NCG020056_COMPLETE FILE - HISTORICAL_20140721

STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.
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DOC TYPE
0 COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
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YYYYMMDD

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Ken Elliott
Bear Garden, Inc.
P.O. Box 2232
Elizabeth City, NC 27909
Dear Mr. Elliott:
John E. Skvarla, III
R CElVI=® Secretary
July 21, 2014 JUL 2 12014
CENTRAL FILES
DWQIBOG
Subject: Rescission of NPDES Stormwater Permit
Certificate of Coverage Number NCG020056
Bear Garden, Inc
Pasquotank County
On June 9, 2014, the Division of Energy, Mineral and Land Resources received your request to rescind your
coverage under Certificate of Coverage Number NCG020056. In accordance with your request, Certificate
of Coverage Number NCG020056 is rescinded effective immediately.
Operating a treatment facility, discharging wastewater or discharging specific types of stormwater to waters
of the State without valid coverage under an NPDES permit.is against federal and state laws and could result
in fines. If something changes and your facility would again require stormwater or wastewater discharge
permit coverage, you should notify this office immediately. We will be happy to assist you in assuring the
proper permit coverage.
If the facility is in the process of being sold, you will be performing a public service if you would inform the
new or prospective owners of their potential need for NPDES permit coverage.
If you have questions about this matter, please contact Julie Ventaloro at 919-807-6370, or the Stormwater
staff in our Washington Office at 252-946-6481
Sincerely,
iforTracy E. D is, PE, CPM, Director
Division of Energy, Mineral and Land Resources
cc: Washington Regional Office —T. Edgerton
Central Files - w/attachments
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 I FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:!/Portal.ncdenr.org/web/ir/
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

�'� • Division of Energy, Mineral & Land Resources
IL� Land Quality Section/Stormwater Permitting Program
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NCDENRNational Pollutant Discharge Elimination System
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RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N: C S' N .FtG,t 0 2 0 5 fi
2) Owner/Facility information: Final correspondence will be mailed to the address noted below
Owner/Facility Name Phillip Harrington / Bear Garden, Inc.
Facility Contact Phillip Harrington (Permit Contact: Ken Elliott, 252-339-9021, [e-mail])
Street Address PO Box 2232
City Elizabeth City State NC ZIP Code 27909
County Pasguotank _ E-mail Address gllendahc(@embargmail.com_
Telephone No. 252-335-4520 Fax:
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
[Facility closed ef-is44e6ic4g.on 20 1. All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to 77x -7��-'r on FT'71, . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
[Other: Sand mine has ceased operation, land reclaimed by Jan 2014 and mining permit released.
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature
MI.
Print or type name of person signing above
Date: June 4, 2014
C,s- 1_1a_. _
Title
Please return this completed rescission request form to: NPDES Permit Coverage Resciss
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] FAX: [phone]
JUN 0.9 2014
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An Equal Opportunity 1Affirmative Action Employer

AAA Division of Energy, Mineral & Land Resources
1 Land Quality Section/Stormwater Permitting
NCDENRNational Pollutant Discharge Elimination System
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EKI « ­,µoN,o -R�a PERMIT NAME/OWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year I
Month
I Day
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N 10 1 S 19 1 1 1 1 N G 10. 0 2 1 0 0 5 6
II. Permit status prior to requested change.
a. Permit issued to (company name): Sear Garden, Inc.
b. Person legally responsible for permit: Phillip
First
Harrint
M 1 Last
President
Title
PO Box 2232
Permit Holder Mailing Address
Elizabeth City NC 27909
City State "Lip
252) 335-4520 )
Phone Fax
c. Facility name (discharge): Bear Garden, Inc.
d. Facility address: Ludford Road
Address
Elizabeth City NC 27909
City State Zip
e. Facility contact person: Phillip Harrington [phone]
First 1 MI 1 Last Phone
Ili. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
First M 1 Last
Title
Permit Bolder Mailing Address
City State Zip
Phone E-mail Address
d. Facility name (discharge):
e. Facility address:
Address
City State Zip
f. Facility contact person:
First MI Last
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan, 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Ken Elliott
1,i rst M 1 Last
Consultant
Title
PO Box 112
Mailing Address
Aydlett NC 27916
City State Zip
[phone] ken rt kenobx.com
Phone E;-mait Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change`!
❑ Yes
® No (please explain) Mine is closed,_D_W_ Q permit rescission form attached.
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERM ITTEE CERTIFICATION (Permit holder prior to ownership change):
1, Ken Elliott, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
�- June 4, 2014
Signature Date
APPLICANT CERTIFICATION
1, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
S ignature
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014