SW4210401_Application_20210422

DEMLR USE ONLY
Date Received Fee Paid Permit Number
Z1 50 5 0Z67 1 6 tti1 21 0 0
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
IJ 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
L GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with r '
specifications, Ietters, operation and maintenance agreements, etc.): 4 4�
Brown Apartments
2. Location of Project (street address);
599 OId 421 S L)SNfl-I.AND QUAI.ITY
City -Boone County:Watauga zi 6p7
P',28
3. Directions to project (from nearest major intersection):
He# a on US 421 North toward Boone turn right onto Old US 421 Quthhesite will be located appr ►x
0.50 miles on the left
4. L.atitude:360 13' 47.60" N Longitude:810 37 54.35" W of the main entrance to the project
IL PERMIT INFORMATION:
a -Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenervals with modifications also requires SKU 102 - Renewal Application Form
Elf this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberN/A , its issue date (if known) and the status of
construction: QNot Started []Partially Completed* ❑ Completed* "'provide a designer's certification
2. Specify the type of project (check one):
®Low Density []High Density ODrains 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, N/A 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):
[QCAMA Major
[]NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 0.50 ac of Disturbed Area
[]404/401 Permit Proposed Impacts
Elf 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 VL htWjJportal.nedenr.org/w1a_an3_r-lg au u=
Form SWU 141 Version Oct 31, 2013 Pagel 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 pwjmO:
Applicant/Organization:lason Kent Brown
Signing Official & Title:Iasonn Kot Brown
b. Contact information for person listed in item la above:
Street Address:230 Hardin Road
City -.Boone State•NC Zip:28607
Mailing Address (if applicable):
City: State:- Zip:
Phone: (828 ) 964-0514 Fax: ( )
Email:[e-mail]
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/Organization-
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City: 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:BREC, PA
Signing Official & Title:lustin C. Church - Principal Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:1520 Meadowview Drive
City:Wilkesboro State:NC Zip:28697
Phone: (336 ) 844-4088 Fax: (336 ) 609-7726
Email.Tghn®brec.biz
4. Local jurisdiction for building permits: Watauga County
Point of Contact: Edwards Maxwell Phone #: (828 ) 265-8043
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, j dpfiy summarize how the stormwater runoff will be treated.
The Rrol"t involves the construction of a new residential apartment building and associated sidewalk on an
existing Shing site that ,already includes an existing building ,an ,pant gThe new building and sidewalk is the
only grogosed new impervious which will be treated with an underglound 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:
C1 Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph Il - Post Construction
3. Stormwater runoff from this project drains to the
4. Total Property Area: 3.52 acres
River basin.
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+: (4) 3.52 acres
+ Total project area shall be calculated to exclude the following: the normal pool of i nded structures, the area
between the banks of streams and rivers, the area below the Normal Hf:ggh Water (r i�wJ line or Mean High Water
(MHiM line, and coastal wetlands landward the NHW (or MHtM line. 'The resultant pro�'ect area is used to
calculate overall percent built upon area (B�Non-coastal wetlands landward of the NHW (orMHiM line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / 'Total Project Area) X 100 = 34 °k
9. How many drainage areas does the project have?l (For high density, count 1 for each proposed engineered
stormwater BMP. For low density 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
South Fork New
River
Stream Class *
C+
Stream Index Number *
Total Drainage Area (sf)
7,282
On -site Drainage Area (sf)
7,282
Off -site Drainage Area (sf)
0
Proposed Impervious Area' * s
7,282
lip rvious Area�k total
100
lm rvious" Surface Area
Drainage Area 1
Drainage Area
Drainage Area
Drainage Area
On -site Buildings/Lots (sf)
6,044
On -site streets (sf)
0
On -site Parkin (sf)
0
On -site Sidewalks (sf)
1,238
Other on -site (sf)
0
Future (sf)
0
Off -site (sf)
0
Existin BUA**" (sf)
0
Total (so:
7,282
* Stream Gass and index Number Can Ue aeterminea at., C W_;(_ UTEUL MfEftI v fXiwCW_WWgaLL0— 4L'.a W"
Im ous areal adasd n as the built upon area including but not limited to, buildings, roads, parking areas,
lks. grave
Form SWIj-101 Version Oct. 31, 2013 Page 3 of 6

""'Report only that amount of existing BLIA that will Ili alter 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. Field Survev
Proiectg in Union Countvw Contact DEMLR Central ice staffto check ifthe project is located within a Threatened &
Endangered Species watershed that maybe subject to more stringent stormwater requirements as per I 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
fromht!p://pgrtal.ncdenr.org/web/wq,/­­ws/­su/``bmIL-manual.
VL SUBM !ITAL 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
ho://portal.ncdenr.org/web/wq/ws/su/statesw/forms 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/portal.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialine 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://12ortal.ncdenr.org/web/wq/ws/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Fart 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.envhelli.ortz/­­­12ay-es/­­­onestonexl2resslbml 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 treatment/management for
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). 7
8. Two sets of plans folded to &5" x 14" (sealed, signed, & dated), including: LID
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
gg 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).
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

�i
A P• Vegetated buffers (where required).
a: 9' Copy of any an lic w
P a e soils report with the associated SHWT ev_
elevations in addition to depths) as well as a map of the boring locations with the existing
. (Please identify
elevations and boring logs. Include an 8.5"xil" copy of the NRCS County
praJ'ect area clearly delineated. For projects with infiltration BMPs, the report should also the
4L—
include the soil type, expected infiltration rate, and the method of determining
(Infiltration Devices submitted to %WQ Schedule a site visitfor DEMLR to vegnthe fy t Silk pry .
to submittal: [phone].)
10. A copy of the most current property deed. Deed book: l
11. For corporations and limited liabilityco -� Page No:
Secretary of State or other official doocumentation, w Provideis documentation from the NC
by the persons listed in Contact Information, item la, 2a, and/or 3a per 5A NCe ti es and ACC1tions held
2H. 003(e).
The corporation or LLC must be listed
Secretary of State, otherwise thas an active corporation in good standing with the NC
e application will be returned.
h : www. state.nc.us Co rations CSeazchas x
VIL DEED RESTRICTIONS AND PROTECnW 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 1p�rtal n �Pnr orb/we/IrlstatP b
storm____ �_wa t -forms rl�, . 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.
V13L 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:iustin C. Church
Consulting Firm: BREC PA
Mailing Address:1520 Meadowview Drive
City:Wilkesboro
Phone: (336 ) 8444088
Email Jotin®brec.biz
State:NC Zip:28697
Fax: (336 ) 609-7726
IX PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type 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 type 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

'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 $25,0M 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 1a) Jason Kent Broom ,
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 sto =ter rules under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Signature: Date
�.Lla ly�l//I _, a Notary Public for the State of" _ , County of
Wa a vt a Gi __ • do hereby certify that ':5�So E\ �1 ' c d W personally appeared
before me this%61day of 4L2 :2�02 • and acknowledp the due execution of the application for
a stormwater permit. Witness my hand and official seal,
'>�3A BRpyy�',�'
O
CIOO�ARy '
pU13v\ 2,
VGA, COv
SEAL
My commission expires Z S
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6