SW6231104_Application Form_20231115

DEMLR USE ONLY
Date Received Fee Paid Permit Number
Applicable Rules: ❑ Coastal SW- 1995 ❑ Coastal SW- 2008 0 Ph II - Post Construction
(select all that apply) 0 Non-Coastal SW- HQW/ORW Waters 0 Universal Stormwater Management Plan
0 Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
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.):
Tractor Supply Store -West End
2. Location of Project (street address):
4020 NC Hwy 73
City:West End County:Moore Zip:27376
3. Directions to project (from nearest major intersection):
At the northeast corner of NC 73 and NC 211
4. Latitude:34.2414" ' " N Longitude:79.565° ' " W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is (check one): ['New ❑Modification ❑ Renewal w/Modification'
'Renewals with modifications also requires SWU-102-Renewal Application Form
b.lf 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 EHigh 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
DEMLR 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 ®Sedimentation/Erosion Control: 5.86 ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 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:
5. Is the project located within 5 miles of a public airport? ®No Eves
If yes, see S.L. 2012-200, Part VI: http://portal.ncdenr.org/web/Ir/rules-and-requlations
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):
Form SWU-101 Version Oct. 31,2013 Page 1 of/

Applicant/Organization: West End Development Group, LLC
Signing Official & Title: Gavin Melia, Manager
b.Contact information for person listed in item la above:
Street Address: 120 Market Square-2—° Floor
City: Pinehurst State:NC Zip: 28374
Mailing Address (if applicable): PO Box 3289
City:Pinehurst State:NC Zip: 28374
Phone: (910 ) 695-3694 cell: 910-724-6720 Fax: ( ) none
Email: gavinAbaselinedevelopment.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: Southern Golf& Land, L.L.C.
Signing Official & Title: Michael T. Phillips, Manager
b.Contact information for person listed in item 2a above:
Street Address: 215 Surry Circle Dr. N
City: Pinehurst State:NC Zip:28374
Mailing Address (if applicable): same
City: State: Zip:
Phone: (910 ) 986-0401 Fax: ( )
Email:mikep6785Agmail.com
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: NA
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: (
Email:
4. Local jurisdiction for building permits: Moore County Planning and Inspections
Point of Contact: Ruth Pedersen, Planner Phone#: (910 ) 947-5010
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be piped from the parking areas into a single raw infiltration basin -dry detention.
O
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IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
Stormwater will be piped from the parking areas into a single rear infiltration basin-dry detention.
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 Cape Fear River basin.
4. Total Property Area:6.14 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': 6.14 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(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.
8. Project percent of impervious area: (Total Impervious Area/ Total Project Area)X 100 = 58.0
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 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 Drainage Area 1 Drainage Area_ Drainage Area_ Drainage Area_
Receiving Stream Name Little River
(Lower Little
River)
Stream Class * WS-III; HQW
Stream Index Number* 18-23-(1)
Total Drainage Area(sf) 285,000
On-site Drainage Area(sf) 237,300
Off-site Drainage Area (sf) 47,700
Proposed Impervious Area**(sf) 155,300
% Impervious Area**(total) 54.5%
Impervious**Surface Area Drainage Area 1 Drainage Area_ Drainage Area Drainage Area_
On-site Buildings/Lots(sf) 22200
On-site Streets (sf) 84100
On-site Parking (sf) 28000
On-site Sidewalks (sf)
Other on-site (sf) 28000
Future(sf) 5000
Off-site (sf) 16000
Existing BUA***(sf)
Total (sf): 155,300
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
Form SWU-101 Version Oct.31,2013 Pageof/