NCG060364_ROS Request_20170523

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NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
REPRESENTATIVE OUTFALL STATUS (ROS)
REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
If a facility is required to sample multiple discharge locations with very similar storm water discharges, the
permittee may petition the Director for Representative Outfall Status (ROS). DWQ may grant Representative
Outfall Status if stormwater discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted, ALL outfalls are still subject to the qualitative monitoring
requirements of the facility's permit —unless otherwise allowed by the permit (such as NCG020000) and DWQ
approval. The approval letter from DWQ must be kept on site with the facility's Stormwater Pollution
Prevention Plan. The facility must notify DWQ in writing if any changes affect representative status.
For questions, please contact the DWQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N C I S N C G 0 6 0 3 6 4
2) Facility Information:
Owner/Facility Name Butterball
Facility Contact
Street Address
City
County
Telephone No.
Lankford Ruffin
3628 South Fields Street
Farmville
Pitt
919-255-7900 ext 7989
State NC ZIP Code 27828
E-mail Address [e-mail]
Fax:
3) List the representative outfalls) information (attach additional sheets if necessary):
Outfall(s) 2
is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities?
Outfalls' drainage areas contain the same or similar materials?
Outfalls have similar monitoring results?
Outfall(s)
is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities?
Outfalls' drainage areas contain the same or similar materials?
Outfalls have similar monitoring results?
Outfall(s)
is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities?
Outfalls' drainage areas contain the same or similar materials?
Outfalls have similar monitoring results?
1and 3
x Yes ❑ No
x Yes ❑ No
x Yes ❑ No x No data* (for
Outfall 3)
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No ❑ No data*
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No ❑ No data*
Page 1 of 4
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfall Status Request
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or, attach a letter or narrative to discuss this information.) For example, describe how activities and/or
materials are similar.
3 to Drainage Area 2, Outfall 2 is considered representative of Outfalls 1 and 3.
5) Certification:
North Carolina General Statute 143-215.6 B([) 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 Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DWQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my NPDES 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: Lankford Ruffin
Title: 0 f 00 P�,'� C5"J-�f� �✓nen ,..) �'[..Ha�i e'r
(Signotu of Applicant) (Date Signed)
Please note: This application for Representative Outfall Status is subject to approval by the
NCDENR Regional Office. The Regional Office may inspect your facility for compliance with the
conditions of the permit prior to that approval.
Page 2 of 4
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfall Status Request
Final Checklist for ROS Request
This application should include the following items:
x This completed form.
❑ Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
x Two (2) copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
x Summary of results from monitoring conducted at the outfalls listed in Question 3.
❑ Any other supporting documentation.
Mail the entire package to:
NC DENR Division of Water Quality
Surface Water Protection Section
at the appropriate Regional Office (See map and addresses below)
Notes
The submission of this document does not guarantee Representative Outfall Status (ROS) will be granted as
requested. Analytical monitoring as per your current permit must be continued, at all outfalls, until written
approval of this request is granted by DWQ. Non-compliance with analytical monitoring prior to this request
may prevent ROS approval. Specific circumstances will be considered by the Regional Office responsible for
review.
For questions, please contact the DWQ Regional Office for your area.
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Phone [phone]
FAX [phone]
Fayetteville Regional Office
Systel Building,
225 Green St., Suite 714
Fayetteville, NC 28301-5094
Phone [phone]
FAX [phone]
Mooresville Regional Office
610 East Center Ave.
Mooresville, NC 28115
Phone [phone]
FAX [phone]
Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
Phone [phone]
FAX [phone]
Page 3 of 4
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfall Status Request
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone [phone]
FAX [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone [phone]
FAX [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Phone [phone]
Water Quality Main FAX [phone]
Central Office
1617 Mail Service Center
Raleigh, NC 27699-1617
Phone [phone]
FAX [phone]
Page 4 of 4
SWU-ROS-2009 Last revised 12/30/2009

CONTAINER LIST ID
DESCRIPTION
CONTENTS
T-1 (8,400-GAL. LIQUID LYSINE)
1
AMINO ACID AST AREA
T-2 (8,400-GAL. METHIONINE)
(NON -OILS)
T-3 (6,500-GAL. LIQUID CHOLINE)
T-4 (7,600-GAL. VEGETABLE OIL)
VEGETABLE OIL &
T-5 (8,600-GAL. VEGETABLE OIL)
2
BLENDED FAT AST AREA
T-6 (19,800-GAL. BLENDED FAT)
T-7 (26,600-GAL. BLENDED FAT)
(4) MACHINE OIL DRUMS (55-GAL.)
(1) USED OIL DRUM (55-GAL.)
3
WAREHOUSE
(1) ALTRA PAO COMPRESSOR 46 OIL
(55-GAL.)
(1) SANTOQUIN TOTE NON -OIL (360-GAL.)
4
SANTOQUIN STORAGE
(1) SANTOQUIN TOTE NON -OIL (350-GAL.)
BUILDING
- `LE/
FERTILIZER TANK FARM
,,USED BY SOUTHERN STATES
FORMER SILO LOCA
— _.._. EQUI
_ LW
ORMWATER PERK
ESTERN BOUNDAI
x
LEGEND
SITE PROPERTY BOUNDARY
iQ
CONTAINER LIST ID
-->-->
WATER FILLED DRAINAGE DITCH
AST SPILL MATERIALS
®
(FOR LARGER SPILLS)
DRAINAGE FLOW DIRECTION
DRAINAGE AREA BOUNDARY
®
STORMWATER CATCH BASIN
—
— — —
STORM SEWER
STORMWATER OUTFALL LOCATION
TRIBUTARY OF MIDDLE SWAMP
®
SPILL KIT LOCATION
TOP DUMPSTER
®CLOSED
LOADING/UNLOADING AREA
®T
PAD -MOUNTED TRANSFORMER
MAINTENANCE SH
$$ BUILDI
17
r
'TE1
1 fill
WAREHOUSE i[,I— T
j 1
/ 2 if •. T f,.
e — DRAPE AREA 1own
_ +
FEED MIEVATED TOWER
I COVERED GRAIN OFFICE
UNLOADING
NNW
WAREHOUSE &RETAIL STORE
/ � _ — � LEASED TO SOUTHERN STATES
RAINAGE AREA 2r WALLACE STREET
OUTFACE #1
NOTES:
1. AST SPILL MATERIALS INCLUDE BOOMS, STORMDRAIN
COVER, PUMPS, HOSES, ETC.
2. USE STORMDRAIN COVER DURING ANY LOADING/
UNLOADING OPERATION
3. AREA 1: APPROX. 2.5 ACRES (54% IMPERVIOUS)
AREA 2: APPROX. 3.4 ACRES (35% IMPERVIOUS)
AREA 3: APPROX. 0.4 ACRES (17% IMPERVIOUS)
FACILITY LAYOUT MAP
PROJECT BUTTERBALL, LLC FEED MILL
APPROXIMATE 0 120 240 3628 SOUTH FIELDS STREET
SCALE IN FEET FARMVILLE, NORTH CAROLINA
• 2923 South Tryon Street -Suite 100
hart h i c k m a n Charlotte, North Carolina 28203
704-586-0007(p) 704-586-0373(f
SMARTER ENVIRONMENTAL SOLUTIONS License # C-1269 / #C-245 Geology
DATE: 5-22-17 REVISION NO. 0
JOB NO. BTB-002 FIGURE NO. 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted cZ 7 )- l o Zalp
i
CERTIFICATE OF COVERAGE NO. NCGO6 U 3 _� q SAMPLE COLLECTION YEAR 2
FACILITY NAME Cia�oJb r� /�7////�q �'o. /rg�,����P��/jli�l FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY P/ f y- ❑ use/process meats Q'use animal fats/byproducts
PERSON COLLECTING SAMPLES 04,17 7e1,-4 DISCHARGING TO SALTWATERS? []YES [Q&O
LABORATORY PROP 14n4 VtjC,; /_ Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall z or ❑ No discharge this period3
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
500
7. 7
6
z 3
Orp -V
y
/,"
7
3 R
o•'PIP, 4
r9
Only applies to facilities -that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ®no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6.0 — 9.0
-
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
S WU-249
(if yes, complete Part B)
Last Revised: October 18, 2012
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