SW6100701_Application Form_20110506

"DWQ USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ 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
W
Division of Water Quality
9
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
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This form may be photocopied for rase as air original
1. GENERAL INFORMATION
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a.,
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1. Project Name (subdivision, facility, or establishment name - should be consistent with project name
laps;
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specifications, letters, operation and maintenance agreements, etc.):
Traemoor Villag_e__,,.,,
-
_
2. Location of Project (street address):
Lakewood Drive and Rockfish Road
City:Hope Mills County:Cumberland Zip:28348
3. Directions to project (from nearest major intersection):
From Hope Mills (Intersection of Rockfish Road and Camden Road) West to Intersection of Rockfish Road
and Lakewood Drive. Property is located on the North East side of the Intersection,
The location of coordinates below are approximately at the southern entrance from Rockfish Road furthest
from the Stoneypoint Road, Lakewood Drive intersection.
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4. Latitude:34° 58' 51" N Longitude:79° 0' 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, Iist the existing
permit numberSW6100701 its issue date (if known)Oct 11, 2010 , 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,1243 and the previous name of the project, if different than currently
proposed, Traemoor.Connection Site
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/Eros ion Control: 48.0 ac of Disturbed Area
❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/ Permit Number,
issue date and the type of each permit:Traemoor Connection, CUMBE-2010-148,July 9, 2010 Erosion Control
Form SWU-101 Version 07Jun2010 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 project):
Applicant/ Organization: H CC Investments LLC
Signing Official & Titleaackie Hairr, Owner
b. Contact information for person listed in item la above:
Street Address:3077 N. Main Street
City:Hope Mills _ State:NC Zip:28348
Mailing Address (if applicable): same
City: State: Zip:
Phone: [phone] Fax: (910 } 426-0567
Email:hccinvestment®nc.rr.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:
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Ad
City;
Mailing Address (if applicable):
City:
Phone: ( }
Email:
State: Z
State: Zip:
Fax: {
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 A
City;
Phone: (
Email:
State:
Fax: ( )
4. Local jurisdiction for building permits: Cumberland Coun
Point of Contact: Phone #:
Form SWU-101 Version 07Jun2010 Page 2 of 7
Zip:

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater Runoff wiII be treated via a wet detention pond designed for 90% TSS removal. Conveyance to
this structure will be via a system of Reinforced Concrete 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 reguIation(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: +or-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
Area+: +or-62.33 acres
Total project area shall be calculated to exclude thefollowing: the normal pool of irrrpounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) lime 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). Nori-coastal zvetla)tds landward of tlue NHW (or MHM line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 50.85 %
9. How many drainage areas does the project have?1 (For high density, count I for each proposed engineered
stormwater BMP. For low density and other projects, use I for the whole property area)
10. Complete the foIIowing 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
Draina e Area _,
Drainage Area _
Draina e'A"rea . �•,
Receiving Stream Name
Little Rockfish
Creek
Stream Class
C
Stream Index Number *
18-31-24-(4)
Total Drainage Area (so
+or-2831400
On -site Drainage Area (so
+or-2810926
Off -site Drainage Area (so
+or-20474
Proposed Impervious Area** s
+or-1439860
Impervious Area** total
50
Irn ervi6us** Surface Area- "
Drainage Area 1
DrainageArea
Draina e Area-.
Draina e'Are'a .
On -site Buildings/Lots (so
+or-650071
On -site Streets (so
+or-270000
On -site Parking (so
+or-494789
On -site Sidewalks (so
+or-25000
Other on -site (so
N/A
Future (so
N/A
Off -site (so
N/A
Existing BUA*** (so
N/A
Total (so:
+or-1439860
* Stream Class and Index Number can be determined at: Litt?. ortal.rncdenr.or veb u s csue elnssi 'cations
Form S WU-101 Version 07Jun2010 Page 3 of 7

Irrrperviorrs 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 existitg 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.
Protects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater 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://portal.ncdenr.org/web/wq/ws/su/bmp-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://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 Iocating project on the interactive online map at http://portaI.ncdeiir.org/web/wq/ws/su/iiiapss.)
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 Iatest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/wsjsu/statesw/forms_docs.
Initial
1. Original and one copy of the Stormwater Management Permit Application Form.
2. OriginaI and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Forni(s) (sealer 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
hU:L/www.envhelp.org/12ages/onestopexpress.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
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 1/z
mile radius on the map.
7. Sealed, signed and dated calculations.
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.
• DeIineate 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.
A/#
Form SWU-101 Version 07Jun2010 Page 4 of 7

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). NIA
9. Copy of any applicable soils report with the associated SHWT elevations (PIease identify
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"xll" 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 verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: (a)7458, (b)7716, (c)7983, (d)7864, (e)7509 Nh
Page No: (a)610, (b121, (c)767,(d)66, 0128
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 21-1.1003(e). The
corporation or LLC must be Iisted 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
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
http:J/portal.ncdenr.org/web/wcl/ws/su/statesw/for-ms_docs. 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 Iand, 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 EngineerJoe.E. Godwin, Sr. PE _
Consulting Firm: Enoch Engineers, PA
Mailing Address:1403 NC 50 S
City:Benson
Phone: (919 ) 894-7765
Email:[e-mail]
State:NC Zip:27504
Fax: (919 ) 894-8190 T
Fornn SWU-101 Version 07Jun2010 Page 5 of 7

IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
LJCC rLAklesfv"H LG
I, (print or type name of person listed in Contact Information, item 2a) � i2Ci F_ Hai tt, , certify that I
own the property identified in this permit application, and thus give permission to (print or hjpe name of person
listed in Contact Information, item Ia) J e c ZN1t_cc », c , Lt C_ with (print or type name of organization listed in
Contact Information, item Ia) I (C -71 vesjn,LLB to develop the project as currently proposed. A copy of
the Iease 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 Gerrah Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penal l , ,�f up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature:
/7c �Nve�f/k�.�is.1Ll Date:
6V
I, C 1-i c" A',_e A "4 oL a Notary Public for the State of L) C , County of
try, nflloe{ kA ,(> do hereby certify that dfy'k; e personally appeared
before me this S day of Mn,3 20 Q , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, (e, �„ J
SEAL
My commission expires '5C D l" [' r'n bey 1 s �aa 6—
Form SWU-101 Version 07Jun2010 Page 6 of 7

X. APPLICANT'S CERTIFICATION
I, (print or hipe name of person listed in Colt tact Inforrcration, item Ia) f �CC - k� e5f "1y k, JLL
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 Oe proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC,I4?,000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Signature:
I, C 14 C- � �-A ; tie a 46 a Notary Public for the State of
Date: 5-`5`) (
County of
� t'M be 'r l A "C' do hereby certify that ..J A, LAC•, r ' , t' _ _ personally appeared
before me this S day of M ran 2C I1 , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
�1�1�II�ltj� SEAL
Pq,�.'�'�,
0.11
V �psAAy s
Z My commission expires Set�iCm ber- 15 aO( 5—
n 'OU81��r'
a
ND
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Form SWU-101 Version 07.1un2010 Page 7 of 7