NCG030655_COMPLETE FILE - HISTORICAL_20171211

NORTH CAROL NA
Department of Environmental W6

/vj 11 C)
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V '�� D 3o
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ -?b 1 7 � a
YYYYMMDD

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
(:NVIItONMENIAL OUALIIY (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Qey
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed,' or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change, Form
and submit the completed form with all required documentation.
What does "legally responsible individual' mean?
The 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 one of the above.
I) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N,CSD3pLS_5
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N. C. G
Address
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
httn://deQ n.c.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/stormwater-pro�rrarn
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: �n= Vla _�5,y-Mg
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: 'FL!°It( RS e � ��-P,'i &u ,sC
First MI Last
Page 1 of 2
SWU-OW NEFRAFFiL-23March2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
V I G C
Title
loq:E� 144 (f64,,�j
l Mailing Address
ki 90),Tg AfG.
City State Zip
74" } ,a ab E5e4z.wre.>ea,"I'01�. Colt
Telephone E-mail Address
r 7z4- 4K f- z z q
Fax Number
5) Reason for this change:
A result of:. ® Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, _(+f aAtA s e • J cdS44. , 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.
Signature
er 4 !7
Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website at:
htipa/deg.ne-gov/about/divisions/energy-mineral-land-resources/stonnwater
Page 2 of 2
SWIG-oWNE RAFFIL-23M1ar2017

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Contacts Summary
NC AE - .1t has the foi(gtiny Sgijotct information in our Permit Database for your permit as of 10/10/2017.
Permit Number: NCGO30655
Permit Type: Metal Fabrication Stormwater Dfscha rue COC
Facility Name, American Roller Bearing and Manufacturing Company
Fedlity Addresai:
Fadlity Address2:
City, State & Zip:
MUST submit a Change of Name/Ownerslu'pform to DEMLR to make any changes to this 04rier Information.
See "Miscellaneous Forms" at httn:I/portal.ncdenrrorgLwebltr/ntades-stortttwater
Owner Name: American Roller Bearing and Manufacturing Company
owner Type: Non -Government Owner Type Group; 0manUtIon
Legally Responsible fbr Permit
(Respamdbie ca poraW aflt w1prindple exeartlye at►isw or raring tlyded alitdal/gemml partner or prop,
or a" ocher person with delegated s%pwtory mahorfty from the legalty responsible persm►) r
Owner Affiliation: 'L F(o�Ca ; -t i ?ruS �ZtiL2 Title: 1/i ir.49 I Da 37
Addressi: 1095 McLialn$d
Addres92:
City, State & Zip: Kiddentte. NC 28636
Worts Phone: [phone] Fax: [phone]
Email Address:
Owner Contact Person(s)
Contact Name ne
Phone DIX LM29
Facility Contact Person(s)
Con aldams I1tt2 9dd[M Phone f" Email
-SM2C=8=== 76I,4.,r,: 14AAW- ae- 1095 McClain Rd, Hiddenite, NC 28636 704-505.2908 704-585.6229
�v W 40 L , Caon
Permit Contact Person(s)
Cant= Name IM Add Phone E11A Enici11
Permit Billing Contact
Contact Nam la LIU Add PhRil En loll
,aaoos3ca'FReNeF 1095 McClain Rd, Hiddenite, NC 28636 704-585-2908 704-SSS-6229
mod.
Ida�dCt
Eb W�P� 6-7rao D -1/
4 ze "6 Pee
wjl i Il2017 Page t

Division of Energy, Mineral, and Land Resources
Land Quality Section I Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy. Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources ENVIRONMENTAL QUALITY (Individual Legally Responsible for Permit)
Use this form if there has been:
rOR AGENCY USF ONLY
Date Received
Year
I Month
I Day
RE��
NOV 2Q201r
f"�tlti
NO CHANGE in facility ownership or facility name, but the individual oi,, y
I vNf',jVVATEt� Pl;+,,v,l 1.
who is legally responsible for the permit has changed. + frv:
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The 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 one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N I c I s 103 101 (-9--e
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N I C I G
Address
City State - Zip
To find the current legally responsible person associated with your permit, go to this websitc:
http://deg.ne.f:ov/about/divisions/energy-niineral-land-resources/energy-mineral-land-permits/stormwater-prog ram
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Sn= vet _�ar v-,V6
First M i Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
'TL16tilA5 Z-1- �� _$1q,u1'L'Sc-.[
First Nil Last
SWU-OWN ERAFFEL-23March2017
Page I of 2

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
V/ U= F
Title
1dgSf /4L (.y 6A�/J
Mailing Address
bL 1 vrJL�-,I�7g ll z' Z S�
City State Zip
( 454 ) 'zL5 �66U4 rjie-s&424%P0
Telephone E-mail Address
( �� �-) 49, -- (,Z 2q
Fax Number
5) Reason for this change:
A result of ® Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERM ITTEE CERTIFICATION:
I, c . J �&4- , 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.
Signature
" �'?//7
Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website at:
http://deg.nc.gov/about/divisions/ene_rgy-mineral-land_-resources/stot nwater
Page 2 of 2
SW U-OW NE RAFF I L-23Ma r2017

Division of Energy, Mineral, and Land Resources
Land Quality Section 1 Stormwater Program
- National Pollutant Discharge Elimination System (NPDES)
Energy. Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL QUALITY (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
I Day
I
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The 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 one of the above.
I) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N I C I S I a.5p &1 Z,5
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N I C I G
ri lti4� /G4 .f �O1.c C yi-r,4R i t��-
30-7 _;Le,,e 2.
Address
ro"/ /),6-
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
http://deq.nc.gov/about/divisions/energy-rnineral-land-resources/energyy-mineral-land-permits/stonuwater-program
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual
�� f?-Vj1.:Z4
First
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit
M 1 Last
r
First M I Last
SM-OWNERAFFI L-23Mar02017
Pagel of 2

R
NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
eE5117
Title
3b7 z-
Mailing Address
`J
rt c,t-& 11l6
City State Zip
{egze) *33 •� /-6-Se-- /V-)I e.5e,-�-' > PL 1r. Goy
Telephone E-mail Address
(828) 4.?a 6734
Fax Number
5) Reason for this change:
A result of: Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, '1t(d•4c,s5 15 • � � le-�z4 , 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.
Signature
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Date
For more information or staff contacts, please call [phone] or visit the website at:
http://deg.nc.t;ov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
SWU-OWNERAFFI L-23Mar2017

NCDEHR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
December 16, 2014
Mr. Steve Bennett
American Roller Bearing Company
1095 McClain Road
Hiddenite, NC 28636
Dear Mr. Barnett:
John E. Skvarla, Ili
Secretary
Subject: General Permit No. NCG030000
American Roller Bearing Company
C©C NCG030655
Alexander County
In accordance with your application for a discharge permit received on
November 13, 2014, 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 & Land Resources (DEMLR). If the facility
changes ownership or is closed, DEMLR may require modification, revocation, or
reissuance of the certificate of coverage.
This permit does not affect the owners legal obligation to obtain other permits
which may be required by DEMLR, or permits required any other federal, state, or local
governmental authorities.
If you have any questions concerning this permit, please contact Larry Wade PE
at telephone number [phone], or email at [e-mail] .
Sincerely,
jorTracy E. Davis, P.E.
cc: Mooresville 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 27699-1612.919-707-9200 I FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: http:/1portal.ncdenr.org/web4rl
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

Wade, Larry
From: Khan, Zahid
Sent: Friday, December 12, 2014 1:56 PM
To: Wade, Larry
Subject: RE: NCG030655- - American Roller Bearing Manufacturing Company - Alexander County
Good afternoon Larry,
We do not have any objection and inspection report is in BIMS. Thanks
Zahid
From: Bou-ghazale, Samar
Sent: Friday, December 12, 2014 1:23 PM
To: Khan, Zahid
Subject: RE: NCG030655- - American Roller Bearing Manufacturing Company - Alexander County
Based on inspection dated 12/11/2014, we offer no objections for this facility to be covered under the general permit.
Samar
From: Khan, Zahid
Sent: Friday, December 05, 2014 12.:48 PM
To: Bou-ghazale, Samar
Subject: FW: NCG030655- - American Roller Bearing Manufacturing Company - Alexander County
Samar,
Please add in your list when you go to Catawba County. Deadline is before Christmas. Thanks
From: Wade, Larry
Sent: Friday, November 21, 2014 10:59 AM
To: Khan, Zahid
Cc: Bou-ghazale, Samar
Subject: NCG030655- - American Roller Bearing Manufacturing Company - Alexander County
Hello Zahid,
Find attached the N01 for the subject existing facility.
am sending you two site maps through inter office mail for your review.
Please let me know if you have any comments or concerns prior to issuance of a permit for this facility.
Thanks,
Larry W. Wade PE Telephone: [phone]
Fax: [phone]
Stormwater Permitting Program
North Carolina Department of Environment & Natural Resources
Division of Energy Mineral and Land Resources

1612 Mail Service Physical Address - 512 N. Salisbury St. Room
942S
Raleigh, NC 27699-1612 Raleigh, NC 27604
************************ThlS is a government E-mail address****************************
*********E-mails sent and received from this address can be disclosed to third parties************

AMERICAN ROLLER BEARING COMPANY
MANUFACTURERS OF
INDUSTRIAL ROLLER BEARINGS
CORPORATE OFFICES 400 2"d Avenue NW
MAILING ADDRESS P 0 Box 68
HICKORY, NC 28603
TELEPHONE: [phone]
October 30, 2014 RECEIVED
NOV 13 2014
Stormwater Permitting Unit Program DNR LAND QUALITY
STCRMWAi'Eft PERMITTING
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Reference: Notice of Intent National Pollutant Discharge Elimination System General
Permit Number NCG0300000
1095 McClain Road
Hiddenite, North Carolina 28636
To Whom It May Concern;
American Roller Bearing Company operates a manufacturing facility located at 1095
McClain Road in Hiddenite, North Carolina. The enclosed Notice of -Intent (NOI) for
coverage under the National Pollutant Discharge Elimination System General Permit
Number NCG0300000 has been prepared for stormwater discharge from this facility.
Manufacturing activities at this facility consist of fabrication of roller bearings. The site is
approximately 31.75 acres. The developed part of the site occupies approximately 14
acres with a manufacturing facility of about 75,000 square feet.
Manufacturing activities consist of the production of roller bearings from cold rolled
carbon steel and brass. The incoming metals are machined to the proper shape and
thickness. Some steel parts are then subject to a blackening process (i.e., manganese
phosphate conversion costing process). Other machined parts are then hardened in a
heat treatment process which consists of heating the material in a furnace followed by

cooling in a quench press. For some products, quenching may be followed by treatment
in a cold box in which nitrogen is used for cooling. Following heat or cold treatment, the
product is then sent through a wash process followed by tempering in a draw oven. The
parts are then subject to grinding to produce a shiny exterior. After application of a
protective oil coating, the products are assembled and packaged for shipping.
Enclosed are figures identifying the site. Figure 1 is a USGS map which identifies the
site location and adjacent surface waters. Figure 2 contains a site plan that shows the
location of the site boundaries and impervious areas. Figure 3 identifies the appropriate
locations of drainage areas associated with industrial activity and stormwater outfalls.
Figure 4 identifies the locations where material or activities that could impact stormwater
are located.
If there are questions regarding this permit application or report, or a need for further
information, please contact me at [phone] or by email at sbennett amroll.com.
Alternatively, you can contact Miriam White, ECS Carolinas LLP at [phone] or
[phone] or by email at mwhiteCc�ecslimited.com.
4enRespeIly submitted,
neft
Environmental, Health and Safety Manager
SINCE 1911

NCDmR
Pam" CAPM"
-o
:NOTICE.OF INTENT
DiAsion of Water Quality / Water Quality Section
National Pollutant Discharge Elimination System
NCG030000
FOR AGENCY USE ONLY
Date Received
Year Month
Da"
Certificate of CoveraRe
r#
o "-
'
unit s d to
Q` '
National Pollutant Discharge Elimination System application for coverage under General Permit ;
NCG030000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extruding of Nonferrous Metals
SIC 3398 Metal Heat Treating
SIC 34 Fabricated Metal Products RECEIVED
SIC 35 Industrial and Commercial Machinery
SIC.36 Electronic and Other Electrical Equipment NOV 13 2014
SIC 37 Transportation.Equipment
SIC 38 Measuring, Analyzing, and Controlling Instruments DENR-LAND QUALITY
STORMWATER PERMITTING
r For questions, please contact the DWO Regional Office for your area. Seepage 4.
(Please print or type)
1) Mailing address of ownerloperator,(address to which all permit correspondence will be mailed):
Name American Roller Bearing and Manufacturing Company
Street Address 1095 McClain Road
City Hiddenite State NC — ZIP Code 28636 `
Telephone No. [phone] Fax:. [phone]
2) Location of facility producing discharge:
Facility Name American Roller:Bearina and'Manufacturing Company
Facility Contact 'Steve Bennett, EnvironmentaL.Health & Safety Manager
Street Address 1095 McClain Road
City Hiddenite State NC _ ZIP Code ' 28636
County Alexander
Telephone No. [phone] Fax:'[phone]
E-mail [e-mail]
Page 1 of 5

3) 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). Take Interstate 40 to exit 1.48 (US- 64 North)-
1
Continue 11.6 miles and turn left onto McClain Road.
A co of a county m or USGS quad sheet with facility clear! located on the ma is required to be submitted with this application)
t
I PY mY map q �Y Y P� eq
4) Latitude 350 52' 58" Longitude.' -8100S' 32" . (deg, min, sec)
5) .This NPDES Permit Applitcation'applies to which of fallowing
E New or Proposed 1=ac#lily Date operation is to begin
X Existing
6) Standard Industrial Classification: ;
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary
industrial activity,at this facility t
SIC Code. 3562
7) Provide a brief narrative description of the types of Industrial activities and products
manufactured at this facility: ' Roller bearings are; manufactured at the facility.
8) Discharge points / Receiving .waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the 4
Property?
There are four discrete -discharge points at -this facility, but only three receive flow associated with _ r
industrial activity. Outfall 001 receives surface stormwater flow from an employee parking 1ot and' i
a -small portion of the outdoor material storage area.. Outfall 002.receives. stormwater -flow from
subsurface piping -located throughout the outdoor material storage and handling areas, and roof drains.
Outfall 003 receives surface flow from the vicinity of the receiving dock. Outfall 004 does not -receive
industrial flow; as it receives stormwater from a portion of the roof that is not expected to have
industrial emissions. '
What Is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility
st6nTiwater discharges end up in? Unnamed tributary to'Third Creek
Receiving water classification: C Third Creek
Is this a 303(d) listed stream? Yes Has a TMDL been approved for the watershed? No
If the site stormwater discharges to a separate sewer system, name of the operator of the
separate storm system. - NIA
Page 2 of 5
f

9) Does this facility have:any other NPDES permits?
X No
[],Yes,
If, yes, list the permit numbers for all currentTNPDES permits for this facility:
e
10) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X No 1
❑ Yes
If yes, list the permit numbersfor all current Non -Discharge -permits for this facility: i
11) Does this facility employ any best management practices for stormwater control?
❑ No
X Yes i
if yes, please briefly describe: The facility emplo s BMPs including.implementation of a.good
housekeeping r ram, preventative maintenance program, inspection Rnram, limiting story e.of
materials in.stormwater conveyance areas, .coverin materials with potential for stormwater .
contamination, and implementation of,a spill prevention and response, program.
12) Does this facility have a Stormwater'Pollution Prevention Plan?
No
X Yes
If yes, when was -it implemented? A written Stormwater Pollution Prevention Plan was,finalized and
implemented during September 2014. _
13) Are vehicle maintenance activities occurring at this facility?
❑ No X Yes (Only lift trucks; not automobiles, trucks or other motor vehicles)
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal. Fac i I ity?
X No ❑ Yes i
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per
month) of hazardous waste?
a
X No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per
month) of hazardous waste?
i
X No ❑ Yes
a
- i
Page 3 of 5

d) Is hazardous waste stored in,the 100-year4lood plain?
X No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Types) of waste: { .
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of ,transport / disposal vendor:
Vendor address:
15) Certification:
North Carolina General Statute 143-215.6 b (i),provides that:
Any personrWho knowingly. makes any false statement,'representation, or certification in any application', record, report, plan, or other
document filed mrequired'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) andtis 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:, � 18r'N/VE7T
Title: ----
10-30-14
(Srgnatur of Appli nt) (Date Signed)
Notice of Intent must be accompanied'by a check or money order for $100.00 made payable to:
NCDENR
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 documents
X A site diagram showing, at a minimum, (existing or proposed):
(a) outline of'drainage.areas, (b) stormwater management structures, (c) location of stormwater outfalls
corresponding to the,drainage areas, (d) runoff conveyance features, (e) areas where materials are
stored, (f) impervious areas, (g) site property lines.
X Copy of county map or USGS Quad sheet with the location of the facility clearly marked on the map.
I
Page 4 of 5

Mall the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, Nohh Carolina 27699-1612
1
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DWO Central Office or Regional Office for your area.
DWO Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office
... [phone]
Mooresville Office
... [phone]
Raleigh Office ........
[phone]
Washington Office
...(252) 946-Wl
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 5 of 5

V
USGS TOPOGRAPHISMU 3 2014
HIDDFNITF. NG OLJARRAWrAKFn ril IAI III

/�
m
m
C
rn