Grace One Church - Signed-SSW-SWU-101-Application-DEMLR-SPU Oct 2013

DEMLR USE ONLY 
Date Received Fee Paid Permit Number 

Applicable Rules: … Coastal 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:

Form SWU-101 Version Oct. 31, 2013 Page 1 of 6
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.):
Grace One Church
2. Location of Project (street address):
2609 Chestnut Lane
City:Matthews County:Union Zip:28104
3. Directions to project (from nearest major intersection):
2300 feet east from the intersection of Chestnut Lane and Weddinton Road

4. Latitude:35° 03’ 40.72” N Longitude:80° 43’ 13.74” W of the main entrance to the project.

II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): New Modification Renewal w/ Modification†
†Renewals 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 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: 5.20 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: http://portal.ncdenr.org/web/lr/rules‐and‐regulations 
Form SWU-101 Version Oct. 31, 2013 Page 2 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:Charlotte Grace One Christ Church
Signing Official & Title:Pastor Haohsin Huang
b. Contact information for person listed in item 1a above:
Street Address:2609 Chestnut Lane
City:Matthews State:NC Zip:28104
Mailing Address (if applicable):
City: State: Zip:
Phone: (704 ) 980-9264 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:
Signing Official & Title:
b. Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
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:
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: Union County
Point of Contact:Building Code Enforcement Phone #: (704 ) 283-3643

Form SWU-101 Version Oct. 31, 2013 Page 3 of 6
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
SW runoff will be treated via a sandfilter/dry detention basin

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 Catawba River basin.
4. Total Property Area: 14.59 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) – Total Coastal Wetlands Area (5) – Total Surface Water Area (6) = Total Project
Area+: 14.59 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 = 24.7 %
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information Drainage Area 1 Drainage Area Drainage Area Drainage Area
Receiving Stream Name Westfork Twelve
Mile Creek

Stream Class * C
Stream Index Number * 11-138-1
Total Drainage Area (sf) 250034
On-site Drainage Area (sf) 250034
Off-site Drainage Area (sf) 0
Proposed Impervious Area** (sf) 174,240
% Impervious Area** (total) 70.0

Impervious** Surface Area Drainage Area 1 Drainage Area Drainage Area Drainage Area
On-site Buildings/Lots (sf) 15,761
On-site Streets (sf) 0
On-site Parking (sf) 59,361
On-site Sidewalks (sf) 6,030
Other on-site (sf)
Future (sf) 89,444
Off-site (sf)
Existing BUA*** (sf) 3,644
Total (sf): 174,240
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
** Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas, sidewalks, gravel areas, etc.