NCG190111_Application_20200511

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Division of Energy, Mineral and Land Resources
Land Quality Section
min National Pollutant Discharge Elimination System
Environmental
Quality NCG190000
FOR AGENCY USE y
Date Rtccived
year
E. E$ Z Day
Certificate ofCoverage
C1,ack
Arnount
ftrnt Assimcd to f
I -
NOTICE OF INTENT RECEIVED
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG190000: MAY 112020
STORMWATER DISCHARGES associated with activities classified as: IDENR-LAND QUALITY
SIC* (Standard Industrial Classification) 373 Ship and Boat Building and RaVPPIWATER PERMITTING
SIC* 4493 Marinas
Standard Indu6trial 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 (address to which all permit correspondence will be mailed):
Name -'5" /A ",-P , '.r G'Vj> 1'1�N -r"t
Owner Contact k-.-, A el t:�M " , . --s- i-
Street Address '1 -3 E PIA "I I i,
City State /V c, ZIP Code '?, 7ii n
Telephone No, Fax: 6 z
E-mail Address
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Ernail
ft
`6
State /Vc— ZIPCode 7/o
3) Physical Location Information:
Fax: -7 s-Z_
Please provide a narrative description of how to get to the facility (use street antes, state road numbers,
distance and direction from a roadway intersec � n).Z;- -rO 1 (,,4 . 'Tit .5 ?, "'; Af e- n'W
,
(A copy of a county inap or USGS quao sheaf with facility Clearly located on the map is a reqdlre'l part of this application.)
41 Latitude �, - Q'� N Longitude -."tA� (degrees, minutes, seconds)
5) This NPDES Permit Application aoplies to which of the following:
El New or Proposed Facility' Date operation is to begin
Existing
*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-
.�_
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0CG190000 N.0,11.
x) 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 abrief narrative description ofthe types ofindustrial activities and products
manufactured atthis facility: (include msite diagram showing the process areas and location mf
activities present adthis faoi|hy.)______
b) Check
all services and activities offered ovallowed adthis
facility
ElTmna��S|im
0
��
ir
�''�^~'`�p="
Permanent ���n
LJ
Dump Station
[]
[]
Lodging
Raetnoomo
��
Haul Out
Fl
Restaurant
L]
Pump Out
��
R��i|Shnne
��
^�
Fueling
+�
Boat
��
�~
Boat Ramp
LJ
�l
Sales
Trash
LJ
Boat Hand VVaehing
^�
LJ
Recycling
Vehio|e/EquipnnontVVoah/ng
Fish Cleaning Area
Boat Pressure Washing
Sanding
�^
Charter
Live
��
LJ
Sand Blasting
LJ
Aboard
Painting
n
Dry Boat Storage
Boat Building
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, boat ram s, lift wells, etc.) convey stormwater from the
What is the name of the body or bodies of water (creek, stream, river, take, etc.) that the facility stormwater
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):_
List discharge points (oxuUaUo)that convey discharge from the site (both on -site and nff*ha>and �omi�n
coordinates. A�achadd�ona|ahm�m��necaoe��urno��otthis inhnma�nninapmrU5ed'nthe site plan.
S&onnwo1erOutfaUNo. / -r(",v/�--
Latitude(dngne*a/minuh*s/seuondn):
Longitude(degreoo/ninutomseoonde VV
StonnwaherOutfaUNo -�
No.
Latitude(dagnyos/minubas/a »
Longitude (deg reeo/minutem/ueoon m). VV
Latitude (degrees/minutes/seconds): N
Longitude Neomao/minuteaisecond VV
Sk/nnwater DutfaU No._____
Latitude (deg voao/minubas/socondn): N
Longiiude(degnooa/m/nuAae/soonndo)' VV
swU-234-052109
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Last revised 6/24/14

Stomnwuter0utfa]|No.
___
Latitude (degrees/minutes/seconds):Longitude (degrees/minutes/seconds):
N
ShormweterDutbd No____
Latitude�
(degreeehninu�esecondo): N
Longitude (deg rees/minutes/seuonds): VV
StormwaterOotfoUNo.
_____
LaUtuda(dagnees/minukee/seonnds): N
VV
9) Does this facility
��
a) Have an untreated wastewater discharge? �� mn LJ Yes
b) Have otreated wastewater discharge? qNo []Yes
|fyes, list the permit number.
u) Have awastewater discharge from n recycle system? XNo
|fyes, list the permit number.
d} Have anon~d\scbmrQepermit? El No []Yon
|fyes, list the permit number.
e) Discharge wastewater to amunicipal wastewater collection system?
If yes, list the municipality and permit number
kl No 0 Yes
Note: Stormwater discharge permit NCG190000 r1-- nnt authorize the discharge of any_Agstewater.
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?
No [] Ye~ (Show any structural BK4F'eonthe site diagrmmj
If yes, please briefly describe:
11)Does this facility have aStornmvotarPollution Prevention Plan?
ONo El Yes
If yes, when was it implemented?
12)Does this facility use solvents on-sbe?
D"�No El Yes
|fyes, does this facility have and implement oSolvent Management Plan? []No []Yea
13)Are vehicle/equipment maintenance activities occurring at this facility (es.fueling, washing, repair, etc.)?
No 0 Yes
14) Hazardous Waste:
o) |athis facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
No El Yes
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swu�4-052/09
Last revised 6/24/14

` NCG190000N.O.[
U) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) o mN
hazardous waste?
��~^ 'Yes
��-
o) |ethis facility o Large Quantity Generator (1UO8 kg. ormore ofhazardous waste generated per month) nf
hazardous waste'?
��No []Yeu
�r
d) Is hazardouswaste stored inthe 1O0-yeerflood plain?
*No []Yaa |fyes, include information todemonstrate protection from flooding.
o) If you answered yes to questions b. or c., please provide the following information:
Type(s)ofwaste:
How ismaterial stored:
Where ismaterial stored:
_________
How many disposal shipments per year:
Name oftransport / disposal vendor:
__
Vendor address:
15)Certificadoo:
North Carolina General Statute 143-215.GB(i)provides that:
Any person who knowingly makes any false statement, representation, mcertification many application, record, report, plan, orother
document filed orrequired muemaintained under this Article or a rule implementing this Article: mwho knowingly makes ufalse
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
(Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not mexceed ten thousand dollars ($1o.Ono).
| hereby request coverage under the referenced General Permit. / understand that coverage under this permit
will constitute the permit requirements for the dischargo(s)and isenforceable inthe same manner moan
individual permit.
| certify that |amfamiliar with the information contained inthis application and that to the best of my
knowledge and belief such information istrue, complete, and accurate. \
Printed Name of Person Signing,
Title: LAA
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDEC\
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S�o��m�1� Last revised 6/24/14

j NCG190000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
Check for $100 made payable to NCDEQ
❑ This completed application and all suNputiing 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, blastin
washing areas, and (i) location of services and activities listed in 7b. 9 painting and
❑ Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
The submission of this document does nNote
ot guarantee the issuance of an NPDES permit.
Um
please contact the DEMLR
DEMLR Regional riff;__ Contact Information:
Asheville Office ...... [phone]
Fayetteville Office
... [phone]
Mooresville Office,
_ [phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
SI,NU-234-052109
Page 5 of 5
Office for your area_
Last revised 6124/14