HomeMy WebLinkAboutNCG190100_COMPLETE FILE - HISTORICAL_20171222STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V �� G Q I '0
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ J O I-) % a a
YYYYM M D D
cCentral.Files- APS _ SWP
—� 12/13/2017
Permit Number
NCG190100
Program Category
NPDES SW
Permit Type
Ship and Boat Building Stormwater Discharge COC
Primary Reviewer
rick.riddle
Coastal SWRule
RECEIVED
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
COC
Permit Contact Affiliation
Permitted Flow
DEC 2 ^ 2017
Facility
CENTRAL PILES
UV'Irl JCV i Illi'l
Facility Name
Major/Minor
Region
Hobo Seafood
Minor
Washington
Location Address
County
275 Landing Rd
Hyde
Swanquarter NC 27885
Owner
Owner Name
Hobo Seafood
Dates/Events
Facility Contact Affiliation
Lee Bland Williams
PO Box 306
Swanquarter NC 27885
Owner Type
Non -Government
Owner Affiliation
Lee Bland Williams
PO Box 306
Swanquarter NC 27885
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
12/8/2017 11/3/2017 12/8/2017 12/8/2017 5/31/2020
Regulated Activities .Requested /Received Events
Marina operation RO staff report received 12/11/17
RO staff report requested 11/8117
Outfall 001
Waterbody Name
Swanquarter Bay
Streamindex Number
29-49
Current Class Subbasin
SA;ORW 03-03-08
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. Lee Bland Williams
Hobo Seafood Inc.
275 Landing Road
Swanquarter, NC 27885
Dear Mr. Williams:
ROY COOPER
G"'nai'
MICHAEL S. REGAN
se "
TRACY DAVIS
nlnrn,
December 08, 2017
Subject: General Permit No. NCG 190000
Hobo Seafood Inc.
CDC NCG190100
Hyde County
In accordance with your application for a discharge permit received on November 03, 2017, 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 October 15, 2007 (or as subsequently amended).
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.
Note that this permit is only for stormwater discharges as described in Section B of the permit. This does
not include other waste streams including, but not limited to, boat hand cleaning, pressure washing, and
fish cleaning stations.
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 Richard Riddle at telephone number
(919) 807-6375 or by email at rick.riddle@ncdenr.gov.
Sincerely,
foilTracy E. Davis,/E., CPM
cc: Wa Regional Office
Central Files
Stormwater Permitting Unit Files
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Street I Raleigh, NC 27699-1612
919 707 9200 T
STATE OF NORTH CAROLINA
DEPARCMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG190000
CERTIFICATE OF COVERAGE No. NCG190100
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,
Hobo Seafood Incorporated
is hereby authorized to discharge stormwater from a facility located at
Hobo Seafood Incorporated
275 Landing Road
Swanquarter
Hyde County
to receiving waters designated as Swanquarter Bay, a class SA, ORW water in the Tar -Pamlico
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts 1, 11, 111, and IV of General Permit No. NCG190000 as attached.
This certificate of coverage shall become effective December 08, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 08, 2017.
for Tracy E. Davis, P.E., Direr
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission
NCG190100. 11 Hobo Seafood Incorporated 111
Map Scale 1:24,000
Latitude: 350 24' 16" N
Longitude: -760 20' 08" W
County: Hyde
Receiving Stream: Swanquarter Bay
Stream Class: SA, ORW
Index Number: 29-49 (Tar-Palmlico River Basin)
Facility Location
T.
�r
NCDENR
N6nv WN C[vuiruCM
ExoxnEIT xi u.a Nrtwu RcywRCL'
NOTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG190000
FOR AGENCY USE ONLY
Daze Received
Year
Month Da
Certificate
of Covers e
ELM
v
COCO I Mount,
jUU
Permit AssigrIedto
National Pollutant Discharge Elimination System application for coverage under General'Perttj //
NCG190000: V ED
STORMWATER DISCHARGES associated with activities classified as:
NOV -3 2017
SIC` (Standard Industrial Classification) 373 Ship and Boat Building and Repairiyl RM �'t�ND pU 7Y
SIC' 4493 Marinas AT RPpk 4l7TlNG
Standard Industrial Classification Code
For questions, please contact the DEMLR Regional Office for your area. (See page 4)
(Please print or type)
1) Mailing address of owner/operator
Name
Hobo Seafood Ine.orporo%{col
Owner Contact
Lee Bland Williams
Street Address
P 0 (3,Dx 30(P
City
Swanquakic P_ State NC _ ZIP Code 27885
Telephone No.
252-926-1415 Fax:
E-mail Address
hoboseafood@embargmail.com
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
Hobo Seafood �r ,,
Lee Bland Williams
275 Landing Road
Swanquarter
Hyde
252-926-1415
_hoboseafood@embarq
3) Physical Location Information:
State NC ZIP Code 27885
Fax:
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). From Hwy. 45 at the stop sign in Swanquarter, turn
right onto Landing Road. Facility will be on left.
(A copy of a county map or USGS quad sheet with facility clearly located on the map is a required part of this application.)
4) Latitude 35' 4,16fl
N Longitude — 760'06" W (degrees, minutes,
seconds) T
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility'
X Existing
Date operation is to begin 01/1997
Page 1 of 4
SWU-234-052109 Last revised 6124/14
T.,
NCG190000 N.O.I.
`If this new or proposed facility in one of the 20 coastal counties, you must contact the appropriate Regional
Office (see page 4) to determine if a State Stormwater Permit is also needed prior to construction.
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:
7) Services and Activities
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facility: (Include a site diagram showing the process areas and location of
activities present at this facility.) No manufacturing is done at the facility. Boats are salvaged at the
facility and dismantled.
b) Check all services and activities offered or allowed at this facility
❑
Transient Slips
❑
Engine Repair
❑
Permanent Slips
❑
Dump Station
❑
Lodging
X
Haul Out -
El
Restrooms
❑
Pump Out
❑
Restaurant
X
Fueling
❑
Retail Store
❑
Boat Ramp
❑
Boat Sales
❑
Boat Hand Washing
❑
Trash Collection
❑
Vehicle/Equipment Washing
❑
Recycling
X
Boat Pressure Washing
❑
Fish Cleaning Area
X
Sanding
❑
Charter
X
Sand Blasting
❑
Live Aboard
X
Painting
X
Dry Boat Storage
❑
Boat Building
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, boat ramps, lift wells, etc.) convey stormwater from the
property? One
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? UT to Swanquarter Bay
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).
Receiving water classification (if known):_SA ORW
9) Does this facility
a) Have an untreated wastewater discharge? X No ❑ Yes
b) Have a treated wastewater discharge? X No
If yes, list the permit number.
❑ Yes
c) Have a wastewater discharge from a recycle system? X No
If yes, list the permit number.
d) Have a non -discharge permit? X No ❑ Yes
If yes, list the permit number.
❑ Yes
e) Discharge wastewater to a municipal wastewater collection system? X No ❑ Yes
If yes, list the municipality and permit number
Page 2 of 4
SWU-234-052109 Last revised 6/24/14
7
NCG190000 N.O.I.
Note: Stormwater discharge permit NCG190000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG190000.
10) Does this facility employ any best management practices for stormwater control?
X No ❑ Yes (Show any structural BMP's on the site diagram.)
If yes, please briefly describe:
11) Does this facility have a Stormwater Pollution Prevention Plan?
X No ❑ Yes
If yes, when was it implemented?
12) Does this facility use solvents on -site?
X No ❑ Yes
If yes, does this facility have and implement a Solvent Management Plan? ❑ No ❑ Yes
13) Are vehicle/equipment maintenance activities occurring at this facility (ex. fueling, washing, repair, etc.)?
❑ No X Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
X No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) 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:
15) 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
Page 3 of 4
SWU-234-052109
Last revised 6/24/14
NCG190000 N.O.I:
[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 ($10,000),
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 familiarwith the information contained in this. application and that to the best of my
knowledge and belief such information isI true, complete, and accurate.
Printed Name of Person Signing: l�p�(j'�l0✓V�� Vy \t 1'�OA S
Title: VQes1dey\4 �E�ob�SeANOd`�n�
(Signature of Applicant)
kO ;n
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
---—
❑ C, heck:for-$400-made-payab`le.to.NCDENR � _
❑ This completed application and all supporting documents
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
(corresponding to which drainage areas), (d) runoff conveyance structures, (e) areas where materials and/or
boats we stored, (f) impervious areas, (g) site property lines,.(h) boat maintenance, blasting, painting and
washing areas, and (i) location of services and activities listed in 7b.
❑ Copy of county map or USGS'quad sheet (preferred) with location of facility clearly marked on -map
Mail the entire package to:
DSto�mwater Permitting Unit Program
ivision of Energy, Mineral and Land Resources
1612 Mail Service Center i
Raleigh, North Carolina 27669-1612
-- -- - Note
The submission of this document;does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Regional Office for your area. I
DEMLR Regional Office Contact Information
Asheville Office ...... (828) 296-4500
Fayetteville Office ... (910) 433-3300
Mooresville Office ... (704) 663-1699
Raleigh Office ......- (919) 791-4200
Washington Office ... (252) 946-6481
Wilmington Office ... (910) 796-7215
Winston-Salem ....- (336) 771-5000
SWU-234-052109
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�Legend
HOBO SEAFOOD�-
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Write a description for yourmap�, i•`,�
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,� 'y µ �.� • . r O'1. /// `!. �..�/^N.a �Y :L�' -. .'ice• �. J� A J - � �t.�
'2 i sue. - . .-"^�. ,. ` "-i _+. .," �►... 4 ./� 1 �•1 r�
�! f ��fw� � tlP� �:.. � f' .l `.� � �►`_-•: '��.�_ trT�� *► iM, d --4.c �
..�4. r. v',y*w..
'.� ❑v<, 4i. 1 > fryx'�'' ... n;.�9u •� ' .i^..:. '�i5': '.�..- . ♦ ♦.• :.1_" � ' S � x �t �
r• � l ��rr
fi A®e�+ma's .._ rr.#� C: i. - °r j' u..♦ � ,G. \� •-.....
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'giI&- 'i - a - Y. ,. 9 '` SSSS— .0 0 0�
Energy, Mineral
and Land Resources
ENVIRONMENTAL OUALITY
Mr. Lee Bland Williams
Hobo Seafood Inc.
275 Landing Road
Swanquarter, NC 27885
Dear Mr. Williams:
ROY COOPER
Governor
MICHAEL S. REGAN
Secremrr
TRACY DAVIS
Ulrector
December 08, 2017
Subject: General Permit No. NCG190000
Hobo Seafood Inc.
COC NCG190100
Hyde County
In accordance with your application for a discharge permit received on November 03, 2017, 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 October 15, 2007 (or as subsequently amended).
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.
Note that this permit is only for stormwater discharges as described in Section B of the permit. This does
not include other waste streams including, but not limited to, boat hand cleaning, pressure washing, and
fish cleaning stations.
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 Richard Riddle at telephone number
(919) 807-6375 or by email at rick.riddle@ncdenr.gov.
Sincerely,
for Tracy E. Davis, P.E., CPM
cc: Wa Regional Office
Central Files
Stormwater Permitting Unit Files
State of North Carolina I Environmental finality I Energy, Mineral and Land Resources
1612 Mail Service Center 1512 North Salisbury Street I Raleigh, NC 27699-1612
919 707 9200 T
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG190000
CERTIFICATE OF COVERAGE No. NCG190100
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,
Hobo Seafood Incorporated
is hereby authorized to discharge stormwater from a facility located at
Hobo Seafood Incorporated
275 Landing Road
Swanquarter
Hyde County
to receiving waters designated as Swanquarter Bay, a class SA, ORW water in the Tar -Pamlico
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, 11, 111, and IV of General Permit No. NCG190000 as attached.
This certificate of coverage shall become effective December 08, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 08, 2017.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission
Division of Energy, Mineral and Land Resources
Land Quality Section
NCDENRNational Pollutant Discharge Elimination System
Nortw uROU a De�mr[ or
ENVIRONMENT v D NMRLL rrS Rcr9
NCG 190000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date
Received
Year
Month
Da
1
I
Unincate of Coverage
Check
Amount
Permit Assigned to
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG190000:
STORMWATER DISCHARGES associated with activities classified as:
SIC` (Standard Industrial Classification) 373 Ship and Boat Building and Repairing
SIC` 4493 Marinas
Standard Industrial Classification Code
For questions, please contact the DEMLR Regional Office for your area. (See page 4)
(Please print or type)
1) Mailing address of owner/operator
Name Hobo Seafood-jnrJoroorcukol
Owner Contact Lee Bland Williams
Street Address PO X 30co
City ! Ai ;mot&: ,�ul15140 q U-a r c-C State NC ZIP Code 27885
Telephone No. 252-926-1415 Fax
E-mail Address hoboseafood@embargmail.com
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
Hobo Seafood
Lee Bland Williams
275 Landing Roac
Swanquarter
Hyde
252-926-1415
_hoboseafood@embargmail.com
3) Physical Location Information:
State NC _ ZIP Code 27885
Fax:
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). From Hwy. 45 at the stop sign in Swanquarter, turn
right onto Landing Road. Facility will be on left.
(A copy of a county map or USGS quad sheet with facility clearly located on the map is a required part of this application.)
4) Latitude 35.24.16 N Longitude 76.20.06 W (degrees, minutes,
seconds)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility`
X Existing
Date operation is to begin 01/1997
SWU-234-052109
Page 1 of 4
Last revised 6/24/14
r T
NCG190000 N.O.I.
'If this new or proposed facility in one of the 20 coastal counties, you must contact the appropriate Regional
Office (see page 4) to determine if a State Stormwater Permit is also needed prior to construction.
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:
7) Services and Activities
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facility: (Include a site diagram showing the process areas and location of
activities present at this facility.) No manufacturing is done at the facility. Boats are salvaged at the
facility and dismantled.
b) Check all services and activities offered or allowed at this facility
❑
Transient Slips
❑
Engine Repair
❑
Permanent Slips
❑
Dump Station
❑
Lodging
X
Haul Out
❑
Restrooms
❑
Pump Out
❑
Restaurant
X
Fueling
❑
Retail Store
❑
Boat Ramp
❑
Boat Sales
❑
Boat Hand Washing
❑
Trash Collection
❑
Vehicle/Equipment Washing
❑
Recycling
X
Boat Pressure Washing
❑
Fish Cleaning Area
X
Sanding
❑
Charter
X
Sand Blasting
❑
Live Aboard
X
Painting
X
Dry Boat Storage
❑
Boat Building
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, boat ramps, lift wells, etc.) convey stormwater from the
property? One
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? UT to Swanquarter Bay
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).
Receiving water classification (if known):_SA ORW
9) Does this facility
a) Have an untreated wastewater discharge? X No ❑ Yes
b) Have a treated wastewater discharge? X No ❑ Yes
If yes, list the permit number.
c) Have a wastewater discharge from a recycle system? X No ❑ Yes
If yes, list the permit number.
d) Have a non -discharge permit? X No ❑ Yes
If yes, list the permit number.
e) Discharge wastewater to a municipal wastewater collection system? X No
If yes, list the municipality and permit number
❑ Yes
Page 2 of 4
SWU-234-052109 Last revised 6/24/14
NCG190000 N.O.I.
0
Note: Stormwater discharge permit NCG190000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG190000.
10) Does this facility employ any best management practices for stormwater control?
X No ❑ Yes (Show any structural BMP's on the site diagram.)
If yes, please briefly describe:
11) Does this facility have a Stormwater Pollution Prevention Plan?
X No ❑ Yes
If yes, when was it implemented?
12) Does this facility use solvents on -site?
X No ❑ Yes
If yes, does this facility have and implement a Solvent Management Plan? ❑ No ❑ Yes
13) Are vehicle/equipment maintenance activities occurring at this facility (ex. fueling, washing, repair, etc.)?
❑ No X Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
X No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) 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:
15) 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
SWU-234-052109
Page 3 of 4
Last revised 6/24114
7
NCG190000 N.O.I.
(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 ($10,000).
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: Lii E(" V� I1tadrs
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDENR
❑ This completed application and all supporting documents
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
(corresponding to which drainage areas), (d) runoff conveyance structures, (e) areas where materials and/or
boats are stored, (f) impervious areas, (g) site property lines, (h) boat maintenance, blasting, painting and
washing areas, and (i) location of services and activities listed in 7b.
❑ Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Reqional Office Contact Information:
Asheville Office ...... (828) 296-4500
Fayetteville Office ... (910) 433-3300
Mooresville Office ... (704) 663-1699
Raleigh Office ........ (919) 791-4200
Washington Office ...(252) 946-6481
Wilmington Office ... (910) 796-7215
Winston-Salem ...... (336) 771-5000
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SWU-234-052109
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