NCG150040_COMPLETE FILE - HISTORICAL_20170801

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
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DOC7YPE
�HISTORICALFILE
❑ MONITORING REPORTS
DOC DATE
❑ � �� � 17V t
YYYYMMDD

Division of Energy, Mineral, and Land Resources FOR AGENCY tJSF ONLY
Datc Received
" Land Quality Section 1 Stormwater Program Vear Mornh Da
National Pollutant Discharge Elimination System (NPDES) 1
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources ENVIRONMENTAL QUALITY (Individual Legally Responsible for Permit)
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 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); JUL
• the principle executive officer or ranking elected official (for a municipalit�y.$tat�e�gf+Qther public
agency); 11'�ORMWA7ER P7=RlulirrWG
• the general partner or proprietor (for a partnership or sole proprietorshi ,T
• 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 I j D
(.U1,11 e,4 A"j
Cr r X
a. do 1 r La �
Address
U)CI 1414 c ",I /f/ c,
ity State Zip
To find the current legally responsible person associated with your permit, go to this website:
http:i/deg.nc.gov/about/divisions/energy-mineral-land-resources/enemy-mineral-land-permits/stormwater-program
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: dk k )y 6 61 c� fl
First M I Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: FyCt 11I ic) 60u� �,
First MI Last
Page 1 of 2
S W U-O W NE RAFFII,23 March 2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Cr1 `-. Stir-��-�^rn l�!►� C- '�^.�3CC�``�'1 �\ 1
5) Reason for this change:
Q viol tC_ W QA6S `1)1
Title
Mailing Address
0 C_
City State Zip
Telephone E-mail Ac1dress
( ZSI') � -�4 640
Fax Number
A result of: ❑ Employee or management change
❑ Inappropriate or incorrect designation before
® Other
If other please explain: S4 tl GI nW �i fi t, �.� �)cn t ,(J l� �Cv • �, i
..................................................................................................................
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, m1 t j lam_ �, 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 understand that if all required parts of this form are not completed, this change may not be
processed.
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:
htt :Ilde .nc. 7ov/about/divisions/ener } -mineral-land-resources/stormwater
Page 2 of 2
S W U-OWNERAFFIL-23Mar2017

NC®ENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
February 5, 2010
Mr. James Smith
City Manager
PO Box 1988
Washington, North Carolina 27889
Natural Resources
Subject: General Permit No. NCG150000
Warren Field
COC NCG150040
Beaufort County.
Dear Mr. Smith:
Dee Freeman
Secretary
In accordance with your application for a discharge permit received on December 10, 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 Tar -Pamlico Riparian Buffer Rule, all storrnwater 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.nc.us/su/bmp_forms.htm.
This permit does not affect the legal requirements to obtain other permits which may be
required by.the D.iv.ision 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 Cory Larsen at [phone]
or cory.larsenancdenr.Qov.
SincereQRIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins
cc: Washington Regional Office, Thom Edgerton
Central Files
Stormwater Permitting Unit Files
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699.1617
Location: 512 N• Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
NorthCarolijla
;Vaturully

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCGI50000
CERTIFICATE OF COVERAGE No. NCGIS0040
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 WASHINGTON
is hereby authorized to discharge stonnwater from a facility located at
Warren Field
200 Airport Road
Washington, NC
Beaufort County
to receiving waters designated as Cherry Run, a class C; Sw; NSW water in the Tar -Pamlico
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, 11, III, IV, V, and VI of General Permit No. NCG150000 as
attached.
This certificate of coverage shall become effective February 5, 2010.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day, February 5, 2010. ORIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins., Director
Division of Water Quality
By the Authority of the Environmental Management Commission

LOCATION MAP:
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CITY OF WASHINGTON
WARREN FIELD
Lab tude: 350 34' 14 " N
Longitude: 7711 02'54" W
County: Beaufort
Receiving Sti-earrs: Cherry Run
Stream Class: C; Sw; NSW
Sub -basin: 03-03-06 (Tar-Parrlico River Basin)
0
Facility Location

Larson, Co
From: Edgerton, Thom
Sent: Friday, January 29, 2010 11:12 AM
To: Larsen, Cory
Subject: RE: Warren Field NCG150040
Mello,
Thanks for the notification, Until the program gets better developed, WaRO will not be inspecting the airport's prior to the
General Permitting. This will give the facilities an opportunity to get started with the new requirements, such as the
development of the S3P plan, etc. I'm sure that we will start receiving plenty of calls as the facilities begin the program
and with a little time our expectations and focus will become as rigid as necessary to maintain compliance.
WaRO does not have any comments or concerns prior to issuance of the COC.
Thanks,
Thom
Thom Edgerton
Environmental Engineer
NCDENR - DWQ - Surface Water Protection Section
Washington Regional Office
[phone] Phone
[phone] Fax
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: Larsen, Cory
Sent: Monday, January 25, 2010 3:50 PM
To: Edgerton, Thom
Subject: Warren Field NCG150040
Thom,
The attached airport in Washington has submitted to us for coverage under NCG15. Are there any comments or
concerns from WARO that would hold up issuance of this COC? Please let me know within 30 days if possible. Thanks.
Cory Larsen
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
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.
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