NCG210490_Application_20210225

Environmental
Quality
ty
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
National Pollutant Discharge Elimination System
NCG210000
FOR AGENCY USE ONLY
Date Received
Year
Month
I Da
o2t
02
2+5
Certificate of Co e4
NCG2 1 bfWn
Check#
Amount
I S3 't
tI ob
Pemut Assigned to
M.
A VZl7
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG210000:
For STORMWATER DISCHARGES associated with activities classified as:
SIC` 24 Timber Products (except as specified below), including Wood Chip Mills;
And, Like activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials, products, by-products, or waste materials.
The foiiuwing activities are -specifically exc!uded from coverage under this General Perr�tt ^771�
• Wood Kitchen Cabinets (SIC 2434)
• Wood Preserving (SIC 2491)��
• Logging (SIC 2411) y �
Standard Industrial Classification Code,�al��V+y�1'1
(Please print or type)
1) Mailing address of owner/operator (addres
s to which official permit correspondence will be mailed):
Name r L �V c
Owner Contact (a person) h y a-G k 5`47
Street Address t Lt 9 Frosy H e 1, L W
City A t41+ `jA �e,,4 State V ZIP Code
Telephone No. S 1 9_ 9 Y e) f Fax:
E-mail Address
2) Location of facility producing discharge:
Facility Name kxcll r V-P VC -end
Facility Contact (a person)
Contact E-mail
Street Address (3(,s /41
City P
County
Telephone No. i.
3) Permit Contact
Se
Permit Contact (a person)'
Contact E-mail
Contact phone number
4) Physical Location Information:
State Al v ZIP Code ')- '�i j '3 q
Fax:
Please provide a narrative description of how to get to the facility (usq street names, state road numbers, and
distance and direction from a roadway intersection). 1 /i �-r k Sic t(!�n e�) /%1 &k rz 2
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application)
5) Latitude Longitude (degrees, minutes, seconds)
Page 1 of 5
SW11-236-080113 1 ast revised 7/2114

NCG210000 N.O.I.
6) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
[jKExisting
7) Standard Industrial Classification (SIC):
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code:
8) Provide a brief narrative desc
this facility: Fey' V/"j
on of,the types of industrial activities and products manufactured at
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? P
List discharge points (outfalls) that convey discharge from the site (both on -site and off -site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
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SWU-236-080113 Last revised 7/2/14

NCG210000 N.O.I.
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
Longitude (degrees/minutes/seconds):
10) Receiving waters:
M
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? M4 G V _ V I�
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
11) Does this facility have any other water quality permits?
C/No
❑ Yes
If yes, list the permit numbers for all current water quality permits for this facility:
12) Does this facility have any Non -Discharge permits (ex: recycle permits)?
d No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
13) Does this facility employ any best management practices for stormwater control?
❑ No
9-Yes
If yes, please briefly describe: 50 w ry_ J G Ng, 5T
14) Does this facility have a Stormwater Pollution Prevention Plan?
allo
❑ Yes
If yes, when was it implemented?
15) Does this facility have exposed accumulations of sawdust, bark, mulch, wood chips, or similar size
woody material on -site for longer than seven (7) days? (Exposed directly to rainfall or to run-on from
areas of the facility.)
7❑ Yes
16) Are vehicle maintenance activities occurring at this facility?
B�No ❑ Yes
17) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
L No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
[�'No ❑ Yes
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SWU-236-080113 Last revised 7/2/14

NCG210000 N.O.I.
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
E�No ❑ Yes
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored: _
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor: _
Vendor address:
18) Certification:
North Carolina General Statute 143-215.6 b (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: R fL h:� r 5�l1
Title: 01) W A-e Y
(Signature of Applicant)
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDEQ
Page 4 of 5
SWU-236-080113 Last revised 7/2/14

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'ConnectGIS Feature Report Page 2 of 2
Geo pin City Deed Date
1612154574 11 /9/2020 12:00:00 AM
ParcellD Township Land Class
60192 Gilkey SINGLE FAMILY RES
Acreage Zoning Deed Book
3.5 NONE 2039
Deed Page Map Book Map Page
83 41 72
Index Type Map Block Lot Parcel Number
CRP 286 1 29 B 1654561
Property Address Neighborhood Fire District
136 MOUNTAIN CREEK RD A32F F13 UNION MILLS
Special Tax Districts Owner Name Owner Mailing Address
JACKSON, RICKY 149 FROG HOLLOW
Owner Mailing Citx Owner Mailing State Owner Mailing Zip
RUTHERFORDTON NC 28139
Land Tax Value Building Tax Value Total Assessed Value
Revenue Stamp Structure Size Under Assmt Flag
0 0 Y
Subdivision Sale Price OBJECTID 1
L01 PL41-72 51456
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of its internal business functions and for the public services it provides. The GIS data which Rutherford County distributes and to which it provides access, may not b
suitable for other purposes or uses. It is the users€-s responsibility to verify any information derived from the GIS data before making any decisions or taking any actions
based on the information. Rutherford County shall not be held liable for any errors in the GIS data. This includes errors of omission, commission, errors concerning the
content of the data, and relative and positional accuracy of the data. Source information used for this data may have been collected at different scales, times or definitions,
resulting in inconsistencies among features represented together on this map. In no event shall Rutherford County become liable to users of these data, or any other party,
or any loss or direct, indirect, special, incidental or consequential damages, including but not limited to time, money or goodwill, arising from the use or modification o
he data. The Geographic Information System (GIS) Data made available on the GIS website does not represent legally recorded maps or surveys and is not intended to b
used as such. The information contained in GIS data is dynamic and constantly changes over time. This data is not better than the original sources from which they were
derived. GIS data should not be used for navigational, tracking or any other purpose requiring exact measurement of distance or direction or precision in the depiction o
geographic features. Nor should it be used for making financial or any other commitments. The maps/data provided herein are for illustration purposes only and are no
suitable for site -specific decision making. Parcel data was prepared for the visual representation of real property found within Rutherford County, and is not necessarily
accurate by surveying standards. If absolute accuracy and detail is required, the deeds, plats and other related records on file should be consulted. Parcel ownership lines
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right to require that the user agree in writing that the data will not be resold or otherwise used for trade or commercial purposes pursuant to N.C. Gen. Stat. A§132.10.
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ConnectGIS Feature Report
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JWCONNECTGIS
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RutherforclCounty
Printed February 11, 2021
See Below for Disclaimer
- "-'-" 1 : 95 FeetY�
itherford County Geographic Information Systems (GIS) Data Distribution Disclaimer The County of Rutherford acquires, develops, maintains and uses GIS data in supp
its internal business functions and for the public services it provides. The GIS data which Rutherford County distributes and to which it provides access, may not
itable for other purposes or uses. It is the users€'s responsibility to verify any information derived from the GIS data before making any decisions or taking any actic
ised on the information. Rutherford County shall not be held liable for any errors in the GIS data. This includes errors of omission, commission, errors concerning I
ntent of the data, and relative and positional accuracy of the data. Source information used for this data may have been collected at different scales, times or definitio
suiting in inconsistencies among features represented together on this map. In no event shall Rutherford County become liable to users of these data, or any other pai
r any loss or direct, indirect, special, incidental or consequential damages, including but not limited to time, money or goodwill, arising from the use or modification
e data. The Geographic Information System (GIS) Data made available on the GIS website does not represent legally recorded maps or surveys and is not intended to
https:llrutherfordeounty.connectgis.comIDownloadFile.ashx?i= Ags_map63cea87cl75542... 2/11/2021

NCG210000 N.O.I.
Final Checklist V
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDEQ W' (4 0�4
❑ This completed application and all supporting documents
❑ I(JJ/'
Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
B 2 5 �071
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
IER PLRIMiTTING
Note
The submission of this document does not guarantee the issuance of an NFDES permit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
To visit our website, go to http://AortaLncdenr.or_glweblir/stormwater
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
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SWU-236-080113 Last revised 712/14

North Carolina Secretary of State Search Results
Page 1 of 1
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email
Notification List • View Filings • Print a Pre -Populated Annual Report form • Print an Amended a Annual Report form
Business Corporation
Legal Name
Jackson Logging, Inc.
Prev Legal Name
Jackson Brothers Logging, Inc.
Information
Sosid: 0577811
Status: Current -Active O
Date Formed: 1/18/2001
Citizenship: Domestic
Fiscal Month: December
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Jackson, Ricky Dean
Addresses
Principal Office
149 Frog Hollow
Rutherfordton, NC 28139-8637
Mailing
163 Frog Hollow
Rutherfordton, NC 28139-8637
Officers
Treasurer
Annette Jackson
149 Hollow Frog Rd.
Rutherfordton NC 28139
Stock
Class: Common
Shares: 100000
No Par Value: Yes
Reg Office
149 Frog Hollow
Rutherfordton, NC 28139-8637
President
Ricky D Jackson
149 Frog Hollow
Rutherfordton NC 28139
Reg Mailing
149 Frog Hollow
Rutherfordton, NC 28139-8637
https://www.sosnc.gov/online_services/search/Business_Registration_Results 3/2/2021