NCG140454_MONITORING INFO_20180829

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

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000 RECEIVED
CERTIFICATE OF COVERAGE NO. NCG14 454
FACILITY NAME: McCarthy Warren County Concrete Batch Plant
PERSON COLLECTING SAMPLES NA
CERTIFIED LABORATORY NA
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
Lab #
Lab #
8 2018
2 �
SAMPLE COLLECTION YEAR: 2018 r AUG
UG
SAMPLING PERIOD: ❑ July -December January�JtENTF� - FILe,3
COUNTY warren County CTION
PHONE NO. ( 864 ) 630-0314
ADD TO LISTSERVE? [—]YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout Mother C
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)
PHEvent
(Standard
Units)
TSS
(mg/L)
Duration
(minutes)
Total
Rainfall 4
(in)
In Tier 2
Monthly
Monitoring?
n
(y/ )
# of Months in Tier
2 Samplingx
-
-
6-9
100 ,
-
-
-
No, I
No Stormwater Disch
Arge Storm water
commingled with Nt
astewater.
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HOW, Trout, and PNA waters where they are 50 mg/l.
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part F Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
[�
Outfp?I
No.
Date Sample
Collected
(mo/dd/yr)1
pH
(Standard
Units)
TPH using method
1664A SGT--HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall4
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n}
# of Months
in Tier 2
Z
Sampling
6-9
15
100 '
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES []NO
HAVE YOU CONTACTED THE REGION? YES []NO 0 NA
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there are signif. nt p Ries for submitting false information, including the possibility of fines a imprisonment for knowing violations."
Zz7111
(Signat a of Permittee) Z (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

�r
PROCESS WASTEWATER —Quarterly Discharge Monitoring Repot" CEIVED
GENERAL PERMIT NO. NW140000
CERTIFICATE OF COVERAGE NO. NCG14 454 _
FACILITY NAME: McCarthy Warren County Concrete Batch Plant
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: Lab #
Lab #
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2018
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec
COUNTY: warren County
AUG 2 9 2o18
CENTP,AL FjLe
_ QIAlr 1;ECTte)N
riJan-March ❑X April -June
PHONE NO. ( 864 630-0314
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other c
Outfall No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-HEV
(mg/L)
Duration
(minutes)
Total Flow
(gallons/day),
-
-
6-93'4
303's
53
(15)5
-
No discharge
occurred during OPE
rating hours.
The Plant was not
operating a
d unmanned between
late
April
1 If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
S TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

a Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
7 Flow rate can be measured continuously or calculated. Flaw limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NG7AC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flaw and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report 6n a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
violations."
[Signs re of Permittee (Date)
Permit Date:7/1/2010-06/30/2015 Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 b 454 SAMPLE COLLECTION YEAR: 2018
FACILITY NAME: McCarthy Warren County Concrete Batch Plant SAMPLE QUARTER: ❑Jul -Sept []Oct -Dec ®Jan -March []April -June
PERSON COLLECTING SAMPLES:
COUNTY: Warren County
CERTIFIED LABORATORY: Lab #
Lab #
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
PHONE NO. 8( 64 ) 630-0314
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other C
OPTIONAL INFO:
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
7PH usingDischarge
method 1664A
SGT-HEM'
(mg/L)
Duration
(minutes)
Total Flow
�
(gallons/day)
-
-
6-93.4
303,S
53
(15)6
No dischane
occurred during op
rating hours.
P
``"t''-"'
6,".v a
. ENTRAL FILES
UVVH SECTION
' If wastewater systems have not discharged in this quarter= report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row; the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring. "
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 7S5 limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

1
c Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
7 Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 0213.0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
_MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO: T _ -
Division of Water Quality
Attn: DWQCentral Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
violations."
(Signature of rmit e) (Dat )
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 2 of 2

W
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 454
FACILITY NAME: McCarthy Warren County Concrete Batch Plant
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: Lab #
Lab #
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring -Requirements
SAMPLE COLLECTION YEAR: 2018
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY: warren County
PHONE NO.( 864 ) 630-0314
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: [:]SA ❑HQW ❑PNA ❑Trout ❑Other C
OPTIONAL INFO:
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD]2
pH
(standard]
Total Suspended
Solids
Solids
Settleable
Solids
(mL/l)
TPH usingDischarge
method 1664A
SGT-HEM'
{mg/L]
Duration
(minutes)
Total Flow
{gallons/day]�
-
-
-
6-93'4
303'5
53
(15)6
-
-
No discharge
occurred during op
rating hours.
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
Z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cieanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.6-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

e Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY INCLUDING ALL "NO FLOW" "NO DISCHARGE" WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW" TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
411'-�90
(Date)
Permit Date: 7/1/2010-06/30/2015
Last Revised 07/13/11
Page 2 of 2

1-
'Ir
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 4S4
FACILITY NAME: McCarthy Warren County Concrete Batch Plant
PERSON COLLECTING SAMPLES NA
CERTIFIED LABORATORY NA Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2017
SAMPLING PERIOD: x❑ July -December
COUNTY Warren County
PHONE NO. ( 864 ) 630-0314
ADD TO LISTSERVE? ❑YES [—]NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW
❑ January -June
❑PNA ❑Trout Mother C
Outfall Na.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)t
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall a
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in i Tier
2 Sampling
-
6-9
100 '
-
-
-
No. 1
No Stormwater Disch
irge Storm water
commingled with w
astewater.
a.+
�
01a
J
UVv U�
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
Z If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/l/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
'
Date Sample
Collected a
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664ASGT-NFM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
,
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
[n Tier 2
Monthly
Monitoring?
(y/n)
it of Months
in Tier 2
Sampling2
6-9
15
100 ,
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES [:]NO Q NA
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that re are sig ' ' a p alties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature f Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

(-r _ �r-;
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 454 SAMPLE COLLECTION YEAR: 2017
FACILITY NAME: McCarthy Warren County Concrete Batch Plant SAMPLE QUARTER: ❑Jul -Sept DOct-Dec "!Jan -March ❑April -June
PERSON COLLECTING SAMPLES: %L COUNTY�:% waarren County
CERTIFIED LABORATORY: Lab # PHONE' NO. S( 64 ) 630-0314
.fQ
Lab # N UDDL,TU LISTSERVE? ❑YES []NO EMAIL:
LIMIT VIOLATIONS? YES ❑ NO ❑-NTRgLDISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other C
.,E(OPTIQNAL INFO:
Part A: Wastewater Monitoring Requirements
Outfa[I No.
Date Sample
i
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-HENf
(mg/L)
Duration
(minutes)
Total Flow
�
(gallons/day)
-
-
-
6-93'4
303'5
S3
(is)"
-
No dischar
occurred during op
rating hours.
1 If wastewater systems have not discharged in this quarter —report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-3.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

r
c Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HOW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY INCLUDING ALL "NO FLOW" "NO DISCHARGE" WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD IN OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
violations."
(Sig ture of Permi e) (Da e)
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 2 of 2

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month Da
i LNTRAL FILES
DWR SECTION
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 I C I S N I C I G 1 1 1 4 1 0 1 4 5 1 4
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name: McCarthy Warren CountyConcrete Batch Plant
Facility Contact
Street Address
City
County
Telephone No.
Kevin Crusa
1224 Ridgeway Drewry Road
Manson
Warren E-mail Address
[phone]
State NC ZIP Code 27553
[e-mail]
Fax: [phone]
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
® Facility closed or is closing on 11/1/2018 . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to I-- ""—I on . 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:
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
Date /Z
// �
KP_yin Cri 1ra..._ Project Manager
Print or type name of person signing above Title
Please return this completed rescission request form to: NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612

• ­< <
SYMBOLS USED
INV=340.68
X
F,o 7 Fly
\ Q
O Y
MFD �/o ALB �O
TyJ �/c
NORTH
G
Topographic Survey:
Pennon Associates, Inc.
401 Providence Road #200
Chapel Hill, NC 27514
919-929-1173
April2017
100
Scale: 1 " = 30'
Proposed Contours in
BL UE
200 FT
1,000 GALLON SEDIMENT FENCE SEDIMENT FENCE
DOUBLE -WALLED (see detail on (see detail on
PORTABLESheet C.501) DIESEL Sheet C.501)
_FUEL TAW
Site Stabilization:
Disturbed areas will be stabilized within
fourteen working days for slopes 3: 1 or
less and within 7 working days on slopes
steeper than 3: 1.
Exceptions to the 1417 rule above include
the following areas, which must be
stabilized within 7 days: All perimeter
dikes, swales, ditches, and perimeter
slopes and all slopes that are longer than
50 feet.
Receiving Waters:
The receiving waters for this site are the waters
of Smith Creek.
Smith Creek is listed as an impaired stream on
the current 303d list.
Smith Creek is classified "C. "
TMDL:
The receiving waters for this site do not have
an approved TMDL.
FEMA Flood Hazard Zones:
This site is not located within a FEMA Flood
Hazard Zone.
Army Corps ofEngineers 404 Permit
This site does not require an Army Corps of
Engineers 404 permit.
NC DEQ 401 Certification
No Water Quality 401 Certification is required
for this site.
Leaks or Spills:
There have been no significant leaks or spills at
this site in the last three years.
Easements:
There are no known easements on this site.
SEDIMENT FENCE
(see detail on
Sheet C.501)
24 HOUR CONTACT:
KEVIN CRUSA
McCARTHY IMPROVEMENT CO.
[phone]
OUTLET
PRO E TI ,
f-^ (see detail on
Sheet C.501) f
/ `f '
SKIMMER BASIN
SPILL WAY
(see detail on
Sheet C.501 �PP ' P._ > TV BOUN
STORMWATERMASTEWATER
l OUTFALL No.1
\ ` !' 3602725.74"N
" OUTLET 78015'53.99"W
/
/
/
SEDIMENT FENCE
(see detail on
Sheet C.501)
\ INLET
PROTECTION
(see detail on
Sheet C.501)
PROTECTION
(see detail on
Sheet C.501)
Waste Water Sources
1) Mixing drum washout.-
800ga/Ions/day waste waterproduced
2) Truck bed washout.•
>0, 000ga//onS/day wastewaferproduced
3) Aggregate & sandoi/e runoff
7,,200ga/lons/day wastewaterproduced
Drainage Area 1 Basin Area:
Drainage Area 2 Basin Area:
2.71 Acres
0.80 Acres
Area 1 Impervious Area:
Area 2 Impervious Area:
1.71 Acres
0.46 Acres
Total site area: 4.39 Acres
Total Site impervious Area: 2.17 Acres
Total Percent impervious: 49%
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