NCG180257_Notice of Intent Application_20170628

June 5, 2017
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Re: Notice of Intent
MasterBrand Cabinets, Inc.
118 Lexington Parkway
Lexington, NC 27295
To Whom It May Concern:
Enclosed with this letter you will find an NOI, site map, and permit fee for MasterBrand
Cabinets, Inc. facility located at the address listed above.
If you have any questions regarding this submittal, please contact me at
®[e-mail].
Sincerely,
Jesse NowickiRECEEIVED
Environmental Specialist
U.S. Compliance Corporation JJN 28 2017
DENR-LAND QUALITY
cc: Heather Knowles — MasterBrand Cabinets, Inc.
STORMWATER PERMITTING
Enclosures
U.S. Compliance Corporation
520 Third Street • Suite 100 • Excelsior, MN 55331 • Phone [phone] . Fax [phone]
www.uscompliance.com

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NCDENR
No— CA OL DevamaFJar of
E—Ror+wur — NRUFAL Resouaoes
Division of Energy, Mineral, and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG180000
FOR AGENCY USE ONLY
Date Received
Year Month
Da
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N C G
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519111 ()
Permit Assi ed to
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NOTICE OF INTENT �°° @�
National Pollutant Discharge Elimination System application for coverage under G`f���rrriity'
ED
NCG180000: JUN 28 2017
STORMWATER DISCHARGES associated with activities classified as:
bENR-LAND QUALITY
SIC" 25 Furniture and Fixtures, and SIC 2434 Wood Kitchen Cabinets, STORMWATER PERMITTING
And, Like activities deemed by DEMLR to be similar in the process, or the exposure of raw
materials, products, by-products, or waste materials.
* Standard Industrial Classification Code
(Please print or type)
1) Mailing address of owner/operator (address to which official permit correspondence will be mailed):
Name
Street Address
City
Telephone No.
E-mail address
MasterBrand Cabinets, Inc.
118 Lexington Parkway
Lexington
336-300-7407
[e-mail]
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
MasterBrand Cabinets, Inc.
Heather Knowles
118 Lexington Parkway_
Lexington
Davidson
336-300-7407
3) Physical Location Information:
State NC ZIP Code 27295
Fax:
State NC ZIP Code 27295
Fax -
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Taking U.S. Route 29 N, take exist to Hargrave Rd.
Continue for 700 ft and take left on Hargrave Ln for 0.3 miles. Hargrave Ln turns into Lexington Pkwy
and MasterBrand Cabinets, Inc. is on the right.
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application)
4) Latitude 35° 46' 51.9" N Longitude _80° 19' 11.4" W (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following:
® New or Proposed Facility
❑ Existing
6) Standard Industrial Classification:
Date operation is to begin
`f
S5 �I
81 q q I -?�)�
. 31 q 91
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 4 3 4
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: The facility conducts woodworking with medium density fiber board to create cabinet
doors.
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NCGI80000 N.O.I.
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 13
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? North Potts Creek
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). N/A
10) Does this facility have any other water quality permits?
x❑ No
❑ Yes
If yes, list the permit numbers for all current water quality permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
® No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
® Yes
If yes, please briefly describe: Good housekeeping, proper disposal of trash, inspections, bring in materials
inside when able, any spills/leaks are cleaned up immediately, and spill equipment are readily available
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
® Yes
If yes, when was it implemented? 6/5/2017
14) Are vehicle maintenance activities occurring at this facility?
® No ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
® No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
0 No ❑ Yes The facility is a CESQG
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
® No ❑ Yes
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NCGI80000 N.O.I.
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored: _
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor: _
Vendor address:
16) Certification:
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 $10,000, 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 $10,000 or imprisonment not more than 5 years, or both, fora similar
offense.)
I hereby request coverage under the referenced General 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.
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: Not, 1Co2 ci,s"
Title: EW
(Signature of Applicant)
6 ZI 17
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included.
Please do not ask us to hold an incomplete application in anticipation of a check under separate cover.
❑ Check for $100 made payable to NCDENR
❑ This completed application, signed by the owner/operator, and all supporting documents
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map
Mail the entire package to:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note: The submission of this document does not _guarantee the issuance of an NPDES permit.
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NCG180000 N.O.I.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
To visit our website, go to http://PortaLncdenr.org/weblirlstormwater
DEMLR Regional Office Contact Information:
Asheville Office..
Fayetteville Office
Mooresville Office
Raleigh Office ...
Washington Office
Wilmington Office
Winston-Salem
Central Office. ..
... [phone]
[phone]
[phone]
[phone]
... [phone]
. [phone]
... [phone]
[phone]
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SWU-233-82814 Last revised 8/28/14

STORM WATER POLLUTION PREVENTION PLAN (SWPPP) SITE MAP
MasterBrand Cabinets, Inc.
118 Lexington Parkway
Lexington, NC 27295
MAP LEGEND
Drainage Features
®= Sampling Locations
® = Outfall
=Direction of Flow
— — = Property Line
Potential Sources of Pollution
y
■ = Uncovered Dumpster
i
Compactor
Covered Dumpster
0 =Load ing/UnloadingArea
t
= Empty Drums
` b
=Scrap Product &Pallets
Obsolete Equipment
■ =Dust Collectors
— -
Structural BMPs
Latitude: 35" 46' 51.9" N
lune
Longitude: 802 19' 11.4" W
2017
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