SW6091201_Application_20091209

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DWQ USE ONLY
Date Received
Fee Paid
Permit Number
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Applicable Rules: ❑ Coastal SW,'.-il995 tr,,,'� '' �O Coastal SW
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters
❑ Other WQ M mt Plan:
- 2008 ❑ Ph 11- Post Construction
❑ Universal Stormwater Management 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.):
Cashwell Elementary School Addition
2. Location of Project (street address):
2970 Legion Road
City:Fayetteville County:Cumberland Zip:28306
3. Directions to project (from nearest major intersection):
RIGHT onto OWEN DR, travel approx. 0.5 miles Turn SLIGHT LEFT onto SOUTHERN AVE travel approx
0.3 miles SOUTHERN AVE becomes LEGION RD travel 0.7 miles and the school is located on the right
4. Latitude:35° 00' 64" N Longitude:-78° 91' 43" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): NNew ❑Modification
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: NNot 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 stonnwater 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):
❑LAMA Major
❑NPDES Industrial Stormwater
NSedimentation/Erosion Control: 2.30 ac of Disturbed Area
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:N/A
Form SWU-101 Version 07Ju1y2009 Page I 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 oroiect):
Applicant/Organization:Cumberland County Board of Education
Signing Official & Title:Tim Kinlaw, Associate Superintendent of Auxilary Services
b.Contact information for person listed in item la above:
Street Address:P.O. Box 2357
City:Fayetteville State:NC Zip:28302
Mailing Address (if applicable):P.O. Box 2357
City:Fayetteville State:NC Zip:28302
Phone: (910 ) 678-2300
Email:[e-mail]
Fax: (910 ) 678-2486
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:Cumberland County Board of Education
Signing Official & Title:Tim Kinlaw, Associate Superintendent of Auxilary Services
b.Contact information for person listed in item 2a above:
Street Address:P.O. Box 2357
City:Fayetteville State:NC Zip:28302
Mailing Address (if applicable):P.O. Box 2357
City:Fayetteville State:NC Zip:28302
Phone: (910 ) 678-2300
Email:[e-mail]
Fax: (910 ) 678-2486
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
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing Address:
Zip:
Phone:
4. Local jurisdiction for building permits:
Fax:
Point of Contact: Phone #:
Form SWU-101 Version 073uly2009 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The storm water runoff from the roofs and new parking lot will be collected and conveyed into concrete
flumes which then release the storm water runoff into the forebays of an infiltration basin. Once the forebays
are filled the runoff will spill over into the infiltration basin to be treated.
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 PUDApproval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.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: 15.12 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':
15.12 acres
Total project area shall be calculated to exclude the following the normal pool of imppounded 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 MHVV) 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 = 23 %
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 —
Drainage Area _
Drainage Area _
.Drainage Area _
Receiving Stream Name
N/A
Stream Class *
N/A
Stream Index Number *
N/A
Total Drainage Area (sf)
43996
On -site Drainage Area (sf)
43996
Off -site Drainage Area (sf)
0
Proposed Impervious Area** (sf)
25265
% Impervious Area** (total)
57
Impervious" Surface Area
Drainage Area-_
Drainage Area _
Drainage Area
Drainage Area _
On -site Buildings/Lots (so
10360
On -site Streets (sf)
0
On -site Parking (sf)
10994
On -site Sidewalks (so
3911
Other on -site (so
0
Future (sf)
0
Off -site (so
0
Existing BUA*** (sf)
0
Total (sf):
25265
* Stream Class and Index Number can be determined at: http://h2o.enr.state.nc.us/bitns/reports/reportsWB.html
** 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 07July2009 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation.
Projects in Union County: Contact DWQ Central 0, fce staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringers 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
fromhtty://h2o.enr.state.nc.us/su/bmD forms.htm.
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://h2o.enr.state.nc.us/su/bmp forms.htm. 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 ht42://h2o.enr.state.nc.us/su/msi maps.htm.)
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://h2o.enr.state.nc.us/su/bmp forms.htm.
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 beloro)
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/onestol2exl2ress.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'h mile of the site boundary, include the'h
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.
I. 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.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
Form SWU-101 Version 07July2009 Page 4 of 6

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9. Copy of any applicable soils report with the associated SHWT elevations (Please identify Act
elevations in addition to depths) as well as a map of the boring locations with the existing <Ay. D%tX(not*h_
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the pasugr�
project area clearly delineated. For projects with infiltration BMPs, the report should also 13Di+A
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 verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 2689 Page No: 0419
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC a tJLk
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.
http: / /www.secretary.state.nc.us /Corporations/CSearch.aspxx
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://h2o.enr.state.nc.us/su/bml2 forms.htmxdeed restrictions. 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:Adriana Hegeman
Consulting Firm: Crawford Design Company
Mailing Address:116 North Cool Spring Street
City:Fayetteville State:NC Zip:28306
Phone: (910 ) 221-0033 Fax: (910 ) 221-0035
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section) �0�
I, (print or type name of person listed in Contact Information, item 2a) ^=-- \ r ify 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 la) with (print or type name of organization listed in
Contact Information, item 1b) 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 07July2009 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 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 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: �//4 n^n� � � � Date: tI//2/Z4V
I, & M i l lQ ZU -/Y[ayiva A , a Notary Public for the State of Abr4AQWQltN4 . County of
0um61r key j . do hereby certify that �m KtN personally appeared
before me this fZ�day of /VOVe nn ?CY)�i , and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal, 412� ii tGyevl/
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X. APPLICANT'S CERTIFICATION
SEAL
My commission expires 19116 LZO/3
I, (print or hype name of person listed in Contact Information, item 2) Tim Kinlaw, Associate Superintendent of Auxilarg
certify that the information included on this permit application form is, to the best of my knowledge, correct anc
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 21-1.1000, SL 2006-246 (Ph. II — Post Construction) or SL 2008-211.
Date:
a Notary Public for the State of
do hereby certify that
County of
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
Form SWU-101 Version 07July2009 Page 6 of 6