NCG070217_Application RJ Corman_20190128

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Environmental
Quality
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge L'liminati©n System
NCG070000
FOR AGENCY [:SE ONLY
Date Received
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Month
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NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG070000:
STORMWATER DISCHARGES associated with activities classified as:
SIC' 32 Stone, Clay, Glass, and Concrete Products (except as specified below)
SIC* N/A Like activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials, products, by-products, or waste materials
The following activities are specifically excluded from coverage under this General Permit:
SIC" 3273 Ready -Mixed Concrete
r. }
* Standard Industrial Classification Code +
(Please print or type) DL-A .LAND QUA.LIT,(
1) Mailing address of owner/operator (address to which all permit corres O%NA&1afiiW"��i
Name 'Ptt`S. clocmw) 1961kmar�l � �►
Street Address lox %&I C.o�af) Ve
City t,}ic�Y�ol�ev:1 State k� ZIP Code q 03S
Telephone No. 16EA _$81 - Q.4CX> Fax: 8-ER eeb - 59GH
E-mail Address 1n�00
2) Location of facility producing discharge:
Facility Name
Facility Contact
Contact E-mail
Street Address
City
County
Telephone No.
659 515t --
3) Physical Location Information:
,vt
State 1JC- ZIP Code
Fax:
VS.V2,0
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).
(A copy of a county map or USGS quad sheet avt' facility clearly located on the map is required to be submitted with this application)
4) Latitude . 'baab Longitude -�B. r}'� $o'�. (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following
C1 New or Proposed Facility
Existing
Date operation is to begin 3 _ \ -\9
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NCG070000 N.O.I.
6) Standard Industrial Classification:
Provide the 4 dlglt Standard Indw%trial Classification Code (,SIC Code) that describes the primary irulustrial
activity at this facility
SIC Code: • 'y
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: r ko 1� to \ Ynl r,k{a
.
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. 1
Latitude (degrees/minutes/seconds): 34.'6;R(52a N
Longitude (degrees/minutes/seconds): '" 8. 97 744 W
Stormwater Outfall No.
Latitude (deg rees/minutes/seconds):y . 3aQ N
Longitude (degrees/minutes/seconds): -45 W
Stormwater Outfall No. 3
Latitude (degrees/minutes/seconds): 34, 3ao� N
Longitude (degrees/minutes/seconds): _ 7i, 78a 7 W
Stormwater Outfall No
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfali No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds); N
Longitude (degrees/minutes/seconds): _ W
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? 0n%D-Cr C-C
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NCG070000 N.O.I.
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).
f 0) Dues this facility have any other NPDES permits?
No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
M 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?
11 No
Yes
If yes, please briefly describe:
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?
)4 No ❑ Yes
15) Hazardous Waste:.
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
4 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
14 No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
t No ❑ Yes
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:
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NCG070000 N.Q.I.
16) Certification:
North Carolina General Statute 143-216.6 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 (y10,000).
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:
Title: r:orr}mLrGia� �1,,,
(Signature of
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDEQ
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NCG070000 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 NCDEQ
C1 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 ©EMLR Central Office or Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ...
Fayetteville Office
Mooresville Office
Raleigh Office .....
Washington Office
Wilmington Office
Winston-Salem ....
Central Office ......
[phone]
[phone]
[phone]
[phone]
.. [phone]
[phone]
[phone]
[phone]
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SWU-222-071408 Last Revised 6/24114

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