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HomeMy WebLinkAboutSW6220506_Application Form_20221122State of North Carolina Department of Environment and Natural. Resources Division of Energy, Mineral and Land Resources STORMWATER MANAGEMENT PERMIT APPLICATION FORM This form tnay be photocopied for use as an original I. GENERAL INFORMATION L Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans, specifications, letters, operation and maintenance agreements, etc.): Williford Cove 2. Location of Project (street address): Bavwood Road City:Eastover County:Cumberland Zip:28312 3. Directions to project (from nearest major intersection): Approx. 1462LF northeast of the intersection of Ba wood Rd SR 1831 and Murphy Rd SR 1832 . 4, Latitude:35° 4' 35.31" N Longitude:780 45' 52.47' W of the main entrance to the project. 11. PERMIT INFORMATION: 1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt tRenezoals zoith modifications also requires SWU-102 - Renezoal 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 Specify the type of project (check one): ®Law Density ❑I ligh Density ❑Drains to an Offsite Stormwater System ❑Other 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 ®Sedimentation/Erosion Control: 12.99 ac of Disturbed Area ❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts b.If any of these permits have already been acquired plea'se: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? []No ®Yes r If yes, see S.L. 2012--200, Part VI: http://portal.ncdenr.org/web/1r/rules-and-regulations Form SWU-101 Version Oct. 31, 2013 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 project): Applicant/Organization:3 Wills and Huff LLC Signing Official & Title:D. Ralph Huff III Registered Agent b. Contact information for person listed in item 1a above: Street Address:2919 Breezewood Ave City: Fayetteville State:NC Zip:28303 Mailing Address (if applicable):same City: State: Zip: Phone: 910 723-6516 Fax: Email:rebeccatreadawU@hufffamilyoffice.com office.com 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: Phillip M. Williford Michael L. Williford and David R. Williford as equal tenants in common Signing Official & Title:Philli M. Williford Michael L. Williford and David R. Williford b. Contact information for person listed in item 2a above: Street Address:2539 Mirror Lake Drive CityTayetteville Mailing Address (if applicable): same City: Phone: Email: State:NC State: Fax: Zip:28303 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/ Signing Official & Title: b. Contact information for person listed in item 3a above: Mailing Address: City: State: Phone: ( ) _ _ Fax: 4. Local jurisdiction for building permits: Point of Contact: Phone #: Form SWU-101 Version Oct. 31, 2013 Page 2 of 6 IV. PROJECT INFORMATION 1. In the space provided below, briefly summarize how the stormwater runoff will be treated. The streets will have roadside ditches that will collect runoff that will be conveyed to one of three outlet swales. 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 Cape Fear River basin. 4. Total Property Area: 84.15 acres 5. Total Coastal Wetlands Area: 0 acres 6. Total Surface Water Area: 0.56 acres 7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project Area+:83.59 acres + Total project area shall be calculated to exclude the following: the normal pool of impoutided structures, the area between the batiks of streams and rivers, the area below the Normal High Water (NHVO line or Mean High Water (MHM line, and coastal wetlands landward from the NHW (or MHM line. The resultant project area is used to calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHM line may be included in the total project area. 8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 10.20 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 Drainage Area _ Dra i m e Area. Receiving Stream Name Brachcoast Swam Stream Class * C Stream Index Number * 18-28-2-1 Total Drainage Area (so 3,641,180 On -site Drainage Area (so 3,641,180 Off -site Drainage Area (so Proposed Impervious Area** s 371,310 % Impervious Area** (total) 10.20 Impervious— Surface Area Drainage Area 1 Drainage Area _ Drainage Area _ Drainage Area _ On -site Buildings/Lots (so 220,000 On -site Streets (so 151,310 On -site Parkin (sf) On -site Sidewalks (sf) Other on -site (so Future (so Off -site (so Existing BUA*** (sf) Total (so: 1 371,310 * Stream Class and Index Number can be determined at: http://portal.tzcdetzr.org yeb/`wq/ps/csu/classi 'catiotzs Form SWU-101 Version Oct. 31, 2013 Page 3 of 6 Impervious area is defined as the built upon area including, but not hinited to, buildings, roads, parking areas, sidezvalks, gravel areas, etc. 'Report only that ainount of existing B UA that will rennin after developinent. Do not report any existing B UA that is to be removed and which will be replaced by nezv B UA. 11. How was the off -site impervious area listed above determined? Provide documentation. n/a Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened & Endangered Species tivateirshed that may be szibject to iiioi•e stringent stoi•ilnvater i-egiiiirenrerits as per I5A 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 Iatest versions of the forms can be downloaded fromhttp://portal.ncdenr.org/web/wq ws/su bmp-manual. VL 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 http://portal.trcdenr.org/web/wq/ws/su/statesw/forms_docs. 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 htt2://portal,ncdetu.oxg/.web/wq/ws/`­su/`­­­maps.) PIease indicate that the following required information have been provided by initialin 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 h!!p://portal.ncdenr.org/web/wq/`­ws/su/statesw/"`forms—docs. 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) (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 htW://.www.envhelp,org/pages/onestopexpiess.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 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 reap. 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 Iines. • 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. Form S Wt)-101 Version Oct. 31, 2013 Page 4 of 6 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 DFMI.R to verifij the SHWT prior to submittal, (910) 796-7378) 10. A copy of the most current property deed. Deed book: 4713 Page No: 0877 _ 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, itern 1a, 2a, and/or 3a per 15A NCAC 2H.1003(e), The corporation or LLC must be Iisted 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 Iot 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 littp://12ortal,ncdenr.org/web/Ir/state_ stormwater-forms flocs. 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 Jeffrey A. Nobles Consulting Firm: Larry King & Associates PLS, PA Mailing Address:1333 Mor anton Rd Ste 201 City:Fayetteville State:NC Zip:28305 Phone: (910 ) 483-4300 Fax: (910 ) 483-4052 Email JnoblesQlkanda.com IX. PROPERTY OWNER AUTHORIZATION (if Contact Informrtion, item 2 has been filled out, complete this section) 1, (print or type name of person listed in Cotztact Information, item 2a) Philli2 M. Williford, Michael L. Willi ord and David R. WilliLord as equal tenants in common , 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) 3 Wills and Hit LLC with (print or type name of organization listed in Contact Information, itent 1.a) 3 Wills and Huff LLC LC 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