HomeMy WebLinkAboutNCG180201_COMPLETE FILE - HISTORICAL_20140515- STORMWATER DIVISION CODING -SHEET - -
RESCISSIONS.
PERMIT NO.
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DOC TYPE
❑COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
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YYYYMMDD
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NCDENR
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Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharge Elimination System
PERMIT NAMEIOWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N G S 1 0 N C G 1118 10 2 0 11
Permit status prior to requested change.
a. Permit issued to (company name): Kellex Corporation
b. Person legally responsible for permit: Chris Rice
First Ml Last
President
Title
P.O. Box 40
Permit Holder Mailing Address
Valdese NC 28690
City State Zip
(828) 874-2124 (828) 874-2842 _
Phone Fax
c. Facility name (discharge):
Kellex Corporation -Valdese
d. Facility address:
T 501 Hoyle Street
Address
Valdese NC 28690
City State Zip
e. Facility contact person:
David Ebert (828} 874-2124
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
® Name change of the facility or owner
If other please explain: Facility contact change.
b. Permit issued to (company name):
Kellex Seating 0
c. Person legally responsible for permit:
Chris Rice
First MI Last
President
Title
501 Hoyle Street d9
Permit Holder Mailing Address
Valdese NC 28690
City State Zip
(828) 8742124 crice?kellex.com Q
Phone E-mail Address
d. Facility name (discharge): Kellex Seating 0
e. Facility address: 501 Hoyle Street
Address
Valdese NC 28690
City State Zip
f. Facility contact person: Donald Grey
First MI Last
(828) 874-2124 dgray@,,kellex.com
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014
NPDES PERMIT NAMEIOWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: David Ebert
First Ml Last
Maintenance Manager
Title
P.O. Box 40
Mailing Address
Valdese NC 28690
City State Zip
(828) 874-2124 debert@kellex.com
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® 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, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete 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
APPLICANT CERTIFICATION
Date
1, Davis d Ebert, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowle . 1 understand that if all required parts of this application are not
completed and th f all required su tng information is not included, this application package will be
returne inc p ete.
Ma 15, 2014
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, M4
David Ebert,
Enclosed is Kellex's prepared stormwater permit contact change form. Please have signed where
indicated and mail in the prepared envelopes by CERTIFIED MAIL ON OR MAY 31".
The changes were also as required submitted electronically to the state of North Carolina
Please make a copy for your files.
If you have any questions, please contact me.
Paul W. Spangenberg
Env. Compliance Manager
Email: pspangenberg@bellsouth.net
Office: (919) 846-7492
Cell: (919) 624-0630
1LV I 274 NFE '1 BOf3I 00 09/ 25109
Sly N DER
: NIGKOFTYRHILLLNFURN
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D
RETURN TO SDgp_00756_6_g 0 9 f R 0 0 9 5 8 4
SC: 27699181799
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i al f is required by the North Carolina Administrative Code. It covers the administrative costs associated with your
{ . required of any person holding a pert -nit for any time during the annual fee period, regardless of the facility's operating
a us. F lure to pay the fee by the due date will subject the permit -to revocation. Operating without a valid permit is a violation
and is ject to a S 10,000 per day fine. If the permit is revoked and you later decide a permit is needed, you must reapply, with the
unde tanding the permit request may be denied due to changes in environmental, regulatory, or modeling conditions.
Permit Number: NCG180201
Burke County
Hickory Hill Furniture
David Ebert
Hickory Hill Furniture
502 Hoyle St S W
Valdese. NC 28690
Annual Fee Period: 2009-09-01 to 2010-08-31
Invoice Date: 09/15/09
Due Date: 10/15/09
Annual Fee: $100,00
v ` I. A $25.00 processing fee will be charged for TOurn ed-checks, in accordance with the North Carolina General Statute 25-3-512.
2. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
3. Remit payment to:
NCDENR -Division of Water Quality z -
1617 Mail Service Center g Q
Raleigh, NC 27699-1617 °r 4
4. Should you have any questions regarding this invoice, please contact the Annual Administerin ompance F rdinatur at
919-807-6321. ( ;�' ,..:..: ;r!
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Permit Number: NCC3180201
Burke County
Hickory Hill Furniture
David Ebert
Hickory Hill Furniture
502 Hoyle St S W
Valdese, NC 28690
2 0 0 9 P R 0 0 9 5 8 4
L
Annual Fee Period: 2009-09-01 to 2010-0B-31
Invoice Date: 09/15/09
Due Date: 10/15/09
Annual Fee: $100.00
Check Number:
1�ti -`-
f
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
2 0 0 8 P R 0 1 0 4 5 7
INVOICE
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative'Cbcfe..- covers the administrative costs associated with your
permit. It is required of any person holding a permit 1;ar,any tide duriti the annual fee period, regardless of the facility's operating
status. Failure to pay the fee by the due date will sitlaject the-p-c init to revocation. Operating without a valid permit is a violation
and is subject to a $10,000 per day fine. 1f the permit is'revoked and you later decide a permit is needed, you must reapply, with the
understanding -the permit request may be denied due to changes in environmental, regulatory, or modeling conditions.
Permit Number: NCG180201
Burke County
Hickory Hill Furniture
David Ebert
Hickory Hill Furniture
502 Hoyle St S W
Valdese, NC 28690
Annual Fee Period: 2008.09-01 to 2009-08-31
Invoice Date: 10/15/08
Due Date: 11/14/08
Annual Fee: $100-00
Notes:
I. A $25.00 processing fee will be charged for returned checks in accordance with the North Carolina General Statute 25-3-512.
2. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
3. Remit payment to:
NCDENR - Division of Water Quality -
1617 Mail Service Center
Raleigh, NC 27699-1617 ": r'it:f`f]r..3l:jii,lai�'-i3ilfi?7nSlit
4. Should you have any questions regarding i}iis invotre, phase contact the Annual Administering and Compliance Fee Coordinator at
919-807-6321,
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Permit Number: NCG180201
Burke County
Hickory Hill Furniture
•. ::
David Ebert
Hickory Hill Furniture
502 Hoyle St S W
Valdese, NC 28690
1111111111111111111111111111
2 0 0 8 P R 0 1 0 4 5 7
Overdue
Annual Fee Period: 2008-09-01 to 2009-08-31
Invoice Date: 10/15/08
Due Date: 11/14/08
Annual Fee: $100.00
Check Number:
116
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
August 27, 1999
DAVID EBERT
NORWALK FURNITURE HICKORY HILL FURNITURE
P.O. BOX 40
VALDESE, NC 28690
Dear Permittee:
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissue - NPDES Stormwater Permit
Norwalk Furniture Hickory Hill Furniture
COC Number NCG180201
Burke County
In response to your renewal application for continued coverage under general permit NCG180000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
* A copy of general stormwater permit NCG180000
* A Stormwater Pollution Prevention Plan (SPPP) Certification Fort. Completion of this form is required to
certify that you have developed and implemented the SPPP as per the conditions of the permit. This forth
must be completed and returned to the Division within 30 days of receipt of this letter.
DO NOT SEND the SPPP with the signed form.
* Five copies of the Analytical Monitoring form and five copies of the Qualitative Monitoring form
* A copy of a Technical Bulletin on the Stormwater program which outlines program components and
addresses frequently asked questions
* A corrected Certificate of Coverage if you indicated a name change on the Renewal Application
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule, standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Darren England of the Central Office
Stormwater and General Permits Unit at (919) 733-5083, ext, 545
Sincerely,
for Kerr T. Stevens
Director, Division of Water Quality
cc: Central Files
Asheville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone 919-733-5083 FAX 919-733-9919
An Equal Opportunity Affirmalive Action Employer 50% recycled/ 10% post -consumer paper
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180201
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,
NORWALK FURNITURE
is hereby authorized to discharge stormwater from a facility located at
NORWALK FURNITURE
501 HOYLE ST
VALDESE
BURKE COUNTY
to receiving waters designated as Valdese MSSS to Micol Creek in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 1I, II1,
IV, V, and VI of General Permit No. NCGI80000 as attached.
This certificate of coverage shall become effective August 27, 1999.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 27, 1999.
for Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
November 17, 1995
David Ebert
Norwalk Furniture
P.O. Box 40
Norwalk, OH 44857
09WMA1
IT 0 0
Ad�j
C) FE
Subject: General Permit No. NCG 180000
Norwalk Furniture
COC NCG 180201
Burke County
Dear David Ebert:
In accordance with your application for discharge permit received on October 11, 1995, 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
December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please tape notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management may require modification or
revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Environmental Management 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 question concerning this permit, please contact MR. STEVE ULMER at telephone
number 919/733-5083.
cc: Asheville Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535
An Equal Opportunity Affirmative Action Employer
Sincerely, YOBY
0,4G ]Wt F,i �.
Ef�`iJL�Y 3�oT
A. Preston Howard, Jr. P.E.
Telephone 919-733-7015 FAX 919-733-2496
50% recycled/ 10% post -consumer paper
0
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO. NCGI80000
CERTIFICATE OF COVERAGE NO. NCG180201
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,
Norwalk Furniture
is hereby authorized to discharge stormwater from a facility located at
Hickory Hill Furniture
501 Hoyle Street
Valdese
Burke County
to receiving waters designated as Micol Creek and the Town of Valdese Storm Sewer System in the Catawba River
Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1,11, 1II
and IV of General Permit No. NCG180000 as attached.
This Certificate of Coverage shall become effective November 17, 1995.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day November 17, 1995.
QMGiNAL SIGNED BY
6'w=,DLEY BENNE T
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission
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