NCG150039_COMPLETE FILE - HISTORICAL_20170630

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMITNO.
/v L& l 5 b 0 ?j
DOC TYPE
HISTORICA4FILE
❑ MONITORING REPORTS
DOC DATE
o 3b.
YYYYMMDD

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
N
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
6NVMejNMENTAL ONAt ITY (Individual Leaally Responsible for Permit)
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
RC/ VED
Use this form if there has been: D8NR`LA .
ND QlpLlTy
NO CHANGE in facility ownership or facility name, but 441 - Wftft
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 must 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:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• 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
N I C I S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N I C I G [ q
n
V• G e
Q .
city. State Zip
To find the current legally responsible person associated with your permit, go to this website:
http:l/deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-pennits/stonnwater-proiyram
and run the Permit Contact Summary Report,
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
First M 1 Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: 7h. _
First MI Last
Page ) of 2
SWU-OWNERAFFI1r23March2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
$) Reason for this change
A result of Q
If other please explain:
(kfflaAz--Te—
I
Ti le
o��h YY
Mail' g Address
,St )ad rl c.r
City State Zip
05A)V41-4Zf— ! �Xyrt%�r s���C od
Telephone E-mail Addr s
<�7
Fax Number
❑ Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, 6., '� A,— , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I enders t if all required parts of this form are not completed, this change may not be
essed.
i 1 y
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website at:
ht :Hdc .ne. ,ov/about/divisions/encr -mineral-land-resources/stormwater
Page 2 of 2
SWU-OWNFRAFF11.,-23WO017

�F•" Division of Energy, Mineral & Land Resources
Land QualitySection/Stormwater Permitting
g
National Pollutant Discharge Elimination System
NC®ENR
. -N�wR­ PERMIT NAME/OWNERSHIP CHANGE FORM
FOR AGENCY 115E ONLY
Date Received
Year
Month Day
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N JQ IS 0 I I I 1N C: G v 3
11, Permit status ELiaL to requested change.
a. Permit issued to (company name): e d ; r0 l
b. Person legally responsible for permit: r
I'irst MI Last
Title
ermit1I ]older Mailin Address C�
2)y.,7o.-rn uR r't�r C_ C a
City State 'Lip
(.ZS_-1)92L—Co!�55 ( )
Phon� Fax
c. Facility name (discharge):
d. Faci I ity address:
Address
r 3�
�Q City State Zip
e. Facility contact person: l r A. (;Lsa)S;zo ^ 4y
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
.5' Name change of the facility or owner
If other please explain:
b. Permit issued to (company name): ` r 0,0 f
legally responsible for permit:
�
� First MI Last
L
c-� per
3tic
MAY 1 5 2014 -max Q
1'e tt holder Mailing Address
S No 41 sty State "Lip
(.25;Z) U �i37a
Phone E-mail Address
d. Facility name (discharge): �r
e. Facility address:
`/-�� yy— Address
�� JtilQr� QLACIr T� N� e;2 )
City State Zip
is Facility contact person: '
First MI Last
Phone i'mail ddre:ss l
1 V. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014

ri
I

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: =L lie
First MI Las
1 �C� l
ccJJ��� Mailing As ddr
G 7F 5
( it Sit e zip
r.. �j0✓
Phone } il Ad ress I
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
0 Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
.......................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, CA—, attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. f understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
P
Signature Date
APPLIC NT CERTIFICATION
1, ttest that this application for a name/ownership change has been reviewed and is accurate and
c mpiet to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

MlA7�
PA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
February 12, 2010
Mr. Carl Classen
Hyde County
PO Box 188
Swan Quarter, NC 27885
Subject: General Permit No. NCGI50000
Hyde County Airport
COC NCG 150039
Hyde County
Dear Mr.'Classen:
Bee Freeman
Secretary
In accordance with your application for a discharge permit received on December 1, 2009,
we are forwarding herewith the subject certificate of coverage 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 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.
Per the requirements of the `far -Pamlico Riparian Buffer Rule, all stormwater drainage to
stream buffers, from portions of this site that have been constructed after January 1, 2000, must be
discharged through a correctly'designed level spreader or another device that meets diffuse flow
requirements per 15A NCAC 2B .0259. Diffuse flow requirements are described in Chapter 8 of
the North Carolina Stormwater BMP Manual, available at:
http://h2o.enr.state.ne.its/su/bmp_forms.htm
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 Robert Patterson at
telephone number [phone].
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbvry St. Raleigh, worth Carolina 27604
Phone: 91 M07-63001 FAX: [phone] Customer Service: 1-877-623-6745
Internet: www.ncwaterquality.org
An Equal Opportunity 4 Affirmative Action Employef
Noi thCarolina
)VatuivII#

Mr. Carl Classen
Hyde County Airport--NCG 150039
February 12, 2010
Page 2 of 2
Sincerely,
ORIGINAL SIGNED By
KEN PSG is
for Coleen I-1, u i
cc: Washington Regional Office, Al Hodge
Central Files
Stormwater Permitting Unit Files

S.
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG 150000
CERTIFICATE OF COVERAGE No. NCG150039
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,
Hyde County
is hereby authorized to discharge stormwater from a facility located at
Hyde County Airport"
470 Airport Road
Engelhard
Hyde County
to receiving waters designated as a UT of Otter Creek, a class SA; HQW water in the Tar -
Pamlico River Basin, in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts 1, 11, III, IV, V, and VI of General Permit No. NCG 150000 as
attached.
This certificate of coverage shall become effective February 12, 2010.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this 12`h day of February, 2010.
ORIGINAL SIGNED By
KEN PICKLE
for Coleen H. Sullins., Director
Division of Water Quality
By the Authority of the Environmental Management Commission

Y�
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NCG150039
N
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Map Scale 1: 30, 000
Hyde County
Aripuft
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Hyde County Airport
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Hyde County
Hyde County Airport
Latitude: 350 33' 45" N
Longitude: 750 57' 19 W
County: Hyde
Receiving Stream: LT of Otter Creek
Stream Class: SA; HQW
Sub -basin: 03-03-08 (Tar -Pamlico River Basin)
Facility Location

Patterson, Robert
From: Hodge, Al
Sent: Monday,, February 08, 201,0 2:33 PM
To: Patterson,- Robert's,,., ,
Subject: RE: NCG150039� Hde County Airport
Please issue
From: Patterson, Robert
Sent: Monday, February 08, 2010 11:52 AM
To: Hodge, Al
Subject: FW: NCG150039 - Hyde County Airport
Al,
I never heard back on this GP. I plan to issue it on 2/12 unless you have concerns.
Thanks
Robert
From: Patterson, Robert
Sent: Thursday, January 07, 2010 8:30 AM
To: Hodge, Al
Subject: NCG150039 - Hyde County Airport
Al,
Please see NOI attached.
We have received an application for coverage of an existing facility under NCG 15 from Hyde County. The facility drains
to a UT of Otter Creek (class SA; HQW) in Engelhard (Hyde County). No de-icing or haz waste. Does the WaRO have any
concerns about issuing this facility a COC for this general permit?
Thanks!
Robert D. Patterson, PE
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting
1617 Mail Service Center, Raleigh, NC 27699-1617 (Mailing)
512 N. Salisbury St, Raleigh, NC 27604 (Location & Parcels)
[phone] Phone I [phone] Fax
Email: robert.patterson a nedenr. ogo
Website: http:llh2o.enr.state.nc.us/su/stormwater.htmi
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