NCG520071_Regional Office Historical File 1998 to 2011

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
October 4, 2001
Dear Mr. Brown:
��•IL
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Regarding your request for rescission of the subject wastewater permit, staff of the
Asheville Regional Office has confirmed that this permit is no longer required.
Therefore, in accordance with your request, NPDES wastewater general permit number
NCG520048 is rescinded, effective immediately.
If in the future you wish to again discharge wastewater to the State's surface waters,
you must first apply for and receive a new NPDES Permit. Operating a facility without
a valid NPDES Permit will subject the responsible party to a civil penalty of up to
$10,000 per day.
If it would be helpful to discuss this matter further, I would suggest that you contact
Jim Reid of the Asheville Regional Office at 828-251-6208 or Rob Lang of our Central
Office at 919-733-5083, extension 361.

'Ae of North Carolina
epartment of Environment,
iHealth and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr.. P.E., Director
JUL 2 3
Paul Brown
Brown Brothers Construction Co.
10801 U.S. Highway 421 North
Zionville, NC 28698
LT.X;WA
AAE'41 0
E3EHNF1
July 23,1997
Subject: Certificate of Coverage No. NCG520048
Renewal of General Permit
Brown Brothers Construction Co
Caldwell County
Dear Permittee:
In accordance with your application for renewal of the subject Certificate of Coverage, the Division is forwarding
the enclosed General Permit. This renewal is valid from the effective date on the permit until July 31, 2002. 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 U.S. 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.
The Certificate of Coverage for your facility is not transferable except after notice to the Division. Use the enclosed
Permit Name/Ownership Change form to notify the Division if you sell or otherwise transfer ownership of the
subject facility. The Division may require modification or revocation and reissuance of the Certificate of Coverage.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the Regional
Office listed below at [phone]. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain other permits which may be required by the Division of
Water Quality, 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 the NPDES Group at the address below.
Sincerely,
A. Preston Howard, Jr., P.E.-
cc: Central Files
Asheville Regional Office
NPDES File
Facility Assessment Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535 [phone] FAX [phone] p&[e-mail]
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG520000
CERTIFICATE OF COVERAGE NO. NCG520048
TO DISCHARGE SAND DREDGING WASTEWATER AND SIMILAR
WASTEWATERS UNDER THE
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,
Brown Brothers Construction Co.
is hereby authorized to operate a facility which discharges wastewater generated during
sand dredging operations with the discharge of wastewater from a facility
located at
Brown Brothers Construction Co
10801 Us Highway 421 North
Zionville
Caldwell County
to receiving waters designated as subbasin 30831 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. NCG520000 as attached.
This certificate of coverage shall become effective August 1, 1997.
This certificate of coverage shall remain in effect for the duration of the General Permit.
Signed this day July 23, 1997.
A. Preston Howard, Jr., P.E., Director
I. Division of Water Quality
By Authority of the Environmental Management Commission

1
R
Np :: GAOLiNA fJEPaA "' OP
ENvigONrnE a NaiU RCS C-
z o o Z
Division of Water Quality / Water Quality Section
National Pollutant Discharge Elimination System
NCG520000
M
_ ONLI'dDavera-emount
Permit Assigned to
NOTICE OF INTENT
National Pollutant Discharge Elimination System application
for coverage under General Permit
NCG520000: In -stream sand mining wastewater, associated stormwater and similar wastewaters
(Please print or type)
ro
1) Mailing address of owner/operator:
DO
Company Name:
Contact Person: D4 V 1 10 T T- J71 r9h
�
Street Address: 7 - hr/d /1 Ai
City: Senn i
State: ZIP C �r
6
Telephone No.:
Fax: ?) f- ��'
z
w�
2) Location of facility producing discharge:
Facility Name:/ )At_di /._/ /
Contact Person: 1J r c{ 14
Street Address: 3 �0 .SD �A&
City:
State: Nam_ ZIP Code:
County: C'G-I ae
Telephone No.: 7 -Y-
Fax: `) `�-c'-
3) Permit Contact (complete this section if permit contact is different from facility contact) :
Contact Person:
Street Address:
City:
County:
Telephone No.:
State: ZIP Code:
Fax:
4) Physical location information:
A copy of an USGS quad map or county map with the facility clearly located on the map IS REQUIRED to
be submitted with this application.
Please provide a narrative description of how to get to the facility (use street names, state road numbers,
and distance and direction from a rWdpay intersection): �4 ' 18�6� TOCJ, - RS G6
5) This NPDES permit application applies to which of the following
Lt/ New or Proposed ❑ Modification
Please describe the modification:
❑ Renewal
Please specify existing permit number and original issue date: _
Page 1 of 4
swU-214-080102

NCG520000 N.O.I.
6) Does this facility have any other NPDES permits, including stormwater general permits?
Z No ❑ Yes
If yes, list the permit numbers for this facility:
7) Description of Discharge:
Will stormwater also be discharged? ❑ Yes CTN0
If yes, does stormwater drain to a settling pond prior to discharge?
a)
❑ Yes ❑ No
b) Is the sand washed or rinsed on the bank after removal from the stream? ❑ Yes ZNo
c) Is the discharge directly to the receiving water? ❑ Yes 2"No
If no, submit a site map with the pathway to the potential receiving waters clearly marked. This
includes tracing the pathway of the storm sewer to the discharge point, if the slorm sewer is the only
viable means of discharge
d) Number of discharge points (ditches, pipes, channels, etc. that convey wastewater from the proper,\):
r1, ,
e) Volume of discharge per each discharge point (in GPD):
# 1: _ N Z4.. 1t 2:
#3: #4
f) Please describe the type of process the sand dredging wastewater Is being discharged from, be
specific.
J'
S a f TSD r/V —
g) Is there any treatment being applied to the wastewater before discharge (check the type of treatment
in use).
❑ Settling pond ❑ Lagoon ❑Other DNone
(Please describe "Other") —
h) How much of the volume discharged is treated (state in percent)?
i) If any box in item (e) above, other than none, was checked, please include design specifics (i.e..
design volume, retention time, surface area, etc.) with submittal package. Existing treatment facilities
should be described in detail. Design criteria and/ operational data (including calculations) should he
provided to ensure that the facility can comply with the requirements of the General Permit
treatment shall be sufficient to meet with the limits set by the general permits. The trapping ef�cie: icy
should be greater than 75%. The surface area should be as large as possible to insure sedimentatio,�
occurs. To secure optimum efficiency the flow length of the basin to the basin width should have, a
ratio of 2:1
Note: Construction of any wastewater treatment facilities requires submission of three (3) sets c;
plans and specifications along with the application. Design of treatment facilities must comply
with requirements of 15A NCAC 2H .0138, If construction applies'to this discharge, incl-_.,de
the three sets of plans and specifications with this application.
8) Discharge Frequency:
a) The discharge is: ❑ Continuous Intermittent ❑ Seasonal
i) If the discharge is intermittent, describe when the discharge will occur. h O
nrU;Dth� Tct_f_ TACT
ii) If seasonal check the monlh(s) the discharge occurs: ❑ Jan. ❑ Fe'o. ❑ 'vlar =•p`
❑ May ❑ Jun. ❑ Jul. ❑ Aug. ❑ Sept. ❑ Oct. ❑ Nov. ❑ Dec.
Page 2 of 4
SWU-214-080102

y 1
Y r
NCG520000 N.O.I.
b) Please check the days discharge occurs: ElSat..❑ Sun. [''Mon. ZTUe. Z/Wed. aThu. D Fri.
9) Receiving waters:
a) What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility
wastewater discharges end up in? If the site wastewater discharges to a separate storm sewer
system (4S), name the operator of the 4S (e.g. City of Raleigh). (7 kLt, r C l-pt,.0
b) Stream Classification (WS-IV, C. etc.): C I a2
10) Alternatives to Direct Discharge:
Address the feasibility of implementing each of the following non -discharge alternatives
a) Connection to a Regional Sewer Collection System
b) Subsurface disposal (including nitrification field, infiltration gallery, injection wells, etc.)
c) Spray irrigation
The alternatives to discharge analysis should include boring logs and/or other information indicating that a
subsurface system is neither feasible nor practical as well as written confirmation indicating that
connection to a POTW is not an option. It should also include a present value of costs analysis as outlined
in the Division's "Guidance For the Evaluation of Wastewater Disposal Alternatives".
11) Additional Application Requirements:
For new or proposed discharges, the following information must be included in triplicate with this
application or it will be returned as incomplete.
a) 7.5 minute series USGS topographic map (or a photocopied portion thereof) with discharge location
clearly indicated.
b) Site map, if the discharge is not directly to a stream, the pathway to the receiving stream must be
clearly indicated. This includes tracing the pathway of a storm sewer to its discharge point.
c) If this application is being submitted by a consulting engineer (or engineering firm), include
documentation from the applicant showing that the engineer (Or firm) submitting the application has
been designated an authorized Representative 11 of the applicant.
d) Final plans for the treatment system (if applicable),. The plans must be signed and sealed by a North
Carolina registered Professional Engineer and stamped -"Final Design -Not released for construction".
e) Final specifications for all major treatment components (if applicable). The specifications must be
signed and sealed by a North Carolina registered Professional Engineer and shall include a narrative
description of the treatment system to be constructed.
I certify that I am familiar with the information contained in this application and that to the best of n,y
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing:
Title: - Ow nr° r
(Signature of Applica ) (Date Signed)
Page 3 of 4
SWU-214-080102

NCG520000 N.O.I.
Nort4 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 Article 21 or regulations of
the Environmental Management Commission implementing that Article, or who falsifies, tampers with or
knowingly renders inaccurate any recording or monitoring device or method required to be operated or
maintained under Article 21 or regulations of the Environmental Management Commission implementing
that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed S10,000, or by
imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a
fine of not more than $10,000 or imprisonment not more than 5 years, or both, for a similar offense.)
Notice of Intent must be accompanied by a check or money order for $$80.00 made payable to:
NCDENR
Mail three (3) copies of the entire package to:
Stormwater and General Permits Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Final Checklist
This application will be returned as incomplete unless all of the following items have been
included:
❑ Check for $80 made payable to NCDENR per r
❑ 3 copies of county map or USGS quad sheet with Location of facility clearly marked on map
❑ 3 copies of this completed application and all supporting documents
113 sets of plans and specifications signed and sealed by a North Carolina P,E. (if applicable)
❑ Alternatives analysis including present value of costs for all alternatives
Note
The submission of this document does not guarantee the issuance of an NPDES permit
Page 4 of 4
SWU-214-080102

No FFoHs/ p! ,
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Michael F. E ey; Gover
k':,ucs.J
Enment
m Ros r. Secret
North Carolina Department of Env an Na our
Alan W. Klimek, P.E. Director
Division of Water Quality
SURFACE WATER PROTECTION
February 23, 2006
Mr. David Hoffman
Hoffman Materials
417 Sharon Avenue
Lenoir, North Carolina 28645
Subject: Sand Dredging Operations
Notice Of Intent NCG520000
Caldwell County
Dear Mr. Hoffman:
Enclosed you will find four (4) copies of the Notice of Intent (NOI) for Sand Dredging Operations.
Please complete an NOI for each location and follow the final instructions on page 4. If you should
have any questions regarding this matter please contact me at [phone].
Sincerely,
Lai Frost7CPE
Environmental Engineer
Enclosures
NorthCarolina
Nahirally
North Carolina Division of Water Quality 2090 U.S. Highway 70 Swannanoa, NC 28778 Phone [phone] Customer Service
Internet: www.ncwaterquality.org FAX [phone]
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- i
Q
Vd A Michael F. Easley
9
Q A Governor
F�L, William G. Ross, Jr., Secretary
NCDENR North Carolina Department of Environment and Natural Resources
--1
'< Alan W. 'Klimek; P.E.; Director'
Division of Water Quality
March 10, 2006
MAR 12006
Mr. David Hoffman , 4
Hoffman Materials
417 Sharon Ave. r-
Lenoir, North Carolina 28645
Subject:Application Acknowledgement
General Permit Coverage
COC# NCG520082
Dear Mr. Hoffman:
The Division of Water Quality received your application for coverage under General Permit
NCG520000. The application has been assigned to Teresa Rodriguez with the NPDES unit. We
are reviewing your application and will contact you if additional information is needed to process
your application. By this letter we are also requesting a Staff Report from the Asheville Regional
Office. If you have any questions concerning your application, please contact me at telephone
number 919-733-5083, extension 553 (e-mail: [e-mail]).
Teresa Rodriguez
NPDES Unit
cc: NPDES General Permit Files
wo heville Regional Office, Water Quality
N. C. Division of Water Quality / NPDES Unit Phone: [phone]
1617 Mail Service Center, Raleigh, NC 27699-1617 fax: [phone]
Internet: h2o.enr.state.nc.us DENR Customer. Service Center: 1 800 623-7748

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• page 74, grid section L-6, • page 74, grid section D-3
Western North Carolina map V i
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Bear left onto US-64 (NC-18)
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Turn right onto Pineburr St
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Turn right onto Calico Rd
...................... ..................................................................................................................................................
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Turn left onto Southard Rd
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You are at 3660 Southard Rd,Lenoir,NC
...................................................................................................................................................................
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Lenoir, NC 28645-8601
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EPA
United States Environmental Protection Agency
Washington, D.C. 20460
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES
I S I 3I yr/mo/day Inspection Type
1 I N I 2
NCG520082 I11 12I 06/04/24 117 18ICI
211 1 1 1 1 1 I t.... Remarks
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
Inspector Fac Type
19I SI 20I I
6f
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1
67I 169 70 QA---------------------------Reserved---- -----------------
I I 71 I I 721 NJ 73I 11 74 75I I I I I I I 180
Section B: Facility Data �J_J
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include Entry Time/Date
POTW name and NPDES permit Number)
Permit Effective Date
Southard Pit
10:00 AM 06/04/24
3660 Southard Rd
Exit Time/Date Permit Expiration Date
Lenoir NC 28645
10:15 AM 06/04/24
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
David Hoffman,417 Sharon Ave Lenoir NC 28645//828-754-5582/82875 OlgtBacted
No
Facility Site Review Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Section D: summary of Find in /Comments Attach additional sheets of narrative and checklists as
(See attachment summary)
Name(s) and Signature(s) of Inspector(s)
Agency/Office/Phone and Fax Numbers Date
Larry Frost ARO WQ//828-296-4500 Ext.4658/
7Z,
Signature of Manageme A Reviewer
Agency/Office/Phone and Fax Numbers Date
Keith Haynes
ARO WQ//828-296-4500/
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete
Page # 1

NPDES yr/mo/day Inspection Type
3I NCG520082 I11 12I 06/04/24 I17 18ICI 1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The purpose of this inspection was to evaluate initial permit issuance. No problems were found and ARID
has no issue with the permit being issued.
Location
- N35 50.843'
- W81 36.298'
Page # 2

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
August 3, 2011
Mr. David Hoffinan
Hoffman Materials
417 Sharon Ave
Lenoir, N.C. 28645
Subject: Rescission of NCG520071 & NCG520084
Cloninger Pit & Smith Pit
Caldwell County & Burke County
Dear Mr. Hoffman:
Division staff has confirmed that the subject Certificates of Coverage are no longer required.
Therefore, in accordance with your request, NCG520071 and NCG520084 are rescinded,
effective immediately.
If in the future your firm wishes to discharge wastewater to the State's surface waters, she must
first apply for and receive a new NPDES permit. Discharge of wastewater without a valid
NPDES permit will subject the responsible party to a civil penalty of up to $25,000 per day.
If you have questions about this matter, please contact Charles Weaver of my staff at the
telephone number or address listed below.
Sincerely,
M4 /_
,�(Coleen H. Sullins
cc: Asheville Regional Office / Linda Wiggs
NPDES Permit file
Fran McPherson, DWQ Budget Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Internet: http:l/portal,ncdenr,org/web/wq
Phone: [phone] / FAX [phone]
[e-mail]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
NorthCarohna
Natitiiiltt�

AF4 ,5
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
January 11, 2007
David Hoffman
Hoffman Materials
417 Sharon Avenue
Lenoir, NC 28645
Subject: Renewal Notice / General Permit NCG520000
Certificate of Coverage NCG520071
Dear Permittee: Caldwell County
You are receiving this notice because your company currently operates a dredging operation covered under the
subject General Permit for the discharge of sand -dredging runoff. NCG520000 will expire on July 31, 2007. Federal (40 CFR
122.41) and North Carolina (15A NCAC 2H.0105(e)) regulations require that permit renewal applications be filed at least 180
days prior to expiration of the current permit. To satisfy this requirement, the Division must receive a renewal request
postmarked no later than February 1, 2007.
The Certificate of Coverage (CoC) specific to your operation was last issued on June 27, 2005. The Division needs
information from you to determine if coverage under NCG520000 is still necessary.
➢ If your property still has a wastewater system like the ones described in the enclosed Technical Bulletin, you must renew the
subject CoC. Complete the enclosed form and submit it to the address on the form.
➢ If you are not sure what type of system your property has, contact Larry Frost in the NC DENR Asheville Regional Office at
[phone]. That person [or other staff members] can help you determine if you should renew your CoC.
➢ If this site has been shut down and no further dredging will occur, contact me at the address or phone number listed below to
request rescission of the CoC.
Please verify that the provided information is correct, or make corrections on the attached form. Complete the
additional questions, then sign and date the form. The completed form should be submitted to the address listed below the
signature block.
below.
If you have any questions concerning this matter, please contact me at th , telephone number or e-mail address listed
_� .,.
Sincerely,
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Files
Asheville Regional Office / Larry Frost
NPDES file
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone], extension 511 / FAX [phone] / charles.weaver@ ncmail. net
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I N
VVAT_r t a ,J
one NCarolina
Amorally

1
Michael F. Easley
© Governor
NCDENR William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
March 17, 2005
fir' H
Mr. David Hoffman
Hoffman Materials
417 Sharon Ave. w-
Lenoir, North Carolina 28645
Subject: Application Acknowledgement
General Permit Coverage
Dear Mr. Hoffman:
COC# NCG520071
The Division of Water Quality received your application for coverage under General Permit
NCG520000. The application has been assigned to Teresa Rodriguez with the NPDES unit. We
are reviewing your application and will contact you if additional information is needed to process
your application. We are also requesting a Staff Report from the Asheville Regional Office. If
you have any questions concerning your application, please contact me at telephone number 919-
733-5083, extension 553 (e-mail: [e-mail]).
Sincerely,
61"
Teresa Rodriguez
NPDES Unit
cc: NPDES General Permit Files
Asheville Regional Office, Water Quality
N. C. Division of Water Quality / NPDES Unit Phone: [phone]
1617 Mail Service Center, Raleigh, NC 27699-1617 fax: [phone]
Internet: h2o.enr.state.nc.us DENR Customer Service Center. 1 800 623-7748

Division of Water Quality / Water Quality Section
NCDENR National Pollutant Discharge Elimination System
NORM C-O - Oef+wTMEW OF
EMVIRO "M MO NR RH Rasou m
NCG520000
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG520000: In -stream sand mining wastewater, associated stormwater and similar wastewaters
(Please print or type)
1) Mailing address of owner/operator:
Company Name:
Contact Person:
Street Address:_, --
City: _ Ldn n /r _ State: ��_ ZIP Code:
Telephone No.:
2) Location of facility producing discharge:
Facility Name:�n L,� �_
Contact Person: OIL-*
Street Address:—.�f�pA� --
City:
County: C��r State:C ZIP Code:
Telephone No.: _ __-� "� Fax: -- 7J"It OLE97
3) Permit Contact (complete this section if permit contact is different from facility contact)
Contact Person:
Street Address:
City:
County:
Telephone No.:
State: ZIP Code:
Fax:
4) Physical location information:
A copy of an USGS quad map or county map with the facility clearly located on the map IS REQUIRED to
be submitted with this application.
Please provide a narrative description of how to get to the facility (use street names, state road numbers,
aQnd /dicta ce and direction froa road ay inte/r�section):
to
rmu99 C 9ih rn ��� 6�0� �,
5) his NPDES permit application applies to which of the following
PY"New or Proposed ❑ Modification
Please describe the modification: _ III 1
❑ Renewal 005
Please specify existing permit number and original issue date:
WATER QUALITY SECTION
ASNEVILLE REGIONAL OFFIC
Page 1 of 4 a -_E___
SWU-214-080102

NCG520000 N.O.I.
6) Does this facility have any other NPDES permits, including stormwater general permits?
Z<o ❑ Yes
If yes, list the permit numbers for this facility:
7) Description of Discharge:
a) Will stormwater also be discharged? ❑ Yes C No
If yes, does stormwater drain to a settling pond prior to discharge? ❑ Yes ❑ No
b) Is the sand washed or rinsed on the bank after removal from the stream? ❑ Yes "o
c)
d)
e)
0
Is the discharge directly to the receiving water? KKes ❑ No
If no, submit a site map with the pathway to the potential receiving waters clearly marked. This
includes tracing the pathway of the storm sewer to the discharge point, if the storm sewer is the only
viable means of discharge.
Please describe the
specific.7<er
of process the sand
from the property):
wastewater is being discharged from,e
/_ / _ n
g) Is there any treatment being applied to the wastewater before discharge (check the type of treatment
in use).
❑ Settling pond' ❑ Lagoon ❑Other ❑None
(Please describe "Other")
h) How much of the volume discharged is treated (state in percent)? _10 %
i) If any box in item (e) above, other than none, was checked, please include design specifics (i.e.,
design volume, retention time, surface area, etc.) with submittal package. Existing treatment facilities
should be described in detail. Design criteria and/ operational data (including calculations) should be
provided to ensure that the facility can comply with the requirements of the General Permit. The
treatment shall be sufficient to meet with the limits set by the general permits. The trapping efficiency
should be greater than 75%. The surface area should be as large as,possible to insure sedimentation
occurs. To secure optimum efficiency the flow length of the basin to the basin width should have a
ratio of 2:1
Note: Construction of any wastewater treatment facilities requires submission of three (3) sets of
plans and specifications along with the application. Design of treatment facilities must comply
with requirements of 15A NCAC 2H .0138. If construction applies to this discharge, include
the three sets of plans,and specifications with this application..
8) Discharge Frequency:
a) The discharge is: ❑ Continuous ❑ Intermittent
4-19easonal
i) If the discharge is intermittent, describe when the discharge will occur: W�pne�o
ii) If seasonal check the month(s) the discharge occurs: ❑ Jan. UFeb. Rh�ar. ❑ Apr.
❑ May ❑ Jun. ❑ Jul. ❑ Aug. ❑ Sept. ❑ Oct. ❑ Nov. ❑ Dec.
SWU-214-080102 Page 2 of 4

NCG520000 N.O.I.
b) Please check the days discharge occurs:
❑ Sat. ❑ Sun. ❑ Mon, ❑ Tue. ❑ Wed. ❑ Thu. El Fri.'
9) Receiving waters:
a) What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility
wastewater discharges end up in? If the site wastewater discharges to a separate storm sewer
system (4S), name the operator of the 4S (e.g. City of Raleigh).��___S_�L
b) Stream Classification (WS-IV, C, etc.): ��_� -•
10) Alternatives to Direct Discharge:
Address the feasibility of implementing each of the following non -discharge alternatives
a) Connection to a Regional Sewer Collection System gof .4n. OoLh' V
b) Subsurface disposal (including nitrification field, infiltration gallery, injection wells, etc.) We Now
c) Spray irrigation No f ,gn, p�C1lakv �r lti
f�e�ds
The alternatives to discharge analysis should include boring logs and/or other information indicating that a
subsurface system is neither feasible nor practical as well as written confirmation indicating that
connection to a POTW is not an option. It should also include a present value of costs analysis as outlined
in the Division's "Guidance For the Evaluation of Wastewater Disposal Alternatives"
11) Additional Application Requirements:
For new or proposed discharges, the following information must be included in triplicate with this
application or it will be returned as incomplete.
a) 7.5 minute series USGS topographic map (or a photocopied portion thereof) with discharge location
clearly indicated.
b) Site map, if the discharge is not directly to a stream, the pathway to the receiving stream must be
clearly indicated. This includes tracing the pathway of a storm sewer to its discharge point.
c) If this application is being submitted by a consulting engineer (or engineering firm), include
documentation from the applicant showing that the engineer (Or firm) submitting the application has
been designated an authorized Representative of the applicant.
d) Final plans for the treatment system (if applicable). The plans must be signed and sealed by a North
Carolina registered Professional Engineer and stamped -"Final Design,Not released for construction".
e) Final specifications for all major treatment components (if applicable). The specifications must be
signed and sealed by a North Carolina registered Professional Engineer and shall include a narrative
description of the treatment system to be constructed.
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:—Z�
Title: // P� —
(Signature of Applicant)
(Date Signed)
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NCG520000 N.O.I.
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 Article 21 or regulations of
the Environmental Management Commission implementing that Article, or who falsifies, tampers with or
knowingly renders inaccurate any recording or monitoring device or method required to be operated or
maintained under Article 21 or regulations of the Environmental Management Commission implementing
that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $10,000, or by
imprisonment not to exceed six months, o.r by both. (18 U.S.C. Section 1001 provides a punishment by a
fine of not more than $10,000 or imprisonment not more than 5 years, or both, for a similar offense.)
Notice of Intent must be accompanied by a, check or money order for $80.00 made payable to:
NCDENR
Mail three (3) copies of the entire package to:
Stormwater and General Permits Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Final Checklist
This application will be returned as incomplete unless all of the following items have been
included:
R�Check for $80 made payable to NCDENR
B3copies of county map or USGS quad sheet with location of facility clearly marked on map
113 copies of this completed application and all supporting documents
C'sets of plans and specifications signed and sealed by a North Carolina P.E. (if applicable)
Alternatives analysis including present value of costs for all alternatives
Note
The submission of this document does not guarantee the issuance of an NPDES permit
SwU-214-080102 Page 4 of 4