NCG210417_COMPLETE FILE - HISTORICAL_20130814

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
Iv
DOC TYPE
,J�HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
p �b/ 3
YYYYMMDD

AeV3-.VyVw1FA
Division of Water Quality / Surface Water Protection
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N4ItIOI1111 POIItItMit Discharge Elimination System
NCDENR
PERMIT NAME/OWNERSHIP CHANGE FORM
LnY+DwlM:.wi !INlYML 13u0.r1CL•
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
I. Please enter the permit number for which the change is requested.
NPDES Permit (or} Celli ricate of Coverage
N C; S 16 1 1 1 1 1 1 1 K I q 10 1 'L1 1 (3 1 4 -7
II. Permit status ar rior to requested change. p
a. Permit issued to (company name): CySM \c`\\�� a\ C�►�1� ` _
b. Person legally wsimsible for permit: LP,
11ra 1%11 1�rst
��D
AUG 2 0 2013
c. Facility name (discharge):
d. Facility address:
e. Facility comact person:
Tith:
Perntit Holder A1;u11nr Address
C c��\`e \)('
City State Lill
Phone Fax
u-S M �-L%e-C C
51 Cam, tJ G
ALklrrs,
city state Zip
First / M I / Last Plx�lu
III. Please provide the following for the requested change (revised permit).
it. Request for change is a result of: C]"'Chatlge in ownership of the facility
❑ Name change of the facility or owner
Il-rrtherplease explain:
b. Permit issued to (company tutme): C-
c. Person legally responsible for permit:
\�\ Hirst III L.:rsl
Tii1v
I ern ii Holdcr N1:ulitie Addre%%
sttstc "Lip
( `WOK) co\� �%Q CL��1p�J�(?Cy,S\�ll�f7a1�e�
Phonr F.-Address
d. Facility name (discharize): ['0, \e� k �,\1?
e. Facility addl-ess:-
Address
Cite SL,11C
f. Facilitycontact pel-son:
Hirst Nil last
qAk
PExx)e H-ntul Address
OC\
02
Ra s13d 2412Apr23

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
1V. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First Nil 1'41�1
Title
Mailing Address
City State Zip
Now E: miiI Address
1�111 t e permitted facility continue to conduct the Same Industrial activities conducted prior
V. to! ', ownership or name change':
Y es
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
AWINCONIPLETE OR NIISSING:
❑� This completed application is required for both nanw, change and/or ownership change
requests.
❑ Legal dOCUnlentation of the transfer of ownership (such as relevant ptlges of it coninuct deed.
or a bit of sale) is required for an ownership change request. Articles of incorporinion are
not sufficient for on ownership change.
The certifications below mist be. completed and sii7ned by both the perrltrt ]folder prior to the change. and
the new applicant in the case of an ownership change request. For :t name change request. the signed
Applicants Cenificution is sufficient.
PERNIITTEE CERTIFICATION (Permit holder priorto ownership change):
1. tub , t►ttest that this application for it nume/ownersh i p change has been reviewed and is accurate and
complete tothe best of my knowledge. I tnldersrtnd that if all required parts of this application are not
completed and that if all rC-cluired ,it pponin,, information is not included, this application package will be
return us ' c ere.
S/ 4140 3
signature Date
APPLICANT CERTIFICATION
attest that this application fora name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required pans of this application are not
completed rind that if till rtXILIired support ini-_ information is not included. this application package will be
returned as incom e.
1�/1,3
Signature c�Dute
PLEASE SEND THE CONIPLETE APPLICATION PACKAGE TO:
Division of Witter QualitV
Surface Water Protection Section
1617 Mail Service Center
Raleigh. North Carolina _'7699-1617
Revised 7/2008

d•
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen K. Sullins
Governor Director
August 26, 2011
Mr. Michael Szczepanski, General Manager
Custom Pallet & Crating
5104 N. Graham Street
Charlotte, North Carolina 28269
Subject. General Permit No. NCG210000
Custom Pallet & Crating
COC No. NCG210417
Mecklenburg County
Dear Mr. Szczepanski:
Dee Freeman
Secretary
In accordance with your application for a discharge permit received on July 1, 2011, we are forwarding
herewith the subject certificate of coverage (COC) 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).
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 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. 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 Bill Diuguid at telephone number
[phone].
Sincerely,
ORIGIML SIGNED
B1
KEN PICKLE
Coleen H. Sullins
cc: Mooresville Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location; 512 N. Salisbury St, Raleigh, North Carolina 27604 ODe
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-674a NorthCarohria
Internet: www.ncwaterquality,org '/j� r
An Equal Opportunity ) Affirmative Action Employer QIt�i aliff

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE No. NCG210417
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;
Custom Pallet & Crating
is hereby authorized to discharge stormwater from a facility located at
Custom Pallet & Crating
5104 N Graham Street
Charlotte
Mecklenburg County
to receiving waters designated as Little Sugar Creek, a Class C creek, Catawba River Basin; in accordance with the
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, IV, V and VI of
General Permit No. NCG210000, as attached.
This Certificate of Coverage shall become effective August 26, 2011.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 26, 2011,
ORIGINAL SIGNED B1
KEN PICKLE
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Latitude: 35c16'58"
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Facility
NCG21041 73F
Longitude: 80148'11 2.'
County: Mecklenburg Custom Pallet & Location
Stream Class: C Crating
Receiving Stream: an unnamed tributary to Liiia_,
Creek NOT ICALID
Sub -basin: M-0&34 (Catawba River Basin)

i
C Custom Pallet & Crating, Inc 5104 N. Graham St
Charlotte, NC 28269
C (704) 921-1i00 -Phone
[phone] - Fax
I
NCDENR June 27, 2011
Stormwater and General Permits Unit j��a
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617 JUL 0 I! 2011
vv�efltsn awnrLrF{ QVAL rY
aw arerx#i
To Whom it May Concern,
In response to a Charlotte -Mecklenburg Storm Water inspection we are required to submit the
attached form NCG210000 Notice of Intent for our Woodchip Mill Operation.
Included with the form is a map showing the property location and a check for $100.00 tax.
Please note this is a resubmission as our initial form was rejected due to use of outdated form.
Regards,
Ml e Szc
General ]
0

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,
13

NCG210000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
LT' Check for $100 made payable to NC DENR
EK This completed application and all supporting documents
5VI, Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DWQ Central Office or Regional Office for your area.
To visit our website, go to http://portal.ncdenr_orglweb/wq/ws/su
DWQ Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office
... [phone]
Mooresville Office
... [phone]
Raleigh Office _....
_...[phone]
Washington Office
...[phone]
Wilmington Office
... [phone]
Winston-Salem ...... [phone]
Central Office .........(919)
807-6300
Page 4 of 4
sw u=236.03 1 a, ,

CUSTOM, PALLET;'&•CRATING, INC. -
'9344 N: GRAHAM ST.
', CHARLOTTE;' NC 28269
(704) 921,-1100
Memo:
PAY . Hundred and 00%100 Dollars •
T6.THE--NCDENR- Stormwat-er ,z&'=Gehera1 Permits
ORDER on _..... _ _. _ _..
Divisi` at :Water Quality
1617 Mail Service' Center
Raleigh,"',NC 27699-1617

5 104 North Graham Street, Charlotte. NC - Google Maps
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