SWA000114_Application Form_20210901

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
ELIGIBILITY FOR FAST -TRACK PERMIT
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.
® 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.
® I 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.
® I understand that the Fast Track ATC Permit will expire five years after the date of issuance.
'I- GENERAL INFORMATION
1 Project Name: Crescent Hill Subdivision
2. Previous Project Name (if applicable):
3. Location of Project (street address): Monarch Way
City:Winston Salem County:Forsyth Zip:27106
4. Directions to project (from nearest major intersection):
Project is located at the terminus of Monarch Way approxiamtely 250' SE of the intersection of Caradco Rd
and Mercia Court.
5. Latitude:360 8' 17.19" N Longitude:-800 22' 5.56" 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
Maio[ 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 all that apply):
❑ Coastal SA-HQW ® 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):
Project Name
Permit/Appl
Issue Date
Other Information
No.
CAMA Major
NA
Erosion &
Crescent Hill PRD Subdivision
EN2100070
7/16/2021
Disturbed Area
Sedimentation Control
12.47 acre
NPDES Industrial
NA
Stormwater
404/401 Permit
Crescent Hill Subdivision
20210469
7/6/2021
Proposed Impacts
89 If/ac
4. Local jurisdiction for building permits: Winston Salem
Point of Contact:WS Inspections Office Phone #: (336 ) 727-2624
D. CONTACT INFORMATION
1. Applicant/Financially Responsible Party (may be an Organization): Thyme Properties, LLC
Signing Official Name & Title: Robert Weidl, Member -Manager
Street Address:2255 Lewisville-Clemmons Rd Suite C
City:Clemmons State:NC Zip:27012
Mailing Address (if different):
City: State: Zip:
Phone: [phone] Fax: ( )
Email: robertweidl(o-)hotmail.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:Stephen J. Phillips
Mailing Address:2255 Lewisville-Clemmons Rd Suite C
City:Clemmons State:NC Zip:27012
Phone: [phone] Fax: ( )
Email: Ste phen(o-)zoominter.com
Stormwater Fast Track ATC Application Form Page 2 of 9 Feb. 10, 2018

3. The Applicant is the (check all that apply):
® Property Owner
❑ Lessee (Attach a copy of the lease agreement & complete Item 4.)
❑ Purchaser (Attach a copy of the pending sales agreement & complete Item 4.)
® Developer (Attach a copy of the development agreement & complete Item 4.)
4. If the Applicant is NOT the Property Owner (skip to Item 5 if the Applicant IS the Property Owner):
Property Owner Name/Organization:
Signing Official & Title:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
5. The licensed Design Professional that will be retained for the duration of the project, who may provide
information on the Applicant's behalf, and who will prepare and certify the as -built package:
Consulting Engineer/Landscape Architect: Alex Carter, PE
Consulting Firm: Beeson & Carter, PA
Mailing Address: PO Box 669
City: Walkertown State: NC Zip:27051
Phone: (336 ) 748-0071 Fax: [phone]
Email: acartera-bc-eng.com
6. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
F PROJECT INFORMATI
1. Specify the type of project (check one): ® Low Density ❑ High Density
2. Briefly summarize how the stormwater runoff will be treated/conveyed:
The project conveys stormwater via: 1) Sheet flows from impervious areas across vegetated lot areas. 2)
Concentrated flows from street curb & putter into curb outlets. These outlets exit into minimum 100' grass
swales. Water treatment is provided primarily thouah Infiltration and ET for both convevances.
3. Stormwater runoff from this project drains to the Yadkin Pee -Dee
River basin(s).
4. Receivinq water information (if more than 3 receivinq waters, provide additional information on an attached sheet):
Receiving
Water 1
Receiving
Water 2
Receiving
Water 3
Receiving Stream Name
Oil Mill Branch
Stream Classification
C
Stream Index Number
12-94-6
Stormwater Fast Track ATC Application Form Page 3 of 9 Feb. 10, 2018

5. Project area and density information:
Total Property Area
889570 sf
Total Surface Water Area
7840 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 (NHVIO line or Mean High Water (MHM line.
Total Coastal Wetlands Area
0 sf
Considered to include: coastal wetlands landward from the NHW (or MHM line.
Total Project Area
881730 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
211465 sf
Includes proposed new BUA that is not associated with existing development.
`BUA" is defined in N. C.G.S. 143-214.7(b2). It includes, but is not limited to: buildings, roads, parking
areas, sidewalks, and some gravel areas. The design volume of SCMs must take into account the runoff
from build out from all surfaces draining to the SCM in accordance with 15A NCAC 02H .1050(1).
Project Density
w/ Existing Development: Project Density = [New BUA]/[Total Project Area —Existing BUA] x 100 or
23,8 %
w/o Existing Development: Project Density = [New BUA]/Total Project Area] x 100
6. Anticipated construction start date As soon as possible
7. Is the project located within 5 miles of a public airport? ® No ❑ 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 NCAC 02B .0600.
Stormwater Fast Track ATC Application Form Page 4 of 9 Feb. 10, 2018

F. SUBMITTAL REQUIREME
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORW). Only application packages that include
all required items listed below will be accepted and reviewed.
Initial each item below to indicate that the required information is provided in the application package:
Initials
1. Two original signed hard copies and one electronic copy of this State Stormwater Fast Track
Process "Authorization to Construct" (ATC) Permit Application Form.
2. Permit application processing fee of $505 payable to NCDEQ.
3. 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 to Class SA waters within 'h mile of the project boundary, include the 'h mile radius
on the map. If the project is within 575 feet of Class SA-ORW waters, include the 575-foot
radius on the map.
AC 4. 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.
AC 5. Two hard copies and one electronic copy of a construction sequence that discusses how any
future development on the project may be phased.
AC 6. A copy of the most current property deed. Deed book: 3503, 3527 Page No: 460, 3937
AC 7. [IF APPLICABLE] When the applicant is a corporation or a limited liability corporation (LLC): Provide
two hard copies and one electronic copy of documentation from the NC Secretary of State, or other
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 in good standing with the NC Department of the Secretary of State; otherwise, the
application will be returned. https://www.sosnc.,qov/search/index/corp
N/A 8. [IF APPLICABLE] When the applicant is a Partnership or other person engaging in business under
an assumed name, attach a copy of the Certificate of Assumed Name.
N/A 9. [IF APPLICABLE] When the applicant is not 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/A 10. [IF APPLICABLE] If modifying an existing permit for completed or partially completed projects, a copy
of the designer's certification.
Stormwater Fast Track ATC Application Form Page 5 of 9 Feb. 10, 2018

G. CERTIFICATION OF APPLICANT/ FINANCIALLY RESPONSIBLE PARTY
The Applicant, who is also the Financially Responsible Party, identified in Section D of this form must sign and have
notarized the following guaranty:
I, (print or type name of Applicant/Financially Responsible Party) Thyme Properties. LLC
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
02H .1050 through .1062, to the best of my knowledge;
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, to the best of my knowledge; 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. If I retain another licensed
professional before the project is complete, then I shall provide an updated
guaranty with the current licensed professional's seal. A licensed 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.
Robert Weidl Member -Manager
Type t name Title or Authority
Signature V L,Date
a Notary Public for the State of LSO( �2 C AV(x--�,
County of � xS( 'l-m do hereby certify that
personally appeared before me this day of I�K and acknowledge the
due execution.of the applicatign-;�}a stormwwater permit. Witnessqny hand and official seal,
Nickie Parker
NOUry Public, North Carolina
Forsyth County
My Commission Expires April 12, 2W6
SEAL
My commission expires 0 L'1- 12 " Z. 02

H. DESIGN PROFESSIONAL'S CERTIFICATION
To be completed by the Design Professional identified in Section D.5.
I, Alex Carter, PE , attest to the 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 MDC as set forth in Rules 15A NCAC 02H
.1050 through .1062, as applicable;
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 SCMs proposed in this
application in accordance with the MDC as set forth in Rules 15A NCAC 02H .1050 through .1062.
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 DEMLR upon transfer of this permit to a new
Applicant/Property Owner.
Note: In accordance with N.C.G.S. 143-215.6A and 143-215.6B, 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 licensing board.
Signature: Date: ��`/ Z
`` 0ti01 4411111 f 11l11/1///j/
CARpjvN,,,,
74 "
�!f �rll N I I I I f illly111��1�\
SEAL
Stormwater Fast Track ATC Application Form Page 7 of 9 Feb. 10, 2018

Operation & Maintenance Agreement
Project Name:
Project Location:
Crescent Hill Subdivision
Winston Salem, NC
Cover Page
Maintenance records shall be kept on the following SCM(s). This maintenance record shall be kept in a log in a known set location.
Any deficient SCM elements noted in the inspection will be corrected, repaired, or replaced immediately. These deficiencies can
affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the SCM(s).
The SCM(s) on this project include (check all that apply & correspor
Infiltration Basin
Quantity:
Infiltration Trench
Quantity:
Bioretention Cell
Quantity:
Wet Pond
Quantity:
Stormwater Wetland
Quantity:
Permeable Pavement
Quantity:
Sand Filter
Quantity:
Rainwater Harvesting
Quantity:
Green Roof
Quantity:
Level Spreader - Filter Strip
Quantity:
Proprietary System
Quantity:
Treatment Swale
Quantity:
Dry Pond
Quantity:
Disconnected Impervious Surface
Present:
No
User Defined SCM
Present:
No
Low Density
Present:
Yes
O&M sheets will
Location(s):
Location(s):
Location(s):
Location(s).
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location (s ):
Location(s):
Location(s):
Location(s):
Type:
be added a
Curb outlet system f
acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each SCM above, and attached O&M tables_ I agree to notify NCDEQ of any problems with the system or prior to any changes to
the system or responsible parry.
Responsible Party:
Title & Organization:
Street address:
City, state, zip:
Phone number(s):
Email:
Signature:
County of
Robert Weidl
Member -Manager, Thyme Properties, LLC
2255 Lewisville-Clemmons Rd Suite C
Clemmons, NC 27012
336-577-7775
[e-mail]
Date: 8
a Notary Public for the State of ( 0-wcklo )
do hereby certify that V)pbe�'c We-\C�
personally appeared before me this 2n� day of and
acknowledge the due execution of the Operations and Main ce Agreemen .
Witness my hand and official seal, �
No" Public, North Cwdho
Forsyth Cairyty
Commisslon E mires ADA IL i
Seal
My commission expires
nuL- 12 - W 2(y

Low Density Residential Subdivisions with Curb Outlet Swales
Deed Restrictions & Protective Covenances
In accordance with Title 15 NCAC 02H.1000, the Stormwater Management Regulations, deed restrictions and
protective covenants are required for Low Density Residential Subdivisions with curb outlet swales,
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, Thyme Properties, LLC acknowledge and affirm by my signature below, that 1 will cause the following
deed restrictions and protective covenants to be recorded for Crescent Hill Subdivision prior to the sale of
any lot:
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 3025 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
goveming maximum built -upon area for that lot shall be the most restrictive of the two.
8. This project includes a curb outlet system. Each designated curb outlet swale shall be maintained in
accordance with the designs shown on the approved plans. This requires a minimum of 100' long with
3:1 (H:V) side slopes or flatter, have a longitudinal slope no steeper than 5%, carry the flow from a 10
year storm in a non -erosive manner, maintain a trapezoidal cross-section with a minimum bottom width
of 2, and maintain a dense vegetated cover.
9. 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.
10. Each lot will maintain a 30* foot wide vegetated buffer between all impervious areas and surface
waters.
11. All roof drains shall terminate at least 30* foot from the mean high water mark of surface waters.
12. Filling in, piping or altering any designated 3:1 curb outlet swale associated with the development is
prohibited by any persons.
*50 foot for projects located in the 20 coastal counties.
Form DRPC-6 Rev 20170420 Page 1 of 2

Low Density Residential Subdivisions with Curb Outlet Swales
Deed Restrictions & Protective Covenances
c
Signature:_ ' Date: 47 Z � z
I, M 1-C K i e PAY Y-ieY a Notary Public in the
State of _N9X)L County of F�4QS'q T
do hereby certify that RebeC \r�ek6\ personally appeared
before me this the 2 day of �C.l��[ 20 2 and acknowledge
the due execution of the foregoing instrument. Witness my hand and official seal,
SEAL
Signature Nfd*fe Parkw
NO" Pubfic, North CSIOWa
My Commission expires (.,H i Z' Za Z �D ForsythCounly
sA
My Commission Expires April 12, 2028
Form DRPC-6 Rev 20170420 Page 2 of 2