WQ0036014_Renewal Application_20210706

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Permit Number (IR)* WQ0036014
Applicant/Permittee Adam Leviner and Lauren Gill
Applicant/Permittee Address 395 McGhee Rd. Chapel Hill, NC 27517
Is the owner in BIMS? r Yes r No Is the facility in BIMS? r Yes r No
Owner Type Individual
Facility Name 395 McGhee Rd. SFR
County Chatham
Fee Category Single -Family Residence Fee Amount $0
Is this a complete
application?*
r Yes r No Complete App Date 07/06/2021
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review bythe hydrogeologist?* r Yes r No
Regional Office
CO Reviewer
Admin Reviewer
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by NF Staff regarding electibnittal, confirmation of receipt, other
.......................................................... electronic surece, aner correspondence.
_ -
Name * Adam Leviner
Email Address*
[e-mail]
Project Information
........ ......... ..........................................................................................................................................
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
919-928-4118
O Modification - Minor
G Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
r Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
r Wastewater Irrigation
r High -Rate Infiltration
r Other Wastewater
r Reclaimed Water
r Closed -Loop Recycle
r Residuals
IT Single -Family Residence Wastewater
r Other
Irrigation
Permit Number:*
WO0036014
Has Current Existing pernit number
Applicant/Permittee *
Adam Leviner and Lauren Gill
Applicant/Permittee Address*
395 McGhee Rd. Chapel Hill, NC 27517
Facility Name *
395 McGhee Rd. SFR
Please provide comments/notes
on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form Engineering Rans, Spec'rfications, Calculations, Rc.)
WQ0036014.pdf 3.63MB
Waiver for WQ0036014.pdf 141.37KB
395 Site Layout WQ0036014.pdf 64.44KB
upload only 1 FLFdocurrent (less than 250 W). Mafliple documents must be corrbined into one R]Ffile unless file is larger than
upload limit.
* W By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617

Signature
Submission Date 7/6/2021

DWR
Division of Water Resources
State of NorthCarolina
1,"I'epartment of Environmental Quality
[IMM i 1" ! 1
FORM: SFRWWIS-R 02-21
Pursuant to 1 SA NCAC 02T .0107Lbl, if the application does not include all required information and the necessary supporting
documentation, the application shall be returned. The application and attachments shall be prepared in accordance with 15A
NCAC 02T .0100, 15A NCAC 02T .0600, and Division Policies. For more information, visit the Water Quality Permitting
Section's Non -Discharge Branch website. The Applicant shall submit an electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) file to htt5;liedocs,d.�.gov/Fot°ntslNnClischar "e-BranchmSubmittalw
Form-Ver2, or emailed to . Jon- ischa .��oi-ts( ?ncdenr. ov if less than 20 megabytes (MB).
$ECTION I , APPLICANT 11NFORMATION
1. Applicant: Adam Leviner & Lauren Gill
2. Permit No.: WO0036014
3. Signature authority: Adam Leviner & Lauren Gill Title: Owners
4. Mailing address: 501 McGhee Rd.
City: Chapel Hill State: NC Zip: 27517-
5. Contact person: /M d,,vo, a.. " Email:
Primary phone number: (I 1 Z /' Select Secondary phone number: ( ) - Select
6. Secondary Contact person: e I t Email:
Primary phone number: 6 �j y�,.3q-&601 Select Secondary phone number: ( ) - Select
1. Physical address: 395 McGhee Rd. County: Chatham
City: Chapel Hill State: NC Zip: 27517-
1. Billing address: ......
. :
City: R
State: f d Zip: r. ° ,B
2. Verify the Applicant does not have any overdue annual fees:
htt//c.?e9vnc. ov( about/divisions/watt z-resourceslwater a_a sources -pc n7lits/wcl-epaytxlents
Pursuant to 15A NCAC 02T .01.20 c), permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: SFRWWIS-R 02-21 Page 1 of 4

Permit No.: WQ0036014 County: Chatham
Permittee: Adam Leviner & Lauren Gill (i.e., all deeded property owners)
The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system as
follows:
1. Inspect the septic tank annually, and pump out solids as needed.
2. Inspect and clean the septic tank effluent filter annually. (if applicable)
3. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets (e.g., calcium hypochlorite) as needed.
Swimming pool grade chlorine tablets are not acceptable. (if applicable)
4. Inspect the ultraviolet disinfection unit weekly. Clean or replace the lamps and quartz sleeves as needed. (if
applicable)
5. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all pump/storage tanks
when pumping the septic tank solids out.
6. Inspect the spray irrigation system monthly to verify: proper operation of the spray heads; that there are no leaks;
that vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not ponding in or running
off the designated irrigation area; and that there are no objectionable odors. (if applicable)
7. Inspect the drip irrigation system monthly to verify: proper operation of the drip lines; that there are no leaks; that
vegetative growth does not obstruct the drip emitters; that the irrigated wastewater is not ponding in or running off
the designated irrigation area; and that there are no objectionable odors. (if'applicable)
8. Maintain a set of Division -approved engineering plans and specifications.
9. Pay the required annual fee.
10. Request renewal of this permit on Division -approved forms no later than 180 days prior to expiration.
11. Sign and provide a C h to any future owner of the single-family residence wastewater
treatment and irrigation system for their completion and submission to the Division of Water Resources.
I/We understand the above requirements and agree to these terms as part of the issued permit.
Signature: 3 Date: 7 1604' r'
Signature: Date:
Signature:
Signature:
Date:
Date:
All deeded property owners shall sign this Operation and Maintenance Agreement
FORM: SFRWWIS-R 02-21 Page 2 of 4

W5 the ra,tttty originally permitted or had a major modification issued after September 1, 2006?
® Yes —Pursuant to 15A NCAC 021 .01.05(4), submit a site map pursuant to the requirements in 15A NCAC 021f .0604 d . These
requirements are:
❑ A scaled map of the site with topographic contour intervals not exceeding 10 feet or 25 percent of total site relief and showing
all facility -related structures and fences within the wastewater treatment, storage, and irrigation areas.
❑ Soil mapping units shown on all irrigation sites.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage,
and irrigation sites.
❑ Delineation of the compliance and review boundaries per 15A NCAC 02L .010i and .0108, and 15A NCAC 02T .0601.
❑ Setbacks as required by 15A NCAC 027' .0606.
❑ Site property boundaries within 500 feet of all wastewater treatment, storage, and irrigation sites.
❑ All habitable residences or places of public assembly within 500 feet of all treatment, storage, and irrigation sites.
❑ No — Skip Attachment A.
Does the signature authority in Section I, Item 3 meet the requirements pursuant to 15A NCAC 02T _Cl l 0(7 '[� ?
® Yes — Skip Attachment B.
❑ No — Submit a dele3atiqn leltgr pursuant to 15A NCAC; 02T ,0106.(c) authorizing the signature authority to sign.
Does the existing permit include an approved flow reduction?
❑ Yes — Submit a copy of the flow reduction approval letter, as well as the measured monthly average amount of wastewater flow
contributed per unit for the 12 months prior to permit renewal. If any of these monthly averages are within 20% of the approved
flow reduction value, the Permittee shall provide a reevaluation of the reduced flow value pursuant to the requirements in 'I 5.A.
NCAC 02T .0114(�,.
® No — Skip Attachment C.
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and irrigation system?
® Yes — Skip Attachment D.
❑ No — Pursuant to 1.5A NCAC 021' .0116 c', provide a copy of all easements, lease agreements, and encroachment agreements
allowing the Permittee to operate and maintain the wastewater collection, treatment, conveyance, and irrigation system on
property not owned by the Permittee.
ATT+kLT,> - AF TIN
�2"
Are the Permittee's affiliations of record correct? Check affiliations.
® Yes — Skip Attachment E.
❑ No — Provide the corrected affiliations and their contact information.
ATE ACIIEN I+-OIYICIrLtA1d!C CJFI1)t7I}
Does the existing permit include any Compliance Schedules? (See Section I of the most recently issued permit)
® Yes — Submit documentation that the compliance schedules have been met.
❑ No — Skip Attachment F.
FORM: SFRWWIS-R 02-21 Page 3 of 4

Does the Permittee have any existing Civil penalties or outstanding violations.
❑ Yes (civil penalties) — Submit payment for the civil penalty, or proof of remission request.
❑ Yes (violations) — Submit a copy of your response to the Notice of Violation.
® No — Skip Attachment G.
Does the existing permit include setback waivers?
® Yes — Pursuant to 15A N-'AC 02T .0606 c), provide setbacks waivers that have been written, notarized, signed by all parties
involved, and recorded with the county Register of Deeds. Waivers involving the compliance boundary shall be in accordance
with 15A NCAC 02L .0107.
❑ No — Skip Attachment H.
attest that this application
(Signature authority's name as noted in Section I, Item 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application package are not completed, and that if all required supporting information and attachments are not included, this
application package will be returned as incomplete. I further certify pursuant to 1 A NCAC 02T . O1.2b), that the applicant, or any
parent, subsidiary, or other affiliate of the applicant has: not been convicted of environmental crimes under; not previously abandoned
a wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with any compliance
schedule in a permit, settlement agreement, or order; not paid an annual fee.
Mote: The Applicant's Certification shall be signed pursuant to 15A NCAC 02T_0106(b). An alternate person may be delegated as
the signing official if a letter is provided pursuant to '15A NCAC 02T .0106(c). Pursuant to § 1.43-215.6A and § 143-215.613, any
person who knowingly makes any false statement, representation, or certification in any application package shall be guilty of a Class
2 misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Email:
Pion-I�nschart gLp�or is �e)na d� nr .t ov
Date: ' �"
1., 1GLE PDF1
L,aserfiche Upload:
tt s-.8edoes.de�<m Gov/I+orms/NonA isehar e- ranch-
ubrmitt,al-FormSubmittal-V.ea 2
FORM: SFRWWIS-R 02-21 Page 4 of 4

March 21, 2017
Subject: Engineering Certification — WQ0036014
Adam Leviner Residence
Parcel 82283, McGhee Rd
Chapel Hill, NC 27517
Chatham County
Dear Mr. Leviner;
We have completed a partial Engineering Certification of the surface drip wastewater
treatment and irrigation system for the single-family residence located at Parcel 82283
McGhee Road, Chapel Hill, NC 27517. The system was installed by Sloan Griffin of
Advanced Septic, Inc. Agri -Waste Technology, Inc. (AWT) inspected the system during
construction and upon completion of the system. The system was installed to meet the
intent of the design.
Power from the residence was not available at the time of the final inspection, so power
was supplied via a generator in order to operate the system. Testing of the system has
confirmed that it will operate in accordance with the original project design. Once power
is available at the residence, an additional inspection will be performed and a Final
Engineering Certification will be completed.
Thank you for your assistance with this matter. If you have any questions or comments,
please feel free to contact me at 919-859-0669 or via email at [e-mail]
Kevin D. Davidson, P.E.
Sr. Project Engineer

Permit No. WQ0036014 Single -Family Residence Wastewater ii-rigatiotiS),stem
Adam Leviner & Lauren Gill November 30, 2016
395 McGhee Rd. SFR, Chatham County
EWNGINFERING Ll-MLIFICATION'
Partial [ I Final
In accordance with 15A NCAC 02T.01 16, Kevin D, Davidson as
a duty registered Professional Engineer in the State of North Carolina, having tliellerrnittee,, authorization
to [X3 periodically Ej weekly 0 fully observe the construction of tile permitted facility, hereby state to the
best of my abilities that due care and diligence was used in the observation of the construction, such that
the facility was built within substantial compliance and intent of this permit, the Division approved plans
and specifications, and other supporting doeurnentation.
Any variation to this pertnit, the Division approved plans and specifications, and other supporting
documentation has been documented in the attached as -built drawings, and shall serve as the
Perinittee's minor modification request to amend the permit accordingly,
Provide a brief narrative description ofany variations: An AdvanTex AX20-RT Unit has
been installed in lieu of the Advantex pod and re -circulation tank.
Kevin D Davidson
Prof'essional Engineer's Narne
A -i-Waste Technology, Inc. gi
18
[.�,ngineering Firm
501, N, Salem Street, Suite 203 4,
Mailing Address
Apex NC 27502
C ity State Zip
[phone] kdavidson@,agriwaste.corn z z r -4-
Telephone E-mail NC PE Seal, Sr restore & Date
THE COMPLETED ENGINEERIN(30 CERTIFICATION, INCLUDING ALL SUPPORTING ,
rNFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS.
NOR111 CAROLINA DEPARTMENT OF ENVIRONMENTAL QUAIXFV
DIVISION OF WATER RESOURCES
WATER QU,kl,ITY PERMITTING SECTION
NON-DISCIIARGE PERMff,rING UNIT
§y, LLS. Postal Service: 'otttiq , e
1617 MAIL SERVICE CENTER 512 N. SALISBURY Sip",
RAI,EIGH, NORT11 CAROLINA 27699-1617 RALEIGI-1, NORTI I CAROIANA 27604
WQ0036014 Version 2,0 Shell Version 151201

BK 1885 PG 0159
FILED
CHATHAM COUNTY NC
LUNDAYA. RIGGSBEE
REGISTER_ OF DEEDS
FILED
Oct 12, 2016
AT
09:59:26 am
BOOK
01885
START PAGE
0159
END PAGE
0161
INSTRUMENT # 10251
EXCISE TAX
(None)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORM M.9 Y BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Resources will not consider this form complete unless all instructions are followed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For more information or for an electronic version of this form, visit our web site at:
ham. %'portal ncdem• orQ�iveb:iveT'uys'lau%appiieaiions.
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non -Discharge Permitting Unit application form.
✓ Any changes to this form will result in the application package being returned.
✓ Any other setbacks required by 15A NCAC Subchapter 02T other than those referenced below, cannot be waived
through execution of this form.
✓ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) and .1006(a)
The undersigned property owner(s) hereby permits:
Applicant's name: Adam Leviner and i niirarill n
Complete mailing address of applicant:
Citv: Chapel Hill
Telephone number: (919 ) 928 4118
501 McGhee Road
State: NC
Zip: 27517
Facsimile number: (� _
Hereinafter referred to as the Permittee, to (check all that apply):
X❑ Non -Discharge disposal of wastewater effluent within 25 feet of the property line,
❑ Non -Discharge disposal of wastewater effluent within feet of the identified residence,
❑ Construct treatment and storage units within feet of the property line,
❑ Construct treatment and storage units within feet of the identified residence.
FORM: NDWSW 11-13
Page 1 of 2

1 .1
The waived setbacks apply as shown on the attached map and located at the following:
Location address of property: 445 McGhee Road
City: Chapel Hill State: NC Zip: 27517
0 I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions
regarding this property on behalf of other deeded property owners. Furthermore, 1 certify that I have read and
understand this Agreement and do hereby grant permission to the Permittee to dispose of wastewater effluent or
construct wastewater treatment units as specified herein. I further agree that upon the Division of Water Resources's
issuance of a permit for the subject non -discharge system I will record this waiver form with the appropriate Register
of Deeds and provide the Permittee and Division of Water Resources with documentation of such.
Property owner(s) name(s): e 1,4r" -suc*- (77 {c etc.- 5- 7- /"t Csi1 f
Signature: d . Date: /,* -/a -IG
Signatur . L Date:
NORTH CAROLINA, U/LGLTYt/.t M COUNTY
I �r i F. yx) 14-i,.k a Notary Public for bu' r&" County, North Carolina,
do hereby certify that UQ,Y� &JVia � tA(6AC0 sonally appeared before me this day and
acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal this the �(� day of Of t pbcr , OQ01a�.
SEAL KRISTI f WHIT<.Ey
Notary Public
Durham County
North Carolina
My Commission Expires Nov 29, 2019
�2a_ j
Signature of Notary Public �—
My commission expires
FORM: NDWSW 11-13 Page 2 of2

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government agency for compliance with
any applicable land development
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