SW3221006_Application Form_20221214

DEMLR USE ONLY
Date Received Fee Paid
Permit Number
Applicable Rules: ❑ CoastaI 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.):
Cottages at Wingate - Phases 1 & 2
2. Location of Project (street address):
Maye Street
City: Win ate County:Union Zip:28174
3. Directions to project (from nearest major intersection):
This project is located apRioximately 0.2 miles north of the intersection of Ed ewood Dr. and Andrew
ackson Highway Highway 74). The project is accessed from Ed ewood Dr. and Ma e St.
4. Latitude:340 59' 25.281" N Longitude:800 28' 1.4772" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification [] RenewaI w/ Modificationt
tRenewals with modifications also requires STNU 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, Iist 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: 81.33 ac of Disturbed Area
❑NPDES Industrial Stormwater Z404/401 Permit: Proposed Impacts Stream crossing for sewer tie-in
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 Dyes
If yes, see S.L. 2012-200, Part VL httplportal.ncdenr.or Iweb/l,r/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:H&H Constructors of Fayetteville
Signing Official & Titlejay C. Lewis 11 General Manager
b. Contact information for person listed in item 1a above:
Street Address:8601 Six Forks Rd
City:Ralei h State:NC Zip:27615
Mailing Address (if applicable):
City: State:
Phone: [phone] Fax:
Email:N A
Zip:
c. 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: DFC Wingate, LLC
Signing Official & Title:C. H. Swan Vice President
b. Contact information for person listed in item 2a above:
Street Address:13000 Saw ass Village Circle
City:Ponte Vedra Beach State:Florida Zip:32082
Mailing Address (if applicable):
City: State: Zip:
Phone: [phone] Fax:
Email:[e-mail]
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:H&H Constructors of Fayetteville „
Signing Official & Title:Marwan Shahin Vice President Land
b. Contact information for person listed in item 3a above:
Mailing Address:2411 Robeson Street Suite 200
City:Fa etteville
Phone: [phone]
EmaiI:[e-mail]
State: NC Zip:28305
Fax: ( )
4. Local jurisdiction for building permits: Town of Wingate
Point of Contact:Brad Sellers Phone #: [phone]
F'ortn SWU-101 Version Oct. 31, 2013 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be. treated.
Stormwater runoff for the entire 12yoJect will be treated throw h the utilization of 4 stormwater ponds
installed throughout the site at multi le different low points of the site. Phase I will use 3 different
stormwater ponds for treatment of runoff while Phase 2 will utilize I additional pond and one of the ponds
constructed with Phase I of the development.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ ApprovaI of a Site Specific Development Plan or PUD Appxoval 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 II - Post Construction
3. Stormwater runoff from this project drains to the Yadkin Pee -Dee River basin.
4. Total Property Area: 136.07 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area,17.43 acres
Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:118,64 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 (NIBIQ line or Mean High Water
(MHW) 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 (orMHW) line may
be included in the total project area.
Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 20.1
9. How many drainage areas does the project have?4 (For high density, count I for each proposed engineered
stormwater BMP. For low densifij and other projects, use 1 for the whole properhj 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.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 7

Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
Receiving Stream Name
Flag Branch
Flag Branch
FIag Branch
Flag Branch
Stream Class *
C
C
C
C
Stream Index Number *
13-17-36-8-2
13-17-36-8-2
13-17-36-8-2
13-17-36-8-2
Total Drainage Area (sf)
1,496,875
1,019,236
459,558
233,461
On -site Drainage Area (sf)
1,391,325
1,001,463
459,558
233,461
Off -site Drainage Area (sf)
105,550
17,773
0
0
Proposed Impervious Area** s
572,937
376,794
174,676
65,776
Impervious Area** total
38 %
37%
38 %
28 %
Irir ervious** Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
On -site Buildings/Lots (sf)
262,231
195,149
93,654
34,848
On -site Streets (so
167,270
99,752
50,530
18,295
On -site Parking (so
98,010
56,192
26,136
10,019
On -site Sidewalks (sf)
42,689
25,700
4,356
2,614
Other on -site (so
0
0
0
0
Future (sf)
0
0
0
0
Off -site (so
26,136
0
0
0
Existing BUA*** (sf)
0
0
0
0
Total (so.
596,336
376,794
174,676
65,776
Stream Glass and index Number can be determined at: ht : ortal.ncdenr.orgZLyebAvqJLs&su classifications
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
"* 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 BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. Combination of
aerial and county GIS.
Projects in Union Count : ContactDL MLR 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 15A 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 h ortal.ncdenr.or. web w ws su bm -manual.
Vt. 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 http:/ / portal.ncdenr.org/webf wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialin 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 hgp://12ortal.ncdenr.org/web/wq/­ws/su/statesw/forms docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application .Form. MK
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants MK
Form. (if required as per Part V 1 below)
3. Original of the applicable Supplement Form(s) (sealed si ed and dated) and O&M MK
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to MK
hqp://w-ww.envhel-D.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.)
Form SWU-101 Version Oct. 31, 2013 Page 4 of

5. A detailed narrative (one to two pages) describing the stormwater treatment/management for MK
6, A USGS map identifying the site location. If the receiving stream is reported as class SA or the MK
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. SeaIed, signed and dated calculations (one copy). MK
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: MK
a, Development/Project name.
b. Engineer and firm.
c. Location neap 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).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify MK
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: 8389 Page No: 428, 455, 459 MK
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC MK
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.
h!fp:/ /www.secretary.state.ne.us/Coporations/­CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
Fox 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 aIIowable 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 httl2://portal.nedenr.org/web lr/state-
stormwater-forms does. 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 therm, 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.
Fonu SWU-101 Version Oct. 31, 2013 Page 5 of 7

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:Matthew C. Kirchner
Consulting Firm: Eagle En ineerin
Mailing Address:2013-A Van Buren Avenue
City:Indian Trail
Phone: [phone]
Email:[e-mail]
State:NC Zip:28079
Fax: l 1
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) C. H. Swan 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) fall C. Lewis II with (print or type name of organization listed in
Contact Information, item 1a) H&H Constructors o Fay etteville 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.
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
Iease 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 t assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
lei �a
Signa
Date: /'f `� Z Z,
I, k Ayn 4 ..1..1r _ , a Notary Public for the State of County of
64- >A" 5_ . do herebycertify that �� SW6tvi
f3' personally appeared
before me this —9— day of /1 Putvn be _ , and acknowledge the xecution of the application for
a stormwater permit. Witness my hand and official seal, - Z�;�
SEAL Notary PUbk State of Florida
William Geaman III
4Uf My Commiss+on HH 282355
E)(Aires 6/2912t026
My commission expires
Form SWU-101 Version Oct. 31, 2013 Page 6 of 7

X. APPLICANT'S CERTIFICATION
1, (pant or type name of person Iisted in Contact Information, item 1a)1!g C. Lewis II
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 2H .1000 and any other applicable state stormwater requirements.
Date:
a Notary Public for the State of A&,gnn CevRo1i mp, , County of
IMaF "Ja q do hereby certify that 3 Le'- personally appeared
before me this )Y day of Novi a2 A and ack wl ge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
JOHN 0, 0 GA
NOTARY PUBLIC ..
WckJenburg County
North Carol{na
My Commission Expfrr 07/12/2025
SEAL,
My commission expires 7
Dorm SYVU-101 Version Oct. 31, 2013 Page 7 of 7