NCG180100_COMPLETE FILE - HISTORICAL_20140917

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ � VJ 0 J 1 -7
YYYYM M D D

0
AFOW
Division of Energy, Mineral and Land Resources
Land Quality Section / Stormwater Permitting Program
w
NCDENRNational Pollutant Discharge Elimination System (NPDES)
,-IRO.Me.,^ N—R^LA°° °^°« PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
FOR AGENCY IIIE ONLY
Uam ReceiccJ
Year
\Imvh
Da,
RECEIVED
Use this form if there has been: DENR-
IAND
NO CHANGE in facility ownership or facility name, but the in6TVffi1W4ERf
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual' mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state. federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N I C I S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N I C I G/ I
AI [sy Cklo &0 L-
Address
nit= ,29742-
City State "Lip
To find the current legally responsible person associated with your permit, go to this website:
her//nortal.ncdanr.or /web/hisl uermit-contacts and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: KOI., A4?¢Tede //
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for -the permit):
Person legally responsible for this permit: 4o e e ,
First MI Last
Page I of 2
SW U-OW NERAFFI L-25July2014

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
ride
Pd.BoX 6-7
Mailing Address
City State Zip
7686" 1-PAPu/A@Frt-r ,4/(ulvC.Cc
Telephone Email Address
Pax Number
5) Reason for this change:
A result of Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I. L,4 RR )/ PAY J r4 . attest that this application for this change in Owner Affiliation
(person l�sponsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
S igiYZure Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call 919-707-9220 or visit the website at:
huo://aortal.ncdenr,orc/t�eb/Ir/stormwater
Page 2 of 2
SW tl-OW NERAFFIL-25Ju1y2014

Spruce Pine Division
100 Ethan Allen Drive
Spruce Pine, NC 28777
ETHAN ALLEN
OPERATIONS, INC.
July 20, 2005
North Carolina Department of
Environment and Natural Resources
Division of Water Quality
Sara Young
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Corporate Reorganization and Name Change for Permits
D. Bruce Ward
Environmental Coordinator
Phone: [phone]
Fax: [phone]
This letter serves to formally notify the North Carolina Department of Environment and Natural
Resources, Division of Water Quality of name change and corporate reorganization regarding
Ethan Allen that will become effective on July 1, 2005. We have just learned that as part of the
reorganization, certain internal transactions within Ethan Allen will result in the transfer of Ethan
Allen's active manufacturing/distribution facilities from one -wholly owned company of Ethan
Allen to another wholly -owned company of Ethan Allen. This corporate restructuring will not
change the manufacturing/distribution processes or operational control of the facilities subject to
permits. These name and internal changes are being implemented to better align our business
operations. Before and after the change, all active manufacturing/distribution facilities are and
still will be directly or indirectly wholly -owned subsidiaries of Ethan Allen Interiors Inc. which is
traded on the New York Stock Exchange under the symbol "ETH."
All permits for manufacturing/distribution operations will need to be issued to Ethan Allen
Operations, Inc. This corporate restructuring will not impact Ethan Allen's closed/discontinued
operations and, therefore, no changes to the permits associated with these operations will be
necessary.

1
We will be contacting your offices in the near future to confirm and submit any forms that are
deemed necessary to reflect this name change and corporate reorganization. Please do not
ny concerns or questions.
D. Bruce Ikard
Environmental Coordinator
Cc:
Pam Banks Esq. Ethan Allen Global
Don Garrett, Ethan Allen Operations
Charlie Farfaglia, Ethan Allen Global
Paul Kaminski, Ethan Allen Global
Mike Baker, Ethan Allen Operations

NccrlyvD 16/ 16Ulou)-/ a0/4.-
�y
Mr. Alan W. Klimek.P.E., Director /► I July 11, 2005
North Carolina Division Water Quality n_ (� (((JJJ��� �1 /f� ld�(� r)t
1617 Mail Service Center
IJJ v ima�V�
Raleigh, NC 27699-1617 a
, II11 j d
ZQO$
DIV. OF WAr QUALITY
Re: Corporate Reorganization and Name Change with address change for GeneafRP�?T>tj I q QUALITY
NCG 180000
This letter serves to formally notify NCDENR of name change and corporate
reorganization regarding Ethan Allen that will become effective on July 1, 2005. We
have just learned that as part of the reorganization, certain internal transactions within
Ethan Allen will result in the transfer of Ethan Allen's active manufacturing/distribution
facilities from one -wholly owned company of Ethan Allen to another wholly -owned
company of Ethan Allen. This corporate restructuring will not change the
manufacturing/distribution processes or operational control of the facilities subject to
permits. These name and internal changes are being implemented to better align our
business operations. Before and after the change, all active manufacturing/distribution
facilities are and still will be directly or indirectly wholly -owned subsidiaries of Ethan
Allen Interiors Inc. which is traded on the New York Stock Exchange under the symbol
"ETH."
All permits for manufacturing/distribution operations will need to be issued to Ethan
Allen Operations, Inc. This corporate restructuring will not impact Ethan Allen's
closed/discontinued operations and, therefore, no changes to the permits associated with
these operations will be necessary.
In addition we are changing our mailing address effective July1, 2005 to
Ethan Allen Operations, Inc.
700 South Main Avenue
Maiden, NC 28650
We will be contacting your offices in the near future to confirm and submit any forms
that are deemed necessary to reflect this name change and corporate reorganization.
Please do not hesitate to call me if you have any concerns or questions.
Sincerely,
Wayne Goble
Cc:
Pam Banks Esq. Ethan Allen Global
Cliff Thom, Ethan Allen Operations
Charlie Farfaglia, Ethan Allen Global
Paul Kaminski, Ethan Allen Global
C:WIy Do rnents\Nlanufacturing Final Reorganization NCDENR hazard waste 7-11-05.DOC

LNG
001ZI��tD-�aov 19a19 D+
J. Michael Baker
Pine valley Division Environmental Manager
P.O. Box 639. Southeast Region
Old Fort, NC 28761
Phone; [phone]
Far: [phone]
ETHAN ALLEN
OPERATIONS, INC.
JUL 1 9 2005 I IJuly 14, 2005
North Carolina Department of
Environment and Natural Resources
Division of Water Quality
Sara Young
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Corporate Reorganization and Name Change for Permits
This letter serves to formally notify the North Carolina Department of Environment and
Natural Resources, Division of Water Quality of name change and corporate
reorganization regarding Ethan Allen that will become effective on July 1, 2005. We
have just learned that as part of the reorganization, certain internal transactions within
Ethan Allen will result in the transfer of Ethan Allen's active manufacturing/distribution
facilities from one -wholly owned company of Ethan Allen to another wholly -owned
company of Ethan Allen. This corporate restructuring will not change the
manufacturing/distribution processes or operational control of the facilities subject to
permits. These name and internal changes are being implemented to better align our
business operations. Before and after the change, all active manufacturing/distribution
facilities are and still will be directly or indirectly wholly -owned subsidiaries of Ethan
Allen Interiors Inc. which is traded on the New York Stock Exchange under the symbol
"BTH."
All permits for manufacturing/distribution operations will need to be issued to Ethan
Allen Operations, Inc. This corporate restructuring will not impact Ethan Allen's
closed/discontinued operations and, therefore, no changes to the permits associated with -
these operations will be necessary.

yow ol
> w
w tat,
Its 104
420A PAN* ry*.�.

We will be contacting your offices in the near future to confirm and submit any forms that
are deemed necessary to reflect this name change and corporate reorganization. Please do
not hesitate to call me if you have any concerns or questions.
Sincerely,
. AC--J ."
J. Michael Baker
Southeast Regional Environmental Manager
Cc:
Pam Banks Esq. Ethan Allen Global
Don Garrett, Ethan Allen Operations
Ron Hartwell, Ethan Allen Operations
Charlie Farfaglia, Ethan Allen Global
Paul Kaminski, Ethan Allen Global

r'
.. � .. .. ,.
.. ..
...
..
.. , ....
:r� .r
... _, ,..
.. ... ... � :..,
.....
., ..
� :.....,.
�:....
....
.y � .... . _
�::
�;,
..r:,
...
..

State of North Carolina
'Department of Environment` o •
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor NCDENR
Wayne McDevitt, Secretary
NORTH CAROLINA DEPARTMENT OF
Kerr T. Stevens, Director
ENVIRONMENT AND NATURAL RESOURCES
August 27, 1999
MICHAEL BAKER
ETHAN ALLEN, INC. PINE VALLEY
P.O. BOX 639
OLD FORT, NC 28762
Subject: Reissue - NPDES Stormwater Permit
Ethan Allen, Inc. Pine Valley
COC Number NCG180100
Mcdowell County
Dear Permittee
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 Form. Completion of this form is required to
certify that you have developed and implemented the SPPP as per the conditions of the permit. This form
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 Aisha Lau of the Central Office Stormwater
and General Permits Unit at [phone], ext. 578
Sincerely,
b4As eileU sx"W-e
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 [phone] FAX [phone]
An .Equal Opportunity Affirmative 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. NCG180100
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,
ETHAN ALLEN, INC.
is hereby authorized to discharge stormwater from a facility located at
ETHAN ALLEN, INC.
802EAST MAIN STREET
OLD FORT
MCDOWELL COUNTY
to receiving waters designated as a UT of Catawba River in the 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. 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.
h,1 ei6y tjG,,v„P '
for Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

I,
1
9
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
May 19, 1995
Mickey O'Keefe
Ethan Allen Inc.
P.O. Box 1966
Danbury, CT 6813
AI F.WYWA
ir
I IL
IDEHNR
Subject: General Permit No. NCG 180000
Ethan Allen Inc.
COC NCGI80100
Mcdowell County
Dear Mickey O'Keefe
In accordance with your application for discharge permit received on March 30, 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 take 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 MS. AISHA LAU at telephone number
919/733-5083.
Sincerely,
in31 Signed Ry
,:�piCen H. Sullins
A. Preston Howard, Jr. P.E.
cc: Asheville Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180100
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,
Ethan Allen, Inc.
is hereby authorized to discharge stonnwater from a facility located at
Pine Valley Division of Ethan Allen, Inc.
Hwy 70 E.
Old Fort
McDowell County
to receiving waters designated as an unnamed tributary to the Catawba River in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, I1, III
and IV of General Permit No. NCG180000 as attached.
This Certificate of Coverage shall become effective May 19, 1995.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day May 19, 1995.
Signed By
�ieert FI. Suilins
A. Preston Howard, Jr., P.E,.Director
Division of Environmental Management
By Authority of the Environmental Management Commission

4
10
10
`IrI�/ 1
tC�y�I
f 9)X
�� (�\�\��,���� rr. ,•� ��ti�wi tip/ i 1 �)I\
'92 (MOFFITT HILL) 03ML TO.v. C " '94
05511SW 10
SCALE 1:24 000
_ o
1 MILE
_1000 2000 3000 4000 5000 6000 7000 FEET
5 0
1 MILOMETER
CONTOUR INTERVAL 40 FEET
i. 2t4 ,�,
nI _ 1/
dp
'95 '96
Primary higl
hard surface
Secondary h
hard surface

FACILITY
Pine Valley Division of Ethan Allen, Inc.
COUNTY
McDowell
NPDES
NCG180100
MAP#
EIONW
DSN FLOW
NA
SUB BASIN
03-08-30
LATTITUDE
350 38' 13"
LONGITUDE
820 10' 12"
RECEIVING STREAM
UT Catawba River
STREAM CLASS
C
DISCHARGE CLASS
Stormwater
EXPIRATION DATE
8/31/99