SW6211101_Application Form_20211130

DEMLR USE ONLY
Date Received Fee Paid Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph lI - 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 photocopiedfor use as an original
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.):
Mason Ridge Subdivision
2. Location of Project (street address):
Nursery Rd - SR 1120
City:SPrinz Lake Townshi :Anderson Creek County:Harnett Zip:28327
3. Directions to project (from nearest major intersection):
From Int of NC-27 E & Barbecue Church Rd go 2.5 miles of NC-27E turn rigilt on Does Rd for 3 miles
Turn Right on Nursga Rd and drive for ap noximatelly 1.5 miles. Site is on the right side.
4. Latitude:35° 16' 36.5" N Longitude:78' 39' 19.4" W of the main entrance to the project.
11. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-702 - 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):
®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 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,
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
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 27 ac of Disturbed Area
❑404/401 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:
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: ht rtal.ncdenr.Or web r rules -and -re lations
Form SWU-101 Version Oct. 31, 2013 Page I of 6

IV. PROJECT INFORMATION
1. In the space provided below, b, riefty summarize how the stormwater runoff will be treated.
This is a low ;itv Rr9ject. The soils are well drained loam sands. The runoff will be treated with
dispersed flow and gKass swales.
Two dry Ronds will be added for volume control.
2. a. If clamming 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.I€ claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph Il - Post Construction
River basin.
3. Stormwater runoff from this project drains to the Cape Fear
4. Total Property Area: 35 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: 1.49 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area,:33.31 acres
Total project area shall be calculated to exclude the followin the normal pool of i ounded structures, the area
between the banks of streams and rivers, the area below the ormaI High Water (N
line or Mean High Water
sd to
(MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant project are
Knee ma
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW y
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 23.86
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BA4P. For law 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.
lImpervious
formation Drainage Area 1 Drains a Area_ Draina a Area Drains a Area _
Stream Name McLeod Creek
Class * C
Index Number * 18-23-29-1
rainage Area (sf) 1,5241600
Drainage Area (sf) 1,524,600
Drainage Area (so
d Impervious Area** (s 348,300
rvious Area** total 23.86
TmnPrvious' Surface Area Drainage Area 1 Drainage Area Drains Area _ Draina a Area _
On -site Buildings/ Lots (st)
On -site Streets (so 92,300
On -site Parking (sf)
On -site Sidewalks (sf)
Other on -site (so 1,000
Future (sf)
Off -site (sf)
Existin BUA*** (sf)
Total (sf):
Stream Class and Index Number can be determined at: http, ortal.ncdenr.o�/web/wq[ps/csu/class cations
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6