SWA000115_Application Form_20211007

DEMLR USE ONLY
Fee Paid
Date ReceivedPermit Number

SW Program(s):CoastalSA-HQWCoastalSA-ORWCoastalFW-ORWCoastalOther
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, allof 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.

B.GENERAL INFORMATION
1 Project Name: TANGLEWOOD
2. Previous Project Name (if applicable):
3. Location of Project (street address): 7.9 ACRES 0 WILMA STREET
City:ANGIER County:HARNETT Zip:27501
4. Directions to project (from nearest major intersection):
NC 55 (RALEIGH STREET) AND NC 210 (E DEPOT ST)
GO EAST ON NC 210 (W DEPOT STREET) TOWARD N BROAD STREET W FOR 0.5 MILES
TURN RIGHT ONTO S WILMA ST PROPERTY IS 0.5 MILES ON THE RIGHT
5. Latitude:35 29’ 58” N Longitude:78 43’ 54” W 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
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)
CoastalSA-ORWNon-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 notapplicable):
Project Name Permit/Appl Issue Date Other Information
No.
CAMA Major NA
Erosion &
Disturbed Area
TANGLEWOOD
Sedimentation Control
6.0 acre
NPDES Industrial
NA
Stormwater
404/401 Permit Proposed Impacts
lf/ac
4.Local jurisdiction for building permits: ANGIER
Point of Contact:SEAN JOHNSONPhone #: (919 ) 331-6702
D.CONTACT INFORMATION
1.Applicant/Financially Responsible Party (may be an Organization):
Signing Official Name & Title:
Street Address:
City: State: Zip:
Mailing Address (if different):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
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: ( )
Email:
Stormwater Fast Track ATC Application Form Page 2 of 9 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:MICHAEL STEWART
Consulting Firm: STEWART-PROCTOR PLLC
Mailing Address:319 CHAPANOKE ROAD - SUITE 106
City:RALEIGH State:NC Zip:27603
Phone: (919 ) 779-1855 Fax: (919) 779-1661
Email:[e-mail]
6.\[OPTIONAL\] If you would like to designate another person to answer questions about the project:
Name & Title:EMILY WILLIAMSON
Organization: STEWART-PROCTOR PLLC
Mailing Address:319 CHAPANOKE ROAD - SUITE 106
City:RALEIGH State:NC Zip:27603
Phone: [phone]Fax: (919) 779-1661
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 GATHERED INTO CATCH BASINS AND RUN THROUGH DRAINAGE SYSTEM
TO WET POND #1, RUNOFF THAT BYPASSES ROADWAY DRAINAGE SYSTEM WILL BE CONVEYED
BY A DIVERSION BERM ON THE SOUTHERN PROPERTY LINE TO WET POND #1
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 1Water 2 Water 3
Receiving Stream NameBLACK RIVER
Stream Classification C; SW
Stream Index Number 18-68-12-1
Stormwater Fast Track ATC Application Form Page 3 of 9 Feb. 10, 2018

5.Project area and density information:
Total Property Area
313,174 sf
Total Surface Water Area
5,351
(CREEK) +
Considered to include:
10,547
the normal pool of impounded structures;
(MAIN
the area between the banks of streams and rivers;and
POOL) =
the area below the Normal High Water (NHW) line or Mean High Water (MHW) line.
15,898 sf
Total Coastal Wetlands Area
0 sf
Considered to include: coastal wetlands landward from the NHW (or MHW) line.
Total Project Area
297,276 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
129,476 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
41.34 %
w/o Existing Development:Project Density = \[New BUA\]/Total Project Area\] x 100
6.Anticipated construction start date 11-01-2021
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

I. PROPERTY OWNER’S AUTHORIZATION (IF APPLICANT IS NOT THE PROPERTY OWNER)
I, (print or type name of the Property Owner) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of Applicant)
with (print or type name of Applicant’s
organization) 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 8 of 9 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 9 of 9 Feb. 10, 2018