NCS000395_MeckCo Permit Renewal Application_20210729

JCharlotte -Mecklenburg
STORM
VtjATER StormWater.CharMeck.org
Services
2145 Suttle Avenue
Charlotte, NC 28208
July 22, 2021
Ms. Jeanette Powell
RECEIVED
NCDEQ-DEMLR Stormwater Program
1612 Mail Service Center
JUL 2 9 2021
Raleigh, NC 27699-1612
DEtJR-LAID Qi.9i+i_I-"iY
STI ORE+MWATER PERMITTING
Subject: Renewal Application for NPDES Phase II Storm Water Permit Number NCS000395
and Stormwater Management Plan (SWMP)
Dear Ms. Powell,
Please find enclosed a completed MS4 permit renewal application for Permit Number
NCS000395 with an original "wet" signature by the officially designated authority. Also
enclosed as supplemental information is the Stormwater Management Plan (SWMP) developed
for this Permit. The application and SWMP are being provided for renewal of "Co -Permit"
coverage under Permit Number NCS000395 for the Regulated Phase II Public Entities in
Mecklenburg County, including Mecklenburg County, Charlotte -Mecklenburg Schools, Central
Piedmont Community College and the Towns of Cornelius, Davidson, Huntersville, Matthews,
Mint Hill, and Pineville.
If you have any questions or require additional information, please do not hesitate to give me a
call at 980-314-3217.
Thank you.
Sincerely,
R4&tV"t��l I e
Water uality Program Manager
Enclosures

Q.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.
Part I: Permittee Information
Current Permit No.
NCS 000395
MS4 Name
Mecklenburg County
Owner Name*
W. Dave Canaan�
202
Owner Title
Division Director II
XfI R-LAND QUALITY
Street Address
2145 Suttle Avenue
City,State Zip
Charlotte North Carolina 28208-5237
Phone Number
980 314-3209
E-mail Address
dave.canaan mecklenbur coun nc. ov
* 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
Russell(Rusty) S. Rozzelle
Contact Title
Environmental Manager
Employer
Mecklenburg County
Street Address
2145 Suttle Avenue
City,State Zip
Charlotte North Carolina 28208-5237
Phone Number
980 314-3217
E-mail Address
rusty. rozzel lemecklenbur coun nc. 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
David Caldwell Environmental Supervisor
E-mail Address
david.caldwellmecklenburqcounlync.gov
Contact Name
Ryan S idel Environmental Supervisor
E-mail Address
r an.s idel mecklenbur coun nc. ov
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.
0 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) :
0 A specific individual having overall responsibility for the stormwater permit.
❑ A specific position having overall responsibility for the stormwater permit.
Signature:*
Print Name:
Title:
ji✓'
Signed this day oil` 0. Z 1 .
* Please note that an oriainal 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