NCG180087_COMPLETE FILE - HISTORICAL_20150107

STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.
DOC TYPE
❑COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
❑ �l,�S-29 d %
YYYYMMDD

AM=
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. David Stout
Heritage Home Group
815 Visionary Street
Lenoir, NC 28645
Dear Mr. Stout:
Donald R. van der Vaart
Secretary
January 7, 2015
Subject: Rescission of NPDES Stormwater Permit
Certificate of Coverage Number NCG 180087
Catawba County
On November 26, 2014 the Division of Energy, Mineral and Land Resources received your request to
rescind your coverage under Certificate of Coverage Number NCG 180087. In accordance with your request,
Certificate of Coverage Number NCG 180087 is rescinded effective immediately.
Operating a treatment facility, discharging wastewater or discharging specific types of stormwater to waters
of the State without valid coverage under an NPDES permit is against federal and state laws and could result
in fines. if something changes and your facility would again require stormwater or wastewater discharge
permit coverage, you should notify this office immediately. We will be happy to assist you in assuring the
proper permit coverage.
If the facility is in the process of being sold, you will be performing a public service if you would inform the
new or prospective owners of their potential need for NPDES permit coverage.
If you have questions about this matter, please contact us at 919-707-9200, or the Stormwater staff in our
Mooresville Regional Office [phone].
Sincerely,
ORIGINAL SIGP.ED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, PE, CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Z. Khan
/Stormwater Permitting Program
Central files - wlattachments
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: httt :Ilportal.nodenr.or_lweb/Ir/
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

Heritage Home Group
November 14, 2014
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Stormwater Permitting
Attention: Ms. Bethany Georgoulias
217 West Jones St.
Raleigh, NC 27603
RE: Heritage Home Group, LLC
Lane Venture Plant 14
1405 Deborah Herman Rd., Conover NC, Catawba County
Stormwater General Permit No. NCG180000
COC NCG180087
Permit Recession Request
Dear Ms. Georgoulias:
David Stout
Director of Environmental Compliance
815 Visionary St.
Lenoir, NC 28645
828-759-8510 Tel
828-406-6079 Cell Phone
828-438-2623 Fax
Email address:
[e-mail]
RPOFIVED
2014
DENR-LAND QUALITY
STQRMWATER PERMITTING
I am writing this letter to notify you that our Lane Venture Plant located at 1405 Deborah
Herman Rd., Conover NC, has been permanently closed and is in the process of being sold. I
would like to request that Stormwater General Permit No. NCG 180000, COC NCGI 80087, be
term inated.
If you need further information or have questions, please contact me.
Sincerely,
Heritage -Home Group
David Stout
I certify, under penalty of law, that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations.
Davy Whittington, Vice Presi ent of Compliance and Logistics, Heritage Home Group LLC
ignature & date)

i
Alexander, Laura
From: Khan, Zahid
Sent: Friday, December 12, 2014 2:04 PM
To: Alexander, Laura
Subject: RE: Two Rescission Requests for Catawba County - Heritage Home Group, LLC
Good Afternoon Laura,
Inspection reports are in BIMS. Please see comments from Samar. Permit # NCG180087 is ready for rescind. Permit #
NCG180061 is not ready yet. Thanks
Zahid
From: Bou-ghazale, Samar
Sent: Friday, December 12, 2014 1:14 PM
To:- Khan, Zahid
Subject: RE: Two Rescission Requests for Catawba County - Heritage Home Group, LLC
It is ok to rescind permit #fNCG180087.
Permit#f NCG180061 is not ready to be rescinded.
Inspection in'Bims (look at the summary)
Thanks,
Samar
From: Khan, Zahid
Sent: Monday, December 01, 2014 2:00 PM
To:'Bou-ghazale, Samar
Subject: FW: Two Rescission Requests for Catawba County - Heritage Home Group, LLC
Can you login and deadline date is Dec. 23, 2014.
From: Alexander, Laura
Sent: Monday, December 01, 2014 1:49 PM
To: Khan, Zahid
Subject: Two Rescission Requests for Catawba County - Heritage Home Group, LLC
Good Afternoon!
Please see both rescission requests for NCG180061 & NCG7.80087.
Thank you!
Laura
i

), o6,6 ag q q. , 0*
Division of Energy, Mineral and Land Resources
Land Quality Section / Stormwater Permitting Program
National Pollutant Discharge Elimination System (NPDLS)
PERMIT OWNER AFFILIATION DESIGNATION FORM
`I11 IVIII NPR LC4410 y I 4 c 111my
FOR AGENCY USE ONLY
Data Received
Year
Month
Da
RECEIVED
ern
"L.' 4 Z) LU
Use this form if there has been: DENR-LANE) QUALITY
STORMINATER P RNIITTING
NO CHANGE in facility ownership or facility name, but the individua�f
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);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
I) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N FC I S
2) facility information:
(o)) Certificate of Coverage
N C G I I C) () 18 7
Facility name: LcLoe, v (,Ili t t,c �.14
Company/Owner Organization:
Facility address:
Address
C(�y�vV�►r t��C �.��
City state Zip
To find the current legally responsible person associated with your permit, go to this website:
littu://i)ortal.ncdenr.oi-g/web/Ir/sw-permit-contacts and run the Permit Contact Summary Report,
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: C 2,y\e, 1� L'. 4 1 t `S
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Da-w' y W V 1 4,1
First M1 Last
Page I of 2
SW U-OWN ERAFF{L-25July2014

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
11, P L 0Q s--�; C aid C© P i a Ln c -e�
Title
Mailing Address
ate
(M) city
-7 S ! —. 4-7 00 Zip
VLl ' U i.4jn
Telephone E-mail Addres J
110-r• J
i+ (�10iM+o + CO V1/\
Fax Number
5) Reason for this change:
A result of: VEniployee or management change
❑ inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
r
[,V e in _attest that this application for this change in Owner Affiliation
(person le- ly responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
s'-Iffy
sigd&ure Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Ralcigh, North Carolina 27699-1612
For more information or staff contacts, please call 919-707-9220 or visit the website at:
littp://portal .ncdem•.orJweb/Ii•/storinNvater
Page 2 of 2
S1NU-04NNERAFFIL-25Ju1y2014

Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NCDENR
"pRM NTAN NffURA1M["'°' PERMIT NAME/OWNERSHIP CHANGE FORM
ENVIRONMENT AND NATL1RAl RCSOURCE9
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
I. Please enter the permit number for which the change is requested.
NPDFIS Permit (or) Certificate of Coverage
111 $ 1 0 1 0 1 0 1_0j ] 8 1 0 10 8 7
IL Permit status _ ior to requested change.
a. Permit issued to (company nanle): Furniture Brands International
b. Person legally responsible for permit: Clyde D Whittington _
First MI last
Vice President of Logistics & Compliance
Title
825 Visionary Street
Permit Holder Mailing Address
Lenoir NC 28645
City State Zip
[phone] NA
Phone Fas
c. Facility name (discharge): Lane Venture
d. Facility address: 1405 Deborah Herman Rd.
Address
Conover NC 28613
City State Zip
e. Facility contact person: David Stout [phone]
First 1 MI I Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: X Change in ownership of the facility
X Name cliange of the facil ity or owner
ifo1her please c?xplahr
b. Permit issued to (company name): Heritage Home Group, LLC
c. Person legally responsible for permit: Gene Bullis
First MI Last
Chief Financial Officer, Lane Venture
Title
205 Workman St.
Permit 1-folder Mailing Address
Conover NC 28613
City State Zip
828 267-5852 gene.bullis a herita ehome.com
Phone F-mail Address
d. Facility name (discharge): Lane Venture
e. Facility address: 1405 Deborah Herman Rd.
Address
Conover NC 28613
City State %ip
f. Facility contact person: David E Stout
First MI Last
[phone] david.stout rr,heritac,,,ehome.coni
Phone E-mail Address
Revised 2012Apr23

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: David E Stout
First M1 Last
Director of Environmental Compliance
Title
815 Visionary Street
Mailing Address
Lenoir NC 28645
City State Zip
[phone] david.stout a,heritagehome.corn _
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
X Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL I3E RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
X This completed application is required for both name change and/or ownership change
requests.
X Legal dOCUmentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by hoth the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, Clyde D. Whittington, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of'my knowledge. i understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
ZQ � 3-y/y
Signature 10/ Date
APPLICANT CERTIFICATION
I, Gene Bullis, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge, I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
2 - S
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 712008

"State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
August 27, 1999
MIKE SMITH
LANE COMPANY, INC. LANEVENTURE PLT 14
P.Q. BOX 151
ALTAVISTA, VA 24517
Dear Permittee:
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissue - NPDES Stormwater Permit
Lane Company, Inc. Laneventure Ph 14
COC Number NCG 180087
Catawba County
In response to your renewal application for continued coverage under general permit NCG180000. the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December b, 1983.
The following information is included with your permit package:
* A copy of general stormwater permit NCG180000
* A Stormwater Pollution Prevention Plan (SPPP) Certification Form. Completion of this form is required to
certify that you have developed and implemented the SPPP as per the conditions of the permit. This form
must be completed and returned to the Division within 30 days of receipt of this letter.
DO NOT SEND the SPPP with the signed form.
* Five copies of the Analytical Monitoring form and five copies of the Qualitative Monitoring form
* A copy of a Technical Bulletin on the Stormwater program which outlines program components and
addresses frequently asked questions
* A corrected Certificate of Coverage if you indicated a name change on the Renewal Application
Your coverage under this general permit is not transferable except after notice to DWQ. 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 DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule, standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Bill Mills of the Central Office Stormwater
and General Permits Unit at [phone], ext. 548
Sincerely,
for Kerr T. Stevens
Director, Division of Water Quality
cc: Central Files
Mooresville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180087
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,
LANE COMPANY, INC.
is hereby authorized to discharge stormwater from a facility located at
LANE COMPANY, INC.
1405 DEBORAH HERMAN RD
CONOVER
CATAWBA COUNTY
to receiving waters designated as Cline Creek in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I,11, III,
IV, V, and VI of General Permit No. NCG180000 as attached.
This certificate of coverage shall become effective August 27, 1999.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 27, 1999.
for Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment,
Health and Natural Resources
Division`of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
June 9, 1995
Mike Smith
Lane Company Inc.
P.O. Box 151
Altavista, VA 24517
Subject: General Permit No. NCGI80000
Lane Company Inc.
COC NCG180087
Catawba County
Dear Mike Smith:
In accordance with your application for discharge permit received on March 29, 1995, 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
December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management 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 Environmental Management or permits required by the Division of Land Resources, Coastal
Area Management Act or any other Federal or Local governmental permit that may be required.
If you have any question concerning this permit, please contact MR. BILL MILLS at telephone number
919/733-5083.
Cfinal
Sincerely, . n W. ,u16tr's
nlee
A. Preston Howard, Jr. P.E.
cc: Mooresville Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE NO. NCG180087
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,
Lane Company, Inc.
is hereby authorized to discharge stormwater from a facility located at
Lane Upholstery Plant No. 14
1405 Deborah Herman Road
Conover
Catawba County
to receiving waters designated as Cline Creek in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, Ill
and IV of General Permit No. NCG 180000 as attached.
This Certificate of Coverage shall become effective June 9, 1995.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day dune 9, 1995.
I�ylil•'ii� ei``+�,ii�i3 GsL'
CU4�ta� ri.:i '
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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MAP
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