NCG120102_COMPLETE FILE - HISTORICAL_20140617

NUH I H GA, ULINA
Department of Environmental Quaff
6

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
1v L& } a, DID
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ I DLe I r7
YYYYMMDD

Wade, Larry
From: Wade, Larry
Sent: Tuesday, June 17, 2014 10:44 AM
To: Parnell; David
Cc: Holley, John
Subject: NCG120102 Highway 55 C & D Landfill
Attachments: NCG120102 NOI.pdf
Hello David,
Attached is the NOI for the subject facility. I am sending you a copy of the site plan through inter office mail.
Please review the information and let me know if you have any concerns issuing a permit for this facilty.
Thanks,
Larry W. Wade PE Telephone: [phone]
Fax: [phone]
Stormwater Permitting Program
North Carolina Department of Environment & Natural Resources
Division of Energy Mineral and Land Resources
1612 Mail Service
Raleigh, NC 27699-1612
Physical Address - 512 N. Salisbury St. Room 942S
Raleigh, NC 27604
is a government E-mail address****************************
*********E-mails sent and received from this address can be disclosed to third parties************

®,�Fffo
Letter of Transmittal
Civil & Environmental Consultants, Inc.
1900 Center Park Drive
Date: 512712014
Job No.: 111-370.003
Suite A
Charlotte, NC 28217
Attention: NCDENR
Phone: [phone] - Toll Free: [phone]
Fax: [phone]
To:
RE:
Stormwater Permitting Unit
NOl Application for Highway 55 C&D Landfill
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
We are sending you attached via FedEx Second Day the following items:
❑Shop drawings ❑Prints ❑Plans ❑Samples ❑Specifications
❑Copy of letter ❑Change order Q Check, NOl Application, Maps
Copies
Date
No.
Description
1
05/27/2014
102354
Check for $100 made payable to NCDENR
1
05/27/2014
NCG120000
Completed NOI application
1
05/27/2014
Figure 1
General Location Map
1
05/27/2014
Figure 2
Site Map
For approval
❑ For your use
❑ As requested
❑ For review and comment
❑ For bids due
❑ Approved as submitted
❑ Approved as noted
❑ Returned for corrections
13
❑ Resubmit _ copies for approval
❑ Submit _ copies for distribution
❑ Return_ prints
❑ Prints returned after loan to us
Remarks:
Copy to:
Signed:
Todd Gingerich
d
3 0 2014

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Ap
Division of Water Quality / Surface Water Protection
Section
National Pollutant Discharge Elimination System
stem
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"�eryw� a NCG 120000
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NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
Momh
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Certificate ofCove ra e
N 2 ll
Check # Amount
Fe tit Assigned to
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG t 20000:
STORMWATER DISCHARGES associated with activities classified as:
Landfills that are permitted by the North Carolina Division of Waste Management under the
provisions and requirements of North Carolina General Statute 130A — 294.
The following activities are specifically excluded from coverage under this General Permit:
Stormwater discharges from open dumps, hazardous waste disposal sites, or discharge of waste (including
leachate) to the waters of the state.
WO I
f 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 permit correspondence will be mailed):
Name
Street Address
City
Telephone No.
Highway 55 C&D Landfill, LLC / Greenway Waste Solutions of Apex, LLC
19109 West Catawba Ave. Suite 200
Cornelius State NC
[phone] Fax:
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
Highway 55 C&D Landfill
John Brown
ZIP Code 28031
5940 Old Smithfield Road
Apex State NC ZIP Code 27539
[phone] Fax:
"Idbrown@gri£finbrothers.com
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). Highway 55 south from Highway 1 approx. 2.2
miles right onto Old Smithfield Road less than 0.1 miles access road to right
(A copy of a county map or USGS quad sheet with facility clearly located must be submitted with this application.)
4) Latitude 35deg-41 - -08"N Longitude 78de -501 -6011W (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
I] Existing
Date operation is to begin
SW U-227-071408
Page 1 of 4
Last revised 7/14/08

NCG120000 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: 9 2 3 0
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
thisfacility: c&D landfilling activities to include: moving, placing and compacting of waste
and soil. Composting of Type 1 materials utilizing the turned windrow method.
8) Discharge points 1 Receiving waters:
}how many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 5
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Tributary of Little Branch and ultimately Shearon Harris Reservoir _
Receiving water classification: class c
Is this a 303(d) listed stream? No Has a TMDI_ been approved for this watershed? No
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?
® 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)?
0 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
0 Yes (Show structural BMPs on the site diagram.)
If yes, please briefly describe: Erosion control Basins
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
ID Yes
If yes, when was it implemented? 2014
13) Are vehicle maintenance activities occurring at this facility?
® No I-] Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
® No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
® No ❑ Yes
Page 2 of 4
5w U-227-071408
Last revised 7/14/08

.,
NCG120000 N.O.I.
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
® 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: N A
How is material stored: N/A
Where is material stored: N/A
How many disposal shipments per year: N/A
Name of transport / disposal vendor: N/A
Vendor address: N/A
15) Certification:
North Carolina General Statute 143-215.68(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report,
plan, or other document tiled 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 shalt 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 igning: j Dptrt D. Brouin
Title: a.A e r
(Signature of Applicant)
O
(Date S ned)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Page 3 of 4
SWU-227.071408 Last revised 7/14/08

--I
NCG120000 N.O.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
El 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.
IS 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 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 ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office ..........(919)
807-6300
SW U-227-071408
Page 4 of 4
Last revised 7114/08

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QUIAL",'-VAM�IA
GREENWAY WASTE SOLUTIONS OF APEX, LLC
M vwZw HIGHWAY 55 C&D LANDFILL
Civil & Environmental Consultants, Inc. APEX, NC
1900 Center Park Drive - Suite A - Charlotte, NC 28217
Ph: 980.237.0373 - Fax: [phone] GENERAL LOCATION MAP
www.cecinc.com
DRAWN BY: MTBICHECKED BY: TIVI G I APPROVED BY: SLB I FIGURE NO.:
DATE: MAY 2014 1 DWG SCALE: 1"=1 MILE IPROJECT NO: 111 -370.0031

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A14i"FA*
WDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, II
Governor Secretary
July 21, 2014
Mr. John Brown
Highway 55 C&D Landfill, LLC
19109 West Catawba Avenue,. Suite 200
Cornelius, NC 28031
Dear Mr. Brown:
Y
JUL 2 , -j;�r
r.0 DENR Rale'-O Regional Once
Subject: General Permit No. NCG120000
Highway 55 C&D Landfill
COC NCG120102
Wake County
In accordance with your application for a discharge permit received on May 30,
2014, we are forwarding herewith the subject certificate of coverage 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
after notice to the Division of Energy Mineral & Land Resources (DEMLR). If the facility
changes ownership or is closed, DEMLR may require modification, revocation, or
reissuance of the certificate of coverage.
This permit does not affect the owners legal obligation to obtain other permits
which may be required by DEMLR, or permits required any other federal, state, or local
governmental authorities.
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/Ir/
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

If you have any questions concerning this permit, please contact Larry Wade PE at
telephone number [phone], or email at larry.wade@ncdenngov. .
Sincerely,
for Tracy E. avis, P.E.
cc: Raleigh Regional Office
Central Piles
Stormwater Permitting Program Piles
Wake County Environmental Services, Attn: Eric Green, P.O. Box 550, Raleigh,
NC 27602

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT -NO, NCG120000
CERTIFICATE OF COVERAGE No. NCG120102
STORMWATER AND PROCESS WASTEWATER DISCHARGES
NATIONAL O L DISCHARGE ATIO 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,
Highway 55 C&D Landfill, LLC
is hereby authorized to discharge stormwater and process wastewater from a facility
located at
Highway 55 C&D Landfill
5940 Old Smithfield Road
Apex
Wake County
to receiving waters designated as Little Branch, a class C water in the Cape Fear 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. NCG120000 as attached.
This certificate of coverage shall become effective July 21, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 21, 2014.
for Tracy E. Da4d, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

Permit Number NCG120102
r
Central Files: APS _ SWP
7/21 /2014
Permit Tracking Slip
Program Category
Status Project Type
NPDES SW
Active New Project
Permit Type
Version Permit Classification
Landfill Stormwater Discharge COC
1.00 COC
�1
Primary Reviewer
RECEIVED
��`{ id
Permit Contact Affiliation
larry.wade
1A
JUL 2 �Q1�
Coastal SWRule
CENT ML FILES
Permitted Flow
DWQIBOG
Facility
Facility Name
Major/Minor Region
Highway 55 C&O Landfill
Minor Raleigh
Location Address
County
5940 Old Smithfield Rd
Wake
Facility Contact Affiliation
Apex NC 27539
John Brown
19109 W Catawba Ave Ste 200
Owner
Cornelius NC 28031
Owner Name
Owner Type
Highway 55 C&D Landfill LLC
Non-Govemment
Owner Affiliation
John Brown
19109 W Catawba Ave Ste 200
Dates/Events
Cornelius NC 28031
Scheduled
Orig Issue App Received Draft Initiated
Issuance Public Notice Issue Effective Expiration
7/21/2014 5/30/2014 7/21 /2014
7/21/2014 7121/2014 10/31/2017
Regulated Activities
Requested /Received Events
Landfill operation
RO staff report received 7117114
RO staff report requested 6/17114
Outfall 100
Waterbody Name
Streamindex Number Current Class Subbasin
Little Branch
18-7-6-1-1 C 03-06-07

on
� o
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla,
Governor Secretary
July 21, 2014
Mr. John Brown
Highway 55 C&D Landfill, LLC
19109 West Catawba Avenue, Suite 200
Cornelius, NC 28031
Subject: General Permit No. NCG120000
Highway 55 C&D Landfill
COC NCG120102
Wake County
Dear Mr. Brown:
In accordance with your application for a discharge permit received on May 30,
2014, we are forwarding herewith the subject certificate of coverage 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
after notice to the Division of Energy Mineral & Land Resources (DEMLR). If the facility
changes ownership or is closed, DEMLR may require modification, revocation, or
reissuance of the certificate of coverage.
This permit does not affect the owners legal obligation to obtain other permits
which may be required by DEMLR, or permits required any other federal, state, or local
governmental authorities.
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:Ilpogal,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 Larry Wade PE at
telephone number [phone], or email at [e-mail].
Sincerely,
far Tracy E. avis, P.E.
cc: Raleigh Regional Office
Central Files
Stormwater Permitting Program Files
Wake County Environmental Services, Attn: Eric Green, P.O. Box 550, Raleigh,
NC 27602

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG120000
CERTIFICATE OF COVERAGE No. NCG120102
STORMWATER AND PROCESS WASTEWATER 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,
Highway 55 C&D Landfill, LLC
is hereby authorized to discharge stormwater and process wastewater from a facility
located at
Highway 55 C&D Landfill
5940 Old Smithfield Road
Apex
Wake County
to receiving waters designated as Little Branch, a class C water in the Cape Fear River
Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, I1,11I, and IV of General Permit No. NCG120000 as attached.
This certificate of coverage shall become effective July 21, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 21, 2014.
for Tracy E. Dam, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

NCG120102
Map Scale 1: 24, 000
Highway 55 C&D Landfill, LLC
Highway 55 C&D Landfill
Latitude: 350 41 08" N
Longitude: -780 51' 00" W
County: Wake
Receiving Stream: Little Branch
Stream Class: C
Sub -basin: 03-06-07 (Cape Fear River Basin)
Facility Location

Wade, Larry
From: Wade, Larry
Sent: Tuesday, June 17, 2014 10:44 AM
To: Parnell, David
Cc: Holley, John
Subject: NCG120102 Highway 55 C & D Landfill
Attachments; NCG120102 NOI.pdf
Hello David,
Attached is the NOI for the subject facility. I am sending you a copy of the site plan through inter office mail.
Please review the information and let me know if you have any concerns issuing a permit for this facilty.
Thanks,
Larry W. Wade PE Telephone: [phone]
Fax: [phone]
Stormwater Permitting Program
North Carolina Department of Environment & Natural Resources
Division of Energy Mineral and Land Resources
1612 Mail Service
Raleigh, NC 27699-1612
Physical Address - 512 N. Salisbury St. Room 942S
Raleigh, NC 27604
************************This is a government E-mail address****************************
*********E-mails sent and received from this address can be disclosed to third parties************

=1
Letter of Transmittal
Civil & Environmental Consultants, Inc.
1900 Center Park Drive
Date: 5/27/2014
Job No.: 111-370.003
Suite A
Charlotte, NC 28217
Attention: NCDENR
Phone: [phone] • Toll Free: [phone]
Fax: [phone]
To:
RE:
Stormwater Permitting Unit
NOI Application for Highway 55 C&D Landfill
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
We are sending you attached via FedEx Second Day the following items:
❑Shop drawings ❑Prints ❑Plans ❑Samples ❑Specifications
❑Copy of letter ❑Change order 0 Check, NOI Application, Maps
Copies
Date
No.
Description
1
05/27/2014
102354
Check for $100 made payable to NCDENR
1
05/27/2014
NCG120000
Completed NOI application
1
05/27/2014
Figure 1
General Location Map
1
05/27/2014
Figure 2
Site Map
0 For approval
❑ For your use
❑ As requested
❑ For review and comment
❑ For bids due
❑ Approved as submitted
❑ Approved as noted
❑ Returned for corrections
13
❑ Resubmit _ copies for approval
❑ Submit _ copies for distribution
❑ Return _ prints
❑ Prints returned after loan to us
Remarks:
Copy to:
Signed:
Todd Gingerich

A
� Division of Water Quality 1 Surface Water Protection
^ Section
rNational P011utant Discharge Elimination System
1RCDENR
n mN Rr.
.K`",.a NCG12000
iMviYJ'IMF.YT u+�Q1.A4. r7�co.:reeea
NOTICE OF INTENT
FOR AGENCY USE ONLY
Dale Received
Year
Month
Da
Ccr ificcuz of Covent
=e
NICIGI 112
Check #
Arnount
3
Ye fil Assl 'nett to
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG120000:
STORMWATER DISCHARGES associated with activities classified as:
Landfills that are permitted by the North Carolina Division of Waste Management under the
provisions and requirements of North Carolina General Statute 130A — 294.
The following activities are specifically excluded from coverage under this General Permit:
Stormwater discharges from open dumps, hazardous waste disposal sites, or discharge of waste (including
leachale) to the waters of the state.
r For questions, please contact the DWO Regional Office for your area. See page 4.
yF
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name
Street Address
City
Telephone No.
Highway 55 C&D Landfill, LLC / Greenw_ay Waste Solutions of Apex, L_LC
19109 west Catawba Ave, Suite 200
Cornelius
[phone]
2) Location of facility producing discharge:
State NC
Fax:
ZIP Code 28031
Facility Name Highway 55 C&D Landfill
Facility Contact John Brown
Street Address 5940 Old Smithfield Road
City Apex _ State NC ZIP Code 27539
County wake
Telephone No. [phone] Fax:
Email [e-mail]
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). Highway 55 south from highway 1 approx. 2.2
miles, right onto Old Smithfield Road less than 0.1 miles, access road to right
(A copy of a county map or USGS quad sheet with facility clearly located must be submitted with this application.)
4) Latitude 35deg-41 r -08 °tv Longitude 78deg-50 r -6o'rw (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
0 Existing
Date operation is to begin
S W U-227-071408
Page 1 of 4
Last revised 7114/08

NCG120000 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: 9 2 3 0
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
thisfaeility: c&o landfilling activities to include: moving, placing and compacting of waste
and soil. Composting of Type 1 materials utilizing the turned windrow method.
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 5
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Tributary of Little Branch and ultimately Shearon Harris Reservoir
Receiving water classification: class c
Is this a 303(d) listed stream? No Hasa TMDL been approved for this watershed? No
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?
® 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)?
E 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
0 Yes (Show structural l3MPs on the site diagram.)
If yes, please briefly describe: Erosion control Basins
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
® Yes
If yes, when was it implemented? 2014
13) Are vehicle maintenance activities occurring at this facility?
® No ❑Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
® No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
® No ❑ Yes
Page 2 of 4
SWU-227-071408 Last revised 7/14/08

NCG120000 N.O.I.
c) 1s this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
® 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-. N/A
How is material stored: N/A
Where is material stored: N/A
How many disposal shipments per year: N/A
Name of transport / disposal vendor: N/A
Vendor address: N/A
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 faise 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 Pers(
Title:
(Signature of Applicant)
W_�
igning: �) ohn o Brow
a/l,aq e r
Zo
(Date S gned)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Page 3 of 4
SW u-227-071408
Last revised 7/14108

NCG120000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
El 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.
E 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 DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office ..........(919)
807-6300
Page 4of4
SW U-227-071408 Last revised 7114108

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GREENWH HIGHWAY 5SOLUTIONS
LANDOAPEX, LLC
ILL
Civil & Environmental Consultants, Inc. APEX, NC
1900 Center Park Drive - Suite A - Charlotte, NC 28217
Ph: 980.237.0373' Fax: [phone] GENERAL LOCATION MAP
www.cocinc.com
DRAWN BY: AB CHECKED BY: TMG APPROVED BY: SLB FIGURE NO.:
DATE: MAY 2014 1 DWG SCALE: V=1 MILE PROJECT NO: 111-370.003

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