NCG160207_COMPLETE FILE - HISTORICAL_20171103

NORTH CAROLINA
Department of Environmental Qual
2 V
v

STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.
DOC TYPE
❑COMPLETE FILE -HISTORICAL
GATE OF
RESCISSION
❑ �b /7/% O.
YYYYMMDD

11I3l2017
�s Registration Division
r l Ifs U North Carolina
Elaine F marshal! DEPART ENT OF THE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh,NG 27626-0622 (919)814-54UO
Filings For: APPALACHIAN PAVING AND GRADING, INCORPORATED
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https://www.sosnc.govISearchltilings/4745462 1/1

NC®ENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
January 27, 2012
Mr. V. Alan Atkins, Owner
Appalachian Paving & Grading
312 Granite Lane
Bakersville, NC 28705
Natural Resources
Subject: General Permit No, NCG 160000
Appalachian Paving & Grading
COC NCG 160207
Mitchell County
Dear Mr. Atkins:
Dee Freeman
Secretary
In accordance with your application for a discharge permit received on December 19,
2011, we are forwarding herewith the subject certificate of coverage to discharge under the subject
state — NPDES general permit. This permit is issued pursuant to the requirements of North
Carolina General Statute 143-215.1 and the Memorandum of Agreement between North Carolina
and the US Environmental Protection Agency dated October 15, 2007 (or as subsequently
amended).
Please take notice that this certificate of coverage is not transferable except after notice to
the Division of Water Quality. The Division of Water Quality may require modification or
revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Water Quality or permits required by the Division of Land Resources,
Coastal Area Management Act or any other federal or local governmental permit that may be
required.
If you have any questions concerning this permit, please contact .lennifer .lones at
telephone number [phone].
Sincerely,
ORIGINAL SIGNED B)
KEN PICKLE
for Charles Wakild, P.E.
cc: Asheville Regional Office, Chuck Cranford
Central Files
Stormwater Permitting Unit Files
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service 1-877-623-6748
Internet: www.ncwaterquality.org
NorthCarolina
;Vatura!!rl

STATE OF NORTI-I CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCE'S
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160207
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215. I, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Appalachian Paving & Grading
is hereby authorized to discharge stormwater from a facility located at:
Appalachian Paving & Grading,
312 Granite Lane
Bakersville
Mitchell County
to receiving waters designated as a UT to Bear Creek, a class C, Tr water in the French Broad
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts 1, II, 111, IV, V, and VI of�General Permit No. NCG160000 as
attached.
This certificate of coverage shall become effective January 27, 2012.
This Certificate of Coverage shall remain in effect for the duration ofthe General Permit.
Signed this day January 27, 2012.
ORIGINAL SIGNED Bl
KEN PICKLE
f,r Charles Wakild, P.E., Director
Division of Water Quality
By the Authority of the Environmental Management Commission

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NCG160207
N
W z!Z'E
S
Map Scale 1:23,854
Appalachian Paving & Grading
Bakersville, NC
Latitude: 350 58` 31" N
Longitude: 82° 05r 47" W
County: Mitchel
Receiving Stream: UT to Bear Creek
Stream Class: C, Tr
Sub -basin: 04-03-06 (French Broad River Basin) Facility Location

Central Files: APS SWP
01/26/12
Permit Number NCG160207 v
Permit Tracking Slip
Program Category
Status Project Type
NPDES SW
In review New Project
Permit Type
Version Permit Classification
Asphalt Paving Mixture Stormwater Discharge COC
COC
Primary Reviewer
Permit Contact Affiliation
jennifer.jones '
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Appalachian Paving & Grading Inc V
Location Address
312 Granite Ln
Bakersville NC 28705
Owner
Owner Name
Appalachian Paving & Grading "
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
12/19/11
Regulated Activities
Asphalt paving mixture production
Outfall 001
Major/Minor
Region
Minor
Asheville
County
Mitchell
Facility Contact Affiliation
Alan Atkins
312 Granite Ln
Bakersville
NC 28705
Owner Type
Non -Government
Owner Affiliation
Alan Atkins
312 Granite Ln
Bakersville
NC 28705
Public Notice Issue
Effective Expiration
I/t"f I1V3bl�Lo��-
Requested/Received Events
Additional information received
RO staff report received
01/04/12
RO staff report requested
01/04/12
Additional information requested
01/04/12
Waterbody Name Stream Index Number Current Class Subbasin
Bear Creek 7-2-46 C;Tr 04-03-06

Jones, Jennifer
From:
Jones, Jennifer
Sent:
Thursday, January 26, 2012 10:43 AM
To:
Cranford, Chuck
Cc:
Wiggs, Linda; Jones, Jennifer; Bennett, Bradley
Subject:
RE: NCG160207 - February 4, 2012
Hey Chuck,
After our phone call today, and considering that you've been trying to get them under permit for two years, and
considering that they haven't responded to my email or phone call, I'm just going to go ahead and issue the permit
because getting these people to respond is like herding cats and we just need to get them under a permit.
Linda — Chuck said you could follow up with them after and get the name sorted out once they were under permit. I
hope you are ok with that — I've just left you a message. Let me know if you are not.
Thanks all!
ten
Jennifer Jones
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: [phone]
Fax: [phone]
Email: [e-mail]
Website: htto:((portal.ncdenr.orp/web/wq/ws/su
** Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulations.**
From: Cranford, Chuck
Sent: Thursday, January 05, 2012 12:56 PM
To: Jones, Jennifer
Subject: RE: NCG160207 - February 4, 2012
Ha! Alright!
Thanks,
Chuck
Chuck Cranford
Supervisor, Surface Water Protection Section
Division of Water Quality
Asheville Regional Office
2090 U.S. 70 Highway

Swannanoa, NC 28778
Tel: [phone]
Fax.-828-299-7043
[e-mail]
Email correspondence to and from this address is subject to
the North Carolina Public Records taw and may be disclosed
to third parties unless the content is exempt by statute or
other regulation.
From: Jones, Jennifer
Sent: Thursday, January 05, 2012 12:37 PM
To: Cranford, Chuck
Subject: RE: NCG160207 - February 4, 2012
Ok — well if he doesn't send in one I'll just issue the permit!
Thanks!
Jennifer Jones
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: [phone]
Fax: [phone]
Email: [e-mail]
Website: http://portal.ncdenr.org/weblwg/wsZsu
** Email correspondence to and from this address is subject to the [forth Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulations.**
From: Cranford, Chuck
Sent: Thursday, January 05, 2012 9:50 AM
To: Jones, Jennifer
Subject: RE: NCG160207 - February 4, 2012
I have been trying to get him to send in an NOI for like a year! Small facility. No environmental concerns. Just need a
permit.
Thanks,
Chuck
Chuck Cranford
Supervisor, Surface Water Protection Section
Division of Water Quality
Asheville Regional Office
2090 U.S. 70 Highway
Swannanoa, INC 28778
Tel: [phone]
Fax: [phone]
2

[e-mail]
Email correspondence to and from this address is subject to
the North Carolina Public Records Law and may be disclosed
to third parties unless the content is exempt by statute or
other regulation.
From: Jones, Jennifer
Sent: Thursday, January 05, 2012 9:20 AM
To: Cranford, Chuck
Cc: Wiggs, Linda
Subject: RE: NCG160207 - February 4, 2012
OK — will do. I am waiting to get their correctly completed NOI and then will issue.
Thanks,
Jennifer Jones
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, INC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: [phone]
Fax: [phone]
Email: jennifer,[e-mail]_v
Website: httg://portal.ncdenr.org_/web w ws/su
** Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulations.**
From: Cranford, Chuck
Sent: Wednesday, January 04, 2012 5:39 PM
To: Jones, Jennifer
Cc: Wiggs, Linda
Subject: RE: NCG160207 - February 4, 2012
Please issue.
Thanks,
Chuck
Chuck Cranford
Supervisor, Surface Water Protection Section
Division of Water Quality
Asheville Regional Office
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
[e-mail]
Email correspondence to and from this address is subject to
9

the North Carolina Public Records Law and may be disclosed
to third parties unless the content is exempt by statute or
other regulation.
From: Jones, Jennifer
Sent: Wednesday, January 04, 2012 3:54 PM
To: Cranford, Chuck
Cc: ]ones, Jennifer
Subject: NCG160207 - February 4, 2012
Hi Chuck,
We've received an NOI from "Appalachian Paving & Grading" in Bakersville (Nlitchcll County) for coverage of
their asphalt paving; site under NCG16 (asphalt permit). The site discharges stormwater into Wallace Creek (C).
The NOI is attached.
Does the Ashevi is Regional Office have anv concerns about issuing this facility a COC for this general permit? If
we don't receive anv objections, we'll issue the COC in ail days.
Thanks,
J en
Jennifer Jones
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: [phone]
Fax: [phone]
Email: 'ennifer.'ones ncdenr. ov
Website: http://12ortal.ncdenr.org/web/wcl/ws/su
** Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulations.**

Jones, Jennifer
From: Jones, Jennifer
Sent: Wednesday, January 04, 2012 3:18 PM
To: [e-mail]
Cc: Jones, Jennifer; Cranford, Chuck
Subject: NCG160207 - Application
Attachments: NOI-NCG16-20090309-DWQ-SPU.doc; ADIS-ADMDissolution_C201119404289 (1).pdf
Dear Mr. Atkins,
The Division of water Quality received a stormwater permit application for your facility on December 19, 2011.
The application you submitted is from "Appalachian Paving and Grading". NC DWQ requires that the application owner
name matches the company name in the NC Secretary of State's database. "Appalachian Paving and Grading" does not
appear in the NC Secretary of State's database. Additionally, "Appalachian Paving and Grading, Inc." exists, however, it
has been dissolved by the NC Secretary of State, on July 21, 2011. See attached notification.
Please submit an application with the company's name as it appears in the NC Secretary of State's database, or
you may apply as an individual (as a personally responsible individual).
Please submit this information within 30 days (by February 4, 2012), or your application will be returned as
incomplete. If you cannot return the application within that time frame, please contact us, and request in writing for a
time extension and a date when you will return the needed information to us.
Please see the attached N01 (application) for you to fill out with the correct owner name. Please fill in the first
page and the appropriate person's signature.
If you have any questions concerning this permit, please contact Jennifer Jones at telephone number (919) 807-
6379
Jennifer Jones
Environmental Engineer
NCDENR j DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: [phone]
Fax: [phone]
Email: jennifcrJones&ncdcnr.gov
Website: http://portal.ncdenr.org/,A,cb/wq/ws/su
** Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulations.**

NOTICE TO REGISTERED AGENT:
Under N.C.G.S Section 55D-30(b), it is the duty of the registered agent to forward this certificate to the business entity at the last known
address
APPALACHIAN PAVING AND GRADING, INCORPORATED (0347685)
5872 N Hwy 226
Bakersville, NC 28705
State of North Carolina
Department of the Secretary of State
CERTIFICATE OF DISSOLUTION
1, Elaine F. Marshall, Secretary of State, as mandated by law, do hereby certify that
APPALACHIAN PAVING AND GRADING, INCORPORATED
has been administratively dissolved pursuant to the procedure set forth in N.C.G.S. Section 55-14-21
for failure to file an annual report effective as of the date set forth hereunder.
A corporation administratively dissolved under N.C.G.S. Section 55-14-21 may apply to the Secretary
of State for reinstatement by complying with the procedure set forth in the N.C_G.S. Section 55-14-22.
This the 21 st day of July, 2011
Elaine F. Marshall
Secretary of State
Document Id: C201 1 19404289

CD479 (35) Business Corporation � >
'-0' North Carolina Annual Report PROPM Um
wftrmo
10
V.(
ra
,a
SOSID: (13-17685
Date Filed: 5120/2102 1 1:390) AM
Elaine F. Marshall
North Carolina Secretary of State
211112 14001359
Name of Corporation: APPALACHIAN PAVING & GRADING, INC
State of Incorporation: NC
Secretary of State Corp. ID Number: Fiscal Year Ending:
Month / Day 1 Year
Federal Employer ID Number. 12-31-01
If this Is the Initial annual report tiling, please complete the entire form. If your business corporation's
Information has not changed since the previous report, check the box and complete Line 8 only.
1. Registered agent & registered office mailing address Agent:
2. Street address & county of registered office
3. If registered agent changed, signature of new agent:
4. Enter principal office address here:
Mailing Address:
Street Address:
Courrty:
5. Enter principal office telephone number here:
6. Enter name, title, and business address of principal officers here:
Complete Form CD-479-A to list additional principal officers
(signsh" wrtattt es mma4m, Amftmt)
Name: Title:
Address:
City: State: Zip:
Name: Title:
Address:
City: State: Zip:
Name: Title:
Address:
City: State: Zip:
7. Briefly describe the nature of business:
S. CertMcation of annual report must be completed by all corporations
Siprtatlea (FQrm must be signed by utter or oorporabon)
Type or Print Name
�-
Det
� 31t�r cf2-•
Title

J �
State of North Carolina
1SECRr RYOFST Department of the Secretary of State
SIiC[tEl'A[ZY OF STATE
April 27. 2011
APPALACHIAN PAVING AND GRADING, INCORPORATED
Vernice a Atkins, Agent
5872 N Hwy 226
Bakersviile, NC 28705
Cheri L, Mverx
DIRECTOR OF CORPOPATIONN
NOTICE OF GROUNDS FOR ADMINISTRATIVE DISSOLUTION OF: APPALACHIAN PAVING
AND GRADING, INCORPORATED
Recently, this office conducted an internal review of the annual reports filed for all business cntitys in
North Carolina. Unfortunately. the review indicates that the above referenced business entity is not in
compliance with the North Carolina Business Entity Act and is delinquent in delivering seven (7) annual
repon(s).
The Secretary of State is authorized by N.C,G.S. 55-14-21 to administratively dissolve a business entity ii
one or more grounds for dissolution exist. Please note that while the dissolution process has not vet been
concluded, this Notice is the first step of the dissolution process. In order to prevent administrative
dissolution, the business entity must file the appropriate annual rcport(s) within sixty (00) days from the
date of this Notice.
Determining Annual Renorts Due
You may view a listing of annual reports previously submitted to the Secretary of State's Office by
clicking the link to the Corporations Division %Ncb pages al www,sosnc.com. You will need to search for
your company by name, then click "File Annual Report Online." This will bring you to a listing of annual
reports submitted. From this page you will be able to see if an annual report was submitted but not filed
due to an error which to date has not been corrected and/or determine how many annual reports are
required to become compliant. The due date for filing a Business Entitys annual report is the fifteenth
day of the fourth month following the fiscal year end date.
-Online Filing
Utilize the above referenced link to the entity profile page, then click on "File an Annual Report" at the
top of the page and follow the directions. The Fee is $20,00.
Paper Filing
You may also print a pre -populated form from the same web page by clicking "Print a pre -populated
annual report form," If (here are any changes, cross out the old information and enter the correct
information; then mail the report and fees to the Corporations division at the address on the bottom of the
form. The fee is $25,00.
If you have any concerns or experience an.), technical difficulty with the filing process, please contact our
staff at [phone].
Respectfully.
The Corporations Division
PO BON 29622
RALEIGI NORTH CAROLINA 27626-0622

North Carolina Department or the. Secretary of State as ate.
Corporations Division
PO Box 29622
Raleigh, NC 27626.0622
APPA ACHIAN PAVING AND
GRADING, INCORPORATED
Attn: ALMA ATKINS
P 0 Box 507 127a Possum Trot
NOTIFICATION OF RIWE.NUE SUSPENSION
Please he advised that, at the direction of the North Carolina
Department of Revenue, the entity identified on the reverse is
hereby suspended upon die records of the Department of the
Secretary of State for its failure to comply with the requirements of
the Department of Revenue pursuant to N.C.G.S. § 105-230(a).
In order to be reinstated, you must contact the North Carolina
Department of Revenue at [phone]. Do not contact the
Depatinient of the Secretary of State since this office has no
authority to clear the suspension or provide related information.
Once you have corrected the deficiency, the North Carolina
Department of Revenue will notify us and we will remove the
SUSpetlSlOn purSUant to N.Cy.G.S. § 105-232 at that time.
North Carolina Department ofthe Secretary of State
Corporations Division Moolb, Date 2004

Division of Water Quality / Surface Water Protection
rw
NCDENRNational Pollutant Discharge Elimination System
Np . CAR —A dEw TMgNT or
EN—o.— — N4 -- Re c[n
NCG160000
NOTICE OF INTENT
FOR AGENCY UtiE ONLY
Dale Received
Year
Month
Day
Ccrtitic.ttc urCuvcrn c
iv u a
Check 9
1 AMOLL S
iof)
Yennii A" w icd In
dws
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG160000:
STORMWATER DISCHARGES associated with activities classified as:
Coverage under this general permit is applicable to all owners or operators of stormwater point source discharges
associated with activities classified as establishments primarily engaged in Asphalt Paving Mixtures and Blocks
[standard industrial classification (SIC) 2951].
r For questions, please contact the DWQ Regional Office for your area. ' Sec page 4)
(Please print or type)
1) Mailing address of own j�j rloperator (address to which all permit correspondence will be mailed):
Name iTDL'Ac Ac'H�A�1/ f'A'VtN[r ! _ 14*;cAL}tvf—
Owner Contact _ ALAA1 /�lY tiS
Street Address 34d 6-/7AAKL2- Z-1,v'"
City 164kc=ram U�ee State /V - ZIP Code. Y-17pS
Telephone No. Fax: — --
E-mail Address
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
f Kam-? 5V�ce State ZIP Code
zls's-- zrr4 Fax:
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street narnes, state road numbers, and
distance and direction from a roadway intersection).
(A copy of a county map or USGS quad sheet with facility clearly located on the map is a required part of this application.)
4) Latitude 31 Longitude a 7 (degrees, minutes, Seconds)
LRO
110
DEC 1
5) This NPDES Permit Application applies to which of the following : 9 201,
❑ New or Proposed Facility* Date operation is to begin 4TLANDsANDST%14 E'rRBRMcN
Existing
*If this new or proposed facility in one of the 20 coastal counties, you must contact the appropriate Regionai
Office (see page 4) to determine if a State Stormwater Permit is also needed prior to construction,
Page 1 of 4
SWU-231-030909 Last revised 319/09

NCG190000 N.O.I.
11��r
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code:
7) Services and Activites
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facility: (Include a site diagram showing the process areas and location of
activities present at this facility.) &:xrT Are f,a i
L VIC L i11V7_
b) Check all services and activities, offered or allowed at this facility
( ✓Outdoor stockpiling of materials
( ✓Storage of raw materials
( ✓Storage of materials in above-
ground tanks
{ ;/Material Loading and Unloading
8) Discharge points 1 Receiving waters:
( v/Transport of materials by a conveyor
or front-end loader
( ✓Vehicle and equipment maintenance
( ✓Vehicle/Equipment Washing
( ./Vehicle and equipment fueling
How many discharge points (ditches, pipes, channels, boat ramps, lift wells, etc.) convey stormwater from the
property? lJF //^F dA'F S ETrL.�N�- G►dlvn �'h.+ rl .F
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in?
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
Receiving water classification (if known):
9) Does this facility
a) Have an untreated wastewater discharge? I No ❑ Yes
b) Have a treated wastewater discharge?
If yes, list the permit number.
12(No ❑ Yes
c) Have a wastewater discharge from a recycle system?
If yes, list the permit number.
d) Have a non -discharge permit? F_/J No
If yes, list the permit number. _
❑ Yes
Q No ❑ Yes
e) Discharge wastewater to a municipal wastewater collection system?
If yes, list the municipality and permit number
R No ❑ Yes
Note: Stormwater discharge permit NCG160000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you. must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG160000.
10) Does this facility employ any best management practices for stormwater control?
Ed No ❑ Yes (Show any structural BMP's on the site diagram.)
If yes, please briefly describe:
,-,, s�`r
SWU-234-030909
Page 2 of 4
Last revised 319I09

z
NCG190000 N.O.I.
11) Does this facility have a Stormwater Pollution Prevention Plan?
F; E�No ❑ Yes
s: .f
If yes, when was it implemented?
12) Are vehicle/equipment maintenance activities occurring at this facility?
>_ ❑ No C'�Yes
'i ii•
13) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
VNo ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
E"No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
UNo ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
EfNo ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport I disposal vendor:
Vendor address:
14) Certification:
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document riled or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10.000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Nme of Person Signing: �c�� ri�,�,� A ri�rJkS
Title: 7'M/4/v r
(Signature of Applicant)
(Date Signed)
Page 3 of 4
SWU-234-030909 Last revised 3/9/09

NGG190000 N.O.I.
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
17' Check for $100 made payable to NCDENR
❑ This completed application and all supporting documents
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
(corresponding to which drainage areas), (d) runoff conveyance structures, (e) areas where materials and/or
boats are stored, (f) impervious areas, (g) site property lines, (h) boat maintenance, blasting, painting and
washing areas, and (i) location of services and activities listed in 7b.
❑ Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ..
_ [phone]
Mooresville Office ..,
[phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4 of 4
SWU-234-030909
Last revised 319109

•
E
0
1 - AP-SPLLAYOUT general layout

APPALACHIAN PAVING AND GRADING, INC. r3C-ClilbN0-7 6499
5872 N HWY 226
BAKERSVILLE, NC 28705 66-1167/531
BRANCH 18
DATE
PAY
TO THE
ORDER OF
M'United
Community Bank
w P