SW6191201_Application_20200319

DEMLR USE ONLY
Date Received
Fee Paid
Permit 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 icse 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.):
Lynn Ridge Subdivision
2. Location of Project (street address):
Count Harnett Zip:27501
City:Angier Y�
3. Directions to project (from nearest major intersection):
a roximatel 2 400 feet on the left.
4. Latitude:35° 30' 51" N Longitude:-78° 42' 54" W of the marl entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one Renetua® uitlW nodificn�tio s al�sohreq,tires WMA02 e Renerval Appl cotiott Frn'nint
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
2. Specify the type of project (check one): ❑Other
®Low Density ❑High Density ❑Drains to an Offsite Stormwater System
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):
❑CAMA Major NSedimentation/Erosion Control:19.8 ac of Disturbed Area
❑NPDES Industrial Stormwater Z404/401 Permit: Proposed Impacts 0.51 ac wetlands impact for
street/utilities
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? ®No ❑Yes
If pes, see S.L. 2012-200, Part VI: httu://aortal.ncde�u•.org/rveb/Ir/rules-and-re�*ulations
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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:L n Rid e of Angier,LLC
Signing Official & TitleeHarvey Montagge, Reg' tered Agent
.Contact information for person listed in item 1a above:
Street Address:10305 Penn Road
City:Ralei h State:NC Zip:27606
Mailing Address (if applicable):10305 Penn Road
City:Ralei h
Phone: (919 ) 86&3586
Email:handtmontague@earthlink net
StNC Zip:27606
ate:
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.)
PrOwner's name and title below, if you are the lessee, purchaser or developer. (This is the
Print operty
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
),Contact information for person listed in item 2a above:
Street
City:
Mailing Address (if applicable):,
City:
State Zip:
State: Zip:
Phone:Fax:
Email:
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:
Signing Official &
b. Contact information for person listedui item 3a above:
Mailing
City:
State: Zip:
Phone: ( ) Fax:
4. Local jurisdiction for building peruuts: Town of An 'er
Point of Contact:Sean Tohnson Phone #: (919 ) 331-6702
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*
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
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
River basin.
3. Stormwater runoff from this project drains to the Ca e Fear
4. Total Property Area: 31.64 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: 0.15 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:31.49 acres
+ Total project area shall be calenlated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal H� 1 It Water (NHM line or Mean High Water
W) (MHline, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is nsed to
calculate overall percent built upon area (B UA). 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 = 24.0
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, nse I 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 nl&6&124-1
Areal Draina e Area _ Draina e Area _ Drainage Area _
Receiving Stream Name ond
Stream Class *
Stream Index Number *
Total Drainage Area (so 11371,486
On -site Drainage Area (so 11371,486
Off -site Drainage Area (so
Proposed Impervious Area** 329,085
Area**
Im ervious�* Surface Area
On -site Buildings/Lots (sf)
On -site Streets (so
On -site Parking (so
On -site Sidewalks (so
Other on -site (so
Future (so
Off -site (so
Existing BUA*** (so
Total (sf):
Stream Class and Index Number can be determined at: htttp //Mortal necie�tr o/rued/w��psicsuic«�5�u��u
24.0
Form t
SWU-101 Version Oc. 31, 2013
age of
P3 7

***Report only that amount of existing BLIA that will remain after development. Do not report any existing BLIA that
is to be removed and which will be replaced by new BLIA.
11. How was the off -site impervious area listed above determined? Provide documentation.
Proiects in Union County: Contact DEAIMR Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent storinimter requirements as per 15A NCAC 02B . 0600.
V. SUPPLEMENT AND O&M FORMS
t permit supplement and operation and maintenance (O&M) forums
The applicable state stormwater managemen
this project. The latest versions of the forms can be downloaded
must be submitted for each BMP specified for
ftomhLLi)://Lm)orLal.iicdet*Lr.org/webZwq/-ws/`­stiZbnip-manual.
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 h complete application package should be
A
The
submitted to the appropriate
interactive online map at htt .
comp a pp
office maybe found by locating project on the
/su maps.)
Please indicate that the rouowrn n uuCu uu�=u���-�-- ----- � -- --__
for each item. All original documents MUST be signed and initialed
For each submitted application package from httJ): / portal.tncdeimr
ovided by initialing vn the space provided
blue ink. Download the latest versions
. 1Original and one copy of the stormwater Management Permit Application Formt.
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
4.
5.
6.
Initials
z
agreements) for each BMP.
Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http1 /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.) �\
A detailed narrative (one to two pages) describing the stormwater treatment/management
A USA mtr ame1drains to class SA waters within %z mule of thstree site boundary, inclis reported as class a ot
ude 1 e /the
rece g
mile radius on the map.
Sealed, signed and dated calculations (one copy).
Two sets of plans folded to 8.5" x W (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 easenments, pipe sizes, runoff calculations.
o. Drainage areas delineated (included it the main set of plans, not as a separate document).
for
z�
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9.
p. Vegetated buffers (where required).
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. hclude 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 WiR.O: Schedule a site visit for DEMLR to verifij the SHWT prior
to submittal, [phone].)
A copy of the most current property deed. Deed book: 3746 & 3744 Page No: 673 & 574'
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 hl Contact Information, item 1a, 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 the application will be returned.
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 htt ,portal ncdeni I.org/,.PvebLIr/state-
stormwaterjorins 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
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:Peter E. Norfleet Tem le
Consulting Firm: Enoch En ' eers PA
Mailing Address:1403 NC Highway 50 South in
City:Benson
Phone: (919 ) 894-7765 —
Euiail:fleetQenochen ' neers.com
State:NC Znp:27504
Fax: (919 ) 894-8190
IX. PROPERTY OWNER AUTHORIZATION (if Contact Informatiot2, item 21tas been filled ottt, complete this
section)
I, (print or hjpe name of person listed in Contact Information, item 2a) 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) with (print or hjpe name of organization listed in
Contact Information, item 1a) 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-lUl Version Oct. 31, 2013 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
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:
Date:
I,
a Notary Public for the State of
do hereby certify that
before me this _day of
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Wihless my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or hjpe Warne of person listed in Contact bifrn7nation, item 1a) Harvei� Montague J
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 under 1A NCAC 2H .1"c,,aany other applicable state stormwater requirements.
Signature:
Date: / """ �✓�'
I El I plt M, ptU yi e5 _.. , a Notary Public for the State of N o►� CctYn I (n0.-. County of
Wa v e... do hereby certify that Nal-,red �-• M ov► %t I u e. personally appeared
before me this 330 day of JCAV1 U OLV2 � _ o20w7b , and acknowledge the due execution of the application for
u
a stormwater permit. Witness my hand and official seal, L
o..
'1E 1N
2023
J'44,*O O : �G
SEAL
My commission expires �' � i
�3
Form SV✓LJ-101 Version Oct. 31, 2013 Page 6 of 6