WQ0004216_Renewal Notification_20230327

DocuSign Envelope ID: 951AF36D-04B8-4AOE-AO31-DECO3lE7C392
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
RICHARD L. GOODSON
1404 STALEY BOSWELL ROAD
YANCEYVILLE, NORTH CAROLINA 27379
Dear Mr. Goodson:
NORTH CAROLINA
Environmental Quality
March 27, 2023
Subject: Permit No. WQ0004216
Permit Renewal Notification
1404 Staley Boswell Rd. SFR
Single -Family Residence
Wastewater Irrigation System
Caswell County
Division of Water Resources' records indicate that Permit No. WQ0004216, issued March 8, 2018,
expires April 30, 2023. As the Permittee, you are responsible for renewing and maintaining this permit.
Pursuant to administrative code 15A NCAC 02T .0109, permit renewal requests shall be submitted at least
180 days prior to permit expiration.
Please complete and submit the attached Single -Family Residence Wastewater Irrigation System
Renewal application (Form: SFRWWIS-R 02-21). This form has been prefilled for your convenience.
Please complete any portions that are not filled out and double-check all information for accuracy.
Within 30 calendar days of receiving this notification, submit the completed forms to:
Email:
Non-Discharge.Reportsgncdenr. goy
Mail:
Attn: Alys Hannum
OR Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Once the application is received, Winston-Salem Regional Office staff will conduct a site visit and
inspect the non -discharge system. Upon completion of the site visit and application review, a renewed non -
discharge permit shall be issued for a length of up to eight years. Failure to provide these forms prior to
the permit expiration date may result in a Notice of Violation for operating the subject facilities without
a valid permit, which is a violation of G.S. 143-215.1, and may subject the Permittee to appropriate
enforcement actions pursuant to G.S. 143-215.6A-6C,
If you have any questions, please contact me at [phone] or [e-mail].
Sincerely, E
DocuSigned by:
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Alys Hannum, Environmental Specialist
Division of Water Resources
cc: Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
NORTH CAROLINA -
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