NCG030743_Application_20230822

FOR AGENCY USE ONLY RECEIVED
NCG03 1 1 3
Assigned to: - Cod AN 2 2 2023
ARO FRO MRO RRO WARD WIRO WSRO
DEMLR-Stormwater Program
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG030000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC335[Rolling, Drawing, and Extruding of Nonferrous Metals],SIC3398[Metal Heat
Treating],SIC34[Fabricated Metal Products],SIC35[Industrial and Commercial Machinery],SIC36[Electronic
and Other Electrical Equipment],SIC 37[Transportation Equipment], and SIC 38[Measuring,Analyzing, and
^t°� v^i,�M fin . he DEMLR Stormwater Program at deq.nc.gov/SW.
J\ n J M� r��r , �1 (' , Send the original, signed application with all required
`S ` l7/ l�l/ r Program,1612 MSC, Raleigh,NC 27699-1612. The
rage under the general permit. Prior to coverage under this
1. ;e will be mailed):
Legally responsible person as signed in Item(7)below:
GERALD ANDERSON
Street address: City: State: Zip Code:
8511 NORCROSS ROAD COLFAX NC 27235
Telephone number: Email address:
336-662-0113 GERALD.ANDERSON ITT.COM
Type of Ownership:
Government
E3County OFederal 13Municipal ©State
Non-government
I'Business(If ownership is business,a copy of NCSOS report must be included with this application)
E3 Individual
2. Industrial Facility (facility being permitted):
Facility name: Facility environmental contact:
GOULDS PUMPS, INC.-NC PRO SERVICES GERALD ANDERSON
Street address: City: State: Zip Code:
8511 NORCROSS ROAD COLFAX NC 27235
Parcel Identification Number(PIN): County:
7805336711 GUILFORD
Telephone number: Email address:
336-662-0113 GERALD.ANDERSON ITT.COM
4-digit SIC code: Facility is: Date operation is to begin or began:
3561 1 ONew OProposed MExisting 1 1/1/22
Latitude of entrance: Longitude of entrance:
36.019652 1 -80.003580
Brief description of the types of industrial activities and products manufactured at this facility:
REPAIR OF INDUSTRIAL ROTATING EQUIPMENT-ASSEMBLY OF PUMPS,GEAR BOXES AND ROTATING EQUIPMENT-LIGHT MACHING OF PARTS USED FOR REPAIRS
If the stormwater discharges to a municipal separate storm sewer system(MS4),name the operator of the MS4:
0 N/A
Page 1 of 5

3. Consultant(if applicable):
Name of consultant: Consulting firm:
MarKeshia Garrison-Boyd Antea Group USA
Street address: City: State: Zip Code:
3725 DaVinci Court Norcross GA 30092
Telephone number: Email address:
800-477-7411 [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: ❑+ This water is impaired.
001 West Fork Deep River WS-IV ❑This watershed has a TMDL
Latitude of outfall: Longitude of outfall:
36.09146 80.00417
Brief description of the industrial activities that drain to this outfall:
UNLOADING/LOADING
3-4 digit identifier: Name of receiving water: Classification: El This water is impaired.
002 West Fork Deep River WS-IV ❑This watershed has a TMDL.
Latitude of outfall: Longitude of outfall:
36.09131 80.00351
Brief description of the industrial activities that drain to this outfall:
UNLOADING/UNLOADING- NITROGEN TANK
3-4 digit identifier: Name of receiving water: Classification: ❑This water is impaired.
003 West Fork Deep River WSW ❑This watershed has a TMDL.
Latitude of outfall: Longitude of outfall:
36.09201 80.00339
Brief description of the industrial activities that drain to this outfall:
UNLOADING/UNLOADING-TWO OUTDOOR OPEN TOP DUMPSTERS LOCATED,ONE FOR WOOD AND ONE FOR METAL:TWO CLOSED TOP OUTDOOR DUMPSTERS
3-4 digit identifier: Name of receiving water: Classification: ❑This 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:
3-4 digit identifier: Name of receiving water: Classification: ❑This 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:
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 NO].
Page 2 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:
❑This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
❑+ This facility has a Stormwater Pollution Prevention Plan(SWPPP).
If checked, please list the date the SWPPP was implemented:
July 2023
❑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)
O 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: Type(s)of waste:
<100 Paints and aerosols
How material is stored: Where material is stored:
Drums Back end of the building
Number of waste shipments per year: Name of transport/disposal vendor:
4 Univar Solutions USA Inc./VLS Environmental Solutions
Transport/disposal vendor EPA ID: Vendor address:
TXR000084869/SCR000762468 3 Waterway Square PI#1000,The Woodlands,TX P3W/305 S Mein Street,Mauldin,SC 2%U
❑This facility is located on a Brownfield or Superfund site
If checked, briefly describe the site conditions
6. Required Items(Application will be returned unless all of the following items have been included):
O Check for$100 made payable to NCDEQ
0 Copy of most recent Annual Report to the NC Secretary of State(if applicable)
❑+ 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 industrial process materials are stored
g) impervious areas
h) site property lines
O 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 143-215.6E(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($10,000).
Under penalty of law, I certify that:
❑ I 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.
1+ The information submitted in this NO1 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 NCG030000 permit. I 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.
0 I hereby request coverage under the NCG030000 General Permit.
Printed Name of Applicant: GERALD ANDERSON
Title: EASTERN REGIONAL MANAGER/NORTH AMERICA PRO SERVICES
"-'A'rZK'L22 8 Zo23
(Signature of Applicant) (Da a Signe
Mail the entire package to: DEMLR—Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

Additional Outfalls
3-4 digit identifier: Name of receiving water: Classification. ❑This 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:
3-4 digit identifier: Name of receiving water: Classification:
Latitude 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:
3-4 digit identifier: Name of receiving water: Classification: ❑This 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:
3-4 digit identifier: Name of receiving water: Classification: ❑This 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:
3-4 digit identifier: Name of receiving water: Classification: ❑This 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:
3-4 digit identifier: Name of receiving water: Classification: ❑This 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:
3-4 digit identifier: Name of receiving water: Classification: ❑This 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:
Page 5 of 5

LIMITED LIABILITY COMPANY ANNUAL REPORT
NAME OF LIMITED LIABILITY_COMPANY__GOUIdS_Pump"PI G) LLC
Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 1539136 STATE OF FORMATION: DE E-Filed Annual Report
1539136
REPORT FOR THE CALENDAR YEAR: CA202305300169
2023 2/22/2023 08:15
SECTION A: REGISTERED AGENT'S INFORMATION Changes
1. NAME OF REGISTERED AGENT: CT Corporation System
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS 8 COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
150 Fayetteville St.,#1011 150 Fayetteville St.,#1011
Raleigh,NC 27601-2957 Wake County Raleigh, NC 27601-2957
SECTION B: PRINCIPAL OFFICE INFORMATION
1.DESCRIPTION OF NATURE OF BUSINESS: Sales Administration
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
240 Fall Street 240 Fall Street
Seneca Falls, NY 13148 Seneca Falls, NY 13148
6. Select one of the following if applicable.(Optional see Instructions)
❑ The company is a veteran-owned small business
❑ The company is a service-disabied veteran-owned small business
SECTION C:COMPANY OFFICIALS(Enter additional company officials in Section E.)
NAME: Brendan Ferretti NAME: Michael J. SByinelli NAME: George Abdo Hanna
TITLE: Manager TITLE: Manager TITLE: Manager
ADDRESS: ADDRESS: ADDRESS:
240 Fall Street 240 Fall Street 240 Fall Street
Seneca Falls, NY 13148 Seneca Falls,NY 13148 Seneca Falls, NY 13148
SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Joanne Scalard 2/22/2023
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Joanne Scalard General Counsel
Print or Type Name of Company Official Print or Type Title of Company Official
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF$200.00
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

SECTION E: ADDITIONAL COMPANY OFFICIALS
NAME=Joanne-Seal d NAME: NAME:
TITLE: General Counsel TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
240 Fall Street
Seneca Falls, NY 13148
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: Name:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:

e
oto
�5
Subject -- --
r
Property -
.1
ni P RV.4NAE .i _
{
USGS 7.5-minute FIGURE 1
Topographic Series SUBJECT PROPERTY LOCATION MAP
Xern r ,Se ITT STORMWATER SUPPORT
8511 NORCROSS ROAD
COLFAX,NC
PROJECT NO. PREPARED BY REF KALE O
M23-03-50Ii334 MDE I:24,"
DATE REVIEWED BY MAP SGU
0 500 1,000 2,000 3,000 4,0D0 71312023 MGB Ilhl3 =;DaDFEET anteagroup
reet
ZAIG15 Proje[tS11TTIColfax,NCILayDutlSabjectPropertyLocabon.mxd

� t
i
t
ppsi
4
T
Al
Y
w
LL
v
{ Y'