NCG160228 NOI Application_20180521

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FOR AGENCY USE ONLY
Date Received Uy
Year Month Da
Division of Energy, Mineral, and Land Resources
Land Quality Section Certificate ofCoverage
National Pollutant Discharge Elimination System N
ICIG
g Y Cheek # I Amount
Environmental
Quality NCG160000 Permit Assigned to
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG160000 for STORMWATER DISCHARGES associated with activities classified as:
SIC 2951 The manufacture of Asphalt Paving Mixtures and Blocks,
And, Like activities deemed by DEMLR to be similar in the process, or the exposure of raw
materials, intermediate products, final products, by-products, or waste materials.
(Please print or type)
1) Mailing address of the owner/operator (address to which official permit correspondence will be mailed):
Name 3 .T. Rvstt t 1 n.wJ S."( Tn (.
Owner Contact
Street Address F.0 . go)( ('l0
City AIVtrnr,�-l�t. State NC ZIP Code Woo7-
TelephoneNo. ?01/ 18z- ZZ2 S Fax:
E-mail Address
2) Location of the facility producing the discharge:
Facility Name TT. RvSif_l I a.,d Sons, T
Facility Contact 1;1tAnV Barr ry1r-
Street Address I I gig Brooke, /�L:I I Rd .
City Charlo+_k_ State. Aj(_ ZIP Code 2622'7
County Mf_GKIew, f,
Telephone No. 'joq 438 • 8133 Fax:
Email kbarn ra.rls?:a-r�sSellandsons.con,
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 direction from a roadway intersection). Lo-, ^sr Frog ax,_j..,P4f_ . Ntad e4 S4-
Turri Le.4 on &osec h: K JU Take, 4;^r4a. US Fd.e• 1,�-y w• 11 6G en r • 4k+
(A copy of a county map or USGS quad sheet with facility clearly located on the map is a required part of this application.)
4) Latitude 3S. Zil6lq
Longitude —go -4116313 (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
RECEIVED
MAY 14 2016
❑ New or Proposed Facility" Date operation is to begin DENR-LAND QUALITY
Q Existing TORMWATER PERMITTING
"If this new or proposed facility is located in one of the 20 coastal counties, please contact the appropriate DEMLR Regional
Office (see page 4) to determine if a State Stormwater Permit is required prior to construction.
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NCG160000 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: 2 9 S I
7) Services and Activities
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facility: (Include a site diagram showing the process areas and location of
activities present at this facility.) "gim O, Dr..,. 2tn..k
b) Check all activities conducted at this facility.
0 Outdoor stockpiling of materials
[]' Storage of raw materials
[� Storage of materials in above-
ground tanks
[a Material Loading and Unloading
8) Discharge points / Receiving waters:
Q' Transport of materials by a conveyor
or front-end loader
Vehicle and equipment maintenance
Vehicle or Equipment Washing
[� Vehicle and equipment fueling
How many discharge points (ditches, pipes, channels, curb and gutter, swales, etc.) convey stormwater from
the property? a^-.
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Co-t6we-11 CarMV-
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).
Receiving water classification (if known):
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. t
Latitude (degrees/minutes/seconds): 3.5 , 129203 N
Longitude (degrees/minutes/seconds): -So • 41 L-1'16 W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
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
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NCG160000 N.O.I.
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): _
Longitude (degrees/minutes/seconds):
N
W
9) Does this facility
a) Have an untreated wastewater discharge? ❑ No V Yes
b) Have a treated wastewater discharge? V No ❑ Yes
If yes, list the permit number.
c) Have a wastewater discharge from a recycle system? 9 No
If yes, list the permit number.
d) Have a non -discharge permit? (9(No ❑ Yes
If yes, list the permit number.
M,
❑ Yes
e) Discharge wastewater to a municipal wastewater collection system? C"No ❑ Yes
If yes, list the municipality and permit number
Note: Stormwater discharge permit NCG160000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG160000.
10) Does this facility employ any best management practices for stormwater control?
Q No ❑ Yes (Show any structural BMP's on the site diagram.)
If yes, please briefly describe:
11) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No ET Yes
If yes, when was it implemented? Zoog
12) Are vehicle/equipment maintenance activities occurring at this facility?
❑ No [;'Yes
13) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
C'No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
G]"No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
Pl No ❑ Yes
d) Is hazardous waste stored in the 100 -year flood plain?
R 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:
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NCG160000 N.O.I.
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
14) Certification:
North Carolina General Statute 143-215.66 (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
[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 ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit. I certify that I am familiar with the information contained in this application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: BCAY 0�� � R(e,L�
Title: `
of Applicant)
p$
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDEQ
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NCG160000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included.
Please do not ask us to "hold" an incomplete application in anticipation of a check under separate cover.
❑ Check for $100 made payable to NCDEQ
❑ This completed application signed by the applicant, 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 which drainage areas), (d) runoff conveyance structures, (e) areas where materials are
stored, (f) impervious areas, (g) site property lines, (h) vehicle and equipment maintenance, blasting,
painting, and washing areas, and (i) location of activities listed in 7b.
❑ Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Please mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note:
The submission of this document does not guarantee the issuance of NPDES permit coverage.
For questions, please contact the DEMLR Regional Office for your area.
To visit our website please go to http.11portal.ncdenr.orgg web/ir/stormwater
DEMLR Regional Office Contact 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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3D Floodzone Print Map Page 1 of 1
3D Interactive Floodzone Mapping
This system is subject to current public information rules a -id regulations. Information presented on this web site is considered public information and may be distributed
or copied. Mecklenburg County provides no warranty, expressed or implied, as to the accuracy, precision, timeliness, completeness, or any other aspect of the data
provided.
RECEIVED
MAY 14 2016
DENR-LAND QUALITY
STORMWATER PERMITTING
http://meckmap.mecklenburgcountync.gov/3dfz/print.html?matid=&taxpid=&groundpid= 4/30/2018