NCG140531_Application_20231106

, RECEIVED
FOR AGENCY USE ONLY
NCG14 b 5 3\ kOV i, 1 2023
Assigned to: W. Cooly Dki&R-Slormwater Program
ARO FRO MRO RRO WARO WIR W O
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,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(9)below:
Forsyth Redi-Mix, Inc Annie Speer
Street address: 100 Anderson Street City: Rural Hall State: NC Zip Code:
27045
Telephone number: 336-969-0446 Email address: [e-mail]
Type of Ownership:
Government
❑County ❑Federal ❑Municipal ❑State
Non-government
®Business(If ownership is business,a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility (facility being permitted):
Facility name: Forsyth Redi-Mix Mocksville Facility environmental contact: Jason Speer
Street address: 322 Bethel Church Road City. Mocksville State: NC Zip Code:
27028
Parcel Identification Number(PIN): 5748-54-4855 County: Davie
Telephone number: 336-969-0446 Email address: [e-mail]
4-digit SIC code: Facility is: Date operation is to begin or began:
3273 ® New ❑ Proposed ❑ Existing 04/01/2024
Latitude of entrance: 35.897004 Longitude of entrance: -80.536547
Brief description of the types of industrial activities and products manufactured at this facility:
Redi-Mix Concrete
If the stormwater discharges to a municipal separate storm sewer system(MS4),name the operator of the MS4:
® N/A
Page 1 of 7

This facility uses:
® Phosphorus-containing detergents
❑ Non-Phosphorus-containing detergents
❑ Brighteners
❑ Other Cleaning Agents
IN Other: See study about limited phosphorus remover"Right Off'
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 N01.Contact DWR Non-Discharge Permitting Program for permitting requirements
® No
3. Consultant(if applicable):
Name of consultant: Consulting firm: PilotSE, PC
Cory George, PE, PLS
Street address: 106 S. Depot Street, STE D City: State: zip c
Pilot Mountain INC 2� 1
Telephone number: Email address: [e-mail]
336-422-6741
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 Dutchman Creek C ❑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 HQW,ORW,Tr,WS-1,WS-11,WS-III,SA,or PNA):
Discharge occurs from this outfall:
9 Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: 35.896544 Longitude of outfall: _80.535414
Brief description of the industrial activities that drain to this outfall: Redi-mix raw materials, mixing plant
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
7C.10 Flow of receiving waterbody(if discharging Wastewater Only or Wastewater Comingled with Stormwater to waters
classified as HQW,ORW,Tr,WS-I,WS41,WS411,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 ear?
Page 2 of 7

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-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?
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.
S. 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
❑ No
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:
Due to location of sewer and desire to observe and test discharge, it is not feasible to connect.
❑ 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: No surface water located onsite, discharge from treatment pit will be onto surface.
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:
In progress.
❑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:
K This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram: Wash-pit/settling basin.
®This facility has a Stormwater Pollution Prevention Plan(SWPPP).
If checked, please list the date the SWPPP was implemented: SWPPP generated for this facility.
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
S. Required Items(Application will be returned unless all of the following items have been included):
IN Check for$120 made payable to NCDEQ
X] Copy of most recent Annual Report to the NC Secretary of State
�]This completed application and any supporting documentation
1 A line drawing of the water flow through the facility.
® Copy of county map or USGS quad sheet with the location of the facility clearly marked
❑ Letter documenting that WWiP 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) 2,r 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-year floodplain 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 143-215.6B(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:
CE71 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.
LYThe 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.
( I will abide by all conditions of the NCG140000 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.
IKI hereby request coverage "under the NCGI400000 General
Permit.
Printed Name of Applicant: I Ur ZL/ ` eC m C
Title: VJQ
,/7 — g3
(Signature of Applicant) (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
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 HQW,ORW,Tr,WS-I,WS-11,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: Classif cation: ❑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 HQW,ORW,Tr,WS-1,WS-11,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 HQW,ORW,Tr,WS-I,WS-11,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