NCG550199_Permit (Issuance)_20170425

ROY COOPER
riOVe%I701
.:a
MICHAEL S. REGAN
Secreta/y
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
April 25,2017
Mr.David Heroux&Ms. Lisa Sossoman
145 Forestdale Drive
Reidsville,NC 27320
Subject: NPDES General Permit NCG550000
Transfer of NCG550199
145 Forestdale Drive
Rockingham County
Dear Mr.Heroux&Ms. Sossoman:
The Division hereby transmits Certificate of Coverage(CoC)NCG550199, 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(919) 807-6479 or via e-mail
[[e-mail]].
incerely,
S.Jay Zimmerm ,P.G.
Director
cc: Winston-Salem Regional Office
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 NCG550199
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,
David Heroux & Lisa Sossoman
are hereby authorized to operate a wastewater treatment with a discharge of<1000 gallons per day;
discharging from
145 Forestdale Drive
Reidsville
Rockingham County
to receiving waters designated as an unnamed tributary(UT)to Town Creek[stream segment 22-42] a waterbody
currently classified C waters located within sub-basin 03-02-03 of the Roanoke 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 April 25,2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 25, 2017.
. ay Zimmerman,P.G.
Director,Division of Water Resources
By Authority of the Environmental Management Commission

PAT MCCRORY
Govern°,
RECEIM
NCDEQIDR DONALD R. VAN DER VAART
•
I .. .- a• APR 0 Sec,etary
7 2017 S. JAY ZIMMERMAN
Water Resources �$�PQil��9�
ENVIRONMENTAL QUALITY
7ittingSeCt1®P➢ ol,ecto,
NPDES Certificate of Coverage (CoC).
_ OWNERSHIP CHANGE FORM. _ _ -- _
I. Please enter the CoC number for which the change is requested.
Certificate of Coverage
cHP, $. 5 0 q
II. Please provide the following for the requested change(revised permit).
a. Request for change is a result of: Change in ownership of the residence/property
Name change of the facility or owner
If other please explain:
b. Permit will be issued to(company
name,if applicable):
c. Person legally responsible for permit:
First MI Last
OWef
Title
Permit Holder Mailing Address
City State Zip
( )
Phone E-mail Address
d. Facility name(discharge): Doti CO e iibt),. oc d (j`Sth. S3 0 i",1✓
e. Facility address: ? k6 ,I e .br•
Address
�e i c�SY, 1 t-e C 320
City State Zip
f. Facility contact person: i)ct,V; 6 tA1 o-Vt"e i (AX
First MI Last
M ) r51 2—.r/q I G� ie UieVrgrhYtcf';• .cat q
Phone E-mail Address
III. Permit contact information(if different from the person legally responsible for the permit)
Permit contact: i i Q( kh1 L 'ulK
First MI Last
Title
Mailing Address
City State Zip
( )
Phone E-mail Address
1V Will this permitted facility continue to discharge the same volume and type of wastewater as
prior to this ownership or name change?
Yes
No(please explain)
\ Revised 9/2016

NCG550000 OWNERSHIP CHANGE FORM
Page 2 of 2-
Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
VI. ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal-documentation of the transfer of ownership(such as a property deed, relevant pages of a
contract, or a bill of sale) is required for an ownership change request.
The certifications below must be completed and signed by the new applicant in the case of an ownership
change request.
APPLICANT CERTIFICATION
I, , 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 is not included,this application package will be
returned as incomplete.
LS'7) - hO U -- 3-2 / % -2e-1-7
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
NC DEQ/DWR/NPDES
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Revised 9/2016

•" NORTI4 CAROLINA GENERAL WARRANTY DEED
Revenue Stamps$260 00
Mail after recording to! GRANTEE,
This instrument was piepared by Matthew W. Smith
Brief description for the Index -
Lot 3,Forestdale,MB 16/25
THIS DEED made day of Qu9u5+ , 2013,by and between
GRANTOR GRANTEE
DETTEAR R.HARRIS DAVID W.HEROUX
fka Dettear IL Ilankins And
and husband,WINFRED HARRIS LISA R.SOSSOMAN
Address: _
429 Longhook Rgad
Eden,NC 27288
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 Wentworth Township,Rockingham County,
North Carolina and more particularly described as follows:
•
•
•
•
SEE EXHIBIT'A'ATTACHED
This property dos/ does not include the primary residence of the Grantor.

•
PAT MCCRORY
' h
Governor
DONALD R.VAN DER VAART
Secretary
WaterResources S.JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
October 10, 2016
Mr.David W.Heroux&Ms. Lisa R. Sossoman
145 Forestdale Drive
Reidsville,NC 27320
Subject: Wastewater Disposal at
• 145 Forestdale Drive,Reidsville
Certificate of Coverage(CoC)NCG550199
Rockingham County
Dear Owners:
Rockingham County tax records list Mr.David W.Heroux&Ms. Lisa R. Sossoman as the current owners of
the subject property. We are contacting you to determine the status of a wastewater disposal system on your property
that was covered by General Permit NCG550000 under CoC NCG550199. The last CoC was issued to Dettear R.
Hankins on 8/1/2013. The Division needs information from you to determine if coverage under NCG550000 is still
necessary.Please respond by November 28,2016 with one the following:
> If you are the current owner of this property and it still has a wastewater system like the ones described in the
enclosed Technical Bulletin,you must submit a change in ownership form.Please complete the enclosed form
and submit it to Charles Weaver at the address on the form. In addition, a$180 in overdue annual fees is
required to maintain this permit.Please send payment for the enclosed invoice(s):
2013PR008933,2014PR009032,2015PR009640.
(Payment instructions are provided on the invoice.)
> If you know that your property no longer discharges wastewater and the treatment system has been replaced
with a different treatment system or connected to a city sewer,please contact me at the address or phone
number listed below to request rescission of the CoC.
> If you are not sure what type of system your property has, contact George Smith in the NC DEQ Winston-
Salem Regional Office at 336-776-9800. This contact [or other staff members] can help you determine if you
should maintain your CoC.
If you have questions concerning this matter,please do not hesitate to contact me at 919-807-6479 or
[e-mail].
Sincerely,
/71.1/1A04----WO:
Meredith Wojcik
Division of Water Resources,DEQ
cc: Winston-Salem Regional Office,DWR WQRO
NPDES General Permit Files
Teresa Revis,DWR Budget Office
State of North Carolina I Environmental Quality I Water Resources
1611 Mail service Center I Raleigh,North Carolina 27699-1611
919 707 9000

1
•
ROY COOPER,
f3rrar
MICHAEL S. REGAI�1
�rrer�zrY
le
Water Resources5,JAY t 1 EltIw1AN
•
ENVIRONMENTAL QUALITY
September 13, 2017 RECEtVEDINCDEQIDWR
David Heroux SEP 18 2017
145 Forestdale Drive
Reidsville, NC 27320 Water�S�ction
Permitt�n�
SUBJECT: Compliance Evaluation Inspection Report
Certificate of Coverage NCG550199 under NPDES General Permit NCG550000
Facility located at 145 Forestdale Drive, Reidsville, Rockingham County
Dear Mr. Heroux:
On September 8,1011
Regional Office , Paul DiMatteo of the Division
system conducted a Co of Water Resources("Division") Winston-Salem
The Division is re Compliance Evaluation Inspection.pf the
summary follows and quires,to inspect these t above referenced wastewater treatment
an inspection report is attached for f systems atleast eVer 5 e
site_ Review your records, y Y ars.An inspection ,
an unnam system consists of
'trc tank Yes,tr�butar a septic tank,said subsurface iced. pleas d that the Creek. Nosewage/ sand filter
e per yeare note that the Persemit
1 tank was i malfu •n ohiorinator
ncfiro
ermit(copy attached)mped abut 3wd s obseryeoidtnd Outfall, Wlth f j'na/
There w require�iviSUears ago The o he sand filters or a disposal
red for wastewater
chlorine to tthe
ed Wee water treatment
present i j
� reviewO ftheutfa//wasuna�/e'/ k/y to ensurethereest" nottablefiatech/°r;n Outfa//t0 be t:be
ease not also
that our an adequa fsUpp/yo rat/forp/d se°ba COnd ucted
'cation system indica.s ' ft/ets 0/use T!n andU
&Monitorin Review
? t�jthe a / he chlO:of
ch/or/nelucw°fd°curve wew 7ual feein the tOr shOu dte beetsthat
t and do ntations ' adoflue currentthef wowinnotcondgt theunt°f$ is oV
'fluent monitoringg• tln�e endue.
sect err components must be perfor ofrnspectio
:eseptictsrn me p the tank and see on ai secondary
ea in the e H'°v/d a/sO
depth in any tank
every 5 years, or Yeast Year titnes ly n�i l'ke tO remind
rtment, W hic�so/;as ielarlY to a�OOa Wor d
eater q//t/'s fo tnrmine ifk/ng order
stare ofNo an u d to so;%ds
4Sp rth Carolii kS b 4S
s e m
u'e$rlianeSMSleefpu h�U/(�be e°re than the rent
g� �% o'��Wate �miepd 1/3 of °fed.
00 'mot o safe N 2jjo��S ofthe;r the
s

ntents 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, plea5e do not hesitate
to contact Paul DiMatteo at 336-776-9691 or our office at 336-776-9800.
Sincerely,
1? E.�Regional Supervisor
��' Sherri\l.KnightReg`onal Operations Section
Water 4ua1i y
inston-Salem eg10na1 OfficNCDEQ
W Water:esoiturces,p�v�s�onofCopy o� ?EESp c
. e ort and Summary
uCS—\ns'PecAO��
nt\os iora�price
ton Sa-} .; .
aSW�ns,. �r \ \\
\
iiiIiIii
0

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 I,, 2 IL 3 I NCG550199 111 121 17/09/O8 117 18 Lir. 19 [ 20I I
21IIIIII IIIIIII II II III IIII I I mil r6
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA -Reserved 67( I 70 L_L I I 71 Li 72 i 731 1 174 75I1 1 1 I 1 1 1 180
Section B:Facility Data Li
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) 01:10PM 17/09/08 13/08/01
145 Forestdale Drive
145 Forestdale Dr Exit Time/Date Permit Expiration Date
• 01:25PM 17/09/08 18/07/31
Reidsville NC 27320
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
David Heroux,145 Forstdale Dr Mebane NC 273021/336-552-8791/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
Permit II Facility Site Review
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/
•s-D 9ti-dr—)
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
31 NCG550199 I11 121 17/09/08 117 18 I_I
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 an unnamed tributary of Town Creek. No sewage malfunction was observed at the sand
filters or at the septic tank.You said that the septic tank was last pumped about 3 years ago.The
outfall was unable to be located. Please note that the Permit(copy attached)requires a visual review of
the outfall to be conducted twice per year.
There were no chlorine tablets present in the chlorinator. Please obtain and use chlorine tablets
that are rated for wastewater treatment, not tablets that are rated for pool use.The chlorinator should
be inspected weekly to ensure there is an adequate supply of tablets.
Documentation & Monitoring Review
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

Permit: NCG550199 Owner-Facility: 145 Forestdale Drive
- Inspection Date: 09/08/2017 - 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 MI 0
application?
Is the facility as described in the permit? • ❑ ❑ 0
#Are there any special conditions for the permit? 0 • 0 0
Is access to the plant site restricted to the general public? • 0 ❑ ❑
Is the inspector granted access to all areas for inspection? • 0 0 0
Comment: Could not locate the outfall.
• Page# 3