NCG550233_Permit (Issuance)_19970721

State of North Carolina
Department of Environment,
Health and Natural Resources AreirilVA
Division of Water Quality V
James B. Hunt, Jr., Governor E H N
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director July 21, 1997
Arthell Goforth
Route 1,Box 26
Hot Springs,NC 28743
Subject: Certificate of Coverage No. NCG550233
Renewal of General Permit
Goforth,Pearl-Residence
Madison Count
y
Dear Permittee:
In accordance with your application for renewal of the subject Certificate of Coverage, the Division is forwarding
the enclosed General Permit. This renewal is valid from the effective date on the permit until July 31, 2002. This
permit 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 December 6, 1983. If any
parts,measurement frequencies or sampling requirements contained in this 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, this Certificate of Coverage shall be final and binding.
The Certificate of Coverage for your facility is not transferable except after notice to the Division. Use the enclosed
Permit Name/Ownership Change form to notify the Division if you sell or otherwise transfer ownership of the
subject facility. The Division may require modification or revocation and reissuance of the Certificate of Coverage.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the Regional
Office listed below at [phone]. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain other permits which may be required by the Division of
Water Quality, 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 the NPDES Group at the address below.
Sincerely,
1)-ifrE:49(--- 4.
A.Preston Howard,Jr.,P.E.
cc: Central Files
Asheville Regional Office
NPDES Group
Facility Assessment Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535 [phone] FAX[phone] p&[e-mail]
An Equal Opportunity Affirmative Action Employer 50% recycled /10%post-consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG550000
CERTIFICATE OF COVERAGE NO. NCG550233
TO DISCHARGE DOMESTIC WASTEWATERFROM 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,
Arthell Goforth
is hereby authorized to operate a wastewater treatment facility which includes a septic tank, sand filter
and associated appurtenances with the discharge of treated wastewater from a facility
located at
Goforth, Pearl- Residence
Route 1,Box 26
Hot Springs
Madison County
to receiving waters designated as subbasin 40304 in the French Broad 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, 1997.
This certificate of coverage shall remain in effect for the duration of the General Permit.
Signed this day July 21, 1997.
•
44,(----*
�A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

- A/C655 25,
N. C. DEPARTMENT OF ENVIRONMENT, HEALTH & NATURAL RESOURCES
ENVIRONMENTAL MANAGEMENT COMMISSION
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM APPLiCATION N1;MIifR
APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM D FOR 1 "i i1�i i 1
AGENCY — J-1_!_
USE DATE RF(f lYED
fo be filed only by services, wholesale and retail trade,
and other commercial establishments including vessels 1 I_ 1 1 j
YEAR MO. DAY
Do not attempt to complete this form without reading the accompanying instructions
Please print or type
I. Name, address, and telephone number of facility producing discharge
A. Name Q (A. `-� Qne) C"4 fih
B. Street 11\
`` address '1--e - _I 1J� ��_
c. city +-101 � f� c� ; n � S 0. State N ' i •
E. County 'CYO A D 1 S V F. IIP 2.V1 43
G. Telephone No. 1d j 2 --1 I.S17
Area
Code
2. SIC 1 1 1 1
(Leave blank)
3. Number of employees
4. Nature of business R1° ,S 4, Y\C9
5. (a) Check here if discharge occurs all year](, or
(b) Check the month(s) discharge occurs:
1.oJanuary 2.0February 3.oNarch 4.oApr1l 5.0Nay
6.0 June 7.OJuly 8.o August 9.0 September 10.0 October
11.o November 12.0 December
(c) How many days per week:
1.01 2.0 2-3 3.04-5 4. 6-7
6. Types of waste water discharged to surface waters only (check as applicable)
Flow, gallons per operating day Volume treated before
Discharge per discharging (percent)
operating day 0.1-999 1000-4999 5000-5999 10,000- 50,000 None 0.1- 30- 65- 95-
49,999 or more 29.9 64.9 94.9 100
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
A. Sanitary, doily
1.,/ v/average
' ' A
B. Cooling water, etc.,
daily average
C. Other discharge(s), r
daily average;
Specify
ti.
D. Maximum per operat-
ing day for combined
discharge (all types)

r . ,
7. If any of the types of waste identified in item 6, either treated or un-
treated, are discharged to places other than surface waters, check below
as applicable.
Waste water is discharged to: 0. 1-999 I 1000-4999 I 5000-9999 10,000-49,999 50,000 or more
(I) (2) (3) ! (4) (5)
a
A. Municipal ScwPr c,ystce
f •
H. VrIder9rounrl will
. y
C. Stet Ic tank
U. Evaporation lagoon or pond
E. Other, specify:
8. Number of separate discharge points:
A.1A 1 6. o 2-3 C.O 4-5 D.O 6 or more
c�
9. Name of receiving water or waters S 1✓ C ) ,() /`; .
10. Does your discharge contain or is it possible for your discharge to contain
one or more of the following substances added as a result of your operations,
activities, or processes: am ania, cyanide, aluminum, beryllium, cadmium,
chromium, copper, lead, mercury, nickel, selenium, zinc, phenols, oil and
grease, and chlorine (residual).
A.Oyes ,,Ono
I certify that I am familiar with the information contained in the application and
that to the best of my knowledge and belief such information is true, complete, and
accurate.
Print I Name of Person Sig ng
Title
-')//i/
7.
Date pplicati S'
Signature of App tcant ,
.h Carolina General Statute 143-215.6(b) (2)TQrovides that: Any person who knowingly makes
false statement repl-esencation, or certification in any applicat .on, 'record, report, plan,
)they document files or required to be maintained under Article 21 or regulations of the
ronmental Management Commission implemsnt4ng that Article, or who falsifies, tampers u t`, ,
:nowly renders inaccurate any recording or monitoring device or method required to be
ated or maintained under Aptlele 21.oc regulations .of the Environmental Management Cods ,or:
ementing that Article, shall 'be 'gui3.ty of a misdemeanor punishable by a fine not to exceed
non, or by imprisonmmnt not to exceed six months, or by both. (18 U.S.C, Section 1001 prow:_ -..
:nishment by a fine of'not more than S10,0O0 or imprisonment not more than 5 years, or both ,
a sinilar offense. )

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1690-6901
North Carolina Department of
Environment, Health & Natural Resources
Division of Environmental Management
PO Box 29535
Raleigh, NC 27626-0535

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PS Form 3811, ecember 1994 Domestic Return Receipt