NCG510117_Permit (Issuance)_20161107

PAT MCCRORY
Water Resources
LNVIRONNEN1 AL OUALI1 Y
November 7, 2016
Mr. Leland Pendergrass
Bowers & Burrows, Inc.
213 Young St
Henderson, NC 27536
(,1111711(4
DONALD R. VAN DER VAART
S. JAY ZIMMERMAN
Subject: General Permit NCG510000
Certificate of Coverage NCG510117
Gillburg Grocery
Vance County
Dear Permittee:
1)irr,lur
The Division received your request to renew Certificate of Coverage (CoC) NCG510117 on October 5,
2016. This CoC renewal is issued pursuant to the requirements of North Carolina General Statute 143-
215.1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection
agency dated October 15, 2007.
A copy of General Permit NCG510000 is enclosed. If any parts, measurement frequencies or
sampling requirements contained in this permit are unacceptable to you, you have the right to request an
individual permit by submitting an individual permit application. Unless such demand is made, this CoC
shall be final and binding.
The CoC is not transferable except after notice to the Division. You must notify the Division if you
sell or otherwise transfer ownership of the permitted facility. The Division may require modification or
reissuance of the CoC.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the
Regional Office listed below. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain any other permit required by Federal, State, or
Local government. If you have any questions concerning this permit, please contact Charles Weaver at the
telephone number listed below, or via email [[e-mail]].
fir S. Jay Zimmerman,
Director, Division of Water Resources
cc: Raleigh Regional Office
NPDES file
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6391 919-807-6389 FAX
httpsJ/deq.na gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG510000
CERTIFICATE OF COVERAGE NCG510117
TO DISCHARGE PETROLEUM CONTAMINATED GROUNDWATER AND SIMILAR WASTEWATERS
UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Bowers & Burrows, Inc.
is hereby authorized to operate a groundwater remediation system for petroleum -contaminated groundwater
or similar waste streams that will discharge treated wastewater from the
Gillburg Grocery
4939 NC Hwy 39
Henderson
Vance County
to receiving waters designated as an unnamed tributary to Cattail Creek, a class C-NSW + stream
in subbasin 03-03-02 of the Tar -Pamlico River Basin.
All discharges shall be in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, III and IV of General Permit NCG510000 as attached.
This certificate of coverage shall become effective November 7, 2016.
This Certificate of Coverage shall remain effective for the duration of the General Permit.
Signed this day, November 7, 2016
ay Zimmerman, P.G.
'rector, Division of Water Resources
By Authority of the Environmental Management Commission

L
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 E. Millbrook Rd., Ste. 121
Raleigh, NC 27604
Telephone [phone]
Fax [phone]
www.atcgroupservices.com
September 6, 2016
Mr. Charles Weaver
NCDEQ DWR Water Quality Permitting Section
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: NPDES General Permit NCG510000
Certificate of Coverage NCG510117
Gillburg Grocery
Henderson, Vance County, North Carolina
Incident No. 7240
ATC Project No. BBOC100P03
Dear Mr. Weaver:
RECEI V EDINCDECYD
sEP 0 9 2016VvR
dater
Permitting Section
On behalf of Bowers & Burrows, Inc., attached is one original and one copy of the Notice of Renewal
Intent application and associated attachment depicting the path of the remediation system effluent
discharge from the site to the discharge point. Note that the application has been signed by an
authorized representative of Bowers & Burrows, Inc. If there are any questions, please direct them to
the undersigned at [phone].
Sincerely,
/PI
Larry George, L.G., R.S.M.
Principal/Senior Project Manager
Attachments — Notice of Renewal Intent application (one original and one copy)

A7A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Thomas A. Reeder
Governor Director
John E. Skvarla, III
Secretary
NOTICE OF RENEWAL INTENT
[Required by 15A NCAC 02H .0127(d)J; [term definition see 15A NCAC 02H .0103(19)1
Application for renewal of existing coverage under General Permit NCG510000
Existing Certificate of Coverage (CoC): NCG510 I 1 7
(Please print or type)
1) Mailing address of site Owner: (address to which all correspondence should be nailed)
Company Name Bowers & Burrows, Inc. RECEIVED/NCDECUDVVR
Company Contact Leland Pendergrass S E P 0 9 2016
Street Address 213 Young Street
City Henderson State NC ZIP 27536
Telephone # [phone] Fax # [phone]
Cell/Mobile # [phone] Email [e-mail]
2) Location of remediation site producing discharge:
Facility Contact
Street Address
City
County
Telephone #
Leland Pendergrass
4765 NC Highway 39
Henderson
Vance
252-492-0181
State NC ZIP 27537
Fax # [phone]
3) System operator / Consultant ID: (if different from Owner)
Company Name
Street Address
City State
County
Telephone # Fax #
Email
ZIP
Water Quaiity.
Permitting Section
Page 1 of 2 Revised 9/1/13

NCG510000 Renewal Application
4) Site ranking & ID:
GW incident #: 7240
Site Ranking (if available): 765 D
Date of most recent discharge: current
Additional Application Requirements:
The following information must be included in duplicate [original + 1 copy] with this application or
it will be returned as incomplete.
> Site map: Clearly showing the path of the remediation system effluent from the site to
its discharge point
> Authorization for representatives. If this application will be submitted by a consulting
engineer (or engineering firm), include documentation from the Permittee showing that
the consultant submitting the application has been designated an Authorized
Representative of the applicant.
CERTIFICATION
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: Leland Pendergrass
Title:
M9.e.
(Signature of A••licant)
North Carolina General Statute 143-215.6 b (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan or other document filed
or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, or who falsifies,
tampers with or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21 or
regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to
exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than
$25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
August 26, 2016
(Date Signed)
This Notice of Renewal Intent does NOT require a separate fee.
The permitted facility already pays an annual fee for coverage under NCG510000.
Mail this application and one copy of the entire package to:
NC DENR / DWR / Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attn: Charles Weaver
Page 2 of 2 Revised 9/1/13

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