NCG150055_COMPLETE FILE - HISTORICAL_20170731

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
DOL TYPE
❑HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ ��� ��� 31
YVYYMMDD
w

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
;u
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL IIVALRY (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE. ONLY
Date Received
Year
Month
Da
of
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 t UMOua!" meanT
The person is either: JUL
• the responsible corporate officer (for a corporation); I A' 4TY
• the principle executive officer or ranking elected official (for a f fjj*er public
agency); STORMWATEfi� '
• 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 (or) Certificate of Coverage
N I C I S I I I I I N I C I G I 1 15 1 014 S.5
2) Facility Information:
Facility name: '�o rl k) 6 jJ 1Qe, & 1 0 04 1 A I y �
Company/Owner Organization: :1 d4 y,15 a d Ga ,0 /-o2t tt. 4 u
Facility address: _` ! `1 `1 �w i { C,v5e ^ T�
! r j 1 Address
��rry6�i17"I el Gi ef C/
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
htt ://de .nc. ov/about/divisions/encr y -mineral-land-resources/ever -mineral-land- ermits/stonnwater- ro rram
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual-. 7:r V 1 A) k 6 1AC,1L M a w
` First M1 Last
4) NEW OWNER AFFILIATION (iegally responsible for the permit):
Person legally responsible for this permit: P � L i L,6 i-j I `o- to,
First MI Last
Page 1 of 2
S W U-OWNERAFFIL-23March2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Title r
Mailing Address
City State Zip
Telephone E-mail Address
t9/9 ) 9317
Fax Number
5) Reason for -this change:
Employee or management change
A result of: ❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
G `Qa-- ,attest that this application for this change in Owner Aff liation
(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.
25 /
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:
http://deg.ne.gov/about/divisions/energy-mineral-land-resources/stonnwater
Page 2 of 2
S W U-0 WNERAFFIL-23Mar2017

r State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION
1, Stormwater Management Permit Number:
2. Project Name: Jo A N,$TO
ME
3
3. Current Permit Holder's Company Name/Organization: Tokti_540V d,6T A
4. Signing Official's Name:.-fr VIA IZ 61Ack m o 1J Title: _L) 1 y_p &+a JL„
5. Mailing Address: 31 Y 9 5 f,Ji eke a ICE
City: 5 t, r�L 4i L Id State: ACS Zip: 27 5�7 " 7
6. Phone: ( ) 9 3y ` 0 7 9 Z Fax: (F t q) 93Y - 1.-.1 Y
II. PROPOSED PERMITTEE 1 OWNER / PROJECT/ ADDRESS INFORMATION RECEIVED
This request is for: (please check all that apply) SEP ] 1 2014
Name change of the owner (Please complete Items 1, 2 and 3 below) DENR_I_AND QUALITY
❑ Name change of project (Please complete Item 5 below) STORMWATRPRMITTI�IG
❑ Change in ownership of the property/company (Please complete Items 1, 2, 3, and 4 e ow
❑ Mailing address / phone number change. (Please complete Item 4 below)
❑ Other (please explain):
1. Proposed permittee's company name/organization: ToA J.5 ay Cd • kngdoe
2. Proposed permittee's signing official's name: T'r yt ivy k 8/Ac,km,Aj
3. Proposed permittee's title:
4. Mailing Add ress:�3! Y7 �c,ji4l C ye&k_ KR
City: State
4/c- zip: 2.7 �5- 7'7
Phone: (719 ) 73�t — O Q7 Fax: ( qt f)` 23y-`1'�-I q
5. New Project Name to be placed on permit:
Please check the appropriate box. The proposed permittee listed above is:
❑ HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA in #1 above and provide name of HOA/POA's authorized representative in #2 above)
The property owner
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
❑ Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner Information on page 4)
SSW N/O Change Rev24Sept2412 Page 1 of 4

" III. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may result in processing delays or denial of the transfer.
1. This completed and signed form. This certification must be completed and sidned.by both the
current permit holder and the new applicant if this is a change of ownership
2. Legal documentation of the property transfer t-o a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4. The designer's certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional office), if required by the permit and if not already submitted to DWQ.
5. If the proposed permittee is a firm, partnership, association, institution, corporation, limited liability
company, or other corporate entity, provide documentation showing the authority of the named
representative to act on behalf of the proposed permittee.
6. The $40.00 processing fee. If this is an initial transfer from the original permittee the processing
fee is not required. Subsequent ownership transfers will require the $40.00 processing fee.
IV. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fill out the certification below that statement:
[Check here if the current permittee is only, changing his/her/it name, fhe project name, .or mailing
address, but will retain the permit. I, Sa „leog A;.r 46 otw the current
permittee, hereby notify the DWQ that I am changing my n me and/or I am changing my mailing
address and/or I am changing the name of the permitted project. I further attest that this application
for a name/ownership change is accurate and complete to the best of my knowledge. I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments listed above are not included, this application package will be returned as
incomplete.
❑ Check here if current permittee is transferring the property to a new owner.and will not retain
ownership of the permit.
I, , the current permittee, am submitting this application
for a transfer of ownership for permit 4 . I hereby notify DWQ of the sale or
other legal transfer of the stormwater system associated with this permit. I have provided a copy of
the most recent permit, the designer's certification for each BMP, any recorded deed restrictions,
covenants, or easements, the DWQ approved plans and/or approved as -built plans, the approved
operation and maintenance agreement, past maintenance records, and the most recent DWQ
stormwater inspection report to the proposed permittee named in Sections II and V of this form. I
further attest that this application for a name/ownership change is accurate and complete to the best
of my knowledge. I understand that if all required parts of this application are not completed or if all
required supporting information and attachments listed above are not included, this application
package will be returned as incomplete. I assign all rights and obligations as permittee to the
proposed permittee named in Sections 11 and V of this form. I understand that this transfer of
ownership cannot b p oved b the DWQ unless and until the facility is in compliance with the
permit.
Signature: Date: /
a Notary Public for the State of
I-1 uti A C�, ►u CZ 0 d. County of ` Q6 A crw , do hereby certify that
1 i,y-.. nc4� 1) LC�cl� ►'►nuw personally appeared before me this the
daySe
of pe64 he,,- , 201_1_, and acknowledge the due exec tion of the
forgoing instru a t. Witness my hand and official seal, (Nod da1lMy��i,
Notary Signature NOTARY —
Og _�� -�n4C, = PUBLIC
r
SSW N/O Change Rev24Sept2012 Page 2 of 4 ti
i���/ToN E0w`\`��

CE14
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
January 29, 2010
Mr. Ray Blackmon, Airport Director
,lohnston County Airport Authority
3149 Swift -Creek Road
Smithfield, NC 27577
Resources
SUbJect: General Permit No. NC(1150000
Johnston County Airport Authority
COC NCG 150055
J0171Istoml County
Dear Mr. Blackmon:
Dee Freeman
Secretary
In accordance with your application for a discharge permit received on December 1, 2009,
we are fonvarding 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 EnvironmentaI'Protection Agency dated October 15, 2007 (or'as subsequently arnended).
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 ,nay require modification or
revocation and reissuance of the certificate of coverage.
Per the requirements of the Neuse Riparian Buffer Rule, all storniwater drainage to streani
buff-ers, from portions of this site that have been constructed niter July 22, 1997, must be
discharged through a correctly designed level spreader or another device that meets diffuse flow
requirements per 15A.NCAC 213 .0233. Diffuse flow requirements are described in Chapter 8 of
the North Carolina Storrilwater.BM.P Manual, available at.-
littp:Hh2o.eiir.state.iic.us/sti/biiip forrns.htm.
This permit does not affect the legal requirements to obtain other perinits 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.
Wetlands and Stormwater Branch 011e
1617 Maif Service Center, Raleigh, North Carolina 27699.1617 North Caro I tt.a
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phoney 919.807.6300 4 FAX: [phone] Customer Service: 1.877-623-6748
Internet: www.ncwaterquafity.osg

Mr. Danny Smith
Johnston County Airport Authority—NCG 6 50055
Jam►ary 29, 2010
If you have any questions concerning this permit, please contact Jennifer Jones at
telephone number (919) 807-U379
Sincerely,
ORIGINAL -SIGNED 6Y
KEN PICKLE.
for Coleeii H. Sullins
cc: Raleigh Regional Office, Dandy Smith
Central Files
,StormWater Permitting Unit Files

'VO
STATE OF NORTH. CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER'QUALITY
GENERAL PERMIT NO. NCG1.50000
CER'.nFICATE OF COVERAGE No. NCGI50055
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,
Johnston County Airport Authority
is hereby authorized to discharge storniwater from a facility located at:
Johnston County Airport Authority
3149 Swift Creek Road
Smithfield
Johnston County
to receiving waters designated as Swift Creek and Reedy Branch, both class C, NSW waters in
the Neuse River Basin, in accordance with the effluent.limitations, monitoring requirements, and
other conditions set forth in Parts I, II, 111, 1 V, V, and VI of General Permit No. NCG 150000 as
attached. . .
This certificate of coverage shall Become effective January 29, 2010.
This Certificate of Coverage shall remain in effect for the duration of (lie General Permit.
Signed this day January 29, 2010.
ORIGINAL PICKS BY
for Coleen H. Sullins., Director
Division of Water Quality
By the Authority of the Environmental Management Commission

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Johnston County Airport Authority
Johnston County
Latitude: 350 32' 50" N
Longitude: 780 23' 22" W
County: Johnston
Receiving Streams: Swift Creek & Reedy Branch
Stream Class: C, NSW
Sub -basin: 03-04-02 ((Neuse River Basin)
Facility Location

Jones, Jennifer
From: Hayes, Mitch
Sent: Tuesday, January 26, 2010 9:05 AM
To: Jones, Jennifer; Smith, Danny
Subject: RE: NCG150055 Johnston County Airport Authority - Feb 11 2010
The RRO has no objection in issuing permit iVCG150055. Than
this office_.
Thanks,
Mitch
Mitch Hayes, Environmental Specialist
NCDFNR, Division of Water Quality, Raleigh Regional Office
1628 MSC, Raleigh, NC 27699-1699
Voice: 919.791.4261-- Fax: [phone]
m it ch, haves@ ncdenr.eov
u for sending the NOI. If they send you a map of the facility, could you please forward a copy to
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: Jones, Jennifer
Sent: Monday, January 11, 2010 12:13 PM
To: Smith, Danny; Hayes, Mitch
Cc: Jones, 7ennifer
Subject: NCG150055 Johnston County Airport Authority - Feb 112010
Hi Danny & Mitch,
We've received an NOI from the Johnston County Airport Authority for their airport in Smithfield 0ohnston County) for coverage under
NCG15 (airport permit). The site discharges stormwater into both Swift Creek and Reedy Branch (both C, NSW). The NOI is attached.
I've will include the Neuse NSW diffuse flow buffer requirements in the cover letter.
Does the Raleigh Regional Office have any concerns about issuing this facility a COC for this general permit? If we don't receive any
objections, we'll issue the COC in 30 days.