NCG551238_Regional Office Physical File Scan Up To 6/2/2020

7,1 ROY COOPER
•••,• iw� ., -. GOYL'
MICHAEL S.REGAN
S'ecma,'
Wafer Resources S.JAY ZIMMERMAN
Environmenhd Quality - Director
March 24, 2017
Jewell King
PO Box 1324
Old Fort,NC 28762
SUBJECT: Compliance Evaluation Inspection
377 Huskins Branch Road
Permit No:NCG551238
McDowell County
Dear Ms. King:
Thank you for sampling your effluent for the parameters required under your permit,NCG551238.
Your facility is now in compliance with your permit,because the results of your effluent sampling
are within your permit limits. Please remember that the effluent needs to be sampled for BOD,
Total Suspended Solids,Fecal Coliform Bacteria,and Total Residual Chlorine once every year. If
you have any questions, please call me at 828-296-4658 or send me an email at
[e-mail].
Sincerely,
Daniel J Boss
Environmental Specialist
Asheville Regional Office
cc: MSC 1617-Central Files-Basement
Asheville Files
G:\WR\WQWcDowell\Wastewater\GeneraINCG55 SFR\King,Eavat\CE1.2.23.2017 Complimme letter 3-N-2017 aocx
":P'No7:11317tg Compares:'ti..,v..
SmteofNodu Carollnn I Environmental Quality Watar Romar,as
2090 US Highway 70,Swannanoe,Norm Carolina 28778
828-296-4500

ROY COOPER
Gm,e "
MICHAEL S. REGAN
N-1 C
S cre(my
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Dirednr
March 3,2017
Mrs.Jewell King
P.O.Box 1324
Old Fort,NC 28762-1324
Subject: NPDES General Permit NCG550000
Transfer of NCG551238
377 Huskins Branch Road Residence
McDowell County
Dear Mrs.King:
The Division hereby transmits Certificate of Coverage(CoC)NCG551238,issued under NPDES General
Permit NCG550000. This action is taken to show that you are now the owner of the subject facility. This CoC 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 October 15, 2007(or as
subsequently amended).
If any parts,measurement frequencies or sampling requirements contained in the General Permit are
unacceptable to you,you have the right to request an individual NPDES permit upon written request within thirty
(30)days following receipt of this letter. Unless such a request is made,this transfer of the subject CoC shall be
final and binding.
This CoC is not transferable except after notice to the Division. The Division may require modification
or revocation and reissuance of the CoC. This permit does not affect the legal requirements to obtain other
permits which may be required by any other Federal,state,or local government. If you have any questions
concerning this matter,please contact Emily Phillips at(919) 807-6479 or via e-mail
[sarali [e-mail]].
me rely,
1
S.Jay Zimmerman,P.G -
Director
REREhVED
WSWRBSQureN
cc:tAshevillctRegional Office 1
NPDES Unit
MAR - 9 2017
Water Ouallty ReglorMopmedons
Asheville Regional ORke
State of North Carolina I Environmental Quality l Water Resources
1617 Mail Service Center I Raleigh,NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.ne.gov/about/divisions/wata-msources/water-resoumm-p=its/wastewater-bmnc]Vnpdes-wastewaterpar its

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
i
DIVISION OF WATER RESOURCES
CERTIFICATE OF COVERAGE NCG551238
Under GENERAL PERMIT NCG550000
TO DISCHARGE 100%-DOMESTIC AND SIMILAR WASTEWATERS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
PDES
In compliance with the provisions 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,
Jewell King
is hereby authorized to operate a wastewater treatment facility with a discharge of<1000 gallons per day);
discharging from
377 Huskins Branch Road
Old Fort
McDowell County
to receiving waters designated as an unnamed tributary(UT)to Limekiln Crock[stream segment 11-24-15],a
waterbody currently classified C located within subbasin 03-08-30 of the Catawba River Basin,in accordance
with the effluent limitations,monitoring requirements,and other conditions set forth in Parts 1,H,and III of
General Permit NCG550000 as attached.
This certificate of coverage shall become effective March 3,2017
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 3,2017.
S.Jay Zimmerman,P.G.,
Director,Division of Water Resources
By Authority of the Environmental Management Commission

ROY COOPER
tia Governor•
MICHAEL S,REGAN
Secmtrmy
Water ResourcesS.JAY ZIMMERMAN
ra"ironoatal Quality
Director
m Q
February 27, 2017
Jewell King
PO Box 1324
Old Fort,NC 28762
SUBJECT: Compliance Evaluation Inspection
377 Hoskins Branch Road
Permit No: NCG551238
McDowell County
Dear Ms. King:
Enclosed please find a copy of the Compliance Evaluation Inspection form from the inspection
conducted on 2/23/2017. The facility was found not to be in compliance with permit NCG551238
because the annual effluent sampling requirements have not been met. The effluent needs to be
sampled for BOD,Total Suspended Solids,Fecal Colifonnt Bacteria, and Total Residual Chlorine.
Please contact me when this action has been taken. You can call me at 828-296-4658 or send me
an email at [e-mail].
Please refer to the enclosed inspection report for additional observations and comments.
Sincerely,
Daniel J Boss
Environmental Specialist -
Asheville Regional Office
Enclosed: Inspection Form
cc: MSC 1617-Central Files-Basement
Asheville Files
G,\WR\WQWcDowell\Wmtewater\GeneralWCG55',.5ER'R,R'rUhTrtp1111C81iL 3.WA!PPLetter 2-23-17.doex
Sratool'North Carolina I Environmmital Quality Water Resaarces
2090 O.S.Highway 70,Swannenoe,NOM C.Mina 28778
828-2964500

United Slates Envmnmenlel Prolecllon Agency Form Ap Ved.
EPA WasM1lnBlon,oon,2096a OMB NP20ge-005]
Water Compliance Inspection Report Approval
expbeeB-31-93
Section A:National Data System Coding(i.e.,PCS)
Trana actlon Cod, NPOES yrlmWdey Inapedion Type Inapector mo Type
1 IN 1 2 15 1 3 I NCG551238 111 12 17/02/23 17 181 n t 19 c I 201 16
2111111111111111111111111111111111111111 11 11 r5
Inspection Work Days Facility Self-Monitoring Evaluation Rating 31 CIA ----Reaerved
67I .......
.l 70 71I I 72 i a, 731 I 174 751 _1 1 1 I I 1BO LJ LyD Section B:Facility Data
LJ I I I
Name and Location of Facility Inspected(For Industrial Users discharging to POTW,also include Entry Time/Date Permit Effective Dale
POTW name and NPDES permit Number) 04:40PM 17/02123 13108/01
377 Hdskins Branch Road
377 Fri Branch Rd - Exit Time/Date Permit Expiration Data
Marian NC 28752 05:1 SPM 17/02123 18107131
Names)of Dmim RepresentativocipTitlosipp/Fhons and Fax Number(.) Other Facility Data
111
Name,Address of Responsible OXlci.11TitlWPhone and Fax Number
J Mounce Klni Box 1324 Old Fort NC 2875VI828-724-39041 Co Yeaetl
Ves
Section G A...Evaluated During Inspection(Check only those areas evaluated)
-.®.panmlt N Operations$Maintenance ®Self-Monitoring Program. ® Facility Site Review
EfguentlReceiving Waters
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(sj and Slgnature(s)of Inapector(.) Agency/OMWPhone and Fax Numbers Data
Daniel J Boas 0 P ARO WO//828-296-46581
Signature of Management O A Reviewer AginglOgicWPhone and Fax Numbers Date
EPA Form 35603(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yrfmWday lnspeclion Ty, (Cont) 1
31 NCG551238 I11 12 llla2/23 17 19 IC
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
I (Dan Boss)conducted a Compliance.Evaluation Inspection at 377 Huslans Branch Road on
2/23/2017. The owner, Jewell King,was present for the duration of the inspection. The septic system has been pumped in 2016. Prior to that the last pumping was in 2011. 1 told Ms. King that she should
probably have the system pumped more frequently since there are 3 people living at the home full time.
My suggestion was that she have it pumped every 3 years.
There were tablets in both the chlorination and dechlorination tubes of the right size and type. I
suggested that fewer tablets be placed in the tubes at a time because they were starting to form a
mushy mass at the bottom. When Ms. King removed and replaced the dechlorination tubes from the
holders, it caused a slight slurry discharge of dechlorination material.
The effluent pipe was consistently discharging during the inspection. The effluent was clear except for
when the dechlorination material was agitated. No water quality impacts on the stream were observed.
Ms. King was not clear about the annual sampling requirements, although she had the effluent tested
consistently before 2014. She said she would begin sampling again and plans to use Kace
Environmental for the testing as she had in the past. -
lei hag e# 2

Permit NCG551238 Owner-Facility: 377 makes Branch Road
Inspection Date: OWN2017 Inspectlon Type: Compliance Evalualion
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted anew ❑ ❑ 0 ❑
application?
Is the facility as described in the permit? 0 ❑ ❑ ❑
#Are there any special conditions for the permit? ❑ ❑ 0 ❑
Is access to the plant site restricted to the general public? ❑ ❑ 0 ❑
Is the inspector granted access to all areas for inspection? 0 ❑ ❑ ❑
Comment:
Operations $ Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? 0 ❑ ❑ ❑
Does the facility analyze process control parameters,for ex:MLSS,MCRT; Settleable ❑ ❑ M ❑
Solids,pH,DO, Sludge Judge, and other that are applicable?
Comment:
Septic Tank Yes No NA NE
(If pumps are used)Is an audible and visual alarm operational? ❑ ❑ 0 ❑
Is septic tank pumped on a schedule? _ ❑ ❑ ❑
Are pumps or syphons operating properly? ❑ ❑ 0 ❑
Are high and low water alarms operating properly? ❑ ❑ M ❑
Comment Septic tank was pumped in 2011 and then 2016. 1 recommended Pumping the tank more
frequently.
Sand Filters(Low rate) Yee No NA NE
(If pumps are used)Is an audible and visible alarm Present and operational? ❑ ❑ M ❑
Is the distribution box level and watertight? ❑ ❑ ❑ 0
Is sand filter free of ponding? 0 ❑ ❑ ❑
Is the sand Alter effluent re-circulated at a valid ratio? ❑ ❑ ■ ❑
#Is the sand filter surface free of algae or excessive vegetation? 0 ❑ ❑ ❑
#Is the sand filter effluent re-circulated at a valid ratio?(Approximately 3 to 1) ❑ ❑ 0 ❑
Comment:
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? 0 ❑ ❑ ❑
Are the tablets the proper size and type? M ❑ ❑ ❑
Page# 3

A
Permit NOG551238 Owner-Facility: 377 Hoskin Bran.h Road
Inspedion Date: 0212=017 Inspection Type: Compliance EwI ion
Disinfection-Tablet Yes No NA NE
Number of tubes in use? 2
Is the level of chlorine residual acceptable? ❑ ❑ ❑
Is the contact chamber free of growth, or sludge buildup? ❑ ❑ ❑
Is there chlorine residual prior to de-chlorination? ❑ ❑ ❑
Comment
De-chlorination Yes No NA NE
Type of system? Tablet
Is the feed ratio proportional to chlorine amount(1 to 1)? E ❑ ❑ ❑
Is storage appropriate for cylinders? ❑ ❑ M ❑
#Is de-chlorination substance stored away from chlorine containers? ❑ ❑ ❑
Comment:.
Are the tablets the proper size and type? ❑ ❑ ❑
Are tablet de-chlorinators operational? 0 ❑ ❑ ❑
Number of tubes in use? 2
Comment:
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? ❑ ❑ ® ❑
Is sample collected below all treatment units? ❑ ❑ 0 ❑
Is proper volume collected? ❑ ❑ 0 ❑
Is the tubing clean? ❑ ❑ M ❑
#Is proper temperature set for sample storage(kept at less than or equal to 6.0 degrees ❑ ❑ 0 ❑
Celsius)?
Is the facility sampling performed as required by the permit(frequency,sampling type ❑ 0 ❑ ❑
representative)?
Comment: Effluent needs to be sampled and lab tested.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? IS ❑ ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? 0 ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ 0 ❑
Comment:
Page# 4

PAT MCCRORY
y
DONALD R. VAN DER VAART
1'ecr✓.'aiy
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY Oneaaor
PERMIT NAME/OWNERSHIP CHANGE FORM
1. CURRENT PERMIT INFORMATION:
Permit Number: NC00_/ / / / orNC//G5y5 /a / ?10
1. Facility Name: 3 7 e F�f YICh a
II. NEW OWNERINAME INFORMATION:
1. This request for a name change is a result of:
—a. Change in ownership of property/company
Xb. Name change only
c. Other(please explain):
2. New owner's name(name to be put on permit):
0-C w c l/ e,' IN o
1
3. New owner's or signing official's name and title: aeW e // ,�' ✓L A
(Person legally respons le for permit)
(Title)
4. Mailing address: PA 90/t /3a ct city: cyd y'52)/l
Stater Zip Coder Phone: (epj ) 8P/
E-mail address:
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,NC 27699-1617
919 807 6300 919-807-6389 FAX
http://podal.nedenr.org/web/wq

_ Applicant's Certification:
I, Je w e t/ X h attest that this application for a
name/ownership change 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:_ Date:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ/ DWR/ NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 1212015

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ROY COOPER
N
Aw. l,l �.>:�5wd . .:.. Governor
MICHAEL S.REGAN
Secretary
Water Resources S.JAY ZIMMERMAN
Environrneutte Quality Director'
2/9/2017
J. Maurice King
PO Box 1324
Old Fort,NC 28762
SUBJECT: Compliance Evaluation Inspection
377 Hoskins Branch Rd
Permit No: NCG551238
McDowell County
Dear Mr. King:
I am writing because your wastewater facility is due for an inspection from the North Carolina
Division of Water Resources. We have tried contacting you by phone at 828-724-3904,but always
receive a busy signal. It is important we speak with you to help assess the state of your wastewater
system. Please contact me by either calling my office phone at 828-296-4658 or sending a message
to my email address: [e-mail]
Sincerely,
Daniel J Boss -
Environmental Specialist
Asheville Regional Office
Email: [e-mail]
cc: MSC 1617-Central Files-Basement
Asheville Files
G:\WR\WQ\MCDowell\Wastewater\GeneralWCG55 SFR\King,Nlauriceu.31.17 Letter of info request.does
Compares:- ,..,:.
Sate of Nom th Catalina l Environmental Quality I Water Reeo nags
2090 US.Highwey 70.Swannanoa,North Ca ctiou 28778
828-296-45M

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A.Reeder John E.Skvarla, III
Governor Director Secretary
January 2, 2014
J. Maurice King
Post Office Box 1324
Old Fort, NC 28762
SUBJECT: December 13, 2013
Compliance Evaluation Inspection
377 Huskins Branch Road Residence
Permit No: NCG551238
McDowell County
Dear Mr. King:
Enclosed please find a copy of the Compliance Evaluation Inspection Form from
the inspection conducted on December 13, 2013. The facility was found to be in
Compliance with permit NCG551238.
It is recommended that you have the septic tank pumped every 3-5 years to
ensure proper operation. I have enclosed an information sheet regarding sampling that
you might find helpful.
Please refer to the enclosed inspection report for additional observations and
comments. If you have any questions, please call me at 828-296-4500 ext.4658.
Sincerely,
�titi �2
Beverly Pri
Environmental Specialist
Enclosure
cc: Water Quality Programs Central Files
Water Quality Asheville Files
G:\WQWP\McDowell\Non-discharge\1238 J Maurice King.doc
Water Quality Regional Operations—Asheville Regional Office
2090 L.S.Highway 70,SWannamm,North Camlina 28778
Phone,828-296 4500 FAX:[phone]
Internet http:llpoUl.nmenr.orgAreblwq
An Equal Opportunity IAHirmative Action Employer

GA
I (�
NC ERR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A.Reeder John E.Skvarla,III
Governor Director Secretary
January 2, 2014
J Maurice King
Post Office Box 1324
Old Fort, NC 28762
SUBJECT: December 13, 2013
Compliance Evaluation Inspection
377 Huskins Branch Road Residence
Permit No: NCG551238
McDowell County
Dear Mr. Huskins:
Enclosed please find a copy of the Compliance Evaluation Inspection Form from
the inspection conducted on December 13, 2013. The facility was found to be in
Compliance with permit NCG551238.
It is recommended that you have the septic tank pumped every 3-5 years to
ensure proper operation. I have enclosed an information sheet regarding sampling that
you might find helpful.
Please refer to the enclosed inspection report for additional observations and
comments. If you have any questions, please call me at 828-296-4500 ext.4658.
Sincerely, n
Beverly Price
Environmental Specialist
Enclosure
cc: Water Quality Programs Central Files
Water Quality Asheville Files
G:\WQ\AP\McDowell\Non-discharge\1238 J Maurice King.doc -
WaterOuality Regional Operations—Asheville Regional Office
2090 U.S.Highway 70,Swannanoa,North Carolina 28778
Phone:[phone] FAX:[phone]
Internet htpUporounodenr.orglwelveq
An Equal Opportunity l Affina8ve Acton Employer

United States Environmental Protection Agency Fonn Approved.
EPA Washington,D.C. OMB IN 204MO57
Approval expires 8-31-98
Section A: National Data System Coding(i.e.,PCS)
Transaction Code NPDES yrlmolday Inspection Type Inspector Fee Type
1 lNl 2 I .I 31 NCO551238 111 121 13/12/13 117 181r1 19E 201 I
tJ LJ Remarks IJ LJ LJ
2711111111111I Jill Jill 111111111111 Jill 1111 Jill 1115
Inspection Work Days Facility Se[Wonitodng Evaluation Rating B1 CIA ---------------------Reserved---------------.--
s71 1 e9 701J 711J 72UN 731 1 fJJ 174 751 I I I I II t 80
Section B: Facility Data
Name and Location of Facility Inspected(For Industrial Users discharging to POTW,also include Entry Time/Date Permit Efiecbve Date
POTW name and NPDES permit Number)
377 Husks.Branch Road 11:00 AM 13/12/13 13/08/01
377 Hoskins Branch Rd Exit Time/Date Permit Expiration Dale
Marion NC 28752 11:30 AM 13112/13 18/07/31
Names)of Onslte Represantative(suTltles(s)/Phone and Fax Numbeds) Other Facility Data
Name,Address of Responsible Of olal/Tltle/Phone and Fax Number
Con
J Maurice King,PO Box 1324 Old Fart NC 28782#828-7243904/ Contacted
No
Section C: Areas Evaluated During Inspection Check only those areas evaluated
Other
Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Names)and Signature(s)of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Beverly Price ARO GW//82&295.4500/
6,1,t-V dv� 12/31/13
Signature of Management O A Reviewer Agency/OfllcelPhone and Fax Numbers Date
EPA Formm 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspedlo�n Type
3I NCO551238 I11 12I 13/12113 17 18 0
Section D: Summary of FlndinglComments(Attach additional sheetsof narrative and checklists as necessary)
The system appeared to be operating properly. The discharge pipe was located. There were 2 pvc tubes
and a cleanout within approximately 10' of the cascade aerator. The tops of the tubes could not be
removed. Numerous attempts were made to contact the owner before and after the inspection.
'1
Page# 2

� n
Permit: NCG551238 Owner-Facility: 377 Hoskin Branch Road
Inspection Date: 12113/2013 Inspection Type: Compliance Evaluation
Other Yes No NA NE
Comment: Unable to make contact with system owner.
Page# 3

NCG660000 Single Family Residence General Perm Inspection Report
DWQ Inspector: B v pYi[ e Inspection date: N- 113 //3
Permittee: J, hY -u ' K;C9 Inspection time: 0',30
Permit Number: NCG551, 329 County: W)i ,Dowell
Location address: 377 P- 4 MariOt4 NG ag75u
Mailing address (if different):
Contact oerson(s): tY)a to i 6e- 4 i raa
Telephone numbers' W- 72 Y- 3 9'0 i
Permit expires 761 19, Annual fees paid yr r /©%<3
}le w,s mat G,,< g -ftn+-� o{' ,'s�arr�.`o<�.
Did homeowner know of system: E>y rAn,,e iiu;„�sAge of system (ATC):
flm rs bef only .J°� (, e,7 s&,al,,. cowH i lwc a
Date & nature of repairs:
Date(s) of septic tank pumping:
Date(s) of sampling by homeowner
Sampling results: BOD: TSS
Total Residual Chlorine: Fecal Coliform:
Certified Lab/Contractor:
Tablet chlorinator present: Number of tubes in use:
Name of receiving stream: Stream classification:
Tablet dechlorinator present' Number of tubes in use:
Cascade aerator present eAs -r'omrc4 -*,5 Discharge pipe located: )/e,S'
Date samples taken by DWQ' NO BOD results:
TSS results: Fecal Coliform results:
Observations: Ctea,io,+ f an myc W6.h 1,cded „� ( ;n / 7 Ev7 �•A��ua
�n?7>� /` al� ✓i u'� ti� � Nn� ro'� o� �„��� nn 5• � S��m a nc�.¢e✓
tv LL (M06dn`�Z13-'1C�,

C Sampling Tips C)
A typical annual sampling event, by a contractor, will probably cost—$150 per year.
That cost includes:
11
A trip charge to and from the single family residence and laboratory analyzing the samples.
Proper collection, preservation and analysis by a NC Certified Laboratory for:
BOD (Biochemical Oxygen Demand)—your daily maximum limit is 45 mg/I,
TSS (Total Suspended Solids) -your daily maximum limit is 45 mg/I,
Fecal Coliform -your daily maximum limit is 400 oolonies/100 mI,
Field analysis of TRC (Total Residual Chlorine) performed on-site (within 15 minutes), with
low level monitoring equipment which measures ug/I (micrograms per liter). Your TRC
limit is 17 ug/I. A mailed copy of the sample analysis report and laboratory quality
control information.
(Keep the laboratory results for 3 years and show them to the DWQ inspector.)
In order to keep costs to a minimum:
Make sure that the discharge pipe can be accessed. Keep the area clear of debris and
vegetation. Make sure that the pipe itself and the cascade aerator does not have algae,
vegetation, or debris obstructing the discharge to the creek.
Make sure that the system discharges. If it doesn't discharge, then determine why and
remedy. At the time of sampling, it may be necessary to make the system discharge by
using water doing laundry or dishes or bathing. If you are not at home and there is no
1 discharge when the sampling event is scheduled to take place, another trip charge will
be added, until a sample can be collected.
Make sure that the system has a sufficient supply of chlorine tablets to disinfect the
wastewater. This will be reflected in the fecal coliform laboratory results. If the
wastewater is not properly disinfected, the system will be considered non-compliant and
will result in a Notice of Violation.
Make sure that the system has a sufficient supply of dechlorination tablets. This will be
reflected in the Total Residual Chlorine (TRC) results. The TRC limit is 17 ug/I
(micrograms per liter). The results will be reported to the lowest detection limit that the
field equipment is annually certified for. For example: 17 ug(I may be reported as < 20
ug/I. Due to the sensitive and unstable nature of this test, any result that is measured
and less than 51 ug/I will be considered compliant with permit limits.

n N(� � Z; '5- l a 38 (--,,
nusklns Brnch Rd,h9edan,NC 28752
NC-226N p(i(6 (' �u n� 8,2 mi, 14 mins
Merlon,NO
1. Heed eeatonWCeurt St twaN NMein St
3 77
Take,,t, bld �a.� Nc '�876�
2 Con fnhuett tfollow NC226 NUS221 B113NWNMain St Nn�..��pN NG A37��
Za 8as—lay s9�
3. Turn right onto NF228 WV8221 N /�
4. Turn left onto Hoskin Branch Rd l(uiN GdN.>e-S 'Op—,
Destination will be on the left
o.4 rril 61d. R-4 NC A87&Z
377 Huekina Bol Rd,Marion,NC 28762
Ni i 'Dome
U(n". (h�•csd.
1
a
o �pod�,tiv1
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N

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley,Governor William G. Ross,Jr.,Secretary
Coleen H. Sullins, Director
July 27, 2007
J Maurice. King
P.O. Box 1324
Old Fort,NO 28762
Subject: Renewal of coverage/General Permit NCG550000
377 Huskins Branch Road
Certificate of Coverage NCG551238
McDowell County
Dear Permittee:
In accordance with your renewal application [received on January 22, 20071,the Division is renewing
Certificate of Coverage(CoC)NCG551238 to discharge under NCG550000. This CoC 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.
Contact the Asheville Regional Office prior to any sale or transfer of the permitted facility.
Regional Office staff will assist you in documenting the transfer of this CoC.
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 the requirements of the General Permit,please contact Toya
Fields [919 733-5083,extension 551 or tova.fields@m mail.net] or Susan Wilson [919 733-5083,extension 510
or susan a wilson@ncmail net].
Sincerely,
for Colson H. Sullmg
ec: Central Files �. 1 2007 �.
Asheville Regional Office/Surface Water Pm- m iory i
NPDES file
4
J A_-I -..__TI..0
lh A� f ITY CON
P.nfitli L[ ,_ION I ,0_RGE
I
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 ^ Qtlf< °��-+ 7^
512 North Salisbury Street,Raleigh,North Camlina 27604
Phone: [phone]/FAX [phone]/Internet:www.ncwaterquali NO CSfty.org ��ffiCuQ71a
hri
An Equal Opportunity/Affirmative Action Employer-50%Recydedl Post Consumer Paper [.v a m

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
1 GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG551238
DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND
OTHER 100%DOMESTIC DISCHARGES WITH SIMILAR CHARACTERISTICS TINDER 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,
J Maurice. King
is hereby authorized to discharge domestic wastewater [<1000 GPD] from a facility located
at
377 Haskins Branch Road
Marion
McDowell County
to receiving waters designated as an unnamed tributary to Limekiln Creek in subbasin 03-
08-30 of the Catawba 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 August 1, 2007.
1 This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 27, 2007.
i
for Coleen H. Sullins, Director
li Division of Water Quality
By Authority of the Environmental Management Commission
4
I

©f, � rf� � LJUCI�'�
rI� I JAN 1 6 2007 [¢�
NCDENR l I
North Carolina Department of Environment andNa ural ggFguek —J
,�i ECrION {
Division of Water Quality ASHgw_t l_E rPCIONAL OFFICE
_ . ._ �.
Michael F. Easley,Governor William G. Ross,Jr.,5ii
c; '""""°'—,"Aran-W?=Klimeki�P.E-,,Direotor,a
January 9, 2007
J. Maurice King
P.O. Box 1324
Old Fort, NC 28762
Subject: Renewal Notice/General Permit NCG550000
Certificate of Coverage NCG551238
McDowell County
Dear Permittee:
You are receiving this notice because you currently own a property covered under the subject
General Permit for the discharge of domestic wastewater. NCG550000 will expire on July 31, 2007.
Federal (40 CFR 122.41) and North Carolina (15A NCAC 2H.0105(e))regulations require
that permit renewal applications be filed at least 180 days prior to expiration of the current permit.
To satisfy this requirement, the Division must receive a renewal request postmarked no later than
February 1, 2007.
The Certificate of Coverage(CoC) specific to your property was last issued on October 10,
2003. 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 must renew the subject CoC. 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 Keith Haynes in the
NC DENR Asheville Regional Office at. That person [or other staff members] can help
you determine if you should renew your CoC.
➢ If you know that your property no longer discharges wastewater, contact me at the
address or phone number listed below to request rescission of the CoC.
➢ This information request does not uertain to the Annual Fee of$50.00 billed
separately by the Division's Budget Office. No money is required for this.
procedure. The Annual Fee is like the fee you annually pay the DMV for the sticker on
your vehicle's license plate. Renewal of your CoC is like the renewal of your Driver's
License [ca. every five years].
➢ If you have already mailed a renewal request,you may disregard this notice.
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 ne
512 North Salisbury Street,Raleigh,North Carolina 27604 �1'thCarOhlla
Phone: [phone],extension 511/FAX [phone]/chades.weaver®ncmail.net Rtura���
An Equal Opportunity/Affirmative Action Employer-50%Recycled/10%Post Consumer Paper

NCG551238 renewal notice
January 9,2007
The attached application form shows the information the Division has on file for your
property. Please verify that the provided information is correct, or make corrections on the form.
Complete the additional questions, then sign and date the form.
The completed form should be submitted to the address listed below the signature block.
If you have any questions concerning this matter, please contact me at the telephone number
or e-mail address listed below. (If it is difficult to reach me, please be aware that your facility is one
of over 1100 that I am contacting regarding the renewal of NCG550000.)
Thanks for your attention to this matter.
Sincerely,
CN "✓ vim/
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Eiles
�.sheville_Regional Office/Keith Hayned
NPDES file

- y
°yATF� t {{n]WMia eel F.EAsley,0ovemor ,
J 9G North Carolina Depatlmeht of'Envirdflmen�z tl Nat rel Resauecos '
rAlan W.Klimek,P.E.Director
p Y _ Dlviaion of Water Duellly
Asheville Regional OKce
SURFACE WATER PROTECTION
September 22, 2005
Mr. Maurice King
Post Office Box 1324
Old Fort, North Carolina 28762
SUBJECT:Compliance Evaluation.
Maurice King - SFR
Permit No: NCG551238
McDowell County
Dear Mr. King:
Enclosed please find a copy of the Compliance Evaluation Inspection form from
the inspection conducted on September 19, 2005 Mr. Larry Frost and Mr. Keith Haynes
of the Asheville Regional Office conducted the Compliance Evaluation Inspection. The
facility was found to be in Compliance with permit NCG551238.
Please refer to the enclosed inspection report for additional observations and
comments. If you any questions, please call me at [phone].
Sincerely,
Lar Fro t
E ironmental Chemist
Enclosure
cc: Central Files
Asheville Files
N�Or�` ICmCIaroliI a
A
2090 U.S.Highway 70,Swannanoa,NC 28778 Telephone'. [phone] Fax:[phone] Customer Service 1 877623.8748

United Stele.Envlmnmenlel Protect.Agency Form Approved.
EPA w""'"B1on0020a60 OMB No.2040-0057
Water QoMpliiInce Inspection O Approval expires 8-31-98
Section A. National Data System Coding(i.e"PCS
Tr�a�,n�saction Code NPDES yamc/day Inspection Type Inspector Fee Type
L'J
1 2 1 31 . NCG551238 11 121 05/09/19 17 18 U 19 U 20 U
Aemarkp
z11111111111111111111111111IIIIII111111111111111r
Inspection Work Days Facility Self-Monitoring Evaluation Rating Rt O�A,,� ----------------------Reserved------------------
87I 69 70 U 71 u lJ T2 73 W 74 751 I I 8C
Section B: Facility Data
Name and Location of Facility Inspected(Far Industrial Users.discharging to POTW,also Include Entry Tlme/Date Permit Effective Data
POTW name and NPDES permit Number)
J Maurice Ring - SFA 01:35 PM 05/09/19 03/10/10
Lewin Lakes or Exit Time/Date Permit Expiration Data
Old Fort NC 28762 01:42 PM 05/09/19 07/07/31
Name(s)of Onslte Representative(s)/Rflesud/Phone and Fax Number(s) Other Facility Data
Name,Address of Responsible OtficialMdell hone and Fax Number
S Maurice King,PO Box 1324 Old Fort NC 28762//828-724-3904/ Contacted
ee
Section C: Areas Evaluated During Inspection(Check only those areas evaluated)
Operations&Maintenance N Facility Site Review
Section D: Summary of Findin /Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Names)and Signatures)of lospeclor(s) genoy/Offce/Phone and Fax Numbers 6 ,!Date
Larry Frost // -GRO WQ//328-296-4500 Ext.4658/
Keith Hay sox // ARK WQ//828-296-4500 Ext.4660/
a aabs
Signature of Management O A Reviewer Agency/Office/Phone and Fax Numbers Data
Roger C Edwards - C - 828-296-4500 Ext.4656/ 2 yZ'VS'
EPA Form 3560-3(Rev 0-94)Previous editions are obsolete.

NPDES ydmo/day Inspection Type 1
31 NCG551238 17 12 o5/09/19 17 18 U
Section D: Summary of Finding(Commenls(Attach additional sheets of harraUve and checklists as necessary)
The system appears to be well maintained and operating ppopenly.
1
i

Perult: NGGS51238 Owner-Faclllty: JMaurlce Nng-SFR
Inspection Date: 09/1912O05 Inspection Type: Compliance Evaluation
rineratlons B Me'ntenanrn Vas No NA NF
Is the plant generally clean with acceptable housekeeping?
Does the facility analyze process control parameters,for ex:MLSS,MCRT,Settleable Solids,pH,DO,Sludge Judge,
and other that are applicable?
Comment:
❑'cinfention-Tahlet Vas No NA NF
Are motor chlorinators operational? _ I] 11 ❑
Are the tablets the proper size and type? 0 0 0 0
Number of tubes In use? 2
Is the level of chlorine residual acceptable? ❑ ❑ ❑
Is the contact chamber flee of growth,or sludge buildup? ❑ ❑ ❑
Is there chlorine residual prior to de-chlorination? ❑ 0 0
Comment:

O�OF W ATF9QG Michael F. Easley
Governor
William G.Ross Jr.,Secretary
Department of Environment and Natural Resources
Alan W.Klimek,P.E.,Director
Division of Ware,Quality
October 10, 2003
Mr.J. Maurice King
PO Box 1324
Old Fort, NC 28762
Subject: General Permit No. NCG550000
Cert. of Coverage NCG551238
J. Maurice King Residence
McDowell County
Dear Mr. King:
In accordance with your application for an NPDES discharge permit received August 19, 2003 by the Division,we
have issued the Certificate of Coverage under the state-NPDES general permit for J. Maurice King. Authorization is
hereby granted by this letter for the construction of a 360 GPD wastewater treatment system consisting of a cleanout
before the septic tank, 1000 gallon septic tank, adjustable cap distribution box with speed levellers, 360 square foot(6'X
60') primary sandfilter with a loading rate of not more than 1.15 GPD/square foot, 180 square foot (3'X 60)secondary
sandfilter with a loading rate of not more than 2.30 GPD/square foot, chlorinator, chlorine contact chamber, cleanout and
cascade aeration with a discharge of treated wastewater into an unnamed tributary to Limekiln Creek, classified C waters
in the Catawba 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 10 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.
The trench must be completely lined,top and bottom with a minimum 30 mil polyethylene liner. Impermeable Goo Cloth
can used on the top of sandfilters. Chlorine contact tank must be installed after the chlorinator.
If any parts, measurement frequencies or sampling requirements contained in this general permit are
unacceptable to you, you have the right to submit an individual permit application and letter requesting coverage under an
individual permit. Unless such demand is made,this decision shall be final and binding. Please take notice this permit is
not transferable. Part II, E.A. addresses the requirements to be followed in case of change of ownership or control of this
discharge.
The Authorization to Construct 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.
The Asheville Regional Office,telephone number 828/251-6208, 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, a 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. Mail the Certification to the Stormwater and
General Permits Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617.
ffi .
Customer Service Division of Water Quality 1617 Mail Service Center Raleigh,NC 27699-1617 [phone]
1 800 623-7748

OF WA7�R (� Michael F.Ee9
O� pG Govern
hr William G.Ross Jr.,Secretary
7 y Department of Environment and Natural Resources
Alan W.Klimek,P.E.,Director
Division of Water Quality
Mr.J. Maurice King
Page 2
October 10,2003
A copy of the approved plans and specifications shall be maintained on file by the Permittee for the life of the
facility.
The sand media of the sandfilters must comply with the Division's sand specifications. The engineer's certification
will be evidence that this certification has been met.
A leakage test shall be performed on the septic tank and dosing tank to insure that any exfiltration occurs at a rate
which 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.
Failure to abide by the requirements contained in this Authorization to Construct may subject the Perri 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 issuance of this permit does not preclude the Permittee from complying with any and all statutes, rules,
regulations,or ordinances which may be required by the Division of Water Quality or permits required by the Division of
Land Resources,the Coastal Area Management Act or any Federal or Local other governmental permit that may be
required.
If you have any questions or need additional information, please contact Mack Wiggins, telephone number
9191733-5083.
Sincerely,
ORIGINAL SIGNED BY
WILLIAM C. MILLS
Alan W. Klimek, P.E.
cc: Central Files
Asheville Regional Office, Water Quality
Roosevelt Childress, EPA
Point Source Compliance Enforcement Unit
} Stormwater Permit File
McDowell County Health Department
i
1
I
ii
�y^F4R
iN ,�`PVR
Customer Service Division of Water Quality 1617 Mail Service Cents, Raleigh,NO 27699-1617 [phone]
1 800 623-7748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
- CERTIFICATE OF COVERAGE
GENERAL PERMIT NO.NCG551238
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,
J.Maurice King
is hereby authorized to operate and construct a wastewater treatment facility that consists of a cleanout, septic tank,
distribution box,primary sandfilter,secondary sandfilteo,chlorinator,chlorine contact chamber,cleanout and cascade
aeration and associated appurtenances with the discharge of treated wastewater from a facility located at the
I.Maurice King Residence
on Hankins Branch Road
%a of a mile southwest of Woodlawn
McDowell County
to receiving waters designated as an unnamed tributary to Kiln Creek in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, I1, III
and IV hereof.
This certificate of coverage shall become effective October 10,2003
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 10,2003
ORIGINAL SIGNED BY
WILLIAM C. MILLS
Alan W. Klimek,P.E.,Direcmr
Division of Water Quality
By Authority of the Environmental Management Commission

1
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bow t
Copyright(C)1997,Meplech.lnc.

Michael F.Easley,Governor
`f ` - CCCJJJ William G.Ross Jr.,Secretary
North Carolina Deparhnent of Envurnon of and Natural Resources
.1 r Alan W.Klimek,P.E.Director
y Division of Water Quality
n��r
`C \ � P Q Coleen H.Sullins,Deputy Director
1 I ' Division of Wear Quality
Asheville Regional Office
WATER QUALITY SECTION
October 1, 2003
TO: Mack Wiggins
FROM: Michael McDonald
SUBJECT: Individual Residence Sewage Treatment System
King Property
Application Number WQ NCG551238
McDowell County
The proposed point of discharge from a private residence sewerage system which the King's hope to
construct would be to Hoskins Branch to Limekiln Creek which bears a class "C " classification and is
located in the Catawba River Basin. The point of discharge is further located as:
Longitude-820 02'48.59" W
Latitude-350 46' 39.40"N
I have inspected the site and recommend that it be approved for the location of the system as described in
the construction plans as submitted by Mr. Maurice King.
Sincerely, '/' y/
/,(�`el eM
3chael McDonald
Environmental Technician
Enclosure
XC: Maurice King
tit
59 Woodfin Place Asheville,North Caroline 28801 Te1ephaae(828)251-6208 Fas(828)251-6452 Customer Service 1-877-623-6748

Srn7t N. C. DEPARTMEr� OF ENVIRONMENT AND
NATURAL RESOURCES
' . a DIVISION OF WATER QUALITY
/ S WATER QUALITY SECTION
g ASHEVILLE REGIONAL OFFICE
59 WOODFIN PLACE
�eunm ha°
ASHEVILLE, NORTH CAROLINA 28801
PHONE: [phone] FAX: [phone]
TO: f-C.l< 1N f�-1S
FAX #: 9 t') 1 .33 01 l 1
FROM: m a-'" 1
DATE: 1o101 103
# OF PAGES INCLUDING THIS COVER: aZ
MESSAGE: If questions, please call 8218/2511I-6208 .I
{�CiT 1_1�`I�1�S S-t d U- +L' S' ,, � A"Ih'SS"� OA—
ct
ItS k4A
C141 ,A �-� w"N

Michael F. Easley
Governor
7 William G-Ross,Jr.,Secretary
r, Depatlment of Environment and Natural Resources
..; S Alan W.Klimek. P.E.
Director
' Division of Water Quality
August 22, 2003
Mi Maurice King
PO Box 1324
Old Fort, NC 28762
Subject: Application No. NCG551238
J.Maurice King Property
McDowell County
Dear Mr. King:
This is to acknowledge receipt of the following documents on August19, 2003'
X Completed Notice of Intent (Application form),
Engineering Proposal (for proposed control facilities),
Request for certificate of coverage.
X Application processing fee of $50.00.
Wastewater Disposal Alternatives,
T ....
Specifications of system.
Local Government Signet,
Source Reduction and Recycling, M�y„T
Interbasin Transfer,
X Other.. County health department letter denying the site for on-site systems.
Topograhic map showing discharge location.
The items checked below are needed before review can begin:
Completed Notice of Intent (Application Form),
Engineering proposal (see attachment),
Application Processing Fee of$00.00,
Delegation of Authority (see attached),
Biocide Sheet (see attached).
Engineering Economics Alternatives Analysis,
X Engineering Plans and Specifications
Local Government Signoff,
Source Reduction and Recycling,
_ Interbasin Transfer,
X Other. Copy of septic tank service receipt if an existing septic tank will be used.
If the application is not made complete within thirty (30) days, it will be returned to you and may be resubmitted when
complete.
� AA� NNELLNR
\Customer Service Division of Water Quality 1617 Mail Service Center Raleigh,NC 27699 1617 [phone]
�`� 800 623-7748

l l Michael F. Eernor
Governor
William G.Ross,Jr.,Secretary
r Department of Environment and Natural Resources
Alan W.Klimek. P.E.
�i;pu Director
Division of Water Quality
This application has been assigned to Mack Wiggins (919/733-5083) Ext. 542 of our Permits Unit for review. You will be
advised of any comments, recommendations, questions or other information necessary for the review of the application.
I am, by copy of this letter, requesting that our Regional Office Supervisor prepare a staff report and recommendations
regarding this discharge. If you have any questions regarding this application, please contact the review person listed
above.
Sincerely,
f2a
ack Wiggins
Stormwater and General Permits Unit
cc: Asheville Regional Office
Permit Application File
Nf:DEP {
Customer service Division of Water Quality 1617 Mail Service Center Raleigh,NO 27699-1617 [phone]
1 800 623 7748

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FOR AGENCY GSE ONLY
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� Division of Water Quality/Water Quality Section Year Month Da
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� Certificate of coy
NCDENRNational Pollutant Discharge Elimination System Chao x Amowt
M aEa NCG550000 eerma Ass ned0
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG550000: Single Family Domestic Units and/or facilities discharging less than 1000 gallons per
day of domestic wastewater and similar point source discharges
(Please print Or type)
1) Region.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 Regil000al `OM �
nce representative(s)with whom you have met:
Name: _—.L irarr __—__—_-- Date: —_
2) Mailing address of owner/operatNo�rl.
Owner Name:
Street Address:
City: � '��3 — _ State: MQ— ZIPCode: 2 7b`Z
Telephone No: (Home) 7c1 Off{_ (Work) Qlj_ IILS2 -a>a Z4
3) Location of facility producing discharge:
�NN II
Contact Person (if different than above): �Y _---_------_
Street Address:
City: --- — State: ZIP Code: --
County: -- —_ --_--_ _
Telephone No: Fax
4) Permit Contact(complete thyis�s"�cbon if permit contact is different from facility contact)
Contact Person: - __ t h. T T
Street Address:
City: __ State: ZIP Code:
County:
Telephone No: _____ Fax
5) Physical location information:
A copy of an USGS quad map or county map with the facility clearly located on the map IS
REQUIRED to he submitted with this application.
Please provide a narrative description of how to get to the facility (use street names, state road
number and distance and dir cbon from a roadway intersection). Z�`(�_ Ihu�'�S
21 �1arc L vski�srav c '� t17 m��
-ia r
Page 1 of 4
SWU-216-080102

( C-1
NCG550000 N.O.L.
6) This NP S permit application applies to which of the following
7New or Proposed (system not constructed)
❑ Existing (system constructed); If previously permitted by local or county health department,
please provide the permit number____— and issue date
❑ Modification; please describe the nature of the modification:
6) Description of Discharge:
a) Amount of wastewater to be discharged:
Number of bedrooms x 120 gallons per bedroom= `3 Gzb gallons per day to be permitted
b) Typ�°f facility producing waste (please check one):
LEI Primary residence ❑ Vacation/second home
❑ Other:
7) P_leaase check the components that comprise the wastewater treatment system:
( ptic tank ❑ Dosing tank
h hmary sand filter ErSecondary sand filter ❑ Recirculating sand filter(s) 1
L9"Chlorination ❑ Dechlorination E�Other form of disinfection: ��aL'Z AexaC�v
❑ Post Aeration(specify type):
8) 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:
a) Connection to a Regional Sewer Collection System.
1 b) Letter from local or county health department describing the suitability or non-suitability of the site
for all types of wastewater ground adsorption systems.
c) Investigate Land Application such as spray irrigation or drip irrigation.
9) Receiving waters:
a) What is the name of the body or bodies of water(creek,stream, river, lake,etc.)that the facility
wastewater discharges �es end up m? V S
✓SS ��° --
b) Stream Classification (WS-IV, C, NSW,etc., if known):____
10) The application must include the following or it will be returned:
a) For Certificates of Coverage:
❑ An original letter and two(2)copies requesting a general permit. .
❑ A signed and completed original and two(2)copies of this document.
❑ A check or money order for the permit fee of$50.00 made payable to NCDENR.
❑ Invoice showing that the septic tank has been pumped and serviced within the last 2 years
!, (for existing facilities only).
- Page 2 of 4
SWU 216-08n1 n2

l I
NCG550000 N.O.I.
Now
wor proposed facilities must also include:
'Lf (..tier from the county health department evaluating the proposed site for all types of ground
absorption systems.
❑ Evaluation of connection to a regional sewer system (approximate distance&cost to connect).
h) For an Authorization to Construct(ATC) only:
❑ A letter requesting an ATC
❑ Three sets of plans and specifications 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 (for existing septic
tanks).
Note: There is no fee when requesting an Authorization to Construct
11) 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.
b) 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 Professional
Engineer and stamped-"Final Design-Not released for construction". - -
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..
12) 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,
tand accurate.
Printed Name of Person Signing:
Title: �f Yvr�-o_vS.ot�aCr
(Sign6ture of Applicant)
_--_ ___-_ (Date Signed)
North Carolina General Statute 143-215.6 b(1) provides that:
Any person who knowingly makes any false statement, representation, or codification in any application,record, report,
plan or other document filed or required to be maintained under Article 21 or regulations of the Environmental
Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders Inaccurate any
recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the
Environmental Management Commission implementing thatArticle, shall be guilty aid misdemeanor punishable by a fine
not to exceed$10,000, or by imprisonment not to ascend six months, at by both. (18 U.S.C. Section 1001 provides a
punishment by a and stool more than$10,000 orimprisonment not more then 5 years,or both,fora similarofense.)
Page 3 of
SWU-21e-060102

NCG550000 N.O.I.
+ Notice of Intent must be accompanied by a check or money order for$50.00 made payable to:
NCDENR F�
Mail three(3)copies of the entire package to:
Stormwater and General Permits Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit
1
i
I
I
j
Page 4 of 4
SWU-216-080102

RUTHERFORD-POLK-McDOWELL
rnmowan DISTRICT HEALTH DEPARTMENT
amnanma
Polk. December 13, 2002
Mr. J. Maurice King
P.O. Box 1324
Old Fort,NC 28762
Re: Application for improvement permit for an 1.47 acre lot on Hoskins Branch Road
Dear Mr. King
On November 25, 2002,Jason Lewis of the McDowell County Health Department,
evaluated the above-referenced property at the site designated on the plat/site plan that
accompanied your improvement permit application. According to your application the site is to
serve a three-bedroom house with adesign wastewater flow of 360 gallons per day. The
evaluation was done in accordance with the laws and rules governing wastewater systems in
North Carolina General Statute 130A-333 and related statutes and Title 15A, Subchapter I SA, of
the North Carolina Administrative code, Rule .1900 and related rules.
Based on the criteria set out in Title I SA, Subchapter 18A, of the North Carolina
Administrative Code, Rules .1940 through.1948, the.evaluation indicated that the site is
UNSUITABLE for a ground absorption sewage system. Therefore,your request for an
improvement permit is DENIED. The site is unsuitable based on the following:
1, Unsuitable Soil Wetness conditions (Rule.1942)
2. Insufficient Soil Depth(Rule .1943)
3. Unsuitable fill(Rule .1957(b))
These severe site limitations could cause premature system failure, leading to the
discharge of untreated sewage on the ground surface, in surface waters, directly into ground
water or inside your structure.
The site evaluation included consideration of possible site modifications, and modified,
innovate or alternative systems. However, the Health Department has determined that none of
the above options will overcome the severe conditions on this site. A possible option might be a
system designed to dispose of sewage to another area of suitable soil or off-site to additional
property.
Rutherlord County Health Department Polk County Health Department McDowell Health Department
221 Callahan-Kcon Road 212 Walker Street 140 Spaulding Road
Spindale,NO 28160 Columbus,NO 28722 Marion,NO 28752
828-287-6100-Health Dept 828-894-8271-Health Dept 828.652.6811-Health Dept
.828-287-6101-Administration 828 894.8678-HD FAX [phone]-HD FAX
828-287-6059-HD FAX [phone]-Home Health 828-659-6901-Home Health
828-287-6026-Home Health 828-894-2055-HH FAX [phone]-HH FAX
828-287-6479-HH FAX 828-652-2019-EH FAX

J.M. King
Page 2
For the reasons set out above,the property is currently classified UNSUITABLE,and an
improvement permit shall not be issued for this site in accordance with Rule .1948(c).
However, the site classified as UNSUITABLE may be classified as PROVISIONALLY
SUITABLE if written documentation is provided that meets the requirements of Rule .1948(d).
A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to
develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE.
You have a right to an informal review of this decision. You may request an informal
review by the environmental health supervisor at the local health department. You may also
request an informal review by the N.C. Department of Environment and Natural Resources
regional soil specialist. A request for informal review must be made in writing to the local health
department. -
You also have a right to a formal appeal of this decision. To pursue a formal appeal,you
must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714
Mail Center,Raleigh,NC 27699-6714. To get a copy of a petition form,you may write the
Office of Administrative Hearings or call the office at(919) 733-0926. The petition for a
contested case hearing must be filed in accordance with the provision of North Carolina General
Statutes 130A-24 and 150B-23 and all other applicable provisions of chapter 150B. N.C.
General Statue 130A-335(g)provides that your hearing would be held in the county where your
property is located.
Please note:If you wish to pursue a formal appeal, you must file the petition form with
the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS
LETTER. The date of this letter is December 13, 2002. Meeting the 30 day deadline is critical
to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere with
any informal review that you might request. Do not wait for the outcome of any informal review
if you wish to file a formal appeal.
If you file a petition for a contested case hearing with the Office of Administrative
Hearings, you are required by law(N.C. General Statute 150B-23)to send a copy of your petition
to the North Carolina Department of Environment and Natural Resources. Send the copy to:
Office of General Counsel,KC. Department of Environment and Natural Resources, 1601 Mail
Service Center, Raleigh,NC 27699-1601. Do NOT send the copy of the petition to your local
health department. Sending a copy of your petition to the local health department will NOT
satisfy the legal requirement in N.C. General Statute 150B-23 that you send a copy to the Office
of General Counsel,NCDENR.

J.M. King
page 3
You may call or write the local health department if you need any additional information
or assistance.
Sincerely,
anon A. Lewis, R.S.
Environmental Health Specialist
JAL/sly
Enclosures: Copy of Rule .1948
cc: Fred Matthews, Environmental Health Supervisor

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State of North Carolina
Department of Environment
and Natural Resources ©�_` ^�
Michael F.Easley,Governor
Alan W.Klimek,P.E.,Director N C D EN R
Division of Water Quality
Asheville Regional Office NORTH c FOLINA DEPARTMENT OF
ENVIRONMENT ANa, NATORAL RrsouncaE
WATER QUALITY SECTION
May 9, 2003
Mr. Maurice King
Post Office Box 1324
Old Fort, North Carolina 28762
Subject: Permit Applications and Information
Single Family Systems
McDowell County
Dear Mr. King:
First please accept my apology for the delay in getting the attached information to you.
You requested information on permitting an Aerobic Treatment Unit (ATU). You will require an
individual NPDES Permit from the State. I have attached documents describing the process
(below), which is neither quick nor easy, EPA Form 1 and the website.
http://h2o.enr.state.nc.us/NPDES/NPDESweb.htmi
Applying for a New NPDES Permit
A submittal for a proposed facility must, at a minimum, include the following (additional
requirements listed below :
• Complete application signed by owner or other authorized representative
• Appropriate fee
• Evaluation of alternatives
• Current USGS flow information
• Site map showing proposed discharge point
• Local Government Sign-off
Asheville Regional Office,59 Woodfin Place,Asheville,Nooh Carolina 28801 Phone: [phone] Fax: [phone]
An Equal Opportunity/Affirmative Action Employer-50%Recycle h110%Post Consumer Paper

Maurice King
May 9, 2003
Page Two
Application
All Permittees must complete EPA Form 1. If the proposed discharge is greater than 0.1-MGD,
you will be required to complete either EPA Form 2A or 2C (depending on whether the discharge
is domestic or industrial). See the Documents or FAQ sections for more information and copies of
the applications. The owner of the proposed facility must sign the completed application(s). If you
are an Authorized Representative of the owner, you may sign the application. Status of an
Authorized Representative must be confirmed by the owner in writing.
Fee
The fee for a new application is the same as the annual fee paid by existing facilities and can be
found in the Documents section of the web site. If the proposed facility will have a design flow
greater than or equal to 1-MGD, then the fee for major facilities applies. If the proposed facility will
have a design flow less than 1-MGD, then the fee for minor facilities applies.
i
Evaluation of alternatives
An evaluation of alternatives to discharge is required of all new or expanding facilities. The
Engineering Alternatives Analysis (EAA) guidance is available in the Documents section of the
site. Applications that do not contain a thorough EAA will be returned.
Current USGS flow information
The most current USGS flow data for the proposed receiving stream of the discharge must be
included. Low flow (summer and winter 7Q10) and average flow data should be provided.
Site map
Attach a site map clearly showing the proposed discharge point and facility location. A section of
a USGS topo map is preferred.
Local Government Sign-off
Local government sign-off must be provided with applications for new permits. Sign-off should
incorporate the City or County, which has jurisdiction over the proposed project. This ensures
that any new projects will conform to an City/County ordinances. A copy of the local government
sign-off form is available in the Documents section.
In addition, you may wish to consult the relevant basin plan for your proposed discharge. If the
receiving stream is impaired from its stated uses, this may prevent the issuance of a new NPDES
Permit. Management strategies, which may affect the EAA, are delineated in the basin plan.
Asheville Regional Office,59 Woodfin Place,Asheville,North Carolina 28801 Phone: [phone] Fax: [phone]
'j An Equal 0wortanit9/Affirmative Action Employer-50%RecycledV 10%Past Consumer Paper

Maurice King
May 9, 2003
Page Three
If the proposed discharge facility is publicly owned, or if public monies will be used to construct
and/or operate the facility, the State Environmental Policy Act(SEPA) will apply. Contact Todd
Kennedy at [phone] ext. 555, to discuss SEPA requirements prior to the submission of
any permit application.
If you have any questions about the permitting process, call a member of the NPDES Unit or the
water quality section of your regional office. There is also a guidance document on the permitting
process available in the Process section.
I have also enclosed the information about the single family sand filter, which is a much
easier process.
If you have any questions regarding this information you may contact me at (828) 251-
6208.
Sincerely,
L Frost
Environmental Chemist
Enclosures
Asheville Regional Office,59 Woodfin Place,Asheville,North Carolina 28801 Phone: [phone] F. 828/251-6452
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