NCG200526_Application_20190904

NCG2 ODSZL
Division of Energy, Mineral, and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
Environmental
Quality NCG200000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
Certificate of Covera e
NCG
Check #
I Amount
D
logy
Permit Assigned to
S. +)f ►c 14,
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG200000 for STORMWATER DISCHARGES associated with activities classified as:
SIC 5093 Scrap Metal Recycling (except as specified below)
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
The following activities are excluded from coverage under this General Permit: 9 T
(. e ., x,.:,
• Automobile Wrecking for Scrap (a portion of SIC 5093)
• Non -Metal Scrap Recycling (a portion of SIC 5093) SEP 0 4 2019
• Used Motor Vehicle Parts (SIC 5015) DENP-LAND QUAD T Y
(Please print or type) STORI�11'01ATE€R R"z'�I1,"iT7ING
1) Mailing address of t,1W ownerl Aerator (address to which official permit correspondence will be mailed):
Name2�� SIA�� (�'l In
Owner Contact
Street Address f t5
City (-(A Statet\;�, _ZIP Code
Telephone No. _3CIj '"% ZJQ Fax:
E-mail Address
2) Location of the facility producing the discharge:
Facility Name F USSR t ij �S(A U CA aI,c. �. �. L
Facility Contact �� CA rljI4 j 11� Ili 1 (A. J
Street Address
City L61 %ram in (/c State (y f ZIP Code 5
County W ct d rl'c
Telepho e No. ZS"LiD(p ` 13��� Fax:
Email
3) Physical Location Information:
Please provide a description of how to get to the facility (use street names, state road numbers, and distance
and direction from Fa roadway intersection). 'I'IAYY\ b r\tU WA1VNi n (A f0 V % S , !A f WV1'A % G
(A copy of a county map or USGS quad sheet with facility clearly located on the map is a required part of this application.) OY)J F%ASSC l t Sd `VPC}t
4 p� V.Y s 11 IQL 0 Vt i
4) Latitude . 3� 13�J, Longitude` —(degrees, minutes, seconds) ,J
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility* Date operation is to begin
Existing
*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 Storrnwater Permit is required prior to construction.
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NCG200000 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: 5 G q
7) Services and Activities
a) Provide a brief description of the types of industrial activities and products manufactured at this
facility: (Include a site diagram of the process areas and location of activities present at this facility.)
b'l'iA.l,Iii) '9� ('6:VCftn tT 1,AJWff MCI ILC(I'l-A I
b) Chec all activities conducted at this facility..
Outdoor stockpiling of materials U111"t���
Processing — cutting, grinding,
crushing, baling, separation, etc.
Storage of materials in above-
ground tanks
Material loading and unloading
8) Discharge points / Receiving waters:
❑ Transport of materials by a conveyor
or front-end loader
Vehicle and equipment maintenance
Vehicle or equipment washing
Vehicle and equipment fueling
How many dis har e points ditch , pipes, channels, curb and gutter, swales, etc.) convey stormwater from
the property?f��
What is the name of the bo y or bodigs of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in?
If the site stormwater disc arges 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. ►
Latitude (degrees/minutes/seconds): j J . I N
Longitude (degrees/minutes/seconds): % _ V-1 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
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NCG200000 N.O.I.
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): _
Longitude (degrees/minutes/seconds):
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): _
Longitude (degrees/minutes/seconds):
N
W
N
W
9) Does this facility:
a) Have an untreated wastewater discharge? No El Yes
b) I lave a treated wabtewaiteEr dibuhargo? Nu ❑Yes
If yes, list the permit number.
c) Have a wastewater discharge from a recycle system? 6d No ❑ Yes
If yes, list the permit number.
d) Have a non -discharge permit? © No ❑ Yes
If yes, list the permit number.
e) Discharge wastewater to a municipal wastewater collection system? V No ❑ Yes
If yes, list the municipality and permit number
Note: Stormwater discharge permit NCG200000 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 NCG200000.
10) Does this facility employ any best management practices for stormwater control?
LJ 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?
NJ No ❑ Yes
If yes, when was it implemented?
12) Are vehicle/ 7es
pment maintenance activities occurring at this facility?
El No
13) Hazardous Waste:
a) IS�this facility a I lazardoris Waste Treatment, Storage, or Disposal Facility?
�d No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
haza -dous waste?
o ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
ha ardous waste?
To ❑ Yes
d) �No
azardous waste stored in the 100-year flood plain?
❑ Yes If yes, include information to demonstrate protection from flooding.
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S W U-235-012815
Last revised 01/28/15

NCG200000 N.O.I.
e) 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:
14) Certification:
North Carolina General Statute 143-215.6B (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 P rson Signing: _;T 4r rj Scc /! iJ otd
Title: v/ p/ C
(Signature of pplicant) (Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDEQ
SEP 0 4 2019
DENR-LAKID QUALITY
STORN[WATER PERMITTING
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NCG200000 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 along with 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://PortaLncdenr.orglweblir/stormwater
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
707-9220
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SWU-235-012815 Last revised 01/28/15

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Use Map Box/Point Current Extent Coaxdinates .. Located Point Polygon:
Map Indices 1 Degree 15 Minute 7.5 Minute All
Address/Place . 134 Fussell Road LaGrange, NC
11
I : viewer.nationalrnap.gov
Name Lon/Lat
134 Fussell Rd, La ,77.8282/
Grange, North 35.3107
Carolina, 28551

North Carolina Secretary of State Search Results
Page 1 of 1
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Limited Liability Company
Legal Name
Fussell Salvage, LLC
Information
Sosld: 1180165
Status. Currerrl Aulive
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 12/16/2010
Registered Agent: Sullivan, Garry Wayne
Addresses
Mailing
134 Fussell Road
LaGrange, NC 28551-7744
Company Officials
Principal Office
134 Fussell Road
LaGrange, NC 28551-7744
Reg Office Reg Mailing
134 Fussell Road 134 Fussell Road
LaGrange, NC 28551-7744 LaGrange, NC 28551-7744
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Garry W Sullivan
134 Fussell Road
LaGrange NC 28551
https://www.sosnc.gov/online_services/searchBusiness Registration_Results 9/5/2019