NCG550220_Permit (Issuance)_20190311

ROY COOPER
STq Governor
iti
`1 MICHAEL S. REGAN
Secretary
5�
LINDA CULPEPPER
Sr r,, Director
r 2 e
NORTH CAROLINA
Environmental Quality
March 11, 2019
Mary F. Saunders
540 Shadow Ln
Winston-Salem, NC 27107
Subject: General Permit NCG550000
Certificate of Coverage (CoC) NCG550220
540 Shadow Ln
Forsyth County
Dear Permittee:
The Division has renewed General Permit NCG550000. The Division hereby issues you a revised
version of NCG550220, along with a copy of the renewed General Permit. Discard any earlier versions of the
permit and use this version until further notice. This CoC is issued pursuant to the requirements of North
Carolina General Statue 143-2151 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection agency dated October 15, 2007 [or as subsequently amended].
If you have an email address,please send it to Charles Weaver [[e-mail]]. Future
CoC renewals can be sent to you electronically.
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 CoC is not transferable except after notice to the Division. The Division
may require modification or revocation and reissuance of the CoC. Contact the Winston-Salem Regional
Office prior to any sale or transfer of thepermitted facility. Regional Office staff will assist you
in documenting the transfer of this CoC.
This permit does not affect the legal requirements to obtain any other State,Federal, or Local
governmental permit that may be required. If you have any questions concerning the requirements of the
General Permit,please contact Derek Denard of the NPDES staff[919 707-3618 or via email at
[e-mail]].
Sinc ely,
/./. raeolf
for ' da Culpepper
Director, Division of Water Resources
cc: NPo, S;fe
DE CV
North Carolina Department of Environmental Quality I Division of Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-707-3616

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550220
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,
•
is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a
facility located at
540 Shadow Ln
Winston-Salem
Forsyth County
to receiving waters designated as Soakas Creek, a class C stream in subbasin 03-07-04 of the
Yadkin-Pee Dee River Basin in accordance with the effluent limitations, monitoring requirements,
and other conditions set forth in Parts I, II, and III hereof.
This certificate of coverage takes effect March 11, 2019.
This Certificate of Coverage shall remain valid for the duration of the General Permit.
Signed this day March 11, 2019
af% e
for Linda Culpepper
Director, Division of Water Resources
By Authority of the Environmental Management Commission

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DIVISION OF
� � ��o ''•,, North Carolina Department of Natural ENVIRONMENTAL
MANAGEMENT
) `4.1 Resources &CommunityDevelopment
Robert F.D Helms
p
James B. Hunt, Jr., Governor Joseph W. Grimsley, Secretary Telephone [phone]
QY au.,,`ma's-
July 21, 19 83 55
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Mr. D. B. Tesh, Jr.
��
540 Shadow Lane
Winston-Salem, North Carolina 27107
SUBJECT: Permit No. NC0055760
Authorization to Construct
Tesh Residence
Wastewater Facilities
Forsyth County
Dear Mr. Tesh:
The final plans and specifications for the subject project have been
reviewed and found to be satisfactory. Authorization is hereby granted for
the construction of a 450 GPD wastewater treatment facility consisting of a
900 gallon septic tank, a 396 square foot subsurface sand filter and all
related piping and appurtenances to serve the D. B. Tesh, Jr. Residence.
This Authorization to Construct is issued in accordance with Part III
paragraph C of NPDES Permit No. NC0055760 issued March 18, 1983, and shall be
subject to revocation unless the wastewater treatment facilities are constructed
in accordance with the conditions and limitations specified in Permit No. NC0055760.
The sludge generated from these treatment facilities must be disposed of in
accordance with G.S. 143-215 .1 and in a manner approvable by the North Carolina
Division of Environmental Management.
The Winston Salem Regional Office, Phone No. 919/761-2351 shall be notified
at least twenty-four (24) hours in advance of backfilling of the installed
subsurface filter system so that an in-place inspection can be made of said
system prior to backfilling. Such notification to the Regional Supervisor
shall be made during the normal office hours from 8:30 A.M. until 5 :30 P.M.
on Monday through Friday, excluding State Holidays.
One (1) set of approved plans is being forwarded to you. If you have any
questions or need additional information, please contact Mr. Richard R. Rohrbaugh
telephone No. 919/733-5083, ext. 103.
SiSWAMORPEry,
FORREST R. WESTALL
FOR
Robert F. Helms
cc: Forsyth County Health Department
Mr. Forrest R. Westall
Winston Salem Regional Supervisor
Winston Salem Regional Manager
POLLUTION PREVENTION PAYS •
P. 0. Box 27687 Raleigh,N. C.27611-7687
An Equal Opportunity Affirmative Action Employer