NCG060424_Application_20211018

FOR AGENCY USE ONLY
NCG06 V #_Z ! `
Assigned to:
ARO FRO MRO RRO WARCII WIRO WSRO
7171771VED
Division of Energy, Mineral, and Land Resources Land Quality S ction .
1 11 I ? 4 2021
National Pollutant Discharge Elimination System
NCG060000 Notice of Intent DEN'R-LANID QUALITY
11 J011^JATEK PERN11TTING
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC20 [Food and Kindred Products], SIC21 [Tobacco Products], SIC283 [Drugs], SIC284
[Soaps, Detergents, & Cleaning Preparations, Perfumes, Cosmetics, & Other Toilet Preparations], SIC 422 [Public
Warehousing and Storage — except for 4226]. You can 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:
Muunlake Farms of Noilli Caiulina
Phillip Plylar
Street address:
City:
State:
Zip Code:
PO Box 1320
Millsboro
IDE
19966
Telephone number:
Email address:
302-934-5787
[e-mail]
Type of Ownership:
Government
®County [IFederal []Municipal ®State
Non -government
E]Business (If ownership is business, a copy of NCSOS report must be included with this application)
171 Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Mountaire Farms - Siler City Hatchery
Elizabeth Gordon
Street address:
City:
State:
Zip Code:
4555 US HWY 421
Siler City
�NC
27344
Parcel Identification Number (PIN):
County:
8689 00 16 1072
Chatham
Telephone number:
Email address:
919-663-6729
[e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
0254
O New ®Proposed ElExisting
Latitude of entrance:
Longitude of entrance:
35.66127
-79.40178
Brief description of the types of industrial activities and products manufactured at this facility:
Poultry Hatchery
This facility processes meat: 0 Yes Il No
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
El N/A
Page 1 of 5

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:
Classification:
❑ This water is impaired.
01
Tick Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35d 39' 42"N
79d 23' 59"W
Brief description of the industrial activities that drain to this outfall:
truck traffic, loading dock
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? Yes M 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.
02
Tick Creek
C"
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35d 39' 43"N
79d 23' 26"W
Brief description of the industrial activities that drain to this outfall:
Truck traffic
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? O 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.
03 Tick Creek C ❑ This watershed has a TMDL.
Latitude of outfall: Longitude of outfall:
35d 39' 45"N 79d 23' 57"W
Brief description of the industrial activities that drain to this outfall:
Truck traffic, loading dock
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? F71 Yes El 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.
04
Tick Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35d 39' 46"N
79d 23' 57"W
Brief description of the industrial activities that drain to this outfall:
Truck traffic, emergency generators, loading dock, egg waste tank
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? El 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 be 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 NOI.
Page 2 of 5

5. Other Facility Conditions (check all that apply and explain accordingly):
Ell This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
N CG500247
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
121 This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
Stormwater first flush at egg loading dock, all stormwater collected at egg waste tank
❑ 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):
R Check for $100 made payable to NCDEQ
0
Copy of most recent Annual Report to the NC Secretary of State
IZI This completed application and any supporting documentation
El
A 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 industrial process materials are stored
g)
impervious areas
h)
site property lines
El
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 143-215.66 (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, I certify that:
❑ I 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.
❑ The information submitted in this NO1 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.
❑ I will abide by all conditions of the NCG060000 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 hereby request coverage under the NCG060000 General Permit.
Printed Name of Applicant: Phillip Plylar
Title: President
(Sign ture of Appl' ant) (Date Signed)
Mail the entire package to: DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, INC 27699-1612 `
Page 4 of 5

Delivery Date: Monday, 10/11/2021
Delivery Time: 10:16 AM
Left At: MAIL ROOM
Signed by: KING
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MOUNTAIRE FARMS OF NC
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1Z2075270195840553
NCDEQ
DFMI R-STORMWATFR PROGRAM
DEPT OF ENVIROMENTAL QUALITY
1612 MAIL SERVICE CENTER
RALEIGH, NC 276991600
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2

BUSINESS CORPORATION ANNUAL REPORT
10-2017
NAME OF BUSINESS CORPORATION: MOUNTAIRE FARMS, INC.
SECRETARY OF STATE ID NUMBER: 0175025 STATE OF FORMATION: DE Filing Office Use Only
REPORT FOR THE FISCAL YEAR END: 12 / 31 / 2 0
SECTION A: REGISTERED AGENT'S INFORMATION E::] Changes
1. NAME OF REGISTERED AGENT: CT CORPORATION SYSTEM
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENTTO THE APPOINTMENT
3. REGISTERED OFFICE STREET ADDRESS & COUNTY 4. REGISTERED OFFICE MAILING ADDRESS
160 MINE LAKE COURT, SUITE 200 160 MINE LAKE COURT, SUITE 200
WAKE COUNTY, RALEIGH, NC 27615 WAKE COUNTY, RALEIGH, NC 27615
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: POULTRY SALES
3. PRINCIPAL
2. PRINCIPAL OFFICE PHONE NUMBER: 5 01— 3 9 9- 8 8 7 6 OFFICE EMAIL:
4. PRINCIPAL OFFICE STREET ADDRESS&COUNTY 5. PRINCIPAL OFFICE MAILING ADDRESS
19 01_ _NAPA,VALLEY -,DRIVE.., _ 1901 �NAPA VALLEY _DRIVE
LITTLE ROCK, AR 72212 PULASKI LITTLE ROCK, AR 72212 - PULASKI
6. Select one of the following if applicable. (Optional see instructions)
The company is a veteran -owned small business
0 The company is a service -disabled veteran -owned small business
SECTION C: OFFICERS (Enter additional officers in Section E.)
NAME: PHIL PLYLAR NAME: DEE ANN ENGLISH
TITLE: PRESIDENT
ADDRESS:
NAME: CRAIG LAIR
TITLE: EXECUTIVE VICE PRES TITLE: CFO
ADDRESS:
29292 JOHN J WILLIAMS H 1901 NAPA VALLEY
MILLSBORO, DE 19966 LITTLE ROCK, AR 72212
ADDRESS:
1901 NAPA VALLEY
LITTLE ROCK, AR 72212
SECTI N D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
SIGNATURE —� L DATE
Form m at be signed by an officer listed under Section C of this form.
CRAIG LAIR CFO
Print or Type Name of Officer Print or Type Title of Officer
069241 MAIL TO, Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525
04-01-20

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