NCG551769_Certificate of Coverage (COC)_20210112

DocuSign Envelope ID: 69FE8FD3-F33A-45EC-883B-CA4ACE85A432
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
Green Meadows Baptist Church
Attn: Josh Greene, Pastor
1646 NC Hwy 801
Mocksville, NC 27028
Dear Mr. Greene:
NORTH CAROLINA
Environmental Quality
1/12/2021
Subject: Issuance to Certificate of Coverage (COC) /
Authorization to Construct (ATC)
NPDES General Permit NCG551769
under General Permit NCG550000
Single Family Residence (SFR)
1646 NC Highway 801, Mocksville NC
Davie County
In accordance with your application for discharge under the subject NPDES General Permit, the Division
of Water Resources (DWR) herewith forwards a Certificate of Coverage (COC) and Authorization to
Construct (ATC) permit for new facilities. We issue this permit pursuant to the requirements of North
Carolina General Statue 143-215 .1, the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency (EPA) dated October 15, 2007 (or as subsequently amended).
Your permit package includes:
• Certificate of Coverage (COC) /Authorization to Construct (ATC)
• Operation & Maintenance Instructions
• A copy of Wastewater Discharge General Permit NCG550000
• A copy of the approved plans and specifications (signed May 11, 2020).
• Engineer's Certification form (to be returned to DWR upon project completion).
To maintain your Certificate of Coverage (COC), you must remit an annual fee of $60, due each year on
the date of this letter, to the Division of Water Resources. Please include the COC number NCG551769
on your check. Mail your Annual Fee to:
NCDEQ / DWR / NPDES / SFR Permitting
Attn. Wren Thedford
1617 Mail Service Center
Raleigh, NC 27699-1617
DWR understands that the subject property has been judged "unsuitable" for a ground -absorption sewer
system by the Davie County Health Depai intent. Therefore, your authorized consultant, Piedmont Design
Associates, P.A., intends to upgrade/install a wastewater treatment system designed to discharge to
Surface Waters of the State in accord with plans and specifications signed by the engineer on May 11,
2020. Compliance under General Permit NCG550000 restricts discharge flow, not to exceed 1,000
gallons per day. This ATC covers treatment facilities for a 600-seat Church estimated to discharge 975
gpd.
NORTH D_E
Department of Environmental Oualily
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

DocuSign Envelope ID: 69FE8FD3-F33A-45EC-883B-CA4ACE85A432
NPDES General Permit NC551769
Please note that you must provide regular treatment -system operation, maintenance and inspections in
accord with manufacturer's recommendations and this ATC; all records, water analyses, and logs to be
kept onsite available for DWR inspection [NCG550000, Section A. (2.)].
Operation and Maintenance. The Permittee is responsible to maintain all components of the
approved treatment system, designed to meet Surface Water -Quality Standards. Compliance includes
following the manufacturer's guidelines, conducting and documenting inspections, establishing sources
for OEM spare parts and supplies, taking samples for analyses, making necessary repairs, and
documenting said maintenance for the duration of the permit. Please note that the receiving stream is
currently classified and governed as WS-IV (Water Supply IV).
If DWR determines that your discharge contributes to future degradation or impairment of this
waterbody, an individual NPDES permit may be mandatory. Upon DWR's request, the Permittee must
provide records and demonstrate regular efforts to maintain the approved treatment system. The
Division recommends that the Permittee solicit manufacture -certified training, or a qualified contractor
or service to regularly inspect and maintain this treatment system.
Authorization to Construct (ATC) Permit. This ATC details the conditions of installation and
operation. Before startup, activation requires notice to the Winston-Salem Regional Office (336-776-
9800), attention Lon Snider, a minimum of three (3) days in advance of discharge. Such notification shall
be made during normal office hours from 8:00 a.m. until 5:00 p.m. Monday through Friday, excluding
State holidays. The attached Engineer's Certification form, must be returned to DWR by the Engineer,
documenting compliance "as built" in accord with this ATC and approved plans and specifications
submitted to DWR on May 11, 2020. No changes may be made without prior approval.
Therefore, in accord with the application and the attached approved plans and specifications, DWR
hereby authorizes the installation of upgrades to the existing surface -water discharge treatment system
described as:
• Conversion of existing septic tank to grease trap
• New septic tank with baffle and effluent filter
• Flow equalization tank & pump
• Recirculation tank & pump
• Orenco AX-100
• UV Disinfection
• Post -aeration (rip -rap)
• Control Panel
Compliance with the above shall include a leakage test performed on reused tanks and proposed new
tanks, or leak -certified new by the manufacture not to exceed an exfiltration rate of twenty (20) gallons
per twenty-four (24) hours per 1,000 gallons of tank capacity. The Engineer's Certification shall serve as
proof of compliance with this condition. Mail the completed Engineer's Certification to:
DEQ / DWR/ NPDES Program
1617 Mail Service Center
Raleigh, NC 27699-1617
❖ The Permittee shall, for the life of the treatment facility, maintain on site a copy
of the approved plans and specifications available for DWR inspection.
All elbow piping must conform to the long -sweeping type. All cleanouts must be housed in meter boxes
below grade. This treatment system shall be located at least 15 feet away from a dwelling, at least 100

DocuSign Envelope ID: 69FE8FD3-F33A-45EC-883B-CA4ACE85A432
NPDES General Permit NC551769
feet from any water -supply well either on- or off -site. The system shall also be located and constructed
above any applicable 100-year flood line; 50-ft setback from property lines.
Upon completing construction and prior to operating this permitted facility, a North Carolina -
registered engineer shall sign and submit to DWR the attached Engineer's Certification form, thereby
certifying that the permitted facility has been installed in accordance with the NPDES Permit, this
Certificate of Coverage, this Authorization to Construct, and the approved plans and specifications.
This ATC permit is issued in accordance with Part III, Paragraph 2 of NPDES General Permit
NCG550000, and is subject to revocation unless wastewater treatment facilities are constructed in
accordance with the conditions and limitations specified in this General Permit. In the event that the
facilities fail to perform satisfactorily, including creating nuisance conditions, the Permittee shall take
immediate corrective action as may be required by this Division, such as the construction of additional or
replacement wastewater treatment(s) or disposal facilities. Failure to abide by the requirements of this
ATC permit may subject the Permittee to an enforcement action by the Division of Water Resources in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
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.
This COC is not transferable except after notice to the Division of Water Resources. The Division may
modify or revoke and reissue this COC. This COC does not affect your legal obligation to obtain other
permits that may be required by the Division of Water Resources, the Division of Energy, Mineral and
Land Resources, the Coastal Area Management Act, or any other Federal or Local government.
NPDES Contact. If you have any questions concerning the requirements of this Certificate of Coverage
or Authorization to Construct (ATC) permit, please email Sydney Carpenter at
[e-mail] or call her direct line [phone].
Sincerely,
EDocuSigned by:
8328B44CE9EB4A1...
S. Daniel Smith
Director, Division of Water Resources
Attachments: COC; Engineer's Certification form (to be signed and returned to DWR)
cc: Winston-Salem Regional Office [Laserfiche]
NPDES General Permit Files [Laserfiche]
David DeCaron, Piedmont Design Associates, P.A.

DocuSign Envelope ID: 69FE8FD3-F33A-45EC-883B-CA4ACE85A432
NPDES General Permit NC551769
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
CERTIFICATE OF COVERAGE - NCG551769
Under GENERAL PERMIT NCG550000
TO DISCHARGE 100%-DOMESTIC AND SIMILAR WASTEWATERS
UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
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,
Green Meadows Baptist Church
are hereby authorized to operate a wastewater treatment facility consisting of a septic tank with effluent
filter, flow equalization tank, Orenco AX-100 recirculating filter, UV disinfection and rip -rap;
discharging from facilities located at the
Single -Family Residence (SFR)
1646 NC Highway 801
Davie County
to receiving waters designated as an unnamed tributary to Hauser Creek [Stream Index: 12-86] a waterbody
currently classified as WS-IV located within sub -basin 03-07-02 [HUC: 0304010112] of the Yadkin Pee -
Dee 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 NCG550000 as attached.
This Authorization to Construct (ATC) shall become effective January 12 , 2021
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day January 12 , 2021
DocuSigned by:
,--„,,A4,
8328B44CE9EB4A1...
S. Daniel Smith
Director, Division of Water Resources
By Authority of the Environmental Management Commission