HomeMy WebLinkAboutSW6100208_HISTORICAL FILE_20100222STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW�l2'
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD
9
.. .. .. DWQ USE ONLY ..,
Date Received
Fee Paid
Permit Number
Z —Z z— o
1 SkI 00
Applicable Ruffs: ❑ Coastal SW —1995 ❑ Coastal SW — 2008 ❑ Ph 11- Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina MyR_pRo
Department of Environment and Natural Resources
Division of Water Quality FEB 12 2010
STORMWATER MANAGEMENT PERMIT APPLICATION FORI WQ
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.):
Township Developers, LLC
2. Location of Project (street address):
94 Three Hunts Road
City: Pembroke, NC County: Robeson Zip: 28372
3. Directions to project (from nearest major intersection):
From I-95 take NC 711 to Pembroke, NC. Take NC 711 and make a left onto Comtech Drive. Once on
Comtech Drive go approximately 0.6 miles to Three Hunts Road. The site is approximately 0.3 miles near the
end of this cul-de-sac.
4. Latitude:34° 38' 49.55" N LonOtude:79° 10' 12.29" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a -Specify whether project is (check one): ®New []Modification
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 ❑Parbiany Completed' ❑ Completed' 'praufde a designei s off tffication
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 DWQ
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):
❑LAMA Major
ONPDES Industrial Stormwater
®Sedimentation/Erosion Control: 4.15 ac of Disturbed Area
1 "
E3404/401 Kermit 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: Township Develops, LLC ; Project ID: Robes-2010-015, Issue Date: 2-
2/10 , Erosion Control
Form SWU-101 Version 07July2009 Page I 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 proiect):
Applicant/Organization: Township Developers, LLC
Signing Official & Title: James Maynor - Owner/Partner
b.Contact information for person listed in item la above:
Street Address:763 Comtech Drive
City:Pembroke State: NC Zip: 28372
Mailing Address (if applicable):PO Box 1359
City:Pembroke State: NC Zip: 28372
Phone: (910 ) 521-8013 Fax: ( 1
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:Venture Properties Group, LLC
Signing Official & Title:James Maynor
b. Contact information for person listed in item 2a above:
Street Address: 763 Comtech Drive
City:Pembroke State: NC Zip: 28372
Mailing Address (if applicable):PO 1359
City:Pembroke State:NC Zip:28372
Phone: (910 ) 521-8103 Fax: Wa )
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:
Signing Official &
b. Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
4. Local jurisdiction for building permits:
Point of Contact: Phone #:
Form SWU-101 Version 07July2009 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 directed to a Wet Detention Basin located to the northwest of the site. The Basin is
designed using 90% TSS Pollutant Removal Efficiency Table 10-3.
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.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 Lumber River basin.
4. Total Property Area: 6.27 acres
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+:6.27 acres
Total project area shall be calculated to exclude thefollowing: the normal pool of impounded structures, the area
between the barks of streams and rioters, the area below the Normal Hi Water (NHIM line or Mean High Water
(MHIM line, and coastal wetlands landward frwu the NHW (or MHl�line. The resultant .ect area is used to
calculate overall percent built upon area (B UA). Non -coastal wetlands landward of the NHW (or MHIM line may
be inc uded in the total project area
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 79 °%
9. How many drainage areas does the project have? One (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.
Baser Information
Dramage Area 1
Dramage Area _Dramage
Area _
Drainage Area _
Receiving Stream Name
Lumber River
Stream Class '
WS-IV, B$w,
HQW
Stream Index Number
14-(7)
Total Drainage Area (A)
273,122
On -site Drainage Any (sf)
7-73,122
Off -site Drainage Area (sf)
0
pro Impervious Ate"
215,766
% Impervious Area" total
79
Im rvwus" Surface Area
Drains Area 1
—
Dras a Area
in —
Drainage Area —
Drainage Area —
On -site Buildings/Lots (sf)
45,000
O"te Streets (sf)
62,766
O"te Parking (sf)
100,000
O"te Sidewalks (sf)
81000
Otber on -site (sf)
0
Future (sf)
0
Off -site (sf)
0
Existing BUA" (sf)
0
Total (sf):
215,766
Stream Class and Index Number can be determined at: http://h2o.enr.state.nc.us/bims/reports/reportsWB.html
Form SWU-101 Version 07July2009 Page 3 of 6
*` Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
*** Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DWQ Central Office staff to check ifihe project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 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
from h_ptt ://h2o.enr.state.nc.us/su/bmp forms.htm.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from hgp://h2o.enr.state.nc.us/su/bmp forms.htm. The complete application
package should be submitted to the appropriate DWQ Office. (The appropriate office may be found by locating
project on the interactive online map at hgp://h2o.enr.state.nc.us/su/`msi_maps.htm.)
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://h2o.enr.state.nc.us/su/bmp forms.htm.
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 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
htW://www.envheiR.org[papes/onestopexpress.html 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/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.
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.
Form SWU-101 Version 07July2009 Page 4 of
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).
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 map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" 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 DWQ to verify the SHWC prior
to submittal, (910) 796-7378.)
10. A copy of the most current property deed. Deed book: 01674 Page No: 0809 _
11. 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 la, 2a, and/or 3a per 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.
http://www.secretary.state.nc.us/CorRorations/CSearch.asi2x
VIL DEED RESTRICTIONS AND PROTECTIVE 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
httD://h2o.enr.state.nc.us/su/bmi) forms.htm#deed restrictions. 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 DWQ 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:Tohnny W. Nobles
Consulting Firm: Johnny W. Nobles & Associates
Mailing Address:PO Box 407 (416 N. Chestnut Street)
City:Lumberton
Phone: (910 ) 738-6875
Email:noblesassociates@nc.rr.com
State:NC Zip:28358
Fax: (910 ) 738-8652
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) lames Maynor , certify that I
own the property identified in this permit application, and thus give permission to (print or hype name of person
listed in Contact Information, item 1a) Tames Maynor with (print or type name of organization listed in
Contact Information, item 1b) 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 07July2009 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 DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ 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.
Date: 11711J.6 jO
I, DehOyypI R I ve' a Notary Public for the State of G County of
P 6 �t do hereby certify that J Atxo 110 Y personally appeared
before me this 12 day of E—tb O� j0 , and acloapwledQe the due xecuti n o�cation for
a stormwater permit. Witness my hand and official seal, r�IL�' Q� n� �(!'
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or hype name of person listed in Contact Information, item 2) lames Maynor
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, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Signature: LL (n %1L /n /ilQeRWD — Date: � �C)
I, U�1')UVct� A- I V el a Notary Public for the State of N County of
6 h e StM do hereby certify that —2z4n ZY10 no V personally appeared
II �
before me this )� day of Fe q ad 10 , and ac wledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, . cj °-
My commission expires ' 11 J
Form S WU-101 Version 07Iu1y2009 Page 6 of 6