SW5100602_Application Form_20100618

ONLY
Date Received Fee Paid
f---� PCrmit Numhrr
Applicable Rules? ❑ Coastal SW - 1995 ❑ Coastal SW - 2008 R-Ph H - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMINATER MANAGEMENT PERMIT APPLICATION FORM JUL
This form may be photocopied for use as an original i� i,
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
ABB Power T & D Companv, Inc
2. Location of Project (street address):
3022 NC 43 North
City:Pinetoos County:Edgecombe ZiP: 27864
3. Directions to project (from nearest major intersection):
Begin at intersection of NC 43 and NC 42 in middle of Pineto s then l2roceed north alon NC 43 for
approximately 1 mile The plant is located on the north side of the hi hv, ati
4. Latitude:35° 48' 10" N Longitude:0770 38' 24" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification
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 knov n) 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 managemeni'permit application, list the stormwater project number, if
assigned, ln/ <1 t0Q 1 %- 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 ®SedimentaLion/ Erosion Control: 8.5 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name,
issue date and the type of each permit:Clear and Grub Erosion i nn nl P.,mif n_,.c..,
Permit Number,
Form S'AIU-101 Version 07July2009 Page 1 of

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 uroiect):
AoDlicant/Oroani7a Hnn- A RR Pn,,or T R, T) !`............. r--
Signing Official & Title:
b.Contact information for person listed in item eta above:
Street Address: ji�� I�)(T A1rPA-k
City:
Mailing Address (if
State: 0 L
.ILY; State: Zip:—
Phone: (u��Jc�) �'a - 'j Fax: ( D5cD ) 8,��'-'3��
Email:__ d I VdV c�CI S Ct �b CON
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:
Mailing Address (if applicable):
City: State:
Phone: ( ) Fax: ( )
3. a. (Optional) Print the name and title of another contact such as the projects construction supervisor or other
person who can answer questions about the project -
Other Contact Person/Organization: Mark A. Russell PE
Signing Official & Title:Professional Eneineer
b.Contact information for person listed in item 3a above:
Mailing Address:1667 Woodruff Road
Cily:Rockv Mount
Phone: (252 ) 446-3017
Email: mrussellQmackgavpa com
State:NC Zip:27804
Fax: (252 ) 446-7715
4. Local jurisdiction for building permits: Pinetous, NC
Point of ContactGree Bethea Phone #: (252 ) 827-4435
Form S WU-101 . Version 07Juiy2009 Paae 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, hrif fly summarize how the stormwater runoff will be treated.
Storm water will be collected from the existing parking lot and existing building via sip ales and underground
storm drainage pipes and conveyed to a water quality pond in the rear of the site The sH ale on the east side
of the site bypasses runoff from the existing plant around the new expansion Roof drains from the new
buildings will be directed to the bypass swale since we are treating water from the existing parking lot and
existing buildings and the treated impervious surface area is more than the proposed impervious surface
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.Identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ® Ph H - Post Construction
3. Stormwater runoff from this project drains to the Tar -Pamlico River basin.
4. Total Property Area: 26.24 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 1.48 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:24.76 acres
Total project area shall be calculated to exclude the following: the laorrnal 001 of im11rounded structures, the area
between flee banks of streams and rivers, the area below the Normal Hi h Water (N AIV) line or Mean High Water
(MHW) line, and coastal. wetlands landward from the NHW (or Mi� line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non-constal wetlands landward of the NHW (or MHW) line nrmt
be included in the total project area.
S. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 33
9. How many drainage areas does the project have7l (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.
M
M
Form SWU-101 Version 01July2009 Page 3 of 7

Basin Information
Draina e Areal
Draina e Area _
Draina e Area
llrainaae Area_
Receiving Stream Name
Town Creek
_
Stream Class *
C;NSW
Stream Index Number `
28-83
Total Drainage Area (so
442572
On -site Drainage Area (so
442572 ✓
Off -site Drainage Area (so
0
Proposed Impervious Area" (sf)
250795
Impervious Area" total
56.7
Im 2ervious'" Surface Area
Draina e Area 1
Draina e Area _
Draina e Area
Draina e Area
On -site Bufldin s/Lots (so
25600 .
_
_
On -site Streets (so
0 . .
On -site Parking '(so
3^981 /
On -site Sidewalks (so
0
Other on -site (so
900
Future (sf)
0
Off -site (so
0
Existing BUA`*` (so
191314 '
Total (st):
250795 V
.,ueeua Lien auu macs ivumner can be aeternunea at: http://h2o.ertr state nc us/bints/reports/renortsWB html
" rill ervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
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 new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. There is no offsile
drainage being conveyed to the water quality pond
Projects in Union County: Contact DWO Central Office staff to check if the project is located within a Threatened ce
Endangered Species watershed that may be subject to more stringent stormwater requirements as per NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The apphcable state stormwater management permit supplement and operation and maintenance (O&M) forms
must W submitted for' each BMP specified for this project. The latest versions of the forms can be downloaded
from http://h2o.6iir.state.nc.us/su/bml2 forms htm.
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 httu://h2o.enr.stite.nc.us/su/bmu forms htin. 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 httu:/ /h2o.enr.state.nc us/su/msi mans htni.)
Please indicate that the following required information have been provided by initialing in flre space provided for
each item. All original documents MUST be signed and initialed in blue irk. Download the latest versions for
each submitted application,package from httu://h2o.enr.state nc us/su/bmp forms htm.
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 V11 below)
3. Origina of the applicable Supplement Forni(s) (sealed, signed and dated) and O&M
agreeme t(s) for each BMP.
4. Permit application processing fee of �505 payable to NCDENR. (For an Express review, refer to
httu://r Mir envhel�orQ/pages onestopexpress html for information on the Express program
Form S WU-101 Version 07]u1y2009 Page 4 of 7

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 rn p
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the 11 j
receiving stream drains to class SA waters within l> mile of the site boundary, include the'/
mile radius on the map. .
7. Sealed, signed and dated calculations. ( (�
S. 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.
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 boundarywith 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.
in. 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).
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
elevations and boring logs. Include an 8.5"01" 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 DINQ to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1045 Page No: 27 _
IL For corporations and limited liability corporations (LLC): Provide documentation from the JJ
Secretary of State or other official documentationJq
, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per NCAC 2H.1003(e). The
corporation or LLC must be fisted as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
h!lp:ZZ-,%,ww.secretar%,.state.nc.us/Cornorations/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
httu:/1h2o.enr state nc us/su/bmp forms htmkdeed restrictions. 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.
Form SWU-101 Version 07July2009 Paee 5 of 7

' 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 the}' may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Mark A. RussellPE
Consulting Firm: Mack Gav Associates PA
Mailing Address:1667 Woodruff Road
City:Rockv Mount State:NC Zip:27804
Phone: (252 ) 446-3017 Fax: (252 ) 446-7775
Email:inrussell@mackgaN,pa.com
LC. PROPERTY OWNER AUTHORIZATION (if Contact h;jornu:tion, item 2 has been filled out, complete this
section.) n
I, (print or type name of person listed in Coln tact Information, item 2a)
own the property identified in this permit application, and thus give permission to (print or type namerofpe oa tify that I
listed in Contact Information, item 1a) with (print or type naive of organization listed ill.
Contact Information, item 1b) 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.
As the legal property owner I acknowledge, mtdershnd, and agree Uy 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 Storm+vater permit reverts Uack to
me, the property owner. As the property owner, it is my responsibility to notify DINQ immediately and submit a completed Name/Ownership Change Form within 30 da}'s; otherwise I will Ue operating a stormwater treatruent
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 act on including the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
a Notary Public for the State of
do hereby certify that
before me this _ day 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
i
Form SA'U-101 Version 07July2o09 Page 6 of 7

X. APPLICANT'S CERTIFICATION
I, (print or hjpe name of person listed in Contact Information, item 2) 14tO la J J�e4 / I r • I Ulf l v
certify that the information included on this permit application form is, to the best of my knohde e, correct and
that the project will be constructed in conformance with the approved plans, that the required eed restrictions
and protective covenants will be recorded, and that the proposed project complies .with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000, SL 2006-246 (Ph. H - Post Construction) or SL,t200S-211.
Signature:Date:lit(�a��-�U .
I, _ J 1 P �. 1j C+ r L a ary Public for the State of tit C County of
NC.-S do hereby certify that J� n (e r t✓i Ye personally appeared
before me this day of J6'• e 20/c' and ack _ -led e the d exec 'on of the application for
a stormwater permit. Witness my hand and official seal, i
Steven L Bide
Notary KWc
Nash County, NC
Exclrer. 09-27-201 O
SEAL
My commission expires C7 - Z 7 '- Z C7 I C
Form SWU-101 Version 07July2009. Page 7 of 7