NCG550110_Permit (Issuance)_20050103

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley,Governor William G. Ross,Jr., Secretary
Alan W. Klimek, P.E., Director
January 3,2005
Eldridge and Victoria Petty
143 Woodlawn Drive
Stoneville,North Carolina 27048
Subject: Renewal of coverage/General Permit NCG550000
Petty residence
Certificate of Coverage NCG550110
Rockingham County
Dear Mr.&Mrs.Petty:
In accordance with your application for a Certificate of Coverage[received on November 16,2004],the Division
is forwarding herewith Certificate of Coverage NCG550110 to discharge under NCG550000. Your residence previously
was assigned this CoC number in 1993. The previous owner allowed the CoC to expire. Thus your application is being
treated as a renewal of an existing CoC,rather than a new discharge application. 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.
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.
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 this permit,please contact Charles H.Weaver,Jr. at telephone number 919
733-5083, extension 511.
Sincerely,
611:749—)
OP...--Alan W.Klimek,P.E.
cc: Central Files
Winston-Salem Regional Office/David Russell
NPDES file
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 N.Salisbury St.,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone]/FAX [phone]/Internet:h2o.enr.state.nc.us Naturally
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• �
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550110
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,
Eldridge and Victoria Petty
is hereby authorized to operate a 450 GPD wastewater treatment facility that consists of a septic tank, subsurface
sandfilter, chlorine disinfection, step aeration and associated appurtenances with the discharge of treated
wastewater from the
Petty Residence
143 Woodlawn Drive
southwest of Eden
Rockingham County
to receiving waters designated as an unnamed tributary to the Dan River in 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 January 3, 2005.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day January 3, 2005.
r)51)
Alan W.Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Latitude:36°27'58" N C G 550110 Facility
Longitude:79°48'38" Location
Quad: Southwest Eden,N.C. Petty residence _
Stream Gass:C
SubbasReceiving
in:Strew �o�t� NOT TO!CALE
Receiving Stream UT Dan River

State of North Carolina
Department of Environment A77;11°111rilrli
and Natural Resources wig,
Division of Water Quality
Michael F. Easley, Governor NCDENR
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Alan W. Klimek, P.E., Director ENVIRONMENT AND NATURAL RESOURCES
GENERAL PERMIT Certificate of Coverage RENEWAL FORM
I. CURRENT PERMIT INFORMATION:
Certificate of Coverage (CoC) Number: NCG550110
Owner's name (name to be put on permit):
c:larri'dy e 4 1/ichi ri a 1° try, c QQ
Owner's or signing official's name and title: cDf /ini
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(Pr'son legally res' i r four permit)
/ �/c (Title)
Mailing address: /�/.3 GJDoc .> £r -
City: ,S on ev ilk-- State: /IBC Zip Code: a 76 5i 2
Phone: (334 ) 6 3--.7-iS 3
E-mail address: V 1 G)4.l] — }7 . m.oy\awkiryl .co In
Applicant's Certification:
I, E1 r/dQe r`"eJ / , attest that this application for renewal
of the subject General Permit Certificate of Coverage has been reviewed and is accurate and
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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 and attachments are not
included, this application package will be returned as incomplete.
Signature: /gi,c,4,e / ,, ���LCC Date: a .?
Send this completed form and a copy of the deed to the property [showing the date on which you became
the owner] to:
Mr. Charles H. Weaver, Jr.
NC DENR / DWQ / NPDES Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 Telephone[phone] FAX[phone]
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross,Jr.,Secretary
Alan W. Klimek, P.E., Director
November 19, 2004
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Rocky Et Vicky Petty
143 Woodlawn Drive
Stoneville, North Carolina 27048
Subject: Renewal notice / General Permit NCG550000
Certificate of Coverage NCG550110
Rockingham County
Dear Mr. a Mrs. Petty:
You are receiving this notice because you currently own [or reside in] a residence previously covered
under the subject General Permit for the discharge of domestic wastewater. The Certificate of Coverage
specific to your residence has expired.
The Division needs information from you to determine if coverage under NCG550000 is still necessary.
➢ If your home still has a wastewater system like the ones described in the enclosed Technical
Bulletin, you should renew the subject permit. Complete the enclosed form and submit it to the
address on the form, with a copy of the property deed showing the date you took ownership of the
home.
➢ If you are not sure what type of system your home uses, contact David Russell in the NC DENR
Winston-Salem Regional Office at [phone]. He can help you determine if you should renew
coverage under the General Permit.
➢ If you know that your home no longer discharges wastewater to a waterbody, contact me at the
address or phone number listed below to request rescission of the permit.
If you have any questions concerning this matter, please contact me at the telephone number or e-mail
address listed below.
Sincerely,
/I. 44-
Charles H. Weaver, Jr.
Point Source Branch
cc: Central Files
Winston-Salem Regional Office / David Russell
NPDES file
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone],extension 511/FAX [phone]/[e-mail] Naturally
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NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
2004PR007230
INVOICE
Annual Permit Fee © 2—
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with your
permit. It is required of any person holding a permit for any time during the annual fee period,regardless of the facility's operating
status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid permit is a violation
and is subject to a$10,000 per day fine. If the permit is revoked and you later decide a permit is needed,you must reapply,with
the understanding the permit request may be denied due to changes in environmental,regulatory,or modeling conditions.
Permit Number: NCG550110 Annual Fee Period: 2004-09-01 to 2005-08-31
Rockingham County Invoice Date: 10/21/04
Chatman Joseph S-Residence
Joseph S. Chatman Due Date: 11/20/04
143 Woodlawn Dr Annual Fee: $50.00
Stoneville, NC 27048
Notes:
1. A$25.00 processing fee will be charged for returned checks in accordance with the North Carolina General Statute 25-3-512.
2. Non-Payment of this fee by the payment due date will initiate the permit revocation process. •
3. Remit payment_; _ %� ✓\vG j/ /C 1
NCDENR-Division of Water Quality / N e /( egr ' o )�
1617 Mail Service Center
Raleigh,NC 27699-1617
4. Should you have any questions regarding this invoice,please comtact the Annual Administering and Compliance Fee Coordinator at
919-733-5083 extension 210
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ANNUAL PERMIT INVOICE
(Return This Portion With Check)
2004PR007230
Permit Number: NCG550110 Annual Fee Period: 2004-09-01 to 2005-08-31
Rockingham County Invoice Date: 10/21/04
Chatman Joseph S-Residence
Joseph S. Chatman Due Date: 11/20/04
143 Woodlawn Dr Annual Fee: $50.00
Stoneville, NC 27048
Check Number:

SENDER:
✓ ■Complete items 1 and/or 2 for additional services. I also wish to receive the
H ■Complete items 3,4a,and 4b. following services(for an
I H ■Print your name and address on the reverse of this form so that we can return this e a fee):
card to you. ai
j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. Addressee's Address
E permit.
a) ■Write'Return Receipt Requested-on the mailpiece below the article number. 2. El estricted Delivery fA
C ■The Return Receipt will show to whom the article was delivered and the date
c delivered. Consult postmaster for fee. °
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a-0i 3.Article Addressed to: 4a.Article Number ¢
—6.
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1 E4b.Service Type
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Rocky& Vicky Petty ❑ Registered 0 Certified c
cf) I
u) 143 Woodlawn Drive ❑ Express Mail ❑ Insured 5
rc Stoneville NC 27048 Receiptto
❑ Return for Merchandise ❑ COD
O 7. Date of Delivery
IZ i ( 1 � o
I cc
m 5.Received By: (Print Name) 8.Addressee's Address( m ;y if requested
w and tee is paid) co
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6.Signature: (Addressee or Agent)
N• X- ) i ,4.,t—f—ii-
PS Form 3811, December 1994 Domestic Return Receipt
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UNITED STATES POSTAL SERVICE 11 I
First-Class MailIII Postage&Fees Paid
LISPS
Permit No.G-10
• Print your name, address, and ZIP Code in this box•
NCDENR/DWQ/Sace Water Protection
Section
Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
ATTN: Charles Weaver
u it►ilil���i,ii3. �fi► whin