SW4210301_STORMWATER_APPLICATION_20210316

DEML R 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 Stormwatex 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
1. 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.):
AEV Parking Expansion
2. Location of Project(street address):
150 Northwest Dr
City:Jefferson County:Ashe zip:28640
3. Directions to project(from nearest major intersection):
From intersection of W Main St(Hwy 88)and South Market(Bus 21),travel west on West Main St for 0.44 miles,turn right onto
Northwest Dr and continue for 0.23 miles.Site is located in field on the right.
4. Latitude: 36 ° 25 ` 27.6"N Longitude: -8'1 ° 28 ' 50.7"W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is (check one): ®New [_]Modification ❑Renewal w/ Modificationt
tRenewals with modifications also requires SWLI 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 stornnwater management permit applications,last 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/Erasion Control: s 4 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 des,see S.L.2012-200, Part VI:htt ortal.ncdenr.or gLyweb jr/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,i�nrdividual,etc.who owns the project):
Applicant/Organization: v
Signing Official&Title: \ � t �-
b.Contact information for person listed in item la above:
Street Address:--
City: KA 0 W State: YL Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: I to) ``i C� C Fax: f'� �- } 9 9'L-- A 1,5
Email: Ck ..xJ o—f-- c,,-c?\.J . C- r
c.Please check the propriate 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 tprojec is located fond):
Property Owner/Organization: ,V� W LLC-
Signing Official&Title:— � �-
b.Contact information for person listed in item 2a above:
Street Address:City: State:State: Zip:
Mailing Address(if applicable):
City: 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: KeW 67W C6 E_ r
Signing Official&Title: )(EJ)N5I (,*AF / CDO+ &
i
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: f �J3�o ) 9 7-7-©Z61 Tax:
Email:
4. Local jurisdiction for building permits: Ashe County Building Department
Point of Contact: Phone#: ( 336 ) 846-5511
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Form SWU-101 Version Oct.31,2013 Page 2 of 6
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IV. PROJECT INFORMATION
1. In the space provided below,br_ iefly summarize how the stormwater runoff will be treated.
Runoff from new gravel parking lot will be collected and treated with a sand filter.
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:
EJ 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 New River basin.
4. Total Property Area: 19.004 acres 5. Total Coastal Wetlands Area:NIA acres
6. Total Surface Water Area:2.005 acres
7. Total Property Area (4)--Total Coastal Wetlands Area(5)--Total Surface Water Area(6)=Total Project
Area+: 16.999 acres
k TotaI project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between Me banks of streams and rivers, the area below the Normal High Water(NHW)line or Mean High Water
(MHI� line,and coastal wetlands landward frown the NHW(or MHM line. The resultant project area is used to
calculate overall percent built upon area(BUA). Non-coastal wetlands landward of the NHW(or A4HM line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area/Total Project Area)X 100 = 7.66116.999*100=45
9. How many drainage areas does the project have?1 (For high density,count 1 for each proposed engineered
storinwater 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 D3raina e Area ,�, Drama e Area_ Drama e.Area_ Drainage Area
Receiving Stream Name Naked Creek
Stream Class * C+
Stream Index Number* 10-1-32
Total Drainage Area(sf) 167,131
On-site Drainage Area(sf) 166,015
Off site Drainage Area(sf) 11,116
Proposed Impervious Area s 90,910
T.Impervious Area** total 54%
.Impervious"Surface Area Drainage Area Drainage Area _ Drainage Area Drainage:Area
On-site Buildings/lots (so 0
On-site Streets (sf) 0
On-site Parking (so 90,273
On-site Sidewalks (so 637
Other on-site (sf) 0
Future(sf) 0
Off--site (sf) 1,436
Existing BUA*** (sf) 0
Total (sf): 192,2913
* Stream Class and Index Number can be determined at: http,Aortal.nedenr.org we�g[ps/cstc%lassigeations
* Im ervious area is defined as the built upon area including,but not limited to, buildings,roads,parking areas,
sidewalks,gravel areas,etc,
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Form SWU-101 Version Oct.31,2013 Page 3 of 6

""Report onli that anjolln't of existing BUA that Trill remain.after dcvclopnient. Do not report any existing BUA flint
Y 0
is to be rcinoved and.zuhich Tvill be replaced by new BUA.
11. How was the off-site impervious area listed above determined? Provide documentation, Field survey
Projects in Union County: Contoo. 0E TIC R Centi-al Qf.ficestqlflo check affhe project is located i0l.hin a Threatened&
EndangeredSpocies imlershed that inay be sub�eef to niore s1rirkge171s1ora7)i,,a1er requirefnews ors tier 15,11 NC4C 02B.0600.
V. SUPPLI.IMENT 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
from htlp://t7ortal.ncdenr,.org/iveb/'wcl/ws/su/laiatp-manual.
V1. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy,Mineral and
Land Resources(DEM1,R). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
httl2://portal.iicdeiir.oi-g/weblwq/ws/si.i/`statesw/foriiis does. 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 at http://12ortal.ncdenr.orZ/webZ wq/ws/su/rnays.)
Please indicate that the following required in have been provided by initialin 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 littl)://I?ortal.ncdeni-.orgZweb/wq,/ws/`sLi/statcsw/forms does..
h is
1. Original and one copy of the Stormwater Management Permit Application Forrn.
2, Original and one copy of the signed and notarized Deed Restrictions &Protective Covenants
Form. (if required as per Part V11 below)
3. Original of the applicable Supple rentForm(s) (sealed,signed and dated)and O&M
agreeruent(s)for each BMP.
4. Permit application processing fee of$505 payable to NCDENR. (For an Express review,refer to
1-iqp://www.ei-yvhelp.org/Liages/oi-iestopexpress.htiiil 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.)
5. A detailed narrative (one to two pages) describing the stormwater treatir-tent/management for .566
6, A USGS rn.ap identifying the site location. If the receiving stream is reported as class SA or the A
receiving stream drains to class SA waters within"/2 mile of the site boundary,include the 1/2
.mile radius on the map,
7. Sealed,signed and dated calculations (one copy). 4/�
S. 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 ntunbers.
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 ba.id<s of streams and rivers,the MHW or NHW line of tidal
waters,and any coastal wetlands landward of the MIJW 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 NIIW)of tidal waters.
j. Dimeiisioi.i,edpropei-ty/projectboundary with bearings&distances.
j. Site Layout:with all BUA identified and dimensioned.
k. Existing contours,proposed contours,spot elevations,fixiishedfloor elevations.
1. Details of roads,drainage features,collection systems,and stormwater control measures.
ni.Wetlands delineated, or,a note on the plans that none exist. (Must be delineated by a
qLtalified 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)-
Forni SWU-101 Versioii 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
elevations in addition to depths) as well as a neap of the boring locations with the existing C- aw
elevations and boring logs. Include an 8.5"xll" copy of the MRCS County Soils snap with the
project area clearly delineated. For projects with infiltration 13MPs,the report should also
include the soil type,expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to lvWiRO:Schedule a site visit for DEMLR to veri frj the S7-ft VT prior
to srrlrmittal', [phone].)
1.0. A copy of the most current property deed.Deed boob: 478 Page No: 1 825
11, For corporations and limited liability corporations (LLC:):IProvide documentation from the NC ! ,1
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 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.
httl2://www secretary.state.nc.rrsZCoi-porations/CSear•cl7.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions,outparc:els,and fixture development,the appropriate property restrictions and protective
covenants are rewired 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 htttr://L)ortal..ncderra:.org/web/h•/state-
stormtvater-forms 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 bolder(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
Harder 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.
V111. 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 additiorial information).
Consulting Engineer: Max Prestwood
Consulting Firm: BREC, P.A.
Mailing Address: 1520 Meadomiew Dr
City:Wilkesboro State: NC zip:28697
Phone: 336 ) 844-4088 Fax: II
Email max@,brec.biz
1
IIC, PROPERTY OWNER AUTHORIZATION (ifCcrrrtnctlrrforrrrcriiorr, it€rrr2lrczsl�eerrltecicrrrt, ccarrrlalthis w_
section) Tev ..
1, (print or type wine of person listed in Contact hi.foruiation,�iterrr 2a) ( ..����• .G"' � (�� i4�,t�.,i� �.,,�;� ��� certiffy tlLdt I
own the property identified in this permit application, and thus give permission to (print or till e rrnrrre of persora
listed in Contact Irrfararratioru, iteni. la) with(prirtf or type°rrapne of organization listed in
C:outra.ct Irr formation, ite.-in l a) 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 stornrwate:r,system..
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Forrrr SWU-101 Version Oct..31, 201 3 Page 5 of
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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 DEM.LR immediately and
submit a completed Name/Ownership Change Dorm 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 County of
do hereby certify that personally appeared
before me this—day of ,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 Ia)
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 recorded,and that the proposed project complies with the requirements of the
applicable stormwater rul • er 15A N AC 21-1.1000 and any other applicable state stormwater]requirements.
Signature: Date: '�1��17-A
I, t�•�/; �,�a .f a Notary Public for the State of County of
ITS , do hereby certify that 6;ee:�e, personally appeared
before me this I day of 606AVA- W 20 Zf ,and acknowle due ex tion of th app 'c n for
a stormwater permit. Witness my hand and official seal,
�.
JEFFRE 1LLIANIS N
NOTARY PUBLIC
SEAL WILKES COUNTY
North Carolina '12412624
My Comm4sslon Expires
My commission expires
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Form 5WU-101 Version Oct. 31,2013 Page 6 of 6