NCG160223_COMPLETE FILE - HISTORICAL_20160928

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
I IV c,& 16,90-a3
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
p 7.b I �,; c)/ ,� a
YYYYMMDD

Central Files: APS _ SWP _
9/2312016
Permit Number NCG160223
Permit Tracking Slip
Program Category
Status
Project Type
NPDES SW
In review
New Project
Permit Type
Version
Permit Classification
Asphalt Paving Mixture Stormwater Discharge COC
COC
Primary Reviewer
Permit Contact Afflilation
julie,ventaloro
Coastal SWRule
RECEIVED
Permitted Flow
S E- P 28 2 n l6
CENTRAL FILES
Facility
DWR SECTION
Facility Name MajortMinor Region
Fibercrete Preservation Technologies, Inc. Minor Winston-Salem
Location Address County
301 Old Hwy 52 S Surry
Facility Contact Affiliation
Mount Airy NC 27030 Keith Miller
301 Old Hwy 52 S
Owner Mount Airy NC 27030
Owner Name Owner Type
Fibercrete Preservation Technologies Inc Non -Government
Owner Affiliation
Jonathan Simmons
131 St James Way
Dates/Events Mount Airy NC 27030
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue
Effective
Expiration
8/2312016
Z3I La
qh-3 f 2-0/ b
9 % 30 401 9
Regulated Activities
Requested /Receiived Events
T
Asphalt paving mixture production
RO staff report requested
919116
RO staff report received
9122/16
Outfal l 001
Waterbody Name
Stoney Creels
Streamindex Number
12-72.12
Current Class Subbasin
0 03-07-03

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
September 23, 2016
Mr. Jonathan Simmons
Fibercrete Preservation Technologies, Inc.
I31 St. .lames Way
Mt. Airy, NC 27030
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
TRACY DAVIS
Director
Subject: General Permit No. NCG 160000
Fibercrete Preservation Technologies, Inc.
COC No. NCG160223
Surry County
Dear Mr. Simmons:
In accordance with your application for a discharge permit received on August 23, 2016, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit. This permit 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 October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and [..and Resources. The Division of Energy, Mineral and Land
Resources 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 Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone number
[phone] or by email julie.veintaloro cr ncdenr.gov.
Sincerely,
for'Fracy E5Dais.. 11.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Winston-Salem Regional Office, Glen White
Central Files
Stormwater Permitting Program Files
0
State of Forth Carolina I linvironmental Quality I Energy, Mineral and land Resources
1612 Mail Service Center 1 512 North Salisbury Street J Raleigh, NC 27699-1612
919 707 9200 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCGI60223
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,
Fibercrete Preservation Technologies, Inc.
is hereby authorized to discharge stormwater from a facility located at
Fibercrete Preservation Technologies, Inc.
301 Old Hwy 52S
Mt. Airy
Surry County
to receiving waters designated as UT to Stoney Creek, a class C water in the Yadkin River Basin,
in accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts 1, II. III. and IV of General Permit No. NCG160000 as attached.
This certificate of coverage shall become effective September 23, 2016,
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 23, 2016.
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

NCG160223
N
w El
S
Map Scale 1.-24, 000
Fibercrete Preservation Technologies, Inc.
Latitude: 360 27' 23" N
Longitude: 800 33' 35" W
County: Surry
Receiving Stream: UT to Stoney Creek
Index No: 12-72-12
Stream Class: C
Sub -basin: 03-07-03 (Yadkin River Basin)
Facility Location

Division of Energy, Mineral, and Land Resources
.�,.p...� Land Quality Section
NCn��®..ENR National Pollutant Discharge Elimination System
Na TH GVtOL DePPFTNENT of
EX VIR�XMEM —0 Nw LL _ R.aq cc.
NCG 160000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
Month
Div
Certificate ol'Cov
Check it
1 Amount
ennit Assi �c to
aid
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG160000 for STORMWATER DISCHARGES associated with activities classified as:
SIC 2951 The manufacture of Asphalt Paving Mixtures and Blocks,
And, Like activities deemed by DEMLR to be similar in the process, or the exposure of raw
materials, intermediate products, final products, by-products, or waste materials.
(Please print or type)
1) Mailing address of t
Name
Owner Contact
Street Address
City
Telephone No.
E-mail Address
2) Location of the facility producing the discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, an
distance and direction from a ro dway intersection). �[o � e cle CA�A�
(A copy of a county map or USGS quad sheet with facility clearly located on the map is a required part of this application.)
./ y 211 ✓ 334 3c 1t
4) Latitude S U 1 J Longitude` J (degrees, minutes, seconds) 10�00
o
5) This NPDES Permit Application applies to which of the following 0�4" 1* �
El New or Proposed Facility" Date operation is to begin �y�%tia �oJ.
5Y Existing
"If this new or proposed facility is located in one of the 20 coastal counties, please contact the appropriate DEMLR ,g�AaI
Office (see page 4) to determine if a State Stormwater Permit is required prior to construction, 40
Page i of 4
RM-231-030909 Last revised 9110/14

NCG160000 N.O.I.
K'
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: Z
7) Services and Activities
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facility: (Include a site diagram showing the process areas and location of
activities present at this facility.)_ 1r,3�k 6A 0 kin q C_C-_-3'-'Yl D 00�-
b) Check all activities conducted at this facility.
( Outdoor stockpiling of materials
( v5torage of raw materials
( ✓Storage of materials in above-
gr and tanks
( ✓Material Loading and Unloading
8) Discharge points 1 Receiving waters:
(ffransport of materials by a conveyor
or front-end loader
( Vehicle and equipment maintenance
( Vehicle or Equipment Washing
( Vehicle and equipment fueling
How many discharge points (ditches, pipes, channels, curb and gutter, swales, etc.) convey stormwater from
the property? _ \ - S L.X-Dckx.e -
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? O,r,P l 1 �Ot e
If the site stormwater discharges to a separate storm seAr system, nrf4
me the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). J_
Receiving water classification (if known): C -
9) Does this facility
a) Have an untreated wastewater discharge? M No ❑ Yes
b) Have a treated wastewater discharge? RIN' o ❑ Yes
If yes, list the permit number,
c) Have a wastewater discharge from a recycle system? EP No ❑ Yes
If yes, list the permit number.
d) Have a non -discharge permit? 13 No ❑ Yes
If yes, list the permit number.
e) Discharge wastewater to a municipal wastewater collection system? No ❑ Yes
If yes, list the municipality and permit number
Note: Stormwater discharge permit NCG160000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG160000.
10) Does this facility employ any best management practices for stormwater control?
El No IrYes (Show any structural BMP's on the site diagram.)
If yes, please briefly describe: Vp c2c WfL�+`\`
5WU-234-030909
Page 2 of 4
Last revised 09/10/14

NCG160000 N.O.I.
11) Does this facility have a Stormwater Pollution Prevention Plan?
El No 11?ites 'n 1
If yes, when was it implemented? AUQ � 5 � Z O 1
12) Are vehicle/equipment maintenance activffies occurring at this facility?
QsNo ❑ Yes
13) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
Dll Io ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
20'No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
h�'No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
&�o ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b, or c., please provide the following information:
Type(s) of waste: lV
How is'material stored. -
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address:
14) Certification:
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rufemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit. I certify that I am familiar with the information contained in this application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Siqninq: J19A94liky 51fW1nD n s
Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Page 3 of 4
SWU-234-030909 Last revised 09/10/14

NCG160000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included.
Please do not ask us to "hold" an incomplete application in anticipation of a check under separate cover.
Id Check for $100 made payable to NCDENR
G50" This completed application signed by the applicant, and all supporting documents
A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
(corresponding to which drainage areas), (d) runoff conveyance structures, (e) areas where materials are
stored, (f) impervious areas, (g) site property lines, (h) vehicle and equipment maintenance, blasting,
painting, and washing areas, and (i) location of activities listed in 7b.
Q� Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Please mail the entire package to:
Stormwater Permitting Program
Division of Energy. Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note:
The submission of this document does not guarantee the issuance of NPDES permit coverage.
For questions, please contact the DEMLR Regional Office for your area.
To visit our website please go to htt :// ortaLncdenr.or /web/!r/stormwater
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
707-9220
Page 4 of 4
SVVU-234-030909 fast revised 09/10/14

---------------------T.\
p
Area
Oil AST
local surface ester Saw direction

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z
I-
e Carports, Inc.
irporate Office)
Miller's Tavern©
Fibrecre�TechnoIog
Astro Pneumatic Tool Co
0
a
Mayberry Auto

Directions
For Fibrecrete:
From 77 -
Take exit 100 to hwy 89 east. Go 1 mile then,
Take exit 101 for Hwy 74 east then,
Take exit 17 for Hwy 52 north then,
Take exit 141 Holly Springs Church Road
Take a left at the top of the ramp
Go down the hill past TNT carports
On the left is a Gold Warehouse
Pull in and stay to the right of the building.
Fibrecrete is at the back of this warehouse.
From 52S -
Take Hwy 52 north to Exit 141 Holly Springs Church Road
Turn left at the top of the ramp
Go down the hill past TNT carports
On the left is a Gold Warehouse
Pull in and stay to the right of the building.
Fibrecrete is at the back of this warehouse.

FIGURE 1
USGS 7.5 MIN TOPOGRAPHY MAP
July 1, 1996
Fibrecrete Preservation Technologies, Inc.
301 Old Highway 52 South
Mount Airy, NC 27030
LRq
INMR,'
Inc
.
Moomswimi,NC 28115

2014 Integrated Report http://ncdenr.maps.arcgis.cord/apps/xvebappviewer/index.htini?id=dcb44...
t2tOB;Q��r County?
301 Old US 52 S, Mount Airy, No X«
Sha+ra search results for 301 Old U5 52,.. y `*�`' •��.�''� `_ �tYl
U.. Ott
fi a. c
xx
)I hftAiry
'i
x S;t'ov Sars
JI
«:.
y
Stream Information: �� w
Stream Fhdex: 12.72-12
I Stream Name: Stoney Creek
fir't Description: From source to
Ararat River ' � _ � : •� ,, eta . Er
Classification: C
i� Date of Class.: April 5, 1955
What does this glass. More info,.�in�ay
' t� n
mean?
t.t} River Basin: Yadkin Pee -Dee
� ,...�7 Zoom to Yr.
Vau�h}tvry �,: •a,c�ilf:}ttl�-=---"` ���,.���`..-^''a';+� iri`_�'frijrlc�T=r -�'��
gtchai i>i*
-'
A
aim
I of 1 _. 8/11/2016 3:05 PsV1

S FIBRECRETE PRESERVATION : Pnic sank, N.A.
J TECHNOLOGIESONC. - ' Pittsburgh, PA _ T '
P.O. BOX 6007 $/22/20.1
131 ST. JAMES WAY 8-9/430
MOUNT AIRY, X (36).7 4 01 OJ�Q `
PH' 336789-7259 FAX (336).7$9-7425 0
PAY TO Tl4E• NCDENR - �******.**�*1 00.00*-
ORDER OF
*ONE HUNDRED AND XX / 100 DOLLARS
TWO SIGNATURES REQUIRED
NCDENR_..0
BY:
MEMO � l_�"_�:G

If'
Energy, Min era!
and Land Resources
ENVIRONMENTAL OLIAUTV
Mr, Jonathan Simmons
Fibercrete Preservation
131 St. James Way
Mt. Airy, NC 27030
Dear Mr. Simmons:
f �-, tp-
1
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
TRACY DAVIS
NC Departmentdf—
September 23, 2016 Environmental quality
Received
OCT 0 5 2016
Technologies, Inc.
Winston-Salem
RepionNl
Subject: General Permit No. NCG160000
Fibercrete Preservation Technologies, Inc.
COC No. NCG 160223
Surry Court y
fit accordance with your application for a discharge permit received on August 23, 2016, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit. This permit is issued pursuant to the requirements ofNohtlt Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
l"Invironmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval ofthe
Division of Energy, Mineral and Land Resources. Tile Division of Energy, Mineral and Land
Resources 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 Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
Ifyou have any questions concerning this permit, please contact Julie Vcntaloro at telephone number
[phone] or by email julie;ventaloro a.ncdenl-.gov.
Sincerely,
ORIGINAL SIGNED BY
RIETHANNY GEORGOULIAS
for Tracy E. Davis, P.E,, CPM, Director
Division of Energy, Mineral and Land Resources
cc: Winston-Salem Regional Office, Glen White
Central Files
Storlrnvater Permitting Prograttt Files
State of Nonh Carolina I Environmental Quality I Energy, Mineral and I.and ResaIRAS > o
1612 !`tail Service Center 1 512 North Salisbury Sirect I Raleigh, NC 27699-1612
919 707 9200 T

lie
STATE OF NORTH CAROLINA
DEPARTMENT Of ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160223
STORMWAT171R. 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,
Fibercrete Preservation Technologies, Inc.
is hereby authorized to discharge stormwater from a facility located at
Fibercretc Preservation Technologies, Inc.
301 Old I-lwy 52S
Mt. Airy
Surry County
to receiving waters designated as UT to, Stoney Creek, a class C water in the Yadkin River Basin,
in accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts 1, 11, 111, and IV of General Permit No. NCG 160000 as attached.
This certificate of coverage shall become effective September 23, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 23, 2016,
ORIGINAL SiGNS BY
BrTI'A�1Y GORGOULIAS
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

1
lwSM�
uur=ar�rrr
riR7[aGh •,_ f• I � r S�
�•• Fibercrete Preservation Technologies, Inc, (�
Airp 1 J •l�r-�-1.��tiW� ti 1 Rai--'7
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IN
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�� ' ��� �• *'� �y�Y's � �� /- R �C�`\".J /" J fr; � .•i•�lI � /'��'. ,_\ `-1 � � =� q � �1 `\Uiq
�! J!/ �,ti_�.. .•x-�. �/4 �/--�, i��f ���/�'-���sJJl r�ra-�_�r �11 �� i' l �� f l ;i f['L
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LD r
Villa \ !T,`; ;�, - ���.��,--� , �_ �_���> ! ► ��, i�1; �, i �::r�.
*� � � 1'� 4 �_.J�`/ �f 4� � •J�' •���✓�� � % � -_V i� �/ 1�1 \, 1 .. fJf
6�.�
��IN�f'!�l%• 7 i� �/',ems=s r ��`t tl ••\ •���� ���`t :�^\� �j �,r J 1` �`a���' /r.��� `�
1�7-:�/ r1i11 l _.•.i=x J �' r,l� •._ ���r�l, `� .-ry t0i2� •j •; �` •�
"��I _._ C,ti���•. ��� . �.r�� ``_�1�.1�;��� !/,�v��..5 ar.%�, �` . � `��.J� . �'�aa� t' � `"r.��, _�rc,� :� J-.�Jlri �.
NCG 160223
N
W
S.
Map Scale 1: 24, 000
Fibercrete Preservation Technologies, Inc.
Latitude: 36° 27' 23" N
Longitude: 800 33' 35" W
County: Surry
Receiving Stream: UT to Stoney Creek
Index No: 12-72-12
Stream Class: C
Sub -basin: 03-07-03 (Yadkin River Basin)
Facility Location

Ventaloro, Julie
From: White, Glen
Sent: Thursday, September 22, 2016 10:27 AM
To: Ventaloro, Julie
Cc: Gantt, Matt; White, Sue
Subject: RE: Review Requests NCG070213 and NCG160223
Julie
I went by the location of the future Fibercrete (NCG160223) yesterday. I don't see any issue with issuing the permit. Ok
to permit.
Sue and I are meeting with Zack at Amanzi Marble's new site in Kernersville tomorrow morning to help him determine
outfalls. That one is ok to permit as well. It will be exactly the same type of operation as they currently have permitted
at another location in Kernersville.
Glen White
Environmental Specialist
NCDENR Winston-Salem Regional Office
Division of Energy, Minerals & Land Resources
450 Hanes Mill Rd — Suite 300
Winston-Salem, NC 27 105
glen. [e-mail]
[phone]
From: Ventaloro, Julie
Sent: Friday, September 09, 2016 3:58 PM
To: White, Sue <[e-mail]>; White, Glen <[e-mail]>
Cc: Gantt, Matt <[e-mail]>
Subject: Review Requests NCG070213 and NCG160223
Sue, Glen, Matt:
We've received NOls for one new facility and one existing facility in your region:
New Facility -- NCG070213 Amanzi Marble and Granite in Forsyth County. This site discharges stormwater to UT to
Reedy Fork (Class WS-III;NSW). The NOI is attached. I think the owner could use some assistance identifying their
stormwater outfalls.
Existing Facility -- NCG160223 Fibercrete Preservation Technologies in Surry County. This site discharges stormwater at
one outfall to LIT to Stoney Creek (Class C). The NOI is attached.
Please let rime know within 30 days if the Winston-Salem Regional Office has any concerns about issuing these COCs.
Thanks!
Julie Ventaloro
Stormwater Permitting Program
NC Division of Energy, Mineral, and Land Resources
1612 Mail Service Center, Raleigh, NC 27699-1612
Phone: [phone] Fax: [phone]

AGENCY USE ONLY I
A ffl1_9;WA
Division of Energy, Mineral, and Land Resources
n :�d..r�
Land Quality Section
NC®ENR
National Pollutant Discharge Elimination System
E —o—ew mi> Nff uq l RCseuRce5
NCG 160000
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG160000 for STORMWATER DISCHARGES associated with activities classified as:
SIC 2951
And,
(Please print or type)
1) Mailing address of
Name
Owner Contact
Street Address
City
Telephone No.
E-mail Address
The manufacture of Asphalt Paving Mixtures and Blocks,
Like activities deemed by DEMLR to be similar in the process, or the exposure of raw
materials, intermediate products, final products, by-products, or waste materials.
2) Location of the facility producing the discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
3) Physical Location Information:
Zr�c..
Please provide a narrative description of how to get to the facility (use street names, state road numbers, an \
distance and direction from a ro dway intersection). J\
1 ^p r n p-�-� I t 1�f'.. lz-, 19--\ , , . A r, 11 n n. A 1,.
(A copy of a county map or USGS quad sheet with facility clearly iocated an the map is a required part of this application.)
o , 2
4) Latitude___ L L J Longitude` (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following:
7
El New
El Exist nr Proposed Facility* Date operation is to begin �'-9�4f;' P" �i�
�¢�9
i
*If this new or proposed facility is located in one of the 20 coastal counties, please contact the appropriate DEMLR F��AaI
Office (see page 4) to determine if a State Stormwater Permit is required prior to construction.
PRop 1 of 4

W
NCG160000 N.O.I.
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: Z q 51
7) Services and Activities
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facility: (Include a site diagram showing the process areas and location of
activities present at this facility.)_ 1�_ �.�1�r _�:n q C.�1 t"] dl�C`
b) Check all activities conducted at this facility.
( Outdoor stockpiling of materials
(%, ' orage of raw materials
( ✓Storage of materials in above-
Xand tanks
( erial Loading and Unloading
8) Discharge points I Receiving waters:
(%/Transport of materials by a conveyor
or front-end loader
( Vehicle and equipment maintenance
( Vehicle or Equipment Washing
( Vehicle and equipment fueling
How many discharge points (ditches, pipes, channels, curb and gutter, swales, etc.) convey stormwater from
the property? \ -- C--, u_:�)0.\ -e _ _
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? _ --_- . ,.1 - cc
If the site stormwater discharges to a separate storm sewer system, n me the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
Receiving water classification (if known): C -
9) Does this facility
a) Have an untreated wastewater discharge? [E No ❑ Yes
b) Have a treated wastewater discharge? Rf4o ❑ Yes
If yes, list the permit number. //
c) Have a wastewater discharge from a recycle system? 0? o ❑ Yes
If yes, list the permit number..
d) Have a non -discharge permit? E No ❑ Yes
If yes, list the permit number.
e) Discharge wastewater to a municipal wastewater collection system? 15"No ❑ Yes
If yes, list the municipality and permit number
Note: Stormwater discharge permit NCG160000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG160000.
10) Does this facility employ any best management practices for stormwater control?
ElE No Yes (Show any structural BMP's on the site diagram.)
If yes, please briefly describe: six-i\f
Page 2 of 4

NCG160000 N.O.I.
11) Does this facility have a Stormwater Pollution Prevention Plan?
El No l �'�'eit!s
If yes, when was it implemented? _ 1 "Q 0 5 A- � (�
12) Are
vehicle/equipment maintenance activi lies occurring at this facility?
C" No ❑ Yes
13) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
UIo ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
2"N"o ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
Ek o ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
D.< ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is'material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address:
14) Certification:
North Carolina General Statute 143-215.6B (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit. I certify that I am familiar with the information contained in this application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: JD12jg T& r ingr75
Title: TreS,riPI
yr �N�„i.w,cf
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
papa q of d

NCG160000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included.
Please do not ask us to "hold" an incomplete application in anticipation of a check under separate cover.
2 Check for $100 made payable to NCDENR
Q/ This completed application signed by the applicant, and all supporting documents
!� A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
(corresponding to which drainage areas), (d) runoff conveyance structures, (e) areas where materials are
stored, (f) impervious areas, (g) site property lines, (h) vehicle and equipment maintenance, blasting,
painting, and washing areas, and (i) location of activities listed in 7b.
I?/ Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Please mail the entire package to:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note:
The submission of this document does not guarantee the issuance of NPDES permit coverage.
For questions, please contact the DEMLR Regional Office for your area.
To visit our website please go to http://Portal.ncdenr.or_g/web/Ir/stormwater
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4 of 4

--------------------
0
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�hnologies, Inc.
id US 52 S. W Airv. W- 27=
NENCO Inc
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.. r
Directions
For Fibrecrete:
From 77 -
Take exit 100 to hwy 89 east. Go 1 mile then,
Take exit 101 for Hwy 74 east then,
Take exit 17 for Hwy 52 north then,
Take exit 141 Holly Springs Church Road
Take a left at the top of the ramp
Go down the hill past TNT carports
On the left is a Gold Warehouse
Pull in and stay to the right of the building.
Fibrecrete is at the back of this warehouse.
From 52S -
Take Hwy 52 north to Exit 141 Holly Springs Church Road
Turn left at the top of the ramp
Go down the hill past TNT carports
On the left is a Gold Warehouse
Pull in and stay to the right of the building.
Fibrecrete is at the back of this warehouse.

FIGURE 1 J
USGS 7.5 MIN TOPOGRAPHY MAP
July 1., 1996
Fibrecrete Preservation Technologies, Inc.
301 Old Highway 52 South
Mount Airy, NC 27030
1.. INENCO, Inc.
•%'� , 132 W. $TATESVILLE AVE.
L,.
MOORESVILLE, NC 28115

A • •
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�' + s•is � ", x��', _ �:. � s: .fir ..p{ ;.
Stream Information: �«• .'
a'
�f Stream Index- 12-72-12a� y�
f
Stream Name: Stoney Creek
! Description: From source to .. s�
;ram Ararat River f
' 17,
ClAssification: C E ;
Date of Class.: April 5, 1955
What does this Class. More info
River Basin: Yadkin Pee -Dee
Zoom to
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. x�'A"°:."i.:[,iCit�rt:l•} .Qp�f�r �ii:{�

t _ 9
N
-RA
Division of Energy, Mineral, and Land Resources
�. A
Land Quality Section
NCDENR
National Pollutant Discharge Elimination System
Nw1 C•nouw. D�o,
�mrgrnar, .rlo Amµ A[pMCcs
NCG160000
NOTICE OF INTENT
Dwe
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG160000 for S T ORMWATER DISCHARGES associated with activities classified as:
SIC 2551 The manufacture of Asphalt Paving Mixtures and Blocks,
And, Like activities deemed by DEMLR to be similar in the process, or the exposure of raw
materials, intermediate products, final products, by-products, or waste materials.
(Please print or type)
1) Mailing address of t
Name
Owner Contact
Street Address
City
Telephone No.
E-mail Address
2) Location of the facility producing the discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
3) Physical Location Information:
-Ef-tG.
Please provide a narrative description of how to get to the facility (use street names, state road numbers, an \
distance and direction from a ro dway intersection). J
(A copy of a county map or USGS quad sheet Wih facility Dearly located on the map is a required part of this application.)
Z to�— A
4) Latitude SU° 2 Longitude' t�
(degrees, minutes, seconds) /�+]
5) This NPDES Permit Application applies to which of the following
ti
❑ New or Proposed Facility` Date operation is to begin
EY Existing
'If this new or proposed facility is located in one of the 20 coastal caunties, please contact the appropriate DEMLRal
Office (see page 4) to determine If a State 5tormweter Permit is required prior to construction.
Page 1 of a
=,RW� i-���lninon�' 'i;s;ct �+ufca�+'ce9ruta

NCG160000 N.O.I.
6) Standard Industrial Classification:
Provide the 4 digit Standard industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: Z C1 5 k
7) Services and Activities
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facliity: (Include a site diagram showing the process areas and location of
b) Check all activities conducted at this facility.
( Outdoor stockpiling of materials
(vStorage of raw malterials
[ ✓Storage of materials in above-
Pund tanks
( ✓Material Loading and Unloading
8) Discharge points / Receiving waters:
(✓Transport of materials by a conveyor
or front-end loader
( Vehicle and equipment maintenance
( Vehicle or Equipment Washing
( Vehicle and equipment fueling
How many discharge points (ditches, ipes, channels, curb and gutter, swales, etc.) convey stormwater from
the property?
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
Ifthesite estormwate discharges to a separate storm sewer system��me the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
Receiving water classification (if known):
9) Does this facility
a) Have an untreated wastewater discharge? &-No ❑ Yes-
b) Have a treated wastewater discharge? R No ❑ Yes
If yes, list the permit number.
c) Have a wastewater discharge from a recycle system? M4o ❑ Yes
If yes, list the permit number.
d) Have a non -discharge permit? [3 No ❑ Yes
If yes, list the permit number.
e) Discharge wastewater to a municipal wastewater collection system? No ❑ Yes
If yes, list the municipality and permit number
Note: Stormwater discharge permit NCG160000 does not authorize the discharge of any wastewater,
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit In addition to coverage for stormwater discharges under NCG160000.
10) Does this facility
--employ any best management practices for stormwater control?
❑ No B Yes (Show any structural BMP's on the site diagram.)
If yes, please briefly describe: tj
Page 2 of 4
i;aW� F.::'�:EYViM114: ilf:oel'ieiilirii rai �'ni *a

NCG160000 N.O.I.
11) Does this facility have a Stormwater Pollution Preventlon Plan?
❑ No les
If yes, when was it implemented? Lin
12) Are vehicle/equipment maintenance actin es occurring at this facility?
9sNo ❑ Yes
13) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
Qe`o ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
Rio ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg, or more of hazardous waste generated per month) of
hazardous waste?
&K ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
f>i < ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: IV
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
14) Certification:
North Carolina General Statute 143-215.6E (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management) Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit. I certify that I am familiar with the information contained in this application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: JZM T/1j/ �rnMprl s
This Notice of Intent must be accompanied by a check or money order for 1,100.00 made payable to:
NCDENR
Page 3 of 4
1 QW! 1..?'il,:f1'{hLYiG .° I~�y,�' isii:X�O� n9+tifi:r N

NCG160000 N.O.I.
Final Checklist
This application will be returned as Incomplete unless all of the following items have been included.
Please do not ask us to "hold" an incomplete application in anticipation of a check under separate cover.
CT Check for $100 made payable to NCDENR
Q/ This completed application signed by the applicant, and all supporting documents
Q� A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
(corresponding to which drainage areas), (d) runoff conveyance structures, (e) areas where materials are
stored, (f) impervious areas, (g) site property lines, (h) vehicle and equipment maintenance, blasting,
painting, and washing areas, and (i) location of activities listed in 7b.
C� Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Please mail the entire package to:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note:
The submission of this document does not guarantee the issuance of NPDES permit coverage.
For questions, please contact the DEMLR Regional Office for your area.
To visit our website please go to httpJ/portal.ncdenr.orq/weblir/stormwater
DEMLR_Regio._nal Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
707-9220
Page 4 of 4

-------------------
i ' \
|
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��
Oil Storage Area
10,000 gallon &phalt AST
50 gallon Hot Oil AST
Oi I Storage Area3,ODO gallon Cold Oil AST
—..... ~'_—................................
Fibrecrate
�Stomater
.e

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Directions
For Fibrecrete:
From 77 -
Take exit 100 to hwy 89 east. Go 1 mile then,
Take exit 101 for Hwy 74 east then,
Take exit 17 for Hwy 52 north then,
Take exit 141 Holly Springs Church Road
Take a left at the top of the ramp
Go down the hill past TNT carports
On the left is a Gold Warehouse
Pull in and stay to the right of the building.
Fibrecrete is at the back of this warehouse.
From 52S
Take Hwy 52 north to Exit 141 Holly Springs Church Road
Turn left at the top of the ramp
Go down the hill past TNT carports
On the left is a Gold Warehouse
Pull in and stay to the right of the building.
Fibrecrete is at the back of this warehouse.

FIGURE 1
USGS 7.5 MIN TOPOGRAPHY MAP
July 1, 1996
Fibrecrete Preservation Technologies, Inc.
301 Old Highway 52 South
Mount Airy, NC 27030
INENCO, Inc.
j 132 W. S A Esviu.E Ave.
111111111 1V(oomvn.L NC 28115

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