NCG070229_Application_20221019

FOR AGENCY USE ONLY ou 19 2022
NCG07 0IZ ol
Assigned to: 5. � �{�igliWtil91Q'
ARO FRO MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG070000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 32 [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:
American Concrete Construction, Inc.
Scoff Niemitalo
Street address:
City:
State:
Zip Code:
3194 Sumner Road
Trinity
N.C.
27370
Telephone number:
Email address:
[phone]
[e-mail]
Type of Ownership:
Government
❑County ❑Federal ❑Municipal ❑State
Non -government
OBusiness (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:
American Concrete Construction, Inc.
David Silva [phone]
Street address:
City:
State:
Zip Code:
3194 Sumner Road
Trinity
N.C.
27370
Parcel Identification Number (PIN):
County:
7715366651
Randolph
Telephone number:
Email address:
[phone]
[e-mail]
4-digit SIC code:
Facility is:
1
Date operation is to begin or began:
1771
❑ New ❑ Proposed ElExisting
04/26/2000
Latitude of entrance:
Longitude of entrance:
35.825152
-79.966673
Brief description of the types of industrial activities and products manufactured at this facility:
General maintenance of construction equipment and fleet vehicles.
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
❑ N/A
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
N/A
Consulting firm:
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.
STEW
N/A
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.824939
-79.966332
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ 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.
STOT
N/A
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.824786
-79.965699
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ 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.
1
STGE
N/A
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.825326
-79.966235
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ 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.
❑ 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? ❑ Yes ❑ 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

S. 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:
N/A
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
N/A
❑ This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
N/A
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
N/A
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
N/A
❑ 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 shipments per 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
N/A
6. Required Items (Application will be returned unless all of the followinR items have been included):
O
Check for $100 made payable to NCDEQ
O
Copy of most recent Annual Report to the NC Secretary of State
O This completed application and any supporting documentation
O
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
El
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 143-21S.6B (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:
O 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.
❑ The information submitted in this NOI 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.
0 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: Scott Niemitalo
Title: President / Owner
(Signature of Applicant)
Mail the entire package to:
(v —lLf— 22
(Date Signed)
DEMLR —Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
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? ❑ 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.
❑ 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? ❑ 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.
❑ 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? ❑ 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.
❑ 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? ❑ 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.
❑ 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? ❑ 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

1. re-
• "-i i� 2/ Storm Water from Main Road i
a
travels into Grate Inlet /Drain y
ie,': •,- (Piping under building) Aq ,
- f OUTFALL3
41
End Wall / spout on
retaining wall
OUTFACE 1 S r �" s �
Outfall for storm _',►i �' y
s ` 7
water that runs
along retaining wall
OUTFACE 2
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Step One: Initial Regulated NIS4OutfallldentiIik, It
The first step in identifying the County s regulated MS4 outfalls utilizes ArcGIS to
perform a desktop analysis of the Countys storm water network GIS database in order
to determine outfalis or other potential outfall structure as a regulated MS4 outfall. In
general. Storm Water nodes with a 'Strucl_Type_Code" of "STEW" or End Wall should
be considered a potential outfall
• O STBMP; STDO - BMP or Detention Outlet
• .� STCB - Catch Basin
•
STEW
End Wall
• G
STGE
- Grate Inlet
STJN
- Junction
}
STMH
- Manhole
•
STOT
Other
• t
STYI -
Yard inlet

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CA202217200092
SOSED: 0547296
Date Filed: 6/21/2022
BUSINESS CORPORATION ANNUAL REPO Elaine F. Marshall
�,% } North Carolina Secretary of State
u6 CA2022 172 00092
NAME OF BUSINESS CORPORATION: American Concrete Construction, Inc.
SECRETARY OF STATE ID NUMBER: 0541296 STATE OF FORMATION: NC 9M Otfte USeo y
REPORT FOR THE FISCAL YEAR END: 2022
SECTION A: REGISTERED AGENTS INFORMATION
® Changes
1. NAME OF REGISTERED AGENT: SCOtt L Niamital0
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
3194 Sumner Rd
P O Box 4940
Trinity, NC 27370 Randolph Archdale, NC 27263-4940 Guilford
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Concrete Construction
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAI, Privacy Redaction
E
4. PRINCIPAL OFFICE STREET ADDRESS 6. PRINCIPAL OFFICE MAILING ADDRESS y
3194 Sumner Rd P O Box 4940
Trinity, NC 27370 Randolph Archdale, NC 27263-4940 Guilford
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: Karen Nlemital0 NAME: Scott Nlemitalo
NAME:
TITLE: Secretary TITLE: President TITLE:
ADDRESS: ADDRESS: ADDRESS:
4340 Morning Side Lane 4340 Morning Side Lane
Trinity, NC 27370 Randolph Trinity, NC 27370 RANDOLPH
SECTION D: CERTIFICATION OF ANNUAL RgW. Section D must be Completed in its entirety by a person/business
entity.
SIGNATURE DATE
Form must be signed by an officer listed under Secgon CCatNsform.
Print or Type Name of Officer Print or Type Title of Officer
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $25
MAIL TO: Secretary of State, Business Regtsbadon Division, Post Office Box 29525, Raleigh, NC 27626-0525