SW6210702_Walters Meadow_20210803 (2)

DWQ 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: 11
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an m iginal
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Walters Meadow
2. Location of Project (street address):
North Horace Walters Road
City:Raeford County:Hoke Zip:28376
3. Directions to project (from nearest major intersection):
The project is located approximately 2,411 ft. from the intersection of North Horace Walters Road and
Montrose Road going south towards Neill Sinclair Road along North Horace Walters Road.
4. Latitude:35° 00' 36.86" N Longitude:79° 21' 31.46" W of the main entrance to the project.
U. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificadont
tRenewals with ►nodifieations also requires SWU-102 - Renewal Application Forrn
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed" [:]Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density NHigh Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major NSedimentation/Erosion Control: 9.28 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Peru -Lit: Proposed Impacts
b.1f 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? NNo ❑Yes
If yes, see S.L. 2012-200, Part VI: http://portil.iicdenr.org/weblivq/­Nvs/su/statesw/i-ules laws
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III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated goverunent official, individual, etc. who owns the project):
Applicant/Organi7.ation:Walters Meadow, LLC
Signing Official & Title:Ralph Huff-ManaMig Partner
b.Contact information for person listed in item 1a above:
Street Address:2919 Breezewood Avenue, Suite 100
City: Fayetteville State:NC Zip:28301
Mailing Address (if applicable):
City: State:
Phone: (910 ) 302-3608 1 ax:
Email:DRhufftsnh ufffamilyoffice.com
Zip:
Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee" (Attach a copy of Llw lease agreement and complete Contact Inforinialion, item 11 and 2b below)
® Purchaser" (Attach a copy of the pending sales agreement and completr 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/Orgw-tization:Lynzandra McFadgion Gray Leroy Baldwin Smith
Signing Official & Title:Owners (Lvnr_andra McFadf;ion Gray is the S a20dal Power of Attorney for Leroy
Baldwin Smith
b.Contacl information for person listed in itenn 2a above:
Street Address:2498 N. Horace Walters Road
City:Raeford State:NC Zip:28376
Mailing Address (if applicable):
City: State: Zip:
Phone:
Email:
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:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
Email:
Slate:
Fax: ( )
Zip:
4. Local jurisdiction for building permits: Hoke County Plann.in /Zonin}�
Point of Contact:Robert Farrell Phone #: (910 ) 875-8407
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IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the storm water runoff will be treated.
Stormwater runoff from the developed areas of the site will he captured and treated in lwo infiltration basins
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 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 11- Post Construction
3. Stormwater runoff from llnis project drains to the Lumber River basil.
4. Total Property Area: 44.756 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+: 0 acres
+ Total project area shall be calculated to exclude lire following: the normal pool of impounded structures, the area
between the banks of sh•cams and rivers, the area below the Normal High Water (NH1lv) line or Mean High Water
(MH1N) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calculate over-all percent built upon area (BLIA). Non -coastal zt)etlands landztpar•d of the NH IV (or• MHIN) line stay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 20.42 %
9. How many drainage areas does the project have?3 (For high density, count I for each proposed engineered
stortnzoater 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 1
Drama a Area 2
Drainage Area _
Drainage Area _
Receiving Stream Name
Buffalo Creek
Buffalo Creek
Stream Class *
C
C
Stream Index Number `
14-2.5
14-2.5
Total Drainage Area (sf)
1,121,013
332,382
On -site Drainage Area (sf)
1,106,384
332,382
Off -site Drainage Area (sf)
14,629
Proposed Impervious Area* (sf)
320,712
92,075
% Impervious Area** (total)
28.61
27.70
Impervious— Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area _
Drainage Area _
On -site Buildings/ Lots (sf)
200,000
68,000
On -site Streets (sf)
90,490
20,420
On -site Parkin (so
On -site Sidewalks (sf)
15,593
3,655
Other on -site (sf)
Future (sf)
Off -site (so
14,629
Existing BUA'' (so
Total (sf):
320,712
1 92,075
* Stream Class and Index Number can be determined at: htth://portal.ncden?-.org/roeb/rtUtd s/csu/classifrcations
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
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'Report only that amount of existing B UA that will remain after- development. Do not report any existing BLIA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above deteniuned? Provide documentation. Contours from
survey file Drainage area shown in calculations.
Proiects in Union County: Contact DT+Q Central Office staffto check ifthe project is located x,ithin a Threatened do
Endangered Species m,atershed that may be subject to more stringent storniu,ater requirements as per 15A 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 hltp://nortaLncdenr.org/wc!b/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from http://nortal.nedenr.org/web/wq/ws/su/staL(!sw/forms_ does. The complete
application package should be submitted to the appropriate DWQ Office. (True appropriate office may be
found by locating project on the interactive online map at ]iLLL)://I-)orLil.ncdeiir.orp,/web/­wq/ws/su/nial2
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://tnorLaLnc denr.orl;/web/wq/ws/su/sLaLesw/forins does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. DTv
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants bl-u
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Fornn(s) (sealed, siaied 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
hltp://www.envhelp.orp/manes/onesLol►c-xi2ress.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
6. A USGS neap identifying the site location. if the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within'/z mile 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 mule.
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 Tune 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 i1 the main set of plans, not as a separate document).
Form SWU-101 Version 06Aug2012 Page 4 of 6
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p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify 0 ro
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verifij the SHWT prior
to srbmittal, [phone].)
10. A copy of the most current property deed. Deed book: 504 Page No: 406 A T�
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC r�
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
lnttp: // wna,%v.secreLarv.s[a Le.nc.us/Corporations/CSearc li.asl2x
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/wq/ws/su/statesw/forms_docs. Download the latest versions for each
submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ, and that they will be recorded prior to the sale of any lot.
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 clay provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting CninneenCarlo Pardo PE
Consulting Firm: Triangle Site Design PLLC
Mailing Address:4004 Barrett Drive Suite 101
City:Raleigh State:NC Zip:27609
Phone: (919 ) 553-6570 Fax:
Ein aiL•cpardoc(t)lrianglesi tedesign.ronn
A. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled or(t, complete this
section) L) n za r,d ea mc" Cvx G M--) ti'
I, (print or hjpe name of person listed in Contact Information, item 2a) 1- - 3CMW)n Sr►,A4. , 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 1a) Ralph Huff with (print or hjpe name of organization listed in
Contact Information, item 1a) Walters Meadow, LLC 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 stormnwater system.
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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 pernut reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ i niumediately 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 o civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: �- Date:��'
I, J " 11 t� Py a Notary Public for the State of County of
Cu.►'l�c be+4 CIYt d do hereby certify that f y ei Z a.eioVQ M c 1=ce plca ,'oit &YOta/ personally appeared
before me this P�7 day of 1-kl y a 06 l , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
RIC a
r1OTAR y s
MY
COMMISSION EXPIRES
Q,A1D GOv a•`
''1nitnllnnccaa�
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires G - 3 -d o ca-'
I, (print or type tiame of person listed in CoWact lnformaliort, item I", Pa! III r
certify that the information included on this permit application form i lhv hest m nc ledge, correct and
that LI)e project will be constructed in conformance with the approved plans, tha the required deed resh•ictions
and protective covenants will be recorded, and that the proposed project complic • with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1(XX) and any other applicable NkaLv stormwater requirements.
Signature:
1, So U fV a Notary Public for the State of kb County of
rU-Vh b&ta.VlC'( , do hereby certify that . J. a(r,L-1 fkc4-:FF At person34 appeared
before me this day of 7yt Ly d Cot and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
IAOTA R �,
MY
COMMISSION EXPIRES
�C. BUG
SEAL
My conwussion expires
3-Dda�-
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