SWA000178_Application Form_20221217

3. The Applicant is the (check all that apply):
X❑ Property Owner
❑ Lessee (Attach a copy of the lease agreement & complete Item 4.)
❑ Purchaser (Attach a copy of the pending sales agreement & complete Item 4.)
❑ Developer (Attach a copy of the development agreement & complete Item 4.)
4. If the Applicant is NOT the Property Owner (skip to Item 5 if the Applicant IS the Property Owner):
Property Owner Name/Organization:
Signing Official & Title:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
5. The licensed Design Professional that will be retained for the duration of the project, who may provide
information on the Applicant's behalf, and who will prepare and certify the as -built package:
Consulting Engineer/Landscape Architect: C• Matthew .Jones, P•E•
Consulting Firm: ,10/VE5 CIVIL DE916N, P-C-
Mailing Address: 1019 %hornsby Lane
City: Matthews State: NC Zip: 29705
Phone: [phone] Fax: ( )
Email: /Matt@JonesCivilDesign•com
6. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
E. PROJECT INFORMATION
1. Specify the type of project (check one): X❑ Low Density ❑ High Density
2. Briefly summarize how the stormwater runoff will be treated/conveyed:
Sheet flow and vegetated conveyances (similar to existing conditions) with a low -density
developed condition of less than 24% built -upon area• Also, all post -development runoff will
be discharged in the same direction and location as pre -development runoff
3. Stormwater runoff from this project drains to the
Yadkin Pee Dee
River basin(s).
Class: (GVS-VS); Index: 73-(75.5)
4. Receivinp water information (if more than 3 receivinq waters, provide additional information on an attached sheet):
Receiving
Water 1
Receiving
Water 2
Receiving
Water 3
Receiving Stream Name
Bearskin Creek
Richardson Creek
Rocky River
Stream Classification
C
C
C
Stream Index Number
13-17-36-6
- - -
13-77
Stormwater Fast Track ATC Application Form Page 3 of 9 Feb. 10, 2018