NCS000299_Dormant Status Request_20221130

FOR AGENCY USE ONLY
NC
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RECEIVED
0 3 2022
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Division of Energy, Mineral, and Land Resources Land Quality Section
N CG 140000
Dormant Status Request Form
Please complete this farm if you are pursuing anew dormant status designation for a facility.
Directions:
• Print or type all entries on this request form.
• Attach this form to the Stormwater Upload Forrr3 by selecting "Dormant Status Initial Request" from the
dropdown list.
• The submission of this form does not guarantee dormant status will be granted. An inspection from the
Division's Regional Office staff will be conducted prior to final determination.
North Carolina General Statute 143-215.613 (1) provides that: Any person who knowingly makes any false
statement, representation, or certification in any application, record, report, plan, or other document filed or
required to be maintained under this Article or a rule implementing this Article . , . shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
Q I, as the legally responsible person or authorized representative, request dormant status for the subject
facility.
Q The subject facility is temporarily inactive and all industrial activities have been suspended.
ry All stockpiles have been covered, removed, and/or stormwater has been diverted prior to reaching the piles.
Q✓ All wastewater collection areas have been cleaned out.
�✓ I am familiar with the information contained in this request and to the best of my knowledge and belief such
information is true, complete, and accurate.
Facilitv Name: Legacy Feeds
Permit Number: NCS000299
Date Facilitv Went Inactive: November 30,2019
Printed Name of Person Signing: Deb Ballance
Title: Mernyc rma])a i-
(Sign lure) (Date)
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'*Z TRC
TRANSMITTAL LETTER
TRC Engineers, Inc.
114 Edinburgh South Drive
Suite 200
Cary, North Carolina 27511
Telephone [phone]
To: Date: November 28, 2022
NC DEQ — DEMLR
Attn: Brianna Young
1612 Mail Service Center
Raleigh, NC 27699-1612
Project No: 499782
Project Name: Kalmbach Feeds
Via 0 Mail 0 Courier 0 Overnight 0 Pick-up ❑ Hand Delivered
We are enclosing the following:
❑ Shop Drawings ❑ Prints ❑ Plans ❑ Specifications
❑ Copy of Letter ❑ Change Order ❑ Permits q Other
COPIES
DATE
I DESCRIPTION
1
11/22/22
1 Permit Dormancy Request, Legacy Feeds, NCS000299
M For your approval ❑ For your review and comment ❑ Returned for corrections
❑ For your use
❑ Approved as submitted
❑ Resubmit
copies for approval
As requested
Approved as noted
Return
corrected prints
❑
❑
0
Comments:
Enclosed is Legacy Feeds' request for permit dormancy for their site located at 2500
Wilco Boulevard, Wilson, NC.
Sincerely,
Andrew Rodak, P.E.
cc: File