NCG210467_Application_20190220

Division of Energy, Mineral and Land Resources FOR AGENCY USE ONLY
_
Stormwater Permitting Program Year Date Received Month F Day 0'1
�_I----LI _
National Pollutant Discharge Elimination System Certificate ofCovera e
N&P NIC 02 11 [C_04 _
Check # _ Amount
Environmental 1 n t h_ 0.0"'_
Quality ` ' �' �i� ` o o " � Pemiit Ass, ed to
-5• v�EYiGt�r�
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit `!c
NCG210000: PO ^ a F I i� ED
For STORMWATER DISCHARGES associated with activities classified as: FEB 13 2019
SIC` 24 Timber Products (except as specified below), including Wood Chip Mills; U 1
And, Like activities deemed by DEMLR to be similar in the process and/or the `v'���ai7ENR' 41 QUALITY
WEuMVrTluG
materials, products, by-products, or waste materials.
The following activities are specifically excluded from coverage under this General Permit:
• Wood Kitchen Cabinets (SIC 2434)
• Wood Preserving (SIC 2491)
• Logging (SIC 2411)
Standard Industrial Classification Code
(Please print or type)
1) Mailing address of owner/operator (address to which official permit correspondence will be mailed):
Name 1MA (:!APtTA` �uc...
Owner Contact (a person) '_71 fAuzv_h4 A ►TRI. j
Street Address 3yn 51uD
City V%'_M11J6%1Z.-, J State NL ZIP Code 7—ft.41 Z
Telephone No. 9 to ' 11:09 - S VVV Fax: 51a - 1(04 - 5Z-74 _
E-mail Address I IMA ®T►Mr��'wQtTA�S. CoM
MA 0/ skulk! L.o 0,?& 441%PXpri +vJ I v-.c-.
2) Location of facility producing discharge:
Facility Name 1 %AAA (APC��►� a:nrL
Facility Contact (a person) RO ME. P_t> Woo"
Contact E-mail RWWt>s ("MMAdapr-mL,,U+)c. Coq
Street Address Q`'x,) �5) N N DALE OP-ty E
City WU-MIA) C-,'r4. State NC.. ZIP Code Zee► 11,2-
County uCW HPIJ�VEe
Telephone No. 1,XL06- 15(6$7 Fax:
3) Permit Contact
Permit Contact (a person) 1 ,:,ntiA6
Contact E-mail {)CA: C Q .)T ►NL—i \AMA A,PtTA"r_Cory
Contact phone number 919-74-9-- 3ZI3
4) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). E kn-62. FAc 1 L I !y A7- 714 5 VNNyJAL4
(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 ,%V.% _10 ?/ Longitude 77. 43 9Y2d' (degrees, minutes, seconds)
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NCG210000 N.O.I.
6) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
X Existing
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: Ar
8) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: Z6 !2' OLWaa!:
9) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 1z__
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): 3 c �� ��,I N
Longitude (degrees/minutes/seconds)94Dcl 511 W
Stormwater Outfall No.
Latitude (deg rees/minutes/seconds): 3 `'l-3 2-$1 N
Longitude (degrees/minutes/seconds):
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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NCG210000 N.O.I.
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): _
Longitude (degrees/minutes/seconds):
10) Receiving waters:
W
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? `p i-T e.14,
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). _xe '
11) Does this facility have any other water quality permits?
ANo
❑ 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)?
$& No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
1 13) Does this facility employ any best management practices for stormwater control?
EK No
❑ Yes
If yes, please briefly describe:
14) Does this facility have a Stormwater Pollution Prevention Plan?
% No
❑ 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
other areas of the facility.)
❑ No KL Yes
16) Are vehicle maintenance activities occurring at this facility?
❑ No �4 Yes
17) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
VL. No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
St No ❑ Yes
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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?
§A --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 ton 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 rue, complete, and accurate.
Printed Name of Person Signing: C � >4C.,\ Ser
Title- ec%
(Signature of Applic
I-)-/ q
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
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SWU-236-080113 Last revised 7/2/14

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