NCG150034_COMPLETE FILE - HISTORICAL_20170627

STORMWATERR-DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
b3
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ 01 a
YYYYMM DD

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NC�D��ENR
Norrn� CO[IVIRT T Or
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Division of Energy, Mineral and Land Resources
Land Quality Section / Stormwater Permitting Program
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
NCY USE ONLY '
te Received
Year
M
Month Dey
1�
ECejVeD
JUN 2 6 2017
DENR=LAND o,, , t,...
if NO CHANGE in company or facility ownership or name has occurred.
If a Name Change and/or Ownership Transfer at the facility has prompted this change, do
NOT use this form. You must fill out the Name -Ownership Change Form and provide all
necessary supporting documentation instead.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner
Affiliation") applies: -
Individual Permit
N I C I S
2) Facility Information:
Facility name-
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N I C I G I J D 10 1 _3
Address
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
http://portal.ncdenr.orgt/web/Ir/sw-permit-contacts and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed: A (4�0A_�
Previous legally responsible individual: AK A Q I- J 4- N �[ ctlC e
First Ml Last
4) NEW OWNER AFFILIATION (Legally responsible for the permit):
Person legally responsible for this permit: CZp,cp0,12 LJ /�Qwel
U
First MI Last
M 11 u A,� i 4n D1dQ_e _ -roA
Title
j D a � GE),c sa %, �� f
Mailing Address
City State Zip
r
Telephone E-mail Address
(?54 ) I)-5--- e)s0 �'
Fax Number
elv-IL,
Page 1 of 2
SW U-0W fNE RAFF IL-22May2014

NPDESStormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
5) Reason for this change:
A result of: 29 Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
What does "legally responsible person" mean?
That person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality,
State, Federal, or other public agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or the duly authorized representative of that person above.
The certification below must be completed and signed by the permit
holder.
PERMITTEE CERTIFICATION:
attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
L�
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please visit our website:
htt:// ortal.ncdenr.or web/1r/stortnwater
Page 2 of 2
SM-OW N ERAFFI L-22May2014

✓L��11(•f t9
NC®ENR
North Carolina Department of Environment and Natural Resources
overly Eaves Perdue
overnor
Mr. Scott Hinton
Elizabeth City Regional Airport
1028 Consolidated Rd.
Elizabeth City, NC 27909
Dear Mr. Hinton:
Division of Water Quality
Coleen H. Sullins
Director
January 15, 2010
Subject: General Permit No. NCG 150000
Elizabeth City Regional Airport
COC NCG150034
Pasquotank County
Dee Freeman
Secretary
In accordance with your application for a discharge pen -nit received on November 24,
2009, Nwe 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 I43-215.1 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 Water Quality. The Division of Water Quality 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 Water Quality or pen -nits required by the Division of Land 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 Brian Lowther at
telephone number [phone].
Sincerely
ORIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins
cc: Washington Regional Office
Central Files
Stornwater Permitting Unit Files
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St, Ralegh, North Carolina 27604
Phone: [phone] FAX: 91M07-64941 Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
None
rthCarolina
;Vaturallf

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCGI50000
CERTIFICATE OF COVERAGE No. NCG150034
STORMWATER 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,
Elizabeth City Regional Airport
is hereby authorized to discharge stonnwater and from a facility located at
Elizabeth City Regional Airport
1028 Consolidated Rd.
Elizabeth City, NC
Pasquotank County
to receiving waters designated as the Pasquotank River, a class SB water in the Pasquotank River
Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, 11, III, IV, V, and VI of General Permit No. NCG 150000 as attached.
This certificate of coverage shall become effective January 15, 2010.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day January 15, 2010. ORIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins., Director
Division of Water Quality
By the Authority of the Environmental Management Commission

LOCATION MAP:
WA
NCG150034
Map Scale P24,4130
Elizabeth City Regional Airport
Lad tude: 360 15' 36" N
Longitude: 760 10' 30" W
County: Pasquota7k
Receiving Stream: P,7isquota-ik River
Stream Class: SB
Sub -basin: 03-01-05 (Pa;quotank River Basin)
a11M:i�`r�K♦�A �� f
n
Facility Location

Lowther, Brian
From: Hodge, Al
Sent: Wednesday, January 13, 2010 1:25 PM
To: Lowther, Brian
Cc: Vinson, Scott; Dumpor, Samir
Subject: RE: SW General Permit NCG150034 and NCG150053
Spoke with Scott and Samir. Please issue
From: Lowther, Brian
Sent: Wednesday, January 13, 2010 8:10 AM
To: Hodge, All
Subject: RE: SW General Permit NCG150034 and NCG150053
That sounds fine. I'll wait until I get your comments.
Brian
From: Hodge, Al
Sent: Tuesday, January 12, 2010 5:24 PM
To: Lowther, Brian
Cc: Vinson, Scott; Dumpor, Samir
Subject: RE: SW General Permit NCG150034 and NCG150053
We will comment please do not isstie the NOls without Yegional corilrilents. If that is ail issue -',please let
me know.
Hocl$e
From: Lowther, Brian
Sent: Tuesday, January 12, 2010 3:50 PM
To: Hodge, Al
Subject: SW General Permit NCG150034 and NCGI50053
Al,
We've received two NOIs for Airports in the WaRO area. One is from Elizabeth City Regional
Airport. The site discharges stormwater into the Pasquotank River (SB). The other is from
the Currituck County Regional Airport. The site discharges stormwater into Coinjock Bay (SC)
and East Creek (C;Sw). The NOIs are attached.
Does the Washington Regional Office have any concerns about issuing this facility a COC for
this general permit, and are there any potential impacts to wetlands? If we don't receive any
objections, we'll issue the COC in 30 days.
Brian
Brian C. Lowther
i

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SARA LEE BAKERY
ATTN: MR. +iOHN H. CHAPMAN, J-R,
110 SARA�LEE ROAD
TARBORO ,NC 27886
ID# : 449 D
DATE COLLECTED: 11/11/09
DATE REPORTED : 11/1.9/09
rI
RL=V I Ei4LD BY
Slormwater
Starrnwater
Slarnn1,ater
Stomm-ater
Stormwater
Analysis
Melbod
PARAAiIME'RS
(i#1, Grab)
(##2, Grab)
03, Grab)
(#4, Grub)
(#5, Crab)
Date
Analyst
Code
HOD. Ing/l
<2.0
2.0
23
2.7
2.5
11/11/09
TR13
SM521011
COD. mg/1
< 10
< 10
< l0
19
11
11 /17/09
TRII
I lAC118000
Total SusimntlLd R sidnc, ntg/l
5.8
4.1
6.1
15
7.8
11111/0
JI.1
SP12540i)
Oil d: Grease pIlsA7), mg/I
<5.0
<5.0
<5.0
<5.0
<5.0
11/19/09
SEA
EPA1664A