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Home My WebLink AboutNCS000412_Bessemer City Permit Renewal Application_20200904State of North Carolina Department of Environment & Natural Resources Division of Water Quality OFFIC USE ONLY Date Rec’d Fee Paid Permit Number Page 1 SWU-264-103102 NPDES STORMWATER PERMIT APPLICATION FORM This application form is for use by public bodies seeking NPDES stormwater permit coverage for Regulated Public Entities (RPE) pursuant to Title 15A North Carolina Administrative Code 2H .0126. A complete application package includes this form and three copies of the narrative documentation required in Section X of this form. This application form, completed in accordance with Instructions for completing NPDES Small MS4 Stormwater Permit Application (SWU-270) and the accompanying narrative documentation, completed in accordance with Instructions for Preparing the Comprehensive Stormwater Management Program Report (SWU-268) are both required for the application package to be considered a complete application submittal. Incomplete application submittals may be returned to the applicant. I. APPLICANT STATUS INFORMATION a. Name of Public Entity Seeking Permit Coverage City of Bessemer City b. Ownership Status (federal, state, or local) Local c. Type of Public Entity (city, town, county, prison, school, etc.) City d. Federal Standard Industrial Classification Code e. County(s) Gaston f. Jurisdictional Area (square miles) 4.862 g. Population Permanent 5,527 Seasonal (if available) - h. Ten-year Growth Rate 3.0% i. Located on Indian Lands? Yes No II. RPE / MS4 SYSTEM INFORMATION a. Storm Sewer Service Area (square miles) 4.862 b. River Basin(s) Catawba River Basin c. Number of Primary Receiving Streams 4 d. Estimated percentage of jurisdictional area containing the following four land use activities: • Residential 34% • Commercial and Business 16% • Industrial 18% • Open Space 14% • Religious 6% • Institutional 12% Total = 100% e. Are there significant water quality issues listed in the attached application report? Yes No NPDES RPE Stormwater Permit Application Page 2 SWU-264-103102 III. EXISTING LOCAL WATER QUALITY PROGRAMS a. Local Nutrient Sensitive Waters Strategy Yes No b. Local Water Supply Watershed Program Yes No c. Delegated Erosion and Sediment Control Program Yes No d. CAMA Land Use Plan Yes No IV. CO-PERMIT APPLICATION STATUS INFORMATION (Complete this section only if co-permitting) a. Do you intend to co-permit with a permitted Phase I entity? Yes No b. If so, provide the name and permit number of that entity: • Name of Phase I MS4 • NPDES Permit Number c. Do you intend to co-permit with another Phase II entity? Yes No d. If so, provide the name(s) of the entity: e. Have legal agreements been finalized between the co- permittees? Yes No V. RELIANCE ON ANOTHER ENTITY TO SATISFY ONE OR MORE OF YOUR PERMIT OBLIGATIONS (If more than one, attach additional sheets) a. Do you intend that another entity perform one or more of your permit obligations? Yes No b. If yes, identify each entity and the element they will be implementing • Name of Entity Regional Stormwater Partnership of the Carolinas • Element they will implement MCM #1 - Public Education and Outreach • Contact Person Kari Guyer, PhD • Contact Address 2414 Westminster Drive / Concord / NC / 28081 • Contact Telephone Number 704-701-2270 c. Are legal agreements in place to establish responsibilities? Yes No a. Do you intend that another entity perform one or more of your permit obligations? Yes No b. If yes, identify each entity and the element they will be implementing • Name of Entity Regional Stormwater Partnership of the Carolinas • Element they will implement MCM #2 - Public Participation • Contact Person Kari Guyer, PhD • Contact Address 2414 Westminster Drive / Concord / NC / 28081 • Contact Telephone Number 704-701-2270 c. Are legal agreements in place to establish responsibilities? Yes No NPDES RPE Stormwater Permit Application Page 3 SWU-264-103102 a.Do you intend that another entity perform one or more of your permit obligations? Yes No b.If yes, identify each entity and the element they will be implementing •Name of Entity Gaston Natural Resources Department •Element they will implement MCM #4 – Management of Construction Site Runoff •Contact Person Joseph Alm, Stormwater Administrator •Contact Address 1303 Dallas-Cherryville Hwy. / Dallas / NC / 28034 •Contact Telephone Number 704-922-2157 c.Are legal agreements in place to establish responsibilities? Yes No a.Do you intend that another entity perform one or more of your permit obligations? Yes No b.If yes, identify each entity and the element they will be implementing •Name of Entity Gaston Natural Resources Department •Element they will implement MCM #5 – Management of Post Construction Site Runoff •Contact Person Joseph Alm, Stormwater Administrator •Contact Address 1303 Dallas-Cherryville Hwy. / Dallas / NC / 28034 •Contact Telephone Number 704-922-2157 c.Are legal agreements in place to establish responsibilities? Yes No VI.DELEGATION OF AUTHORITY (OPTIONAL) The signing official may delegate permit implementation authority to an appropriate staff member. This delegation must name a specific person and position and include documentation of the delegation action through board action. a.Name of person to which permit authority has been delegated b.Title/position of person above c.Documentation of board action delegating permit authority to this person/position must be provided in the attached application report. VII.SIGNING OFFICIAL’S STATEMENT Please see the application instructions to determine who has signatory authority for this permit application. If authority for the NPDES stormwater permit has been appropriately delegated through board action and documented in this permit application, the person/position listed in Section VI above may sign the official statement below. I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. Signature NPDES RPE Stormwater Permit Application Page 4 SWU-264-103102 Name James Inman Title City Manager Street Address 132 W. Virginia Ave. PO Box City Bessemer City State NC Zip 28016 Telephone 704-629-5542 Fax E-Mail jinman@bessemercity.com VIII. MS4 CONTACT INFORMATION Provide the following information for the person/position that will be responsible for day to day implementation and oversight of the stormwater program. a. Name of Contact Person Greg Thompson b. Title Stormwater Administrator c. Street Address 321 East Lee Street d. PO Box e. City Bessemer City f. State NC g. Zip 28016 h. Telephone Number 704-692-5610 i. Fax Number j. E-Mail Address gthompson@bessemercity.com NPDES RPE Stormwater Permit Application Page 5 SWU-264-103102 IX. PERMITS AND CONSTRUCTION APPROVALS List permits or construction approvals received or applied for under the following programs. Include contact name if different than the person listed in Item VIII. If further space needed, attach additional sheets. a. RCRA Hazardous Waste Management Program b. UIC program under SDWA c. NPDES Wastewater Discharge Permit Number d. Prevention of Significant Deterioration (PSD) Program e. Non Attainment Program f. National Emission Standards for Hazardous Pollutants (NESHAPS) preconstruction approval g. Ocean dumping permits under the Marine Protection Research and Sanctuaries Act N/A h. Dredge or fill permits under section 404 of CWA X. NARRATIVE APPLICATION SUPPLEMENT: STORMWATER MANAGEMENT PROGRAM REPORT Attach three copies of a comprehensive report detailing the proposed stormwater management program for the five-year permit term. The report shall be formatted in accordance with the Table of Contents shown below. The required narrative information for each section is provided in the Instructions for Preparing the Comprehensive Stormwater Management Program Report (SWU-268). The report must be assembled in the following order, bound with tabs identifying each section by name, and include a Table of Contents with page numbers for each entry. NCDEQ Audit completed in September 2019. Revised Draft Stormwater Management Plan enclosed for review. Self-Audit document based on NCDEQ Audit template enclosed for reference.