NCG550060_Permit (Issuance)_20060612

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
June 12, 2006
CERTIFIED MAIL — 7006 0100 0001 8758 5798
RETURN RECEIPT REQUESTED
Ms. Barbara Little
3993 Queens Grant Ct
High Point, N.C. 27265
Subject: General Permit NCG550000
Certificate of Coverage NCG550060
130 Roswell Dr.
Forsyth County
Dear Ms. Little:
You are receiving this notice because you currently own a home/property covered under the
subject General Permit for the discharge of domestic wastewater. The Certificate of Coverage
specific to your property expired in 2002.
The Division needs information from you to determine if coverage under NCG550000 is still necessary.
➢ If your property still has a wastewater system like the ones described in the enclosed Technical
Bulletin,you should renew the subject permit. Complete the enclosed form and submit it to the
address on the form.
> If you are not sure what type of system your property has, contact Rose Pruitt in the NC DENR
Winston-Salem Regional Office at(336) 771-5000. She can help you determine if you should
renew coverage under the General Permit.
> If you know that your property no longer discharges wastewater to a waterbody, contact me at the
address or phone number listed below to request rescission of the Certificate of Coverage.
If you have any questions concerning this matter, please contact me at the telephone number
or e-mail address listed below.
Sincerely,
Charles H. Weaver, Jr.
)6617
NPDES Unit
CW/RP
cc: Central Files
Winston-Salem Regional Office
.>. .Weaver NPDES file
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone],extension 511/FAX [phone]/[e-mail] Naturally
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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
GENERAL PERMIT Certificate of Coverage RENEWAL FORM
I. CURRENT PERMIT INFORMATION:
Certificate of Coverage (CoC) Number: NCG55
Owner's name (name to be put on permit):
Owner's or signing official's name and title:
(Person legally responsible for permit)
(Title)
Mailing address:
City: State: Zip Code:
Phone: ( )
E-mail address:
Applicant's Certification:
I , 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.
Signature: Date:
Send this completed form and a copy of the property deed to:
Mr. Charles H. Weaver, Jr.
NC DENR / DWQ / NPDES Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 Naturally
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

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Block Lot 5395 058 New Deed Date
I
Property Address 130 Roswell Dr New Deed Stamps l
Additional Lots Map Number 678874
PIN 6887-25-8727 WIP
Tax Jurisdiction Forsyth County/ Piney Grove FD Land Value $25,245 !,
Taxable Owner Namel LITTLE, BARBARA ELIZABETH Dwelling Value 1
$74 055
Taxable Owner Name2 Commercial Value
Taxable Owner Address 3993 Queens Grant Ct Industrial Value
Taxable Owner City St Zip High Point, NC 27265-7916 Misc Imp Value -
Taxable Deed Bk-Pg - Total Value $99,300
Taxable Deed Date Acreage 0.7
Taxable Deed Stamps Sq Ft Living Area (Res) 1304
New Owner Namel Gross Sq Ft(Com)
i
New Owner Name2 Year Built(Res) 1976
New Owner Address Year Built(Com)
New Owner City St Zip Census Tract 31.04
New Deed Bk-Pg Zoning RS20
Disclaimer: Forsyth County cannot guarantee the accuracy of this information, and the Map Scale
I of 2 6/5/2006 1:42 PM