NCG020924_COMPLETE FILE - HISTORICAL_20180207

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO,
W L)�a
DOC TYPE
X'HISTORICALFILE
❑ MONITORING REPORTS
DOC DATE
ae1� o�o�
❑
YYYYMMDD

Central Fifes: APS — SWP
2/5/2018
Permit Number NCG020924 Permit Tracking Slip
Program Category
NPDES SW
Permit Type
Mining Activities Stormwater Discharge COC
Primary Reviewer
robert.patterson
Coastal SWRule
Permitted Flow
Facility
Status Project Type
Active New Project
Version Permit Classification
1.00 COC
Permit Contact Affiliation
FEB 0 7 2018
CENTRAL FILES
DWR SECTION
Facility Name
Major/Minor
Region
Jerry Smith Mine
Minor
Mooresville
Location Address
County
3431 Airport Rd
Catawba
Facility Contact Affiliation
Maiden NC 28650
Samar Bou Ghazale
6076 Diamond PI
Owner
Harrisburg
NC 28075
Owner Name
Owner Type
Smith Grading Company
Non -Government
Owner Affiliation
Jerry E. Smith
President
3486 Airport Rd
Dates/Events
Maiden
NC 28650
Scheduled
Orig Issue App Received Draft Initiated
Issuance Public Notice Issue Effective Expiration
215/2018 1/2312018 2/5/2018
2/5/2018 2/512018
9/30/2020
Regulated Activities
Requested !Received Events
Mining activities - stormwater discharges
RO staff report received
1129/18
RO staff report requested
1/29/18
Outfall 001
Waterbody Name
Streamindex Number Current Class
Subbasin
South Fork Mountain Creek
11-98-(0.5) WS-Iv
03-08-32
Outfall 002
Waterbody Name
Streamindex Number Current Class
Subbasin
South Fork Mountain Creek
11-98-(0.5) WS-Iv
03-08-32

F
Energy. Mineral
and Land Resources
ENVIRONMENTAL OUALITV
February 5, 2018
Jerry E. Smith
3486 Airport Road
Maiden, NC 28650
ROY COOPER
Clove mor
MICHAEL S. REGAN
Secrerary
WILLIAM E. TOBY VINSON, JR.
Interim Director
Subject: General Permit No, NCG020000
Jerry Smith Mine
COC NCG020924
Catawba County
Dear Mr. Smith:
In accordance with your application for a discharge permit received on January 23, 2018, 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 Energy, Mineral, and Land Resources. 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 of Energy, Mining, and Land Resources, or permits required by the Division of Water
Resources, Coastal Area Management Act, or any other federal -or local governmental permit that may be
required. Mining activities cannot begin until the associated mining permit is issued.
If you have any questions concerning this perrn it, please contact Robert Patterson at (919) 807-
6369 or [e-mail].
Sincerely,
,for William E. Toby Vinson, Jr., P.E., CPESC, CPM
cc: Mooresville Regional Office
Central Files
Stormwater Program Files
Samar Bou-Ghazale — Envirotech NC
Slate of North Carolina I Environmental Quality I Energy, Mineral and Eand Resources
1612 Mail Service Center 1 512 N. Salisbury St. I Raleigh, NC 27699
919 707 9200 T

STATE OF NORTI-I CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020924
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,
Jerry E. Smith
is hereby authorized to discharge stormwater from a facility located at
Jerry Smith Mine
3431 Airport Road
Maiden
Catawba County
to receiving waters designated as South Fork Mountain Creek, a class WS-IV water in the
Catawba 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 February 5, 2018,
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 5, 2018.
7 - -o'�� � �
for William E. Toby Vinson, Jr., P.E., CPESC, CAM, Interim Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

Patterson, Robert D
From: Georgoulias, Bethany
Sent: Monday, January 29, 2018 1:23 PM
To: Khan, Zahid; [e-mail]; Patterson, Robert D
Cc: Alexander, Laura
Subject: RE: NCG020924 Jerry Smith Mine
Thank you, Zahid. I am forwarding to the assigned reviewer— Robert Patterson.
Bg
Bethany Georgoulias
Environmental Engineer
Stormwater Program, Division of Energy, Mineral, and Land Resources
N.C. Department of Environmental Quality
919 807 6372 office
bethany.georgoulias(a7ncdenr.gau
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
512 N. Salisbury Street, Raleigh, NC 27604 (location)
Website: htti0dea.nc.P-ovlabout/divisionslenerav-mineral-land-resources/stormwater
Email correspondence to and from this address is subject to the North Carolina Public Records
Law and may be disclosed to third parties.
From: Khan, Zahid
Sent: Monday, January 29, 2018 1:21 PM
To: [e-mail]
Cc: Alexander, Laura <[e-mail]>; Georgoulias, Bethany <[e-mail]>
Subject: FW: NCG020924 Jerry Smith Mine
Bethany,
We reviewed the mine package and very much familiar with this site. Please see below comments from James Moore.
We do not have any objection for issuance of this COC. Please let me know if you have any questions Thanks
Zahid Khan, CPM, CPESC, CPSWQ
Regional Engineer
Mooresville Regional Office
Division of Energy, Mineral, and Land Resources
Department of Environmental Quality
704 663 1699 Office
704 663 6040 Fax
[e-mail]
610 East Center Ave., Suite 3C1
Mooresville, NC 28115

-- Nothing Compares---.,
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Moore, James
Sent: Monday, January 29, 2018 1:10 PM
To: Khan, Zahid <zahid.khan ncdenr.gov>
Subject: NCG020924 Jerry Smith Mine
I have reviewed the stormwater NOI and my only issue is question 38, they checked no to the bulk storage. How are
they going to fill the backhoe with fuel? I would not hold up permit coverage, we can investigate this during the first
inspection.
James Moore MRO-LQ
r
2

a i
I Date Received I
Division of Energy, Mineral and Land Resources /
Land Quality Section — Stormwater Permitting Program
National Pollutant Discharge Elimination System
NCG020000
NOTICE OF INTENT — General Permit Application
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG020000:
STORMWATER AND/OR WASTEWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) Code - 14XX Mineral Mining Industry (except as specified below) and
like activities
The following activities are included:
• Active or inactive mining operations (including borrow pits —except for NCDOT borrow pits) -that discharge
stormwater contaminated with or that has come in contact with, any overburden, raw material, intermediate
products, finished products, byproducts or waste products located on the site of such operations;
• Stormwater from vehicle maintenance activities (VMA) at mining operations;
• Overflow from facilities that recycle process wastewater; and/or
• Mine dewatering (wastewater)
The following activities are specifically excluded from coverage under this General Permit:
• Stormwater discharges associated with peat mining, coal mining, and metal mining;
• Stormwater discharges from mining operations which are intermixed on site with stormwater from concrete
operations;
• Stormwater discharges associated with oil and gas extraction operations; and
• Stormwater discharges associated with tourist gem mines
• NCDOT borrow pits (covered under individual permit NCS000150)
The following discharges are covered by NPDES general permit NCG520000 instead of NCG020000:
Point source discharges of stormwater and wastewater from in -stream sand mining operations (sand dredging
or dipping operations) are covered instead by NPDES General Permit NCG520000, administered by the Division
of Water Resources NPDES Wastewater Permitting Program. Please contact DWR for more information.
Please print or tyj2e all entries in this application form.
1) Mailing address of ownerloperator official address to which all Permit correspondence will be mailed):
Legal Owner Name jercy E. Smith
(Attach the most recent Annual Report to the NC Secretary of State showing the current )egal name ofige corporatiJ or eWi .
Alternatively this permit can be given to an individual or government authority. This name must be the same name as appears on the
Division of Energy, Mineral, and Land Resources' Mining Permit.)
Signee's Name (as signed for in question 41. at end): Jerry E, Smith
Street Address 3486 Airport Road
City Maiden State North Carolina ZIP Code 28650
Telephone No. 828-312-2780 E-mail [e-mail] Alternate Contact Name" Melinda Smith E-mail (if different) RECEIVED
�-•�✓i�/C(�
JAN 2 3 2013
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Alternate Contact Telephone (if different) 828-302-2517
`Alternate contact should be affiliated with the Owner/Operator. Consultant information can be provided
in question 5.
2) Location of facility producing discharge:
Facility Name
Jerry Smith Mine
Facility Street Address 3431 Airport Road
Facility City
Maiden
Facility County
Catawba
Facility Contact
Jerry E. Smith
Telephone No.
82B-312-2780
State: North Carolina ZIP Code
Contact E-mail [e-mail]
3) Physical Location Information:
Fax: NIA
28650
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 Mooresville take Highway 150 towards west, at
the intersection of Highway 16 take North highway towards Newton/Conover. After 5 miles takes right on
Airport Road. Property is on left before Mist lane.
Facility Location Coordinates:
Latitude 35.59646 N Longitude-81.08276 W (degrees I minutes 1 seconds or decimal degrees)
4) Consultant Information (if applicable):
Consultant: Samar Bou-Ghazale
Consulting Firm: _Envirotech NC, LLC
Mailing Address: 6076 Diamond Place,
City: Harrisburg
State: NC Zip Code: 28075
Phone: (704) _307-0660 Fax: ( )
E-mail: [e-mail]
Permits:
5) This NPDES Permit Application applies to which of the following:
X New or Proposed Facility
❑ Existing
6) Standard Industrial Classification:
(Optional)
Staple Business Card Here
Date operation is to begin: 03/01/2018
Date began mining:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility SIC Code: 1 4 9 9
7) Provide a description of the types of minerals mined at this facility: A borrow pit for dirt soil
8) Is this a PROCESSING -ONLY facility for materials mined elsewhere? X No C! Yes
9) Is this an inactive mine site?
X No
Cl Yes If yes, have you certified to the Stormwater Permitting Program that all portions of the site where
clearing, grading, and/or excavation activities have occurred have been stabilized?
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❑ No ❑ Yes (If yes, the site may be eligible for "Dormant Status" and reduced BMP
inspections. See the General Permit.)
10) Does this facility already have a valid Mining Permit from DEMLR's Land Quality Section?
X No If no, please indicate the status of the Mining Permit application: Applied for the permit
❑ Yes If yes, please provide the Mining Permit number: Also provide a copy of
the DEMLR Mining Permit with this NPDES application.
11) Does this facility have any other NPDES permits?
X No
❑ Yes If yes, list the permit numbers for all current NPDES permits for this facility:
12) Are you applying for a discharge permit in the same location as a previously permitted mine?
X No
❑ Yes If yes, specify permit number and mine name if known:
13) Does this facility have any Non -Discharge permits from DWR (e.g., recycle permits)?
X No
❑ Yes If yes, list the permit numbers for all current Non -Discharge permits for this facility:
14) Does total area of this mine site include ready -mixed concrete plant andlor asphalt plant areas?
X No
❑ Yes If yes, do they have separate NPDES stormwater permits? ❑ No ❑ Yes (provide permit
number(s) )
If not owned by the same company, who is the owner?
Development Activities and Buffers:
15) Will this mining operation precede development activities at this site?
X No
❑ Yes
16) Is this mine located within one of the 20 Coastal Counties, and will it add more than 10,000 ft2 of
impervious surface?
❑ Yes (to both)
❑ No, this mine site IS in one of the 20 Coastal Counties but will NOT add 10,000 ft2 of impervious surface.
X No, this mine site is NOT in any of the 20 Coastal Counties.
If this site is in one of the 20 Coastal Counties, you may be required to apply for an additional State
Stormwater Permit. Check with your local Regional Office (see contact information and checklist below),
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17) is this mine located the Neuse, Tar -Pamlico, or Catawba River Basins, or the Randleman or Jordan
Water supply Watersheds?
X No
❑ Yes If yes, what size stream buffers are included on site? ft_ You must show buffers on site
plans. Also include information and plans showing diffuse flow through buffers as required.
Discharge Points, Receiving Waters & Wetlands:
1 B) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
and/or wastewater discharges will end up in? unnamed Tributary to South Fork
.50U A FOV-K Ao"oot+✓ c Q.K. l
To find the waterbody, please see the "MAPS" tab on http:ltportal.ncdenr.orglwebtwg for a map of NC
Surface Waterbody Classifications.
Receiving water classification(s) for the waters: Unnamed Tributary to South Fork
If the site will discharge to a separate storm sewer system, name the operator of the separate storm sewer
system (e.g. City of Raleigh municipal storm sewer). NIA
Discharge of wastewater to receiving waters classified as WS-11 through WS-V, or SA, must be
approved by the Division of Water Resources (DWR) or Division of Marine Fisheries
(DMF). DEMLR cannot grant coverage under NGG020000 without that approval. Also be advised that
no new discharges of wastewater are permitted in receiving waters classified as WS-1 or
freshwater ORW. Wastewater discharges to saltwater ORW will not be approved under General Permit
NCG02 but may be eligible for an individual permit.
19) Will this mine site discharge wastewater or stormwater to waters classified as High Quality Waters
(HQW), Primary Nursery Areas (PNA), Trout jr) waters, or a class with a symbol like "+" or "@" that
denotes a special management strategy is in place?
X No ❑ Yes, HQW" ❑ Yes, includes "+" or
❑ Yes, PNA' ❑ Yes, Trout jr)
20) Will this mine site discharge wastewater or stormwater to waters classified as Shellfish (SA) waters?
X No
❑ Yes, SA"
"For questions 19-20, be advised that the NCG02 General Permit limits the discharge volume of total combined
wastewaters to 50 percent of the receiving water in -stream flow under 7Q10 conditions in HQW waters (PNA and
SA waters are considered HQW by definition). You may be required to contact USGS to obtain a 7Q10 flow.
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21) Will this mine site discharge wastewater or stormwater to impaired waters, or to waters with an
approved "Total Maximum Daily Load" (TMDL)?
To find impaired waters, please see the "Impaired Waters" map on the "MAPS" tab on
http://portal.ncdenr.orglweb/wq.
To find approved TMDLs in North Carolina, please see DWR's Water Planning Section website:
http:/Iportal.ncdenr.org/web/wq/ps/mtu/tmdl/tmdls.
X No
❑ Yes, these waters are impaired for (list pollutants):
❑ Yes, these waters have a TMDL for (list pollutants):
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22) List discharge points (outfalls) that convey discharge from the mine site (both on -site and off -site) and
location coordinates. Attach additional sheets if necessary, or note that this, information is specified
on the site plan. Include proposed maximum daily flow rate for each wastewater outfall.
You must show all discharge points clearly on the submitted site plan. Be advised
that NCDEQ may require you to apply for an individual permit, based on proposed
discharge rates and receiving stream conditions (low flows, impairments, etc.)
Stormwater
Stormwater Outfall No. �1
Latitude (degreeslminuteslseconds or decimal degrees): 35,5971 N
Longitude (degrees/minutes/seconds or decimal degrees): 81.0825 W
Stormwater Outfall No. _2
Latitude (degreeslminuteslseconds or decimal degrees): 35.5986 N
Longitude (degrees/minutes/seconds or decimal degrees): 81.0880 W
Stormwater Outfall No.
Latitude (degreeslminuteslseconds or decimal degrees):
Longitude (degrees/minutes/seconds or decimal degrees):
Stormwater Outfall No.
Latitude (deg reeslminuteslseconds or decimal degrees):
Longitude (degrees/minutes/seconds or decimal degrees):
Stormwater Outfall No.
Latitude (degrees/minutes/seconds or decimal degrees):
Longitude (degrees/minutes/seconds or decimal degrees):
Stormwater Ouffall No.
Latitude (degrees/minutes/seconds or decimal degrees):
Longitude (degrees/minutes/seconds or decimal degrees):
Stormwater Outfall No.
Latitude (degrees/minutes/seconds or decimal degrees):
Longitude (degrees/minutes/seconds or decimal degrees):
Stormwater Outfall No.
Latitude (degrees/minutes/seconds or decimal degrees):
Longitude (degrees/minutes/seconds or decimal degrees).
Stormwater Outfall No.
Latitude (degrees/minutes/seconds or decimal degrees):
Longitude (degrees/minutes/seconds or decimal degrees):
Stormwater Outfall No.
Latitude (degreeslminuteslseconds or decimal degrees):
Longitude (deg reeslminuteslseconds or decimal degrees):
N
W
N
W
N
W
N
W
N
W
N
W
N
W
N
W
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Mine Dewatering
Mine Dewatering (Wastewater) Outfall No.
Proposed maximum flow rate:
Latitude (degreeslminuteslseconds or decimal.degrees):
N
Longitude (degrees/minutes/seconds or decimal degrees):
W
Mine Dewatering (Wastewater) Outfall No.
Proposed maximum flow rate:
Latitude (deg reeslminuteslseconds or decimal degrees):
N
Longitude (degrees/minutes/seconds or decimal degrees):
W
Mine Dewatering (Wastewater) Outfall No.
Proposed maximum flow rate:
Latitude (deg reeslminuteslseconds or decimal degrees):
N
Longitude (degrees/minutes/seconds or decimal degrees):
W
Mine Dewatering (Wastewater) Outfall No.
Proposed maximum flow rate:
Latitude (deg reeslminuteslseconds or decimal degrees):
N
Longitude (deg reeslminuteslseconds or decimal degrees):
W
Process Wastewater
Process Wastewater Outfall No. Wastewater Description:
Proposed maximum flow rate:
Latitude (degreeslminuteslseconds or decimal degrees):
N
Longitude (deg reeslminuteslseconds or decimal degrees):
W
Process Wastewater Outfall No. Wastewater Description:
Proposed maximum flow rate:
Latitude (degrees/minutes/seconds or decimal degrees): N
Longitude (degrees/minutes/seconds or decimal degrees): W
Process Wastewater Outfall No. Wastewater Description:
Proposed maximum flow rate:
Latitude (deg reeslminuteslseconds or decimal degrees): N
Longitude (degrees/minutes/seconds or decimal degrees): W
Process Wastewater Outfall No. Wastewater Description;
Proposed maximum flow rate:
Latitude (degreeslminuteslseconds or decimal degrees): N
Longitude (deg reeslminuteslseconds or decimal degrees): W
Process Wastewater Outfall No. Wastewater Description:
Proposed maximum flow rate:
Latitude (deg reeslminuteslseconds or decimal degrees): N
Longitude (degrees/minutes/seconds or decimal degrees): W
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1[9101 III1I1I11►teal
23) Help us understand what will happen to the dewatering water at this mine site:
X NIA — this mine is not dewatering at all and will not dewater in the future.
a) Will this mine be dewatering and discharging to waters of the state? (Answer only if dewatering)
❑ No
❑ Yes If yes, where to? ❑ Surface Waters and/or Wetlands (on -site or off -site)
❑ Other (on -site or off -site) Describe:-
b) Will this mine be dewatering but not discharging to waters of the state? (Answer only if dewatering)
❑ No
❑ Yes If yes, explain how you are dewatering, and where that water will be directed:
24) Are there wetlands or surface waters within 400' of the mine pit perimeter?
X No
❑ Yes If yes, what distance are they from the mine pit perimeter? feet.
25) Will mining operations require dewatering near wetlands or other waterbodies, and will dewatering
potentially impact any wetlands or other waterbodies?
X No, dewatering will not occur near (within 400') of wetlands or other waterbodies (e.g., streams, lake, etc.)
❑ Yes, dewatering will be near wetlands or other waterbodies
Wetlands must be CLEARLY DELINEATED on the site plan. Mine dewatering activities that
have the potential to drain wetlands or otherwise impact surface water or groundwater MUST develop and
implement a Pumping Operation and Monitoring (POM) Plan that has been approved by the
Department.
For sites that may drain wetlands — approval of a POM Plan may be required prior to coverage under
this permit. The POM Plan should be submitted to the appropriate Regional Office and in all cases must be
approved prior to operation.
The plan shall include, but is not limited to: (1) Groundwater monitoring strategies to demonstrate the effect of
pumping and to establish any pumping regime necessary to reduce impacts, and (2) Detailed plans to maintain
surrounding hydrology and respective monitoring to demonstrate compliance. See checklist at the end of the
application. Contact the Regional Office for questions specific to your mine.
26) Have you been required to obtain 404/401 Certification permits?
X No
❑ Yes If yes, please briefly describe below (include information such a required mitigation, BMPs,
setbacks, and/or O&M plans for on or off -site wetlands or otherpertinent information). Attach other sheets as
necessary:
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27) Have you been required to obtain a wetland delineation certified by the US Army Corps of Engineers?
X No ❑ Yes If yes, please attach to application submission.
Stormwater BMPs and Vehicle Maintenance:
28) Does this facility employ best management practices for stormwater control?
❑ No X Yes If yes, please briefly describe: _Stormwater Detention basin will be designed and
skimmer basins will be designed for the mine site.
29) Does this facility have a Stormwater Pollution Prevention Plan?
X No ❑ Yes If yes, when was it implemented?
30) Are vehicle maintenance activities (VMA) occurring or planned at this mine site?
X No ❑Yes, If yes, will VMA area runoff discharge into the wastewater treatment system(s)?
❑ No, VMA runoff will discharge separately through a stormwater outfall
❑ Yes, VMA runoff will drain back to the mine pit or other wastewater system
Wastewater Treatment Facilities:
31) Will mine dewatering occur? (Yes, we are asking about dewatering again.)
X No
❑ Yes If yes, will the mine discharge this water?
32) Will this facility wash mined materials?
X No
❑ Yes If yes, will the mine discharge this water?
33) Will discharges of process wastewater treatment systems occur (including possible recycle system
overflows)?
X No
❑ Yes If yes, describe what kind of systems:
34) Will this facility employ chemical additives to flocculate suspended solids?
X No
❑ Yes If yes, provide the name, manufacturer, and the quantity of average daily usage of the chemical
additive (if known):
Note: Please see our website for a list of evaluated polyacrylamide (PAMS) products for use in North
Carolina: http://portal.ncdenr,org/web/ir/construction-stormwater
35) Will any of the wastewater treatment facilities at this mine overflow only during rainfall events that
exceed the 10-yr, 24-hr rainfall event? NIA
❑ Yes If yes, which treatment systems are those? N/A Basins are designed for 25 year storm.
❑ No, all wastewater treatment facilities will discharge more frequently (i.e., during smaller rain events)
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36) Are wastewater treatment facilities (including recycle systems) planned in the 100-year flood plain?
X No
❑ Yes
Other:
37) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No ❑ Yes
b) is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month). of
hazardous waste?
XNo El Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) 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:
How many disposal shipments per year:
Name of transport I disposal vendor: _
Vendor address:
38) Is your facility providing appropriate secondary containment for bulk storage of liquid materials? (See
permit text for secondary containment requirements.)
X No We are not planning to have a Bulk Storage or liquid material. If needed, we will provide secondary
containment.
❑ Yes
39) Does your site have an active landfill within the mining permit boundary?
X No
❑ Yes If yes, specify type: ❑ LCID (Land Clearing and Inert Debris) ❑ Other:
Final Checklist:
This application will be returned as. incomplete unless all of the following items have been included and
t initialed for. Please show that the following required information has been included by initialing in each
space below.
_X_ Fee of $100 made payable to NCDEQ.
_X_ Completed application and all supporting documents.
_X, Copy of the valid approved mining permit (MP) for the facility or indication of MP application status.
_X_ Copy of a county map or other general location map that shows the mining site and nearest major roads.
_X_ Copy of USGS topographic map showing the mining site and surrounding areas, or other map that clearly
shows site location in relation to nearby streams, wetlands, and other waters, etc.
_X_ 2 copies of large-scale (minimum 24" x 36") site plan with topographical lines with
all outfalls, applicable buffers and wetlands clearly delineated, receiving waters, and
100-year flood plain line if applicable.
_X_ I have contacted my local regional office about a POM Plan.
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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 of contested case under this Article; or who falsifies, tampers with, or know'ngty
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the r
[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).
41) Signatory Requirements (per 40 CFR 122.22)
All applications. reports, or information submitted to the Director shall be signed and certified.
a. All notices of intent to be covered under this General Permit shall be signed as follows:
(1) For a corporation: by a responsible corporate officer, For the purpose of this permit, a responsible corporate officer means: (a) a president,
secretary, treasurer or vice president of the corporation in charge of a principal business function, or any other person who performs similar
policy or decision making functions for the corporation, or (b) the manager of one at more manufacturing production or operating facilities
employing more than 250 persons or having gross annual sales or expenditures exceeding 25 million (in second quarter 1980 dollars), if
authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.
(2) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or
(3) For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official.
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.
agree to abide by the following as a part of coverage under this General Permit.-
1. 1 agree to abide by the approved Mining Permit for this mining activity. (A copy of the valid mining i
permit must be attached to this request.)
2. 1 agree to not discharge any sanitary wastewater from this mining activity except under the
provisions of another NPDES permit specifically issued therefore.
3. 1 agree that bulk storage of petroleum products and other chemicals shall have adequate protection
so as to contain all spills on the site.
4, 1 agree that solid wastes will be disposed of in accordance with N.C. statutes and rules governing 1
solid waste disposal. , 1
5. 1 agree that maintenance activities for vehicles and heavy equipment will be performed so as to not I
result in contamination of the surface or ground waters.
I agree to abide by the provisions as listed above and recognize that the provisions are to be considered as
enforceable requirements of the General 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: y%% / V
Title: fS/ s,�/Tf/G�� "�,
✓ (5&ature o Applicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for 1100.00 made payable to NCDEQ.
Page 11 of 12
5WU-NCG02-NOI Last revised 9/10/2015

NCG020000 N.O.I.
Mail the entire package to:
Stormwater Permitting Program
Division of Energy. Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee coverage under
the NPDES NCG02 General Permit. Upon review of the submittal, the
Division may determine that coverage under an individual permit is
more appropriate. Also be advised that renewed and continued
coverage under NCG02 may be dependent upon the permittee's
compliance success and/or status of the receiving waters.
For questions, please contact the DEMLR/Land Quality Section Regional Office for your area.
DEMLRILand Quality Section Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 12 of 12
SWU-NCG02-NOI Lest revised 9/10/2015

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subject to Rand McNally's Terms of Use and Privacy Policy. Do not use this site or other Rand McNally mobile devices or services in a way that
distracts you and prevents you from obeying traffic and safety laws. Rand McNally makes no representation or guarantee concerning the
accuracy of the content, route usability, traffic, road conditions or road construction projects, and you assume all risk in planning your route.
2014 Rand McNally

Parcel Report
Page 1 of 1
Parcel Report - Catawba County NC
Parcel Information: Owner Information:
Parcel ID: 368701089418 Owner: SMITH JERRY E
Parcel Address: 3431 AIRPORT RD Owner2:
City: MAIDEN, 28650 Address: 3486 AIRPORT RD
LRK(REI D): 201481 Address2:
Deed Book/Page: 3399/0777 City: MAIDEN
Subdivision:
State/Zip: NC 28650-9055
Lots/Block: 1
School Information:
Last Sale:
School District: COUNTY
Plat Book/Page:
Elementary School: BALLS CREEK
Legal:
Middle School: MILL CREEK
Calculated Acreage: 14.800
High School: BANDYS
Tax Map: �
Township: CALDWELL
School Map
State Road #: 1891
Tax/Value Information: Tax Rates(pdt
Zoning Information:
City Tax District: All in County
Zoning District: COUNTY
County Fire District: BANDYS
Zoningl: R-40
Building(s) Value: $19,300
Zoningl:
Land Value: $72,600
Zoning3i
Assessed Total Value: $91,900
Zoning Overlay: DWMH-O,WP-O
Year Built/Remodeled: 1
Small Area: SHERRILLS FORD
Current Tax Bill
Split Zoning Districts: 1
Zoning Agency Phone Numbers
Miscellaneous:
Firm Panel Date:
Building Permits for this parcel.
Firm Panel #:
Building Details
2010 Census Block: 2029
WaterShed: WS-IV Protected Area
2010 Census Tract: 011501
Voter Precinct: P1
Agricultural District: Proximity
Parcel Report Data Descriptions
List all Owners Deed History Report
Assessment Report
This maplreport product was prepared from the Catawba County, NC Geospatial Information services. Catawba County has made substantial efforts to ensure
the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends the independent
verification of any data contained on this map/report product by the user. The County of Catawba, lts employees, agents, and personnel, disclaim, and shall not be
held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map/report product or the use
thereof by any person or entity.
© 2017, Catawba County Government, North Carolina. All rights reserved.
h"T-tL IlrT;v 01——14o-rn1 none 1 o 1'11r7PI01?

CA'AWBA Geospatial
'�""'' Information Services
Real Estate Search
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Parcel: 368701089418, 3431 AIRPORT RD MAIDEN, 28650
Owners: SMITH JERRY E,
Owner Address: 3486 AIRPORT RD
Values - Building(s): $19,300, Land: $72,600, Total: $91,900
TA C
2 8' 6�a
1 in=600ft
This map/report product was prepared from the Catawba County, NC Geospatial Information services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this maplreport product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
12/04/2017

Ms. Judy Wehner
Assistant State Mining Specialist
NCDEQ- Division of Energy, Mineral and Land Resources
1612 Mail Service center Raleigh, North Carolina 27699-1612
RE: Jerry Smith Mine
New Mine Permit
Dear Ms. Wehner:
This is the letter requesting a mining permit for Jerry Smith Mine located at 3486 Airport Road,
Maiden, NC 28650. 1 have included the Mine permit application, Mine permit fee, Mine Map,
Reclamation map, USGS Exhibit map, Roadway map, Erosion control Drainage area map, Erosion
Control map and calculations.
Please feel free to contact me at 704-307-0660 or at Samar Bou-ghazale
<[e-mail]> should you have any questions or need additional information.
Sincerely,
Samar Bou-Ghazale
Envirotech.NC.US
6076 Diamond Place, Harrisburg, NC 28075

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