SW1210902_Application Form_20220425

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 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 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.):
Broadpointe Industrial Facility for Minkles Broadpointe II, LLC.
2. Location of Project (street address):
684 Broadpointe Drive
City:Mills River County:Henderson Zip:28759
3. Directions to project (from nearest major intersection):
From Boylston Hwy, turn onto Fernchff Park Drive, then go around the roundabout to the Old Fanning
Bridge Road exit. Remain on Old Fanning Bridge for just over a mile, then turn left onto Broadpointe Drive.
The main entrance will be immediately on the left.
4. Latitude:35° 25' 32.1" N Longitude:82° 33' 17.9" 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
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, SW1210902 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: 7.17 ac of Disturbed Area
❑NPDES Industrial Stormwater E404/401 Permit: Proposed Impacts 88.4 LF/0.006 AC
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:404 Permit - 2018-02316 issued 11/04/2021
Sedimentation/Erosion Control Permit - HENDE-2022-006 issued 10/29/2021
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/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:Minkles Broadpointe II LLC.
Signing Official & Title:David Gibbons - Manager
b. Contact information for person listed in item 1a above:
Street Address:? Parliament Place
City:Dallas
State:Texas
Zip:75225
Mailing Address (if applicable):? Parliament Place
City:Dallas State:Texas Zip:75225
Phone: (214 ) 616-0652 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 Address:
City:
State:
Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
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:Wade Trim, Inc.
Signing Official & Title:Ariel Regnier - EIT
b. Contact information for person listed in item 3a above:
Mailing Address:53 North Market Street, Suite 200
City:Asheville State:North Carolina Zip:28801
Phone: (828 ) 237-8192 Fax:
Email:[e-mail]
4. Local jurisdiction for building permits: Henderson County
Point of Contact:Permit Center 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.
The majority of the development area run-off will be directed to the east corner of the development into a
sand filter. The small drainage area incorporating the truck court entrance rune -off will be piped down the
slope to a level spreader to evenly disperse in the floodway.
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 Il - Post Construction
3. Stormwater runoff from this project drains to the French Broad River basin.
4. Total Property Area: 25.07 acres 5. TotaI Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0.006 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:25,064 acres
* Total project area shall be calculated to exclude the following lire norriial pool of iiapowided structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHVO lure or Mean High Water
(MHW) line, and coastal wetlands larrdzoard froin the NHW (or MHIline. The resultant project area is used to
calarlate overall percenI built upon area (BUA). Non -coastal wetlands landuiard of fire NHW (or- MHV1>) line finny
lie included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 20.5
9. How many drainage areas does the project have?2 (Forhigh density, count 1 for each proposed engineered
sforiuwater BMP. For loin densihj and other projects, rise I for fire 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 2
Drainage Area
Drainage Area
Receiving Stream Name
French Broad
French Broad
Stream Class *
B
B
Stream Index Number *
6-(54.75)
6-(54.75)
Total Drainage Area (sf)
273174
818875
On -site Drainage Area (so
273174
818875
Off -site Drainage Area (so
0
0
Proposed Impervious Area** (so
216801
6599
% Impervious Area" total
79.4%
1.0%
impervious`* Surface Area
Draina e Area 1
Draina a Area 2
Draina e Area _
Drainage Area —
On -site Buildings/ Lots (sf)
120562
0
On -site Streets (sf)
0
0
On -site Parking (so
91274
6599
On -site Sidewalks (so
4965
0
Other on -site (sf)
0
0
Future (sf)
0
0
Off -site (sf)
0
0
Existing BUA*** (sf)
0
0
Total (sf):
216801
6599
* Stream Class and Index Nuinber cart be deterinined at: lrthi://�inrlal.rrcrterrr,nrg%rnebhur�jis/csrr/class ificatioirs
inyw}ervious area is defined as fire built upon area including, but not liinifed to, buildings, roads, parking areas,
sirtewalks, gravel areas, etc.
Form SWU-101 Version Oct. 31, 2013 Page 3 of

„;r_ Wporl orrlrl that rrrrrount of v istiag Bi IA that zoill remain rl_fter dc'oclopmeiiI. Do not rep}rl arrrl e isting BLIA that
is to be r'cranaed aid iohich a>ill be replaced Iril aera B1.IA.
IL, Hoiv +vas [lie off -site impervious area listed above determines{? 1'roviLit' documentation.
Proieels in thdorr Comity: Contacl DE,IILR Central O/)ic•e stafflo check if the pro ect is located n,ithin a Thrmlened d-
EnckargeredSpevies ic(rleished thal urav he s•rrhjerl to more sti-hWe ul shirmw Ater requirements (is per 15,4 rl'C,4U 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&N,{) Forms
must 110 submitted For each BN,11'specified for this project. The latest versions of the forms can be downloaded
from http://portaLncdem.org/web/+vd/+as/su/I?mp manual.
V I. 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 lasted below. A detailed application
instruction sheet and BMP checklists are available from
�ortai.ncdenr.org/tivcb/+ycl/ws/su/statesw/fornns_docs. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be fount{ by locating project on the
interactive online trap at .)
PIease 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 _.docs.
Initials
L. Origirrrrl rrrr,l one coin/ of the Storm+vater Xlanagennent Permit Application Form, L-;L
2. Original and one c opll of the signed and notarized Deed Restrictions & Protective Covenants Ouz
Form. (if regaired as per Part VII belov?)
3. Origixal of the applicable Supplement Form(s) (sealed, signed anti dated) and O&NI
agreement(s) for each 13.N4P.
4. Permit application processing fee of $505 payable to NCDE.NR. (For an Express review, refer to
h -i: ivtivi%,.eiivliel .or )a Tes oilesto pex ress.htli-d for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to sclneduIe the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management
6. A USCS map identifying the site location. If the receiving stream is reported as class SA or the
receiving streann drains to class SA waters within'/2 mile of the site boundary, include the'/z
mile radius on tine snap.
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, Enoieer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g, !\evision number and mates.
ln. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the N1H1V or NI-I1,V line of tidal
waters, and any coastal nvetlands landward of the 1\4I-I1,V or NHVV lines.
• Delune itc tlne ►vegetated buffer land++'ar•d fronn the normal pool elevation of impounded
sh•uctures, the banks of strearns or rivers, and the 1'v1HW (or NJ 1W) of tidal Heaters.
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. (10tist be delineated by a
grialified person. Provide documentation of qualifications and identify the person wlno
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).
�)C4
LL
for (_L6
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Form SWIJ-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify NIZ
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 neap with the
project area clearly delineated. For projects with infiltration BIAPs, the report should also
include the soil type, expected infiltration rate, and the metliod of determining the infiltration rate.
(infiltration Devices submitted to WIRO: Schohnle rr Site visit fen' DEXILR to verify /he SHW7' prhrr
to submif(rrl, [phone],)
10. A copy of the most current property deed. Deed book: 3749 Page No: 453-457(5) _A L �
11. For corp orationns and limited liability corporations (LLC): Provide dOCLlmen tation from the NC R(_ R
Secretary of State or other official documentation, which supports the titles and positions held
1)), Elie persons listed in Contact htformation, item 1 a, 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 Elie application will be returned.
beep:// w�v�v.secrctart�state.nc.us/Corporations/CSearcln.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 fortes can be downloaded from hitp:llportai.nrdcnr.urgl4vcb/lr/staie-
stormivater-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
wider 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 mlotlier 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 Eng, neer:Ariel RegLuer
Consulting Firm: Wade Trim Inc.
lvlailing; Address:53 North IVlarket Street, Suite 200
City:Ashevil.le State:North Carolina Zip:28801
Phone: (828 ] 237-8192 Fam-
Eninail:a regnier a xvadetrinn.com
IX. PROPERTY OWNER AUTHORIZATION (if Cwrtact Information, item 2 lurs beery filler! oul, complete this
secliorr)
1, (print or (/!re rrrrnue of pen.sou listed irr Contact trrfarmatinu, item 2a) N/A certify that I
own the property identified in this permit application, and thus give permission to (prirrl or type ionic of person
listed in Contact Information, item 1a) N/A with (pr•irrf or (t/pc imme of orgimizatiurr lister! ill
Corrtrrct Information, item 1a) N/A 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 storrnivater system.
Dorm SWU-101 Version Oct. 31, 2013 Page 5 of

As the legal property Owner I acknowledge, understand, and agree by nn}r signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company anti/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DFN4LR Stormwater permit reverts back
to ine, the property owner. As the property owner, it is my responsibility to notify DEMLR inunediatel}' and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stornnvater
treatment facility Without a valid permit. I understand that the operation of a stornnvater treatment facility
without a valid peruut 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.
Signattu':
Date:
1, a Notary Public for the State of , County of
do hereby certify that
before me this _ day of
Personally appeared
, 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 hplte uame of prer.sou listed iu Coutract lrtjo)'nr(rtiwr, item 1R) David Gibbons ,
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 155AA NCAC 2H .1000 and any other' applicable state stormwater requirements.
Signature: �''��� � Date: t I Qt I
1, ` ° c �JYe\�l�L+L a Notary Public for the State of 1 XL 5 Count), of
do hereby certify that N?.,v t 4, C, I. &( Z C) 01 personally appeared
before me this �� day of 130"' ��r 2 t and a nowledge the due exe ution of the application for
Witness �. a stort>!>I�+, Ater permit. my Band and official seal,
PAMELA L FREDERICK
�X
1 Y rgGtiry ID #131-i44671
yY Commissiwr, Expires
March 19, 2022
SEAL
My commssion expires
3/C ! 1-2-60-2­�—
Form SWIJ-101 Version Oct. 31, 2013 Page 6 of