NCG020120_Name-Owner Change Approval and COC_20180125

_ ROY COOPER
Governor
x�'Secretary
MICHAEL S. REGAN
W WILLIAM E. TOBY VINSON, JR.
Energy, Mineral Interim Director
and Land Resources
ENVIRONMENTAL QUALITY
January 25, 2018
Mr. J. David McKeown
Meridian Brick, LLC
5100 Brickyard Road
Columbia, S.C. 29203
Subject: NPDES Stormwater Permit NCG020120
Meridian Brick, LLC
Formerly Forterra Brick, LLC
Anson County
Dear Mr. McKeown:
Division personnel received your request to revise your stormwater permit Certificate of Coverage to accurately
reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in the General
Permit remain unchanged and in full effect. This revised Certificate of Coverage is issued under the
requirements of North Carolina General Statutes 143-215.1 and the Memorandum of Agreement between
North Carolina and the U.S. Environmental Protection Agency.
If you have any questions or need further information, please contact the Stormwater Permitting Program
at [phone].
State of North Carolina I Environmental Quality I Energy, Mineral, and Land Resources
Central Office 1 1612 Mail Service Center I Raleigh, NC 27609
919 707 9200

Sincerely,
Original Signed by
Robert D. Patterson, P.E.
for William E. Toby Vinson, Jr., PE, CPESC, CPM
Interim Director
Division of Energy, Mineral and Land Resources
cc: Fayetteville Regional Office
Stormwater Permitting Program
Central Files

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE No. NCG020120
STORMWATER AND 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,
Meridian Brick, LLC
is hereby authorized to operate approved wastewater treatment system(s) and discharge
stormwater and/or wastewater, as approved in the original permit/application or subsequent
permit modification, from a facility located at:
Anson County Mine
S Horton Road & Camden Church Road
Monroe
Anson County
to receiving waters designated as Little Brown Creek, a class C stream in the Yadkin -Pee Dee
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in accordance in Parts I, II, III, and IV of General Permit No. NCG020000 as
attached.
This certificate of coverage shall become effective January 25, 2018.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day January 25, 2018.
Original Signed by
Robert D. Patterson, P.E.
for William E. Toby Vinson, Jr., P.E., Interim Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATE-STORMWATER PERMIT NAME/OWNERSHIP CHAT ORM�g ,
I. CURRENT PERMIT INFORMATION �, A®fF�
�2d Q
1. Stormwater Management Permit Number: NcG020120
`=. Project Name: Forterra Brick -Anson County Mine
3. Current Permit Holder's Company Name/Organization:
4. Signing Official's Name: J. David McKeown
5. Mailing Address:
5100 Brickyard Road
Forterra Brick, LLC
Title: Regional Environmental Manager
amity: _ Columbia State: SC Zip: 29203
6. Phone:8( 03 ) 691-3121
Fax: (_�03__) 786-9703
If. € ROPOSED PERMI'CTEE-/ OWNER / PROJECT / ADDRESS INFORMATION
This request is for: (please check all that apply)
,% Name change; of the owner (Please complete Items 1, 2 and 3 below)
�] Name change of project (Please complete Item 5 below)
❑ Change in ownership of the property/company (Please complete Items 1, 2, 3, and 4 below)
Mailing address / !phone number change. (Please complete Item 4 below)
Cf � :thea (please explain):
1. Proposed permittee's company name/organization: Meridian Brick LLC
2. Proposed permittee's signing official's name: J. David McKeown
�. Proposed permltt2e`S title: Corporate Environmental Manager
4. Mailing Address: 5100 Brickyard Road
City:
Columbia
Phone: (_803 ) 691-3121
State: SC
Fax: ( 803 ) 786-9703
Zip: 29203
5. New Project Name to be placed on permit: Meridian Brick LLC - Anson County Mine
Please check the appropriate box. The proposed permittee listed above is:
C7 HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA in -V above and provide name of HOA/POA's authorized representative in #2 above)
The property owner
Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
❑ Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner Information on page 4)
SSW N/O Change Rev24Sept2012 Page 1 of 4

III. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may result in processing delays or denial of the transfer.
i. This compieted and.signed form. This certification must be completed and signed by both the
current permit holder and the new applicant if this _is a change of ownership.
2. Legal documentation of the property transfer to a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4. The designer's certification (DWQ Engineer and Designer Certification Forms are available from
_each DWQ Regional office), if required by the permit and if not already submitted to DWQ.
5.11f the proposed permittee is a firm; partnership, association, institution, corporation, limited liability
company, or other corporate entity, provide documentation showing the authority of the named
representative to act on behalf of the proposed permittee.
a. The $40.00 processing fee. If this is an initial transfer trom the original permittee the processing
fee is, not required. Subsequent ownership transfers will require the $40.00 processing fee.
IV. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fill out the certification below that statement.,
j
Check here if the current permittee is rl changing his/her/its name, the project name, or mailing
address, but will retain the permit. I, j 1 , the'current
permittee, hereby notify the DWQ that I a!m changing my name and/or I am changing my mailing,
address and/or ['am changing the name of the permitted project. I further attest that this applicatioh
for a name/ownership change is accurate and complete to the best of my knowledge. I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments listed above are not included, this application package will be returned as ,
incomplete.
[_] . Check here if current permittee is transfernng the property to a new owner and will riot retain
ownership of the permit.
I. _ __, the current permittee, am Submitting Mis application
for a transfer of ownership for permit # I hereby notify DWQ of the sale or
other legal transfer of the stormwater system associated with this permit. I have provided a copy of
the most recent permit, the designer's certification for each EMP, any recorded deed restrictions,
covenants, or easements, the DWQ approved plans and/cr approved as -built plans, the approved
operation and maintenance agreement, pass maintenance records, and the most recent DWQ
stormwater inspection report to the proposed permittee named in Sections II and V of this form.
further atiost that this application for a name/ownership change is accurate and complete to the best
of my knowledge. I understand that if all required parts of this application are not completed or if all
required supporting information and attachments listed above are not included, this application
package will be returned as incomplete. I assign all rights and obligations as permittee to the
proposed permittee named in Sections II and V of this form. I understand that this transfer or
ownership cannot be approved by the DWQ unless and until the facility is in compliance with the
permit.
Signature: _ Date:
a Notary Public for the State of
County of , do hereby certify that
personally appeared before me this the
day of , 20 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal, (Notary Seal)
Notary Signature
SSW N/O Change Rev24Sept2012 Page 2 of 4

J
V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed Permittee for all transfers of ownership)
hereby notify the DWQ that I have acquired
through sale, lease or legal transfer, the responsibility for operating and maintaining the perrAtted
stormwater-management system, and, -if applicable, constructing the permitted system. I
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
the most recent permit
the designer's certification for each BMP
0 any recorded deed restrictions, covenants, or easements
0 tho DWQ approved plans and/or approved as -built plans
E] the approved operation and maintenance agreement
' past mai ntenance -records from the previous permittee (where required)
H� DWQ stormwater inspection report showing compliance within 90 days -prior to this transfer
I have -reviewed the permit, approved plans and other,documents listed above,,and I will comply with
the terms and conditions of -the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to the regiaire,.bents listed in the permit and in the
operation -and maintenance agreement. I further attest that this application for a name;ownership
change is accurate and complete to the best of my knowledge. I understand that if all required parts
of this application are not completed or if all required supporting information and attachments listed
above�are not included, this application package will be returned as incomplete. j
Signature:
Date:
a Notary Public for thib State of
,County of do hereby certify that
personally appeared before me this the '
day of 320 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
(Notary'Seal)
Notary Signature
Additional copies of the original permit and the approved Operation and Maintenance agreement can
be obtained from the appropriate Regional Office of the Division of Water Quality.
This completed form, including all supporting documents and processing fee (if required), should be
sent to the appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources, Division of Water Quality, as shown on the attached map.
- Please note that if the Proposed Permittee listed above is not the property owner, the property owner
must complete and sign page 4 of this document. Both the lessee / developer and the property
owner will appear on the permit as permittees.
SSW N/O Change Rev24Sept2012 Page 8 of 4

r
VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections 11 and V of this form is not Me Property Owner, the
Property Owner .must provide his/her Contact Information below and sign this form:
Printed Name:
Organization:
Title within the Organization: -
Jtreet Address:
City: _ State: Zip:
Mailing Address: -
(if different from street address)
City: _ State: Zip:
Phone: Fax:
Email:
I certify that I own the property identified in this permit transfer document and have given permission
to the Proposed Permittee "listed in Sections II and V to� develop and/or, lease the property. A copy --
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and I will therefore share responsibility for
compliance with the DWQ Stormwater permit. As the property owner, it is my responsibility -to notify
DWQ by submitting a completed Name/Ownership Change Form,within30 days of procuring a
developer, lessee or purchaser for the property.. i understand that failure to operate and maintain the
- stormwater treatment facility in accordance with the permit is a violation of NC General Statute
(NCGS) 143-215.1, and may result in appropriate enforcement action including the assessment of
civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature'of the property owner
Date:
i, , a Notary Public for the State of
County -of _ , do hereby certify that
personally appeared before me this the
day of , 20 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signature
SSW N/O Change Rev24Sept2012 Page 4 of 4