NCGNE1636_Application_20230825

ptj5 AlC6N� 163 RECEIVED
AUr 5 2013
1. Owner/Operator(to whom all permit correspondence will be mailed): �c�^I_R StOf111W8tBf Pt00' n
Name of legal organizational entity:Sedia Systems, Inc. Legally responsible person(as signed in Item 7 below):
Wilson Troup
Street address:335 Commerce Place City:Asheboro State:NC Zip Code:
27203
Telephone number:[phone] Email address:[e-mail]
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non-government
❑ X Business(If ownership is business,a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility(facility requesting exclusion):
Facility name:Sedia Systems,Inc. Facility environmental contact:Wilson Troup
Street address:335 Commerce Place Telephone number: [phone]
Email address:[e-mail]
City:Asheboro County:Randolph State:NC Zip Code:27203
Latitude of entrance:35 46'41.10"N
Longitude of entrance:-79 48'52.21"W
Parcel Identification Number(PIN):7753883982
Date operation began: 5-1-2021 Standard Industrial Classification(SIC)Code:2531
Brief description of the types of industrial activities and products produced at this facility:
Manufacturer of fixed upholstered furniture.
3. Consultant(if applicable):
Name of consultant:Bruce Braswell Consulting firm: Phoenix Environmental,Inc.
Street address:300 New Hope Road City:Thomasville State and zip code:NC,27360
Telephone number: Email address:[e-mail]
[phone]
4. Exposure Checklists
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?If you
answer"Yes'to any of these items,you are not eligible for the no exposure exclusion.
Using,storing,or cleaning industrial machinery or equipment,and areas where residuals from
using,storing,or cleaning industrial machinery or equipment remain and are exposed to ❑ Yes X No ❑ N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑Yes X No ❑ N/A
Materials or products from past industrial activity ❑Yes X No ❑ N/A
Material handling equipment(except adequately maintained vehicles) ❑Yes X No ❑ N/A
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Materials or products during loading/unloading or transporting activities ❑Yes X No ❑ N/A
Materials or products stored outdoors(except final products intended for outside use[e.g., new El Yes X No ❑ N/A
cars]where exposure to stormwater does not result in the discharge of pollutants)
Materials contained in open,deteriorated, non-sealed',or leaking storage drums barrels,tanks, ❑yes X No El N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑Yes X No ❑ N/A
Final products that would be mobilized in stormwater discharges(e.g.,rock salt) ❑ Yes X No ❑ N/A
Waste material(except waste in covered,non-leaking containers[e.g.,dumpsters]) ❑ Yes X No ❑ N/A
Application or disposafof process wastewater(unless otherwise permitted) ❑ Yes X No ❑ N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise ❑ Yes X No ❑ N/A
regulated (i.e.under an air quality control permit)and evident in the stormwater outflow
Empty containers that previously contained materials that are not properly stored(i.e.,not closed
and stored upside down to prevent precipitation accumulation) ❑Yes X No ❑ N/A
FtF,or any exterior ASTs,as well as drums,barrels,tanks and similar containers stored outside,has
e facility had any releases in the past three(3)years? ❑Yes❑ No X N/A
'Sealed means banded or otherwise secured and with locked or non-operational taps orvalves.
Above Ground Storage Tanks(ASTs) and Secondary Containment
If you answer"No"to any of the following items;ryou•are-not eligible fo?:the no exposure exclusion.`a.
Are exterior ASTs or piping free of_rust,damaged or,weath'ered coating,pits,'or deterioration,or
evidence of leaks? - D-Yes 0 No X N/A
I.
Is secondary containment provided for all exterior;ASTs?,If so;is it free ofany.cracks, holes,or
evidence of leaks,and are drain valves-maintained locked shut? ❑`Yes`O No X N/A
Is seconda. containment. rovided for single. round storage containers mcludin "drums;.
rY__ _ P g g_ g - ( g_ - '. .❑Yes❑ No X N/A
barrels,etc.)with a capacity of more than 660-gallons?'` -Is secondary,:containment provided1or above ground storage;containers,stored in close'proximity�`­
to each other with a combined capacity of more than 1,320 gallons? ❑Yes❑ No X N/A
Is secondary containment provided for Title III Section 313 Superfund Amendments and
Reauthorization Act(SARA)water priority chemicals? ❑Yes❑ No X N/A
Is secondary containment provided for hazardous substances designated in 40 CFR§116? ❑Yes❑ No X N/A
Are release valves on all secondary containment structures locked? ❑Yes O No X N/A
Other information
If you answer"Yes"to any of the following items,you might not be eligible for the no exposure exclusion.Amore
in-depth evaluation of the site circumstances may be required.
Are vehicles used in material handling in disrepair and/or leaking fluid? ❑Yes X No ❑ N/A
Does this facility store used, recycled,or otherwise reclaimed pallets outside? ❑Yes X No ❑ N/A
Does this facility have coal piles on site? ❑Yes X No❑ N/A
Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑Yes X No ❑ N/A
Page 4 of 6

Does this facility have air emissions associated with industrial activity(e.g.,degreasing operations, LN Yes❑ No ❑ N/A
plating,painting,or metal finishing)?
If yes:
Describe the industrial activity: Two spray booths are used to apply adhesive to substrates being
covered with foam(wood and plastic)that is part of the manufacturing process.
Are those emissions permitted by an Air Quality Permit? ❑Yes ff No
Please specify: The operation is exempt-emissions are<5 tpy.
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:
❑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:
❑This facility is located on Native American Lands.
6. Required Items (Application will be returned unless all of the following items have been included):
[X Copy of most recent Annual Report to the NC Secretary of State(if applicable)
29 This completed application and any supporting documentation
EXCopy of county map or USGS quad sheet with the location of the facility clearly marked
Page 5 of 6

7. 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 fled 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($50,000). I hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
I am the person responsible for the industrial activity,for satisfying the requirements of this exclusion,and for any civil
or criminal penalties incurred due to violations of this exclusion.
IX I have read and understand the eligibility requirements for claiming a condition of"no exposure"and obtaining an
exclusion from NPDES stormwater permitting.
($ There are no discharges of stormwater contaminated by exposure to industrial activities or materials from the industrial
facility or site identified in this document(except as allowed under 40 CFR 122.26(g)(2)).
IX I understand that I am obligated to maintain no exposure conditions and complete a Self-Recertification form at least
once each year and,if requested, provide this certification to the operator of the local municipal separate storm sewer
system(MS4)into which the facility discharges(where applicable).I understand that I must allow the North Carolina
Division of Energy, Mineral,and Land Resources,or MS4 operator where applicable,to perform inspections to confirm
the condition of no exposure and to make such inspection reports publicly available upon request. I understand I must
keep a copy of annual recertifications on file at the facility.
I K I understand that in the event that the site no longer qualifies for a No Exposure Exclusion that 1 must obtain coverage
under an NPDES permit prior to any point source discharge of stormwater from the facility.
[X 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.
Printed Name of Person Signing: Wilson Troup
Title:
Sig re o Ap I' t Da _ igned
Mail the entire package to: DEMLR—Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 6 of 6

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