HomeMy WebLinkAboutNCG020366_MONITORING INFO_20180105STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
❑HISTORICAL FILE
J�MONITORING REPORTS
DOC DATE
❑ �UIFSUI U`J
YYYYMMDD
I - — -1
ANN,.UA.L.SUM.MkkY�IDI.SC.HARGE: MONITORING.
:REPORT,(DMR EWATER,
.-S '$A U TO CENTRAL OFFICE
General 'Perm ' i ' t-N& N CG 0 ' 2b6 ' 60'
-Y
`-Re �ort ALL WASTEYVAT't;�"4�6`hitbriq§ d6iabn this fbnrn (include. 4No Flow.TN6, Mchirge"' diihiftVi6fah'
an OF14-#rdm
the previous calefidary6duto lhebby MARCH 1- �b of eadh year.
Cefflfite Q 'N_ NC002"'EMN�
Ayera e o
:gac(�Jty Name� e-Mifie.
c CumberlandPUOY:
P,hoM N . dffib'Or: 1.910-990-7928 ToW -n 6 . :VioUftfK-Mbhit6i-ed, Na'.
Qdrfified Labd.rafor' tab
�iiewatdt � WW i�thq Wige",0qtfai1 No .'
Is this an Fnttustrial°sand hi iie (See 40 CFR" §436.S:Ubpait C41- *ei El M60'
T
.Qbes-this..g�qtt4!!"Oisi�.hcirq lo SA-.Watqro Yes El
Doesl-his otitf.411 disco4roe_W* joLj§gior_-!oN'A-,.jva jjjS?' Yo_i'D W6 0.
Ddeg'tfiji,* __IL ' discharge' W.Wtio.-HQWor.ORWwat . ers? Y1eiiF_T .100
It so; what:is :Tql 0 flow rater _',oK Ticf611yAnfiUd'hcddwqiers 7Q'
Does this putiajfdikfiarg6.WVII to Trout (Tr)'designateai4it6rs? YesEl .4dD
Were Oqre ;i_pyj1m it -vidiatidtis',Iri'th6:cdl6iiqA!- year?, _Yes.E] N6[]
'T
DailyTlo*'
--TSsr�
SS,,
Discharge
pS
V
I09n
Outfall±Naimul
4461dit
-o
(U)ZpA)lI,
-'
(6�T Turbidity;
m 1,
-NTU.
'7
S
Wd.5tn&2 gff�
Effluent
-HQworoRw
60% dto
!n=hwWar
6.0-9.0
25145
- _1
NO Limit
NIA
Lknitations
Qj 6
- •20130
1,
ny Troia
W+ctc Vftt" .
. _N/A..
;
WA
-0.1/02
I
'
Ma- Ave I DaUy y1ax.
kdk�i6N6FLOW
50/25/16
10115
1
'r1'ifc0qaMn1t&i
Pinnif Difte.1011/1015-S!3612626
L4st R& visa
C&Mcate ofCbveraiianNo. NCOW."mmmIM 6 J-6
Pt fllc,,AT"ION.'
prepared undeir-my-directWor
.',spperWsioniii6ct6fdaiibe.with ia:systeni.designed to.assurOth6fquajiffied.' -)P,qrli, . g,�ther- aind;
personnel p
ev-p-luk6ith' .04' tipn'submftWsBar;ed,o person prppMpg�w q managdth;6 systp
6lef9C 'th' f W 'th fprmafi6n'subffiftbb-dA& 46thd:Wstaf-my,'
ns,�dihactl those persons ysesponsq, pixffi.pTing�_pp ip.qTi. pq e:in--
kn lied 9--e'a- aid beret;4rue,;�aixuratei andb6fti6letv. ta ow
s"Ubm oni.;l!tO'uid-m'—the�ob�iibilh.,6i.6n-e!-s.-�-nd"imprisonmeni,fb('kffoWing--'Vi6iiiff66S., -
Ig 41
ibaiel:
p
,Mai! Annual Summary ,1Nastewater bmkt6iheI.4CbbU Ceh&AI Office:.
,V&te-the4-ddmssiscormct.'=-"bentrai,Ft7,-s.-i§tious,-d.,-'- :'dLf ',(n4t.' LR
t iDUlifi-vir6hfiibiAal duj* (bEQ).:
pivisibm of Water'RegbUrcesir
,Atth'i[)WR:Ceh I kilbs.,
Cenral , �
161T Mail S�6rv'jce Center 4 ?J61ghAC 27699-1617
Central FrlesTslephone (OP) 6049P
Qti6sbbnlq?- CoiftacOtikk 8t6ftfi"tidr-P® r-mmwhg Z" ln'.tffe;CL%IitrM.'.Qffice--'#t-,
-
10-0226'
iI /2Q1 5,—.9130=20�
Laq. P"c(10-24015.,
ANNUAL SUMMARY DISCHARGE MONITORING'
REPORT`(QMR}._-'WASTEWATER _
SUBMT T4 -.CENTRAL OFF{CEO: 7
General -Perinif:No'. NCG020000•
Calendar`Yea 201t
E'*kepor ALL WASTEWATER monftaring ifata an this. form Qhclude "No RoW1`N ' Discharge" aqd i mil V' lafiors j:from
the previous calendar year to the'DEQ by MARCH 1.`ofea6h.year.-.
Ceriiffcate of Coirerage;No NC002 ®Q�Q
Fae�lity Name `WadevMine:
Cuiiibeitarid; -
County � . - - .. ... .
Phone Number: -9( O-RPa792$ _. _ ~To#al r16
::4f outfalls mariitored , Na,
- - --
•Gertif ' - _ ied Lalyaratory �Na-
_ .Lab:*-
Wastewater, ( rwr Darge'Oudall�Na
Is this an. ;industrial:sarid mire (See 40 CFR§436:Subpart D)?' Yes; N�
Dads-this"out#a1l discharge WVif to_3A-Waters? Yes No[f
DQes:thi§:outFall discharge WW-to'SB or'PNA!*Aters?- Yes146[l,
Does this outfafl discharge WW taHQW or ORW graters? Yes[ No Q
16'so; what'is the 7.Q9Q flow rated or, Tidally influenced`.vvaiters, 7Q1Q,not'availi 46 []
Doesjt isboutfah disctla -e:-WW to Trout Tr dehated si ' ` - waters? ° Yes ❑ No[]
;'Were;there any lisriit �ioiatlo sin the;calendAuear?- Yes,O Nv0
,.... ..
- .. - :.
-, . -
-
. - �
.. x -;�
,•Fecal .
- `&
Daffy Flow
`., pH,TSS,DischargeUpstreaini�;
Qntream
f Coliform; �.
Out#MJA6 "r
1 �.
:Rate; cis
SiJ
,,
nigh
rnVl =.
Turbidity,k
(U)=Turbidity,
:(D)Tuibidjiy :
col%700ml
R.
NTU� ti
' Y MNTIJ. ..
1"3(SA
...:....._
:�a6�ta1 Rand
:.
.-.:_. _.. _ ....
.........._ -
-
..:
Effluent
HgwnrDRW
50%-of
"hi%cafcr
-5:0-9.0;
25145'
i6wcwom
ac�vr aRrv,
No Liralt
NIA
NIA
Limitations.
7G}'!0
�
2QI -
.ass. �
CW MTMd
°
°im1, `�
NSA
,-
s"
uo.Ave!Day lia
hKkutaNOFi6W
Mg orPM _
501251101
.i
P, ermit. Date?1 O/l /2015'—.913012020
Last Reyisad 16-2-'2015;
-PeMdatkaf. C6%(qf*qe No: NCG02!.
CERTWICA:T10'
"I cerEify under e.n �L3W'�thcat thii,46�u6entand at Aft6d�jjj,6jjt§ Wdre,.pr6
,P,- -A , - 'd. -�or
p ,Amd under My . irebticir
suPU &cc-O'rdO n de- W-ttiI i -
,rrt—Pqury,64kejhOrif�.0 uase.-
Yth&per§dn b6isortswho rpanagelklsy em-or
tiofilthe infdft6aMbm u mitteidlis.L:tbLu-i6Ibest:bf'
kndwleldgei. and belief
,8ccurate;,and-d6mOl6t&.,, J-jm:4wa-"thattherd a' 'si§fijfjdjE(nt,ppqajfes'
fbr
(Req
mltupg.f SU6 ornirig the ,Possibitrty of fines and _fi§.6n etif fo rkn
0 2
6 Ic 71
p
Marl Annual"summary We, DMR,td the -NdjEO don"I ofribLi:
Note_ the_aiiclress is. correct Centre! Fr7es;'is house[i, in
N.C: Departinent,of tiiiifircili'
-..menW' - f
P*(Wqn of
Miter'Resotfrees
Aftq.-:bWk-C--d-rittal Files-
'1617 MMl,-S6MC6,-C;anter.l
fWf6J6h,,,.NC,,`27699-1617
t0htral FiRig-Tele h 10) !80 . 7 . -6300
QL.i.0.#i6..ns.?, Pontad bEMUR,storthmitee
(01.9) 707:9220
lasi.--)4eksed .10-242015
. 4
ANNUAL SUMMARY 01S1CAROt, MONITORING
M WAS TEWATER,..
.$U9miTTOCENTRAk:. -AVj�- OF
On'e'ii'l : O'e' r mi fN di.. NOOO 26060-
a 2017 .,.Caleind 4-Y
.Report ALL WASTEWATER rrfbnitq.!tng data on this fberii (includwNo F16wmrNo Dischar i6lkonsl froir
ge" and Limit V
tfieprevious 6ilendar year to the DEQ by MARM i of each.y4ar,
GOZEEII Eg'-
Wade Mine�
Facllity,,Na�&�
c6d*-, I 'Cumberland-
-Phone Number. �,t",L910-0Q'7Oig."'. NA,
.,Qdffl6d �Na
Lab:#'-
"Waitewaier is
Fi, jndustiial.sAlndjr,h.!*,(�� F4436. gubpa( P) Yes. El
D600-thisputfall,disc"rge WW' -.witeis? es
-El *60
-ijoes�this;o6dall.'disctiairge,WW:to'tg,;br:PNA-,watL-rs?' �fes0 No
arg Widr-,ORW Waterr;7 Yes[ No
D66t�lhif,"6dtfiill discharge -Aio" H__Q_
-fibt *Aaihible.
If -�sqj )�Ocit'.1s,thOMO flio wii. rate? :or Ti.dally.inflPenced w6ters, 7QIO,
-01 -N El'
ffal liii�h-�i-OL-WW,"tb'-Trou't-(tr-)des'['gnatd matefs Ye6 `No
Does:El'
' id
; Were there any. limit v - jolationsin the caldndaf Yciae? Yes'Ej -No El.-
ETuent
-
HQWb� ORW
: 50%,of
No Lim -it
7Q1 0
50126/10
TIT
5.,i`iQ
M
R
L-M
Permit bai(iACVIl2d1'5,— 9.1-36/2-620
NCGO2''0000;
CERTIFICATION
CATION
`Lcertify -,under ,p@6kfty: of-'6W,ffi tthi§do&ftidrfand 'affaftach_-
Meh.tS Wee DreppTed,mfder;mY'4i,i6,6fi,or ffledpersdrihel proobfl��O#*r.And_
�qupervisidn in accord'a"n'ce'�iMth:a�sy6tem�d6s"lgoieid;WaSSUF6:tA6t.ciUaI
ev6lq?�t rffiation''submitted. ...BagiW:&K fti�, !ngUi r-'y,.,,df't-he .piarsbn',.&'-Pei-sonswho, _manage
Ahose"ple'rikins, i y resp"n lb.le,f e:ihio�a�66;1 infbfffi S o
for th_
- � r :q r r I -,fl, nalties f6r
'knowledge, am-aw�re'ihiifih ate- v qbj� iefi-true.::accuratq,""Eirid'66rbplete., I,-.- ere sigpi Icant, P
s aS es. -a- d' . ... .. tidh'irfcl(jdik0h6O.q� ibilifv,,-O�f in- n Imprison
.'MAil,- finual'.'Summar y WasteWAW"
Ndt6,rth6,address-is:correct-�ConLi-al.Ffldsis hi�ti inrQWR (aoLfbEfqLR)
N -0; Depaiime_k,otbf-4i'hifie MOO
U7
DiVislon,04 WatiDrflei�ti rc St,
Aftn: bWR Central Files -
I '"' 7' Z7�99!_ 61;
t
Central Fildi ';T&e he'(9,I.,0y!,8,0T6 300.
dbestibnO, jC:bn6ct'DtMLJWSto t6ePdfthitfihj`rStaiff, filthe Central 6ffldotat,
-:9
f
:OeMihLbaie
jbilji616 — 9130/2020
L:6seReviq4,di 40-27-2015'
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT DMR — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year
*Report All WASTEWATER monitoring data on this form (include "No Flov+ rNo Discharge' and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year,
Certificate of Coverage No. NCG02
Facility Name:
County:
Phone Number. (alp i . M Total no. of outfalls monitored _._ 0
Certified Laboratory N* Lab #
Lab #
Wastewater (WW) Discharge outfall No
Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes ❑ No ❑
Does this outrall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SI3 or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7010 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year? Yes ❑ No ❑
Outfail No.
Daily Flow
Rate, c%
pH,
SU
TSS,
mgll
SS,
mlll
ff
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
col/1 00 ml
SA
EffluentHnwa
Limitations
s nva t ossy
oRw
50 /� Of
ff
i'as„mt`r
6.0-9A
`anwad'20
6.8-8.5
HOW w�w
130
jawram
rf or '
10I1S
Haw. oRw,
S& SS. PNP
wanyrru
0.110.2
Na Limit mit
b®m-
Qtys
thaappirea:
50125/10
NIA
Wated uri
Standard
N/A
wal"Quali�7Q10
StandarG applies
NIA
Date Sample
Collected,
mold dlyr
i
Permit Date 10/1/2015 - 9/30/2020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02 U®F91W
CERTIFICATION
"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 am aware that there are significant penalties for
submitting false inforrpA4, including the possibility of fines and imprisonment for knowing violations."
[Required byl'40 CFI%§ f 22.22]
Signature'
Date i
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office:
Note the address is correct - Central Files is housed in DWR (not DEIrPLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone (919) B07-6300
Questions? Contact DEMI_R Stormwater Permitting Staff in the Central Office at,
(919) 707-9220
Permit Date 101112015 — 9130/2020
Last Revised 10--2-2015
Certificate of Coverage No. NCG02®�
Additional Quffall Attachment (make copies as needed for additional outhalls) -
Wastewater (WW) Discharge Outfall No
Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes ❑ No L❑
Does this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge VYW to SB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q1Q not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations In the calendar year reported? Yes ❑ No ❑
s
■.
—F-
Discharge
gni
Upstream
■.
Eff luleitt
mitotir
Mo. Ave I 112111Y MaL
•E' ••
MI 1
•
1 1
25/45
HQWor
1 3!
Raw or ORW 1,
Mg Tr or MA
!
'-
Trout—;
rany 1
•
Circle Water
! !
x
Collected,115
molddlyr
MOMMU
Pennit Date 10f1f2015 — 913ol2020
Last Revised 10-2-2015
Certificate of Coverage No. NGG02®[]
Additional Outfall Attachment (make copies.as needed for.additional ouftls).
Wastewater (WW) Discharge Outfall No.
Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes ❑ No ❑
Does this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q14 not available ❑
Does this outfall discharge WW to Trout (To designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year reported? Yes ❑ No ❑
Outfall No.
Daily Flow
Rate, efs
pH,
SU
TSS,
mgll
SS,
mill
NaWkea
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
N RJ
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
SA
Effluent
Limitations
6b. Ave I pally Max.
HOW or GRIN
50 /o of
7Q10
G-aficam NO FLOW
aat
freshwater
6.13-9.0
°°""""'water
6.8-&5
2514a
r+ew ar oaw
20130
hewornmv
VA Tr or PHA
,101,15
"A"orrw
sa, ss, PHa
craoyTrvut
D.110.2
No Limit
oUW3tyltahaald
ffwaPPI,es=
nln� f� A
50 G f 0
NIA
sta&a apa
NIA
Standara.rpgsa
NIA
Date Sample
Collected,
moldg!yr
- ..
Permit Date 1011/2015 — 9/30/2020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02 ®F&®L]
Additional Quifall Attachment (snake copies as needed for additional.outWls)
Wastewater (WW) Discharge Outfall No.
Is this an industrial sand mine (See 40 CFR W6 Subpart D)? Yes ❑ No ❑
Does this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HOW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year reported? Yes ❑ No ❑
Outfall Na.
Daily Flow
Rate, efs
pH,
SU
TSS,
mgll
SS,
mill
rrepfuuabra
Discharge
Turbidity, I
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliforrn,
co11100 ml
SA
tt
�ff�u�l7t
Limiteons
&IM Ava ! Daily Max.
NOWofor ORW
50% of
�Q 10
R,dbatb NO FLOW
Pl" PkBDh
lreshV1 tar
6.0-9.0
saltwater
6.8-8.J'
tatluetrftl Uaa
25M5
HOW orORIN
�e1'YA
flaweroRW
ael Tr or PMA
10I1$
HQW, ORW,
SA $6,"A,
OraryTropt
0.110.2
No Limit
Ciral Water
amatystanaa,d
et>at .apprfes:
�gfLJI1 /1
i//[[ 5 0
NIA
Waterouauty
Standardap{,uas
NIA
Wet•rnuHry
Stantlar4apPHes
NIA
Date Sample
Collected,
moldd/ r
I
I
E
I
I
I
I
Permit Date 10/112016—1313012020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02 53W
Additional ❑utfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfall No.
Is this an industrial sand mine (See 40 CFR §436 Subpart D)7 Yes ❑ No ❑
Does, this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HOW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q1Q not available ❑
Dues this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year reported? Yes ❑ No ❑
Outfall No.
Daily Flow
Rate, efs
PH,
SU
TSS,
mg/1
SS,
mill
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
6.011100 ml
SA
Effluent
Limitations
Vl Ave € Daily Max.
HOW or ORW
50%of
-7Q16
Endkaw NO FLOW
ram
frashxoter
6.0-$.0
sanwater
6•S-&5
tndust" Sand
25145
HQWvroRw
2t7130
Haw er URW
Q¢ Tr ar PNA
10115
HOW, ORW
sA sa,PN;;
or any Trout
0.1/0.2 .
No Limit
ClmleWater
O thatla�l rd
50125I1
NIA
Watercualny
Standard aPP€tee
NIA
water Quality
standard �pl€es
NIA
Date Sample
Collected,
molddl r
;
Permit Bate 101112015 — 913012020
Last Revised 10-2-2015
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year _Zoikp
'Report ALL WASTEWATER monitoring data on this form (include "No Flow"!"No Discharge" and Limit Violations) from
the {previous calendar year to the DEQ by MARCH 1 of each near.
Certificate of Coverage No. NCG02
Facility Name:
County:
Phone Number. LS
Certified Laboratory
Wastewater (WW) Discharge Outfall No
Lab #
Lab #
Total no. of outfalls monitored -- Q
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No ❑
Does this outfall discharge WW to SA waters?
Yes []
No ❑
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No ❑
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No ❑
If so, what, is the TQ10 flow rate? or Ttdatty influenced waters,
7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters?
Yes ❑
No ❑
Were there any limit violations in the calendar year?
Yes ❑
No ❑
Outfali No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mg/I
SS,
mlfl
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
cot/100 ml
SA
Effluent
LlmttatrORS
mo A" r owty max
HQWor0RW
50R�oi
7010
W
rndkagaNR i-LOW
tra�cabx
tre hvmtar
6.0�.t1
sattv'Wer
6.8-8. 5
25
t�wwoxar
20/31�
rlaw or oRw
M, Tr or PNA
10115
HQW.ORW
SAISBIPX&
or any Trout
0.1I0.2
No Limit
C1rc1e Water
Q mall applies:Slandtd
50l25110
V 25
NIA
water Qual tg
sraltdard appttes
NIA
wafer oua qr
Standafd �R�lae
NIA
Date Sample
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_
1
Permit Date 1011/2015 — 9/3012020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02 kjgWE,
CERTIFICATION
" 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 infon-nation submitted. Based on my inquiry of the person or persons who manage the system, or
these 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 (here are significant penalties for
submitting false infgRtnation, including the possibility of fines and imprisonment for knowing violations."
(Required Ily 40
Signature
Date 1"
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not DEMLP)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone (919) 807-6300
Questions? Contact DEll LR Stormwater Permitting Staff in the Central ice at. T
(919) 707-9220
Permit Date 10/112016 — 9/30/2020
Last Revised 10-2-2015
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year Z RP
"Report ALL WASTEWATER monitoring data on this form (include "No Flow"1"No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 7 of each near.
Certificate of Coverage No. NCG02
Facility Name:
County:
Phone Number: (%fir --ICIM_ Total no. of outfalis monitored
Certified Laboratory t%* Lab #
to Ar Lab #
Wastewater (WW) Discharge Outfall No
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No ❑
Does this outfall discharge WW to SA waters?
Yes ❑
No ❑
Does this outlall discharge WW to SB or RNA waters?
Yes ❑
No ❑
Does this outfa€I discharge WW to HQW or ORW waters?
Yes ❑
No ❑
If so, what is the 7Q10 flown rate? or Tidally influenced watem,
7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters?
Yes 0
No ❑
Were there any limit violations in the calendar year?
Yes ❑
No,❑
Outfall No.
Daily Flow
Rate, efs
pH,
SU
TSS,
mgll
SS,
mill
trappikabra
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
SA
Effluent
Limitations
Ma. Ave I Wdty Mu.
Haw or oRw
50%of
fndicalaHP R
mare
+rashwater
6.0-9.0
"s`20
6.8-8.5
25/�45
HOW "ORW
I3
HawaroRw
�OW Tr or PNA
10115
Hnw, GRA
9A.S9.F%A.
°"�`u'tUa
0.110.2
No Limit
ar&ndrd
Ctf,nW appiles,
J W 2[ Q
NIA
t2d
srarW
NIA
ad ap7Q10
srwaarplies
NIA
Date Sample
Collected,
mold
: . J.
-
Permit Date 1011120/5 - 9130/2020
Last Revised 10-2-2015
Certificate of Coverage No. N CG02®®
CERTIFICATION
" l 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 property 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 jnfqnnption, including the possibility of fines and imprisonment for knowing violations."
(Required 40 C § 22. 21
Signature
Date
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not DFMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attu: DWR Central files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone (919) 807-6300
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
(919) 707-9220
permit Date 10/112016 — 9/30/2020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02 ®®®®
Additional Outfall AttaCi'lment (make copies as needed for addidonal.outfalis) ...
Wastewater (WW) Discharge Outfa11 No.
Is this are industrial sand mine (See 40 CFR §436 Subpart D)? Yes ❑
Does this outfall discharge WW to SA waters? Yes ❑
Does this outfall discharge WW to SB or PNA waters? Yes ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters,
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑
Were there any lirrrit violations in the calendar year reported? Yes ❑
No ❑
No ❑
No ❑
No ❑
7Q10 not available ❑
No ❑
No ❑
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mgll
SS,
mill
ff
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
SA
ss
Effluent
MO Ave EPaiy Max-
KO Qor ORW
50% of
7Q1Q
Axlket'e No r'LOW
Ilappireabfe
trashveter
6.0-9.0
satwetor
6.8-8.5
��
25MS
MOW orORW
20130
craw.,oaw
Tr or PNA
10115
HOw, oRYY,
'A "'
°ra,ro�t
0.110.2
No Limit
yt`°
thatePVra�_
��Ir��f10
NIA
SandMpli
NIA
ta„adup�Limtations
Standard
NIA
Date Sample
Collected,
molddl r
Permit Date 10/112016 — 913012020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02 ®®�
Additional Outfall Attachment (make copies as needed for additional outfalis)
Wastewater (WW) Discharge Outfall No.
Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes ❑ No ❑
Does this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year reported? Yes ❑ No ❑
Outfall No.
Daily Flow
Rate, efs
pH,
SU
TSS,
mgll
SS,
m111
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
SA
Effluent
Limitations
-NAKAvg tDaily M2X
NOW or ORW
50 Io of
7010
IndicateHOFLRW
arappffcatk
lreahmter
6.0-9.0
'PahwWof
6.8-8.5�
IndustrialSand
,251�l5
tsaw or 0,
20130
mQw w oRw
alidTraPNA
10118
t aw, oaw,
�A. 8B, PUA
°ra" Trot
0.110.2
No Limit
Gale watar
°uam.�&/ aaallle/es�
7V(2r�11n
0
NIA
water Quality
srandard ap,ttlu
NIA
water Qaatfty
standard aPs>tre.
NIA
Hate Sample
Collected,
mo/ddtyr
Permit Date 10/112015 — 9/30/2020
Last Revised 10-2 2015
Certificate of Coverage No. NCG02 ®®�®
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WM Discharge Outfall No. -
Is this an industrial sand mine (See 40 CI=R §436 Subpart D)? Yes ❑ No ❑
Does this outfall discharge WW to SA waters? Yes Cl No ❑
Does this outfall discharge WW to SIB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout jr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year reported? Yes ❑ No ❑
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mg1l
SS,
mlil
"a'pac°"°
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
SA
Effluent
Limitations
olio, Ave I Defly Max.
PQW or ORW
50 % of
7Q10
htdk W
ffapgaable
fmshvAtor
6.0-9.0
°a`�"°`°,
S.B-8.5
��ria, saga
25145
Flow or ORW
20130
H4worORW
pad Tr or PNA
10115
Now, ow
rR% $8, PNA.
oranyTMW
0.VO.2
No Limit
a ,'•s,
tha4prm
50125110
NIA
s andars �i€es
NIA
Standard " S
NIA
Date Sample
Collected,
moldd! r
.
Parmit Data 1011/2016 — $13012020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02 ®®
Additional OUtfall Attachment- (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfalt No.
Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes ❑ No ❑
Does this outfall discharge WW to SA waters? Yes 0 No ❑
Does this outfall discharge WW to SIB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year reported? Yes ❑ No El
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mgll
SS,
mill
trappfka8de
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal .
Coliform,
co11100 mi
SA
Effluent
Limitations
Ma. Ave f Oaw �.
HQW or ORw
5Ofl/Q of
7010
Ird1tf BpAtf FLOW
fraohwWor
6.0-9.0
"IwffQterc
6.".5
hrduslrFak Ssttd
26/45
w�0"
20130
mqw. or oRw
&LO Tr or PHA
10115
Now, aRW.
sA,sa,INA,
or anyrrour
0.110.2
No Limit
Clmlewater
¢fiappifttertl
50125110
.
NIA
waterauat"y
et-°ndard QAAI[ra
NIA
WaterQuafity,
Standard aRptbe
NIA
Date Sample
Collected,
molddl r
Permit Date 101112016 — 9/30/2020
Last Revised 10-2-2015
American. Materials Company
Storm Water Pollution Prevention Plan
Wade Mine
I. INTRODUCTION
A. Materials Management Narrative
This operation mines sand and aggregates, which are delivered to off site
construction projects. The aggregates are transported by truck to the plant,
stored in stockpiles located outside and fed into the plant via loader and
conveyors.
B. Plant Operations — A description of plant operations follows:
1. Production — Sand and aggregates are ribbon fed, by way of conveyor,
into the plant. Sand and aggregates are separated and stockpiled on
site. Wash water is captured and solids are allowed to settle out.
2. Process Water Management — Process water from the plant area flows
into previously mined area.
2. ,SITE ASSESSMENT
• Site Map A site map for this plant.
• USGS Map A USGS map showing the plant location.
• Significant Spills and Leaks -
There have been no significant spills or leaks at this location in the past
three years.
3. STORM WATER MANGEMENT PLAN
A. Feasibility of Modifying Operations -
Sand and aggregates used ;n this operation are stockpiled outside where they
are exposed to rain. It is judged to be impractical to cover these stockpiles.
Since the aggregates are all processed with water and required to contain less
than 2% by weight passing the #200 sieve, there is minimal contribution of
sediments from this source.
B. Best Management Practices (BMP's)-
Best management practices are physical, structural or management practices
that prevent or reduce pollution of waters of the state. The following BMP's
are in effect at this plant:
1. Process water is channeled from the plant in to previously rnine area to
allow sediment to settle out.
2. Drivers and operators are assigned a specific parking location. They
must report any fuel, hydraulic, or other fluid leaks to the plant
manager.
3. Water from the aggregate stockpiles drains into previously mined area.
4. Spill Prevention and Response Plan
A. Potential Contaminates -
The most likely sources for contaminates are listed below:
1. Parked trucks and equipment,
2. Sand and aggregate stockpiles.
3. Fuel storage and truck fueling area.
The following table lists a complete inventory of materials at this plant along with a risk
assessment of polluting storm water:
Material
Location
F= osed to Storm Water
Sand
Stockpile
Yes
Stone
Stockpile
Yes
Diesel Fuel AST
AST/Secondary Cont.
Yes
Motor oil
Maintenance Area
No
Transmission Oil
Maintenance Area
No
B. Spill Prevention & Response
Plant Manager: Justin Jackson (910) 624-2932
Lead Man: Daniel Conway
C. Spill Prevention and Countermeasure Plan
The best defense for spill prevention is training and awareness by all .plant
personnel. This training should include the importance of operating procedures to
minimize potential spills and emergency responses to take in the event of a spill.
Diesel and hydraulic oil spills are also a concern with the high volume of activity we
have with our off -road trucks. Large spills will be contained with sand and properly
disposed of. The state will be notified of any fuel/oil in excess of 25 gallons.
Spills of other liquids are most likely to occur as a result of handling liquids in 5 gallon
buckets or transferring liquids from 55 gallon drums. These spills should be small enough
to be easily manageable.
5. Preventive Maintenance & Good Housekeeping -
A. Preventive Maintenance & Monthly Visual Inspection Log
Preventive maintenance {PM) includes monthly inspections and random
visual inspections of the maintenance area, plant facilities and equipment. The
purpose of PM is to locate and correct equipment problems before they occur or
cause major problems. PM will reduce truck breakdowns and plant shutdowns in
addition to reducing the risk of polluting storm water. The following lists items to
be checked and frequency:
I. Trucks and equipment will be inspected daily for fuel, oil, and
hydraulic leaks and recorded on the site inspection report.
2. Settling ponds and detention pond/pit, will be maintained in good
operating condition_
3. Secondary containment structures will be inspected as part of the
Monthly Visual Inspection Report. Reports will be maintained in
SWPPP file. Any needed repairs will be made immediately.
4. Storm Drain Outfalls will be inspected monthly as part of the Good
Housekeeping Checklist. (There are no SDO at this site)
B. Good Housekeeping
Good housekeeping means taking the time and effort to maintain a clean, orderly,
and safe environment in the work place. These steps will help to minimize any potential
for storm water pollution in addition to promoting safety and a sense of well being at
work:
i. Trash and other waste will be picked up regularly. A covered trash. receptacle
will be placed outside and emptied on a regular basis.
2. Interior floors will be kept clean and dry. Brooms, mops, and dustpans will be
stored for convenient use.
3. Empty drums and unused pallets will be disposed. of,
4. Inspection records shall be incorporated into daily site inspections
6. Training
Training of employees is essential to the success of the program. The following
training will be conducted:
A. Annual training for all employees will include:
L An introduction to the SWPPP, the Storm Water Discharge Permit and
what their responsibilities are.
2. Spill response and cleanup procedures.
3. Preventive maintenance requirements.
4. The role that good housekeeping plays in the plan,
B_ Follow-up training at the plant will deal with specific problems and problem
areas to include the implementation of any new BMP's.
C. Training will be continued monthly during the safety meetings.
7. Responsible Party
The Plant Manager shall be responsible for the overall coordination, development,
implementation and revision of this plan. Other responsible parties and their
responsibilities are listed.in the Action List at the end of this plan.
S. Plan Amendments
This plan will be amended whenever there is a change in design, construction,
operation, or maintenance, which has a significant effect on the potential for the
discharge of pollutants to surface waters. At a minimum the plan will be reviewed and
updated on an annual basis.
9. Facility Inspections and Monitoring Inspections and monitoring will be conducted as
follows:
I. Each outfall is identified on the site plan.
2. Each outfall must be observed twice a year, once in the spring (April through
July) and once in the fall (September through. November).
3. (There are no SDO at this site)
10. Implementation — Implementation of this plan will include the required
documentation of all monitoring, measurements, inspections, maintenance activities, and
training provided to employees.
Monitoring will be included in daily site inspections that will be maintained in mine
office for one calendar year.
SWPPP I SWPPP I Report
Activity Responsibility I Pane # Section Required
'Jnspect vemrles for fupj, 0i & Llr3vers 5 5.A.I No
lhvdraulic leaks. Operators
Weekly:
Ins e I vehicles hoses and clamps.
Drivers/0 er.
5
5.AA
No
Inspect Stockpile Area and Pit Area
Plant Lead Man
5
5.A.3
No
:Inspect Plant Area
Plant Lead Man
5
5.A.4_
_No_,
Semi -Annually:
Visually monitor all outfalls in Spring
Plant Lead Man
6
9.A.2
Yes
between April and June
Visually monitor all outfalls in fall
Plant Lead Man
6
9.A.2
Yes
between Se t. and November.
Good Housekeeping checklist spring
Plant Lead Man
5
5.B.7
Yes
and fall.
Inspect secondary containment
Plant Lead Man
5
5.A.5
Yes
structures spring and fall.
Storm drainage inspection checklist.
Plant Lead Man
5
5.A.6
Yes
Annual:
SWPPP training
Plant Man a er
6
B.A.1
Yes
Review House Keep!aq Policy..Plant
Manager
5
5.A.2
Yes
Spill Response and Clean up training.
Plant Lead Man
5
4.0
Yes .
Analytical Monitoring of..
re resentative storm
Plant Lead Man
6
9.A.3
Yes
SWPPP review
Plant Manager
6
8
Yes
Analytical Data Submittal
Plant manager
Yes
As Needed:
Document Significant Spills
Plant Lead Man
Release of rain water from
secondary containment
Plant Lead Man
2
3.B
Yes
All encornpassed into daily site inspection including water canals
5-- ) -- i7-017-
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) - WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year ?4p]�p
*Report ALL WASTEWATER monitoring data on this form (include "No Flow"/No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each wear,
Certificate of Coverage No. NCG02
Facility Name:
County: CLlY] blaL L
Phone Number: (CJIpl
Certified Laboratory
Lab #
Lab #
Total no. of outfails monitored C-)
Wastewater (WW) Discharge Outfall No.
Is this an industrial sand mine�(See 40 CFR §436 Subpart D)?
Yes ❑
No ❑
Does this outfall discharge WW to SA waters?
Yes ❑
No ❑
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No ❑
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No ❑
If so, what is the. 7Q10 flow rate? or Tidally influenced waters,
7QIQ not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters?
Yes ❑
No ❑
Were there any limit violations in the calendar year?
Yes ❑
No ❑
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mg/I
SS,
mill
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
SA
Effluent
Limitations
Ado. Ave f Daily Max.
..
HRW or ORW
50%of
7Q10
7rKflc2fe NQFL0W
rrapplrcaba
freshumter
6.0-9.0
$""�`°`
6.8-8.5
Yn6vatiVad 9atrS
25I4
Hnwo,ORW
20130
KQworoRw
Rod Tr or PHA
Hnw, atxw,
sase,vfda
or any Trout
0.1/0.2
No Limit
as At Stan care
MalappRee:
5012511010115
_ _
NIA
Standardap'Wier
.. _
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stare p Flies
N/A
Date Sample
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1 Y: Y wr 3
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1
Permit Date 101112015 - 9130/2020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfall No.
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No ❑
Does this outfall discharge WW to SA waters?
Yes ❑
No ❑
Does this outfali discharge WW to SB or PNA waters?
Yes ❑
No ❑
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters,
7Q10 not available ❑
Does this outfall discharge WW to Trout jr) designated waters?
Yes ❑
No ❑
Were there any limit violations in the calendar year reported?
Yes ❑
No ❑
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mgR
SS,
mill
ffapprkabie
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
MN
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co1I100 ml
SA
I Effluent
Limitations
Mo. Ave r Daily Max.
NQW ar ORW
50%of
7Q10
�rC
kidles(aXOFLOW
ffapplicaAfe
ireshYYater
6.0-9.0
saltwater
6•8-8•5
Industrial Sand
25/4J
MOWoroRW
20I30
HCWorORW
$a¢TrarPNA
10115
HOW, ORW,
$A,SB,PNA,
orrany TroW
1D,110.2
No Limit
ClreleWater
rd
pp
50I25I10
NIA
Watercuallty
Rtandardepplles
NIA
Water Duality
Sandardapplka
N/A
Date Sample
,.e
Collected s
molddl �-
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t•` X 's
x`f F;
� .-t� i�,:N�,
r YYyy
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13
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Permit Date 10/1/2016 — 9/3012020
Last Revised 10-2-2015
Certificate of Coverage No. NCG02 5LNQO
Additional Outfall Attachment (make copies as needed for additional outtalls) --- -
Wastewater (WW) Discharge Outfall No.
Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes ❑ No ❑
Does this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ ' No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year reported? Yes ❑ No ❑
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mgll
SS,
mill
"aMicable
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 mi
SA
Effluent
Limitations
Mo- Ave ! Daily Max.
HOW ar ORW
50%, of
7C,110
Indicate NO FLOW
trappttcable
trephwatar
6.0-9.0
saltwater
6.8-8.5
lntlustrial6and
25145`
HQW or ORW
2 130
HQW , oRW
AM Tr or PH
10t 15
HCW, ORW,
SA, sa, PNA,
oranyrrrunt
0.110.2
No Limit
ClrcleWater
Quality Standard
that applies:
i�tlZ.rit 1 V
5 7 0
NIA
Watert]uallty
Standard appllss
NIA
Waterrdualty
Standard applies
NIA
Date Sample
Collected,
F
AL
S i
r
_`+'.ski
xs
r ta;
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Permit Date 1011/2015 — 913012020
Last Revised 10-2-2015
..N,
Certificate of Coverage No. NCG02
CERTIFICATION
" 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. l am aware that there are significant penalties for
submitting false inforryat*, including the possibility of fines and imprisonment for knowing violations."
(Required
Signature
Date �»
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office:
Note the address is correct -- Central Fifes is housed in DWR (not DFMLR)
N.C. Department of Environmental Quality (DEQ)
Division'of Water Resources
Attn: DWR Central Files
1617 Mall Service Center
Raleigh, NC 27699-1617
Central Files Teiephone (919) 807-6300
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
(919) 707-9220
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015
North Carolina Department of Environmental Quality
Division of Energy, Mineral, and Land Resources
MINE INSPECTION REPORT
X PERMITTED MINE SITE ❑ UNPERMITTED MINE SITE
1. MINE NAME: Wade Mine 2. MINE LOCATION: River Road
3. COUNTY: Cumberland 4. RIVER BASIN: Cape Fear 5. CASE:
6. OPERATOR: American Materials Company,LLC/Tony Harris
7. ADDRESS: P.O. Box 88, Clinton, NC 28329
8. MINING PERMIT #: 26-33 ❑ NIA 9. PERMIT EXPIRATION DATE: 1 1/2/2019 ❑ NIA
10. PERSON(S) CONTACTED AT SITE: Tony Harris
11. PICTURES? ❑ Yes X No TAKEN BY:
12. TYPE OF INSPECTION:
❑ A. Initial Inspection (Unpermitted Mine Sites)
1. Size of affected land: ac. (attach sketch map)
2. How was this area measured? Measured by:
X B. Routine Inspection (Permitted Mine Sites)
77C. Follow-up Inspection
13. Date of last inspection: 7/28/2016
14. Any mining since that date? X Yes ❑ No If yes, cite evidence of such mining activity:
Additional material has been mined.
15. Was mine operating at time of inspection? X Yes ❑ No If yes, explain: Haul trucks were in operation.
16. Is the mine in compliance with the Operating Conditions of the Permit? X Yes U No LJ NIA If
no, explain:
17. Is the mine in compliance with the Reclamation Conditions of the Permit? X Yes ❑ No ❑ NIA If
no, explain:
18. Is there any off -site damage? A. ❑ Yes B. X No C. ❑ None observed
If A, describe the type and severity of the damage:
If B or C, is there potential for offsite damage? ❑ Yes X No Explain:
19. Corrective measures needed and/or taken: 1. At Wetland Crossing # I there is a bare, eroding slope near the
outfall which needs stabilization with permanent groundcover.
20. Other recommendations and comments: There is additional reclamation work noted in various sections of
the mine.
21. Is the Annual Reclamation Report +/- map accurate? ❑ Yes ❑ No (Explain) X Not Reviewed ❑ NIA
22. Follow-up inspection needed? X Yes Lj No Proposed date 7/1 1/2017
23. No. of additional pages of Inspection Report 24. Copy of Report sent to operator 4/12/2017
INSPECTED BY: Melissa Joyner DATE 4/11/2017
Telephone No: 910-433-3300
Copy to file Copy to operator Copy to Mining Specialist
ems®
NC10 E N R'
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
November 4, 2014
American Materials Company, LLC
Attn: Gary T. Bizzell, President
6131 Oleander Drive
Wilmington, NC 28403
Subject: COMPLIANCE EVALUATION INSPECTION
American Materials Company, LLC
Wade Mine, Certificate of Coverage-NCG020366
NPDES Stormwater General Permit-NCG020000
Cumberland County
Dear Mr. Bizzell:
John E. Skvarla, III
Secretary
On October 29, 2014, a site inspection was conducted for the Wade Mine located on 4755 Game Road,
Cumberland County, North Carolina. A copy of the Compliance- Inspection Report is enclosed for your
review. Tony Harris, General Manager, was also present during the inspection and his assistance is greatly
appreciated. Permit coverage authorizes the discharge of stormwater and/or wastewater from the facility to
receiving waters designated as UT of the Cape Fear River, a Class WS-IV waterbody in the Cape Fear River
Basin. The site visit and file review revealed that the subject facility is covered by NPDES Stormwater
General Permit-NCG020000, Certificate of C overage- NCG020366.
As a result of the inspection, the facility was found to be in compliance with the conditions of the NCG020000
permit. Please refer to the enclosed Compliance inspection Report for additional comments and
observations made during the inspection.
Please be advised that violations of the NPDES Stormwater General Permit are subject to a civil
penalty assessment of up to $25,600 per day for each violation. If you or your staff has any questions,
comments, or needs assistance with understanding any aspect of your permit, please contact me at (910-
433-3300 or by e-mail at melissa.joyner@ncdenr.gov.
Sincerely,
LP�w�
- -Melissa Joyner - - - - --
Environmental Specialist
Land Quality Section
Enclosure: Compliance Inspection Report
cc: Tony Harris, General Manager -American Materials Company, LLC (via email)
FRO -- Land Quality Section, Stormwater Files-NCG020366
Division of Energy, Mineral, and Land Resources
Land Quality Section
Fayetteville Regional Office, 225 Green Street -- Suite 714, Fayetteville, North Carolina 28301
- Phone: 910-433-33001 FAX: 910-486-07071 Internet: hUp://Pogal.ncdenr.org/web/irl
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 1 10% Post Consumer Paper
i
Compliance Inspection Report
Permit: NCG020366 Effective: 01/01/10 Expiration: 12/31114 Owner: American Materials Company LLC
SOC: Effective: Expiration: Facility: Wade Mine
County: Cumberland 4755 Game Rd
Region: Fayetteville
Wade NC 28395
Contact Person: Gary T Bizzell Title: President Phone: 910-592-2176
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
On -site representative Tony Harris 910-592-1753
Related Permits:
Inspection Date: 10/29/2014 EntryTime: 0170OPM Exit Time: " 03:30PM
Primary Inspector: Melissa A Joyner Phone:
Secondary Inspector(s):
Mike Lawyer Phone :910-433-3300-
Reason for Inspection: Complaint Inspection Type: Compliance Evaluation
Permit Inspection Type: Mining Activities Stormwater Discharge COC
Facility Status: ® Compliant Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1
Permit: NCG020366 Owner -Facility -.American Materials Company [_l-C
Inspection Date: 10/29/2014 Inspection Type : Compliance Evaluation Reason for Visit: Complaint
Inspection Summary:
This inspection was initiated due to a complaint about turbid water being discharged from the mine into the nearby wetland
.and canal. Mike Lawyer and myself met with Mr. Tony Harris, General Manager on Wednesday, Oct. 29th. Melissa Joyner
had also met with Mr. Harris on Tuesday, Oct. 28th in regards to the complaint. A defective hose which was the cause of
the turbid water in the wetland had been removed at the time of the inspection. The defective hose did not appear to be the
cause of the turbidity in the canal
The water in the excavated areas continues to be pumped from one pit to another. Two mobile pumps are utilized in this
operation. During the site inspection, no stormwater outfalls were noted. A 550 gl, fuel tank used in conjunction with the
pumps was observed which had no containment system installed. Containment is recommended to control possible
accidental spillage, leakage and impacts to natural resources.
The Stormwater Pollution Prevention Plan (SPPP) was reviewed along with the monitoring records for mine dewatering and
process wastewater discharges from 2011, 2012, 2013 and the first through third quarters of 2014. There were no off -site
discharges noted in the records. In the last quarter of 2014, the recent accidental wastewater discharge should be
recorded. It is recommended that there be future organized documentation of the mobile pumps, including their locations,
date of locations and how long the pumps are at each location. It is also recommended that all problems with accidental
stormwater or wastewater discharges due to leakage, spillage, etc, should be systematically recorded in the SPPP,
including the day the problem was noted, the day it was addressed and the actions taken to correct the problem. According
to the NPDES Stormwwater General Permit NCG020000, it is required that if an accidental discharge occurs, that this
information is relayed to this office verbally within 24 hours of the incident. The permit also states that a written report be
sent to this office within five days of the incident, documenting the problem, detailing the steps in its eradication and stating
how this problem will be prevented from reoccurring,
The Spill Prevention and Response Plan portion of the SPPP should be updated. The stated Team Leader is Mayford Sells
who is now retired.
The maps were not observed in the SPPP. Both a general location map and a detailed site map including the components
detailed in NPDES General Permit-NCG020000 should be included in the SPPP. Also, the annual review of the SPPP
should be clearly documented with a dated signature each year.
Pager 2
Permit: NCG020366 Owner - Facility: American Materials Company LLC
Inspection Date: 10/2912014 Inspection Type : Compliance Evaluation Reason for Visit: Complaint
Stormwater Pollution Prevention Plan
Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
® ❑ ❑ ❑
# Does the Plan include a General Location (USGS) map?
❑ ®❑ ❑
# Does the Plan include a "Narrative Description of Practices"?
® ❑ ❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
❑ ®❑ ❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
® ❑ ❑ ❑
# Has the facility evaluated feasible alternatives to current practices?
® ❑ ❑ ❑
# Does the facility provide all necessary secondary containment?
®❑ ❑ ❑
# Does the Plan include a BMP summary?
® ❑ ❑ ❑
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
IN ❑ ❑ ❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
® ❑ ❑ ❑
# Does the facility provide and document Employee Training?
11 ❑ ❑ ❑
# Does the Plan include a list of Responsible Party(s)?
® ❑ 0 ❑
# Is the Plan reviewed and updated annually?
❑ ®❑ ❑
# Does the Plan include a Stormwater Facility Inspection Program?
® ❑ ❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented?
® ❑ ❑ ❑
Comment
rr
Qualitative Monitoring Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ❑ ❑ ® ❑
Comment: The facility does not have any stormwater discharge outfalls.
Areal tical Monitoring Yes No NA NE
Has the facility conducted its Analytical monitoring? ® ❑ ❑ ❑
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ❑ ❑ ® ❑
Comment: The available monitoring records from 2011 through the third quarter of 2014 indicate that there
have been no discharges.
Permit and Qutfalls
Yes NO NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ❑ ❑ ❑
# Were all outfalls observed during the inspection? - ® ❑ ❑ ❑
# if the facility has representative outfall status, is it properly documented by the Division? .❑ ❑ 93 ❑
# Has the facility evaluated all illicit (non stormwater) discharges? Is ❑ ❑ ❑
Comment:
Page: 3
Department of Environmental Quality
(910) 433-3384 office
melissa.joyner@ncdenr.gov
225 Green Street, Suite 714
Fayetteville, NC 28301-5043
. -="> Nothing Compares—,%,L
Email correspondence to and from this address is subject to the
North Carolina Public Records Lave and may be disclosed to third parties.
N
Joyner, Melissa
From: Joyner, Melissa
Sent: Monday, April 24, 2017 4:34 PM
To: 'Tristarbuildi ng @ya hoo.com'
Subject: Shadow Creek Financial Responsibility Ownership Form and Erosion Control Plan
Attachments: FRO Prep.ppt; Checklist.pdf; Financial Responsibility Ownership Form.pdf; Shadow Creek
Financial Responsibility Ownership Form.pdf; Groundcover Information.pdf;
Construction Entrance and Silt Fence Information.pdf
Hi, Dave,
In reviewing the Financial Responsibility Ownership Form (FRO):
Part A, Line 1— Please include the numbers of the Lots being develop in the roject Name for the project.
Part A, Line 2 — Latitude and Longitude — please fill in this info rmati n, prefer ly in Decimal Degrees.
Part A, Line 6 — For the Amount of fee enclosed please write' Pr iously Pai '.
Part A, Line 9 —Please include the current street address, cit , emend e Gtaae c-�pany.
Part B, Line 1 — Please include the current street address, cit , state and pcode of the company.
levised, original, notarized FRO will need to be resubm' ted with ese ange . I have also included an attachment in
ich it is explained how an FRO is prepared.
The attached check list includes the items which ne to b ubmitted wg l erosion.Gontrol plan including:
1. Deed for the property — you can submit th new eed which you wi e�eiving soo
2. Narrative for the project.
3. Soil information for the Lots which can ccessed on the USDA Web Soil Survey websit for Hoke County
4. A construction drawing, specificati nd maintenance requirements for the constructio entrance and silt
fence will be needed. Also, t pecifi ations and maintenance requirements for the temp ary and permanent
groundcover. The original full size er sion control plan contained this information, but the aled down version
of this erosion control plan which I nt to you earlier is missing the page that contained th' information. I
scanned in the construction entran e, silt fence and groundcover information from the ful size plan so you will
have this information
5. On the erosion control plan'you su mitted, please highlight the limits of disturbance fo the Lots which you are
disturbing.
�- I,-?- ce l 51xl it is advised that the revised FRO be resubmi ed as soon as possible as the erosion c trol plan can't be processed or
reviewed until this information is received. The ditional information for the er on control plan could also be
submitted at this time. If the new Deed is received la during the review ess , that is fine, as long as we receive it
within the next 2-3 weeks. If you have any questions about in orma ion discussed in this email, please contact me.
Sincerely,
Melissa
Melissa Joyner
Environmental Specialist
Division of Energy, Mineral and Land Resources
1
American Materials Company
Storm Water Pollution. Prevention. Plan
Wade Mine
!. INTRODUCTION
A. Materials Management Narrative
This operation mines sand and aggregates, which are delivered to otf site
construction projects. The aggregates are transported by truck to the plant,
stored in stockpiles located outside and fed into the plant via loader and
conveyors.
B. Plant Operations — A description of plant operations follows:
1. Production — Sand and aggregates are ribbon fed, by way of conveyor,
into the plant. Sand and aggregates are separated and stockpiled on
site. Wash water is captured and solids are allowed to settle out.
2. Process Water Management — Process water from the plant area flows
into previously mined area.
2. SITE ASSESSMENT
• Site Map A site reap for this plant.
s USGS Map A USGS map showing the plant location.
+ Significant Spills and Leaks -
There have been no significant spills or leaks at this location in the past
three years.
3. STORM WATER MANGEMENT PLAN
A. Feasibility of Modifying Operations -
Sand and aggregates used in this operation are stockpiled outside where they
are exposed to rain. It is judged to be impractical to cover these stockpiles.
Since the aggregates are all processed with water and required to contain less
than 2% by weight passing the 4200 sieve, there is minimal contribution of
sediments from this source.
B. Best Management .Practices (BMP's)-
Best management practices are physical, structural or management practices
that prevent or reduce pollution of waters of the state. The following BW's
are in effect at this plant:
l . Process water is channeled from the plant in to previously mine area to
allow sediment to settle out.
2. Drivers and operators are assigned a specific parking location. They
must report any fuel, hydraulic, or other fluid leaks to the plant
manager.
3. Water from the aggregate stockpiles drains into previously mined area.
Y
4. Spill Prevention and Response Plan
A. Potential Contaminates -
The most likely sources for contaminates are listed below:
1. Parked trucks and equipment.
2. Sand and aggregate stockpiles_
3. Fuel storage and truck fueling area.
The following table lists a completeinventory of materials at this plant Along with a risk
assessment of polluting storm water:
Material Location Exposed to Storm Water?
Sand Stockpile Yes
Stone Stockpile Yes
Diesel Fuel AST AST/Seconds Cont. Yes
Motor Oil Maintenance Area No
Transmission Oil Maintenance Area No
B. Spill Prevention & Response
Plant Manager: Justin Jackson (910) 624-2932
Lead Man: Daniel Conway
C. Spill Prevention and Countermeasure Plan
The best defense for spill prevention is training and awareness by all plant
personnel. This training should include the importance of operating procedures to
minimize potential spills and emergency responses to take in the event of spill.
Diesel and hydraulic oil spills are also a concern with the high volume of activity we
have with our off road trucks. Large spills will be contained with sand and properly
disposed of. The state will be notified of any fuel/oil in excess of 25 gallons_
Spills of other liquids are most likely to occur as a result of handling liquids in 5 gallon
buckets or transferring liquids from 55 gallon drums. These spills should be small enough
to be easily manageable.
5. Preventive Maintenance & Good Housekeeping -
A. Preventive Maintenance & Monthly Visual .inspection Log
Preventive maintenance (PM) includes monthly inspections and random
visual inspections of the maintenance area, plant facilities and equipment. The
purpose of PM: is to locate and correct equipment problems before they occur or
cause major. problems. PM will reduce truck breakdowns and plant shutdowns in
addition to reducing the risk of polluting storm water. The following lists items to
be checked and frequency:
I. Trucks and.equipment will be inspected daily for fuel, oil, and
hydraulic leaks and recorded on the site inspection report.
2. Settling ponds and detention pond/pitwill be maintained in good
operating condition_
3. Secondary containment structures will be inspected -as part of the
Monthly Visual Inspection Report. Reports will be maintained in
SWPPP file. Any needed repairs will be made immediately.
4. Storm Drain Outfalls will be inspected monthly as part of the Good
Housekeeping Checklist. (There are no SDO at this site)
B. Good Housekeeping
Good housekeeping means taking the time and effort to maintain a clean; orderly,
and safe environment in the work place. These steps will help to minimize any potential
for storm water pollution in addition to promoting safety and a sense of well being at
work:
I. Trash and other waste will be picked up regularly. A covered trash receptacle
will be placed outside and emptied on a regular basis.
2. Interior floors will be kept clean and dry. Brooms, mops, and dustpans will be
stored for convenient use.
3. Empty drums and unused pallets will be disposed of,
4. Inspection records shall be incorporated into daily site inspections
6. Training
Training of employees is essential to the success of the program. The following
training will be conducted:
A.. Annual. training for all employees will include:
1. An introduction to the SWPPP, the Storm Water Discharge Permit and
what their responsibilities are.
2. Spill response and cleanup procedures.
3. Preventive maintenance requirements.
4. The role that good housekeeping plays in the plan.
B_ Follow-up training at the plant will deal with specific problems and problem
areas to include the implementation of any new BMP's.
C. Training will be continued monthly during the safety meetings.
7. Responsible Party
The Plant Manager shall be responsible for the overall coordination, development,
implementation and revision of this plan. Other responsible parties and their
responsibilities are listed in the Action List at the end of this plan.
8. Plan Amendments
This plan will be amended whenever there is a change in design, construction,
operation, or maintenance, which has a significant effect on the potential for the
discharge of pollutants to surface waters. At a minimum the plan will be reviewed and
updated on an annual basis.
9. Facility Inspections and Monitoring Inspections and monitoring will be conducted as
follows:
1. Each outfall is identified on the site plan.
2. Each outfall must be observed twice a year, once in the spring (April through
July) and once in the fall (September through November).
3. (There are no SDO at this site)
10. Implementation — Implementation of this plan will include the required
documentation of all monitoring, measurements, inspections, maintenance activities, and
training provided to employees.
Monitoring will be included in daily site inspections that will be maintained in mine
office for one calendar year.
SWPPPage SW PP Report
Activity Res ponsibili P# Section Required
Daily:
Inspect vawdas for fueJ, a & Drivers 5 5.A..1 :1No
h drauiic leaks. O erators
Weekly:
Inspect vehicles hoses and clam s.
Drivers/0 er.
5
5_A.1
No
tnspect Stockpile Area and Pit Area
Plant Lead Man
5
5.A.3
No
,Inspect Plant Area
Plant Lead Man
5
5.A.4
No
�.. A €€,.•
Visually monitor all outfalls in Spring
Plant Lead Man
6
9.A.2
Yes
between April and June
Visually monitor all outfalls in fail
Plant Lead Man
6
9.A.2
Yes
between Sept. and November.
Good Housekeeping checklist spring
Plant Lead Man
5
5.8.7
Yes
and fall.
i
Inspect secondary containment
Plant Lead Man
5
i 5.A.5
Yes
structures spring and fall.
Storm drainage.. inspection checklist.
Plant Lead Man
=5
5.A.6
Yes
Annual:
SWPPP training
Plant Manager'
6
6.A.1
Yes
Review House Keeping Polic
Plant Mana er
5
5.A.2
Yes
Spill Response and Clean up training.
Plant Lead Man
5
4.0
Yes
Analytical Monitoring of .
representative storm
Plant Lead Man
6
9.A.3
Yes
SWPPP review
Plant Manager
6
8
Yes
Analytical Data Submittal
Plant manager
Yes
As Needed -
Document Significant Spills
Plant Lead Man
Release of rain water from
secondary containment
Plant Lead Man
2
3.13
Yes
All encompassed into daily site inspection including wager canals
I ANNUAL SUMMARY DMR - WASTEWATER 1,
11 SEND TO CENTRAL OFFICE* Ill
PROCESS MINEIDEWATERING WASTEWATER
GENERAL PERMIT NO. NCG020000
'ENR-FRO
JAN 18 2011
C
* Report All Wastewater discharge monitoring data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year. If
you have limit violations, you must also have turned in a Limit Violation DMR to your local Regional Office within 30 days of receiving sample results front a lab.
CERTIFICATE OF C ,LECTION
O OVERAGE NO..NCG02Q ,�, fQ ,�, SAMPLE C YEAR:
FACILITY NAME: U)Ocke_ 1tYL.a_ __ COUNTY: UA
PERSON COLLECTING SAMPLES: NA PHONE NO. (910)
CERTIFIED LABORATORY: NA Lab # ADDTOLISTERVEIYESFTN07 EMAIL:
Lab #
LIMITS VIOLATIONS? YES ❑ NO INDUSTRIAL SAND! DISCHARGING TO SA WATERS'? ❑
Part A: Wastewater Monitorine Reuuirements
Outfall No.
Date Sample
Collected
50050
Total Flow
00530
Total Suspended
Solids
00400
Turbidity3
00545
Settleable Solids
00400
pH
31616
Fecal Coliforms
-
mm/dd/yr
MG
mg/l '
NTU"'
MIA7.Standard
cot/ml '
Ilk
J All mines must monitor WW discharges for TSS. Only industrial sand mine discharges are subject to TSS limits.
2 If an effluent limit is exceeded, the permittee is required to -institute monthly monitoring for that parameter for the remaining permit term.
3 The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs
designated as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the
Stormwater Discharge Outfall. Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the discharge.
a Only facilities discharging to SA waters are required to monitor for Fecal Coliforms.
Permit Date: 1/l/2010-12/31/2014
Last Revised 0 1 -05-10
Page I of 2
Part A Continued: Wastewater Monitoring Requirements
Outfall No.
Date SampI a
Collected
50050
Total Flow
00530
Total Suspended
Solids
00400
Turbidity'
00545
Settleable Solids
00400
pH
31616
Fecal Coliforms
-
mm/dd/yr
MG
mg/1 '
NTU '
ml/l
Standard
col/ml '
AN
U
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT
a[Qlrr.1.11 MI��nAT"Taws]01DyMerl-sad�103
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 q 'tied personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
;th"o ers n dire tly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aw t at t re are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee)
Permit bate; 1/1/2010-12/31/2014
1-13-2011
(Date)
Last Revised 0 1 -05-10
Page 2 of 2