SW3170403 - McBride Place Energy

014 37U ,g4 DEMLR USE ONLY
0-50
5° Date Received Fee Paid Permit Number Sw 7 Q 03
Applicable Rules: 7 Coastal SW-1995 ! Coastal SW-2008 Ph II-Post Construction
(select all that apply) ` 'Non-Coastal SW-HQW/ORW Waters 7 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, D1('
specifications,letters,operation and maintenance agreements,etc.): `
McBride Place Energy VI
2. Location of Project(street address): l/ d, 113
9375 US Highway 601 South ` � ��5k
City: N/A County: Cabarrus Zip: �" / 0 7 � �(j'• p,,o
3. Directions to project(from nearest major intersection):
Entrance to Breaker Station(Entrance#2)is on Mt.Pleasant Road,2.12 miles north of its intersection with
Route 601 and 0.70 miles south of its intersection with Route 1190,Joyner Road.
Entrance#1 in on Route 601,opposite its intersection with Cal Bost Road.
4. Latitude:35° 17'6"N Longitude:80°30'28.8"W of the main entrance to the project.
35. Qy / -8a-37ois
II. PERMIT INFORMATION:
1.a.Specify whether project is(check one): X New Modification Renewal w/ Modificationt
tRenewals with modifications also requires SWLI-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):
X 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:484.7 ac of Disturbed Area
NPDES Industrial Stormwater 404/401 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:
5. Is the project located within 5 miles of a public airport? X No Yes
If yes,see S.L.2012-200,Part VI:ltttp://portal.ncdenr.orglweb/Ir/rules-and-regulations
Form SWU-101 Version Oct.31,2013 Page 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: McBride Place Energy LLC
Signing Official&Title: Henry T.'Tal'McBride,III Managing Member
b.Contact information for person listed in item la above:
Street Address: 202 Johnson Street
City: Bristol State: VA Zip: 24201
Mailing Address(if applicable): 2002 Lee Highway,#16005
City: Bristol State: VA Zip: 24209
Phone: ( 571) 228-5105 Fax: ( )
Email: [e-mail]
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: Five M's LLC
Signing Official&Title: Henry T.McBride Manager
b.Contact information for person listed in item 2a above:
Street Address:202 Johnson Street
City: Bristol State:VA Zip:24201
Mailing Address(if applicable): 2002 Lee Highway,#16005
City: Bristol State: VA Zip: 24209
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:
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: Cabarrus County,NC
Point of Contact: Matt Love Phone#: (704) 361-8979 Email: [e-mail]
Form SWU-l01 Version Oct.31,2013 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
During construction stormwater will be controlled with several channels and sediment basins as shown
on a DEQ approved plan.Approval Date:Feb.27,2017
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 PUP Approval Date:Feb.27,2017
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_627.55 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area:5.69 acres
7. Total Property Area(4)—Total Coastal Wetlands Area(5)—Total Surface Water Area(6)=Total Project Area+:
621.86 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
(MHW)line,and coastal wetlands landward from the NHW(or MHW)line. The resultant project area is used to
calculate overall percent built upon area(BUA). Non-coastal wetlands landward of the NHW(or MHW)line'may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area)X 100 =0.3%
9. How many drainage areas does the project have?2Q(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 4
Receiving Stream Name Rocky River Rocky River Bost Creek Bost Creek
Stream Class * C C C C
Stream Index Number* 13-17 13-17 13-17-12 13-17-12
Total Drainage Area (sf) 766,656 862,488 936,540 1,276,308
On-site Drainage Area (sf) 766,656 862,488 936,540 1,276,308
Off-site Drainage Area (sf) 0 0 0 0
Proposed Impervious Area** 910 475 1360 1020
(sf)
%Impervious Area**(total) 0.12% 0.06% 0.15% 0.08%
Form SWU-101 Version Oct.31,2013 Page 3 of 7

Impervious*Surface Area Drainage Area 1 Drainage Area 2 Drainage Area 3 Drainage Area 4
On-site Buildings/Lots(sf) 0 0 0 0
On-site Streets (sf) 0 0 0 0
On-site Parking (sf) 0 0 0 0
On-site Sidewalks (sf) 0 0 0 0
Other on-site (sf) 910 475 1360 1020
Future(sf) 0 0 0 0
Off-site (sf) 0 0 0 0
Existing BUA***(sf) 0 0 0 0
Total (sf): 910 475 1360 1020
Stream Class and Index Number can be determined at: http:/lportal.ncdenr.orglweblwglps/csu/classifications
Impervious areas defined as the built upon area including,but not limited to,buildings,roads,parking areas,
sidewaks,gravel areas,etc.
'F 'F 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 BUA.
11. How was the off-site impervious area listed above determined?Provide documentation.N/A
Projects in Union County: 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 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 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 http://portal.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 http://portal.ncdenr.org/web/wq/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 1
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 Mt7
the project. This is required in addition to the brief summary provided in the Project
Information,item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the oat
receiving stream drains to class SA waters within 1h mile of the site boundary,include the 1/
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: Tom(
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 MI IW 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 MEM(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
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].) ] Altr I � �.y� �7'
10. A copy of the most current property deed.Deed book: e X72 Page No: 1`� ` / l�-f�
11. For corporations and limited liability corporations(LLC):Provide documentation from the NC r
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 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.
Form SWU-101 Version Oct.31,2013 Page 5 of 7

5. A detailed narrative(one to two pages)describing the stormwater treatment/management for
the project. This is required in addition to the brief summary provided in the Project
Information,item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the 1-17-441L
receiving stream drains to class SA waters within lh mile of the site boundary,include the 1
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.
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 NI IW)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 tiP--i--
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:Snc'l Jule a site visit for DEMLR to verify the SH WT prior
to submittal, [phone].)
Tit '`� 1,.tc 'P A
10. A copy of the most current property deed.Deed book: Page No:
11. For corporations and limited liability corporations(LLC):Provide documentation from the NC a .._i
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 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 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 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

5. A detailed narrative(one to two pages)describing the stormwater treatment/management for kit
the project. This is required in addition to the brief summary provided in the Project
Information,item 1. frriliti
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/
mile radius on the map. 144
7. Sealed,signed and dated calculations(one copy).
8. Two sets of plans folded to 8.5"x 14" (sealed,signed,&dated),including: au £
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.
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). ti i
9. Copy of any applicable soils report with the associated SHWT elevations(Please identify (1 ( 11
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].) 1116N6(l � � I2Z t/®,
10. A copy of the most current pro er !761 ty deed.Deed book: Page No: -7M
11. For corporations and limited liability corporations(LLC):Provide documentation from the NC -'--=�-T-T
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 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 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 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

5. A detailed narrative(one to two pages)describing the stormwater treatment/management for ,1-
the project. This is required in addition to the brief summary provided in the Project
Information,item 1.
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�h
mile radius on the map.
7. Sealed,signed and dated calculations(one copy). 14P111
8. Two sets of plans folded to 8.5"x 14" (sealed,signed, &dated),including: 41110
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.
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 VAr L#
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%R0•Schedule a site visit for DEMLR to verify the SHWT prior
to submittal, [phone].) ei 1
10. A copy of the most current property deed. Ueed book: Page No: ern/
11. For corporations and limited liability corporations(LLC):Provide documentation from the NC sem! LI
Secretary of State or other official documentation,which supports the titles and positions held .y
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:/Iwww.secretary.state.nc.us/
Corporations/CSearch.asp
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 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 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 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:Edmond H.Blackwell,P.E.
Consulting Firm:Blackwell Engineering,PLC
Mailing Address:566 E.Market Street
City:Harrisonburg State:VA Zip:22801
Phone: (540) 432-9555 Fax: (540) 434-7604
Email: [e-mail]
IX. PROPERTY OWNER AUTHORIZATION(if Contact Information,item 2 has been filled out,complete this
section)
I,Henry T.McBride,certify that Five M's LLC owns the property identified in this permit application,and thus
give permission to McBride Place Energy LLC with Tal McBride as the contact person 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/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 ivil penalties of up to$25,000 per day,pursuant to NCGS 143-215.6.
Signature: S 14272 (C
g � Date: 4%1—
L. i ,a otary Public for the State of V u' OU 1 l Ota ,County of
•OC r\ hLYYl, do hereby certify that r\rc j T. mC,a race -.r. personally appeared
before me this day of Apri,L , 2Olt] ,and acknowledge the due execution of the application for
1
a stormwater permit. Witness my hand and official seal, /
9©000011©6,88
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® :REGISTRATION C o m'
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SEAL
My commission expires ‘3.,- 31-20
Form SWU-101 Version Oct.31,2013 Page 6 of 7

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: McBride Place Energy LLC
Signing Official&Title: Henry T.'Tal'McBride,III Managing Member
b.Contact information for person listed in item la above:
Street Address: 2002 Lee Highway,#16005
City: Bristol State: VA Zip: 24209
Mailing Address(if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
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: E.T 'Gene'Bost III
Signing Official&Title: Owner of 220.73 acres(delineated areas of 54,7.52,1.27.and 157.94 acres)included in
the Project
b.Contact information for person listed in item 2a above:
Street Address: 4701 NC Highway 200
City: Concord State: NC Zip: 28025
Mailing Address(if applicable):
City: State: Zip:
Phone: ( 704 ) 782-1600 Fax: ( )
Email: eugenetbostegmail.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:
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:
Point of Contact: Phone#: ( )
Form SWU-101 Version Oct.31,2013 Page 2 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:Edmond H Blackwell,P.E.
Consulting Firm:Blackwell Engineering,PLC
Mailing Address:566 E.Market Street
City:Harrisonburg, State:VA Zip:22801
Phone: (540 ) 432-9555 Fax: (540 ) 434-7604
Email:
IAC. 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) E.T.Bost, III 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 la) Henry T.McBride,Illwith(print or type name of organization listed in
Contact Information,item 1a) McBride Place Energy LLC 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/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: / . " ' I Date: V/7 2 b/ 7
I, 1 I KO C, LO 1 \SU" ,a Notary Public for the State of North Carolina ,County of
Cabarrus ,do hereby certify that E.T.Bost, Ill personally appeared
before me this l day of April ,2017 ,and acknowledge the due exe tion of the application for
1
a stormwater permit. Witness my hand and official seal, (IV/ ( t ( ,^_,(1 ,J�-�
J
6`S'q�i I I19 BF VV"
4e„
fo T4 ` `YC
' ,�.. \
ii Commission Expires
n 2/3/19 U
�� aj���Li�' 1 ='
+"1. YS Onto6S'(.41;1 k�
SEAL
My commission expires c2/31 20! 17
Form SWU-101 Version Oct.31,2013 Page 6 of 7

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: McBride Place Energy LLC
Signing Official&Title: Henry T.'Tal'McBride,III Managing Member
b.Contact information for person listed in item la above:
Street Address: 2002 Lee Highway,#16005
City: Bristol State: VA Zip: 24209
Mailing Address(if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
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: S4 3 P PramsL
LC �/
Signing Official&Title: 1, ° ,,c%t `!N , ML=Yi 8,r t flfr-6-,
b.Contact information for person listed in item 2a above:
Street Address: 117- EAir W 61-11 1.01 $TK-e
City: Ne170000 State: 1W c- Zip: 2S v
Mailing Addresst (if applicable): Po 0 —y- D
City: 1v0'�-W00'9 State: NJ t/ Zip: ZiC 12.$
Phone: ( 7c 1+ ) 14:714' S...°1 0 C Fax: ( )
Email: '�',$ 0 u-KrA
@ afig0 slizeityiL
,N6-1"---
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:
Point of Contact: Phone#: ( )
Form SWU-101 Version Oct.31,2013 Page 2 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:Edmond H Blackwell,P.E.
Consulting Firm:Blackwell Engineering,PLC
Mailing Address:566 E.Market Street
City:Harrisonburg, State:VA Zip:22801
Phone: (540 ) 432-9555 Fax: (540 ) 434-7604
Email:
IX. PROPERTY OWNER AUTHORIZATION(if Contact Information, item 2 has been filled out,complete this
section)
tLEfLmei Le5uE7ov04, V.-
I, (print or type name of person listed in Contact Information,item 2a) (SP4c5 ciaratakSLL�'� ,certify that I
own the property identified in this permit application,and thus v permission to(print or type name of person
listed in Contact Information,item 1n) Itfl1 7. 'T L/ht6B/4h(print or type name of organization listed in
Contact Information,item la)M IA1,6 Qeatt' E? 'Lg.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/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: 16 �Y"' Date: Qt�kZit- 7 2477
p
L �-° thifirb3 ,a Notary Public for the State of irk-- ,County of
,do hereby certify that V : i-11/4„e �;z 1 .- personally appeared
before me this day of i l , 72 i'1,and ackn ledge the
due execution of the application for
a stormwater permit. Witness my hand and official seal, 2
SPY uRurr ���/,
NOTARY
PUBLIC
SEAL
My commission expires 1.0 - ,c) I I
Form SWU-10I Version Oct.31,2013 Page 6 of 7

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: McBride Place Energy LLC
Signing Official&Title: Henry T.'Tal'McBride,III Managing Member
b.Contact information for person listed in item la above:
Street Address: 2002 Lee Highway, #16005
City: Bristol State: VA Zip: 24209
Mailing Address(if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
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 Contactinformation,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: ()DA n A �=1 vei((f a, rl 4deiVajc/e. 71 'f\ &) ,; f 1
Signing Official&Title: af4 -P J c Yl-t;2e 47d&e.2,d1) z ' ,&../��
b.Contact information for per listed in item 2a above:
Street Address:// /�I I\(P,u) S re,e.
City: AI,'r,, n,9 d State: A V Zip: � q i ,9,,
Mailing Address (if applicable): p,Q. 6-La
City: Ajartekad, State: AY/_. Zip: 2
Phone: (7v 0 ) -7Zi .30,, Fax: ( )
Email: Jr.174c,n e,i iI 0 iifind cTYP_e_T m, i4
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:
Point of Contact: _ Phone#: ( )
Form SWU-101 Version Oct.31,2013 Page 2 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:Edmond H Blackwell,P.E.
Consulting Firm:Blackwell Engineering,PLC
MailingAddress:566 E.Market Street
City:Harrisonburg, State:VA Zip:22801
Phone: (540 ) 432-9555 - Fax: (540 ) 434-7604
Email:
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information,item 2 has been filledlout,complete this
section) John P .GN6( 1./
744174410,I,(print or type name of person listed in Contact Information,item 2a) � l a i�•j p Y./n&A. j/tertify that I
own the property identified in this permit application,and thus give permission to(print or type name of person
Iisted in Contact Information,item 1a) gem- , e f ith(print or type name of organization listed in
Contact Information, item 1a)JI' • • e tc5-4lgvelop the project as currently proposed. A copy of
the lease agreement or pending property sales contract 'a 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/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.
Signature4e,:P.2 2Z. 4PEe-e/ Date: 4'7' .//v l /
I, 14'nu .j 176e.,61--4 ,a Notary Public for the State of ,County of
6 ,do hereby certify that ? >fL 1. personally appeared
before me this '1 day of t ')rt t , Zol'1 ,and ac owledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
o�RanH, a/,
NOTARY
PUBLIC 2G`I
/1/4,„„„2200
SEAL
My commission expires a�� I D ' ?it 19
Form SWU-101 Version Oct.31,2013 Page 6 of 7

X. APPLICANT'S CERTIFICATION
I,Henry Talmage McBride,III,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 re ii irements. r /
Signature: /f,I_'..,Al / /" / Date:April 7th,2017
I, cJovizi 4-fAo.v. /-1(- r,,,o ,a Notary Public for the State of JIovq-lam Caroiv, , County of
in?ct IGe. ,do hereby certify that f.\-e.or)T "Tal Pa-Iv-11,i(_. personally appeared
before me this 7 day of Aio,r,'i , .?-r2t1 ,an cknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, 4 "67-.
JONATHAN AL NO
NOTARY PUB IC
Wake County, C
My Commission Expires gust 15,2021
SEAL
My commission expires Aver g-1- ISI 2021
Form SWU-101 Version Oct.31,2013 Page 7 of 7