NCG020542_COMPLETE FILE - HISTORICAL_20151209

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v CG, bad
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOCUATE
❑ �bIS /c)O �
YYYYMMDD

December 9, 2015
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Cott ntryscapes I_LC
Attn: Daniel Cartwright
382 N Gregory Rd
Shawboro, NC 27973
PAT MCCRORY
Gu ernor
DONAI_D R. VAN DER VAART
Subject: NPDES Stormwater Permit Coverage Renewal COC #NCG020542
Dear Permittee:
ser rr,rrr,
TRACY DAVIS
!Nr<rrnr
For coverage under NPDES General Permit NCG020000, the Division of Energy. Mineral and Land
Resources (DEMLR) is forwarding herewith the reissued Certificate of Coverage and
Stormwater/Wastewater General Permit. This permit is reissued pursuant to the requirements of North
Carolina General Statute 143-215. l and the Memorandum of Agreement between the state of North
Carolina and the U.S. Environmental Protection Agency, dated October 15. 2007 (or as subsequently
amended.) The following information is included with your permit package:
• New Certificate of Coverage
• Stormwater/Wastewater General Permit
• Technical Bulletin for the General Permit
• Discharge Monitoring Report (DMR) Forms
• Annual Discharge Monitoring Report Forms
• Qualitative Monitoring Report Forms
The General Permit authorizes discharges of Stormwater and/or wastewater (as applicable to your site),
and it specifies your obligations with respect to discharge controls, management, monitoring and record
keeping. Please review the new permit to familiarize yourself with all changes in the reissued permit.
Significant changes to the General Permit are outlined in the 'rechnical Bulletin.
Your coverage under the General Permit is transferable only through the specific action of DEMLR. This
permit does not affect the legal requirements to obtain other permits which may be required by the N,C.
Department of Environmental Quality, nor does it relieve the permittee from responsibility for
compliance with any other applicable federal, state, or local law, rule, standard, ordinance, order,
Judgment or decree.
]f you have any questions regarding this permit package please contact the DI:MLR Stormwater
Permitting Program at 919-707-9220.
Sincerely,
for Tracy E. Davis, P.E., C.P.M
Cc: Stormwater Permitting files
Slate o1norlh Carolina I I;nei ron mentn] Qmdity I I:nargy. Nlinerd and Land Resources
1612 Ntuil Service Center i 512 north Salisbuy curet I Raleigh. NC 27699.1612
919 707 9200 "r

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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG0200QO
CERTIFICATE OF COVERAGE No. NCGO20542
STORMWATER AND WASTEWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Countryscapes LLC.
is hereby authorized to operate approved wastewater treatment system(s) and discharge
stormwater and/or wastewater, as approved in the original permit/application or
subsequent permit modification, from a facility located at:
Countryscapes, LLC
S Of US 168 W Of Intersection With Hwy 34
Shawboro
Currituck County
to receiving waters designated as Cowells Creek, a class C;Sw water in the Pasquotank
River Basin, in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts 1, II,111, and IV of General Permit No. NCG020000 as
attached.
This certificate of coverage shall become effective October 1, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 1, 2015.
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

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NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Daniel C. Cartright
Countryscapes, LLC
382 N Gregory Road
Shawboro, NC 27973
Dear Mr. Cartright:
John E. Skvarla, III
Secretary
November 3, 2014
Subject: NPDES General Permit NCG020542
Countryscapes, LLC
Formerly Route 168 Inc.
Certificate of Coverage NCO20542
Currituck County
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in
the General Permit remain unchanged and in full effect. This revised Certificate of Coverage is
issued under the requirements of North Carolina General Statutes 143-215.1 and the
Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions or need further information, please contact the Stormwater Permitting
Program at [phone].
Sincerely,
MGINAL SIGNED BY
BETHANY GEORGOUEIAS
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Washington Regional Office, T. Edgerton
Stormwater Permitting Program Files
Central Files
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section - Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 I FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: http://portal.ncdenr.org/webAr/
An Equal opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

l
STATE OF NORTH CAROI,INA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG020542
CERTIFICATE OF COVERAGE No. NCG020542
SI.ORMWATER, MINE DEWATERING, AND/OR OVERFLOW FROM PROCESS
WATER RECYCLE SYSTEMS DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In coinpliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended.
Countryscapes, LLC
is hereby authorized to operate treatment systems and to discharge stormwater and mine
dewatering wastewater and process wastewater, from a facility located at:
Countryscapes, LLC
South of US 168, West of intersection with Hwy 34
Shawboro
Currituck County
to receiving waters designated as an unnamed tributary to Cowells Creek, class C SW,
waterbody in the Pasquotank River Basin, in accordance with the effluent limitations, monitoring
requirements, and other conditions set forth in Parts 1, II, III, and IV of General Permit No.
NCG020542 as attached.
This certificate of coverage shall become effective November 3, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day November 3, 2014.
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
lbr Tracy E. Davis, P.E., Director
Division of Energy.. Mineral, and Land Resources
By the Authority of the Environmental Management Commission

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Daniel C. Cartright
Countryscapes, LLC
382 N Gregory Road
Shawboro, NC 27973
Dear Mr. Cartright:
John E. Skvarla, III
Secretary
November 3, 2014
Subject: NPDES General Permit NCG020542
Countryscapes, LLC
Formerly Route 168 Inc.
Certificate of Coverage NCO20542
Currituck County
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in
the General Permit remain unchanged and in full effect. This revised Certificate of Coverage is
issued under the requirements of North Carolina General Statutes 143-215.1 and the
Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions or need further information, please contact the Stormwater Permitting
Program at [phone].
Sincerely,
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Washington Regional Office, T. Edgerton
Stormwater Permitting Program Files
Central Files
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:llportal.ncdenr,orglwebllr/
An Equal opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL. RESOURCES
DIVISION OF ENERGY, MINERAL. AND LAND RESOURCES
GENERAL PERMIT NO. NCG020542
CERTIFICATE OF COVERAGE No. NCG020542
STORMWATER, MINE DEWATERING. AND/OR OVERFt_OW FROM PROCESS
WA"rER RECYCLE SYSTEMS DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Countryscapes, LLC
is hereby authorized to operate treatment systems and to discharge stormwater and mine
dewatering wastewater and process wastewater, from a facility located at:
Countryscapes, LLC
South of US 168, West of intersection with I-Iwy 34
Shawboro
Currituck County
to receiving waters designated as an unnamed tributary to Cowells Creek, class C SW,
waterbody in the Pasquotank River Basin, in accordance with the effluent limitations, monitoring
requirements, and other conditions set forth in Parts 1,'11, 111, and IV of General Permit No.
NCG020542 as attached.
This certificate ofcoverage shall become effective November 3. 2014
"Phis Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day November 3, 2014,
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

6�jv\4 qu tom( CL .
Division of Energy, Mineral & Land Resources
Land Quality SectionlStormwater Permitting
NCDENRNational Pollutant Discharge Elimination System
M— E�wrxr.wo N- Reedreces PERMIT NAMEIOWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
bay
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N G S 16 1 1 1 1 1 1 N I C 10 10 12 10 5 4 2
11. Permit status nreor to requested change.
a. Permit issued to (company name): Route 168 Incorporated Mine
b. Person legally responsible for permit: Larry �^ Hazelwood
First M1 Last
Title
6330 N Center Dr. Ste. 125
Permit Holder Mailing Address
Norfolk VA 23502
City State 'Lip
[phone] [phone]
Phone Fax
c. Facility name (discharge): Route 168 Incorporated Mine
d. Facility address: S of US 168 W of intersection of NC 34
Address
City State `Lip
e. Facility contact person: Larry Hazelwood (757) 46W800
First / M11 Last Phone
Ill. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ® Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit -issued to (company name):
c. Person legally responsible for permit
RECEIVED
K T 3 0 2014
DENR-LAND QUALITY
STDRMWATER PERMITTING
d. Facility name (discharge):
e. Facility address:
Countryscapes LLC
Daniel C Cartwright
first M l Last
Owner
Title
382 N Gre o Rd
Permit Holder Mailing Address
Shawboro NC 27973
City State Zip
2) 202 6645
Phone E-mail Address
Countryscapes LLC
S of US 168 W of intersection of NC 34
Address
City State Zip
f. Facility contact person: Daniel C Cartwright
First M1 Last
252)202 6645
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014

.N

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Daniel C Cartwright
First MI Last
Owner
Title
382 N Gregory Rd
Mailing Address
Shawboro NC 27973
City State Zip
[phone] countryscapesclay@hotmail.
Phone 1;-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, ,zj!•, attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
r
Signature Date
APPLICANT CERTIFICATION
I, L , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
laj
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27.2014

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A
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
SETTLEMENT STATEMENT
B. TYPE OF LOAN:
I 1 FHA �XFMHA 3. CONY UNINS. []VA 5. [JCONV. INS.
[]
6.NUMBER[]
14846276
LOAN N4.
1 7110434543
8. MORTGAGE INS CASE NUMBER.
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(POC]" were paid outside the closing, they are shown here for informational purposes and are not included in the totals.
1.0 3198 (14B46276.PF(N14B46276n1)
D. NAMEAND ADDRESS OF BORROWER:
Countryscapes, LLC
382 N. Gregory Road
Shawboro, NC 27973
E_ NAME AND ADDRESS OF SELLER:
Route 168, Inc.
6330 N. Center Drive, Ste. 125
Norfolk, VA 23502
F. NAME AND ADDRESS OF LENDER:
The Bank of Hampton Roads
PO Box 1908
Elizabeth City, NC 27906-1908
G. PROPERTY LOCATION:
100 acres, more or less
Shawboro, NC 27973
Currituck County, North Carolina
H. SETTLEMENT AGENT: W2162623
Brumsey & Brumsey, PLLC
I. SETTLEMENT DATE:
March 21, 2014
PLACE OF SETTLEMENT
2883 Caratoke Highway, P. O. Box 100
Currituck, NC 27929
J. SUMMARY OF BORROWER'S TRANSACTION
K SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price
100,000.00
401, Contract Sales Price
100,000.00
102. Personal Property
402. Personal Property
103. Settlement Char es to Borrower Line 1400
6,605.50
403.
104.
404.
105.
405.
Adjustments For Items Paid @y Seller in advance
Adjustments For Items Paid By Seller in advance
106. City/Town Taxes to
406. Cityrrown Taxes to
107. County Taxes to
407, County Taxes to
108. Assessments to
408. Assessments to
109.
409.
1%
410.
111.
411.
112.
412.
120. GROSS AMOUNT DUE FROM BORROWER
106,605.50
420. GROSS AMOUNT DUE TO SELLER
100,000.00
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER:
500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money
501. Excess De sit See Instructions
202. Principal Amount of New Loans
74,750.00
502. Settlement Char es to Seller Line 1400
1,660.00
203. E)astin loans taken subject to
503. E)dstin loans taken subject to
204.
5W. Payoff of first Mortgage
205.
505. P2yoff of second Mortgage
206.
506.
207.
507.
208.
508.
209.
509.
Adjustments For Items Urpaid By Seller
Adjustments For Items Unpaid By Seller
210. Cityffawn Taxes to
510. City/Town Taxes to
211. County Taxes 01/01/14 to 03rM14
229.08
511_ County Taxes 01/01/14 to 03122/14
229.08
212. Assessments to
512. Assessments to
213.
513.
214.
514.
215.
515.
216.
516.
217.
517,
218,
518.
219.
519.
220. TOTALPAID BY/FORBORROWER
74,979.08
520. TOTAL REDUCTION AMOUNT DUESELLER
1,889.08
300. CASH AT SETTLEMENT FROMITO BORROWER:
600. CASH AT SETTLEMENT TOIFROM SELLER:
301. Gross Amount Due From Borrower tine 120
106.605.50
601. Gross Amount Due To Seller line 420
100,000.00
302. Less Amount PaidBy/For Borrower (Line 220)
( 74,979.08)
602. Less Reductions Due Seller (Line 520)
( 1,889.0
303. CASH ( X FROM) ( TO) BORROWER
31,626.42
603. CASH ( X TO) ( FROM) SELLER
98,110.92
The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein.

DEED Of TRUST
RECORDATION REQUESTED BY:
The Bank of Hampton Roads, Operations / Administration, 112 Corporate Drive, Elizabeth City, NC 27909
WHEN RECORDED MAIL TO:
The Bank of Hampton Roads, Loan Servicing & Quality Control, P.O. Box 1908, Elizabeth City, NC
27906-1908
SEND TAX NOTICES TO:
COUNTRYSCAPES, LLC; 382 North Gregory Road; Shawboro, NC 27973
This Deed of Trust prepared by:
X William Brumse , IlIltij 14B46276
MAXIMUM LIEN. The maximum principal amount secured by this Deed of Trust shall not exceed at any one
time $74,750.00.
THIS DEED OF TRUST is dated March 21, 2014, among COUNTRYSCAPES, LLC, whose address is 382 North
Gregory Road , Shawboro, NC 27973 ("Grantor'); The Bank of Hampton Roads, whose address is Operations
/ Administration, 112 Corporate Drive, Elizabeth City, NC 27909 (referred to below sometimes as "Lender"
and sometimes as "Beneficiary"); and GBTC, INC_, whose address is P.O. Box 1908, Elizabeth City, NC
27906-1908 (referred to below as "Trustee").
CONVEYANCE AND GRANT_ NOW, THEREFORE, as security for the Indebtedness, advancements and other
sums expended by the Beneficiary pursuant to this Deed of Trust and costs of collection (including attorneys'
fees as
. provided in .the Note). and other valuable consideration, the receipt of which is hereby acknowledged,
Grantor has bargained, sold, given, granted and conveyed and does by these presents bargain, sell, give, grant
and convey to Trustee, acid Trustee's heirs. or successors and assigns, for the benefit of Lender as Beneficiary,
all of Grantor's right. title. and -interest in and to the following described real property, together with all existing
cr suhsequently ..erected. or --affixed buildings. improvements and fixtures; all easements, rights of way, and
aomirtemnan}ces: all ,,voter; water. rights and -ditch rights (including stock in utilities with ditch or irrigation rights);
aad all outer rights: royalties, and profits relating to the real property, including without limitation all minerals,
oil, gas''_ geotherrztal and similar matters, (the "Real Property") located in Currituck County, State of North
Carolina:
See Exhibit "A ",:which is attached to this Deed of Trust and made a part of this Deed of Trust as if fully
set forth herein,
The Real Property or its address is commonly known as 102.7 Acres off of Caratoke Highway, Moyock, NC
27958. The Real Property tax identification number is 0032000083E0000.
To have and to hold said Real Property with all privileges and appurtenances thereunto belonging, to the
Trustee, his heirs, successors and assigns forever, upon the trusts, terms and conditions and for the uses
hereinafter set forth.
Grantor presently assigns to Lender (also known as Beneficiary in this Deed of Trust) all of Grantor's right, title,
and interest in and to all present and future leases of the Property and all Rents from the Property. in addition,
Grantor grants to Lender a Uniform Commercial Code security interest in the Personal Property and Rents.
THiS DEED OF TRUST, INCLUDING THE ASSIGNMENT OF RENTS AND THE SECURITY INTEREST IN THE
RENTS AND PERSONAL PROPERTY, IS GIVEN TO SECURE (A) PAYMENT OF THE INDEBTEDNESS AND (B)
PERFORMANCE OF ANY AND ALL OBLIGATIONS UNDER THE NOTE, THE RELATED DOCUMENTS, AND THIS
DEED OF TRUST. THIS DEED OF TRUST IS GIVEN AND ACCEPTED ON THE FOLLOWING TERMS:
PAYMENT AND PERFORMANCE. Except as otherwise provided in this Deed of Trust, Grantor shall pay to
Lender all amounts secured by this Deed of Trust as they become due, and shall strictly and in a timely manner
perform all of Grantor's obligations under the Note, this Deed of Trust, and the Related Documents.
POSSESSION AND MAINTENANCE OF THE PROPERTY. Grantor agrees that Grantor's possession and use of

A,L..
Division of Ener v. A7ineral S Land Resources
Land Qualify Section/Stormwater Permitting Program
RCDENR]national Pollulaw Discharge Elimination System
E"Ro—Ee ono Na - Re Rcn
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
I Day
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N C I 5 N I C G bap
2) Owner/Facility Information: * Final correspondence will be marled to the address noted below
Owner/Facility Name -R 064e I to 9 -:rJ c . m r 'J '—
Facility Contact L A22- V H A ZP_ 14 c>A-
Street Address (13 3 0 rA G e a`D r2 ;
City Nv r k State -VA ZIP Code 7, 3 -5-6rZ ,
County E-mail Address �cz��+ha_xeflniooc��SL�bu✓bahClrD�o�1►��},
Telephone No. 7Yr7 (- I $ O Fax: -7 5 7 4 I - (J 98 9 �J •�JJ
�d m
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on I-'.-1 . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
] Facility sold to EC1 �, �Ca�t �� on I If the facility will continue operations under the new owner it
O& lr Sca c.r +� r✓
may be more a propnat�to re ues>tan ownership change to reissue to permit to the new owner.
❑ Other:
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. 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.
Signature / I �vv Date
Print or type name of person signing above Title
Please return this completed rescission request form to: NPDES Permit Coverage Rescission J�
Stormwater Permitting Program - "
1612 Mail Service Center 8 , V
Raleigh, North Carolina 27699-1610 kp
FNR ND
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 SrORMWA �RpQUALI Y
Phone: [phone] FAX: [phone] �RNIl77j,VG
An Equal Opportunity 1 Affirmative Action Employer

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
�� � FIIIlI � IIIII � I� Illill II �II� IIIIII�IIlII
INVOICE * 2 0 1 4 P R 0 0 b 9 5 8
Annual Permit Fee Open
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facility's
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice Number: 2014PR006958
Permit Number: NC:G020642
Currituck County
Route 168 Incorporated Mine
Larry Hazelwood
Route 168 Inc Mine
6330 N Center Or
Ste 125
Norfolk, VA 23502
Annual Fee Period: 2014-09-01 to 2015-08-31
Invoice Date: 0810712014
Due Date: 09/06/2014
Annual Fee: $100.00
Notes:
I. You may pay either by checklmoney order OR by electronic payment.
2. If payment is by check/money order, please remit payment to:
NCDENR - Division of Energy, Mineral and Land Resources
Attw Stormwater Billing
1612 Mail Service Center
Raleigh, INC 27699.1612
33 If payment is electronic, see http:llportal.ncdenr.org/web/wolhot-looicstepaayment for additional details. See
http:llportal.ncdenr.org/web/wq/epayment to pay electronically. Only eCheck transactions are allowed at this time. Credit Card
transactions are not accepted.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $25,00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
6. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
7. Should you have any questions regarding this invoice, please contact the Annual Administering and Compliance Fee
Coordinator at 919-707-9220.
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2014PROO6958
Permit Number: NCG020542
Currituck County
Route 168 Incorporated Mine
Larry Hazelwood
Route 168 Inc Mine
6330 N Center Or
Ste 125
Norfolk, VA 23502
II I I II I I l l l II I I I II Il I I I I I flll I ill
* 2 0 1 4 P R 0 0 6 9 5'8
Open
Annual Fee Period: 2014-09-01 to 2015-08-31
Invoice Date: 8/712014
Due Date: 9/6/2014
Annual Fee: $100.00
Check Number:

P+2-
Gti...rr��uL
Edgerton, Thom
From: Alexander, Laura
Sent: Tuesday, October 21, 2014 8:17 AM
To: Edgerton, Thom
Subject: RE: NCG020542 - Rescission Request
Thank you! I will be in touch with Mr. Cartwright.
From: Edgerton, Thom
Sent: Monday, October 20, 2014 4:17 PM
To: [e-mail]; Alexander, Laura
Subject: FW: NCG020542 - Rescission Request
Hello,
Friday during the site visit, I met the new operation owner Gary Cartwright, Countryscapes LLC, [phone]
onsite. We discussed permitting.
I have attached the inspection report and the new ownership/facility name change form to be completed in order for
the required information to be updated.
Please contact Mr. Cartwright directly with any clarification needed, and/or let me know if I can be of further assistance.
Thanks,
Thom
Thom Edgerton, Environmental Engineer
North Carolina Department of Environment and Natural Resources (NCDENR)
Division of Energy, Mineral, and Land Resources JDEMLR)
Land Quality Section (LQ)
Washington Regional Office {WaRO)
943 Washington Square Mall
Washington, NC 27889
[phone] phone
E-mail correspondence may be subject to the North Carolina Public Records Law and may be disclosed to third parties. &_

Compliance Inspection Report
Permit: NCG020542 Effective: 11/20/12 Expiration: 12/31/14 Owner: Route 168 Inc Mine
SOC: Effective: Expiration: Facility: Route 168 Incorporated Mine
County: Currituck S Of US 168 W Of Intersection With Hwy 34
Region: Washington
Moyock NC 27958
Contact Person: Larry Hazelwood Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Corporate Responsible Official
Related Permits:
Inspection Date: 10/17/2014
Primary Inspector: Thom Edgerton
Secondary Inspector(s):
Certification:
Gary Cartwright
Phone:
Entry Time: 01:OOPM Exit Time: 01:30PM
Phone: [phone]
Reason for Inspection: Other Inspection Type: Compliance Evaluation
Permit Inspection Type: Mining Activities Stormwater Discharge COC
Facility Status: ❑ Compliant ❑ Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

permit; NCG020542 Owner - Facility: Route 168 Inc Mine
Inspection Date; 10117/2014 Inspection Type :Compliance Evaluation Reason for Visit: Other
Inspection Summary:
The new owner is operating under this NCG020542 NPDES SW permit and will complete any required ownership and
facility name change requirements.
If you need to speak with me directly, please call Thom Edgerton at [phone].
Page: 2

I
Permit: NCG020542 Owner • Facility: Route 168 Inc Mine
Inspection Date: 10/1712014 Inspection Type :Compliance Evaluation Reason for Visit: Other
Permit and Outfalls Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ❑ ❑ ❑ ■
# Were all outfalls observed during the inspection? ❑ ❑ ❑ S
# If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ M ❑
# Has the facility evaluated all illicit (non stormwater) discharges? ❑ ❑ ❑
Comment: This inspection was in response to the rescission request.
Based on my evaluation and inspection. I have determined that the rescission request form was
also intended to have the ownership changed
Attached to this inspection report is the ownership change form for completion Please contact
Laura Alexander [phone] of the Raleigh, Stormwater Permittinq Program with questions
or for additional information).
Page: 3

93
.. r '� � r � - �.: , � ~r = +fir � .. s _ • ,
fe
IS411 Cam
r '

Edgerton, Thom
From:
Sent:
To:
Subject:
Attachments:
ram- P A�r4 cU.. .
Alexander, Laura
Friday, September 19, 2014 3:04 PM
Edgerton, Thom
NCG020542 - Rescission Request
SKM C224e14091914511.pd#
Laura Alexander
Stormwater Permitting Program
NC Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, NC 27699-1612
[phone]
I

Bivikkm III' \Ijilt-1-.11 &- Land 14%oill-ccs
MCDENC3`Y\
RESCISSION REQUEST FORM
Pfeitsc fill out and rctuin this V-m if you no longer need to maintain YOUr NPDIS stormvqater permit,
1) Enter the permit number to which this request applies:
Individual Permit Cprlificate of Coverage
N C
71 Owner/Facility Information; Final correspondence MY be mailed to the address noted below
0wner/4-acilitv Name �-e 0 j-JjL
F— acility Cont;ict V- t1
A(n ta
Street Address
City State ZW Code
E-mail' Address o
I elephorv- No- --7
fax:
3) Reason for rescission request (This is rectuired information. Attach separate sheet if necessary):
L i Facility closer! or is closing on ___ All industrial activities I ioVC' CP-1';0d SLJCl; llial ric discharges, of
stormwaLtef are contaminated by exposure to industrial activities of materials.
f-agility sold to ✓on If the: fac4ity will continue operations wider the now owner it
/7 CL
sc_ to t
'r �Nnershio charige to reissue to permil� he new owner.
may be wom �fipropriat� to rQ(f11i(1V �irl �i
D c) t f-i (-
4) Certificatinn-.
1, as an aUthorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
SUbjed facility. I am far-niliar with the information contained in this request and to the best of my knowledge and belief
such information ;,, true, compiete and accurate.
Dat
Print or type name of person signing above Title
Pluase return this completed rescission request form to: NPOES Permit Coverage Rescission
Stormwater Peirnitting Program f ci /
1612 Mai! Service Center
1-1/rip
,Aje,- la�e7,YI-7- Raleigh, North Carolina 27699-1612
TC'R4v,1 'LAND

NORTH CAROLINA DEPARTMENT O
ENVIRONMENT AND NATURAL RESOURCES II I'Iilll I llilllli I I +II 111'II I II � I � 11
INVOICE 2 0 1 r, P R 0 0 6 9 5 8
Annual Permit Fee Open
This annual fee is required by the North Carolina Admirlistrative Con II covers the adminlsliatrve costs associated with
your p[rn.tit. It ,s required of any person holding a p.rrnit for anv time during the annual fee period, regardless o' the facdily s
QVI,-, atrrg status, Fa;luro to pw2 the lee by the cue dwe will subject the perrmt to rovocation ;)pefatirlq without a valiri,
Permit 5 a v?olation and I% sudlecl to a $10.000 per day fine If the perrnit Is -evoked and you later decide a permit is
'u:tded you m:lsl reapply with the understandmq 1hc' POrTrI t 'egl+e9l i-iay be denied dIIQ 10 Changes m environrnetlta?,
regfllalory or mocWwg concMirrms
InvoweNumber• ?{)I4Pj'•,410,395H �/ �/d
Permit Number: N1:1Fr_,;1tii�4t �' Ge-Dr� --D5 / Z-
Cuiriluck, County
Roatr? 168lncorp,),glad'M;fle
I.,iiry H,-),? ;waod
Ruth? 1615 Inr, t.hne
GJ30 N Crlllef t7�
Sr.. 125 i
No:f4k. VA 23b02
Annual Fee Period: 2ri 14-r)9-01 10 .'.01� 08�31
Invoice Uaie: 0ar07r20 id
Due Watt: 091DII12014
Arinual Few 3100 00
rJntes
You in, pay rither by checklmoney order OR by electronic. payrr,efit
11 u!:yrr;rit is by WecKrivortly order I)lcas,e. rein''. payinerit te'.
NCDFNR - Division of Energy, rSincraf and [.arid ReSnlircos
Attn: Slurrnwatei Billing
1612 Mail Service Center
Raleigh, NC 27699-1612
3 11 pay,nant is electionic, soe. ntttl'JL(iItal •11:denr U _r'b,w(tLh9l loINr_51Ct)i Y+cif ;a for additional nelads See
MIS,, Io pay electronically 9 1 eUheck, transactions are. 30owed at this Wl ie [.;relit r:aid
;r11nSaCtitn i5 fire. nut ar.acptcd
4. Please melodic your Permit Number and Invoice Number on all correspondence.
{t S'__.Oi; ulciress,ng ht,: will he thafyed Inl Icturnerj chr:cks In acCiydance r:i?h Nor!h Gaze°Trio Fielrcral Statute::' 3-5
!i Nrn-f7ayrn nr of tl is `.ac by I., payinenl due dafe wiR in Ualo the perrrlN revocalion process
S!4o4r':I Vol] haVe all'; rliiCSlions •ec Aiding !hIS WVDl ;e, plea5P- Contact [On A ewl,ai AdariniStE'.fl'13 arxj Cow j;It. in " I�ee
L:onnJi;+ain1 la! 17 i!+7(779_l.J
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoicn Nirnlhar: 2Pt4QRr)06`•15Fj
Primilt NIIrilbCr: NCG020542
(,,uf ritlll:k Culirly
koi Ite IGR lrlcoriiorateli A;;re
01!y Ilazelwooi'l
roole 168 Inc f0.ire
G'.130 N Gamier Or
Sk! 125
t\r!1I'i11ti„ VA
li ! 111I l�llll I I Il��ll li�'I II I I I I
2 0 1 4 P r1 0 0 6 9 5 8
Open
Annual Fco Period: 2r'14 w) 01 to 2D15 08-3?
lnvoiee pate: 91712014
Due Date: W(jf2014
Annual Fee: 5100 QG
Check Number:

NCG020542��%-
Program Category
NPDES SW
Permit Type
Mining Activities Stormwater Discharge COC
Primary Reviewer
sheri,montalvo
Coastal SWRule
Permitted Flow
0
Central Files: APS _ SWP _
9/25/2014
Permit Tracking Slip
Status
Project Type
Active
Renewal
Version
Permit Classification
2.00
COC
Permit Contact Affiliation
Facility Name Major/Minor Region
Route 168 Incorporated Mine Minor Washington
Location Address County
S Of US 168 W Of Intersection With Hwy 34 Currituck
Facility Contact Affiliation
Moyock NC 27958 Larry Hazelwood (75-1) ¢61 _1804)
1190 Harmony Rd
Norfolk VA 23502
Owner Name Owner Type
Route 168 Inc Mine Non -Government
Owner Affiliation
Percy C. Bums Il!
530 Woodlake Cir
Chesapeake VA 23320
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
9/2512000 7/19/2012 11/14/2012 11120/2012 12/31/2014
Mine dewatering RO staff report received
Mining & material processing RO staff report requested
Mining dosed loop recycle system Rescission requested 9l19114
Vehicle ma;ntenance y� ` � - 76.1 Zv
oat 3G, Z?: bo - 76.06. o$
Waterbody Name Streamindex Number Current Class Subbasin
Cowells Creek 30-1-2-2-5-1-1 C;Sw 03-01-54

• NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RE§OURCES IIIIII IIIII I III I I II I II II I III I I II III I II I I
INVOICE * 2 0 1 4 P R 0 0 6 9 5 8
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facility's
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice Number: 2014PR006958 Annual Fee Period: 2014-09-01 to 2015-08-31
Permit Number: ' NCG020542 Invoice Date: 0810712014
Currituck County
Route 168 Incorporated Mine Due Date:. 00/06/2014
Larry Hazelwood Annual Fee: $100.00
Route 168 Inc Mine
6330 N Center Dr
Ste 125
Norfolk, VA 23502
Notes:
1. You may pay either by checklmoney order OR by electronic payment. LDENRgV­
a 2. If payment is by checklmoney order, please remit payment to:NCDENR - Division of Energy, Mineral and Land ResourcesAttn: Stormwater Billing U A 2011612 Mail Service Center/FRaleigh, NC 27699-1612h3. If payment is electronic, see http;llportal.ncdenr.org/web/wghot-topics/eliavment for additional details. See R pERMi1RCES
htto:llportal.ncdenr.orglweblwQ/epavment to pay electronically. Only eCheck transactions are allowed at this time. Credit card TTING
transactions are not accepted.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $25.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
6. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
7. Should you have any questions regarding this invoice, please contact the Annual Administering and Compliance Fee
Coordinator at 919-707-9220.
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2014PR006958
Permit Number: NCG020542
Currituck County
Route 166 Incorporated Mine
Larry Hazelwood
Route 168 Inc Mine
6330 N Center Dr
Ste 125
Norfolk, VA 23502
Illl l 111 Illlli l llllll IIIII I II I I II II
* 2 0 1 4 P R 0 0 6 9 5 8
Overdue
Annual Fee Period: 2014-09.01 to 2015-08-31
Invoice Date: 8/7/2014
Due Date: 91612014
Annual Fee: $100.00
Check Number:

VWA
"- • DiN,ision of Elnergly, Alineral & Land Resources
Land Quality Section/Stortwater Permitting Program
NCDENRNational Pollutant Discharge Elimination System
�o+nC—OL­ DEw..+ - of
[uyppNMGM u,o ii 0-
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Dale Received
Year MonIh
Day
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N C 5 N C I G Q 1 p2 p 15
2) Owner/Facility Information: `Final correspondence will he marled to the address noted below
Owner/Facility Name -R p(_�(? i { D _rJ c- • M '-^j �e-
Facility Contact
Street Address
City
County
Telephone No.
A `� I- v
vU
_ 6330 C_ L, Sff- /'�_ :5-
/V0 ►' 1 State ✓A ZIP Code Z3.S_6,Z_,
E-mail Address IArryhaxrkh,00 J P sL buv bar,cyr0'4) ,1�
_75,9 4-(� f - 1800 Fax: - .�JJ
Ga nT
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
�+] Facility sold to V 0 04eyl fO on 3.? If the facility will continue operations under the new owner it
ou r yy Sc c_0 .s L C_
may be more a propriater to re ues(an ownership change to reissue to permit to the new owner.
❑ Other:
4) Certification:
1, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. 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.
SignatureOd Date
Z,+,ekZ' / L wv�v� &&_ V-a Y/1014
Print or type name of person signing above Title
Please return this completed rescission request form to: NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] l FAX: [phone]
An Equal Opporlunily 1 Affirmative Action Employer
{ A nt;;tl.A

North Carolina
Beverly Eaves Perdue
Governor
Larry Hazelwood
Route 168 Inc Mine
530 Woodlake Cir
Chesapeake, VA 23320
Dear Permittee:
A'F ai
NC®ENR
Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E. m E C E Iqe �
Director
November 20, 2012
NOV 2 0 2012
DWQ-WARD
Subject: NPDES Stormwater Permit Coverage Renewal
Route 168 Inc Mine
COC Number NCG020542
Currituck County
In response to your renewal application for continued coverage under Stormwater General Permit
NCG020542 July 19, 2012, the Division of Water Quality (DWQ) is forwarding herewith the reissued
Certificate of Coverage and stormwater General Permit. This permit is reissued pursuant to the
requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between
the state of North Carolina and the U.S. Environmental Protection Agency, dated October 15, 2007 (or as
subsequently amended.)
The following information is included with your permit package:
• A new Certificate of Coverage
• A copy of the stormwater General Permit
• A copy of a Technical Bulletin for the General Permit
• Copies of the Discharge Monitoring Report (DMR) Form
• Copies of the Annual Discharge Monitoring Report Norm (if applicable)
• Copies of the Qualitative Monitoring Report Form
The General Permit authorizes discharges of stormwater only, and it specifies your obligations with
respect to stormwater discharge controls, management, monitoring, and record keeping. Please review
the new permit to familiarize yourself with all changes in the reissued permit. Significant changes to the
General, Permit are outlined in the attached Technical Bulletin.
Your coverage under the General Permit is transferable only through the specific action of DWQ.
This permit does not affect the legal requirements to obtain other pert -nits which may be required by
DENR, nor does it relieve the permittee from responsibility for compliance with any other applicable
federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
1617 Mall Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: [phone] l FAX: [phone] Customer Service' 1-877.623-6748
Internet: vrwvv.ncwaterguality.orq One
An Equal Opportunity 1 Affirmative ACGan Employer North C aro f i B a
Natumlly

If you have any questions regarding this -permit package please contact the DWQ Stormwater Permitting
Unit at 919-807-6300.
Sincerely,
ORIGINAL. SIGNED 131
KEN PICKLE
for Charles Wakild, P.E.
cc: jDW�QJCentraMF�il e�s
Stotiw
rmater Permitting
n�g'
F
Unit Files
Washington Regional Office, Surface Water Protection Section Supervisor

r
STATE OF NORTH CAROLINA
DEPAR'rMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020542
STORMWATER, MINE DEWATERING, AND/OR OVERFLOW FROM PROCESS
WATER RECYCLE SYSTEMS DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
is hereby authorized to discharge stormwater and to operate treatment systems and
discharges associated with mine dewatering and wastewater and process wastewater from
a facility located at:
Spruill Mine
913 Caratoke Hwy NC
Sligo
Cwrituck County
to receiving waters designated as an unnamed tributary to Cowells Creek, class C SW,
waterbody in the Pasquotank River Basin in accordance with the effluent limitations,
monitoring requirements, and other conditions set forth in Parts I, II, 111, IV, V, and VI of
the General Permit as attached.
This certificate of coverage shall became effective November 20, 2012.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day November 20, 2012.
ORIGINAL SIGNED P
KEN PICKLE
for , Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

&YA, 'l „r P 120014
�04 WAr�., Permit Coverage
�°w4 Renewal Application Form
National Pollutant Discharge Elimination System
Stormwater Discharge Permit
Permit Number
NCGO20542
The following is the owner affiliation information currently in our database for your facility. Please review this information carefully and make all
corrections/additions as necessary in the space provided to the right of the current information.
Owner Affiliation Information * Reisrueil Pernuf will be mailed to the owner address
Owner/Organization Name: Route 168 Inc Mine
Owner Contact: Percy Burns
/4.P-RY 9AZGLW6017
Mailing Address: 530 Woodlake Cir 11,20 AIA R A,10A/ C/
Chesapeake, VA 23320-3320 AlO R -G, /k - V/-\ 3 S6,4
Phone Number: [phone] -75-,7 - //�o / _ /B00
Fax Number: 7,5-7 - e161- 0989
E-mail address: /av r cif-z d wood Ap
S Leh L.1 ✓ h cd v,
Facility/Permit Contact Information J J
If there has been any change to your facility/ permit contact information, please indicate updates in the space provided below.
Facility Name:
.�'rrn.a-
Facility Physical Address:
Facility Contact: , // 1
LQ.r r Ha I WDD
Mailing Address: / / 90 //aeM0, fV 11?d
Alo r �ro fk , VA _2.3.Sp,Z
Phone Number:
Fax Number:
E-mail address:
757- z/6/-/800
yAaze- Wdod�.56L uv�}2h�Cr- �/ Q_ (off
Impaired Waters/TMDL
Does this facility discharge to waters listed as impaired or waters with a finalized TMDI-? ❑ Yes ❑ No "'21 Don't Know
(For information on these waters refer to{ufp:%ih�o.enr.stute.nc.trs/ru/lrrq�aired H''aters_TrtIDLi j
CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the best of my knowledge and belief such information is true,
complete and accurate.
SignatureDate
-f3,CRy 7`�hZelrC,0 Jec.trc -Are)
Print or type name of person signing above Title
Please return this completed renewal application form to: Stormwater Permitting Unit
Attn: Julie Ventaloro
1617 Mail Service Center
Raleigh, North Carolina 27699-
L�b�
17l JUL j 9 2012 ],

Jaz=a
NC®ENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Percy Burns
Route 168 Inc Mine
l 190'Harmony Rd
Norfolk, VA 23502-3502
Dear Permittee:
Division of Water Quality
Charles Wakild, P.E.
Director
June 26, 2012
Subject: NPDES Stormwater Permit Coverage Renewal
Route 168 Incorporated Mine
Permit Number NCG020542
Currituck County
Dee Freeman
Secretary
Your facility was covered for stormwater discharge under NPDES Permit NCG020542, however, this
permit expired on 11/30/2004. To assure consideration for continuing coverage under your permit, you
must apply to the Division of Water Quality (DWQ) for renewal of your permit. Enclosed you will find a
Permit Coverage Renewal Application Form. Filing the application form will constitute your application
for renewal of this permit.
The application must be completed and returned to DWQ by August 1, 2012. Failure to request
renewal within this time period will result in the inactivation of your expired permit in our system.
Discharge of stormwater without coverage under a valid stormwater NPDES permit constitutes a
violation of N.C. General Statute 143-215.1 and may result in the assessment of civil penalties of up to
$25,000 per day.
If you have any questions regarding permit renewal procedures please contact Julie Ventaloro of the
Stormwater Permitting Unit at [phone] or Jul [e-mail].
Sincerely,
Bradley Bennett, Supervisor
Stormwater Permitting Unit
Cc: Central Files
SPU Files
1617 Mail Service Center, Raleigh, North Carollna 27699.1617
Location: 512 N Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: 91M07-64921 Customer Service: 1-877.623-6748
Internet: www.ncwaterquality.org
An Equal Opporfuky 1 Affirmative Action Employer
One
NorthCarolina
Aw rallry

Michael F. Easley. Governor
William G. Ross Jr., Secretary
North Carolina Departrnc= of Environment and Natural Resources
Alan W. Klimek~ Y.E. Director
Division of Water Quality
June 12, 2006
Mr. Percy C. Burns III
Route 168 Inc. Mine
1150 Harmony Road
Norfolk, VA 23502
Subject: Stormwater General Permit NCG020000
Operations and Maintenance Reminder
Route 168 Inc. Mine
COC Number NCG020542
Currituck County
Dear Permittee:
Our records indicate that you have been issued a Stormwater General Permit and a Certificate .
of Coverage for your facility. These permits have specific conditions that must be met in order for you
to be in compliance with your permit. It is your responsibility, as the permit holder, to read and
comply with the conditions contained in the permit.
It is our responsibility, as the issuing authority, to make sure that the operation and
maintenance of your facility complies with the conditions contained in your permit. To assist you in
complying with these conditions, we are attaching a Technical Bulletin specific to your permit
requirements. We are currently in the process of developing our inspection schedule. Therefore, you
should have all of your records up to date as we may be contacting you in the near future to set up
an inspection of your facility.
If you have any questions, please do not hesitate to contact Samir Dumpor, Pat Durrett or
myself at [phone].
Sincerely
-L
Al Ho ge, p N150f
Washington Regional Office
Surface Water Protection Unit
Encl.
CC: WaRO files
North Carolina Division of Water Quality Internet: h2o.enr.sta1s.nc.us
943 Washington Square Mall Phone: [phone] One
Washington, NC Z7889 FAX [phone] NorthCaroiina
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consume. Paper AaturalCY

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr_, Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Mr. Percy C. Burns, III
530 Woodlake Circle
Chesapeake, VA 23320
Dear Mr. Burns:
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
September 22, 2000 �{ D
SEP 2 6 2000
aW0_
Subject: General Permit No. NCG020000
Route 168, Inc.
COC NCG020542
Currituck County
In accordance with your application for a discharge permit received on August 9, 2000
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 December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit
are unacceptable to you, you have the right to request an individual permit by submitting an
individual permit application. Unless such demand is made, this certificate of coverage shall be
final and binding.
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 Aisha Lau at telephone
number [phone] ext. 578.
Sincerely,
ORIGINAL SIGNED By
MWft'CiVhLS
cc: Washington Regional Office
Central Files
Stormwater and General Permits Unit Files
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

I
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020542
STORMWATER, MINE DEWATERING, AND/OR OVERFLOW FROM
PROCESS WATER RECYCLE SYSTEMS DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215,1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Percy C. Burns, III
is hereby authorized to discharge stormwater from a facility located at
Route 168, Inc.
South of US 168, West of intersection with Hwy. 34
Sligo
Currituck County
to receiving waters designated as an unnamed tributary to Cowells Creek, class C SW waters, in the Pasquotank
River Basin in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in
Parts I, 1I, 111, IV, V, VI and VII of General Permit No. NCG020000 as attached.
'Phis certificate of coverage shall become effective September 22, 2000.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 22. 2000.
QRIGIN& SIGNED BY
wfLL1Al1+1 C. MILS
Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission