NCG110048_Renewal COC Request_20180718 1:22:12 PM

JI
Environmental
Quality
Permit COC
NCG110048
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
Facility Name
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Monica Dodson
Obtaining COC*
First and Last Name
Phone Number* 9195374205
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (Optional) Enter an additional enail address to whom to send the COC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General NCG110000
Permit No.
COC No.
NCG110048
Permittee
Orange Water and Sewer Authority
Facility Name
Mason Farm WWTP
Address
170 Old Mason Farm Rd
City
Chapel Hill
County
Orange
Waterbody
Morgan Creek
Classification
WS-IV;NSW
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
1 hereby request a copy of the Certificate of Coverage (COC) entered above. I understand that the COC e-mailed as a
result of this request will serve as the Permittee's record of renewed coverage under the General Permit, and that this
record must be maintained with the Permittee's NPDES Stormwater Permit records.
Signature *
A1111WIGA- PVPSCAf
Date * 07/18/2018