NCG030654_COMPLETE FILE - HISTORICAL_20170411

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
Iv C,,& 0 3 D �l�I
DOC TYPE
VHISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ d-o l 7 o "! I f
YYYYMMDD

Energy, Mineral &
Land Resources
ENVIRONMENTAL QUALITY
Mr. Byron Bellman
General Dynamics
3801 Boren Drive
Greensboro, NC 27407
Dear Mr. Bellman:
April 11, 2017
E CI,
ri'E'-_ <j IiE U
APR 18 1;917
ROY COOPER
Governor
MICHAEL S. REGAN
Secremry
'RACY DAVIS
Dineaor
Subject: Rescission of NPDES Stormwater Permit
a� ttii•�'- Certificate of Coverage Number NCG030654
E;
z1r"-Its' `Cxatawba County
On January 6, 2017, the Division of Energy, Mineral and Land Resources received your request
to rescind your coverage under Certificate of Coverage Number NCG030654. In accordance
with your request, Certificate of Coverage Number NCG030654 is rescinded effective
immediately.
Operating a treatment facility, discharging wastewater or discharging specific types of
stormwater to waters of the State without valid coverage under an NPDES permit is against
federal and state laws and could result in fines. If something changes and your facility would
again require stormwater or wastewater discharge permit coverage, you should notify this office
immediately. We will be happy to assist you in assuring the proper permit coverage.
If the facility is in the process of being sold, you will be performing a public service if you would
inform the new or prospective owners of their potential need for NPDES permit coverage.
If you have questions about this matter, please contact us at 919-707-9200, or the Stormwater
staff in our Mooresville Regional Office [phone].
cc: Mooresville Regional Office
Stormwater Permitting Program
Central Files - w/attachments
Sincerely,
Original Signed By
Bethany Georgoulias
for Tracy E. Davis, PE, CPM, Director
Division of Energy, Mineral and Land Resources
Nothing Compares�,
State of North Carolina I Environmental Quality i Energy, Mineral and Land Resources
512 N. Salisbury Street 1 1612 Mail Service Center I Raleigh. North Carolina 27699-1612
919 707 9200

i
M florrdv �rf'c.. - Za�•.d kk,,�.v
-AG" FA�
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Mohammad Karimi
General Dynamics
1500 Prodelin Drive
Newton, NC 28658
Dear Mr. Karimi:
'AVISION UIF LAN0 HESWSIMn E. Skvada, III
'AND QUALITY SECTION Secretary
December 2, 2014
DEC 0 5 2014
�t�:rnri r,ntt� k r
Subject: General Permit No. NCG030000
Republic Services of North Carolina
COC No. NCG030654
Catawba County
In accordance with your application for a discharge permit received on November 4,
2014, we are forwarding herewith the subject certificate of coverage (COC) to discharge under
the subject state — NPDES general permit. This permit is issued pursuant to the requirements of
North Carolina General Statute 143-215.1 and the Memorandum of Agreement between North
Carolina and the US Environmental Protection Agency dated October 15, 2007 (or as
subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon
approval of the Division of Energy, Mineral, and Land Resources. The Division of Energy,
Mineral, and Land Resources may require modification or revocation and reissuance of the
certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Energy, Mineral, and Land Resources, the Coastal Area
Management Act, or any other federal or local government permit that may be required.
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://Dorial.nodenr.org/webAr/
An Equal Opportunity 1 Affirmative Action Employer — 50.% Recycled 110°% Post Consumer Paper

10-5
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone
number [phone] or by email 'ulie.ventaloro cdenr. ov.
Sincerely,
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central. Files
Stormwater Permitting Program Files

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCENViSION Ut. LAW MQZ0Uurr4.,L
+ AND QUALITY SEGO"
-.rne•ir rrv"
GENERAL PERMIT NO. NCG030000 DEC 0 5 2014
CERTIFICATE OF COVERAGE No. NCG030654
JC#'Hf�+mGtiv1 k.wrir%mrAtt
AND NAB
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
General Dynamics
is hereby authorized to discharge stormwater from a facility located at
General Dynamics
1500 Prodelin Drive
Newton
Catawba County
to receiving waters designated as UT to Smyre Creek, a class C water in the Catawba River
Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, and IV of General Permit No. NCG030000 as attached.
This certificate of coverage shall become effective December 2, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 2, 2014.
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

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NCG030654
N
W. E
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Map Scale 1:24,000
M
General Dynamics
General Dynamics
Latitude: 350 38' 58" N
Longitude: 810 12' 07" W
County: Catawba
Receiving Stream: UT to Smyre Creek
Index No: 11-129-5-4-1
Stream Class: C
Sub -basin: 03-08-35 (Catawba River Basin)
Facility Location .

W"V,
Permit Number NCG030654
Program Category
NPDES SW
Permit Type
Metal Fabrication Stonnwater Discharge COC
Primary Reviewer
julie.ventaloro
Coastal SWRule
Permitted Flow
Facility
RECEIVED
DEC 0 8 2014
CENTRAL FILES
OWR SECTION
Central Files: APS ____ SWP _
12/2/2014
Permit Tracking Slip .
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
COC
Permit Contact Affiliation
Facility Name Major/Minor Region
General Dynamics Minor Mooresville
Location Address County
1500 Prodelin Dr Catawba
Facility Contact Affiliation .
Newton NC 28658 Mohammad Kadmi
1500 Prodelin Dr. .
Owner Newton NC' '28658
Owner Name Owner Type
General Dynamics Non-Govemment
Owner Affiliation ..
Mohammad Kariml
1500 Prodelin Dr
Dates/Events Newton NC 28658
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
12/2/2014 11/4/2014 12/2/2014 12/212014 10131/2017
Regulated Activities Requested /Received Events
Metal products manufacture RO staff report received 11W/14
RO staff report requested 11/19/14
Outfall 001
Waterbody Name Streamindex Number Current Class Subbasin
Smyre Creek 11-129-5-4-1 C 03-08-35

T
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG030000
CERTIFICATE OF COVERAGE No. NCG030654
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
General Dynamics
is hereby authorized to discharge stormwater from a facility located at
General Dynamics
1500 Prodelin Drive
Newton
Catawba County
to receiving waters designated as UT to Smyre Creek, a class C water in the Catawba River
Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, and IV�of General Permit No. NCG030000 as attached.
This certificate of coverage shall become effective December 2, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 2, 2014.
for Tracy E. Davis .E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

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NCG030654
N
W E
S
Map Scale 1:24,000
General Dynamics
General Dynamics
Latitude: 351 38' 58" N
Longitude: 811 12' 07" W
County: Catawba
Receiving Stream: UT to Smyre Creek
-Index No: 11-129-5-4-1
Stream Class: C
Sub -basin: 03-08-35 (Catawba River Basin)
Facility Location

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Mohammad Karimi
General Dynamics
1500 Prodelin Drive
Newton, NC 28658
Dear Mr. Karimi:
John E. Skvada, III
Secretary
December 2, 2014
Subject: General Permit No. NCG030000
Republic Services of North Carolina
COC No. NCG030654
Catawba County
In accordance with your application for a discharge permit received on November 4,
2014, we are forwarding herewith the subject certificate of coverage (COC) to discharge under
the subject state — NPDES general permit. This permit is issued pursuant to the requirements of
North Carolina General Statute 143-215.1 and the Memorandum of Agreement between North
Carolina and the US Environmental Protection Agency dated October 15, 2007 (or as
subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon
approval of the Division of Energy, Mineral, and Land Resources. The Division of Energy,
Mineral, and Land Resources may require modification or revocation and reissuance of the
certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Energy, Mineral, and Land Resources, the Coastal Area
Management Act, or any other federal or local government permit that may be required.
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: httg:1/Wrtal.ncdenr.orglwebRrl
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled l 10°% Post Consumer Paper

If you have any questions concerning this permit, please contact Julie Ventaloro at telephone
number [phone] or by email iulie.ventaloroamcdenr. ov.
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central Files
Stormwater Permitting Program Files

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At ZA.
NCDENR
NOTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG030000
National Pollutant Discharge Elimination System application for coverage under General Permit
NC0030000:
STORMWATER DISCHARGES associated with activities classified as:
to
SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extruding of Nonferrous Metals
-SIC 3398 Metal Heat Treating
SIC 34 Fabricated Metal Products
SIC 35 Industrial and Commercial Machinery
SIC 3$ Electronic and Other Electrical Equipment
SIC 37 Transportation Equipment
SIC 38 Measuring, Analyzing, and Controlling Instruments
K-a For questions, please contact the OEMLR Regional Office for your area. tee'page 4.
(Please print or type)
i) Mailing address of ownerloperator (address to which al�ermit correspondence will _be mailed):
Name CevlQX-&-P T�)VAP�Wu_A—S
Street Address
City zW State M!� _ZIP Code —9 C,�
Telephone.No. R 2g to _ 4'+ Fax:
2) Location of facility producing discharge;
Facility Name
Facility Contact -
Street Address
City
County
Telephone No.
Email
E
State N C- _ ..ZIP Code
. R _
M .' I W." I . as n ff a j; 4 . io
3) Physical Location Information:
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). 7 23A2 _ WW y .U= SMLXA T� 1
d v.' —
(A copy of a county map or USGS quad sheet with the facility cieady located must be submitted with this application.)
4) Latitude 3 �. �^ Longitude g • Z (deg, min, sec)
35-0 391 5$, 8" gl ° IQ' T-7 RECEIVED
NOV 0 4 2014
Page 1 of 4 DENR-LAND QUALITY
SWU-218-071408 ST0}7NW"f4 AVfTING

..b
NCG030000 N.O.I.
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
%. Existing
6) Standard Industrial Classification:
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility.
SIC Code: 3 j� 6
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: ML_��r,_Y
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? VA 41,OtJ-y\
What is the name of.the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in?
Receiving water classification:
Is this a 303(d) listed stream? Has a TMDL been approved for this watershed?
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).
9) Does this facility have any other NPDES permits?
M'No
ID Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
U-4o
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
11) Does this facility employ any best management practices for stormwater control?
id No
❑ Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe:
12) Does this facility have a Stormwater Pollution Prevention Plan?
ia1'No
❑ Yes
If yes, when was it implemented?
13) Are vehicle maintenance activities occurring at this facility?
o ❑ Yes
14) Hazardous Waste:
a) is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
1b No ❑ Yes
Page 2 of 4 -
SWU-216-071408 Last revised 7014

NCGO30000 N.o.i.
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
U'No ❑ Yes
e) Is this facility a Large Quantity Generator (1000 kg, or more of hazardous waste generated per month) of
hazardous waste?
t2"N'o ❑ Yes
d) Is hazardous
hhazardous waste stored in the 100-year flood plain?
,2 No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) 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 1 disposal vendor,
Vendor address:
16) Certification:
North Carolina General Statute 143-215.6E (1) provides that:
Any person who'knowingty makes any false statement, representation, or certification in arry 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 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 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
knovAedge and relief such Information Is true, complete, and acmurate.
PersonPrinted Name of ,��►7;raTTru�u�"�t171 d�le'.r� r u�
.- -
(§gnature of •+.licant) (Date Signed)
This. Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDt=NR
Page 3 of 4
Swu-218-071408 Last re%dsed 712/14

A
NCG030000 N.0.1.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDENR.
❑ This completed application and all supporting documents.
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stotmwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features,, (e) areas where materials are stored,
(f) Impervious areas, (g) site property lines.
0 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 ,Unit Program
Division of Energy, Mineral And Land Resources
1612 Mail Service Center.
Raleigh, North Carolina 27699-1612
Nte
The submission of this document does not guarantee coverage under the General Permit.
For questloris, please contact the DEMLR Regional Office for your area. .
DEMLR Recional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
(704) 663-16.99
Raleigh Office ........
[phone] ,
Washington Office ...(252)
946-6481 '
Wilmington Office ...
(910) 79617215
Winston-Salem ......
[phone]
Central Office .........[phone]
Page 4 of 4
5WU-218-071408 Last revlsed 712114

USGS Map Name: Newton NC Map MRC: 35081 F2
RECEIVED
NOV 0 4 2014
DENR-LAND QUALITY
STORMWATER PERWliIT i ING

• 35.��t9��3 8/,ao�l3�
USGS Map Name: Newton, NC Map MRC: 35081 F2
RECEIVED
NOV 0 4 2014
DENR-LAND QUALITY
STORMWATER PEROARTING

Ert�s�s>u� •n�rtran�>Ics
QC )V CTologies
Check No: 601015
Check Date: 08/21/2014
i Invoice No.
Date
Remark
Inv Amount
Discount
Check Amount
:G50000 8/20114
08/20l2014
Permit
$100.00
$100.0C
$100.00
$100.0C
RE
�'
NUV 04 201
-„
CFN� i}liti��4' ' i'
S`CDRiviV� i sic1`Jii�"i Is
del
a
G
Do�
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1P1�{�TEP.OVP.L!
Stormwa!3r Bra
3ENERAL DYNAMICS
Wells 3ATCOM Technologies Chapel Hill Cn275i4 5�31 00601015
°
General Dynamics SATCOM Technologies, Inc. REF NO DATE Amount
1500 Prodelin Drive, Newton NC 28658 235889 8/21/2014 $'•""•100.00
PAY ONE HUNDRED AND 00/100................................. *.......
,,..,................,
PAY NCDENR-DIVISION OF WATER
TO THE 1646 MAIL SERVICE CENTER
ORDER OF RALEIGH NC 27699-1646
iIc(-j-o •3Q

a
MWA
NCDENR
.0k , �RCWAP%cz,
NQTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG030000
National Pollutant Discharge Elimination System application for coverage'under General Permit
NC0030000;
STORMWATER DISCHARGES associated with activities classified as:
1)
2)
S1C (Standard Industrial Classification) 336 Rolling, Drawing, and Extruding of Nonferrous Metals
SIC 3398 Metal Neat Treating
SIC 34 Fabricated Metal Products
SIC 35 Industrial and Commercial Machinery
SIC 38 Electronic and Other Electrical Egkjipment
SIC 3T Transportation Equipment
SIC 38 Measuring, Analyzing, and Controlling Instruments
For questions, please contact the AFMLR Regional Office for your area: 'Seepage 4.
(Please print or type)
Mailing address of ownerloperatDr (addresl Ig which all Rermit corres ondence will lie mailed :
Narne (7-A�-r1V-rVk FW LA ekYy)-j (�
Street Address
City
Q_tZ
Telephone.No.
R2Z
Location of facility
producing discharge;
Facility Name
_ e.yya--ram D
Facility. Contact
n 4a
Street Address
15 trt `7 e t
City
i n
County
C_-.A�_ aca4
Telephone No.
email
rv1e v+1w.o"A
3) Physical Location Information:
Fax:
Stata
Fax:.
ICA
SGGBYri = [��Y\
Please provide a narrative description of how to, get to the facility (use::street names, state road numbers, and
distance and direction from aroadway iti#ersectian}: . - fLtJY i t-, � c i tom'- rk a�
(A copy of a wunt map or i1SGS Quad sheet with the facility dEarty located must be submitted OM alto application:)
4) Latitudes•1,3 Longitude (deg, min, sec)
RECEIVED
Nov o 4 2014.
Page 1 of 4 DENRI -W4D QUALITY,
swu-21M71408 STOrRI4MA1mVI N! If -INIG

I-
NCG030000 N.O.I..
5) This NPDES Permit Application applies to which of the following:
© New or Proposed Facility Date operation is to begin
0,F_xisting
6) Standard Industrial Classification:
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility.
81C-Code: 3 Z, 6 3
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility:PC�tC';jd'p ry-,Y 1/1`'Ce�ytin.r�n��nr��
8) Discharge points ! Receiving waters:
How many 41sPharge points (ditches, pipes, channels, etc.) convey stormwater from the property? VA Y\
What is the' name of -the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in`?
Receiving water classification:
Is.this a 3€33(d),iisterJ stream? Has a TMDI_ been approved for this watershed?
If the_sitestormwater discharges to a separate storm sewer system, name the, operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm•sewer)
9) Does this.facility have any other NPDES permits?
I� No
CI Yes
If yes, list the permit numbers for all current NPDES perm" is for this facility.
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
Vivo
O Yes
If yes. list: the permit numbers for all current Non -Discharge permits for this, facility.
11) Does this facility employ any hest management practices for stonmwater control?
No
El Yes (Show any structural BMPs on_the site diagram.)
If yes,. please briefly describe:
42) Doesstth(s.faeility have a Stormwater Pollution Prevention Plan?
gY�vo
© Yes
If yes, when was it implemented?
13) Are vehicle maintenance activities occurring at.this facility?
CTIN�o 13 Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or disposal Facility?
'ZNo l] Yes
SWU-21"71408
Page2 of 4
Last revised M114

NCG030000 N.O.I.
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hhmaardous waste?
Jid'No 0 Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
ht; ardous waisfe?
VKN0 0 Yes.
d) Is hazardous waste stored in the 100-year flood plain?
3" No 13 Yes if yes, include.infomnation to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following Information:
Type(s) of waste:
Hornis material stored:
Where is material stored: .
How many disposal shipments.per year:
Name of transport! disposal vendor:
Vendor address:
15) Certification:
North Carolina General Statute 143-216.68 (i) provides that:
Any person who knowingly makes any Wse,statement. representation, or certtfrcallon In any application, record, report,
plan, or other document fi3ad or required to be maintained tinder this Article or a rule implementing this Article; or who
knowingly makes a false statement of a material fact to a tulemaking proceeding or contested case under this Article; or
w#ro faisifles, tampers with, or knowingly renders Inaccurate any recording or monlioring device or meth requlmd to be
operated err rrialrrtained under this Article or nAs of the Comrrslsslon IrnplernenfJng this Article shall be guilty of a Class 2
rrdsderneanor which may include a fine not to exceed tan thousand dollars ($10,0b0).
I hereby request coverage tinder the referenced General Permit. )-understand that coverage under this permit
will consbtute,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 Bind belief such Information Is true, complete, and'acaufate.
Printed Name of Pemn Slgn�ng: uTailj aTu�22 -1 ���ulM, u
(ghgnatufe s sr: (Date Signed)
This Notice of Intent must.be accompanied by a check or money order for $100.00, made payable to:
NCDENR
Page 3 of 4
SWIJ-21 &0714DS Last revised 7014

NCG030000 N.O.f.
Final.Checklist
This application will be returned as incomplete unless all of the following items have been Included:
0 Check for $100 made payable to NCDENR.
© This completed application and all supporting documents.
0 A site diagram showing, at a minimum, (existing or proposed);.
(a) outline of drainage areas, (b) stcrhiwater management structures, (c) location of stormwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features,`(e) areas where materials are stored,
{f) irnpervious areas, (g) site property llnes.
© 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 Unit Program
Division -of Energy, Mineral and Land Resources
1612.Mail Service,Center..
Raleigh, North Carolina 27699-1612
to
The.submisslbn of this document does not guarantee coverage under the General Permit
For questions, please contact the DEMLR Regional Office for yvur area. ,
DEMLR Regional Office Contact Information:
Asheville Office ......
(82B) 296-4500
Fayetteville Office ...
(910) a33-3300
Mooresville Office ...
(704) 663�1699
Raleigh Office ........
[phone]
Washington Office ,..(252)
94676481
Wilmington Office,...
[phone]
Winston-Salem ......
[phone]
Central Office .........(419)
807-8300
Page 4 of 4
31MJ•�18-071408 Last refted 7OU

35.��f9��3 8/,aoa-l3�
USGS Map Name: Newton. NC Map MRC: 35081 F2
RECEIVED
NOV 0 4 2014
DENIR-LAND QUALITY
STORM14VATER PERMiT T ING