NCG140543_Application_20240905

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Chalam Pakala Engineering and Environmental Solutions
10017 Allyson Park Dr.,Charlotte,NC 28277 Tel[phone],Fax:[phone]
August 29,2024
Mrs.Brittany Carson,Permit Coordinator
NC DEMLR—Stormwater Permitting Unit
1612 Mail Service Center F
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Raleigh,
North office
27699-1612919 707 s
bethany.georgouliasAncdenrgov
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Re: NPDES Stormwater General Permit(NCG140000)Approval Request �rQgy�
Mathis Concrete,LLC
6591 Old 60.
Roaring River,Wilkes County,NC 28669
CPEES Proiect No. 1232-001
Dear Mrs. Carson:
On behalf of Mathis Concrete located at 6951 Old 60. Roaring River,Wilkes County,North Carolina,
CP Engineering and Environmental Solutions(CPEES)is pleased to submit the attached Stormwater
NPDES General Permit(NCO140000)request for the subject facility operations. The facility intends to
complete a concrete dry truck mix plant at the subject location described above. The operations are
conducted under SIC/NAICS Code 3273/327320,"Ready Mixed Concrete Manufacturing". We intend
to discharge stormwater from the yard, mixing drum washing and wetting raw stockpiles to the
outfall located at the site. The outfall location with lat/long is provided on the Site Aerial Map.
The Stormwater NPDES General Permit Application package includes:
• A check for S 120 Payable to NC DEQ:
• A signed NC DELMR supplied NCG 140000 NOI application;
• Copy of most recent Annual Report to the NC Secretary of State
• USGS TOPO Map;
• Site Aerial Map;
• County GIS Map;and
• TMDL and 303(d)Maps.
Please call me at 704-756-7451 or Mr.Jordan Mathis at 336-984-3380(0)/336-469-2588(Cell)should
you have any questions on this permit application request.
Respectfully submitted,
CP Engineering and Environmental Solutions CAR0!1'/,
(A Cost Effective Solution Provider for Manufacturing) . 1 •••••.
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Chalam V.Pakala,P.E. ygNp!NE
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08/29/2024
Attachment:NPDES NCG140000 Application Package

FOR AGENCY USE ONLY
NCG14 Q 5 W 3
Assigned to: ' 0v
ARO FRO MRO RRO WARO WIRO WSRO
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, NC 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 oreanizational en ity: Legally responsible person as signed in Item(9)below:
L� JORDAN MATHIS
Street address: City: State: Zip Code:
615 MATHIS FARM RD ROARING RIVER NC 28669
Telephone number: Email address:
336-984-3380 '[e-mail]
Type of Ownership:
Government
❑County ❑ Federal ❑ Municipal ❑State
Non-government
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: Facility environmental contact:
MATHIS CONCRETE, LLC JORDAN MATHIS
Street address: City: State: Zip Code:
6591 OLD 60 ROARING RIVER NC 28669
Parcel Identification Number(PIN): County:
4809-13-7473 W ILKES
Telephone number: Email address:
336-984-3380 [e-mail]
4-digit SIC code: Facility is: Date operation is to begin or began:
3273 0 New ❑ Proposed ❑ Existing 2024
Latitude of entrance: Longitude of entrance:
36*11'15.85"N 81° 01'43.1"W
Brief description of the types of industrial activities and products manufactured at this facility:
CONCRETE DRY TRUCK MIX PLANT
If the stormwater discharges to a municipal separate storm sewer system(MS4),name the operator of the MS4:
0 N/A
Page 1 of 7

This facility uses:
❑ Phosphorus-containing detergents
0 Non-Phosphorus-containing detergents
❑ Brighteners
❑ Other Cleaning Agents
❑ Other:
This facility has a closed-loop recycle system that meets design requirements in 15A NCAC 02T. 1000 and hold the facilities
working volume
❑ Yes—stop completion of this N01.Contact DWR Non-Discharge Permitting Program for permitting requirements
12 No
3. Consultant(if applicable):
Name of consultant: Consulting firm:
CHALAM PAKALA CP ENGINEERING AND ENVIRONMENTAL SOLUTION
Street address: City: State: Zip code:
10017 ALLYSON PARK DR. CHARLOTTE INC 28277
Telephone number: Email address:
704-756-7451 [e-mail]
4. Outfall(s) (at least one outfall is required to be eligible for coverage):
3-4 digit identifier: I Name of receiving water: Classification: ❑This water is impaired.
OUTFALL-01 ADKIN RIVER WS-V ❑This watershed has a TMDL.
Discharge from this outfall is from:
❑ Stormwater Only ❑ Wastewater Only [3 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-11,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑ Only during a rainfall event 12 Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
ONCE A WEEK
Latitude of outfall: Longitude of outfall:
36*11'14.44"N 81° 01'44.81"W
Brief description of the industrial activities that drain to this outfall:
STORMWATR FROM THE YARD,WASH PITS WATER AND WATER FROM STONE COOLING
Do Vehicle Maintenance Activities occur in the drainage are of this outfall? ❑ Yes E� 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
70,10 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?
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
7Q30 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 N01.
5. Wastewater
Types of Wastewater facility will generate or discharge
Vehicle&equipment cleaning(VE) 13 Generate 0 Discharge ❑ Sent to WW Treatment System
Wetting of raw material stockpiles (RM) D Generate 2 Discharge ❑ Sent to WW Treatment System
Mixing drum cleaning(MD) 0 Generate 0 Discharge ❑ Sent to WW Treatment System
Facility will spray-down or actively wet aggregate piles
0 Yes
❑ No
Page 3 of 7

6. Wastewater treatment alternatives
What wastewaters were considered for this alternatives review: O VE ❑ RM ❑ MD
Are there existing sewer lines with a one mile radius: [� Yes ❑ 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:
0 The wastewater treatment plant will not accept the wastewater(attach a letter documenting)
❑ Surface or subsurface disposal is technologically feasible
0 Surface or subsurface disposal is not technologically feasible
Explain:
❑ Surface or subsurface disposal system is feasible to implement
13 Surface or subsurface disposal system is not feasible to implement
Explain: QUANTITIES ARE TOO MUCH TO DISPOSE TO SURFACE /SUBSURFACE
What is the feasibility of employing a subsurface or surface discharge as compared to a direct discharge to
surface waters?Explain:
QUANTITIES ARE TOO MUCH TO DISPOSE TO SURFACE/SUBSURFACE
Discharge to surface waters is the most environmentally sound alternative of all reasonably cost-effective
options of the wastewaters being considered:
D 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?
D 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:
❑This facility has other NPDES permits.
If checked,list the permit numbers for all current NPDES permits:
❑This facility has Non-Discharge permits(e.g. recycle permit).
If checked,list the permit numbers for all current Non-Discharge permits:
0 This facility uses best management practices or structural stormwater control measures.
If checked,briefly describe the practices/measures and show on site diagram:
SECONDARY CONTAINMENT DIKES AND STEEL CONTAINERS TO STORE ADMIX TANKS
❑This facility has a Stormwater Pollution Prevention Plan(SWPPP).
If checked,please list the date the SWPPP was implemented:
IN THE PROCEESS OF COMPLETION
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):
12 Check for$ ade payable to NCDEQ
0 Copy of most recent Annual Report to the NC Secretary of State
0 This completed application and any supporting documentation
0 A line drawing of the water flow through the facility.
0 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

12 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 143-215.6E(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:
13 1 am the person responsible for the permitted industrial activity,for satisfying the requirements of this permit,and for any
civil or criminal penalties incurred due to violations of this permit.
Ea The information submitted in this NCI 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.
12 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.
12 1 hereby request coverage under the NCG140000 General Permit.
JORDAN MATHIS
Printed Name of Applicant:
OWNER
Title:
08/30/2024
(Signat re 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

Additional Outfalls
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 overthe 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
7030 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?
Page 7 of 7

FIGURES
Figure—1 Site USGS TOPO Map
Figure—2 Site Aerial Map
Figure—3 County GIS Map

Map Name: ROARING RIVER Scale: 1 inch = 2,000 ft.
Print Date: 08/29/24 Map Center: 036° 11' 16,34" N, 081° 01'42.33"W
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MN 7.70°W
SCALE 1:24000 SITE LOCATION MAP
0 1000 2000 3000 4000 5000 6000 MATHIS CONCRETE
ROARING RIVER, NORTH CAROLINA
�� FIGURE 1 JOB NO. 1232-001

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Wilkes County-JORDAN MATHIS CONCRETE
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PARCELID: 0101162 ACREAGE: 120.59 1:14,985
PI N: 4809-13-7473 BOOK/PAGE: 1215/20
Owner Name: DOUBLE B INVESTMENTS LLC TOTAL VALUE:
873 COVE CREEK DR 0 750 1,500 3,000 Feet
LAND VALUE:
NORTH WILKESBORO, NC 28659 BUILDING VALUE:

COPY OF MOST RECENT ANNUAL REPORT TO THE NC SECRETARY
OF STATE

LIMITED LIABILITY COMPANY ANNUAL REPORT
a
NAME OF LIMITED LIABILITY COMPANY: Mathis Concrete, LLC
Foing Office use Ony
SECRETARY OF STATE ID NUMBER: 1818797 STATE OF FORMATION: NC E-Filed Annual Report
1818797
CA202403102794
REPORT FOR THE CALENDAR YEAR: 2024 1/31/2024 04:32
SECTION A: REGISTERED AGENT'S INFORMATION Changes
1.NAME OF REGISTERED AGENT: Mathis, Luke Steven
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS 8 COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
605 Winston Road 605 Winston Road
Jonesville, NC 28642 Yadkin County Jonesville,NC 28642
SECTION B: PRINCIPAL OFFICE INFORMATION
1.DESCRIPTION OF NATURE OF BUSINESS: Concrete
2.PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4.PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
605 Winston Road 605 Winston Road
Jonesville,NC 28642 Jonesville,NC 28642
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: Luke S. Mathis NAME: Luke S. Mathis NAME: Jordan Mathis
TITLE: Member TITLE: Manager TITLE: Member
ADDRESS: ADDRESS: ADDRESS:
615 Mathis Farm Road 615 Mathis Farm Road 615 Mathis Farm Road
Roaring River,NC 28669 Roaring River, NC 28669 Roaring River,NC 28669
SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Luke S.Mathis 1/31/2024
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Luke S.Mathis Member
Print or Type Name of Company Official Print or Type Title of Company Official
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF$200.00
MAIL TO:Secmtary of State, Business Registration Division,Post Office Box 29525,Raleigh,NO 27625-0525

SECTION E: ADDITIONAL COMPANY OFFICIALS
NAME: Jordan Mathis NAME: Clint Mathis NAME: Clint Mathis _
TITLE: Manager TITLE: Member TITLE: Manager
ADDRESS: ADDRESS: ADDRESS:
615 Mathis Farm Road 615 Mathis Farm Road 615 Mathis Farm Road
Roaring River, NC 28669 Roaring River, NC 28669 Roaring River, NC 28669
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: Name:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:

TMDL AND 303 D MAP

C�EQ (ater Classifications
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Surface Water Classifications:
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Stream lndon 12445)
Stream Namc. YADKIN RIVER
Description: From a point 1.0 mile upsteam
Surlaca Watar CbnMkalloro `: - , \ of Roaring River to a point 0.2
mile upstream of the mouth of
Big Bugaboo Creek
Classdication; WS V
Date of Class.: July 31,1998
What dons this Class.mean? View
River Basin: Yadkin PerDee
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