NCG081012_2022 DMR_20220321 (3)

'DEInd Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
With
I Day
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N I C I S
2) Facility Information:
Facility name:
Company/Owner Organization
Facility address:
Or) Certificate of Coverage or No Exposure
N I C I G 0 8 11 10 11 12
Union County Water Operations Center
Union County
4600 Goldmine Road
Address
Monroe NC 28110
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
hops://deg.nc.gov/sw Navigate to the "NPDES Industrial Program" section and run the Stormwater Permit
Contact Summary Report for your permit number.
3) OLD OWNER AFFILIATION that should he removed:
Previous legally responsible individual: Hyong Yi
First M1 last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: William M Watson
First %I] Lasz
Page 1 of 2
Last revised 20 Feb 2022

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
County Manager
Title
500 North Main Street
Mailing Address
Monroe NC 28112
City State Zip
(704 ) 296-2625 [e-mail]
Telephone E-mail Address
Fax Number
5) Reason for this change:
A result of: ❑ Employee or management change
❑✓ Inappropriate or incorrect designation before
❑ Other
If other please explain:
...................................................................................................................
The certification below must be completed and signed by the permit holder.
Note: 40 CFR 122.22(c) requires an original signature (not digital)
PERMITTEE CERTIFICATION:
1, William M Watson , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of
my knowledge. I understand that if all required parts of this form are not completed, this change may not
be pr9ce5sed.
03 0 3 20 Z�
Signature Date
PLEASE SEND THE ORIGINAL SIGNED COPY OF THE COMPLETED
OWNER AFFILIATION CHANGE FORM TO:
DEMLR - Stonnwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: http://deg.nc.gov/sw
Per NC General Statute 143-215.6B (i), 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 he guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars ($10.000).
Page 2 of 2
Last revised 20 Feb 2022

DocuSign Envelope ID7BA2128D-9451-413E-851)5-EFeA957335C8
ROY COOPER
Governor
ELIZABETH S. RISER
secretary
BRIAN WRENN
01reaor
Union County Water
Attn: Hyong Yi
4600 Goldmine Rd
Monroe, NC 28112
Dear Hyong Yi:
NORTH CAROLINA
Emrtronmental Quality
1/7/2022
Subject: General Permit No. NCG080000
Operations Center
COC No. NCGO81012
Union County
In accordance with your application for a discharge permit received on November 4, 2021, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state -
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina
General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
In order to comply with the conditions of NCGO80000 to which you are now subject, you are
required to do the following:
➢ Implement a SWPPP before beginning operations.
➢ Download and print a copy of the NCG080000 Permit from the General Permits page on the
NPDES industrial Stormwater Program web site, which can be reached by typing
"dCQ.nc,gov/SW-Industrial" into your browser and hitting enter.
➢ When you receive an invoice for your annual permit fee each year, pay it promptly.
Electronic payment is convenient and quick, you can access the ePayment web site by
typing "deq.nc.gov.JSW-ePayments" into your browser and hitting enter.
➢ If you have not already enrolled in electronic Data Monitoring Reports (eDMR), view the six
step process and complete the registration by typing "deeq,nc,gov/SW-eDMR" into your
browser and hitting enter.
➢ Keep information about your facility name, ownership, legally responsible person, address,
and stormwater outfalls up to date. See the Industrial Stormwater Program web site for
instructions.
Per the requirements of the Catawba Riparian Buffer Rule, all stormwater drainage to stream buffers,
from portions of this site that have been constructed after June 30, 2001, must meet diffuse flow
requirements per 15A NCAC 2B .0243(5).
..- North Carolina Department of Environmental Quality : Division of Energy. Mtnerai and Land Resournes
512 North Salisbury Street i M Mali Service Center I Raleigh, North Carolina 27699-1612
919.707.9200

DocuSign Envelope lD: 78A2128D-9451-413E-85D5-EF8A957335C8
Please take notice that this certificate of coverage is not transferable except upon approval from the
Division of Energy, Mineral, and Land Resources (Division). The Division may require modification
or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required
by the Division of Water Resources, the Coastal Area Management Act, or any other federal or local
government permit that may be required.
If you have any questions concerning this permit, please contact Brittany Carson at [phone]
or by email at [e-mail].
Sincerely,
DocuSignod C by. 6tar�au�ias
for Brian Wrenn, Director
Division of Energy, Mineral, and Land Resources
cc-. Mooresville Regional Office J Z. Khan
DE
� North Carolina Department of Environmental Quality I Division of Energy. Mineral and [and Resources
512.North Salisbury Street I ibt2 Mail Service Center I Raleigh, North Caroltna 27boA-1612
E Q
".707.4200

DocuSign Envelope ID' 7BA2128D-9451-413E-8505-EF8A957335C8
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
STORMWATER DISCHARGES
In compliance with the provisions of North Carolina General Statute 143-215.1, other
lawful standards and regulations promulgated and adopted by the North Carolina
Environmental Management Commission, and the Federal Water Pollution Control Act, as
amended,
Union County Water
is hereby authorized to discharge storrnwater from a facility located at
Operations Center
4600 Goldmine Road
Monroe
Union County
to receiving waters designated as East Fork Twelvemile Creek, class C, waters in the
Catawba River Basin in accordance with the effluent limitations, monitoring requirements,
and other conditions set forth in General Permit No. NCG080000 which can be downloaded
by entering "deQ.nc,gov_f SW -industrial" in a browser window and navigating to the "NPDES
Stormwater General Permits" web page.
This Certificate of Coverage shall become effective January 7, 2022.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day of January 7, 2022.
EDocuftnedby-.
Gt,4�1�61�,iai
0407...
for Brian Wrenn
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

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LOCATION 35.014764,-80.647420
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March 7, 2022
Division of Energy, Mineral, and Land Resources
NC Department of Environmental Quality
DEMLR Stormwater Program
512 N Sailsbury Street; 61h Floor
Raleigh, NC 27604
Subject: Delegation of Signatory Authority
Operations Center
General Permit NCGO81012
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to the following individual for all permit
applications, discharge monitoring reporting, and other information relating to the operations at the
subject facility as required by all applicable federal, state , and local environmental agencies specifically
with requirements for signatory authority as specified in 15A NCAC 2B.0506.
Name:
Kate Fleming
Title:
Industrial Pretreatment Manager
Mailing Address:
8299 Kensington Drive, Waxhaw NC 28173
Physical Address:
4600 Goldmine Road, Monroe NC 28110
Email Address:
[e-mail]
Office Phone:
704-296-4286
Mobile Phone:
980-425-0735
If you have any questions regarding this letter, please feel free to contact me at
mark.watson unioncount nc. ov .
Sincerely,
William M. Watson
County Manager
500 North Main Street
Monroe NC 28112
Mark.Watson(cDunioncountvnc.p,ov
704-292-2625