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HomeMy WebLinkAboutSW7080709_CURRENT PERMIT_20080807STORMWATER DIVISION CODING SHEET POST -CONSTRUCTION PERMITS PERMIT NO. SW DOC TYPE CURRENT PERMIT APPROVED PLANS ❑ HISTORICAL FILE ❑ COMPLIANCE EVALUATION INSPECTION DOC DATEjQ'D�QD YYYYMMDD p�pF NATFgOG Michael F. Easley, Governor r CO North G. Ross Jr., Secretary North Carolina Department of Environment and Natural Resources O Y Coleen H. Sullins, Director Division of Water Quality August 7, 2008 Mr. Charles R. Price Carter Lumber Partnership of Indiana 601 Tallmadge Road Kent, OH 44240 Subject: Stormwater Permit No. SW7080709 Griggs Lumber— Edenton Store High Density Project Chowan County Dear Mr. Price: The Washington Regional Office received a complete Stormwater Management Permit Application for Griggs Lumber — Edenton Store on July 17, 2008. Staff review of the plans and specifications has determined that the project, as proposed, will comp)y with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000. We are forwarding Permit No. SW7080709 dated August 7, 2008, for the construction of the subject project. tiv(3>(2f This permit shall be effective from the date of issuance until August 7, 2018, and shall be subject to the conditions and limitations as specified therein. Please pay special attention to the Operation and Maintenance requirements in this permit. Failure to establish an adequate system for operation and maintenance of the stormwater management system will result in future compliance problems. If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit. This request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. Unless such demands are made this permit shall be final and binding. If you have any questions, or need additional information concerning this matter, please contact Samir Dumpor, or me at (252) 946-6481. Sinc rely, Regional Supervisor Surface Water Protection Section AH/sd: J:\WPDATA\WQS\ State SW-SD\Permits —Wet Pond \SW7080709 cc: Bob Farris, CIE Solutions howan County Building Inspections ,,,,'Washington Regional Office Central Files North Carolina Division of Water Quality Internet: www.ncwaterguality.org One 943 Washington Square Mall Phone (252) 946-6481 NorthCaiolina Washington, NC 27889 Fax (252) 946-9215 ati An Equal Opportunity/Affirmative Action Employer -50%Recycled/10%a Post Consumer Paper �/Ym�y/ f L `LICE{, State Stormwater Management Systems Permit No. SW7080709 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WATER QUALITY STATE STORMWATER MANAGEMENT PERMIT HIGH DENSITY DEVELOPMENT In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as amended, and other applicable Laws, Rules, and Regulations PERMISSION IS HEREBY GRANTED TO Carter Lumber Partnership of Indiana Griggs Lumber— Edenton Store Chowan County FOR THE construction, operation and maintenance of a wet detention pond in compliance with the provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and the approved stormwater management plans and specifications and other supporting data as attached and on file with and approved by the Division of Water Quality and considered a part of this permit. IZ(3d./z! This permit shall be effective from the date of issuance until August 7, 2018, and shall be subject to the following specified conditions and limitations: I. DESIGN STANDARDS This permit is effective only with respect to the nature and volume of stormwater described in the application and other supporting data. 2. This stormwater system has been approved for the management of stormwater runoff as described on page 3 of this permit, the Project Data Sheet. The stormwater control has been designed to handle the runoff from 243,705 square feet of impervious area. 3. The tract will be limited to the amount of built -upon area indicated on page 3 of this permit, and per approved plans. 4. All stormwater collection and treatment systems must be located in either dedicated common areas or recorded easements. The final plats for the project will be recorded showing all such required easements, in accordance with the approved plans. 5. The runoff from all built -upon area within the permitted drainage area of this project must be directed into the permitted stormwater control system. Page 2 of 8 State Stormwater Management Systems Permit No. SW7080709 C9 The following design criteria have been provided in the Wet Detention pond and must be maintained at design condition: a. Drainage Area, acres: 9.06 b. Total Impervious Surfaces, ftZ: 243,705 c: Pond Depth, feet: 5.50 d. TSS removal efficiency: 90% e. Permanent Pool Elevation, FMSL: 13.50 f. Required Permanent Pool Surface Area, ftZ: 21,505 g. Provided Permanent Pool Surface Area, ftZ: 23,090 h. Permanent Pool Volume, ft3: 91,904 i. Temporary Storage Elevation, FMSL: 16.50 j. Required Storage Volume, ft3: 19,922 k. Provided Storage Volume, ft3: 100,076 I. Controlling Orifice: 2.5" 0 pipe M. Receiving Stream/River Basin n. Stream Index Number: o. Classification of Water Body: II. SCHEDULE OF COMPLIANCE Chowan River / Chowan River Basin 25 "B, NSW" 1. The stormwater management system shall be constructed in its entirety, vegetated and operational for its intended use prior to the construction of any built -upon surface. 2. During construction, erosion shall be kept to a minimum and any eroded areas of the system will be repaired immediately. 3. The permittee shall at all times provide the operation and maintenance necessary to assure the permitted stormwater system functions at optimum efficiency. The approved Operation and Maintenance Plan must be followed in its entirety and maintenance must occur at the scheduled intervals including, but not limited to: a. Semiannual scheduled inspections _(every _6 months). b. Sediment removal. c. Mowing and revegetation of slopes and the vegetated filter. d. Immediate repair of eroded areas. e. Maintenance of all slopes in accordance with approved plans and specifications. f. Debris removal and unclogging of outlet structure, orifice device, flow spreader, catch basins and piping. g. Access to the outlet structure must be available at all times. Page 3 of 8 State Stormwater Management Systems Permit No. SW7080709 4. Records of maintenance activities must be kept and made available upon request to authorized personnel of DWQ. The records will indicate the date, activity, name of person performing the work and what actions were taken. Decorative spray fountains will be allowed in the stormwater treatment system, subject to the following criteria: a. The fountain must draw its water from less than 2' below the permanent pool surface. b. Separated units, where the nozzle, pump and intake are connected by tubing, may be used only if they draw water from the surface in the deepest part of the pond. c. The falling water from the fountain must be centered in the pond, away from the shoreline. d. The maximum horsepower for a fountain in this pond is 1/3 horsepower. 6. The facilities shall be constructed as shown on the approved plans. This permit shall become voidable unless the facilities are constructed in accordance with the conditions of this permit, the approved plans and specifications, and other supporting data. 7. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and prior to operation of this permitted facility, a certification must be received from an appropriate designer for the system installed certifying that the permitted facility has been installed in accordance with this permit, the approved plans and specifications, and other supporting documentation. Any deviations from the approved plans and specifications must be noted on the Certification. A modification may be required for those deviations. 8. If the stormwater system was used as an Erosion Control device, it must be restored to design condition prior to operation as a stormwater treatment device, and prior to occupancy of the facility. 9. Access to the stormwater facilities shall be maintained via appropriate easements at all times. 10. The permittee shall submit to the Director and shall have received approval for revised plans, specifications, and calculations prior to construction, for any modification to the approved plans, including, but not limited to, those listed below: a. Any revision to any item shown on the approved plans, including the stormwater management measures, built -upon area, details, etc. b. Project name change. C. Transfer of ownership. d. Redesign or addition to the approved amount of built -upon area or to the drainage area. e. Further subdivision, acquisition, lease or sale of all or part of the project area. The project area is defined as all property owned by the permittee, fow which Sedimentation annd Erosion -Control Plaapproval or a CAMA Major permit was sought. f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan. 11. The permittee shall submit final site layout and grading plans for any permitted future areas shown on the approved plans, prior to construction. 12. A copy of the approved plans and specifications shall be maintained on file by Page 4 of 8 State Stormwater Management Systems Permit No. SW7080709 the Permittee at all times. 13. The Director may notify the permittee when the permitted site does not meet one or more of the minimum requirements of the permit. Within the time frame specified in the notice, the permittee shall submit a written time schedule to the Director for modifying the site to meet minimum requirements. The permittee shall provide copies of revised plans and certification in writing to the Director that the changes have been made. III. GENERAL CONDITIONS This permit is not transferable except after notice to and approval by the Director. In the event of a change of ownership, or a name change, the permittee must submit a formal permit transfer request to the Division of Water Quality, accompanied by a completed name/ownership change form, documentation from the parties involved, and other supporting materials as may be appropriate. The approval of this request will be considered on its merits and may or may not be approved. The permittee is responsible for compliance with all permit conditions until such time as the Division approves the transfer request. 2. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee to enforcement action by the Division of Water Quality, in accordance with North Carolina General Statute 143-215.6A to 143-215.6C. 3. The issuance of this permit does not preclude the Permittee from complying with any and all statutes, rules, regulations, or ordinances, which may be imposed by other government agencies (local, state, and federal) having jurisdiction. 4. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the Permittee shall take immediate corrective action, including those as may be required by this Division, such as the construction of additional or replacement stormwater management systems. 5. The permittee grants DENR Staff permission to enter the property during normal business hours for the purpose of inspecting all components of the permitted stormwater management facility. 6. The permit may be modified, revoked and reissued or terminated for cause. The filing of a request for a permit modification, revocation and reissuance or termination does not stay any permit condition. 7. Unless specified elsewhere, permanent seeding requirements for the stormwater control must follow the guidelines established in the North Carolina Erosion and Sediment Control Planning and Design Manual. 8. Approved plans and specifications for this project are incorporated by reference and are enforceable parts of the permit. + - -- 9. -- The- permittee--r— - sh-all notify— — the Division--- an--y hame, ownership or mailing address changes within 30 days. 10. This permit shall be effective from the date of issuance until August 7, 2018. Application for permit renewal shall be submitted 180 days prior to the expiration date of this permit and must be accompanied by the processing fee. Page 5 of 8 State Stormwater Management Systems Permit No. SW7080709 Permit issued this the 7th day of August, 2008. NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION _AL- r- for Coleen H. Sullins, Director Division of Water Quality By Authority of the Environmental Management Commission Stormwater Permit No. SW7080709 Page 6 of 8 State Stormwater Management Systems Permit No. SW7080709 Griggs Lumber— Edenton Store Stormwater Permit No. SW7080709 Chowan County Designer's Certification I, , as a duly registered in the State of North Carolina, having been authorized to observe (periodically/ weekly/ full time) the construction of the project, (Project) for (Project Owner) hereby state that, to the best of my abilities, due care and diligence was used in the observation of the project construction such that the construction was observed to be built within substantial compliance and intent of the approved plans and specifications. The checklist of items on page 2 of this form is included in the Certification. Noted deviations from approved plans and specification: Signature Registration Number Date SEAL Page 7 of 8 State Stormwater Management Systems Permit No. SW7080709 Certification Requirements: .1. The drainage area to the system contains approximately the permitted acreage. 2. The drainage area to the system contains no more than the permitted amount of built -upon area. 3. All the built -upon area associated with the project is graded such that the runoff drains to the system. 4. All roof drains are located such that the runoff is directed into the system. 5. The outlet/bypass structure elevations are per the approved plan. 6. The outlet structure is located per the approved plans. 7. Trash rack is provided on the outlet/bypass structure. 8. All slopes are grassed with permanent vegetation. 9. Vegetated slopes are no steeper than 3:1. 10. The inlets are located per the approved plans and do not cause short- circuiting of the system. 11. The permitted amounts of surface area and/or volume have been provided. 12. Required drawdown devices are correctly sized per the approved plans. 13. All required design depths are provided. 14. All required parts of the system are provided, such as a vegetated shelf, and a forebay. 15. The required system dimensions are provided per the approved plans. cc: NCDENR-DWQ Washington Regional Office Chowan County Building Inspections DWO USE ONL Date Received Fee Faid Permit Number `7-17-08 SW 7080705 State of North Carolina Department of Environment and Natural Resources Division of Water Quality STORMWATER MANAGEMENT PERMIT APPLICATION FORM This form may be photocopied for use as an original I. GENERAL INFORMATION 1. Applicants name (specify the name of the corporation, individual, etc. who owns the project): Carter Lumber Partnership of Indiana 2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance): Charles R. Price Vice President 3. Mailing Address for person listed in item 2 above: 601 Tallmadge Road City:Kent State:OH Zip:44240 Phone: (330 ) 673-6100 ext270 Email: 4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans, specifications, letters, operation and maintenance agreements, etc.): Griggs Lumber Edenton Store 5. Location of Project (street address): •11 0 mm r. re- mn .. City:Edenton County:Chowan Zip:_ -- - - 6. Directions to project (from nearest major intersection): Exit US Route 17 Bypass at SR 32. travel west one block to Whitemon Lane, turn right, pass the Ford Dealership and Hampton Drive. the prooety is located on the left side of the road. 7. Latitude:36° 4' 45.6" N Longitude:76° 36' 35.53" W of project 8. Contact person who can answer questions about the project: Name:Bob Farris Telephone Number: ((252 1 264-3222 Email: Ifarris@rroadrunner.com EXPRESS I1. PERMIT INFORMATION: AUG 0 5 2008 1. Specify whether project is (check one): ®New �eCEHR OModification F... Run 1.1nI va�:,, rnT7nu Danni,sa 2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the existing permit number_-_-_ and its issue date (if known)_____ 3. Specify the type of project (check one): ❑Low Density ®High Density []Redevelop []General Permit []Universal SMP ❑Other 4. 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/Erosion Control 0404/401 Permit ®NPDES Stormwater III. PROJECT INFORMATION 1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative (one to two pages) describing stormwater management for the project. Water from the Griggs Lumber Store and 2 commercial outlots will be collected and conveyed via storm oioes to a WOP The Bond is designe dto treat the standard 1" rain however it will detain 5" of stormwater. 2. Stormwater runoff from this project drains to the Chowan River basin. 3. Total Property Area:9.06 acres 4. Total Wetlands Area:019 acres 5. 100' Wide Strip of Wetland Area:_____ acres (not applicable if no wetlands exist on site) 6. Total Project Area**:9.06 acres 7. Project Built Upon Area:61.8 % 8. How many drainage areas does the project have?1 9. Complete the following information for each drainage area. If there are more than two drainage areas in the project, attach an additional sheet with the information for each area provided in the same format as below. For high density projects, complete the table with one drainage area for each engineered stormwater A Basin Info mationa, rtCvf +„ Dra�nageQrealr,' - x Dramage,Area 2 Receiving Stream Name Chowan River Stream Class & Index No. B, NSW Total Drainage Area (sf) 394,584 On -site Drainage Area (so 394,584 Off -site Drainage Area (sf) 0 Existing Impervious* Area (so 0 Proposed Impervious*Area (so 243,705 % Impervious* Area (total) 61.8 " _ t Drama e Area51 3U, R,Drainaii—ge Area 2* ,., On -site Buildings (so 61,420 On -site Streets (so 0 On -site Parking (so 177,929 On -site Sidewalks (so 4,356 Other on -site (sf) 0 Off -site (sf) 0 Total (so: 243,705 Impervious area is defined as the built upon area including, but not limited to, buildings, roans, parking areas, sidewalks, gravel areas, etc. Pn_QWIT_In1 VP,6n¢olnQ Pn 9 of d "Total project area shall be calculated based on the current policy regarding inclusion of wetlands in the built upon area percentage calculation. This is the area used to calculate percent project built upon area (B UA). 10. How was the off -site impervious area listed above derived?Offsite water drains around the site and it is � RGF.f IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS One of the following deed restrictions and protective covenants are required to be recorded for all subdivisions, outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table listing each lot number, size and the allowable built -upon area for each lot must be provided as an attachment. Forms canbedownloadedfromhttu://h2o.enr.state.nc.us/su/bmp forms.htm - deed restrictions. Form DRPC-1 High Density Commercial Subdivisions Form DRPC-2 High Density Developments with Outparcels Form DRPC-3 High Density Residential Subdivisions Form DRPC-4 Low Density Commercial Subdivisions Form DRPC-5 Low Density Residential Subdivisions Form DRPC-6 Low Density Residential Subdivisions with Curb Outlets By your signature below, you certify that the recorded deed restrictions and protective covenants for this project shall include all the applicable items required in the above form, 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 State, and that they will be recorded prior to the sale of any lot. V. SUPPLEMENT FORMS The applicable state stormwater management permit supplement form(s) listed below must be submitted for each BMP specified for this project. Contact the Stormwater and General Permits Unit at (919) 733-5083 for the status and availability of these forms. Forms can be downloaded from http://h2o.enr.state.nc.us/su/bmp forms.htm. Form SW401-Low Density Form SW401-Curb Outlet System Form SW401-Off-Site System Form SW401-Wet Detention Basin Form SW401-Infiltration Basin Form SW401-Infiltration Trench Form SW401-Bioretention Cell Form SW401-Level Spreader Form SW401-Wetland Form SW401-Grassed Swale Form SW401-Sand Filter Form SW401-Permeable Pavement Low Density Supplement Curb Outlet System Supplement Off -Site System Supplement Wet Detention Basin Supplement Infiltration Basin Supplement Underground Infiltration Trench Supplement Bioretention Cell Supplement Level Spreader/Filter Strip/Restored Riparian Buffer Supplement Constructed Wetland Supplement Grassed Swale Supplement Sand Filter Supplement Permeable Pavement Supplement P,.. lZurl LInI Vnr;in na17nu: Panna..fd 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. The complete application package should be submitted to the appropriate DWQ Office. (Appropriate office may be found by locating project on the interactive online map at http7//h2o.enr.state.nc.us/su/msi maps.htm) 1. Please indicate that you have provided the following required information by initialing in the space provided next to each item. LvAtia • Original and one copy of the Stormwater Management Permit Application Form • Original and one copy of the Deed Restrictions &Protective Covenants Form (if required as per Part IV above) • Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP (2J.— • Permit application processing fee of $505 (Express: $4,000 for HD, $2,000 for LD) payable to NCDENR (24 • Calculations & detailed narrative description of stormwater treatment/management • Copy of any applicable soils report • Two copies of plans and specifications (sealed, signed & dated), including: - Development/Project name - Engineer and firm -Legend - North arrow - Scale - Revision number & date - Mean high water line - Dimensioned property/project boundary - Location map with named streets or NCSR numbers - Original contours, proposed contours, spot elevations, finished floor elevations - Details of roads, drainage features, collection systems, and stormwater control measures - Wetlands delineated, or a note on plans that none exist - Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations - Drainage areas delineated - Vegetated buffers (where required) VII. AGENT AUTHORIZATION If you wish to designate authority to another individual or firm so that they may provide information on your behalf, please complete this section. (ex. designing engineer or firm) Designated agent (individual or firm):Robert Farris at CE Solutions Mailing Address:201 Lane Drive City:Elizabeth City State:NC Zip:27909 Phone: (252 ) 264-3222 Fax: (252 ) 264-3022 Email: lfarris@roadrunner.com VIII. APPLICANT'S CERTIFICATION I, (print or type name of person listed in Gtepffal Information, item 2) Charles R. Price certify that the information include o)( this permit application form is, to the best of my knowledge, correct and that the project will be co tr c . conformance with the approved plans, that the required deed restrictions and protective coven wi corded, and at the proposed roject complies with the requirements of 15A NCAC 2H .1000. Signature: Date: 9 Form SWU-101 �Xrsion 03.27.08 Page 4 of 4 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. The complete application package should be submitted to the appropriate DWQ Office. (Appropriate office may be found by locating project on the interactive online map at http://h2o.enr.state.nc.us/su/msi maps.htm) 1. Please indicate that you have provided the following required information by initialing in the space provided next to each item. • Original and one copy of the Stormwater Management Permit Application Form Is • Original and one copy of the Deed Restrictions &Protective Covenants Form (if required as per Part IV above) • Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP • Permit application processing fee of $505 (Express: $4,000 for HD, $2,000 for LD) payable to NCDENR • Calculations & detailed narrative description of stormwater treatment/management • Copy of any applicable soils report • Two copies of plans and specifications (sealed, signed & dated), including: - Development/Project name - Engineer and firm -Legend - North arrow - Scale - Revision number & date - Mean high water line - Dimensioned property/project boundary - Location map with named streets or NCSR numbers - Original contours, proposed contours, spot elevations, finished floor elevations - Details of roads, drainage features, collection systems, and stormwater control measures - Wetlands delineated, or a note on plans that none exist - Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations - Drainage areas delineated - Vegetated buffers (where required) VII. AGENT AUTHORIZATION If you wish to designate authority to another individual or firm so that they may provide information on your behalf, please complete this section. (ex. designing engineer or firm) Designated agent (individual or firm):Robert Farris at CE Solutions Mailing Address:201 Lane Drive City:Elizabeth City State:NC Zip:27909 Phone: (252 ) 264-3222 Fax: (252 ) 264-3022 Email: lfarris@roadrunner.com VIII. APPLICANT'S CERTIFICATION I, (print or hype none of person listed in G eral I» forniation, item 2) Cliarles R. Price certify that the information include o this permit application form is, to the best of my knowledge, correct and that the project will be co tr Liconformance with the approved plans, that the required deed restrictions and protective covena wi, and at the proposed roject complies with the requirements of 15A NCAC 2H .1000. Signature: ^ VDate: / c/ Form SWU-101 LYfrsion 03.27.08 Page 4 of 4 High Density Developments with Outparcels Deed Restrictions & Protective Covenances In accordance with Title 15 NCAC 211.1000, the Stormwater Management Regulations, deed restrictions and protective covenants are required for High Density Developments with Outparcels where outparcel lots will be subdivided from the main tract and sold. Deed restrictions and protective covenants are necessary to ensure that the development maintains a "built -upon" area consistent with the design criteria used to size the stormwater control facility. I, Charles R. Price , acknowledge, affirm and agree by my signature below, that I will cause the following deed restrictions and covenants to be recorded prior to the sale of any outparcel or future development area: 1. The following covenants are intended to ensure ongoing compliance with State Stormwater Management Permit Number as issued by the Division of Water Quality under NCAC 2H.1000. 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 Water Quality. 5. Alteration of the drainage as shown on the approved plan may not take place without the concurrence of the Division of Water Quality. 6. The maximum built -upon area for the outparcel(s) shown on the approved plans is as follows: Outparcel # BUA Outparcel # BUA 1 60%=ZZ&Oif 2 60%-;W gyQW These allotted amounts include any built -upon area constructed within the property boundaries, and that portion of the right-of-way between the lot lines and the edge of the pavement. Built upon area includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate, coquina and parking areas, but does not include raised, open wood decking, or the water surface of swimming pools. 7. The runoff from all built -upon area within the outparcel or future development area must be directed into the permitted stormwater control system. 8. Built -upon area in excess of the permitted amount will require a permit modification. 9. The connection from the outparcel's collection system into the stormwater control shall be made such that short-circuiting of the s ern does not occur. 10. For those outparcels or future elopment areas whose ownership is not retained by the permittee, the new ow s I ubmit�eerpmit -ate off Ite stormwater permit application to the Division of Water Q lit receiveZo'�_Date: prior, ooconstruction. Signature: Jules, 2008 I, h a Notary Public in the State of 0010 County of 7RETA& do hereby certify that eNpr-Les RICE personally appeared before me this the 96 day of �TULy 2002—, and acknowledge the due exec tion of the foregoing instrument. Witness my hand and official seal, SEAL Signat 7� My Commission expires Dcc, ar a0u Fn" nRPr.-9 Rcv 1 HEATHER IS%blo)api ftblic Residence. f�odap County State Wide Jurisdiction, Ohio My Commission Expires Dec. 13, 2011 y,',;,�uiun2:.,ovrxUiv�:;eC f3'SG:! NEvifiEH iBVi / Nc{4t3 it Pli •ee Permit No. (to be provided by DIND) ATF9O NCDENR STORMWATER MANAGEMENT PERMIT APPLICATION FORM 401 CERTIFICATION APPLICATION FORM WET DETENTION BASIN SUPPLEMENT This form must be filled out, printed and submitted. The Required Items Checklist (Pad III) must be printed, filled out and submitted along with all of the required information. 1. PROJECT INFORMATION Project name GRIGGS LUMBER EDENTON STORE Contact person BOB FARRIS Phone number 2522643222 Date 814108 Drainage area number 1 II: DESIGN INFORMATION.. _.. :..,... ;........ _,. , .. ,.:. , �. ,..... Site Characteristics Drainage area 394,584.00 t? Impervious area 243,705.00 ff %impervious 61.76 % Design rainfall depth 1.00 in Storage Volume: Non -SR Waters Minimum volume required 19,921.98 rya Volume provided 100,076.00 its Storage Volume: SR Waters 1-yr, 24-hr runoff depth in Pre -development 1-yr, 24-hr runoff ff3 Post -development 1-yr, 24-hr runoff it, Minimum volume required it, Volume provided 8' Peak Flow Calculations 1-yr, 24-hr rainfall depth 3.35 in Rational C, pre -development 0.30 (unidess) Rational C, post -development 0.60 (unidess) Rainfall intensity: 1-yr, 24-hr storm 1.66 Whir Pre -development 1-yr, 24-hr peak flow 4.51 ft'Isec Post -development 1-yr, 24-hr peak flow 9.45 gllsec Pre/Post 1-yr, 24-hr peak flow control 4.94 fli li Basin Elevations Basin bottom elevation 7.00 it Sediment cleanout elevation 8.00 it Bottom of shelf elevation 13.00 it Permanent pool elevation 13.50 It SHWT elevation 13.50 It Top of shelf elevation 14.00 it Temporary pool elevation 16.50 it EXPRESS AUG 0 51008 NC DENR Form SW401-Wet Detention Basin-Rev.4 Paris I. a 11. Design Summary, Page 1 of 2 t . - Permit No. (to be prodded by DWD) II, DESIGN INFORMATION Volume and Surface Area Calculations SAIDA ratio 5.45 (unittess) Surface area at the bottom of shelf 18,595.00 ft2 Volume at the bottom of shelf 10,421.00 If; Permanent pool, surface area required 21,505.00 tt Permanent pool, surface area provided 23,090.00 OK Permanent pool volume 91,904.00 {� Average depth for SAIDA tables 3.98 It OK Surface area at the top of shelf 27,648.00 e Volume at the lop of shelf 12,685.00 to Forebay volume 17,138.00 ft' Forebay %of permanent pool volume 18.65 % OK Temporary pool, surface area provided 42,265.00 {tz Drawdown Calculations Treatment volume drawdown time 2.69 days OK Treatment volume discharge rate 0.09 ft'Is Pre -development 1-yr, 24-hr discharge 4.51 ft'Is OK Post -development l-yr, 24-hr discharge 0.17 ft'Is OK Additional Information Diameter of orifice 2.5 in Design TSS removal 90 % Basin side slopes 3.00 :1 OK Vegetated shelf slope 10.00 :1 OK Vegetated shelf width 10.00 ft OK Length of flowpath to width ratio 3.00 :1 OK Length to width ratio 3.50 :1 OK Trash rack for overflow 8 odfce? Y (Y or N) OK Freeboard provided 1.00 ft OK Vegetated filter provided? Y (Y or N) OK Recorded drainage easement provided? Y (Y or N) OK Capures all runoff at ultimate build -out? Y (Y or N) OK Drain mechanism for maintenance or emergencies TO BE PUMPED Form S W401-Wet Detention Basin-Rev.4 Parts I. a II. Design Summary, Pape 2 of 2 Permit No. (robe provided by Dwly 111: f REQUIRED,ITEMSCHECKLIST Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will result in a request for additional information. This will delay final review and approval of the project Initial in the space provided to indicate the following design requirements have been met If the applicant has designated an agent, the agent may initial below. If a requirement has not been met, attach justification. Pagel Plan ,taiti,�(s Sheet No. �"� 182 1. Plans (1' • 50' or larger) of the entire site showing: - Design at ultimate build -out, - Off -site drainage (d applicable), - Delineated drainage basins (include Rational C coefficient per basin), - Basin dimensions, - Pretreatment system, - High flow bypass system, - Maintenance access, - Proposed drainage easement and public right of way (ROW), -Overflow device, and - Boundaries of drainage easement 2 2. Partial plan (1' = 30' or larger) and details for the wet detention basin showing: • Outlet structure with trash rack or similar, - Maintenance access, - Permanent pool dimensions, - Forebay and main pond with hardened emergency spilbeay, - Basin cross-section, -Vegetation specification for planting shelf, and - Fitter strip. 2 3. Section view of the dry detention basin (1' = 20' or larger) showing: - Side slopes, 3:1 or lower, - Pretreatment and treatment areas, and - Inlet and outlet structures. 3 4. If the basin is used for sediment and erosion control during construction, clean out of the basin is specked on the Plans prior to use as a wet detention basin. 2 5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for forebay, to verity � ^ volume provided. 3 6. A construction sequence that shows how the wet detention basin will be protected from sediment until the entire drainage area is stabilized. . 7. The supporting calculations. 8. A copy of the signed and notarized operation and maintenance (0&M) agreement 9. A copy of the deed restrictions (if required). !,.4v 10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. Counly soil maps are not an acceptable source of soils information. Form Sw401-Wet Detention Basin-RwA Part III. Required Items Checklist, Page 1 of 1 Permit Numtxttr. (to be prot`Iited't, 0111,Q) Drnhinge Area NNita cr. Wet Detention Basin Operation and Maintenance Agreement I will keep a nLiintettance record on this 13aMR This maintenance record will be kept in a log in a known set location. Any deficient WNW element-rn ted in the inspection will be corrected, repaired or replaced immediately. These dt:ficiemies can affect the integrity of structures, safety of the public, and the removal efficiency of the t IMP. The wet detention basin system is defined as the wet detention tkasin, pretreatment including forebays and the vegetated filter if one is provided. . This system (Check otlr): JUL � 7 2008 i�/,I does ❑ does tot incorporate a vegetated filter at the outlet. This system (chrrk orte): does X does not. incorporate pretreatment other than a forebay. Important maintenance procedures: - Immediately of ter the wet detention basin is established, the plants on the vegetated shelf and perimeicr of the basin should be watered twice weekly if needed, until the plants K± coome established (commonly sit weeks). - No portion of the wet ide *, tition pond should be fertilizo! after the first initial fertilization that is retluired to u-itublish the plants on the vegulatett shelf. - Stable groundcover should he maintained in the drainage area to reduce the sediment toad to the wet detention basin. - If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through the emergency drain should be minimized to the 11taxitlivol extent prac:tioal. Once a year, a dart safety cx,pert should inspect the embankment. After the wet detention pond is estnblishLd, it should be inspected once a month and within 24 hours after every storin event greater than 1.0 inches (or 1S inches if in a Coastal C'ounty). Records of ajNxation and maintenance should be kept in a known set Wadaon and roust be availahl! upon request. Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately. Olvill element:_ The entire fi:411' T t poterstaaL rrobie:l �._ �a� „� �1 rash ,iebris is . remanl. Note I will n nMiate the probleriv. l Remove lhtt trash/debris. 'nut perimeter of the wet Areas of bare soil anti jor Regrade the soil if nec�.scary to detention basin erosive gullies have formed, remove the gully, and then plant a glouruf cotter and hater until it is established. Provide linte and ii vegi Sg7tictn is too short or too Lon one: ST-C+f--rii1irVr APPiiCafiOn. Maintain megetntion at a height of appfoximatelX six in6e-, form SW401-Wcr Detention Nuin O&M-Rev.3 Page I of 4 __,c I+r �/V V Q4+C-IT- BLt 3 %�- 224 - oz-cz- � A-,&410 Permit Ntanbprtt (to be pro hied 41,3' D 110 Dralnaga Area Xtnnber:_ � PIN, P Cletnenl: Potential problem: Noun i will remediate the problem: 'rho inlet tim ice; pipe or Swale The pine is clogrv4, t Uorlug the pore Dispose of the sediment ufi-site The pipe is cra<ked <!r Replace the pipe othcm%w (lama EM'lion is clatrrring in the Regmde thest.ale if necessary to swnle, Smooth It over and provide etosion i control devicessuch as reinforced turf matting or riprap to avoid fuhrra robttrtrs with erasion. 1 #re fnrnt+ay+ 5r dlmerat has accu nuthrted to Search for the sourta of the- he n n depth greater than the sedimenttand remedy tire problem if on ;hurl design depth for # possible. Rernove the sediment and sediment storavo dispose of it in a location where it p will not cause imparts to streams or i the BlvI'. Erosion has occurred. Provide additiotuil erosion protection such as tehi forced turf matting or riprap if tweded a) revert futttre erosion Problerns, f Remove the woods, preferably by tifa,r:ds are psest" at: hand. If pesticide is used, wipe, it on #its akmis retiree than s ratLng�^ t The vegetated shelf 'hest pmiesslonal practices _Prune accolding to bestprofrssiOna! shDt:` that pruning iS "needed praCtite'a to maintain optinaral plant health. Punts are dead, t;ea1sm1 or Deternune tilesource -of dying. problem: soils, hydrology, disease, etc. Remedy the problem and raplaceplants. i'rtavlrlcarorn?time fertilizer application to Mmmish the ground cover if a snit test indicates It is necessarv. Weeds are pre-cntr remove "weeds, preferably by hand, If pesticide is users. wipe it on the plants, rather than sgravfnY. The main treatment area � Sklliment Ira$ accumulated to S Arcii for the sour a of the a depth greater than the sediment arul remedy the: problem if Original desigrrseclinrent possible- Remove the sediment and storage depth, dispose of it in a lDration wfacre it Will not cause impacts to streams or the hill P. Algal growth covers over Coe 711 a professional to remove 50% of the area. and control tho algill growth. Cattails, phragmftes or other Remove the plants by wiping there invasive plants cover 50% of with pesticide (do not spray). ___.. I the h sin Surface -- reran SW401-Wet Detention Basin 04 M-Re%%' Page 2 of" Pcrttt%t l amtrr {�o h: loan-tded by DIVQ) Drainage Area Vambrr fh'47I' element: Potential problem: How I will remediate the roblem The embankment Shrubs have started to grow Removeshntbs imnutdiat¢tly. on the enUankruent. E;vidonce of muskrat or Use traps to remove muskrats and beaver activity L. present, consult a professional to'remove heavers. A tree haft ,tarted to grow on Consult a dam sufety specialist to they einban3, mend. remove the uee. An annual inspection by an Make all nutated repalrs. appropriate Istxrfesslanal sltow!> thatthe embankment needs repair. Tire out device. Clogging has omurred. Clean mtthe ouIlei device. Mspase of the sedimentot%stte_ The nutlet device ii damaeci Re a4r or telaco the outlet dinjce, _ The receiving water Fxosion or other signs of Contact the local INC Di"isian of damage have occurred at the Water Quality Regional Offue, or tmtlet. the 01OversightUnitut4l�it3 1786. The measuring device: used to determine the soEment elevation shall be such that it will give an accun,te depth reading and not readily penetrate into accu.niuloted sediments. When the permanent pool depth reacts, `/ fart in the main psand, the sedirnentshalt be removed. When the permanent pool depth reads - .L_ .- feet in the forebav, the sediment shall be removed. Sediment PXMDV41 Bottom BASIN DIACRANI tall in tho blanks) 1'eztn arat ewl glevtttion [at tam 1,01 \,wUInc Scditncm Removal Ele�ation _. 4 �r Rhin. ------------------------------- -_"=---------- Sedio t tioturna Elevation Storage FORPHA1` MAIN POND Farm SWI401-Wet Dcunnion Basin t3&hl-Rev.3 gage 3 of 4 Permit Munher _ �(ta be,F»vidiv1hy n 1 j Q) I acknowledge and agree by my signature below that i am responsible for the pertbrtmutc: of the nuuntcnancc procedures listed above, t agree to notify DNV Q of any problems with the system or prior to any changes to the system or responsible part•. Project G(Z U,1fP drainage ureu ntuttber: Print L-u M 8e2 EIaC'.v roN Address: uatc;d- Now: 'rho frg l!} rzsturrasiblc pony shrrutd not bra humeawalt1 rssociirtitaa untrue mere thanmaztf the tons, kivcb,evi woW and zt resident of she subdivision has been nzmtrd the presittent_ I, _� ���/l�.�e ry,t (� . a Notary Public for the State of 0M) J✓CaUntr of, Y�( �111.� (to hereby certify that N, personally appeared belore me this day of �,{ (�y d� , and acknowledge the due, execution of the ftrrgtsing, tvet detention basin maintenance rquirernents, Witness my hand and official seat. I0/k l0 `,,%urtuti. `�`•C P'F1A•L• S�'�i NOTARY ILENAGY HUBLIC STATE OF OHO ::.0 Recorded in 9r ... Summit County e F o �. My Comm! Exp. 1177112 SEAL Nir commission expires_ �_��( ' 1)10 Form SW401-Wet Detention Bash O&M-Rcs,3 Fags 4 of t l d ;p IV. VI. 246, SSo t,5 c6r,e r+ Z STORMWATER SUBMITTAL REQUIREMENTS WET DETENTION POND Objective A. Collect all runoff from all BUA (proposed and/or existing and/or offsite) as the case may be, by any means including piping or swales, and direct it to the pond. B. Check the proposed pond design to make sure it meets or exceeds the minimum design criteria for surface area, volume and drawdown. What makes up a complete wet detention pond application package? A.7 Two sets of sealed, signed & dated layout & grading plans with appropriate details. (Additional sets of plans may be requested for projects in certain counties) B. Completed application with supplement(s), SWU-101, SW401-Wet Pond, and inspection and Jmaintenance agreements. C. /Deed restriction document, if applicable (for subdivisions & projects with out parcels) D. V/Sealed, signed & dated calculations. E. Y Estimated seasonal high water table elevation at all pond locations. F. ^l AChlorides test results must be provided if the project is within '% mile of SR waters (Phase 11). III (This is only required to test out of SR water treatment requirements) BIMS entry (for DWQ use only) Enter & track application acknowledged date, review date, add info requested/received dates, permit issue dates, and drainage area info. Best done after the add info letter is written and before sending permit up for signature. Shell documents (for DWQ use only) Permit shells: s:\wqs\stormwater\shells\highcom pond s:\wqs\stormwater\shells\highsubpond s:\wqs\stormwater\shells\HDhybrid Spreadsheet: s:\wqs\stormwater\excel spreadsheets\pond Review Procedure A. APPLICATION 1. V An original signature is required. Photocopied signatures cannot be accepted. 2. ✓A completed wet detention pond supplement and a signed, dated and notarized wet detention pond Inspection and Maintenance Agreement with an original signature. 3. The numbers on the supplement match up to the numbers used in the calculations and shown on the plan details. �— 4. Built -upon areas are reported in square feet in Section 111.6. a, 5. Receiving stream name and classification. This is important because in the non -Phase II counties, a wet pond cannot be used on a project that is within'/2 mile of and draining ' /to SA waters. For Phase II, a wet pond is allowed within Y2 mile of SA waters. y 6. Section 111.6 is filled in -cannot be left blank. One column must be filled in for each proposed wet pond. 7. ('If the applicant is a corporation, partnership or LLC, look it up on the Secretary of State Corporations Database. Make sure corporation is spelled correctly (capitalization and punctuation matter) and that the person signing the application is at least a vice- president in the corporation, a General Partner in the partnership, a member in a member -managed LLC, or the manager of a manager -managed LLC. Need documentation to support if the Articles of Incorporation do not list the members or managers of the LLC. If an agent signs, then a letter of authorization is needed from the president, vice president, general partner, member or manager. S. VFor subdivided projects, a signed and notarized deed restriction statement must be provided. ft 0 Wet Detention Pond, cont. B. CALCULATIONS 1. /The orifice is sized based on drawing down the calculated minimum volume in 2-5 days. The average head to use in the orifice equation is approximately one-third of the distance between the permanent pool elevation (PPE) and the elevation of the next available outlet above the permanent pool. The elevation of the next available outlet must be either the elevation where the minimum volume is provided, or it can be higher. The temporary pool elevation (TPE) to report on the supplement will be the elevation of the next available outlet above the PPE. The temporary pool volume (TPV) to report on the supplement is the volume between the specified PPE and the 2. owTPE. or Phase II projects that are within '/z mile of and draining to SR waters, the difference in runoff from the predevelopment and post -development conditions for 3.0/4the 1 year 24 hour storm must be controlled and treated. For Phase II projects, the discharge rate leaving the pond can be no more than the re -development discharge rate for the 1 year 24 hour storm. 4.� ,or Phase II projects draining to SA water, no discharge to surface waters may occur f om wet ponds. The discharge leaving the orifice must be effectively infiltrated prior to eaching surface waters. 5. The average pond depth is the permanent pool volume divided by the permanent pool rface area. The result must be between 3 ft. and 7.5 ft. Parts of the pond can be deeper than 7.5 ft., but in no case can any part of the pond be less than 3 ft deep. 6 If�the 85% TSS chart is used a 30' vegetated filter must be provided at the outlet of the pond. If the 90% TSS chart is used, no filter is required. 7. Use the correct SA/DA TSS chart from the BMP Manual noting that there are different ✓charts for different areas of the State. 8. /Required surface area at permanent pool. 9. Provided surface area at permanent pool (Based on pond dimensions) 10. Required volume calculation based on 1.5" storm for Phase II projects* and 1" storm for all others projects. *unless the project is Phase II and within ''/z mile of and draining to SR waters then the volume calculation must be based on difference between the pre and post development conditions for the 1-yr 24-hr storm. 11. Table of elevations, areas, incremental volumes and accumulated volumes for overall pond and for forebay, to verify volumes provided. 12.VForebay designed to hold 20% of the permanent pool volume. (Range of 18%-22% OK.) J1 P Non -erosive flow for 10 yr. storm in the vegetated filter, if using 85% TSS. 14. The seasonal high water table must be at or below the proposed permanent pool elevation to assure that the necessary volume will be available above the permanent pool. 15. Rounding numbers off during the calculation process can result in deficiencies. Do not Vround the numbers until you get to the final result. 16. An additional one foot must be excavated below the bottom elevation of the pond. The 1 foot sediment accumulation depth is not included in the average depth calculation. -X sk'w 246,496 '4 er'l ;1y. 'r Wet Detention Pond, cont. C. PLANS- Due to storage space constraints, plan sheets should be kept to a minimum. For small commercial single wet pond projects, the plan set could consist of only 2 or 3 sheets, layout,, grading and details. For larger projects, show as much information as possible on as few sheets as possible, without cluttering them up. 1. ✓/Development/Project Name 2. v Engineer name and firm. 3. Legend 4. ✓North Arrow 5. ✓Location Map with nearest intersection of two major roads shown. Major road is any 1, 6. ✓2, or 3 digit NC, US or interstate highway. Scale- standard engineering scale, no off-the-wall stuff. 7. 'Date 8. j/Revision number and date, if applicable. 9. VOriginal contours, proposed contours, spot elevations, finished floor elevations, pipe nverts, swale inverts, etc. 10.1/Existing drainage (piping, swales, ditches, ponds, etc.), including off -site. Include a map delineating the offsite drainage areas. 11.✓Property/Project boundary lines, bearing & distances. 120JIP lean High Water Line or Normal High Water Line, if applicable. 13.VThe permanent pool elevation must be above the SHWT and above the lowest elevation of adjacent wetlands. Evaluate the need for a liner and/or berm/slurry wall to prevent dewatering the wetland. 14.�Drainage easement widths, pipe sizes and swale inverts are provided. 15. /Wetlands delineated, or a note on the plans that none exist. Get a copy of the wetlands delineation map signed by the Corps of Engineers, or have the applicant include a copy of the unsigned delineation map submitted to the Corps. Wet ponds may not be located ih wetlands unless a permit to fill those wetlands has been obtained. 16�Details for the roads, parking, cul-de-sacs, including sidewalk width, radii, dimensions & slopes. 17 Y//'Apartment / Condo development- Provide a typical building footprint with dimensions and note all concrete and wood deck areas. 18. /The drainage area for each wet pond is clearly delineated and numbered to match up to the calculations and supplement. Drainage area delineation is best done as a separate plan sheet. 191✓A pond section detail to include the forebay, a 10 foot wide vegetated shelf, pertinent elevations for the bottom, permanent pool, temporary pool, and SHWT, 3:1 slopes above the permanent pool, and the weir elevation between the main pond and the forebay. 20.✓T.he 10 vegetated shelf extends 6" below and 6" above the permanent pool elevation. 21.KAn outlet structure detail showing a trash rack with <_6" square openings, the necessary orifice invert elevation (i.e., the permanent pool), orifice size and temporary pool elevation. 22 VDimensions for each line and arc formed by the permanent pool contour. 23�A-Where the 85% TSS chart was used, a 30 ft. vegetated filter strip is required to be shown on the plans & detailed (elevations, inverts, slopes, and flow spreader mechanism). Please note that the filter strip is not a ditch. 24.✓A forebay is provided for each inlet and located so as to prevent short-circuiting. 25 ✓The pond must have a minimum 1.5:1 length to width ratio and a minimum 3:1 flow path length. Artificial "baffles" of timber, vinyl, or earth can be used to create a longer flow path. The top elevation of the baffle should be set at the temporary pool elevation or higher. 26.✓A Vegetation plan is specified for the pond, including slopes. Wetlands species are listed for planting on the 10:1 shelf. Weeping Love Grass is not suitable as a permanent vegetated cover for pond slopes. 27.✓All roof drainage must be directed to the pond. Show the roof drain collection lines on the plan. This is necessary for projects where the buildings back up the property lines 1L where roof drainage may leave the site prior to going through the pond. Imp _ ems, 2 �p4n�els ��. �e 1b 243, at oVrielp /dC¢ rub( —one aJ el. AWca Toy- � - FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT EXPRESS PERMITTING OPTION 08012007 No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Land Quality Section, N.C. Department of Environment and Natural Resources. (Please type or print and, if the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.) Part A. 1. Project Name Griggs Lumber Edenton Store 2. Location of land -disturbing activity: County Chowan City or Township Edenton Highway/Street Whitemon Lane Latitude 36d 4' 45.6" N Longitude 76d 36' 35.53" W 3. Approximate date land -disturbing activity will commence: August 15. 2008 4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 11.0 6. Amount of fee enclosed: $ 715.00. The Express Permitting application fee is a dual charge. The normal fee of $65.00 per acre is assessed without a ceiling amount. In addition, the Express Permitting supplement is $250.00 per acre up to eight acres, after which the Express Permitting supplemental fee is a fixed $2,000.00 (Example: 9 acres total is $2,585). NOTE: Both fees are rounded up to the next whole acre and need to be paid by separate checks to NCDENR. 7. Has an erosion and sediment control plan been filed? Yes No Enclosed X 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name E-mail Address aavanesvan(a)carteriumber.com Telephone 330-673-6100 ext 495 Cell # 330-221-0252 Fax # 888-761-8313 9. Landowner(s) of Record (attach accompanied page to list additional owners): Carter Lumber Partnership of Indiana 330-673-6100 888-761-8313 Name Telephone Fax Number Current Mailing Address 601 Tallmadge Rd Current Street Address Kent, OH 44240 City State Zip City State 10. Deed Book No 375 Page No. 750 Provide a copy of the most current deed. Part B. 1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all responsible parties on an attached sheet): Carter Lumber Partnership of Indiana Name 601 Tallmadge Rd Current Mailing Address Kent, OH 44240 City State Zip E-mail Address Current Street Address Zip City State Zip i Telephone 330-673-6100 Fax Number 888-761-8313 2. (a) If the Financially Responsible Parry is not a resident of North Carolina, give name and street address of the designated North Carolina Agent: Marvin Sackett Name of Registered Agent 122 Redwick Lane Current Mailing Address Mooresville, NC 28115-6660 City State Telephone 704-664-6308 E-mail Address Current Street Address Zip City State Zip Fax Number 704-664-2211 (b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation, give name and street address of the Registered Agent: Name of Registered Agent Current Mailing Address City State Zip E-mail Address Current Street Address City State Zip Fax Number (c) In order to facilitate Express Permitting, it is necessary to be able to contact the Engineer or other consultant who can assist in providing any necessary information regarding the plan and its preparation: CE Solutions lfarris anroadrunner.com Engineering Firm or other consultant E-mail Address Robert T.Farris 252-264-3222 252-264-3022 Individual contact person (type or print) Telephone Fax Number The above information is true and correct to the best of my knowledge and belief and was provided by me under oath (This form must be signed by the Financially Responsible Person if an individual or his attomey-in- fact, or if not an individual, by an officer, director, partner, or registered agent with the authority to execute instruments for the Financi y Responsible Person). I agree to provide corrected information should there be any change in the informogh provided herein. Charles R. Pric / Vice President Type or print Title or Authorii n Signatur Date a Notary Public of the County off/{�G-E State of North Carolina, hereby certify that (t,{iARLGS f?. �L1✓ appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him. Witness my hand and notarial seal, this qfb day of 0-ULY 20OR Nota Seal /1 HEATHER ISALY, Notary commission expires �Ec . of aaa Residence - Portage County Slate Wide Jurisdiction, Ohio My Commission Expires Dec. 13, 2011 r oii,ta tiMc:! .'f 4v:1 fi?NTn'N yfnuo09C11)U'eonotvp GOO Y Y 0$, L f .na G.:^Qr ] fGb?i Tn; ; J'(M