NCG190123_ScannedNOI_20211229

FOR AGENCY USE ONLY
NCG19(ll3 ''
Assigned to: r"' L%n
ARO FRO MRO RRO WAR WIaO WSRO
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Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG19O000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 373 [Ship and Boat Building and Repairing] and SIC4493 [Marinas]. You can find
information on the DEMLR Stormwater Program of 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:
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E E 73t&VAK&MMAA
Street address:
61 RM04TOtt3r "RoPi>
City:
CiAiL_DIISAf_
State:
N(A
Zip Code:
23oZ.5-
Telephone number
q?-6 -344o
Email address:
si6vE'�P�"tvllAulEiZt�IAr�A1A�;N�. �,
Type of Ownership:
Government
[3County ❑Federal []Municipal []State
Non -government
lousiness (If ownership is business, a copy of NCSOS report must be included with this application)
ClIndividual
2. Industrial Facility (facility being permitted):
Facility name:
Fa c' ity environmental contact:
Street address:
Vo 6—JPre. V_0A j
City:
!6umy
State:
Zip Code:
4
Parcel Identification Number (PI •
ip 5831 R 1`N0511
County:
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Telephone number(Email
5�j-BE)
address:
N I M e,-7-t 04<.ZI�kt3 vkA_ML N � • CDAA
4-2i SnnIC code:
Facility is:
Date operation is to begin or began:
"Y
0 New 0 Proposed afxisting
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Latitude of entrance: 33' 55 r IV" r4
Longitude of entrance:-.1506, r _3;?�,�
Brief description of the types of industrial activities and products manufactured a this facility:
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If he stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
N/A
Page 1 of 5
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Check all that are offered or allowed at this facility:
❑ Lodging
❑ Trash Collections
❑ Dump Station
Sanding
VL Restrooms
❑ Recycling
X Haul Out
❑ Sand Blasting
❑ Restaurant
❑ Fish Cleaning Area
❑ Pump Out
YPainting
❑ Vehicle/Equipment Washing
❑ Charter
❑ Fueling
❑ Boat Building
Boat Pressure Washing
❑ Live Aboard
❑ Boat Ramp
❑ Transient Slips
❑ Retail Store
WDry Boat Storage
WBoat Hand Washing
❑ Boat Sales
'Engine Repair
❑ Permanent Slips
3. Consultant (if applicable):
Name of consultant:
s - R� NVtts
Consulting firm-
RfiZoor-tom IV�oNJl�t n x
a�sx7�l
Street address: v tTE
23 : Cr}zDt fv l� �xT �� t cw
City;
W ��M t N��co,-1
State:
tJG
Zip Code:
28 d o
Telephone number: S �bZ
Email address:DO u & (' jZkAAC.M&ErJ . c=f3lt t
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.
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1 ❑ This watershed has a TMDL.
Latitude of outfall: 33955 ' O,-'�
Longitude of outfall:—.18o
Brief description of the industrial activities that drain to this outfall:
$OAT 6r'cor—AW.-r-- I FA'tzy-Lf'� ikmZ&XS. 1ESr7AT (!-t+&Ltt-tIM(m16kAa�ArV4a( PAitzi\inY
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? Oyes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year? J� 1
3-4 digit identifier:
Name of receiving water:
Classification:
RrThis water is impaired.
007,—
(SjRPtGOAf,V WA(ferarojiv
❑This watershed has a TMDL.
Latitude of outfall: o , „ r
Longitude of outfall: o r
Brief description of the industrial activities that drain to this outfall:
olio 'SrCoVA'G'& NL k-Mbts �O k [
c � A r.J tic, A Q t
Do Vehicle Maintenance Activities occur in the drainage area of this outfall?
VrJ'Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year? 4 55 GA�
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? E3 Yes 13 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 Outfalis" found on the last page of this N01.
Page 2 of 5
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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/measur s and show on site diagram:
tint��o�nEa 'T+QJ? W Way . l�� v-�Ptw� '6rrbt'eGt�.Fkt,c_�-t
'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):
Check for $100 made payable to NCDEQ 7�
M-Copy of most recent Annual Report to the NC Secretary of State
This completed application and any supporting documentation
14 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
opy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5
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7. Applicant Certification:
North Carolina General Statute 143-215.6E (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:
❑ 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.
❑ 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. '
❑ 1 will abide by all conditions of the NCG190000 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.
❑ 1 hereby request coverage under the NCG190000 General Permit.
Printed Name of Applicant. c IAe V ' Z i r h✓ ,(Mt
Title: pry • : JAI
. an \ 1 121 /21
(Sigma r¢'ofAppcant) (Date Signed)
Mail the entire pa age to: DEMLR —Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of S

Zimmerman Marine Inc. ` '—� ENKL
59 Heron Point Rd [�AN
Z1wNtFa&iANMrtewa Cardinal, VA 23025 6ea771514 —
a €vnmrxb nen rnvrs- ""
PAY TO THE
ORDER OF J
!Inn0 J/I I, IAA OJ 1704IV Id 'M, A _, 46/ni !! ,a-"�
509382
DATE
$
MEMO
C
J�C�Q dYll� f C.���� n�Trwtazws+�.+nu�
116509313 2119 1:05 L4037791:0 L3533913,18
Zimmerman Marine Inc.
509382

BUSINESS CORPORATION ANNUAL REPORT
re.tslr
NAME OF BUSINESS CORPORATION: Zimmerman Marine, Incorporated
SECRETARY OF STATE ID NUMBER: 1332595
REPORT FOR THE FISCAL YEAR END: 12/31 /2020
SECTION A:
STATE OF FORMATION: VA
1. NAME OF REGISTERED AGENT: Incorp Services, Inc.
2. SIGNATURE OF THE NEW REGISTERED AGENT
- Filed Annual
1332595
® Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS S COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
176 Mine Lake Court, Suite 100
Raleigh, NC 27615-6417 Wake County
SECTION B:
1. DESCRIPTION OF NATURE OF BUSINESS: Boat Repair
176 Mine Lake Court, Suite 100
Raleigh, NC 27615-6417
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL, OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
59 Heron Point Road
Cardinal, VA 23025-2022
5. PRINCIPAL OFFICE MAILING ADDRESS
59 Heron Point Road
Cardinal, VA 23025-2022
6. Select one of the following If applicable. (Optional see Instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: OFFICERS (Enter additional officers in Section E.)
NAME: Kathryn Perry
TITLE: Vice President
ADDRESS:
59 Heron Point Road
Cardinal, VA 23025
NAME: Steve Zimmerman NAME:
TITLE: President TITLE:
ADDRESS:
59 Heron Point Road
Cardinal, VA 23025
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed In its entirety by a person/business
en%thryn Perry 4/13/2021
SIGNATURE DATE
Form must be signed by an Wit= listed under Seclbn C of this form.
Kathryn Perry Vice President
Print m Type tame d Ol5ger Print or Type Title of Ofliter
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Site Map
Boat storage Main office
yard (So uth end)
Outfall Outfoll
DSN002 DSN001
Boat storage yard Facility entrance from /
(North end) to B-Var Road
**Site is unpaved / gravel surfaced.
b = Stormwater Flow Direction
1
Maintenance shop /
storage shed
Intracoastal
Waterway (ICW )
Boat Lift Area / Location
of Wash Pad
Bulkhead along Waterfront (Steel
Sheeting Topped by Concrete)

AMoFR,NCENK
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FNV.R^.Y1ENc/.V.l N4IF.Y RL.aFLE9
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
REPRESENTATIVE OUTFALL STATUS (ROS)
REQUEST FORM
FOR AGENCY USE ONLY
Dare Rueind
Year
Month
bay
If a facility is required to sample multiple discharge locations with very similar stormwater discharges, the
permittee may petition the Directorfor Representative Outfall Status (ROS). DWQ may grant Representative
0utfall Status if storm water discharges from a single autfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analvticol sampling requirements apply.
If Representative Outfall Status is granted, A1C outfalls are still subject to the gualitative monitoring
requirements of the facility's permit —unless otherwise allowed by the permit (such as NCG020000) and DWQ
approval. The approval letter from DWQ must be kept on site with the facility s Stormwater Pollution
Prevention Plon. The facility must notify DWQ in writing if any changes affect representative status.
I For questions please contact the DWQ Regional Office for your area (see page 3)
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N Cr.S.
2) Facility Information:
Owner/Facility Name L lv1, &14C !�&Pir i VM10e �1 C_
Facility Contact 1V 1C.k S-cG-6i.
Street Address l0 3 R-v/+rz-TLDAzt>
City State N G ZIP Code
Z b
County 6CLU ;�lac� E-mail Address NICV�-(u,-Z_MMtggAA,4aWArtzt�
Telephone No. Cg10
F2A-z--'SAE) Fax:
�
3) List the representative outfail(s) information (attach additional sheets if necessary):
Outfall(s) C>©l is representative of Outfall(s) 00�Z_
Outfalls' drainage areas have the same or similar activities? VYes ❑ No
Outfalls' drainage areas contain the same or similar materials? fees ❑ No
Outfalls have similar monitoring results? ❑ Yes ❑ No
kltoclata* LQ i�Z06LZCe
J
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? ❑ Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑ Yes ❑ No
Outfalls have similar monitoring results? ❑ Yes ❑ No
❑ No data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? ❑ Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑ Yes ❑ No
Outfalls have similar monitoring results? ❑ Yes ❑ No
❑ No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
swu-ROS-2009 Page 1 of 3
Last revised 12130/2009

Representative Outfall Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or, attach a letter or narrative to discuss this information.) For example, describe how activities and/or
materials are similar.
001 L 00Z 1'2CC�Jiz, f-L)A 3 2�mvtn l b&VJ—v'tC.&L
5) Certification:
North Carolina General Statute 143-215.6 B(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 [Environmental Management]
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).
1 hereby request Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DWQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my NPDES 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: &i - -RV 1-EL.crA
MA za M
(Date Sianed)
Please note: This application for Representative Outfall Status is subject to approval by the
NCDENR Regional Office. The Regional Office may inspect yourfacility for compliance with the
conditions of the permit prior to that approval.
Final Checklist for ROS Request
Thisapplicationshould include the following items:
df This completed form.
❑ Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
&,/ Two (2) copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
i.S l 1k ❑ Summary of results from monitoring conducted at the outfalls listed in Question 3. l i OC�TZ
❑ Any other supporting documentation.
SW U-ROS-2009
Page 2 of 3
Last revised 12/30/2009