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Home My WebLink AboutNCG180259_Application_20200115 NCG-L2OZ5q FOR AGENCY USE ONLY Date Received Year Month Day Division of Energy, Mineral, and Land Resources zozo of t 5 M Land Quality Section Certificate ofCoveraee K National Pollutant Discharge Elimination System tvICIGI l I to }� Check M Amount Environmental 5oa(.30 *I oD Quality Pennit Assigned to L I NCG 180000 5►1ite T77i1'1 Wand NOTICE OF INTENT National Pollutant Discharge Elimination System application for coverage under General Permit NCG180000: RECEIVED STORMWATER DISCHARGES associated with activities classified as: 1%�N 1 5 SIC* 25 Furniture and Fixtures, and SIC 2434 Wood Kitchen Cabinets, ZO20 And, Like activities deemed by DEMLR to be similar in the process, or the expos BLAND QUALITY materials, products, by-products, or waste materials. ORMWATER PERMITTING *Standard Industrial Classification Code (Please print or type) 1) Mailing address of owner/operator(address to which official permit correspondence will be mailed): Name Ashley Furniture Industries, Inc. Street Address One Ashley Way City Arcadia State WI ZIP Code 54612 Telephone No. 608 323-3377 Fax: E-mail address ameinerz0ashleyfurniture.com 2) Location of facility producing discharge: Facility Name Statesville RTA MFG LLC Facility Contact Steve Nolan Street Address 607 Meacham Road City Statesville State NC ZIP Code 28677 County Iredell Telephone No. 608 323-3377 Fax: 3) Physical Location Information: Please provide a narrative description of how to get to the facility(use street names, state road numbers, and distance and direction from a roadway intersection). Please see attached Map (A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application) 4) Latitude 35.793365 Longitude -80.923793 (degrees, minutes, seconds) 5) This NPDES Permit Application applies to which of the following : ❑ New or Proposed Facility Date operation is to begin 8/26/2019 EI Existing 6) Standard Industrial Classification: Provide the 4 digit Standard Industrial Classification Code (SIC Code)that describes the primary industrial activity at this facility SIC Code: 2 5 1 1 7) Provide a brief narrative description of the types of industrial activities and products manufactured at this facility: Wood Furniture Manufacturing Page 1 of 5 SWU-233-82814 Last revised 8/28/14 NCG180000 N.O.I. 8) Discharge points/Receiving waters: How many discharge points(ditches, pipes, channels, etc.)convey stormwater from the property? 1 List discharge points(outfalls)that convey discharge from the site(both on-site and off-site) and location coordinates.Attach additional sheets if necessary, or note that this information is specified on the site plan. Stormwater Outfall No. 1 Latitude(degrees/minutes/seconds): 35°47'41 N Longitude(degrees/minutes/seconds): 80°55132 W Stormwater Outfall No. Latitude(degrees/minutes/seconds): N Longitude(degrees/minutes/seconds): W Stormwater Outfall No. Latitude(degrees/minutes/seconds): N Longitude(degrees/minutes/seconds): W Stormwater Outfall No. Latitude(degrees/minutes/seconds): . N Longitude(degrees/minutes/seconds): _ W Stormwater Outfall No. Latitude(degrees/minutes/seconds): N Longitude(degrees/minutes/seconds): Stormwater Outfall No. Latitude(degrees/minutes/seconds): N Longitude(degrees/minutes/seconds): W Stormwater Outfall No. Latitude(degrees/minutes/seconds): N Longitude(degrees/minutes/seconds): W 9) Receiving waters: What is the name of the body or bodies of water(creek, stream, river, lake, etc.)that the facility stormwater discharges end up in? Gregory Creek If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm sewer system (e.g. City of Raleigh municipal storm sewer). Page 2 of 5 SWU-233-82814 Last revised 8/28/14 NCG180000 N.O.I. 10) Does this facility have any other water quality permits? ▪ No ❑ Yes If yes, list the permit numbers for all current water quality permits for this facility: 11) Does this facility have any Non-Discharge permits(ex: recycle permits)? I No ❑ Yes If yes, list the permit numbers for all current Non-Discharge permits for this facility: 12) Does this facility employ any best management practices for stormwater control? III No • Yes if yes, please briefly describe: Try to minimize any exposed materials onsite by bringing them indoors or covering them if practicable. 13) Does this facility have a Stormwater Pollution Prevention Plan? • No ❑ Yes If yes, when was it implemented? 14) Are vehicle maintenance activities occurring at this facility? I No ❑ Yes 15) Hazardous Waste: a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? I No ❑ Yes b) Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste generated per month) of hazardous waste? INo ❑ Yes c) Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste generated per month) of hazardous waste? • No ❑ Yes d) If you answered yes to questions b. or c., please provide the following information: Type(s) of waste: How is material stored: Where is material stored: How many disposal shipments per year: Name of transport/disposal vendor: Vendor address: Page 3 of 5 SWU-233-82814 Last revised 8/28/14 NCG180000 N.O.I. 16) Certification: North Carolina General Statute 143-215.6 b(i) provides that: Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan or other document filed or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $10,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than$10,000 or imprisonment not more than 5 years,or both,for a similar offense.) I hereby request coverage under the referenced General Permit. I understand that coverage under this permit will constitute the permit requirements for the discharge(s)and is enforceable in the same manner as an individual permit. I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief such information is true, complete, and accurate. Printed Name of Person Signing: Michael Moran Title: Corporate Director of Plant Engineering /A// 2-cy (Signatur ' f Applicant) (Date Signed) Notice of Intent must be accompanied by a check or money order for$100.00 made payable to: NCDEQ. Page 4 of 5 SWU-233-82814 Last revised 8/28/14 |REDELL COUNTY MAP: Statesville RTAK4FG' LL[ location illustrated with the =-`° symbol. ' /�� ._~ Union Grove ' V / vanhi / Valley ^ Lfield Harmony Stony e Point u7i Scotts Cool Springs Phtsburg Loray ®r Cleveland /muon �4 Lungm|ar'd Bear Poplar \ MtU||a � � Snrn/o / um ` kc '` � �� Norma, �of ""~~~' i Qenvc \ ~ ~ Davidson o Kan North Carolina Secretary of State Search Results Page 1 of 1 • File an Annual Report/Amend an Annual Report• Upload a PDF Filing • Order a Document Online•Add Entity to My Email Notification List•View Filings• Print a Pre-Populated Annual Report form • Print an Amended a Annual Report form Business Corporation Legal Name Ashley Furniture Industries, Inc. Information Sosld: 0347607 Status: Current-Active Annual Report Status: Current Citizenship: Foreign Date Formed: 6/29/1994 Fiscal Month: December State of Incorporation: WI Registered Agent: Corporation Service Company Addresses Reg Office Reg Mailing Mailing 2626 Glenwood Avenue, Suite 550 2626 Glenwood Avenue, Suite 550 One Ashley Way Raleigh, NC 27608 Raleigh, NC 27608 Arcadia, WI 54612-1218 Principal Office One Ashley Way Arcadia, WI 54612-1218 Officers Treasurer Secretary President Troy Muller Shari Wagner Todd R Wanek One Ashley Way One Ashley Way 1427 Oceanview Dr Arcadia WI 54612 Arcadia WI 54612 Tierra Verde FL 33715 Stock https://www.sosnc.gov/online_services/search/Business_Registration_Results 1/15/2020