NCG210439_NOI_20151201

m Division of Energy,Mineral and Land Resources FOR AGENCY USE ONLY
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Stormwater Permitting Program Oae Receives
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National Pollutant Discharge Elimination System I
NCDENR 4 ounl
G^� o NCG210000
Rlou Pe i si A •ned to
1
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG210000:
For STORMWATER DISCHARGES associated with activities classified as:
SIC• 24 Timber Products (except as specified below), including Wood Chip Mills; DEC 012015
And, Like activities deemed by DEMLR to be similar in the process and/or the exposure of raw
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
Owner Contact(a person)
Street Address 1Q a r NL It uY 1 t
City State fJL,_ZIPCode ;21Sa3
Telephone No. -Lt 1 1 Y<-1 Fax: t� G Z`2Cl -c M ST
E-mail Address i.J(LL60%10 —
2) Location of facility producing discharge:
Facility Name A,nt*
Facility Contact(a person) rTJL_ !`z,hf u- ?
Contact E-mail Wax r.a1r 0.ar.c ,t r /�1
Street Address o79 a�1V -L-W� BSI
City l State IVL ZIP Code 21S'23
County
Telephone No. q►g 4 D-Tall Fax: 914 �SSI—c 4 T�-
3) Permit Contact
Permit Contact(a person)��� l 2tlilw
Contact E-mail Ljrt.aQkA. a:i.cu
Contact phone number Rla �t9 2 9bT
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). L.�% �I,f�( IVA L,-J � IJL lid' 751 N l
yti;tta . AAA Nutrayu 0, +Aas- L4f-i..
(A copy of a county manor IISGS quad sheet with facility clearly located on the map is required to be submitted with this application)
5) Latitude 3 ! , I77077 Longitude + IS A Y140 (degrees, minutes,seconds)
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NCG210000 N.O.I.
6) ;7New
NPDES Permit Application appl ies to which of the following
or Proposed Facility Date operation is to begin vs
❑ 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: 24,V
8) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: �r.-,2. ►c,�. [4-.b
9) Discharge points/Receiving waters:
How many discharge points(ditches, pipes,channels, etc.)convey stormwater from the property?
10) Receiving waters:
0
What is the name of the or bodies o ater(creek strea river, lake, etc.)that the facility stormwater
4
discharges end up in? A
If the site stormwater discharges to a separate storm sewer system, name t operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
11) Does is facility have any other water quality permits?
0
❑ Yes
If yes, list the permit numbers for all current water quality permits for this facility:
12) 7No
is facility have any Non-Discharge permits(ex: recycle permits)?
;Wes
If yes,list the permit numbers for all current Non-Discharge permits for this facility:
13) Does this facility employ any best management practices for stormwater control?
Goo,
;Zs
If yes, please briefly describe: OILL.XL GmA V- M �uw:
Cam►
14) Does this facility have a Stormwater Pollution Prevention Plan?
L�YNo
❑ 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 V<e s
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NCG210000 N.O.I.
16) Are vehicle maintenance activities occurring at this facility?
ao ❑ Yes
17) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage,or Disposal Facility?
Ci�lo ❑ Yes
b) Is this facility a Small Quantity Generator(less than 1000 kg.of hazardous waste generated per month)of
hazardous waste?
4Ao ❑ Yes
c) Is this facility a Large Quantity Generator(1000 kg.or more of hazardous waste generated per month)of
Z
zar ous waste?
o ❑ 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 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)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 true,complete, and accurate.
Printed Name of Pe s n Signing: bu a _ o A t.1c..�
Title: vN
• /)
19
(Signature of Applicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for$100.00 made payable to:
NCDENR
Page 3 of 4
SWU-236-080113 Last revised 7/2/14

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