NCG551423_Owner (Name Change)_20140905

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory, Governor John E. Skvarla III, Secretary
September 5, 2014
Angela M. Clements
1017 Patterson Rd
Durham, NC 27704
Subject: Ownership Modification / General Permit NCG550000
1017 Patterson Rd
Certificate of Coverage NCG551423
Durham County
Dear Permittee:
On September 3, 2014, the Division received your request to modify the existing Certificate of
Coverage (CoC) for the subject facility. The Division has approved your request, and hereby reissues the
subject CoC under General Permit 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 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 Charles Weaver of the NPDES staff [919 807-6391 or
charle s. w e aver@nc d enr. gov] .
rely,
or Thomas A. Reeder
cc: Raleigh Regional Office
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
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG551423
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,
Angela M. Clements
is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a
facility located at
1017 Patterson Rd
Durham
Durham County
to receiving waters designated as an unnamed tributary to Little Lick Creek, a class WS-IV NSW
CA 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 5, 2014.
This Certificate of Coverage shall remain valid for the duration of the General Permit.
Signed this day September 5, 2014
for Th s A. Reeder, Director �.
D ision of Water Resources
By Authority of the Environmental Management Commission

North Carolina Department of Environment and Natural Resources
NCDENR
Pat McCrory, Governor
John E. Skvarla, III, Secretary
I. Please enter the permit number for which the change is requested.
Primary Related Permit (or) Certificate of Coverage
N
C
5
5
0
0
0
0
II. Permit status prior to status change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
c. Facility name (discharge):
d. Facility address:
e. Facility contact person:
a
5
At4Gei4- M. O' MEAL
First MI
2-
3
Title
1 r� PPiTiE b
Last
Permit Holder Mailing Address
Q I kP'CYl C
C'ty State Zip
Phone Fax
Address
City
State Zip
( )
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
54 Name change of the facility or owner
Revised 51201�
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
r \ . C LErn6 to
First MI Last
Title
t 0 17 (ARE') b%.l
Permit Holder Mailing Address
1)U R-ANM 1\k-
City State Zip
(� �) (sI1-13�J
Phone E-mail Address
Address
City
State Zip
First MI Last
( )
E-mail Address
Phone

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
V.
VI.
First
MI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
Will the permitted facility continue to conduct the same industrial activities conducted prior
to his ownership or name change?
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 name change and/or ownership change
requests.
0 Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
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.
Signature Date
APP ►. CANT . ER 1: IC ON
I, 4 I, / , ttest that this application for a name/ownership change has
been revie 4 d and is accurate and comp ete to the best of my knowledge. I understand that if all required
part of this application -are -not completed -and -that -if -all required supporting -information is not -included;
this application package will be returned as incomplete.
Revised 512014
Signature
ogl3i�iy
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
June 25, 2014
Angela M. Clements
1017 Patterson Road
Durham, NC 27704
RECEIVED
JUL 0 ] Z014
CENTRAL FILES
DWQIBOG
Subject: Compliance Evaluation Inspection
Single Family Wastewater Treatment System
Permit No. NCG551423
Durham County
Dear Ms Clements:
On June 25, 2014, Mitch Hayes from the Raleigh Regional Office visited your single-family residence
(SFR) wastewater treatment system to evaluate compliance with the above permit to discharge
wastewater. The checked boxes below show what conditions were noted at your facility:
❑ In compliance: You are reminded to regularly maintain the chlorine disinfection and
dechlorination systems, have the effluent sampled once a year, and have the septic tank
pumped out every 3 to 5 years. Your good record of operation and meeting the permit
requirements is highly commended.
❑ Your home is improperly plumbed: Some of the wastewater discharges are going directly
to the environment without first passing through the treatment system. This must be corrected
immediately. Please submit a schedule to this office within 30 days of receipt of this letter that
states your plan for correcting this deficiency. The work is to be completed within the next 3
months.
❑ Disinfection: Your system is lacking disinfection, either chlorine tablets or a UV light
system. New rules put into place on August 1, 2007 require all SFR systems to have a means
of disinfection (and dechlorination when chlorine tablets are used to disinfect, if the system was
installed since that date). Since your system had no disinfection, the installation is to include a
chlorine tablet dispenser, a contact chamber capable of providing a minimum 30 minute contact
time, and another tablet dispenser that will hold dechlorination tablets. Please submit a
schedule to this office within 20 calendar days of receipt of this letter that states your plan for
correcting this deficiency.
❑ Treatment tablets missing or are wrong kind: You are responsible for always having
chlorine tablets and dechlorination tablets (if a required part of your system) in place. They must
be the kind for wastewater treatment and not for swimming pools.
❑ Dechlorination: Your system was installed after August 1, 2007, so must have a means of
dechlorination located downstream of the chlorinator and its contact chamber. See Disinfection
paragraph above. Please submit a schedule to this office within 20 calendar days of receipt of
this letter stating your plan for correcting this deficiency.
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Phone [phone] Customer Service
Internet: http://oortal.ncdenr.orq/web/wo/ 1628 Mail Service Center Raleigh, NC 27699-1628 FAX [phone]
An Equal Opportunity/AffirmativeAction Employer
Noe Carolina
Vturall4
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Angela Clements Residence Page 2 of 2
® Pumping the septic tank: The septic tank should be pumped out every 3 to 5 years. A
pumping company can check the status periodically and determine when pumping is required.
Failure to analyze the effluent: The effluent that is discharged from your system must be
analyzed once each year. See Part I (A) of your permit about his requirement. A list of NC
certified laboratories that provide this service was left at your residence during the inspection.
Make arrangements for sampling to be carried out within the next 3 months, and submit results
to this office within 3 weeks after the sampling has been done.
❑ Locations of treatment units are unknown: Determine this and report to this office within
30 days of receipt of this letter with a sketch or map.
® Other: Durham tax records indicate that your last name has changed to Clements. Division
of Water Resources records list Angela M. O'Neal as the Permittee. Please fill out the attached
name / ownership change form and mail the completed form to the address listed on page 2 of
the form below the applicant signature. There were no chlorine tablets in the chlorinator. Please
maintain weeks' worth tablets in the chlorinator. Access to the dechlorinator could not be
gained. Please ensure dechlorination tablets are maintained in the dechlorinator.
If you have questions or comments about this inspection or the requirements to take corrective action,
please contact Mitch Hayes at 919-791-4200. Licensed plumbers should be used to make plumbing
changes within your home. Contractors for installing disinfection or other equipment may be found in
the Yellow Pages under Environmental Consultants.
Sincerely,
/da /2 ,;-/Z-1/
S. Daniel Smith, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
cc: RRO/SWP Files
Central Files
Attachments

United States Environmental Protection Agency
EPA Washington, D.C. 20460
Water Compliance Inspection Report
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
. Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/molday Inspection
1 LJ 2 15j 3 I NCG551423 111 12 14/06/25 17
Type
18 I ,• I
l l l
Inspector
19
FacType
Ls] I 2011
211 1 1 1 1 I I l i I I l II i I l i I I I I I milli
i li
l l l l l l66
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
67 I I 70 L 71 Li 72 LJ
Reserved
73 1 I74 75j
I I I I I t 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
1017 Patterson Road
1017 Patterson Rd
Durham NC 27704
Entry Time/Date
11:50AM 14/06/25
Permit Effective Date
13/08/01
Exit Time/Date
12:15PM 14/06/25
Permit Expiration Date
18/07/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Ill
Angela M O'NeaVOwner//
Other Facility Data
Name, Address of Responsible OfficialTtle/Phone and Fax Number
Angela M O'Nea1,1017 Patterson Rd Durham NC 27704/// Contacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Records/Reports Facility Site Review Effluent/Receiving Waters
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
Mitchell S Hayes RRO WQ//919-791-4200/
/V. b0-i-tne. .25, go 1 hi
Si net of Managemen A Revi r Agency/Office/Phone and Fax Numbers Date
p#d* i bliOleh (f»vrd .77a;i0 / C
EPA Form 35(Rev 9-94) Previous editions re obsolete.
Page# 1

NPDES
NCG551423
yr/mo/day
14/06/25
Inspection Type
17 18 uj�
(Cont.)
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Waste treatment system consists of the following units: septic tank with effluent filter, distribution box,
sandfilter for a 4 bedroom home, chlorinator / contact chamber, pump tank with high water alarm,
dechlorination unit, discharge pipe with rip / rap pad for aeration. Efflunet discharge is to a shallow wet
are ravine. There was evidence of sewage at the discharge point. There were no chlorine tablets in the
chlorinator / contact chamber. Access to the dechlorinator could not be gained. There were no records
available during the inspection.
Page# 2

Permit: NCG551423
Owner - Facility: 1017 Patterson Road
Inspection Date: 06/25/2014 Inspection Type: Compliance Evaluation
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new
application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment: No special conditions in•the permit.
Record Keeping
Are records kept and maintained as required by the permit?
Is all required information readily available, complete and current?
Are all records maintained for 3 years (lab. reg. required 5 years)?
Are analytical results consistent with data reported on DMRs?
Is the chain -of -custody complete?
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?
Has the facility submitted its annual compliance report to users and DWQ?
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
on each shift?
Is the ORC visitation log available and current?
Is the ORC certified at grade equal to or higher than the facility classification?
Is the backup operator certified at one grade less or greater than the facility classification?
Is a copy of the current NPDES permit available on site?
Facility has copy of previous year's Annual Report on file for review?
Comment: Records were not available during inspection.
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
•
Yes No NA NE
❑ ❑■❑
MI ❑ ❑ ❑
❑ ■❑❑
❑ ❑ • ❑
• ❑ ❑ ❑
Yes No NA NE
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ MI ❑
❑ ❑ MI ❑
❑❑ ■❑
0
0
0
0
0
0
❑ ❑ • ❑
❑ ❑ I ❑
❑ ❑ � ❑
❑ ❑ • ❑
❑ D ■ ❑
❑ ❑ II
❑ ❑ II ❑
❑ ❑ • ❑
Yes No NA NE
▪ ❑ ❑ ❑
❑❑❑
Page# 3

Permit: NCG551423 owner - Facility: 1017 Patterson Road
Inspection Date: 06/25/2014 Inspection Type: Compliance Evaluation
Effluent Pipe Yes No NA NE
If effluent (diffuser pipes are required) are they operating properly?
❑❑■❑
Comment: There was no discharge at the time of inspection. There was no evidence of sewage on the
ground.
Page# 4