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HomeMy WebLinkAboutSWA000114_Application Form_20210901DEMLR USE ONLY Date Received Fee Paid Permit Number SW Program(s): ❑ Coastal SA-HQW ❑ Coastal SA-ORW ❑ Coastal FW-ORW ❑ Coastal Other ❑ Non -coastal HOW ❑ Non -coastal ORW ❑ Urbanizing Areas ❑ USMP NC DEQ Division of Energy, Mineral and Land Resources STATE STORMWATER FAST TRACK PROCESS: "AUTHORIZATION TO CONSTRUCT" (ATC) PERMIT APPLICATION FORM Link to Application Instructions ELIGIBILITY FOR FAST -TRACK PERMIT To be considered for a Fast Track ATC Permit, all of the items below must be checked. If any item cannot be checked, then the project must apply under the Standard Permitting Process. ® The project and all SCMs (including existing SCMs associated with the project) will meet all applicable requirements of 15A NCAC 02H .1000 - .1062, including the Minimum Design Criteria (MDC), upon project completion. ® The project is not proposing an alternative design. ® The project is not claiming an exemption from the MDC based on vested rights, a waiver or a Director's Certification. ® The project is not out of compliance with an existing stormwater permit or any other environmental permit. ® The project is not applying for an offsite permit, an exemption, or a minor modification (as defined in 15A NCAC 02H .1002(25)) to an existing state stormwater permit. ® The project application bears the signature and seal of a professional licensed pursuant to either Chapter 89A or 89C of the NC General Statutes. ® I understand that at project completion, an application with the as -built stormwater plans (as described in 15A NCAC 02H .1044 must be submitted, and DEQ will review the as -built stormwater plans to confirm compliance with the MDC. Approval of the as -built stormwater plans will be required before the Erosion and Sedimentation Control Plan for the project may be closed out. ® I understand that the Fast Track ATC Permit will expire five years after the date of issuance. 'I- GENERAL INFORMATION 1 Project Name: Crescent Hill Subdivision 2. Previous Project Name (if applicable): 3. Location of Project (street address): Monarch Way City:Winston Salem County:Forsyth Zip:27106 4. Directions to project (from nearest major intersection): Project is located at the terminus of Monarch Way approxiamtely 250' SE of the intersection of Caradco Rd and Mercia Court. 5. Latitude:360 8' 17.19" N Longitude:-800 22' 5.56" W of the main entrance to the project. C. PERMIT INFORMATION 1. Specify whether project is (check one): ® New, no previous application ❑ New, replacing a previous Fast Track ATC Permit -- provide previous permit number: SWA By choosing this option, you are also requesting that DEQ rescind the previous Fast Track ATC Permit upon issuance of the new Fast Track ATC Permit. Stormwater Fast Track ATC Application Form Page 1 of 9 Feb. 10. 2018 ❑ Major Modification, replacing an existing stormwater permit — provide existing permit number: SW Status of construction? ❑ Not Started ❑ Partially Completed ❑ Completed Maio[ modifications must be submitted by the original permittee and are allowed only if the SW permit is not expired. Minor modifications must use Standard Permitting Process. By choosing this option, you are also requesting that DEQ rescind the previous SW Permit upon issuance of the new Fast Track ATC Permit. ❑ Transfer of existing Fast Track ATC Permit — provide existing ATC permit number: SWA 2. Applicable state stormwater program(s) (check all that apply): ❑ Coastal SA-HQW ® Urbanizing Areas (Phase 2) ❑ Coastal SA-ORW ❑ Non -Coastal HQW Is any portion of the project within 575 feet of SA-ORW waters? ❑ Yes ❑ No ❑ Non -Coastal ORW ❑ Coastal Freshwater ORW ❑ USMP ❑ Coastal — Other 3. Other Permits (as applicable; write "NA" for those permit types that are not applicable): Project Name Permit/Appl Issue Date Other Information No. CAMA Major NA Erosion & Crescent Hill PRD Subdivision EN2100070 7/16/2021 Disturbed Area Sedimentation Control 12.47 acre NPDES Industrial NA Stormwater 404/401 Permit Crescent Hill Subdivision 20210469 7/6/2021 Proposed Impacts 89 If/ac 4. Local jurisdiction for building permits: Winston Salem Point of Contact:WS Inspections Office Phone #: (336 ) 727-2624 D. CONTACT INFORMATION 1. Applicant/Financially Responsible Party (may be an Organization): Thyme Properties, LLC Signing Official Name & Title: Robert Weidl, Member -Manager Street Address:2255 Lewisville-Clemmons Rd Suite C City:Clemmons State:NC Zip:27012 Mailing Address (if different): City: State: Zip: Phone: (336) 577-7775 Fax: ( ) Email: robertweidl(o-)hotmail.com 2. If the Applicant is a Corporation or LLC (Address must match address on file with NC Dept of the Secretary of State): Name of Registered Agent:Stephen J. Phillips Mailing Address:2255 Lewisville-Clemmons Rd Suite C City:Clemmons State:NC Zip:27012 Phone: (336) 287-4224 Fax: ( ) Email: Ste phen(o-)zoominter.com Stormwater Fast Track ATC Application Form Page 2 of 9 Feb. 10, 2018 3. The Applicant is the (check all that apply): ® Property Owner ❑ Lessee (Attach a copy of the lease agreement & complete Item 4.) ❑ Purchaser (Attach a copy of the pending sales agreement & complete Item 4.) ® Developer (Attach a copy of the development agreement & complete Item 4.) 4. If the Applicant is NOT the Property Owner (skip to Item 5 if the Applicant IS the Property Owner): Property Owner Name/Organization: Signing Official & Title: Street Address: City: State: Zip: Mailing Address (if applicable): City: State: Zip: Phone: ( ) Fax: ( ) Email: 5. The licensed Design Professional that will be retained for the duration of the project, who may provide information on the Applicant's behalf, and who will prepare and certify the as -built package: Consulting Engineer/Landscape Architect: Alex Carter, PE Consulting Firm: Beeson & Carter, PA Mailing Address: PO Box 669 City: Walkertown State: NC Zip:27051 Phone: (336 ) 748-0071 Fax: (336) 748-0470 Email: acartera-bc-eng.com 6. [OPTIONAL] If you would like to designate another person to answer questions about the project: Name & Title: Organization: Mailing Address: City: State: Zip: Phone: ( ) Fax: ( ) Email: F PROJECT INFORMATI 1. Specify the type of project (check one): ® Low Density ❑ High Density 2. Briefly summarize how the stormwater runoff will be treated/conveyed: The project conveys stormwater via: 1) Sheet flows from impervious areas across vegetated lot areas. 2) Concentrated flows from street curb & putter into curb outlets. These outlets exit into minimum 100' grass swales. Water treatment is provided primarily thouah Infiltration and ET for both convevances. 3. Stormwater runoff from this project drains to the Yadkin Pee -Dee River basin(s). 4. Receivinq water information (if more than 3 receivinq waters, provide additional information on an attached sheet): Receiving Water 1 Receiving Water 2 Receiving Water 3 Receiving Stream Name Oil Mill Branch Stream Classification C Stream Index Number 12-94-6 Stormwater Fast Track ATC Application Form Page 3 of 9 Feb. 10, 2018 5. Project area and density information: Total Property Area 889570 sf Total Surface Water Area 7840 sf Considered to include: • the normal pool of impounded structures, • the area between the banks of streams and rivers, and • the area below the Normal High Water (NHVIO line or Mean High Water (MHM line. Total Coastal Wetlands Area 0 sf Considered to include: coastal wetlands landward from the NHW (or MHM line. Total Project Area 881730 sf Excludes the surface water area and coastal wetland area identified above. May or may not be the same as Property Area. Built -Upon Area (BUA) associated with Existing Development 0 sf "Existing development" means those projects that are built or those projects that have established a vested right under North Carolina law as of the effective date of the state stormwater program or applicable local government ordinance to which the project is subject. Proposed New BUA 211465 sf Includes proposed new BUA that is not associated with existing development. `BUA" is defined in N. C.G.S. 143-214.7(b2). It includes, but is not limited to: buildings, roads, parking areas, sidewalks, and some gravel areas. The design volume of SCMs must take into account the runoff from build out from all surfaces draining to the SCM in accordance with 15A NCAC 02H .1050(1). Project Density w/ Existing Development: Project Density = [New BUA]/[Total Project Area —Existing BUA] x 100 or 23,8 % w/o Existing Development: Project Density = [New BUA]/Total Project Area] x 100 6. Anticipated construction start date As soon as possible 7. Is the project located within 5 miles of a public airport? ® No ❑ Yes If `Yes,' see S.L. 2012-200, Part VI: http://www.ncleg.net/Sessions/2011/Bills/Senate/PDF/S229v6.pdf and DEQ Stormwater Design Manual Chapter E-4 Airports. 8. For projects in Union County: Contact DEMLR Central Office Stormwater staff at 919-707-9200 to determine if the project is located within a Threatened & Endangered Species watershed that may be subject to more stringent stormwater requirements per 15A NCAC 02B .0600. Stormwater Fast Track ATC Application Form Page 4 of 9 Feb. 10, 2018 F. SUBMITTAL REQUIREME Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORW). Only application packages that include all required items listed below will be accepted and reviewed. Initial each item below to indicate that the required information is provided in the application package: Initials 1. Two original signed hard copies and one electronic copy of this State Stormwater Fast Track Process "Authorization to Construct" (ATC) Permit Application Form. 2. Permit application processing fee of $505 payable to NCDEQ. 3. Two hard copies and one electronic copy of a USGS map identifying the project location and GPS coordinates for the project. If the receiving water is Class SA or the receiving water drains to Class SA waters within 'h mile of the project boundary, include the 'h mile radius on the map. If the project is within 575 feet of Class SA-ORW waters, include the 575-foot radius on the map. AC 4. Two original signed hard copies and one electronic copy of a site plan depicting the boundary of the project or project phase currently being permitted, including the locations of SCMs, streams, wetlands, and buffers. AC 5. Two hard copies and one electronic copy of a construction sequence that discusses how any future development on the project may be phased. AC 6. A copy of the most current property deed. Deed book: 3503, 3527 Page No: 460, 3937 AC 7. [IF APPLICABLE] When the applicant is a corporation or a limited liability corporation (LLC): Provide two hard copies and one electronic copy of documentation from the NC Secretary of State, or other official documentation, which supports the titles and positions held by the persons listed in Section C.2 per 15A NCAC 2H. 1043(3)(b). The corporation or LLC must be listed as an active corporation in good standing with the NC Department of the Secretary of State; otherwise, the application will be returned. https://www.sosnc.,qov/search/index/corp N/A 8. [IF APPLICABLE] When the applicant is a Partnership or other person engaging in business under an assumed name, attach a copy of the Certificate of Assumed Name. N/A 9. [IF APPLICABLE] When the applicant is not the property owner: Provide two hard copies and one electronic copy of lease agreements, affidavits, pending sales agreement, development agreement, or other documents showing that the applicant has obtained legal rights to submit a stormwater permit application within the proposed project area. N/A 10. [IF APPLICABLE] If modifying an existing permit for completed or partially completed projects, a copy of the designer's certification. Stormwater Fast Track ATC Application Form Page 5 of 9 Feb. 10, 2018 G. CERTIFICATION OF APPLICANT/ FINANCIALLY RESPONSIBLE PARTY The Applicant, who is also the Financially Responsible Party, identified in Section D of this form must sign and have notarized the following guaranty: I, (print or type name of Applicant/Financially Responsible Party) Thyme Properties. LLC certify that the information included on this permit application form is, to the best of my knowledge, correct and that: 1. the design has been or will be completed in accordance with the MDC as set forth in Rules 15A NCAC 02H .1050 through .1062, to the best of my knowledge; 2. the completed design meets or will meet the MDC and that the percentage BUA that is the basis for the design shall not be exceeded, to the best of my knowledge; and 3. As the applicant, I shall maintain a licensed professional of record for the duration of the project who will prepare and certify the as -built package. If I retain another licensed professional before the project is complete, then I shall provide an updated guaranty with the current licensed professional's seal. A licensed professional shall inform the Division if he is no longer associated with this project. The above information is true and correct to the best of my knowledge and belief and was provided by me under oath I agree to provide corrected information should there be any change in the information provided herein. Robert Weidl Member -Manager Type t name Title or Authority Signature V L,Date a Notary Public for the State of LSO( �2 C AV(x--�, County of � xS( 'l-m do hereby certify that personally appeared before me this day of I�K and acknowledge the due execution.of the applicatign-;�}a stormwwater permit. Witnessqny hand and official seal, Nickie Parker NOUry Public, North Carolina Forsyth County My Commission Expires April 12, 2W6 SEAL My commission expires 0 L'1- 12 " Z. 02 H. DESIGN PROFESSIONAL'S CERTIFICATION To be completed by the Design Professional identified in Section D.5. I, Alex Carter, PE , attest to the following: 1. This application has been reviewed by me and is accurate and complete, to the best of my knowledge; 2. The design has been completed in accordance with the MDC as set forth in Rules 15A NCAC 02H .1050 through .1062, as applicable; 3. The percentage built -upon area that is the basis for the design will not be exceeded; and 4. 1 have the expertise, education, and experience required to design the SCMs proposed in this application in accordance with the MDC as set forth in Rules 15A NCAC 02H .1050 through .1062. 5. 1 will provide all documents and certified as -built plans in hard copy and electronic format related to this permit to a new Applicant/Property Owner and to DEMLR upon transfer of this permit to a new Applicant/Property Owner. Note: In accordance with N.C.G.S. 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation. In addition, any person who knowingly makes any false statement, representation, or certification in any application may be reported to the appropriate NC professional licensing board. Signature: Date: ��`/ Z `` 0ti01 4411111 f 11l11/1///j/ CARpjvN,,,, 74 " �!f �rll N I I I I f illly111��1�\ SEAL Stormwater Fast Track ATC Application Form Page 7 of 9 Feb. 10, 2018 Operation & Maintenance Agreement Project Name: Project Location: Crescent Hill Subdivision Winston Salem, NC Cover Page Maintenance records shall be kept on the following SCM(s). This maintenance record shall be kept in a log in a known set location. Any deficient SCM elements noted in the inspection will be corrected, repaired, or replaced immediately. These deficiencies can affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the SCM(s). The SCM(s) on this project include (check all that apply & correspor Infiltration Basin Quantity: Infiltration Trench Quantity: Bioretention Cell Quantity: Wet Pond Quantity: Stormwater Wetland Quantity: Permeable Pavement Quantity: Sand Filter Quantity: Rainwater Harvesting Quantity: Green Roof Quantity: Level Spreader - Filter Strip Quantity: Proprietary System Quantity: Treatment Swale Quantity: Dry Pond Quantity: Disconnected Impervious Surface Present: No User Defined SCM Present: No Low Density Present: Yes O&M sheets will Location(s): Location(s): Location(s): Location(s). Location(s): Location(s): Location(s): Location(s): Location(s): Location(s): Location(s): Location (s ): Location(s): Location(s): Location(s): Type: be added a Curb outlet system f acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for each SCM above, and attached O&M tables_ I agree to notify NCDEQ of any problems with the system or prior to any changes to the system or responsible parry. Responsible Party: Title & Organization: Street address: City, state, zip: Phone number(s): Email: Signature: County of Robert Weidl Member -Manager, Thyme Properties, LLC 2255 Lewisville-Clemmons Rd Suite C Clemmons, NC 27012 336-577-7775 robertweidl@hotmail.com Date: 8 a Notary Public for the State of ( 0-wcklo ) do hereby certify that V)pbe�'c We-\C� personally appeared before me this 2n� day of and acknowledge the due execution of the Operations and Main ce Agreemen . Witness my hand and official seal, � No" Public, North Cwdho Forsyth Cairyty Commisslon E mires ADA IL i Seal My commission expires nuL- 12 - W 2(y Low Density Residential Subdivisions with Curb Outlet Swales Deed Restrictions & Protective Covenances In accordance with Title 15 NCAC 02H.1000, the Stormwater Management Regulations, deed restrictions and protective covenants are required for Low Density Residential Subdivisions with curb outlet swales, 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. I, Thyme Properties, LLC acknowledge and affirm by my signature below, that 1 will cause the following deed restrictions and protective covenants to be recorded for Crescent Hill Subdivision prior to the sale of any lot: 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 3025 square feet. This allotted amount includes 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, and coquina, 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, where the Division of Coastal Management calculates a different maximum allowable built -upon area for that lot than is shown herein, the goveming maximum built -upon area for that lot shall be the most restrictive of the two. 8. This project includes a curb outlet system. Each designated curb outlet swale shall be maintained in accordance with the designs shown on the approved plans. This requires a minimum of 100' long with 3:1 (H:V) side slopes or flatter, have a longitudinal slope no steeper than 5%, carry the flow from a 10 year storm in a non -erosive manner, maintain a trapezoidal cross-section with a minimum bottom width of 2, and maintain a dense vegetated cover. 9. 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. 10. Each lot will maintain a 30* foot wide vegetated buffer between all impervious areas and surface waters. 11. All roof drains shall terminate at least 30* foot from the mean high water mark of surface waters. 12. Filling in, piping or altering any designated 3:1 curb outlet swale associated with the development is prohibited by any persons. *50 foot for projects located in the 20 coastal counties. Form DRPC-6 Rev 20170420 Page 1 of 2 Low Density Residential Subdivisions with Curb Outlet Swales Deed Restrictions & Protective Covenances c Signature:_ ' Date: 47 Z � z I, M 1-C K i e PAY Y-ieY a Notary Public in the State of _N9X)L County of F�4QS'q T do hereby certify that RebeC \r�ek6\ personally appeared before me this the 2 day of �C.l��[ 20 2 and acknowledge the due execution of the foregoing instrument. Witness my hand and official seal, SEAL Signature Nfd*fe Parkw NO" Pubfic, North CSIOWa My Commission expires (.,H i Z' Za Z �D ForsythCounly sA My Commission Expires April 12, 2028 Form DRPC-6 Rev 20170420 Page 2 of 2