NCG550166_Permit (Issuance)_20041213

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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
December 13,2004
Charles&Kristy Benton
1080 Baker Crossroads Road
Redisville,North Carolina 27320
Subject: Renewal of coverage/General Permit NCG550000
Benton residence
Certificate of Coverage NCG550166
Rockingham County
Dear Mr.&Mrs. Benton:
In accordance with your application for a Certificate of Coverage [received on October 14,2004],the Division is
forwarding herewith Certificate of Coverage NCG550166 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 CoC.
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,
74"94) � ?>
-Alan W. Klimek
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 JVatura//y
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 NCG550166
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,
Charles & Kristy Benton
is hereby authorized to operate a 450 GPD wastewater treatment facility that consists of a septic tank, primary
sandfilter,chlorinator and associated appurtenances with the discharge of treated wastewater from the
Benton Residence
1080 baker Crossroads Road
Reidsville
Rockingham County
to receiving waters designated as an unnamed tributary to Rock House Creek 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 December 13, 2004.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 13, 2004.
&441.0 )
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Latitude:36°21'58" N C G 550 166 Facility
Longitude: 79°48'33" Benton residence Location
Quad: Bethany,N.0
Stream Class:C
Subbasin:30203 LL NOT TO SCALE
Receiving Stream:UT Rock House Creek �OttR

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State of North Carolina --
Department of Environment p 1 0 d A/19
and Natural Resources v11•Clireli
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Division of Water Quality I OCT 1 4 2004
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Michael F. Easley, Governor i 1"1CDE11I -
William UALITY G. Ross, Jr., Secretary PQTMj SOURCE BRANCH N DEPARTMENT OF
' '' ENYPR M N N AT A RE�6Ei w
Alan W. Klimek, P.E., Directory$�*„{ - �- '
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GENERAL PERMIT Certificate of Covera e RE ALOPbFkM 2004
DENR - WATER QUALITY
I. CURRENT PERMIT INFORMATION: POINT SOURCE BRANCH
Certificate of Coverage (CoC) Number: NCG550166 • ,_
Owner's name (name to be put on permit):
CAS 4 ; &, J
Owner's or signing official's name and title:C 4 aidik-17-/Y a --4 �
(Person legally re onsible for permit)
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(Title)
Mailing address: 10 go soli, CALp55 z4. Jed
City: 't,-t, As viii,L State: /J C Zip Code: 4-4 --2-(,)
Phone: ( 3 3 tF ) 34AAS - ab -
E-mail address: C_t611A 'S teeo ao. , Covl„
Applicant's Certification:
I, NaJk tta 1 KAa 9 t� i ' , attest that this application for renewal
of the subject General Permit U
ermit Certificate of Coverage has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this appiication
are not completed and that if all required supporting information and attachments are not
included, this application package will be returned as incomplete.
Signature:OkALQ4,, -- A--4-r.OG'?'� Date: `O I iI lb
THE COMPLETED APPLICATION PACK E, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
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
Charles Et Kristy Benton
1080 Baker Crossroad Road
Reidsville, North Carolina 27320
Subject: Renewal notice / General Permit NCG550000
Certificate of Coverage NCG550166
Rockingham County
Dear Mr. Et Mrs. Benton:
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,
ter it 14(17i
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] Naturallff
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NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES 1111111111111111111111111111
f'J� 2004PR007241
INVOICE
bAta 1.4,11414, Ontami49"."0
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: NCG550166 Annual Fee Period: 2004-09-01 to 2005-08-31
Rockingham County Invoice Date: 10/21/04
Charles&Kristy Benton-Residence
Due Date: 11/20/04
Charles&Kristy Benton Annual Fee: $50.00
Reidsville, NC 27320
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 to: �
NCDENR Quality /c�6��/Division of Water
1617 Mail Service Center /G
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
3X 3yr-2577
ANNUAL PERMIT INVOICE 1111111111111111111111111111
(Return This Portion With Check)
2004PR007241
Permit Number: NCG550166 Annual Fee Period: 2004-09-01 to 2005-08-31
Rockingham County Invoice Date: 10/21/04
Charles&Kristy Benton-Residence
Due Date: 11/20/04
Charles&Kristy Benton Annual Fee: $50.00
Rt4- - /15 o &dee.?Reidsville, NC 27320 Check Number:

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°' SENDER:
■Complete items 1 and/or 2 for additional services. I also wish to receive the
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■Print your name and address on the reverse of this form so that we can return this extra fee):
card to you. w
•Attach this form to the front of the mail piece,or on the back if spacedoes not u
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■Write'Return Receipt Requested'on the mail piece below the article number. a>
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PS Form 811,' ecember 1994 Domestic Return Receipt

UNITED STATES POSTAL SERVICE111111 First-Class MailPostage&Fees Paid
LISPS
Permit No.G-10
• Print your name, address, and ZIP Code in this box •
I I
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NCDENR/DWQ/Surface Water Protection
Section
Point Source Branch
1617 Mail Service Center
Raleigh,NC 27699-1617
A I-IN:Charles Weaver