NCG551755_Application_20190118

FOR AGENCY USE ONLY
Division of Water Resources Date Received
ATA National Pollutant Discharge Elimination System(NPDES) Year Month Day
NCDENR Application for Coverage Under General Permit `k l Lt 01 /6
Certificate of Coverage
NCG550000 NC G s 5 1 515
Single Family Residences and/or facilities discharging Check# Amount
< 1000 gallons per day of domestic wastewater 11CA il(Qpitx
Assigned To:
NOTICE OF INTENT
[Required by 15A NCAC 02H.0127(d)];[term definition see 15A NCAC 02H.0103(191]
(Please print or type)
1. 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 Regio al ffice representative(s)with whom you have met:E. ,� i
• Name(s): LAAAA� 17/ O tto Date: I2— ,'
2. Mailing address of owner/operator: (address to which all correspondence should be mailed)
Owner Name DDAV i 9 IJ) N•I i�
Street Address 3 a a�2 0O rl d Q` IS
City ) J E H an State Ni C C. ZIP e.•7 70 10/
Telephone#(H) 'j 7 123 3\$S Telephone#(W) q1 , C7 a5t lr
Cell/Mobile# Email �\Ol'* @ D d�,'�A' • COM
3. Location of facility producing discharge: (Iffacilny is not yet constructe4 give street address or lot#)
Street Address 'y 0 d r 1 Ri2A3 ul(DUI` k J , ` I
City �i'�t State N Q ZIP Q.,1 7 C
County . _- )(2 3rl 1
Telephone# q 1a— (sea, a Co Cell/Mobile# Ck 1.9 313- /I a5
4. Physical location information:
Please provide a narrative description of how to get to the facility(use street names,state road n amb-viers,and distance
and direction from a roadway intersec on). T �� 10 1 n 1 t� ‘C(ai •
5. This NPDES permit application applies to which of the following:
6 New[term definition see 15A NCAC 02H.0103(16)]or Proposed(system not constructed)
❑ Existing[term definition see 15A NCAC 02H.0103(111];If previously permitted by local or ctfat haVt D/DENRIDWF
department,please provide the permit number J A N 18 2019
and issue date
❑ Modification; please describe the nature of the modification: 'vste► Resources
PRrrnitting Section
Page 1 of 3 Revised 9/1/13
J

NCG550000 New Applicant
6. Description of Discharge: [Required by 15A NCAC 02H.0105(c)(l)]
a) Amount of wastewater to be discharged: G'
gallons 120 per bedroom= 3
Number of bedrooms 3 x
gallons per day to be permitted
b) Type of facility producing waste(please check one):
• Primary residence ❑ Vacation/second home
O Other:
7. Please check the components that comprise the wastewater treatment system:
[Required by 15A NCAC 02H.0105(c)(3)]
peptic tank 0 Dosing tank
5/Primary sand filter 0 Secondary sand filter 0 Recirculating sand filter(s)
❑ Chlorination 0 Dechlorination 0 Other form of disinfection:
❑Post Aeration(specify type)
S. For 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 G.S.S 143-215.1(b)(5)(a)and I5A NCAC 02H.0105(c)(2)]
a) Connection to a Regional or Municipal Sewer Collection System.
b) 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 NCAC 02H .0105(c)(1)]
a) What is the name of the body or bodies of water(creek,stream,river,lake,etc.)that the facility wastewater
discharges end up in?
b) Stream Classification(if known):
10. The application must include the following or it will be returned,as allowed by 15A NCAC 02H.0107(b1:
a) For Certificates of Coverage:
❑ An original letter and two`(1)copy requesting coverage under NCG550000.
❑ A signed and completed original and one copy of this Notice of Intent Application.
O A check or money order for the permit fee of$60.00[per G.S.&143-215.3(a)(1b)]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).
Page 2 of 3 Revised 9/1/13
1

NCG550000 New Applicant
New or proposed facilities must also include:
❑ 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.
❑ Evaluation of connection to a regional sewer system(approximate distance&cost to connect).
❑ Provide a 7Q10 flow estimate at the proposed wastewater discharge point from the US Geological Survey(919-
571-4000)
b) For an Authorization to Construct(ATC)only: (Note: There is no fee for an ATC)
❑ A letter requesting an ATC
❑ Three sets of plans and specifications(required by 15A NCAC 02H.0138)of proposed treatment system(see
Permit Application Checklist and Design Criteria for Single Family Discharge)
❑ 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,per 15A NCAC 02H.0138(b)(1).
b) If this application is being submitted by a consulting engineer(or engineering firm),fmal plans for the
treatment system must be signed and sealed by a North Carolina registered Professional Engineer and
stamped-"Final Design-Not released for construction;"per 15A NCAC 02H.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
Professional Engineer and shall include a narrative description of the treatment system to be
constructed;per 15A NCAC 02H.0139.
Page 3 of 3 Revised 9/1/13

NCG550000 New Applicant
CERTIFICATION
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true,complete,and accurate.
Printed Name of Perr__ n Signing:
1�_ Y 14r) t�( . T 1
Title: 1" o t - I�J�"
(Please review 15A NCAC 02H.0106(e)for authorized signing officials)
- /(h 0 ) (4
(Si ture ofApplicant) (Date Signed)
North Carolina General Statute&143-215.6E 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 not to
exceed ten thousand dollars($10,000). 18 U.S.C.Section 1001 provides a punishment by a fine or imprisonment not more than 5
years,or both,for a similar offense.
Application must be accompanied by a check or money order for$60.00 fper G.S. & 143-215.3(a)(lb)1
made payable to: •
NCDENR
❑ ❑ ❑ ❑ ❑
Mail this application and one copy of the entire package(with check)to:
NC DENR/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 3 Revised 9/1/13

SCOTTY'S SEPTIC SERVICE
PO BOX 15130
DURHAM, NC 27704
919-682-2400
CUSTOMERS ORDER NO PHONE DATE
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THANK YOU

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ROY COOPER { _�` -�-
Governor '� :, ;
MICHAEL S.REGAN .0 N..�,�.
secretary �``;"� ' •
LINDA CULPEPPER NORTH CAROLINA
Director Environmental Quality
January 22, 2019
David Hunt
Julie Hunt
3007 Redwood Rd
Durham, NC 27704
Subject: Permit Application
Application No. NCG551755
3007 Redwood Road
Durham County
Dear Applicant:
The Water Quality Permitting Section acknowledges receipt of your application for a new NPDES WW permit, including
supporting documentation and your check number 1104 in the amount of$60.00 as payment of the application fee. These
items were received in our offices on January 18, 2019. Your application will be assigned to a permit writer within the
Section's NPDES WW permitting branch. The permit writer will contact you if additional information is required to
complete evaluation of your application. Your timely and direct response to any such request will help to expedite the
review process. Please note that acceptance of the application does not guarantee a NPDES permit will be issued for the
proposed activity. A permit will only be issued following a complete review of the application, concluding the proposed
discharge is allowable per applicable statutes and rules.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/perm its-regulations/permit-guida nce/envi ronmental-appl ication-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
c 3,t*.•' 'd,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
,� North Carolina Departrael mat of Environmefatal Quality I DiY5:4ft of Wat_r Resource
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