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STORMWATER CONSTRUCTION APPROVAL APPLICATION (Town of Summerville)

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STORMWATER CONSTRUCTION APPROVAL APPLICATION
(Applicable for single family homes that disturb one (1) acre or more and commercial, industrial, or major subdivisions
that disturb one-half (0.5) acres or more)
DATE: ___________________
PROJECT/SITE NAME: ______________________________________________________________
I. Project Information
Project Owner/ Operator (Company or person): ___________________________________________________
Contact Person: __________________________________________ Company EIN: ____________________
Mailing Address: ___________________________________________________________________________
City: _____________________________________________________________ State: _______ Zip: _______
Phone: (Day) _______________________ (Mobile) _______________________ (Fax) _______________________
Email address: _____________________________________________________________________________
Person Financially Responsible: _______________________________________________________________
(If different than above, a person must be named in both spaces)
Mailing Address: ___________________________________________________________________________
City: _____________________________________________________________ State: _______ Zip:_______
Phone: (Day) ______________________ (Mobile) _______________________ (Fax) _______________________
Email address: _____________________________________________________________________________
Agent or Contact Person (if applicable): _________________________________________________________
Mailing Address: ___________________________________________________________________________
City: _____________________________________________________________ State: _______ Zip: _______
Email address: ____
_________________________________________________________________________
Engineer, Technical Representative or Firm: _____________________________________________________
(If different from Agent)
Mailing Address: ___________________________________________________________________________
City: _____________________________________________________________ State: _______ Zip: _______
Phone: (Day) ______________________ (Mobile) ______________________ (Fax) __________________________
Email address: _____________________________________________________________________________
II. Property Information
A. Site Location (street address, nearest intersection, etc.): _____________________________________________
City/ Town: __________________________ Latitude: ___° ___’ ___”N Longitude: ___° ___’ ___”W
Tax map # (list all): _________________________________________________________________________
B. Property Owner (if different from section I above): ________________________________________________
Mailing Address: ___________________________________________________________________________
City: _____________________________________________________________ State: _______ Zip: ______
Phone: (Day) _____________________________
III. Site Information
A. Disturbed area (to the nearest tenth of an acre): ______________ Total area: ______________
Impervious 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: _____________________________________________________________
Town of Summerville, South Carolina 1 of 6
Revised April 2015
STORMWATER CONSTRUCTION APPROVAL APPLICATION
C. Start Date (MM/DD/YYYY): ____________________ Completion Date: _________________________ (estimated)
D. Type of Activit
y (check all that apply):
Commercial Residential: Single-family Linear (Roads, utility lines, etc.)
Institutional Residential: Multi-family Site Preparation (No new impervious)
Re-development Other: _____________________
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
Waters of the U.S./ State
On the site?
If yes, delineated/
identified?
Impacts? Amount of impacts
a. Jurisdictional wetlands
Yes No
Yes No
Yes No
_____ Ac ______ Feet
b. Non-jurisdictional wetlands
Yes No
Yes No
Yes No
_____ Ac ______ Feet
c. Other (List):_____________
Yes No
Yes No
Yes No
_____ Ac ______ Feet
1. If yes for de
lineation, has documentation of the delineation from the USACOE been provided?
Yes No N/A
2. If yes for impacts, has a USACOE permit been applied for or obtained for those impacts?
Yes No N/A If yes, provide copy of the approved USACOE permit.
C. Special Protectio
n Areas
1. Are there any known flooding problems downstream of or adjacent to this site? Yes No
If yes, see attached instruction.
2. Are any portions of the site located in a designated floodplain? Yes No If yes, which zone? _________
If yes, what are the FIRM Numbers? ___________________________________________________________
3. List the nearest DHEC water quality monitoring station(s) [WQMS(s)] to which stormwater (SW) discharges
will drain: _______________________Wat
erbody(s): _____________________________________________
3.1. Is this WQMS listed on the most current 303(d) List for Impaired Waters? Yes No
a. If yes for (3.1), list the impairment(s). _____________________________________________________
b. If yes for (3.1), will construction SW discharges from your site contain the pollutant(s) of impairment?
Yes No
c. If yes for (b), will use of the proposed BMPs ensure that the site’s discharges will not contribute to or
cause further water quality standard violations?
Yes No
3.2. Has a TMDL(s) been developed? Yes No
a. If yes for (3.2), 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 selected BMPs ensure that the site’s discharges will not contribute to or cause
further water quality standard violations?
Yes No
Town of Summerville, South Carolina 2 of 6
Revised April 2015
STORMWATER CONSTRUCTION APPROVAL APPLICATION
V. Preparer/Operator Information
A. Plan Preparer: ___________________________________________________ S.C. Registration #: ____________
Company/ Firm: ___________________________________________________________ S.C. COA #:__________
Mailing Address: ______________________________________________________________________________
City: _____________________________________________________________ State: _______ Zip: __________
Phone: (Day) ________________________ (Mobile) _________________________ (Fax) _________________________
Email address: ________________________________________________________________________________
B. Operator of Day-to-Day Site Activities (Company or person): _________________________________________
Site Contact (if ODSA is company): _______________________________________________________________
Mailing Address: ______________________________________________________________________________
City: _____________________________________________________________ State: _______ Zip: __________
Phone: (Day) _____________________ (Mobile) ________________________ (Fax) ______________________
Email address: _________________________________________________________________________________
VI. Signatures and Certifications
A. One copy of the stormwater plan, 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 the Town of Summerville
Stormwater Management Ordinance and the Stormwater Management Design Manual. (This should be the
person identified in Section V.A.)
Please check one.
___________________________ ___________________________ ______________________
Printed name of Plan Preparer Signature of Plan Preparer S.C. Registration Number
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 construction and associated activity pertaining to this site shall be accomplished
pursuant to and in keeping with the terms and conditions of the approved plans. I also certify that a responsible
person will be assigned to the project for day-to-day control. I hereby grant authorization to the Town of
Summerville Engineering Department 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.
_____________________________ _______
__________________________ ______________
Printed name of Owner/Operator Signature of Project Owner/ Operator Title/ Position
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. One copy 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 and belief that the design is consistent with the Town of
Summerville Stormwater Management Ordinance and the Design Manual.
__________________________________
_____ __________________________________________
Signature S.C. Registration Number
Town of Summerville, South Carolina 3 of 6
Revised April 2015
STORMWATER CONSTRUCTION APPROVAL APPLICATION
Instructions
Completing the Application:
You must type or print legibly. You must include the original, signed application form, required fees, one copy of
the stormwater plan, and one copy of all other supporting documentation with the initial submittal. Additionally, the
checklist must be completed and attached. List how and where each item on the checklist was addressed (e.g., page
4 of the calculations).
Who Must Submit an Application:
Anyone submitting a project that is an individual single family home that disturbs one (1) acre or more or any
commercial, industrial, or subdivision project that disturbs one-half (0.5) acre or more.
Projects located in the TOWN OF SUMMERVILLE submit to:
The Town of Summerville
Engineering Department
200 South Main Street
Summerville, S.C. 29483
(843) 851-4226
Fax 832-8182
Project/ Site Name: The Project/ Site Name should be a unique or distinguishing name (e.g., not Proposed
Subdivision). The Department should be notified in writing if the Project/ Site Name changes.
I. Project Information
• 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.
• The Company EIN is the Employer Identification Number as established by the U.S. Internal Revenue
Service.
• The Project Owner/ Operator is responsible for all portions of the site until a Project Closeout or Transfer of
Ownership form is submitted.
II. Property Information
A. List a city/town only if the site is within the city/ town limits. See the following website for assistance in
obtaining latitude/ longitude coordinates:.
http://water.epa.gov/polwaste/npdes/stormwater/Latitude-
Longitude.cfm. 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. Permit 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 Town must be notified if the actual disturbed area is greater than the disturbed area listed on
the application.
B. If master stormwater 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 project 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.
Town of Summerville, South Carolina 4 of 6
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STORMWATER CONSTRUCTION APPROVAL APPLICATION
D. 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 checked.
IV. Waterbody Information
A. The nearest receiving waterbody is the nearest waters of the State 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.
B. Complete the “On the Site?” column for items a-c. If yes is selected for that column, then the next 3 columns
must be completed. If there are other waters of the U.S./ State (WoS) on the site not listed in items a and b (e.g.,
stream, river, lake, pond), then list those in item c. Delineation means identification by U.S. Army Corps of
Engineers (USACOE) or wetlands consultant. If there are WoS within 100’ of the disturbed area that were not
delineated/identified, then explain this in the narrative; this includes WoS that are not on the project site but are
within 100’ of the disturbed area. If construction activities will occur in and/ or will impact WoS, then select
yes for “Impacts?” and list the amount of impacts to WoS. Provide an additional, separate plan sheet that shows
all WoS on the site and the impacted areas. If there are proposed impacts to WoS, please contact USACOE
(866-329-8187) and S.C. DHEC Water Quality Certification, Standards & Wetlands Programs Section (803-
898-4300) to determine additional requirements before submitting this NOI. In the SCCZ, also contact S.C.
DHEC Page 7 OCRM Wetlands Section (843-953-0200). Please note that it is the Project Owner/ Operator’s
responsibility to ensure that all WoS are shown and identified in the SWPPP. USACOE is U.S. Army Corps of
Engineers. If there are impacts to waters of the U.S./ State (should be listed in item IV.B), then list all permits
and certifications that have been applied for or obtained for those impacts. Describe the activity(s), whether the
impact is permanent or temporary, and any other relevant information. Provide a copy of all permits and
certifications for and correspondence with USACOE and DHEC for the impacts. Make sure to include all plats
referenced in the permits or correspondence.
C1. If there are flooding problems, the extent of the flooding problems and the effect of this project on those
problems must be explained in the Project Narrative.
C2. If the site falls within a designated flood plain, list the zone and FIRM number.
C3. Maps showing WQMS locations are available at the following website for each watershed:
http://www.scdhec.gov/HomeAndEnvironment/Water/ImpairedWaters/Overview/#5
. List the nearest DHEC
WQMS(s) and corresponding waterbody(ies).
3.1 See the following website for the most current 303(d) List for Impaired Waters and related information:
http://www.scdhec.gov/HomeAndEnvironment/Water/ImpairedWaters/Overview/#5
. To search this document
to determine whether a WQMS is listed, select “Edit” from the top toolbar. Then, select “Find”. Enter the
WQMS exactly as listed on the map and hit enter. If none of the WQMS(s) are found, then select no for item
3.1 and proceed to item 3.2. If any of the WQMS(s) are found within the document, then select yes and proceed
to item 3.1.a.
a. List the cause(s) of the impairment (see last column labeled “CAUSE”) for the WQMS(s) and proceed to item
b.
b. DHEC has determined that construction SW discharges are expected to contain pollutants causing the following
impairments: TURBIDITY, BIO (Macroinvertebrate), TP (Total Phosphorus), and TN (Total Nitrogen). You
should carefully evaluate whether the site’s constructions SW discharges will contain any pollutants causing
other impairments, not explicitly listed above. You should also consider previous land uses at the site in
answering this question. For example, if the previous land use was a copper processing facility and the
impairment at the nearest WQMS is copper, then you should carefully evaluate whether the site’s construction
SW discharges would contain copper. If this question is answered yes and the disturbed area is less than 25
acres, then provide an evaluation of the site’s proposed Best Management Practices (BMPs) as described in
section 3.2.12.B of the CGP. If this question is answered yes and the disturbed area is greater than or equal to
25 acres, then provide a written qualitative and quantitative assessment of the site’s proposed BMPs as
described in section 3.2.12.B.II of the CGP. See item 20 on the checklist.
c. If the answer to this question is no, then the site is not eligible for coverage under the CGP.
3.2 See the following website for a list of all WQMS with Approved S.C. Total Maximum Daily Loads (TMDLs):
http://www.scdhec.gov/HomeAndEnvironment/Water/ImpairedWaters/ApprovedTMDLs/
. To search this
Town of Summerville, South Carolina 5 of 6
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STORMWATER CONSTRUCTION APPROVAL APPLICATION
document to determine whether a WQMS is listed, select “Edit” from the top toolbar. Then, select “Find”. Enter
the WQMS exactly as listed on the map and hit enter. If none of the WQMS(s) are found, then select “No” for
item 3.2 and proceed to item V. If any of the WQMS(s) are found within the document, then select yes and
proceed to item (a). The same document will be used for item 3.1a.
a. List the cause(s) of the impairment (see 7th column labeled “CAUSE”) and proceed to item b. If the WQMS(s)
is impaired for more than one parameter, then the WQMS will be listed multiple times on successive rows. The
same document will be used to answer item b.
b. See the 8th column labeled “USE SUPPORT” to determine if the standard has been attained for each
impairment for each WQMS. “FULLY SUPPORTED” means the standard has been attained for the impairment
listed in the “CAUSE” column. “NOT SUPPORTED” means that the standard has NOT been attained for that
impairment. If the standard has NOT been attained for all impairments for all WQMS(s), then select no and
proceed to item c. If the standard has been attained for all impairments for all WQMS(s); select yes and proceed
to item d.
c. DHEC has determined that construction SW discharges are expected to contain pollutants causing the following
impairments: TURBIDITY, BIO (Macroinvertebrate), TP (Total Phosphorus), and TN (Total Nitrogen). You
should carefully evaluate whether the site’s constructions SW discharges will contain any pollutants causing
other impairments, not explicitly listed above. You should also consider previous land uses at the site in
answering this question.
d. Check the TMDL to make sure the site meets the assumptions and requirements. If the site cannot meet the
appropriate TMDL, BMPs must be used.
e. If the answer to this question is no, then the site is not eligible for coverage under the CGP.
V. Preparer/Operator Information
A. Enter the name and registration number of the stormwater plan preparer. S.C. COA is the company’s S.C.
Certificate of Authorization. Enter N/A for S.C. COA if the firm does not have a COA or the preparer is an
individual. If an email address is entered, the plan preparer may be contacted via email.
B. Enter the name of the operator or day-to-day site operations contact and pertinent information.
VI. Certifications
A. The same registered professional must sign and seal the application, drawings, calculations, and supporting
documentation.
B. A person with signatory authority for the Project Owner/ Operator must sign the application. The plan preparer
cannot sign the application for the Project Owner/ Operator. The plans, 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.
• 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 Town’s Engineering Department files (hard copy or
digitized copy).
Town of Summerville, South Carolina 6 of 6
Revised April 2015
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Completed 16 July 2020

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