NCG550034_Permit (Issuance)_20070719

Agel7rr
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
July 19,2007
Terence Kelly&Kathryn Washburn
2121 Pershing Street
Durham,NC 27705
Subject: Renewal of coverage/General Permit NCG550000
Certificate of Coverage NCG550034
Durham County
Dear Permittee:
In response to your renewal application,the Division is issuing a renewed Certificate of Coverage
(CoC)to discharge under NCG550000. This permit 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.
This CoC is not transferable except after notice to the Division. Contact the Raleigh Regional
Office at [phone] if you intend to sell the property covered by this CoC. A staff member will
tell you what steps are necessary to document the transfer of ownership. The Division may require
modification or revocation and reissuance of the 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 in this permit,please contact Toya Fields
[919 733-5083, extension 551 or [e-mail]] or Susan A. Wilson [919 733-5083, extension 510 or
[e-mail]].
Sincerely,
•
AL-- '76
for Coleen H. Sullins
cc: Central Files
Ra lei•h Regional Office/Surface Water Protection
orc
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 North Carolina
Phone: [phone]/FAX [phone]/Internet:www.ncwaterquality.org Natural!,
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper L

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550034
TO DISCHARGE DOMESTIC WASTEWATERS FROM SINGLE FAMILY RESIDENCES AND
OTHER 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,
Terence Kelly & Kathryn Washburn
is hereby authorized to operate a wastewater treatment facility for the discharge of treated
domestic wastewater [< 1000 gallons per day] from a facility located at:
3323 Redwood Road
Durham
Durham County
to receiving waters designated as an unnamed tributary to Panther Creek in subbasin 30401 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 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 19, 2007.
k76 ;-
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

FOR AGENCY USE ONLY
Date Received
Year Month Day
A 'f Division of Water Quality/Water Quality Section
Al
Certificate of Coverage
_N CDENR National Pollutant Discharge Elimination System N G
g Y Check# Amount
NORTH CAROUNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES Permit Assigned to
NCG550000
RENEWAL FORM FOR EXISTING PERMITTED FACILITIES
NPDES renewal application for continued coverage under General Permit NCG550000:
Certificate of Coverage NCG550034
(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: F^ I
Owner Name Kathryn Washburn&Terence Kelly
Street Address 2121 Pershing Street
City Durham,NC 27705
Telephone (Home) c6 ? -Z �+ 2 6,a7(Mobile)
(e-mail address)
*Address to which all permit correspondence will be mailed
2) Location of facility producing discharge*:
Street Address 3323 Redwood Rd
City: Durham,NC 27704
County Durham
Telephone (Home) _ (Mobile)
* If the facility 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):
,Cl" Primary residence
❑ Vacation/second home
❑ Undeveloped property
❑ Other [describe]:
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NCG550000 renewal form
4) Please check the components that comprise the wastewater treatment system:
,Septic tank ❑ Dosing tank ,'Primary sand filter ❑ Secondary sand filter
❑ Recirculating sand filter(s) Zr Chlorination ❑ Dechlorination . _ .
❑ Other form of disinfection: ❑ Post Aeration(describe)
5) Other Information:
a) When was the septic tank last pumped out? LT t'i7.74
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? ,/
c) Approximately how many people use the facility when it is occupied? G i l 'v ,
d) When was the wastewater system installed? ti-'l if 14 t9(A/4
6) Certification:
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: X e
f
o�-�- 21 9/O 7
(Signature of Applicant) (Date Signed)
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 to:
Mr. Charles H. Weaver, Jr.
NC DENR/DWQ/NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
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