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HomeMy WebLinkAboutSW6140802_CURRENT PERMIT_20140902STORMWATER DIVISION CODING SHEET POST -CONSTRUCTION PERMITS PERMIT NO. SW &Z§�n DOC TYPE CURRENT PERMIT ❑ APPROVED PLANS ❑ HISTORICAL FILE ❑ COMPLIANCE EVALUATION INSPECTION DOC DATE YYYYMMDD NCDENR North Carolina Department of Environment and Natural Resources Pat McCrory John E. Skvarla, III Governor Secretary September 2, 2014 Mr. Andrew Taylor, Lead Pastor Liberty Baptist Church of Spring Lake, Inc. 1625 Ray Road Spring Lake, North Carolina 28390 Subject: Stormwater Permit No. SW6140802 Liberty Baptist Church — Worship Center Addition_ High Density Stormwater Wetland Project Harnett County OCT 1 6 2014 Dear Mr. Taylor: The Stormwater Permitting Unit received a complete Stormwater-Management Permit Application for Liberty Baptist Church — Worship Center Addition -on August 1, 20141 .Staff review of the plans and specifications has determined that the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A NCAC 02H.1000. We are forwarding Permit No. SW6140802, dated September 2, 2014, for the construction, operation and maintenance of the subject project and the stormwater BMPs. This permit shall be effective from the date of issuance until September 2, 2022, and shall be subject to the conditions and limitations as specified therein, and does not supersede any other agency permit that may be required. Please pay special attention to the conditions listed in this permit regarding the Operation and Maintenance of the BMP(s), recordation of deed restrictions, procedures for changes of ownership, transferring the permit, and renewing the permit. Failure to establish an adequate system for operation and maintenance of the stormwater management system, to record deed restrictions, to follow the procedures for transfer of the permit, or to renew the permit, will result in future compliance problems. If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings (OAH). The written petition must conform to Chapter 150E of the North Carolina General Statutes. Per NCGS 143-215(e) the petition must be filed with the OAH within thirty (30) days of receipt of this permit. You should contact the OAH with all questions regarding the filing fee (if a filing fee is required) and/or the details of the filing process at 6714 Mail Service Center, Raleigh, NC 27699-6714, or via telephone at 919- 431-3000, or visit their website at www.NCOAH.com. Unless such demands are made this permit shall be final and binding. 1612 Mail Service Center, Raleigh, North Carolina 27699-1612 Phone: 919-707-86001Internet: www.ncdenr,gov An Equal Opportunity 1 Af(rmative Action Employer -Made in part by recycled paper After thirty days from the date of this letter, this project will be kept on file at the NCDENR Division of Energy, Mineral and Land Resources, Land Quality Section, Fayetteville xc Regional Office. If you have questions after that time, please contact Brad Cole, brad. cole(C7ncdenr.goy or Mike Lawyer, mike.lawyer@ncdenr.gove, of that office. Until that time, if you have any questions or need additional information concerning this permit, please contact Bill Diuguid at (919) 807-6369; or bill.diuguid@ncdenr.gov. Sincerely, Original Signed by William H. Diuguid William H. Diuguid, AICP, Plans Reviewer for Tracy E. Davis, P.E., CPM Director, Division of Energy, Mineral and Land Resources cc: SW6140802 File ec: NC DENR DEMLR Land Quality Section, Fayetteville Regional Office Kevin Lindsay, P.E., Crawford Design Company Stormwater Permitting Unit Files Attachments State Stormwater Permit Permit No.SW6140802 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENERGY, MINERAL AND LAND RESOURCES STATE STORMWATER MANAGEMENT PERMIT HIGH DENSITY DEVELOPMENT In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as amended, and other applicable Laws, Rules, and Regulations PERMISSION IS HEREBY GRANTED TO Liberty Baptist Church of Spring Lake, Inc. Liberty Baptist Church — Worship Center Addition 1625 Ray Road, Spring Lake, Harnett County FOR THE construction, operation and maintenance of one stormwater wetland in compliance with the provisions of 15A NCAC 02H .1000 (hereafter referred to as the "stormwater rules') and the approved stormwater management plans and specifications and other supporting data as attached and on file with and approved by the Division of Energy, Mineral and Land Resources, Land Quality Section and considered a part of this permit. This permit shall be effective from the date of issuance until September 2, 2022, and shall be subject to the following specified conditions and limitations: I. DESIGN STANDARDS 1. This permit is effective only with respect to the nature and volume of stormwater described in the application and other supporting data. 2. This stormwater system has been approved for the management of stormwater runoff as described in Section 1.7 of this permit. The stormwater control has been designed to handle the runoff from 74,657 square feet of impervious area. 3. The tract will be limited to the amount of built -upon area indicated in Section 1.7 of this permit, and per approved plans. 4. All stormwater collection and treatment systems must be located in either dedicated common areas or recorded easements. The final plats for the project will be recorded showing all such required easements, in accordance with the approved plans. 5. The runoff from all built -upon area within the permitted drainage area of this project must be directed into the permitted stormwater control system. 6. The built -upon areas associated with this project shall be located at least 30 feet landward of all perennial and intermittent surface waters. Page 1 of 6 State Stormwater Permit Permit No.SW6140802 The following design criteria have been provided in the stormwater wetlands and wet detention BMPs and must be maintained at design co dition: Wetland a C. d. e. f. 9. h. i. M. n. Drainage Area, acres: Onsite, ft Offsite, ftz: Total Imperzious Surfaces, ft 2: Onsite ft Offsite, ft2: Design Storm, inches: Shallow Land Depth, feet: Permitted Storage Volume ft3: Permanent pool Volume, ft�: Forebay Volume, ft TSS efficiency: Elevations, FMSL: Temporary Pool: Permanent Pool: Shallow Water Bottom: Deep Pool Pttom: Surface Areas, ft Total: Shallow Land: Shallow Water: Forebay Deep Pool: Non-Forebay Deep Pool: Controlling Orifice: Receiving Stream/River Basin: Stream Index Number: Classification of Water Body: IIII&YyCI4Big] 11410]Zole]JdC74/_1.[6y 3.78 146,678 0 74,657 74,657 0 1.0 1.0 10,575.77 at temp. 1099.97 297.50 296.50 296.00 293.50 10575.77 4230.30 4214.87 1099.97 1030.63 2.0" 0 pipe Jumping Run Creek / Cape Fear 18-23-29 "C The stormwater management system shall be constructed in its entirety, vegetated and operational for its intended use prior to the complete of construction of any built -upon surface. 2. During construction, erosion shall be kept to a minimum and any eroded areas of the system will be repaired immediately. 3. The permittee shall at all times provide the operation and maintenance necessary to assure the permitted stormwater system functions at optimum efficiency. The approved Operation and Maintenance Plan must be followed in its entirety and maintenance must occur at the scheduled intervals including, but not limited to: a. Semiannual scheduled inspections (every 6 months). b. Sediment removal. C. Mowing and revegetation of slopes and the vegetated filter. d. Immediate repair of eroded areas. e. Maintenance of all slopes in accordance with approved plans and specifications. f. Debris removal and unclogging of outlet structure, orifice device, flow spreader, catch basins and piping. g. Access to the outlet structure must be available at all times. 4. Records of maintenance activities must be kept and made available upon request to authorized personnel of the Division of Energy, Mineral and Land Resources, Land Quality Section. The records will indicate the date, activity, Page 2 of 6 State Stormwater Permit Permit No.SW6140802 name of person performing the work and what actions were taken. 5. The stormwater treatment system shall be constructed in accordance with the approved plans and specifications, the conditions of this permit, and with other supporting data. 6. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and prior to operation of this permitted facility, a certification must be received from an appropriate designer for the system installed certifying that the permitted facility has been installed in accordance with this permit, the approved plans and specifications, and other supporting documentation. Any deviations from the approved plans and specifications must be noted on the Certification. A modification may be required for those deviations. 7. If the stormwater system was used as an Erosion Control device, it must be restored to design condition prior to operation as a stormwater treatment device, and prior to occupancy of the facility. 8. Access to the stormwater facilities shall be maintained via appropriate easements at all times. 9. The permittee shall submit to the Director and shall have received approval for revised plans, specifications, and calculations prior to construction, for any modification to the approved plans, including, but not limited to, those listed below: a. Any revision to any item shown on the approved plans, including the stormwater management measures, built -upon area, details, etc. b. Project name change. C. Transfer, of ownership. d. Redesign or addition to the approved amount of built -upon area or to the drainage area. e. Further subdivision, acquisition, lease or sale of all or part of the project area. The project area is defined as all property owned by the permittee, for which Sedimentation and Erosion Control Plan approval or a CAMA Major permit was sought. f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan. 10. The permittee shall submit final site layout and grading plans for, any permitted future areas shown on the approved plans, prior to construction. 11. A copy of the approved plans and specifications shall be maintained on file by the Permittee for a minimum of ten years from the date of the completion of construction. 12. The Director may notify the permittee when the permitted site does not meet one or more of the minimum requirements of the permit. Within the time frame specified in the notice, the permittee.shall submit a written time schedule to the Director for modifying the site to meet minimum requirements. The permittee shall provide copies of revised plans and certification in writing to the Director that the changes have been made. III. GENERAL CONDITIONS 1. This permit is not transferable except after notice to and approval by the Director. In the event of a change of ownership, or a name change, the permittee must submit a completed Name/Ownership Change form, to the Division of Energy, Mineral and Land Resources, Land Quality Section, signed by both parties, and Page 3 of 6 State Stormwater Permit Permit No.SW6140802 accompanied by supporting documentation as listed on page 2 of the form. The project must be in good standing with the Division. The approval of this request will be considered on its merits and may or may not be approved. 2. The permittee is responsible for compliance with all permit conditions until such time as the Division approves the transfer request. 3. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee to enforcement action by the Division of Energy, Mineral and Land Resources, Land Quality Section, in accordance with North Carolina General Statute 143-215.6A to 143-215.6C. 4. The issuance of this permit does not preclude the Permittee from complying with any and all statutes, rules, regulations, or ordinances, which may be imposed by other government agencies (local, state, and federal) having jurisdiction. 5. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the Permittee shall take immediate corrective action, including those as may be required by this Division, such as the: construction of additional or replacement stormwater management systems. 6. The permittee grants DENR Staff permission to enter the property during normal business hours for the purpose of inspecting all components of the permitted stormwater management facility. 7. The permit issued shall continue in force and effect until revoked or terminated. The permit may be modified, revoked and reissued or terminated for cause. The filing of a request for a permit modification, revocation and re -issuance or termination does not stay any permit condition. 8. Unless specified elsewhere, permanent seeding requirements for the stormwater control must follow the guidelines established in the North Carolina Erosion and Sediment Control Planning and Design Manual. 9. Approved plans and specifications for this project are incorporated by reference and are enforceable parts of the permit. 10.The issuance of this permit does not prohibit the Director from reopening and modifying the permit, revoking and reissuing the permit, or terminating the permit as allowed by the laws, rules and regulations contained in Session Law 2006- 246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al. 11.The permittee shall notify the Division of any name, ownership or mailing address changes at least 30 days prior to making such changes. 12.The permittee shall submit a renewal request with all required forms and documentation at least 180 days prior to the expiration date of this permit. Permit issued this the 2"d day of September, 2014. NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION Original Signed by William H. Diuguid William H. Diuguid, AICP, Plans Reviewer for Tracy E. Davis, P.E., CPM, Director Division of Energy, Mineral and Land Resources By Authority of the Environmental Management Commission Page 4 of 6 State Stormwater Permit Permit No.SW6140802 Liberty Baptist Church —Worship Center Addition Stormwater Permit No. SW6140802 Harnett County Designer's Certification I, , as a duly registered in the State of North Carolina, having been authorized to observe (periodically/ weekly/ full time) the construction of the project, Liberty Baptist Church —Worship Center Addition (Project) for (Project Owner) hereby state that, to the best of my abilities, due care and diligence was used in the observation of the project construction such that the construction was observed to be built within substantial compliance and intent of the approved plans and specifications. The checklist of items on page 2 of this form is included in the Certification. Noted deviations from approved plans and specification: Signature Registration Number Date SEAL Page 5 of 6 State Stormwater Permit Permit No.SW6140802 Certification Requirements: _1. The drainage area to the system contains approximately the permitted acreage. 2. The drainage area to the system contains no more than the permitted amount of built -upon area. 3. All the built -upon area associated with the project is graded such that the runoff drains to the system. 4. All roof drains are located such that the runoff is directed into the system. 5. The outlet/bypass structure elevations are per the approved plan. 6. The outlet structure is located per the approved plans. 7. Trash rack is provided on the outlet/bypass structure. 8. All slopes are grassed with permanent vegetation. 9. Vegetated slopes are no steeper than shown on the approved plans. 10. The inlets are located per the approved plans and do not cause short- circuiting of the system. 11. The permitted amounts of surface area and volume have been provided. 12. Required drawdown devices are correctly sized per the approved plans. 13. All required design depths are provided. 14. All required parts of the system are provided, such as deep pools, shallow water area, shallow land area, forebay, and vegetation. 15. The required system dimensions are provided per the approved plans. Please submit this Designer's Certification to: NCDENR DEMLR Regional Office Land Quality Section 225 Green Street Systel Building Suite 714 Fayetteville, NC 28301-5043 cc: Building Inspections — Harnett County Page 6 of 6 22-0/5 LQlI S2L- nib I J V DJ 619 25S 2r1 State Stormwater Permit Permit No.SW6140802 Liberty Baptist Church —Worship Center Addition Stormwater Permit No. SW6140802 Harnett County Designer's Certification Kevin S Lindsay , as a duly registered Professional Engineer in the State of North Carolina, having been authorized to obsery eriodical eekly/ full time) the construction of the project, Liberty Baptist Church —Worship Center Addition (Project) for Liberty Baptist Church (ProjectIOwner) hereby state that, to the best of my abilities, due care and diligence was used in the observation of the project construction such that the construction was observed to be built within substantial compliance and intent of the approved plans and specifications. The checklist of items on page 2 of this form is included in the Certification. Noted deviations from approved plans and specification: NOV 2 3 2015 1 �11 541-1: o, SEAL 027502 SEAL Signature —_-1 Registration Number 27502 Date 11-10-15 Page 5 of 6 0 0 State Stormwater Permit Permit No.SW6140802 Certification Requirements: X 1. The drainage area to the system contains approximately the permitted acreage. X 2. The drainage area to the system contains no more than the permitted amount of built -upon area. X 3. All the built -upon area associated with the project is graded such that the runoff drains to the system. X 4. All roof drains are located such that the runoff is directed into the system. X 5. The outlet/bypass structure elevations are per the approved plan. X 6. The outlet structure is located per the approved plans. X 7. Trash rack is provided on the outlet/bypass structure. X 8. All slopes are grassed with permanent vegetation. X 9. Vegetated slopes are no steeper than shown on the approved plans. X 10. The inlets are located per the approved plans and do not cause short- circuiting of the system. X 11. The permitted amounts of surface area and volume have been provided. X 12. Required drawdown devices are correctly sized per the approved plans. X 13. All required design depths are provided. X 14. All required parts of the system are provided, such as deep pools, shallow water area, shallow land area, forebay, and vegetation. X 15. The required system dimensions are provided per the approved plans. Please submit this Designer's Certification to: NCDENR DEMLR Regional Office Land Quality Section 225 Green Street Systel Building Suite 714 Fayetteville, NC 28301-5043 cc: Building Inspections — Harnett County Page 6 of 6 ixs-"40 g17_1 2-0i4-P - 1 DEMLR USE ONLY _;, Date Received Fee Paid Permit Num er zoi Sos = U Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 h 11- Post Constru lion (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 This form ruay be photocopied for use as an original I. GENERAL INFORMATION 1. Project Name (subdivision, facility, or establishment name -should be consistent wI specifications, letters, operation and maintenance agreements; etc.): l+ Libertv Baptist Church - Worship Center Addition 2. Location of Project (street address): I - . OCT 1 6 2014 City: Spring Lake, NC County! Harnett 3. Directions to project (from nearest major intersection): AUG 0 12014 ject name on plans, A W- ,. Zip:28390 Turn onto Ray Road from NC210. Liberty Baptist Church is approximately 1.6 miles on the left. 4. Latitude:35° 13' 53.03" N Longitude:78° 57' 53.80" W of the main entrance to the project. H. PERMIT INFORMATION: 1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt tRenemals nvith modifications also requires SWU-102 - Reneenal 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, 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 ❑NPDES Industrial Stormwater ®Sedimentation/Erosion Control: 6 ac of Disturbed Area ❑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: http://portal.ncdenr.org/web/Ir/rules-and-regulations Form SWU-101 Version Oct. 31, 2013 Page 1 of ;i. 'ql ..11,�;... it ' .:IS f .� ......__.._�.�._...Jh L. �'V. .. 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: Liberty Baptist Church of Spring Lake, Inc. Signing Official & Title: Andrew Taylor, Lead Pastor b.Contact information for person listed in item la above: Street Address: 1625 Ray Road City: Spring Lake State: NC Zip: 28390 Mailing Address (if applicable): Same City: State: Zip: Phone: ( 910 ) 497-5315 Email: pastorandrew@libertybaptistchurch.com Fax: ( 910 ) 497-6920 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: See item Ill.l.b above. Signing Official & b.Contact information for person listed in item 2a above: Street Address: City: Mailing Address (if City: Phone: ( ) Fax: 3. a. (Optional) Print the name and title of another contact such as the projects construction supervisor or other person who can answer questions about the project: Other Contact Person/Organization: Randall Wheeler Signing Official & b.Contact information for person listed in item 3a above: Mailing Address: 1625 Ray Road City: Spring Lake Phone: ( 910 ) 497-5315 Cell: (910) 797-8954 Email: sapperr@hotmail.com 4. Local jurisdiction for building permits: Harnett County State: NC Zip: 28390 Fax: ( 910 ) 497-6920 Point of Contact: Phone #: Form SWU-101 Version Oct. 31, 2013 Page 2 of 6 IV: PROJECT INFORMATION r 1. In the space provided below, hriefly summarize how the storm water runoff will be treated. Stormwater from new worship center shall be treated with a new stormwater wetland. 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: 3.37 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': 3.37 acres Total project area shall be calculated to exclude the followingR the norral 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 fron 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 stay be included in the total project area. 8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 66.10 (50.9% new) % 9. How many drainage areas does the project have? 1 (For high density, count 1 for each proposed engineered stormwater BMP. For low deusihj and other projects, use I 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 Jumping Run Creek Stream Class * C Stream Index Number * 18 - 23 -29 Total Drainage Area (so 146,678 On -site Drainage Area (so 146,678 Off -site Drainage Area (so 0 Pro osed Impervious Area** s 74,657 (new) Im ervious Area** total 50.9% Impervious— Surface Area Drainage Area _ Drainage Area _ Drainage Area _ Drainage Area _ On -site Buildings/Lots (so On -site Streets (so On -site Parking (so On -site Sidewalks (so Other on -site (so Future (so Off -site (sf) Existing BUA*** (so Total (so: Streant Class and Index Number can be determined at: httn://portal.ncdenr.or aeb/wq(ps/csu/classificatioits 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 rentain 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 Projects 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 15A 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 http://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/w2/ws/su/statesw/forms does. 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: / / portal.ncdennorg/ web/ wq / ws / so / 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 andanitialed=in=blue:inkr Download the latest versions for each submitted application package from http://portal.ncdenr.org/web/wg/ws/su/statesw/forms dots. Initials 1. Original and one copy of the Storm water Management Permit Application Form. KS c 2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants kA Form. (if required as per Part VII below) 3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M �SL agreement(s) for each BMP. 4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to KA- http://www.envhelp.org/pages/onestopexpress.htnil 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 additional information and to schedule the required application meeting.) 5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor ley L 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 KSL receiving stream drains to class SA waters within lh 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 planstf6ldJd-t5'.85'x-143 (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. It. 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. KSZ ZS�.- Form SWU-101 Version Oct. 31, 2013 Page 4 of 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 KSL 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 verifij the SHWT prior to submittal, (910) 796-7378.) 10. A copy of the most current property deed. Deed book: 1036 Page No: 656 KS L 11. For corporations and limited liability corporations (LLC): Provide documentation from the NC J4I 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. httR://www.secretary.state.nc,us/Corporations/`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 htto://porta1.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. VIIL 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: Consulting Firm: Crawford Design Company Mailing Address: 116 N. Cool Spring Street City: Fayetteville State: NC Zip: 28301 Phone: (910 ) 221-0033 Email:—kevinlindsay@crawforddsn.com Fax: (910 ) 221-0035 —t44-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) I certify that I own the property identified in this permit application, and thus give permission to (print or hjpe name ofperson listed in Contact Information, item 1a) with (print or hjpe name of organization listed in Contact Information, item la) 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 6 As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated agent (entity listed in Contact Information, Uem'l) 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 inappropriate enforcement action including the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6. Signature: 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, SEAL My commission expires X. APPLICANT'S CERTIFICATION 1, (print or type name of person listed in Contact Information, item 1e) Andrew TaIllor 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 storm ater rules under 15A NCAC 21-1 .1000 and any other applicable state stormwater requirements. Signature: ^ Date: `> r I, l��S �YnLnd_I AV(L;r . a Notary Public for the State of -Al -NIRCounty of _ p r_y�g=t —,do hereby certify that 8ndr_e_w_Ti_ _y.(a r personally appeared before me this 3Q day of w L Y , -dDI and ack�wlecige the due exe ution of the application for a stormwater permit. Witness my hand and official seal, �1wo u/ri�rn� SEAL MV commission expires91rZ71oZG/S Form SWU-101 Version Oct. 31, 2013 Page 6 of 1, UIL"I uo t �uu unr SOSID: 0323543 Date Filed: 4/6/2010 3:56:00 PM Elaine F. Marshall STATE OF NORTH CAROLINA North Carolina Secretary of State DEPARTMENT OF THE SECRETARY OF STATE C201007500106 STATEMENT OF CHANGE OF REGISTERED OFFICE AND/OR REGISTERED AGENT Pursuant to §55D-31 of the General Statutes of North Carolina, the undersigned entity submits the following for the purpose of changing its registered office and/or registered agent in the State of North Carolina. MINURIuG YteliYke :7.i UOiG'la1J11114M The name of the entity is: L ; 6 r, a La Entity Type: ❑Corporation, ❑Foreign Corporation, p(JNonpro6t Corporation, []Foreign Nonprofit Corporation, ❑Limited Liability Company, ❑Forei Limited Liability Company ❑Limited Partnership, []Foreign Limited Partnership, [)Limited Liability Partnership, []Foreign Limited Liability Partnership The street address and county of the entity's registered office currently on file is: Number and Street: (L.aS Qu PDQd /I'' City, State, Zip Code: S o f- i n c La (�C C. 18390 County: H O r n P The mailing address if different froln the street address of the registered office currently on file is: The name of the current registered agent is: 1. The street address and county of the new registered office of the entity is: (complete this item only if the address of the registered office is being changed) Number and Street: OCT 1 6 miti., City, State, Zip Code: County: 2. The trailing address if different from the street address of the new registered office is: (complete this item only if the address of the registered office is being changed) 3. The name of the new registered agent and the new agent's consent to appointment appears below: (complete this item only iifthe name of the registered agent is being changed) K. 4n4tr^ew TaU/t,r I r ?-esido,-t— Type or Print Name ofjYew Agent P Signature & Title 4. The address of the entity's registered office and the address of the business office of its registered agent, as changed, will be identical. 5. This statement will be effective upon filing, unless a date and/or time is specified: This is the /0 4day of / t t a r 04 20_LO. Notes: Filingfee CORPORATIOT Revised January 2002 c4 c.,Cl, of s ,gig to Entin, Name A—TSignature f`� J -t- �'�. /+n�rCrr 1 0..,t �urr `('fQSiGren t Type orPri tName and Title must be filed with the Secretary of State. P. O. BOX 29622 RALEIGH, NC 27626-0622 Fort BE-06 7/17/2oia North Carolina Secretary of State North Carolina Elaine F. Marshall DEPARTMENT o1 ,-HE Secretary SECRETARYOFSTATE PO Box 29622 Raleigh, NC 27626-0622 (919)607-2000 Date: 7/17/2014 t here to: v Document Filings i PLLC, LP and Non -Profit entities are not required to file annual reports. Corporation Names Name Name Type NC LIBERTY BAPTIST CHURCH LEGAL OF SPRING LAKE Non -Profit Corporation Information S OS I D: 0323543 Status: Current-Acti\e Effective Date: 4/22/1993 Citizenship: DOMESTIC State of Inc.: NC Duration: PERPETUAL gistered Agent Agent Name: TAYLOR, K ANDREW Office Address: 1625 RAY RD SPRING LAKE NC 28390 Mailing Address: 1625 RAY RD SPRING LAKE NC 28390 rincipal Office Office Address: NO ADDRESS Mailing Address: NO ADDRESS Icers/COmoanv Officials This website is promded to the public as a part of the Secretary of State Knowledge Base (SOSKB) system. Version: 3617 http:/Aw .secretary.state.nc.us/corporations/Cup.aspVPitemld=4642090 1/1 ATTACHMENT C : OPERATIONS & MAINTENANCE AGREEMENT WORSHIP CENTER ADDITION LIBERTY BAPTIST CHURCH STORMWATER WETLAND SPRING LAKE, NC Crawford est 1CDn kui '. OCT 1 6 2C1-1 Crawford es com my Permit Number: (to be provided by DWQ) Drainage Area Number: Stormwater Wetland Operation and Maintenance Agreement I will keep a maintenance record on this BMP. This maintenance record will be kept in a log in a known set location. Any deficient BMP 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 removal efficiency of the BMP. Important maintenance procedures: — Immediately following construction of the stormwater wetland, bi-weekly inspections will be conducted and wetland plants will be watered bi-weekly until vegetation becomes established (commonly six weeks). — No portion of the stormwater wetland will be fertilized after the first 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. — Once a year, a dam safety expert should inspect the embankment. After the stormwater wetland is established, I will inspect it monthly 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 will be kept in a known set location and will be available upon request. Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately. BMP element: - Potentialproblem: How l will remediate the problem: Entire BMP Trash debris is present. Remove the trash debris. . Perimeter of wetland Areas of bare soil and/or erosive Regrade the soil if necessary to remove the gullies have formed. gully, and then plant a ground cover and water until it is established. Provide lime and a one-time fertilizer application. _ Vegetation is too short of too long. Maintain vegetation at an appropriate height, Inlet device: pipe or _ The pipe is clogged (if applicable). Unclog the pipe. Dispose of the sediment Swale offsite. _ The pipe is cracked or otherwise Replace the pipe. damaged if applicable . Erosion is occurring in the Swale (if Regrade the Swale if necessary to smooth applicable). it over and provide erosion control devices such as reinforced turf matting or riprap to avoid future problems with erosion. Form SW401-Wetland O&M-Rev.4 Page 1 of 3 f.. Pennit Number: (Io be provided by DWQ) BMP element:.' ;' Potentialproblem: How I will remediate the `roblerm Forebay Sediment has accumulated in the Search for the source of the sediment and forebay to a depth that inhibits the remedy the problem if possible. Remove forebay from functioning well. the sediment and dispose of it in a location where it will not cause impacts to streams or the BMP. _ 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 a pesticide is used, wipe it on the plants rather than spraying. Deep pool, shallow water _ Algal growth covers over 50% of the Consult a professional to remove and and shallow land areas deep of and shallow water areas. control the algal growth. Cattails, phragmites or other invasive Remove invasives by physical removal or plants cover 50% of the deep pool and by wiping them with pesticide (do not shallow water areas. spray) - consult a professional. Shallow land remains flooded more Unclog the outlet device immediately. than 5 days after a_storm event. Plants are dead, diseased or dying. Determine the source of the problem: soils, hydrology, disease, etc. Remedy the problem and replace plants. Provide a one-time fertilizer application to establish the ground cover if necessary, Best professional practices show that Prune according to best professional pruning is needed to maintain optimal practices. plant health. Sediment has accumulated and Search for the source of the sediment and reduced the depth to 75% of the remedy the problem if possible. Remove original design depth of the deep the sediment and dispose of it in a location pools. where it will not cause impacts to streams or the BMP. Embankment A tree has started to grow on the Consult a dam safety specialist to remove embankment. the tree. An annual inspection by appropriate Make all needed repairs. professional shows that the embankment needs repair. Evidence of muskrat or beaver activity Consult a professional to remove muskrats is present, or beavers. Micropool _ Sediment has accumulated and Search for the source of the sediment and reduced the depth to 75% of the remedy the problem if possible. Remove original design depth, the sediment and dispose of it in a location where it will not cause impacts to streams or the BMP. Outlet device Clogging has occurred. Clean out the outlet device. Dispose of the sediment off -site. _ The outlet device is damaged Repair or replace the outlet device. Receiving water Erosion or other signs of damage have Contact the NC Division of Water Quality occurred at the outlet. 401 Oversight Unit at 919-733-1786. Form SW401-Wetland O&M-RevA Page 2 of 3 Permit Number: (lobe provided by DWQ) I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior to any changes to the system or responsible party. Project name: L,iberly Baptist Church_Worship Center Addition BMP drainage area number: Print Title: bead Pastor Address: 1625 Ray Road, Spring Lake, NC: 28390 Note: 'rhe legally responsible party should not be a homeowners association unless more than 50% of the lots have been sold and a resident of the subdivision has been named the president. I, i s A rnu�� _T (y. _. a Notary Public for the State of County of } c:rtevtl___,do hereby certify that Personally appeared before me this 36 `day of __Jki y �7�, and acknowledge the due execution of the forgoing stttoormwater wetland maintenance requirements. Witness my hand and official seal, SEAL My commission expires_.__�� Form SW40i-Wetland O&M-Rev.4 Page 3 of 3