Development and Redevelopment Mitigation Notification Form
Mecklenburg County Land Use and Environmental Services Agency
Notification Recvd. Date:
Time:
Form #PCO13
(rev. 2/2013)
Application/Permit Number:_____D
Information Regarding Site Where Mitigation is Requested:
Name of Development:
Street Name & Number:
Original Tax Parcel:
Name of Creek System Where Development is Located:
Total Area of Project (acres):
Total Disturbed Area (acres):
% Built Upon:
Fee Paid: $
Amendment to Permit #:
Type of Development:
Commercial
Residential (As defined in the Post-Construction
Storm Water Ordinance.)
Jurisdiction or Town:
Resubmittal:
Yes
No If yes provide notification date that resubmittal was required:
Owner’s Name:
Owner’s Address:
Owner’s Phone Number:
Fax:
Owner’s Email:
Calculation of Mitigation Fee: Use the Site Evaluation Tool (SET) developed for compliance
with the Huntersville Low Impact Development Ordinance to complete calculations. A copy of
the SET analysis showing all calculations must be attached to this form for it to be valid. SET is
available at the following website: http://stormwater.charmeck.org (Select Regulations; Select
Low Impact Development (LID); Select Huntersville LID; Select Mecklenburg County Site
Evaluation Tool v3.3).
1
Total sediment loading from site (post-development
without BMPs) =
2
Sediment loading at 85% removal efficiency (row 1 x
0.85) =
3
85% loading reduction calculated over 20 years (row 2 x
20) =
4
Mitigation Fee (row 3 x $1,000) =
5
Mitigation Fee + $4,400/acre for Operation &
Maintenance Fee (row 4 + ($4,400 x total site acreage))
6
Mitigation Fee + Maintenance Fee increased by 12% for
administrative costs (row 5 x 1.12)
7
Total Mitigation Fee =
IMPORTANT: Check must be made payable to applicable Jurisdiction.
tons / yr
tons / yr
tons
$
$
$
$
This form serves as notification to the Storm Water Administrator that the owner shall mitigate
the above described site by paying the Mitigation Fee indicated in row 7 of the above table. This
form must be submitted with the Concept Plan Application form. Total payment is due to the
Storm Water Administrator within 30 calendar days of receipt of notification of approval of the
Concept Plan Application. Failure to receive such payment shall nullify this mitigation option
and full compliance with the Post-Construction Storm Water Ordinance shall be required.
Received By: _______________________________________ Date: _____________________