NCG190113_Application_20200605

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Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
U7 Check for $100 made payable to NCDEQ
Fi� 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 US GS quad shoot (preferred) with location of facility clearly marked on map
LV
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh,
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
MoNlIG&M-r 11 . I.- . . I'tRIK-111.
Asheville Office ......
[phone]
Fayetteville Office...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
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SWU-234-052109 Last revised 6/24/14

NURAUENC;Y UN
Date Receiv
Division of Energy, Mineral and Land Resources Yam` Month
j.s
Land Quality Section Certificate of co
National Pollutant Discharge Elimination System Check #
Environmental
Quality NCG190000 Permit Assi
NOTICE OF INTENT
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 ownerloperator (address to which all permit correspondence will be mailed):
Name P
Owner Contact
Street Address _ u/
City Vim` State- ZIP Code _d `•Z_
Telephone No. V.;'- 33 7 —S Fax: -^
E-mail Address f--14A A - J'_'s4 --fC0 G IhA / L.,r �hrn
2)
Location of facility producing dischar e:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
3) Physical Location Information:
rax:
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).
(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 34, dad WN Longitude 74,6 .� *JYe W (degrees, minutes, seconds)
6) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility* Date operation is to begin
X 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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SWU-234-052109
Last revised 6/24/14

NCG190000 N.O.I.
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: 41 1 3
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.) ,AI AIW
b) Check all services and activities offered or allowed at this facility
ff
Transient Slips
❑ Engine Repair
B
Permanent Slips
❑ Dump Station
❑
Lodging
❑ Haul Out
49
Restrooms
❑ Pump Out
❑
Restaurant
[H" Fueling
❑
Retail Store
Boat Ramp
❑
Boat Sales
❑ Boat Hand Washing
❑
Trash Collection
❑ Vehicle/Equipment Washing
❑
Recycling
❑ Boat Pressure Washing
❑
Fish Cleaning Area
❑ Sanding
❑
Charter
❑ Sand Blasting
❑
Live Aboard
❑ Painting
❑
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? C
What is the name of the body orb dies of wat creek stream, river, lake, etc.) that the facility stormwater
discharges end up in? _ ,a401 b le9 12:- e-
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). s✓%L�
Receiving water classification (if known):
List discharge points (outfalls) that convey discharge from the site (both on -site and off -site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Stormwater Outfall No. i
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No. �v.(
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.&/&
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No/V—
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Page 2 of 5
SWU-234-052109 Last revised 6/24/14

NCG190000 N.O.I.
Stormwater Outfall No.
Latitude (degrees/minutes/ econds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No. A
Latitude (degrees/minutes seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No. `"'�"�
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
9) Does this facility
a) Have an untreated wastewater discharge? Q-Wo ❑ Yes
b) Have a treated wastewater discharge? ErNo ❑ Yes
If yes, list the permit number.
c) Have a wastewater discharge from a recycle system? Er No ❑ Yes
If yes, list the permit number.
d) Have a non -discharge permit? Z No ❑ Yes
If yes, list the permit number.
e) Discharge wastewater to a municipal wastewater collection system? 0 No ❑ Yes
If yes, list the municipality and permit number
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?
❑ No kYes (Show any structural BMP's on the site diagram.)
If yes, please briefly describe:
11) Does this facility have a Stormwater Pollution Prevention Plan?
g No ❑ Yes
If yes, when was it implemented?
12) Does this facility use solvents on -site?
XNo ❑ 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 ❑ Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
1 No ❑ Yes
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SWU-234-052109 Last revised 6/24/14

NCG190000 N.O.I.
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
$( No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
WNo ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
J' 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:
16) Certification:
North Carolina General Statute 143-216.6 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
[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, YYcomplete, and accurate.
Printed Name of Person Signing:
Title:
f,
(Signature of A
Notice of
.5-- ;L / — ,;LP
(Date Signed)
be accompanied by a check or money order for $100.00 made payable to:
NCDEQ
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SWU-234-052109 Last revised 6/24/14