NCG550083_Owner (Name Change)_20240530

State of North Carolina
Department of Environment,
Health and Natural Resources AiF
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary p E I-I N 1
A. Preston Howard, Jr., P.E., Director
September 5, 1995
Ms. Terry C. Miller
8800 Buckey Court
Clemmons, North Carolina 27012
Subject: Permit Modification-Ownership Change
Certificate of Coverage#NCG550083
(formerly Wells Residence)
Forsyth County
Dear Ms. Miller:
In accordance with your request the Division is forwarding the subject permit. The only
change in this permit regards ownership. All other terms and conditions in the original permit
remain unchanged and in full effect. This permit modification 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 150B 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.
If you have any questions concerning this permit, please contact Ms. Maureen Kiper at
telephone number [phone], extension 538.
Sincerely,
Original Signed By
David A. Goodrich
A. Preston Howard, Jr., P.E.
cc: Central Files
Winston-Salem Regional Office, Water Quality Section
Permits and Engineering Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
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 ENVIRONMENTAL MANAGEMENT
CERTIFICATE OF COVERAGE
GENERAL PERMIT NO. NCG550083
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,
Miller Residence -..$
is hereby authorized to operate of a wastewater treatment facility that consist of a septic tank,recirculation sandfilter,
chlorination, post aeration and associated appurtenances with the discharge of treated wastewater from a facility
located at the
Miller Residence
8800 Buckey Court
Clemmons,North Carolina
Forsyth County
to receiving waters designated as Ellison Creek in the Yadkin-Pee Dee 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 September 5, 1995
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 5, 1995
Original Signed By
David A. Goodrich
A. Preston Howard,Jr.,P.E.,Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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