20061804 Ver 25_SSW-SWU-101-Application - Publix_20190412

DEMLR 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 Mgmt Plan:
Form SWU-101 Version Oct. 31, 2013 Page 1 of 6
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.):
Publix at Flowers Plantation
2. Location of Project (street address):
4684 NC Hwy 42
City:Clayton County:Johnston Zip:27527
3. Directions to project (from nearest major intersection):
At the intersection of US Hwy 70 Bus and NC Hwy 42 head Northwest on NC 42 for 5.2 miles. The site
emtrance will be on the rignt directly across from the intersection of NC Hwy 42 and Flowers Parkway.
4. Latitude:35° 39’ 09.08” N Longitude:78° 21’ 11.27” 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. 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):
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
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: 19.05 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,
issue date and the type of each permit:Publix at Flowers Plantation, ID: JC#19-015-P April 4th, 2019 Erosion
Control Approval
5. Is the project located within 5 miles of a public airport?No Yes
If yes, see S.L. 2012-200, Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6
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:Rebecca Flowers
Signing Official & Title:Reid Stephenson / Power of Attorney
b. Contact information for person listed in item 1a above:
Street Address:4880 NC 42 East
City:Clayton State:NC Zip:27520
Mailing Address (if applicable):
City: State: Zip:
Phone: (800 ) 343-0659 Fax: ()
Email:[e-mail]
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 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: State: Zip:
Phone: ( ) Fax: ( )
Email:
4. Local jurisdiction for building permits: Johnston County
Point of Contact: Phone #: ( )
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6
IV.PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be treated on this site by a 1.3 Ac. wet pond which has been designed to treat all runoff from
Lots #1 -5 and 7. In future development, Lot #6 will be treated and permitted separately.
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: 3/11/2013
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.
4. Total Property Area: 54.82 acres 5. Total Coastal Wetlands Area: 0.0 acres
6. Total Surface Water Area: 4.9 acres
7. Total Property Area (4) – Total Coastal Wetlands Area (5) – Total Surface Water Area (6) = Total Project
Area+: 49.92 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 = 38.2 %
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 Neuse River
Stream Class *WS-IV;NSW
Stream Index Number *27-(38.5)
Total Drainage Area (sf)1,744,297
On-site Drainage Area (sf)1,690,002
Off-site Drainage Area (sf)54,295
Proposed Impervious Area** (sf)858,546
% Impervious Area**(total)49%
Impervious** Surface Area Drainage Area 1 Drainage Area Drainage Area Drainage Area
On-site Buildings/Lots (sf)139,220
On-site Streets (sf)80,705
On-site Parking (sf)114,950
On-site Sidewalks (sf)5,140
Other on-site (sf)
Future (sf)504,331
Off-site (sf)14,200
Existing BUA*** (sf)0
Total (sf):858,546
* Stream Class and Index Number can be determined at:http://portal.ncdenr.org/web/wq/ps/csu/classifications
** Impervious 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 existing BUA that
is to be removed and which will be replaced by new BUA.
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6
11. How was the off-site impervious area listed above determined? Provide documentation. Off site impervious
counted was existing roadway which is included in the survey.
Projects in Union County:Contact DEMLR 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 15A 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 Energy, Mineral and
Land Resources (DEMLR). 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_docs. The complete application package should be
submitted to the appropriate DEMLR Office.(The appropriate office may be found by locating project on the
interactive online map at http://portal.ncdenr.org/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.
2.Original 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 Form(s) (sealed, 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.envhelp.org/pages/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/management for
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 ½ mile of the site boundary, include the ½
mile radius on the map.
7.Sealed, signed and dated calculations (one copy).
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.
l.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.
Form SWU-101 Version Oct. 31, 2013 Page 5 of 6
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
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 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 DEMLR to verify the SHWT prior
to submittal, [phone].)
10.A copy of the most current property deed. Deed book: Page No:
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 1a, 2a, and/or 3a per 15A 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.
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://portal.ncdenr.org/web/lr/state-stormwater-
forms_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 land, that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR, 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:
Consulting Firm:
Mailing Address:
City:State: Zip:
Phone: ()Fax: ()
Email:
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I,(print or type name 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 1a) with (print or type name of organization listed 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.
Form SWU-101 Version Oct. 31, 2013 Page 6 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 DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR 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:
I, _____________________________________, a Notary Public for the State of ____________________, County of
____________________, do hereby certify that ______________________________________ personally appeared
before me this day of _________________, _______, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, _________________________________________________
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I,(print or type name of person listed in Contact Information, item 1a),
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 and any other applicable state stormwater requirements.
Signature: Date:
I, _____________________________________, a Notary Public for the State of ____________________, County of
____________________, do hereby certify that ______________________________________ personally appeared
before me this day of _________________, _______, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, _________________________________________________
SEAL
My commission expires
SURPLEMENT-EZ COVER PAGE
FORMS LOADED
PROJECT INFORMATION
1 Project Name Pu.blix at Flowers Plantation
2 Project Area ac 54.82
3 Coastal Wetland Area(ac) 0
4 Surface Water Area ac 4.9
5 Is this project High or Low Density? High
6 Does this project use an off-site SCM? No
CE WITH 02H.1003(4)
7 Width of vegetated setbacks provided feet 50'
8 Will the vegetated setback remain vegetated? Yes
9 is BUA other that as listed in.1 003 4 c-d out of the setback? No
1 D Is streambank stabilization proposed on this project? No
NU AND TYPE OF SCMs:
11 Infiltration System 0
12 Bioretention Cell 0
13 Wet Pond 1
14 Stormwater Wetland 0
15 Permeable Pavement 0
16 Sand Filter 0
17 Rainwater Harvesting RWHI 0
18 Green Roof 0
19 Level Spreader-Filter Strip LS-FS 0
20 Disconnected Impervious Surface(DIS) 0
21 Treatment Swale 0
22 Dry Pond 0
23 StormFilter 0
24 Silva Cell 0
25 Bayfilter 0
26 Filterra 0
FORMS LOADED
DESIGNER CERTIFICATION
27 Name and Title: Mike Stocks,P.E.
28 Organization: Stocks En ineerin
29 Street address: 801 E Washington St.
30 City,State,Zip: Nashville, NC 27856
31 1 Phone number(s): 252-459-8196
32 1 Email: [e-mail]
Certification Statement:
i certify,under penalty of law that this Supplement-EZ form and all supporting information were prepared under my direction or
supervision;that the.information provided in the form is,to the best of my knowledge and belief,true,accurate,and complete;and
that the engineering plans,specifications,operation and maintenance agreements and other supporting information are consistent
with the information provided here.
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DRAINAGE AREAS
1 Is this a high density project? Yes
2 If so,number of drainage areas/SCMs 1
Is all/part of this project subject to previous rule
3 versions? No
FORMS LOADED
DRAINAGE AREA INFORMATION Entire Site 1
i 4 Type of SCM Wet Pond
5 Total BUA in project(sq ft 354215 sf
New BUA on subdivided lots(subject to permitting)
6 (sq ft 504331 sf
New BUA outside of subdivided lots(subject to
7permitting) s
8 Offsite-total area(sq ft 54295 sf
9 Offstte BUA(sq ft 14200 sf
10 Breakdown of new BUA outside subdivided lots:
-Parking(sq ft 114950 sf
-Sidewalk(sq ft 5140 sf
-Roof(sq ft 139220 sf
-Roadway s ft 80705 sf
-Future(sq ft 504331 sf
-Other,please specify in the comment box
below(sq ft
New infiltrating permeable pavement on
11 subdivided lots(sq ft
New infiltrating permeable pavement outside of
12 subdivided lots(sg ft
Exisitng BUA that will remain(not subject to
13 ermillin s ft
14 Existing BUA that is already ermined(sq ft
15 Existing BUA that will be removed(sq ft
16 Percent BUA 49%
_17 design storm Inches 1 in
18 Design volume of SCM cu ft 71219 cf
19 Calculation method for design volume SIMPLE
;ADDITIONAL INFORMATION
Please use this space to provide any additional information about the
20 drainage area(s):
;
DRAINAGE AREA INFORMATION Entire Sife 1
4 Type of SCM Wet Pond
5 Total BUA from project(sq ft)
6 1995 rules
SL 2006-246
2008 rules
2017 rules 354215 sf
New BUA on subdivided lots(subject to
7 permitting)(sq ft)
1995 rules
SL_2006-246
2008 rules
2017 rules 504331 sf
New BUA outside of subdivided lots(subjoct to
8 permitting)(sf)
1995 rules
SL 2006-246
2008 rules
2017 rules sf
9 Offsite-total area(sq ft)
1995 rules
rSL 2006-246
2008 rules
2017 rules 54295 sf
10 Offsite BUA(sq ft)

1-995 rules
SL 2006-246
2008 rules
2017 rules 14200 sf
11 Design storm(inches)
1995 rules
SL 2006-246
2008 rules
2017 rules 1 in
12 Breakdown of new BUA:
Parking(sq ft 114950 sf
Sidewalk(sq ft 5140 sf
Roof(sq ft 139220 sf
Roadways ff 80705 sf
Future(sq ft 504331 sf
Other,please specify in the comment box
below(sq ft
New infiltrating permeable pavement on
13 subdivided lots s ft
New infiltrating permeable pavement outside of
14 subdivided lots(sg ft
Exisitng BUA that will remain(not subject to
15permitting) s fi
16 Existing BUA that is already permitted s ft
17 Existing BUA that will be removed(sq ft
18 Percent BUA 49%
19 Design volume of SCM cu ft 71219 of _
20 Calculation method for design volume SIMPLE
TIONAL INFORMATION
Please use this space to provide any additional
121 1 information about the drainage area(s):

WET PON
11 Drainage area number 1
21 Design volume of SCM(cu ft) 71219 cf
GENERAL MDC FROM 02H.1050
3 Is the SCM sized to treat the SW from all surfaces at build-out? Yes
4 Is the SCM located away from contaminated soils? Yes
5 What are the side slopes of the SCM(H:V)? 3:1
Does the SCM have retaining walls,gabion walls or other engineered
6 side slopes? No
Are the inlets,outlets,and receiving stream protected from erosion
7 (10-year storm)? Yes
Is there an overflow or bypass for inflow volume in excess of the
8 design volume? Yes
9 What is the method for dewatering the SCM for maintenance? Drawdown Orifice
10 If applicable,will the SCM be cleaned out after construction? Yes
11 Does the maintenance access comply with General MDC(8)? Yes
12 Does the drainage easement comply with General MDC(9)? Yes
If the SCM is on a single family lot,does(will?)the plat comply with
13 General MDC(10)? Yes
14 Is there an O&M Agreement that complies with General MDC(11)? Yes
151 Is there an O&M Plan that complies with General MDC(12)? Yes
161 Does the SCM follow the device specific MDC? Yes
17 Was the SCM designed by an NC Licensed professional? Yes
WET POND MDC FROM 02H.1053
18 Method used SA/DA
19 Has a stagelstorage table been provided in the calculations? Yes
Elevation of the excavated main pool depth(bottom of sediment
20 removal)(fmsf) 257.00
I
21 Elevation of the main pool bottom-(tap of sediment removal)(fmsf) 258.00
22 Elevation of the bottom of the vegetated shelf(fmsl) 262.00
23 Elevation of the permanent pool(fmsf) 262.00 j
24 Elevation of the top of the vegetated shelf(fmsl) 263,00
25 Elevation of the temporary pool(fmsl) 264.00
26 Surface area of the main permanent pool(square feet) 3275971
27 Volume of the main permanent pool(cubic feet) 80111 cf
28 jAverage depth of the main pool(feet) 3.00 ft
29 Average depth equation used Equation 2
30 if using equation 3,main pool perimeter(feet)
31 If using equation 3,width of submerged veg.shelf(feet)
32 Volume of the forebay(cubic feet) 15976 cf
33 Is this 15-20%of the volume in the main pool? Yes
34 Clean-out depth for forebay(inches) 12 in
351 Design volume of SCM(cu ft) 71219 cf
36 Is the outlet an orifice or a weir? Orifice
37 If orifice,orifice diameter(inches) 6 in
38 If weir,weir height(inches)
39 If weir,weir length(inches)
40 Drawdown time for the temporary pool(days) 2.4
Are the inlet(s)and outlet located in a manner that avoids short-
41 circuiting? Yes
42 Are berms or baffles provided to improve the flow path? No
43 Depth of forebay at entrance(inches) 96 in
44 Depth of forebay at exit(inches) 12 in
45 Does water flow out of the forebay in a non-erosive manner? Yes
46 Width of the vegetated shelf(feet) 6 ft
47 Slope of vegetated shelf(H:V) 6:1
Does the orifice drawdown from below the top surface of the
48 permanent pool? Yes
Does the pond minimize impacts to the receiving channel from the 1-
49 yr,24-hr storm? Yes
Are fountains proposed?(If Y,please provide documentation that
50 1 MDG(9)is met.) No
51 Is a trash rack or other device provided to protect the outlet system? Yes
52 Are the dam and embankment planted in non-clumping turf grass? Yes
53 Species of turf that will be used on the dam and embankment Centipede
54 Has a planting plan been provided for the vegetated shelf? Yes
ADDITIONAL.INFORMATION
Please use this space to provide any additional information about the
55 wet pond(s):
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EXISTINGWETLANDS / STREAMTO REMAINCE-11PUBLIX at FLOWERS PLANTATION
CLAYTON, NORTH CAROLINA