NCG080937_COMPLETE FILE - HISTORICAL_20150615

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ a�%� 5 d 1(/ I S
YYYYMMDD

Permit Number NCGO80937
Program Category
NPDES SW
Permit Type
Transportation w/Vehicle Maintenance/Petroleum Bulk/Oil Water Separator Stormwater
Discharge COC
Primary Reviewer
julle.ventaloro' RECEIVED
Coastal SWRule 1 V
Permitted Flow
Facility
JUN 15 2015
CENTRAL FILES
DWR SECTION
Central Files: APS _ SWP _
6/1012015
Permit Tracking Slip
Status Project Type
In review New Project
Version Permit Classification
COC
Permit Contact Affiliation
Facility Name
MajortMinor Region
Town of Maiden - Public Works ✓
Minor Mooresville
Location Address
County
115 W Main St
Catawba
Maiden NC 28650
Owner
Facility Contact Affiliation
Micah Beal
115 W Main St
Maiden NC 28650
Owner Name Owner Type
Town of Maiden Government - Municipal
Owner Affiliation
Micah Beal -
115 W Main St
Dates/Events Maiden NC 28650
Scheduled
Orig Issue App Received Draft Initiated
Issuance Public Notice Issue
Effective
Expiratioi
5/20/2015
io 01"15
f
� f it 12,OL5
10I3112o11
Regulated Activities
Requested /Received Events
Transportation with vehicle maintenance
RO staff report received
6/8/15
Vehicle maintenance
RO staff report requested
6/4/15
Outfal I 001
Waterbody Name
Streamindex Number Current Class
Subbasin
Carpenter Creek
11-129-5-7-2-5 C
03-08-35

I--
4
29=
WNW
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Micah Beal
Town of Maiden
Public Works
115 W. Main St.
Maiden, NC 28650
Dear Mr. Beal:
Donald R. van der Vaart
Secretary
June 11, 2015
Subject: General Permit No. NCG080000
Town of Maiden — Public Works
COC No. NCGO80937
Catawba County
In accordance with your application for a discharge permit received on May 20, 2015,
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.
Per the requirements of the Catawba Riparian Buffer Rule, all stormwater drainage to
stream buffers, from portions of this site that have been constructed after June 30, 2001, must be
discharged through a correctly designed level spreader or another device that meets diffuse flow
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: http:ltportal.ncdenr.org/web/Ir/
Mailing Address:1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

requirements per 15A NCAC 2B .0243. Diffuse flow requirements are described in Chapter 8
of the North Carolina Stormwater BMP Manual, available at:
http://Portal.ncdenr.ora/web/Ir/bmv-manual.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone
number [phone] or by email iulie.ventaloroancdenr.gov.
Sincerely,
P
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Z. Khan
Central Files
Stormwater Permitting Program Files

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG080000
CERTIFICATE OF COVERAGE No. NCG080937
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,
Town of Maiden
is hereby authorized to discharge stormwater from a facility located at
Town of Maiden — Public Works
115 W. Main Street
Maiden
Catawba County
to receiving waters designated as Carpenter Creek, a class C water in the Catawba River Basin,
in accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts I, II, III, and IV of General Permit No. NCG080000 as attached.
This certificate of coverage shall become effective June 11, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 11, 2015.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

Town of Maiden - Public Works
'n=_1.• U
e ofal r1 ���o •� - Sub � � _ � �
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NCGO80937
N
W E
S
Map Scale 1: 24, 000
Town of Maiden
Town of Maiden - Public Works
Latitude: 35° 34' 38" N
Longitude: 810 12' 53" W
County: Catawba
Receiving Stream: Carpenter Creek
Index No: 11-129-5-7-2-5
Stream Class: C
Sub -basin: 03-08-35 (Catawba River Basin)
Facility Location

' L
i
I
RNMA Division of Water Quality / Surface Water Protection
Section
NCDMRNational Pollutant Discharge Elimination System
iMJMJ•�r1 Wtl�/lM �.1O..wJO
NCG080000
FOR ACENCY USE ONLY
Date Received
Year
I Month
Pa
Certificate of Cove
c
k p I I.ArWnt
Pgrfit As ned to
�a
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG080000:
STORMWATER DISCHARGES from Vehicle Maintenance Areas (including vehicle rehabilitation,
mechanical repairs, painting, fueling, lubrication, and equipment cleaning operations areas) associated
with activities classified as:
SIC 40 (Standard Industrial Classification) railroad Transportation
SIC 41 Local and Suburban Transit and Interurban Highway Passenger Trans ion j
SIC 42 Motor Freight Transportation and Warehousing (except SIC 4221-422) MAY 2 J 2015
SIC 43 United States Postal Service
DEN
The following activities are also Included:
• Other industrial activities where the vehicle maintenance area(s) is the only area requiring permitting
• Petroleum Bulk Stations and Terminals (SIC 5171) with total petroleum site storage capacity of less than 1
million gallons
• Stormwater discharges from oil water separators and/or from secondary containment structures
associated with petroleum storage facilities with less than 1 million gallons of total petroleum site storage
capacity. _
• Discharges associated with vehicle maintenance operations at activities, which are otherwise designated
on a case -by -case basis for permitting.
WE For questions, please contact the DWO Regional Office for your area. See page 4.
1) Mailing address of owner/operator
Name
Street Address
City
Telephone No.
2) Location of facility producing
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
SW U-223-071408
P
(Please print or type)
�5. 5q � 51)-.1
Page 1 of 4 f a
i t "H 3 q j Last revised 7114108

NCG080000 N.O.I.
3) Physical Location Information:
Please provide a narrative description of how to get tot facility (use street names, ate road numbers, and
disjpnce and.direhtion from a road►Ny intersection). �bLc wo1,ki ; S �"1,tq (wrL7:S.f'_
(A copy of a county map or USGS quad sheet with faculty clearly located must be submitted whh this applicatidn)
4) Latitude. 35�jq ' 39.11 " Longitude - g] � 1��53 � 1'7 " (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ Ne r gProposed Facility Date operation is to begin
xistin
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:
7) Provide a brief narrative descriptl of the types of IInndu ial activities and products manufactur at
facility: -
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?
What is the name of the bod or bodies f wate (creek, stream, river, fake, etc.) that the facility stormwater
discharges end up in? L!"
Receiving water classification:
Is this a 303(d) listed stream? Alk Has a TMDL been approved for this watershed?
If the site stormwater discharges to a separate storm sewer system, name e operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
9) Doesthisfacility have any other NPDES permits?
P-60
❑ 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)?
P- Igo
❑ 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
2ofe-s- (Show any structural BMPs on the sitecAagram.) Ah 5;"�W�
If yes, please briefly describe: d M
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ Nam�
B'Yes
If yes, when was it implemented? —Y-Wt,414 1466 't CW4 FEA c 41150. /fir �� tj►�o u
J,,1r 'Ire nP�c'� 1IOMor Sa .
Page 2 of 4
SWU-223-071408 Last revised 7/14/08

NCG080000 N.O.I.
13) Are vehicle maintenance activities occurring at this facility?
El No K4ent/s
14) Hazardous Waste:
a) Is thiiss acility a Hazardous Waste Treatment, Storage, or Disposal Facility?
L9'N0 ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazer us waste?
o ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazer us waste?
o ❑ Yes
d) Is haz ous waste stored in the 100-year flood plain?
o ❑ 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 143-215.68 (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 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 ($f 0,000).
1 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 Perso Signing:
Title: -"LLP 1
R1
(Signature
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Page 3 of 4
SWU•223-071408 Last revised 7/14/08

- NCGO80000 N.Q.I.
Final Checklist
This application will be returned as incomplete unless all of the following Items have been included:
Check for $100 made payable to NCDENR
9��his completed application and 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 the drainage areas, (d) runoff conveyance features, (a) areas where materials are stored,
/(f) impervious areas, (g) site property lines.
Er Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee coverage under the NPDES General Permit.
For questions, please contact the DWO Regional Office for your area.
DWO Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...,(910),433-3300
Mooresville Office ...
(704)'663-1699
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........[phone]
Page 4of4
SWU-223.071408 last revised 7/14/08

2529 - NCDENR
REFERENCE DATE DESCRIPTION AMOUNT DISCOUNT NET PAID
-------------------------------------------------------------------------------
NCUOT0000 03/03/15 100.00 0.00 100.00
NOTICE OF INTENT 35-731-5301 100.00
pjc&ogo937
CHECK 4 - DATE I GROSS.DISCOUNT CHECK AMOUNT
---------- r--------------------------------------------------------------------
3941 03/06/15 100.00 0.00 100.00
'Town of Maiden
19 N. Main Avenue
Maiden, N.C. 28650
[phone]
PAY ****10.0 DOLLARS AND 00 CENTS ****
:.. .NCDENR
PAY STORMWATER PERMITTING UNIT
'TOTER PIVISION OF WATER QUALITY'
'
... '
OF . 1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
Branch Banking & Trust Company
Maiden,'N.C.
66-112
531
003941.
DATE CHECK NO. ' CHECK•AMOUNT
03/06/2015 3941 $100.00
THIS DISBURSEMENT HAS'BEEN APPROVED AS REQUIRED BY
THE LOCAL GOVERNMENT BUDGET AND FISCAL CONTROL ACT.',
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KNEW
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Micah Beal
Town of Maiden
Public Works
115 W. Main St.
Maiden, NC 28650
Dear Mr. Beal:
Donald R. van der Vaart
Secretary
June 11, 2015
Subject: General Permit No. NCG080000
Town of Maiden - Public Works
COC No. NCG080937
Catawba County
In accordance with your application for a discharge permit received on May 20, 2015,
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. l 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.
Per the requirements of the Catawba Riparian Buffer Rule, all stormwater drainage to
stream buffers, from portions of this site that have been constructed after June 30, 2001, must be
discharged through a correctly designed level spreader or another device that meets diffuse flow
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section - Land Quality Section
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: htto:l/oortal.ncdenr.org/web/Ir/
Mailing Address:1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper

requirements per 15A NCAC 2B .0243. Diffuse flow requirements are described in Chapter 8
of the North Carolina Stormwater BMP Manual, available at:
htti)://portal.ncdenr.org/web/Ir/bmp-manual.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone
number [phone] or by email Julie ventaloroAncdenr, og_v.
Sincerely,
ORIGINAL SIGNED M
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Z. Khan
Central Files
Stormwater Permitting Program Files

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG080000
CERTIFICATE OF COVERAGE No. NCG080937
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,
Town of Maiden
is hereby authorized to discharge stormwater from a facility located at
Town of Maiden — Public Works
115 W. Main Street
Maiden
Catawba County
to receiving waters designated as Carpenter Creek, a class C water in the Catawba River Basin,
in accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts I, II, III, and IV of General Permit No. NCG080000 as attached.
This certificate of coverage shall become effective June 11, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 11, 2015.
ORIGINAL SIGNED B)
KEN PICKLE
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

NCGO80937
Map Scale 1: 24, 000
Town of Maiden
Town of Maiden - Public Works
Latitude: 350 34' 38" N
Longitude: 810 12' 53" W
County: Catawba
Receiving Stream: Carpenter Creek
Index No: 11-129-5-7-2-5
Stream Class: C
Sub -basin: 03-08-35 (Catawba River Basin)
Facility Location

Ventaloro, Julie
From:
Khan, Zahid
Sent:
Monday, June 08, 2015 2:28 PM
To:
Ventaloro, Julie
Subject:
FW: Review Request NCGO80937 Town of Maiden Public Works
Follow Up Flag:
Follow up
Flag Status:
Flagged
Please see Samar e-mail. Thanks
From: Bou-ghazale, Samar
Sent: Monday, June 08, 2015 2:13 PM .
To: Khan, Zahid
Subject: RE: Review Request NCGO80937 Town of Maiden Public Works
We offer no objections for issuing the subject permit.
Thanks,
Samar
From: Khan, Zahid
Sent: Thursday, June 04, 2015 12:41 PM
To: Bou-ghazale, Samar
Subject: FW: Review Request NCG080937 Town of Maiden Public Works
Deadline June 26; 2015
From: Ventaloro, Julie
Sent: Thursday, June 04, 2015 11:18 AM
To: Khan, Zahid
Subject: Review Request NCGO80937 Town of Maiden Public Works
Zahid,
We've received an NOi for an existing public works facility in your region:
NCGO80937 Town of Maiden Public Works in Catawba County. This site discharges stormwater at one point to
Carpenter Creek (Class C). The NOI is attached.
Please let me know if the Mooresville Regional Office has any concerns about issuing this COC.
Thank you,
Julie Ventaloro
Stormwater Permitting Program
NC Division of Energy, Mineral, and Land Resources
1612 Mail Service Center, Raleigh, NC 27699-j6ia
Phone: (gig) 807-637o Fax: [phone]
Website: http://watersuoRywatershed.nc,gov

i
NCDEHR'
W.� CAOKX� fta
NOTICE OF INTENT
Division of Water Quality / Surface Water Protection
Section
National Pollutant Discharge Elimination System
NCG080000
mom
Mom NI�iMMA
National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO80OW:
STORMWATER DISCHARGES from Vehicle Maintenance Areas (including vehicle rehabilitation,
mechanical repairs, painting, fueling, lubrication, and equipment cleaning operations areas) associated
with activities classified as: r-- _
SIC 40 (Standard Industrial Classification) Railroad Transportation fl L
SIC 41 Local and Suburban Transit and Interurban Highway Passenger Trans ion
SIC 42 Motor Freight Transportation and Warehousing (except SIC 4221-422) M,Qy v 2015 1
SIC 43 United States Postal Service
The following activities are also Included: ao1 a sc;= <
• Other industrial activities where the vehicle maintenance area(s) is the only area requiring permitting
• Petroleum Bulk Stations and Terminals (SIC 6171) with total petroleum site storage capacity of less than 1
million gallons
• Sto►mwater discharges from oil water separators and/or from secondary containment structures
associated with petroleum storage facilities with less than 1 million gallons of total petroleum site storage
capacity.
• Discharges associated with vehicle maintenance operations at activities, which are otherwise designated
on a case -by -case basis for permitting.
For questions, please contact the DWO Regional Office for your area. See page 4.
(Please print or type)
1) Mailing address of owner/operator
Name 6 1 j P1 G+ /ll
Street Address A -
City r State
Telephone No. Fax;
2) Location of facility
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
v ar (M) `k;-8-.sr03-7
ZIP Code
SWU-223.071408
4 of 1 Page g �� Last revised 7114108

NCG080000 N.O.I.
M
3) Physical Location Information:
Please provide a narrative description of how to get to thjfacility (use street names,
distance and direction from a roadway intersection). I Lall-L Nor k., I's I
(A copy of a county map or USGS quad sheet with facility clearly located must be submitted with this applicatidn)
4) Latitude 3Sc,3q ' 3 j) Longitude -- V-)d-�zet3' )? �� (deg, min, sec)
5) This NPDES (Permit Application applies to which of the following:
aN �r Proposed Facility
xisting
6) Standard Industrial Classification:
Date operation is to begin
numbers, and
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code:
7) Provide a brief narrative deyrtptipn of the types of IInndu al activities and products manufactu d at
facility: �j
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? I
What is the name of the bod or bodies Pf wate (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? c,,u,I`q,Q,iC
Receiving water classification:
Is this a 303(d) listed stream? A6 Has a TMDL been approved for this watershed?
If the site stormwater discharges to a separate storm sewer system, name a operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
9) Does this facility have any other NPDES permits?
ly'Na
❑ 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)?
. �la
❑ 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
(Show any structural BMPs on the site diagram.) .NG
If yes, please briefly describe. Q �'
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
B'Yes
If yes, when was it implemented?
Page 2 of 4
SW U-223-071408 Last revised 7114/08

i f i
NCGOS0000 N.O.I.
13) Are vehicle maintenance activities occurring at this facility?
❑ No DI es
14) Hazardous Waste:
a) Is this acility a Hazardous Waste Treatment, Storage, or Disposal Facility?
NKO ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazar s waste?
o ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
h�azaarr °us waste?
L9'N0 ❑ Yes
d) Is hazz ous waste stored in the 100-year flood plain?
0 ❑ 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 143.215.6E (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 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, and accurate.
Printed Name of Personf� Signing;
Title. 1�1�P !K4JOAf11!
15
(Signature
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Page 3 of 4
SWU-223.071408 Last revised 7/14/08

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SITE PLAN
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STORMWATER POWTION PREWAON PLAN
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A'krT.W1FAA Division of Water Qttailty / Surface Water Protection
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DFARNational Pollutant Discharge Elimination System
NCGO80000
NOTICE OE INTENT
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National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO80000:
STORMWATER DISCHARGES from Vehicle Maintenance Areas (Including vehicle rehabilitation,
mechanical repairs, painting, fueling, lubrication, and equipment cleaning operations areas) associated
with activities classified no:
SIC 40(Standard Industrial Classification) Railroad Transportation L
SIC 41 Local and Suburban Transit and Interurban Highway Passenger Trans Ion '�
SIC 42 Motor Freight Transportation and Warehousing (except SIC 4221-42 ) 119Qr : 2Q1$
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SIC 43 United States Postal Service
O�NR • .
The following activities are also included: a a ti ;rces
• Other industrial activities where the vehicle maintenance area(s) is the only area requiring permitting
'•-s Petroleum Sulk Stations and Terminals (SIC 6171) with total petroleum site storage capacity of less than 1
million gallons
• Stormwater discharges from oil water separators and/or from secondary containment structures
associated with petroleum storage facilities with less than 1 million gallons of total petroleum site storage
capacity.
• Discharges associated with vehicle maintenance operations at activities, which are otherwise designated
on a case -by -case basis for permitting.
For questions, please contact the DWq Regional Office for your area. See page 4.
1) Mailing address of
Name
Street Address
City
Telephone No.
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
(Please print or type)
() LPLT-.s03.7 �'
SWU-223-071408
Page 1 of 4 - y p� } Ll Last revlewl 7114108

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NCGos0000 N.O.I.
3) Physical Location information:
Please provide a narrative description of how to get to facility (use street names,
dis*nce ano dire#on from a roadWgy intersection). . P.S IS
(A copy of a county map or USGS quad sheet with facility dearly located must be submitted Ah this aOIC4 idn)
4) L.atftude MLaq
. 1,% Longitude " 1) c 1X 's3 , r7 v (deg, min, sec)
5) This NPOES Permit Application applies to which of the following:
❑ NN r Proposed Facility Date operation is to begin
I�YExisting
B) -Standard Industrial Classification:
numbers, and
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary Industrial
activity at this facility
SIC Code:
7) Provide a brief
facility:
of the types of induWlel activities
8) Discharge points I Receiving waters:
at
How many discharge points (ditches, pipes, channels, etc.) convey slormwater from the property? [
What is the name of the bodypr bodies pf wata; (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? 11Pr]O Lf APA4
Receiving water classification:
Is this a 303(d) listed stream? Has a TMDL been approved for this watershed?
If the site stormwater discharges to a separate storm sewer system, nam operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
9) Does this facility have any other NPDEJ9 permits?
I2'I I�
❑ 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)?
Lilo
❑ 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
(Show any structural BMPs on the site &agram.) �G
If yes, please briefly descri &Sf, _ d CO
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ NNo
t es
If yes, when was it implemented?
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SWU•223-071408
Page 2 of 4
Lest reviser! 7114/08

NCGO80000 NAL
13) Are vehicle maintenance activities occurring at this facility?
0 No l
14) Hazardous Waste:
a) Is It is acility a Hazardous Waste Treatment, Storage, or Disposal Facility?
Q'N0 ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
o ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
haeo
us waste?
R ❑ Yes
d) Is h us waste stored in the 100-year flood plain?
R'a❑ 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 143-215.68 (1) provides that:
Any parson 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 monRoring 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 tan 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 hest of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Persop Signing:
Title: LLLLFP ->&OA- ,-
15
(Signature
Notice of Intent must be accompanied by a check or money order for $1tJOM made payable to:
NCOENR
Page 3 of 4
SWU-223-071408 Last revised 7114/08

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North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Micah Beal
Town of Maiden
Public Works
115 W. Main St.
Maiden, NC 28650
Dear Mr. Beal:
June 11, 2015
DIVISIO ANFort
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JUN 17 2015
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AM NAURK
Subject: General Permit No. NCG080000
Town of Maiden — Public Works
COC No. NCG080937
Catawba County
In accordance with your application for a discharge permit received on May 20, 2015,
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.
Per the requirements of the Catawba Riparian Buffer Rule, all stormwater drainage to
stream buffers, from portions of this site that have been constructed after June 30, 2001, must be
discharged through a correctly designed level spreader or another device that meets diffuse flow
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: http:/Ipoqal.ncdenr.org/web/Ir/
Mailing Address:1612 Mail Service Center, Raleigh, North Carolina 2769971612.919-707-92001 FAX: [phone]
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

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requirements per 15A NCAC 2B .0243. Diffuse flow requirements are described in Chapter 8
of the North Carolina Stormwater BMP Manual, available at:
http://portal.ncdenr.org/web/Ir/bmp-manual.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone
number [phone] or by email julie.ventaloroamcdenr.gov.
Sincerely,
ORIGINAL SIGNED B1
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Z. Khan
Central Files
Stormwater Permitting Program Files

r�y�s/O
STATE OF NORTH CAROLINA ,9Nd OF
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES CRF�j,�,,
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES ✓(/N c�1��nCF,c
'46 1
ry/I Cip, OS
GENERAL PERMIT NO. NCG080000V�4Zr,yh
CERTIFICATE OF COVERAGE No. NCG080937 �4
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,
Town of Maiden
is hereby authorized to discharge stormwater from a facility located at
Town of Maiden — Public Works
115 W. Main Street
Maiden
Catawba County
to receiving waters designated as Carpenter Creek, a class C water in the Catawba River Basin,
in accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts I, II, III, and IV of General Permit No. NCG080000 as attached.
This certificate of coverage shall become effective June 11, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 11, 2015.
ORIGINAL SIGNED W
KEN PICKLE
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

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Map Scale 124, 000
Town of Maiden
Town of Maiden - Public Works
Latitude: 3511 34' 38" N
Longitude: 811 12' 53" W
County: Catawba
Receiving Stream: Carpenter Creek
Index No: 11-129-5-7-2-5
Stream Class: C
Sub -basin: 03-08-35 (Catawba River Basin)
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Facility Location