SW4170501- The Arbors at Meadowlark

• DEMLR USE ONLY , '
Date Received ee Paid Permit Number
l 17050/
.5'102- =-
Applicable Rules: ❑ Coastal SW-1995 ❑ oastal SW-2008 ❑Ph II-Post Construction
(select all that apply) ❑Non-Coastal SW-HQW/ORW Waters ❑Universal Stormwater Management Plan
0 Other WQ Mgmt Plan:
State of North Carolina et.
Department of Environment and Natural Resources
Division of Energy,Mineral and Land Resources 137-
e��
STORMWATER MANAGEMENT PERMIT APPLICATION FORM(''
This form may be photocopied for use as an original /e`
I. GENERAL INFORMATION �u�-°
1. Project Name(subdivision,facility,or establishment name-should be consistent with project name on plans,
specifications,letters,operation and maintenance agreements,etc.):
The Arbors at Meadowlark
2. Location of Project(street address):
1200 Meadowlark Drive
City: Winston-Salem County: Forsyth Zip: 27106
3. Directions to project(from nearest major intersection):
New subdivision entrance will be located on west side of Meadowlark Drive approximately 0.1 miles south of
intersection with Robinhood Road.
el)*
4. Latitude: 36°7'4.16" N P Longitude: 80°22' 0.24" W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is (check one) New [Modification ❑Renewal w/ Modificationt
tRenewals with modifications also requires SVVU-102-Renewal Application Forth
b.If this application is being submitted as the result of a modification to an existing permit,list the existing
permit number N/A ,its issue date(if known) N/A ,and the status of
construction: [Not Started [Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project(check one):
-ZLow 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, 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: 10.9 ac of Disturbed Area
[NPDES Industrial Stormwater ❑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 permit:
5. Is the project located within 5 miles of a public airport? No I 'Yes
If yes,see S L 2012-200,Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations
Form SWU-101 Version Oct 31,2013 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: Meadowlark Developers,LLC
Signing Official&Title- Ronald C.Davis-Manager
b.Contact information for person listed m item la above:
Street Address: 380-H Knollwood Street,#253
City: Winston-Salem State: NC Zip: 27103
Mailing Address (if applicable): 380-H Knollwood Street,#253
City: Winston-Salem State: NC Zip: 27103
Phone: ( 336 ) 462-0705 Fax: (
Email: [e-mail]
c.Please check the appropriate box.The applicant listed above is:
®The property owner(Skip to Contact Information,item 3a)
n Lessee* (Attach a copy of the lease agreement and complete Contact Information,item 2a and 2b below)
T 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: Zip-
Mailing Address (if applicable):
City: State Zip:
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:
Signing Official&Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
4. Local jurisdiction for building permits:Winston-Salem and Forsyth County-Inspections Division of the
Planning and Development Services Department
Point of Contact: Phone#: (336 ) 748-3097
Form SWU-101 Version Oct.31,2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
Stormwater runoff from the low density project will be conveyed via overland flow/ dipersed flow through
vegetated areas;curb&gutter outlets to vegetated conveyances.Minimal non-vegetated conveyances will be
used to pipe below roads and for erosion control.Treatment via SCM is not required for 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:
n 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: 23.27 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: 0.03 acres
7. Total Property Area(4)-Total Coastal Wetlands Area(5)-Total Surface Water Area(6)=Total Project
Area+: 23.24 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(NHVV) line or Mean High Water
(MHW) line,and coastal wetlands landward from the NHW(or MHVV)line. The resultant project area is used to
calculate overall percent built upon area(BUA). Non-coastal wetlands landward of the NHW(or MHVV)line may
be included in the total project area. T e^f,'I(y _
8. Project percer-e€-impervious-area-E-etal Intpei ieus—rea-/-Total Projeet 'ca)X 109--1.98 UNITS/AC
9. How many drainage areas does the project have? 1 (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 Tomahawk
Creek
Stream Class * C
Stream Index Number* 12-94-9-1 -
Total Drainage Area(sf) 1,320,332
On-site Drainage Area(sf) 1,013,524
Off-site Drainage Area(sf) 306,808
Proposed Impervious Area**(sf) N/A
Impervious Area**(total) N/A
1.98 Units/AC Low l'eA5,71y
Impervious" Surface Area Drainage Area_ Drainage Area_ Drainage Area_ Drainage Area_
On-site Buildings/Lots(sf) N/A
On-site Streets (sf) 87,859
On-site Parking (sf) 0
On-site Sidewalks (sf) 13,197
Other on-site (sf) 0
Future(sf) N/A
Off-site (sf) 20,831
Existing BUA***(sf) 0
Total (sf): N/A 1.91 044000 Log D-eAay
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
** bnpenvious area is defined as the built upon area including,but not limited to, buildings,roads,parking areas,
sidewalks,gravel areas,etc.
Form SWU-101 Version Oct.31,2013 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.Survey,aerial
imagery,and field observation.
Protects in Union County:Contact DEMLR 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 Energy,Mineral and
Land Resources(DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checldists are available from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs. 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 http://portal.ncdenr.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 http://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs.
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 VII below)
3. Original of the applicable Supplement Form(s) (sealed,signed and dated)and--®&M
°-agreem f eh-B Y Na aid prlviceo(a 744 ;5 a tutu 2)4.4 pr*SEc
4. Permit application processing fee of$505 payable to NCDENR. (For an Express review,refer to
http://www.envhelp.org/pages/onestopexpress.html 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/managementfor ' r .
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 lh mile of the site boundary,include the 1
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.
Form SWU-101 Version Oct.31,2013 Page 4 of 6

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).No amp pro amyl. Ad- pup 0c5 51.4W 7 kg,
9. Copy of any applicable soils reportwith-th asseeiate —F-elevations(Please=identify-
-ele ians-in=acklition-ta=€Iepth+as=wel-as-a tap-of ►ed3o3ing loeations with-the-exisE g-
e▪ Rens nd-toting--logs:Include an 8.5"x11"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 verify the SHINT prior
to submittal, [phone].)
10. A copy of the most current property deed.Deed book: 3340 Page No: 375
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 la,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
Secretary of State,otherwise the application will be returned.
http://www.secretary.state.nc.us/Corporations/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 http://portal.ncdenr.org/web/Ir/state-stormwater-
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 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 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: K.Brent Gatlin,P.E.,LEED AP
Consulting Firm: Stimmel Associates,P.A.
Mailing Address: 601 N.Trade Street,Suite 200
City: Winston-Salem State: NC Zip: 27101
Phone: ( 336 ) 723-1067 Fax: (
Email: [e-mail]
IX. PROPERTY OWNER AUTHORIZATION(if Contact Information,item 2 has been filled out, complete this
section)
I,(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.
Form SWU-101 Version Oct.31,2013 Page 5 of 6

, r
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 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: 1�. ,r.-1„ j/ (Date: S'S '�U 1'-)
I, J(A PI r ki Q ,a Notary Public for the State of /Y dr'%R ect roll(10. ,County of
FO r5 y ,'hereby certify that a nal d C• )0,,'/1 s personally appeared
before me this , day of A A y , 25 r? ,and a wledge the due execution of the application for
a stormwater permit Witness my hand and official seal, r /2
SEAL
JUDY FINKLE
NOTARY PUBLIC
FORSYTH COUNTY,NC
My Commission Expires
My commission expires d y- /- a)Z.
X. APPLICANT'S CERTIFICATION
I,(print or type name of person listed in Contact Information,item la) Ronald C.Davis ,
certify that the information induded 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 stormwater rules under 15A NCAC 2H.1000 and any other applicable state stormwater requirements.
Signature: R D msf Date: `S ,oaOt' )
I, i " ,-,-‘0 Q. ,a Notary Public for the State of u0 AIN ect,t-ot.no k.,County of
fOr yi-k ,do hereby certify that Rd'no`« C- 0,0\4 i S personally appeared
before me this k day of / , 20 1r- ,and a owledge the due
/execution of the application for
Lk t vee
a stormwater permit. Witness my hand and official seal, t
SEAL
JUDY FINKLE
NOTARY PUBLIC
FORSYTH COUNTY,NC
hey Commission Exnires y-Z/-Z/
`..... My commission expires D t(- 2/ - 20 Z (
Form SWU-101 Version Oct.31,2013 Page 6 of 6

Permit No.
(to be provided by DEMLR)
State of North Carolina
Department of Environment and Natural Resources
Division of Energy,Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
LOW DENSITY SUPPLEMENT
This form may be photocopied for use as an original
A low density project is one that meets the appropriate criteria for built upon area and transports stormwater
runoff primarily through vegetated conveyances. Low density projects should not have a discrete stormwater
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 211 .1000, Session Law 2006-246 and the State of North Carolina
Stormwater Best Management Practice Manual. Curb and gutter systems are allowed provided they meet the
requirements in 15A NCAC 211 .1008(g).
I. PROJECT INFORMATION
Project Name : The Arbors at Meadowlark
Contact Person: Ronald C. Davis Phone Number: ( 336 )462-0705
Number of Lots:46 Allowable Built Upon Area(BUA) Per Lot*: N/A
Number of Dwelling Units Per Acre**: 1.98
Low Density Development(check one): n without curb &gutter ® with curb & gutter, outlets to (check one):
® Swales n 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 be
shown in units of square feet.
**(phase II Post-Construction [non-SAI only)
II. BUILT UPON AREA
Refer to DEMLR's forms and applications website for specific language that must be recorded in the deed
restrictions for all subdivided projects. (http://ponal.ncdenr.org/web/lr/state-stormwater-forms does)
Complete the following calculation in the space provided below where:
o SA Site Area-the total project area above Mean High Water.
o DF Density Factor-the appropriate percent built upon area divided by 100.
o RA Road Area-the total impervious surface occupied by roadways.
o OA Other Area-the total area of impervious surfaces such as clubhouses,tennis courts, sidewalks, etc.
o 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.
o Total allowable lot BUA-the computed allowable built upon area for all lots combined.
o 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 1 of 4

Calculation:
For uniform lot sizes:
(SA: ft2 x DF: )—(RA: ft2)—(OA: ft2) =BUA per Lot= N/A ft2
(No of Lots: )
For non-uniform lot sizes:
a. (SA: ft2 x DF: )—(RA: ft2)—(OA: ft2)=Total allowable lot BUA= N/A ft2
b. Total BUA from lot listing: N/A 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 1 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/pfds/
Table 1. Swale design information based on the 10-year storm.
Swale No. Drainage 'ImperviousGrassed C Q' Slope Vallow Vactual Flow
Area.(ac)] _Area-(ac) Area(ac) (cfs) .(%o) _ (fps) (fps) Depth(ft)
1 Attached
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Form SW401-Low Density-Rev.3-2/10/09 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 justification must be attached. Only complete items n through p for projects with curb outlets.
Page/Plan
Initials Sheet No.
N/A N/A a.t For projects in the 20 coastal counties: Per NCAC 2H.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 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.
2 0C-3.3 c.t For Phase II Post-Construction projects:All built upon area is located at least 30 feet
landward of all perennial and intermittent surface waters.
�()___Encl. 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.
N/A N/A e. Built upon area calculations are provided for the overall project and all lots.
N/A N/A f. Project conforms to low density requirements within the ORW AEC. (if applicable per
15A NCAC 2H .1007) 5 1 reQui re4 A* rc move& k tidy raley
se
2C) C-3.3 g. Side slopes of swales are no steeper than 3:1; ae-steeper=than l-f e-u aut t-swl -
Attached C-3.3 h. 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%.
2 u- Calcs. i. At a minimum, swales are designed to carry the 10 year storm velocity at a non-erosive rate.
N/A _. 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).
2.O— C-6.8 k. Swale detail and permanent vegetation is specified on the plans.
`- C-6.8 I. Swale detail provided on plans; includes grass type(s) for permanent vegetative cover.
Z)----'C-3.3 m. Swales are located in recorded drainage easements.
p-C-3.3 n.tt Length of swale or vegetated area is at least 100 feet for each curb outlet.
EX-1.0 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).
Z9/d-3.3 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
1. 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.
5. 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.
6. Swales will not be altered,piped, or filled in without approval from NCDENR Division of Energy,Mineral
and Land Resources.
I acknowledge and agree by my signature below that I am responsible for the performance of the six
maintenance procedures listed above. I agree to notify DEMLR of any problems with the system or prior to any
changes to the system or responsible party.
Print Name and Title: Ronald C. Davis -Manager
Address: 308-H Knollwood Street, #253, Winston-Salem,NC 27103
Phone: [phone] Date: 6 :c.aoy-1
Signature: ► D rv,sr
Note: The I all responsible party should not be a homeowners association unless more than 50%of the lots have been sold and a
reside of the subdivision has been named the president.
I, Ju ck\-F.01.U-1? ,aN�otary Public for the State of)1d r1-L.Ca Rt I I(16..._,County of
for ‘It-� c
,do hereby certify that NCJfIO,Ici C. VIS personally appeared before me this _
day of/Ail�/S '- , 20 l 7 ,and acknowledge the due execution of the forgoing swale maintenance requirements.
Witness my hand and official seal,
11' 7 ?
/144-
Not ry signature
JUDY FINKLE
NOTARY PUBLIC
FORSYTH COUNTY, C
My Commission Expires y/zl 2021
SEAL My commission expires 0 y-2/-- 26 2
Form SW401-Low Density-Rev.3-2/10/09 Page 4 of 4

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Justifications related to Low Density Supplement Section IV:
g. All swales are designed with 3:1 side slopes in accordance with the new rules. Supporting calculations
have been provided to demonstrate stability of swales.Temporary or Permanent erosion control
matting is provided where necessary for stabilization of swales and to promote growth of grass within
swales.The requirement for 5:1 side slopes at curb outlet swales has been removed from the new rules
made effective on 1/1/2017. See 15A NCAC 02H .1003 (2). Per discussions with Mike Randall and
Annette Lucas of NCDEQ,the application form will be updated in the future to reflect these new rules
(update application form not available at time of this submission).
h.The site was designed to limit the amount of disturbance and to maintain existing grades,trees and
vegetation where possible (no mass grading). Existing grades exceed 5%, therefore grades of some
swales exceed 5%due to physical constraints. Supporting calculations have been provided to
demonstrate stability of swales.Temporary or Permanent erosion control matting is provided where
necessary for stabilization of swales and to promote growth of grass within swales.

Low Density Residential Subdivisions with Curb Outlet Swales
Deed Restrictions & Protective Covenances
In accordance with Title 15 NCAC 2H.1000 and S.L. 2006-246, the Stormwater Management Regulations,
deed restrictions and protective covenants are required for Low Density Residential Subdivisions with curb
outlet swales, where lots will be subdivided and sold. Deed restrictions and protective covenants are
necessary to ensure that the development maintains a"built-upon"area consistent with the applicable
regulation governing the density level.
I, Roro?d c C5aUs acknowledge and affirm by my signs sure below, that I will cause the
following deed restrictions and protective covenants to be recorded for geces r t3ortk c.,Ic prior
to the sale of any lot:
1. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number , as issued by the Division of Energy, Mineral and Land
Resources under the Stormwater Management Regulations.
2. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to
maintain compliance with the stormwater management permit.
3. These covenants are to run with the land and be binding on all persons and parties claiming under
them.
4. The covenants pertaining to stormwater may not be altered or rescinded without the express written
consent of the State of North Carolina, Division of Energy, Mineral and Land Resources.
5. Alteration of the drainage as shown on the approved plan may not take place without the concurrence
of the Division of Energy, Mineral and Land Resources.
6. The maximum number of dwelling units for the 23.27 acre development is 46 dwelling units(less than 2
dwelling units per acre).
7. This project proposes a curb outlet system. Each designated curb outlet swale shown on the approved
plan must be maintained at a minimum of 100'long (unless shown otherwise on approved plan) with
3:1 (H:V)side slopes or flatter, have a longitudinal slope no steeper than 5% (unless shown otherwise
on approved plan), carry the flow from a 10 year storm in a non-erosive manner, and maintain a dense
vegetated cover.
8. Filling in or piping of any vegetative conveyances(ditches, swales, etc.) associated with the
development except for average driveway crossings, is strictly prohibited by any persons.
9. Each lot will maintain a 30*foot wide vegetated buffer between all impervious areas and surface
waters.
10. All roof drains shall terminate at least 30*foot from the mean high water mark of surface waters.
11. Filling in, piping or altering any designated 3:1 curb outlet swale associated with the development is
prohibited by any persons.
*50 foot for projects located in the 20 coastal counties.
Form DRPC-6 Rev2 05Nov2009
Revised 5/3/17 Page 1 of 2

Low Density Residential Subdivisions with Curb Outlet Swales
Deed Restrictions & Protective Covenances
Signature: 1� _ f.,‘ �r Date: S-s-c v
I, �uott'�Ere_
bp.,›,.‹ , a Notary Public in the
�k �
State of p r re,c :Ra ,+County of t-61 ,►\ ,
do hereby certify that �Un a` C. U
C. at I S personally appeared
0-1
before me this the ,D day of MAI , 20 I'r-7 , and acknowledge
the due execution of the foregoing instrument.Witness my hand and official seal,
1-/Ale
SEAL
iibt 41
Signature JUDY FINKLE
NOTARY PUBLIC
My Commission expires — �Z— z
(� / FORSYTH COUNTY,NC
My Commission Expires 11-2/- Z/
i
Form DRPC-6 Rev2 05Nov2009
Revised 5/3/17 Page 2 of 2