NCG550054_Permit (Issuance)_20060809

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NCDENR -
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross,Jr.,Secretary
_ Alan W. Klimek, P.E., Director
August 9,2006
Mr.Henry O.Washington
504 Gayron Drive
Winston-Salem,North Carolina 27105
Subject: Renewal of coverage/General Permit NCG550000
Washington residence
Certificate of Coverage NCG550054
Forsyth County
Dear Mr.Washington:
In accordance with your status as the owner of the permitted residence,the Division is forwarding herewith
Certificate of Coverage NCG550054 to discharge under NCG550000. This action is a renewal of an existing CoC,rather
than a new discharge application. 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. -
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.
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 this permit,please contact Charles
H.Weaver,Jr.at telephone number 919 733-5083,extension 511.
Sincerely,
J
/,,"_ Alan W.Klimek,P.E.
cc: Central Files
Winston-Salem Regional Office/Rose Pruitt
'-NPDES file
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone]/FAX [phone]/Internet:h2o.enr.state.nc.us XaturallAn Equal Opportunity/Affirmative Action Employer-50%Recycled/10%Post Consumer Paper

�•S
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
•
CERTIFICATE OF COVERAGE NCG550054 . ,•
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,
Henry O. Washington
is hereby authorized to operate a wastewater treatment facility that includes a septic tank, sandfilter, chlorine
disinfection,and associated appurtenances with the discharge of treated wastewater from
504 Gayron Drive
Winston-Salem
Forsyth County
to receiving waters designated as an unnamed tributary to Mill Creek in the Yadkin-Pee Dee 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 9, 2006.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 9, 2006.-
1Jj`- Alan W.Klimek,P.E.,Director
Division of Water Quality
By Authority'of the Environmental Management Commission

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Facility ai•ry '•
° NCG55oo54 '� .Y ' ,
Latitude:36 10'41" j , x'
Longitude:80°14'S3" Location '` ' ?rv ,.,
Quad:Walkertown,N.C. Washington residence - • ole.,
Stream Class:C
subbasin:3o7o4 �7J�/� Plot to SCALE
Receiving Stream:UT Mill Creek �7/dii I

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AVA ,...,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross,Jr., Secretary
Alan W. Klimek, P.E., Director
GENERAL PERMIT Certificate of Coverage RENEWAL FORM
• I. CURRENT PERMIT INFORMATION:
Certificate of Coverage (CoC) Number: NCG55 0 0 5 q
Owner's name (name to be put o permit):
Owner's or signing official's name and title:
(Person legally responsible r permit)
L ,,
7/ s-� /✓y (Title)
Mailing address: $ MA. ) PAil
City: A// /5/751 _51"Z'' State: VC...— Zip Code: c/ 7/ 05
—
Phone: (3 NO) 6 O c _ c I NS
E-mail address:
Applicant's Certification:
I, //0//Y- d, . �, , attest that the.property previously
covered byte Certificate of Covera (CoCylisted above is under my.ownership/control. I
hereby request renewal of the CoC listed above and assume responsibility for wastewater
discharge[s] from the site.
Si •
gnature: / D Date: 2_42?..„,.*
Send this completed form and a copy of the property deed to: DEC
\n'i
I
i ,
Mr. Charles H. Weaver, Jr. AUG 8 2006 1b)
NC DENR / DWQ / NPDES Unit i
1617 Mail Service Center
Raleigh, North Carolina 27699-1617 DENNR-WATER QUALITY
R BRANCH
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 ' North Carolina
Phone: [phone]/FAX [phone]/Internet:h2o.enr.state.nc.us Naturally
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper