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Home My WebLink AboutNCG550616_complete file - historical_20190524ROY COOPER Governor MICHAEL S. REGAN Secretamy LINDA CULPEPPER Director NORTH CAROLINA Environmental Quality May 24, 2019 Rachel M. Blouin 1126 Thompson Rd Durham, NC 27704 Subject: General Permit NCG550000 Certificate of Coverage (CoC) NCG550616 1126 Thompson Rd Durham County Dear Permittee: The Division has renewed General Permit NCG550000. The Division hereby issues you a revised version of NCG550616, along with a copy of the renewed General Permit. Discard any earlier versions of the permit and use this version until further notice. This CoC is issued pursuant to the requirements of North Carolina General Statue 143-215.1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated October 15, 2007 [or as subsequently amended]. If any parts, measurement frequencies or sampling requirements contained in this General 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, the certificate of coverage shall be final and binding. Please take notice that this CoC is not transferable except after notice to the Division. The Division may require modification or revocation and reissuance of the CoC. Contact the Raleigh Regional Office prior to anv sale or transfer of the permitted facility. Regional Office staff will assist you in documenting the transfer of this CoC. This permit does not affect the legal requirements to obtain any other State, Federal, or Local governmental permit that may be required. If you have any questions concerning the requirements of the General Permit, please contact Derek Denard of the NPDES staff [919 707-3618 or via email at derek. de nard@ncde nr. gov] . cc: NPDES file Sin fornda Culpepper Director, Division of Water Resources North Carolina Department of Environmental Quality l Division of Water Resources 1617 Mail Service Center Raleigh, North Carolina 27699-1617 919-707-3616 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF WATER RESOURCES GENERAL PERMIT NCG550000 CERTIFICATE OF COVERAGE NCG550616 DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND OTHER 100% DOMESTIC DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE 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, Rachel M. Blouin is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a facility located at 1126 Thompson Rd Durham Durham County to receiving waters designated as an unnamed tributary to Ellerbe Creek, currently a class WS-V NSW stream in subbasin 03-04-01 of the Neuse River Basin in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, and III hereof. This certificate of coverage takes effect May 24, 2019. This Certificate of Coverage shall remain valid for the duration of the General Permit. Signed this day May 24, 2019 % 1#:/' V-#0(1 for Lin Culpepper Director, Division of Water Resources By Authority of the Environmental Management Commission ROY COOPER Governor MICHAEL S. REGAN Secretary LINDA CULPEPPER Director NORTH CAROLINA Environmental Quality NPDES Certificate of Coverage (CoC) OWNERSHIP CHANGE FORM 1. Please enter the CoC number for which the change is requested. Certificate of Coverage G 5 5 r., Fl/ II. Please provide the following for the requested change (revised permit). a. Request for change is a result of: ® Change in ownership of the residence/property ❑ Name change of the facility or owner If other please explain: b. Permit will be issued to (company ,- name, if applicable): C' c-1 t 13 IQ 1 c. Person legally responsible for permit: d. Facility name (discharge): e. Facility address: f. Facility contact person: First MI Last Title 11 _(, -rhea?(95k) (Raac. Permit Holder Mailing Address 'DU C h a Ofk (‘) 924y City Stay Zip c�Iq-`-/75- 995c7 Phone E-mail Address crrnQ 11 5 ThA 1 AJ (,� q cic a -A-' f p hr,,o — - Address City State r Citfra First MI Last Zip Phone E-mail Address M. Permit contact information (if different from the person legally responsible for the permit) Permit contact: 'j h(� .j(1 Sago 11 I" to —First M I Last D.E Title &LJ!O r1c.D Mailing Address City State Zip North Carolina Department of Environmental Quality I Division of Water Resourt.e' Raleigh Re tonal Offk c ' 3800 Barrett Drive i Ralrkih, North Carolina 27609 919 7914200 VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS INCOMPLETE OR MISSING: This completed application is required for both name change and/or ownership change requests. .I4 Legal documentation of the transfer of ownership (such as a property deed, relevant pages of a contract, or a bill of sale) is required for an ownership change request. The certifications below must be completed and signed by the new applicant in the case of an ownership change request. APPLICANT CERTIFICATION 1,pc,14 e...1 N mkt rv--._ , 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 is not included, this application package will be returned as incomplete. PeA114-€224e ,cli 1 1 i 1 Signature Date PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO: NC DEQ / DWR / NPDES 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Durham, NC Tax Parcel Report PIN Acreage Deed Book Plat Book Subdivision Owner Name Land Value Total Value DL1Fii IAIv1 r • 1 8 6 9 0833-12-85-2228 0.59800000 007402 000000 N/A - NO SUBDIVISION BLOUIN RACHEL $35,955.00 $137,032.00 Friday, May 17, 2019 160392 Land Use RES/ RURAL RES W/ ACREAGE Deed Page 000161 Plat Page 000000 Site Address 1126 THOMPSON RD Owner Address 1126 THOMPSON RD DURHAM , NC 27704 Building Value S101.077.00 Sale Price 684,000.00 Parcel ID Water Resources ENVIRONMENTAL QUALITY Ms. Rachel Blouin 1126 Thompson Rd Durham NC 27704-2368 Dear Ms. Blouin: PA. .I MCCRORY (r:Ji.'E'F nor DONALD R. VAN DER VAART secretcv:, S.:JAY ZIM.M.ERMA.N September 19, 2016 Subject: Compliance Evaluation Inspection 1126 Thompson Road Single Family Wastewater Treatment System (former owner Stephan Micheletto-Blouin) Permit No. NCG550616 E F */ED1, 00E -kV Durham County SEP 2 ti at<ryyQ€Uoitty On August 17, 2016, Joan Schreier from the Raleigh Regional Office visited your single -fan -illy' residence (SFR) wastewater treatment system to evaluate compliance with the above permit to discharge wastewater. The checked boxes below show what conditions were noted at your facility: ❑ In compliance: You are reminded to regularly maintain the chlorine disinfection system, have the effluent sampled once a year, and have the septic tank pumped out every 3 to 5 years. Your good record of operation and meeting the permit requirements is highly commended. ❑ Your home is improperly plumbed: Some of the wastewater discharges are going directly to the environment without first passing through the treatment system. This must be corrected immediately. Please submit a schedule to this office within 20 days of receipt of this letter that states your plan for correcting this deficiency. The work is to be completed within the next 3 months. ❑ Disinfection: Your system is lacking disinfection, either chlorine tablets or a UV light system. New rules put into place on August 1, 2007 require all SFR systems to have a means of disinfection (and dechlorination when chlorine tablets are used to disinfect, if the system was installed since that date). Since your system had no disinfection, the installation is to include a chlorine tablet dispenser, a contact chamber capable of providing a minimum 30 minute contact time, and another tablet dispenser that will hold dechlorination tablets. Please submit a schedule to this office within 20 calendar days of receipt of this letter that states your plan for correcting this deficiency. ® Treatment tablets missing or are wrong kind: You are responsible for always having chlorine tablets in place. They must be the kind for wastewater treatment and not for swimming pools. State of North Carolina I Environmental Quality I Water Resources 1628 Mail Service Center I Raleigh, North Carolina 27609-1628 919 791 4200 1126 Thompson Rd ❑ Dechlorination: Your system was installed after August 1, 2007, so must have a means of dechlorination located downstream of the chlorinator and its contact chamber. See Disinfection paragraph above. Please submit a schedule to this office within 20 calendar days of receipt of this letter stating your plan for correcting this deficiency. ❑ Pumping the septic tank: The septic tank should be pumped out every 3 to 5 years. A pumping company can check the status periodically and determine when pumping is required. E Failure to analyze the effluent: The effluent that is discharged from your system must be analyzed once each year. See Part I(A) of your permit about his requirement. A list of NC certified laboratories that provide this service was left at your residence during the inspection. Make arrangements for sampling to be carried out within the next 3 months, and submit results to this office within 3 weeks after the sampling has been done. ❑ Locations of treatment units are unknown: Determine this and report to this office within 30 days of receipt of this letter with a sketch or map. ® Other: • A list of chlorine tablet suppliers is attached. Please mail or email a copy of your receipt, after you buy new tablets. Only stock 2 tablets per tube to prevent jamming. • Please fill out the attached change of ownership form and mail it back to the address listed on the form (and not here). • If you wish to test your well water quality, this office recommends that you contact Durham County Health Department for assistance. If you have questions or com'ments about this inspection or the requirements to take corrective action, please contact Joan Schneier or me at 919-791-4200. Licensed plumbers should be used to make plumbing changes within your home. Contractors for installing disinfection or other equipment may be found in the Yellow Pages under Environmental Consultants. Sincerely, S. Daniel Smith, Supervisor Water Quality Regional Supervisor Raleigh Regional Office Attachments: Inspection Form Tablet Suppliers Samplers + Sampling Requirements Change of Ownership Form + Deed Copy cc: (minus attachments) RRO/SWP Files NPDES Permitting Unit Files — Charles Weaver — NCG550616 United States Environmental Protection Agency EPA Washington, D.C. 20460 Water Compliance Inspection Report Form Approved. OMB No. 2040-0057 Approval expires 8-31-98 Section A: National Data System Coding (i.e., PCS) Transaction Code NPDES yr/mo/day Inspection 1 [ 2 Li 3 I NCG550616 111 121 16/08/17 117 Type 18 LI IIIIIIIIII1 Inspector Fac Type 19 W 201 211IIIII IIIIII IIIIIIIIIIII I IIIIII r6 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA 67 I I 70 I I 71 u 72 Li Reserved-- 731 1 174 75I I I I I I I l80 Section B: Facility Data Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include POTW name and NPDES permit Number) 1126 Thompson Road 1126 Thompson Rd Durham NC 27704 ' Entry Time/Date 11:OOAM 16/08/17 Permit Effective Date 13/10/15 Exit Time/Date 11:40AM 16/08/17 Permit Expiration Date 18/07/31 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) /// Other Facility Data Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Stephan Micheletto-Blouin,1327 Mars Dr Nashville TN 37217//919-450-6256/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) 1111 Permit ® Operations & Maintenance • Effluent/Receiving Waters Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Joan Schneier RRO GW/// gnatur of Managem t Q A eviewe Agency/Office/Phone and Fax Numbers 2-'-'-,Date a ,7,7 4,1;? )W7--'72-. EPA Form 35-3 (Rev 9-94) Previous editions are obsolete. Page# 1 31 NPDES NCG550616 111 121 yr/mo/day 16/08/17 17 Inspection Type 18IcI (Cont.) 1 Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) The system consists of a septic tank, underground sand filter, chlorinator, and pump tank without alarms or possibly floats, all in the back yard. The dechlorinator and outfall are in the front yard near the storm water road ditch. Apparently the system used to be gravity drainage to the neighboring property in back. A pump tank was added to reroute the effluent to the road ditch in front and a dechlorinator added (probably about 2013). A change of ownership form is being sent to the new owner, Rachel Blouin. The inspection was unannounced and unattended due to lack of contact information but her son gave permission to check the yard before he left on business. The main issue seemed to be missing or degraded tablets but the system appeared functional. The pump was not observed running due to low water level and lack of a switch with which to turn it on. However, there was a small amount of effluent at the discharge pipe and the pump tank level was low. The assumed well was paced at about 65 feet from the assumed septic tank cover and about 165 feet from the pump tank. Ms. Blouin was contacted on 09/15/16 for additional information. Page# 2 Permit: NCG550616 Owner - Facility: 1126 Thompson Road Inspection Date: 08/17/2016 Inspection Type: Compliance Evaluation Permit (If the present permit expires in 6 months or less). Has the permittee submitted a new application? Is the facility as described in the permit? # Are there any special conditions for the permit? Is access to the plant site restricted to the general public? Is the inspector granted access to all areas for inspection? Yes No NA NE ❑ ❑ R ❑ ❑ ■❑❑ ❑ ® ❑ ❑ El El III ■ ❑ ❑ ❑ Comment: The home is under new ownership, the former permittee's sister, named Rachel Blouin. The pump tank apparently was added since the last inspection in 2011. Operations & Maintenance Is the plant generally clean with acceptable housekeeping? Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge Judge, and other that are applicable? Comment: Septic Tank (If pumps are used) Is an audible and visual alarm operational? Is septic tank pumped on a schedule? Are pumps or syphons operating properly? Are high and low water alarms operating properly? Yes No NA NE II ❑ ❑II❑ Yes No NA NE ❑ ❑ ❑ ❑ I El CI ❑ ❑ ® ❑ Comment: The septic tank was pumped in conjunction with the system reconfiguration, probably about 2013. One pump tank is in the back yard without alarms. Sand Filters (Low rate) (If pumps are used) Is an audible and visible alarm Present and operational? Is the distribution box level and watertight? Is sand filter free of ponding? Is the sand filter effluent re -circulated at a valid ratio? # Is the sand filter surface free of algae or excessive vegetation? # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) Comment: The sand filter is believed to be in the back yard and is mowed. Disinfection -Tablet Are tablet chlorinators operational? Yes No NA NE III ❑ ❑ ❑ ■ i ❑ ❑ ❑ • Ill ❑ ❑ ❑ Yes No NA NE II ❑ ❑ ❑ Page# 3 Permit: NCG550616 Owner - Facility: 1126 Thompson Road Inspection Date: 08/17/2016 Inspection Type: Compliance Evaluation Disinfection -Tablet Are the tablets the proper size and type? Number of tubes in use? Is the level of chlorine residual acceptable? Is the contact chamber free of growth, or sludge buildup? Is there chlorine residual prior to de -chlorination? Comment: No tablets were found. The chlorinator lacks tube caps but has an overall cap. De -chlorination Type of system ? Is the feed ratio proportional to chlorine amount (1 to 1)? Is storage appropriate for cylinders? # Is de -chlorination substance stored away from chlorine containers? Comment: Are the tablets the proper size and type? Are tablet de -chlorinators operational? Number of tubes in use? Comment: The dechlorinator was in the front yard .A tablet was found in only 1 tube. Effluent Pipe Is right of way to the outfall properly maintained? Are the receiving water free of foam other than trace amounts and other debris? If effluent (diffuser pipes are required) are they operating properly? Yes No NA NE 2 ❑ ❑ ❑ • ® ❑ ❑ ❑ ❑ ❑ ❑ • Yes No NA NE Tablet ❑ ❑ ❑ • ❑ ❑ IN ❑ ❑ ❑ ❑ 11 El El 0 11 ❑ ❑ ❑ 2 Yes No NA NE ® ❑ ❑ ❑ Comment: The end of the pipe was somewhat overgrown but readily Iocated.lt is in the front yard near the road ditch.No residuals were observed. Page# 4 ern NCDENR North Carolina Department of Environment and Natural Resources Division of Water Resources Pat McCrory, Governor Thomas A. Reeder, Director John E. Skvarla III, Secretary October 15, 2013 Stephan Micheletto-Blouin 1327 Mars Dr Nashville, TN 37217 Subject: Renewal of coverage / General Permit NCG550000 1126 Thompson Rd Certificate of Coverage NCG550616 Durham County Dear Permittee: The Division has reissued General Permit NCG550000. Therefore, the Division is hereby renewing Certificate of Coverage (CoC) NCG550616 to discharge under NCG550000. This CoC is issued pursuant to the requirements of North Carolina General Statue 143-215.1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated October 15, 2007 [or as subsequently amended]. If any parts, measurement frequencies or sampling requirements contained in this General 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, the 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. The Division may require modification or revocation and reissuance of the certificate of coverage. Contact the Raleigh Regional Office prior to any sale or transfer of the permitted facility. Regional Office staff will assist you in documenting the transfer of this CoC. This permit does not affect the legal requirements to obtain any other State, Federal, or Local governmental permit that may be required. If you have any questions concerning the requirements of the General Permit, please contact Charles Weaver of the NPDES staff [919 807-6391 or charle s .weaver@ncd e nr. gov] . rely, for Thomas A. Reeder cc: Raleigh Regional Office / Surface Water Protection NPDES file 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 512 North Salisbury Street, Raleigh, North Carolina 27604 Phone: 919 807-6300 / FAX 919 807-6489 / Internet: www,ncwaterquality.org 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 RESOURCES GENERAL PERMIT NCG550000 CERTIFICATE OF COVERAGE NCG550616 DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND OTHER 100% DOMESTIC DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE 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, Stephan Micheletto-Blouin is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a facility located at 1126 Thompson Rd Durham Durham County to receiving waters designated as an unnamed tributary to Ellerbe Creek, a class WS-V NSW stream in subbasin 03-04-01 of the Neuse River Basin in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof. This certificate of coverage is effective October 15, 2013. This Certificate of Coverage shall remain valid for the duration of the General Permit. Signed this day October 15, 2013 C', 2M2tir for Tor as A. Reeder, Director pi -vision of Water Resources By Authority of the Environmental Management Commission /1)(655-0(1/6 1,4 TN 3/217 stephanblouin@vahoo.com NC r2-2flf t. nit if317 t• 9 • . r e I-%'.ttt)1 J1tA.svC 0 IN h0rn cr,nrerns: fnr isn fnr Ihn !E:nnt7.r 2/6/04, ihis .t; z two loc.:-.1room prirnary b—C jtd iJLsjMt!? 2.0.-M I 7C ;Li 'al, I C LJILI4. I i6UHU,;,,, 16 ti iit_Yt ti 1.111%.1 :-!-; r4r- h Car lina Sr‘ptir: pc...r instruction by rk.a.:1,7. \fifns Nifs,i.„9,--Nirk, Lit I:, ay ve. ta.a: a:1 NE, ; ;1.1. r S Ai! waste water produced at this residence LAI Fj b No A. '5. ',LA •.:1 I k c_41 r".1 1 1 • • • • k , , lit 1.4t -sit, "frz..r.77 f was pumped out from August 2.i, 2013. Li ATA NCDENR NORTH CAROUNA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Division of Water Quality / Water Quality Section National Pollutant Discharge Elimination System NCG550000 FOR AGENCY USE ONLY Date Received Year Month Day Certificate of1Co ierafe N C IC1 1(Amount Check # Permit Assigned to NOTICE OF INTENT National Pollutant Discharge Elimination System application for coverage under General Permit NCG550000: Single Family Residences and/or facilities discharging < 1000 gallons per day domestic wastewater (Please print or type) 1) Regional Office contact (Please note: This application will be returned if you have not with a representative from the appropriate regional office): Please list the NCDENR Regional Office representative(s) with whom you ave met: r Name: c(.... ; 4 S Date: G 1. 2) Mailing address of owner/operator: Owner Name " c.,, t �R mot, t\c) Street Address l'AccpcV r , City Telephone # (Home) T (`` 7 }} -- p 2, (Work) 42 e-mail address fte4,-1 11,o t� �� r4 o •�.�,. State" \ ( ZIP Code 7 2,17 * Address to which all permit correspondence will be mailed 3) Location of facility producing discharge: Street Address it Leo ci City -f• County 4^�� Telephone No. / 'r & cif-,--- e Z. 3 State /\,,Ae ZIP Code Z 7 7 e; 4) Physical location information: Please provide a narrative description of how`to get to the facility (use street names, state road numbers,, and distrce and idifection frpm a roadway intersection). /Q. ‘C r '1Z4.1- - , c) O x �cc 1, R 5) This NPDES permit application applies to which of the following : 0 New or Proposed (system not constructed) 51, Existing (system constructed); If previously permitted by local or county health department, please provide the permit number and issue date ['( Modification; lease describe the nature of the modification: Sttin C RR (JA(artvCIAO �� P 1S t'• A) r✓1S (I A:6�, 6) Description of Discharge: a) Amount of wastewater to be discharged: Number of bedrooms Z- x 120 gallons per bedroom = 2_(-1 t3 gallons per day to be permitted La NCG550000 N.0.I. b) Type of facility producing waste (please check one): Primary residence ❑ Vacation/second home 0 Other: 7) Please check the components that comprise the wastewater treatment system: M. Septic tank 0 Dosing tank Primary sand filter ❑ Secondary sand filter ❑ Recirculating sand filter(s) ti Chlorination Dechlorination 0 Other form of disinfection: ❑ Post Aeration (specify type) 8) For new or proposed systems only - Please address the feasibility of alternatives to discharging for the following options in the cover letter for this application: a) Connection to a Regional or Municipal Sewer Collection System. b) Letter from local or county health department describing the suitability or non -suitability of the site for all types of wastewater ground adsorption and innovative non -discharge systems. Document the repair potential of the failed system. c) Land Application such as spray irrigation or drip irrigation. 9) Receiving waters: a) What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility wastewater discharges end up in? ;fin vt�4n.- b) Stream Classification (if known): 10) The application must include the following or it will be returned: a) For Certificates of Coverage: An original letter and two (1) copy requesting coverage under NCG550000. O A signed and completed original and one copy of this Notice of Intent Application. El A check or money order for the permit fee of $60.00 made payable to NCDENR. I1 Invoice showing that the septic tank has been pumped and serviced within the last 12 months (only when existing service tank will be used). New or proposed facilities must also include: ❑ Letter from the county health department evaluating the proposed site for all types of ground absorption and innovative non -discharge systems. Document the repair potential of the failed system. 0 Evaluation of connection to a regional sewer system (approximate distance & cost to connect). ❑ Provide a 7Q10 flow estimate at the proposed wastewater discharge point from the US Geological Survey (919- 571-4000) b) For an Authorization to Construct (ATC) only: (Note: There is no fee for an AtC) O A letter requesting an ATC ❑ Three sets of plans and specifications of proposed treatment system (see Permit Application Checklist and Design Criteria for Single Family Discharge) ❑ Invoice showing that the septic tank has been pumped and serviced within the last 12 months (only when existing septic tank will be used)_ NCG550000 N.O.I. 11) Additional Application Requirements: a) If this application is being submitted by a consulting engineer (or engineering firm), include documentation from the applicant showing that the engineer (or firm) submitting the application has been designated an authorized Representative of the applicant, b) If this application is being submitted by a consulting engineer (or engineering firm), final plans for the treatment system must be signed and sealed by a North Carolina registered Professional Engineer and stamped - "Final Design - Not released for construction". c) If this application is being submitted by a consulting engineer (or engineering firm), final specifications for all major treatment components must be signed and sealed by a North Carolina registered Professional Engineer and shall include a narrative description of the treatment system to be constructed. 12) Certification: I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief such information is true, complete, and accurate. Printed Na a of Person Signing: Title: � �-�-- 07\ Ut-e-lt--7 4\,\ (Signature of Applicant) (Date Signed) North Carolina General Statute 143-215.6 b (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 Article 21 or regulations of the Environmental Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section f001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.) Notice of Intent must be accompanied by a check or money order for $60.00 made payable to: NCDENR Mail the completed original and one copy of the entire package to: NC DENR / DWQ / NPDES Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Note The submission of this document does not guarantee the issuance of an NPDES permit September 17, 2013 Mr. Mack Wiggins Division of Water Quality Raleigh Region 1617 Mail Service Center Raleigh, NC 27699 Applicant: Stephen and Amanda Micheletto Blouin 1327 Mars Dr Nashville, TN 37217 Dear Mr. Wiggins: Public Health Address: 1126 Thompson Durham, NC 27704 The Durham County Health Department has determined the above referenced property is served by a discharging sandfilter sewage system. The site characteristics identified on the property do not meet the requirements of 15A NCAC Section .1900, therefore, no permits may be issued to convert the existing sandfilter system to ground absorption sewage disposal system. Municipal_ sewer is not available to the property as of September. Should you have any questions concerning this matter, please feel free to contact me at (919) 560-7800. Sincerely, Matthew Yearout, REHS Monitoring Program Specialist Environmental Health Division 414 East Main Street Durham, NC 27701Phone: 919-560-7800 Fax: 919-560-7830 http:/idconc.gov/ All -American Septic All -American Septic Office-919-398-1045 3056 Emmitt Pond Rd. Fax- 919-752-6171 Account # Raleigh, NC. 27616 E-mail all_americanseptic@yahoo.conbate WWW.allamericansepticnc.com Due By Terms Bill To Steve Micheletto-Blouin 1126 Thompson Rd Durham, NC 27704 Invoice # 620614-2 08-21-2013 Paid On Receipt Code Description QTY Rate T Amount Pump Septic Tank 1 $250.00 N $250.00 CC Process Fee 1 $7.50 N $7.50 Payments : 08-21-2013 - Credit Card - $257.50 Subtotal Tax Total Payments Balance Due $257.50 $0.00 $257.50 (-) $257.50 PAID IN FULL Beverly Eaves Perdue Governor AVA NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Coleen H. Sullins Director Dee Freeman Secretary 7008 2810 0001 7413 2020 CERTIFIED MAIL RETURN RECEIPT REQUESTED Mr. Stephen Blouin 1126 Thompson Road Durham, NC 27704 Subject: Dear Mr. Blouin: March 29, 2011 Compliance Evaluation Inspection Single Family Wastewater Treatment System Permit No. NCG550616 Durham County On March 11, Mandy Hall from the Raleigh Regional Office visited your single-family residence (SFR) wastewater treatment system to evaluate compliance with the above permit to discharge wastewater. The help of your sister, Ms. Rachel Blouin was appreciated. In order to complete the Inspection, please contact Mandy Hall upon receipt of this letter at 919-791- 4200 to answer several questions regarding your system. 12r2 Danny Smith, Supervisor Surface Water Protection Raleigh Regional Office cc: RRO/SWP Files Central Files RECEIVED MAR 3 1 2011 Information opcessing Unit DW, °, olina vaturallr/ North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Internet: www.ncwaterquality.org 1628 Mail Service Center Raleigh, NC 27699-1628 Phone (919) 791-4200 Customer Service FAX (919) 788-7159 877-623-6748 An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper ATA NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Michael F. Easley, Governor William G. Ross, Jr., Secretary Coleen H. Sullins, Director July 19, 2007 Stephan Blouin & Amanda Michiletto 1126 Thompson Road Durham, NC 27704 Subject: Renewal of coverage / General Permit NCG550000 Certificate of Coverage NCG550616 Durham County Dear Permittee: In response to your renewal application, the Division is issuing a renewed Certificate of Coverage (CoC) to discharge under NCG550000. This permit is issued pursuant to the requirements of North Carolina General Statue 143-215 .1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated May 9, 1994 [or as subsequently amended] . If any parts, measurement frequencies or sampling requirements contained in this General 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, the certificate of coverage shall be final and binding. This CoC is not transferable except after notice to the Division. Contact the Raleigh Regional Office at (919) 791-4200 if you intend to sell the property covered by this CoC. A staff member will tell you what steps are necessary to document the transfer of ownership. The Division may require modification or revocation and reissuance of the CoC. This permit does not affect the legal requirements to obtain other permits which may be required by the Division of Water Quality 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 questions concerning the requirements in this permit, please contact Toya Fields [919 733-5083, extension 551 or toya.fields@ncmail.net] or Susan A. Wilson [919 733-5083, extension 510 or susan. a.wilson@ncmail.net] . Sincerely, for Coleen H. Sullins cc: Central Files Raleigh Regional Office / Surface Water Protection NPDES file 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 512 North Salisbury Street, Raleigh, North Carolina 27604 Phone: 919 733-5083 / FAX 919 733-0719 / Internet: www.ncwaterquality.org An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper NorthCarolina Naturally STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WATER QUALITY GENERAL PERMIT NCG550000 CERTIFICATE OF COVERAGE NCG550616 TO DISCHARGE DOMESTIC WASTEWATERS FROM SINGLE FAMILY RESIDENCES AND OTHER DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE 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, Stephan Blouin & Amanda Michiletto is hereby authorized to operate a wastewater treatment facility for the discharge of treated domestic wastewater [< 1000 gallons per day] from a facility located at: 1126 Thompson Road Durham Durham County to receiving waters designated as an unnamed tributary to Ellerbe Creek in subbasin 30401 of the Neuse River Basin in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof. This certificate of coverage shall become effective August 1, 2007. This Certificate of Coverage shall remain in effect for the duration of the General Permit. Signed this day July 19, 2007. for Coleen H. Sullins, Director Division of Water Quality By Authority of the Environmental Management Commission ern NCDENR NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Division of Water Quality / Water Quality Section National Pollutant Discharge Elimination System NCG550000 FOR AGENCY USE ONLY Date Received Year Month Day Certificate of Coverage N CIGI 11111 Check # Amount Permit Assigned to RENEWAL FORM FOR EXISTING PERMITTED FACILITIES NPDES renewal application for continued coverage under General Permit NCG550000: Certificate of Coverage NCG550616 (Please verify the information in items 1 & 2 as correct, or note any corrections that should be made.) (Please print or type) 1) Mailing address* of property owner: Owner Name Stephan Blouin & Amanda Michiletto Street Address 1126 Thompson Rd City Durham, NC 27704 Telephone (Home) J' / L2_° "4/5 7 7 (Mobile) (e-mail address) * Address to which all permit correspondence will be mailed 2) Location of facility producing discharge*: Street Address 1126 Thompson Rd City: Durham, NC 27704 County Durham Telephone (Home) (Mobile) * If the facility is not yet constructed, give the street sddress or lot number where the structure will be built. 3) Description of Discharge: a) Type of facility producing waste (please check one): XPrimary residence ❑ Vacation/second home E Undeveloped property ❑ Other [describe] : Page 1 of 2 NCG550000 renewal form 4) Please check the components that comprise the wastewater treatment system: ❑ Septic tank ❑ Dosing tank ❑ Primary sand filter ❑ Secondary sand filter ❑ Recirculating sand filter(s) ❑ Chlorination ❑ Dechlorination ❑ Other form of disinfection: ❑ Post Aeration (describe) 5) Other Information: a) When was the septic tank last pumped out? (jn.S v re, NOTE: the septic tank must be pumped out at least once every 3-5 years b) Is the facility [home] occupied year-round, or only seasonally? - 1 (R41 ✓ c) Approximately how many people use the facility when it is occupied? 2- d) When was the wastewater system installed? / 9eq . 6) Certification: I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief such information is true, complete, and accurate. Printed Name of Person Signing: 5:+e.p bwV/ (O(4 Vo 7 (Signature of Applicant) (Date Signed) North Carolina General Statute 143-215.6 b (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 Article 21 or regulations of the Environmental Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.) Mail this completed form to: Mr. Charles H. Weaver, Jr. NC DENR / DWQ / NPDES 1617 Mail Service Center Raleigh, NC 27699-1617 Page 2 of 2 NPDES SFR WASTELOAD ALLOCATION Facility Namc: ). F,- t--b 1i0 Permit: Date: J/5-/S- ti7C6- 5'0 Co Up Receiving St ream:(A-ck- C1 855:C/3k) Sub -Basin:, -(1(7' County:(ZiAIl�,f-t.ARegional Oi f i ce : Reference USGS Ouad:Cs txistin Proposed: Elevation: 36a nn Drainage Arca: Hydrologic Group:, Design Temperature: S I ope : Comments : 2 Elio t�� _ ti ~?`'1 CSJC SJ rye i&� L- Ck Wasteflow (gpd): BOD5 (mg/I): NH3-N (mg/1): D.O. (mg/1): pH (SU): Fecal Coll (/100m1): TSS (mg/I): RECOMMENDED BY: APPROVED BY: Regional Engineer: Regional Supervisor: RECOMMENDED EFFLUENT LIMITS / >— C- 9 aJ� PLOTTED oe A), Dale: � L Date: 6/l/,2 3991 :2'6< 2'30" 3990 3989 3987 820 000 FEET 3986 78 0 62,30,, 2 040 000 FEET Mapped, edite!:1, and published by the Geological Survey 3 / Fieldcrest Ch • r- - wage • is Qsa I r, • • • Z?(( / • • • ‘, •,' -\\ / / , 39 -7/7 Y82 RALE GH 22 MI. SMITHFIELD 49 MI. ontrol by USGS, NOS/NOAA, USCE, and North Carolina Geodetic Survey ,...-.,- ,2g2graphy by photogrammetric methods from aerial photographs a 972. Field -checked 1973 , 10.000-foot grid ticks: North Carolina coordinate system BM -: Glen 389 • S - ."•-• • i • ,O"• • • • 0 376 o • .. • • • ••• . .7.; • ...*) First inity ••••••Ch Grave 4.713 • 7 694 695 50' G N To: Permits and Engineering Unit Water Quality Section DATE:May 28,1992 Uthi JliN 0 2 1992 TECHNICAL SUPPORT BRANCH NPDES STAFF REPORT AND RECOMMENDATIONS COUNTY:Durham PERMIT NUMBER:NC0082066 /le PART I - GENERAL INFORMATION 1. Facility and Address:Dolman Franklin Baldwin, Jr. 3309 Thompson Rd. Durham, NC 27704 2. Date of Investigation:May 1, 1992 3. Report Prepared by: S. Mitchell 4. Person Contacted & Telephone Number:Frank Baldwin 5. Directions to Site:Old Oxford Rd to Thompson Rd house on right. 6. Location of Discharge Point. a. Latitude:78 52'45" Longitude:36 02' 40" See Attached USGS Map Extract Indicating Treatment Facility Site and Discharge Point. b. USGS Quad Number:C23SE USGS Quad Name:NE Durham 7. Size (land available for expansion and upgrading):No. 8. Topography (including relationship to flood plain):Flat <10% 9. Location of Nearest Dwelling:100 ft. 10. Description of Receiving Stream or Affected Surface Waters. a. Name:UT ditch to pond to Ellerbe Creek b. Classification:C NSW c. River Basin and Subbasin Number:Neuse 03-04-01 d. Receiving Stream Features and Pertinent Downstream Uses: Small pond downstream. Discharge may never reach it. PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS 1. Description of Wastewater. a. Type of Wastewater: 100_ % Domestic % Industrial b. Volume of Wastewater (design capacity): 360_ GPD c. Types and Quantities of Industrial Wastewater:NA d. Prevalent Toxic Constituents in Industrial Wastewater:NA 2. Pretreatment Program Status: In Development Approved Should Be Required XX Not Needed 3. Description of Industrial Processes and Applicable 40 CFR Parts and Subparts:NA 4. Industrial Production Rates (in appropriate mass/day units).NA a. Long Term Average Production Rate: b. Highest Monthly Production in Past 12 Months: c. Highest Yearly Production in Past 5 Years: 5. Treatment System Information. a. Status of Treatment System: XX Existing Proposed b. Description of Treatment System:New septic tank/sand filter w/chlorinator 6. Residual Solids Treatment and Disposal Method:As necessary. 7. Treatment System Classification (rating sheet attached, if appropriate): 8. Codes. a. SIC Code:4952 b. Wastewater Code:04 c. Main Treatment Unit Code:440 7 9. Treatment System Compliance Status:New/compliant. PART III - OTHER PERTINENT INFORMATION 1. Is This Facility Being Constructed With Construction Grants Funds?No. 2. Special Monitoring Requests:No. 3. Additional Effluent Limits Requests:No. 4. Other: PART IV - EVALUATION AND RECOMMENDATIONS This is a single family residence treatment system that has been reconstructed. The Raleigh Regional Office recommends granting the permit for a period of time consistent with the river basin policy and discharge limitations for a single family residence. Report Writer Regional Water Quality Supervisor Date TD:SM:sm