SW6080804_Application_20081009

—DWQ-USE-ONLY ----
Date Received
Fee Paid
Permit Number
sdS-=
-SW6oi-08'0
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. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
Boiangles Restaurants Inc.
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
ZA7ie. %,f � +ie&hr 4pit.vc j Execim2c, Vj ?,-siDt',T-
3. Mailing Address for person listed in item 2 above:
9432 Southern Pine Blvd
City:Charlotte State:NC Zip:28273
Phone: (704 ) 527-2675 Fax: (704 ) 522-8677
4. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
5. Location of Project (street address):
116 Fayetteville Road
City:Raeford County:Hoke Zip:28376
6. Directions to project (from nearest major intersection):
Coming from Hwy 211 East - Take a Right at the Intersection of Hwy 211 and H317Y 401 Bypass Site is on the
left at the next road, Intersection of Hwy 401 Bypass and W. Edinborough
7. Latitude:34058' 48" N Longitude:79° 14' 9" W of project
8. Contact person who can answer questions about the project:
Name:Bob Spalding Telephone Number: (704 ) 227-9424
Email: bspaldingQisaacsgrp.com
II. PERMIT INFORMATION:
1. Specify whether project is (check one): ®New ❑Renewal ❑Modification
Form SWU-101 Version 03.27.08 Pagel of4

2. If this application'is being submitted -as the'result of-arenewal or modification to -an -existing permit, list the e:+
existing permit number N/A and its issue date (if known)N/A
3. Specify the type of project (check one):
❑Low Density ®High Density ❑Redevelop []General Permit ❑Universal'SMP ❑Other
4. 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 ®Sedimentation/Erosion Control ❑404/401 Permit ❑NPDES Stormwater
III. PROJECT INFORMATION
1. In the space provided below, summarize how Stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project.
Stormwater Leaves both the existing site and the proposed site at 3 different concentration points 1 A swale via
the back of the property down W. Edinborogh Rd. 2 A swale on Fayetteville Road at the new proposed drivewaYL
into the NCDOT SW System. 3. An NCDOT SW System at the Corner of Fayetteville Road and W. Edinborough
A BMP/Bioretention Cell is used to treat additional impervious and exits into the NCDOT SW System
2. Stormwater runoff from this project drains to the Trib. of Raft Swamp/Trib. to Pedlers Branch River
basin.
3. Total Property Area: 1.02 acres
4. Total Wetlands Area: N/A acres
5. 100' Wide Strip of Wetland Area: N/A acres (not applicable if no wetlands exist on site)
6. Total Project Area**:1.40 acres 7. Project Built Upon Area:74.7 %
8. How many drainage areas does the project have?3
0
Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach. an additional sheet with the information for each area provided in the same format as below.
For high density projects, coin lete the table with one drainage area for each engineered stormwater device.
Basin Information r
i ' , ,.: r.Dratnage'A' 1,' ;'' I
1, ;r Dramage'Area 2, "a`'
Receiving Stream Name
Trib. of Raft Swamp Creek
Trib of Raft Swamp Creek
Stream Class & Index No.
N/A
N/A
Total Drainage Area (so
13,863
61,420
On -site Drainage Area (so
13,308
44,467
Off -site Drainage Area (so
555
16,953
Existing Impervious* Area (so
0
24,350
Proposed Impervious*Area (so
9,862
33,193
% Impervious* Area (total)
71.20
_74.65
�.YC....BSI tis.: +
Im erviousz Surface4Area" r^
-- P _ r. sir
} 'r„t'Drama e Area'7 �,
t�. _pm .,,t, , g. . MN' t� u?,�i P'(4�?'out�+F�`.o
.�
' a �_ :Drama e-Area 4 " �,:'
g I r;{ �.
On -site Buildings (so
0
3,564
On -site Streets (so
0
On -site Parking (so
3,268
4,810
On -site Sidewalks (so
237
989
Other on -site (so
6,357
21,834
Off -site (so
0
1,996
Total (so:
9,862
33,193
* Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
14
Form SWU-101 Version 03.27.08 Page 2 of 4

**Total project area shall be calculated based on the current policy regarding inclusion of wetlands in the built upon -area
----
percentage calculation. This is the area used to calculate percent project built upon area (BUA).
10. How was the off -site impervious area listed above
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
One of the following deed restrictions and protective covenants are required to be recorded for all subdivisions,
outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table listing each lot
number, size and the allowable built -upon area for each lot must be provided as an attachment. Forms can be
downloaded from httl2://h2o.enr.state.nc.us/su/bmp forms.htm - deed restrictions.
Form DRPC-1
High Density Commercial Subdivisions
Form DRPC-2
High Density Developments with Outparcels
Form DRPC-3
High Density Residential Subdivisions
Form DRPC-4
Low Density Commercial Subdivisions
Form DRPC-5
Low Density Residential Subdivisions
Form DRPC-6
Low Density Residential Subdivisions with Curb Outlets
By your signature below, you certify that the recorded deed restrictions and protective covenants for this
project shall include all the applicable items required in the above form, 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 State, and that they will be recorded prior to the
sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each
BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the status
and availability of these forms. Forms can be downloaded from htto://h2o.enr.state.nc.us/su/bmp forms.htm.
Form SW401-Low Density
Form SW401-Curb Outlet System
Form SW401-Off-Site System
Form SW401-Wet Detention Basin
Form SW401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-Level Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Form SW401-Permeable Pavement
Low Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
Permeable Pavement Supplement
Form SWU-101 Version 03.27.08 Page 3 of 4

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. The complete application package should be
submitted to the appropriate DWQ Office. (Appropriate office may be found by locating project on the
interactive online map at httl2://h2o.enr.state.nc.us/su/msi maps hum)
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• Original and one copy of the Stormwater Management Permit Application Form
• Original and one copy of the Deed Restrictions & Protective Covenants Form (if
required as per Part IV above)
• Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP
• Permit application processing fee of $505 (Express: $4,000 for HD, $2,000 for LD)
payable to NCDENR
• Calculations & detailed narrative description of stormwater treatment/management
• Copy of any applicable soils report
• Two copies of plans and specifications (sealed, signed & dated), including:
- Development/ Project name
- Engineer and firm
-Legend
- North arrow
- Scale
- Revision number & date
- Mean high water line
- Dimensioned property/project boundary
- Location map with named streets or NCSR numbers
- Original contours, proposed contours, spot elevations, finished floor elevations
- Details of roads, drainage features, collection systems, and stormwater control measures
- Wetlands delineated, or a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
- Drainage areas delineated
- Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section. (ex. designing engineer or firm)
Designated agent (individual or firm):The Isaacs Group
Mailing Address:8720 Red Oak Blvd, Suite 420
City:Charlotte State:NC Zip:28217
Phone: (704 ) 227-9424
Emafl:bsl2a][e-mail]
VIII. APPLICANT'S CERTIFICATION
Fax: [phone]
I, (print or type name of person listed in General Information, item 2) . C/tit %%�. 1 .JM1-1-W
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 coy�nants will be r orded, and that the proposed project complies with the requirements of 15A
NCAC 2H .100c. / P) n
it ,
Date: !— ZS— Ob
Form SWU-101 Version 03.27.08 Page 4 of