SW3200601_02A_SpeedwaySubstation_StormwaterManagementPermitApplication_Howell_SIGNED_20200720

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
Project Name (subdivision, facility, or establishment name - should be consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
Speedway Substation
2. Location of Project (street address):
2410 Wallace Road
City:Midland, NC County:Cabarrus
3. Directions to project (from nearest major intersection):
1 mile West of the intersection of Wallace Road and US-601.
Zip:28107
4. Latitude:35° 13' 18.65" N Longitude:80° 31' 48.86" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): NNew ❑
Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWLI-102 - Renewal Application Form
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):
N Low Density ❑ High Density ❑ Drains to an Offsite Stormwater System ❑ Other
4
If this application is being submitted as the result of a previously returned application or a letter from
DEMLR 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,
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 NSedimentation/ Erosion Control: 10 ac of Disturbed Area
❑ NPDES Industrial Stormwater ❑ 404/401 Permit: Proposed Impacts
Form SWU-101 Version Oct. 31, 2013 Page 1 of 6

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 ❑Yes
If yes, see S.L 2012-200, Part VI.- http://Portal.ncdenr.org/web/Ir/rules-and-regulations
III. CONTACT INFORMATION
1. a.Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:Swinerton Builders
Signing Official & Title Jennifer Kirby, ToR, OSD / OSP, CPESC, LEED AP
b. Contact information for person listed in item 1a above:
Street Address:16798 West Bernardo Drive
City:San Diego State:CA Zip:92127
Mailing Address (if applicable):16798 West Bernardo Drive
City:San Diego
Phone: (858 ) 357-5006
Email:[e-mail]
State:CA
Fax: ( )
Zip:92127
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: Ira B. Howell, Jr.
Signing Official & Title: Property Owner
b. Contact information for person listed in item 2a above:
Street Address:2410 Wallace Road
City:Midland State:NC Zip:28107
Mailing Address (if applicable):14158 Elm Street
City:Stanfield
Phone: (704 ) 622-6129
Email:
State:NC
Fax: ( )
Zip:28163
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:Swinerton Builders
Signing Official & Title:Brian Hoopes, Senior Project Manager
b. Contact information for person listed in item 3a above:
Form SWU-101 Version Oct. 31, 2013 Page 2 of 8

Mailing Address:15 Business Park Way, Suite 101
City:Sacramento State:CA Zip:95828
Phone: (916 ) 754-4281 Fax: ( )
Email:
4. Local jurisdiction for building permits: Cabarrus County
Point of Contact:Todd Culp Phone #: (704 ) 920-2128
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Existingdrainage rainage patterns will been maintained. Stormwater will ultimately drain into the existing_
jurisdictional drainage features.
2. a. If claiming vested rights, identify the supporting documents
provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD
❑ Valid Building Permit
❑ Other:
Approval Date:
Issued Date:
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 Yadkin - Pee Dee River basin.
4. Total Property Area:10 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+:10 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NW line or Mean High
Water (MHM line, and coastal wetlands landward from the NHW (or MHKq line. The resultant project area is
used to calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHiq
line may be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 13.7 %
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If
there are more than four drainage areas in the project, attach an additional sheet with the information for
each area provided in the same format as below.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 8

Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area
Drainage Area
Receiving Stream Name
Clear Creek
Muddy Creek
Stream Class *
C
C
Stream Index Number *
13-17-17
13-17-16
Total Drainage Area (so
5.96
3.67
On -site Drainage Area (so
5.96
3.67
Off -site Drainage Area (sf)
0
0
Proposed Impervious Area**
(sf)
1.02
0.33
% Impervious Area** (total)
17.11
9.24
Impervious— Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area
Drainage Area
On -site Buildings/Lots (sf)
0
0
On -site Streets (sf)
0
0
On -site Parkin (sf)
0
0
On -site Sidewalks (sf)
0
0
Other on -site (so
0
0
Future (sf)
44,431
14,375
Off -site (so
0
0
Existing BUA*** (sf)
0
0
Total (sf):
44,431
14,375
* Stream Class and Index Number can be determined at: http.aortal.ncdenr.or /wg eb/wcl(ps/csu/classifications
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
'Report only that amount of existing BUA that will remain after development. Do not report any existing BUA
that is to be removed and which will 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 DEMLRCentral Officestaff tocheck iftheprojectislocated within
Threatened & Endangered Species watershed thatmay be subject to more stringent storm water requirements asper
15A NC4CO2B .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 fromhttp://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 Energy, Mineral
and Land Resources (DEMLR). 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/ws/su/statesw/forms_docs. The complete application package
should be submitted to the appropriate DEMLR 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
httn://nortal.ncdenr.orLy/web/wo/ws/su/statesw/forms docs.
Initials
Form SWU-101 Version Oct. 31, 2013 Page 4 of 8

1. Original and one copy of the Stormwater Management Permit Application Form.
2. 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.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to _
http://www.envhelp.org/pages/onestol2ex2ress.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.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for _
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 1/2mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the 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.
1. 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"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 for DEMLR to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 0303 Page No: 0036
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 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.secretary.state.nc.us/Corporations/CSearch.aspx
Form SWU-101 Version Oct. 31, 2013 Page 5 of 8

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.ncdenr.org/web/lr/state-stormwater-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 DEMLR, and that they will be recorded prior to the sale of any
lot.
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:Della Shaw, P.E.
Consulting Firm: Kinley-Horn and Associates, Inc.
Mailing Address:421 Fayetteville Street, Suite 600
City:Raleigh State:NC Zip:27601
Phone: (919 ) 678-4071 Fax: (919 ) 677-2051
Email:[e-mail]
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) Ira B. Howell Jr. , 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) Jennifer Kirby with (print or
type name of organization listed in Contact Information, item 1a) Swinerton Builders 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 Oct. 31, 2013 Page 6 of 8

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 DEMLR stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR 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: V'�r_ 'rt /SAX, � Date: s (C� �d'� i�
I, 7 �V � V l /1 � , a Notary Public for the State of J�Ot2T}} CARoGI /I A' ,County of
10/\ , do hereby certify that �iQ}} �, %f°W �(-L TIC personally appeared
before me this � day of {� �'li ZUZU and ackno�wledg a dtle execution of the application for
a stormwater permit. Witness my hand and official seal, �/�
PAUL QUINN
NOTARY PUBLIC
UNION COUNTY
North Carolina
M1Y Commission Expires JULY 2t, 2024
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires J V V� Z �' z 02'-j
I, (print or hjpe name of person listed in Contact Infarmation, item 1a)
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
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
Form SWU-]O] Version Oct. 31, 2013 Page 6 of6