SW3221006_Application Form_20230419

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: El Coastal SW -1995 ❑ Coastal SW - 2008 El Ph Il - Post Construction
(select all, that apply) ❑ Non -Coastal S[N- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt 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 nzay 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, Ietters, operation and maintenance agreements, etc.):
Cottages at Wingate - Phases 1 & 2
2. Location of Project (street address):
Maye Street
City:Wingate County:Union Zip:28174
3. Directions to project (from nearest major intersection):
This project is located approximately 0.2 miles north of the intersection of Edgewood Dr. and Andrew
Tackson Highway fHighway 74) The project is accessed from Edgewood Dr. and Maye St
4. Latitude:340 59' 25.281" N Longitude:80128' 1.4772" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): NNew ❑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 NHigh Density ❑Drains to an Offsite Stormwater System ❑Other
If this application is being submitted as the result of a previously returned application or a Ietter 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 NSedimentation/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:___
5. Is the project located within 5 miles of a public airport? NNo ❑Yes
If yes, see S.L. 2012-200, Part VI. http://portal.ncdenr.org/web/ir/­­rLiles-and-regulations
Form SWU-101 Version Oct. 31, 2013 Page I 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):
AmAicant/Orizanization: H&H Constructors of Fayetteville
Signing Official & TitIe:ia.y C. Lewis II, General Manager.
b. Contact information for person listed in item 1a above:
Street Address: 8601 Six Forks Road
City: Raleh State:NC Zvi :27615
Mailing Address (if applicable):
City: State: Zip:
Phone: [phone] Fax:
Emai1:N/A
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
9ow)
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:Shelby Cattle Farm, LLC
Signing Official & Title:Dennis Maser, President
b. Contact information for person listed in item 2a above:
Street Address: 231 Post Office Drive
City:Indian Trail State: NC - Zip:28079
Mailing Address (if applicable):
City: State: Zip:
Phone: [phone] Fax:
Email: tcrouch@ themosereroupinc.com
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:Fayetteville State:NC Zip:28305
Phone: (980 } 417-2126 Fax: ( _
Email:[e-mail]
4. Local jurisdiction for building permits: Town of Wingate
Point of Cnntart•Rrarl Sellars Phone #: 704 ) 233-4411
Form SWU-101 Version Oct. 31, 2013 Page 2 of 7

IV. PROJECT INFORMATION
I. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff for the entire project will be treated through the utilization of 4 stoxmwater_ponds
installed throughout the site at multiple different low points of the site. Phase 1 will use 3 different
stormwater ponds for treatment of runoff while Phase 2 will utilize 1 additional pond and one of the ponds
constructed with Phase 1 of the development.
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 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
7. 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 (NHtN) 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 (or MHM line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 20.1
9. How many drainage areas does the project have74 (For high densihj, count 1 for each proposed engineered
stormwater BMP. For low density 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.
Forin 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
flag 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 (so
1,496,875
1,019,236
459,674
233,461
On -site Drainage Area (sf)
1,391,325
1,001,463
459,674
233,461
Off -site Drainage Area (so
105,550
17,773
0
0
Proposed Impervious Area**(so
578,768
376,873
174,676
65,776
Impervious Area** (total)
39%
37%
38%
28%
Impervious- Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Draina e Area 4
On -site Buildings/Lots (so
268,213
195,325
93,548
34,697
On -site Streets (sf)
161,288
99,656
50,836
18,446
On -site Parking (sf)
98,010
56,192
26,136
10,019
On -site Sidewalks (so
42,689
25,700
4,356
2,614
Other on -site (so
0
0
0
0
Future (s0
0
0
0
0
Off -site (so
8,568
0
0
0
Existing BUA*** (so
0
0
0
174,676 1165,776
0
Total (so:
1 578,768
_
376,873
x' Stream Class and Index Nu nber can be deterinined at: 1,ffn:/f)inrfal.ncdem•.or-g/zveblzvra/ps/csulelassificatioits
xx limited to, buildings, roads, parking areas,
***iceport onty tnat amount of existing 13UA 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. Combination of
aerial and_county GIS.
Proiects in Union County: Contact DEAILR Central Office stafflo check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent slormwaler requirements as per 1 SA NC11C 0213.0600.
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 1-ittl2://12ortal.ncdenr.org/web/wQ/ws/su/biii12-iiianual.
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://12ortal.ncdettr.org/web/wQ/ws/su/statesw/forms does. 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/web/wd/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 Iatest versions
for each submitted application package from htt /portal.ncdenr.org/web wq ws su statesw forms does.
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 VI1 below)
3. Original of the applicable Supplement Form(s) (sealed, signed 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
1-itt2://www.envhelp.org/12ages/onestol2exl2ress.1-itml 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 7

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 sheam 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. Sealed, 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 map 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.
in. 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).
�. 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 verij the SHWT prior
to subnttal, [phone].)
10. A copy of the most current property deed. Deed book: 8389 Page No: 428, 455, 459 M K
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 1a, 2a, and/or 3a per 15A NCAC 21-1.1003(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.secretar,y.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 Iot 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-.Aportal.ncdenr.org/web/lr/state-
stormwater-forms dots. 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.
Form SWU-101 Version Oct. 31, 2013 Page 5 of 7

VIII. CONSULTANT INFORIMATION 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 Engineering
Mailing Ad.dress:2013-A Van Buren Avenue
Citv:Indian Trail
Phone: (704 ) 882-4222
Email: mkirchner®eagleonlitie. net
State:NC
Fax:
Zip:28079
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) Shelby Cattle Farm, LLC , certify that I
own the property identified in this permit application, and thus give permission to (print or hjpe name of person
listed in Contact Information, item 1a) Dennis Moser with (print or hjpe name of organization listed in
Contact Information, item 1a) H&H Constructors of Fayettville 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
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/ nership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility with valid permit. I understand that the operation of a stormwater treatment facility
without a valid perm' v'6lation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including th s ent of civil penalties of up to $25,000 per day, pursuant to NC 14/3-215.6.
Signature: Date:
I, K� (L G Y. L 1 11 , a Notary Public for the State of Ale-- County of
do hereby certify that ✓1 f S��• MO5P� personally appeared
before me this � day of / ,L -w Z�, and wledge the due executio f the application for
a stormwater permit. Witness my hand and official seal, Al I
RAENAE H. LITTLE
NOTARY PUBLIC
Stanly County
North Carolina
My Commission Expires April 16, 2027
SEAL
My commission expires:
Form SWU-101 Version Oct. 31, 2013 Page 6 of 7

X. APPLICANT'S CERTIFICATION
I, (print or hjpe name of person listed in Contact Information, item 1a) lay 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.
Signature:
I,
Date: G t' Ly, 2✓
a Notary Public for the State of _N-ngni (Wgi, mg- , County of
Yin ttFruR,a c� , do hereby certify that _�A-y C Lcti 6, f7— personally appeared
before me this 29 day of _IVOW4 tlaoas__, and ack jl wl��ige the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
JOHN D, OSINOA
NOTARY PUSLiC
Mecklenburg County
North Carolina
My Commission Expires 07/12/2026
My commission expires 7La1-1)08
Form SWU-101 Version Oct. 31, 2013 Page 7 of 7