NCG550274_Permit (Completion Request)_20171012

i
i
ROY COOPER
Governor
N
.a MICHAEL S. REGAN
Secretary
M S. JAY ZIMMERMAN
Water Resources Director
ENVIRONMENTAL QUALITY
October 12, 2017
Mr. William Hirt
581 Hideaway Lane
Leasburg, NC 27291
Subject: NPDES General Permit NCG550000
Transfer of NCG550274
581 Hideaway Lane
Person County
Dear Mr. Hirt:
The Division hereby transmits Certificate of Coverage (CoC) NCG550274, 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 fmal 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]].
5. cerely,
C-
S. Jay Zimme an, P.G.
Director
cc: Raleigh Regional Office
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
hops://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 NCG550274
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
standard and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
William Hirt
are hereby authorized to operate a wastewater treatment facility with a discharge of<1000
gallons per day); discharging from
581 Hideaway Lane
Leasburg _
Caswell County
to receiving waters designated as Hyco River [stream segment 22-58(0.5)], a waterbody
currently classified WS-V; B located within sub-basin 03-02-05 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 October 12, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 12, 2017.
///4/
. Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission

f.
PAT MCCRORY
covernoi.
DONALD R. VAN DER VAART
Secrelmy
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY Director
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NC00 / / / / or NCG5 5 / 0 / 2 / 7 / 4
1. Facility Name: (Residence) 581 Hideaway Lane, Leasburg, NC 27291
IL NEW OWNER/NAME INFORMATION: ENS
•
1. This request for a name change is a result of: SEC Z011
SEP
_X_a. Change in ownership of property/company a�tty.
dater®gect on
b. Name change only PetrtOn9
c. Other(please explain):
2. New owner's name (name to be put on permit):
William Hirt
3. New owner's or signing official's name and title: i Ciia'rPt
(Person legally responsible for permit)
cC
(Title)
4. Mailing address: 581 Hideaway Lane City: Leasburg
State: NC_ Zip Code: 27291 Phone: [phone]
E-mail address: bhirtyahoo.com
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
State of North Carolina l Environmental Quality I Water Resources
1617 Mail Service Center j 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

NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
I, William Hirt , 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 and attachments are not included, this application
package will be returned as incomplete.
Signature: Date: Z57//3/2 / 7
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ/ DWR/ NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 7/2016

Document# 9/13/2017 3:12 PM
11076
FILED
Person County
Russell Jones
Tax Administrator
FILED in PERSON County NC
on Sep 13 2017 at 03:10:15 PM
bREGISTER OF DEEDS 12
•
Book 962 Pagge3
III IIIIIIIIIIIIIIIIIIIIIIIIIIII III
Issued Sep 13, 2017
$930.00
State Of North Carolina
Person County
Real Estate Excise Tax
372373
NORTH CAROLINA
GENERAL WARRANTY DEED
Excise Tax: $430.00 Recording Time,Book and Page:
Tax Map No. A4 Parcel Identifier No: 137
Mail after recording to: J.Linwood Cates,P.O.Box 679,36 Court Street,Roxboro,NC 27573
This instrument was prepared by: J.Linwood Cates,Attorney
THIS DEED made this 11thday of Sept., �y ancd between
GRANTOR
David W Fowler and wife,Janice W Fowler
Mailing Address:3818 NC Highway 86 S Hillsborough NC 27278
GRANTEE
William Joseph Hirt
Property Address: 581 Hideaway Lane,Leasburg,NC 27291
Mailing Address:581 Hideaway Lane Leasburg NC 27291
The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,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,bargain,sell and convey unto the Grantee in fee simple,all that certain lot or parcel of land
and more particularly described as follows:
Being that certain lot or parcel of land lying and being in the Cunningham Township,Person County,State of North
Carolina,on or near Carolina Power and Light Company's Hyco Lake Project,and being all of what is shown and
designated as Lot No.7,containing 0.46 of an acre on plat of survey entitled"PROPERTY OF JAMES RAMSEY,"as
surveyed by Phillip J.Hall,Surveyor,dated October,1976,and recorded in Deed Book 166,at Page 511,Person County
Registry,which plat is incorporated as an integral part of this description by reference thereto.
Also conveyed herewith is a right of easement for purposes of ingress and egress over and across those private subdivision
roadways extending in a Northwesterly direction from N.C.State Road#1102,crossing lands now or formerly owned by H.
W.Winstead Estate and lands formerly owned by J.T.Ramsey,which access roadway is more particularly described on
that plat of survey entitled"Access Easement to Subdivision of James Ramsey,"surveyed by Hall-Hamlett and Associates,
Surveyors,dated July,1982,and recorded in Plat Cabinet 1,Page 289,Person County Registry,which plat is incorporated

BOOK 962 PAGE 121 372373
as an integral part of this description by reference.A portion of the access roadway shown on plat of survey by J.IL
Howard,County Surveyor,surveyed on April 21,1900,intersecting Tract 1 allotted to Lulu Oliver of record in that Special
Proceeding entitled"Bell V.Covington,et al,vs.Bettie S.Winstead,et al,"which special proceeding and the survey is of
record in the office of the Clerk of Superior Court of Person County.Robert T.Ramsey and James E.Ramsey,heirs of J.
T.Ramsey,granted a Deed of Easement to Roger P.McLaughlin,et ux,and to the successors in title to lands acquired by
the late J.T.Ramsey by Deed of record in Book 85,Page 279,Person County Registry,being the same lands from which
the subject property was divided,and which Deed of Easement is of record in Deed Book 200,Page 167,Person Registry.
Upon the above-described premises,there is located a 1988 Parkway Manufactured Home,which manufactured home was
established as real property by Affidavit dated August 22,1994,and recorded in Book 239,Page 884,Person County
Registry.
This conveyance is subject to that Road Maintenance Agreement of record in Deed Book 243,Page 599,Person Registry.
For chain of title,see that Deed from Jessie L.Moore,H,et ux,to David W.Fowler,et ux,recorded on June 13,2005,in
Book 540,Page 596,Person Registry.
All or a portion of the property hereinabove described was acquired by Grantor by instrument recorded in Book 540 ,Page
596 , Person County Registry.
A map showing the above described property is recorded in Plat Book_,Page_,and referenced within this instrument.
Does the above described property include the primary residence(yes/no)?No
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee
in fee simple.
And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee simple,has the right to convey the same in
fee simple,that title is marketable and free and clear of all encumbrances,and that Grantor will warrant and defend the title against
the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
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.
�XcJ Q—} I ' (SEAL)
(Entity Name) David W Fowler `o
BY a i ,�2 2 / (SEAL)
Jani W Fowler
Title:
By: (SEAL)
Title:
(SEAL)
NORTH CAROLINA°":1"9COUNTY
I certify that the following person(s)personally appeared before me this day,each acknowledging to me that he or she signed the
foregoing document: David W Fowler and wife.Janice W Fowler .Witness my hand and official stamp or seal,this the
day of R P P-4-e.r-r%1m , 3.0 t'7
My Commission Expires: June_ 23, 20 22_ C ij c n n go D `►L
Notary Publi
OFFICIAL SEAL Print Notary Name: P 0 G `-p S- r
� Q�� ANGELA O. FOSTER Aryl
� :_ - - --- - -
j '' NOTARY PUBLIC-NORTH CAROLMIA. Document shows proof/acknowledgement be o e
COUNTY OF ALAMANCE officer authorized to take proof/acknowledgement;
My Commission ExpiresOG1?_J/22— acknowledgement India officer's signature,
commission expir o e,official seal,if required.
5Milcnn PP.on County Register of Deeds

:‘;
PAT MCCRORY
l Governor
••
MICHAEL S.REGAN
Secretary
Water Resources S.JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
September 29,2017
Certified Mail Item 7015 0640 0007 9833 8029—Return Receipt Requested
Mr.William Hirt
581 Hideaway Lane
Leasburg, NC 27291
Subject: Wastewater Disposal at
581 Hideaway Lane, Leasburg
Certificate of Coverage(CoC) NCG550274
Person County
Dear Mr. Hirt:
Person County tax records list Mr.& Mrs. David Fowler as the current owner of the subject property.We are
contacting you to determine the status of a wastewater disposal system on your property that was covered by
General Permit NCG550000 under CoC NCG550274.The last CoC was issued to the Fowlers in 2007. The Division
needs information from you to determine if coverage under NCG550000 is still necessary. Please respond with one
the following:
> If you are the current owner of this property and it still has a wastewater system like the ones described in
the enclosed Technical Bulletin,you must submit a change in ownership form. Please complete the enclosed
form and submit it to Emily Phillips at the address on the form. In addition,a copy of your deed is required
to maintain this permit.
➢ If you know that your property no longer discharges wastewater and the treatment system has been
replaced with a different treatment system or connected to a city sewer, please contact me at the address
or phone number listed below to request rescission of the CoC.
➢ If you are not sure what type of system your property has,contact Danny Smith in the NC DEQ Raleigh
Regional Office at 919-791-4200.This contact[or other staff members]can help you determine if you should
maintain your CoC.
If you have questions concerning this matter, please do not hesitate to contact me at 919-807-6479 or
[e-mail].
Sincere! ,
let4/11
Emily Phillips
Division of Water Resources, DEQ
cc: Raleigh Regional Office,DWR
Ir M.%(gial li[giant v`likk
State of North Carolina I Environmental Quality I.Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1611
919-707-9000

UNITED STATESW Al ERVICE First-Class Mail I.
Ni 2.7x- PostaPermitge&Fees Paid
,19 SE '..L/ USPS
No.G-10
Cc. • Sender: Please print your name, address, and ZIP+4 in this box •
g
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2 O ^� Emily Phillips
�4 E i NC DEQ/DWR/NPDES
O p0 1617 Mail Service Center
Raleigh, NC 27699-1617
ivS1
EN-
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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. /' 1 LE� Agent
• Print your name and address on the reverse x l/� ddressee
so that we can return the card to you. Rec ived y(Printed Name) HS. Date of livery
▪ Attach this card to the back of the mailpiece,
or on the front if space permits. (tq H ®`t l-2_q I V7
D. Is delivery address different from Item 1? ❑Yes
Mr. William Hirt If YES,enter delivery address below: / c
581 Hideaway Lane
Leasburg, NC 27291
3. Service Type
Xitertified Mail ❑Express Mail
I V g 0�� L� ❑I Registered ❑Return Receipt for Merchandise❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
7015 0640 0007 9833 8029
PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540