SW6140505_Application_20140728

DWQ LSE ONLY
Dote Received Fee Paid 9f ` �Ait Number
s _ z zoi�sos.
Applicable Rules: ❑ Coastaly SW -1995 ❑ Coastal SW - 2008 Gl3'f II I - Post Cons6vction
(select all that apply) 1�] Non -Coastal SW- HQW/ORW Waters ❑ Universal Stmmwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This lone may be photocopied fir use as an original
L 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.):
KFI Motor Pool Expansion at Fort Bragg
2 Location of Project (street address):
Pratt Street
City:l'ort Bragg C.,unty:Cumbcrland Zip:'18310
3. Directions to project (from nearest major intersection):
The project is located on the northern side of Pratt Sheet ap-proximately 1100 feet east of the intersection of
Pratt Sheet and Lewis Street in Fort Bragg, NC
4. Latitude:35° 09' 26" N Longitude:790 00' 54" W of the main entrance to the project.
It. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modification[
r Rcruanols zrith orodi/ications also requires 5'NLI-102 - Renewal AppliMiun Dorm
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
coils hvction: ❑Not Started ❑Partially Completed* ❑ Completed* "provide a designer's certification
2. Specify the type of project (check one):
❑Low Density NFligh 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, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; hnformation on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ❑Sedimentation/Erosion Control: 1.3 ac of Disturbed Area
❑NPDFS Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have aheady been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
5. Is the project located within 5 miles of a public airport? IXNc, "Yes
If ye.,, see S.L. 2012-200, Part VI: httl2://portal.ticdenr.org/web/wq/wsrsu/Stltesw/rules laws
Farm SWU-101 Version 06Aug2012 Page I of 6

III. CONTACT INFORMATION
I. 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:NC National Guard
Signing Official & Title:Cul. Toni L. Coats
b.Contact information for person listed in item la above:
Street Address:
Mailing Address (if
Phone:
State: Z
State
Fax:
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):
Properly Owner/Organization:nepartrnentof Defense
Signing Official & Title:Dave Heins, DPW - Water Management Branch
b.Contact information for person listed in item 2a above:
Street Address:Building 3-1631 Butner Road
City:Fort Bragg State:NC Zip:28310
Mailing Address (if applicable):
'Lip:
Phone: 91( 0 ) 396-0321 Fax:
E-niail:[e-mail]
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:NC National Guard
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State:
Phone: ( 1 Fax: ( )
4. Local jurisdiction for building permits: Fort Bragg
Point of Contact:Hector Cruz Phone k: 911( ) ) 432-4111
Form SWU-101 Version 06Aug2012 Page 2 of

11. How was the off -site impervious area listed above determined? Provide documentation. n/a
ProiecU in Union County: Contact D19'Q Cwrtra! Office clq(fto check J the project is located within a Threnfened &
EndangeredSpecies watershed thut nruy be.uabiecl to more slringeat srnrmn•uler requiremants' as per 15A NCAC 025 .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&Ivl) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.iiedenr.org/web/wq/ws/su/bmi)-nnaiival.
VL 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. Thecomplete
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 http://portal.ncdenr.org/web/wq/ws/su/ map .)
Please indicate that the following rellUired 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 hh>tp://Vortal.ncLieiir.or5tweb/wq/ws/su/statesw/forms does.
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) (scaleai,_signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCOL'NR. (For an Express review, refer to
htW:/ /www.envhelp.org/pages/onestopexprus.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 stormwa ter treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USCS 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 1/2
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. Devetopment/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 dolineah:d (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
FormSWLJ-101 Version06Aug2012 Page 4nf6

IV. PROJECFIN FORMATION
1. [n the space provided below, briefly summarize how the storm water runoff will be treated.
'The stornrwater runoff will be treated by routin ig [ through a grassed Swale that drains to a dry detention
basin before being outlet to another grass swale
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 Conshtiction
3. $tormwater runoff from this project drains to the
4. Total Property Area: 1.33 acres
River basin.
5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area,: 1.33 acres
Totat project nrea shall be calculated to exclude the following the nornrnl pool of impounded structures, the area
betroeen the banks of streams and ricers, the awn bclotu the Normal High Witter (NNW) line ur Mean High bunter
(MHW) line, and constnl tuethi nis landrorrr•+1 from the NHW (or MHW) line. The resulhmt project area is used to
caladnie overmtl percent built upon area (BLIA). Non -coastal tuethmds landward of dte NHW (or MHl'V) line Wray
be included in the total project amn.
8. Project percent of impervious area: ('Total Impervious Area / Total Project Area) X 100 = 60.91
9. How many drainage areas does the project have?l (For high density, court I for each proposed engineered
,storrnumter BMP. For loco 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 I_
Drainage Area
Drainage Area
Drainage Area _ I
Receiving Stream Name
Tank Creek
Stream Class "
C
Stream Index Number `
18-23-27
Total Drainage Area (so
50966
On -site Drainage Area (st)
50966
Off -site Drainage Area (sf)
0
Proposed Impervious Area" (s
35302
% Impervious Area" (total)
69.27%
Impervious'* Surface Area
Drainage Area l
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
On -site Streets (so
On -site Parking (so
35302
On -site Sidewalks (sf)
Other on -site (so
Future (sf)
_
Off -site (sf)
Existing BUA""" (so
_
Total (sf):
35302
" Stream Class and Index Number can be deternnmed at: hitaVImr1al.urderrr.arg[rcei unI/p,%:rr/tlu5si ic•uNnrrs
Imppervious arren is dtf red as due built upon area including, but not limited to, buildings, roads, parking areas,
si+le•roalks, gravel areas. etc.
Report omit that amount of existing BUA that toill remain after development. Do not report nny eristiug SLIA that
its to be remover/ and which will be replaced bg nczw BUA.
Forst S W U-101 Version 06Aug2012 Page 3 ut6

9. Copy of any applicabie soils report with lie associated SIUVT elevations (Please identify _
elevations in addihon to depths) as well as a neap of the boring locations with the existing
elevations and boring logs. Include an 8 5"xI I" copy of the NRCS County Soils map with the
project area clearly delineated. 1'or projects with infiltration BivlPs, the report should also
Include the soi! type, expected infiltration rate, and the method of determining the infiltration rate
(infiltration Devices submitted to MRO: Schedlde n ilte nlsit far DbVt1 to ten/ti/ the SIB:'/T pnmr
to subnlithd. [phone].1
10. A copy of the most current property deed. Deed book: n/a Page No: Ida
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 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of Shitc. otherwise the application will be rehrrned.
htto:/ / www.secretary.5tate.nc.us/Cornoratiuns /CSearch.asox
VTI. DEED RESTRICTIONS AND PROT'FCTIVE 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
vrotective covenants forms can be downloaded from
.http:/ /portrd.ncclenr.org web/wg/ws/su/;tatesw/forms docv. 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 lie deed restricUoss and protective covenants form while the applicant is responsible lot ensuring
that the deed restrictions are recorded.
By the notarized signatures) 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.
Vlll. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual andJor 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).
ConsultingLllgineer:Scott
Consulting Firm.
:\tailing Address:222"l Schnuck Road
(AWC'olumbus —_-_-' __—.._---- State:01-1 — Zip 43229 --
Phone: i+l4 n9h 7Iv'0 Fax: 0l4 1 d93-75iU
h.mailsleih•dP)mscnrrsultants.com—
M PROPERTY OWNER AUTHORIZATION !If Contact hrji;lrinatfon, Item 2 has been filled out, eongrfete this
rt•ChvlJ
1, (priW ;r type name of person hthrti in Contain hiformatimr, Item 2a) Fort Bragg DPW (Uave Hems) • certify that t
owit the property iclentitird in this ponnit application, and thus give permission to ipplot or h/pe mmle .at c on
%urea nl t_untnR hlibnuntiaa. Itcn' i10 Col. Tall i.. ccat; ll't:•:1:1,
Caatnct .l, ucvu !al"_ r_`inp,.;;d! l„Ilir;i -_-.-- to develop the pruject as cut rentiq propueed. A Copy of
the lease agreement or vending property sales contract has been provided with t!ae submittal, which indicate; the
party nesponsible. for the operaticm and mainLena lice of Lho storm �watei syslem.
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F�lte� wl,..,p tt-...._-_ a Motary Public for the State of �!,,r,,r�-.,�,t,»:__.,,,_._. County of
rasa •��rv.Krz, do hereby certify that D�.�. +� - He:.. y-_ perenally appea:od
before me this 'a✓, day of �'!�Tz. � __ 1:; it--- And ac?,net�•(Gel'r t e du a execution of the applicatim for
a stormwatr permit. Witness my hand and official seal,
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:rat Te rrtert'.,'1q be ConBtimcmd In ,:om, rr ;epCn AT me approved plain lha: thr required ;teed reSionam
and pateak ewenants ✓dl A re•.:::i led and :hat :he proposed project zomphes -,nth the nnlunemens of me
app iicab'e iorrP'nshr riles '.infer 13A �NCA�C T�H AM -ind im• ether fate storm',: :ter r;quir-,menr
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------ a Notary 7ublic for the State of County of
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do hereby certify that D— d;. AL - —V- ltl .. - -- ----
hcm.-2 'MIC this , O dav or tiic due execution of the applUcation for
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