NCS000584_SWMPermitApplication_LEXINGTON Water Resources_20200720

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LEXINGTON
NORTH CAROLINA
WATER RESOURCES
QUALITY FIRST
City of Lexington
Stormwater Management Permit Application
A complete application form must accompany each Stormwater Management (SWM) Plan submittal. Two (2) copies of
the proposed Site/SWM Plan, SWM Study, and Erosion & Sediment Control Plan are required for submittal along with
the permit application fee. The City will issue a SWM Permit for each site upon demonstrated and approved
compliance with City's watershed protection and stormwater management requirements per Section 3.11 of the Unified
Development Ordinance (UDO). Sections 1 through 6 below are the minimum permit application requirements for City
review, approval, and issuance of a SWM Permit. Section 7 provides minimum requirements for City review, approval,
and issuance of a Stormwater Management Permit.
This section for City of Lexington
use only
SWM Permit Number:
Date SWM Plan Received:
SW M Permit Application Fee: $
Exemption if Disturbed Area < 1 acre + Site Not Part of Larger Common Plan of Development: Y N
Other applicable Exemption per UDO Section 3.11.6
Date SWM Permit Issued:
1. Project/Site Information
Project/Site Name:
Project Location (Address):
Parcel(s):
Total Site Area (ac):
Existing Built -Upon Area, BUA (ac):_
Site within a Water -Supply Watershed:
2. Applicant/Engineer Information
Applicant/Engineer Name:
Company:
Company Address:
Office Phone:
E-mail Address:
Applicant Signature:
Date SWM Certificate of Compliance Issued:
Total Proposed Disturbed Area (ac):
Proposed BUA (ac): Proposed BUA (% of site):
Y N Low Density Development: Y N
Cell Phone:
WATER RESOURCES
NC PE License #:
ax:
Date:
mailing address :28 West Center Street, Lexington, North Carolina 27292
Phone [phone] / www.LexingtonNC.gov

3. Project Owner information (if different from Applicant)
Owner Name:
Owner Company/Firm:
Owner Company/Firm Address:
Office Phone: Cell Phone: Fax:
E-mail Address:
Owner Signature: Date:
4. Posting of Financial Security for Required Stormwater Control Structure(s)
[Applicant/Owner must provide adequate financial assurance in the form of a performance bond and/or other cash
security for required stormwater control structure(s) prior to issuance of SWM Permit.]
Applicant/Owner shall file with the City of Lexington one of the following (check one):
0 Performance bond
0 Irrevocable letter of credit issued by a bank
0 Deposit of funds in escrow under the same terms and conditions applicable to bonds
Amount of Financial Security Posted: $,
Date Financial Security provided to City of Lexington:
0 Not applicable [No required stormwater control structure(s)]
5. Site/SWM Plan Requirements
Please review and check items below indicating that the proposed Site/SWM Plan contains the following minimum
information. More information may be required by the City of Lexington as directed.
0 Project owner and project designer contact information
0 A vicinity map
0 North arrow
0 Appropriate scale
0 Benchmark information
0 Appropriate legend identifying features and layers on the Site/SWM Plan
0 Property boundaries for the proposed development/redevelopment site along with all properties contiguous to the
site proposed for development/redevelopment
WATER RESOURCES
mailing address :28 West Center Street, Lexington, North Carolina 27292
Phone [phone] / www.LexingtonNC.gov

0 Show all areas downstream of the site to a point where the area of the site proposed for development constitutes
less than ten percent (10%) of the total area draining to that point
0 Show ownership information for the proposed development site and all properties contiguous to the site
0 Note existing and proposed land use(s) for the proposed site development area
0 Note existing land use(s) for all off -site areas
0 Proposed limits of disturbed area(s)
0 Show existing and proposed built -upon areas and other proposed site improvements
0 Note existing and proposed built -upon area in terms of total acreage and % BUA
0 Designated water -supply watershed classification, if applicable
0 Note allowable limits on BUA %
0 Existing streams (identify intermittent and perennial streams, to the extent possible)
0 Show stream buffer widths along streams (where required)
0 Existing wetlands, water impoundments, and other surface water features on the site (as applicable)
0 Regulatory floodways and floodplains (as applicable). Identify and label 100-year Base Flood Elevations (BFEs)
where available. Show limits of both the floodway and floodplain along with BFEs where available.
0 Note if site drains to a 3O3(d) listed stream identified by the North Carolina Division of Water Quality (see NC
DWQ Website for more information - http://h2o.enr.state.nc.us/tmdl/)
0 Note precipitation and hydrologic design parameters required for drainage and flow calculations for site
stormwater conveyance and stormwater quality and quantity management features, as applicable (note: this may
include but not be limited to design rainfall intensities and depths, soil classifications and hydrologic soil types,
time of concentration values, Rational C runoff factors, NRCS Curve Number values, etc.)
0 Existing and proposed site topography showing existing and proposed drainage patterns (note: utilize a contour
interval appropriate for the site conditions, typically 2-ft unless specific site conditions dictate a smaller or larger
internal)
0 Existing and proposed utilities
0 Existing and proposed easements (note: include temporary and permanent easements of all types, including
easements required for storm drainage systems and structural stormwater BMPs/controls such as ponds)
0 15-ft minimum maintenance access easement required for all permanent stormwater BMPs/controls, where
applicable (note: maintenance access easement must connect to a public right-of-way)
0 Identify and note the watershed area for any off -site runoff that flows onto the proposed development site (note:
applicant must also provide watershed delineation and mapping for any off -site runoff that flows onto the
proposed site)
0 Identify and label proposed stormwater drainage system including but not limited to storm drainage inlets, catch
basins, junction boxes, storm drainage pipes, natural vegetated conveyances, infiltration areas, swales, energy
dissipaters, and/or structural stormwater BMPs/controls such as wet ponds, as may be applicable
WATER RESOURCES
mailing address :28 West Center Street, Lexington, North Carolina 27292
Phone [phone] / www.LexingtonNC.gov

0 Details and profiles of proposed storm drainage systems
0 Details of proposed permanent structural stormwater BMPs/controls, where applicable
0 Note the latitude and longitude beside each BMP structure. Report latitude and longitude in degrees, minutes and
seconds to the nearest tenth of a second (e.g. 36'01' 14.2"N, 80'22'59.1"W)
0 Identify and delineate drainage areas and flow paths of runoff to each structural stormwater BMP/control, where
applicable
0 Identify and show where runoff discharges from the proposed development site (including outflows from
BMPs/controls, where applicable) with appropriate connections into a downstream receiving municipal drainage
system and/or open stream channel. Note that the point(s) of discharge from the proposed development site must
not contribute to erosion or other degradation of the receiving municipal drainage system or stream channel.
• Show mitigation measures proposed to protect the downstream system where the volume of runoff from the
post -development, 2-year, 1-hour rainfall event is 10% greater than the volume of runoff from a pre -
development, 2-year, 1-hour rainfall event.
0 Envisioned sequence of construction for permanent stormwater BMPs/controls, where applicable
0 Identification of the entity responsible for long-term maintenance of permanent structural stormwater
BMPs/controls, where applicable
0 Certification of design for permanent structural stormwater BMPs/controls, where applicable
• A licensed professional engineer or landscape architect, to the extent allowed by North Carolina General
Statutes, shall sign and seal a certification on the plan that the plan satisfies applicable stormwater management
control design requirements.
• Certification of Design for Stormwater Management BMP(s)/Control(s):
"I, (Name of licensed designs professional), to the best of my knowledge, certify that the permanent stormwater
management control(s) labeled as (identify structural stormwater control or controls hereon this plan has been
designed in accordance with stormwater management quantity and stormwater management quality
requirements of the City of Lexington and the State of North Carolina, as applicable. I also certify that other
applicable local, state, and federal permits have been applied for and/or received."
Check other permits applied for and/or received, if applicable:
Erosion and Sediment Control permit (Lexington/Davidson County)
Floodplain Development permit (Lexington/Davidson County)
401 water quality certification (State of NC)
404 permit for work in waters/wetlands of the US (US Army Corps of Engineers)
Dam Safety permit (State of NC)
Other: specify here
Signature of licensed design professional
[Licensed professional seal]
WATER RESOURCES
Date
mailing address :28 West Center Street, Lexington, North Carolina 27292
Phone [phone] / www.LexingtonNC.gov

O Prominently display on the drawing cover sheet the following statement: The General Contractor/Developer
shall contact the Stormwater Administrator for an inspection of the stormwater features prior to the
issuance of the Stormwater Management Certificate of Compliance.
0 Where improvements to the downstream (off -site) drainage system are proposed as part of the SWM Plan for the
proposed site development, documentation shall be provided which demonstrates the developer's authority to
perform construction on the downstream property/drainage system
Stormwater Control Operations & Maintenance Lien & Easement Agreement between the Developer and City,
where applicable (refer to section 3.14 of the UDO)
• Note: A signed and sealed Agreement must be provided as part of the SWM Permit Application Package prior
to City issuance of a SWM Permit. The Agreement must also be filed and recorded with the Davidson County
Register of Deeds, in accordance with the ordinance requirements, prior to City issuance of a SWM Certificate
of Compliance, per Section 7 of this form.
0 Operation & Maintenance Plan for each permanent structural stormwater BMPs/controls, where applicable, to
accompany the Stormwater Control Operations & Maintenance Lien & Easement
• Note: The Operation & Maintenance Plan shall be provided by the applicant/developer for each stormwater
control structure, indicating what operation and maintenance actions are needed, what specific quantitative
criteria will be used for determining when those actions are to be taken and, consistent with the Operation &
Maintenance Agreement, who is responsible for those actions. The Plan shall also clearly indicate the steps that
will be taken for restoring a stormwater control structure to design specifications if a failure occurs.
• Note: Annual maintenance inspection and report required — The owner of a permitted structural stormwater
BMP/control shall annually submit a maintenance and inspection report for each BMP to the City of Lexington
Stormwater Administrator. Annual inspections shall begin within one year of the recordation of any deed(s)
showing stormwater BMPs/control structures. The Operation & Maintenance Agreement and Plan shall include
and specify the owner responsibilities and requirements for the annual maintenance and inspection report.
0 Separate Erosion and Sediment Control (E&SC) Plan sheet(s), where required, with site construction sequence
and E&SC details
• Note: The E&SC Program for Lexington is administered by NCDEQ. Applicant/Owner is responsible for
preparing an Erosion and Sedimentation Control Plan (E&SC). City SWM Plan review shall commence upon
receipt of City SWM Permit application, including a copy of the E&SC Plan submitted to NCDEQ. In addition
to meeting all City SWM Permit requirements, the City shall not issue the SWM Permit until the
applicant/owner has satisfied NCDEQ requirements for approval of the E&SC Plan. The Applicant/Owner is then
responsible for providing the City with a copy of the final, approved E&SC Plan that satisfies NCDEQ
requirements.
• Note: On the E&SC Plan, be sure to label E&SC features which are also intended to become permanent
structural stormwater BMPs/controls, if any, and note the process for transitioning the device from a temporary
E&SC measure to a permanent stormwater control feature.
0 Sealed and certified plan set: All plan sheets shall be signed and sealed by a licensed professional engineer or
landscape architect, to the extent allowed by North Carolina General Statutes
WATER RESOURCES
mailing address :28 West Center Street, Lexington, North Carolina 27292
Phone [phone] / www.LexingtonNC.gov

6. SWM Study Requirements for Non -Exempt Sites
[In addition to the minimum Site/SWM Plan requirements identified in Section 5, a SWM Study is required for
non-exem tp sites]
0 Project narrative — brief description of project, pre- and post -development site conditions, hydrologic and
hydraulic study, and proposed SWM plan
0 Hydrologic and hydraulic calculations demonstrating analysis and design of all stormwater management features
and systems on site
0 Calculations and procedures used to design permanent structural stormwater BMPs/controls (note: analysis and
design of BMPs must be based on State of NC DENR Stormwater BMP Guidance Manual)
0 Precipitation data used in stormwater conveyance system and/or stormwater BMP/control analysis and design
0 Time of concentration (Tc) calculations for existing and proposed site conditions and drainage features (also
identify and show flowpaths used for Tc determinations on the SWM Plan or separate map)
0 NRCS Curve Number (CN) and/or Rational C* analysis and determinations for existing and proposed site
conditions (also show on the SWM Plan or separate map).
* Where runoff volume analysis and design is required to satisfy stormwater management requirements, discuss the
most appropriate technical methodology to utilize with Village Stormwater Administrator. The Rational Method
may generally only be appropriate for peak flow estimations from drainage areas of 200 acres or less.
0 Peak Flows, Runoff Volumes, and Hydrographs (as applicable) to analyze and design site stormwater
management features. Stormwater quantity management per Section 3.12.3 of the UDO must include analysis
and design of features and controls per the following minimum performance standards
• Peak discharge control for the 2-year, 10-year, and 25-year storm events. Post -development peak
flows for the 2-year, 10-year, and 25-year events must not exceed pre -development peak flows.
Storm durations should be appropriate for the site of interest and confirmed with the Village
Stormwater Administrator.
• Volume control for the difference in runoff volume from the pre -development 25-year, 6-hour storm
to the post -development 25-year, 6-hour storm
• Volume control where the post -development 2-year, 1-hour storm event is 10% greater than the
volume of runoff from the pre -development 2-year, 1-hour storm
• Any proposed water impounding structures (i.e., dams) shall be designed in accordance with North
Carolina Dam Safety Standards, and if required, shall be reviewed and approved by the NC State
Dam Safety Engineer
0 Other stormwater analysis and design calculations as appropriate for the site to satisfy ordinance requirements
WATER RESOURCES
mailing address :28 West Center Street, Lexington, North Carolina 27292
Phone [phone] / www.LexingtonNC.gov

7. Requirements Prior to Issuance of Stormwater Management Certificate of Compliance
[Prior to City issuance of a Stormwater Management Certificate of Compliance, the following are required]
0 City of Lexington Stormwater Management Permit
0 Certified "as -built" drawings of the site plan and stormwater management BMPs/controls
• The designer of the permanent structural stormwater management BMP(s)/control(s) shall certify, under
professional seal, that the "as -built" stormwater measures, BMPs, controls, drainage system components, and
other stormwater management features are in compliance with the approved stormwater management plans and
designs and with the requirements of applicable ordinances
• Designer's Certification of Stormwater BMP/Control Completion:
"I, (Name of licensed design professional), certify that the permanent stormwater management control(s)
labeled as (identify structural stormwater control or controls here) on this plan has been completed in
conformance with the approved design plans and specifications, has its full design volume available, and is
functioning as designed."
Signature of licensed design professional
[Licensed professional seal]
Date
0 Stormwater Control Operations & Maintenance Lien & Easement Agreement(s) and any other legal documents
and recordation must be properly filed and recorded with the Davidson County Register of Deeds
• The continuous, ongoing obligation of all subsequent property owners to operate, maintain, and re -construct the
stormwater control structure(s) shall be disclosed in all plats and deeds of conveyance. The deed for the
property or any part thereof subsequently presented for recording to the office of the Register of Deeds shall
contain a full disclosure regarding the stormwater control structure(s) together with any restrictive covenants
and liens pertaining to maintenance of said structure(s). The following disclosure statement shall appear on all
plats and deeds recorded for property developed under the provisions of the ordinance
• NOTICE: THIS PROPERTY IS LOCATED IN A STORMWATER MANAGEMENT PROTECTION
AREA AND/OR PUBLIC WATER SUPPLY WATERSHED. DEVELOPMENT RESTRICTIONS
APPLY. THIS PROPERTY IS SUBJECT TO RESTRICTIVE COVENANTS AND A
CONTRACTUAL LIEN REQUIRING MAINTENANCE OF A STORMWATER CONTROL
STRUCTURE.
0 Final inspection of the site and stormwater management BMPs/controls scheduled with and completed by the City
Stormwater Administrator
0 Copies of any/all applicable local, state, and federal permits/permit applications (note: this would include 404/401
permits for work in regulated waters/wetlands, State Dam Safety permits, floodplain development permits, and/or
other as applicable)
WATER RESOURCES
mailing address :28 West Center Street, Lexington, North Carolina 27292
Phone [phone] / www.LexingtonNC.gov