NCG120099_COMPLETE FILE - HISTORICAL_20171103

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
C9'HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
o U10 11 03
YYYYMMDD

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy. Mineral PERMIT OWNER. AFFILIATION DESIGNATION FORM
Land Resources EN VIRONMEN7 Al QUALITY (Individual Legally Responsible for Permit)
FORAGENCY USE OPLY
Date Received
Year
Month
Dav
-,k � \'�
tl"
Use this form if there has been:
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 musf 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:
RECEIVED
• the responsible corporate officer (for a corporation); NOV — 3 2017
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency); D!_NR-LAND QUALITY
g • the general partner or proprietor (for a partnership or sole proprietorship); STORMVJATER PERMITTING
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit (ot) Certificate of Coverage
N I C I S ! N I C G 009
2) Facility Information:
Facility name: old Scd ISf>UrL
Company/Owner Organization: t j-t!�Sti
Facility address:adtFd
Address
City ! State - Zip
To find the current legally responsible person associated'with your permit, go to this wcbsite:
littj2:Hdcg.iic.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/stomiwater-pro ram
and run the Permit Contact Summary Report.
3) OLD OWNER AI -FILIATION that should be removed:
Previous legally responsible individual: V-N4amy-ovic,
First M[ Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
First MI Last
Page 1 of 2
SWU-OwnERAFFIL-23NIarch 2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Title
Mailing Ado
W� hs - even2� toZ
City State � Zip
Telephone Ganail Address
Fax Number f
5) Reason for this change:
A result of: Et ployee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERM ITTEE CERTIFICATION:
1 , attest that this application for this change in Owner Affiliation
(pens legally responsible or he 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 are not completed, this change may not be
,processed._
. Z L
Signature Date
U� c V
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Ralcigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website at:
littp://deq.nc.gov/about/divisions/energy-mineral-land-resources/storrnwater
Page 2 of 2
Swt1-0wNE:RA1-'1-'IL-23Mar201 7

P(A,et6+-SuieM Ro-'EUe uyG,; fe
Rr-CE1.---�
Akwe
N.C.Dept. of Z.
AUG 13 2013
NCDENR�
North Carolina Department of Environment and Natural Resottes4'°na: Gt` a --
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM
Director
Mr. Roger Marcum
WI High Point Landfill, LLC
5830 Riverdale Drive
Jamestown, NC 27282
Dear Mr. Marcum:
Pat McCrory, Governor
John E. Skvarla, III, Secretary
August 8, 2013
Subject: General Permit No. NCG 120000
WI High Point C&D Landfill
COC No. NCG 120099
Guilford County
In accordance with your application for a discharge permit received on July 23, 2013,
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). This letter also serves as notification that your facility's permit
coverage under COC No. NCG130053 is rescinded effective immediately in accordance with
your request.
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.
Per the requirements of the Randleman Lake Water Supply Watershed Buffer Rule,
all stormwater drainage to stream buffers, from portions of this site that have been
constructed after April 1, 1999, must be discharged through a correctly designed level
spreader or another device that meets diffuse flow requirements per 15A NCAC 2B .0250.
Diffuse flow requirements are described in Chapter 8 of the North Carolina Stormwater BMP
Manual, available at: http://portal.nedenr.org/web/wg/ws/s_u/bmp-manual.
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 • Telephone [phone] FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet htt :/1 ortal.ncdenr.or lwebllrlland uali
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

Mr. Roger Marcum
WI High Point C&D Landfill — NCG120099
August 8, 2013
If you have any questions concerning this permit, please contact Julie Ventaloro at
telephone number [phone] or by email [e-mail].
Sincerely,
ORIGINAL SIGNED M '
KEN PICKLE
for Tracy E. Davis, P.E., CPM
cc: v4inston-Salem Regional Office, Sue White
Central Files
Stormwater Permitting Unit Files
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 - Telephone [phone] FAX; 919-733-2876
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: htti):l/Portal,ncdenr.orglwebllrf and -quality
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG120000
CERTIFICATE OF COVERAGE No. NCG120099
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,
WI High Point Landfill, LLC
is hereby authorized to discharge stormwater from a facility located at
WI High Point C&D Landfill
5830 Riverdale Drive
Jamestown
Guilford County
to receiving waters designated as Richland Creek, a class WS-IV;CA;* water in the Cape Fear
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. NCG120000 as attached.
This certificate of coverage shall become effective August 8, 2013.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 8, 2013.
ORIGINALP CK�E 81
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

��A
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, RE,
Governor Director
February 15, 2013
Mr. Edward Gibson, Solid Waste Engineer
c/o City of Winston-Salem/City-County Utilities Commission
P.O. Box 2511
Winston-Salem, North Carolina 27102
Dear Mr. Gibson:
John E. Skvarla, III
Secretary
Subject: General Permit No. NCG120000
Winston-Salem Old Salisbury Road Landfill
COC No, NCG120095
Forsyth County
In accordance with your application for a discharge permit received on November 15, 2012, 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).
If any parts, measurement frequencies, or sampling requirements contained in this permit are unacceptable to
you, you have the right to request an individual permit by submitting an individual permit application. Unless such
demand is made, this certificate of coverage shall be final and binding.
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 Bill Diuguid, Stormwater Staff
Planner at telephone number [phone].
Sincerely,
ORIGINAL SIGNED 61
KEN PICKLE
Charles Wakild, P.E.
cc: Winston-Salem Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699.1617 NorthCarolina
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: 91M07.63001 PAX: 919-807-6494 Naturally
ww. Internet: wncwaterquallty.org
An Equal Opportunity 1 AftrmaUve Action Employer

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG120000
CERTIFICATE OF COVERAGE No. NCG120095
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 Winston-Salem/City-County Utilities Commission
is hereby authorized to discharge stormwater from a facility located at
Old Salisbury Road Landfill
3336 Old Salisbury Road
Winston-Salem
Forsyth County
to receiving waters designated as South Fork Muddy Creek, a Class C waterbody, Yadkin River Basin; in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, I1, I11, IV,
V and VI of General Permit No. NCG 120000, as attached.
This Certificate of Coverage shall become effective February 15, 2013.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 15, 2013.
ORIGINAL
SIGNED 131CKLE
KEN
Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Winston-Salem West Quadrangle
i
k
Welcome Quadrangle
10 0 1000 2000 3000 =000 5000 6000 7000 FEET
I K I LOMETER
Figure 2. Location of Project Area in bouthern.Forsyth County.
OLD SALISBURY ROAD LANDFILL
==9____-� I
Gulf Cot
Ot)A!)RANGLE. LOCATION

�C
PROJECT MANAGER M.D
PROJECT NUMBER 1000000190537,018

LANDFILL
M
I
TYPICAL SIDESLOPE DIVERSION BERM 3
NTS
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SOIL BORROW
AREA �
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0
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to } YY.
IOT FOR I NPDES NOTICE OF INTENT
STRUCTION
OLD SALISBURY ROAD
CONSTRUCTION AND DEMOLITIOlk
LANDFILL
WINSTON-SALEM
NORTH C

3 4
rTURF REINFORCED MATTING
TOP OF DAM ! f (NORTH AMERICAN GREEN C3`
5 ,
I-- L �1
TYPICAL EMERGENCY SPILLWAY CA
NTS
50' TO 100'
MIN, 15' 3
1
r77o MIN. SLOPE
TYPICAL TERRACE DETAIL

NTS
.OLINA
TO[
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FLOW TOE OF BENCH
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TYPICAL SLOPE DRAIN
NTS
SLOPE DRAINS ARE 12 OR 15 INCH DIAMETER CORRUGATED HDPE.
OLD SALISBURY ROAD
NPDES PERMIT
SITE DIAGRAM
0 2"
FILENAME 04C-02.dwg SHEET
SCALE 1"=200' Figure 1
:'
w

W A
EMERGENCY SPILLWAY
TOP OF DAM
EMBANKMENT STABILIZED
WITH VEGETATION
TURF REINFORCED MATTING (NORTH
1 AMERICAN GRE C350 OR EQUAL)
M
OUTLET APRON
DB
1ARREL)
YPICAL SEDIMENT
ASIN RISER BARREL 2
S -
2 :1 SIDE ''''i•
SLOPE MAX.
FILTER FABRIC
#57 STONE
1800 Cu Ft/ Acre
ANTI —SEEP COLLAR
9"-14" RIP —RAP
A OVERFILL 6" FOR
SETTLEMENT
4' MIN57
I l ILI=
EMERGENCY
BY—PASS 6"
BELOW SETTLED
TOP OF DAM
3' MIN 1:1 SIDE NATURAL GROUND
SLOPE MAX.
""-FILTER FABRIC
C
SECTION —
TYPIC:AI SFDIMFNT TRAP �1

7 I 8
W A
EMERGENCY SPILLWAY
TOP OF DAM
EMBANKMENT STABILIZED
r
�j.
WITH VEGETATION
TURF REINFORCED MATTING (NORTH
�1 z 1� AMERICAN GRE C350 OR EQUAL)
M B
OUTLET APRON
013
BARREL)
YPICAL SEDIMENT
ASIN RISER BARREL 2
S I -
2:1 SIDE
SLOPE MAX.
FILTER FABRIC
#57 STONE
1800 Cu Ft/ Acre
ANTI —SEEP COLLAR
9"-14" RIP —RAP
A OVERFILL 6" FOR
SETTLEMENT
4' MINMIN`�
EMERGENCY
BY—PASS 6"
.`' BELOW SETTLED
TOP OF DAM
3' MIN 1:1 SIDE NATURAL GROUND
i SLOPE MAX.
"—FILTER FABRIC
will
C
S
TYPICAL. SEDIMENT TRAP

N
LEGEND
SEDIMENT TRA
Y S'E'DIVENT-
STD #
UNPAVED ROAD -- ---- -- --- - - - -
I
DRAINAGE DIRECTION
LIMITS OF WASTE
PROPERTY LIN
fal
HOR Engineering, Inc.
of the Carolinas
J A
N.C.S.E.L.S. License Number: F-0116
"0 S Church Street, Suite 1000 1 Charlotte, NC 28202
11/201
DATE

NOTES:
1. THERE ARE 10 SEDIMENT BASINS AND 1 SEDIMENT TRAP ONSITE.
2. THE DRIVEWAY FROM OLD SALISBURY ROAD, PAST THE SCALEHOUSE AND
APPROXIMATELY UP TO THE LIMITS OF WASTE IS ASPHALT PAVED.
Ns
BORROW
AREA�J
� � ,�'`~ � Hr� � � � � mow,.. -� "^.� �/✓� �f �
� �'"� (pp / !'.ram � �✓%. � j t
fr

I 5 1 .6
)R EQUAL)
TRASH RACK
L
PLACE RIPRAP PROTECTION
AROUND CULVERT�i
j
CULVERT---\
W
L
RIPRAP STONE
DR CMP RISER PIPE
PRINCIPAL SPILLWAY
2' THICK NCDOT #5
STONE HALF THE
HEIGHT OF THE RISE
CONCRETE F_
CULVERT
RIPRAP STONE
EXISTING GROUND (TYP)
2' ANCHOR - `
8 OZ/SY NON -WOVEN GEOTEXTILE-/
SECTION 2' ANCHOR
TYPICAL OUTLET APRON
NTS `
CURLEX 11 LINING OR
APPROVED EQUAL
r 2' MIN. J _

For questions regarding this payment or any other payment,
please call Accounts Payable at [phone].
— - - - -_
�_�- - `' -- r---------------------------
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WINSTQN�-SALEMNCC271p2 C7� �'� N salem, NC sst
PM NO,
DATE: 11113112
PAY TO THE €
:. o � NC D PT ENR �. s. ORDER OF STORMWATER PERMIT UNiT ?
1617 MAIAVICE CENTER
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NCa 276991617
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11'

Diuguid, Bill
From: Boone, Ron
Sent: Thursday, January 17, 2013 12:02 PM
To: Diuguid, Bill
Cc: Basinger, Corey
Subject: FW: NCG120095 Old Salisbury Road Landfill NO]
Attachments: NCG120095 Old Salisbury Road Landfill Winston-Salem NOI.pdf
My only comment would be ... why didn't these guys have the permit a long time ago? But that's irrelevant now. ;-)
Please, proceed with issuance.
Thanks,
Ron Boone
NC DENR Winston-Salem Regional Office
Division of Water Quality, Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Email: ron.boone(@ncdenr.eov
Voice: [phone]
FAX: [phone]
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: Basinger, Corey
Sent: Monday, January 14, 2013 9:00 AM
To: Boone, Ron
Subject: FW: NCG120095 Old Salisbury Road Landfill NOI
Please review and comment back to Bill Diuduid in CO.
Thanks.
CB
W. Corey Basinger
Regional Supervisor
Surface Water Protection Section
Winston-Salem Regional Office
Division of Water Quality
Email: [e-mail]
Phone: [phone]
Fax [phone]
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: Diuguid, Bill
Sent: Friday, January 11, 2013 11:48 AM
To: Basinger, Corey
Subject: NCG120095 Old Salisbury Road Landfill NOI
Corey Basinger, Winston-Salem Regional Office: Didn't know who does Forsyth/Winston these days?
can send you the large map if you need it now. Or just send it to you with your copy of the permit.
M
Please review the attached NOI application with the objective of responding to me with a recommendation to issue the
permit. I recognize that you may not visit each new permittee during this NOI review, but it affords you the opportunity
to log the permit into your regional database and add the facility to a future monitoring and compliance visit schedule.
Therefore, your recommendation now to issue the permit serves as your acknowledgement that (1) the facility is located
in your region, (2) that there are no current complaints outstanding about the facility that have not been dealt with, and
(3) that the facility may ultimately be inspected by the regional staff. I've also attached a scanned copy of the NOI and a
location map for your review.
COC # Facility —� Location City/County
NCG120095 Old Salisbury Road Landfill 3336 Old Salisbury Road Winston-Salem/Forsyth
If you need any more info, give me a call. If you could send me a recommendation to issue the permit by 02/11/2013,
I'd appreciate it, so I can issue their COC. I cannot issue the permit until the respective regional office reviews and
comments back to me with a recommendation to issue the permit.
Thanks.
Bill
Bill Diuguid, AICP
Staff Planner, Stormwater Permitting
Wetlands and Stormwater Branch
Division of Water Quality I NCDENR
1617 Mail Service Center (Mail)
512 N. Salisbury St, Raleigh, NC 27604 1 91h Floor (Location & Parcels)
Raleigh North Carolina 27699-1617
Phone: [phone] Fax: [phone]
Website: http://portal.ncdenr.or web/wq/wslsu
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.

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