NCG520101_owner (name change)_20240122

NORTH CAROLINA
Environmental Quality
RECEIVED
NC DEPARTMENT OF ENVIRONMENTAL QUALITY
JAN 2 2 'l'U -.
W(-,DEQ/DWR/NPDES
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: or NCG520101
1. Facility Name: Prevette Pit
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
_a. Change in ownership of property/company
b. Name change only
NPDES PERMITTING
x c. Other (please explain): Current oermitee, Carl Rose & Sons Inc. transferred mining
permit to Tarheel Sand & Stone Inc. A new lease agreement was made with land owner and permit
NCG520101 needs to be updated to reflect Tarheel Sand & Stone Inc as the permitee
2. New owner's name (name to be put on permit):
Tarheel Sand & Stone, Inc
3. New owner's or signing official's name and title: J. Keith Adams
(Person legally responsible for permit)
President
(Title)
4. Mailing address: 1108 Tuckda Way City: Hamotonville
State: NC Zip Code: 27020 Phone: [phone]
E-mail address: tarheelssinc(&Vadtel.net
FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same asunder the previous owner? Yes Q No ❑
2. Will the treatment system and discharge location remain the same? Yes 0 No ❑
"No Responses"
If either or both of these questions ore answered "No" then more information will be needed to review the
request. Please attach documentation to describe and explain the changes to the facility activities, waste
om�vmuna�ua.en� /'�
North Carolina Department of Environmental Quality I Division of Water Quality
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

NPDES Name and Ownership Change
Page 2 of 2
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
3. Information to document facility, waste stream, treatment system or outfall changes as noted in
item III above (if appropriate)
Applicant's Certification:
I, J. Keith Adams attest that this application for a
name/ownership change has been reviewed and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required
supporting information and attachments are not included, this application package will be returned as
incomplete. I understand that Permit Name/Ownership Change can only take place through action
taken by the Division of Water Resources and that no actions on my part or the part of my company
result in the automatic transfer of permit coverage.
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 07/2021