NCG550486_permit issuance_20190524

Weaver, Charles
From: Weaver, Charles
Sent Friday, May 24, 2019 3:04 PM
To: [e-mail]
Cc: Tuvia, Ori A
Subject renewal of NCG550486 / 3041 Wagonwheel Court
Attachments: NCG550000 - 2018 permit renewal Final (10232018).pdf, NCG55-Tech-Bulletin-2018-
DWR-WQPS-NPDES.pdf
Importance: High
Tracking: Recipient Delivery
[e-mail]
Tuvia, Ori A
Delivered: 5/24/2019 3.04 PM
The Division has renewed General Permit NCG550000. A copy of the General Permit is
attached. You may begin using this version immediately. Please discard any old versions of
NCG550000 that you have.
Your existing Certificate of Coverage (CoC) does not have an expiration date. It remains accurate for
your facility, so no new paper documents are required.
If you have any questions, simply reply to this message.
PLEASE NOTE: as part of the Division's conversion to paperless communication, this email is the
only notification you will be sent regarding the CoC renewal. No hard copies will be mailed.
Charles H. Weaver
Environmental Specialist
N.C. Division of Water Resources
N.C. Department of Environmental Quality
919-707-3616
[e-mail]
(mailing address) 1617 Mail Service Center, Raleigh, NC 27699-1617
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed
to third parties.
lsummary - nutrient requirements by category 20130524.docx

t PAT MCCRORY
-w
N
DONALD R. VAN DER VAART
e^ �c Lretary
Water Resources
S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
RENEWAL FORM FOR EXISTING PERMITTED FACILITIES
NPDES renewal application for continued coverage under General Permit NCG550000:
Certificate of Coverage NCG55 c
(Please verify the information in items 1 & 2 as correct, or note any corrections that should be made.)
(Please print or type)
1) Mailing address* of property owner:
Owner Name R cr(
Street Address 3011.41 C-T.
City F �_i , 01C ZbDkZ
Telephone (Home) ?DL+ B25 - S'1 io I (Mobile) 704 '�600 0 % Z,0
(e-mail address) R r_1Z i 01DLJE Q X6 L ; Cc nil
Address to which all permit correspondence will be mailed
2) Location of facility producing discharge*:
Street Address 3 04 1 V,ALt-� uj ►4EF.L C`► .
City: f 1 l � Za O i 2—
County &AS +`D ►--k
Telephone
(Home) _ W94 132'5' a`161
(Mobile) 764 8 6 U -01 Zb
* If the facility is not yet constructed, give the street address or lot number where the structure will be
built.
3) Description of Discharge: jt=EQ1DWR
a) Type of facility producing waste (please check one):
/ MAY 17 20�
v Primary residence
Water duality
ElVacation/second home ParmMing S n
❑ Undeveloped property
❑ Other [describe]:
Page 1 of 2

NCG550000 renewal form
4) Please check the components that comprise the wastewater treatment system:
L"Septic tank ❑ Dosing tank C" Primary sand filter ❑ Secondary sand filter
❑ Recirculating sand filter(s) Chlorination ❑ Dechlorination
❑ Other form of disinfection: 126Post Aeration (describe) RAP C_A A-0>✓
5) Other Information:
a) When was the septic tank last pumped out? ?t 1 :5 ! 201-1
NOTE: the septic tank must be pumped out at least once every 3-5 years
b) Is the facility [home] occupied year-round, or only seasonally? (N61 YEA(L---PzVfJD
c) Approximately how many people use the facility when it is occupied?
d) When was the wastewater system installed?
6) Certification:
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: �' R + D U �� 3R,
�� S �_ 1516711
(Signature of Applicant) (Date Signed)
North Carolina General Statute 143-215.6 b (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any
application, record, report, plan or other document filed or required to be maintained under Article
21 or regulations of the Environmental Management Commission implementing that Article, or who
falsifies, tampers with or knowingly renders inaccurate any recording or monitoring device or
method required to be operated or maintained under Article 21 or regulations of the Environmental
Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C.
Section 1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more
than 5 years, or both, for a similar offense.)
Mail this completed form and a copy of the receipt for your last septic service to:
Charles H. Weaver
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Page 2 of 2

Owner
System Location
Riddle Sherry
3041 Wagonwheel Court
Belmont, NC, 28012
(704)-616-7322 x
K-Zyme
Custom Clean
Zabel Filter
Inspection/T5
Sdrvice Date
FRI 02/03/2017 01:00 PM
County: GASTON
Pumping
Primary Home
3041 Wagonwheel Court
Belmont, NC, 28012
(704)-616-7322 x
Sherry Riddle / Home
Call Confi
Approx. Gals: 0 to rm
Cust Home : No
Service Type: Standard
Frequency :
Previous Serv. 01/24/2017
Build Up
Depth Below Grade:
Township:
Qty Unit Price
Ext
1 250.0000 $250.00
Subtotal $250.00
Tax $0. 00
Total $250.00
Disposal Permit: SDTF36-04
Pumping Permit: NCS01373 Plumbing Permit: 32828
Location Details
Tank bservations :
We suggest these 3 keys to keep your system healthy
Payment Detail
�S stem Operating Fine
Y P 9
1) Regular servicing
Type :
Visa
2) Use K-ryme BacteriaAmitive
Waste Code :
3) Use a Filter
Card # :
XXXXXXXXXX5924
Waste Consistency
Excessive Solids [ ] Heavy Sludge
Exp. Date:
03/2019
Disposal Point: �� "
z. 1.7il S
PO Number:
none
Disposal Volume :
Gals Tons ICY
pH: Prior to Loading: Lab
Terms:
Due on Receipt
Inlet Baffle Outlet Baffle
_ Backflushes Runback Tank Level
Truck: _
Shop to Shop Break [ ]
Tech Initials: i l' OnSite 3 • S 5 Break [ ]
Tech Name: Thai Puih Sales Rep: NO Rep
CSR: Monica Ballard
G
Tech Notes : v roj, 1 N O +-t Itow, jt'4''f!C fv'� C lewfZ')
Stanley Environmental (877)-263-8186
Remit Payment to: 131 Mariposa Rd, Stanley, NC 28164
Customer Signature
stanley
environmental
solutions