SW4131202_CURRENT PERMIT_20140203

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW ���
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

��A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM
Director
February 3, 2014
Ms. Erin Lawrence, Supervising Engineer
NCDENR North Carolina State Parks
217 West Jones Street
Raleigh, North Carolina 27603
Pat McCrory, Governor
John E. Skvarla, III, Secretary
N.C. Dept. of ENR
MAR 2 f 20g,
Winston-Salem
Subject: Stormwater Permit No. SW4131202
Haw River State Park - Church Street Phase I
Public Roads and Bridges Stormwater Project
Greensboro, Guilford County
Dear Ms. Erin Lawrence:
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application
for the subject project on January 31, 2014. 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 Permit No. SW4131202
dated February 3, 2014, for the construction, operation and maintenance of the subject project.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the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).'I'he written petition must conform to Chapter 1506 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.NC.OAH.com.
Unless such demands are made, this permit shall be final and binding.
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 - Telephone [phone] / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://pgrtal.ncdenr.org/webhr/land-gualily
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper

Ms. Erin Lawrence, NCDENR State Parks
Flaw River State Park — Church Street Phase I — S W4131202
February 3, 2014
Page 2 of 2
After thirty days (30) from the date of this permit, this project will be kept on file at the Winston-
Salem NCDENR Regional Office, Land Quality Section. At that time, if you have any questions, or
need additional information concerning this permit, you can contact Sue White,
[e-mail]. Stormwater Contact, Land Quality Section, Division of Energy, Mineral and
Land Resources, Winston-Salem Regional Office, [phone]. In the interim, if you have any
questions, or need additional information concerning this permit, please contact Bill Diuguid,
[e-mail], at [phone], in the Raleigh NCDENR DEMLR Central Office, Land
Quality Section, Stormwater Permitting.
Sincerely,
Original Signed by William H. Diuguid
William FI. Diuguid, AICP, Plans Reviewer
for Tracy E. Davis, P.E., CFM
ec: Matt Ludwig, PE, Stewart, Inc., Raleigh, North Carolina
Matt Gantt, Land Quality Section, NCDENR DEMLR Winston-Salem Regional Office
Sue White, Land Quality Section, NCDENR DEMLR Winston-Salem Regional Office

State Stormwater Permit
Permit No.SVV4131202
STATE OF NORTH CAROLINA
DEPARTMENT -OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCE'S
STATE STORMWATER MANAGEMENT PERMIT
FOR PUBLIC ROADS AND BRIDGES
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
NCDENR North Carolina State Parks
Haw River State Park — Church Street Phase 1
6064 Church Street, Greensboro, Guilford County
FOR THE
construction, operation and maintenance of a public.road and.bridgge and'stormwater
conveyyance project in compliance with the provisions of 15ANCAC 2H .1000 and S.L.
2006-24&(hereafter referred.to as the "stormwater rules) and the approved stormwater
mane ggement'plans and specifications;>and othef supporting data as attached and on
file with and approved by the Division of Energy; Mineral and Land Resources Land
Quality Section and considered a part of this permit.
The Permit shall be effective from the date of issuance until rescinded and shall be
subject to the following specific conditions and limitations:
I. DESIGN STANDARDS
1. This permit covers the construction of public roads and bridges and the
stormwater management conveyance system as shown on the approved site
plan.
Approved plans and specifications for projects covered by this permit are
incorporated by reference and are enforceable parts of the permit.
3. The only runoff conveyance systems allowed will be vegetated conveyances
such as swales with minimum side slopes of 3:1 (H:V) as defined in the
stormwater rules and approved by the Division.
No piping is allowed except that minimum amount necessary to direct runoff
beneath an impervious surface such as a road or to provide access.
5. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent streams.
6. Level spreaders, plunge pools and other water velocity dissipaters shall be
provided at the ends of all swales that discharge into a regulated stream buffer.
7. All swales shall that discharge into a wetland shall do so at a non -erosive velocity
for the 10 year storm.
Page 1 of 4

State Stormwater Permit
Permit No.SW4131202
Ill. SCHEDULE OF COMPLIANCE
The permittee is responsible for verifying that the proposed public road and bridge
project stormwater management system will function as designed and meet the
minimum requirements of the permit.
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.
3. This project may not be sold or subdivided in whole or in part without first receiving a
permit modification from the Division.
4. The following deed restrictions must be recorded with the Office of the Register of
Deeds:
a. The following covenants are intended to ensure ongoing compliance with
State Stormwater Management Permit Number SW4131202, as issued by
the Division of Energy, Mineral and Land Resources Land Quality Section
under the stormwater rules.
b. The State of North Carolina is made a beneficiary of these covenants to
the extent necessary to maintain compliance with the Stormwater
Management Permit.
C. These covenants are to run with the land and be binding on all persons
and parties claiming under them.
d. The covenantspertaining to stormwater may not be altered>,or rescinded
without the express written consent ofthe State of North Carolina,
Division of Energy, Mineral and Land Resources Land Quality Section.
e. Alteration of the,drainage as shown on the.approved plans may not take
place without the concurrence, of the.Division:of Energy, Mineral and Land
Resources Land.Quality Section.
f. This project is'permitted fora public road and bridge project. Construction
Of additional built -upon area within the permitted project area will require a
permit modification.
g. This project may not be sold or subdivided, in whole or in part, without first
receiving a permit modification from the Division.
h. Construction of additional impervious areas such that the stormwater
management system will no longer function as designed will require a
permit modification prior to construction. An engineered system will be
required to collect and treat the runoff from all built -upon area associated
with the project, including that.area originally permitted under the public
roads and, bridges. stormwater permit option.
L Filling in or piping of any vegetative conveyances'(ditches, swales, etc.)
associated with this.developme6f,;except for average driveway crossings,
is strictly prohibited by any'.persons.
j. The built -upon areas shall be located a minimum of 30 feet landward of all
perennial and intermittent surface waters.
5. Filling in or piping of any vegetative conveyances (ditches, swales, etc.) associated
with the permitted development, except for average driveway crossings, is strictly
prohibited by any persons.
Page 2 of 4

State Stormwater Permit
Permit No.SW4131202
6. 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 the approved plans, regardless of size.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area.
e, Further subdivision, acquisition, or sale of the project area in whole or in
part. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval was sought.
f. Filling in, altering or piping any vegetative conveyance shown on the
approved plan.
8. Swales and other vegetated conveyances shall be constructed in their entirety,
vegetated, and be operational for their intended use prior to the construction of
any built -upon surface.
9. During construction, erosion shall be kept to a minimum and any eroded areas of
the swales or other vegetated conveyances will be repaired immediately,
10. The permittee shall at all times provide the operation and maintenance
necessary to operate the permitted stormwater management systems at
optimum efficiency to include:
a. Inspections
b. Sediment removal.
c. Mowing, and re -vegetating of the side slopes.
d. Immediate repair of eroded areas.
e. Maintenance of side slopes in accordance with approved plans and
specifications.
11. Within 30 days of completion of the project, the permittee shall certify in writing
that the project has been constructed in accordance with the approved plans.
12. The permittee shall submit all information requested by the Director or his
representative within the time frame specified in the written information request.
III. GENERAL CONDITIONS
This permit is not transferable to any person or entity except after notice to and
approval by the Director. The Director may require modification or revocation and
re -issuance of the permit to change the name and incorporate such other
requirements as may be necessary. In the event of a name or ownership
change, a completed Name/Ownership Change form, signed by both parties,
must be submitted to the Division of Energy, Mineral and Land Resources Land
Quality Section accompanied by the supporting documentation as listed on page
2 of the form. 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 the
Director approves a transfer of ownership. Neither the sale of the project nor the
transfer of common areas to a third party, such as a homeowner's association,
constitutes an approved transfer of the stormwater permit.
Page 3 of 4

State Stormwater Permit
Permit No.SW4131202
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to an enforcement action by the Division of Energy, Mineral
and Land Resources Land Quality Section, in accordance with North Carolina
General Statutes 143-215.6A to 143-215.6C.
4. 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 of the North Carolina Administrative Code, Subchapter 2H.1000;
and North Carolina General Statute 143-215.1 et. al.
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 the Division, such as the construction of
additional or replacement stormwater management systems.
The permittee grants permission to DENR Staff to enter the property during
normal business hours, for the purpose of inspecting all components of the
stormwater management facility.
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 swales
must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
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 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), which have jurisdiction.
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
Permit issued this the P day of February, 2014.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Original Signed by William H. Diuguid
William H. Diuguid, AICP, Plans Reviewer
/or Tracy E. Davis;-P..E., Director
Division of Energy; Mineral.and Land Resources
By Authority of the Environmental Management Commission
Page 4 of 4

F
DWQ USE ONLY
Date Received
Fee Paid
Permit Number
/7_—_!5— —
Za 3
1 b1/ 3 2-0 7-
Applicable Rules:
(select all that apply)
❑ Coastal SW - 1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLIC.
This fonu may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent with
specifications, letters, operation and maintenance agreements, etc.):
2. Location of Project (street address):
City:Greensboro County:Guilford
3. Directions to project (from nearest major intersection):
From NC 150 & Church Street: North approximately 1.4 miles.
&M
0
on plans,
rmtJvED ___,
N.C.Dept. of Enip I
MAP 2 1 269
4. Latitude:36° 14' 11" N Longitude:79° 4711" 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 tnith modifications also requires SWU-102 - Renewal Application Fonn
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: -p7Not 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 DWQ
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 he
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control: 8.06 ac of Disturbed Area
❑NPDES Industrial Stormwater ®404/401 Permit: Proposed Impacts 404/401 Wetlands, Buffers -Zone 1
&2
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:401 Permit: Haw River State Park, Church Street Interim Development
- Phase 1, DWO # 13-0656, Issued 8/2/2013
404 Permit: Haw River State Park, Church Street Interim Development - Phase 1, Action ID: SAW-2013-01704,
Issued: 9/10/2013 •
5. is the project located within 5 miles of a public airport? ®No ❑Yes
FonnSWU-101 Version06Aug2012 Page 1 of

If yes, see S.L. 2012-200, Part Vl: http:/112ortal.ncdenr.org/web/wq/ws/su/statesw/rules laws
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: N CD E N R/N orth Carolina State Parks
Signing Official & Title:Erin Lawrence, PE, Engineering Supervisor
b.Contact information for person listed in item la above:
Street Address:217 W. Tones Street
City:Raleigh State:NC Zip:27603
Mailing Address (if applicable):1615 Mail Service Center
City:Raleigh State:NC Zip:27699
Phone: (919 ) 707-9322 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: ( )
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: Matt Ludwig, PE
Signing Official & Title:Design Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:421 Fayetteville Street, Suite 400
City:Raleigh State:NC Zip:27601
Phone: (919 ) 866-4734 Fax: )
Email: [e-mail]
4. Local jurisdiction for building permits: Guiford County
Point of Contact: A)114 Phone #: (336 ) 641-3707
Form SWU-101 Version 06Aug2012 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Runoff from the street will be conveyed by ditches and enclosed systems to one of three bio-retention ponds
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
4. Total Property Area: 136.17 acres
River basin.
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 1.11 acres
Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area4:135.06 acres
Total project area shall be calculated to exclude thefollowing: the normal pool of impounded stnuchures, the area
between the banks of streams and rivers, the area below the Normal High Water (NW 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 rvetlaruds landward of tlne NHW (orMHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =
9. How many drainage areas does the project have? 3 (For high density, count 1 for each proposed engineered
stonmwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area _
Receiving Stream Name
Haw River
Haw River
Haw River
Stream Class *
WS-V;NSW
WS-V;NSW
WS-V;NSW
Stream Index Number *
16-(1)
16-(1)
16-(1)
Total Drainage Area (so
96,994
149,099
272,594
On -site Drainage Area (so
96,994
149,099
272,584
Off -site Drainage Area (so
0
0
0
Pro osed Impervious Area** s
22,255
26,937
46,471
Im pervious Area** total
23%
118%
17%
Impervious— Surface Area
Drainage Area ]
Drainage Area 2
Drainage Area 3
Drainage Area _
On -site Buildings/Lots (so
0
0
0
On -site Streets (so
22,255
26,937
46,471
On -site Parking (so
0
0
0
On -site Sidewalks (so
0
0
0
Other on -site (so
0
0
0
Future (so
0
0
0
Off -site (sf)
1 0
0
0
Existing BUA*** (sf)
1 0
0
0
Total (so:
1 22,255
26,937
46,471
9 (o
* Stream Class and Index Number can be determined at: bttjn://portal.iicdenr.or 7eb/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.
*** 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.
Form SWU-101 Version 06Aug20]2 Page 3 of

11. I-Iow was the off -site impervious area listed above determined? Provide documentation. CAD Drawings of
site and survey
Projects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that maybe subject to more stringent stormwater requirements as per I5A 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 httD://Dortal.ncdenr.org/web/wa/ws/su/bmD-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
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 does. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://portal.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does.
Imrals
1. Original and one copy of the Storm water Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants AdA
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://www.envhelp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
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'/2 mile of the site boundary, include the
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.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person.who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
r�
Form SWU-101 Version 06Aug2012 Page 4 of 6

p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHIh'T elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" 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 DWQ to verifij the SHWT prior
to submittal, [phone].) /
10. A copy of the most current property deed. Deed book: 6855 Page No: 2810/2817
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.
h"://www.secretary.state.nc.us/Corporations/CSearch.aspx
VIL DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms dots. Download the latestversions 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 DWQ 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:Matt Ludwig, PE
Consulting Firm: Stewart, Inc.
Mailing Address:421 Fayetteville Street, Suite 400
City:Raleigh State:NC Zip:27601
Phone: (919 ) 866-4734 Fax: ( )
Email: [e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Infonnation, item 2 has been filled out, complete this
section)
I, (print or hjpe name of person listed in Contact Information, item 2a) ltiJ 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 Infonnation, item la) with (print or type name of organization listed in
Contact Infonnation, item ]a) 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 06Aug2012 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 l) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ 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.
Date: /V//�L
I, N 4A . a Notary Public for the State of n/ IF- . County of
O � , do hereby certify that PJ14 personally appeared eared
before me this L4 day of /V K —N14_, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, N.Jld-
SEAL
My commission expires N
X. APPLICANT'S CERTIFICATION
1, (print or hjpe name of person listed in Contact Information, item ]a) Erin Lawrence
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 r*s under 15A NCAC 21-1.1000 and any other applicable state stormwater requirements.
Date: )1 l 3a IIx(2 f Z
a Notary Public for the State of Anerh C�FlRo jl+�tti . Countyof
WH,tC— , do hereby certify that [-Q/ n LAW AeOf F:� personally appeared
before me this2Zfioday of Alo✓embEi a013 • and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
/i?N/(crI a3, 201 q
Form SWU-101 Version 06Aug2012 Page 6 of