SW1230501_Application Form_20230612

�1 DEMLR USE ONLY
I Date Roxeived I Fee Paid I Permit Number
Applicable Rules: (-] Coastal SW - 1995 Cl Coastal SW - 2008 11 Ph II - Post Construction
(select all that apply) F1 Non -Coastal SW- HQW/ORW Waters 11 Universal Stormwater Management Plan
I-] 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 foriii )iiay be photocopied for rise 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.):
Verner
2. Location of Project (street address):
550 North Louisiana Avenue
City:Asheville COUnty:Buncon-ibe 7ip:28806
3. Directions to project (frorn nearest major intersection):
Pat-tol.2 Avenue West to right on North Louisiana
..ILQjeq is on the left at 566 North Louisiana Aveq1ue,...KL1in # 9639-22-3201)
Verner is the name of the Davcare oin,2 on a leased property on the Emma Elementqj�ySchool Site..
4. Latitude:35' 35'57" N - Longitude:-82' 35' 28" W of the main entrance to the project.
It. PERMIT INFORMATION:
I a. Specify whether project is (check one): ZNew [:]Modification [:1 Renewal w/ Modificationt
tRewwals wilh k7wdificalioiis also requires SWLI-102 - RcHeWal AppZicntiori Form
b. If this application is being Submitted as the result Of a modification to an existing permit, list the existing
permit number --- I its issue date (if known)---.---.---.. and the status Of
constrLlCti011: FINot Started ElPartially Completed* F1 Completed* '-provide a designer's certificatim
2. Specify the type of project (check one):
FILow Density MI-Iligh Density F]Drains to an. Offsite Stormwater System L:10ther
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 storntwater project number,
if assigned, and the preViOLIS name of the project, if different than currently
proposed,
a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Centel- at"1-877-623-6748):
[]LAMA Major [�7'Sedirnentation/Eros ion Control: 3.94 ac of Disturbed Area
/N
FINPDES Industrial Stormwater F1404/40I 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 1-)erii7it:SeLiiiiieiitatioii/Erosioii Control Permit #BUNCO-2020-019 issued May
5. Is the project located Within 5 miles Of a public airport?
Foriii S1htL.J-10 I Versioti Oct. 31, 2013 Page I of 6
NNo DYes

If yes, see S.L. 2012-200, Part VI: _/ _Kjj� g/web Ur i
Ill. 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):
Applicaiit/Orgai-iizatioii:Btinconibe County Board of EdUcaLion
Signing Official & Title:Clark Wyatt, Director of Maintenance
b.Contact information for person listed in item Ja above:
Street Address:175 Bingham Road
City:Asheville State:NC Zip:28806
Mailing Address (if applicable):LZ5
City:Asheville
Phone. k828 232-4244
Ern ail: clark.wyitt@b(.seiiiail.org
State:NC Zip:28806
Fax: (
Please check the appropriate box.The applicant listed above is:
N The property owner (Skip to Contact Information, item 3a)
El Lessee" (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
r] Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
El 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:
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City:-_
Mailing Address (if applicable):
City:
Phone: (
Email:
State:
State: Zip:
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 Pel'soji/Oi-gaiiizatioi):C!aLYKit _ irectoi- of Maintenance at BLIncombe Co. Board of I'd.
Signing Official & Title:Clark Wyatt Director of Maintenance
b.Contact information for person listed in item 3a above:
Mailing Address:175 Bingham Road
City:Aqheville State:NC ............ 2'ip:28806
Phone: [phone] Fax:
Ernail:clark.wvatt(kbcs
4. Local jurisdiction for building permits: BuncOrnbe COUnt
Point of Contact:Clark Wvatt Phone #: [phone]
1''orm SWU-101 Versioji Oct. 31, 2013 I'me 2 of 7
1

IV. PROJECT INFORMATION
1. In the space provided below, briefly sunurrarize how the stormwater runoff will be treated.
Stormwater facilities include curb inlets,.drop inlets, junction boxes acid connectingpi-ping. Stormwater
detention is provided utilizing two (2) Stor,mlech below -ground detention facilities, each with inlet diversion
and outlet control structures with orifice and weirs capable of controlling the 1-year, 10-vear and 25-yr. storm
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific DevelopnYent Plan or P'UD Approval Date:
F1 Valid Building Permit Issrred Date:
❑ Other: _._. Date: _._.._..a.w.._.._w_
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 l rench Broad __. Diver basin.
4. Total Property Area: 13.7 _ __acres
5. "Total Coastal Wetlands tlrca: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) —Total Coastal Wetlands Area (5) —Total Surface 'Water Area (6) = Total. Project Area,:
6.12 acres
Toted project area shad be calca.dated to exchide the follozoing: the iiormrrl pool of imporrraded stnich.rres, the area
betiveen the brinks of streams awl rivers, the area belozv the Norarral High. Water (N11W) line or Mean HighWater
(MHW) brae, arid coastal wetlaaads larrdzoard frown the NHW (or MI4W) litre. The resadtard project area is arsed to
calcrflate overall percerat bault atpm. area (BUA). Nors..coastal wetlands landward of the NNW (or M11W) line may
be irac°luded in the total project area.
S. Project percent of impervious area: (Total Imperviorxs Area f 'Total Project Area) X 100 = 29.16 _ %
9. Flow zany drainage areas (toes the project have?2 (For high density, coarrrt 1 for each proposed engineered
stornavater PMP, For low density and other projects, z.rse 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 hi the sane format as below.
Forrii SWU-101 Version Oct. 31, 2013 Page 3 of7

Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area
Drainage Area
Receiving Stream Name
Eninia Branch
Emma branch
Stream Class *
c
c
Stream Index Number *
6-79-2
6-79-2
Total Drainage Area (sf)
74,488
22,651
On -site Drainage Area (sf)
74,488
22,651.
Off -site Drainage Area (sf)
0
0
Proposed Impervious Area"* (sf)
51,1.1.6
22,65.1.
% Impervious Area** (total)
68.62
1.00.00
Impervious"' Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area
Ora. -site Buildings/Lots (sf)
1.4,834
On -site Streets (sf)
18,482
20,328
On -site Parking (sf)
13,068
2,323
On -site Sidewalks (sf)
4,732
Other on -site (sf)
Futore (sf)
0
Off -site (sf)
0
Existing BUA*** (sf)
0
Total (sf):
51,1.16
22651
Stream Class and Index Number can be deteerrnirred ot: lit ltL //portal.�a�dc�ul.xrrf�lZcptirllcr l/pslc relcPrrssi_rcrrtr0 11
kt Im rervioras area is deflnecl as the built iipon area inch(ding, brit not limited to, buildings, roads, parking areas,
�siYezvalks, gravel areas, etc.
Deport only that amor.rnt of existing BUA that will remain, after developr)ient. Igo not report any existing BIJA that
is to be removed and which will be replaced by new BUA.
11. I -low was the off -site impervious area listed above determined? Provide docuattentation. no offsite
impervious area drainin)mto site
Projects in Union Cciirrtty: Contact DEA4LR Central O face straff to check if the project is located uvithin a Threatened car
Endcukr erect Species imlershed that may be saNect to more stringent stoma mler re0arirernents as per 15A NCAC 02B .06a0©.
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 litt.p /llt it tl decal <1t,g/ b titlfitir / u/bal�kl-ntl,f lal.
VI. SUBMITTAL REQMUIREM.ENTS
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 front
17tt1?..1/l.'--�" t al.r cclti�r t l rc;1 /e fcl(a _/si taty �/ftar tip dcITr{.m . The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project oil the
interactive online reap at 17.tt1a1/perl;tl ricdeaia cac_'gltreL>fw ef��_stn.ps.)
Please indicate that the following Kecluired information have been provided by initialing; in the space provided
for each item. All original documents MUST be signed and initialed in blare ink. Download the latest versions
for each submitted application package from l Up ��.peryc t it rt� ��,ett�_orl /.tip �k�ti�_4]t�1 S( �r/�kal� ��� (��qw a11S, doc;s..
Initials
I . Origbiol and one copy of the Storntwater Management Permit Application Form. .:
2. Original and one copy of the signed and notarized Deed restrictions & Protective Covenants
Form. (if regaired as per Part VIIbelow)
3. 0)r• �,inal of the applicable Surpplernent Forni(s) (sealed, signed and dated) and O&M IV
-
agrer merits) for each BMP.
4. Permit application processing fee of $505 pear/able to NCDENIZ. (For an Express review, refer to
litt 21LL%w v.en% elp o gjpages/onestc)l)-cxpi°ess.litriil for information on the Express program
Forrn ` WIJ-101 Version Oct. 31, 201; Page 4 of 7

and the associated fees. Contact the appropriate regional office Express Permit Coordinator to,
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for
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
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the ?/a
mile radius on the snap.
7. Sealed, signed and dated calculations (one copy).
K Two sets of plans folded to 8.5" x 1.4" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
& 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
unpou.nded structures, the banks of streams and rivers, the MHW or NH W lane of tidal
waters, and any coastal wetlands landward of the MH:W or N1IW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MH: (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.
in, Wetlands delineated, or a dote 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 tire associated SHW 1` 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"xll" copy of the MRCS 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 WiRC). Schecdrle a site visitfor f)EWR to veri/y the SIIWT prior
to sirbinittal, [phone].)
rv-A�—
.e
10. A copy of the most current property deed. Deed book: 245 Page No: 471
11. For corporations and limited liability corporations (hLC): 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 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.
late.p: /www.secretary.state,I-ic.us Cor e rations/CSe- IL - ..aspx
Forna. SWU-101 Versicm Oct. 3 1, 20'13 Page 5 of

VIL 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 Litt )-, )orta1.ncdenr.oijgLN gl?/ it - -0. _y_- td�-e-
storinwater-fornis clocs. 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.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as .1
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:Gary-Q.WviS-E.h,' . . ......
Consulting Firm: Davis CiVilS01116011S, P.A. . ... . ......
Mailing Address:135-A Charlotte 1--Iwv.
City:Asheville State:NC Zip:28803
Phone: (828 -) 299-9449 Fax:
Eiiiail:c![e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Coa tact Inforination, iteni 2 has been filled oast, coniplete this
section)
I, (print or type unnie of person listed in Contact Information, iteni 2a) .....................__I certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed hi Contact lnfcwniation, item with (print or type naaw of organization listed hi
Contact 111forniation, Win 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 stori-t-twater system.
Form SWLJ-101 Version Oct. 31, 2013 lla-e 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/car cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stornzwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DP.MLR immediately and
Submit a completed Name/Ownership Change Form within 30 clays; otherwise I will be operating a stormwater
treatment facility without a valid permit. I understand that the operation of a storixiwater treatment facility
Without a vapid 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 $23,000 per day, pursuant to NCGS 143-215.6.
Da
a Notary Public for the State of County of
do hereby certify that personally appeared
before me this ..._ day of .............. and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,,
am
My commission
X. APPLICANT"S CERT'IFICATI©N
I, (prhit or type: iiwiie of paersm listed hi Coiitcict Inforiiiation, Win W Clark Matt ._ -....
certify that the information included on this permit application form is, to the best of nay knowledge, correct and
that the project
will be i structed in conformance with proposed
th approved plans, that the required deed restrictions
l J
tt �vr11 be recorded, and that the pro osecl project complies with the requirements of the
applicable stormwa � r es NCAC 2H .1000 and any other applicable state storrnwater requirements.
Signature: _. Date. i ..`�
1, •....�( a Notary Public for the State of f�......�m, Cortnty of
01
do hereby certify that _._._:� __. personally appeared
before me this%day of fL4_ and acknowledge the due execution of the application for
a stormwater permit. Witness nay hand and official seal,
lt/v 0IARI - a
Z=
PUBV
'111111111
SEA l._,
My commission expires 1 . i _ U 3
Form S1h U-101 Versioa Oct. 31, 2013
Pate 7 of 7