NCG081004_Rescission Request_20230111

FOR AGENCY USE ONLY
Assigned to: '5• Cook
ARO FRO MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
Rescission Request Form
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLR
Stormwater Program, 1612 Mail Service Center, Raleigh, INC 27699-1612. The submission of this form does not
guarantee recission of your NPDES stormwater permit. Prior to the recission of your NPDES stormwater 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 (4) below:
Town of Black Mountain
Jessica Trotman
Street address:
City:
State and zip code:
160 Midland Ave
Black Mountain
NC 28711
Telephone number:
Email address:
828-419-9370
[e-mail]
2. Industrial Facility (facility requesting rescission):
Facility name:
Fire Station 1
Street address:
106 Montreat Rd
City:
State:
Zip Code:
County:
Black Mountain
NC
28711
Buncombe
Permit Number to which this request applies:
NCGO81004
3. Reason for rescission Request
This is required information. Attach separate sheets if necessary.
Facility is closed or closing. All Industrial activities have ceased such that no discharges of stormwater are contaminated
by exposure to industrial activities or materials.
Date closed/closing:
Facility sold.
Sold to:
On date:
Mother (please explain): The facility will no longer perform vehicle oil changes and has filled in the maintenance
bay.
No vehicle service maintenance (oil changes, exchange of fluids) will occur at this facility. Only preventative
maintenance, such as changing light bulbs on a vehicle, will occur.
Small equipment such as chainsaws will still have oil changed indoors in the facility. Used oil will be taken to a
local auto supply store for processing.
Please also see attached letter mailed to DEQ 12/28/2022.

4. Applicant Certification:
North Carolina General Statute 143-215.613 (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).1 hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
I, as an authorized representative, hereby request recission of coverage under the NPDES stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing:
Title:
Si ature of Applica (Date Signed)
Mail the entire package to: DEMLR —Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 2 of 2

Town of Black Mountain
160 Midland Avenue • Black Mountain, North Carolina 28711
Phone [phone] • Fax [phone] • TDD 800-735-2962
www.townofblackmountain.ore
December 28, 2022
Dear Ms. Brittany Carson,
The Town of Black Mountain requests rescission of the NCG081004 General Industrial
Stormwater Permit that has been held by Fire Station 1. The NCG08 Permit was applied for and
given to the facility since vehicle oil changes were performed at the facility.
Facility information:
NCG081004
Fire Station 1, 106 Montreal Rd, Black Mountain, NC 28711
828-419-9300, ext. 1
The facility will no longer perform vehicle oil changes and has filled in the maintenance bay (see
photo attached to email accompanying this letter).
No vehicle service maintenance (oil changes, exchange of fluids) will occur at this facility. Only
preventative maintenance, such as changing light bulbs on a vehicle, will occur.
Small equipment such as chainsaws will still have oil changed indoors in the facility. The used
oil will be taken to a local auto supply store for processing.
We request that the Fire Station I no longer be covered by the NCG08 permit since it is no
longer performing vehicle oil changes. It is my understanding that activity was what prompted
the permit.
Please let us know if you require additional information.
Thank you,
v
Anne Phillip
Stormwater Technician
828-419-9374
Anne.PhillAnne.Phi lip tobm.oreore
CCJ s: Josh Harrold, Town Manager
Mayor
C. Michael Sobol
Town Council
Vice -Mayor Archie Pertiller
Council Member Alice Berry
Council Member William Christy
Council Member Doug Hay
Council Member Pam King
,j k ASS l (.tr
Jessica Trotman
Stormwater Administrator
828419-9370
Jessica Jessica. Trotman (atobm.ore
Town Manager
Josh M. Harrold
Town Clerk
savannah Parrish