NCGNE0807_COMPLETE FILE - HISTORICAL_20110919

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V C�NEOFSU�
DOC TYPE VHISTORICAI FILE
❑ MONITORING REPORTS
DOC DATE ❑ �UI l V � � S
YYYYMMDD

.w r
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
September 19, 2011
Gainsbourough Baths LLC
Attn: Mr. Daniel H. Mills
41 Rogers Rd,
Lexington, NC 27292
Subject: No-Exposure Certification NCGNE0807
Gainsborough Baths
Davidson County
Dear Mr. Mills:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting applications. Based on your submittal of a signed certification of no exposure at the
above referenced facilities, and on an inspection by Jenifer Carter of the Winston-Salem Regional office, the
Division is granting your conditional exclusion from permitting as provided for under 40 CFR 122.26(g),
which is incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your no-exposure certification, you are obligated to maintain no-
exposure conditions at your facilities, including no further dumping of process water from the indoor rinse
tank into the storm drain system. If conditions change such that your facility no longer qualifies for no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharges. Otherwise, the discharges becomes subject to enforcement as un-permitted discharges. You
must self re-certify annually using the included form, or obtain NPDES permit coverage for any stormwater
discharges from your facility. The annual self re-certification does not need to be submitted to DWQ, unless
requested.
Your conditional exclusion from permitting does not affect your facilities' legal requirements to obtain
environmental permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Jenifer Carter at [phone], or at
[e-mail]
Sincerely, 4
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: WSRO files
LStorm ,atei_P_ermitiin _Unit_No-Exposure_Fi�
Forth Carolina DI'Vislon of l-Jater Quality,Vinston-Salem Regio nai Office One
�L,
l.o.ssorl:555 Waughtown St.Winston-Salem,North Carolina 27107 O On 111CaTollna
Phone:[phone] f,FAX:[phone] Customer Service:1-877-623-6746
Internet:wt%v ncwaterq!�ality.org ;Vatul ally
An Equal Opporwimy 1,kArrmaiiv�:C!ion Ennlo;er i/

AM
AD A
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of tiNater Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
September 19, 2011
Gainsbourough Baths LLC
Attn: Mr. Daniel H. Mills
41 Rogers Rd.
Lexington, NC 27292
Subject: No-Exposure Certification NCGNE0807
Gainsborough Baths
Davidson County
Dear Mr. Mills:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from INTPDES
Stormwater Permitting applications. Based on your submittal of a signed certification of no exposure at the
above referenced facilities, and on an inspection by Jenifer Carter of the Winston-Salem Regional office, the
Division is granting your conditional exclusion from permitting as provided for under 40 CFR 122.26(g),
which is incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your no-exposure certification, you are obligated to maintain no-
exposure conditions at your facilities, including no further dumping of process water from the indoor rinse
tank into the storm drain system. If conditions change such that your facility no longer qualifies for no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharges. Otherwise, the discharges becomes subject to enforcement as un-permitted discharges. You
must self re-certify annually using the included form, or obtain NPDES permit coverage for any stormwater
discharges from your facility. The annual self re-certification does not need to be submitted to DWQ, unless
requested.
Your conditional exclusion from permitting does not affect your facilities' legal requirements to obtain
environmental permits that may be required under other federal, state,or local regulations or ordinances.
If you have any questions or need further information, please contact Jenifer Carter at [phone], or at
j [e-mail]
Sincerely, a
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: %--WSRO_files
Stormwater Permitting Unit: No-Exposure File
North Carolina Division of Water Quality,Winston-Salem Reg�onal Office One
Location:585 Waughtmnn St.Winston-Salem,Nort`t Carolina 27107 NorthCarolina
Pfiione 336-771-5GOO l rAX 336-771-46301 Customer Service:1-877.623-67?8
intemet wtm%-oaterquality.org ;Vaturallry
k--i=qual Opxrenity A.,,,,m:,a;ve Acton Employe;

Compliance Inspection Report
Permit: NCGNE0807 Effective: Expiration: Owner: Gainsborough Baths LLC
SOC: Effective: Expiration: Facility: Gainsborough Baths LLC
County: Davidson 41 Rogers Rd
Region: Winston-Salem
Lexington NC 27292
Contact Person: Daniel Mills Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
On-site representative Daniel Mills Phone: [phone]
Related Permits:
Inspection Date: 09/14/2011 Entry Time: 10:00 AM Exit Time: 11:00 AM
Primary Inspector: Jenifer Carter Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: N Compliant ❑ Not Compliant
Question Areas:
Miscellaneous Questions 0 Misc
(See attachment summary)
Page: 1

Permit NCGNE0807 Owner-Facility: Gainsborough Baths LLC
Inspection Date: 09/14/2011 Inspection Type:Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
This inspection was in response to the application for No Exposure certification. The only correction needed was an easy
one... no longer discharging contents (-2xlyear) of rinse tank into storm drain. Owner said he could pump into septic
system. Certificaton granted in a letter dated September 19, 2011.
Mlsc Yes No NA NE
Is the facility compliant? ❑ fn ❑
Comment:
Page: 2

gansborough o
specialist bathing G
Storm Water Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617 DS�f�nnn�
AUG I 5 2011
August 11ih 2011 KVLANaDEN�VATER
STW VA�TM wMtCH
Dear Sir 1 Madam,
Please find enclosed my submission for NO EXPOSURE CERTIFICATION for
Exclusion.
If you have any questions please do not hesitate to contact me.
Y�ours�tru
V�
Daniel H Mills
General Manager
41 Rogers Road Lexington, NC 27292 (336)-357-0797 Phone [phone] Fax

FOR AGENCY USE ONLY
Date Received
Division of Water Quality/Surface Water Protection Year 1 Mond, Day
NCDENRNational Pollutant Discharge Elimination System Certificate of Coverage -
NO EXPOSURE CERTIFICATION for Exclusion N
RECEIVED
NCGNE0000 N.c,DOM of Erie
AUG 2 3 2011 f
NO EXPOSURE CERTIFICATION Please.check here if this is a renewal: tRENEVd/A6o..salLn,
Regional office
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit-based
on NO'EXPOSURE: ' r
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means all
industrial materials and activities are protected by a storm resistant shelter(with some exceptions)to
prevent exposure to rain, snow, snowmett, and/or runoff.
For permitted facilities in North Carolina, DWQ must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
to abide by the terms and conditions of the current permit.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
Material handling activities include the storage, loading and unloading, transportation, or conveyance of
any raw material, intermediate product, final product or waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed,provided those containers are not deteriorated and do not leak. "Sealed"means
banded or otherwise secured and with locked or non-operational taps or valves;adequately maintained
vehicles used in material handling;and final products, other than products that would be mobilized in
stormwater discharges(e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, the exclusion from NPDES permitting is available on a facility-wide basis only—not for individual
outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the facility is not
eligible for the no exposure exclusion. By signing and submitting this No Exposure Certification form, you
certify that a condition of no exposure exists at this facility or site and are obligated to comply with the
terms and conditions of 40 CFR 122.26(g).
You are-required_to reapply for the No Exposure_Exclusion once every five (5) years.
For questions,please contact the DWO Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of owner/operator address to which all certific tion corresE2ondence will be mailed):
Name G 1 KIss 12rv—mj G L4 L.L�
Contact Prf", 1 M h I
Street Address Q _
City _ / -� State C, ZIP Code 27z-q-2—
Telephone No. 4D 4M-7 Fax: ; '
Page 1 of 7
AUG Y 5 2011
SWU-NE-024309 Last revised 2/13/2009
IJENR-V ATER QUAt.ITY
WEi1ANMS AND STORMWATER MACH

NCGNE0000 No Exposure Certification
2) Location of facility producing dischar e: J r
Facility Name 9�'1 � /'v!
9 -
Facility Contact Af\j , LUS
Street Address S
City A
i State C.. ZIP Cade 2 Z
County
Telephone No. 8.36 `gA 7 _n7y7 Fax: 236 3 57 0 783
3) Physical location information.-
Please provide a narrative description of how to get to the facility(use street names state road numbers, and
distance and direct' n from a roa way intersection). F,XI!•„4 1 I flog g-5 Tulz A_Tow ,
SW__Mft l�A`_ R i d� 1 inn i LL�' ;r _ 1 S - .
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) is the facility located on Native American Lands? ❑ Yes v No
5) is this a Federal facility? ��11❑ Yes I/No
6) Latitude.59. 41� . L .ZT Longitude 20 1 J� 2D, (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
VExisting Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes Vo
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code)that describes the primary industrial
activity at thi facility
SIC Code:
10) Provide a bri descripti of a types f industrialceGrictivi ies and p d cts odu�f this facility:
fC 1 1°1ra
11) Does this facility have any Non-Discharge permits(ex: recycle permits)?
',/No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Page 2 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
Exposure Checklists(12. - 14.)
12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either "Yes" or"No.") If you answer"Yes" to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes W/No ❑ N/A
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes Gd No ❑ N/A
c. Materials or products from past industrial activity ❑ Yes Z No ❑ N/A-, 4
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes &4o ❑ NIA
e. Materials or products during loading/unloading or transporting activities 0 Yes WK0 ❑ N/A
I. Materials or products stored outdoors (except final products intended for outside ❑ Yes P o ❑ N/A
use [e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes V'No ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes V<o ❑ N/A
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes V<o ❑ N/A
j.Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes -& o ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ISO ❑ N/A
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes VNo ❑ N/A
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes Vfl'o ❑ N/A
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks(ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No kN/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No </A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
5WU-NE-021309 Last revised 211312009

NCGNE0000 No Exposure Certification
14) Secondary Containment: If you answer "No"to any of the following items,you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers ❑ Yes ❑ No I4/A
(including drums, barrels, etc.)with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored ❑ Yes ❑ No tN/A
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund ❑ Yes ❑ No k<IA
Amendments and Reauthorization Act(SARA) water priority chemicals"?
d. Is secondary containment provided for hazardous substances" designated in 40 ❑ Yes ❑ No OMN/A
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No V'NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? V1.1yes ❑ No ❑ N/A
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste VYes ❑ No ❑ N/A
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes UK ❑ NIA
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following inform ion: _
Type(s) of waste: (4�L M CAJ&1 AL ��
How is material stored: ±��T 6ALLvri1
Where is material stored: -HAZ rl ll�Vl' U Ill
_
How many disposal shipments per year: hf ,
Name of transport/disposal vendor: Lfv ► L
Vendor address: '42 .00 6 k L6/ LVJ I
I 2 f 0`Z
Footnotes to Questions 14) c. & d.
'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38.
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR§117-1
Page 4 of 7
SWU-NE-021309 Last revised 2/13/2009

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✓ �j l�-�llI�r
f

NCGNE0000 No Exposure Certification
16) Other information: If you answer "Yes"to any of the following items,you might not be eligible for the
no exposure exclusion. A more in-depth evaluation of the site circumstances may be�equired.
a. Does our facility store used, recy led, or otherwise reclaimed pallets outside? 'Yes ❑ No ❑ NIA
iEMIro�ZheA 'Sj� ANQ GiiJ4� P,tw_ uP r—.n-rL b. Does your facility have coal piles on site? 9_Q5L,4e,u e.1Z. ❑ Yes W/o ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes W/No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., Vyes ❑ No ❑ NIA
degreasing operations, platin painting and�,metal lseg ? If , describe the
industrial activity: rY11�tJ111�Z 1!iQ i`t 1!SLA.SS U SS
e. If you answered yes to d. are those issions er itted b an Air Quality Permit? es ❑ No ❑ NIA
Please specify: _iN G t� � P I X F4�✓Ab_! t
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier
Gin]'this application (such as Hazardous Waste Permits, etc. :
Permit: JV o O q!j 00 Program:
Permit: H AZ A9CZ)es-s' � , >ram
L :
Permit: Sm4 �LIAN;l i`� m:Permit: G���_N' m: /1 /�
Permit: L0M�P� �n , Prograr40 L 2-7 1
Permit: Program:
Permit: Program:
Page 5 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
17) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of"no
exposure"and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that 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)).
I understand that I am obligated to submit a no exposure certification form once every five (5)years to the North Carolina
Division of Water Quality and,if requested,to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges(where applicable). I understand that 1 must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4,to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility.Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information,the information submitted is to the best of my knowledge and belief true,accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
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. i
rinted Name of erson Sig Tg 1,J hi 1__ , L`-
Ti G Lr`1Ldt'Z^
(Signature of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(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;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
[EnvEronmental 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),
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
l� This completed application and all supporting documentation.
t A map with the location of the facility clearly marked.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
❑ If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question B.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions,please contact the D WQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ...... [phone] �^ Win ro Sale
Fayetteville Office ... [phone] at gh .i
Mooresville Office ... [phone]
Raleigh Office [phone]
��• .}�n Ala r
Washington Office ...[phone] '" L rip
Wilmington Office ... [phone]
Winston-Salem ...... [phone]
Central Office .........[phone]
1'Wel ngton
Page 7 of 7
SWU-NE-021309 Last revised 2/13/2009

Receiving Drain Protection training
Date trained: August 1'k 2011
Training
• Prior to moving loading or unloading any liquid from around the dock the drain
MUST be covered with the rubber drain cover
• There are to be NO EXECTIONS to this rule
• Once the activity has been completed the rubber drain cover is to be removed
and stored in a clean dry location closed to the point of use.
ignatures o Trained personnel
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