NCG550771_owner name change_20160926

FOCI
Water Resources
ENVIRONMENTAL OUALITY
September 26, 2016
Peggy Ruth Allen and Valentenio Belton
1521 S Mineral Springs Road
Durham, NC 27703
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Subject: General Permit NCG550000
1521 South Mineral Springs Road
Certificate of Coverage NCG550771
Durham County
Dear Permittee:
Director
The Division has received and approved your request to transfer ownership of the subject Certificate
of Coverage (CoC) under General Permit NCG550000. As a result, the Division hereby reissues NCG550771.
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].
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 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 Brianna Young of the NPDES staff [919-807-6388 or
brianna.young@ncdenr. gov] .
for S. Jay Zimmerman, .G.
Director, Division of Water Resources
cc: Raleigh Regional Office
NPDES File
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.nc.gov/aboubdivisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550771
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,
Peggy Ruth Allen and Valentenio Belton
is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a
facility located at
1521 South Mineal Springs Road
Durham
Durham County
to receiving waters designated as an unnamed tributary to Little Lick Creek, a class WS-IV NSW
stream in subbasin 03-04-01 of the Neuse 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 takes effect September 26, 2016.
This Certificate of Coverage shall remain valid for the duration of the General Permit.
Signed this day September 26, 2016.
for Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission

PAT MCCRORY
t*
M
Water Resources
ENVIRONMENTAL QUALITY
Governor
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NC00 . / / / / or NCG5 /
1. Facility Name: - r t
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
.4. Change in ownership of property/company
b. Name change only
c. Other (please explain):
Director
RECEIVED/NCDEQ/DWR
APR 19 2016
Water Quality
Permitting Section
2. New owner's name (name
to be put on permit):
'efif').\/
3. New owner's or signing official's name and title:
Ake ,ron gaily responsibile for permit)
4. Mailing address: ;' S I Y ,d-,l(
State:/ , . Zip Code:
E-mail address: re. _05 )/r ta-
(Title)
U.11.;-\
r Phone: Al ) S (� cl -ico
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
http://portal.ncdenr.org/web/wq

Applicant's Certification:
1,R( 1 �,� , attest that this application for a
name/ownership change has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed and that
if all required supporting information and attachments are not included, this application
package will be returned as incomplete.
Signature:
/t
Date:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 12/2015