SW3140903_Application Form_20210809 (3)

A VA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
November 25, 2014
Mr. John Feezor, Division President !q �
Traton Homes 'A !jV 6e,
10700 Sikes Place, #105 � /•, 40 8C
Charlotte, North Carolina 28277 Get DFC 0 g ��N S
Subject: Stormwater Permit No. SW3140903 44�o,%!
Oak Grove Estates in Union County �0 ►e
Dear Mr. Feezor:
The Division of Energy, Mineral, and Land Resources (DELMR), received a complete Stormwater
Management Permit Application for the subject project on September 19, 2014. Staff review of the
plans and specifications has determined that the project, as proposed, will comply with the
Stormwater Regulations set forth in Title 1SA NCAC 2H.1000 and Session Law 2006-246. We are
forwarding Permit No. SW3140903, dated November 25, 2014, for the construction, operation and
maintenance of the subject project. This permit shall be effective from the date of issuance and shall be
subject to the conditions and limitations as specified therein, and does not supersede any other agency
permit that may be required.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right
to request an adjudicatory hearing by filing a written petition with the Office of Administrative
Hearings (OAH). The written petition must conform to Chapter 150B of the North Carolina General
Statutes. Per NCGS 143-215(e) the petition must be filed with the OAH within thirty (30) days of
receipt of this permit. You should contact the OAH with all questions regarding the filing fee (if a filing
fee is required) and/or the details of the filing process at 6714 Mail Service Center, Raleigh, NC 27699-
6714, or via telephone at 919-431-3000, or visit their website at www.NCOAH.com. Unless such
demands are made this permit shall be final and binding.
This project will be kept on file at the Mooresville Regional Office. If you have any questions, or need
additional information concerning this matter, please contact Mike Randall at (919) 80776374; or
[e-mail].
Sincerely,
for Tracy E. Davis, PE, CPM, Director
cc: SW3140903 File, Mooresville Regional Office
ec: Danis Simmons, P.E., ESP Associates
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: http://portal.ncdenr.org/web/Ir/
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper

State Stormwater Permit
Permit No.SW3140903
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
In accordance with the provisions of Article 21 of Chapter 143, Gex'Oral Statutes of
North Carolina as amended, and other applicable Laws, Rules and�gplations
,, Uel,
PERMISSION IS HEREBY GRANTKD TC�
Traton Homes'ko''•,� F��
Oak Grove Estates
•r
4100 Waxhaw-Marvin Road in Waxhaw, Union Co
FOR THE
construction, operation and maintenance of a low density development in compliance
with the provisions of 15A NCAC 2H .1000 and S.L. 2006-246 (hereafter referred to as
the "stormwater rules') and the approved stormwater management plans and
specifications, and other supporting data as attached and on file with and approved by
the State and considered a part of this permit.
The Permit shall be effective from the date of issuance until rescinded and shall be
subject to the following specific conditions and limitations:
I. DESIGN STANDARDS
The overall tract built -upon area percentage for the project must be maintained
below 24%, as required by Session Law 2006-246 of the stormwater rules.
3. Approved plans and specifications for projects covered by this permit are
incorporated by reference and are enforceable parts of the permit.
4. The only runoff conveyance systems allowed will be vegetated conveyances
such as swales with minimum side slopes of 3:1 (H:V) as defined in the
stormwater rules and approved by the Division.
5. No piping is allowed except that minimum amount necessary to direct runoff
beneath an impervious surface such as a road or to provide access.
6. All roof drains must terminate at least 30 foot from the mean high water mark.
7. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent streams.
8. All swales shall that discharge into a wetland shall do so at a non -erosive velocity
for the 10 year storm.
9. Each builder and/or property owner must have plans for individual lots approved,
knowing and understanding the BUA limit and the prohibition against excessive
piping, how to size the driveway pipe, knowing where the buffer is on that lot,
knowing where the drainage easements are and the expectation to keep existing
swales open, and ensuring roof gutters and impervious surfaces are
disconnected to the maximum extent technically feasible.
Page 1 of 4

State Stormwater Permit
Permit No.SW3140903
II. SCHEDULE OF COMPLIANCE
1. The permittee is responsible for verifying that the proposed built -upon area does
not exceed the allowable built -upon area.
2. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
3. This project may not be sold or subdivided in whole or in part without first
receiving a permit modification.
4. The following deed restrictions must be recorded with the Office of the Register
of Deeds:
a. The following covenants are intended to ensure ongoing compliance with
State Stormwater Management Permit Number SW3140903.
b. The State of North Carolina is made a beneficiary of these covenants to
the extent necessary to maintain compliance with the Stormwater
Management Permit.
C. These covenants are to run with the land and be binding on all persons
and parties claiming under them.
d. The covenants pertaining to stormwater may not be altered or rescinded
without the express written consent of the State.
e. Alteration of the drainage as shown on the approved plans may not take
place without the concurrence of the State.
f. This project may not be sold or subdivided, in whole or in part, without first
receiving a permit modification from the Division.
h. Construction of additional impervious areas such that low -density
requirements are no longer met will require a permit modification prior to
construction. An engineered system will be required to collect and treat
the runoff from all built -upon area associated with the project, including
that area permitted under the low density option.
i. Filling in or piping of any vegetative conveyances (ditches, swales, etc.)
associated with this development, except for average driveway crossings,
is strictly prohibited by any persons.
j. The built -upon areas shall be located a minimum of 30 feet landward of all
perennial and intermittent surface waters.
5. A copy of the recorded restrictions must be received in this Office within 30 days
of the date of sale.
6. Filling in or piping of any vegetative conveyances (ditches, swales, etc.)
associated with the permitted development, except for average driveway
crossings, is strictly prohibited by any persons.
7. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to the approved plans, regardless of size.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area.
Page 2 of 4

State Stormwater Permit
Permit No.SW3140903
e. Further subdivision, acquisition, or sale of the project area in whole or in
part. The project area is defined, as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval was sought.
f. Filling in, altering or piping any vegetative conveyance shown on the
approved plan.
8. During construction, erosion shall be kept to a minimum and any eroded areas of
the swales or other vegetated conveyances will be repaired immediately.
9. The permittee shall at all times provide the operation and maintenance
necessary to operate the permitted stormwater management systems at
optimum efficiency to include:
a. Inspections.
b. Sediment removal.
c. Mowing, and re -vegetating of the side slopes.
d. Immediate repair of eroded areas.
e. Maintenance of side slopes in accordance with approved plans and
specifications.
10. Within 30 days of completion of the project, the permittee shall certify in writing
that the project has been constructed in accordance with the approved plans.
11. The permittee shall submit all information requested by the Director or his
representative within the time frame specified in the written information request.
III. GENERAL CONDITIONS
This permit is not transferable to any person or entity except after notice to and
approval by the Director. The Director may require modification or revocation and
re -issuance of the permit to change the name and incorporate such other
requirements as may be necessary. In the event of a name or ownership
change, a completed Name/Ownership Change form, signed by both parties,
must be submitted to the State accompanied by the supporting documentation
as listed on page 2 of the form. The approval of this request will be considered
on its merits, and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until the
Director approves a transfer of ownership. Neither the sale of the project nor the
transfer of common areas to a third party, such as a homeowner's association,
constitutes an approved transfer of the stormwater permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to an enforcement action in accordance with North
Carolina General Statutes 143-215.6A to 143-215.6C.
4. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules, and regulations contained in Session Law 2006-
246, Title 15A of the North Carolina Administrative Code, Subchapter 2H.1000;
and North Carolina General Statute 143-215.1 et. al.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by the State, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants permission to DENR Staff to enter the property during
Page 3 of 4

State Stormwater Permit
Permit No.SW3140903
normal business hours, for the purpose of inspecting all components of the
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance, or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the swales
must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state and federal), which have jurisdiction.
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
Permit issued this the 25t" day of November, 2014.
2
A�2�V
for Tracy E. Davis, P.E., CPM
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

rAND
e�IRE�F,97070ulnvces
R RECEIVED
atr. 0 420 - SEP 19 2014
�p 14 111N • 11IIn QUALITY
STOkMW TeR PCR1 411 7143
DWQ u TbNLY
Date Received Fee Paid Permit Numb
ZO/ O4- � 1 117 7 7 7 17 7 ) (-7 - -- % �]
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 h II - Post Construction
(select all that apply) ❑ 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 Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Oak Grove Estates
2. Location of Project (street address):
4100 Waxhaw-Marvin Road (SR 1301)
City: Waxhaw
County: Union
3. Directions to project (from nearest major intersection):
The site is located +/-1/2 mile north of the intersection of Waxhaw- Marvin Road (SR 1301) and
of Waxhaw Marvin Road; across from Quellin Drive.
Zip: 28173
Drive (SR 1305) on the west side
4. Latitude: 34'57'11.15" " N Longitude: 80°46'35'89" " W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): QNew ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-102 - Renewal Application Form
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 certification
2. Specify the type of p (thee one): P�%�-
❑■ Low Density ct h Dens' ❑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 DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, N/A and the previous name of the project, if different than currently
proposed, N/A
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: 19 ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 Permit: Proposed Impacts
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: -
5. Is the project located within 5 miles of a public airport? ONo ❑Yes
If yes, see S.L. 2012-200, Part VI: http://portal.ncdenr.or�,/web/wq/,As/su/statesva/rules laws
Form SWU-101 Version 06Aug2012
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:##### Traton Homes
Signing Official & Title: John Feezor, Division President
b. Contact information for person listed in item 1a above:
Street Address:10700 Sikes Place, #105
City: Charlotte
Mailing Address (if applicable): same as listed above.
City: -
State: NC Zip: 28277
State: -
Phone: (704 ) 246-8705 Fax:
[e-mail]
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:#####
Signing Official &
b. Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
City:_
State: Zip:
State:
Phone: ( ) Fax:
Email:
Zip:
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:#####
Signing Official & Title:
b. Contact information for person listed in item 3a above:
Mailing Address: -
City: State:
Phone: ( ) Fax:
Email:
4. Local Jurisdiction for building pe-r--nits:
Point of Contact: Phone #:
Form SWU-101 Version 06Aug2012 Page 2 of 6
Zip:

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater for this project is being drained and treated by two separate dry basins to allow for treatment and filtering. While the proposed project is considered low -density per the State Stormwater
Rules, the local jurisdiction has an Ordinance which requires the attenuation of the 2yr 24hr and 25yr 24hr storm events to pre -developed levels. In order to meet this requirement, two, dry detention
basins are being provided for the project site which have been designed to attenuate flows from the design storms while providing 1' of freeboard on the embankments for the 100yr 24hr emergency overflow.
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 Catawba
4. Total Property Area: 26.47 acres
River basin.
5. Total Coastal Wetlands Area: - acres
6. Total Surface Water Area: - acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+: 26.47 acres
+ Total project area shall be calculated to exclude the ollozving the normal pool o im ounded structures, the area
betzveen the banks of streams and rivers, the area belozv the Normal High Water (N" line or Mean High Water
(MITM line, and coastal wetlands landzvard from the NHW (or MHV� line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landzvard of the NHW (or MHM line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 16.41 %
9. How many drainage areas does the project have? 2 (For high density, count 1 for each proposed engineered
stornavater BMP. For lozv 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 A
Drainage Area B
Drainage Area _
Drainage Area
Receiving Stream Name
12 Mile Creek Trib. 5
12 Mile Creek Trib. 5
_
Stream Class *
C
C
Stream Index Number *
_
_
Total Drainage Area (sf)
273,992.4
360,241.2
On -site Drainage Area (sf)
273,992.4
360,241.2
Off -site Drainage Area (sf)
N/A
N/A
Proposed Impervious Area** s
76,210
87,113
% Impervious Area** total
27.81
24.18
Impervious— Surface Area
Drainage Area A
Draina e Area B
Drainage Area _
Draina e Area
On -site Buildings/Lots (so
36,260 SF (7 Lots)
59,570 SF (11.5 Lots)
_
On -site Streets (so
35,468
24,638
On -site Parking (sf)
-
_
On -site Sidewalks (sf)
4,482
2,905
Other on -site (so
-
_
Future (so
Off -site (so
N/A
N/A
Existing BUA*** (so
-
Total (sf):
76,210
87,113
T Stream Class and index Number can be determined at: http://pnrtal.nedertF .org zvebhvcl/ps/csu/classi�eatirnPs
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
si ezvalks, gravel areas, etc.
Form SWU-101 Version 06Aug2012 Page 3 of 6

'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.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Proiects in Union County: Contact DWQ Central Office staff to check if the project is located within 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 http:/ /portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from hqp://portal.ncdenr.org;/web/3yq/ws/su/statesw/forms docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map ath=://12ortal.ncden.r.org/web/wq/`­`ws/­­­su/```maps.)
Please indicate that the following required 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 htt2://j2ortal.ncdenr.org/web/wq/ws/su/statesw/forms docs.
Initials
1. Original and one copy 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 V1I below) /V
3. Original of the applicable Supplement Form(s) (sealed, 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 ML.
hi!p://www.envhtlg.org/12ages/onesto]2express.htrnl 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 —
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 1/2 mile of the site boundary, include the 1/2
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).
Form SWU-101 Version 06Aug2012 Page 4 of 6

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"xll" copy of the NRCS County Soils map with the A
project area clearly delineated. For projects with infiltration BMPs, the report should also A
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 DWQ to verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 6284 Page No: 209
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 1a, 2a, and/or 3a per 15A NCAC 2H.1003(e)
The corporation or LLC must be listed as an active corporation in good standing with the NC 014
Secretary of State, otherwise the application will be returned.
ht!g://www.secretarv.state.nc.us/Coi:2orations/`­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
hgp://portal.ncdenr.org/web/w>q/ws/su/statesw/forms docs. 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 DWQ 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 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: Danis Simmons, PE
Consulting Firm: ESP Associates, PA
Mailing Address: 3475 Lakemont Blvd
City: Fort Mill
Phone:( 803 1 802-2440
Email: [e-mail]
State: SC Zip: 29708
Fax: ( 803 ) 902-2515
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or hjpe name of person listed in Contact Information, item 2a) . certify that I
own the property identified in this permit application, and
listed in Contact Information, item la)
Contact Information, item 1a)
thus give permission to (print or hjpe name of person
with (print or type name of organization listed in
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 stormwater system.
Form SWU-101 Version 06Aug2012 Page 5 of 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 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ 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:
a Notary Public for the State of
do hereby certify that
before me this _ day of
Date:
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or hjpe name of person listed in Contact Information, item 1a) John Feezor
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 stor at rules nder 15 NCAC 2H .1000 and an other applicable state stormwater re uirements.
Signature: -`' Date:
Ia No Public for the State of AA �� c, rt h LO U0 I I OG County of
%�N M �6 �Iwil 1 s tart' iV
�6 W -61 , do hereby certify that RIB Yl R e Zb i personally appeared
before me this ay of e �e m k r' 2O1 L and acknowledge the due execution of the application for
a stormwater permit.. Witness my hand and official seal,
n, `
SEAL
�-/ 13 1 al WITNESS
My commission expires��
Fonn SWU-101 Version 06Aug2012 Page 6 of 6

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