SW3130304_HISTORICAL FILE_20130328

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
El CURRENT PERMIT
❑ APPROVED PLANS
p HISTORICAL FILE
DOC DATE
��%(2 3,/�2�
YYYYMMDD

46
444e�*�' MCKIM&CREED
1730 VARSITY DRIVE, SUITE 500, RALEIGH, NC 27606
TEL [phone] FAX [phone]
LETTER OF TRANSMITTAL
ADDRESS: NCDENR - DWQ Stormwater Permitting
512 N. Salisbury St, 9th Floor
Raleigh, NC 27604
ATTENTION: Robert Patterson, PE
WE ARE SENDING: ❑✓ Originals
❑ Specifications
DATE: March 27, 2013
PROJECT' NR 01517-0233 TASK. NO.
RE: SECLI - Locust
TRANSMITI'AI. NO:
PACE 1 OI' 1
✓❑ Prints
✓❑ Calculations
❑ Shop Drawings
✓❑ Other - Check
❑ Samples
Drawing No.
Rev.
Description
Status
MQuantity
2 Sets
Construction Plans
1
Narrative & Calculation Booklet
2
Stormwater Management Permit form (I original + 1 copy)
1
Wet Detention Supplement form (original)
1
Wet Detention O&M Agreement (original)
I
Application Fee Check - $505.00
1
113ced
Issue Status Code: A. Preliminary B. Fabrication Only C. For Information D. Bid
E. Construction F. For Review & Comments G. For Approval H. See Remarks
Action Status Code: 1. No Exceptions Taken 2. Make Corrections Noted 3.Other
4. Amend & Resubmit 5. Rejected - See Remarks
REMARKS:Please find attached the stormwater materials for the State Employees' Credit Union in Locust.
Please let me know if you have any questions or need additional information.
Thanks,
CC: 12 LI i:/
MAR 282013
n NR -_ WATFR uaurr
McKIM & CREED, INC.
Signed �G
Mackenzie McBride, EI

WET DETENTION O & M Inspection Checklist
1. Inlets are located per the approved plans:
2. Inlet device (swale or pipe) is free of damage, clogs or erosion:
3. Forebay berm is in place and without erosion:
4. Forebay is free of excessive sediment:
A NE
5. Vegetated slopes are 3:1 or less:
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6. Banks are stable and free of erosion or bare soil:
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7. Slopes or berms are free of woody vegetation:
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8. Free of muskrats or beaver activity:
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9. Grass is being maintained and mowed (not scalped) as required:
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�PEItIMETER�AND�M,
10. Vegetated shelf is 6:1 or 10:1 as permitted and properly vegetated:
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11. Algal growth covers less 50% of the area:
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12. Cattails, phragmites or other invasive plants cover less than 50% of the basin surface:
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13. Main treatment area is free from excess sediment accumulation:
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�! y x to 1 i Sr ,x .�,'a'. " T"{�' , ^'ia Yi�i� r + } s�-t�
.'.-���+.' �fo'�FTr.` orcri,"mi
1.0 4s. w7 .E♦ i 'ik s«:.'k�. lE.! ?��^i � : .i' {S.'Y:'ri"� C 7;r. iSi'L.iM
14. Swale or emergency outlet bypass is in the correct place and is in good condition:
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15. Drawdown device is correctly sized free of damage or clogging:
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16. Orifice size matches the approved plans
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17. Outlet is free of erosion or other signs of damage:
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18. Trash rack is installed
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19. Vegetated filter is in place (if applicable)
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20. Relative elevations match approved plans
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21. Fountain pump (if permitted) is less than or equal to the maximum allowable size:
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V3.3_09

Application Completeness Review
❑ First Submittal ❑ Re -submittal
Development/Project Name: Srl
Receiving strea name , Ti�z
River Basin: �A'h�1,.1
Reviewed: / 3 By Bill Diuguid,(
High Density Projects that require a 401/404 within an NSW require 85% TSS, 30% TN and 30% TP removal.
T&E Species (Goose Creek, Waxhaw Creek or Six Mile Creek Water Sheds):
Latitude and Longitude:3s /S /7 ,4.) -1?,9 27 .3 7 6f Jurisdi tion oi:as ' �N�
Project Address: Z z a3 v
Engineer name and firm: Gr�[o _ M, /_r,/6( C,.A-b "_ ¢ . /rr,y..r„
Pt zm: ! t v� e iv, D 'I: q- S3 3— 8 a 9
Is the project con irmed to be in the _S�t_ateMSi Stormwater Permit jurisdiction? 2Yes or ❑ No
❑ Low Density (no curb and gutter) ❑ Low Density with curb and gutter outlets 5kHigh Density ❑ Other
❑ 401/404 impacts to surface waters, wetlands, and buffers (add language to cover letter and/or add info letter)
&`_y BUA _*"9 '
a.,>e k for $505.00 included
p/ Rginal signature (not photocopy) on application
Legal signature (Corporation-VP/higher, Partnership -General Partner/higher, LLC-member/manager, Agent).
Check spelling, capitalization, punctuation: http://www,secretary.state.nc.us/corporations/thepage.aspx
If an agent signs the application, a signed letter of authorization from the applicant must be provided which
includes the name, title, mailing address and phone number of the person signing the letter.
❑ For subdivided projects, a signed and notarized deed restriction statement
Sealed, signed & dated calculations 6it*- m , i-/V rN 6-4 o.D, 1 F.
[Correct supplement and O&M provided for each BMP on site (check all that were provided & number of each)
❑ Bioretention
❑ Dry Detention Basin
❑ Filter Strip
❑ Grass Swale
❑ Infiltration Basin
❑ Infiltration Trench
❑ Level Spreader
❑ Permeable Pavement
❑ Restored Riparian Buffer
❑ Rooftop Runoff Management
❑ Sand Filter
❑ Slormwater Wetland
et Detention Basin
❑ Low Density
❑ Curb Outlet
❑ Off -Site
❑ NCDOT Linear Road
ra'J Wo sets of sealed, signed & dated layout & finish grading plans with appropriate details
r� Narrative Description of stormwater management provided
� oils report, geotech information provided
Wetlands delineated or a note on the plans or in the accompanying documents that none exist on site and/or
adjacent property
Q. ZDetails for the roads, parking area, cul-de-sac radii, sidewalk widths, curb and gutter;
■' imensions & slopes provided
�rainage areas delineated ❑ El and impervious reported for each Areas of high density
MP operation and maintenance agreements provided
Application complete ❑ Application Incomplete Returned: (Date)
Oct 29 2012 Revision, Bill Diuguid

10172
0269
PARCEL NO. 100
1 op l 100 1 e.riria �(ar ail
Return to: Stale Employeestredi nton
o IU�ri� )50(,QA .
D-7 It
Prepared by: David A, Beal
Attorney at Law
Albemarle NC 28002
Stamps: $2,000.00
FILED
CA13ARRUS COUNTY NC
LINDA F. McABEE
FILED Sep 24, 2012
AT
01:15 pm
BOOK
10172
START PAGE
0269
END PAGE
0271
INSTRUMENT #
24327
EXCISE TAX
$2,000.00
ERV
This insmunent was prepared by David A. Braver, a
licensed North Carolina attorney, Delinquent taxes, if
any, to be paid by the closing attorney to the county tax
collector upon disbursement of closins proceeds.
This is ( ) is not 0
Grantors Primary Residence.
Recording Time, Book, and Page
Brief description for the Index: 3.35 Acres - No 10 Township— Cabarrus County
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this 2r day of September, 2012, by and between:
GRANTOR
Gus Schad (Unmarried);
James J. Schad (Unmarried);
Todd M. Schad and spouse,
Terri R. Schad
304 S. Second Street
Albemarle, NC 28001
GRANTEE
State Employees Credit Union
3101 Wake Forest Road
Raleigh, NC 27611
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and
assigns, and shall include singular, plural, masculine, feminine or neuter as required by context.
1NITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which, hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple,
all that certain lot or parcel of land situated in the City of Locust, No. 10 Township, Cabarrus County, North
Carolina, and more particularly described as follows:
SEE EXHIBIT A OR LEGAL DESCRIPTION ATTACHED HERETO AND
INCORPORATED HEREIN, AS WELL AS ANY AND ALL OTHER
EXHIBITS, ADDENDUMS, OR ATTACHMENTS HERETO,
REFERENCE TO ALL OF WHICH BEING HEREBY MADE.
M

10172
0270
The property hereinabove described was aoquired by Grantor by instrument recorded in Book 3775. Page 305, and Book
698, page 70.
A map showing the above -described property is recorded in Plat Book_ Page
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to
the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey
the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and
defend the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
This conveyance is made subject to all restrictive covenants, set -backs, easements, and restrictions of
record affecting the title to said real estate and all easements or rights -of --way visible upon the property,
as well as Grantee's pro -rated share of the current year's ad valorem taxes, if any.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this instrument to
be signed in its corporate name by its duly authorized officers and Its seal to be hereunto affixed by authority of its Board
of Directors, the day and year first above written.
(Corporate Name)
By:
President
ATTEST:
Secretary (Corporate Seal)
1� , �.L,� C• c —(SEAL)
Terri R. Schad
SEAJ,k%k r,
NORTH CAROLINA, Stanly County,
P S
I, a Notary Public of the County and State aforesaid, certify that, Gus Schad (Unmarried): James J.
_ NOTARY
Schad (Unmarried): Todd M. Schad and spouse, Terri R. Schad, Grantor(s), personally appeared
— PUBLIC =
before me this day and acknowledged the execution of the foregoing instrument. Witness my
hand and official stamp or seal, this 20" day of September, 2012.
t��
My commission eKpires: 9-14-2017 Notary Public
SEAL - STAMP
NORTH CAROLINA, Stanly County,
I, a Notary Public of the County and State aforesaid, certify that
personally came before me this day and acknowledged that — he is Secretary
of , a North Carolina corporation, and that by authority
duly given and as the act of the corporation, the foregoing instrument was signed in its name by
its President, sealed with its corporate seal and attested by as its
Secretary.
c,
Witness my hand and official stamp or seal, this day of .2012.
My commission expires: Notary Public
The foregoing Certificate(r)
of
isiare certified to be correct. This instrument and this certificale are duly registered at the date and time and in the Book and Page
shown on the first page hereof.
SUZANNE W. LOWDER, REGISTER OF DEEDS FOR STANLY COUNTY
By Deputy/Assistant— Register of Deeds

e , . ,
10172
0271 BARRETT EATMAN, L-3556
PROFESSIONAL LAND SURVEYOR
26162 Cabin Ridge Road
ALBEMARLE, NC 28001
[phone]
EXHIBIT'A'
(3,35 ACRES)
LYING AND BEING in No. 10 Township, Cabarrus County, North Carolina, and the POINT OF BEGINNING being a
point in the center line of Teeter Branch and the northern right of way of NC Hwy. 24-27, said point being the
southwest comer of James Schad and Todd Schad as described in Deed Book 3775, Page 0305 and a common
comer of Gerald 1. Friedman and Stephen K. Content as described in Deed Book 7017, Page 0052 and recorded in
the Cabarrus County Registry; Thence nine (9) calls with the center fine of Teeter Branch and the lines of Friedman
and Content, (1) N19°39'33`W 135.9l' to a pant in the center line of said branch, (2) N56'33'42"W 24.99' to a
point in the center line of said branch, (3) N3001556'W 80,53' to a point in the center line of said branch, (4)
N10'29'10'E 35,94' to a point in the center line of said branch, (5) N36°26'34'E 46.00' to a point In the center line of
said branch; (6) N4°.45'27'E 16.20' to a pant in the center line of said branch, (7) N24'4031'W 63.70' to a point in
the center fine of said branch, (8) N50'1714'W 24,83' to a point in the center line of said branch, (9) N59'04'14'W
13.34' to a point in the center line of said branch and a common comer of The Villages at Redbd*s, LLC as
described in Deed Book 6499, Page 0210 and recorded in the Cabarrus County Registry; Thence two (2) lines with
The Villages at Redbridges, LLC, (1) N1 °36'37'W 13.92' to a set W rebar flush with the ground, (2) NV3617'W
51.02' to a set'" rebar 0.1' above ground, a new comer in the line of The Villages at Redbridges, LLC and in the
southern right of way of a Proposed Road (50' right of way), said mbar being located S63'5600'E 96.13' from a
found 1/4' iron pipe flush with ground on the east side of Teeter Branch and in the northem One of Shads; Thence with
said right a new line N56"58'37'E 69.24' to a set 'A' rebar flush with the ground, anew comer in said right of way
and new the common line of said Schads, and Gus Schad as described in Deed Book 698, Page 70 and recorded in
the Cabarrus County Registry; Thence a new line, an arc, with said right of way across Schad, said arc having the
following curve data, Radius: 250.00', Delta: 20'19'30', Arc length: 88.69% Tangent 44.81', Chord bearing: .
N67'0823' E to a set rebar flush with the ground, a now corner in said right of way; Thence a new line with said
right of way across Schad N77 °18WE 111.34' to a set W rebar flush with the ground, anew comer in said right of
way; Thence a new line, an arc, with said right of way across Schad, said arc having the following curve data,
Radius; 25.00', Delta: 87'11'32, Arc length: 38.04', Tangent: 23.80', Chord bearing: 659'06'05'E to a set'/:'
rebar in the western right of way of Redbridge Blvd. (100' right of way) as described in Deed Book 7407, Page 188
and recorded in the Cabamts County Registry; Thence with said right of way One crossing the common fine of Gus
Schad and James Schad and Todd Schad, S15'3019'E 444,04' to a set 'A' rebar flush with ground; Ther>ce with
an arc of said right of way, said am having the following curve data, PMus: 36.00', Delia: 93"19'55, Are length:
58.64', Tangent 38.16', Chord bearing: 931009'39'W to a set 'A' rebar flush * th grouts, a comer in the norfhem
right of way fine of NC Hwy. 24.27; Thence two (2) Ones with said night of way, (1) S77'49'36"W 221.52' to a tound
'/; iron pipe 0.3' below ground; (2) S77°4736W 22.19' to the POINT OF BEGINNING and containing 3.35 acres,
and referenced to NC Grid North (HAD 27).
This 3.35 acres being a portion of the lands described in Deed Book 3775, Page 305 and Deed Book 698, Page 70
of the Cabarrus County Registry, Also shown on an unrecorded map by Barrett D. Eatman, PLS. entitled New Lot
Survey for Gus Schad, dated September 5, 2012.
Said 3.35 acres is suf>jeat to a 15' san'itary sewer easement as described in Deed Book 8139, Page 126, and a 10'
utility easement along the western right of way line of Redbridge Blvd. as described in Deed Book 8134, Page 147.
Said 3.35 acre is also subject to the following easements:
1) A 10' utility easement along the interior side of all boundary fines that describe the above 3.35 acres tract.
2) A 15' storm drainage easement with the described center lie of said easement being; The Point of
Beginning berg a found'!: €non pipe 0.3' below ground, said pipe being loacated N77'49'36'E 22.19' from
the beginning pant of 3.35 acres tract Thence from The Point of Beginning N65'1 MWE 241,13'; Thence
N08"46'38'E 139.17'; Thenoe N70'05'28'E 5.01' to a poird in the east fine of said tract and west right of
way line of Redbridge Blvd.
3) A 15' storm drainage easement with the described center One of said easement being; The Point of
Beg€nn€ng being a pant located the following two (2) calls from the beginning point of 3.35 acres tract; (1)
N77-4736-E 22.19', (2) N65°10'341 241.113% Thence from The Point of Beginrmg S89'51'07'E 22,08'
to a point in the east fine of said tract and west right of way line of Redbridge Blvd.
4) A wag and landscaping easement, said easement being the area inside an arc with a twenty five (25)foot
radius; Said arc consist of all the area inside arc and located witlrin above 3.35 acre tract. Center of said
25' arc is located the following four (4) calls from the beg ming point of 3.35 acres tract (1) N77'49'36'E
22.19'; (2) N65'101VE 241.13'; (3) S89°51'07'E 22.08'; (4) S15'30'19'E 10.13' Center of said arc is a
set W rebar flush with ground. Said rebar is in the east tine of said tract and west right of way line of
Redbridge Blvd. arW being the point of the beginning of an arc and the comer between calls sixteen and
seventeen of above description of 3.35 acres tract " ""
L•3556 �?
. 9,p '%.� sukvEy..•• t�P
D. �p'�

-. NE t., l •}44 '� "Y d•£N,.[ ri yy � -, .,� { Sf{u'7 tw3%Ahi'4 kf �iMb1 f� �Si. ��Y. �' S �'i i,�.
i �t:#_ � ti..: i�b & <<a... »,.= „�i �r .'�.,.t� ..:J.. DWQ:USE'ONLY;, ri - " "e x1•:�`� " i. ,�F 1_..
Date Received
Fee Paid
Permit Number
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 PIan
❑ Other WQ M mt 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 far use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
State Employees' Credit Union - Locust
2. Location of Project (street address):
H 24/27 and Redbridge Blvd
City:Locust County:NC Zip:28107
3. Directions to project (from nearest major intersection):
From Hwy 24/27, turn onto Redbridge Blvd. Project is immediately on the left (western) side of Redbridge
Blvd.
4. I_atitude:35° 15' 17" N Longitude:-80° 27' 37" W of the main entrance to the project.
IL PERMIT, INFORMATION:
1.. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tReneu?als with modifications also requires SIAU-102 - Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of 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 ®Sedimentation/Erosion Control: 3.46 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:Erosion Control: State Employees' Credit Union - Locust, CABAR-2013-.
045, March 18, 2013
5. is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part Vl: littl2:Hportal.ncdenr.orgZweb/wq/ws/su/statesw/rules laws
Form SWU-101 Version 06Aug2012 Page 1 of 6

Ill. 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:State Employees' Credit Union _
Signing Official & Title:Robert S. Hall, Sr. Exec. Vice President
b.Contact information for person listed in item 1a above:
Street Address:1000 Wade Avenue
City:Raleigh State:NC Zip:27605
Mailing Address (if applicable): P.O. Box 37665
City:Raleigh _
State:NC
Zip:27605
Phone: (919 ) 839-5000 Fax: (919 ) 839-5353 _
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 Iisted in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
City:
State:
State:
Phone: ( _ Fax:
Email:
Zip:
Zip:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization-.McKim & Creed, Inc.
Signing Official & Title:Grant Livengood, PE (Project Manager)
b.Contact information for person listed in item 3a above:
Mailing Address:1730 Varsi Drive Suite 500
City:RaIeigh State:NC Zip:27606
Phone: (919 ) 233-8091 Fax: (919 ) 233-8031
Email:[e-mail]
4. Local jurisdiction for building permits: Ci of Locust
Point of Contact:Administration Department Phone #: (704 ) 888-5260
Form SWU-101 Version 06Aug2012 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The stormwater runoff will be treated using a 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 PIan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW - 1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the Yadkin -Pee Dee River basin.
4. Total Property Area: 3.35 acres 5. Total Coastal Wetlands Area: acres
6. TotaI Surface Water Area: acres
Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area':3.35 acres
' Total project area shall be calculated to exclude the following: the normal pool of imppounded structures, the area
between the banks of streams and rivers, the area below the Normal Hi li Water (N" line or Mean High Water
(MHM line, and coastal wetlands landward from the NHW (or MHM line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHM line iva y
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 49.8 %
9. How many drainage areas does the project have?2 (For high density, count I for each proposed engineered
stormwater BMP. For low densihf 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.lnformatiorir, tk, 1 !�,,
1Draina eiAreaul
Drama e`Area 4
Drama�9,M6 M
:Drama e AreA'si
Receiving Stream Name
Teeter Branch
Stream Class *
C
Stream Index Number *
13-17-15
Total Drainage Area (so
97,656
On -site Drainage Area (sf)
97,656
Off -site Drainage Area (so
Proposed Impervious Area** (so
48,678
% Impervious Area** total
49.8%
lin'wervious" 5u`iface Area��'^i: ,
;Drainae'AreaL1`'
;Drama" ejArea 23'.Dra>iia
a Area
Drama `e"Area:L:
On -site Buildings/Lots (so
8,638
On -site Streets (so
On -site Parking (so
40,040
On -site Sidewalks (so
Other on -site (so
Future (so
Off -site (so
Existing BUA*** (so
Total (so:
48,678
* Stream Class and Index Number can be determined at: http.Aortal.iiedertr.orglweblupg&s/csii/classifieatioiis
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.
Farm SWU-101 Version 06Aug2012 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation.
Projects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each 13MP specified for this project. The latest versions of the forms can be downloaded
from httl�:/f�'nrtal.ncdcnr.or�;/+vtG/+�q 4vti su/l�m�i-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 fromhttp://portal.ncdear.org/web/wq/ws/su/s(atesw/forms flocs. Thecomplete
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 htt r �ort�il.ncderu.arg/ti+eb/�+�)j�+�s/su n�a Is)
Please indicate that the following required information have been provided by initialinF, 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 does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. G-Iml-
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants MA
Form. (y required as per Part V11 below)
3. Original of the applicable Supplement Form(s) (sealed si ied 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
httpJ/www.envhelp.org/pastes/onestopexhress.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
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'/x mile of the site boundary, include the r/z
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
S. 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 narned streets and NCSR numbers.
& 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 Iandward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n, Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
amL
C-1M L
LLM[ _
C-tM t-
Form SWU-101 Version 06Aug2012 Page 4 of 6

9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"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 DWQ to venfiJ the SHKrr prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 10172 Page No: 0269 G'I M 1. y
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC [—
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per 15A NCAC 21-1,1003(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.
hn://www.secretary.state,nc.us/Cori2orations/­CSearch.aspx
VI1. 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 sigiuficantly 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
kitty.//portal.ncdennorQ/web/ wgZws/su/stalesw/forms_ dots. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Grant Livengood, PE
Consulting Firm: McKim & Creed Inc
Mailing Address:1730 Varsity Drive, Suite 500
City.Raleigh
Phone: (919 ) 233-8091
Email: lig vengoodQmckimcreed.coin
Sta te: NC Zi p:27606
Fax: (919 ) 233-8031 _....___
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has becir filled ont, complete this
section)
1, (print or hjpe 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 hjpe na►ne of person
listed in Contact Information, item 7a) with (print or hype 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 06Aug2012 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature:
M
do hereby certify that
before me this _ day of
Date:
a Notary Public for the State of
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
1, (print or type naive of person listed in Contact In'forriration, iteur In) Robert S. Hall
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 stormwater ru s under A5A N�Ae2I-I .1000 and any other applicable state stormwater requirements.
Signature:
Date: -�-- (70-3
Np
a N f'Cublic for the State of C— , County of
W ' do hereby certify that O-CiM personally appeared
before me this day of Fe,6) a nowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, _ _ ,�_
fQtp H
a�OlAp � y
C
c� k Ya+nvN �- C Ir
SEAL
My commission expires 1 ` , QO Z
Form SWU-101 Version 06Aug2012 Page 6 of 6