SWA000106_Application Form_20210621

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
SW Program(s): , ❑ Coastal SA-HQW ❑ Coastal SA-ORW ❑ Coastal FW-ORW ❑ Coastal Other
❑ Non -coastal HOW ❑ Non -coastal ORW ❑ Urbanizing Areas ❑ USMP
NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER FAST TRACK PROCESS:
"AUTHORIZATION TO CONSTRUCT" (ATC) PERMIT APPLICATION FORM
Link to Application Instructions
A. ELIGIBILITY FOR FAST -TRACK PERMITTING
To be considered for a Fast Track ATC Permit, all of the items below must be checked if any item cannot
be checked, then the project must apply under the Standard Permitting Process.
[91 The project and all SCMs (including existing SCMs associated with the project) will meet all applicable
requirements of 15A NCAC 02H .1000 - .1062, including the Minimum Design Criteria (MDC), upon project
completion.
® The project is not proposing an alternative design.
® The project is not claiming an exemption from the MDC based on vested rights, a waiver or a Director's
Certification.
® The project is not out of compliance with an existing stormwater permit or any other environmental permit.
® The project is not applying for an offsite permit, an exemption, or a minor modification (as defined in 15A
NCAC 02H .1002(25)) to an existing state stormwater permit.
® The project application bears the signature and seal of a professional licensed pursuant to either Chapter 89A
or 89C of the NC General Statutes.
® 1 understand that at project completion, an application with the as -built stormwater plans (as described in 15A
NCAC 02H .1044 must be submitted, and DEQ will review the as -built stormwater plans to confirm
compliance with the MDC. Approval of the as -built stormwater plans will be required before the Erosion and
Sedimentation Control Plan for the project may be closed out.
® 1 understand that the Fast Track ATC Permit will expire five years after the date of issuance.
B. GENERAL INFORMATION
1 Project Name: Pinewood Subdivision
2. Previous Project Name (if applicable): N/A
3. Location of Project (street address): Temporary Construction Address: 230 Pinewood Ln
City:Concord County:Cabarrus Zip:28027
4. Directions to project (from nearest major intersection):
Head West on NC-24/NC-27 W Toward US-601 S
Left onto Old Camden Rd, Right onto Robinwood Dr, Right onto Woddbine Dr, Left onto Robinwood Dr
Right onto Pinewood Ln
5. Latitude:350 13' 54.17" N Longitude:800 34' 32.04" W of the main entrance to the project.
C. PERMIT INFORMATION
1. Specify whether project is (check one):
® New, no previous application
❑ New, replacing a previous Fast Track ATC Permit -- provide previous permit number: SWA
By choosing this option, you are also requesting that DEQ rescind the previous Fast Track ATC Permit
upon issuance of the new Fast Track ATC Permit.
Stormwater Fast Track ATC Application Form Page 1 of 9 Feb. 10. 2018

❑ Major Modification, replacing an existing stormwater permit — provide existing permit number: SW
Status of construction? ❑ Not Started ❑ Partially Completed ❑ Completed
AlgigE modifications must be submitted by the original permittee and are allowed only if the SW permit is
not expired. Minor modifications must use Standard Permitting Process. By choosing this option, you
are also requesting that DEQ rescind the previous SW Permit upon issuance of the new Fast
Track ATC Permit.
❑ Transfer of existing Fast Track ATC Permit — provide existing ATC permit number: SWA
2. Applicable state stormwater program(s) (check a// that apply):
❑ Coastal SA-HQW Z Urbanizing Areas (Phase 2)
❑ Coastal SA-ORW ❑ Non -Coastal HQW
Is any portion of the project within 575 feet
of SA-ORW waters? ❑ Yes ❑ No ❑ Non -Coastal ORW
❑ Coastal Freshwater ORW ❑ USMP
❑ Coastal — Other
3. Other Permits (as applicable; write "NA" for those permit types that are not applicable):
4. Local jurisdiction for building permits: Cabarrus County
Point of Contact:Todd Culp - Phone#: [phone]
1. Applicant/Financially Responsible Party (may be an Organization):Olde South Land Partners, Inc.
Signing Official Name & Title:David E. Tibbals, President
Street Address: 11121 Carmel Commons Blvd
City:Charlotte State:NC Zip:28226
Mailing Address (if different):PO Box 470643
City:Charlotte State:NC Zip:28247
Phone: [phone] Fax:
Email: d avid (cDcharlotteco m mercial part ners.com
2. If the Applicant is a Corporation or LLC (Address must match address on file with NC Dept of the Secretary of
State):
Name of Registered Agent:David E. Tibbals
Mailing Address:PO Box 470643
City:Charlotte State:NC Zip:28247
Phone: [phone] Fax:
E mail:david (a)charlottecom mercial partners. com
Stormwater Fast Track ATC Application Form Page 2 of 9 Feb. 10,2018

3. The Applicant isthe (check all that aooh/:
FlProperty Owner
nLmamee (Attach acopy ofthe lease agreement & complete Item 4.)
El Purchaser (Attach a copy of the pending sales agreement & complete Item 4.)
2 Developer (Attach a copy of the development agreement & complete Item 4.)
4. If the Applicant is NOT the Property Owner (skip boItem 5if the Applicant /S the Property :
Property Owner Name/Organization�
Signing Official &Title:
Street Address:
City StateZip
Mailing Address (if :
8baba: Zip:
Pmms Fax:
The licensed Design Professional that will be retained for the duration of the project,vvho may provide
information on the Applicant's behalf, and who will prepare and certify the as -built :
Consulting Engineer/Landscape Architect:
Consulting Firm:
K4oi|inQAddremm:
CityState Zip:28026-0268
Phone: Fan:
0. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name &Title:
Organization: __
Mailing Address:
City:_
Phone:
Email:
1. Specify the type ofproject (check ona\: ELow Density
Fax:
El High Density
2. Briefly summarize how the otormwxabarrunoff will betnaated/oonveved:
anads-,fte. d 'tches to conve)4 water, The water is collected in the ditches, crosses the
driveway viaculvert, and then continues off -site through an existingSwale.
3. 8tormwatarrunoff from this project drains to the Riverbasin(s).
4. Receivinq water information (if more than 3receivina waters, Drovide additional information on an attached sheet),
Receiving
Receiving
Receiving
Receiving Stream Name
Far Branch
Stream Classification
C
Stream Index Number
13-17-17-2-1
StonnwaterFast Track ATCApplication Form Page 3of8 Feb.10.2018

5. Proiect area and density information:
Total Property Area
2,049,846 sf
Total Surface Water Area
0 sf
Considered to include:
• the normal pool of impounded structures,
• the area between the banks of streams and rivers, and
• the area below the Normal High Water (NHM line or Mean High Water (MHVL) line.
Total Coastal Wetlands Area
0 sf
Considered to include: coastal wetlands landward from the NHW (or MHK9 line.
Total Project Area
2,049,846 sf
Excludes the surface water area and coastal wetland area identified above.
May or may not be the same as Property Area.
Built -Upon Area (BUA) associated with Existing Development
0 sf
"Existing development" means those projects that are built or those projects that have established a
vested right under North Carolina law as of the effective date of the state stormwater program or
applicable local government ordinance to which the project is subject.
Proposed New BUA 40,554s
(18,054 in new
Includes proposed new BUA that is not associated with existing development. shared access
"BUA" is defined in N. C. G. S. 143-214.7(b2). It includes, but Is not limited to: buildings, roads, parking drive adn up to
areas, sidewalks, and some gravel areas. The design volume of SCMs must take into account the runoff 22,500 in future
from build out from all surfaces draining to the SCM in accordance with 15A NCAC 02H. 1050residential
(l).
homes
Project Density
wl Existing Development: Project Density= [New BUA]I[Total Project Area —Existing BUA] x100 or 1.98
w10 Existing Development- Project Density = [New BUA]ITotal Project Area] x 100
6. Anticipated construction start date July 1, 2021
7. Is the project located within 5 miles of a public airport? E No El Yes
If 'Yes,'see S.L. 2012-200, Part VI: http://www.ncleg.net/Sessions/2011/Bills/Senate/PDF/S229v6.pdf and
DEQ Stormwater Design Manual Chapter E-4 Airports,
8. For projects in Union County: Contact DEMLR Central Office Stormwater staff at 919-707-9200 to determine
if the project is located within a Threatened & Endangered Species watershed that may be subject to more
stringent stormwater requirements per 15A NCA C 02B.0600.
Stormwater Fast Track ATC Application Form Page 4 of 9 Feb. 10,2018

Submit EMLR
Central Office (Urbanizing Areas Ph 2.Ub[NP.Non-Coastal MOW/ORVV. Only application. packages that include
all required items listed below will baaccepted and reviewed.
Initial each item be/owtm{ndiomtmthetihwnnquirmdhwformation/sprovided&nthe application package:
Initials
KWU 1 . Two original signed hard copies and one electronic copy of this State Stormwater Fast Track
Process "Authorization toConstruct" (/Q-C)Permit Application Form.
K}AXJ2.Permit application processing fee uf$505payable toNCDEQ.
K}8/U3. Two hard copies and one electronic copy of a USGS map identifying the project location
and GPS coordinates for the project. If the receiving water is Class SA or the receiving water
drains toClass 8Awaters within }6mile ofthe project boundary.inc|udotha|6mi|onadiue
onthe map. If the project is within 575 feet of Class SA-ORW waters, include the 575-foot
radius onthe map.
KVyL4. Two original signed hard copies and one electronic copy of a site plan depicting the boundary
of the project or project phase currently being permitted, including the locations of SCMs,
streams, wetlands, and buffers,
}J/yl1S. Two hard copies and one electronic copy of a construction sequence that discusses how any
future development unthe project may bophased.
X]A/U0.Acopy ofthe most current property deed. Deed book: 5627'Page No: 217
KA8J�7. [IF APPLICABLE] When the applicant is a corporation or a limited liability corporation (LLC): Provide
two hard copies and one electronic copy nfdocumentation from the NC Secretary ofState, orother
official documentation, which supports the titles and positions held by the persons listed
in Section C.2 per 15A NCAC 2H. 1043(3)(b). The corporation or LLC must be listed as an active
corporation ingood standing with the NC Department ofthe Secretary ofState; otherwise, the
application will be returned.
NkA8. [IF APPLICABLE] When the applicant is a Partnership or other person engaging in business under
onassumed name, attach acopy nfthe Certificate ofAssumed Name.
N/AU. [IF APPLICABLE] When the applicant ionot the property owner: Provide two hard copies and one
electronic copy of lease agreements, affidavits, pending sales agreement, development agreement,
or other documents showing that the applicant has obtained legal rights to submit a stormwater
permit application within the proposed project area.
N/A10. [IF APPLICABLE] |fmodifying enexisting permit for completed orpartially completed projects, aoopy
nfthe designer's certification.
GturmwaterFast Track ATCApplication Form Page 5of8 Feb.10,2018

G. CERTIFICATION OF APPLICANT/ FINANCIALLY RESPONSIBLE PARTY
The Applicant, who isalso the Financially ResponsiblePmdy identified inSection Dufthis form must sign and have
notarized the following guaranty:
| t or type name of ApplicantlFinanciallyReaponoiblePa .
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that:
1. the design has been or will be completed in accordance with the MDC as set forth in Rules 15A NCAC
D2H.1U5Dthrough .1O02'tothe best ofmyknowledge;
2. the completed design meets or will meet the MDC and that the percentage BUA that is the basis for the
design shall not be exceeded, tothe best ofmyknowledge; and
3. As the applicant, I shall maintain a licensed professional of record for the duration of the project
who will prepare and certify the as -built package. |f|retain another licensed
professional before the project then | shall provide anupdated
guaranty with the current licensed professional's seal. Alicensed professional shall inform
the Division if he is no longer associated with this project.
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath I
agree to provide corrected information should there be any change in the information provided herein.
Title or Authority
Signature
|. eNotary Public for the State of
County of dohereby certify that
personally appeared before me this day of 7S f0 rl_Q� Zo 2A and acknowledge the
due execution of the application for a storngw9ter permit. Witness my hand and official seal,
My commission expires 2Q2-
Stormwater Fast Track ATCApplication Form Page 0of9 Feb.10.2018

H. DESIGN PROFESSIONALS CERTIFICATION
Tnbecompleted bythe Design Professional identified inSection D.5.
[ attest tnthe following:
1. This application has been reviewed by me and is accurate and complete, to the best of my knowledge;
2. The design has been completed in accordance with the IVIDC as set forth in Rules 15A NCAC 02H
.1858through 1OG2.amapplicable;
3. The percentage built -upon area that is the basis for the design will not be exceeded; and
4. 1 have the expertise, education, and experience required to design the SCIVIs proposed in this
application inaccordance with the yWUC amset forth inRules 15ANCACO2H.1Ob0through .1O62.
5. 1 will provide all documents and certified as -built plans in hard copy and electronic format related to
this permit to a new Applicant/Property Owner and to DEIVILR upon transfer of this permit to a new
App|icant/PrnpertyOvvner.
Note: In accordance with N.C.G.S. 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation. In addition, any person
who knowingly makes any false statement, representation, or certification in any application may be reported to
the appropriate NC professional lice_4ng board.
06/ 7/2021
Signature: Date:
StormwmterFast Track /QlCApplication Form Page 7of8 Feb.10.2018