SW6221006_Application Form_20230531

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff from an existing unpervious area will be conveyed through two (2) Filterra treatment
units to an existing pipe network to an existing wet pond. Treating the existing impervious area will offset the
requirement of treating the new proposed impervious area.
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: 13.7 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+:13.7 acres
+ Total project area shall be calculated to exclude the following: the normal pool of im ounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NM line or Mean High Water
(MHM line, and coastal wetlands landward from the NHW (or MHM line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (orMHV) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 55
9. How many drainage areas does the project have?2 (For high density, count 1 for each proposed engineered
stormwater 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 2
Drainage Area _
Drainage Area _
Receiving Stream Name
Rockfish Creek
Rockfish Creek
Stream Class *
C
C
Stream Index Number *
18-31-(23)
18-31-(23)
Total Drainage Area (sf)
22651
22651
On -site Drainage Area (so
22651
22651
Off -site Drainage Area (sf)
0
0
Proposed Impervious Area** s
0
0
% Impervious Area** total
94
194
impervious" Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area _
Drainage Area _
On -site Buildings/Lots (sf)
0
0
On -site Streets (sf)
0
0
On -site Parking (sf)
0
0
On -site Sidewalks (sf)
0
0
Other on -site (sf)
0
0
Future (sf)
0
0
Off -site (sf)
0
0
Existing BUA*** (sf)
21344
1 21344
Total (sf):
21344
1 21344
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wqZps/csu/classi cations
Form SWU-101 Version Oct. 31, 2013 Page 3 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 DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR 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: Date:
I, , 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 expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 1a) Melanie Sabella
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 stor ter rules 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Signature: 1 Dater
I, V" J� U , Tc,fot Yyn a Notary Public for the State of County of
do hereby certify that Man I ii � ,'� A personally appeared
before me this day of (,CJG 3, and cknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires 5 /1' l N
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6