SW6140201_CURRENT PERMIT_20140304

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYM M DD

�r
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Tracy E. Davis, PE, CPM
Director
March 4, 2014
Mr. Clark Rowe, Project Manager
David E. Looper & Company
320 15th Street SE
Hickory, North Carolina 28602
Subject: Stormwater Permit No. SW6140201
FMC Anderson Creek Project
Dear Mr. Rowe:
Pat McCrory, Governor
John E. Skvarla, III, Secretary
MAR 6 2014
The Stormwater Program under the Division of Energy, Mineral, and Land Resources (DELMR),
received a complete Stormwater Management Permit Application for the subject project. 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. SW6140201, dated February 25, 2014, 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 March 3, 2022, and shall be subject to the conditions and
limitations as specified therein, and does not supersede any other agency permit that may be
required.
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 150B 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 Mail 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 Mike Randall at [phone]; or
[e-mail].
Sincerely.
for Tracy E.
Davis, PE, CPM, Director
cc: SW6140201 File, Fayetteville Regional Office
cc: Jim Chandler, Chandler Engineering, PA
Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://portal.ncdenr.org/web/Ir/
An Equal Opportunity 1 Affirmative Action Employer- 50% Recycled 110% Post Consumer Paper

State Stormwater Permit
Permit No. SW6140201
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
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 E. Looper & Company, Inc.
FMC Anderson Creek
HM Cagle Drive. Cameron NC, Harnett 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 State and considered a part of this permit.
This permit shall be effective from the date of issuance until March 3, 2022, 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. The infiltration basin is approved for the management of stormwater runoff as
described in the application documents and as shown on the approved plans.
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.
4. 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.
Page 1 of 4

State Stormwater Permit
Permit No. SW6140201
II. SCHEDULE OF COMPLIANCE
1. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
2. The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted infiltration basin 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 re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
3. 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.
4. The permittee shall submit an annual summary report of the maintenance and
inspection records for the infiltration basin. The report shall summarize the
inspection dates, results of the inspections, and the maintenance work
performed at each inspection.
5. The infiltration basin shall be constructed in accordance with the approved plans
and specifications, the conditions of this permit, and with other supporting data.
6. 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 infiltration basin 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.
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. 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 was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
Page 2 of 4

State Stormwater Permit
Permit No. SW6140201
A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of eight years from the date of the completion of
construction.
10. 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.
III. GENERAL CONDITIONS
This permit is not transferable 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 signed by both parties, to the
State, accompanied by the supporting documentation. 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 a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the State, in accordance with
North Carolina General Statute 143-215.6A to 143-215.6C.
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.
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 re -issuance or
termination does not stay any permit condition.
Unless specified elsewhere, permanent seeding requirements for the stormwater
control 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 21-1.1000, and NCGS 143-215.1 et.al.
Page 3 of 4

State Stormwater Permit
Permit No. SW6140201
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.
Permit issued this the 4'" day of March, 2014.
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

State Stormwater Permit
Permit No. SW6140201
FMC Anderson Creek
HM Cagle Drive. Cameron NC, Harnett 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 Name)
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.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
cc: NCDENR-DEMLR Regional Office
Page 1 of 1

Permit
(to be provided by DM)
®k� yO OFWATFg
STORMWATER MANAGEMENT PERMIT APPLICATION FORM o�
NCDENR 401 CERTIFICATION APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part III) must be printed, filled out and submitted along with all of the required information.
I. PROJECT INFORMATION
Project Name
FMC Anderson Creek
Contact Person
Jim Chandler, PE
Phone Number
919-3904227
Date
2/312014
Drainage Area Number
1
II. DESIGN INFORMATION
Site Characteristics
Drainage area
78,408.00
ft'
us
Imper
43,
ft'
rp�
Percent im rvious
Percent impervious
55.99
5.99
%
�iH BAR II',
Design rainfall depth
1.00
in
••••
.• 0........O •,
t' j
Peak Flow Calculations
••.
: ,•'Q-0 G.t ?9
1-yr, 24-hr rainfall depth
3.06
in
j Q SEA'
1-yr, 24-hr intensity
0.13
in/hr
N ;• 026466 •`
Pre -development 1-yr, 24-hr discharge
0.01
ft'/sec
,� •, '
Post -development 1-yr, 24-hr discharge
0.00
ft'/sec
:,l� •••.yG'NE�� •• ���`�
Pre/Post 1-yr, 24-hr peak flow control
-0.01
ft'/secq'•��`�
Storage Volume: Non -SA Waters -r41
Minimum design volume required 3,658.00 ft'
Design volume provided 7,725.00 ft' OK for non -SA waters
Storage Volume: SA Waters
1.5' runoff volume ft,
Pre -development 1-yr, 24-hr runoff volume ft'
Post -development 1-yr, 24-hr runoff volume
Minimum required volume ft'
i
Volume provided ft'
Soils Report Summary 1
Soil type Lakeland Sand
Infiltration rate 12.11 in/hr ✓ MAR 6 2014 .
SHWT elevation 327.00 fmsl
Basin Design Parameters
I
Drawdown time 0.24 days OK -'
Basin side slopes 3.00 :1 OK -
Basin bottom elevation 335.00 fmsl OK
Storage elevation 338.00 fmsl
Storage Surface Area 3,930.00 ft'
Top elevation 339.00 fmsl
Basin Bottom Dimensions
Basin length 160.00 ft
Basin width 8.00 ft Bottom Surface Area 1,270.00 ft DEFpp�ER—FRC.
MAR 6 6 2014
Owo
Fonn SW401-InfiaraWn Basin-Rev.5 11Ap2011 Pans I. & II. Design Summary, Page 1 of 2

Permit No.
(to be Provided by DWO)
Additional Information
Maximum runoff to each inlet to the basin?
1.80
ac-in
OK
Length of vegetative filter for overflow
NIA
It
OK
Distance to structure
120.00
ft
OK
Distance from surface waters
125.00
ft
OK
Distance from water supply well(s)
N/A
ft
OK
Separation from impervious soil layer
8.00
It
OK
Naturally occuring soil above shwt
8.00
ft
OK
Bottom covered with 4-in of clean sand?
Y
(Y or N)
OK
Proposed drainage easement provided?
Y
(Y or N)
OK
Capures all runoff at ultimate build -out?
Y
(Y or N)
OK
Bypass provided for larger storms?
Y
(Y or N)
OK
Pretreatment device provided
Catch Basins and Energy Dissipator
Form SW401-Infiltration Basin-Rev.5 11Ap2011 Parts I. & 11, Design Summary, Page 2 of 2

Permit
(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.
JC C3.01 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.
JC C7.03 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,
- Flow distribution detail for inflow,
- Vegetated filter, and
- Pretreatment device.
JC C7.03 3. Section view of the infiltration basin (1" = 20' or larger) showing:
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
JC C7.03 4. A table of elevations, areas, incremental volumes & accumulated volumes to verify the volume provided.
JC Calc Manual 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.
JC C7.03 6. A construction sequence that shows how the infillration basin will be protected from sediment until the
entire drainage area is stabilized.
JC Calc Manual 7. The supporting calculations.
JC Attached 8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
JC NIA 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

Permit Number:
(to be provided by DWQ)
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. MAR 6 2014
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 set 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 I 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 lime 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

t

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
prevent 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 grow 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-
outlet.
733-1786.
Form 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:FMC Anderson Creek
6MP drainage area number:
Print name: e"4 4- (=s P_ %�<aelC
Title: i�u�_ie�Iin.r/tI� 0%.4^at&ce_
Address:3035 NC 87 South, Cameron, NC
—Ga(. - S/6 9 6
Signature: �—
Date: 2 l«Lip/
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.
I, eI_/. )y) j -I'l, 'J) , Clams - tW V , a Notary Public for the State of
Np� (AA—Q, County of WdJAl-k� , do hereby certify that
W(_CC personally appeared before me this
c
day of _1tioWA6 awl , and acknowledge the due execution of the
forgoing infiltration basin, maintenance requirements. Witness my hand and official seal,
My commission expires \, d_ 7
Form SW401-Infiltration Basin O&M-Rev.3
Page 3 of 3

i I . 4
3

2gAdQll
DWQ USE ONLY
Date Received
Fee Paid
Permit Number
ScL5
W N6201
Applicable Rules:
(select all that apply)
❑ Coastal SW -1995 ❑ Coastal SW - 2008 O Ph Il - Post Construction
❑ 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 n v
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORMFEB
This form may be photocopied for use as an original pENR-W nwlll E?,
I. GENERAL INFORMATION
WM001 pN0 S1
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
FMC Anderson Creek
2. Location of Project (street address): vtoz 9 RN
City:Cameron County:NC IJAO' I Pam"_ Zip:28326
3. Directions to project (from nearest major intersection): "(I
Approximately 0.25 miles north along HM Cagle Drive from its intersection with NC Hwy 87 in Harnett
County. The site is behind the Cagle Furniture Store
v-
4. Latitude:35* 15' 50" N �J
II. PERMIT INFORMATION:
Longitude:79002' 34" W t of the main entrance to the project.
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-702 - Renewal Application Fonn
b.If this application is being submitted as the result of a modification to an existing perm t, 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 stonnwater 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):
❑LAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control:4.0 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
If yes, see S.L. 2012-200, Part VI: httl2,//12ortal.ncdenr.org/web/wg/ws/sulstatesw/`rules laws
Form SWU-101 Version 06Aug2012 Page 1 of

III. CONTACT INFORMATION
La. 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:David E. Looper & Company. Inc.
Signing Official & Title:Clark Rowe, Project Manager
b.Contact information for person listed in item la above:
Street Address:32015f Street SE
City:Hickory State:NC Zip:28602
Mailing Address (ff apphcable):PO Box 3224
City:Hickory State:NC Zip:28603
Phone: (828 ) 324-1284 Fax: [phone]
Email:[e-mail]
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:HM's Kids, Inc
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:3038 NC 87 South
City:Cameron State:NC Zip:28326
Mailing Address (if applicable):Same
City:
Phone: [phone]
Email:[e-mail]
State:
Fax: (910 ) 814-1615
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:Chandler Engineering. PA
Signing Official & Title:lim Chandler, PE - President
b. Contact information for person listed in item 3a above:
Mailing Address:309 S. Fuqua Avenue
City:Fuquay-Varina State:NC Zip:27526
Phone: [phone]
E mail:j im@chand lerengineerinypa.com
Fax: (919 ) 552-6962
4. Local jurisdiction for building permits: Harnett County
Point of Contact:Amanda Bader Phone #: [phone]
Form SWU-101 Version 06Aug2012 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, hrLefly summarize how the stormwater runoff will be treated.
Based on the in -situ soil type for the project site stormwater runoff will be treated by an infiltration basin
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 II —Post Construction
3. Stormwater runoff from this project drains to the Cape Fear River basin.
4. Total Property Area: 1.80 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*:1.80 acres
Total project urea shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streanns and rivers, the area below the Nonnal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BLIA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 56.1
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stornnvater BMP. For low 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.
Basin Information
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area
Receiving Stream Name
Reedys Swamp
Stream Class *
C
Stream Index Number.
18-23-29-2
Total Drainage Area (sf)
78408
On -site Drainage Area (sf)
78408
Off -site Drainage Area (sf)
0
Proposed Impervious Area** (sf)
43900
% Im ervious Area** (total)
56.1
Impervious— Surface Area
Draina a Area 1
Draina e Area _
Draina e Area _
Draina a Area _
On -site Buildings/Lots (sf)
7467
On -site Streets (sf)
27569
On -site Parking (so
4718
On -site Sidewalks (sf)
2783
Other on -site (so
1363
Future (so
0
Off -site (sf)
0
Existing BUA*** (sf)
0
Total (so:
43900
* Stream Class and Index Number can be determined at: http://portal.ncdmr.orgAwebheq/ps/csu/dnssi cations
** Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
*** Report only that annount 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 new BLIA.
Form SWU-101 Version 06Aug2012 Page 3 of

11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DI1'Q Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stornnvater requirements as per 15A A'CAC 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
fromhtW://12ortal.ncdenr.org/web/wq/­­w-,/­su/bml2-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 ht42://12ortal.ncdenr.org/web/wq/­ws/su/statesw/­`forms does. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office maybe
found by locating project on the interactive online map at htip://12ortal.ncdenr.org/web/wg/ws/su/mays.)
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 hthr//portal ncdenrorg/web/wq/ws/su/statesw/forms does.
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VIl below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M yu
agreement(s) for each BMP. Ur
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
htip://www.envheII2.org/12ages/­onestol2exl2ress.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/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USCS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within'h mile of the site boundary, include the'h
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
B. Two sets of plans folded to 6.5" 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.
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 line 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 in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
Farm SWU-101 Version 06Aug2012 Page 4 of

9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing UU
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 submittal, [phone].)
10. A copy of the most current property deed. Deed book: 2799 Page No: 362
11. 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 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.
http://www.secretary.state.nc.us/Corporations/CSearch.aspx
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
hU://12ortal.ncdenr.org/web/wq/ws/su/statesw/forms dots. 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:lim Chandler, PE
Consulting Firm: Chandler Engineering, PA
Mailing Address:309 S. Fuquay Avenue
City:Fuquay-Varina State:NC Zip:27526
Phone: (919 ) 390-4227 Fax: [phone]
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) HM's Kids Inc. . certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item 1a) Clark Rowe with (print or type name of organization listed in
Contact Information, item 1a) David E Looper & Co.. Inc. 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 stormwater 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.
Signature:/Da'/te:
I, ,) MN' f i'1 (f a Notary Public for the State of �ITkY 0 l ACL, County of
do hereby certify that in VQ personally appeared
before me this\L day of % ON _1 %�, d knowle ge the du cecutio of the ap lic lion for
a stormwater permit. Witness my hand and officials
a�„�NMIM„NM,h,h4,.
u Comm. ExP• g
11-23 2O'l r
rbOUWe
X. APPLICANTS CERTIFICATION
SEAL
My commission expires
I, (print or tijpe name of person listed in Contact Information, item 1a) Clark Rowe
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 covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 21-1.1000 and any other applicable state stormwater requirements.
Signature: I:: Date: February4,2014
I, Joyce A. Kessler , a Notary Public for the State of North Carolina County of
Catawba do hereby certify that Clark Rowe personally appeared
before me this 4thday of February 2014 , and acknowledge the due execution of he application for
a stormwater permit. Witness my hand and official seal, /�./G!
r �JOYCE A KES��L�i
NOTARY PUSUC
' CATAWBACOUN7Y
.STATE OF NORTH CAROL(NA
SEAL
My commission
August17,2018
Form SWU-101 Version 06Aug2012 Page 6 of

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