NCG210503_Application_20221021

RECEIVED
FOR AGENCY USE ONLY OCT 21 M2
NCG21Q5-Q3
Assigned to: LAM N
ARO FRO RO RRO WARO WIRO WSRO DEMLR-StormwaterProgram
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG210000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 24 [Timber Products, including Wood Chip Mills — except as specified below] and like
activities deemed by DEMLR to be similar in the process and/or the exposure of raw materials, products by-
products, or waste materials. The following activities are specifically excluded from coverage under this General
Permit: SIC2434 [Wood Kitchen Cabinets], SIC 2491 [Wood Preserving], and SIC 2411 [Logging]. You con 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 Storrnwater 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:
Kamps, Inc.
Curtis Brushman
Streetaddress:
City:
State:
Zip Code:
2900 Peachridge Avenue NW
Grand Rapids
MI
49543
Telephone number:
Email address:
616-560-5678
[e-mail]
Type of Ownership:
Government
OCounty ❑Federal OMunicipal OState
Non -government
El Business (If ownership is business, a copy of NCSOS report must be included with this application)
O Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Kamps Pallets Plant 2
Antonio Neal
Street address:
City:
State:
Zip Code:
3500 North Graham Street
Charlotte
NC
P8206
Parcel Identification Number (PIN):
County:
08508204
Mecklenburg
Telephone number:
Email address:
704-921-1100
[e-mail]
4-digit SIC code:
Facility is: Date operation is to begin or began:
2448
ONew OProposed MExisting
Latitude of entrance: ,s
nc Longitude of ent_Sc
'
s�
�r,e:.8'I
Brief description of the types of industrial activities and products manufactured at this facility:
Assembly, repair, and shredding of untreated wood pallets.
Thisfacility will produce Wood Pellets: EIYes ONO
If the stormwater discharges to a municipal separate storm sewer system (M54), name the operator of the MS4:
El N/A
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Mark F. Weise, P.E.
GZA GeoEnvironmental, Inc.
Street address:
City:
State:
Zip Code:
601 Fifth Street NW
Grand Rapids
MI
48504
Telephone number:
Email address:
616.258.7226
[e-mail]
4. Outfall(s) At least one outfall is required to be eligible for coverage
3-4 digit identifier:
Name of receiving water:
Classification:
El This water is impaired.
001
Litter Sugar Creek
C
El This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.28286 N
-80.80169 W
Brief description of the industrial activities that drain to this outfall:
Storage of wood pallets,forklift traffic, storage of scrap wood, shredding wood, loader use
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes 0 No
if yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
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? ❑ Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
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? 0 Yes 13 No
If yes, how many gallons of new motor oil are used each month when averaged overthe calendar year?
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? El 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 Outfails" found on the last page of this NOL
Page 2 of 5

S. 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:
O This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
Good housekeeping, employee training, sift fences, and double wall tanks.
O This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
ugust 2022
❑ 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):
0 Check for $100 made payable to NCDEQ
0 Copy of most recent Annual Report to the NC Secretary of State (if applicable)
O This completed application and any supporting documentation
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 materials are stored
g) impervious areas
h) site property lines
O 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 143-215.66 (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:
O I 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.
0 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 NCG210000 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] I hereby request coverage under the NCG210000 General Permit.
Printed Name of Applicant: Curtis Brushman
Title: Kamps Pallets Corporate Safety Manager
(Signature fApplicant) (Date Signed)
Mail the entire package to: DEMLR—StormwaterProgram
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

Criditinnal Ctutfalls
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? ❑ Yes E3 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
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? 0 Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
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? ®Yes ONO
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
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? Dyes ONO
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
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? 0 Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

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PREPARED BY'.
PREPARED FOR:
3500 NORTH GRAHAM STREET, CHARLOTTE,
GZA GeoEnvironmental, I Ec.
KAMPS, INC.
NORTH CAROLINA 28206
Cj� Engineers and Scientists
2900 PEACH RIDGE AVENUE N
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GRAND RAPIDS, MI 49534
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r. l BUSINESS CORPORATION ANNUAL REPORT
t/6/2022
NAME OF BUSINESS CORPORATION: KAMPS, INC
SECRETARY OF STATE ID NUMBER: 1534358 STATE OF FORMATION: MI
REPORT FOR THE FISCAL YEAR END: 12/31/2021
SECTION A:
AMENDING DOC ID
1. NAME OF REGISTERED AGENT: CT Corporation System
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
1534358
CA202206606485
3f7/2022 03:15
OX 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:
160 Mine Lake Ct Ste 200
Raleigh, NC 27615
1. DESCRIPTION OF NATURE OF BUSINESS: Wood pallet brokering
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
2900 Peachridqe NW
Grand Rapids, MI 49534
5. PRINCIPAL OFFICE MAILING ADDRESS
2900 Peachridge NW
Grand Raoids. MI 49534
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: Bill Zeilstra
TITLE: Chief Financial Officer
ADDRESS:
NAME: Kamps, M. Bernard NAME: KampS, M. Bernard
TITLE: Treasurer TITLE: Secretary
ADDRESS:
ADDRESS:
2900 Peachridge NW 2900 Peachridge NW 2900 Peachridge NW
Grand Rapids, MI 49534 Grand Rapids, MI 49534 Grand Rapids, MI 49534
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
entWll Zeilstra 3/7/2022
SIGNATURE
Fomr must be signed by an officer listed under Section C of this torte.
Bill Zeilstra
Print or Type Name of Officer
DATE
Chief Financial Officer
Print or Type Title at Officer
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

SECTION E: ADDITIONAL OFFICERS
NAME: Kamps, M. Bernard NAME:
TITLE: president TITLE:
ADDRESS: ADDRESS:
2900 Peachridge NW
Grand Rapids, MI 49534
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