SW3201202_Application_20210302

III. CONTACT INFORMATION
I. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the erect):
Applicant/Organization: Union County
Signing Official & Title: William M. Watson, County Manager
b.Contact information for person listed in item la above:
Street Address: 500 North Main Street
City: Monroe Statc:,.NC Zip: 28112
Mailing Address (if applical7(e): 500 North Main Street
City: Monroe State:_NC Zip: 28112
Phone: Fax: (704 ) 282-0121
Em.ai]:Mark.Watson@Lllli011COUllt'VtIC.gov
c. Please check the appropriate box. The applicant listed above is:
ZThe property owner (Skip to Contact Information, itern 3a)
E] 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.11rint Property Owner's name and title below, if you are the lessee, Purchaser or developer. (This isthe
pet -son who owns the property that the project is located on):
Property Owner/ Organization:
Signing Official &'Title:
b. Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applical4c):
Phone:
Email:
State: Zip:
Zip:
Fax:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact person/(Organization: Jonathan S. Laysley, P.E.
Signing Official &Title: Senior Project Manager/ Vice President
b. Contact information for person listed in item 3a above:
Mailing Address:4.600 Park Road Suite 240
City:Charlotte
State:NC
Zip:28209
Phone: tZQ4._J_ 342-4546 Fax: [phone]
Enlail:lal2s][e-mail]
4. I.,ocal jurisdiction for building permits: Union Count�
Point of Contact:Brian Hawkins (for, stormwater) - Phone #: (704 I ..2t13-3642
Form SWU-101 Version Oct. 31, 2013 Ilage 2 of'6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Runoff will be minimized by keeping the built-upon area less than 24% of the total site area. Runoff will be
treated using vegetated conveyances, preserving vegetated setbacks on streams, discharging runoff so that it
is dispersed before reaching buffers, and minimizing piping for driveway crossings. Site will be low-density.
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-Pee Dee River basin.
4. Total Property Area: 49.44 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0.087 acres
7. Total Property Area (4) Total Coastal Wetlands Area (5) Total Surface Water Area (6) = Total Project
+
Area: 49.35 acres
+
Total project area shall be calculated to exclude the following: the normal pool of impounded 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 from 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 = 14.2 %
9. How many drainage areas does the project have? 1 (low-density) (For high density, count 1 for each proposed
engineered stormwater BMP. For low density and other projects, use 1 for the whole property 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 1 Drainage Area Drainage Area Drainage Area
Receiving Stream Name UT of
Richardson
Creek
Stream Class * C
Stream Index Number * 13-17-36-(5)
Total Drainage Area (sf) 2,149,820
On-site Drainage Area (sf) 2,149,820
Off-site Drainage Area (sf) 0 (low-density)
**304,548
Proposed Impervious Area (sf)
14.2%
**
% Impervious Area(total)

**
Drainage Area 1 Drainage Area Drainage Area Drainage Area
Impervious Surface Area
On-site Buildings/Lots (sf) 81,495
On-site Streets (sf) 104,775
On-site Parking (sf) 9,013
On-site Sidewalks (sf) 3,791
Other on-site (sf) 0
Future (sf) 102,000
Off-site (sf) 0 (low density)
Existing BUA*** (sf) 3,474 (road)
Total (sf): 304,548
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

n. Existing drainage (including off -site), drainage easements, pil.1e sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required),
Copy of any applicable soils report with the associated SHWT elevations (Please identify JSL TSL
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] I" copy of the NRCS County Soils snap with the
project area clearly delineated. For projects with infiltration BMF's, 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 vcrifi y the S11W]'prior
to suinnittal, [phone].)
10. A copy of the most current property deed. Deed book: 07199 Page No:0208 JSL-I-SL
11, For corporations and limited liability corporations (11A Provide documentation from the NC not required
Secretary of State or other official documentation, which supports the titles and positions field
by the persons listed in Contact Information, item I a, 2a, and/or 3a per 15A NCAC 2HA 003(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.
litti)://www,secy-etarv.stat-(.,.iic.tis/Cc)rvoi�atiniis/Cl;c,ircti.ast-.)x
V11. DEED RESTRICTIONS AND PROTECTIVE COVENANT'S
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
BLJA 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 ht :r ljltL
stormwater-fornis doui. Download the latest version,., 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.
VIII, CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to design
ate 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-Jonatl1i n l,a . sley,
Consulting Firm: CDM Smith
Mailing Address:4600 Park Road Suite 240
City:Charlotte State:NC Zip:28209
Phone: A;-4546
Ernail:latIsle. [e-mail]
Fax: tTQ4 . ..... J_._342-4546
. ..........
IX PROPERTY OWNER AUTHORIZATION (if Contact! Infimnation, ifein 2 has beenfilled oul, coniplete this
section)
1, (prin.1 or type naine of person listed in Contact InIbrniation, iteni 2a) certify that I
own the property identified in this permit application, arid thus give permission to (print or type naine of person
listed in Contact Intbr7nation, item Ja) v,-ith (print or type natne (rf organization listed in
C'ontact Information, item 1a) to develop the project as currently proposed, A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the storinwater system.
Lorna SW1J-101 \)r ersion Oct. 3 1, 2013 Page 5 ol'6

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 NCCS143-215.6.
Signature: . . . .. . . ................. ------------- -- _ ---------- - Date:
1, , a Notary Public for the State of County of
do hereby certify that
personally appeared
before me this — day of — and acknowledge the due execution of the application for
a storrnwater permit. Witness my hand and official seal
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
1, (print or (ype name of person listed in Contact Information, itetri ]a) William M. Watson, County Manager
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwateK rules under 15A NCAC 21-1.1000 and my other applicable state stormwater requirements.
Signature:— Date:
a Notary Public for the State of Jvr+tCu YVlTYJ0' , County of
�,' a e, n 6 L) rot, do hereby certify that --- 1ALLL!Lazki,— IAJa -k 0 n personally appeared
V rA
before me this day of and ;a-:know�lledge e due execution of the application for
a storm%vater permit. Witness my hand and official seal, ZL
My commission expires J�'h L, '�' � 2e'g 5
Form SWIJ-101 Version Oct. 31, 2013 Page 6 of`6