WQ0031593_Final Permit_20200406

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANI£L SMITH
Director
NORTH CAROLINA
Environmental Quality
April 6, 2020
DONALD C. JACKSON — TRUSTEE
DONALD C. JACKSON REVOCABLE TRUST
533 WEST SADDLE RIVER ROAD
UPPER SADDLE RIVER, NEW JERSEY 07458
KATBERINE M. JACKSON — TRUSTEE
KATBERINE M. JACKSON REVOCABLE TRUST
533 WEST SADDLE RIVER ROAD
UPPER SADDLE RIVER, NEW JERSEY 07458
EMMA G. JACKSON AND ISMAEL A. HERNANDEZ-CRUZ
533 WEST SADDLE RIVER ROAD
UPPER SADDLE RIVER, NEW JERSEY 07458
Subject: Permit No. WQ0031593
117 Lexington Dr. SFR
Single -Family Residence
Wastewater Irrigation System
Chatham County
Dear Mr. Jackson, Ms. Jackson, Mrs. Jackson, and Mr. Hernandez -Cruz:
In accordance with your permit change of ownership and major modification request received
November 12, 2019, and subsequent additional information received February 19, 2020, we are forwarding
herewith Permit No. WQ0031593 dated April 6, 2020, to the Donald C. Jackson Revocable Trust, the
Katherine M. Jackson Revocable Trust, Emma G. Jackson, and Ismael A. Hernandez -Cruz for the
construction and operation of the subject single-family residence wastewater treatment and irrigation
facilities.
The following modifications to the subject permit are as follows: The residence has been approved
for a flow reduction allowing the existing 480 gallon per day (GPD) system to accommodate five bedrooms
rather than four; the 2,400 gallon recirculation tank has been replaced by a 1,000 gallon recirculation tank;
the 4,650 gallon field -dosing tank has been replaced by a 4,500 gallon field -dosing tank; the 27 gallon per
minute (GPM) field -dosing pup has been replaced by a 20 GPM t/2 horsepower (Hp) field -dosing pump, the
two 10 GPM UV disinfection units are being relocated; the K-Rain indexing valve is being replaced by a
solenoid valve; and the drip irrigation area is being reconfigured from six zones into four zones.
This permit shall be effective from the date of issuance through July 31, 2026, shall void Permit
No. WQ0031593 issued November 10, 2016, and shall be subject to the conditions and limitations therein.
The Permittee shall submit a renewal application no later than February 1, 2026.
Please pay attention to the operation and maintenance requirements listed in Section III. Failure to
establish an adequate system for collecting and maintaining the required operational information shall result
in future compliance problems.
N11H fH (:A�i(1!.INA �
D E Q North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
0­O'torenwm­talQ"I 919,707.9000

Mr. Donald C. Jackson, Ms. Katherine M. Jackson, Mrs. Emma G. Jackson, and Mr. Ismael A. Hernandez -Cruz
April 6, 2020
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.
One set of approved plans and specifications is being forwarded to you. If you need additional
information concerning this permit, please contact Ashley Kabat at [phone] or
ashley.kabatkncdenr.gov.
Sincerely,
S. Daniel Smith, Director
Division of Water Resources
cc: Chatham County Health Department (Electronic Copy)
Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Gary S. MacConnell, PE — MacConnell and Associates, P.C. (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

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
Donald C. Jackson Revocable Trust, Katherine M.
Jackson Revocable Trust, Emma G. Jackson, and
Ismael A. Hernandez -Cruz
Chatham County
FOR THE
construction and operation of a 480 gallon per day (GPD) single-family residence wastewater treatment
and irrigation facility consisting of.
a 1,500 gallon baffled septic tank with an effluent filter; a 1,000 gallon recirculation tank with a 30 gallon
per minute (GPM) '/2 horsepower (hp) submersible recirculation pump, a float tree, high-water alarms, and
an effluent bypass valve; a 600 GPD E-Z Treat Pod filter; two (one primary and one back-up) 10 GPM
ultraviolet (UV) disinfection units in series; a 4,500 gallon field dosing effluent storage tank with a 20 GPM
'/2 hp submersible effluent pump and a float tree with high-water alarms; a hydraulic unit and zone valves;
0.4 acre drip irrigation area consisting of four zones; and all associated piping, valves, controls, and
appurtenances
to serve the single-family residence at 117 Lexington Dr., Apex, NC 27523, with no discharge of wastes to
surface waters, pursuant to the application received November 12, 2019, subsequent additional information
received February 19, 2020, and in conformity with the Division -approved plans and specifications
considered a part of this permit.
This permit shall be effective from the date of issuance through July 31, 2026, shall void Permit No.
WQ0031593 issued November 10, 2016, and shall be subject to the following conditions and limitations:
L SCHEDULES
Upon completion of construction and prior to operation of this permitted facility, the Permittee shall
submit an engineering certification from a North Carolina licensed Professional Engineer certifying
that the permitted facility has been constructed in accordance with G.S. 143-215.1, Administrative
Code Title 15A Subchapter 02T, this permit, and the Division -approved plans and specifications. For
phased and partially certified facilities, the Permittee shall retain the responsibility to track further
construction approved under this permit, and shall provide a final engineering certification upon project
completion. Mail the Engineering Certification to the Division of Water Resources, Non -Discharge
Branch, 1617 Mail Service Center, Raleigh, NC 27699-1617, or Non-Discharge.Reports&ncdenr. og_v.
[15A NCAC 02T .0116(a)]
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2. The Permittee shall notify the Raleigh Regional Office, telephone number [phone], at least two
business days in advance of initial operation of the constructed facilities so that the Division can
conduct a startup inspection. [15A NCAC 02T .0108(b)(1)(B)]
3. The Permittee shall request renewal of this permit on Division -approved forms no later than February
1, 2026. [15A NCAC 02T .0105(b), 02T .0109]
4. 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]
II. 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
0.7
18.95
inches
[15A NCAC 02T .06050)]
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
Donald C. Jackson Revocable
Trust, Katherine M. Jackson
1
Revocable Trust, Emma G.
Chatham
35.778261'
-78.959363'
0.4
Creedmoor
Jackson, and Ismael A.
Hernandez -Cruz
[15A NCAC 02T .0108(b)(1)(A)]
5. 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 Permittee shall connect the irrigation system to a rain or moisture sensor designed to prevent
irrigation during precipitation events or wet conditions. [15A NCAC 02T .0605(o)]
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7. 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)]
8. 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]
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 (i.e., parcel subdivision). [ 15A NCAC
02L .0107(c)]
10. The facilities herein were permitted per the following setbacks:
a. The irrigation sites were modified April 6, 2020. The setbacks for drip irrigation sites originally
permitted or modified on or after September 1, 2018 are as follows (all distances in feet):
I. Each habitable residence or place of assembly under separate ownership: 1001
ii. Each habitable residence or place of assembly owned by the Permittee: 15
iii. Each private or public water supply source: 100
iv. Surface waters: 100
v. Groundwater lowering ditches: 100
vi. Surface water diversions: 25
vii. Each well with exception of monitoring wells:
100
viii. Each property line:
50 Z
ix. Top of slope of embankments or cuts of two feet or more in vertical height:
15
x. Each water line:
10
xi. Subsurface groundwater lowering drainage systems:
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 Perinittee, or the entity from which the
Permittee is leasing, owns both parcels separated by the property line.
[15A NCAC 02T .0606(a), 02T .0606(d), 02T .0606(e)]
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b. The storage and treatment units were modified April 6, 2020. The setbacks for storage and
treatment units originally permitted or modified on or after September 1, 2018 are as follows (all
distances in feet):
I. Each habitable residence or place of assembly under separate ownership: 1001
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 Z
' 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 02T .0606(b), 02T .0606(d), 02T .0606(e)]
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 117 Lexington Dr.,
Apex, NC 27523 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)]
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12. The Permittee shall line any excavation into bedrock with a 10 millimeter synthetic liner. [15A NCAC
02T .0605(d)]
13. Metering equipment shall be tested and calibrated annually. [15A NCAC 02T .0608(c)]
14. 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 ultraviolet disinfection unit weekly. Clean or replace the lamps and quartz sleeves as
needed.
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 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.
[15A NCAC 02T .0608]
IV. MONITORING AND REPORTING REQUIREMENTS
1. 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 Raleigh 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 Raleigh 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)]
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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)]
VI. 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)]
5. If the permitted facilities change ownership, or the Pennittee 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 .01050)]
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]
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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. 143-215.613, or under Federal law that would otherwise be
prosecuted under G.S. 143-215.613, 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.
[15A 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)]
11. Pursuant to the flow reduction request approved December 3, 2019, the Division accepts the data -based
design flow rate of 96 gallons per day per bedroom (GPDBR) for the users served by this facility. At
no time shall wastewater flows exceed the limits defined in this permit, or exceed the sewer capacity
downstream of any new sewer extension or service connection.
The Permittee shall report the measured monthly average amount of wastewater flow contributed per
unit (GPDBR) for the 12 months prior to permit renewal. If any of these monthly averages are within
20% of the approved value, the Permittee shall reevaluate the approved value using the methodology
applied to determine the approved flow rate of 96 GPDBR, and submit this information with the
renewal application for reevaluation of the approve flow rate. [15A NCAC 02T .0114(f)]
12. The Permittee shall retain the Division's written approval of the authorized adjusted daily design flow
rate for the life of this facility, and shall transfer this approval to any future Permittee. [15A NCAC
02T .0114(f)]
Permit issued this the 6"' day of April 2020
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
S. Daniel Smith, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0031593
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Permit No. WQ0031593 Single -Family Residence Wastewater Irrigation System
Donald C. Jackson Revocable Trust, Katherine April 6, 2020
M. Jackson Revocable Trust, Emma G. Jackson,
and Ismael A. Hernandez -Cruz
117 Lexington Dr. SFR Chatham County
ENGINEERING CERTIFICATION
❑ Partial ❑ Final
I, , as a duly licensed North Carolina Professional
Engineer, having ❑ periodically / ❑ fully observed the construction of the permitted facilities, do hereby
state to the best of my abilities that the facility was constructed in compliance with G.S. 143-215.1,
Administrative Code Title 15A Subchapter 02T, this permit, and the Division -approved plans and
specifications.
Documentation of any variation to this permit, and the Division -approved plans and specifications, is in the
attached as -built drawings.
Description of variations:
Seal, Signature, and Date
Professional Engineer's Name
Firm Name
Firm No.
Address
City Zip Code
Telephone Mai
THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING
DOCUMENTATION, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
NON -DISCHARGE BRANCH
By U.S. Postal Service By Courier/Special DelivM
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
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DocuSign Envelope ID: 5F01D44F-41316-4D33-8A3D-A31BE29AE51D
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
DWR
15A NCAC 02T .0600 — SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEMS
OPERATION AND MAINTENANCE AGREEMENT
Division of Water Resources FORM: SFRWWIS O&M 08-13
Permit No. W00031593
County: Chatham
Donald C. Jackson, Trustee of the Donald C. Jackson Revocable
Property owner(s) as appearing on the recorded deed: Trust & Katherin M. Jackson, Trustee of the Katherine M. Jackson
Revocable Trust
Mailing address: 533 W Saddle River Road, U
Facility address: 117 Lexington Drive, Ape
Irrigation Method: ❑ SPRAY ® DRIP
Saddle River, Nj 02458
NC 27523 (Lot 2 Lexington Subdivision
I / We agree to operate and maintain the single-family residence wastewater treatment and irrigation system as follows:
1. The Permittee is responsible for the operation and maintenance of the entire wastewater treatment and irrigation
system including, but not limited to, the following items:
a. The septic tank shall be checked annually and pumped out as needed.
b. The septic tank effluent filter shall be checked and cleaned annually.
c. Accessible sand filter surfaces shall be raked and leveled every six months and any vegetative growth shall be
removed manually.
d. ❑ The tablet chlorinator shall be checked weekly. Wastewater grade tablets (calcium hypochlorite) shall be
added as needed to provide proper chlorination (pool chlorine tablets shall not be used), OR
® The ultraviolet disinfection unit shall be checked weekly. The lamp(s) and quartz sleeve(s) shall be
cleaned or replaced as needed to ensure proper disinfection.
e. All pump and alarm systems shall be inspected monthly.
f. The irrigation system shall be inspected monthly to ensure that the system is free of leaks, that all irrigation
equipment is operating as designed, that vegetative growth does not interfere with the system inspection or
operation, that the soil is assimilating the disposed treated wastewater with no visible runoff or ponding, and
that no objectionable odors are being generated.
2. Failure to pay the annual fee shall be cause for the Division to revoke the permit pursuant to 15A NCAC 02T
.0105(e)(3).
3. The Permittee's failure to properly operate this system is subject to a penalty up to $25,000 per day.
4. Failure to meet the permit conditions or violation of the State's surface water or groundwater regulations may void
the permit.
All owners appearing on the legally recorded property, deed shall sign this Operation & Maintenance Agreement
I / We understand the above requirements and agree to these terms as part of the issued permit.
DocuSigned by:
Owner Signature: _�aG�Sbin, Date:
Docu
RD8
Signed by:
DAOB�C9341 -.
Owner Signature: kA, �aLrcSbin, Date:
9563D4A3F5B34D2...
2/13/2020
2/13/2020
FORM: SFRWWIS O&M 08-13 Page 1 of 1

DocuSign Envelope ID: F261 D30D-AB2D-4FF7-A3CF-7F0E8567A1 FA
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
DWR
15A NCAC 02T.0600 — SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEMS
OPERATION AND MAINTENANCE AGREEMENT
FORM: SFRWWIS O&M 08-13
1311w lon of Water Resources
Permit No.
WQ0031593
County:
Chatham
Property owner(s) as appearing on the recorded deed: Emma G. Jackson and spouse, Ismael A Hernandez Cruz
Mailing address: 533 W Saddle River Road, Upper Saddle River, Nj 02458
Facility address: 117 Lexington Drive, Apex, NC 27523 Lot 2 Lexin ton Subdivision
Irrigation Method: ❑ SPRAY ® DRIP
1 / We agree to operate and maintain the single-family residence wastewater treatment and irrigation system as follows:
1. The Permittee is responsible for the operation and maintenance of the entire wastewater treatment and irrigation
system including, but not limited to, the following items:
a. The septic tank shall be checked annually and pumped out as needed.
b. The septic tank effluent filter shall be checked and cleaned annually.
c. Accessible sand filter surfaces shall be raked and leveled every six months and any vegetative growth shall be
removed manually.
d. ❑ The tablet chlorinator shall be checked weekly. Wastewater grade tablets (calcium hypochlorite) shall be
added as needed to provide proper chlorination (pool chlorine tablets shall not be used), OR
® The ultraviolet disinfection unit shall be checked weekly. The lamps) and quartz sleeve(s) shall be
cleaned or replaced as needed to ensure proper disinfection.
e. All pump and alarm systems shall be inspected monthly.
f. The irrigation system shall be inspected monthly to ensure that the system is free of leaks, that all irrigation
equipment is operating as designed, that vegetative growth does not interfere with the system inspection or
operation, that the soil is assimilating the disposed treated wastewater with no visible runoff or ponding, and
that no objectionable odors are being generated.
2. Failure to pay the annual fee shall be cause for the Division to revoke the permit pursuant to 15A NCAC 02T
.0105(e)(3).
3. The Permittee's failure to properly operate this system is subject to a penalty up to $25,000 per day.
4. Failure to meet the permit conditions or violation of the State's surface water or groundwater regulations may void
the permit.
All owners amwaring on the legally recorded pronerty deed shall sign this Operation & Maintenance Agreement
i / We understand theFoSigned
rern nts nd se terms as part of the issued permit. It
Owner Signature: Date:
g :
Owner Signature:Ay_ , A&Sby, Date: 2/16/2020
46E.-.
FORM: SFRWWIS O&M 08-13 Page I of 1

MAINTENANCE SCHEDULE
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COMPLUACE BOUNMRr AT
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\I I NOTES
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LEGEND
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HEARTHSTONE LUXURY
HOMES,LLC-
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SURFACE DRIP IRRIGATION
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SITE LAYOUT
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