NCG550094_Permit (Issuance)_20041228

AAA
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
December 28,2004
Jeffrey S.Everett
187 Marajo Court
Winston-Salem,North Carolina 27127-9117
Subject: Renewal of coverage/General Permit NCG550000
Everett residence
Certificate of Coverage NCG550094
Davidson County
Dear Mr. Everett:
In accordance with your application for a Certificate of Coverage[received on November 16,2004],the Division
is forwarding herewith Certificate of Coverage NCG550094 to discharge under NCG550000. Your residence previously
was assigned this CoC number in 1993. The previous owner allowed the CoC to expire. Thus your application is being
treated as 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.
Sine ely,
(--In W.Klimek,P.E.
-6re4/
cc: Central Files
Winston-Salem Regional Office/Steve Mauney
NPDES file
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 N.Salisbury St.,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone]/FAX [phone]/Internet:h2o.enr.state.nc.us )Vatural/jjAn Equal Opportunity/Affirmative Action Employer-50%Recycled/10%Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550094
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 450 GPD wastewater treatment facility that consists of a septic tank,
nitrification line, subsurface sandfilter and associated appurtenances with the discharge of treated wastewater
from the
Everett Residence
187 Marajo Court
south of Winston-Salem
Davidson County
to receiving waters designated as an unnamed tributary to Miller 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 December 28, 2004.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 28, 2004.
Al. , .Klimek,P.E.,Director
Division of Water Quality
By Authority of the Environmental Management Commission

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NCG550094 Facility
Latitude:35°59'21"
Longitude:80'15'53" Location
Quad: Welcome,NC. Everett residence
Stream Class:C
Subbasin:30704 E
Receiving Stream:UT Miller Creek dirotth. NOT TO!CAL
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State of North Carolina iliEflW [ ,I s ii, ��'r`Department of Environment 4 •
and Natural Resourcesi -' NOV 1 6 2004 =__m\.i...... /• r
Division of Water Quality
Michael F. Easley, Governor DENR -WATER QUALITY 1CDE1R
POIANCH
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OFNT SOURCE BR
Alan W. Klimek, P.E., Director ENVIRONMENT AND NATURAL RESOURCES
GENERAL PERMIT Certificate of Coverage RENEWAL FORM
I. CURRENT PERMIT INFORMATION:
Certificate of Coverage (CoC) Number: NCG550094
Owner's name (name to be put on permit):
_.si
E---v erta Yi
' official'sname and title: e 5 .Owner's or signing � y'�'s''`�-�1.1
(P rson legally responsible for permit)
(1-0-0/E a t,42,/
(Title)
Mailing address: /?7 ,l1, A4.ao ?'.
City: G.-U/46 0/V— .6i% &. ivt State: /IC Zip Code: 3-7/a17-(7//7
Phone: ( 3.3,) 775 -oZ Y 7/
E-mail address: J&�eV2feii- he]Isv, p1e.i
Applicant's Certification:
I, P -a _5 . .Eve_/`,e_G! , attest that this application for renewal
of the subject Ger(eral Permit Certificate of Coverage 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 and attachments are not
included, this application package will be returned as incomplete.
Signature: T Date: /- /V0y-Cr
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DENR I DWQ I NPDES Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 Telephone[phone] FAX[phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/10%post-consumer paper

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NPDES Permit No. t i {\,--.7-4,-4-,: !,
r - i j Discharges into an U.T. to Miller _.. ( Vr
J ). Creek, Class "C" waters. ` ; o
- III Located on Marajo Court near the Hwy '�f`-BS°
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•

Permit NCG550094
Subject: Permit NCG550094
From: "Jeffrey S. Everett" <[e-mail]>
Date: Mon, 1 Nov 2004 17:04:06 -0500
To: <[e-mail]>
CC: <[e-mail]>
Mr. Weaver:
This is in response to the General Permit Renewal Form you sent me in
early Oct. I am returning the form to you by US Mail . The map you
included is correct to the best of my knowledge.
Besides the map with my confirmation, I am not including any other
documentation with the form. If this is not correct, please let me
know.
Payment for the renewal fee has been mailed separately to NC DENR.
Thank you.
Jeff Everett
1 of 1 11/3/2004 8:54 AM

General permit renewals
Subject: General permit renewals
From: Steve Mauney <[e-mail]>
Date: Thu, 23 Sep 2004 16:56:07 -0400
To: Charles Weaver <[e-mail]>
Charles-More updates follow for Davidson County:
'LliQCG520006-Triad Sand-No activity at site according to Land Quality and no active
perm)t with them. I called the listed phone but was told that I had the wrong #. The
o er is deceased and I recommend that we consider this file closed.
CG550094-Jeffrey Everett-The address is valid and Mr. Everett said that he sent
something in a year or two ago to renew permit. Please mail the renewal form to him
„en.
550302-Jane Morphis-The current address is 146 Summers Trail Thomasville,
NC 27360. Please mail the renewal form to her.
Will send more info. as I get return calls from several individuals.
Steve Mauney
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771-4608 ext 262
FAX: (336) 771-4630
5'6/1/ re/Ieka 44(

NIDES`RENEWALSNOIDS
Subject: NPDES RENEWALS/VOIDS
From: Steve Mauney <[e-mail]>
Date: Mon, 20 Sep 2004 14:57:06 -0400
To: Charles Weaver <[e-mail]>
CHARLES-Comments are given below for several permits. I will provide information
on the other permits as I get return calls from them or visit the sites.
NCG510355-Center Gulf, Welcome. This site has contamination from solvents and
would apparently not be able to get the general permit. The contact is Tom Taylor,
SAIC 1904 Twin Lake Drive, Holly Springs, NC 27540 and I advised him to apply for
an in 'vidual permit.
G550248-Randy Culler- This is a vacant lot but Mr. Culler, RCR Development Co.i10 9 Finch Ave. High Point, NC 27263 would like to renew the permit.
• CG550094-Jeffrey Everett- We do not have a file for this facility. I have left a
message at the last phone #[phone]). If you could find a staff report in central files it
would elp to fill-in our missing info.
G550922-Thomas Hauser sold land to Jeff Dixon who got a permit from the Health
Dept. for a standard on site system. This permit can be voided.
More soon.
Steve Mauney
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771-4608 ext 295
FAX: (336) 771-4630

State of North Carolina
Department of Environment,
Health and Natural Resources AT:1•117A
Division of Water Quality
James B. Hunt, Jr., Governor p E H N
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director July 21, 1997
H. Brian Tucker
187 Marajo Court
Winston-Salem,NC 27127
Subject: Certificate of Coverage No. NCG550094
Renewal of General Permit
Tucker,H.Brian-Residence
Davidson County
Dear Permittee:
In accordance with your application for renewal of the subject Certificate of Coverage, the Division is forwarding
the enclosed General Permit. This renewal is valid from the effective date on the permit until July 31, 2002. This
permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the Memorandum of
Agreement between North Carolina and the U.S. Environmental Protection Agency dated December 6, 1983. If any
parts,measurement frequencies or sampling requirements contained in this 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, this Certificate of Coverage shall be final and binding.
The Certificate of Coverage for your facility is not transferable except after notice to the Division. Use the enclosed
Permit Name/Ownership Change form to notify the Division if you sell or otherwise transfer ownership of the
subject facility. The Division may require modification or revocation and reissuance of the Certificate of Coverage.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the Regional
Office listed below at [phone]. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain other permits which may be required by the Division of
Water Quality, 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 the NPDES Group at the address below.
Sincerely,
•
/4407:4 4.
A.Preston Howard,Jr.,P.E.
cc: Central Files
Winston-Salem Regional Office
NPDES Group
Facility Assessment Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535 [phone] FAX[phone] p&[e-mail]
An Equal Opportunity Affirmative Action Employer 50% recycled / 10%post-consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG550000
CERTIFICATE OF COVERAGE NO. NCG550094
TO DISCHARGE DOMESTIC WASTEWATERFROM 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,
H. Brian Tucker
is hereby authorized to operate a wastewater treatment facility which includes a septic tank, sand filter
and associated appurtenances with the discharge of treated wastewater from a facility
located at
Tucker,H. Brian-Residence
187 Marajo Court
Winston-Salem
Davidson County
to receiving waters designated as subbasin 30704 in the Yadkin 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 No. NCG550000 as attached.
This certificate of coverage shall become effective August 1, 1997.
This certificate of coverage shall remain in effect for the duration of the General Permit.
Signed this day July 21, 1997.
4.71(----. 9,77,10,a,
f -v'A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Page 3
Version:July 30, 1998

Letter to H. Brian Tucker May 1, 1997
NCG550094
INVOICE FOR RENEWAL OF 2��`
NPDES PERMIT
Check here if you do NOT wish to renew this permit. ,P I Q,w
Please return this page along with a letter documenting your reasons
for not requesting renewal to:
Mr. Charles H. Weaver, Jr. -<
Division of Water Quality/WQ Section
NPDES Group
Post Office Box 29535
Raleigh, North Carolina 27626-0535
0 Check here if you wish to renew this permit. _-
Please verify that the following information is documented accurately:
Mailing Address
H. Brian Tucker ❑ No revision required.
TUCKER, H. BRIAN - RESIDENCE
187 Marajo Court ❑ Revision required. (Please specify below.)
WINSTON-SALEM, NC 27127
Phone number: [phone]
Fax number:
e-mail address:
Facility Location
❑ No revision required.
H. Brian Tucker
TUCKER, H. BRIAN - RESIDENCE
MARAJO COURT ® Revision required. (Please specify below.)
WINSTON SALEM, NC 27127
/ E 7 Mara.J© Co urf
Please return this page with your letter requesting renewal, and $240 fee (payable to NCDEHNR) to:
Mr. Charles H. Weaver, Jr.
Division of Water Quality/WQ Section
NPDES Group
Post Office Box 29535
Raleigh, North Carolina 27626-0535
Signature of applicant or authorized representative /1• 'Amt...
Date 5/2/97

•
H. Brian Tucker
187 Marajo Court
Winston-Salem, NC 27127
Mr. Charles H. Weaver, Jr.
Division of Water Quality/WQ Section
NPDES Group
Post Office Box 29535
Raleigh,NC 27626-0535
Dear Mr. Weaver:
This letter is to request a renewal of NPDES Permit No. NCG550094, in Davidson
County. The location of the discharge drain is 187 Marajo Court, Winston-Salem, North
Carolina. According to the letter we received from the DEHNR, our permit expires July 31,
1997.
Along with this request, I am enclosing the Invoice for Renewal of NPDES Permit, and a
check for$240.00
For future reference, when this permit is up for renewal the next time (which I presume is
in five more years),the property will be owned by someone else. We will be selling the property
later this year.
Thank you.
Sincerely,
714. Awn,
H. Brian Tucker