SW3120102_Application_20120208

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
11199 S
Sw 1 a o k D a --
Applicable Mules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph 11 - 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
RECEIVED
Department of Environment and Natural Resources DIVISION OF WATER QUALITY
Division of Water Quality
FEB 0 8 2012
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This forth may be photocopied for use as an original SWR
MOORESVILLE REGIONAL OFFICE
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.):
AutoZone - Indian Trail, NC
2. Location of Project (street address):
Idlewild Road % .mil %rh
City:
County:Union
3. Directions to project (from nearest major intersection):
Project located 362 feet South of the intersection of Hillcrest Circle and Idlewild Road
Zip:28079
4. Latitude:35° 06' 91" N Longitude:80° 38' 04" W of the main entrance to the `trro L
IL PERMIT INFORMATION: •lLl � ��`�
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 known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑1_ow Density ®I-ligh 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 Ietter 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: 1.3 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: -e r". 2\
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Form SWU-101 Version 07Jun2010
Page I of 6

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:AutoZone Development Corp.
Signing Official & Title:lames Griffith - Vice -President
b.Contact information for person listed in item 1a above:
Street Address:123 South Front Street. 3rd Floor
City:Memphis
Mailing Address (if applicable):
City:
Sta te:TN
State:
Zip:38103
Zip:
Phone: (901 ) 495-8701 Fax: (901 ) 495-8969
Email:wade.davis©autozone.com
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:Current: Theodore & Demetra Karres Proposed: AutoZone Develompent Corp
Signing Official & Title:Current: Theodore Karres - Owner Proposed: lames Griffith - Vice -President„
b.Contact information for person listed in item 2a above:
Street Address:Current Theodore Karres-442 Blairmore Dr. Pro osed AutoZone Development Corp):
Charlotte, NC 28211 123 South Front Street, 3r,I Floor
City:Current: Charlotte Proposed: Memphis State:NC TN Zip:C: 28211 1": 38103
Mailing Address (if applicable):
City: State: Zip:
Phone: ( } Fax:
Email:
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:
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
Email:
State:
Fax: ( --
Zip:
4. Local jurisdiction for building permits: Union County
Point of Contact:Lee lenson - T Phone #: (704_ _) 283-3605
Form SWU-101 Version 07Jun2010 Pape 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater from the site will be treated within a bio-retention pond at the rear of the proposed AutoZone
store. Runoff from the impervious areas of the site associated with the AutoZone development will drain
into the proposed bio-retention pond.
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 Yadkin
4. Total Property Area: 3.23 net acres
River basin.
5. Total Coastal Wetlands Area: 0.0 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,:3.23 acres
Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NNW) lure or Mean High Water
(MHW) line, and coastal zoetlands landward frorn the NNW (or MHW) line. The resultant faro' ct area is used to
calculate overall percent built urpon area (BUA). Non -coastal zoetlands landward of the NHW (or MHW) line nray
be included in fire total project area.
& Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 21.3 %
9. How many drainage areas does the project have?l (For high density, count I for each proposed engineered
stornaaater BMP. For low density and other projects, rise 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
Draina e Area 1
Draina e Area _
Drainage Area _
Drainage Area _
Receiving Stream Name
N. Fork Crooked
.
Stream Class *
C
Stream Index Number *
13-17-20-1
Total Drainage Area (sf)
37,900
On -site Drainage Area (so
37,900
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
30,042
% Impervious Area** total
79.3
Im ervious" Surface Area
Drainage Area 1
Drainage Area _
Draina e Area _
Drainage Area _
On -site Buildings/Lots (so
7,381
On -site Streets (sf)
0
On -site Parking (so
20,846
On -site Sidewalks (so
1,815
Other on -site (so
0
Future (so
0
Off -site (sf)
0
Existing BUA*** (so
0
Total (so:
30,042
* Streant Class and Index Number can be determined at:lrttp.,rlj7ortal.)rcChear.orglztyebAt1 g4)s/csu/classi{icatiotts
lrn )ervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
siyezuyalks, gravel areas, etc.
Form SWU-101 Version 07Jun2010 Page 3 of

'Report only flint 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. MA
tQ
Proiects in union County: Contact DPVQ Central Office staff to check if the project is located within a Threatened
Endangered Species watershed that nray be subject to more stringent stormwater requirements as per 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 http!/portal.ncdenr.org/web/wq/ws/su/burp-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 http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does. The complete
application package should be submitted to the appropriate DWQ Office. (1'he appropriate office may be
found by locating project on the interactive online map at http://portal.ncdenr.org/web/wd/ws/su/maps.)
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://pot-tal.ncdenr.org/web/wq/ws/su/statesw/fortes does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. '%L
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part Vll below)
3. Original of the applicable Supplement )~oren(s) (sealed, signed and dated) and O&M 1 L
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to AK
http://www.enviielp.org/12ages/onestol2express.htmt 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 h•eattztent/managementfor /IKZ-
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the M `LL-
receiving stream drains to class SA eaters within r/z mile of the site boundary, include the r/2
mile radius on the map.
7. Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: Mt L
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 MI-IW (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.
Form SWU-101 Version 07Jun2010 Page 4 of 6

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 1'N/PC_
elevations in addition to depths) as well as a map of the boring locations with the existing try lcs)
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 verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 0329 Page No: 733
11. For corporations and limited liability corporations (LLC): Provide documentation From the NC NetL..
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 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:fZwww.secretary.state.i-ic.us/Corporatiot-is/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
http://12ortal,ncdem•.org/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: Matthew Lowder, PE
Consulting Firm: Triangle Site Design, PLLC
Mailing Address:4006 Barrett Drive Suite 203
City:Raleigh
Phone: (919 i 553-6570
Email:nnlowder®trianglesitedesign.com �T
State:NC Zip:27609
Fax: ( )
IX.' PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, conplete this
section)
1, (prinnt or hjpe name of person listed in Contact Information, item 2n) Theodore 6 Demetra Karrasrtify that
own the property identified in this permit application, an �7u give permission to (print or hjpe name of person
listed in Contact Information, itein 7a) -Rants Z-Ames �{�; with (print or type nannne of organization listed in
Contact Information, item 1a) AutoZonne Development Corp 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 07Jun2010 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
Date:L.2 -'�.-//
Date: 12 -Q77 -1 l
County of
Mecklenburg do hereby certify that Theodore & Demetra Karres personally appeared
before me this.J day of December- 2011—, and acknowledge the due execution of the application for
a Stormwater permit. Witness my hand and official seal,
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My commission expires -C�? / toLa G/
X. APPLICANT'S CERTIFICATION rrII
1, (print or hjpe manic of person listed in Contact Information, iteni Ia) 444d&4_4av4 J_66wt[5
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 2H .1000, SL 2006-246 (Ph. 11 - Post Construction) or SL 2008-211.
Signature:
Date: I . iS•
I, d IZ . i�+u, a Notary Public for the State of County of
SLu.� do hereby certify that �T- i!'�+-Wr. - ' personally appeared
before me this )SNay of 4 ����-, and acknowledge thh�e due execution of the application for
a stormwater permit. Witness my hand and official seal, / fL
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Form SWU-101 Version 07Jun2010 Page 6 of 6