NCG550065_Regional Office Historical File Pre 2018

TWO VERS
u"r 1 1.1 T I T S
We are TR U to our customers!
Date: 19/21/17
Attn: Roger Dixon
Address: 1117 New Prospect Church Road
Shelby, NC 28150
704-472-7473
LAB REPORT
RECEIVED/Nc QENRJD1,�+R
wQROS
MOORESVILLE REGIONAL OFFICE
The following analytical results have been obtained for the indicated samples which were submitted to this laboratory:
Sample ID
Sample Date
Parameter
Analysis Result
Units
Date Tested
Homeowners effleunt
9/15/2017
Fecals '
1
cfu/100 ml
9/15/2017
Homeowners effleunt
9/15/2017
TSS
12.5
mg/1
9/15/2017
Homeowners effleunt
9/15/2017
BOD
9.5
mg/I
9/15/2017
Sample Comments: All samples were grab samples taken from 8:40 am to 9:00 am.
Samples were received by the lab at 9:58 am.
sire xlly lv
d�,
Crowders Creek Laboratory
NC Certification No. 210
Page 1 of 1

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OIC-N�>`StCA. �G � c'.�vv
'rwvo vERs Two Rivers Utilities
fli iLtYI ES.
,"a°lg_u tc°veusl=w Wastewater Treatment Division
Chain of Custody Record
Crowders Creek Wastewater Treament Facility
NPDES Number: NCO074628
Sample Identification
a
Sample Collection
s-pk
CWs a
Preservative
Analyses Requested
Lab use
Start End i
Time i Time Type
Tempi
(°C) '
pH
(su)
#
Size
(ml)
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1101-7 Y• (S4—re)
Rece ed By. ( i flture Date:
\'1
Time:
q` G 9CAV
Relh By. anise)
?R dBY.(Si cure) Date:
Time:
Relingtushed By. (Sign—)
Received for Lab By: (Signature) Date:
'�Timc
N•
Additional Comments:
Start Date for Composite Sample(s): Total Nitrogen & NH3-N Samples: added 1ml 10% Sodium Thiosulfate (Na2S203)? —yes No
End Date for Composite Sample(s): Field pH/1'emp Analysts) Initials
Collection Date for Gmb Sample(s):� � Lab pH/Temp Analyst(s) Initials Document #: WCR-0101.105A
♦ 1- Field pH and Temperature measurements are taken within 15 min of sample collection Revision #: 6
M&'` �a�pPi� ��-�� "Sample container type: P = plastic / G= glass Date Revised: 09/20/I6
Corresponding Procedures: WCR-0100.002, WCR-0100.105, WCR-0100.1II
``�G C.ttZ-JAL �FFjC RO
5��t�G a-8�SZ7

ROY COOPER
Governor
° hC,H EL S. REGAN
Secretary
a
Environmental S. JAY ZIMMERMAN
Quality Director
August 31, 2017
Mr. Rodger Dixon
1117 New Prospect Church Road
Shelby, NC 28152
Subject: Notice of Deficiency
Compliance Evaluation Inspection
NOD-2017-PC-0227
1117 New Prospect Church Road
Certificate of Coverage No. NCG550065
Cleveland County
Dear Mr. Dixon:
Enclosed is a copy of the Compliance Evaluation Inspection for the inspection conducted
at the subject facility on August 30, 2017, by Ori Tuvia. Your cooperation during the site visit
was much appreciated.
The main area of concern discovered during the inspection was that the most recent
record of sampling done was from 2010. Annual sampling is needed to ensure the treatment
system is working. Sampling records must be kept so they can be reviewed in future
inspections. (list of approved labs attached)
The report should be self-explanatory; however, should you have any questions
concerning this report, please do not hesitate to contact Or! Tuvia at [phone], or at
ori:[e-mail]
Cc: NPDES Unit;
MRO Files
Sincerely,
f
W. Corey Basinger
Regional Supervisor
Mooresville Regional Office
Division of Water Resources
Mooresville Regional Office
Location: 610 East Center Ave -Suite 301 Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer Service:1-877-623-6748
Internet: www,ncwaterquality.org

&:I
. ". ... ?'':. ...: �'
! �..�
,...... _...,,_, ,� .
=Moore Co. Water Pollution
�Janna Scherer 1094 Addor Road jAberdeen 910-281-3146 �[e-mail] i
Control Plant
;PACE Analytical Services, Inc. 828-254-7176
t Barry Johnson 2225 Riverside Drive Asheville (29) [e-mail]
Asheville ,
Environmental Testing
Kelley E. Keenan ;PO Box 7565 Asheville 1828-350-9364 [e-mail]
!Solutions, Inc. I-<------
Water Quality Labs, Inc. Paul Isenhour APO Box 1167 ;Banner Elk 828-898-6277 [e-mail]
£Environmental Conservation 102 Woodwinds
IDale Mori lCary 919-467-3090 [e-mail] I
11-aboratories, Inc. Industrial Ct. Ste. A
3
PAR Laboratories, Inc. Russell Everett Box 411483 !Charlotte 704-588-8333 [e-mail]
£Charlotte Water- g
Environmental Laboratory Rhonda Hutson 14222 Westmont Drive lCharlotte 704-336-3690 [e-mail]
Services
=Helmuth M.B. I
;Prism Laboratories, Inc. P.O.. Box 240543 ;Charlotte 704-529-6364 [e-mail]
Janssen
I Keith D _ 2401 Whitehall Park
Biota Diagnostics, LLC (Charlotte �704-936-8260 �khambright@biotadiag,com
Hamb right _ Drive, Suite 700
Michael Bolt -
Cherokee WWTP Laboratory EBC1106 Water P.O.-Box 547 Cherokee 828-554-6772 �[e-mail] 1
_ Quality
iWater &Sewer Authority of I-�704-788-4164
i Cayce Atkinson 6400 Breezy Lane !Concord [e-mail]
Cabarrus County I� (116)
Environmental, Inc. - Sylva Anthony Tirona P.O. Box 954 Cullowhee 828 586-5588 [e-mail] m mMVY
Pace Analytical Services, Inc. - 205 East Meadow
Barry Johnson Eden 828-254-7176 [e-mail]
Eden Road - Suite A
rob. dermer@micro bac.com;andrew.gaydos
Microbac Laboratories, Inc. Rob Dermer 2592 Hope Mills Road 1Fayetteville 910-864-1920
I I @microbac.com
City of Gastonia - Crowders Annette Utilities Dept. ?Gastonia 704-854-6658 [e-mail]
Creek Laboratory McMurray P.O. Box 1748

La Fayette A.
Water Tech Labs, Inc.P.O. Box 1056 Granite Falls i828-396-4444 [e-mail]
ai
gg__M�.__,,
Environment) Inc.ark Oliveira PO Box 7085 Greenville 1252-756-6208 [e-mail];
i [e-mail]
Environment 1, Inc. Satellite�
Mark Oliveira P.O. Box 7085 Greenville 252-756-6208 [e-mail]
Laboratory ..:..._....__.._,.._. __ __._� .__. ...._
...._....�.e...,..,�_� � ._:.....__._ ... �
Pace Analytical Services, Incnc...- . -_ ;9800 Kincey 704-875-9092
Cheryl Johnson ey Avenue, Huntersville 243 [e-mail]
I
Huntersville Suite 100--���. )
Duke Power Company LLC
13339 Hagers Ferry
Id/b/a Duke Energy Carolinas, Girish Sharma Road Huntersville 980-875-5213 [e-mail]
LLC
Research & Analytical Sidney L_.I_ info@ randalabs.com;schampion@randalabs
P.O. Box 473 nersville 336-996-2841
1Laboratories IChampion � J�! -.......__ .com
Blue Ridge Labs David Wessinger IP.O.' Box2940 ILenoir 828-728-0149 [e-mail]
Lewiston
1
iPerdue, Incorporated Tina B. Rawls P.O. Box460 1252-348-4400 [e-mail]
Woodville
ITBL Environmental
I Pamela S. Hester P.O. Box589 ,Lumberton 910-738-6190 [e-mail]
1 La bo rato ry, Inc.
Environmental Chemists,
Ray Porter ;P.O Box 2228 iManteo 252-473-5702 [e-mail]
)Inc./Outer Banks Div.----
"'`"'" [e-mail];
[K & W Laboratories Gosia Kraska 1121 Hwy. 24/27 W IMidland 704-888-1211
[e-mail]
'James&James..M._�._.�__.�.,.,aM�w..,.�...��__..�,.....�.__��.w,w _._H....._...�.�._.W........_..e_....,_�.�_........_.._._.._.�........._._..�__.,_.
I I Mountain
IEnvironmental Management, Juanita James 'PO Box 1354 ome i828-697-0063 ijjemilabmgr@.yahoo.com
Hi
0.
I nc._....
!Earth Environmental Services Michael J. Ladd 175 Bison Lane Murphy 828-479-6428 [e-mail]
6701 Conference Raleigh 919-834-4984 [e-mail]
'
Pace Analytical Services, Inc. Barry Johnson Drive g rY J �
i
Agronomic Division Colleen Hudak- 1040 Mail Service Ralei h 919-733-2655 [e-mail]
'boratLaor - NCDA Wise Center g� _. 1(204)� �. .._ .�

Columbia Technologies LLC - 6701 Conference i
Bob George lRaleigh 352-538-6507 �[e-mail] i
Mobile Unit 9 Drive
7517 Precision Drive,
;First Analytical Laboratories Steve Hunter Raleigh 1919-942-8607 [e-mail]
i 3 ISuite 101
Meritech, Inc. Kris Pawlak P.O. Box 27 Reidsville _ 336-342-4748 [e-mail]
._. .perit ._..__b..
Cameron Testing Services, Chris Cameron 4219 S. Steele Street Sanford 919-208-4240 [e-mail]
i
;Inc.
,...__._ __ _ -_ . .
j Stephanie I
Meritech Inc. II 14350 Sea Pines Drive ?Southport 1910-617-1353 [e-mail]
I Moore
jStatesville Analytical Dena Myers P,oBox 228 !Statesville 704-872-4697 [e-mail]
�.._..__,._�.......�...._._..._.�..�._,_.�.�....�._.�_ �..--...--.�------�•-�--- Wallace 910-285-3966 [e-mail]
I
Vann Laboratories James W. Vann
IP.O. Box 668
[e-mail];
Beacham Labs - Division of [e-mail];
Ray Porter 16602 Windmill Way Wilmington 910-392-0223 I
[e-mail];
nvironmental Chemists !
i
ray@environmentalchemistsmcom
Environmental Chemists, Inc. F
IRay Porter 16602 Windmill Way Wilmington 910-392-0223 [e-mail]
I�..:..�.....,.....�..._-...,�..__�_.,..�..�...._._.�..�,.._...._._..._M.�..__.-�.. �
ISGS North America, Inc. Jeannie 15500 Business Drive Wilmington •910-350-1903 �[e-mail]
Milholland
i 6319-D Carolina Beach
;Element One, Inc. Ken Smith Rd ]Wilmington J910-793-0128 �[e-mail]
Aquatic Ecology Lab - UNCW 15600 Marvin Moss 1
Matthew McIver 1 lWilmington 1910-962-2357 €[e-mail]
;Center for Marine Science Lane 1 ;

F
United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 IN 1 2 15 1 3 I NCG550065 I11 12 17/08/30 17
18 lic 19 I ! I 20I
211 1 1 1 1 1 1 1 1 j I I I I I I I I 1 .1 1 1 1 1 1, 1 1 1 1
I
1 1 1 1 1 -I 1[ I I I I I f6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
Reserved
67 1.0 70 71 72 L
L_I -
73I 75
I
80
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
09:50AM 17/08/30
13/08/01
1117 New Prospect Church Road
1117 New Prospect Church Rd
Exit Time/Date
Permit Expiration Date
Shelby NC 28150
10:20AM . 17/08/30 .
18/07/31
Name(s) of Onsite Representative(s)Mtles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Roger D Dixon,1117 New Prospect Church Shelby NC 28150/1704-484-25431
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance Records/Reports Sludge Handling Disposal.
Facility Site Review Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers
Date
Ori A Tuvia MRO WQ/1704-663-1699/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
W. Corey Basinger MRO WQ/n04-235-2194/
EPA Form 35 -3 (Rev 9-94) revious editions are obsolete. / —P�
eat 20 &q—
Page#

NPDES yr/mo/day Inspection Type
31 NCG550065 I11 12 17/08/30 17 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
1
Page# 2

Permit: NCG550065 Owner -Facility: 1117 New Prospect Church Road
Inspection Date: 08/30/2017 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
0
❑
❑
❑
application?
Is the facility as described in the permit?
M
❑
❑
❑
# Are there any special conditions for the permit?
❑
❑
M
❑
Is access to the plant site restricted to the general public?
0
❑
❑
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment: Subject permit expires 7/31/2018.
Record Keepinq
Yes No NA NE
Are records kept and maintained as required by the permit?
❑
M
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❑
Is all required information readily available, complete and current?
❑
M
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
❑
0
❑
❑
Are analytical results consistent with data reported on DMRs?
❑
❑
❑
Is the chain -of -custody complete?
❑
❑
0
❑ .
Dates, times and. location of sampling
❑
Name of individual performing the sampling
❑
Results of analysis and calibration
❑
Dates of analysis
❑
Name of person performing analyses
❑
Transported COCs
❑
Are DMRs complete: do they include all permit parameters?
❑
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M
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Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
M
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
M '
E]
on each shift?
Is the ORC visitation log available and current?
❑
❑
M
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Is the ORC certified at grade equal to or higher than the facility classification?
❑
❑
M
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Is the backup operator certified at one grade less or greater than the facility classification?
❑
❑
0
❑
Is a copy of the current NPDES permit'available on site?
0
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
0
❑
Comment: No sampling has been conducted since 2010. Sampling must be done to insure system is
working properly, a list of approved labs is attached to the report.
Laboratory - Yes No NA NE
Are field parameters performed by certified personnel or laboratory? ❑ ❑ M ❑
Page# 3

Permit: NCG550085 Owner -Facility: 1117 New Prospect Church Road
Inspection Date: 08/30/2017 Inspection Type: Compliance Evaluation
Laboratory
Yes No NA NE,
Are all other parameters(excluding field parameters) performed by a certified lab?
❑ ❑
M
❑
# Is the facility using a contract lab?
❑ ❑
0
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑ ❑
❑
Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees_ Celsius+/- 0.2 degrees? ❑ ❑ ❑
Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees? ❑ ❑ M ❑
Comment: Sampling was last done in 2010 by Pace Labs.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? M ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: Septic tank was last pumped on 8/20/2015 by Wesson septic.
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
M
❑
❑
❑
Are the tablets the proper size and type?
❑
❑
❑
Number of tubes in use?
1
Is the level of chlorine residual acceptable?
❑
❑
M
❑
Is the contact chamber free of growth, or sludge buildup?
❑
❑
M
❑
Is there chlorine residual prior to de -chlorination?
❑
❑
M
❑
Comment:
Sand Filters (Low rate)
Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational?
❑
❑
0
❑
Is the distribution box level and watertight?
0
❑
❑
❑
Is sand filter free of ponding?
0
❑
❑
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Is the sand filter effluent re -circulated at a valid ratio?
❑
❑
0
❑
# Is the sand filter surface free of algae or excessive. vegetation?
❑
❑
❑
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
❑
❑
❑
Comment:
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? M ❑ ❑ ❑
Page# 4

F
Permit: NCG550065 Owner -Facility: 1117 New Prospect Church Road
Inspection Date: O8/30/2017 Inspection Type: Compliance Evaluation
Effluent Pipe Yes No NA NE
Are the receiving water free of foam other than trace amounts and other debris? M ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ M ❑
Comment:
Page# 5

Environmental
Quality
.� qy 3zl-1 �3 July 31, 2017
_l 1 �
Mr. Rodger Dixon or current tenan
11.17 New Prospect Church Road
Shelby, NC 28152
Dear Mr. Dixon or current tenant:
',TROY COOPER,
�1 Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
Subject: Compliance Evaluation Inspection
1117 New Prospect Church Road
Certificate of Coverage No. NCG550065
Cleveland County
Please be advised that NCDEQ inspector will be"coming to inspect subject permit on
August 30, 2017, at about 10 AM. Your presence during the inspection is advised to discuss
compliance with the conditions listed in subject permit.
If you wish to reschedule or have any questions, please contact Ori Tuvia at (704) 235-
2190, or via email at oi7.tuvianncdenr.gov.
Sincerely,
Ori Tuvia, Environmental Engineer
Mooresville Regional Office
Division of Water Resources, DEQ
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer Service:1.877-623-6748
Internet: www.ncwaterquality.org

Inspection Date: Start TMRAFT End Time:
SINGLE FAMILY WASTEWATER SYSTEM CHECKLIST
1012812014
Permittee:
Permit: A) &65L
tS
/
Address: Meto lL&s C� SAE -mail -
Phone:( Cell Phone:.( -
County:
The Permittee is responsible for the operation and maintenance of the entire wastewater treatment and disposal system.
Doesn't Did Not
Yes./
No
Apply Investigate
1. Is the current resident in the home the Permittee?
Li
Li
2. If not does the resident rent from the permittee?
❑
❑
❑
3. Change of Ownership form needed? (mail the form with the inspection letter).
❑
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4. Is there a inspection and maintenance agreement with a coritracto_r?-
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❑
❑
60;4
5. If yes to #4 who is the contractor? $,OQWV11c,
j
f
SEPTIC TANK The septic tank and filters should be checked anrUlly and pumped/cleaned as ne ded.
6. Is all wastewater from the home connected to the septic tank?
P
Fvl
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El
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7. Does the permittee/resident knovWwhere the septic tank is to ted? 0�
EZ
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❑
❑
f o/ c7
8. Has the septic tank been pumped in the last 5 years? P,
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.[�
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9. If yes to #8 date, if known If proof, describe o&t&JL/z"o
10. Does the septic tank have an EFFLUENT FILTER or SANITARY T? (circle one)
jl ,4
MAI
11. If Yes to filter when was the filter cleaned? By who?
-
SAND FILTER / TREATMENT PODS YES NO
If no proceed to the next section.
Accessible sand filter surfaces shall be raked and leveled every six months and any vegetative growth shall be removed
manu y.
12. Is system something other than a sand filter?
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13. If yes, what kind? (examples - Peat, Textile or brand name - Advantex, etc.)
14. Does the permittee know where the filter is?
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15. If above ground does the filter require maintenance?
❑
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0
If maintenace is required explain in the comment section.
DISINFECTION / UV YES NO
If no proceed to the next section.
The ultraviolet unit shall be checked weekly. The lamps and sleeves should be cleaned or replaced as needed to ensure proper disinfection.
16. Is UV working?
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❑
17. Has the UV Unit been serviced and bulbs cleaned?
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18. Who completes the weekly check for the UV?( Non-Dis arge)
DISINFECTION / TABLETS YES V NO
If no proceed to the next section.
The tablet chlorinator unit shall be checked weekly to ensure continuous and proper operation.
❑
El22.
19. Does'''the permittee' have the correct chlorine tablets?(If none, mark No)'' '
' ''
El
Does the Permittee know the location of the chlorinator? " a
' '"�"
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El
El
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23. Were chlorine tablets observed in the chlorinator? .
�`L`T
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24: Are tablets contacting water? If possible'poke them to determine. u
`❑
DECHLOR (Discharge only) YES NO If no proceed to the next section.
The dechlorinator unit shall be checked weekly to ensure continuous and proper operatio
_ ti nv
25.- Does the permittee know where the-dechlor is?,-
0
0
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El26.
Dy.� .A/'{//u1I.
Does the permittee have .the correct dechlor tablets?
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27. Were dechlor tablets observed in the dechlorination chamber?
El

28. Are tablets
DRAFT Does
Yes No Apl
If possible poke them to determine. ❑ C
PUMP TANK YES NO.: .:..,=.If,
nQ proceed to;the next section.
All pump and alarm sytems shall be inspected monthly. (non -discharge)
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29. Is thepumpworking? GkM�
30. Is the audible and visual high water alarm operational?-
El
El
0
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0
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31. Did the permittee know how to check the pump & high water alarm?
32. Last functional test?
DISCHARGE ONLY YES NO
If no proceed to the next section.
A visual review of the"butfall location shall be executed twice each year (one at the time of sampling to ensure no vi ble solids or evidence of a malfunction.
33. Does the permittee know where the outfall is?
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34. Were j 6u able to locate -the outfall? -
El
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35. Is the end of the discharge pipe visible? If not, explain why.
❑
❑
36. Is outlet discharging?
37. Is right of way maintained around the discharge;point?
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❑
�p ! t'�
38. Any Lab Results available?'""'
❑
L�
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LZ
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39. Is thereeVid`ence ofsolids•around the discharge point?
DRIP orSPRAY ., YES NO
If no proceed to the next section.
The irrigation sysetm shall -be inspected monthly to ensure the system is free of leaks and equi ment is operating as designed.
40. Is the system DRIP or IRRIGATION (circle one)? If irrigation number of
sprinkler heads.
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41. Are the buffers adequate?
0
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42. Is the site free of ponding and runoff?
El
El
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43. Does the application equipment appear to be working properly?
44. Is there a two wire fence?
El
El
El
El
GENERAL n
45. Are the treatment units locked and or secured? c(�,/
❑El
El
`
El
F/
37. Has resident had any sewage problems?
jj If yes explain in thhe_ comment section.
^/
Fite
❑
❑ -
❑
37. Is the system compliant? AD
❑
&IX
❑
❑
38. Is the system failing? if yes, take pictures if possible.
L 7--'
❑
❑
39. If system is failing, any sign of children or animals contacting, sewage?
❑
Comments: Photos Taken?
YES
Lj
NO
�Y
t
G

Who Is Covered Under This Permit?
This permit covers discharges of treated domestic
wastewater from single family residences at flows not to
exceed 1000 gallons per day. Other types of facilities
discharging less than 1000 gallons per day of treated
domestic wastewater may be covered under this permit
with the approval of the Division.
ChanlZes in Reissued General Permit
The previous General Permit expired July 31, 2007. The
permit has been reissued for an additional five years. The
new permit contains the following significant changes
from the previous version:
• Dechlorination is now required for all facilities
installing chlorination after the effective date of the
final permit.
Risers will be required on all new septic tanks
making them easier to locate.
There were also changes made to the Notice of Intent
(NOI) which is filed to gain coverage under this permit.
The NOI requires updated buffer requirements aligning
with 15A NCAC 02T.0506, and the sign -off of a
professional engineer for all new systems.
Key Permit Requirements
• Annual sampling of the effluent from the system is
required. The parameters to be sampled can be found
in Part I, Section A. A North Carolina certified
laboratory should be contacted to perform the
analytical monitoring. A list of certified laboratories
can be obtained by calling the Division.
• All samples should be collected before the effluent
joins or is diluted by any other wastestream, water or
substance. (Part II, Section D:1)
• The permittee shall give notice to the Division of any
planned physical alterations or additions to the
system that could significantly increase the quantity
of pollutants discharged or introduce new pollutants
to the discharge. These alterations include any types
of residence/facility expansions. (Part II, Section
E:3)
• Submission of monitoring reports is not required. All
monitoring information must be retained on site for a
period of 3 years. (Part II, Section E:1)
Minimum Treatment System Requirements
System requirements for existing (previously
constructed) systems are a septic tank, sand filter and
disinfection apparatus. All existing facilities adding
chlorination after August 1, 2007 will also be required to
add dechlorination. System requirements for a new (not
yet constructed) system are a septic tank, primary and
secondary (or recirculating) sand filters,
chlorination/dechlorination (or equivalent means of
disinfection) and post -aeration apparatus.
Operation and Maintenance
In order to protect water quality and to ensure proper
operation of domestic wastewater systems, the following
measures should be taken:
• Check the septic tank every year to see if solids
should be removed.
• Have the septic tank pumped out every three to five
years. Contact a local septic service/repair company
from the yellow pages:
• Inspect disinfection and dechlorination equipment
(if applicable) weekly to confirm proper operation.
• If a chlorinator and/or dechlorinator is installed,
replace tablets whenever necessary.
Tips for Maintaining Your Septic Tank
The septic tank is usually a watertight concrete box buried
in the ground outside the house. Wastewaters from the
house, including the toilets, shower, bathtub, washing
machine and dishwasher flow into the tank. Heavier solid
materials settle to the bottom and the liquid flows out of
the tank into a soil drainfield. Both the septic tank and
drainfield must be properly maintained for the system to
work correctly for many years. Some tips for maintaining
your septic system are:
• Do not put too much water into the septic system.
Try to conserve water Wherever possible.
• Do not add materials such 'as chemicals, sanitary
napkins, or other foreign objects.
• Restrict the use of your garbage disposal.
• Do not pour grease or cooking oils down the drain.
• Have the solids pumped out of the septic tank every
3-5 years.
• Keep automobiles and heavy equipment off of the
septic tank and drain field.
Chlorination and Dechlorination Tablets
If the treatment system has a chlorinator or dechlorinator,
it is important that there is an adequate supply of tablets
to ensure proper operation. There will usually be a white
PVC pipe sticking up from the chlorinator/dechlorinator
where the tablets should be inserted. Tablets can be

obtained from most plumbing supply stores. Make sure
that the tablets are certified for wastewater use. Chlorine
tablets are NOT the same type of chlorine used for
swimming pools.
Signs of Septic System Problems
Some of the signs that your septic system may be having
problems are:
• Sewage backing up into your toilets, tubs or sinks.
• Slowly draining fixtures; particularly after it has
rained.
• The smell of raw sewage accompanied by soggy soil
over the drainfield.
• Sewage discharging over the ground or in nearby
ditches or woods.
If you see any of these signs, contact a septic repair
company from the yellow pages in your area.
Right -of -Way
Issuance of this general permit does not relieve the
permittee from obtaining all necessary right-of-way or
easement rights to discharge wastewater on or across
another property.
Frequently Asked Questions
1) Do I need to submit the monitoring results
annually?
No. The submission of monitoring reports for this
permit is not required. There are no standardized
Discharge Monitoring Reports (DMRs) associated
with this permit. All monitoring results should be
kept on site for three years. The Division may
request these reports for review at any time. (Part II,
Section E:1)
2) Do I need to employ a certified wastewater
treatment plant operator to manage and run the
system?
Not at this time. The Division's Operator Training
and Certification Unit does not currently plan to
classify these types of facilities for the purposes of
needing a certified operator. The requirement was
left in the permit at this time with clarification, in the
event that classification was assigned in the future.
(Part H, Section C:1)
3) Where do I find my stream classification?
The stream classification, i.e. WS-IV, C, Tr, etc. can
usually be found in the Certificate of Coverage. If
you are unsure of your stream classification, you can
contact the NPDES Permitting Program.
4) Does a certified lab need to be used to analyze
samples?
Yes, a North Carolina certified lab must be used to
perform analytical monitoring. The only exception to
this rule is when measuring the value of pH. pH
values should be measured in the field because they
may change considerably between when the sample
is pulled and it is analyzed at the laboratory. A list of
certified labs is available from the Division.
5) What If I Sell My Property?
The Division views changes of name or ownership as
a minor modification and requires the Director's
approval. Name and ownership changes require you
to complete a Name/Ownership Change Form. The
forms are available by contacting the NPDES
Permitting Program at [phone].
6) When does my permit expire and how do I renew
it?
The expiration date of the permit is on the first page
of the General Permit. This General Permit expires
on July 31, 2012. Approximately 180 days prior the
expiration of the General Permit, you will receive a
renewal notice in the mail from the Division.
Contact Us
For additional information, please contact us at:
N.C. Division of Water Quality
Surface Water Protection Section
NPDES Program
1617 Mail Service Center
Raleigh, N.C. 27699-1617
Phone: [phone]
Fax: [phone]
You may also contact your local Regional Office at:
Asheville: [phone]
Mooresville: [phone]
Winston-Salem: [phone]
Raleigh: [phone]
Fayetteville: [phone]
Washington: [phone]
Wilmington: [phone]
The NPDES Permitting Program can be found online at
http://portal.ncdenr.org/web/wq/sM/ps/npdes. Another
source of information is the DENR Customer Service
Center. They may be reached at 1-877-NC ENR 4 U (1-
877-623-6748). An additional source of information is
the North Carolina Division of Pollution Prevention and
Environmental Assistance. They have information on
how to minimize pollutants at various types of industries.
They may be reached at [phone].

'17 L E
A! LA.
HCDEHR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Roger D. Dixon
1117 New Prospect Church Rd.
Shelby, NC 28150
Dear Mr. Dixon:
Division of Water Quality
Coleen H. Sullins Dee Freeman
Director Secretary
November 24, 2010
Subject: Compliance Evaluation inspection
Single Family Residence
NPDES Permit No. NCG550065
Cleveland County
Enclosed is a copy of the Compliance Evaluation Inspection (CEI) for the inspection conducted at the subject
facility on November 22, 2010, by Ms. Barbara Sifford with this Office. Thank you for your assistance and cooperation
during the inspection. The system appeared to be operational and maintained.
Analytical data for compliance monitoring for the treatment system has not been evaluated. This should be
completed by February 2011, and annually thereafter. A list of commercial certified labs is included with this letter.
Documentation of the septic tank being pumped was available for 2007 and 2010.
The chlorine tablet dispenser was appropriately located in the wastewater flow. Chlorine tablets for pools should
not be used in the system as they are toxic to aquatic life. Chlorine tablets can be purchased from USA Blue Book on
line or McCall Brothers plumbing supply in Charlotte. A MSDS is enclosed stating the required type of chlorine
compound and proper product use. Please submit a copy of the laboratory data for the permitted parameters within 90
days of receipt of this letter.
The enclosed reports should be self-explanatory. If you have any questions, comments, or need assistance with
understanding any aspect of your permit or this report, please do not hesitate to contact Ms. Sifford at [phone].
Sincerely,
Robert Krebs
Regional Supervisor Surface Water Protection
Mooresville Regional Office
Enclosure —Inspection report/commercial lab list
Chlorine tablet information
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] Fax:.[phone]'t Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
None
rthCarolina
An Equal Opporwnity', Affirmative Action Employer — 50% Recycled/10% Post Consumer paper

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 I SI 31 NCG550065 111 121 10/11/22 117 181 CI 191 SI 201
Remarks
21111111111111111111111111111111111111111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating 81 QA -------------- -------- -- Reserved ---------- --------
67I .5 169 70 15 I 711 I 721 NJ 73 I I 174 751 I I I I I I 180
W
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:00 AM 10/11/22
07/08/01
1117 New Prospect Church Road
Exit Time/Date
Permit Expiration Date
1117 New Prospect Church Rd
Shelby NC 28150
11:00 AM 10/11/22
12/07/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Roger D Dixon,1117 New Prospect Church Shelby NC 28150//704-484-2543/No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit ® Flow Measurement ® Operations & Maintenance ® CSO/SSO(Sewer Overflow)
Records/Reports Self -Monitoring Program Sludge Handling Disposal ® Facility Site Review
Compliance Schedules ® Effluent/Receiving Waters ® Laboratory ® Storm Water
Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Barbara Sifford MRO WQ//704-663-1699 Ext.2196/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCG550065 I11 12I 10/11/22 117 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Annual analytical has not been completed. Enclosed is a new (2010) commercial lab list to contact.
Please forward a copy of this analytical to the MRO by March 1, 2010.
Information on chlorine tablet composition is included.
The Technical Bulletin for NCG550000 with system requirements is also included with the report.
Page # 2

Permit: NCG550065
Inspection Date: 11/22/2010
Owner - Facility: 1117 New Prospect Church Road
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ ❑ ® ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑ ❑ M 0
Judge, and other that are applicable?
Comment:
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
®❑
n
n
Is the facility as described in the permit?
®❑
n
n
# Are there any special conditions for the permit?
❑
®
❑
❑
Is access to the plant site restricted to the general public?
❑
❑
A
❑
Is the inspector granted access to all areas for inspection? -
❑
❑
❑
Comment: Permit renewal in 2012. Annual fees paid in 2010.
Effluent Pipe
Yes
No
NA
NE
Is right of way to the outfall properly maintained?
®
n
o
o
Are the receiving water free of foam other than trace amounts and other debris?
®
n
n
n
If effluent (diffuser pipes are required) are they operating properly?
❑
❑
®
❑
Comment: Outfall is located on bank of UT to Hickory Creek. Stormwater drainage
has eroded the stream banks in this area.
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
®
n
n
n
Is all required information readily available, complete and current?
®
n
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
®
n
n
n
Are analytical results consistent with data reported on DM Rs?
n
n
■
n
Is the chain -of -custody complete?
❑
❑
M
Cl
Dates, times and location of sampling
❑
Name of individual performing the sampling
n
Results of analysis and calibration
❑
Dates of analysis I
❑
Name of person performing analyses
n
Transported COCs
n
Are DMRs complete: do they include all permit parameters?
❑
❑
®
❑
Has the facility submitted its annual compliance report to users and DWQ?
n
n
❑
Page # 3

Permit: NCG550065
Inspection Date: 11/22/2010
Owner - Facility: 1117 New Prospect Church Road
Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑
n
®
n
Is the ORC visitation log available and current?
n
n
®
n
Is the ORC certified at grade equal to or higher than the facility classification?
n
n
K2
n
Is the backup operator certified at one grade less or greater than the facility classification?
n
n
®
n
Is a copy of the current NPDES permit available on site?
n
n
®
n
Facility has copy of previous year's Annual Report on file for review?
n
n
®
n
Comment: Facility is not required to have an operator. Analytical is to be performed
annually. Reference permit and technical bulletin included with this inspection report.
Septic Tank
Yes
No
NA
NE
(If pumps are used) Is an audible and visual alarm operational?
n
n
®
n
Is septic tank pumped on a schedule?
■
n
n
n
Are pumps or syphons operating properly?
n
n
®
n
Are high and low water alarms operating properly?
n
n
®
n
Comment: Septic tank has been pumped according to permit requirements, dates
were January 2007 and May 2010.
Sand Filters (Low rate)
Yes
No
NA
NE
(If pumps are used) Is an audible and visible alarm Present and operational?
n
❑
■
n
Is the distribution box level and watertight?
®
n
n
n
Is sand filter free of ponding?
®
n
n
n
Is the sand filter effluent re -circulated at a valid ratio?
n
n
■
n
# Is the sand filter surface free of algae or excessive vegetation?
■
n
n
n
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
n
■
n
n
Comment: Single pass sand filter in yard to right of driveway.
Laboratory
Yes
No
NA
NE
Are field parameters performed by certified personnel or laboratory?
n
n
■
n
Are all other parameters(excluding field parameters) performed by a certified lab?
❑
®n
n
# Is the facility using a contract lab?
n
■
n
n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
n
n
■
n
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
n
n
■
n
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
n
n
■
n
Page # 4

Permit: NCG550065 Owner - Facility: 1117 New Prospect Church Road
Inspection Date: 11/22/2010 Inspection Type: Compliance Evaluation
Laboratory Yes No NA NE
Comment: Annual parameters have not been performed as listed in permit. This was
discussed and a list of certified commercial labs in NC was provided to Mr. Dixion.
Disinfection -Tablet Yes No NA NE
Are tablet chlorinators operational? ® In n n
Are the tablets the proper size and type? n ®n n
Number of tubes in use? 2
Is the level of chlorine residual acceptable? n n n
Is the contact chamber free of growth, or sludge buildup? n n n
Is there chlorine residual prior to de -chlorination? n n ■ n
Comment: Pool tablets are not to be used for disinfection; they should be chlorine
tablets approved for wastewater. Information is provided on the chemical composition
of the correct tablets.
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? ❑ ❑ ■ n .
Is sample collected below all treatment units? in n n n
Is proper volume collected? ❑ ❑ ■
Is the tubing clean? ❑ ❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n n ■ n
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? n ■ n n
Comment: Samples should be collected at the discharge pipe.
Compliance Schedules Yes No NA NE
Is there a compliance schedule for this facility?. ❑ ■ ❑ n
Is the facility compliant with the permit and conditions for the review period? n ® n n
Comment: Annual sampling is required by the permit. this should be completed by
February 1, 2011.
Page # 5

ATLILA.
FqCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
July 27, 2007
Roger D. Dixon
1117 New Prospect Church
Shelby, NC 28150
William G. Ross, Jr., Secretary
Coleen H. Sullins, Director
Subject: Renewal of coverage / General Permit NCG550000
1117 New Prospect Church Road
Certificate of Coverage NCG550065
Cleveland County
Dear Permittee:
In accordance with your renewal application [received on January 18, 20071, the Division is renewing
Certificate of Coverage (CoC) NCG550065 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 Mooresville 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 I
Fields [919 733-5083, extension 551 or [e-mail] or Susan Wilson
or [e-mail].
Sincerely,
for Coleen H. Sullins
cc: Central Files
V.L0r , x eavi ecc / Su.lace to 1'xotrc 'o ,
NPDES file
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: www.ncwaterquality.org
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper
3
1�� `2007
t
J+,
NorthCarohna
Naturally

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550065
DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND
OTHER 100% DOMESTIC 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,
Roger D. Dixon
is hereby authorized to discharge domestic wastewater [300 GPD] from a facility located at
1117 New Prospect Church Road
Shelby
Cleveland County
to receiving waters designated as an unnamed tributary to Hickory Creek in subbasin 03-
08-04 of the Broad 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.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
��igned'this�.dav4 V-27.2007.
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality.
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Roger D. Dixon
1117 Prospect Church Road
Shelby, NC 28150
Dear Permittee:
July 21, 1997
Subject: Certificate of Coverage No. NCG550065
Renewal of General Permit
Dixon, Roger - Residence
Cleveland County
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.
cc:.. Central Files
, oores_v_ille.-RegionalOffCce )
NPDES Group
Facility Assessment Unit
Sincerely,
y�^✓ A. Preston Howard, Jr., P.E.
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. NCG550065
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,
Roger D. Dixon
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
Dixon, Roger - Residence
117 Prospect Church Road
Shelby
Cleveland County
to receiving waters designated as subbasin 30804 in the Broad 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.
T�
A. Preston Howard, Jr., P.E., Director
f Division of Water Quality
By Authority of the Environmental Management Commission

rFDEC.10._2010111.01AM USABLUEnOOK PURCHPSINC
P.O. Box good www.usabinebaak_com
Gumea' iL 60031-M FAX: (847) M-303o
CALL aEFonZ- V I IMIKO PkD1)UCT8_ TOLL FREE! 1-800.54E-123a
F_E.1.N.: 36-3645787
IN'TERNA"nONAL DIRECT: [phone]
1
F"H
ROGER DIXON
EATTIV: 0001 RMER DIXON
lT 1117 NEW PROSPECT 1;H RD
SHELBY NC L81 Sr i
CUSTOMER P_4.8 ORDER DATE ~ -
SLP.
USA STOCK # - - - DESCRIPTION
26527
PACKING
tHM) Coal Hypo Giant Chlorine
Tablets, 50 lb Pail 2-5/81-D
SLIP. This is NOT a p ur^ch as e 0
N0.1193 P. 8.04
PAGE
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DATE
12/OR/10
a ROGER OIXON
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1117 NEW PROSPECT CH RD
SSHEI-BY , NC E8130
TERMS
w/N FREIGHT SHIP VIA
ORDERED SNIPPED joacKoFi U/M PAGE (_L,OC. n�
D I RECl 11 EFII S3 I
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rhank you far your order.
aked by: _ Checked by: Packed hv:
TQTRL P.04
RECEIVED
DIVISION OF WATER QUALITY
DEC 2 0 20M
SWP SECTION
MOORESVILLE REGIONAL OFFICE

a ceAnalyticalo
www.pacelabs.com
December. 13, 2010
Private Drinking Wate Client
Private Drinking Water Client
Client Services Dept.
Asheville, NC 28804
RE: Project: EFF SAMPLE 11/30
Pace Project No.: 9283007
Dear Private Wate Client:
Pace Analytical Services, Inc.
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Pace Analytical Services, Inc
9800 Kincey Ave. Suite 10
Huntersville, NC 2807
(704)875-909
Enclosed are the analytical results for sample(s) received by the laboratory on November 30, 2010.
The results relate only to the samples included in this report. Results reported herein conform to the
most current NELAC standards, where applicable, unless otherwise narrated in the body of the
report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
/JaneMeehan
[e-mail]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 1 of

Pace Analytical Services, Inc. Pace Analytical Services, Inc
ac'AnalXical ® 2225 Riverside Dr. 9800 Kincey Ave. Suite 10
mvw.pacelabs.com Asheville, NC 28804 Huntersville, NC 2807
1 [phone] (704)875-909
a
Project: EFF SAMPLE 11/30
Pace Project No.: 9283007
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
Louisiana/LELAP Certification #: 04034
New Jersey Certification #: NC012
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
Pennsylvania Certification #: 68-00784
South Carolina Certification #: 99006001
Asheville Certification IDs
2225 Riverside Dr., Asheville, NC 28804
Connecticut Certification #: PH-0106
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
New Jersey Certification #: NC011
North Carolina Bioassay Certification #: 9
North Carolina Drinking Water Certification #: 37712
CERTIFICATIONS
South Carolina Drinking Water Cert. #: 99006003
Virginia Certification #: 00213
Connecticut Certification #: PH-0104
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Louisiana DHH Drinking Water# LA 100031
West Virginia Certification #: 357
North Carolina Wastewater Certification #: 40
Pennsylvania Certification #: 68-03578
South Carolina Bioassay Certification #: 99030002
South Carolina Certification #: 99030001
Virginia Certification #: 00072
West Virginia Certification #: 356
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
..,N• F
Page 2 of

Zz"r aceAnalytical
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Project: EFF SAMPLE 11/30
Pace Project No.: 9283007
Pace Analytical Services, Inc. Pace Analytical Services, Inc
2225 Riverside Dr. 9800 Kincey Ave. Suite 10
Asheville, NC 28804 Huntersville, NC 2807
[phone] (704)875-909
ANALYTICAL RESULTS
Sample: EFFLUENT
Parameters
Lab ID: 9283007001 Collected: 11/30/10 14:30
Results Units Report Limit DF
Received: 11/30/10 16:50 Matrix: Water
Prepared Analyzed CAS No. Qua]
Flow Monitoring Data
Analytical Method:
Date(s)
11/30/10
1
12/13/10 12:03
Time(s)
14:30
1
12/13/10 12:03
Flow
50 GPD
1
12/13/10 12:03
Field Data
Analytical Method:
Collected By
MPS
1
12/13/10 12:04
Collected Date
11/30/10
1
12/13/10 12:04
Collected Time
14:30
1
12/13/10 12:04
Field Residual Chlorine
qqo�i f -V)
1
12/13/10 12:04
MBIO 9222D Fecal Coliform AVL
Analytical Method: SM 9222D
Fecal Coliforms
. ff CQFU BOA-
2.0
2
11/30/10 16:50
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
T
_4 4irig'10
2.6
1
12/02/10 20:23
5210B BOD, 5 day
Analytical Method: SM 5210B
BOD, 5 day
1=2 8?rnglL!
2.0
1
12/01/10 16:10 12/06/10 13:10
<-
Date: 12/13/2010 12:04 PM REPORT OF LABORATORY ANALYSIS Page 3 of
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
,N • 0­

aceAnalytical
wwx pacelabs.com
i
i
Project: EFF SAMPLE 11/30
Pace Project No.: 9283007
Pace Analytical Services, Inc.
2225 Riverside Dr.
Asheville, NC 28804
[phone]
QUALITY CONTROL DATA
QC Batch: MBIO/4673 Analysis. Method: SM 9222D
QC Batch Method: SM 9222D Analysis Description: 9222D MBIO Fecal Coliform - AVL
Associated Lab Samples: 9283007001
METHOD BLANK: 535373
Associated Lab Samples: 9283007001
Parameter Units
Fecal Coliforms CFU/100 mL
SAMPLE DUPLICATE: 535374
Parameter
Fecal Coliforms
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 1.0 11/30/1016:50
9283007001 Dup
Units Result Result
CFU/100 mL ND ND
RPD Qualifiers
Pace Analytical Services, Inc
9800 Kincey Ave. Suite 10
Huntersville, NC 2807
(704)875-909
Date: 12/13/2010 12:04 PM REPORT OF LABORATORY ANALYSIS Page 4 of
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..

r, ZacAnalytical
i wevw pacelabs.com
i
1
Project: EFF SAMPLE 11/30
Pace Project No.: 9283007
QC Batch: W ET/14637
QC Batch Method: SM 2540D
Associated Lab Samples: 9283007001
METHOD BLANK: 535855
Associated Lab Samples: 9283007001
Parameter Units
Total Suspended Solids mg/L
Pace Analytical Services, Inc.
2225 Riverside Dr.
Asheville, NC 28804
[phone]
QUALITY CONTROL DATA
Analysis Method: SM 2540D
Analysis Description: 2540D Total Suspended Solids
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 2.5 12/02/10 20:18
Pace Analytical Services, Inc
9800 Kincey Ave. Suite 10
Huntersville, NC 2807
(704)875-909
LABORATORY CONTROL SAMPLE:
535856
Spike LCS LCS
% Rec
Parameter
Units
Conc. Result % Rec
Limits Qualifiers
Total Suspended Solids
mg/L
250 250 100
80-120
SAMPLE DUPLICATE: 535857
9282987001 Dup
Parameter
Units
Result Result RPD
Qualifiers
Total Suspended Solids
mg/L
9.0 9.8
9
Date: 12/13/2010 12:04 PM REPORT OF LABORATORY ANALYSIS Page 5 of
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..

aceAnaIXical
www.pacelabs.com
Project: EFF SAMPLE 11/30
Pace Project No.: 9283007
Pace Analytical Services, Inc.
2225 Riverside Dr.
Asheville, NC 28804
[phone]
QUALITY CONTROL DATA
QC Batch: WET/14611 Analysis Method: SM 5210B
QC Batch Method: SM 5210B Analysis Description: 5210B BOD, 5 day
Associated Lab Samples: 9283007001
METHOD BLANK: 534737
Associated Lab Samples: 9283007001
Parameter Units
BOD, 5 day mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 2.0 12/06/1013:10
Pace Analytical Services, Inc
9800 Kincey Ave. Suite 10
Huntersville, NC 2807
(704)875-909
LABORATORY CONTROL SAMPLE: 534738
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
BOD, 5 day mg/L 198 184 93 84-115
SAMPLE DUPLICATE: 534749
Parameter
BOD, 5 day
9282937001 Dup
Units Result Result
mg/L 2.6 2.6
RPD Qualifiers
0
Date: 12/13/2010 12:04 PM REPORT OF LABORATORY ANALYSIS Page 6 of
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
- \N _

/)_!,2c,eAnalXical
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CHAIN -OF -CUSTODY / Analytical Request Document
The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately.
V /'71 1'- J
Section A Section B Section C
Page: of
Required Client Information: Required Project Information: Invoice Information:
Company: Report To: //�� j Attention:
1 3 9 6 7 O 6
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Address:/ 01 ` t>' C '� ,Copy
To:
Company Name:
REGULATORY AGENCY
�4`/
Address:
i NPDES r GROUND WATER (— DRINKING WATER
�` UST (- RCRA r OTHER
Email To: Purchase
Order No.:
Pace Quote
Reference:
Phone:
p f �' . µ3
Fax: Project
Name: /
i f � /e-
Pace Project
Manager:
Site Location
STATE.
/
Requested Due DaterrAT: Project
Number:
Pace Profile #:
Requested
Analysis
Filtered
(YIN)
Section D Matrix Codes
z
RequiredClient Information MATRIX / CODE
m
COLLECTED
Preservatives
Y
Drinking Water DINv
o
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zz
LD
Water WT
Waste Water WW
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COMPOSITE
COMPOSITE
U
_
Product P
—
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START
ENDIGRAB
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Soil/Solid SL
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SAMPLE ID Oil OL
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Wipe WIP
(A-Z, 0-9 / ;) Air AR
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DATE
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ace Project No./ Lab I.D.
2
3
4
5
6
7
8
9
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ADDITIONAL COMMENTS
R NQUISHED BY / AFFILIATION
DATE
TIME
ACCEPTED BY / AFFILIATION
DATE
TIME
SAMPLE CONDITIONS .
a� � G�9D
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SAMPLER NAME AND SIGNATURE
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DATE Signed
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r lr ortanl Note: B si nin this form ou are accepting Pace's NET 30 day agreeing g p y p y y • p y g g y p g y payment terms and a reein to late charges of 1.5 % per month for an invoices not aid within 30 days. F-ALL-Q-020fev.07, 15-Ma -2007

Instructions for completing Chain of Custody (COC)
Section A add B: Complete all Client information at top of sheet: company name, address, phone, fax, contact (the person to contact if there are
questions, and who will receive the final report.), e-mail address (if available), PO#, Project Name and/or Project Number as you would like to see,it
appear on the report.
2. Section C: Invoice Infonnation: Billing information is included in this section. This information should include the name and address of the person
receiving the invoice.
3. Quote Reference should be completed if a quotation was provided by Pace Analytical. The Project Manager, and Profile No. will be completed by
Pace Analytical Services.
4. Site Location: A separate COC must be filled out for each day of sample collection. Record the two letter postal code for the US state in which the
samples were collected.
5. Regulatory Agency: List the program that is guiding the work to ensure proper regulations are followed.
6. Section D: Complete a Sample Description in the "SAMPLE ID' section as you would like it to appear on the laboratory report. The following
information should also be included: the sample matrix, sample type (G (grab) or C (composite). When collecting a composite, the start time and end
time should be documented in the respective boxes. The collection time for a grab (G) sample should be entered in the boxes marked `Composite
End/Grab'), Sample temp at collection (if required by state), the total number of containers, and preservative used.
7. Mark if the sample was filtered in the field by marking Y or N in 'Filtered' row by the Analysis requested.
8. Requested Analysis: List the required analysis and methods on the lines provided and place a check in the column for the samples requiring the
analysis. Additional comments should be referenced in the bottom left hand corer or include attachments for extended lists of parameters.
9. The sampler should print their name in the space provided and sign their name followed by the date of the sampling event at the bottom of the COC in
the spaces designated for `SAMPLER NAME AND SIGNATURE'.
10. When relinquishing custody of the samples to a representative of the laboratory or other organization, indicate the Item Numbers of those samples
being transferred; sign relinquished by, date and time, and include your affiliation.
*Important Mote:
Standard .Turnaround Time is 2 Weeks/10 business days. Results will be delivered by end of business on the date due unless other arrangements
have been made with your project manager.
Special Project Requirements such as Low Level Detection Limits or level of QC reported must be included on the chain of custody in the Additional
Comments section.

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www.pacelabs.com
Sold To:
Private Drinking orate Client
Private Drinking Water Client
Client Services Dept.
Asheville, NC 28804
Pace Analytical Services, Inc
IN „ E C 9800 Kincey Ave., Suite 10(
Huntersville, NC 2807E
Phone: [phone]F
Invoice Number: 109277318
Date: 12/14/2010
Total Amount Due: $150.00
Please Remit To:
Pace Analytical Services, Inc.
P.O. Box 684056
Milwaukee, WI 53268-4056
Client Number/C!►ent tD s Purchase'brder fVo Pace Rrolect Mgr Terms n Page
Jane Meehan Net 30 Days** 1
93-703954 / 93-Private �%,� , I-�-
Client Project: EFF SAMPLE 11/30 Client Name: Private Drinking Water Client
Pace Project No: 9283007 Sample Received. 11 /30/2010
Report Sent To: Private Drinking Wate Client, Private Drinking Water Client
Comments:
Quantity Unit
Description
ANALYTICAL CHARGES
Method
Matrix
Price
Tota
1 Ea
2540D Total Suspended Solids
SM 2540D
Water
$20.00
$20.0(
1 Ea
5210B BOD
SM 5210B
Water
$35.00
$35.0(
1 Ea
Field Data
Water
$50.00
$50.0(
1 Ea
Flow Monitoring Data
Water
$0.00
$0.0(
1 Ea
MBIO 9222D Fecal Coli (Water) AVL
SM 9222D
Water
$25.00
$25.0(
1 Ea
Mileage Charge
Miscellaneous Charges
Water
$20.00
$20.0(
Analytical Subtotal $150.0(
Total Number of Charges 6 Total Invoice Amount $150.0(
Samples Received for analysis:
Lab ID Client Sample ID _ Received
9283007001 EFFLUENT 11/30/2010
If you have any questions or to pay by credit card, please contact Jane Meehan at Pace.
Phone: [phone] [e-mail]
Page 1 of
**1.5% MONTHLY FINANCE CHARGE ASSESSED AFTER 30 DAYS OR TERMS OF CONTRACT.
PLEASE REFERENCE THE INVOICE NUMBER ON ALL REMITTANCE ADVICE.
AN EQUAL OPPORTUNITY EMPLOYE
Please complete and return copy of invoice with your payment.
INVOICE TOTAL $150.00
Amount Paid: $ ,1 any . e) ------
Check No: - 2)-1
Customer No: 93-703954 Invoice No: 109277318

jJ._�5aceAnalyticalo
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QUALIFIERS
Project: EFF SAMPLE 11/30
Pace Project No.: 9283007
DEFINITIONS
Pace Analytical Services, Inc.
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Pace Analytical Services, Inc
9800 Kincey Ave. Suite 10
Huntersville, NC 2807
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to changes in sample preparation, dilution of
the sample aliquot, or moisture content.
ND - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL - Adjusted Method Detection Limit.
S - Surrogate
1,2-Diphenylhydrazine (8270 listed analyte) decomposes to Azobenzene.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
U - Indicates the compound was analyzed for, but not detected.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is NELAP accredited. Contact your Pace PM for the current list of accredited analytes.
(704)875-909
Date: 12/13/2010 12:04 PM REPORT OF LABORATORY ANALYSIS Page 7 of
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
_ ,N ♦CCCo..

Form 101 NC Division of Water Quality
Surface Water Protection Section

Form 101
NC Division of Water Quality
Surface Water Protection Section
Question I Yes No NIA N/E Remarks:
Are there chlorine tablets in the chlorinator?
VII. Dec hlorination
Are the dechlorination tablets wastewater rated? (Inspect
original container for wastewater rating. If not, require
1 permittee to get tablets rated for wastewater. Only new
facilities constructed after August 1, 2007 {Effective date
of latest general permit} are required to install
dechlorination.)
2 Are there dechlorination tablets in the dechlorinator?
VI I I. Ultraviolet (UV)
1
Is the UV disinfection system working?
Does permittee know how to determine if the UV system
/
2
is working?
3
Do they know how to clean and replace UV bulbs?
t/
4
Do they have extra UV bulbs on site?
stems
IX. Pump Systems
1
Is/are the pump(s) working?
t�
2
Is the high water alarm in the pump tank operational?
Does the permittee know how to check the pump and
3
high water alarm to ensure operability?
X.
Detecting Possible le Pro blem s/SY s tem Failure
Is there any evidence of sewage surfacing or ponding
1
anywhere on the grounds?
2
Is there any overflow or soggy soils on the property?
Is there any sewage on the ground near the septic tank,
3
distribution box(es), sand filters or contact chambers,
/
indicating a possible failure of the system?
V
Does any area of the property appear to be greener with
4
vegetation growth than any where else on the property?
/
(Indicates a possible sandfilter failure.)
If standing sewage or possible system failure is observed,
are there signs of human and animal traffic in the area?
5
(Need to understand if human contact/vector concerns
are evident/prevalent.)
If the system shows failure advise the owner that the
system must be replaced. The system must be designed
6
for 120 gallons per bedroom. They should contact the
Mooresville Regional Office, Surface Water Protection at
704-663-1699.
e
XI. Effluent Pipe Discharge
1
Did you observe the end of the discharge pipe?
2
Was the outlet discharging?
3
Was the discharge clear and free of solids?
Is there any evidence of solids at the end. of the pipe or in
4
nearby ditches or creeks?
V/7�
Page 2 of 3 SFR Inspection Checklist 11119/2010, 10:19 AM

s� Form 101
NC Division of Water Quality
Surface Water Protection Section
##
Question
Yes
No
N/A
N/E
Remarks:
Is the outlet submerged in stream flow, or does it appear
that it may become submerged under slightly higher
e SI -
O C ?1'�
Q 11
5
stream flows? (Outlet should never be submerged.)
Xll. Illegal
........................................
Is all wastewater from the home connected to drain into
the septic tank?
Is there any discharge of gray water (i.e. washing
machine or dishwashing machine wastewater) from the
2
residence straight into the creek, ditch, stream, etc? (If
yes, then the discharge must be connected to drain into
the septic tank immediately. Any discharge of untreated
wastewater into the environment is illegal.)
NOTES:
�j O
Q/1 � 9 Imat4' Tke-�
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Page 3 of 3 SFR Inspection Checklist ' 11/19/2010, 10:19 AM

Beverly Eaves Perdue
Governor
riLt
HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
November 1, 2010
Roger D. Dixon
1117 New Prospect Church Road
Shelby, NC 28150 -
Dee Freeman
Secretary
Subject: Single Family Residence Wastewater Treatment
System
NPDES General Wastewater Permit No./Certificate
of Coverage NCG550065
Compliance Evaluation Inspection
Dear Mr. Dixon: Jll&uz j �,- 4(( -',-P5(13
Division of Water Quality (DWQ) database records show that you currently own/operate a single
family residence (SFR) wastewater treatment and disposal system. DWQ personnel from the Mooresville
Regional Office (MRO) need to. conduct a comprehensive review of your system with you in order .to
verify that your system is operating properly and to determine the compliance status of the system
pursuant to your NCG550065 permit. We anticipate such a review would take approximately one to two
hours, provided that all needed documentation and data is readily available at the time of the site visit.
Due to the difficulties involved with catching owners at home during the workday, we would like
to pre -schedule this site visit with you to ensure we can meet and complete the required system review as
expeditiously as possible. In order to facilitate this we ask that you contact Ms. Barbara Sifford, of our
office, at 704-663-1699, between the hours of 8AM and 5PM, Monday through Friday. Please contact
Ms. Sifford within the next 10 days to identify the best possible time to inspect your SFR and conduct this
review with you.
Also, in the interest of conducting the most efficient evaluation possible, we ask that you have
certain items of documentation on hand at the time of the site visit. These items include the following:
1. Permit/Certificate of Coverage: Issued by DWQ, you would have received this via regular U.S.
Postal Service mail.
2. A Schematic of the Treatment/Disposal System:' Please have available all schematics or other
technical drawings and/or design specifications that show the complete and/or partial layout of
your treatment/disposal system.
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer Service: 1-877-623-6748 One
NorthCarolina
Internet: www.ncwaterquality.org
An Equal Opportunity's Affirmative Action Employer — 50% Recycledr10% Post Consumer paper 1,1Y1llff

3. Documentation of Analytical Monitoring: Required in Part I(A) of the general NCG550000
permit, please have available all official records of analytical monitoring conducted to date.
4. Documentation of Septic Tank Inspections/Pumping: Required in Part I(A) of the general
NC6550000 permit, please have available all records of annual septic tank inspections and septic
tank pumping.
S. Chlorination/Dechlorination Tablets: Please have available the original containers in which
both the chlorination and dechlorination tablets were stored when you purchased them.
We appreciate your time and understanding of our mission to preserve the natural resources of our great
state and look forward to you contacting us to schedule this site visit. If you have questions or concerns about
this letter or the required review, please contact Ms. Sifford between the hours of 8AM and 5PM, Monday
through Friday at 704-663-1699. If she is not available when you call, please leave your name and a contact
phone number and she will return your call as soon as possible.
Sincerely,
r
Robert Krebs
Regional Supervisor
Surface Water Protection Section Supervisor
Mooresville Regional Office

� '
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor January 5, 2006 William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
Roger D. Dixon
1117 Prospect Church Road
Shelby, NC 28150
Subject: NPDES Permit NCG550065
Cleveland County
Dear Mr. Dixon <or> Current Occupant:
Our files indicate that a domestic wastewater discharge permit was issued to Roger D.
Dixon for a domestic wastewater discharge from the subject single family residence. The
Surface Water Protection Section requests that you contact our staff if you do not have a copy of
the current permit, if a change in property ownership has occurred, or should you have any
questions regarding system operations and monitoring requirements.
Pursuant to the conditions of North Carolina General Permit NCG550000, the following
documentation is required to be maintained, and readily available for inspection for a period of at
least three (3) years:
• All operation and maintenance activities relating to the wastewater treatment system
0 Analytical monitoring results for the parameters listed in Part I, Section A — "Effluent
Limitations and Monitoring Requirements — Final" to be performed annually by a North
Carolina Certified Laboratory
a Inspections of septic tank and disinfection/dechlorination apparatus (if applicable)
Thank you in advance for your cooperation. Should you have any questions concerning
this matter, please contact me at [phone].
Sincerely,
�ames B. Bealle III
Environmental Technician
enclosures
cc: Cleveland County Environmental Health Department
Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Phone: [phone] / Fax: [phone] / Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
None
rthCarohna
;Vahmallff

orth Garo4urra ent,
;nt of Env�rs urces a ement
a
id Natural Reental Man 9
of F-mWonm
NUnt, Jr., GoVernor
eS, Secretary .
� B• H°W Jr„ erector
)n H°Wara'
D. DQ CE ROGER)
� RESIDE CHURCH �
'ROSPECN C 28150.
BY
September 30,1993
,SAL cS��oGEt�f�
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gEsIDENG555
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Subject. Certificate ECG550000
PDenalwpermitNC0p339
O
l
Formerly
Cleveland County
is for potential
d all e sting ma vidual 0127 allows 'lie Division to
to d issue
tree; has recently evalua 15A N.C.A•C eneral permmits and
has
ear Fermi ement e Divisi°n• der g Th e
EnviroTimental Mar►ag ed by d' for coverage'm in t� n'yr1ierebY the
ion of emits currently 1 discharge activities more apPrOP ete�e Division shah void e
'he Divis des general p having of the discharg e Zherefor 550000 wlul` CaioliT'a and th
,overage under ermi control °f es for ch coverag t no. NCG of North uently
evaluate gr`°u Ps of
Division ��azge qualifi ,DES general Fermto i the Tequem 983 and as subseq
subject d der the state- a is issued pursu dated December 6,
coverage ed that thof Coverage un table to
deteermm ert�ca{e is Certificate of ove angd of Agreem unaccep eSt g
tare
suennit NC0033901 this general Perini letter raga
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if any parts, a the right to sub unit. Unless suaisferable. Past II, conditions, th the
Y ou have ual t tr ce as
you Y der an individ Coverage is no discharge the creation of nuis Division, such
coverage under Certificate of control of of any
take notice tY►is a of ownership or c factor'I includingmay be required by
an saris those facilities. this Division•
in case of change to etform including oral from
fail -perform. action, in or disp Construct fT t may
that the facilities corrective ater treatmeuor�ahOn to general permit
In the event ediate ant wastew Ce of respective g with
ttee shall take isnnal or reanCoverage and yea ement in actor eq
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cow water treatment facilities contained in this Cer On of En iron hat theg n -al permted. to a Division
waste emeTLts con note bmi per
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Failure to
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• 27626-0535 P 50 /
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Page 2.
ROGER. D. DIXON
DIXON, RESIDENCE (ROGER)
Certificate of Coverage No. NCG550065
The issuance of this Certificate of Coverage is an administrative action initiated by the Division of
Environmental Management and therefore, no fees are due at this time. In accordance with current rules, there
are no annual administrative and compliance monitoring fees for coverage under general permits. The only fee
you will, be responsible for is a renewal fee at the time of renewal. The current permit expires July 31,1997.
This coverage will remain valid through the duration of the attached general permit. The Division will be
responsible for the reissuance of the general permit and at such time, you will be notified of the procedures to
follow to continue coverage under the reissued permit. Unless you fail to follow the procedures for continued
coverage; you will continue to be permitted to discharge in accordance with the attached general permit.
The issuance of this Certificate of Coverage does not preclude the Permittee from complying with any and all
statutes, rules, regulations, or ordinances which may be required by the Division of Environmental Management
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 regarding this matter, please contact either the
Mooresville Regional Office, Water Quality Section at telephone number 704/ 663-1699, or a review engineer
in the NPDES Group in the Central Office at telephone number 919/733-5083.
S' erely,
A. Preston Howar , P.E.
cc: Mooresville Regional Office
Central Files

NOR TIACAROLIN NA L RESO)jon'_'�rr.
STA TE OF HE LTH, AND TU
P,GEMENT
MAN
N,t OF ENVIRONMF g NMEN IAL rs`
DEFAFU DVISION OF ENS p 1993
L PERMIT NO' NCo NCG550065XFLk59DF]���='a�Y�i�;�ia4
CERT e TE OF COVERAGE N
y RESIDENCES AND
FROM SINGLE FANUL
WATERS
TA TED DOMES wAWATERs UNDER TxE N�TI®N SYSTEM
TO DISCHARGE SIIviIL IkGE ELIMI
OLLUNTp'NT DISCHA l standards and
N ATION AL P General Statute Management143-2er ommission, and fl'e
of North Carolina G Environmental
with the provision the North Carolina En Act, as amended,
In compliance w adopted by ollution Control
regulations promulgate and Federal Water 1' SIDENCE (ROGER)
-DIXON RE a facility located at
tea Od domestic wastewater from
authorized to discharge GER)
is hereby
RESIDENCE (R
DIXON County Cleveland CouRIVER BASIN Farts
HICK CREEK/ CA eA 13A set forth in
c and other conditions
designated as the quirements, attached -
waters monitoring re CG550000 as
to receiving limitations, t No. N
ith the effluent of General Fermi November 1,1993.
in accordance ��' become effective
certificate of coverage shall e General Permit.
This certif in effect for the duration of
e shall remain
Certificate of Coverag 1993.
This Certif' day, September 30,
Signed this
war
E''DjreCtor
ent Comnussion
A. Preston of
Eri onmental Management
Division e Environmental Managem
By Authority of th

AA yy�
N AAA t� \AI,
State of North Carolina'{ 1 1 1991
Department of Environment, Health, and Natural Resources: r
Division of Environmental ManagementrQ{+P,�Ft�F
512 North Salisbury Street • Raleigh, North Carolina 276-
James G. Martin, Governor
William W. Cobey, Jr., Secretary
Mr. Roger D. Dixon
1117 Prospect Church Road
Shelby, NC 28150
Dear Mr. Dixon:
George T. Everett, Ph.D.
Director
February 8, 1991.
Subject: Permit No. NCO033901
Roger 'Dixon Residence
Cleveland County
In accordance with your application for discharge permit received on
September 21, 1990, we are forwarding herewith the subject State - NPDES permit.
This permit is issued pursuant to the requirements of Nor.tli Carolina General Statute
143-215.1 and the Memorandum of Agreement between North Carolina and the US
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 an adjudicatory hearing
upon written request within thirty (30) days following receipt of this letter. This
request must be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings,
Post Office Drawer 27447, Raleigh, North Carolina 2761.1-7447. Unless such demand is
made, this decision shall be final and binding.
Please take notice that this permit is not transferable. Part II, B.2.
addresses the requirements to be followed in case of change in ownership or control of
this discharge.
This permit does not affect the legal requirements to obtain other permits
which may be required by the Division of Env.ronment:al. Management or permits required
by the Division of Land Resources, Coastal Area Plnnagemenl: Act- or any other Federal or
Local governmental permit that may be requi.i-nd.
If you have any questions concerning this permit, please contact Mr. Mack
Wiggins at telephone number 919/733-5083.
Sincerely,
Original. signed by
Hale Overcasba 1`ar
George T. Everett:
cc: Mr. Jim Patrick, EPA
Mporesv"-le Regional O `4ice
Pollution Prevention Pays
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
w_ —.-, A,+4— Fmnlnvr r

Permit No. NCO033901
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURG'ES
DIVISION OF ENVIRONMENTAL MANAGEMENT
PERMIT FE3 1 1 199'i
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM'
' Po OFFICE
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,
Mr. Roger D. Dixon
is hereby authorized to discharge wastewater from a facility located at
Roger D. Dixon Residence
on NCSR 1908
northeast of Shelby
Cleveland County
to receiving waters designated as an unnamed tributary to Hickory Creek in the Catawba River Basin
in accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts I, H, and III hereof.
This permit shall become effective April 1, 1991
This permit and the authorization to discharge shall expire at midnight on December 31, 1993
Signed this day February 8, 1991
0,:'4(p Overcash:for
George T. Everett, Director
Division of Environmental Management
By Authority of the Environmental Management Commission

Permit No. NC0033901
SUPPLEMENT TO PERMIT COVER SHEET
Mr. Roger D. Dixon
is hereby authorized to:
1. Continue to operate an existing wastewater treatment system consisting of a septic tank,
subsurface sand filter trench, and sanuril chlorinator located at Roger D. Dixon Residence, on
NCSR 1908, northeast of Shelby, Cleveland County (See Part III of this Permit), and
2. Discharge from said treatment works at the location specified on the attached map into an
unnamed tributary to Hickory Creek which is classified Class C waters in the Catawba River
Basin.

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A..( ). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS FINAL Permit No. NCO033901
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is authorized to discharge from
outfall(s) serial number 001. Such discharges shall be limited and monitored by the permittee as specified below:
Effluent Characteristics
Flow .
BOD, 5 day, 200C
Total Suspended Residue
NH3 asN
Fecal Coliform (geometric mean)
Total Residual Chlorine
Temperature
Discharge .Limitations
Units (specify)
Monthly Avg,, Weekly Avg.
3 0 0 CPD
30.0 mg/I 45.0 mg/I
30.0 mg/I 45.0 mg/I
200.0 /100 ml 400.0 /100 ml
r
Monitoring Requirements
Measurement Sample *Sample
Frequency is" Location
The chlorinator shall be inspected weekly to ensure there is an ample supply of chlorine tablets for continuous disinfection of the effluent.
The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

PART 1
"Act" used herein means the Federal Water Pollution Control Act, As
Amended.
11DEM" used herein means the Division of Environmental Management of
the Department of Natural Resources and Community Development.
"EMC" used herein means the North Carolina Environmental Management
Commission.
Definitions
a. The monthly average, other than for fecal coliform bacteria, is
the arithmetic mean of all the composite samples collected in a
one -month period. The monthly average for fecal coliform bacteria
is the geometric mean of samples collected in a one -month period.
b. The weekly average, other than for fecal coliform bacteria, is the
arithmetic mean of all the composite samples collected during a
one -week period. The weekly average for fecal coliform bacteria
is the geometric mean of samples collected in a one -week period.
c. Flow, M3/day (MGD): The flow limit expressed in this permit is the
24-hour average flow, averaged monthly. It is determined as the
arithmetic mean of the total daily flows recorded during the calendar
month.
d. Arithmetic Mean: The arithmetic mean of any set of values is the
summation of the individual values divided by the number of indi-
vidual values.
e. Geometric Mean: The geometric mean of any set of values is the Nth
root of the product of the individual values where N is equal to the
number of individual values. The geometric mean is equivalent to
the antilog of the arithmetic mean of the logarithms of the indi-
vidual values. For purposes of calculating the geometric mean,
values of zero (0) shall be considered to be one (1).

PAPT 11
A. MANAGEMENT REQUIREMENTS
1. Change in Discharge
All discharges authorized herein shall be consistent with the terms
and conditions of this permit. The discharge of any pollutant
identified in this permit more frequently than or at a level in
excess of that authorized shall constitute a violation of the
permit. Any anticipated facility expansions, production increases,
or process modifications which will result in new, different, or
increased discharges of pollutants must be reported by submission
of a new NPDES application or, if such changes will not violate the
effluent limitations specified in this permit, by notice to the DEM
of such changes. Following such notice, the permit may be modified
to specify and limit any pollutants not previously limited.
2. Facilities Operation
The permittee shall at all times maintain in good working order and
operate as efficiently as possible all treatment or control facili-
ties or systems installed or used by the permittee to achieve coc-
pliance with the terms and conditions of this permit.
3. Adverse Impact
The permittee shall take all reasonable steps to minimize any adverse
impact to navigable waters resulting from noncompliance with any
effluent limitations specified in this permit, including such accel-
erated or additional monitoring as necessary to determine the nature
and impact of the noncomplying discharge.
4. Bypassing
Any diversion from or bypass of facilities necessary to maintain com-
pliance with the terms and conditions of this permit is prohibited,
except (i) where unavoidable to prevent loss of life or severe
property damage, or (ii) where excessive storm drainage or runoff
would damage any facilities necessary for compliance with the
effluent limitations and prohibitions of this permit. The permittee
shall promptly notify the Water Quality Section of DEM in writing of
each such diversion or bypass.
5. Removed Substances
Solids, sludges, filter backwash, or other pollutants removed in the
course of treatment or control of wastewaters shall be disposed of in
a manner such as to prevent any pollutant from such material from
entering waters of the State or navigable waters of the United
States.

PART II
6. Power Failures
In order to maintain compliance with the effluent limitations and
prohibitions of this permit, the permittee shall either:
a. Provide an alternative power source sufficient to operate
the wastewater control facilities;
or, if such alternative power source is not in existence,
b. Halt, reduce, or otherwise control production and/or all dis-
charges from wastewater control facilities upon the reduction,
loss, or failure of the primary source of power to said waste-
water control facilities.
B. RESPONSIBILITIES
1. Right of Entry
The permittee shall allow the Director of the Division of Environ-
mental Management, the Regional Administrator, and/or their author-
ized representatives, upon the presentations of credentials:
a. To enter upon the permittee's premises where an effluent
source is located or in which any records are required to
be kept under the terms and conditions'of this permit; and
b. At reasonable times to have access to and copy any record
required t•o be kept under the terms and conditions of this
permit; to inspect any monitoring equipment or monitoring
method required in this permit; and to sample any discharge
of pollutants.
2. Transfer of Ownership or Control
This permit is not transferable. In the event of any change in con-
trol or ownership of facilities from which the authorized discharge
emanates or is contemplated, the permittee shall notify the prospt•c.-
tive owner or controller by letter of the existence of this permit
and of the need to obtain a permit in the name of the prospective
owner. A copy of the letter shall be forwarded to the Division of
Environmental Management.
3. Permit Modification
After notice and opportunity for a hearing pursuant to NCGS 143-215.1
(b)(2) and NCGS 143-215:1(e) respectively, this permit may be modi-
fied, suspended, or revoked in whole or in part during its term for
cause including, but not limited to, the following:

i
PART II
a. Violation of any terms or conditions of this permit;
b. Obtaining this permit by misrepresentation or failure to
disclose fully all relevant facts; or
C. A change in any condition that requires either a temporary
or permanent reduction or elimination of the authorized
discharge.
4. Civil and Criminal Liability
Except as provided in permit conditions on "Bypassing" (Part II.
A-4) and "Power Failures (Part II, A-6), nothing in this permit
shall be construed to relieve the permittee from civil or criminal
penalties for noncompliance pursuant to NCGS 143-215.6 or Section
309 of the Federal Act, 33 USC 1319.
5. Property Rights
The issuance of this permit does not convey any property rights in
either real or personal property, or any exclusive privileges, nor
does it authorize any injury to private property or any invasion of
personal rights, nor any infringement of Federal, State, or local
laws or regulations.
6. Severability
The provisions of this permit are severable, and if any provision Of
this permit, or the application of any provision of this permit to
any circumstance, is held invalid, the application of such provision
to other circumstances, and the remainder of this permit shall not
be affected thereby.
7. Expiration of Permit
Permittee is not authorized to discharge after the expiration date.
In order to receive authorization to discharge beyond the expiration
date, the permittee shall submit such information, forms, and fees
as are required by the agency authorized to issue permits no later
than 180 days prior to the expiration date. Any discharge without
a permit after the expiration will subject the permittee to enforce-
ment procedures as provided in NCGS 143-215.6 and 33 USC 1251 et seq..

PART III
A. PREVIOUS PERMITS
A11 previous State water quality permits issued to this facility,
whether for construction or operation, or discharge, are hereby
revoked by issuance of this permit. The conditions, requirements,
terms, and provisions of this permit authorizing discharge under tklu
National Pollutant Discharge Elimination System govern discharges
from this facility.
B . CONSTRUCTION
No construction of wastewater treatment facilities or additions thereto
shall be begun until Final Plans and Specifications have been submitted
to the Division of Environmental Management and written approval and
Authorization to Construct have been issued. If no objections to Final
Plans and Specifications have been made by the DEM after 30 days follow-
ing receipt of the plans or issuance of this permit, whichever is latter,
the plans may be considered approved and construction authorized.
C. SPECIAL CONDITIONS
1. The Permittee shall be responsible for the following items regard-
ing the maintenance of the treatment system:
a. Septic tanks shall be maintained at all times to prevent
seepage of sewage or effluents to the surface of the ground.
b. Septic tanks need routine maintenance and should be checked
at least yearly to determine if solids need to be removed
or other maintenance performed.
C. Contents removed from septic tanks shall be discharged into
an approved sewer system, buried or plowed under at an
approved location within 24 hours, or otherwise disposed of
at a location and in a manner approved by the State or local
agency.
2. The permittee shall properly connect to are operational publicly -
owned wastewater collection system within 180 days of its availability
to the site.

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
11 /26/01
ROGER D DIXON
DIXON ROGER- RESIDENCE
1117 PROSPECT CHURCH RD
SHELBY, NC 28150
1••
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: NPDES Wastewater Permit Coverage Renewal
Dixon Roger- Residence
COC Number NCG550065
Cleveland County
Dear Permittee:
Your residence or facility is currently covered for wastewater discharge under General Permit NCG550000. This
permit expires on July 31, 2002. Division of Water Quality (DWQ) staff is in the process of rewriting this permit
with a scheduled reissue in the summer of 2002. Once the permit is reissued, your residence or facility would be
eligible for continued coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the DWQ for renewal of
your permit coverage. To make this renewal process easier, we are informing you in advance that your permit will
be expiring. Enclosed you will find a general permit coverage renewal application form. This will serve as
your application for renewal of your permit coverage. The application must be completed and returned with the
required information by February 01, 2002 in order to assure continued coverage under the general permit. There is
no renewal fee associated with this process.
Failure to request renewal within this time period may result in a civil assessment of at least $250.00. Larger
penalties may be assessed depending on the delinquency of the request. Discharge of wastewater from your
residence or facility without coverage under a valid wastewater NPDES permit would constitute a violation of
NCGS 143-215.1 and could result in assessments of civil penalties of up to $10,000 per day.
If the subject wastewater discharge to waters of the state has been terminated, please complete the enclosed
rescission request form. Mailing instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed.
If,yo6 have any questions regarding the permit coverage renewal procedures please contact the Mooresville
Regional Office at 704-663-1699 or Mack Wiggins of the Central Office Stormwater Unit at [phone], ext.
542
Sincerely,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater and General Permits Unit Files
Mooresville Regional Office
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

RECFIVED
V n dater Quality Section
0 CT 2 -1990
State of North Carolina
Department of Environment, Health, and Natural Resourj�%ille Regional, OfficB
Division of Environmental Management �h�vilie, North Carolina
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor George T. Everett, Ph.D.
William W. Cobey, Jr., Secretary Director
9/28/90
Mr. Roger D.
1117 Prospect Dixonix Rd. Subject: NPDES Permit Application
Shelby, NC 28150 NPDES Permit No.NC0033901
Roger D. Dixon Residence
Dear Mr. Dixon Cleveland County
This is to acknowledge receipt of the following documents on September 28, 1990:
Application Form
Engineering Proposal (for proposed control facilities),
Request for permit renewal,
Application Processing Fee of $60.00,
Other
The items checked below are needed before review can begin:
Application Form ,
Engineering proposal (see attachment),
Application Processing Fee of ,
Delegation of Authority (see attached)
Biocide Sheet (see attached)
Other Need a copy of your deed showing ownership —
If the application is not made complete within thirty (30) days, it will be
returned to you and may be resubmitted when complete.
This application has been assigned to Mack Wiggins
(919/733-5083) of our Permits Unit for review. You will e advised ot 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 applications,
please contact the review person listed above.
Sincerely,
M�'
-, M. Dale Overca P.
CC: hevi - e_Regiona-l-0-f-f-ice
PoHudon Prevention Pays
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

NORTH CAROL I NA DEPT . OF NATURAL RESOURCES AND COP 01"T r
DMOPNT
ENVIRONMENTAL MANAGEMENT COWISSION
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM G
Ar►l.tr�Tlol aaaiLsLa
•
FOR
WA 3 O
At�ElaCr
P
To be filed o0 y by services, wholesale and retail trade,
USE DATE 1E(LIVLp
and other commercial establishments including weasels
0 1��Aj I i
TEAR 00. DAY
•
�h�, 1 flog
Eta not attempt to complete this form without reading the ace~yssg IRstmetloes (ao � 0 D
Please print or type
t7
one nsrmber of facility Producing discharge
1. NW, address, and toler0a
A. Name e-r
S. Street address , ,
C. City e140 1/
o. s imam
E. County
F. Zq f/_5 /I
G. Telephone No. 7A 44
Area
Code
l �4��=���•z�y�
2. S1C
SE
(Leave blank)
21 1990
�/
"'WITS
3. Nun+ber of erployees Lo
rf,7n r-
,lllrFRll�f;
A. Nature of business
r e
5. (a) Check here if discharge occurs all yoar�r
(b) Check the months) discharge occurs:
1.0January 2.0Fab rum ry. 3.0111arch 4.0AOrti
f.OMay
6.0June 7.OJuly 8.aAugust 9.0sahtalssber 10.aOctober
11. O hovembe r 12. 0 Cleeamber
(c) how Iy ny days per Meek: �
1 .O 1 2.0 2-3 3.0 4.5 4.k6.7
6. Types of waste water discharged to surface waters only (check as 80911eable)
flow, gallons per wratlssg day
Volume treated before
Discharge per _
discharging (Percent)
"crating day O.l.dgg 1000•dl9g i000•S'!!g IO,Opp. i0,000 Ileft 0.1• 310-65
4g,"q K more lg.g N.g f4.9 lOt
(T) (2) (3) (t) W
A. Sanitary. daily.'
average f
1. COOl1nq water, etc.,
/afly average
C. Other diseharpe;s), ,
daily average;
Specify
�. 71a><tlmtrr De• ooe•at.
Ing day for co�+:tnac
-discharge (ell typesl

N'
te
ied
n It" Go 01talar tr
7. if any of types of to placesteftker ithW surfac* ustsrs- Oleo bat«
fretted, •rt � disCMr1�
as applicable.
Waste rater is discharged to: 0:1-9"
(1)
A. HUnlcipr) tc'W*r systen
it. Isite 4•1gr1rlid W.II
C. Septic tank
)..Evaporation lagoon or pond
E. other, specify:
--------------
1000-61l� sm-tv"
a. 11uppober of separate dischargm points:
A. O 1 S. 02-3 C.O 4-5 0.0 6 or ere
9. Mine of receiving rater or waters
10.00049.1" 1 S0.0W or more
10..0oes yo4jr.dhscnar9# contain or is it possible, for your discharge to Contain
one or more of the following substances 4 �I i, beryllium. 98fmiumeult of your �s•
activities, or processes: eeleonia. Cyan a 1st •11 tad
chromium. coMor, laid. wrcu*ry�. Picket, ssleeiim. i111C. 10M
grease, and chlorine (residual)•
A.ayes 5.0no
1 certify that 1 aw fwith the lnfornatioh Contained In the opllC41tien "d
that to the best of mry knowledge and belief such infortamtion is trot edo1ste$ e"
accurate.
►rinte Mahe of person Signing
Title
2..ZL_94L
ate Application Sigurd
i;Z_vr% 01cWt .
(4) 1 _ (s)
Any Person who ias<owin(tl:' >t
%orth Carolina Geairal Statute 143-215.6Cb) 2 roQidea that: lieat�ose,secord, report,
any false statemtnt represantat on, or cart eat on 1a re7 �P
or other document filas •or required to be saintalA at Article. or who falsifleat taa�erst
En-Aronatatal *IanaSeteeaht Calanisston 4s 160424" ®r esthod required to be
cr knoviy renders inaccurate any sacerd-ofrial et Matt ri>4O i
aerated or .mainl:ained under 11Ftials.22roc rssulations of the �� ale lb;,&:44na,sdoo,to t
::''_e=eating that Article, "a'U •bs �juUt•"�f `a �isdss�a>sor ��(1S C.S.C. Section 1001
-or .by 1Mris0nm*at not to axcasd six lsontha, or by t sot .more than S :years. or
pur.:shmen: by a fine of'aot uora 'that-110tW0 Vr ie ImPr0l�
f,.* a siniiar c`_fRnse.) . . .

a STATED
State of North Carolina
tment of Environment, Health, and Natural Resources
Division of Environmental Management
2 North Salisbury Street ® Raleigh, North Carolina 27611
James G. Martin, Governor
William W. Cobey, Jr., Secretary
September 19, 1990.
ROGER D. DIXON
DIXON RESIDENCE (ROGER)
1117 PROSPECT CHURCH RD
SHELBY, NC 28150
George T. Everett, Ph.D.
Director
Subject: NPDES PERMI'.T' NO. NG0033901
CLEVELAND COUNTY
Dear Permittee:
The subject permit issued on 7/21/86 expires on 6/30/91. North Carolina
General Statute (NCGS) 143-215.1(c) requires that an application for permit renewal
be filed at least 180 days prior to the expiration date. As of the date of this
letter, the Division of Environmental Management had not received an application for
renewal.
If operation of a discharge or waste treatment facility is to occur after the
permit's expiration date, or if continuation of the permit is desired, it must not be
allowed to expire. A renewal request must be submitted no later than 180 days prior_
to the permit's expiration date. Operation of the. waste treatment works or
continuation of a. discharge after the expiration date would constitute a violation of
NCGS 143-215.1 and could result in assessment of civil penalties of up to $10,000 per
day. If continuation of the permit is desired, failure to request renewal at least
180 days prior to expiration will result in a.civil assessment of at least $300.00;
larger penalties may be assessed depending upon the delinquency of the request.
A renewal application shall consist of a letter requesting permit renewal along
with the appropriate completed and signed application form (copy attached), submitted
in triplicate, referenced in Title 15 of. the North Ca.rol..i-na. Administrative Code (15
NCAC) Subchapter 2H .0105(a). Primary industries listed in Appendix A of Title 40 of
the Code of Federal Regulations, Part 122 shall also submit a priority pollutant
analysis in accordance with Part 122.21. A processing fee must be submitted with the
application. In addition to penalties referenced above, a permit renewal request
received after the expiration date will be considered as a .new application and will
require the higher application fee.
Water Quality Section
SEP 19 1990
Asheville Regional Office
Poffudon Prevendon Pays Asheville, North Carolina
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Fm in] C)nnnr+i mifv ARirmativP Artinn Fmnlnver

Attached is a copy of the fee schedule from 1.5 NCAC 2B.0105(b). The application
processing fee is based on the design or permitted flow, whichever is appropriate,
listed in the first five categories of facilities. Presently, no facility is allowed
to submit a fee for the general permits listed in the schedule since the Environmental
Protection Agency has not approved the State of North Carolina's general permit. If
the facility covered by this permit contains some type of treatment works, a narrative
description of the sludge management plan must be submitted with the application for
renewal.
The Environmental Management Commission adopted rules on August 1, 1.988,
requiring the payment of an annual fee for most permitted facilities (see attached 15
NCAC 2H .0105(b) regulations). You will be billed separately :for that fee (if
applicable), after your permit is approved.
The letter requesting renewal, the completed Permit application, and appropriate
fee should be sent to:
Permits and Engineering Unit
Division of Environmental Management
Post Office Box 27687
Raleigh, North Carolina 2761.1-7687
The check should be made payable to the North Carolina Department of Environment,
Health, and Natural Resources which may be abbreviated as DEHNR.
If there are questions or a need for additional information regarding the permit
renewal procedure, please contact me at telephone number [phone].
Sincerely,
originA-1 signed REY
M. i. e Over�cr,Sh
M. Dale Overcash, P.E.
Supervisor, NPDES Permits Group
cc: Asheville Regional Office
Permits and Engineering Unit
Central Files

��::
NCDENR
North Carolina Department of Environment and Natu
Division of Water Quality
Michael F. Easley, Governor
January 9, 2007
Roger Dixon
1117 New Prospect Church Rd
Shelby, NC 28150
0 W E
liam G. Ross, Jr.,
in W)./Klimek,;P.E
Subject: Renewal Notice / General Permit NCG550000
Certificate of Coverage NCG550065
Cleveland 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 August 1, 2002.
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.
9 If you are not sure what type of system your property has, contact James Bealle in the
NC DENR Mooresville 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 reauest does not ueitain to the Annual Fee of 950.00 billed
seuarately by the Division's BudLyet Office. No monev is reauired 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
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone], extension 511 / FAX [phone]/[e-mail]
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper
NorthCarolina
;Vatmrally

NCG550065 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,
Il
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Files
NPDES file

DAMES B. HUNT J
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
MOORESVILLE REGIONAL OFFICE
DIVISION OF WATER QUALITY
June 3,1999
Roger D. Dixon
1117 Prospect Church Road
Shelby, North Carolina 28150
Subject: Wastewater Discharge Permit
Roger Dixon Residence
NPDES Permit No. NCG550000
Cert. of Coverage No. NCG550065
Cleveland County, NC
Dear Mr. Dixon:
Our files indicate that the subject wastewater discharge permit was issued to Roger
Dixon for a wastewater discharge from the subject residence. The Mooresville Regional
Office requests that you contact this Office if you do not have a copy of the subject permit,
if a change in property ownership has occurred, or if you have any questions regarding this
matter.
Pursuant to conditions of North Carolina General Permit Number NCG550000,
the following documentation must be kept and readily available for inspection for a period
of at least three years:
0.
required maintenance activities relating to the wastewater treatment system
yearly sample analyses results for the parameters listed on the effluent
limitation/monitoring page of the permit
required inspections of disinfection apparatus and septic tanks
Please do not hesitate to contact Linda Love at [phone] if you have any
questions.
Sincerely,
D. Rex Gleason, P.E.
v Water Quality Regional Supervisor
cc: Cleveland County Health Department
LL 919 NORTH MAIN STREET, MOORESVILLE, NORTH CAROLINA 281 15
PHONE [phone] FAX [phone]
AN EQUAL OPPORTUNITY /AFFIRMATIVE ACTION EMPLOYER -SO RECYCLED/1 Oq POST -CONSUMER PAPER

TO: PERMITS AND ENG ERING UNIT
WATER QUALITY SECTION
DATE: October 12, 1990
NPDES STAFF REPORT AND RECOMMENDATION
COUNTY Cleveland
PERMIT NUMBER N00033901
PART I - GENERAL INFORMATION
1. Facility and Address: Roger Dixon Residence
1117 New Prospect Rd.
Shelby, North Carolina 28150
2. Date of Investigation: August 30, 1989
3. Report Prepared By: Kerry S. Becker
4. Persons Contacted and Telephone Number: Roger Dixon
704-482-5825
5. Directions to Site: Highway .180 north of Shelby to NCSR
1908 (New Prospect Rd.) on left. Turn left on NCSR 1908 and
travel 0.25 miles to Dixon Residence on thr right.
6. Discharge Point(s), List for all discharge points:
Latitude: 35 deg. 19 min. 45 sec.
Longitude: 81 deg. 30 min. 25 sec.
Attach a USGS map extract and indicate treatment facility site and
discharge point on map.
U.S.G.S. Quad No. F12SE U.S.G.S. Quad Name Shelby, NC
7. Size (land available for expansion and upgrading): 1/2 acre
8. Topography (relationship to flood plain included): Flat
9. Location of nearest dwelling: >100 ft.

T
10. Receiving stream or affected surface waters: UT to Hickory
Creek
a. Classification: C
b. River Basin and Subbasin No.: CTB 04
C. Describe receiving stream features and pertinent downstream
uses: Feeder stream supporting insect and wildlife
populations.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. Type of wastewater: 100 % Domestic
Industrial
a. Volume of Wastewater: .00030 MGD (Design Capacity)
b. Types and quantities of industrial wastewater:
C. Prevalent toxic constituents in wastewater:
d. Pretreatment Program (POTWs only):
in development approved
should be required not needed
2. Production rates (industrial discharges only) in pounds per day:
a. Highest month in the past 12 months: lbs/day
b. Highest year in the past 5 years: lbs/day
3. Description of industrial process (for industries only) and
applicable CFR Part and Subpart:
4. Type of treatment (specify whether proposed or existing): The
existing facility consists of a septic tank followed by a
subsurface sand filter trench and sannuril chlorination.
5. Sludge handling and disposal scheme: Licensed commercial septic
tank cleaning firm.
6. Treatment plant classification: Less than.5 points; no rating
(include rating sheet, if appropriate). N/A
7. SIC Codes(s): 4952
Wastewater Code(s): Primary 04 Secondary

PART 'III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant funds
(municipals only)?
2. Special monitoring requests:
3. Additional effluent limits requests:
4. Other:
PART IV - EVALUATION AND RECOMMENDATIONS
The Asheville Regional Office recommends renewal of NPDES Permit
#NCO033901.
A,-, 4&�,
Signature 4f Report Preparer
Regional Supervisor

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SOC Priority Project: Yes No X
If Yes, SOC No.:
To: Permits and Engineering Unit
Water Quality Section
Attention: Mack Wiggins
Dater June 3, 1993
NPDES STAFF REPORT AND RECOMMENDATION
County: Cleveland
Permit No. NC0033901
PART I - GENERAL INFORMATION
1. Facility and Address: Dixon Single Family Residence
Roger D. Dixon
1117 Prospect Church Road
Shelby, North Carolina 28150
2. Date of Investigation: June 3, 1993
3. Report Prepared by: Kim H. Colson, Environmental Engineer I
4. Persons Contacted and Telephone Number: Roger Dixon, Owner,
[phone].
5. Directions to Site: From the intersection of NC Hwy 180
(North Post Road) and SR 1908 (New Prospect Church Road),
travel west on SR 1908 approximately 0.4 mile. The Dixon
Residence is located on the right (north) side of SR 1908.
6. Discharge Point(s), List for all discharge points:
Latitude: 35' 19' 44" Longitude: 81' 30' 19"
Attach a USGS map extract and indicate treatment facility site
and discharge point on map.
U.S.G.S. Quad No.: F12SE U.S.G.S. Quad Name: Shelby, NC
7. Site size and expansion area consistent with application?
Yes.
8. Topography (relationship to flood plain included): Flat to
moderate slopes; the WWT facilities are not located within the
100 year flood plain.
9. Location of nearest dwelling: Several dwellings are located
approximately 300 feet from the WWT facilities.
10. Receiving stream or affected surface waters: Hickory Creek
a. Classification: C
b. River Basin and Subbasin No.: Broad 030804

Page Two
c. Describe receiving stream features and pertinent
downstream uses: Stream is a small creek that is fed by
several springs in the area. Probably has 30Q2 stream
flow greater than 0.0 cfs. General "C" classification
uses downstream.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of wastewater to be permitted: 0.0003 MGE
(ultimate design capacity)
b. Current permitted capacity of the wastewater treatment
facility: 0.0003 MGD
C. Actual treatment capacity of the' current facility
(current design capacity): 0.0003 MGD
d. Date(s) and construction activities allowed by previous
Authorizations to Construct issued in the previous two
years: N/A
e. Please provide a description of existing or substantially
constructed wastewater treatment facilities: Existing
WWT facilities consist of a septic tank, subsurface sand
filter, and a tablet type chlorinator.
f. Please provide a description of proposed wastewater
treatment facilities: N/A
g. Possible toxic impacts to surface waters: N/A
h. Pretreatment Program (POTWs only): N/A
2. Residuals handling and utilization/disposal scheme:
a. If residuals are being land applied, please specify DEM
Permit No.: N/A
Residuals Contractor: N/A
Telephone No.: N/A
b. Residuals stabilization: PSRP PFRP Other
C. Landfill: N/A
d. Other disposal/utilization scheme (Specify): Septage is
pumped by Wesson Septic Tank Service.
3. Treatment plant classification (attach completed rating
sheet): No rating - single family residence.
4. SIC Code(s): 9999
Wastewater Code(s)
Primary: 04 Secondary:
Main Treatment Unit Code: 44007

Page Three
PART III — OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant
Funds or are any public monies involved (municipals only)?
N/A
2. Special monitoring or limitations (including toxicity)
requests: N/A
3. Important SOC, JOC or Compliance Schedule dates (Please
indicate): N/A
4. Alternative Analysis Evaluation:
Spray Irrigation: Insufficient area.
Connection to Regional Sewer System: Sewer not available in
area.
Subsurface: High groundwater prevents subsurface disposal.
Other disposal options: N/A
5. Air quality and/or groundwater. concerns or hazardous materials
utilized at this facility that may impact water quality, air
quality, or groundwater: There are no known air quality,
groundwater, or hazardous materials concerns.
6. Other Special Items: N/A
PART IV — EVALUATION AND RECOMMENDATIONS
The permittee, Roger Dixon, has applied for permit renewal.
The subject permit covers the discharge from the Dixon's single
family residence.
It is not recommended that the permit be covered under the
General Permit for single family residences since the facility
could not consistently meet the General Permit's effluent limits.
It is recommended that the permit be renewed as requested.
.7;�;—//— GV
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Signature of report preparer
Water Quality R tonal Supervisor
/-ill .f
Date

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State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howar�., P.E., Director
Rev S°..,ce��
V0
m
Sg93
also
Mr. Roger D. Dixon
1117 Prospect Ch. Rd.
Shelby, ::C 28150
Dear Mr. Dixon :
May 19, 1993
Subject: NPDES Permit Application
NPDES Permit No.NC0033901
Dixon Residence
Cleveland
County
This is to acknowledge receipt of the following documents on April 19, 1993:
� Application Form
Engineering Proposal (for proposed control facilities),
Request for permit renewal,
Application Processing Fee of $240.00,
Engineering Economics Alternatives Analysis,
Local Government Signoff,
Source Reduction and Recycling,
Interbasin Transfer,
Other Topographic map showing discharge point.,
a
The items checked below are needed before review can begin:
Application Form ,
Engineering proposal (see attachment),
Application Processing Fee of
Delegation of Authority (see attached)
Biocide Sheet (see attached)
Engineering Economics Alternatives Analysis,
Local Government Signoff,
Source Reduction and Recycling,
Interbasin Transfer,
Other
P.O. Box 29535, Raleigh, North Carolina 27626-0535
An Equal Opportunity Affirmative Action Employer
MAY 2 4 1993
IIL-.
L Vi1�1�L \ IJ Ui'l! I TY S E G-i10 1�
_ F?vs iEV1�LC ;�iGli►�6',f. C4_ �FfC�-:,, _IIII!
Telephone [phone] FAX [phone]
50% recycled/ 10% post -consumer paper

application is not made complete within thirty (30) days, it will be
ied to you and may be resubmitted when complete.
application has been assigned
N-- -, !33-5083) of our Permits Unit
comments recommendations, questions
review of the application.
to Mack Wiggins
for review, You will e advised of -any
or other information necessary for the
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 applications,
please contact the review person listed above.
Sincerely,
. Su11 P.E.
CC• Asheville Regional Office Co een H

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
ENVIRONMENTAL MANAGEMENT COMMISSION
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM D-SFR FOR AGENCY USE
DATE RECEIVED
YEAR MONTH DAY
TO BE FILED BY SINGLE FAMILY RESIDENCES ONLY
�a�o.oa
FEES: NEW APPLICATION ....... $240 PERMIT MODIFICATION ....... $240
PERMIT RENEWAL ........ $ 24 0 PERMIT NAME CHANGE......... $ 5 0
1. Mailing address of applicant:
A. Name
B. Street Address
C. City
D. County
E ZIP Code _,z
F. Telephone No. (Home) 71) (Work) Ye)_3 �/•� 7—`f 3-3'
AREA AREA
CODE CODE
2. Location of residence producing discharge:
A. Street Address and State Road # /// % foY05!mac
A(1) f'areei/Lot,#__� d- - Deed Book #/Page#°{-
B. City '/1 e- /�v /tl C, - l ll�� `J 00
Co
C. County
D. ZIP Code f 5 D
3.
This NPDES Permit application applies to which of the following (check appropriate space):
A. New or Proposed
B. Existing Unpermitted
C. Existing Renewal
D. Modification
E Renewal w/ Modification
Description of Modification
4. Number of bedrooms at residence: Number of Homes on System:
S. Type of system being used to treat wastewater check appropriate space):
A. Septic Tank and Sand Filter
B. Septic -Tank, -Dual or Recirculating Sandfilters, Cascade Reaeration
C.' "Conventional Septic Tank _
D.' Other (describe treatment) '
6. Does your treatment system have chlorination? Yes No
(continued on back)
Short Form D-SFR
Revised 3/93

7. Name of receiving water or waters which will accept the
rge
8.. Is any activity being performed at the residence which would generate w, astt other than domestic wastes,
such as photographic processing? Yes No
If yes, please explain:
I certify that I am familiar with the information contained in the
application and that to the Kest of my knowledge and belief such .
information is true, complete and accurate.
Printed Name of Person Signing
Title (homeowner, etc.)
�_7;2—i
Date Application Signed
Signature Q Applicant
Mail three copies of the completed application, a map or drawing showing the location of
discharge, along with the appropriate processing fee to:
DIVISION OF ENVIRONMENTAL MANAGEMENT
WATER QUALITY SECTION - PERMITS & ENGINEERING UNIT
ATTENTION: NPDES GROUP
POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
North Carolina General Statute 143-215 6(B) provides that: Any person who knowingly mi
any false statement, representation, or certification In any application, record, report,
or other document filed .or required to be maintained under Article 21 or regulations of
Environmental Management Commission Implementing that Article, or who falsifies, tare
with, or knowingly renders Inaccurate any recording or monitoring device or method rec
to be operated or maintained under Article 21 or regulations of the Environmental Manage
Commission implementing that Article, shall be guilty of q misdemeanor punishable by a
not to exceed $10,000, or by imprisonment not to exceed six months, or by both, (18 U.:
Section 1001 provides a punishment by a fine of not more than $10,000 or Imprisonment
more than 5 years, or both, for a similar offense).
Short Form D-SFR
Revised 3/93

' I& l
kPUBLIC NOTICE
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
POST OFFICE BOX 27687
RALEIGH, NORTH CAROLINA 27611-7687
NOTIFICATION OF INTENT TO ISSUE A STATE NPDES PERMIT
On the basis of thorough staff review and application of Article 21 of Chapter 143, General Statutes of
North Carolina, Public Law 92-500 and other lawful standards and regulations, the North Carolina
Environmental Management Commission proposes to issue a permit to discharge to the persons listed
below effective 12/16/90 and subject to special conditions.
Persons wishing to comment upon or object to the proposed determinations are invited to submit same in
writing to the above address no later than 1211190 . All comments received prior to that date will be
considered in the formulation of final determinations regarding the proposed permit. A public meeting may
be held where the Director of the Division of Environmental Management finds a significant degree of
public interest in a proposed permit.
A copy of the draft permit is available by. writing or calling the Division of Environmental Management,
P.O. Box 27687, Raleigh, North Carolina 27611-7687, [phone].
The application and other information may be inspected at these locations during normal office hours.
Copies of the information on file are available upon request and payment of the costs of reproduction.
All such comments or requests regarding a proposed permit should make reference to the NPDES permit
number listed below.
Date_ vZY%
George T. Everett, Director
Division of Environmental Management
Public notice of intent to issue a State NPDES permit to the following;
I. NPDES No. NC0033901. Mr. Roger D. Dixon, 1117 Prospect Church Road, Shelby, NC 28150
has applied for a permit renewal for a facility located at the Roger D. Dixon Residence on NCSR 1908,
northeast of Shelby, Cleveland County. The facility discharges 0.0003 MGD of treated domestic
wastewater from one outfall into an unnamed tributary to Hickory Creek, a Class C stream in the Catawba
River Basin.
Ric IV F-D
matet Quality gec"on
y
OCT n u lvffl
mbeville Regional Office
Asheville, forth Carolina

A
A
Permit No. NCO033901
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
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,
Mr. Roger D. Dixon
is hereby authorized to discharge wastewater from a facility located at
Roger D. Dixon Residence
on NCSR 1908
northeast of Shelby
Cleveland County
to receiving waters designated as an unnamed tributary to Hickory Creek in the Catawba River Basin
in accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts I, II, and III hereof.
This permit shall become effective
This permit and the authorization to discharge shall expire at midnight on December 31, 1993
Signed this day°
George T. Everett, Director
Division of Environmental Management
By Authority of the Environmental Management Commission

Permit No. NC0033901
SUPPLEMENT TO PERMIT COVER SHEET
Mr. Roger D. Dixon
is hereby authorized to:
1. Continue to operate an existing wastewater treatment system consisting of a septic tank,
subsurface sand filter trench, and sanuril chlorinator located at Roger D. Dixon Residence, on
NCSR 1908, northeast of Shelby, Cleveland County (See Part III of this Permit), and
2. Discharge from said treatment works at the location specified on the attached map into an
unnamed tributary to Hickory Creek which is classified Class C waters in the Catawba River
Basin.

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A. (). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS FINAL
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is authorized to discharge from
outfall(s) serial number 001. Such discharges shall be limited and monitored by the permittee as specified below:
Effluent Characteristics
Flow
BOD, 5 day, 200C
Total Suspended Residue
NH3 asN
Fecal Coliform (geometric mean)
Total Residual Chlorine
Temperature
Discharge Limitations
Units (specify)
Monthly Avg, Weekly Avg.
300 CPD
30.0 mg/I 45.0 mg/I
30.0 mg/I 45.0 mg/I
200.0 /100 ml 400.0 /100 ml
Monitoring Requirements
Measurement Sample *Sample
Frequency Type Location
The chlorinator shall be inspected weekly to ensure there is an ample supply of chlorine tablets for continuous disinfection of the effluent.
The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

State of North Carolina
Department of Natural Resources and Community Development
Division. of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Govemor
S. Thomas Rhodes, Secretary.
Mr. Roger Dixon
1117 Prospect Church Road
Shelby, North Carolina 28150
Dear Mr. Dixon :
July 21, 1986
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
ham- Cw� _7
SUBJECT: Permit No. NCO033901
Roger Dixon - Residence
Cleveland County
R. Paul Wilms
Director
In accordance with your application for discharge permit received on February 12,
1986, we are forwarding herewith the subject State NPDES Permit. 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 may request a waiver or modification pursuant to
Regulation 15 NCAC ..050-8(b) by written request to the Director identifying the specific
issues to be contended. Unless such request is made within 30 days following receipt of
this 'permit, this permit shall be final and binding. Should your request be denied, you
will have the right to request an adju°dicatory hearing-.
Please take notice that this permit is not t.ransferable Part II, B.2. addresses the
requirements to be foalowed: i-n case of change in ow-nership or control of this discharge.
This permit does not affect the legal • -requirement to obtain other permits which may
be required by the Division of Environmental -Management or permits required by the
Division of Land. Resources, Coastal Area Management Act or any other Federal or Local
governmental permit that m-ay be required=.
If you have any questions concerning this permit, please contact Mr. Dale Overcash,
at telephone number 919/733-5083. .,
Sincerely, RECEIVE
OPJGjN�AL SiGrgF[) t3'1, Water Q#-jality Divician
ARTHUR OITERRY
FOn_R. Paul Wilms JUL 29 1986
J
: Jim Patrick, EPA,, Pollution Prevention Pays
A s he V i l le; :;R eg`io. a l- -O:­� t 7 Raleigh North Carolina 27611 7687 Telephone [phone] Wad ite rn Rzj K:-ncf O r f is n
65iov#1e,C�srniir c
/gwt An Equal Opportunity Affirmative Action Employer

Permit No. NCO033901
STATE OF NORTH CAROLINA
DEPARTMENT OF NAT.VR,AL,.RESOURCES .& COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT
P E R M I T
To Discharge Wastewater Under the NATIONAL
POLLUTANT DISCHARGE ELIMINATION SYSTEM
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,
ROGER DIXON
is hereby authorized to discharge wastewater from a facility located at
Roger Dixon - Residence
Cleveland County
to receiving waters designated as an unnamed tributary to Hickory Creek in the
Broad River Basin.
in accordance with effluent limitations, monitoring requirements, and other conditions
set forth in Part I, 11, and III hereof.
This permit shall become effective July 21, 1986.
This permit and t-he. authorization to discharge shall expire at midnight on
June 30, 1=991.
S:4g-ned this day of JuFy 21, 19:86.
R. PAUL WILMS, DIRECTOR
DIVISION OF ENVIRONMENTAL MANAGEMENT
BY AUTHORITY OF THE ENVIRONMENTAL
MANAGEMENT COMMISSION
M1 S 11

SUPPLEMENT TO PERMIT COVER SHEET
Roger Dixon
is hereby authorized to:
Permit No:. NC0033901
1. Continue operation of a 1,000 gallon septic tank, a 300-square foot
subsurface sand filter trench, and effluent chlorination facilities,
located adjacent to N.C.Secondary Road 1908, Route 7, Shelby, North
Carolina, subject to Part III of this Permit, and
2. After receiving an Authorization to Construction from Division of
Environmental construct wastewater treatment facilities as may be needed
to comply with the permit limitations and conditions of this permit, (subject
to�Part III of this permit).
3. Discharge from said treatment works into an unnamed tributary to Hickory
Creek which is classified Class "C" waters in the Broad River Basin.

A. (1j. EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS Final '
During the period be ftnin n the effective date of the Permitand las in9 until expiration,
the permittee is authorized to discharge from outfall(s) serial numb1 41).001.
Such discharges shall be limited and monitored by the pertaittee a: ipecifi6d below:
Effluent --
Ruch rali a 1
• Othsrounits (specify
BOD, 5Day, 200C 300 GPD
Total Suspended Residue 30.0 mcc/I 45.0 mg/1
NH as N 30.0 nag/1 45.0 mg/1
Fetal Coliform (geometric mean) 1000.0/100 mi. 2000.0/100 mi.
Residual Chlorine
Temperature
.:li .� 1 • ;:� 1
The pH shall not be less than 6:0 standard units nor greater than 9.0 standard units
There shall be no discharge of floating solids or visible foam in other than trace amounts.

PART I
"Act" used herein means the Federal Water Pollution Control Act, As
Amended.
"DEM" used herein means the Division of Environmental Management of
the Department of Natural Resources and Community Development.
"EMC" used herein means the North Carolina Environmental Management
Commission.
Definitions
a. The monthly average, other than for fecal coliform bacteria, is
the arithmetic mean of all the composite samples collected in a
one -month period. The monthly average for fecal coliform bacteria
is the geometric mean of samples collected in a one -month period.
b. The weekly average, other than for fecal coliform bacteria, is the
arithmetic mean of all the composite samples collected during a
one -week period. The weekly average for fecal coliform bacteria
is the geometric mean of samples collected in a one -week period.
c. Flow, Mi/day (MGD): The flow limit expressed in this permit is the
24-hour average flow, averaged monthly. It is determined as the
arithmetic mean of the total daily flows recorded during the calendar
month.
d. Arithmetic Mean: The arithmetic mean of any set of values is the
summation of the individual values divided by the number of indi-
vidual values.
e. Geometric Mean: The geometric mean of any set of values is the Nth
root of the product of the individual values where N is equal to the
number of individual values. The geometric mean is equivalent to
the antilog of the arithmetic mean of the logarithms of the indi-
vidual values. For purposes of calculating the geometric mean,
values of zero (0) shall be considered to be one (1).

PART 11
A. MANAGEMENT REQUIREMENTS
1. Change in Discharge
All discharges authorized herein shall be consistent with the terms
and conditions of this permit. The discharge of any pollutant
identified in this permit more frequently than or at a level in
excess of that authorized shall constitute a violation of the
permit. Any anticipated facility expansions, production increases,
or process modifications which will result in new, different, or
increased discharges of pollutants must be reported by submission
of a new NPDES application or, if such changes will not violate the
effluent limitations specified in this permit, by notice to the DEM
of such changes. Following such notice, the permit may be modified
to specify and limit any pollutants not previously limited.
2. Facilities Operation
The permittee shall at all times maintain in good working order and
operate as efficiently as possible all treatment or control facili-
ties or systems installed or used by the permittee to achieve com-
pliance with the terms and conditions of this permit.
3. Adverse Impact
The permittee shall take all reasonable steps to minimize any adverse
impact to navigable waters resulting from noncompliance with any
effluent limitations specified in this permit, including such accel-
erated or additional monitoring as necessary to determine the nature
and impact of the noncomplying discharge.
4. Bypassing
Any diversion from or bypass of facilities necessary to maintain com-
pliance with the terms and conditions of this permit is prohibited,
except (i) where unavoidable to prevent loss of life or severe
property damage, or (ii) where excessive storm drainage or runoff
would damage any facilities necessary for compliance with the
effluent limitations and prohibitions of this permit. The permittee
shall promptly notify the Water Quality Section of DEM in writing of
each such diversion or bypass.
5. Removed Substances
Solids, sludges, filter backwash, or other pollutants removed in the
course of treatment or control of wastewaters shall be disposed of in
a manner such as to prevent any pollutant from such material from
entering waters of the State or navigable waters of the United
States.

PART II
6. Power Failures
In order to maintain compliance with the effluent limitations and
prohibitions of this permit, the permittee shall either:
a. Provide an alternative power source sufficient to operate
the wastewater control facilities;
or, if such alternative power source is not in existence,
b. Halt, reduce, or otherwise control production and/or all dis-
charges from wastewater control facilities upon the reduction,
loss, or failure of the primary source of power to said waste-
water control facilities.
B. RESPONSIBILITIES
1. Right of Entry
The permittee shall allow the Director of the Division of Environ-
mental Management, the Regional Administrator, and/or their author-
ized representatives, upon the presentations of credentials:
a. To enter upon the permittee's premises where an effluent
source is located or in which any records are required to
be kept under the terms and conditions of this permit; and
b. At reasonable times to have access to and copy any records
required to be kept under the terms and conditions of this
permit; to inspect any monitoring equipment or monitoring
method required in this permit; and to sample any discharge
of pollutants.
2. Transfer of Ownership or Control
This permit is not transferable. In the event of any change in con-
trol or ownership of facilities from which the authorized discharge
emanates or is contemplated, the permittee shall notify the prospec-
tive owner or controller by letter of the existence of this permit
and of the need to obtain a permit in the name of the prospective
owner. A copy of the letter shall be forwarded to the Division of
Environmental Management.
3. Permit Modification
After notice and opportunity for a hearing pursuant to NCGS 143-215.1
(b)(2) and NCGS 143-215.1(e) respectively, this permit may be modi-
fied, suspended, or revoked in whole or in part during its term for
cause including, but not limited to, the following:

PART II
a. Violation of any terms or conditions of this permit;
b. Obtaining this permit by misrepresentation or failure to
disclose fully all relevant facts; or
c. A change in any condition that requires either a temporary
or permanent reduction or elimination of the authorized
discharge.
4. Civil and Criminal Liability
Except as provided in permit conditions on "Bypassing" (Part II,
A-4) and "Power Failures (Part II, A-6), nothing in this permit
shall be construed to relieve the permittee from civil or criminal
penalties for noncompliance pursuant to NCGS 143-215.6 or Section
309 of the Federal Act, 33 USC 1319.
5. Property Rights
The issuance of this permit does not convey any property rights in
either real or personal property, or any exclusive privileges, nor
does it authorize any injury to private property or any invasion of
personal rights, nor any infringement of Federal, State, or local
laws or regulations.
6. Severability
The provisions of this permit are severable, and if any provision of
this permit, or the application of any provision of this permit to
any circumstance, is held invalid, the application of such provision
to other circumstances, and the remainder of this permit shall not
be affected thereby.
7. Expiration of Permit
Permittee is not authorized to discharge after the expiration date.
In order to receive authorization to discharge beyond the expiration
date, the permittee shall submit such information, forms, and fees
as are required by the agency authorized to issue permits no later
than 180 days prior to the expiration date. Any discharge without
a permit after the expiration will subject the permittee to enforce-
ment procedures as provided in NCGS 143-215.6 and 33 USC 1251 et seq..

PART III
A. PREVIOUS PERMITS
All previous State water quality permits issued to this facility,
whether for construction or operation, or discharge, are hereby
revoked by issuance of this permit. The conditions, requirements,
terms, and provisions of this permit authorizing discharge under the
National Pollutant Discharge Elimination System govern discharges
from this facility.
B. CONSTRUCTION
No construction of wastewater treatment facilities or additions thereto
shall be begun until Final Plans and Specifications have been submitted
to the Division of Environmental Management and written approval and
Authorization to Construct have been issued. If no objections to Final
Plans and Specifications have been made by the DEM.after 30 days follow-
ing receipt of the plans or issuance of this permit, whichever is latter,
the plans may be considered approved and construction authorized.
C. SPECIAL CONDITIONS
1. The Permittee shall be responsible for the following items regard-
ing the maintenance of the treatment system:
a. Septic tanks shall be maintained at all times to prevent
seepage of sewage or effluents to the surface of the ground.
b. Septic tanks need routine maintenance and should be checked
at least yearly to determine if solids need to be removed
or other maintenance performed.
c. Contents removed from septic tanks shall be discharged into
an approved sewer system, buried or plowed under at an
approved location within 24 hours, or otherwise disposed of
at a location and in a manner approved by the State or local
agency.
2. The permittee shall properly connect to an operational publicly -
owned wastewater collection system within 180 days of its availability
to the site.

josepi, w. crLmnsley, Secretary
DIVISION ,Or MMIROMENUAL KANAG=MT1
20, Watar Quality Division
Mr. Roger D. Dixon
1117 Prospect Church Road - AUG 27 1981
Shelby, Horth Carolina 28150
ional-Offic
Western R(59 e . I
1� Subject: Termi, t No NCO033901. &heville, North Carolina
Dixon Residence, R0,9er D—
_Cleveland County
Dear Mr. Dixon;
In accordancei with YoUr application for discharge Permit received June .123%-
1981, we are forwarding herewith the subject State - hTDES Permit.- This Permit
is issued pursuant to the requiremeuts of Forth Carolina General Statutes
143-215.1 and the Mewrandum of Agreement between North Carolina and the
U. 8. Environmental.Protection Agency' dated October 1.9, 1975.
If any parts, requirements, or limitations contained in this Permit
are unacceptable to you, you have the -right to aa-adjudicatery hearing before
a hearing officer upon urritten demand to -the, Director withii-L - 34. days followinr,
receipt of this Permit, identifying the specific issues to'be-contended..
Unless such demand is -made, this Permit shall be final and binding...-
Pleasee-take notice that this Permit is not transferable. Part II, B.2.
addresses the requirements to be. followed in case of change in oiMership or
control of 'this
leis Permit does.not affect the legal requirement to obtain other Permits
which may be required by the Division of Environmental M4napmQnt. Xfyou.
have any questions concerning this Permit, Ple&se contact Ar-Bill Hills,
telephone [phone].
Sincerely yours*
Original Signed by
L. P, BENTON
obert F. e
- Director
eel Mr.- EPA
e Regiona Supervisor
Asheville Regional Office Manager

Permit No
NC 0033901
STATE OF NORTH CAROLINA
DEPARTMENT OF NATURAL RESOURCES & COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT
P E R M I T
To Discharge Wastewater Under the NATIONAL
POLLUTANT DISCHARGE ELIMINATION SYSTEM
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,
Mr. Roger Dixon
is hereby authorized to discharge wastewater from a facility located at
The Roger Dixon Residence Wastewater Treatment Plant_
Cleveland County
to receiving waters unnamed tributary to Hickory Creek in the Broad River Basin
in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, and III hereof.
This permit shall become effective AUG 2
0 1981
This permit and the authorization to discharge shall expire at midnight
on JUL 3 1 1986
Signed this day of
M1 & I1
AUG 2 0 1981
.Original Signed by,
L. P. BENTON, JR,
Robert F. Helms, Director
Division of Environmental Management
By Authority of the Environmental
Management Commission

Permit No. NCO033901
Mr. Roger Dixon
is hereby authorized to:
1. Continue operation of a 1,000-gallon septic tank, a 300-square
foot subsurface sand filter trench, and effluent chlorination
facilities, located adjacent to N. C. Secondary Road 1908, Route 7,
Shelby, North Carolina, subject to Part III, condition No. C of
this Permit, and
2. Discharge from said treatment works into an unnamed tributary to
Hickory Creek which is classified Class "C".
3. All references in this Permit pertaining to monitoring, reporting,
sample collection, and certified operator shall be considered
not applicable until such time as this Permit may be modified.
4. Construct wastewater treatment facilities as may be required to
comply with the conditions of this Permit.
M2&I2.

A. ( ). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - Final
During the period beginning the effective date of this Permit and lasting until expiration,
the permittee is authorized to discharge from outfal1(s) serial number(s) 001.
Such discharges shall be limited and monitored by the permittee as specified below:
Effluent Characteristics
Discharge Limitations
Monitoring Requirements
K da
lbs da Other -Units
(Specify)
Measurement Sample Sampl.
Monthly Avg.
Weekly Avg. Mont - vg.
ee y vg.
requency. Type Locatian
Flow,
M3/Day (MGD) --
-- 1.14 (0.0003)
1.70 (0.00045)
-- -- --
BOD,
5-Day, 200C --
-- 30 mg/l
45 mg/1
-- -- --
fotal
Suspended Solids --
-- 30 mg/l
45 mg/l
-- -- --
=ecal
Coliform --
-- 1000/100 ml
2000/100 ml
-- -- --
f�
The pH shall not be less than N/A standard units nor greater than N/A standard units and
shall be monitored N/A.
There shall be no discharge of floating solids or vi!ible foam in other than trace amounts.
:Z -v -o -0
n M su a
C:)
�Z
O O
• o

f
. Part I
Permit No. NC0033901
B. SCHEDULE OF COMPLIANCE
1. The permittee shall achieve compliance with the effluent limitations
specified for discharges in accordance with the following schedule:
N/A
2. No later than 14 calendar days following a date identified in the above
schedule of compliance, the permittee shall submit either a report of
progress or, in the case of specific actions being required by identified
dates, a written notice of compliance or noncompliance. In the latter
case, the notice shall include the cause of noncompliance, any remedial
actions taken, and the probability of meeting the next scheduled requirement.
N/A
M A o. T A

Part I
Permit No. NC
"Act" used herein means the Federal Water Pollution Control Act, As Amended.
"DEM" used herein means the Division of Environmental Management of the
Department of Natural Resources and Community Development.
"EMC". used herein means the North Carolina Environmental Management Commission,
C. MONITORING AND REPORTING
0 !
A P P
f
1. Representative Sampling
Samples and measurements taken as required herein shall be representative
of the volume and nature of the monitored discharge.
2. Reporting
Monitoring results obtained during the previous month(s) shall be
summarized for each month and reported on a Monthly 14onitorfng Report
Form (DEM No. MR 1.0, 1.1, and 1..4) . postmarked no later than the
45th day following the completed reporting period.
The first report is due on Duplicate signed copies of
these, and all other reports required herein, shall be submitted to
the following address:
Division of Environmental Management
Water Quality Section
Post Office Box 27687
Raleigh, North Carolina 27611
3. Definitions
a. The monthly average, other than for fecal coliform bacteria, is the
arithmetic mean of all the composite samples collected in a one -
month period. The monthly average for fecal coliform bacteria is
the geometric mean of samples collected in a one -month period.
b. The weekly average, other than for fecal coliform bacteria, is the
arithmetic mean of all the composite samples collected during a
one -week period. The weekly average for fecal coliform bacteria
is the geometric mean of samples collected in a one -week period.
c. Flow, M3/day (MGD): The flow limit expressed in this permit is the
24 hour average flow, averaged_month'ly. It is determined as the
arithmetic mean of the total daily flows recorded during the calendar
month.
d. Arithmetic Mean: The arithmetic mean of any set of values is the
summation of the individual values divided by the number of individual
values.
M5

Part I
Permit No. NC
e. Geometric Mean: The geometric mean of any set of values is the
Nth root of the product of the individual values where N is equal
to the number of individual values. The geometric mean is equiva-
lent to the antilog of'the arithmetic mean of the logarithms of
the individual values. For purposes of calculating the geometric
mean, values of zero (0) shall be considered to be one (1)..
f. Composite Sample: A "composite sample" is any of the following:
(1) Not less than four influent or effluent portions collected
at regular -intervals over a period of 24 hours and composited
in proportion to flow.
(2) Not less than four equal volume influent or effluent portions
collected over a period of 24 hours at intervals proportional
to the flow.
(3) An influent or effluent portion collected continuously over
a period of 24 hours at a rate proportional to the flow.
g. Grab Sample: A "grab sample". is a single influent or effluent
portion which is not a composite sample. The sample(s) shall be
collected at the period(s) most representative of the total discharge.
4. Test Procedures
Test procedures for the analysis of pollutants shall conform to the EMC
regulations published pursuant to N. C. G. S. 143-215.63 et seq, The
Water and Air Quality Reporting Act, and to regulations published pursuant
to Section 304(g), 33 USC 1314, of the Federal Water Pollution Control Act,
As Amended, and Regulation 40 CFR 136.
5. Recording Results
For each measurement or sample taken pursuant to the requirements of
this permit, the permittee shall record the following information:
a. The exact place, date, and time of sampling;
b. The dates the analyses were performed; and
c. The person(s) who performed the analyses.
M6

PART I
Permit No. NC
6. additional Monitoring by Permittee
If -the permittee monitors any pollutant at the locations) designated
herein more frequently than required by this permit, using approved
analytical methods as specified above, the results of such monitoring
shall be included. in the calculation and reporting of the values required
in the Monthly Monitoring Report Form (DEM No. MR 1.0, 1.1, and 1.4)
Such increased frequency shall also be indicated. The DEM may require
more frequent monitoring or the monitoring of other pollutants not
required in this permit by written notification.
7. Records Retention
All records and information resulting from the monitoring activities
required by this Permit including all records of analyses performed and
calibration and maintenance of instrumentation and recordings from.
continuous monitoring instrumentation shall be retained for a mini.mum of
three (3) years, or longer if requested by the Division of Environmental
Management or the Regional Administrator of the. Environmental Protection
Agency.
M 7

PART II
Permit No. NC
A. MANAGEMENT REQUIREMENTS
1. Change in Discharge
All discharges authorized herein shall be consistent with the terms and
conditions of this permit. The discharge of any pollutant identified
in this permit more frequently than or at a level in excess of that
authorized shall constitute a violation of the permit. Any anticipated
facility expansions, production increases, or process modifications which
will result in new, different, or increased discharges of pollutants must
be reported by submission of a new NPDES application or, if such changes
will not violate the effluent limitations specified in this permit, by
notice to the DEM of such changes. Following such notice, the permit
may be modified to specify and limit any pollutants not previously limited.
2. Non compliance Notification
If, for any reason, the permittee does not comply with or will be unable
to comply with any effluent limitation specified in this permit, the per-
mittee shall provide the Division of Environmental Management with the
following information, in writing, within five (5) days of becoming aware
of such condition:
a. A description of the discharge and cause of noncompliance; and
b. The period of noncompliance, including exact dates and times; or,
if not corrected; the anticipated time the noncompliance is expected
to continue, and steps being taken to reduce, eliminate and prevent
recurrence of the noncomplying discharge.
3. Facilities Operation
The permittee shall at all times maintain in good working order and
operate as efficiently as possible all treatment or control facilities
or systems installed or used by the permittee to achieve compliance with
the terms and conditions of this permit.
4. Adverse Impact
The permittee shall take all reasonable steps to minimize any adverse
impact to navigable wasters resulting from noncompliance with any effluent
limitations specified in this permit, including such accelerated or
additional monitoring as necessary to determine the nature and impact of
the noncomplying discharge.
5. Bypassing
Any diversion from or bypass of facilities necessary to maintain compliance
with the terms and conditions of this permit is prohibited, except (i) where
M8&I7

PART II
Permit No. NC
unavoidable to prevent loss of life or severe property damage, or
(ii) where excessive storm drainage or runoff would damage any
facilities necessary for compliance with the effluent limitations
and prohibitions.of this permit. The permittee shall promptly
notify the Water Quality Section of DEM in writing of each such
diversion or bypass.
6. Removed Substances
Solids,.sludges, filter backwash, or other pollutants removed in the
course of treatment or control of wastewaters shall be disposed of in
a manner such as to prevent any pollutant from such materials from
entering waters of the State or navigable waters of the United States.
7. Power Failures
In order to maintain compliance with the effluent limitations and
prohibitions of this permit, the permittee shall either:
a. In accordance with the Schedule of Compliance contained in Part I,
provide an alternative power source sufficient to operate the waste-
water control facilities;
or, if such alternative power source is not in existence, and no date for
its implementation appears in Part I,
b. Halt, reduce or otherwise control production and/or all discharges
from wastewater control facilities upon the reduction, loss, or
failure of the primary source of power to said wastewater control
facilities.
8. Onshore or Offshore Construction
This permit does not authorize or approve the construction of any onshore
or offshore physical structures or facilities or the undertaking of any
work in any navigable waters.
I8

PART II
Permit No. NC
B. RESPONSIBILITIES
1. Right of Entry
The permittee shall allow the Director of the Division of Environmental
Management, the Regional Administrator, and/or their authorized represen-
tatives, upon the presentations of credentials:
a. 'The enter upon the permittee°s premises where an effluent source is
located or in which any records are required to be kept under the
terms and conditions of this permit; and
b. At reasonable times to have access to and copy any records required
to be kept under the terms and conditions of this permit; to inspect
any monitoring equipment or monitoring method required in this permit;
and to sample any discharge of pollutants.
2.. Transfer of Ownership or Control
This permit is not transferable. In the event of any change in control
or ownership of facilities from which the authorized discharge emanates
or is contemplated, the permittee shall notify the prospective owner or
controller by letter of the existence of this permit and of the need to
obtain a permit'in the name of the prospective owner. A copy of the
letter shall be,forwarded to the Division of Environmental Management.
3. Availability of Reports
Except .for data determined to be confidential under N. C. G. S. 143-215.
3(a)(2)'-or Section 308 of the Federal Act, 33 USC 1318, all reports prepared
in accordance with the terms shall be available for public inspection at the
offices of the Division of Environmental Management. As required by the Act,
effluent data shall not be considered confidential. Knowingly making any
false statement on any such report may result in the im osition of criminal
penalties as provided for in N. C. G. S. 143-215.6(b)(2� or in Section
309 of the Federal Act.
4. Permit Modification
After notice and opportunity for a hearing pursuant to N. C. G. S. 143-
215.1(b)(2) and G. S. 143-215.1(e) respectively, this permit may be
modified, suspended, or revoked in whole or in part during its term for
cause including, but -not limited to, the following:
a. Violation of any terms or conditions of this permit;
b. Obtaining this permit by misrepresentation or failure to disclose
fully all relevant facts; or
c. A change in any condition that requires either a temporary or
permanent reduction or elimination of the authorized discharge.
M10&I9

PART II
Permit No. NC
5. Toxic Pollutants
Notwithstanding Part II, B-4 above, if a toxic effluent standard or
prohibition (including any schedule of compliance specified in such
effluent standard or prohibition) is established under Section 307(a)
of the Act for a toxic pollutant which is present in the discharge and
such standard or prohibition is more stringent than any limitation for
such pollutant in this permit, this permit shall be revised or modified
in accordance with the toxic effluent standard or prohibition and the
permittee so notified.
6. Civil and Criminal Liability
Except as provided in permit conditions on "Bypassing" (Part II, A-5)
and "Power Failures" (Part II, A-7), nothing in this permit shall be
construed to relieve the permittee from civil or criminal penalties for
noncompliance pursuant to N. C. G. S. 143-215.6 or Section 309 of the
Federal Act, 33 USC 1319.
7. Oil and Hazardous Substance Liability
Nothing in this permit shall be construed to preclude the institution
of any legal action or relieve the permittee from any -responsibilities,
liabilities, or penalties to which the permittee is or may be subject
under N. C. G. S. 143-215.75 et seq. or Section 311 of the Federal Act,
33 USC 1321.
8. Property Rights
The issuance of this permit does not convey any property rights in either
real or personal property, or any exclusive privileges, nor does it
authorize any injury to private property or any invasion of personal
rights, nor any infringement of Federal,State or local laws'or regulations.
9. Severability
The provisions of this permit are severable, and if any provision of this
permit, or the application of any provision of this permit to any circum-
stance, is held invalid,, the application of such provision to other cir-
cumstances, and the remlinder of this permit shall not be affected thereby.
M11 &I10

PART II
Permit No NC
10. Expiration of Permit
Permittee is not authorized to discharge after .the expiration date.
In order to receive authorization to discharge beyond the expiration
date, the permittee shall submit such information, forms, and fees as
are required by the agency authorized to issue permits no later than 180
days prior to the expiration date' Any discharge without a permit after
the expiration will subject the permittee to enforcement procedures as
provided in N. C. G. S. 143-215.6 and 33 USC 1251 et seq..
I 11

F
PART III
Permit No. NCO033901
B. Previous Permits
All previous State water quality permits issued to this facility,
whether for construction or operation or discharge, are hereby revoked
by issuance of this permit. The conditions, requirements, terms, and
provisions of this permit authorizing discharge under the National
Pollutant Discharge Elimination System governs discharges from this
facility.
C. Construction
No construction of wastewater treatment facilities or additions thereto
shall be begun until Final Plans and Specifications have been submitted
to the Division of Environmental Management and written approval and
Authorization to Construct has been issued. If no objections to Final
Plans and Specifications has been made by the DEM after 30 days following
receipt of the plans -or issuance of this permit, whichever is latter, the
plans may be considered approved and construction authorized.
D. Certified Operator pp ii
Pursuant to AOL 9APf..WAW1C rolina General Statutes, the permittee
shall employ a certified wastewater treatment plant operator in responsible
charge of the wastewater treatment facilities. Such operator must hold a
certification of the grade equivalent to the classification assigned to
the wastewater treatment facilities.
ALL REFERENCES TO MONITORING, REPORTING, SAMPLE COLLECTION, AND CERTIFIED
OPERATOR. SHALL NOT APPLY TO THIS DISCHARGE.
E. Upon the availability of a public sewerage system, the wastewater;.treatment
facility serving the Roger Dixon Residence shall be abandoned and the waste-
water generated by -the residence discharged to that system.
F. The chlorination facilities shall be properly maintained and operated at
all times.
M15&I12

i
DiVISIGid OF ENVIRONMEN MANAGEMENT
WATER QUALITY SEuiION
ASHEVILLE REGIONAL OFFICE ,' .
July 27, 1981
MEMO TO: R. S. Taylor, Acting Manager
Permits and Engineering
THROUGH: Roy M. Davis, Regional Supervisor
Division of Environmental Management
THROUGH: Heath P. Dobson, Regional Engineer
Water Quality Section j
FROM: Roy M. Davis, Regional Supervisor
Division of Environmental Management -Li
SUBJECT: NPDES Permit Renewal
No: NC0033901
Roger Dixon Residence
Cleveland County, North Carolina
Attached is subject Permit Renewal. r
sb
it
I ,
I
1
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DATA LOADING SHEET
Check one: ❑
'Now Permit
Modification to Existing Pormit
C"These items may ba changad when using form for modification.
FACILITY INVENTORY DATA
For new parmit: Fill in this ontiry block.
For modification: Fill in facility number and ONLY items that have changed.
� Fcoc�ljty Ncfm�: ( I
7 4
° A�dra3s: l 1
(street)
1 (city) ' (st�a)a) !_ (zip) t.
FacHity Number: (�,,'�:.bdL�}-3l
WELL CONSTRUCTION PsRMIT DATA
For naw wall construction permit: Fill in this ontira block,
Permit Number: l -SW. C 1 Permit Isiva Dgata:
y y m m
NPDES P'w-: iMIT DATA
For now NPDPS pprmitr Fill in, this anttra
block. .
For modisicc aion: Fill in NPDES number and
ONLY items that have chanq&d.
Nurrabar: . C .Q.-0. 3 3..M 1 l
FOR _
----
USL
ONLY Community & Facility Humbw
County 3laas:e: 1 I Re
g;oral Offki, Coda. U
communiry Name-, 1 y 1
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sauq or Wa-:ssa'Ja�
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yymmdd
>Expiration Drtap: 1
y ymmd
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Pormit A1>oIi3itaa7-%A
❑ Case DbcharSo-CD
lJ
Existing
°Cr�r.,rs rile:
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Municipal-,'r111
❑ Snnitnry Distrirt-MD
❑
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❑
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❑ lt'btar Traatmant Plant-W-A
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°Dai3� i BOA/ r�$'y3��•3f.-aB1ifl5i�tr: l 1 SUIi'AA3)Tt {l�lU17t�✓P' l ._� J
(i:z•�vanrzis of �ye:ians/dny) •

Permit No.- NC 0033901
STATE OF NORTH CAROLINA
DEPARTMENT OF NATURAL RESOURCES & COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT
P E R M I T
To Discharge Wastewater Under the NATIONAL
POLLUTANT DISCHARGE ELIMINATION SYSTEM
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,
Mr. Roger Dixon
is.hereby authorized to discharge wastewater from a facility located at
The Roger Dixon Residence Wastewater Treatment Plant
Cleveland County
to receiving waters unnamed tributary to Hickory Creek in the Broad River Basin
in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, and III hereof.
This permit shall become effective
on This permit and the authorization to discharge shall expire at midnight
Signed this day of
Robert F. Helms, Director. .
Division of Environmental Management
ByIAuthority of the Environmental
Management Commission
M1 & I1

Permit No. NCO033901
Mr. Roger Dixon
Is hereby authorized to:
1. Continue operation of'a 1,000-gallon septic tank, a 300-square
foot subsurface sand filter trench, and effluent chlorination
facilities, located adjacent to N. C. Secondary Road.1908, Route 7,
Shelby, North Carolina, subject to. Part III, condition No. 'C of
this Permit, and
2. Discharge from said treatment works into an unnamed tributary to
Hickory Creek which is classified Class "C
3. All references in this Permit pertaining to monitoring, reporting,
sample collection, and certified operator shall be considered
not applicable until such time as this Permit may be modified.
4. Construct wastewater treatment facilities as may be required to
comply with the conditions of this Permit..
M2UI2

eo
A. ( ). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - Final
During the period beginning the effective date of this Permit and lasting until expiration,
the permitter is authorized to .discharge from outfal1(s) serial number(s) 001.
Such discharges shall be limited and monitored by the permittee as specified below:
Effluent Characteristids Discharge Limitations Monitoring Requirements
K dalbs da Other -Units (Specify) Measurement Sample Sampli
Monthly.Avg. -eek y Avg` Month ly AV.9.. weeKlY vg. requency Type Locatiu►,
Flow, M3/Day (MMGD) _^ 1J4 (0.0003) 1.70 (0.00045)
BOD, 5-Day, 20 C 30 mg/l 45 mg/l
Total Suspended Solids -- -- 30 mg/l 45 mg/1 - -- --
Fecal Coliform -- -- 1000/100 ml 2000/100 ml -- -- --
c-�
o -s cn -s
The pH shall not be less than N/A standard units nor greater than. N/A standard units and W _J.
shall be monitored N/A. o z
'o
There shall be no discharge of floating solids or'vit ble foam in other than.trace amounts. —�,

Part I
Permit No. NC0033901
Q. SCHEDULE OF COMPLIANCE
1. the permittee shall achieve compliance with the effluent limitations
specified for discharges in accordance with the following schedule:
N/A
1
2. No later than 14 calendar days following a date identified in the above
schedule of compliance,the permittee shall submit either a report of
progress or, in the case of specific actions being required by identified
dates, a written notice of compliance or noncompliance. In the latter
case, the notice shall include the cause of noncompliance, any remedial
actions taken, and the probability of meeting the next scheduled requirement.
N/A
M4&I4

PART III
Permit No. NC0033901
B. Previous Permits
All previous State water quality permits issued to this facility,
Whether for construction or operation or discharge, are hereby revoked
by issuance of this permit. /The conditions, requirements, terms, and
provisions of this permit authorizing discharge under the National
Pollutant Discharge Elimination System governs discharges from this
facility.
C. Construction
No construction of wastewater treatment facilities or additions thereto
shall be begun until Final Plans and Specifications have been submitted
to the Division of Environmental Management and written approval and
Authorization to Construct has been issued. If no objections to Final
Plans and Specifications has been made by the DEM after 30 days following
receipt of the'plans-or issuance of this. permit, whichever is latter, the
plans may be considered approved and construction authorized.
D. Certified Operator
Pursuant to Chapter 90A of North'Carolina General Statutes, the.permittee
shall employ a certified wastewater treatment plant operator in responsible
charge of the wastewater treatment facilities. Such operator must hold a..
certification of the grade equivalent to the classification assigned to
the wastewater treatment facilities.
ALL REFERENCES TO MONITORING, REPORTING, SAMPLE COLLECTION, AND CERTIFIED
OPERATOR SHALL NOT APPLY TO THIS DISCHARGE.
E. Upon the availability of a public sewerage system, the wastewater treatment
facility serving the Roger Dixon Residence shall be abandoned and the waste-
water generated by the residence discharged. to that system.
F. The chlorination facilities shall be properly maintained and operated at
all times.
M15&I12

r.ermiz no. Huuuj.iyui
STAFF REPORT AND RECOMMENDATIONS
Date: July 24, 1981
PART I - INSPECTION OF WASTEWATER TREATMENT PLANT SITE -EXISTING
1. Facility: Roger Dixon Residence
Cleveland County
2. Inspected By:
3. Persons contacted:
4. Directions to site: Midway between N. C. Highways'18 and 180 on NCSR
1908 northeast of the City of Shelby.
5. 'Latitude: 350 19' 45" North Longitude: 810 30' 25" West
PART II - WASTEWATER TREATMENT WORKS - EXISTING
1. Description of waste treatment facility: Septic tank, subsurface sand
filter trench, and San-U-Ril chlorinator to serve a single-family resi-
dence.
2. Final disposition of sludge: Commercial septic tank cleaning firm.
PART III - EVALUATION AND RECOMMENDATIONS:
Wastewater treatment.system is not classifiable.
Secondary effluent limits used.
No requirements for self -monitoring or certified operator.
Recommend that Permit be renewed. .
Prepared By: Roy M. Davis

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level
June 10, 1981
1117 Prospect Church Rd.
Shelby, N.C. 28150
RECEIVED
Watar Quality Division
Roy Davis JUN 12 1981
N. C."Division of Environmental Management
P. ®. BOX 37® Western Re�ion::l Office
Asheville, North Carolina
Asheville, North Carolina 28802
Dear Mr. Davis:
Please renew the discharge permit for our waste water
treatment system. The permit number is N. C. 0033901. Thank you.
Yours truly, ,(�
Ar Gt`J - kipo
Mr. & Mrs. Roger D. Dixon

F