SW1210902_Application Form_20211124

DEMLR USE ONLY
Datc Received
Fee Paid Permit Number
Applicable Rules: ❑ Coastal SIV -1995 ❑ Coastal SW - 2008 ❑ Ph II -- Post Construction
(";elecl all flial appJ i/) ❑ Non -Coastal SW- HQI,V/ORI-V Waters ❑ Universal Stormwater iManagement Plan
❑ Other WQ M nt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
1.11is fi)1-m may be pliolocopied for list, as rill origilml
1. 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.):
Broadpointe Industrial Facility for Minkles Broadpointe 11, LI,C.
2. Location of Project (street address):
684 Broadpointe Drive
City:Mills River County:i Ienderson Zip:28759
3. Directions to project (from nearest major intersection):
From Boylston Hivy, turn onto Ferncliff Park Drive, then go around the roundabout to the Old Fannutg
BJdV,c, Road exit. Remain on Old Fanning Bridge for just over a mile, then turn left onto Broadpointe Drive.
The main entrance will be inunediately on the left.
1. Latitude:35" 25' 32.1" N Longitude:82° 33' 17.9" W
iI. PERMIT INFORMATION:
of the main entrance to the project.
'I. a. Specify whether project is (check one): ❑New ®Modification ❑ Renewal w/ iklodificationt
t Rare arls wilt moiificalious StVi1-102 - Retr ind Applicalim frrm
b.If this application is being submitted as the result of a modification to an existing Kermit, list the existing;
permit number , its issue date (if known) , and the status of
consh•nction: ❑Not Started ®Partially Completed' ❑ Completed" *pravidc a designer's cerli f'tcatimr
2. Specify the type of project (check one):
❑Low Density ©High Density ❑Drains to an Offsite Storutwater System ❑Other
�. It this application is being submitted as the result of a previously rehu•ned application or a letter from
DEMLR requesting a state stornrivater management pennit application, list the storntwater project number,
if assigned, SVV1210902 and the previous name of the project, if different than ctu•rentl)'
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: 7.17 ac of Disturbed Area
❑NPDES Industrial Stormivater [Z404/401 Perntit: Proposed Impacts 88.4 LF/0.006 AC
U.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:404 Permit - 2018-02316 issued 11 /04/2021
Sedimentation/Erosion Control Permit - HENDE-2022-006 issued 10/29/2021
5. Is the project located within 5 miles of a public airport? ❑No ®Yes
lj Iles, set, S.L. 2012-200, Part Vl: httl portal,ncdertr.ot ttieb/h�rules anct-regulations
Forrn 5WU-101 Versim Oct. 31, 2013 Page I oi'6

Ill. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's mmne and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organizatiori:N4irikles 13roadpointe 11 LLC.
Signing Official &- Title:David Gibbons - Manager
b. Contact ii'dormation for person listed in item I a above:
Street Address:7 Parliament Place
Ci ty:Dai las State:Texas Zip:75225
\flailing Address (ijrrpplicable):7 Parliament Place
City:Dal las State:Texas Zip:75225
Phone: (214 ) 616-0652 Fax: (-
Enia i I: d avidCc�bu nrootis. coni
Please check the appropriate box. The applicant listed above is:
N 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 agr•eernent wid. 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 Add ress (if upplicuble):
City:
Phone: ( )
Email:
State:
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: Wade Trim, hic.
Signing Official & Title:Ariel Regnier - LIT
b. Contact information for person listed in item 3a above:
\Mailing Address:53 North Market Street, Suite 200
City:Asheville State:North Carolina Zip:28801
Phone: [phone] Fax: (- ]
E ma i I:aregii ier�'ct7wad etrini.ccun
4. Local jurisdiction for building permits: Henderson County
Point of Con tact: Perm it Center Phone 4: (828 } 697-4830
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
'I. In the space provided below, Ejr fly, siululnarize how the storin►vater runoff will be treated.
The majority of the development area r•IIn-off will be directed to the east corner of the development into a
sand filter. The sinall drainage area incorporating the truck court entrance rune -off will be Aped down the
slope to a level sureader to evenly disperse u1 the floodway
2. a. If claiming vested rights, identify the supporting docununts 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 regrrlation(s) the project has been designed in accordance with;
❑ Coastal SW -1995 ❑ Ph II - Post Construction
3. Storinwater runoff froin this project drains to the French Broad River basin.
4. Total Property Area: 25.07 acres 5. Total Coastal Wetlands Area: 0 acres
6. 'Total Surface Water Area: 0.006 acres
Total Property Area (4) -Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area°:25.064 acres
Total project area shall he calculated to exciffde the following: the normal pool of iru)7orrndr°rd structures, the arell
between file banks of streaurs fund roars, the area below fhc Norval High Water (NH[ I) liar or Mcau High Water
(A'IHIN) lime, rand ciaasfal u7ctlands landward frofa the NHW (or MHI,V) line. The resullant project area is used to
calculafr ooeral! prr•cerut built urplorr fare'a (BLIA). Nan cnasta! znetlrnads laardau7rrrd of file NHl V{ur AdIT[V) liar rump
lit, included ire the total project area.
8. Project percent of irnpervious area: (Total Impervious Area / Total Project Area) X 100 = 20.5
9. I Iow many drainage areas does the project have?2 (For high deusitlp, count I fin• each proposed cogiueered
storarmfater BX11". For !oily densiht and other projects, use I for the whole prnprrht 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 2
Drainage Area _
Drama Ye Area _
Receiving Stream dame
French Broad
French Broad
Stream Class *
B
B
Stream Index Number *
6-(54.75)
6-(54.75)
Total Drainage Area (sf)
273174
818613.81
On -site Drainage Area (so
818613.84
Off -site Drainage Area (so
2252052
Proposed Impervious Area" (st)
223399
d
6598.5
io Im envious Area* total
0.818
0.3
Impervious'* Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area
Drainage Area _
On -site Buildings/Lots (so
120562
0
Oil -site Streets (sf)
0
0
On -site Parking (st)
91273.5
6598.5
On -site Sidewalks (st)
4965
0
Other on -site (sf)
0
0
Future (sf)
0
0
Off -site (sl)
0
0
Existing BuA"'* (sf)
0
0
Total (st):
216800.5
6598.5
T Sfrearra Class and lnlex Nffmber call be (leternrirred at:lrtIp;//p?frrtap.►fcde)Ir.•srr/clas,sificafious
111117111,171 orfs alas is defined as the buu ilt pon area including, but not limited to, buildings, roads, par•khrg areas,
sirezoalks, gravel areias, etc.
Forrn SWU-101 Version Oct. 31, 2013 rage 3 of

„;r_ Wporl orrlrl that rrrrrount of v istiag Bi IA that zoill remain rl_fter dc'oclopmeiiI. Do not rep}rl arrrl e isting BLIA that
is to be r'cranaed aid iohich a>ill be replaced Iril aera B1.IA.
IL, Hoiv +vas [lie off -site impervious area listed above determines{? 1'roviLit' documentation.
Proieels in thdorr Comity: Contacl DE,IILR Central O/)ic•e stafflo check if the pro ect is located n,ithin a Thrmlened d-
EnckargeredSpevies ic(rleished thal urav he s•rrhjerl to more sti-hWe ul shirmw Ater requirements (is per 15,4 rl'C,4U 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&N,{) Forms
must 110 submitted For each BN,11'specified for this project. The latest versions of the forms can be downloaded
from http://portaLncdem.org/web/+vd/+as/su/I?mp manual.
V I. 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 lasted below. A detailed application
instruction sheet and BMP checklists are available from
�ortai.ncdenr.org/tivcb/+ycl/ws/su/statesw/fornns_docs. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be fount{ by locating project on the
interactive online trap at .)
PIease 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 _.docs.
Initials
L. Origirrrrl rrrr,l one coin/ of the Storm+vater Xlanagennent Permit Application Form, L-;L
2. Original and one c opll of the signed and notarized Deed Restrictions & Protective Covenants Ouz
Form. (if regaired as per Part VII belov?)
3. Origixal of the applicable Supplement Form(s) (sealed, signed anti dated) and O&NI
agreement(s) for each 13.N4P.
4. Permit application processing fee of $505 payable to NCDE.NR. (For an Express review, refer to
h -i: ivtivi%,.eiivliel .or )a Tes oilesto pex ress.htli-d for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to sclneduIe the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management
6. A USCS map identifying the site location. If the receiving stream is reported as class SA or the
receiving streann drains to class SA waters within'/2 mile of the site boundary, include the'/z
mile radius on tine snap.
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, Enoieer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g, !\evision number and mates.
ln. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the N1H1V or NI-I1,V line of tidal
waters, and any coastal nvetlands landward of the 1\4I-I1,V or NHVV lines.
• Delune itc tlne ►vegetated buffer land++'ar•d fronn the normal pool elevation of impounded
sh•uctures, the banks of strearns or rivers, and the 1'v1HW (or NJ 1W) of tidal Heaters.
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. (10tist be delineated by a
grialified person. Provide documentation of qualifications and identify the person wlno
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).
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Form SWIJ-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 NIZ
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 neap with the
project area clearly delineated. For projects with infiltration BIAPs, the report should also
include the soil type, expected infiltration rate, and the metliod of determining the infiltration rate.
(infiltration Devices submitted to WIRO: Schohnle rr Site visit fen' DEXILR to verify /he SHW7' prhrr
to submif(rrl, [phone],)
10. A copy of the most current property deed. Deed book: 3749 Page No: 453-457(5) _A L �
11. For corp orationns and limited liability corporations (LLC): Provide dOCLlmen tation from the NC R(_ R
Secretary of State or other official documentation, which supports the titles and positions held
1)), Elie persons listed in Contact htformation, item 1 a, 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 Elie application will be returned.
beep:// w�v�v.secrctart�state.nc.us/Corporations/CSearcln.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 fortes can be downloaded from hitp:llportai.nrdcnr.urgl4vcb/lr/staie-
stormivater-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 listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
wider 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 mlotlier 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 Eng, neer:Ariel RegLuer
Consulting Firm: Wade Trim Inc.
lvlailing; Address:53 North IVlarket Street, Suite 200
City:Ashevil.le State:North Carolina Zip:28801
Phone: (828 ] 237-8192 Fam-
Eninail:a regnier a xvadetrinn.com
IX. PROPERTY OWNER AUTHORIZATION (if Cwrtact Information, item 2 lurs beery filler! oul, complete this
secliorr)
1, (print or (/!re rrrrnue of pen.sou listed irr Contact trrfarmatinu, item 2a) N/A certify that I
own the property identified in this permit application, and thus give permission to (prirrl or type ionic of person
listed in Contact Information, item 1a) N/A with (pr•irrf or (t/pc imme of orgimizatiurr lister! ill
Corrtrrct Information, item 1a) N/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 storrnivater system.
Dorm SWU-101 Version Oct. 31, 2013 Page 5 of

As the legal property Owner I acknowledge, understand, and agree by nn}r signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company anti/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DFN4LR Stormwater permit reverts back
to ine, the property owner. As the property owner, it is my responsibility to notify DEMLR inunediatel}' and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stornnvater
treatment facility Without a valid permit. I understand that the operation of a stornnvater treatment facility
without a valid peruut 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.
Signattu':
Date:
1, a Notary Public for the State of , County of
do hereby certify that
before me this _ day of
Personally appeared
, 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 hplte uame of prer.sou listed iu Coutract lrtjo)'nr(rtiwr, item 1R) David Gibbons ,
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 155AA NCAC 2H .1000 and any other' applicable state stormwater requirements.
Signature: �''��� � Date: t I Qt I
1, ` ° c �JYe\�l�L+L a Notary Public for the State of 1 XL 5 Count), of
do hereby certify that N?.,v t 4, C, I. &( Z C) 01 personally appeared
before me this �� day of 130"' ��r 2 t and a nowledge the due exe ution of the application for
Witness �. a stort>!>I�+, Ater permit. my Band and official seal,
PAMELA L FREDERICK
�X
1 Y rgGtiry ID #131-i44671
yY Commissiwr, Expires
March 19, 2022
SEAL
My commssion expires
3/C ! 1-2-60-2­�—
Form SWIJ-101 Version Oct. 31, 2013 Page 6 of