NCG120113_Application_20210611

NU9lW L�3
Environmental
Quality
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG120000
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
Certificate nfCovera e
NCG 1 2
Check n Amount
Permit Assigned to
W A-V.d
NOTICE OF INTENT I
National Pollutant Discharge Elimination System application for coverage under General PerrdDi 1Cj �j�ts3e ,D
NCG120000:
STORMWATER DISCHARGES associated with activities classified as: JUN 02 2021
Landfills that are permitted by the North Carolina Division of Waste Management under the DENR_1AND QUALITY
provisions and requirements of North Carolina General Statute 130A -- 294. 8TORMWNATER PERMUTING
The following activities are specifically excluded from coverage under this General Permit:
• Stormwater discharges from open dumps, hazardous waste disposal sites, or discharge of waste (including
leachate) to the waters of the state.
' 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 Brad Gardner, Solid Waste Director
Street Address 317 Pritchard St
City Elizabeth City State N.C. ZIP Code 27909
Telephone No. 252 335-4105 Fax: [phone]
2) Location of facility producing discharge:
Facility Name Pasquotank County Landfill (NC Solid Waste Permit No. 70-02)
Facility Contact Brad Gardner
Street Address 983 Simpson Ditch Rd
City Elizabeth City State N.C. ZIP Code 27909
County Pasquotank County
Telephone No. 252 335-4105 Fax: [phone]
Email [e-mail]
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). US17 to 983 Simpson Ditch Rd.(SR# 1144)
(A copy of a county map or USGS quad sheet with facility clearly located must be submitted with this application.)
4) Latitude 36' 14' 20.74" Longitude 76 '15'56.33"
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
❑✓ Existing
deg, min, sec)
SW U-227-071408
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Last revised 6/24114

NCG120000 N.0.1.
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
this facility: NONDNA
8) Discharge points ! Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 3
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Halls Creek
Receiving water classification: c, sw
Is this a 303(d) listed stream? NO Has a TMDL been approved for this watershed? NIA
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
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. 1
Latitude (degrees/minutes/seconds): 36° 14- 4a.2o°
N
Longitude (degrees/minutes/seconds): 76° 16- 1o,s7"
W
Stormwater Outfall Na. 2
Latitude (deg reeslminutes/seconds): 36° 14' 11,15"
N
Longitude (degreeslminutes/seconds): 76° 16 03.7a'
W
Stormwater Outfall No. 3
Latitude (degrees/minutes/seconds): 36-14-07.27"
N
Longitude(degreeslminutes/seconds): 76°15'52.54!'
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
9) Does this facility have any other NPDES permits?
M No
© Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
If
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NCG120000 N.O.I.
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
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
Yes (Show structural BMPs on the site diagram.)
If yes, please briefly describe: ponds, Grass Swales, Filter Strips, Vegetation, Erosion Control Fences, Gravel
12) Does this facility have a Stormwater Pollution Prevention Plan?
11 No
❑ Yes
If yes, when was it implemented?
13) Are vehicle maintenance activities occurring at this facility?
No 11 Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
9 No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
11 No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
11 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 1 disposal vendor:
Vendor address:
15) Certification:
North Carolina General Statute 143-215.613(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 Commission implementing this Article shall be guilty of a Class
2 misdemeanor which may include a fine not to exceed ten thousand dollars ($u10,000).
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NCG120000 N.O.I.
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: Brad Gardner
Title: Director of Solid Waste, Pasquotank County
I-- zt, -.7— /
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $1 00.00 made payable to:
NCDEQ
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NCG120000 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
RI This completed application and all supporting documents
M 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 ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
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SWU-227-071408 Last revised 6I24I14

NIXONTON QUADRANGLE
NORTH CAROLINA
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