NCG150026_ROS Request Page 1_20250916

FOR AGENCY USE ONLY
Division of Energy,Mineral &Land Resources Date Received
"• Year Month Day
Stormwater Program
w National Pollutant Discharge Elimination System
Environmental REPRESENTATIVE OUTFALL STATUS (ROS)
Quality REQUEST FORM
If a facility is required to sample multiple discharge locations with very similar stormwater discharges, the
permittee may petition the Director for Representative Outfall Status(ROS). DEQ may grant Representative
Outfall Status if storm water discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted,ALL outfalls are still subject to the qualitative monitoring
requirements of the facility's permit—unless otherwise allowed by the permit(such as NCG020000)and DEQ
approval. The approval letter from DEQ must be kept on site with the facility's Stormwater Pollution
Prevention Plan. The facility must notify DEQ in writing if any changes affect representative status.
For questions, please contact the DEQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N I c s I I N I C I G 11 15 10 J§ 2 6
2) Facility Information:
Owner/Facility Name Halifax-Northampton Regional Airport
Facility Contact Fred Draper
Street Address 700 Gregory Farm Road
City Halifax State NC ZIP Code 27839
County Halifax E-mail Address [e-mail]
Telephone No. 252 578-3774 Fax:
3) List the representative outfall(s)information(attach additional sheets if necessary):
Outfall(s) II is representative of Outfall(s) III,Iv,v,vi
Outfalls' drainage areas have the same or similar activities? 2rYes ❑ No
Outfalls' drainage areas contain the same or similar materials? , Yes ❑ No
Outfalls have similar monitoring results? ❑Yes ❑ No v^o data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? ❑Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑Yes ❑ No
Outfalls have similar monitoring results? ❑Yes ❑ No ❑ No data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? ❑Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑Yes ❑ No
Outfalls have similar monitoring results? ❑Yes ❑ No ❑ No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
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SWU-ROS-2009 Last revised 12/30/2009