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Home My WebLink AboutNCG210153_Renewal Application Form_20180619Permit Coverage AG�J Renewal Application Form NPDES Permit Number NCDENR National Pollutant Discharge Elimination System NCS NCG ZIJ 153 Stormwater Individual Permit Please provide your permit number in box in the upper right hand corner, complete the information in the space provided below and return the completed renewal form along with the required supplemental information to the address indicated. Owner Information Owner/ Organization Name: Owner Contact: Mailing Address: Phone Number: Fax Number: E-mail address: Facilitv Information Facility Name: Facility Physical Address: Facility Contact: Mailing Address: Phone Number: Fax Number: E-mail address: Permit Information Permit Contact: Mailing Address: Phone Number: Fax Number: E-mail address: Discharge Information Receiving Stream: Stream Class: Basin: Sub -Basin: Number of Outfalls: RECEIVED JUN 19 2018 tm Facility/Activity Changes Please describe below any changes to your facility or activities since issuance of your permit. Attached a separate sheet if necessary. CERTIFICATION I certify that I am familiar with the information contained in the application and that to the best of my knowledge and belief such information is tr co tete and :'4ccate/ Signature `' Dates' �� Print or type name of person signing above Title SW Individual Permit Coverage Renewal Please return this completed application form Stormwater Permitting Program and requested supplemental information to: 1612 Mail Service Center Raleigh, North Carolina 27699-1612 SUPPLEMENTAL INFORMATION REQUIRED FOR RENEWAL OF INDIVIDUAL NPDES STORMWATER PERMIT Two copies of each of the following shall accompany this submittal in order for the application to be considered complete: (Do not submit the site Stormwater Pollution Prevention Plan) Initials 6-4 1. A current Site Map from the Stormwater Pollution Prevention Plan. The location of industrial activities (including storage of materials, disposal areas, process areas and loading and unloading areas), drainage structures, drainage areas for each outfall, building locations and impervious surfaces should be clearly noted. Nor ZejuJ2. A summary of Analytical Monitoring results during the term of the existing permit (if your permit required analytical sampling). Do not submit individual lab reports. The summary can consist of a table including such items as outfall number, parameters sampled, lab results, date sampled, and storm event data. Js"L— 3. A summary of the Visual Monitoring results. Do not submit individual monitoring reports. The summary can consist of a table including such items as outfall number, parameters surveyed, observations, and date monitoring conducted. A summary of the Best Management Practices utilized at the permitted facility. Summary should consist of a short narrative description of each BMP's in place at the facility. If the implementation of any BMP's is planned, please include information on these BMP's. �dGj+ A short narrative describing any significant changes in industrial activities at the permitted facility. Significant changes could include the addition or deletion of work processes, changes in material handling practices, changes in material storage practices, and/or changes in the raw materials used by the facility. 6. Certification of the development and implementation of a Stormwater Pollution Prevention Plan for the permitted facility (Sign and return attached form). If the final year analytical monitoring of the existing permit term has not been completed prior to filing the renewal submittal, then the last years monitoring results should be submitted within 30 days of receipt of the laboratory reports. (i.e. do not withhold renewal submittal waiting on lab results) Google Maps Go gle Maps Page 1 of 1 Imagery ©2018 Google, Map data ©2018 Google 200 ft https://www.google.com/maps/@35.9079374,-79.7075859,708m/data=!3ml ! le3 6/15/2018 Google Maps Go gle Maps Page 1 of 1 C5 �m Z M ca M p ti LO M 6� Imagery ©2018 Google, Map data ©2018 Google 200 ft https://www.google.com/maps/@35.9079374,-79.7075859,708m/data=! 3ml ! 1 e3 6/15/2018 13% CO's: 3397 CV o -----,\`•, - _ .. _/ _ `'\�.\�-,�- ql t �' /'fir �; til q - _ - , ___ •I• \ \G �, _ .�//��•�- •i' �--i L� 3395 J ASO �_ a/ i' •- - �•� _ �f, 474 /j, _ y /`�_�/jam'• - -` 3 96 '• �:f0; - Gr9 �. % j (. - �� Quaker cP SM 7971 Lake •� J St John. 22 = OUTFALL - ._ ,�{ ` • •II:' INDUSTRIAZ WOOD PRODUCTS SM at Li `�•. T �• �i _ „ Subst tion � .3400 � i • X383 - GUILFORD CO 33�a i�l '1 \ _ ;'- . , • / m ,� ' II Ac'DOLPH - - I max2• "- ,,�---�-•-- 3 5 ° 5 4 ' 2 3 " �' V ` � �� ; 22 �a : � - i5c 0 r •�- . i 3380 2 1509,11 41 1V325 - i.�; �� o.. . �J - ems._ I T. J'- =W0, c� 1767 CLIMAX. N. C. N3552.5—W7937.5/7. 5 1970 Ila DHOTOREVISED 19E, If .'\.• 1 DMA 5055 1 NW-SERIES V842 r . ; , ( - Dug. USGS Name: TOPOGRAPHICAL MAP No: FACILITY LOCATION • �_-� Ir�� . � �l ,.,. 7 �_�J Sheet scale Rev_ �\ • 1 e ;� _ ' -- - _ -sue -. � _ ( 0 � 339 eo II .�` _ �_ 769;�- _ co 3397 N 79 = 01A • \�•\-. � � _ � �. `_ate - - �� _ �_ / I • \ r �� . _ // � �,-� � � 3395 j -iso , • i' , , ' OG 7 t _ /• , _ pyo - �3 6 = � - -^� A •• •• � � & ' /ems -.- � ��-_� •� � � _ `� -�• i; 3470• 0. / I .i I Quaker 19 '_ �• ,� �/ ' / L -BM 797 cA Lake �;• -- ` _800 8 - / II l - St '/� •G ' �': OUTFALL #1INDUSTRIAL WOOD PRODUCTS • •`�_ --BM 6"•. •8� l\\ X825 a. -Subst tion � 3400 - ' /3MI'/ �- , `:;�-f� _• .o,_ � 1 -_'�� \_ "`�. _ GUILFORD Co 3334.�� 1` •) _ ,�' j - A-'DOLPH m J I e r' S Co _`m\ �iima`:2• a�' t.. zz lit - �, _ t 1, �,; •.--"•' + � � J CLIMAX. N. C. N3552.5—W7937.5: 7.5 1970 HOTOREVISED 19E, n' " ��\ \ • _,=� \ • i DMA 5055 1 NW -SERIES V842 !� (��✓ owg. USGS Name: TOPOGRAPHICAL MAP `' ;,• �_ �? No: FACILITY LOCATION Sheet Scale Rev. L`'�"`_y.�l I � •-nen..,. `3 �,`;"/-�`{Vi--��' 06/15/2018 Addendum to Storm Water Permit. Item #3 Visual Monitoring Results. All taken from outfall # 1. Monitoring dates were 04/26/17 and 12/20/2017. Surveyed were; Outfall Description, Color, Odor, Clarity, Floating Solids. There was no foam or Oil sheen. There was some evidence of erosion of the outfall. Samples were kept. Item#4 Best Management Practices. All operations are connected to Cyclones and sawdust is collected in trailers by an outside Contractor. Sawdust is removed and sold by contractor. Any sawdust that falls on the ground is placed in a collection bin by a maintenance person that maintains all the grounds. Unsold sawdust is disposed of by the contractor. SWPP is reviewed annually during safety and health meetings. We did construct a new building in March 2017, at the recommendation of our last inspector, to cover extra equipment. In November of 2017 we constructed a new outfall. Item #5 Significant Changes. No changes in work in process or raw material storage. 06/15/2018 Addendum to Storm Water Permit. Item #3 Visual Monitoring Results. All taken from outfall # 1. Monitoring dates were 04/26/17 and 12/20/2017. Surveyed were; Outfall Description, Color, Odor, Clarity, Floating Solids. There was no foam or Oil sheen. There was some evidence of erosion of the outfall. Samples were kept. Item#4 Best Management Practices. All operations are connected to Cyclones and sawdust is collected in trailers by an outside Contractor. Sawdust is removed and sold by contractor. Any sawdust that falls on the ground is placed in a collection bin by a maintenance person that maintains all the grounds. Unsold sawdust is disposed of by the contractor. SWPP is reviewed annually during safety and health meetings. We did construct a new building in March 2017, at the recommendation of our last inspector, to cover extra equipment. In November of 2017 we constructed a new outfall. Item #5 Significant Changes. No changes in work in process or raw material storage. STORMWATER POLLUTION PREVENTION PLAN DEVELOPMENT AND IMPLEMENTATION CERTIFICATION North Carolina Division of Energy, Mineral, and Land Resources - Stormwater Permitting Facility Name: Permit Number: Location Address: County: "I certify, under penalty of law, that the Stormwater Pollution Prevention Plan (SPPP) document and all attachments were developed and implemented under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information required by the SPPP. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information gathered is, to the best of my knowledge and belief, true, accurate and complete." And "I certify that the SPPP has been developed, signed and retained at the named facility location, and the SPPP has been fully implemented at this facility location in accordance with the terms and conditions of the stormwater discharge permit." And "I am aware that there are significant penalties for falsifying information, including the possibility of fines and imprisonment for knowing violations." ISign (according to permit signatory requirements) and return this Certification. DO NOT I SEND STORMWATER POLLUTION PREVENTION PLAN WITH THIS CERTIFICATION. Signature -76 � , -1-?, 6 : � Print or type name of person signing above Date %,//�� 1l AWS Title SPPP Certification 10/13 STORMWATER POLLUTION PREVENTION PLAN DEVELOPMENT AND IMPLEMENTATION CERTIFICATION. North Carolina Division of Energy, Mineral, and Land Resources - Stormwater Permitting Facility Name: Permit Number: Location Address: County: "I certify, under penalty of law, that the Stormwater Pollution Prevention Plan (SPPP) document and all attachments were developed and implemented under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information required by the SPPP. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information gathered is, to the best of my knowledge and belief, true, accurate and complete." And "I certify that the SPPP has been developed, signed and retained at the named facility location, and the SPPP has been fully implemented at this facility location in accordance with the terms and conditions of the stormwater discharge permit." And "I am aware that there are significant penalties for falsifying information, including the possibility of fines and imprisonment for knowing violations." Sign (according.to permit signatory requirements) and return this Certification. DO NOT SEND STORMWATER POLLUTION PREVENTION PLAN WITH THIS CERTIFICATION. Signature / 3kN2 z L �cLf l Print or type name of person signing above Date Title SPPP Certification 10/13