WQ0037236_Application_20191205

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 09-19
This form is for renewal without modification for all non -discharge system permits, except Residuals Management and Single -
Family Residence Wastewater Irrigation System permits.
For more information, visit the Water Quality Permitting Section's Non -Discharge Branch Website.
I. PERMITTEE INFORMATION:
1. Permittee: Matthew Tracy, 7328 Ridgeline Dr, Raleigh NC 27613
2. Signature authority's name: Matthew Tracy per 15A NCAC 02T .0106(b)Title: Owner
Primary Telephone number: 201 341-2484 Cell Secondary number: (_) _- Select
Email Address: [e-mail]
3. Permittee's mailing address: 2568 Chaplin Creek Dr
City: Loveland State: CO Zip: 80538
4. Billing address (if different from above):
City: State: Zip:
5. Contact person's name (if different from signature authority): Title:
Primary Telephone number: () _- Select Secondary number: () = Select
Email Address:
H. PERMIT INFORMATION:
1. Existing permit number: WQ0037236
2. Has the facility been constructed? ❑ Yes or ® No
If yes, has the facility been constructed in accordance with the permit and the Division -approved plans and specifications?
[15A NCAC 02T .0110] ❑ Yes or ❑ No
If no, a formal permit modification request shall be submitted to the Division.
3. Has any of the property ownership within the facility and/or disposal area changed from what is indicated in the current permit
(Attachment B — disposal field owner/lessee)? ❑ Yes or ® No
Has the Permittee had a name change or has the permit changed ownership? ❑ Yes or ® No
If yes to either, a permit modification request shall be submitted to the Division. [15A NCAC 02T .01051
4. Is this facility a Privately -Owned Public Utility? ❑ Yes or ® No
If yes, provide two copies of the Certificate of Public Convenience and Necessity from the North Carolina Utilities Commission
demonstrating the Applicant is authorized to hold the utility franchise. [15A NCAC 02T .0115(a)(1)1
5. Is the Permittee a Home/Property Owners' Associations or Developers of lots to be sold? ❑ Yes or ® No
If yes, provide the following:
• For Home/Property Owners' Associations — Operational Agreement (FORM: HOA) and a copy of the proposed or
approved Articles of Incorporation, Declarations, and By-laws [15A NCAC 02T .0115(c)]
• For Developers of lots to be sold —Operational Agreement (FORM: DEV) [15A NCAC 02T .0115(b)1
FORM: NDSR 09-19 Page 1 of 4

DW.R
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 09-19
6. Does the facility treat and dispose of industrial wastewater? If yes, complete items below. If no, skip to the next section.
Provide a detailed industrial process description including:
• An overview of the manufacturing process
• An inventory of all materials used for manufacture, including chemicals and biological matter
• An overview of cleaning and treatment methodology, including an inventory of treatment materials and compounds
Indicate the approximate percentage of wastewater makeup:
Industrial: % Domestic: % Stormwater: %
Has the nature of wastes (e.g., change in industrial processes, introduction of new materials or chemicals, etc.) described in the
approved permit application(s) changed? ❑ Yes or ❑ No
If yes, a permit modification request shall be submitted to the Division. jG.S. 141-215.1(d)1
M. SITE MAP:
1. Provide an updated site map in accordance with 15A NCAC 02T .0105(d) that shows the following:
The site map is not required to be signed or sealed by a Professional Engineer. However, the map must indicate the source of
information. For example, parcel lines taken from a county GIS map should reference the GIS website.
❑ Legend, north arrow, scale, and legible in black and white
❑ Topographic contour intervals not exceeding 10 feet or 25 percent of total site relief
❑ Soil mapping units on all disposal sites
❑ All facility -related structures and fences within the treatment, storage, and disposal areas
❑ All habitable residences and places of assembly within 500 feet of all treatment, storage, and irrigations sites
❑ Location of all wells, streams (ephemeral, intermittent, and perennial), springs, lakes, ponds, ditches, and other surface
drainage features within 500 feet of all waste treatment, storage, and disposal site(s)
❑ Latitude and longitude coordinates of all monitoring wells (decimal degrees to 6 digits)
❑ Location and identification of major components of the waste disposal system
❑ The wetted perimeter of all irrigation fields with field names (named according to the approved permit)
❑ Location and ownership of property boundaries within 500 feet of the disposal area (including road/rail right-of-ways)
❑ The delineation of compliance and review boundaries
❑ Distance measurements verifying all setbacks are being met
❑ Stormwater drainage controls
❑ 100-year floodplain (if applicable)
❑ For reclaimed water generation permits only, provide a separate map showing all distribution lines and utilization permit
locations that are connected to the water generation facility and are permitted by the Non -Discharge Branch (excludes
Local Program permitted facilities). Include all reclaimed water distribution line and reclaimed water utilization permit
numbers.
FORM: NDSR 09-19 Page 2 of

DWR
Division of Water Resources
IV. GROUNDWATER MONITORING WELLS
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 09-19
1. Does the facility have a proposed or existing groundwater monitoring well network? ❑ Yes or ❑ No
If no, skip to next section.
If yes, complete the following table (NOTE — This table may be expanded for additional wells):
Well Name
Status
Latitude 8
Longitude 8
Gradient
Location
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
a. Coordinates must be in NAD83 and have 6 decimal degrees
V. SETBACK WAIVERS, EASEMENTS, AND LEASES:
1. Does the permit have any setback waivers, easements, or leases? ❑ Yes or ® No
If yes, provide copies of all documents and complete the table below:
Document
Type
Grantor or
Parcel No.
Grantee
Expiration
Date
County
Registered
Deed
Book
Deed Page
Document
Description e
Select
Select
Select
Select
Select
Select
Select
a. The document description shall list any reduced setbacks with distance, etc.
2. For reclaimed water utilization permits only:
Is reclaimed water utilized on property not controlled by the generator? ❑ Yes or ❑ No
A lease, easement, or agreement must be provided allowing for the utilization of reclaimed water on the property or within the
facility. For irrigation of reclaimed water, an easement is required per 15A NCAC 02U .0501(6). All documents shall be listed
in the table above.
FORM: NDSR 09-19 Page 3 of 4

L1�i17
Division of Water Resources
VI. RELATED PERMITS
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 09-19
1. If this permit has interactions with other wastewater permits (collection systems, NPDES, etc.), complete the table below
(provide additional pages if necessary):
Permit Type Permit No. Description
2. Does the facility have an approved flow reduction [15A NCAC 02T .0114(fll? ❑ Yes or ❑ No
If yes, attach 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 value, the Permittee shall provide a reevaluation of
the reduced flow value using the methodology applied to the original flow reduction application. Also, attach a copy of the
flow reduction approval letter.
APPLICANT'S CERTIFICATION 15A NCAC 02T .0106(b)
I, Matthew Tracy_, attest that this renewal application has been reviewed by me, and is accurate and complete to the best of my
knowledge. I understand that any unauthorized discharge of wastewater from this non -discharge system to surface waters or the land
may result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim
against the Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this
application are not completed, this application may be returned to me as incomplete. I further certify that the Applicant or any parent,
subsidiary, or other affiliate of the Applicant has not been convicted of an environmental crime, has not abandoned a wastewater facility
without proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant
with any active compliance schedule, and does not have any overdue annual fees.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, 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. The Applicant's Certification shall be signed in accordance with
15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation
letter is provided from a person who meets the criteria in 15A NCAC 02T .0106(b)
Signature: ZL4a-�- Date: / ,;2'
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE BRANCH
By U.S. Postal Service: By Courier: By Email:
Non -Discharge Branch Non -Discharge Branch — Archdale 942W Non-Discharge.Renorts(dncdenr.gov
1617 Mail Service Center 512 N. Salisbury St.
Raleigh, NC 27699-1617 Raleigh, NC 27604
TELEPHONE NUMBER: [phone]
FORM: NDSR 09-19 Page 4 of 4

Water Resources
ENVIRONMENTAL QUALITY
February 27, 2018
MATTHEW B. TRACY
1173 RIDGELAND DRIVE
CREEDMOOR, NORTH CAROLINA 27522
Dear Mr. Tracy:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
Subject: Permit No. W00037236
7328 Ridgeline Dr. SFR
Reclaimed Water Generation
and Non -Conjunctive
Reclaimed Water Utilization
System
Wake County
In accordance with your permit major modification request received July 6, 2017, and subsequent
additional information received November 7, 2017, and February 13, 2018, we are forwarding herewith
Permit No. W00037236 dated February 27, 2018, to Matthew B. Tracy for the construction and operation
of the subject reclaimed water generation and non -conjunctive reclaimed water utilization facilities.
Modifications to the subject permit are as follows:
➢ The treatment system has been changed from a membrane biological reactor (MBR) system to
an E-Z Treat recirculation system.
This permit shall be effective from the date of issuance until January 31, 2020, shall void Permit
No. W00037236 issued February 17, 2015, and shall be subject to the conditions and limitations as
specified therein. Please pay particular attention to the monitoring requirements listed in Attachments A
and B 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.
Please note the following permit conditions have been removed since the last permit issuance
dated February 17, 2015:
➢ Old Condition I.3. - This condition has been met.
➢ Old Condition I.4. - This condition has been met.
➢ Old Condition I.7. - As this is a reclaimed water system, it is not required for the facility to
connect to public or community sewer if it becomes available. However, any change to this
facility's source of potable water or disposal of wastewater requires the Permittee to inform the
Regional Office and may warrant a permit modification.
<5>"Nothing Compares:-....
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6332

Mr. Matthew B. Tracy
February 27, 2018
Page 2 of 3
➢ Old Condition I1.5. — There is not an Operation and Maintenance Agreement between the
Permittee and the Division of Water Resources because this is a reclaimed water system.
➢ Old Condition III.3. — This condition has been removed because the ORC or their back-up shall
visit the facilities in accordance with 15A NCAC 08G .0200.
➢ Old Condition II1.5. — The ORC or their back-up shall visit the facilities in accordance with
15A NCAC 08G .0200.
➢ Old Condition 111.18. — The reclaimed water generation system shall adhere to the design
criteria listed in 15A NCAC 02U .0402.
➢ Old Condition M.19. — Reclaimed water shall be utilized in accordance with 15A NCAC 02U
.0501(a).
➢ Old Condition III.20. - The reclaimed water generation system shall adhere to the design
criteria listed in 15A NCAC 02U .0402.
Please note the following permit conditions are new since the last permit issuance dated
February 17, 2015:
➢ Condition I.4. — This condition requires that the Permittee modify the deed for the subject
facility to state that this residence includes a reclaimed water generation system and non -
conjunctive reclaimed water utilization system (Permit No. WQ0036557), the Permittee
(landowner) shall designate and employ a North Carolina certified operator in responsible
charge (ORC) to perform maintenance and fulfill monitoring requirements on the system, the
system is subject to inspection by Wake County and the Division of Water Resources, and the
Permittee shall be responsible for any permit violations.
➢ Condition 11I.9. — Requires the turbidimeter to be tested and calibrated once per year.
➢ Condition III.15. — This condition requires that a protective vegetative cover be established and
maintained on all earthen embankments, berms, pipe runs, erosion control areas, and surface
water diversions.
➢ Condition 111.17. — Requires the Permittee to develop an education program for the use of
reclaimed water.
➢ Condition III.18. — Requires the Permittee to notify the public about the use of reclaimed water.
➢ Condition IV.5.b. — Requires the Permittee to maintain the volume of reclaimed water irrigated
in the records.
➢ Condition IV.7.b. — Requires the Permittee to record and keep record of the date of calibration
of the flow measurement device.
➢ Condition IV.7.c. — Requires the Permittee to record and keep record of the date of calibration
of the turbidimeter.
➢ Condition IV.7.d. — Requires the Permittee to record and keep record of the date and results of
power interruption testing.

Mr. Matthew B. Tracy
February 27, 2018
Page 3 of 3
➢ Condition IV.8. —Three copies of all effluent monitoring data and reclaimed water distribution
data (as specified in Conditions IV.3. and IVA.) shall be submitted on Form NDMR for each
PPI listed in Attachment A.
➢ Attachment A — Total Residual Chlorine (50060), Total Kjeldahl Nitrogen (00625), Total
Nitrate Nitrogen (00620), Total Nitrogen (00600), and Total Phosphorous (00665) have been
added to the reclaimed water generation system effluent monitoring parameters.
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. Unless such demands are made, this permit shall be final and binding.
One set of approved plans and specifications is being forwarded to you. If you need additional
information concerning this permit, please contact Tessa Monday at [phone] or
tessa.monday�a,ncdenr.gov.
Sincerely,
7rLmda Culpepper, Interim Director
Division of Water Resources
cc: Wake County Health Department (Electronic Copy)
Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Wake County Water Quality Division, Wastewater Management (Electronic Copy)
Gary S. MacConnell, PE — MacConnell & Associates, P.C. (Electronic Copy)
Beth Buffington — Protection and Enforcement Branch (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

THIS PAGE BLANK

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
RECLAIMED WATER GENERATION AND NON -CONJUNCTIVE RECLAIMED WATER
UTILIZATION 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
Matthew B. Tracy
Wake County
FOR THE
operation of a 480 gallon per day (GPD) reclaimed water generation and non -conjunctive reclaimed water
utilization system consisting of the:
construction and operation of a reclaimed water generation system consisting of. a 1,500 gallon septic tank
an effluent filter; a 600 GPD E-Z Treat pod; a 1,500 gallon recirculation tank with dual 36 gallon per minute
(GPM) recirculation pumps and three floats; an external filter basin; a turbidimeter; a tablet chlorinator; a
4,000 gallon 5 day upset tank with a 15 GPM return pump; a 4,000 gallon pump tank with dual 15 GPM
irrigation pumps; and all associated piping, valves, controls, and appurtenances; and the
construction and operation of a non -conjunctive reclaimed water utilization system consisting of: a 0.41
acre spray irrigation area with an ornamental plant cover crop; 15 spray heads with a 46 foot spray diameter
(1.10 GPM); a flow measuring device; and all associated piping, valves, controls and appurtenances
to serve the single-family residence at 7328 Ridgeline Dr., Raleigh, NC 27613, with no discharge of wastes
to surface waters, pursuant to the application received July 6, 2017, and subsequent additional information
received by the Division of Water Resources, and in conformity with the project plans, specifications, and
other supporting data subsequently filed and approved by the Department of Environmental Quality and
considered a part of this permit.
Please note that several Alternative design criteria have been approved for this facility in accordance with
15A NCAC 02T .0105(n). The following administrative codes have been approved for alternative design
criteria:
➢ 15A NCAC 02U .0402(b) —Aerated flow equalization facilities shall be provided.
The bypass valve has been moved closer to the pump in order to ensure that flow going to the field
dosing tank has a sufficient amount of oxygen.
W00037236 Version 1.1 Shell Version 171103 Page 1 of 11

➢ 15A NCAC 02U .0402(c) —Dual facilities shall be provided for all essential treatment units.
I.
Two chlorine tablet tubes will be provided in the event that one is not working sufficiently. If the entire
chlorine disinfection unit is not working properly, the wastewater will be diverted to the five-day upset
pond and the unit will be replaced in five days or less. The E-Z Treat pod and septic tank effluent filter
will not be provided in a dual fashion and will be replaced in five days or less if necessary.
This permit shall be effective from the date of issuance until January 31, 2020, shall void Permit No.
WQ0037236 issued February 17, 2015, and shall be subject to the following specified conditions and
limitations:
1. Upon completion of construction and prior to operation of the new reclaimed water generation and
utilization facilities, a certification (attached) shall be submitted from a licensed North Carolina
Professional Engineer certifying that the permitted facility has been installed in accordance with this
permit, Division approved plans and specifications, and other supporting documentation, including the
location of all monitoring wells as applicable. If this project is to be completed in phases and partially
same permit, and shall provide a final certificate of completion once the entire project has been
completed. Mail the Certification to the Division of Water Resources, Non -Discharge Branch, 1617
Mail Service Center, Raleigh, NC 27699-1617. [15A NCAC 02T .0116]
2. The Raleigh Regional Office, telephone number [phone], shall be notified at least 48 hours in
advance (excluding weekends and holidays) of operation of the newly installed facilities such that an
in -place inspection can be made. Notification to the regional supervisor shall be made from 8:00 a.m.
until 5:00 p.m. on Monday through Friday, excluding State Holidays. [15A NCAC 02T .0108(b)(2)]
3. The Permittee shall submit a landscaping plan for the proposed irrigation field and obtain approval
from the Raleigh Regional Office prior to construction of the reclaimed water treatment and utilization
facilities. The irrigation areas shall be planted in accordance with the approved plan and prior to the
operation of the facilities pursuant to Condition I11.7. Mail the landscaping plan to the Division of
Water Resources, Non -Discharge Branch, 1617 Mail Service Center, Raleigh, NC 27699-1617.
[15A NCAC 02T .0108(b)(1)]
4. Within 90 days of the effective date of this permit, the Permittee shall submit a copy of a modified
property deed registered with the Wake County Register of Deeds stating that the reclaimed water
generation and utilization system permitted for this residence shall maintain a non -discharge permit
with the State of North Carolina. The deed shall state that this residence includes a reclaimed water
generation system and non -conjunctive reclaimed water utilization system (Permit No. WQ0037236),
the Permittee (landowner) shall designate and employ a North Carolina certified operator in responsible
charge (ORC) to perform maintenance and fulfill monitoring requirements on the system, the system
is subject to inspection by Wake County and the Division of Water Resources, and the Permittee shall
be responsible for any permit violations. [15A NCAC 02T .0108(b)(2)]
5. No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal application.
[15A NCAC 02U .0106, 02U .0109]
W00037236 Version 1.1 Shell Version 171103 Page 2 of 11

II. PERFORMANCE STANDARDS
1. The subject reclaimed water facilities shall be effectively maintained and operated at all times 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 utilization areas to adequately assimilate the
reclaimed water, the Permittee shall take immediate corrective actions including Division required
actions, such as the construction of additional or replacement reclaimed water generation and utilization
facilities. [G.S. 143-215.1, 143-213.3(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 02B .0200, 02L .0100]
3. Effluent limitations for generated reclaimed water shall not exceed those specified in Attachment A.
[ 15A NCAC 02U .0300]
4. Application rates shall not exceed those specified in Attachment B. [15A NCAC 02U .0401(g), 02U
.0402(m)]
5. The reclaimed water irrigation system shall be connected to a rain or moisture sensor, which shall
indicate when utilization is not appropriate in accordance with Conditions 111.8. and II1.9. of this permit.
[ 15A NCAC 02T .0I08(b)(1)]
6. The following shall be requirements for the reclaimed water utilization facilities:
a. All reclaimed water valves, storage facilities and outlets shall be tagged or labeled to warn the
public or employees that reclaimed water is not intended for drinking. Where appropriate, such
warning shall inform the public or employees to avoid contact with reclaimed water.
b. All reclaimed water piping, valves, outlets and other appurtenances shall be color -coded, taped or
otherwise marked to identify the source of the water as being reclaimed water.
i. All reclaimed water piping and appurtenances shall be either colored purple (i.e., Pantone 522)
and embossed or integrally stamped or marked "CAUTION: RECLAIMED WATER — DO
NOT DRINK" or be installed with a purple (i.e., Pantone 522) identification tape or
polyethylene vinyl wrap. The warning shall be stamped on opposite sides of the pipe and
repeated every three feet or less.
ii. Identification tape shall be at least three inches wide and have white or black lettering on purple
(i.e., Pantone 522) field stating "CAUTION: RECLAIMED WATER — DO NOT DRINK."
Identification tape shall be installed on reclaimed water pipelines in a visible manner, fastened
at least every 10 feet to each pipe length and run continuously the entire length of the pipe.
iii. Existing underground distribution systems retrofitted for the purpose of distributing reclaimed
water shall be taped or otherwise identified as noted above. This identification need not extend
the entire length of the distribution system, but shall be incorporated within 10 feet of crossing
any potable water supply line or sanitary sewer line.
c. All reclaimed water valves and outlets shall be of a type, or secured in a manner, that permits
operation by authorized personnel only.
d. Hose bibs shall be located in locked, below grade vaults that shall be labeled as being of non -
potable quality. As an alternative to the use of locked vaults with standard hose bib services, other
locking mechanisms such as hose bibs which can only be operated by a tool may be placed above
ground and labeled as non -potable water.
[ 15A NCAC 02U .0403]
7. No direct cross -connections shall be allowed between reclaimed water and potable water systems,
unless such connection has been approved by the Department pursuant to 15A NCAC 18C .0406. [15A
NCAC 02U .0403(t)]
W00037236 Version 1.1 Shell Version 171103 Page 3 of 11

8. The compliance and review boundaries are established at the utilization area boundaries. Any
exceedance of standards at the compliance or review boundary shall require action in accordance with
15A NCAC 02L .0106. [15A NCAC 02U .0501(a)(6)]
9. 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. [15A NCAC 02L .0107(c)]
10. No wells, excluding Division approved monitoring wells, shall be constructed within the compliance
boundary except as provided for in 15A NCAC 02L .0107(g). [15A NCAC 02L .0107(d)]
11. Except as provided for in 15A NCAC 02L .0107(g), the Permittee shall ensure any landowner who is
not the Permittee and owns land within the compliance boundary shall execute and file with the Wake
County Register of Deeds an easement running with the land containing the following items:
a. A notice of the permit and number or other description as allowed in 15A NCAC 02L .0107(f)(1);
b. Prohibits construction and operation of water supply wells within the compliance boundary; and
c. Reserves the right of the Permittee or the State to enter the property within the compliance boundary
for purposes related to the permit.
The Director may terminate the easement when its purpose has been fulfilled or is no longer needed.
[15A NCAC 02L .0107(f)]
12. The facilities permitted herein shall be constructed according to the following setbacks:
a. The setbacks for reclaimed utilization sites shall be as follows (all distances in feet):
i. Surface waters not classified SA:
ii. Surface waters classified SA:
iii. Any well with exception to monitoring wells:
b. The setbacks for treatment units shall be as follows (all distances in feet):
i. Any habitable residence or place of public assembly under separate ownership:
ii. Any private or public water supply source:
iii. Surface waters:
iv. Any well with exception of monitoring wells:
v. Any property line:
c. The setbacks for final effluent storage units shall be as follows (all distances in feet):
i. Any private or public water supply source:
ii. Surface waters:
iii. Any well with exception of monitoring wells:
iv. Any property line:
[15A NCAC 02U .07011
25
100
100
100
100
50
100
50
100
50
100
50
W00037236 Version 1.1 Shell Version 171103 Page 4 of 11

M. OPERATION AND MAINTENANCE REOUIREMENTS
1. The reclaimed water generation and utilization facilities shall be properly maintained and operated at
all times. The facilities shall be effectively maintained and operated as a reclaimed water system to
prevent the discharge of any reclaimed water or partially treated effluent resulting from the operation
ofthis facility. [15ANCAC 02T .0108(b)(1)]
2. The Permittee shall maintain an Operation and Maintenance Plan, which at a minimum shall include
the following:
a. Description of the system in sufficient detail to show what operations are necessary for the system
to function and by whom the functions will be conducted;
b. A map of all distribution lines and record drawings of all utilization systems under the Pennittee's
control;
c. Description of anticipated maintenance activities;
d. Landscaping plan;
e. Include provisions for safety measures including restriction of access to sites and equipment; and
f. Spill control provisions including response to upsets and bypasses including control, containment,
remediation, and contact information for plant personnel, emergency responders and regulatory
agencies.
[ 15A NCAC 02U .0801 ]
3. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the subject non -discharge facilities, in accordance with 15A NCAC 08G .0200 the
Permittee shall designate and employ a certified operator in responsible charge (ORC) and one or more
certified operator(s) as back-up ORC(s). The ORC or their back-up shall visit the facilities in
accordance with 15A NCAC 08G .0200, and shall comply with all other conditions specified in the
previously cited rules. [15A NCAC 02U .0117]
4. An operator certified by the Water Pollution Control System Operators Certification Commission
(WPCSOCC) of a grade equivalent or greater than the facility classification shall be on call 24 hours
per day. [15A NCAC 02U .0401(e), 02U .0402(i)]
5. A suitable year round vegetative cover (including plants listed in the landscaping plan) shall be
maintained on irrigation sites at all times, such that crop health is optimized, allows for even distribution
of reclaimed water, and allows inspection of the irrigation system. [15A NCAC 02T .0108(b)(1)]
6. Adequate measures shall be taken to prevent reclaimed water ponding in or runoff from the irrigation
sites. [15A NCAC 02T .0108(b)(1)]
7. Irrigation shall not be performed during inclement weather or when the ground is in a condition that
will cause ponding or runoff. [15A NCAC 02T .0108(b)(1)]
8. All reclaimed water irrigation equipment shall be tested and calibrated at least once per permit cycle.
Calibration records shall be maintained at the facility for a period of no less than five years, and shall
be made available to the Division upon request. [15A NCAC 02T .0108(b)(1)]
9. The turbidimeter shall be tested and calibrated at a minimum of once per year. Calibration records
shall be maintained at the facility for a period of no less than five years, and shall be made available to
the Division upon request. [15A NCAC 02T .0108(b)(1)]
10. Only reclaimed water generated from the single-family residence at 7328 Ridgeline Dr., Raleigh, NC
27613 shall be utilized in accordance with this permit. [G.S. 143-215.1]
WQ0037236 Version 1.1 Shell Version 171103 Page 5 of I 1

11. An automatically activated standby power source capable of powering all essential treatment units shall
be on site and operational at all times if the water supply well has a generator attached or the house is
connected to an alternative water supply. If a generator is employed as an alternate power supply, it
shall be tested weekly by interrupting the primary power source. [15A NCAC 02U .0402(h)]
12. Public access to the reclaimed water generation facilities shall be prohibited. [15A NCAC 02U
.0402(f)]
13. Public access to reclaimed water utilization sites shall be controlled during active site use. Such
controls may include the posting of signs showing the activities being conducted at each site. [15A
NCAC 02U .0501]
14. Diversion or bypassing of untreated or partially treated wastewater from the treatment facilities is
prohibited unless diverted to an alternate treatment or collection system. [15A NCAC 02T .0108(b)(1)]
15. A protective vegetative cover shall be established and maintained on all earthen embankments (i.e.,
outside toe of embankment to maximum allowable temporary storage elevation on the inside of the
embankment), berms, pipe runs, erosion control areas, and surface water diversions. Trees, shrubs, and
other woody vegetation shall not be allowed to grow on the earthen dikes or embankments. Earthen
embankment areas shall be kept mowed or otherwise controlled and accessible. [15A NCAC 02T
.0108(b)(1)]
16. All effluent shall be routed to the five day upset tank should the limit for fecal coliform (e.g., daily
maximum concentration of 25 colonies per 100 mL) or turbidity (e.g., instantaneous maximum of 10
NTU) be exceeded, until the problems associated with the wastewater treatment plant have been
corrected. The wastewater in the five day upset tank shall be pumped back to the treatment plant
headworks for re -treatment or treated in the five day upset tank prior to utilization. [15A NCAC 02U
.0402(e)]
17. The Permittee shall develop and implement an education program to inform users (including
employees) about the proper use of reclaimed water. Educational material shall be provided to all
residents and/or other facilities provided with reclaimed water, and these materials shall be maintained
consistent with the reclaimed water uses. All educational materials shall be made available to the
Division upon request. [15A NCAC 02U .0501(a)(4)]
18. The Permittee shall provide notification to the public and/or employees about the use of reclaimed
water, and that reclaimed water is not intended for drinking. Such notification shall be provided to
employees in a language they can understand. [15A NCAC 02U .0501]
19. The residuals generated from the wastewater treatment facilities shall be disposed or utilized in
accordance with 15A NCAC 02T .1100. The Permittee shall maintain a residual management plan
pursuant to 15A NCAC 02U .0802. [15A NCAC 02T .1100, 02U .0802]
W00037236 Version 1.1 Shell Version 171103 Page 6 of 11

IVA
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water analyses)
necessary to ensure groundwater and surface water protection shall be established, and an acceptable
sampling reporting schedule shall be followed. [15A NCAC 02T .0108(c)]
2. A Division certified laboratory shall conduct all laboratory analyses for the required effluent,
groundwater or surface water parameters. [15A NCAC 02H .0800]
3. Flow through the reclaimed water generating facility shall be continuously monitored, and daily
average flow values shall be reported on Form NDMR. Flow may be estimated from water use records,
provided the Permittee's water use is metered. Daily average flow values shall be calculated by
dividing the monthly metered water usage by the number of days in the month. [15A NCAC 02T
.0105(k)]
4. The Permittee shall monitor the reclaimed water from the generating facility at the frequencies and
locations for the parameters specified in Attachment A. [15A NCAC 02T .0108(c)]
5. The Permittee shall maintain adequate records tracking the amount of reclaimed water utilized.
Records shall be maintained for a minimum of five years. At a minimum, these records shall include
the following information for each utilization site listed in Attachment B:
a. Date of reclaimed water utilization;
b. Volume of reclaimed water irrigated;
c. Site irrigated;
d. Length of time site is irrigated;
e. Continuous weekly, monthly, and year-to-date hydraulic (inches/acre) loadings;
f. Weather conditions; and
g. Maintenance of cover crops.
[ 15A NCAC 02T .0108(c)]
6. A record shall be maintained of all residuals removed from this facility. This record shall be maintained
at the facility for a period of no less than five years, and shall be made available to the Division upon
request. At a minimum, this record shall include:
a. Name of the residuals hauler;
b. Non -Discharge permit number authorizing the residuals disposal, or a letter from a municipality
agreeing to accept the residuals;
c. Date the residuals were hauled; and
d. Volume of residuals removed.
[ 15A NCAC 02T .0108(c)]
W00037236 Version 1.1 Shell Version 171103 Page 7 of 11

7. A maintenance log shall be maintained at this facility. This log shall be maintained at the facility for a
period of no less than five years, and shall be made available to the Division upon request. At a
minimum, this log shall include:
a. Visual observations of treatment plant and plant site;
b. Date of calibration of flow measurement device(s);
c. Date of calibration of turbidimeter;
d. Date and results of power interruption testing on alternate power supply (if a generator is required);
e. Record of preventative maintenance (e.g., changing/adjusting of equipment, pump and valve
maintenance, cross connection control, testing, inspections and cleanings, etc.; and
f. Record of all unpermitted releases of reclaimed water to surface water or land surface including
date of occurrence, estimated volume of release, cause, and corrective action taken.
[15A NCAC 02T .0108(b)(1)]
8. Three copies of all effluent monitoring data and reclaimed water distribution data (as specified in
Conditions IV.3. and IVA.) shall be submitted on Form NDMR for each PPI listed in Attachment A.
Reporting forms shall be submitted on or before the last day of the following month. If no reclaimed
water distribution activities occurred during the monitoring month, monitoring reports documenting
the absence of the activity are still required to be submitted. All effluent monitoring data shall be
submitted to the following address: Division of Water Resources, Information Processing Unit, 1617
Mail Service Center, Raleigh, North Carolina, 27699-1617. [15A NCAC 02T .0105(1)]
9. Three copies of all operation and utilization records (as specified in Condition IV.S.) shall be submitted
on Form NDAR-I for every non -conjunctive utilization site listed in Attachment B. (Note: conjunctive
use sites do not require NDAR-1 submission). Reporting forms shall be submitted on or before the last
day of the following month. If no reclaimed water utilization activities occurred during the month,
monitoring reports are still required documenting the absence of the activity. All information shall be
submitted to the following address: Division of Water Resources, Information Processing Unit, 1617
Mail Service Center, Raleigh, North Carolina, 27699-1617. [15A NCAC 02T .0105(1)]
10. Noncompliance Notification:
The Permittee shall report by telephone to the Raleigh Regional Office, telephone number (919) 791-
4200, as soon as possible, but in no case more than 24 hours, or on the next working day following the
occurrence or first knowledge of the occurrence of any of the following:
a. Treatment of wastes abnormal in quantity or characteristic, including the known passage of a
hazardous substance.
b. Any process unit failure (e.g., mechanical, electrical, etc.), due to known or unknown reasons,
rendering the facility incapable of adequate wastewater treatment.
c. Any failure resulting in a discharge of reclaimed water directly to surface waters or any unpermitted
release of reclaimed water to land surface greater than or equal to 5,000 gallons. Unpermitted
releases less than 5,000 gallons to land surface shall be documented by the Permittee in accordance
with Condition IV.71 but do not require Regional Office notification.
d. Any time self -monitoring indicates the facilities permitted herein have gone out of compliance with
the limitations contained in this permit.
e. Ponding in or runoff from the reclaimed water utilization sites.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
betaken to ensure the problem does not recur. [15A NCAC 02T .0108(b)(1)]
WQ0037236 Version 1.1 Shell Version 171103 Page 8 of 11

U
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
reclaimed water generation and utilization facilities. [15A NCAC 02T .0108(b)]
2. The Permittee or their designee shall inspect the reclaimed water generation and utilization facilities to
prevent malfunction, facility deterioration and operator errors resulting in discharges, which may cause
the release of wastes to the environment, a threat to human health or a public nuisance. The Permittee
shall maintain an inspection log that includes, at a minimum, the date and time of inspection,
observations made, and any 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 .0108(b)]
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the reclaimed water generation utilization facilities
permitted herein at any reasonable time for the purpose of determining compliance with this permit;
may inspect or copy any records required to be maintained under the terms and conditions of this permit,
and may collect groundwater, surface water or leachate samples. [G.S. 143-215.1]
VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to an
enforcement action by the Division in accordance with North Carolina General Statutes 143-215.6A to
143-215.6C. [G.S. 143-215.6A to 143-215.6C]
2. This permit shall become voidable if the permitted facilities are not constructed in accordance with the
conditions of this permit, the Division approved plans and specifications, and other supporting
documentation. [15A NCAC 02T .0110]
3. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, Division approved plans and specifications, and other supporting documentation. No
variances to applicable rules governing the construction or operation of the permitted facilities are
granted, unless specifically requested and approved in this permit pursuant to 15A NCAC 02T .0105(n).
[G.S. 142-215.11
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules in
15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4 and
under the Division's General Permit NCGO10000; any requirements pertaining to wetlands under 15A
NCAC 02B .0200 and 02H .0500; National Pollutant Discharge Elimination System (NPDES)
requirements under 15A NCAC 02H .0100, and documentation of compliance with Article 21 Part 6
of Chapter 143 of the General Statutes. [ 15A NCAC 02T .0105(c)(6)]
5. In the event the permitted facilities change ownership or the Permittee changes their name, a written
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate property ownership documentation and other supporting
documentation as necessary. The Permittee of record shall remain fully responsible for maintaining
and operating the facilities permitted herein until a permit is issued to the new owner. [15A NCAC
02T .0104]
6. The Permittee shall retain a set of Division approved plans and specifications for the life of the facilities
permitted herein. [15A NCAC 02T .0108(b)(1)]
7. The Permittee shall maintain this permit until all permitted facilities herein are properly closed or
permitted under another permit issued by the appropriate permitting authority. [15A NCAC 02T
.01050)]
WO0037236 Version 1.1 Shell Version 171103 Page 9 of 11

8. This permit is subject to revocation or unilateral modification upon 60 days notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110. [ 15A NCAC 02T .0110]
9. Unless the Division Director grants a variance, expansion of the permitted facilities contained herein
shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC 02T .0120(b). [15A
NCAC 02T .0120]
10. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to pay
the annual fee accordingly shall be cause for the Division to revoke this permit. [15A NCAC 02T
.0105(e)(3)]
Permit issued this the 27' day of February 2018
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
CTLinda Culpepper, Interim Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0037236
W00037236 Version 1.1 Shell Version 171103 Page 10 of 11

Permit No. WQ0037236 Reclaimed Water Generation and
Matthew B. Tracy Non -Conjunctive Reclaimed Water Utilization System
7328 Ridgeline Dr. SFR February 27, 2018
Wake County
ENGINEERING CERTIFICATION
❑ Partial ❑ Final
In accordance with 15A NCAC 02T .0116, I, as
a duly registered Professional Engineer in the State of North Carolina, having the Permittee's authorization
to ❑ periodically ❑ weekly ❑ fully observe the construction of the 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 documentation.
❑ Any variation to this permit, the Division approved plans and specifications, and other supporting
documentation has been documented in the attached as -built drawings, and shall serve as the
Permittee's minor modification request to amend the permit accordingly.
Provide a brief narrative description of any variations:
Professional Engineer's Name
i
Engineering Firm
i
Mailing Address
i
i
City State zip
Telephone E-mail NC PE Seal, Signature & Date
THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING
INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
NON -DISCHARGE BRANCH
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
W00037236 Version 1.1 Shell Version 171103 Page 11 of 11

THIS PAGE BLANK

w
x
d
d�
o
dd
z
y'
O
d w
M
M
M
M
M
M
M
M
M
M
M
B
O
!+
N
T
Q
e
e
T
WD
ii
W
F
T�"
z
=:
a
�e
w
w
�$
=
a
o
O �
�
�a
e
o
�
�
O
•�
w
o
�_
^��
0.
�
E
0.'
�
U
O
�
o
W
P7
U
U
w
2
'z
z
z
a
ate.
ci
F
m d
o
o
�o
o
O
vi
o
o
O
vi
o
c
U O
M
O
D
O
�D
iD
iD
i0
�
iD
v1
O
r.
0

L
�
h
z
o
=«
o
5�
a
O
o
F
U
V.,
a
a
d
a,
r
m
a
q
a
z
a
0
e
�d
o•
A�
v
o
e
d
O
r
i.y
O
Fa
W
O
�
W
�
�
a
M
F
V
�F
C
�
O
�
�
q
w
F

FIGURE 1 — SITE MAP
Number: WQ0037236
Matthew B. Tracy — 7328 Ridgeline Drive SFR
Permit
Version: 2.0
wLMD tNo' ..A..
..� Eta
s
as
qt
ca-
r' .—. .—.—._.
aurae = i vay { - i
r I
O Mfl. :L 1(w� ._
CD
_.J
S i
� I
i
- I
gg1
irf ,5
J_
,aP
/a 1.
�w-� t1
� � _ x •• t/I° 9GFi, aU
e ���/1•��� .. �i
` t
s
x SCH 40 AYC
EE RtWcN(i I'£ N
RF�Ffl
q S lQ' 4
M h9 R0 `PpP UV' RO'pR MODE:
"24
�I
;7
v :1
I
t.�