NCG550078_Permit (Issuance)_20240530

OF \N A TE,9p Michael F.Easley,Governor
O G William G.Ross Jr.,Secretary
rNorth Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
Division of Water Quality
October 3,2005
Steven M Wagner
5940 El Camino Dr.
Pfafftown,NC 27040
Subject:NPDES General Permit NCG550000
Certificate of Coverage NCG550078
Steven M Wagner-Residence
Formerly Stephen L Estep-Residence
Forsyth County
Dear Mr.Wagner:
Division personnel have reviewed and approved your request to transfer coverage under the General Permit,
received on October 3,2005.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in the General
Permit remain unchanged and in full effect. This revised Certificate of Coverage is issued under the requirements of
North Carolina General Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S.
Environmental Protection Agency.
If you have any questions,please contact the NPDES Permitting Unit at(919) 733-5083,extension 520.
Sincerely,
X.,
c=)62-) z
jc2 Alan W. Klimek,P.E.
cc: DWQ Central Files
Winston Salem Regional Office,Surface Water Protection
NPDES Unit File
ot`N Carolina
atura!!y
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh,NC 27699-1617 Phone[phone] Customer Service
Internet h2o.enr.state.nc.us 512 N.Salisbury St. Raleigh,NC 27604 FAX [phone] 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG550000
CERTIFICATE OF COVERAGE No. NCG550078
TO DISCHARGE DOMESTIC WASTEWATER 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,
Steven M. Wagner
is hereby authorized to operate a wastewater facility which includes a septic tank, sand filter and associated
appurtenances with the discharge of treated wastewater from a facility located at
STEVEN M WAGNER-RESIDENCE
5940 EL CAMINO DR
PFAFFTOWN
FORSYTH COUNTY
to receiving waters designated as Shope Creek,a class C water,in the French Broad 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 October 7,2005.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 7,2005.
r‘-7L 400-7,,)
E"912-- Alan W. Klimek,P.E.,Director
Division of Water Quality
By Authority of the Environmental Management Commission

c.s;h r Michael F.Easley,Governor
William G.Ross Jr.,Secretary
L:1 ? North Carolina Department of Environment and Natural Resources
'r Alan W.Klimek,P.E.Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C N C G ,S S O 0 7 8
II. Permit status prior to status change.
a. Permit issued to(company name):
b. Person legally responsible for permit: ,STeia V CS RE t'
First / MI / Last
Title
S9�o EL CgmrNv
Permit Holder Mailing Address
/I/�FFrGIN� 4/,C, a 7 o zl0
City State Zip
G1/ o7,f c >
Phone Fax
c. Facility name(discharge):
d. Facility address:
Address
City State Zip
e. Facility contact person: ( )
First / MI / Last Phone
III. Please provide the following for the requested change(revised permit).
a. Request for change is a result of: [IV-Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to(company name):
c. Person legally responsible for permit: s+eke v1 M (,d(�Qy�er
First / MI / Last
Title
. I..D g 5g4o E I Ca.m no Dr.
Permit Holder Mailing Address
cpFci- +ou. n Viler a7O4O
_ OCT 3 2005 City State Zip
•
c 33fo) 9aa- l�4 85 5Gt t c Jaan�v sbc�tl o ba l.
Phone E-mail Addr ne+
C d. Facility name discharge):
t'v;;., .Juiwt_ Onv to
. I a.. ess:
Address
City State Zip
f. Facility contact person:
First / MI / Last
c )
Phone E-mail Address
Revised 7/2005

Book 2582 Page 4375
•
2005045649 00165
FORSYTH CO, NC FEE $20.00
STATE OF NC REAL ESTATE EXTX
$264 .00
PRESENT= f RECORDED:
r - 07-15-2005 12:51 PM
DICKIE C WOOD ^�
�.- REGISTER O1 DEEDS
By:E NAVARRO DPTY
BK:RE 2582
PG:4375-4377
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $264.00
Parcel Identifier No. Verified by County on the day of 20
By:
Mail/Box to: Grantee at address below.
This instrument was prepared by: Bunch&Associates,PLLC,514 S. Stratford Road, Suite 240, Winston Salem,NC 27103
Brief description for the Index:
THIS I1th July 05
DEED mad..� day of ,20 ,by and between
GRANTOR GRANTEE
Stephen L.Estep and wife, Steve Wagner and wife,
Sharon Martin Estep Amy R.Wagner
5940 El Camino Drive
Pfafftown,NC 27040
The designation Grantor and Grantee as used herein shall include said parties;their heirs,successors,and assigns,and sh2.11 include
singular,plural,masculine,feminine or neuter as required by context.
WITNESSETH,that the Grantor,for a valuable consideration paid by the Grantee,the receipt of which is hereby acknowledged,has
and by these presents does grant,bargain,sell and convey unto the Grantee in fee simple,all that certain lot or parcel of land situated in
the City of Pfafftown , Vienna Township, Forsyth County,North Carolina and more
particularly described as follows:
See attachment"EXHIBIT A" for legal description.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 1219 page 0017
A map showing the above described property is recorded in Plat Book _ page .
NC Bar Association Form No.L-3 C 1976,Revised® 1977,2002
Printed by Agreement with the NC Bar Association—1981 SoftPro Corporation,333 E. Six Forks Rd.,Raleigh,NC 27609

Book 2582 Page 4376
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee simple,has the right to convey the same in fee
simple,that title is marketable and free and clear of all encumbrances,and that Grantor will warrant and defend the title against the
lawful claims of all persons whomsoever,other than the following exceptions: Subject to Easements,Rights of Way and
Restrictions of record, if any,and Ad Valorem taxes prorated through the date herewith.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
Gr� WI)
(Entity Name) St en L. Estep
By: 4Ri7-2 2 &ile7Tate )
Title: Sh Martin
art n Estep I
By:
MAP
Title:
By:
Title:
State of North Carolina-County of Forsyth
I,the undersigned Notary Public of the County and State aforesaid,certify that Stephen L.Estep and wife, Sharon
Martin Ester' personally appeared before me this day and acknowledged the due
execution of the foregoing instrument for the purposes therein expressed. Witness my hand And Notarial or this 11 th day
of July ,2005
My Commission Expires: `yr key
otary Public
•
State of North Carolina-County of ' 1>f rori ;c°
I,the undersigned Notary Public of the County and State aforesaid,certify that personally
came before me this day and acknowledged that_he is the of
a North Carolina or corporation/limited liability company/general partnership/limited partnership(strike through the
inapplicable),and that by authority duly given and as the act of such entity,_he signed the foregoing instrument in its name on its
behalf as its act and deed Witness my hand and Notarial stamp or seal,this day of ,20
My Commission Expires:
Notary Public
State of North Carolina-County of
I,the undersigned Notary Public of the County and State aforesaid,certify that
•
Witness my hand and Notarial stamp or seal,this day of ,20_.
My Commission Expires:
Notary Public
The foregoing Certificate(s)of MAJ.-) fit is/are
certified to be correct. This instrument and this certificate are duly registered at the date and time and in the Book and Page shown on the
first page hereof.
DICKIE C.WOOD. REGISTE F nF prRegiister of Deeds for Po _ County
By: '�� Deputy/4104 gister of Deeds
NC Bar Association Form .L-3© 1976,Revised© 1977,2002
Printed by Agreement with the NC Bar Association—1981 SofPro Corporation,333 E. Six Forks Rd.,Raleigh,NC 27609

' Book 2582 Page 4377
j
11
RECORDER'S MEMO
Record of Poor Quality Due $
to Condition of Original
EXHIBIT "A" 1
Beginning on an iron stake in the south right of way line of Cl Camino Drive, said iron stake
being the northeast comer of Lot 019 of Granada Estates as is recorded in Plat Book 25 nt
page 67 of the Forsyth County Rogistry; running thence with the east line of sold Lot 1101
South 05° 26' Nest 203.94 feet to an iron stake, the southeast corner of Lot 619; thoncu,
with the south lino of said Lot 019, North 84' 51' West, crossing an iron stake ut 93.14
feet, continuing 28,37 feet, or in all 121.51 foot to an iron stake, a new corner; thence,
, a new line, North 00' OS' East 194.06 feet to on iron stako, a new corner in the south
right-of-way line of said E1 Camino Drive; thence, with tho south right-of-way lino of
said E1 Camino Drive, South 89° 55' Cast, crossing un iron stake at 28.25 foot, continuing
33,40 feat, or in a11, 61.65 feet to nn iron stake; thence with tho south right-of-way
line of said El Camino Drive as it curvoa in a clockwise direction to an iron stake
located by the chord, South 88° 37' Cast 78.35 foot, said iron stake being the place of
Beginning, containing 0.598 acres, more or loss, and being a parcel from the oast side
of Lot 019 of Granada Estatos as is recorded in Plat Book.25 at page 67 of the Forsyth
County Registry. The foregoing description vas taken from a plat of survey prepared by
Steve Lineback dated March 23, 1977. -
1
i
t;

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information: (if different from the person legally responsible for the permit)
Permit contact:
First / MI / Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior to
this ownership or name change?
❑ Yes
❑ No(please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE
INCOMPLETE OR MISSING:
❑r This completed application is required for both name change and/or ownership change requests.
❑K Legal documentation of the transfer of ownership (such as relevant pages of a contract deed, or a bill
of sale) is required for an ownership change request. Articles of incorporation are not sufficient for
an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and the new
applicant in the case of an ownership change request. For a name change request,the signed Applicant's Certification
is sufficient.
PERMITTEE CERTIFICATION(Permit holder prior to ownership change):
I, _/ , attest that this application for a name/ownership
change fias been reviewed 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 is not included, this
application package will be returned
as incomplete.
Sin re Dale
APPLICANT CERTIFICATION:�
I, St e V e h !n v` • fl Pr , attest that this application for a name/ownership
change has been reviewed and is accurst 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 is not included, this
application package will be returned as incomplete.
Signatur Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Revised 7/2005