NCG550268_Permit (Issuance)_20170428

ROY COOPER
i Governor
IJA
. MICHAEL S. REGAN
Secretory
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
April 28, 2017
Mr. Scott L. Rakestraw
134 Meadow Brook Road
Reidsville, NC 27320
Subject: NPDES General Permit NCG550000
Transfer of NCG550268
751 Eagle Falls Road
Rockingham County
Dear Mr. Rakestraw:
The Division hereby transmits Certificate of Coverage (CoC) NCG550268, 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 [phone] or via e-mail [[e-mail]].
erely,
.14 e-6.
66/1
/ S. Jay Zimmerman, P.G.
Director
cc: Winston-Salem Regional Office
dPDES IT t_
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 NCG550268
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,
Scott L. Rakestraw
are hereby authorized to operate a wastewater treatment facility with a discharge of<1000
gallons per day); discharging from
751 Eagle Falls Road
Madison
Rockingham County
to receiving waters designated as an unnamed tributary (UT) to the Dan River [stream
segment 22-(38.5)], a waterbody currently classified WS-IV; CA located within subbasin 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 28, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 28, 2017.
. Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission

•
ROY COOPER
MICHAEL S. REGAN
S,neta,i
S. JAY ZIMMERMAN
Water Resources v;et
ENVIRONMEN FAL QUALITY
- -NPDES Certificate of Coverage (CoC)-
- OWNERSHIP CHANGE FORM
I. Please enter the CoC number for which the change is requested.
Certificate of Coverage
N C G 5 50A61-6
II. Please provide the following for the requested ange(revised permit).
a. Request for change is a result of: hange 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): .5 o f-t I. t ' tI eSY-thu,i
c. Person legally responsible for permit: .5 f t I irc5f 'ec�
First MI Last
Title
,3q Aleacio c,.) .d 1va K /S G ,
Permit Holder Mailing Address
Rel►d, J: I le_ iv c— a 73a�o
City State Zip
(33(0 ) 4/5)-5)1_5 ..Sc o+tta1<e5hraultgadm,�.4-eteciV;c,cOm.
Phone E-mail Address
d. Facility name(discharge):
e. Facility address: 751 �cr�l.P r 6(5
Address
/i'la4C1 i5042 /lJ L DI-,?od-,5"
City State Zip
f. Facility contact person: LSGo+t- L. Rare,511VA4J
First MI Last
(336 ) 4/53-5315 scot-i-PAlres t✓P nF-ete.emc..coy
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
IV. 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
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
AR!l>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 j rgperty 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.
APPJLLJCANT 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.
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

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NORTH CAROLINA -
GENERAL WARRANTY DEED
'Excise Tax S NT C.
Tax Mao No. Parcel Identifier No
Mail after recording to_Curtis Howe.105 N.Franklin Street.Madison,NC'27025 ' •
This instrument was prepared by:Curtis Howe.Attorney at Law
THIS DEED made this 4th day of October ,
'011 - by and between
' GRANTOR
SARAH J.RAKESTRAW,Widow
(conveying her life estate interest)
GRANTEE
SCOTT LAWSON RAKESTRAW
751 Eagle Falls Road
Madison,NC 27025
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successor. 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,barga'ri,sell and convey unto the Grantee in fee simple, all
that certain lot or parcel of land situated in the Town of ,Wentworth Township, Rockingham
County,North Carolina and more particularly described as follows:
BEGINNING at a stake on the northerly edge of St, Rd. 2127 said beginning point being located South 61
deg.20 min,East'129.37 feet from the southeast corner of Martha Mitchell on the edge of the aforesaid
road.and sarne being the northeast corner of the tract conveyed to Cordell Rakestraw; thence South 61
deg.20 Min.East 140.13 feat to a stake; thence North 83 deg, 5 min. East 255.0 feet to a stake; thence
South 79 deg.55 min.East 207.5 feet to a stake;thence South 66 deg. East 100 feet to a stake; thence
South 79 deg.9 min.East 18.0 feet to a stake in the branch;thence following the meanders of the branch
the totkowing courses and distances, South 59 deg. 5t1 min. West 99.0 feet to a stake; thence South 76
deg.at inin.West 209.19 feet to a stake;thence South 78 deg.45 min.West 339.38 feet to a stake;thence
North 68 deg.28 min.West 51.0 feet to a stake,the same being the southeast corner of Cordell Rakestraw;
thence leaving the branch and proceeding North 2 deg. 54 min. West 185.0 feet to a stake on the edge of
.St.Rd 2127;thence continuing North 2 deg. 54 min, West 70 feet to a stake on the northerly edge of said
road, the point and place of beginning, and containing 2..6 acres, more or less according to a ptat of
survey for L.P. Rakestraw dated December 4, 1972 by Robert S. McHenry, registered land surveyor, to
which plat reference is hereby made,and being also a northeast portion of Lot 48 of the Eagle Falls tract.
See Plat book 2,page 22.
it is the intention of the parties hereto that the Grantor convey to the Grantee her
interest,such that the Grantee is now the sole fee simple owner of the above describedretained lreal r estate
property.

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i\'•' \\'�i L"� „'':c +hr,'e S.t tili-N ti�� :i:il1:t tilts lit\\to t'i,Wit:; ill oillltllt11111::LN11t1111F1t iNt)1 0%1'E)pi lt�l llltt tt1(t ttllllllllt;
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'e:�,..'��\ 't\ �t t<`.,..it\`i 0 :V"lyrist is`Sint+it`<1 tO OW ttlilili\ily I*\('t)hihllla
t. Taxes for the curient year, rights of way of public hi thwaya and roads and public utilltiea, oasomental
and rti'.strkCtkotls of public record, and Iloilcolllpliance, if ally, with local, county, state or federal
government taws, ordinances, or regulations relative to zoning, environment, subdivision, occupancy,
use.construction.or the development of the subject property.
2., Curtis Howe, Attorney At Law, has not examined the title to the above described real property
and therefore in no way guarantees that good and marketable title is being conveyed.
IN WITNESS WHEREOF,the Grantor has hereunto set his hand and seal,or if corporate.has caused this
instrument to be signed in its corporate name by its duly authorized officer(s),the day and year first
above written. .77____ ;z4
--- '4 -- — T Sl?A1.)
tCv. porn a\ame'i Sarah J. E cstraw
By: (SEAL)
,President (SEAL)
STATE'OF NORTH CAROLiNA �.Mw...age
t,c�CKC GHA�t cob 1 z �.. * M. No�,'Ny,,�
aa _� F,��s
I, Ellen M. N'unnen. a Notary Public of the County and the State ator-fIN ten' v �l s,AR'rfltlyl, RAl�1;STRt\\b',
Grantor,personals` appeared heron e this day a ac not edged the exectliton of riot`folti"+i il�ti;instml�lent. Witness my
hsttd and official stamp or seal,this I day of L` 1 c:,it)l I. e O ti >t
C c- 42-1(1 t�'t t,..1t�t-L pug>r�G
•
Notary Public:Alen M.Nunne' 0•`�.y1 v,c`�.•,
My Commission expires: l o -.01 S VV 4,6,4 CQ ' 0 '
STAltOrNORTH CAROLiNA ROC1:liVGHAA7 COUNTY
______n Notnn' Public of the County and Slate aforesaid. certify that
- a Norm Cnrvlinn Corp onrtion`Lilnited Littb;Ggr
`ntarilt'txet lei)t foregoing
instrument
re-it before the tUis dnp nttd aclr7t;I' cd�;ed tint hiv.11e, be'
nuthttr;rrd to riu ao,
voluntarily�o.etwca the foregoing insuuu)r nt for airs on bchall'ot'thr corpotittfon,
R'imess my hand and official sunup or seal this the
_dad of_ ,"'011,
Bt. —,� — —_
i\olar-Public:. �--- ---- _
A1v Commission Expires: -
The foregoing Certilicate(s)of
---.:-IT------
_
is/ate certified to be correct. This instrument - -- Li-iliult-_ _T- - - -^ - —--- -- -
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