NCG140057_COMPLETE FILE - HISTORICAL_20121120

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. I IV CG I1-JpJ57
DOC TYPE 1 4 HISTORICAL FILE
MONITORING REPORTS
DOC DATE ❑ q 'U I �, 1110
YYYYMMDD

North Carolina
Beverly Eaves Perdue
Govemor
Jetty Black
Black Concrete Inc
705 Cotton Grove Rd
Lexington NC 27292-7292
Dear Permittee
A.
NCDENR
Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P E
Director
November 20 2012
Dee Freeman
Secretary
Subject NPDES Stormwater Permit Coverage Renewal
Black Concrete, In
COC Number NCG I40057
Davidson County
In response to your renewal application for continued coverage under Stormwater General Permit
NCG140057 received April 24, 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 Form (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 D`['Q
This permit does not affect the legal requirements to obtain other permits which may be required by
DENR, nor does it relieve the permtttee from responsibility for compliance with any other applicable
federal, state, or local law, rule, standard, ordinance, order, judgment, or decree
1617 Mai€ Service Center Raleigh North Carolina 27699 1617
Location 512 N Salisbury St Rateigh North Carolina 27604
Phone 91 M07-63001 FAX [phone] Customer Service 1 877-623-6748
Internet www ncwaterguality g[g One
An Equal Opportunely 1 Affirmative AOon Employed No rth C aro l 1 n a
Natumllr�

If you have any questions regarding this permit package please contact the DWQ Stormwater Permitting
Unit at 919-807-6300
Sincerely,
ORIGINAL SIGNED 83
KEN PICKLE
for Charles Wakild, P E
cc DWQ Central Files
Stormwater Permitting Unit Files
Winston-Salem Regional Office, Surface Water Protection Section Supervisor

J�
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE No NCG140057
STORMWATER AND PROCESS WASTEWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215 1, other la"Aful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Black Concrete, Inc
is hereby authorized to operate a process wastewater treatment system, and is hereby
authorized to discharge process wastewater and stormwater from a facility located at
Black Concrete, Inc
705 Cotton Grove Rd
Lexington
Davidson County
to receiving waters designated as Rat Spring Blanch, in the Catawba River Basin in
accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts 1, II, III, IV, V and VI of the General Permit as attached
This certificate of coverage shall become effective November 20 2012
This Certificate of Coverage shall remain in effect for the duration of the General Permit
Signed this day Novembei 20, 2012
ORIGINAL SIGNED Sl
KEN PICKLE
far Charles Wakild, P E , Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit Coverage
Renewal Application Farm
E National Pollutant Discharge Elimination System Permit Number
A�J q° Stormwater Discharge Permit NCG140057
The following is the owner affiliation information currentlN in our database for vour facility Please review this information carefullN and make al
correcttons/additions as necessary in the space, provided to the right of the current information
Owner Affiliation Information *Reissued Permit will be mailed to the owner address
Owner / Organization Name Black Concrete Inc
Owner Contact
Jerry Black
Mailing Address
705 Cotton Grove Rd
I exington NC 27292-7292
Phone Number
[phone]
Fdx Number
F mdd address
Facility/Permit Contact Information
If there has been any change to your facility/ permit contact information please Indicate updates in the space provided bclo%{
facilm Name
Facility Physical Address
FaolaN Contact tl
Mailing Address �L
Phone Number
Fax Number
E mail address
Impaired Waters/TMDL
Does this facility discharge to waters listed as impaired or waters with a finalized FMDl ? 0 Yes 05o D Don t Know
(For information on these waters refer to hup /1h2o enr state nc us/su/Impaired Waters_T,l4DL/ )
CERTIFICATION
I certify that I amrllith the information contained in the application and that to the best of my kno,,Oedge and belief such information is true
complete and accu ate 11 '--,1 A /
Signature
IT i -S c t7T 4S C G e- L
Print or type name of person signing above
Please. return this completed renewal
APR 2Q 2012
TE Q ALITY
rids & srQ�ri> l alef Brancr,
bale L �3 2 ,,9!
Title
Stormwater Permitting Unit
Attn Robert Patterson
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

A�
NC®ENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Charles Waklld, P E
Governor nirecror
April 2, 2012
Jerry Black
Black Concrete Inc
705 Cotton Grove Rd
Lexington, NC 27292-7292
Natural Resources
Subject NPDES Stormwater Permit Coverage Renewal
Black Concrete Incorporated
Peinut Nuili NC"]. +OuS i
Davidson County
Dear Permittee
Dee Freeman
SpCrptary
Your facility was covered for stormwater discharge under NPDES Permit NCG 140057, however, this
permit expired on 7/31/2004 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 Renewal Application Form, Supplemental Information request, and a Stormwater Pollution
Prevention Plan Certification for your facility Filing the application form along with the requested
supplemental information will constitute your application for renewal of this permit
The application and supplemental information must be completed and returned to DWQ by May
15,_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 Robert Patterson of the
Stormwater Permitting Unit at Robert Patterson@ncdenr gov or [phone]
Sincerely,
Bradley Bennett, Supervisor
Stormwater Permitting Unit
Cc Central Files
SPU Files
1617 Mad Service Center Raleigh North Carolina 27699 1617
Location 512 N Salisbury St Raleigh North Carolina 27604 One
Phone [phone] FAX [phone] Customer Service 1 877-623 6748 NorthCarohna
Internet www ncwaterquahty org
Naturally
An Equal Opportunity 1 Affi mauve Aciion Employer

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B Hunt, Jr , Governor
Wayne McDevitt, Secretary
Kerr T Stevens, Director
JERRY B BLACK
BLACK CONCRETE INC
705 COTTON GROVE RD
LEXINGTON NC 27292
Dear Permittee
1 r •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT ANp NATURAL RESOURCES
July 26 1999
Subject Reissue - NPDES Stormwater Permit
Black Concrete Inc
COC Number NCG140057
Davidson County
1n response to your renewal application for continued coverage under general permit NCG140000 the Division of
Water Quality (DWQ) is forwarding herewith the reissued 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 December 6 1983
The following information is included with your permit package
* A copy of general stormwater permit NCG140000
* A Stormwater Pollution Prevention Plan (SPPP) Certification Form Completion of this form is required to
certify that you have developed and implemented the SPPP as per the conditions of the permit This form
must be completed and returned to the Division within 30 days of receipt of this letter
DO NOT SEND the SPPP with the signed form
* Five copies of the Analvucal Monitoring form and five copies of the Qualitative Monitoring form
* A copy of a Technical Bulletin for the general permit which outlines changes in the permit key requirements
and addresses frequently asked questions
* A Certificate of Coverage
Your coverage under this general permit is not transferable except after notice to DWQ The Division 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 DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state or local law rule standard ordinance order judgment or
decree
If you have anv questions regarding this permit package please contact Tony Evans of the Central Otfice Stormwater
and General Permits Unit at (919) 733-50S3 ext 584
Sincerely
for Kerr T Stevens
cc Central Files
Stormwater and Gener,11 _rmits Unit Files
Winston Salem Region it Office
1617 Mad Service Center Raleigh North Carolina 27699 1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE No NCG140057
STORMWATER AND PROCESS 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
BLACK CONCRETE INC
is hereby authorized to operate a process wastewater treatment system and is hereby authorized to discharge process
wastewater and stormwater from a facility located at
BLACK CONCRETE INC
705 COTTON GROVE RD
LEXINGTON
DAVIDSON COUNTY
to receiving waters designated as Rat Spring Branch in the Yadkin - Pee Dee River Basin
in accordance with the effluent limitations monitoring requirements and other conditions set forth in Parts I, 1I, 1II
IV V and VI of General Permit No NCG140000 as attached
This certificate of coverage shall become effective August 1 1999
This Certificate of Coverage shall remain in effect for the duration of the General Permit
Signed this day July 26 1999
for Kerr T Stevens Director
Division of Water Quality
By Authority of the Environmental Management Commission

Michael F Easley Governor
William G Ross Jr Secretary
North Carolina Department of Environment and Natural Resources
Alan W Klimek P E Director
Division of Water Quality
3/ 18/2004
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
"A-11 :AaM1.31A[e".
BLACK CONCRETE INCORPORATED
705 COTTON GROVE RD
LEXING fON, NC 27292
Subject FINAL NOTICE - NPDES Stormwater Permit Renewal
Black Concrete Incorporated
COC Number NCG140057
Davidson County
Dear Permittee
Your facility is currently covered for Stormwater discharge under General Permit NCG140000 This permit will
expire on July 31 2004 North Carolina General Statute 143 215 1(c) requires that an application for permit
coverage renewal be filed in a timely manner A prior notice of renewal was sent for this site on December I,
2003 To date no response has been received by the Division of Water Quality (DWQ) In order to assure your
continued coverage under the general permit, you must ipply to DWQ for renewal of your pei mit coverage
Enclosed you will find a general permit renewal application form The application must be completed and returned
by April 19 2004 in order to assure continued coverage under the general permit
F ulure to request renewal by April 9 2004 can result in a civil assessinent of at least $250 00 Larger penalties
in iy be assessed depending on the delinquency of the request Discharge of stormwater from your tacallty without
coverage under a valid stormwater NPDES permit would constitute a violation of NCGS 143-215 1 and could
result in assessments of civil penalties of up to $10000 per day
If you have any questions regarding the permit renewal procedures please contact Bill Mills of the Central Office
Stormwater Unit at [phone], ext 548
Sincerely,
Bradley Bennett Supervisor
Stormwater and General Permits Unit
cc Central Files
SWGPU Files
Winston-Salem Regional Of ficc
N C Division of Water Quality 1617 Marl Service Center Raleigh NC 27699 1617 [phone]
e
NCDENR
Customer Service
1 800 623 7748

Stake of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B Hunt, Jr, Governor
Jonathan B Howes, Secretary
A Preston Howard, Jr, P E , Director
March 24, 1995
Jerry B Black
Black Concrete Inc
705 Cotton Grove Rd
Lexington, NC 27292
Y1.9MA,
E DEHNF�
Subject General Permit No NCG140000
Black Concrete Inc
COC NCG140057
Davidson County
Dear Jerry B Black
In accordance with your application for a stormwater discharge permit received on November 23, 1994, we
are forwarding herewith the subject certificate of coverage to discharge under the subject state - NPDES general
permit This perrrut 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
The stormwater permit you are receiving, NCG 140000, does not permit wasting concrete, dumping excess
concrete, directly into storm sewer outfalls or into waters of the state Any facility which either dumps excess
concrete or washes excess concrete into storm sewers or waters of the state will be operating in direct violation to
both the terms of this permit and the North Carolina General Statutes Such a discharge shall be considered an
illegal discharge and may subject the owner to enforcement actions in accordance with North Carolina General
Statutes 143-215 6A
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
Environmental Management The Division of Environmental Management 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 Environmental Management 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 question concerning this permit, please contact MR ANTONIO EVANS at telephone
number 919/733-5083, extension 584
Sincerely,
ortgmal Signed BY
Coleen H Sullins
A Preston Howard, Jr P E
cc Winston-Salem Regional Office
Mr Roosevelt Childress, EPA
P O Box 29535, Raleigh, North Carolina 27626 0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE No NCG140057
STORMWATER 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,
Black Concrete, Inc
is hereby authorized to discharge stormwater from a facility located at
Black Concrete, Inc
705 Cotton Grove Road
Lexington, NC
Davidson County
to receiving waters designated as Rat Spring Branch in 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 of General Perrmt No NCG140000 as attached
This certificate of coverage shall become effective March 24 1995
Thus Certificate of Coverage shall remain in effect for the duration of the General Permit
Signed this day March 24, 1995
Or-g,nal Signed By
4Yi� �
A Preston Howard, Jr , P E ,v Directo�r
Division of Environmental Management
By Authority of the Environmental Management Commission

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LATITUDE
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STREAM CLASS C
DISCHARGE CLASS 'Stc)tM woj-e�
EXPIRATION DATE ` 113' ! 1 �