NCG150071_ROS Request_20240401

ROS Reviewer,
Included in this package are maps to use to review the ROS request. We are in the process of updating
the maps. We have a contractor on board to revise our SWPPP which will include minor revisions to the
maps. If the ROS is approved they will want to include that in the final SWPPP as well.
Sam Ingram !
NC Air Guard
c �
Federal Environmental Manager ,�� s ;, ,
Off,(.'
[e-mail]
704-391-4327 Desk
704-650-8620 Cell

Division of Energy,Mineral & Land Resources FOR AGENCY
c e RcUSE otaLY
Year Month Day
Stormwater Program
National Pollutant Discharge Elimination System /
Environmental REPRESENTATIVE OUTFALL STATUS (ROS)
Quality REQUEST FORM ' _ sr
If a facility is required to sample multiple discharge locations with very similar storm ward (�f , ar,.gas,.,the
permittee may petition the Director for Representative Outfall Status(ROS). DEQ mb'j3" rd'ttit t!epre3 uitative
Outfall Status if stormwater discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
if Representative Outfall Status is granted,ALL outfalls are still subject to the qualitative monitoring
requirements of the facility's permit—unless otherwise allowed by the permit(such as NCG020000)and DEQ
approval. The approval letter from DEQ must be kept on site with the facility's Stormwater Pollution
Prevention Plan. The facility must notify DEQ in writing if any changes affect representative status.
For questions, please contact the DEQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
NCS NCG150071
2) Facility Information:
Owner/Facility Name North Carolina Air Guard tj
Facility Contact Sam Ingram/Jon Gynn
Street Address 4930 Minuteman Way
City Charlotte State NC ZIP Code 28208
County Mecklenburg E-mail Address [e-mail]
Telephone No. 704 391-4327 Fax:
3) List the representative outfall(s)information(attach additional sheets if necessary):
Outfall(s) 005 is representative of Outfall(s) 004,003,002,001
Outfalls' drainage areas have the same or similar activities? ❑Yes ❑No g
gi
Outfalls' drainage areas contain the same or similar materials? o Yes ❑No
Outfalls have similar monitoring results? B tNo o No data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? ❑Yes o No
Outfalls' drainage areas contain the same or similar materials? ❑Yes o No
Outfalls have similar monitoring results? ❑Yes ❑ No ❑ No data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? o Yes o No
Outfalls' drainage areas contain the same or similar materials? o Yes o No
Outfalls have similar monitoring results? ❑Yes ❑ No ❑ No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
Page 1 of 3
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfail Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or, attach a letter or narrative to discuss this information.) For example,describe how activities and/or
materials are similar.
Base just switched from NCG080607 General Permit to NCG150071 on advice from a Contractor. Previously we had Representative Outfall Status for
NCG0080607 permit-letter dated 30 March 2010. The five outfalls which flow off our property to the East toward Taggart Creek have not changed
since that original letter. Activities remain the same within the industrial areas on base. We have not sampled the outfalls 001-004 since receiving
the ROS in 2010. Currently we are working with contractor to update our SWPPP due to receipt of our new permit.It was brought to our attention
that with the new permit we should apply for an updated ROS.
k '
5) Certification:
North Carolina General Statute 143-215.6 B(i)provides that:
Any person who knowingly makes any false statement,representation,or certification in anyu j ti teXpAI
report,plan,or other document filed or required to be maintained under this Article or a rule implementing this
Article;or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case
under this Article;or who falsifies,tampers with,or knowingly renders inaccurate any recording or monitoring device
or method required to be operated or maintained under this Article or rules of the[Environmental Management]
Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
ten thousand dollars($10,000).
I hereby request Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DEQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my NPDES permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true,complete, and accurate.
Printed Name of Person Signing: Sam Ingram
Title: Federal Environmental Manager
INGRAM.SAMUEL.COVI {=1snMu bIcanNGIONJRios3a
NGTONJR.1053824958 zA958
mm:zozaozaoia:vnz.osno' 20 February 2024
(Signature of Applicant) (Date Signed)
Please note: This application for Representative Outfall Status is subject to
approval by the NCDEQ Regional Office. The Regional Office may inspect your
facility for compliance with the conditions of the permit prior to that approval.
Final Checklist for ROS Request
This application should include the following items:
❑ This completed form.
o Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
o Two (2)copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
o Summary of results from monitoring conducted at the outfalls listed in Question 3.
o Any other supporting documentation.
Page 2 of 3
SWU-ROS-2009 Last revised 12/30/2009

FOR AGENCY USE ONLY
Division of Energy,Mineral & Land Resources Date Received
Year Month Day
Stormwater Program
National Pollutant Discharge Elimination System
Environmental REPRESENTATIVE OUTFALL STATUS (ROS)
QualityREQUEST FORM
if a facility is required to sample multiple discharge locations with very similar storm wate (d#'ehitrpes, the"
permittee may petition the Director for Representative Outfall Status(ROS). DEQ may grant Representative`
Outfall Status if storm water discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted,ALL outfalls are still subject to the qualitative monitoring
requirements of the facility's permit-unless otherwise allowed by the permit(such as NCG020000)and DEQ
approval. The approval letter from DEQ must be kept on site with the facility's Storm water Pollution
Prevention Plan. The facility must notify DEQ in writing if any changes affect representative status.
For questions, please contact the DEQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N C s N C G 1 5 0 0 7 1
2) Facility Information:
Owner/Facility Name North Carolina Air Guard
Facility Contact Sam Ingram/Jon Gynn
Street Address 4930 Minuteman Way
City Charlotte State NC ZIP Code 28208
County Mecklenburg E-mail Address [e-mail]
Telephone No. 704 391-4327 Fax:
3) List the representative outfall(s)information(attach additional sheets if necessary):
Outfall(s) 005 is representative of Outfall(s) 004,003,002,001
Outfalls' drainage areas have the same or similar activities? ❑Yes o No
Outfalls' drainage areas contain the same or similar materials? a Yes a No
Outfalls have similar monitoring results? eYes El Ns o No data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? a Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑Yes a No
Outfalls have similar monitoring results? ❑Yes a No o No data*
Outfall(s) is representative of Outfall(s)
Outfalls'drainage areas have the same or similar activities? o Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑Yes ❑ No
Outfalls have similar monitoring results? ❑Yes a No o No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
Page 1 of 3
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfall Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or, attach a letter or narrative to discuss this information.) For example,describe how activities and/or
materials are similar.
Base just switched from NCG080607 General Permit to NCG 150071 on advice from a Contractor. Previously we had Representative Outfall Status for
NCG0080607 permit-letter dated 30 March 2010. The five outfalls which flow off our property to the East toward Taggart Creek have not changed
since that original letter. Activities remain the same within the industrial areas on base. We have not sampled the outfalls 001-004 since receiving
the ROS in 2010. Currently we are working with contractor to update our SWPPP due to receipt of our new permit.It was brought to our attention
that with the new permit we should apply for an updated ROS.
5) Certification:
North Carolina General Statute 143-215.6 B(i) provides that: 3=
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;or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case
under this Article;or who falsifies,tampers with,or knowingly renders inaccurate any recording or monitoring device
or method required to be operated or maintained under this Article or rules of the[Environmental Management]
Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
ten thousand dollars($10,000).
I hereby request Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
stt
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DEQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my NPDES permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true,complete, and accurate,
Printed Name of Person Signing: Sam Ingram
Title: Federal Environmental Manager
INGRAM.SAMUEL.cOVI DV tally
5ronedb
UiGMMSAMUELCOMOTONJ0.10518
NGTONJR.1053824958 za.o:.m,a:vm:osno 20 February 2024
(Signature of Applicant) (Date Signed)
Please note: This application for Representative Outfall Status is subject to
approval by the NCDEQ Regional Office. The Regional Office may inspect your
facility for compliance with the conditions of the permit prior to that approval.
Final Checklist for ROS Request
This application should include the following items:
o This completed form.
o Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
o Two(2)copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
o Summary of results from monitoring conducted at the outfalls listed in Question 3.
o Any other supporting documentation.
Page2of3
SWU-ROS-2009 Last revised 12/30/2009

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