NCG550060_Permit (Issuance)_20060802

•
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 2,2006
Ms.Barbara E.Little
3993 Queens Grant Court
High Point,North Carolina 27265-7916
Subject: Renewal of coverage/General Permit NCG550000
Little residence
Certificate of Coverage NCG550060
Forsyth County
Dear Ms.Little:
In accordance with your status as the owner of the permitted residence,the Division is forwarding herewith
Certificate of Coverage NCG550060 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,
t)A 6491-"--1
an W.Klimek,P.E.
cc: Central Files
Winston-Salem Regional Office/Rose Pruitt
cNPDES-fil'e=
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 5 NorthCarolina
Phone: [phone] I FAX [phone]/Internet:h2o.enr.state.nc.us Natural!,
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550060 -
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,
Barbara E. Little
is hereby authorized to operate a wastewater treatment facility that includes a septic tank, sandfilters, chlorine
disinfection, and associated appurtenances with the discharge of treated wastewater from
3993 Queens Grant Court
High Point
Forsyth County
to receiving waters designated as an unnamed tributary to Belews Creek in the Roanoke 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 2, 2006.
• This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 2,2006.
c-74 d
raitAlan W.Klimek,P.E.,Director
Division of Water Quality
By Authority of the Environmental Management Commission

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�' 1CG550060 Facilittf -
Latitude:36°09'05" -
Longitude:80°04'25" 1•. Location
Quad:Belews Creek,N.C. Barbara Little residence
Stream Class:C
Subbasin:30201 ,
Receiving Stream:UT Belews Creek i' • �� Not to SCALE

SPA
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 (t) 0
Owner's name (name to be put on permit):
Owner's or signing official's name and title: .o�� Ait.dautz_
(Person legally responsible for permit)
•
(Title)
Mailing address: 36(.61 3 R.LA..wr,--) bXe""`t-
City_3� o(l� P(5-t- ± State: he_ Zip Code: An - '19 �P
Phone: ('S314 ) s`6 5- -1') o
E-mail address: be_\ arl q 01 «� /QX'Oo C-0 r\-
Applicant's Certification:
I, ''3_ JJL , attest that the property previously
covered by the Certificate of Coverage (CoC) listed 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.
• &
_c�
Signature: e Date: - -v(o
Send this completed form and a copy of the property deed to: HIND 30 110S N08 1
Mr. Charles H. Weaver, Jr. Z fin[,
NC DENR / DWQ / NPDES Unit 900Z
td.
1617 Mail Service Center
Raleigh, North Carolina 27699-1617k.\\ n
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 XaturaiiiAn Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

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p
.. . , . Mail to:
- (Name) (Street and Number) (City) —(Slain) --'--(Zinl--—
...:i4 , ,:l:-..;''' • . THIS DEED Made this the 31st day of January . 19 79 by_
y --_-
RANDALL D. BENNETT and wife, GAYLON D. BENNETT
t•Ift, - • • • purl ies of the first art, to BARBARA F, TZMIRT of Forsyth County,North C;uolin I
p I• R TITTLE (Divorced)
`,'`!w: • of Forsyth County,North Carolina,part.y_--of the second part;
s: • • Witnesseth that the said part tea of the first part,in consideration of($1�.00 & O.V.C. ) Ten Dollars and
Other Valuable Considerations to them aid bythe said
. p • party of the second
part,the receipt of which is hereby acknowledged,km/have bargained and sold,and by these presents do__ bargain,sell and con-
vey unto the said part_yt_of the second part and her _heirs a tract or parcel of land in Forsyth County, North Carolina, in
Kernersville Township, and bounded as follows:
BEING all of Lot 5B of Cliffwood, Section 2, as shown on a plat
which is duly recorded in the Office of the Register of Deeds
of Forsyth County, North Carolina, in Plat Book 23, Page 200,
reference to which is hereby made for a more particular description.
• This conveyance is made subject to restrictive covenants in Deed
Book 990, Page 145, in the Office of the Register of Deeds of
• Forsyth County, North Carolina, and subject to any and all
easements visible upon the ground or appearing of record, if any. rP '
\'
The above land was conveyed to grantor by John H. Baxley and wife (See Book No. 1215 Page 1096 )
TO HAVE AND TO HOLD the aforesaid tract or parcel of land all privileges and appurtenances (hereunto belonging to the said part
-Y of the second part and her heirs and assigns forever, And the said part ies _of the first part do _ cov-
enant that _ they is/arc seized of said premises in fee and __..hale_ the right to convey the same in fee simple;that the same
• are free front encumbrances;and that_they_____.will warrant and defend the said title to the same against the claims of all persons
whatsoever.
IN TESTIM HE OF t s,i art to f the first part_hhY_e __hereunto set their hand s and seal s
D. BENNETT (Seal) --rJ '�4.X--,(�/',4c �- (Seal)
RANDALL (soar .GA--T_�ON I)_a__BI NNE T (Seal)
STATE OF RTH CAR A -rForsyt tttyp --_ _ '- ter' '"
—
LLB
i'— E. a Notary Public of ForsydhiCttunty.,,Morth Carolina,
do hereby cern y tl Bean t_.and_wife.,4IYGoN 0• 6 ',v&TT Ctiinmis'ion 1,:pi,:•: •k.,r•r/ •IS
grantor(s), each personally appeared before me this day rind'acknowledged the executiefi of the foregoing deed of conveyance. , ;-1
• s (Notarial Stamp or Seal) �Witness my hand and n+il;nial seal�or stamp -. day of I'1 L7 ' •
My commission expires t / _ , 192 _ \.. Nntaly Public
I STATE OF NORTH CAROLINA - Forsyth County _
I, -- r
i !'., .lt,
do hereby certify that
-:i ' ,. .. i •t4- ''''i.:-:-.--- : •-,••- .•
•
grantor(s),each personally appeared before me this day and acknowledge: 'i%tt• .,ar-::p ..�
Witness my hand and notarial seal or stam i th . t•rr :. mu l 5 i) -• I^ S_ lj I:_
(Notarial Stamp or Seal) 1
My commission expires , Ir)
STATE OF NORTH CAROLINA-Forsyth County / .
Th foregoing(or annexed)certificate of— �/l
q
PRESENT name and Vidal title of they officer caning the to/tiricare—oas19 u oe) s
,�� is(aeycerti(ied tl>RIIS1s4fra OD c_ 11//t�,, rlCf"i(/l� //7
AND RECORDS
L — r Eunice Ayers, Register of Deeds
Probate and filing fee $ �/ midi 9 21 FN 1 •
Dratted b R. Allen Osborne, Jr. By—— 1-% Deputy- Innt-
Y EUNICE HERS
NOTE TO RECORDING PARTY: REGISTER OF [lEEDS
Ills Please give permanent address of grantees) FDR$YTIi CT1'.N•C ' Z$. ` 'A6
$ - 'J� Y
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