NCG110144_COMPLETE FILE - HISTORICAL_20130207

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
/v Cc, ho l qq
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ ���3 ��`�
YYYYMMDD

Ff9 Permit Coverage W61I 01 �GI
Renewal Auplication Form
National Pollutant Discharge Elimination System Certificate of Coverage Number I7
Stormwater General Permit NCG 110000 NCG110000
Please complete the information in the space provided and return the completed renewal form to the address indicated
below.
Owner Information
* Address to which permit correspondence willbe mailed
Owner / Organization Name:
Town of Denton
Owner Contact:
Scott S. Morris, Mayor
Mailing Address:
PO Box 306
Denton, NC 27239
Phone Number:
336-859-4231
1 QZ.- E'er
Fax Number:
336-859-3381
E-mail address:
[e-mail]
�tV
Facility Information
Facility Name:
Denton WWTP
Facility Physical Address:
300 Council Access Road
Denton, NC 27239
Facility Contact:
B. Branch
Mailing Address:
_Troy
PO Box 306
Denton, NC 27239
Phone Number:
336-859-4460
Fax Number:
336-859-3381
E-mail address:
[e-mail]
Permit Information
Permit Contact:
Troy B. Branch
Mailing Address:
PO Box 306
Denton, NC 27239 ^
Phone Number:
Fax Number:
336-859-4460
336-859-3381 41'(� n
E-mail address:
[e-mail]
Discharge Information
0 7 2013
Receiving Stream:
Lick Creekg
Stream Class:
IV
WATE Uan
Basin:
Yadkin River
MR - Bier &>�
aot"V
Sub -Basin:
Pee Dee River
Webs�s &
Number of Outfalls:
01
Facility Activity Changes
Please describe below any changes to your facility or activities since issuance of your permit. Attached a
separate sheet if necessary.
None noted
CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the best of my knowledge and belief
such informatiory is true, complete and accurate.
Trn4 R Branch WWTP ORQ Pretreatment Cool linator
Print or type name of person signing above Title
SW General Permit Coverage Renewal
Please return this completed application form to: Stormwater Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

O Q,.I ATe Permit Coverage
o�Y Renewal Application Form Certificate of Coverage Number
National Pollutant Discharge Elimination System
Stormwater General Permit NCG 1lobo0 NCG110000
Please complete the information in the space provided and return the completed renewal form to the address indicated
below.
Owner Information
* Address to which permit correspondence will be mailed
Owner / Organization Name:
Town of Denton
Owner Contact:
Scott S. Morris, Mayor _
Mailing Address:
PO Box 306
Denton NC 27239
Phone Number:
336-859-4231
Fax Number:
336-859-3381
E-mail address:
[e-mail]
Facility Information
Facility Name:
Denton WWTP
Facility Physical Address:
300 Council Access Road
Denton, NC 27239
Facility Contact:
Troy B. Branch
Mailing Address:
PO Box 306
Denton, NC 27239
Phone Number:
336-859-4460
Fax Number:
336-859-3381
E-mail address:
[e-mail]
Permit Information
Permit Contact:
Troy B. Branch
Mailing Address:
PO Box 306
Denton, NC 27239
Phone Number:
336-859-4460
Fax Number:
336-859-3381
E-mail address:
[e-mail]
Discharge -Information
Receiving Stream:
tick Creek
Stream Class:
IV
Basin:
Yadkin River
Sub -Basin:
Pee Dee River
Number of OutFalls:
01
FFg 0 7 2013
151�t4R - wATF- ALTY
Indands & SkgrmaW Branch
Facility/Activity Changes Please describe below any changes to your facility or activities since issuance of your permit. Attached a
separate sheet if necessary.
None noted
CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the best of my knowledge and belief
such informatioq is true, complete and accurate.
i/��ruS���iiJ_ Sim - - . . ■
WWTP 011C.1 PrPtrPatmPnt rnnrriinator
Print or type name of person signing above Title
SW General Permit Coverage Renewal
Please return this completed application form to: Stormwater Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617