NCG140423_MONITORING INFO_20181114

PERMIT NO.
DOC TYPE
DOC DATE
STORMWATER DIVISION CODING SHEET
NCG PERMITS
HISTORICAL FILE
MONITORING REPORTS
YYYYMMDD

STORMWATER DISCHARGE OUTFA L (00) - Semi -Annual MONOTORING NORM
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO
FACILITY NAME Y5 V
PERSON COLLECTING SAM LES ! - Y,
CERTIFIED LABORATORY Lab #t
Lab #
OPTIONAL (INFO
Part A Stormwater Monitoring Requirements
OPLE COLLECTION YEAR O
e.LING PERIOD July -December January -.tune
10.y I��
IJIV i [r. i!
)INE N! i IL I q !�
:YTo LISTSERVE? ❑VES ONO EMAIL
CHARGING TO CLASS [:]SA ❑HQW ❑PINA []Trout her
Outfall No
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pµ
(Standard
Units}
TSS
tm
Event
(minutes) DurationRainfall°
inj
Tots!
jinj
In Tier 2
Monthly
Monitoring?
(y/n)
0 of Months In Tier
2 Sampling;
AA) kliQ
i If "NO FLOW" or "NCI DISCHARGE, Enter "NO I i�W a " � e Please make sure to mark the sample period above
' If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must Implement the Tier 1 ar Tier respo
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/1
4For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
Permit pate 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

f•
Part 8 Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year
Outfall
No
Date Sample
Collected
(mo/ddlyr)'
PH
(Standard
llnitsl
TPH using method
1664A 5GT-FISH
1mg/L)
Total Suspended
Solids
(rng/L)
Event
Duration
(minutes)
Total
Ratnfalli
(In)
New Motor Oil
Usage
(gal/month]
In Tier 2
Monthly
Monitoring?
ly/nl
# of Months
in Tier 2�
Sampling
�-s
ss
1W.3
-
.
HAS YOUR FACIUTY HAD 4 OR MORE BENCHMARK EXCEEDS ES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ N&Q
HAVE YOU CONTACTED THE REGION? YES ❑ N
REGIONAL OFFICE CONTACT NAME
Mail OriPlnal and one copy of this DMR including, all "No Flow" & "No D€scharize"reports)_ within 30 days of receipt of sample for at end of monitorms aeriod
In case of "No Flow") to
Division of Water Quality
Attu DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOC! MUST SlGIV THIS CERTfFl+CATlQUORAMIYIIIlAQBMAjL_ REPORTED
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure.t ersonnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gat er ni g tWfitted is to the best of my of fines knowledge and belief, true, accurate, and complete
am a%�t at theTa� significant penalties for submitting false information, including the psibility osan nip kt�r nrfng-vlolati "
of
At / T
(Date)
Permit Date 7/1/2011-60/30/2015 Last Revised 7113/11
Page 2 of 2

TOTAL PRECIPITATION �.Facihty
DAILY LOG -YEAR 20
Name )AA ran ul
location
- -
Directions- ._ily rainfall amounts in inches
�MMM
ME
a
.
MMM
M
fA
IMM
MMM
GPM
�-
ar�r��Ma
MI
MMM:
gar
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,...
MUMMM
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r�
•
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tee®
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i�
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r
Z
M
"MMM
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i
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MM
MME-PU_M_Ii
,�L
FQrm*5

r (~
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CER71FICATE OF CO ERAGE NO NCG14C'. q - -�) SAMPLE COLLECTION YEAR D VI L7
FACILITY NAME kut�> r) tC ci �-lkV- � Q­ SAMPLING PERIOD ❑ July -December January -June
PERSON COLLECTING SAM,P LES C- f COUNTY a `�
CERTIFIED LABORATORY , d(, Lab # PHONE NO {G C t
Lab # ADD TO LISTSERVE? []YES O EMAIL
OPTIONAL INFO DISCHARGING TO CLASS QSA ❑HQW []PNA ❑Trout Other
Part A Stormwater Monitoring Requirements
Date Sample I Iin Tier Z
Collected pH TSS Event Total Monthly # of Months in Tier
Outfall No (mo/dd/yr OR (Standard (mR/L) Duration, Rainfall Monitoring? 2 Sampling'
NO FLOW)' Units) Iminutes) (in) (y/n)
6-9 l00 - - _
- 4 ,L r�-
1�cM..'tIIVt1l)
AM' 1 h ) n
ig
?-(AL_i" ILL -
I A
V„V 1 11J1
If "NO FLOW' or "NO DISCHARGE Enter "NO FLOW" or "NO DISCHARGE" for each uutfall here Please make suxe to mark thew
tf a value is ir-excess`o"tFe benchmark, or e the b ou s enchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecuVve samples are below the benchmark or within the benchmark range
a TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I
°For+each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
Permit Date 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year
outfall
No
Date Sample
Collected
(mo/dd/yr)1
PHTFH
(Standard
Units)
using method
2664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mgJL)
Event
Duration
(mitsutes)
Total
Rainfall'
(in)
New Motor Oi! In Tier Z # of Months
Usage Monthly in Tier 2
Monitoring?
(gaiJmonth) (y/n) Sampline
6-9
is
100
(I -(A 1
C
(41
Zc:
C:)
�U —
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCE E CES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO [�
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME
Mall 0ri ig naI and one cory of this D M R (including ail'No Flow" & 'No _Discharrte" reports within 30 days of receipt of sample (or at end of monitoring Period
in case of "No Flow") to
Division of Water Quality
Attn DWQCentral Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU M4/S'T-S1GN THLS CER HCA77ON FOR ANY INf M 77ON _gRTED,
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the Information submitted Based on my Inquiry of the person or persons who manage the system, or
those, ersons directly resnonsibie for gathering the Information. thelnformatlon.submitted_Ls-ta_thebest-c f v-knowledae-and 4iP9P"ri hsrp ..sa*�
am ware that there are sig =iqntpenaltles for submitting false information, including the possibil f finesapd imprisonment for knowing violations� jOul(
(Signature of Permlti ee) (Date)
Permit Date 7/1/2011-60/30/2415 Last Revised 7/13/11
Page 2 of 2

DAILY LOG -YEAR 20 1?
Enter • - daily rainfall
a�rNA
IMMM
MMMMM=
a
.
=
%
MMom
MMMMMM
=�1®�����i
IL
Form Its

ESEARCh & ANAly-drAt Report of Analysis
oRATORiE5, INC. 4/10/2018
For: Forsyth Idi-MIX
`c100 And n Street :t
Rural Ha i, NC 27045 NC #34
NC 837701
Attn• Anne Sp' er .so G
Client Sample ID- Stormwrater Lob Sample ID 48705-01
site Forsyth Redi Mix Inc Collection Dabs 4/412018 1030
Eft--mlT—iff
mgmg &Quoit QN19 Rep WIDLt Awft AnPWQ Oattfto
Hydrocarbon 08G EPA 1884 Revision WSillca Gel <5 mg/L 5 AW 4/412018
PH SM 45M H+&2000 692 Std Units AP 4WO18
Sattleable Matter SM 2540 F-1997 <0 1 MIA 01 AA 41412018 1400
Total Suspended S UdS (TSS) SM 25Q D-1997 276 m91L 5 AA 46=18
NA = not analyzed
P 0 Box 473 108 Short i Street Kemesatil@e Nwth Camlira 27284 Tat 33S-SW 841 Fax [phone] www randasabs com Pagel
Ca8 ral__basie Vid

RESEARCh & ANAIYTiCA1
LAbORATORiES' INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
FBI-
REQUESTED ANALYSIS
OSUMI
CONTACT PHONE
Nil
SEEN
WINE
11
1
ON
MEN
01
INN
11100
so
Emmons
ME
=MENEM==
moon
E
No
on
on
E'Noloom
mom
0
0
Emmons
0
No
no
MINE
MIENSIN
on
No
ONES
Is
SEEN
on
0
MEMO
Emmons
MEEME
Emmons
=MOON
MEN
own
11000100001
ME
IN
MEMO
moon
REMAR KS
SAMPLE TEMPERATUREAT RECEIPT. --'C
RELNGUISHED BY

Completed ByI�C
VISUAL MONITORING
QUALITATIVE ASSESSMENT Title � �
Date S-- t —� 0
Directions Identify the containment area being inspected and note any obervations Any 'yes' answers require explanation Attach additional
sheets as necessary Each containment area should be inspected on a quarterly basis, with at least one per year inspection during a discharge
I Yes I No I Problems Noted I Actions Taken I
is any odor emitted from the water in /
containment? L/
re any floating solids present in the
water in containment?
Are any suspended solids present in the / C?
water in containment? 1/ �J �{ j�--� Ie- k6- �c
tN-
Is any foam visible on the water In /
containment? '
Is a visible sheen present on the water in , `
Is any treatment or absorbent needed on
the water to containment?
Are there any signs of leaks or corrosion
associated with the system?
iment area?
r� t�
Form'#8

W
Facility Name
NON-STORMWATER DISCHARGE
ASSESSMENT AND CERTIFICATION
Location
Date of Test
or
Outfall Directly Observed During the Test
Method Used to
Test or Evaluate
Describe Results from
Test for the presence of
Identify Potential
Name of Person who
Conducted the Test or
Evaluation
(as indicated on the site plan)
Discharge
Non-Stormwater
Significant Sources
Evaluation
--Discharge
Crod
r--4
n- nnu�,Sw
CERTIFICATION
1, _ _ (responsible corporate official), certify under penalty of law that this document and all attachments were prepared
under my d;rectnn or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true accurate and complete l am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations
Title (type or pr+nt)
�u (. �
B Area Code & Telephone No
-C c
D Date
Form #1

S71'OWWATER DISCHARGE CUMALL QSDO� - Semu-Annual MOMTORNG FORM
GENERAL PERMIT NO NCG.140030
CERTIFICATE OF COVERAGE NO NCG146 L-� 3
FACILITY NAME _a -,5V _ J-h J,2
PERSON COLLECTING SAM LES
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR
SAMPLING PERIOD July -December 5j Januiary-June
COUNTY 5Cs ' � P -)
13HONE NO 5 E1 ) Gf Lr'�/ 6 1(,-p
ADD TO LISTSERVEI� []YES []NO EMAIL
DISCHARGING TO CLASS ❑SA ❑IIQW ❑PNA ❑Trout Other
Outfall No
Date Sample
Collected
Emo/dd/yr OR
NO FI,OW)1
PR
Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall°
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Moirti�s ira� ier
2 Sampling
-
) r1)
to
100r
C
..+ . r t-* r"%
-
C I V 1— x
A
018
rllniq
`�r`r f1P1
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" of "NO DISCHARGE" for each outfali here Please make sure to mark the sample }period above
= If a value Is In excess of the benchmark, of outside the benchmark range (for pHJ, you must impfernert the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchinarlc range
TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters whei e they are 50 mg/I
A For each sampled measurable stoi in event the total precipitation racist he recoi ded using data from an on site rain gauge
Permit fate 7/1/2011-60/30/2025 Last Revised 7/13/11
Pape 1 of 2

Part 8 Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gat of new motor oil/month —averaged over a calendar Veal
Outfall
No
Date Sample
Collected
(ma/dd/yr)'
PH
tlnitsl
TPH using method
2664A SGT-14EM
(mg/!.)
Total Suspended
Solids
(rng/L)
Event
Duration
(minutes)
Total
a
Rainfall
(+n)
New Motol Oil
Usage
(gal/month)
In Tier 2
Monthly(Standard
Monitor ing7
0 of Months
in Tier 2
z
Samp!!ng
6-92
is
10Dz
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDS CS AT ANY ONC OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ N(�Q
HAVE YOU CONTACTED THE REGION? YES ❑ N
REGIONAL OFFICE CONTACT NAME
Mail Orwinal and one coov of this DMR dincludine all "No Flow" & "No Discharee" reports) within 30 days of receipt of sample for at end of monitorine nerlod
to case of "No Flow") to
Division of Water Quality
Attn DWCI Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU_N1U_ TSIGAI LN 5 CERTIFICATION FORAN_YINFORMA_TION RFPO_RTEU_
"I certify, under penalty of law, that this document and aft attachments were prepared under my direction or supervision m accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
a�awhat th rp significant penalties for submitting false mfoi matton, including the possiTtf fines aandimprisonment for knowing violations_!
gnature of P mttee) (Bate)
Permit hate 7/1/2011. 60/30/2015 Last Revised 7/13/11
Page 2 of 2

TOTAL PRECIPITATION
DAILY LOG -YEAR 20
Facility Name
Location
Directions Enter • daily
rs
Gomm
�-
MMMMMMMMM
������
�
MMM
:
MMMMMMMM
MMM
•
.•
�
!ice=
���i�����
®M
f
-M=_====_
MMM
r���r�r■�MMMM
I_
Form 45

STOR / WATER DISCHARGE OUTTF'ALL �SDQ) P Semi -Annual
GENERAL PERMIT NO N CG140000
CERTIFICATE OF COVERAGE NO N_C4Mr� 3
FACILITY NAME Y5� I _
PERSON COLLECTING SAM LES
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
MONOTORMIG FORM
PP NIC711
SAMPLE COLLECTION YE R 3 0 Z618
SAMPLING PERIOD July -December !, Jand#fryRSfiCTION
COUNTY Fo L �10NpR��SSjG
PHONE NO fi C)_ , 15 11� Cf' 111VIT
ADD TO LISTSERVE? []YES ❑NO EMAIL /I
DISCHARGING TO CLASS- []SA [HQW []PNA []Trout Other
DutfialS Na
Date Sample
Collected
(mo/dd/yr OR
i
NO FLOW)
pH
(standard
Units}
TSS
(mg/L}
Event
Duration
(minutes)
Total a
Ratnfal!
(in)
in Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
z
2 Sampling
- —
64
Too,-
-
-
if "No FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfali here Please make sure to mark the sample period above
If a value is In excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
TSS benchmark values are 100 mg/i, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I
For each sampled measurable storm event the total prectpJation must he recorded using data from an on site rain gauge
Permit hate 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part S Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year
autfali
No
Date Sample
Collected
(mo/dd/yr)1
pN
(Standard
Units
TPH using merhad
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(rng/L)
Event
Duration
(minutes)
Total
a
Rainfall"
(+n1
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
MonitoriW
(y/n)
4 of Months
in Tier Z
z
Sampling
6-92
152
tool 3
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDS ES AT ANY ONC OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NC�n,
HAVE YOU CONTACTED THE REGION? YES ❑ N
REGIONAL OFFICE CONTACT NAME
Mail Original and one copv of this DMR (including all "No Flow" & "No Discharge" reportsl within 30 days of receipt of sample for at.end. of monitoring period
in case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mall Service Center
Raleigh, North Carolina 27699 1617
YOU MUST SIGN THIS CERTIFICATION FOR AIVYIINFQRli11AION REPORTED
"i certify, under penalty of law, that this document and all attachments were prepared udder my direction or supervivan in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the Information, the information submitted is, to the nest of my knowledge and belief, true, accurate, and complete
am aw hat therm significant penalties for submitting false information, including the possiblllty of fines a ti imprisonment for knowing violations "
C I :2 , �y
gnature of P rr>irttee) (Dat )
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

TOTAL PRECIPITATION
DAILY LOG -YEAR 20--
FarrlUtyName
Location
Directions Enter on -site daily rainfall amounts in inches
Jan
iFete
Mar
Apr
May
Jun
Jul
AugSep
Oct
Nov
Dec
3
4
I
Cam
/
F C
rJ
iL,
,
i
1n1C1
l �, i
�1c
i`�/l.
)
9
.31
�y
//'/�
[V,{�
+. '
[ /
j�
8
!
07
10
11
12i�r
�c7�oC�J�
13
E'er
���
�Lr'
S >
>i
ELa
15
1
4a
y
1
i
IN
VJ
17
1148
57
19
2021
t
�
10
bc: '
1c�
U
aiOf�ot
22I-
23
e
24
25
26
27
29
G
am!
►OLG�
1(7,
-e-
b t 5
30
Form #5

ST®RMWATER DISCHARGE ®UTFALL (00) - Semi-Anr uaa MONOTORING FORM
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG14 M 3
FACILITY NAME h I
PERS0N COLLECTING SAM LES t e
CERTIFIED LABORATORY Lab #
Lab # - --
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE C0LLECTI0N YEAR 6 i t _
SAMPLING PERIOD 4 !uly-December N January -June
COUNTY _ -_G r
PHONE NO
ADD TO LISTSERVE? OYES ONO EMAIL
DISCHARGING TO CLASS []SA ❑HQW ❑PNA ❑Trout Other
Outfall No
Date Sample
Collected
{moldd/yr OR
NO FLOW)r
p�
{Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sarnpling2
-
6 92
100
-
' If "NQ FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfali here Please make sure to marls the sample period above
1 If a value is In excess of the benchmark, or outside the benchmark range for pH), you must implement the Tier 1 or Tier 2 re5ponses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TS5 benchmarks values are 100 mg%l, except when dischargsng to ORW, HQW, Trout, and PNA waters where they are 50 mg/I
4 For each sampled measurable stoi m event the total precipitation must be recorded using data from an on site rain gauge
Permit Bate 7/1/2011 GO/30/2015 Last Revised 7/13/11
Page 1 of 2

Part a Vehicle Maintenance Activity Monitoring Requirements for facilities using a 55 gal of new motor oil/month - averaged over a calendar year
Dutfall
No
pate Sample
Collected
(rno/dd/yr)
pH
(Standard
Units)
)
TPH using method
1664A SGT-HEM
m /L
g
Total Suspended
Solids
(m /L
g l
Event
Duration
minutes l
Total
Rainfalla
m )
New Motoi Oil
Usage
a! ntanth
(g / �
2 Tier
I In Tieronthy
Monitoring7
(y/nl
it of Months
in Tier 2
Sara Iin
p gz
6-9
is
1002 3
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDS ES AT ANY ONC OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO)n
HAVE YOU CONTACTED THE REGION? YES ❑ N
REGIONAL OFFICE CONTACT NAME
Mati Original and one copy of this DIVjR (including all "No Flow" & "No Discharpe" reports) within 30 days of receipt of sample for at end of monitorine period
in case of "No Flowl to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699 1617
YOU MUST SIG1V THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervlsiori rn accordance with a system designed to
assure that qualified personnel properly gather and evaluate the Information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aw hat there ar significant penalties for submitting false information, including the possibility of fines and imprisonment for icnaw€ng violations "
—2^/0'/�
tore of P mitteel
Permit Bate 7/1/2011 60/30/2015
(bate)
Last Revised 7/13111
Page 2 of 2

TOTAL PRECIPITATION
DAILY LOG -YEAR 20_L-j7j_
facility Narne fj-*­'(_�i�\iiiitwl UAW
Location
i daily rainfall amounts
MAIM,
"MMMAOMMMMMMM
M0=
MMMMMM
©M®•
®=
.,
MMMMMM
�"
i
�
UMMM=MM_MM
�M
.
�®
MM__MM
_
MM
Form #5

--4 STORMWATER DISCHARCE OUTI ALL (S®O) - Saud -Annual MONITORING FORM
GENERAL PERMIT NO NC6140000
CERTIFICATE OF COVERAGE NO W614Mi c� 3
FACILITY NAME Sj 1 ,� k
PERSON COLLECTING SAM LE5 iif r - e C
CERTIFIED LABORATORY. -.--..._ ...._-_-_-_ Lab#
Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR (,_1 i,Q_�_- _
SAMPLING PERIOD July -December ;N January -June
couNTY _ FG Y `'J �
PHONE NO 10 -_ i .Gl 6 (',
ACID TO LISTSERVE? DYES ONO EMAIL
DISCHARGING TO CLASS ❑SA []HQW E]PNA []Trout Other
Outfall No
Date Sample
Collected
I,mn, dd/yr all
NO FLOW)t
pH
(standard
Units )
TSS
(m�/L)
Event
Duration
(minutes)
Total n
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
`y1n)
# of Months in Tier
2
2 SamplFng
7 - r }
fi 9,
106
-
-
-
97-
APR �
ENTRt
1r_ �.w_
WR s
CENT
UVVR SE
TION
'If "NO FLOW" of "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall Here Please make sure to mark the sample period above
2 if a value Is In excess of the benchmark, or outside the benchmark range for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
' TSS benchmark values are 10o mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/1
"For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
iVED
5 Z017
,L FiLES
;CTI ON
Permit Date 7/t/2011-60/3G/203.5 Last Revised 7/13/11
Page 1 of 2

Part a_V41 tcle Maintenance Activity Monitoring Requirements for facilities using n 55 gal of new motor od/month— averaged over a calendar year
Outfall
No
Date Sample
Collected
(mo/dd/yr)'
pH
(Standard
Units)
TPH using method
1664A 5GT-HEM
(rng/L)
Total Suspended
Solids
{rr,g/i)
Event
Duration
(minutes)
Total
a
RaknfaN
{rn)
New Motor Oil
Usage
(gal/manthj
In Tier 2
Monthly
Monitoring? Mo
Wn)
4 of Months
in Tier 2
Samplingz
6 8
is2
100�
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDEItES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTI~NANCE)? YES [INC►j
HAVE YOU CONTACTED THE REGION? YES ❑ Nqg—
REGIONAL OFFICE CONTACT NAME
Mail Orieinal and one copy of this DMR (includmp, all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring verlod
in case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699 1617
YOU MUST SICIV THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"I certify, under penalty of law, that this document and Al attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the hest of my knowledge and belief, true, accurate, and complete I
am awaw—that therea�p significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
of
b --
(Date)
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

STGRMWAT,ER DISCHARGE OUTFALL (S®O) - Semu-Annual MONITORING FORM
GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG)1464 c` J_
FACILITY NAME , Si f _
PERSON COLLECTING SAM LE5 1 2 '
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR L
SAMPLING PERIOD July -December January -June
couNTY Fc,
PHONE NO
ADD TO LISTSERVE? []YES []NO EMAIL
DISCHARGING TO CLASS ❑SA ❑HQW OPNA ❑Trout Other
Outfafi No
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)�
pH (Standard
Units}
TSS
(mg/L)
Duration
(minutes)
Totalration Rainfall 4
(in)
In Tier 2
Monthly
Monitoring?
(yin)
# of Months in Tier
2 Sarripiirig2
-
692
10011
-
-
-
►
. .�..�L;r
v L—
JAN 1
0 2017
lr-�l,i`rr,
LP6 EG
d'1'1R S'
C-TI
r�
i If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to marts the sample period above
If a value !s in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 respoi)ses in the General Permit Tier 2
Monthly sampling shalt be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout and PNA waters where they are So mg/1
For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
C
Permit bate 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part a Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor or!/month —averaged over a calendar year
Outfall
No
Date Sample
Collected
(mo/dd/yr)'
PH
{standard
Units)Monitoring?
nits}
TPH using method
1664A SGT-NEN!
jmg/L}
Total Suspended
Solids
(mg/L)
Event
Duration
{minutes)
Total
a
Rainfall
{in}
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
{y%n)
i# of Months
in Tier 2
Sampling z
69
15
1002
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDS ES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ON C1�
HAVE YOU CONTACTED THE REGIONS YES ❑ N
REGIONAL OFFICE CONTACT NAME
Mail Oriainal and one COOV of this DMR (ind idina all "No Flow" & "No Discharee" reports) mthin 30 days of receipt of sample for at end of monitorinF_ period
in case of "No How") to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST S16N THIS CERTIFICATION FOR ANY &FORMATION REPORTFO
t certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted Is, to the best of my knowledge and belief, true, accurate, and complete
am aw hat her r significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations"
of
Permit Date 7/1/2011 60/30/2015
(Date)
Last Revised 7113/11
Page 2 of 2

-Form
TOTAL PRECIPITATION
DAILY LOG - YEAR 20
M Ii,
MOM:i
EnterDirechons daily
1�MM®1
rim
ll
A:
MMMM
%
M[
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r
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Farm #5

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG146 LA 2
FACILITY NAME 'PU rSA �'Y1 0At �h\X,
PERSON COLLECTING SAMPLES _ �_k a '�
CERTIFIED LABORATORY ab #
Ut Y Lab #
OPTIONAL INFO
Part A 5tormwater Monitoring Requirements
SAMPLE COLLECTION�7uly
Z o I Le
SAMPLING PERIOD -December ❑ January -June
COUNTY 0"N
PHONE NO (3;5A i 'Cl LOC I - OUd U
ADD TO LISTSERVE7 DYES 090 EMAIL
DISCHARGING TO CLASS SA ❑HQW ❑pNA ❑Trout" Other
Outfall No
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Ra n all4
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling
-
-
6-
100
-
1 1
1
7
ZU
Q
' If "NO FLOW" or "NO DISCHARGE, Enter 'NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
' If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
!Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TSS benchmark values are l00 mg/I, except when discharging to DRW, HQW, Trout and PNA waters where they are 5o mg/1
For each sampled measurable storm event the total precipitation must be recorded using data from an on site ram gauge
Permit Date 7/l/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part a Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year
r
Outfall
No
Date Sample
Collected
{rno/dd/yr)1
PH
{Standard
Units)
TPH using method
1664A S6T•NEM
(mg/t)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfail
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
{Y/n)
R of Months
in Tier 2
a
Sampling
6-9
is
100"
-
-
-
-
-?[%-
-7 Ci -1
Z S ra237lZc
0
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEED N ES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? _x5 ❑ NO
REGIONAL OFFICE CONTACT NAME
Mail Original and one coov of this DMR (mcludina all "No Flow" & "No Mscharse" reports) within 30 days of receipt of sample for at end of monitoring neriod
in case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
LO_U MUS�StGN TH5 LI RTWfCATION FOR AIUY INFORM, A IaN RE 0 TED
"i certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those per directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aw a tha there a nificant penalties for submitting false information including the possibility of fin s and imprisonment for knowing violations "
{X
(Signature of Permittee) U (Date)
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

TOTAL PRECIPITATION
! . -YEAR
DAILY
a
. r_ • Atl
i
Direeb• - • •. ounts in inches
.
ommmmm
"llm
,
m®:
s�pmm®m
,
m
Wgmmmm
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M,
�r•�©�
•
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r
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"ll
mm-
y
/ •
m
m
mm
©_--'
�MmmM
mm
� I
m-_m.
mMAI
, r
r�M�
•
©mm
mm"Mo
mmmm
m
`
r
r
ter:=
�mmm,
"a
mm�
"ter-�o���
Form #5

VISUAL MONITORING &
Completed By (. nnj -& �e- cr
Title v
QUALITATIVE ASSESSMENT
Date 401(>
Directions tdenttfy the containment area being inspected and note any obervations Any 'yes' answers require explanation Attach additional
sheets as necessary Each containment area should be inspected on a quarterly basis, with at least one per year inspection during a discharge
event
Yes
No
Problems Noted
Actions Taken
Is any odor emitted from the water in
containment?
Are any floating solids present in the
water in containment?
Are any suspended solids present in the
water in containment'
✓�'�
`�
1 �,
�(� Y'4'pu-
Is any foam visible on the water in
containment?
V
Is a visible sheen present on the water in
containment?
Is any treatment or absorbent needed on
the water in containment?
Are there any signs of leaks cr corrosion
associated with the system?
Was water released from the
containment area?
Form 98

NON-STORMWATER DISCHARGE
Facility Name
ASSESSMENT AND CERTIFICATION
Location
Date Test
orr
Outfall Directly Observed During the Test
Method Used to
Test or Evaluate
Describe Results from
Test
Test for the presence of
Identify Potential
Name of Person who
the Test or
Evaluation
(as indicated on the site plan)
Discharge
Non-Stormwater
Significant Sources
Evaluation
Discharge
to -Zo 1 Le
'�
ivy
C :C�
4vl
-rya S m,r
CERTIFICATION
I, (responsible corporate official), certify under penalty of law that this document and all attachments were prepared
under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true accurate and complete I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations
A Name & Official Title (type or print)
B Area Code & Telephone No
f,'vY1 cw ',- --) p e- e
':�
O Signature
D Date
`
Form #1

RESEARCh & ANA[yTICA1 Report of Analysis
LA O RATO RI ESQ INC. 11 i3i2O16
BL
For Forsyth Redi-Mix
•� �+ ..••• ••.*i
100 Anderson Street
ot
C6
Rural Half, NC 27045
4
Cr s:to ivc a34 x? u'
Attn Annie Speer
r ; NC#37701 =
•s
PA
Client Sample ID Plant
Lab Sample lD
26231-01
Site Forsyth Redi Mix Inc
Collection Date
10/20/2016 10 00
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Date/Time
Hydrocarbon O&G
EPA 1664 Revision B/Silica
45
mg/L
5
DID 10/21/2016
Gel
PH
SM 4500 H+8-2000
797
Std Units
AP 10/20/2016 1658
Settleable Matter
SM 2540 F-1997
03
mill
01
AW 10/21/2016
Total Suspended Solids (TSS)
SM 2540 D-1997
237
mg/L
5
AW 10/25/2016
NA = not onofyzed

CHAIN OF CUSTODY RECORD
WATER ! WASTEWATER H AAISC
CO_WANY
JOB NO
y
Ym wa
�
o
o
0 C3 =o,
, hQa
V
'�•�,O }�O p�
OVm op ¢ r�°i SQyp �U�s��
0vpppSAMPLE:
2OQ
REQUESTED ANALYSISK0Vo
STR;E(ETA yDRfESS p�
I©(J Y�LI'�r (�I� h 've A- 1��- 5I�
r_
PROJECT p I a l)
CI STATE ZIP r
SANjE�I..fR NAME (PLEASE PRINT)
CONTACT PHONE
SAMLERSIGNATU
llv)w, 2LA
RUMBIER
(LABUSONLY)
DATE
TIME
C)NPQiABTE
NrRCEI9,x
(YcrN)
l3mM
5MdPEELOCATi0V!ID
z�
i�oa
_
� JsS S
6�
I
I
RELINQUISHeD BY p i
DATEITIME
VW
ECEIVED BY
REMARKS i
SAMPLE TEMPERATURE AT RECEIPT I °C
REUNQUIS ED$Y
DATEMME
RECEIVEDBY

STORMWATER DISCHARGE OUTFALL (00) a Semi -Annual
f GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NCI NC IA
FACILITY NAME f—n1-,51/ �h i(;
PERSON COLLECTING SAMOLES Li")htP a7C -e Y-_
CERTIFIED LABORATORY Lab #i
Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
MOMTORING FORM
SAMPLE COLLECTION YEARL�
SAMPLING PERIOD July-Decernber , January -June'
COUNTY G `+
PHONE NO ' b ] to I
ADD TO LISTSERVE? [:]YES ONO EMAIL _ a
DISCHARGING TO CLASS ❑SA ❑HQW ❑PNA ❑Trout Other
Outfall No
Date Sample
Collected
(rno/dd/yr OR
NO FLOW )t
PH
(Standard
Units)
T55
(mg/L)
Event
Duration
(minutes)
Total
Rainfall4
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
fi of Months InT ier
2 5amPHng
-
- � i
s-�
goo
-
-
-
-
i�
CE
itFiLt
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
l if a value is in excess of the benchmark, or outside the benchmark range (for pH), you roust implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
' T55 benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I
4 for each sampled measurable storm event the total precipitation must be recorded using data from an an site rain gauge
Permit Date 7/1/20EI-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part 0- Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month - averaged over a calendar year
'
outfatt
No
Date Sample
Collected
tmo/cld/yr)�
pH
;Standard
Units)
TPH using method
1664A SGT NEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(ininutes)
Total
Rainfall'
(fn)
New Motor oil
Usage
igal/month)
2 TierTier
!n InR
Monthly
Monitoring?
IY/n�
of Months
In TIer 2
a
Sampling
6-9
15
1 Of3a
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDS ES AT ANY ONE QUTi=ALL (INCLUDING VEHICLE MAINTENANCE)? YES Q N&Q
HAVE YOU CONTACTED THE: REGION? YES ❑ N
REGIONAL OFFICE CONTACT NAME
Mail ONelna) and one coav of this DMR (inciudine all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for at end.of monitorme period
in case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mall Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THfS CERTIFICATION FOR IdNY ffIFORMAWQ REPORTED
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision rn accordance with a system designed to
assure that qualified personnel properly gather and evaluate the Information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the Information, the information submitted Is, to the best of my knowledge and belief, true, accurate, and complete
am aw at ther r scgmficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
gnature of P ittee) (Gate)
Permit [late 7/1/2011 60/30/2015 last Revised 7/13/11
Page 2 of 2

TOTAL PRECIPITATION
DAILY LOG - YEAR 20
ij=
j A It 1 ail
-:Dir• a - .. • -
©
s,
r
IM
"
MMMMM—M
M.
MMEMMMMMMM
■seam
. ■o
•
MMMMM�=
M&
M
===Mrs
mmmmmrm
NMI
R •
�w'M
1
_MMM-M
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row
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Il
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r�MMMMMM
-�Mm=
��MMM
'l,,__lr�_---m-
SAMMM_M--
"A
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MA
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mmmmmm
mmmmmm
Form #5

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NC 146c-I P -4:VIC
FACILITY NAME YSl
PERSON COLLECTING SAM LES l
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
MONITORING FORM
►ZA �
e� ,f
SAMPLE COLLECTION YEAR l
SAMPLING PERIOD July -December ;� January -.tune
COUNTY Fo
PHONE NO Ba lP 1 , QtZOOLILIQ
ADD TO LISTSERVE? [YES ❑NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW ❑PNA [Trout Other
Outfall No
Date Sample
Collected
Collected
OR
t
NO FLOW]
pk
{Standard
Units)
TS5
l�ng/L)
Event
Duration
(minutes)
Total a
Rainfall
(!n)
In Tier 2
Monthly
Monitoring?
I[y/n)
# of Months in Tier
2
2 Sampling
69 2
zoo 3-
-
-
-
APR
DNVAL
FILEJUN
' if "NO FLOW" or "NO DISCHARGE, Enter 'NO FLOW or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
i If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit TFer 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/1
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
G
Permit Date 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year
'
Qutfall
No
Date Sample
Coilected 1
(mo/dd/yr)
pH
(Standard
Units(
TPH using m
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfai14
{in)
New Motor Oil
Usage
(gal/month)
In Tier 2ethod
Monthly
Monitoring?
(y/n)
# of Months
In Tier 2
Sampling'
6-9
15
100
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEE2DfENtES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NCK
HAVE YOU CONTACTED THE REGION? YES ❑ N
REGIONAL OFFICE CONTACT NAME
Malt Oni?inal and one coov of this DMR (rncludine all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for at end of monitonne perlod
in case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699 1617
YOU MULST ,SIGN THIS CERTIFXATIONI FOR .4NYINFORMATION RFPORM
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aw at they significant penalties for submitting false information, including the possibility of fines and imprisonment for knowrng violations"
gnature of P ittee) (Date)
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

TOTAL PRECIPITATION
DAILY . YEAR
Name
. ...
..
Directions daily
a
MMMMMMMMMM
■ter®r_.�■�����r�����
�!�'
a
Form #5

STORMWATER DISCHARGE OUTFAtt (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG14 D 41Z
FACILITY NAME rUrScILh ICI InIx, `T_hr
PERSON COLLECTING SAMPLES _ 14- hhle34Jeirr
CERTIFIED LABORATORY Lab #!
Lab i#
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR , 2A /,< _
SAMPLING PERIOD �uly-December January -June
COUNTY &i5 -& _
PHONE NO Lff�, j 4&9— 00�4v T
ADD TO LISTSERVE3 E]YES [:]NO EMAIL
DISCHARGING TO CLASS ❑SA []HQW []PNA Trout Other
Outfall No
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall'
(in)
In Tier 2
Monthly
Monitoring?
(v/n?
4 of Months in Tier
2 Sampling
apt
F d� f
6 9
100
-
ti
CENTF
AL FILES
I ION
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 respcnses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TS5 benchmark values are 10C mg/% except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I
° For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 1. of 2

Part B Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year
Outfall
No
_
Date Sample
Collected
(mo/dd/yr]1
pH
(standard
Units)
TPH using method
1664A SCOT i�IFM
(mg/L]
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
3
Sampling
6.9
15
100 23
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES [:]NO
REGIONAL OFFICE CONTACT NAME
Mali Original and one eoszv of this DMR (including all "No Flow' & "No Discharge" reoorts) within 30 days of recelot of sample for at end of monitoring oeriod
in case of "No Flow"Ito
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am awar t there are sr mftcant penalties for submitting false information, including the possibility f fines d imprisonment for knowing violations
7n��� "
I
( ure of Permi ) (64tel
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

TOTAL PRECIPITATIONFacilit
DAILY .-YEAR 1
Name i
Location
!lDirections• daily rainfall amountsinches
I
as
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mw_
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Form #5

STORMWATFR DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO NCG140000
12 �� I� f .� � ���
CERTIFICATE OF COVERAGE NO NCG14 SAMPLE COLLECTION YEAR _
FACILITY NAME rnjStlhCIfI�-/1'fl�C Y SAMpuNGPERIOD uly-December [January -June OCT 0015
PERSON COLLECTING SAMPLES f 'at`*'f COUNTY T-�rsy CEN7.RAL FILES
CERTIFIED LABORATORY v L Lab# PHONE NO CJid-l-6Q(4 (D L)WR SECTION
1frit, Lab # ADD TO LISTSERVE? DYES '®NO EMAIL
OPTIONAL INFO DISCHARGING TO CLASS []SA OHQW ❑PNA []Trout 26ther
Part A Stormwater Monitoring Requirements
Outfall No
Date Sample
Collected
(ma/dd/yr OR
NO FLOW)'
pH
(Standard
Units)
T55
(rng/L)
Event
Duration
(minutes)
Total
Rainfalls
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling,
-
-
69
100 23
-
-
-
If 'NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
r If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/1
`For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year
Outfal!
No
'
Date Sample p
Collected 1
(mo/dd/yr)
PH
{Standard
Units)
TPH using method
1664A SGT HEM
{mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall°
(in)
New Motor Oil#
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
of Months
in Tier 2
Sampling
1S
100 23
-
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [] NO 5V
HAVE YOU CONTACTED THE REGION? —YES ❑ NO K
REGIONAL OFFICE CONTACT NAME ,CL=—, , ,, .2:�POL'i
Mail Ordinal and one copy of this DMR finciudini? all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow) to
Division of Water Quality
Attn OWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY f,{VFORMATION REPORUD
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based an my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware here are significant penalties for submitting false information, including the possibility o1fi �and imprisonment for knowing violations "
�,5%yefure of Pprk3Wej {D6te)
Permit Date 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

MwOhNEW % hmno a mbd
}�'-
314_AOAKMONT
iV C 27835-7a85
READY MIX CONCRETE (AYDEN)
MR RICKIE GRAY
P O BOX 877
GREENVILLE ,NC 27834
ID#f 1097
DATE COLLECTED 09/24/15
DATE REPORTED 09/29/15
REVIEWED BY
001 002 Analysis Method
PARAMETERS Discharge Discharge Date Analyst Code
PH (not to be used for reporting) 72 80 09/25/15 KKF 4500HR-00
Total Suspended Residue, mg/1 <2 6 33 09/28/15 M1.H 254OD-97
2�y 11
to

Completed ByPIl
VISUAL MONITORING &
cc
QUALITATIVE ASSESSMENT
Title
Date
Directions Identify the containment area being inspected and note any obervations Any 'yes' answers require explanation Attach additional
sheets as necessary Each containment area should be inspected on a quarterly basis with at least one per year inspection during a discharge
event
Yes
No
Problems Noted
Actions 'taken
Is any odor emitted from the water in
/
containment?
V
Are any floating solids present in the
water in containment?
v
Are any suspended solids present in the
water in containment?
9es
idKo
Is any foam visible on the water in
/
containment?
Is a visible sheen present on the water in
containment?
Is any treatment or absorbent needed on
the water in containment?
Are there any signs of leaks or corrosion
/
associated with the system?
V
Was water released from the
containment area?
Form #8

��A
NON-STORMWATER DISCHARGE
Fac€lity Name //J_ ���
ASSESSMENT AND CERTIFICATION
Location
A&iul Ild1l �fL
Date of Test
or
Outfall Directly Observed During the Test
Method Used to
Test or Evaluate
Describe Results from
Test for the presence of
Identify Potential
Name of Person who
Conducted the Test or
Evaluation
(as indicated on the site plan)
Discharge
Non-Stormwater
Sigmficant Sources
Evaluation
Discharge
CERTIFICATION
I, (responsible corporate official), certify under penalty of law that this document and all attachments were prepared
under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true accurate and complete I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations
A Name &..QfFtCral Title (type oi� print)
B Area Code & Telephone No
C Signature—,,
D Date
q-;2—
Form #1

RESEARCH & ANA1yTICA1
pap LABORATORIES, INC.
©®Q
For Forsyth Redi-Mix
100 Anderson Street
Rural Hall, NC 27045
Attn Annie Speer
Report of Analysis
9129/2015
=op NC #34 - N
;s NC tr37701
•�4.�i ` � ��A$CTOQ ``raj C
Client Sample ID Plant Lab Sample ID 9342-01
Site Forsyth Redi Mix Inc Collection Date 9/2212015 845
Parameter Method Result Units Rep Limit Analyst Analysis DatelTime
Hydrocarbons Oil ,& Grease EPA 1664 Revision A/Silica <5 mg/L 5 JB 9/24/2015
Gel
pH
SM 4500 H+8-2000
830
Std Units
AP
9/23/2015
Settleable Matter
SM 2540 F 1997
<0 1
mI/I 01
YJ
9/22/2015
Total Suspended Solids (TSS)
SM 2540 0-1997
<5
mg/L 5
JB
9/23/2015
NA = not analyzed
P 0 Box 473 106 Short Street Kemersville North Carolina 27284 Tel [phone] Fax [phone] www randalabs corn Page 1
ral coa_basic_Od

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG 14 D
FACILITY NAME H :,' P; .
PERSON COLLECTING SAMPLES F! r. ,
CERTIFIED LABORATORY U114 _ Lab #
+�� Lab #
OPTIONAL INFO I/a
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR l�
SAMPLING PERIOD ❑ July -December January -June
COUNTY l�
6�i
PHONE NO (,) C
ADD TO LISTSERVE7 []YES []NO EMAIL N ,SJE F/LeS
DISCHARGING TO CLASS ❑SA ❑HQW ❑PNA []Trout Cher � SECTION
Qutfali No
Date Sample
Collected
mo/dd/yr OR
NO FLOW)
pH
(standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total 4
Rainfall
(In)
In Tier 2
Monthly
Monitoring?
n
# of Months in Tier
2
2 Sampling
69
100
-
i`?---------
'If "NO FLOW" or "NO DISCHARGE, Enter 'NO FLOW or ' NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
n TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I
4For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year
Outfall
No
Date Sample
Collected
(mo/dd/yr)1
pH
(standard
Units)
TPH using method
1564AS6T-NEM
(mg/L)
Total Suspended
Salads
(mg/L)
Event
Duration
(minutes)
Total
Rainfall°
(in)
New Motor Oil
Usage
(gal/month)
In Tier Z
Monthly
Monitoring?
(Y/n)
R of Months
in Tier 2
a
Sampling
6-9
15
100 23
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES F-1 N0*F;6
REGIONAL OFFICE CONTACT NAME
Mail Orteinal and one coov of this DMR frncludine all "No Flow" & "No Discharee" reports) within 30 days of recejot of sample for at end of monitorine period
In case of"No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699 1617
YOU MUST SfGN THI5 CERTIFICATION FOR ANY INFORMATION REPORTED
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
ama aware thlat to re �gn�ficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
nature of Per ) (Date)
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

h
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO NCG14 O 14 3
FACILITY NAME -�t�<Zed, - X
PERSON COLLECTING SAMPLES J
CERTIFIED LABORATORY -Qe4,eag li► -� Rnc _l_.t3,aj Lab # t
o Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR �L) � S, RECEIVED
SAMPLING PERIOD ❑ July -December January-Janpi Z01
COUNTY C N T RA L FILES
PHONE NO ( 3l , %,cl [7�li4k+ DU' R SECTION
ADD TO LISTSERVE? []YES BNO EMAIL
DISCHARGING TO CLASS ❑SA ❑HQW []PNA []Trout +Other C
Outfall No
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
H
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall "
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months In Tier
2 Sampiing2
-
6-9
IGO
-
-
A—
`7
1 D
—
' If `NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
TSS benchmark values are 100 mg/I, except when discharging to ORW, HOW, Trout, and PNA waters where they are 50 mg/l
°For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
Permit Date 7/i/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year
Outfall
�
iNo
pate Sample
Collected
tmo/ecteddd/yr1
PH
(Standard
Units)
TPH using method
i6G4A SOT -HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
duration
(minutes)
Total
Rainfall`
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
N of Months
in Tier 2
3
Sampling
6-9
15
100
-
-
-
-
-
$ 51
G O M I
fD V
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [I NO
HAVE YOU CONTACTED THE REGION? YES [INOD'
REGIONAL OFFICE CONTACT NAME -:Y0.Son ], I -
Mall Original and one copv of this DMit fincludine all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for at end of monitoring period
in case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mad Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMAM& REPORTED
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete I
am3ware4lqit there a gnifi ant penalties for submitting false information, including the possibility of fines and Imprisonment for knowing violations "
of
Permit Date 7/1/2011-60/30/2015
Date)
Last Revised 7/13/11
Page 2 of 2

NON-STORMWATER DISCHARGE
Facility Name toc s-Ak Pe',�-
ASSESSMENT AND CERTIFICATION
Location
Date of Test
Outfall Directly Observed During the Test
Method Used to
Describe Results from
Test for the presence of
Identify Potential
Name of Person who
or
Evaluation
(as indicated on the site plan)
Test oEvaluate
r
Discharge
Non-Stormwater
Significant Sources
Conducted the Test or
Evaluation
Discharge
CERTIFICATION
(responsible corporate official), certify under penalty of law that this document and all attachments were prepared
under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief true accurate and complete I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations
A Name & Official Title (type or print)
B Area Code & Telephone No
retsm
33'�-9(01 pL4u(�
C Signature
D Date
31
Form #1

VISUAL MONITORING &
Completed ByY+C
QUALITATIVE ASSESSMENT
Title
Date
Directions Identify the containment area being inspected and note any obervations Any'yes' answers require explanation Attach additional
sheets as necessary Each containment area should be inspected on a quarterly basis, with at least one per year inspection during a discharge
event
Yes
No
Problems Noted
Actions Taken
Is any odor emitted from the water in
/
containment?
Are any floating solids present in the
water in containment)
Are any suspended solids present in the
water in containment?
5CXMP
Is any foam visible on the water in
containment
Is a visible sheen present on the water in
containment?
✓
1s any treatment or absorbent needed on
/
the water in containment?
1%
Are there any signs of leaks or corrosion
associated with the system?
Was water released from the
/
containment area?
Form #8

RESEARch & ANA[yTiCA[
L.AbORATORIES, INC.
Analytical/Process Consultations
Forsjth redi-Mix
100 Anderson Street
Rural Hall, NC 27045
Attn Eric Dolan
Datc Sample Collected
Date Sample Received
Date Sample Analyzed
Date of Report
Analyses Performed by
Lab Sample Number
--------------------
902374
Parameter Strret # Results
PH
(00400)
a
57
Std Units
TSS
(00530)
10
6
mg/1
Oil
& Grease -MINERAL
t5
0
mg/1
--------------------
Clients Sample Source OUTFALL #2
r
Number
Time Collected (Firs) 0830
4=/osl�5
al/os/15
01/05J15
01/15/15
AP -JB -JP
P O Box 473 • 106 Short Street + Kernersvdle North Carolina 27284. 336 996-2641 • Fax [phone]
www randalabs corn

RESEARCh & ANA1yTiCA1
L-AbORATORIES, INC.
Analytical 1 Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER 1 WASTEWATER I w3C
r a
•
4 •
•
• • • •
•
REQUESTED ANALYSIS
CITY STATE ZIP
SAMPtER NAME (PLEASE PRINT)
CONTACT PHONE
SIMEON
No
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.:

e
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL. PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO NCG14-t 9 Z 3
FACILITY NAME IM:
PERSON COLLECTING SAMPLES rGr.. lo•g _T
CERTIFIED LABORATORY Lab it
_Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR 7,01q
SAMPLING PERIOD ✓1uly-December 0 January -June
COUNTY
PHONE NO [2aL. j .916R - OltI4
ADD TO LISTSERVE? []YES ❑NO EMAIL
DISCHARGING TO CLASS []SA ❑HQW ❑PNA ❑Trout Other C
Outfall No
Date Sample Collected
(mo/dd/yr OR
1
NO FLOW]
pH
(Standard,
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall a
(in)
In Tier 2
Monthly
Monitoring?
(Y/n)
#f of Months In Tier
2
2 Sampling
- jOX-)
' if "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
' If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TSS benchmark values are 100 mg/i, except when discharging to ORW, HOW, Trout, and PNA waters where they are 5o mg/I
`For each sampled measurable storm event the total precipitation must be recorded using data from an on -site ram gauge
RECEIVED
JAN 2 3 2015
CENTRAL FILES
DWR SECTION
Permit Date 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

l
Part B• Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month - averaged over a calendar year
� DutfaiS
No
Rate Sample
Collected
(mo/dd/Yr)1
F H
[Standard
Units)
TPH usfn ` method
1664,A -HEM HEM
(mg/L)
,,-Z
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total a
Ralnfall
(in)
New Motor Oil
!!sage
(gal/month)
In Tier 2
Month! y
Monitoring?
(y/n)
� of Months
in Tier 2
Sampling2
6-9
05
100
.
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EX(EEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ ,!0
REGIONAL OFFICE CONTACT NAME
Mail Original and one copy of this DMR bnclu_d..ineall "No Flow" & "No Discharn" reports) within 30 days of recesat of sample (or at end of rnonitorine period
In case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mali Service Center
Raleigh, North Carolina 27699-1617
YOU MUSTSION WAS CERIUF CATIObt FOR ANY ! F R AT ON E O FD
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the Information subrrltted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the Information, the Information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware that there are significant penalties for submitting false information, Including the possibllity of fines any imprisonment for knowing violations "
(S ure of Perml ) (Date)
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG14 0 14 X
FACILITY NAME
PERSON COLLECTING SAMPLES _ (v � A
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR Z 01 �
SAMPLING PERIOD ❑ July -December ['January -June
COUNTY T=j2nq4k�-,
PHONE NO (;i3L, 1 ) U-1 - Ot4q(,,
ADD TO LISTSERVE? AYES []NO EMAIL
DISCHARGING TO CLASS ❑SA []HQW ❑PNA ❑Trout [Other C-
Outfall No
Date Sample
Collected
( mo/dd/yr OR
NO FLOW)1
PH
(Standard
Units)
TSS
Event
Duration
(minutes)
Total a
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
y
O
6 9
100 13
OCT
r�r. -_
DVlri� �wL F+
'if "NO FLOW" or "NO DISCHARGE, Enter 'NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
a TS5 benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I
"For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
Permit Date 7/1/2011 60/30/2015
/E0
?n Id
Last Revised 7/13/11
Page 1 of 2

Part 8 Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year
Outfall
No
Date Sample
Collected
(mo/dd/yr}1
pH
Standard
Units)
TPH using method
1664A SGT HEM
(mg/L)
Total Suspended
Solids
(mgjL)
Event I
Duration
(minutes)
Total
Rainfall°
{in)
New Motor Oil
Usage
(galjmonthj
In Tier 2
Monthly
Monitoring?
Wn)
g of Months
in Tier 2
Sampling"
6-9
15
100 23
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENSES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)7 YES ONO Z'
HAVE YOU CONTACTED THE REGION? YES [:]NO
REGIONAL OFFICE CONTACT NAME
Mail Original and one coov of this DMR (includine all "No Flow" & "No Discharge" reoorts) within 30 days of receipt of sample (or at end of monitorine period
in case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699 1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am awar that there are significant penalties for submitting false information, including the possibility of fi eir and, imprisonment for knowing violations"
SignAwfe of Permltte
Permit Date 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

VISUAL MONITORING &
Completed By
QUALITATIVE ASSESSMENT
Title
Date ! - Z5
Directions Identify the containment area being inspected and note any obervations Any'yes' answers require explanation Attach additional
sheets as necessary Each containment area should be inspected on a quarterly basis, with at least one per year inspection during a discharge
event
Yes
No
Problems Noted
Actions Taken
Is any odor emitted from the water in
containment?
Are any floating solids present in the
water in containment?
Are any suspended solids present in the
water in containment?
.�
Is any foam visible on the water in
containment?
✓
Is a visible sheen present on the water in
/
containment?
is any treatment or absorbent needed on
f
the water in containment?
Are there any signs of leaks or corrosion
/
associated with the system?
Was water released from the
/
containment area?
Form #8

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG14 0 Z 3
FACILITY NAME
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY lab #
Lab #
OPTIONAL INFO
Part A Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR D
SAMPLING PERIOD ❑ July -December January -June
COUNTY <_j
PHONE NQ (!;V) -1LgC1- L)-1'i
ADD TO LISTSERVE? ❑YES ❑NO EMAIL
DISCHARGING TO CLASS ❑SA ❑HQW ❑PNA ❑Trout Other_
Outfall No
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
PH
(Standard
Units)
T55
(mg/L)
Event
Duration
(minutes)
Total
Rainfall'
(m)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in2Tier
2 Sampling
69
100
-
.2
'a Flow
2014
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here Please make sure to mark the sample period above
a if a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 T55 benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout and PNA waters where they are 50 mg/I
"For each sampled measurable storm event the total precipitation must be recorded using data from an on site rain gauge
Permit Date 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part 8 Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year
Outfall
No
Date Sample
Collected
(mo/dd/yr)1
PH
(Standard
Units )
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mgJE)
Event
Duration
(minutes)
Total
Rainfall°
(in)
New Motor Oil
Usage
(gal/month]
In Tier 2
Monthly
Monitoring?
(y/n)
q of Months
in Tier 2
x
Sampling'
69
15
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDWES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO Qr
HAVE YOU CONTACTED THE REGION? YES ❑ NO Lf
REGIONAL OFFICE CONTACT NAME
Mail Original and one coot/ of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring veriod
in case of "No Flow") to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699 1617
YOU MUSTSIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete 1
am aw at th significant penalties for submitting false information, including the possibility f fines nd 7iprisonment for knowing violations "
(JtWure of Permitt (Dale)
Permit Cate 7/1/2011 60/30/2015 Last Revised 7/13/11
Page 2 of 2

NON-STORMWATER DISCHARGE
Facility Name
ASSESSMENT AND CERTIFICATION
Location
Date of Test
Method Used to
Describe Results from
Name of Person who
or
Outfall Directly Observed During the Test
Test or Evaluate
Test for the presence of
Identify Potential
Conducted the Test or
Evaluation
(as indicated on the site plan)
Discharge
Non-Stormwater
Significant Sources
Evaluation
Discharge
1
fl =toss
N i�-
CERTIFICATION
(responsible corporate official), certify under penalty of law that this document and all attachments were prepared
under My direction ors pervasion in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true accurate and complete l am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations
A Name & Official Title (type or print)
B Area Code & Telephone No
C Sign
D Date
30
Form #1

HISTORY OF
SIGNIFICANT SPILLS
Completed By on S e -
Title "�Pr:est d e r1i-
Directions Record below all spills and leaks of toxic or hazardous pollutants, which resulted in a "hazardous condition" that have occurred at the facility
Date
(month/day/year)
dame of Material
Location
(as indicated on map)
Reason for Spill or Leak
Preventative Measure(s) taken to Prevent
Reoccurence of Spill or Leak
Form #2

Completed By J a SQ%'\
MATERIAL INVENTORY Title P 'r e sA r,�-� T
Date V- 3 o I q
Directions List all significant materials used, stored, handled, disposed, processed, or produced on -site Assess and evaluate these materials for their
potential to contribute pollutants to stormwater runoff
Name of Material
i%� DVF `C
0
Quantity
IWhere is it Located? (units)
Used l Producedl Disch
?_D
What is the likelihood of contact
Has any of the material
with the stormwater? What
been exposed to
conditions would cause contact
stormwater in the last thre
with stormwater? Explain
years? (yes or no)
LriG
Form #3

Completed By -) & 5c n t
SITE EVALUATION SUMMARY
Title +-
Date k4
Directions Inspect each of the following areas List all identified stormwater pollutant sources and note any corrective actions that may be necessary
Activity
Stormwater Pollutant Source
Notes
Loading/ Unloading
Operations
CV 0 7
Maintenance 1
Equipment Cleaning
c00 %D
Operations
Outdoor Storage
Operations
d 0
On -Site Practices
/
6 0 c o
Comments or
ommendations
r
Form #4

i
TOTAL'Facility
PRECIPITATION
• . ,'Location
DAILY
_LLI
Name
i
• - • daily rainfall amountsinches
!■�e■
--
.
r.�®ram®������
�
Form #5

SPPP REVIEW/
AMENDMENT REPORT
Facility Name �o, •,.�- G. �'?�d; - t�;x
Location RJ
`',1
By signing below, I have completed review and evaluation of the SPPP plan for facility on the date noted and will amend the SPPP, if necessary, as a
result
Date
Amendment
Necessary
(yes or no)
Description of Amendment
Printed Name
Signature
Form #6

VISUAL MONITORING &
Completed By
QUALITATIVE ASSESSMENT
Title �7r-4-cv
Date
Directions Identify the containment area being inspected and note any obervations Any 'yes' answers require explanation Attach additional
sheets as necessary Each containment area should be inspected on a quarterly basis, with at least one per year inspection during a discharge
event
Yes
No
Problems Noted
Actions Taken
Is any odor emitted from the water in
containment?
Are any floating solids present in the
water in containment?
Are any suspended solids present rn the
water in containment?
Is any foam visible on the water in
/
containment?
+/
Is a visible sheen present on the water in
containment?
Is any treatment or absorbent needed on
the water in containment?
Are there any signs of leaks or corrosion
associated with the system?
Was water released from the
/
containment area?
Form #8

LEGEND
N
q�
PROPERTY LINE
BUILDING FOOTPRINT
ANDERSON ST.
W E
— — —
---
RIGHT OF WAY LINE
yG_ S
— — —
— —
LINE FROM DEED OR PLAT
✓✓✓I�
SITE �FA
rl-b'6+
W
LIST. WATER LINE
p)
�4'
SS
EXIST. SAN. SEWER LINE
=
_ =
EXIST. STORM DRAIN
P:
PROP. STORM DRAIN
—OHPwr— — —
Gas G —
OVERHEAD POWER LINES
GAS MAIN
6),
g
— FO -----
Tele
FIBER OPTIC / TELEPHONE
TV
N/F
TV CABLE
NOW OR FORMERLY
®
STORM DRAIN PIPE NUMBER
01
PROPOSED SPOT ELEVATION
q
O
EIP
EXISTING IRON PIN
O
NIP
NEW IRON PIN
O
NPS
NO POINT SET
`
-(D-
PP
POWER POLE
O
Z
NO
O
HYD
TB
HYDRANT
TRAFFIC SIGN BOX
rn
O
TV
CABLE TV PED.
0
TELE
TELEPHONE PED.
LOCATION MAP
— NOT TO SCALE
�
LP
LIGHT POLE
p
WM
WATER METER
O
CO
SEWER CLEAN —OUT
"
M
YI
YARD INLET
❑®
TI
THROAT INLET
0
CB
CATCH BASIN
0
MH
MANHOLE
O
m
a
ICi
N
0
N
0
a
Cl)
m
a
U
Y
Cn
o_
L .
r
C)
0
0
N
W
m
2
CL
J
SITE PLAN LEGEND
/ now or former)
/ ANGEL RICHARD formerly
/
PIN: 911-50-9788
DB 2 73 PG. 2076
\ W.E. 963.4 CURRE T ZONING: GI
\
10' STREETYARD
11 X X X - X—mi X— X X - X= X-- X-= X X---
E� P PP S86°24'26"E— P
441.50'
PUBLIC - NOR ORDED R O ND) DE-R S EX. DRIVEWAY
OI -PRON CK — _
Y — —
PROP. FENC
a wl � \
LLJ I \
0 \
0
01\
- � P
---n-ow or formerl
yy \
DWA D. WALSH
PIN: 69111-50---_9307
2471 PG: -37�� �
DB � \
CURRENT ZONING: GI m 0
o
ZONING
BUFFER YARDS (if applicable)
Existing Zoning: GI
Adjoining Zoning: GI; RS-20
Proposed Zoning: GI
Plant F)
Type Required: IV
Proposed Use: Aphalt - _Concrete
Width Provided: varies (see note on -flan)
Fence Option: Yes x No
Type of Review Requested: Zoning Permit
SITE DATA
OFF-STREET PARKING
Current Zoning: GI
Total Site Area: 6.929 cc.
Proposed Use(s) Aphalt / Concrete Plant
Watershed: Muddy Creek Basin
Parking Calculation: 1 Spaces/ Employee
(Not in a Protected Watershed)
(may be more that one calculation required)
Site Address:
Required Parking: 15 Spaces
100 Anderson Street
Parking Provided: 15 std. Spaces
Rural Hall, NC
+ 8 truck parking
Forsyth County
All standard spaces 9' x 20' (typical)
Tract A: Tract B:
All truck spaces 12' x 40' (typical)
PIN: 691 1-60-2381 PIN: 691 1-60-5384
DB 3004, Pg. 2224 DB 1835, Pg. 4690
SITE SIZE AND COVERAGES
Lot Area: 5.496f cc. Lot Area: 1.433f ac.
Total Acreage: 6.929t acres
Owner: Owner:
Site Coverages:
Jason & Annie Speer Rickey & Anita Clayton
Building to Land 2.35
PO Box 95 8701 Crestbrook Rd
Pavement to Land 3.26 qo
Rural Hall, NC 27045 Rural Hall, NC 27045
Gravel to Land 15.20
Open space 79.19
INFRASTRUCTURE
TOTAL 100%
Water: x Public Private
Sewer: x Public Private
Note: Includes existing impervious to remain.
Streets: x Public Private
g concre�
MATERIAL
TORAGE­-,.,,
BINS
FIFE: 970t
wLU
�� \
o�
a WASTE
\ DUMP &
a STORAGE
sr�ti„ -�
GENERAL NOTES:
1) PROPOSED DEVELOPMENT SHALL UTILIIZE EXISTING BUILDINGS, TO BE
CONVERTED INTO OFFICES AND GARAGE WORKSPACE. EXISTING DOMESTIC UTILITY
CONNECTIONS SERVING THESE BUILDINGS WILL REMAIN. AN ADDITIONAL 2"
WATER TAP WILL BE INSTALLED FOR CONCRETE PLANT OPERATIONS.
2) HANDICAP ACCESSIBLE PARKING SPACE AND AISLE TO BE PAVED. ALL OTHER
PARKING AND DRIVES TO BE GRAVEL.
3) PROPOSED DEVELOPMENT SHALL UTILIZE EXISTING DRIVEWAY CONNECTIONS.
4) THE PORTION OF PROPERTY ON SOUTH SIDE OF BEAVER DAM CREEK IS NOT
PROPOSED FOR DEVELOPMENT. EXISTING VEGETATION IN THIS AREA SHALL
SUFFICE FOR BUFFERYARD REQUIREMENTS ALONG THE REAR PROPERTY LINE.
n
/ MAIN
C TD OF W IST. JOB8905
NEW " WATER
METE W/ RPZ
X X =—— X =>
STR EETYAR D
EXISTING
BUILDING
CALL NC ONECALLN,
BEFORE YOU DIG
S 0 P
1-800-632-4949
\ AVOID UTILITY DAMAGE /
W Eft MAIN �PP
OHP EX. 6'
w
HYD w S8611712-E
El _20.03' NPS �� \
N88'2;'27"1bL K
,n0v�or formerly � 1�2'PAP�
ED W.A'R D C �c ,�U--LIA M BALL °0-
PIN: 6910-58-4839
DB. PG.
CURRENT ZONING: RS20
\ \
Required Trees: 250 LF / 100 LF x 2 = 5 trees
(2 trees / 100 linear feet streetyard)
Note: Trees must be min. 8' high and 2" diameter, spaced
20-75 feet apart. Existing deciduous trees may suffice.
Required Shrubs: spaced max. 18" edge —to —edge
Note: Shrubs roust be min. 18" high. No more than 30%
of shrubs may be deciduous.
MOTOR VEHICLE AREA LANDSCAPING
Required Trees: 45,886 SF 2500 SF = 18.4 trees
(one tree / 2,500 SF motor vehicle surface area)
Proposed Trees: 19 Native Evergreens
Note: All parking spaces shall be located no more
than 50' from the trunk of a required tree.
GRAPHIC SCALE
40 0 20 40 80
( IN FEET )
I inch = 40 ft.
160
J
Gupton &
Webb, P.A.
ENGINEERS -PLANNERS -SURVEYORS
Am
GUPTON & WEBB P.A.
PO BOX 1070
KING, N.C. 27021
336-985-6519 FAX [phone]
E-MAIL guptonpa@GuptonGoxcm
C9RP_aWE,�OV E NO: C-0423
Laz Ito✓Y a \YlLg
W
W�
to
QNa.
�NN�W
L5
a
Z t,c5
-
so
w
aQ 2 0
_70 sl
0
Z
Q
3 �
O
�U
PROGRESS
DRAWINGS
GOVERNMENTAL
PERMITS
APPUED
FOR
DO NOT
USE FOR
CONSTRUCTION
SCALE:
1 "= 40'
REVISIONS:
SURVEYED BY: JSG
DRAWN BY: ASW
DESIGNED BY: HBG
APPROVED BY: HBG
11F11///
A
.�
O ,
5S'j
= E
- 360 -
1111���
SHEET TITLE:
SITE PLAN
1 of 2
DATE: 8/28/12
PROJECT NO: 12500-12D
EA

frz.
LEGEND
PROPERTY LINE
BUILDING FOOTPRINTANDERSON ST. W — — — — RIGHT OF WAY LINE
S LINE FROM DEED OR PLAT
SITE W EXIST. WATER LINE /
p� L SS EXIST. SAN. SEWER LINE
s7a
= = = EXIST. STORM DRAIN
EL —PROP. STORM DRAIN
— G eHPwr G- OVERHH GAS IN POWER LINES n o w or formerly
18 - Fo — Te16 - FIBER OPTIC / TELEPHONE A N G E L A R I C H A R D SCOT T
TVW CABLE �� PIN: 911-50-9788
N/F NOW OR FORMERLY
® STORM DRAIN PIPE NUMBER D B 2 73 PG. 2076
4� PROPOSED SPOT ELEVATION / \ C U R R E T ZONING: G
<° O EIP EXISTING IRON PIN WE. 963.4
O NIP NEW IRON PIN
'Z O NPS No POINT SET
JQ x � PP POWER POLE ` L6�204"
STREETYARD6� »� HYD HYDRANTZ © TB TRAFFIC SIGN BOX
MO TV CABLE TV PED.
X X X X— X— X X X X X X X— PTELL TELEPHONE PED. EI r PP S826 E
LOCATION MAP — NOT TO SCALE LP LIGHT POLE
441 .50'
(a) WM WATER METER
® EWE CO SR CLEAN -OUT \ _
PUBLIC - NOR ORDED RW 0 ND)�E� S R��T
YI YARD INLET Ex. DRIVEWAY
[] TI THROAT INLET
Q CB CATCH BASIN 0' I I\ O N S L I LEA C fi r
0 MR MANHOLE —
ZONING
BUFFER YARDS (if applicable)
Existing Zoning: GI
Adjoining Zoning: GI; RS-20
Proposed Zoning: GI
Plant F)
Type Required: IV
Proposed Use: A halt Concrete
Width Provided: varies (see note onplan)
Fence Option: Yes x No
Type of Review Requested: Zoning
Permit
SITE DATA
OFF-STREET PARKING
Current Zoning: GI
Total Site Area: 6.929 ac.
A halt Concrete Plant
Proposed Use(s) P %
Watershed: Muddy Creek Basin
Parking Calculation: 1 Spaces/ Employe
(Not in a Protected Watershed)
(may be more that one calculation required)
Site Address:
Required Parking: 15 Spaces
100 Anderson Street
Parking Provided: 15 std. Spaces
Rural Hall, NC
+ 8 truck parking
Forsyth County
All standard spaces 9' x 20' (typical)
Tract A: Tract B:
All truck spaces 12' x 40' (typical)
PIN: 691 1- 60-2381 PIN: 6911
—60--5384
DB 3004, Pg. 2224 DB 1835,
Pg. 4690
SITE SIZE AND COVERAGES
Lot Area: 5.496E cc. Lot Area:
1.433E cc.
Total Acreage: 6.929E acres
Owner: Owner:
Site Coverages:
Jason & Annie Speer Rickey & Anita Clayton
Building to Land 2.35
PO Box 95 8701 Crestbrook
Rd
Pavement to Land 3.26
Rural Hall, NC 27045 Rural Hall,
NC 27045
Gravel to Land 15.20
Open space 79.19
INFRASTRUCTURE
TOTAL 100
Water: x Public
Private
Sewer: x Public
Private
Note: Includes existing impervious to remain.
Streets: x Public
Private
EEND/F EXIST. WATER/ MAIN
CIT OF WW—S OB #8905
NEW " WATER
METE W/ RPZ
X— XX �7
EXISTING
BUILDING `
X�
X� W F_R MAIN
X� OHP FX• f" ��
X X� Xf w
HYD w S'E
EIP
a20.G3' N P S
1 E—
�—
wM
X
FT,iiS�...T _:. .-. •. ' PP TI
STD.
XIS
WATER CONN.
I EIP \
� 1/2A PIPE 120.10' J 1 ljd" so. STM \
N88'2127 �J
/ 0*-,,or formerly EIP �
-� -EDWAfRD C & JU-N-A M- ALL 1 1/2° PIPE 410 \ \ \
PIN: 6910-58-4839 ' 0
DB. PG.
CURRENT ZONING: RS20
GENERAL NOTES:
1) PROPOSED DEVELOPMENT SHALL UTILIIZE EXISTING BUILDINGS, TO BE
CONVERTED INTO OFFICES AND GARAGE WORKSPACE. EXISTING DOMESTIC UTILITY
CONNECTIONS SERVING THESE BUILDINGS WILL REMAIN. AN ADDITIONAL 2"
WATER TAP WILL BE INSTALLED FOR CONCRETE PLANT OPERATIONS.
2) HANDICAP ACCESSIBLE PARKING SPACE AND AISLE TO BE PAVED. ALL OTHER
PARKING AND DRIVES TO BE GRAVEL.
3) PROPOSED DEVELOPMENT SHALL UTILIZE EXISTING DRIVEWAY CONNECTIONS.
4) THE PORTION OF PROPERTY ON SOUTH SIDE OF BEAVER DAM CREEK IS NOT
PROPOSED FOR DEVELOPMENT, EXISTING VEGETATION IN THIS AREA SHALL
SUFFICE FOR BUFFERYARD REQUIREMENTS ALONG THE REAR PROPERTY LINE.
STREETYARD
Required Trees: 250 LF / 100 LF x 2 = 5 trees
(2 trees / 100 linear feet streetyard)
Note: Trees must be min. 8' high and 2" diameter, spaced
20-75 feet apart. Existing deciduous trees may suffice.
Required Shrubs: spaced max. 18" edge--to—edge
Note: Shrubs must be min. 18" high. No more than 30%
of shrubs may be deciduous.
MOTOR VEHICLE AREA LANDSCAPING
Required Trees: _45,886 SF / 2500 SF = 18.4 trees
(one tree / 2,500 SF motor vehicle surface area)
Proposed Trees: I9 Native Evergreens
Note: All parking spaces shall be located no more
than 50' from the trunk of a required tree.
/CALL NC ONECALL\
BEFORE YOU DIG
S 01
1-800-632-4949
\ AVOID UTILITY DAMAGE /
GRAPHIC SCALE
40 0 20 40 Bo 160
( IN FEET )
1 inch = 40 ft.
Gupton &
Webb, P.A.
ENGINEERS -PLANNERS -SURVEYORS
GUPTON & WEBB, P.A.
. PO BOX 1070
KING, N.C. 27021
336-985-6519 FAX [phone]
E-MAIL [e-mail]
CORPORATE LICENSE NO: G-0423
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PROGRESS
DRAWINGS
GOVERNMENTAL
PERMITS
APPLIED
FOR
DO NOT
USE FOR
CONSTRUCTION
SCALE:
1 °°- 40'
REVISIONS:
SURVEYED BY: JSG
DRAWN BY: ASW
DESIGNED BY: HBG
APPROVED BY: HBG
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360
SHEET TITLE:
SITE PLAN
1
OF 2
DATE:
8/28/ 12
PROJECT
NO: 12500-12D