NCG160201_COMPLETE FILE - HISTORICAL_20100702

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0. /V (�� I u 0 DO
DOC TYPE 1. HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ 9 % -6c.)
YYYYM M DD

`.. 1
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
July 2, 2010
Mr. David Glover
Barnhill Contracting Company
PO Box 1529
Tarboro, NC 27886
Subject: General Permit No. NCG160000
Weldon Asphalt Plant
COC NCG160201
Halifax County
Dear Mr. Glover:
Dee Freeman
Secretary
In accordance with your application for a discharge pern3it received on June 17, 2010, 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 October 15, 2007 (or as subsequently amended).
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 Robert Patterson at
telephone number [phone], or [e-mail].
ncdenr.gov.
Sincerely,
PRIGINA!.. SIGNED 13111
for Coleen 1-Mullins', I
cc: Raleigh Regional Office - Myrl 1�Ilsely
Central Files
Stormwater Permitting Unit Files
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877623-6748
Internet: w .ncwaterquality.org
An Equal opportunity 1 Affirmative Action Employer
t�l
One
Not-thCarolina,
Natuhally

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160201
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision ofNorth 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,
Barnhill Contracting Company -
is hereby authorized to discharge stormwater from a facility located at
Weldon Asphalt Plant.
Hwy 301 (-1,000 ft. south of Washington Ave.)
Weldon
Halifax County
to receiving waters designated as UT to Mush Island Gut, a class C water in the Roanoke River
Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts 1, II, Ill, IV, V, and VI of General Permit No. NCG160000 as attached.
This certificate of coverage shall become effective July 2, 2010.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this 2nd day of July, 2010.
ORIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins, Director
Division of Water Quality
By the Authority of the Environmental Management Commission

NCG160201
Map Scale 1:30,000
Barnhill Contracting Company
Weldon Asphalt Plant
Latitude: 361 24' 04" N
Longitude: 771 35' 37" W
County: Halifax
Receiving Stream: UT to Mush Island Gut
Stream Class: C
Sub -basin:( 03-02-08 (Roanoke River Basin)
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Facility Location

Division of Water Quality / Surface Water Protection
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NCDENRNational Pollutant Discharge Elimination System
Dnrxun.e+, n
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NCG160000
NOTICE OF INTENT
FOR AGENCY USEONLY
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National Pollutant Discharge Elimination System application for coverage under General
NCG160000:
STORMWATER DISCHARGES associated with activities classified as:
iEIVE
JUN 1 7 2010
Coverage under this general permit is applicable to all owners or operators of stormwater point guuft"dt5cl lai
associated with activities classified as establishments primarily engaged in Asphalt Paving Mixtures and Blocks
[standard industrial classification (SIC) 2951].
VKA For questions, please contact the DWO Regional Office for your area. (See page 4)
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name Barnhill Contracting Company
Owner Contact David Glover Asphalt/ OC General Manager
Street Address PO Box 1529
City Tarboro State NC ZIP Code 27886
Telephone No. 252.823.1021 Fax: - 2-57— 824.8276
E-mail Address [e-mail]
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
Weldon State NC ZIP Code 27890
Halifax
252 977.9637 Fax:
—d-gTo—[e-mail]
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection).
From 1-95. take all #173 at Roanoke Rapids onto NC 158, Take NC 158 (Julien R Nlsbrook Highway) appropmalely 3 miles east to the Town of IVeldon. Continue east
on E 3rd Stree4 and turn right onto US Hwy 301 South. continue south on US Hwy 301 for approximately 1.8 miles, then turn left onto a dirt driveway mr.hed by a sign
indicating'Rightrnyer Machine Rentals.' The site is approximately 0.1 mile on the left -
4) Latitude 36.40138
Longitude-77.59367 (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following:
X New or Proposed Facility' Date operation is to begin
❑ Existing
July 2010
`If this new or proposed facility in one of the 20 coastal counties, you must contact the appropriate Regional
Office (see page 4) to determine if a State Stormwater Permit is also needed prior to construction.
Page 1 of 4
SWU-234-030909 Last revised 3/9/09

NCG190000 N.0.1.
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 9 5 1
7) Services and Activites
a) Provide a brief narrative description of the types of industrial activities and products
manufactured at this facility: (Include a site diagram showing the process areas and location of
activities present at this facility.) Asphalt and asphalt mixture for paving
b) Check all services and activities offered or allowed at this facility
1_' Outdoor stockpiling of materials
*r Storage of raw materials
;;a Storage of materials in above-
ground tanks
X Material Loading and Unloading
8) Discharge points / Receiving waters:
5C Transport of materials by a conveyor
or front-end loader
❑ Vehicle and equipment maintenance
X Vehicle/Equipment Washing
5' Vehicle and equipment fueling
How many discharge points (ditches, pipes, channels, boat ramps, lift wells, etc.) convey stormwater from the
property? 1
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? unnamed tributary to Mush Island
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). n/a
Receiving water classification (if known): n/a
9) Does this facility
a) Have an untreated wastewater discharge? A'No ❑ Yes
b) Have a treated wastewater discharge? NrNo ❑ Yes
If yes, list the permit number. n/a
c) Have a wastewater discharge from a recycle system? VNo ❑ Yes
If yes, list the permit number. n/a
d) Have a non -discharge permit? K No ❑ Yes
If yes, list the permit number
e) Discharge wastewater to a municipal wastewater collection system?
If yes, list the municipality and permit number n/a
W No ❑ Yes
Note: Stormwater discharge permit NCG160000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG160000.
10) Does this facility employ any best management practices for stormwater control?
❑ No bkYes (Show any structural BMP's on the site diagram.)
The existing basin, aka watering hole, has no outlet and will flood back into the large ditch and law lying area of the existing pit. All
runoff from the asphalt plant will run into the ditch and be contained in in the pond.
Page 2 of 4
SWU-234-030909 Last revised 3/9/09

NCG190000 N.O.I.
11) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No K Yes
If yes, when was it implemented? currently being implemented
12) Are vehicle/equipment maintenance activities occurring at this facility?
-kNo ❑ Yes
13) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
`RL No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
9 No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
K No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
K No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: n/a
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
14) Certification:
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Articls shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person
of Applicant)
David Glover
a
(Dot fgned)
S W U-234-030909
Page 3 of 4
Last revised 3/9/09

NCGI90000 N.O.I.
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
J2r Check for $100 made payable to NCDENR
Z This completed application and all supporting documents
A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
(corresponding to which drainage areas), (d) runoff conveyance structures, (e) areas where materials and/or
boats are stored, (f) impervious areas, (g) site property lines, (h) boat maintenance, blasting, painting and
washing areas, and (i) location of services and activities listed in 7b.
Copy of county map or USGS quad sheet (preferred) with location of facility clearly, marked on map
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DINO Regional Office for your area.
DWO Reoional Office Contact Informa*t^
Asheville Office ......
[phone]
Fayetteville Office...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 4 of 4
SWU-234-030909 Last revised 3/9/09

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CONSULTING ENGINEERS, P.A.
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BARNHILL ASPHALT PLANT
WELDON N.C.
COMPRE ENVIRONMENTAL SERVICES
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PO Box 7966 / Rocky Mounl, N.C. 27804
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1 OF 2

Bamhil Contracting Company
Weldon Asphalt Plant
Exisiting'Pierce Pit' by Rightmyer Machine Rentals
December 2009

TerraServer Image Courtesy of the USGS
http://terraserver-usa.com/Printlrrege.aspx7T=2&S=1 I &Z=I &&X=667...
Send To Printer Back To TerraServer Change to 11x 17 Print Size Show Grid Lines Change to Landscape
aluGS 1 km S of South Weldon North Carolina, United States 01 Jul 1974
cr.
'� Barnhill Asphalt Plant
1 one `: 4�` — .,.tk Weldon, NC
Halifax County
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Soil Map —Halifax County, North Carolina
(Weldon- Pierce Pit)
MAP LEGEND
MAP INFORMATION
Area of Interest (AOI)
Very Stony Spot
Map Scale: 1:5,370 if printed on A size (8.5" s 11 ") sheet.
Area of Interest (AOI)
Wet Spot
The soil surveys that comprise your ACI were mapped at 1:24,000.
Soils
Other
Please rely on the bar scale on each map sheet for accurate map
Soil Map Units
measurements.
Special Line Fsarea
W
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Point Features
Gully
Source of Map: Natural Resources Conservation Service
Vy
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Web Soil Survey URL: http://websoilsuNey.nrr .usda.gov
Short Steep Slope
Coordinate System: UTM Zone 18N NAD83
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X
say soot
... Other
This product is generated from the USDA-NRCS certified data as of
Political Feature
the version date(s) listed below.
s
Closed Depression
Cities
Soil Survey Area: Halifax County, North Carolina
X
Gravel Pit
Water Features
Survey Area Data: Version 12, Mar 29, 2009
..
Gravely Spot
Oceans
Date(s) aerial images were photographed: 6/30/2006
®
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Streams and Canals
The orthophoto or other base map on which the soil lines were
A
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compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor shifting
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a..t. Rails
of map unit boundaries may be evident.
V
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®
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DANatural Resources Web Soil Survey 121212009
Conservation Service National Cooperative Soil Survey Page 2 of 3

Sail Map —Halifax County, North Carolina
Weldon- Pierce Pit
Map Unit Legend
Halifax County, North Carolina (NC083)
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AOI
BaA
Bethera loam, 0 to 1 percent slopes
3.4
3.4%
DgA
Dogue silt loam, 0 to 3 percent slopes
3.4
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EmA
Emporia fine sandy loam, 0 to 2 percent slopes
7.1
7.1 %
EmB
Emporia fine sandy loam, 2 to 6 percent slopes
15.4
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GoA
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14.0
14A %
GtB
Gdtney fine sandy loam, 2 to 6 percent slopes
1.6
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MrA
Marlboro fine sandy loam, 0 to 2 percent slopes
9.1
9.2 %
RoA
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Ud
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31.2
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WnF
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8.4
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Totals for Area of Interest
99.3
100.0%
USDA Natural Resources Web Soil Survey 12/2/2009
;am Conservation Service National Cooperative Soil Survey Page 3 of 3

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WATER. QUALITY
1617 MAIL SERVICE CENTER
,RALEIGH NC 27699 1617 -
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AII'other deliveries: 800 Tiffany Blvd., Suite 200 Rocky Mount,; NC 27804
P6one:252-823-1021 Fax:252=823-0137'

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE,
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ W V poi
YYYYM M DD

NC®ENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
July 2, 2010
Mr. David Glover
Barnhill Contracting Company
PO Box 1529
Tarboro, NC 27886
Natural Resources
Subject: General Permit No. NCG 160000
Weldon Asphalt Plant
COC NCG160201
Halifax County
Dear Mr. Glover:
Dee Freeman
Secretary
In accordance with your application for a discharge permit received on June 17, 2010, we
are forwarding herewith the subject certificate of coverage to discharge under the subject state —
NPDES general permit. This pennit 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 October 15, 2007 (or as subsequently amended).
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 Robert Patterson at
telephone number [phone], or [e-mail].
ncdenr.gov.
Sincerely,
ORIGINAL SIGNE04V
KEN PICKLE
for Colleen H. Sullins
cc: Raleigh Regional Office - Myrl Nisely
Central Files
Stormwater Permitting Unit Files
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone] \ Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
JUL - 8 ?010 J'I
If
1r[ 1 L OFFICE1
Noi thCarolina

Q;
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160201
STORMWATER 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,
Barnhill Contracting Company
is hereby authorized to discharge stormwater from a facility located at
Weldon Asphalt Plant
Hwy 301 (-1,000 ft. south of Washington Ave.)
Weldon
Halifax County
to receiving waters designated as UT to Mush Island Gut, a class C water in the Roanoke River
Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts 1, 11, 111, IV, V, and VI of General Permit No. NCG 160000 as attached.
This certificate of coverage shall become effective July 2, 2010.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this 2nd day of July, 2010.
ORIGINAL SIGNED BY
KEN PICKLE
for Coleen 1-1. Sullins, Director
Division of Water Quality
By the.Authorily of the Environmental Management Commission

NCG160201
0
Map Scale 1:30, 000
Barnhill Contracting Company
Weldon Asphalt Plant
Latitude: 361 24' 04" N
Longitude: 77' 35' 37" W
County: Halifax
Receiving Stream: UT to Mush Island Gut
Stream Class: C
Sub -basin: 03-02-08 (Roanoke River Basin)
1
Facility Location

Permit: NCG160201 Owner - Facility: Barnhill Contracting Company
Inspection Date: 07/01/2010 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
This site inspection carried out jointly by RRO and the Stormwater Permitting Unit was made to better understand
topographic features of the site as described in the permit application and aerial views of the location. This former mining
site is a shallow pit with stable slopes around all sides. The information on hand showed a signficant ditch carved into the
middle of the site that carried rainwater to a small retention pond.
During the tour of the site, it became evident that Barnwell planners had altered the earthmoving plan to remove the ditch
and better direct stormwater to minimize velocities. Water from the stone and reclaimed asphalt piles will flow to the north
and west, to come to a small retention basin on the north side of the entrance road. When that pond level reaches the 24"
culvert pipe, placed at a higher elevation that the existing 48" pipe, the overflow will travel to a larger retention pond. That
pond has a standpipe, and its overflow enters a wooded area and spreads as sheet flow on its way to the Roanoke River.
Water from the asphalt manufacturing plant will go two directions, either to the east or to the center of the site to the
above mentioned small retention pond at the roadway. Water collected on the east side will travel around the perimeter to
the south end and through vegetation to join the channel into the final retention pond. This flow pattern will stop erosion
observed near the inlet to the final pond.
With this new understanding of stormwater management, SWPU will issue the permit immediately. Startup of production
is expected in about 2 to 3 weeks. , v l a 6 0
Other
Comment: Construction was confirmed to bean improvement from what had been
submitted with the permit application. See Summary.
Yes No NA NE
Page:2

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SITE SKETCH for nviL. NHHIEIGAL = $IFpEIHi.L LH .EEwS In
COYPPEHf N$IVE [NVIPONN(NILL $LFVICC$ O � �
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NC®ENR
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FnJY1JJwe�♦ y�lr N/MV.M�0..\!S
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
alitil11i1)lllc
FOR AGENCY USE ONLY
Dam Received
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Month
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NOTICE OF INTENT 0 @@� V IS
National Pollutant Discharge Elimination System application for coverage under General it
NCG160000: JUN 1 7 7010
STORMWATER DISCHARGES associated with activities classified as:
DENR -WATER
Coverage under this general permit is applicable to all owners or operators of stormwater point �r Brar
associated with activities classified as establishments primarily engaged in Asphalt Paving Mixtures and Blocks
[standard industrial classification (SIC) 29511.
For questions, please contact the DWQ Regional Office for your area. (See page 4)
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name Barnhill Contracting Company
Owner Contact
Street Address
City
Telephone No.
E-mail Address
David Glover
PO Box 1529
Tarboro State NC ZIP Code 27886
252.823.1021 Fax: 257— 824.827
[e-mail]
2) Location of facility producing discharge:
Facility Name
Facility Contact Emerson Etheridge Jr Plant Superintendent
Street Address Hwy 301
City Weldon State NC ZIP Code 27890
County Halifax
Telephone No. 252 977,9637 Fax:
Email �CgTo—ver am I contracting.com
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection).
From 1.95, take exit #173 at Roanoke Rapids onto NC 158. Take NC 158 (Julien R. Allsbrook Highway) approximately 3 miles east to the Town of Weldon. Continue east
on E 3rd Street and bum right onto US Hwy 301 South. Continue south on US Hwy 301 for approximately 1.8 miles, then turn left onto a din driveway marked by a sign
indicating'Pighhnyer Machine Rentals' The site is approximately 0.1 mile on the IeR
4) Latitude 36.40138
Longitude -77.59367 (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
0 New or Proposed Facility"
❑ Existing
Date operation is to begin July 2010
'If this new or proposed facility in one of the 20 coastal counties, you must contact the appropriate Regional
Office (see page 4) to determine if a State Stormwater Permit is also needed prior to construction.
Page t of 4
SW I I-2a4-nsn4no I SQr Mvinwl aiam4

NCG190000 N.O.I.
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 9 5 1
7) Services and Activites
a) Provide a brief narrative description of the types of Industrial activities and products
manufactured at this facility: (Include a site diagram showing the process areas and location of
activities present at this facility.)_ Asphalt and asphalt mixture for paving
b) Check all services and activities offered or allowed at this facility
D? Outdoor stockpiling of materials
10' Storage of raw materials
Storage of materials in above-
ground tanks
�t Material Loading and Unloading
8) Discharge points I Receiving waters:
5r Transport of materials by a conveyor
or front-end loader
❑ Vehicle and equipment maintenance
9 Vehicle/Equipment Washing
R Vehicle and equipment fueling
How many discharge points (ditches, pipes, channels, boat ramps, lift wells, etc.) convey stormwater from the
property? 1
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? unnamed tributary to Mush Island
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). n/a
Receiving water classification (if known): n/a
9) Does this facility
a) Have an untreated wastewater discharge? ArNo ❑ Yes
b) Have a treated wastewater discharge? NrNo ❑ Yes
If yes, list the permit number. n!a
c) Have a wastewater discharge from a recycle system? 5rNo ❑ Yes
If yes, list the permit number. n/a
d) Have a non -discharge permit? 9 No ❑ Yes
If yes, list the permit number
e) Discharge wastewater to a municipal wastewater collection system?
If yes, list the municipality and permit number n/a
5? No ❑ Yes
Note: Stormwater discharge permit NCG160000 does not authorize the discharge of any wastewater.
If this site discharges wastewater, you must obtain the appropriate wastewater discharge
permit in addition to coverage for stormwater discharges under NCG160000.
10) Does this facility employ any best management practices for stormwater control?
❑ No CCYes (Show any structural BMP's on the site diagram.)
The existing basin, aka watering hole, has no outlet and will flood back into the large ditch and low lying area of the existing pit. All
runoff from the asphalt plant will run into the ditch and be contained in in the pond.
Page 2 of 4
S W U-234-030909 1 aromo

NCG190000 N.O.J.
11) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No R Yes
If yes, when was it implemented? currently being implemented
12) Are vehicle/equipment maintenance activities occurring at this facility?
'kNo ❑ Yes
13) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
`4 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
9 No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
K No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored: _
Where is material stored:
n/a
How many disposal shipments per year:
Name of transport / disposal vendor: _
Vendor address:
14) Certification:
North Carolina General Statute 143-215.6 B(I) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested rase under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management) Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: David Glover
4s halt/ QC a ral Manager
c a
of Applicant) (Dat gned)
Page 3 of 4
SW U-234-030909 1 acr rcvfeui vomo

NCG190000 N.O.I.
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Final Checklist
This application will be returned as incomplete unless all of the following hems have been included:
R' Check for $100 made payable to NCDENR
This completed application and all supporting documents
A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater ouffalls
(corresponding to which drainage areas), (d) runoff conveyance structures, (e) areas where materials and/or
boats are stored, (f) impervious areas, (g) site property lines, (h) boat maintenance, blasting, painting and
washing areas, and (i) location of services and activities listed in 7b.
Copy of county map or USGS quad sheet (preferred) with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Nye
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DWO Regional Office for your area.
DWO Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 4 of 4
SWU-234-030909 Last revised 3/9/09