WQ0016232_Application_20211019

VWK Department of Environmental Quality
Division of Water Resources
Division of Water Resources ISA NCAC 02T .0600 — SINGLE-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM — RENEWAL
FORM: SFRWWIS-R 02-21
Pursuant to 1 tiA NCAC 02T .0107tbl, if the application does not include all required information and the necessary supporting
documentation, the application shall be returned. The application and attachments shall be prepared in accordance with 1;,
NCAC 021- .Oj Q0, 15A NCAC 02T .0600, and Djvhion Policics. For more information, visit the Water Quality Permitting
Section's Non -Discharge Branch ►►ebsite. The Applicant shall submit an electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) file to E ►'1 �i i )' ! 3 ! -
5uhmitlal-Form-Ver2, or emailed to NQ11 - )' • r(r C.RV 120 r 'u 110 C it = v if less than 20 megabytes (MB).
SECTION 1—APPLICANT INFORMATION
1. Applicant: Ronald & Amanda Spinks
2. Permit No.: WQOO16232
3. Signature authority: Owner Title: Owner
4. Mailing address: 3819 Old US l
City: Moncure State: NC Zip: 27559
5. Contact person: Ron Spinks Email: rorLsLin,[k T,;_g.gmail.com
Primary phone number: [phone] Secondary phone number: [phone]
6 Secondary Contact person:Amanda Spinks Email: amandaspinks 12ra yahoo.com
Primary phone number: [phone] Secondary phone number: ( ) -
SECTION 11-- FACILITY INFORMATION
1. Physical address: 3819 Old US 1 County: Chatham
City:Moncure State: NC Zip: 27559
SECTION III — BILLING INFORMATION
I. Billing address: 3819 Did US 1
City: Moncure State:NC Zip: 27559
2. Verify the Applicant does not have any overdue annual fees:
lltipsb!;'deg.nc"g 1 isionslwater-resourcesiwater-resources-permits/wq?,payipents
Pursuant to 15A NCAC 02T .0120(c), permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: SFRWWIS-R02-21 Pagel of4

SECTION IV — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQOO County:
Permittee: (i.e., all deeded property owners)
The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system
as follows:
l . 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)
S. 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 Chan e of Ownership application 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:1-�Ajl Date:
Signature:. ��� Date: U I
Signature: Date:
Signature: Date:
All deeded property owners shall sign this Operation and Maintenance Agreement
FORM: SFRW WIS-R 02-21 Page 2 of 4

ATTACHMENT A —SITE MAP
Was the facility originally permitted or had a major modification issued after September 1, 2006?
Yes — Pursuant to II5A NCAC 021 .0105(d), submit a site map pursuant to the requirements in 15A NCAC 02T_.0604(d). These
requirements are:
A scaled map of the site with topographic contour intervals not exceeding 10 feet or 25 percent of total site relief and
showing all facility -related structures and fences within the wastewater treatment, storage, and irrigation areas.
Soil mapping units shown on all irrigation sites.
The location of all wells (including usage and construction details if available), streams (ephemeral, intennittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage,
and irrigation sites.
Delineation of the compliance and review boundaries per 15A NCAQ Q2L.0 107 and .0108, and 15A 2T 1.
Setbacks as required by 15A NCAC 02T _0606.
Site property boundaries within 500 feet of all wastewater treatment, storage, and irrigation sites.
All habitable residences or places of public assembly within 500 feet of all treatment, storage, and irrigation sites.
No Skip Attachment A.
ATTACHMENT B — SIGNATURE AUTHORITY DELEGATION
Does the signature authority in Section[, Item 3 meet the requirements pursuant to 15A NCAC 02T .0106 b ?
Yes Skip Attachment B.
No — Submit a delegation letter pursuant to 15A NCAC 02T .0106(c) authorizing the signature authority to sign.
ATTACHMENT C —FLOW REDUCTION
Does the existing permit include an approved flow reduction?
Yes — Submit a copy of the flow reduction approval letter, as well as the measured monthly average amount of wastewater flow
contributed per unit for the 12 months prior to permit renewal. If any of these monthly averages are within 20%u of the approved
flow reduction value, the Permittee shall provide a reevaluation of the reduced flow value pursuant to the requirements in 15A
NCAC 02T .01 14(f}.
& Skip Attachment C.
ATTACHMENT D—EASEMENT, ENCROACHMENT, AND LEASE AGREEMENTS
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and irrigation system?
Ye Skip Attachment D.
No — Pursuant to 15A NCAC 021' .01 16(c, provide a copy of all easements, lease agreements, and encroachment agreements
allowing the Permittee to operate and maintain the wastewater collection, treatment, conveyance, and irrigation system on
property not owned by the Permittee.
ATTACHMENT E—AFFILIATIONS
Are the Permittee's affiliations of record correct? Check affiliations.
Ye — Skip Attachment E.
No— Provide the corrected affiliations and their contact information.
ATTACHMENT F — COMPLIANCE SCHEDULES
Does the existing permit include any Compliance Schedules? (See Section I of the most recently issued permit)
es Submit documentation that the compliance schedules have been met.
L�No — Skip Attachment F.
FORM: SFRWWIS-R 02-2 1 Page 3 of 4

ATTACHMENT G—CIVIL PENALTIES AND OUTSTANDING VIOLATIONS
Does the Permittee have any existing civil penalties or outstanding violations?
Yes (civil penalties) — Submit payment for the civil penalty, or proof of remission request.
Yes (violations) — Submit a copy of your response to the Notice of Violation.
�::� ' Skip Attachment G.
ATTACHMENT H — SETBACK WAIVERS
Does the existing permit include setback waivers?
Ye — Pursuant to 15A NCAC 02T .0606(c), provide setbacks waivers that have been written, notarized, signed by all parties
involved, and recorded with the county Register of Deeds. Waivers involving the compliance boundary shall be in accordance
with 15ANCAC 02L.0107.
No — Skip Attachment H.
APPLICANT'S CERTIFICATION
that this
ap lication
(Signature authority's name as noted in Section 1, Item 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application package are not completed, and that if all required supporting information and attachments are not included, this
application package will be returned as incomplete. I further certify pursuant to 15A NCAC 02T .012that the applicant, or any
parent, subsidiary, or other affiliate of the applicant has: not been convicted of environmental crimes under; not previously
abandoned a wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with
any compliance schedule in a permit, settlement agreement, or order; not paid an annual fee.
Note: The Applicant's Certification shall be signed pursuant to 15A NCAC 02T .0106(b). An alternate person may be delegated as
the signing official if a letter is provided pursuant to 1 sA NCAC 02T .0106{c), Pursuant to § 1 43-215.0A and § 14;-215.GE3 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.
Q'IIY&IAC J )OAA-M) Date: /V _/9 ,A t
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Laserfiche Upload:
litt fs:lle us.ca v F r s nDi har - n h-
tiu�i-flischar e.iteiturts u r�cdenr.go► Submittal -Form -Vert
FORM: SFRWWIS-R 02-21 Page 4 of 4

� p[ f►tc+1} PERMISSION 1S HERESY GRANTED TO
G. Ronald and Amanda L. Spinks
Chatham Count}
FOR THE
continued operation of a 600 gallon per day (GPD) single-family residence wastewater treatment and
irrigation facility consisting of:
a 1,250 gallon baffled septic tank; a 216 square -foot (W) pressure -dosed surface sand filter; a 1,200 gallon
sand filter pump tank with a 12 gallon per minute (GPM) pump; a tablet chlorinator; a 3,000 gallon chlorine
contact/storage/pump tank with a 11.4 GPM pump, and audible/visual high-water alarms; a 0.41 acre spray
irrigation area with six full -circle, overlapping, 72-foot-diameter, 1.9-GPM sprinkler heads, a precipitation
sensor, and a soil moisture sensor; and all associated piping, valves, controls, and appurtenances
to serve the single-family residence at 3819 Old US 1, Moncure, NC 27559, with no discharge of wastes to
surface waters, pursuant to the application received September 21, 2016, 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.
This permit shall be effective from April 1, 2017 until March 31, 2022, shall void Permit No. WQ0016232
issued April 15, 2008, and shall be subject to the following specified conditions and limitations:
I. SCHEDULES
1. 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.
f 15A NCAC 02T .0105, 02T .0109, 02T .0115(c)] , � j4 e5T R F_ G osg, E o A S f A k r D F
TWE ❑ jU G,sa+4i 5 u$rf1a-rrA L
2. If a public or community sewage system is or becomes available, the subject single-family residence
wastewater treatment and irrigation facilities shall be closed and all wastewater shall be discharged into
the public or community sewage system within 180 days of its availability. Prior to the initiation of
these connection activities, appropriate Division approval shall be received. [15A NCAC 02T .0607]
Np)► F- AV ArL A5Lf:
WQ0016232 Version 4.0 SheH Version 151201 Page 1 of 6

4".rVN C fA.T H
BK 1902 PG 0286
-14,y cpE�D�R
x
ion � 2017
RQ ;ttr 9 Oe
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FILED
CHATHAM COUNTY NC
LUNDAY A. RiGGSSEE
REGISTER OF DEEDS
FILED
Jan 17. 2017
AT
04 19�30 pm
BOOK
01902
START PAGE
0286
END PAGE
0288
iNSTRUMENT # 00533
EXCISE TAX
(None)
State of North Carolina
Department of Environment and Natural Resource&
Dmston of Water Resoarcts
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
(IHfS FOkAV AM y i3F. P139TaCOPIEO FOR USF, ASAN OR7CINAL)
The Division of Water Resources will not consider this form eaaapkte uuleas all iastructioas are followed Failure
to follow instracdons or to submit all required items will lead to additional proresslag it ad review time.
Far more rnfor n iarr or for wr electronic version efV4fa m, vr_riw+o• web sk u
httn..lrgrrof nrdrnr. r ivebhr Il,s7o I tir'rnitonN.
INSTRUC"nONS To'£FIE APP1lICANT-
+r M not submit this form for review without a corresponding Nan-Discha%e Permitting !Snit applirativrp(mr ".
Any changes to this fmm will result in the application package being returned- - I
+� Any other setbacks requited by 15A NCAC Subchapter 02T other than those referenced be 1pw, a * waiVcd
through execknion of this from. �}
✓ A copy of the completed and appropriately executed form nwst be provided to the property oyher. ; ,yI j% e •
AGREEMENT TO WAIVE SETBACKS AS REQUYRED By
I5A NCAC t12 f ,U546(aj, .U5U6(b} .tifvti(a}, .D71i6(a] and .IUDG(s)
The undersigued property owner(s) bereby penr:its:
Applicmnt's name: Ronald ck S Oinks
Complele mailing address of applican(: _ 3/)`7 -I- —
City: mo State: N-C r.;p 75
Telephone number: (q i 9 } 9 & 7-01 a Facsimile number-. C___)
her :
reinafter referred to as the Ptrmlttee, to (check all that apply)
�
1Yon-Discharge disposal of wastewater effluent within 137 feet of the property line,
❑ Non -Discharge disposal of wastewater effluent within feet of the identified residence,
❑ Construct treatment and storage units withla Feet of the property tine,
❑ Construct treatment and storage units within feet orthe identified residence,
FORM: ?4DWSW i I.13 Page l 012

BK 1902 PG 0287
The waWed selbaelm apply as ahowm oa the attached mapandlocated at the f "Owing:
Location address of property: i ka��o �n Co. C0.t ea 670
city: iri oneM r � state: N G zip: a 7 S59
� l certify the 1 am it deeded property oww of above-refermoed pmpaty and am authorized to make decisions
regprdtng this property on behalf of other deeded property owners. Furthermore, I certify thst I ba►c trod and
understand this Agreement and do hereby grant permission to the Permittee to dispose of waslawstar diluent or
consourt waste nacv treeLrieslt jmits as Specified herein.
[ssuan" of a pmail f9f the Wt iect fm-that system l 3adli reword this waives form with t�,gp[v�rinte RcCi�l&I
of Dads and Qrovida the Permitwe and Diybiou Qf WaW Rr.4urm iS d�]Lt2rson Qf>sttch
Property owner(s) uame(a): e m r n
Signarura: Date: /�� Y��� 77
Sigrratum:
Date:
NORTH CAROLINA, _I lAk 14 COUNTY CaY
I. trTs N �—*Oss" a Notmy public for County, North Carolina,
I
do hereby certify that (�A_,sr►�C�E17tdn1 r� personally appeared before me this day and
acknowledged the doe execution of the foregoing instrwwnt,
tttt161prsj,.
WiV pVQ94 ial sal this the `day of J i N . �h l �
SEC _
SV- Or
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FORM: NDWSW I1-13 Page 2 of2

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GRADY RONALD JR. SPANKS
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& AMANDA LEMONS SPINKS
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MONCURE
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CHATRAM COUNTY NORTH CAROIJNA
JOHN A. EDWARDS RI COMPANY
NC License F-029S
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w in
3 2 a W.do AYD., Ra lalgh, NC 27GO5
phone (419) 8m"m