NCG550372_owner name change_20230220

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR. NORTH CAROLINA
Director Environmental Quality
February 20, 2023
Carolyn B. Sigmon
713 Cascade Avenue
Eden, NC 27288
Subject: General Permit NCG550000
Certificate of Coverage (CoC) NCG550372
713 Cascade Avenue
Rockingham County
Dear Permittee:
The Division has approved your request to transfer coverage under the subject General Permit.
Accordingly, the Division hereby issues you a revised version of NCG550372, 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 C waterbody. Therefore, you will use the limits
and monitoring frequencies found in Part I, section C. (1.) 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 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 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
Sincerely,
li V.7)7
.
for Richard E. Rogers, Jr.
Director, Division of Water Resources
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11611 Mail Service Center I Raleigh, North Carolina 27699-1611
919.707.9000

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550372
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,
Carolyn B. Sigmon
is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a
facility located at
713 Cascade Avenue
Eden
Rockingham County
to receiving waters designated as an unnamed tributary to Dry Creek, currently a class C stream
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, and III hereof.
This certificate of coverage takes effect 2/20/2023.
This Certificate of Coverage shall remain valid for the duration of the General Permit.
Signed this day 2/20/2023
ii 144
for Richard E. Rogers, Jr.
Director, Division of Water Resources
By Authority of the Environmental Management Commission

NORTH CAROLINA
Environmental Quality
NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NPDES PERMITTING
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCOO //// or NCG5.5///6_/7f42-.,
1. Facility Name: C�Gi''!OJ �5l r r) 7/3ea_s-q de
II. NEW OWNER/NAME INFORMATION: '
IA/c,
1. This request for a name change is a result of: -7� ?7
a. Change in ownership of property/company
b. Name change only
c. Other (please explain):
2. N w owner's name n rpe to be put on permit):
C..ctrolpi I Mar)
3. New owner's or signing official's name and title:
P n I ally responsible f
awson
(Title)
I� �1
4. Mailing address:7/3 �SCg MeCity:
State: A/C Zip Codev 57.,E Phone: ( 334) (< 75
E-mail address: alro/ 4 Si5n//046 /lQi •
III. FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same as under the previous owner? Yes
2. Will the treatment system and discharge location remain the same? Yes,' No 0
"No Responses"
If either or both of these questions are answered "No" then more information will be needed to review the
request. Please attach documentation to describe and explain the changes to the facility activities, waste
stream, treatment process or outfall location. The Division may not be able to process the Permit
Name/Ownership Change request and may require that the new owner file a new permit application.
E
NORTH CAROLINA/
Department of Emrironme el away,\ �h.°
North Carolina Department of Environmental Quality I Division of Water Quality
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

NPDES Name and Ownership Change
Page 2 of 2
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)
3. Information to document facility, waste stream, treatment system or outfall changes as noted in
item III above (if appropriate)
Applicant's Certification:
/ l
, attest that this application for a
name/owners p change has been v' wed 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. I understand that Permit Name/Ownership Change can only take place through action
taken by the Division of Water Resources and that no actions on my part or the part of my company
result in the automatic transfer of permit coverage.
Signature:?
Date,2—/—
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 07/2021