NCG180251_COMPLETE FILE - HISTORICAL_20161021

STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.
�IIL 6 /SdaS�
DOC TYPE
❑COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
YYYYMMDD

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
October 21, 2016
Mr. Chris Farabee
Heritage Home Group, LLC
1925 Eastchester Drive
High Point, NC 27265
PAT MCCRORY
Govemor
DONALD R. VAN DER VAART
Sccrelary
TRACY DAVIS
DIftMor
Subject: Rescission of NPDES Stormwater Permit
Certificate of Coverage Number NCG 180251
Davidson County
Dear Mr. Farabee:
On August 23, 2016, the Division of Energy, Mineral and Land Resources received your request to
rescind your coverage under Certificate of Coverage Number NCG 180251. In accordance with your
request, Certificate of Coverage Number NCG 180251 is rescinded effective immediately.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 storunwater 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
Winston-Salem Regional Office [phone].
Sincerely,
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, PE, CPM, Director
Division of Energy, Mineral and Land Resources
cc: Winston-Salem Regional Office
Storrnw-,ater Peamitting_Program
Central Files - w/attachments
i,
State nfNorlh Carolina 5nvirrnnnenlal Quality I Energy, Mineral and rand Resources
1612 Mail Service Censer 512 North Salisbury Street I Raleigh, North Carolina 27699-1612
919 707 9220 T

IA
'� • .
Division of Energy, Mineral &Land Resources
WL
Land Quality Section/Stormwater Permitting Program
NC®ENR
National Pollutant Discharge Elimination System
NO G. -- De'.Rr T or
r—V NmEN µO N.4U RKS RCC5
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Data Received
Year I Month
Da
RECEIVED
'r i -5 ?016
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
t �ri`1'JiVP
Individual Permit (or) Certificate of Coverage
2) Owner/Facility information: * Final correspondence will be �Ir (mailed to the address noted below �
Owner/Facility Name �•1Q�C` CLg�' ha&f' Grr:VLA p j u—C — r7y
Facility Contact LylZ = S ., la �QhCy{'
Street Address Ent, s74rc k e 4-
City 14 1 n6i State . rl C ZIP Code '7 kfo County tN E-mail Address T . ee 6—cj-4 , e
Telephone No. -33 Fax: �A'r
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on Cal All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to F�'�1_ on . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
Other: r' Gvb l a- ( .
t
0 a �f W.
4) Certification:��
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained Jn this request and to the best of my knowledge and belief
such information is true, complete and accurate.
SignaturecLa-i,
Date //(,
& -- I
b s L-� ( - i� /
Print or type name of person signing above Title
Please return this Completed rescission request form to: NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mail Service Center, Raleigh, North Carolina 27699.1612
Phone: [phone] FAX: [phone]
An Equal Opportunity L Affirmative Action Employer

Alexander, Laura
From:
White, Glen
Sent:
Friday, September 02, 2016 1:28 PM
To:
Alexander, Laura
Subject:
RE- Scanned page
Follow Up Flag:
Follow up
Flag Status:
Flagged
Laura
lga-5 �
NCG18251 is OK to rescind.
Glen White
Environmental Specialist
NCDENR Winston-Salem Regional Office
Division of Energy, Minerals & Land Resources
450 Hanes Mill Rd — Suite 300
Winston-Salem, NC 27105
glen,[e-mail]
[phone]
From: Alexander, Laura
Sent: Wednesday, August 24, 2016 8:44 AM
To: White, Glen <[e-mail]>
Subject: FW: Scanned page
Good Morning Glen,
Attached is a rescission request for permit NCG180251. Please let me know if/when okay to rescind.
Thank you,
Laura Alexander
Administrative Assistant
Stormwater Permitting Program
North Carolina Division of Energy. Mineral and Land Resources
North Carolina Department of Environmental Quality
919 807 6368 Office
919 807 6494 Fax
laura.alexander Qncd_enr.gov
512 North Salisbury Street
1612 Mail Service Center
Raleigh, North Carolina 27699
�---Nothing Compares
1

Division of Water Quality 1 Surface Water Protection
Ay
�
NCDENRNational Pollutant Discharge Elimination System
IRONMEIJe ID NATuRA RENT O. PERMIT NAMEIOWNERSHIP CHANGE FORM
ENV4RONMENT AID IJ ATl1RAL RE9IX1REE9
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N G G 11111 8 1 0 1 0 0 0 N 1 G G I I 1 8 1 0 12 5 1
11. Permit status prior to requested change.
a. Permit issued to (company name): Heritage Home Group LLC.
b. Person legally responsible for permit:
���R-LAL`1D P���t�ING
S1�RMNIP�ER
c. Facility name (discharge):
d. Facility address:
Clyde D Whittington
First M I Last
Vice President of Logistics & Compliance
Title
825 Visionary Street
Permit I ]older Mailing Address
Lenoir NC 28645
City State Zip
[phone] NIA
Phone Fas
Heritage Home Group LLC — IDS
1425 Unity Street
Address
Thomasville NC 27360
City State Zip
e. Facility contact person: _Chris L Farabee [phone]
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
X Name change ofthe facility or owner
If other please explcurr:
b. Permit issued to (company name):
Heritage Home Group LLC
c. Person legally responsible for permit:
Clyde l) Whittington
First M 1 Last
Vice President of Logistics & Compliance
Title
825 Visionary Street
Permit Holder Mailing Address
Lenoir NC 28645
City State "Lip
[phone] davy.whittington a, heritagehonte.com
Phone F-mail Address
d. Facility name (discharge):
Heritage Home Group Unity Street
c. Facility address:
1425 Unity Street
Address
"Thomasville NC 27360
City State Zip
f Facility contact person:
Chris L Farabee
First MI Dist
[phone] chris.fi►rabee cr heritagehorne.catn
Phone I; -mail Address
Revised 2012Ap23

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 M 1 last
Director of Environmental Compliance
Title
815 Visionary Street
Mailing Address
Lenoir NC 28645
City State Zip
[phone] dayid.stOUt (of heritagehome.con7
Plwric 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 13E RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
X This completed application is required for both name change and/or ownership change
requests.
❑ I,egal 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 both 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):
I, 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 returnedasincom fete.
Sigt tore Date
APPLICANT CERTIFICATION
I, David Stout, 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.
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGI? TO:
Division of Water Quality',
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2008

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
October 8, 2014
Mr. Chris L. Farabee
Heritage Home Group, LLC
815 Visionary Street
Lenoir, North Carolina 28645
Subject: General Permit No. NCG180000
Heritage Home Group, LLCADS
COC No. NCG180251
Davidson County
Dear Mr. Farabee:
John E. Skvarla, III
Secretary
In accordance with your application -for a discharge permit received on July 10, 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).
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 Energy, Mineral and Land Resources (Division). 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 or permits required by
the Division of Water Resources, Coastal Area Management Act or any other federal, state or local
governmental permit that may be required.
If you have any questions concerning this permit, please contact Bill Diuguid, Stormwater
Program Planner at telephone number [phone].
Sincerely,
ORIGINAL SIGNED 8Z
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and
Land Resources
cc: Winston-Salem Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity V Affirmative Action Employer —Made in part by recycled paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCGI80000
CERTIFICATE OF COVERAGE No. NCG180251
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,
Heritage Home Group LLC
is hereby authorized to discharge stormwater from a facility located at
Heritage Home Group LLC-IDS
1425 Unity Street
Thomasville
Davidson County
to receiving waters designated as an unnamed tributary to Hamby Creek, a Class C waterbody to Yadkin Basin; in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, IV,
V and VI of General Permit No. NCG 180000, as attached.
This Certificate of Coverage shall become effective October 8, 2014,
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 8, 2014,
ORIGINAL SIGNED M
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission

MIN
SCALE
0 2000 4000 FEET
Reference:
U.S. Geological Survey
High Paint, West and Fair Grove Quadrangles
North Carolina
7.5 Minute Series (Topographic)
Nationol Geodetic Vertical Datum
Photorevised 1987
Woodward --Clyde Consultants, lnc.992k FILE NO.
Consulting Engineers, Codoglota
Thomasville FurnifiL:ra Industries, Inc. and Environmentd Sdentlals Site LDCOtIOn Map
Raleigh, North Carolina FIG. NO.
Thomasville, North Carolina
SCALE DRAAN BY: DSIA JDATE. 3 95
As Shawn CHKD, 9Y. DSLt I DATA 3 95

11 g�g,- g 4, q A
N IMUNUMW lUZW /,ISIR ju
I , () - t,, �)
iE
U
Al 4
fp A- kjj,, *4 Vfoo 00
K
- '01 THE� ER
,,,16 1 �;7.`, M A I 1�,SERVICE.CENTER -J
v Z4� %X4r
61 VC,27699-1
By
DEN R,`-�: DIVI SIOW,OF WATEQUALITY-
Ir 0
Authorized Signature
0130 L 791ol 10.0 3 1 20 2 7 701: 80 26 29867 3,10 -

IHHGI
Heritage Home Group
.7/I/14-
Stormwater and General Permits Unit
Division of water Quality
1617 Mail Service Center
Chris Farabee
Environmental Engineer
401 E. Main Street
Thomasville, NC 27361
Tel: [phone]
Fax: [phone]
[e-mail]
Raleigh, NC 27699-1617
Certified Mail # r] 00 (0 o_1760 000 .'k, gG ,?, a f -7q 5-
Heritage Home Group, LLC wishes to obtain a certificate of coverage for their IDS facility located 1425
Unity Street, Thomasville, NC. This facility was part of the County line Road Complex; COC #NCG180243
located at 509 County Line Road, Thomasville, NC. The County Line Road property is being sold and only
the IDS building will remain.
If you have any questions or comments, please contact me at [phone].
Best. /,
Chris Farabee
Environmental
Engineer, Heritage Home
Enclosures:-NCG180000 NOI for Heritage Home Group, LLC - IDS
-USGS quad sheet
-Check for $100 application fee
Cc: IDS - environmental files
Ec: David Stout - HHG
Val Fields - HHG
JUL Y a 2014

Diuquid, Bill
From: Taylor -Smith, Aana
Sent: Thursday, August 07, 2014 7:08 AM
To: Diuguid, Bill
Cc: Gantt, Matt; Bennett, Bradley
Subject: RE: NCG180251 Heritage Home Group LLC-IDS NOI Thomasville Davidson County Jul 14
2014
Hi Bill,
I went by the Heritage Home Group plant in Thomasville yesterday and they are good to go on this N01. No concerns or
questions from WSRO.
Thanks!
Aana Taylor -Smith
Land Quality Section
Division of Energy, Mineral, and Land Resources
NC DENR Winston-Salem Regional Office
Phone: [phone]
Fax [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Low and may be disclosed to
third parties.
From: Gantt, Matt
Sent: Wednesday, July 30, 2014 4:54 PM
To: Taylor -Smith, Aana
Subject: FW: NCG180251 Heritage Home Group LLC-IDS NOI Thomasville Davidson County Jul 14 2014
I think I forgot to send this to you.
Oops!
Matthew E. Gantt, P.E.
NC DENR Winston-Salem Regional Office
Division of Energy, Mineral, and Land Resources
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
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.
t

From: Diuguid, Bill
Sent: Monday, July 14, 2014 11:36 AM
To: Gantt, Matt
Subject: NCG180251 Heritage Home Group LLC-IDS NOI Thomasville Davidson County Jul 14 2014
Matt Gantt, Winston-Salem Regional Office:
Please review the attached N01 application with the objective of responding to me with a recommendation to issue the
permit. I recognize that you may not visit each new permittee during this NOI review, but it affords you the opportunity
to log the permit into your regional database and add the facility to a future monitoring and compliance visit
schedule. Therefore, your recommendation now to issue the permit serves as your acknowledgement that (1) the
facility is located in your region, (2) that there are no current complaints outstanding about the facility that have not
been dealt with, and (3) that the facility may ultimately be inspected by the regional staff. I've also attached a scanned
copy of the NOI and a location reap for your review.
COC # Facility Location City/County
NCG180251 Heritage Home Group, LLC-IDS J 1425 Unity Street Thomasville/Davidson
If you need any more info, give me a call. If you could send me a recommendation to issue the permit by 08/14/2014,
I'd appreciate it, so I can issue their COC. I cannot issue the permit until the respective regional office reviews and
comments back to me with a recommendation to issue the permit.
Thanks
Bill
Sill Diuguid, AICP, Planner
Stormwater Permitting
Land Quality Section
Division of Energy, Mineral and Land Resources I NCDENR
1612 Mail Service Center (Mail)
512 N. Salisbury St, Raleigh, NC 27604 1 91h Floor (Location & Parcels)
Raleigh North Carolina 27699-1612
Phone: [phone] Fax: [phone]
Website: http://Poi-tal.ncdenr.orr~/-cb/wa/ws/su
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.

Division of Water Quality 1 Water Quality Section
NCDENRNational Pollutant Discharge Elimination Systetni
Ncr CAR w Ocw CRT av
E'V ROHnew µo NaLRAL Re Rees
NCG 180000
NOTICE OF INTENT
rOR AGENCY USE ONLY
Date Received
Year Month
Da
Certificate of Covemm
Check tJ 1 Ama nt
0
Pcnni Asai ed to
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG180000:
STORMWATER DISCHARGES associated with activities classified as: 5icaror�CUt�Je
� ,, `�,�
SIC 25 Furniture and Fixtures [JS�W74
SIC* 2434 Wood Kitchen Cabinets ,�:
j 0 ZO 14 ! �,
*Standard Industrial Class
(Please print or type)
1) Mailing address of owner/operator:
Name Heritage Horne Group, LLC
Street Address 815 VisionarV Street
City Lenoir
Telephone No. 828-759-8510
2) Location of facility producing discharge:
State NC ZIP Code 28645
Fax:
' Address to which all permit correspondence will be mailed
Facility Name Heritage Home Group, LLC - IDS
Facility Contact Chris Farabee
Facility Address 1425 Unity Street
City Thomasville State NC ZIP Code 27360
County Davidson
Telephone No. 336-476-2250 Fax:
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). Take Hwy 109 South to Thomasville; Left on Unity St,
plant is several miles on the ri ht
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application)
3s 1 Z 0 7, 314, A/ — 80 0 3 oLf. 9 q
4) Latitude 35.882509 Longitude-80.0514 (degrees, minutes, secondsl
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
X Existing
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: 2511
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: furniture repair operation and warehouse
Page 1 of 4
SWU-233-081511

NCG180000 N.O.I.
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 5
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Hamby Creek G �l�s S G • D 3 _ a 7._ o �, 5� r �„ ;t?d,� ��- J 14 0'7 _.LL
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). City of Thomasville
10) Does this facility have any other NPDES permits?
XNo
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
XYes
If yes, please briefly describe: minimize outside storage, seconds containment monthly inspections
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
fYes
yes, when was it implemented? 05-01-1998
14) Are vehicle maintenance activities occurring at this facility?
fXNo ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
ANo ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No ,XYes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
,l No ❑ Yes
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: D001 paint and D001. F003, F005 spent solvent
Page 2 of 4
S W U-233-o8 1511

NCG180000 N.O.I.
How is material stored: 55-gallon steel drums
Where is material stored: 180 day hazardous waste storage area
How many disposal shipments per year: less than one per year
Name of transport 1 disposal vendor: North Star Logistics, Inc.
Vendor address: 917 Beaver Dam Road, Canton, NC 28716
16) Certification:
North Carolina General Statute 143-215.6 b (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 Article 21 or regulations of the Environmental
Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate
any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of
the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a fine not to exceed $10,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both, for a similar
offense.)
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.
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: Chris L. Farabee
Title: Environmental Enclineer
UISL d 7�1 - //'
(Signature of Applicant) (Dath Sigled)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
\b�J Check for $100 made payable to NCDENR
This completed application and all supporting documents
Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
Stormwater and General Permits Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
Page 3 of 4
SWU-233-081511