NCG210475_Application_20190612

k&210 415
nviror £ntal
Quality
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
National Pollutant Discharge Elimination System
NCG210000
FOR AGENCY USE ONLY
Date Received
Year
Month
I Da
of Covera e
iClCertificate
1 D4-2
Check #
Amount
oo
Permit Assigned to
e" 5 !
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG210000:
For STORMWATER DISCHARGES associated with activities classified as:
SIC` 24 Timber Products (except as specified below), including Wood Chip Mills;
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.
The following activities are specifically excluded from coverage under this General Permit:
• Wood Kitchen Cabinets (SIC 2434)
• Wood Preserving (SIC 2491)
• Logging (SIC 2411)
* Standard Industrial Classification Code
(Please print or type)
.SUN 12 2019
DEE R-L/aND QUAL iTY
STORMVV",T FAR "r'FRiV?iTI INN
1) Mailing address of owner/operator (address to which official permit correspondence will be mailedl:
Name
Owner Contact (a person)
Street Address P e 9cx (,.?T
City jM1lc�ks v%Olt.
Telephone No.
E-mail Address 14e-'+t. 4���4ts+d°► (a.,iQ `C�+�.I�
2) Location of facility producing discharge:
State /J L ZIP Code 2-7 v `Z S
Fax: '3 3 (e q 7 "L SS $ 3
.,-go o'—f ley a ic. - C-C'-%t
Facility Name Ade-' s-c,%-
Facility Contact (a person) —
Contact E-mail
Street Address
City M of iksState ZIP Code 2-7 o `Z 8
County DG.v`e-
Telephone No. "3 3 6 14 R 2- - Li <`T Fax: 3 3 4 g 5 Z' S sS'-3
3) Permit Contact
Permit Contact (a person) C I "- r
Contact E-mail ► ,.-t4, q c, , te,
Contact phone number - `-I S
4) Physical Location Information:
► , cet,-r0r'%
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). �rGw� i'S'�t,.T-, o •- 1'�a.`� C�.� - �-�
(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)
5) Latitude 3SOS Ce � I I IJ Longitude !r0"? `I' 3 `I « (degrees, minutes, seconds)
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SWU-236-080113 Last revised 7/2/14

❑ New or Proposed Facility Date operation is to begin
I� Existing
7) Standard Industrial Classification (SIG):
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: G, 1 O
8) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: W.a P'C_C-t"CJ"
9) 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): 3
Longitude (degrees/minutes/seconds): v'C,- s Y ` 3 V re
Stormwater Outfall No. 2--
0
I
Latitude (degrees/minutes/seconds): :S' JS � e !G E N
Longitude (degrees/minutes/seconds): TD u?� r 36 ' ' W
Stormwater Outfall No. 7
Latitude (degrees/minutes/seconds): u�� e /+ a N
Longitude (degrees/minutes/seconds): �e 3�/ r �� 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
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SWU-236-080113 Last revised 7/2/14

`
StonnwaterOutfallNo.
___
Latitude (degrees/minutes/seconds)-. N
Longitude (deg naeo/minubos/sennnda): YV
10) Receiving waters:
What iathe name ofthe body bodies ofwater (oroekstream, river, lake, etc)that the facility otormvvator
discharges end upin?
e-
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).
11) Does this facility have any other water quality permits?
XNn
UYes
If yes, list the permit numbers for all current water quality permits for this facility:
12) Does this facility have any Non -Discharge permits (ex: recycle permits)?
XNo
El Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
13) Does this facility employ any best management practices for stormwater control?
XNo
El Yes
If yes, please briefly describe:
$No
El Yes
|fyes, when was itimplemented?
i5)Does this facility have exposed accumulations ofsawdust, bark, mulch, wood chips, orsimilar size
woody material on -site for longer than seven (7)days? (Exposed directly torainfall orbmrun-on from
other areas of the facility.)
16) Are vehicle maintenance activities occurring at this facility?
XNo 1:1 Yes
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
No Yes
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c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
KNo ❑ 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:
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:
Title: 0wvee .
(Sign re of Applicant)
lippilipippliql
(Date Signed)
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SWU-236-080113 Last revised 7/2/14

This application will bereturned maincomplete unless all ofthe following items have been included:
Check for $1OOmade payable huNCDEQ
This completed application and all supporting documents
Copy of county map or USGS quad sheet with location of facility clearly marked on map
DEWLR-StonnwaterPmgnam
Dept of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27GAA-1S12
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact thmQBMLR Central Office or Regional Office for your area.
To visit our website, go to ht!2.IlDortal.ncdenr.oMlweblirlstormwater
Asheville Office ......
(82O)20S'45O0
Fayetteville Office ...
(910)433-330O
Mooresville Office ...
[phone]
Raleigh Office ........
(O1Q)701-42U8
Washington Office
'(252)046'6481
Wilmington Office ...
[phone]
Winston-Salem...
(336)771~5000
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