NCG020301_COMPLETE FILE - HISTORICAL_20170303

STORMWATER DIVISION CODING SHEET -
RESCISSIONS
PERMIT NO.
/11060 l030�
DOC TYPE
El COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
❑ pc.Lo 3 D,3
YYYYMMDD

Energy, Mineral &
Land Resources
ENVIRONMENTAL OUALITY
Mr. Sam W. Smith, Jr.
Sam W. Smith, Inc.
P.O. Box 428
Eden, N.C. 27289-0428
Dear Mr. Smith:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
March 3, 2017
Subject: Rescission of NPDES Stormwater Permit
Certificate of Coverage Number NCG020301
Rockingham County
On December 22, 2016, the Division of Energy, Mineral and Land Resources received your
request to rescind your coverage under Certificate of Coverage Number NCG020301. In
accordance with your request, Certificate of Coverage Number NCGO020301 is rescinded
effective immediately.
Operating a treatment facility, discharging wastewater or discharging specific types of
stormwater to waters of the State without valid coverage under an NPDES permit is against
federal and state laws and could result in fines. If something changes and your facility would
again require stormwater or wastewater discharge permit coverage, you should notify this office
immediately. We will be happy to assist you in assuring the proper permit coverage.
If the facility is in the process of being sold, you will be performing a public service if you would
inform the new or prospective owners of their potential need for NPDES permit coverage.
If you have questions about this matter, please contact us at 919-707-9200, or the Stormwater
staff in our Winston-Salem Regional Office [phone].
cc: Winston-Salem Regional Office
Stormwater Permitting Program
Central Files - w/attachments
Sincerely,
OR:UNAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, PE, CPM, Director
Division of Energy, Mineral and Land Resources
Nothing Compares_�_,
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salishury Street 1 1612 Mail Service Center I Raleigh. North Carolina 27699-1612
919 707 9200

Alexander, _Laura
From:
White, Glen
Sent:
Friday, February 24, 2017 11:50 AM
To:
Alexander, Laura
Subject:
RE: Rescission Request for NCG020301
Follow Up Flag:
Fallow up
Flag Status:
Flagged
We are fine with rescinding NCG020301.
Glen White
Environmental Specialist
NCDENR Winston-Salem Regional Office
Division of Energy, Minerals & Land Resources
450 Hanes Mill Rd — Suite 300
Winston-Salem, NC 27105
glen. wh [e-mail]
[phone]
From: Alexander, Laura
Sent: Friday, February 24, 2017 11:09 AM
To: White, Glen <[e-mail]>
Subject: FW: Rescission Request for NCG020301
Glen,
Can you give me a status on the rescission? The lady that owns the facility has left me a message.
Thank you,
Laura
From: Alexander, Laura
Sent: Tuesday, January 10, 2017 11:17 AM
To: White, Glen <[e-mail]>
Subject: Rescission Request for NCG020301
Glen,
Please see attached rescission request for a facility in Rockingham county.
Thank you,
Laura
From: scanner.942A.arc_h_@ncdenr.R [mailto:scanner.942A.arch2ncdenr. ovj
Sent: Tuesday, January 10, 2017 12:23 PM
To: Alexander, Laura <Iaura.alexanderC�ncdenr.gov>
Subject: Scanned page
1

AV
r��
NORTH GROLINA OERAN��OF
ENVIRONMENT AND NATURAL RESOURCE,
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date, Received
Year
Month day
r u„ ✓
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit,
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N�101 PLC
2) Owner/Facility Information: * Final correspondence will he moiled to the address noted below
Owner/Facility Name S-Ckh4
Facility Contact
Street Address
City
County
Telephone No.
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
Facility closed or is closing on $,` 3ci All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
Q'lFacility sold to V ' "' ` 60 6 on C l/ . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
❑ Other:
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for 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.
V 2
Signature I. �� � 1'� Date
Print or type name of person sign' i�r g above Title
Please return this completed rescission request form to: NPDE5 Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mal Service Center, Raleigh, North Carolina 27699.1612
Phone, 919-807-6300 L FAX: 919$07-6492
An Equal Opportunely 1 Affirmative Action Employer

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
February 7, 2005
Sam Smith, Jr
Sam W Smith Inc
PO Box 428
Eden, NC 27288
Subject: NPDES Stormwater Permit Coverage Renewal
Sam W Smith Incorporated
COC Number NCG020301
Rockingham County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG020000 the Division of Water
Quality (DWQ) is forwarding herewith the reissued stormwater general permit. Please review the new permit to familiarize
yourself with the changes in the reissued permit. The general permit authorizes discharges of stormwater and some types of
wastewater. You must meet the provisions of the permit for the types of discharges present at your facility. This permit is
reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
• A new Certificate of Coverage
A copy of General Stormwater Permit NCG020000
• A copy of a Technical Bulletin for the general permit
• Five copies of Discharge Monitoring Report (DMR) Forms - wastewater and stormwater
Five copies of Qualitative Monitoring Report Form
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require modification
or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal requirements to obtain other
permits which may be required by DENR or relieve the permittee from responsibility for compliance with any other applicable
federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
If you have any questions regarding this permit package please contact Bethany Georgoulias of the Central Office Stormwater
Permitting Unit at [phone], ext.529.
Sincerelv,II
for Alan W. Klimek, P.E.
cc: Central Files
Stormwater & General Permits Unit Files
Winston-Salem Regional Office
Onc
No ihCaroI'na
��flf!llYl��lf
North Carolina Division of Water Quality 1617 Mail Scrvice Center Raleigh, NC 27699-t617 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.uslsulstomrxater.htmi 512 N. SaliSbury St. Raleigh, NC 27604 FAX [phone]
An Equal OpportunitylAffrmative Action Employer — 50% Recycled110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020301
STORMWATER AND PROCESS WASTEWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended,
Sam W Smith Inc
is hereby authorized to discharge stormwater and to operate treatment systems and discharges associated
with mine dewatering wastewater and process wastewater from a facility located at
Sam W Smith Incorporated
NC Hwy 770
Eden
Rockingham County
to receiving waters designated as the Dan River, a class C TR stream in the Roanoke River Basin in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II,
III, IV, V, and VI of General Permit No. NCG020000 as attached.
This certificate of coverage shall become effective February 7, 2005.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 7, 2005
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
December 17, 1999
SAM SMITH JR
SAM W SMITH INC.
P.O. BOX 428
EDEN, NC 27288
r�
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissue - NPDES Stormwater Permit
Sam W Smith Inc.
COC Number NCG020301
Rockingham County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG020000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
* A copy of general stormwater permit NCG020000
* Five copies of the Analytical Monitoring form and five copies of the Qualitative Monitoring form
* A copy of a Technical Bulletin on this permit which outlines permit components and
addresses frequently asked questions
* A Certificate of Coverage for your facility
* DWQ fee schedule
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule, standard, ordinance, order, judgment, or
decree.
Please note that in 1998 Senate Bill 1366 established changes to the permit fee structure for DWQ permits effective
January 1, 1999. This change requires that you pay an annual fee to assure continued coverage under this permit.
You will be invoiced for this fee beginning next year. A copy of the current fee schedule is included with this letter.
If you have any questions regarding this permit package please contact Tony Evans of the Central Office Stormwater
and General Permits Unit at [phone], ext. 584
Sincerely,
b�'���/fir
for Kerr T. Stevens
Director, Division of Water Quality
cc: Central Files
Winston-Salem Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020301
STORMWATER AND PROCESS WASTEWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
SAM W SMITH INC.
is hereby authorized to discharge stormwater and to operate or continue operation of treatment systems and
discharges associated with mine dewatering and process wastewater from a facility located at
SAM W SMITH INC.
NC HWY 770
EDEN
ROCKINGHAM COUNTY
to receiving waters designated as the Dan River in the Roanoke River Basin in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II,11I. IV, V, and VI of General
Permit No. NCG020000 as attached.
This certificate of coverage shall become effective December 17, 1999.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 17. 1999.
eiv
for Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

.State of North Carolina
bepartment of Environment,
:Health and Natural Resources
Division of Environmental Management
'James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
July 14, 1995
Sam Smith Jr
Sam W Smith Inc
P.O. Box 428
Eden, NC 27288
Dear Sam Smith Jr:
A MIW
14 00
IDEHNF1
Subject: General Permit No. NCG020000
Sam W Smith Inc
COC NCG020301
Rockingham County
In accordance with your application for discharge permit received on April 25, 1995, we are forwarding
herewith the subject certificate of coverage to discharge under the subject state - NPDES general permit. This
permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated
r:
December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management may require modification or
f . revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Environmental Management or permits required by the Division of Land Resources, Coastal
Area Management Act or any other Federal or Local governmental permit that may be required
If you have any question concerning this permit, please contact MR. STEVE ULMER at telephone
number 919f733-5083.
Sincerely, Original Signed Sy
Coleen H. Sullins
cc: Winston-Salem Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535
An Equal Opportunity Affirmative Action Employer
A. Preston Howard, Jr. P.E.
Telephone [phone] FAX [phone]
50% recycled/ 100% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO. NCGQ20Q.QQ
CERTIFICATE OF CQVERAQE NO, NCG020301
STORMWATER, MINE DEWATERING, AND/OR OVERFLOW FROM
PROCESS WATER RECYCLE SYSTEMS DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Stun W. Smith, Inc.
is hereby authorized to discharge stormwater from a facility located at
NC Hwy 770
Eden
Rockinolia m County
to receiving waters designated as the Dan River in the Roanoke River Basin
in accordance with the effluent limitations, monitoring requirements, acid other conditions set forth in Parts 1, il, Ill
and IV of General Permit No. NCG020000 as attached.
This Certificate of Coverage shall become effective July 14, 1995.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 14, 1995.
0"*,11 SignPcl Fay
Culom }i. Stlifirts
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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