NCS000376_Last Chance to Renew Notification_20120402

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
April 2, 2012
Keith Russell
NC State University
804 Cedar Ln
Reidsville, NC 27320-7320
Subject: NPDES Stormwater Permit Coverage Renewal
North Carolina State University
Permit Number NCS000376
Wake County
Dear Permittee:
Dee Freeman
Secretary
Your facility was covered for stormwater discharge under NPDES Permit NCS000376, however, this
permit expired on 4/30/2010. To assure consideration for continuing coverage under your permit, you
must apply to the Division of Water Quality (DWQ) for renewal of your permit. Enclosed you will find a
permit Renewal Application Form, Supplemental Information request, and a Stormwater Pollution
Prevention Plan Certification for your facility. Filing the application form along with the requested
supplemental information will constitute your application for renewal of this permit. .
The application and supplemental information must be completed and returned to DWQ by May
15, 2012. Failure to request renewal within this time period will result in the inactivation of your expired
permit in our system. Discharge of stormwater without coverage under a valid stormwater NPDES permit
constitutes a violation of N.C. General Statute 143-215.1 and may result in the assessment of civil
penalties of up to $25,000 per day.
If you have any questions regarding permit renewal procedures please contact Ken Pickle of the
Stormwater Permitting Unit at [e-mail] or [phone].
Sincerely,
Bradley Bennett, Supervisor
Stormwater Permitting Unit
Cc: Central Files
SPU Files
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 one
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 NorthCarolina
Internet: www.ncwaterquality.org Natura!!rf
An Equal Opportunity 1 Affirmative Action Employer

Permit Coverage
Renewal Application Form
o�oF wArE9oG National Pollutant Discharge Elimination System Permit Number
Stormwater Discharge Permit NCS000376
O Y
The following is the owner affiliation information currently in our database for your facility. Please review this information carefully and make all
corrections/additions as necessary in the space provided to the right of the current information.
Owner Affiliation Information *Reissued Permit will be mailed to the owner address
Owner / Organization Name: NC State University
Owner Contact: Keith Russell
Mailing Address: 804 Cedar Ln
Reidsville, NC 27320-7320
Phone Number: [phone]
Fax Number:
E-mail address:
Facility/Permit Contact Information
If there has been any change to your facility/ permit contact information, please indicate updates in the space provided below.
Facility Name:
Facility Physical Address:
Facility Contact:
Mailing Address:
Phone Number:
Fax Number:
E-mail address:
Impaired Waters/TMDL
Does this facility discharge to waters listed as impaired or waters with a finalized TMDL? ❑ Yes ❑ No ❑ Don't Know
(For information on these waters refer to http://h2o.enr.state.ne.uslsu/Impaired Waters TMDL/ )
CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the best of my knowledge and belief such information is true,
complete and accurate.
Signature
Print or type name of person signing above
Date
Title
Please return this completed renewal application form to: Stormwater Permitting Unit
Attn: Ken Pickle
1617 Mail Service Center
Raleigh, North Carolina 27699-1617