NCG550783_Authorization to Construct_20180522

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DIEHL & PHILLIPS, P.A.
CONSULTING ENGINEERS WILLIAM C.DIEHL,P.E.
1500 Piney Plains Rd.,Suite 200 JOHN F.PHILLIPS,P.E.
Cary,North Carolina 27518 ALAN R.KEITH,P.E.
Telephone[phone]—Fax[phone]
May 22, 2018
RECEIVED/DENR/DWR
NCDEQ/DWR/NPDES Permitting MAY 2 5 2018
Archdale Building, 925C Water Resources
1617 Mail Service Center permitting Section
Raleigh, North Carolina 27699
Re: Authorization to Construct Modifications to General Permit NCG550783
Dear Reviewer,
Attached for your review please find the following:
One (1) copy of Construction Drawings with specifications on drawings
One (1) copy of NOI Application
One (1) copy of Request for Authorization to Construct letter
One (1) copy of Request for Continuation of Coverage Letter
One (1) copy of receipt from Septic Tank pump out
Check #14176 in the amount of $60.00
One (1) CD with electronic copies of attached documents
We request that you approve these modifications as directed by NOV-2015-PC-0233
dated September 16, 2015.
Sincerely,
Diehl & Phillips, P.A.
John F. Phillips, P.E.

Division of Water Resources UDR AGENCY USE ONLY
National Pollutant Discharge Elimination System(NPDES) Date Received
.,w_-.....-AtWatwaftwiNtit Assanielassmosom Year titunt[r Day
Application for Coverage Under General Permit --
NCG550000 Certificate of Coverage
Single Family Residences and/or facilities discharging u ' c 1 ci'1 -5 rti 1Hm
< 1000 gallons per day of domestic wastewater check n 1 Amount
Assirncd'fo:
NOTiCE OF INTENT
IRequired by I:iterm definition see 15A "4( \(.'02H;0103(19 tl
(Press TAB to navigate_limn)
I. Regional Office contact(Please note: This application will be returned if you have not met with a
representative from the appropriate regional office.):
Please list the NCDENR Regional Office representative(s)with whom you have net:
Name(s): Jane Bernard Date: 3/15/201S
2. Mailing address of owner/operator: (address to which all correspondence should be mailed)
Owner Name Victor&Susan Pickard
Street Address t403 Farmview Rd.
City Hillsborough State lit' Zip27278-
Telephone#(H) Telephone#(W)
Cell/Mobile# [phone] Email safesurting650'nc.rr.ctam
3. Location of facility producing discharge: (lfJaeility is not yet constructed.give street address or lot#)
Street Address $621)Blue Spruce Drive
City Durham State NC Zip 27712-
County Durham
Telephone# Cell/Mobile It
4. Physical location information:
Please provide a narrative description of how to get to the facility 1 use street names,state road numbers.and distance
and direction from a roadway intersection). Travel north on Guess Road to Ashfeld Drive.Turn rieht and go to
the end of Ashfield Drive.Turn left onto Prices Ferry Drive and Lo to I.aketiew Road.Go to Blue Spruce Drive
and turn dein.Site is a)•>rox, 11941 feet ahead on the tett,
5. This NPDES permit application applies to which of the following:
❑ New Irerm definition see t .-.;1 or Proposed(system not constructed)
Q Existing'term definition see t A ^s.; '\t 021 0,1(I 1 sI:if previously permitted by local or county health
department.please provide the permit number 3938 Note:This system has an existing
and issue date 9/18/1973 Certificate of Coverage-NCG5507$3
® Modification: please describe the nature of the modification: Ab autlon esistina sand filter and tablet
chlorinator and replace with an Advantex; X.20-RT`treatment System with Ultraviolet disinfection."this
is a retaair.as directed In NOV-2ttli-PC-0233,dated September 16,2015.
Page 1 of 4 Revised 9/1/13

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NC(:5500100 New Application
6. Description of Discharge: (Required by
a) Amount of wastewater to he discharged:
Number of bedrooms 4 s 120 gallons per bedroom= 4X0
-MO gallons per day to he permitted
b) Type of facility producing waste(please rheek one):
O Primary residence 0 Vacation/second home
® Other: Rental['roper();
7. Please check the components that comprise the wastewater treatment system:
'Required by 1 \ '`' i W"1 ° tl
❑� Septic tank 0 Dosing tank
0 Primary sand filter ❑ Secondary sand filter ❑ Recirculating sand Milter(s)
0 Chlorination ❑ Dechlorination 0 Other form of disinfection:
❑Post Aeration(sped/i•type)
8. icor new or proposed systems only- Please address the feasibility of alternatives to discharging for the
following options in the cover letter for this application:
(Evaluation required by G8_1..14,-2.ti1, thn .)0)..and 15 i c:ACi 211,01 5b.T:'.1
a) Connection to a Regional or Municipal Sewer Collection System.
h) Letter from local or county health department describing the suitability or non-suitability of the site for all types of
wastewater ground adsorption and innovative non-discharge systems.Document the repair potential of the failed
system.
c) Land Application such as spray irrigation or drip irrigation.
9. Receiving waters: (Required by 15A Nt:,,'e( (CH .0 05tca
a) What is the name of the body or bodies of water(creek.stream,river.lake.etc.)that the ltcility wastewater
discharges end up in? An UT to Crooked( reek
ht Stream Classification(if known): Crooked Creek is classified as WS-IV; NSW
19. The application must include the following or it will be returned.as allowed by i.` NC AC 02H .01074,h1:
a)
For r �.
,. psi ( < <r�3. �.
® An original letter and two(I)copy requesting coverage under NCG550000.
O A signed and completed original and one copy of this Notice of Intent Application.
[l A check or money order iiir the permit fee of$60.04)[per i i.. i '+ . it l?' I made payable to NCDENR.
® Invoice showing that the septic tank has been pumped and serviced within the last 12 months(only when
existing service tank will be used).
iay,gc.2of4 Revised 9/1/13

NCG550000 New Application
New or proposed facilities must also include:
0 Letter from the county health department evaluating the proposed site for all types of ground absorption and
innovative non-discharge systems.Document the repair potential of the failed system.
0 Evaluation of connection to a regional sewer system(approximate distance&cost to connect).
0 Provide a 7010 flow estimate at the proposed wastewater discharge point from the US Geological Survey(919-
571-40x))
b) For an Atn poi iia[iz,it o( 4>n �e��rt(ATC)only: (Note: There is no fee for an ATC)
Fi A letter requesting an ATC
❑ Three sets of plans and specifications (required by i 5\._NCAC 2)1 011K)of proposed treatment system(ser:
Permit Application Checklist and Design Criteria for Single Family Discharge)
0 Invoice showing that the septic tank has been pumped and serviced within the last 12 months (only when
existing septic tank will be used).
Additional Application Requirements:
a) If this application is being submitted by a consulting engineer(or engineering firm), include
documentation from the applicant showing that the engineer(or firm)submitting the application has
been designated an authorized Representative of the applicant,peri A N At 021 „.,
h) If this application is being submitted by a consulting engineer(or engineering firm),final plans for the
treatment system must be signed and sealed by a North Carolina registered Pfoit ai pmt tl and
stamped -"Final Design-Not released for construction:"per I 5,A Nt ('0211 .0139.
c) If this application is being submitted by a consulting engineer(or engineering firm), final specifications
for all major treatment components must be signed and sealed by a North Carolina registered
and shall include a narrative description of the treatment system to be
constructed: per I c v (`,V 0211 ti _0,
Page 3 of 4 Revised 9/1/13

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NC( 55000() New Application
CERTIFICATION
I certify that I am familiar with the interntation contained in this application and that to the best of my
knowledge and belief such information is true,complete.and accurate.
Printed Name of Person Signing: Victor Pickard
Title: Owner
(,Please-._• C'1,(,;0211f''1i�3�":i for authorized signing officials)
(Signature of Applicant) (Date Signed) 5 10 1
1 /
North Carolina General Statute.14.!.:215.01 provides that:
Any person who knowingly makes any false statement representation.or certification in any application,record,report,plan.or other
document filed or required to be maintained under this Article or a rule implementing this Article;or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or
knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article
or rules of the Commission implementing this Article, shall be guilty of a Class 2 misdemeanor which may include a fine riot to
exceed ten thousand dollars($10,000) ` provides a punishment by a line or imprisonment not more than 5
years,or both.for a similar offense.
Application must he.accompanied b a check rr_money order li►r 0 0NI jper(i , 1.1 ; 2 '',ase. !,�1
made payable to:
NCDENR
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Mail this application and one copy of the entire package(with check) to:
NC DENR I DWR/Water Quality Permitting Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Attn: Charles Weaver
Note: The submission of this document does not guarantee the issuance of an NPDES permit
Page 4 of 4 Revised 9/1/13

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Mr.Victor Pickard
1403 Farmview Rd.
Hillsborough, NC 27278
919-417-8417
[e-mail]
May 9,2018
NC DEQ
Division of Water Resources
3800 Barrett Drive
Raleigh,NC 27609
RE: Request for Authorization to Construct
Modifications to General Permit NCG550783
To Whom It May Concern,
This letter is my formal request for an Authorization to Construct modifications to General Permit
NCG550783,as directed by NOV-2015-PC-0233,dated September 16,2015.
e . tfully,
t
Victor Pickard
Owner

Mr.Victor Pickard
1403 Farmview Rd.
Hillsborough, NC 27278
919-417-8417
[e-mail]
May 9,2018
NC DEQ
Division of Water Resources
3800 Barrett Drive
Raleigh, NC 27609
RE: Request for Continuation of Coverage under General Permit NCG550783
To Whom It May Concern,
This letter is my formal request for continuation of coverage of a discharge of treated domestic
wastewater from a single family residence under General Permit NCG550783.
lies ully,
Victor Pickard
Owner

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A Trucking & Tractor Service
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