NCG180189_COMPLETE FILE - HISTORICAL_20140519

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v
DOC TYPE
[)CHISTORICALFILE
❑ MONITORING REPORTS
DOC DATE
❑ 01/0
YYYYMMDD

©m Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharge Elimination System
NCDENR
K a PERMIT NAMEIOWNERSHIP CHANGE FORM
ErmirduCxr wo Nuw..liEzpnc[a
FOR AGENCY USE ONLY
Date Received
Year
Moran
Day
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C S 10 1 1 N G G I I 1 8 1 0 1 1 1 8 1 9
IL Permit status prior to requested change.
a. Permit issued to (company name): Fairfield Chair Company
b. Person legally responsible for permit: John M Robbins
First MI Last
Corporate Secretary
RECEIVED Title
PO Box 1710
1r1MI 19 [1Ji4 Permit l-]older Mailing Address
Lenoir NC 28645
DENR•LAND QUALITY
PERMITTING
acility name (discharge):
acility address:
City State Zip
[phone] (828) 758-021 1
Phone Fax
Fairfield Chair Co Plant 42
606 Kincaid Circle SW
Address
Lenoir NC 28645
City State "Zip
e. Facility contact person: Rick (P) Pierce
First / MI / Last Phone
111. 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 other please explain: name change for legally responsible person
b. Permit issued to (company name):
Fairfield Chair Company
c. Person legally responsible for permit:
Jamie FI White e
First MI Last
Corporate Secretary
Title
PO Box 1710
Permit I-lolder Mailing Address
Lenoir NC 28645
City State Zip
q
[phone] Jwhitea tairfieldchair.com
Phone E-mail Address
d. Facility name (discharge):
Fairfield Chair Co Plant #2
e. Facility address:
606 Kincaid Circle SW
Address
Lenoir NC 28645
City State Zip
f. Facility contact person:
Rick P Pierce
First MI Last
[phone] rpierceRefairfieldchair.conr
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014

,... i .. t ,:�,.• � � .

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Rick P Pierce
First MI Last
Environmental Manager
Title
PO Box 1710
Mailing Address
Lenoir NC 28645
City State Zip
[phone] rpierce Wairfieldchair.com
Phone E-mail 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 must 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. Por a name change request, the signed
Applicant's Certification is sufficient.
PERM ITTEE 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 of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
I, Jamie H White, 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
lnwill
�bpe returned as incomplete.
Signature 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

®` State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
August 27, 1999
RICHARD PIERCE
FAIRFIELD CHAIR CO. PLANT NO. 2
POST OFFICE BOX 1710
LENOIR, NC 28645
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissue - NPDES Stormwater Permit
Fairfield Chair Co. Plant No. 2
CDC Number NCG180189
Caldwell 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. Enivironmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
* A copy of general stormwater permit NCGI80600
* 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 Divisionlwithin 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. I
If you have any questions regarding this permit package please contact Bill Mills of the Central Office Stormwater
and General Permits Unit at [phone], ext. 548
Sincerely,
for Kerr T. Stevens
Director, Division of Water Quality
I
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

4
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG180000
CERTIFICATE OFI COVERAGE No. NCG180189
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolinal 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.
FAIRFIELD CHAIR CO.
i
is hereby authorized to discharge stormwater from a facility located at
FAIRFIELD CHAIR CO.
2042 NORWOOD STREET
I LENOIR
CALDWELL COUNTY
i
to receiving waters designated as a UT of Gunpowder Creek in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, I1,111,
IV, V, and VI of General Permit No. NCG180000 as attached.
i
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.
for Kerr t Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Mate 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
August 11, 1995
Richard Pierce
Fairfield Chair Company
1331 Harper Ave Sw
Lenoir, NC 28645
MAI
WK
IDFEE HNR
Subject: General Permit No. NCG 180000
Fairfield Chair Company
COC NCG180189
Caldwell County
Dear Richard Pierce:
In accordance with your application for discharge permit received on April 18, 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 MR. BILL MILLS at telephone number
919/733-5083.
Sincerely, Original Signed By
Coleen 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. NCG180189
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,
Fairfield Chair Company
is hereby authorized to discharge stormwater from a facility located at
Fairfield Chair Company, Plant No. 2
2042 Norwood Street
Lenoir
Caldwell County
to receiving waters designated as an unnamed triburtary to Gunpowder Creek in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III
and IV of General Permit No. NCG180000 as attached.
This Certificate of Coverage shall become effective August 11, 1995.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 11, 1995.
C-iginal Signed By
Coleen H. Sullins
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Comrission

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COUNTY �(Q
NPDES NCC 18aItoq
MAP # � 12 S E
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SUB BASIN D 3" os 32-
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LATTITUDE SSo S� /a
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LONGITUDE $ 30 5
RECEIVING STREAM Cr,,,y, pw4er (ree(L
STREAM CLASS
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