NCG520061_Renewal Application_20200826

11
A 7L_
HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
NOTICE OF RENEWAL INTENT
[Required by 15A NCAC 02H .0127(d)]; [term definition see 15A NCAC 02H .0103(19)]
Application for renewal of existing coverage under General Permit NCG520000
Existing Certificate of Coverage (CoQ: NCG520 061
(Please print or type)
1) Mailing address of facility owner/operator: (address to which all correspondence should he mailed)
Company Name Slate Sand Mining, LLC
Owner Name Locke Rowe
Street Address
City
Telephone #
Email
639 Old US 52 South
Mt Airy
336-789-8221
[e-mail]
2) Location of facility producing discharge:
Facility Name Slate Sand Mining, LLC
State NC ZIP 27030
Fax # [phone]
Facility Contact Mike Stanley
Street Address 1073 John Mickles Road
City Pinnacle State NC ZIP 27043-
County Surry
Telephone # [phone] Fax #
Email [e-mail]
3) Description of Discharge:
a) Is the discharge directly to the receiving water? ❑ Yes ® No
b) Number of discharge points (ditches, pipes, channels, etc. that convey wastewater from the property): 8
c) Is there any treatment being applied to the wastewater before discharge (check the type of treatment in use).
® Settling pond ❑ Lagoon ❑ None
❑ Other:
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NCG520000 Renewal Application
4) Discharge Frequency:
a) The discharge is: ❑ Continuous ❑ Intermittent ® Seasonal
i) If the discharge is intermittent, describe when the discharge will occur:
ii) If seasonal check the month(s) the discharge occurs: ❑ Jan. ❑ Feb. N Mar. N Apr. ❑ May ❑ Jun.
N Jul. N Aug. N Sept. N Oct. ® Nov. N Dec.
b) How many days per week is there a discharge? 5
c) Please check the days discharge occurs:
❑ Saturday ❑ Sunday N Monday N Tuesday N Wednesday N Thursday N Friday
CERTIFICATION
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: Locke Rowe
Title:
(Signature of Applicant)
North Carolina General Statute 143-215.6 b (i) provides that:
licl: li re to c lifff"'l' a Clate.
(Date Signed)
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 Article 21 or regulations of the Environmental Management Commission
implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate any recording or monitoring device or
method required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission
implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $25, 000, or by imprisonment not to
exceed six months, or by both. (18 U.S. C. Section 1001 provides a punishment by a fine of not more than $25, 000 or imprisonment
not more than 5 years, or both, for a similar offense.)
This Notice of Renewal Intent does NOT require a separate fee The permitted facility already
pays an annual fee for coverage under NCG520000.
Mail this application and one copy of the entire package to:
NC DENR / DWR / Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attn: Charles Weaver
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