NCG550094_Permit (Issuance)_20081212

• y
OF W A 9 Michael F.Easley
O �C. Governor
Cq 7' William G.Ross,Jr.,Secretary
[ North Carolina Department of Environment and Natural Resources
Coleen H. Sullins,Director
Division of Water Quality
December 12, 2008
Mr. Jeffrey S. Everett
187 Marajo Court
Winston-Salem,North Carolina 27127
Subject: General Permit No. NCG550094
Add on chlorination/dechlorination to
existing system
Jeffrey S. Everett Residence
Davidson County
Dear Mr. Everett:
General Permit Coverage. In accordance with your application for discharge, the Division is
forwarding herewith the subject Certificate of Coverage to discharge under the subject state-
NPDES general permit. 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 August 1, 2007 (or as subsequently amended).-
The following information is included with your permit package:
• A copy of the Certificate of Coverage for your treatment facility
• A copy of General Wastewater Discharge Permit NCG550000
• A copy of a Technical Bulletin for General Wastewater Discharge Permit NCG550000
• Engineer's Certification to be completed and returned.
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 of Water Quality. The Division of Water Quality 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.
N.C.Division of Water Quality/NPDES Unit Phone:[phone]
1617 Mail Service Center,Raleigh,NC 27699-1617 fax:[phone]
Internet:h2o.enr.state.nc.us DENR Customer Service Center:1 800 623-7748

Authorization to Construct Permit. In accordance with your application for discharge, the
Division is also authorizing the construction of a chlorinator and chlorine contact tank,
dechlorinator, and a pump tank into an unnamed tributary to Miller Creek, classified C NSW
waters in the Yadkin Pee-Dee River Basin. All elbow piping must be of the long sweeping type.
All cleanouts are to be housed in meter boxes below the surface. This system must be at least 50
feet from the dwelling and property lines and at least 100 feet from water supply wells on and off
the site. The system must also be constructed and located above a 100-year flood.
This Authorization to Construct permit is issued in accordance with Part III, Paragraph 2 of
NPDES Permit No. NCG550000, and shall be subject to revocation unless the wastewater
treatment facilities are constructed in accordance with the conditions and limitations specified in
Permit No. NCG550000. In the event that the facilities fail to perform satisfactorily, including
the creation of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of additional or
replacement wastewater treatment or disposal facilities. Failure to abide by the requirements
contained in this Authorization to Construct may subject the Permittee to an enforcement action
by the Division of Water Quality in accordance with North Carolina General Statute 143-215.6A
to 143-215.6C.
The Winston-Salem Regional Office, telephone number 336-771-5000, shall be notified at
least forty-eight (48) hours in advance of operation of the installed facilities so that an in-
place inspection can be made. Such notification to the regional supervisor shall be made
during the normal office hours from 8:00 a.m. until 5:00 p.m. on Monday through Friday,
excluding State Holidays.
Upon completion of construction and prior to operation of this permitted facility, an Engineer's
Certification must be received certifying that the permitted facility has been installed in
accordance with the NPDES Permit, the Certificate of Coverage, this Authorization to Construct
and the approved plans and specifications. A leakage test shall be performed on the septic tank
and dosing tank to insure that any exfiltration occurs at a rate that does not exceed twenty (20)
gallons per twenty-four (24) hour per 1,000 gallons of tank capacity. The Engineer's
Certification will serve as proof of compliance with this condition. Mail the completed
Engineer's Certification to the NPDES Unit, 1617 Mail Service Center, Raleigh, NC 27699-
1617.
A copy of the approved plans and specifications shall be maintained on file by the Permittee for
the life of the facility.

NPDES Permit Contact. If you have any questions concerning the requirements of this permit,
please contact Jacquelyn M. Nowell at telephone number 919-807-6386.
(' Sincerely,
Coleen H. Sullins, Director
•
cc: Central Files
4"NPDES'9Gene-Pe rn a Files�NCG5500941
Winston-Salem Regional Office/Surface Water Protection
Davidson County Health Department
Technical Assistance and Certification

0C).F W A7- ,9 Michael F.Easley
•
Governor
William G.Ross,Jr.,Secretary
•
North Carolina Department of Environment and Natural Resources
's" Coleen H.Sullins,Director
• Division of Water Quality
December 12, 2008
Mr. Jeffrey S. Everett
187 Marajo Court
Winston-Salem,North Carolina 27127
•
Subject: General Permit No. NCG550094
Add on chlorination/dechlorination to
• existing system
Jeffrey S. Everett Residence
Davidson County
Dear Mr. Everett:
General Permit Coverage. In accordance with your application for discharge, the Division is
. forwarding herewith the subject Certificate of Coverage to discharge under the subject state-
NPDES general permit. 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 August 1, 2007 (or as subsequently amended).
The following information is included with your permit package:
•
• A copy of the Certificate of Coverage for your treatment facility
• A copy of General Wastewater Discharge Permit NCG550000
• A copy of a Technical Bulletin for General Wastewater Discharge Permit NCG550000
• Engineer's Certification to be completed and returned.
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 of Water Quality. The Division of Water Quality 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.
•
N.C.Division of Water Quality/NPDES Unit Phone:[phone]
1617 Mail Service Center,Raleigh,NC 27699-1617 fax:[phone]
Internet:h2o.enr.state.nc.us DENR Customer Service Center.1 800 623-7748

NCG550094 __ --
Engineer's Certification
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe(periodically, weekly, full time)the construction of
the following chlorination/dechlorination system project:
Project Name Location
For the permittee hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the approved plans and specifications.
Signature
Registration No.
Date

• STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
CERTIFICATE OF COVERAGE NCG550094
GENERAL PERMIT NO. NCG550000
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,
•
Jeffrey S. Everett
is hereby authorized to operate a wastewater treatment facility consisting of a septic tank, one primary sand filter, ,
chlorinator, chlorine contact chamber, dechlorinator, discharge pipe and associated appurtenances, and with the
discharge of treated wastewater from a facility located at the
Jeffrey S. Everett Residence
187 Marajo Court
Winston-Salem
Davidson County
to receiving waters designated as an unnamed tributary to Miller Creek in subbasin 03-07-04 of 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 of General Permit NCG550000 as attached.
This certificate of coverage shall become effective December 12,2008.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 12,2008.
Original signed by Sergei Chernikov for
Coleen H. Sullins,Director
Division of Water Quality
By Authority of the Environmental Management Commission

ENGINEERS SURVEYORS PLANNERS
l 'i
December 5, 2008 {15 J s
1)111
DEC 9 2008 IA))
Jackie Nowell L..__ f l�
' I
tni ;:--
North Carolina Division of Water Quality-NPDES Daft -putt,' ��
So
1617 Mail Source Center �'- U"`'F
Raleigh,NC 27699— 1617
Please find 3 sets of revised plans attached. Per your phone call on Dec. 4, 2008 the
following revisions have been made:
• A cross section of the typical contact chamber has been added
• A note that contact time must be 30 minutes minimum has been added
• A note that all piping must be SCH40 PVC has been added
Kindest Regards,
Alex Carter, EI
•
503 High Street Winston Salem, NC 27101 Ph. 336.748.0071
Fax [phone]

z- £i2E. � f— - /V e
lyf4 AE6-1trdy "AirAi
4,0/ -- i-5-61-615-e., ay
_% v d'7,- /a4_cit.c-i_ ,e,{„cf,z-17‘ /-2 ., i--,QA2 7k- soapti„
0 /5-00/4 , ,
,j4 7L242. -7--wc_ 3 7 i r-,1,,,<.„L /,/,‘ ,- ,
)4j---
39/ ys 1Zf
A z_ /r 64 -::
7,rio/Itz
i ' Qv.-
ex(iLee___ ,L2e,,4 3 o 4,,, _ 7-d,--14;-.. -41 c
Asa;c2-1 A V V -;t — tre/1414; r ��
rl
�r
And �`e`d`� ;AA) Sze=�C,.�e �'G
— /111/n - e-P,a 96 /V(, 4,7‘4,
keit- ,-/ Jo /0---, fc- ,i /2,v C. -1-c-,
1 -tios 3 A _.!..0"_...
~-gcc-4 4x-`d
---7 7#1wCA--k--

E S ' Bur W1 C.
ENGINEERS SURVEYORS PLANNERS
PECS'F D
May 14, 2008
_
( A� .r Y
NC Division of Water Quality
Construction Grants &Loans Section 'd h ' Cie rinrro
1633 Mail Service CenterSECTIONuC�• ��1 ;�
Raleigh,N.0 27699-1633 F LOAN
Attention: Daniel M. Blaisdell, P.E.
Daniel M. Blaisdell, P.E.:
Please find included in this package a submission for Authorization to Construct for a
single family residential OSWW system with a point source discharge to a nearby stream
in Davidson County,NC.
A brief history of this OSWW facility is it was constructed by previous owners around
1977 under county oversight. The OSWW system had a 1000 gal. tank and 600' of
nitrification lines. Apparently the system failed early in its life and a 391 sq ft. sand filter
was added to the system.
The state originally issued a NPDES permit in 1979 and the current owner purchased the
property in 1998. No records of the original installation were transferred or are available
per Mr. Charles Weaver in DWQ Central Files.
The current owner has received a notice of violation for failure to have a
chlorination/dechlorination system as required by the NPDES permit. Beeson
Engineering, Inc. has been retained to assist in updating the system and making sure the
owner returns to good standing with the local and state DWQ.
The addition of the chlorination/dechlorination to the existing system is fairly straight
forward and we are hopeful you can offer a speedy approval on this improvement to a
residential home site.
Best Regards,
//lS4e7
John Beeson, PE
503 High Street Winston Salem, NC 27101 Ph. 336.748.0071
Fax [phone]

•
•
•
•
187 Marajo Ct
Winston Salem,NC 27127
•
May 1,2008
Mr. Alex Carter
Beeson Engineering, Inc.
503 High Street
Winston-Salem,NC 27010
Dear Mr. Carter:
Subject:ATC for NCG550094
This is to provide you with written authorization for Beeson Engineering, Inc.to prepare
an Authorization to Construct Application and to submit it to the North Carolina Division
of Water Quality for the purpose of adding a chlorination and de-chlorination system to
the existing sand filter septic system at my single family residence at the above noted
•address.
Thank you. •
Sincerely,
effrey S.Everett

North Carolina Division Of Water Quality t RECEIVED
Construction Grants & Loans Section
MAY 2 1
M 2008
Authorization To Construct (ATC) Application Form
(To Be Used On and After August 1, 2007) CONSTROM GRANTs&
LOAN SECTION
Date: 5/14/2008
Permittee/Owner Name: Jeffrey S. Everett Professional Engineer of Record: John Beeson, P.E.
Contact Person: Alex Carter, E.I. Engineering Firm: Beeson Engineering, Inc.
Address: 503 High Street Address: 503 High Street
Winston-Salem, NC 27101 Winston-Salem, NC 27101
Telephone Number: [phone] Telephone Number: [phone]
Please Note: The following items and information must be Information Is
submitted to be considered a complete application Provided Remarks/Explanation
package. If any applicable item is missing the package will
be returned as incomplete.
1 Letter of request for ATC from Permittee/Owner or ® Letter Dated Mayl, 2008
authorized agent with written authorization.
2 Brief description of the proposed project. ® Cover letter Dated May 14, 2008
3 Complete copy of the NPDES permit or public notice of ® CoC NCG550094
a draft NPDES permit.
4 Design capacity in Million Gallons per Day(MGD). ® 0.00045 MGD
If new or expanding design capacity is greater than or
5 equal to 0.5 MGD, include a copy of Finding Of No ❑ N/A
Significant Impact(FNSI).
Two sets of plans: signed, sealed, and dated by a NC
6 Professional Engineer and stamped "Final Drawing -
Not Released For Construction".
Two sets of technical specifications: signed, sealed,
7 and dated by a NC Professional Engineer.
Two sets each of process, design, buoyancy, and
8 hydraulic profile calculations: signed, sealed, and dated ❑ N/A-retrofit Chlorination to Residential
by a NC Professional Engineer.
9 Hydraulic profile and a flow schematic with sizes of CI N/A-retrofit Chlorination to Residential
major components on 8%"X 11" paper.
Documentation that a Soil & Erosion Control permit
10 application has been submitted to the Division of Land ❑ N/A-Less than 10K Sq Ft disturbed
Resources.
Residuals Management Plan for all new or expanding
11 facilities producing residuals, or when modifying ❑ N/A
residual facilities.
12 Construction Sequence Plan for all modifications. ® Plan Sheet 1 of 1
13 110 volt GFCI receptacle and potable water source �� Residence shown on plans
included on plans.

Please Note: The following items and information must be Information Is
submitted to be considered a complete application Provided Remarks/Explanation
package. If any applicable item is missing the package will
be returned as incomplete.
14 Hydrogeologic information must be provided if a ❑ N/A
potential for groundwater contravention exists.
15 For abandonment of WWTPs: a statement that the ❑ N/A
facility will be properly disconnected.
16 All property lines, construction easements, permanent Per Davidson County Plat Bk 16, Pg
easements, and ROW shown. 50
17 All wells within 200 feet of project shown. El N/A
18 All houses and places of public assembly within 100
feet shown.
Wetlands, watercourses, and drainage features within
19 50 feet of all wastewater treatment or storage facilities ►1
shown.
20 Identify on the plans each water body's watershed
classification.
21 Plan sheets for all applicable disciplines.
22 Reliability per NCAC 2T .0505 (I). El N/A
23 Identify 100 year flood elevation on plans. El N/A
24 North arrow on each plan sheet.
25 Horizontal and vertical control.
26 Subsurface investigation for new structures. El N/A
Municipal/Public Facilities, also include the following:
Engineer's Certification signed, sealed, and dated by
27 the Engineer Of Record stating that the project El N/A
complies with G.S. 133-3.
28 Minority Business Forms for Local Government ❑ N/A
Projects.
29 Minority Business Guide. El N/A
30 Dispute Resolution with mediation for Local ❑ N/A
Governments.
31 Contract Duration included. El N/A
Projects funded through CG&L must include the
32 Submittal Checklist, found under Plans &
Specificiations at: El N/A
http://www.nccgl.net/Engineering/plans.html

North Carolina Division Of Water Quality
Construction Grants & Loans Section
Dechlorination Facilities Fast-Track
Authorization To Construct (ATC) Application Form
(To Be Used On and After August 1, 2007)
Date: 5/14/2008
Permittee/Owner Name: Jeffrey S. Everett Professional Engineer of Record: John Beeson, P.E.
Contact Person: Alex Carter, E.I. Engineering Firm: Beeson Engineering, Inc.
Address: 503 High Street Address: 503 High Street
Winston Salem, NC Winston-Salem, NC 27101
Telephone Number: (336) 748-M7/ Telephone Number: (336)748- 7/
NPDES Permit Number: NC550094 Date Issued: 7/27/2007
Facility Name: Domestic Wastewater
Facility Address (Physical Location): 187 Maraio Court
Winston-Salem, NC 27127
County project is located in: Davidson County
Name of receiving stream: Unnamed tributary to Miller
Creek in subbasin 03-07-04
Name of river basin: Yadkin River Basin
Project Description:Addition of Chlorination and Dechlorination to effluent discharge of existing OSWW system including
1000gal Storage Tank, 600' Nitrification line and 391 Sgft. Sand filter.
Type of dechlorinating agent used (chemical): Sodium Sulfite (Na2SO3)
If other, please specify: