NCG050461_Application_20221117

RECEIVED
FOR AGENCY L1 E ONLY
Q NCG05 !
Assigned to: C
ARO FRO RO RRO WARO WIRO WSRO
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DENR-LAND QUALITY
c r'".,"MINATER PERMITiIidP
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Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG050000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC23 ]Apparel and Other Finished Products Mode from Fabrics and Similar Materials],
SIC265 [Paperboard Containers and Boxes], SIC267 [Converted Paper and Paperboard Products], SIC27[Printing,
Publishing and Allied Industries], SIC 30 (Rubber and Miscellaneous Products — except as specified below], SIC 31
[Leather and Leather Products — except as specified below], and SIC 39 [Miscellaneous Manufacturing Industries],
and other like activities deemed by DEMLR to be similar in the process and/or the exposure of raw materials,
products, by-products, or waste materials. SIC 301 [Tires and Inner Tubes] and SIC 312 [Leather Tanning and
Finishing] are specifically excluded from coverage under this General Permit. 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:
JELD-WEN Inc
Jeff Mang, Plant Manger
Street address:
City:
State:
Zip Code:
2061 Sherrill Or
Statesville
NC
28625
Telephone number:
Email address:
276-235-2414
[e-mail]
Type of Ownership:
Government
OCounty ®Federal QMunlcipal )3State
Non -government
MBusiness (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:
VPI Windows - Statesville
Chris Alvis, EHS Manager
Street address:
City:
State:
Zip Code:
2061 Sherrill Dr, NC
Statesville
NC
28625
Parcel Identification Number (PIN):
County:
4754114091
Iredell
Telephone number:
Email address:
276-235-2414
[e-mail]; [e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
3269
[ New OProposed DExisting
July 1,2021
Latitude of entrance:
Longitude of entrance:
35.7707
-80.8474
Page 1 of 5

Brief description of the types of industrial activities and products manufactured at this facility:
Vinyl window production
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
0 N/A
3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Street address:
City:
State:
Zip code:
Telephone number:
Email address:
4. Outfall(s) (at least one outfall is required to be eligible for coverage):
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
001
Infiltration via detention pond(s)
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35,771321
-80.846432
Brief description of the industrial activities that drain to this outfall:
Loading and unloading of vinyl windows and components. Trash and recyclable glass, metal, and vinyl container.
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 13 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 © 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? E3 Yes © 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 Outfalls" found on the last page of this NOI.
Page 2 of 5

5. Other Facility Conditions (check all that apply and explain accordingly):
O This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
NCGNE1484
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
El This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
No industrial processes outside. Covered compactor infeed, RO dumpster cover. Site has detention pond.
17 This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
Being prepared, implement NLT Jan 2023
❑ 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):
❑ Check for $100 made payable to NCDEQ
El Copy of most recent Annual Report to the NC Secretary of State
El 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
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 143-215.68 (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 ($50,000).
Under penalty of law, I certify that:
0 1 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.
Cl 1 will abide by all conditions of the NCGO50000 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.
❑ 1 hereby request coverage under the NCG0500M General Permit.
Printed Name of Applicant: Jeff Mang
Title: Plant Managei
(Signature of Applicant)
Mail the entire package to:
Lc11+/Z2
(Date Signed)
DEM LR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

Additional Outfalls
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
O 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:
13 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 © 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 receivingwaW.,
Classification:
0 This water is impaired.
O 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?
34 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
O 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:
0 This water is Impaired.
O 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

F3A JELoI� WEN.
Attachments:
NCG05 Notice of Intent
NCSOS Annual Report for JELD-WEN Inc
Topographical map showing site location
NC Stream Classification GIS screen capture showing site location in relation to listed waters of
the state.
Land Title Survey Diagram extract annotated for industrial waste storage, water flows, and
Outfall 001.
Land Title Survey Diagram showing surrounding properties and stormwater structures.

o.v BUSINESS CORPORATION ANNUAL REPORT
11612022
NAME OF BUSINESS CORPORATION: JELD-WEN Holding, Inc.
SECRETARY OF STATE ID NUMBER: 1577865
REPORT FOR THE FISCAL YEAR END: 12/31/2021
SECTION A: REGISTERED AGENT'S INFORMATION
STATE OF FORMATION: DE
AMENDING DOC IU
q
1. NAME OF REGISTERED AGENT: CT Corporation System
2. SIGNATURE OF THE NEW REGISTERED AGENT:
dine Uri. U.Only
E - Filed Annual Report
1577865
CA202206604381
31712022 01:45
❑K Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
2645 Silver Crescent Dr
2645 Silver Crescent Dr
Charlotte, NC 28273 Mecklenburg County Charlotte, NC 28273
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Holding company
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
2645 Silver Crescent Drive 2645 Silver Crescent Drive
Charlotte, NC 28273 Charlotte, NC 28273
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: Gary S. Michel NAME: ,James S. Hayes
TITLE: President TITLE: Secretary
ADDRESS:
ADDRESS:
NAME: Brian Luke
TITLE: Treasurer
ADDRESS:
2645 Silver Crescent Drive 2645 Silver Crescent Drive 2645 Silver Crescent Drive
Charlotte, NC 28273 Charlotte, NC 28273 Charlotte, NC 28273
SECTION D: CERTIFICATION OF ANNUAL REPORT, Section D must be completed in Its entirety by a person/business
entity. S. Hayes 3/7/2022
SIGNATURE
Form must be signed by an officer listed under Section C of This farm.
James S. Hayes
Name of Officer
Secretary
DATE
Print or Type Title of Officer
MAIL TO: Secretary of State. Business Registration Division. Post Office Boa 29525. Raleigh. NC 27626-0525

SECTION E: ADDITIONAL OFFICERS
NAME: Brian Luke NAME: Daniel Castillo NAME: David Guernsey
TITLE: Vice President TITLE: President TITLE: President
ADDRESS: ADDRESS: ADDRESS:
2645 Silver Crescent Drive 2645 Silver Crescent Drive 2645 Silver Crescent Drive
Charlotte, NC 28273 Charlotte, NC 28273 Charlotte, NC 28273
NAME: John Raymond Linker NAME: NAME:
TITLE: Treasurer TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
2645 Silver Crescent Drive
Charlotte, NC 28273
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
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ADDRESS:

MA JELWWEN.
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Figure 1: USGS Z5 minute Topographic map from https.Iloops.notionalmap.govldownloode

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Figure 3 Site stormwater flows and industrial material storage areas. Outfal1001 designation.

F JELD WEN.
November 7, 2022
RECEIVED
M 171Ji24
NCDEMLR Stormwater Program DENRLANDQUALITY
1612 MSC TC�!IMATER PERMITTING
Raleigh, NC 27699-1612
RE: NOI for NCG05 and Rescind No Exposure Certification
JELD-WEN, Inc. — VPI Windows
Statesville, NC
Dear Ms. McCoy:
The JELD-WEN facility located at 2061 Sherrill Dr, Statesville, NC, 28625 (Iredell County)
submits the attached NOI for coverage under NCG05 and request the No Exposure Certification
NCGNE1484 issued in October 2021 be rescinded.
The site utilizes a detention pond to collect stormwater and control discharge. When the pond
exceeds the discharge level, the discharge is routed to an adjacent wooded depression. There
is an ephemeral stream that crosses this area and proceeds toward another wooded area in the
industrial park where it infiltrates. The NC Surface Water Classifications GIS was reviewed, and
no streams were located in the area of the industrial park.
The NOI will be paid via the DEQ Stormwater e-Payments system upon receipt of invoice from
the agency.
If you require additional information regarding this application, please contact our Regional
Environmental Manager, Aaron Brite at [e-mail].
Respectfully Submitted,
VPI Quality Windows / JELD-WEN, Inc.
(14
Jeff Mang
Plant Manager
JELD-WEN, inc. 2645 Silver Crescent Drive, Charlotte, NC 28273 USA www.jeld-wen.com