NCG210499_Application_20210817

FOR AGENCY USE ONLY
NCG21 O 49
Assigned to:
ARO FRO MRO RRO AR WIRO WSRO
RECEIVE©
AUG 17 2021
DENR-LAND (QUALITY
STgRMjATER PERMITTING
Division of Energy, Mineral, and Land Resources Land Qua ity ection
National Pollutant Discharge Elimination System
NCG210000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 24 [Timber Products, including Wood Chip Mills — except as specified below] and like
activities deemed by DEMLR to be similar in the process and/or the exposure of raw materials, products by-
products, or waste materials. The following activities are specifically excluded from coverage under this General
Permit: SIC 2434 [Wood Kitchen Cabinets], SIC 2491 [Wood Preserving], and SIC 2411 [Logging]. You con find
information on the DEMLR Stormwater Program at deq.nc.gov/SW.
Directions: Print or type all entries on this application. Send the original, signed application with all required
items listed in Item (6) below to: NCDEMLR Stormwater Program, 1612 MSC, Raleigh, NC 27699-1612. The
submission of this application does not guarantee coverage under the General Permit. Prior to coverage under
this General Permit a site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (7) below:
QUALITY MATS LLC
DAVID LEE EVANS
Street address:
City:
State:
Zip Code:
1361 SAINT ANDREWS ST PO BOX 34
JAMESVILLE
INC
�27846
Telephone number:
Email address:
252-809-2005
[e-mail]
Type of Ownership:
Government
ElCounty ElFederal OMunicipal [IState
Non -government
El Business (If ownership is business, a copy of NCSOS report
must be included with this application)
r]Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
QUALITY MATS LLC
LEE EVANS
Street address:
City:
State:
Zip Code:
1516 MORRATTOCK RD
PLYMOUTH INC
127962
Parcel Identification Number (PIN):
County:
6766520962
WASHINGTON
Telephone number:
Email address:
252-809-2005
[e-mail]
4-digit SIC code:
Facility is:
I
Date operation is to begin or began:
�2006
El New 0 Proposed [D Existing
Latitude of entrance:
Longitude of entrance:
35.824230
-76.757292
Brief description of the types of industrial activities and products manufactured at this facility:
WOODEN MATS USED AS TEMPORARY ROADWAYS
This facility will produce Wood Pellets: IlYes O No
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
0 N/A
Page 1 of 5

r .I
3. Consultant (if applicable):
Name of consultant: Consulting firm:
Street address: City: State: Zip Code:
Telephone number: Email address:
4. Outfall(s) At least one outfall is required to be eligible for coverage.
3-4 digit identifier:
Name of receiving water:
1
Classification:
❑This water is impaired.
23-56
CONABY CREEK
QSW
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.825912
-76.753221
Brief description of the industrial activities that drain to this outfall:
SAWMILL AND MANUFACTURING
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes E No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL._
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? I] Yes ©No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? E) Yes El No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
All outfalls must he listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalls" found on the last page of this N01.
Page 2 of 5

5. Other Facility Conditions (check all that apply and explain accordingly):
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
❑ This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If checked,
indicate:
Kilograms of waste generated each month:
Type(s) of waste:
How material is stored:
Where material is stored:
Number of waste shipments per year:
Name of transport/disposal vendor:
Transport/disposal vendor EPA ID:
Vendor address:
❑ This facility is located on a Brownfield or Superfund site
If checked, briefly describe the site conditions
6. Required Items (Application will be returned unless all of the following items have been included):
ReCheck for $100 made payable to NCDEQ
WCopy of most recent Annual Report to the NC Secretary of State (if applicable)
56his completed application and any supporting documentation
IyA site diagram showing, at a minimum, existing and proposed:
a) outline of drainage areas
b) surface waters
c) stormwater management structures
d) location of stormwater outfalls corresponding to the drainage areas
e) runoff conveyance features
f) areas where materials are stored
g) impervious areas
h) site property lines _
Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

7. Applicant 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 ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Under penalty of law, 1 certify that:
0 1 am the person responsible for the permitted industrial activity, for satisfying the requirements of this permit, and for any
civil or criminal penalties incurred due to violations of this permit.
0 The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information.
0 1 will abide by all conditions of the NCG210000 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.
0 1 hereby request coverage under the NCG210000 General Permit.
Printed Name of Applicant: DAVID LEE EVANS
Title: MANAGER
8/13/21
(Signature of Applicant) (Date Signed)
Mail the entire package to: DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

Additional Outfalls
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes I] No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3 4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? El Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes I] No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes I] No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

NORTH C-AR(.*JN--A--
Department of The Secretaryof
To all whom these presents shall come, Greetings:
I, ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do
hereby certify the following and hereto attached to be a true copy of
ARTICLES Off'ORGANIZATION
i
QUALITY MATS, LLC
the original of which was filed in this office on the 7th day of November, 2003.
IN WITNESS WHEREOF, I have hereunto
set my hand and affixed my official seal at the
City of Raleigh, this 7th day of November, 2003
Secretary of State
Document Id: C20033090007
8

` e
SOSID: 697951
Bate Filed: 11/7/2003 9:09:00 AM
Elaine F. Marshall
North Carolina Secretary of State
C200330900070
ARTICLES OF ORGANIZATION
OF
QUALITY MATS, LLC
Pursuant to Section 57C-2-20 of the General Statutes of North Carolina,
the undersigned does hereby submit these Articles of Organization for
the purpose of forming a limited liability company.
1. The name of the limited liability company is Quality Mats,
LLC.
2. There shall be no limit on the duration of the limited liability
company.
3. The name and address of each person executing these articles of
organization is Lee Evans, Organizer, 1032 Fleming Circle,
Jamesville, N.C. 27846
4. The street address and county of the initial registered office
of the limited liability company is 1032 Fleming Circle,
Jamesville, Martin County, North Carolina, 27846.
5. The mailing address of the initial registered office is P. O.
Box 34, Jamesville, N.C. 27846.
6, The name of the initial registered agent is Lea Evans.
7. The limited liability company shall be Manager -managed LLC,
except as provided by N.C.G.S. Section 57C-3-20(a), the members
of this limited liability company shall not be managers by
virtue of their status as members.
8. Any other provisions which the limited liability company elects
to include are attached.
9. These articles will be effective upon filing.
This the 3rd day of November, 2003.
Lee Evans, Organizer

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JAMESVILLE
27846.
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DAVID LEE EVANS,
s TRUSTEE FOR THE EVANS
FAMILY TRUST
4.12
MORRATTOCK RD

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Limited Liability Company
Legal Name
Quality Mats, LLC
Information
Sosld: 0697951
Status: Current -Active O
Date Formed: 11/7/2003
Citizenship: Domestic
Annual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: Evans, Lee
Addresses
Principal Office
1361 Saint Andrews Street
Jamesville, NC 27846-9829
Company Officials
Reg Office Reg Mailing Mailing
1361 Saint Andrews Street PO Box 34 PO Box 34
Jamesville, NC 27846-9829 Jamesville, NC 27846-9829 Jamesville, NC 27846-9829
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Lee Evans
PO Box 34
Jamesville NC 27846