NCG080799_COMPLETE FILE - HISTORICAL_20171027

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. vgN (� C
DOC TYPE
DOC DATE
I /HISTORICAL FILE
❑ MONITORING REPORTS
YYYYMMDD

if ti "'
i Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
Kr,o.
National Pollutant Discharge Elimination System (NPDI-.S)
Energy Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources ENVIRONMENTAL QUALITY (Individual Legally Responsible for Permit)
Use this form If there has been
I OR AGI NM USL DNI Y
DItL Itecened
Y far
Manlh
Div
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation
What does "legally responsible individual" mean'
The person is either
RECE: k
I VED
• the responsible corporate olficer (lor a corporation) OCT 17 2017
• the principle e\eeUt]Ve officer or ranking elected official (for a municipality, state federal or other pubhe
L)LNR LAI jr) OUAI ITY
agency}, T0F\',,A1A1 h ; yG
• the general partner or proprietor (for a partnership or sole proprietorship)Kr�fT
• or the duly authori/ed representative of one of the above
1) Enter the permit number for which this change in Legally Responsible Individual ("OiNner Affiliation")
applies
Individual Permit 0)) Certificate of Coverage
N C 6 Q Q O� N C G Q (} `� c� 9
2) Facility Information
Facility naive Y C A V
CornpanylOwncr Organization
Facility address 4A P0,WDri
AddrL,o,
('-tYele SUS yC _ Z-1116 U
Ctt1 1wite /tp
To find the current legally responsible person associated with your permit go to this weMite
http I/deg nc govlabout/divisions/em.rgy-mineral-land -resourceslenergy-mineral-land-permits/Stormwater-prograln
and run the Permit Contact Summary Report
3) OLD OWNER AFFILIATION that should be removed
Previous legally responsible individual r"galk C--1 t-AAA
Vim M1 I ISt `
4) NEW OWNER AFFILIATION (legally responsible, for the, permit)
Person legally responsible for this permit
R� Unavd P l 4V
I ir,,t MI 1 »t
Page I oft
SWU OWN[ RAI 1 Iir23klm h2D17

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
[ ulc
�[� 1 PC�ttn n Atii�x�uc�
Mailing Addru s
61 It ft 6 g 20 YO AI (I z-T 4o Cv
Cit) State 71P
lele.phnne I mail Address eby
H12 LoI`�5"1
I ix Number
5) Reason for this change
A result of Et"Ernployee or management change
❑ Inappropriate or incorrect designation before
❑ Other
!f ouzel please e,,plain
The certification below must be completed and signed by the permit holder
PERMITTEE CERTIFICATION
I -;? L.C.rem attest that this apphcation for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge I understand that if all required parts of this form m c not completed, this change may not be
processed
Ja/��/��
Signature Date
PLEASE SEND THE COMPI,E I ED FORM TO
Division of Energy Mineral and Land Resources
Stormwater Program
1612 Mall Service Center
Raleigh North Carolina 27699-1612
For more Information or staff contacts, please call [phone] or visit the website at
http Hdeq nc gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
SWU OWNI RAI 111,23NIar2017

r City of Greensboro
J North Carohna
October 12, 2011
Hugh Medford Municipal Operations, City of Greensboro
Attn Mike Mabe
401 Patton Avenue
Greensboro, NC 27406
RE Industrial Compliance Inspection
Inspection location Hugh Medford Municipal Operations, City of Greensboro
401 Patton Avenue
SW Permit # NCGO80799
Dear Mr Mabe
On October 10, 2011 the City of Greensboro Stormwater Management Division completed an industrial
compliance inspection of Hugh Medford Municipal Operations Local regulations permit an inspection of
industrial facilities under authority granted by City of Greensboro Code of Ordinance Chapter 30, Article 12,
Section 7 1 (C-5) This inspection consisted of two parts a review of the facility files/records and an on -site
facility inspection
The inspection was performed by Debbie Shoffner, and the following deficiencies/observations were noted
during the inspection
Stormwater Pollution Prevention PlAWSplll Plan Review
Site Maps and SWP3
• No deficiencies observed
Spill Prevention and Response Plan
• Indicate the protcol for proper disposal of materials in the event of a spill
• Prepare spill lots containing various clean-up materials Place these lots throughout the
facility so that they are easily accessible
Monitoring
• No deficiencies observed
Employee Training
• No deficiencies observed
640 P 0 Box 3136 Greensboio VC 27402 3136 www greensboro nc gov (336) 373 CITY (2489) TTY # 333 6930

Site Inspection
Preventative Maintenance/Good Housekeeping
Establish a procedure to contain (and properly dispose of) excess washwater exiting the
truck wash bays in order to keep wastewater from entering the stormwater conveyance
system
Non-Stormwater Discharges
• No deficiencies observed
It is recommended that Hugh Medford Municipal Operations take appropriate actions to correct the noted
deficiencies If you have any questions concerning this inspection, please contact me at 336-373-2741 or
Debbie Shoffner a@greensboro-nc gov
Sincerely,
Debbie Shoffner, Water Quality Specialist
City of Greensboro, Water Resources Department
cc Peter Schneider, Water Quality Supervisor
Corey Basinger, N C Dept of Environment and Natural Resources
Industrial Inspection File

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H Sullins
Governor Director
September 23, 2009
Mr Mike Mabe
City of Greensboro
401 Patton AN e
Greensboro, NC 27406
Subject Notice of Violation
Compliance Evaluation Inspection
Hugh Medford Municipal Operations Center
NPDES Permit # NCGO80799
Guilford County
Dear Mr Mabe
Dee Freeman
Secretary
On September 18, 2009 a Compliance Inspection was performed by George Smith, of this office Mr Mile
Mabe, Division Manager and Mr Peter Schneider, Water Resources, Stormwater Management Division 'A erc
present for the inspection
Permit
The NPDES general permit became effective on NoN ember 1, 2007 and expires on October 31, 2012
Records & Reports
The following records for this site were inspected per the Ternis & Conditions of the NTPD1 S pernut
1 Monitoring, Controls, and Limitations for Pennitted Discharges per Part II, Section A requires a
Stormwater Pollution Prevention Plan
2 Analytical Monitoring Requirements — Vehicle Maintenance Activities per Part II, Section B
3 Qualitative Monitoring Requirements Part 11, Section D
North Carolina Diwston of Water Quality Winston Salem Regional office
Location 585 Waughtown St Winston Salem North Carolina 27107
Phone [phone] FAX [phone]' Customer Service 1 877.623 6746
Internet www ncwaterquality org
An Equal Opportunely 1 Affirmative Act*n Employer
NorthCarolina
Aaturally

Compliance Evaluation Inspection
September 23, 2009
Page 2 of 2
Facility Site Review
The Storin%%ater Pollution Prevention Plan was developed and neatly organized in a binder
The vehicle maintenance area uses greater than 55 gallons of new motor oil per month over the calendar year
No analytical sampling was performed
There are live outfalls (A, B, C, D, E) The May 14, 2008 letter from the Division granted representative outfall
status for outfalls A, C, and E
Self-Monitonng Pro am
Monitoring requirement for analytical sampling for Vehicle Maintenance Activities was not performed
Qualitative monitoring is performed as required on all five outfalls (A, B, C, D, E)
Please be advised, these v lolations and any future violations are subject to cv, it penalty assessment of up
to $251000 00 per day, per N tolat on, as -v+ell as other actions by the Dui ision of Water Quality
The analytical monitonng for the Vehicle Maintenance Activity must be performed If you have any questions
please contact George Smith or me at [phone]
Sincerely,
Steve W Tedder
Regional Supervisor
cc WSRO Files

4
Compliance Inspection Report
Permit NCG080799 Effective 02M5/08 Expiration 10/31/12 Owner City of Greensboro
SOC Effective Expiration Facility Hugh Medford Municipal Operations Center
County Guilford 401 Patton Ave
Region Winston Salem
Greensboro NC 27408
Contact Person Michael Mabe Title Phone [phone]
Directions to Facility
140 to Elm Eugene street (exit 37) north on Elm Eugene Street to Patton Avenue right on Patton Avenue to 401 Patton Avenue
System Classifications
Primary ORC Certification Phone
Secondary ORC(s)
On Site Representative(s)
Related Permits
Inspection Date 09118/2009 Entry Time 01 25 PM Exit Time 01 45 PM
Primary Inspector George S Smith Phone [phone]
Secondary Inspector(s)
Reason for Inspection Routine Inspection Type Compliance Evaluation
Permit Inspection Type Transportation wlVehicle Maintenance/Petroleum Bulk/Oil
Water Separator Stormwater Discharge COC
Facility Status ❑ Compliant ■ Not Compliant
Question Areas
® Storm Water
(See attachment summary)
Page 1

Permit NCG080799 owner Facility City of Greensboro
Inspection Date 09/1812009 Inspection Type Compliance Evaluation
inspection Summary
Stormwater Pollution Prevention Plan
Does the site have a Stormwater Poilutmn Prevention Pian7
# 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 lint 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)7
# Is the Plan reviewed and updated annually?
# Does the Plan include a Stormwater Facility Inspection Program?
Has the Stormwater PoElution Prevention Plan been implemented?
Comment
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi annually?
Comment
Analytical Monitoring
Has the facility conducted its Analytical monitoring?
Reason for Visit Routine
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas'?
Comment A Notive of Violation for not sampling ROS given for outfalls A C and E
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Yes No NA NE
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Page 2

Stormwater Inspection
General Information
Facility LIl d �or� %�un �[ tie! bp�r��toh �tn�tr
Permit Number J� (',� oj!p 7 Activity
Mailing Address PO goy, 31 34- _
City
County cc.4.f 4a ^ I
State Ali G Zip 2 Y qo z
■aaaaaaa■aararraaaa■■aaaaaaaaaaaa0aaaaa■a a aaa9aaaaaaa■■aaaaaaaaaaaa0aaa■■aaaraa
Facility Information
Contact Person N t c L,. r fta 6 L Title Dv A!",
Telephone Number 3 3 6j 3 7 3- Y I V 7
Physical Location p ! ect"Z Lan )9v-c.
a a a r r a a a a a a a■■ a a a a a a a■■ a a a a a■■ a■■ a a is a a a■ a IN IN a r IN a IN a a a a a a a a a a a a a a a a a a a a a a a a a a a a Is
Key Permit Requirements
Yes No NA
Implement SPPP -Z — —
Secondary Containment _ _11
On -site Vehicle Maint
Yes No NA
Analytical Monitoring _ r/
Qualitative Monitoring lz_
a a a a a a a■ a a a Is a a a a a a a a a a a a a a a a a a a IS a a a a a a a a a a a a a a a a a a a a a a r■ a a a a a a a a a a a a a a a a a a a Is IN a a
Inspection Comments/Site Review
Otcfttls 14 —C
0 !t 6, A-, C-
NUV
(q&j ryj 'kvus Peer- Lcrr
■■ IN a Is a a a a a a a a a a a a a aa a a a a a a a a a a a a a aaa a a a a a r a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a 4
Inspector /yc Date

OC. V�I/47�C - '— J -� Tit= V/ NEichael F Easley Governor
Q State of North Carolina
0 William G Ross Jr Secretary
Department of Environment and Natural Resources
ov Coleen H Sullins Director
Division of Water Quality
May 14, 200$ RECEIVria -
N t 0011t of ENR
Mr Mike Mabe � SAY � � Z008
City of Greensboro
401 Patton Avenue Winston Safe,"
Greensboro, NC 27406 I Wgional office
Subject NPDES Stormwater Permit
Certificate of Coverage NCG080799
Representative Outfall Status Request
Hugh Medford Municipal Operations Center
Guilford County
Dear Mr Mabe
The DWQ Stormwater Permitting Unit staff have reviewed your second request dated March 7,
2008, for a determination that stormwater discharge outfalls from drainage areas A, C, and E be
granted representative outfall status for Stormwater outfalls from drainage areas A, B, C, D, and E
Based on the site map you provided, and on concurrence with your request by DWQ Staff from the
Winston-Salem Regional Office after their site inspection, we are granting your request for
representative outfall status In accordance with 40 CFR §122 21(g)(7), you are authorized to
sample the three outfalls as representative of all five outfalls This approval is effective with the
next sampling event Note that General Permit NCGO80000 still requires that you perform
Qualitative Monitoring at all five outfalls regardless of representative status
Please note that any actions you initiate in response to benchmark exceedences as directed in the
tiered response provisions of your permit must address all drainage areas represented by the three
representative outfalls
Please append this letter to your Stormwater Pollution Prevention Plan (SPPP) to document that
representative outfall status has been approved
If changes in drainage areas, structures, processes, storage practices, or other activities occur that
significantly alter the basis of this approval, representative outfall status is no longer valid In that
case, you should resume sampling at all outfalls, or reapply for representative outfall status based
on updated information
In the event of non-compliance with the permit provisions, or in the event of repeated exceedences
of benchmark values, DWQ may retract our approval of representative outfall status If you have
any questions or comments concerning this letter, please contact me at [phone], ext 584
or at ken pickle@ncmail net
Sincerely,
Ken Pickle
Environmental Engineer
DWQ Stormwater Permitting Unit
cc Corey Basinger, Winston-Salem Regional Office
Stormwater Permitting Unit file NCGO80799
DWQ Central Files
North Carolina Division of Water Quality 1617 Mail Service CenterRaleigh NC 27699 1617 Phone [phone]
Internet 4%uw,ncw ncrcujlit�rg Location 512 N Salisbury St Raleigh NC 27W Fax [phone]i2
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper
a ir NCarolina
Customer Service
1 877-623 6748

C� warE,�Q
� G
7 y`
Michael F Easley Goventor
State of North Carolina
William G Ross Jr Secretary
Department of Environment and Natural Resources
�Q Coleen H Sullins Director
Division of Water Owility
May 14, 2008
Mr Mike Mabe
City of Greensboro
401 Patton Avenue
Greensboro, NC 27406
Subject NPDES Stormwater Permit
Certificate of Coverage NCG080799
Representative Outfall Status Request
Hugh Medford Municipal Operations Center
Guilford County
Dear Mr Mabe
The DWQ Stormwater Permitting Unit staff have reviewed your second request dated March 7,
2008, for a determination that stormwater discharge outfalls from drainage areas A, C, and E be
granted representative outfall status for stormwater outfalls from drainage areas A, B, C, D, and E
Based on the site map you provided, and on concurrence with your request by DWQ staff from the
Winston-Salem Regional Office after their site inspection, we are granting your request for
representative outfall status In accordance with 40 CFR §122 21(g)(7), you are authorized to
sample the three outfalls as representative of all five outfalls This approval is effective with the
next sampling event Note that General Permit NCGO80000 still requires that you perform
Qualitative Monitortng at all five outfalls regardless of representative status
Please note that any actions you initiate in response to benchmark exceedences as dirE�cted in the
tiered response provisions of your permit must address all drainage areas represented by the three
representative outfalls
Please append this letter to your Stormwater Pollution Prevention Plan (SPPP) to document that
representative outfall status has been approved
If changes in drainage areas, structures, processes, storage practices, or other activities occur that
significantly alter the basis of this approval, representative outfall status is no longer valid In that
case, you should resume sampling at all outfalls, or reapply for representative outfall status based
on updated information
In the event of non-compliance with the permit provisions, or in the event of repeated exceedences
of benchmark values, DWQ may retract our approval of representative outfall status If you have
any questions or comments concerning this letter, please contact me at [phone], ext 584
or at ken pickle@ncmail net
Sincerely, Q
Ken Pickle
Environmental Engineer
DWQ Stormwater Permitting Unit
cc Corey Basinger, Winston-Salem Regional Office
Stormwater Permitting Unit file NCGO80799
DWQ Central Files
lV?`hcain uia
Niaturally
North Carolina Division of Water Quality 1617 Mail Service CenterRaleigh NC 27699 1617 Phone [phone] Customer Service
Internet n W ater uelit or g Location 512 N Salisbury St Raleigh NC 27604 Fax [phone] 623 6749
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper

1
Ci
March 7 2008
Mr Ken Pickle
NC Department of Environment & Natural Resources
Division of Water Quality -Storm water Unit
1617 Mail Service Center
Raleigh, NC 27699
RE Representative Outfall Status foi NPDLS No NCGO80799
Dear Mr Pickle
ro
Fidd Operations Departmc it
I he City of Greensboro is in the process of developing a stormwater pollution pie"cntton plan
(SWP-3) for the I Iugh Medford Municipal Operations Centet, which is located at 401 Patton
Avcnue rn Greensboro North Carolina I']ne City has hoed ARCADES G&M ofNotth Carolina
Inc to complete the SWP-3 (currently in draft form) foi this location
ARCADIS identified five outfalls that receive stormwater runoff from the Hugh Medford
facility Upon review of the outfalls, it was observed that some of the drainage areas had similar
land use activities and therefore similar pollutant discharges Based on this information, the City
of Greensboro is of [icrally requesting teptetientative outtall statti,, for three of the five outfalls If
approved by NCDLNIZ the three outfalls will be sampled in accoidance with permit conditions
as listed in No NCGO80799 hncluded with this letter is a map that shows the location of the
thtcc outfalls that were selected during ouH meeting with Mr Covey Bastnget fiom the Regional
Of flee on 1/3/2008
I hank you for assisting with this request If there is any additional information that is needed
please do not hesitate to contact me at [phone] or mike nnabc a�greensboro-nL gov
Sincerely
--MID
Mile Mabe, Manager of Street Maintenance Opeeations
Field Operations Department
PdIC)9P,S�jS�t���GGiO�jlTr��i��l���
Enclosure Location Map of Outfalls
T r�-O
z)k- i PrQ
Cc Kennev McDowell, Manager of Stornnwatcr Management
David Phlegar Water Quality Supervisor /as,
�1 Z/ lea' 6
29 401 Patton Avenue • Greensbot o NC 27406 • Telephone [phone] • Fax [phone]

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CRY Map Legend
-61 o.ro ide •, _0,8..1.
® Combo Not
N This map was created on June 28, 2007 with the use
of Geographic Information Systems (GIS). It was
®�1ne
created by the Field Operations Department of the
r rrc.rtan�ne
Hugh Medford Operations Center: Stormwater Drainage
. ��hoa � ����I���n��
Men no,n
City of Greensboro for the purposes of shaving
Biter from the Hugh Medford
Operations
OperaLarrs Center.
a,+m.gs
S
V P. LW¢No�grp Parbn9/4Eas
cn�easgcs��
40vou,„, d Lh�h NaoteN Operations Parma I
oo�
Feet

LOCATION MAP
Latitude 36°02'30" N NCG080799 FacilitysF
Longitude 79046'54" W
County Guilford City of Greensboro Location
1
Stream Class C, NSW
Receiving Stream We Run Creek & South Buffalo Grcck
Sub -basin 03-06-02 (Cape Fear River Basin) [�o'tthIF
Not to Scale

Ci
January 15, 2008
NC Department of Environment & Natuia] Resources
Division of r uality
CIO M orey Basin
58 treet
inston-Salem, NC 27107
RE Representative Outfall Status for N PD ES No NCGO90799
Dear Mr Basinger
Fjj1 �ra1jons Department
NO Dept of ENR
JAN 1 6 2008
Winston Salem
Regloual office
The City of Greensboro is in the process of developing a storm -water pollution prevention plan
(SWP-3) for the Hugh Medford Municipal Operations Center, which is located at 401 Patton
Avenue in Greensboro, North Carolina the City has hired ARCADIS G&M of North Carolina,
Inc to complete the SWP-3 (currently in draft form) for this location
ARCADIS identified five outfalls that receive stormwater runoff from the Hugh Medford
facility Upon review of the outfalls, it was observed that some of the drainage areas had similar
land use activities and therefore similar pollutant discharges Based on this information, the City
of Greensboro is officially requesting representative outfall status for three of the five outfalls If
approved by NCDENR, the three outfalls will be sampled in accordance with permit conditions
as listed in No NC6080799 Included with this letter is a map that shows the location of the
three outfalls that were selected during the meeting Peter Schneider and l had with you on
1 /3/2008
Thank you for visiting the City facility and assisting with this request If there is any additional
information that is needed please do not hesitate to contact me at [phone] or
mike mabe(a�,greensboio-nc gov
Sincerely,
,
Mike Mabc, Manager of Street Maintenance Operations
Field Operations Department
Enclosure Location Map of Outfalls
Cc Kenney McDowell, Manager of Stormwater Management
David Phlegar, Water Quality Supervisor
Jana Chaney, ARCADIS, Inc
29 401 Patton Avenue. - Gicensboto, NC 27406 0 telephone [phone] Fax ( 436) 412 6187

Hugh Medford Municipal Operations Center; Outfall Locations
Legend
County Centerline
A Outfall Marker
1 inch equals 271 feet
1:3,257
Sensitive Information NOT
to be copied or distributed
without written permission
from the City of Greensboro.
WATER
esources
City of Greensboro

'$—[..e w� ncmren.,. n Pus map was created m Jule 28. 29D7 wth She use of Ge WWivc IMumaum Systems
MEA (GZ). M was —k d by She Reid Opeahoes Departm-t of She C!y of G-cnsbo b the
Hugh Medford Operations Center: Stormwater Drainag�9,d-e Legend N ` ¢-, ©� "- w I' pu�ofsha rq stormwate dudtwge frw.5 Uw Hugh Medfud Ope bti Center
62
■ r ' o ioo mo ena �o

r 'l
Michael F Easley Governor ✓ " "
William G Ross Jr Secrelary
North Carolina Department of Environment and Natural Resources
i
Coleen H Sullins Director
Division of Water Quality
July 20, 2007
Mike Mabe
City of Greensboro
401 Patton Avenue
Gi eensboro, NC 27408
Subject General Permit No NCGO80000
Hugh Medford Municipal
Operations Center
COC NCGO80799
Guilford County
Dear Mr Mabe
In accordance with your application for a discharge permit received on July 13, 2007, 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 May 9, 1994 (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 pf.rmits required by the Division of Land 11
Resources, Coastal Area Management Act or any other federal or local governmental pernart that
may be required
If you have any questions concerning this permit, please contact Robert P-qcterson at
telephone number [phone] ext 360
cc Winston-Salem Regional Office
Central Files
Stormwater Permitting Unit files
Sincerely,
ORIGINAL SIGNED BY j
E RADLEY 6ENNE-f i
for Coleen H Sullins
N"ox�nCarolina
watura1&
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh NC 27699 1617 Phone (919) 7
83 Customer Service
Q y Location 512 N Saltsbun St Raleigh NC 27604 Fax 919 7" i12 1 877 6'3 6748
]nlemct www nc,«atcrqullrtr ors g ( )�
Jr
An Equal OpportundylAffrmative Acton Employer— 50% Recycled110% Post Consurn r

I�
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO NCGO80000
CERTIFICATE OF COVERAGE No NCGO80799
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,
City of Greensboro
is hereby authorized to discharge stormwater from a facility located at
Hugh Medford Municipal Operations Center
401 Patton Avenue
Greensboro
Guilford County
to receiving waters designated as Mile Run Creek and South Buffalo Creek, both class C, NSW
waters in the Cape Fear River Basin, in accordance with the effluent limitations, monztonng
requirements, and other conditions set forth in Parts I, II, III, IV, V, and VI of General Permit No
NCGO80000 as attached
This certificate of coverage shall become effective July 20, 2007
This Certificate of Coverage shall remain in effect for the duration of the General Permit
Signed this 20th Day of July 2007
ORIGINAL SIGNED BY
BRADLEY BENNETT
for Coleen H Sullins, Director
Division of Water Quality
By the Authority of the Environmental Management Commission

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BROOKS&MEOLOCK
ENGINEERING PLLG
Phone [phone] Fax [phone]
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Subject _ By,5-- _ Sheet
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R'aK'FERENC.ES
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31
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f FOUND 51e
- - IRON ROD
S - r
1995.5
R 1 ASK NG LOT r
l pAR '1
N/F .
O BO YD P. A YERS AND WIFF, 1
Q ANNABEL LEE A YERS
REMAINDER OF r
DEED BOOK 1403, PAGE 277
.® PIN # 9699-17-11- 7391 2000.0
TRACT I
PLAT BOOK 79, PAGE 29 r
P CHAIN LINK FENCE
ALONG LINE f
10
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L �r9 2000.0 !,
I FOUND N.C. G. 5
"SWANNAN04"
$ E 991955.74
1 FOUND 518 4'¢1
85.10'49 E IRON ROD
PLAT TIE N
701.
178 . 6 �-
GROUNO DISTANCE �� �.,: ;� 8¢ ¢j g4.
GRID 86J5TIE N CE 170 .59' - � !, � �,. s.�i �.' .. .- 5 74•�5 �� I�OUNL
GRID DISTANCE .®
i' I IRG
T[CLIN� 14-7 91
74
.�
�" F FOUND 3/4 "
IRON PIPE
Pipe Bedding, Encasement, and Backfill-
1. Pipe bedding material shall be a granular material consisting of gravel, crusnecl gravel or stone
G meeting the requirements of ASTM C-33, gradation #67 (3/4 inch to No. 4) .
2. Concrete for cradles, encasement or thrust blocking shall be 3000 psi, Class 11.
3. All soil that is soft, unstable, unsuitable, or saturated with water shall be removed and the trench
subgrade shall be stabilized with a granular material having a maximum size of 2 inches. A
F concrete cradle shall be provided to bridge highly unstable soils.
4. Pipe to be installed above the existing ground level (in fill) shall be installed in trenches excavated
after the embankment has been constructed to a minimum elevation of one -foot above the top of the
proposed pipe.
5. Compacted granular backfill under and around the pipe shall be placed in 6" lifts and compacted
E to obtain not less than 90% relative density, as determined by ASTM method D-2049.
6. BACKFILL: All material used for backfilling trenches shall be free of excess amounts of
deleterious materials such as organic matter, frozen clods, and sticky masses or clay and gumbo
which are difficult to properly compact. Any rock materials used for backfill will have no single
dimension greater than 4" and shall not be placed within 12" of the installed pipe in any direction.
0 Material as specified for pipe bedding may be substituted for backfill material defined above from
the top of pipe bedding to 12" above the top of the pipe.
( A) Backfill shall be placed in 8" lifts from the top of the pipe bedding to a point at least 12"
above the top of the pipe. Above this point, backfill shall be placed in lifts suitable to
achieve the compaction as specified hereinafter.
C
(B) The lifts of backfill material will be compacted to a density of at least 90% of the
maximum dry density as determined by the AASHTO Standard Test T99 or other
approved method wherever the pipe is installed in open fields or areas which carry no
vehicular traffic_ The top portion of the backfill areas that are to be seeded or sodded
shall be composed of topsoil at least 6" in depth and corresponding to that of the
B adjoining areas.
(C) The lifts of backfill material will be compacted to a density if 95% of the standard
Proctor within +/- 2% wet of optimum under all pavements and in those areas subject to
future pavements. Pavement shall not be restored until the backfill material has been
tested and determined to be satisfactory according to the geotechnical engineer.
A Pavement restoration shall conform as closely as possible to the existing pavement
section in the area of the trench.
11 2 131 4 R 7 R
FOUND 3/4"
IRON PIPE
N/F
WLLIAM L. DAUGHERTY AND WIFE,
JO YCE P. DA UGHERTY
DEED BOOK 2786, PAGE 663
PIN # 9699-17-11--9047
LOT 8
PLAT BOOK 24, PAGE 58
GRAPHIC SCALE
iiiii
0 10 20 40
1" = 20'
4 in 11 17
- REFERENCES
DEED BOOK 4041, PAGE 42
PLAT BOOK 79, PA GF 29
PLAT BOOK 24, PA GF 58
V#S _
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WAY
70
gsahgL T P PgGE 29
A UE�eNT
5 cul
FOUND 1-112"
IRON PIPE -
FOUND PK NAIL
11 1 14 1 15 1 16 1 17 1 I€1 1 1p I g0
HlGywAY 70
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LOCATION SKETCH
NOT TO SCALE
L EGEND
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O R/W RIGHT OF WA Y ® DRAINAGE MANHOLE
r�4
0 FOUND IRON PIN 0 SA NI TA R Y MA NHOL E
FOUND STONE WM WATER METER
O f wv
SET BENCHMARK WA TER VAL I/E
O ^
l W WOOD POWER POLE ® CA TCI I BASIN
l� o CENiE"RLINE O CONCRETE POWER POLE
I m L PROPERTY LINE ❑T TELEPHONE RISER
I �
a FIRE H YDRAN T E M ELECTRIC METER
�- PROPOSED DRAINAGE FLOW C/O CLEAN OUT
PROPOSED FINISHED GRADE SPOT ELF 11A TION
_ _ _ _ _ N/F NOW OR FORMERL Y
01.0 /Ii -OH- OIAFFrHEAD WIRE
FOUND 314 " - BOUADAR Y LINE NOT SURVEYED
IRON PIPE
SET 5/8" IRON ROD WITH L - 4JI9 CAP
Ji. N 1
LINE NOT TO SCALE
l3 \ "' I \
DRAINAGE AREA BOUNDARY
/W
NOTES
1.) THIS SUR i/EY IS OF AN EXIS77NG PARCEL OR PARCELS OF LAND
2) THE BEARINGS SHOWN HEREON ARE BASED ON PLAT BOOK 79, PAGE
29 AND ARE REFERENCED TO THE NORTHERL Y LINE OF TRACT 2 OF SAID
lilt PLA T BOOK HA VING A BEARING OF S75 23'00 E
N/F
AL VIN W. BERRY, IR. AND WIFE, 3.) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS,
SADIE B. BERRY RIGHT OF WAYS OR OWNERSHIPS.
DEED BOOK 3728, PAGE 75
s j l 3 N c,s PIN # 9699-17-21-2264 4.) THE RA TO OF PRECISION OF THE UNBALANCED IRA VERSE MEETS OR
IFR o� LOT 4 EXCEFD 1 101wo.
l
d+ / . PLA T BOOK 24, PAGE 58 q, .
5.) TI•r'c HORIZONTAL AND VERTICAL DATA AND FEATURES SHOWN HEREON
WERE 037AINED UTILIZING A "TRIMBLE 3306" TOTAL STATION AND "TDS "
DATA COLLECTION SYSTEM.
Zo '�� ��^ � // 6. THE FEA TURF SYMBOL LOCH TONS ARE TO THE CENTER OF THE
SYMBOL AND MA Y BE ENLARGED FOR CLARITY.
7.) UNDERGROUND FOUNDATIONS AND/OR UNDERGROUND UTILI77ES HA VE
�2Z35 NOT BEEN LOCATED.
8.) BEARINGS AND DISTANCES SHOWN IN PARENTHESIS REPRESENT DEED
e AND OR PLAT VALUES.
Q�• , FOUND 3/4 " 9.) ACRrAGE COMPUTED BY THE COORDINA TE METHOD.
0
99.98) IRON PIPE 10.) THE SUBJECT PROPERTY IS NOT LOCATED W/THIN A SPECIAL FLOOD
5'49" 'N HAZARE AREA AS DETERMINED BY F.E.M.A.
11.) THt GRID TIE SHOWN HEREON IS BASED ON NORTH CAROLINA
GEODETC CONTROL POINTS.
SWANN,I NOA: N. 691171.04, F. 990257. 17, SCALE FACTOR = 0.999891177
W 139: M 69024J05, E 994498.621, SCALE FACTOR = 0.999890949
NAD 1 03.
12.) ELr VATIONS AND CONTOURS SHOWN HEREON ARE BASED ON THE
NA TIONIL GEODE77C VERTICAL DATUM OF 1929 (NGV929) AND IS
RFFERL'VCED TO NORTH CAROLINA GEODETIC CONTROL POINT
p 'SWANMNOA ', ELEVATION: 2189.15'
° I3.) COJSUL T PROJECT ENGINEER IF GROUND WA TER IS ENCOUNTERED
N/F Z DURIN'CONSTRUC RON OF POND & TANK EXCA VA TION.
REW K. COOPER s�
OK 2960, PAGE 300
9699-17211069 N3 SANDERS
LOT 6
'OOK 24, PAGE 58 SURVEYING & MAPPING
cm
SERVICES, INC.
[phone]
510 PVENA ROAD, BLACK MOUNTAIN, NORTH CAROLINA, 28711
SITE KEYS.
(D
NEW RETENTION POND, STORMWATER VOLUME PROVIDED 7,991 CU. -FT.
ORETENTION
POND PUMP VAULT 3'x3'X4' PRECAST BASIN; PROVIDE 6" 0 OPENING @ Center of 3 sides,
O166
IE=2195.0 ALL NREE
L. F. OF 2" 0 SCH 40 PVC FORCEMAIN
FOUND 314 " 4O
GRADE TOP OFPOND TO DAYLIGHT @ 1.5: 1 MAX. SLOPE
IRON PIPE
OS
WASTEWATER COLLECTION BASIN, SEE DETAIL SHEET C2
O12
L.F. OF 8"U;CH 40 PVC GRAVITY PIPE, IEin=2197.5, IEouft=2197.28
O3,
000 GALLON NASTEWATER STORAGE TANK W/ PUMP RATED AT 50 GPM @ 25' TD; HIGH WATER
ALARM SET @ E5% OF TANK CAPACITY
O145
L.F. OF 2" ¢ SCH 40 PVC FORCEMAIN TO EXISTING ABOVE GROUND WATER STORAGE TANK
OEXISTING
10' DIAMETER, 21' HIGH WATER STORAGE TANK
1fl
CONSTRUCT EARTH SWALE FOR POND EMERGENCY OVERFLOW, SEE DETAIL
91 1 99 1 23 1 24 1 95 1 9R 1 97
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