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HomeMy WebLinkAboutSW1221201_Application Form_20221215DEMLR USE ONLY Date Received Fee Paid Permit Number Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 W Ph 11- Post Construction (select atl that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwa ter 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 forth 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.): James River Equipment - Mills River Site 2. Location of Project (street address): 675 Fanninj4 Fields Road City: Mills River County: Henderson Zip; 28759 3. Directions to project (from nearest major intersection): The main entrance to the devela"ment al]1210ximatelY 750 feet cast 21 gF2nninlzFedBd (SR-1354) from the major intersection of Boylston Highway (NC-280) and Fanning Fields Rd (SR-1354) 4. Latitude: 35 ° 24 ' 59.7 " N Longitude: 82 ° 33 ' 09.4" W of the main entrance to the project. II. PERMIT INFORMATION: 1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt tReiiezwls witli atodifacatims also requires SWLI-102 - Rewzwl Application Form b.If this application is being submitted as the result of a modification to an existing permit, list the existing pert -nit number its issue date (if known) and the status of construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification 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 at1-877-623-6748): ❑LAMA Major ❑NPDES Indus trial Stormwater ®Sedimentation/Erosion Control: 14.0 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 X❑Yes If yes, see S.L. 2012-200, Part VI: htt �03 tal.ncdenr.or web it rules -and 'e �clations Form SWU-101 Version Oct. 31, 2013 Page I of 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: JRE ASHEVILLE, LLC Signing Official & Title: Mark Romer- President b.Contact information for person listed in item 1a above: Street Address: 11047 Leadbetter Road City: Ashland State: VA Zip:23005 Mailing Address (if applicable): City: State: Phone: 804 338-2123 Fax: Email: MRomer@jamesriverequipment.com Zip: 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. ('Phis is the person who owns the property that the project is located on): b. Contact information for person listed in item 2a above: Street Add Phone: Email: Street Address: Phone: ( Email: Fax: Fax: 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: Phone: ( ) Email: State: Fax: 4. Local jurisdiction for building permits: Henderson County Point of Contact: Sarabeth Deluca Zip: Phone #: 828 697-4830 Fornl SWU-101 Version Oct. 31, 2013 Pale 2 of'6 IV. PROJECT INFORMATION In the space provided below, briefly summarize how the stormwater runoff will be treated. Stormwater runoff will be treated with bioretention 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 0 Ph lI - Post Construction 3. Stormwater runoff from this project drains to the 4. Total Property Area: 16.61 acres French Broad River basin. 5. Total Coastal Wetlands Area: 0.0 acres 6. Total Surface Water Area: 0.0 acres 7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project Area: 16.61 acres Total project area shall be calculated to exclude the follotoin : the normal pool of impounded structures, the area between the banks of streams and rivers, the area below the Normal Hi h Water (NUM line or Mean High Water (MHW) line, and coastal wetlands landward front the NHW (or MHV� line. The resultant project area is used to calculate overall percent builtupon area (BUA). Non -coastal wetlands landward of the NHW (orMHW) line ntay be included in the total project area. 8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 51.2 % 9. How many drainage areas does the project have?--2- (For high density, count I for each proposed engineered stormwater BMP. For loco density and other projects, use I for the whole property area) 70. 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. Basin Information Drainage Area I ` Drainage Area `2 Drainage Area _ Drainage Area Receiving Stream Name McDowell Creek McDowell Creek Stream Class * C C Stream Index Number * 6-58 6-58 Total Drainage Area (sf) 225,834 294,847 On -site Drainage Area (sf) 225,834 284,847 Off -site Drainage Area (so 0 0 Pro osed Im envious Area** s 170,002 200,668 % Impervious Area** total 75.3% 70.4% Impervious': Surface Area Drainage Area 1 Drainage e Area 2 Draina a Area _ Drains e Area On -site Buildings/Lots (sf) 33,821 14,500 On -site Streets (so 8,468 27,586 On -site Parking (so Included in other ---------------------- -----------parking L t included in streets On -site Sidewalks (so 11080 596 Other on -site (sf) 126,633 157,986 Future (so Off -site (so Existing BUA*' (so Total (so: 170,002 200,668 Stream Class and Index Number can be determined at: hitp//poHal. ncde) 1r.otgfyeb/u�g/pslssrt/class;ht'atzars Inrper�rious area is defrrzed as the built upon area indudirrg, but not limited to, buildings, roads, parking areas, sidetvalks, gravel areas, etc. ***Report only that amount of existing BUA that will remain after development. Do not report any existing BLIA that is to be removed and which will be replaced by new BUA. Form SWU-101 Version Oct. 31, 2013 Page 3 of 6 11. How was the off -site impervious area listed above determined? Provide documentation. No off -site area is collected in these drainage areas. A roadside ditch routs all upstream water around the site. Pro'ects in Union County: Contact DFWLR Central Office staff to check if the project is located within a Threatened & F,ndangered tSpecies ii atershed that inay be subject to more stringent storim>>ater requirements as per 15,4 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 ht ortal.ticdenr.or web w ws su bm -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://12ortal.ncdenr,org/web/i�,q/ws/su/stateswZforiiis dots. 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:/LporLal.ticdertr.org/web/wci/ws/sEi/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 from littp://Mortal ncdenr org/web/ivq/ws su/statesw/forms dots. Initials 1. Original and one copy of the Stormwater Management Permit Application Form. 2. Oiiginal and one copy of the signed and notarized Deed Restrictions & Protective Covenants Form. (if required as per Part V11 belozo) 3. Original of the applicable SupplementForm(s) (sealed si ed 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 1-ittg://www.envlieII2.org/l?ages/onestol2express.1-itml 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 sun-anary provided in the Project Information, item 1. 6. A USGS neap identifying the site location. If the receiving stream is reported as class SA or the receiving stream drains to class SA waters within'/2 mile of the site boundary, include the 1/2 mile radius on the snap. 7. Sealed, signed and dated calculations (one copy). 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 trap 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 litres. 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. rn. 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). Form SWU-101 Version Oct. 31, 2013 Page 4 of 6 p. Vegetated buffers (where required). 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"x11" 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 far DEMLR to verifij the 5HWF prior to submittal, (910) 796-7378.) A copy of the most current property deed. Deed book: Page No: 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 1a, 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/Cori2orations/CSearch.aWx VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS For all subdivisions, outparcets, 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 htt ): ortat.ncdenr.oi- r web ]r state-stormCvater- forms docs. 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 wilt 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. 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 Engineer: Mark Brooks PE Consulting Firm: Brooks Engineering Associates PA Mailing Address: 15 Arlington Street City: Asheville Phone: ( 828 h 232-4700 Email: mbrooksnbrooksea.com State: NC Zip: 28801 Fax: 828 ) 232-1331 - IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this section) I, (print or type natne of person listed in Contact Iuforfnation, item 2a) 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 fnfortnation, item Ia) with (print or type name of organization listed in Contact Information, item 1a) 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 5WU-101 Version Oct. 31, 2013 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 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 $25,000 per day, pursuant to NCGS 143-215.6. a Notary Public for the State of do hereby certify that before me this !, day of Date: County of personally appeared . and acknowledge the due execution of the application for a stormwater permit. Witness my hand and official seal, SEAL My commission expires X. APPLICANT'S CERTIFICATION &9K rint or a name o erson listed in Contact Information, item 1a) 9 �;Ma— I, !P �P f P 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 unc L,15A NCAC 2H .1000 and any other applicable state stormwater requirements. Signa Date: 12147-0 G 00 a Notary Public for the State of Vi y c (� I a ,County of �'l"(.il,r�OVG do hereby certify that M�� h a personally appeared before me this � day of —1{'�C' �U. b � _ and ac ledge ] dyge e c tion of the application for a stormwategpplFk„Witness my nano YPrvmoty✓0 ' gP S ISS v pug RY 2 p R LIC Z My Co#7z48i6sCS _ '•. 04/30/2 25 =,0ti 9; 7i-i of F'l��/l if 11 lillll1Lj11 and official seal, SEAL My commission expires 4, 3"6 -46 f onn SWU-I0l Version Oct. 31, 2013 Page 6 of 6