NCS000536_APPLICATION_20180215

STORIVIWATER DIVISION CODING SHEET
PERMIT NO.
DOC TYPE
❑FINAL PERMIT
❑ MONITORING INFO
7-APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ 70I�OZ I5
YYYYMMDD

Energy, Min eras &
Land Resources
ENVIRONMENTAL QUALITY
February 15, 2018
Mr. John Sich
FloorzazzoTile, LLC
215 W. Third St
Siler City, NC 27344
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
WILLIAM E. (TOBY) VINSON, JR.
lnterlm Director
Subject: NPDES Stormwater Permit Renewal
Floorzazzo Tile, LLC
NPDES Individual Permit No. NCS000536
Chatham County
Dear Mr. Sich:
Your facility was covered for stormwater discharge under NPDES Individual Permit NCS000536;
however, this permit expired on November 30, 2015. To assure consideration for continuing coverage
under your permit, you must apply to the Division of Energy, Mineral and Land Resources (DEMLR)
for renewal of your permit.
Enclosed you will find a permit Renewal Application Farm, Supplemental Information request, and a
Stormwater Pollution Prevention Plan Certification for your facility. You can also find this information
on our website: https:/ldeg.nc.gov/about/divisions/energy-mineral-land-resourceslnpdes=industrial-
stormwater. Submitting the application form along with the requested supplemental information will
constitute your application for renewal of this permit. Until your permit renewal is completed and you
receive a new permit, please continue to comply with all conditions and monitoring requirements in
your expired NPDES stormwater permit.
Please submit the application and supplemental information to DEMLR by March 31, 2018.
Discharge of stormwater without coverage under a valid stormwater NPDES permit constitutes a
violation of N.C. General Statute 143-215.1 and may result in the assessment of civil penalties up to
$25,000 per day.
State oFNorth Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street 11612 Mail Service Center I Raleigh, North Carolina 27699-1612
919 707 9200

If you have any questions concerning this permit renewal, please contact Julie Ventaloro at telephone
number [phone] or by email [e-mail].
Sincerely,
C&VoAa CA>
Annette Lucas, Supervisor
Stormwater Permitting Program
cc: Central Files
Stormwater Permitting Program Files
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street 11612 Mall Service Center I Raleigh, North Carolina 276991612
919 707 9200

KC-5CW 53cp ILOV5E-4
Please print or We in the urW mKW arms only. � Form Approved. OMB No. 204GMW.
FORM
U.S. ENVIRONMENTAL PROTEC
AG
I. EPA I.D. NUMBER
EPA GENERAL INFORMA
V.
Consolidated penults P
�y
GENERAL
(Read the "Generulltutrrrcrlow"be
g.) xy
LABEL ITEMS �/ T I�
�rO6 V- el �� r) L
go 11 ti' GENERAL INSTRUCTIONS
label rwa her+ okin ca W.aft Y in the
y� I e p+eWWWW Review Its t.ly; if cry or It
i qsa
L 14114 S' 1 �°°O
InowrecY, awe 4uou{js C anti arbr the rivretl tleL In tlw
I. EPA I.D. NUMBER O Wasse Ili
T
r s W /�W-sr
area below. Also, if any al the ProDIs led data
dw
III. FACILITY NAME PLEASE PLACE LABEL IN THIS p p oar That sohW.W p . le firs robot apes e P W
b co p� it in aw proper
V. FACILITY MAILING s.% Cr NC �
area(s) below. e and v� you
7 � not oanplets Altars I, III, V. and VI (axaape vi-a »mar
t ,+icomoce
�
ADDRESS l
Q Z be Can~ ropa�aa). Cempleta d items If no label
�} is been pr beovides. Rehr lo lha loslfudlom for detailed item
VI. FACILITY LOCATION
desorlpeorw and for toI"al aulhortratbns wxler whleh Ws
date IS collacled.
It. POLLUTANT CHARACTERISTICS
INSTRUCTIONS: Complete A through J to determine whether you need to submit any permit application forms to the EPA. If you anew w •yes" to any questions, you must
submit this form and the supplemental form Bated in the paraMhesis following the question. Mark Win the box In the third column 0 the supplemental form Is attached. If
you answer "W to each question, you need not vAwdt any of these forms, You may answer "no" if your activity Is excluded from permit requirements; see Section C of the
instruction . See also, Section D of the instrud}oru for definitions of bolddacad tsin
wd
•x'
wnr
•)r
YES
NO"M
ATTACHED
SPECIFIC QUESTIONS
rEe
NO
FORM
ArF
SPECIFIC QUESTIONS
A. Is this facility a publicly owned troabnemt worsts which
B. Does or will, this facility (either adsMg or proposed)
results In a discharge to welters of the U.S,? (FORM 2A)
Inciude a conceritratad animal feeding operation or
aquatic animal production faclAty which results in a
+a
n
+.
discharge to waters of the U.S.? (FORM 2B)
C. to this a facility wNch currently results In dlschargw_to
D. Is this a proposed facility (other fhan Unse doscdbod In A
waters of fM U.S. other than ihoea described in A or B
or 6 above) which will result In a discharge to watws of
above? (FORM 2C)
a
a
y
tits U.S.? (FORM 2D)
a
a
n
E. Does or will Uds facility tract, store, or dispose of
F. Do you or will you inject at this fac[iily Industrial or
hazardous wastes? (FORM 3)
municipal effluent below the lowermost stratum
containing, within one quarter mile of the well bore,
underground sources of drinking water? (FORM 4)
„
S
b
a
20
'0
O. Do you or will you inject at this fadllty any produced water
H. Do you or will you Inject at this facility fluids for special
or other fluids which are brought to the surface in
processes such as mining of sulfur by the Frasch process,
connection with conventional oil or natural gas production,
solution mining of minerals, in edu combustion of fosall
inject fluids used for enhanced recovery of oil or natural
fuel, or recovery of geothermal energy? (FORM 4)
gas, or inject fluids for storage of liquid hydrocarbons?
(FORM 4)
er
x
s
A
>•
s
I. Is this foo ty a proposed stationary source which is one
J. Is Uds fadMy a proposed stationary aauree which Is
of the 28 industrial categories listed in the Instructions and
NOT one of the 28 lndustriai categories listed in the
which will potentially emit 100 tons per year of any air
instructions and which will potentially emit 250 tons per
pollutant regulated under the Cleen Air Act and may affect
year of any air Pollutant regulated under the Clean Air Act
or be located In an altainmerd area? (FORM S) c
and may aliad or be located in an aftatnment area? n " a
(FORM 5)
Ill. NAME OF FACILITY
sx,P IF Z OvRR-z-D LC UGC
1V. FACILITY CONTACT
A. NAME 9 TITLE (tart, fmi, dr title)
B. PHONE (arcs .de & nu J
2
/+
C P r ��N�
r,
�"1��
a 145 41140 s, 1151. m
V. FACILTY MAILING ADDRESS
A. STREET OR P.O. BOX
3 1 Y# 25 5
B. CITY OR TOWN
C. STATE D. ZIP CODE
4 �(:,e c y
J73yy
also
401 41 a 1,07 a
VI. FACILITY LOCATION
A. STREET, ROUTE NO. OR OTHER SPECIFIC IDENTIFIER
6 �� w r >� r,e D S FE
15 +6
d
B. COUNTY NAME
CitArifA-M
M
1u
C. CITY OR TOWN
D. STATE
E. ZIP CODE
F. COUNTY CODE (rfbrown)
BSA
ceR Crt�
a�73gy
+a
iso
a u
a at
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EPA Form 3510-1 (a-w) CONTINUE ON REVERSE

CS Ales � �i i ✓d 51rL Sr f ✓ C y
NC a 73 yy
�A d} Phenlbm (ygpyAam lLsra f of Form Form Appeorad OMB NIL 4R40� M
m In do unelhaded areas d3t-2
U.S. t rnArarhmm W P.dmC yo Agemy
AwlEPA
ZF Application for Permit to Discharge Storm Wafter
e Disc Associated with industrial A
Paperwoeft Reduction Act Motley
Puma mpyr" hurdeo fru oft appdoWlon is a to avem" MS hams par appRmd 11 time for mvkmft bMSVucdyrs, semtldrrg ardrttlrq data emnoms,
g and nshhfai I G the date +reedad, add am oefhro and rags the adWcUmu cf itt m=Mk n. Sand oatm mft ram Be &ff*m eathrhaes, arty arum ampec
d two
a t> om d iffic mbar. a asp�dlyahs hrr ire�uoMrrs t#ds lorrr4 hhrirrcrhs somata wfdah rrrsfr hhonease ar raduhoe tub burden bx Cute! lnfmrasdorh PdbY
Branch. PM-223, U.B. aMrannmM ftftcdon Agmmy, I= Pm Wvartia Amp^ NW. Waahbticn, DC 2MM, or f]mAm. OR* d lfo=Wjmh and etaWftM
AIM% ORfoe es hftmgmnmd and Mqd Wasfdrrsmn, aC 20M.
For aadh andf d Rat the hrWrde wid lmgihrda d Rs IyCatian tothe .vem 15 aenords and Um name al the wAtsf
A. Ouft Nwneer a Ric A 1Rtrder
EL c
) r
i
. InlproY�9rrleiir�
A. Are you now n qubad by mhy FadmaL Stft or taem stOm y to mast any molmnadtRian admdr,te for the avatrudlem UPW&ft or opma0oa d rhhastarrmer
hemba m egrdprrrerrt or praWaes m any noes pragrmne rdrich may mesa the dbdhmpae desolbed In 26 4pdmdm.7 Ttds h+abdoo ere fs net Rralted
to, permit condClons, adit affm or mrfaoemeM alma mrfaamnent oompdmma earodule leltms sdpddbm caul ardma and grard or fame =mMImm
2. Affeded Ordkft 4. f�
1. k mhdda Rmn d CadHo tide
� number acmes d 3 Doafptfon Yrvjea a e
LE
,� rt r / ✓t
B: You may altach a shams deso111 g m V a wdw paCL6m (or ad mmrviroro mM praimb Mid r may aced yoacdbchmges) ym new harm Loofah
way arwhidh you plan. tre[f r o k wfwgtm each pmgrmru fs nar mslmway or ptemred. dad hrdirmte yme arbW (F ptmared srbedhdes ftw am &uct an.
M. mile Dmkwp Nup
Affadh a ells map athoa I typography (yr Wa2ca bug the mddrm of dnmmge aaeae served by the ourtlmle(s) co+hehed In the appRrwROrh R e tapogrepadc map is hslahheRable)
depiaing the fadiNy bckm2V each of Is kftm and dbdwp sbuctmee: the I I mge area cf each elms wudm od*. paved areas end DuHttp wMM tlm drabuW
am of each dam water otdfd. each known pot or prasmd mom used for cuebdoyr skmW of dhapumd d a4 idemht rrsbmtafa. am* a- 14 H g soucltsal earshot nmasme
to reduce pdhftrab fn alarm water m mu. madale trading and a mess areas, areas whore pew, hmMddys, =8 oyrhhNonms and fmtRams we applied: each of
ft heam Omz waeta tremnlmd. etonw of dbpyem mole (bhaktdv each see not raqubmd to have a RCRA pasta wfdd is used fbr eoamr<dadnp hum 2m waste
urAw 40 CM MZ34);each wM whmw 9aaida tmm the fmioty are humded uud corer swfaca waw, fradl, wtddh tamived sums warm dfadmran
hamthefaaty. ...... 4% 43 =-Zf
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ConUntred from Paw 2 1
EPA ID Monber(*Wf Mlftm 1 ofFOM 1)
VILDIschalwlntomawn
A. % C. a Ix sae hmtnrc6m berera offing CanVbft ant ad of tsb a for eed, aatea Ammtft spo a" epee ppaoa
VIF2
Table VIM.t3 Ve . Vtl-C a,e i,tritrded as sapa a al,eela raatd,ere Yl-t and
ee a r /J[* C •� ►+tir ry M 1
E PoterAW He g no! oa�erad by anetyate _ Is any toAc pa kdM Mod In tuft 2F-2, 2FA or 2F-f, a subataree at a co,rgrore,rI of a ■riaferroe which you
cuien4y ust or memdacbua as an trdern a Be 0 arEnel podod OF byp edLed?
❑ Yes (pat a@ $ad, pofhdsnts bdMO No (gt fo S^GM DO
II. Bld"ical Taxi ft TOWN Data
De yw tmra any larI 1 19, or amp to hea , two" tact far adee ar drsarde tm :Iiy hm teen ms>I ar wW of ym dlsahsgas cr on a seoshfn0 w%ft in
MtO& n W y= dWchoW wlW the last 3 pours?
El ye. um es sra) pamdentabobo No (Oo to sass m
DL Contact Ana"Is �
V the am of the grab= n*or ad In Nam VO pmftmned by a wr I ad tabmdOry or c=mMM flan?
+� Yes (93t the nwm MOM= and taf4phone atx,drer of andpdhdw a No (go to serllanA)
am* such or&m
A. Name
B. Address
C. Area Code & Phone No.
D. Pdkdw is Anobmod
C4 tilerv� %sf%�
oil S s �� S `
g !�-ate -
5 / re Pt,-' CV
Ser✓lCD/ 7-IC,
c� n �i� /UlJ
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rss
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X. Certtcaftn
t cw* wWtrpvmW d law VW ft doamrefd and aff atf7anen0 warm prepara0 raderrny I s c fiat ora pwvtdw in aaoardar,os we a syafam d*,ed to aasrae
RWqua6liedpanmrnafpmVpeNy anderaemfethebdan,retbr,u*mttmdBasedcnayiaprfyofthepw=arpeno wafrore1 m theayafarr,arlhoaego so s
d rocW mapansM fbr gathe ft fhe hdar,rmaani u,e brthrmetfan ara3vnrZfed i� m the best of my fs,ondecn s arrd bedr4 tenet aartaafai and f am aware d er
teem rot aperrafflea fbraudraiftkrgfdse hdbrrrreflarL tnr2urArrg theposst�rofttre a,rdfiopdsarrrsrrt fbrl�r,arfrg rioretions
A d, OMdd T OD (I)Im Crfi *
S-©ti� SL�u o��
B. Area Cade arrd Phan No.
q �a- -1 a
C.
a. Dada Sigrid
7 —23-2,6 ra.
EPAr 3510-2F (14M Paps 3 d 3

EPA M Nmrbw (Cagy f}om Them ? Of Form 1)
Form Appmvod OMB N0. 2040-DOW
appowd expires 5-31-22
VIL Discharge 1nfbnnaftn (Condmmd from page 3 of Arm 2F)
Part A — You must x the results of at least one for In ft hdft Compkft ono fable foreadr a ftL Soe irAbucft s for adm w►al dsta t
Pdhdmd
and
C,AS N mrbm
(d1
MMdnum Vahan
Average Values
lfurrrper
a!
+gym
Em
Sampled
Sams of perIIrdarus
Chap sm"
Twmn omtng
Fiat 20
16rurtas
Fb-VVaWted
Grab ganrpla
Takhar Durtrn
Flint 20
Mheutes
Fbw4VeW W
ou and Gmese
WA
Bidogical Oxygart
Demand
chwrkdoxmm
Demerrd =D
C
o L
N4 e 7
sTOW
rr� er✓�
f
Totei Amrrgen
1
TOW Phosphonre
pry
mbimum
Mmdnaan
LV,* ma
lMmdmm
Part 8— Ud each pa4erJarrt fhei is limited in an elNmd pdde3ne wIdd the be ty is-dtJer! Lo or mry pIN to I gsftd is tpe bmWe MPM pema far qa Pam=
wrasteirm&ff ¢f Me tardy is apareting carder an er I tirp NPES pamt� Campleta acre fable far each ouffA Sae the hw7rrrrYioro for add4lorad doMft end
Palm m
Wd CAS Number
PfaeskecleJ
Mwbmpa Values
unft
Avmage Vahree
Number
5t f
ewaft
Somaes of Pogatwb
Gmb S-Aps
Tef In ouebeg
Alban
Fto&Wdgt+ted
Grob Sempb
T Fast 20 g
Mbwrtes
Fbw4Vdgtftd
ern
EPa Fomr 361a 7F {1-6¢1 Page V{�1 Coon= on Raw"
M

r mTKnued frmn the Front
Part C - list each pollutant shorn in Table 2F-Z, 2F-3. and 2F4 Mat You know or have reason to beHave Is pwm Sae the hubuatians Tor a*fi lmnal detab and
rerrarrft one tale for each au w
Pollutant
and
CAS Number
(if ev"a le)
lrtmdrnum Values
urdw
Avw pe Vakms
rrrknde
Number
of
Storm
Events
Sampled
Sources of Poputands
Grab Semple
Taken During
First 20
Minutes
Florr-Weiglted
Glib Sangria
Taken During
First 20
tdernte3
Fim-Wakhted
P I
a•/�
INt r r
�j
v► Z'
GY
Pat D - Pratte data far the strum s wWch rewMad in Me mmdnwm value3 for the tbw
1.
Data of
Storm
Evert
2.
Duration
of Storm Event
All minutes)
3.
Total rainm
during storm event
(n fndresl
4.
Number of hoes bahveen
beginning of storm measured
and end of previous
measurable rain event
S.
Mwdmum flow rate during
rain evert
(gafla orr(rrras or
4peoty
B•
Total flow from
rain event
080ons craxw*Y ur"
% f
�
O. /e--r-`/h��r1
jziy /0"V3
GCh /�►�✓.�
(.fin kn,#► 4
7. Provide a daaai)flon of the method of flow measurement or estimate.
Gp^a� 54 ��olrs ✓ 5— O K� l� , / /Al,, w
7 MePA,SorRCLk��TA
S e- 4-4, 41el ^ram 6ot4 7�'✓ /C� !t°� �f �rPr-Hs
EPA Farm 35142F {14M Pegs VII-2
do

nONTINUErh FROM THE FRONT
Vtl. SIC CODES (4-dgit in order of
A. FIRST B. SECOND
'
co)
�4 rru r F/
,
(specify)
/N
.� jr1 ,.+-
C. THIRD
D. FOURTH
'
, (specll')
4
N
IV
VIII. OPERATOR INFORMATION
A. NAME B.Is the name Gsled in Item
VIII-A also the owner?
e 1. 00 AW ex�O �Lt' GKIES13HO
m w
C. STATUS OF OPERATOR Enter the aAwopridiv Jean into the answer box. t "Orker. "3pecyyj D.
PHONE (mca code & no.
F FEDERAL
S c STATE M n PUBLIC (other than fedem! or erase)
0 OTHER (spec fy)
r
4
1 j 3 1 r
14 10
P Is PRIVATE
m
E. STREET OR P.O. BOX
al STRD $
a m
F. CITY OR TOM O. STATE H. ZIP CODE IX. INDIAN LAND
B
5 t- ►2 G
N G
7 3 Y y IsthheEfaadiity located on I di lands?
KWO
X. EXISTING; ENVIRONMENTAL PERMITS
A. NPDES PILaF to 5 ace Wafer D. PSO Air Emis9iona Pro ed Sources
9 N B P p rl
B. U1C odor nd l ecrton Fluidr E. OTHER t
fJpedfy)
9 U
9UJ
e
C. RCP rTLdpq Wcutea E. OTHER LVd
fiper6)
a
rt
v �1 9
N
IS
is v
is 301 ,e w 1 17 u
s
XI. MAP
Attach to this application a topographic map of the area extending to at least one mpe beyond property boundaries. The map must show the outline of the fadiity, the
taeatlon of each d Its ehdstlng and proposed Intake and discharge structures, each of its hazardous waste treatment, storage, or disposal fadlitles, and each well where H
injeds fluids underground. Induce all springs, rivers, and other surface water bodies In the map area. See instnxlions for precise mquiranents.
XII. NATURE/ OF BUSINESS a bria/dsscrf on
�lODta�ty %ry /' -4Aw /cA,deeS' A 41t-je �Ot le, -in �vtu.irl! Cltr�
'mAr
AW) ea'.- w' ew ,p0� Ps r frss'n /'G✓r lei") 5ty,rr�>+. D,v 51)'we 1047V_
,
Trr�.�
��oa>ra 71,• s �f� s M/
rev
�t �.✓,G
f�! H'T�n w Dl � ,�y ,
�Y}I/lr+ftr�N f�Ihgf7 /✓ IYIYSS a 79e �4.tS iN[�7v.s SIT!.
XIII. CERTIFICATION (sea lngrudons)
l caWy under ponalty of law Chet ! have personeffy axamined and am hadlar with fhe krfa moon &&MWed in 09s eppikeSwr and all attedwmis and fhak based cn my
inquiry of those persons irrrnsdaf* respwrsibie for obtatrrfrg fAs lydonnadon contained in the applkalton t believe NW the irdbrm Lbn is true• ace refix and oWWWO. l
am aware that there are OvOcant penalties for submitting false inlwmetion, indudog the possibtty of Noe and fnrprisortmem
A. NAME & OFFICIAL TITLE (type orprim)
B. SI RE
C. DATE SIGNED
T(ivA S�t✓�t PhQ_;
COMMENTS FOR OFFICIAL USE ONLY
c
C
EPA Form 3510.1 W90)

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Parcel Number; 81468 Dead Book: 486
CHATHAM COUNTY, NC Map Number. 8761-18-6568.000 Deed Page: 0196
Owner Name: WREN INDUSTRIES INC Plat Book:: 2002
Owner Address: P 0 BOX 447 Plat Page: 0419
Propeq Map Owner City: SILER CITY Deed Acres: 3.301
Owner Address: Physical Address: 229 W THIRD ST
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Owner State: NC Improvement Value: 193199
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Pamxl Number. 61468 Dead Book: 486
CHATHAM COUNTY, NC
Map Number: 8761-18-6568.000 Deed Page: 0195
Owner Name: WREN INDUSTRIES INC Plat Book:: 2002
POwner Address: P O BOX 447 Plat Page: 0419
Property Ma
p r t P Owner City: SILER CITY Deed Acres: 3.301
1 — ldillw Owner Address: Physical Address: 229 W THIRD ST
/r i Tr. dm° av W dd.l� M MPWW 1W m. ►tea m la W"" fmm wm,a Owner State: NC Improvement Value: 193199
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CHATHAM COUNTY, NC Parcel Number. 61468 Deed Book: 486
Map Number. 8761-18-GMB.000 Deed Page: 0195
Owner Name: WREN INDUSTRIES INC Plat Book:: 2002
Property Map Owner Address: P O BOX 447 Plat Page: 0419
Owner City: SILER CITY Deed Acres: 3.301
Owner Address: Physical Address: 229 W THIRD ST
�81 i dmnr melded on mr m.v Q. n,. m mn.r w.a.ny �,m wm a, Owner State: NC Improvement Valle: 193199
CrMUM. C *, WCand.. coma ftm recorded F1m, Rode, WO UUW albk roam Owner Zip: 27344 Land Value: 99030
. � w w6 " Description: SC-109 E 3 Fire District: 202 One Inch = 2305 Feel
Township Code: 10
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