NCG160241_NOI Application_20211202

FOR AGENCY USE ONLY RECEIVED
NCG16 jQ Z 1 GA�SO%`,1�
Assigned to:
ARO FRO MRO RRO WARD RO WSRO DENR IANO QUALITY
STOWWAMR PERMIT1310
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG160000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: 51C2951 [Asphalt Paving Mixtures and Blocks] and like activities deemed by DEMLR to
be similar in the process or the exposure of raw materials, intermediate products, final products, by-products, or
waste materials. You can find information on the DEMLR Stormwater Program at deq.nc.gov/SW.
Directions: Print or type all entries on this application. Send the original, signed application with all required
items listed in Item (6) below to: NCDEMLR Stormwater Program, 1612 MSG, Raleigh, NC 27699-1612. The
submission of this application does not guarantee coverage under the General Permit. Prior to coverage under
this General Permit a site inspection will be conducted.
1. Owner/Operator (to whom all p
Name of legal organ,(zational entity:
1.. .
M•.01r,
will be
--( Legally
yresponsible
as signed in item (7) below:
State Zip Code:
Telephone number: Emailaddress:
Type of Ownership:
Government
(3County OFederal 13Municipal [3St4e
Non -government
No
LtlBusiness (If ownership is business, a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility (facility being permitted):
Facility r�me: ✓k 1c�n.�/ �T
k'1�___ s� �`_
Parcel Identification Number (PIN):
--PSM Yti 77 99
Telephone number:
_ _/ _,yip - 3ff- &/y
4-digitSICcode: Facility is:
;9 V [3 New 0 Proposed 13
Latitude of entrance:
City: 4V .State:_ Zip Code:
e �
County 2'r
Email address -
Date oiler ion is to begin o agan:
Longitude of entrance:
_3S• 77nrr 1 —/V. O&QWyy
Brief description of the typys of industrial activities and products manufactured at this facility:
If pe stcrmwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
W N/A
Page 1 of 5

Check all activities conducted at this facility:
Outdoor Stockpiling of Materials
lyStorage of Raw Materials
91 Storage of Materials in Above -ground Storage Tanks
[(Material Loading and Unloading
3. Consultant (if applicable):
Name of consultant:
Street address:
Telephone number:
4. Outfall(s) At least one outfall is required to be
3-4 digit identifier: Name of receiving water:
ill -%7-1
Latitude of outfall:
Brief
that drain to
INTransport of Materials by a Conveyor or Front-end Loader
Vehicle and Equipment Maintenance
Vehicle or Equipment Washing
Vehicle and Equipment Fueling
Consulting firm:
City;�
Email address:
for coverage.
Classification:
G,_S",
Longitude of outfall:
—742
State: Zip Code:
❑ This water is impaired.
❑ This watershed has a TMDL
Do Vehicle Maintenance Activities occur it thWdramase am 611this outfai ? 13Yes OrNo
If yes, how many gallons of new motoroil are used each month when averaged over the calendar year? --
3-4 digit identifier. Name of receiving water / MissifrAtion: ❑ This water is impaired.
27-1 _6 ❑ This watershed has a TMDL
Latitude of outfall: �Lorigitude of outfall:
o7, 0. v — b.rao
Brief description of the industrial activities that drain to this outfall:
Do Vehicle aintenance Activities occur in the drainage area of this outfall? Dyes 12 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier: Name of receiving water: Classification: ❑ This water is impaired.
❑ This watershed has a TMDL.
Lanruae or ourrau: Longitude of outs all:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall?
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
0 Yes U No
All outfalls must be listed and at least one outfall is required. Additional outfalls maybe added in the section
"Additional Outfalls" found on the last page of this NO].
Page 2 of 5

5. Other Facility Conditions (check all that apply and
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
® This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and shpw on site diagram:
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list t date the SWPP__P�was
///
❑ This facility stores hazardous waste in the 100-year floodplain,
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
Kilograms of waste
How material is stored:
of waste shipments peryear:
indicate:
Type(s) of waste:
Where material is stored:
I
Name of transport/disposal
Transport/disposal vendor EPA ID: Vendor address:
❑ This facility is located on a Brownfield or Superfund site
If checked, briefly describe the site conditions
6. Required fterrts (Application will be returned unless all of the following items have been included):
❑ Check for $100 made payable to NCDEQ
J
Copy of most recent Annual Report to the NC Secretary of State
fi This completed application and any supporting documentation
❑ A site diagram showing, at a minimum, existing and proposed:
a) outline of drainage areas
b) surface waters
c) stormwater management structures
d) location of stormwater outfalls corresponding to the drainage areas
e) runoff conveyance features
0 areas where industrial process materials are stored
g) impervious areas
h) site property lines
8i Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

LIMITED LIABILITY COMPANY ANNUAL REPORT ■
1012017
NAME OF LIMITED LIABILITY COMPANY., Highland Paving Co., LLC
SECRETARY OF STATE ID NUMBER: 0699078 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2021
SECTION A. REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: McCauley, John W
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
CA202107101225
3112I2021 09:30
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
2031 Middle Road
1 Middle Road
Eastover, NC 28312 Cumberland County Eastover, NC 28312
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Highland Paving Co, LLC
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x_ 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
2031 Middle Road
5. PRINCIPAL OFFICE MAILING ADDRESS
PO Box 1843
Eastover, NC 28312 Fayetteville, NC 28302-1843
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME:
John W McCauley
NAME:
David Brian Raynor
NAME:
TITLE:
Managing Member
TITLE:
Managing Member
TITLE:
ADDRESS:
2054 Middle Road
ADDRESS:
2204 Bayview Drive
ADDRESS:
Fayetteville, NC 28312 Fayetteville, NC 28305
SECTION D: CERTIFICATION OF ANNUAL REPORT Section D must be completed in its entirety by a persontbusiness entity.
John W McCauley 3/12/2021
SIGNATURE
Forth must be signed by a Company Official listed under Section C of This fame.
John W McCauley Managing Member
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525