WQ0018153_Notice of Deficiency_20221207

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Paul and Sylvia Cox
6407 Carl Cox Rd
Bennett, NC 27208
NORTH CAROLINA
Environmental Quality
December 7, 2022
SUBJECT: Notice of Deficiency (NOD-2022-PC-0200)
6407 Carl Cox Rd SFR WWI
Permit No. WQ0018153
Randolph County
Dear Permittees:
On December 6, 2022, Division of Water Resources staff Caitlin Caudle conducted a
routine compliance inspection. Paul Cox, property owner, was present during the entire
inspection. A review of treatment units, irrigation field, and records was completed.
This review mostly reflected compliance with the subject permit. The following deficiency
was noted:
A. No records were available for review at the time of inspection. This was also noted
in correspondence dated March 8, 2018. Per Permit Condition V.2, the
Permittee shall maintain and inspection log that includes the date and time
of inspection, observations made, and maintenance, repairs, or corrective
actions taken. Permit Condition 111.13 also lists minimum inspection
frequencies for certain system components.
The following item of concern was noted:
• Mr. Cox stated that the septic tank has not been pumped since 2018, and the filter
in the septic tank was cleaned two weeks previously. As a reminder, Permit
Condition 111.13.a. states that the septic tank shall be inspected annually and
solids pumped as needed, and the septic tank filter cleaned annually. Please
inspect the septic tank within a year and pump the tank if needed.
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 W. Hanes Mill Rd, Suite 300 I Winston-Salem, North Carolina 27105
NoanicaaouNn
oep.m.m or em�nmen� Qualm
336.776.9800

Please refer to the enclosed inspection report for additional comments and observations.
If you have any questions, please contact me or Caitlin Caudle at the letterhead address
or phone number, or by email at Ion. snider(D-ncdenr.gov or caitlin.caudle(a)_ncdenr.gov.
Sincerely,
DocuSiTgned by:
%A. l . 5,,. Gr
145B49E225CMEA...
Lon T. Snider, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ-WSRO
Enc: Inspection Report
Most Recent Permit
Cc: Randolph County Environmental Health (electronic copy)
D North Carolina Department of Environmental Quality I Division of Water Resources
✓ Winston-Salem Regional Office 1 450 W. Hanes Mill Rd, Suite 300 1 Raleigh, North Carolina 27105
NORTH CAROLINA 336.776.9800
naparMeM of EmironmanW 9uallly

Compliance Inspection Report
Permit: WQ0018153
SOC:
County: Randolph
Region: Winston-Salem
Contact Person: Paul Cox
Effective: 12/01/21 Expiration: 05/31/28 Owner: Paul Cox
Effective: Expiration: Facility: 6407 Carl Cox Rd. SFR
6407 Carl Cox Rd
Title:
Bennett NC 27208
Phone:
Directions to Facility:
From 1-40 in Greensboro take US-220S to NC 42E in Asheboro, follow NC 42E for --15.5 mi to NC 22, turn R and follow NC 22/42S
follow for —5.6 mi, turn R onto Carl Cox Rd drive is —.75 mi on R.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 12/06/2022 Entry Time 10:OOAM Exit Time: 10:39AM
DocuSigned by:
Primary Inspector: Caitlin CaudleE68B834968199D49D...
� �llll� f�.� I'� Phone: [phone]
Secondary Inspector(s): �rulti l�D�
12/8/2022
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Single -Family Residence Wastewater Irrigation
Facility Status: ❑ Compliant Not Compliant
Question Areas:
Miscellaneous Questions Septic Tank Sand Filter/Treatment Pods
Disinfection Tablets Pump Tank Drip or Irrigation
General
(See attachment summary)
Page 1 of 4

Permit: WQ0018153 Owner -Facility: Paul Cox
Inspection Date: 12/06/2022 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
On December 6, 2022, Division of Water Resources staff Caitlin Caudle conducted a routine compliance inspection. Paul
Cox, property owner, was present during the entire inspection. A review of treatment units, irrigation field, and records was
completed.
It was noted that the spray heads had been repaired and the septic tank filter cleaned and repaired.
This review mostly reflected compliance with the subject permit. The following deficiency was noted:
A. No records were available for review at the time of inspection. This was also noted in correspondence dated March 8,
2018. Per Permit Condition V.2, the Permittee shall maintain and inspection log that includes the date and time of
inspection, observations made, and maintenance, repairs, or corrective actions taken. Permit Condition 111.13 also lists
minimum inspection frequencies for certain system components.
The following item of concern was noted:
• Mr. Cox stated that the septic tank has not been pumped since 2018, and the filter in the septic tank was cleaned two
weeks previously. As a reminder, Permit Condition 111.13.a. states that the septic tank shall be inspected annually and solids
pumped as needed, and the septic tank filter cleaned annually. Please inspect the septic tank within a year and pump the
tank if needed.
Other observations:
• There is no metering equipment in the system.
• Mr. Cox is still cutting power to the system when there is prolonged wet weather.
• There is a singular water supply well on the property approximately 230ft upslope of the application area.
• The permit description is incorrect. There are two 1,000 gallon storage/pump tanks.
• Proper chlorine tablets were being used and tablets were present in the tubes.
• There was a small leak visible on the stand pipe for the sprinkler on the left closest to the pump tanks.
• The alarm is in a utility room inside the house.
Page 2 of 4

Permit: WQ0018153 Owner -Facility: Paul Cox
Inspection Date: 12/06/2022 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Septic Tank
Yes No NA NE
*** The septic tank and filters should be checked annually and pumped/cleaned as needed. **
Is all wastewater from the home connected to the septic tank? ❑ ❑ ❑
# Does the permittee/resident know where the septic tank is located? ❑ ❑ ❑
Has the septic tank been pumped in the last 5 years? ❑ ❑ ❑
If YES, describe if known and proof (include date pumped):
Septic tank was last pumped in 2018. Recommended it be checked, and pumped if needed, within the next
year.
# Does the septic tank have an EFFLUENT FILTER or SANITARY T? ❑ ❑ ❑
If FILTER, when was the filter cleaned and by who? 11/21/2022 by Mr.
Cox and his son
Comment:
Sand Filter/Treatment Pods Yes No NA NE
*** Accessible sand filter surfaces shall be raked/leveled every 6 months and vegetative growth shall be
removed manually. ***
# Is system something other than a sand filter? ❑ ❑ ❑
# If YES, what kind? (examples - Peat, Textile or brand name - Advantex, etc.)
# Does the permittee know where the sandfilter is located? 0 ❑ ❑ ❑
Does the sandfilter require maintenance? ❑ 0 ❑ ❑
If maintenace is required, explain:
Comment: Sand filter is subsurface
Disinfection Tablets Yes No NA NE
*** Tablet chlorinator unit shall be checked weekly to ensure continuous and proper operation. ***
Does the permittee have the correct chlorine tablets? (If none, mark No) ❑ ❑ ❑
# Does the Permittee know the location of the chlorinator? ❑ ❑ ❑
Were chlorine tablets observed in the chlorinator? ❑ ❑ ❑
Are tablets contacting water? (If possible, poke them to determine.) 0 ❑ ❑ ❑
Comment:
Pump Tank Yes No NA NE
*** All pump and alarm sytems shall be inspected monthly. (Non -Discharge) ***
Is the pump working? ❑ ❑ ❑
Is the audible and visual high water alarm operational? ❑ ❑ ❑
# Does the permittee know how to check the pump & high water alarm? 0 ❑ ❑ ❑
# Last functional test: 12/6/2022
Comment:
Drip or Irrigation Yes No NA NE
Page 3 of 4

Permit: WQ0018153 Owner -Facility: Paul Cox
Inspection Date: 12/06/2022 Inspection Type: Compliance Evaluation Reason for Visit: Routine
*** Irrigation sysetm shall be inspected monthly to ensure system is free of leaks and equipment is operating
as designed. ***
# Type of system (DRIP or IRRIGATION):
# If IRRIGATION, number of sprinkler heads:
Are buffers and setbacks adequate?
Is the site free of ponding and runoff?
Does the application equipment appear to be working properly?
Is there a minimum two wire fence surrounding the entire irrigation area?
Comment:
# Are the treatment units locked and/or secured?
# Has resident had any sewage problems?
If YES, explain:
Does the system match the permit description?
If NO, explain:
There are 2 1,000 gallon pump/storage tank not a singular 2,000 gallon tank
Is the system compliant?
Is the system failing? (If yes, take pictures if possible)
If system is failing, describe any exposures to people/animals or environmental risks.
Comment: No records available for review.
Irrigation
4
• ❑ ❑ ❑
• ❑ ❑ ❑
• ❑ ❑ ❑
• ❑ ❑ ❑
Yes No NA NE
❑■❑❑
Page 4 of 4

R:OY COOPER.
t`.rraverroor
ELIZABETH S. MISER,
Sec,rerrra.7.
S. DANIEL SMITH
Director
PAUL AND SYLVIA G. Cox
6407 CARL Cox ROAD
BENNETT, NORTH CAROLINA 27208
Dear Mr. and Mrs. Cox:
NC7F2TId C:.4ROLINA
Environmental Quality
October 5, 2021
Subject: PermitNo. WQ0018153
6407 Carl Cox Rd. SFR
Single -Family Residence
Wastewater Irrigation System
Randolph County
In accordance with your permit renewal request received August 9, 2021, we are forwarding
herewith Permit No. WQ0018153 dated October 5, 2021, to Paul and Sylvia G. Cox for the continued
operation of the subject single-family residence wastewater treatment and irrigation facilities. Please note
that this renewed permit shall become effective on December 1, 2021 (i.e., the day after the expiration date
of the existing permit).
This permit shall be effective from December 1, 2021 through May 31, 2028, shall void Permit No.
WQ0018153 issued December 7, 2016, and shall be subject to the conditions and limitations therein. The
Permittee shall submit a renewal application no later than December 3, 2027.
Please pay attention to the operation and maintenance requirements listed in Section III for they
may differ from the previous permit issuance. Failure to establish an adequate system for collecting and
maintaining the required operational information shall result in future compliance problems.
The Division has removed the following permit condition since the last permit issuance dated
December 7, 2016:
➢ Old Condition VI.2. — This condition has been removed because the permit is not voidable.
The following permit conditions are new since the last permit issuance dated December 7,
2016:
➢ Condition IL9. —All setbacks applicable to 15A NCAC 02H .0219(j)(5) have been added.
➢ Condition III.12. — Metering equipment shall be tested and calibrated annually.
➢ Condition VI.10. —This permit shall not be renewed if the Permittee or any affiliation has not
paid the required annual fee.
North Carolina a Department of Lnvarcanrnental Qaaality I Division of Water Ike° oul ces
5I2 North SaB sbury Street I IOU MaaH Service Center I Raleigh, North Carolina 27699'M7
919307.90,00

Mr. Paul Cox and Mrs. Sylvia G. Cox
October 5, 2021
Page 2 of 2
If any parts, requirements, or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Otherwise, this permit shall be final and binding.
If you need additional information concerning this permit, please contact Chloe Lloyd at (919) 707-
3657 or chloe.11oyd a)ncdenr.gov.
Sincerely,
w.
cS. Daniel Smith Director
Division of Water Resources
cc: Randolph County Health Department (Electronic Copy)
Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Paul and Sylvia G. Cox
Randolph County
FOR THE
continued operation of a 360 gallon per day (GPD) single-family residence wastewater treatment and
irrigation facility consisting of:
a 1,000 gallon baffled septic tank; a 396 square foot (ft') subsurface sand filter; a tablet chlorinator; a 2,000
gallon storage/pump tank; a 0.42 acre spray irrigation area; and all associated piping, valves, controls, and
appurtenances
to serve the single-family residence at 6407 Carl Cox Rd., Bennett, NC 27208, with no discharge of wastes
to surface waters, pursuant to the application received August 9, 2021, and in conformity with the Division -
approved plans and specifications considered a part of this permit.
This permit shall be effective from December 1, 2021 through May 31, 2028, shall void Permit No.
WQ0018153 issued December 7, 2016, and shall be subject to the following conditions and limitations:
I. SCHEDULES
1. The Permittee shall request renewal of this permit on Division -approved forms no later than December
3, 2027. [15A NCAC 02T .0105(b), 02T .0109]
2. If a public or community sewage system is or becomes available, the Permittee shall connect to this
system, and shall request rescission of the single-family residence wastewater treatment and irrigation
facilities permitted herein. [15A NCAC 02T .0607]
WQ0018153 Version 4.0 Shell Version 200201 Page 1 of 7

IL PERFORMANCE STANDARDS
The Permittee shall maintain and operate the subject non -discharge facilities so there is no discharge to
surface waters, nor any contravention of groundwater or surface water standards. In the event the
facilities fail to perform satisfactorily, including the creation of nuisance conditions due to improper
operation and maintenance, or failure of the irrigation areas to assimilate the effluent, the Permittee
shall take immediate corrective actions, including Division required actions, such as the construction
of additional or replacement wastewater treatment or disposal facilities. [15A NCAC 02T
.0108(b)(1)(A)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this facility. [15A NCAC 02T .0108(b)(1)(A)]
3. The Permittee shall apply treated wastewater effluent at or below the following rates:
TABLE 1— APPLICATION LIMITATIONS
Field
Parameter
Hourly Rate
Yearly Max
Units
1
01284 — Non -Discharge Application Rate
0.1
13
inches
[15A NCAC 02T .0605(j)]
4. The Permittee shall only apply treated wastewater effluent to the following:
TABLE 2 — IRRIGATION AREA INFORMATION
Net
Dominant
Field
Owner
County
Latitude
Longitude
Acreage
Soil Series
CaB — Callison-
1
Paul and Sylvia G. Cox
Randolph
35.572984'
-79.573994'
0.42
Lignum complex,
2 to 6 % slopes
[15A NCAC 02T .0108(b)(1)(A)]
The attached Operation and Maintenance Agreement shall be a condition of this permit.
Noncompliance with the terms of the Operation and Maintenance Agreement shall subject the Permittee
to all sanctions under G. S. 143-215.6A, G.S. 143-215.613, and G.S. 143-215.6C for violation of or
failure to act in accordance with the terms and conditions of this permit. [15A NCAC 02T .0604(h)]
6. The compliance boundary is the property boundary. Any exceedance of groundwater standards at or
beyond the compliance boundary shall require corrective action. Division -approved relocation of the
compliance boundary shall be noted in Condition IL4. Multiple contiguous properties under common
ownership and permitted for use as a disposal system shall be treated as a single property with regard
to determination of a compliance boundary. [15A NCAC 02L .0106(d)(2), 02L .0107(i), 02T .0105(h),
G.S. 143-215.1(1), G.S. 143-215.1(k)]
7. The review boundary is midway between the compliance boundary and the effluent disposal area. Any
exceedance of groundwater standards at or beyond the review boundary shall require preventative
action. [15A NCAC 02L .0106(d)(1), 02L .0108]
8. The Permittee shall apply for a permit modification to establish a new compliance boundary prior to
any sale or transfer of property affecting a compliance boundary (i.e., parcel subdivision). [15A NCAC
02L .0107(c)]
WQ0018153 Version 4.0 Shell Version 200201 Page 2 of 7

9. The facilities herein were permitted per the following setbacks:
a. The irrigation sites were originally permitted May 22, 2000. The setbacks for spray irrigation sites
originally permitted or modified from February 1, 1993 to August 31, 2006 are as follows (all
distances in feet):
I. Each habitable residence or place of assembly under separate ownership:
400
ii. Each private or public water supply source:
100
iii. Surface waters:
100
iv. Groundwater lowering ditches:
100
v. Surface water diversions (upslope):
100
vi. Surface water diversions (downslope):
100
vii. Each well with exception of monitoring wells:
100
viii. Each property line:
150
ix. Top of slope of embankments or cuts of two feet or more in vertical height:
15
x. Each water line:
10
xi. Each swimming pool:
100
xii. Public right of way:
50
xiii. Nitrification field:
20
xiv. Each building foundation or basement:
15
Habitable residences or places of assembly under separate ownership constructed
after the
facilities herein were originally permitted or subsequently modified are exempt from this
setback.
2 Setbacks to property lines are not applicable when the Permittee, or the entity from which the
Permittee is leasing, owns both parcels separated by the property line.
[15A NCAC 02H .0219(j)(5)]
b. The storage and treatment units were originally permitted May 22, 2000. The setbacks for storage
and treatment units originally permitted or modified from February 1, 1993 to August 31, 2006 are
as follows (all distances in feet):
I. Each habitable residence or place of assembly under separate ownership (only 1001
applicable to surface sand filters):
ii. Each private or public water supply source: 100
iii. Surface waters: 50
iv. Each well with exception of monitoring wells: 100
v. Each property line: 50 2
vi. Nitrification field: 20
Habitable residences or places of assembly under separate ownership constructed after the
facilities herein were originally permitted or subsequently modified are exempt from this
setback.
2 Setbacks to property lines are not applicable when the Permittee, or the entity from which the
Permittee is leasing, owns both parcels separated by the property line.
[15A NCAC 02H .0219(i)(5)]
WQ0018153 Version 4.0 Shell Version 200201 Page 3 of 7

III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The Permittee shall operate and maintain the subject facilities as anon -discharge system. [15A NCAC
02T .0600]
2. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the subject non -discharge facilities, the Permittee shall designate and employ a certified
operator in responsible charge (ORC), and one or more certified operators as back-up ORCs. The ORC
or their back-up shall operate and visit the facilities as required by the WPCSOCC. [15A NCAC 02T
.0117]
3. The Permittee shall maintain vegetative cover on the irrigation sites, such that crop health is optimal,
allows even effluent distribution, and allows inspection of the irrigation system. [15A NCAC 02T
.0608(a)]
4. The Permittee shall take measures to prevent effluent ponding in or runoff from the irrigation sites
listed in Condition IL4. [15A NCAC 02T .0608(b)]
5. The Permittee shall not irrigate treated effluent during inclement weather, or when the soil is in a
condition that will cause ponding or runoff. [15A NCAC 02T .0605(o)]
6. The Permittee shall only irrigate treated effluent from the single-family residence at 6407 Carl Cox Rd.,
Bennett, NC 27208 on the sites listed in Condition IL4. [15A NCAC 02T .0601]
7. The Permittee shall not allow vehicles or heavy machinery on the irrigation area, except during
equipment installation or maintenance activities. [15A NCAC 02T .0608(d)]
8. The Permittee shall prohibit public access to the wastewater treatment and irrigation facilities through
lockable treatment units, and fencing around the irrigation sites. [15A NCAC 02T .0605(i)]
9. The Permittee shall dispose or utilize generated residuals in a Division -approved manner. [15A NCAC
02T .1100].
10. The Permittee shall not divert or bypass untreated or partially treated wastewater from the subject
facilities. [15A NCAC 02T .0605(f)]
11. Pump tanks shall have audible and visual alarms external to any structure. [15A NCAC 02T .0605(n)]
12. Metering equipment shall be tested and calibrated annually. [15A NCAC 02T .0608(c)]
13. The Permittee is responsible for the operation and maintenance of the wastewater treatment and
irrigation system including the following:
a. Inspect the septic tank annually, and pump out solids as needed. Inspect and clean the septic tank
effluent filter annually.
b. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets (e.g., calcium
hypochlorite) as needed. Swimming pool grade chlorine tablets are not acceptable.
c. 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.
d. 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.
[15A NCAC 02T .0608]
WQ0018153 Version 4.0 Shell Version 200201 Page 4 of 7

IV. MONITORING AND REPORTING REQUIREMENTS
The Permittee shall conduct and report any Division required monitoring necessary to evaluate this
facility's impact on groundwater and surface water. [15A NCAC 02T .0108(c)]
2. Noncompliance Notification:
The Permittee shall report to the Winston-Salem Regional Office, telephone number [phone],
within 24 hours of first knowledge of the following:
a. Any process unit failure (e.g., mechanical, electrical, etc.) rendering the facility incapable of
adequate wastewater treatment.
b. Any facility failure resulting in a discharge to surface waters.
c. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Ponding in or runoff from the irrigation sites.
Emergencies requiring reporting outside normal business hours shall call the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. All
noncompliance notifications shall file a written report to the Winston-Salem Regional Office within
five days of first knowledge of the occurrence, and this report shall outline the actions proposed or
taken to ensure the problem does not recur. [15A NCAC 02T .0108(b)(1)(A)]
V. INSPECTIONS
1. The Permittee shall perform inspections and maintenance to ensure proper operation of the wastewater
treatment and irrigation facilities. [15A NCAC 02T .0608(f)]
2. The Permittee shall inspect the wastewater treatment and irrigation facilities to prevent malfunctions,
facility deterioration, and operator errors that may result in discharges of wastes to the environment,
threats to human health, or public nuisances. The Permittee shall maintain an inspection log that
includes the date and time of inspection, observations made, and maintenance, repairs, or corrective
actions taken. The Permittee shall maintain this inspection log for a period of five years from the date
of the inspection, and this log shall be made available to the Division upon request. [15A NCAC 02T
.0608(e), 02T .0608(f)]
Division authorized representatives may, upon presentation of credentials, enter and inspect any
property, premises, or place related to the wastewater treatment and irrigation facilities permitted herein
at any reasonable time for determining compliance with this permit. Division authorized
representatives may inspect or copy records maintained under the terms and conditions of this permit,
and may collect groundwater, surface water, or leachate samples. [G.S. 143-215.3(a)(2)]
WQ0018153 Version 4.0 Shell Version 200201 Page 5 of 7

VL GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to a
Division enforcement action. [G.S. 143-215.6A, 143-215.613, 143-215.6C]
2. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, and Division -approved plans and specifications. [G.S. 143-215.1(d)]
3. Unless specifically requested and approved in this permit, there are no variances to administrative codes
or general statutes governing the construction or operation of the facilities permitted herein. [15A
NCAC 02T .0105(n)]
4. The issuance of this permit does not exempt the Permittee from complying with all statutes, rules,
regulations, or ordinances that other jurisdictional government agencies (e.g., local, state, and federal)
may require. [15A NCAC 02T .0105(c)(6)]
If the permitted facilities change ownership, or the Permittee changes their name, the Permittee shall
submit a permit modification request on Division -approved forms. The Permittee shall comply with
all terms and conditions of this permit until the permit is transferred to the successor -owner. [G.S. 143-
215.1(d3)]
6. The Permittee shall retain a set of Division -approved plans and specifications for the life of the facilities
permitted herein. [15A NCAC 02T .0105(o)]
7. The Permittee shall maintain this permit until the proper closure of all facilities permitted herein, or
until the facilities permitted herein are permitted by another authority. [15A NCAC 02T .0105(j)]
8. This permit is subject to revocation or modification upon 60-day notice from the Division Director, in
whole or part for:
a. violation of any terms or conditions of this permit or Administrative Code Title 15A Subchapter
02T;
b. obtaining a permit by misrepresentation or failure to disclose all relevant facts;
c. the Permittee's refusal to allow authorized Department employees upon presentation of credentials:
I. to enter the Permittee's premises where a system is located or where any records are required
to be kept;
ii. to have access to any permit required documents and records;
iii. to inspect any monitoring equipment or method as required in this permit; or
iv. to sample any pollutants;
d. the Permittee's failure to pay the annual fee for administering and compliance monitoring; or
e. a Division determination that the conditions of this permit are in conflict with North Carolina
Administrative Code or General Statutes.
[15A NCAC 02T .0110]
WQ0018153 Version 4.0 Shell Version 200201 Page 6 of 7

9. Unless the Division Director grants a variance, expansion of the facilities permitted herein shall not
occur if any of the following apply:
a. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has been convicted of
environmental crimes under G.S. 143-215.6B, or under Federal law that would otherwise be
prosecuted under G.S. 143-215.6B, and all appeals of this conviction have been abandoned or
exhausted.
b. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has previously abandoned
a wastewater treatment facility without properly closing the facility.
c. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid a civil
penalty, and all appeals of this penalty have been abandoned or exhausted.
d. The Permittee or any parent, subsidiary, or other affiliate of the Permittee is currently not compliant
with any compliance schedule in a permit, settlement agreement, or order.
e. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid an annual
fee.
[I5A NCAC 02T .0120(b), 02T .0120(d)]
10. This permit shall not be renewed if the Permittee or any affiliation has not paid the required annual fee.
[15A NCAC 02T .0120(c)]
Permit issued this the 5`" day of October 2021
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Ex
S. Daniel Smith, Director„
Division of Water Resources°
By Authority of the Environmental Management Commission
Permit Number WQ0018153
WQ0018153 Version 4.0 Shell Version 200201 Page 7 of 7

IV OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQ0018153
Permittee: Paul and Sylvia Cox (i.e., all deeded property owners)
County: Randolph
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 (�halille 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: �`°
Date:
_
Signature: .... �� �����":m"' � ."�
mo
Date:
Signature:
Date:
Signature:......_..
Date:
All deededproperty owners shall sign this O eration and Maintenance A reement
FORM: SFRWWIS-R 02-21 Page 2 of 4

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