SW6100701_Application Form_20100702 (2)

F-eb
DWQ, JSE ONLY
Date R g eived
Fee Paid
Permit Number
­.712J to
56bX_3,2__1
60) U IO)rin I
Applicable Rulbs: " ❑ Coastal SW -1995 ❑ Coastal SW -
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters
❑ Other WQ M mt Plan:
2008 ErPh II - Post Construction
❑ Universal Stormwater Management Plan
J(A k6y i
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
77ris fornt nray be photocopiedfor use as an original
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 Connectio
2. Location of Project (street address):
Lakewood Drive and Rockfish Road
City:l-lope 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 bast side of the Intersection.
The location of coordinates below are approximately at the southern entrance from Rockfish Road furthest
int Road. Lakewood Drive intersection.
4. Latitude:34° 58' 51" N Longitude:79° 0' 36" W of the mail
0
H. PERMIT INFORMATION: ---
1.a.Specify whether project is (check one): ®New ❑Modification JUL _ 2 2010
b.If this application is being submitted as the result of a modification to an existing pe mil list the existin
permit number its issue date (if known) an t s& OUALIT
OW Orwich
R
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *pro
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 ®Sedimentation/Erosion Control: 48.0 ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 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:

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 & Title:jackie Hairr, Owner
b.Contact information for person listed in item 1a above:
Street Address:3077 N. Main Street
City:Hope Mills _ State:NC Zip:28348
Mailing Address (if applicable): (same)
City:
Phone: (910 ) 426-0567
Email:[e-mail]
State: Zip:
Fax: (910 ) 426-0567
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 Address:
City:
,,Mailing Address (if applicable):
City:
Phone: ( }
Email:
State: Zip:
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 & Ti
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
Email:
State: Zip:
Fax: f 1
4. Local jurisdiction for building permits: Cumberland County _.
Point of Contact: Phone #:

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater Runoff will 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 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: +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 the following tyre normal pool of impounded structures, the area
between the banks of streams and rivers, tire area below the Normal High Water (NHW) lure or Mean High Water
(MHW) lure, and coastal wetlands landward from the NHW (or MHW) lure. The resultant project area is used to
calculate overall percent built upon area (BUA). Notr-coastal zoetlarrcts larrdzoard of tyre NHW (or MHW) litre tuay
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, rise T 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
Draina a Area _
Drainage Area _
Drainage Area _
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 (sf)
+or-2810926
Off -site Drainage Area (so
+or-20474
Proposed Impervious Area** s
+or-1439860
Impervious Area** total
50
Impervious** Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
+or-650071
On -site Streets (so
+or-270000
On -site Parking (so.
+or494789
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: littp//portal.ruderrr.org/uct_eb/icJqZps csulclgssifications
Form SWU-101 Version 07Jun2010 Page 3 of 7

** hu rcruious area is defirted as the built rrpoti rhea bi'Midiug, brit )rot limited to, buildings, roads, parking areas,
sir ezoalks, gravel areas, etc.
* � Report only that amonrrt a f esistbtg BUA that will renmiu after development. Do not report any et•istiug BUA that
is to be removed arrd 701101 Will be replaced by uercr BLIA.
1-1. I -low was the off -site impervious area listed above determined? Provide documentation.
Projects in Union County: Contact DfVQ Central OJJice stafjtn check if the project is located tiritlria rr '!'hrerrterrerl d'
Ewlangercd Species watershed that nrav he subjeci to more s'triagew stonmi Ater r'equirciaetrls 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 13MP specified for this project. The latest versions of the forms can be downloaded
from httu://vortal.ncdenr.ore/web/wa/ws/su/l)mU-1llanLlal.
Vl. SUBMITTAL REQUIREMENT'S
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://portaI.ncdenr.org/web/wq/ws/su/statesw/forms_docs. The complete
application package should be submitted to the appropriate DWQ Office. ('File appropriate office may be
found by locating project on the interactive online map at http://portal.ncdcnr.ors /web/wy/tivs/su/maw.)
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 does.
Irrr tars
1. Original all one copy of the Storniwa ter Management Permit Application Form. cD��
2. Original awl o)re copy of the signed and notarized Deed Restrictions & Protective Covenants
form. (if required as I?cr Part V11 17CIOir7)
3. Original of the applicable Supplement Forrn(s) (sealed, signed and dated) and O&M
agreement(s) for each 13MP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://www.envlielp.org/pa,ges/onestopexpr•ess.litrnl 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/nianagementfor
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
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. Frigineer and firm.
c. Location map with named streets and NCSf2 numbers.
d. Legend.
e. North arrow.
f. Scale.
g. 1Zevision 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 MFJl ,V or NHW line of tidal
waters, and any coastal %vetiands landward of the MHV'V or NI-IW 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 13UA 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.
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1701.11, SWU-101 Version 07.Jun2010 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. 1xisting drainage (including off -site), drainage easements, pipe sizes, 111110tl Ca1CUlatto115.
o. Drainage areas delineated (included in the main setof 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
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"01" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration 13MPs, the report should also
include the soli type, expected infiltration rate, and the method of deterrllining the infiltration fate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verify the SHWT prior
to subinittaTl, [phone].)
'10. A copy of the most current property deed. Deed book: (a)7458, (b)7716, (c)7983, (d)7864, (e)7509
Page No: (a)6'10, (lb)'I21, (c)767, (d)66, ( 128 fir) R
VI. For corporations and htnited 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 2I-1.1003(e). The
corporation or LLC 111Ust be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
Iltt www.secretarv.state.nc.US/ Cor orations CSearch.as x
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparceis, 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 cacti 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://pin'tar.eudenr.org/+web/wq/ws/sir/statesw/fortes 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 farm 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.
VII1. CONSUL"PANT 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 I3ngineeraoe E. Godwin, Sr.
Consulting Firm: Enoch Engineers, PA
Flailing Address:1403 NC 50 S
Ciiy:13enson
Phone: (9-19 ) 894-7765
l�uiail:[e-mail]
Sta te: NC Z i p:27504
Fax: (919 ) 894-8190
Form SWU-101 Version 07311112010 Page 5 of 7

IX. PROPERTY OWNER AUTHOIZIZATION' (if Co)rtact Information, item 2 has been filled orrt, complete this
section)
1, (print or type trance of person lister! in Contact Information, item 2a) r�GZGe�I� � ��ir✓ certify that I
own the property identified in this permit application, and thus give permission to (print or type rranre of person
listed in Contact Information, item 1a) with (print or type name of organization listed i)r
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 tile stormwater system.
As the legal property owner I acknowiedge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 'l) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stornnvater 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 f'o1•m within 30 days; otherwise 1 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 Gen ral Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penaltil&f up to $25,000 per day, pursuant to NCGS 143-2-15.6.
Signature:
CNmbet �4��
Date: :(,-2 �'- /U
C , a Notary Public for the State of NV("' C(' "6 1 , County of
do hereby certify that
Jacic,�e ko;d �(
personally appeared
before me this 9� day of JL4 ad to , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
O�Qti T . G
.� p
4 Notary Public n`
Cumberland County
2 �T
O
SEAL
My commission expires `' oQ) —C)
Form SWU-101 Version 07.1un2010 Page 6 of 7

X. APPLICANT'S CERTIFICATION
1, (print or type name of person listen in Contact Information, item Ia) —TaC z
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 (iced restrictions
and protective covenants w 1 be recorded, and that the proposed project complies with the requirements of the
applicable stormwater ru ,? Jier 15A NCAC 21-1 .1000, SL 2006-246 (Ph. 11 - Post Construction) or SL 2008-21.1.
Signature:
Date:_ _6- z 5 !n
% ` e- 6 } ! 1 L a Notary Public for the State of �Gr'fh �a�d r> �, County of
oymba: 1Gn4 ,doherebycertifythat- - ja4k,�t gGtl/'
personally appeared
before me this �j day of j uAg- , 061 V , and acknowledge the clue execution of the application for
a stormwrater permit. Witness my hand rind official seal, '� '
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`\\\xO�P�[�Ol.,�i�
w O Rp1asV Public
Cumberland CoUnW r
ti
O
TH I C
SEAL
My commission expires
Form SWU-101 Version 07Jun2010 Page 7 of 7