NCG551387_Owner (Name Change)_20210813

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
August 13, 2021
Charles L. Gibbs
Charles L. Gibbs Family Trust
P.O. Box 1246
Durham, NC 27702-1246
Subject: General Permit NCG550000
Certificate of Coverage (CoC) NCG551387
3714 Esther Rd
Durham County
Dear Permittee:
The Division has received and approved your request to transfer coverage under the subject General
Permit. Accordingly, the Division hereby issues you a revised version of NCG551387, along with a copy of
NCG550000. Discard any earlier versions of the permit and use this version until further notice. 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 October 15, 2007 [or
as subsequently amended].
PLEASE NOTE: Your facility discharges to a class WS-V NSW waterbody. Therefore, you will use
the limits and monitoring frequencies found in Part I, section C. (3.) of NCG550000.
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. The Division may require
modification or revocation and reissuance of the CoC. Contact the Raleigh 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 any other State, Federal, or Local
governmental permit that may be required. If you have any questions concerning the requirements of the
General Permit, please contact Derek Denard of the NPDES staff [[e-mail]].
cc: NPDES file
NORT
Department of Environmental Dual
Sincerely,
for S. Daniel Smith
Director, Division of Water Resources
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

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG551387
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,
Charles L. Gibbs
Charles L. Gibbs Family Trust
is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a
facility located at
3714 Esther Rd
Durham
Durham County
to receiving waters designated as an unnamed tributary to Northeast Creek, currently a class WS-
V NSW stream in subbasin 03-06-05 of the Cape Fear River Basin in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, and III hereof.
This certificate of coverage takes effect 8/13/2021.
This Certificate of Coverage shall remain valid for the duration of the General Permit.
Signed this day 8/13/2021
for S. Daniel Smith
Director, Division of Water Resources
By Authority of the Environmental Management Commission

ROY COOPER
Genvpror
MICHAEL S. REGAN
S. ©ANIEL SMITH
NORTH CAROLINA
Environmental Quality
NPDES Certificate of Coverage (CoC)
NCG550000 OWNERSHIP CHANGE FORM
I. Please enter the CoC number for which the change is requested.
Certificate of Coverage
II. Please provide the following for the requested change (revised CoC).
a. Request for change is a result of: ❑ Change in ownership of the residence/property
Name change of the facility or owner
If other please explain:
N,C,G 5 5 /
I 3 art
b. CoC will be issued to (person's name
or company name, if applicable):
c. Owner: person legally responsible for
CoC:
d. Facility name (if applicable):
e. Facility address:
Netc‘,n L C.7 ► 00S Feiry Tr IA4-
Norl-es L. 6-i bbs
First MI Last Tr u-ee
{''�—J Title
O V 13 c PAP
Permit Holder Mailing Address
(DULY AAVVt NC (9770
City State Zip
(91 ) -10-8 ibhsa35 ao1. pow,
Phone E-Mail Address
^{ r / LiEst het a
uL _
Address
City State Zip
f. Facility contact person: x s L. f b
[if different from Owner] First MI Last
_( ._ 1 S rif.-Lo- & � _ -4
Phone E-mail Address
III. Contact person (if different from the person legally responsible for the CoC)
First
MI Last
Title
Mailing Address
City State Zip
( )
Phone E-mail Address
Revised 12/2018

IV.
V.
NCG550000 OWNERSHIP CHANGE FORM
Page2of2
Will this permitted facility continue to discharge the same volume and type of wastewater as
prior to this ownership or name change?
-S Yes
No (please explain)
Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both facility -name change and/or facility ownership
change requests.
❑ Legal documentation of the transfer of ownership (such as a property deed, relevant pages of a
contract, or a bill of sale) is required for an ownership change request.
The certifications below must be completed and signed by the new applicant in the case of an ownership
change request.
APPLICANT CERTIFICATION
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
2At
F
/(.(5. 202I
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Mr. Charles H. Weaver
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Revised 412020

STATE OF NORTH CAROLINA REVOCABLE
COUNTY OF DURHAM TRUST AGREEMENT
THIS REVCABLE TRUST AGREEMENT (hereinafter "Agreement")is entered
into this Z'l.-. day of May, 2015, by and between CHARLES L. GIBBS, who is
sometimes referred to in this Agreement in the first person (hereinafter
"Grantor") and COURTNEY DEAVER MATTHEWS, who is sometimes referred to in
this Agreement as the "independent Trustee", and CHARLES L. GIBBS, who
is sometimes referred to in this trust instrument as the "family
Trustee" (hereinafter "Trustee"). This Trust shall be known as the
"CHARLES L. GIBBS FAMILY TRUST."
ARTICLE I
Trust Property
A. Original Trust Property. I have delivered to the Trustees as the
original trust property that property listed on Exhibit A attached
hereto, receipt of which the Trustees acknowledge.
B. Additions to Trust Property. I or any other person may make
additions to the principal of any trust under this trust instrument by
lifetime gift, will, designation of the Trustees as beneficiary or
otherwise.
ARTICLE II
Disposition of Trust
Property During Grantor's lifetime
During such time as Grantor shall be living, the trust property
shall be disposed of as follows:
A. Distribution in Family Trustee's Discretion. The family Trustee
may distribute all or any portion of the net income and principal of the
trust to any one or more of the group consisting of the in such amounts
and at such times as the family Trustee, in his discretion, may
determine.
B. Distribution as Grantor Directs. In addition, the Trustees
shall distribute the net income and principal as Grantor may direct from
time to time by instructions signed by Grantor and delivered to the
Trustees, except that during such periods as Grantor is incapacitated
the independent Trustee, in its discretion, may decline to follow any
such instructions.
ARTICLE III
Disposition of Trust
Property After Grantor's Death
After the death of Grantor the trust property, including any
property payable to the Trustees as a result of a Grantor's death, shall
be disposed of as provided in this Article.

_triThe Trustees and I have signed and sealed this instrument on the
`aay of May, 2015.
t"' (SEAL)
les L. Gibbs, Grantor and
Family Trustee
(SEAL)
Courtney Deaver Matthews, Trustee
STATE OF NORTH CAROLINA
COUNTY OF DURHAM
I, Paula M. Turner, a Notary Public for said County and State, do
hereby certify that Charles L. Gibbs, Grantor/Trustee, personally
appeared before me this day and acknowledged the due execution of the
foregoing instrument.
W1t���gUUCH1:7U� EI
b � CO*
pC
MrNorth Caco
Convramion
My Commission' 'expires:03,-27-2015
STATE OF NORTH CAROLINA
COUNTY OF
notarial seal, this the C i ay of May, 2015.
Notary Public
I, , a Notary Public for said County and
State, do hereby certify that Courtney Deaver Matthews, Trustee,
personally appeared before me this day and acknowledged the due
execution of the foregoing instrument.
2015.
Witness my hand and notarial seal, this the day of
My Commission expires: Notary Public
14