NCG160214_COMPLETE FILE - HISTORICAL_20141014

PERMIT NO
rDOC TYPE
DOC DATE
................
STORMWATER DIVISION CODING SHEET
NCG PERMITS
V HISTORICAL FILE
El MONITORING REPORTS
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Division of Energy, Mineral and Land Resources
Land Quality Section / Stormwater Permitting Program
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AC'F' ' USIi O\L1'
Dmc Rccciaed
Year
I \torch
I M
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does `legally responsible individual' mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation')
applies:
Individual Permit (or) Certificate ofCoverage
N I C I S 1 1 1 N I C I G
2) Facility Information. KLCEIVED
t1 i Facility name: 2014 name: t a �aJ
Company/Owner Organi22i HRi LAND QUALITY
Facility address: STORMINATER PERMITTI
Address
mop.-e,00'D /VC Z I�14—
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
http://Portal.ncdenr.orpjweb/ir/sw-permit-contacts and nm the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Wh /ier L.
First MI Las[
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit
First MI last
Page I of 2
SW U-OWNERAFFI L-25July2014

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Title
4ZI 6-veA%CirGAe led
Mailing Address
Nus
City State Zip
O OH+
Telephone E-mail Address
(615)564,579/
Fax Number
5) Reason for this change:
A result of: 21�Etnployee or management change
❑ Inappropriate or incorrect designation before
❑ Other
/f other please explain:
The certification below must be completed and signed by the permit holder.
PER'M//ITTEE CERTIFICATION:
I, ye4 N me'r�t/e G k , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
i Ll
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stonnwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call 919-707-9220 or visit the website at:
http://portal. ncdenr.orp-/web/Ir/stormwater
Page 2 of 2
SW ll-OWNERAFF IL-25July2014

Ad"
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM Pat McCrory, Governor
Director John E. Skvarla, III, Secretary
October 11, 2013
Mr. ''Walter L. Hillis, III
Ralph Rogers and Company
250 Union Valley Road
Oak Ridge, Tennessee 37830
Subject: General Permit No. NCG160000
Ralph Rogers & Company Henrietta Asphalt
CDC No. NCG160214
Rutherford County
Dear Mr. Hillis:
In accordance with your application for a discharge permit received on May 21, 2013, we
are forwarding herewith the subject certificate of coverage (CDC) 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).
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 Energy, Mineral and Land Resources (Division). 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 the Division or
permits required by the Division of Water Resources, Coastal Area Management Act or any other
federal, state or local governmental permit that may be required.
If you have any questions concerning this permit, please contact Bill Diuguid, Stormwater
Program Planner at telephone number [phone].
Sincerely,
ORIGINAL SIGNED Bl
KEN PICKLE
for Tracy E. Davis
cc: Asheville Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 • Telephone [phone] FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://portal.ncdenr,org/web/Ir/land-quality
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper.

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160214
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,
Ralph Rogers and Company
is hereby authorized to discharge stormwater from a facility located at
Ralph Rogers and Company — Henrietta Asphalt
1385 Ferry Road
Mooresboro
Rutherford County
to receiving waters designated as an unnamed tributary to Hog Pen Branch, a Class WS-IV waterbody, Broad 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. NCG160000, as attached.
This Certificate of Coverage shall become effective October 11, 2013.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 11, 2013.
ORIGINAL SIGNED B1
KEN PICKLE
for Tracy E. Davis, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission

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�i'

Walter L. Hillis III
Sr. Environmental Engineer
Environmental Services
Via Federal Express #7998 0310 0524
May 20, 2013
Stormwater Permitting Unit
NCDENR-Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Ralph Rogers & Company - Henrietta Asphalt
Notice of Intent NCG160000 Stormwater Permit
To Whom It May Concern:
250 Union Valley Road
Oak Ridge, TN 37830
Telephone: [phone]
Fax: [phone]
waf t. hillis@rogersgrou pi nc.wm
Attached please find a Notice of Intent (NOI) for coverage under NCG160000 for the Ralph Rogers and
Company Henrietta Asphalt Plant located at 1385 Ferry Road, Mooresboro, North Carolina 28114.
Check No. 1872943 in the amount of $100.00 is attached for the processing fee.
If you have any questions concerning this correspondence, please contact me at [phone].
Sincerely,
Walter L. Hillis III
Senior Environmental Engineer
Attachments

Henrietta, NC to 1385 Ferry Rd, Mooresboro, NC 28114 - Google Maps Page 2 of 2
Henrietta, NC
1.
Head southwest on Highland Ave
go 112 ft
total 112 ft
2.
Take the 1st right toward Harris Henrietta Rd/Haynes St
go 144 ft
total 256 ft
3.
Turn left onto Harris Henrietta RdlHaynes St
go 1.7 mi
Continue to follow Harris Henrietta Rd
total 1.7 mi
About 3 mins
41 4.
Turn left onto Ferry Rd
go 0.9 mi
Destination will be on the left
total 2.6 mi
About 2 mins
g) 1385 Ferry Rd, Mooresboro, NC 28114
These directions are for planning purposes only. You may find that construction projects, traffic, weather, or other events may cause
conditions to differ from the map results, and you should plan your route accordingly. You must obey all signs or notices regarding your
route.
Map data ©2013 Google
Directions weren't right? Please find your route on maps.google.com and dick "Report a problem" at the bottom left.
https:llmaps. google.com/maps?mod&source=s_d&saddr=Henrietta,+N C&daddr-13 85+Fer... 5/ 10/2013

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Rogers Group Inc. `.

Diuguid, Bill
From: Stepp, Jonathan
Sent: Friday, August 23, 2013 11:04 AM
To: Diuguid, Bill
Cc: Herbert, Laura C
Subject: RE: NCG160214 Ralph Rogers & Comp Henrietta Asphalt Mooresboro
an
Our recommendation to proceed with this one as well. They are in good standing with air quality and located in our
region.
Thank you,
Jonathan
Jonathan Stepp—[e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Energy, Mineral, and Land Resources - Land Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.
From: Diuguid, Bill
Sent: Thursday, August 22, 2013 3:29 PM
To: Herbert, Laura C; Stepp, Jonathan
Subject: NCG160214 Ralph Rogers & Comp Henrietta Asphalt Mooresboro
Laura Herbert, Jonathan Stepp, Asheville Regional Office:
Please review the attached NO1 application with the objective of responding to me with a recommendation to issue the
permit. I recognize that you may not visit each new permittee during this NOI review, but it affords you the opportunity
to log the permit into your regional database and add the facility to a future monitoring and compliance visit schedule.
Therefore, your recommendation now to issue the permit serves as your acknowledgement that (1) the facility is located
in your region, (2) that there are no current complaints outstanding about the facility that have not been dealt with, and
(3) that the facility may ultimately be inspected by the regional staff. I've also attached a scanned copy of the NO1 and a
location map for your review.
�COC# I Facility 11-ocation lCity/County
INCG160214 !Ralph Rogers & Company Henrietta Asphalt :1385 Ferry Road (Mooresboro/Rutherford
If you need any more info, give me a call. If you could send me a recommendation to issue the permit by 09/22/2013,
I'd appreciate it, so I can issue their COC. I cannot issue the permit until the respective regional office reviews and
comments back to me with a recommendation to issue the permit.
Thanks

Bill Diuguid, AICP, Planner
Stormwater Permitting
Land Quality Section
Division of Energy, Mineral and Land Resources I NCDENR
1617 Mail Service Center (Mail)
512 N. Salisbury St, Raleigh, NC 27604 1 9th Floor (Location & Parcels)
Raleigh North Carolina 27699-1617
Phone: [phone] Fax: [phone]
Website: http://portal.ncdenr.org/web/wq/ws/su
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties.