NCG030727_Application_20220329

RECEIVED
FOR AGENCY USE ONLY MAR 2 9 2022
NCG03 -0 J Z 3'
Assigned to:
ARO FRO RO RRO WARO WIRO WSRO DEMLR-Stormwater Program
Division of Energy, Mineral, and Land Resources Land Quality Section
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[Transportotion Equipment], and SIC38 [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:
Kelly Pipe Co., LLC
John Bailey
Street address:
City:
State:
Zip Code:
11024 Nations Ford Road
Pineville
NC
28134
Telephone number:
Email address:
704-504-3302
[e-mail]
Type of Ownership:
Government
❑County ❑Federal []Municipal ❑State
Non -government
Q Business (If ownership is business, a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Kelly Pipe
John Bailey
Street address:
City:
State:
Zip Code:
11024 Nations Ford Road
Pineville
NC
28134
Parcel Identification Number (PIN):
County:
20305404
Mecklenburg
Telephone number:
Email address:
704-504-3302
'[e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
5051 1
❑ New E3 Proposed ❑ Existing
Latitude of entrance:
Longitude of entrance:
35.113785
-80.913050
Brief description of the types of industrial activities and products manufactured at this facility:
Distributor of galvanized, steel and coated pipes; less than 10% are customized on -site
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
❑ N/A Mecklenburg County
Page 1 of 5

3. Consultant (if applicable):
4.
Name of consultant:
Consulting firm:
Melinda Greene
Shield Engineering, Inc.
Street address:
City:
State:
Zip Code:
4301 Taggart Creek Road
Charlotte
NC
28208
Telephone number:
Email address:
704-971-4159
[e-mail]
Cluttall(s) (at least one outtall is required to be eligible Tor coverage)
3-4 digit identifier: Name of receiving water: Classification: ❑+ This water is impaired.
001 1 unnamed trib to Sugar Creek C-FW ❑ This watershed has a TMDL.
Latitude of outfall: Longitude of outfall:
35.11396-80.91460
Brief description of the industrial activities that drain to this outfall:
Material handling of and storage of metal pipes
3-4 digit identifier: Name of receiving water: Classification: El This water is impaired.
002 1 unnamed trib to Sugar Creek C-FW ❑ This watershed has a TMDL
Latitude of outfall: Longitude of outfall:
35.114130-80.914448
Brief description of the industrial activities that drain to this outfall:
Material handling of and storage of metal pipes
3-4 digit identifier: Name of receiving water: Classification: 0 This water is impaired.
003 1 unnamed trib to Sugar Creek C-FW ❑ This watershed has a TMDL
Latitude of outfall: Longitude of outfall:
35.114452-80.913638
Brief description of the industrial activities that drain to this outfall:
Material handling of and storage of metal pipes
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
C Latitude of outfall: I 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 NO1.
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):
t7 Check for $100 made payable to NCDEQ
• Copy of most recent Annual Report to the NC Secretary of State (if applicable)
O This completed application and any supporting documentation
O 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
0 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 143-215.6E (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:
0 t 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.
f7 The information submitted in this N01 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.
O 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.
O I hereby request coverage under the NCG0300DO General Permit,
Printed Name of Applicant: John Bailey
Title: Branch Manager
9(Signaepplicant) (Datg Signed)
Mail the entire package to: DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4of5

AdditionalOutfalls N/A
3-4 digit identifier: Name of receiving water: Classification: ❑ This water is impaired.
II ❑ This watershed has a TMDL.
Latitude of outfall: Longitude of outfall:
Brief description of the industrial activities that drain to
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 outfalI:
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: I 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 S

4r LIMITED LIABILITY COMPANY ANNUAL REPORT
IOQOU
NAME OF LIMITED LIABILITY COMPANY: Kelly Pipe Co., LLC
Fd'ng Office Use Only
SECRETARY OF STATE ID NUMBER: 1165856 STATE OF FORMATION: DE E - Filed Annual
REPORT FOR THE CALENDAR YEAR: 2021 Report
1165856
SECTION A: REGISTERED AGENT'S INFORMATION Changes
1. NAME OF REGISTERED AGENT: Corporation Service Company
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
2626 Glenwood Avenue, 2626 Glenwood Avenue„ Suite 550
Raleigh, NC 27608 Wake County Raleigh, NC 27608
SECTION B:
1. DESCRIPTION OF NATURE OF BUSINESS:
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
11680 Bloomfield Ave 11680 Bloomfield Ave
Santa Fe Springs, CA 90670-4608 Santa Fe Springs, CA 90670-4608
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: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Hideki Matsumoto NAME: Art Shelton NAME: JUnli Yamada
TITLE: Chief Financial Officer
ADDRESS:
TITLE: President
ADDRESS:
11680 Bloomfield Avenue 11680 Bloomfield Avenue
TITLE: Chairman
ADDRESS:
11680 BLOOMFIELD AVE
Santa Fe Springs, CA 90670 Santa Fe Springs, CA 90670 SANTA FE SPRINGS, CA 90670
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in Its entirety by a person/business entity.
Art Shelton 4/14/2021
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Art Shelton
Print or Type Name of Company
President
Print or Type Tile of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post O6ice Box 29525. Raleigh. NC 2762"525

SHIELD
ENGINEERING
0 .05 0.10 0.20
(IN MILES)
1"=0.10 MILE
43U1 TAGGART CREEK ROAD
CHARLOTTE, NC 28208
704 394-6913 e .wwmeiden9ineenngcom
Lce+=e No. '-1111
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The drawings, spetluadns and ether documents prepared by
FILE NUMBER: 122001 1-01
DRAWING NAME: 122001141 SV PVICINITY.dwg
Shad Engineering for this pmjent are instruments of Shield
Engineering for use sielely with respeG to des project and, unle
SCALE: 1" = 1/10 MILE
DRAWN BY: DIN
othemnse provided, Shield shall be deemed the author of these
dl c hnems and shall Main all common law, statutory and other
reservedrights, indud,hg copyright
DATE: 3.4.2022
CHECKED BY: RLG
CLIENT NAME:
PROJECT NAME:
SHEET TITLE:
KEL YPl➢£, LLC
KELLY PIPE NOI - SVvPPP
11024NATIONSFORDROAD
11 W4 NATIONS FORD ROAD
LOCATION MAP
PINE"U..E, NC 28134
PINEVILLE. MECKLENBURG COUNTY. NORTH CAROLINA
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March 18, 2022
SHIELD
ENGINEERING
RECEIVED
RECEIVED
4"k � ?022
DEMLR — Stormwater Program W 2 9 2022 NC GEOLOGICAL SURVEY
NC Dept. of Environmental Quality
1612 Mail Service Center DEMLR4WMw8WProgwD
Raleigh, North Carolina 27699-1612
Subj: Notice of Intent for Coverage under NPDES Permit NCG030000
Kelly Pipe Company, LLC, - Pineville, NC
Shield Project No. 1220011-01
Dear Program Manager:
Shield Engineering, Inc. (Shield), on behalf of Kelly Pipe Company, LLC is submitting a
Notice of Intent for Coverage (NOI) under NPDES Permit NCG030000 for its facility
located at 11024 Nations Ford Road in Pineville, North Carolina. Kelly Pipe is an existing
facility; therefore, a Stormwater Pollution Prevention Plan will be developed and
implemented within 12 months of the effective date of the Certificate of Coverage in
accordance with Part 1-1(a) of the General Permit.
Shield has prepared the attached NOI and supporting documentation for Kelly Pipe which
includes a location map (Figure 1) and a current site map (Figure 2). The NOI requests
coverage under NCG030000 for stormwater associated with metal fabricating industrial
activities. Though Kelly Pipe is classified with SIC code 5051, the site stores metal pipes
outside, uncovered and performs fabrication operations on approximately 10% of its
inventory. Kelly Pipe discharges stormwater associated with its industrial activity into the
Charlotte Mecklenburg MS4. The associated fee for the NOI is also attached.
Please feel free to contact us should you have any questions or require additional
information regarding this NOI.
Sincerely,
SHIELD Engineering, Inc.
Melinda . Greene, E.I.
Senior Engineer
ATTACHMENTS
2
Robert L. Griffin, P. .
President/CEO
cc: John Bailey, Kelly Pipe Co., LLC
James Fiorillo, Kelly Pipe Co., LLC
4301 Taggart Creek Road www.shieldengineering.com
Charlotte, NC 28208
Telephone [phone]
License No. F-0856

LEGEND
DIESEL TANK
�T
TRASH/RECYCLE
Qs
SCRAP METAL
©
PIPE STORAGE
©
LOADING/UNLOADING
®
SPILL KIT
STORMWATER INLET
o®
STORMWATER OUTFALL
—�
STORMWATER PIPE (CMP)
DIRECTION OF STORMWATER
FLOW ARROW
— — —
UNNAMED DITCH
STORMWATER OUTFALL 001—I
L_ DRAINAGE AREA = 1_20 AC. J
1 STORMWATEROUTFALL 0027
L DRAINAGE AREA = 0_57 AC.
STORMWATER OUTFACE 003
L DRAINAGE AREA = 0.73 AC. J
T
NOTE: FIELD INSPECTION CONDUCTED ON
MARCH 3, 2022.
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