NCG020204_Dormant Status Recertification N/A_20221215

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 Annual Certification Form
Please complete this form if you want to maintain a facility's current dormant status designation.
Directions:
Print or type all entries on this certification form.
Attach this form to the by selecting "Dormant Status Recertification" from the
dropdown menu.
Once you receive the email stating the upload was received, mail this certification form to the appropriate
'Q Regional Office.
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:
0 I, as the legally responsible person or authorized representative, request renewal of the dormant status
designation currently granted to the subject facility.
FV The subject facility is still temporarily inactive and all portions of the site where clearing, grading, and/or
excavation activities have occurred are stabilized with permanent vegetation.
❑✓ I will notify the Division in writing within thirty (30) days prior to reactivating and/or commencing mining
activity at the subject facility.
❑✓ 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 - Lexington Quarry
Permit Number: NCG020204
Date of Dormant Status Approval: Dormant Status Request submitted on 9/29/2021
Printed Name of Person Signing: Jack Garvey
Title: Environmental Manager
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(Signature) (Date Signed)
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From: [e-mail]
Sent: Wednesday, September 29, 2021 3:43 PM
To: Garvey, Jack H (Raleigh) USA
Cc: [e-mail], [e-mail], Garvey, Jack H (Raleigh)
USA
Subject: Stormwater Supplemental Upload Received
Thank you for submitting the supplemental information for NCG020204 - Hanson Aggregates - Lexington Quarry. If you
have questions about the status, contact Suzanne McCoy at [e-mail].
Be sure to add [e-mail] to your contacts to avoid future a -mails from going into Spam filters.
The NC DEMLR Stormwater Program
512 N. Salisbury Street, Archdale Building 6th Floor (640K), 1612 Mail Service Center, Raleigh, NC 27699-1612

D_E IBC Stormwater - Supplemental Information Upload
Fields marked with an asterisk * are required.
NOTE. Do not use this form to upload industrial stormwater Data Monitoring Reports (DMRs). Please use this
DMR Upload form instead.
Permit Information:
Please provide specific permit details below.
......................................................................................................................
What Type of Permit? Choose one:
* NPDES Industrial or MS4 Permit
State Stormwater (Post -Construction) Permit
Other
Permit Number* NCG020204
Begins with "SW", "NCG", or "NCS"
Post -construction projects in the 20 coastal counties are reviewed by the regional office, and other projects are reviewed
by the Central Office. To see counties handled by each coastal office, view information for the Wilmington Regional
Office or Washington Regional Office. Be sure to choose the office below that matches the one listed in your
confirmation email.
Facility Name* Hanson Aggregates - Lexington Quarry
For NPDES permits
OwnerlOperator* Hanson Aggregates Southeast LLC
County: Davidson
Submitter Name:* Jack Garvey
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 13366697565
Additional E-mail for [e-mail]
Submittal (Optional)
Confirmation:
NPDES Permit Information Uploads

Choose file type and upload attachment
File Type* Dormant Status Initial Request
File Upload* Click the upload button, or drag and drop files to attach
Lexington 2021 Dormant Staus Request Form.pdf 58.96KB
Lexington 6-20-17 Stormwater Inspection Report 6... 70KB
Only PDF files are accepted.
Please alert us to any conPdential information contained in the uploaded documents. Also, please do NOT
upload copies of checks with routing number information.
Uploads contain NO
Confidential YES
Information * NOTE: The following information cannot be claimed as confidential: the name and address of any permit applicant
or permittee, permit applications, permits, effluent data, information required by NPDES application forms provided
by the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Notes about the attachments:
The completed dormant status initial request form is attached for this "greenfield" site that has never been disturbed.
The attached WSRO inspection in 2017 confirms the site is a greenfield site and is stabilized.
* By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this form;
o I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of the
NC General Statutes (the "Uniform Electronic Transactions Act")
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
a I intend to electronically sign and submit the Supplemental Information Upload form.
Full Name:*
Signature: *
Jack Garvey
0&.16 41;? 4
Date Submitted: 09/29/2021

FOR AGENCY USE ONLY
NC
ARO FRO MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
NCGO2O000
Dormant Status Request Form
Please complete this form if you are pursuing a new dormant status designation for a facility.
Directions:
• Print or type all entries on this request form.
• Attach this form to the S_tormwater Upload Fv 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:
0✓ 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.
✓❑ 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 - Lexington Quarry
Permit Number: NCG02O204
Date Facility Went Inactive: Greenfield site; has never been active.
Printed Name of Person Signing: Jack Garvey
Title: Area Environmental Manager
9/29/21
(Signature) (Date Signed)
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PermitNCGO20204
SOC:
County: Davidson
Region: Winston-Salem
Contact Person: Jack Garvey
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Compliance Inspection Re;?ort
Effective: 10/01/15 Expiration: 09/30/20 Owner: Hanson Aggregates Southeast LLC
Effective: Expiration: Facility: Hanson Aggregates - Lexngton Quarry
NC Hwy #8
Inspection Date: 06/20/2017
Primary Inspector. Blair Palmer
Secondary Inspector(s): ,
Title:
EntryTime: 10:O0AM
Certification:
Lexington NC 27292
Phone: [phone]
Phone:
Exit Tlme: 10:00AM
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Mining Activities Stormwater Discharge COC
Facility Status: Compliant [] Not Compliant
Question Areas:
r Storm Water
(See attachment summary)
Page: 1

permit: NCG020204 Owner - Facility: Hanson Aggregates Southeast LLC
Inspection Date: 06/20/2017 Inspection Type: Compliance Evaluation Reason for Vtsit: Routine
Inspection Summary:
Facility is a greenfield.
Page: 2

Permit: NCG020204 Owner -Facility: Hanson Aggregates Southeast LLC
Inspection Date: 06/2012017 Inspection Type: Compliance Evaluation
Stormwater Pollution Prevention Plan
Does the site have a Stormwater Pollution Prevention Plan?
# Does the Plan include a General Location (USGS) map?
# Does the Plan include a 'Narrative Description of Practices"?
# Does the Plan include a detailed site map including outfall locations and drainage areas?
# Does the Plan include a list of significant spills occurring during the past 3 years?
# Has the facility evaluated feasible alternatives to current pradices?
# Does the facility provide all necessary secondary containment?
# Does the Plan include a BMP summary?
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
# Does the facility provide and document Employee Training?
# Does the Plan include a list of Responsible Party(s)?
# Is the Plan reviewed and updated annually?
# Does the Plan include a Stormwater Facility Inspection Program?
Has the Stormwater Pollution Prevention Plan been implemented?
Comment:
ualitative Monitorinw,
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment:
Analy#ical Monitoring
Has the facility conducted its Analytical monitoring?
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Comment:
Permit and Outfalls
# Is a copy of the Permit and the Certificate of Coverage available at the site?
# Were all outfalls observed during the inspection?
# If the facility has representative outfall status, is it properly documented by the Division?
# Has the facility evaluated all illicit (non stormwater) discharges?
Comment:
Reason for Visit: Routine
Yes No NA NE
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Page: 3