NCG100245

,If 15WA
NCDENK
NORTIi cl-- pEaAmr ' av
ENVIRONMENT AND NATURAL HESOURCE,
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG100000
FOR AGENCY USE ONLY
Date Received
Year
Mondi Da
Certificate of Covera re
N G 1 0
hock i' An �ucri
ennit Assi i ed to
NOTICE OF INTENT he C� 100 a �
National Pollutant Discharge Elimination System application for coverage under Gene>�Ijp` �C�
NCG100000: 11�� CC! V C
STORMWATER DISCHARGES associated with activities classified as: MAR 28 2018
SIC (Standard Industrial Classification) 5015 Used Motor Vehicle Parts DEER -LAND
SIC 5093 Automobile Wrecking for Scrap, (except as specified below) QUALITY PERMITTING
The following activities are specifically excluded from coverage under this General Permit:
• Establishments primarily engaged in the wholesale trade of metal waste and scrap, iron and steel scrap, and
nonferrous metal scrap (hereafter referred to as the metal waste recycling industry)
WKFor questions, please contact the DEMLR Regional Office for your area. See page 4.
(Please print or type)
1) Mailing address of ownerloperator
Name deo T yA-C'V-2�'a]'
Street Address _�'->ok o�'?>-I )p (o4 kk�g-
City -/ \ --State N L ZIP
Telephone No. , Fax: 61 cxA
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
3) Physical Location Information:
Please provide a narrative description of how to get tohe facilit (use
distance and direction from a_roadwav intersection). % :2, Al A
(A copy of a countl'map or USGS quad sheet with facility clearly located must be
4) Latitude Longitude
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
IV( Existing
names state rgad numbers and
' zy a F'���' 4-3
with this application.)
(deg, min, sec)
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NCG100000 N.O.I.
6) Standard Industrial Classification:
Provide the 4 -digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code:
7) Provide a brief narrative de ition of the types Qf industrial activities and products manufactured at
this facility: —._ 1* Al l , tco'dk'A 9p- ,O®J ,1 aG
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?`
What is the name of the bod or bodies of water reek, strear� river, lake, etc.) that the facility stormwater
discharges end up in? jrG ;-A41
y�
Receiving water classification:
Is this a 303(d) listed stream? Has a TMDL been approved for this watershed?
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
9) Doe his facility have any other NPDES permits?
ZNo
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10);7No
s is facility have any Non -Discharge permits (ex: recycle permit)?
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
11) Does this facility employ any best management practices for stormwater control?
avo
❑ Yes (Show structural BMPs on the site diagram.)
If yes, please briefly describe:
12) Does this facility have a Stormwater Pollution Prevention Plan?
Jar No
❑ Yes
If yes, when was it implemented?
13) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
Y `"" ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No Z/Yes
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NCG1 00000 N.0.1.
c) is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
9""" El Yes
d) is hazardous waste stored in the 100 -year flood plain?
/o ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
Now is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
14) Certification:
North Carolina General Statute 143-215.68(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 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).
hereby request coverage under the referenced General Permit. 1 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.
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:G�i9
Title: Oj-aZle-Y'
(Signature of Applicant)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
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NCG100000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
Check for $100 made payable to NCDENR
This completed application and all supporting documents
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
(f) impervious areas, (g) site property lines.
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee coverage under the NPDES General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contract Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office_
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
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