SW8150508_CURRENT PERMIT_20150918 (2)

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW �6SDv�DR�
DOC TYPE
� CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
WYYMMDD

WNWA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
September 18, 2015
Adam G. Sosne, Member/Manager
Belle Meade Development Partners, LLC
6626-C Gordon Road
Wilmington, NC 28411
Subject: State Stormwater Management Permit No. SW8 150508
Belle Meade Mixed Use
High Density Wet Detention Pond Project
New Hanover County
Dear Mr. Sosne:
Donald van der Vaart
Secretary
The Wilmington Regional Office received a complete Stormwater Management Permit Application for
Belle Meade Mixed Use on September 18, 2015. 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 2008-211. We are forwarding Permit No. SW8 150508 dated
September 18, 2015, for the construction, operation and maintenance of the BMP's and built -upon
areas associated with the subject project.
This permit shall be effective from the date of issuance until October 5, 2020, and shall be subject to
the'conditions and limitations as'specified therein. - 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 changing 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 transfer 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, and
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.
If you have any questions, or need additional information concerning this matter, please contact Linda
Lewis in the Wilmington Regional Office, at [phone]. .
S nnc rely,
�. Tracy Davr,P. ., Director
Division of Energy, Mineral and Land Resources
GDS/arl: 111Stormwater\Permits & Projects120151150508 HD12015 09 permit 150508
cc: Garry Pape, P. E., GSP Consulting
New Hanover County Building Inspections
New Hanover County Engineering
Wilmington Regional Office Stormwater File
Division of Energy, Mineral, and Land Resources
Land Quality Section -Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405
(910) 796-72151 fax: [phone] • Internet: htt :11 ortal.ncdenr.or lwebArl

State Stormwater Management Systems
Permit No. SW8 150508
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
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
PERMISSION IS HEREBY GRANTED TO
Belle Meade Development Partners, LLC
Belle Meade Mixed Use
4703 Carolina Beach Road, Wilmington, New Hanover County
FOR THE
construction, operation and maintenance of one (1) wet detention pond in compliance with
the provisions of 15A NCAC 2H .1000 and Session Law 2008-211 (hereafter referred to as
the "stormwater rules') the approved stormwater management plans and specifications and
other supporting data as attached and on file with and approved by the Division and
considered a part of this permit.
This permit shall be effective from the date of issuance until October 5, 2020, and shall be
subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. The stormwater system was previously permitted as Pond #1 under SW8 050214.
That project was subdivided and the future development tract was sold to a new
owner including Pond #1. Per Section 2.(d)(5) of Session Law 2008-211, the proposed
project is a minor modification of an existing state stormwater permit which does not
increase the net amount of built -upon area and does not increase the size of the
previously permitted BMP. Therefore, the provisions of the 1995 stormwater
regulations under NCAC 02H.1000 apply to the pond design.
3. This stormwater system has been approved for the management of stormwater runoff
as described in Section 1.5 of this permit. The runoff from all built -upon area within the
permitted drainage area of this project must be directed into the permitted stormwater
control system(s). The stormwater control has been designed to handle the runoff
from a total of 566,013 square feet of impervious area, which includes 281,649 square
feet of onsite proposed BUA; 203,013 square feet of offsite BUA from SW8 0502141
and 81,351 square feet of future BUA.
4. The drainage area will be limited to the amount of built -upon -area indicated in
Sections 1.3 and 1.5 of this permit, and per approved plans.
Page 2 of 8

State Stormwater Management Systems
Permit No. SW8 150508
5. The following design criteria have been provided in the wet detention pond and must
be maintained at design condition:
a. Drainage Area, acres:
Onsite, ft2:
Offsite, ft2:
b. Total Impervious Surfaces, ft2:
Onsite, ft2:
Offsite, ft2:
c. Pond Design Depth, feet (1995 rule):
d. TSS removal efficiency:
e. Design Storm, inches (1995 rule):
f. Permanent Pool Elevation, FMSL:
g. Permitted Surface Area @PP, ft2-
h. Permitted Temporary Storage Volume, ft3:
i. Temporary Storage Elevation, FMSL:
j. Predevelopment 1 yr-24 hr. discharge rate, cfs
k. Controlling Orifice:
I. Average Orifice Flowrate, cfs
m. Permanent Pool Volume, ft3 :
n. Forebay Volume, ft3:
o. Maximum Fountain Horsepower:
p. Receiving Stream 1 River Basin:
q. Stream Index Number:
r. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
19.15
579,210
254,903
566,013
363,000
203,013
7.0
90%
1.0
12.0
31,390
57,290
13.7
nla
YO pipe
0.17
127,603
26,703
112
Barnards Creek 1 CPF17
18-80
Pic Sw"
1. No person or entity, including the permittee, shall alter any component of the approved
stormwater system shown on the approved plans unless and until the Division has
approved of the revised plan.
2. The stormwater management system shall be constructed in its entirety, vegetated
and operational for its intended use prior to the construction of any built -upon surface.
3. During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately.
4. If the stormwater system is used as an Erosion Control device, it must be restored to
design condition prior to operation as a stormwater treatment device, and prior to
occupancy of the facility
5. The facilities shall be constructed in accordance with the conditions of this permit, the
approved plans and specifications, and other supporting data on file with the Division
and considered an enforceable part of this permit.
6. The permittee shall at all times provide the operation and maintenance necessary to
assure that all components of the permitted stormwater system function at design
condition. The approved Operation and Maintenance Agreement is incorporated by
reference into this permit and must be followed in its entirety and maintenance must
occur at the scheduled intervals.
7. Records of maintenance activities must be kept and made available upon request to
authorized personnel of the Division. The records will indicate the date, activity, name
of person performing the work and what actions were taken.
Page 3 of 8

State Stormwater Management Systems
Permit No. SW8 150508
8. If the permanent pool volume is greater than 30,000 cubic feet, a decorative spray
fountain will be allowed in the stormwater treatment system, subject to the following
criteria:
a. The fountain must draw its water from less than 2' below the permanent pool
surface.
b. Separated units, where the.nozzle, pump and intake are connected by tubing,
may be used only if they draw water from the surface in the deepest part of the
pond.
c. The falling water from the fountain must be centered in the pond, away from the
shoreline.
d. The maximum horsepower for a fountain in this pond is 1/2 horsepower.
9. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and
prior to operation of this permitted facility, the permittee shall cause a certification from
an appropriate designer for the system installed to be submitted, certifying that the
permitted facility has been installed in accordance with this,permit, the approved plans
and specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A modification
may be required for those deviations.
10. All stormwater collection and treatment systems must be located in either public
rights -of -way, dedicated common areas or recorded easements. The final plats for the
project will be recorded showing all such rights -of -way, common areas and
easements, in accordance with the approved plans. Clear access to the stormwater
facilities for inspection and maintenance shall be maintained at all times.
11. 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 any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
C. Further development, subdivision, lease or sale of any, all or part of the project
area.
d. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
e. The construction of any future BUA listed on the application.
12. Prior to transfer of the permit, the stormwater facilities will be inspected by Division
personnel. The project and the stormwater facility must be in substantial compliance
with all permit conditions. Any items not in substantial compliance must be repaired,
replaced or restored to design condition prior to the transfer. Records of maintenance
activities performed to date will be required.
13. 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.
III. GENERAL CONDITIONS
Any individual or entity found to be in noncompliance with the provisions of a
stormwater management permit or the Stormwater rules is subject to enforcement
procedures as set forth in NCGS 143 Article 21.
Page 4 of 8

State Stormwater Management Systems
Permit No. SW8 150508
2. 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) having jurisdiction.
3. In the event that the facilities fail to perform satisfactorily the Permittee shall take
immediate corrective action, including those as may be required by this Division, such
as the construction of additional or replacement stormwater management systems.
Additional or replacement stormwater management systems shall receive a permit
from the Division prior to construction.
4. This permit is not transferable to any person or entity except after notice to and
approval by the Director. The permittee shall submit a completed and signed
Name/Ownership Change Form, accompanied by the supporting documentation as
listed on the form, to the Division at least 60 days prior to any one or more of the
following events:
a. An ownership change including the subdivision, sale or conveyance of the project
area in whole or in part;
b. The sale or conveyance of the common areas to a Homeowner's or Property
Owner's Association, subject to the requirements of Session Law 2011-256,
c. Bankruptcy;
d. Foreclosure;
e. Dissolution of the partnership or corporate entity;
f. A name change of the current permittee;
g. A name change of the project;
h. A mailing address change of the permittee;
5. The permittee is responsible for compliance with all permit conditions until such time
as the Division approves the transfer request. Neither the sale of the project, in whole
or in part, nor the conveyance of common area to a third party constitutes an
approved transfer of the stormwater permit.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until modified, revoked, terminated
or renewed. 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. Approved plans and specifications for this project are incorporated by reference and
are enforceable parts of the permit. The permittee shall maintain a copy of the permit,
O&M agreements, and the approved plans at all times.
9. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
10. 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 NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall submit a permit renewal application request at least 180 days prior
to the expiration date of this permit. The renewal request must include the appropriate
application, documentation and the processing fee.
Page 5 of 8

State Stormwater Management Systems
Permit No. SW8 150508
Permit issued this the 18t" day of September 2015.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
--- ,Uc� Ss?,
� Tr cy D s, P.E., ' c or
Division of nergy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 150508
Page 6 of 8

State Stormwater Management Systems
Permit No. SW8 150508
Belle Meade Mixed Use
Stormwater Permit No. SW8 150508
New Hanover County
Designer's Certification
I, , as a duly registered in the State
of North Carolina, having been authorized to observe (periodically/ weekly/ full time) the
construction of the project,
(Project)
for (Project Owner) hereby state that, to the best
of my abilities, due care and diligence was used in the observation of the project construction
such that the construction was observed to be built within substantial compliance and intent
of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specifications:
Signature
Registration Number
Date
SEAL
Page 7of8

State Stormwater Management Systems
Permit No. SW8 150508
Certification Requirements:
.1. The drainage area to the system contains approximately the permitted acreage.
2. The drainage area to the system contains no more than the permitted amount
of built -upon area.
3. All the built -upon area associated with the project is graded such that the runoff
drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-circuiting
of the system.
11. The permitted amounts of surface area and/or volume have been provided.
12. Required drawdown devices are correctly sized and located per the approved
plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf, and a
forebay.
15. The required system dimensions are provided per the approved plans.
16. All components of the stormwater BMP are located in either recorded common
areas, or recorded easements.
cc: NCDENR-DEMLR Wilmington Regional Office
New Hanover County Building Inspections
Page 8 of 8

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
5- (-ICO)'I- 4 S rf
505 34(,Po
1 5Gv I S050
Applicable Rules: ❑ Coastal SW —1995 ❑ Coastal SW — 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
11 ❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATIO . E90E J E
This form may be photocopied for use as an original
I. GENERAL INFORMATION JUL 2 4 2015
1. Project Name (subdivision, facility, or establishment name - should be consistent w' ��project name on Tans,
specifications, letters, operation and maintenance agreements, etc.):
Belle Meade Mixed -Use
2. Location of Project (street address):
4703 Carolina Beach Road
City:Wilmington County:New Hanover Zip:28412
3. Directions to project (from nearest major intersection):
Heading north on Carolina Beach Road, site „is approximately 1.5 mile on the right from the intersection of
Carolina Beach Road and S. College Road
4. Latitude:34009' 28" N Longitude:77° 54' 30" W of the main entrance to the project.
H. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ❑New ®Modification ❑ Renewal w/ Modifications
'Renetuals vyith modifications also requires SWU-102 — Renewal Application Forrn
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberSW8 050214 , its issue date (if known)May 5, 2014 , 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
If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application, list the stormwater project number,
if assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control: 10.93 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? ®No ❑Yes
If yes, see S.L . 2012-200, Part VI: http://12ortal.ncdenr.org/web/Irlrules-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 theproject):
Applicant/Organization: Belle Meade Development_ Partners, LLC
Signing Official & Title -.Adam Sosne - Member/Manager
b.Contact information for person listed in item 1a above:
Street Address:6626-C Gordon Road
City:Wilmin ton State:NC Zip:28411
Mailing Address (if applicable):
City: State: Zip:
Phone: (910 ) 799-3006 Fax: (910 } 799-6659
Email:[e-mail]
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 Addres
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) _ Fax: ( ) _
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project: ITC. E I V E N
Other Contact Person/Organiza
Signing Official & Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
Email:
4. Local jurisdiction for building permits: New Hanover
L
State: Zip:
Fax:
Point of Contact: Phone #: ( )
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.
The storm water for this project will be treated by an existing wet detention basin
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: SW8 050214 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 Barnards Creek River basin.
4. Total Property Area: 19.15 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) —Total Coastal Wetlands Area (5) —Total Surface Water Area (6) = Total Project Area':
19.15 acres
Total project area shalt be calculated to exclude thefollowing: the normal p001 of imppounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) tine may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 67.9 %U
9. How many drainage areas does the project have?l (For high density, count I for each proposed engineered
stormwater BMP. For low density and other projects, use I 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.
;Drama a Area 1
Draiiia e Area'
Draina` e `Area
Di aina "A: ea' Y
Receiving Stream Name
Barnards Creek
Stream Class *
18-80
Stream Index Number *
C; Sw
Total Drainage Area (sf)
834,113
On -site Drainage Area (sf)
579,210
Off -site Drainage Area (sf)
254,903
Proposed Impervious Area** (sf)
566,013
% Impervious Area** (total)
67.9
Im °ervious'":Surface`Area i .,`
Draiha e Area 1'
Draina "e Area _
Drama e.Area
Drama e'A"
On -site Buildings/Lots (so
105,800
On -site Streets (sf)
On -site Parking (sf)
147,227
On -site Sidewalks (sf)
28,622
Other on -site (so
CIM I 1
Future (sf)
81,351
Off -site (sf) (_'5&oyoSoZ!¢
203,013
Existing BUA*** (sf)
'
Total (sf):
566,013
* Stream Class and Index Number can be determined at: littp://portal.ncdenr.orghi)eb/zt?q[ps/csulclassifications
** 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 amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

11.. How was the off -site impervious area listed above determined? Provide documentation. From SW Permit
SW8 050214 90,000 sf from Lots, 12,402 sf from Streets, 4,813 sf from sidewalks and 95,798 sf Existing
Projects in Union Countv: 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 storrnwater requirements as per 1 SA 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://12ortal.ncdenr.brg/web/wq/ws/su/bmp-manua1.
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 checklists are available from
http://p_ortal.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://12ortal.ncdenr.org/web/wq/ws/su/statesw/forms does.
Init'
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
Farm. (if required as per Part V!I below)
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
htt12: //www.envhelp.org/12ages/onestol2exl2ress.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/management fo
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 1h
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. .. E E I VIE,
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control m ures
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated k JUL 2 4 2015
qualified person. Provide documentation of qualifications and identify the perso 'ho
made the determination on the plans. BY:
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 Oct. 31, 2013 Page 4 of 6

9. Copy of any applicable soils report with the associated SHWT elevations (Please identify t�4
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
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 far DEMLR to verify the SHWT prior
to submittal, [phone].) �_ /j
10. A copy of the most current property deed. Deed book: 5888 Page No: 1734 `��
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: Lwww.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:/jportal.ncdenr.orglweb/lr/state-
stormwater-forms does. 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:Garry S. Pape, P.E.
Consulting Firm: GSP Consulting, PLLC
Mailing Address:6626 Gordon Road, Unit C
City: Wilmington
Phone: (910 ] 442-7870
Email:gpape@gsp-consul_ting.com
State:NC Zip:28411
Fax: [phone] _
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.
JUL 2 4 20115
BY:
Form SWU-101 Version Oct. 31, 2013 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 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 $25,000 per day, pursuant to NCGS 143-215.6.
Signature:
I,
a Notary Public for the State of
do hereby certify that
before me this _ day of
Date:
County of
personally appeared
. and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item Ta) Adani Sosne
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions j
and protective c antj will be recorded, and that the proposed project complies with the requirements of the
applicable stor wi$t flies under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Signature: Date:
1 Va �r r �4 S .?4,J�r a Notary Public for the State of M o 604% [.�tn �inu� County of
Yew CJG„uvr do hereby certify that � ar- SOS �,� _� personally appeared
before me this �'ay of 7we 11' and acknowledge the du execution of the application for
a stormwater permit. Witness my hand and official seal,
��PQ;ptY 5 pgnfi
\,1pTARY
P=UBOC'' _
SEAL
My commission expires_ -1-' yr i � 3 t 202y
C E I V E
JUL 242015
EsY:
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6