NCG520049_Owner (Name Change)_20160930

PAT MCCRORY
Governor
Water Resources
ENVIRONMENTAL QUALITY
September 30, 2016
Mr. Jerry K. Adams
Tarheel Sand & Stone, Inc.
1108 Tuckda Way
Hamptonville, NC 27020
DONAI.D R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Subject: Issuance of Certificate of Coverage NCG520049
NPDES General Permit NCG520000
Tarheel Sand #52 Mine
Davie County
Dear Mr. Adams:
Director
The Division has reviewed and approved your request for coverage under the subject General Permit.
The Division hereby issues Certificate of Coverage (CoC) NCG520049 to discharge under wastewater
General Permit NCG520000. This CoC is issued pursuant to the requirements of North Carolina General
Statue 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].
If any parts, measurement frequencies or sampling requirements contained in this General 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, the 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.
The Division may require modification.or revocation and reissuance of the certificate of coverage. Contact
the Asheville Regional Office prior to anv sale or transfer of the permitted facility. Regional
Office staff will assist you in documenting the transfer of this CoC.
If you have any questions concerning the requirements of the General Permit, please contact
Brianna Young of the NPDES Unit at [phone] or via e-mail [[e-mail]].
y.
S. Jay Zimmerman, Director
Division of Water Resources
cc: Winston-Salem Regional Office
NPDES Unit
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
hops://deq. nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG520000
CERTIFICATE OF COVERAGE NCG520049
DISCHARGE OF INSTREAM MINING WASTEWATER, ASSOCIATED STORMWATER AND
SIMILAR DISCHARGES UNDER THE
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, the
Tarheel Sand & Stone, Inc.
is hereby authorized to discharge sand dredging wastewater from the following facility:
Tarheel Sand #52 Mine
6880 NC Highway 64
Cooleemee
Davie County
to receiving waters designated as the Yadkin River, currently classified as WS-IV CA
waters in subbasin 03-07-02 of the Yadkin Pee -Dee River Basin, in accordance with the
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II,
III and IV hereof.
This certificate of coverage shall become effective September 30, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 30, 2016.
for S. . immerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission

Pat McCrory
Governor
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
WATER QUALITY PERMITTING SECTION
Donald R. van der Vaart
Secretary
PERMIT NAME/OWNERSHIP CHANGE REQUEST
This form is for ownership changes or name changes of NPDES wastewater permits.
• "Permittee" references the existing permit holder
• "Applicant" references the entity applying for the ownership/name change.
I. NPDES Permit No. (for which the change is requested):
or
Certificate of Coverage #:
II. Existing Permittee Information:
a. Permit issued to (company name):
b. Person legally responsible for permit:
NC00
NCG520049
Aaron Sand & Gravel
Tim G Beeman
First M I Last
Title
Manager
Permit Holder Mailing Address
Winston Salem NC 27127-
City
[phone]
State
Zip
( )
Phone Fax
c. Facility name: Aaron Sand # 52 Mine
d. Facility's physical address:
e. Facility contact person:
6880 NC Hwy. 64
Address
Cooleemee NC
27014-
City
Tim Beeman
First / MI / Last
State
111. Applicant Information:
a. Request for change is a result of: ® Change in ownership of the facility
® Name change of the facility or owner
!f other please explain:
Zip
[phone]
Phone
b. Permit issued to (company name): Tarheel Sand & Stone Inc.
c. Person legally responsible for permit:
Jerry
K Adams
First
MI
President
Last
Title
1108 Tuckda Way
Permit Holder Mailing Address
Hamptonville NC 27020-
City State Zip
[phone] [e-mail]
Page 1 of2
Phone E-mail Address
Revised 7/01/2014

d. Facility name: Tarheel Sand #52 Mine
e. Facility's physical address: 6880 NC Hwy 64
f. Facility contact person:
Cooleemee
Address
NC
27020-
City State Zip
Jerry K Adams
First MI Last
President
Title
[phone] [e-mail]
Phone E-mail Address
IV. Will the permitted facility continue to conduct the same commercial/industrial activities conducted prior to
this ownership or name change?
® Yes
❑ No (please explain)
If applicable, the applicant shall submit a major permit modification request to DWR. A major modification shall be
defined as one that increases the volume, increases the pollutant load, results in a significant relocation of the
discharge point, or results in a change in the characteristics of the waste generated.
V. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE
INCOMPLETE OR MISSING:
1. This completed application is required for both name change and/or ownership change requests.
2. 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.
Applicable regulations: 40 CFR 122.41, 40 CFR 122.61 and 15A NCAC 02H .0114
The certifications below must be completed and signed by both the permit holder prior to the change (Permittee), 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):
I, , attest that this application for a name/ownership change has been reviewed and is accurate and complete to the
best of my knowledge. 1 un rstand that if all required parts of this application are not completed and that if all required
supporting matiot of includ, this application package will be returned as incomplete.
Date
APPLICANT CIERTIFICATION
I, , 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
suppQrting7information is not included, this application package will be returned as incomplete.
Signature
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST
Page 2 of 2
Revised 7/01/2014