NCG110146_COMPLETE FILE - HISTORICAL_20121015

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V o t
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ <�Lo 1 a, / 17 i 5
YYYYMMDD

ALF
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverfy Eaves Perdue Charles Wakild, P. E.
Governor Director
October 15, 2012
W. Tim Church, Water Resource Director
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
Subject: Compliance Evaluation Inspection
Town of Jefferson
Permit # NCG 110146
Ashe County
Dear W. Church:
Dee Freeman
Secretary
On October 10, 2012 a Compliance Evaluation Inspection was performed by George Smith, of this office, Mr. Tim
Church was present for the inspection.
Records & Reports
The Stormwater Pollution Prevention Plan SPPP was developed.
Facility Site Review
The site plan identified one stormwater outfall-
The Town has secondary containment measures to control chemicals in the event of a spill.
Self -Monitoring Program
The facility had the qualitative monitoring records for the outfall. The outfall is required to be monitored semi-annually.
The compliance evaluation is satisfactory. If you have any questions please contact George Smith or me at (336) 771--
5000.
Sincerely,
r
W. Corey Basinger
Regional Supervisor
cc: WSRO Files
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 5M Waughtown St. Winston-Salem, North Carolina 27107
Phone:[phone] FAX: 336-T71-4630
Internet www.nwaterquality.org
An Equal opportunity 1 Affirmative Action Employer
�orthCarolina
Araturallr�

i
f Compliance Inspection. Report
Permit: NCGI 10146 Effective: 04/01/10 Expiration: 05/31/13 Owner: Town -of Jefferson
SOC: Effective: Expiration: Facility: Jefferson WWTP
County: Ashe 1233 NC Hwy 16 S
Region- Winston-Salem
Jefferson NC 28640
Contact Person: D E Hightower Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 10/1012012 Entry Time: 09:00 AM Exit Time: 11:15 AM
Primary Inspector: George S Smith Phone: [phone]
Secondary Inspector(s):
Reason for Inspection. Routine Inspection Type: Compliance -Evaluation
Permit Inspection Type: Municipal WWTP n 1MGD, Stormwater Discharge, COC
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
Storm Water
f
(See attachment summary)
Page: 1

9
Permit: NCG110146 Owner - Facility: Town of Jefferson
Inspection Date: 10110/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Stortnwater 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?
❑
❑ ■
n
# Has the facility evaluated feasible alternatives to current practices?
❑
❑ ❑
■
# Does the facility provide all necessary secondary containment?
■
❑ ❑
❑
# Does the Plan include a BMP summary?
■
❑ ❑
n
# 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?
■
❑ ❑
❑
Has the Stormwater Pollution Prevention Plan been implemented?
■
❑ ❑
❑
Comment:
Qualitative Monitoring
Yes No NA
NE
Has the facility conducted its Qualitative Monitoring semi-annually?
■
O ❑
❑
Comment:
Page: 2

i
M
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Chades Wakild, P. E.
Governor Director
February 1, 2012
Mr. Tim Church, Water Resource Director
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
Subject: Compliance Evaluation Inspection
Town of Jefferson
Permit # NCG110146
Ashe County
Dear Mr. Church:
Dee Freeman
Secretary
On January 24, 2012 a Compliance Evaluation Inspection was performed by George Smith, of this office, Mr. Tim
Church was present for the inspection.
Records & Reports
The Stormwater Pollution Prevention Plan SPPP was developed.
Facility Site Review
The site plan identified one stormwater outfall.
The Town has secondary containment measures to control chemicals in the event of a spill.
Self -Monitoring Program
The facility had the qualitative monitoring records for the outfall. The outfall is required to be monitored semi. -annually.
The stormwater program is satisfactory. 1f you have any questions please contact George Smith or me at [phone].
cc: •WSR9+ilm
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 565 Waughtown St, Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone]
Internet: www.ncwatergUality.org
An Equal Opportunity 1 Affirmative Action Employer
Sincerely,
W. Corey Basinger
Regional Supervisor
NorthCarolina
Naturally,

Compliance Inspection Report
Permit: NCG110146 Effective: 04101/10 Expiration: 05/31/13 Owner: Town of Jefferson
SOC: Effective: Expiration: Facility: Jefferson WWTP
County: Ashe 1233 NC Hwy 16 8
Region: Winston-Salem
Contact Person: C E Hightower Title:
Directions to Facility:
System Classifications:
Primary ORC: '
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 01/2412012 Entry Time: 09:00 AM
Primary Inspector: George 8 Smith
Secondary Inspector(s):
Jefferson NC 28640
Phone: [phone]
Certification: Phone:
Exit Time: 11:30 AM
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Municipal WWTP > 1MGD, Stormwater Discharge, COC
Facility Status: ■ Compliant 0 Not Compliant
Question Areas:
0 Storm Water.
(See attachment summary)
Page: 1
0

1
Permit: NCG110146 Owner - Facility: Town of Jefferson
Inspection Date: 01/24/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Stormwater Pollution Prevention Plan
Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
n
n n
# Does the Plan include a General Location (USES) map?
■ n
n n
# Does the Plan include a "Narrative Description of Practices"?
■ n
n n
# Does the Plan include a detailed site map including outfail locations and drainage areas?
■ n
n n
# Does the Plan include a list of significant spills occurring during the past 3 years?
■ n
n n
# Has the facility evaluated feasible alternatives to current practices?
■ n
n n
# Does the facility provide all necessary secondary containment?
n
n n
# Does the Plan include a BMP summary?
M n
❑ n
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
■ n
n n
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
■ n
n n
# Does the facility provide and document Employee Training?
■ n
n n
# Does the Plan include a list of Responsible Party(s)?
■ n
n n
# Is the Plan reviewed and updated annually?
n n
n ■
# Does the Plan include a Stormwater Facility Inspection Program?
■ n
n n
Has the Stormwater Pollution Prevention Plan been implemented?
n D
0 ■
Comment:
Qualitative Monitoring Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ■ n 0 n
Comment:
Page: 2

l NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
August 1, 2011
Mr. Tim Church, Water Resource Director
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
Subject: Compliance Evaluation Inspection
Town of Jefferson
Permit # NCG110146
Ashe County
Dear Mr. Church:
On July 27, 2011 a Compliance Stormwater Inspection was performed by George Smith, of this office, Mr. Tim Church
was present for the inspection.
Records & Reports
The basic elements of Stormwater Pollution Prevention Plan SPPP were developed.
Analytical monitoring for on -site vehicle maintenance is not required, since an average 55 gallons per month of new
motor oil is not used.
Facility Site Review
The site plan identified one stormwater outfall.
The Town has secondary containment measures to control chemicals in the event of a spill.
Self -Monitoring Program
The facility had all monitoring records on -site.
Stormwater Discharge Outfalls (SDO) were inspected semi-annually and qualitatively monitored as required in the permit.
The stormwater program is satisfactory. If you have any questions please contact George Smith or me at [phone].
Sincerely, h
W. Corey Basinger
Regional Supervisor
cc: WSRO Files
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: 336-771-M I FAX: [phone] Customer Service:1-877-623-6748
Internet: www.ncwaterquaidy.org
An Equal opportunity 1 Affirmative Action Employer
NorthCarolina
)Vaturally

Compliance Inspection Report
Permit: NGG110146 Effective: 04101/10 , Expiration: 05/31/13 Owner: Town of Jefferson
SOC: Effective: Expiration: Facility: Jefferson VWfP
County: Ashe 1233 NC Hwy 16 S
Region: Winston-Salem
Jefferson NC 28640
Contact Person: D E Hightower Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:. Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection pate: 07/27/2011 Entry Time: 09:30 AM Exit Time: 11:20 AM
Primary Inspector. George S Smith Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Municipal VWVfP > 1 MGD, Stormwater Discharge, COC
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
■ Storm Water
(See attachment summary)
Page: 1

r
Permit: NCG110146 Owner - Facility: Town of Jefferson
Inspection Date: 07/27/2011 Inspection Type: Compliance Evaluation
Reason for Visit: Routine
Inspection Summary:
Stormwater Pollution Prevention Plan
Yes No
NA NE
Does the site have a Stormwater Pollution Prevention Plan?
■ ❑
❑ Cl
# Does the Plan include a General Location (USGS) map?
■ ❑
n n .
# Does the Plan include a `Narrative Description of Practices'?
■ ❑
❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
■ ❑
❑ Cl
# 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)?
■ ❑
Cl ❑
# 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?
■ ❑
Cl ❑
Has the Stormwater Pollution Prevention Plan been implemented?
■ ❑
❑ ❑
Comment:
Qualitative Monitoring
Yes No
NA NE
Has the facility conducted its Qualitative Monitoring semi-annually?
■ ❑
Cl ❑
Comment:
Permit and Outfalls
Yes No
NA NE
# is a copy of the Permit and the Certificate of Coverage available at the site?
■ ❑
❑ ❑
# Were all out€ails observed during the inspection?
■ ❑
❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division?
❑ ❑
■ n
# Has the facility evaluated all illicit (non stormwater) discharges?
❑ ❑
■ ❑
Comment:
Page: 2
0

e
A
�� Division of Water Quality / Water Quality Section
NCDENRNational Pollutant Discharge Elimination System
`twl.+ G.+rsw De..wrveX er
i1kRYIY!Tr Vd r1AVRA, ii9SJ►J}
NCGlIO000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Y. I Wnt't Day
CcrSicatc [ ceveraae
N1
Cixck A
mount
PSnjt ASS =*n rO
w M 't
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG110000:
STORMWATER DISCHARGES associated with activities classified as:
Treatment Works treating domestic sewage or any other sewage sludge or wastewater treatment
device or system, used in the storage, treatment, recycling, and reclamation of municipal or
domestic sewage, with a design flow of 1.0 million gallons per day or more, or required to have an
approved pretreatment program under Title 40 Code of Federal Regulations (CFR) Part 403,
including lands dedicated to the disposal of sewage sludge that is located',within the confines of
the facility; and like activities deemed by DWQ to be similar in the process and/or the exposure of
raw materials, products, by-products, or waste materials.
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
-Town wn f)1�t: Sersm WWTP r/�
o , chura
Street Address
City
Telephone No.
E-mail Address
2) Location of facility producing discharge:
Facility Name
Facility Contact
Contact E-mail
Street Address
City
County
Telephone No.
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street naj� es, state road
distance and direction from a roadwa intersec Ion)_ From inT�lset6n of 11Wy 16/V a
k 1_ t r 1 li nry , i_ . t t .V_ r
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application)
alp° Z7' 314 $! oZg, 37It
4) Latitude X 36. y Longit de ~ 31. UJ9221 (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
1
iJ Existing
Page 1 of 4
SWU-226-071408
Last Revised 7/14/2008
and

T
.IN
NCG110000 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:
7) Provide a brief narrative descri tion of the types of industrial activities and products manufactured at
this facility: �TPAfynf.rd ti'Mul-If EDP i Wq.S�-t��fllf a _ _ _...._....-
8) Discharge points / Receiving waters:
Wow many discharge points (ditches, pipes, channels, etc-) convey stormwater from the property?
9) Receiving waters:
What is the name of the body or Ipodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in?
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
10) Does this facility have any other NPDES permits?
❑ No
[dyes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
lo
Ye
Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:WOOZ173)
12) Does this facility employ any best management practices for stormwater control?
L,d No
❑ Yes
If yes, please briefly describe:
13) Does this facility have a Stormwater Pollution Prevention Plan?
�d(No
❑ Yes
If yes, when was it implemented?
14) Are vehicle maintenance activities occurring at this facility?
®(No ❑ Yes p
15) Hazardous Waste:
a) Is is facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
Is
❑ Yes
Page 2 of 4
5WU-22"71408 Last Revised 7114/2"

NCG110000 N.O.I.
b) Is this facility a Small Quantity Generator (loss than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
Er-4o ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
5(No ❑ Yes
d) 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 f disposai vendor: _
Vendor address:
16),Certification: ' -
North Carolina General Statute 1 a3-215.6 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 Articte; 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 {$l O.COO).
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,
knowledge and belief such information is true, complete, and accurate.
Printed Name 9fgPer(Aopn Signing'.
I itie: IAI&k A&-ZnftrCei
LAin�
ure of Applicant) . (Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDENR
SWU-226-0714m
Page 3 of 4
Last Revised 7l14l2008

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Towri of Jefferson,.'
WWTP NCG110146 i {:. �.
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Latitude:3b°L4'34" N{,G�'���4s Facility
Longitude: 81025'39" _ y
County: Ashe Town of Jefferson Location
Stream Class: C VVWTP
Receiving Stream: Nal-d Creek
Sub -basin: 05-07-01(New River Basin) N4T ltlILIED

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