SW5201001_Application Form_20230622

DEMLR USE ONLY
Date ReceivedFee PaidPermit Number
Applicable Rules: Coastal SW – 1995 Coastal SW – 2008 Ph II - Post Construction
(select all that apply) Non-Coastal SW- HQW/ORW Waters Universal Stormwater Management Plan
Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
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.):
Walnut Cove Subdivision - Phase 2
2. Location of Project (street address):
Walnut Street
City:Spring Hope County:Nash Zip:27882
3. Directions to project (from nearest major intersection):
From US -64 East take Exit 450 toward Spring Hope. Turn Left on NC Hwy 581 and continue on NC 581
(Walnut Street) for 1.6 miles. The site is on the right approximately 600' past the intersection of N. Walnut St.
and McLean Street.
4. Latitude:35 56’ 56.4” N Longitude:-78 06’ 54.4” W of the main entrance to the project.
II.PERMIT INFORMATION:
†
1. a. Specify whether project is (check one):NewModification Renewal w/ Modification
†
Renewals with modifications also requires SWU-102 – Renewal Application Form
b. If this application is being submitted as the result of amodification to an existing permit, list the existing
permit numberSW5201001 , its issue date (if known)03/24/21, and the status of
construction:Not StartedPartially Completed* Completed**provide a designer’s certification
2. Specify the type of project (check one):
Low DensityHigh DensityDrains to an Offsite Stormwater SystemOther
3. If this application is being submitted as the result of apreviously returned application or aletter 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 MajorSedimentation/Erosion Control: 4.32 ac of Disturbed Area
NPDES Industrial Stormwater404/401 Permit: Proposed Impacts Both permitted in 2020 for Phase 1
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:
5. Is the project located within 5 miles of a public airport?NoYes
If yes, see S.L. 2012-200, Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations
Form SWU-101 Version Oct. 31, 2013Page 1 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:Axiom Holdings, LLC.
Signing Official & Title:Thomas White, Manager
b. Contact information for person listed in item 1a above:
Street Address:3739 National Drive Suite 105
City:Raleigh State:NC Zip:27612
Mailing Address (if applicable):3739 National Drive Suite 105
City:Raleigh State:NC Zip:27612
Phone: (919) 760-0101Fax: ()
Email:[e-mail]
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:Axiom Holdings, LLC.
Signing Official & Title:Thomas White, Manager
b. Contact information for person listed in item 2a above:
Street Address:3739 National Drive Suite 105
City:Raleigh State:NC Zip:27612
Mailing Address (if applicable):3739 National Drive Suite 105
City:Raleigh State:NC Zip:27612
Phone: (919) 760-0101Fax: ()
Email:[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:Ethan Averette / Stocks Engineering
Signing Official & Title:Project Manager
b. Contact information for person listed in item 3a above:
Mailing Address:PO Box 1108
City:Nashville State:NC Zip:27856
Phone: (252) 459-8196 Fax: (252) 459-8197
Email:[e-mail]
4. Local jurisdiction for building permits: Spring Hope, NC
Point of Contact:Andrew Deionno Phone #: (252) 478-5186 ext. 225
Form SWU-101 Version Oct. 31, 2013Page 2 of 6

IV.PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be conveyed through the roadway pipes and catch basins that will carry runoff to the
stormater wet ponds between lots 46 and 47 in "Phase 1" of the project and behind lots 9 & 10 in "Phase 2".
"Phase 1" of the project consists of 21.24 acres, "Phase 2" of the project consists of 4.89 Acres.
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 PermitIssued 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 Tar-Pam River basin.
26.126.1
4. Total Property Area: 26.13acres5. Total Coastal Wetlands Area:acres
0.10
6. Total Surface Water Area: 0.13acres
7. Total Property Area (4) – Total Coastal Wetlands Area (5) – Total Surface Water Area (6) = Total Project
+
26.0
Area: 26.0acres
+
Total project area shall be calculated to exclude the following: the normal pool of impounded 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 MHW) 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 = 7.24 Ac. (27.8%) %
9. How many drainage areas does the project have?3(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 InformationDrainage Area 1Drainage Area 2Drainage Area 3Drainage Area
Receiving Stream NameLittle TurkeyLittle TurkeyLittle Turkey
CreekCreekCreek
Stream Class *C;NSWC;NSWC;NSW
Stream Index Number *28-33-228-33-228-33-2
Total Drainage Area (sf)558,780144,619433,517
On-site Drainage Area (sf)558,780144,619433,517
Off-site Drainage Area (sf)000
**195,83851,33168,207
Proposed Impervious Area (sf)
**35%35.5%15.7%
% Impervious Area(total)
**
Drainage Area 1Drainage Area 2Drainage Area 3Drainage Area
Impervious Surface Area
On-site Buildings/Lots (sf)115,50025,50058,500
On-site Streets (sf)59,87421,4468,726
On-site Parking (sf)000
On-site Sidewalks (sf)20,4644,385981
Other on-site (sf)000
Future (sf)000
Off-site (sf)000
Existing BUA*** (sf)000
Total (sf):195,83851,33168,207
* Stream Class and Index Number can be determined at:http://portal.ncdenr.org/web/wq/ps/csu/classifications
Form SWU-101 Version Oct. 31, 2013Page 3 of 6