SW5220101_Supplement-EZ Form_20220623

SUPPLEMENT-EZ COVER PAGE
FORMS LOADED
PROJECT INFORMATION
1 Project Name
Hardee's - Main Street
2 Project Area ac
2.07
3 Coastal Wetland Area ac
4 Surface Water Area ac
5
Is this project High or Low Density?
High
6
Does this project use an off -site SCM?
No
COMPLIANCE WITH 02H .1003(4)
7
Width of vegetated setbacks provided feet
N/A
8
Will the vegetated setback remain vegetated?
N/A
9
If BUA is proposed in the setback, does it meet NCAC 02H.1003 4 c-d ?
N/A
10
Is streambank stabilization proposed on this project?
No
NUMBER AND TYPE OF SCMs:
11
Infiltration System
12
Bioretention Cell
13
Wet Pond
14
Stormwater Wetland
1
15
Permeable Pavement
16
Sand Filter
17
Rainwater Harvesting RWH
18
Green Roof
19
Level Spreader -Filter Strip LS-FS
20
Disconnected Impervious Surface DIS
21
Treatment Swale
22
1 Dry Pond
23
StormFilter
Silva Cell
Bayfilter
Filterra
24
25
26
FORMS LOADED
DESIGNER CERTIFICATION
27 IName and Title:
29 IStreet address:
30 ICitv, State, Zip:
Davidl- Smith. PE
2905 Meridian Parkwa
Durham, NC, 27713
1 32 JEmail: I [e-mail] I
Certification Statement:
I certify, under penalty of law that this Supplement-EZ form and all supporting information were prepared under my direction or supervision; that the
information provided in the form is, to the best of my knowledge and belief, true, accurate, and complete; and that the engineering plans,
specifications, operation and maintenance agreements and other supporting information are consistent with the information provided here.
06/21 /22
Signature of Designer
Date