SW5200701_Stormwater Management Permit Application - REV 8-28-20_20200828

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 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.):
BoianLrles at Spring Hove, 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
feet on the left.
4. Latitude:35° 56' 03.35" N Longitude:78° 05' 57.48" W of the main entrance to the project.
II. 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
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 ❑404/401 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: http://12ortal.ncdenr.org/web/lr/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 Vice President of Real Estate
b. Contact information for person listed in item 1a above:
Street Address:337 N Queen Street
City:Kinston State:
Mailing Address (if applicable):PO Box 277
City:Kinston
State:
Phone: (1-800 ) 366-9921 Fax:
Email:[e-mail]
Zi
Zip:28501
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/Or
Signing Official & Ti
b. Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
City:
Phone: ( )
Email:
State:
State: Zip:
Fax: ( )
3. a. (Optional) Print the name and title of another contact such as the projects 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
Phone: (252 ) 459-8196
Email:[e-mail]
4. Local jurisdiction for building permits: Spring Hope, NC
State:NC
Zip:27856
Fax: (252 ) 459-8197
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 the roadway pipes for Street B and then into a constructed swale
for 365 LF to a constructed wet pond. The wet pond will outlet into an existing ditch.
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 follozing: the normal pool of impounded stritchires, the area
betzveen the banks of streams and rivers, the area belozv the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal zvetlands landward from the NHW (or MHM line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal zvetlands landzvard of the NHW (orMHW) line map
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 2.54 43.7%) %
9. How many drainage areas does the project have?1 (For high densihj, count 1 for each proposed engineered
stornnvater BMP. For lozv densihj 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 _
Drainage Area _
Receiving Stream Name
Hendricks Creek
Stream Class *
QNSW
Stream Index Number *
28-55-2
Total Drainage Area (so
7.87
On -site Drainage Area (sf)
7.87
Off -site Drainage Area (sf)
0
Proposed Impervious Area** (so
144,920
% Impervious Area** total
43.7%
Impervious** Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area
On -site Buildings/Lots (sf)
3,500
On -site Streets (so
21,645
On -site Parking (so
51,962
On -site Sidewalks (so
2,473
Other on -site (so
0
Future (so
65,340
Off -site (so
0
Existing BUA*** (so
0
Total (so:
144,920
* Stream Class and Index Number can be determined at: ltttp.Aortal.ncdenr.org zvebAvq&s/csn/classi 'cations
Imppervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
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 may be 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
ht!p://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 copy 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
ht!p://www.envhelp.org/pages/onesto]2express.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).
IVI,A
TK✓
J-cc✓
I'K✓
a-k ✓
J'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 SHW7 prior
to submittal, [phone].)
� 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 http://2ortal.ncdenr.org/web/lr/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
Phone: (252 ) 459-8196
Email:[e-mail]
State:NC Zip:27856
Fax: [phone] )
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or hjpe name of person listed in Contact Infonnation, 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 hiformation, 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,
a Notary Public for the State of
do hereby certify that
before me this _ 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.
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
1. 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