SW7120705_CURRENT PERMIT_20120714

I
STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW Z� 5
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
C
YYYYM M DD

Permit Number: SW -7 1 Zo"7Q
(to be provided by DWQ)
Drainage Area Number:
EMEWfiltration Basin Operation and Maintenance Agreement
JUL 2.4 2012
INCUE a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
important maintenance procedures:
- The drainage area will be carefully managed to reduce the sediment load to the
infiltration basin.
- Immediately after the infiltration basin is established, the vegetation will be
watered twice weekly if needed until the plants become established (commonly
six weeks).
- No portion of the infiltration basin will be fertilized after the initial fertilization
that is required to establish the vegetation.
- The vegetation in and around the basin will be maintained at a height of
approximately six inches.
After the infiltration basin is established, it will be inspected once a quarter and within
24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of operation and maintenance will be kept in a known set location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
infiltration basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
The inlet device: pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Form SW401-Infiltration Basin O&M-Rev.3 Page 1 of 3

BMP element:
The forebay
The main treatment area
The embankment
The outlet device
The receiving water
Potential problem:
Sediment has accumulated
and reduced the depth to 75%
of the original design depth.
Erosion has occurred or
riprap is displaced.
Weeds are present.
A visible layer of sediment
has accumulated.
Water is standing more than
5 days after a storm event.
Weeds and noxious plants are
growing in the main
treatment area.
Shrubs or trees have started
to grow on the embankment.
An annual inspection by an
appropriate professional
shows that the embankment
needs repair.
CIogging has occurred.
The outlet device is damaged
Erosion or other signs of
damage have occurred at the
outlet.
How I will remediate the rolilem:
Search for the source of the {
sediment and remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Provide additional erosion.
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Remove the weeds, preferably by
hand. If pesticides are used, wipe
them on the plants rather than
spraying.
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP. Replace any media that
was removed in the process.
Revegetate disturbed areas
immediately.
Replace the top few inches of filter
media and see if this corrects the
standing water problem. If so,
revegetate immediately. If not,
consult an appropriate professional
for a more extensive repair.
Remove the plants by hand or by
wiping them with pesticide {do not
spray.
Remove shrubs or trees
immediately.
Make all needed repairs.
Clean out the outlet device. Dispose
of the sediment off -site.
Repair or replace the outlet device.
Contact the NC Division of Water
Quality 401 Oversight Unit at 919-
733-1786.
Form SW401-Infiltration Basin O&M-Rev.3 Page 2 of 3

Permit Number:
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name: Marine Corps Air Station, Cherry Point, NC
BW drainage area number: -I
G. W. RADFORD
Print name:Geor ge Radford Fnytronmental Affairs Officer
'I,itic:AE Officer By direction of the Commanding 0mcer
Addr(
Phony
Signa
Date:
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
a Notary Public for the State of
County of CQ��C�� , do hereby certify that
2G0personally appeared before me this 17
day of,7'u /14 , �Qr� , and acknowledge the due execution of the
forgoing infiltration basin maintenance requirements. Witn ss my hand a official seal,
`,\N LIL t,q ���ii
pO
UJ30C L}=
z`
SEAL
My commission expires )/` S- C�0/6—
Form SW40I-infiltration Basin O&M-Rev.3
Page 3 of 3

- N

NCDEENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Charles Wakild, P.E. Dee Freeman
Governor
Director Secretary
August 1, 2012
Mr. George Radford, EA Officer
MCAS Cherry Point, EAD
PSC Box 8006
Cherry Point, NC 28533
Subject:
Stormwater Permit No. SW7120705
MCAS Chery Point Mess Hall Renovation
High Density Project
Craven County
Dear Mr. Radford:
The Washington Regional Office received a complete Stormwater Management Permit
Application for MCAS Cherry Point Mess Hall Renovation project on July 24, 2012. Staff
review of the plans and specifications has determined that the project, as proposed, will
comply with the Stormwater Regulations set forth in Session Law 2008-211 and Title 15A
NCAC 2H.1000. We are forwarding Permit No. SW7120705 dated August 1, 2012, for the
construction of the subject project.
This permit shall be effective from the date of issuance until August 1, 2020, 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 filed with the Office of
Administrative Hearings, 6714 Mail -Service Center, Raleigh, NC 27699-6714. 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 Samir Dumpor, or me at [phone].
kAl
erel ,
odg
Regional Supervisor
Surface Water Protection Section
AHlsd: K:1SD1Permits - Infiltration\SW7120705
cc: Daniel DeYoung, PE, DJG, Inc. (449 McLaws Circle, Williamsburg, VA 23185)
Craven County Building Inspections
t/Washington Regional Office
North Carolina Division of Water Quality Internet W%V%V.ncwalcrqualit} or
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] NorthCarofiina
An Equal opportunitylAffirmative Action Employer— 50% Recycled110% Post Consumer Paper Aatural&

State Stormwater Management Systems
Permit No. SW7120705
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
MCAS Cherry Point
MCAS Cherry Point Mess Hall Renovation
Craven County
FOR THE
construction, operation and maintenance of a infiltration basin, in compliance with the
provisions of Session Law 2008-211 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 August 1, 2020, 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 1.7 on page 3 of this permit: The stormwater control
has been designed to handle the runoff from total of 54,885 square feet of
impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.7 on
page 3 of this permit, and as shown on the approved plans.
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 50 feet
landward of all surface waters.
7. The following design criteria have been permitted for the infiltration basin and must
be provided and maintained at design condition:
Page 2 of 7

INFILTRATION BASINS
State Stormwater Management Systems
Permit No. SW7120705
e,
a. Drainage Area, ft2:
b. Total Impervious Surfaces, ft2:
C. Design Storm, inches:
d. Basin Depth, feet:
e. Bottom Elevation, FMS�:
f. Bottom Surface Area, ft :
g. Bypass Weir Elevation, FMSy
h. Permitted Storage Volume, ft
i. Type of Soil:
j: Expected Infiltration Rate, in/hr:
k. Seasonal High Water Table, FMSL
I. Time to Draw Down, days:
M. Receiving Stream/River Basin:
n. Stream Index Number:
o. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
123,274
54,885
1.5"
6.00
15.00
4,968
23.00
18,723
Gray silty sand
1.28
13.00
3.25
Slocum Creek/Neuse River Basin
27-112
"SC, Sw, NSW"
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.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of bypass structure, infiltration media, flow
spreader, catch basins piping and vegetated filter.
g. A clear access path to the bypass structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and what
actions were taken.
5. The 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. 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.
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
Page 3 of 7

J
Stake Stormwater Management Systems
Permit No. SW7120705
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. 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 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.
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 at all times.
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.
III. GENERAL CONDITIONS
This permit is not transferable to any person or entity except after notice to and
approval by the Director. In the event of a change of ownership, or a name change,
the permittee must submit a completed Name/Ownership Change form to the
Division of Water Quality, signed by both parties, and accompanied by the
appropriate documentation as listed on page 2 of the form. The approval of this
request will be considered on its merits and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such time
as the Division approves the transfer request.
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.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7120705
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 orterminated. The
permit may be modified, revoked and reissued or terminated for cause. The filing of
a request for a permit modification, revocation and reissuance or termination does
not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
controls must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference and
are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit as
allowed by the laws, rules and regulations contained in Session Law2008-211, 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. This permit shall be effective from the date of issuance until August 1, 2020.
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.
Permit issued this the 1 st day of August, 2012.
LINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
v... ,:-- ....,.... v., . ._.,- - - -�
-.
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. SW7120705
Page 5 of 7

State Stormwater Management Systems
Permit No. SW7120705
MCAs Cherry Point Mess Hall Renovation
Stormwater Permit No. SW7120705
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
SEAT_
Page 6 of 7

State Stormwater Management Systems
Permit No. SW7120705
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 bypass structure weir elevation is per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been provided.
12. All required design depths are provided.
13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Craven County Building Inspections
Page 7 of 7

V
DWQ USE ONLY
Date Received
Fie Paid G I S3
Permit Number
2—i sn aµ V uyx7
1 2-0 7 DS
❑ Coastal SW -1995 El Coastal SW`- 2008 El Ph lI - Post Construction
ApplicabW'aEWon-Coasta1SW-HQW/ORW
(select a!1 Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources vR—kGAt.)AL
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This forru ntay be photocopied for use as an original
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.):
Cherry Point Mess Hall Renovation
2. Location of Project (street address):
Building 3451 on 411, Avenue
City:Cherry Point MCAS_ ._ County:Craven Zip:28533
3. Directions to project (from nearest major intersection):
The ro'ect is located on 41h Avenue at the Cherry Point Marine Corps Air Station between "C" and "I;" Streets.
4. Latitude:34° 54' 5.169" N Longitude:-76° 53' 51.5214" W of the main entrance to the project.
H. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) T , 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 Ietter 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):
❑LAMA Major ®Sedimentation/Erosion Control: 5.00 ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 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:
Form SWU-101 Version 07Jun2010
Page 1 of 6

-
III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, properylo►vne"r; lessee,
designated government official, individual, etc. who owns the project): r • -
Applicant/OrganizatiomMarine Corps Air Station Cherry Point NC
Signing Official & Title:George Radford, EA Officer _
b.Contact information for person listed in item I above:
Street Address:
City:MCAS Cherry Point State:NC Zip:28533
Mailing Address (if applicable):
City:
Phone: (252 ) 466-4599
[e-mail]
State: Zip:
Fax: (252 )_466-2000
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 & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
City:
Phone: ( 1
Em
State: Zip:
State: Zip:
Fax: ( )
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization: Jerry Connolly, DIG, Inc.
Signing Official & Title:
b. Contact information for person listed in item 3a above:
Mailing Address:449 McLaws Circle
City:Williamsbu
Phone: (757 ) 253.0673
Email:jconnolly@ jginc.com
State:VA Zip:23185
Fax: (757 ) 253.2319
4. Local jurisdiction for building permits: Cih' of Havelock
Point of Contact:1. Scott Chase AICP Phone #: (252_ )444.641.1
Form SWU-101 Version 07Jun2010 Page 2 of 6

IV~. PROJECT INFORMATION
In the space provided below, briefly summarize how the stormwater runoff will be treated.
The stormwater will be treated with an infiltration basin
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development PIan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph lI - Post Construction
3. Stormwater runoff from this project drains to the Neuse River basin.
4. Total Property Area: 5.0
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`: 5 acres
' Total project area shall be calculated to exclude the follozoing. the normal pool of impounded structures, the area
between the banks of streams and rivers, the area belozo the Nortual High Water (NHW) line or Mean High Water
(MHW) line, and coastal zoetlands landward froni the NHW (or MHW) litre. The resultant project area is used to �
calculate overall percent built upon area (BUA). Noti-coastal zoetlafids landward of the NHW (or MHW) line tuay ,-;, �{
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 45 %
9. I -low many drainage areas does the project have?7 (For high density, count I for each proposed engineered
stormwater BMP. For low densihj and other projects, use I 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.
Basin Information ;
Drainage Area
Drainage'Area'_'
"°Drama e Area'.
�Drainae Area L
Receiving Stream Name
A.1-I*0t0r-Gib
.5L-0C M CRAM
Stream Class
SC;Sw,NSW
r
Stream Index Number *
27-112.4—
%— //Z
Total Drainage Area (so
123,274 sf
z, SZ Ac.
On -site Drainage Area (so
123,274 sf
Off -site Drainage Area (so
0
Proposed Impervious Area** (sq
54,885 sf
e
% Impervious Area** total
45
,T
Im 'ervious'' Surface Area .
'Draina e Area
Draina e Area
Draina e=Area :..
Drainage Area`J
On -site Buildings/Lots (so
24, 387 sf
On -site Streets (so
0
On -site Parking (so
18,895 sf
On -site Sidewalks (so
4,785 sf
Other on -site (so
6,818 sf
Future (so
0
Off -site (so
0
Existing BUA*** (so
0
Total (so:
54,885 sf
, Ac.
"
* Stream Class and Index Number can be determined at: lrtt . ortal.ttcdetu•.or )eb o s csrt class' icatiotls
ltp ervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas, �.
sidewalks, gravel areas, etc. 1
*** Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be reproved and which will be replaced by new BUA.
Forth SWU-101 Version 07Jun2010 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation. No off site drainage
Proiects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from littp_//portal.ncdenr.org/web/wq/ws/su/blip-manual.
V1. 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 littp://portaWcdenr.org/web/wq/ws/su/statesw/forms_docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://portal.ncdenr.org/web/wq/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 littp://portii.ncdenr.org/web/wq/ws/su/statesw/foriiis docs.
� ' I'
V 1. Original and one copy of the Stormwater Management Permit Application Form.
0 f/4T Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
✓3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
V4, Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://www.envhelp.org/pages/onestopexpress.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.)
Y 5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
�6. A USGS map identifying the site location, If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations.'„P
8Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
,i a. Development/Project name.
r b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
✓/ f. Scale.
A// g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of.streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
/ • Delineate the vegetated buffer landward from the normal pool elevation of impounded
1/ structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
I. Site Layout with all BUA identified and dimensioned.
i/j k. Existing contours, proposed contours, spot elevations, finished floor elevations.
V % 1. Details of roads, drainage features, coilection.systems, and stormwater control measures.
�J m. Wetlands delineated, or a note on the-plansthat none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
/ o. Drainage areas delineated (included in the main set of plans, not as a separate document).
+ p. Vegetated buffers (where required).
Form SWU-101 Version 07Jun2010 Page 4 of 6

9:% Copy of any applicable soils report with the associated SHWT elevations (Please identify
levations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
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 far DWQ to verify the SHW'i prior
to submittal, [phone].)
�10. A copy of the most current property deed. Deed book: NA Page No: NA 066
r% 11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per NCAC 21-1.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http:/ / www.secretary;state.nc.us/ Corporations/ CSearch.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
httR:, /portal.ncdenr.orgLwe_b/wc1/ws/sustatesw/forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if yod'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:Daniel 1, DeYoung, P.E.
Consulting Firm: DIG, Inc.
Mailing Address:449 McLaws Circle
City: Williamsburg
Phone: (757 ] 253.0673
Email:[e-mail]
State: VA Zip:23185
Fax: (757 ] 253.2319
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, itent 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or hjpe name of person
listed in Contact Information, item Ia) with (print or type name of organization listed in
Contact Information, itent Ia) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the'
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version 07Jun2010 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults'on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a .valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date:
1, , a Notary Public for the State of , County of
do hereby certify that
before me this _ _ day of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION G. W. RADFORD
EnvironiTil"! ftal Affairs OF`-
-1, (print or type name of person fisted in Contact Information, item 1a) By direotion of the Commar-10109 Officer
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 stornjl vz ,ter�rulers,tynoq 15A NCAC 2H .1000, SL 2006-246 (Ph. 1I - Post Construction) or SL 2008-211.
Signature ( Date:
.%
I,n 4�114"
kil MK a Notary Public for the State of %� C- County of
Llc/�Ni do hereby certify that )aW-Av/d personally appeared
before me this day of � 01_/1, and ac owledg�e thedueexecution of the application for
a stormwater permit. Witness my hand and official seal, Ae, a,
_= NO-TAR"f
pvBLtiC
5-0
'RE1•
0/1111111/
SEAL
My commission expires
.V S- ao/s
Fonn SWU-101 Version 07Jun2010 Page 6 of 6