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CITY OF CHARLESTON, SOUTH CAROLINA Department of Public (City of Charleston)

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CITY OF CHARLESTON, SOUTH CAROLINA
Department of Public Service
Engineering Division
Application for Medium and Large Construction Activities
(TYPE II and TYPE III)
ALL REQUESTED INFORMATION MUST BE PROVIDED ON THIS FORM
(Only applicable for sites that disturb one or more acres or ½ or more acres within ½ mile of receiving water)
Date: ___________________
Project/Site Name: __________________________________________ County: _________________
I. Project Information
Project Owner/ Operator (Company or person):
Permit Contact (if owner is company): ___________________________________ Company EIN: _____________
Mailing Address: ____________________________________ City: __________________ State:
____ Zip_______
Phone: (Day)
_________________________ (Mobile) _________________________ (Fax) _________________________
Email address (optional): _________________________________________________________
Person Financially Responsible:
(If different than above)
Mailing Address: ____________________________________ City: __________________ State:
____ Zip_______
Phone: (Day)
_________________________ (Mobile) _________________________ (Fax) _________________________
Email address (optional): _________________________________________________________
Agent or Contact Person (if applicable): _____________________________________________________________
Mailing Address: ____________________________________ City: __________________ State:
____ Zip_______
Phone: (Day)
_________________________ (Mobile) _________________________ (Fax) _________________________
Email address (optional): _________________________________________________________
Engineer, Technical Representative or Firm __________________________________________________________
Mailing Address: ____________________________________ City: __________________ State:
____ Zip_______
Phone: (Day)
_________________________ (Mobile) _________________________ (Fax) _________________________
Email address (optional): _________________________________________________________
II. Property Information
A. Site Location (street address, nearest intersection, etc.): ________________________________________________
Latitude:
_____°_____’_____” N Longitude: _____°_____’_____” W
Tax map numbers (list all): _______________________________________________________________________
B. Property Owner (if different from section I above):____________________________________________________
Mailing Address: ____________________________________ City: __________________ State:
____ Zip_______
Phone: (Day)
_________________________ (Mobile) _________________________ (Fax) _________________________
Email address (optional): _________________________________________________________
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Stormwater Design Standards Manual
Print Form
III. Site Information
A. Disturbed area (to the nearest tenth of an acre): _______________________ Total area: ______________________
B. Is this project part of a Larger Common Plan for Development or Sale (LCP)? Yes No
If yes, what is the previous state permit no.? ______________________Previous NPDES number: SCR10 _______
LCP/ Overall Development Name: _________________________________________________________________
C. Start Date (MM/DD/YYYY): __________________________Completion Date: __________________________
D. Type of Activity (check all that apply):
Commercial Residential: Single-family Linear (Roads, utility lines, etc.) Other:_______________
Institutional Residential: Multi-family Site Preparation (No new impervious)
E. Are there any flooding problems downstream of or adjacent to this site? Yes No
F. Are any portions of the site located in a designated floodplain? Yes No
If yes, what are the FIRM Numbers? _______________________________________________________________
IV. Waterbody Information
A. Nearest receiving waterbody(s): _______________________________ Distance to this waterbody (feet): ______
Next/Nearest named receiving waterbody(s): ________________________________________________________
B. Wetlands/ Waters of the State
On the site? If yes, delineated/
identified?
Impacts? Amount of impacts
a.
Receiving Waters Yes No Yes No Yes No _____ Ac ______ Feet
b.
Perennial stream(s) Yes No Yes No Yes No _____ Ac ______ Feet
c.
Intermittent stream(s) Yes No Yes No Yes No _____ Ac ______ Feet
d.
Ephemeral stream(s) Yes No Yes No Yes No _____ Ac ______ Feet
e.
Jurisdictional wetlands Yes No Yes No Yes No _____ Ac ______ Feet
f.
Non-jurisdictional wetlands Yes No Yes No Yes No _____ Ac ______ Feet
g.
Other (List):__________________ Yes No Yes No Yes No _____ Ac ______ Feet
If yes for delineation in item B.1, has documentation of the delineation from the USACE been provided?
Yes No N/A
If yes for impacts in item B.1, has a U.S. Army Corps of Engineers (USACE) permit been applied for or obtained for those
impacts?
Yes No N/A If yes, list the permit/ application number. ______________________________
C. Impaired Waterbodies
List the nearest DHEC water quality monitoring station(s) [WQMS(s)] to which construction stormwater (SW)
discharges will drain and the corresponding waterbody(s):
WQMS:______________________________________Waterbody(s): ___________________________________
1. Is the WQMS(s) listed on the most current 303(d) List for Impaired Waters? Yes No
a. If yes for 1, list the impairment(s): ______________________________________________________
b. If yes for 1, will the site's construction SW discharges contain any pollutants causing the
impairment(s)? Yes No
c. If yes for b. list the impairment(s) affected by the pollutant(s) referenced in b.
_________________________________________________________________________________
d. If yes for (c), will use of the selected BMPs ensure that the site’s discharges will not contribute to or
cause further water quality standard violations? Yes No
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2. Has a TMDL(s) been developed for this WQMS(s)? Yes No
a. If yes for (2), list the waterbody. _______________________________________________________
List the impairment(s). _______________________________________________________________
b. Has the standard been attained for the impairment(s)? Yes No
c. If no for (b), will construction SW discharges from your site contain the pollutant of impairment?
Yes No
d. If yes for (c), are your discharges consistent with the assumptions and requirements of the TMDL(s)?
Yes No
e. If no for (d), will use of the selected BMPs ensure that the site’s discharges will not contribute to or
cause further water quality standard violations? Yes No
D. Are S.C. Navigable Waters (SCNW) on the site? Yes No
If yes, list the SCNW: _________________________________________________________________________
Will any construction activities cross over or occur in, under, or through the SCNW? Yes No
If yes, then describe activity (e.g., road crossing, sub aqueous utility line). _________________________________
Has an SCNW permit been issued for this site? Yes, for all activities Yes, for some activities No
If yes, list permit number and corresponding activities. ________________________________________________
V. Operator Information
G. SWPPP Preparer: ____________________________________________________ S.C. Registration #: _________
Company/ Firm: _____________________________________________________ S.C. COA #: ______________
Mailing Address: _______________________________ City: ___________________ State: ____ Zip__________
Phone: (Day) _____________________ (Mobile) _______________________ (Fax) _______________________
Email address (optional): __________________________________________________
H. Operator of Day-to-Day Site Activities [ODSA] (Company or person): ___________________________________
Site Contact (if ODSA is company): _______________________________________________________________
Mailing Address: _______________________________ City: ___________________ State: ____ Zip__________
Phone: (Day) _____________________ (Mobile) ________________________ (Fax) _______________________
VI. Signatures and Certifications
A. Three copies of the SWPPP, all specifications and supporting calculations, forms, and reports are herewith
submitted and made a part of this application. I have placed my signature and seal on the design documents
submitted signifying that I accept responsibility for the design of the system. Further, I certify to the best of my
knowledge and belief that the design is consistent with the requirements of Title 48, Chapter 14 of the Code of Laws
of SC, 1976 as amended, pursuant to Regulation 72-300 et seq., and in accordance with the terms and conditions of
SCR100000. (This should be person identified in Section V.A.)
Please check one: Engineer Tier B Land Surveyor Landscape Architect
__________________________________________ ______________________________________ _________________
Printed name of SWPPP Preparer Signature of SWPPP Preparer S.C. Registration #
B. I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
I hereby certify that all land-disturbing construction, development, and re-development activities and associated
activities pertaining to this site shall be accomplished pursuant to and in keeping with the terms and conditions of
the approved plans and SCR100000. I also certify that a responsible person will be assigned to the project for day-
to-day control. I hereby grant authorization to the Department of Health and Environmental Control and/or the local
implementing agency the right of access to the site at all times for the purpose of on site inspections during the
course of construction and to perform maintenance inspections following the completion of the land-disturbing
activity. (
See Section 122.22 of S.C. Reg. 61-9 for signatory authority information.)
________________________________________ ______________________________________ _________________
Printed name of Project Owner/Operator Signature of Project Owner/ Operator Title/ Position
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C. Designer Certification-One copy of the plans, all specifications and supporting calculations, forms, and reports are
herewith submitted and made a part of this application. Three copies of the plans, all specifications and supporting
calculations, forms, and reports shall be submitted upon approval. I have placed my signature and seal on the design
documents submitted signifying that I accept responsibility for the design of the system. Further, I certify to the best
of my knowledge that the design is consistent with the City of Charleston Stormwater Management Ordinance and
the requirements of Title 48, Chapter 14 of the Code of Laws of SC, 1976 as amended, and pursuant Regulation 72-
300.
__________________________________________ __________________________________
SIGNATURE S.C. REGISTRATION NUMBER
Engineer Tier B Land Surveyor Landscape Architect
Stormwater Plan Review Fee: $100.00 per disturbed acre rounded up to the next whole acre (
up to $2,000 max)
Instructions
Completing the Application:
You must type or print legibly. You must include the original, signed application form, required fees and appropriate fees,
one copy of the Stormwater Pollution Prevention Plan (SWPPP), and three copies of all other supporting documentation with
the initial submittal.
Who Must File a Construction Activity Application:
The Owner/Operator of a single project or larger common plan for development or sale that will ultimately disturb 1 acre or
more or that is within 0.5 mile of a receiving waterbody (RWB) and will ultimately disturb 0.5 acre or more. Submittal of this
application may not be required for projects disturbing 0.5 acre or less, but may require the submittal of a Small Construction
Activity Application.
Project/ Site Name: The Project/ Site Name should be a unique or distinguishing name (e.g., not Proposed Subdivision).
The Department shall be notified in writing if the Project/ Site Name changes.
County: Enter either Charleston or Berkeley.
I. Project Information
A. The official or legal name of the Project Owner/Operator should be listed. If the Project Owner/Operator is a
company, then a Permit Contact person should be listed. This can be someone other than the person that has
signatory authority for the company. All correspondence regarding this permit application will be sent to Permit
Contact at the address listed.
B. The Company EIN is the Employer Identification Number as established by the U.S. Internal Revenue Service.
ATTACH CHECKS HERE
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C. NPDES coverage under SCR100000 will be issued to the Project Owner/ Operator. If an email address is entered,
the Department may contact the Project Owner/Operator via email.
D. The Project Owner/Operator is responsible for all portions of the site until a Notice of Termination (NOT) or
Transfer of Ownership form is submitted. See our website for additional information on NOTs and transfers of
permit coverage and ownership.
II. Property Information
A. See the following website for assistance in obtaining latitude/ longitude coordinates:
http://www.epa.gov/tri/report/siting_tool/index.htm. Latitude (from 32° to 35°) and longitude (78° to 83°)
should be for the center of the site to the nearest 15”. Minutes (’) should be from 0 to 59, and seconds (”) should be
0, 15, 30, or 45.
B. If the Project Owner/ Operator does not own the project site, then list the official or legal name of the current
Property Owner of the site. NPDES coverage will be issued to the Project Owner/ Operator (Section I), not the
Property Owner, unless same entity.
III. Site Information
A. The total and disturbed areas should be rounded to the nearest tenth of an acre. For subdivisions, if the exact build-
out is not known, the disturbed area can be estimated using the following equation:
Disturbed area = 2(Maximum
Footprint of House)(# of lots) + Road/ Right-of-Way areas + Other easements/ disturbance. Please note that the
Department must be notified if the actual disturbed area is greater than the disturbed area listed on the application.
B. The plan in LCP is “broadly defined as any announcement or piece of documentation (including a sign, public notice
or hearing, sales pitch, advertisement, drawing, permit application, zoning request, computer design, etc.) or
physical demarcation (including boundary signs, lot stakes, surveyor markings, etc.) indicating construction
activities may occur on a specific plot.” [63 Federal Register No. 128, July 6, 1998, p. 36491] For example, if master
calculations have been prepared and/ or submitted for an entire site, then all phases and parcels at that site would be
considered part of a LCP. If this is the first phase of an LCP, then this item should be answered yes and the LCP/
Overall Development name should be listed. This LCP/ Overall Development name should also be listed on all
applications for future projects that are part of this LCP, including subsequent phases. If the project is part of an
LCP, then list the previous state permit number and previous NPDES coverage number (not SCR100000).
C. List the estimated start and completion dates of the construction activity.
D. Select ALL activity types that best describe the development proposed for the site. “Institutional” includes schools
and other publicly owned projects, except linear projects. “Site Preparation” includes clearing, grubbing, and
grading only; no new impervious areas should be proposed if this activity type is selected. If none describe the
development, then select “Other” and list the activity.
E. If yes, then the extent of the flooding problems and the effect of this project on those problems must be explained in
the project narrative.
F. See the following website for obtaining FIRM Numbers
https://msc.fema.gov/webapp/wcs/stores/servlet/mapstore/homepage/MapSearch.html .
IV. Waterbody Information
A. The nearest receiving waterbody is the nearest waters of the State (see definition in §122.2 S.C. Regulation 61-9—
http://www.scdhec.gov/environment/water/regs/r61-9.pdf) to which the site’s stormwater will discharge. If
this waterbody is unnamed, then provide a description that references the nearest, named waterbody (e.g., tributary
to Grove Creek). If the site’s stormwater discharges to multiple waterbodies, then list all such waterbodies and
attach additional sheets, if necessary. See the following website for information about identifying and classifying
ephemeral, intermittent, and perennial streams:
http://portal.ncdenr.org/c/document_library/get_file?uuid=0ddc6ea1-d736-4b55-8e50-
169a4476de96&groupId=38364.
B. 1. If there are other waters of the U.S./ State on the site not listed in items a-e (e.g., lake, pond), then list those in
item f. Delineation means identification by USACE. If there are waters of the State (WoS) located within 100’ of
the disturbed area, then the WoS must be delineated. The surveyed delineation and boundaries of the WoS must
be shown and labeled on the plans. For an ephemeral stream, the centerline of the stream must be shown and
labeled on the plans. If WoS will be impacted, then provide an additional, separate plan sheet that shows all WoS
on the site and the impacted areas. Provide a description of the activity(s), whether it is permanent or temporary,
and any other relevant information. If there are proposed impacts to WoS, then it is advised that you contact
USACE (866-329-8187) and/ or Water Quality Certification, Standards & Wetlands Programs Section (803-898-
4300) to determine additional requirements before submitting this NOI. Please note that it is Project Owner/
Operator’s responsibility to ensure that all WoS are shown and identified in the SWPPP.
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2. You must provide a copy of the letter from the USACE and map showing the boundaries of the delineated area.
3. If a USACE permit has been applied for or issued for impacts to waters of the U.S. and State listed in item B.1,
then list the permit/ application number. Provide a copy of that permit. If a USACE permit has been applied for,
then provide a copy of associated correspondence. Make sure to include all plats referenced in the permit or
correspondence.
C. See the following website for the most current 303(d) List for Impaired Waters, Approved TMDLs, and related
information:
http://www.scdhec.gov/HomeAndEnvironment/Water/ImpairedWaters/ApprovedTMDLs/.
Maps showing WQMS locations are available at the following website for each watershed by clicking the
appropriate basin on the S.C. map:
http://www.scdhec.gov/HomeAndEnvironment/Water/ImpairedWaters/WatershedAreas/. Determine which
WQMS are in the watershed in which your site is located and check the 303(d) List and Approved TMDLs to see if
any of the WQMS are listed as impaired. If item 1.c is answered yes and the disturbed area is less than 25 acres, then
provide an evaluation of the selected BMPs described in section 3.4C.2(c) of the Construction General Permit
(CGP). If item 1.c is answered yes and the disturbed area is greater than or equal to 25 acres, then provide the
written quantitative and qualitative assessment described in section 3.4C.2(c) of the CGP.
D. See http://www.scdhec.gov/Environment/WaterQuality/NavigableWaters/ for the definition of S.C.
Navigable Water(s) [SCNW] and other information related to SCNW. Or, contact Water Quality Certification,
Standards & Wetlands Programs Section at (803) 898-4300 for assistance determining the navigability of the waters
on your site or with questions related to SCNW. If an SCNW will be crossed (under, over, or through) during
construction, then provide an additional plan sheet that shows plan and profile views of the SCNW and associated
activities; include a description of the proposed activities on this plan sheet. If the SCNW is not named, then
provide a description that references the nearest, named waterbody (e.g., tributary to Grove Creek). If an SCNW
permit has already been issued for all or some of the activities at this site, then provide a copy of that permit and list
the permit number.
V. Operator Information
A. SWPPP is the Stormwater Pollution Prevention Plan. Enter N/A for the S.C. Registration # if the SWPPP preparer is
not a registered professional in S.C. (engineer, Tier B land surveyor, or landscape architect). For projects disturbing
more than 2 acres, the SWPPP preparer must be one of the listed professionals or federal government employee as
described in Title 40, Chapter 22. S.C. COA is S.C. Certificate of Authorization. Enter N/A for S.C. COA if the firm
does not have a COA. If an email address is entered, the Department may contact the SWPPP Preparer via email.
B. If the Project Owner/ Operator will not be the ODSA, then complete this section. See Appendix A of the CGP for
the definition of Operator. If the ODSA is a company, then a person should be listed as the Site Contact. If there are
multiple ODSAs, then attach additional sheets with all information in Section V.B of this application listed. ODSA
must be co-permittees with the Project Owner/ Operator or have their own separate NPDES coverage under the
CGP.
VI. Certifications
A. The same registered professional must sign and seal the application, SWPPP, calculations, and supporting
documentation.
B. A person with signatory authority for the Project Owner/ Operator must sign the application. The SWPPP Preparer
cannot sign the application for the Project Owner/ Operator. The SWPPP, all reports, including monthly reports, and
any information requested by the Department must be signed by a person with signatory authority for the Project
Owner/ Operator or a duly authorized representative. See Section 122.22 of S.C. Reg. 61-9 (Appendix C of the
CGP) for complete information about signatory authority requirements.
•
Corporation: A responsible corporate officer (e.g., president, vice-president, certain managers)
•
Partnership or Sole Proprietorship: A general partner or the proprietor, respectively
•
Municipality, State, Federal or Other Public Agency: Principal executive officer or ranking elected official
Office Mechanics and Filing
This form and supporting documentation will be kept in the Central Office files (hard copy or digitized copy) or by the City’s
Records Retention Department in accordance with the City’s Retention Schedule.
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Stormwater Design Standards Manual
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CITY OF CHARLESTON, SOUTH CAROLINA Department of Public (City of Charleston)

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Completed 17 January 2021

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