SW3140101_CURRENT PERMIT_20140206

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO. SW ��DIDI
DOC TYPE f7y
C CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE�((o
YYYYMMDD

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy. Mineral, and Land Resources
Tracy E. Davis, PE, CPM
Director
February 6, 2014
Mr. Alfred Owens
Anderson Behavioral Health, Inc.
9635 Southern Pines Blvd., Suite 152
Charlotte, North Carolina 28273
Subject: Stormwater Permit No. SW3140101
Hasty Road Development, Union County
Dear Mr. Owens:
Pat Mc� ier�r( o't Eer�ori SECTIONI AND ES
John E. Skvarla, Al, Sec�refaFy.t.en
MAR 21 2014
DEl?lnnn",., vi ,.,r nrt.iiirdEN
�nriar!uu F1.ElIOUFlGESl
The Stormwater Program under the Division of Energy, Mineral, and Land Resources (DELMR),
received a complete .Storm_ water Management Permit Application for the subject project on January
16, 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 15A NCAC 2H.1000 and Session Law
2006-246. We are forwarding Permit No. SW3140101, dated February 6, 2014. 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 Larry Wade PE at (919) 8n7-6375; or
larry.wade a ncdencgov.
Sincerely,
jor Tracy E. Davis, PE, CPYi, Director
cc: SW3140101 File
Mooresville Regional Office
cc: Flehan Engineering, Inc.
i
i, Afl 1 7 2014
i.
d •:,F'ICE
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. SW3140101
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules and Regulations
DIVISION OF LAN, , ;tcauURCES
PERMISSION IS HEREBY GRANT ED TO LAND QUALITY SECTION
Anderson Behavioral Health
Hasty Road Development
Hasty Rd., Union County
FOR THE
MAR 21 2014
DEPAhIIjq,�Y v, ,uf',rAEN
r
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
1. 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 rof drains roust terminate at ;east 3C1 foot fton-! the !Wean 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.
It. SCHEDULE OF COMPLIANCE
The permittee is responsible for verifying that the proposed built -upon area does
not exceed the allowable built -upon area.
Page 1 of 4

State Stormwater Permit
Permit No.SW3140101
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.
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 SW3140101.
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 taker:.
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,
isstrictly 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.
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.
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.
Page 2 of 4

State Stormwater Permit
Permit No.SW3140101
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 riot 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.
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.
Failure to abide by the conditions and limitations contained in this permit may
subjeci the Permitiee to an enforcement action in accordance vMh worth
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-
G4", 1 i!le 15A �Jt "he Noi'I'i laiolina A.dmiriislrar�'ve i ;ociH, SO!b �ji l�jier 2H.1 00;
and North Caroina General Statute 143-215.1 et. al.
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
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
Page 3 of 4

State Stormwater Permit
Permit No. SW3140101
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 6" day of February, 2014.
Director Division of Energy, Mineral, and Land Resources
Page 4 of 4

Permit No.
State of North Carolina
(to be provided by DIhQ)
Department of Environment and Natural Resources r.
Division of Water Quality r se
zZ
STORMWATER MANAGEMENT PERMIT APPLICATION FORM 20
LOW DENSITY SUPPLEMENT`
This forni cony be photocopied for use as an original 9 ' o j rn ;
0n : t c_1
A low density project is one that meets the appropriate criteria for built upon area and transports stormw ter
runoff primarily through vegetated conveyances. Low density projects should not have a discrete stormwatel")
collection system as defined by 15A NCAC 2H .1002(18). Low density requirements and density factors can be
found in Session Law 2008-211, 15A NCAC 2H .1000. Session Law 2006-246, and the DWQ BMP Manual.
Curb and gutter systems are allowed provided they meet the requirements in 15A NCAC 2H .1008(g).
PROJECT INFORMATION
Project Name : Hasty Road Development
Contact Person: Cindy Flehan Phone Number: ( 704-904-1832 )
Number of Lots: Allowable Built Upon Area (BUA) Per Lot*: 171.297 SF
Number of Dwelling Units Per Acre**:
Low Density Development (check one): ® without curb & gutter ❑ with curb & gutter, outlets to (check one):
❑ Swales ❑ Vegetated Area
*If lot sizes are not uniform, attach a table indicating the number of lots, lot sizes and allowable built upon area for each lot.
The attachment must include the project name, phase, page numbers and provide area subtotals and totals. BUA shall he
shown in units of square feet.
**(Phase II Post -Construction (non -SA) only)
IL BUILT UPON AREA
Refer to DWQ`s forms and applications website for specific language that must be recorded in the deed
restrictions for all subdivided projects. (http://h2o.enr.state.nc.us/sLi/bmp_forms.htni)
Complete the following calculation in the space provided below where:
• SA Site Area - the total project area above Mean High Water.
• DF Density Factor - the appropriate percent built upon area divided by 100.
• RA Road Area - the total impervious surface occupied by roadways.
• OA Other Area - the total area of impervious surfaces such as clubhouses, tennis courts, sidewalks. etc.
• No. of Lots - the total number of lots in the subdivision.
• BUA per Lot - the computed allowable built upon area for each lot including driveways and impervious
surfaces located between the front lot line and the edge of pavement.
• Total allowable lot BUA - the computed allowable built upon area for all lots combined.
• Total BUA from lot listing - the sum of built upon area allocated for each lot on the list of non -uniform lots.
Form SW401-Low Density-Rev.3-2/10/09 Page I of 4

Calculation:
For uniform lot sizes:
(SA: ft2 x DF: ) - (RA: ft2) - (OA: ft2) = BUA per Lot = ft2
(No of Lots: )
For non -uniform lot sizes:
a. (SA: 1574694 ft2 x DF:.24) - (RA: 0 ft2) - (OA: 0 ft2) = Total allowable lot BUA = 377,927 ft2
b. Total BUA from lot listing: 200,307 sf. b must be < a
III. DESIGN INFORMATION
Complete the following table. If additional space is needed the information should be provided in the same
format as Table I and attached to this form. Rainfall intensity data can be found in Appendix 8.03 of the State
of North Carolina Erosion and Sediment Control Planning and Design Manual or at
http://hdsc.nws.noaa.gov/hdsc/pi'ds/
Table 1. Swale design information based on the 10-year storm.
Swale No.
Drainage
Area (ac)
Impervious
Area (ac)
Grassed
Area (ac)
C
Q
(cfs)
Slope
(0/u)
Vallow
(fps)
Vactual
(fps)
Flow
Depth (ft)
1
AA 1.13
0.50
4.10
5.0
3.65
0.61
2
BB 0.27
0.70
1.37
5.0
2.78
0.41
3
CC 0.34
1 0.85
2.10
10.0
4.00
0.42
4
DD 0.48
0.85
2.96
5.0
3.37
0.54
5
EE 1.21
0.50
4.39
5.0
3.71
0.63
6
FF 0.41
0.85
2.53
7.5
3.76
0.47
7
GG 0.94
0.85
5.80
3.5
3.48
0.75
8
HH 0.98
0.70
4.98
5.0
3.83
0.66
9
Il 0.20
1 0.70
1.02
2.5
1.99
0.42
10
JJ 0.35
0.70
1.78
2.5
2.28
0.51
11
KK 0.64
0.50
2.32
2.0
2.25
0.59
12
LL 1.76
0.50
6.39
1.5
2.60
0.91
13
MIA 0.19
0.50
0.69
1.0
1.28
0.42
14
NN 1.54
1 0.85
9.50
1 0.75
2.21
1.20
15
006.75
0.85
41.65
3.5
5.70
1.56
16
PP 2.39
0.70
12.15
2.0
3.40
1.09
17
18
19
20
Form SW401-Low Density-Rev3-2/10/09 Page 2 of 4

IV. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the North Carolina Administrative Code Section 15A
NCAC 2H .1000, NCDENR BMP Manual (2007), Session Law 2006-246, and Session Law 2008-211.
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An
incomplete submittal package will result in a request for additional information. This will delay final
review and approval of the project. Initial in the space provided to indicate that the following requirements
have been met and supporting documentation is provided as necessary. If the applicant has designated an agent
on the Stormwater Management Permit Application Form, the agent may initial below. If any item is not met,
then iustifieation must be attached. Only complete items to through p for projects with curb outlets.
Page/Plan
Initials Sheet No.
N/A a. t For projects in the 20 coastal counties: Per NCAC 21-1.1005, a 50 foot wide vegetative buffer
is provided adjacent to surface waters. For Redevelopment projects, a 30' wide vegetative
buffer adjacent surface waters is provided.
N/A b..t For HQW or ORW projects outside the 20 coastal counties: A 30 foot wide vegetative buffer
is provided adjacent to surface waters.
6W X C. t For Phase 11 Post -Construction projects: All built upon area is located at least 30 feet
landward of all perennial and intermittent surface waters.
N/A d. Deed restriction language as required on form SWU-101 shall be recorded as a restrictive
covenant. A copy of the recorded document shall be provided to DWQ within 30 days of
platting and prior to the sale of any lots.
LAf Cl e. Built upon area calculations are provided for the overall project and all lots.
6Af X f. Project conforms to low density requirements within the ORW AEC. (if applicable per
15A NCAC 2H .1007)
C4 g. Side slopes of swales are no steeper than 3:1; or no steeper than 5:1 for curb outlet swales.
C4 It. Longitudinal slope of swales is no greater than 5%; for non -curb outlet projects, calculations
for shear stress and velocity are provided if slope is greater than 5%.
C4 i. At a minimum, swales are designed to carry the 10 year storm velocity at a non -erosive rate.
N/A j. Swales discharging to wetlands are designed to flow into and through the wetlands at a non -
erosive velocity (for this flow requirement into wetlands, non -erosive is velocity < 2 ft/s).
C4 k. Swale detail and permanent vegetation is specified on the plans.
6kr C4/C14 1. Swale detail provided on plans; includes grass type(s) for permanent vegetative cover.
6PO C7/C8 m. Swales are located in recorded drainage easements.
N/A n.tt Length of swale or vegetated area is at least 100 feet for each curb outlet.
CPX C14A o.tt The system takes into account the run-off at ultimate built -out potential from all surfaces
draining to the system (delineate drainage area for each swale).
N/A p.tt Curb outlets direct flow to a swale or vegetated area.
t Projects in the Neuse, Tar -Pamlico, Catawba River basins, and Randleman Lake may require additional buffers.
tt Only complete these items for projects with curb outlets.
Form SW401-Low Density-Rev.3-2/10/09 Page 3 of 4

V. SWALE SYSTEM MAINTENANCE REQUIREMENTS
Mowing will be accomplished as needed according to the season. Grass height will not exceed six inches
at any time; and grass will not be mowed too close to the ground or "scalped".
2. Swales will be inspected monthly or after every runoff producing rainfall event for sediment build-up,
erosion, and trash accumulation.
3. Accumulated sediment and trash will be removed as necessary. Swales will be reseeded or sodded
following sediment removal.
4. Eroded areas of the swales will be repaired and reseeded. Swales will be revegetated as needed and in a
timely manner based on the monthly inspections. Side slopes must be maintained at the permitted slope.
Catch basins, curb cuts, velocity reduction devices, and piping will be inspected monthly or after every
significant runoff producing rainfall event. Trash and debris will be cleared away from grates, curb cuts,
velocity reduction devices and piping.
Swales will not be altered, piped, or filled in without approval from NCDENR Division of Water Quality.
l acknowledge and agree by my signature below that 1 am responsible for the performance of the six
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior to any
changes to the system or responsible party.
Print Name and Title: Alfred Owens, CEO
Address: 9635 Southern Pines Blvd
Phone: 704-907,3,162 Date:
Note: The legally responsible part), should not be a homeowners association unless more than? 50% of the lots here been sold and a
resident of the subdivision has been named the president.
I. //4[cc," 19 1,, ., 5 , a Notary Public for the State of tj L , County of
Q-1 g ;a.v , do hereby certify that /jt. F?ZOw &.rj personally appeared before me this
day of 3 AoAz4 Z e (c( , and acknowledge the due execution of the forgoing swale maintenance requirements.
Witness my hand and>ofliciai seal,
ry signature
PHILI,IR D pMMOIdS 11
NOTARY PUBLIC
GASTON COUNTY
NORTH CAROLINA
MY COMMISSION EXPIRES MAY 31, 2018
My commission expires_eM4_( I ) l L
Form SW401-1.ow Density- Rev.3-2/10/09 Page 4 of 4

A*
�7*_
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor " Secretary
April 16, 2014 MID o QUAL17-y tc;OURCES
OA
Mr. Alfred Owens APR2
Anderson Behavioral Health, Inc. 1 ?oi4
9635 Southern Pines B, Su
Charlotte, North Caro Ina 2 273e 152 �TORAL RESOIjQ.!V r
Subject: Stormwater Permit No. SW3140101 — Minor Revision
Hasty Road Development - Marshville
Low Density Permit
Union County
Dear Mr. Owens:
The Stormwater Permitting Unit received a complete minor revision package to the existing
Stormwater Management Permit for Hasty Road Development on April 10, 2014. Staff review of
the plans and specifications has determined that this minor revision, as proposed, will comply with
the Stormwater Regulations set forth in Title 15A NCAC 2H.1000 and Session Law 2006-246. We
are forwarding approval of this minor revision dated April 16, 2014, to Permit No. SW3140101
(issued February 6, 2014), for the construction of the subject project and the stormwater BMPs.
This permit expiration date shall not change and shall be effective from the original date of issuance
until February 6, 2022 and shall be subject to the conditions and limitations as specified therein, and
does not supersede any other agency permit that may be required. Please pay special attention to the
conditions listed in this permit regarding the Operation and Maintenance of the BMP(s), recordation
of deed restrictions, procedures for changes of ownership, transferring the permit, and renewing the
permit. Failure to establish an adequate system for operation and maintenance of the stormwater
management system, to record deed restrictions, to follow the procedures for transfer of the permit,
or to renew the permit, will result in future compliance problems.
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.
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

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 Larry Wade at [phone];
or [e-mail].
ncdenr.gov.
Sincerely,
William H. Diuguid, AICP, Plans Reviewer
for Tracy E. Davis, PE, Director
Division of Energy, Mineral and Land Resources
By Authority of the NC Environmental Management Commission
cc: SW3140101 File
cc: NCDENR DEMLR, Mooresville Regional Office,

Walz-
DWQ USE ONLY
Date Received
Fee Paid
Permit Number
1 I!r
1 350-S$
1y610 t
Applicable Rules:
(select all that apply)
❑ Coastal SW -1995 ❑ Coastal SW
❑ Non -Coastal SW- HQW/ORW Waters
❑ Other WQ M mt Plan:
- 2008 ❑ Ph II - Post Construction
❑ Universal Storm water Management 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
L 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.):
Hasty Road Development
2. Location of Project (street address):
City:Marshville County:Union Zip:
3. Directions to project (from nearest major intersection):
US 74 to White Street, south on White Street and travel 0.5 miles Turn left(east) onto Hasty Road Travel
I mile. Site is on north side of Hasty Road
4. Latitude:34* 58' 40.19" N Longitude: -800 20' 29.90" W of the main entrance to the project.
IL PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
1Renezoals with nmdifications also requires SWU-702 - Renewal Application Fora
b.lf 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 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 DWQ
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
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 19 ac of Disturbed Area
❑404/401 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 permitSedimentation/Erosion Control
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part Vl: http://portal.ncclenr.orghveb/wq/ws/su/Statesw/rules laws
Form SWU-101 Version 06Aug2012 Page I of

Ill. 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 project):
Applicant/Organization: Anderson Behavioral Health
Signing Official & Title: Alfred Owens
b.Contact information for person listed in item la above:
Street Address:9635 Southern Pines Boulevard, Suite 152
City: Charlotte State: NC Zip: 28273
Mailing Address (if applicable): SAME
City:
Phone: (704 ) 907-3162
Email:
State: Zip:
Fax: (704 ) 749-3482
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 & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City: State:
Mailing Address (if applicable):
City: State:
Phone: ( ) Fax:
Email:
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: Charles Cooley, Anderson Health Services, Inc.
Signing Official & Title: Alfred Owens - President/CEO
b.Contact information for person listed in item 3a above:
Mailing Address:9635 Southern Pines 131vd
City:Charlotte State: NC Zip: 28273
Phone: (704 ) 900-9585 Fax: [phone]
Email: [e-mail]
Form SWU-101 Version 06Aug2012 Page 2 of 7

4. Local jurisdiction for building permits:
Point of Contact: Terry Griffin Phone #: (704 ) 283-3816
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be treated in roadside ditches and cross pipes. There will be no curb and gutter along
driveway and less than 24% of site will be developed.
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 Il - Post Construction
3. Stormwater runoff from this project drains to the Yadkin Pee -Dee River basin.
4. Total Property Area: 36.15 acres 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`:36.15 acres
Total project area shall be calculated to exclude thefollowing: the normal pool of impounded structures, tine area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Meat High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant t roject area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) title may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =10.88 %
9. How many drainage areas does the project have?] (For high density, count 1 for each proposed engineered
storuneoater 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.
Form SWU-101 Version 06Aug2012 Page 3 of 7

Basin Information
Draina e Area 1
Draina e Area
Draina e Area _
Draina e Area _
Receiving Stream Name
Yadkin/PeeDee
Stream Class *
C
Stream Index Number *
Total Drainage Area (so
(3,195347)
On -site Drainage Area (so
1,574,694
Off -site Drainage Area (sf)
(1,597,653)
Proposed Impervious Area** (so
171,297
Impervious Area** total
10.88
Impervious— Surface Area
Drainage Area -
Drainage Area
Drainage Area
Drainage Area _
On -site Buildings/Lots (so
34,719
On -site Streets (sf)
47,563
On -site Parking (so
40,122
On -site Sidewalks (so
14099
Other on -site (so
10,080
Future (so
24,714
Off -site (so
(1,118,357)
Existing BUA*** (so
0
Total (sf):
171,297
Stream Class and Index Number can be determined at: her//trgrtaLncdenr.or4/eoeh/u /ps/csu/classifr'cntinns
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Report only that annount 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 nezo BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. GIS topo. Autocad
file. Assumed C=0.85 for 70% developed on off -site future development in storm/swale calculations
Projects in Union County: Contact DWQ Central OJ)'tce stajfto check ifthe project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stornnvater 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 littp://r)ortal.ncdeor.ore/hveb/wci/ws/su/bap-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 http://LiortaLncdenr.ore/web/wq/ws/su/stitesw/forms does. 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 at http://portal.ncdenr.or,/web/wg/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 http://portal.ncdenr,org/web/wq/ws/su/statesw/forms does.
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 CovenantsQ
Form. (if required as per Part VII belozo)
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
http://www.envhelp.org/pages/oiiestopexpress.htniI 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.)
Form SWU-101 Version 06Aug2012 Pa*e 4 of 7

V III. 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:Cynthia A. Flehan
Consulting Firm: Flehan Engineering, Inc.
Mailing Address:5408 Guildbrook Road
City:Charlotte State:NC Zip:28226
Phone: (704 ) 364-3842
EniaiLcind [e-mail]
Fax: (704 ) 364-3843
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or type name of person listed in Contact Information, item 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item 1a) with (print or type name of organization listed in
Contact 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 stormwater system.
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 , County of
do hereby certify that
personally appeared
before me this _ day of and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
1W14
My commission
Form SWU-101 Version 06Auo?012 Page 6 of

X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Information, item 1a) Alfred Owens
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 storm r es under 15A NCAC 2H .1000 and any other applicable state stor/mwateer requirements.
re: SignatuDate: i� / 6 — /7
I, a Notary P +blic for the State of �t%� County of
/ do hereby certify that ®nS personally appeared
before me this Sday of �1) c;and acknow e execution of the application for
a stormwater permit. Witness my hand and official seal, ,
0TAI
;z
C' d
My commission expires
Form SWU-101 Version 06Aug2012 Page 7 of 7