HomeMy WebLinkAboutSW3200801_SSW-SWU-101-Application-DEMLR-SPU Oct 2013-signed_20200810DEMLR USE ONLY
Date Received Fee Paid Permit Number
Applicable Rules: D Coastal SW - 1995 0 Coastal SW - 2008 [1 Ph 11 - Post Construction
(select all that apply) 0 Non-CoastalSW- HQW/ORW Waters 0 Universal Stormwater Management Plan
El Other WQ Mgmt Plan:
State of North Carolina
Division of Ener,-
STORMWATER MANAGEMENT PERMIT APPLICATION FOR1,T1
Thisforni may be photocopiedfor use as an original
•
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements,
rr Colnercial [luildill
NC I l'wv 200 Concord
City:Concord
CIOL,Inty:Cabarrus
660 feet south east of the intersection of NC 200 and Mt Pleasant Road 5.,LJj ..........
4. Latitude:35' 19' 1.52" N . . . . . ............. - Longitude:80' 28' 26.1" W of the main entrance to the projelu
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): New E]Modification E] Renewal w/ Modificationf
tReneivals ivith modifications also requires STIVU-102 - Renewal Application Fornz
ifi-llj&mTmwzwAtiL!iM#r�r�..Iist the existing
permit number its issue date (if known)_-- and the status of
construction: ONot Started F-11'artially Completed* 0 Completed* *provide a designer's certification
Specify the type of project (check one):
ZLow Density DHigh Density RDrains to an Offsite Stormwater System ROther
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):
DLAMA Major oSedimentation/Erosion Control: 3.96 -- ac of Disturbed Area
ONPDES 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 perniiLCABAR-2020-021 - October 2,9 2019_
Is the project located within 5 miles of a public airport? ENo [--]Yes
Ifues. see S.L. 2012-200, Part VI: http:H2 tal.ncdei-ir.ore/web/Ir/rules-and-Egglilations
Fon-nSWU-101 Version Oct. 31,2013 Pagel ofe
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns ther6ect):
Applicant/ Organization: Tim Furr
SigningOfficial & Title:Ow.ner . . . . . . . .. . ............... . ............................ . . ..................... . . ..... . .
11,14-py,TP IN
,%=! p 1! 1! 11! 111! 11! 11 1 1! 11 111! MOSIMM
Street Address:5615 Shoreview Drive
Conc
ord
. . . . . ..........
Mailing Address (if applicable)
City: -- ----
Phone: (704 y791-2849
11mail:rossftirr(i 0O.00111
. . . ........ -- . ....... . .
State:NC Zip:28025
State:. Zip:
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)
E] 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:.. . �....�.�,,,,,,,,,,,,,,�p, ��.........,,,.,,p� �� � �...
Signing Official& Title:,111",,,,-,-,---,,,,,,,,, ....
.. ......
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/Or anization:., ............ . .. ....... -- . ................
Signing Official & Title:—
b. Contact information for person listed in item 3a above:
Mailing Address: ------
City: .......... State:-,---,.-. -11. Zip:
Phone: Fax:
Email:
4. Local jurisdiction for building permits: CabarrLls Comity -
Point of Contact:Phil Collins . Phone #: (704 —_)- 920-2181
. ........ ........... -
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6
Runoff will itch
„be sheet flow across site into drainage dalong existing roadway.,
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:
vestedb. If claiming s project has been designed accordance
D Coastal SW - 1*Post Construction
3. Stormwater runoff from this project drains to the Y k n-Pee Dee _- River basin.
4. Total Property Area:.9...22.. 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*:9.22 acres
J"(14aal praI shall 1ae caalcrrlyded to d xcla0c Ihd' jiollow hfP. they normal pool a��rrrrlaoaraaala�rl strrach.wes, the area
1�dladad°a rC tlra^ lraarrl�s Of'streaarrr;s andr i�avr.s, tha° a�a�ra�ra laaTla�ra�aP parr f or anal %1rg�r lai"a�ta�r (N1-1 V) line or Mean F-irglr Water
(M1-11/v) liner, and codistaal-wetlands landward J`J~oarr tho NHIA/ (orMN'1V) line,-, The resOtantpro'jcct area is rased to
R:°arlodlate ozre;°r�aall pa�rd~r;W l�arllt rr��orr rarca (13UA), i' mi-coao.s�tal wetlamis land -ward a;af�the , 1- IV (or'M111V) lime may
lee rrrclraild°al in thc local prolccl area.
8. Project percent of impervious area: (Total Impervious Area / "Total Project Area) X 100 = 16.8 %
9. How many drainage areas does the project have?1 (For high densihf, comet 1 for each proposed engineered
story water BMP. For low density and other projects, use 1 for the whole properhf 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 ormation Drainage Area 1 Drainage Area DramaE Area Drainage Area
Receiving Stream Name Rocky River
..............
.....
....... _ _ .. .....�.._..-... ..... .........
'Stream Class * C
_.. _.. ......_.._..........�
'Stream Index Number * 13-17
Total Drainage Area (sf) 92,347.2
On -site Drainage Area (so 92,374.2
Off -site Drainage Area (sf) 0
_. _....._ .. _ .. ...........-_.._... . ...........
...-
Proposed Impervious Area** (sf) 67,474
70 impervious Area (total) 73
.... ...._ ... --.._ _ _.
Impervious— Surface Area
On -site Buildings/Lots (so
On -site Streets (sf)
Draina e Area 1
22,400
17,790
.__ .............
Drainage Area
Drainage Area ®
.......
Drainage Area
On -site Parking (sf)
25,601
On -site Sidewalks (sf)
...Other
1,683
on -site (so
w�w..�.'_._.....-.�
.,�
Future (sf)
.......__w.,W.�___.0...._.��
Off -site (so
Existing BUA*** (so
0
Total (sf):
67,474
.A
�ewaplk�s, gravel areas, etc.
Form Version
'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.
11. How was the off -site impervious area listed above determined? Provide documentation. AutoCAD
Protects 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 1 SA 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 lo:i� �.i"mu�Y ii��a)�:nu o:y.�"...".r_i� '�)jw"�f�'�:�:_u�
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
:pill? Z'111a�ws q gl ���x 4 c n u /AA,cl�41 ��� v � :A ahP 1 �folillu1rr.��s. 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 Imp, �r ip11L[, 1.tlYcJhe9 Rr" m �, 44`4'l'w," ) L1�/�� s f 'WRgI�..�Al� ' l �.
Please indicate thatthe following required infor°niation 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 l r l t„ � f 1" �� � � �9 ➢ a � r) y �� r `f P w bZ1 W.4,/ �.dI°..:Stq _ _s docs.
1 ' A I S
1. Original and one copy of the Stormwater Management Permit Application Form. 4-
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants _ L
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
hqp://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
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 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. 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.
1. 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).
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6
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"xll" 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 verifij the SHWT prior
to submittal, (910) 796-7378.) {
10. A copy of the most current property deed. Deed book: 11575 Page No: 0257 4C
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 21-1.1003(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.
Iittl)r//www.seci;ciiii,,,=.,state.nc.us ("Otl)oldatiol-i�,'!-'ea ch a;— 211
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 ;gm�iml,' ; � c; ONrrslr t.>
storm water forms 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 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 li§ted
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 I n wneor: onathan A. Carter P F
Consulting Firm Bluestone i. and Management, PLLC
—1111111",Mailing Address: 70 North 13road Stw tx uiic
CityMooresvi.11e
Phone:
649-2863
Email:jo natha i i c ade14oislUestonc Nall�lLabat si&,�,p7c!nt.corri _.
State:NC Zip:281„15
Fax: 1 1
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) Tim Furr , certify that I
own the property identified in this permit application, and thus give permission to (print or hjpe name of person
listed in Contact Information, item 1a) Tim Fu„rr„_- _ with (print or type name of organization listed in
Contact Information, item la) i TmFurr �a 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 5 of 6
sale,
0LIJlllUTTdLCl WC1 -ILUL I Cl C I Fli ON
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:
t . . ...... . /V( a Notary Public for the State of County of
Y Y'1.4 d do hereby certify that...
Ti'.J......f, Y personally appeared
before me this -a day of (.,jj_j 2D -1-0 and ac ;;e the d e
a stormwater permit. Witness my hand and official seal, execution of the application for
7'-"7-'-'7-7,'- 777771Z77=�M77j�
Joan Greene
Nl*tary Public,
Cabiarrus County
North Carolit
My commission expires
1, (print or hjpe nanze of person listed in Contact Information, item 1a) Tim Furr
A
Signature:, Da te:
L .......................................... a Notary Public for the State of County of
. ................ . . ...................................... ............ .. do hereby certify that personally appeared
before me this day of........ . I I I I — and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, ............. ....... ... ....... ................................... .................................................. . ...................... ....... . ............ — I I
zas��f
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6