SW3140601_Stormwater Management Permit Application _9/10/2019

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
1i
Applicable Rules: 0 Coastal SW - 1995 0 Coastal SW - 2008 0 Ph II - Post Construction
(select all that apply) 0 Non -Coastal SW- HQW/ORW Waters El Universal Stormwater Management Plan
1 0 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.):
Courtykirds Alt Marvin
-
2. Location of Project (street address):
2012 Providence Road South
City:Marvin County:Union Zip:28173
3. Directions to project (from nearest major intersection):
North 0.25 miles of Providence Road South and Bonds Grove Church Road.
4. Latitude:34' 58' 43" N _ Longitude:801 46' 23" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ONew ®Modification 171 Renewal w/ Modificationt
tReneioals with modifications also requires SWU-102 - Renemul Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
-permit numberaW .3140661 its issue date (if known) JIfly 3 2014,and the status of
construction: nNot Started [Partially Completed* 0 Completed" *provide a designer's certification
2. Specify the type of project (check one):
[]Low Density CgHigh Density nDrains 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 app
lication, 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).
J:1CAMA Major OSedimentation /Erosion Control: 18.96 ac of Disturbed Area
[]NPDES Industrial Stormwater 0404/401 Permit: Proposed Impacts Excavation and fill placement and
installation of culvert
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:Courtvards at Marvin, 404 Pert
nit_
Courtyards at Marvin, Sedmintatign and E-rosio ControlNCG010000
5. Is the project located within 5 miles of a public airport? ®No [-]Yes
If yes, see S.L. 2012-200, Part VI., tit ��strtal.ncdenr.org�iyebllrlrulcs-ancl-;ul<�tions
Form SWU-101 Version Oct. 31,2013 Pagel of6

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 Q6Lls the Dr 'ect):
Applicant/Organization:Epcon Marvin LLC
Signing Official & Title:Bob Kardos-J&qgional PresidentRECON Carolinas
b.Contact information for person listed in item la above:
Street Address:11020 David Taylor Drive, Suite 1.05
City:Charlotte -- State:NC Zip:28262
Mailing Address (if applicable):LIQZO.D4vict_lay]_Qr Drive,Suite
City:Charlotte State:NC Zip:28262
Phone: 704 __ 997-8316 e Fax:
Ei-ni)il:bkai,dosOgp!�oncqjnMLI[litieS
c. Please check the appropriate box. The applicant listed above is:
Z The property owner (Skip to Contact 1'riformation, item 3a)
0 Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
0 Purchaser' (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
21) below)
0 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:_
Mailing Address (if applicable):
City:_
Phone -
State: Zi
State: Zip:
Fax:
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:Scott Twiddy/EPCON Communities
Signing Official & Title:Scott Twidd.y/Land Manager
b.Contact information for person listed in item 3a above:
Mailing Address:11020 David Tailor DLquite 105
City:Charlotte State:NC Zip:28262
Phone: [phone] Fax: C__
EmaiI:�tv�Lid�dyRL,pgoi.icom!n mites.,corn jaLL-.� --
4. Local jurisdiction for building permits: Village of Marvin
Point of Contact:Rohit Ammanamanchi Phone#: [phone] ext.104
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. hi the space provided below, briefly summarize how the stormwater runoff will be treated.
Stonnwater runoff will be treated in it wetpond consisting of two ba.inconiectedan e -ualizer pipe.
2.
Basin Information
Drainage Area I
Drainage Area
Drainage Area _
Drainage Area
Receiving Stream Name
Twelve Mile
Creek
Stream Class
C
Stream Index Number
11-138
Total Drainage Area (sf)
1,098,148
On -site Drainage Area (sf)
-Off-site
621,601
Drainage Area (sf)
476,546
Proposed Impervious Area** (sf)
328,780
% Impervious Area" (total)
29.94
Impervious** Surface Area
Drainage Area I.
Drainage Area
Drainage Area
Drainage Area
On -site Buildings Lots (sf)
241,417
On -site Streets (sf)
69,448
On -site Parking (sf)
900
On -site Sidewalks (sf)
17,015
Other on -site (sf)
-
Future (sf)
Off -site (8f)
-
Existing BUA*** (sf)
0
I Total —(sf)-
L 328,780
Stream Class and Index Number can be determined at: hilpl
lin ervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
shrlen lalks, gravel areas, etc.
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
Form SWU- 10 1 Version Oct. 31, 2013 Page 3 of 6

Projects ill Uniotl Cowtty: 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 t�kt:l?:.1.lpoz ittl,� � denr,org%ouch Gvc�Jws su ULlip--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
11pox tal.izccle�itnrg/tt�l�j4uc /u� sLsu stateswirn�s fines. 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 1ttiC ,.//pnt:t�Ei - cdcnr-qr web wcl� sti/t� pti.)
Please indicate that the followW required information have been provided by inifiat ng 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 lyttp:Jpc�rtt�l,t�ccict3r atg/ovEsLkvti/o��s/su,jsknk!/Fot�7� dc�cs.
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) Seale i 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
(tttp:/1'www.envhelp.or pages/onestopnx),reas litml 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,)
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
receiving stream drains to class SA waters within 1h mile of the site boundary, include the Y2
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 NHW) of tidal waters.
L 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).
Form SWU-101 Version Oct, 31, 2013 Page 4 of 6

Copy of any applicable soils report with
elevations in addition to depths) as well
elevations and boring logs. Include an 8.
project area clearly delineated. For projr
include the soil type, expected infiltratic
(Infiltration Devices submitted to WiR
to submittal, [phone].)
the associated SHWT plevatL ns (Please identify _
as a map of the boring locations with the existing
5"x11" copy of the NRCS County Soils reap with the
ets with infiltration BMPs, the report should also
i rate, and the method of determining the infiltration rate.
3: Schedule as site visit, f or DEA41.1? to verifi/ the SHWT prior
10. A copy of the most current property deed. Deed book: 6178 Page No: 693
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
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.
Littp://www.seca•etat�y,st.,3te.nc.0 lCprporations CSearch.asp-N.
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparceis, 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 t tt �: 1>0� tal.ncdenr.orglwebflr/stake storm4v�rter-
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.
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 Engineen-Bi an Rossi
Consulting Firm: EM1-I&T
Mailing Address:301 MrCcallough Drive Suite 109
City:Charl2tte State:NC Zip:28262
Phone: (704 ) 548-0333
Email:brossi �entht corn
Fax: (704 ) 548-0334
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type matte of*person listed in Contact In of nnaation, item 2ca) certify that I
own the property identified in this permit application, and thus give permission to (print or type mine of person
listed in Contact lift rnation, item 1a) wild (print of, type nalne e>f orgarnizafiort lasted in
Contact trrfor•rncatnin, item 1a) 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 storanwater 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 pend ing 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 DFMLR 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:
Date:
I, ___.__ __. _.__..._.__, a Notary Public for the State of , County of
_._ do hereby certify that _..,_ personally appeared
before me this — day of -_ , and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal, mm .
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
1, (lariat or type nanne of person 10ed in Contact lnff>rnration, item 7a) .�_ _77 . 5__
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 confor lance with the approved plans, that the required deed restrictions
and protective cove pants will be recorder and that the proposed project complies with the requirements of the
applicable stormwo er r les and(r 1 A CAC 21-1 .1000 and any other applicable state stormwater requirements.
Signature: Date:
I, .hf1Q Lv) Ov a Notary Public for the State of (� o Z_ (� (`C _eo\,�.� _ , Countyof
do hereby certify that �_Cillo__ personally appeared
before me this _1`1 day of U CA -_. ____, s 6 and ac owledge the due e. ecution of the application for a
stormwater permit. Witness my hand and official seal, t e C22
NOTARY W
3 PUBLIC aC4
.:
SEAL
My Commission
Expires April il, 2023
My commission expires_
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6