NCG060382_COMPLETE FILE - HISTORICAL_20180614

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV C,&O�D I"�.
W
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

..iN£A t OP6MTEh _.
June 14, 2018
James Moore
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Mr. James Moore,
In accordance to General Permit No. NCG060000, I am forwarding you Section E's requirement of an
assessment of best management practices for our Statesville Breeder Feed Mill, COC No. NCG060382. A
BMP assessment was submitted in October of 2017; however, the site was only in the permit for 4
months and an adequate BMP assessment was not able to be conducted. This submittal is a follow up to
the October 2017 assessment.
I hope that you find the attached BMP Assessment satisfactory to meet the permit requirement. if you
have any questions, please feel free to contact me at 302-934-3070.
Thank you,
Austin Pajda
Environmental Manager
Cc: John Wren (Mountaire)
Beth Sise (Mountaire)
Tanya Rogers -Vickers (Mountaire)
John Jacobs (Mountaire)
Mountaire Farms Inc.
"We measure quality by how well we service our internal and external customers"

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Assessment Report - Mountaire Farn% b
Statesville Feed Mill `n N `�
m n as m
c
1. A narrative description of all the material handling activities that are outside: The Statesville
Feed Mill produces poultry feed. The materials that are stored outside are liquid and are stored
in tanks within a locked containment dike. Animal Fat, choline, lysine, and alimet are all stored
in this containment area. There is also a 12,000-gallon double walled diesel tank located on a
concrete pad towards the back of the facility outside.
2. A feasibility evaluation as to whether reduced exposure can be achieved at the site: Due to
the size and the number of storage tanks, and the need to have accessibility by tanker trucks,
this area must be outside_ However, exposure to rainfall is kept to a minimum through existing
Best Management Practices (BMP's). These bulk liquids are off loaded using a strict protocol.
Each fill line is kept locked when not in use. Catch pans are mounted beneath each fill line.
Buckets are used beneath the truck that is offloading to catch any drips from the hose. The
driver remains with the truck during offloading as a precaution.
The Statesville Feed Mill maintains and complies with a Spill Prevention Control &
Countermeasure Plan (SPCC) as well as a Storm Water Pollution Prevention Plan (SWP3). This
includes good housekeeping practices, preventative maintenance, monthly tank inspections,
semi-annual facility inspections, and annual training. These measures reduce the risk of spills
and in turn exposure to rainfall. Rainfall accumulated within the containment dike is inspected
for contamination prior to release.
3. An evaluation of the presence or absence of animals/wildlife on -site and whether fecal
coliform concentrations might be correlated to the presence or absence of those
animals/wildlife: A storm water sample was obtained in December of 2017 which showed a
fecal concentration of >6000. A sample for the first half of 2018 has not yet been taken due to
timing of rain events; however, one is scheduled to be taken before the end of June. As cited in
the previous submittal, there is not a major presence of wildlife; however, there are birds on
site whose refuse may contribute to elevated fecal results.
4. A corrective action measures plan with milestones and schedule for implementation: The
Statesville Feed Mill will continue to maintain and implement the SPCC and SWP3 plans. In
addition, the procedures in place for offloading liquid ingredients will continue. Statesville Feed
Mill completed a storm water upgrade at the end of last year which included installing concrete
drives as well as multiple catch basins and an oil and water separator leading to the outfall. To
alleviate the potential for elevated effluent results, the oil and water separator will now be
cleaned on a quarterly basis (previously it was semi-annual). The storm water plan has been
updated to reflect this increased BMP practice. Current BMP's will be reviewed upon analyzing
the next sample results.

..aiNF.Q x or6MreD �.
October 25, 2017
James Moore
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Mr. James Moore,
nVA
i�
J1
0
In accordance to General Permit No. NCG060000 which is set to expire on October 31, 2017, 1 am
forwarding you Section E's requirement of an assessment of best management practices for our
Statesville Breeder Feed Mill, COC No, NCG060382. A discussion was held with the Raleigh Office in
regards to this expiring permit to which they suggested that the BMP Assessment be submitted now to
satisfy the requirement per the expiring permit.
Please take note that our facility received coverage under this permit on June 13, 2017; however, due to
a storm water construction project, a representative sample of facility conditions was not able to be
taken. We are anticipating to obtain a sample for the second half of 2017 as construction is near
completion and, as stated in the BMP assessment, we will be able to further evaluate our control
practices during that time.
I hope that you find the attached BMP Assessment satisfactory to meet the permit requirement. If you
have any questions, please feel free to contact me at 302-934-3070.
Thank you,
Austin Pajda
Environmental Compliance Coordinator
Cc: John Wren (Mountaire)
Beth Sise (Mountaire)Q*
Mountaire Farms Inc.
"We measure quality by how well we service our internal and external customers"

Assessment Report - Mountaire Farms,
Statesville Feed Mill
1. A narrative description of all the material handling activities that are outside: The Statesville
Feed Mill produces poultry feed. The materials that are stored outside are liquid and are stored
in tanks within a locked containment dike. Animal Fat, choline, lysine, and alimet are all stored
in this containment area. There is also a 12,000-gallon double walled diesel tank located on a
concrete pad towards the back of the facility outside.
2. A feasibility evaluation as to whether reduced exposure can be achieved at the site: Due to
the size and the number of storage tanks, and the need to have accessibility by tanker trucks,
this area must be outside. However, exposure to rainfall is kept to a minimum through existing
Best Management Practices (BMP's). These bulk liquids are offloaded using a strict protocol.
Each fill line is kept locked when not in use. Catch pans are mounted beneath each fill line.
Buckets are used beneath the truck that is offloading to catch any drips from the hose. The
driver remains with the truck during offloading as a precaution.
The Statesville Feed Mill maintains and complies with a Spill Prevention Control &
Countermeasure Plan (SPCC) as well as a Storm Water Pollution Prevention Plan (SWP3). This
includes good housekeeping practices, preventative maintenance, monthly tank inspections,
semi-annual facility inspections, and annual training. These measures reduce the risk of spills
and in turn exposure to rainfall. Rainfall accumulated within the containment dike is inspected
for contamination prior to release.
3. An evaluation of the presence or absence of animals/wildlife on -site and whether fecal
coliform concentrations might be correlated to the presence or absence of those
animals/wildlife: Due to the stormwater construction project upgrade, a sample representative
of facility conditions has not been obtained. During previous inspections, there was no major
indications of animals on -site (other than passing birds) which would cause elevated fecal
coliform concentrations to be present in samples. This will be evaluated further as the facility
continues inspections and can obtain a representative sample of actual facility conditions post
construction.
4. A corrective action measures plan with milestones and schedule for implementation: The
Statesville Feed Mill will continue to maintain and implement the SPCC and SWP3 plans. In
addition, the procedures in place for offloading liquid ingredients will continue. Statesville Feed
Mill just completed a storm water upgrade which included installing concrete drives as well as
multiple catch basins and an oil and water separator leading to the outfall. This has an
associated cleaning practices outlined in the SWP. Continued evaluation of current processes
will be conducted and, if a need for improvement is noticed, necessary actions will be taken.

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060382
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Mountaire Farms, Inc.
is hereby authorized to discharge stormwater from a facility located at
Mountaire Farms — Statesville Breeder Feed Mill
2206 West Front Street
Statesville
lredeli County
to receiving waters designated as UT to Third Creek, a class C water in the Yadkin -Pee Dee
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts 1, II, III, and IV of General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective June 13, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 13, 2017.
ORIGINAL SIGNATURE by RICHARD L. RIDDLE, JR.
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
June 13, 2017
Mr. Jimmy Paulakuhn
Vice President of Live Operations
Mountaire Farms, Inc.
P.O. Box 1320
Millsboro, DE 19966
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
Subject: General Permit No. NCG060000
Mountaire Farms — Statesville Breeder Feed Mill
COC No. NCG060382
Iredell County
Dear Mr. Paulakuhn:
In accordance with your application for a discharge permit received on May 23, 2017, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
Please note that the attached permit expires on October 31, 2017. Your COC will be automatically
renewed to cover the full 5 year term of the soon to be reissued permit. In the interim you must abide
by the terms of the expiring permit. You can review the proposed general permit changes once they
are posted at: htW://deg.nc.govlabout/divisions%energy-mineral-land-resources/events.
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Sueet I Raleigh, NC 27699-1612
919 707 9200 T

If you have any questions concerning this permit, please contact Julie Ventaloro at telephone number
[phone] or by email [e-mail].
Sincerely,
ORIGINAL SIGNATURE by RICHARD L. RIDDLE, JR
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central Files
Stormwater Permitting Program Files
$to ofN m&C=F= I Env==wW Q=1dYI Ena . gal andLacd Re�axa
1612 Mid senire meter 1 512 Norm S&Ebwyk aet I Ral 06 NC 776MI612
919 707 9200 T

W
NCDENR
E—-Ew —D n'"l RESEg
NOTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG060000
mom
National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO60000:
STORMWATER DISCHARGES associated with activities classified as:
1)
2)
SIC (Standard Industrial Classification) 20 Food and Kindred Products
SIC 21 Tobacco Products
SIC 283 Drugs
SIC 284 Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations
SIC 422 Public Warehousing and Storage (except 4226)
For questions, please contact the DEMLR Regional Office for your area. See page 4.
Do Not use this N01 for renewals.
(Please print or type)
Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name Mountaire Farms Inc.
Street Address PO Box 1320
City Maisboto State DE ZIP Code 19966
Telephone No. 302 934-3070 Fax: [phone]
Location of facility producing discharge:
Facility Name Mountaire Farms -Statesville Breeder Feed Mill
Facility Contact John Jacobs
Facility Address 2206 west Front street
Facility City Statesville State Nr- ZIP Code
Facility County iredell
Telephone No. 704 978-3055 Fax:
Email j acobsarnountaire.com
3) Physical Location Information:
28687
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). From 1-40, take exit to take NG-90 EIUS-64E. In two tenths
of a mile, turn left on to State Rd 1359. In one half of a mile, the feed mill will be on the left at address 2206 W Front St_
(A copy of a county map or USGS quad sheet with the facility dearly located must be submitted with this application.)�y
4) Latitude 350 47' 24.6372" N Longitude 80' 35' 34.248" W (deg, min, sec) W. 1 y ?00 1 I
5) This NPDES Permit Application applies to which of the following: O V ' 9 O��
❑ New or Proposed Facility
IR Existing
Date operation is to begin
Page 1 of 4
Last revised 6/24114

NCG060000 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. 2 0 4 8
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility: Feed is produced for chicken
b) Check all activities occurring at this facility:
0 use or process meats 9 use or process animal fats/byproducts
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 2
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Third Creek
Receiving water classification: c
Is this a 303(d) listed stream? NO Has a TMDL been approved for this watershed? N/A
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). NIA
9) Does this facility have any other NPDES permits?
X No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
11) Does this facility employ any best management practices for stormwater control?
❑ No
X Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe: Routine sweepings and catch basin cleanings.
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
IR Yes
If yes, when was it implemented? May 1, 2017
13) Are vehicle maintenance activities occurring at this facility?
X No ❑ Yes
Page 2 of 4
5WU-221 Last revised 6/24114

NCG060000 N.O.I.
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
M No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
R No ❑ Yes If yes, include information to demonstrate protection from flooding.
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:
15) Certification:
North Carolina General Statute 143-215.613 (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 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,4anda accurate.
Printed Name of Person j�igniQi—
Title: .� ; rh aK y f �t k �a. �G �_in ll i �-C� f e5 �` t G (.,r y e. drh-n
5� 17
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR. Do not send the check or money order separately.
Page 3 of 4
SWU-221 Last revised 6/24114

NCG060000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
l� Check for $100 made payable to NCDENR. Must be included with this application (not sent separately).
This completed application and all supporting documents.
if 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 the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
loaded, and unloaded, (f) impervious areas, (g) site property lines.
52( Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-W1
Wilmington Office...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 4 of 4
SWU-221 Last revised 6124114

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May 1, 2017
Stormwater Permitting Unit Program
Division of Energy, Mineral and land Resources
1612 Mail Service Center
Raleigh, North Carolina 27669-1612
To whom it may concern:
RFC
DPA
pRM ��NOQUQ ZVI?
RpFRM[� G
Please find the attached Notice of Intent application for coverage under General Permit
NCG060000 for the Mountaire Farms Statesville Breeder Feed Mill. The application, check made
payable to NCDENR for $100, site diagram, and USGS quad sheet with the facility's location are
all included within this submittal.
Should you have any questions, please feel free to contact me at 302-934-3070.
Sincerely,
Austin Pajda
Environmental Compliance Coordinator
CC: John Wren (Mountaire Farms]��`"
Beth Sise (Mountaire Farms
If
Mountaire Farms
"We measure quality by how well we service our internal and external customers"

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Compliance Inspection Reaolrt
Permit: NCG060382 Effective: Expiration:
SOC: Effective: Expiration:
County: Iredell
Region: Mooresville
Contact Person: John Jacobs Tide:
Directions to Facility:
from 1-40 take exit to take NC 90 FJUS 64E, left on State Rd 1359, feed mill is on left.
System Class'd'ications:
Primary ORC: Certification:
Secondary ORC(s):
OnSite Repressntative(s).
Related Permits:
Owner: Mountaire Farms Inc
Facility: Mountaire Farms - Statesville Breeder Feed Mill
2206 W Front St
Statesville NC 28687
Phone: [phone]
Phone:
Inspection Date: 06/08/2017 Entry Time: 02:30PM licit Time: 02:50PM
Primary Inspector: James D Moore Phone:
Secondary Inspector(s):
Angela Y Lee
Reason for Inspection: Routine Inspection Type: Technical Assistance
Permit Inspection Type: Food!Tobacco/Soaps/CosmeticslPublic Warehousing Stormwater Discharge COC
Faciltty Status: Compliant ❑ Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

Permit NCGO60302 Owner - Facility: Mountaire Farms Inc
Inspection Oafs: 06/G81201 7 Inspection Type: Technical Assistance Reason for Visit: Routine
Inspection Summary:
MRO recommends issuing certificate of coverage.
Page: 2

permit NCGO60382 owner - Facility: Mountaire Farms Inc
Inspection Date: 06108l2017 Inspection Type : Technical Assistance Reason for Visit Routine
Permit and Outfalls
Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ❑ ❑ ❑ M
# Were all outfalls observed during the inspection? M ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented. by the Division? ❑ M 110
# Has the facility evaluated all illicit (non store water) discharges? ❑ 0 ❑ ❑
Comment: The inspection was conducted as a result of a notice of intent submitted to Raleigh, May 8.2017.
Based on the inspection we recommend issuing certificate of coverage for NCG060000.
Page: 3

0
Division of Energy, Mineral and Land Resources
��•' Land Quality Section
.�� National Pollutant Discharge Elimination System
c0- NCDR
HNCG060000 �
orn. u.o.,.. m.A,.E� a.
NOTICE OF INTENT
-. J
raram[a[i / : 7.
r�Ee _ .T
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG060000:
STORMWATER DISCHARGES associated with activities classified as:
J
SIC (Standard Industrial Classification) 20 Food and Kindred Products
SIC 21 Tobacco Products
SIC 283 Drugs
SIC 284 Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations
SIC 422 Public Warehousing and Storage (except 4226)
For questions, please contact the DEMLR Regional Office for your area. See page A
Do Not use this NOI forrenewals.
(Please print or type)
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed):
Name Mountalre Farms Inc
Street Address PO Box 1320
City M+lsbom State DE ZIP Code 19966
Telephone No. 302 934-3070 Fax: [phone]
2) Location of facility producing discharge:
Facility Name Mountaire Farms -Statesville Breeder Feed Mill
Facility Contact Join Jacobs
Facility Address rzos west Front Street
Facility City StateS+nEe State NC ZIP Code 28687
Facility County
Telephone No. 704 978-3055 Fax.
Email yambs@moue acre corn
3) Physical Location Information:
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)_ From 1-40, take exit to take NG-90 EfUS-64E In two tenths
of a mile, turn left on to State Rd 1359 In one half of a mile, the feed mill will be on the left at address 2206 W Front St
(A copy of a county map or USGS quad sheet mth the facilely clearly located must be submitted with this applicabon ))r� I �r
4) Latitude 35` 47' 24.6372" N Longitude 80' 55' 34 248" W (deg, min, sec) 36.7
! ?00
5) This NPDES Permit Application applies to which of the following: _ o V
❑ New or Proposed Facility Date operation is to begin
X Existing
Page 1 of 4
SW U-221
Last revised 6124/14

NCGO60000 N.o.l.
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: 2 0 4 8
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility: Feed is produced for chicken
b) Check all activities occurring at this facility:
❑ use or process meats X use or process animal fatslbyproducts
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 2
What is the name of the body or bodies of water (creek, stream, river, lake, etc ) that the facility stormwater
discharges end up in? Third Creek
Receiving water classification. c
Is this a 303(d) listed stream? No Has a TMDL been approved for this watershed? NIA
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). N/A
9) Does this facility have any other NPDES permits?
X No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
1( No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility.
11) Does this fac€lity employ any best management practices for stormwater control?
❑ No
�¢ Yes (Show any structural SMPs on the site diagram.)
If yes, please briefly describe: Routine sweepings and catch basin cleanings.
12) Does this facility have a 5tormwater Pollution Prevention Plan?
❑ No
R Yes
If yes, when was it implemented? May 1, 2017
13) Are vehicle maintenance activities occurring at this facility?
14 No ❑ Yes
Page 2 of 4
SWU-221 Last revised 6/24114

NCGO60000 N.0.1.
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
a No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
JI No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
XNo El Yes
d) Is hazardous waste stored in the 100-year flood plain?
R No ❑ Yes If yes, include information to demonstrate protection from flooding
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 1 disposal vendor: _
Vendor address.
15) Certification:
North Carolina General Statute 143-215.6B (i) provides that:
Any person who knowingiy 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 ruie 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 Commission implementing this Article shall be guilty of a Class t
misdemeanor which may include a fine not to exceed ten thousand donars ($10,000).
t 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
accurate.
Printed Name of Person igni : �1' d
Title: J; n, Aq k F& Fr&SJ` G tl t rr S
5- 17
(Signature -Applicant) (Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR. Do not send the check or money order sei3arately.
Page 3 of 4
SWU-221 Last revised 6124114

NCG060000 N.01
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
9 Check for $100 made payable to NCDENR. Must be included with this application (not sent separately)_
iA This completed application and all supporting documents
W1 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 the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
loaded, and unloaded, (f) impervious areas, (g) site property lines_
Ir Copy of county map or USGS quad sheet wrath the location of the facility clearly marked on the map.
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ...
[phone]
Fayetteville Office ..
[phone]
Mooresville Office ..
[phone]
Raleigh Office_
[phone]
Washington Office
.[phone]
Wilmington Office ..
[phone]
Winston-Salem
[phone]
Central Office
[phone]
Page 4 of 4
SW U-221 Last revised 6124114

r�
May 1, 2017
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27669-1612
To whom it may concern:
Please find the attached Notice of Intent application for coverage under General Permit
NCG060000 for the Mountaire Farms Statesville Breeder Feed Mill. The application, check made
payable to NCDENR for $100, site diagram, and USGS quad sheet with the facility's location arelI
all included within this submittal I
Should you have any questions, please feel free to contact me at 302-934-3070.
Sincerely,
Austin Pajda
Environmental Compliance Coordinator
CC: John Wren {Mountaire Farmsr�`
Beth Sise (Mountaire Farms
Mountaire Farms
"We measure quality by how well we service our infernal and external customers"

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Statesville Breeder Feed Mill Storm Water Site Map_
PIN 4724886592
n/1 WILSON PROPERTIES LIMITED PARTNERSHIP
DO 1344 O PC 1736
LOTS 9-13
PIEDMONT EXPERIMENTAL SIATION
PB 5 O PG 90
PIN 4724082M
n/1 TRANSCAROLINA CORPORATI01
& TRANSCAROLINA HOLDING, INC.
DB 1149 O PC 643
Part at LOT 3
Part 01 LOT 5
& LOT 6
PIEDMONT E)cPCRIMENTAL STATION
PB 5 O PC 90
RECEIVED
MAY 23 2017
DENR-LAND QUALITY
STORMWATER PERMITTING
NMP Point B
NMP Alexander Railroad
Mainline Centerline
200' Railroad R/W
(100' aoch side of C/L)
NMP Point C
Survey for: ,
MO UNTAIRE FARMS INC.
STONE LAND SURVEYING CO. CERTIFIES TO THE FOLLOWiNGI
MOUNTAIRE FARMS INC, '
FIRST AMERICAN 11TLE INSURANCE COMPANY,
ROSE L.AW FIRM, A PROFESSIONAL ASSOCIATION
& CARRUTHERS & ROTH, PA
S

mgo- gOA,-,a k4aAl
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. Jimmy Paulakuhn
Vice President of Live Operations
Mountaire Farms, Inc.
P.O. Box 1320
Millsboro, DE 19966
Dear Mr. Paulakuhn:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Or G Director
June 13, 201rN w�°- In
sn a
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Ln
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�°'� ro
Subject: General Permit No. NCG060000
Mountaire Farms — Statesville Breeder Feed Mill
COC No. NCG060382
lredell County
In accordance with your application for a discharge permit received on May 23, 2017, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
Please note that the attached permit expires on October 31, 2017. Your COC will be automatically
renewed to cover the full 5 year term of the soon to be reissued permit. In the interim you must abide
by the terms of the expiring permit. You can review the proposed general permit changes once they
are posted at: hhtl ://de9ncgov/about divisions energy-mineral-land-resources/events.
State of North Carolina I Environmcntal Quality I EzcW, Mineral and Land Resources
1612 Mail service Center 1 512 Nonb SaGsbu y SeW I Raleigh, NC 27699-1612
919 707 9200 T

If you have any questions concerning this permit, please contact Julie Ventaloro at telephone number
[phone] or by email,[e-mail]_v.
Sincerely,
ORIGINAL SIGNATURE by RICHARD L. RIDDLE, JR.
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central Files
Stormwater Permitting Program Files
Stemsof w&C=m = I Ewnm= WQm6fylEnna}.Ndnua1=dLmdRawmes
161211aSw4w Qmw 1 512Nw&Sa1bgy&wes I Rdef6PC276MI612
919 707 9200 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060382
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-21 a.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Mountaire Farms, Inc.
70
is hereby authorized to discharge stormwater from a facility located at o
GrM
ro
�
Mountaire Farms — Statesville Breeder Feed MiA.Cn
2206 West Front Street
Statesville
Iredell County
to receiving waters designated as UT to Third Creek, a class C water in the Yadkin -Pee Dee
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, I1, III, and IV of General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective June 13, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 13, 2017.
ORIGINAL SIGNATURE by RICHARD L. RIDDLE, JR.
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

V

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AGO"Av—
NCDENR
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r �N� Res
NOTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG060000
. _Ir.
National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO60000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 20 Food and Kindred Products
SIC 21 Tobacco Products
SIC 283 Drugs
SIC 284 Soaps, Detergents,.& Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations
SIC 422 Public Warehousing and Storage (except 4226)
For questions, please contact the DEMLR Regional Office for your area. See page A
Do Not use this NOI for renewals.
(Please print or type)
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed):
Name Mountaire Farms Inc
Street Address PO Box 1320
City
Telephone No.
Mdkb= State DE ZIP Code 19966
302 934-3070 Fax: [phone]
2) Location of facility producing discharge:
Facility Name Mountaire Fars -Statesville Breeder Feed Mill
Facility Contact John Jacobs
Facility Address
Facility City
Facility County
Telephone No.
Email
2206 West Front Street
StatesviQe State NC ZIP Code 28667
iredM
704 978-3055 Fax.
pambs"untatre corn
3) Physical Location Information:
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)_ From IAA, take exit to take NC-90 EIUS-64E In two tenths
of a mile, turn left an to State Rd 1359 In one half of a mile, the feed mill will be on the left at address 2206 W Front St
(A copy of a county map or USGS quad sheet vnth the fatality clearly located must be submitted with this application )
4) Latitude 35' 47' 24.6372" N Longitude 800 55' 34 248" W (deg, min, sec) 26.7 ?oo 7 I
5) This NPDES Permit Application applies to which of the following: O V' `' / f
❑ New or Proposed Facility Date operation is to begin
R Existing
SW U-221
Page 1 of 4
Last revised 6124114

NCG060000 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: 2 0 4 8
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility: Feed is produced for chicken
b) Check all activities occurring at this facility:
❑ use or process meats l9 use or process animal fats/byproducts
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 2
What is the name of the body or bodies of water (creek, stream, river, lake, etc ) that the facility stormwater
discharges end up in? Third Creek
Receiving water classification. c
Is this a 303(d) listed stream? NO Has a TMDL been approved for this watershed? NIA
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). N/A
9) Does this facility have any other NPDES permits?
j� No
❑ Yes
If yes, list the permit numbers for all current NPDES permits.for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility.
11) Does this facility employ any best management practices for stormwater control?
❑ No
X Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe: Routine sweepings and catch basin cleanings.
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
R Yes
If yes, when was it implemented? May 1, 2017
13) Are vehicle maintenance activities occurring at this facility?
14 No ❑ Yes
Page 2 of 4
SW U-221 Last revised 6124l14

NCGO60000 N.O.I.
14) Hazardous Waste:
a) Is this facility a Hazardous 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
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?
X No ❑ Yes
d) Is hazardous waste stored In the 100-year flood plain?
No ❑ Yes if yes, include information to demonstrate protection from flooding
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.
15) Certification:
North Carolina General Statute 143-215.613 (1) 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 Articie, 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 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�da naccurate.
Printed Name of Person Pat
g: 'u► k4
Title: �i ; rri fat ct? C.c— Pr1*" t ef t4 V e
(Signa# pplicano (Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR. Do not send the check or money order separately,
Page 3 of 4
SWU-221 Last revised 6124114

NCGO60000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
V Check for $100 made payable to NCDENR Must be included with this application (not sent separately).
IA This completed application and all supporting documents
iI A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) sormwater management structures, (c) location of stormwater outfails
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
loaded, and unloaded, (f) impervious areas, (g) site property lines.
Ir Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
Stormwater Permitting Unit Program
Dmsion of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 276991612
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
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
[phone]
Page 4 of 4
SWU-221 Last revised 6124114

May 1, 2017
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27669-1612
To whom it may concern:
Please find the attached Notice of Intent application for coverage under General Permit
NCGO60000 for the Mountaire Farms Statesville Breeder Feed Mill. The application, check mad
payable to NCDENR for $100, site diagram, and USGS quad sheet with the facility's location are
all included within this submittal. j
Should you have any questions, please feel free to contact me at 302-934-3070.
Sincerely,
ax-0-
Austin Pajda
Environmental Compliance Coordinator
CC: John Wren (Mountaire Farmsj�V`
Beth Sise (Mountaire Farms
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Mountaire Farms
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MOUNTAIRE FARMS INC.
FIRST AMERICAN TITLE INSURANCE COMPANY,
ROSE LAW FIRM. A PROFESSIONAL ASSOCIATION
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