SW3220202_Application Form_20221101 (2)

IV. PROJECT INFORMATION
1. In the space provided below, br_ _ iefly summarize how the stormwater runoff will be treated.
STORMWATER RUNOFF WILL BE CAPTURED BY ONE PERMANENT SCM, A SAND FILTER
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:
❑ VaIid 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 II - Post Construction
3. Stormwater runoff from this project drains to the CATAWBA River basin.
4. Total Property Area: 17.40 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0.10 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area+:17.30 acres
+ Total project area shall be calculated to exclude the followin : the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal Hfggh Water (NHWj line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHM line. The resultant pproject area is used to
calculate overall percent built upon area (BUA). Nan -coastal zetlands landward of tlae NHW (orMHM litre may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 28.9 %
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 2
Drainage Area 3
Drainage Area _
Receiving Stream Name
12 Mile Creek
Stream Class *
C
Stream Index Number *
11-138
Total Drainage Area (so
310,359
On -site Drainage Area (so
310,359
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
218,019
% Impervious Area** totaI
70.2
Impervious" Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area _
On -site Buildings/Lots (so
30,392
On -site Streets (so
0
On -site Parking (so
127,196
On -site Sidewalks (so
15,180
Other on -site (so
1,251
Future (sf)
44,000
Off -site (so
0
Existing BUA*** (so
0
Total (so:
218,019
* Stream Class and Index Number can be determined at: ht ortal.iictleiir.orgLzvebAvg&slcsiilclassiLcatioiis
Impervious 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

o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (PIease 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 verifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 7686 Page No: 0838
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 la, 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 Iot number, Iot 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 http1Lportal.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:MORGAN WOOLNER, PE _
Consulting Firm: ALFRED BENESCH & COMPANY
Mailing Address:2359 PERIMETER POINTE PARKWAY, SUITE 350
City:CHARLOTTE
State:NC Zip:28208
Phone: (704 ) 521-9880 Fax: (704_ ) 521-8955
Email: MWOOLNERQBENESCH.COM
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or hype name of person Iisted in Contact Information, item 2a) t°i. certify that I
own the property identified in this permit application, and thus give permission (print or hype name of person
listed in Contact Information, item 1 a) with (print or tape name of organization listed in
Contact Information, item Ia) 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 Iisted 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 un&rstand that the operation of a stormwater treatment facility
without a valid per is a v' la ion of C G t eral Statue 143-215.1 and may result hi appropriate enforcement
action including as a en civil a s of up to $2.5,000 per day, pursuant to NCG®S 14-215.6.
Signature: Date: P 6 a
_ 1
1,
a Notary Public for the State of
County of
U- , do hereby certify that W-E�.C/ZJ personally appeared
before me thiaAk day of and acknowledge the due execution of the application for
a stormwater permit. Witt ss my han and official seal,
Wendy F Davenport ; SEAL
NOTARY PUBLIC
Union County, NC
Commission Expires September 10, 2022 My commission expires-------------
O U 2
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listen in Contact Information, item[ Ia} �� � �.�.
certify that the information included on this permit application form is, to the best my krnowle ge, correct and
that the project will be construct d it confor an e with the approved plans, that e required deed restrictions
and protective covena wil bfi re `ded, a d t t the proposed project complies with the requirements of the
applicable stormwa �y/rle fder 5 NC .1000 and any other applicable state stormw ter req 'rements.
Signature: •J Date:
G� !
I, a Notary Public for the State ofiYtl.d1_ COWL, County of
do hereby certify that personally appeared
before me thisi day ofA �� and acknowledge the due execution of the application for
a stormwater permit. Witne my hand Ind official seal,
Wendy F Davenport
NofARY PUBLIC
Union County, NC
My Commission Expires September 11, 2122
SEAL
My commission expires D ,
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6