NCG060388_NOI Application_20180426

Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
ln�€r:utrrtttal NCG060000
NOTICE OF INTENT
FOR AGFNCY USE: ONL
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG060000: c t '
STORMWATER DISCHARGES associated with activities classified as: OR /V�®
SIC (Standard Industrial Classification) 20 Food and Kindred Products
SIC 21 Tobacco Products tirj`nl%Qj,, �O/�
SIC 2.83 Drugs
SIC 284 Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Prepa ra idr�QCj�
SIC 422 Public Warehousing and Storage (except 4226) 1"IVG
r+ For questions, please contact the DEMLR Regional Office for your area. See page 4. ,
t Do Not use this NOl for renewals.
1)
2)
(Please print or type)
Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name
Date Received
Year
I M011th I Dav
-201 A/ S+-
Certificate of Coverat-e
0
Check H Alnonnt
Telephone No.
Pennit Assi2ned to
Fax: /u -S92- 3ii ii
FOR AGFNCY USE: ONL
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG060000: c t '
STORMWATER DISCHARGES associated with activities classified as: OR /V�®
SIC (Standard Industrial Classification) 20 Food and Kindred Products
SIC 21 Tobacco Products tirj`nl%Qj,, �O/�
SIC 2.83 Drugs
SIC 284 Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Prepa ra idr�QCj�
SIC 422 Public Warehousing and Storage (except 4226) 1"IVG
r+ For questions, please contact the DEMLR Regional Office for your area. See page 4. ,
t Do Not use this NOl for renewals.
1)
2)
(Please print or type)
Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name
L
Street Address
-201 A/ S+-
City
W'fl-,�„a}a.
State WC-- ZIP Code ,-2$4"o/
Telephone No.
111 u -S92- 3S21•e
Fax: /u -S92- 3ii ii
Location of facility producing discharge:
Facility Name—
Facility Contact
Facility Address
)-4 t\ 44w� dol g
( 'moi
Facility City
Facility County
Telephone No.
Email
i State NI.— ZIP Code 2 -: j5'T
31, Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a dway intersection). e,4SC p„ I* )4w-1 -79,i
;c7, f T C i'f �+ a��n
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application
4) Latitude 3 - y�/�Z / , .�� N Longitude �o f�, IN 13 �V (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
Existing
Date operation is to begin
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NCG060000 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: ,9 U V
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility: C-r�; , Slx�arlL �Z�c� lln�.,�. ,.�B� / , ;" '/ ' ' -
b) Check all activities occurring at this facility:
Cl use or process meats ❑ use or process animal fats/byproducts
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? _
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in?
Receiving water classification: iJ MS'LV
Is this a 303(d) listed stream? as a TMDL been approved for this watershed?
If the site stormwater discharge to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).�V�
List discharge points (outfalls) that convey discharge from the site (both on-site and off-site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Stormwater Outfall No. 1 o
Latitude (degrees/minutes/seconds): ;� �l1 /�l }3 �� N
Longitude (degrees/minutes/seconds): /f, lu i,✓ W
Stormwater Outfall No. - - N
Latitude (degrees/minutes/seconds):
Longitude (degrees,minutes/seconds): �� �S' /�/S W
Stormwater Outfall No. _ o
Latitude (degrees/minutes/seconds): 3f /1 go N
Longitude (degreeslminutes/seconds): SS' /LGA =WW
Stormwater Outfall No. �' 3s° V�),16,3/ I
Latitude (degrees/minutes/seconds): N
Longitude(degrees/minutes/seconds): SS /s•31 W
Stormwater Outfall No
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes,'seconds): W
Stormwater Outfall No. only
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No. only
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
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NCG060000 N.O.I.
9) Does this facility have any other NPDES permits?
No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
❑ No
❑ 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?
❑ No
Yes (Show any structural BMPs on the ite diagram.)
If yes, please briefly describe: o,.se - 14' rpvl�k S (''/� ,257e -7A
kr cavi r s e f"kS <eu E
'1(t.4,. /fJ ew,-- i,.c,_ 8 wed 0' '+
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
Yes
If yes. when was it implemented?'
13) Are vehicle maintenance activities occurring at this facility?
21 No ❑ Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
L7 No ❑ Yes
d) Is hazardous waste stored in the 100 -year flood plain?
No ❑ 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:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor: _
Vendor address:
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NCG060000 N.O.I.
15) Certification:
North Carolina General Statute 143-215.6B (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).
I hereby request coverage under the referenced General 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.
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 N aDgi of Person Signing:.
Title: �1
Applicant)
Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable
to: NCDEQ. Do not send the check or money order separately.
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NCO060000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following Items Have been Included:
1�r' Check for $1:00 made payable to NCDEQ. Must be included with this application (not sent separately).
Ll' 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,
`/ loaded, and unloaded, (f) impervious areas, (g) site property lines.
OR Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional gffice Contact Information:
Asheville Office ......
[phone]
Fayetteville Office...
[phone]
Mooresville Office ...
[phone]
Raleigh Offrce ._... -
(919) 791-420.0
Washington Office ...(252)
8466481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .....,...(919)
807-6300
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SWU_221 Last revised 6/24/14