SW6240702_Application Form_20240924

DEMLR 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 M mt 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
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.):
NC Highway 27 Self-Storage
2. Location of Project(street address):
302 East Stewart Street
City:Coats County:NC Zip:27521
3. Directions to project(from nearest major intersection):
At the intersection of NC Highway 27 and N Orange Street
4. Latitude:35°24'49" N Longitude:78'40'4.1" W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is (check one): ®New []Modification ❑ Renewal w/ Modificationt
tRenezoals 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 ,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,SWA000051 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 ❑Sedimentation/Erosion Control: ac of Disturbed Area
❑NPDES Industrial Stormwater ❑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
If yes,see S.L.2012-200, Part VI:httl2://12ortal.ncdenr.org/web/Ir/rules-and-regulations
Form SWU-101 Version Oct.31,2013 Page I 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/Organization:T&L Coats LLC
Signing Official&Title:Lee Smith-Manager
b.Contact information for person listed in item 1a above:
Street Address:165 Sommerville Park Drive
City:Raleigh State:NC Zip:27603
Mailing Address (if applicable):
City: State:
Zip:
Phone: (919 ) 651-0009 Fax: ( )
Email:lee@,,!wynnsitedev.com
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:
Signing Official&Title:
b.Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
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 Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
4. Local jurisdiction for building permits:Town of Coats Planning,Zoning, &Inspection Department
Point of Contact:Nick Holcomb Phone#: (910 ) 897-5138
Form S W U-101 Version Oct.31,2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
Stormwater will be collected in two se Darate small conve ance s tems and directed to 2i2rimary SCMs
(Stormwater Wetlands)
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:8.26 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+:8.26 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 MHM 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 =64
9. How many drainage areas does the project have?2 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, ttse 1 for the whole properhj 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 Drainage Area 1 Drainage Area 2 Drainage Area_ Drainage Area_
Receiving Stream Name Black River Thorton's Creek
Stream Class C;Sw WS-IV
Stream Index Number* 18-19 18-68-12-1
Total Drainage Area(so 204,190 sf 100,604 sf
On-site Drainage Area (so 199,914 sf 99,426 sf
Off-site Drainage Area (so 4,276 sf 1,178 sf
Proposed Impervious Area**(so 162,484 sf 69,382 sf
% Impervious Area** total 80% 69%
Impervious"Surface Area Drainage Area 1 _Drainage Area 2 Drainage Area_ Drainage Area_
On-site Buildings/Lots (so 55,300 sf 0 sf
On-site Streets (so 83,296 sf 4,847 sf
On-site Parking (so 22,037 sf 35,044 sf
On-site Sidewalks (sf) 0 sf 0 sf
Other on-site (so 0 sf 0 sf
Future(so 0 sf 28,635 sf
Off-site (so 1,851 sf 856 sf
Existing BUA*** (so 0 sf 0 sf
Total (so: 162,484 sf 69,382 sf
Stream Class and Index Number can be determined at: lTttn://portal.ncdenr.or /web/wq/ps/csu/classiflcations
impervious area is defined as the built upon area including, but not limited to, buildings, roads,parking areas,
sidewalks,gravel areas,etc.
Form SWU-101 Version Oct.31,2013 Page 3 of

'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. Based off drainage
areas delineated using field survey and gis data for existing conditions and topography.
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened c&
Endangered Species watershed that may be subject to more stringent stormwater requirements as per I5A 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 httg://12ortal.ncdenr.orgZweb/wq/ws/su/bml2-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
httn://t)ortal.ncdenr.org/web/wg/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 htt12://portal.ncdenr.org web/wq/ws/su/mates.)
Please indicate that the followw ne 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 httl2://12ortal.ncdenr.org/web/wq/ws/su/statesw/forms docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. L (�
2. Original and one copy of the signed and notarized Deed Restrictions&Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed,signed and dated) and O&M L L
agreement(s) for each BMP.
4. Permit application processing fee of$505 payable to NCDENR. (For an Express review,refer to L L
httl2://www.envheIR.org/12ages/onegg�pexl2ress.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
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the L—
receiving stream drains to class SA waters within 1/2 mile of the site boundary,include the 1/2
mile radius on the map.
7. Sealed,signed and dated calculations (one copy). L
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 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.
1. 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.
Form SWU-101 Version Oct.31,2013 Page 4 of

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 V L
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 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, [phone].)
10. A copy of the most current property deed. Deed book: Page No: L L
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC L L.
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/C2rporations/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://12ortal.ncdenr.org/web/lr/state-
stormwater-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 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:Landon Lovelace
Consulting Firm: Underfoot Engineering,INC.
Mailing Address:1149 Executive Circle Suite C
City:Cary State:NC Zip:27511
Phone: (919 ) 576-9733 Fax:
Email:[e-mail]
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)Lee Smith certify that I
own the property identified in this permit application,and thus give permission to (print or hjpe name of person
listed in Contact Information, item 1a)Lee Smith with(print or type name of organization listed in
Contact Information, item 1a)Lee Smith 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 SWU-101 Version Oct. 31,2013 Page 5 of

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.
Signature: Date:
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,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION I c
I, (print or type name of person listed in Contact Information, item 1a) L e e J M-.y- -
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 under 15A NCAC 2H.1000 and any other applicable state stormwater requirements.
Signature: Date:174Ne �V �oa.�
1, Ca-RAQf I Au-C k k h i;h` ,a Notary Public for the State of_A V Oe+oL%(-ar p(i W&-,County of
W re— do hereby certify that L2e Yh;T,-- personally appeared
before me this jv day of Ak,and acknowledge he due eucution of the application for
a stormwater permit. Witness my hand and official seal, Z'
SEAL
Catherine Hoiland Smith
NOTARY PUBLIC
Watauga County,NO
My Commission Expires
My commission expires M a1 `�a a-D a•�
Form SWU-101 Version Oct. 31,2013 Page 6 of 6

Operation & Maintenance Agreement
Project Name: NC Highway 27 Self - Storage
Project Location: Coats, NC
Cover Page
Maintenance records shall be kept on the following SCM(s). This maintenance record shall be kept in a log in a known set location.
Any deficient SCM elements noted in the inspection will be corrected, repaired, or replaced immediately. These deficiencies can
affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the SCM(s).
The SCM(s) on this project include(check all that apply & corres onding O&M sheets will be added automatically):
Infiltration Basin Quantity: Location(s):
Infiltration Trench Quantity: Location(s):
Bioretention Cell Quantity: Location(s):
Wet Pond Quantity: Location(s):
Stormwater Wetland Quantity: 2 Location(s): 35.4133091 -78.666898
Permeable Pavement Quantity: Location(s):
Sand Filter Quantity: Location(s):
Rainwater Harvesting Quantity: Location(s):
Green Roof Quantity: Location(s):
Level Spreader- Filter Strip Quantity: Location(s):
Proprietary System Quantity: Location(s):
Treatment Swale Quantity: Location(s):
Dry Pond Quantity: Location(s).
Disconnected Impervious Surface Present: No Location(s):
User Defined SCM Present: No Location(s):
Low Density Present: No Type:
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each SCM above, and attached O&M tables. I agree to notify NCDEQ of any problems with the system or prior to any changes to
the system or responsible party.
Responsible Party: Lee Smith
Title& Organization: Manager, T&L Coats LLC
Street address: 165 Sommerville Park Road
City, state, zip: Raleigh, NC 27603
Phone number(s): 919.651.0009
Email: [e-mail]
Signature: Date: c�me.1�a u�f
l e fa a Notary Public for the State of rvCct-
County of w c-k c do hereby certify that yNJ .(,,a e-
personally appeared before me this �_ day of V UN -e-- 5Z o.2- and
acknowledge the due execution of the Operations a d Maintenance Agrr(me'nt .
Witness my hand and official seal, � J�;
Catherine Holland ith
NOTARY PUBLI
Watauga County, C
My Commission Expires
Seal My commission expires nVl a.s
STORM-EZ
6/10/2024
Version 1.5 O&M Agreement Page 1 of 4

Stormwater Wetland Maintenance Requirements
Important operation and maintenance procedures:
Immediately following construction of the stormwater wetland, conduct bi-weekly inspections and water
wetland plants bi-weekly until vegetation becomes established (commonly six weeks).
Before and immediately after plant installation, monitor water level and adjust to ensure that plants are
not completely inundated.
No portion of the stormwater wetland will be fertilized after the initial fertilization that is required to
establish the wetland plants.
- Stable groundcover will be maintained in the drainage area to reduce the sediment load to the wetland.
At least once annually, a dam safety expert will inspect the embankment. Any problems that are found
will be repaired immediately.
After the wetland is established, it shall be inspected quarterly and within 24 hours after every storm event greater than
1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and maintenance shall be kept in a known set
location and shall be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
SCM element: Potential problem: How I will remediate the problem:
The entire wetland Trash/debris is present. Remove the trash/debris.
The perimeter of the Areas of bare soil and/or Regrade the soil if necessary to remove the gully, plant ground
wetland erosive gullies have cover and water until it is established. Provide lime and a one-
formed. time fertilizer application.
The inlet pipe is clogged (if Unclog the pipe. Dispose of the sediment off-site.
applicable).
The inlet pipe is cracked or
otherwise damaged (if Repair or replace the pipe.
The inlet device applicable).
Erosion is occurring in the Regrade the swale if necessary and provide erosion control
swale (if applicable). devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
Sediment has accumulated
in the forebay to a depth of Search for the source of the sediment and remedy the problem if
less than 15" or that inhibits possible. Remove the sediment and dispose of it in a location
the forebay from functioning where it will not cause impacts to streams or the SCM.
well.
The forebay
Erosion has occurred. Provide additional erosion protection such as reinforced turf
matting or riprap if needed to prevent future erosion problems.
[Weeds are present. Remove the weeds, preferably by hand. If pesticide is used, wipe
lit on the plants rather than spraying.
1

Stormwater Wetland Maintenance Requirements (Continued)
SCM element: Potential problem: How I will remediate the problem:
A tree has started to grow If the tree is <6" in diameter, remove the tree. If the tree is >6" in
on the embankment, diameter, consult a dam safety specialist to remove the tree.
An annual inspection by an
Embankment appropriate professional
shows that the Make all needed repairs immediately.
embankment needs repair.
Evidence of muskrat or Consult a professional to remove muskrats or beavers and repair
beaver activity is present. any holes or erosion.
Algal growth covers over
30% of the deep pool and Consult a professional to remove and control the algal growth.
shallow water areas.
Cattails, phragmites or
other invasive plants cover Remove the plants by hand or by wiping them with pesticide (do
30% of the deep pool and not spray) - consult a professional.
shallow water areas.
The temporary inundation
zone remains flooded more
than 5 days after a storm Unclog the outlet device immediately.
event.
Deep pool, shallow water
and shallow land areas Plants are dead, diseased Determine the source of the problem: soils, hydrology, disease,
or dying. etc. Remedy the problem and replace plants. Provide a one-time
y g fertilizer application to establish the ground cover if necessary.
Best professional practices
show that pruning is
needed to maintain optimal Prune according to best professional practices.
plant health.
Sediment has accumulated
andand reduced the depth Search for the source of the sediment and remedy the problem if
of the original design possible. Remove the sediment and dispose of it in a location
depth of the deep pools. where it will not cause impacts to streams or the SCM.
Sediment has accumulated
and reduced the depth Search for the source of the sediment and remedy the problem if
Micropool o possible. Remove the sediment and dispose of it in a location
75/o of the original design
depth. where it will not cause impacts to streams or the SCM.
Clogging has occurred. Clean out the outlet device. Dispose of the sediment in a location
gg g
The outlet device where it will not cause impacts to streams or the SCM.
The outlet device is
damaged Repair or replace the outlet device.
1

Stormwater Wetland Maintenance Requirements (Continued)
SCM element: Potential problem: How I will remediate the problem:
Erosion or other signs of
damage have occurred at Repair the damage and improve the flow dissipation structure.
the outlet.
The receiving water Discharges from the
wetland are causing erosion or sedimentation in Contact the local NCDEQ Regional Office.
the receiving water.
1