NCG120116_NOI_20220216

Il6G �2`6116
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
Environmental NCG120000
Quality
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG120000:
STORMWATER DISCHARGES associated with activities classified as:
Landfills that are permitted by the North Carolina Division of Waste Management under the
provisions and requirements of North Carolina General Statute 130A — 294.
The following activities are specifically excluded from coverage under this General Permit:
Stormwater discharges from open dumps, hazardous waste disposal sites, or discharge of waste (including
leachate) to the waters of the state.
TU For questions, please contact the DEMUR Regional Office for your area. See page'
(Please print or type)
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed):
Name Dan Wall
Street Address 2310 Garner Road
City Raleigh State NC
Telephone No. 919. 650-8353 Fax: 919
2) Location of facility producing discharge:
ZIP Code 27610
828-7649
Facility Name
Gold Hill Road Landfill
Facility Contact
Dan Jarboe
Street Address
385 Gold Hill Road
City
County
Asheboro State NC ZIP Code 27203
Randolph
Telephone No.
Email
336 629-7175 Fax:
d)[e-mail]
3) Physical Location Information:
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). From E. Presnell, tum onto Gold Hill Road, Facility on left
(A copy of a county map or USGS quad sheet with facility clearly located must be submitted with this application.)
4) Latitude 35 43' 2.175" Longitude 79 47' 29.3136- (deg, min, sec)
5) This NPDES Permit Application applies to which of the following: ❑ New or Proposed Facility Date operation is to begin IRECEI " VE ED
Q Existing
DE,NR4 AND QUALITY
STORNM1Ai'ER PERM'TT'Nil
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NCG120O0O N.O.I.
6) Standard Industrial Classification:
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary Industrial
activity at this facility.
SIC Code: 4 9 5 3
7) Provide a brief narrative description of the types of Industrial activities and products manufactured at
this facility: construction & demolition, asphalt, concrete, wood
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 4
Whet Is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Penwood Branch
Receiving water classification: c
Is this a 303(d) listed stream? No Hasa TMDL been approved for this watershed? No If
the site stomtwater discharges to a separate stone sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
List discharge points (outfalls) that convey discharge from the 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.
Stormwater Outfall No. 1
Latitude(degrees/minutes/seconds): 3543,4• N
Longitude (degrees/minutes/seconds): 79 47' 30^ W
Stormwater Outfall No. 2
Latitude (degrees/minutes/seconds): .. 3543' 12" N
Longitude(degrees/minutes/seconds): 7947'37• W
Stormwater Outfall No. 3
Latitude (degrees/minutes/seconds): 35 a 17" N
Longitude(degrees/minutes/seconds): 714T35^ W
Stormwater Outfall No. 4
Latitude (degrees/minutes/seconds): 3543"" N
Longitude(degrees/minutes/seconds): 794T20" W
Stormwater Outfall No. _
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No. _
Latitude(degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
9) Does this facility have any other NPDES permits?
e No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
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NCG120000 N.O.I.
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
A No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility. _
11) Does this facility employ any best management practices for stormwater control?
❑ No
IN Yes (Show structural BMPs on the site diagram.)
If yes, please briefly describe: Sediment traps, sediment basins, berms, vegeation, gravel roads
12) Does this facility have a Stormwater Pollution Prevention Plan?
11 No
❑ Yes
If yes, when was it implemented?
13) Are vehicle maintenance activities occurring at this facility?
e No ❑Yes
14) 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?
R No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
e No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
M No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) 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:
15) Certification:
North Carolina General Statute 143-215.611(i) provides that:
Any person who knovdngly 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 Commission implementing this Article shall be guilty of a Class
2 misdemeanor which may Include a fine not to exceed ten thousand dollars ($10,0M).
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NCG120000 N.O.I.
1 hereby request coverage under the referenced General 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 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
Title: MC-P1(k4
(Signature
Signing: Dart Wall
% U -jZ
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDEQ
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NCta120Q1)0. N Q.1.°
Anel Checklist
THIS applicatfor will b0stur'ned,aet6complete unless all ofthefoilowing items have been included:
0 Ghec►licir$'loo mace payable to NCDEQ'
LI itrts:colr plated apl llcaflon and all supporlitig documarite
A II site d-figm6n"ahowing, As Imuiiii�um,.,(e)dsfhg or proposed)}
(a) outline ofdrainage, areas, (t5 stormwater managemenfistruciu[es, (g3 location of stormwator autfalis;
carmsponding to tliagdr Linage a aas, til) rlitloff,cgrayeyetice featuras,,(e) areas vi+hera tnaterisit are doted, -
(11-Impetvious areas, ;(s3 site Property lines:
C7, Capynf c ou map'or USGS quad stleet-wittt loCai of fagtlityvleariy marked ®n Hipp-
Nialltheentlre,padcage7a_+ y
DEWjLR - Storniwator Program
Rapti of Environmental QuaI4
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