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Home My WebLink AboutNCG550233_Compliance Evaluation Inspection_20141114 461;1•1176, NCDENR North Carolina Department of Environment and Natural Resources Pat McCrory John E.Skvarla, III Governor Secretary November 14, 2014 • Mr. David Goforth 9475 NC Highway 209 Hot Springs, NC 28743 SUBJECT: Compliance Evaluation inspection Goforth Residence Permit No: NCG55023;3" Madison County Dear Mr. Goforth: On November 4, 2014, I conducted a compliance evaluation inspection of the subject facility. During a review of the system file, and during a discussion with you, it was determined that the current permittee in our system, Pearl Goforth, is deceased. As you are the current property owner, we are requesting that you complete the enclosed Change of Ownership form in order to have the system permitted in your name. Please complete the form and mail to the address indicated. • During the November 4, 2014 inspection, I collected a water sample from your effluent pipe for analysis of fecal coliform bacteria. Those results are forthcoming and I will provide them to you once they are received. If you have any questions regarding the Change of Ownership form, please call RECEIVED me at 828-296-4500. NOV 17 zui Sincerely, Ct:WTR\L FILES DWR SECTION /ab its Andrew Moore Environmental Senior Technician Enclosure IVIS.i rg Central Files-6as�men�t—=� WQ Asheville Files • Water Quality Regional Operations—Asheville Regional Office 2090 U.S.Highway 70,Swannanoa,North Carolina 28778 Phone:828-296-4500 FAX:828-299-7043 Internet http:llportal.ncdenr.orglweblwq An Equal Opportunity 1 Affirmative Action Employer • ATM NCDENR North Carolina Department of Environment and Natural Resources Pat McCrory, Governor John E.Skvarla III, Secretary ��x•",.s,,� �,,;.<<aari., ,a.M,,;;,�.. =n•a v'�y,•r a`x'a.M4.-.i ;.,a4:. .ski".. :,{�T. s<,.,f-g,s �'.,°i.� IP: IIIUiII : :d.»�;s :�N�,j'�„<''�4-'z<'��`„'' L, xv4t, �€'J-4'�'�•Y" 'Ark..C' I. Please enter the CoC number for which the change is requested. Certificate of Coverage q C 0, 5 0 2 3 3 II. Please provide the following for the requested change(revised permit). a. Request for change is a result of: x 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: David Goforth First MI Last owner Title ,9475 NC Highway 209 Permit Holder Mailing Address Hot Springs NC 28743 City State Zip (805)291-6777 • Phone E-mail Address d. Facility name(discharge): _ 11 Woolyshot Branch Road e. Facility address: 11 Woolyshot Branch Road Address Hot Springs NC 28743 • City State Zip f. Facility contact person: First MI Last ( ) Phone E-mail Address III. Permit contact information(if different from the person legally responsible for the permit) Permit contact: First MI Last Title Mailing Address City State Zip ( ) Phone E-mail Address Will this permitted facility continue to discharge the same volume and type of wastewater as prior to this ownership or name change? x Yes ❑ No(please explain) Revised 2/2009 NCG550000 OWNERSHIP CHANGE FORM - Page 2 of 2 VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS 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 relevant pages of a contract deed, or a bill of sale) is required for an ownership change request. Articles of incorporation are not sufficient for an ownership change. The certifications below must be completed and signed by the new applicant in the case of an ownership change request. APPLICANT CERTIFICATION I,David Goforth, 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. Signature Date • • PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO: NC DENR/DWR/NPDES 1617 Mail Service Center Raleigh,North Carolina 27699-1617 • • Revised 7/2008 11/13/2014 8853-1.jpg(1050x 800) ...,t-..f,•f.A14",I,II'LLS,2 .1",'4'...- ,i't-'-'-'. Madisorx 6ounfy,i\lt.' essom'tc-usr-ttl',;.• . 4o-i•-,.41,;-4,--04,..At.:-tta. 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Cotgre .'PLASTER, liaidUcbd. 7 . , -, „_- ---- . . OPENINGS . - • - ItYY,I---","-a,,LIL,-,-,,,,,,,,,,,I,IIIILYI4X,4LINFT,INJIL0IN0$1011ffil4WIROVELIENTs,,,,,<,-,'''',,,SAW,,,,,.`,,,,,',,,,,,....,,q.e.,,.:0.,,,,,,,,' n.., . , ...'llifiliTING.,tii rentusysAsEllEtrfei/MITSWSUIMECTJONS,1",:e,3,-41,4'74', TYPE. ,I GRADE-I‘YEAR ICOND - ' `LENGTH•XIIIIIDTH ' I AREASEE I , VALUE' - - 'TYPE— ' ""l• GRADE l''-"art/SEE '"I " UPON 0 : „ f ,-.5,1ST0'.,SHED - ,C •20 00 fr. _SF' 8100 „ „ . - . . 3.1..e.‘:* •' .s., •-,),„ „ „ . . . . .. „ , , . . ". . ' . .. '' ' -'-'-'' <'-'-'-'1,'"'''','''''''''',,, "gr NVINGSEPTDtq,!,9-74-4 ,WI-t-",- '4RA SEE-I I-TYPE I GRADE'I SOFT I -SHOT UPON I'S-COUP A , --4-g , . HAI:OPEN FRAME PCH E+10 - .12D,.: 1.00 .•4 3•52 100* ,A,'•--llifii,1-.*$4,4,4 • • • -. • CO OPEN FRAME-PCH E+10•• 114 1.00 -•4 3.34'.:100k DA:.SINGLE:•TAMDLY• E+10 1.2•6 1-.OCI •-:41.,-7-09• 100% /4•-',..,•--‘,,,,, ,AVVVVVVVVVVVVVVVVVVV :0;SINGLE „FAMILY E+10 ,57,5 1.00 47,801 -100% Mk y-t} . . • . V -" - ,-- - " - ." - ;TOTAL OUT BUILDING'VALUE . $100 . . . .',...t,,-; ,...z.-..-....,v. -.-.,,,,,-,, ,,,-..-,,,,,,,,,,..,... ,-,,,,,,,,,vomireopoioev.,-.,-,- , -„,..- ----..,:.,,, , -,. '.. ,,.,,,,__,_ ,..._ ,,,. , _ .,_ .. .. ... , * . ... „...,„. ....„.„.,.., • 04--,,-. •/,:-• .TOPO • -. . -SITEACCESS -' -" UTILMES - < ZONING • . „ .„ - -. -.. , - , . ...,„ .„„ , - , „ . . -- - , .., . --.- , 4 ,:-.44*, ' t'n-at• . . RAe'd.:!, . . • Y2* VI.A'Itil,,..,...., ; --",,,tk-ttIIII,UI,,,, •....'ToTAL. c-ip...,,g'''' . ii.,',-;i6D I ' SEE I DEPTH I RATE• I USETYPE I IUSEVALUE I r,,,,XN..4 • -LIAR SET VALUE '','--,---.-i —.k. -'1,-'-• 1 1,131 dg5ite • • ACRE 1.000 - :420,000 . EL--.§.1.114iiiilt 4' , „ TOTAL BLD Cr'VALVE *10,576 GANG VAL,VE", , , '42 0;00 0 - • - • . . OBLDF,VALUC - $10C1 - . . - - - - IL -CgFPRAI,SMD,,VhL,LIE , *30,676 . . . . rDzr LIMED LIA LIE _ f,..$0 . . z•V4'.P4 ,, - ,7.,??.F.E ;...,,,,,-,i,.. ..,',:,:-.:Aset-t--7.6 'A ".:.•-,'.1.4.0, .'VE '1.:.""--f,-,•,:.'',I.::,,-1-:<• i5,„„,i,-,:, IN.,,,,,,,, • gkViTo tal Aerei • 1.00 * / Acie $20,0 0 Os,Land Use Value $0 larld-Value $20,060 PRINTED: 8/12%2014 • . , __,7 .....-,- L-101C... 7-115 e"-t (.._ . Willi 11/4. Cfr74• • )7(1 , O'vfil r'Sii'r Fc)rvt, . ..... 410t re V-1 - t • . _ http://www.madcotax.com/cards/8853-1.jpg , 1/1