NCG070227_Application_20220324

FOR AGENCY USE ONLY
NCG07 a 2 2. 11 RECEIVED
Assigned to:
ARO FRO MR RRO WARO WIRO WSRO ("`I�4R 23 2022
Division of Energy, Mineral, and Land Resources 1-44419 UAUIY G
National Pollutant Discharge Elimination System
NCG070000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC32 [Stone, Clay, Glass and Concrete Products], and like activities deemed by DEMLR
to be similar in the process and/or the exposure of raw materials, products, by-products, or waste materials. SIC
3273 [Ready -Mixed Concrete] is specifically excluded from coverage under this General Permit and is instead
covered under NCG140000. 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 MSC, 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 permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (7) below:
Metro Stone & Granite Inc.
Michael Webb
Street address:
City:
State:
Zip Code:
1720 Tower Industrial Drive
Monroe
C
8110
Telephone number:
Email address:
04-791-5882
[e-mail]
Type of Ownership:
Government
®County ®Federal ®Municipal ®State
Non -government
ElBusiness (If ownership is business, a copy of NCSOS report
must be included with this application)
® Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Metro Stone & Granite Inc.
Michael Webb
Street address:
City:
State:
Zip Code:
1720 Tower Industrial Drive
Monroe
NC
8110
Parcel Identification Number (PIN):
County: ,
9366018J
V V1 i oyl
Telephone number:
Email address:
04-283-3041
[e-mail]
4-digit SIC code:
Facility is:
1
I Date operation is to begin or began:
281
®New EjProposed EjExisting
4/2002
Latitude of entrance:
Longitude of entrance:
5`01'56.0"N
0`37'41.1 "W
Brief description of the types of industrial activities and products manufactured at this facility:
Fabrication of Quartz and Granite Countertops
If the Stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
0 N/A
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
N/A
Consulting firm:
N/A
Street address:
City:
State:
Zip Code:
Telephone number:
Email address:
4. Outfall(s) At least one outfall is required to be eligible for coverage.
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
001
ast Fork 12 Mile Creek
C
I This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
5*01'55.7"N
0*37'41.7"W
Brief description of the industrial activities that drain to this outfall:
Granite and Quartz production, minimal run-off
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes )] 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.
002
lEast Fork 12 Mile -Creek - -
-- - - - -
❑ This watershed-F gs a TMDL.
Latitude of outfall:
Longitude of outfall: -
5*01'56.2"N —
0*37'40.4"W
Brief description of the industrial activities that drain to this outfall
Slab Storage & Water'treatment facility run off ,
Do Vehicle Maintenance Activities occurin,the drainage area of this outfall? 0 Yes ;El No
If yes, how; many gallons of n-ew 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.
003
East Fork 12 Mile Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall: -
35*01'53.7"N
0*37'40.2"W
Brief description of the industrial activities that drain to this outfall:
Slab Storage & Granite and Quartz production, minimal run-off
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes Il 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.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? Il Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
All outfalls must be listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalls" found on the last page of this NOI.
Page 2 of 5

5. Other Facility Conditions (check all that apply and explain accordingly):
❑ 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:
ID This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
e collect and recycle fabrication water making our water usage self-sufficient.
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
❑ 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_
If checked, indicate:
Kilograms of waste generated each month:
Type(s) of waste: -
How material is stored:.•'
Where material is stored:
Number of waste shiprrents'pCr year:
Name of transport/disposal vendor:
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 Items (Application will be returned unless all of the following items have been included):
0 Check for $100 made payable to NCDEQ
0 Copy of most recent Annual Report to the NC Secretary of State
El This completed application and any supporting documentation
0 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
f) areas where industrial process materials are stored
g) impervious areas
h) site property lines
0 Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

7. Applicant Certification:
North Carolina General Statute 143-215.613 (1) provides that: Any person who knowingly makes any false statement,
representation, or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
El I am the person responsible for the permitted industrial activity, for satisfying the requirements of this permit, and for any
civil or criminal penalties incurred due to violations of this permit.
ID The information submitted in this N01 is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information.
El I will abide by all conditions of the NCG070000 permit. I understand that coverage under this permit will constitute the
permit requirements for the discharge(s) and is enforceable in the same manner as an individual permit.
O I hereby request coverage under the NCG070000 General Permit.
Printed Name of Applicant: Michael Webb
Title: Operations Manager
(Signature of Applicant)
03/14/2022 - -
(Date Signed)
Mail the entire.p_ac_kage to: DEMLR— Stormwater Program
_ _.Department of Environmental Quality
1612 Mail Service Center
ma Raleigh, NC 27699-1612 _
Page 4 of 5

Additional Outfalls
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? El Yes 0 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.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? El Yes El 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.
Latitude of outfall:
Longitude of outfall:
Brief description -of the industrial activities that drain to this outfall:
Do Vehicle Maintenance'Acfivities occur in the drainage area of this outfall? Oyes © 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.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? fl Yes I] 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.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ll Yes ®No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

NORTH CARWNA. OHM CWNTY
L .IEFfERY 5. GORDON. CERNY THAT THIS PLAY WAS 0.GW1 IMDER
MY SUPERMAON FROM AN ACTUAL SURVEY WADE UNDER MT SLPERNSTei
(DEED DESCRIPTIONS AS SHOW W 1111LF MOCK BELOW): 1HAT
THE BOUNDARIES NOT SURAYEO ME CLEARLY MUM AS DRAWN
FROM INFORMATION FWND W DEED BOCK_y PACE: THAT THE
RATIO OF PRE09M AS CALOLLAIM IS 1:10.0001: THAT THIS PEkT
WAS NOT PREPARED IN ACCORDAMCE WITH GS. 47-50 AS MENDED.
10114E5S MT �G A ANVTW ND, M
THIS / C NIL 20R.
GDRIIDN, L-3731
000,
Lot 22
-.;Aar ladaao-lr. raTR
PC E. File: $90
___TONER INDUSTRIAL DRIVE_
60' Public R/W
Asphalt
Porkin9
Existing I
RuAdhlg 0.9Do SF)
Existing Concrete
(6,611 SO
1.11 ACRES
N/F )
Danny W. Henan
h wife. Mgda H. i
Del See PC +12I
N/F
i(09-3-368-017A17A I
Danny W.
GB 498 PCC 65 657
1
I
#09-368-017
I
GRAPHIC SCALE
so a u so nao pep
( I71 1FIP,ID )
3 faeh - raS0 tL
THIS PROPERTY IS NOT SUBJECT TD A FEMA
REWLAIM FLOW HAZARD ZONE. AS PEN FEMA
MN KIM. MAP NM 3nO5xMML PANEL 6,07,
EFFECTIVE DAIS WTDNER 16. 2006.
—__--R/W
Told ImperAcus Area (Ex. Conditlons)
Is 27.800 SF.
Told impervious Aura offer Improvements
w01 be 27.800 SF
Proposed New C..nete Addition b 4.126 SF
and will be cavering existing grovel urea.
®
(Shown gp shaded area.)
)0' —R/W
There is no net Increase of haperAois area.
Any retaining wall over five (5') feet In
height must follow the Towne guld.laos for
reiainbg wall deegn.
It
My removal of existing trees, do. to
aorwouction, eholl be replaced with similar/
Ike kind.
Contractor to notify The Town of Indian
Troll, Prior to any construction.
A
- Si_ ire Z NM4
— GU}41�11`S
Retain, Wall (�
In length)— 4JCCA•^0'9c
Lot 20
Tower Industrial Park
PC E. Flle: 188
APPROVED
By Kevin kerrl AICP, CZO at 3:01 pm, Sep 19, 2014
09-18-14 A10:21 IN ,
T-
LEGEND
I RE - Rebor Found
PKNF - P.K. Nail Found
R/W - Right of Way
N/F - Now or Formedy
I DB - Deed Soak
1 PG - Page
PC - Plot Cobinet
/09-356-019,1 - Tax I.D.
MG - Metal Grote
CM - pope Myrtle
LC - LeNand Cypraes
SG - Sweet Gum
ontier Land Surveying SITE PLAN FOR: B REV. 4
1394—B Walkup Avenue LOT 21, TOWER iNDUSTIAL PARK 9//17/2014
Monroe, N.C. 28110 Property of: Scott D. Pederson
[phone] Business: Metro Stone & Granite
L I Ref DB 5948 PC 551 PC E F'I 215
ee9a . , 1 IS:
By: Jeffery S. Gordon, MCPLS, L-3751 Indian Trail, Monroe Township, Union County, N.C.
i" - 5o' Date: 24 July 2014 Dag. FRO: y5\13T-LOL21-Tower.dOg
-S
16X5
re 1A.

AMENDED BUSINESS CORPORATION ANNUAL REPORT
1/6f2022
NAME OF BUSINESS CORPORATION: Metro Stone & Granite Inc.
SECRETARY OF STATE ID NUMBER: 0674685 STATE OF FORMATION: NC
REPORT FOR THE FISCAL YEAR END:
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT:
QX Changes
Scott D. Pedersen
2. SIGNATURE OF THE NEW REGISTERED AGENT:
AMENDING DOC ID
EMO
# ❑�
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
1720 Tower Industrial Drive
Monroe, NC 28110-8565 Union
SECTION B: PRINCIPAL OFFICE INFORMATION
1720 Tower Industrial Drive
Monroe, NC 28110-8565
1. DESCRIPTION OF NATURE OF BUSINESS: residential granite countertop construction
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL:
p• •o
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
1720 Tower Industrial Drive 1720 Tower Industrial Drive
Monroe, NC 28110-8565 Monroe, NC 28110-8565 Union
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: OFFICERS (Enter additional officers in Section E.)
NAME: D. Scott Pederson NAME:
TITLE: President
TA SS
1720 Tower Industrial Drive
Monroe, NC 28110 Union
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
SECTION D• RTIFICATION F A NUAL REPORT. Section D must be completed in its entirely by a person/business
entity.
�. ,Y. zozy
SIGNATURE DATE
Form mu a signed by an officer listed under Section C of this form.
Sc. -a y E0Q2itf_�
DL✓LjE2
Print or Type Name of Officer Print or Type Title of Officer
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $10.00
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

SECTION E: ADDITIONAL OFFICERS
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME: NAME:
TITLE: TITLE:
ADDRESS: ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
•Name:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:

North Carolina Department of the Secretary of State
Elaine F. Marshall, Secretary
BELOW IS THE CHECK LIST FOR BUSINESS CORPORATION ANNUAL REPORT. Please take a few minutes and read the
information provided. The Business Corporation's Annual Report is due by the 15th of the 4th month after the end of the
Business Corporation's fiscal year, with the filing fee of $20.00 if filed online, if filed in paper form the fee is $25.00.
Each Business Corporation filing an annual report with the North Carolina Department of Secretary of State must
provide the following information:
1. NAME OF BUSINESS CORPORATION
2. STATE OF FORMATION
3. ANNUAL REPORT FILING YEAR
4. THE REGISTERED AGENT STREET ADDRESS AND MAILING ADDRESS IF DIFFERENT
5. THE REGISTERED AGENT'S NAME AND SIGNATURE IF CHANGED
6. THE PRINCIPAL OFFICE ADDRESS, COUNTY AND TELEPHONE NUMBER
7. THE NAMES, TITLES AND BUSINESS ADDRESS OF THE PRINCIPAL OFFICERS
8. A BRIEF DESCRIPTION OF THE NATURE OF BUSINESS
IF THE INFORMATION REQUIRED TO BE ENTERED IN SECTION A THROUGH SECTION C HAS NOT CHANGED SINCE THE MOST
RECENTLY FILED ANNUAL REPORT, COMPLETE HEADER SECTION AND SECTION D TO CERTIFY THE ANNUAL REPORT.
SECTION A: REGISTERED AGENT'S INFORMATION
1. The name of the registered agent must be typed or printed.
2. If the registered agent has changed, the new registered agent MUST SIGN CONSENT to the appointment in the space provided. If the registered agent's
name has changed due to marriage, or by any other legal means, the business corporation must indicate such change in the space provided and have the
agent sign consent to the appointment under their new name. If the new registered agent is a business entity, then the appropriate representative of that
entity must sign and print their name and title. The registered agent must reside in NC.
3. If the street address of the registered office has changed, indicate the change. The address of the registered office must be a Street Address and NOT a
Post Office Box Address. The street address of the registered office must be a North Carolina address.
4. If the mailing address of the registered office has changed it should be indicated in this item. The registered office's mailing address may be a Post Office
Box. The registered office mailing address must be a NORTH CAROLINA ADDRESS.
SECTION B: PRINCIPAL OFFICE INFORMATION
1. Provide a brief description of the nature of the Business Corporation's business.
2. Enter the principal office telephone number.
3. Enter the principal office E-mail address.
4. The principal office address should reveal the Business Corporation's physical location. The principal office street address must be a street address and
NOT a Post Office Box Address.
5. The principal office mailing address may be a Post Office Box.
6. You may voluntarily report whether the company qualifies as a service -disabled veteran -owned or veteran -owned small business. The annual net receipts
cannot exceed one million dollars ($1,000.000) to report as either veteran -owned small business designation. Choose the designation of a service -disabled
veteran -owned small business if one or more service -disabled veterans owns more than 50%of the business. Choose the designation of veteran -owned small
business if one or more veteran owns more than 50%of the business. For further definitions see N.C.G.S. §55-1-40; §57D-1-03; or §59-32.
SECTION C: OFFICERS
Provide the names and addresses of each officer. Use Section E or a plain 8 1/2 X 11 sheet of paper if more space is needed. A person listed in this section
must sign the annual report and is then authorized to sign on other documents filed with this office.
SECTION D: CERTIFICATION OF ANNUAL REPORT
Check the annual report carefully to ensure all infannation required for filing has been provided. Only an officer listed on this report or past completed and
filed report may sign. Complete the signature, date, title and typed or printed name in the space provided on the form to certify that the information is accurate
and current. If the Officer of the business corporation is another business entity then the appropriate representative of that business entity must certify the
annual report.
SECTION E: ADDITIONAL OFFICERS
Provide the names and addresses of each additional officer. A person listed in this section is then authorized to sign on other documents filed with this
office.
Mail the annual report to: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525. For information or assistance, contact
the Business Registration Division at [phone] or Toll Free 1-989-246-7636. The or] address is httn://www.sosnc.env. /Revised 1012017)