NCS000545_Renewal Application_20231103

City of Creedmoor
P.O. Box 765
111 Masonic Street
moorCreedmoor, NC 27522
919.528.3332
COMMU.IVr;Y DE 1,111OAMEN7 �
www.cityofcreedmoor.org
November 3rd, 2023
Isaiah Reed
MS4 Program Coordinator
2090 U.S. 70 Highway
Swannanoa, NC 28778
RE: MS4 Permit Renewal Creedmoor NCS 000545
Dear Mr. Reed,
The City of Creedmoor has been informed that our MS4 permit renewal materials were never
received. Due to multiple staffing changes within the Community Development Office,the
status of our renewal application had not been followed up on and any communication
regarding these missing materials was not received by the new staff.
A package containing the application materials for renewal was sent to 1612 Mail Service
Center, Raleigh, NC 27699 on July 28th, 2022 by former Planning Technician Heidi Salminen.
Please accept the attached renewal application in place of the original application materials.
If there is any additional information needed please email me at
mfran gos CrDcit ofcreed moor.org or call [phone].
Sincerely,
W6�5'6�' A(LP,c 21,0
Michael S. Frangos ACIP, CZO
Community Development Director
City of Creedmoor
P.O. Box 765
Creedmoor, NC 27522
[phone]
[e-mail]
Enclosure: Picture of the renewal package
Archer Wilkins, Emma Albright, Edward Gleason, Georgana Kicinski, Robert Way
Mayor Robert V. Wheeler I City Manager Michael 0.Turner

NPDES MS4 Permit Renewal Application Form
EQi� National Pollutant Discharge Elimination System (NPDES)
=--�-'1% Municipal Separate Storm Sewer System (MS4)
Nwr
Please complete the information below and submit this form along with the required supplemental information
to the address indicated.
Part I: Permittee Information
Current Permit No. NCS 000545
MS4 Name City of Creedmoor
Owner Name* Robert V. Wheeler
Owner Title Mayor
Street Address 111 Masonic Street .PO Box 765
Ci State Zip Creedmoor, NC 27522
Phone Number 919-764-1014
E-mail Address ma or@ci ofcreedmoor.or
*The owner must be a principal executive officer or ranking elected official for the city/town/entity that
owns/operates the permitted M54. Any permit enforcement actions will be sent to the owner on record.
Part 11: Primary Contact**
Contact Name Michael S. Fran os
Contact Title Community Development Director Stormwater Administrator
Em to er City of Creedmoor
Street Address 211 North Main Street, PO Box 765
City, State Zip Creedmoor, NC 27522
Phone Number 919-764-1016
E-mail Address [e-mail]
** The primary contact is the responsible party who will oversee the day-today permit compliance and
Stormwater Management Program implementation. With the exception of enforcement actions,permit
communications originating from NCDEQ will be sent to the primary contact and will be copied to the other
contacts listed below
Part III: Other Contacts
Contact Name Carl Barclay, City-Engineer PE
E-mail Address [e-mail]
Contact Name Rebecca Middleton, Planning Technician
E-mail Address rmiddleton@ci ofcreedmoor.org
Part IV: Required Supplemental Information
Submit one (1) hard copy and one (1) electronic copy of a Draft Stormwater Management Plan (SWMP)
with this permit renewal application. The Draft SWMP must be in the current NCDEQ SWMP Template
format and shall include all required information in order for the permit renewal application to be
considered complete.
Page 1 of 2

Part V: Certification
By my signature below I hereby 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. I am also aware that incomplete permit renewal
applications, inclusive of the required Draft SWMP, will not be processed and will be returned to the
permittee.
❑ I am a ranking elected official for the permitted MS4.
❑ I am a principal executive officer for the permitted MS4.
® I am a duly authorized representative for the permitted MS4 and have attached the authorization
made in writing by the permit owner listed in Part I of this application, which specifies me as (check
one):
® A specific individual having overall responsibility for the stormwater permit.
❑ A specific position having overall responsibility for the stormwater permit.
Signature:* [ C Z4
! � i-
Print Name: �• � r os C 20
Title:
Goa+ vc.[a {/'c
Signed this day of 20
*Please notb that an original signature is required on this form, any required supplemental information, and any
representative authorization. Photocopies cannot be accepted.
Return this completed form along with the required supplemental information to:
DEQ-DEMLR Stormwater Program
Attn: MS4 Permitting
1612 Mail Service Center
Raleigh, NC 27699-1612
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