SW5210701_Application Form_20210707

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
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
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for 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.):
Beaver Creek Subdivision, Phase 2 & 3
2. Location of Project (street address):
Claude Lewis Road
City:Middlesex County:Nash Zip:27557
3. Directions to project (from nearest major intersection):
Located at the intersection of Beaver Dam Road (NCSR 1111) and Claude Lewis Roas (NCSR 1101)
4. Latitude:350 46' 18.5592" N Longitude:-780 10' 56.1216" 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 , 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 ❑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):
❑CAMA Major ®Sedimentation/Erosion Control:11.0 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:
Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: httl2://12ortal.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:Little Bear Creek Properties, LLC
Signing Official & Title:David Geiger - Owner
b. Contact information for person listed in item 1a above:
Street Address:755 Ranch Road
City:Cla
State:NC
Zip:27520
Mailing Address (if applicable):755 Ranch Road
City:Clayton State:NC Zip:27520
Phone: (919 ) 612-5531 Fax: ( ) none
Email:littlebear-creek.com
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 &
b. Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( 1 Fax: ( 1
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: Town of Middlesex
Point of Contact:Luther Lewis -mayor Phone #: (252 ) 235-5761
Form SWU-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.
not applicable
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 11- Post Construction
3. Stormwater runoff from this project drains to the Neuse River basin.
4. Total Property Area: 36.324 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+:36.324 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
(MHVv) line, and coastal wetlands landward from the NHW (or MHM line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHV0 line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 23.90
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.
Basin Information
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
Receiving Stream Name
Beaverdam
Creek
Stream Class
QNSW
Stream Index Number *
24-86-3-8
Total Drainage Area (sf)
1,584,565
On -site Drainage Area (sf)
1,582,273
Off -site Drainage Area (sf)
2,292
Proposed Im ervious Area** (sf)
378,168
Impervious Area** (total)
23.90
Impervious- Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
259,363 sf
On -site Streets (sf)
67,362 sf
On -site Parking (so
2,267 sf
On -site Sidewalks (so
378 sf
Other on -site (so
0
Future (so
46,506 sf
Off -site (sf)
2,292 sf
Existing BUA*** (so
0
Total (sf):
378,168 sf
Stream Class and Index Number can be determined at: http.aortal.ncdenr.or web/wg&s/csu/classifications
Im ervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

'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 B UA.
11. How was the off -site impervious area listed above determined? Provide documentation. see attached
Proiects in Union Countv: 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 I5A 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 htt2://j2ortal.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 httj2://j2ortal.ncdenr.org/web/w!j/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
http:/ /www.envhelp.org/pages/onestopexpress.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 for
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 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. The signed paper document was
c. Location map with named streets and NCSR numbers. mailed to NCDEQ. Refer to the
d. Legend. paper signed document, which you
e. North arrow. received via mail.
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).
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 SHWT 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 DEMLR to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 3038 Page No: 548
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
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 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
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:Stephen 1. Ballentine
Consulting Firm: Rivers & Associates, Inc.
Mailing Address:353 E. Six Forks Road
City:Raleigh State:NC Zip:27609
Phone: (919 ) 594-1626 Fax: ( ) N/A
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) r , 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) with (print or type name of organization listed in
Contact Information, item 1a) 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 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: Date:
I,
a Notary Public for the State of
do hereby certify that
before me this _ day of
County of
personally appeared
, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
The signed paper document was
mailed to NCDEQ. Refer to the
paper signed document, which you
X. APPLICANT'S CERTIFICATION received via mail.
I, (print or type name of person listed in Contact Information, item 1a) David Geiger
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 under 15A NCAC 21-1.1000 and any other applicable state stormwater requirements.
Signature: Date:
I, , a Notary Public for the State of County of
do hereby certify that
before me this _ day of
personally appeared
, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6

Low Density Residential Subdivisions
Deed Restrictions & Protective Covenances
In accordance with Title 15 NCAC 21-1.1000 and S.L. 2006-246, the Stormwater Management
Regulations, deed restrictions and protective covenants are required for Low Density Residential
Subdivisions where lots will be subdivided and sold. Deed restrictions and protective covenants are
necessary to ensure that the development maintains a "built -upon" area consistent with the applicable
regulation governing the density level.
I, David Geiger acknowledge and affirm by my signature below, that I will cause the following deed
restrictions and protective covenants to be recorded for Beaver Creek Subdivision Phase 2 & 3 prior to
the sale of any lot:
1. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number , as issued by the Division of Energy, Mineral and
Land Resources under the Stormwater Management Regulations.
2. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to
maintain compliance with the stormwater management permit.
3. These covenants are to run with the land and be binding on all persons and parties claiming
under them.
4. The covenants pertaining to stormwater may not be altered or rescinded without the express
written consent of the State of North Carolina, Division of Energy, Mineral and Land Resources.
5. Alteration of the drainage as shown on the approved plan may not take place without the
concurrence of the Division of Energy, Mineral and Land Resources.
6. The maximum allowable built -upon area per lot is 8,000 square feet. This allotted amount includes
any built -upon area constructed within the lot 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, and coquina, but does
not include raised, open wood decking, or the water surface of swimming pools.
7. In the case of a lot within CAMA's regulated AEC, where the Division of Coastal Management
calculates a different maximum allowable built -upon area for that lot than is shown herein, the
governing maximum built -upon area for that lot shall be the most restrictive of the two.
8. Filling in or piping of any vegetative conveyances (ditches, swales, etc.) associated with the
development except for average driveway crossings is strictly prohibited by any persons.
9. Each lot will maintain a 30* foot wide vegetated buffer between all impervious areas and surface
waters.
10. All roof drains shall terminate at least 30* foot from the mean high water mark of surface waters.
The signed paper document was mailed to NCDEQ. Refer
*50 foot for projects located in the 20 coastal counties, to the paper signed document, which you received via mail.
Signature: Date:
State of , County of
do hereby certify that
before me this the day of
a Notary Public in the
rsonally appeared
20 , and acknowledge
the due execution of the foregoing instrument. Witness my hand and official seal,
SEAL
Signature
My Commission expires
Form DRPC-5 Rev.2 05Nov2009 Page 1 of 1

Lot Number Allowable Built -Upon Area
24
8,000 sf
25
8,000 sf
26
8,000 sf
27
8,000 sf
28
8,000 sf
29
8,000 sf
30
8,000 sf
31
8,000 sf
32
8,000 sf
33
8,000 sf
34
8,000 sf
35
8,000 sf
36
8,000 sf
37
8,000 sf
38
8,000 sf
39
8,000 sf
40
8,000 sf
41
8,000 sf
42
8,000 sf
43
8,000 sf
44
8,000 sf
45
8,000 sf
46
8,000 sf
47
8,000 sf
48
8,000 sf
49
8,000 sf
50
8,000 sf
51
8,000 sf
52
8,000 sf
53
8,000 sf
54
8,000 sf
55
8,000 sf
Mail Kiosk Lot 8,000 sf

i� ivers
& ASSOCIATES, INC.
SInw 1918
ENGINEERS, PLANNERS, SURVEYORS & LANDSCAPE ARCHITECTS
NARRATIVE
BEAVER CREEK SUBDIVISION PHASE 2 AND 3
NASH COUNTY, NORTH CAROLINA
107 East 2-1 Street
6/17/2021
oz
14,
e �
■ � 5FJ1l.
■
26493 iuu `
F-0334 Greenville NC 27858
Cell:252-714-3002 Office:252-752-4135
sjanowski@riversandassocia tes.com

1
i Y�rs
ATES. INC,
SIRm 191E
ENGINEERS,PLANNERS, SURVEYORS& LANDSCAPE ARCHITECTS
Narrative:
This is a prosed 32-lot single-family residential subdivision with 40,000 sf minimum lot sizes, and
includes a mail kiosk, parking lot, and NCDOT roads. The roads will have vegetated ditches. The
roads will not have curb and gutter. Storm pipe conveyances are limited to culvert road and
driveway crossings. This project is located in the Town of Middlesex zoning jurisdiction and is in
Nash County. Deed restrictions and protective covenants are attached, which will limit the
impervious allocation for each lot, so that the project is less than 24% impervious and qualifies for
Low Density.
tormwater Management Reutdrements:
This project is located in the Neuse River Basin and is applying to NCDEQ for a Low Density
Stormwater Permit, which requires that the project not exceed a 24% impervious limit. Any
proposed storm pipe conveyances are to be limited to culverts under roads and driveways.
NCDEQ has confirmed that there are no nitrogen nor phosphorus limits for this project, which is
located within the Town of Middlesex jurisdiction. Since this is a Low Density project, there are
no requirements for this project to construct a stormwater SCM. There are no known stormwater
detention requirements for this project.
There is a jurisdictional stream and Neuse Riparian Stream Buffer running along the west
perimeter of Phase 3. Wetlands were mapped by Dan Bliley, and are located along the west portion
of Phase 3.
This project drains to Beaverdam Creek, which is classified as QNSW waters.
The completed project will consist of one 36.324 acre project.
IMPERVIOUS AREA
CALCULATIONS
Roadway
Allocation per lot
Mail Kiosk Lot
Impervious Contingency
Total Impervious area
% Impervious Area
107 East 2iic7 Street
69,354 sf
8,000 sf x 32 lots = 256,000 sf
8,000 sf
44,814 sf
378,168 sf = 8.6815 ac
23.90%
F-0334 Greenville NC
27858
Cell:252-714-3002 Office:252-752-4135
[e-mail]

t 0
lVe-S
8 ASSOCIATES, INC
Since 1919
ENGINEERS,PLANNERS, SURVEYORS S LANDSCAPEARCHrrECTS
APPENDIX
107 East 2nd Street F-0334 Greenville NC 27858
Cell:252-714-3002 Office:252-752-4135 [e-mail]

North Carolina Secretary of State Search Results
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Limited Liability Company
Legal Name
Little Bear Creek Properties , LLC
Information
Sosld: 1745953
Status: Current -Active O
Date Formed: 8/31 /2018
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnuaL Report Status:
Registered Agent: Kristoff, Lawrence E, II
Addresses
Reg Office
444 East Main Street
Clayton, NC 27520
Reg Mailing
444 East Main Street
Clayton, NC 27520
Company Officials
Mailing
755 Ranch Road
Clayton, NC 27520
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Member/Manager Member/Manager
David Geiger Karen Geiger
755 Ranch Road 755 Ranch Road
Clayton NC 27520 Clayton NC 27520
Principal Office
755 Ranch Road
Clayton, NC 27520
https://www.sosnc.gov/online_services/search/Business_Registration_ResuIts 1 /1