SW3170804_Application Form_20170830

R 1 T�, A 1— i--
DEMLR USE ONLY
Date ReceivedFee
Paid
Perrmt Nurnber
/ 1
Applicable R es: ❑ Coastal SW -1995 oastal SW - 2008 Leh II -Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Pl
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICA T F",' JM�
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent withrt nine on plans,
specifications, letters, operation and maintenance agreements, etc.):a%
ALEXANDER
2. Location of Project (street address):
PID# 372 001, NC HWY 152
City:ROCKWELL
County -ROWAN Zip:28138
3. Directions to project (from nearest major intersection):
FROM MAIN STREET AND HWY 152 IN ROCKWELL, NC, TRAVEL WEST ON HWY 152 FOR 1.1 MILES.
PROTECT SITE IS LOCATED ON THE SOUTH SIDE ACROSS FROM SHADY CREEK DRIVE.
4. Latitude:35° 32' 59" N
Longitude -80' 25' 31" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SKU -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, 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):
❑LAMA Major ®Sedimentation/Erosion Control: 32 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? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: b=-//portal.ncdenr.org/web/lr/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: LEN NAR CAROLINAS, LLC
Signing Official & Title -THOMAS TOHNSON - DIRECTOR OF LAND DEVELOPMENT
b. Contact information for person listed in item 1a above:
Street Address:11230 CARMEL COMMONS BLVD
City:CHARLOTTE State:NC Zip:28226
Mailing Address (if applicable):11230 CARMEL COMMONS BLVD
City:CHARLOTTE State:NC Zip:28226
Phone: (704 ) 542-8300 Fax:
Ems: [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. ('Phis is the
person who owns the property that the project is located on):
Property Owner/Organization: NC PROPERTIES I, LLC
Signing Official & Title: DAVID NELSON - MANAGER
b. Contact information for person listed in item 2a above:
Street Address: 2626 GLENWOOD AVENUE, SUITE 550
City: RALEIGH State: NC Zip: 27608
Mailing Address (if applicable):
City: State: Zip:
Phone: ) Fax:
Email:
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:ESP ASSOCIATES, PA
Signing Official & Title:DANIS E SIMMONS, PE
b. Contact information for person listed in item 3a above:
Mailing Address:3475 LAICEMONT BLVD
City:FORT MILL State:SC Zip:29708
Phone: (803 ) 802-2440 Fax: (803 ) 802-2515
Email:[e-mail]
4. Local jurisdiction for building permits: ROWAN COUNTY
Point of Contact:
Phone #: (
Form S1NU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff is collected in catch basins/inlets and redirected into one of two bmp sand filters on site.
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 H - Post Construction
3. Stormwater runoff from this project drains to the Yadkin-PeeDee River basin.
4. Total Property Area: 35.93 acres 5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) =Total Project
Area+:35.93 acres
+ Total project area sliall be calculated to exclude the follazvin : the normal pool of imppou��nded strnchtres, the area
betzveen the banks of streams and rivers, the area belozv the Normal Higlt Water (NHS/) line or Mean High Water
(MHVv) line, and coastal wetlands landward front the NHW (or MHM line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal zvetlattds latzdzvard of the NHW (oz• MHV19 litre stay
be inchzded in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 27.2 %
9. How many drainage areas does the project have?2 (For Itigh density, cozurt I for each proposed engineered
stornnvater BMP. For low densihj and other projects, use I for the zolzole 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 _ Drainage Area
Receiving Stream Name
Second Creek
Second Creek
Stream Class *
C
C
Stream Index Number *
12-117-2
12-117-2
Total Drainage Area (sf)
643817
550163
On-site Drainage Area (so
643817
550163
Off-site Drainage Area (so
0 (bypassed)
0 (bypassed)
Proposed Impervious Area (sf)
220415
206038
% Impervious Area's total)
34.2%
37.5%
Impervious' Surface Area
Drainage Area 1
Drainage Area 2 Drainage Area _ Drainage Area
On-site Buildings/Lots (so
102333
107507
On-site Streets (so
72072
54106
On-site Parking (so
32150
34020
On-site Sidewalks (sf)
13860
10405
Other on-site (so
0
0
Future (so
0
0
Off-site (so
0
0
Existing BUA*** (so
0
0
Total (sf):
220415
206038
* Stream Class and Index Number can be determined at: http.- portal.ncdenr.orgfwebfzvq&s/csu/ciassif cations
Intperviorts area is defined as the bztilt upon area including, but not limited to, buildings, roads, parking areas,
sidezvalks, gravel areas, etc.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

***Report only that amount of existing B UA that zoill retrain after developtriertt. 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. Off-site impervious
area is being bypassed through the proposed development.
Proiects in Union Countv: 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 stornnvater 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://portalncdenr.org/web/­wg/­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 ath=://12ortal.ncdenr.org/web/­wg/­-,vs/­su/maRs )
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://Dortal.ncdenr.org/web/­wg/ivs/su/statesw/­forms docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. TMM
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants TO BE SENT UPON APPROVAL
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M TMM
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to TMM
hU://www.envheIp.org/]Rages/onestol2exl2ress.htmlfor 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.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/ management for SEE CALCS
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the TMM
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). TMM
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: TMM
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.
o 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.
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required). INPEONT UNDER
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify SEPARATE COVER
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: 1168 Page No: 850 TMM
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC TMM
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 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.
htty: / /www.secretarv.state.nc.us/CorlDorations/CSearch.asi)x
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://l2ortal.ncdenr.org/webAr/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:Dannis E Simmons, PE
Consulting Firm: ESP Associates, PA
Mailing Address:3475 Lakemont Blvd
City:Fort Mill State:SC Zip:29708
Phone: (803 ) 802-2440 Fax: (803 ) 802-2515
Email:[e-mail]
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) DAVID NELSON 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) THOMAS JOHNSON with (print or type name of organization listed in
Contact Information, item 1a) LENNAR CAROLINAS, 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.
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 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 ow r. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed m /Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility i ou a valid permit. I understand that the operation of a stormwater treatment facility
without a valid erm t ' a violation of NC General Statue 143-215.1 and may result inappropriate enforcement
action inclu the ss sment of civil penalties of up to $25,000 per day, pursuant to NCGS%143-215.6.
Signature: Date:
I, TI oMaS U • 1"ia'fAMA. � n . . a Notary Public for the State of Soy -VA CA2aUlpft . County of
do hereby certify that ewa"- personally appeared
before me this 2.3mday of AyVI'r 01 and ac wled a due execution of the application for
a stormwater permit. Witness my hand and official seal,
THOMAS J. PATANIA, JR.
NOTARY PUBLIC
Lancaster County, South Carclina
My Commi ion Expires January 9, 2027
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires
I, (print or hype pante of person listed in Contact Information, item Ia) THOMAS JOHNSON
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 N 2H.1000 and any other applicable state stormwat r requirements.
Signature: ter' s Date: $
I, Leo" T f ' S- a Notary Public for the State of r.JOUN CAIt-OVI+1AL- . County of
JAj,K04TeVL- , do hereby certify that T%Wd JWW0, J personally appeared
before me this 23Mday of Zoll , and a ovule a due execution of the application for
a stormwater permit. Witness my hand and official seal,
a
MAS J. PATANIA, JR.NOTARY PUBLICaster County, South CarolinaOmm1SS;or? expires January 9, 2027
SEAL
My commission expires � I at I7-7
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6