NCG550136_Owner (Affiliation Change)_20060705

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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
July 5,2006
Mr.Robert Craig Widener
1401 Bridgton Road
Winston-Salem,North Carolina 27127
Subject: Renewal of coverage/General Permit NCG550000
Widener residence
Certificate of Coverage NCG550136
Forsyth County
Dear Mr.Widener:
In accordance with your status as the owner of the permitted residence,the Division is forwarding herewith
Certificate of Coverage NCG550136 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,
/ol"-- Alan W.Klimek,P.E.
cc: Central Files
Winston-Salem Regional Office/Rose Pruitt
NPDES file
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,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 NCG550136
TO DISCHARGE DOMESTIC WASTEWATERS FROM SINGLE FAMILY RESIDENCES AND OTHER
DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with theprovision of North Carolina General Statute 143-215.1, other lawful standards and regulations
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promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution
Control Act,as amended,
Robert C. Widener
is hereby authorized to operate a wastewater treatment facilitythat includes a septic tank, sandfilter, chlorine
disinfection, and associated appurtenances with the discharge of treated wastewater from
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1401 Bridgton Road
Winston-Salem
Forsyth County
to receiving waters designated as South Fork Muddy 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 July 5, 2006.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 5, 2006.
/),‘/ - Alan W. Klimek,P.E.,Director
Division of Water Quality
By Authority of the Environmental Management Commission

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NCG550136 Facility .
Latitude:36°01'12"f ,
Longitude: Location
l9" Robert C. Widener
Quad:Winston-Salem West,N.C.
Stream Class:C residence �j�Receiving 3070Stream:
C K:rd Not to SCALE
Receiving Stream:South Fork Muddy Creek

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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
GENERAL PERMIT Certificate of Coverage RENEWAL FORM
CURRENT PERMIT INFORMATION:
Certificate of Coverage (CoC) Number: NCG55 6
Owner's name (name to be put on permit):
1?ekri C19.
i I( !dtner
Owner's or signing official's name and title: f .JLrf Cnt.ij k c f
(Person legally responsible for permit)
•
(Title)
Mailing address: )401 Br-Allen P
City: 1/6f154-b
n Scl�lun State: /v Z Zip Code: 17 I Z7
Phone: (Op ) 711 •-0 577
E-mail address:
Applicant's Certification:
I, EGA C i tU3 ►'> f , attest that the property previously
covered by the Certificate of Coverage (CoC) listed above is under my ownership/control. I
hereby request renewal of the CoC listed above and assume responsibility for wastewater
discharge[s] from the site.
Signature: kOa/ I' A ` & Date: to kite,
Send this completed form and a copy of the property deed 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 One
512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone]/FAX [phone]/Internet:h2o.enr.state.nc.us !2atiirally
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The property hereinabove described was acquired by Grantor by instrument recorded in
Deed Book 1834, Page 3798
A map showing the above described property is recorded in Plat Book page
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 except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
save and except easements and restricitons of record, if any and 1998 ad valorem taxes
which will be pro—rated at the time of closing.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or 1 *orate, has caused this instrument to be signed in its
corporate name by its duly authorized officers and its seal to be hereunto affixes ,• • Its Boa of Di s, the day and year first
above written. /
(SEAL)
(Corporate Name) MI HAEL R.. ll 0
cr coQ�US
By:
I PATRICIA A. GREC DRAGOS (SEAL)
►M
President
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ATTEST: C.)
.' (SEAL)
a
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Secretary (Corporate Seal) rf)
(SEAL)
SEAL-STAMP NORTH CAROLINA, Forsyth County.
^N� ,... , a Notary Public of the County and State aforesaid, certify that _MT(:HAFL_R._.DRAL;.OS_And_WLfe-,.
OFPICIALSEAL a PATRICIA A. GRECO DRAGOS Cf ormerly known as Patricia A. GrecQ)_ Grantor,
.R j s + Not Public,North Caroltts
�' t 1i _y
1.4 colJN(Y OF FC1eSY 11-+ �,, ersonally appeared before me this day and acknowledged the execution of the foregoing instrument. Witness my
r�yATVDA J.tit-E: ] 30thJl 1998
and and official stamp or seal, this day of u y ,
My commission expires: April 25,_ OQO iQ-- --0J{=4"'e4 Notary Public
SEAL-STAMP NORTH CAROLINA, County.
I, a Notary Public of the County and State aforesaid, certify that ,
,pq personally came before me this day and acknowledged that ____ he is Secretary of
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a North Carolina corporation, and that by authority duly
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:: given and as the act of the corporation, the foregoing instrument was signed in its name by its
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Nu President, sealed with its corporate seal and attested by as its Secretary.
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Witness my hand and official stamp or seal, this day of ,
My commission expires: Notary Public
The foregoing Certificate(s) of.z"/ .2�=670C.--/ _'-&' c-C� C�
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.
REGISTER OF DEEDS F s#1uu COUNTY
,t i: 9il4.. A F1.wiN, i-lt:0f'E Eif .. fl
By 4i'P. , 141 Deputy/Ass ant-Register of Deeds
(J1' ).-`- 4.
BK90117:1PG4056
N.C.Bar Assoc.Form No.3©1976,Revised©1977—James Williams&Co.,Inc.,Boo 127.vadkinviue,N.C.27055
Printed by Agreement with the N.C.Bar Assoc.—1981

9
FORSYTH CO,NC X- FEE:$ 10.00
• PRESENTED & RECORDED: O7/30/1998 3:21PM
DICKIE C. WOOD REGISTER OF DEEDS BY:THOMAS
STATE OF NC REAL ESTATE EXTX:$ 'I AA
BK2)16 P4u55 - P4 i5y,
._jcifif\i-n.„)Ly,
Excise Tax Recording Time,Book and Page
Tax Lot No. 137, Block 4025 Parcel Identifier No.
Verified by County on the day of
by •
Mail after recording to Grantee -+ (GC ( ,. ✓'1-o-'-c/Ix ,°:7 l 2 7
This instrument was prepared by PARKS ROBERTS, ATTORNEY
Brief description for the Index Wilshire Estates, Sec. 3, Lot 137
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this ...30th... day of July , 1998 , by and between
GRANTOR GRANTEE
•
•
MICHAEL R. DRAGOS and wife, R. CRAIG WIDENER (Single)
PATRICIA A. GRECO DRAGOS
(formerly known as Patricia A.
Greco)
Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.q. corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and
shall 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 Wizls.t.cm7Sal.ewn , Wins.ton Township,
Forsyth County, North•Carolina and more particularly described as follows:
BEGINNING at an iron in the Northern right-of-way line of Brigton Road (formerly Sides Road),
said iron stake being the Southeast corner of the property of Lawrence D. Williams and wife,
Mary W. Williams, (See Deed Book 966, Page 068, Forsyth County Registry); running thence
North 11° 40' 00" East 222.98 feet to an iron; thence South 76° 41' 34" East 98.57 feet to an iron;
thence South 04° 49' 18" West 221.98 feet to an iron in the Northern right-of-way of Bridgton
Road; thence along the Northern right-of-way of Bridgton Road, North 78° 13' 32" West 124.99
feet to an iron; the POINT AND PLACE OF BEGINNING. Being known and designated as Lot
137 on an unrecorded map of Wilshire Estates, Section 3, also being Lot 137, Block 4025 on the
Forsyth County Tax Maps. All according to a survey by Ray E. Crouse, R.L.S., dated 22 August
1994, Job No. JN300.
WC.Htr Assoc.Form No.3©1976,Revised©1977—James Williams&Co.,Inc,Box 127,Yedkinville,N.C.27055
Printed by Agreement with the N.C.Bar Assoc.—1981