 5, 2016. Application for permit
renewal shall be submitted 180 days prior to the expiration date of this permit and must be
accompanied by the processing fee.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7060107
III. GENERAL CONDITIONS
1. 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 formal permit transfer
request to the Division of Water Quality, accompanied by a completed name/ownership change
form, documentation from the parties involved, and other supporting materials as may be
appropriate. The approval of this request will be considered on its merits and may or may not be
approved. The permittee is responsible for compliance with all permit conditions until such time
as the Division approves the transfer request.
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.
3. 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.
4. 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.
5. 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,
6'. 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.
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.
8. Approved ptans'and specifications for this project are incorporated by reference and are enforceable
parts of the permit.
9. The permittee shall notify the Division of any name, ownership or mailing address
changes within 30 days.
Permit issued this the 5t" day of May, 2006.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan VV. Klimef, P.E. Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5 of 7

State Stormwater Management Systems
Permit No, SW7060107
West Cross Roads
Stormwater Permit No. SW7060107
Craven 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)
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
R9A_l11
Page 6 of 7

State Stormwater Management Systems "
Permit No. SW7060107
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 systern.
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.
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
Craven County Building Inspections
Page 7 of 7

ROY COOPER
Governor
MICHAEL S. REGAN
Serrefory
S. DANIEL SMITH
interim Direrfor
MCDI Properties, LLC
Attention: Mr. Donald E
1281 Colony Drive
New Bern, NC 28562
NORTH CAROLINA
Environmental Quality
November 18, 2019
Dixon, Registered Agent
�Vt, P6
Subject: Stormwater Permit No. SW7060107 Renewal
West Cross Roads
High Density Stormwater Project
Craven County
Dear Mr. Dixon:
A Division of Energy, Mineral, and Land Resources file review has determined that
Stormwater Permit SW7060107 for a stormwater treatment system consisting of a wet
detention pond serving West Cross Roads located on NC 43 in New Bern, NC expires
on May 5, 2020. This is a reminder that permit renewal applications are due 180 days
prior to expiration. We do not have a record of receiving a renewal application.
Please submit a completed permit renewal application along with a $505.00 fee for
permit renewal. Permit application forms for renewal can be found on our website at:
htt s: de .nc. ov ou di i i n ne -mine •a -1 nd-re urc ener - ineral-land-
rules/stormwater-prQgram ost-construction. North Carolina General Statutes and the
Coastal Stormwater rules require that this property be covered under a stormwater
permit. Failure to maintain a permit subjects the owner to assessment of civil penalties.
Stormwater permit are not automatically transferred if property is sold. If the property
has been sold you will need to submit a transfer of ownership application along with a
$505.00 application processing fee.
If you have questions, please feel free to contact me at [phone]. 1 will be glad to
discuss this by phone or meet with you. If you would like, I can e-mail you a copy of the
application forms. You can request a copy by e-mailing me at [e-mail].
Sincerely,
VI
Rog7r K. Thorpe
Environmental Engineer
��� North Carolina Department of hnvironmental Quality I Divislan of Energy, Mineral and Land Resources
®�
_ Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
252.946,6481

West Cross Roads
Stormwater Permit No. SW7060107
Craven County
Designer's Certification
State Stormwater Management Systems
f Permit No. SW706Q107
was a duly reg' ��� Qsst�».•w I^�Q�in the State of
North Carolina, having been authorized to observe periodically) eekly/ full time) the construction of the
project,
(Project)
for M C D 1 1-- t .LL (—(Project Owner) hereby state that, to the best of my
abilities, due care and biligence 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 checidist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
--_---------_ — Page 6 of 7

cx�

State Stormwater Management Systems
'1. permit No. SW7060707 »
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.
L, 3. . All the buif#-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 outleYbypass structure elevations are per the approved plan.
B. The outlet structure Is located per the approved plans.
7. , Trash rack Is provided on the outletlbypass structure.
88.. All slopes are grassed with permanent vegetation.
�9. Vegetated slopes are no steeper than 3:1.
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.
�i5. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Craven County Building Inspections
1
7of7
r

'I'HOMAS ENGINEERING, PA
CIVIL ENGIN7EERING.LA1vD DRVRLOPMRNT.PROJECT MANAGEMENT
To: NCDENR
Division of Water Quality
943 Washington Square mall
Washington, NC 27889
Re: West Crossroads
State Stormwater Permit No. SW7060107
New Bern, Craven County, NC
Dear Sirs,
February 2, 2009
"Mca va)
FEB 0 zaa
DWO - "ARIO
Please find enclosed for your files the Engineer's Certification for the referenced project
along with a copy of the recorded "Declaration of Covenants, Conditions, Restrictions,
and Easements"./
If you hav any questions or comments, please do not hesitate to call.
Sinc ely
G. Thomas, PE
in �thrnnsacnihnmacP��oinerrincrn;a onm
Enclosures
309 Aletcalf Street.P.0. Box 1309.New Bern, NC 28563
Phone: [phone]- ax: [phone].Website: ThomasEngineeringl'A.com

Permit No. 01d(Q D)y
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources GRIGIML
Division of Water Quality 6
STORMWATER MANAGEMENT PERMIT APPLICATION FORMqK-:([;FR' '[U
WET DETENTION BASIN SUPPLEMENT JAN - 9 2006
This form may be photocopied for use as an original
DWQ Stormwater Management Plan Review:
DWQ-WARD
A complete stormwater management plan submittal includes an application form, a wet detention basin
supplement for each basin, design calculations, and plans and specifications showing all basin and outlet
structure details.
1. PROJECT INFORMATION
Project Name:
S
Contact Person: i,,.. N &7. 1 �a~fs Phone Number: (2SZ)_ ("a r} -2 2-'7
For projects with multiple basins, specify which basin this worksheet applies to:
elevations
Basin Bottom Elevation 12,66 ft. (floor of the basin)
Permanent Pool Elevation 8. 6 d ft. (elevation of the orifice)
Temporary Pool Elevation ZO - S(D ft. (elevation of the discharge structure overflow)
areas
Permanent Pool Surface Area sq. ft. (water surface area at the orifice elevation)
Drainage Area 1 i. 431 o ac. (on -site and off -site drainage to the basin)
Impervious Area e • ao 11+ ac. (on -site and off -site drainage to the basin)
volumes
Permanent Pool Volume ,3 7 151 cu. ft. (combined volume of main basin and forebay)
Temporary Pool Volume Z 9 cu. ft. (volume detained above the permanent pool)
Forebay Volume 72- 113 cu. ft. (approximately 20% of total volume)
Other parameters
SA/DA1 Jeo a (surface area to drainage area ratio from DWQ table)
Diameter of Orifice Z' j' in. (2 to S day temporary pool draw -down required)
Design Rainfall j in.
Design TSS Removal Z % (minimum 85% required)
Form SWU-102 Rev 3.99 Page 1 of 4

Footnotes:
When using the Division SA/DA tables, the correct SAIDA ratio for permanent pool sizing should be computed based upon the
actual impervious % and permanent pool depth. Linear interpolation should be employed to determine the correct value for non-
standard table entries.
In the 20 coastal counties, the requirement for a vegetative filter may be waived if the wet detention basin is designed to provide
90% TSS removal. The NCDENR BMP manual provides design tables for both 85% TSS removal and 90% TSS removal.
11. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Pen -nit
Application Form, the agent may initial below. if a requirement has not been met, attach justification.
itials
The permanent pool depth is between 3 and 6 feet (required minimum of 3 feet).
The forebay volume is approximately equal to 20% of the basin volume.
The temporary pool controls runoff from the design storm event.
temporary pool draws down in 2 to 5 days.
e. if required, a 30-foot vegetative filter is provided at the outlet (include non -erosive flow
culations)
basin length to width ratio is greater than 3:1.
g. The basin side slopes above the permanent pool are no steeper than 3:1.
h.. A submerged and vegetated perimeter shelf with a slope of 6:1 or less (show detail).
i. Vegetative cover above the permanent pool elevation is specified.
trash rack or similar device is provided for both the overflow and orifice.
k. A recorded drainage easement is provided for each basin including access to nearest right-
-'of -way.
1. If the basin is used for sediment and erosion control during construction, clean out of the
basin is specified prior to use as a wet detention basin.
in. A m anism is specified which will drain the basin for maintenance or an emergency.
111. WET DETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
The wet detention basin system is defined as the wet detention basin, pretreatment including forebays and the
vegetated filter if one is provided.
This system (check one) [YHoes 0 doe incorporate a vegetated filter at the outlet.
This system (check one) 0 does oes not incorporate pretreatment other than a forebay.
Form SWU-102 Rev 399 Page 2 of

Maintenance activities shall be performed as follows:
After every significant runoff producing rainfall event and at least monthly:
a. Inspect the wet detention basin system for sediment accumulation, erosion, trash accumulation,
vegetated cover, and general condition.
b. Check and clear the orifice of any obstructions such that drawdown of the temporary pool occurs within
2 to 5 days as designed.
2. Repair eroded areas immediately, re -seed as necessary to maintain good vegetative cover, mow vegetative
cover to maintain a maximum height of six inches, and remove trash as needed.
3. Inspect and repair the collection system (i.e. catch basins, piping, swales, riprap, etc.) quarterly to maintain
proper functioning,
4. Remove accumulated sediment from the wet detention basin system semi-annually or when depth is
reduced to 75% of the original design depth (see diagram below). Removed sediment shall be disposed of
in an appropriate manner and shall be handled in a manner that will not adversely impact water quality (i.e.
stockpiling near a wet detention basin or stream, etc.).
The measuring device used to determine the sediment elevation shall be such that it will give an accurate
depth reading and not readily penetrate into accumulated sediments.
When the penmanent pool depth reads Lt. S feet in the main pond, the sediment shall be removed.
When the permanent pool depth reads L}, 5 feet in the forebay, the sediment shall be removed.
BASIN DIAGRAM
ill ha the blanks)
17 Permanent Pool Elevation
SaEimcnt Rcn oval El. 13,j� 75 o
-------------- -- Sediment Removal Elevation 1 3.SU 75%
Bottom Isle ation lZ.� r %-------------------------------------- --------------
Bottom Elevation /Z,od 25% /
FOREBAY
MAIN POND
5. Remove cattails and other indigenous wetland plants when they cover 50% of the basin surface. These
plants shall be encouraged to grow along the vegetated shelf and forebay berm.
6. If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through
the emergency drain shall be minimized to the maximum extent practical.
Form SWU-102 Rev 3.99 Page 3 of 4

7. All components of the wet detention basin system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the seven
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.
Print name:
r �%�,(10 Title: �i4'�,.�e� 1�NA_.. n
Address:i�dX iZ� z3 . `�I�w l5Ci�a. �(�G ��St; I
Phone: 2 4 �{
Date:— Oro
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 : S P, A. a ri,1--s , a Notary Public for the State of
County of C.Qy .J , do hereby certify that GE e e—
personally appeared before me this day of Q Ya-� , and acknowledge the due
execution of the forgoing wet detention basin maintenance requirements. Witness my hand and official seal,
NI
% G
4• c,•
4o�q BEN GC'.Bo+'e
SEAL
My commission expires_ �Z Q
Form SWU-102 Rev 3.99 Page 4 of 4

! r
t® r" d"Wal Ir a TI Jr ice" U"'il
OFFICE USE ONLY
Date Received
Fee Paid
Permit Number
JA -- 9 2006
v wry 4 Y +►/ 4'0
DWQ-W RQ SW -- 10 a��
A State of North Carolina
Department of Environment and Natural Resources ORIGINAL
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
MC D j ?n, Aer � -- e, . L Z-- G
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
&M _
3. Mailing Address for person listed in item 2 above:
Fc5. R,3x (2-42-3
City: N Q..y 13 r- rJ _ State: L L Zip: 7 8 56 I„
Telephone Number: ( 2 !�Z ) 6 '? f — Z 44--Z
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
5. Location of Project (street address):
N L r �.•i3 !
City: !ti e_6 Q1 rti] County:CP—ic, t��
6. Directions to project (from nearest major intersection):
N L �!-3
7. Latitude: -� 5,(312 319 )y Longitude: 7'? dG O4 W _ of project
8. Contact person who can answ r questions about the project:
Name: J6 ti r--% CV, Xw,i4-S Telephone Number: ( 2S7—
II. PERMIT INFORMATION:
1. Specify whether project is (check one): ✓ New Renewal Modification
Form S WU-101 Version 3.99 Page I of 4

t'
A . 'll i'�l .
�`Y��IS �y� 1. 1 k ti L�ti

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the
existing permit number and its issue date (if known)
3. Specify the type of project (check ne):
Low Density ✓High Density Redevelop General Permit Other
Additional Project Requirements (check applicable blanks):
_CAMA Major _&e!f5'edimentation/Erasion Control _404/401 Permit _NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748.
III, PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project,
QT 4 �al`1 dN
2. Stormwater runoff from this project drains to the N @ k Se River basin.
3. Total Project Area: / 9. '43/O acres
5, How many drainage areas does the project have?
4. Project Built Upon Area: �L Y %
6, Complete the following information for each drainage area. If there are more than two 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
Receiving Stream Name
N
Receiving Stream Class
ZC_
Drainage Area
Existing Impervious* Area
--
Proposed Impervious*Area
Q, e /Lt qL
% Impervious* Area (total)
6 "/Q
Impervious` Surface Area
Drainage Area 1
Drainage Area 2
On -site Buildings
ZZ e
On -site Streets
/Z0S4 Z S
On -site Parking
On -site Sidewalks
Other on -site
Off -site
Total: tt.8 ,SL{-z S
Total:
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc. g pd / '� G e
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7. How was the off -site impervious area listed above derived?
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
The following italicized deed restrictions and protective covenants are required to be recorded for all
subdivisions, outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table
listing each lot number, size and the allowable built -upon area for each lot must be provided as an attachment.
1. The following covenants are intended to ensure ongoing compliance with state stormwater management permit number
as issued by the Division of Water Quality. These covenants may not be
changed or deleted without the consent of the State.
2. No more than 3 square feet of any lot shall be covered by structures or impervious materials.
Impervious materials include asphalt, gravel, concrete, brick, stone, slate or similar material but do not include wood
decking or the water surface of swimming pools.
3. Swales shall not be filled in, piped, or altered except as necessary to provide driveway crossings.
4. Built -upon area in excess of the permitted amount requires a state stormwater management permit modification prior to
construction.
5. All permitted runoff from outparcels or future development shall be directed into the permitted stormwater control
system. These connections to the stormwater control system shall be performed in a manner- that maintains the integrity
and performance of the system as permitted.
By your signature below, you certify that the recorded deed restrictions and protective covenants for this project
shall include all the applicable items required above, 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 State, and that they will be recorded prior to the sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each
BMP specified for this project. Contact the Stormwater and Ceneral Permits Unit at [phone] for the status
and availability of these forms.
Form SWU-102
Wet Detention Basin Supplement
Form SWU-103
Infiltration Basin Supplement
Form SWU-104
Low Density Supplement
Form SWU-105
Curb Outlet System Supplement
Form SWU-106
Off -Site System Supplement
Form SWU-107
Underground Infiltration Trench Supplement
Form SWU-108
Neuse River Basin Supplement
Form SWU-109
Innovative Best Management Practice Supplement
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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. The complete application package should be
submitted to the appropriate DWQ Regional Office.
Please indicate that you have provided the following required information by init
next to each item.
• Original and one copy of the Stormwater Management Permit Application Fon
• One copy of the applicable Supplement Form(s) for each BMP
• Permit application processing fee of $420 (payable to NCDENR)
• Detailed narrative description of stormwater treatment/management
• Two copies of plans and specifications, including:
Development/Project name
Engineer and,firm
-Legend
North arrow
Scale
Revision number & date
Mean high water line
Dimensioned property/project boundary
Location map with named streets or NCSR numbers
Original contours, proposed contours, spot elevations, finished floor elevations
Details of roads, drainage features, collection systems, and stormwater control measures
Wetlands delineated, or a note on plans that none exist
Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
Drainage areas delineated
Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section. /�
Designated agent (individual or firm): w1A& G;
Mailing Address: . P—,::) X .— ( `�;- d 9 _
City: Q t� State: Zip: Z 8 3
Phone: ('Z�Z ) b 3'� -- Z''1Z�] Fax: ( ZSL ) G 3. 6 - Z
��� r�Ms'74-c{-@ gd�CO
VIII. APPLICANT'S CERTIFICATION
1. (print or type name of person listed in General Information, item 2) m cr-(0�4 0✓— ,
certify that the information included on this permit application form t6 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 he proposed project complies with the requirements of 15A
NCAC 2H .1000. --,-I.'� „
Date: ! g
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