SW3210301_Application Form_20210309 (2)

DEMLR USE ONLY
Applicable Rules: 0 Coastal SW - 1995 0 Coastal SW - 2008 0 Ph 11 - Post Construction
(select all that apply) 0 Non-CoastalSW- HQW/ORW Waters 0 Universal Stormwater Management Plan
0 Other WQ Memt Plan:
State of North Carolina
Wr
VA 6110) NPI W1 its 8.1ril 11! F K;&141
I
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Cresswind Phase 2 —
ME=
City:Monroe County:Union Zip:28110
I- * I a 1 0 - 4 '_ ' ' ' ' __ . I
1.8 miles south from the -intersection of Weddington Road and Potter Road - -------
4. Latitude:34'59'08"N Longitude:-800 39'40" W - of the main entrance to the project.
H. PERMIT INFORMATIOA:
1. a. Specify whether project is (check one): ENew []Modification El Renewal w/ Modificationt
tRenewals with modifications also reqWres SWU-102 - Rernewal 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: E]Not Started []Partially Completed* [I Completed* *provide a designer's certificatimi
2. Specify the type of project (check one):
E]Low Density JOHighDensity ElDrains to an Offsite Stormwa ter System []Other
3. If this application is being submitted as the result of a previously rehtrned application or a letter from
DEMLR requesting a state stormwater management permit application, list the stormwa ter project numbe
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 ZSedimentation/ Erosion Control: 37 acof Disturbed Area
EINPDES Industrial Stormwater E1404/401 Permit: Proposed Impacts -----------------------------------
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Numbe
issue date and the type of each permit: I
5. Is the project located within 5 miles of a public airport? FINo ZYes
Ifyes, see S.L. 2012-200, Part VI: http�1112ortal.ncden!����,�cii�,S/webtir/­`rules-and-regulation.-;
FomiSWU-101 Version Oct. 31,2013 Page I of 6

!1 ! a a ►" r !f+ ! !,
designated g!vernment official, individual,who owns the groject
City:Charlotte State -NC Zip:28215
Mailing Address (if plicsmble):
City: State. :
Phone: 98 2 Fax:
Email:[e-mail]
c. Please check the appropriate box. The applicant listed above is:
C] 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 a
2b below)
2.a. Print Property Owner's name and tide below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property # r i i !
rOfficial bTitle:AuthorizedSiSpatory
! !% ! i! ! !f i' !
Street Address:4807 PGA BLVD
CityTalm Beach Gardens State:FL ip:3318
Mailing Address (if applicable):
City: State: Zip:
Phone: [phone] —
Fax: ( }
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact• R Chapel, LLQ
Signing Official eDevelopment ;
Fax: ( }
4. Local jurisdiction for building permits: Union Coun ®
Point of Contact:Lee Ten n Phone : [phone]
Form S -1 1 Version Oct. 31, 2013 Page 2 of 7

MKM=. 3"Uromro f .74 1 I'MrOTM 07ml 111 11111 1 l��illill I! � I " I IN - 4 ;
2.a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
El Approval of a Site Specific Development Plan or PUD Approval Date:
C] Valid Building Permit Issued Date;
0 Other: Date:
b. If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
[] Coasta I SW - 1995 C1 Ph 11 - Post Construction
3. Stormwater runoff from this project drains to the Catawba River basin.
4. Total Property Area. 44.1 —acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: .5 —acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) -Total Surface Water Area (6) =Total Project
Area+: 43.6 acres
+ Total project area shall be calculated to exclude thefollmuing: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal Hz 'Rh Water (NW line or Mean High Water
(MFIM line, and coastal wetlands landwardftorn the NHW (or MHAO 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 may
be included in the total project area.
8. Project percent of impervious area. (Total Impervious Area / Total Project Area) X 100 = 67 71
9. How many drainage are -as does the project have?l (For high density, count I foreach proposed engineered
stormwater BMP. For low density and other prqects, use I for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
FormSWU-101 Version Oct. 31,2013 Page 3 of 7

111ITTY11
Receiving Stream Name
East Fork
Twelvemile
j Creek
Stream dex Number
a MR i 1222.MM�
� FAW-3
% Impervious Area** (total)
ImperyLious'surfitce Area
I -On -site Streets (sf) mg-giiiiiiiiiii
On -site Parking —(SO
On -site Sidewalks (so
Other on site (so
Stream Class mid Index flumber can be determined at: fit
Impervi . ous area i . s defined as the built upon area including, but not limited to, buildings, roads, par)dng areas,
sidewalks, gravel areas, etc.
Report only that amount of existing BUA that uqll remain after development. Do not report any existing B UA that
is to be removed and witich will be replaced by new BLIA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
ineapplicame -FIXF31UMUM, ter ma nagem AT 0—M—TY) =1
must be submitted for each BMP specified for this projeL The latest ve�sions of the forms can be downloaded
■
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 detailled application
instruction sheet and BMP checklists are available from
Ws Su s- esw orins e C
I r L —aL � IC te 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 lilt LL_ RJ �!Wfl -�s al.incdenr.or Veil/ s.)
XLL .. .............. ....
- V "I M777TTOT'Mr.
. . . . . . rMITTZ rT. a M, TJTTT9
for each item. All original documents MUST be signed and initialed in blue ink. Download the late at versions
for each submitted appUcation package from LiiL[VJ-J orms docs.
Initials
1. Original mid opy 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, sigped and dated) and O&M &K
agreement(s) for each BMP.
FormSWU-101 Version Oct, 31,2013 Page 4 o IN

TI W I VA I I w I P A* J MAA &WILWAILLBhM WW•
W =-FRIT
FonnSWU-101 Version Oct. 31,2013 Page 5 of 7

73MMOM V Tell 0 R4W 1 LIA15USITIRERM
MIT
I
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 liste
lbebindingonalWartiesan personscammun,
W
IM $1144 MLN 9 VJ IWIJ -lu III NPF M. a I I F. I a 1 .14773 11 a OYS M.L.) PLIVA LIJ a t4MJ
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
zddressing requests for additional information).
Consulting Engineer:Matthew S.-Kike PE
Consulting Firm: Thomas & Hutton
Mailft, Address:1020 Euclid Avenue ------------------
City:Charlotte State -NC Zip:28203
.Phone: f980 ) 521-5999 - ----------------------------- -------------------- a
1 T n H ff ■IT. r.
Fax:
•
?eV4
party responsible for the operation and maintenance of the stormwater system.
FormSVAJ-101 VeTsionOct.31,2013 Page 6 of 7