NCG140530_Application_20230915

�CcGived
FOR AGENCY USE ONLY
NCG140 5 30
Assigned to: T. Coop•
ARO CF�p MRO RRO WARD WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG140000 Notice of Intent
This General Permit covers STORMWATER AND/OR WASTEWATER DISCHARGES associated with activities under
SIC(Standard Industrial Classification)Code 3273(Ready Mix Concrete)and like activities. 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 (8) below to: NCDEMLR Stormwater Program, 1612 MSC,Raleigh,INC 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):
{,ame of legal organizational entity: Legally res nsibi person as signed in Item(9) below:
HcrTL
3u f m'kt 5uv,ca CDc rr �on G/
rQet ad ss: �� City: State: Zip Code:
-a 'v tc SrM�oc C ,+330
Tel hone umb r: Email address:
e
9"1175 - SoIU Csk; h*-nsC� �+ �sCn � . fom
Type of Ownership:
Government
❑County ❑ Federal ❑ Municipal ❑State
No government
Business(If ownership is business,a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility (facility being permitted):
F di name: Facilitya vvonmental c ntact:
btrr crt C laa+ 3 or�4ble �-�t.► r C. Sl. rl
Street add ess: City: Sta a Zip Code:
a C,�r0�ina Ardcul c, a8s(s
Parcel Identification Number(PIN): County: n
4 9G3a48& gs M06rG
Telephone number: I / _, -7 e _ r l Email address: 1U C' VI h I Q Ip r"OLI' , d
4-digit SIC cde: I' is: J J te operation is to begin or beg
3211 Ne ❑ ElDa
Proposed Existing j-t 4rnbtr�� 6 a3
Latitude of entrance: Longitude of entrance:
35 , 0 O - 11. 39a5161
Brief description of the types of industrial activities and products manufactured at this facility:
1 s )Pro,wCVlon 6f dj mi x 15 e UA4 .unmet} MA fly
If the storm ater discharges to a municipal se arate storm sewer Vystem(MS4), na a the operator of the MS4:
❑ N/A
Page 1 of 7

This facility uses:
❑ Phosphorus-containing detergents
❑ Non-Phosphorus-containing detergents
❑ Brighteners
❑dither Cleaning Agents
Other: 5 f VIA
This facility has a closed-loop recycle system that meets design requirements in 15A NCAC 02T. 1000 and hold the facilities
working volume
❑Yes—stop completion of this NOL Contact DW R Non-Discharge Permitting Program for permitting requirements
❑ No
3. Consultant(if applicable):
Name of consultant: Consulting firm: �(
�,.ftwl+ eVY1�S IhbMGS �n '�ntcr;•�, �
Street ddress: City: State: Zi ode:
43 6k( 10}4 a e *e- 1154 S j, NIL 7336
Telephone number: I Email address:
R(q ' 1-11.4bl J-{ kahIaS 4Ao►»astn intuin , Co►rl
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.
114 '2.- ( _` a G ID This watershed has a TMDL
Discharge from this outfall is from:
Stormwater Only ❑ Wastewater Only ❑Wastewater Comingled with Stormwater
7Q30 Flow of receiving waterbody(if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW,ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA):
Discharge occurs from this outfall:
Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: 35 0 Longitude of outfall:
. ► �8
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage are 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.
Discharge from this outfall is from:
❑Stormwater Only ❑Wastewater Only ❑ Wastewater Comingled with Stormwater
7Q30 Flow of receiving waterbody(if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW,ORW,Tr,WS-I,WS-11,WS-111,SA,or PNA):
Discharge occurs from this outfall:
❑Only during a rainfall event ❑Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
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 are 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 2 of 7

3-4 digit identifier: Name of receiving water: Classification: ❑This water is impaired.
E]This watershed has a TMDL.
Discharge from this outfall is from:
❑ Stormwater Only ❑Wastewater Only ❑Wastewater Comingled with Stormwater
7Q10 Flow of receiving waterbody(if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW,ORW,Tr,WS-I,WS-ll,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
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 are 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.
Discharge from this outfall is from:
❑Stormwater Only ❑Wastewater Only ❑ Wastewater Comingled with Stormwater
7Q30 Flow of receiving waterbody(if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW,ORW,Tr,WS-1,WS-II,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
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 are 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.
5. Wastewater
Types of Wastewater facility will generate or discharge
Vehicle&equipment cleaning(VE) ❑ Generate ❑ Discharge ❑ Sent to WW Treatment System
Wetting of raw material stockpiles(RM) ❑ Generate ❑ Discharge ❑ Sent to WW Treatment System
Mixing drum cleaning(MD) ❑ Generate ❑ Discharge ❑ Sent to WW Treatment System
Facility will spray-down or actively wet aggregate piles
Yes fI I 11 II �1,/
❑ No Qn t Qrtri n d d h� S teS G/t�i�td/` -to
�rev4" 1u5} d- vsev frrA;nfui� qu�ci+i�r Con�+ol
Page 3 of 7

6. Wastewater treatment alternatives
What wastewaters were considered for this alternatives review: ❑ VE ❑ RM ❑ MD
Are there existing sewer lines with a one mile radius: ❑ Yes No
If Yes:
❑The wastewater treatment plant will accept the wastewater.It is feasible to connect. Explain:
❑The wastewater treatment plant will accept the wastewater. It is not feasible to connect. Explain:
❑ The wastewater treatment plant will not accept the wastewater(attach a letter documenting)
❑ Surface or subsurface disposal is technologically feasible
❑ Surface or subsurface disposal is not technologically feasible
Explain:
❑ Surface or subsurface disposal system is feasible to implement
❑ Surface or subsurface disposal system is not feasible to implement
Explain:
What is the feasibility of employing a subsurface or surface discharge as compared to a direct discharge to
surface waters?Explain:
Discharge to surface waters is the most environmentally sound alternative of all reasonably cost-effective
options of the wastewaters being considered:
❑ Yes
❑ No—contact DEMLR's Land Application Unit to determine permitting requirements
If this review included all wastewater discharge types,would excluding some types make of the above non-
discharge options feasible?
❑ Yes
❑ No
7. Other Facility Conditions (check all that apply and explain accordingly):
❑This facility has a DMLR Erosion&Sedimentation Control Permit.
If checked,list the permit numbers for all current E&SC permits for this facility:
❑This facility has a Division of Waste Management permit.
If checked,list the permit numbers for all current DWM permits for this facility:
❑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 show on site diagram:
❑This facility has a Stormwater Pollution Prevention Plan(SW PPP).
If checked,please list the date the SWPPP was implemented:
Page 4 of 7

❑This facility is subject to Phase II Post-Construction Area
If checked,please list the permitting authority:
❑This facility is located in one of the 20 Coastal Counties
If checked,please indicate if the facility is adding more than 10,000 ft2 of built-upon area or is a CAMA Major Permit
❑ Will add more than 10,0000 ft of built-upon area
❑ Is a CMA Major Permit
❑Yes to both
No to both
❑This facility is discharging wastewater to a stormwater BMP
If checked,please indicate the permitting authority,and attach letter approval to do so:
❑This facility has wastewater treatment facilities in the 100-year floodplain
❑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 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
8. RE red Items (Application will be returned unless all of the following items have been included):
Check for$100 made payable to NCDEQ
C y of most recent Annual Report to the NC Secretary of State
T ' completed application and any supporting documentation
A line drawing of the water flow through the facility.
10 Copy of county map or USGS quad sheet with the location of the facility clearly marked
❑ Letter documenting that W WTP will not accept wastewater(if applicable)
❑ Approval from permitting authority to discharge wastewater to a stormwater BMP(if applicable)
Page 5 of 7

❑Two(2)24"x 36" site diagrams showing,at a minimum,existing and proposed:
a) outline of drainage areas
b) Stormwater/wastewater treatment structures
c) Location of numbered stormwater/wastewater outfalls(corresponding to which drainage areas)
d) Delineation of drainage areas to each discharge point
e) Runoff conveyance structures
f) Areas and acreage where materials are stored
g) Impervious area acreages
h) Locations(s)of streams and/or wetlands the site is draining to, and applicable buffers
i) Site property lines, North Arrow,and bar scale
j) If applicable,the 100-yearfloodplain line
k) Acreage of each stormwater and wastewater topographical area
1) Each of the facilities'wastewater or Stormwater source and discharge structures and each of its hazardous waste
treatment,storage,or disposal facilities
m) Notation of the water quality classification of the receiving water that site waters eventually discharge to
n) Site location(insert)
9. Applicant Certification:
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).
Un r penalty of law, I certify that:
I am the person responsible for the permitted industrial activity,.for satisfying the requirements of this permit,and for any
w il 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
m inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the
nfcrm 'on.
I wl bide by all conditions of the NCG140000 permit. I understand that coverage under this permit will constitute the
rmit requirements for the discharge(s)and is enforceable in the same manner as an individual permit.
I hereby request coverage undde ` 7er the NCG14000000 General Permit. L
Printed Name of Applicant: L'</F',a -0.0HE'NS X wel Sl q�
Title: -,Qes/bEA/T
9//q /z3
(Signature of Ap li ant) c (Date Signed)
Mail the entire package to: DEMLR—Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 6 of 7

Additional Outfalls
34 digit identifier: Name of receiving water: Classification: ❑This water is impaired.
❑This watershed has a TMDL.
Discharge from this outfall is from:
❑Stormwater Only ❑ Wastewater Only ❑Wastewater Comingled with Stormwater
7Q10 Flow of receiving waterbody(if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW,ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑Only during a rainfall event ❑Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
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 are 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.
Discharge from this outfall is from:
❑Stormwater Only ❑Wastewater Only ❑Wastewater Comingled with Stormwater
7Q10 Flow of receiving waterbody,(if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW,ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
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 are 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.
Discharge from this outfall is from:
❑Stormwater Only ❑Wastewater Only ❑Wastewater Comingled with Stormwater
7Q10 Flow of receiving waterbody(if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HOW,ORW,Tr,WS-1,WS-II,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑Only during a rainfall event ❑ Intermittently(indicate how often) ❑Continuously(indicate flow in CFS)
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 are 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 7 of 7

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CONDITIONS
1) This concrete contains correct water content for strength of mix indicated.We do not assume responsibility for strength test when water is added at customer's request.
2) We make deliveries inside of curb line and on the lot at customer's risk only,and accept no responsibility whatsoever for damage resulting from such deliveries.
3) Stand-By condition:When trucks are held at work side,in excess of free delivery time,the purchaser will be billed for excess time.
MATERIAL SAFETY DATA SHEET
(Only Applicable Data Provided for Each Section)
SECTION I - DATE: 3-26-87
Manufacturer's Name: Heritage Concrete Emergency Telephone Number: [phone]
Address: 140 Deep River Road, Sanford, NC 27330 Trade Names: Heritage Concrete
Chemical Family: Portland Cement
SECTION It- HAZARDOUS INGREDIENTS: Cement(Lime) and,possible traces of hexavalent chromium
SECTION III-PHYSICAL DATAti.
Specific Gravity: 1.9 to 2.4 Solubilityin Water:01. to 1.0%
Appearance and Odor: Gray, plastic, flowable, granular, mud;odorless
SECTION IV-FIRE AND EXPLOSION HAZARD DATA: N.A:all sections
SECTION V-HEALTH HAZARD DATA 11*
TLV: None Effects of Over zposure: Dry skin and possible alkali burns (cement dermatitis).
Also possible traces of hexavalent chromium.
Emergency First Aid Procedures: Irrigate eyes with water.Wash affected areas of the body with soap and water.
rs
SECTION VI-REACTIVITY DATA
Stability Unstable Conditions-fo Avoid: Product sets and hardens in 2 to 8 his.
X ,z- and is no longer hazardous.
Hazardous WIII,Not OccukJ
Polymerization 1 / X
SECTION VII-SPILL OR LEAK'PROCEDURES '
Steps to be Taken in Case material is Released or Spilled: Spill does not increase hazard.
Waste Disposal Method: Once hardened, material can be disposed of as common waste.
SECTION VIII-SPECIAL PROTECTION INFORMATION
Protective Gloves:Yes Eye Protection: Yes,when placement methods cause splashing.
Other Protective Equipment. Use barrier creams, gloves, boots, and clothing to protect skin from
prolonged contact with plastic concrete.
SECTION IX-SPECIAL PRECAUTIONS
Precautions to be Taken in Handl'itig-and-Storage: See above
Other Precautions: Immediately after working with concrete, workers should shower with soap and water.
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