NCG020204_Dormant Status Initial Request_20210929

FOR AGENCY USE ONLY
NC
ARO FRO MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
NCG020000
Dormant Status Request Form
Please complete this form if you are pursuing a new dormant status designation for a facility.
Directions:
Print or type all entries on this request form.
Attach this form to the by selecting "Dormant Status Initial Request" from the
dropdown list.
The submission of this form does not guarantee dormant status will be granted. An inspection from the
Division's Regional Office staff will be conducted prior to final determination.
North Carolina General Statute 143-215.613 (1) provides that: Any person who knowingly makes any false
statement, representation, or certification in any application, record, report, plan, or other document filed or
required to be maintained under this Article or a rule implementing this Article ... shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
Q I, as the legally responsible person or authorized representative, request dormant status for the subject
facility.
Q✓ The subject facility is temporarily inactive and all portions of the site where clearing, grading, and/or
excavation activities occurred are stabilized with permanent vegetation.
❑✓ 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.
Facility Name: Hanson Aggregates - Lexington Quarry
Permit Number: NCG020204
Date Facility Went Inactive: Greenfield site; has never been active.
Printed Name of Person Signing: Jack Garvey
Title: Area Environmental Manager
1V
(Signature)
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9/29/21
(Date Signed)

Compliance Inspection Report
Permit: NCG020204 Effective: 10/01/15 Expiration: 09/30/20 Owner : Hanson Aggregates Southeast LLC
SOC: Effective: Expiration: Facility: Hanson Aggregates - Lexington Quarry
County: Davidson NC Hwy #8
Region: Winston-Salem
Lexington NC 27292
Contact Person: Jack Garvey Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 06/20/2017 Entry Time: 10:OOAM Exit Time: 10:OOAM
Primary Inspector: Blair Palmer Phone: [phone]
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Secondary Inspector(s):
Reason for Inspection: Routine 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: NCG020204 Owner - Facility: Hanson Aggregates Southeast LLC
Inspection Date: 06/20/2017 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Facility is a greenfield.
Page: 2

Permit: NCG020204 Owner - Facility: Hanson Aggregates Southeast LLC
Inspection Date: 06/20/2017 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
❑ ❑ ❑
# Does the Plan include a General Location (USGS) map?
❑ ❑ ❑ E
# Does the Plan include a "Narrative Description of Practices"?
❑ ❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
❑ ❑ ❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
❑ ❑ ❑
# Has the facility evaluated feasible alternatives to current practices?
❑ ❑ ❑
# Does the facility provide all necessary secondary containment?
❑ ❑ ❑
# Does the Plan include a BMP summary?
❑ ❑ ❑
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
❑ ❑ ❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
❑ ❑ ❑
# Does the facility provide and document Employee Training?
❑ ❑ ❑
# Does the Plan include a list of Responsible Party(s)?
❑ ❑ ❑
# Is the Plan reviewed and updated annually?
❑ ❑ ❑ E
# Does the Plan include a Stormwater Facility Inspection Program?
❑ ❑ ❑ ■
Has the Stormwater Pollution Prevention Plan been implemented?
❑ ❑ ❑
Comment:
Qualitative Monitoring
Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ❑ ❑ ❑
Comment:
Analytical Monitoring Yes No NA NE
Has the facility conducted its Analytical monitoring? ❑ ❑ ❑ E
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ❑ ❑ ❑
Comment:
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? ❑ ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ ❑ ❑
# Has the facility evaluated all illicit (non stormwater) discharges? ❑ ❑ ❑ ❑
Comment:
Page: 3