NCGNE0511_COMPLETE FILE - HISTORICAL_20081024

STORMWA-TER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. IINCGNE
DOC TYPE HISTORICAL FILE
DOC DATE ID2v
YYYYMMDD

Li
Memo
Dais 917/2007
TO: Stormwater Permitting Unit
Frorm Andy Srrdh
RE: Attachment C
To whom it may concern.
�LR@ -
SEP 1 3 2007
Wenan s WR &"' a LTER &anon .
Upon re-evaluating the Fourth Creek VWVTP, I am respectfully asking and applying for
the "No Exposure Certification". I received the Certificate of Coverage for this facility on
August 22, 2007. After getting some of the requested information together I realized that
everything that we have regarding chemicals and routine operations is under roof.
If you need more information, please contact me.
�VE
OCT 2 4 2nG8
1
Pon

FOP, AGENCY USE ONLY
at
4 eived
0a Division of Water Quality / Surface Water Protection Yv� °Mont I °
Ay
NCDENRNational Pollutant Discharge Elimination System �" °f Covcnp`
NO EXPOSURE CERTIFICATION for Exclusion Vul
'"" -DK NCGNE0000
NO EXPOSURE CERTIFICATION SFp �n
National Pollutant Discharge Elimination System application for exclusion from a PermW��
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility does not requirgoit
authorization for its storm water discharges associated with industrial activity in the State of North
Carolina because it qualifies for a no exposure exclusion. A condition of no exposure at an industrial
facility means all industrial materials and activities are protected by a storm resistant shelter (with some
exceptions) to prevent exposure to rain, snow, snowmelt, and/or runoff.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste
products. Material handling activities include the storage, loading and unloading, transportation, or
conveyance of any raw material, intermediate product, final product or waste product A storm resistant
shelter is not required for the following industrial materials and activities: drums, barrels, tanks, and
similar containers that are tightly sealed, provided those containers are not deteriorated and do not leak.
"Sealed" means banded or otherwise secured and with locked or non -operational taps or valves;
adequately maintained vehicles used in material handling; and final products, other than products that
would be mobilized in stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion.
In addition, the exclusion from NPDES permitting is available on a facility -wide basis only -not for
Individual outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the
facility is not eligible for the no exposure exclusion. By signing and submitting this No Exposure
Certification form, you certify that a condition of no exposure exists at this facility or site and are
obligated to comply with the terms and conditions of 40 CFR 122.26(g).
You are required to reapply for the No Exposure Exclusion once every five (5) Years.
For questions, please contact the DWO Regional Office for your area. (See page 5)
(Please print or type)
f) Mailing address of owner/operator address to which all certification correspondence will be mailed :
Name C I,+v f 1� {� S v i E. 411- e Ceo-,
Street Address _VO kio).( l V, vt
City �c "S V : iL P. State ABC- ZIP Code -
Telephone No. le- 3L S Fax: "1� S -ta(o S5-
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
city
County
Telephone No.
Page 1 of 5
SWU-NE-WO607 Last revised 06/06/07

NCGNEOD00 No Exposure Certification
3) Physical location information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). s
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes &<O
5) Is this a Federal facility? 0 Yes O'No
6) Latitude3Cc Longitude^+o� �5 _ (deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
i�Existing Date operation began
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes Er-96
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: q1— J a
10) Provide a brief description of the types of industrial activities and products produced at this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
0 No
ET Yes `
If yes, list the permit numbers for all current Nan -Discharge permits for this facility.
Exposure Checklists (12. - 14.)
12) Are any of the following materials or activities exposed to precipitation, now or In the foreseeable
future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spillsAeaks
❑ Yes
2<0
c. Materials or products from past industrial activity
❑ Yes
C;_KO'
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
E
e. Materials or products during loading/unloading or transporting activities
❑ Yes
2-96
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
I -ISO
use (e.g., new cars) where exposure to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
SWIG-NE-060607 Last revised 06/05/07

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes 641
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes Td' 0
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes gl/a
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes 2 o
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes O-1 o
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not property stored
❑ Yes ❑'hio
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as welt as drums, barrels, tanks, and similar containers
❑ Yes 2' o
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior.ASTs or piping free of rust, damaged or weathered coating, pits, or dYes ❑ No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ffYes ❑ No
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers
(including drams, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
in dose proximity to each other with a combined capacity of more than 1, 320-
gallons?
c. Are release valves on all secondary containment structures locked?
❑"Yes ❑ No
Y85 ❑ No
eyes ❑ No
Page 3 of S
SWU-NE-060607 Last revised 06/06/07

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes efNo
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes No
generated per month) of hazardous waste?
c. Is this facility a large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes 2-lgo
generated per month) of hazardous waste?
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 / disposal vendor:
Vendor address:
1 B) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of 'no
exposure' and obtaining an exclusion from NPDES stornwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a„no exposure certification form once every five (5) years to the North Caroiina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of slormwater from the facility. Additionally, I certify under penalty
of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based
on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiarwith 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
: e H tiJ—.-S'a M
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
Page 4 of 5
SWU-NE-060607 Last revised 06/06/07

NCGNEOOOO No Exposure Certification
North Carolina General Statute 143-215.6 B(I) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact In a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders Inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management) Commission implementing this Article shall be guilty of a Gass 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,0110).
There is currently no fee for a No Exposure Exclusion.
Inal Checklist
This application should Include the following items:
This completed application and all supporting documentation.
A map with the location of the facility clearly marked.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWQ Regional Office for your area.
DWG), Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office ..........
[phone]
Page 5 of 5
SWU-NE-060607 . Last revised 06/06/07

Directions to STATESVILLE, NC Page I of I
Directions to STATESVILLE, NCLOCAL
Hap!
Summary and Notes
START P MOORESVILLE, NC Add your notes here... II
FINISH P 693 Bell Farm Rd, ST TESVILLE, NC
i + �
yet Gre6 K wu
Total Distance: 20.5 miles, Total Time: i
25 mins (approx.) I
-------- -- —_ _ _— �— --- — ------ -- -' _.-.-. --- ------
instance
uumuauve
P MOORESVILLE, NC
1. Starting in MOORESVILLE, NC on W IREDELL AVE
go < 0.1 mi
< 0.1 mi
2-Turn on N BROAD ST(NC-115)
go 0.3 mi
0.3 mi
3- Turn on W MCLELLAND AVE(NC-152)
go 0.9 mi
1.2 mi
4. Bear on HIGHWAY 150 W(NC-150)
go 0.3 mi
2.5 mi
5. Continue to follow NC-150
go 1.5 mi
3 mi
6- Turn Q to take ramp onto I-77 N
go 12.5 mi
i5.5 mi
7. Take exit #49AIG BAGNAL BOULEVARD onto E GARNER
go 0.5 mi
26 -ni
BAGNAL BLVD(US-70) toward US-70 E
8. Continue to follow US-70
go 2.7 mi
18.7 mi
i
9. Beare on BELL FARM RD
go 1-7 mi
20.4 mi
10- Arrive at 693 BELL FARM RD, STATESVILLE
693 BELL FARM RD, STATESVILLE, NC
Distance: 20-5miles, Time: 25 mins
When using any driving directions or map, it's a good idea to do a reality check and make sure the road still exists, watch out for
constri,c.tien, and follow all traffic safety precautions. This is only to be used as :in aid in planning.
http.-//xriill,maps.yahoo.com/pmt.php?v3=0&m' vt=m&q2=693 BELL FARM RD, Statesvill... 7/5/2007

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DISCHARG
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STATESVILLE-FOURTH CREEK WASTEWATER TREATMENT PLANT ' � 301,
NC0431836 :. '-1.
FOURTH CREEK (O=� �—
f
Ul =
y acts+
Latitude:
35°46'36"
Longitude:
80047' 15"
USGS Quad #:
D15SE
River Basin #:
03-07-06
Receiving Stream:
Fourth Creek
Stream Class:
C
Fourth Creek WWTP
NCO031836
Iredell County

ATT. B
Non -Discharge Permits
• Permit # WQ0001759 — Surface Disposal/Monofil
• Permit # WQ0006245- N Viro Process
• Permit # WQ0014543- City of Statesville Land Application