NCS000592_Application_20170526

May 25, 2017
Robert Patterson
Storm water Programming
1612 Mail Service Center
Raleigh, NC 27699-1612
Mr. Patterson,
CULPEPER
WOOD PRESERVERS
RECEN D
MAY 2 6 2017
LAND QUALITY SECTION
Culpeper Wood is opening a treating facility on a previously permitted site. We hope to be processing
by September 1, 2017. The site address is 2262 W. 10th Street, Roanoke Rapids, NC and was previously
permitted to Georgia-Pacific.
Any assistance you could provide in expediting our permits would be greatly appreciated.
Thanks for your consideration,
Sincerely,
QS
Billy Rodgers
Facility Manager
Culpeper of Roanoke Rapids
252-308-8474
culpeperwood.com
HEADQUARTERS
15487 Braggs Comer Road
PO Box 1148
Culpeper, VA 22701
TF. [phone]
LOCAL [phone]
FAX. [phone]
FREDERICKSBURG, VA
10299 Tidewater Trail
Fredericksburg, VA 22408
TF: [phone]
LOCAL: [phone]
FAX: [phone]
SHELBYVILLE, IN
701 Mausoleum Road
PO Box 260
Shelbyville, IN 46176
TF: [phone]
LOCAL [phone]
FAX: [phone]
COLUMBIA, SC
208 Flint Lake Road
PO Box 23958
Columbia, SC 29224
TF: [phone]
LOCAL -[phone]
FAX: [phone]
FEDERALSBURG, MD
2000 Industrial Park Road
PO Box 298
Federalsburg, MD 21632
TF: [phone]
LOCAL [phone]
FAX: [phone]

A 0 e -o 00 5q 0111—
Please Please arint or tune in the unchartari areae nnlu
FORM
-
U.S. ENVIRONMENTAL PROTEC Ye
comm APPIOVee. UMC No. LU4U-UUUU.
A I.D. NUMBER
1
NEPA GENERAL INFORMAf l� E
1CR000169292
Consolidated AermftsProgram
,� U
—
GENERAL
(Read the "Gweral haructions"Wore starang.)
7
2
LABEL ITEMS
-"NAY-24-2017
GENERAL INSTRUCTIONS
' -
LAND A ITT SE��
H a preprinted labal has been provided, affix It in the
designted space. Review the irdormation carefu(fy, if any of it
IS mooned, cuss through it and enter the correct data in the
appropriate fUkn area Also, below. d any of the preprinted date
�a torne taR rte rte, fists
EPA I.D. NUMBER
FACILITY NAME =
PLEASE PLACE LABEL IN THIS
SPA .-
or sperm
spe
me111.
�& dwWW080 Pie provide it in the proper
fill-in area(s) below. if the label is complete and coned you
need not complete Items 1, III, V. and VI (except VI -8 whkh
V. FACILITY -MAILING
ADDRESS-._ -
:. ;- _`: =_ _
_
_ -- .
must be oorrlpleted regardless). Complete all items if no label
has been provided. Refer to the instructiaxs for detailed item
descdptixmxs and for the legal augrorirations xxnder which this
VI., ,FACILITY LOCATION '_-
data is collected.
11. POLLUTANT CHARACTERISTICS
INSTRUCTIONS: Complete A through J to determine whether you need to submit any permit application fors to the EPA. If you answer fires' to any questions, you must
submit this for and the supplemental for listed in the parenthesis following the question. Mark 9(' in the box in the third column if the supplemental for is attached. If
'no'
YOU answer to each question, you need not submit any of these fonts. You may
answer 'no* if your activity is excluded from petit requirements; see Section C of the
Inst action& See also, Section D of the instructions for definitions of bold-faced terms.
Nene
w
Mark W
WS
NO
A ®
"1O
A �
SPECIFIC QUESTIONS
SPECIFIC QUESTIONS
A. Is this facility a publicly owned treabrient works which
B. Does or will this facility (either striding or prop
remits In a dy
iecharge to waters of the U.S.?U? (FORM 2A)
X
include a concentrated animal feeding operation or
n or
aquatic animal production facility which results in a
+s
m
21
discharge to waters of the U.S.? (FORM 26)
C. Is this a facility which currently results in discharges to
waters of the U.S. other than those described in A or B
x
D. Is this a proposed facility (other than those described In A
cr B above) which Ina
X
above? (FORM 2C)
will result discharge to waters of
the U.S.? (FORM 2D)
22
2e
27
2s
m
27
E Does or will this facility beat, store, or dispose of
F. Do you or will you inject at this facility industrial or
hazardous wastes? (FORM 3)
X
municipal effluent below the lowermost stratum
Y
containing, within one quarter mile of the well bore,
/ `
underground sources of drinking water? (FORM 4)
20
1 79
1 m
st
1 a
zt
G. Do you or will you Inject at this facility any produced water
H. Do you or will you inject at this facility fluids for special
or other fluids which are brought to the surface in
processes such as mining of sulfur by the Frasch process,
connection with conventional oil or natural gas production,
inject fluids for
X
solution mining of minerals, in situ combustion of fossil
Xi
used enhanced recovery of off or natural
fuel, or recovery of geothermal energy? (FORM 4)
gas, or inject fluids for storage of liquid hydrocarbons?
(FORM 4)
n
38 1
39
s,
ss
35
1. Is this facility a proposed stationary source which Is one
J. Is this facility a proposed stationary source which is
Of the 28 industrial categories fisted in the instructions and
which will potentially emit 100 tons per year of any air
x
NOT one of the 28 Industrial categories listed in the
Instructions
v
and which will potentially emit 250 tons per
pollutant regulated under the Clean Air Act and may affect
year of arty air pollutant regulated under the Clean Air Act
or be located in an attainment area? (FORM 5)
and may affect or be located in an attainment area?
40
41
42
«
u
(FORM 5)
III. NAME OF FACILITY
1 SLOP G U L P 0 R O A N O RAP
I D
IV FACILITY CONTACT
A NAME 8 TITLE (Imr, frrA & tide)
B. PHONE (arra code & no.)
21 R 0 D G E R S I L L Y FAC I L I T
A N A G E R( 5) 3 8-8 7
u 1 ,e
a 46 AS 142 61 1 62- sa
VXACILTY MAILING ADDRESS
A STREET OR P.O. BOX
3 2 2 6 2 W E S T 1 0 S T R E E T
_- -- _ -
B. CITY OR TOWN
C. STATE
D. ZIP CODE
=
,
-
4ROANOKE RAP I DSC
2 870
is 1 16
401
tl Q
6 et
VI. FACILITY LOCATION
A. STREET, ROUTE NO. OR OTHER SPECIFIC IDENTIFIER ..
5 2 2 6 2 W E S H 1 0 T H S T R E E
B. COUNTY NAME
"
H A L I F A X
143
C. CITY OR TOWN
own)
D. STATE E. ZIP CODE F. COUNTY CODE (rfAn77
6 R 0 A N 0 K E 1 R A P I D S
1JC
2 00
16 1H
40 H 12 A
t --PA t -or 3570-T (ti -9u)
CQONTiNUE ON REVERSE
. of �a �

CONTINUED FROM THF PRnYiT
VII. SIC CODES (4-crigit in order ofpo*j
A. FIRST -8. SECOND
NUUU TREATING (V"fy)
J9411 1
10 15 1e 12
C. THIRD D. FOURTH
—
1(spedfy)
I
13 ie 1B 19 le 107
VIII.OPERATOR INFORMATION
A. NAME B. Is the name listed in Item
I I . . . I . .
I I I I I I
VIII -A also the owner?
81C U L'P' E P E R 0 F ROAN 6'K'E' ' RA P ' I DI IS 1 r?0
15 YES El NO
- - - r5im
C. STATUS OF OPERATOR (Enter the appropriate lever into the answer bac if "Other,Vedfy.)
D. PHONE (mea code & no.)
F = FEDERAL M = PUBLIC(other dumfederal or
= STATE 31-69)
(specify)S
308-8474
P = PRIVATE 0 = OTHER (qmrify)
15
AJ(252)
16 - to 119 122 Z
E. STREET OR P.O. BOX
-
'S'T'R'
2 2 6 2 1 0' E'
26
551-
F. CITY OR TOWN I G. STATE
H. ZIP CODE ILYL INDIAN LAND
I 0 K E R A P I D S NC
B ROAN 1i8io
I is the facility located an Indian lands?
is lie
40141 42
0 YES 0 NO
52
47 - 51
X EXISTING ENVIRONMENTAL PERMITS
A. NPDES Pc1TE p rFProposed ---
1 I D.PSDqiri!�Vff,1171
0 T I
C T I
NA 9 P NA
9:
15 70P" to >0 is 1 151 a to
B. U
B� IC I— OTHER
"I, Tim *am
C I T I I N I I i C T I
91U1 91 1
r I
1
I (,pdfy)
15 le O In 30 IS 1 16 1 17
to
C. RCRA tff=vdm Bastes E OTHER (4wdfy)
C T I
C I T I I I
N-dfy)
9 R
1.91 1 1
15 to n t0 30115115117113 301
XI. MAP
Attach to this application a topographic map of the area extending to at least one mile beyond property boundaries. The map must show the outline of the facility, the
location of each of Its existing and proposed Intake and discharge structures, each of its hazardous waste treabmnt storage, or disposal facilities, and each well where It
Injects fluids underground. Include all springs, rivers, and other surface water bodies in the map area. See instructions for precise requirements.
XII. NATURE OF BUSINESS (ptovidea biletdescripfion) M
Wood preserving plant which uses various products and pressure treats them to yield a wood product that resist
nildew, rot and insect attack,
XIII. CERTIFICATION (see instrucffons)
I certify under penally of law that I have personally examined and am familiar with the inthrmallon submitted in this appFcaffan and all attachments and that, based on my
Inquiry of those persons Immediately responsible for obtaining the Information contained In the application, I believe that the information Is true, accurate, and complete. I
am aware that there are significant penalties far submitting false imbimatihn, including the possibility of fine and Imprisonment
MANAGER
B. SIGNATURE
C. DATE SIGNED
05/24/2017
COMMENTS FOR OFFICIAL USE ONLY
JCC
r-t,Arorm iu-1 (a -vu)

EPA ID Number (copy from Item 1 of Form 1) 'RECEIVED
Please print or tvne in the und shadeareae nniv
NCR000169292 Form Approved. OMB No. 2040-0086
2FFOIM
NPDES
U.S. Environmental Protection Agency
EPA Washington, DC 20460
Application for Permit to Discharge Storm Water
Discharges Associated with9lAts"JV1QWT10N
Paperwork Reduction Act Notice
Public reporting burden for this application is estimated to average 28.6 hours per application, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate, any other aspect
of this collection of information, or suggestions for Improving this form, including suggestions which may Increase or reduce this burden to: Chief, Information Policy
Branch, PM -223, U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW, Washington, DC 20460, or Director, Office of Information and Regulatory
Affairs, Office of Management and Budget, Washington, DC 20503.
,. Outfall Location
For each outfall, fist the latitude and longitude of its location to the nearest 15 seconds and the name of the receiving water.
A. Ouffall Number D. Receiving Water
(list) B. Latitude C. Longitude (name)
001 36.00 27.00 99.17 77.00 91.00 23.12 Chockoyotte Creek
002 36.00 27.00 55.32 77.00 91.00 19.55 Chockoyotte Greek
11. Improvements
A. Are you now required by any Federal, State, or local authority to meet any implementation schedule for the construction, upgrading or operation of wastewater
treatment equipment or practices or any other environmental programs which may affect the discharges described in this application? This includes, but Is not limited
to, permit conditions, administrative or enforcement orders, enforcement compliance schedule letters, stipulations, court orders, and grant or loan conditions.
4. Final
1. Identification of Conditions, 2 Affected Outfalls Compliance Data
Agreements, Etc• number source of discharge 3. Brief Description of Project a. req. b. prof.
TJA
B: You may altach additional sheets describing any additional water pollution (or other environmental projects which may affect your discharges) you now have under
way or which you plan. Indicate whether each program Is now under way or planned, and indicate your actual or planned schedules for construction.
III. Site Drainage Map
Attach a site map showing topography (or indicating the outline of drainage areas served by the outfalls(s) covered in the application if a topographic map is unavailable)
depicting the facility including: each of its intake and discharge structures, the drainage area of each storm water outfall; paved areas and buildings within the drainage
area of each storm water outfall, each known past or present areas used for outdoor storage of disposal of significant materials, each existing structural control measure
to reduce pollutants in storm water runoff, materials loading and access areas, areas where pesticides, herbicides, soil conditioners and fertilizers are applied; each of
its hazardous waste treatment, storage or disposal units (including each area not required to have a RCRA permit which is used for accumulating hazardous waste
under 40 CFR 26234); each well where fluids from the facility are Injected underground; springs, and other surface water bodies which received storm water discharges
from the facility.
EPA Forth 3510-2F (1-92) Page 1 of 3 Continue on Page 2

Continued from the Front
IV. Narrative Description of Pollutant Sources
A For each outfall, provide an estimate of the area (mdude units) of Imperious surfaces (IndLttling paved areas and bug" roofs) drained to the outfall, ami an estimate of fire total surface area
drained by the outfall
outfan
Area of Impervious Surface
Total Area Drained
Outfall
Area of Impervious Surface
Total Area Dralned
Number
(provide units)
(provide amts)
Number
(provide aria)
(pmvide rub)
001 4.650
ACRE
002 4.850
ACRES
B. Provide a narrative description of significant materials that are currently or in the past three years have been treated, stored or disposed in a manner to allow exposure
to storm water, method of treatment, storage, or disposal: past and present materials management practices employed to minimize contact by these materials with
storm water runoff, materials loading and access areas, and the location, manner, and frequency In which pesticides, herbicides, soil conditioners, and fertilizers are
applied.
This is a facility being constructed on a previously owned facility.
Future activities:
Pressure treat various wood products with a cooper -based treating solution.
Inside above ground contained tank storage of the wood treating solutions.
Inside and outside storage of wood.
Operation of diesel fueled mobile equipment and inside fuel storage.
Management of used oil products.
Proper and constant management of stormwater runoff,
C. For each outfall, provide the location and a description of existing structural and nonstructural control measures to reduce pollutants in storm water runoff: and a
description of the treatment the storm water receives, including the schedule and type of maintenance for control and treatment measures and the ultimate disposal
of any solid or fluid wastes other than by discharge.
Outfall
List Codes from
Number
Treatment
Table 2F-1
001 ti 002 Detention ponds, berms, storage of materials in buildings. employee training and basic good
ousekeeping.
V. Nonstormwater Discharges
A. I certify under penalty of law hat the outfall(s) covered by this application have been tested or evaluated for the presence of nonstonnwater discharges, and that all
nonstormwater discharged from these outfall(s) are identified In either an accompanying Form 2C or From 2E application for the outfall.
Name and Olficiai Title (type or print)
Signature
Date Signed
Billy Rodgers Facility Manager
05/24/2017
B. Provide a description of the method used, the date of any testing, and the onsite drainage points that were directly observed during a test
A visual review of the property was made and no non-stormwater sources were located.
W. Significant Leaks or Spills
Provide existing infomwtion regarding the history of significant leaks or spills of toxic or hazardous pollutants at the facility in the last three years, including the
approximate data and location of the spat or leak, and the type and amount of material released.
None ,this is a facility that was under previous ownership being reconstructed.
EPA Forth 3510.2F (1-92) Page 2 of 3 Continue on Page 3

EPA ID Number (copy from Item 1 of Form 1)
Continued from Page 2 NCR000169292
1. Discharge Information
A, B, C, & D: See instructions before proceeding. Complete one set of tables for each outfall. Annotate the outfall number in the space provided.
Table Vll-& VII -B, VII -C are Included on separate streets numbers VII -1 and VII -2-
E. Potential discharges not covered by analysis — is any tohdc pollutant listed in table 2F-2, 2F-3, or 2F-4, a substance or a component of a substance which you
currently use or manufacture as an intermediate or final product or byproduct?
❑✓ Yes (list all such pollutants below) ❑ No (go to Section Dt)
Recall that we stated this facility is under construction and will be new with no analytical data.
Materials list that will be used at our facility:
Mold inhibitor- attached SDS
NP -200A concentrate- attached SDS
CCA concentrate- attached SDS
Diesel fuel- attached SDS
11. Biological Toxicity Testing Data
Do you have any knowledge or reason to believe that any biological test for acute or chronic to)ddty has been made on any of your discharges or on a receiving water in
relation to your discharge within the last 3 years?
❑ Yes (list all such pollutants below) ❑✓ No (go to Section N
DL Contract Analysis Information
Were any of the analyses reported in Item VII performed by a contract laboratory or consulting firm?
❑ Yes (Est the name, address, and telephone number of, and pollutants
❑✓ No (go to Section X)
analyzed by, each such laboratory or firm below)
A. Name
B. Address
C. Area Code & Phone No.
D. Pollutants Analyzed
Environment 1, Inc hire once
P.O. Box 7085 Greenville,NC 27835-7085
252-756-6208
processing begins
Certification
I car* under penafty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
Mat qualified personnel propedy gather and evaluate the information submitted.138sed on my Inquiry of the person orpersons who manage the system or those persons
dimctty 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
Mere are significant penalties for submitting false information, including the possibUfty offine and imprisonment fork rowing violations.
A. Name & Official Title (Type OrPdnf)
B. Area Code and Phone No.
Billy Rodgers Facility Manager
[phone]
C. Signature
9�� -
D. Date Signed
-/Zql 1-7
EPA Form 3510-21' (1-92P `'I Page 3 of 3

EPA ID Number (copy from Item 1 of Form 1) Form Approved. OMB No. 2040-0086
Amnmval emirPa X41-99
VII. Discharge information (Continued from page 3 of Form 2F)
Part A— You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See instructions for additional details.
Pollutant
and
CAS Number
(If available)
Maximum Values
include units)
Average Values
(indude units)
Number
of
Storm
Events
Sampled
Sources of Pollutants
Grab Sample
Taken During
First 20
Minutes
Flow -Weighted
Composite
Grab Sample
Taken During
First 20
Minutes
Flow -Weighted
Composite
Oil and Grease
WA
Biological Oxygen
Demand (BODS)
Chemical Oxygen
Demand (COD)
Total Suspended
Solids (TSS)
Total Nitrogen
Total Phosphorus
pH
Minimum
Maximum
Minimum
Maximum
Part B — List each pollutant that is limited in an effluent guideline which the facility is subject to or any pollutant listed In the facil[Vs NPDES permit for its process
wastewater (if the facility Is operating under an existing NPDES permit). Complete one table for each outfall. See the Instructions for additional details and
requirements.
Maximum Values Average Values
rndude units) (include units)
Pollutant Grab Sample Grab Sample
and Taken During Taken During
CAS Number First 20 Flow -Weighted First 20 Flow -Weighted
(ifavailable) Minutes Composite Minutes Composite
Number
of
Storm
Events
Sampled Sources of Pollutants
EPA Forth 3510-2F (1-92) Page VII -1 Continue an Reverse

Continued from the Front
Part C - List each pollutant shown in Table 2F-2, 217-3, and 2F-4 that you know or have reason to believe is pnsseM. See the instructions for additional details and
requirements. Complete one table for each outfall.
Maximum Values Average Values
mdude units) rinclude units) Number
Pollutant Grab Sample Grab Sample of
and Taken During Taken During Storm
CAS Number First 20 Flow -Weighted Fust 20 Flow -Weighted Events
(ifaveflable) Minutes Composite Minutes Composite Sampled Sources of Pollutants
COPPER
CHROME
ARSENIC
Part D — Provide data for the storm event(s) which resulted In the maximum values for the flow weighted composite sample.
1.
Date of
Ston
Event
2.
Duration
of Storm Event
rin minutes)
3.
Total rainfall
during storm event
(n Inches)
4.
Number of hours between
beginning of storm measured
and end of previous
measurable rain event
5.
Maximum flow rate during
rain event
(gallons(minute or
specify units)
6.
Total flow from
rain event
(gallons or specify units)
7. Provide a description of the method of flow measurement or estimate.
EPA Forth 3510-2F (1-92) Page VII -2