NCG550197_Permit (Issuance)_20171019

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ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
Water Resources w S. JAY ZIMMERMAN
Director
ENVIRONMENTAL QUALITY
October 19, 2017
Jordan Trey Cagle
1618 Petty Road
Graham, NC 27253
Subject: NPDES General Permit NCG550000
Transfer of NCG550197
1618 Petty Road
Alamance County
Dear Permittee:
The Division hereby transmits Certificate of Coverage (CoC) NCG550197, issued under
NPDES General Permit NCG550000. This action is taken to show that you are now the
owner of the subject facility. This CoC 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 October 15, 2007 (or as
subsequently amended).
If any parts, measurement frequencies or sampling requirements contained in the
General Permit are unacceptable to you, you have the right to request an individual NPDES
permit upon written request within thirty (30) days following receipt of this letter. Unless
such a request is made, this transfer of the subject CoC shall be final and binding.
This CoC 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 any other Federal,
state, or local government. If you have any questions concerning this matter, please contact
Emily Phillips at [phone] or via e-mail [[e-mail]].
'ncerely,
17-7 C. /./Z,/
S. Jay Zimmerman, P.G.
Director
cc: Winston-Salem Regional Office
NPDES files
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
CERTIFICATE OF COVERAGE NCG550197
Under GENERAL PERMIT NCG550000
TO DISCHARGE 100%-DOMESTIC AND SIMILAR WASTEWATERS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
In compliance with the provisions 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,
Jordan Trey Cagle
are hereby authorized to operate a wastewater treatment facility with a discharge of<1000
gallons per day); discharging from
1618 Petty Road
Graham
Alamance County
to receiving waters designated as the Haw River [stream segment 16-(1)], a waterbody
currently classified WS-V; NSW located within sub-basin 03-06-02 of the Cape Fear River
Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, and III of General Permit NCG550000 as attached.
This certificate of coverage shall become effective October 19, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 19, 2017.
t 7/X-Z
. Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission

liP' `•
PAT MCCRORY
IllirC.
DONAL.D R. VAN DER VAART
S. JAY ZIMMERMAN
Di ector
Water Resources
ENVMONM ENTAL OUALlTY
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION: Q
Permit Number: NC00 / / / / or NCG5,51. / t /7/J
1. Facility Name: (6 1 I 0e-1 f- 42.a G-iric -i-'\ /l/C� ; 7($3
II. NEW OWNER/NAME INFORMATION:
1. Thi request for a name change is a result of: CE!/ /NCDEQ/DWR
`/ a. Change in ownership of property/company OCT
b. Name change only w'vLater Quality
Permitting Section
1 c. Other(please explain):
2. New owner's name (name to be put on permit):
l u f-ci, 1 'I Ce-y (-o y 6-
3. New owner's or signing official's name and title: circa c-n ''`c.-1 Cuc.,/-(2
(Person legally responsii6le for permit)
U wNLr
II (Title)
4. Mailing address: I(a (7 P e4--4"y c(d City: GI file
State: ✓vv Zip Code: 7'74- S Phone: ( 3 5 4, ) c--1 3U -- o 71 .—
E-mail address: OUC.K.fir' S 30Z 4+ , 1 ,Conn
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements] ---rn -.P1-e.t-e
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits
E

NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
I, 0 e✓r1,un C 142- , attest that this application for a
name/ownership change-has been reviewed and is accurate and 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: 511
. Date: (07i/ o/
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 7/2016

ROY COOPER
Governor
MICHAEL S. REGAN
Svcretary
Gt aterResnurces S.JAY ZIMMERMAN
L1ifLC#Cu'
ENVIRONMENTAL QUALITY
September 19, 2017
RECEIVED/NCDEQ/DWR EC NCDEQ/DWR
Jordan Cagle SEP 2 2 2017
1618 Petty Road
Graham, NC 27253 Water Quality
Permitting Section
SUBJECT: Compliance Evaluation Inspection Report
Certificate of Coverage NCG550197 under NPDES General Permit NCG550000
Facility Located at 1618 Petty Road, Graham, Alamance County
Dear Mr. Cagle:
On September 15, 2017, Paul DiMatteo of the Division of Water Resources ("Division"), Winston-Salem
Regional Office met with you to conduct a Compliance Evaluation Inspection of the above referenced
wastewater treatment system. The Division is required to inspect these types of systems at least every 5 years.
An inspection summary follows and an inspection report is attached for your records.
Site Review
septic tank, subsurface sand filter, chlorinator, and outfall, with final disposal
The system consists of a sep cp
to the Haw River. No sewage malfunction was observed at the sand filters or at the septic tank. No discharge
was observed from the outfall at the time of inspection and you said that you have never seen a discharge. No
negative impact of the receiving stream was observed.
Chlorine tablets were present in the chlorinator. You said that chlorine tablets indicated for
wastewater treatment are used. The chlorinator should be inspected weekly to ensure there is an adequate
supply of tablets.
Documentation & Monitoring Review
Alamance County tax records indicate that you are the current owner of the property. However, this
Certificate of Coverage was issued to Ruby Cagle. Please complete and return the attached "Permit
Name/Ownership Change Form" so that the CoC may be updated.
A review of documentation was not conducted at the time of inspection. We would also like to remind
you to conduct and document the following:
- Effluent monitoring must be performed as required in the permit.
- All system components must be maintained at all times and in good working order.
- Inspect the septic tank and secondary tanks at least yearly to determine if solids must be removed.
- Pump the septic tank every 5 years, or when the solids level is found to be more than 1/3 of the
State of North Carolina I Environmental Quality I Water Resources
450 West Hanes Mill Road,Suite 300,Winston-Salem,NC 27105
336-776-9800

I t
liquid depth in any compartment, whichever is greater. All tanks should be emptied of their
contents whenever any of the tanks meet this requirement.
- Contents removed from septic tanks shall be disposed of at a location and in a manner compliant
with all local and state regulations.
- Inspect the outfall location at least twice per year to ensure that no visible solids or other obvious
evidence of system malfunctioning is observed.
- Inspect the tablet chlorinator (if applicable) at least weekly to ensure there is an adequate supply
of tablets for continuous & proper operation. Tablets used for chlorination must be labeled for
wastewater use.
- Any monitoring data obtained shall be retained onsite for a minimum of 5 years.
- Additional requirements as stated in NCG550000.
There were no significant issues noted during the inspection; therefore, a response to this report is not
required.
Thank you for your cooperation in this matter. If you should have any questions, please do not hesitate
to contact Paul DiMatteo at 336-776-9691 or our office at 336-776-9800.
Sincerely,
Fv," 'Sherri V. Knight, P.E., Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
Enclosures— Inspection Report and Summary, Permit Name Change Form
Cc: -'y/C emstert-S--ae Reg ona ffice
NPDES Unit, 1617 Mail Service Center
State of North Carolina Environmental Quality Water Resources
450 West Hanes Mill Road,Suite 300,Winston-Salem,NC 27105
336-776-9800

United States Environmental Protection Agency
Form Approved.
EPA Washington,D.C.20460 OMB No.2040-0057
Water Compliance Inspection Report Approval expires 8-31-98
Section A:National Data System Coding(i.e.,PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 �N 2 �5 3 I NCG550197 111 12 17/09/15 117 18 I r•I 19 I g I 20I
211u11111 1111111 11 11 1 11 1111 1 1 11111 1111111u 11 r6
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA — -Reserved---- —
671 I 70 u 71 Li 72 I N I 731 I 174 751 1 1 1 1 1 1 180
Section B:Facility Data
Name and Location of Facility Inspected(For Industrial Users discharging to POTW,also include Entry Time/Date Permit Effective Date
POTW name and NPDES permit Number) 12:05PM 17/09/15 13/08/01
1618 Petty Road
1618 Petty Rd Exit Time/Date Permit Expiration Date
12:20PM 17/09/15 18/07/31
Graham NC 27253
Name(s)of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data
///
Name,Address of Responsible Official/Title/Phone and Fax Number
Contacted
Ruby Cagle,1618 Petty Rd Graham NC 27253//336-376-9062/
jo,thavl C�1Q 336- `(,s
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
Permit IIII Effluent/Receiving Waters
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s)and Signature(s)of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Paul DiMatteo WSRO WQ//336-776-9691/
Signature o Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspection Type (Cont.) 1 ti
31 NCG550197 I11 121 17/09/15 117 18 Li
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Site Review
The system consists of a septic tank, subsurface sand filter, chlorinator, and outfall,with final
disposal to the Haw River. No sewage malfunction was observed at the sand filters or at the septic
tank. No discharge was observed from the outfall at the time of inspection and you said that you have
never seen a discharge. No negative impact of the receiving stream was observed.
Chlorine tablets were present in the chlorinator.You said that chlorine tablets indicated for
wastewater treatment are used. The chlorinator should be inspected weekly to ensure there is an
adequate supply of tablets.
Documentation& Monitoring Review
Alamance County tax records indicate that you are the current owner of the property. However,this
Certificate of Coverage was issued to Ruby Cagle. Please complete and return the attached "Permit
Name/Ownership Change Form"so that the CoC may be updated.
A review of documentation was not conducted at the time of inspection. We would also like to
remind you to conduct and document the following:
- Effluent monitoring must be performed as required in the permit.
- All system components must be maintained at all times and in good working order.
- Inspect the septic tank and secondary tanks at least yearly to determine if solids must be removed.
- Pump the septic tank every 5 years, or when the solids level is found to be more than 1/3 of the
liquid depth in any compartment,whichever is greater.All tanks should be emptied of their contents
whenever any of the tanks meet this requirement.
Contents removed from septic tanks shall be disposed of at a location and in a manner
compliant with all local and state regulations.
- Inspect the outfall location at least twice per year to ensure that no visible solids or other obvious
evidence of system malfunctioning is observed.
- Inspect the tablet chlorinator(if applicable)at least weekly to ensure there is an adequate supply of
tablets for continuous& proper operation. Tablets used for chlorination must be labeled for wastewater
use.
- Any monitoring data obtained shall be retained onsite for a minimum of 5 years.
- Additional requirements as stated in NCG550000.
Page# 2

1
Permit: NCG550197 Owner-Facility: 1618 Petty Road
Inspection Date: 09/15/2017 Inspection Type: Compliance Evaluation
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new 0 0 • 0
application?
Is the facility as described in the permit? • 0 0 0
#Are there any special conditions for the permit? 0 IN 0 0
Is access to the plant site restricted to the general public? • 0 0 0
Is the
inspector granted access to all areas for inspection? • 0 0 0
P
Comment: Alamance County tax records show that the property is owned by Jordan and Sheri Cagle. I
will send a change of ownership form with the inspection report.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? • 0 0 0
Are the receiving water free of foam other than trace amounts and other debris? • 0 0 0
If effluent (diffuser pipes are required) are they operating properly? 0 0 • 0
Comment: Outfall located near 35.947991 N, 79.328781 W.
Pipe was half submerged in water. Jordan said that he's never seen it discharge, and that
he sees the pipe fairly often.
Page# 3