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HomeMy WebLinkAboutNCG020983_Application_20210804A - LEAS Environmental Quality Division of Energy, Mineral and Land Resources / Land Quality Section — Stormwater Permitting Program National Pollutant Discharge Elimination System NCG020000 NOTICE OF INTENT — General Permit Application FOR AGENCY USE ONLY Date Received Year Month Day 021 op, 04 Certificate of Coverage NICIG1012[0191-3 Check # Amount Ioo— .%1 3b d AUG 0 4 2021 National Pollutant Discharge Elimination System application for coverage under Ge Or, 'R-LAND QUALITY NCG020000: d �,�R PERMITTING STORMWATER AND/OR WASTEWATER DISCHARGES associated with activities classified as: SIC (Standard Industrial Classification) Code - 14XX Mineral Mining Industry (except as specified below) and like activities The following activities are included: • Active or inactive mining operations (including borrow pits —except for NCDOT borrow pits) that discharge stormwater contaminated with or that has come in contact with, any overburden, raw material, intermediate products, finished products, byproducts or waste products located on the site of such operations; • Stormwater from vehicle maintenance activities (VMA) at mining operations; • Overflow from facilities that recycle process wastewater; and/or • Mine dewatering (wastewater) The following activities are specifically excluded from coverage under this General Permit: • Stormwater discharges associated with peat mining, coal mining, and metal mining; • Stormwater discharges from mining operations which are intermixed on site with stormwater from concrete operations; • Stormwater discharges associated with oil and gas extraction operations; and • Stormwater discharges associated with tourist gem mines • NCDOT borrow pits (covered under individual permit NCS000150) The following discharges are covered by NPDES general permit NCG520000 instead of NCG020000: Point source discharges of stormwater and wastewater from in -stream sand mining operations (sand dredging or dipping operations) are covered instead by NPDES General Permit NCG520000, administered by the Division of Water Resources NPDES Wastewater Permitting Program. Please contact DWR for more information. Please print or type all entries in this application form. 1) Mailing address of owner/operator (official address to which all permit correspondence will be mailed): Legal Owner Name Donald Smith (Attach the most recent Annual Report to the NC Secretary of State showing the current legal name of the corporation or entity. Alternatively this permit can be given to an individual or government authority. This name must be the same name as appears on the Division of Energy, Mineral, and Land Resources' Mining Permit.) Signee's Name (as signed for in question 41. at end) Donald Smith Street Address 1402 Canal Cove Rd. City Telephone No. Lake Waccamaw, N.C. 910 810-3534 Alternate Contact Name` State NC ZIP Code 28450 E-mail smithstruck@yahoo.com Alternate Contact Telephone (if different) `Alternate contact should be affiliated with the Owner/Operator. in question 5. E-mail (if different) Consultant information can be provided Page 1 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. 2) Location of facility producing discharge: Facility Name Rosindale Sand Mine Facility Street Address Rosindale Road Facility City Council Facility County Bladen Facility Contact Telephone No. Contact E-mail Donal Smith 910 840-3534 smithstruck@yahoo.com 3) Physical Location Information: State NC ZIP Code 28434 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). Turn north onto Rosindale Road off of Hwy. 211 and travel approximately 0.2 mile crosing railroad track and turn onto private gated dirt road. Site is down dirt road approx.1.1 mile. 4) Facility Location Coordinates: Latitude 34.4545 N Longitude 78.5166 degrees) 5) Consultant Information (if applicable): Consultant: Greg A. Wayne, PLS Consulting Firm: Hanover Design Services, PA Mailing Address: 1123 Floral Parkway City: Wilmington State: North Carolina Zip Code: 28403 Phone: (910 ) 343-8002 Fax: (910 ) 343-9941 E-mail: gwayne@hdsilm.com W (degrees / minutes / seconds or decimal Permits: 6) This NPDES Permit Application applies to which of the following: 11 New or Proposed Facility Date operation is to begin: ASAP ❑ Existing Date began mining: ASAP 7) Standard Industrial Classification: (Optional) Staple Business Card Here Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial activity at this facility SIC Code: 1 4 4 2 8) Provide a description of the types of minerals mined at this facility: Sand/Borrow Material 9) Is this a PROCESSING -ONLY facility for materials mined elsewhere? No ❑ Yes 10) Is this an inactive mine site? 11 No ❑ Yes If yes, have you certified to the Stormwater Permitting Program that all portions of the site where clearing, grading, and/or excavation activities have occurred have been stabilized? ❑ No ❑ Yes (If yes, the site may be eligible for "Dormant Status" and reduced BMP inspections. See the General Permit.) Page 2 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. 11) Does this facility already have a valid Mining Permit from DEMLR's Land Quality Section? 11 No ❑ Yes If no, please indicate the status of the Mining Permit application: If yes, please provide the Mining Permit number: the DEMLR Mining Permit with this NPDES application. 12) Does this facility have any other NPDES permits? Also provide a copy of 11 No ❑ Yes If yes, list the permit numbers for all current NPDES permits for this facility: 13) Are you applying for a discharge permit in the same location as a previously permitted mine? P No ❑ Yes If yes, specify permit number and mine name if known: 14) Does this facility have any Non -Discharge permits from DWR (e.g., recycle permits)? N No ❑ Yes If yes, list the permit numbers for all current Non -Discharge permits for this facility: 15) Does total area of this mine site include ready -mixed concrete plant and/or asphalt plant areas? 4 No ❑ Yes If yes, do they have separate NPDES stormwater permits? ❑ No ❑ Yes (provide permit number(s) ) If not owned by the same company, who is the owner? Development Activities and Buffers: 16) Will this mining operation precede development activities at this site? ❑ No P Yes 17) Is this mine located within one of the 20 Coastal Counties, and will it add more than 10,000 ft2 of impervious surface? ❑ Yes (to both) ❑ No, this mine site IS in one of the 20 Coastal Counties but will NOT add 10,000 ft2 of impervious surface. N No, this mine site is NOT in any of the 20 Coastal Counties. If this site is in one of the 20 Coastal Counties, you may be required to apply for an additional State Stormwater Permit. Check with your local Regional Office (see contact information and checklist below). 18) Is this mine located the Neuse, Tar -Pamlico, or Catawba River Basins, or the Randleman or Jordan Water supply Watersheds? P No ❑ Yes If yes, what size stream buffers are included on site? ft. You must show buffers on site plans. Also include information and plans showing diffuse flow through buffers as required. Page 3 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. Discharge Points, Receiving Waters & Wetlands: 19) Receiving waters: What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater and/or wastewater discharges will end up in? Any overflow that may occur will discharge into vegetated areas and will eventually infiltrate or surface drain to the head of Boggy Branch, that is approximately 600 ft. away from the project area. To find the waterbody, please see the NC Surface Waterbody Classifications map at https://deq.nc.gov/abouVdivisions/water-resources/water-resources-science-data Receiving water classification(s) for the waters: c; sw If the site will discharge to a separate storm sewer system, name the operator of the separate storm sewer system (e.g. City of Raleigh municipal storm sewer). NSA Discharge of wastewater to receiving waters classified as WS-11 through WS-V, or SA, must be approved by the Division of Water Resources (DWR) or Division of Marine Fisheries (DMF). DEMLR cannot grant coverage under NCG020000 without that approval. Also be advised that no new discharges of wastewater are permitted in receiving waters classified as WS-1 or freshwater ORW. Wastewater discharges to saltwater ORW will not be approved under General Permit NCG02 but may be eligible for an individual permit. 20) Will this mine site discharge wastewater or stormwater to waters classified as High Quality Waters (HQW), Primary Nursery Areas (PNA), Trout (Tr) waters, or a class with a symbol like "+" or "@" that denotes a special management strategy is in place? 4 No ❑ Yes, PNA* ❑ Yes, HQW* ❑ Yes, includes "+" or ❑ Yes, Trout (Tr) 21) Will this mine site discharge wastewater or stormwater to waters classified as Shellfish (SA) waters? P No ❑ Yes, SA* *For questions 19-20, be advised that the NCG02 General Permit limits the discharge volume of total combined wastewaters to 50 percent of the receiving water in -stream flow under 7Q10 conditions in HQW waters (PNA and SA waters are considered HQW by definition). You maybe required to contact USGS to obtain a 7Q10 flow. 22) Will this mine site discharge wastewater or stormwater to impaired waters, or to waters with an approved "Total Maximum Daily Load" (TMDL)? To find impaired waters & TMDLs, please see the Impaired Waters Map & TMDL map on hops://deq.nc.gov/about/divisions/water-resources/water-resources-science-data P No ❑ Yes, these waters are impaired for (list pollutants): ❑ Yes, these waters have a TMDL for (list pollutants): Page 4 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. 23) List discharge points (outfalls) that convey discharge from the mine 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. Include proposed maximum daily flow rate for each wastewater outfall. You must show all discharge points clearly on the submitted site plan. Be advised that NCDEQ may require you to apply for an individual permit, based on proposed discharge rates and receiving stream conditions (low flows, impairments, etc.) Stormwater Stormwater Outfall No. 1 Latitude (degrees/minutes/seconds or decimal degrees): 34.4551 N Longitude (degrees/minutes/seconds or decimal degrees): 78.5164 W Stormwater Outfall No. Latitude (degrees/minutes/seconds or decimal degrees): N Longitude (degrees/minutes/seconds or decimal degrees): W Stormwater Outfall No. Latitude (degrees/minutes/seconds or decimal degrees): N Longitude (degrees/minutes/seconds or decimal degrees): W Stormwater Outfall No. Latitude (degrees/minutes/seconds or decimal degrees): N Longitude (degrees/minutes/seconds or decimal degrees): W Stormwater Outfall No. Latitude (degrees/minutes/seconds or decimal degrees): N Longitude (degrees/minutes/seconds or decimal degrees): W Stormwater Outfall No. Latitude (degrees/minutes/seconds or decimal degrees): N Longitude (degrees/minutes/seconds or decimal degrees): W Mine Dewatering Mine Dewatering (Wastewater) Outfall No. Proposed maximum flow rate: 500 Latitude (degrees/minutes/seconds or decimal degrees): 34.4551 N Longitude (degrees/minutes/seconds or decimal degrees): 78.6164 W Mine Dewatering (Wastewater) Outfall No. Proposed maximum flow rate: Latitude (degrees/minutes/seconds or decimal degrees): N Longitude (degrees/minutes/seconds or decimal degrees): W Process Wastewater Process Wastewater Outfall No. Wastewater Description: Proposed maximum flow rate: Latitude (degrees/minutes/seconds or decimal degrees): N Longitude (degrees/minutes/seconds or decimal degrees): W Process Wastewater Outfall No. Wastewater Description: Proposed maximum flow rate: Latitude (degrees/minutes/seconds or decimal degrees): N Longitude (degrees/minutes/seconds or decimal degrees): W Page 5 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. 24) Help us understand what will happen to the dewatering water at this mine site: ❑ N/A — this mine is not dewatering at all and will not dewater in the future. a) Will this mine be dewatering and discharging to waters of the state? (Answer only if dewatering) F No ❑ Yes If yes, where to? ❑ Surface Waters and/or Wetlands (on -site or off -site) ❑ Other (on -site or off -site) Describe: b) Will this mine be dewatering but not discharging to waters of the state? (Answer only if dewatering) ❑ No 11 Yes If yes, explain how you are dewatering, and where that water will be directed. The mine will dewatered by iping into a sediment trap and eventually discharged/infiltrated and when dicharging occurs will surface drain into adjoining vegetation. 25) Are there wetlands or surface waters within 400' of the mine pit perimeter? ❑ No 11 Yes If yes, what distance are they from the mine pit perimeter? 50' min feet. 26) Will mining operations require dewatering near wetlands or other waterbodies, and will dewatering potentially impact any wetlands or other waterbodies? ❑ No, dewatering will not occur near (within 400') of wetlands or other waterbodies (e.g., streams, lake, etc.) 11 Yes, dewatering will be near wetlands or other waterbodies Wetlands must be CLEARLY DELINEATED on the site plan. Mine dewatering activities that have the potential to drain wetlands or otherwise impact surface water or groundwater MUST develop and implement a Pumping Operation and Monitoring (POM) Plan that has been approved by the Department. For sites that may drain wetlands — approval of a POM Plan may be required prior to coverage under this permit. The POM Plan should be submitted to the appropriate Regional Office and in all cases must be approved prior to operation. The plan shall include, but is not limited to: (1) Groundwater monitoring strategies to demonstrate the effect of pumping and to establish any pumping regime necessary to reduce impacts, and (2) Detailed plans to maintain surrounding hydrology and respective monitoring to demonstrate compliance. See checklist at the end of the application. Contact the Regional Office for questions specific to your mine. 27) Have you been required to obtain 404/401 Certification permits? P No ❑ Yes If yes, please briefly describe below (include information such a required mitigation, BMPs, setbacks, and/or O&M plans for on or off -site wetlands or other pertinent information). Attach other sheets as necessary: Page 6 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. 28) Have you been required to obtain a wetland delineation certified by the US Army Corps of Engineers? M No ❑ Yes If yes, please attach to application submission. Stormwater BMPs and Vehicle Maintenance: 29) Does this facility employ best management practices for stormwater control? ❑ No 11 Yes If yes, please briefly describe: storm water and water from dewatering will be treated in a sediment basin and sediment trap as needed. 30) Does this facility have a Stormwater Pollution Prevention Plan? 11 No ❑ Yes If yes, when was it implemented? 31) Are vehicle maintenance activities (VMA) occurring or planned at this mine site? No ❑Yes, If yes, will VMA area runoff discharge into the wastewater treatment system(s)? ❑ No, VMA runoff will discharge separately through a stormwater outfall ❑ Yes, VMA runoff will drain back to the mine pit or other wastewater system Wastewater Treatment Facilities: 32) Will mine dewatering occur? (Yes, we are asking about dewatering again.) ❑ No M Yes If yes, will the mine discharge this water? 33) Will this facility wash mined materials? M No ❑ Yes If yes, will the mine discharge this water? 34) Will discharges of process wastewater treatment systems occur (including possible recycle system overflows)? M No ❑ Yes If yes, describe what kind of systems: 35) Will this facility employ chemical additives to flocculate suspended solids? M No ❑ Yes If yes, provide the name, manufacturer, and the quantity of average daily usage of the chemical additive (if known): Note: Please see our website for a list of evaluated polyacrylamide (PAMS) products for use in North Carolina: https://deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/stormwater-permits/ construction-sw 36) Will any of the wastewater treatment facilities at this mine overflow only during rainfall events that exceed the 10-yr, 24-hr rainfall event? M Yes If yes, which treatment systems are those? The basin/pit will only discharge manually as needed. Existing runoff is to be diverted from the minina area. ❑ No, all wastewater treatment facilities will discharge more frequently (i.e., during smaller rain events) Page 7 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. 37) Are wastewater treatment facilities (including recycle systems) planned in the 100-year flood plain? P No ❑ Yes 38) A WaSteWater treatment alternatives reviewis required by 15A NCAC 2H.0105 (c)(2) for any new or expanding water pollution control facility discharges in North Carolina. You may attach additional sheets. List the types of wastewater this mine site will discharge: ❑ Mine Dewatering ❑ Process Wastewater (such as washing or recycle system overflows, other mining activity wastewater) a) What wastewaters were considered for this alternatives review? I Dewatering ❑ Process WW b) Connection to a Municipal or Regional Sewer Collection System: i) Are there existing sewer lines within a one -mile radius? ..................................... ❑ Yes ✓❑ No (1) If Yes, will the wastewater treatment plant (WWTP) accept the wastewater? .... ❑ Yes ❑ No (a) If No, please attach a letter documenting that the WWTP will not accept the wastewater. (b) If Yes, is it feasible to connect to the WWTP? Why or why not?` c) Closed -loop Recycle System (meets design requirements of 15A NCAC 2T .1000): i) Are you already proposing a closed -loop recycle system (CLRS)? ......................... ❑ Yes ❑ No (1) If Yes, for what type of wastewater at this mine site? ❑ Dewatering ❑ Process WW (2) If No, is this option technologically feasible (possible)? Why or why not?* (3) If No, is it otherwise feasible to build a CLRS at this site? Why or why not?* (4) What is the feasibility of building a CLRS compared to direct surface water discharge?* d) Surface or Subsurface Disposal System (e.g., spray irrigation): i) Is a surface or subsurface disposal technologically feasible (possible)? ..................... ❑ Yes ❑ No Why or Why not?* ii) Is a surface or subsurface disposal system otherwise feasible to implement?*............ ❑ Yes ❑ No Why or Why not?* Page 8 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. iii) What is the feasibility of employing a subsurface or surface discharge as compared to a direct discharge to surface waters?" e) Direct Discharge to Surface Waters: Is discharge to surface waters the most environmentally sound alternative of all reasonably cost-effective options for the wastewaters being considered?" ❑ Yes ❑ No f) If this review included all wastewater discharge types, would excluding some types (e.g. mine dewatering) make any of the above non -discharge options feasible for some of the wastewaters? ❑ Yes ❑ No * Feasibility should take into account initial and recurring costs. You may be asked to provide further information to support your answers to these questions after the initial review. Other: 39) Hazardous Waste: a) Is 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? 11 No ❑ Yes c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of hazardous waste? M No ❑ Yes 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 / disposal vendor: Vendor address: 40) Is your facility providing appropriate secondary containment for bulk storage of liquid materials? (See permit text for secondary containment requirements.) 11 No ❑ Yes 41) Does your site have an active landfill within the mining permit boundary? 0 No ❑ Yes If yes, specify type: ❑ LCID (Land Clearing and Inert Debris) ❑ Other: Page 9 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. Final Checklist: '—� This application will be returned as incomplete unless all of the following items have been included and 1 — initialed for. Please show that the following required information has been included by initialing in each space below. Fee of $100 made payable to NCDEQ. Completed application and all supporting documents. Copy of the valid approved mining permit (MP) for the facility or indication of MP application status. Copy of a county map or other general location map that shows the mining site and nearest major roads. Copy of USGS topographic map showing the mining site and surrounding areas, or other map that clearly shows site location in relation to nearby streams, wetlands, and other waters, etc. 2 copies of large-scale (minimum 24" x 36") site plan with topographical lines with all outfalls, applicable buffers and wetlands clearly delineated, receiving waters, and 100-year flood plain line if applicable. N/A A copy of your US Army Corps -approved wetland delineation if you marked "yes" to question 27 above. A line drawing of the water flow through the facility or block flow diagram. A pictorial description of the nature of any sources of water and any collection and treatment measures. If mine site is in one of the 20 Coastal Counties: • Applicant has checked with the appropriate regional office to verify the need for a Coastal State Stormwater permit. Indicate the Regional Office Contact. • Applicant has included a detailed list of impervious surface areas and percentages, sub -drainage areas, and total drainage area. If the mine is dewatering and near wetlands, or may otherwise impact surface waters or groundwater, include the following and contact your local regional office about a Pumping Operation and Monitoring (POM) Plan. An approved POM plan may be required prior to NCG02 issuance. Y 2 copies of detailed Full Size Plans (at least 24" x 36") delineating areas on the plans and listing acreage (including: wetlands, ditches, well -placements, pits, borrow areas, overburden storage, stormwater controls/BMPs, vehicle maintenance areas, settling basins, product process (such as screening, stockpiles, waste piles), total drainage area, impervious surface percentages (if state SW programs apply), applicable buffers, and access and/or haul roads). Y Pump dewatering size and information on its specifications. N/A Well information (design, depths, maintenance). N/A Physical monitoring for the wetlands areas. Y Settling pond sizing information, if applicable. N/A Level spreader design, if applicable. Y Details about dewatering method. N/A Cone of influence calculations. Y Description of measures to prevent erosion and flooding. N/A Description and information about 401/404 permits that have been obtained. Y Copy of US Army Corps of Engineers wetland delineations or approved wetland delineation (if applicable). N/A I have contacted my local regional office about a POM Plan. Regional Office Contact: . Date contacted: -OR- Y I will not impact any nearby wetlands, surface waters, or groundwaters by dewatering. Page 10 of 12 SWU-NCG02-NOI Last revised 9/10/2015 NCG020000 N.O.I. Certification. North Carolina General Statute 143-216.6 b (i) provides that, Any person ehe knowingly 'raker any al:r, s<atemr.M, represcrtatcn.. Or CerrfiC2110 n any apprr�.mrt, record repot, plan, cr other do-1,rrmt fi5ed o- mqu ei to be mairtairt. nbert1ts:srbcie or a rule itnpttmerltng thts Article. or vinb Wvw,Vpj makes a false r&t enl of a Tatcrial fx in a r kiernakiN prgCeedlnQ O(0Wd Wets date U-ckf the fuck, or wtro ralatez. tarnpn_rs with. or knpxn+p°y sanders irucm- rate any recordin; cr monsorinsr de•rrr or method requred to be ope-ated or rna ma�inn -n ter M%r Article or rules Ot tie (Env1rMmirttal ManagemerY; Ccmmission mplcmerrtin r tho Atcte shall be gusty of a doss 2 nsrw-4Yrunner wtuch may imude a fine W tc exceed tent uxiusa.-d ddtars ($10.po0).. 41) Signatory Requirements (per4D CFR. 122,22) At a.-picatons, reports Or rifon atcn submthrd to ttrr U.mc:tor cal oa sig—c- and oatifed. a Al nctict-n. or iremt to be oovored under this Cene:al Permit ihsn be signed as rolaws rC f o• a corpm etort by a resporccie-rporarc p3rgr cot eye p;, Se of this permit. a resporyNe oorpmile ofter names ia) a armiderr, seVV y treas;aer of vicee pfesdert of the corporation in charga ,of a prncipal business function, Of any other person wflo panto m s simitar pelk�y or deesion matting ftinmons for V* corporation, Of tb) the marogr~ of OM or mc, u rnar&ftC ;6nq production or operatirg faolibes M r.4Dyirg mom than 250 persons Or haunt; gross armua'sa'es of expenmt: res ex:er_dmg 25 mlhon {rn second quarto 1930 c�ciIlaml. if auhor4y to s gn docwrerfis has ben^ assbgned or de;egated to the manager in accordance wire covorwe procedure (7) =or a parr-wrV ip Or sae ;rcpretershl; by a peeral pirtner or the aroerie" resaeetiti ely, or (3) For a muricipa;ity, stares faderAi or :;tver p.,,Vr. . agency' by "her a ppriapa; executive officer or ranking erected cdGtiii I hereby request coverage under the referenced General Permit. I understand that coverage under this permit will constitute the permit requirements for the discharges) and is enforceable in the same manner as an individual permit. I agree to abide by the following as a part of coverage under this Genera I Permit- 1. I agree to abide by the approved Mining Permit for this mining activity. (A copy of the valid mining permit must toe attached to this request) 2. l agree to not discharge any sanitary wastewater from this mining activity except under the provisions of another NPOES permit specifically issued therefore 3 1 agree that bulk storage of petroleum products and other chemicals shalt have adequate protection so as to contain all spills on the site. 4 1 agree that solid wastes will be disposed of in accordance with N.C. statutes aria rules governing solid waste disposal. 3. € agree that mairrtenanoe a ctivibes for vehicles aril heavy equipment will be performed so as to not resutf in contamination of the surface or ground waters_ I agree to abide by the provisions as listed above aril recognize that the provisions are to be considered as enforoeable requirement, of the General Permit. I certify that I am fami6arwith the information contained in this application and that fo the best of my knowledge aria belief such information is true, complete, and accurate. Printed Name of Person Signing- Donald Smith Title Mince Manager_ 'f Notice of Intent must be accompanied by a check or moaner artier for $1X0G made payable to NCDEd_ NCG020000 N.O.I. 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 NCG02 General Permit. Upon review of the submittal, the Division may determine that coverage under an individual permit is more appropriate. Also be advised that renewed and continued coverage under NCG02 may be dependent upon the permittee's compliance success and/or status of the receiving waters. For questions, please contact the DEMLR/Land Quality Section Regional Office for your area. DEMLR/Land Quality Section Regional Office Contact Information: Asheville Office..... Fayetteville Office .. Mooresville Office.. Raleigh Office ....... Washington Office. Wilmington Office.. Winston-Salem ..... Central Office ....... (828) 296-4500 (910) 433-3300 (704) 663-1699 (919) 791-4200 .. (252) 946-6481 (910) 796-7215 (336) 776-9800 .. (919) 707-9220 Page 12 of 12 SWU-NCG02-NOf Last revised 9/10/2015