SWA000097_Application_20210315

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
STATE
Wi y. w FAST
TRACK
PROCESS:
1MY..
"AUTHORIZATION
A 3 PERMIT
R -R * M F ii P ..
Link to Application Instructions
MAR 15 202
DEAR -LAND QUA ITY
A. ELIGIBILITY FOR FAST -TRACK PERMITTING 6 GR .A
` ;'` '` PeRll-ii 1-TING
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:
Hennessey International Warehouse
2. Previous Project Name (if applicable):
3. Location of Project (street address): 4301 N NC Highway 8 /
City: Elon County: Alamance Zip: 27244
4. Directions to project (from nearest major intersection):
The site is located approximately 790 feet south of the intersection
of N NC Highway 87 and Stoney Creek Church Road on the west side of
N NC Highway 87.
5. Latitude: 36 ° 13 ' 13 " N Longitude: 7 9 ° 3 0 , 4 9 " W of the main entrance to the project.
1. Specify whether project is (check one):
❑x 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 ❑ Partially Completed ❑ Completed
Major 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 Fast
Track ATC Permit.
❑ Transfer of existing Fast Track ATC Permit — provide existing ATC permit number: SWA
2. Applicable state stormwater program(s) (check all that apply):
❑ Coastal SA-HQW ❑ Urbanizing Areas (Phase 2)
❑ Coastal SA-ORW ❑ Non -Coastal HQW
Is any portion of the project within 575 feet
of SA-ORW waters? ❑ Yes ❑ No ❑ Non -Coastal ORW
❑ Coastal Freshwater ORW ❑ USMP
❑ Coastal — Other
3. Other Permits (as applicable; write "NA" for those permit types that are not applicable):
Project Name
Permit/Appl
Issue Date
Other Information
No.
CAMA Major
NA
111NA;
Erosion&
Hennessy International
FRO
1/20/21
Disturbed Area
Sedimentation Control
Warehouse
2 . 3 0 acre
NPDES Industrial
NA
E x'
Stormwater``
"
404/401 Permit
NA
Proposed Impacts
If/ac
4. Local jurisdiction for building permits: Alamance county
Point of Contact: Alamance County EH
Phone#: ( 336 ) 641-3171
Applicant/Financially Responsible Party (maybe an Organization): Hennessy International
Signing Official Name & Title: John Hagf ors
Street Address: 485 Alisal Road #212
City: Solvang State: CA Zip:93463
Mailing Address (if different): PO Box 1983
City: Bue l l t on State: CA Zip: 93427
Phone: [phone] Fax: ( 805 ) 693-8870
Email:[e-mail] or [e-mail]
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: Hennessy International
Mailing Address: 485 Alisal Road #212
City: Solvang State: CA Zip: 93463
Phone: [phone] Fax: [phone]
Email:[e-mail] or [e-mail]
Stormwater Fast Track ATC Application Form Page 2 of 9 Feb. 10, 2018

,
3. The Applicant is the (check all that aooh/ :
nx Property Owner
n Lessee (Attach e copy of the lease agreement&completeItem 4.\
F-1 Purchaser(Attach a copy of the pending sales agreement&complete Item 4.)
[] Developer(Attach o copy of the development egneo/nnnt&oump/obe /to/n 4j
4. |f the Applicant is NOT the Property Owner (skip bo Item 5 if the Applicant/S the Property(Jmmed:
Property Owner Nom*/C)rQanization:
Signing Official &Tit|e:
Street Address:
City: State: Zip:
Mailing Address (if applicab/e):
City: State: Zip:
Phone: Fax:
Email:
6. The licensed Design Professional that will be retained for the duration of the may provide
information onthe Applicant's behalf, and who will prepare and certify theas-built package:
Conau|tingEngineer/ l/izzne �LandscapeArohihact� ' Townsend(Consulting Firm: Green Mountain Engineering LLC
City: Greensboro State: NC Zip: 27409
Phone: Fax:
Email:
O. [OFTIUNAOK 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): El Low Density nx High Density
2. Brieflye izehowthe to �be
The storm c*torm water will be routed to a gazz(1 iIter nvlzere the water will
be cleaned and released at the south west corner of the property
3. Stnrmvvater runoff from this project drains tothe BJ\W Riverbesin(s).
4. Receiving water information
Receiving Receiving Receiving
Receiving Stream Name HAW River
Stream Classification WS-V: NWS
Stream Index Number 16- (10 . 5)
5tnrmwotnr Fast T rack ATCApp|icotionFo/w Page. 3o(3 Feb. 1O. 2O18

5. Proiect area and densitv information:
Total Property Area
9 3 915 sf
Total Surface Water Area
0 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 (NHW) line or Mean High Water (MHM line.
Total Coastal Wetlands Area
0 sf
Considered to include: coastal wetlands landward from the NHW (or MHtM line.
Total Project Area
93 915 sf
Excludes the surface water area iand 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
3 9 6 3 9 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).
Project Density
w/ Existing Development: Project Density = [New BUA]/[Total Project Area — Existing BUA] x 100 or
42 ova
w/o Existing Development.' Project Density = (New BUA]/Total Project Area] x 100
6. Anticipated construction start date July 2021
7. Is the project located within 5 miles of a public airport? © No ❑ Yes
If `Yes,'see S.L. 2012-200, Part VI: http://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 requirements per 15A NCAC 02B .0600.
Stormwater Fast Track ATC Application Form Page 4 of 9 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 HQW/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
1. Two original signed hard copies and one electronic copy of this State Stormwater Fast Track
Process "Authorization to Construct" (ATC) Permit Application Form.
2. Permit application processing fee of $505 payable to NCDEQ.
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'/ mile of the project boundary, include the'/ 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.
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.
5. Two hard copies and one electronic copy of a construction sequence that discusses how any
future development on the project may be phased.
6. A copy of the most current property deed. Deed book: 3 917 Page No
0985
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/corp
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.
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.
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 Fond Page 5 of 9 Feb. 10, 2018

11111�1
•
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)
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 rue and correct to the best of my knowledge and belief and was provided by me under oath I
agree to provide corre t d information should there be any change in the information provided herein.
} 15-O lrS �9A%r.�i�
Type or print
ure
Title or Authority
Date -'s/l Z
I, , a Notary Public for the State of ,
County of , do hereby certify that
personally appeared before me this day of , and acknowledge the
due execution of the application for a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Storrnwater Fast Track ATC Application Form Page 6 of 9 Feb. 10, 2018

CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document
to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of Calif rnia
County
O 1�✓CJ before me, t�tsrJl(�
Dat Here Insert Name and Title of the O r
personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s) whose name( i are subscribed
to the within instrument and acknowl ged to me thaph /she/they executed the same i i /her/their
authorized capacity(ies), and that hi /her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s)cted, executed the instrument.
MARIA L. TORRES
COMM. $22151554 <
a� NOTARY PUBLIC-CALIFORNIA X
> SANIA BARBARA COUNTY rn
My Comm, Expim July 28,2022 11
Place Notary Seal and/or Stamp Above
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand an al seal.
Signa
Signature of Notary Public
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee
❑ Other:
Signer is Representing:
❑ Guardian or Conservator
©2019 National Notary Association
Number of Pages:
Signer's Name:
❑ Corporate Officer —
El Partner — ❑ Limite
❑ Individual
❑ Trustee
❑ Other:
Signer is Representing
Title(s):
I ❑ General
❑ Attorney in Fact
❑ Guardian or Conservator

' ^..
H. DESIGN PROFESSIONAL'S CERTIFICATION
Tobe completed bv the Design Professional identified in Section D.5.
i . 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 IVIDC as set forth in Rules 15A NCAC 02H
.1O5O through .1O82' eeapplicable;
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 SCIVIs proposed in this
application in accordance with the IVIDC as set forth in Rules 1 5A NCAC 02H .1050 through .1062.
5. | 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
App|icant/PnoportyOwnor.
Note: In accordance with N.C.G.S. 143-215.GA and 143-215.8B. 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. |n addition, any person
who knowingly makes any false statement, reprenentation, or certification in any application may be reported to
the appropriate NC professional licensing board.
Signature: / Date:
SEAL
SEAL
23951
Stnrmwoter Fast T rack ATCApp|ioahunForm Page 7of9 Fnb 10. 2018

I. PROPERTY OWNER'S AUTHORIZATION (IF APPLICANT IS NOT THE PROPERTY OWNER)
, (print or type name of the Property Owner) , certify that I
own the property ide ' ied in this permit application, and thus give permission to (print or type name of Applicant)
n s with (print or type name of Applicant's
organization) _ ° to develop the project as
currently proposed. A copy of the lease agr_ee'm ent 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.
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
the assessment of civi efr`altiesyf,,09�,$25,000 per day, pursuant to NCGS 143-215.6.
Signature- Date:
I t 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 8 of 9 Fels. 10, 2018

CALIFORNIA ACKNOWLEDGMENT
CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document
to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of-aXn}q!s mVi_.� j k �c�.,
On before me, u: low � M
D Here Insert Name and Title of the Officer
personally appeared
me(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name( is/ re subscribed
to the within instrument and acknowledged to me thaoshe/they executed the same i i her/their
authorized capacity(ies), and that b s/
ersoer/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the pns acted, executed the instrument.
MARIA L. TORRES C
COMM. #2251554
¢� . NOTARY PUBLIC-CALIFORNIA
s ? SANTA BARBARA COUNTY
My COMM, upires Jely 2"11112 uu
s�••��s�M.yy�d+►I Ai4i�4� •1A �a.4.f•"
Place Notary Seal and/or Stamp Above
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand ffi 'al seal.
S
Signature of Notary Public
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other -
Signer is Representing:
C2019 National Notary Association
Number of Pages:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:

J. CERTIFICATION OF CURRENT PERMITTEE (COMPLETE ONLYIF PERMIT TRANSFER IS
REQUESTED)
I, (print or type name of the Current Permittee) d 'w .�`Oa�' 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
Permittee/Applicant 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:
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,
5, 'J�'du_A
SEAL
My commission expi
Storrnwater Fast Track ATC Application Forrn Page 9 of 9 Fels. 1 U, 2018

CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document
to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of CagDrnia
Caumy of
- F-P
On before me, ��--
t Here Insert Name and Title of the ficer
personally appeared Jjq\ �k� -
( Name(s) of Signer(s)
who proved to me on the basis of satisfactory evident be the person(s) whose name( re subscribed
to the within instrument and acknowledged to met t /she/they executed the same i /her/their
authorized capacity(ies), and that by is her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
MARIA L. TORRES
cD COMM. #2251554 G
NOTARY PUBLIC•CALIFORNIA cnn
MANTAxplARA COUNTY
My Comm, E�xplrse July 28,20w22 N
ra+r.�
Place Notary Seal and/or Stamp Above
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
Lnatu
ESS my hand an offic I seal.
�Z
Signature of Notary Public
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:
National• • •
Number of Pages:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:

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Business Corporation
Legal Name
Hennessy International, Inc.
Information
SOsld: 2105405
Status: Current -Active O
Date Formed: 1/5/2021
Citizenship: Foreign
State of Incorporation: CA
Fiscal Month: December
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Northwest Registered Agent Service, Inc.
Addresses
Principal Office
1623 MISSION DRIVE, SUITE 14
Solvang, CA 93463-3630
Mailing
PO BOX 1983
Buellton, CA 93427-1983
Officers
John Hagfors
1623 MISSION DRIVE, SUITE 14
Solvang CA 93463-3630
Stock
Reg Office Reg Mailing
4030 Wake Forest Road, Ste 349 4030 Wake Forest Road, Ste 349
Raleigh, NC 27609
Raleigh, NC 27609
https://www.sosnc.gov/online_services/search/Business_Registration—Results 3/16/2021