SW3191001_Application_11/5/2019

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW — 1995 ❑ Coastal SW — 2008 ❑ Ph 11 - Post Construction
(select all that appl)) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
I, Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
POPLIN MEADOWS PHASE 11
2. Location of Project (street address):
5922 B_ONTERRA PILLAGE WAY
City:[NDIAN TRAIL County:UNION Zip:28079
3. Directions to project (from nearest major intersection):
FROM US-74 BYPASS NORTH, TAKE THE UNIONVILLE-INDIAN TRAIL ROAD W EXIT, TURN RIGHT
ON UNIONVILLE-I.NDIAN TRAIL ROAD W, TURN LEFT ON POPLIN RD. TURN LEFT ON RONTERRA
VILLAGE WAY. SITE IS 0.2 MILES ON RIGHT
4. Latitude:35* 04' 59.50" N Longitude:80° 36' 33.06" W of the main entrance to the project.
Ii. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenezoals with niodifications also requires SINU-102 - Renewal Application Forni
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
cerl{fication
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 ®Sedimentation/Erosion Control: 10.2 ac of Disturbed Area
❑NPDES Industrial Stormwater Z404/401 Permit: Proposed Impacts 0.39 AC
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:
Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S,L, 2012-200, Part VI:.lS.lt :(purlal.itc�E�tir.arll���i�hl[rlrule s-si�iei-r�l_ttion5
Form SWU-101 Version Oct. 3l, 2013 Page 1 of 6

' 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:Ll UID MANAGEMENT LLC
Signing Official & Title:DENNIS MOSER
b. Contact information for person listed in item la above:
Street Address:231 POST OFFICE DRIVE, SUITE B-8
City-INDIAN TRAIL State:NC Zip:28079
Mailing Address (if applicable): SAME
City: State:
Phone: (704 ] 882-1700 Fax. -
Email: DMOSElttDTI,IEMOSERGROUPINC.COM
Zip:
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:ROBEIZT W. AND LINDA L. BRIGMAN, TRUSTEE,% _
Signing Official & Title:
b. Contact information for person listed in item 2a above:
Street Address:5922 BONTERRA VILLAGE WAY
City:INDIAN TRAIL. State:NC Zip:28079
Mailing Address (if applicahle):5922 POPLIN RD
City:INDIAN TRAIL
Phone: ( 1
Email:
State:NC Zip:280
Fax: ( ]
3. a. (Optional) Print the name and title of another contact such as (lie project's construction supervisor or other person who
can answer questions about the project:
Other Contact Person/Organization:Michael Theberge..P.E._ _
Signing Official & Title:Michael Theberge, P.E.. Project Manager
b. Contact information for person listed in item 3a above:
Mailing Address:1927 South Tr, on Street Suite 310
City; Charlotte State:NC Zip:28203
Phone: (980 ) 272-3400
Email:ntilteber e c-0ohleren .com
4. Local jurisdiction for building permits: UNION COUNTY
Fax: (980 ) 272-3401
Point of Contact:MARK GRIFFIN Plione 9: (704-283-3643 _)
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
l . in the space provided below, briefly summarize how the stormwater runoff will be treated.
SiTE IMPERVIOUS AREA WiLL DRAIN TO WET POND 1 TO BE TREATED AND DETAINED AS
REQUIRED BEFORE BEING DISCHARGED TO ONSiTE WETLANDS. UNTREATABLE/BYPASS AREAS
❑RAIN AROUND THE POND OR TO ANALYSIS POINTS IDENTIFIED ON CONSTRUCTION PLANS
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 YADKiN-PEEDEE River basin.
4. Total Property Area: 11.71 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area:.55 acres
7. Total Property Area (4) — Total Coastal Wetlands Area (5) — Total Surface Water Area (6) — Total Project Area': 1 1.16acres
+ Total project area shall be calculated to exclude theJbllowing: the normal pool ol'irnpounded 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,frona the NHW (or MHW) 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 may be
included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 43.7 %
9. How many drainage areas does the project have?3 (For high density, count I,for each proposed engineered storrmvaler
BMP. For low density and other projects, use l.Jor the whole properly 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 I
Drainage Area 2
Drainage Area 3
Drainage Area IA
Receiving Stream Name
NORTH FORK
CROOKED
CREEK
NORTH FORK
CROOKED
CREEK
NORTH FORK
CROOKED
CREEK
NORTH FORK
CROOKED
CREEK
Stream Class *
C
C
C
C
Stream index Number *
13-17-20-1
13-17-20-1
13-17-20-1
13-17-20-1
Total Drainage Area (so
294,079
20,070
48,520
147,405
On -site Drainage Area (so
294,079
20,070
48,520
147,405
Off -site Drainage Area (sf)
0
0
0
Proposed Impervious Area** (sf)
211,908
390
1,878
0
% Impervious Area** (total)
72.00
1.9
3.9
0
Impervious" Surface Area
Draina e Area iB
Drainage Area 2
Drainage Area 3
Drainage Area IA
On -site Buildings/Lots (sf)
141,567
0
0
0
On -site Streets (sf)
39,620
0
0
0
On -site Parking (sf)
6,748
0
0
0
On -site Sidewalks (st)
13,031
390
1,878
0
Other on -site (sf)
3,942
0
0
0
Future (sf)
7,000
0
0
0
Off -site (sf)
0
0
0
0
Existing BUA*** (sf)
0
0
1 0
0
Total (sf):
211,908
390
1 1,878
0
* Stream Class and Index Number can be determined at: ham:�kni_ula n�ei�ivt�'�r..+ i str i lass'+ i� rrli�rrrs
** hnpen ious avert is dc�ined as the built upon area including, but not limited lo, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
*** Report only that amount of existing BUA that will remain after development. Do
not report any existing BUA that is to be removed and which will be replaced by new BUA.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

]'I. How was the off -site impervious area listed above determined? Provide documentation. N/A
Proiects in Union County: Contact DEMLR Central Office staff to check if the project is located vvithin 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
littl%I��rtal.ncdurr.s�r�l�rt�ly�;{stUbL�ti, t3lta. .
Vl. 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 httll�c[,i}ctiitlr,i�rgilyc 7lweFvvs suisfi�awrlivrtns clues. 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 fl'1�+41sutiir�Ps.)
Please indicate that the following reguired information have been provided by initialing in the space provided for each
item. All original documents MUST be signed and initialed in blue ink. Download the latest versions for each submitted
application package from Ir�y:llpartaLned4rrr_o�r1v►1�lhews/su/statcsw/lbrms_ clocs.
l . Original and one cop), of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part V11 belovv)
3. Original of the applicable Supplement Form(s) (scaled signed and dated.) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
litip://www..c6vlielp.orglpaggILo.nestopexpt-c,ss.litmi 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/management for
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
receiving stream drains to class SA waters within % mile of the site boundary, include the '/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14' (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.
h. 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.
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).
Initials
Al 7:-
M 7-
41rr
M T._..
m/
� r-
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

T. Copy of any applicable soils report with the associated SHWT elevations (Please identify _
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"x 1 1" 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 veri/y the SKWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1434 Page No: 251
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact information, item 1 a, 2a, and/or 3a per 15A NCAC 2H.I003(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. http:Pwww.seeretary.state.ne.us/C'orporations/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 hilp.] lortIILnCtlenno i,Vweb lr[state-slnt'm�yalvr-forills flocs. 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.
Vill. 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. -Michael Theberge. P.E.
Consulting Firm: Bohler Engineering NC, PLLG
Mailing Address:1927 South Tion Street Suite 310
City:Cliarlotte State:NC Zip:28203
Phone: (980 ) 272-3400 Fax: (980 ) 272-3401
Email _mtheber_ge(cybutilereng.com
IX. PROPERTY OWNER AUTHORIZATION (if'Contact Information, item 2 has been filled out, complete this section)
i, (print or type name ofperson listed in. Contact inl'ormation, item 2a)foWItl t-►.,mL L L�r��manI � �ify that [
own the property identified in this permit application, and thus give permission to (print or type name of person listed in
Contact Information, item Irr) _ Delm•� M&Fdr _ with (print or iJ pe name of or�Tet►rization listed in
Contact Information, item IrrJ.Lticr�;d ►hwtiasz LLC to develop Elie project as currently proposed. A copy of the
lease agreement or pending propert�s 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

' t As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated agent (entity
listed in Contact Information, item 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 in appropriate enforcement action including the assessment of civil penalties of up to $25,000 per day, pursuant to
NCGS 143-215.6.
Signature: - z Date; �Q
I, VC.hu.S M J CLCc e Y-% , a Notary Public for the State of VAOIA4^ (!A V*O i:n�county of
"�y%st. s "r1 do hereby certify that {�p�oeyt W ty j3 qoA�k-+YAO -L BviYY� nesonally appeared before
me this -� day of _OC-Aa 3 ,P42X9_, and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal,
vt Plop,
SOTAgr
comiur Aw
e���karR�s
Zd' AU�LIC �U
co
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires- � 02-�
I, (pr•intor type name ofperson listed in Contact /r2for•nintion, ilem Ia) J ^V\ W. MV Lf ,
certify that the information . e tided on this permit application form is, to the best of my knowledge, correct and that the
project will be constructer in t onformance with the approved plans, that the required deed restrictions and protective
covenants will be recoi• to I that the proposed project complies with the requirements of the applicable stormwater rules
under l5A NCAC 2H . t f1 ai rl any other applicable state stormwater requirements.
under 15A NCAC 2H. ( ( A
Signature:
Date: l 0 • Z - 17
i, t�cc� e, '� ��. , a Notary Public for the State of/ County of
do hereby certify that ��8I *r eiv _ personally appeared before
me this day of -a bed , 121 , � td acknowledge th due ex �i�f f the application for a
stormwater permit. Witness my hand and official seal, &&-P- A,1, ell
RAENAE H. UTTLE
NOTARY PUBLIC
5tanty County
North Carolina
My Commission Expires April 16. 2022
y commission expiry;
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6
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