NCG030723_NOI_20220201

FOR AGENCY USE ONLY
NCG03 0 ';t 2 .3
Assigned to: A G $A
ARO FRO MRO RRO WARO WIR WSRO
RECEIVE®
jAN 20 2022
IUENNR�-LLAANRD QUAUTY
Division of Energy, Mineral, and Land Resources LandSt�uRal%ity3e Tn ING
National Pollutant Discharge Elimination System
NCG030000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 335 [Rolling, Drawing, and Extruding of Nonferrous Metals], SIC 3398 [Metal Heat
Treating], SIC34 [Fabricated Metal Products], SIC35 (Industrial and Commercial Machinery], SIC36 [Electronic
and Other Electrical Equipment], SIC37 [Transportation Equipment], and SIC 38 [Measuring, Analyzing, and
Controlling Instruments]. 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:
t1:DNAadr - (5=r A� cehic
(IUIU.tAM RcAikt b&As
Street address:
City:
State:
Zip Code:
3350 OAD
W I&MTO.i - $ALEM
N C
10
Telephone number:
ctq
Email address:
336- Z - t 3S5
1'Zbucns a GdtNe a�s�, co►+�
Type of Ownership:
Government
1--]County OFederal OMunicipai OState
Non -government
Business (If ownership is business, a copy of NCSOS report must be included with this application)
13Individual
2. Industrial Facility (facility being permitted):
Facility name: ', ff
rr*0f-N tt01 ;r AW UAW
Facility environmental contact:
_%xzI:i 'PkrKWS
Street address:
3350 L ScNo P-o1'n
City:
Wlco•� -
State:
NG
Zip Code:
Z71d7
Parcel Identification Number (PIN):
County:
�o2S
Telephone number:
336- Z- 13S5
Email address:
�1�erktns it ►BAN'06464. Cvw'�
4-digit SIC code:
Facility is:
Date operation is to begin or began:
New Q Proposed Il Existing
Latitude of entrancy: „
U003 z9 V
Longitude of entrance: . r
®o Q7 Y3
Brief description of the types of industrial activities and products manufactured at this facility:
"AGI IfvlkA I W 11-fl'lW Ansf—VIKSUNI Olt INI U.C;7r h1_ C4r_ANM'
If the stormwater discharges to a munici al separate storm sewer system (MS4), name the operator of the MS4:
19 N/A
Page 1 of 5

3. Consultant (if applicable):
4.
Name of consultant:
Consulting firm:
Street address:
City:
State:
Zip Code:
Telephone number:
Email address:
outrall(s) (at least one outtall is requireo to be eligible for coverage)
3-4 digit identifier: Name of receiving water: Classification: ❑ This water is impaired.
pp / .SOMA rerA �brds cfte-k C ❑ This watershed has a TMDL.
Latitude of outfall: / 1 2 Longitude of outfall: 34 63/2 &0
o7'0' `. ,
Brief description of the industrial activities that drain to this outfall
3-4 digit identifier: Name of receiving water: Classification: ❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Brief description of the
3-4 digit iderrif'ier: I Name a�
Latitude o .
Brief descriW of Me!hilti`strial aet'MU09 thW
is
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:
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:
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):
❑ 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:
`)TMVA VvI+T$- WWIX W D
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SW PPP 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 Fac.1.
❑ Hazardous Waste Disposal F '
Ro d,in
.z
Kilograms of waste g cti month: T of waste:
How material ore aterial is
Number olavoksoMOMs per yea r. port/dis
Trans ort/cl
p p i 41441l11"lioi1
a ddress:
❑ This facility is located on a Brownfield or Superfunci site
If checked, briefly describe the site conditions
6. Required Items (Application will be returned unless all of the following items have been included):
i Check for $100 made payable to NCDEQ
a Copy of most recent Annual Report to the NC Secretary of State (if applicable)
ID 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
EfCopy 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, I certify that:
1K1 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.
%I will abide by all conditions of the NCG030000 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.
girl hereby request coverage under the NCG030000 General Permit.
Printed Name of Applicant: -t;>• pEgkike
1106 Title: 'T?ArAflPkXV Of �gIAolVs
(Signature
Mail the entir to: DFMLR Stormwatef*ogra
OF �W�11111" entof Environ'MentMality
1612 Mail Service Cenfer
Raleigh, NC 27699-1641111110
Dcuarl(Tr}krrft fit k.'f1eJ f1l71"rIL`i i v 1 4s�,�tty
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:
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:
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:
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:
Page 5 of 5

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Nry PIEDMONT HOIST AND CRANE , Allied Design, Inc.
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3350 TEMPLE SCHOOL ROAD �a +; .E+ °,„„° o„ E. ap
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North Carolina Department of The Secretary of State
Billing Information
Piedmont Hoist and Crane, Inc.
85 I IA Norcross Road
Colfax, NC 27235-8703
Invoice Number: 17978536
Contact: Piedmont Hoist and Crane, Inc.
Invoiced Items
Invoice Number: 17978536
Customer Id Number: 200353140
Invoice Date: 1/6/2022
Account Type: Payment upon Delivery
Ship Via: Online
Certificate Customer
Item
Sub
Amount
Description
Number Reference
Qty
Pages Cost
Total
Due
Online Annual Report Piedmont Hoist and Crane, Inc.
1210 0511 435900061
111797326
1
$18.00
$18.00
Paid
Electronic Transaction Fee
2120 0502 437993
111797327
1
$3.00
$3.00
Paid
Payment Details
Credit: Cart for $21.00, Amex Acct
4008, TXId:
1
$21.00
$21.00
Payment
$0.00
Make check payable to:
Include Invoice Number on all remitance and send to:
NC Secretary of State Secretary of State
Online Payment: 0 PO Box 29622
https://www.sosuc.gov/payinvoice SRaleigh, NC 27626
Seen to pay online.
For information regarding your (ding contact:
Customer Service at [phone] or toll free at [phone]
Notice: To avoid an additional assessment of a one-time 10% late penalty and interest of 5% per annum, as
mandated by G.S. 147-86.23, the invoice must be paid in full.
There will be a $35.00 processing fee for all returned checks and ACH returns.

BUSINESS CORPORATION ANNUAL REPORT
m-zgv
NAME OF BUSINESS CORPORATION: Piedmont Hoist and Crane, Inc.
SECRETARY OF STATE ID NUMBER: 0316101
REPORT FOR THE FISCAL YEAR END: 12/31/2020
SECTION A: REGISTERED AGENT'S INFORMATION
STATE OF FORMATION: NC
1. NAME OF REGISTERED AGENT: Business Filings International, Inc.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
Filing 011ice use only
E - Filed Annual
Report
0316101
❑K Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
160 Mine Lake Ct Ste 200
Raleigh, NC 27615 Wake County
SECTION B: PRINCIPAL OFFICE INFORMATION
160 Mine Lake Ct Ste 200
Raleigh, NC 27615
1. DESCRIPTION OF NATURE OF BUSINESS: InStallation and Service of Overhead Cranes
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
8511 A Norcross Road 8511 A Norcross Road
Colfax, NC 27235-8703 Colfax, NC 27235-8703
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: James Bryson NAME: Mike Lipscomb
NAME: William R Burns
TITLE: Vice President TITLE: Vice President
TITLE: President
ADDRESS: ADDRESS:
ADDRESS:
8511 Norcross Road 8511 Norcross Road
8511 Norcross Road
Colfax, NC 27235 Colfax, NC 27235
Colfax, NC 27235
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
enb'illiam R Burns 4/6/2021
SIGNATURE
DATE
Form must be signed by an officer listed under Section C of this forth.
William R Burns President
Print or Type Name of Officer
Print or Type Title of Officer
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525