NCG150054_COMPLETE FILE - HISTORICAL_20170612

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
/V
DOC TYPE
Z9 HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
p Qo)�o Lot
YYYYMMDD

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
Energy, Mineral &
Land Resources
EkvIRONMENTAL QUALITY
June 12, 2017
Eddie Madden
Town of Elizabethtown
PO Box 700
Elizabethtown, NC 28337
Subject: NPDES General Permit Renewal — Fees Owed
Elizabethtown Airport
NPDES Permit Certificate of Coverage (COC) Number: NCG150054
Dear NPDES Permittee:
TRACY DAVIS
ohvrrar
The NCG150000 General Permit expires on August 31, 2017. Our records indicate that annual fees are
owed on this permit. Coverage under this permit for this site cannot be renewed until these fees are
paid. If you no longer need this permit, a rescission form is enclosed.
Sometimes fees lapse because billing contact or other information is out of date. Please review the
permit contact information enclosed. Ensure that all contact information is accurate and complete, and
that e-mail addresses are provided wherever possible.
To update contact information for your permit: You may simply e-mail us changes to contact
information, unless there is a chani'e to the Owner Affiliation, Because Owner.Affiliation is the person
legally responsible for the permit_, we require a hard copy of the signed Owner Affiliation Change Form
(enclosed) to make this change. A change in company Name or Ownership requires a different form, so
please contact us if necessary. Changes to other contacts can be e-mailed to Laura Alexander at
[e-mail].
If you have any questions, please contact Laura Alexander at the e-mail above or at [phone], or
Bethany Georgoulias at [phone] or [e-mail].
Sincerely,
j6eday �e0/�va&e
Bethany Georgoulias,
DEMLR Stormwater Program
Cc: Stormwater Program Permit File
Fayetteville Regional Office / DEMLR Stormwater Program
<-�Nothing Compares....-, ,..:.
SS ae of North Carolina I invtronmental Quality I Energy. Mineral arid Land Resources
512 N. Salishury Street 1 1612 Mail Servlce Center I Raleigh. North Curo[loa 27699-t612
919 707 9200

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H, Sullins
Governor Director
June 28, 2011
CERTIFIED MAIL: 7009 082Q 0000 2473 8121
RETURN RECEIPT REQUESTED
Town of Elizabethtown
Attn: Eddie Madden, Town Manager
PO Box 716
Elizabethtown, NC 28337
Subject: NOTICE OF VIOLATION (NOV-2011-PC-0390)
Elizabethtown Airport, COC-NCGI50054
NPDES Stormwater General Perm it-NCG150000
Bladen County
Dear Mr. Madden:
Dee Freeman
Secretary
On June 24, 2011, Michael Lawyer from the Fayetteville Regional Office of the Division of Water
Quality conducted a site inspection for the Elizabethtown Airport facility located at 466 Airport Road,
Elizabethtown, Bladen County, North Carolina. A copy of the Compliance Inspection► Report is enclosed
for your review. Mr. Mitch Taylor, Airport Manager, was also present during the inspection and his time
and assistance is greatly appreciated. Permit coverage authorizes the discharge of stormwater from the
facility to receiving waters designated as a UT of Browns Creek and a UT of Plum Branch, both Class C
waters in the Cape Fear River Basin. The site visit and file review revealed that the subject facility is
covered by NPDES Stormwater General Permit-NCG150000, Certificate of Coverage-NCG150054.
Accordingly, the following observations and/or permit conditions violations were noted during the
Division of Water Quality inspection:
1) Stormwater Pollution Prevention Plan (SWPPP)
A Stormwater Pollution Prevention Plan (SWPPP) has been developed, recorded, and properly
[Yes ■ No ❑ (implementation not evaluated, see comments on inspection report)l
2) Qualitative Monitoring
Qualitative monitoring has been conducted and recorded in accordance with permit requirements.
es❑No■
Location: 225 Green Street, Suite 714, Fayetteville, North Carolina 28301
Phone: MA33-33001 FAX: [phone] � Cuvomer Service:1-877-623-6748
lnternd http:llportal.ncdenr.orglwebtwq
An Equal Opportunity 1 Affirmative A0on Employer
One
No Carolina
Naturally

Other Observations:
Please refer to the enclosed Compliance Inspection Report for additional comments and observations
made during the inspection.
Requested Response:
You are asked to respond to this office, in writing, within 30 calendar days from receipt of this notice.
Your response should include a Plan of Action to address the aforementioned violation along with a
reasonable time frame that you expect to be in full compliance with the conditions of the NCG150000
general permit.
Thank you for your attention to this matter. This office requires that the violation as detailed above
be properly resolved. This violation and any future violations are subject to a civil penalty
assessment of up to $25,000 per day for each violation. Should you have any questions regarding,this
matter, please contact Mr. Lawyer or myself at [phone].
Sincerely,
Belinda S. Henson
Regional Supervisor
Surface Water Protection Section
BSH: ML/ml
Enclosure
cc: V/Mitch Taylor, Airport Manager -Elizabethtown Airport (via e-mail)
FRO -Surface Water Protection
Katie Merritt-WBS Compliance & Permits Unit
DWQ Central Files
ru
r-1 For delivery Information visit our website-at www.usps.conL__4
Postage $ J
N Certified Fee
O 0 I Postmark
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Permit: NCG150054
SOC:
County: Bladen
Region: Fayetteville
Compliance Inspection Report
Effective: 02/12/10 Expiration: 08/31/14 Owner: Town of Elizabethtown
Effective: Expiration: Facility: Elizabethtown Airport
466 Airport Rd
Contact Person: David Bone Title:
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
On -site representative Mitch Taylor
Related Permits:
Elizabethtown NC 28337
Phone: [phone]
Certification: Phone:
Phone: [phone]
Inspection Date: 0612412011 Entry Time: 10:OOAW Exit Time: 11:50 AM
Primary Inspector: Mike Lawyer��' Phone: E1� 300
xp2gSecondary Inspector(s): 330 9
Belinda S Henson Phone: [phone] Exj.7K
Reason for Inspection: Routine Inspection Type: Compliance Evaluation 33Z�
Permit Inspection Type: Air Transportation Stormwater Discharge COC
Facility Status: ❑ Compliant ■ Not Compliant
Question Areas:
■ Storm Water
1 N Complete%,tems 1, 2, and 3. Also complete
Item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the ma€lplece,
or on the front If space permits.
t, Article Addressed to:
MA Fold► "-
'Pa 'M3dx '71
A. S nature '
X L ❑ Agent
c31 J t ❑ Addressee
aceived by (Printed Name) ,. C. Date of Delivery
D. Is delivery address dikererlf from Item 1? ❑ Yes
If YES, enter delivery address below; ❑ No
wn IliC, a8Z3? 3. Service Type
■ Certified Mail ❑ Express Mall
❑ Reglstersd ■ Return Receipt for Merchandise
❑ Insured Mall ❑ C.C.D.
4. Restricted Delivery? (Extra Fee) ❑ yes
2. Article Number 1T iY70 09 0820 TT
0000, 203 $� � t 7
(Transfer frnm servlGe label) i
PS Form 3811, February 2004 Domestic Return Receipt 102595.02-M-1540
Page: 1

Permit: NCG150054 Owner - Facility: Town of Elizabethtown
Inspection Date: 06/24/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Inspection conducted to ensure compliance with the conditions of the NCG150000 general stormwater permit for General
Aviation facilities. Permit coverage for this facility was issued on February 12, 2010. Met with Mr. Mitch Taylor, Airport
Manager, who provided the facility's Stormwater Pollution Prevention Plan (SWPPP) for review. The SWPPP was
developed by WK Dickson and finalized in May 2011. It contains all permit -required components and is detailed yet easy
to follow. A visual monitoring record was completed by the consultant for March 2011 indicating no flow conditions. A
statement prepared by Mr. Taylor on 6/24/11 stated that there was no rainfall during normal operating hours sufficient to
produce any runoff since receipt of the SWPPP in May 2011. There were no records of visual monitoring conducted
during the first year of permit coverage in 2010. It was relayed to Mr. Taylor that although the general permit contains a
compliance schedule of 12 months to develop the SWPPP and provide any necessary secondary containment, all other
permit conditions including monitoring became effective immediately upon issuance of permit coverage. It was also
relayed that a Notice of Violation letter would be issued for failure to conduct monitoring during the first year of coverage.
Observations were made of the facility's fuel storage/fueling area, hangars where maintenance occurs and outfalls.
Page: 2

Permit: NCG150064 Owner - Facility: Town of Elizabethtown
Inspection Date: 06/24/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Yes No
NA
NE
Does the site have a Stormwater Pollution Prevention Plan?
■ ❑
❑
❑
# Does the Plan include a General Location (USGS) map?
■ ❑
❑
❑
# Does the Plan include a "Narrative Description of Practices"?
■ ❑
❑
❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
■ ❑
❑
❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
■ ❑
❑
❑
# Has the facility evaluated feasible alternatives to current practices?
■ ❑
❑
❑
# Does the facility provide all necessary secondary containment?
■ ❑
❑
❑
# Does the Plan include a BMP summary?
■ ❑
❑
❑
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?'
■ ❑
❑
❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
■ ❑
❑
❑
# Does the facility provide and document Employee Training?
❑ ❑
❑
■
# Does the Plan include a list of Responsible Party(s)?
■ ❑
❑
❑
# Is the Plan reviewed and updated annually?
❑ ❑
❑
■
# Does the Plan include a Stormwater Facility Inspection Program?
■ 17
❑
❑
Has the Stormwater Pollution Prevention Plan been implemented?
❑ ❑
❑
■
Comment: Due to recent development of the facility's SWPPP, items such as
employee training, annual review/update and implementation were not evaluated during
this inspection. These items will be reviewed during the next scheduled inspection.
Qualitative Monitoring
Yes No
NA
NE
Has the facility conducted its Qualitative Monitoring semi-annually?
❑ ■
❑
❑
Comment: A monitoring event was documented for March 2011 that indicated 'No
flow', however there were no monitoring records for the first year of permit coverage in
2010.
Permit and Outfalls
Yes No
NA
NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
■ ❑
❑
❑
# Were all outfalls observed during the inspection?
■ ❑.
❑
❑
# If the facility has representative outfall status, is it properly documented by the Division?
Cl ❑
■
Cl
# Has the facility evaluated all illicit (non stormwater) discharges?
■ ❑
❑
❑
Comment: Facility has 5 total outfalls, which were observed at the time of inspection.
Outfall 3 appears to only receive flow from the runway and vegetated areas and could
be removed from the monitoring schedule.
Page: 3

i r
+ • i
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
Mr. Eddie Madden
Town of Elizabethtown
PO Box 716
Elizabethtown, NC 28337
February 12, 2010
Dee Freeman
Secretary
MA.R 0 12010
Subject:' General Permit No. NCG150000
Elizabethtown Airport
COC NCG150054
Bladen County
Dear Mr. Madden:
MID
In accordance with your application for a discharge permit received on December 1, 2009,
we are forwarding herewith the subject certificate of coverage 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 after notice to
the Division of Water Quality. The Division of Water Quality 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 Water Quality or permits required by the Division of Land Resources,
Coastal Area Management Act or any other federal or local governmental permit that may be
required.
If you have any questions concerning this permit, please contact Robert Patterson at
telephone number [phone].
ORIGINAL SIGNED BY
Sincerely, KEN PICKLE
for Coleen H. Sullins
cc: Fayetteville Regional Office, Mike Lawyer
Central Files
Stormwater Permitting Unit Files
Wetlands and Stormwater Branch
1617 Mall Service Center, Raleigh, North Carolina 27699.1617 One
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 NorthCarolina
Phone: [phone] FAX: [phone] Customer Service: "77-623-6748 Amorally
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Internet: www.ncwaterquall�.org �f ►� l
An Equal opportunity 4 Affirmative Action Employer

T.»
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG150000
CERTIFICATE OF COVERAGE No. NCGI50054
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
Incompliance 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,
Town of Elizabethtown
is hereby authorized to discharge stormwater from a facility located at
Curtis L. Brown, Jr. Field; Elizabethtown Airport
466 Airport Road
Elizabethtown
Bladen County
to receiving waters designated as a UT of Browns Creek & a UT of Plunr£-reek both class C
waters in the Cape Fear River Basin, in accordance with the effluent limitations, monitoring
requirements, and other conditions set forth in Parts I, 11, I11, IV, V, and VI of General Permit No.
NCG150000 as attached.
This certificate of coverage shall become effective February 12, 2010.
This Certificate of Coverage shall remain in effect for -the duration of the General Permit.
Signed this 121h day of February, 2010.
ORIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins., Director
Division of Water Quality
By the Authority of the Environmental Management Commission

NCG 150054
Map Scale 1:30,000
Town of Elizabethtown
Elizabethtown Airport
Latitude: 340 36' 17" N
Longitude: 780 34' 47" W
County: Bladen
Receiving Stream: UT of Browns Crk. & UT of Plum Cris.
Stream Class: C
Sub -basin: 03-06-16 (Cape Fear River Basin)
Facility Location

Patterson, Robert
From: Lawyer, Mike
Sent: Monday, February 08, 2010 12:08 PM
To: Patterson, Robert
Subject: RE: NCG150054 - Curtis L. Brown, Jr. Field; Elizabethtown Airport - Bladen County
Robert,
I had made contact with the facility a few weeks ago and they wanted me to discuss things with their
engineer/consultant..l then spoke with him about whether or not a meeting is warranted to discuss permit conditions,
which he was going to contact the Town Manager and get back to me. He has not done so. I'd like to check back with
him, but I would recommend proceeding with issuance of coverage and we can deal with questions or concerns about
the permit once issued.
Sorry forth e delay,
Mike
Michael Lawyer
Environmental Specialist
NCDENR-Division of Water Quality
Surface Water Protection Section
Fayetteville Regional Office
Direct: [phone]
Main: [phone]
Fax: [phone]
e-mail: [e-mail] (please note my current e-mail address)
*E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Patterson, Robert
Sent: Monday, February 08,. 2010 11:53 AM
To: Lawyer, Mike
Subject: FW: NCG150054 - Curtis L. Brown, Jr. Field; Elizabethtown Airport - Bladen County
M ike,
I never heard back about this GP. I plan to issue it 2/12 unless you have concerns.
Thanks.
Robert
From: Patterson, Robert
Sent: Thursday, January 07, 2010 10.44 AM
To: Lawyer, Mike
Subject: NCG150054 - Curtis L. Brown, Jr. Field; Elizabethtown Airport - Bladen County
Mike,

Please see NO1 attached.
We have received an application for coverage of an existing facility under NCG 15 from Town of Elizabethtown. The
facility drains to Browns Creek and Plum Creek (class C) in Elizabethtown (Bladen County). No de-icing or haz waste.
Does the FRO have any concerns about issuing this facility a COC for this general permit?
Thanks!
Robert D. Patterson, PE
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting
1617 Mail Service Center, Raleigh, NC 27699-1617 (Mailing)
512 N. Salisbury St, Raleigh, NC 27604 (Location & Parcels)
[phone] Phone [phone] Fax
Email: robert,pattersonu,ncdenr.gov
Website: http://h2o.enr.state.nc.us/suIstormwater.html
*Please consider the environment before deciding to print this email*
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties.

Lawyer, Mike
From: Lawyer, Mike
Sent: Monday, February 08, 2010 12:08 PM
To: Patterson, Robert
Subject: RE: NCG150054 - Curtis L. Brown, Jr. Field; Elizabethtown Airport - Bladen County
Robert,
I had made contact with the facility a few weeks ago and they wanted me to discuss things with their
engineer/consultant. I then spoke with him about whether or not a meeting is warranted to discuss permit conditions,
which he was going to contact the Town Manager and get back to me. He has not done so. I'd like to check back with
him, but I would recommend proceeding with issuance of coverage and we can deal with questions or concerns about
the permit once issued.
Sorry for the delay,
Mike
Michael lawyer
Environmental Specialist
NCI7ENR-Division of Water Quality
Surface Water Protection Section
Fayetteville Regional Office
Direct: [phone]
Main: [phone]
Fax. [phone]
e-mail: [e-mail], (please note my current e-mail address)
*E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Patterson, Robert
Sent: Monday, February 08, 2010 11:53 AM
To: Lawyer, Mike
Subject: FW: NCG150054 - Curtis L. Brown, Jr. Field; Elizabethtown Airport - Bladen County
Mike,
I never heard back about this GP. I plan to issue it 2/12 unless you have concerns.
Thanks
Robert
From: Patterson, Robert
Sent: Thursday, Jarivary 07, 2010 10:44 AM
To: Lawyer, Mike
Subject: NCG150054 - Curtis L, Brown, Jr. Field; Elizabethtown Airport - Bladen County
Mike,

Please see N01 attached.
We have received an application for coverage of an existing facility under NCG 15 from Town of Elizabethtown. The
facility drains to Browns Creek and Plum Creek (class C) in Elizabethtown (Bladen County). No de-icing or haz waste.
Does the FRO have any concerns about issuing this facility a COC for this general permit?
Thanks!
Robert D. Patterson, PE
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting
1617 Mail Service Center, Raleigh, NC 27699-1617 (Mtaiiiiir)
512 N. Salisbury St, Raleigh, NC 27604 li-Awatioi7 A, Pr,rtelti)
[phone] P+ii,no 1 [phone] Fax
Email: robert.pattersona,ncdenr.gov
Website: http://h2o.enr.state.nc.us/su/stormwater.html
*Please consider the environment before deciding to print this email*
E-mail correspondence to and from this address may be subject to the North Caroiina Public Records Law and may be disclosed to third parties.

A'ke' Division of Water Quality / Surface Water Protection
NCDENRNational Pollutant Discharge Elimination System
riprtm CAROLINA V Iry W or
ENVViONNCNT AND h"UNAL HC> RCCS NCG150000
NOTICE OF INTENT
FOR AGEWY LISH ONLY
Dale Received
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Ccnifecatc <iF Ccwero e
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National Pollutant Discharge Elimination System application for coverage under General Permit
N C G150000:
STORMWATER DISCHARGES associated with activities classified as:
SIC' (Standard Industrial Classification) Code 45 Air Transportation Facilities including air transportation,
scheduled, and air courier (SIC 4512 and 4513); air transportation, non scheduled (SIC 4522); airports,
flying fields, except those maintained by aviation clubs, and airport terminal services including: air traffic
control, except government; aircraft storage at airports; aircraft upholstery repair; airfreight handling at
airports; airport hangar rental; airport leasing, if operating airport; airport terminal services; and hangar
operations; and airport and aircraft service and maintenance including: aircraft cleaning and janitorial
service; aircraft servicinglrepalring, except on a factory basis; vehicle maintenance shops (including
vehicle and equipment rehabilitation mechanical repairs, painting, fueling, lubrication); and
handling facilities. ;, —f�•
For questions, please contact the DWO Regional Office for your area.,(See page 4)
(Please print or type)
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed): ;
Name Town of Elizabethtown, North Carolina IL:
Owner Contact
Street Address
city
Telephone No.
E-mail Address
Eddie madden, Town manager
805 W. Broad Street; PO Box 716
Elizabethtown State NC ZIP Code 28337 _.1
[phone] Fax: [phone]
managerpelizabethtownnc.org
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
Curtis L. Brown, Jr. Field; Elizabethtown Airport
Oscar Taylor
466 Airport Road; PO Box 1716
Elizabethtown State NC ZIP Code 28337
Bladen
[phone] Fax: [phone]
keysQintrstar.net
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). Entrance to Airport is located on the eastern
side of the Airfield, approximately 0.3 miles to the southeast of us WwX B7 Byp. on Airport Rd.
(A copy of a county map or USGS quad shed, with facility clearly located on the map is a required part of this applicalion.)
4) Latitude 34d 36m 16.56s N Longitude 7Bd 34m 47.46s W (degrees, minutes, seconds) (Coordinates of
terminal building)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
a Existing
Page 1 of 4
SWU-234-051309
Last revised 5113109

V*�
NCG150000 N.O.I.
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: 4522
7) Services and Activites
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facility.
b) Check all services and activities offered or allowed at this facility
❑ Scheduled air transportation
© Air courier
�9 Non-scheduled air transportation
❑ Airport terminal services
1!5 Aircraft storage
❑ Aircraft upholstery services
❑ Airfreight handling
U Airport hangar rental
U Airport leasing
8) Discharge points / Receiving waters:
U Aircraft service and maintenance
U Aircraft cleaning and janitorial services
❑ Aircraft and/or vehicle rehabilitation
EX Aircraft and vehicle maintenance
:9 Aircraft and/or vehicle fueling
Kx Aircraft and/or vehicle lubrication
❑ Aircraft and/or vehicle painting
U Aircraft and/or vehicle mechanical repair
❑ Material handling facilities
How many.discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? unknown
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Brown's Creek; Plum Branch, Hammonds Creek, Cape fear River
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
Receiving water classification (if known):
9) Does this facility
a) Have an untreated wastewater discharge? ;f No ❑ Yes
b) Have a treated wastewater discharge? ;9 No ❑ Yes
If yes, list the permit number.
c) Have a wastewater discharge from a recycle system? IgNo ❑ Yes
If yes, list the permit number.
d) Have anon -discharge permit? UNo ❑ Yes
If yes, list the permit number.
e) Discharge wastewater to a municipal wastewater collection system? ❑ No I5Yes
If yes, list the municipality and permit number Town of Elizabethtown, NC; Permit No. NCOO26671
Note: Stormwater discharge permit NCG150000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG150000.
10) Does this facility employ any best management practices for stormwater control?
❑ No T5 Yes
If yes, please briefly describe: Unknown at this time, BMP's (if any) to be determined during
development of SWPPP in the next 12 months.
Page 2 of 4
SWU-234.030909 Last revised 319109

NCG150000 N.O.I.
11) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No ❑ Yes U Being Developed Being developed
If yes, when was it implemented? If being developed, when will it be implemented? next 12 months;
implementation
12) Hazardous Waste: unknown.
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
U No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month)
of hazardous waste?
❑ No UYes (Assumed)
c) Is this facility a large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
U No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
❑ No ❑ Yes If yes, include information to demonstrate protection from flooding. Tse through SWPPP
e) If you answered yes to questions b. or c,, please provide the following information:
Type(s) of waste: Aviation -related fuel and oil products.
How is material stored: Full analysis to be performed as part of SWPPP development over the
Where is material stored: next 12 months.
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address:
13) 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 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 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.
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: Eddie Madden
Title: Town Manager
of
//a � 'i•1--_
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
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NCG150000 N.O.I.
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
❑ Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the D WQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
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SWU-234-030909 Last revised 319109