SW5190902_Application_20191001

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW —1995 ❑ Coastal SW — 2008 ❑ Ph 11- Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ 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
f • •
1. Project Name (subdivision, facility, or establishment name - should.be consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
CanfiveAire Expansion
2. Location of Project (street address):
305 Northbrook Drive
City:Youngsville County:Franklin Zip:27596
3. Directions to project (from nearest major intersection):
At intersection of Bert Winston Rd (SR 1133) and Northbrook Drive (SR 1970) head south for 3,300' and
CaptiveAire Expansion Site location will be on left.
4. Latitude:36° 02' 56" N Longitude:78° 29' 02" W of the main entrance to the project.
11 M MV5 81010040•„
1. a. Specify whether project is (check one): NNew [-]Modification ❑ Renewal w/ Modificationt
tRenewals 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 NHigh 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 NSedimentation/Erosion Control: 5.19 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:
Is the project located within 5 miles of a public airport? NNo ❑Yes
If yes, see S.L. 2012-200, Part VI.- l�)J rtal.ncdenr.or� �webllr rules-anci-rem Qtions
FormSWU-101 Version Oct. 31, 2013 Page 1 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 ChPPTX � /�;r -� S —1� S
Signing Official & Title:Brandon Hafner
b. Contact information for person listed in item 1a above:
Street Address:4641 Paragon Park Road
City:Raleigh
Mailing Address (if applicable):Same
City:
Phone: (919 ) 882-2410
Email:[e-mail]
State:NC Zip:27616
State:
Fax: ( ) N / A
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: c-"ts Za,11V Z-& e
Signing Official & Title: 126L-?j 7 z-L//j�,DY
b. Contact information for person listed in item 2a above:
StreetAddress: p�f�,�'n� /�`� r
city: l L State: /U C- Zip: 02,76/6
Mailing Address (if applicable): Sy"17—
City: State:
Phone: ( ) Fax:
Zip:
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 &
b. Contact information for person listed in item 3a above:
Mailing
City:_
State: Zip:
Phone: ( ) Fax:
Email:
4. Local jurisdiction for building permits: Youngsville
Point of Contact:Andrew Thomas Phone #: (919 ) 925-3401
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The new building addition and a portion of the new impervious pavements shall be collected and
discharged into the created wetland as shown in the plans.
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 Tar -Pam River basin.
4. Total Property Area: 6.85 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+:6.85 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 zs 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 = 67.6 %
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 By
Drainage Area _
Drainage Area
Receiving Stream Name
Brandy Creek
Brandy Creek
Stream Class *
B;NSW
B;NSW
Stream Index Number *
28-29
28-29
Total Drainage Area (sf)
194,277
95,109
On -site Drainage Area (sf)
194,277
95,109
Off -site Drainage Area (sf)
0
0
Proposed Impervious Area**
(sf)
123,710
72012
Impervious Area** (total)
63.68%
75.727,
Impervious— Surface Area
Drainage Area 1
Drainage Area By
Drainage Area _
Drainage Area
On -site Buildings/Lots (sf)
72,000
0
On -site Streets (so
0
0
On -site Parking (so
14,222
0
On -site Sidewalks (sf)
3,512
0
Other on -site (sf)
0
0
Future (so
0
0
Off -site (sf)
0
0
Existing BUA*** (sf)
11,761
104,108
Total (sf):
101495
1 104,108
* Stream Class and Index Number can be determined at: Lilt,,: ` �rtal.a�cdenr.o� �!zvch we l as csa� c1ssifir,atr'c��
** Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form S WU-101 Version Oct. 31, 2013 Page 3 of 6

'Report LI
AfhutmiDremain after Dunot remor any BUA that
�to beremoved and which will be replaced hxnew BUA.
11. How was the off -site impervious urealisbedubuvedeteroioed?Provided
Projects in Union CopjLq: Contact DfMLDContral 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 forms
must beonbn�i�edfor each B2�Papec�edfor this project. The latest vera�n`eoithe forroocan bedovvzdoadedis-
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed 6ythe Division of Energy, Mineral and
application instruction sheet and BMP checklists are available from
Lt4i- tyk—,eb6vqL-,v. su states", fornis docs. The complete application package should Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map -)
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
Initials
1. Original and one copy ofthe Storozp/utec Management Permit Application Fornz
2. Original and one copy th
e signedondnotarLaedDeedReotricti8c Restrictions Cov
enants
Form
.6��7dxy������6�o/�
3. Originalofthe applicable Supplement Forrn(o) and O&M
agreeruent(s)for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
htto://www.envheII2.or /pages/onestopexpress.html for information on the Express program
and the associated fees. t6ntact 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 _
6. AL)SGSmap identifying the site location. 8the receiving stream ioreported uaclass SAorthe _
receiving stream drains to class SAwaters within 1/2 mile ofthe site boundary, include the 1/2
mile radius oothe map.
7. Sealed, signed and dated calculations (one cupy). ------____.
8. Two sets ofplans (aealed,signed, 8zduted),including:
u. Development/ Project ounoe.
h. Engineer and firm.
c. Location map with named streets and NCSRnumbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
b. Identify all surface waters oothe plans bvdelineating the normal poolelevation of
impounded structures, the banks ofstreams and rivers, the MHWorNHW line oftidal
waters, and any coastalwetlands landward ofthe MIIWorNHW lines.
Delineate the vegetatedbuffer landward fr the normal poolelevutiof 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 BUf\identified and dimensioned.
lc Existing contours, proposedcortours, spotelevations, finished floor elevations.
L Details of roads, drainage features, collection systems, and atorozwazercontrol measures.
m.Wetlands delineated, or amote on the plans that none exist. (Must bedelineated byu
qualified person. Provide documentation ofqualifications and identify the person who
made the determination uuthe plans.
ForuSWU-101 Version Oct. 31,2013 Pa�o4of6

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).
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: 2052 Page No: 198
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 htjll?€7r6l,cmc3_r._owerl�state_
storrnwater-for�rns dogs. 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:T Michael Stocks
Consulting Firm: Stocks Engineering
Mailing Address:P.O. Box 1108
City:Nashville
Phone: (252 ) 459-8196
Email:[e-mail]
State:NC Zip:27856
Fax: ( )
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) Rc�Bt--g i L.. Lta:-,yy 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) BftAu om l4r):FAtE--R with (print or type name of organization listed in
Contact Information, item 1a) Qge 1vr 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 5 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 appropriat cement action inch the assessment of civil penalties of up to $25,000 per day,
pursuant to N 143- j /� .6. X ,I
Signature: � Date:'e�� ���
I, a Notary Public for the State of kJa kVQ . County of
Er q `? r do hereby certify that �W- - QG L, UJA� 4 personally appeared
before me this fday of f (" and ackgiowledge th ue execution of the application for
a stormwater permit. Witness my hand and official seal,
���\11111I�J�
N E p
ZP 9�
_co �,OTARy
PUBL1O =�
✓< i E C Ova
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires d ® I ;�-3 �2"'
I, (print or type name of person listed in Contact Information, item 1a) Brandon Hafner
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. n
Signature: Date: a26,*A I
I, l� ��eL1✓ a Notary Public for the State of 'fit °✓County of
Lei, 4n'I , do hereby certify that I/V /fAl P1.0f?-1Z personally appeared
before me this dY day of � i� h./ , --)-Q 1'� and a owle the • ue execution of the application for
a stormwater permit. Witness my hand and official seal,
TRY _
B L I C
SEAL
My commission expires —i
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6