NCS000482_Renewal Application_20210823

x
City of
1Monroe
Engineering
DEQ-DEMLR Stormwater Program
Attn.: MS4 Permitting
1612 Mail Service Center
Raleigh, NC 27699-1617
300 W Crowell Street, Monroe, NC 28112
monroenc.org • 704-282-4500 • PO Box 69, Monroe, NC 281 1 1
Re: NPDES Stormwater Permit Renewal
City of Monroe (Permit No. NCS000482)
To Whom It May Concern,
August 18, 2021
AUG 2 3 2021
DENR-LAND QUALITY
STORMWATER PERMITTING
Please find enclosed one copy of the City of Monroe Comprehensive Stormwater Management
Program Report, along with an original signed NPDES Stormwater Permit application form by
Mayor Bobby G. Kilgore
If you have any questions, feel free to contact me at [phone] or email me at
[e-mail].
Sincerely,
Czl S�
Chris Costner, P.E., CSM, CFM
Stormwater Engineer
Enclosures
I:\Stormwater\Stormwater Management Program\NPDES Phase II\NPDES Permit\Permit Renewal
2022\NPDES Renewal letter 081821.clocx

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 000482
MS4 Name
City of Monroe
Owner Name*
Bobby G. Kilgore
Owner Title
Mayor
Street Address
300 West Crowell Street
-City, State, Zip
Monroe NC 28111
Phone Number
704-282-4502
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 M54. Any permit enforcement actions will be sent to the owner on record.
Part II: Primary Contact**
Contact Name
Chris Costner, P.E., CSM, CFM
Contact Title
Stormwater Engineer
-Employer
City of Monroe
Street Address
300 West Crowell Street
-City, State, Zip
Monroe NC 28111
Phone Number
704-282-4537
E-mail Address
I [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.
4rt III: Other Contacts
Contact Name
Sarah McAllister, P.E.
E-mail Address
[e-mail]
Contact Name
Heather Freeman
E-mail Address
[e-mail]
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.
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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:*
Print Name:
�� Q✓�,
Title:
Signed this day of 20- .
* Please note that an on final 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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