SW1190704_Application_20190725

3
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DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
b'1- 25-2�1°1
UL Het 1505
5W 09 D—t
Applicable Rules:
(select all that apply)
❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina R F_ C F I VF
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources JUL 2 a 2019
STORMWATER MANAGEMENT PERMIT APPLICATION FCAAN4-LAND QUALITY
This form may be photocopied for use as an original STORMWATER PERMITTING
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.):
French Broad River Intake and Pumvine Station
2. Location of Project (street address):
880 Hooper Lane
City:Mills River County:Henderson Zip:28
3. Directions to project (from nearest major intersection):
Traveling northwest on 191 (Haywood Rd) turn right onto Hooper Lane.
Travel +/-4,300 ft north on Hooper Lane, turn right onto access road.
Travel 4,000 feet east on access road, site is located at the end of the access road on the bank of the French
4. Latitude:35° 23' 25" N Longitude:82° 31' 52" 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 , 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
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 ®Sedimentation/Erosion Control: 1.9 ac of Disturbed Area
❑NPDES Industrial Stormwater Z404/401 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: http://portal.ncdenr.org/web/lr/rules-and-regulations
Form 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/Organization: City of Hendersonville
Signing Official & Title:Brent Detwiler, City Engineer
b. Contact information for person listed in item 1a above:
Street Address:305 Williams Street
City:Hendersonville State:NC Zip:28792
Mailing Address (if applicable):305 Williams Street
City:Hendersonville State:NC Zip:28792
Phone: (828 ) 697-3060 Fax:
Email:[e-mail]
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 Ad
City:
Mailing Address (if applicable):
State:
Zip:
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:l. Ryan Shy - Black & Veatch
Signing Official & Title:T. Ryan Shy, PE - Engineering Manager
b. Contact information for person listed in item 3a above:
Mailing Address:10715 David Taylor Drive, Suite 240
City:Charlotte State:NC Zip:28262
Phone: (704 ) 510-8420 Fax: ( )
Email:s![e-mail]
4. Local jurisdiction for building permits: Henderson
Point of Contact:CEystal Lyda Phone #: (828 ) 697-4830
Form SWU-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.
Project consists of the construction of a new raw water intake structure and pumping station, and associated
site pavement. Runoff from impervious areas will be treated via overland sheet flow.
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 French Broad River basin.
4. Total Property Area: 2.163 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0.12 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:2.043 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 MFIM 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 =14.9 %
9. How many drainage areas does the project have?1 (For high density, count 1 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.
Basin Information
Drainage Area 1
Drainage Area
Drainage Area
Drainage Area
Receiving Stream Name
French Broad
River
Stream Class *
B
Stream Index Number *
6-(54.75)
Total Drainage Area (so
88,984
On -site Drainage Area (sf)
88,984
Off -site Drainage Area (sf)
0
Proposed Impervious Area** s
13,286
% Impervious Area** total
14.9%
Impervious' Surface Area
Drainage Area
Drainage Area
Drainage Area
Drainage Area
On -site Buildings/Lots (so
3,769
On -site Streets (sf)
9,517
On -site Parking (sf)
On -site Sidewalks (sf)
Other on -site (sf)
Future (sf)
Off -site (sf)
Existing BUA*** (sf)
Total (sf):
13,286
* Stream Class and Index Number can be determined at: http.aortal.ncdenr.org web/wq&s/esu/classifications
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 6

'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. N/A
-. Proiects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened &
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 hW2://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://12ortal.ncdenr.org/web/wq/ws/su/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 hgp://12ortal.ncdenr.org/web/wq/ws/su/­statesw/forms docs.
Initials
1.
Original and one copy of the Storinwater Management Permit Application Form.
_
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�
agreement(s) for each BMP.
.. 4.
Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
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
5.
additional information and to schedule the required application meeting.)
A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
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 1/2
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 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.
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

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
1 tim ddi ti4- d 4-1, 11 f 4-1, 1, 1 atiwth thee eva onsa on o ep s) awe aa mp o e ormg oci tin
g
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 verify the SHWT prior
to submittal, [phone].) -�
10. A copy of the most current property deed. Deed book: 1548 Page No: 24-25
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 Information, item 1a, 2a, and/or 3a per 15A NCAC 21-1.1003(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.
httg://www.secretary.state.nc.us/Corporations/CSearch.asl2x
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.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.
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:Toseph Ryan Shy
Consulting Firm: Black & Veatch
Mailing Address:10715 David Taylor Drive, Suite 240
City:Charlotte State:NC Zip:28262
Phone: (704 ) 510-8420 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) , 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 1a) with (print or type name of organization listed in
Contact Information, item 1a) to develop the project as currently proposed. A copy of
t 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 6

As the Iegal 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:
I, 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 RFORNIM
DENR-LAND QUALITY
STORMWATER PERMITTING
X. APPLICANT'S CERTIFICATION
�- I, (print or type name of person listed in Contact Information, item 1a) -T%rf-V\k �� +
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 NCAt)2H .10N and any other applicable state stormwater requirements.
Date: C.6%Cl
I, —'J - iq—/l) 6 z]& ) , a Notary Public for the State of M2M CA&Z iLifll'County of
ljl� ;SOA I , do hereby certify that /30e6-/J7" %(,t�ll / '� personally appeared
before me this /0 Qay of and acknowI d e due exe . n of the application for
a stormwater permit. Witness my hand and official seal, ,
\\\11A N i 1(Ii I�/fi
NOTABUG ci
RY _
� ,. t%%
. ., a.. 11%%-
SEAL
My commission expires U 7 e
Form SWU-101 Version Oct. 31. 2013
Page 6 of 6

BOOK 1548 PAGE 24 (2)
79153IIIIIIIIIIIIIIIIIIIIIR
This document presented and filed:
09/19/2013 09:35:32 AM
NEDRA W. MOLES, Henderson COUNTY, NC
Transfer Tax: $4. 00
Excise Tax $4.00 Recording Time, Book and Page
Tax Lot No. Parcel Identifier No.
Verified:by County on the_ day of 20_
by
Mail aftte re ording to Samuel H. Fritschner,145 Fifth Ave. East Hendersonville NC 2879
This instrument was prepared by Samuel H. Fritschner _
Brief Description for the index EBtc.e:dPiver
59 Acres +/- Mills River at French
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made 14 day of Se tember 2013 , by and between
GRANTOR GRANTEE
The CITY OF HENDERSONVILLE, A North Carolina
PATTEN SEED COMPANY Municipal Corporation
Address: 145 Fifth Ave. East
Hendersonville NC 28792
Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.g., corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, theirheirs, successors, and assigns, and shall include singular,
plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and
by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in Mills
River Township, Henderson County, North Carolina and more particularly described as follows:
BEING all of that real property shown on that plat recorded at Plat Slide 8267 Henderson County Registry.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right toconvey the same in fee
simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the lawful
claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
Subject to Henderson County Ad Valorem taxes.
Subject to Restrictions and Easements of Record
Subject to rights of way of record.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this instrument to be signed
in its corporate name by its duly authorized officers and its seal to be hereunto affixed by authority of its Board of Directors, the day
and year first above written.
N.C. Bar Assoc. Fonn No. 3 ® 1977
Printed by Aoreement with the N.C. Bar Assoc.

book 1548
Page 25
PAT EN SEED COMPA�
' by: �� ---- — (SEAL)
i
nam . ftnE5 W • �RoRu /cam
Titl : E O
State of Shy O�
County of c�
;:e(!T certify that MMM personally came before me this
day and acknowledged that he/she is C-ZO of Patten Seed Company and that he/she, as C E O
, being authorized to do so, executed the foregoing on behalf of the corporation.
Witness my hand and official seal, this the day of 2013.
�—
Notary Public
My commission expires: a,5'aoiLk �•` G .• Pp1Y •.�
N.C. Bar Assoc. Form No. 3 01977
o.,.,��n K, --- v h tt N r. Rar Acuu.

106/01 12 50 20 PM
Fee: $21.00
Henderson County, North Carolina
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