SW6201005_Application Form_20211103 (2)

Basin Information
Drainage Area _
Drainage Area _
Drainage Area _
Drainage Area _
Receiving Stream Name
Black Branch
Stream Class *
C
Stream Index Number *
18-31-19-5-1
Total Drainage Area (sf)
838.965
On -site Drainage Area (sf)
838.965
Off -site Drainage Area (sf)
0
Proposed Impervious Area** (sf)
201,352
% Impervious Area** (total)
24
Impervious— Surface Area
Drainage Area _
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
83,436
On -site Streets (sf)
51,735
On -site Parking (sf)
0
On -site Sidewalks (sf)
6,812
Other on -site (sf)
0
Future (sf)
59,357
Off -site (sf)
0
Existing BUA*** (sf)
0
Total (sf):
201,340
* Stream Class and Index Number can be determined at: http.aortal.ncdenr.or web/wcl(ps/csu/classifications
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
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
from htt2://12orLal.ncdenr.org/web/wq/ws/su/bMp-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
http://portal.ncdenr.ore/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 at http://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 fromhtt2://12ortal.ncdenr.ore/web/wq/ws/su/statesw/forms docs.
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
http://www.envhelp.org/pages/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.)
Form SWU-101 Version Oct. 31, 2013 Page 4 of 7