NCS000609_Application_20191103

Form
1
NPDES
+ro
j�(� Tom' pI FormApprb4e443Rt�u ��
I`1G.1.",i /L i 1'Y 1-1 aMB Ne. Ya4a-0009
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
GENERAL INNFORMATION
1.1 Applicants Not Requfredto Submit Form 1
1 11 Is the facility a new or existing publicly owned
treatment works?
If yes, STOP. Do NOT complete Ef No
Form 1. Complete Form 2A
1.2 Applicants Required to Submit Form 1
12.1 Is the facility a concentrated animal feeding
operation or a concentrated aquatic animal
production facility?
Yes + Complete Form 1 LA I
and Form 2B.
1.2.3 Is the facility a new manufacturing, commercial,
mining, or silvicultural facility that has not yet
commenced to discharge?
Yes 4 Complete Form 1 No
and Form 2D. _
1.2.5 Is the facility a new or existing facility whose
discharge is composed entirety of stonnwater
associated with industrial activity or whose
discharge is composed of both stormwater and
no tormwater? -- - --
Yes 4 Complete Form 1 Ej No
and Form 2F
unless exempted by
40 CFR
12226(b)(14)(x) or
2.1 1 Facift Name
P. K�..Fc--n
2.2 EPA Identiflealion Numl
r�
2.3 Facility Contact
Name (first and last)
2.4 Facility Meiling A
Sfrcet or P.O. box
Cilv or town
EPA Form 351D-1(re4ed 319)
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Tille PRIES
�M @ K iv
1 12 Is the facility a new or existing treatment works
treating domestic sewage? � ;-'; L
If yes, STOP. Do NOT El VOR?t
complete Form 1. Complete
Form 2S.
1.2.2 Is the facility an existing manufacturing,
onmmercial, mining, or silviculturai facility that is
currently discharging process wastewater?
Yes 4 Complete Form Ef No
1 and Form 2C.
1.2.4 Is the farifily anew or existing manufacturing,
commercial, mining, or stivicultural facility that
discharges only nonprocess waste r?
[] Yes 4 Complete form
Q f JaX
State
Phone numborr
G, `Jot I
Page 1
ER � tiClPii 11!iVv

EPA Identikation Number NPDES Permit Number radlity Name \ Form Approved 0310919
_ ) [�o Tg�+ 1 A 1 OMB No. 2040-0004
t 2.5 Facility Location
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Street, route number, or other specific identifier
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County name
County code (d known)
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City or town
State ZIP code
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SECTION
3. SIC
• NAICS CODES•1
3.1
SIC Code(s)
Description (optional)
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3.2
NAICS Code(s)
Description (optional)
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4.1
LEN TECH G
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4.2
2namein Item 4.1 also the owner?
l;the
4.3
0 Public —federal ❑ Public —state ❑ Other public (specify)
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M Private ❑ Other specify)
4.4
Phone Number of Operator
2
39 - 3 7
4.5
0 eratorAddress
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Street or P.O. Box
//0 3RD DT. NE
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City or town
14(�DEO AN
Slate
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ZIP code
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Email address of operator
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SECTION
5. •
• •r
5.1
Is the facility located on Indian Land?
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❑ Yes OoatNo
EPA Form 3510.1 (revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 204NO04
SECTION 6. EXISTING ENVIRONMENTAL PERMITS (40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits (check all that apply and print or type the corresponding permit number for each)
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❑ NPDES (discharges to surface
❑ RCRA (hazardous wastes)
❑ UIC (underground injection of
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water)
fluids)
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❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
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❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ❑ Other (specify)
SECTION1
7.1
Have you attached a topographic map containing all required information to this application? (See instructions for
R
specific requirements.)
O Yes ❑ No ❑ CAFO—Not Applicable (See requirements in Form 2B.)
SECTION•
I
8.1
Describe the nature of your business.
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SECTION.•
1
9.1
Does your facility use cooling water?
•y
El Yes L�J No 4 SKIP to Item 10.1.
E
9.2
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
o,
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
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NPDES permitting authority to determine what specific information needs to be submitted and when.)
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SECTIONI
VARIANCE
REQUESTS41 I
10.1
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)? (Check all that
v,
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
0
when.)
�
❑ Fundamentally different factors (CWA ❑ Water quality related effluent limitations (CWA Section
Section 301(n)) 302(b)(2))
R
❑ Non -conventional pollutants (CWA ❑ Thermal discharges (CWA Section 316(a))
c ton 301(c) and (g))
Not applicable
EPA Form 3510-1 (revised 3-19) Page 3

( - - - EPA IderxifiaUon Number _ — ---NPDES P^ermil Number � LE ry NamaA I A� Form MBBNNoo.204DON
SECTION
11. CHECKLIST
AND CERTIFICATION STATEMENT •1
11.1
In Column 1 below, mark the sections of Form 1 that you have completed and are submitting with your application.
For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to provide attachments.
Column 1
Column 2
Section f: Activities Requiring an NPDES Permit
❑ w/ attachments
[� Section 2: Name, Mailing Address, and Location
❑ wl attachments
Section 3: SIC Codes
❑ w/ attachments
Section 4: Operator Information
❑ w/ attachments
❑ Section 5: Indian Land
❑ w/ attachments
❑ Section 6: Existing Environmental Permits
❑ w/ attachments
m
Section 7: Map
maf0 pogmphlc ❑ w/ additional attachments
g
Section 8: Nature of Business
❑ w/ attachments
Y
❑ Section 9: Cooling Water Intake Structures
❑ w/ attachments
v
❑ Section 10: Variance Requests
❑ wl attachments
N
Section 11: Checklist and Certification Statement
❑ w/ attachments
Y
d
11.2
Certification Statement
s
U
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 qual i d 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 forgathering 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 fine and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Signature
Date signed
�-
I6/a2
EPA Form 151M (revised 3-19) Page 4

' EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105/19
I! t CC t r T E �- fl f 11
OMB No, 2040-0004
Form
U.S Environmental Protection Agency
2F
Application for NPDES Permit to Discharge Wastewater
NPDES
\`,EPA
STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY
SECTIONOUTFALL
LOCATIONI
1.1 Provide information
on each of the facility's ouffalls in the table below
Outfall
Number
Receiving Water Name
Latitude
Longitude
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SECTION•
I
2.1
Are you presently required by any federal, state, or local authority to meet an implementation schedule for constructing,
upgrading, or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
J
❑ Yes d No 4 SKIP to Section 3.
2.2
Briefly identify each applicable project in the table below.
Brief Identification and
Affected Outfalls
Source(s) of Discharge
Final Compliance Dates
Required
Projected
Description of Project
(listoutiall numbers)
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2.3
Have you attached sheets describing any additional water pollution control programs (or other environmental projects
that may affect your discharges) that you now have underway or planned? (Optional Item)
❑ Yes ❑ No
EPA Form 3510-2F (Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Fan Approved 03105/19'
�• •,-�• I,�� YT h( T't l t I /� • OMB No. 2040-0004
GIY fF1.17 V
SECTION DRAINAGE Ir
W 3.1 Have you attached a site drainage map containing all required information to this application? (See instructions for
specific guidance.)
N A rL
$ Yes ❑ No
SECTION• • r
4.1 Provide information on the facility's pollutant sources in the table below. Q
Outfall
Impervious Surface Area
Total SurfaceArea Drained
Number
(within a mile radius of the facility)
(within a mile radius of the facility)
specify units
specify units
specify units
specify units
specify units
specify units
specify units
specify units
specify units
specify units
specify units
specifyunils
4.2
Provide a narrative descripti of the facility's significant material in the space below. (See instructions for content
requirements.) / A1041C)
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4.3
Provide the location and a description of existing structural and non-structur ontrol measures to reduce pollutants in
stormwater runoff. See instructions forspecificuidance. 0
Stormwater Treatment
Codes
Outfall
from
Number
Control Measures and Treatment
Exhibit
2F-1
sl
EPA Form 3510-21' (Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Faciliy Name Form Approved 03/05/19
OMB No. 2040-0004
5.1 1 certify under penalty of law that the outfall(s) covered by this application have been tested or evaluated for the
presence of non-stormwater discharges. Moreover, I certify that the outfalls identified as having non-stormwater
discharges are described in either an accompanying NPDES Form 2C, 2D, or 2E application.
Name (print or type first and last name) Official title
8R UCr WES l'R6�G�SS1Qr��L EI gI
Signature Date signed
{ . /O _2 ^ I
N
W 5.2 Provide t e testing in ormation reqV6sted in the table below.
s Onsite Drainage Points
N Ouffall Description of Testing Method Used Date(s) of Testing Directly Observed
o Number
During Test
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SECTION 6. SIGNIFICANT LEAKS OR SPILLS r
6.1 Describe any significant leaks or spills of toxic or hazardous pollutants in the last three years.
N
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Y
N
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C
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SECTIONDISCHARGE INFORMATION, 1
See the instructions to determine the pollutants and parameters you are required to mo itor an turn, the tables you must
o com fete. Not all applicants need to complete each tabl .�
7.1 Is this a new source or new discharge?
`o ❑ Yes 4 See instructions regarding submission of ❑ No 4 See instructions regarding submission of
= estimated data. actual data.
d
Tables A, B, C, and D
N 7.2 Have you completed Table A for each oulfall?
❑ Yes ❑ No
EPA Form 3510-2F (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105119'
01- �
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{ 1 8Q ZMLJ i NU
OMB No. 2040-0004
7.3
Is the facility subject to an effluent limitation guideline (ELG) or effluent limitations in an NPDES permit for its process
wastewater?
❑ Yes [►� No 4 SKIP to Item 7.5.
7.4
Have you completed Table B by providing quantitative data for those pollutants that are (1) limited either directly or
indirectly in an ELG and/or (2) subject to effluent limitations in an NPDES permit for the facility's process wastewater?
❑ Yes ❑ No
7.5
Exhibit
Do you know or have reason to believe any pollutants in Exhibit 2E 2 are present in the discharge?
El Yes 4 SKIP to Item 7.7.
7.6
Have you listed all pollutants in Exhibit 2F-2 that you know or have reason to believe are present in the discharge and
provided quantitative data or an explanation for those pollutants in Table C?
❑ Yes ❑ No
7.7
Do you qualify for a small business exemption under the criteria specified in the Instructions?
❑ Yes 4SKIP to Item 7.18. IJ No
7.8
Do you know or have reason to believe any pollutants in Exhibit 2F-3 are present in the discharge?
❑ Yes No 4 SKIP to Item 7.10.
7.9
Have you listed all pollutants in Exhibit 2F-3 that you know or have reason to believe are present in the discharge in
=
Table C?
G
❑ Yes ❑ No
0
0
7.10
Do you expect any of the pollutants in Exhibit 2F-3 to be discharged in concentrations of 10 ppb or greater?
0
❑ Yes B17 No 4 SKIP to Item 7.12.
0
ns
7.11
Have you provided quantitative data in Table C for those pollutants in Exhibit 2F-3 that you expect to be discharged in
concentrations of 10 ppb or greater?
N
❑ Yes ❑ No
7.12
Do you expect acrolein, acrylonitrile, 2,4-dinitrophenol, or 2-methyl-4,6-dinitrophenol to be discharged in concentrations
of 100 ppb or greater?
❑ Yes No 4 SKIP to Item 7.14.
7.13
Have you provided quantitative data in Table C for the pollutants identified in Item 7.12 that you expect to be
discharged in concentrations of 100 ppb or greater?
❑ Yes ❑ No
7.14
Have you provided quantitative data or an explanation in Table C for pollutants you expect to be present in the
discharge at concentrations less than 10 ppb (or less than 100 ppb for the pollutants identified in Item 7.12)?
❑ Yes YNo
7.15
Do you know or have reason to believe any pollutants in Exhibit 2F are present in the discharge?
❑ Yes No 4 SKIP to Item 7.17.
7.16
Have you listed pollutants in Exhibit 2F-4 that you know or believe to be present in the discharge and provided an
explanation in Table C?
❑ Yes ❑ No
7.17
Have you provided information for the storm event(s) sampled in Table D?
❑ Yes C� No
EPA Form 3510-2F (Revised 3-19) Page 4

EPA Identification umber
NPDES PermitNumber
Facility Name
Form Approved
N A)
J�!
No.200-0004
OMB No. 2040-0004
a
Used or Manufactured Toxics
7.18
Is any pollutant listed on Exhibits 2F-2 through 2F-4 a substance or a component of a substance used or
manufactured as an intermediate or final product or byproduct?
0
❑ Yes No 4 SKIP to Section 8.
�
0
7.19
List the pollutants below, including TCDD if applicable.
1. 4. 7.
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2. 5. 8.
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3. 6. 9.
SECTION•
•GICAL TOXICITY TESTING D t
8.1
Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made on
any of your discharges or on a receiving water in relation to your disc rge within the last three years?
0
c
❑ Yes No 4 SKIP to Section 9.
N
8.2
Identify the tests and their purposes below.
Z'
x
Test(s)
Purpose of Test(s)
Submitted to NPDES
Permitting Authority?
Date Submitted
0
~
❑ Yes ❑ No
A
rn
�
❑ Yes ❑ No
0
m
❑ Yes ❑ No
SECTION•
• • ,t
9.1
Were any of the analyses reported in Section 7 (on Tables A through C) performed by a contract laboratory or
consulting firm?
❑ Yes No 4 SKIP to Section 10.
9.2
Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1
Laboratory Number 2
Laboratory Number 3
Name of laboratory/firm
c
0
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H
Laboratory address
T:
A
C
Q
U
N
o
Phone number
cr
Pollutant(s) analyzed
EPA Form 3510-217 (Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Farm Approved 03105119'
1 OMB No. 2040-0004
1-7`�
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KL�A 1Y V
SECTIONr
.�4
r , r
10.1
In Column 1 below, mark the sections of Form 2F that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to com lete all sections or provide attachments.
Column 1
Column 2
Section 1
w/ attachments (e.g., responses for additional oulfalls)
❑ Section 2
❑ w/ attachments
Section 3
wl site drainage map
❑ Section 4
❑ w/ attachments
❑ Section 5
❑ w/ attachments
❑ Section 6
❑ w/ attachments
E
❑ Section 7
❑ Table A ❑ w/ small business exemption request
❑ Table B ❑ w/ analytical results as an attachment
0
❑ Table C ❑ Table D
r
❑ Section 8
❑ w/attachments
v
c
❑ ection 9
❑ w/attachments (e.g., responses for additional contact laboratories or firms)
d
Section 10
❑
c)
10.2
Certification Statement
1 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 informaton 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 fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Signature
Date signed
'
/via 71d0-1
EPA Form 3510-2F (Revised 3-19) Page 6

Environmental FirstSearch
.25 Mile Radius
ASTM Map: RCRAGEN, ERNS, UST
113 THIRD ST, HILDEBRAN NC 28637
rI
Ne
Source: 2005 U.S. Census TIGER Files
Target Site (Latitude: 35.719426 Longitude: -81.421144)........... .._.............
Identified Site, Multiple Sites. Receptor ......._............ ......_............................
NPL, DELNPL, Brownfield, Solid Waste Landfill (SWL), Haeardous Waste
Tnballand......................... ................. ...................................................
...............
Railroads...........................................................................................................
Black Rings Represent 1/4 Mile Radius; Reet Ring Represem; AU) fi. Radius
Eu•iavrmeote
FIRSTS
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9

,v Environmental FirstSearch
.5 Mile Radius
ASTM Map: CERCLIS, RCRATSD, LUST, SWL
d
113 THIRD ST, HILDEBRAN NC 28637
Source: 2005 U.S. Census TIGER files
Target Site (Latitude:35.70426 Longitude:-81.421144).............................
Jdentified Site, Multiple Situ. Receptor....... ..................................................
NPL. DELNPL, Bmwnfield, Solid Waste Landfill (SWL), Hazardous Waste
Tnballand...................................................... .................................................... ..
Rai6oads...........................................................................................................
Black Rings Represent 1/4 Mile Radius: Red Ring Repmwn. 500 fL Radius
Emicuooa
FIRST!j

Environmental FirstSearch
1 Mile Radius
ASTM Map: NPL, RCRACOR, STATE Sites
113 THIRD ST, HILDEBRAN NC 28637
Source: 2005 U.S. Census TIGER Files
Target Site (Latiwde: 35.719426 Longitude: -51.421144).............................
Identified Site, Multiple Sites. Receptor ................. ......... ............ ...... I.............
NPL, DELNPL, Brownfield. Solid Waste Landfill (SWL), Hazardous Waste
Triballand................. ...... ........... .............. .....................
.......................................
Rzilnuds............ .........._.... .........._............,......................................................
Black Rings Represent I/4 Mile Radius; Red Bing Represenu 500 ft. Radius
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MANUFACTURING
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ENVIRONMENTAL& ENGINEERING, P.C. nRl TAX MAP 1 00a-isfl2

NORTH CAROLING
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USGS IDENTIFICATION
SCALES
MINUTE MAP LONGVIEW, NC
1/2 0 1
ORIGINAL DATE: 1993
MILES:
PHOTOREVISION
DATE: NA
1000 0 2000 4000 6000
FEET:
PRIMARY HIGHWAY, HARD SURFACE
1' - 2000'
SECONDARY HIGHWAY, HARD SURFACE
NOTES: ►TOPOGRAPHICAL CONTOUR INTERVAL = 20 FEET
PHOTOREVISIONS DENOTED IN PURPLE
UROAD HARD OR
ETIC
NORM
COUNTY MAP .;F:
NORTH CAROLINA
COUNTY: B U R K E
APPROXIMATE SITE LOCATION
IMPROVED SURFACE
UNIMPROVED ROAD
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