NCG070220_Application_20191202

P1GC.-O-7 0 22rJ
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
Environmental
Quality NCG070000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
I Month
Da
2,000
IZ
aZ
Certificate of Covera e
NCG
Check #
I Amount
G$ 0
D
Permit Assigned to
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG070000:
STORMWATER DISCHARGES associated with activities classified as:
SIC' 32 Stone, Clay, Glass, and Concrete Products (except as specified below)
SIC* N/A Like activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials, products, by-products, or waste materials
The following activities are specifically excluded from coverage under this General Permit: SIC' 3273 Ready -Mixed Concrete RFCFINIFE Jnn
* Standard Industrial Classification Code
(Please print or type)
DEC 02 2019
DENR-LAND OUALITf
STORMll1ATER PERkli'l 1'INO
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name
Street Address
City
Telephone No.
E-mail Address
U&ShbNrr
05 ZZI
my'r;on State AJG ZIP Code Z7751
92T 7574 - YZY 7 Fax: 829 156 - ` ?b9
2) Location of facility producing discharge:
Facility Name MAJ"J"w' 5t'•- M HFtn4.�� %ate' /�'( ✓
Facility Contact
Contact E-mail
Street Address
City
County
Telephone No.
M :an State Nc- ZIP Code if 7 S'Z
yr.t 75-6-YZ 97 Fax: cr % I >5-6-yp69
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). 70 Ola( t%rvil& led ALr~tiot ►VC-
w
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application)
4) Latitude 35•$06526Longitude " 8Z .0151/Y (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility
Rr Existing
Date operation is to begin
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NCG070000 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:
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility:
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?
List discharge points (outfalls) that convey discharge from the site (both on -site and off -site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in?
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NCG070000 N.O.I.
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
10) Does this facility have any other NPDES permits?
No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
Q"No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
2T"Yes
If yes, please briefly describe:
13) Does this facility have a Stormwater Pollution Prevention Plan?
Z'No
❑ Yes
If yes, when was it implemented?
14) Are vehicle maintenance activities occurring at this facility?
❑ No D Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
ONo ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
ZrNo ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
Z"'No ❑ Yes
d) 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 / disposal vendor:
Vendor address:
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NCG070000 N.O.I.
16) Certification:
North Carolina General Statute 143-215.6 b (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:
Title:
(Signature of Applicant)
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDEQ
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NCG070000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDEQ
❑ This completed application and all supporting documents
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES pernnit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
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 .........(919)
807-6300
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SWU-222-071408 Last Revised 6/24/14

Imagery ©2019 Google, Imagery ©2019 Burke County, Maxar Technologies, Orbis Inc, U.S. Geological Survey, USDA Farm Service Agency, Map data ©2019 1000 ft

z
Imagery @2019 Google, Imagery 02019 Maxar Technologies, Orbis Inc, Map data @2019 50 ft

North Carolina Secretary of State Search Results
Page 1 of 1
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Business Corporation
Legal Name
Appalachian Stone Company, Inc.
Information
Sosld: 0357565
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 12/12/1994
Fiscal Month: December
Registered Agent: Washburn, T Kevin
Addresses
Mailing
4582 Us 221 North
Marion, NC 28752
Officers
Principal Office
4582 Us 221 North
Marion, NC 28752
President
TIMOTHY K WASHBURN
4582 Us 221 North
Marion NC 28752
Stock
Class: COMMON
Shares: 100000
Par Value 1
Reg Office
4582 Us 221 North
Marion, NC 28752
Reg Mailing
4582 US 221 North
Marion, NC 28752
https://www.sosnc.gov/online_services/search/Business_Registration_Results 12/2/2019