SW4201101_Application_20201119

0KA0.I RL
DEMLR USE ONLY
Date Received Fee Paid Permit Number
It- tq-2o20 5O5 GG27ov SW 42-0 It 01 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 Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources RECEIVED
Division of Energy, Mineral and Land Resources
NOV 1.g 2020
STORMWATER MANAGEMENT PERMIT APPLICATION FORM flENR-LAND QUALITY
This form may be photocopied for use as an original STORMWATER PERMITTING
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.):
Heritage Oaks,Section II-Residential Subdivision
2. Location of Project(street address):
Pin#5897-43-2848.00,5897-44-0046.00,5897-34-7223.00 and 5897.44.6250.00;5426 Heritage Oaks Lane
City:Winston Salem County:Forsyth Zip:27106
3. Directions to project(from nearest major intersection):
From the intersection of Yadkinville Road and Olivet Church Road go south on Olivet Church Road. Turn on
the first street to the left,Heritage Oaks Lane. Project is located at the terminus of Heritage Oaks Lane.
4. Latitude:36°08'36.98"N Longitude:80°22'35.40"W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is(check one): New Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-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 N/A ,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 EDrains to an Offsite Stormwater System [Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application,list the stormwater project number,
if assigned, N/A and the previous name of the project,if different than currently
proposed, N/A
4.a.Additional Project Requirements(check applicable blanks;information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control: 5.76 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:EC permit EN1800113 by Forsyth County/City of WS
5. Is the project located within 5 miles of a public airport? No ❑Yes
If yes, see S.L.2012-200,Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations
Form SWU-101 Version Oct.31,2013 Page 1 of 6

III. CONTACT INFORMATION
1.a.Print Applicant/ Signing Official's name and title(specifically the developer,property owner,lessee,
designated government official,individual,etc.who owns the project):
Applicant/Organization:Heritage Oaks Holdings,LLC By Scott Craver
Signing Official&Title:Scott Craver,Member-Manager
b.Contact information for person listed in item la above:
Street Address:5426 Heritage Oaks Lane
City:WinstonSalem State: NC Zip:27106
Mailing Address(if applicable):Same
City: State: Zip:
Phone: (336 ) 399-3744 Fax: ( )
Email:[e-mail]
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 listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address(if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
3.a. (Optional)Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official&Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
4. Local jurisdiction for building permits:City of Winston Salem/Forsyth County
Point of Contact:WS Inspections Phone#: (336 ) 727-2625
Form SWU-101 Version Oct.31,2013 Page 2 of 8

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
The project consists of 27 lots fronting on ribbon pavement streets with side ditches. The sideditches will
provide some some water quality treatment. The water will be transported from the side ditches using open
throat boxes with pipe running down the side property lines at planned intervals. Outlet ditches will be lined
with vegetative cover for a minumum of 100' after exiting the pipes to provide for the final water treatment.
The development is less than 2 lots per acre and less than 24% planned impervious.
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: 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:15.822 acres 5. Total Coastal Wetlands Area:0.0 acres
6. Total Surface Water Area:0.275 acres
7. Total Property Area(4) -Total Coastal Wetlands Area(5)-Total Surface Water Area(6) =Total Project
Area*:15.547 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water(NHW)line or Mean High Water
(MHW)line,and coastal wetlands landward from the NHW(or MHV`1)line. The resultant project area Is used to
calculate overall percent built upon area(BLIA). Non-coastal wetlands landward of the NHW(or MH )line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area/ Total Project Area)X 100 =22.3&1.70 lots/ac%
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project,attach an additional sheet with the information for each area
provided in the same format as below.
Form SWU-101 Version Oct.31,2013 Page 3 of 8

Basin Information Drainage Area 1 Drainage Area- Drainage Area_ Drainage Area
Receiving Stream Name Oil Mill Branch
Stream Class * C
Stream Index Number* 12-94-6
Total Drainage Area(sf) 698,200
On-site Drainage Area(sf) 698,200
Off-site Drainage Area(sf) N/A
Proposed Impervious Area**(sf) 150,850
/ Impervious Area**(total) 22.3% or 1.7
Lots/ac
Impervious"Surface Area Drainage Area 1 Drainage Area _ Drainage Area_ Drainage Area_
On-site Buildings/Lots(sf) 102,600
On-site Streets (sf) 37,500
On-site Parking (sf) 0
On-site Sidewalks (sf) 0
Other on-site (sf) N/A
Future(sf) N/A
Off-site (sf) N/A
Existing BUA***(sf) 10,750
Total (sf): 150,850
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
** 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.
11. How was the off-site impervious area listed above determined?Provide documentation.N/A
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened&
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B.0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance(O&M)forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy,Mineral and
Land Resources(DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at http://portal.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item.All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions&Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed,signed and dated)and O&M
agreement(s)for each BMP.
4. Permit application processing fee of$505 payable to NCDENR. (For an Express review,refer to iK—
http://www.envhelp.org/pages/onestopexpress.html for information on the Express program
Form SWU-101 Version Oct. 31,2013 Page 4 of 8

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 for
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 Ac
receiving stream drains to class SA waters within 1/2 mile of the site boundary,include the 1/2
mile radius on the map.
7. Sealed,signed and dated calculations(one copy). Pe-
8. Two sets of plans folded to 8.5" x 14" (sealed,signed,&dated),including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures,the banks of streams and rivers,the MHW or NHW line of tidal
waters,and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures,the banks of streams or rivers,and the MHW(or NHW)of tidal waters.
i. Dimensioned property/project boundary with bearings&distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours,proposed contours,spot elevations,finished floor elevations.
1. Details of roads,drainage features,collection systems,and stormwater control measures.
m.Wetlands delineated,or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
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 SHWT elevations(Please identify N/A
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 DEMLR to verify the SHWT prior
to submittal, [phone].) Plo 310
10. A copy of the most current property deed.Deed book:3391 Page No:1004 A.
11. For corporations and limited liability corporations (LLC):Provide documentation from the NC AC-
Secretary of State or other official documentation,which supports the titles and positions held
by the persons listed in Contact Information,item la,2a,and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State,otherwise the application will be returned.
http://www.secretary.state.nc.us/Corporations/CSearch.aspx
Form SWU-101 Version Oct.31,2013 Page 5 of 8

VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions,outparcels,and future development,the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary,a table listing each lot number,lot size,and the allowable built-upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from http://portal.ncdenr.org/web/lr/state-
stormwater-forms docs.Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner,it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s)below,the permit holder(s)certify that the recorded property restrictions and
protective covenants for this project,if required,shall include all the items required in the permit and listed
on the forms available on the website,that the covenants will be binding on all parties and persons claiming
under them,that they will run with the land,that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR,and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm(such as a
consulting engineer and/or firm)so that they may provide information on your behalf for this project(such as
addressing requests for additional information).
Consulting Engineer:Alex Carter,PE
Consulting Firm:Beeson&Carter,PA
Mailing Address:PO Box 669
City:Walkertown State:NC Zip:27051
Phone: (336 ) 748-0071 Fax: (336 ) 748-0470
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) ,certify that I
own the property identified in this permit application,and thus give permission to (print or type name of person
listed in Contact Information, item la) with(print or type name of organization listed in
Contact Information, item la) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal,which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version Oct.31,2013 Page 6 of 8

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 a essment of civil penalties of up to$25,000 per day,pursuant to NCGS 143-215.6.
n^v, /? r v
Signature: Y C i Cti,/ Date:_ `7 I5 ) I O
I,J1kflC IV D ,a Notary Public for the State of NOV4+1 Caliph na ,County of
c pyj 44 ` ;'do hereby certify that w I V� 5• CVa'Ve,V personally appeared
before metis 25 day of "Suki ,WO ,and ac nowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
L—P----
`%O
�OIARy
s
',1''i?'Yf CO "V ��
SEAL
My commission expires II12122
Form SWU-101 Version Oct. 31,2013 Page 7 of 8

X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 1a)Heritage Oaks Holdings, LLC by Scott Craver ,
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 r les under 15A NCAC 2H.1000 and any other applicable state stormwater requirements.
/
Signature: �,�. r � Date: 1 /2 s f) �
I, Dnt cad V 1 ,a Notary Public for the State of N014 1 l vv1;r1a ,County of
F65(4
,do hereby certify that WI111 Vh S, CVaVe ' personally appeared
before me this� ay of 2015 ,and a nowledge the due execution of the application for
a stormwater permit. Witness my and and official seal,
� P TRH✓O�'.
ct p'(AR}-
t'UB\xG Z
���i v C,O 4 %•
SEAL
My commission expires 1112121
Form SWU-101 Version Oct.31,2013 Page 8 of 8

DocuSign Envelope ID.73DF7B21-A286-472A-A975-FCA4AEF4C149
BEESOII x CIIHTER, I'll.
CIVIL ENGINEERS LAND SURVEYORS
LAND PLANNING
November 14, 2020
Division of Energy,Mineral& Land Resources
Stormwater Program
1612 Mail Service Center
512 North Salisbury Street
Raleigh,NC 27699-1612
RE: POST CONSTRUCTION STORMWATER PERMIT FOR HERITAGE OAKS SEC II
This narrative is provided for background and additional information on the post construction
stormwater submission for Heritage Oaks, Sec II residential subdivision.
BACKGROUND
The site is located in Forsyth county at the terminus of Heritage Oaks Lane, a residential
subdivision developed in the late 1980's. This site is zoned residential single family(RS-9)and
the developer/owner has a home within the tract to be developed. Forsyth County/Winston Salem
planning board approved a site plan for the extension of Heritage Oaks Lane and an
accompanying major subdivision on May 10,2018 and further revised a minor change for lots
44-45 on February 10,2020.
The development plan indicates 27 lots with less than 24%impervious coverage and 1.7 lots per
acre for low density development. The site permitting for erosion control, streets, and public
water and sewer utilities has been completed and the first section of infrastructure has been
installed. At the time of plat review for the first phase of 10 lots it was discovered the post
construction stormwater permit has been overlooked. This submission is to ensure the remainder
of permitting is completed prior to platting and conveying any lots.
The pre-constructed site is a combination of open grassed areas and mature tree stands. The
post-constructed site is planned to minimize grading of lot areas and removal of existing trees to
the maximum extent practical.
STORMWATER CONVEYANCE
The undeveloped areas of the site outside of the planned right of way area are covered in mature
grass and trees. Stormwater outside of the right of way is planned for existing surface flows to
remain the maximum extent practical.
The stub street to the site and the site itself is 20' ribbon pavement streets with side ditches.
Water is conveyed across intersections and periodically from ditch lines between lots using open
throat catch basins and pipe. The pipe runs are limited with the primary method of conveyance
being performed via grassed ditch lines.
PO Box 669 Walkertown, NC 27051 336-748-0071

•
DocuSign Envelope ID:73DF7B21-A286-472A-A975-FCA4AEF4C 149
/11F BEESOII CDR TER, F'R.
CIVIL ENGINEERS LAND SURVEYORS
LAND PLANNING
STORMWATER CONVEYANCE(Cont'd)
Where street grades exceed 5%and erosive velocities are calculated in the ditch line,an
appropriately specified matting(Excelsior II) is planned to protect underlying soils from erosion.
At the end of piped outlets,wide ditch lines/swales are planned also with specified outlet
protection and channel matting.
Sheet C-4.0 outlines the drainage areas and shows 10yr storm event calculations for expected
ditch line volume,velocity and stability/matting needed throughout the street and conveyance
system. The first 400' of street/ditch line entering the site has 6-8.75%grades. The remainder of
the street/ditch line grades are 1-1.25%.
The grassed conveyance system within the right of way and the existing site conditions outside
of the right of way provide for the maximum extent practical length of conveyance for cleaning
water prior to reaching the site boundaries.
%.aanewouun,
l``�N C A is)Q°,tttt .,,�%
Best Regards, s oQ-. s s '••,� '�-
a?. y :y•
038574
Alex Carter PE i�4i `•�•FNG I N E��••(<,Q
11/14/2020
PO Box 669 Walkertown, NC 27051 336-748-0071

41111#‘ BEEH[JI1&CARTER,PH. TRANSMITTAL
CIVIL ENGINEERS LAND SURVEYORS
LAND PLANNING
PO Box 669, Walkertown, NC 27051
Phone [phone] Fax [phone]
www.bc-eng.com
RECEIVED
TO: DIVISION OF ENERGY, MINERAL &t LAND RESOURCES
��
STORMWATER PROGRAM
POST CONSTRUCTION PERMITTING DENR.LANDQUALITY
STORMWATER PERMITTING
RE: HERITAGE OAKS RESIDENTIAL SUBDIVISION
We are sending you: Other pPPt,c•s v� Dees f- PLa.js
COPIES DATE DESCRIPTION ACTION
1 11/9/2020 Original Application And Supplement For Approval
1 11/9/2020 ; Copy Of Application And Supplement { For your use
2 11/9/2020 Plan Sets For your use
1 11/9/2020 Fee Check - $505 Permit Fee ' As requested
Remarks:
Please find enclosed all applications, documents, and plans for post construction stormwater
permitting. This project is under 24% impervious and under 2 lots per acre. Additional
information contained in the cover letter and application documents.
CC TO:
Signed: _
Alex T. Carter, PE

North Carolina Secretary of State Search Results Page 1 of 1
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online •
Add Entity to My Email Notification List • View Filings • Print a Pre-Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
HERITAGE OAKS HOLDINGS, LLC
Information
Sosld: 1654596
Status: Current-Active 0
Date Formed: 1/19/2018
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Craver, W. Scott
Addresses
Mailing Principal Office Reg Office
5426 Heritage Oaks Lane 5426 Heritage Oaks Lane 5426 Heritage Oaks Lane
Winston Salem, NC 27106 Winston Salem, NC 27106 Winston Salem, NC 27106
Reg Mailing
5426 Heritage Oaks Lane
Winston Salem, NC 27106
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
President
W. Scott Craver
5426 Heritage Oaks Lane
Winston Salem NC 27106
https://www.sosnc.gov/online_services/search/Business_Registration Results 11/24/2020