HomeMy WebLinkAboutSW6211205_Application Form_20220712DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW - 1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
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.):
Brookstone Village
2. Location of Project (street address):
Along US 410 in Hoke County
City:McLauchlin County:Hoke Zip:
3. Directions to project (from nearest major intersection):
700 LF West of US 401 & Hobson Road intersection
4. Latitude:350 1' 28.5" N Longitude:790 8' 39.5" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-102 - Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number
construction:
certification
❑Not Started
_ , its issue date (if known) , and the status of
❑Partially Completed* ❑ Completed* *provide a designer's
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 DEMLR
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):
❑CAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 19.8 ac of Disturbed Area
❑404/401 Permit: 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:
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
Form SWU-101 Version Oct. 31, 2013 Page 1 of 6
If yes, see S.L. 2012-200, Part VP htt.12://12ortal.ncdenr.org/web/lr/rules-and-regulations
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 project):
Applicant/Organization:McNair Mill, LLC
Signing Official & Title:Charles C, Morris, Manager
b.Contact information for person listed in item la above:
Street Address:85 Cherry Hill Dr.
City:Pinehurst State:NC Zip:28374
Mailing Address (if applicable):
City: State: Zip:
Phone: (910 ) 977-3438
Email:charlescmorris@gmail.com
Fax: (910 ) 684-8701
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:John Anderson Williams. Jr.. et al. (See attached)
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:P.O. Box 53361
City:Fayetteville State:NC Zip:28305
Mailing Address (if appiicabie):same
City:
Phone: (910 ) 977-3438
Email:charlescmorris@gmail.com
State:
Zip:
Fax: (910 ) 684-8701
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 & Title:
b.Contact information for person listed in item 3a above:
Mailing Add
City:
Phone:
Email:
4. Local jurisdiction for building permits:
Fax:
Point of Co
Phone #:
Form SWU-101 Version Oct. 31, 2013 Page 2 of 7
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff is collected by an underground drainage system and conveyed to an onsite wet detention
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.If claiming vested rights, 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 Cape Fear River basin.
4. Total Property Area: 60.64 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':
60.64 acres
Total project area shall be calculated to exclude the following: the normal pool of impounded structures,
the area between the banks of streams and rivers, the area below the Normal High Water (NHW) line or
Mean High Water (MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant
project area is used to calculate overall percent built upon area (BUA). Non -coastal wetlands landward of
the NHW (or MHW) line may be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 52.3 %
9. How many drainage areas does the project have?l (For high density, count l 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.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 7
Basin Information
Drainage Area 1
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)
2,565,939
On -site Drainage Area (sf)
2,557,625
Off -site Drainage Area (sf)
8,314
Proposed Impervious Area** (sf)
1,380,437
% Impervious Area** (total)
54.0
Impervious' Surface Area
Drainage Area 1
Drainage Area
Drainage Area
Drainage Area
On -site Buildings/Lots (sf)
239,580
On -site Streets (sf)
67,518
On -site Parking (sf)
On -site Sidewalks (sf)
13,939
Other on -site (sf)
Future (sf)
1,051,086
Off -site (sf)
8,314
Existing BUA*** (sf)
Total (sf):
1,380,437
* Stream Class and Index Number can be determined at:
h ttp.//portal. ncd enr. orp/web/wglps/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. NCDOT
Improvements in Public R/W
Proiects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that maybe 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 http://portal.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.org/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/maaps.)
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://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs.
Initials
1. Original and one copyof the Stormwater Management Permit Application Form. ASR
2. Original and one copyof the signed and notarized Deed Restrictions & Protective Covenants ASR
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M ASR
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to ASR
http://www.envhelp.org/pacies/onestopexpress.html for information on the Express program
Form SWU-101 Version Oct. 31, 2013 Page 4 of 7
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to ASR
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.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for ASR
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 ASR
receiving stream drains to class SA waters within'/z mile of the site boundary, include the'/z
mile radius on the map.
7. Sealed, signed and dated calculations (one copy). ASR
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: ASR
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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify ASR
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"xl1" 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 DEMLR to verify the SHWT prior
to submittal, (910) 796-7378.)
10. A copy of the most current property deed. Deed book: 722 Page No: 292 ASR
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC ASR
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 15A 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/Corporations/CSearch.aspx
Form SWU-101 Version Oct. 31, 2013 Page 5 of 7
VII. 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 htip://12ortal.ncdenr.org/web/Ir/state-stormwater-
forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed on the
forms available on the website, that the covenants will be binding on all parties and persons claiming under them,
that they will run with the land, that the required covenants cannot be changed or deleted without concurrence
from the NC DEMLR, and that they will be recorded prior to the sale of any lot
Vill. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Rob Balland
Consulting Firm: Paramounte Engineering
Mailing Address:122 Cinema Drive
City:Wilmington
Phone: (910 ) 791-6707
EmaiCrbal land 0 paramou nte-eng.com
State:NC Zip:28403
Fax: (910 ) 791-6760
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) John Anderson Williams. Jr.. certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item la) Charles C Morris with (print or type name of organization listed
in Contact Information, item 1a) McNair Mills. LLC 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
parry responsible for the operation and maintenance of the stormwater system.
Form SWU-l01 Version Oct. 31, 2013 Page 6 of 7
As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and submit
a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,0,6L0 per day, pursuant to NCGS 143-215.6.
Date: +Noolrm�12ozi
i
I, ,,,,�� ""� a Notary
PPu lic for the State of T� County of
"Vll do hereby certify that ck (iCUYISUr personally appeared before me this
"t: c day of (WQ�(7 and �keclge execution of the application for a
stormwater permit. Witness my hand and official seal
COLLEEN LAWRENC
N'rMry Public -State of Arizona
COCHISE couN1Y
�e CommiubnN597156
Explme November 23, 2024
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item la) Charles C. Morris. Manager
certify that the information in ed on this permit application form is, to the best of my knowledge, correct and
that the project will be con cted in conformance with the approved plans, that the required deed restrictions
and protective covenant I be recorded, and that the proposed project complies with the requirements of the
applicable stormwater es under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Signature: Date:
,216/2(
I, 1—\P kl �� r � a Notary Public for the State of I r A Cf-n l,1u , County of
ti Do, a do hereby certify that Ckr"' Ins I�drf personally appeared before me this
6 day of Deceµ6 ZQl and ack ledge the
due execution of the application for a
stormwater permit. Witness my hand and official seal, p17
EM]
SEAL
My commission expires
Form SWU-101 Version Oct. 31, 2013 Page 7 of 7
IX. PROPERTY OWNER AUTHORIZATION
I, Charles C. Williams, certify that I own the property identified in this permit application, and
thus give permission to Charles C. Morris with McNair Mills, LLC 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.
As the legal property owner, I acknowledge, understand, and agree by my signature below, that
if my designated agent (McNair Mills, LLC) dissolves their company and/or cancels or defaults
on their lease agreement, or pending sale, responsibility for compliance with the DEMLR
Stormwater permit reverts to me, the property owner. As the property owner, it is my
responsibility to notify DEMLR immediately and submit a completed Name/Ownership
Change Form within 30 days; otherwise, I will be operating s 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 Statute 143-215.1 and may result in
appropriate enforcement a on including the assessment of civil penalties of up to $25,000 per
day, pur,40t to NCGS� 15.6
(/' Naav-�- //- � Y-tozl
Signature Date
I, 112dry ,4 Le&Aw. Lek. a Notary Public of the State of C o/a riacl Q County of
,e'l /DSO , do hereby certify that G%1Arl4s A4111AIaS personally appeared before me this
llovtmber day of JW E021 , and acknowledge the due execution of the
application for a stormwater permit. Witness my hand and official seal, GL
Seal
My commission expires 18 Oa
MARY A. LEUTWILER
Notary Public
State of Colorado
Notary ID a 19914001166
My Commission Expires 03-18-2026
IX. PROPERTY OWNER AUTHORIZATION
I, Edmund M. Williams, certify that I own the property identified in this permit application, and
thus give permission to Charles C. Morris with McNair Mills. LLC 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.
As the legal property owner, I acknowledge, understand, and agree by my signature below, that
if my designated agent (McNair Mills, LLC) dissolves their company and/or cancels or defaults
on their lease agreement, or pending sale, responsibility for compliance with the DEMLR
Stormwater permit reverts back to me, the property owner. As the property owner, it is my
responsibility to notify DEMLR immediately and submit a completed Name/Ownership
Change Form within 30 days; otherwise, I will be operating s stormwater treatment facility
without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid pemut is a violation of NC General Statute 143-215.1 and may result in
appropriate enforcement action including the assessment of civil penalties of up to $25,000 per
day, pursu t to NNC,G/S 143-215.6
l0 — 2 7 Z
Signature Date
I, -� eq&-y I� a Notary Public of the State of �) Or 4i Lro(, ,� F , County of
n of e do hereby certify that 6d" 6,Ad tl( W,41," personally appeared before me this
Z1 day of DcfD lrel , ZD N and acknowledge the d execution of the
application for a stormwater permit. Witness my hand and official seal,
Seal
Jeffery Markham
Notary Public
Moore County, NC
My commission expires t1a g 1. toe
My commission expires H0111. 211zS
IX. PROPERTY OWNER AUTHORIZATION
I, Victoria Williams Hall, certify that I own the property identified in this permit application, and
thus give permission to Charles C. Morris with McNair Mills, LLC 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.
As the legal property owner, I acknowledge, understand, and agree by my signature below, that
if my designated agent (McNair Mills, LLC) dissolves their company and/or cancels or defaults
on their lease agreement, or pending sale, responsibility for compliance with the DEMLR
Stormwater permit reverts back to me, the property owner. As the property owner, it is my
responsibility to notify DEMLR immediately and submit a completed Name/Ownership
Change Form within 30 days; otherwise, I will be operating s 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 Statute 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
WL [�# pl
Date
I, a Notary Public of the State of l-C�C - IC
County of o hereby certify that ac'. ersonally appeared
before me this
4 day of and acknowledge the due execution of the
application for a stormwater permit. Witness my hand and official seal,
My commission expires 314aoa3
IX. PROPERTY OWNER AUTHORIZATION
I, Deborah B. Cutts, certify that I own the property identified in this permit application, and
thus give permission to Charles C. Morris with McNair Mills. LLC 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.
As the legal property owner, I acknowledge, understand, and agree by my signature below, that
if my designated agent (McNair Mills, LLC) dissolves their company and/or cancels or defaults
on their lease agreement, or pending sale, responsibility for compliance with the DEMLR
Stormwater permit reverts to me, the property owner. As the property owner, it is my
responsibility to notify DEMLR immediately and submit a completed Name/Ownership
Change Form within 30 days; otherwise, I will be operating s 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 Statute 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
a012/
Signature n` �;) _ p/� Date
State of U
County of
I, a Notary Public for said County and State, do
hereby certify that 4 .lJ•N.0 attorney -in -Fact for pc & Ck-f16- personally
appeared before me this day and by me duly sworn affirmed tat he executed the foregoing
instrument in on behalf of 6. CxQln as his/her Attorney -in -Fact and that by
authority of an instrument as appears f public records, he executed the foregoing instrument
for the purposes expressed therein.
my hand and notarial seal this the 4 day of ENL�2QA,21.
TAR IC
spires:
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