HomeMy WebLinkAboutNCG180255_COMPLETE FILE - HISTORICAL_20180612PERMIT NO.
DOC TYPE
STORMWATER DIVISION CODING SHI
NCG PERMITS
HISTORICAL FILE
MONITORING REPORTS
DOC DATE ❑ �,p� �
YYYYMMDD
® ROY COOPER
Governor
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
June 12, 2018
Ferguson Copeland LLC DBA Chaddock Home
Attention: Nikki Cucina
100 Reep Drive
Morganton, North Carolina 28655
Subject: Compliance Evaluation Inspection
Permit: NCG180255
Burke County, North Carolina
Dear Mrs. Cucina:
MICHAEL S. REGAN
Secretary
WILLIAM E. VINSON, JR
Interim Director
Enclosed please find a copy of the Compliance Evaluation Inspection Report for the inspection I conducted at
the subject facility on June 5, 2018.
The report should be self-explanatory; however, should you have any questions concerning this report,
please do not hesitate to contact me at (828) 296-4500 or by email at Isaiah.reed@ncdenr.gov.
Enclosure: Inspection Report
Sincere ,
Isaiah Reed, CEPSCI
Environmental Specialist
Land Quality Section
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
2090 US 70 Highway j Swannanoa, NC 28779-821 I
828 296 4500 S
Compliance Inspection Report
Permit: NCG180255 Effective: 07121117 Expiration: - 08/31/19 Owner; Ferguson Copeland LLC DBA Chaddock
Home
SOC: Effective: Expiration: Facility: Chaddock Home
county: Burke 100 Reep Dr
Region: Asheville
Morganton NC 28655
Contact Person: James Kennedy Title: Phone: 828-584-0664
Directions to Facility:
from westbound i-40 take exit 100, continue across jamestown rd onto reep dr, turn right to continue on reep dr, the facility is
located on the right, approximately 600 feet west of the intersection of jamestown rd and reep dr.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 06/0512018 Entry Time: 02:00PM Exit Time: 0100PM
Primary Inspector_ Isaiah L Reed Phone: 828-296-4614
Secondary Inspector(s):
Reason for inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Furniture and Fixtures Stormwater Discharge COC
Facility Status: 0 Compliant ❑ Not Compliant
Question Areas:
■ Storm Water
(See attachment summary)
Page: 1
Permit: NCG180255 Owner- Facility: Ferguson Copeland LLC ❑SA Chaddock Home
Inspection hate: 0610512018 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
On June 5, 2018 this facitlity was inspected for compliance. I met with Nikke Cucina, Thomas Parlier, and Richard Creson
on site. During the inspection, the following items were noted.
1) General housekeeping around the exterior of the facility should be implemented further.
2) Erosion was occuring at the outfall on the far North perimeter of the site. The outfall areas should be cleaned up and
stabilized to allow for better sampling.
Wage: 2
•
Permit: NGG 180255 Owner - Facility: Ferguson Copeland LLC DBA Chaddock Home
Inspection pate: 06/0512018 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?
®❑ 110
# 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 Ptan 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? ®❑ ❑ ❑
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 outfails observed during the inspection? N ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ ■ ❑
# Has the facility evaluated all illicit (non stormwater) discharges? N ❑ ❑ ❑
Comment:
Page: 3
Compliance Inspection Report
Permit: NCG180255 Effective: 07/21/17 Expiration: 08/31/19 Owner: Ferguson Copeland LLC DBA Chaddock
Home
SOC: Effective: Expiration: Facility: Chaddock Home
County: Burke 100 Reep Dr
Region: Asheville
Morganton NC 28655
Contact Person: James Kennedy Title: Phone: 828-584-0664
Directions to Facility:
from westbound i-40 take exit 100, continue across jamestown rd onto reep dr, turn right to continue on reep dr, the facility is
located on the right, approximately 600 feet west of the intersection of jamestown rd and reep dr.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Reprose ntative(s):
Related Permits:
Inspection Date: 06/05/2018 Entry Time: 02:OOPM Exit Time: 03:OOPM
Primary Inspector: Isaiah L Reed Phone: 828-296.4614
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Furniture and Fixtures 5tormwater Discharge COC
Facility Status'. Compliant ❑ Not Compliant
Question Areas:
Storm Water
{See attachment summary)
Page: 1
f� J
permit: NCG18€1255 Owner • Facility: Ferguson Copeland LLC DBA Chaddock Home
Inspection Date: 06/0512018 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
On June 5, 2018 this facitlity was inspected for compliance. I met with Nikke Cucina, Thomas Parlier, and Richard Creson
on site. During the inspection, the following items were noted.
1) General housekeeping around the exterior of the facility should be implemented further.
2) Erosion was occuring at the outfail on the far North perimeter of the site. The outfall areas should be cleaned up and
stabilized to allow for better sampling.
Page: 2
Permit: NCG180255 Owner - Facility: Ferguson Copeland LLC DBA Chaddock Home
Inspection Date: 06/05/2018 Inspection Type : Compliance EvaluatlOn 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?
0 ❑ ❑ ❑
# Does the Plan include a "Narrative Description of Practices"?
0 ❑ ❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
0 ❑ ❑ ❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
0 ❑ ❑ ❑
# Has the facility evaluated feasible alternatives to current practices?
■ ❑ ❑ ❑
# Does the facility provide all necessary secondary containment?
0 ❑ ❑ ❑
# 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?
0 ❑ ❑ ❑
# Does the facility provide and document Employee Training?
0 ❑ ❑ ❑
# Does the Plan include a list of Responsible Party(s)?
0 ❑ ❑ ❑
# Is the Plan reviewed and updated annually?
0 ❑ ❑ ❑
# Does the Plan include a Stormwater Facility Inspection Program?
0 ❑ ❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented?
0 ❑ ❑ ❑
Comment
Qualitative Monitoring
Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ■ ❑ ❑ ❑
Comment:
Permit and Outfalls Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? 0 ❑ ❑ ❑
# Were all outfalls observed during the inspection? 0 ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ ❑
# Has the facility evaluated all illicit (non stormwater) discharges? E ❑ ❑ ❑
Comment:
Page: 3
Central Files: APS _ SWP _
7/20/2017
Permit Number C— NCGI80-255 Permit Tracking Slip
Program Category Status Project Type
NPDES SW In review New Project
Permit Type Version Permit Classification
Furniture and Fixtures Stormwater Discharge COC COC
Primary Reviewer Permit Contact Affiliation
Bethany, Georgoulias
Coastal SWRule R..� 4�J
Permitted Flow JUL 2
CENTRAL F1LEEi
Facility
DWR I NI
Facility Name
Major/Minor Region
Chaddock Home
Minor Asheville
Location Address
County
100 Reep Or
Burke
Facility Contact Affiliation
Morganton NC 28655 James Kennedy
PO Box 10
Owner Morganton NC 28680
Owner Name Owner Type
Ferguson Copeland LLC DBA Chaddock Home Non -Government
Owner Affiliation
James Kennedy
PO Box 10
Dates/Events Morganton NC 28680
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration `
4/6/2017 �12 f U I7 7)7.i,lul 7 O 31'/ZDO
Regulated Activities Requested /Received Events
Furniture and fixtures manufacture RO staff report requested 6130117
RO staff report received 7119117
Outfall 001
Waterbody Name Streamindex Number Current Class Subbasin
Little Silver Creek 11-34-7-(1) C 03-08-31
yAy
Energy. Mineral &
Land Resources
ENVIRONMENTAL QUALITY
July 21, 2017
Mr. James Kennedy
Ferguson Copeland, LLC dba Chaddock Home
P.O. Box 10
Morganton, NC 28680
Dear Mr. Kennedy:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
Subject: General Permit. No. NCG 180000
Chaddock Home
COC No. NCG180255
Burke County
In accordance with your application for a discharge permit received on April 6, 2017, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state --
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral, and Land Resources. The Division of Energy, Mineral, and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Water Resources, the Coastal Area Management Act, or any other federal or local
government permit that may be required.
Nothing Compares—,-,-
SState of North Carolina Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street W2 Mail Service Center I Rateigh, Nor1 h Carolina 27699-1612
919 707 g200
If you have any questions concerning this permit, please contact Bethany Georgoulias at telephone
number (919) 807-6372 or by email bethany.geor off, uliasna ncdenr.gov.
cc: Asheville Regional Office
Stormwater Program Files
DWR Central Files
Sincerely,
far Tracy E. vis, P.E., CPM, irector
Division of Energy, Mineral, and Land Resources
Nothing Compares_
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street 1 1612 Mail Service Center 1 Raleigh, North Carolina 27699-1612
919 707 9200
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL_PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180255
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,
Ferguson Copeland, LLC d/b/a Chaddock Home
is hereby authorized to discharge stormwater from a facility located at
Chaddock Home
100 Reep Drive
Morganton
Burke County
to receiving waters designated as Little Silver Creek, a class C water in the Catawba River
Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, I1, 1I1, and IV of General Permit No. NCG180000 as attached.
This certificate of coverage shall become effective July 21, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this 211, day of July 9.017
for
Director, Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission
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Ferguson Copeland, LLC d/b/a
Chaddock Home
Latitude: 3511 43' 11" N
Longitude: 811 45' 10" W
County: Burke
Receiving Stream: Little Silver Creek
Stream Class: C
Index Number: 11-34-7-(1) (Catawba River Basin)
VA
P
Facility Location
Energy, Mineral &
Land Resources
ENWRONMEWAL QUALITY
July 21, 2017
Mr. James Kennedy
Ferguson Copeland, LLC dba Chaddock Home
P.O. Box 10
Morganton, NC 28680
Dear Mr. Kennedy:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
Subject: General Permit No. NCG180000
Chaddock Home
COC No. NCGIS0255
Burke County
In accordance with your application for a discharge permit received on April 6, 2017, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral, and Land Resources. The Division of Energy, Mineral, and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Water Resources, the Coastal Area Management Act, or any other federal or local
government permit that may be required.
Nothing Compares—,---
SState of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street 1 1612 Mail Service Center I Ralcigh, North Carolina 27b99.1612
919 707 9200
r
If you have any questions concerning this permit, please contact Bethany Georgoulias at telephone
number (919) 807-6372 or by email bethany.georgouliasPmcdenngov.
cc. Asheville Regional Office
Stormwater Program Files
DWR Central Files
Sincerely,
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, P.E., CAM, Director
Division of Energy, Mineral, and Land Resources
Nothing Compares
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699.1612
919 707 9200
ti
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180255
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,
Ferguson Copeland, LLC d/b/a Chaddock Home
is hereby authorized to discharge stormwater from a facility located at
Chaddock Home
100 Reep Drive
Morganton
Burke County
to receiving waters designated as Little Silver Creek, a class C water in the Catawba River
Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, I1, III, and IV of General Permit No. NCG180000 as attached.
This certificate of coverage shall become effective July 21, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this 215t day of July 2017.
SIGNED BY
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission
LOCATION MAP:
NCG180255
W E
S
M,3P SOIL- 1:24,000
Ferguson Copeland, LLC d/b/a
Chaddock Home
Latitude: 350 43' 11" N
Longitude: 810 45'10" W
County: Burke
Receiving Stream. Little Silver Creek
Stream Cass: C
Index Number: 11-34-7-(1) (Catawba River Basin)
Facility Location
Georgoulias, Bethany
From: Conway, Jean
Sent: Wednesday, July 19, 2017 2:30 PM
To: Georgoulias, Bethany
Cc: Aiken, Stan E
Subject: RE: NOI from Chaddock Home for NCG18
Bethany,
Hope you are doing well.
i did a site visit to this site and do not have any concerns for issuing this permit.
They have a very clean site with much of their outside products under cover and they have a good SWPPP.
I have not put in an inspection yet but will if we now counting NOI inspections in RIMS.
Thanks, Jean
From: Aiken, Stan E
Sent: Friday, June 30, 2017 12:02 PM
To: Conway, Jean <jean.conway@ncdenr.gov>; Riddle, Shawna <shawna.riddle@ncdenr.gov>
Subject: FW: NOI from Chaddock Home for NCG18
Please take a look at the site and let me know your comments. Thank you for your help in this matter.
Thank You,
Stanley E Aiken
Regional Engineer
Land Quality Section
North Carolina Department of Environmental Quality
828 296-4500 main
828 296-4610 office
stan.aiken((Dncdenr.gov
2090 US70 Highway
Swannanoa, NC 28778-8211
%'Nothing Compares
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to thud parties.
From: Georgoulias, Bethany
Sent: Friday, June 30, 2017 12:00 PM
To: Aiken, Stan E <stan.aiken@ncdenr.gov>
Subject: NOI from Chaddock Home for NCG18
Sta n,
We received the attached NOI for coverage under NCG180000 for the Chaddock Home facility in Morganton, Burke
County. The site manufactures wood household furniture and discharges stormwater to Little Silver Creek, a class C
water in the Catawba River Basin. Does the ARO have any objections to issuing a COC to this facility?
Thanks,
Bethany
13ethany Georgoulias
13nviroil mentaI 1 ngineer
Stornlwater Program, Division of Lnergy, Mineral, and Land Resources
N.C. Department. of Environmental Quality
919 807 6372 office
bethany.eor�,oulias(7ncdenr.go_v
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
512 N. Salisbury Street, Raleigh, NC 27604 (location)
Website: http://deg.ne.Lyov/about/divisions/energy-mineral-land-resources/stonnwater
Email correspondence to and from this address is subject to the North Carolina Public Records
Law and may be disclosed to third parties.
Permit Number NCG180255
Program Category
NPDES SW
Permit Type
Furniture and Fixtures Stormwater Discharge COC
Primary Reviewer
Bethany.Georgoulias
Coastal SWRule
Permitted Flow
Facility
Facility Name
Chaddock Hone
Location Address
100 Reep Or
Morganton
NC 28655
Owner
Owner Name
Ferguson Copeland LLC DBA Chaddock Home
Dates/Events
Central Files: APS _ SWP
7/20/2017
Permit Tracking Slip
Status Project Type
in review New Project
Version Permit Classification
COC
Permit Contact Aff illation
Major/Minor Region
Minor Asheville
County
Burke
Facility Contact Affiliation
James Kennedy
PO Box 10
Morganton NC 28680
Owner Type
Non -Government
Owner Affiliation
James Kennedy
PO Box 10
Morganton NC 28680
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
4/6/2017 W211U 17 ^! f 2,il All D{'33/,Zo I9
Regulated Activities Requested !Received Events !
Furniture and fixtures manufacture RO staff report requested 6/30/17
RO staff report received 7/19/17
Outfall 001
Waterbody Name Streamindex Number Current Class Subbasin
Little Silver Creek 11.34.7-(1) C 03-08-31
19
harthickman
SMARTER ENVIRONMENTAL SOLUTIONS
Via 2"d Day FedEx
April 4, 2017
NC DEQ — Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: Notice of Intent for NCG 180000
Chaddock Home
100 Reep Drive
Morganton, NC 28655
I-I&H .lob No. BDP-009
Dear Sir/Madam:
Please find the attached Notice of Intent for coverage under Stormwater General Permit NCG
180000 for the above -site. If you have any questions, please feel free to contact me at
704.887.4620.
Sincerely,
Hurt & Hickman, PC
ZVX44-to
Matt Braniblett, PE
Principal
Enclosures
Cc: Mr. Don Nielsen, BDP (via email)
Mr. James Kennedy, Chaddock (via email)
Ms. Anna Buckley. 1700 LLC (via email)
RECEIVED
APR 0 6 2017
DENR-L AND QUALITY
STORMWATER PERMITTING
2923 South Tryon Street, Suite 100 3334 Hillsborough Street
Charlotte, NC 28203 Raleigh, NC 27607 www.harthickman.corn
704.586.0007 main 919.847.4241 main
WADivision of Energy, Mineral, and Land Resources 4 s
Land Quality Section
NCDENRNational Pollutant Discharge Elimination System
rw.rror✓r .r ..vN4+mu rtr.�e..Kra ,\CG1.80
0
0
0
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG180000: REMVED
STORMWATER DISCHARGES associated with activities classified as: AN in 5 2017
SIC' 25 Furniture and Fixtures, and SIC 2434 Wood Kitchen Cabinets,
And, Like activities deemed by DEMLR to be similar in the process, or the a A,ALITY
materials, products, by-products, or waste materials. A MiiTING
' Standard Industrial Classification Code
(Please print or type)
1) Mailing address of owner/operator (address to which official permit correspondence will be mailed):
Name Ferguson Copeland, LLC dba Chaddock Home
Street Address P.O. Box 10
City Morganton State NC ZIP Code 28680
Telephone No. 828 584-0664 Fax:
E-mail address jkennedy@chaddockhome.com
2) Location of facility producing discharge:
Facility Name Chaddock Home
Facility Contact .lames Kennedy
Street Address 100 Reep (give
City Morganton State "c ZIP Code 28655
County Burke
Telephone No. 828 584-0664 Fax:
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 frorn a roadway intersection). Fromwestbound I-Q, take exit 100. Condnueacross Jamestown Road onto Reep Drive.
Turn right to continue on Reep Drive. The facility is located on the right, approximately 600 feet west of the intersection of Jamestown Road and Reep Drive.
(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) F
4) Latitude 35' 43' 11" Longitude -81° 45' 10" (degrees, minutes, seconds) ��. �� 3
�� 5) This NPDES Permit Application applies to which of the following : � ! /
❑ New or Proposed Facility Date operation is to begin
El Existing
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 5 1 1
7) Provide a brief narrative description of the types of Industrial activities and products manufactured at
this faCility: The Chaddock facility manufactures wood household fumlture.
Page 1 of 4
SWU-233.82814 Last revised 8/28/14
NCG180000 N.O.I.
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Life Silver Creek
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).
10) Does this facility have any other water quality permits?
p No
❑ Yes
If yes, list the permit numbers for all current water quality permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
I] No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
0 Yes
It yes, please briefly describe: The facility employs pollution prevention practices, which include spill prevention practices, Including maintaining a
covered, diked storage area for hazardous wastes, using covered containers for sawdust collected at the site, and minimizing outdoor storage of materials.
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
El Yes
If yes, when was it implemented? ApH12017
14) Are vehicle maintenance activities occurring at this facility?
Q No ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
0 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No ❑� Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
0 No ❑ Yes
Page 2 of 4
SWU-233-82814 Last revised 8/28/14
NCG180000 N.O.I.
d) If you answered yes to questions b. or c., please provide the following information:
Types) of waste: Ignitable waste and spent non -halogenated solvents (D001, F003, F005)
How is material Stored: Hazardous waste materials are stored in sealed 55-gallon drums
Where i5 material stored: .Hazardous waste materials are stow in a mvgroa, ii&Aa arum storage area iooalu l along We eastern site DOunoary, P OO& of the ails bulldog,
How many disposal shipments per year: 12
Name of transport 1 disposal vendor: clean Earth
Vendor address: 402 Webster chapel Road f R(- 3S9b5'
16) 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 Article 21 or regulations of the Environmental
Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate
any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of
the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a tine not to exceed $10,000, or by imprisonment not to exceed six months, or by both. (1a U_S.C. Section 1001
provides a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both, for a similar
offense.)
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate. Printed Name of Person Signing: J(5(me s 1KPJnYiejV
Title: r Y,
3
(Signature Appficanf) (Date Signed)
Notice of Intent must be accompanied by a c eck or money order for $100.00 made payable to:
NCDENR.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included.
Please do not ask us to hold an incomplete application in anticipation of a check under separate cover.
Z Check for $100 made payable to NCDENR
[ This completed application, signed by the owner/operator, and all supporting documents
Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map
Mail the entire package to:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note: The submission of this document does not uarantee the issuance of an NPDES permit.
Page 3 of 4
5WU-233.82814 Last revised 8/28/14
NCGI80000 N.O.I.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
To visit our website, go to http://portal.ncdenr.org/web//rlstormwater
DEMLR Regional_ Office Contact Information:
Asheville Office ...... (828) 296-4500
Fayetteville Office ...
(910) 433-3300
Mooresville Office ...
(704) 663-1699
Raleigh Office ........
(919) 791-4200
Washington Office ...(252)
946-6481
Wilmington Office ...
(910) 796-7215
Winston-Salem ......
(336) 771-5000
Central Office .........(919)
707-9220
Page 4 of 4
5W U-233-82814 Last revised 8/28/14
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GLEN ALPINE, NC 1994 10 2923 S Tryon Street, Suite 100
hart 01• hickman Charlotte. MC28203
U.S G.S. QUADRANGLE MAP w 704 586 0007(p) 704.5860373(o
7.5 MINUTE SERIES (TOPOGRAPHIC)
DATE:
1-24-17
REVISION NO
0
JOB NO:
BDP-009
FIGURE NO
1
HART & HICKMAN PC
42565
Re,
Pay To NC DENR - Stormwater Permitting Program
Invoice No. Invoice Date Invoice Amount Amount Due
04032017 04/03/2017 100.00 100.00
'y1Cr15��0 2-.5�
Check Total: $100.00 04/03/2017
Discount Apply Balance
0.00 100.00 0.00
RECEIVED
DENR-LAND QUALITY
STORMWATER PERMITTING
hart `-hickmanWellsfargo'Bank, N-A.
A Professional Corporation - "66.21/53D
? 2923 S. Tryon Street, Suite 100
Charlotte;; NC 28203-5449
DATE
One,Hundred' and 00/100PDolla`s
42 66 51
cnrrs�srar
I/ AMOUNT,
F 4/3/2017 f $100:f?0
PAY
TOTHE . ' - NC DENR,-`St&mn eater Permitting Program ,
ORDER''. 'Attn: Division of Energy; Mineral; and'Land-Resources r 8
3%U.�. x
('I 1612 Mail SenriceiCeriter ��• •�.
'Raleigh, NC 27699-1612 f 1 r•. // ,� t
AUTHORIZED SIGNATURE
11
11804 2