NCG180257_COMPLETE FILE - HISTORICAL_20170802

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f
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV C& OD 5-7
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
ci "l%I -7 D � 0 �
YYYYMMDD

Central Files: APS _ SWP V
8/1/2017
Permit Number NCGIB0257 Permit Tracking Slip
Program Category Status Project Type
NPDES SW Active New Project
Permit Type Version Permit Classification
Furniture and Fixtures Stormwater Discharge COG 1.00 COG
Primary Reviewer
Permit Contact Affiliation
robert.patterson
RECEIVED
Coastal SWRule
AUG 0 2 ZU17
Permitted Flow
CENTRAL FILES
GWR SECTION
Facility
Facility Name
Major/Minor Region
MasterBrand Cabinets, Inc.
Minor Winston-Salem
Location Address
County
118 Lexington Pkwy
Davidson
Facility Contact Affiliation
Lexington NC 27295 Heather Knowles
118 Lexington Pkwy
Owner Lexington NC 27295
Owner Name Owner Type
Masterbrand Cabinets Inc Nan -Government
Owner Affiliation
Heather Knowles
118 Lexington Pkwy
Dates/Events Lexington NC 27295
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
8/1/2017 6/28/2017 8/1/2017 8/1/2017 8/3112019
Regulated Activities Requested /Received Events
Wood kitchen cabinets manufacture
Outfall 001
Walerbody Name Streamindex Number Current Class Subbasin
North Potts Creek (Second Potts Creek) 12-112 C 03-07-04

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
August 1, 2017
Ms. Heather Knowles
MasterBrand Cabinets, Inc.
118 Lexington Parkway
Lexington, NC 27295
IZOY COOPER
MICHAEL S. REGAN
Seuerory
TRACY DAVIS
Director
Subject: General Permit No. NCG180000
MasterBrand Cabinets, Inc.
COC No. NCG180257
Davidson County
Dear Ms. Knowles:
In accordance with your application for a discharge permit received on June 28, 2017, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit. 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 US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and Land Resources, The Division of Energy, Mineral, and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
If you have any questions concerning this permit, please contact Robert Patterson at [phone]
or [e-mail].
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Winston-Salem Regional Office
Stormwater Program Hiles
Stale of North Carolina I Environmental Quality I Energy. Mineral and Land Resources
1612 Mail Service Center 1 512 N. Salisbury St. I Raleigh. NC 27699
919 707 9200 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180257
STORMWATER DISCHARGES
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,
MasterBrand Cabinets, Inc.
is hereby authorized to discharge stonnwater from a facility located at
MasterBrand Cabinets, Inc.
118 Lexington Pkwy
Lcxinggton
Davidson County
to receiving waters designated as North Potts Creek, a class C water in the Yadkin — Pee Dee
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts 1, 11, III, IV, V, and VI of General Permit No. NCG180000 as
attached.
This certificate of coverage shall become effective August 1, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Pennit.
Signed this day August 1, 2017.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

:11

4
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NCDENR
NC a G,Rp OEPYilNEH of
EHVIRO—ENT AHD NwTlRi.ti RESOUIICES
NOTICE OF INTENT
Division of Energy, Mineral, and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG 180000
FOR AGENCY USE ONLY
Date Received
Year
M.n1h
1)
Ccnitir is Cov
NCG
U
Permit Assi ed to
.T E
TM
National Pollutant Discharge Elimination System application for coverage under GtPeRE"mfi#v C
NCG180000: JUN 28 2017
STORMWATER DISCHARGES associated with activities classified as:
nENR-LAND QUALITY
SIC" 25 Furniture and Fixtures, and SIC 2434 Wood Kitchen Cabinets, STORNIWATER PERMITTING
And, Like activities deemed by DEMLR to be similar in the process, or the exposure of raw
materials, products, by-products, or waste materials.
. standard Industrial Classification Code
(Please print or type)
1) Mailing address of ownerloperator (address to which official permit correspondence will be mailed):
Name
Street Address
City
Telephone No.
E-mail address
MasterBrand Cabinets, Inc
118 Lexington Parkway
Lexington
336-300-7407
[e-mail]
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
MasterBrand Cabinets, Inc
Heather Knowles
118 Lexington Parkway_
Lexington
Davidson
336-300-7407
3) Physical Location Information:
State NC ZIP Code 27295
Fax:
State NC ZIP Code 27295
Fax:
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). Taking U.S. Route 29 N, take exist to Hargrave Rd.
Continue for 700 ft and take left on Hargrave Ln for 0.3 miles. Hargrave Ln turns into Lexington Pkwy
and MasterBrand Cabinets, Inc. is on the right.
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application)
4) Latitude 35° 46' 51.9" N Longitude _800 19' 11.4" W (degrees, minutes, seconds)
5) This NPOES Permit Application applies to which of the following:
® New or Proposed Facility
❑ Existing
6) Standard Industrial Classification:
Date operation is to begin
�91 q� I -F0131g77E
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 4 3 4
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: The facility conducts woodworking with medium density fiber board to create cabinet
doors.
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NCG180000 N.O.I.
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 13
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? North Potts Creek
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). NIA
10) Does this facility have any other water quality permits?
® No
❑ Yes
If yes, list the permit numbers for all current water quality permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
® No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
® Yes
If yes, please briefly describe: Good housekeeping, proper disposal of trash, inspections, bring in materials
inside when able, any spills/leaks are cleaned up immediately, and spill equipment are readily available
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
0 Yes
If yes, when was it implemented? 6/5/2017
14) Are vehicle maintenance activities occurring at this facility?
® No ❑ Yes
15) Hazardous Waste:
a) 1s this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
M No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
0 No ❑ Yes The facility is a CESQG
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
© No ❑ Yes
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SWU-233-82814 Last revised 8128/14

NCG180000 N.O.I.
d) 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 1 disposal vendor:
Vendor address:
16) Certification:
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, 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.)
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, complete, and accurate.
Printed Name of Person Signing: �. L ICE 2 ct,
Title: L EW G'1'Uf t• N A/JAe, 0&
L r 7
(Signature of Applicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included.
Please do not ask us to hold an incomplete application in anticipation of a check under separate cover.
❑ Check for $100 made payable to NCDENR
❑ This completed application, signed by the owner/operator, and all supporting documents
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map
Mail the entire package to:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note: The submission of this document does not guarantee the issuance of an NPDES permit.
Page 3 of 4
SWU-233-82814 Last revised 8/28/14

NCG180000 N.O.I.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
To visit our website, go to http://portal.ncdenr.org/web/Ir/storm water
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4of4
SW U-233-82814 Last revised 8/28114

3
June 5, 2017
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Re: Notice of Intent
MasterBrand Cabinets, Inc.
118 Lexington Parkway
Lexington, NC 27295
To Whom It May Concern:
Enclosed with this letter you will find an NO[, site map, and permit fee for MasterBrand
Cabinets, Inc. facility located at the address listed above.
If you have any questions regarding this submittal, please contact me at
,jnowicki@uscompliance..com.
Sincerely,
Jesse Nowicki RECEIVE
Environmental Specialist
U.S. Compliance Corporation J JN 2 8 2017
DENR-LAND QUALITY
cc: Heather Knowles — MasterBrand Cabinets, Inc.
STORMWA`4•ER F'ERIAII'TING
Enclosures
U.S. Compliance Corporation
520 Third Street . Suite 100 r Excelsior, MN 55331 . Phone [phone] • Fax [phone]
www.uscompliance.com

STORM WATER POLLUTION PREVENTION PLAN (SWPPP) SITE MAP
Master8rand Cabinets, Inc.
118 Lexington Parkway
Lexington, NC 27295
-
MAP LEGEND
Drainage Features
• = Sampling Locations
® = Outfall
ty
—P = Direction of Flow
— — = Property Line
Potential Sources of Pollution
■ = Uncovered Dumpster
= Compactor
- = covered Dumpster
i
= Loading/Unloading Area
. = Empty Drums
Scrap Product & Pallets
= Obsolete Equipment
s
■ = Dust Collectors
it ..
StructuralSMPs
2
3
I
tatltude: 359 46' S1-9" N
1Wte
LWVttude: Wt 19' 11.4" W
2017
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