NCG550059_Other Agency Documents_19970721

State of North Carolina
Department of Environment,
Health and Natural Resources / •
• •
Division of Water Qualityoik
p
James B. Hunt, Jr., Governor E:20.E H N
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director July 21, 1997
Mike Cservenko
4663 Paula Drive
Winston-Salem,NC 27127
Subject: Certificate of Coverage No. NCG550059
Renewal of General Permit
Cservenko,Mike-Residence
Forsyth County
Dear Permittee:
In accordance with your application for renewal of the subject Certificate of Coverage,the Division is forwarding
the enclosed General Permit. This renewal is valid from the effective date on the permit until July 31,2002. This
permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the Memorandum of
Agreement between North Carolina and the U.S. Environmental Protection Agency dated December 6,1983. If any
parts,measurement frequencies or sampling requirements contained in this 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, this Certificate of Coverage shall be final and binding.
The Certificate of Coverage for your facility is not transferable except after notice to the Division. Use the enclosed
Permit Name/Ownership Change form to notify the Division if you sell or otherwise transfer ownership of the
subject facility. The Division may require modification or revocation and reissuance of the Certificate of Coverage.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the Regional
Office listed below at [phone]. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain other permits which may be required by the Division of
Water Quality,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 this permit,please contact the NPDES Group at the address below.
Sincerely,
1),fiv:4---A 977,44,A____---
A.Preston Howard,Jr.,P.E.
cc: Central Files
Winston-Salem Regional Office
NPDES Group
Facility Assessment Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535 [phone] FAX[phone] p&[e-mail]
An Equal Opportunity Affirmative Action Employer 50% recycled /10%post-consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG550000
CERTIFICATE OF COVERAGE NO. NCG550059
TO DISCHARGE DOMESTIC WASTEWATERFROM 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,
Mike Cservenko
is hereby authorized to operate a wastewater treatment facility which includes a septic tank, sand filter
and associated appurtenances with the discharge of treated wastewater from a facility
located at
Cservenko,Mike-Residence
4663 Paula Drive
Winston-Salem
Forsyth County
to receiving waters designated as subbasin 30704 in the Yadkin River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts I,II, III and IV of General Permit No. NCG550000 as attached.
This certificate of coverage shall become effective August 1, 1997.
This certificate of coverage shall remain in effect for the duration of the General Permit.
Signed this day July 21, 1997.
1)-4,1:ic,- A
fel/A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

""-4 Letter to MIKE CSERVENKO February 7,1997
'*AT4 ; a 059
INVOICE FOR RENEWAL OF
NPDES PERMIT
ElCheck here if you do NOT wish to renew this permit.
of
Please return this page along with a letter documenting your reasons OP
for not requesting renewal to: - v k0 ill
Jr. ®�� 3t r
Mr. Charles H. Weaver, „ _,,, �:
Division of Water Quality/WQ Section -- cn==:',.
NPDES Group ,, .L;'
p
Post Office Box 29535 rn
Raleigh, North Carolina 27626-0535 • _ c"-t 6
'• �fJ
Check here if you wish to renew this permit. - -
Please verify the following information and revise any incorrect entries: - -_. __
Mailing Address
MIKE CSERVENKO ❑ No revision required.
CSERVENKO, MIKE - RESIDENCE
4663 PAULA DRIVE
WINSTON-SALEM, NC 27127 ❑ Revision required. (Please specify below.)
Phone number:(919)-659-1659
5/O 7 ,-o' .7
Fax number:
e-mail address:
Facility Location
MIKE CSERVENKO ❑ No revision required.
4663 PAULA DR
WINSTON SALEM,NC 27127 0 Revision required. (Please specify below.)
Please return this page with your letter requesting renewal, and $240 fee (payable to NCDEHNR) to:
Mr. Charles H. Weaver, Jr.
Division of Water Quality/WQ Section
NPDES Group
Post Office Box 29535
Raleigh, North Carolina 27626-0535
. -rad
Signature of applicant or authorized representative 2
Date 3 6 9

•
RECEIVED
4401
SEP 2 3 1992
TECHNICAL SUPPORT BRANCH
State of North Carolina ' r,
Department of Environment, Health and Natural Resources
Division of Environmental Management
512 North Salisbury Street•Raleigh,North Carolina 27626-0535
James G. Martin,Governor A. Preston Howard,Jr.,P.E.
William W. Cobey,Jr., Secretary Acting Director
September 21, 1992
Mike Cservenko
4663 Paula Drive
Winston-Salem, NC 27127
Subject: NPDES No. NC0030961
Cservenko Residence
formerly issued to
Larry M. Peddle
Forsyth County
Dear Mr. Cservenko:
In accordance with your request received August 27, 1992, we are forwarding
herewith the subject permit now issued to you. The only changes in this permit are in name
and ownership as well as update the permit to current DEM regulations. This permit is issued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between North Carolina and the U. S. Environmental Protection
Agency dated December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this
permit are unacceptable to you, you have the right to an adjudicatory hearing upon written
request within thirty (30) days following receipt of this letter. This request must be in the
form of a written petition, conforming to Chapter 150E of the North Carolina General Statutes,
and filed with the Office of Administrative Hearings, Post Office Drawer 27447, Raleigh, North
Carolina 27611-7447. Unless such demand is made, this decision shall be final and binding.
Please take notice that this permit is not transferable. Part II, E.4. addresses the
requirements to be followed in case of change in ownership or control of this discharge.
This permit does not affect the legal requirement to obtain other permits which may be
required by the Division of Environmental Management 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.
Pollution Prevention Pays
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

•
Page 2
September 21, 1992
If you have any questions concerning this permit, please contact Susan Robson at
telephone number 919/733-5083.
Sincerely,
(162e,/47/A-1-€--4-'----
� Preston Howard, Jr., P.E.g
ctin Director
cc: Mr. Jim Patrick, EPA
Winston-Salem Regional Office
Compliance
Central Files
Technical Support Branch
Kim Brantley