NCG550001_Permit Renewal_20070730

AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross, Jr., Secretary
Coleen H. Sullins, Director
David N. Watson
1319 Tellowee Road
Eden, NC
Dear Permittee:
27288
July 30, 2007
Subject: Renewal of coverage / General Permit NCG550000
1319 Tellowee Road
Certificate of Coverage NCG550001
Rockingham County
In accordance with your renewal application [received on January 31, 2007], the Division is renewing
Certificate of Coverage (CoC) NCG550001 to discharge under 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 May 9, 1994 [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 Winston-Salem 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 other permits which may be required by
the Division of Water Quality or permits required by the Division of Land Resources, Coastal Area
Management Act or any other Federal or Local governmental permit that may be required.
If you have any questions concerning the requirements of the General Permit, please contact Toya
Fields [919 733-5083, extension 551 or [e-mail] or Susan Wilson [919 733-5083, extension 510
or [e-mail]].
Sincerely,
for Coleen H. Sullins
cc: Central Files
Winston-Salem Regional Office / Surface Water Protection
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
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
One
NorthCarolina
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550001
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,
David N. Watson
is hereby authorized to discharge domestic wastewater [360 GPD] from a facility located at
1319 Tellowee Road
Eden
Rockingham County
to receiving waters designated as an unnamed tributary to the Dan River in subbasin 03-02-03 of
the Roanoke 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 shall become effective August 1, 2007.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 30, 2007.
t'A c..1/,,,,
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

rA
NCDENR
NORh+ CJROUNA DeR4RTMENT OF
EPARRONMENr ANO NATURAL RESOURCES
Division of Water Quality / Water Quality Section
National Pollutant Discharge Elimination System
NCG550000
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
Certificate ofICo Coverage
N I C
Check #
Amollunt
Permit Assigned to
RENEWAL FORM FOR EXISTING PERMITTED FACILITIES
NPDES renewal application for continued coverage under General Permit NCG550000:
Certificate of Coverage NCG550001
(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 David Kay Watson _ - --
Street Address 1319 Tellowee Rd
City Eden, NC 27288
Telephone (Home 3. 3 6) 6.23 t (871gMobile)
(e-mail address)
* Address to which all permit correspondence will be mailed
2) Location of facility producing discharge*:
Street Address 1319 Tellowee Rd
City: Eden, NC 27288
County Rockingham
Telephone (Home) 3 5�') (923 - g (Mobile)
* If thefacility is not yet constructed, give the street address or lot number where the structure will be
built.
3) Description of Discharge:
a) Type of facility producing waste (please check one):
IePrimary residence
❑ Vacation/second home
❑ Undeveloped property
❑ Other [describe):
Page 1 of 2

NCG550000 renewal form -
4) Please check the components that comprise the wastewater treatment system:
Ei-Septic tank ❑ Dosing tank Primary sand filter C2'8econdary sand filter
❑ Recirculating sand filter(s) f-Chlorination ❑ Dechlorination
❑ Other form of disinfection: 0 Post Aeration (describe)
5) Other Information:
a) When was the septic tank last pumped out?7)
. C /6 ZOOC(
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? \'1'? int./
c) Approximately how many people use the facility when it is occupied? 3
d) When was the wastewater system installed?
6) Certification:
D1E C',. ) 003
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: 11AkLi) /f W.41 5') V
(Signature of Applicant)
A -1 '
(D6te Signed)
r/
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 [if available] copy of the receipt for your last septic service
to:
Mr. Charles H. Weaver, Jr.
NC DENR / DWQ / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Page 2 of 2

InvoicE
BILLINGSLEY SEPTIC TANK COMPANY
149 PENN RD.
REIDSVILLE, NC 27320
Voice: [phone]
Fax: [phone]
Sold To:
NEAL WATSON
1319 TELLOWEE
EDEN, NC 27288
Customer ID:NEAL W
Invoice Number:
10491
Invoice Date:
10/16/04
Page:
1
Customer PO
Payment Terms
Sales Rep ID
Due Date
Net 30 Days
11/15/04
Description
Amount
PUMPED SEPTIC TANK
-4cL) 9.„) /01A60,
150.00
Check No:
Subtotal 150.00
Sales Tax
Total Invoice Amount 150.00
Payment Received 0.00
TOTAL 150.00
We will add finance charges on invoices more than 30 days overdue.