SW3070901_Permit Application_20070927

OFFICE USE ONLY
State of North Carolina
S E P 2 1 2007
Department of Environment and Natural Resources
Division of Water Quality rr�� NC DENR MRO
STORMWATER MANAGEMENT PERMIT APPLICATI(�pp��''�� 1' FUmfoce Water Pr®fect(ar
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
t..i r
V�'S-1. L._C, At -i , , . \A 07-.t r.
3. Mailing Address for person listed in item 2 above:
c 00 L..<F_1
City: ( N�2��ii" _ State: t- C.. Zip: `r,2
Telephone Number: ( .? i, ) �1 b LJ
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
R
5. Location of Project (street address): '
n i9,
City: tiVAk H County: �;�i-r•r, =>
6. Directions to project (from nearest major intersection):
N L1L� _ Co,r� L 6.7
7. Latitude: 3 y 1 Longitude: 6 O of project
8. Contact person who can answer questions about the project:
Name: `. , . t Telephone Number: ( 7C;
II. PERMIT INFORMATION:
1. Specify whether project is (check one): % _New Renewal Modification
Form SWU-101 Version 3.99 Page 1 of 4
State of North Carolina
S E P 2 1 2007
Department of Environment and Natural Resources
Division of Water Quality rr�� NC DENR MRO
STORMWATER MANAGEMENT PERMIT APPLICATI(�pp��''�� 1' FUmfoce Water Pr®fect(ar
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
t..i r
V�'S-1. L._C, At -i , , . \A 07-.t r.
3. Mailing Address for person listed in item 2 above:
c 00 L..<F_1
City: ( N�2��ii" _ State: t- C.. Zip: `r,2
Telephone Number: ( .? i, ) �1 b LJ
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
R
5. Location of Project (street address): '
n i9,
City: tiVAk H County: �;�i-r•r, =>
6. Directions to project (from nearest major intersection):
N L1L� _ Co,r� L 6.7
7. Latitude: 3 y 1 Longitude: 6 O of project
8. Contact person who can answer questions about the project:
Name: `. , . t Telephone Number: ( 7C;
II. PERMIT INFORMATION:
1. Specify whether project is (check one): % _New Renewal Modification
Form SWU-101 Version 3.99 Page 1 of 4

2. If this application is being submitted as the result of a renewal or modification to an existing permit list the
existing permit number N / —A and its issue date (if known) iN / A
3. Specify the type of project (check one):
XLow Density High Density Redevelop General Permit Other
4. Additional Project Requirements (check applicable blanks):
_CAMA Major Y Sedimentation/Erosion 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.
IIl. 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.
_ U
'1 ti
2. Stormwater runoff from this project drains to the River basin.
3. Total Project Area: 1'i iti . acres 4. Project Built Upon Area:
5. How many drainage areas does the project have?
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
VJ i>t..•
Receiving Stream Class
Drainage Area
S r
Existing Impervious* Area
( 3 2-( 5
Proposed Impervious*Area
. Q. 3 "7 �
C -2 f t�
% Impervious* Area (total)
Z '
Z 3 , 9 c�
Impervious* Surface Area
Drainage Area 1
Drainage Area 2
On -site Buildings ( D ,,
< 0c) t n;
L 2On-site
Streets
- 91 4 v «;
(0 q-
On-site Parking
N / A
On -site Sidewalks
Other on -site
Off -site
zi a i
Total:
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Fonn SWU-101 Version 3.99 Page 2 of 4

7. How was the off -site impervious area listed above derived? rl? v �.
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 0, -SOO 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 as ta te 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 General 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
Fonn SWU-101 Version 3.99 Page 3 of 4

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.
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• Original and one copy of the Stormwater Management Permit Application FormL'`
• 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): PI/ P-RNIA-1
Mailing Address:
City: State: Zip: ' 2..-
Phone: ( -40L] gq.5 J Fax: ( )
VIII. APPLICANT'S CERTIFICATION
/c c
I, (print or type name of person listed in General Information, item 2) Al,
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be nstruc ed in conformance with the approved plans, that the required deed restrictions
and protective covena is will e recorded, and that the proposed project complies with the requirements of 15A
NCAC 2H .1000.
Signature: --
Form SWU-101 Version 3.99 Page 4 of
Date:

Permit No.
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
LOW DENSITY SUPPLEMENT
This form inay be photocopied for use as an original
A low density project is one that meets the appropriate criteria for built upon area and transports stormwater
runoff primarily through vegetated conveyances. Low density projects should not have a discrete stormwater
collection system as defined by 15A NCAC 2H .1002(18). Low density requirements and density factors can be
found in 15A NCAC 2H .1005 through .1007.
I. PROJECT INFORMATION
Project Name: ` . r;,- :�.r F 6 C _ , .5 = Y::
Contact Person: rZ t? t N�C"t. , ry `4<. Phone Number: (,-oq ) rLz:l-
M }c
Number of Lots: L 8 Allowable Built Upon Area Per Lot*:
*If lot sizes are not uniform, attach a table indicating the number of lots, lot sizes and allowable built upon area
for each lot. The attachment must include the project name, phase, page numbers and provide area subtotals
and totals.
II. BUILT UPON AREA
See the Stormwater Management Permit Application for specific language that must be recorded in the deed
restrictions for all subdivisions.
For uniform lot sizes, complete the following calculation in the space provided below where:
• SA Site Area - the total project area above Mean High Water. Wetlands may be excluded when the
development results in high density pockets.
• DF Density Factor - the appropriate percent built upon area divided by 100.
• RA Road Area - the total impervious surface occupied by roadways.
• OA Other Area - the total area of impervious surfaces such as clubhouses, tennis courts, sidewalks, etc.
• No. Lots - the total number of lots in the subdivision.
• BUA/Lot - the computed allowable built upon area for each lot including driveways and impervious
surfaces located between the front lot line and the edge of pavement.
Fonn SW-U-104 Rev 3.99 Page 1 of 2

(SA x DF) - RA - OA = BUA
No. Lots Lot
Calculation:
III. REQUIRED ITEMS CHECKLIST
z6 Z-.�!
('
Initial in the space provided to indicate that the following requirements have been met and supporting
documentation is provided as necessary. If the applicant has designated an agent on the Stormwater
Management Permit Application Form, the agent may initial below.
Applicants Initials
Cy-\ a. A 30 foot vegetative buffer is provided adjacent to surface waters. Projects in the Neuse
River basin may require additional buffers.
b. Deed restriction language as required on form SWU-101 shall be recorded as a restrictive
covenant. A copy of the recorded document shall be provided to DWQ within 30 days of
platting and prior to sale of any lots.
c. Built upon area calculations are provided for the overall project and all lots.
d. Project conforms to low density requirements within the ORW AEC (if applicable).
[15A NCAC 2H .1007(2)(b)]
Form SWU-104 Rev 3.99 Page 2 of 2