NCG020417_COMPLETE FILE - HISTORICAL_20180917

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/VC� hp1�y�
V
DOC TYPE
q( HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
060i4 oq /--7
YYYYMMDD

Division of Energy, Mineral & Land Resources
I;a-nd Qualit !SectinrilStarm►sater Permitting Program
Wiunal'Pollutant DiscliarRc Elimiiiaiion System
RESCISSION REQUEST FORM
1
!.r�' l'AF
I
FOR AGENCY USE ONLY
Date Received
near
th
Da
Please fill out and retu r& 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 C G a � j
2) Owner/Facility Information: ' Final correspondence will he moiled to the address not below
'.f i„; U VI C �,c� e . e-([ (dalstu
Owner/Facility Narnd,.�
Facility Contact I.e— l 1
Street Address MID S
City State N.� ZIP Code
County �� E-mail Address c��es�k EAisr u �g ! ,CDC
Telephone No. O&S D— 53 -4" )-y!a Fax: JV I
3) Reason for rescission request (This is rgtuired information. Attach separate sheet if necessary):
acility closed or is closing on s . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to 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. -
❑ Othee,"
_--- -- —.— _ — — — — SEA' 1, Cults —
4) Certification: CENTRAL FILES
QWR SECTION
i, as an authorised representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
'`subject facility. 1 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
Print or type name of person sigk above Title
! lease return this completed rescission request form to: DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
ECEIV D
FEB 13 2018
Revised 20183an10 DENR-LAND QUALITY
STORMWATER PERMITTING

a , ..
i
Division of Lnergy, Alineral & Land Resources
' Land Quality Section/Stormm-ater Permitting Program
3 i •.
National Pollutant Discharge Elimination System
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 I C S � N C G I Q 02 f
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name L{yt �0.0 nA (�+
Facility Contact Ce L
Street Address AS 7' ,
City _
County
Telephone No. pZ 5
CA(e-
State A Y -- ZIP Code
E-mail Address Lc e
Fax:
C-0 T—r-11
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
acility closed or is closing on 9 S . All industrial activities have ceased such that no discharges of
stormwater ar( contaminated by exposure to industrial activities or. materials. .
❑ Facility sold to 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 a1 131 )
Print or type name of person signt4 above Title
Please return this completed rescission request form to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612RECEIVED
FEB 19 2013
DENR-LAND QUALITY
Revised 2018Jan10 STORMWATER PERMITTING

Eastern Environmental Management-,
P.O. Box 4030
Rocky Mount, NC 27803
Office [phone] (24 Hrs.)
Fax [phone] HIECEMED
February 14, 2007 www.eastern-environmental.cont
NC Division of Water Quality FEB 16 2007
Attu: Ed Warren l��1���
943 Washington Square Mall �V�6� `Elp!
Washington, NC 27889
RE. NO.V. 20f)7.=SIZf)05 for-Union=Sand-and�Grw, 16
Dear Mr. Warren:
In response to the NOV given to Union Sand and Gravel, Eastern Environmental
Management has been retained to prepare a Stormwaler Flan, including sampling and
rnoniloring, al least for the Ist quarter.
The plan has been written; Mr.-Lewis.has.it.for-final_review; idono wilh-thc-Enginccr tcc
seal the stormwatcr calculations. The analytical monitoring Ior Mine Dewatering R
Activities was perfo�ped on Jan. 30 2007. The -results have-not been obtained frond
Microbac, to,d"ate They should he read) }� day now.
4
Lhave enclosed a copy of the Table of Contents or the Stormwater Plan. The BM I s'arc
bcin b implemented with employee training�'co y,of the Visual Ins eclion perlornW ui
the sanic limc,as•the 5amplins evert.
anticipate the Engineer to be complete with liis ca]cuEali«ns in two weeks1the�lali�
results should be complete by [lie end of the week. The final of the plan should he
complete in two weeks ,is well. In two weeks, everything should he com1,lcic for the
General Permit NCG0211417. \,=j
The recommended BMP's are being implemented now and the sampling/r11onitoriiig has
been performed, lhis should clear the NOV's, with exception of the Engineer Seal for
calculatiOnS. If this time line is unacceptable, please call me 252-443-2224. If you
Should have any ducstions, comments or concerns please call me or Mr. Lewis of Union
Sand and Gravel.
Respectfully Submitted;
C YA, � , r6:7( ,�cx cn
Mrs. Cath Baines aines CES, CEM
Eastern Erlvironrnenial Management
cc: Union Sand & Gravel

STORMWATER POLLUTION PREVENTION PLAN
FOR
UNION SAND AND GRAVEL INC.

TABLE OF CO I$ (SECTION 1)
page-
1.0 INTRODUCTION
1
1:1
Facility, Description
;
1.2
Type of Facility
1.
1.3
Regulatory Background
1.
2.0 SOURCE EVALUATION
2
2.1
Potential, Pollutant Sources
1).
2.2
Historical Spills
2
2.3 .
Sturmwater Disdwge Outfalls
3.
2.4
Stormwater Monitoring Data
3,
2.4.1 Qualtative Monitoring
3.
2.4.2 Analytical Monitoring
4.
2.42a Analytical Monitoring for Mine Dewatering
4.
3.0 STORMRVATER MANAGEMENT PLAN
4
3.1
Storage Practices
4
3.1.1 Oil and Fuel Storage Areas
5
.3.1.2 Drum Storage Areas
5 .
3.1.3 Refuse Disposal
5 .
3.1.4 Machinery Storage Areas
' 5 .
3.15 Erosion Control
5
3.2
Stormwater Diversion
6,
3.3
Dust/Particulate Control
6
3.4
inspection of Stormwater Conveyances
7
3.5
Eroded Areas
6
4.0 BEST MANAGENffiNT PRACTICES
7
4.1 Non-Structural'Controls
7
4.1.1 Preventative Maintenance
8
4.1.2 Good Housekeeping Practices
9
4.1.3 Sedimentation Control Measures
9
4,1.4 Employee Training
9
4.1.5 List of Significant Materials Still Present
10
4.2
Structural Controls
10
• 5.0 SPILL PIREVENTION :AND -RESPONSE PROCEDURES
10
5.1
Spill Response Team
11
5.2
, Saftey Measures
11

_ y
r -
1ABL OF CONTENTS {Continued - ,qection n
5.2.1 Spill Response Equipment Location 11
5.2.2 Spill Reporting Procedures. 11.
6.0 STORMWAnm RFSPONSIBILmES 11.
7:0 LMTATIONS 12,
8.0 CERTIRCATION OF THE SWPP PLAN 12,

L'
j
Visual Stormwater Outfall Inspection Log DateJ 156i0r7
Color: Semi-annual Location Completed by
L � 5 4 k'.� L&S_�
Odor: Semi -Annual Location Completed by
Clarity: Semi Annual Location Completed by
CCh
Floating Solids: Semi Annual Location Completed by
�x-w c
Suspended Solids: Semi Annual Location Completed by
%E'L - CU
Foam: Semi Annual Location Completed by
Oil Sheen: Semi Annual Location Completed by
N 14 �--
Deposition, Erosion, Other obvious indicators of stormwater pollution
mn1'_N IL�c3�-

Michael F. Easlcy, Governor
William G. Ross Jr., Secretary
North Carolina Department of linvironment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
February 5, 2007
CERTIFIED MAIL 7006 0100 0000 8379 1552
RETURN RECEIPT REQUESTED
Thomas Lewis .
Union Sand & Gravel
121 W Modlin Rd
Ahoskie NC 27910
Subject: NOTICE OF VIOLATION
NOV-2007-SP-0005
Permit No. NCG020417
Union Sand and Gravel Inc
Hertford County .
Dear Mr Lewis:
Ed Warren from the Washington Regional Office of the Division of Water
Quality conducted a site inspection of your facility, Union Sand and Gravel located oil
Liverman Mill Rd., Hertford County, North Carolina on November 14, 2006. The site
drains to an unnamed tributary to Potecasi Creek, Class C-NSW waters located in the
Chowan River Basin. The site visit and file review revealed that the subject project is
covered by NPDES Stormwater General Permit NCG020417.
The following observations and/or permit conditions violations (please see the attached
addendum for information about your permit) were noted during the Division of Water
Quality inspection:
1) Stormwater Best Management Practices Plan
A Stormwater Best Management Practices Plan has been developed, recorded, and
properly implemented.
es ❑ No 4 Not] ❑
2) Qualitative Monitoring
Qualitative monitoring has been conducted and recorded in accordance with permit
requirements.
cs ❑ No � Not] nspected ❑
N�('.nehcan)11
llvfl rrralG,
N. C. Division of Water Quality 943 Washington Square Mall Washington, NC 27889 Phone Number 252-948-6481
Washington Regional Office
An Equal Opportunity/Affirmative Aclion Employer — 50% Recycicd110%a Post Consumer Paper

Page 2
Union'Sand and Gravel
Hertford County
3) Analytical Monitoring
Analytical monitoring has been conducted and recorded in accordance with permit
requirements.
Yes ❑ No 4 Not lns ected ❑
Other Observations:
1. The required Best Management Practices Plan was not completed and being
implemented. The analytical and qualitative monitoring has not been completed. Part III,
Section B and C of your permit outlines the requirements for analytical and qualitative
monitoring. Failure to comply with the conditions contained in your permit is considered
to be a violation.
2. You should read your entire permit and be aware of what is required in it. It is your
responsibility as the permit holder to read and understand what your responsibilities are.
3. You are reminded that you.must keep a copy of your permit and most current
certificate of coverage on site.
Please provide this Office with a written response within fifteen (15) days of your receipt
of this letter. Please include anything you would like submitted to DWQ to address the
violations observed on site.
Thank you for your attention to this matter. This office requires that the violations, as'
detailed above, be properly resolved. These violations and any future violations are,
subject to a civil penalty assessment of up to $25,000.00 per day for each violation.
Should you have any questions regarding these matters, please contact Ed Warren at
[phone].
Sincerely,
Al I -lodge, Supervisor
`7`6 Surface Water Protection Section
Addendum eiO
cc: WaRO -- Water Quality
Danny Smith — NPS-ACO Unit
Water Quality Central Files

Page 3
Union Sand and Gravel
Hertford County
ADDENDUM
The National Pollutant Discharge Elimination System (NPDES) program was established under
the federal Clean Water Act and then delegated to the Division of Water Quality for
implementation in North Carolina. The NPDES permitting program for stormwater discharges
was established in 1990. Phase I focuses on site and operations planning to reduce pollutant
sources.
Through the NPDES permitting program industrial facilities that fall into one of the subject ten
categories are required to obtain permit coverage under a general permit or an individual pei7mit,
depending upon the facilities SIC code and the industrial activity occurring at the facility. There
are currently 19 active general stormwater permits in North Carolina. One condition that is
applicable to both the general permits and individual stormwater permits is the requirement to
develop and implement site -specific comprehensive stormwater pollution prevention plans
(SPPP). "These plans are required to include a comprehensive evaluation of the site and
operations to reduce pollutant sources and prevent pollutant discharge.
Copies of the general permits and accompanying documents can be accessed from the following
webpage: http://h2o.enr.state.nc.us/su/Forms_Documents.htm Permit text, technical bulletins,
discharge monitoring forms, and a Notice of Intent [which is the application of for coverage
under a NPDES General Stormwater Permit] can be found at this web site.
The following items are a subset of permit requirements and are listed to assist you and help
bring your attention to certain permitting issues, process and condition requirements of your:
permit. That said, please see the above mentioned web site in order to obtain a copy of the permit
such that you may fully comply with all the conditions therein. Failure to properly comply'
with conditions of the permit, like those bulleted below, constitutes violations and are
subject civil penalty assessment of up to $25,000.00 per day.
• Industrial facilities that fall into one of the subject ten categories are required to obtain
permit coverage under a general NPDES stormwater permit or an individual NPDES
stormwater permit
• All persons desiring to have facilities covered by a General Permit must register with the
Division of Water Quality (DWQ) by the filing of a Notice of Intent (NOI) and
Applicable Fees.
• This Notice of Intent (NOI) must be submitted and a Certificate of Coverage issued prior
to any discharge of stormwater associated with the industrial activity, process
wastewater, and/or mine dewatering. -
• Once the Notice of Intent is received, DWQ will review and determine whether a
Certificate of Coverage (COC) may be issued. If this Certificate of Coverage is issued the
facility is covered by the General Permit. That is, the permittee is authorized to discharge
stormwater, process wastewater, and/or mine dewatering pursuant to the type of General
Permit until the permit expires or is modified or revoked.
• Any other point source discharge to surface water of the state is prohibited unless it is an
allowable non-stormwater discharge or is covered by another permit, authorization or
approval.

Page 4
Union Sand and Gravel
Hertford County
There are currently 19 active general permits. Permit conditions vary accordingly;
however, most of the permits have following condition requirements (you must read your
entire permit to ensure full compliance):
o Development and compliance with the Stormwater Pollution Prevention Plan
o Collection, reporting, and recording of Analytical Monitoring
o Collection, reporting and recording of Qualitative Monitoring
o Collection, reporting and recording of Vehicle Maintenance Monitoring
o Records — Visual monitoring shall be documented and records maintained at the
facility along with the Stormwater Pollution Prevention Plan. Copies of the
analytical monitoring results shall also be maintained on -site. The Permitter
shall retain records of all monitoring information, including all calibration and
maintenance records and all original strip chart recordings for continuous
monitoring instrumentation, and copies of all reports required by this general
permit for a period of least 5 years for the date of the sample measurement, report
or application.
o Expiration — The permittee is not authorized to discharge after the expiration date
of the general permit. In order to receive automatic authorization to discharge,
beyond the expiration date, the permittee shall submit forms and fees as are
required by the agency authorized to issue permits no later than 180-days prior to
expiration date. Any permittee that has not requested renewal at least 180 days
prior to expiration, or any permittee that does not have a pert -nit after the
expiration and has not requested renewal at least 180 days prior to expiration, will
be subject to enforcement. Failure to renew your permit is a violation.
o Transfer — The Certificate of Coverage (COC) issued pursuant to this general
permit is not transferable to any person expect after notice to and approval by the
Director. The Director may require modification or revocation and reissuance of
the Certificate of Coverage to change the name and incorporate such other
requirements as may be necessary under the Clean Water Act. The Permit is
NOT transferable.
o Name Change, Closure or Facility Ownership change — Permittee is required to
notify the Division in writing in the event the permitted facility is sold or closed.
The Division of Water Quality views changes of name or ownership as a
modification that requires.the Director's approval and reissuance of the permit.
Name and ownership changes required you to complete a Name/ownership
Change Form from the Division and mail it back to the Division of Water Quality
along with all appropriate information.
o Proper Operation and Maintenance is a requirement of the permit.

of w A TF9 w No Z- 6 Q 7 Michael F. Easley, Governor
PG William G. Ross Jr., Secretary'
7 North Carolina Department of Environment and Natural Resources
00
1~
Alan W. Klimek, P,E, Director
0 Division of Water Quality
Colcen Fl. Sullins, Deputy Director
Division of Water Quality
February 5, 2007
CERTIFIED MAIL 7006 0100 0000 8379 1552
RETURN RECEIPT REQUESTED
Thomas Lewis
Union Sand & Gravel
121 W Modlin Rd
Ahoskie NC 27910
Subject: NOTICE OF VIOLATION
NOV-2007-SP-0005
Permit No. NCG020417
Union Sand and Gravel Inc
Hertford County
Dear Mr Lewis:
Ed Warren from the Washington Regional Office of the Division of Water
Quality conducted a site inspection of your facility, Union Sand and Gravel located on
Liverman Mill Rd., Hertford County, North Carolina on November 14, 2006, The site
drains to an unnamed tributary to Potecasi Creek, Class C-NSW waters located in the
Chowan River Basin. The site visit and file review revealed that the subject project is
covered by NPDES Stormwater General Permit NCG020417.
The following observations and/or permit conditions violations (please see the, attached
addendum for information about your permit) were noted during the Division of Water
Quality inspection:
1) Stormwater Best Management Practices Plan
A Stormwater Best Management Practices Plan has been developed, recorded, and
properly implemented.
es ❑ No 4 Not Inspected ❑
2) Qualitative Monitoring
Qualitative monitoring has been conducted and recorded in accordance with permit
requirements.
Yes ❑ No � Not Inspected ❑
One
NonhCaroli
N. C. Division of Water Quality 943 Washington Square Mall Washington, NC 27899 Phone Number 252-948-6481
Washington Regional Office
An Equal Opportunity/Affirmative Action Employer— 50'% Recycled/10% Post Consumer Paper

Page 2
Union Sand and Gravel
Hertford County
3) Analytical _Monitori�n
Analytical monitoring has been conducted and recorded in accordance with permit
requirements.
es ❑ No � Not Insected ❑
Other Observations:
1. The required Best Management Practices Plan was not completed and being
implemented. The analytical and qualitative monitoring has not been completed. Part III,
Section B and C of your permit outlines the requirements for analytical and qualitative
monitoring. Failure to comply with the conditions contained in your permit is considered
to be a violation.
2. You should read your entire permit and be aware of what is required in it. It is your
responsibility as the permit holder to read and understand what your responsibilities are.
3. You are reminded that you must keep a copy of your permit and most current
certificate of coverage on site.
Please provide this Office with a written response within fifteen (15) days of your receipt
of this letter. Please include anything you would like submitted to DWQ to address the
violations observed on site.
Thank you for your attention to this matter. This office requires that the violations, as
detailed above, be properly resolved. These violations and any future violations are
subject to a civil penalty assessment of up to $25,000.00 per day for each violation.
Should you have any questions regarding these matters, please contact Ed Warren at
[phone].
ASncere ,
A1 Hodge, Supervisor
Surface Water Protection Section
Addendum
cc: WaRO — Water Quality
Danny Smith — NPS-ACO Unit
Water Quality Central Files

Page 3
Union Sand and Gravel
Hertford County
ADDENDUM
The National Pollutant Discharge Elimination System (NPDES) program was established under
the federal Clean Water Act and then delegated to the Division of Water Quality for
implementation in North Carolina. The NPDES permitting program for stormwater discharges
was established in 1990. Phase I focuses on site and operations planning to reduce pollutant
sources.
Through the NPDES permitting program industrial facilities that fall into one of the subject ten
categories are required to obtain permit coverage under a general permit or an individual permit,
depending upon the facilities SIC code and the industrial activity occurring at the facility. There
are currently 19 active general stormwater permits in North Carolina. One condition that is
applicable to both the general permits and individual stormwater permits is the requirement to
develop and implement site -specific comprehensive stormwater pollution prevention plans
(SPI'P). These plans are required to include a comprehensive evaluation of the site and
operations to reduce pollutant sources and prevent pollutant discharge.
Copies of the general permits and accompanying documents can be accessed from the following
webpage: http://h2o.enr.state.nc.us/su/Forms_Documents.htm Permit text, technical bulletins,
discharge monitoring forms, and a Notice of Intent [which is the application of for coverage
under a NPDES General Stormwater Permit] can be found at this web site.
The following items are a subset of permit requirements and are listed to assist you and help
bring your attention to certain permitting issues, process and condition requirements of your
permit. That said, please see the above mentioned web site in order to obtain a copy of the permit
such that you may fully comply with all the conditions therein. Failure to properly comply
with conditions of the permit, like those bulleted below, constitutes violations and are
subject civil penalty assessment of up to $25,000.00 per day.
• Industrial facilities that fall into one of the subject ten categories are required to obtain
permit coverage under a general NPDES stormwater permit or an individual NPDES
stormwater permit
• All persons desiring to have facilities covered by a General Permit must register with the
Division of Water Quality (DWQ) by the filing of a Notice of Intent (NOI) and
Applicable Fees.
• This Notice of Intent (NOI) must be submitted and a Certificate of Coverage issued prior
to any discharge of stormwater associated with the industrial activity, process
wastewater, and/or mine dewatering.
• Once the Notice of Intent is received, DWQ will review and determine whether a
Certificate of Coverage (COC) may be issued. If this Certificate of Coverage is issued the
facility is covered by the General Permit. That is, the permittee is authorized to discharge
stormwater, process wastewater, and/or mine dewatering pursuant to the type of General
Permit until the permit expires or is modified or revoked.
• Any other point source discharge to surface water of the state is prohibited unless it is an
allowable non-stormwater discharge or is covered by another permit, authorization or
approval.

Page 4
Union Sand and Gravel
Hertford County
• There are currently 19 active general permits. Permit conditions vary accordingly;
however, most of the permits have following condition requirements (you must read your
entire permit to ensure full compliance):
o Development and compliance with the Stormwater Pollution Prevention Plan
o Collection, reporting, and recording of Analytical Monitoring
o Collection, reporting and recording of Qualitative Monitoring
o Collection, reporting and recording of Vehicle Maintenance Monitoring
o Records — Visual monitoring shall be documented and records maintained at the
facility along with the Stormwater Pollution Prevention Plan. Copies of the
analytical monitoring results shall also be maintained on -site. The Permittee
shall retain records of all monitoring information, including all calibration and
maintenance records and all original strip chart recordings for continuous
monitoring instrumentation, and copies of all reports required by this general
permit for a period of least 5 years for the date of the sample measurement, report
or application.
o Expiration — The permittee is not authorized to discharge after the expiration date
of the general permit. In order to receive automatic authorization to discharge
beyond the expiration date, the permittee shall submit forms and fees as are
required by the agency authorized to issue permits no later than 180-days prior to
expiration date. Any permittee that has not requested renewal at least 180 days
priorto expiration, or any permittee that does not have a permit after the
expiration and has not requested renewal at least 180 days prior to expiration, will
be subject to enforcement. Failure to renew your permit is a violation.
o Transfer — The Certificate of Coverage (COC) issued pursuant to this general
permit is not transferable to any person expect after notice to and approval by the
Director. The Director may require modification or revocation and reissuance of
the Certificate of Coverage to change the name and incorporate such other
requirements as may be necessary under the Clean Water Act. The Permit is
NOT transferable.
o Name Change, Closure or Facility Ownership change — Permittee is required to
notify the Division in writing in the event the permitted facility is sold or closed.
The Division of Water Quality views changes of name or ownership as a
modification that requires the Director's approval and reissuance of the permit.
Name and ownership changes required you to complete a Name/ownership
Change Form. from the Division and mail it back to the Division of Water Quality
along with all appropriate information.
o Proper Operation and Maintenance is a requirement of the permit.

Stormwater Inspection Checklist
Type of Visit: ® Compliance lnspection/Program []Technical Assistance ❑ Recon
Location: Liverman Mill Road (SR 1_1.37) approx. 2.25 mi. North of Union, NC
Facility Name: Union Sand and Gravel COC# 020417 Date: 11/14/2006
Time in; 11:05 am Time Out: 2:10 pm Name/Title of contact(s): Thomas Lewis, Owner
Stream Name: UT to Potecasi Creels Classification: C-NSW -RiverBasin: Chowan
YES
NO
NA
NE
1.
Is a copy of the Permit and the Certificate of Coverage available at the site?
®
❑
❑
❑
2.
Does the Plan include a General Location (USGS) map?
❑
®
❑
❑
3.
Does the Plan include a "Narrative Description of Practices"?
❑
®
❑
❑
4.
Does the Plan include a detailed site map including outfall locations?
❑
®
❑
❑
5.
Does the Plan include a list of significant spills in the past 3 years?
❑
®
❑
❑
6.
Has the facility evaluated all illicit (non stormwater) discharges to the storm
Sewer system?
❑
❑
0
❑
7.
Has the facility evaluated feasible alternatives to current practices?
❑
®
❑
❑
8.
Does the facility provide all necessary secondary containment?
❑
❑
®
❑
9.
Does the Plan include a BMP summary?
❑
Z
❑
❑
10.
Does the Plan include a Spill Prevention and Response Plan (SPRP)?
❑
®
❑
❑
11.
Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
❑
®
❑
❑
12.
Does the facility provide and document Employee Training?
❑
®
❑
❑
13.
Does the Plan include a list of Responsible Party(s)?
❑
®
❑
❑
14.
Is the Plan reviewed and/or updated annually?
❑
®
❑
❑
15.
Does the Plan include a Stormwater Facility Inspection Program?
❑
®
❑
❑
16.
Has the Plan been implemented?
❑
®
❑
❑
17.
Has the facility conducted its Qualitative Monitoring semi-annually?
❑
®
❑
❑
18.
Has the facility conducted its Quantitative (Analytical) monitoring?
❑
®
❑
❑
19.
Does the facility have Vehicle Maintenance activities on site (uses more than
55 gallons of new motor oil per month)?
❑
®
❑
❑

19a, Has the facility conducted its Annual Quantitative (Analytical) monitoring at outfalls
receiving runoff from Vehicle Maintenance areas? ❑ 0 ® 0
20. Were all outfalls observed during the inspection? ® El [] El
21. If the facility has representative outfall status, is it properly documented by the
Division?
Comments:
(1)-Facility has current permit; most recent COC on site is 418105 effective date.
(2)-Permit does not require a Stormwater Pollution Prevention Plan. Questions 2 through 15 are based on items that have
to be in a Stormwater Pollution Prevention Plan. However, the permit does require that the facility have a 'Best
Management Plan.' The facility did not have a `Best Management Plan' on day of inspection. The subjects addressed in
Questions 2.15 provide a guide for the types of items the `Best Management Plan' should contain, and it is suggested that
the `Best Management Plan' address these subjects, as applicable to this facility.
(17)-Facility has not performed Qualitative monitoring as required in permit condition Part III, Section B (3), Table.(5).
(18)-Facility has not performed Quantitative monitoring as required in permit condition Part III, Section B (1), Table (1),
which is applicable to stormwater runoff from areas on site that do not drain back to sand pits and/or do not pass through
the settling ponds used to treat mine dewatering discharges; and facility did not monitor as required in Part III,
Section C (1), Table (6).
Inspector Name: Ed Warren Date: 2/5107
e Complete items 1, 2, and S. Also complete
Item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front if space permits.
1. Article Addressed to:
THOMAS LEWIS
UNION SAND & GRAVEL
121 WEST MODLIN ROAD
AHOSKIE NC 27910
Signature
0 Agent
❑ Addressee
B Received byTPrinted Name) Date of Delivery
D-1—&7
D. Is delivery address different from Item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mall
❑ Registered
❑ Insured Mall
❑ Exprass Mall
❑ Return Receipt for Merchandise
o C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number t 7006 0100 0000 8 3 7 9., ,552
(rransfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

��0F W A rF,gQG Michael F. Easley, Governor
William G. Ross Jr., Secretary
7 North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
June 12, 2006
Mr. Thomas Lewis
Union Sand and Gravel Inc.
121 W. Modlin Road
Ahoskie, NC 27910
Subject: Stormwater General Permit NCG020000
Operations and Maintenance Reminder
Union Sand and Gravel Inc.
COC Number NCG020417
Hertford County
Dear Permittee:
Our records indicate that you have been issued a Stormwater General Permit and a Certificate
of Coverage for your facility. -These permits have specific conditions that must be met in order for you
to be in compliance with your permit. It is your responsibility, as the permit holder, to read and
comply with the conditions contained in the permit.
It is our responsibility, as the issuing authority, to make sure that the operation and
maintenance of your facility complies with the conditions contained in your permit. To assist you in
complying with these conditions, we are attaching a Technical Bulletin specific to your permit
requirements. We are currently in the process of developing our inspection schedule. Therefore, you
should have all of your records up to date as we may be contacting you in the near future to set up
an inspection of your facility.
If you have any questions, please do not hesitate to contact Samir Dumpor, Pat Durrett or
myself at [phone].
Sincerely
Al Hodge, Supervisor
Washington Regional Office
Surface Water Protection Unit
Encl.
CC: WaRO files
North Carolina Division of Water Quality Internet h2o.err.state.nc.us
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] NpirthCuolina
An Equal Opportunity/Affirmative Action Employer— 50°% Recycled110°% Past Consumer Paper Aaturally

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a"'n-'THOMAS LEWIS
r~ Wri�iUNION SAND & GRAVELor Pf-
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*-,121 WEST,MODLIN ROAD
—igeHOSK1E.14C 21910

Thomas Lewis
Union Sand and Gravel Inc
121 W Modlin Rd
Ahoskie, NC 27910
Dear Permittee: .
"fEcEg�tC*L) April8, 2005
APR 1 2 2005
DW4-WARo
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Subject: NPDES Stormwater Permit Coverage Renewal
Union Sand and Gravel Inc
COC Number NCG020417
Hertford County
In response to your renewal application for continued coverage under general permit NCG020000 the Division of Water
Quality (DWQ) is forwarding herewith the reissued stormwater general permit. Please review the new permit to familiarize
yourself with the changes in the reissued permit. The general permit authorizes discharges of stormwater and some types of
wastewater, You must meet the provisions of the permit for the types of discharges present at your facility. This permit is
reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
• A new Certificate of Coverage
• A copy of General Stormwater Permit NCG020000
• A copy of a Technical Bulletin for the general permit
• Five copies of Discharge Monitoring Report (DMR) Forms - wastewater and stormwater
Five copies of Qualitative Monitoring Report Form
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require modification
or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal requirements to obtain other
permits which may be required by DENR or relieve the permittee from responsibility for compliance with any other applicable
federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
If you have any questions regarding this permit package please contact Aisha Lau of the Central Office Stormwater Permitting
Unit at [phone], ext.578.
Sincerelv,,. b�4"A y
for Alan W. Klimek, P.E.
cc: Central Files
Stormwater & General Permits Unit Files
Washington Regional Office
O
NppS hcarolina
Alaturallff
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.uslsulstormwater.htmi 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/AlSrmative Action Employer— 50% Recycledl10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020417
STORMWATER AND PROCESS WASTEWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended,
Union Sand and Gravel Inc
is hereby authorized to discharge stormwater and to operate treatment systems and discharges associated
with mine dewatering wastewater and process wastewater from a facility located at
Union Sand and Gravel Inc
121 W Modlin Rd
Ahoskie
Hertford County
to receiving waters designated as UT to Potecasi Creek, a class C;NSW stream in the Chowan River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I,
II, III, IV, V, and VI of General Permit No. NCG020000 as attached.
This certificate of coverage shall become effective April 8, 2005.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 8, 2005
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
March 7, 2000
Mr. Thomas Lewis
Union Sand & Gravel
Route 3, Box 19 112
Ahoskie, North Carolina 27910
NCDENR
Subject: General Permit No. NCG020000
Union Sand & Gravel
COC NCG020417
Hertford County
Dear Mr. McNeely:
In accordance with your application for discharge permit received on April 21, 1997, we are forwarding
herewith the subject certificate of coverage to discharge under the subject state - NPDES general permit. This
permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the Memorandum
of Agreement between North Carolina and the US Environmental Protection agency dated December 6,,1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division of
Water Quality. The Division of Water Quality may require modification or revocation and reissuance of the
certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Water Quality or permits required by the Division of Land Resources, Coastal Area Management Act
or any other Federal or Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Aisha Lau at telephone number
919/733-5083 ext. 578.
Sincerely,
O wIG1NAM C. MILDY S
Kerr T. Stevens
cc: 'Washington Regional Office r
v�
�jJ MAR - 9 2000
WASNINGTOP,l REGIONAL OFFICE
DWO
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020417
STORMWATER, MINE DEWATERING, AND/OR OVERFLOW FROM
PROCESS WATER RECYCLE SYSTEMS DISCHARGES
NATIONAI, POLLurANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215,1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Union Sand and Gravel
is hereby authorized to discharge mine dewatering water and stormwater from a facility located at
Union Sand and Gravel
SR 1137
Union
Hertford County
to receiving waters designated as an unnamed tributary to Potecasi Creek, class C NSW waters, in the Chowan River
Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, II, lll,
IV, V, VI and VI of General Permit No. NCG020WO as attached.
This certificate of coverage shall become effective March 7, 2000.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 7, 2000.
aRIWI SIGHED BY
%ILLIAM C• MILLS
Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

14 WVRFREESBOROI
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`State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
March 7, 2000
Mr. Thomas Lewis
Union Sand & Gravel
Route 3, Box 19 1/2
Ahoskie, North Carolina 27910
NCDENR
Subject: General Permit No. NCG020000
Union Sand & Gravel
COC NCG020417
Hertford County
Dear Mr. McNeely:
In accordance with your application for discharge permit received on April 21, 1997, we are forwarding
herewith the subject certificate of coverage to discharge under the subject state - NPDES general permit. This
permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the Memorandum
of Agreement between North Carolina and the US Environmental Protection agency dated December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division of
Water Quality. The Division of Water Quality may require modification or revocation and reissuance of the
certificate or coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Water Quality or permits required by the Division of Land Resources, Coastal Area Management Act
or any other Federal or Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Aisha Lau at telephone number
919/733-5083 ext. 578.
Sincerely,
ORIGINAL SIGNED
WILLIAM C. MIL SY
Kerr T. Stevens
cc: Washington Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Emptoyer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020417
STORMWAI'ER, MINE DEWATERING, AND/OR OVERFLOW FROM
PROCESS WAFER RECYCLE SYSTEMS DISCHARGES
NATIONAL POLLUTANT' DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the.
Federal Water Pollution Control Act, as amended,
Union Sand and Gravel
is hereby authorized to discharge mine dewatering water and stormwater from a facility located at
Union Sand and Gravel
SR 1 137
Union
Hertford County
to receiving waters designated as an Unnamed tributary to Potecasi Creek, class C NSW waters, in the Chowan River
Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, 111,
IV, V, V[ and VII of General Permit No. NCG020000 as attached.
This certificate of coverage shall become effective March 7, 2000.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 7. 2000.
pRIGg\- SOGNE) aY
'VlwAm C. MILLS
Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

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FACILITY j h +` `' S /'.n "e, j r
COUNTY
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DISCHARGE CLASS S -)-d r sn iv alp- f,
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DRAFT
OPERATION AND MONITORING PLAN
Union Sand & Gravel, Inc.
Lewis Brothers Pit
Mine Permit No. 46-05
Hertford County
Operator: Union Sand & Gravel, Inc.
Facility Name: Lewis Brothers Pit (Mine Permit No. 46705)
The Lewis Brother Pit is located approximately 6 miles northwest of Ahoskie, in Hertford
County. The Mine Permit area is 199 acres with approval to disturb 105 acres which includes
the access road of 1.0 acres, mine excavation area of 102 acres, and stockpile area of 1.5 acres.
The mine will have a depth of 50 feet from the original ground surface elevation.
DESCRIPTION AND OPERATION OF THE LEWIS BROTHERS PIT DEWATERING ACTIVITIES:
Mining activities have taken place at this mine under a North Carolina Mining Permit since
early 1981. The site consists of a number of ponds, stockpile area and active and future mine
areas. Mining takes place by removing material to a depth below the water table and then
dewatering the active pit area begins. As needed, pit water is pumped from the pit into a 30'
wide by 350 foot long initial settling pond. Water leaves this site by way of a 24" corrugated
metal pipe and then flows into a 2 acre pond. Discharge from this pond is by way of a 36"
corrugated metal riser pipe with an anti- vortex device and trash rack. The discharge barrel is a
24" corrugated outlet pipe which is the point of discharge for the dewatering activities. Water is
discharged into a natural well vegetated low area and flows into a swamp within the mine
permit area. Areas around the settling pond and the 2 acre pond are well stabilized with trees
and underbrush. Union Sand & Gravel, Inc. (US&G) has two pumps both with John Deer
engines. One is an 8" Rainbow Pump with a capacity of 1800 gallons/minute and the other is, a
10" Cornell Pump with a capacity of 2000 gallons/minute. Only one pump is used at any given
time with pumping usually for a span of 24 hours. At times, pumping may take place for 48
hours. After 24 or 48 hours of pumping, the pump is cut off and stays off for a number of days.
Stormwater runoff from disturbed areas drains internal to the mine pits.
Monitoring:
All stormwater and wastewater discharges within the permitted boundary associated with land
disturbing activities shall be monitored, analyzed and reported as required by the NPDES
General Permit No. NCG020000. The intent of the permit is to minimize potential negative
impacts to water quality. The mine operator shall keep a copy of all records related to
inspections, reports, etc., regarding stormwater/wastewater and provide these records to the
Division of Water Quality as required by the General Permit. The BMP controls shall be
inspected at least weekly and within 24 hours following a storm event which produces a
discharge. All maintenance of these BMP measures shall be documented. The maintenance

Union Sand & Gravel, Inc.
0 & M Plan
Page 2
shall include, but is not limited to good house keeping, repair of measures, settling basin clean
out as necessary to prevent downstream impacts. Outflow of dewatering activities will be
monitored, analyzed and reported as required by the NPDES General Permit 020000. US&G
has General Permit NCG020000 for Stormwater/ Mine Dewatering and/or Processed
Wastewater Certificate of Covera a No. NCG020417 issued by the Division of Water Quality.

Print this form to PDF Retum PDF of this form to DLR CO by email. cc DLR RO and DWQ SPU
i
MINING PERMIT APPLICATION REVIEW FORM
for the
DIVISION OF WATER QUALITY
OUT BY DLR:
Project Name: Lewis Brothers Pit DLR Permit #: 46-05 County: Hertford Address: 121 W Medlin Rd,
Ahoskie, NC 2791.0 1
YES NO
Is this mine a new mine? r I r
Have land disturbing activities
started? Date? r r
Latitude:36.3547 Longitude:-77.0428
Please return comments to (at DLR CO): Judy Wehner
Comments due by:
SECTION BELOW TO BE FILLED OUT BY DWQ:
Date Commencing
1981
1981
Is the RO concerned that the operation, as proposed, would violate standards of water quality? No
Comments: Since the Modification is to increase the depth of the Mine, and O&M plan will be required. I
already contacted Consultant (Floyd Williams and he said that he will make one.
Watershed/Stream Name & Classification: Chowan River basin/UT to Potecasi Creek/_ C; NSW 125-4-8
DWQ Compliance Status of Mine: NE
YES NO
IVPDES permit required?
..
NPDES permit existing?
r (Permit #NCG020417. }
r
If an NPDES' permit is not required, is DWQ
;
still. concerned about wetland degradation
r `
r
by dewatering?
Should permittee contact DWQ RO
immediately? (e.g. to schedule a site visit if
r � RO Contact Name:
r
mine has already begun digging or is
Contact Reason:
dewatering without DWQ permit)
401 Wetland Cert. required? _ti
r ri
i✓r ,
401 Wetland Cert. existing?
r Permit #
r ,
Does DWQ RO currently have enough
information to determine if a, 401 k
r Existing'Mine.
r
t`
certification. is required?,
Rev September 2010

Print this form to PDF
Return PDF of this form to DLR CO by email. cc DLR RO and DWQ SPU
YES NO
Are wetlands disturbed at this site?
Does DWQ RO suspect or know of nearby
r
r
wetlands to the site?
Is a wetland delineation required prior.to -
DWQ
r By: r JD or r ,Consultant
r r
r
issuing the permit?
Onsite? Or .•" Offsite?
Stream Determination Needed?
r
Streambetermination Completed?.
r
r
Does DWQ RO need a statement that no
wetlandsistreams are disturbed
r
r
for this project from applicant?
Buffer Determination Needed?
Buffer Determination Completed?
r
r
Recycle system permit existing?*
Permit #
r
New Recycle System permit required?*
r
r
Enough information to determine?
Non -discharge permit existing?*
r � Permit #. • :f
Will wastewaters discharge to HQW waters
r
F. 7Q10
Unknown (permittee determine): r
with a 71010=0? **
Flow:
r Has Violation
A
r D&M Requirements
Does DWQ require DLR to hold the permit
(e.g. so DWQ can;revie►ni it further or
Nr ' HQW17Q10 Concerns
because DWQ requires, more information)?
r' Other. Reason:
-
RO contact:
r Hold,Until:
{
Mine must wait to dewater until an O&M
r
r
plan is approved?
*The NPDES SW and WW permit NCG020000 covers closed -loop recycle systems, designed to exclude all stormwater run-off from_
the system and operate at or below two -feet of freeboard. These systems maybe permitted by a Non -discharge Recycle System
Permit from the Aquifer Protection Section_(APS). OR may instead be permitted under NCG020000 to eliminate an additional permit.
Recvcle systems that do not meet those criteria are considered discharginq systems, and are subiect to the NCG020000 discharge_
permit.
*`To obtain 7Q10 flows, permittees must contact the DWQ StormwaterPermitting Unit. If DWQ does not have a flow estimate fora
specific stream, pemuttees will be asked to obtain one. Permittees should contact J. Curtis Weaver at the USGS: 919-571-4043, for
more information on obtaining a 7Q10 flow. USGS will not determine a 7Q 10 flow for tidally influenced water bodies.
Reviewed by:
DWQ RO Surface Water: WaRO Regional Office: Samir Dum or Date: May 6, 2011
RO Aquifer Protection Section: Regional Office: Date:
SPU DWQ Central Office Reviewer (if applicable):
Rev September 2010

% WILLIAMS
��� L:it:'ll"Uttt31C111:1� � ��tt'.�Cx'lC:[i �ti'1'ICt'ti i•f.!::
April 15, 201.1
Mining Program
Dept. of Environment & Natural Resources
Division of Land Resources
Land Quality Section
1612 Mail Service Center
Raleigh, NC 27699-1612
Mining Program:
P.O. Box 190 � BATH, NC 27808
[phone]
�� C j'D
APR 1 a 201,
Rl-: Renewal & Modification. Application.
Union Sand & Gravel, Inc.
Lewis Brothers Pit (Mine Permit # 46-05)
Hertford County
I: have been retained by Mr. Thomas Lewis to process the Renewal and Modification
Application for the Lewis Brothers Pit (M.ining Permit # 46-05) in Hertford County.
Enclosed is a check from Union Sand & Gravel, Inc. in the amount of $ 1,750.00
($ 1,000.00 for Renewal and $ 750.00 for Modification) and five (5) copies of the Renewal
and Modification Application along with the maps. Please note that the modification is to
increase the mine depth from 35' to 50' from natural ground elevation.
Please feel free to contact me regarding any question you may have.
cc. Mr. Thomas Lewis
Fric. Original Renewal Application & 5 Copies with maps
Application Review Fee: Ck. # 12888 dated 4/1.4/11
Sincer 1 ,
Floyd . Williams, PG, CPESC, CPG
1
0v� RAC ��aP�
�0� .
v'AA`

APPLICATION FOR A MINING PERMIT
0Vc b" 5-5 -'1Q0tt
NORTH CARO.LINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
LAND QUALITY SECTION
APPLICATION FOR A MINING PERMIT
(PLEASE PRINT OR TYPE) APR 2 1 2 011
1. Name of Mine Lewis Brothers Pit County Hertford
River Basin Chowan
Latitude (decimal degrees to four places) 36' 21' 16.00" N
Longitude (decimal degrees to four places) 770 02' 36.85" W
2. Name of Applicant*_ _Union Sand & Gravel, -Inc.
3. Permanent address for receipt of official mail** 121 W. Modlin Road
Ahoskie, NC 27910
Telephone [phone] Alternate No.
4. Mine Office
Telephone
5. Mine Manager Mr. Thomas Lewis
We hereby certify that all details contained in this Permit Application are true and correct to the best of our
knowledge. We fully understand that any willful misrepresentation of facts will be cause for permit
revocation.
1
***Signature �� Date
Print Name Thomas Lewis
Title V. President
* This will be the name that the mining pen -nit will be issued to and the nai
reclamation bond (security) that corresponds to this site.
** The Land Quality Section must be notified of any changes in the permanent address
*** Signature of company officer required.
T%\\
.phone number.
G.S. 74-51 provides that the Department shall grant or deny an application for a permit within 60 days of receipt of a
complete application or, if a public hearing is held, within 30 days following the hearing and the filing of any
supplemental infonnation required by the Department. All questions must be addressed and all required maps
provided before this application can be considered complete. Attach additional sheets as needed.
l ! J J- -1-
UT (� f oCctSi �rC--� C , NSkj

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'fyq+Alt f7.532'Yt' 0

APPLICATION FOR A MINING PERMIT
NOTE: All of the following questions must be thoroughly answered regarding your mining operation for
the intended life of the mine. All responses must be clearly conveyed on a corresponding, detailed mine map.
A. GENERAL CHARACTERISTICS OF THE MINE
1. Answer all of the following that apply:
❑ If this is an application for a NEW permit, indicate the total acreage at the site to be covered by the
permit (this is the acreage that the "new permit" fee. will be based upon):
Of this acreage, how much is owned and how much is leased? Acres owned:
Acres leased: Property owner if leased:
X_ If this is an application for.RENEWAL of a mining permit, indicate the mining pennit number and
the total (overall) acreage covered by the existing permit: Mining Permit No.: 46-05
Total permitted acreage (this is the acreage that the "renewal" fee will be based upon):
X If this is an application for a MODIFICATION to a mining permit, indicate the mining permit
number and the total (overall) acreage covered by the existing permit.
Mining Permit No.: 46-055 Total permitted acreage:
(Modification request is to mine to a .depth of 50 .)
Does the modification involve acreage within the previously approved permitted boundary?
Yes - X No ❑. If yes, indicate the acreage to be covered by this modification (this is the acreage
that the '"major modification" fee will be based upon):
Does the modification involve acreage outside the previously approved permitted boundary?
Yes ❑ No - X. if yes, indicate the additional acreage to be covered by this
modification: . (NOTE: you must complete all of Section F. of this application form
entitled Notification of Adjoining Landowners).
Of this acreage to be added to the permit, will any portion of this acreage be affected (i.e.: disturbed,
ground cover removed) by the mining operation? Yes ❑ No ❑ (If no, a "minor modification"
fee of $100.00 is required, despite the "undisturbed" acreage to be added). if yes, indicate the
acreage to be affected within the acreage to be added to the permit (the total acreage to beadded to
the permit is the acreage that the "major modification" fee will be based upon):
❑ If this is an application .for TRANSFER of a mining permit, indicate the mining perinit number and
the total (overall) acreage covered by the existing permit.
Mining Permit No.: Total permitted acreage:
SEE THE FEE SCHEDULE AT THE END OF THIS FORM FOR THE PROPER FEE AMOUNT TO BE
PAID FOR THE REQUESTED PERMIT ACTION(S) AND CORRESPONDING ACREAGE NOTED
ABOVE
2. Name of all materials mined:
3. Mining method:
Hydraulic Dredge X - Front-end Loader & Truck X - Shovel & Truck
Dragline & Truck X_- Self -loading Scraper
Other (explain):
4. a. Lxpected maximum depth of mine (feet) 50'
Depth is relative to what benchmark? (e.g., natural ground level, mean sea level, road elevation, etc.)
Natural Ground Elvation
b. Expected average depth of mine (feet) 509
-2-

APPLICATION FOR A MINING PERMIT
5. Has any area(s) at this site been mined in the past? Yes X No
If yes, when and by whom was this activity conducted? neon Sand raved Inc.
6. Number of years for which the permit is requested (10 years maximum):
B. MAPS
Clearly mark and label the location of your mining operation on six (6) copies of a 7.5-minute quadrangle
and a county highway map. These maps, in addition to six (6) copies of all mine maps and reclamation
maps, must be submitted with each permit application.
7.5-minute quadrangles may be obtained from the N.C. Geological Survey:
Mailini2 Address:
1612 Mail Service Center OR
Raleigh, North Carolina 27699-1612
[phone]
«� w.<�eolo<��r.enr.state.nc. us/
Physical Address:
512 North Salisbury Street, 5`h Floor
Raleigh, North Carolina 27604
County highway maps may be obtained from the N.C. Department of Transportation:
North Carolina Department of Transportation — Geographic Information Systems (GIS)
Mailing Address:
NCDOT GIS Unit
1587 Mail Service Center
Raleigh, North Carolina 27699-1587
Physical Address:
NCDOT GIS Unit
3401 Carl Sandburg Court
Raleigh, North Carolina 27610
[phone]
WWW.ncdot.or.Jit/gisContact/dcliEult.html
2. Mine maps must. be accurate and appropriately scaled drawings, aerial photographs or, enlarged
topographic maps of the entire mine site. All aspects of the mine site must be clearly labeled on the
maps along with their corresponding (approximate) acreage. As a reminder, mining permits can
only be issued for up to 10 years; thus, all mine and reclamation maps must only denote those
activities that are intended to be conducted during the life of the mining permit. All maps must be
of a scale sufficient (see minimum requirements listed below) to clearly illustrate the following, at a
minimum:
a. Property lines of the tract or tracts of land on which the proposed mining activity is to be located
including easements and rights -of -way.
b. Existing or proposed permit boundaries.
c. Initial and ultimate limits of clearing and grading.
d. Outline and width of all buffer zones (both undisturbed and unexcavated).
e. Outline and acreage of all pits/excavations.
f. Outline and acreage of all stockpile areas.
g. Outline and acreage of all temporary and/or permanent overburden disposal areas.
h. Location and acreage of all processing plants (processing plants may be described as to location and
distance from mine if sufficiently far removed).
i. Locations and names of all streams, rivers and lakes.
j. Outline and acreage of all settling and/or processing wastewater ponds.
k. Location and acreage of all planned and existing access roads and on -site haul roads.
1. Location of planned and existing on -site buildings.
m. Location and dimensions of all proposed sediment and erosion control measures.
n. Location of 100-year floodplain limits and wetland boundaries.
o. Names of owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary; if an adjoining tract is owned or leased by the applicant or is owned by the lessor of
the mine tract, names of owners of record of tracts adjoining these tracts, that are within 1,000 feet of
the mining permit boundary, must be provided on the mine map.
-3-

APPLICATION FOR A MINING PERMIT
p. Names of owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary which lie directly across and are contiguous to any highway, creek, stream, river, or
other watercourse, railroad track, or utility or other public right-of-way. If an adjoining tract is owned
or ]eased by the applicant or is owned by the lessor of the mine tract, names of owners of record of
tracts adjoining these tracts, that are within. 1,000 feet of the mining permit boundary, must be
provided on the mine map(s). NOTE: "Highway" means a road that has four lanes of travel or less
and is not designated as an Interstate Highway.
q. Map legend:
1. Name of applicant
2. Name of mine
3 . ' North arrow
4. County
5. Scale
G. Symbols used and corresponding names
7. Date prepared and revised
8. Name and title of person preparing map
Map scales should meet the following guidelines:
PERMITTED ACREAGE
MAP SCALE
0-49 Acres
1 inch = 50 feet
50-199 Acres
I inch = 100 feet
200+ Acres
I inch = 200 feet
(NOTE: Smaller scaled maps may be acceptable if they clearly illustrate the above items)
-4-

APPLICATION FOR A MINING: PERMIT
A table/chart must be provided on the mine map that clearly lists the approximate acreage of tailings/sediment
ponds, stockpiles, wastepiles, processing area/haul roads, mine excavation and any other major aspect of the
mining operation that is proposed to be affected/disturbed during the life of the mining permit. A table/chart
similar to the following will be acceptable:
CATEGORY
AFFECTED ACREAGE
Tailings/Sediment Ponds
Stockpiles
1.5
wastepiles
Processing Area/Haul Roads
1.0
Mine Excavation
1.02.5
Other (Explain)
Total. Disturbed Acreage
1.05.0
NOTE:
IN ADDITION TO THE ABOVE, THE MAPS MUST ALSO INCLUDE ANY SITE -SPECIFIC
INFORMATION THAT IS PROVIDED IN THE ANSWERS TO THE FOLLOWING QUESTIONS IN
THIS APPLICATION FORM (PLEASE NOTE THE ITALICIZED QUESTIONS/STATEMENTS
THROUGHOUT THE FORM). THIS APPLICATION WILL NOT BE CONSIDERED COMPLETE
WITHOUT ALL RELEVANT ITEMS 13EING ADEQUATELY ADDRESSED ON THE MINE MAPS.
- 5 -

APPLICATION FOR A MINING PERMIT
C. PROTECTION OF NATURAL RESOURCES
Describe in detail the sequence of events for the development and operation of the mine and reference the
sequence to the mine map(s). Attach additional sheets as needed.
Lewis Brothers Pit is an existing active mining oeration. All areas that have been
approved to be affected in the past are shown on tKe map as active areas or areas that
have been approved to be.affected. Please see new mine map.
2. Describe specific erosion control measures to be installed prior to land disturbing activities and during
mining to prevent offsite sedimentation (include specific plans for sediment and erosion control for mine
excavation(s), waste piles, access/mine roads and process areas), and give a detailed sequence of
installation and schedule for maintenance of the measures. Locate and label all sediment and erosion
control measures on the mine map(s) and provide typical cross-sections/construction details of each
measure. Engineering designs and calculations are required to justify the adequacy of any proposed
measures.
All affected areas and future approved mine areas have been designed for internal
drainage. A settling pond is being utilized for the first dewatering discharge area. A
24" CMP barrel discharges from the initial pond into a second pond that has a 36"
CMP riser and CMP 24' barrel. This pond discharges into a natural drainage way.
3. a. Will the operation involve washing the material mined, recycling process water, or other waste water
handling? Yes ❑ No - X. If yes, briefly describe all such processes including any chemicals to be
used.
b. Will the operation involve discharging fresh or waste water from the mine or plant as a point discharge to
the waters of the State? Yes - X No ❑. Ifyes, briefly describe the nature of the discharge and locale
all proposed discharge points (along with their method of stabilization) on your mine map(s).
See map for mine dewatering point of discharge. Union Sand & Gravel, has a
Stormwater-Dewatering Wastewater Discharge General Permit that was issued by the
Division of Water Quality. .
-6-

APPLICATION FOR A MINING PERMIT
c. Will any part of the proposed mine excavation(s) extend below the water table? Yes - X_ No ❑.
If yes, do you intend to dewater the excavation(s)? Yes - X No ❑.
If yes, what impact, if any, will mine dewatering have on ne ghboring wells? Estimated withdrawal rate
in gallons per day: . Locate all existing wells on the mine maps) that lie within
500 feet of the proposed excavation area. Provide data to support any conclusions or statements made,
including any monitoring well data, well construction data and current water withdrawal rates. Indicate
whether the proposed mine locale is served by a public water system or private welts.
The mining operation is already covered by NPDES General Permit for Stormwater —
Dewatering and Wastewater Discharge.
d. If you answered yes to any of the above questions, provide evidence that you have applied for or
obtained the appropriate water quality permit(s) (i.e., non -discharge, NPDES, Stormwater, etc.) from the
Division of Water Quality, Water Quality Section. In addition, the applicant is required to register water
use with the Division of Water Resources if the operation withdraws more than 10,000 gallons per day
and needs a capacity use permit from the Division of Water Resources if the.operation lies in a capacity
use area and withdraws more than 100,000 gallons per day.
Same as c.
4. a. Will the operation involve crushing or any other air contaminant emissions? Yes ❑ No - X.
If yes, indicate evidence that you have applied for or obtained an air quality permit issued7y the
Division of Air Quality or local governing body.
b. How will dust from stockpiles, haul roads, etc., be controlled?
A water truck will be utilized as necessary to prevent dust problems.
-7-

APPLICATION FOR A MINING PERMIT
a. A buffer will be required between any mining activity and any mining permit boundary or right-of-
way. It may be an unexcavated buffer (no excavation, but roadways, berms and erosion &
sedimentation control measures may be installed within it), an undisturbed buffer (no disturbance
within the buffer whatsoever), or a combination of the two, depending upon the site conditions. Note
that all butlers must b,e located within the mining permit boundaries.
How wide a buffer wi 11 be maintained between any mi ning activity and any mining permit boundary
or right-of-way at this ,site? A minimum buffer of 25 feet is recommended, although a wider buffer
may be needed depending on site conditions. Show all buffer locations and widths on the mine
mapW
Please see map for buffers. The closest property lines are provided with a minimum of
50' plus undisturbed bui7fer.
b. A minimum 50 foot wide undisturbed buffer will be required between any land disturbing activities
within the mining permit boundaries and any natural watercourses and wetlands unless smaller
undisturbed buffers can be justified. Depending on site conditions, a buffer wider than 50 feet may
be needed.
How wide an undisturbed buffer will be maintained between any land disturbing activities within the
mining pen -nit boundaries and any natural watercourses and wetlands at this site? Shotiv all buffer
locations and widths or, the mine map(s).
A minimum 50' buffer is provided for mining activities near wetlands.
6. a. Describe methods to prevent landslide or slope instability adjacent to adjoining permit boundaries
during mining. Minimum 2 horizontal to I vertical slopes or flatter for clayey material and
minimum 3 horizontal to I vertical slopes or flatter for sandy material are generally required, unless
technical justification can be provided to allow steeper slopes.
Mining activities are far enough away from adjoining properties to prevent any possible
damage.
-8-

APPLICATION FOR A MINING PERMIT
b. Provide a cross-section on the mine maps) for all fill slopes (berms, wastepiles, overburden
disposal areas, etc), clearly indicating the intended side slope gradient, installation ofany benches
and/or slope drains !with supporting design information) if needed, and the method of final
stabilization.
The only thing that is applicable in section "b" is two berms, which are proposed, along
the south side of the site where additional mining areas were approved fo be affected on
December 7, 2001. These additional areas have not been disturbed at this time.
c. In excavation(s) of unconsolidated (non -rock) materials, specify the angle of all cut slopes including
specifications for benching and sloping. Cross-sectionsfor all cut slopes must be provided on the
mine map(s).
d. In hardrock excavations, specify proposed bench widths and heights in feet. Provide cross -sections
of the mine excavation clearly noting the angles of the cut slopes, widths of all safety benches and
mine benches, and the expected maximum depth of the excrn>ation.
N/A
7. Describe other methods to be taken during mining to prevent physical hazard to any neighboring dwelling
house, public road, public, commercial or industrial building from any mine excavation. Locate all such
structures on the mine map if they are within 300 feet of any proposed excavation,
The buffers provided around excavation areas are adequate to prevent an physical
hazard to any neighboring dwelling, house, public, commercial or industrial building.
8. Describe what kind of barricade will be used to prevent inadvertent public access along any high wall area
and when it will be implemented. Vegetated earthen berms, appropriate fencing and adequate 1boulder
barriers may be acceptable high wall barricades. A construction detail/cross-section and location of each
type of barricade to be used must be indicated on the mine map(s).
Berms will be constructed along south side of site when mining begins in these areas.

APPLICATION FOR A MINING PERMIT
9. Are acid producing minerals or soils present? Yes ❑ No - X.
If yes, how will acid water pollution from the excavation, stoc p' iles and waste areas be controlled?
10. a. Describe specific plans (including a schedule of implementation) for screening the operation from
public view such as maintaining or planting trees, bushes or other vegetation, building berms or other
measures. Show the location ofall visual screening on the mine map(s) and provide cross -sections
through all proposed berms or proposed spacing, sizes and species for tree plantings.
Please see the mine map for details of berm that will be utilized to screen the residential
areas and SR1137 along the south side of the mine.
b. Could the operation have a significantly adverse effect on the purposes of a publicly owned park,
forest or recreation area? If so, how will such effects (i.e., noise, visibility, etc.) be mitigated?
No
11. Will explosives be used? Yes ❑ No - X.
If yes, specify the types of explosive(s) anTdescribe what precaution(s) will be used to prevent physical
hazard to persons or neighboring property from flying rocks or excessive air blasts or ground vibrations.
Depending on the mine's location to nearby structures, more detailed technical information may be
required on the blasting program (such as a third -party blasting study). Locate the nearest o fsite occupied
structures) to the proposed excavation(r) on the mine map and indicate its approximate distance to the
proposed excavation.
12. Will fuel tanks. solvents, or other chemical reagents be stored on -site? Yes ❑ No - X.
Ifyes, describe these materials, how they will be stored and method ofcontainment in case ofspill. Indicate
the location(s) of all storage facilities on the mine map(S).
9"1

APPLICATION FOR A MINING PERIIUT
D. RECLAMATION PLAN
Describe your intended plan for the final reclamation and subsequent use of all affected lands and indicate
the sequence and general methods to be used in reclaiming this land. This must include the method of
reclamation of settling ponds and/or sediment control basins and the method of'restoration or establishment
of -'any permanent drainage channels to a condition minimizing erosion, siltation and other pollution. This
information must be illustrated on a reclamation map and must correspond directly with the information
provided on the mine map(s). In addition, design information, including typical cross -sections, of any
permanent channels to be constructed as part of the reclamation plan and the location(s) ofall permanent
channels must be indicated on the reclamation map.
Mining areas will be reclaimed as ponds. Any areas affected around the ponds will be
ieveledand provided with vegetative groundcover as indicated in the Revegetation Plan
of the Mining Application. All pond side slopes will be provided with 3H to 1V slopes to
the water level and 2H to IV from water level to bottom on pond.
2. Is an excavated or impounded body of water to be left as a part of the reclamation? Yes - X No ❑.
If yes, illustrate the location of the body(s) of water on the reclamation map and provide a scaled
cross-section(s) through the proposed body(s) of water. The minirnum water depth must be at least 4 feet,
measured from the normal low water table elevation, unless information is provided to indicate that a more
shallow water body will be productive and beneficial at this site.
Will the body(s) of water be stocked with fish?. Yes - X No ❑
If yes, specify species.
Ponds will be stocked with fish species as recommended by the NC Wildlife
Commission.
3. Describe provisions for safety to persons and to adjoining property in all completed excavations in rock
including what kind of permanent barricade will be left. Acceptable permanent barricades are appropriate
fencing, large boulders placed end -to -end, etc. Construction details and locations of all permanent
barricades must be shown on the reclamation map.
NIA

APPLICATION FOR A MINING PERMIT
4. Indicate the method(s) of reclamation of overburden, refuse, spoil banks or other such on -site mine waste
areas, including specifications for benching acid sloping. Final cross -sections and locations for such
areas must be provided on the reclamation map.
M
a. Describe reclamation of processing facilities, stockpile areas, and on -site roadways.
The mine access road will be left to access the property.
b. Will any on -site roadways be left as part of the reclamation? Yes - X No ❑.
If yes, identify such roadways on the reclamation map and provide details on permanent road and ditch
line stabilization.
The existing access road will be left.
6. Describe the method of control of contaminants and disposal of scrap metal, junk machinery, cables, or
other such waste products of mining. (Note definition of refuse in The Mining Act of 1971.)
No off -site Generated waste shall be disposed of on the mine site without prior written approval
from the NC Department of Environment and Natural Resources, Land Quality Section and either
the Division of Waste Management (DWM) or local governing body. if a disposal permit has been
issued by DWM. for the site, a copy of said permit must be attached to this application. All
temporary and permanent refuse disposal areas must be clearly delineated on the mine map(s) and
reclamation map, along with a list of items to be disposed in said areas.
No offsite enerated waste will be deposed of at the mine site without prior approval
from DENR and other applicable agencies.
-12-

APPLICATION FOR A MINING PERMIT
7. Describe your plan for revegetation or other surface treatment of the affected areas. This plan must
include recommendations forbear -round seeding, including the time of seeding and the amount and type of
seed, fertilizer, lime and mulch per acre. The recommendations roust include general seeding instructions
for both permanent and temporary revegetation. Revegetation utilizing only tree plantings is not
acceptable. Recommendations can be sought from:
a. Authorized representatives of the local Soil and Water Conservation District;
b. Authorized representatives of the Division of Forest Resources, Department of Environment and
Natural Resources;
c. Authorized county representatives of the North Carolina Cooperative Extension Service, specialists
and research faculty with the Colleges of Agriculture and Life Sciences and Forest Resources at
North Carolina State University;
d. North Carolina licensed landscape architects;
e. Private consulting foresters referred by the .Division of Forest Resources, Department of Environment
and Natural 'Resources;
f. N.C. Erosion and Sedimentation Control Planning and Design Manual;
g. N.C. Surface Mining Manual: A Guide for Permitting, Operation and Reclamation;
h. Others as may be approved by the Department.
LIME - RATE OF APPLICATION (tons/acre):
FERTILIZER - ANALYSIS AND RATE OF APPLICATION (pounds/acre):
SEED - TYPE(S) AND RATE(S) OF APPLICATION INCLUDING YEAR-ROUND SF_ElxNG
SCHEDULE (pounds/acre): [NOTE: Include Legumes]
Seed Types:
Seeding Dates
Seeding Rates:
Seed Types:
Seeding Dates:
Seeding Rates_
Feb. 15 —April 1
Kobe Lespedeza
10
Bahiagrass
50
Redtop
I.
Winter rye (grain)
15
April 1 — July
Common Bermuda
50
August l — October 24
Lespedeza (unscarified)
30
German millet
40
October 25 — February 15
Rye (grain -temporary)
120
M.ULCfl - TYPE AND RATE OF APPLICATION (pounds/acre) AND METHOD OF ANCHORING:
OTRER VEGETATIVE COVERS — TYPE (S) AND RATE (S) OF APPLICATION INCLUDING
SEEDING SCHEDULE (pounds/acre, trees/acre, spacing of trees/shrubs, etc):
Revegetation and/or reforestation plan approved by:
Print Name Floyd R. Williams, PG, CPG CPESC
Title President
Agency Williams Environmental & Geological Services, PLLC
-13-

APPLICATION FOR A MINING PERMIT
E. DETERMINATION OF AFFECTED ACREAGE AND BOND
The following bond calculation worksheet is to be used to establish an appropriate bond (based upon a range
of $500 to $5, 000 per affected acre) for each permitted mine site based upon the acreage approved by the
Department to be affected during the life of the mining permit. Please insert the approximate acreage, for each
aspect ofthe mining operation, that you intend to affect during the life o this miningper mit (in addition, please
insert the .appropriate reclamation cost/acre for each category from the Schedule of Reclamation Costs
provided with this application Lqrm2 OR you can defer to the Department to calculate your bond for yau based
upon your maps and standard reclamation costs:
AFFECTED RECLAMATION RECLAMATION
CATEGORY ACREAGE COST/ACRE * COST
Tailings/Sediment Ponds:
Ac.
X
$
/Ac. —
$
Stockpiles:
1.5
Ac.
X
$ _
.1,800. /Ac. _
$ 2,700.
Wastepiles:
Ac.
X
$
/Ac. _
$
Processing Area/Haul Roads:
1.0
Ac_
X
S
1,800. /Ac. —
$ 1,800.
Mine Excavation:
102.5
Ac.
X
$
500. /Ac. —
$ 51,250,
Other:
Ac.
X
$
IAc. w
$
TOTAL AFFECTED AC.:
105.0
Ac.
(TOTAL PERMITTED AC.: 199. Ac.)
Temporary & Permanent Sedimentation & Erosion Control Measures:
Divide the TOTAL AFFECTED AC. above into the following two categories: a) affected acres that drain into
proposed/existing excavation and/or b) affected acres that will be graded for positive drainage where measures will
be needed to prevent offsite sedimentation and sedimentation to onsite watercourses and wetlands.
a) Internal Drainage 105.0 Ac.
b) Positive Drainage Ac. X $1,500.00 = $
SUBTOTAL COST: $ 553750.
Inflation Factor:
0.02 X SUBTOTAL COST: $ 1,115. X Permit Life (I to 10 years): 10
INFLATION COST: $ 11,150.
TOTAL COST = SUBTOTAL COST + INFLATION COST = $ 66,900.
Total Reclamation Bond Cost: $ 66,900.
- (round down to the nearest $100.00) T
-14-

APPLICATION FOR A MINING PERMIT
F. NOTIFICATION OF ADJOINING LANDOWNERS
The "Notice"form, or a facsimile thereof, attached to this application must be sent certified or registered mail,
return receipt requested, to:
(1) the chief administrative officer of each county and municipality in which any part of the permitted
area is located as indicated on the mine map(s);
(2) all owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary; if an adjoining tract is owned or leased by the applicant or is owned by the lessor
of the mine tract, all owners of record of tracts adjoining these tracts must be notified (that are
within 1,000 feet of the mining permit boundary) as indicated on the mine map(s); and
(3) all owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary which lie directly across and are contiguous to any highway, creek, stream, river,
or other watercourse, railroad track, or utility or other public right-of-way. If an adjoining tract is
owned or leased by the applicant or is owned by the lessor of the mine tract, all owners of record of
tracts adjoining these tracts must be notified (that are within 1,000 feet of the mining permit
boundary) as indicated on the mine map(s). "Highway" means a road that has four lanes of travel
or less and is not designated as an Interstate Highway.
The only exception to the above method of giving notice is if another means of notice is approved in advance by
the Director, Division of land Resources.
A copy of a tax map (or other alternative acceptable to the Department) must be mailed with the completed
"Notice" form (the proposed overall permit boundaries and the names and locations of all owners of
record of lands adjoining said boundaries must be clearly denoted on the tax map).
The "Affidavit of Notification" attached to this application must be completed, notarized and submitted to the
Department, with the remainder of the completed application form, before the application will be considered
complete.
THIS SECTION MUST BE COMPLETED FOR ALL APPLICATIONS FOR NEW MINING PERMITS
AND ALL MODIFICATIONS OF A MINING PERMIT TO ADD LAND TO THE PERMITTED AREA, AS
REQUIRED BY NCGS 74-50(b1).
SEE THE NEXT TWO PAGES FOR THE "NOTICE" FORM AND THE "AFFIDAVIT OF
NOTIFICATION"
-IS-

NOTICE
Pursuant to provisions G.S. 74-50(b1) of The Mining Act of 1971, Notice is hereby given that
has applied on
(Applicant Name) (Date)
to the Land Quality Section, Division of Land Resources, North Carolina Department of Environment
and Natural Resources, 1612 Mail Service Center, Raleigh, North Carolina 27699-1612, for (check one):
❑ a new surface mining permit,
❑ a modification of an existing surface mining permit to add land to the permitted area; or
❑ a modification of an existing surface mining permit to add land to the permitted area with no disturbance
in the area proposed. Please note that future modification(s) may be submitted by the applicant to
allow disturbance within this area without re -notification of adjoining landowners.
The applicant proposes to mine on acres located
(Mineral, Ore) (Number)
(Miles)
of off/near road
(Direction) (Nearest Town) (Number/Name)
in County.
*SEE ATTACHED MAP FOR PROPOSED PERMUT BOUNDARIES AND CORRESPONDING
ADJOINING LANDOWNER NAMES AND LOCATIONS*
In accordance with G.S. 74-50(b1), the mine operator is required to make a reasonable effort, satisfactory to the
Department, to notify all owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary; if an adjoining tract is owned or leased by the applicant or is owned by the lessor of the mine tract,
all owners of record of tracts adjoining these tracts must be notified (that are within 1,000 feet of the mining permit
boundary). In addition, the mine operator must also notify the chief administrative officer of the county or
municipality in which any part of the permitted area is located. Any person may file written comment(s) to the
Department at the above address within thirty (30) days of the issuance of this Notice or the filing of the application
for a permit, whichever is later. Should the Department determine that a significant public interest exists relative to
G.S. 74-51, a public hearing will be held within 60 days of the end of the 30-day comment period specified above.
A copy of the permit application materials is on file and available for public review during normal business
hours at the above listed address as well as at the appropriate regional office. For information regarding
specifies of the proposed mining activity, please contact the applicant at the following telephone num'
. For information on the mining permit application review process, please contact
the Mining Program staff at [phone]. Please note that the Department will consider any relevant written
comments/documentation within the nrovisions of the Mining Act of 1971 throughout the application review
(Addressee/Owner of Record's
Name and Address)
(Date of Issuance of this Notice/
Mailed to Addressee/Owner of Record)
(Name of Applicant: Include Contact Person
& Company Name, if Applicable)
(Address of Applicant)
-16-

APPLICATION FOR A MINING PERMIT
AFFIDAVIT OF NOTIFICATION
I, , an applicant, or an agent, or employee of an -applicant, for a
new Mining Permit, or a modification of an existing Mining Permit to add land to the permitted area, from the N.C.
Department of Lnviroiunent and Natural Resources, being first duly sworn, do hereby attest that the following are all
known owners of record, both public and private, of all tracts of land that are adjoining the mining permit boundary
(including, where an adjoining tract is owned or ]eased by the applicant or is owned by the lessor of the mine tract,
all owners of record of tracts adjoining these tracts, that are within 1,000 feet of the mining permit boundary) and
that notice of the pending application has been caused to be mailed, by certified or registered mail, return receipt
requested, to said owners of record at their addresses shown below, such notice being given on a form provided by
the Department:
(Adjoining Landowner Name) (Address)
(Attach additional list if necessary)
I do also attest that the following individual is the chief administrative officer of the county or municipality in which
any part of the permitted area is located acid that notice of the pending application has been caused to be mailed, by
certified or registered mail, return receipt requested, to said office at the following address:
(Chief Administrative Officer Name) (Address)
[i.e.: City Massager, County Manager, Mayor, etc.]
The above attestation was made by me while under oath to provide proof satisfactory to the Department that a
reasonable effort has been made to notify all known owners of record, both public and private, of all tracts of land
that are adjoining the mining permit boundary (including, where an adjoining tract is owned or ]eased by the
applicant or is owned by the lessor of the mine tract, all owners of record of tracts adjoining these tracts, that are
within 1,000 feet of the mining permit boundary) and the chief administrative officer of the county or municipality in
which any part of the permitted area is located in compliance kAth N.C.G.S. 74-50(b1) and 15A NCAC 513.0004(d).
I understand that it is the responsibility of the applicant to retain the receipts of mailing showing that the above
notices were caused to be mailed and to provide them to the Department upon request.
Signature of Applicant or Agent
Date
if person executing Affidavit is an agent or employee of an applicant, provide the following information:
Name of applicant:
Title of person executing Affidavit
I,
a Notary Public of the County of
State of North Carolina, do hereby certify that
appeared before me this day and under oath acknowledged that the above Affidavit was made by him/her.
Witness my hand and notarial seal, this day of 20
Notary: my Commission expires:
-17-

APPLICATION FOR A MINING PERMIT
G. LAND ENTRY AGREEMENT
We hereby grant to the Department or its appointed representatives the right of entry and travel upon our lands
or operation during regular business hours for the purpose of making necessary field inspections or investigations as
may be reasonably required in the administration of the Mining Act of 1971 pursuant to G.S. 74-56.
We further grant to the Department or its appointed representatives the right to make whatever entries on the
land as may be reasonably necessary and to take whatever actions as may be reasonably necessary in order to carry
out reclamation which the operator has failed to complete in the event a bond forfeiture is ordered pursuant to G.S.
74-59.
LANDOWNER:
Signature:
Print Name: Thomas Lewis
(Title, if applicable) .
Company
(if applicable)
Address: 121 W. Modlin .Road
Ahoskie, NC 2791.0
Telephone: (252)
332-5464
APPLICANT:
Signature:*
Print Name: Thomas Lewis
Title: Vice President
Company: Union Sand & Gravel, Inc.
Mine Name: Lewis Brothers Pit
Telephone: ((252)
332-5464
Date Signed: Y-- % II Date Signed:
*Signature must be the same as the individual who signed Page 1 of this application.
or money order payable to the North Carolina Department of Environment and Natural Resources must be
sent to the Land Quality Section Central Office at the address listed on the front cover of this application
form.
Inquiries regarding the status of the review of this application should be directed to the Mining Program staff at
[phone].
-18-

APPLICATION FOR A MINING PERMIT
G. LAND ENTRY AGREEMENT
We hereby grant to the Department or its appointed representatives the right of entry and travel upon our lands
or operation during regular business hours for the purpose of making necessary field inspections or investigations as
may be reasonably required in the administration of the Mining Act of 1971 pursuant to G.S. 74-56.
We further grant to the Department or its appointed representatives the right to make whatever entries on the
land as may be reasonably necessary and to take whatever actions as may be reasonably necessary in order to carry
out reclamation which the operator has failed to complete in the event a bond forfeiture is ordered pursuant to G.S.
74-59.
LANDOWNER:
Signature:
Print Name: Thomas Lewis
(Title, if applicable)
Company Union Sand & Gravel Inc.
(If applicable
Address: 121 W. Modlin Road
Ahoskie NC 27910
Telephone: [phone]
APPLICANT:
Signature:*�
Print Name: Thomas Lewis
Title: Vice President
Company: Union Sand & Gravel Inc.
Mine Name: Lewis Brothers Pit
Telephone: ([phone]
Date Signed: L% -- ) q —1 / _Date Signed: Z� " % —rl
*Signature must be the same as the individual who signed Page 1 of this application.
- a
or money order payable to the North Carolina Department of Environment and Natural Resources must he
sent to the Land Quality Section Central Office at the address listed on the front cover of this application
form.
Inquiries regarding the status of the review of this application should be directed to the Mining Program staff at
[phone].
-18-

APPLICATION FOR A MINING PERMIT
MINING FEE SCHEDULE
Anon refundable permit application processing fee when filing for anew mining permit, a major permit modification or a renewal permit is
required as follows:
New Permit Applications
Permit Modifications
Permit Renewals
Transfers/Minor Modifications*
0-25 acres 26+acres
$3,750.00
$5,000.00
$750.00
$1,000.00
$750.00
$1,000.00
$100.00
$100.00
* A nonrefundable 5100.00 permit application processing; fee is required for minor permit modifications. Minor permit modifications include ownership transfers, name
changes, bond substitutions and permit renewals where the mine is inactive and fully stabilized. A minor permit modification also includes lands added to a permitted area,
outside of the minimum permit buffer zone requirements, where no plans for mining related disturbance of the added lands have been approved. All other changes are
considered major permit modifications.
Acres for new permits and renewal permits means the total acreage at the site. ,Acres for major modification of permits means that area of land affected by the modification
within the permitted mine area, or any additional land that is to he disturbed and added to an existing; permitted area, or both.

APPLICATION FOR A MINING PERMIT
There are seven band Quality Section (LQS) Regional Offices. Use the map below to locate the Regional Office
serving your county.
Asheville Regional Office
• Counties: Avery, Buncombe, Burke, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell., Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey
• Address: 2090 U.S. Highway 70, Swannanoa, NC 28778
• Voice:828.296.4500
• FAX:[phone]
Fayetteville Regional Office
• Counties: Anson, Bladen, Cumberland, Harnett, Hoke, Montgomery, Moore, Richmond, Robeson, Sampson,
Scotland
• Address: 225 Green Street, (Systel Building), Suite 714, Fayetteville, NC 28301-5094
• Voice.910,433.3300
• FAX:910,486.0707
Mooresville Regional Office
• Counties: Alexander, Cabarrus, Catawba, Cleveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly,
Union
• Address: 610 Fast Center Ave., Suite 301, Mooresville, NC 28115
• Voice:704.663.1699
• FAX:[phone]
Raleigh Regional Office
• Counties: Chatham, Durham, Edgecombe, Franklin, Granville, Halifax, Johnston, Lee, Nash, Northampton,
Orange, Person, Vance, Wake, Warren, Wilson
• Address: 1628 Mail Service Center, Raleigh, NC 27699-1628 or 3800 Barrett Drive, Raleigh, NC 27609
• Voice:919.791.4200
• FAX:[phone]
Washington Regional Office
• Counties: Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Greene, Hertford, I -lyric, .Jones,
Lenoir, Martin, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, Washington, Wayne
• Address: 943 Washington Square Mall, Washington, NC 27889
• Voice:252.946.6481
• FAX:[phone]
- 20 -

APPLICATION FOR A MINING PERMIT
LAND QUALITY REGIONAL OFFICES (continued)
Wilmington Regional Office
• Counties: Brunswick, Carteret, Columbus, Duplin, New Hanover, Onslow, Pender
• Address: 127 Cardinal Drive Extension, Wilmington, NC 28405
• Voice:910.796.7215
• FAX:[phone]
Winston-Salem Regional Office
• Counties: Alamance, Alleghany, Ashe, Caswell, Davidson, .Davie, Forsyth, Guilford, Rockingham; Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
• Address- 585 Waughtown Street, Winston-Salem, NC 27107
• Voice:336.771.5000
• FAX:336,771.4631
-21-