SWA000166_Application Form_20220914

® Major Modification, replacing an existing stormwater permit— provide existing permit number: SW09-0411
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):
J 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):
CAMA Major
Erosion &
Sedimentation Control
NPDES Industrial
Stormwater
404/401 Permit
Project Name
North Carolina State Laboratory
Permit/Appl
No.
WAKE-
2022-061
4. Local jurisdiction for building permits: State Construction Office
Point of Contact: Phone #: (919
D. CONTACT INFORMATION
Issue Date
05.05.2022
Other Information
NA
Disturbed Area,1.28
acre
NA
Proposed Impacts
If/ac
1. Applicant/Financially Responsible Party (may be an Organization):NC Department of Health and Human
Services
Signing Official Name & Title --Luke Hoff. Director Division of Property and Construction
Street Address:3026 Mail Service Center
City:Raleigh _ State:NC Zip:27699
Mailing Address (if different):
City: State: Zip:
Phone: [phone]
Email: luke.hoff(&dhss.nc.gov
Fax: ( 1
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;_
Phone:
Email:
State:
Fax:
Zip:
Stormwater Fast Track ATC Application Form Page 3 of 11 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.
5
0
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:
Citv:
State: _ Zip:
Mailing Address (if applicable):
City: State: Zip:_
Phone: ( ) Fax: ( )
Email:
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:Roy Lorenzen, P.E.
Consulting Firm: Stewart Inc.
Mailing Address:223 S. West Street, Suite 1100
City:Raleigh State:NC Zip:27603
Phone: (919 ) 866-4813 Fax: [phone]
Email:rlorenzen Rstewartinc.com
[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:
Stormwater Fast Track ATC Application Form Page 4 of 11 Feb. 10. 2018

Project area and density information:
43,560,000
Total Property Area
sf
-- sf
Total Surface Water Area
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.
-- sf
Total Coastal Wetlands Area
Considered to include: coastal wetlands landward from the NHW (or MHW) line.
Total Project Area
55,757 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
294,812 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.
10,600 sf
Proposed New BUA
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
19
w/o Existing Development. Project Density = [New BUA]/Total Project Area] x 100
6. Anticipated construction start date August 2022
7. Is the project located within 5 miles of a public airport? ® No ❑ Yes
If'Yes,'see S.L. 2012-200, Part VI: http:/iwww.ncleg.net/Sessions/2011/13ills/Senate/PDF/S22M_.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 6 of 11 Feb. 10, 2018