NCGNE0195_COMPLETE FILE - HISTORICAL_20050420

A-umt I ,I)w
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑
YYYYM M DD

Michael F. Easley, Governor
William G. Ross Jr., Secretary
%
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleco H. Sullins, Deputy Director
Division of Water Quality
April 20, 2005
Samuel W Noble, Jr, Town Manager
Town of Tarboro
PO Box 220
Tarboro, NC 27886
Subject: No Exposure Certification NCGNE0195
Tarboro Public Works Department - 506 Dowd St
Edgecombe County
Dear Permittee:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on March 5, 2003. We apologize for the extended period it
has taken us to get back to you on this request and we appreciate your patience as we have worked through
this process. Based on your submittal and signed certification of no exposure at the above referenced facility
the Division is granting your certification as provided for under 40 CFR 126.22(g) which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no -
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no -exposure exclusion expires in five years (April 30, 2010). At that time you must re -certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you'have any questions or need further information, please contact Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
�Zey r •,y
for Alan W. Klimek, P.E.
cc: Raleigh Regional Office Central Files — w/attachments
Stormwater Permitting Unit Files
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone] Customer Service
1-877-623-6748

C
m pprtsved-
United States Environmental Protection Agency ID OM8F1p.2�40{02`
NPDES A Washington, DC 20460
FORM \`�'� ��q NO EXPOSURE CERTIFICATION for Exclusion fir MAR 5 2003
3510-11 NPDES Storm Water Permitting
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit out o its. orm water
discharges associated with industrial activity in Me State identified in Section B under EPA's Storm Water Multi -Sector General Peat due to
of a condition of no exposure.
as are ected by a storm resistant shelter to
industrial
ivid
eA condition of xposure to min,
now, srlmxmett, ats tan industrial facility nd/or runoff. Industrialnen materlials or activities materials
include, but not limited to, material handling equipment or acfivifies,
loading and unload g, transportation,ruts,tor conveyanarmediate ce of any raw matriafirinter date product, final produal products, or Waste pmducts. ct or vast aterial eproduct ndling activities
storm resistant shelter s
not required for the following industrial materials and activities:
, led, provided those confiners are not deteriorated and do not leak. "Sealed"
- drums, barrelstanks, and similar containers that are tightly sea
means banded or otherwise secured and without operational taps or valves;
- adequately maintained vehicles used in material handling; and
- final pmduds, other than products that would be mobilized in storm water discharges (e.g., rock sat).
for the no
xclusion. In addition,
e exclusion from NPDES
is
aA No vailable on a fdlty-wide basis only,ot for individual ofacility
lNalls. 6 qualifying
industrial activities rorematerials are or will be exposed to precipitation, the facility is
not eligible for the no exposure exclusion.
and is signing
t submitting
comply his the terms conditions form.
0 CFR 1 entity
in Section A is certifying that a condition of no exposure exists at its facility or site,
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.
A. Facility Operator Information
1. Name: DfJ,AlO F Talrlbiclr101 1 1 1 1 1 1 1 1 1 1 1 ICJ 2. Phone: 1�1512IG ly l/Iylzl� I
3. Mailing Address: a. Street: pl, 101.B O f- I I I I I I I I I I I I I I
b. City: I Ta r 0 1_o l I "I"I 11 1 1 1 1 1 1 1 1 1 1 c. State: Nal d. Zip Code:
B. Facility/Sit Location Information n
1.FacilityName: Q r b 0 no r /( BlLl r lCl I! kOI�IK151 ICI EIPIT• I I I J�
2. a. Street Address: So ✓? 0 0 D S7RI el eITl i 1 1 I I 1 1' i I I f 1 1
b. City: lTrb 0 mol 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 C. County:' 1—Fi a/191�I elA rr4 �'14 I
d. State: v • 44 e. Zip Cade:
3. Is the facility located on Indian Lands? Yes ❑ No Q'
4. Is this a Federal
facility? ��Yes ❑ No
5. a. Latitude: 1�2�nnL, WS� I� CAAJ" b. Longitude: 101 %I% 13121 t- " ray
6. a. Was the facility or site previously covered under an NPDES storm water permit? Ys ❑
No
b. If yes, enter NPDES permit number: I
7. SIC/Activity Codes: Primary: I
J 2 Secondary (if applicable): I I I
8. Total size of acres site associated with industrial activity:
9. a. Have you paved or roofed over a formerly exposed' pervious area in order to quality for the no exposure exclusion? Yes 0� N° LJ
ing
ure
b. If yes, please indicate ourapproximately how much area
permitting authority may uswas
this information indconsidering pwhtetherthis
storm question
water discharges from your sitefor
are likely to have
exclusion. However, your water
9
an adverse impact on water quality, in which case you could be required to obtain permit coverage.
Less than une acre One to five acres ❑ .- More than five acres ❑
i
Page 1 of 4
EPA Form 3510-11 (10-99) '
1 C rill

NPDES A NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM �-OEPA OMB No. 2040.0211
3510-11 NPDES Storm Water Permitting
C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation. now or in the foreseeable future?
(Please check either'Yes' or'Ne in the appropriate box.) If you answer "Yes" to any of those questions
(1) through (11), you are not eligible for the no exposure exclusion.
Yes
No
1.
Using, storing or cleaning industrial machinery or equipment, and areas where residuals from using, storing
❑
/
I!I
or cleaning industrial machinery or equipment remain and are exposed to storm water
2.
Materials or residuals on the ground or in storm water inlets from spillstleaks
❑
LI
❑
3.
Materials or products from past industrial activity
4.
Material handling equipment (except adequately maintained vehicles)
❑
rum(
Yr
5.
Materials or products during loading/unloading or transporting activities
❑
I�r1/
6.
Materials or products stored outdoors (except final products intended for outside use [e.g., new card where
❑
IK
exposure to storm water does not result in the discharge of pollutants)
7.
Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers
❑�/
8.
Materials or products handled/stared on roads or railways owned or maintained by the discharger
❑
[�✓,J{
9.
Waste material (except waste in covered, non -leaking containers [e.g., dumpsteml)
❑
t�l
10.
Application or disposal of process wastewater (unless otherwise permitted)
❑
Le
11.
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
❑
Lj
(i.e., under an air quality control permit) and evident in the storm water outflow
D. Certification Statement
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no exposure' and obtaining an
exclusion from NPDES storm water permitting.
I certify under penalty of law that there are no discharges of storm water contaminated by exposure to industrial activities or materials from the industrial
facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every five years to the NPDES permitting authority and, if requested, to
the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where applicable). 1 understand that I must
allow the NPDES permitting authority, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request. I understand that I must obtain coverage under an NPDES permit prior
to any point source discharge of storm water from the facility.
Additionally, I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. eased an my inquiry of the person or
persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is to the best of my
knowledge and belief true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility
of fine and imprisonment for knowing violations.
Print Name: �I �I ✓I / I dl IL I I �IHIS IN ICI `I LI L I I I I I I I I I I I I I I I I I
Print Title:
Signature:
Date: 10 131 01 ` 1 u 3I
EPA Form 3510-11(10-99)