NCG110158_NOI Application_20180606

SCG l I 015s
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
Environmental
Quality NCG110000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
Certificate of Covera e
N C G
Check #
Amount
Permit Assigned to
G � �
National Pollutant Discharge Elimination System application for coverage under General PernR CC t I
NCG110000: C VED
STORMWATER DISCHARGES associated with activities classified as:
MAY 3 0 2018
Treatment Works treating domestic sewage or any other sewage sludge or wastewater treat LAND
device ors stem, used in the storage, treatment, recycling,and reclamation of munici aPTiiORMW QRMI T I
Y 9 P ATER PERMITTING
domestic sewage, with a design flow of 1.0 million gallons per day or more, or required to have an
approved pretreatment program under Title 40 Code of Federal Regulations (CFR) Part 403,
including lands dedicated to the disposal of sewage sludge that is located within the confines of
the facility; and like activities deemed by DEMLR to be similar in the process and/or the exposure
of raw materials, products, by-products, or waste materials.A-'rn� pp0'� (2 W
(Please print or type) Dr s�i'ZG� O
1) Mailing address of owner/operator (address
Name
Street Address
City
Telephone No.
E-mail Address
2O
2) Location of facility producing discharge:
Facility Name
Facility Contact
Contact E-mail
Street Address
City
County
Telephone No.
Hca 73)2p)w R1 �� w91�
i!t ;PC- 7&2 C.
n2 cJ 51;;' aC_lr—
3) Physical Location Information:
will be mail
ZIP CodeU�-
�54- 329'9
State ZIP Code
Zo 1+ Fax: f<Zc4 '7,57—
Please
57—
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction fkom a roadway intersection). Loraf :'QED LjEST OF FeV-Y Z z
7/,A,, Aoar//,
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application)
4) Latitude 3!; 3q Longitude 82 S4 (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following : 35,6416331
❑ New or Proposed Facility
Dd Existing
Date operation is to begin
8a. 5`77 VD/
Page 1 of 4
SWU-226-071408 Last Revised 6/24/14

4
NCG110000 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: 1 9 2
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: jFcj&c_LX QLA2A2gQ Wks-7K449M26,L. ?/tfAl/�iIF.t1T �}I,CJL/TT_
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?
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.
Latitude (degrees/minutes/seconds): �J� 3S 3S N
Longitude (degrees/minutes/seconds): SZo 3S L W
Stormwater Outfall No. 2
Latitude (degrees/minutes/seconds): 39 N
Longitude(degrees/minutes/seconds): ts2� �S� 6W
Stormwater Outfall No. 3
Latitude (degrees/minutes/seconds): 35� 38 / �N
Longitude (degrees/minutes/seconds): �2� S6 d, W
Stormwater Outfall No. —t— 0 f ,Y
Latitude (degrees/minutes/seconds): '' o .38 46 N
�.
Longitude (degrees/minutes/seconds): 3654. W
Stormwater Outfall No. 0 f N
Latitude (degrees/minutes/seconds): 3-5 3'8 95" N
Longitude (degrees/minutes/seconds): 49 Z-0 3S 15 t6 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
Page 2 of 4
SWU-226-071408 Last Revised 6/24/14

NCG110000 N.O.I.
9) Receiving waters:
What is the name of the bo,d,,,,yy or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? r'445 C44 '$ RQ46 Al
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).
10) Does this facility have any other NPDES permits?
❑ No
pK Yes
If yes, list the permit numbers for all current NPDES permits for this facility: )iC co ?-+q
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
)d Yes
If yes, please briefly describe: Sip&c_ �Gl�ll�i✓T/ %f/1 fJ6�2,4r� — So /lpo/
'4'�a "AM A20 A&A6
13) Does this facility have a Stormwater Pollution Prevention Plan?
( No
❑ Yes
If yes, when was it implemented?
14) Are vehicle maintenance activities occurring at this facility?
)< No ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
)E No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
tai No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
Page 3 of 4
SWU-226-071408 Last Revised 6/24/14

NCG110000 N.O.I.
d) 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:
16) Certification:
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
[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.
� tt /I
Printed me of Person Signing: %/� E, AtAe7%L
Title: G,�i✓�/!� 5
z �
nature of Applicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDEQ
Page 4 of 4
SWU-226-071408 Last Revised 6/24/14

NCG110000 N.O.I.
Final rharlelicf
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDEQ
❑ This completed application and all supporting documents
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on 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 the issuance of an NPDES permit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
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]
Page 5 of 4
SWU-226-071408 Last Revised 6/24/14

NCDEQ National Pollutant Discharge Elimination System
NCG110000 Notice of Intent — Facility Physical Location

.MSD"Stormwater ; ,.A. ,. , Legend
Y
2225 Riverside Dr
n
Ao
40
1.
— . c
`r
r i
R
n y �
j v
F
i- �j