NCG070140_COMPLETE FILE - HISTORICAL_20140417 (2)

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
HISTORICAL FILE
0 MONITORING REPORTS
DOC DATE
0 Db I I 0,-(12
YYYYMMDD

'7'2
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Steve Wyse
General Shale Brick, Inc.
P.O. Box 3547
Johnson City, TN 37602
Dear Mr. Wyse:
John E. Skvarla, III
Secretary
April 17, 2014 RECEIVED
MAY 0 8 .ZM
CENTRAL FILES
DWQIBOG
Subject: NPDES General Permit NCG070000
General Shale Brick, Inc.
Formerly Cunningham Brick Company
Certificate of Coverage NCG070140
Cleveland County
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained
in the General Permit remain unchanged and in full effect. This revised Certificate of Coverage
is issued under the requirements of North Carolina General Statutes 143-215.1 and the
Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
ZLLe-C.,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Z. Khan
Deborah Reese, DEMLR Budget Office — please update billing info
Stormwater Permitting Program Files
Central Files
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 I FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:llportal.ncdenr.org/web/Ir/
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. NCG070000
CERTIFICATE OF COVERAGE No. NCG070140
STORMWA'rER 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,
General Shale Brick, Inc.
is hereby authorized to discharge stormwater from a facility located at
General Shale Brick, Inc - Cleveland County Plant
1622 Longbranch Rd
Grover
Cleveland County
to receiving waters designated as unnamed tributary to Buffalo Creek, a class C water in the
Broad River Basin, in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, III, and IV of General Permit No. NCG070000 as
attached.
This certificate of coverage shall become effective April 17, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 17, 2014
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

��Division of Water Quality / Surface Water Protection
i�
National Pollutant Discharge Elimination System
NCDENR
PERMIT NAME/OWNERSHIP CHANGE FORM
l w. r-„ru-wwH.. 'l.iltiu_ Ih.v:we:.n
FOR AGENCY USE ONLY
Date Received
Year
IMonth
Da
I. Please enter the permit number for which the change is requested.
NPDFS Permit (or) Certificate of Coverage
N I C I X1 b 17 1 0 1 1N C G
ll. Permit status prior to requested change.
a. Permit issued to (company name): Cunnim-,ham Brick Company _.
b. Person legally responsible for permit: lZichard Cunningham
First M1 Last
Corp. Secretary
Titte
701 N. Main St.
Permit Hot(ter Mailing Address
Lcxin,gton NC 27292
City State Zip
( 336) 248-8541 ( 336 ) 224-0002 _
Phone Fax
c. Facility name (discharge): Cunningham Brick Co - Kim-,s Mountain
d. Facility address: 1622 Longbranch Rd
Address
Grover NC 28073
City Stale Zip
c. Facility contact person: Dale Russell ( 336 ) 248-9541
First I MI 1 Last Phone
Ill. Please provide the following for the requested change (revised permit).
a. Request for change is a result of': ® Change in ownership of the I'acility
❑ Name change of the facility or owner
please explain:
to (company name): Cieneral Shale Rrick,Jnc.
responsible for permit: Gregory Bowles
First MI Last
Facility name (discharge):
e. Facility address:
Director of Environment
Title
PO Box 3547
Permit Holder Mailing Address
Johnson City IN 37602
City State Zip
( 423)282-4661
Phone E-mail Address
Cleveland C unty Plant
tCi?? 1 nncrhr-nnr•h Rd
Address
City Stale Zip
f. Facility contact person: Clif Marklin
First MI Last
( 704) 937-7431 clif.marklin cirencralshale.com
Phone F-mail Address
Revised 2012Apr23

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (il' clifferent from the person legally responsible for the permit)
Permit contact:
First MI Fast
Environmental Engineer
Title
PO Box 3547 _
Mailing Address
Johnson City IN 37602
City State 'Lip
( 473 ) 95?-4')R 1 steve wy` 4guneralshale rnm
Phonc E-mail Address
V.
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or narne change?
X❑ Yes
❑ No (please explain)
Required Items: THIS APPLICATION WILL. BE RETURNED UNPROCESSED IF ITEMS
VI, ARE INCOMPLETE OR MISSING.:
X❑ This completed application is required for both name change and/or ownership change
requests.
® Legal documentation of the transfer of ownership (such as relevant pages of- a contract deed,
or a bill of sale) is required f'or an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, anti
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTBE CERTIFICATION (Permit holder prior to ownership change):
I, attest that this application for a name/ownership change has been reviewed and is accurate and
complete to - best of my knowledge. I understand that if all required parts of this application are not
completed and tha4111,quired supporting information is not included, this application package will be
returned as incomplete. Richard Cunnungham
ly
Signature Date
APPLICANT CERTIFICATION
I, attest that this application fora name/ownership change has been reviewed and is accurate and
complete to best of my knowledge. I understand that if all required parts of this application are not
completed and t all required supporting information is not included, this application package will be
returned as irlcom lete. Gregory Bowles
ignature Date
I'I,1:ASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2008

2013-011702 B: 1668 P: 2027
11/22/2013 02:31:00 Ph TotalPagges: 4 Fees: 4215.00
Bonnie E. Reece, Register of Deeds, Cleveland County,NC
11111111111111111111111111111111111111111111111111111I1111111111I IN
Receipt.lt 13-19170 2013-011702
Issued 11/2212013 ClevelandCounly, XC
by Bonnie E. Reece,Register of Deeds
Excise Amount: $4189.00 Excise ID 9027411
Real Estate Excise Tax
FEE1_9& I .� 1 9.00
1� NORTH CAROLINA SPECIAL WARRANTY DEED
Excise Tax: $4,189.00
Parcel Identifier No. Verified by County on the — day of�_ 20
By:
Mail/Box to: Grantee
This instrument was prepared by: Bradshaw & Robinson, LLP, P.O. Box 607, Pittsboro, North Carolina 27312
Brief description for the Index:24.70 acres, more or less, Number pour Township
THIS DEED made this 22nd day of ovember, 2013, by and between
GRANTOR
CUNNINGHAM BRICK COMPANY,
a North Carolina corporation
701 North Main Street
Lexington, North Carolina 27292
GRANTEE
*GENERAL SHALE, INC., a Delaware corporation
3015 Bristol Highway
Johnson City, Tennessee 37601
Enter in appropriate block for each Grantor and Grantee: name, mailing address, and, if appropriate, character of entity, e.g.
corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, fendnine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and
by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot, parcel of land or condominium
unit situated in Number Four Township, Cleveland County, North Carolina, including any and all fixtures, buildings and
improvements located thereon, and more particularly described as follows:
See "Exhibit A," a copy of which is attached hereto and incorporated herein by reference, for the property description.
Page 1 0f4

IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
CUNNINGHAM BRICK COMPANY,
a North Carolina Corporation
By:
Print Name: �! r��✓ i�/L�'!
Title:
State of North Carolina — County of
[ e ders' ed Notary public o the linty of (V and State aforesaid, certify that
1 ! o persorally came before me this day and acknowledged that he is the
of CUAMNGHAM BRICK COMPANY, a North Carolina corporation, and that by authority
duly given and as the act of such entity, _he signed the foregoing instrument in its name on its behalf as its act and deed.
Witness my hand and Notarial stamp or seal, this d y of November, 2013.
JLJ
My Commission Expires: Q-� 4 0 1 Notary Public
(Affix Seal) f INotary's Printed or Typed Name
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