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Home My WebLink AboutNCG550045_Permit (Issuance)_20070730 Arlin 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 30,2007 David E. Sexton 129 Forestdale Drive Reidsville,NC 27320 Subject: Renewal of coverage/General Permit NCG550000 129 Forestdale Drive Certificate of Coverage NCG550045 Rockingham County Dear Permittee: In accordance with your renewal application [received on February 1,2007],the Division is renewing Certificate of Coverage(CoC)NCG550045 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 toya.fields@ncmail.netl or Susan Wilson [919 733-5083, extension 510 or susan.a.wilson@ncmail.netl. Sincerely, /4" ` jam for Coleen H. Sullins cc: Central Files Winston-Salem Regional Office/Surface Water Protection WP124 ( 1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One 512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarolina Phone: 919 733-5083/FAX 919 733-071 9/Internet:www.ncwaterquality.org Naturally 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 NCG550045 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 E. Sexton is hereby authorized to discharge domestic wastewater [450 GPI)] from a facility located at 129 Forestdale Drive Reidsville Rockingham County to receiving waters designated as an unnamed tributary to Town Creek (Sharps Lake) 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. / rf _ for Coleen H. Sullins, Director Division of Water Quality By Authority of the Environmental Management Commission • • North Carolina Department of Environment and Natural Resources Division of Water Quality RENEWAL FORM FOR EXISTING PERMITTED FACILITIES NPDES renewal application for continued coverage under General Permit NCG550000: Certificate of Coverage NCG550045 (Please verify the information in items 1 &2 as correct, or note any corrections that should be made.) C - (Please print or type all other answers) _ 1) Mailing address* of property owner: ' Fr-B CI 2007r n Owner Name David E Sexton/ " Street Address 129 Forestdale Dr Address Reidsville,NC 27320 Telephone (Home) 33 C 6 2 /r�- o f d�j 7 (Mobile) 236 G 3 - 2 0 3 3 (e-mail address) d S e-KT N612d do- i e. Cc / *Address to which all permit correspondence will be mailed • 2) Location of facility-producing discharge*: ,-- - Facility ID Sexton David E-Residence Address: 129 Forestdale Dr, Reidsville,NC 27320 (Rockingham County) Telephone (Home) 3 3 6 - G 2-?- of ! (Mobile)33 6, 3 - 2 033 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): yek. Primary residence ❑ Vacation/second home ❑ Undeveloped property ❑ Other [describe]: 4) Please check the components that comprise the wastewater treatment system: Septic tank ElDosing tank ' V\Primary sand filter ❑ Secondary sand filter ❑ Recirculating sand filter(s) ❑ Chlorination 7 ❑ Dechlorination 0 Other form of disinfection: 0 Post Aeration(describe) Page 1 of 2 • NCG550000 renewal form _ 5) Other Information: / O$ a) When was the septic tank last pumped out? ,f"'' � `(`Yam. 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? Ye-tt.,1* y u-/4 l c) Approximately how many people use the facility when it is occupied? �'Z d) When was the wastewater system installed? /112.6oa 19 9 ? 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: U i U � e-)L / f.O/U b 07 (Signature of Applicant) ( ate 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 and a 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 Brooks Septic Tank Service & Port-A-John Service invoice Larry Brooks —DATE INVOICE# 246 Green Leaf Cr. 3 / a0 192 > r'' 533 I Ridgeway, VA 24148 �, , - --_, 0 � ti--- � (276) 956-3510--(276) 956-2870 n\ BILL TO ----------- I ^ Davos Constuction / \ J P.O.Box 2215 Eden,NC 27289-2215 P.O. NO. TERMS PROJECT Due on receipt QUANTITY DESCRIPTION RATE AMOUNT C61>ua 150.00 150.00 @ Poresidale L7iia Sfles Tax , 7.00% 0.00 • 2005 ) . 1 Thank you for your business. Total $150.00;'l