NCG170407_COMPLETE FILE - HISTORICAL_20140529

STORMWATER DIVISION CODING SHEET
NCG PERMITS
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PERMIT NO.
DOC TYPE HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ y d
YYYYM M D D

A k - A
Glalv
NC®ENR
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharge Elimination System
PERMIT NAME/OWNERSHIP CHANGE FORM
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DENR-LAND QUALITY
STORMINATER PERMITTING
Please enter the permit number for which the change is requested.
NPDLS Permit (or) Certificate of Coverage
1V d S. 0I N I,C, ,G. I I 1 110 14 10 '7
IL Permit status prior to requested change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
c. Facility name (discharge):
d. Facility address:
e. Facility contact person:
01O mtr i1r0up 'Inc.
Buster 5Aone
First MI Last
Title
1Z03 `). 0(u e'At,ap Rd
Permit Ilolder Mailing Address
Benson NC Z7504-
City State Zip
(gra ) a07-31('5 ( erg) 207-3Z47
phone FIX
Pol�mcr 6FDup Sne
12 n."� 'I) Zd
Address
Awn INC Z750L4
City State Zip
Buster 5-bne ( 019 ) 2,07-3Ito5
First / MI / Last Phone
Ill. 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 olher please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
Polymer 6roup -Inc.
Brian VenIc7, '
First MI last
')eniof ?Iant- 'D-i mckOr
Til le
I7-03 Chicopee
Permit Bolder Mailing Address
Benson N C 2 750 L✓
Citv State Zip
( cIIF ) Z07.3Z34 venieZ6 nw. mm
Phone Email Address
l�t mu PoGroup SnC.
IZn� C.t'llrnuep_ Fj
Address
ien5on Nr_ Z7504
City State Zip
R0556nc, i?MyOS�-
First MI Last
( Glq ) ZO7.3tpfi �revostra min .(ovrl
Phone E-mail Address
W. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014

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NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact:
First MI Last
'title
Mailing Address
City State /„ip
Phone Ginail 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 most 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):
I, , 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 ol'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
I, , 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.
Signatto
S A -l4-
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, 2014

WATF9
Michael F. Easley, Governor
April 13, 2007
Mr. Don Yates
Polymer Group Inc.
1203 S. Chicopee Road
Benson, NC 27504
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Subject: General Permit No. NCG170000
Polymer Group Inc.
COC No. NCG170407
Johnston County
Dear Mr. Yates:
In accordance with your application for a discharge permit received on December 15,
2006 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 May 9, 1994 (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 Aisha Lau at telephone
number [phone] ext. 578.
Sincerely,
ORIGINAL SIGNED BY
BRADLEY BENNETT
Alan W. Klimek, P.E.
cc: Raleigh Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
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nNltCarolina
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North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: h2o.encstate.nc.us 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

IV
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG170000
CERTIFICATE OF COVERAGE No. NCG170407
STORM WATER 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,
Polymer Group Inc.
is hereby authorized to discharge stormwater from a facility located at
Polymer Group Inc.
1203 S. Chicopee Road
Benson
Johnston County
to receiving waters designated as Mingo Swamp, class C, SW water, in the Cape Fear River Basin in accordance
with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, 111, IV, V and VI
.of General Permit No. NCG 170000 as attached.
This certificate of coverage shall become effective April 13, 2007.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 13, 2007.
ORIGINAL SIGNED BY
BRADLEY BENNETT
Alan W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Latitude:35"21'48" NCG170407
Longitude: 78"33'08"
County: Johnston Polymer Group Inc.
Stream Class: C, SW
Receiving Stream: Mingo Swamp
Sub -basin: 03-06-08 (Cape Pear River Basin)
Facility
Location
Not scaled