NCG180190_COMPLETE FILE - HISTORICAL_20140519

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
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DOC TYPE
R HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ jo ly S
YYYYMMDD

�t�;WA Division of Energy, Mineral & Land Resources
�A Land Quality Section/Stormwater Permitting
NCDENR National Pollutant Discharge Elimination System
�. MD 'KMo. PERMIT NAME/OWNERSHIP CHANGE FORM
Ery NOFOO rrt.xo NmAu FFW OF [f
FOR AGENCY USE ONLY
Date Receivetl
Year
I Month
Day
I. Please enter the permit number for which the change is requested.
NPDES Permit
(or) Certificate of Coverage
N I C I S 16
N I G 10 1 I 1 8 0 1 - 0
11. Permit status prior to requested change.
a. Permit issued to (company name):
Fairfield Chair Company
b. Person legally responsible for permit:
John M Robbins
First Last
Corporate Secretary
Mlle
RECEIVED
PO Box 1710
MAY 19 2p14
Permit I folder Mailing Address
Lenoir NC 28645
DENR-LAND QUALITY
Citv State Zip
STORMWATER PERMITTING
[phone] (828) 758-021 I
Phone Fax
c. Facility name (discharge):
Fairfield Chair Co Plant # 1
d. Facility address:
107 Beall St SW
Address
Lenoir NC 28645
City State Zip
e. Facility contact person:
Rick (P) Pierce
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of:
❑ Change in ownership of the facility
❑ Name change of the facility or owner
/f other please explain: name change for legally responsible person
b. Permit issued to (company name):
Fairfield Chair Company
c. Person legally responsible for permit:
Jamie li White a
First MI Last
Corporate Secretary
Title
PO Box 1710
Permit Holder Mailing Address
Lenoir NC 28645
City State Zip
[phone] Jwhite(i�fairfieldchairxom D
Phone E-mail Address
d. Facility name (discharge):
Fairfield Chair Co Plant # I
e. Facility address:
107 Beall St SW
Address
Lenoir NC 28645
City State Zip
f. Facility contact person:
Rick P Pierce
First MI Last
[phone] rpierce(Wairfieldchaiccom
Phone E-mail Address '
IV. Permit contact information (if different from
the person legally responsible for the permit)
Revised Jan. 27, 2014

az,

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
V
VI
Permit contact:
Rick P Pierce
First MI Last
Environmental Manager
Title
PO Box 1710
Mailing Address
Lenoir NC 28645
City State Zip
[phone] rpierce(Mfairfieldchair.com
Phone E-mail Address
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change'
® Yes
❑ No (please explain)
Required Items: THIS APPLICATION WILL BE RETURNED
ARE INCOMPLETE OR MISSING:
UNPROCESSED IF ITEMS
This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation arc
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature
APPLICANT CERTIFICATION
Date
I, Jamie H White, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
n-/dA.W JI WLtLt 5/ql/�
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
August 27, 1999
RICHARD P PIERCE
FAIRFIELD CHAIR COMPANY PLANT NOA
POST OFFICE BOX 1710
LENOIR, NC 28645
Dear Permittee:
1�
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissue - NPDES Stormwater Permit
Fairfield Chair Company Plant No.l
COC Number NCGIS0190
Caldwell County
In response to your renewal application for continued coverage under general permit NCG180000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
* A copy of general stormwater permit NCG180000
* A Stormwater Pollution Prevention Plan (SPPP) Certification Form. Completion of this form is required to
certify that you have developed and implemented the SPPP as per the conditions of the permit. This form
must be completed and returned to the Division within 30 days of receipt of this letter.
DO NOT SEND the SPPP with the signed form.
* Five copies of the Analytical Monitoring form and five copies of the Qualitative Monitoring form
* A copy of a Technical Bulletin on the Stormwater program which outlines program components and
addresses frequently asked questions
* A corrected Certificate of Coverage if you indicated a name change on the Renewal Application
Your coverage under this general permit is not transferable except after notice to DWQ. 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 DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule, standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Bill Mills of the Central Office Stormwater
and General Permits Unit at [phone], ext. 548
Sincerely,
for Kerr T. Stevens
Director, Division of Water Quality
cc: Central Files
Asheville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

.`
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180190
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,
FAIRFIELD CHAIR COMPANY
is hereby authorized to discharge stormwater from a facility located at
FAIRFIELD CHAIR COMPANY
1331 HARPER AVE SW
LENOIR
CALDWELL COUNTY
to receiving waters designated as Town Creek in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, II, III,
IV, V, and VI of General Permit No. NCG180000 as attached.
This certificate of coverage shall become effective August 27, 1999.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 27, 1999.
for Kerr T. Steven%, Director
Division of Water Quality
By Authority of the Environmental Management Commission

State'of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
August 11, 1995
Richard P Pierce
Fairfield Chair Company
1331 Harper Ave Sw
Lenoir, NC 28645
Subject: General Permit No. NCG180000
Fairfield Chair Company
COC NCG180190
Caldwell County
Dear Richard P Pierce:
In accordance with your application for discharge permit received on April 18, 1995, 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
December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management 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 Environmental Management or permits 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 question concerning this permit, please contact MR. BILL MILLS at telephone number
919/733-5083.
Sincerel�.,:ajnal Signed BY
Coleen H. Sullins
A. Preston Howard, Jr. P.E.
cc: Asheville Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 101% post-oonsumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO. NCGI80000
CERTIFICATE OF COVERAGE NO. NCG180190
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,
Fairfield Chair Company
is hereby authorized to discharge stormwater from a facility located at
Fairfield Chair Company, Plant No. 1
1331 Harper Avenue, S.W.
Lenoir
Caldwell County
to receiving waters designated as Town Creek in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, III
and IV of General Permit No. NCG 180000 as attached.
This Certificate of Coverage shall become effective August 11, 1995.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 11, 1995.
Ot4nnai Signed By
Celeen H. Sullins
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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LATTITUDE 3570540
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STREAM CLASS (/
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EXPIRATION DATE I ���� R I