NCG081004_Application_20210510

Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
Environmental NCG080000
Quality
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
i
c1
1,7)
Certificate of Coverage
NC G 01811 14>1011
Check #
Amount
Ivt82$
1100
Permit Assigned to
N. M
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG080000:
WJ
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 TransportationMQY 10 2021
SIC 42 Motor Freight Transportation and Warehousing (except SIC 4221-4225)
SIC 43 United States Postal Service DEfvR LAND QUALITY
4TM4WATER Pcc"EMITTING
The following activities are also included:
• 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.
t For questions, please contact the DEMLR Regional Office for your area. See page 4.
1
(Please print or type)
1) Mailing address of owner/operator (address to which all correspondence will be mailed):
Name t u W n ck g� (Ac iyU�v� C��n ►'�'. i�. 5 �1'cl ►r�c�I-rnt �
Street Address ` ' ` '
City
Telephone No.
V)iCkOe MQLLV%ta4-N StateZIPCode 2-!R11 )
L l q- 93,9L) Fax:
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
5C-0Ak�t, AC'.-rr(S . C--i mac'_ _
tL M u
u VV\. h e,
%rV'iS
State_ 1`( L ZIP Code 2S- -1 1
Fax:
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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 f(direction from a roadway intersection).
a� t 10t,ea,j C'u-4�'
(A copy of a county map or USGS quad sheet with facility clearly located must be submitted with this application)
4) Latitude 35, U1 N �1) Longitude —U- , .� 2- 13 (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
V❑ lyew 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: e '(2, LiuC,kr CknA
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?`► Gi�'� slct_� ocA iv
Receiving water classification: C_.
Is this a 303(d) listed stream?Has a TMDL been approved for this watershed? [�
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). M j A \
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.
., t' e 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): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Does this facility have any other NPDES permits?
❑ No �-E- l S Lk hC� 't�' I DL)3 1 S uk' Y>'�
L?rYes �40 0 00 4 22-
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)?
d2�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
O"Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe:
12) Does this facility have a Stormwater Pollution Prevention Plan? k
"o //1�(� cl d-1 S� ems` L
❑ Yes r�-r�l' � P �D
If yes, when was it implemented? sphp -�ar +V o .
13) Are vehicle maintenance activities occurring at this facility?
El No L1As
14) Hazardous Waste:
a) Is thi facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
;Z ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No U/ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
ha z�rAous waste?
El No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
"lo ❑ 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:
Types) of waste: (k S i I'l j ��'v i ✓1 l l,t�—`
How is material stored:
Where is material stored:
How many disposal shipments per year: 06 0� f S
V
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NCGO80000 N.O.I.
Name of transport / disposal vendor:
Vendor address:
15) Certification:
North Carolina General Statute 143-215.66 (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
Title:
r
of
ning: J 35i LG,- lam" -Ty-f3tr' is n
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDEQ
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NCGO80000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
0 Check for $100 made payable to NCDEQ
C 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 the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
/ (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
...[phone]
Wilmington Office...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 5 of 4
SWU-223-071408 Last revised 6/24/14

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