Fillable Notication Form for Sites Disturbing Less Than 1-Acre (Town of Fort Mill)

Fill Online, Printable, Fillable, Blank Notication Form for Sites Disturbing Less Than 1-Acre (Town of Fort Mill) Form

Use Fill to complete blank online TOWN OF FORT MILL (SC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Notication Form for Sites Disturbing Less Than 1-Acre (Town of Fort Mill)

On average this form takes 18 minutes to complete

The Notication Form for Sites Disturbing Less Than 1-Acre (Town of Fort Mill) form is 1 page long and contains:

  • 0 signatures
  • 21 check-boxes
  • 62 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Fort Mill

BROWSE TOWN OF FORT MILL (SC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
DHEC 2628 (01/2010)
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Notication #: ____________ (For Ofcial Use Only)
Note: This form is for use on projects located outside of the eight coastal counties (Beaufort, Berkeley,
Charleston, Colleton, Dorchester, Georgetown, Horry, and Jasper) and that are NOT part of a larger common
plan for development or sale.
Notication Form for Sites Disturbing
Less Than 1-Acre
(Not Part of a Larger Common Plan,
Non-Coastal County)
Date: ______________
Project/ Site Name: ______________________________________________________ County: ___________________________
I. Project Information
A. Is this project part of a Larger Common Plan for Development or Sale (LCP)? o Yes o No
B. Project Owner/ Operator (Company or person): ____________________________________________________________
Company EIN: __ __ - __ __ __ __ __ __ __ Phone: __________________________ Fax: _________________________
Mailing Address: ____________________________________ City: __________________ State: ____ Zip: ____________
Email address: ______________________________________________________________________________________
C. Permit Contact (if owner is company): ____________________________________________________________________
Mailing Address: ____________________________________ City: __________________ State: ____ Zip: ____________
Phone: (Day) _______________________ (Mobile) _______________________ (Fax)_____________________________
Email address: ______________________________________________________________________________________
II. Property Information
A. Site Location (street address, nearest intersection, etc.): _____________________________________________________
City/ Town (if in limits): _____________________________ Latitude: ____
o
____’____” N Longitude: -____
o
____’____” W
Tax map # (list all): ___________________________________________________________________________________
B. Property Owner (if different from section I above): __________________________________________________________
Mailing Address: ______________________________________ City: __________________ State: ____ Zip: __________
Phone: (Day) ____________________ Email address: ______________________________________________________
III. Site Information
A. Disturbed area (to the nearest tenth of an acre): ____________ Total area: ____________
B. Start Date (MM/DD/YYYY): ____/____/________ Completion Date: ____/____/________
C. Are there any ooding problems downstream of or adjacent to this site? o Yes o No
D. Has S.C. DHEC issued a Notice to Comply or Notice of Violation for this site or LCP? o Yes o No
E. Type of Activity (check all that apply): o Commercial o Industrial o Institutional
o Residential: Single-family o Residential: Multi-family o Linear o Other:
o Multi-use (Commercial & Residential) o Site Preparation (No new impervious) ____________________
F. Is any part of the property located inside an MS4 or urbanized area? o Yes o No
If yes, list the MS4 operator or urbanized area name. _______________________________________________________
IV. Waterbody Information
A. Nearest receiving waterbody(s) [RWB]: ______________ Distance to Nearest RWB (feet): __________________________
B. 1. Are there any Waters of the United States/ Waters of the State, jurisdictional or non-jurisdictional wetlands, or any other
waters located on site? o Yes o No
2. Are there any impacts to any of the on-site Waters of the U.S./State, jurisdictional or non-jurisdictional wetlands, or any
other waters? o Yes o No
C. If yes for impacts in item B.2, describe each impact and activity, and list all permits (e.g., USACOE Nationwide Permit,
DHEC General Permit) and certications that have been applied for or obtained for each impact.
V. Signatures and Certications: DO NOT SIGN IN BLACK INK!
A. Per my signature below, I hereby certify that this project is not part of a Larger Common Plan (LCP) for Development or
Sale. I understand that additional construction activities at this site may require permit coverage and I am responsible for
obtaining any federal, state, or local permits that may be required for this project.
I certify that all land-disturbing construction and associated activity pertaining to this site shall be accomplished pursuant
to and in keeping with the terms and conditions of all relevant regulations, including the Storm Water Management and
Sediment Reduction Act of 1991 and the Federal Clean Water Act. Failure to do so may result in penalties. 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. I am aware that there are signicant
penalties for submitting false information, including the possibility of ne and imprisonment for knowing violations.
Printed name of Project Owner/Operator Signature of Project Owner/Operator Date
DHEC2628 (01/2010)
Instructions
This form is for the use on projects that will disturb less than 1 acre and are not a part of Larger Common Plan (LCP) for
development or sale. It may not be used on projects located in the eight counties comprising the S.C. Coastal Zone (Beaufort,
Berkeley, Charleston, Colleton, Dorchester, Georgetown, Horry, and Jasper counties).
Completing the Application:
You must type or print legibly. You must include the original, signed notication form and one (1) copy of a sketch plan outlining the
anticipated activities and the location of all proposed sediment and erosion control devices.
Where to File: (For projects that are not located within the Coastal Zone and are not part of a LCP.)
Via Email Via Mail
Stormwaterlessthan1@dhec.sc.gov S.C.DHEC—Stormwater Permitting Section
(All les must be submitted as PDFs.) 2600 Bull Street
Columbia, SC 29201-1708
Project/ Site Name
The Project/ Site Name should be a unique or distinguishing name (e.g., not Proposed Subdivi sion).
Property Information
The ofcial or legal name of the Project Owner/ Operator should be listed under section A. If the Project Owner/ Operator is a
company, then a Permit Contact person should be listed under section B. This can be someone other than the person that has
signatory authority for the company. Please provide all requested information including email addresses.
Property Information
If this project is part of a Larger Common Plan for sale or development, then mark Yes. Otherwise mark No.A.
List a city/town only if the site is within the city/ town limits. See the following website for assistance in obtaining latitude/ longitudeB.
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.
If the Project Owner/ Operator does not own the project site, then list the ofcial or legal name of the current Property Owner ofC.
the site. NPDES coverage will be issued to the Project Owner/ Operator (Section I), not the Property Owner, unless same entity.
Site Information
The total and disturbed areas should be rounded to the nearest tenth of an acre.A.
List the estimated start and completion dates of the construction activity.B.
If there are any downstream ooding problems, then mark Yes. Otherwise mark No.C.
If S.C. DHEC has issued a Notice to Comply or Notice of Violation for this site or LCP check Yes, otherwise check No.D.
Identity the type of activity on this site by checking all that apply. Institutional includes schools and other publicly owned projects,E.
except Linear projects. Site Preparation includes clearing, grubbing, and grading only; no new impervious areas should be pro-
posed if this activity type is checked.
If any of the property is located inside an urbanized area or MS4, then list the entity and contact the respective MS4 or UA to iden-F.
tify applicable project requirements. See the following website for information about MS4s: http://www.scdhec.gov/environment/
water/swnsms4.htm.
Urbanized area boundary maps are available at http://cfpub.epa.gov/npdes/stormwater/urbanmapresult.cfm?state=SC.
Waterbody Information
The nearest receiving waterbody is the nearest Waters of the State (WOS)(see denition in S.C. Regulation 61-9—A.
http://www.scdhec.gov/environment/water/reg.htm) 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.
If there are other waters of the U.S./ State on the site not listed in item A (e.g., lake, pond), then mark Yes under item B.1. If thereB.
are proposed impacts to these or any WoS, then mark Yes under item B.2. It is also advised that you contact USACOE (866-
329-8187) and/ or S.C. DHEC Water Quality Certication, Standards & Wetlands Programs Section (803-898-4300) about these
impacts.
If items B.1 and B.2 where marked Yes, then describe the scope of all impacts to the referenced Waters of the State and list allC.
permits and certications that have been applied for or obtain which addresses each impact.
Signatures and Certications
DO NOT SIGN IN BLACK INK! This form must contain original signatures.
If the Project Owner / Operator is a company, print the name of the person who is signing the NOI for the Project Owner / Opera-A.
tor. A person with signatory authority for the Project Owner / Operator must sign the application. Please see §122.22 of S.C. Reg.
61-9 (Appendix C of the CGP) for complete information about signatory authority.
Ofce Mechanics & Filing
A. Form will be available online for all applicants.
Page 2
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Less Than One Acre (Not Part of LCP)
Project Requirements In Non-Coastal Counties
This document provides guidance for projects that disturb less than one (1) acre; are not part of a larger common plan for development or sale
(LCP); and are located outside of the 8 coastal counties (Beaufort, Berkeley, Charleston, Colleton, Dorchester, Georgetown, Horry and Jasper)
subject to the requirements of the S.C. Coastal Zone Management Plan. ; and are not part of a MS4 or Urbanized Area (UA). If the less than
one (1) acre project is to be constructed in a MS4 or urbanized area, the respective MS4 or UA must be consulted to identify applicable project
requirements. The Wheretoapply guidance may also be consulted for MS4/UA contact information.
Regulatory Basis: The S.C. Stormwater Management and Sediment Reduction Act (R.72-300) requires that for land disturbing activities involving two
(2) acres or less of actual land disturbance which are not part of a larger common plan of development or sale, the person responsible for the land
disturbing activity shall submit a simplied stormwater management and sediment control plan meeting the requirements of R.72-307H. In addition
to R.72-300, all projects that disturb 1 acre or more are subject to the requirements of the NPDES General Permit for Storm Water Discharges from
Large and Small Construction Activities (CGP). Additionally, projects may be subject to requirements of local governments through local ordinances, in
particular, those areas that are considered Municipal Separate Storm Sewer Systems (MS4s) under the NPDES program. Please see http://www.scdhec.
gov/environment/water/swnsms4.htm for more information. This specic guidance addresses requirements only for less than one (1) acre non-
coastal projects that are not part of a LCP.
Denition LCP: The plan in LCP is “broadly dened 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 specic 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 an LCP. If the site is part of a subdivision, industrial park, commercial park, etc., then it is considered to be part of an LCP. If there have been land-
disturbing activities, including clearing, grading or excavating, that resulted in one (1) disturbed acre or more since 1992, then any future land-disturbing
activities at the site are considered to be part of an LCP.
Less Than One (1) Acre Non-Coastal Project Requirements:
Projects that disturb less than 1 acre and are not part of a larger common plan for development or sale (LCP) require the submittal of a simplied
plan sheet and Notication Form (DHEC Form 2628) or other form provided by DHEC. Please note that stormwater detention is not required under
R. 72-300 for projects in this program area, however, these projects are required to provide adequate sediment and erosion controls in order to
insure no offsite sedimentation into Waters of the State, adjacent properties, and public right-of-ways. Please also note that the Department
does not regulate the placement of ll in oodplains. You must contact your local city or county ofcial for such approval. Following is a
summary of DHEC’s submittal requirements for non-coastal projects that disturb less than one (1) acre and are not part of a LCP or MS4/UA:
Provide 1. one (1) complete (signed and dated) Notication Form (DHEC Form 2628) or other form provided by DHEC. Note: The Notication
form must be signed and dated by the Project Owner/Operator.
Provide 2. one (1) copy of the plan/sketch. Note: Plan is not required to be prepared by an engineer, Tier B surveyor, or landscape
architect; however, if an individual with one of these licenses prepares the plan, then they must sign and seal the plans. The sketched
plan should include:
(a) A site location drawing of the proposed project, indicating the location of the proposed project in relation to roadways, jurisdictional
boundaries, streams and rivers; (b) The boundary lines of the site on which the work is to be performed; (c) The location of temporary
and permanent vegetative and structural stormwater management and sediment control measures; and (d) A topographic map of the
site (if required by the implementing agency).
A 3. narrative description of the stormwater management and sediment control plan to be used during land disturbing activities. Note: This may
be included on the plans instead of in a written narrative. Include a general description of topographic and soil conditions of the property.
Include a general description of adjacent property and a description of existing structures, buildings, and other xed improvements located on
surrounding properties.
Once completed, the notication package (form, plans, and narrative) may be e-mailed (as pdf) to Stormwaterlessthan1@dhec.sc.gov for electronic
processing by the Bureau of Water. A notice of receipt will be e-mailed to the applicant upon successful receipt of the notication package.
Once the notication package has been screened for completeness and applicability, a letter requesting additional information or an approval
letter will be e-mailed to the project owner/operator at the e-mail address provided on the notication form. If electronic submittal is not possible
or desired, Less Than One Acre notications may be mailed to SCDHEC - Bureau of Water, Stormwater Permitting Section, 2600 Bull Street, Columbia,
S.C. 29201
2600 Bull Street
•
Columbia, SC 29201
•
Phone: (803) 898-3432
•
www.scdhec.gov
S O U T H C A R O L I N A D E P A R T M E N T O F H E A L T H A N D E N V I R O N M E N T A L C O N T R O L
Promoting and protecting the health of
the public and the environment
C. Earl Hunter, Commissioner
DHEC 2628 (01/2010) Page 3
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Notication Form for Sites Disturbing Less Than 1-Acre (Town of Fort Mill)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 9 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document