SW6100701_Application Form_20120726

DWQ USE ONLY
Date Received ree Paid Permit Number
,S OS -* Xr3 3 3 o— I Lwo t-P t a D "10 1
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph B - Post Construction
L�Irrt.nit_tflnt.rlrpa�tl L1_T\[nn-�sra4taf �W- H y�I,/L?RW [Qla rc .[I 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.):
Traemoor Village
2. Location of Project (street address):
Lakewood Drive & Rockfish Road
City:I-9ope MIIls County:Cumberland %ip:28348
3. Directions to project (from nearest major intersection):
From Hope Mills (Intersection of Rockfish Road & Camden Road) West to intersection of Rockfish Road and
Lakewood Drive. Property is located on the Northeast side of the intersection. The location of coordinates
below are approximately at the southeastern entrance furtherst from Rockfish Rd,
4. Latitude:34° 58' 51" N Longitude:79° 00' 36" 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 numberSW6100701 , its issue date (if known)May11, 2011 _ , 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 ®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 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,
1. 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
®Sedimentation/Erosion Control: 49.1 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
ssue date and the type of each permit:Rockfish Road Connection- Common Rd A - Traemoor Village
Nov. 17, 2011 - Erosion Control; Traemoor Connection, CUMBE2010-148, IW-)L 9,2010

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:HCC Investments LLC
Signing Official & Titleaackie Hairr, Owner
b.Contact information for person listed in item la above:
Street Add ress:3077 N. Main Street
City:Hope Mills _
Mailing Address (if applicable):
City:
Phone: (910 } 426-0867
Email:hccinvestments©nc.rr.com
State:NC Zip:28348
State: Zip:
Fax: (910 } 426-0567
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 & Title:
).Contact information for person listed in item 2a above:
Street Add ress:
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/Organ
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone: l 1
Email:
4. Local jurisdiction for building permits: Cum
Point of Con
State:_
Fax: C_
nd County
Phone #:
Zip:

Iv., PROJECT INFORMATION
'L In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff will be treated vis a wet detention pond designed for 90% TSS removal. Conveyance to
this structure will be through a system of Stormwater pipes_
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: 62.33
acres 5. Total Coastal Wetlands Area: N/A acres
6. Total Surface Water Area: N/A acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area4:62.33 acres
Total project area shall be calculated to exclude thefollonying. the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Nortnal High Water (NH W) line or Mean High Water
(MHW) litre, and coastal wetlands landward front file 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 (orMHW) litre tttay
be included in the total project area.
8. Project percent of impervious area: ('rota[ Impervious Area / 'Total Project Area) X 100 = 59.2
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stornavater 8MP. 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
Drains e Area 1
Drainage Area
Drama e Area
Drains e Area _
Receiving Stream Name
Little Rockfish
Creek
Stream Class *
C
Stream Index Number*
18-31-24(4)
Total Drainage Area (so
2,831,400
On -site Drainage Area (so
2,810,926
Off -site Drainage Area (so
20,474
Proposed Impervious Area** (so
1,675,669
u 0 qC
% Impervious Area** total
59.2
impervious— Surface Area
Drainage Area 1
Drainage Area _
Drains e Area _
Drainage Area _
On -site Buildings/ Lots (so
601,149
J 3 , 'M ,q C ,
On -site Streets (so
700,000
r�
On -site Parking (so
299,520
?5�
On -site Sidewalks (so
75,000
1, 17 Z
Other on -site (§f)
N/A 11
Future (so
N/A
Off -site (sf)
N/A
Existing BUA*** (sf)
N/A
Total (s0
1,675,669
* Stream Class and Index Number can be determined at: lit .. ortal.tt.cdetir.or veb v s cstt class! cations
Itttppervious area is defined as the built upon area including, but not lintited to, buildings, roads, parking areas,
siIUwalks, gravel areas, etc.

--,***Report only that amount of existing BUA that mill remain after development. Do not report any existing BUA that
is to be removed and which Will be replaced by nciv B UA.
11. How was the off -site impervious area listed above determined? Provide documentation.
Pro'ects in Union County: Contact DWQ Centro! Of
lice staff to check if the project is located within a Threatened &
Endangered Species watershed that may he suhlect to more stringent stormwater requirements as per NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
['he 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 h!W://portal.ncdenr.org/weblwq/ws/su/bmp-manual.
V1. 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/wg/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 http://portal.ncdennorg/web/wg/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 htt ortal.ncdenr.or web w ws su statesw forms dots.
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^
Form, (if required as per fart V11 below)
3. Original of the applicable Supplement Form(s) (scaled, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR, (For an Express review, refer to
http://www.envheII2.org/pages/onestopexpress.htmI 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
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
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the'/z
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:
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.

i
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 (PIease identify 44
elevations in addition to depths) as well as a map of the boring locations with the existing ti
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 BMPs, the report should alsor'
include the soil type, expected infiltration rate, and the method of determining the infiltration rate. S`
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verify the SITYVT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: Page No: rJ
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 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.
hgp:ZZwww.secretaiy.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
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
httl2://portal.ncdenr.or&Zweb/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:Fleet Temple, PE
Consulting Firm: Enoch Engineers, PA
Mailing Address:1403 NC 50 South
City:Benson
Phone: (919 ) 894-7765
Email: fleet®enochen eers.com
State:NC Zip:27504
Fax: [phone]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section) �%���/ L1 G
I, (print or type name of person listed in Contact Information, item 2a) VI#At4g VAG 11 , 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 1a) t.-LLC— with (print or type name of organization listed in
Contact Information, item 1a) 04,e, lrwmjOrt�^A %-%-L' 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 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 Genera S tue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties g f,,u to $25,000 per day, pursuant to NCGS 143-215.6.
Date: Z 1,q-I-Z—
I, r s 1, AJC a Notary Public for the State of �' J C County of
0-amb2^4,n/h . do hereby certify that TRC&C �140'I r personally appeared
before me this 19 day of -Tu1. 4 and acknowledge the due execution of the application for
a stormwater pergM ) litness my hand and official seal, Ch-L„ -C-) 7 _
SEAL
f
My commission expires � / x 1.7
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 1a) W4 1*Ivcsrwv9PiV5. Lt_ .—
certify that the information included on is permit application form is, to the best of my knowledge, correct and
that the project will be constructed in c orm nce with the approved plans, that the required deed restrictions
and protective covenants will be recor ed, and that the proposed project complies with the requirements of the
applicable stormwater rules und�r i Y A NCAC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Date: Z- i 9 / 7--
I, _ L H , 5 t -6&- a Notary Public for the State of AI.i6- County of
L unt hrt /i9Wh do hereby certify that , J CL. r. f�F)i , f personally appeared
nefore me this I day of _ U 6- b rQ. , and acknowledge the du execution of the application for
i stormwater permit. Witness my hand and official seal,
SEAL
My commission expires C1 / 5 /c— _