SWA000108_Application Form_20210809

DEMLR USE ONLY
Fee Paid
Date Received Permit Number

ɎɎ
SW Program(s): Coastal SA-HQW Coastal SA-ORW Coastal FW-ORW Coastal Other
Non-coastal HQWNon-coastal ORWUrbanizing Areas USMP

NC DEQ Division of Energy, Mineral and Land Resources

STATE STORMWATER FAST TRACK PROCESS:
AUTHORIZATION TO CONSTRUCT (ATC) PERMIT APPLICATION FORM

Link to Application Instructions

A. ELIGIBILITY FOR FAST-TRACK PERMITTING
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
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.

B.GENERAL INFORMATION
1Project Name: Chatham Hospital Tower Project
2. Previous Project Name (if applicable):
3. Location of Project (street address): 492 Progress Blvd.
City:Siler City County:Chatham Zip:27344
4. Directions to project (from nearest major intersection):
From Hwy 421 head East on Hwy 64 for .4 miles, turn right on to Progress Blvd. Drive, continue
1 mile on Progress Blvd. Site will be gravel drive on right hand side across from Medical Park Dr.

5. Latitude:35 4323.17 Longitude:79 2540.97 of the main entrance to the project.

C. PERMIT INFORMATION
1. Specify whether project is (check one):

New, no previous application
New, replacing a previous Fast Track ATC Permit -- provide previous permit number: SWA
Stormwater Fast Track ATC Application Form Page 1 of 10 Feb. 10. 2018

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 2 of 10 Feb. 10, 2018

Major Modification, replacing an existing stormwater permit provide existing permit number: SW
Statusof construction?Not StartedPartially CompletedCompleted
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 ( applicable):
Project Name Permit/Appl Issue Date Other Information

No.
CAMA Major NA

Erosion &
Disturbed Area
Chatham Hospital Tower CHATH-1/22/21
Sedimentation Control
2.175 acre
2021-008
NPDES Industrial
NA

Stormwater
404/401 Permit Proposed Impacts

lf/ac
4. Local jurisdiction for building permits: Chatham County / Siler City
Point of Contact:David Camp / Jack Meadows Phone #: (919 ) 542-8293 / [phone]

D. CONTACT INFORMATION
1. Applicant/Financially Responsible Party (may be an Organization):Pyramid Network Services, LLC

Signing Official Name & Title:Ron Brunozzi, P.E / Chief Operating Officer
Street Address:6615 Towpath Road
City:East Syracuse State:NY Zip:13057
Mailing Address (if different):
City: State: Zip:
Phone: (315) 278-1275 Fax: (315) 445-0653
Email: [e-mail]
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:CT Corporation System
Mailing Address:160 Mine Lake Ct. Ste 200
City:Raleigh State:NC Zip:27615-6417
Phone: (919) 821-7139 Fax: ( )
Email:
Stormwater Fast Track ATC Application Form Page 3 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:Chatham County
Signing Official & Title:Mike Reitz / Emergency Communications Director

Street Address:297 West St
City:Pittsboro State:NC Zip:27312
Mailing Address (if applicable):
City: State: Zip:
Phone: (919 ) 545-8160 Fax: [phone]
Email:[e-mail]

5. The licensed Design Professional that will be retained for the duration of the project, who may provide
information on behalf, and who will prepare and certify the as-built package:
Consulting Engineer/Landscape Architect:Eric Kohl
Consulting Firm: KCI
Mailing Address:4505 Falss of Neuse Road, Suite 400
City:Raleigh State:NC Zip:27609
Phone: (919 ) 278-2478 Fax: (919) 783-9266
Email:eric.kohl.kci.com
6. \[OPTIONAL\] If you would like to designate another person to answer questions about the project:
Name & Title:William Hudgins / Project Manager
Organization: Pyramid Network Services, LLC
Mailing Address:6615 TowpathRoad
City:East Syracuse State:NY Zip:13057
Phone: (276 ) 226-5104 Fax: (315 ) 445-0653
Email:[e-mail]

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:
Stormwater will be minimal based on locatio of property. Most will be handled in a sheet flow capacity
with the exception of a couple of culverts for current low spots which have rip rap to slow the velocity
on the inlet and outlet protection. The compound itself is pervios, but has been examined as impervious.
3. Stormwater runoff from this project drains to the Cape Fear River basin(s).
4. Receiving water information (i f more than 3 receiving waters, provide additional information on an attached sheet):
Receiving Receiving Receiving
Water 1 Water 2 Water 3
Receiving Stream Name Rocky River
Stream Classification C
Stream Index Number 17-43-(8)

Stormwater Fast Track ATC Application Form Page 4 of 10 Feb. 10, 2018

5. Project area and density information:
Total PropertyArea
1,505,869
sf

Total Surface Water Area
5,000 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 (MHW) line.
Total Coastal Wetlands Area
0 sf
Considered to include: coastal wetlands landward from the NHW (or MHW) line.
Total Project Area
1,500,869

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

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
35713 sf
Includes proposed new BUA that is not associated with existing development.
-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
2.38 %

w/o Existing Development: Project Density = \[New BUA\]/Total Project Area\] x 100

6. Anticipated construction start date August 16, 2021

7. Is the project located within 5 miles of a public airport? No Yes
es, 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 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 HQW/ORW). Only application packages that include
allrequired 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
WH 1. Two original signed hard copies and one electronic copy of this State Stormwater Fast Track
Process lication Form.

WH 2. Permit application processing fee of $505 payable to NCDEQ.

WH 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 ½ mile of the project boundary, include the ½ 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.

WH 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.

WH 5. Two hard copies and one electronic copy of a construction sequence that discusses how any
future development on the project may be phased.

WH 6. A copy of the most current property deed. Deed book: 821 Page No: 639

WH 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.

WH 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

Stormwater Fast Track ATC Application Form Page 6 of 10 Feb. 10, 2018

H. DESIGN PROFESSIONAL'S CERTIFICATION
To be completed by the Design Professional identified in Section D.5.
I, Eric S. Kohl. 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 143-215.613, 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 statem t, representation, or certification in any application may be reported to
the appropriate NC professional lic in board.
Signature: .00 Date: �t 12,1
%_1 IS
,e`!�� �„yi a �G•yI' s
EAL
225949
Al
9` 0
SEAL
Stormwater Fast Track ATC Application Form Page 7 of 9 Feb. 10, 2018

I.PROPERTY OWNER AUTHORIZATION (IF APPLICANT IS NOT THE PROPERTY OWNER)

I, (print or type name of the Property Owner) Mike Reitz , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of Applicant)
Ronald J. Brunnozzi with (print or type name of
organization) Pyramid Network Services, LLC 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.

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 civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.

Signature: Date:

I, _____________________________________, a Notary Public for the State of ____________________, County
of ____________________, do 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 10 Feb. 10, 2018

J. CERTIFICATION OF CURRENT PERMITTEE (COMPLETE ONLY IF PERMIT TRANSFER IS
REQUESTED)

I, (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
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:

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

Stormwater Fast Track ATC Application Form Page 10 of 10 Feb. 10, 2018