SW5120101_Application_20120402

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Applicable Rules: ❑ Coastal SW - 1995 ❑ Coastal SW - 2008 IWN II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
Other WQ M 7mt Plan: f•4•Ul.S L.f K PZ- Alk-rl! lAfovr 140fAeC. 5-rX f'r--
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may 17c photocopied for use as are 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.):
Cantonment Trailer Relocations
2. Location of Project (street address):
339 Roberts Chapel Road
City:Butner County:Granville
3. Directions to project (from nearest major intersection):
Zip:27509
'fake Central Avenue North Through the Town of Butner. At end take lefts onto Old 75 HWY and then
take a right on Range Road. Roberts Chapel will be on the ri ht after travelling approx. 2 miles.
4. Latitude:360 10' 39.8" N Longitude:78° 47' 47.6" W
II. PERMIT INFORMATION:
of the main entrance to the project.
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):
®I..ow Density 01-iigh 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, fist the stornwater project number, if
assigned, SW5110902 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: 5.55 ac of Disturbed Area
❑404/401 Permit: Proposed Impacts
b.lf any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:Sed/Erosion Control, GRANV-2012-006, September 21, 2011
JAN 3 0 2012
DENR • WATER QUALITY
WETLANDS AND STORIMATER BP',ANCH
Form SWU-101 Version 07Jun2010 Page I 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 project):
Applicant/Organization:North Carolina National Guard
Signing Official & Title: LTC Toni Coats, CFMO__
b. Contact information for person listed in item 1 a above:
Street Address:4105 Reed y Creek Road
City:Raleigh___ _ State:NC Zip:27607-6410
Mailing Address (if applicable):
City:
Phone: (919 } 665-6000
E�mai]:[e-mail]
State:
Fax:
Zip:
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 & TitIe:
b.Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
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:
4. Local jurisdiction for building permits: State Construction Office
Point of Contact: Phone #: )
Form SWU-101 Version 07Jun2010 Page 2 of
Zip:

1V. PROJECT INFORMATION
1. In the space provided below, I7riefly summarize how the stormwater runoff will be treated.
Both drainage basins will utilize a bioretention basin with IWS and one will also include a level spreader.
All flow is sheet flow to the grass lined ditches that convey the water to the proposed BMPs.
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 Neuse River basin.
Total Property Area: 11.13
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':11.13 acres
Total project area shall be calculated to exclude the folloiuirig the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) like or Mean High Water
(MHW) line, and coastal wetlands landward front the NNW (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) lire may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 35.8
9. I -low many drainage areas sloes the project have?2 (For high densihj, count I for each proposed engineered
stormWater BMP. For low density and other projects, use 1 for the whole property area)
10.
Basin Information
rainy e Area 1
Draina e Area 2
Draina e Ar _
Draina e Area _
Receiving Stream Name
u o Knapp of
eds Creek
ut to Knapp of
Reeds Creek
Stream Class *
WS-I1, -IQW,
N W
WS-Il; HQW,
NSW
/
Stream Index Number "
27-4-(1)
27-4-(1)
Total Drainage Area (so
128,208
179,740
On -site Drainage Area (so
128,208
179,740
Off -site Drainage Area (so
0
0
,
p
Proposed Impervious Area'* (so
66475
47,$0
.9n� _V " P
% Impervious Area** total
51.8
J
2 4
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. » Rt7vr5K4t>
—rA ULA ^MZX`r
t�ktr10
Impervious" Surface Area
Draina e Area 1
Dr, 'na e Ar 2
Draina e Area
Draina e Area
On -site Buildings/Lots (so
0
13, 447
On -site Streets (so
9891
4,871
On -site Parking (so
56,584
23,451
On -site Sidewalks (so
0
9,244
Other on -site (so
0
0
Future(so
0
20,434
Off -site (sf)
0
Existing BUA*** (so
0
19,234
Total (so:
66,856
90,281
* Stream Class and Index Number c4e deem^ Cried at: littki o)ortaI.ncdenr.or tyebAtrq&s/csir/classi ications
- /DP
Form SWU-101 Version 07Jun2010 Page 3 of

Basin Information
Draina a Area 1
Draina e Area 2
Draina e Area _
Drainage Area _
Receiving Stream Name
ut to Knapp of
Reeds Creek
tit to Knapp of
Reeds Creek
Stream Class
WS-nil; HQW,
NSW
WS-I1; HQW,
NSW
Stream Index Number *
27-4-(1)
27-4-(1)
Total Drainage Area (so
128,208
176,272
On -site Drainage Area (so
128,208
174,647
Off -site Drainage Area (so
0
2625
Proposed Impervious Area** (so
66,856
76,057
Impervious Area*# total
52.1
43.1
lni ervious" Surface Area
Draiina e Area 1
Draina e Area 2
Draina a Area _
Drainage Area _
On -site Buildings/Lots (so
0
5,520
On -site Streets (sf)
9891
0
On -site Parking (sf)
56,584
23,406
Oil -site Sidewalks (so
0
5032
Other on -site (sf)
0
0
Future (sf)
0
20,240
Off -site (SO
0
2625
Existing BUA*** (so
381
19,234
Total (so:
66,856
76,057
Sttearn Class and Index Number can lie deternriticd at:litil):Uportal.ticdetrr.orgAvebAt) /tts csrr classi eations
Irupervious area is defined as the built upon area including, but not lbuited to, buildings, roads, parkhrg areas,
sidewalks, gravel areas, etc.
** Report only that amount of existing B LIA that will reutaiu after developinent. Do not report any existing BUA that
is to be removed and which will be replaced by new B UA.
11, How was the off -site impervious area listed above determined? Provide documentation. CADD
Projects in Union County: Contact DIVQ Central Office staff to check if the project is located ►i,ithin a Threatened &
Endangered Species watershed thaf tray be subject to more stringent stornni,arer requirentents as per NCI C 02B .0600.
V. SUPPLEMENT AND O&M FORMS RD�
The applicable state stonnnnvater management permit supplement and operation and maintenance (O&M) forms
nnust be submitted for each BMP specified for this project. The latest versions of the forms car, be_[totivnioaded'
from http://I)ortal.ticdetir.org/web/wq/ivs/su/bnnp-manual. "
VI. SUBMITTAL REQUIREMENTS
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
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 litt ortal.ncdeiir.orgf nveb/nvq/nvs/su/statesw/Forms dots. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office mnay be
found by locating project on the interactive online map at htti)://portal.ncdeiir.oWI%veb/__%v�c jws/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 _docs,
Initials
I. Original and one copy of the Stormwater Management Permit Application Form, 40f
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants N�
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Forms) (sealed, signed and dated) and O&M �
agreennent(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDF,NR. (For an Express review, refer to
littp://,.v%%iv.enviielp.org/pages/­oiie.5top,expre.9s.litni for information on the Express program
Fornn SWU-101 Version 07Jun2010 Page 4 of

�* lm pervious area is dcf ned as the built rapon area including, but not limited to, buildings, roads, parking areas,
sir cioalks, gravel areas, etc.
*** Report only that amount of existing BUA that will remain after development. Oo not report any existing BUA that
is to be removed and Which Will be replaced hi/ new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. CARD
Projects in union County: Contact DWQ Central Office slclfto check if'the project is located within a Threatened &
Endangered .Species watershed that may he subject to more stringent stornrt+,ater requirements as per NC9C 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 I3MP specified for this project. The latest versions of the forms can be downloaded
from http:f [ ortal.ncdenr.orgf web/wq/ws/suZbmi2-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://12ortal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. 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 http://portal.ncdenr.orq/web/wq/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://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. !T
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants a
Form. (if required as per Part VIt belmo)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M GT
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to '>'-
http://www.envlielp.org/pages/onestopexi2ress.html 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 treatment/managementfor 4,T
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 it
receiving stream drains to class SA waters within 1/2mile of the site boundary, include the'/z
mile radius on the map.
7. SeaIed, signed and dated calculations. 'Cr
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.
it. 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 Iandward from the normal pool elevation of impounded
structures, the banks of strearns or rivers, and the MHW (or NI-IW) 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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
Form SWU-101 Version 07Jun2010 Page 4 of 6

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 'J A4
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"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration 13MPs, 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 far DWQ to verifij [lie SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 0 Page No: 0
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC #"-
Secretary of State or other official documentation, which supports the titles and positions held _
by the persons listed in Contact Information, item 1 a, 2a, and/or 3a per NCAC 21-1.1003(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:// www.secretary.st,ite.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
httl2://portal.ncdenr.org/web/wq ws1su/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:Eric Tweed, PE
Consulting Firm: CH Engineering, PLLC
Mailing Address:3220 GIen Royal Road
City:Raleigh Stnte:NC Zip:27617
Phone: (919 ) 788-0224
Eiiiail:[e-mail]
ch-en-gr.com T
Fax: (919 ) 788-0232
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or hjlre rranre 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 name of person
listed in Contact Information, item In) with (print or type name of organization listen in
Contact Information, item 1a) 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.
1�orm SWU-101 Version 073un2010 Pave 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.
Signature: � - - - - - Date: -! �� 0-41. [ Q
I, Rtwuajl B. Nj'Q n V dr a Notary Public for the State of iNog, County of
1404 Jke do hereby certify that T'..?:: 1 • COa% personally appeared
before me this L? day of T 20 fa , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,,�,,�
SEAL RUSSELL B NIEMYER
NOTARY PUBLIC
WAKE COUNTY, NC
My Commission Expires 3-16-2015
My commission expires 3—1&—zow
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item Ia) I L•il 1 L� ° L,t �Q�S
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. II - Post Construction)
or SL 2008-2111.
Signature: lin4u 67e • epa� Date: C�7 r 2 f
I, 0G{1'a Notary Public for the State of n-)orA Ca-follY+� County of
do hereby certify that �!2 t (.. �p[�1 S personally appeared
before me this IgA day of ;T�LAo- CV , PlPl Zr and ackaqwledge the e execution of the application for
a stormwater permit. Witness my hand and official seal
4s Notary Public _
SEAL = Durham Cour)ty
%gyp
"H C�AIi�+�O��\`\\`\`
M} commission expir�Y
T—.
Form SWU-101 Version 07Jun2010 Page 6 of 6

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