NCS000466_APPLICATION_20040510

STORMWATER DIVISION CODING SHEET
MS4 PERMITS
PERMIT NO.
DOC TYPE
❑FINAL PERMIT
❑ /jAfNUAL REPORT .
B�APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
6'1
YYYYMMDD

f
State of North Carolina
Department of Environment & Natural Resources
Division of Water Quality
OFFIC USE ONLY
Date Rec'd
Fee Paid
7i5 J
Permit Number
NPDES STORMWATER-PERMIT"APPLICATI N F0fjM
This application form is for use by -public bodies seeking NPDES stormwater permit coverage for Regulated Public
Entities (RPE) pursuant -to Title 15A North Carolina Administrative Code 2H :0126. A complete application
package includes this form and three copies of the narrative documentation -required in Section X of this form.
This application form, completed in accordance with Instructions for completing NPDES Small MS4 Stormwater,: -
�. .n'C.yv... f
Permit Application(SWU-274) and the accompanying narrative documentation,,cogs►pleted-`in'atcbrtianwithyl ;
Instructions for Preparing -the Comprehensive Stormwater Management Program Report (SWU 266)_are�tio>
required for the application packageto be considered a complete applicat' submittal,:, Incompl " -a�"7 �1pli 10r1
submittals may be returned to the applicant.
I. APPLICANT STATUS INFORMATION
a.
Name of Public Entity
Hillsborough
Seeking Permit Coverage
b.
Ownership Status (federal,
Local
state or local
c.
Type of Public Entity (city,
Town „ ..... ....n...,. .... ...,.-.. _. L,_.ww,_... -
town, county, prison, school,
etc.
d.
Federal Standard Industrial
SIC 91 - 97
Classification Code
e.
County(s)
Orange
f.
Jurisdictional Area (square
5.6 sq. mi.-Town Limits (calculated from GIS database)
miles)
5.1 sq. mi.-ETJ (calculated from GIS database
g.
Population
Permanent
5,535 (7/02-NC State Data Center)
Seasonal (if available)
N/A
h.
Ten-year Growth Rate
27.750/o (2.78% Annual Growth Rate)
2001-2010 projection based on 1990-2000 growth rate
L
Located on Indian Lands?
❑ Yes ® No
II. -RPE / MS4 SYSTEM INFORMATION
a.
Storm Sewer Service Area
(square miles
5.6 sq. mi. (Town Limits)
b.
River Basin(s)
Neuse
c.
Number of Primary Receiving
Streams
Two (Eno River,'Sevenmile Creek)
d.
Estimated percentacle of jurisdictional
area containing the following four land use activities:
•
Residential
26%
•
Commercial
14%
•
Industrial
4%
•
Open Space
56%
Total =
100%
e.
Are there significant water
quality issues listed in the
attached application report?
❑ Yes ® No
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I

NPDES RPE Stormwater Permit Application
III. EXISTING LOCAL WATER QUALITY PROGRAMS
a. Local Nutrient Sensitive Waters Strategy
❑ Yes ® No
b. Local Water Supply Watershed Program
® Yes ❑ No
c. Delegated Erosion and Sediment Control Program
❑ Yes ® No
d. CAMA Land Use Plan
❑ Yes ® No
IV. CO -PERMIT APPLICATION STATUS INFORMATION
(Complete this section only if co -permitting)
a. Do you intend to co -permit with
❑ Yes ® No
a permitted Phase I entity?
b. If so, provide the name and permit number of that entity:
• Name of Phase I MS4
N/A
• NPDES Permit Number
N/A
c. Do you intend to co -permit
❑ Yes ® No
with another Phase II entity?
d. If so, provide the name(s) of
the entity:
N/A
e. Have legal agreements been
finalized between the co-
❑ Yes ® No
ermittees?
V. RELIANCE ON ANOTHER ENTITY TO SATISFY ONE OR MORE OF YOUR PERMIT OBLIGATIONS
(If more than one, attach additional sheets)
a. Do you intend that another
entity perform one or more of
® Yes ❑ No
our permit obligations?
b. If yes, identify each entity and the element they will be implementing
• Name of Entity
Orange County
NC DOT
• Element they will implement
Erosion/Sediment Control
State Highway BMP's
• Contact Person
Reynolds (Ren) J. Ivins
Tommy Dyer
Div. Maintenance Eng.
P.O. Box 8181
District 7/Division 1
• Contact Address
Hillsborough, NC 27278
8245 Main St.
Graham NC 27253
• Contact Telephone Number
[phone]
[phone]
c. Are legal agreements in place
® Yes ❑ No
to establish responsibilities?
VI. DELEGATION OF AUTHORITY (OPTIONAL)
The signing official may delegate permit implementation authority to an appropriate staff member. This
delegation must name a specific person and position and include documentation of the delegation action
through board action.
a. Name of person to which permit authority
N/A
has been delegated
b. Tide/position of person above
N/A
c. Documentation of board action delegating permit authority to this person/position must be
_provided in the attached application report.
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SWU-264-103102

NPDES RPE Stormwater Permit Application
VII. SIGNING OFFICIAL'S STATEMENT
Please see the application instructions to determine who has signatory authority for this permit
application. If authority for the NPDES stormwater permit has been appropriately delegated through
board action and documented in this permit application, the person/position listed in Section VI above
may sign the official statement below.
I certify, under penalty of law, that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible forgathering the
information, the information submitted is, to the best of my knowledge and belief, true, accurate,
and complete. lam aware that there are signiAcant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations.
Signature
_
Name
Eric kterson
Title
Town Manager
Street Address
101 E. Orange Street
PO Box
429
city
Hillsborough
State
NC
Zip
27278
Telephone
919-732-1270 xt.80
Fax
919-644-2390
E-Mail
[e-mail]
VIII. MS4 CONTACT INFORMATION
Provide the following information for the person/position that will be responsible for day to day
implementation and oversight of the stormwater program.
a.
Name of Contact
Person
Demetric Potts
b.
Title
Public Works Director
c.
Street Address
101 E. Orange Street
d.
PO Box
429
e.
City
Hillsborough
f.
State
NC
g.
Zip
27278
h.
Telephone Number
919-732-1270 xt.77
i.
Fax Number
919-644-2390
j.
E-Mail Address
[e-mail]
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NPDES RPE Stormwater Permit Application
IX. PERMITS AND CONSTRUCTION APPROVALS
List permits or construction approvals received or applied for under the following programs. Include contact
name if different than the person listed in Item VIII. If further space needed, attach additional sheets.
a.
RCRA Hazardous Waste
N/A
Management Program
N/A
b.
UIC program under SDWA
c.
NPDES Wastewater Discharge
NCO026433
Permit Number
d.
Prevention of Significant
N/A
Deterioration (PSD) Program
N/A
e.
Non Attainment Program
f.
National Emission Standards for
N/A
Hazardous Pollutants (NESHAPS)
reconstruction approval
g.
Ocean dumping permits under the
N/A
Marine Protection Research and
Sanctuaries Act
h.
Dredge or fill permits under
N/A
section 404 of CWA
X. NARRATIVE APPLICATION SUPPLEMENT; STORMWATER MANAGEMENT PROGRAM REPORT
Attach three copies of a comprehensive report detailing the proposed stormwater management program for
the five-year permit term. The report shall be formatted in accordance with the Table of Contents shown
below. The required narrative information for each section is provided in the Instructions for Preparing the
Comprehensive Stormwater Management Program Report (SWU-268). The report must be assembled in the
following order, bound with tabs identifying each section by name, and include a Table of Contents with
page numbers for each entry.
TABLE OF CONTENTS
STORM SEWER SYSTEM INFORMATION
1.1. Population Served
1.2. Growth Rate
1.3. Jurisdictional and MS4 Service Areas
1.4. MS4 Conveyance System
1.5. Land Use Composition Estimates
1.6. Estimate Methodology
1.7. TMDL Identification
2. RECEIVING STREAMS
3. EXISTING WATER QUALITY PROGRAMS
3.1. Local Programs
3.2. State programs
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NPDES RPE Stormwater Permit Application
4. PERMITTING INFORMATION
4.1. Responsible Party Contact List
4.2. Organizational Chart
4.3. Signing Official
4.4. Duly Authorized Representative
5. Co -Permitting Information (if applicable)
5.1. Co-Permittees
5.2. Legal Agreements
5.3. Responsible Parties
6. Reliance on Other Government Entity
6.1.
Name of Entity
6.2.
Measure Implemented
6.3.
Contact Information
6.4.
Legal Agreements
7. STORMWATER MANAGEMENT PROGRAM
7.1. Public Education and Outreach on Storm Water Impacts
7.2. Public Involvement and Participation
7.3, Illicit Discharge Detection and Elimination
7.4. Construction Site Stormwater Runoff Control
7.5. Post -Construction Storm Water Management in New Development and Redevelopment
7.6. Pollution Prevention/Good Housekeeping for Municipal Operations
Page 5
5W U-264-103102