SW3150102_CURRENT PERMIT_20150306

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO. SW�OIO�
DOC TYPECURRENT PERMIT
`❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ .COMPLIANCE EVALUATION INSPECTION
DOC DATE��30(/�
YYYYMMDD

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Richard Angino
Sari and Associates NC, LLC
463-1/2 Carolina Circle
Winston-Salem, North Carolina 27104
Dear Mr. Angino:
Donald R. van der Vaart
1�,,,• Secretary
i
March 6, 2C99Flq�,O
Mqy � •. cis
i
Subject: Stormwater Permit No. SW3150102
The Retreat at Statesville Apartment Complex
High Density Wet Detention Stormwater Project
Statesville, Iredell County
The Stormwater Permitting Unit received a complete package for The Retreat at Statesville
Apartment Complex project on March 3, 2015. Staff review of the plans and specifications has
determined that the project, as proposed, will comply with the Stormwater Regulations set forth in
Title 15A NCAC 2H.1000 and Session Law 2006-246. We are forwarding this Stormwater
Management Permit No. SW3150102, issued March 6, 2015, for the construction, operation and
maintenance of the subject project and the stormwater BMPs.
This permit shall be effective from the original date of issuance until March 6, 2023, and shall be
subject to the conditions and limitations as specified therein, and does not supersede any other
agency permit that may be required. Please pay special attention to the conditions listed in this
permit regarding the Operation and Maintenance of the BMP(s), recordation of deed restrictions,
procedures for changes of ownership, transferring the permit, and renewing the permit. Failure to
establish an adequate system for operation and maintenance of the stormwater management
system, to record deed restrictions, to follow the procedures for transfer of the permit, or to renew
the permit, will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing by filing a written petition with the Office of Administrative
Hearings (OAH). The written petition must conform to Chapter 150B of the North Carolina General
Statutes. Per NCGS 143-215(e) the petition must be filed with the OAH within thirty (30) days of
receipt of this permit. You should contact the OAH with all questions regarding the filing fee (if a
filing fee is required) and/or the details of the filing process at 6714 Mail Service Center, Raleigh,
NC 27699-6714, or via telephone at 919-431-3000, or visit their website at www.NCOAH.com.
Unless such demands are made this permit shall be final and binding.
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://portal.ncdenr.org/web/Ir/
An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper

Mr. Richard Angino
Sari and Associates NC, LLC
SW3150102 -- The Retreat at Statesville, Iredell County
March 6, 2015
Page 2
After thirty days from the date of this letter, this project will be kept on file at the NCDENR Division
of Energy, Mineral and Land Resources, Land Quality Section, Mooresville Regional Office. If you
have questions after that time, please contact Zahid Khan, zahid.khan(a)ncdenr.gov, or Samar
Bou-Ghazale, samar.bou-ghazaleCa.ncdenr.gov of that office. Until that time, if you have any
questions or need additional information concerning this permit, please contact Bill Diuguid at (919)
807-6369; or bill.diuguid(ancdenr.gov.
Sincerely,
Original signed by William H Diuguid
William H. Diuguid, AICP, Plans Reviewer
for Tracy E. Davis, P.E., CPM
Director, Division of Energy,
Mineral and Land Resources
cc: NCDENR DEMLR Mooresville Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments

State Stormwater Permit
Permit No.SW3150102
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Sari and Associates NC, LLC
for The Retreat at Statesville Apartment Complex
Adjacent to 182 North Pointe Blvd
Statesville, Iredell County
FOR THE
construction, operation and maintenance of one wet detention basin in compliance with
the provisions of 15A NCAC 2H .1000 and S.L. 2006-246 (hereafter referred to as the
"stormwater rules') and the approved stormwater management plans and specifications
and other supporting data as attached and on file with and approved by the Division of
Energy, Mineral and Land Resources (DEMLR), Land Quality Section and considered a
part of this permit.
This permit dated March 6, 2015 shall be effective from the original permit date of
issuance until March 6, 2023, and shall be subject to the following specified conditions
and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 of this permit. The stormwater control has been
designed to handle the runoff from 96,547 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.7
of this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
Page 1 of 7

State Stormwater Permit
Permit No.SW3150102
The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
7. The following design criteria have been provided in the revised wet detention
basin design and must be maintained at design condition:
Wet Detention Basin
a.
Drainage Area, aSres:
4.35
Onsite, ft :
189,398
Offsite, ft2:
1
b.
Total Impervioys Surfaces, ft2:
96,547
Buildings ft :
31,708
Roads/Parking, ft2:
57,406
Other, ft2 -sidewalks
7,433
Future, ft�:
0
C.
Pond Depth, feet, b.shelf to sediment top:
5.0
d.
TSS removal efficiency:
90%
e.
Design Storm: inches
1.0
f.
Permanent Pool Elevation, FMSJ� :
93.5
g.
Permitted Surface Area @PP ft :
6,142
h.
Permitted Storage Volume, ftJ:
22,051
i.
Storage Elevation, FMSL:
94.6
j.
Controlling Orifice: inches
1.50
k.
Permanent Pool Volume, ft3:
13,235
l..
Forebay Volume, ft3:
2,608
m.
Receiving Stream/River Basin:
Fourth Creek, Yadkin River Basin
n.
Stream Index Number:
12-108-20
o.
Classification of Water Body:
"C"
II. SCHEDULE OF COMPLIANCE
1. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the completion of any
built -upon surface and the issuance of any certificate of occupancy.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions at optimum
efficiency. The approved Operation and Maintenance Plan must be followed in
its entirety and maintenance must occur at the scheduled intervals including, but
not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
Page 2 of 7

State Stormwater Permit
Permit No.SW3150102
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DEMLR. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
5. The stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with other
supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
7. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
8. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of ten years from the date of the completion of
construction.
12. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
Page 3 of 7

State Stormwater Permit
Permit No.SW3150102
III. GENERAL CONDITIONS
1. This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form, to the Division of Energy,
Mineral and Land Resources, Land Quality Section, signed by both parties, and
accompanied by supporting documentation as listed on page 2 of the form. The
project must be in good standing with the Division. The approval of this request
will be considered on its merits and may or may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Energy, Mineral
and Land Resources, Land Quality Section, in accordance with North Carolina
General Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11.The permittee shall notify the Division of any name, ownership or mailing
address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Page 4 of 7

State Stormwater Permit
Permit No.SW3150102
This Permit issued this the 6th day of March , 2015.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Original Signed by William H Diuguid
William H. Diuguid, AICP, Plans Reviewer
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 5 of 7

State Stormwater Permit
Permit No.SW3150102
The Retreat at Statesville Apartment Complex
Stormwater Permit No. SW3150102
Statesville, Iredell County
Designer's Certification
I, , as a duly registered
in the State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
The Retreat at Statesville Apartment Complex
(Project)
for
Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number _
Date
SEAL
Page 6 of 7

State Stormwater Permit
Permit No.SW3150102
Certification Requirements:
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
Please submit this Designer's Certification to: Zahid Khan, Regional Engineer
NCDENR DEMLR
Mooresville Regional Office
Land Quality Section
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Page 7 of 7

Statesville, NC IREDELL County
ti�yvT
The Retreat at Statesville (apartment coaplex) g,� A
•
Statesville, NC IREDELL County rN®
Benjamin B. Thomas, PE, West Consultants, PLL'", G' `R
,'Application
Type of application: _ New Permit
Only complete application packages will be accepted and reviewed. A complete package includes all of'Rilms in the checklist
below. Add any comments, and indicate the page or plan sheet number where the following information can be found. Please
indicate that you have provided the following required information by initialing in the space provided next to each item.
spart I ;Submittal;Checklist
Notes/comments Initials
1 Original and one copy of this application form (all worksheets) and the permit
$505
application fee. For applications submitted to the DEMLR regular permitting
program, the fee is $505 payable to NCDENR. For Express Review, click on the
link below for information and fee schedule. Contact the appropriate regional
office Express Review Coordinator to schedule the required pre -application
meeting.
Click here for Express Permitting info
2 A USGS map identifying the site location. If the receiving stream is reported as
class SA or the receiving stream drains to and is within 1/2 mile of SA waters,
then include the 1/2 mile radius on the map.
3 A copy of the most current property deed. JOB
1059, PG 635
4 Two copies of additional calculations (as needed). Sealed, signed and dated.
5iT;
6 Two sets of sealed, signed, & dated full-sized plans of the entire site at a
rr'
% 'Y-
readable scale, including:
a. Project name, engineer and firm, revision number and dates.
, �L
b. Location map with street names and SR numbers, legend, north arrow,
4
scale.
c. Dimensioned property/project boundary with bearings & distances.
%�-/
d. The boundaries of all surface waters, regulatory flood zones, and protected
riparian buffers or a note on the plans that none exist.
e. The boundaries of all vegetated or protected riparian buffers.
N/A
I. Site layout showing all built -upon areas, drainage features, stormwater
collection systems (inlets, outlets, swales, pipe elevations, slopes and
diameters), and SCMs at ultimate build -out.
M
g. Existing contours, proposed contours, spot elevations, and fnishe
IRM
IS
_ /
II�
—�II11
elevations.
r
h. Existing drainage (including off -site), drainage easements, pipe si
&01J
A N 0 9 2015
runoff calculations.
i. Drainage area boundaries (included in the main set of plans, not a
a
,
- WATER RESOURCES
separate document).
DEN
j. Existing and proposed maintenance access routes, utility easeme
drainage easements, public rights -of -way etc.
k. A construction sequence that shows how the SCMs will be protected from
.L
sediment until the entire drainage area is stabilized.
6 Two sets of sealed, signed, & dated full-sized plan details of each SCM (or
typical if appropriate) in both plan view and cross-section at a scale of 1" = 30' of
/
I I=
4y JJ
/' +7'
larger, including:
a. Dimensions, side slopes, length to width ratios and elevations with a
benchmark for clean -out if appropriate.
b. All applicable conveyance devices, including: bypass structure,
pretreatment area, Flow distribution device, underdrains, outlet device, outlet
dissipater and level spreader.
c. A table of elevations, incremental volumes and accumulated volumes (if
see stage -storage table in talcs
applicable).
d. Specifications for applicable materials, such as planting media, aggregate,
Ott
sod, underdrains, outlet devices, etc.
STORM-EZ 12131 /2014
Version 1.4 Application Page 1 of 5

Statesville, NC IREDELL County
7 Two sealed, signed, & dated planting plans for each SCM (or typical) at a scale
T • !G'
of V = 20' or larger, as applicable, including:
a. The locations of each species and a planting detail.
J •��
b. A table summarizing the size, spacing and total quantity of each plant
species that should be used.?-�
c. The source nursery for the plants.
%>•��%
d. A one-time fertilizer specification to establish plants if necessary.
j;+; I • LNI(G
%76t
8 A soils report based on field evaluation indicating the SHWT elevations within
N/A
the footprints of the proposed SCM(s). Provide a map of the boring locations
;'.-i-f �� )�• i,i'�rxt `
with the existing elevations and boring logs. For infiltration SCMs, the report
shall include the soil type, infiltration rate and method for determining the
I'r L,_„ C j
2
infiltration rate. Soils information shall be signed and sealed by a licensed soil
9 A copy of the signed and notarized operation and maintenance (O & M),f-
T
agreement.
10 A copy of the proposed deed restrictions protecting the SCMs and limiting the
N/A - no future development
built -upon area so that it does not exceed the capacity of the SCM(s) or the high
planned or possible on the site
M
density threshold (as applicable).
NCDENR Deed Restriction Forms
11 For corporations and limited liability corporations (LLC): Documentation from the
NC Secretary of State or other official documentation, which supports the titles
and positions held by the persons listed in the Contact Information section. The
.?A
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.
NC Dept of the Secretary of State
12 A copy of the lease agreement or pending sales agreement if applicable.
STORM-EZ 12/3112014
Version 1.4 Application Page 2 of 5

Statesville, NC IREDELL County
;1part;ll',General;.Peojectand;A,'pplicant1nformatibn,,_,:p.�.:.
Project Name:
Project Street Address:
City:
Directions to Project:
(from nearest intersection)
Project Applicant:
Date:
Lat.
Long:
30-Dec-14
The Retreat at Statesville (apartment complex)
Adjacent to 182 North Pointe Blvd
35.81893
Statesville I Zip: 28626
80.882635
Take US21 north from 140, turn left onto North Pointe Blvd, travel approx. 0.5
miles, site is on the right
County:
IREDELL
NON -COASTAL
IShellys World LLC
(Identify the corporation, organization, property owner,
government official, etc. which owns the proiecL)
Owner / Signing Offical's Name:
Title:
Address:
City:
Stale:
Zip:
Phone:
Fax:
Email:
Status of applicant:
Richard An ino
Mana in Member
463 112 Carolina Circle '
Winston-Salem
NC
27104
336 499-1963
richard thirdwavehousin .com
Purchaser Attach a copy of the pending sales agreement and complete contact
for current property owner below.
River Basin:r28r
Receiving Stram(s):Creek
Stream Class(es):Surface Water Area (ac):Total property area (ac):
Goals/characteristics: NO
NO
YES
Status of construction: Not Started
Coastal wetland area (ac):
Total project area (so):
Volume Matching (LID)
Low Density
High Density
stormwater runoff will be treated:
YES Drains to an offsile stormwater system
NO Within 575' of Saltwater ORW
NO Within 5 miles of a public airport
._ r rvc t"[s;i_ the sv{ 'i ST 1R`i ".t':�1 t"5E ykl. t"'W Part;lll Permit?Information ,�,;-?;�',''ti$,... �r„'�.. ,.�.t".'?�. y,.v.�.rc�;✓:>r a.
Other permits needed:PNOqThreatened
Sedimentation & erosion control PNqONPDES
404 Permit 1401 Certification
CAMA Major Permit Isolated Wetlands Permit
& Endangered Species Industrial Stormwater Permit
If an application for this project has been previously returned, provide the original project number and previous name of the project:
n/a
Provide the permit type, number and issue dale for any permits that have
for this
If claiming vested rights, then identify (and attach) the supporting documents and approval dates:
Valid building
of a permit site -specific development Plan or PUD Approval date:
Valid building permit Issue date:
Other Date:
Not Started
Point of Contact:
Phone number:
STORM-EZ 12/30/2014
Version 1.4 Application Page 3 of 5

Property Ovmer/Organization:
Signing Official &Title:
Street address
City. State, Mp:
Phone number(s):
Email:
(OPtioneq AddlM
Person /
Signing 0!
Sir
Cit
Phon,
Statesville, NC IREDELLCounty
Part IV: Additional Contact Information
Venture Properties I, LLC
r n t70 r2M r A
924 Main Street
N. Wilkesboro, NC 28659
336-667-6000 x IS
aaron'i vodeveloomerd.com
(Note: Porson/Organization noted above may be contacted for additional project Information If applicant
cannot be reached)
Pert V: Consu!Wnt Irdonnetion
Complete this sectlon If you wish to designate authority to another Individual or firm so that they may provide Information on your
behalf for this project (such as addressing requests for additional Information).
Ste
City
Phone
STORM-EZ 12/30/2014
Version 1.4 Application Page 4 of 5

Statesville, NC IREDELL County
Part VI: Pro^rty Owner Authorization
1, (the Property Owner listed above), ,n D.Kbon , certify that I own the property Identified
In this permit application and thus give permission to (the Appllcant), Sad and Associates NC, LLC
to develop the project as currently proposed. A copy of the lease agreement or pending property sales contract has been provided with this
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 (listed as the Applicant
above) dissolves histher company or cancelsndefau.0 on hisher 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 contact DEMLR Immediately
and submit a completed Name/Ownership Change Fmm within 30 days; otherwise. I will be operating a stornater treatment facility without a
valid permit. I understand that the operation of a ormwater treatment facility without a valid permit is a violation of NC General Statute 143-
215.1 end may result In p 'a a tan including the assessment of cNll penalties up to $25.000 per day, pursuant to NCGS
143-215.6.
Signature: Date:
a Notary Public
personally appeared before ms this,=day of fHeor.hblr
and acknowledge the due execution o cation for o to pertNl
Witness my hand and official seal,
Notary Public, North Carol na
Wilkes County
My Commission Expire
January 25. 2015
My commission expires Ija5j j 5
Seal
' •i::: ... _ .Part VII: Applicant's certification
I, (the Applicant listed above), , certify that the Intarmation Included
on this permit applicant 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 (II applicable), and that the proposed project compiles with
the requirements of the applicable state stormwater rules and requirements.
Signature:
a Notary Public for the State of
County of , do heaiby certify that
personally appeared before me this _ day of _
and acknowledge the due execution of the application for a stormwater panniL
Witness my hand and official seal,
Seal
ILM
STORM-EZ 1213012014
Version 1.4 Application Page 5 of 5

Statesville, NC IREDELL County
Part VI: Property Owner Authorization'
I, (the Property Owner listed above), , certify that I own the property identified
in this permit application and thus give permission to (the Applicant), Sari and Associates NC, LLC
to develop the project as currently proposed. A copy of the lease agreement or pending property sales contract has been provided with this
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 (listed as the Applicant
above) dissolves hisfher company or cancelsidefaults on his/her 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 contact DEMLR immediately
and submit a completed Name/Ownership Change Form within 30 days; otherwise, I will be operating a stormater 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 Statute 143-
215.1 and may result in appropriate enforcement action including the assessment of civil penalties up to $25,000 per day, pursuant to NCGS
143-215.6.
Signature:
I, , a Notary Public for the State of
County of do hearby 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,
commission
seat
Date:
PartVII: pplicaot's Certification.'
Q t 11
I, (the Applicant listed above), .Ir Gf'1 GNy A C t� � Zj I t1 V , certify that the information included
on this permit applicant form is, to the best of my knowledge, correct and that �' project in conformance with the approved
plans, that the required dead restrictions and protective ovenants will be recorded (if applicable), and that the proposed project complies with
the requi'rements of the appable state stor=t es end requirements. ,
Signature: Date: 1 2130 /Z/.0 { �J
1,)'�). (C"14r) Ce) a Notary Public tor the Stat�ei� of .njrn h NA VC, j�r\C,
County of 1 fC`rC1 PIC w:9 do earty certifythat WC`iC1fA — nQ�tl l3
personallyappeare beforeme this 'day of ��Prf P\I10I'
and acknowledge the due execution of the application fo(a sto[mwater permit.
Witness my hand and official seal, tls2�(1 YI , 11rti' �i, n/1 �Ipf)
S�''
• R: a.„�,{, •: ,Q \\\ My commission expires .S')
STORM-EZ 12/302014
Version 1.4 Application Page 5 of 5

The Retreat at Statesville (apartment complex) ®��
Statesville, NC IREDELL County NCDENR
6 Yadkin River Basin
RAINFALL & CALCULATION'DATA -
Project County: IREDELL
Project City: I Statesville
Rainfall Source: I Load Data
Loaded Rainfall:
User Defined
Design Storm:
First Flush I WQV
Simple Method,
Calculation Method
Post Only
(Minimum Design Storm =l"for non -coastal, 1.5"for coastal, 1-yr,
24-hr for SA)
NOTE: Please use SCM Supplement Forms to summarize the stormwater design. The
O&M Agreement can be generated using the O&M tab below.
Storm Event
Depth
(inches)
Apt , r. ffi
P90
1.00
0.00
P95
0.00
1-yr, 24-hr
2.84
2- r 24-hr
3.45
10-yr, 24-hr
5.09
25- r, 24-hr
6.08
50- r, 24-hr
6.88
100- r, 24-hr
1 7.69
Highlighted Storm is Design Storm
_„ �,• - ' PROJECTS INFORMATION;j..
e a -
p
Total ProDertv Area
5.28
acres
Total Coastal Wetlands Area
0.00
acres
Total Surface Water Area
1 0.00
lacres
How many drainage areas does your project have? 1
Complete the breakdown of impervious area for the project
Total Impervious Area 0.00 acres
Project %impervious area Error
ALL AREAS ARE IN SQUARE FEET
BaSin�lrifonn8tion�rt�^!'.i.';L:ar0a1Y+
2--Draina'e Area,.li`_.F
CLDiaina-e Area 2nr
r�.Draina a Area,3'a
V*ADrain$ de'AFea*4'.0,
Receiving Stream name
Fourth Ck
Stream Class
C
Stream Index Number
12-108-20
Total Drainage Area
189.399
0
0
0
On -Site Drainage Area (so
189,398
Offsite Drainage Areas
1
Proposed Impervious Areas
96,547
% Im ervious Area total
50.98 %
lin Ryodifs5ifa6e AfeeH� e,olt+Diaiila-e
.a Draina eAree24
�:lDiaiMaaAr6m3va
LU-Diai6a&W, 6a'4`*Z
On -Site Buildings/Lots s
31.708
On -Site Streets (so
0
On -Site Parkin s
57 406
On -Site Sidewalks (so
7.433
Other On -Site (so
0
Future (so
0
Off -site s
0
Existin BUA s
0
Total
1 96.547
0
0
1 0
STORM-EZ 12/31/2014
Version 1.4 Project Data Page 1 of I

�� �-- � moo �I��i✓i � �. �� ' � l
��
i
W<�
ELMRIDGE DR_ •.
:2j _ l__
21
850
850
RD
GgITHER
50 ---8 � �
I
NUSGS MAP SCALE: i"=eoo'
RETREAT AT STATESVILLE v2c2�
SHELLYS WORLD, LLC n L52 u
emio
STATESVILLE, NORTH CAROLINA co�S. "- 1-0 C

14
Operation & Maintenance Agreement
The Retreat at Statesville (apartment complex)
Statesville, NC IREDELL County
Prepared By: Benjamin B. Thomas, PE, West Consultants, PLLC
ind❑ nendnce recoras snail De Kept on the tollowing BMP(s). This maintenance record shall be kept in a login a known set locatir
Any deficient BMP elements noted in the inspection will be corrected, repaired, or replacedimmediately. These deficiencies can
affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the BMP(s).
The BMP(s) on this project include (check all that apply &
Bioretention Cell
Quantity:
Dry Detention Basin
Quantity:
Grassed Swale
Quantity:
Green Roof
Quantity:
Infiltration Basin
Quantity:
Infiltration Trench
Quantity:
Level SpreaderNFS
Quantity:
Permeable Pavement
Quantity:
Proprietary System
Quantity:
Rainwater Harvesting
Quantity:
Sand Filter
Quantity:
Stonnwater Wetland
Quantity:
Wet Detention Basin
Quantity:
Disconnected Impervious Area
Present:
Soil Amendments
Present:
O&M tables will
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each BMP above, and attached O&M tables. I agree to notify NCDENR of any problems with the system or prior to any changes to
the system or responsible party.
* Responsible Party:
Title & Organization:
Street address:
City, state, zip:
Phone number(s):
Email:
Sari and Associates NC, LLC
Owner
463-1/2 Carolina Circle
Winston-Salem NC 27104
336-499-1963
[e-mail]
Signature: / Z /Z U J
Date:
a Notary Public for the State of
County of �41 0 C' q M n"I 1r1 do hearby certify that
personally appeared before me this 1r) day of Qr�U 1,t' 70 and
acknowledge the due execution of the Operations and Maintenance Agreement.
Witness my hand and official seal,
Seal My commission expires {�
ORM-EZ uou 1 20)
r tl n I n __.. ... 12/31/2014

Wet'Detention PondMaintenance.Requireriments
The wet detention basin system is defined as the wet detention basin, pretreatment including forebays and the vegetated filter if one
is provided.
Important maintenance procedures:
Immediately after the wet detention basin is established, the plants on the vegetated shelf and perimeter of the
basin should be watered twice weekly if needed, until the plants become established (commonly six weeks).
No portion of the wet detention pond should be fertilized after the first initial fertilization that is required to
establish the plants on the vegetated shelf.
Stable groundcover should be maintained in the drainage area to reduce the sediment load to the wet detention
basin.
If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through the
emergency drain should be minimized to the maximum extent practical.
Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspectedonce a month and within 24 hours after every storm event
greater than 1.0 inches (or 1.6 inches if in a Coastal County) Records of operation and maintenance should be kept in a known)
set location and must be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
BMP element:
Potential problem:
How I will remediate the problem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the BMP
Areas of bare soil and/or
Regrade the soil if necessary to remove the gully, and then plant a
erosive gullies have formed.
ground cover and water until it is established. Provide time and a one-
time fertilizer application.
Vegetation is too short or too
Maintain vegetation at a height of approximately six inches.
long.
The inlet device
The pipe is clogged.
Unclog the pipe. Dispose of the sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the Swale if necessary to smooth it over and provide erosion
swale.
control devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
Stone verge is clogged or
Remove sediment and replace with dean stone.
covered in sediment (if
applicable).
The forebay
Sediment has accumulated to
Search for the source of the sediment and remedy the problem if
a depth greater than the
possible. Remove the sediment and dispose of it in a location where it
original design depth for
will not cause impacts to streams or the BMP.
sediment storage.
Erosion has occurred.
Provide additional erosion protection such as reinforced turf matting or
riprap if needed to prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by hand. If pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional practices
show that pruning is needed to
maintain optimal plant health.
Plants are dead, diseased or
Determine the source of the problem: soils, hydrology, disease, etc.
dying.
Remedy the problem and replace plants. Provide a one-time fertilizer
application to establish the ground cover if a soil test indicates it is
necessary.
Weeds are present.
Remove the weeds, preferably by hand. If pesticide is used, wipe it on
the plants rather than spraying.
ORM-EZ 12/31/2014

" - :-'Wet Uetetltion Pond Maintenance Requlrements.IContinuedl
7Themaineatment area
Sediment has accumulated to
a depth greater than the
original design sediment
storage depth.
Search for the source Of the sediment and remedy the problem if
possible. Remove the sediment and dispose of it in a location where it
will not cause impacts to streams or the BMP.
Algal growth covers over 66§6
of the area.
Consult a professional to remove and control the algal growth,
Cattails, phragmites or other
invasive plants cover 50% of
Remove the plants by wiping them with pestic de (do not spray).
the basin surface.
The embankment
Shrubs have started to grow
on the embankment.
Remove shrubs immediately.
Evidence of muskrat or beaver
activity is present.
use traps to remove muskrats and consult a professional to remove
beavers.
A tree has started to grow on
the embankment.
Consult a dam safety specialist to remove the tree.
An annual inspection by an
appropriate professional
Make all needed repairs.
shows that the embankment
needs repair. (if applicable)
The outlet device
The receiving water
Clogging has occurred.
Clean out the outlet device. Dispose of the sediment off -site.
The outlet device is damaged
Erosion or other signs of
damage have occurred at the
outlet.
Repair or replace the outlet device.
Contact the local NC Department of Environment and Natural
Resources Regional Office.
The measuring device used to determine the sediment elevation shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
WET POND ID FOREBAY
WET —PO —ND MAIN POND
Normal Pool El. 93.5 Normal Pool EI. M
Temporary Pool El: 94.6 Temporary Pool El:Pretreatment other NoClean out depth: 1Clean out depth:
than fore Filt Sediment Storage El: 90Sediment Storage El:1;Has Veg. Filter? No Bottom EI: 89Bottom EI:
IRM-EZ

Permit
(to be provided by DWQ)
III!';REQGIREDIITEM__$,CHECKLISTfrm±"r k"•d"Yr4:'�Mtsah2u� ti'�?t'tPcr !ei
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Page/ Plan
Inl ls
7a
Sheet No.
C /;/, u`
1. Plans (V - 50' or larger) of the entire site showing:
Design at ultimate build -out,
Off -site drainage (if applicable),
Delineated drainage basins (include Rational C coefficient per basin),
Basin dimensions,
Pretreatment system,
High Flow bypass system,
Maintenance access,
Proposed drainage easement and public right of way (ROW),
Overflow device, and
Boundaries of drainage easement.
d
C.5
2. Partial plan (1" = 30' or larger) and details for the wet detention basin showing:
- Outlet structure with trash rack or similar,
- Maintenance access,
- Permanent pool dimensions,
- Forebay and main pond with hardened emergency spillway,
- Basin cross-section,
- Vegetation specification for planting shelf, and
- Filter strip.
3. Section view of the wet detention basin (1" = 2(Yor larger) shoving:
- Side slopes, 3:1 or lower,
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
�J
G �J
(
4. If the basin is used for sediment and erosion control during construction, clean out of the basin is specified
on the plans prior to use as a wet detention basin.
✓fir y'
C��(c�l w �5
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for Forebay,
to verify volume provided.
•�'_
6. A construction sequence that shows how the wet detention basin will be protected from sediment until the
entire drainage area is stabilized.
Ccv1 C 5
7. The supporting calculations.
8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
ry l tt
9. A copy of the deed restrictions (if required).
N I
10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. County
soil maps are not an acceptable source of soils information.
Form SW401-Wet Detention Basin-Rev.9-4/18/12
Part III. Required Items Checklist, Page 1 of 1

Ir
Permit No.
(to be provided by D WQ)
AM
f WA7E
h
NCDENR
�
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET
DETENTION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required. Items Checklist (Pad !II) must be printed, filled out and submitted along with all of the required information.
INP.ROJECTONEORMATIONlf2a:v�`,?uT.`�+�i
Project name
The Retreat at Statesville
Contact person
Benjamin B Thomas, PE
Phone number
828-433-5661
Date
1212912014
Drainage area number
1 - - -
I1KIDESIGNIINEORMATION 'ud. ', ":r ..+.,.i&"'"'#i,.,
r , .r ,wr «;' e s@1°.."rii'4�5",.inn .'w",r-",?°1,yr,,lrns;:`V ?3 ': "+Klkww"*3'
Site Characteristics
Drainage area
189.398 fl2
Impervious area, post -development
96,547 it"
%impervious
50.98 %
Design rainfall depth
1.0 in
Storage Volume: Non-SAWaters
Minimum volume required
8,413 f1'
Volume provided
8,816 fit"
OK, volume provided is equal to or in excess of volume required.
Storage Volume: SA Waters
1.5' runoff volume
NIA ff'
Pre -development 1-yr, 24-hr runoff
to
Post -development 1-yr, 24-hr runoff
to
Minimum volume required
to
Volume provided - ft'
Peak Flow Calculations
Is the pre/post control of the lyr 24hr storm peak flow required?
N (Y or N)
1-yr. 24-hr rainfall depth
- in
Rational C, pre -development
(umUess)
Rational C, post -development
(unitless)
Rainfall intensity: 1-yr, 24-hr storm
infhr
Pre -development 1-yr, 24-hr peak flow
6.80 fts/sec
Post -development 1-yr, 24-hr peak Cow
12.90 8'tsec
PrelPost 1-yr, 24-hr peak Cow control
6.10 fl'/sec
Elevations
Temporary pool elevation
94.60 fmsl
Permanent pool elevation
93.50 fmsl
SHWT elevation (approx. at the perm. pool elevation)
80.00 trust
Top of 10ft vegetated shelf elevation
94.00 fmsl
Bottom of 10ft vegetated shelf elevation
93.00 fmsl
Sediment cleanout, top elevation (bottom of pond)
88.00 fmsl
Sediment cleanout, bottom elevation
87.00 fmsl
Sediment storage provided
1.00 it
Is there additional volume stored above the state -required temp. pool?
N (Y or N)
Elevation of the top of the additional volume
fmsl
Fom, SW401-Wet Detention Basin-Rev.9-4/1 Bil2
Pans I. S it. Design Summary, Page 1 or 2

Permit No.
(to be pmvlded by DWD)
Surface Areas
Area, temporary pool
Area REQUIRED, permanent pool
SAIDA ratio
Area PROVIDED, permanent pool, A._p,
Area, bottom of 10f1 vegetated shelf, Aw , ,
Area, sediment cleanout, top elevation (bottom of pond), A..,a
9,217 It'
5,777 ft2
3A5 (unitless)
6,142 ft` OK
4,444 ft'
504 If
Volumes
Volume, temporary pool 8,816 fl'
Volume, permanent pool, Vp _Pw 13,235 it'
Volume, forebay (sum of forebays if more than one forebay) 2,608 ft'
Forebay % of permanent pool volume 19.7% %
SAIDA Table Data
Design TSS removal
Coastal SAIDA Table Used?
Mountain/Piedmont SAIDA Table Used?
SAIDA ratio
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 10-2b)
Volume, permanent pool, V,�
Area provided, permanent pool, A.yoy
Average depth calculated
Average depth used in SAIDA, d,,, (Round to nearest 0.5ft)
Calculation option 2 used? (See Figure 10-2b)
Area provided, permanent pool, A..
Area, bottom of 1 Oft vegetated shelf, A,_,,,,
Area, sediment cleanout, top elevation (bottom of pond), Ai,.,
90 %
N (YorN)
Y (YorN)
3.05 (unitless)
N (YorN)
13,235 ft'
6,142 ft'
If
ft
Y (Y or N)
6,142 n'
4,444 fie
504 it'
'Depth' (distance b/w bottom of 10ft shelf and top of sediment) 5.00 It
Average depth calculated 3.21 it
Average depth used in SAIDA, d„, (Round to down to nearest 0.5ft) 3.0 If
Drawdown Calculations
Dmwdown through orifice?
Diameter of office (if circular)
Area of orifice (if -non -circular)
Coefficient of discharge (Co)
Driving head (Ho)
Drawdown through weir?
Weir type
Coefficient of discharge (C„)
Length of weir(L)
Driving head (H)
Pre -development 1-yr, 24-hr peak Bow
Post -development 1-yr, 24-hr peak Bow
Storage volume discharge rate (through discharge orifice or weir)
Storage volume drawdown time
Additional Information
Vegetated side slopes
Vegetated shelf slope
Vegetated shelf width
Length of nowpalh to width ratio
Length to width ratio
Trash rack for overnow & office?
Freeboard provided
Vegetated filter provided?
Recorded drainage easement provided?
Capures all runoff at ultimate buildoul?
Drain mechanism for maintenance or emergencies is:
Y. (YorN)
1.50 in
in
0.60 (unitless)
0.37 it
N (YorN)
(unitless)
_ .(unitless)
ft
It
6.80 ft'/sec
12.90 ft'/sec
0.06 fta/sec
2.10 days
3 :1
10 :1
.10.0
If
4 :1
1.7 :1
Y
(Y or N)
2.5 It
N
(YorN)
Y
(YorN)
Y
(YorN)
PUMP OUT
0
OK
Need 3 It min.
OK
OK
OK, draws down in 2-5 days.
OK
OK
OK
OK
OK
OK
OK
OK
OK
OK
Form SW401-Wet Detention Basin-Rev.9-4I18112 Parts 1. & II. Design Summary, Page 2 of 2

Statesville, INC IREDELL County �-w J I _�_ v I
The Retreat at Statesville (apartment complex) Q ©��
n Statesville, NC IREDELL County o ryy ''"'•'`
Benjamin B. Thomas, PE, West Consultants, I�C G�'O NGDENR
i Application '� O
r s�F
Type of application: New Permit ,
Only complete application packages will be accepted and reviewed. A complete package includ\00r,
of Re items in th�ehecklist
below. Add any comments, and indicate the page or plan sheet number where the following ine�on can be found. Please
indicate that you have provided the following required information by initialing in the spac_dad next to each item.
Item
Original and one copy of this application form (all worksheets) and the permit
application fee. For applications submitted to the DEMLR regular permitting
program, the fee is $505 payable to NCDENR. For Express Review, click on the
link below for information and fee schedule. Contact the appropriate regional
office Express Review Coordinator to schedule the required pre -application
meeting.
2 A USGS map identifying the site location. If the receiving stream is reported as
class SA or the receiving stream drains to and is within 1/2 mile of SA waters,
then include the 1/2 mile radius on the map.
4
calculations
readable scale, including
and dated.
to at a
a. Project name, engineer and firm, revision number and dates.
b. Location map with street names and SR numbers, legend, north arrow,
scale.
c. Dimensioned property/project boundary with bearings & distances.
d. The boundaries of all surface waters, regulatory flood zones, and prote,
riparian buffers or a note on the plans that none exist.
e. The boundaries of all vegetated or protected riparian buffers.
f. Site layout showing all built -upon areas, drainage features, stormwater
collection systems (inlets, outlets, swales, pipe elevations, slopes and
diameters), and SCMs at ultimate build -out.
g. Existing contours, proposed contours, spot elevations, and finish(
elevations.
h. Existing drainage (including off -site), drainage easements, pipe si
runoff calculations.
i. Drainage area boundaries (included in the main set of plans, not a
separate document).
j. Existing and proposed maintenance access routes, utility easemei
drainage easements, public rights -of -way etc.
k. A construction sequence that shows how the SCMs will be protec
sediment until the entire drainage area is stabilized.
Notes / Comments
;J
I o (
a
'
s, DEN
4
• WATER RESOURCES
BUFFER PERMITTING
Initials
A,_�-
typical if appropriate) in both plan view and cross-section at a scale of 1" = 30' or
larger, including:
I
a. Dimensions, side slopes, length to width ratios and elevations with a
��'
" benchmark for clean -out if appropriate.
%
b. All applicable conveyance devices, including: bypass structure,
pretreatment area, flow distribution device, underdrains, outlet device, outlet
dissipater and level spreader.
c. A table of elevations, incremental volumes and accumulated volumes (if
see stage -storage table in calcs
��77,,
applicable).
A,
d. Specifications for applicable materials, such as planting media, aggregate,
0�1 L��Ai✓ih
I FYI
sod, underdrains, outlet devices, etc.
,7'
STORM-EZ 12/31/2014
Version 1.4 Application Page 1 of 5

Statesville, NC IREDELL County
7 Two sealed, signed, & dated planting plans for each SCM (or typical) at a scale
;r-•
of 1" = 20' or larger, as applicable, including:
%j-
a. The locations of each species and a planting detail.
b. A table summarizing the size, spacing and total quantity of each plant
%�• �•
species that should be used.
c. The source nursery for the plants.
T
d. A one-time fertilizer specification to establish plants if necessary.
2' c.•vk2
8 A soils report based on field evaluation indicating the SHWT elevations within
N/A
the footprints of the proposed SCM(s). Provide a map of the boring locations
11 !
t
with the existing elevations and boring logs. For infiltration SCMs, the report
I
shall include the soil type, infiltration rate and method for determining the
r n cq-C C 5
2 ��
infiltration rate. Soils information shall be signed and sealed by a licensed soil
9 A copy of the signed and notarized operation and maintenance (O & M)
`T
agreement.
10 A copy of the proposed deed restrictions protecting the SCMs and limiting the
N/A - no future development
built -upon area so that it does not exceed the capacity of the SCM(s) or the high
planned or possible on the site
density threshold (as applicable).
NCDENR Deed Restriction Forms
11 For corporations and limited liability corporations (LLC): Documentation from the
INC Secretary of State or other official documentation, which supports the titles
and positions held by the persons listed in the Contact Information section. 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.
NC Dept. of the Secretary of Slate
12 A copy of the lease agreement or pending sales agreement if applicable.
i
STORM-EZ 12/31/2014
Version 1.4 Application Page 2 of 5

Statesville, NC IREDELL County
, Part If: General Project and Applicant Information -
. - j
Project Name:
The Retreat at Statesville (apartment complex)
Date:
30-Dec-14
Project Street Address:
Adjacent to 182 North Pointe Blvd
Lat:
35.81893
City:
Statesville I Zip: 28625
Long:
80.882635
Directions to Project:
Take US21 north from 1-40, turn left onto North Pointe Blvd, travel approx. 0.5
County:
IREDELL
(from nearest intersection)
miles, site is on the right
NON -COASTAL
Project Applicant:
IShollys World, LLC
(Identify the corporation, organization, property owner, designated
government official, etc. which owns the project.)
Owner / Signing Offical's Name:
Title:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Status of applicant:
River E
Receiving Strea
Stream Clas:
Surface Water Area
Total property area
Goals/characteristics: NO
NO
YES
Richard An ino Jht'rd WAVe- DU!;) h
Managing Member
463 1/2 Carolina Circle
Winston-Salem
NC
27104
336 499-1963
[e-mail]
Purchaser Attach a copy of the pending sales agreement and complete contact
information for current property owner below.
Coastal wetland area Inc)y'LAr✓: OAK17d
Total project area (ac): 5.28 !}?Pb 6 F sr'TE,?
Volume Matching (LID) YES Drains to an offsite stormwater system
Low Density NO Within 575' of SSa �va7er ORW
High Density NO Within 5 miles of a public airport
summarize how the stormwater runoff will be treated:
Part III: Permit Information
Status of construction: Not Started
Other permits needed:PN
ES Sedimentation & erosion control PNOqNPDES
404 Permit / 401 Certification
O CAMA Major Permit Isolated Wetlands Permit
O Threatened & Endangered Species Industrial Stormwaler Permit
If an application for this project has been previously returned, provide the original project number and previous name of the project:
n/a
Provide the
If claiming vested rights, then identify (and attach) the supporting documents and approval dates:
Approval of a site -specific development plan or PUD Approval date:
Valid building permit Issue date:
Other Dale:
Not Started
Point of Contact:
Phone number:
STORM-EZ 12/30/2014
Version 1.4 Application Page 3 of 5

Property OwnerlOrganiration
Signing Official & title:
Street address:
City, State. 71p:
Phone number(s):
Email:
(Opd-80 Ac
Peru
Slgnlnl
P!
Statesville, NO IREDELL County
Part IV: Additional Contact Information
Venture Properties I, LLC
r n O e� r I ly Influnt
1924 Main Street
N. Wilkesboro, NC 28659
335.BB7A000 x 18
aaron &vodevelopment.corn
(Now., Porson/Oigantradon noted above may be contacted for additional project Information ifapplkant
cannot be reached.)
1 Part V: Consultant Information
Complete this section If you wish to designed authority to another Individual or firm so that they may provide Info radon on your
behalf for this project (such as addressing requests for additional information).
B. Thomas, PE
City, State, Zip: Moigantan, NC 28855
Phone numbedsl: 828-033 J x 308
STORWEZ 12/30/2014
Version 1.4 Application Page 4 of 5

Statesville, NC IREDELL County
Part VI: Pnopertv Owner Authorization
I, (the Property Owner ILstetl above). / r tarp n u, /C OOn , certify that I own the property Identi0ed
In this permit application and thus give permission to (the Applicant), San and Associates NC. LLC
to develop the project as currently proposed. A copy of the lease agreement or pending property sales contract has been provided with this
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 (listed as the Applicant
above) dissolves hislher company or cancels/defauYs on Mal lease agreement or pending aele, responsibility for compliance with the
DEMLR stormwater permit reverts back to me, the property owner. As the property owner, it is my responsibility to contact DEMLR immediately
and submit a completed Name/Ownership Change Form within 30 days otherwise. I will be operating a stonnater treatment Facility witow a
ch. valid peaI understand that the operation of a Ftormwater treatment facility wlttoul a valid permit is a violation of INC General Statute 143-
215.1 and may result in p 'a e n Including the assessment of cMI penalties up to $25,000 per day, pursuant to NCGS
143-215.6. f (/
Signature: Date:
I, /Kc CSA Lu L" a Notary Public forthof L/���� G
County of dehearby cer y that Mt ' /
personally appeared before me thl day of 1�e` t tv%_6Ge-
01
and acknowledge the due execution °( lication for a mmw to permlL
Witness my hand and official seal, X r:
SHERRY LUCKEY
Notary Public, North Carol
Wilkes County
My Commission Expire!
expires Ilas 1)5
Part VII: Applicant's Certification I
I, (the Applicant listed above), , certify that the Information Included
on this permit applicant form Is. to the best of my knowledge, coned and that the project will be constructed in conformance with the approved
Plane, that the required deed restrictions and protective covenants will be recorded (d applicable), and that the proposed project complies with
the requirements of the applicable state slormwator rules and requirements.
Signature: Date:
I, a Notary Public for the State of
County of do hearby certify that
personally appeared before me this day of ,
and acknowledge the due execution of the application for a stommvater permit
Witness my hand and official seal,
commission expires
Seal
STORM-FZ 12130/2014
Version 1 A Application Page 5 of 5

Statesville,NC IREDELLCounty
I Part I& Property Owner Authorization
I, (the Property Owner listed above), , certify that I own the property identified
in this permit application and thus give permission to (the Applicant), Sari and Associates NC, LLC
to develop the project as currently proposed. A copy of the lease agreement or pending property sales contract has been provided with this
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 (listed as the Applicant
above) dissolves his/her company or cancels/defaults on his/her 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 contact DEMLR immediately
and submit a completed Name/Ownership Change Form within 30 days; otherwise, I will be operating a stormater treatment fadlity without a
valid permit. I understand that the operation of a stormwater treatment facility without a valid permit is a violation of NC General Statute 143-
215.1 and may result in appropriate enforcement action including the assessment of civil penalties 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 hearby 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,
commission expires
Part VII: Applicant's Cert�cation I
I, (the Applicant listed above), 'R I GYt A C A14 Ct I {'� O certify that the information included
on this permit applicant form is, to the best of my knowledge, correct and that thlb project will be constructed in conformance with the approved
plans, that the required deed restrictions and protective govenants will be recorded (if applicable), and that the proposed project complies with
the requirements of the applicable state stormwat as and requirements. '
Signature: Date: I Z/�U /Z/.0 1 �J
I, f�I• �.e P), (C)IIInWen .allota Public or the Statq of-�q(m lih i(^M{�JN 6;
County Yli PCrC)PIC w:'1T .dohearty cerofy that1 iC hcifh 1'r In
personally appeare b� afore me this Wro day of UPfP U11101- I
and acknowledge the due execution of the application fora stormwater permit.
Witness my hand and official seal, lhNl }'I . 11AIi. M1!i611
\lilt 0.130L11tic
�5:Vu� &I -•.To=
Q NpTAgy'';2 `.
�., N
to •'•, o.;.a.2o11 Q' \\ My commission expires IavnN)s)
Seal
STORM-EZ 12/30/2014
Version 1.4 Application Page 5 of 5

� J
,,
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The Retreat at Statesville (apartment complex) ©k - A
6
Statesville, NC IREDELL County --'—�
Yadkin River Basin NCDENR
RAINFALL & CALCULATION DATA
Project County: IREDELL
Project City: Statesville
Rainfall Source: Load Data
Loaded Rainfall:
User Defined
Design Storm:
First Flush / WOV
Simple Method,
Calculation Method
Post Only
(Minimum Design Storm = 1 "for non -coastal, 1.5"for coastal, 1-yr,
24-hr for SA)
NOTE; Please use SCM Supplement Forms to summarize the stormwater design. The
O&M Agreement can be generated using the O&M tab below.
Storm Event
First Flush /�WQV
Depth
(inches)
1.00
P90
0.00
P95
0.00
1-yr, 24-hr
2.84
2- r 24-hr
3.45
10-yr, 24-hr
5.09
25- r, 24-hr
6.08
50- r, 24-hr
6.88
100- r, 24-hr
7.69
Highlighted Storm is Design Storm
I PROJECT INFORMATION I
Total Property Area
5.28
acres
Total Coastal Wetlands Area
0,00
acres
Total Surface Water Area
0.00
acres
How many drainage areas does your project have? 1
Complete the breakdown of impervious area for the project
Total Impervious Area 0.00 acres
Project % im ervious area Error
ALL AREAS ARE IN SQUARE FEET
Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
Receiving Stream name
Fourth Ck
Stream Class
C
Stream Index Number
12-108-20
Total Drainage Area
189,399
0
0
0
On -Site Drainage Area (sfi
189,398
Offsile Drainage Area (so
1
Proposed Impervious Area(so-96,547
% Impervious Area total
50.98%
Impervious Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area 4
On -Site Buildings/Lots (sfl
31,708
On -Site Streets s
0
On -Site Parkin s
57,406
On -Site Sidewalks (sO
7433
Other On -Site (st
0
Future s
0
Off -site s
0
Existin BUA (so
0
Total
1 96,547
1 0
1 0
1 0
STORM-EZ 12/31/2014
Version 1.4 Project Data Page 1 of 1

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SITE
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USGS MAP SCALE: 1"=800'
RETREAT AT STATESVILLE
�- SHELLYS WORLD, LLC
CIONSUMM
IYC 18]BI .JJ�>N�i
STATESVILLE, NORTH CAROLINA