NCG520009_Regional Office Historical File Pre 2018

Water Resources
ENVIRONMENTAL QUALITY
December 29, 2017
Mr. Wayne Cassavaugh
Carolina Sand Inc.
2440 Angus Lane
Lenoir, North Carolina 28645.
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
SUBJECT: Compliance Evaluation •Inspection
Second Creek Sand Mine &
Grants Creek Sand Mine
NPDES Permit NCG520009,
C�G'52©s1106
Rowan County, NC
Dear Mr. Cassavaugh:
On December 19, 2017, Mr. Roberto Scheller-of this Office conducted inspections at the subject
facilities. These inspections were conducted as Compliance EV.aluation Inspections (CEI) to
insure compliance with permit requirements and conditions. We wish to thank you and your
staff for their assistance regarding these inspections.
The enclosed reports should be self-explanatory; however, should .you have any questions,
please do not hesitate to contact myself of Roberto Scheller at [phone] or
[e-mail].
Sincerely,
W. Corey -Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
Enclosure: Inspection Reports
cc: Wastewater Branch
File
State of North Carolina I Environmental Quality I Water Resources f Water Quality Regional Operations
Mooresville Regional Office) 610 East Center Avenue, Suite 3011 Mooresville, North Carolina 28115
704 663 1699

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C.20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 6-31-0e
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES. yr/mo/day Inspection Type Inspector 'Fee Type
1 IN i 2 15 I 3 I NCG520106 I11 12 17/12/19 17
18 ICI 19 i G I 201
211 I I I I I I I I I I 1 I 1 I I I I I I I I I I I I I I I
I I I I I I 11 I I I I -166
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA
Reserved —
67 70 I, I 71 I I 72 i N i
L1 LJ
731 I 174 75
I I
80
Section B: Faclility—Data
Name and.Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
11:02AM 17/12/19
16/07/20
Grants Creek Sand Mine
Exit Time/Date
Permit Expiration Date
1915 Grub Ferry Rd
11:43AM 17/12/19
20/07/31
Salisbury NC 28144.
Name(s) of Onsite Representative(s)/Tities(s)/Phone and. Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Wayne Cassavaugh,2440 Angus Ln Lenoir NC 28645//828-728-6815/8287580617
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers
Date
Roberto Schaller MRO WQ//252-946-6481/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
W. Corey Basinger MRO WQ//704-235-2194/
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete..
Page#

NPDES yr/mo/day Inspection Type
I1 2 17/12/19 18 ,,
31 NC9520106
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page# 2

or
Permit: NCG520106 Owner - Facility: Grants Creek Sand Mine
Inspection Date: 12l19/2017 Inspection Type: Compliance Evaluation
Flow Measurement - Influent
Yes No NA NE
# Is flow meter used for reporting?
❑
❑
N
❑
Is flow meter calibrated annually?
❑
❑
0
❑
Is the flow meter operational?
❑
❑
N
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑'0
❑
Comment: In accordance with General Permit NCG520000 the Dermittee shall estimate the
semi-annual flow during times of operation. Record is being kept of recording 0 flow at the
subject site.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ ❑ 0 ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑. 0 ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: Sand dredging site has not been active to allow sand to accumulate within dredge area.
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
0
❑
application?
Is the facility as described in the permit?
0
❑
❑
❑
# Are there any special conditions for the permit?
❑
N
❑
❑
Is access to the plant site restricted to the general public?
0
❑
❑
❑
Is the inspector granted access to all areas for inspection?
!
❑
❑
❑
Comment: The current permit is active and annual fees for 2017 have been paid.
In the event this site
should become active and sand dredging operations resume the Division of Water
Resources in the Mooresville Regional Office should be contacted.
Page# 3 ..

Water Resources
ENVIRONMENTAL QUALITY
ROY COOGovernorPER_ �y
MICHAEL S. REGAN
. Secretary
LINDA CULPEPPER
Interim Director
December 29, 2017
Mr. Wayne Cassavaugh
Carolina Sand Inc.
2440 Angus Lane
Lenoir, North Carolina 28645
SUBJECT: Compliance Evaluation Inspection
Second Creek Sand Mine &
Grants Creek -Sand Mine
N'6-@ES e m f NBC9;G52�-O►r009 5
NCG520106
Rowan County, NC
Dear Mr. Cassavaugh:
On December 19, 2017, Mr. Roberto Scheller of this Office conducted inspections at the subject
facilities. These inspections were conducted as Compliance Evaluation Inspections (CEI) to
insure compliance with permit requirements and conditions. We wish to thank you and your
staff for their assistance regarding these inspections.
The enclosed reports should be self-explanatory; however, should you have any questions,
please do not hesitate to contact myself of Roberto Scheller at [phone] or
[e-mail].
Sincerely,
e�.. W. Corey -Basinger, Regional Supervisor
-i1'" Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
Enclosure: Inspection Reports
cc: Wastewater Branch
File
State of North Carolina I Environmental Quality I Water Resources I Water Quality Regional Operations
Mooresville Regional Office) 610 East Center Avenue, Suite 3011 Mooresville, North Carolina 28115
704 663 1699

I
United States Environmental Protection Agency
r
Form Approved.
EPA Washington, D.C.20460
OMB No. 2040-0057
Water.Cot't'1pllance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 IN 2 u 3 I NCG520009 111 12 17/12/19 17
18 L C J 19 i G i 20I
211 1 1 1 1 J I I I I I I I I I I I I I I I I I I I I I I I
I I I I I I I I 1 1 1 1 1 t66
I
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA
— Reserved
67 70 I., � 71 I I 72 L N' j
LJ it l_I
73 I I 174 75 I_U80
Section B: Facility—Dlata
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES Permit Number)
10:10AM 17/12/19
16/06/24
Second Creek Sand Mine
Exit Time/Date
Permit Expiration Date
875 Hannah Ferry Rd
10:43AM 17/12/19
20/07/31
Salisbury NC 28144
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Officiallritle/Phone and Fax Number
Contacted
Ferry Rd Salisbury NC 28'144//704637-0419/
TeddyBledsoe,875 Hannah Fe
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers
Date
Roberto Schaller MRO WQ//252-946-6481/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
W. Corey Basinger MRO VVQ//704-235-2194/
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES
yr/mo/day
31 NCG520009 I11 12 17/12/19 17
Inspection Type
18, ,
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page#

Permit: NCG520009 Owner - Facility: Second Creek Sand Mine
Inspection Date: 12/19/2017 Inspection Type: Compliance Evaluation
Flow Measurement - Influent
Yes No NA NE
# Is flow meter used for reporting?
❑
❑
N
❑
Is flow meter calibrated annually?
❑
❑
0
❑
Is the flow meter operational?
❑
❑
M
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
011
Comment: In accordance with General Permit NCG520000 the
permittee shall estimate the
semi-annual flow during times of operation. The current permit is active and annual fees
have been paid for 2017.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑. ❑ E ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ 0 ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: This site has not been active for several years to allow sand to accumulate within dredge
area.
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
N
❑
application?
Is the facility as described in the permit?
N
❑
❑
❑
# Are there any special conditions for the permit?
❑
❑
E
❑
Is access to.the plant site restricted to the general public?
N
❑
❑
❑
Is the inspector granted access to all areas for inspection?
E
❑
❑
❑
Comment: If this site should become active and sand dredging operations resume, the Division of -
Water Resources. in the Mooresville Regional Office, should be notified.
Page# 3. ,

Water Resources
ENVIRONMENTAL QUALITY
Mr. Wayne Cassavaugh
Carolina Sand, Inc.
2440 Angus Ln
Lenoir, NC 28645
Dear Permittee:
PAT MCCRORY
DONALD R. VAN DER VAART
s.-o'ere,, I
S. JAY ZIMMERMAN
RECEIVED/NCDENR/MWR
June 2, 2016 j U N 10 2016
WQROS
MOORESVILLE REGIONAL OFFICE
Subject: Renewal of coverage / General Permit NCG520000
Second Creek Sand Mine
Certificate of Coverage NCG520009
Rowan County
The Division hereby renews Certificate of Coverage (CoC) NCG520009 to discharge under General
Permit NCG520000. This CoC is issued pursuant to the requirements of North Carolina General Statue
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 General 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, the 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. The Division may require modification or revocation and reissuance of the certificate of coverage.
Contact the Mooresville Regional Office prior to any sale or transfer of the permitted facility.
Regional Office staff will assist you in documenting the transfer of this CoC
This permit does not affect the legal requirements to obtain any other Federal, State, or Local
governmental permit that may be required.
If you have any questions concerning the requirements of the General Permit, please contact John
Hennessy [919 807-6307 or [e-mail]].
cc: Moo--resvillelRegionalCJfEc'e
NPDES file
for S. Jay Zimmerman,
Director, Division of Water Resources
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https:lldeq. nc. govlaboutldivisions/water-resources/water-resources-permitslwastewater-branchlnpdes-wastewater-permits

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG520000
CERTIFICATE OF COVERAGE NCG520009
DISCHARGE OF IN -STREAM SAND MINING WASTEWATER, ASSOCIATED STORMWATER
AND SIMILAR, DISCHARGES UNDER THE
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,
Carolina Sand, Inc.
is hereby authorized to discharge instream mining wastewater from.the following facility:
Second Creek Sand Mine
875 Hannah Ferry Rd
Salisbury
Rowan County
to receiving waters designated as the Yadkin River, a class WS-V stream in subbasin 03-07-04 of
the Yadkin -Pee Dee River Basin. All discharges shall be in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV
hereof.
This certificate of coverage shall become effective June 2, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 2, 2016
G
r
for ay Zimmerman, P.G.
irector, Division of Water Resources
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Alan W. Klimek, P.E., Director
July 26, 2002
WAYNE CASSAVAUGH
CAROLINA SAND COMPANY INCORPORATED
2440 ANGUS LN
LENOIR, NC 28645
Dear Permittee:
1�•
NCDENR-
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissue - NPDES Wastewater Discharge Permit
Carolina Sand Company Incorporated
COC Number NCG520009
Rowan County
In response to your renewal application for continued coverage under general' per t►it NCG520000,'tM Division of .
Water Quality (DWQ) is forwarding herewith the reissued wastewater general permit Certificate of Coverage
(COC). This COC is reissued pursuant to the requirements of North Carolina General Statute '1'43-2.!.1 and the
Memorandum_ of Agreement between the state of North Carolina and the, U:S. Environmental Protection A e c; ;__\
dated May 9, 1994 (or as subseluently amended).
The following information is included with your permit package: . .
* A copy of the Certificate of Coverage for your treatment facility
* A copy of General Wastewater Discharge Permit NCG520000
* A copy of a Technical Bulletin for General Wastewater Discharge Permit NCG520000
Your coverage under this general permit is not transferable except afternotice to DWQ. 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 DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule, standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Aisha Lau of the Central Office Stormwater
and General Permits Unit at [phone], ext. 578
Sincerely,
iv'c^ DEPT. C"-
for Alan W. Klimek, P.E.
f
JUL 3 1 2002
i
cc: Central Files
Stormwater & General Permits Unit Files
Mooresville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
An Equal Opportunity Affirmative Action Employer
Telephone [phone] FAX [phone]
50% recycled/ 10% post -consumer paper

_ ATMP
Environmental
Quality
October 21, 2015
Mr. Wayne Cassavaugh, Owner
Carolina Sand, Inc.
2440 Angus Lane
Lenoir, NC 28645
Subject: Compliance Evaluation Inspection
Carolina Sand - Hannah Ferry Road Site
Certificate of Coverage No. NCG520009
Rowan County
Dear Mr. Cassavaugh:
Enclosed is a copy of the Compliance Evaluation Inspection for the inspection conducted
at the subject facility on October 16, 2015 by Mr. Ori Tuvia. Your cooperation during the site
visit was much appreciated. Please advise any staff involved with this NPDES Permit of the
findings on this inspection by forwarding them a copy of the enclosed report.
As was discussed with your onsite representative Mr. Scott Allen, flow should be
monitored bi-annually as required by the subject permit. If no flow is present, then you should
indicate "No Flow" on the facility's monitoring report. Also please note that all permit records
should be kept for at least three years.
The attached report, should be self-explanatory; however, should you have any questions,
please do not hesitate to contact Mr. Tuvia at [phone], or via email at [e-mail].
Sincerely,
Michael Parker, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office, DWR
Enclosure: Inspection Report
CC: MSC 1617- Central files/Basement

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., -PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 IN 1 2 15 1 3 I NCG520009 I11 12 15/10/16 17 18 I C I 19 I G I 20I
21111:111111111111111111111111111111111111111 f6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA ----- Reserved----
67 10 70 Id I 71 �ti 72 n � 731 I 174 75
LJ I I I
80
Section B: FacilityDataLJ
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES Dermit Number)
10:30AM 15/10/16
12/08/01
Second Creek Sand Mine
Exit Time/Date
Permit Expiration Date
875 Hannah Ferry Rd
10:45AM 15/10/16
15/07/31
Salisbury NC 28144
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Scott Allen//828-312-7880 /
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Teddy Bledsoe,875 Hannah Ferry Rd Salisbury NC 28144//704-637=0419/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance E Facility Site Review
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ori A Tuvia MRO WQ//704-663-1699/
re f Management Q A evie Agency/Office/Phone and Fax Numbers Date
V/v 2-elL:
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type 1
31 Ncc520009I11 121 15/10/16 117 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page# 2
11

Permit: NCG520009 Owner -Facility: Second Creek Sand Mine
Inspection Date: 10/16/2015 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ ❑ E ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ E ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: The facility has not been in operation for the past five years.
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
E
❑
❑
❑
application?
Is the facility as described in the permit?
0
❑
❑
❑
# Are there any special conditions for the permit?
❑
E
❑
❑
Is access to the plant site restricted to the general public?
❑
❑
❑
Is the inspector granted access to all areas for inspection?
❑
❑
❑
Comment:
Flow Measurement - Influent
Yes No NA NE
# Is flow meter used for reporting?
❑
❑
0
❑
Is flow meter calibrated annually?
❑
❑
❑
Is the flow meter operational?
❑
❑
0
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
N
❑
Comment: no evidnce of discharge.
Page# 3

COMPLIANCE EVALUATION INSPECTION CHECKLIST
DATE: ORC:
ENTRY TIME:) NPDES PERMIT NO: NC00
EXIT TIME:. , p '1� FACILITY NAME: T ev �lz AJ
COUNTY:
NaET " TIi Ott SITE: 'GCO I 1 Cti- �C`v
PERMIT: EFFECTIVE DATE: EXPIRATION DATE:
.n.
FLOW MEASUREMENT: fiMSTANTANEOUS/CONiRNUOUS-RECORDING/TOTALIZER (IN PERMIT)
EFFLUENT/RECEIVING STREAM: STREAM NAME:
SLUDGE DISPOSAL: NON -DISCHARGE PERMIT #:(If Applicable
RECORD'IMEPING:
LABORATORY: CERTIFICATION (FIELD) #. (pH, TRC, DO, Temp., SS, Cond.)
OPERATION & MAINTENANCE/FACILITY SITE REVIEW:

SELF -MONITORING PROGRAM:
Sample Type (Composite or Grab)
DMR REVIEW: TIME PERIOD through

\o�0F vv n r FgPG
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Wayne Cassavaugh, Owner
Carolina Sand, Inc.
2440 Angus Lane
Lenoir, North Carolina 28645
Dear Mr. Cassavaugh:
Alan W. Klimek, P.E. Director
Division of Water Quality
Subject: Violations of G.S. 143-215.1 and
General Permit No. NCG520009
Compliance Evaluation Inspection
Carolina Sand, Inc./Rowan County Site
Rowan County, N.C.
Tracking No. NOV-2006-SP-0026
Chapter 143, Article 21 of the North Carolina General Statutes (G.S.) authorizes and
directs the Environmental Management Commission of this Department to protect and preserve
the water resources of the State. The Division of Water Quality has the delegated authority to
enforce adopted pollution control rules and regulations.
Enclosed please find copies of the Complaint Investigation and Compliance Evaluation
Inspection Reports for the inspection conducted on July 13, 2006 by Mr. Wes Bell of this office.
As a result of this inspection, the following conditions were found in violation of G.S. 143-215.:
and General Permit No. NCG520009:
The facility failed to monitor the effluent for settleable solids, turbidity, and flow
on fifteen (15) occasions from January 2004 through April 2006.
Please be advised that this report is being issued as a Notice of Violation (NOV) for the
violations of G.S. 143.215.1 and General Permit No. NCG520009. Also be advised that G.S.
143-215.6A provides for a civil penalty assessment of not more that twenty-five thousand
dollars ($25,000.00), or twenty-five thousand dollars ($25,000.00) per day when the violation is
of a continuing nature, against any person who fails to abide by the conditions of the permit (G.S.
143-215.1).
AMA N""o�rehCarolina
NCDENR Naturally
Mooresville Regional Office Division of Water Quality Phone [phone] Customer Service
Internet: www.newaterquality.org 610 East Center Ave, Suite 301 Mooresville, NC 28115 Fax [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

Mr. Wayne Cassavaugh
Notice of Violation
July 25, 2006
To comply with the regulations it will be necessary to comply with all permit monitoring
requirements (twice per year) during the appropriate discharge events (Spring and Fall). A copy
of the sampling documentation should be kept on -site for future review.
It is requested that you respond, in writing, to this Notice, indicating the actions you have
taken to ensure compliance with the monitoring requirements of the permit. Please address your
response to Mr. Bell by no later than August 15, 2006.
Should you have questions, please do not hesitate to contact Mr. Bell or me at (704) 663-
1699.
Sincerely,
/- n-'C' --I--
D. Rex Gleason, P.E.
Surface Water Protection Regional Supervisor
Attachment
cc: Rowan County Health Department
0_

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
SURFACE WATER PROTECTION UNIT
610 EAST CENTER AVENUE/SUITE 301
MOORESVILLE, NORTH CAROLINA 28115
REPORT OF: Complaint Investigation
DATE OF INVESTIGATION: July�13, 2006
,4
INVESTIGATED BY: Wes Belle TIME SPENT: 2.0 hours
PLACE VISITED: Carolina Sand, Inc./Rowan County -Dredging Site
PHYSICAL LOCATION: off Hannah's Ferry Road/Rowan County
REASON FOR VISIT: Investigation regarding illegal discharges of oil into the Yadkin River.
COPIES TO: Rowan County Health Department
REPORT:
On July 6, 2006, this office received a complaint regarding buried oil and diesel fuel
discharging into the Yadkin River from the Carolina Sand, Inc. dredging site off Hannah's Ferry
Road in Rowan County. Mr. Wes Bell of this office investigated the complaint on July 13, 2006.
Mr. Bell met with Mr. Ted Bledso, Site Manager, at the dredging site. No oil or diesel
fuel was observed discharging into the Yadkin River. Mr. Bledso indicated that there were no
underground storage tanks on -site and all equipment was refueled by a portable fuel tank.
The Division issued General Permit No. NCG520009 for this facility on August 1, 2002
(effective date) with an expiration date of July 31, 2007. The facility utilizes two sediment
basins in series prior to discharging into a tributary to the Yadkin River. The water within the
final settling basin did not appear turbid; however, the access to the outfall location was difficult
and needed maintenance. Mr. Bledso provided copies of chain of custody (COC) forms for
sampling events performed in April and September; however, the years were not documented.
Mr. Bell determined through conversations with the certified lab (Tri-Test) utilized by Mr.
Bledso that no samples had been collected and/or submitted for analysis since 2004. Note: Tri-
Test stores their data prior to 2004 at a separate storage facility; therefore, compliance with the
permit requirements was not determined from 2002 through 2004. Mr. Bledso performed the
effluent pH tests on -site; however, no flows had been measured as required by the Permit. The
facility had a total of fifteen (15) monitoring violations from January 2004 through April 2006.
Mr. Bell discussed the permit/regulatory requirements pertaining to the facility's General
Permit to Mr. Bledso and Mr. Wayne Cassavaugh, Owner. Mr. Bledso indicated that he would
contact the City of Salisbury's water/wastewater staff to assist him in future sampling events. A
follow-up investigation regarding compliance with the facility's General Permit may be
necessary by this office.

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Com pliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
I ri 2 I� 3I NCG520009--- —I 11 -12I-—06/07/13 117---- 181CI----19I SI 20I (-
Remarks
211111 (III (III IIIi 11111111111111111111111111111Li6
Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA --------------------------- Reserved ----------------------
67I 1.0 169 70 L 2 I 71 I N I 721 N I 73 L1J 74 751 I I I I I I 180
tl�—
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
Carolina Sand Company Incorporated
01:45 PM 06/07/13
02/08/01
Exit Time/Date
Permit Expiration Date
Hannah Ferry Rd
Salisbury NC 28144
02:15 PM 06/07/13
07/07/31
Name(s) of Onsite Rep resentative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Ted Bledso/Manager Site/704-637-0419 /
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Wayne Cassavaugh,2440 Angus Ln Lenoir NC
28645//704-872-9566/8287282992 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Operations & Maintenance Records/Reports ■ Self -Monitoring Program E Facility Site Review
Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signatures) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Wesley N Bell �. MRO WQ//704-663-1699 Ext.231/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
Delno R Gleason MRO WQ//704-663-1699 Ext.204/
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

Permit: NCG520009
Inspection Date: 07/13/2006
Laboratory
Are field parameters performed by certified personnel or laboratory?
Owner - Facility: Carolina Sand Company Incorporated
Inspection Type: Compliance Evaluation
Are all other parameters(excluding field parameters) performed by a certified lab?
# Is the facility using a contract lab?
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
Comment: The facility had not obtained a field laboratory certification to perform the
on -site effluent pH analyses. The facility staff have indicated that the City of Salisbury's
Grants Creek Regional WWTP Laboratory (#112) will be utilized for all future analyses
(including pH).
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
Comment: The facility failed to sample (twice per year) for effluent settleable solids,
turbidity, and flow from January 2004 through April 2006 (fifteen total violations).
Operations & Maintenance
Is the plant generally clean with acceptable housekeeping?
Yes No NA NE
❑ ■ ❑ ❑
®❑❑❑
❑❑■❑
❑❑■❑
Yes No NA NE
❑❑■❑
■❑❑❑
■❑❑❑
Cl ❑ ■ ❑
❑❑■❑
❑■❑❑
Yes No NA NE
■ ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑ ❑ ■ ❑
Judge, and other that are applicable?
Comment: The facility utilizes two sediment basins that are operated in series prior to
the effluent discharge. The water in the final sediment basin was not turbid. The facility
has not dredged since April 2006.
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment: The facility was not discharging at the time of the inspection. The
vegetation at and leading to the outfall location was excessive and needs to be
maintainedfremoved.
V.. un AIA MP
❑■❑❑
❑❑■❑
❑❑■❑
Page # 3

NCDENR 'VED
North Carolina Department of Environment a: C
E
Division of Water Quality1: IC
Michael F. Easley, Governor William G. Ross, Jr., Secretary
December 11, 2007
D EC C olen Wrllins, Director
Wayne Cassavaugh IBC DENR MR®
Carolina Sand Company, Inc.
2440 Angus Ln �A�
Lenoir, NC 28645 M-Surface Water Protection
Subject: Renewal of coverage / General Permit NCG520000
Rowan County site � 5'ec0 `W C /LeE/G X*%io
Certificate of Coverage NCG520009
Rowan County
Dear Permittee:
In accordance with your renewal application [received on February 2, 20071, the Division is renewing
Certificate of Coverage (CoC) NCG520009 to discharge under NCG520000. This CoC is issued pursuant to
the requirements of North Carolina General Statue 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 General 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, the 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. The Division may require modification or revocation and reissuance of the certificate of coverage.
Contact the Mooresville Regional Office prior to any sale or transfer of the permitted facility.
Regional Office staff will assist you in documenting the transfer of this CoC.
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 the requirements of the General Permit, please contact Bob
Guerra [919 733-5083, extension 539 or bob. g�[e-mail]] or Susan Wilson [919 733-5083, extension
510 or [e-mail].
Sincerely,
for Coleen H. Sullins
cc: Central Files
NPDES file
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
512 North Salisbury Street, Raleigh, North Carolina 27604 NofthCarolina
Phone: [phone] / FAX [phone] / Internet: www.ncwaterquality.org ;Vaturally
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG520000
"CERTIFICATE OF COVERAGE NCG520009
DISCHARGE OF INSTREAM MINING WASTEWATER, ASSOCIATED STORMWATER AND
,SIMILAR DISCHARGES UNDER THE
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,
Carolina Sand Company, Inc.
is hereby authorized to discharge instream mining wastewater from the following facility:
Rowan County site
875 Hannah Ferry Road
Salisbury
Rowan County
to receiving waters designated as the Yadkin River, a class WS-V stream in subbasin 03-07-04 of
the Yadkin -Pee Dee River Basin. All discharges shall be in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV
hereof.
This certificate' of coverage shall become effective December 11, 2007.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 11, 2007.
r-
for Coleen. H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

PF-
PI
State of North Carolina
Department of Environment
s, and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Mr. Wayne Cassavaugh
Carolina Sand Company
2440 Angus Lane
Lenoir, North Carolina 28645
Dear Mr. Cassavaugh:
NG NR
February 12, 1999
t"r 21. J1- 1;n�13
Subject: Permit Modification -Name and
Ownership Change
Carolina Sand Company
Permit No. NCG520009
(formerly American Concrete Products)
Rowan County
In accordance with your request received January 20, 1999, the Division is forwarding the subject
permit. The changes in this permit are only with regard to a name and an ownership. All other terms and
conditions in the original permit remain unchanged and in full effect. This permit modification is issued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of
Agreement between North Carolina and the U. S. Environmental Protection Agency dated December 6,
1983.
This permit does not affect the legal requirement 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 government permit that may be required. .
If you have any questions concerning this permit, please contact Ms. Vanessa Wiggins at telephone
number [phone], extension 520.
Sincerely,
�MA. Preston Howard, Jr., P.E.
cc: Central,Files- �;
Dore v l e?�Reg7 ria1®ff ce, .' 50-b it udl- Sectiow
Stormwater and General Permits Unit
Point Source Compliance Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG520000
CERTIFICATE OF COVERAGE NO. NCG520009
TO DISCHARGE SAND DREDGING WASTEWATER AND SIMILAR WASTEWATERS UNDER
THE
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,
Carolina Sand Company, Inc.
is hereby authorized to operate a treatment system consisting of a sediment basin and discharge channel
with the discharge of treated wastewater from a facility located at
Carolina Sand Company, Inc.
Hannah Ferry Road
Salisbury
Rowan County
to receiving waters designated as the Yadkin River in the Yadkin - Pee Dee River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts
I, II, III and IV hereof.
This certificate of coverage shall become effective February 12, 1999.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 12, 1999.
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
IDIS
g�ESo�I C S AND
�M�Ii�dITY DEtitELOP1ViEP1T
MAY a 7 1993
Andy Stankwytch IM11%1% 6F E�VIR�itllEkin g'-.'L11FK
P O Box 1835 '150 tES111LI liP�041 BUICE
Statesville, NC 28687
Dear Mr. Stankwytch:
A.4�j
[DEHNR
May 25 1993
Subject: General Permit No. NCG520000
American Concrete Products, Inc.
COC NCG0520009.
Rowan County
In accordance with your application for discharge permit received on February 2, 1993, we are
forwarding herewith the subject certificate of coverage to discharge under the subject state - NPDES general
permit. Issuance of this certificate of coverage supercedes the individual NPDES permit No. NC0048682.
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
December 6, 1983.
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 Environmental Management. The Division of Environmental Management 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 Environmental Management 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 Ms. Susan Robson at telephone number
919/733-5083.
Sincerel
Original Seed BY
coleen K Sal"s
A. Preston Howard, Jr.
Director
cc: �q�y i
4 f . ^-'�v.eYl - 1gi' .' w i1 f
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/'10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOUR'��EVE On
DIVISION OF ENVIRONMENTAL MANAGEMENT lKo
GENERAL PERMIT NO. NCG520000 0 Bf
CERTIFICATE OF COVERAGE NO. NCG5200
TO DISCHARGE SAND DREDGING WASTEWATER AND SIMILIAR WASTEWATERS UNDER
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,
American Concrete Products, Inc.
is hereby authorized to continue operation of a treatment system consisting of settling and/or screening for sand
dredging or similar operations with the discharge of treated wastewater from a facility located at
NCSR 1926
north of Ellis Crossroads
Rowan County
to receiving waters designated as the Yadkin River in the Yadkin/Pee-Dee River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, H, III
and IV of General Permit No. NCG520000 as attached.
This certificate of coverage shall become effective May 25, 1993
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day May 25, 1993
Co Origina Sy
fined
. �ulGns
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

AM kAftli
UNITED STATES
DEPARTMENT OF THE INTERIOR
GEOLOGICAL SURVEY 0741J.
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To: Permits and Engineering Unit
Water Quality Section
Attention: Susan Robson
SOC PRIORITY PROJECT: Yes
If Yes, SOC No. N/A
Date: March 11, 1993
NPDES STAFF REPORT AND RECOMMENDATIONS
County: Rowan
NPDES Permit No.: NCO048682
MRO No.: 93-38
PART I - GENERAL INFORMATION
1. Facility and Address: American Concrete Products, Inc.
Post Office Box 1835
Statesville, N.C. 28687
2. Date of Investigation: March 8, 1993
3. Report Prepared By: Michael L•. Parker, Environ. Engr. II
4. Person Contacted and Telephone Number: Andy Stankwytch,
[phone]
5. Directions to Site: From the junction of SR.1915 (E. Ridge
Road) and Hwy. 601, travel east on SR 1915 2.0 miles to the
junction with SR 1910 (Old Mocksville Road). Turn left on SR
1910 and travel 0.6 miles to the junction with SR 1926
(Hannah Ferry Road). Turn right on SR 1926 and travel 0.9
mile. The entrance to the American Concrete Products site
will be on the right side of SR 1926.
6. Discharge Point(s),,List for all discharge Points: -
Latitude: 350 44' 38"
Longitude: 800 2738"
Attach a USES Map Extract and indicate treatment plant site
and discharge.point on map.
USES Quad No.: E 17 NW
7. Site size and expansion area consistent with application:
Yes. If No, explain.
8. Topography (relationship to flood plain included): This
site lies adjacent to the Yadkin River, and appears to be
within the 100 year flood plain.
9. Location of Nearest Dwelling: No dwelling exists within 500
feet of the site.

r
i
c
0
Page Two
10. Receiving Stream or Affected Surface Waters: Yadkin River
a. Classification: WS-III
b. River Basin and Subbasin No.: Yadkin 0.30704
C. Describe receiving stream features and pertinent
downstream uses: Excellent flow in the receiving
stream at the point of discharge. The area surrounding
this facility is generally rural. Downstream uses are
for secondary recreation, however, High Rock Lake
begins approx. 4.0 miles downstream and is used for
primary recreation with frequent bodily contact.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of Wastewater: * MGD (Design Capacity.)
b. What is the current permitted capacity: *
* Flow is dependant on the amount of dredging that
occurs, which is dependant on consumer demand.
C. Actual treatment capacity of current facility (current
design capacity): unknown
d. Date(s) and construction activities allowed by previous
ATCs issued in the previous two years: NIA
e. Description of existing or substantially constructed
WWT facilities: The existing WWT facilities consist of
two (2) settling basins connected in series.
f. Description of proposed 14WT facilities: N/A
g. Possible toxic impacts to surface waters: None
expected.
h. Pretreatment Program (POTWs only): N/A
2. Residual handling and utilization/disposal scheme:
a. If residuals -are being land applied specify DEM Permit
No. N/A.
Residuals Contractor: N/A
Telephone No. N/A
b. Residuals stabilization: N/A
C. Landfill: N/A
d. Other disposal/utilization scheme (specify): Settled
solids are removed as needed and stockpiled on -site.
3. Treatment Plant Classification: Less than 5 points; no
rating (include rating sheet). This facility does not meet
the minimum criteria for a class I rating.

Page Three
4. SIC Code(s): 1422
Wastewater Code(s):
Primary: 43
Secondary:
5. MTU Code(s): 50000
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant
Funds or are any public monies involved (municipals only)?
No
2. Special monitoring or limitations (including toxicity)
requests: None at this time.
3. Important SOr_./JOC or Compliance Schedule dates: N/A
4. Alternative Analysis Evaluation: N/A
a. Spray Irrigation:
b. Connect to regional sewer system:
c . Subsurface:
d. Other disposal options:
PART IV - EVALUATION AND RECOMMENDATIONS
The permittee requests renewal of the subject Permit.
Discharges do not occur at this facility except when dredging is
taking place or during rainfall events. Dredging activity
generally coincides with consumer demand or when existing
stockpiles need replenishing.
This facility qualifies for coverage under a General Permit.
It is recommended that the NPDES Permit for this be renewed.
Si nature of eport Preparer Date
D ��y
Water Quality k4gional Supervisor Date

AM "A Codtl9f ?EuD&lj
' - UNITED STATES
L DEPARTMENT OF THE INTERIOR
GEOLOGICAL SURVEY
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TURAL
I �, n
�'n�. off' PP!i __vri �9
1r�
.04
IB 1. 9 1995
EiiVI�OF?f,M1Et+T�I.
State of North Carolina 69�0�taS��LIE REB-9q,fiFICE
1 Department of Environment, Health and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27604
James B. Hunt, Jr., Governor
February 15, 1993
Andy Stankwytch Subject :
American Concrete Products, Inc.
P.O. Box 1835
Statesville, NC 28687
Dear Mr. Stankwytch
Jonathan B. Howes,- Secretary .
NPDE'S Permit Application
NPDES Permit No . NC0048.682
Rowan
Countv
This is to acknowledge receipt of the following documents on February 2, 1993:
Application Form
Engineering Proposal (for proposed control facilities),
Request for permit renewal,
Application Processing Fee of $300.00,
Engineering Economics Alternatives Analysis,..
Local Government Signoff,
Source Reduction and Recycling,
Interbasin Transfer,
Other Request for coverage under a general permit is under consideration.,
The items checked below are needed before review can, begin:
Application Form ,
Engineering proposal (sea attachment),
Application Processing Fee of _
Delegation of Al.ithority (see attached).
Biocide Sheet (see at4:ached)
Engineering Economics Alternatives Analysis,
Local Government Signoff,
Source Reduction and Recycling,
Interbasin Transfer,
Other
Pollution Prevention Pays
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

If the application is not made complete within thirty (30) days, it will be
returned to you and may be resubmitted when -complete.
This application has been assigned to Susan Robson
(919/733-5083) of our Permits Unit for review. You wiii be advised of any_
comments recommendations, questions or other information necessary for the
review of the application.
I am, by copy of this letter, _requesting that our Regional Office
Supervisor prepare a staff report and recommendations regarding this
discharge. If you have any questions regarding this applications,
please contact the review person listed above.
Sincerely,
'
1
CC: Mooresville Regional Office COleen H. Sullins, P.E.

NORTH CAROLINA DEPT. OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT, P.O. BOX 27687, RALEIGH, NC 27611
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM C FOR
AGENCY
USE
To be filed only by persons engaged in manufacturing and mining
Do not attempt to complete this form before reading accompanying instructions
Please print or type
APPLICATION NUMBER
DATE RECEIVED
3 1
o 2- D I Z.
YEAR M0. DAY
Cii�,!O3s'D32.
� 3oo.aa
1. Name, address, location, and tele/h one number of facility producing discharge
A. Name C—
B. Mailing address
1. Street address Q
2. City 3. State Vc-.
4. County-�TLenE�� 5. IIP _ Z&S 97
C. Location:
1. Street - 1714At 19-H
2. City �,gc158u2c� 3. County POLJ4A%
4. State .c-
D. Teleohone No 1_4 97_Z
Area n
Code
2. SIC
(Leave blank)
3. Number of employees `Y
If all your waste is discharged into a publicly owned waste treatment facility
and to the best of your knowledge you are not required to obtain a discharge
permit, proceed to item 4. Otherwise proceed directly to item 5.
4. If you meet the condition stated above, check heret7 and supply the information y
asked for below. After completing these items, please complete the date, title,
and signature blocks below and return this form to the proper reviewing office-''
without completing the remainder of the form.
A. Name of organization responsible for receiving waste
B. Facility receiving waste:
1. Name
2. Street address
3. City 4. County
5. State 6. 21P
5. 0 Principal product, (raw material (Check one)
1i. Principal process Z,aNm' DRCFZDG /NG
7. Maximum amount of principal product produced or raw material consumed per (Check one)
Amount
Basis 1-99
100-199
200-499
500-999
1000- 5000-
10,000- 50,000
4999 9999
49.999 or more
(1)
(2)
(3)
(�)
(5) (5)
(1) (B)
A. pay
S. Month
C, Year
PREVIOUS EDITION MAY of USED UNTIL SUPPLY IS ExNAuiTED

It. Mn><Im.im aeuarnl of principal prnrlurl. prrallnr•d o► raw alnlr•rl.rl r
irar•.rwr.l, reyairl.•.I
n I Lem / above 1s
Ireasur"u in KhULk une):
A. a pounds 8 .ions C. 0 barre Is D. 0 bushels E. a square feet
F.0 gallons G.0 pieces or units M.0_other, specify
9. (a) Check here if discharge occurs all year )'�(, or
(b.) Check the month(s) discharge occurs:
1.0 January 2.0 February 3. a Marcn 4.0 Apri 1 5.0 May 6.0 June
7.0 July 8.0 August 9.0 September 10.0 October 11.0 November
(c) Check how many days per week: 1.01 2.o2-3 3.m.4-5 4.06-7
10. Types of waste water discharged to surface waters only (check as applicable)
F low, gallons per operating day
Discharge per
operating day
0.1-999
1000-4999 5000-9999 10,000-
49,999
(1)
(2) (3) (4)
A_ Sanitary, daily
N�/1
average
8. Cooling water, etc.
daily
N�A
average
C. Process water,
daily average
1. Maximum per operat-
ing day for total
r
discharge (all types)
I
12.13 December
Volume treated before
discharging (percent)
50,000- None 0.1- 30- 65- 95-
or more 29.9 64.9 94.9 100
(5) (6) (7) (8) (9) (10)
11. If any cf Lila three types of waste identified in Item 10. either treated or untreated•
are discharged to places other thar. surface water., checl, below as applicable_
Average flaw. oallons Der oneratine day
w a]lC--
discharged to: 0.1-999
(1)
1000-4999
(2)
5000-9999
(3)
10,00049.999
(4)
50,000 or more
(5)
A. Municipal sewer system
B. Underground well
C. Septic tangy
D. Evaporation lagoon or pond
E. Otner, specify
rc. numoer or separate discharge points: A.Kl 8.02-3 C.04-5 0.a6 or more
13. Name of receiving water or waters - VPKLN 7[It/��1
14. Does your discharge contain or is it possible for your discharge to contain
one or more of the following substances added as a result of your operations,
activities, or processes: ammonia, cyanide. aluminum, beryllium, cadmium,
chromium, copper. lead, mercury, nickel, selenium,, phenols, oil and
.grease. and chlorine (residual). A.0 yes B. no
I certify that I am familiar with the information contained in the application and
that to the best of my knowledge and belief such information is true, complete, and
accurate.
Printed Name of PefsDn Signing Title
/ - 2-7- 5 3
11,
Date Application Signed -
Signature oaf Appt•y%;ant
North Carolina General Statute 143-215.6 b 2provides that: Any person who knowingly makes
any false statement representation, or certification in any application, record, report, plan,
or other document files or required to be maintained under Article 21 or regulations of the
Environmental Management Commission implementing that Article, or vho falsifies, tampers with,
or knowly renders inaccurate any recording or monitoring device or method required to .be
operated or maintained under Article 21 or regulations of the Environmental Management Commissit
implementing that Article, shill be guilty of a misdemeanor pumishable by a ::ine not to exceed
$10,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provic
a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both,
for a similar offense.)

Is
C. DEPT. OF NATURAL
RESOURCES AND
�! I COMMUNITY DEVELOPMENT
l S F EB 1 91992
State of North Carolina DIVISION OF ERVIRlINVENT41 VAVUEMENT
Department of Environment, Health and Natural l��urcues REGIONAL OFFICE
Division of Environmental Management
512 North Salisbury Street - Raleigh, North Carolina 27611
James G. Martin, Governor George T. Everett, Ph.D
William W. Cobey, Jr., Secretary Director
Andy Stankwytch
P. O. Box 288
Statesville, NC 28677
Dear Mr. Stankwytch:
February 14, 1992
Subject: NPDES Permit No. NCO048682
American Concrete Products, Inc.
Rowan County
In accordance with your application for discharge permit received on August 21, 1991, we
are forwarding herewith the subject state - NPDES 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 December 6,1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within
thirty (30) days following receipt of this letter. This request must be in the form of a written
petition, conforming to Chapter 150B of the North Carolina General Statutes, and filed with the
Office of Administrative Hearings, Post Office Drawer 27447, Raleigh, North Carolina 27611
-7447. Unless such demand is made, this decision shall be final and binding.
Please take notice this permit is not transferable. Part II, E.4. addresses the requirements to
be followed in case of change in ownership or control of this discharge.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Environmental Management 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 Mr. Randy Kepler at
telephone number 9191733-5083.
Sincerely,
s %pwd by
Dah 0—owm A for
George T. Everett
cc: Mr. Jim Patrick, EPA
l eiRgrr lOffii)
Pollution Prevention Pays
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

Permit No. NCO048682
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESC NJ"M&.
DIVISION OF ENVIRONMENTAL MANAGEMENT Cp REsoURc�s aNn��L
MMUNITY DBVLLOPRIENT
PERMIT
TO DISCHARGE WASTEWATER UNDER THE FEB 1 91992
DF ENV(RONHENTAt MANAGEMENF
`SVIL[E REGIDNAI OFFICE
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,
American Concrete Products, Inc.
is hereby authorized to discharge wastewater from a facility located at
American Concrete Products, Inc.
Hannah Ferry Rd. (Pump Station Rd.)
Salisbury, NC
Rowan County
to receiving waters designated as Yadkin River.in the Yadkin -Pee Dee River Basin
in accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts I, II, and III hereof.
This permit shall become effective April 1, 1992
This permit and the authorization to discharge shall expire at midnight on July 31, 1993
Signed this day February 14, 1992
pA for
George T. Everett, Director
Division of Environmental Management
By Authority of the Environmental Management Commission

Permit No. NC0048682
SUPPLEMENT TO PERMIT COVER SHEET
American Concrete Products, Inc.
is hereby authorized to:
1. Continue to operate two settling basins in series located at American Concrete Products, Inc.,
Hannah Ferry Rd. (Pump Station Rd.), Salisbury, NC, Rowan County (See Part III of this
Permit), and
2. Discharge from said treatment works at the location specified on the attached map into Yadkin
River which is classified Class WS-III and B waters in the Yadkin -Pee Dee River Basin.

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A. (). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS FINAL Permit No. NCO048682
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is authorized to discharge from
outfall(s) serial number 001. Such discharges shall be limited and monitored by the permittee as specified below:
Effluent Characteristics
Flow
Settleable Solids
Turbidity
Discharge Limitations Monitoring Requirements
Lbs/day. Units (specify) Measurement Sample
'Sample
Mon. Avg. Daily Max Mon. Avg. Daily Max. Frequency Type Location
0.1 ml/I 0.2 ml/I
,
** The discharge shall not cause the turbidity of the receiving water to exceed 50 NTU. If the turbidity exceeds these levels due to natural
background conditions, the discharge level cannot cause any increase in the turbidity in the receiving water.
Sticks, leaves, and other debris removed on shore shall not be returned to the surface waters of the State.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

PART
Section B. Schedule of Compliance
1. The permittee shall comply with Final Effluent Limitations specified for discharges in
accordance with the following schedule:
Permittee shall comply with Final Effluent Limitations by the effective date of the
permit unless specified below.
2. Permittee shall at all times provide the operation and maintenance necessary to operate the
existing facilities at optimum efficiency.
3. No later than 14 calendar days following a date identified in the above schedule of
compliance, the pemuttee shall submit either a report of progress or, in the case of specific
actions being required by identified dates, a written notice of compliance or noncompliance.
In the latter case, the notice shall include the cause of noncompliance, any remedial actions
taken, and the probability of meeting the next schedule requirements.

Part II
Page 1 of 14
PART II
STANDARD CONDITIONS FOR NPDES PERMITS
SECTION A. DEFINITIONS
1. Permit Issuing Authority
The Director of the Division of Environmental Management.
Means the Division of Environmental Management, Department of Environment, Health
and Natural Resources.
3. EMMC
Used herein means the North Carolina Environmental Management Commission.
4. Act or "the Act"
The Federal Water Pollution Control Act, also known as the Clean Water Act, as amended,
33 USC 1251, et. seq.
5. Mass/Day Measurements
a. The "monthly average discharge" is defined as the total mass of all daily discharges
sampled and/or measured during a calendar month on which daily discharges are
sampled and measured, divided by the number of daily discharges sampled and/or
measured during such month. It is therefore, an arithmetic mean found by adding the
weights of the pollutant found each day of the month and then dividing this sum by the
number of days the tests were reported. The limitation is identified as "Monthly
Average" in Part I of the permit.
b. The "weekly average discharge" is defined as the total mass of all daily discharges
sampled and/or measured during the calendar week (Sunday - Saturday) on which daily
discharges are sampled and measured, divided by the number of daily discharges
sampled and/or measured during such week. It is, therefore, an arithmetic mean found
by adding the weights of pollutants found each day of the week and then dividing this
sum by the number of days the tests were reported. This limitation is identified as
"Weekly Average" in Part I of the permit.
c. The "maximum daily discharge" is the total mass (weight) of a pollutant discharged
during a calendar day. If only one sample is taken during any calendar day the weight
of pollutant calculated from it is the "maximum daily discharge." This limitation is
identified as 'Daily Maximum," in Part I of the permit.

Part lI
Page 2 of 14
d. The "average annual discharge" is defined as the total mass of all daily discharges
sampled and/or measured during the calendar year on which daily discharges are
sampled and measured, divided by the number of daily discharges sampled and/or
measured during such year. It is, therefore, an arithmetic mean found by adding the
weights of pollutants found each day of the year and then dividing this sum by the
number of days the tests were reported. This limitation is defined as "Annual Average"
in Part I of the permit.
6. Concentration Measurement
a. The "average monthly concentration," other than for fecal coliform bacteria, is the sum
of the concentrations of all daily discharges sampled and/or measured during a calendar
month on which daily discharges are sampled and measured, divided by the number of
daily discharges sampled and/or measured during such month (arithmetic mean of the
daily concentration values). The daily concentration value is equal to the concentration
of a composite sample or in the case of grab samples is the arithmetic mean (weighted
by flow value) of all the samples collected during that calendar day. The average
monthly count for fecal coliform bacteria is the geometric mean of the counts for
samples collected during a calendar month. This limitation is identified as "Monthly
Average" under "Other Units" in Part I of the permit.
b. The "average weekly concentration," other than for fecal coliform bacteria, is the sum
of the concentrations of all daily discharges sampled and/or measured during a calendar
week (Sunday/Saturday) on which daily discharges are sampled and measured divided
by the number of daily discharges sampled and/or measured during such week
(arithmetic mean of the daily concentration values). The daily concentration value is
equal to the concentration of a composite sample or in the case of grab samples is the
arithmetic mean (weighted by flow value) of all, the samples collected during that
calendar day. The average weekly count for fecal coliform bacteria is the geometric
mean of the counts for samples collected during a calendar week. This limitation is
identified as "Weekly Average" under "Other Units" in Part I of the permit.
c. The "maximum daily concentration" is the concentration of a pollutant discharge during
a calendar day. If only one sample is taken during any calendar day the concentration
of pollutant calculated from it is the "Maximum Daily Concentration". It is identified
as 'Daily Maximum" under "Other Units" in Part I of the permit.
d. The "average annual concentration," other than for fecal coliform bacteria, is the sum of
the concentrations of all daily discharges sampled and/or measured during a calendar
year on which daily discharges are sampled and measured divided by the number of
daily discharges sampled and/or measured during such year (arithmetic mean of the
daily concentration values). The daily concentration value is equal to the concentration
of a composite sample or in the case of grab samples is the arithmetic mean (weighted
by flow value) of all the samples collected during that calendar day . The average
yearly count for fecal coliform bacteria is the geometric mean of the counts for samples
collected during a calendar year.
e. The "daily average concentration" (for dissolved oxygen) is the minimum allowable
amount of dissolved oxygen required to be available in the effluent prior to discharge
averaged over a calendar day. If only one dissolved oxygen sample is taken over a
calendar day, the sample is considered to be the "daily average concentration" for the
discharge. It is identified as "daily average" in the text of Part I.

Part II
Page 3 of 14
f. The "quarterly average concentration" is the average of all samples taken over a
calendar quarter. It is identified as "Quarterly Average Limitation" in the text of Part I
of the permit.
g. A calendar quarter is defined as one of the following distinct periods: January through
March, April through June, July through September, and October through December.
7. Other Measurements
a. Flow, (MGD): The flow limit expressed in this permit is the 24 hours average flow,
averaged monthly. It is determined as the arithmetic mean of the total daily flows
recorded during the calendar month.
b. An "instantaneous flow measurement" is a measure of flow taken at the time of
sampling, when both the sample and flow will be representative of the total discharge.
c. A "continuous flow measurement" is a measure of discharge flow from the facility
which occurs continually without interruption throughout the operating hours of the
facility. Flow shall be monitored continually except for the infrequent times when
there may be no flow or for infrequent maintenance activities on the flow device.
a. Composite Sample: A composite sample shall consist of:
(1) a series of grab samples collected at equal time intervals over a 24 hour period of
discharge and combined proportional to the rate of flow measured at the time of
individual sample collection, or
(2) a series of grab samples of equal volume collected over a 24 hour period with the
time intervals between samples determined by a preset number of gallons passing
the sampling point. Flow measurement between sample intervals shall be
determined by use of a flow recorder and totalizer, and the present gallon interval
between sample collection fixed at no greater than 1/24 of the expected total daily
flow at the treatment system, or
(3) a single, continuous sample collected over a 24 hour period proportional
to the rate of flow.
In accordance with (1) above, the time interval between influent grab samples shall be
no greater than once per hour, and the time interval between effluent grab samples shall
be no greater .than once per hour except at wastewater treatment systems having a
detention time of greater than 24 hours. In such cases, effluent grab samples may be
collected at time intervals evenly spaced over the 24 hour period which are equal in
number of hours to the detention time of the system in number of days. However, in
no case may the time interval between effluent grab samples be greater than six. (6)
hours nor the number of samples less than four (4) during a 24 hour sampling period.
b. Grab Sample: Grab samples are individual samples collected over a period of time not
exceeding 15 minutes; the grab sample can be taken manually.
9. Calculation of Means
a Arithmetic Mean: The arithmetic mean of any set of values is the summation of the
individual values divided by the number of individual values.

Part II
Page 4 of 14
b. Geometric Mean: The geometric mean of any set of values is the Nth root of the
product of the individual values where N is equal to the number of individual values.
The geometric mean is equivalent to the antilog of the arithmetic mean of the logarithms
of the individual values. For purposes of calculating the geometric mean, values of
zero (0) shall be considered to be one (1).
c. Weighted by Flow Value: Weighted by flow value means the summation of each
concentration times its respective flow divided by the summation of the respective
flows.
10. Calendar Day
A calendar day is defined as the period from midnight of one day until midnight of the next
day. Howevei, for purposes of this permit, any consecutive 24-hour period that
reasonably represents the calendar day may be used for sampling.
11. Hazardous Substance
A hazardous substance means any substance designated under 40 CFR Part 116 pursuant
to Section 311 of the Clean Water Act.
12. Toxic Pollutant
A toxic pollutant is any pollutant listed as toxic under Section 307(a)(1) of the Clean Water
Act.
SECTION B. GENERAL CONDITIONS
1. Duty to Comply
The permittee must comply with all conditions of this permit. Any permit noncompliance
constitutes a violation of the Clean Water Act and is grounds for enforcement action; for
permit termination, revocation and reissuance, or modification; or denial of a permit
renewal application.
a. The permittee shall comply with effluent standards or prohibitions established under
section 307(a) of the Clean Water Act for toxic pollutants and with standards for
sewage sludge use or disposal established under section 405(d) of the Clean Water Act
within the time provided in the regulations that establish these standards or
prohibitions, even if the permit has not yet been modified to incorporate the
requirement.
b. The Clean Water Act provides that any person who violates a permit condition is
subject to a civil penalty not to exceed $25,000 per day for each violation.
Any person who negligently violates any permit condition is subject to criminal
penalties of $2,500 to $25,000 per day of violation, or imprisonment for not more than
1 year, or both. Any person who knowingly violates permit conditions is subject to
criminal penalties of $5,000 to $50,000 per day of violation, or imprisonment for not
more than 3 years, or both. Also, any person who violates a permit condition may be
assessed an administrative penalty not to exceed $10,000 per violation with the
maximum amount not to exceed $125,000. [Ref: Section 309 of the Federal Act 33
U.S.C. 1319 and 40 CFR 122.41 (a)]

Part II
Page 5 of 14
c. Understate law, a daily civil penalty of not more than ten thousand dollars ($10,000)
per violation may be assessed against any person who violates or fails to act in
accordance with the terms, conditions, or requirements of a permit. [Ref: North
Carolina General Statutes § 143-215.6 (a)]
The permittee shall take all reasonable steps to minimize or prevent any discharge in
violation of this permit which has a reasonable likelihood of adversely affecting human
health or the environment.
3. Civil and Criminal Liability
Except as provided in permit conditions on "Bypassing" (Part II, CA.) and "Power
Failures" (Part II, C.7.), nothing in this permit shall be construed to relieve the permittee
from any responsibilities, liabilities, or penalties for noncompliance pursuant to NCGS
143-215.3, 143-215.6 or Section 309 of the Federal Act, 33 USC 1319. Furthermore, the
permittee is responsible for consequential damages, such as fish kills, even though the
responsibility for effective compliance may be temporarily suspended.
Nothing in this permit shall be construed to preclude the institution of any legal action or
relieve the permittee from any responsibilities, liabilities, or penalties to which the permittee
is or may be subject to under NCGS 143-215.75 et seq. or Section 311 of the Federal Act,
33 USG 1321. Furthermore, the permittee is responsible for consequential damages, such
as fish kills, even though the responsibility for effective compliance may be temporarily
suspended.
The issuance of this permit does not convey any property rights in either real or personal
property, or any exclusive privileges, nor does it authorize any injury to private property or
any invasion of personal rights, nor any infringement of Federal, State or local laws or
regulations.
6. Onshore or Offshore Construction
This permit does not authorize or approve the construction of any onshore or offshore
physical structures or facilities or the undertaking of any work in any navigable waters.
7. Severability
The provisions of this permit are severable, and if any provision of this permit, or the
application of any provision of this permit to any circumstances, is held invalid, the
application of such provision to other circumstances, and the remainder of this permit, shall
not be affected thereby.

Part II
Page 6 of 14
The permittee shall furnish to the Permit Issuing Authority, within a reasonable time, any
information which the Permit Issuing Authority may request to determine whether cause
exists for modifying, revoking and reissuing, or terminating this permit or to determine
compliance with this permit. The permittee shall also furnish to the Permit Issuing
Authority upon request, copies of records required to be kept by this permit.
If the permittee wishes to continue an activity regulated by this permit after the expiration
date of this permit, the permittee must apply for and obtain a new permit.
10. Expiration of Permit
The permittee is not authorized to discharge after the expiration date. In order to receive
automatic authorization to discharge beyond the expiration date, the permittee shall submit
such information, forms, and fees as are required by the agency authorized to issue permits
no later than 180 days prior to the expiration date. Any discharge that has not requested
renewal at least 180 days prior to expiration, or any discharge that does not have a permit
after the expiration and has not requested renewal at least 180 days prior to expiration, will
subject the permittee to enforcement procedures as provided in NCGS 143-215.6 and 33
USC 1251 et. seq.
11. Signatory Requirements
All applications, reports, or information submitted to the Permit Issuing Authority shall be
signed and certified.
a. All permit applications shall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this
Section, 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 or 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.
b. All reports required by the permit and other information requested by the Permit Issuing
Authority shall be signed by a person described above or by a duly authorized
representative of that person. A person is a duly authorized representative only if:
p) The authorization is made in writing by a person described above;
(2) The authorization specified either an individual or a position having responsibility
for the overall operation of the regulated facility or activity, such as the position of
plant manager, operator of a well or well field, superintendent, a position of

Part II
Page 7 of 14
equivalent responsibility, or an individual or position having overall responsibility
for environmental matters for the company. (A duly authorized representative may
thus be either a named individual or any individual occupying a named position.);
and
(3) The written authorization is submitted to the Permit Issuing Authority.
c. Certification. Any person signing a document under paragraphs a. or b. of this section
shall make the following certification:
"I certify, under penalty of law, that this document and all attachments were prepared
under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gather and evaluate the information submitted. Based on
my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of
my knowledge and believe, true, accurate, and complete. I am aware that there are
significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
12. Permit Actions
This permit may be modified, revoked and reissued, or .terminated for cause.The filing of a
request by the permittee for a permit modification, revocation and reissuance, or
termination, or a notification of planned changes or anticipated noncompliance does not
stay any permit condition.
13. Permit Modification. Revocation and Reissuance, or Termination
The issuance of this permit does not prohibit the permit issuing authority from reopening
and modifying the permit, revoking and reissuing the permit, or terminating the permit as
allowed by the laws, rules, and regulations contained in Title 40, Code of Federal
Regulations, Parts 122 and 123; Title 15A of the North Carolina Administrative Code,
Subchapter 2H .0100; and North Carolina General Statute 143-215.1 et. al.
14. Previous Permits
The exclusive authority to operate this facility arises under this permit. The authority to
operate the facility under previously issued permits bearing this number is no longer
effective. The conditions, requirements, terms, and provisions of this permit authorizing
discharge under the National Pollutant Discharge Elimination System govern discharges
from this facility.
SECTION C. OPERATION AND MAINTENANCE OF POLLUTION CONTROLS
1. Certified Operator
Pursuant to Chapter 90A-44 of North Carolina General Statutes, the permittee shall
employ a certified wastewater treatment plant operator in responsible charge (ORC) of the
wastewater treatment facilities. Such operator must hold a certification of the grade
equivalent to or greater than the classification assigned to the wastewater treatment
facilities. The permittee shall notify the Division's Operator Training and Certification Unit
within thirty days of any change in the ORC status.

Part II
Page 8 of 14
The permittee shall at all times properly operate and maintain all facilities and systems of
treatment and control (and related appurtenances) which are installed or used by the
permittee to achieve compliance with the conditions of this permit. Proper operation and
maintenance also includes adequate laboratory controls and appropriate quality assurance
procedures. This provision requires the operation of back-up or auxiliary facilities or
similar systems which are installed by a permittee only when the operation is necessary to
achieve compliance with the conditions of the permit.
3. _Need to Halt or Reduce not a Defense
It shall not be a defense for a permittee in an enforcement action that it would have been
necessary to halt or reduce the permitted activity in order to maintain compliance with the
condition of this permit.
4. Bypassing of Treatment Facilities
a. Definitions
(1). "Bypass" means the known diversion of waste streams from any portion of a
treatment facility including the collection system, which is not a designed or
established or operating mode for the facility.
(2) "Severe property damage" means substantial physical damage to property, damage
to the treatment facilities which causes them to become inoperable, or substantial
and permanent loss of natural resources which can reasonably be expected to occur
in the absence of a bypass. Severe property damage does not mean economic loss
caused by delays in production.
b. Bypass not exceeding limitations.
The peimittee may allow any bypass to occur which does not cause effluent limitations
to be exceeded, but only if it also is for essential maintenance to assure efficient
operation. These bypasses are not subject to the provisions of Paragraphs c. and d. of
this section.
c. Notice
(1) Anticipated bypass. If the permittee knows in advance of the need for a bypass, it
shall submit prior notice, if possible at least ten days before the date of the bypass;
including an evaluation of the anticipated quality and affect of the bypass.
(2) Unanticipated bypass: The permittee shall submit notice of an unanticipated bypass
as required in Part II, E. 6. of this permit. (24-hour notice).
d. Prohibition of Bypass
(1) Bypass is prohibited and the Permit Issuing Authority may take enforcement action
against a permittee for bypass, unless:
(a) Bypass was unavoidable to prevent loss of life, personal injury or severe
property damage;

Part 11
Page 9 of 14
(b) There were no feasible alternatives to the bypass, such as the use of auxiliary
treatment facilities, retention of untreated wastes or maintenance during normal
periods of equipment downtime. This condition is not satisfied if adequate
backup equipment should have been installed in the exercise of reasonable
engineering judgment to prevent a bypass which occurred during normal
periods of equipment downtime or preventive maintenance; and
(c) The permittee submitted notices as required under Paragraph c. of this section.
(2) The Permit Issuing Authority may approve an anticipated bypass, after considering
its adverse affects, if the Permit Issuing Authority determines that it will meet the
three conditions listed above in Paragraph d. (1) of this section.
5. 11D, sets
a. - Definition.
"Upset " means an exceptional incident in which there is unintentional and
temporary noncompliance with technology based permit effluent limitations because of
factors beyond the reasonable control of the permittee. An upset does not include
noncompliance to the extent caused by operational error, improperly designed treatment
facilities, inadequate treatment facilities, lack of preventive maintenance, or careless or
improper operation.
b. Effect of an upset.
An upset constitutes an affirmative defense to an action brought for
noncompliance with such technology based permit effluent limitations if the
requirements of paragraph c. of this condition are met. No determination made during
administrative review of claims that noncompliance was caused by upset, and before an
action for noncompliance, is final administrative action subject to judicial review.
c. Conditions necessary for a demonstration of upset.
A permittee who wishes to establish the affirmative defense of upset shall demonstrate,
through properly signed, contemporaneous operating logs, or other relevant evidence
that:
(a) An upset occurred and that the permittee can identify the cause(s) of the upset;
(b) The permittee facility was at the time being properly operated; and
(c) The permittee submitted notice of the upset as required in Part II, E. 6. (b) (B) of
this permit.
(d) The permittee complied with any remedial measures required under Part II, B. 2. of
this permit.
d. Burden of proof.
In any enforcement proceeding the permittee seeking to establish the occurrence of an
upset has the burden of proof.

Part II
Page 10 of 14
Solids, sludges, filter backwash, or other pollutants removed in the course of treatment or
control of wastewaters shall be disposed of in accordance with NCGS 143-215.1 and'in a
manner such as to prevent any pollutant from such materials from entering waters of the
State or navigable waters of the United States. The permittee shall comply with all existing
federal regulations governing the disposal of sewage sludge. Upon promulgation of 40
CFR Part 503, any permit issued by the Permit Issuing Authority for the disposal of sludge
may be reopened, and modified, or revoked and reissued, to incorporate applicable
requirements at 40 CFR Part 503. The permittee shall comply with applicable 40 CFR Part
503 Standards for the Use and Disposal of Sewage Sludge (when promulgated) within the
time provided in the regulation, even if the permit is not modified to incorporate the
requirement. The permittee shall notify the Permit Issuing Authority of any significant
change in its sludge use or disposal practices.
7. Power Failures
The permittee is responsible for maintaining adequate safeguards as required by DEM
Regulation, Title 15A, North Carolina Administrative Code, Subchapter 211, .0124
Reliability, to prevent the discharge of untreated or inadequately treated wastes during
electrical power failures either by means of alternate power sources, standby generators or
retention of inadequately treated effluent.
SECTION D. MONITORING AND RECORDS
1. Representative Sampling
Samples collected and measurements taken, as required herein, shall be characteristic of the
volume and nature of the permitted discharge. Samples collected at a frequency less than
daily shall be taken on a day and time that is characteristic of the discharge over the entire
period which the sample represents. All samples shall be taken at the monitoring points
specified in this permit and, unless otherwise specified, before the effluent joins or is
diluted by any other wastestream, body of water, or substance. Monitoring points shall
not be changed without notification to and the approval of the Permit Issuing Authority.
2. Roortin
Monitoring results obtained during the previous month(s) shall be summarized for each
month and reported on a monthly Discharge Monitoring Report (DMR) Form (DEM No.
MR 1,1.1, 2, 3) or alternative forms approved by the Director, DEM, postmarked no later
than the 30th day following the completed reporting period.
The first DMR is due on the last day of the month following the issuance of the permit or in
the case of a new facility, on the last day of the month following the commencement of
discharge. Duplicate signed copies of these, and all other reports required herein, shall be
submitted to the following address:
Division of Environmental Management
Water Quality Section
ATTENTION: Central Files
Post Office Box 27687
Raleigh, North Carolina 27611

Part II
Page 11 of 14
3: Flow Measurements
Appropriate flow measurement devices and methods consistent with accepted scientific
practices shall be selected and used to ensure the accuracy and reliability of measurements
of the volume of monitored discharges. The devices shall be installed, calibrated and
maintained to ensure that. the accuracy of the measurements are consistent with the accepted
capability of that type of device. Devices selected shall be capable of measuring flows with
a maximum deviation of less than 10% from the true discharge rates throughout the range .
of expected discharge volumes. Once -through condenser cooling water flow which is
monitored by pump logs, or pump hour meters as specified in Part I of this permit and
based on the manufacturer's pump curves shall not be subject to this requirement.
4. Test Procedures
Test procedures for the analysis of pollutants shall conform to the EMC regulations
published pursuant to NCGS 143-215.63 et. seq, the Water and Air Quality Reporting Acts,
and to regulations published pursuant to Section 304(g), 33 USC 1314, of the Federal
Water Pollution Control Act, as Amended, and Regulation 40 CFR 136.
To meet the intent of the monitoring required by this permit, all test procedures must
produce minimum detection and reporting levels that are below the permit discharge
requirements and all data generated must be reported down to the minimum detection or
lower reporting level of the procedure. If no approved methods are detemuned capable of
achieving minimum detection and reporting levels below permit discharge requirements,
then the most sensitive (method with the lowest possible detection and reporting level)
approved method must be used.
5. Penalties for Tampering
The Clean Water Act provides that any person who falsifies, tampers with, or knowingly
renders inaccurate, any monitoring device or method required to be maintained under this
permit shall, upon conviction, be punished by a fine of not more than $10,000 per
violation, or by imprisonment for not more than two years per violation, or by both.
6. Records Retention
The permittee shall retain records of all monitoring information, including all calibration
and maintenance records and all original strip chart recordings for continuous monitoring
instrumentation, copies of all reports required by this permit, for a period of at least 3
years from the date of the sample, measurement, report or application. This period may be
extended by request of the Director at any time.
7. Recording Results
For each measurement or sample taken pursuant to the requirements of this permit, the
pernuttee shall record the following information:
a. The date, exact place, and time of sampling or measurements;
b. The individual(s) who performed the sampling or measurements;
c. The date(s) analyses were performed;
d. The individual(s) who performed the analyses;
e. The analytical techniques or methods used; and
f. The results of such analyses.

Part II
Page 12 of 14
8. Inspection and End►
The permittee shall allow the Director, or an authorized representative, upon the
presentation of credentials and other documents as may be required by law, to;
a. Enter upon the permittee's premises where a regulated facility or activity is located or
conducted, or where records must be kept under the conditions of this permit;
b. Have access to and copy, at reasonable times, any records that must be kept under the
conditions of this permit;
c. Inspect at reasonable times any facilities, equipment (including monitoring and control
equipment), practices, or operations regulated or required under this permit; and
d. Sample or monitor at reasonable times, for the purposes of assuring permit compliance
or as otherwise authorized by the Clean Water Act, any substances or parameters at any
location.
SECTION E. REPORTING REOMEMENTS
1. Change in Discharge
All discharges authorized herein shall be consistent with the terms and conditions of this
permit. The discharge of any pollutant identified in this permit more frequently than or at a
level in excess of that authorized shall constitute a violation of the permit.
2. Planned Changes
The permittee shall give notice to the Director as soon as possible of any planned physical
alterations or additions to the permitted facility. Notice is required only when:
a. The alteration or addition to a permitted facility may meet one of the criteria for
determining whether a facility is a new source in 40 CFR Part 122.29 (b); or
b. The alteration or addition could significantly change the nature or increase the quantity
of pollutants discharged. This notification applies to pollutants which are subject
neither to effluent limitations in the permit, nor to notification requirements under 40
CFR Part 122.42 (a) (1).
3. Anticipated Noncompliance
The permittee shall give advance notice to the Director of any planned changes in the
permitted facility or activity which may result in noncompliance with permit requirements.
4. Transfers.
This permit is not transferable to any.person except after notice to the Director. The
Director may require modification or revocation and reissuance of the permittee and
incorporate such other requirements as may be necessary under the Clean Water Act.

Part II
Page 13 of 14
5. Monitoring Reps
Monitoring results shall be reported at the. intervals specified elsewhere in this permit.
a. Monitoring results must be reported on a Discharge Monitoring Report (DAM) (See
Part II. D. 2. of this permit).
b. If the permittee monitors any pollutant more frequently than required by the permit,
using test procedures specified in Part II, D. 4. of this permit, the results of this
monitoring shall be included in the calculation and reporting of the data submitted in the
DMR.
c. Calculations for all limitations which require averaging of measurements shall utilize an
arithmetic mean unless otherwise specified by the Director in the permit.
6. Twenty-four Hour Reporting
a. The permittee shall report to the central office or the appropriate regional office any
noncompliance which may endanger health or the environment. Any information shall
be provided orally within 24 hours from the time the permittee became aware of the
circumstances. A written submission shall also be provided within 5 days of the time
the permittee becomes aware of the circumstances. The written submission shall
contain a description of the noncompliance, and its cause; the period of noncompliance,
including exact dates and times, and if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and steps taken or planned to reduce,
eliminate, and prevent reoccurrence of the noncompliance.
b. The following shall be included as information which must be reported within 24 hours
under this paragraph.
(A) Any unanticipated bypass which exceeds any effluent limitation in the permit.
(B) Any upset which exceeds any effluent limitation in the permit.
(C) Violation of a maximum daily discharge limitation for any of the pollutants listed by
the Director in the permit to be reported within 24 hours.
c. The Director may waive the written report on a case -by -case basis for reports under
paragraph b. above of this condition if the oral report has been received within 24
hours.
7. Other Noncompliance
The permittee shall report all instances of noncompliance not reported under Part II. E. 5
and 6. of this permit at the time monitoring reports are submitted. The reports shall contain
the information listed in Part H. E. 6. of this permit.
8. 9Sher Information
Where the permittee becomes aware that it failed to submit any relevant facts in a permit
application, or submitted incorrect information in a permit application or in any report to the
Director, it shall promptly submit such facts or information.

Part II
Page 14 of 14
The pernrittee shall report by telephone to either the central office or the appropriate regional
office of the Division as soon as possible, but in no case more than 24 hours or on the next
working day following the occurrence or first knowledge of the occurrence of any of the
following:
a. Any occurrence at, the water pollution control facility which results in the discharge of
significant amounts of wastes which are abnormal in quantity or characteristic, such as
the dumping of the contents of a sludge digester, the known passage of a slug of
hazardous substance through the facility; or any other unusual circumstances.
b. Any process unit failure, due to known or unknown reasons, that render the facility
incapable of adequate wastewater treatment such as mechanical or electrical failures of
pumps, aerators, compressors, etc.
c. Any failure of a pumping station, sewer line, or treatment facility resulting in a by-pass
directly to receiving waters without treatment of all or any portion of the influent to
such station or facility.
Persons reporting such occurrences by telephone shall also file a written report in letter
form within 5 days following first knowledge of the occurrence.
10. Availability of RMorts
Except for data determined to be confidential under NCGS 143-215.3(a)(2) or Section 308
of the Federal Act, 33 USC 1318, all reports prepared in accordance with the terms shall be
available for public inspection at the offices of the Division of Environmental Management.
As required by the Act, effluent data shall not be considered confidential. Knowingly
making any false statement on any such report may result in the imposition of criminal
penalties as provided for in NCGS 143-215.1(b)(2) or in Section 309 of the Federal Act.
11. Penalties for Falsification of Reports
The Clean Water Act provides that any person who knowingly makes any false statement,
representation, or certification in any record or other document submitted or required to be
maintained under this permit, including monitoring reports or reports of compliance or
noncompliance shall, upon conviction, be punished by a fine of not more than $10,000 per
violation, or by imprisonment for not more than two years per violation, or by both.

PART III
OTHER REQUIREMENTS
A. Construction
No construction of wastewater treatment facilities or additions to add to the plant's treatment
capacity or to change the type of process utilized at the treatment plant shall be begun until Final
Plans and Specifications have been submitted to the Division of Environmental Management
and written approval and Authorization to Construct has been issued.
B. Groundwater Monitoring
The permittee shall, upon written notice from the Director of the Division of Environmental
Management, conduct groundwater monitoring as may be required to determine the compliance
of this NPDES permitted facility with the current groundwater standards.
C. Changes in Discharges of Toxic Substances
The permittee shall notify the Permit Issuing Authority as soon as it knows or has reason to
believe:
a. That any activity has occurred or will occur which would result in the discharge, on a
routine or frequent basis, of any toxic pollutant which is not limited in the permit, if that
discharge will exceed the highest of the following "notification levels";
(1) One hundred micrograms per liter (100 ug/1);
(2) Two hundred micrograms per liter (200 ug/1) for acrolein and acrylonitrile; five hundred
micrograms per liter (500 ug/1) for 2.4-dinitrophenol and for
2-methyl-4.6-dinitrophenol; and one milligram per liter (1 mg/1) for antimony;
(3) Five (5) times the maximum concentration value reported for that pollutant in the permit
application.
b. That any activity has occurred or will occur which would result in any discharge, on a
non -routine or infrequent basis, of a toxic pollutant which is not limited in the permit, if
that discharge will exceed the highest of the following "notification levels";
(1) Five hundred micrograms per liter (500 ug/1);
(2) One milligram per liter (1 mg/1) for antimony;
(3) Ten (10) times the maximum concentration value reported for that pollutant in the permit
application.

PART IV
ANNUAL ADMINISTERING AND COMPLIANCE MONITORING FEE REQUIREMENTS
A. The permittee must pay the annual administering and compliance monitoring fee within 30
(thirty) days after being billed by the Division. Failure to pay the fee in a timely manner in
accordance with 15A NCAC 2H .0105(b)(4) may cause this Division to initiate action to
revoke the permit.

To: Permits and Engineering Unit
Water Quality Section
Date: November 4, 1991
NPDES STAFF REPORT AND RECOMMENDATIONS
County: Rowan
Permit No.: NCO048682
MRO No.: 91-231
PART I - GENERAL INFORMATION
1. Facility and Address: American Concrete Products, Inc.
P. 0. Box 288
Statesville, NC 28677
2. Date of Investigation: October 31, 1991
3. Report Prepared by: W. Allen Hardy, Environmental Engineer I
4. Persons Contacted and Telephone Number: Andy Stankwytch,
[phone]
5. Directions to Site: From the intersection of E. Ridge Road
(S. R. 1915) and Old Mocksville Road (S. R. 1910) travel north
on the latter approximately 0.6 mile to the junction with
Hannah Ferry Road (S. R. 1926). Proceed on S. R. 1926 0.8
mile and cross a single lane bridge. Proceed 0.1 mile on the
unpaved segment to the gate on the right side of the road.
The site is through the gate at the end of this road.
6. Discharge Point(s), List for all discharge points:
Latitude: 350 44' 38"
Longitude: 800 27' 38"
Attach a USGS map extract and indicate treatment facility
site and discharge point on map.
USGS Quad No.: E17NW USGS Quad Name: Salisbury, NC
7. Size (land available for expansion and upgrading): There is
adequate land available for expansion and upgrading.
8. Topography (relationship to flood plain included): The
topography is relatively flat. The site is adjacent to the
Yadkin River and appeared to be in the flood plain.
9. Location of nearest dwelling: The nearest dwelling is greater
than 500 feet.

Page Two
10. Receiving stream or affected surface waters: Yadkin River
a. Classification: WS-III
b. River Basin and Subbasin No.: Yadkin 03-07-04
C. Describe receiving stream features and pertinent
downstream uses: The receiving stream is the Yadkin
River which contains a good flow at all times. The
pertinent downstream uses are those typical on a shallow
flowing river (i.e. drift fishing, bank fishing,
irrigation, etc.). However, High Rock Lake which starts
approximately four miles downstream receives frequent
human contact through typical recreational activities.
There are no known water intakes within several (at
least two) miles of the discharge location.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. Type of wastewater: 0% Domestic
100% Industrial
a. Volume.of Wastewater: * MGD (Design Capacity)
b. Types and quantities of industrial wastewater: *The
volume of wastewater is dependent on the amount of
dredging that occurs. The dredging operation fluctuates
with consumer demand.
C. Prevalent toxic constituents in wastewater: N/A
d. Pretreatment Program (POTWs only): N/A
in development approved
should be required not needed
2. Production rates (industrial discharges only) in pounds per
day: N/A
a. Highest month in past 12 months: lbs/day
b. Highest year in the past 5 years: lbs/day
3._ Description of industrial process (for industries only) and
applicable CFR Part and Subpart: N/A
4. Type of treatment (specify whether proposed or existing): The
existing treatment consists of two settling basins in series.
Overflow pipes connect the basin.
5. Sludge handling and disposal scheme: N/A
6. Treatment plant classification (attach completed rating
sheet): A rating yielded 4 points, 2 points for each (2)
settling basin.

Page Three
7. SIC Code(s): 1442
Wastewater Code(s):
Primary: 43
Secondary:
Main Treatment Unit Code: 50000
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant
Funds (municipals only)? No
2. Special monitoring requests: No
3. Additional effluent limits requests: No
4. Other: No
PART IV - EVALUATION AND RECOMMENDATIONS
The applicant, American Concrete Products, Inc., has requested
that the permit which allows them to discharge wastewater produced
from sand dredging of the Yadkin River be renewed. The company
is not dredging at this site until the demand increases or the
existing stockpile gets low. There did not appear to be any
problems with the treatment works, or any detrimental effects
caused to the receiving stream by the discharge.
It should be noted that the permittee wishes to have the
permit renewed in the name of American Concrete Products, Inc.
instead of Statesville Concrete Products. A request should be
forthcoming.
It is recommended that the permit be renewed.
Water Quality Regional Supervisor
Date

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,$ eta SCAT[
Or' rdt'a'rFJgI ,
ND
1991
State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Management „J(aiT
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor George T. Everett, Ph.D.
William W. Cobey, Jr., Secretary Director
October 10, 1991
American Concrete Products, Inc.
P.O. Box 288
Statesville, NC 28677
A,, A q m', (ze
Dear Mr. Stankwytch
Subject: NPDES Permit Application
NPDES Permit NO.NC0048682
American Concrete Products,Inc.
Rowan County
This is to acknowledge receipt of the following documents on August 21, 1991:
Application Form
Engineering Proposal (for proposed control facilities),
Request for permit renewal,
Application Processing Fee of $350.00,
Engineering Economics Alternatives Analysis,
Local Government Signoff,
Source Reduction and Recycling,
Interbasin Transfer,
Other Request for name change,
The items checked below are needed before review can begin:
Application Form ,
Engineering proposal (see attachment),
Application Processing Fee of
Delegation of Authority (see attached)
Biocide Sheet (see attached)
Engineering Economics Alternatives Analysis,
Local Government Signoff,
Source Reduction and Recycling,
Interbasin Transfer,
Other Need letter from Statesville Concrete Products, Inc. concurring with name
chancre to American Concrete Products, Inc.
Pollution Prevention Pays
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

If the application is not made complete within thirty (30) days, it will be
returned to you and may be resubmitted when complete.
This application has been assigned to Randy Kepler
(919/733-5083) of our Permits Unit for review. You wiii be advised of any
comments recommendations, questions or other information necessary for the
review of the application.
I am, by copy of this letter, requesting that our Regional Office
Supervisor prepare a staff report and recommendations regarding this
discharge. If you have any questions regarding this applications,
please contact the review person listed above.
Sincerely,
Qom) 9k��
CC: Mooresville Regional Office M. Dale Overcash, P.E.

NORTH CAROLINA DEPT. OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT �j�����
DIVISION OF ENVIRONMENTAL MANAGEMENT, P.O. BOX 27687, RALEIGH, NC 2761I
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM C FOR
AGENCY
USE
To be filed only by persons engaged in manufacturing and mining
Do not attempt to complete this form before reading accompanying instructions
Please print or type
1. Name, address, location, and telephone number offacilityproducing discharge
A. Name �r1 f_T2/clan/ I is� it 7l e'�c, Yizn nub 7 r
B. Mailing. -address
1. Street address c • u• r�mf GXa
-
2. City 1 f ._:,ter„'� �a,r�•
4. County 7Tr't D(r.L.!_.
3. State
APPLICATION NUMBER
�fi
a
V
Y
(O
:;- I
Z.
DATE RECEIVED
1 D j S,
1 2-
YEAR Mo. DAY
5. ZIP_ �;7n'�7"�
C. Location: _
1. Street F__-)�.71_.I/ �d. l i U „-,o� .:� ors? J •, �, r�
r �
2. City _f'A4177 1/ 3. County
4. State
„_ C
D. Telephone No. '�(J y �%-'�-6 �r�
Area
Code
7n*1
2. S I C ® �� DEPT. OF NATURAL
(Leave blank) —RESOURCES AND
UN TY DEVELOPMENT
3. Number of employees
If all your waste is discharged into a publicly owned waste treatment facility NOV - 4 .19-91
and to the best of your knowledge you are not required to obtain a discharge
permit, proceed to item 4. Otherwise proceed directly to item 5.
�q of aruoxla�xrk �,�c��=�:• .
4. If you meet the condition stated above, check here o and supply the information �f
asked for below. After completing these items, please complete the date, title,
and signature blocks below and return this form to the proper reviewing office
without completing the remainder of the form.
A. Name of organization responsible for receiving waste
B. Facility receiving waste:
1. Name
2. Street address
3. City
5. State
5. ❑ Principal product, raw material (Check
'6. Principal process
4; County
6. ZIP
7. Maximum amount of principal product produced or raw material consumed per (Check one)
Basis
Amount
1-99
(1)
100-199
(2)
200-499.
(3)
500-999
(4)
1000-
4.999
(5)
5000-
9999
(6)
10,000-
49.999
(7)
50,000
or more
(B)
A. Day
B. Month
C. Year
PREVIOUS EDITION MAY BE USED UNTIL SUPPLY 15 EXHAUSTED

fI... MnxIn,.lm mmounl of lirInr.tpaI pruiIm I. Isrnelutrd nr
1 In Item 1, above. Is meas�urrd In (LheLk une):
A.o pounds B.ons L.o barrels
rnw mnl er I n I r nn-omp. I. reint 1 rrl
D, o bushels E. o square feet
F.o gallons G.o pieces or units H.�o other, specify
9. (a) Check here if discharge occurs all year or
(b) Check the month(s) discharge ocrurs:
1.0 January 2. o February 3. p March 4-0 Apri 1 5.o May 6.0 June
7.0 July 8.0 August 9.0 September I0.00ctoher 11.0November IL13 December
(c) Check how many days per week: 1.13 1 2.13 2-3 3.19 4-5 4.p 6-7
10. Types of waste water discharged to surface waters only (check as applicable)
Flow. Mons per
gallons p operating day
Volume treated before
discharging (percent)
Discharge per
operating day
0.1-999
1000-4999
5000-9999
10,000-
50,000-
None
0.1-
30-
65-
95-
49,999
or more
29.9
64.9
94.9
100
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
A. Sanitary, daily
average
B. Cooling water, etc.
N
daily averaqe
�-
C. Process water,
/
daily averageMax
.✓
). operat-
dayurr per
/
ing
ing day for iota l
total*
discharge (all types)
11. If anv of the three types of waste identified in item 10.eithertreated or untreated,
are discharged to places other thar surface water., check below as applicable.
Waste water is
discharged to:
Average flow, gallons per operating day
0.1-999
(1)
1000-4999
(2)
5000-9999
(3)
10.000-49.999
(4)
50.000 or more
(5)
A. Municipal sewer system
B. Underground well
C. Septic tanK
D. Evaporation lagarn or pond
E. Other, specify
12. Number of separate discharge points: A. 1 B.o2-3 C.[34-5 D.06 or more
13. Name of receiving water or waters n �/ i/f
14. Does your discharge contain or is it possible for your discharge to contain
one or more of the following substances added_as a result of your operations,
activities, or processes: ammonia, cyanide, aluminum, beryllium, cadmium,
chromium, copper, lead, mercur nickel, selenium, zinc, phenols, oil and
grease. and chlorine (residual. A.oyes B .Im3no
I certify that 1 am familiar with the information contained in the application and
that to the best of my knowledge and belief such information is true, complete, and
accurate.
Printed Niof Persn Sig ing Title '
.J'S� %�•'"''� / r, it i�
Date Application Signed Signature St App ani
North Carolina General Statute 143-215.6(b)(2) provides that: Any person who•knowingly makes
any false statement representation, or certification in any application, record, report, plan,
or other document files or required to be maintained under Article 21 or regulations -,Of the
Environmental Management Commission implementing that Article, or who falsifies, tampers with,
or knowly renders inaccurate any recording or monitoring device or method required to .be
operated or maintained under Article 21 or regulations of the Environmental Management Commissj
implementing that Article, shall be guilty of a misdemeanor pumishable by a ,:ine not to exceed
$10,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provi
a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both,
for a similar offense.)