NCG550209_Permit (Issuance)_20070727

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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
Coleen H. Sullins, Director
July 27, 2007
Dennis &Lisa Sykes
5650 Lakeside Dr
Pfafftown,NC 27040
Subject: Renewal of coverage/General Permit NCG550000
5650 Lakeside Drive
Certificate of Coverage NCG550209
Forsyth County
Dear Permittee:
In accordance with your renewal application [received on April 24,2007],the Division is renewing
Certificate of Coverage(CoC)NCG550209 to discharge under NCG550000. This CoC 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.
Contact the Winston-Salem Regional Office prior to any sale or transfer of the permitted facility.
Regional Office staff will assist you in documenting the transfer of this 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 the requirements of the General Permit,please contact Toya
Fields [919 733-5083, extension 551 or [e-mail]] or Susan Wilson [919 733-5083, extension 510
or [e-mail]].
Sincerely,
for Coleen H. Sullins
cc: Central Files
Winston-Salem Regional Office/Surface Water Protection
Nuatirsirom
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone]/FAX [phone]/Internet:www.ncwaterquality.org Natural',
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

6
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550209
DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND
OTHER 100% DOMESTIC 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,
Dennis & Lisa Sykes
is hereby authorized to discharge domestic wastewater [300 GPD] from a facility located at
5650 Lakeside Drive
Pfafftown
Forsyth County
to receiving waters designated as an unnamed tributary to Mill Creek No. 3 in subbasin 03-07-04 of
the Yadkin 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 August 1, 2007.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 27, 2007.
t."A (NFU`
J
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

FOR AGENCY USE ONLY
• Date Received
Year Month Day
Division of Water Quality/Water Quality Section
Certificate of Coverage
NCDENR National Pollutant Discharge Elimination System NI heck# I I Amount
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES Permit Assigned to
NCG550000
RENEWAL FORM FOR EXISTING PERMITTED FACILITIES
NPDES renewal application for continued coverage under General Permit NCG550000:
Certificate of Coverage NCG550209
(Please verify the information in items 1 &2 as correct, or note any corrections that should be made.)
(Please print or type) y
1) Mailing address* of property owner: 3:'t
Owner Name .Dennis &Lisa Sykes APR 2 4 ni,
Street Address 5650 Lakeside Dr DENR - q;a-E, 6o
POINT SOURCE BRANCH
i
City Pfafftown,NC 27040 1, x
Telephone (Home) /3 2 4 ,g 2 (Mobile) J 3 6 9/6 '13/ 7
(e-mail address) ► `5 Do j i4o od i c,r0
*Address to which all permit correspondence will be mailed
2) Location of facility producing discharge*:
Street Address 5650 Lakeside Dr
City: Pfafftown,NC 27040
County Forsyth tl -7 !
� I/b
Telephone (Home) _6 3'G� I p�Z-f-1(g 2-/ (Mobile) 3 —1 3 r
* If the facility is not yet constructed,give the street address or lot number where the structure will be
built.
3) Description of Discharge:
a) Type of facility producing waste (please check one):
(}9 Primary residence
❑ Vacation/second home
❑ Undeveloped property
0 Other [describe]:
Page 1 of 2

I
NCG550000 renewal form
4) Please check the components that comprise the wastewater treatment system:
VI Septic tank ❑ Dosing tank t] Primary sand filter ❑ Secondary sand filter
❑ Recirculating sand filter(s) ❑ Chlorination ❑ Dechlorination
❑ Other form of disinfection: ❑ Post Aeration(describe)
5) Other Information:
a) When was the septic tank last pumped out? "0 -I
NOTE: the septic tank must be pumped out at least once every 3-5 years
b) Is the facility [home] occupied year-round, or only seasonally? ` cv ro°N
c) Approximately how many people use the facility when it is occupied? 3
d) When was the wastewater system installed? lI Pet`4, I q D T
6) 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: Pell in I'5 CI 11-8f
`f 23/o
(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.)
Mail this completed form and a [if available) copy of the receipt for your last septic service
to:
Mr. Charles H. Weaver, Jr.
NC DENR/DWQ/NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Page 2 of 2

State of North Carolina
Department of Environment 4ig;
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor NCDENR
William G. Ross Jr., Secretary
Alan W. Klimek, P.E., Director NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
July 26,2002
DENNIS LISA SYKES
SYKES DENNIS&LISA-RES
5650 LAKESIDE DR
PFAFFTOWN, NC 27040
Subject: Reissue-NPDES Wastewater Discharge Permit
Sykes Dennis&Lisa-Res
COC Number NCG550209
Forsyth County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG550000,the Division of
Water Quality(DWQ)is forwarding herewith the reissued wastewater general permit Certificate of Coverage
(COC). This COC is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S.Environmental Protection Agency,
dated May 9, 1994(or as subsquently amended).
The following information is included with your permit package:
* A copy of the Certificate of Coverage for your treatment facility
* A copy of General Wastewater Discharge Permit NCG550000
* A copy of a Technical Bulletin for General Wastewater Discharge Permit NCG550000
Your coverage under this general permit is not transferable except after notice to DWQ. 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 DENR or relieve the permittee from responsibility
for compliance with any other applicable federal,state,or local law rule,standard,ordinance,order,judgment,or
decree.
Please note that effective January 1, 1999 the fees for all permits issued by DWQ were changed. This changed the
fee for your wastewater general permit coverage from a$240 fee paid once every five years to a yearly fee of$50.
If you have not already been billed this year for the yearly fee,you will receive a bill later this year.
If you have any questions regarding this permit package please contact Mack Wiggins of the Central Office
Stormwater and General Permits Unit at(919)733-5083,ext.542
Sincerely,
•
34.t2 4 —
for Alan W.Klimek,P.E.
cc: Central Files
Stormwater&General Permits Unit Files
Winston-Salem Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO.NCG550000
CERTIFICATE OF COVERAGE No.NCG550209
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,
DENNIS SYKES
is hereby authorized to operate a domestic wastewater treatment facility which includes a septic tank,sand filter,
and associated appurtenances with discharge of treated domestic wastewater from the facility located at
SYKES DENNIS &LISA-RES
5650 LAKESIDE DR
PFAFFTOWN
FORSYTH COUNTY
to receiving waters designated as Mill Creek,a class C water,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 of
General Permit No.NCG550000 as attached.
This certificate of coverage shall become effective August 1,2002.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 26,2002.
y • -9-
for Alan W.Klimek,P.E.,Director
Division of Water Quality
By Authority of the Environmental Management Commission