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Home My WebLink AboutNCG021045_Application_20240813 4250 Congress Street A\ Albemarle Suite 900 Char Charlotte, North Carolina 28209 980-299-5700 August 2, 2024 RECEIVED AUG 13 b)14 Brittany Cook LAND QtjAU -y NC Department of Environmental Quality MINING �AM Division of Energy, Mineral, and Land Resources Stormwater Program 1612 Mail Service Center Raleigh, North Carolina, 27699-1612 Subject: Kings Mountain Lithium Project—Tailings Storage Facility North Carolina NCG02 Permit Application NCG02—Albemarle/ Kings Mountain 348 Holiday Inn Drive, Kings Mountain Cleveland County/ MRO Dear Mrs. Cook: Please find one original signed North Carolina NCG02 Permit Application enclosed for the proposed tailings storage facility (the "Project" or"TSF Project") associated with the Kings Mountain Lithium Mine. The TSF Project is located approximately 3 miles south of the Kings Mountain Lithium Mine in Cleveland County. The Project will consist of the development of a dry stack tailings storage facility for permanent storage of filtered tailings generated from the Kings Mountain concentrator plant. Albemarle U.S. Inc. ("Applicant") owns the land at the proposed tailings storage facility and the Kings Mountain Lithium Mine. Imerys currently holds the mining permit for the Archdale TSF under permit number 23-03, and stormwater and wastewater permit number NCG020089. At the direction of the North Carolina Department of Environmental Quality, and in conjunction with this permit application, Imerys has submitted a modification to their mine permit to remove the Archdale site from a portion of their permit. Upon review and approval and based upon coordination with the North Carolina Department of Environmental Quality, a simultaneous regulatory action would occur to approve Imerys' modification and approve the Albemarle new mine permit application. Following these actions, Imerys will receive release from the Archdale portion of their mine permit giving the Applicant full operational control and responsibility for the site. The Project will include the construction of a tailings storage facility, infrastructure and service facilities, related impervious areas located at the north and south site entrances, access and haul roads, and associated stormwater management systems on 143.8 acres of previously hftps:/&vww.albemade.com August 2, 2024 Page 2 disturbed and undisturbed land. The North Carolina NCG02 Permit Application form for the TSF Project is associated with a supplementary report document, and a full list of appendices for both is attached to this letter. Per discussions with the North Carolina Division of Energy, Mineral, and Land Resources on July 25, 2023, the proposed Project can be authorized through the issuance of a new NCG02 Permit Application. A check for the new mine application fee of $120 is also attached. An electronic PDF version of the permit application package will also be provided for further distribution and review. Please do not hesitate to contact me directly if you have any questions or need additional information. On behalf of Albemarle, our team is looking forward to working with you during the permitting process. Sincerely, John ?uhn Mine Environmental Permitting Lead Enclosure: Permit Application North Carolina Stormwater and Wastewater Management and Discharge Supplemental Report Appendix A Figures Appendix B Archdale Development and Operational Erosion and Sediment Control Plan Appendix C Preliminary Archdale Tailings Storage Facility Design Drawings Appendix D Archdale Stormwater Management Report Appendix E Archdale Operational Stormwater Management Flowsheet Appendix F U.S Army Corps of Engineers Approved Jurisdictional Determination for Archdale TSF Property Appendix G Business Corporation Annual Report (Section 9 of NCG02 Application Form) Appendix H Archdale TSF Mine Permit Application Cover Letter and Application Form (supporting narrative and appendices are not provided with this application) T'r4e�Ys FOR AG NCYUSEONLY NCG02 _ Assigned to: Q. vo ARO FRO PRO WARD WIRO WSRO Division of Energy, Mineral, and Land Resources Land Quality Section National Pollutant Discharge Elimination System NCG020000 Notice of Intent This General Permit covers STORMWATER AND/OR WASTEWATER DISCHARGES associated with activities under SIC(Standard Industrial Classification)Code 14[Mineral Mining Industry]except for:peat mining, coal mining, metal mining, oil and gas extraction, tourist gem mines, NCDOT borrow pits, in-stream sand mining, and discharges from mining operations which are intermixed on site with stormwater from concrete operations. 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 (9) below to: NCDEMLR Stormwater Program, 1612 MSC, Raleigh,INC 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(10)below: Albemarle U.S., Inc. Christopher Danauskas, Site Director Street address: City: State: Zip Code: 348 Holiday Inn Drive Kings Mountain NC 28086 Telephone number: Email address: 704-734-2711 Christopher.Danauskas@albemarle.com Type of Ownership: Government ❑ County ❑Federal ❑Municipal OState Non-government ®Business(If ownership is business,a copy of NCSOS report must be included with this application) ❑Individual 2. Industrial Facility(facility being permitted): Facility name: Facility environmental contact: Archdale Tailings Storage Facility John Kuhn Street address: City: State: Zip Code: 1463 S. Battleground Avenue Kings Mountain NC 28086 Parcel Identification Number(PIN) County: 66814 Cleveland Telephone number: Email address: 704-231-4208 john.kuhn@albemarle.com Latitude of entrance: Longitude of entrance: 35.18982 -81.40753 4-digit SIC code: Tlacility is: Date operation is to begin or began: 1479 New ® Proposed Existing (TBD—dependent on other permits) Types of minerals mined at this facility: El Clay ❑Feldspar Ore ❑Lithium Ore ❑Phosphate ❑Sail ❑Construction Sand ❑Industrial Sand ®Other: Tailings Storage Facility(TSF)only, no extractive mining Page 1 of 13 Is this a processing-only facility for materials mined elsewhere? Is this an inactive mine site? ®Yes ❑Yes ONO For storage of tailings from Kings Mountain Mine ®No Does total area of this mine site include ready-mixed concrete plant and/or asphalt plant areas? ❑Yes,and has separate NPDES stormwater permits(provide permit numbers): ❑Yes,and does not have separate NPDES stormwater permits ®No Does this facility already have a valid Mining Permit from DEMLR's Land Quality Section? ❑Yes(please provide the Mining Permit Number) ®No(please indicate the status of the Mining Permit application).The current operations at the site are covered b mine permit 23-03 and by NCG020089, issued to IMERYS S.A. The proposed Albemarle operations will b covered under a new mine permit and the NCG02 being applied for herein. Are you applying for a discharge permit in the same location as a previously permitted mine? ®Yes(please provide permit number and mine name).The current operations at the site are covered by mine permit 23-03 and by NCG020089,issued to IMERYS S.A.The proposed Albemarle operations will be covered under a new mine permit and the NCG02 being applied for herein. ❑No If the stormwater discharges to a municipal separate storm sewer system(MS4),name the operator of the MS4: ®N/A 3. Consultant(if applicable): Name of consultant: Consulting firm: Brian Sterner ERM-NC, Inc. City: State Zip Code 300 West Summit Avenue, Suite 330 Charlotte NC 28203 Telephone number: Email address: 412-559-2139 Brian.Sterner@erm.com 4. Development Activities and Buffers Mining operation will precede development activities at this site: ❑Yes ®No Previous mica mining was conducted by IMERYS under permit 23-03.The new permitted use will be to store tailings generated and transported from spodumene mining and processing at Kings Mountain Mine. No development post closure is anticipated at this time. Mine is located within one of the 20 Coastal Counties,and will it add more than 10,000ft2 of impervious surface: Dyes(to both) ❑No,this mine is within one of the 20 Coastal Counties,but will not at more than 10,000 ftz of impervious surface ®No,this mine is not within one of the 20 Coastal Counties Mine is in the Neuse,Tar-Pamlico,or Catawba River Basins,OR in the Randleman or Jordan Water supply Watersheds? Dyes(specify size of stream buffers) ®No Mine site will include wastewater discharges from a ready-mix concrete batch plant? Dyes(please seek additional coverage under General Permit NCG140000:Ready-Mix Concrete) ®No Page 2 of 13 5. Mine Dewatering Mine dewatering will occur atthis site: Existing pit area will continue to be dewatered by IMERYS under their mine permit. Once the TSF becomes operational,Albemarle will engage in stormwater management. Groundwater infiltration into the TSF structure and water from precipitation will be discharged. ®Yes ❑No(mark N/A for the rest of this section) Mine dewatering from this facility will be discharged to: ®Surface waters and/or wetlands Dewatering the TSF will only discharge to the unnamed tributary to Dixon Branch.There are no wetlands within 400 feet of the TSF perimeter. OOther(specify) []Mine will not discharge dewatering to Surface Waters and/or Wetlands;specify how dewatering will occur and where water will be directed: ®N/A Pump and Operation Maintenance Plan is not applicable(N/A) Wetlands and/or Surface Waters are within 400'of the mine pit perimeter: 404/401 Certification permits required: ®Yes(specify distance)Unnamed tributary to Dixon Branch is ❑Yes(briefly describe) approximately 530 feet from the closest edge of the TSF. ®No ❑ No ❑ N/A El N/A Have you been required to obtain a wetland delineation certified by the US Army Corps of Engineers? ®Yes(please attach to this application) ❑ No,IMERYS surveyed the TSF area for wetlands and waterbodies.The U.S.Army Corps of Engineers determined that no jurisdictional wetlands or waterbodies were present,and they issued an Approved Jurisdictional Determination(AJD). No changes to the site have occurred since the AJD was issued.The AJD is provided in Appendix F of this application. 6. Wastewater Treatment—no wastewater treatment will occur,other than sedimentation control of waters from dewatered TSF. Will this facility wash mined materials? ❑Yes ®Jo Will discharges of process wastewater treatment systems occur(including possible recycle system overflows) ❑Yes(please describe) ® No Will this facility employ chemical additives to flocculate suspended solids? []Yes(specify name/manufacturer/quantity of daily use) ®No Note:please visit:https:Hfiles.nc.gov/ncdeg/Water+Quality/Environmental+Sciences/ATU/PAM8 30 18.pdf for list of approved PAMS Will any of the wastewater treatment facilities at this mine overflow only during rainfall events that exceed the 10-yr,24-hr rainfall event? ❑Yes(specify which systems) ®No Are wastewater treatment facilities(including recycle systems)planned in the 100-year flood plain? 0Yes DJo Wastewater Treatment Alternative Review as required by 15A NCAC 2H.0105(c)(2) (treatment required is solely sediment control) Types of wastewater this mine site will discharge: ®Mine Dewatering ❑Process Wastewater Types of wastewater considered for this alternative review: ®Mine Dewatering ❑ Process Wastewater Page 3 of 13 Are thece_existingsewer_lines-within a one-mile radius? - - -— — -- ®Yes ®Wastewater treatment plant will accept wastewater His feasible to connect(explain) Truck wash water in the southern non-process infrastructure (NPI) area will be collected, routed to the new sewer line, and connected to the existing sewer main along Route 29 (See Figure 5 in Appendix A). His not feasible to connect(explain) The groundwater component of tailings contact water is classified as wastewater since it is mine dewatering. It will be pumped to the TSF collection pond before discharge to Outfall 002 without need for further treatment to meet North Carolina state surface water quality standards.The water management system is further explained in Section 7 below and illustrated on the stormwater management flowsheet provided in Appendix E of this application. ❑No Are you already proposing a closed-loop recycle system(CLRS)that meets design requirements of 15A NCAC 2T.10000? ❑ Yes,for dewatering ❑ Yes,for process wastewater ❑ Yes,for both ❑ No,this option is technologically feasible(explain) ❑ No,this option is not technologically feasible(explain) ❑ No,this option is otherwise feasible(explain) 19No,this option is otherwise is not feasible(explain) Truck wash water will be captured and treated at an offsite municipal wastewater treatment plant. Other site water requires only treatment through settling and can then be discharged to an unnamed tributary to Dixon Branch without need for further treatment to meet North Carolina state water quality standards. What is the feasibility of building a CURS compared to direct surface water discharge? Not feasible, as described above. Surface or Subsurface Disposal System ❑A surface or subsurface disposal system is technologically feasible(explain) 0 A surface or subsurface disposal system is not technologically feasible(explain) Surface and subsurface disposal is not technologically feasible due to the site facilities, availability of land,and the elevation of the site as it pertains to the proximity and influence of groundwater. ❑Asurface drsubsurface disposal system is otherwise feasible to implement(explain) ❑A surface of subsurface disposal system is not otherwise feasible to implement(explain) What is the feasibility of employing a subsurface of surface discharge as compared to a direct discharge to surface waters? Direct Discharge to surface waters is the most environmentally sound alternative to all reasonably cost-effective options for the wastewaters being considered? ®Yes-Water-discharged from the TSF will not need treatment beyond the settling ponds before discharge to an unnamed tributary to Dixon Branch. ❑No If this review included all wastewater discharge types,would excluding some types make any of the above non-discharge options feasible for some the wastewaters? ❑Yes ® No Page 4 of 13 7. Outfalls(s)At least one outfall is required to be eligible for coverage. 3-4 digit identifier: Name of receiving water: Classification: ❑This water is impaired. 001 UNTto Dixon Branch C ❑This watershed has aTMDL Discharge from this outfall is from: ®Stormwater DAine Dewatering IProcessWastewater 7Q30 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW, ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): N/A Discharge occurs from this outfall: ®Only during a rainfall event ❑Intermittently(indicate how often) ❑Continuously(indicate flow in CFS) Latitude of outfall: Longitude of outfall: 35.186823 1 -81.404814 Brief description of the industrial activities that drain to this outfall: Water discharged through this outfall will consist of stormwater collected from the site perimeter ditches, stabilized surfaces in the NPI area, and offsite areas. Water will be discharged through a new 24-inch culvert (Outfall 001) and then to an existing 36-inch culvert under Interstate 85 (1-85), which flows to an unnamed tributary(sometimes referred to as Archdale Creek)to Dixon Branch. Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes DJo 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. 00 1 UNTto Dixon Branch C ❑This watershed has aTMDL. Discharge from this outfall is from: ®Stormwater EMine Dewatering EProcess Wastewater 7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW, ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): N/A Discharge occurs from this outfall: ❑ Only during a rainfall event ❑Intermittently(indicate how often) M Continuously(indicate flow in CFS) 0.448 cfs(201 gpm) Latitude of outfall: Longitude of outfall: 35.185148 -81.407035 Brief description of the industrial activities that drain to this outfall:Water discharged from this outfall will be contact water from the TSF and collected in the contact water transfer pond,stormwater from the NPI area,and stormwater from offsite areas. Water collected in the contact water transfer pond will join the NPI and offsite stormwater flow discharging through a new 30-inch culvert, with the combined flow of Outfall 002 passing through an existing 30-inch culvert under 1-85, which flows to an unnamed tributary (sometimes referred to as Archdale Creek)to Dixon Branch. Do Vehicle Maintenance Activities occur in the drainage area of this outfall? • ❑Yes ENo If yes, how many gallons of new motor oil are used each month when averaged over the calendar year? Page 5 of 13 14 digit identifier: Name of receiving water: Classification: OThis water is impaired. 003 UNT to Dixon Branch C ❑This watershed has aTMDL. Discharge from this outfall is from: NStormwater Qvline Dewatering EProcess Wastewater 7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW, ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA):N/A Discharge occurs from this outfall: El Only during a rainfall event ❑Intermittently(indicate how often) ®Continuously(indicate flow in CFS) 0.0811 cfs (36.4 g m) Latitude of outfall: Longitude of outfall: 35.187983 -81.403287 Brief description of the industrial activities that drain to this outfall:Water discharged through this outfall will consist of stormwater from the perimeter/haul road channel corridor, and from offsite areas. Water discharged from this new 18-inch culvert will also receive water from the reclaimed TSF perimeter during post-closure. Perimeter road drainage and offsite flow will pass through a sediment control pond (outfall 003) and be joined by additional offsite flow before discharging through an existing 60-inch culvert under 1-85, which flows to an unnamed tributary (sometimes referred to as Archdale Creek)to Dixon Branch. Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes ❑O 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. 004 UNIT to Dixon Branch C ❑This watershed has aTMDL. Discharge from this outfall is from: O Stormwater O Mine Dewatering ❑ Process Wastewater 7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW, ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): N/A Discharge occurs from this outfall: ❑ Only during a rainfall event ® Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS) Once per week Latitude of outfall: Longitude of outfall: 35.1876438 -81.4053120 Brief description of the industrial activities that drain to this outfall: This outfall(currently represented in Imerys NCG00289) discharges groundwater and precipitation that enters the open pit,which is collected in ponds and pumped to a forebay before discharge occurs.Albemarle will continue to operate this outfall in a similar manner until construction of the TSF stormwater management system begins.The discharge from the forebay(to be redesignated as Outfall 004)will continue to flow into an existing 60-inch culvert under 1-85 and into an unnamed tributary(sometimes referred to Archdale Creek)to Dixon Branch. Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes ZNo 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. -Discharge.from-this outfall is from: ❑Stormwater ❑ Mine Dewatering ❑ Process Wastewater 7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewaterto waters classified as HOW, ORW,Tr,WS-1,WS-Il,WS-III,SA,or PNA): Discharge occurs from this outfall: ❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS) Latitude of outfall: Longitude of outfall: Page 6 of 13 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 NO1. 8. Other Facility Conditions(check all that apply and explain accordingly): OThisfacility has other NPDES permits. If checked,list the permit numbers for all current NPDES permits: The site is currently covered by NCG020089, issued to IMERYS S.A for Kings Mountain Mining, Inc. and will be supplanted by a new NCG02 issued to Albemarle. ❑This facility has Non-Discharge permits(e.g.recycle permit). If checked,list the permit numbers for all current Non- Discharge permits: ®This facility uses best management practices or structural stormwater control measures. If checked,briefly describe the practices/measures and show on site diagram: The facility will use perimeter swales to intercept stormwater and route it to Outfalls 001 and 002, which will flow to an unnamed tributary(sometimes referred to as Archdale Creek) to Dixon Branch. The stormwater collection system will intercept stormwater from the NPI area for discharge to Outfalls 001 and 002. Contact water from the filtered tailings facility will be collected and pumped to the TSF contact water collection pond before being discharged to Outfall 002, which will flow to the unnamed tributary to Dixon Branch. Perimeter swales and a groundwater sump collection system will also be used to collect stormwater, which is routed to the perimeter sediment control pond, then discharged through Outfall 003, which flows to an unnamed tributary to Dixon Branch. OThis facility has a Stormwater Pollution Prevention Plan(SWPPP). If checked,please list the date the SWPPP was implemented: The current IMERYS operation has a SWPPP, but it will become obsolete when the Albemarle operations begin. A new SWPPP will be developed before Albemarle construction and operations begin. ❑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 peryear: 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: ®Facility provides appropriate secondary containment for bulk storage of liquid materials If checked,briefly describe these measures: Appropriate secondary containment will be provided for diesel storage tank. Page 7 of 13 ❑Site has an active landfill within the mining permit boundary If checked, please indicate type: a) ❑LCID(Land clearing and Inert Debris) b) ❑other(specify) 9. Required Items(Application will be returned unless all of the following items have been included): ®Check for$120 made payable to NCDEQ ®Copy of most recent Annual Report to the NC Secretary of State(if applicable) See Appendix G. ®This completed application and any supporting documentation ®Copy of the approved mining permit or indication of mining permit application status The Archdale TSF property is currently operated by Imerys and permitted separately. A new mining permit application for the Archdale TSF has been submitted to NCDEQ. See Appendix H. ®Copy of US Army Corps—approved wetland delineation(if applicable) See Appendix F for the AID. ®Line drawing of the water flow through the facility or block flow diagram See Appendix E. El Pictorial description of the nature of any sources of water and any collection and treatment measures N/ ®A site diagram showing,at a minimum,existing and proposed: See Figure 9 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 0 areas where process materials are stored g) impervious areas h) site property lines ®2 copies of large scale(24"x36"minimum)site plan showing: See Figure 10 a) topographical lines b) all outfall locations c) applicable buffers and delineated wetlands d) receiving waters e) 100-year flood plain(if applicable) ®Copy of county map or USGS quad sheet with the location of the facility clearly marked See Figure 3 If mines site is in one of the 20 Coastal Counties (if applicable) ❑Applicant has check with the appropriate regional office to verify the need for a Coastal State Stormwater permit. a) Indicate the Regional Office Contact: N/A ® Detailed list of: See Figure 9 a) impervious surface areas and percentages b) sub-drainage areas c) total drainage area If mine is dewatering and near wetlands,or may otherwise impact surface waters or groundwater Page 8 of 13 Z2 copies of large scale(24"x36"minimum)plans delineating areas on the listing acreage including: See Figure 11 a) wetlands b) ditches c) well-placements d) pits e) borrow areas 9 overburden storage g) stormwatercontrols/BM Ps h) vehicle maintenance areas i) settling basins j) product process(such as screening,stockpiles,and waste piles) k) total drainage area 1) impervious surface percentages(if state Stormwater programs apply) m) applicable buffers n) access and/or haul roads 0 Pump dewatering size and information on its specifications See Stormwater Flowsheet in Appendix E ❑Well information(design,depths,maintenance) N/ ❑Physical monitoring for the wetland areas N/ ®Settling pond size information,if applicable One permanent sediment control pond will be constructed along the south side of the TSF,adjacent to 1-85 (See Figure 5). The pond will be 0.7 acre in size and measure 500 feet long and 90 feet wide at the top. The pond has a contributing watershed of 64 acres and has a volume of 3.11 acre-feet and will discharge to Outfall 003. ®Level spreader design,if applicable See Erosion and Sediment Control Plan in Appendix B. ®Details about dewatering method See Stormwater Management Plan in Appendix D. Precipitation entering the TSF will be collected and pumped to the TSF collection pond, where it will discharge to Outfall 002. Groundwater that enters the TSF will be collected in an underdrain sump, flow to the perimeter sediment control pond, and then discharge to Outfall 003. ❑Cone of influence calculations N/ ®Description of measures to prevent erosion and flooding See Erosion and Sediment Control Plan in Appendix B. ❑Description and information about401/404 permits that have been obtained N/A ®Copy of US Army Corps of Engineers wetlands delineations or approved wetland delineation(if applicable) See Appendix F for the Approved Jurisdictional Determination 01 have contacted my local regional office about a Pumping Operation and Monitoring(POM)plan a) Regional Office Contact: b) Date Contacted: 10. Applicant Certification: North Carolina General Statute 143-215.6B(1)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: a 1 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. Page 9 of 13 0 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. 2 1 will abide by all conditions of the NCG020000 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. H I hereby request coverage under the NCG020000 General Permit. Printed Name of Applicant: Christopher Dana uskas Title: Site Director hilt `l L' O Z� (Signature ofAppli ant) (Date Signed) Mail the entire package to: DEMLR—Stormwater Program Department of Environmental Quality 1612 Mail Service Center Raleigh, NC 27699-1612 Page 10 of 13 Additional Outfalls El This water is impaired. 3-4 digit identifier: Name of receiving water: Classification: ❑This watershed has a TMDL. Discharge from this outfall is from: ❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater 7Q30 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW, ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): Discharge occurs from this outfall: ❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow inCFS) 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. Discharge from this outfall is from: ❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater 7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW, ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): Discharge occurs from this outfall: ❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow inCFS) 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. Discharge from this outfall is from: ❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater 7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW, ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): Discharge occurs from this outfall: ❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow inCFS) Page 11 of 13 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. Discharge from this outfall is from: ❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater 7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW, ORW,Tr,WS-1,WS-11,WS-III,SA,or PNA): Discharge occurs from this outfall: ❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS) 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. Discharge from this outfall is from: ❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater 7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW, ORW,Tr,WS-I,WS-11,WS-III,SA,or PNA): Discharge occurs from this outfall: ❑ Only during a rainfall event — Intermittently(indicatehowoften) ❑ Continuously(indicate flow inCFS) 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 Discharge from this outfall is from: ❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater 7Q30 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW, ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): Discharge occurs from this outfall: ❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS) Latitude of outfall: Longitude of outfall: Page 12 of 13 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? 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