NCG110006_ROS Request and map_20240709

FOR AGENCY USE ONLY
Division of Energy, Mineral & Land Resources Date Received
,r1f
Year Month Day
�; Stormwater Program 2024 07 09
National Pollutant Discharge Elimination System
Environmental REPRESENTATIVE OUTFALL STATUS (ROS)
Quality REQUEST FORM
if a facility is required to sample multiple discharge locations with very similar stormwater discharges, the
permittee may petition the Director for Representative Outfall Status(ROS). DEQ may grant Representative
outfall Status if stormwater discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted,ALL outfalls are still subject to the ualg itative monitoring
requirements of the facility's permit—unless otherwise allowed by the permit(such as NCGO20000)and DEQ
approval. The approval letter from DEQ must be kept on site with the facility's Stormwater Pollution
Prevention Plon. The facility must notify DEQ in writing if any changes affect representative status.
For questions, please contact the DEQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N I C I 5 N C G 11 11 10 10 0 6
2) Facility Information:
Owner/Facility Name City of Raleigh Smith Creek Resource Recovery Facility
Facility Contact Michael Loveless
Street Address 8505 Ligon Mill rd
City Wake Forest State NC ZIP Cade 27587
County Wake E-mail Address [e-mail]
Telephone No. 919 796-6392 Fax:
3) List the representative outfalls) information (attach additional sheets if necessary):
Outfall(s) 001 is representative of Outfall(s) 001,002,003
Outfalls' drainage areas have the same or similar activities? Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? KYes ❑ No
Outfalls have similar monitoring results? ❑ Yes ❑ No cw-filo data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? ❑ Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑ Yes ❑ No
outfalls have similar monitoring results? ❑ Yes ❑ No ❑ No data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? ❑ Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑ Yes ❑ No
Outfalls have similar monitoring results? ❑ Yes ❑ No ❑ No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
Page 1 of 3
SWU-ROS-2009 Last revised 1 213 0/2 00 9

Representative Outfall Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status;
(Or, attach a letter or narrative to discuss this information.) For example,describe how activities and/or
materials are similar.
Drainage areas have similar activities and materials.All three areas end up in the same place. DEMLR staff identified ROS
as identified above during an on-site evaluation.
5) Certification:
North Carolina General Statute 143-215.6 1 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;or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case
under this Article;or who falsifies,tampers with,or knowingly renders inaccurate any recording or monitoring device
or method required to be operated or maintained under this Article or rules of the[Environmental Management]
Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
ten thousand dollars($10,000).
I hereby request Representative Outfall Status for my Ni Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DEQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my Ni permit.
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: Lisa Joseph
Resource Redo anager
)/n�C. 7 L9 /11;(-;a
rgn ure of Apg r ntJ Gate Signed)
Please note: Th application for Representative Outfall Status is subject to
approval by the NCDEQ Regional Office. The Regional Office may inspect your
facility for compliance with the conditions of the permit prior to that approval.
Final Checklist for ROS Request
This application should include the following items:
❑ This completed form.
❑ Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
❑ Two (2) copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
❑ Summary of results from monitoring conducted at the outfalls listed in Question 3.
Cl Any other supporting documentation.
Page 2 of 3
SWU-ROS-2009 Last revised 12/30/2009

STORMWATER CONVEYANCES WITH SHEET FLOW ZONES
=y y y rr/
f i
lor
A--4St2GG c F f r I
_ I r
� I �
• �• r Jf+rr
I —
OUTLET
ti J kF FOIR'S.=
IL
I r
I■ � � I _ - r. "aa-SIC n�lx•
+h •� r. _.t �j 1 i �
L ti. o';•. k OUTLET
Na I
i y 4 1 14
pp
DA43
i � k - � L .•���I r. lair Sr•A#ara�aw- rs
r
F
0fY h1
-�-- '�fJ No, 2 r
y OUTLET -Y
ho,3
r'
' -
.oranr�
yyy yyyyyy _�