NCG550121_Permit (Issuance)_20060221

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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
February 21, 2006
Ms. Linda Grounds
1011 Kelly Road
Mount Holly, NC 28120
Subject: Renewal of coverage/General Permit NCG550000
Grounds residence
Certificate of Coverage NCG550121
Burke County
Dear Ms. Grounds:
In accordance with your status as the owner of the permitted residence, the Division is forwarding
herewith Certificate of Coverage NCG550121 to discharge under NCG550000. This action is 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,
Vk.
/Z1 Alan W. Klimek, P.E.
cc: Central Files
Mooresville Regional Office/James Bealle
NPDES file
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One 512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarO7 ina
Phone: [phone]/FAX [phone]/Internet:h2o.enr.state.nc.us Naturally
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper `

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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550121
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,
Linda Grounds
is hereby authorized to operate a wastewater treatment facility that includes a septic tank, primary & secondary
sandfilters, chlorine disinfection, cascade aeration and associated appurtenances with the discharge of treated
wastewater from
1011 Kelly Road
Mount Holly
Gaston County
to receiving waters designated as an unnamed tributary to Taylors Creek in the Catawba 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 February 21, 2006.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 21, 2006.
/ a
.!"). lan W. Klimek, P.E.,Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Latitude:35'19'20" N C G 550121 Facility ; ',
Longitude:81�03'SG"
Location yr . . z, ,
Quad:FI4SE Linda Grounds
Stream Class:WS-IV residence
Subbasin:30833
Receiving Stream:UT Taylors Creek �;'d Not to SCALE

G, { d t•OK AUCNI.T UJC OIV L T
— � �• Date Received
1 Year Month Day
AVM Oi iisii-n o ter Quality/ Water Quality Section
-- a Certificate of Covers}e
Assismommem Q N CJGI I I
NCDENR tilt al t Discharge Elimination System u Amount
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NO7,GRouru DEPM R7so"e ^"
ENviRONMENT u+o NIUURIL REsourxces (`//l/1 y y Permit Assigned to
I "" o NCG550000
NOTICE OF INTENT A !3
...„....,--------
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG550000: Single Family Domestic Units and/or facilities discharging less than 1000 gallons per
day of domestic wastewater and similar point source discharges
(Please print or type)
1) Region contact(Please note: This application will be returned if you have not met with a
representative from the appropriate regional office):
Please li t the NCDEN((R��Regional Office epresentative(s) with whom you hay et:
Name: A17?PS 130 aI�E Date: o7i�ot
2) Mailing address* of owner/operator: /
Owner Name L i/t; LV z, L�'r(91 '40S'
Street Address %C / / I<e//y / cP
City Alf. }.J6((y State /' ZIP Code ,2q��c�
Telephone No. (Home)7c�/ /$'•2 7-t/ /Ir (Work) .7c V 6 4 757C>
*Address to which all permit correspondence will be mailed
3) Location of facility producing discharge:
Street Address /(-3/t I<e// Z'd
City /) f.I/oil y State /UL ZIP Code L k12-C-'
County 6=a--r34 i✓
Telephone No. ?a q 7-ti t1 L
4) Physical location information:
Please provide a narrative description of how to get to the facility(use street names, state road
numbers, and distance and direction from a roadway intersection).
Lti r 141uy .37 4c /,/i
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5) This NPDES permit application applies to which of the following :
❑ New or Proposed (system not constructed)
Pr Existing (system constructed); If previously permitted by local or county health department,
please provide the permit number and issue date
❑ Modification; please describe the nature of the modification:
6) Description of Discharge:
a) Amount of wastewater to be discharged:
Number of bedrooms x 120 gallons per bedroom = :27(' v gallons per day to be permitted
b) Type of facility producing waste (please check one):
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NCG55000 .O.I.
Primary residence ❑ Vacation/second home
❑ Other:
7) Please check the components that comprise the wastewater treatment system:
C 'S'eptic tank ❑Dosing tank
❑ Primary sand filter E Secondary sand filter ❑ Recirculating sand filter(s)
©-Chlorination ❑ Dechlorination ❑ Other form of disinfection:
❑ Post Aeration (specify type)
8) For new or proposed systems only - Please address the feasibility of alternatives to
discharging for the following options in the cover letter for this application:
a) Regional to a Re Tonal or Municipal Sewer Collection System.
stem.
b) Letter from local or county health department describing the suitability or non-suitability of the site
for all types of wastewater ground adsorption and innovative non-discharge systems. Document
the repair potential of the failed system.
c) Investigate Land Application such as spray irrigation or drip irrigation.
9) Receiving waters:
a) What is the name of the body or bodies of water(creek, stream, river, lake, etc.) that the facility
wastewater discharges end up in?
b) Stream Classification (if known):
10) The application must include the following or it will be returned:
a) For Certificates of Coverage:
❑ An original letter and two (2) copies requesting a general permit.
❑ A signed and completed original and two copies of this Notice of Intent Application.
p
A check or money order for the permit fee of$50.00 made payable to NCDENR.
❑ Invoice showing that the septic tank has been pumped and serviced within the last 12
months (only when existing service tank will be used).
New or proposed facilities must also include:
❑ Letter from the county health department evaluating the proposed site for all types of
ground absorption and innovative non-discharge systems. Document the repair potential of
the failed system.
❑ Evaluation of connection to a regional sewer system (approximate distance & cost to connect).
❑ Provide a 7Q10 flow estimate at the proposed wastewater discharge point from the US Geological
Survey (919-571-4000)
b) For an Authorization to Construct(ATC) only:
❑ A letter requesting an ATC
❑ Three sets of plans and specifications of proposed treatment system (see Permit
Application Checklist and Design Criteria for Single Family Discharge)
❑ Invoice showing that the septic tank has been pumped and serviced within the last 12
months (only when existing septic tank will be used).
Note: There is no fee when requesting an Authorization to Construct
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11) Additional Ajipli&ation RegtthefilefitS:
a) If this atipliCtitiOn is being submitted by a consulting engineer(or engineering firm), include
documentation from the applicant showing that the engineer(Or firm) submitting the application
ha6 been designated an authorized Representative of the applicant.
b) If this application is being submitted by a consulting engineer(or engineering firm), final plans for
the treatment system must be signed and sealed by a North Carolina registered Professional
Engineer and stamped -"Final Design - Not released for construction".
c) If this application is being submitted by a consulting engineer(or engineering firm), final
specifications for all major treatment components must be signed and sealed by a North Carolina
registered Professional Engineer and shall include a narrative description of the treatment system
to be constructed.
12}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: �.IN CX C� (3-a. UN�`
Title:
(Signature of Applicant) (Date 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.)
Notice of Intent must be accompanied by a check or money order for$50.00 made payable to:
NCDENR
Mail three (3) copies of the entire package to:
NPDES Permits Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit
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11) Additional A►tYpiieation Regtllfittlentt:
a) If this ilOp'rbiflon is being submitted by a consulting engineer(or engineering firm), include
docufndnfftion from the applicant showing that the engineer(Or firm)submitting the application
had beeh'designated an authorized Representative of the applicant.
b) If this applibation is being submitted by a consulting engineer(or engineering firm), final plans for
the treatment system must be signed and sealed by a North Carolina registered Professional
Engineer and stamped-"Final Design- Not released for construction".
c) If this application is being submitted by a consulting engineer(or engineering firm), final
specifications for all major treatment components must be signed and sealed by a North Carolina
registered Professional Engineer and shall include a narrative description of the treatment system
to be constructed.
12)~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: LJAJ ePo-K2A0 ciNcOj
Title:
7. L
-ter.4-1-, 441-€14‘411----, #2/06
(Signature of Applicant) (Date 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.)
Notice of Intent must be accompanied by a check or money order for$50.00 made payable to:
NCDENR
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Mail three(3)copies of the entire package to:
NPDES Permits Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit
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