SWA000072_YPUB_ATC_Form_20200812

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
SW Program(s): ❑ Coastal SA-HQW ❑ Coastal SA-ORW ❑ Coastal FW-ORW ❑ Coastal Other
❑ Non -coastal HQW ❑ Non -coastal ORW ❑ Urbanizing Areas ❑ USMP
NC DEQ Division of Energy, Mineral and Land Resources
TRACKSTATE STORMWATER FAST .ems
"AUTHORIZATION TO CONSTRUCT" (ATC) PERMIT APPLICATION FORM
Link to Application Instructions
To be considered for a Fast Track ATC Permit, all of the items below must be checked. if any item cannot
be checked, then the project must apply under the Standard Permitting Process.
® The project and all SCMs (including existing SCMs associated with the project) will meet all applicable
requirements of 15A NCAC 02H .1000 - .1062, including the Minimum Design Criteria (MDC), upon project
completion.
® The project is not proposing an alternative design.
® The project is not claiming an exemption from the MDC based on vested rights, a waiver or a Director's
Certification.
❑ The project is not out of compliance with an existing stormwater permit or any other environmental permit.
® The project is not applying for an offsite permit, an exemption, or a minor modification (as defined in 15A
NCAC 02H .1002(25)) to an existing state stormwater permit.
® The project application bears the signature and seal of a professional licensed pursuant to either Chapter 89A
or 89C of the NC General Statutes.
® I understand that at project completion, an application with the as -built stormwater plans (as described in 15A
NCAC 02H .1044 must be submitted, and DEQ will review the as -built stormwater plans to confirm compliance
with the MDC. Approval of the as -built stormwater plans will be required before the Erosion and
Sedimentation Control Plan for the project may be closed out.
® I understand that the Fast Track ATC Permit will expire five years after the date of issuance.
1 Project Name: Youngsville Public Utility Buildin
2. Previous Project Name (if applicable):
3. Location of Project (street address): South College Street
City:Youngsville County:Franklin Zip:27596
4. Directions to project (from nearest major intersection):
Driving North along US 1 alt. take a right at the intersection of Holden/W Main Street and US 1 alt east
towards W Main Street. Take an immediate right after the intersection onto S College Street then proceed
.4 miles then turn left onto the site
5. Latitude:360 01' 8.3" N Longitude:780 28' 44.2" W of the main entrance to the project.
1. Specify whether project is (check one):
® New, no previous application
❑ New, replacing a previous Fast Track ATC Permit -- provide previous permit number: SWA
By choosing this option, you are also requesting that DEQ rescind the previous Fast Track ATC Permit
upon issuance of the new Fast Track ATC Permit.
Stormwater Fast Track ATC Application Form Page 1 of 9 Feb. 10. 2018

Major Modification, replacing an existing stormwater;permit - provide existing permit number: SW
Status of construction? (] Not Started E Partially Completed r-1 Completed
Maio[ modifications must be submitted by the original permittee and are allowed only, if the SW permit is
not expired. Minor modifications must use Standard Permitting Process: By choosing this option, you
are also requesting that DEQ rescind the previous SW Permit upon issuance of the new Past
Track ATC Permit_
❑ Transfer of existing Fast Track ATC Permit —provide- existing ATC permit number: SWA
2. Applicable state stormwater program(s) (check alf that apply):
0 Coastal SA -HOW M Urbanizing Areas (Phase 2)
❑ Coastal SA-ORW El Non -Coal HQW
Is any portion of the project within 575 feet
of SA-ORW waters? Q Yes Q No ❑ Non -Coastal ORW
El Coastal Freshwater ORW USMP
Coastal — Other
3. Other Permits (as applicable; write "NA" for those permit types that are not applicable):
Print Name
PerndWAppt
issue Date
Cmer tnfbrmaftn
No.
CAMA Major
N/A
WA
Erosion &
Younosyille Public Utility
Disturbed Area 1.25
Sedimentation Control
Building
acre
NPDES Industrial
N/A
NA
Stormwater
-----
---
4041401 Permit
_Youngsyil e Public utility
20200818
Proposed Impacts
Buildin
84 if Wac
4. Local jurisdiction for building permits: Franklin County
Point of Contact:Building inspections Department Phone #: (919 ) 496-2281
D. CONTACT INFORMATION
Appllcant(Financially Responsible Warty (may be an Organization):Town of Younpsville
Signing Official dame & Titie:Phillin Q. Cordeiro, Town Administrator
Street Address:134 US I South
City`Younasville State:NC Zip:27896
Mailing Address (if different):P.O. Box 190
City:Younetsvilie State:NC Zip:27
Rhone: f919) 925-3399 Fax:
Email: pgordeiroCa tow nofyounesvilte.orrl
2_ If the Applicant is a Corporation or LLC (Address must match address on file .with NC Dept of the Secretary of
State):
Name of Registered Agent:
Mailing Address:
City: State: _ Zip
Phone: ( ) Fax,: L )
Email:
Stormwater Fast Track ATC Application Form Page 2 of 10 Feb. 10, 2018

3. The Applicant is the (check all that apply):
® Property Owner
❑ Lessee (Attach a copy of the lease agreement & complete Item 4.)
❑ Purchaser (Attach a copy of the pending sales agreement & complete Item 4.)
❑ Developer (Attach a copy of the development agreement & complete Item 4.)
4. If the Applicant is NOT the Property Owner (skip to Item 5 if the Applicant IS the Property Owner):
Property Owner Name/Organization:
Signing Official & Title:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
5. The licensed Design Professional that will be retained for the duration of the project, who may provide
information on the Applicant's behalf, and who will prepare and certify the as -built package:
Consulting Engineer/Landscape Architect:Sam Nye
Consulting Firm: The Site Group, PLLC
Mailing Address:1111 Oberlin Road
City: Raleigh State: NC Zip:27605
Phone: (919 ) 835-4787 Fax: ( )
Email:srn(c)thesitegroup.net
6. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
E. PROJECT INFORMATION
1. Specify the type of project (check one): ❑ Low Density ® High Density
2. Briefly summarize how the stormwater runoff will be treated/conveyed:
Most of the runoff will be either captured in yard inlets and piped or allowed to sheet flow off of the parking lot
Runoff will be treated in a bioretention pond designed to meet the MDC
3. Stormwater runoff from this project drains to the Neuse River basin(s).
4. Receiving water information (if more than 3 receivina watarq nrnvirla ar1r1itinna1 infnrmatinn nn nn afarhar1 chcafl-
Receiving
Water 1
Receiving
Water 2
Receiving
Water 3'
Receiving Stream Name
Hattles Branch
Stream Classification
C;NSW
Stream Index Number
27-21-1
Stormwater Fast Track ATC Application Form Page 3 of 9 Feb, 10, 2018

5. Proiect area and density inforrnatinn-
Total Property Area
132,427 sf
Total Surface Water Area
7,429 sf
Considered to include:
• the normal pool of impounded structures;
• the area between the banks of streams and rivers, and
. the area below the Normal High Water (AfHlq line or Mean High Water (MHW) line.
Total Coastal Wetlands Area
0 sf
Considered to include: coastal wetlands landward from the NNW (or MHW) line.
Total Project Area
124,998 sf
.Excludes the surface water area and coastal wetland area identified above_
May or may not be the same as Property Area.
Built -Upon Area (BUA) associated with Existing Development
0 sf
`
"Existing development" means those projects that are built or those ,projects that have established a
vested right under North Carolina law as of the effective date of the state stormwater program or
applicable local government ordinance to which the project is subject.
Proposed New BUA
28,715 sf
Includes proposed new BUA that is not associated with existing development_
"BUA" is defined in N.C. G. S. 143-214.7(b2). It includes, but is not limited to: buildings, roads, parking
areas, sidewalks, and some gravel areas. The design volume of SCMs must take into account the runoff
from build out from all surfaces draining to the SCM in accordance with 15A NCAC 02H' .1050(1).
ProjectDensity
wl Existing Development: Project Density = [New BUA]l[Total Project Area — Existing BUAj x 100 or
23.0 %
w/o Existing Development Project Density = (New BUAjlTotaf Project Area] x 100
6. Anticipated construction start date 9/1/2020
7. Is the project located within 5 miles of a public airport? 0 No El Yes
if `Yes,'see'S.L. 2012-200, Part V1. htti)://www.ncleg.net/Sessions/2011/Bills/Senate/PDF/S229v6 pdf and
DEQ Stormwater Design Manual Chapter E-4 Airports.
8. For projects in Union County: Contact DEMLR Central Office Stormwater staff at 919-707-9200 to determine
if the project is located within a Threatened & Endangered Species watershed that may be subject to more
stringent stormwater.requiremenfs per 15A NCAC 02B _ .
Stormwater Fast Track ATC Application Form Page 5 of 10 Feb. 10, 2018

F, SUBMITTAL REQUIREMENTS
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HOW/ORW). Only application packages that include
all required items listed below will be accepted and reviewed.
Initial each item below to indicate that the required information is provided in the application package:
Initials
SN 1. Two original signed hard copies and one electronic copy of this State Stormwater Fast Track
Process "Authorization to Construct" (ATC) Permit Application Form.
SN 2. Permit application processing fee of $505 payable to NCDEQ.
SN 3. Two hard copies and one electronic copy of a USGS map identifying the project location
and GPS coordinates for the project. If the receiving water is Class SA or the receiving water
drains to Class SA waters within '/z mile of the project boundary, include the %2 mile radius
on the map. If the project is within 575 feet of Class SA-ORW waters, include the 575-foot
radius on the map.
SN 4. Two original signed hard copies and one electronic copy of a site plan depicting the boundary
of the project or project phase currently being permitted, including the locations of SCMs,
streams, wetlands, and buffers.
SN 5. Two hard copies and one electronic copy of a construction sequence that discusses how any
future development on the project may be phased.
SN 6. A copy of the most current property deed. Deed book: 357 Page No: 298
N/A 7. [IF APPLICABLE] When the applicant is a corporation or a limited liability corporation (LLC): Provide
two hard copies and one electronic copy of documentation from the NC Secretary of State, or other
official documentation, which supports the titles and positions held by the persons listed
in Section C.2 per 15A NCAC 2H. 1043(3)(b). The corporation or LLC must be listed as an active
corporation in good standing with the NC Department of the Secretary of State; otherwise, the
application will be returned. https://www.sosnc.gov/search/index/core
N/A 8. [IF APPLICABLE] When the applicant is a Partnership or other person engaging in business under
an assumed name, attach a copy of the Certificate of Assumed Name.
N/A 9. [IF APPLICABLE] When the applicant is not the property owner: Provide two hard copies and one
electronic copy of lease agreements, affidavits, pending sales agreement, development agreement,
or other documents showing that the applicant has obtained legal rights to submit a stormwater
permit application within the proposed project area.
N/A 10. [IF APPLICABLE] If modifying an existing permit for completed or partially completed projects, a copy
of the designer's certification.
Stormwater Fast Track ATC Application Form Page 5 of 9 Feb. 10, 2018

The Applicant, who is also the Financially Responsible Party, identified in Section D of this form must sign and have
notarized the following guaranty:
1, (print or type name of Applicant/Financially Responsible Party) Phillip D. Cordeiro
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that:
1. the design has been or will be completed in accordance with the MDC as set forth in Rules 15A NCAC
02H .1050 through .1062, to the best of my knowledge;
2. the completed design meets or will meet the MDC and that the percentage BUA that is the basis for the
design shall not be exceeded, to the best of my knowledge; and
3. As the applicant, I shall maintain a licensed professional of record for the duration of the project
who will prepare and certify the as -built package. If I retain another licensed
professional before the project is complete, then I shall provide an updated
guaranty with the current licensed professional's seal. A licensed professional shall inform
the Division if he is no longer associated with this project.
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath I
agree to provide corrected information should there be any change in the information provided herein.
Phillip D. Cordeiro Town Administrator
Type or print names`' Title or Authority
Signature
Date <97" ( I — z� ez.�6
i, " I h , a Notary Public for the State of,4or4-k7 County
of t, e n do hereby certify that A J 11 P A Cond J�r-+d personally
appeared before me this day off + , Qoan and acknowledge the due execution of
the applicat' f r a stormwater per t. Witness my hand and official seal,
11Y Hv
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SEAL
My commission expires 5-�A00l
Stormwater Fast Track ATC Application Form Page 6 of 9 Feb, 1 p, 2018

H. DESIGN PROFESSIONAL'S
To be completed by the Design Professional identified in Section D.5.
I, Samuel R Nye, PE , attest to the following:
1. This application has been reviewed by me and is accurate and complete, to the best of my knowledge;
2. The design has been completed in accordance with the MDC as set forth in Rules 15A NCAC 02H
.1050 through .1062, as applicable;
3. The percentage built -upon area that is the basis for the design will not be exceeded; and
4. 1 have the expertise, education, and experience required to design the SCMs proposed in this
application in accordance with the MDC as set forth in Rules 15A NCAC 02H .1050 through .1062.
5. 1 will provide all documents and certified as -built plans in hard copy and electronic format related to this
permit to a new Applicant/Property Owner and to DEMLR upon transfer of this permit to a new
Applicant/Property Owner.
Note: In accordance with N.C.G.S. 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation. In addition, any person
who knowingly makes any false statement, representation, or certification in any application may be reported to
the appropriate NC/,irofessional.licensing board.
Signature: Date: 9z1I ) zoZ �
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Stormwater Fast Track ATC Application Form Page 7 of 9 Feb. 10, 201 8

J. FRO VGil TY OWNERS AUTHORIZATION OF APPLICANT IS NOT THE PROPERTY OWNER)
1, (print or type name of the Property Owner) , certify that I
own the property identified in this permit app4ication, and thus give permission to (print or type na -me, of Applicant}
with (print or type name of-Applicanfs
organization) to develop the project as
currently proposed. -A copy of the lease agreement or pending property sales ocontract has been provided with the
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, thatif 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, itis ra� y responsibility to notify DEMLR immediaWy and submit
a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a: valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, -pursuant to NCGS; 143-215.6.
Signature: Date:
a Notary Public for the State of
County of , do hereby certify that
personally appeared before me this day of and acknowledge the
due execution of the application for a stormwater permit. Witness my hand and official seat,
SEAL
My commission expires,
Stormwater Fast Track ATC Application Form Page 9 of 10 Feb.10,2018

REQUESTED)4. N OF CURRENT PERMITTEE (COMPLETE ONLY IF PERMIT TRANSFER I
#
1, (print or type name of the Current Permittee) am submitting
this request for a transfer of Fast Track ATC permit # SWA With the
submission of this transfer request I am providing a copy of the most recent permit, all related documents and as -
built plans certified by my design professional in hard copy and electronic format to the Proposed
PermitteeiApplicant identified in Section G of this application and to DEMLR . I further attest that this request for a
permit transfer is accurate and complete to the best of my knowledge. I assign all rights and obligations as
permittee to the proposed permittee named in Section G of this form.
Signature:
Date:
1, , a Notary Public for the State of County
of do hereby certify that personally
appeared before me this day of , and acknowledge the due execution of
the application for a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Stormwater Fast Track ATC Application Form Page 9 of 9 Feb_ 10, 2018