SW6130601_CURRENT PERMIT_20130621

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW (.Z/�lQ��
DOC TYPE
rURRENTPERMIT
PPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE�OIQ�
/
YYYYMMDD

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder
Governor Acting Director
June 21, 2013
Mr. David A. Heins, Environmental Division Chief
Directorate of Public Works
Fort Bragg
2175 Reilly Road Stop A
Fort Bragg, North Carolina 28310-5000
Subject: Stormwater Permit No. SW6130601
Lewis Street Repair and Widening Project, Fort Bragg
High Density Military Infiltration Basin Project
Cumberland County
OCT 2 9 K6
Dear Mr. Heins:
John V. Skvarla
Secretary
The Stormwater Permitting Unit received a complete Stormwater Management Permit
Application for the Lewis Street Repair and Widening Project on June 18, 2013. Staff review
of the plans and specifications has determined that the project, as proposed, will comply with the
Stormwater Regulations set forth in Title 15A NCAC 2H.1000 and Session Law 2006-246. We
are forwarding Permit No. SW6130601, dated June 21, 2013, for the construction, operation and
maintenance of the subject project and the stormwater BMPs.
This permit shall be effective from the date of issuance until June 21, 2021 and shall be subject
to the conditions and limitations as specified therein, and does not supersede any other agency
permit that may be required. Please pay special attention to the conditions listed in this permit
regarding the Operation and Maintenance of the BMP(s), recordation of deed restrictions,
procedures for changes of ownership, transferring the permit, and renewing the permit. Failure to
establish an adequate system for operation and maintenance of the stormwater management
system, to record deed restrictions, to follow the procedures for transfer of the permit, or to
renew the permit, will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing by filing a written petition with the Office of Administrative
Hearings (OAH). The written petition must conform to Chapter 150E of the North Carolina
General Statutes. Per NCGS 143-215(e) the petition must be filed with the OAH within thirty (30)
days of receipt of this permit. You should contact the OAH with all questions regarding the filing
fee (if a filing fee is required) and/or the details of the filing process at 6714 Mall Service Center,
Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at
www.NCOAH.com. Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the Fayetteville Regional Office. If you have any questions, or
need additional information concerning this matter, please contact Bill Diuguid at (919) 807-
6369; or [e-mail].
Wetlands and Stonwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: w .ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
Naturally"

Mr. David A. Heins, Environmental Division Chief, Directorate of public Works, Fort Bragg
S%6130601 — Lewis Street Repair and Widening Project, Fort Bragg, NC
June 21, 2013
Sincerely,
Original Signed by William H. Diuguid
William H. Diuguid, AICP, Stormwater Permitting
for Thomas A. Reeder, Director
Division of Water Quality
By Authority of the NC Environmental Management Commission
cc: SW6130601 File
ec: NC DENR DWQ Surface Water Protection, Fayetteville Regional Office
C. Heath Wadsworth, Call Sign Engineers, Fayettevillle, North Carolina
Lee Ward, Directorate of Public Works, Fort Bragg
Page 2 of 2

State Stormwater Permit
Permit No. SW6130601
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT -- MILITARY
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
David A. Heins, Environmental Division Chief
Directorate of Public Works, Fort Bragg
Lewis Street Repair and Widening to 3 Lanes
Lewis Street between Hurst Drive and DeGlopper Street, Fort Bragg
Cumberland County
FOR THE
construction, operation and maintenance of one infiltration basin in compliance with the
provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter referred to as
the "stormwater rules') and the approved stormwater management plans and
specifications and other supporting data as attached and on file with and approved by
the Division of Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until June 21, 2021, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.8 of this permit. The stormwater control has been
designed to handle the runoff from 32,980 square feet of impervious area.
3. The infiltration basin is designed, and must be maintained, to capture and
infiltrate 2.5x the 1.0" design storm in lieu of providing a vegetated filter strip and
bypass.
4. The tract will be limited to the amount of built -upon area indicated in Section 1.8
of this permit, and as shown on the approved plans.
5. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
Page 1 of 7

State Stormwater Permit
Permit No. SW6130601
6. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
The following design criteria have been permitted for the infiltration basin and
must be provided and maintained at design condition:
Infiltration Basin
Drainage Area
a.
Drainage Area, acres:
88,316
Onsite, ft :
59,268
Offsite, ftZ:
29,048
b.
Total Impervious Surfaces, ftZ:
32,980
Onsite, ft :
18,779
Offsite, ftZ:
14,201
C.
Design Storm, inches:
1.0
d.
Basin Depth, feet:
2.1
e.
Bottom Elevation, FMS�:
235.50
f.
Bottom Surface Area, ft :
4,950.00
g.
Bypass Weir Elevation, FMSy
237.60
h.
Permitted Storage Volume, ft :
14,150.00
i.
Predevelopment 1 year 24 hour:
8.90
j.
Post -development 1 year 24 hour:
8.40
k.
Type of Soil:
Wagram Series
I.
Expected Infiltration Rate, in/hr:
1.05
M.
Seasonal High Water Table, FMSL: 233.30
n.
Time to Draw Down, days :
2.0
o.
Receiving Stream/River Basin:
Tank Creek / Cape Fear
P.
Stream Index Number:
18-23-27
q.
Classification of Water Body:
"C"
II. SCHEDULE OF COMPLIANCE
The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must be followed in
its entirety and maintenance must occur at the scheduled intervals including, but
not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of bypass structure, infiltration media, flow
spreader, catch basins, piping and vegetated filter.
g. A clear access path to the bypass structure must be available at all times.
Page 2 of 7

State Stormwater Permit
Permit No. SW6130601
4. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
5. The permittee shall submit to the Division of Water Quality an annual summary
report of the maintenance and inspection records for each BMP. The report
shall summarize the inspection dates, results of the inspections, and the
maintenance work performed at each inspection.
6. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with other
supporting data.
7. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
8. Upon completion of construction, prior to issuance of a Certificate of
Occupancy, and prior to operation of this permitted facility, a certification must
be received from an appropriate designer for the system installed certifying that
the permitted facility has been installed in accordance with this permit, the
approved plans and specifications, and other supporting documentation. Any
deviations from the approved plans and specifications must be noted on the
Certification. A modification may be required for those deviations.
9. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
10. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
12. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
13. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
Page 3 of 7

State Stormwater Permit
Permit No. SW6130601
III. GENERAL CONDITIONS
1. This permit is not transferable to any person or entity except after notice to and
approval by the Director. In the event of a change of ownership, or a name
change, the permittee must submit a completed Name/Ownership Change form
to the Division of Water Quality, signed by both parties, and accompanied by the
appropriate documentation as listed on page 2 of the form. The approval of this
request will be considered on its merits and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
controls must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et. al.
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Page 4 of 7

State Stormwater Permit
Permit No. SW6130601
Permit issued this the 21st day of June, 2013.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Original Signed by William H. Diuguid
William H. Diuguid, AICP, Stormwater Permitting
for Thomas A. Reeder, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5 of 7

State Stormwater Permit
Permit No. SW6130601
Lewis Street Repair and Widening Project, Fort Bragg, North Carolina
Stormwater Permit No. SW6130403
Cumberland County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/ full
time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on following page is included in the Certification.
Noted deviations from approved plans and specification, if any:
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Permit
Permit No. SW6130601
Certification Requirements:
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The bypass structure weir elevation is per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. All required design depths are provided.
13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Surface Water Protection
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5043
Page 7 of 7

State Stormwater Permit
Permit No. SW6130601
Lewis Street Repair and Widening Project, Fort Bragg, North Carolina
Stormwater Permit No-&W6-13649e— ��N 1 9 2014
Cumberland County 5tv&(30roo(
Designer's Certification
I, C. Heath Wadsworth , as a duly registered Pr e in the
State of North Carolina, having been authorized to observes periodically/�eekly/ full
time) the construction of the project,
Lewis Street Repair and Widening_ Project Fort Bragg North Carolina
(Project)
for Directorate of Public Works - Water Management Branch (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on following page is included in the Certification.
Noted deviations from approved plans and specification, if any:
*Note: A small portion of the basin side -slopes are steeper than 3:1 (approximately 2.5:1), but
they have been stabilized with sod.
**Note: The basin footprint was slightly alternated in order to avoid utilities.
However, the basin still provides the required storage volume.
Signs
Regis
Date
JUN 1 9 2014 ` I
IY
Page 6 of 7

State Stormwater Permit
Permit No. SW6130601
Certification Requirements:
X
1.
The drainage area to the system contains approximately the permitted
acreage.
X
2.
The drainage area to the system contains no more than the permitted
amount of built -upon area.
*3.
All the built -upon area associated with the project is graded such that the
runoff drains to the system.
N/A
4.
All roof drains are located such that the runoff is directed into the system.
X
5.
The bypass structure weir elevation is per the approved plan.
X
6.
The bypass structure is located per the approved plans.
X
7.
A Trash Rack is provided on the bypass structure.
X
8.
All slopes are grassed with permanent vegetation.
X*
9.
Vegetated slopes are no steeper than 3:1.
X
10.
The inlets are located per the approved plans and do not cause short-
circuiting of the system.
X **11.
The permitted amounts of surface area and/or volume have been
provided.
X
12.
All required design depths are provided.
X
13.
All required parts of the system are provided.
X
14.
The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Surface Water Protection
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5043
Page 7 of 7

1
..r.. __ .'.. :.. DWQ USE ONLY
Date Received
Pee Paid
Permit Number
I'
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 M mt Plan:
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 original
I. GENERAL INFORMATION
1. Project Nance (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Repair Lewis Street and Widen Lewis Street to 3 Lanes
2. Location of Project (street address):
Lewis Street between Hurst Drive acid DeGlopper Street OCT 2 9 2013
City:Fort Bragg County:Cumberland Zip:28307
3. Directions to project (from nearest major intersection):
From the All -American Expressway exit north onto Reilly Road. Then take a left onto Butner Road.
Travel on Butner Road past McFayden Pond and take a right onto Lewis Street.
4. Latitude:35° 09' 15.87" N Longitude:79° 01' 05.10" W of the main entrance to the project.
IL PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRencvaals with modifications also requires SWU-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):
❑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 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
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 2.0 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 [1 V (pl
If yes, see S.L. 2012-200, Part Vl: htt ortal.ncdenr.or web w ws su state w �Jaws I
JUN 1 8 2013
Forn] SWU-101 Version 06Aug2012 Page I of 6
s
l

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:Directorate of Public Works (DPW) Water Management Branch
Signing Official & Title:Mr. David Heins, Environmental Division Chief (DPW)
b.Contact information for person listed in item 1a above:
Street Address:2175 Reilly Road Stop A
City:Fort Bragg State:NC Zip:28310-5000
Mailing Address (if applicable):2175 Reilly Road Stop A
City:Fort Bragg State:NC Zip:28310-5000
Phone: (910 ) 396-8207 Fax: (910 ) 907-2420
Ent ail:david.a.heins.civOO mail. miI
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:
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) 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:Mr. Lee Ward
Signing Official & Title:DPW / Water Management Branch
b.Contact information for person listed in item 3a above:
Mailing Address:Bldg 0-9125, McKellars Road
City:Fort Bragg - State:NC Zip:28310-5000
Phone: (910 ) 396-2301
Email:lee.p.ward.civQmail.mil
4. Local jurisdiction for building permits:
Fax: (910 ) 907-2420
.Point of Contact: Phone #:
Form SWU-101 Version 06Aug2012 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Storm vater will be collected and routed through an infiltration basin consisting of a rip -rap forebay
and a sod filter strip. Prior to entering the forebay, the inflow travels through a 200 LF grass Swale
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 this project drains to the Cape Fear River basin.
4. Total Property Area: 4.84 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':
4.84 acres
Total project area shall be calculated to exclude the fallozoing: the normal pool of impounded structures, fire area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Mean High Water
WHIN) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line pray
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 60 %
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stornnoater BMP. For low density 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
Draina e Area 1
Draina e Area _
Draina e Area _
Draina e Area _
Receiving Stream Name
Tank Creek
Stream Class *
C
Stream Index Number *
18-23-27
Total Drainage Area (sf)
88,316
On -site Drainage Area (sf)
59,268
Off -site Drainage Area (sf)
29,048
Proposed Impervious Area** (sf)
32,980
Im ervious Area** (total)
37%,
Impervious— Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (sf)
0
On -site Streets (sf)
3,883
On -site Parking (sf)
0
On -site Sidewalks (sf)
0
Other on -site (sf)
0
Future (sf)
0
Off -site (sf)
14,201
Existing BUA*** (sf)
14,896
Total (sf):
32,980
Stream Class and lndex Number can be determined at: httV.4ortal.nedenr.org/zaeb/zurl/ps/csu/classifications
Inr pervious area is defined as the built upon area including, but rwt limited to, buildings, roads, parking areas,
sidewalks, gravel areas, ctc.
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 nezv BUA.
Form SWU-101 Version 06Au,-2012 Page 3 of 6

*** Report only that onount of existing BUA that Will remain after development. Do not report any existing BUA that
is to be reproved mid Which Will be replaced by tie it, BUA.
11. I-Iow was the off -site impervious area listed above determined? Provide documentation. The off -site imp.
area was determined using a combination of aerial photographs, field survey, and reconnaissance
Praiects in Union Countv: Contact DfvQ Central Of stafflo check if die project is localed within a Vireatened &
Endangered Species watershed that may be subject to more stringent storpnvater 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 littp://Liot-tal.iicdenr.org/web/­wq/­ws/su/bjilp-niantial.
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://12ortal.nc(ienr.org/web/wq/ws/su/statesw/forms does. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://portal.ncdenr.org/web/wq/ws/su/ma ids.)
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://portal.ncdennorg/web/wy/ws/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. z2 V
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants "Ifi
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M z1al-
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to z hme
http://www.envlielp.org/pages/onestopexpress.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 _-Z1W
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy). ', bw
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.
I. Scale.
g. Revision number and dates.
It. 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 NNW line of tidal
waters, and any coastal wetlands landward of the MFIW or NI-1W lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MI-IW (or NI-IW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all 13UA 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).
Form SWU-101 Version 06Aug2012 Page 4 of 6

Copy of any applicable soils report with the associated SHWT elevations (Please identify Z')<
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 13MPs, 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 SHWA prior
tosit brnittnl, [phone].) ,CIA
NIA
A copy of the most current property deed. Deed book: Page No:
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 la, 2a, and/or 3a per 15A NCAC 2I-1.1003(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..StatC.[IC.LIS/Corporatioiis/CSearcli.aspx
VIL 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
13UA 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 N
http://portal.ncdennorg/web/wq/ws/su/statesw/forms does. 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 may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:C. Heath Wadsworth, PE
Consulting Firm: Call Sign Engineers, PA
Mailing Address:104 Gillespie Street
City: FayetteviIle State:NC Zip:28301
Phone: (919 ) 622-4568
Email:heath.wadswo rthQcallsignengineers.com
Fax: (919 ) 622-4568
IX. PROPERTY OWNER AUTHORIZATION (if Con tact Information, item 2 has been filled out, complete this
section)
I, (print or type nnrne of person listed in Contact Information, item 2n) certify that I
own the property identified in this permit application, and thus give permission to (print or type nnrne of person
listed in Contact Information, item 1n) with (print or type name of organization listed in
Contact Information, item 1a) 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 storawater system.
Form SWU-101 Version 06Aug2012 Page 5 of 6

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 permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ 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.
Signatu
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
X. APPLICANT'S CERTIFICATION
I, (print or type nnme of person listed in Contact Information, item 1 a) Mr. David Heins
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 covena will beorecorded, and that the proposed project complies with the requirements of the
applicable stormwaV-�
I/�eJj(u//n/��(er(15A NCAC 21-I.1000 and any other applicable state stormwater requirements.
Signature:%�--IX�/'�r Date. ��U/✓��
do hereby certify
before me this _ day of
a Notary Public for the State of , County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
Form SWU-101 Version 06Aug2012
Page 6 of 6

Permit Number:
(to be provided by OWQ)
Drainage Area Number:
Infiltration Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
Important maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the
infiltration basin.
— Immediately after the infiltration basin is established, the vegetation will be
watered twice weekly if needed until the plants become established (commonly
six weeks).
— No portion of the infiltration basin will be fertilized after the initial fertilization
that is required to establish the vegetation.
— The vegetation in and around the basin will be maintained at a height of
approximately six inches. OCT 2 9 2013
After the infiltration basin is established, it will be inspected once a quarter and within ,
24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of operation and maintenance will be kept in a known sef location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblem:
How 1 will remediate theproblem:
The entire BMP
Trash debris is present.
Remove the trash debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
infiltration basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide time and a
one-time fertilizer application.
The inlet device: pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Form SW401-Infiltration Basin O&M-Rev.3
Page 1 of 3

BMP element:
Potentialproblem:
How I will remediate theproblem:
The forebay
Sediment has accumulated
Search for the source of the
and reduced the depth to 75%
sediment and remedy the problem if
of the original design depth.
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Erosion has occurred or
Provide additional erosion
riprap is displaced.
protection such as reinforced turf
matting or riprap if needed to
revent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticides are used, wipe
them on the plants rather than
spraying.
The main treatment area
A visible layer of sediment
Search for the source of the
has accumulated.
sediment and remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP. Replace any media that
was removed in the process.
Revegetate disturbed areas
immediately.
Water is standing more than
Replace the top few inches of filter
5 days after a storm event.
media and see if this corrects the
standing water problem. If so,
revegetate immediately. If not,
consult an appropriate professional
for a more extensive repair.
Weeds and noxious plants are
Remove the plants by hand or by
growing in the main
wiping them with pesticide (do not
treatment area.
spray).
The embankment
Shrubs or trees have started
Remove shrubs or trees
to *row on the embankment.
immediately.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair.
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
ou tlet.
733-1786.
Porn SW401-Infiltration Basin O&M-Rev.3
Page 2 of 3

Permit Number:
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:Repair Lewis Street and Widen Lewis Street to 3 Lanes
BMP drainage area number:Post (Into Basin)
Print name:Mr. David Heins
Title: Environmental Division Chief (DPW)
Address:2175 Reilly Road Stop A
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
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
forgoing infiltration basin maintenance requirements. Witness my hand and. official seal,
SEAL
My commission expires
Form SW401-Infiltration Basin O&M-Rev.3
Page 3 of 3

Permit No.
(to be provided by DWQ)
III. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Page/ Plan
Initials Sheet No.
1.
Plans (1"- 50' or larger) of the entire site showing:
Design at ultimate build -out,
Off -site drainage (if applicable),
Delineated drainage basins (include Rational C coefficient per basin),
Basin dimensions,
Pretreatment system,
High flow bypass system,
Maintenance access,
Proposed drainage easement and public right of way (ROW),
Overflow device, and
Boundaries of drainage easement.
L441J 51�- 43 Q 2. Partial plan (1" = 30' or larger) and details for the infiltration basin showing:
Bypass structure,
Maintenance access,
Basin bottom dimensions,
Basin cross-section with benchmark for sediment cleanout, OCT 2 9
Flow distribution detail for inflow,
Vegetated filter, and
Pretreatment device.
SYiT 03P 3. Section view of the infiltration basin (1"= 20' or larger) showing:
- Pretreatment and treatment areas, and
PaND?ACK - Inlet and outlet structures.
UJ3J o°TP 4. A table of elevations, areas, incremental volumes & accumulated volumes to verify the volume provided.
(3to aG S5�
5. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified in the field by DWO, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
.Zht 1 4— 3 6. A construction sequence that shows how the infitlration basin will be protected from sediment until the
entire drainage area is stabilized.
7. The supporting calculations.
"Via /NS l DE 8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
N✓ � 9. A copy of the deed restrictions (if required).
Form SW401-Infiltration Basin-Rev.4 Page 1 of 1 Part III. Required items Checklist, Page 1 of 1