SW3170305_Application_20170327

R. Joe Harris & Associates, Inc.
127 Ben Casey Drive, Suite 101, Fort Mill, S.C. 29708
- ° [phone]
March 22, 2017
Stormwater Permitting Program
Land Quality Section
NCDEMLR I NCDEQ
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Re: Larkin Multi-Family Development
Stormwater Management Permit—Initial Submittal
RJH Ref.No.: 2382
To Whom It May Concern:
On behalf of Dependable Development, Inc., we have enclosed the following items for the review and
approval of the above referenced project
1. Two(2)copies of the Larkin MF Development Construction Plans—dated 2/03/17
2. One(1)copy of the Project Report&drainage maps—dated 11/11/16
3. 1 Original& 1 Copy-Stormwater Management Permit Application
4. BMP Supplement forms(included in Section VI of the Project Report)
5. Detailed project summary(included in Section I of the Project Report)
6. Separate USGS map with project site identified
7. Copies of the most current deeds that cover all the associated parcels
8. One(1)check(#91613)for S505 00 made payable to NCDENR
If you should have any questions or require any additional information, please feel free to contact me at
[phone] or via email at pmurph.(eorioeharris._om.
Sincerely, RECEIVE®
R.JOE HARRIS&ASSOCIATES, INC. �/
i i? 272077
c")(\nDENR.LAND
�ORMWAERQt1AlITY
�RM1TTlN¢
Patrick Murphy, P.E.
Engineering Director
www rloeharns cum

DEMLR USE ONLY
Te Rev d f Ettn,. .
Perini umb rc3 �I�LJ
Applicable Rules: El Coastal SW—1995 El Coastal SW—2008 ErPh II-Post Construc on
(select all that apply) ❑Non-Coastal SW-HQW/ORW Waters ❑Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina P4 q-fp/soN
Department of Environment and Natural Resources [G N 17✓?-x/31 T
Division of Energy,Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision,facility,or establishment name-should be consistent with project name on plans,
specifications,letters,operation and maintenance agreements,etc.):
Larkin Multi-Family Development
2. Location of Project(street address):
198 Fox Den Circle
City:Statesville County:Iredell Zip:28677
3. Directions to project(from nearest major intersection):
East on Amity Hill Road from intersection of Amity Hill Road&Shelton Avenue(Hwy 21).
4. Latitude:35°44'30.5842"N Longitufdee:80°52'1.8005"W of the main entrance to the project.
II. PERMIT INFORMATION: 6• 1 / 3) l
1.a.Specify whether project is (check one): New ❑Modification ❑Renewal w/Modificationt
tRenezoals with modifications also requires SWU-102-Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit,list the existing
permit number ,its issue date(if known) ,and the status of
construction: ❑Not Started ['Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project(check one):
['Low Density ®High Density ['Drains to an Offsite Stormwater System ['Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application,list the stormwater project number,
if assigned, and the previous name of the project,if different than currently
proposed,
4.a.Additional Project Requirements(check applicable blanks;information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control:4.0 ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 Permit:Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name,Project/Permit Number,
issue date and the type of each permit:Larkin Multi-Family Development STVLE-2017-042
Letter of Approval with Modifications December 15,2016
5. Is the project located within 5 miles of a public airport? ❑No ®Yes
If yes,see S.L 2012-200,Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations
Form SWU-101 Version Oct.31,2013 Page 1 of 6

III. CONTACT INFORMATION
1.a.Print Applicant/ Signing Official's name and title(specifically the developer,property owner,lessee,
designated government official,individual,etc.who owns the project):
Applicant/Organization:Dependable Development,Inc.
Signing Official&Title:Michael Foess / Operations Partner-Land Development
b.Contact information for person listed in item la above:
Street Address:2649 Brekonridge Centre Drive,Suite 104
City:Monroe State:NC Zip:22110
Mailing Address (if applicable):Same as above
City• State: Zip:
Phone: X704 ) 361-9119 Fax: (704 ) 238-1150
Email:[e-mail]
c.Please check the appropriate box.The applicant listed above is:
n The property owner(Skip to Contact Information,item 3a)
n Lessee*(Attach a copy of the lease agreement and complete Contact Information,item 2a and 2b below)
n 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:Carolina Development Services,LLC
Signing Official&Title:David Cuthberson
b.Contact information for person listed in item 2a above:
Street Address:2627 Brekonridge Centre Drive
City:Monroe State:NC Zip-28110
Mailing Address(if applicable)•same as above
City. State: Zip:
Phone: (N/A ) Fax: (N/A )
Email:N/A
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:R.toe Harris&Associates,Inc.
Signing Official&Title:Patrick Murphy,P.E. / Engineering Director
b.Contact information for person listed m item 3a above:
Mailing Address:127 Ben Casey Drive,Suite 101
City:Fort Mill State:SC Zip:29708
Phone: (803 ) 802-1799 Fax: (N/A )
Email:[e-mail]
4. Local jurisdiction for building permits:City of Statesville-Code Enforcement
Point of Contact:Eric Fox Phone#: (704 ) 878-3560
Form SWU-101 Version Oct. 31,2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
The stormwater runoff for the site will be collected and discharged into 1 of either the BMP wet pond or the 2
BMP sand filters.
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 Yadkin Pee Dee River basin.
4. Total Property Area:4.79 acres 5. Total Coastal Wetlands Area:0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area(4)-Total Coastal Wetlands Area(5)-Total Surface Water Area(6)=Total Project
Area':4.79 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water(NHVV)line or Mean High Water
(MHVV) line,and coastal wetlands landward from the NHW(or MHVV)line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non-coastal wetlands landward of the NHW(or MHVV)line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area/Total Project Area)X 100 =26.1 %
9. How many drainage areas does the project have?3 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects,use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project,attach an additional sheet with the information for each area
provided in the same format as below.
Basin'Information , - Drainage Area 1 Drainage Area 2 Drainage"Area 3 Drainage Area
Receiving Stream Name Third Creek Third Creek Third Creek
Stream Class * C C C
Stream Index Number* 12-108-20-4 12-108-20-4 12-108-20-4
Total Drainage Area(sf) 49,748 39,523 34,332
On-site Drainage Area(sf) 49,748 39,523 34,332
Off-site Drainage Area(sf) 0 0 0
Proposed Impervious Area**(sf) 22,929 16,244 15,209
% Impervious Area**(total) 46.09 41.1 44.3
Impervious*Surface Area _ Drainage Area 1 Drainage Area 2, Drainage Area 3 Drainage Area,
On-site Buildings/Lots(sf) 12,943 9,106 10,663
On-site Streets (sf) 8,018 5,450 3,710
On-site Parking (sf) 1,968 1,688 836
On-site Sidewalks (sf) N/A N/A N/A
Other on-site (sf) 0 0 0
Future(sf) 0 0 0
Off-site (sf) 0 0 0
Existing BUA***(sf) 0 0 0
Total (sf): 22,929 16,244 15,209
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
** Impervious area is defined as the built upon area including, but not limited to,buildings,roads,parking areas,
sidewalks,gravel areas,etc.
***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 Oct.31,2013 Page 3 of 6

11. How was the off-site impervious area listed above determined?Provide documentation.N/A
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened&
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B.0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M)forms
must be subrrutted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy,Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map athttp://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 docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. Pan
2. Original and one copy of the signed and notarized Deed Restrictions&Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed,signed and dated)and O&M PM
agreement(s)for each BMP.
4. Permit application processing fee of$505 payable to NCDENR. (For an Express review,refer to P M
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 PF\
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 Pm
receiving stream drains to class SA waters within 1/z mile of the site boundary,include the 1/z
mile radius on the map.
7. Sealed,signed and dated calculations(one copy). Pen
8. Two sets of plans folded to 8.5"x 14" (sealed,signed,&dated),including: PM
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).
Form SWU-101 Version Oct.31,2013 Page 4 of 6

p Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT 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"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs,the report should also
include the soil type,expected infiltration rate,and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO:Schedule a site visit for DEMLR to verify the SHWT prior
to submittal, [phone].) nn
10. A copy of the most current property deed.Deed book.2448&2467 Page No:2052&191 1'M
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.
http://www.secretary.state.nc us/Corporations/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions,outparcels,and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary,a table listing each lot number,lot size,and the allowable built-upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from http://portal.ncdenr.org/web/lr/state-stormwater-
forms docs.Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner,it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded
By the notarized signature(s)below,the permit holder(s)certify that the recorded property restrictions and
protective covenants for this project,if required,shall include all the items required in the permit and listed
on the forms available on the website,that the covenants will be binding on all parties and persons claiming
under them,that they will run with the land,that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR,and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm(such as a
consulting engineer and/or firm)so that they may provide information on your behalf for this project(such as
addressing requests for additional information).
Consulting Engineer:Patrick Murphy,P.E.
Consulting Firm:R. Joe Harris&Associates,Inc.
Mailing Address:127 Ben Casey Drive,Suite 101
City:Fort Mill State:SC Zip:29708
Phone: (803 ) 802-1799 Fax- (N/A
Email:pmurphy@rjoeharris coin
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) David Cuthberson ,certify that I
own the property identified in this permit application,and thus give permission to (print or type name of person
listed in Contact Information, item la)Michael Foess with (print or type name of organization listed in
Contact Information,item la) Dependable Development, Inc. to develop the project as currently proposed. A copy of
the lease agreement or pendmg property sales contract has been provided with the submittal,which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version Oct. 31,2013 Page 5 of 6

As the legal property owner I acknowledge,understand,and agree by my signature below,that if my designated
agent(entity listed in Contact Information,item 1) dissolves their company and/or cancels or defaults on their
lease agreement,or pending sale,responsibility for compliance with the DEMLR Stormwater permit reverts back
to me,the property owner.As the property owner,it is my responsibility to notify DEMLR 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 t e asse n ,1 of civil penalties of up to$25,000 per day,pursuant to NCGS 143-215.6.
Signature: 1 Date:3 (4 1`7
IT—Fen-4r ' J J ,a Nota Public or the$t to of ,V & 1 V„�County of
,do hereby c tify that t11kN i .11 personally appeared
before me thiay of M , 1 ,and ac. owled: • - -cu •1 of tl • asplication for
a stormwater permit. Witness my hand and official seal, SI. .,^ 1 A --
JOA
p,R , ,,,',,
�,( . . SEAL
OSAR y -
-
�, :U=
'BUBO _ My commission expires .1.1
,,,,,�ONCOO,
X. APPLICANT'S CERTIFICATION
I,(print or type name of person listed in Contact Information,item la)Michael Foess-Dependable Development,Inc. ,
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 coven is ' be recorded,and that the proposed project complies with the requirements of the
applicable sto w er les der 15A NCAC 2H.1000 and any other applicable state stormwater requirements.
Signature: Date: 3 14/17
I, L v �� ,a NootaarytPublicfor S i ofd lel, � 1 ' ,� ounty of
UA' ,do hereby ce tif ► 1 1 y that L J ( I, personally appeared
before me this d day of MKL✓rh ,NO 11 ,and :c . owledg, • • - ec.-•• of th pplication for
a stormwater permit. Witness my hand and official seal, ��
�O`J`� Oiy� SEAL
o
. AUB LSC' 1 V My commission expire 11 1
"--,•OA
COU\�,`,,,``,
, ,
Form SWU-101 Version Oct.31,2013 Page 6 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
The stormwater runoff for the site will be collected and discharged into 1 of either the BMP wet pond or the 2
BMP sand filters.
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 Yadkin Pee Dee
4. Total Property Area: 4.79
River basin.
acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:4.79 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal Hi h Water (NSW, line or Mean High Water
(MHM line, and coastal wetlands landward from the NHW (or Normal
line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHM line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 33.4 %
9. How many drainage areas does the project have?3 (For high density, count I for each proposed engineered
stormwater BMP. For low density and other projects, use I 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
Third Creek
Third Creek
Duck Creek
Stream Class *
C
C
C
Stream Index Number *
12-108-20-4
12-108-20-4
12-108-20-4-3
Total Drainage Area (sf)
49,935
45,707
33,466
On-site Drainage Area (sf)
49,935
45,707
33,466
Off-site Drainage Area (sf)
0
0
0
Proposed Impervious Area** sf
22,888
22,317
15,209
% Impervious Area** total
45.84
48.83
45.45
Impervious— Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3 Drainage Area
On-site Buildings/Lots (sf)
13,006
15,179
10.546
On-site Streets (sf)
8,018
5,450
3,710
On-site Parking (sf)
1,864
1,688
836
On-site Sidewalks (sf)
N/A
N/A
N/A
Other on-site (sf)
0
0
0
Future (sf)
0
0
0
Off-site (sf)
0
0
0
Existing BUA*** (sf)
0
0
0
Total (so:
22,888
22,317
15,092
* Stream Class and Index Number can be determined at: http.aortal.ncdenr.org web/wq&s/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 B UA.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

DEMLR USE ONLY
Date Recei l d
F
Permit Numbr
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ffPh II - Post Construe ion
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina Pq 7-r"--VN
Department of Environment and Natural Resources H,,,a 'D"$2T/
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
1. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name or
specifications, letters, operation and maintenance agreements, etc.): �/ 2
Larkin Multi -Family Development � �d� �"4"
2. Location of Project (street address):
City:Statesville County:lredell
3. Directions to project (from nearest major intersection):
Easton Amity Hill Road from intersection of Amity Hill Road & Shelton Avenue (Hwy 21).
4. Latitude:35° 44' 30.5842" N Longitude:80° 2' 1.8005" WJ(j]�V of the mai0innn entrance to the project.
It. PERMIT INFORMATION: �5.1' 3) 1 W 01- 1
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenezoals With unodifications also requires SWU-102 - Renewal Application Forin
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application, list the stormwater project number,
if assigned, and the previous name of the project, if different than currently
proposed,
4.a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 4.0 ac of Disturbed Area
0404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:Larkin Multi -Family Development STVLE-2017-042
Letter of Approval with Modifications December 15, 2016
5. Is the project located within 5 miles of a public airport? [:]No ®Yes
If yes, see S.L. 2012-200, Part VI: http://portal.ncdenr.org/web/Ir/rules-and-regulations
Form SWU-101 Version Oct. 31. 2013 Page I of 6

III. CONTACT INFORMATION
La.. 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:De endable Development, Inc.
Signing Official &"Title:Michael Foess / Operations Partner- Land Development
b.Contact information for person listed in item la above:
Street Address:2649 Brekonridge Centre Drive, Suite 104
City:Monroe State:NC zip:22110
Mailing Address (if applicable):Same as above
City:
Phone: [phone]
[e-mail]
zi
Pax: (704 ) 238-1150
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:Carolina Development Services LLC
Signing Official & 1'itle:David Cuthbeison
b.Contact information for person listed in item 2a above:
Street Address:2627 Brekonridge Centre Drive
City:Monroe State:NC 7ip28110
Mailing Address (if applicable):same as above
City: State: zip:
Phone (N/A ) Pax: (N/A )
Enrail:N/A -
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:R. Joe Barris & Associates, Inc.
Signing Official &'I'RIcTatrick Murphy, P.E. / Engineering Director
b.Contact information for person listed in item 3a above:
Mailing Address:127 Ben Casey Drive, Suite 101
City:Fort Mill State:SC zip:29708
Phone: (803 ) 802-1799 Pax: (N/A )
Email:pmur )[e-mail]
4. Local jurisdiction for building permits: City of Statesville- Code 1, nforcement
Point of ContactEric Pox Phone #: (704 ) 878-3560
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, bnefly summarize how the stormwater runoff will be treated.
The stormwater runoff for the site will be collected and discharged into 1 of either the BMP wetpond or the 2
BMP sand filters.
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 11- Post Construction
3. Stormwater runoff from this project drains to the Yadkin Pee Dee River basin.
4. Total Property Area: 4.79 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:4.79 acres
Total project area slm(l be calculated to exclude the follaeoingg the nornrnl pool of imppounded structures, the area
belveen flue banks of strealns and rivers, the area below the Normal High Water (NE9 line or Mean High Water
(MHM line, and coastal wetlands landrard from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line nray
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 33.4 %
9. How many drainage areas does the project have?3 (For high density, count 1 for each proposed engineered
stormwater BMP. For Iced density and other projects, use 1 for the Whole properly/ 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
Third Creek
Third Creek
Duck Creek
Stream Class *
C
C
C
Stream Index Number *
12-708-204
12-108-20.4
12-108-204-3
Total Drainage Area (sf)
49,935
45,707
33,466
On -site Drainage Area (so
49,935
45,707
33,466
Off -site Drainage Area (so
0
0
0
Proposed Impervious Area** (so
22,888
22,317
15,209
% Impervious Area** total
45.84
48.83
45.45
Impervious- Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area _
On -site Buildings/Lots (so
13,006
15,179
10.546
On -site Streets (sf)
8,018
5,450
3,710
On -site Parkin (so
1,864
1,688
836
On -site Sidewalks (so
N/A
N/A
N/A
Other on -site (so
0
0
0
Future(so
0
0
0
Off -site (so
0
0
0
Existing BUA*** (so
0
0
0
Total (so:
22,888
22,317
15,092
Stream Class and Index Number call be determined at: httn://portal.ncde)ir.orMvcb/wq/pslcsu/classiRcations
Lnyyervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sideevalks, gravel areas, etc.
*"* Report only that amount of existing BUA that rvill 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 Oct. 31, 2013 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation.
Projects in Union County: Contact DEMLR Central Office .staff to check if the project is located within a Threatened &
Endangered Species watershed that mar be subject to more stringent stornnoater requirements as per 1511 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://r)ortal.nctienr.oriz/web/wa/ws/su/bmD-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
htto://12ortal.ncdenr.org/web/wq/ws/su/statesw/forms dots. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at http://portal.ncdenr.org/web/wq/ws/su/maw.)
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.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. PM
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VIl 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.envlielp.org/12ages/onestopexl2ress.litml for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/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'fz mile of the site boundary, include the 1h
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.
L 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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
in. 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).
Pan
PM
PM
PM
en
PM
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where re(Juired).
9. Copy of any applicable soils report with the associated SH WT 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"x1"1" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to verify the SHMT prior
to submittal, [phone].) 10. A copy of the most current property deed. Deed book: 2448 & 2467 Page No: 2052 & "191 PM
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 21-1.1003(c).
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.
http:/ /ww",.secretai,y.statene.us/Corporations/CSeal cli.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate proper[-,, restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
13UA 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 httu://portil.nccienr.org/web/Ir/state-stormwater-
forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR, and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Patrick Murphy, P.E.
Consulting Firm: R. toe Harris & Associates, Inc.
Mailing Address:"127 Ben Casey Drive, Suite 101
Phone: (803 ) 802-1799
Email:pnuirpliv rjocharris.com
State:SCZip29708
Fax: (N/A )
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled oat, complete this
section)
I, (print or type rame ofperson lisled iu Coutact Inforruulimt, iteru 2(i) David Cuthberson , certify that I
own the property identified in this permit application, and thus give permission to (print or ti/pe panne of person
listed in Contact information, item in) Michael Foess with (print or hype name of organization listed in
Con tact Information, item 1a) Dependable Development Inc. to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version Oct. 31.2013 Page 5 uf6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR 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 gnc assep3rFflj of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Public
do herebv certifv that
RSi
personally appeared
before me this by of I 1 I(W�4 y "�, and ac howled the e cu iHn of tl f a placation for
a stormwater permit. Witness my hand and official seal,
J 0,
OjARy'.
PUS
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires l Ca c
I, (print or type name of person listed in Contact Information, item la) Michael Foess - Dependable Development Inc.
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 coven nts l be recorded, and that the proposed project complies with the requirements of the
applicable storrAwrlr les�i nder 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
personally appeared
Witness my hand and official
My commission
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6