NCG020182_Dormant Status Recertification_20210929

FOR AGENCY USE ONLY
NC
ARO FRO MRO RRO WARD WIRO WSRO
Division of Energy, Mineral, and land Resources Land Quality Section
NCG020000
Dormant Status Request Form
Please complete this form if you are pursuing anew dormant status designation for a facility.
Directions:
• Print or type all entries on this request form.
• Attach this form to the Stormwater Upload For— by selecting "Dormant Status Initial Request" from the
dropdown list.
• The submission of this form does not guarantee dormant status will be granted. An inspection from the
Division's Regional Office staff will be conducted prior to final determination.
North Carolina General Statute 143-215.613 (i) 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:
�✓ I, as the legally responsible person or authorized representative, request dormant status for the subject
facility.
Q✓ The subject facility is temporarily inactive and all portions of the site where clearing, grading, and/or
excavation activities occurred are stabilized with permanent vegetation.
p✓ I am familiar with the information contained in this request and to the best of my knowledge and belief such
information is true, complete, and accurate.
Facility Name: Hanson Aggregates - Elm City Quarry
Permit Number: NCG020182
Date Facility went Inactive: The quarry became inactive in the mid-1990s.
Printed Name of Person Signing: Jack Garvey
Title: Area Environmental Manager
(Signature)
4/11 /22
(Date Signed)
TH
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Georgoulias, Bethany
From: Garvey, Jack H (Raleigh) USA <[e-mail]>
Sent: Monday, April 11, 2022 1:00 PM
To: Georgoulias, Bethany
Subject: [External] RE: NCG020182 - Hanson Aggregates - Elm City Quarry
Attachments: NCG02-Dormant Status Request Form 4-11-22.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
My error. Thanks
From: Georgoulias, Bethany <[e-mail]>
Sent: Monday, April 11, 2022 11:13 AM
To: Garvey, Jack H (Raleigh) USA <[e-mail]>
Subject: NCG020182 - Hanson Aggregates - Elm City Quarry
External Email - Please use properjudgment and caution when opening attachments, clicking links, or
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Jack,
We just need a revised form for this one. None of the boxes were checked on the Certification.
Thanks,
Bethany
Bethany Georgoulias (she/her)
Environmental Engineer
Stormwater Program, Division of Energy, Mineral, and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
[e-mail]
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your

requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.

FOR AGENCY USE ONLY
NC
ARO FRO MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
NCG020000
Dormant Status Request Form
Please complete this form if you are pursuing anew dormant status designation for a facility.
Directions:
• Print or type all entries on this request form.
• Attach this form to the rmwater Upload Form by selecting "Dormant Status Initial Request" from the
dropdown list.
• The submission of this form does not guarantee dormant status will be granted. An inspection from the
Division's Regional Office staff will be conducted prior to final determination.
North Carolina General Statute 143-215.613 (i) 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:
❑ I, as the legally responsible person or authorized representative, request dormant status for the subject
facility.
❑ The subject facility is temporarily inactive and all portions of the site where clearing, grading, and/or
excavation activities occurred are stabilized with permanent vegetation.
❑ I am familiar with the information contained in this request and to the best of my knowledge and belief such
information is true, complete, and accurate.
Facility Name:
Hanson Aggregates - Elm City Quarry
Permit Number: NCG020182
Date Facility Went Inactive: The quarry became inactive in the mid-1990's.
Printed Name of Person Signing: Jack Garvey
Title: Area Environmental Manager
9/29/21
(Signature) , l (Date Signed)
aE