SW1170501_Application Form_20221223

DEMLR USE ONLY
Date Received
Fee Paid
Pernut Number
Applicable Rules: ❑ Coastal SW -1995 ❑ CoastaI SW -- 2009 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SVV- I-IQW/ORW Waters ❑ Universal Storniivater Management Plaii
❑ 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 niay be photocopiedfor 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.):
Bell - Phase 3
2. Location of Project (street address):
10517 Boylston H
City:MiIls River Cotunty:Henderson Zip:28759
3. Directions to project (from nearest major intersection):
Boylston Hivy_ (NC-280), 5.5 mules N from Brevard or 6 miles S from Mills River to Brickyard Rd (SR-1323).
0.1 Holes SE on Brickyard Rd, development entrance is on the S side „of Brickyard Rd.
4. Latitude:35° 19' 47" N
II. PERMIT INFORMATION:
Longitude: 82' 38' 14" W of the mail entrance to the project.
1. a. Specify whether project is (check one): ❑Nero ®Modification ❑ Renewal w/ Modificationt
tRenewals u7it1t inodifiications also requires SINI-102 -Renewal Application Forin
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberSW11750501 , its issue date (if known)05/23/2017 , and the status of
construction: ❑Not Started ®Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
MLow Density ❑High Density ❑Drains to an Offsite Stormivater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter frorn
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):
❑LAMA Major
❑NPDES Industrial Storn7ZVater
MSedimentation/Erosion Control: 5.0 (new) ac of Disturbed Area
0404/401 Peru -it: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Pernut Number,
issue date and the type of each permit:HENDE-2022-008 under review at NCDE Swannanoa Office b
Fred Walker
Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: http:l/portal.ncdenr.org/iveb/Ir/rules-and-regulations
Foriu SWU-101 Version Oct. 31, 2013 Page 1 of 6

III. CONTACT INFORMATION
1, a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organizationn:Acoiay Sell of WNC LLC
Signing Official & Title;Mark Brooks -..Manager
b. Contact information for person listed in item la above:
Street Address:17 Arlington St
City:Asheville
Mailing Address (if applicable)
City:
Phone: ( )
Email:
State:NC Zip:28801
State:
Fax:
Zip:
c. Please check the appropriate box. The applicant listed above is:
® The property okvner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser's (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):
Property Owner/Organization:
Signing Official & Title:
b. Contact information for person listed in item 2a above:
Street Address:
City:
State:
Mailing Address (if applicable):
City: State: Zip:
Phone:
Email:
Fax:
3. a. (Optional) Print the name and title of another contact such as the projects 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 Address:
City: State: Zip:
Phone: ( ) Fax:
4. Local jurisdiction for building permits: Mills River - Henderson Count�,_NC
Point of Contact:Henderson County Permits Phone #: (828 )_ 697-4830
Form SWU-101 Versioan Oct. 31, 2013 Page 2 of

1V. PROJECT INFORMATION
1. In the space provided below, briefly summarize holy the stormwater runoff will be treated.
In com fiance with the terms of the existing ern -Lit low -density design. elements will be utilized to collect
conve and dischar e stormwater runoff. Permanent conveyance measures include stabilized conveyance
channels, roadside ditches cross -culverts and energy dissi ation a ions for outfalI stabilization.
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 regulations) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph If -- Post Construction
3. Stormwater runoff from this project drains to the French Broad River basin.
4. Total Property Area: 50.5 acres
5. TotaI Coastal Wetlands Area: 0.0 acres
6. Total Surface Water Area: 0.5 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total otal Surface Water Area (6) = Total Project
Area+:50.0 acres
+ Total project area shall be calculated to exchtde the followhig: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Norttial High Water (NHM Bare or Meatt High Water
(MHM lute, and coastal Wetlands landward froth the NHW (or MHM lute. The restdtaut project area is used to
calculate overall percent built upon area (B UA). Nott-coastal wetlands Widznard of the NHW (or MHM litre tuay
be itichtded hi the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 9.3
9. How many drainage areas does the project have? 1 (For high density, count 1 for each proposed engineered
stornuvater BMP. For loin density atad 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.
Basin Information
Draina e Area 1
Draina e Area _
Drainage Area _
Drainage Area
Receiving Stream Name
Boylston Creek
Stream Class *
C
Stream Index Number
6-52-(0.5)
Total Drainage Area (so
4295.Oac
On -site Drainage Area (sf)
50.5ac
Off -site Drainage Area (sf)
4244.5ac
Proposed Im ervious Area** (sf)
4.7ac
Impervious Area* (total)
0.1
Impervious** Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (sf)
50957
On -site Streets (sf)
100553
On -site Parking (so
50239
On -site Sidewalks (so
0
Other on -site (sf)
1121
Future (so
0
Off -site (so
0
Existing BUA*** (so
0
Total (sf):
202870
5treattt Class acid Index Number cats be deferi)dtted at: lttflt://portal.ttcdettr.oig zneb/zurp`ps/cstt/classiricatiotts
.......—
hnppetvious area is defined as the built upon area utchtditig, but not Iitnited to, buildutgs, roads, parking areas,
sldezoalks, gravel areas, etc.
Fortin 5WU-101 Version Oct. 31, 2013 Page 3 of 6

'Report only that amount of existing Bl lA that hill remain after development. Do not report any existing B UA that
is to be removed and zcrlriclr Will be replaced br1 nezo B UA.
11. How was the off -site impervious area listed above determined? Provide documentation. CAD geometric
modeling of ro osed site build -out plan.
Projects in Union County: Contact DE111LR Cen#•al Ojfrce staff to check if the project is located lrithin a Threatened
Endangered Species watershed that may be subject to asper I5A NC.1 C 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormivater 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:/ /portalncdenr.org/iveb/ivrr/ws/su/bmu-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
littp:/ /portaLncdenr.org/web/wgZi ,s/ s u/ sta tesw/ 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 littl?://portal,nccienr.org/iNebZwq/ivs/su/iiiaLis.)
Please indicate that the following required information have been provided by inutialin 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 1-ittp://portal,ncdenr.org/iveb/ivq./ii,s/su/­statesi%,/forms dots.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. t 1A
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants N
Form. (if required as per Part VII belozo)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http: / /N"-,,iv.envhelp.or / pages/onestopexpress.htinl 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
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the r/2
mile radius on the map.
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 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 flanks of streams and rivers, the MI-IW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormivater 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 (inncluded in the main set of plans, not as a separate document).
for })
f�
Form SWU-101 Version Oct. 31, 2013 Page 4 of

p. Vegetated buffers (where required). A Y��
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify I"
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 for DEMLR to verifij the SHWI' prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 3077 Page No: 0656
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Informatior, 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:/ / witinv. secretary. state nc.tls /Corporations / CSearch. aspx
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 http://portal,ncdeiir.org/iveb/lr/state-
stormwater-forms does. Download the latest versions for each submittal,
to 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.
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:Eric T. Hutchison III, PE
Consulting Firm: Brooks Engineering Associates, PA
Mailing Address:15 Arlington St
City: Asheville
Phone: [phone]
Email:[e-mail]
State:NC Zip:28801
Fax:
IX. PROPERTY OWNER AUTHORIZATION (if Contract Information, item 2 has been filled out, complete this
section)
1, (print or type riatlie of person listed in Contact Information, item 2a) w , , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listen in Contact Information, iteni 1a) with (print or injpe name of organization listed in
Conztset 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 S V U-101 Versio►i 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 inmiediately and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a storm xvater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
ivithout a valid pern-it 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.
I,
a Notary Public for the State of
do hereby certify that
Date:
County of
personally appeared
before me this clay of _ _ __. 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
I, (print or type name of person listed hi Contact Inforwatim, iteili N Mark Brooks of Acomt Bell ofVVNC LLC
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 stornnwa • Zles;uigoer 15A CAC .1000 and any other applicable state stormwater requirements.
Signature; Date:
)444 Lli a Notary Public for the State of Al. ee �L-Z'&/&— County of
s do hereby certify that -S personally appeared
before me this &mac ay of 24' 24 , and acknowledge the Oue execution of the application for
a stormsvater permit. Witness my hand and official seal, _
S M.
tea' ZJ800 `v
ON 0®t1N�
J1r+il1lil1101,
SEAL
My commission expires
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6