NCS000450_Carrboro Permit Renewal Application_20210617

NPDES MS4 Permit Renewal Application Form
National Pollutant Discharge Elimination System (NPDES)
Municipal Separate Storm Sewer System (MS4)
Please complete the information below and submit this form along with the required supplemental information
to the address indicated.
Part I: Permittee Information
Current Permit No.
NCS 000450
MS4 Name
Town of Carrboro JUN 17 2021
Owner Name*
David Andrews
Owner Title
Town Manager STORMWATER PERMIT
Street Address
301 West Main Street
City, State Zip
Carrboro NC 27510
Phone Number
919 917-7315
E-mail Address
I [e-mail]
* The owner must be a principal executive officer or ranking elected official for the city/town/entity that
owns/operates the permitted M54. Any permit enforcement actions will be sent to the owner on record.
Part II: Primary Contact**
Y
TING
Contact Name
Randy Dodd
Contact Title
Stormwater Utility Manager
Employer
Town of Carrboro
Street Address
301 West Main Street
City,State Zip
Carrboro NC 27510
Phone Number
919 918-7341
E-mail Address
[e-mail]
** The primary contact is the responsible party who will oversee the day-to-day permit compliance and
Stormwater Management Program implementation. With the exception of enforcement actions, permit
communications originating from NCDEQ will be sent to the primary contact and will be copied to the other
contacts listed below.
Part III: Other Contacts
Contact Name
Emily Cochran
E-mail Address
[e-mail]
Contact Name
Heather Holley
E-mail Address
hholl t� townofcarrboro.or
Part IV: Required Supplemental Information
Submit one (1) hard copy and one (1) electronic copy of a Draft Stormwater Management Plan (SWMP)
with this permit renewal application. The Draft SWMP must be in the current NCDEQ SWMP Template
format and shall include all required information in order for the permit renewal application to be
considered complete.
Page 1 of 2

Part V: Certification
By my signature below I hereby 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. I am also aware that incomplete permit renewal
applications, inclusive of the required Draft SWMP, will not be processed and will be returned to the
permittee.
❑ I am a ranking elected official for the permitted MS4.
® I am a principal executive officer for the permitted MS4.
❑ I am a duly authorized representative for the permitted MS4 and have attached the authorization
made in writing by the permit owner listed in Part I of this application, which specifies me as (check
one):
❑ A specific individual having overall responsibility for the stormwater permit.
❑ A specific position having overall responsibility for the stormwater permit.
Signature:*
(1a,
Print Name:
Da�ldAndrews
Title:
Town Manager
Signed this Z J'I�ay of 21
Please note that an original signature is required on this form, any required supplemental information, and any
representative authorization. Photocopies cannot be accepted.
Return this completed form along with the required supplemental information to:
DEQ-DEMLR Stormwater Program
Attn: MS4 Permitting
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 2 of 2

Randy Dodd
From:
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Powell, Jeanette <[e-mail]>
Sent:
Tuesday, May 25, 2021 8:26 AM
To:
[e-mail]; [e-mail]; [e-mail];
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[e-mail]; Jaclyn Stannard; [e-mail];
Weakley, Allison; [e-mail]; [e-mail];
[e-mail]; [e-mail]; [e-mail];
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{
[e-mail]; Huntsinger, Todd;
Donham, Rob; Matthew B.
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[e-mail]; [e-mail];
Poling, PE, CFM; Allred, Marc; [e-mail]; [e-mail];
Baines, Jamey; Todd, Christopher W; [e-mail]; Scheuer, Nick;
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Young, Jason A; [e-mail]; [e-mail];
[e-mail]; Salmon, Timothy; [e-mail];
[e-mail]; [e-mail]; Blanchard, Paul; Smith,
Kyle; Cy Stober; [e-mail]; [e-mail]; Tencer, Sean;
[e-mail]; [e-mail]; David Johnson;
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aholland @cityofgraham.com;jgreen@townofran lo.org; [e-mail];
�t Q-� `�'
[e-mail]; Charles Brown; [e-mail]; Denton, Dale;
[e-mail]; [e-mail]; [e-mail]; DJ
Senores; Brandt, Michael M; [e-mail]; Kirby, Lisa; Daryl Norris;
[e-mail]; [e-mail]; Donald Perry;
[e-mail]; James Misciagno; Ritchie, Chris; Randy Dodd; Sewell, Alex;
[e-mail]; [e-mail]; Paige, Martha;
[e-mail]; [e-mail],
[e-mail]; [e-mail]; Stinnett, Melisa S; Griffin,
RECEIVED
Andrew D; [e-mail]; [e-mail]; [e-mail];
[e-mail]; Huffman, Mike; [e-mail];
JUN 17 2021
[e-mail]; Daniel Colavito; [e-mail];
[e-mail]; Radcliff, Sarah W; Mitchell, Jennifer;
DEIVRATER ERIMITY
i ^vRil4WATE�t FRIE/lll'TING
[e-mail]; [e-mail]; [e-mail];
Young, Jonathan; [e-mail]; [e-mail];
[e-mail]
Cc:
McCoy, Suzanne; Selkane, Aziza; Morman, Alaina; Lucas, Annette; Clark, Paul; Aiken, Stan
E; Houck, Blane; Dalton, Jack; Denton, Bill; Eplin, Tamera; Graybeal, Christopher E;
McDonnell, Jesse M; Khan, Zahid; Garcia, Lauren V; Lawyer, Mike; Lentz, Zachary; Hiatt,
Levi; Norberg, Natalie B; Valentine, Thad
Subject:
MS4 Permit Renewal Application Reminder
You are receiving this email because the current MS4 permit expires on February 19, 2022. This is a friendly reminder
that an MS4 permit renewal application must be submitted by Friday, August 23, 2021.
The MS4 permit and federal regulations require that a permit renewal application be submitted at least 180 days prior
to permit expiration. The application form must include an original "wet" signature by the permit owner or their
officially designated signatory authority, and should be submitted to me at the highlighted address below. The MS4
Permit Renewal Application form is available on the MS4 Forms & Resources web page.
The permit renewal application requires that a Stormwater Management Plan (SWMP) be included as supplemental
information. Please include the appropriate supplemental information with the application:

• If the MS4 has been audited by DEQ and has received a compliance notice with a required Draft SWMP
submittal deadline prior to August 23, 2021; then the supplemental information requirement shall be met by
submitting the required Draft SWMP.
• For all other MS4s, the supplemental information requirement shall be met by the submitting either (a) the
SWMP currently in use by the MS4, or (b) a Draft SWMP for the next permit term which utilizes the standardized
DEQ SWMP Template.
The permit renewal application submittal will not affect DEQ's MS4 Audit Schedule, but does constitute a permit
violation if not submitted. Prior to issuing a permit renewal, each MS4 will be:
• Audited by DEQ
• Issued an audit report and associated compliance notice
• Required to submit a Draft SWMP utilizing the DEQ standardized template.
If you have any questions, please contact me via email.
Regards,
J
Jeanette Powell
MS4 Program Coordinator
919-707-3620
Jeanette. [e-mail]
NCDEQ-DEMLR Stormwater Program
1612 Mail Service Center
Raleigh, NC 27699-1612
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third
parties.
https://deg. nc. gov/sw
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