NCG120108_ROS Request_20180920

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FOR AGENCI USE ONLY
Division of Energy, Mineral& Land Resources DatcRcccived
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Stormwater Program
National Pollutant Discharge Elimination System
REPRESENTATIVE OUTFALL STATUS(ROS)
REQUEST FORM
If a facility is required to sample multiple discharge locations with very similar stormwater discharges, the
permittee may petition the Director for Representative Outfall Status(ROS). DEQ may grant Representative
Outfall Status ifstormwater discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outf ails where analytical sampling requirements apply.
If Representative Outfall Status is granted,ALL out
falls are still subject to the qualitative monitoring
requirements of the facility's permit—unless otherwise allowed by the permit(such as NC6020000)and DEQ
approval. The approval letter from DEQ must be kept on site with the facility's Storm water Pollution
Prevention Plan. The facility must notify DEQ in writing if any changes affect representative status.
For questions, please contact the DEQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N I C I S I I I I I I N C G 1 12 loll 0 8
2) Facility Information:
Owner/Facility Name Edgecombe County Landfill
Facility Contact Mr.Larry Moore,Landfill Manager
Street Address 2872 Cotonial Road
City Tarboro State NC ZIP Code 27886
County Edgecombe E-mail Address [e-mail]
Telephone No. 252 8274253(Landfill) Fax: no fax number
3) List the representative outfall(s) information(attach additional sheets if necessary):
Outfall(s) SOOA is representative of Outfall(s) SDO-2,sop-5,SDO-6A,SDO-6B
Outfalls'drainage areas have the same or similar activities? )Q Yes ❑ No
Outfalls'drainage areas contain the same or similar materials? Xt Yes ❑ No
Outfalls have similar monitoring results? -j Yes ❑ No X No data* C�
Outfall(s) is representative of Outfall s
( )
Outfalls'drainage areas have the same or similar activities? ❑ Yes c No ,
Outfalls'drainage areas contain the same or similar materials? ❑Yes ❑ No
Outfalls have similar monitoring results? u Yes ❑ No z No data* _AJ V}
Outfall(s) is representative of Outfall(s) c
Outfalls'drainage areas have the same or similar activities? - Yes - N u
No
Outfalls'drainage areas contain the same or similar materials? Yes r. No
Outfalls have similar monitoring results? n Yes to No zi No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
SWU-ROS-2009 Page 1 of 3
past revised 12l30l2009

Representative Outfall Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or,attach a letter or narrative to discuss this information.) For example,describe how activities and/or
materials are similar.
Outfalls SDO-1, SDO-2, SDO-5,SDO-6A and SDO-613 receive stormwater that has come in contact
with the construction and demolition landfill. This includes the active working face(currently in
Drainage Area 1 (DA-1)and the inactive areas under vegetative cover(DA-2, DA-5,and DA-6).
We are requesting sampling of outfall SDO-1 and eliminating sampling at SDO-2,SDO-5,SDO-6A
and SDO-6B.
,Sampling would still be conducted at Outfalls 03(Storage of tires in trailers.diesel tank)and 44___
(Maintenance area,electronics storage building, landfill gas to energy_generators and system).
5) 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 this Article or a rule implementing this
Article;or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case
under this Article;or who falsifies,tampers with,or knowingly renders inaccurate any recording or monitoring device
or method required to be operated or maintained under this Article or rules of the[Environmental Management]
Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
ten thousand dollars(510,000).
I hereby request Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit,unless otherwise allowed by the permit
and regional office approval. I must notify DWQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my NPDES 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: Eric Evans
Title: deco be County Manager
' g folle
(Signature of Applicant) (Date Signed)
Please note: This application for Representative Outfall Status is subject to approval by the
NCDENR Regional Office. The Regional Office may inspect your factilty for compliance with the
conditions of the permit prior to that approval.
Final Checklist for ROS Regugst
This application should Include the following items:
X This completed form.
a Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status,unless all information can be included in Question 4.
X Two(2)copies of a site map of the facility with the location of all outfalls clearly marked,including the
drainage areas,industrial activities,and raw materials/finished products within each drainage area.
❑ Summary of results from monitoring conducted at the outfalls listed in Question 3.
❑ Any other supporting documentation.
Page 2 of 3
Swu-ROS-2009 Lasl revised 1 2/3 012 0 09

Representative Outfall Status Request
Mail the entire package to:
NC DENR Division of Water Quality
Surface Water Protection Section
at the appropriate Regional Office(See map and addresses below)
Notes
The submission of this document does not guarantee Representative Outfall Status(ROS)will be granted as
requested. Analytical monitoring as per your current permit must be continued,at all outfalls, until written
approval of this request is granted by DWQ. Non-compliance with analytical monitoring prior to this request
may prevent ROS approval. Specific circumstances will be considered by the Regional Office responsible for
review.
For questions,please contact the DWQ Regional Office for your area.
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Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778 Washington Regional Office
943 Washington Square Mall
Phone [phone] Washington, NC 27889
FAX [phone]
Phone [phone]
Fayetteville Regional Office FAX [phone]
Systel Building,
225 Green St., Suite 714 Wilmington Regional Office
Fayetteville, NC 28301-5094 127 Cardinal Drive Extension
Phone [phone] Wilmington, NC 28405
FAX [phone] Phone [phone]
Mooresville Regional Office FAX [phone]
610 East Center Ave. Winston-Salem Regional Office
Mooresville, NC 28115 585 Waughtown Street
Winston-Salem, NC 27107
Phone [phone] Phone [phone]
FAX [phone] Water Quality Main FAX [phone]
Raleigh Regional Office Central Office
1628 Mail Service Center 1617 Mail Service Center
Raleigh, NC 27699-1628 Raleigh, NC 27699-1617
Phone [phone] Phone [phone]
FAX [phone] FAX [phone]
Page 3 of 3
SWU•ROS.2009 Last revised 12/30'2009

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