SW6120903_CURRENT PERMIT_20121120

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
DOC TYPE
�' CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
c2Z2 LIAa
YYYYMMDD

A�A _ FF
o
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Gray Hill
RHGC Investments LLC.
1350 City View Center
Oviedo, FL 32789
Division of Water Quality
Charles Wakild, PE
Director
October 16, 2012
Subject: Stormwater Permit No. SW6120903
DaVita Red Springs
Low Density with a Curb Outlet Swale System
Hoke County
Dear Mr. Hill:
NOV 2 0 1012
I)WQ
Dee Freeman
Secretary
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for
Edneyville Community Park on October 10, 2012. Staff review of the plans and specifications has
determined that the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A
NCAC 2H.1000 and Session Law 2006-246. We are forwarding Permit No. SW6120903, dated October
16, 2012, for the construction, operation and maintenance of the subject project.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
conditions and limitations as specified therein, -and does not supersede any other agency permit that may
be required. Please pay special attention to the conditions listed in this permit regarding the Operation and
Maintenance of the BMP(s), recordation of deed restrictions, procedures for changes of ownership,
transferring the permit, and renewing the permit. Failure to establish an adequate system for operation and
maintenance of the stormwater management system, to record deed restrictions, to follow the procedures
for transfer of the permit, or to renew the permit, will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit.
This request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC
27611-7447. 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 Brian
Lowther at [phone], or [e-mail].
Sincerely,
�?�- -�-g2"v
for Charles Wakild, PE
cc: FayettevilleRegional Office
SW6120903 File
ec: Matthew Johnson, PE — [e-mail]
Wetlands and Stormwater Branch . One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NorthCaroli na
Location: 512 -8 7 Salisburyt. Raleigh, North Carolina r27604
Service:
Alaturall�
Phone: [phone]DD 1 F 919-807-64941 Customer Service: 1-877-623-6148
Internet: www.ncwalerqua ity.org i
An Equal Opportunity 4 Affirmjlive Action Employer '

State Stormwater Permit
Permit No. SW6120903
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
LOW DENSITY DEVELOPMENT
WITH A CURB OUTLET SWALE SYSTEM
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
RHGC Investments LLC.
Da Vita Red Springs
11016 NC211, Red Springs, Hoke County
FOR THE
construction, operation and maintenance of a 24% low density subdivision with a curb
outlet swale system in compliance with the provisions of Session Law 2006-246 and
15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and the approved
stormwater management plans and specifications, and other supporting data as
attached and on file with and approved by the Division of Water Quality and considered
a part of this permit.
The Permit shall be effective from the date of issuance until rescinded and shall be
subject to the following specific conditions and limitations:
I. DESIGN STANDARDS
This permit covers the construction of 43,995.6 square feet of built -upon area.
2. The overall tract built -upon area percentage for the project must be maintained
at 21.31 %, per the requirements of Session Law 2006-246 of the Stormwater
rules.
3. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
4. Runoff conveyances other than the curb outlet system swales, such as perimeter
ditches, must be vegetated with side slopes no steeper than 3:1 (H:V).
5. This project proposes a curb outlet system. Each designated curb outlet swale or
100' vegetated area shown on the approved plan must be maintained at a
minimum of 100' long, maintain 5:1 (H:V) side slopes or flatter, have a
longitudinal slope no steeper than 5%, carry the flow from a 10 year storm in a
non -erosive manner, maintain a dense vegetated cover, and be located in either
a dedicated common area or a recorded drainage easement.
il. SCHEDULE OF COMPLIANCE
Curb outlet swales, vegetated areas and other vegetated conveyances shall be
constructed in their entirety, vegetated, and be operational for their intended use
prior to the construction of any built -upon surface, per the approved plans
Page 1 of 5

State Stormwater Permit
Permit No. SW61209
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the swales or other vegetated conveyances will be repaired immediately.
3. The permittee shall at all times provide the operation and maintenance
necessary to operate the permitted stormwater management systems at
optimum efficiency to include:
a. Inspections
b. Sediment removal.
C. Mowing, and re -vegetating of the side slopes.
d. Immediate repair of eroded areas.
e. Maintenance of side slopes in accordance with approved plans and
specifications.
f. Cleaning and repair of catch basin grates, flumes, piping, and the flow
spreader mechanism.
g. Maintenance of level spreaders and infiltration areas, in accordance with
approved plans and O&M documents.
4. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to the approved plans, regardless of size.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition or sale of the project area. The project
area is defined as all property owned by the permittee, for which
Sedimentation and Erosion Control Plan approval was sought.
f. Filling in, piping, or altering any vegetative conveyance shown on the
approved plan.
5. The permittee shall submit all information requested by the Director or his
representative within the time frame specified in the written information request.
6. Deed restrictions are incorporated into this permit by reference and must be
recorded with the Office of the Register of Deeds prior to the sale of any lot.
7. Recorded deed restrictions must include, at a minimum, the following statements
related to stormwater management:
a. The following covenants are intended to ensure ongoing compliance with
State Stormwater Management Permit Number 6120903, as issued by the
Division of Water Quality under the stormwater rules.
b. The State of North Carolina is made a beneficiary of these covenants to
the extent necessary to maintain compliance with the Stormwater
Management Permit.
c. These covenants are to run with the land and be binding on all persons
and parties claiming under them.
d. The covenants pertaining to stormwater may not be altered or rescinded
without the express written consent of the State of North Carolina,
Division of Water Quality.
e. Alteration of the drainage as shown on the approved plans may not take
place without the concurrence of the Division of Water Quality.
f. The maximum built -upon area for the project is 43,995.6 square feet. This
allotted amount includes any built -upon area constructed within the lot
Page 2 of 5

State Stormwater Permit
Permit No. SW6120903
property boundaries, and that portion of the right-of-way between the front
lot line and the edge of the pavement. Built upon area includes, but is not
limited to, structures, asphalt, concrete, gravel, brick, stone, slate,
coquina, driveways, and, parking areas, but does not include raised, open
wood decking, or the water surface of swimming pools.
g. Filling in, piping or altering any 3:1 vegetated conveyances (ditches,
swales, etc.) associated with the development except for average
driveway crossings, is prohibited by any persons.
h. Filling in, piping or altering any designated 5:1 curb outlet swale or
vegetated area associated with the development is prohibited by any
persons.
i. A 30' vegetated buffer must be maintained between all built -upon area
and the Mean High Water line of surface waters.
j. All roof drains shall terminate at least 30' from the Mean High Water mark.
k. Each designated curb outlet swale or 100' vegetated area shown on the
approved plan must be maintained at a minimum of 100' long, maintain
5:1 (H:V) side slopes or flatter, have a longitudinal slope no steeper than
5%, carry the flow from a 10 year storm in a non -erosive manner, maintain
a dense vegetated cover, and be located in either a dedicated common
area or a recorded drainage easement.
8. The permittee must submit a copy of the recorded deed restrictions within 30
days of the date of recording.
9. No piping shall be allowed except those minimum amounts necessary to direct
runoff beneath an impervious surface such as a road or under driveways to
provide access to lots.
10. The permittee must certify in writing that the project's stormwater controls, and
impervious surfaces have been constructed within substantial intent of the
approved plans and specifications. Any deviation from the approved plans must
be noted on the Certification. The permittee shall submit the Certification to the
Division within 30 days of completion of the project.
11. The permittee is responsible for verifying that the proposed built -upon area does
not exceed the allowable built -upon area. Once the lot transfer is complete, the
built -upon area may not be revised without approval from the Division of Water
Quality, and responsibility for meeting the built -upon area limit is transferred to
the individual property owner.
12. 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.
13. Prior to transfer of ownership, the swales must be inspected and determined to
be in compliance with the permit. Any deficiencies will be repaired or replaced
prior to the transfer.
14. The final plats for the project will be recorded showing all required drainage
easements and common areas, in accordance with the approved plans.
15. The permittee shall submit for approval, final layout and grading plans for any
future development areas shown on the approved plans, prior to construction.
Page 3 of 5

State Stormwater Permit
Permit No. SW612090�,
III. GENERAL CONDITIONS
This permit is not transferable to any person or entity except after notice to and
approval by the Director. The Director may require modification or revocation and
re -issuance of the permit to change the name and incorporate such other
requirements as may be necessary. In the event of a name or ownership
change, a completed Name/Ownership Change form, signed by both parties,
must be submitted to the Division of Water Quality accompanied by the
supporting documentation as listed on page 2 of the form. The approval of this
request will be considered on its merits, and may or may not be approved.
The permittee is responsible for compliance with all permit conditions until the
Director approves a transfer of ownership. Conveyance of common areas to third
parties, such as a homeowner's association, by the permittee, where the
required Name/Ownership Change form has not been submitted to and
approved by the Division, does not constitute transfer of the stormwater permit
and does not relieve the permittee of responsibility formaintaining compliance
with the permit or transferring the permit.
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to an enforcement action by the Division.of Water Quality,
in accordance with North Carolina General Statutes 143-215.6A to 143-215.6C.
3. 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 of the North Carolina Administrative Code, Subchapter 2H.10001
and North Carolina General Statute 143-215.1 et. al.
4. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by the Division, such as the construction of
additional or replacement stormwater management systems.
5. The permittee grants permission to DENR Staff to enter the property during
normal business hours, for the purpose of inspecting all components of the
stormwater management facility.
6. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance, or
termination does not stay any permit condition.
7. Unless specified elsewhere, permanent seeding requirements for the swales
must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state and federal), which have jurisdiction.
10. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
Page 4 of 5

State Stormwater Permit
Permit No. SW6120903
Permit issued this the 16th day of October 2012.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
------- >;-�----------------==--=�-----------------------------
.for Charles Wakild, PE, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 5 of 5

DWQ USG -ONLY '
Date Received
Fee Paid
Permit Number
—/Z
6-0,rf` 610\SA,>
1D i 0.091)3
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
❑ 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 rimy be photocopied for rise as air original
1. 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.):
DaVita Red Springs
2. Location of Project (street address):
11016 NC 211
City:Red Springs County:I-Ioke zip: a 8 31'i1
3. Directions to project (from nearest major intersection):
From Downtown Red Springs, Head north on NC211 untill you get to the Robeson/1-Ioke County Line, lust
north of the intersection of Industrial Road and NC211. Site will be on your left -
Latitude:34° 50' 17.28" N
if. PERMIT INFORMATION:
Longitude:79° 11' 9.54" W of the main entrance to the project.
1. a. Specify whether project is (check one): ®New [-]Modification
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
Specify the type of project (check one):
®Low Density 01-figh 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 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):
❑LAMA Major ®Sedimentation/Erosion Control: 1.80 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.1f any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
Form SWU-101 Version 07Jun2010 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:RHGC Investments LLC.
Signing Official & Title:
b.Contact information for person listed in item I above:
Street Address: 13 15D C 1TY I6"') ,N i
city:(�AA F.DO State: EL— Zip: 3z
Mailing Address (if applicable): 31? C ,5 = d il + �
City: State: Zip:
Phone: 3S 5225 Pax: ( L�
Email: Cjr yo— ��t4c- s�o.� . clo�
T
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 ao. 'tle below, if you are the lessee, purchaser or developer. (This is the
person who owns the pro atyt�h roo ecct is located on)::
Property Owner/Org bi',&-e 61'"r L LL
Signing Official & Titl I" Vtr' -�er 6 rc,
b.Contact information for
Street Address:_
City: &V ?
N
erson listed in item 2a above:
vY°
Mailing Address (if applicable):
City:
State: Et— Zip: 3 Z 7 FT
y State: u Zip:
Phone: (4 U7) 517 21 1l Fax: ( i U 7 ) 5;P Y z r Z
Email: �1 cti �( ate' I t l `j fc, ,e
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: Zi
Phone: ( ) Pax:
Email:
4. Local jurisdiction for building permits: Hoke County - North Carolina
Point of Contact:
Phone #:
FL
Form SWU-101 Version 07Jun2010 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
13UA is below the 24% low density threshold. Storinwater will exit site via grassed swales and by sheet flow.
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 Dale:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.lf claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW - 1995 ❑ Ph 11 - Post Construction
3. Stormwater runoff from this project drains to the
River basin.
4. Total Property Area: 5.02 acres 5. 'Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. 'Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area*:4.72 acres
Total project area shall be calculated to exclude the folloivitr the normal pool of impounded structures, the area
between fire 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 MHM lime. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) litre may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = Z{%
9. I -low many drainage areas does the project have?] (For high density, count 1 for each proposed engineered
stornavater BMP. For loco density and other projects, use 1 for lire 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
Draina e Area 1
Draina e Area _
Drainage Area _
Drainage Area _
Receiving Stream Name
Little haft
Swam
Stream Class
C, Sw
Stream Index Number *
14-10-5
Total Drainage Area (so
206474.4
On -site Drainage Area (so
206474.4
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
43995.6
% Impervious Area** total
21.31
Impervious- Surface Area
Drainage Area
Drainage Area
Drainage Area
Draina e Area
On -site Buildings/Lots (so
7316
On -site Streets (so
0
On -site Parking (so
33157,20
On -site Sidewalks (so
3522.4
Other on -site (so
0
Future (so
0
Off -site (sf)
0
Existing BUA*** (so
0
Total (so:
43995.60
* Stream Class and Index Number can be determined at: lrttil,O?ortal.rrcdenr.orgh+teh/iurl/)s/csu/classifrcatioirs
Irtrppervious area is defincd as the built upon area including, but not litnited to, buildings, roads, parking areas,
side7valks, gravel areas, etc.
Form SWU-101 Version 07Jun2010 Page 3 of6

"'Report only that amount of existing BUA that will remain after development. Do not report ally existing BUA that
is to be retnoved and which will be replaced by new BUA.
11. I-Iow was the off -site impervious area listed above determined? Provide documentation. From Topographic
maps; topographic survey; GIS Data; Site inspections; and aerial photographs
Projects in Union Count Contact DWQ Central Office staff to check if the project is located tis,ithin a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per NCAC 028.0600.
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 htt ortal.ncdenr.or web w ws su bm -manual.
V1. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from http;/ZportaLncdenr.org/web/wq/ws/su/statesw/forms_docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://12ortal.ncdenr.org/web/wq/ws/su/maw.)
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 litt ortal.ncdenr.or web we ws su statesw forms flocs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. ► 01
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants +�-J4
Form. (if required as per Part V11 below)
3. Original of the applicable Supplement Form(s) (sealed signed and dated) and O&M M W S
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to +N't'JS
littp://www.envhelp.org/pages/onestopexpress.ht-mI 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 103
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'/2 mile of the site boundary, include the
mile radius on the map.
7. Sealed, signed and dated calculations. I�-ZUi 1f
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 wet{ands 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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
Form SWU-101 Version 07Jun2010 Page 4 of

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).
9. Copy of any applicable soils report with the associated SFIWT 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 verifij the SHWT prior
to submittal, [phone].) ��� e4-4-SI A(., C- ,a Tv,,� °i -13— lZ
10. A copy of the most current property deed. Deed book: Page No: Iµv-1115
11. For corporations and limited liability corporations (LI_C): Provide documentation from the NC &A-(
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 NCAC 2I-I.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:Z/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 sires 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.or,g/web/wq/ws/su/statesw/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.
Vlll. 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:Matthew lohnson, P.E.
Consulting Firm: Triad Design Group, P.C.
Mailing Address:4807-C Koger Blvd
City:Greensboro State:NC %ip:27407
Phone: (336 ) 218-8282 Fax: (336 ) 218-8010
Email:miohnsonQtriad-desi"group.com
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, ilem 2 has been filled out, complete this
section)
1, (print or type name of person listed in Contact Information, item 2a) LO r� i certify that I
own the property identified in this per t appIicatynr and thus give per ission to (print or type name of person
listed in Contact Information, item ?a) ��` I with (print or type name of organization listed in
Contact Information, item 1n) 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.
Fonn SWU-101 Version 07Jun2010 Page 5 of6

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 COtForm within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid per rstand that the operation of a stormwater treatment facility without a valipermit is a violation of Genatue 143-215.1 and may result in appropriate enforcement action including
the assessment of civ up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date: Z z
a Notary Public for the State of County of
do hereby certify that personally appeared
before me thik�_)day of and acknowledge the due exec ion o the application for
a stormwater permit. Witness my hand and official seal,
CARONI LUISA CONTINI
'c MY COMMISSION # EE142548
EXPIRES December 12, 2015
396-01'33 F10riUH0W IVIW.0om
SEAL
My commission expires 1Q 11l I J t
X. APPLICANT'S CERTIFICATION
I, (print or type name of person fisted in Contact lnformalion, item In) r �
certify that the informatio 1.included on this permit application form is, to th best of my knowledge, correct and
that the project will co tructed in conformance with the approved plans, that the required deed restrictions
and protective enat will be recorded, and that the proposed project complies with the requirements of the
applicable sto r es under 15A NCAC 2H .1000, SL 2006-246 (Ph. It -Post Construction) or SL 2008-211.
J
Signature: Date: YZ,`)
1, OAtLY1, 0-C�C7, C, a Notary Public for the State of 1-_�_n_ County of
do hereby certify that �, personally appeared
before me thisday ofand acknowledge the due ex ci lion the application for
a stormwater permit. Witness my hand and official seal, 1
CARONI LUISACONTINI
MY COMMISSION # EE142548
gI`,.•� EXPIRES December 12, 2015
ta07) 398-0165 FlorideNow nice.00m
SEAL
My commission expires 0- l 1 c - i
Form SWU-101 Version 07Jun2010 Page 6 of6

0,171 01 A2[0-1
ym
V,,fTVu7j:l A�-WJ-1 !fI( 'iji

Permit No.
(10 he provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
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 214 .1000, Session Law 2006-246, and the DWQ 13MP Manual.
Curb and gutter systems are allowed provided they meet the requirements in 15A NCAC 21-1 .1008(g).
1. PROJECT INFORMATION
Project Name : Davita Red Springs
Contact Person: Gray Hill Phone Number: ( )
Number of Lots:I Allowable Built Upon Area (BUA) Per Lot*:49,365.68 Sh
Number of Dwelling Units Per Acre**:
Low Density Development (check one): ❑ wilhoul curb & gutter ® with curb & gutter, outlets to (cheek one):
❑ Swales ® Vegetated Area
*If lot sizes are not uniform, attach a table indicating the number of lots, lot sizes and allowable built upon area for each lot.
The attachment must include the project name, phase, page numbers and provide area subtotals and totals. BUA shall be
shown in units of square reel.
**(Phase II Post -Construction (non -SA) only)
I1. BUILT UPON AREA
Refer to DWQ's forms and applications website for specific language that must be recorded in the deed
restrictions for all subdivided projects.(http://h2o.enr.state.nc.us/su/bmp_foniis.htm)
Complete the following calculation in the space provided below where:
• SA Site Area - the total project area above Mean High Water.
• DF Density Factor - the appropriate percent built upon area divided by 100.
• RA Road Area - the total impervious surface occupied by roadways.
• OA Other Area - the total area of impervious surfaces such as clubhouses, tennis courts, sidewalks, etc.
• No. of Lots - the total number of lots in the subdivision.
• BUA per Lot - the computed allowable built upon area for each lot including driveways and impervious
surfaces located between the front lot line and the edge of pavement.
• Total allowable lot BUA - the computed allowable built upon area for all lots combined.
• Total BUA from lot listing - the sum of'built upon area allocated for each lot on the list of non-unilorm lots.
Form SW40I-Low Dens ity- Rev. 3-2/10/09 Page I of 4

Calculation:
For uniform lot sizes:
(SA: ft2 x DF: } - (RA: ft2) - (OA: ft2) = BUA per Lot = ft2
(No of Lots: )
For non -uniform lot sizes:
a. (SA: 205,603, ft2 x DF: 0.24) - (RA: 0 ft) - (OA: 0 112) = Total allowable lot 13UA = 49344.77 ft2
b. Total BUA from lot listing: 43995. 60 sr. b must be < a
Ill. DESIGN INFORMATION
Complete the following table. If additional space is needed the information should be provided in the same
format as Table I and attached to this form. Rainfall intensity data can be found in Appendix 8.03 of the State
of North Carolina Erosion and Sediment Control Planning and Design Manual or at
http://hdsc.nws.noaa.gov/hdsc/pl'ds/
Table 1. Swale desiLn information based on the 10-vear storm.
Swale No.
Drainage
Area (ac)
Impervious
Area (ac)
Grassed
Area (ac)
C
Q
(efs)
Slope
N
Vallow
("Ps)
Vactual
(f s)
Flow
Depth (ft
1
0.34
0.21
0.14
.72
1.96
1.64
5.0
0.99
0.63
2
0.71
0.30
0.41
0.72
3.41
1.40
5.0
1.00
0.65
3
1 0.86
0.25
0.61
0.56
3.82
0.67
5.0
0.55
0.55
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Donn SW40I-Low Dens ity- 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 21-1 .1000, NCDI---NR 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
lnitialc Chrm Nn
NIA a. t For projects in the 20 coastal counties: Per NCAC 21-1.1005, a 50 foot wide vegetative buffer
is provided adjacent to surface waters. For Redevelopment projects. a 30' wide vegetative
buffer adjacent surface waters is provided.
N/A b. t For I-IQW or ORW projects outside the 20 coastal counties: A 30 foot wide vegetative buffer
is provided adjacent to surface waters.
C1.1 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.
NIA 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.
Cl .1 e. Built upon area calculations are provided for the overall project and all lots.
NIA 1. Project conforms to low density requirements within the ORW AI---C. (if applicable per
15A NCAC 21-1 .1007)
Cl .2 g. Side slopes of swales are no steeper than 3:1; or no steeper than 5:1 for curb outlet sivales.
C1.2 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%.
C2.1 i. At a minimum, swales are designed to carry the 10 year storm velocity at a non -erosive rate.
NIA 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).
C2.1 k. Swale detail and permanent vegetation is specified on the plans.
C2.1 I. Swale detail provided on plans; includes grass type(s) for permanent vegetative cover.
C 1.1 m. Swales are located in recorded drainage easements.
C L2 n.tt Length of swale or vegetated area is at least 100 feet for each curb outlet.
C1.2 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).
C 1.2 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 SW40i-Low Dens ity- Rev. 3-2/10/09 Page 3 of 4

.V. SWALE SYSTEM MAINTENANCE REQUIREMENTS
Mowing will be accomplished as needed according to the season. Grass height will not exceed six inches
at any time; and grass will not be mowed too close to the ground or "scalped".
2. Swales will be inspected monthly or after every runoff producing rainfall event for sediment build-up,
erosion, and trash accumulation.
3. Accumulated sediment and trash will be removed as necessary. Swales will be reseeded or sodded
following sediment removal.
4. Eroded areas of the swales will be repaired and reseeded. Swales will be revegetated as needed and in a
timely manner based on the monthly inspections. Side slopes must be maintained at the permitted slope.
Catch basins, curb cuts, velocity reduction devices, and piping will be inspected monthly or after every
significant runoff'producing rainfall event. Trash and debris will be cleared away from grates, curb cuts,
velocity reduction devices and piping.
6. Swales will not be altered, piped, or filled in without approval from NCDENR Division of Water Quality.
acknowledge and agree by my signature below that I am responsible for the performance of the six
maintenance procedures listed above. 1 agree to notify DWQ of any problems with the system or prior to any
changes to the system or responsible party.
Print Name and Title:
Address: 13 5d G 14
Phone: qU%�SYY— 7-1V
Signature
Me,,,t-er
Date: 4VA�& /( Z
Z 7?7
Note: The lei>ally responsible parry should not he a homeowners association unless more than 50% of the lots have been sold and u
resident of the subdivision has been named the president.
I, 04Pct-L�N. L a Yin 1 , a Notary Public for the State of _ t-1Z: Q(�, County of
do hereby certify that , personally appeared before me this
day of and acknowledge the due execution of the forgoing swale maintenance requirements.
Witness my hand and official sea],
Notary signature
YN, ONI l.k11SA CONTINI
MY COMMISSION # EE142548
EXPIRES December 12, 2015
497 S49-0tA7 FbndaHop rviu,oan
My commission expires
form SW401-Low Dens ity-Rev.3-2/10/09 Page 4 of 4