SWG040115_Application_20190913

GINGo`f d 11 5
N.C. DIVISION OF WATER QUALITFECEIVED
SURFACE WATER PROTECTION SE'CTI( P 13 2019
STATE STORMWATER NOTICE OF INTEN'EdMIAND QUALITY
STORMWATER PERMITTING
SWG040000 - GENERAL PERMIT TO CONSTRUCT A LINEAR UTILITY LINE
AND ASSOCIATED INCIDENTAL BUILT -UPON AREA
FOR AGENCY USE ONLY
Date
Received
Year
Month Da
t
t"1 It
Certificate of Coverage
101111
Check #
Amount
Lo I'l
Permit Assigned to
e- -
/V19,C)
State Stormwater Management Application Notice of Intent for coverage under the General Stormwater Management
Permit to construct a utility line and incidental built -upon area associated with a linear utility project including water,
sewer, gas, telephone, and electric.
For the construction, operation and maintenance of incidental impervious areas associated with the construction of a
linear utility line. Incidental built -upon area associated with the utility project includes small, single pump stations,
access roads which minimize their built -upon area, concrete pads, manhole covers, etc.
(Please print or type)
1. Mailing address of owner/developer: (The address to which all permit correspondence will be mailed.)
Owner/Developer Name SH Monroe, LLC
Street Address 3115 Lion Lane, Suite 300
City Salt Lake City State UT ZIP Code 84121
Telephone No. ( 801) 830-8300 Fax ( )
2. Proposed Project Information:
3.
Project Name
Street Address
of the Project
City
Sanitary Sewer Extension to serve the Apprentice Academy High School in Union County, North Carolina
2505 Weddington Road
Monroe
State NC ZIP Code 28110
County Union
Contact Person Jeff Edney, Senior Project Manager
Mailing Address 124 Verdae Blvd. Bonaventure II, Suite 505
City Greenville State SC ZIP Code 29601
Telephone No. ( 864) 284-1740 Fax ( )
Physical Location Information:
Please provide the street address of the project and describe how to get to the project, using street names,
state road numbers, and the distance and direction from the nearest,major intersection:
4. What is the name of the receiving stream? Camp Branch
5. River Basin Yadkin Pee -Dee
Receiving Stream Classification
6. This Certificate of Coverage is being submitted as a result of:
® New or proposed, project ❑ Modification to an existing project
Existing COC or Permit Number:
Date project is scheduled to begin construction
7. What is the total project area above mean high water?
C: Aquatic Life, Secondary Recreation,
Fresh Water
ftZ
8. What is the total amount of built -upon area proposed at this site? 3,403 ftZ
(Please include all manhole covers, pump stations, concrete pads, and gravel access roads)
SWU-116-17FEB2010 Page 1 of 3

9. What type of utility project will be constructed?
❑ Water ® Sewer ❑ Gas ❑ Telephone ❑ Electric ❑ Other
10. Has the built -upon area been minimized to the extent practicable?
® YES ❑ NO
11. Is the runoff from the built -upon area outside the vegetative buffer directed away from surface waters, to the
extent practicable?
® YES ❑ NO
12. Is the project within 575' of the Mean High Water line of class ORW waters?
❑ YES (Please show the 575' AEC line on plans) ® NO
(If yes, total built -upon area must be less than or equal to 25% of the total project area within the AEC above mean high water.)
13. Are there any wetlands on the site? ® YES (please delineate on the plans) ❑ NO
Name and affiliation of person making this determination: The wetlands determination will be provided upon receipt
14. Please list all Best Management Practices employed at this site:
None - The area will be grassed back to original condition. Sediment tubes and erosion control matting will be placed at
the banks of the two (2) creek crossings
15. Certification:
North Carolina General Statute 143-215.6131 (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan,
or other document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly
makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies,
tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or
maintained under this Article or rules of the Commission implementing this Article shall be guilty of a Class 2 misdemeanor
which may include a fine not to exceed $10,000. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than
$10,000 or imprisonment of not more than 5 years, or both, for a similar offense.)
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit will
constitute the permit requirement for the project and is enforceable in the same manner as an individual permit.
I certify that I am familiar with the information contained in the application and that to the best of my knowledge and
belief such information is true, complete, and accurate.
Printed name of person signing: Scott Brand
(Signature of
0) l 01
(Date gned
A check or money order must accompany this Notice of Intent for $505.00, made payable to: NCDENR.
Your application will be returned unprocessed unless all of the following items are submitted:
❑ This completed form RECEIVED
❑ Two sets of site and grading plans
❑ A check for $505.00 SEP 13 20119
❑ A USGS map with the project clearly located on it. DENR-LAND QUALITY
Mail the entire package to: NCDENR Division of Water Quality STORMWAI'ER PERMITTING
Surface Water Protection Section — Stormwater
at the Appropriate Contact Address (see the following page)
Note: The submission of this document does not guarantee the issuance of a Certificate of Coverage under the
General Permit.
SWU-116-17FEB2010 Page 2 of 3

For questions, please contact the DWO Central Office or Regional Office for your area.
DWQ Regional Office Contact Information:
SHEVILLE REGIONAL OFFIC
FAYETTEVILLE REGIONAL OFFI
MOORESVILLE REGIONAL OFFIC
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
HOW & ORW Projects to Counties Above
[phone]
HOW & ORW Projects in Counties Above
HOW & ORW Projects in Counties Above
ALEIGH REGIONAL OFFIC
WASHINGTON REGIONAL OFFICO
WILMINGTON REGIONAL OFFIC
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
HOW & ORW Projects in Counties Above
Coastal Stormwater, HOW & ORW Projects in Counties
Coastal Stormwater, HQW & ORW Projects in
Above
Counties Above
WINSTON-SALEM REGIONA
`OFFIC
CENTRAL-OFFIC
585 Waughtown Street
1617 Mail Service Center
Raleigh, NC 27699-1617
, �op�senre, protect
and enhance
Winston-Salem, NC 27107
[phone]
QW, North Carolinas wafer.."
[phone]
Phase 2 Post -Construction Projects not covered
HOW & ORW Projects in Counties Above
by local government
SWU-1 16-17FEB201 0 Page 3 of 3

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