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Home My WebLink AboutNCG120106_COMPLETE FILE - HISTORICAL_20171103STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT N0. /v C� Ia.l7 IO �O DOC TYPE �-MISTORICALFILE ❑ MONITORING REPORTS DOC DATE ate, -i i i d 3 ❑ YYYYMMDD Energy, Mineral & Land Resources FNVIRONMENTAL QUALITY Division of Energy, Mineral, and Land Resources Land Quality Section / Stormwater Program National Pollutant Discharge Elimination System (NPDES) PERMIT OWNER AFFILIATION DESIGNATION FORM (Individual Legally Responsible for Permit) Use this form if there has been: FOR AGENCY USE ON Y Date Received Year Month I Da NO CHANGE in facility ownership or facility name, but the individual who is legally responsible for the permit has changed. If the name of the facility has changed, or if the ownership of the facility has changed, do NOT use this form. Instead, you must fill out a Name -Ownership Change Form and submit the completed form with all required documentation. What does "legally responsible individual" mean? The person is either: • the responsible corporate officer (for a corporation); PREC E IVE D • the principle executive officer or ranking elected official (for a munic, ty� state, federal or other public agency); UU 2017 • the general partner or proprietor (for a partnership or sole proprietorship�. • or, the duly authorized representative of one of the above. -� l.tL A 'l) Of{1-In' �� dl�`IlrlrJA1 1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation") applies: Individual Permit 2) Facility Information: Facility name: Company/Owner Organization: Facility address: (or) Certificate of Coverage 1i.kf1T,1&:]1t"d`j 1 12 10 1 0 8 Scotland County Landfill Government - County _ 10681 Patterson Road Address Maxton NC 28364 City State Zip To find the current legally responsible person associated with your permit, go to this website: http:/Ideg.ne.gov/abotit/divisions/energy-mineral-land-resources/energy-miiiei-al-land-ocrtnits/stormwater-program and run the Permit Contact Summary Report. 3) OLD OWNER AFFILIATION that should be removed: Previous legally responsible individual: Jim Blackwell First MI Last 4) NEW OWNER AFFILIATION (legally responsible for the permit): Page I of 2 SWU-0WNERAFFiL-23March2017 NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form (if no Facility Name/Ownership Change) Person legally responsible for this permit: 5) Reason for this change: A result of: Kevin Patterson First MI Last County Manager Title PO Box 489 Mailing Address Laurinburg NC 28353 City State Zip 910 277-2406 Telephone E-mail Address 910-277-2411 kpatterson@scotlandcounty.org Fax Number ❑ Employee or management change ❑ Inappropriate or incorrect designation before X Other If other please explain: Jim Blackwell, County Engineer, Retired. The certification below must be completed and signed by the permit holder. PERMITTEE CERTIFICATION: I, Bryant L. Higgins, attest that this application for this change in Owner Affiliation (person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my knowledge. understand that if all required parts of this form are not completed, this change may not be processed. G 10-24-17 gna Date PLEASE SEND THE COMPLETED FORM TO: Division of Energy, Mineral, and Land Resources Stormwater Program 1612 Mail Service Center Raleigh, North Carolina 27699-1612 For more information or staff contacts, please call (919) 707-9220 or visit the website at: http://deg.nc.gov/about/divisions/energy-mineral-land- resources/stormwater Page 2 of 2 SW1.1-OWNERAFFIL-2310ar2017 - Affly KUM North Carolina Department of Environment and Natural Resources Pat McCrory Governor Mr. Bryant Higgins Public Works Director Scotland County 10681 Patterson Road Maxton, NC 28364 Dear Mr. Higgins: Donald R. van der Vaart Secretary June 19, 2015 Subject: General Permit No. NCG120000. Scotland County Landfill COC NCG120106 , jUN 3 0 2015 Scotland County In accordance with your application for a discharge permit received on May 11, 2015, 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 and Land Resources. The Division 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 or permits required by the Division of Water Resources, Coastal Area Management Act or any other federal or local governmental 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: 919-715-8801 512 North Salisbury Street, Raleigh, North Carolina 27604 - Intemet: htt :11 ortal,nodenr.or /web/Ir/ An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper y Mr. Bryant Higgins June 19, 2015 Page 2 of 2 If you have any questions concerning this permit, please contact Bradley Bennett at telephone number (919) 807-6378 Sincerely, for Tracy E. Davis, P.E., CPM cc: Fayetteville Regional Office, Mike Lawyer Central Files Stormwater Permitting Unit Files 0E STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES STORMWATER DISCHARGES 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, Scotland County is hereby authorized to discharge stormwater from a facility located at Scotland County Landfill 10681 Patterson Road Maxton Scotland County Ott 10- to receiving waters designated as UT to Shoe)I'Creek, a class C, SW water in the Lumber River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, I1, II1, IV, V of General Permit No. NCG120000 as attached. 90/0 This certificate of coverage shall become effective June 19, 2015 This Certificate of Coverage shall remain in effect for the duration of the General Permit. Signed this day June 19, 2015. for Tracy E. Davis, P.E., Director Division of Energy, Mineral, and Land Resources By the Authority of the Environmental Management Commission LOCATION MAP: USGS Maps: Johns Latitude: 34' 43' 29.71" N ' NCG120106 Facility Longitude: 79' 22' 54.05" W `�' Scotland County County: Scotland Location Scotland County Landfill Stream Class: C, SW Receiving Stream: UT to Shoe Hill Creek L Sub -basin: 03-07-55 (Lumber River Basin) Not to Scale �O'ttl� Bennett, Bradley From: Lawyer, Mike Sent: Tuesday, June 09, 2015 1:13 PM To: Bennett, Bradley Cc: bhiggins@scotlandcounty.org Subject: RE: NOI - Scotland County Landfill - NCG120106 Bradley, Conducted site visit at subject facility today where I met with Mr. Bryant Higgins, Public Works Director. I went over the requirements of the NCG120000 General Permit and we made observations of site conditions and the stormwater outfall. Mr. Higgins relayed that they have contracted with an engineering firm to review sampling protocols. Please proceed with issuance of permit coverage and provide our office with a copy of the issuance letter and Certificate of Coverage for our files. Thanks, Mike Michael Lawyer, CPSWQ Environmental Program Consultant NCDENR -- Division of Energy, Mineral and Land Resources Land Quality Section Fayetteville Regional Office P: (910) 433-3394 F: (910) 486-0707 e-mail: mike.lawyer@ncdenr.gov 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: Bennett, Bradley Sent: Thursday, May 21, 2015 12:30 PM To: Lawyer, Mike Subject: NOI - Scotland County Landfill - NCG120106 Mike, See attached NOI and map for this application request. Let us know if we can move forward with the permit or if you have concerns. Thanks BB Bradley Bennett Stormwater Permitting Program Phone: (919) 807-6378 NC Division of Energy, Mineral and Land Resources Fax: (919) 807-6494 1612 Mail Service Center Email: brad ley. bennett ncdenr. ov Raleigh, NC 27699-1612 Web: http:llportal.ncdenr.oralweb/Ir/stormwater Email correspondence to and from this address may be subject to public records laws Central Files: APS _ SWP _ 6/18/2015 Permit Number NCG120106 Permit Tracking Slip Program Category Status Project Type NPDES SW in review New Project Permit Type Version Permit Classification Landfill Stormwater Discharge COC RECEIVED ] COC Primary Reviewer R EC E I WE D Permit Contact Affiliation bradiey.bennett ' JUN 2 5 2015 - Coastal SWRule CENTRAL FILES Permitted Flow DWR SECTION Facility Facility Name Major/Minor Region Scotland County Landfill r Minor Fayetteville Location Address County 10681 Patterson Rd Scotland Facility Contact Affiliation Maxton NC 28384 Owner Owner Name Owner Type Scotland County Government - County Owner Affiliation Jim Blackwell County Engineer 507 W Covington St Dates/Events Laurinburg NC 28352 Scheduled Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration 6/19/2015 5/11/2015 5/19/2015 .611912015 6/19/2016 10/31/2017 Regulated Activities _ Requested /Received Events Landfill operation RO staff report received 619115 V RO staff report requested 5121/15 Outfall 001 Waterbody Name Streamindex Number Current Class Subbasin Shoe Heel Crook (Big Shoe Heel Creek)(Maxton Pond) 14-34 C;Sw 03-07-55 'E NDEE R North Carolina Department of Environment and Natural Resources Pat McCrory Governor Mr. Bryant Higgins Public Works Director Scotland County 10681 Patterson Road Maxton, NC 28364 Dear Mr. Higgins: Donald R. van der Vaart Secretary June 19, 2015 Subject: General Permit No. NCG120000 Scotland County Landfill COC NCG120106 Scotland County In accordance with your application for a discharge permit received on May 11, 2015, 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 and Land Resources. The Division 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 or permits required by the Division of Water Resources, Coastal Area Management Act or any other federal or local governmental 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 Carollna 27699-1612.919-707-92001 FAX: 919-715-8801 512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: http:/1porta1.ncdenr.orglwebllrl An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper •,y-a 1�► Mr. Bryant Higgins June 19, 2015 Page 2 of 2 If you have any questions concerning this permit, please contact Bradley Bennett at telephone number (919) 807-6378 Sincerely, e&�) — for Tracy E. Davis, P.E., CPM cc: Fayetteville Regional Office, Mike Lawyer Central Files Stormwater Permitting Unit Files STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES STORMWATER DISCHARGES 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 Federa] Water Pollution Control Act, as amended, Scotland County is hereby authorized to discharge stormwater from a facility located at Scotland County Landfill 10681 Patterson Road Maxton Scotland County to receiving waters designated as UT to Shoe Hill Creek, a class C, SW water in the Lumber River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, IV, of General Permit No. NCG120000 as attached. This certificate of coverage shall become effective June 19, 2015. This Certificate of Coverage shall remain in effect for the duration of the General Permit. Signed this day June 19, 2015. for Tracy E. Davis, P.E., Director Division of Energy, Mineral, and Land Resources By the Authority of the Environmental Management Commission LOCATION MAP: - IL USGS Maps: Johns Latitude: 34' 43' 29.71" N ' N C G 120106 Longitude: 79' 22' 54.05" W CScotland County — County: Scotland Scotland County landfill Stream Class: C, SW Receiving Stream: UT to Shoe Hill Creek Sub -basin: 03-07-55 (Lumber River Basin) Facility Location Aodow al{rp�t/� Not to Scale a SMITMARDNER EN 6 IN [E R S--- -- _.-_ --- May 11, 2015 Mr. Ken Pickle Stormwater Engineer Stormwater Permitting unit 512 N, Salisbury St, Archdale Building - 9th Floor, Raleigh, NC 27604 RE; Notice Of Intent Scotland County landfill Maxton, North Carolina NCO120000 - landfills Dear Ken: kow'q� I1E WR 14N.RnylanAvenue, RaleighNC27603 9R828,057i www.smuhgaflinerincxoin On behalf of Scottand County, NC, Smith Gardner, Inc. (5+01 is pleased to submit the attached NOI for coverage under the NCG120000 NPDES permit for Landfills. Please contact me, should you have any questions or require clarification, at (9191 828-0577 or by email below. Sincerely, SMITH GARDNER, INC. /OnMisen imer Project Sc entist, Ext. 224 Att. cc: Ms. Bethany Georgoutias, NCOENR RECEIVED MAY 112015 DENR-LAND QUALITY S70RMWATER PERMITTIN13., Division of Water Quality / Surface Water Protection Ajy�e� Section National Pollutant Discharge Elimination System NCDENR No1M Cu UNA tXr MENT or ENN110 ENT µo N,m RE*oWACEg NC G 120000 NOTICE OF INTENT FOR AGENCY USE ONLY Date Received Year Month Da Certirtcate of Covers e Check # Amount Permit Asallea to nn etr National Pollutant Discharge Elimination System application for coverage under General Permit NCG120000: STORMWATER DISCHARGES associated with activities classified as: ECE[VED, Landfills that are permitted by the North Carolina Division of Waste Management under JAY 112015 provisions and requirements of North Carolina General Statute 130A — 294. DE'NR-LAND QUALITY The following activities are specifically excluded from coverage under this General Pe"MMWATER PERMITTING • Stormwater discharges from open dumps, hazardous waste disposal sites, or discharge of waste (including leachate) to the waters of the state. WKFor questions, please contact the DWQ Regional Office for your area. See page 4. (Please print or type) 1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed): Name Scotland County landfill Street Address PO Box 489 City Laurinburg State NC ZIP Code 28353 Telephone No. 910.277.2421 Fax: 910.844.7048 2) Location of facility producing discharge: Facility Name Scotland County landfill Facility Contact Mr. Bryant Higgins, Public Works Director Street Address 10681 Patterson Road City Maxton State NC ZIP Code 28 4 County Scotland Telephone No. 910-277-2421 Fax: 910.277.3141 Email bhiggins@scotlandcounty.org 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). The facility is located on Patterson Drive, approximately 1.9 miles southeast of the intersection of S. Rocky Ford Road and Patterson Rd, in Maxton, NC. (A copy of a county map or USGS quad sheet with facility clearly located must be submitted with this application.) 4) Latitude 34° 43' 29.71" Longitude 790 22' 54.05" (deg, min, sec) 5) This NPDES Permit Application applies to which of the following: ❑ New or Proposed Facility X Existing Date operation is to beginN/A Page 1 of 4 SWU-227-071408 Last revised 7114108 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: 4 9 5 3 Provide a brief narrative description of the types of industrial activities and products manufactured at this facility: Scotland County, North Carolina currently owns and operates the Scotland County Landfill facility. The facility is permitted for the disposal of construction and demolition waste (C&D) under Solid Waste Permit No. 83.01(COD landfill) and the transfer of municipal solid waste NO) under solid waste Permit No.83-02T(Transfer Station). 7) Discharge points / Receiving waters: How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 1 What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater discharges end up in? Unnamed tribute of Shoe Hill Creek. Receiving water classification: C SW ✓ Is this a 303(d) listed stream? No Hasa 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). L 8) Does this facility have any other NPDES permits? X No ❑ Yes If yes, list the permit numbers for all current NPDES permits for this facility: 9) Does this facility have any Non -Discharge permits (ex: recycle permit)? ❑ No X Yes If yes, list the permit numbers for all current Non -Discharge permits for this facility: Solid Waste Permit Nos. 83-01and 83-o2T 10) Does this facility employ any best management practices for stormwater control? ❑ No X Yes (Show structural BMPs on the site diagram.) If yes, please briefly describe: The site has an Erosion Sediment Control Plan Approved by the Division of Waste Management. The site utilizes a sediment basin, drainage ditches, rip wrap channels, diversion berms, check dams, among other BMPs on -site. 11) Does this facility have a Stormwater Pollution Prevention Plan? X No ❑ Yes If yes, when was it implemented? 12) Are vehicle maintenance activities occurring at this facility? ❑ No XYes 13) Hazardous Waste: a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? X No ❑ Yes b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of hazardous waste? X No ❑ Yes Page 2 of 4 SWU-227-071408 Last revised 7114108 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? X No ❑ Yes d) Is hazardous waste stored in the 100-year flood plain?, X No ❑ Yes If yes, include information to demonstrate protection from flooding. e) If you answered yes to questions b. or c., please provide the following information: Type(s) of waste: How is material stored: Where is material stored: How many disposal shipments per year: Name of transport 1 disposal vendor: Vendor address: 14) Certification: North Carolina General Statute 143-216.6B(i) provides that: Any person who knowingly makes any false statement, representation, or certification In any application, record, report, plan, or other document riled 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 rulamaking 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, Notice of Intent must be accompanied by a check or money order for $100.00 made payable to: NCDENR Page 3 of 4 SWU-227-071408 Last revised 7/14108 25' JOHNS QUADRANGLE NORTH CAROLINA-SOUTH CAROLINA 7.5-MINUTE SERIES 1 880 000 FEET {NCI 79°22'30" 3a°a5' F . 4 wrr�rrrrrrirr► NCDENR Hp+rw cxeuw P� :.ir�r ar CNY,wp,Me N: aMo N�S,Jiu. �bOWG[5 Division of Water Quality / Surface Water Protection Section National Pollutant Discharge Elimination System NCG1 20000 BoR AGENCY IiSE ONLY Datx Rceei%ed Year h[mtth Dav CeniticateofCocrn e Check M Mnoant Perrml A45i nC 10 °nr1e' NOTICE OIL INTENT National Pollutant Discharge Elimination System application for coverage under General Permit NCG120000: STORMWATER DISCHARGES associated with activities classified as: HECEIVED Landfills that are permitted by the North Carolina Division of Waste Management under JAY.1 12015 provisions and requirements of North Carolina General Statute 130A — 294. I)ENR-LAND QUALITY The following activities are specifically excluded from coverage under this General PaA1RMATER PERMITTING Stormwater discharges from open dumps, hazardous waste disposal sites, or discharge of waste (including leachate) to the waters of the state. 1 I For questions, please contact the OWQ Regional Office for your area. See page A (Please print or type) 1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed): Name Scotland County Landfill Street Address PO Box 489 City Leurinbur __..... .._. State NC ZIP Code 28353 Telephone No, 910.277-2421 Fax: 910.844-7048 2) Location of facility producing discharge: Facility Name Scotland County Landfill Facility Contact MLBryant.liiggins, Public Works Director Street Address 10681 Patterson Road City Maxten State NC _ ZIP Code 28 4 County Scotland / Telephone No, 910-277-2421 Fax: 910-277.3141 3 Email bhig$ins@scattandeountyxq 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). The facility is located on Patterson Orive, approximately 1.9 miles southeast of the intersection of S. Rocky Ford Road and Patterson Rd in Mextun, NC. (A copy of a county map or USGS quad sheet with facility dearly located must be submitted with this application.) 4) Latitude 34043' 29.71" Longitude W 22' 54.05" (deg, min, sec) 5) This NPDES Permit Application applies to which of the following: ❑ New or Proposed Facility X Existing Date operation is to beginN/A Page 1 of 4 SWU-227.071408 Last revised 7/14108 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: 4 9 5 3 Provide a brief narrative description of the types of industrial activities and products manufactured at this facility: Scotland County, North Carolina currently owns and operates the Scotland Coun landfill facilitV. The facility is permitted for the disposal of construction and demolition waste (CtiD) under Solid Waste Permit No, 83-01(COD landfill and the transfer of municipal solid waste (M5W) undersuUd waste Permit No. 83-02T a ansfar Station), 7) Discharge points) Receiving waters: How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 1 What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater discharges end up in? Unnamed tributary of Shan (fill Creek. Receiving water classification: C, SW Is this a 303(d) listed stream? _Ha Has a 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). 1A B) Does this facility have any other NPDES permits? X No ❑ Yes If yes, list the permit numbers for all current NPDES permits for this facility: 9) Does this facility have any Non -Discharge permits (ex: recycle permit)? ❑ No X Yes If yes, fist the permit numbers for all current Non -Discharge permits for this facility:$otiaiWaste Permit Nils, 23•01and 83-02T 10) Does this facility employ any best management practices for stormwater control? ❑ No X Yes (Show structural BMPs on the site diagram.) If yes, please briefly describe: Th_e.site has, an Erosion Sediment Control Plan Approved the Division of Waste Management. The site utilizes a sediment basin, drainage ditches rip wrap channels, diversion berms, check dams, among other BMPs an -site. 11) Does this facility have a Stormwater Pollution Prevention Plan? X No ❑ Yes If yes, when was it implemented? 12) Are vehicle maintenance activities occurring at this facility? ❑ No XYes 13) Hazardous Waste: a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? X No ❑ Yes b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of hazardous waste? X No ❑ Yes Page 2 of 4 SWU•227-071408 Last revised 7/14108 NCG120000 N.O.L c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of hazardous waste? X No 0 Yes d) Is hazardous waste stored in the 100-year flood plain? X No 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: Now many disposal shipments per year: Name of transport / disposal vendor: Vendor address: 14) Certification: North Carolina General Statute 143-215.6B(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 Artide; or who knowingly makes a lalse statement of a material fact in a rulemaking proceeding or contested case under this Article; or who fatsittes. tampers with. or knowingly renders inaccurate any recording or monitoring device or melhod 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 tnousand 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. Notice of Intent must be accompanied by a check or money order for $100.00 made payable to: NCOENR Page 3of4 5WU-227.071408 bast revised 704108 m JOHNS QUADRANGLE NORTH CAROL,INA-SOUTH CAROL,INA 7.5-MINUTE SERIES 25' 79°22'30" �$ 1 880 000 FEET (NC) 648 a a i+� N iQ