NCG210504_Corrected Application_20221205

RECFI VED
FOR AGENCY USE. QNLY
NCG21 050rf DEC 052022
Assign VCAWK)
ARO F 0 MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG210000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the fallowing Standard
Industrial Classifications: SIC24 [Timber Products, including Wood Chip Mills —except as specified below] and like
activities deemed by DEMLR to be similar in the process and/or the exposure of raw materials, products by-
products, or waste materials. The following activities are specifically excluded from coverage under this General
Permit. SIC 2434 [Wood Kitchen Cabinets], SIC2491 [Wood Preserving], and SIC 2411 [Logging]. You can find
information on the DEMLR Stormwater Program at deq.nc.gov/SW.
Directions: Print or type all entries on this application. Send the original, signed application with all required
items listed in Item (6) below to: NCDEMLR Stormwater Program, 1612 MSC, Raleigh, INC 27699-1612. The
submission of this application does not guarantee coverage under the General Permit. Prior to coverage under
this General Permit a site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (7) below:
Cavco Industries, Inc.
Tyler Fuller
Street address:
City:.
State:
Zip Code:
106 Innovative Way
Hamlet
NC
28345
Telephone number:
Email address:
910-410-5050
[e-mail]
Type of Ownership:
-
Government
❑County ❑Federal []Municipal ❑State
Non -government
El Business (If ownership is business, a copy of NCSOS report
must be included with this application)
❑Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Cavco Industries, Inc. dba Cavco Homes of North Carolina
Tyler Fuller
Street address:
City:
State:
Zip Code:
106 Innovative Way
Hamlet
NC
28345
Parcel Identification Number (PIN):
County:
748000936806
Richmond
Telephone number:
Email address:
[phone]
[e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
2451
❑New ❑Proposed IDExisting
10/3/2022
Latitude of entrance:
Longitude of entrance:
34.855692
-79.705233
Brief description of the types of industrial activities and products manufactured at this facility:
Manufacturing manufactured homes.
This facility will produce Wood Pellets: ❑Yes MNo
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
O N/A
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
Consulting firm:
James Maynes, P.E.
Strata Environmental Services, Inc.
Street address:
City:
State:
Zip Code:
110 Perimeter Park Road, Suite E
Knoxville
TN
37922
Telephone number:
Email address:
865-539-2077
[e-mail]
4. Outfall(s) At least one outfall is required to be eligible for coverage.
3-4 digit identifier:
Name of receiving water:
Classification:
0 This water is impaired.
1
001
Marks Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall;
34.858188
-79.702509
Brief description of the industrial activities that drain to this outfall:
Frame storage, solid waste from home manufacturing, finished manufactured home components (windows, etc.)
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ID No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receivi
"Classsiiicat16n," -''' ` - '�`
r0 This water"is'im'pa'ired.
002
MarksCreekr'
C
❑ This watershed has aTMDL
Latitude of outfall
Longitude of outfall:
34.857377
79.707396
Brief description of tlie.industrial activities that drain to this-outfall:
Finished manufactured home,stora e, frame stor96e, and solid waste from home manufacturin .
Do Vehicle'IMlaintenance Activities occur in the drainage area of this outfall? ❑,Y_es' I] No
If yes, how many gallons of new motor oil are used each m8ni when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
O This water is impaired.
003
Marks Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
34.857679
-79.707338
Brief description of the industrial activities that drain to this outfall:
Finished manufactured home storage, frame storage, and solid waste from home manufacturing.
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ♦] No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
is water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
All outfalls must be listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalls" found on the last page of this NOI.
Page 2 of 5

5. Other Facility Conditions (check all that apply and explain accordinelv):
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
O This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
The facility has a SWPPP in place describing best management practices (preventative maintenance, good housekeeping, etc.)
I7 This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
11 /1 /2022
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
' ❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If.checked, indicate::, -
Kilograms of waste generated each month
Types) of waste
How material is stored2 ''
Where material is stofed:
Number of waste shipments peh year:
Name of transport/disposal vendor:
Transport/disppsal vendor EPA ID:
Vendor address:
❑ This facility is located on a Brownfield orSuperfund site "
If checked, briefly describe the site conditions z
6. Required Items (Application will be returned unless all of the following items have been includedh
p
Check for $100 made payable to NCDEQ
0
Copy of most recent Annual Report to the NC Secretary of State (if applicable)
0 This completed application and any supporting documentation
O
A site diagram showing, at a minimum, existing and proposed:
a)
outline of drainage areas
b)
surface waters
c)
stormwater management structures
d)
location of stormwater outfalls corresponding to the drainage areas
e)
runoff conveyance features
f)
areas where materials are stored
g)
impervious areas
h)
site property lines
0
Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

7. Applicant Certification:
North Carolina General Statute 143-215.66 (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 this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($30,000).
Under penalty of law, I certify that:
O 1 am the person responsible for the permitted industrial activity, for satisfying the requirements of this permit, and for any
civil or criminal penalties incurred due to violations of this permit.
O The information submitted in this N01 is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information.
O I will abide by all conditions of the NCG210000 permit. 1 understand that coverage under this permit will constitute the
permit requirements for the discharge(s) and is enforceable in the same manner as an individual permit.
O I hereby request coverage under the NCG210000 General Permit.
Printed Name of Applicant: Tyler Fuller
Title: General
� �Z2
(Signature of Ap icant) (Date Signed)
Mail the entire package to: DEMLR— Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

S. Other Facility Conditions (check all that apply and explain accordingly):
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
0 This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
The facility has a SWPPP in place describing best management practices (preventative maintenance, good housekeeping, etc.)
I] This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
11 /1 /2022
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility -..—„,,-_..._ _.--- ---<--,--.� ._---
1f checked, indicate , --i.
Kilograms of waste generated each Month i _
Type(s) of wake
t;
y
How material is stored:{
Where maferial is stoked: r s .
f
• .. - r
Number ofwasteshipment speryear:��
Name of transport/disposalvendory
, - 7
Na
AVendor
Transport/disposal vendor EPA ID
address:
y r{
~
❑ This facility is located do a Brownfield'or Supe'rfund srte A'
If checked, briefly describe the site conditions
6. Required Items (Application will be returned unless all of the following items have been included):
El
Check for $100 made payable to NCDEQ
El
Copy of most recent Annual Report to the NC Secretary of State (if applicable)
I]
This completed application and any supporting documentation
I7
A site diagram showing, at a minimum, existing and proposed:
a)
outline of drainage areas
b)
surface waters
c)
stormwater management structures
d)
location of stormwater outfalls corresponding to the drainage areas
e)
runoff conveyance features
f)
areas where materials are stored
g)
impervious areas
h)
site property lines
8
Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

NC DEQ
PACKET AND INSTRUCTIONS
1) Sign the NOI in blue ink on page 4 of the NOI;
2) Type or photocopy the suggested cover letter onto company
letterhead and sign;
3) Make a copy of signed cover letter and NOI. Keep a copy for your
files and email a copy to [e-mail].
4) Mail the state package with signed cover letter and NOI to the state
in the provided envelope.
5) Be sure to include each of the following items (all provided by
Strata):
- Cover letter (signed)
- Notice of Intent (signed)
- Site Map
- Topographic Map
- Check for $100 made payable to NCDEQ
- NCSOS Annual Report
2252100-32-50a.38287

SOSID: 2387885
Date Filed: 4/112022 2:59:00 PbI
Elaine F. Marshall
State of North Carolina North Carolina Secretary of State
Department of the Secretary of State C2022 091 04877
APPLICATION FOR CERTIFICATE OF AUTHORITY
Pursuant to §55-15-03 of the General Statutes of North Carolina, the undersigned corporation hereby applies for a Certificate of
Authority to transact business in the State of North Carolina, and for Ibat purpose submits the following:
1. The name of the corporation is Cavco Industries, Inc.
and if the corporate name is unavailable for use in the State of North Carolina, the name the corporation wishes to use is:
2. The state or country under whose laws the corporation was organized is: Delaware
3. The date of incorporation was 01/14l20.03
4. Its period of duration is: Z perpetual or 11 a dale certain (mm/dd/yyyy)
5. Principal office information: (Select either a or b)
a. 7'rhe corporation has a principal office.
The street address and county of the principal office of the corporation is:
Number and Street
City, State, Zip Code
3636 N Central Avenue, Suite 1200
Phoenix, AZ, 85012 County Maricopa
The mailing address, if different from the street address, of the principal office of the corporation is:
Number and Street
City, State, Zip Code _ County
b.❑The corporation does not have a principal office.
6. The street address and county of the registered office in the State of North Carolina is:
Number and Street 2626 Glenwood Avenue Suite 550
City: Raleigh State NC,ZipCode:27608 County:
Wake
7.. The mailing address, if different from the street address, of the registered office in the State of North Carolina is:
Number and Street
City:
State NC, Zip Code:.,_ County:
8. The name of the registered agent in the State of North Carolina is: Corporation Service Company
BUSINESS REGISTRATION DIVISION P, 0. BOX 29622 RALEIGH, NC 27626-0622
(Revised July 2017) (Form B-09)

9. The names, titles, and usual business addresses of the current officer of the corporation are (attach if necessary):
Name Title Business Address
William C. Boor President & CEO 3636 N Central Avenue, Suite 1200, Phx, AZ 85012
Allison K. Aden
EVP, CFO, Treasurer 3636 N Central Avenue, Suite 1200, Phx, AZ 85012
Paul W. Bigbee Chief Accounting Officer 3636.N Central Avenue, Suite 1200, Phx, AZ 85012
10. Attached is a Certificate of Existence (or document of similar import) duly authenticated by the Secretary of Stale or other official
having custody of corporate records in the state or country of incorporation. Tire Cerdtheate of) xistenceJnust he.a/i.
odginal dnd less than six months old .
11. If the corporation is required to use a fictitious name in order to transact business in this State, a copy of the resolution of its board
of directors, certified by its secretary, adopting the fictitious name is attached.
12. This application will be effective upon filing, unless a delayed date and/or time is specified:
This is the 31. ,^day of March 20 22
Cavco Industries, Inc.
NAME OF CORPO YfiTION
r
ignature ... .
Steven K. Like, Senior Vice President
Type or Print Name end Ti$e
NOTES:
1. Filing fee is $250. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
(Revised Jidy 2017) (Form B-09)

9. The names, titles, and usual business addresses of the current officers of the corporation are (attach if necessary):
Name Title Business Address
Steven K. Like Senior Vice President 3636 N Central Avenue, Suite 1200, Phx, AZ 85012
Mickey R_Dragash J� Exec. VP, GC, CCO, Secre� 3636 N Central Avenue, Suite 1200, Phx AZ 85012
10. Attached is a Certificate of Existence (or document of similar import) duly authenticated by the Secretary of State or other official
having custody of corporate records in the state or country of incorporation..The CetWlicate O(Existence_must hewn:
original and less than six months old
11. If the corporation is required to use a fictitious name in order to transact business in this State, a copy of the resolution of its board
of directors, certified by its secretary, adopting the fictitious name is attached.
12. This application will be effective upon filing, unless a delayed date and/or time is specified:
This is the
of 4 i 7 20
NArVIE OF CORPORATION
Signature
Type or Prim -Name and Title
NOTES:
1. Filing fee is $250. This docrunent must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
(Revised Jul), 2017) (Fomr B-09)

Delaware Pagel
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY "CAVCO INDUSTRIES, INC." IS DULY
INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE AND IS IN GOOD
STANDING AND HAS A LEGAL CORPORATE EXISTENCE SO FAR AS THE RECORDS
OF THIS OFFICE SHOW, AS OF THE THIRTY—FIRST DAY OF MARCH, A.D.
2022.
AND I DO HEREBY FURTHER CERTIFY THAT THE ANNUAL REPORTS HAVE
BEEN FILED TO DATE.
AND I DO HEREBY FURTHER CERTIFY THAT THE SAID "CAVCO
INDUSTRIES, INC." WAS INCORPORATED ON THE FOURTEENTH DAY OF
JANUARY, A.D. 2003.
AND I DO HEREBY FURTHER CERTIFY THAT THE FRANCHISE TAXES HAVE
BEEN PAID TO DATE.
3614447 8300 C1`• J •' {j
SRiF20221260350
You may verify this certificate online at corp.delaware.gov/authver.shtm]
lenrvY ri,um�xv. Sekrcf,rywsbv. ..
Authentication:203065413
Date: 03-31-22

CaVC0
November 10, 2022
DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Initial Notice of Intent
Cavco Industries, Inc. dba Cavco Homes of North Carolina
106 Innovative Way, Hamlet, North Carolina 28345
Dear Sir or Madam:
Enclosed is a completed Notice of Intent for Storm Water Discharges Associated with Industrial Activity
under the North Carolina NPDES Multi -Sector General Permit for the Cavco Industries, Inc. dba Cavco
Homes of North Carolina facility located in Hamlet, North Carolina.
If you have any questions regarding the enclosed application, please call me at (910-410-5050) or James
Maynes at Strata Environmental (865-539-2077). Thank you for your consideration in this matter. Best
regards.
Sincerely,
Tyler Fuller
General Manager
Enclosure
225210032_50a38287

Strata
=ENVIRONMENTAL
November 7, 2022
Mr. Tyler Fuller
Cavco Homes of North Carolina
106 Innovative Way
Hamlet, North Carolina 28345
Initial Notice of Intent (NOI) for General Storm Water Permit Coverage
Cavco Industries, Inc. — Hamlet, North Carolina
Strata Project Number 2252100.32-50a
Dear Tyler:
Enclosed please find a completed initial Notice of Intent (NOI) for coverage under the State of North
Carolina Department of Environmental Quality (DEQ), Department of Energy, Mineral, and Land
Resources National Pollutant Discharge Elimination System (NPDES) permit NC210000 for storm water
discharges associated with industrial activity for the Cavco Homes of North Carolina facility in Hamlet,
North Carolina. Strata has already prepared the NOI on your behalf.
All required documents have been attached in order to submit the completed NOI for storm water
discharges associated with industrial activity under the North Carolina NPDES Multi -Sector General
Permit (MSGP). Please ensure all attachments are included in the submission along with a $100 check
made payable to the NCDEQ. In order to complete the NOI for submission to the North Carolina DEQ
please review the enclosed completed NOI for accuracy, type or photocopy the suggested cover letter on
your letterhead and sign the NOI form in blue ink on page 4. Once the cover letter and NOI are signed,
send the original signed cover letter and NOI to:
DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Please send the completed NOI package to the North Carolina DEQ at your earliest convenience. Strata
appreciates the continued opportunity to support Cavco Homes of North Carolina. Please feel free to call
if you have any questions (865-539-2077). Best regards.
Sincerely,
STRATA ENVIRONMENTAL SERVICES, INC.
James G. Maynes, P.E.
Engineer
JGM/tmb
Enclosures
2252100-32At03?gNTeter Park, Suite E, Knoxville, TN 37922 • tel[phone] • fax [phone] • www.strataenv.com

November 10, 2022
DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Initial Notice of Intent
Cavco Industries, Inc. dba Cavco Homes of North Carolina
106 Innovative Way, Hamlet, North Carolina 28345
Dear Sir or Madam:
Enclosed is a completed Notice of Intent for Storm Water Discharges Associated with Industrial Activity
under the North Carolina NPDES Multi -Sector General Permit for the Cavco Industries, Inc. dba Cavco
Homes of North Carolina facility located in Hamlet, North Carolina.
If you have any questions regarding the enclosed application, please call me at (910-410-5050) or James
Maynes at Strata Environmental (865-539-2077). Thank you for your consideration in this matter. Best
regards.
Sincerely,
Tyler Fuller
General Manager
Enclosure
2252100-32-50a.38287

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35109-20)T
55) 539.3970
2252100-32
Site Layout FIGURE
Stormwater Pollution Prevention Plan 2
Cavco Industries, Inc. DBA Cavco Homes of North Carolina
September 2022 106 Innovative Way, Hamlet, NC 28345

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MENVIRONMENTAL PFOIECTNUMBER DATE
Cavco Homes of NOAR Carolina
2252100-32 September 2022 106 Innovative Way, Hamlet, NC 28345