NCS000421_High Point Permit Renewal Application_20210803

Public Services Department
Stormwater Services Division
July 29, 2021
EMAIL and FEDERAL EXPRESS
DEQ-DEMLR Stormwater Program
Attn: Jeanette Powell
1612 Mail Service Center
Raleigh, NC 27699-1612
NORTH CAROLINA'S INTERNATIONAL CITY""
RECEIVED
AUG 0 3 2021
DENR•LAND QUALITY
STORMWATER PERMITTING
RE: City of High Point Permit No. NCS000421
NPDES MS4 Permit Renewal Application Form
Dear Jeanette:
Enclosed please find the NPDES MS4 Permit Renewal Application Form and Final Draft
of the Stormwater Management Program Plan for the City of High Point.
Due to the unresolvable formatting issues within the previously submitted Word
document, it was necessary for us to prepare a new SWMP using DEQ's updated SWMP
Template in order to address all comments and concerns pertaining to the Final Draft
submission.
If you have any questions or concerns, please do not hesitate to contact me.
Respectfully,
Justin T. Gray
Public Services Manager
Enclosures
cc: Randy McCaslin, Deputy City Manager
T e r ry H o u k, Public Services Director
Robby Stone, PE, Deputy Public Services Director
Anita Simpson, Storm water Opera tionsAnalyst
City of High Point, P.O. Box 230, 211 South Hamilton Street, High Point, NC 27261 USA
Fax:[phone] Phone:[phone] TDD:336.883.8517

E
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. t�
Part I: Permittee Information RECEIVED
Current Permit No.
NCS 000421 AUG0 3 "
MS4 Name
City of High Point
Owner Name*
Randy E. McCaslin STORMWATER PERMITTI
Owner Title
Interim City Manager
Street Address
211 S. Hamilton Street
City,State Zip
High Point NC 27260
Phone Number
336-883-3291
E-mail Address
[e-mail]
* The owner must be a principal executive officer or ranking elected official for the city/town/entity that
owns/operates the permitted MS4. Any permit enforcement actions will be sent to the owner on record.
Part II: Primary Contact**
Contact Name
Terry Houk
Contact Title
Public Services Director
Employer
City of High Point
Street Address
211 S. Hamilton Street
City,State Zip
High Point NC 27260
Phone Number
336-883-3218
E-mail Address
terry. houk@hih ointnc. ov
** 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
Robby Stone
E-mail Address
[e-mail]
Contact Name
Justin Gray
E-mail Address
[e-mail]
Contact Name
Anita Simpson
E-mail Address
[e-mail]
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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.
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:*
�p
Print Name:
Randy E. McCaslin
Title:
Interim City
Manager
Signed this A day of
2021.
* Please note that an on inal 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
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