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Home My WebLink AboutWQ0001077_Application_20210125Division of Water Resources State of North Carolina Department of Environmental Quality Division of Water Resources NON -DISCHARGE SYSTEM RENEWAL FORM: NDSR 01-20 This form is for renewal without modification for all non -discharge system permits, except Residuals Management and Single - Family Residence Wastewater Irrigation System permits. For more information, visit the Water Quality Permitting Section's Non -Discharge Branch Website. I. PERMITTEE INFORMATION: 1. Permittee: Vic Jameson 2. Signature authority's name: Allen Robe v per 15A NCAC 02T .0106(b) Title: SHE Director. NA Primary Telephone number: 336 847-5061 Select Secondary number: U04 338-8802 Select Email Address: allen.robey@,innoMecinc.com 3. Permittee's mailing address: 500 Hinkle Lane City. Salsibry State: NC Zip: 28I44- 4. Billing address (if different from above): City: State: Zip: - 5. Contact person's name (if different from signature authority): Title: Primary Telephone number: �) _- Select Secondary number: Select Email Address: It. PERMIT INFORMATION: 1. Existing permit number: WQ0001077 2. Has the facility been constructed? ® Yes or ❑ No If yes, has the facility been constructed in accordance with the permit and the Division -approved plans and specifications? 15A NCAC 02T .0110 ® Yes or ❑ No If no, a formal permit modification request shall be submitted to the Division. 3. Has any of the property ownership within the facility and/or disposal area changed from what is indicated in the current permit (Attachment B — disposal field owner/lessee)? ❑ Yes or ® No Has the Permittee had a name change or has the permit changed ownership? ❑ Yes or ® No If yes to either, a permit modification request shall be submitted to the Division. rl 5A NCAC 02T .01051 4. Is this facility a Privately -Owned Public Utility? ❑ Yes or ® No If yes, provide two copies of the Certificate of Public Convenience and Necessity from the North Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise. 15A NCAC 02T .0115 a 1 5. is the Permittee a Home/Property Owners' Associations or Developers of lots to be sold? ❑ Yes or ® No If yes, provide the following: • For Home/Property Owners' Associations — Operational Agreement (FORM: HOA) and a copy of the proposed or approved Articles of Incorporation, Declarations, and By-laws f 15A NCAC 02T .0115(c)l • For Developers of lots to be sold Operational Agreement (FORM: DEV) r15A NCAC 02T.01 15(b)b 1 FORM: NDSR 01-20 Page I of 5 DW.R Division of Water Resources 6. Does the facility treat and dispose of industrial wastewater? Yes If yes, complete items below. If no, skip to the next section. Indicate the approximate percentage of wastewater makeup: Industrial: 95% Domestic: 0% Stormwater: 5 est% State of North Carolina Department of Environmental Quality Division of Water Resources NON -DISCHARGE SYSTEM RENEWAL FORM: NDSR 01-20 For all industrial wastewater sources (excluding those permitted under a pretreatment permit), provide a detailed industrial process description including: • An overview of the manufacturing process • An inventory of all materials used for manufacture, including chemicals and biological matter • An overview of cleaning and treatment methodology, including an inventory of treatment materials and compounds ➢ The facility manufactures synthetic detergents for us in the personal care industry (soaps, shampoos body washes etc.) ➢ Attached 2021 Inventory ➢ Cleaning is done only by boiling out reactors with a soap and water mixture. Has the nature of wastes (e.g., change in industrial processes, introduction of new materials or chemicals, etc.) described in the approved permit application(s) changed? ❑ Yes or ® No If yes, a permit modification request shall be submitted to the Division. [G.S. 141-215.l(d)1 III. SITE MAP: 1. Provide an updated site map in accordance with 1.5A NCAC 02T .0105(d) that shows the following (if applicable): The site map is not required to be signed or sealed by a Professional Engineer. However, the map must indicate the source of information. For example, parcel lines taken from a county GIS map should reference the GIS website. ® Legend, north arrow, and scale ❑ Topographic contours on all disposal sites ❑ Soil mapping units on all disposal sites E All facility -related structures and fences within the treatment, storage, and disposal areas ❑ All habitable residences and places of assembly within 500 feet of all treatment, storage, and irrigations sites ® Iocation of all wells, streams (ephemeral, intermittent, and perennial), springs, lakes, ponds, ditches, and other surface drainage features within 500 feet of all waste treatment, storage, and disposal site(s) ® Latitude and longitude coordinates of all monitoring wells (decimal degrees to 6 digits) ® Location and identification of major components of the waste disposal system ® The wetted perimeter of all irrigation fields with field names (named according to the approved permit) ® Location and ownership of property boundaries within 500 feet of the disposal area (including road/rail right-of-ways) ® The delineation of compliance and review boundaries ® Distance measurements verifying all setbacks are being met ® Stormwater drainage controls ❑ 100-year floodplain ❑ For reclaimed water generation hermits, provide a separate map showing all distribution lines and utilization permit locations that are connected to the water generation facility and are permitted by the Non -Discharge Branch (excludes Local Program permitted facilities). Include all reclaimed water distribution line and reclaimed water utilization permit numbers. FORM: NDSR 01-20 Page 2 of 5 DWR Division of Water Resources State of North Carolina Department of Environmental Quality Division of Water Resources NON -DISCHARGE SYSTEM RENEWAL FORM: NDSR 01-20 IV. GROUNDWATER MONITORING WELLS 1. Does the facility have a proposed or existing groundwater monitoring well network? ® Yes or ❑ No If no, skip to next section. If yes, complete the following table (NOTE — This table may be expanded for additional weIls): Well Name Status Latitude 3 Longitude & Gradient Location M W-6 Active 35.6998750 -80.402344" Down Gradient Inside Com liance Boun M W-7 Active 35.6942610 -80.403969" Up Gradient Inside Compliance Boun MW-8 Active 35.6989750 -80.7030830 Cross Gradient Inside Compliance Boun Select 0- 0Select Select Select 0- Select Select Select c-0 Select Select Select - Select Select Select 0- Select Select Select _ - ° Select Select Select - Select Select a_ Coordinates must be in NAD83 and have 6 decimaI degrees V. SETBACK WAIVERS, EASEMENTS, AND LEASES: 1. Does the permit have any setback waivers, easements, or leases? ® Yes or ❑ No If yes, provide copies of all documents and complete the table below: Document Grantor or Grantee Expiration County Deed Deed Page Document Type Parcel No. Date Registered Boot: a Description 051017 John T. Innospec Active Easement Hudson Chemicals Annually, Rowan 1239 179 Tax record, Trustee for October Rowan GIS Francis Hinkle Select Select Select Select Select Select a. The document description shall list any reduced setbacks with distance, etc. 2. For reclaimed water utilization permits: Is reclaimed water utilized on property not controlled by the generator? ❑ Yes or ® No FORM: NDSR 01-20 Page 3 of 5 DW-R Division of Water Resources State of North Carolina Department of Environmental Quality Division of Water Resources NON -DISCHARGE SYSTEM RENEWAL FORM: NDSR 01-20 A lease, easement, or agreement roust be provided allowing for the utilization of reclaimed water on the property or within the facility. For irrigation of reclaimed water, an easement is required per 15A NCAC 02U.0501(6). All documents shall be listed in the table above. VI. RELATED PERMITS 1. If this permit has interactions with other wastewater permits (collection systems, NPDES, etc.), complete the table below (provide additional pages if necessary): Permit Type Permit No. Description industrial Pretreatment NP-0038 Pretreatment Permit to discharge treated wastewater to Salisubry/Rowan Utilities General Stormwater Permit Permit No. NCG060000 COC No. NCG060230 Permit to discharge Stormwater associated with an industrial activity 2. Does the facility have an approved flow reduction [15A NCAC 02T .0114(f)]? ❑ Yes or ®No If yes, attach the measured monthly average amount of wastewater flow contributed per unit for the 12 months prior to permit renewal. If any of these monthly averages are within 20% of the approved value, the Permittee shall provide a reevaluation of the reduced flow value using the methodology applied to the original flow reduction application. Also, attach a copy of the flow reduction approval letter_ APPLICANT'S CERTIFICATION 15A NCAC 02T .0106(b) 1, Allen Robey, attest that this renewal application has been reviewed by me, and is accurate and complete to the best of my knowledge. I understand that any unauthorized discharge of wastewater from this non -discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed, this application may be returned to me as incomplete. I further certify that the Applicant or any parent, subsidiary, or other affiliate of the Applicant has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active compliance schedule, and does not have any overdue annual fees. NOTE — In accordance with General Statutes 143-215.6A and 143-2I5.6% any person who knowingly makes any false statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation. The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T .0106(b) Signature: am- Date: THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO: NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF WATER RESOURCES WATER QUALITY PERMITTING SECTION NON -DISCHARGE BRANCH By U.S. Postal Service: By Courier: By Email: Non -Discharge Branch Non -Discharge Branch — Archdale 942W Non-Discharge.Reports@ncdenr.gov 1617 Mail Service Center 512 N. Salisbury St. FORM: NDSR 01-20 Page 4 of 5 State of North Carolina DWR - J Department of Environmental Quality Division of Water Resources i NON -DISCHARGE SYSTEM RENEWAL " Dtvlsion of Water Resources FORM: NDSR 01-20 Raleigh, NC 27699-1617 Raleigh, NC 27604 TELEPHONE NUMBER: (919) 707-3654 FORM: NDSR 0 1 -20 Page 5 of 5 AO T�i FwAOB":MNRM,2 pi11(gM1 rwa 4�s�;1,gNr wvvwaN rw In+w n a�w•a nol wl wTu� rar •iaL Nw w wLird �nsi>'nor�a wn,rru4w Mwor w1Poi�r�i ri w.aT.L,Raw ii rwM nN rwrArw Lpnn -SW xpyi � xw9L a nLr A R 51Q I l[,YI R■ 7N•N1 wr •[rl00 wryfw LF OlA�i1�wI1RFe r W rt tiff m imr n N.ti Nun1c �•wnl Nv v@AMQ� IIY u •a 1 !w Gr R IVY•r a►, pq nomw ui •ror wwe -- _- _ . . ❑ 4 C ❑ D $ C d ❑ ° D ❑ o a L� • <• yT• ww •�A +11 POL vRwwp� vm nwwLT / lwMLmS XN v rvu woo lz pL v M I'M M wo •ow wL — nrn '... iXF �1 IYv IrLwns . Ya •e �A ns c0•ilwn w[ 1r9 r N � ILL O i 1®li Now NIL iLW Mwr 1Lrwra � T� M YiS v 1•[�c wG ll�O i ilmca � Tr INNOSPEC ACTIVE CHEMICALS ova nTr Y[ w�� i MMA FR11411 r iimawa�s.c�� 1iMT in WILT G �L. IIJ L-L1r � e •�o•�Ifei�u.�r�a4 a•s�i r. •c sur 4M 1CRC 1' . i'O n0 wro rwwwr . wn• Rowan County GIS PARCEL ID: 051 091 Owner Name: INNOSPEC ACTIVE CHEMICALS LLC Mailing Address: 500 HINKLE LN CSz Property Address: 0 LONG FERRY RD Tax District Code: 103 Tax District: SPENCER Land FMV: Land LIJV: IMP FMV: Total Value: 454866 Deed Ref: 1185/138/2011 Date Sold: 9/2/2011 Sa le Amt: Legal Description: 32.26AC 1:3,384 0 0.0275 0.055 0.11 mi 0 0.045 0.09 0.18 km ROWAN January 25, 2021 C*Ulfry Be an original.