NCG210446_Rescission Request_20230309

EDEIVED
FOR AGENCY USE ONLY
Assigned to: A. Cov�2
ARO FRO MRO RO WARO WIRO wsRA,StormwaterProgram
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, NC 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:
GOLDSTON LUMBER SUPPLY, LLC
JODY RAGAN
Street address:
City:
State and zip code:
2963 NC HWY 751
APEX
NC 27523
Telephone number:
Email address:
919-696-4989
[e-mail]
2. Industrial Facility (facility requesting rescission):
Facility name:
GOLDSTON LUMBER SUPPLY, LLC
Street address:
2304 S. MAIN ST
City:
State:
Zip Code:
County:
GOLDSTON
NC
27527
CHATHAM
Permit Number to which this request applies:
NCG210000 COC NCG210446
3. Reason for rescission Request
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❑ 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.
❑ Facility sold.
Sold to:
On date:
El Other (please explain):
FACILITY HAS INDIVIDUAL STORMWATER PERMIT NCS000610

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:
0 1, 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: JODY RAGAN
Title: FACILITY MANAGER
MARCH 3, 2023
(Signatur ofApplica (Date Signed)
Mail the entire package to: DEMLR—Stormwater Program
DepartmentofEnvironmental Quality"" : "-
16.12 Mail Service Center
--,-_-.-Raleigh, NC27699-1612, -
n tt
Page 2 of 2

Docuslq} Envelope ID: 03E82E9F-SAA9-4E12-9BAC-2BF845C4642A
Permit NCS000610
r
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL'QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
PERMIT
TO DISCHARGE. STORMWATER,UNDER THE
t .
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, acid the Federal Water Pollution Control Act,, as amended,
Goldston Lumber, LLC
is hereby authorized to discharge stormwater from a facility located, at:
Goldston Lumber Supply
2304 South Main Street
­Goldston,,NC
Chatham County
to receiving waters designated as an unnamed tributary to Cedar Creek, a.Class C'stream, in the Cape
Fear River Basin, in accordance with the discharge limitations, monitoring requirements, and other
conditions set forth in Parts A through J hereof
This permit shall become effective March 1, 2023.
. .. T
This permit and the authorization to discharge shall expire at midnight.on February 29, 2028.
Signed this day February 20, 2023.
E���uGas
3D057TEJ11 7..,
for` Douglas R.'Arisel, Interim Director
Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission
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