NCG140012_Modification Application_20221129

FOR AGENCY USE ONLY
NCG140 0L1.
Assigned to: 8. COND
ARO FRO MRO RRO WARD WIRO WSRO
M6 J ij:' C �4 ECEIVED
DEMLR-Stormwater Program
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG140000 Notice of Intent
This General Permit covers STORMWATER AND/OR WASTEWATER DISCHARGES associated with activities under
SIC (Standard Industrial Classification) Code 3273 [Ready Mix Concrete] and like activities. you can find
information on the DEMLR Stormwater Program at deq.nc.gov/SW.
Directions: Print or type all entries on this application. Send the original, signed application with all required
items listed in Item (8) below to: NCDEMLR Stormwater Program, 1612 MSC, Raleigh, INC 27699-1612. The
submission of this application does not guarantee coverage under the General Permit. Prior to coverage under
this General Permit a site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsibl
person as signed in Item (9) below:
C S„ v Co, w
5�
Street address:
f
Cit :
�1.
State:
A/
Zip Code:
s ,
�..(a t
2 � ofo—
Telephone number:
Email address:
o Y - 3 72— ; 9 10
S./r co,
0-%C V1t_ 6-+
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non -government
N,Business (If ownership is business, a copy of NCSOS report
must be included with
this application)
❑ Individual
2. Industrial Facility (facility being permitted):
Facility name:
(f S �PPI Co— l7pvn
Facility environmental contact:
cS.,, 41
hCr r
C.. cW1c/
Street address: n(� n
F' 3 UM h Ka (C AY
City:
hov,.,'r P.i'W I
State:
Zip Code:
Sv
Parcel Identification Number (PIN):
County:
SV //
Telephone number:
70 Lf -- 37.1--?93
Email address: /
,+ m&S Ca
4-digit SIC code:
Facility is:
Date operatio is to begin or began:
7jc�
❑ New ❑ Proposed xisting
.SIC •2d I j
Latitude of entrance:
*3`C- S47 I04"
Longitude of entrance:
B 'ef description of the tyQjles of industrial activities and products manufactured at this facility:
�6f.�"
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
(_N/A
Page 1 of 7

This facility uses:
❑ Phosphorus -containing detergents
Cri Non -Phosphorus -containing detergents
❑ Brighteners
XJ Other Cleaning Agents
❑ Other:
This facility has a closed -loop recycle system that meets design requirements in 15A NCAC 02T. 1000 and hold the f
working volume
❑ Yes — stop completion of this N01. Contact DWR Non -Discharge Permitting Program for permitting requirements
3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Street address:
City:
State:
Zip code:
Telephone number:
Email address:
4. Outfall(s) (at least one outfall is required to be eligible for coverage):
3-4 digit identifier:
time of receiving water: Classification:
ElThis water is impaired.
pcj CrccK w
❑ This watershed has a TMDL.
Discharge from this outfall is from:
❑ Stormwater Only ❑ Wastewater Only Kwastewater Comingled with Stormwater
7Q10 Flow of receiving waterbody (if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW, ORW, Tr, WS-I, WS-II, WS-III, SA, or PNA):
Discharge occurs from this outfall:
IK Only during a rainfall event
❑ Intermittently (indicate how often)
❑ Continuously (indicate flow in CFS)
Latitude of outfall:
Longitude of outfall:
6' 31 'er , 5
ys. c,o w,
Brief description of the industrial activities that drain to this outfall:
w,st• t,.f' Art.
Do Vehicle Maintenance Activities occur in the drainage are of this outfall? ❑ Yes V( No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3.4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
OWL
aCie Crtc
FW
❑ This watershed has a TMDL.
Discharge from this outfall is fr m:
❑ Stormwater Only ❑ Wastewater Only astewater Comingled with Stormwater
7Q10 Flow of receiving waterbody (if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HQW, ORW, Tr, WS-I, WS-II, WS-III, SA, or PNA):
Discharge occurs from this outfall:
6.Only during a rainfall event
❑ Intermittently (indicate how often)
❑ Continuously (indicate flow in CFS)
Latitude of outfall:
Longitude of outfall:
' 3 35. 7 7w
Br' f description of the industrial activities that drain to this outfall:
Ki 'rra,k W—�< dvocts, n— A
Do Vehicle Maintenance Activities occur in the drainage are of this outfall? ❑ Yes JKNo
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 2 of 7

3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Discharge from this outfall is from:
❑ Stormwater Only ❑ Wastewater Only ❑ Wastewater Comingled with Stormwater
7Q10 Flow of receiving waterbody (if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW, ORW, Tr, WS-I, WS-II, WS-III, SA, or PNA):
Discharge occurs from this outfall:
❑ Only during a rainfall event
❑ Intermittently (indicate how often)
❑ Continuously (indicate flow in CFS)
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage are of this outfall? ❑ Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Discharge from this outfall is from:
❑ Stormwater Only ❑ Wastewater Only ❑ Wastewater Comingled with Stormwater
7Q10 Flow of receiving waterbody (if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW, ORW, Tr, WS-I, WS-II, WS-III, SA, or PNA):
Discharge occurs from this outfall:
❑ Only during a rainfall event
❑ Intermittently (indicate how often)
❑ Continuously (indicate flow in CFS)
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage are of this outfall? ❑ Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
All outfalls must be listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalls" found on the last page of this NOL
S. Wastewater
Types of Wastewater facility will generate or discharge
Vehicle & equipment cleaning (VE)
Generate le?Discharge ❑ Sent to WW Treatment System
Wetting of raw material stockpiles (RM)
O Generate [?'Discharge ❑ Sent to WW Treatment System
Mixing drum cleaning (MD)
If Generate PT Discharge ❑ Sent to WW Treatment System
Facility will spray -down or actively wet aggregate piles
Z'Yes
❑ No
Page 3 of 7

6. Wastewater treatment alternatives
What wastewaters were considered for this alternatives review: 0'VE GRM IrMD
Are there existing sewer lines with a one mile radius: 0Yes ❑ No
If Yes:
❑ The wastewater treatment plant will accept the wastewater. It is feasible to connect. Explain:
❑ The wastewater treatment plant will accept the wastewater. It is not feasible to connect. Explain:
k7he wastewater treatment plant will not accept the wastewater (attach a letter documenting)
In&Surface or subsurface disposal is technologically feasible
❑ Surface or subsurface disposal is not technologically feasible
Explain: r-,J-- i.) ,` „r )'*
QI-Surface or subsurface disposal system is feasible to implement
❑ Surface or subsurface disposal system is not feasible to implement
Explain:
What is the feasibility of employing a subsurface or surface discharge as compared to a direct discharge to
surface waters? Explain: 0 c t" S row -a 15 W, Pje 9 C „A+ -,4 n»:, fi"i y klc-j• COVIX
Discharge to surface waters is the most environmentally sound alternative of all reasonably cost-effective
options of the wastewaters being considered:
E,Yes
❑ No — contact DEMLR's Land Application Unit to determine permitting requirements
If this review included all wastewater discharge types, would excluding some types make of the above non -
discharge options feasible?
❑ Yes
No
7. Other Facility Conditions (check all that apply and explain accordingly):
❑ This facility has a DMLR Erosion & Sedimentation Control Permit.
If checked, list the permit numbers for all current E&SC permits for this facility:
❑ This facility has a Division of Waste Management permit.
If checked, list the permit numbers for all current DWM permits for this facility:
IVThis facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
Nc6 1`1vo z
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
511rhis facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
6./ l V t ova / S tit 4
21his facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
x 4- (-� � ? na o f_-, upj,.kj 4.0 ao aJ �r...a-
Page 4 of 7

❑ This facility is subject to Phase II Post -Construction Area
If checked, please list the permitting authority:
❑ This facility is located in one of the 20 Coastal Counties
If checked, please indicate if the facility is adding more than 10,000 ft2 of built -upon area or is a CAMA Major Permit
❑ Will add more than 10,0000 ft of built -upon area
❑ Is a CMA Major Permit
❑ Yes to both
❑ No to both
❑ This facility is discharging wastewater to a stormwater BMP
If checked, please indicate the permitting authority, and attach letter approval to do so:
❑ This facility has wastewater treatment facilities in the 100-year floodplain
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If checked, indicate:
Kilograms of waste generated each month:
Type(s) of waste:
How material is stored:
Where material is stored:
Number of waste shipments per year:
Name of transport/disposal vendor:
Transport/disposal vendor EPA ID:
Vendor address:
❑ This facility is located on a Brownfield or Superfund site
If checked, briefly describe the site conditions
8. Required Items (Application will be returned unless all of the following items have been included):
❑ Check for $100 made payable to NCDEQ
❑ Copy of most recent Annual Report to the NC Secretary of State
❑ This completed application and any supporting documentation
❑ A line drawing of the water flow through the facility.
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked
❑ Letter documenting that WWTP will not accept wastewater (if applicable)
❑ Approval from permitting authority to discharge wastewater to a stormwater BMP (if applicable)
Page 5 of 7

❑ Two (2) 24" x 36" site diagrams showing, at a minimum, existing and proposed:
a) outline of drainage areas
b) Stormwater/wastewater treatment structures
c) Location of numbered stormwater/wastewater outfalls (corresponding to which drainage areas)
d) Delineation of drainage areas to each discharge point
e) Runoff conveyance structures
f) Areas and acreage where materials are stored
g) Impervious area acreages
h) Locations(s) of streams and/or wetlands the site is draining to, and applicable buffers
i) Site property lines, North Arrow, and bar scale
j) If applicable, the 100-year floodplain line
k) Acreage of each stormwater and wastewater topographical area
1) Each of the facilities' wastewater or stormwater source and discharge structures and each of its hazardous waste
treatment, storage, or disposal facilities
m) Notation of the water quality classification of the receiving water that site waters eventually discharge to
n) Site location (insert)
9. Applicant Certification:
North Carolina General Statute 143-215.66 (i) 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:
Cal am the person responsible for the permitted industrial activity, for satisfying the requirements of this permit, and for any
.i civil or criminal penalties incurred due to violations of this permit.
❑ The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information.
0-1 will abide by all conditions of the NCG140000 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.
EMereby request coverage under the NCG140000 General Permit.
Printed Name of Applicant: , oLytls, µlwr-tio
Title: CNU.ronhc„,{--( VA
&L4:f� «/ f O
(S nature of Applicant) (Date Signed)
Mail the entire package to:
DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 6 of 7

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Map Name: CANA Scale: 1 inch = 2,000 ft.
Print Date: 12/10/20 Map Center: 036' 31' 27.59" N, 080' 37' 42.91" W
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30.00" W 080° 37'
00.00" W 080° 36'
SCALE 1:24000
0 1000 2000 3000 4000 5000 6000
FEET
SITE LOCATION MAP
CENTRAL CAROLINA CONCRETE -MT AIRY PLANT
MOUNTAIRY, NC
FIGURE 1 JOB NO. 1129-001

CITY OF MOUNT AIRY WWTP
P.O BOX 70
MOUNTAIRY, NC27030
PHONE: [phone]
FAX.- 336-786-3573
November 9, 2022
Mr. Johnie Alexander
Environmental Manager
Concrete Supply Co.
Central Carolina Concrete, LLC.
139 Tumbling Rock Road
Mount Airy, NC 27030
Subject: Process Wastewater/Stormwater Discharge
Dear Mr. Alexander,
The City of Mount Airy has reviewed your Company's request to discharge comingled
process wastewater/storm water in the sanitary sewer system. At this time, the City
prohibits the discharge of stormwater into our system. Ready Mix Concrete wastewater
usually contains high metal concentrations, high total and dissolved solids, and a high pH
value requiring on site pretreatment to meet local limits.
Should you have any questions or need any additional information, please contact me at
[phone].
Sincerely,
JP� 1 41'r1
Christopher S. Marion
WWTP Supervisor/ORC
City of Mount Airy

LIMITED LIABILITY COMPANY ANNUAL REPORT
IIN2a22
NAME OF LIMITED LIABILITY COMPANY: Concrete Supply CO., LLC
SECRETARY OF STATE ID NUMBER: 1301341 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2022
SECTION A: REGISTERED. AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Ramsey, H Vaughn
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E- Filed Annual Report
1301341
CA202208104116
3/22/2022 01:45
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
400 Bellemeade Street Ste 800
400 Bellemeade Street Ste 800
Greensboro, NC 27401 Guilford County Greensboro, NC 27401
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Carolina Ready Mix 8r Builders Supply LLC
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
3823 Raleigh St. PO Box 5247
Charlotte, NC 28206-2042 Charlotte, NC 28299-5247
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Henry Batten NAME: Shannon Barwick
TITLE: President
ADDRESS:
NAME:
TITLE: Chief Financial Officer TITLE:
ADDRESS:
3823 Raleigh Street PO Box 5247
Charlotte, NC 28206
Charlotte, NC 28299
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Henry Batten 3/22/2022
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Henry Batten President
Print or Type Name of Company Official Pnnt or Type Thle of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NO 27626-0525