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HomeMy WebLinkAboutSW5200701_Stormwater Management Permit Application_20200708DEMLR 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 M mt 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.): Boianeles at Suring Hope, NC 2. Location of Project (street address): NC Hwy 581 and US 64 West City:Spring Hope County:Nash 3. Directions to project (from nearest major intersection): Zip:27882 From US -64 East take Exit 450 toward Spring Hope. Turn Left on NC Hwy 581 and the site is approximately 1000 feet on the left. 4. Latitude:35° 56' 03.35" N II. PERMIT INFORMATION: Longitude:780 05' 57.48" W of the main entrance to the project. 1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt tRenezoals zvitli modifications also requires SWU-102 - Renezval 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 2. Specify the type of project (check one): ❑Low Density ❑High Density ❑Drains to an Offsite Stormwater System ❑Other 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 ®Sedimentation/Erosion Control: 14.94 ac of Disturbed Area ❑NPDES 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 permit: 5. Is the project located within 5 miles of a public airport? ®No ❑Yes If yes, see S.L. 2012-200, Part VI: httl2:/bortal.ncdenr.org/web/Ir/rules-and-regulations Form SWU-101 Version Oct. 31, 2013 Page 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: It's Farm Time LLC Signing Official & Title:Brad Mercer Director of Real Estate b. Contact information for person listed in item 1a above: Street Address:335 N Queen Street City:Kinston State: Mailing Address (if applicable):PO Box 277 City:Kinston Zip: State:NC Zip:28501 Phone: (1-800 ) 366-9921 Fax: Email:brad.mercer@becajun.com 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: Signing Official & Title: b. Contact information for person listed in item 2a above: Street Address: City: Mailing Address (if applicable State: Zip: City: State: Zip: Phone: ( 1 Fax: ( 1 Email: 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: Kevin Varnell /Stocks Engineering Signing Official & Title: 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:kvarnell@stocksengineering.com 4. Local jurisdiction for building permits: Spring Hope, NC Point of Contact:lae Kim Phone #: (252 ) 478-5186 ext. 225 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. Stormwater will be conveyed through natural channels to the roadway pipe for Street B. Runoff will then discharge into the existing roadside ditch which will enter a stream after approximately 1,200 LF 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 Tar -Pam River basin. 4. Total Property Area: 74.11 acres 5. Total Coastal Wetlands Area: acres 6. Total Surface Water Area: acres 7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project Area+:74.11 acres + Total project area shall be calculated to exclude the following: the normal pool of ini ounded stratctures, the area between the banks of streams and rivers, the area below the Normal High Water (NM line or Mean High Water (MHV1>) line, and coastal wetlands landward from the NHW (or MH[N) line. The resultant project area is used to calculate overall percent built upon area (B UA). Non -coastal wetlands landward of the NHW (or MHM line nnay be included in the total project area. 8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 2.54 9. How many drainage areas does the project have?1 (For high densihj, count 1 for each proposed engineered stormwater BMP. For low density and other projects, use 1 for the whole properhj 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 _ Drainage Area _ Receiving Stream Name Hendricks Creek Stream Class * QNSW Stream Index Number * 28-55-2 Total Drainage Area (so 74.11 On -site Drainage Area (so 74.11 Off -site Drainage Area (so 0 Proposed Impervious Area** (so 205,167 Impervious Area** total 6.36% Impervious' Surface Area Drainage Area 1 Drainage Area _ Drainage Area _ Drainage Area On -site Buildings/Lots (so 3,500 On -site Streets (so 24,829 On -site Parking (sf) 51,090 On -site Sidewalks (sf) 2,473 Other on -site (sf) 0 Future (so 123,275 Off -site (so 0 Existing BUA*** (so 0 Total (so: 205,167 * Stream Class and Index Number can be determined at: http. portal.ncdenr.orghvebAvg&s/csu/classi cations Inn ervious area is defined as the built upon area including, but not hi sited to, buildings, roads, parking areas, sidewalks, gravel areas, etc. '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. Form SWU-101 Version Oct. 31, 2013 Page 3 of 6 11. How was the off -site impervious area listed above determined? Provide documentation. N/A Proiects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened & Endangered Species watershed that maybe 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 fromh!W://12ortal.ncdenr.org/web/­wq/ws/su/bml2-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 hgp://portal.ncdenr.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 athgp://portal.ncdenr.org/web/wq/ws/su/maps.) Please 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 http://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. Initials 1. Original and one copy of the Stormwater Management Permit Application Form. � K✓ 2. Original and one copit of the signed and notarized Deed Restrictions & Protective Covenants I-(✓ 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 http://www.envhelp.org/pages/onestopexpress.htmlfor 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/managementfor the project. This is required in addition to the brief summary provided in the Project Information, item 1. 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). -t1A TK✓ Tvv TVV a-k ✓ T'K✓ Form SVIU-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 10 11 A copy of the most current property deed. Deed book: 2967 Page No: 363 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 1a, 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. http:/ /www.secretary.state.nc.us/Corporations/CSearch.aspx VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS 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 DEMLR to verifij the SHWT prior to submittal, (910) 796-7378.) 1111(✓ K✓ 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 http1Lportal.ncdenr.org/web/Ir/state-stormwater- forms docs. 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:Kevin Varnell Consulting Firm: Stocks Engineering Mailing Address:PO Box 1108 City:Nashville State:NC Zip:27856 Phone: (252 ) 459-8196 Fax: (252-459-8197 ) Email:kvarneH@stocksengmeering.com IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this section) I, (print or hjpe nattte 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 hjpe name of person listed in Contact btformation, 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-101 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:_ I, before me this a Notary Public for the State of do hereby certify that day of Date: County 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 type name of person listed in Contact Information, item 'h: 1a) �` /sir, w ZLe - A��. 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 15A NCAC 21-1.1000 and any other applicable state stormwater requirements. Signature: Date: 'L� X/zC I, [:� V0" ZIAA) , a Notary Public for the State of 'V� , County of uo-"L' ai ify th do her by certify i�1A i personally appeared before me thiAy of and acknowledge the due execution of the application for a stormwater permit. Witness my hand and official seal, IQA A SEAL My commission expires 02- /Lq.L� _ Form SWU-101 Version Oct. 31, 2013 Page 6 of 6 Low Density Commercial Subdivisions Deed Restrictions & Protective Covenances In accordance with Title 15 NCAC 2H.1000 and S.L. 2006-246, the Stormwater Management Regulations, deed restrictions and protective covenants are required for Low Density Commercial Subdivisions where lots will be subdivided and sold. Deed restrictions and protective covenants are necessary to ensure that the development maintains a "built -upon" area consistent with the applicable regulation governing the density level. The following deed restrictions and covenants must be recorded prior to the sale of any lot: I, , acknowledge, affirm and agree by my signature below, that I will cause the following deed restrictions and covenants to be recorded prior to the sale of any lot within the project known as The following covenants are intended to ensure ongoing compliance with State Stormwater Management Permit Number , as issued by the Division of Energy, Mineral and Land Resources under the Stormwater Management Regulations. 2. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to maintain compliance with the stormwater management permit. 3. These covenants are to run with the land and be binding on all persons and parties claiming under them. 4. The covenants pertaining to stormwater may not be altered or rescinded without the express written consent of the State of North Carolina, Division of Energy, Mineral and Land Resources. 5. Alteration of the drainage as shown on the approved plan may not take place without the concurrence of the Division of Energy, Mineral and Land Resources. 6. The maximum allowable built -upon area per lot is square feet. *Note: If the BUA per lot varies, please substitute the following statement for the one above and provide a complete listing of the proposed BUA for each lot: The maximum allowable built -upon area per lot is as follows: Lot # Max. BUA Lot # Max. BUA Lot # Max. BUA 1 _1.33Ac. 2 _1.31 Ac. _3 _1.50Ac. These allotted amounts include any built -upon area constructed within the lot property boundaries, and that portion of the right-of-way between the front lot line and the edge of the pavement. Built upon area includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate, coquina and parking areas, but does not include raised, open wood decking, or the water surface of swimming pools. 7. In the case of a lot within CAMA's regulated AEC, if the built -upon area for that lot, as calculated by CAMA, is less than the amount shown in these restrictions, the most restrictive BUA will be the maximum permitted limit for that lot. 8 Filling in or piping of any vegetative conveyances (ditches, swales, etc.) associated with the development except for average driveway crossings, is strictly prohibited by any persons. 9. Each lot will maintain a 30** foot wide vegetated buffer between all impervious areas and surface waters. 10. All roof drains shall terminate at least 30** foot from the mean high water mark of surface waters. 11. Each lot, whose ownership is not retained by the permittee, shall submit a separate stormwater permit application to the Division of Energy, Mineral and Land Resources and receive a permit prior to construction. The application shall demonstrate compliance with the maximum BUA limit and the low density requirements set forth in 15A NCAC 2H.1000. Lots whose ownership is retained by the permittee shall be submitted as modifications to the original permit. **50 foot for projects located in the 20 coastal counties. Form DRPC-4 Rev.3 05Nov2009 Page 1 of 2 12. The maximum assigned built -upon area limit shall not be exceeded on any lot, unless the permit is modified to Pigh nsity for all the lots in the permitted subdivision. Signature: Date: 6' Y-70 I, , a Notary Public in the State of KC , County of LLVVILIy , do hereby certify pthaat personally appeared before me this the Z-1fyday of 202,-------� , and acknowledge the due execution of the foregoing instrument. Witness 1=e I, SEAL No ary Signature I My Commission expires O U lq. 12-2— Form DRPC-4 Rev.3 05Nov2009 Page 2 of 2