NCG080928_COMPLETE FILE - HISTORICAL_20140506

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
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DOCTYPE.
�(-HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ JC) / 0 5 D
YYYYMMDD

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Central Files: APS _._ SWP
5/6/2014
Permit Number NCG080928 ' Permit Tracking Slip
Program Category
Status
Project Type
NPDES SW
In review
New Project
Permit Type
Version
Permit Classiflcatlon
Transportation wNehicle Mai ntenancelPetroleum Bulk/Oil Water Separator Stormwater
COC
Discharge COC
Primary Reviewer
Permit Contact Affiliation
julle.ventaloro
RECEIVED
Coastal SWRuIe
MAY 072014
Permitted Flow
CENTRAL FILES
DWO/BOG
Facility
Facility Name
MajorlMlnor
Region
Waste Industries - Stedman Garage '
Minor
Fayetteville
Location Address
County
5318 Front St
Cumberland
Facility Contact Affiliation
Stedman NC 28391
Ted Habets
5318 Front St
Owner
Stedman
NC 28391
Owner Name
Owner Type
Waste Industries LLC
Non-Govemment
Owner Affiliation
John Pfleger
3301 Benson Dr
Dates/Events Raleigh NC 27609
Scheduled
Orig Issue App Received draft Initiated Issuance Public Notice Issue Effective Expiration
4/14/2014 61W201y sllaf1p1 /0/,120/7
Regulated Activities Requested /Received Events
Transportation with vehicle maintenance RO staff report received 515114
RO staff report requested 4125114
Outfall 001
Waterbody Name Streamindex Number Current Class Subbasin
Sandy Creek 18-68-12-6 C;Sw 03-06-18

WDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Ted Habets
Waste Industries USA
5318 Front Street
Stedman, NC 28391
Dear Mr. Habets:
John E. Skvarla, III
Secretary
May 6, 2014
Subject: General Permit No. NCGO80000
Waste Industries -- Stedman Garage
COC No. NCG080928
Cumberland County
In accordance with your application for a discharge permit received on April 14, 2014,
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.
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section - Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:llportal.ncdenr.org/web/Irl
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

If you have any questions concerning this permit, please contact Julie Ventaloro at telephone
number [phone] or by email julie.ventaloronncdenr.yzov.
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Fayetteville Regional Office, B. Cole
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. NCGO80000
CERTIFICATE OF COVERAGE No. NCGO80928
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,
Waste Industries USA, Inc
is hereby authorized to discharge stormwater from a facility located at
Waste Industries — Stedman Garage
5318 Front Street
Stedman
Cumberland County
to receiving waters designated as unnamed tributary to Sandy Creek, a class C;Sw water in the
Cape Fear River Basin, in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, 111, and 1V of General Permit No. NCGO80000 as
attached.
This certificate of coverage shall become effective May 6, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day May 6, 2014.
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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NCGO80928
Map Scale Scale 1:24,000
Waste Industries USA, Inc. '
Waste Industries - Stedman Garage
Latitude: 350 00' 27" N
Longitude: 780 41' 12" W
County: Cumberland
Receiving Stream: UT to Sandy Creek
Index No: 18-68-12-6
Stream Class: C;Sw
Sub -basin: 03-06-18 (Cape Fear River Basin)
r V40- .��i�61, k
Facility Location

� 1NCDEN'R
`!_7rIH :.4Y.C.l.Y.t L'EMWrwLvl C.
Division of Water Quality / Surface Water Protection
Section
National Pollutant Discharge Elimination System
FOR AGENCY USE oNLY
Date Reccived
Year
Month
Da
Certlrlcatc or covCf'1i
N o
a
Check #
Amount
413
IUl7
Perri it As51 d to
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NCG080000 FA to
NOTICE OF INTENT 0,0 D
National Pollutant Discharge Elimination System application for coverage under eneral 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: Y .wSIC 40 (Standard Industrial Classification) Railroad Transportation1v//1i5�SIC 41 f-ocal and Suburban Transit and Interurban Highway Passenger Transport 1 4 2014
SIC 42 Motor Freight Transportation and Warehousing (except SIC 4221-4225)
SIC 43 United States Postal Service
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.
' l For questions, please contact the DWO Regional Office for your area. See page 4.
(Please print or type)
1) Mailing address of owner/operator (address to which all correspondence will be mailed/:
Name
Street Address
City
Telephone No.
'5_ I a ff r2pAj
e - Cq> M r+"
10 2si• 1Z2
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
State ZIP Gode
Fax:
As,TiE �� �-� STr DMAo4 C t
�T'E� f-tiAP�E T s
ST�bMAl.l State N� ZIP Code 83
910
Fax:
Page 1 of 4
SWU-223-071408 Last revised 7114108

NCG08000Q N.O.I.
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road num
distance and direction fr9nt a roadway intersection). LG-0_A-T' ti O►.I '7 ouT+4 S I r o1
rsvi t LC—. v -RS. crro, 4 w r rH el--ZOL
(A copy of a county map or USGS quad sheet with facility clearly focated must be submitted with this application)
4) Latitude ✓ vdO fl 1'Z7 11 Longltude OZQJ 44_ a t 12 t' (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑l ew or Proposed Facility Date operation is to begin0"3 M Adt '2-411¢
Existing
6) Standard Industrial Classification:
and
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: .4- :?- I
7) Provide a brief narrative description of the
facility: -F^,Gt U ry }✓M i0 NTfH NJS
8) Discharge points 1 Receiving waters:
of industrial activities and products manufactured at
2aL --o�� T�Si-t t�►aTA-I1.1z2S
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? Z
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? V N al AA&=-� _'Tp_iLMV TA _TO 'Q.44tyq!( �.
Receiving water classification: g�� Sw _
Is this a 303(d) listed stream? We- Has a TMDL been approved for this watershed? N o
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 ,4
9) Does this facility have any other NPDES permits?
f2No
❑ 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)?
O No
C 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
R"Y'es (Show any structural BMPs on the site diagram.)
If yes, please briefly describe: TWO *1441 't?ETc'aJ Tl OAJ P2W bdSP- w ZB2
CiW EL i L.e2 el-TWE-
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
-ery-es
If yes, when was it implemented?�-
T
Page 2 of 4
SWU-223-071408 Last revised 7114)08

NCG080000 N.O.I.
Q-
1.
13) Are vehicle maintenance activities occurring at this facility?
❑ No IVYes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
R"N-o ❑ 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
7rdous waste?
a ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
E'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:
Now 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, and accurate.
Printed Name of Person Signing:
Title: --- (�Qv� 1 ct� _ re-
of Applicant)
5
( ate igned)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
SW 15-223.071408
Page 3of4
Last revised 7114/08

NCG080000 N.0.1.
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
This 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, (e) areas where materials are stored,
(f) impervious areas, (g) site property lines.
i� Copy of county map or USGS quad street 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 DWQ Regional Office for your area.
DWO Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office..
.(M) 946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........[phone]
Page 4 of 4
SW U-223-071408 Last revised 7114108

d
WASTE INDUSTRIES LLC
3301 Benson Drive, Suite 60?
Raleigh, NC 27609
K
Check No. - 134048
Check Date - 04/10/14
100.00 100.00
----------- ----------- -----------
100.00 100.00
FAP R 1 4 2 0,1-4 N — AMP
R --WATER ALITY
61 a �� 113W il
4111�� 0417 41
00134048
WAST&INDUST UES LLC.-'Ak'§"' 04/10/14
Bank of America
��
3301 Bq. enson Drive, iUY_t6_ 61'0'1 2-5
1-M" s2-­-.-�O' 0AME
N6 ,g
66-191530 NC
il'1�4.�"­. I - ­ ­1 1-'-
Ril6igh, N&.27609
R
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PAI
ONE HUNDRED AWO 0 i'o 01 t:*
tA v Z
AMOUNTS OVER $ 10,000 REQUIRE 2 SIGNATURES
Void after 60 days
6 _'�. 4 , ..
TO THE 'NCDENR
ORDER b, i v df-Water Qua ii y-,
ision
OF
Permfts &�,.Engineering
e r 16,17 Mai w�'Seivlce`�bint
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Raleigh NC'r2 7"6- 9 9.�:l 617
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FWA
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NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Ted Habets
Waste Industries USA
5318 Front Street
Stedman, NC 28391
Dear Mr. Habets:
John E. Skvarla, III
Secretary
May 6, 2014
Subject: General Permit No. NCG080000
Waste Industries — Stedman Garage
COC No. NCGO80928
Cumberland County
In accordance with your application for a discharge permit received on April 14, 2014,
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.
M Ay 1 4 2014
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: http://portal.ncdenr.org/web/Ir/
An Equal Opportunity 1 Affirmative Action Employer -- 50% Recycled 110% Post Consumer Paper

If you have any questions concerning this permit, please contact Julie Ventaloro at telephone
number [phone] or by email julic.ventaloronnedenr.gov.
Sincerely,
ORIGINAL SIGNED 81.
KEN PICKLE
for Tracy E. Davis, F.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Fayetteville Regional Office, B. Cole
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. NCG080928
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,
Waste Industries USA, Inc
is hereby authorized to discharge stormwater from a facility located at
Waste Industries — Stedman Garage
5318 Front Street
Stedman
Cumberland County
to receiving waters designated as unnamed tributary to Sandy Creek, a class C;Sw water in the
Cape Fear River Basin, in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I,11, III, and 1V of General Permit No. NCGO80000 as
attached.
This certificate of coverage shall become effective May 6, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day May 6, 2014.
ORIGINAL SIGNED B)
KEN Per✓Lc
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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NCGO80928
N
W E
S
Map Scale 1:24,000
Waste Industries USA, Inc.
Waste Industries - Stedman Garage
Latitude: 350 00' 27" N
Longitude: 780 41' 12" W
County: Cumberland
Receiving Stream: UT to Sandy Creek
Index No: 18-68-12-6
Stream Class: C;Sw
Sub -basin: 03-06-18 (Cape Fear River Basin)
waafi�lw�ii���\'
Facility Location

Ventaloro, Julie
From:
Joyner, Melissa
Sent:
Monday, May 05, 2014 10:21 AM
To:
Ventaloro, Julie
Cc:
Cole, Brad; Lawyer, Mike
Subject:
Review Request NCG080928 Waste Industries Stedman Garage
Follow Up Flag:
Follow up
Flag Status:
Flagged
Good Morning, Julie,
I spoke with Mr. Ted Habets, General Manager of the Waste Industries Stedman Garage (NCG080928) in Cumberland
County this morning and he is familiar with the requirements of the NCG080000 permit. The Fayetteville Regional Office
has no concerns regarding potential wetland impacts. There are no objectives to issuing this permit.
Melissa
Melissa Joyner
Environmental Specialist
Land Quality Section
N.C. Department of Natural Resources
225 Green Street
Suite 714
Fayetteville, North Carolina 28301
910.433.3300
melissa.'o ner ncdenr. xov
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed
to third parties.

Joyner, Melissa
From: Lawyer, Mike
Sent: Thursday, May 01, 2014 8:59 AM
To: Joyner, Melissa
Subject: FW: Review Request NCGO80928 Waste Industries Stedman Garage
Attachments: NCG080928-Waste Industries_NOI.pdf
Michael Lawyer, CPSWQ
Environmental Specialist
NCDE;NR - Division of Energy, Mineral and Land Resources
Land Quality Section
Fayetteville Regional Office
P: [phone]
F: [phone]
e-mail: [e-mail]
E-mail correspondence to and from this address is subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulation.
From: Ventaloro, Julie
Sent: Friday, April 25, 2014 12:24 PM
To: Cole, Brad
Cc: Lawyer, Mike
Subject: Review Request NCG080928 Waste Industries Stedman Garage
Brad,
We've received an NOI for an existing facility in your region:
NCG080928 - Waste Industries Stedman Garage in Cumberland County. This site discharges stormwater attwo points
to an unnamed tributary to Sandy Creek (Class C;Sw) The NOI is attached. They didn't attach a site diagram to their
application, but the description of their BMPs on the NOI matches up with the aerial photos on Google Maps (two wet
detention ponds, level spreader w/ filter strip).
Please let me know if the Fayetteville Regional Office has any concerns about issuing this COC. Please also let me know
of any potential impacts to wetlands. If we don't receive any objections, we'll issue the COC in 30 days.
Thanks,
Julie Ventaloro
Stormwater Permitting Program
NC Division of Energy, Mineral, and Land Re50UrCC5
t612 Mail Service Center, Raleigh, NC 27699-612
Phone: (gig) 807-637o Fax: [phone]
Website: http://watersupp]Mateished.nc.gQv
E-!Rail correspondence to and %tom this address may he suhjcct to the North Carolina ruhlic Records Law and may he disclosed to third
parties.

Joyner,.Melissa
From:
Sent:
To:
Cc:
Subject:
Tracking:
Good Morning, Julie,
Joyner, Melissa
Monday, May 05, 2014 10:21 AM
Ventaloro, Julie
Cole, Brad; Lawyer, Mike
Review Request NCG080928 Waste Industries Stedman Garage
Recipient Delivery Read
Ventaloro, Julie Delivered: 5/5/2014 10:21 AM
Cole, Brad Delivered: 5/5/2014 10:21 AM Read; 5/5/2014 10:38 AM
Lawyer, Mike Delivered: 5/5%2014 10:21 AM Read: 5/5/2014 10:23 AM
spoke with Mr. Ted Habets, General Manager of the Waste Industries Stedman Garage (NCG080928) in Cumberland
County this morning and he is familiar with the requirements of the NCG080000 permit. The Fayetteville Regional Office
has no concerns regarding potential wetland impacts. There are no objectives to issuing this permit.
Melissa
Melissa Joyner
Environmental Specialist
Land Quality Section
N.C. Department of Natural Resources
225 Green Street
Suite 714
Fayetteville, North Carolina 28301
910.433.3300
mel issa.jovnern.Eiederir.gov
*******************************************************************************
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed
to third parties.
*******************************************************************************
1

F-5 A A
N..C.DENR
_tlh r1:r,31y liV•R)..Z•:/[.
Division of Dater Quality / Sul ace Water Protection
Section
National Pollutant Discharge Elimination System
1 V ����iio�® Q"---�\ NOTICE OF 1�4TEN'T
National Pollutant Discharge Elimination System application for coverage underVeneral Permit
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NCG080000:
STORMWATER DISCkARGES 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 Transport do APR 1 4 2014 Do
SIC 42 Motor Freight Transportation and Warehousing (except SIC 4221-4225)
SIC 43 United States Postal Service
►'� WA FJ7 nkliY
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.
-at_^ ..�_.-. _.
C.` For questions, please contact the DWO Regional Office for your area. Sera page: 4.
(Please print or type)
1) Mailing address of owner/operator address to which all corres ondence will be mailed':
Name
Street Address
City
Telephone No.
_� "� 1 43 ;= XJ e-T ,
%t-i�....._._.�
2) Location of facility producing discharge:
Facility Marne
Facility Contact
Street Address
City
County
Telephone No.
Email
� er:)
_431e�
state ZIP code
Fax: _
State NC— ZIP Code 2�3
4U...M.r3e L,�ta rs
��
Fax:
Page 1 of 4
S W U-223.071408 Last revised 7114108

NCOO80000 N.O.E.
3)
Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road nurn
distance and direction
S-r. d.tS`M
(A copy of a county map or USG& quad sheet with facility clearly located must be submitted with this application)
4) Latitude '?7'5'900 f �Zl Longitude. 0710°4 11 12 it -_ (deg, min, sec)
5) This NPDES Permit Application applies to.which of the following:
[--I /New or Proposed Facility Date operation is to begin 43 'MA4Z '�14
L'� Existing
6) Standard Industrlal 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 description of the
facility:
8) Discharge points / Receiving waters:
of industrial, activities and products manufactured at
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? V M W AAAxE?r� _-- VP_k%U T v �• ,u nY R �"~tC _.
Receiving water classification: 4_� �_ Sw _
Is this a 303(d) listed stream? � 4, Has a TMI]L been approved for this watershed? o
If the site stormwater discharges to a sppartiia storm sewer system, riamo thG operator of the enpnrate storm
sewer system (e.g. City of Raleigh municipal storm sewer)..
5) Does this facility have any other NPDES permits?
"No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
14) Does this facility have any Non -Discharge permits (ex: recycle permit)?
9Y IN
❑ 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
E 1'es (Show any structural BMPs on the site diagram.)
If yes, please briefly describe. TWO Wt-T 1:k-- T_=� 71 OAJ f�10 W`'4�;'__
(ggvEl_ L T�1� .� _..........
12) Does this facility have a Stormwater Pollution Prevention Plan?
C] No
es
if yes, when was it implemented?
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T

NCG080000 N.01
13) Are vehicle maintenance activities occurring at this facility?
I No 00?'Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
R"No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
R"N-o ❑ Yes
(7) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
Yrdous waste?
rt 13 Yes
d) Is hazardous waste stored in the 100-year flood plain?
ErNo ❑ 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:
Flow 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 (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 Articlo 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 Person Signing: ,
Title: (nov,2-t,a tAaQ*—
Si nat re of A llcant (�r neci
(9 � rot' 1 � )
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
Nv .11ENR
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SWU-223-071408 Last revised 7114108

NCG080000 N,G.I.
Final checklist
This application will be returned as Incomplete unless all of the following items have been Included:
© Check for $100 rude payable to NCDFNR
This ccmpleted application and all supporting-docurnents
V 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,
(f) impervious areas, (g) site property lines.
Y Copy of county map or USGS quad sheet with location of facility clearly marked on reap
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 DWQ Regional Office for your area.
DWG? Regional Office Contact lnforma ion:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
Raleigh Office
[phone]
791-4200.V
........
(919)
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
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SWU-223-071408 Last revised 7/14/08