SW6100601_Application_20100625

DWQ USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules:
❑ Coastal SW -1995 ❑ Coastal SW _ 2008 IN Ph II - 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
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. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Lot 2, Airport Commerce Park
2. Location of Project (street address):
City: Fayetteville County: Cumberland Zip:28306
3. Directions to project (from nearest major intersection):
0.20 miles Southeast along Airport Road from the intersectin of I-95 and Airport Road
4. Latitude:340 59' 57" N Longitude:78° 53' 45" 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 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 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):
❑LAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 2.56 ac of Disturbed Area
0404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project
issue date and the type of each permit:n/a lr�
Fonn SWU-l01 Version 14May2010 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 oroiect):
Applicant/Organiza
Signing Official & Title:William D. Puller Jr., Managing Member
b.Contact information for person listed in item la above:
Street Address:321 North Front Street
City:Wilmington
Mailing Address (if applicable):
City:
Phone: (910 ) 763-0380
Hma i l: wbfu l ler@aol. co m-
State:NC Zip:28401
State:
Fax: (910 ) 251-1040
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. ('Phis is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:
Mailing Address (if
City:
Phone: ( 1
State:
Fax: ( 1
Zip:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or tither
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State:
Form SWU-101 Version 14May2010 Page 2 of

Phone:
Pax:
Email:
4. Local jurisdiction for building permits:
Point of Con
IV. PROJECT INFORMATION
Phone #:
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
All stormwater runoff will be conveyed by a storm drainage system to a wet detention 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.Identify the regulation(s) the project has been designed in accordance with:.
❑ Coastal SW -1.995 ® Ph II - Post Construction
3. Stormwater runoff from this project drains to the Cape Fear River basin.
4. Total Property Area: 2.14 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':-2:14 acres -
' Total project area shall be calculated to exclude the followinR the normal pool of impo��u�nded structures, the area
between the banks of streams and rivers, the area below the Nornml 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 (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area.
S. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 47.8
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use "I 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.
Form SWU-101 Version 14May2010 Page 3 of

Basin Information
Drainage Areal
Draina e Area _
Draina e Area _
Drainage Area
Receiving Stream Name
Big Sandy Run
_
Stream Class *
C
Stream Index Number *
18-31-25
Total Drainage Area (so
101,170 ✓
On -site Drainage Area (so
101,170
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
48,350
Impervious Area** total
47.8 ✓
Impervious— Surface Area
Draina e Area 1
Draina e Area _
Draina e Area _
Draina e Area
On -site Buildings/Lots (so
12,120
_
On -site Streets (so
0
On -site Parking (so
33,130
On -site Sidewalks (so
3,100
Other on -site (so
0
Future (so
0
Off -site (sf)
0
Existing BUA*** (sf)
0
Total (so:
48,350
Stream Class and Index Number can be determined at: bttp://portal.nc(lear.org/e )eb/euq/us/esu/classifications
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 amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be reproved and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation.
Projects in Union County: Contact DWQ Cenral 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 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:Z/poi-tal.iiccienr.orgZweb/wq/ws/­su/t)lnp-lllalltl,11.
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. (The appropriate office may be
found by locating project on the interactive online map at htlp:// portal.ncdenr.org/web/wg/ws/suhnaps.)
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://portal.ncdenr:ore/web/wq/ws/su/statesw/forms does
Initials
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 efW W\
Form. (if required as per Part VII beloeo)
3. Original of the applicable Supplement Fonn(s) (sealed, signed and dated) and O&M Gam,/ /J)
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to GvJ ^l�_
littp://www.envhelp.org/pages/onestopexpress.litiiil 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.)
FormSWU-101 Version l4May2010 Paae4of7

5. A detailed narrative (one to two pages) describing the stormwater treatment/management for cn)
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the _(W M
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. LNfv\
8. 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.
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).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify w✓✓vl
elevations in addition to de ths) as well as a map of the boring locations with the existing
elevations and boring logslnclude an 8.5"x11" 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 subruittal, [phone].)
10. A copy of the most current property deed. Deed book: 08346 Page No: 0839 (fm A-1
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC Cw✓oj
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per NCAC 21-11003(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
13UA 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: /portaImcdennory/web/wg/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.
Form SWU-101 Version 14May20I0 Page 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 they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Christooher W. Millis, PE
Consulting Firm: Paramounte Engineering Inc
Mailing Address:5911 Oleander Drive, Suite 201
City: Wilmin ,ton
Phone: [phone]
Email:cmill [e-mail]
State:NC Zip:28403
Fax: [phone]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type none of person listed in Contact Information, item 2a) certify that I
own the property identified in this permit application, and thus give permission to (print or type tame ofperson
listed in Contact In ornration, item 1n
f ) with (print or hype name of organization listed in '
Contact Information, item la) 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 1 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 I5WQ 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 143-2I5.1 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.
Date:
a Notary Public for the State of
do hereby certify that
County of
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,
SEAT,
My commission
-1
Form SWU-101 Version 14May2010 Page 6 of

X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item Ia) William B. Fuller Jr., Managing Member
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. Si. 2006-246 (Ph. 11 -Post Construction) or SL 2008-211.
G-1- aolD
I, Clv�jeh¢il L M� �x a Notary Public for the State of tQo«{In Co-w1'.no- County of
syv tnP 1sa, Lk , do hereby certify that _ 4X P'%aw, $ .�F"U-c -, A,. personally appeared
before me this I day of JL AA_ tut o and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, yeA . "
SEAL
5 0 NOTARY X
PUBLIC
My commission expires Ni/1 4 �O 201
• "npmnp_;q� "C
r
«�M1T.i�y R
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Form SWU-101 Version 14May2010 Page 7 of 7