SW5210304_Application_20210609

DEMLR USE ONLY
Date Received Fee Paid
Permit Number
Applicable Rules: 0 Coastal SW - 1995 0 Coastal SW - 2008 0 Ph II - Post Construction
(select all that apply) El Non-CoastalSW- HQW/ORW Waters El Universal Stormwater Management Plan
0 Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
Thisform may be photocopiedfor 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.):
Younasville Storaee
2. Location of Project (street address):
519 N. Hillsboro St.
City.Youngsville County:Franklin
3. Directions to project (from nearest major intersection):
Zip:27596
From the intersection of of W. Main Street and College Street, head north on CollMe Street (Route 1148) fo
.25 miles, veer left at fork in road onto Park Avenue, site is .14 miles from intersection of Park Avenue and
Hillsboro Street
4. Latitude:36' 01' 53" N
II. PERMIT INFORMATION:
Longitude:-780 28' 53" W of the main entrance to the project.
1. a. Specify whether project is (check one): ZNew ElModification EIRenewal w/ Modificationf
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 , its issue date (if known)_________, and the status of
construction: E]Not Started E]Partially Completed* El Completed* *provide a designer's certification
2. Specify the type of project (check one):
E]Low Density ZHigh Density E]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
DEMLR 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):
F-JCAMA Major
F�NPDES Industrial Stormwater
OSedimentation/ Erosion Control: 8 ac of Disturbed Area
E]404/401 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:
5. Is the project located within 5 miles of a public airport? ENo ElYes
If yes, see S.L. 2012-200, Part VI: htti2://12ortal.ncdenr.orp�web/Ir/rules-and-rggulations
FormSWU-101 Version Oct. 31,2013 Page I 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 pro-ject :
Apphcant/Organization:C4-YS, LLC
Signing Official & Title:). Austin Williams, Manager
b. Contact information for person listed in item la above:
Street Address:121 W. Trade St., Suite 2550
City:Charolotte State:NC Zip:28202
Mailing Address (if applicable):
City:_
Sta
Phone: (704 ) 621-6430 Fax:
Emafl:[e-mail]
Zip;
c. Please check the appropriate box. The applicant listed above is:
F1 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.james T. Moss Heirs (David B. Moss, Tames T. Moss Jr., William T. Moss)
Signing Official & Title:David B. Moss, Owner
b. Contact information for person listed in item 2a above:
Street Address:3609 Carriage Drive
City:Raleigh State:NC Zip:27612
Mailing Address (if applicable):
City:
State:
Phone: (919 ) 215-1430 Fax:
Email:[e-mail]
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/ OrganizationArk Consulting Group, PLLC
Signing Official & Title:Dan Withers, PE, Project Manager
b. Contact information for person listed in item 3a above:
Mailing Address:2755-B Charles Blvd.
City:GreenviHe
State:NC Zip:27858
Phone: (252 ) 565-1017 Fax: [phone]
Email:dan.withers@arkconsuLt�nggroup.com
4. Local jurisdiction for building permits: Franklin Counv
Point of Contact:Tommy Harris, Insp. Supervisor Phone #: [phone] x1311
Form SW-101 Version Oct. 3 1, 2013 Page 2 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):
Apphcant/Organization:C4-YS, LLC
Signing Official & Title:1. Austin Williams, Manager
b. Contact information for person listed in item la above:
Street Address:121 W. Trade St.. Suite 2550
City:Charolotte
Mailing Address (if applicable):
City:
Phone: [phone]
Emajl:[e-mail]
State:NC
Zip:28202
State: Zip:
Fax:
c. Please check the appropriate box. The applicant listed above is:
Z The property owner (Skip to Contact Information, item 3a)
r-1 Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
Z Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
Ej 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. (TI-ds is the
person who owns the property that the project is located on):
Property Owner/ Organization:Cora Underwood Lee
Signing Official & Title:Cora Underwood Lee, Property Owner
b. Contact information for person listed in item 2a above:
Street Address:501 Hillsboro Street
City:YoupZsvflle
0�1
Mailing Address (if applicable): I
City: 140y413-5VAe-,
Phone: ( 513 ) 511 - 3
Email: C—k ;? lu, Q dw
State:NC Zip:27596
State: zip:-Z755 (a
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 Persori/Organization:Ark Consulting Group, PLLC
Signing Official & Title:Dan Withers, PE, Project Man@LZer
b. Contact information for person listed in item 3a above:
Mailing Address:2755-B Charles Blvd.
City:Greenville State:NC Zip:27858
Phone: [phone] Fax: [phone]
Email:dan.withers@arkconsulfiLt=oug.com
4. Local jurisdiction for building permits: Franklin Couft
Point of Contact:Tommy Harris, Insp. Supervisor Phone #: [phone] x1311
FormSWU-101 Version Oct. 31,2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Runoff will be conveyed via sheet flow, swale, and piped conveyance to two infiltration basins. Some
runoff will 12ypass the treatment system, but runoff volume match will be met.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
F-1 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:
F-1 Coastal SW - 1995 F-1 Ph 11 - Post Construction
3. Stormwater runoff from this project drains to the Tar -Pamlico & Neuse River basin.
4. Total Property Area: 8.81 —acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+: 8.81 acres
+ Total project area shall be calculated to exclude thefollowing: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Watei (NH") line or Mean High Water
(MHKq line, and coastal wetlands landwardfrom the NHW (or MHW line. The resultant project area is used to
calculate overall percent built upon area (B U& 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 = 61.2 %
9. How many drainage areas does the project have?4 (For high density, count I for each proposed engineered
stormwater BMP. For low density and other projects, 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.
Basin Information
Drainage Area I
Drainage Area 2
Drainage Area a
Drainage Area 4
Receiving Stream Name
Richland Creek
Richland Creek
Brandy Creek
Brandy Creek
Stream Class *
QNSW
QNSW
B;NSW
B;NSW
Stream Index Number
27-21-(0.5)
27-21-(0.5)
28-29-3-(l)
28-29-3-(l)
Total Drainage Area (sf)
110767
62552
149814
60662
On -site Drainage Area (so
110767
62552
149814
60662
Off -site Drainage Area (sf)
Proposed Impervious Area** (sf)
90693
27595
96107
20504
% Impervious Area** (total)
81.9
44.1
64.2
33.8
Impervious' Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 2
Drainage Area 4
On -site Buildings/Lots (so
49146
9600
On -site Streets (sf)
6506
On -site Parking (sf)
27479
10073
90938
On -site Sidewalks (so
1416
Other on -site (so
Future (sf)
Off -site (sf)
Existing BUA*** (so
14068
5169
20504
Total (sf):
90693
27595
96107
1 20504
Stream Class and Index Number can be determined at: http.aortal.ncdenr.orglweblwq&slcsulclassifications
Imyervi . ous area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
ewalks, gravel areas, etc.
Form SVVU-101 Version Oct. 31, 2013 Page 3 of 6

'Report only that amount of existing B UA that will remain after development. Do not report any existing B UA that
is to be removed and which will be replaced by new B UA.
11. How was the off -site impervious area listed above determined? Provide documentation. Togog2:aRhic %12Ley
Projects in Union CounU: Contact DEMLR Central Office staff to check ifthe project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements asper 15A NC,4C 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 hgp://portal.ncdenr.org/web/w!g/ws/su/bml2-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEM1R). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
htW://portal.ncdenr.orgZweb/n/ws/su/st, _ -;ms 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 bft://portal.ncdenr.org/web/3�rA/ws/su/mal2s.)
Please indicate that the following rgq uired information have been Rrovided hy 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/suZstatesw/forms docs.
ITu't4'als
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 dattd) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
h!fp:JJwww.envheJp.org/ pagesl onestopexRress.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/ management
6. A USGS map idenfifying the site location. If the receiving stream is reported as class SA or the
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).
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).
for
'bA)
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where required).
9, Copy of any applicable soils report with the associated SHVVT elevations (Please identify so
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"xll" 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 visitfor DEMLR to veri)y the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: Attached. Page No: Attached. 1W
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC SW
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 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.
hftp: / / www.secretaEy.state.nc.us/ Corporations/ CSearch.aspx
VIL 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 htip://12ortal.ncdenr.org/web/Ir/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:Dan Withers, PE
Consulting Firm: Ark Consulting Group, PLLC
Mailing Address:2755-B Charles Boulevard
City:Greenville State:NC Zip:27858
Phone:[phone] Fax: (
Email:dan.withers@arkconsul�n�oup.com
IX PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has beenfilled out, complete this
section)
I, (print or type name ofperson listed in Contact Information, item 2a) Cora Undenvood Lee ------- . 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 1a) 1. Austin Williams — with (print or type name of organization listed in
Contact Information, item 1a) C4-YS, LLC 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 SW-101 Version Oct. 31, 2013 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 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 assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: 0& a Date: 3 - 11 - -w-
I, a Notary Public for the State of County of
WA ke do hereby certify that (�/, 1/. 1, 10 e personally appeared
I- '/ and acknowl I ge the due execution of the application for
before me thisfl-day of A010"I , gO),
a stormwater permit. Witness my hand and official seal,
suN i cHOE
NotarY Public
\fVake C;o., North Carolina
June 11. 2024
my commiss�lon Expire's --Pvfvl
X. APPLICANT'S CERTIFICATION
expires 06111) 2rJ'L-1
1, (print or hjpe name of person listed in Contact information, item 1a) L Austin Williams I
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 rules underJ-5A NCAC 2H.1000 and any other applicable state stormwater requirements.
':7" q-0 2-1
Signature -,L Date:
1, 10-fle. IV6 QPL a Notary Public for the State of CA Jj/) e, County of
f�e, — do hereby certify that dA 44S f; personally appeared
before me this 21n6ay of JiL. I 2DZI and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, L:AL . - '?Lvdyyz� -
SEAL
My commission expires 9 - IN. ID'Z5-
1J I
Form SWU- 10 1 Version Oct. 3 1, 2013 Page 6 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 DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLK 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 includin % t o penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature:—= Date: 2. 2-
I, M a Notary Public for the State of fill XJdA Oktn ty of
do hereby certify that.. Y-Y, personally appeared
W X U& 13 mns
before me thios ay of R )D an tion for
_rx.!�u �;ckgledge the due execution of the applica
a stormwater permit. Witness my hand an dfiqi4�1�al,
THEI�/ 1�
-S
,ZX SEALIVO
rT M
i AA_
X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Information, item 1a) 1. Austin Williams
certify that the information included on this permit application form is, to the best of my knowledge, correct
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 rules under 15A NCAC 2H.1000 and any other applicable state stormwater requirements.
61,
Date:
a Notary Public for the State of AL) �,A�041r_ County of
Ctf do hereby certify that I personally appeared
d � U Sf In W" 1!1k&g*&
before me this ZL'dday of ­2,&�andacknowledg the due execution of the application for
41 _ f
I -)q, I U 6-6-u
a stormwater permit. Witness my hand and official seal,. lb
2
SEAL
My commission expires 2q. 2025--___
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6

Subject: Youngsville Mini Storage Expansion
Franklin County Tax Parcel Identification Nos: 1853-31-3172
Youngsville, Franklin County, North Carolina
To whom it may concern:
As the owner of an interest in the property identified as Franklin County Parcel Number
1853-31-3172 as referenced in Deed Book 2198, Page 1865, of the Franklin County
Registry, please accept this letter as permission for David B. Moss to act on my behalf in
order to authorize C4-YS, LLC the right to apply for State Stormwater and Sedimentation
and Erosion Control permits in accordance with the executed sales contracts.
Sincerely,
�t - VIq 0'rs-
Printed Name
Ti
�,e
AnW M UdUOa Notary Public for the State of North Carolina, County of
UO,O _do hereby certify that WOUM H M65S personally appeared
before me this day of R)Df (JOA.Al 2021, and
acknowledged the due execution of the forgoing document. Witness my hand and
official seal. " 0%%%111111111
E F1 //V
140,�r
:O� rn
>
My Commission expires

Subject: Youngsville Mini Storage Expansion
Franklin County Tax Parcel Identification Nos: 1853-31-3172
Youngsville, Franklin County, North Carolina
To whom it may concern:
As the owner of an interest in the property identified as Franklin County Parcel Number
1853-31-3172 as referenced in Deed Book 2198, Page 1865, of the Franklin County
Registry, please accept this letter as permission for David B. Moss to act on my behalf in
order to authorize C4-YS, LLC the right to apply for State Stormwater and Sedimentation
and Erosion Control permits in accordance with the executed sales contracts.
Sinc ely,
ely,
oss
5
C
Printed Name
Title
1, a Notary Public for the State of North Carolina, County of
VVA-Ve do hereby certify thaJOWW5 I A4 X&AS 1 0 personally appeared
before me this ot day of ft4 2021, and
acknowledged the due execution of the forgoing document. Witness my hand and
official seal.
Seal
My Commission expires
OF
Amy L Warren
NOTARY PUBUC
Wake County, NC
My Commisslon Expires February 2,2023

Subject: Youngsville Mini Storage Expansion
Franklin County Tax Parcel Identification Nos: 1853-20-8270
Youngsville, Franklin County, North Carolina
To whom it may concern:
As the owner of an interest in the property identified as Franklin County Parcel Number
1853-20-8270 as referenced in Deed Book 2193, Page 1944, of the Franklin County
Registry, please accept this letter as permission for Cora Underwood Lee to act on my
behalf in order to authorize C4-YS, LLC the right to apply for State Stormwater and
Sedimentation and Erosion Control permits in accordance with the executed sales
contracts.
Sincere[
Printed Name
Title ( h
1, — a Notary Public for the State of North Carolina, County of
. wo-kd do hereby certify that 14'wer L-ee personally appeared
before me this - / 7 A— day of Al'fl-fA- 2021, and
acknowledged the due execution of the forgoing document. Witness my hand and
official seal.
My Commission expires 4 /// Z 2-'0 2— /
SUN J CHOE
Notary Public
Wake Co., North Carolina
My Comm 10 Expires June 11, 2024