NCG081005_Application_20210510

iN,!�- &— D40 [0 0 5
FOR AGENCY USE ONLY
Division of Energy, Mineral and Land Resources
Date Received
Year
Month Da
Ic
Land Quality Section
011 G� ro
National Pollutant Discharge Elimination System
Certificate ofcovera e
N t G d r,Q
Check # Amount
Environmental
NCG080000
o $Z 1' o o
Quality
Pemut Assigned to
to • M v
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under
General Permit
NCGO80000:
STORMWATER DISCHARGES from Vehicle Maintenance Areas (including vehicle rehabilitation,
mechanical repairs, painting, fueling, lubrication, and equipment cleaning operations areas) associated
with activities classified as:
SIC 40 (Standard Industrial Classification) Railroad Transportation
SIC 41 Local and Suburban Transit and Interurban Highway Passenger Transportation �4Ay ,
SIC 42 Motor Freight Transportation and Warehousing (except SIC 4221-4225)��
SIC 43 United States Postal Service DENR_1 AKim
The following activities are also included:
STORMWATER WALITY
PERMITTING
• Other industrial activities where the vehicle maintenance area(s) is the only area requiring permitting
• Petroleum Bulk Stations and Terminals (SIC 5171) with total petroleum site storage capacity of less than 1
million gallons
• Stormwater discharges from oil water separators and/or from secondary containment structures
associated with petroleum storage facilities with less than 1 million gallons of total petroleum site storage
capacity.
• Discharges associated with vehicle maintenance operations at activities, which are otherwise designated
on a case -by -case basis for permitting.
jplFor 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 correspondence will be mailed):
Name � l(. C 6kk►'V Jv
Street Address ` A) o"8 A� Ve'
City (iC Otk-i-tki'►1 State ZIPCode
Telephone No. Lt (q - q 300 Fax:
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
State. ZIP Code '2—k1l� ij
.,IL'b 16 "I— "L -')L-)(d t9111- L _ t-ax:
0' I4.' 1y , A A.A i yl c'LixS � - ow .N a �(�e [ _�C Yyt � l�r. t G� � � Q l 1 �_
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NCG080000 N.O.I.
3) Physical Location Information:
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). (tot' `a /� ; . i L�` hourt4 o'i z)
&Kd 1 N e-5-4 tk ,c r d vim.
(A copy of a county map or USGS quad sheet with facility clearly located must be submitted with this application)
4) Latitude .2- � Longitude J �� t (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
'Existing
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:
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
facility: , Cieart(YNG awa Mai,�Y)C' c.e (D-- + VV ck'5 O.V)c
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in?
Receiving water classification: G
Is this a 303(d) listed stream? j es Has a TMDL been approved for this watershed? V10
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).
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.
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.
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.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
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NCG080000 N.O.I.
9)
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): _
Longitude (degrees/minutes/seconds):
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): _
Longitude (degrees/minutes/seconds):
N
W
N
W
Does this facility have any other NPDES permits?
❑ No CSC �l i t t �-� l S C� nG E'er -f" �'1-P. �� 1��� S P C r� f +-, ( {-
❑ Yes NC,S042'
If yes, list the permit numbers for all current NPDES permits for this facility:
10) �Does this facility have any Non -Discharge permits (ex: recycle permit)?
t�,d'No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
11) Does this facility employ any best management practices for stormwater control?
❑ No
Wyes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe:
12) Does this facility have a Stormwater Pollution Prevention Plan?
do hc�vty ��c� hLD e- P i c� ra
No
❑ Yes
If yes, when was it implemented? � Xy `S �12 d 3 CU-n1-{' q+-
13) Are vehicle maintenance activities occurring at this facility?
El No ❑"Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
!d No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
El No t+d" Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
Oj KNo ❑ Yes
d) Is hazardous was stored in the 100-year flood plain?
❑ 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: 150 ,301 ( OrIj n' 1
How is material stored: 1-O Ar - L,�_,-t n
Where is material stored: Oy t st-�-P i
How many disposal shipments per year: J >r Nc ollr
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NCGO80000 N.O.I.
Name of transport / disposal vendor:
Vendor address:
15) Certification:
North Carolina General Statute 143-215.613 (1) 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 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, complete, and accurate.
Printed Name of Person Signing: je ss t LC, -
Title: 1­ ICAv\v'x
in
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
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NCG080000 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 supporting documents
j2K 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 the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
j (f) impervious areas, (g) site property lines.
Copy of county map or USGS quad sheet 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
Note
The submission of this document does not guarantee coverage under the NPDES General Permit.
For questions, please contact the DEMLR Regional Office for your area.
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 .........(919)
807-6300
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SWU-223-071408 Last revised 6/24/14

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1 message
Jessica Trotman <[e-mail]>
To: [e-mail]
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Jessica Trotman<[e-mail]>
Tue, Apr 27, 2021 at 5:05 PM
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