NCG140441_COMPLETE FILE - HISTORICAL_20171201

PERMIT NO.
DOC TYPE
DATE OF
RESCISSION
STORMWATER DIVISION CODING SHEET
RESCISSIONS
WG ly Uy�4 1
❑ COMPLETE FILE - HISTORICAL
El
YYYYMMDD

Energy. Mineral &
Land Resources
ENVIRONMENTAL OUALiTY
Mr. Christopher M. Ange
28.14 Assembly Road
Greensboro, NC 27405
Dear Mr. Christopher:
ROY COOPER
Covernor
MICHAEL S. REGAN
Secretary
November 29.2017 �� TA CY DAVIS
!: Director
DEC U x 2017
CENTRAL FILES
DWR SECTION
Subject: Rescission of NPDES Stormwater Permit
Certificate of Coverage Number NCG 140441
Guilford County
The Division of Energy, Mineral and Land Resources received your request to rescind your
coverage under Certificate of Coverage Number NCG140441. In accordance with your request,
Certificate of Coverage Number NCG 140441 is rescinded effective immediately.
Operating a treatment facility, discharging wastewater or discharging specific types of
stormwater to waters of the State without valid coverage under an NPDES permit is against
federal and state laws and could result in fines. If something changes and your facility would
again require stormwater or wastewater discharge permit coverage, you should notify this office
immediately. We will be happy to assist you in assuring the proper permit coverage.
If the facility is in the process of being sold, you will be performing a public service if you would
inform the new or prospective owners of their potential need for NPDES permit coverage.
If you have questions about this matter, please contact us at 919-707-9200, or the Stormwater
staff in our Winston-Salem Regional Office [phone],
cc: Winston-Salem Regional Office
stormwater Permitting Program
Central Files
Sincerely,
for Tracy E. Davis, PE, CPM, Director
Division of Energy, Mineral and Land Resources
Nothing Compares_
State a North Carolina I Environmental Quality I Energy, ;Mineral and Lind Resources
512 N. Salisbury Street 1 €612 Mail Service Center I Raletgr, Nurth Carolina 27699 Ib€2
1419 707 9200

A 7__A
NCDENR
N+� C—W.. De�a1—f of
E�.11.0_e T ..o Hn - RESOURCES
Dk►ision of Energy, Alineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
NC5 NC I G140441
2) Owner/Facility Information: ' Final correspondence will be moiled to the address noted below
Owner/Facility Name The Lane Construction Corporation
Facility Contact Christopher M. Ange
Street Address 2814 Assembly Rd
City Greensboro State NC ZIP Code 27405
County Guilford E-mail Address cmangeOlaneconstruct.com
Telephone No. 336 406-9060 Fax:
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
® Facility closed or is closing on-8/7/17 . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to F _ - on F ! If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
❑ Other:
All VV0j
4) Certification:
DENRIA D OUAIITy
I, as an authorized representative, hereby request rescission of coverage under the NPDE9,1_4�7ffA1WRftTgtl
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is Cru omplete a d accurate.
SignatureA. Date _ 5- aoI
Christopher M. Ange, PE Senior Job Engineer
Print or type name of person signing above Title
Please return this completed rescission request form to: NPDES Permit Coverage Rescission
Stormwater Permitting Program
16i2 mail Service Center
VVV
Raleigh, North Carolina 27699-1612, ,,,
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] FAX: [phone]
An Equal Opportunity I Affirmative Actlon Employer

Alexander, Laura
From: White, Glen
Sent: Thursday, August 24, 2017 11:30 AM
To: Alexander, Laura
Cc: White, Sue
Subject: NCG140441 (Rescission Request)
Attachments: NCG 140441GUILF 08-23-2017 - RECOMMEND RESCISSION.pdf
Laura
1 visited 2814 Assembly Road on 8/23/17. The temporary concrete plant has been removed and the site appears
compliant. Recommend that the request for rescission be granted.
Glen White
Environmental Specialist
NCDENR Winston-Salem Regional'Office
Division of Energy, Minerals & Land Resources
450 Hanes Mill Rd — Suite 300
Winston-Salem, NC 27105
[e-mail]
[phone]

Permit Number NCG140441
Program Category
NPDES SW
Permit Type
Ready Mix Concrete StormwaterANastewater Discharge COC
Primary Reviewer
rick.riddle
Coastal SWRule
Permitted Flow
Facility
Central Files: APS _ SWP
9/24/2015
Permit Tracking Slip
Status Project Type
In review New Project
Version Permit Classification
COC
®
E I V E ®
Permit Contact Affiliation
SEP 3 0 2m
CENTRAL FILES
DWR SECTION
Facility Name Major/Minor Region
Greensboro Eastern Urban Loop Concrete Batch Plant Site Minor Winston-Salem
Location Address County
2814 Assembly Rd Guilford
Facility Contact Affiliation
Greensboro NC 27405 Chad M. Curran
2149 Fleming Rd
Owner Greensboro NC 27410
Owner Name Owner Type
The Lane Construction Corporation Non -Government
Owner Affiliation
Chad M. Curran
2149 Fleming Rd
Dates/Events Greensboro NC 27410
Scheduled
Orig Issue App Received Draft Initiated Issuance
8/17/2015
Public Notice Iss a
°1In /OL �
Eff9ctiv
�/( 15
Expiration
413
Regulated Activities
Requested /Received Events
t/
Ready mixed concrete production
RO staff report received
RO staff report requested
Other agency comments requested
�v
1
<
1918/15
918/15
Other agency comments received
Outfall 1
Waterbody Name Streamindex Number Current Class Subbasin
HAW RIVER 16-(10.5) WS-V;NSW 03-06-01

North Carolina Department of Environmental Quality
Pat McCrory
Governor
Chad M. Curran
The Lane Construction Corporation
6125 Tyvola Centre Dr.
Charlotte, NC 28217
Dear Mr. Curran:
Donald R. van der Vaart
Secretary
September 24, 2015
Subject: General Permit No.'NCG 140000
Greensboro Eastern Loop
Temporary Concrete Plant
COC NCG140441
Guilford County
In accordance with your application for a discharge permit received on August 17, 2015, we are
forwarding herewith the subject certificate of coverage to discharge under the subject state — NPDES
general permit. This permit is issued pursuant to the requirements of North Carolina General Statute 143-
215.1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection
Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except after notice to the Division of
Energy, Mineral, and Land Resources. The Division may require modification or revocation and
reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Energy, Mining, and Land Resources, or permits required by the Division of Water
Resources, Coastal Area Management Act, or any other federal or local governmental permit that may be
required.
If you have any questions concerning this permit, please contact Richard Riddle at telephone number
[phone].
Sincerely,
for Tracy E. Davis, P.E., CPM-
cc: Winston Salem Regional Office
Central Files
Stormwater Permitting Program Files
Division of Energy, Mineral and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 • Telephone [phone] / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:Lportal.ncdenr.org/web/Ir/`
An Equal Opportunity \ Affirmative Action Employer— 50% Recycled \ 10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCGI40000
CERTIFICATE OF COVERAGE No, NCGI40441
STORMWATER and WASTEWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
The Lane Construction Corporation
is hereby authorized to discharge stormwater and process wastewater from a facility located at
Greensboro Eastern Urban Loop — Temporary Concrete Plant
2814 Assembly Road
Greensboro
Guilford
to receiving waters designated as Haw River, a class WS-V, NSW water in the Cape Fear River
Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, and IV of General Permit No. NCG140000 as attached.
This certificate of coverage shall become effective September 24, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 24, 2015.
/Z�
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

1
.w
reen5ouro casiern uroan Loup
encrete Batch Plant

A."
NCDENR
Roq,M C AOLINA CEP TMENT OF
£eI -OD Er —D NAJIA L REy CEs
NOTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG140000
FOR AGENCY USE ONLY
Date Received
Year Montle
Dav
Certificate ofC xea
C eck 9.
AI ou 1
Permit As. � fined to
dd 111
National Pollutant Discharge Elimination System application for coverage under General Permit NCG140000:
STORMWATER AND PROCESS WASTEWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) Code: 3273 and like activities - Ready Mixed Concrete
This NOI may be an application to discharge process wastewater. NCG140000 contains effluent limitations for
process wastewater discharges. Wastewater discharges must meet the requirements of these effluent
limitations. An exceedance of any of these limitations will result in a violation of the permit conditions.
For questions, please contact the DEMLR Central Office or Regional Office in your area. (See page 6)
(Please print or type)
1) Mailing address of ownerloperator (official address to which all permit correspondence will be mailed :
• (Please print or type all entries in this application form.)
Legal Owner Name: The Lane Construction Corporation
(Please attach the most recent Annual Report to the NC Secretary of State showing the current legal name. Alternatively this
permit can be given to an individual.)
Signee's Name (as signed for in question 29 below) Chad Curran
Street Address: 6125 Tyvola Centre Drive
City: Charlotte State: NC ZIP Code: 28217������
Telephone No.: [phone] Email: [e-mail] AUG 17 2015
Alternate Contact Name: Email (if different):
Alternate Contact Telephone (if different): DENR-LAND QUAL1Ty
2) Location of facility producing discharge: STORMWg7ER PERMITTING
Facility Name: Greensboro Eastern Urban Loop Concrete Batch Plant Site
Facility Contact: Chad M. Curran
Street Address: 2814 Assembly Rd
City: Greensboro State: NC ZIP Code: 27405
County: Guilford
Telephone No.: [phone] Fax: [phone]
3) Physical location information:
Please provide narrative directions to the facility (use street names, state road numbers, and distance and
direction from a roadway intersection): From the intersection of 140 and US 29 in Greensboro head north
on US 29 10.2 miles to the northwest quadrant of the intersection of US 29 and Assembly Rd.
(A copy of a county map or USGS quad sheet with facility clearly located on the map is a required part of this application.) a
4) Latitude: 36 Deg 8 Min 35.6 Sec Longitude _79 Deg 44 Min 19.19 Sec s� , t 1 ca 19 9
5) This NPDES Permit Application applies to the following (check all that apply):
r
Page 1 of 8
Last revised 812114

NCG140000 N.O.I.
. ❑ New or Proposed Facility
Date operation is to begin: 10/1/2015
❑ Existing Facility Permit #
SWU-229-11032011
6) Consultant's application information:
Consultant:
Consulting Firm:
Mailing Address:
City!
State:
Phone:( )
Email:
Zip Code: _
Fax: ( )
(Optional)
Staple Business Card Here:
7) Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility: SIC Code: 3273
8) Provide a brief description of the types of industrial activities and products produced at this facility: (Attach
a site diagram showing the process areas present at this facility.): Temporary Concrete batch plant to
manufacture concrete for the Greensboro Eastern Urban Loop project. The operation will include material
stockpiles, bulk water storage, bulk flyash and cement storage.
Stormwater Discharge, Wastewater Treatment & Discharge and Permitting Information
• 9) Discharge points I Receiving waters: One
Number of discharge points (ditches, pipes, channels, etc.) that convey stormwater and/or wastewater from
the property:
Storm water -only.- 1 Wastewater -only: 1 Wastewater Commingled with Stormwater. NA
For new facilities: Expected date of commencement of discharge: 10/1/2015
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
and/or wastewater discharges end up in? Haw River
Receiving water classification(s), if known:
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).
Will this facility discharge wastewater to SA (Shellfishing) waters? ❑ Yes X No
Note: Discharge of process wastewater to receiving waters classified as WS-11 to WS-V or SA must
be approved by the N.C. Division of Water Resources, Public Water Supply Section. If DWR
does not approve, coverage under NCG140000 cannot be granted. No new discharges of
process wastewater are permitted in receiving waters classified as WS-I or freshwater ORW.
10) Each applicant shall provide the following information (attach additional sheets as necessary):
• Two (2) site plans depicting the facility or site with numbered outfalls which indicate stormwater and
40 wastewater outfalls. The plans shall legibly show. at a minimum, (existing or proposed):
o Outline of drainage areas with topographical lines and features o
Stormwater/wastewater treatment structures
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SWU-229-07122011 Last revised 812/14

NCG140000 N.O.I.
o Location of numbered stormwater/wastewater outfalls (corresponding to which drainage
areas) o Runoff conveyance structures o Areas and acreage where materials are
stored o Impervious area acreages o Location(s) of streams and/or wetlands the
site is draining to, and any applicable buffers o Site property lines, North Arrow, and bar
scale
o If applicable, the 100-year floodplain line c Acreage of each stormwater and wastewater
topographical area o Each of the facilities' wastewater or stormwater source and discharge
structures and each of its hazardous waste treatment, storage, or disposal facilities
a Site location (insert)
Site plans shall be 24" x 36" in size.
• Line drawing and description: A line drawing of the water flow through the facility. A pictorial description
of the nature and amount of any sources of water and any collection and treatment measures.
• A narrative description and identification of each type of process, operation, or production area which
contributes wastewater to the effluent for each outfall, and a description of the treatment the wastewater
receives (or will receive), including the ultimate disposal of any solid or fluid wastes other than by
discharge. Processes, operations, or production areas may be described in general terms (e.g. "ash silo"),
11) Does the applicant have any unresolved Notice of Violations (NOVs)? XNo ❑ Yes
Wastewater.
12) What types of wastewater does your facility generate or discharge?
Type of Authorized Wastewater
Generate
Discharge
Sent to WW
Treatment
System
Vehicle and equipment cleanin VE
❑
❑
❑
Wettinq of raw material stockpiles RM
X
X
❑
Mixing drum cleaning MD
X
X
❑
Further explanation, if necessary:
13) Will your facility spray -down or actively wet aggregate piles? ❑ No X Yes
14) Does the facility use any of the following on site?
❑ Phosphorus -containing Detergents
❑ Brighteners ❑ Other Cleaning Agents
❑ Non -Phosphorus -containing Detergents
❑ Other:
15) Are wastewater treatment facilities planned in the 100-year flood plain? X No ❑ Yes
• 16) Does your facility use or plan to use a recycle system, or recycle components in your treatment system?
X Yes ❑ No
Page 3 of 8
5W U-229-07122011
Last revised 812114

NCG140000 N.O.I.
If yes, what size storm event is the system designed to hold before overflowing? (for example, 10-yr, 24-hr)
year, 24-hr rainfall event
17) Will your facility build a closed -loop recycle system that meets design requirements in 15A NCAC 02T
r
.1000 and hold your facilities' working volume ?
❑ Yes XNo
Will your facility discharge wastewater to surface waters?
❑ Yes X No
If the facility's treatment system meets the design requirements of 15A NCACO2T .1000 (including holding
the 25-year, 24-hour storm plus one foot of freeboard), holds the working volume of your site, and does
not discharge wastewater to surface waters, you may not be required to obtain an NPDES permit for
wastewater discharges. If you believe this is the case, please contact DEMLR's Aquifer Protection Section
Land Application Unit Central Office Supervisor or staff (1636 Mail Service Center, Raleigh, NC 27699-1636)
for more information on obtaining the necessary permits or approvals. If you will discharge wastewater or
stormwater to surface waters, please continue to apply for a permit to discharge associated with ready -mixed
concrete or like operations under NCG140000. For further questions, please contact DEMLR's Stormwater
Permitting Unit Staff.
18) A wastewater treatment alternatives review is required by 15A NCAC 2H.0105 (c)(2) for any new or
expanding water pollution control facility's discharge in North Carolina. You may attach additional sheets.
. a) What wastewaters were considered for this alternatives review? ❑ VE ❑ RM ❑ MD
b) Connection to a Municipal or Regional Sewer Collection System:
•
i) Are there existing sewer lines within a one -mile radius? ..................................... XYes ❑ No
(1) If Yes, will the wastewater treatment plant (WWTP) accept the wastewater? .... ❑ Yes X No If
(a) If No, please attach a letter documenting that the WWTP will not accept the wastewater.
(b) If Yes, is it feasible to connect to the WWTP? Why or why not? No
c) Closed -loop Recycle System (must meet design requirements of 15A NCAC 2T .1000):
i) Are you already proposing a closed -loop recycle system (CLRS)? ❑ Yes X No
(1) If Yes, contact DEMLR's Aquifer Protection Section's Land Application Unit
(2) 1f No, is this option technologically feasible (possible)? Why or why not?*
(3) If No, is it feasible to build a CLRS on your site? Why or wily not? The temporary concrete plant
will not be on the site long enough to consider this option.
(4) What is the feasibility of building a CLRS compared to direct surface water discharge? This is not
feasible. Please see the answer to question 18.i.3.
Page 4 of 8
SWU-229-07122011 Last revised 8/2114

NCG140000 N.O.I.
d) Surface or Subsurface Disposal System (e.g., spray irrigation):
IS
i} Is a surface or subsurface disposal technologically feasible (possible)? .................... ❑ Yes X No
Why y� o�y not? . �.
ii) Is a surface or subsurface disposal system feasible to implement?*__... ... ........ 0 Yes X No
Why or Why not?
iii) What is the feasibility of employing a subsurface or surface discharge as compared to a direct
discharge to surface waters?' -?
e) Direct Discharge to Surface Waters: Is discharge to surface waters the most environmentally sound
alternative of all reasonably cost-effective options of the wastewaters being considered?* ... X Yes ❑ No i)
If No, contact DEMLR's Land Application Unit to determine permitting requirements.
f) If this review included all wastewater discharge types, would excluding some types (e.g. raw
stockpile wetting) make any of the above non -discharge options feasible? ....... X Yes No
You may be asked to provide further information to support your answers to these questions after the initial review.
Feasibility should take into account initial and recurring costs.
Stormwater:
19) Does this facility employ any best management practices for Stormwater control? ❑ No X Yes
If yes, please briefly describe: Retention basins properly sized with diversion ditches.
20) Does this facility have a Stormwater Pollution Prevention Plan? ❑ No X Yes
If yes, when was it implemented? 10/1/2015
21) Are vehicle maintenance activities (VIVIA) occurring or planned at this facility? X No ❑Yes
If yes, does your VMA area discharge into your wastewater treatment device? ❑ No ❑ Yes
OtherlPermittin_q:
22) Does this facility have a Division of Land Resources Erosion & Sedimentation Control (E&SC) Permit?
❑ No XYes Flatiron Blythe Development
If yes, list the permit numbers for all current E&SC permits for this facility:
23) is your facility subject to Phase II Post -Construction Area? ❑ Yes X No
If yes, who is the permitting authority?
24) Is your facility located in one of the 20 Coastal Counties? ❑ Yes X No
• Is your facility adding more than 10,000 ftz of built -upon area or CAMA Major Permit? ❑ Yes X No
Page 5 of 8
SWU-229-07122011 Last revised 8/2114

NCG140000 N.O.I.
• 25) Is your facility discharging wastewater (treated or untreated) such as water from wetting of aggregate piles,
PA., r
V
r
�
drum rinse -out, or vehicle and equipment cleaning to a stormwater BMP? ❑ No X Yes If
yes, please attach your approval from the permitting authority to do so.
26) Does this facility have any other NPDES permits? X No ❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
27) Does this facility have any Non -Discharge permits (ex: recycle permits)? X No ❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
28) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Type(s) of waste:
How is material stored
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor: _
Vendor address:
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
X Check for $100 made payable to NCDENR.
X This completed application and all supporting documentation. See Question 10.
Page 6 of 8
SWU-229-07122011 Last revised 812114

NCG140000 N.O.I.
X If an Erosion & Sedimentation Control (E&SC) Plan is required from Division of Land Resources (DLR)
or local designee: documentation verifying applicant has developed and submitted that Plan to the
governing agency (required per 15A NCAC 02H .0138).
X Two (2) site plans depicting the site plan with numbered outfalls which indicate stormwater and wastewater
outfalls. See Question 10.
X A county map or USGS quad sheet with location of facility clearly marked.
29) Signatory Requirements (per 40 CFR 122.22)
All applications, reports, or information submitted to the Director shall be signed and certified. a.
All notices of intent to be covered under this General Permit shall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this permit, a responsible corporate officer means: (a) a president,
secretary, treasurer or vice president of the corporation in charge of a principal business function, or any other person who performs similar policy
or decision making functions for the corporation, or (b) the manager of one or more manufacturing production or operating facilities employing
more than 250 persons or having gross annual sales or expenditures exceeding 25 million (in second quarter 1980 dollars), if authority to sign
documents has been assigned or delegated to the manager in accordance with corporate procedures.
(2) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or
(3) For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official.
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
10 constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an individual
permit.
0
Page 7 of 8
SWU-229.07122011 Last revised 812114

NCG 140000 N.4.1.
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: C h M , Cj r con 2 fL .
Title: D � Sir. C m4ii
b�_ �-k 8ljg 1���
(Signature of Applicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to: NCDENR
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 8 of 8
SWU-229-07122011 Last revised 8/2/14

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