NCG070232_Application_20230131

RECEIVED
FOR AGENCY USE ONLY
NCG07 Q Z 3 2 JAN 312023
Assigned to: Co<
ARO FRO MRO r3WARO WIRO WSRO DEMLR-StormwaterProgram
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG070000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 32 [Stone, Clay, Glass and Concrete Products], 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. SIC
3273 [Ready -Mixed Concrete] is specifically excluded from coverage under this General Permit and is instead
covered under NCG140000. 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:
Powell's Septic Tank
Allie M. Powell
Street address:
City:
State:
Zip Code:
PO Box 395
Roanoke Rapids
NC
27870
Telephone number:
Email address:
252535-9717
[e-mail]
Type of Ownership:
Government
I]County ❑Federal I31VIunicipal ❑State
Non -government
0 Business (If ownership is business, a copy of NCSOS report must be included with this application)
E3 Individual
2. Industrial Facility (facility being oermitted):
Facility name:
Facility environmental contact:
Powell's Septic Tank
Mile M. Powell
Street address:
City:
State:
Zip Code:
3296 NC Hwy 48
Roanoke Rapids
I NC
27870
Parcel Identification Number (PIN):
County:
0911610
Halifax
Telephone number:
Email address:
252-535-9717
tpowellk mail.com
4-digit SIC code:
Facility is:
Date operation is to begin or began:
3272
E3 New 0 Proposed M Existing
Before 2006
Latitude of entrance:
Longitude of entrance:
36.4116
-77.7027
Brief description of the types of industrial activities and products manufactured at this facility:
Facility manufactures septic tanks using concrete produced on -site.
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
13 N/A NCDOT
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Jim Frei
Stonnwater Services Group LLC
Street address:
City:
State:
Zip Code:
8916 Oregon Inlet Ct
Raleigh
I NC
27603
Telephone number:
Email address:
919-661-9954
[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:
water is impaired.
001
UT to Quankey Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
N 36d 24m 39s
W 077d 42m 03s
Brief description of the industrial activities that drain to this outfall:
Manufacturing of Septic Tanks
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? E]Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
+1- 15
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?
3A 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 E3 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-0 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? ❑ 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 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:
NGG140332 to be rescinded since principle product has changed
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
No
❑ 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, Spill Prevention, Secondary Containment, Grass Buffer. No SCMs on -site.
0 This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
Initially 2006. Current SWPPP written in 2018.
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
No
❑ 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
No
6. Required Items (Application will be returned unless all of the following items have been included):
0 Check for $100 made payable to NCDEQ
❑ Copy of most recent Annual Report to the NC Secretary of State
+❑ This completed application and any supporting documentation
0 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
❑ 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 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.
ID The information submitted in this NOI 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.
E) I will abide by all conditions of the NCG070000 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 hereby request coverage under the NCG070000 General Permit.
Printed Name of Applicant: Allie M. Powell
Title: Owner
® l- Z4, 2o2,3
(Signature re oaf Applicant) (Date Signed)
Mail the entire package to: DEMLR —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.
❑ 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? ❑ Yes EINo
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? Oyes ❑ 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? 0 Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

ROANOKE RAPIDS, NC (1974) QUADRANGLE
7.5 MINUTE SERIES, 1:24000
MAP 1 - SITE LOCATION MAP
Powell's Septic Tank Stormwater Pollution Prevention Plan
NPDES General Permit NCGO70000 Page 4

I Coordinates of SDO-0011
• • •
. GRASS BUFFER i N 36a 24,651' .
..... SEPTIC TANK MOLDS & W 0]]° 42.035'
STONE CURING AREA
STONE AGGREGATE I ►�
O (�
S SAND BINS
GRAVEL
SAND I VI
1
I I • •• „" PUMP MOTOR . L. o
I I CEMENT TRAILER � 8i
FUEL TANKS ADMIXTURE TANKS x
(serves C-Store) PROPANE TANK
a o�
STORAGE w
a CONCRETE PLANT OFFICE & TRAILER Hi
zCONTROL ROOM of
SDO-001
GRAVEL
�1y DA = 84,000 sf
GRAVEL
I TRUCK PARKING I m p — 30 %
I I •,
I I WMPSTER •• (•------ l ALE--� ,.
I I ••
I C-STORE TRUCK N
I GARAGE a
GATE
G
i
GRASS BUFFER
FUEL ISLAND
To V
Qu nkey 0 A 00 lw
Creek
NC 48 HWY MAP 2 - FACILITY SITE PLAN
deFelopedfor
C-Store, Fuel Island, and L'SSEPTI
POWELL'S SEPTIC TANK
Fuel Tanks are not part of Roanoke Rapids, North Carolina
Septic Tank production,
NPDES General Permit NCG070000
Map Date: Javuury J0, 2GIs DTeW a By: Jim Frei
Mep Soak: See Bar Sole Checked By: Tim Frei
6tolmaler 6eeNus litoup, LLC Baler, NC (919) B "O"