WQ0042360_Application_20211215

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0042360
Applicant/Permittee Jay and Nancy Kennedy
Applicant/Permittee Address 3652 Apache Rd Winnabow NC 28479
Is the owner in BIMS? Yes • No Is the facility in BIMS?
Owner Type Individual
Facility Name 3652 Apache Rd. SFR
County Brunswick
Fee Category Single -Family Residence
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
llr�ore
Fee Amount $0
Complete App Date 12/15/2021
Below list any additional email address that need notification about a new project.
... ... ..
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Name* Jay Kennedy
Email Address*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
908-461-4532
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Perm it Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number: *
WQ0042360
Has Current Existing permit number
Applicant/Permittee*
Jay and Nancy Kennedy
Applicant/Permittee Address*
3652 Apache Rd Winnabow NC 28479
Facility Name*
3652 Apache Rd. SFR
Please provide comments/notes on your current submittal below.
Trying to get a building permit as soon as possible from the town. This should be the last thing
they need.
This submission has a correction on the form as advised by Lauren Plummer
Thank you
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
Kennedy DWR form change of ownership.pdf 531.03KB
Kennedy 3652 Apache Rd Septic Permit.pdf 2.3MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617

Signature
04, -W`�
Submission Date 12/15/2021

UU
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources
15A NCAC 02T .0600 - SINGLE-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM - CHANGE OF OWNERSHIP
FORM: SFRWWIS-CO 03-21
Pursuant to 15A NCAC 02T .0107(b), if the application does not include all required information and the necessary supporting
documentation, the application shall be returned. The application and attachments shall be prepared in accordance with 15A
NCAC 02T .0100, 15A NCAC 02T .0600, and Division Policies. For more information, visit the Water Quality Permitting
Section's Non -Discharge Branch website. The Applicant shall submit an electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) file to httus://edocs.de(i.nc.p-ov/Forms/NonDischarae-Branch-Submittal-
Form-Vert, or emailed to Non-Discharge.Ret)orts(a)ncdenr.aov if less than 20 megabytes (MB).
SECTION I - APPLICANT INFORMATION
i.
Applicant: Jay Kennedy and Nancy Kennedy
2.
Permit No.: WQ0042360
3.
Signature authority:
Title:
4.
Mailing address: 3652 Apache Rd
City: Winnabow
State: NC Zip: 28479-
5.
Contact person: Jay Kennedy
Primary phone number: [phone] Select
Email: [e-mail]
Secondary phone number: ( ) - Select
6.
Secondary Contact person:
Primary phone number: ( } - Select
Email:
Secondary phone number: ( ) - Select
SECTION II - FACILITY INFORMATION
1. Physical address: FAf2cCz- Air i a-1 4nm t Soo S F (2- County: Brunswick
City: Winnabow State: NC Zip: 28479-
SECTION III - BILLING INFORMATION
1. Billing address: 3652 Apache Rd
City: Winnabow State: NC Zip: 28479-
SECTION IV - DEED INFORMATION
Has a deed been executed and recorded in the County Register of Deeds pursuant to 15A NCAC 02T .0604(e)(1)?
® Yes - Complete Items 1 through 4 below.
❑ No - See Attachment B on Page 3.
1. Parcel No.: 1270001504
2. Date of Purchase: June 21, 2021
3. Deed Book: 04645
4. Deed Page Nos.: 0921 -
FORM: SFRWWIS-CO 03-21 Page 1 of 3

SECTION V — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQ0042360 County: brunswick
Permittee: Jay Kennedy and Nancy Kennedy (i.e., all deeded property owners)
The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system as
follows:
1. Inspect the septic tank annually, and pump out solids as needed.
2. Inspect and clean the septic tank effluent filter annually. (if applicable)
3. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets (e.g., calcium hypochlorite) as needed.
Swimming pool grade chlorine tablets are not acceptable. (f applicable)
4. Inspect the ultraviolet disinfection unit weekly. Clean or replace the lamps and quartz sleeves as needed. (if
applicable)
5. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all pump/storage tanks
when pumping the septic tank solids out.
6. Inspect the spray irrigation system monthly to verify: proper operation of the spray heads; that there are no leaks;
that vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not ponding in or running
off the designated irrigation area; and that there are no objectionable odors. (if applicable)
7. Inspect the drip irrigation system monthly to verify: proper operation of the drip lines; that there are no leaks; that
vegetative growth does not obstruct the drip emitters; that the irrigated wastewater is not ponding in or running off
the designated irrigation area; and that there are no objectionable odors. (if applicable)
8. Maintain a set of Division -approved engineering plans and specifications.
9. Pay the required annual fee.
10. Request renewal of this permit on Division -approved forms no later than 180 days prior to expiration.
11. Sign and provide a Change 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:
Signature:
Signature:
Signature:
``^� o ✓ .r."�'�-�1-,- Date: l2 ' t !'" . t
/ Date:
Date:
Date:
All deeded property owners shall sign this Operation and Maintenance Agreement
FORM: SFRWWIS-CO 03-21 Page 2 of 3

ATTACHMENT A — SIGNATURE AUTHORITY DELEGATION
Does the signature authority in Section I, Item 3 meet the requirements pursuant to 15A NCAC 02T A 106(b)?
® Yes — Skip Attachment A.
❑ No — Submit a delegation letter pursuant to 15A NCAC 02T .0106(c) authorizing the signature authority to sign.
I ATTACHMENT B — PROPERTY OWNERSHIP DOCUMENTATION I
Has a deed been executed and recorded in the County Register of Deeds pursuant to 15A NCAC 02T ,0604(f)(1)?
® Yes — Complete Items 1 through 4 in Section IV on Page 1.
❑ No
❑ Submit a written notarized intent to purchase agreement sign by both parties with a plat or survey map pursuant to 15A NCAC
02T .0604(e)(2); or
❑ Submit a written notarized lease agreement that specifically indicates the intended use of the property and has been signed by
both parties, as well as a plat or survey map pursuant to 15A NCAC 02T .0604(e)(3). Lease agreements shall adhere to the
requirements of 15A NCAC 02L .0107.
APPLICANT'S CERTIFICATION
attest that this application
(Signature authority's name as noted in Section I, Item 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application package are not completed, and that if all required supporting information and attachments are not included, this
application package will be returned as incomplete. I further certify pursuant to 15A NCAC 02T .0120(b), that the applicant, or any
parent, subsidiary, or other affiliate of the applicant has: not been convicted of environmental crimes under; not previously abandoned
a wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with any compliance
schedule in a permit, settlement agreement, or order; not paid an annual fee.
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 15A NCAC 02T .0106(c). Pursuant to § 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.
Signature:' i, [`1 Date: t 5 2 )
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email:
Non-Discharge.ReaortsOncdeur.gov
Laserfiche Upload:
httus://edocs.deg.nc.eov/F"ms/NonDischarge-Branch-
S ub mittal-Form-V er2:
FORM: SFRWWIS-CO 03-21 Page 3 of 3

ROY COOPER
Governor
JOHN NICHOLSON
Interim Secretary
S. DANIEL SMITH
Director
PEGGY DOUGLAS WATERMAN
397 WEST RANCH ROAD
WfNNABow, NORTH CAROLfNA 28479
Dear Mrs. Waterman:
NORTH CAROLINA
Environmental Quality
June 18, 2021
Subject: Permit No. WQ0042360
Parcel No. 1270001504 SFR
Single -Family Residence
Wastewater Irrigation System
Brunswick County
In accordance with your permit application request received March 3, 2021, and subsequent
additional information received June 3, 2021, we are forwarding herewith Permit No. WQ0042360 dated
June 18, 2021, to Peggy Douglas Waterman for the construction and operation of the subject single-family
residence wastewater treatment and irrigation facilities.
This permit shall be effective from the date of issuance through September 30, 2027, and shall be
subject to the conditions and limitations therein. The Permittee shall submit a renewal application no
later than April 3, 2027.
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.
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 Poorva Mokashi at [phone] or
poorva.mokashi &ncdenr. gov.
Sincerely,
S. Daniel Smith, Director
Division of Water Resources
cc: Brunswick County Health Department (Electronic Copy)
Wilmington Regional Office, Water Quality Regional Operations Section (Electronic Copy)
D ��� North Carolina Department of Environmental Quality I Division of Water Resources
NORrR CAROLINA 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
�� 919.707.9000

Mrs. Peggy Douglas Waterman
June 18, 2021
Page 2 of 2
Comer Lyons, PE — GS&E, Inc. (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Peggy Douglas Waterman
Brunswick County
FOR THE
construction and operation of a 360 gallon per day (GPD) single-family residence wastewater treatment
and irrigation facility consisting of.
a 1,000 gallon septic tank with an effluent filter; a 600 GPD E-Z Treat treatment system with a recirculating
media filter; a 1,250 gallon recirculation tank with a 50 gallon per minute (GPM) recirculation pump,
audible/visual high-water alarms, and a control panel; a 10 GPM E-Z Treat ultraviolet (UV) dual lamp
disinfection unit; a 3,000 gallon field dosing tank with a 30 GPM pump, audible/visual high-water alarms,
and a control panel; a Perc-Rite drip dispersal system with an automatic disc filtration system; a rain sensor;
a 0.19 acre drip irrigation area; and all associated piping, valves, controls, and appurtenances
to serve the single-family residence at Parcel No. 1270001504, Winnabow, NC 28479, with no discharge
of wastes to surface waters, pursuant to the application received March 3, 2021, subsequent additional
information received June 3, 2021, 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 September 30, 2027, 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.gov.
[15A NCAC 02T .0116(a)]
2. The Permittee shall notify the Wilmington 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)]
WQ0042360 Version 1.0 Shell Version 200201 Page 1 of 8

Upon completion of construction and prior to irrigation, a soil evaluation shall be completed for all
areas where fill material is placed within the permitted irrigation areas. The report shall certify that
areas utilizing fill material are capable of accepting the designed loading rate. This report shall
specifically address, but not be limited to, soil features such as soil compaction and saturated hydraulic
conductivity of the least permeable layer, soil fertility report and any amendments added, verification
of fill suitability and depth of fill material (and to the seasonal high water table) across the field, as well
as any other properties that might impact the soil's ability to accept irrigation water. The soil scientist
evaluation shall be mailed to the Division of Water Resources, Non -Discharge Branch, 1617 Mail
Service Center, Raleigh, NC 27699-1617 or Non-Discharge.Reportskncdenr.gov. Irrigation of
wastewater shall not occur until the Wilmington Regional Office approves the soils evaluation. [15A
NCAC 02T .0108(b)(1)(A)]
4. Prior to operation of the newly installed facilities, a Final Operation and Maintenance Plan shall be
submitted for review. The plan shall be sent to the Division of Water Resources, Non -Discharge
Branch, 1617 Mail Service Center, Raleigh, NC 27699-1617 or Non-Discharge.Reportskncdenr.gov.
[15A NCAC 02T .0108(b)(1)(B), 02T .0604(f)]
5. The Permittee shall request renewal of this permit on Division -approved forms no later than April 3,
2027. [15A NCAC 02T .0105(b), 02T .0109]
6. 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]
IL PERFORMANCE STANDARDS
The Permittee shall maintain and operate the subject non -discharge facilities so there is no discharge to
surface waters, nor any contravention of groundwater or surface water standards. In the event the
facilities fail to perform satisfactorily, including the creation of nuisance conditions due to improper
operation and maintenance, or failure of the irrigation areas to assimilate the effluent, the Permittee
shall take immediate corrective actions, including Division required actions, such as the construction
of additional or replacement wastewater treatment or disposal facilities. [15A NCAC 02T
.0108(b)(1)(A)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this facility. [15A NCAC 02T .0108(b)(1)(A)]
3. The Permittee shall apply treated wastewater effluent at or below the following rates:
TABLE 1— APPLICATION LIMITATIONS
Field
Parameter
Hourly Rate
Yearly Max
Units
1
01284 — Non -Discharge Application Rate
0.14
26.16
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
1
Peggy Douglas Waterman
Brunswick
34.083464'
-78.029761 °
0.19
Lynn Haven
[I5A NCAC 02T .0 1 08(b)(1)(A)]
WQ0042360 Version 1.0 Shell Version 200201 Page 2 of 8

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)]
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 originally permitted June 18, 2021. 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 '`
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 Permittee, 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)]
WQ0042360 Version 1.0 Shell Version 200201 Page 3 of 8

b. The storage and treatment units were originally permitted June 18, 2021. 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 II.4. [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 Parcel No.
1270001504, Winnabow, NC 28479 on the sites listed in Condition II.4. [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)]
WQ0042360 Version 1.0 Shell Version 200201 Page 4 of 8

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 Wilmington 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 Wilmington 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)]
WQ0042360 Version 1.0 Shell Version 200201 Page 5 of 8

V. INSPECTIONS
1. The Permittee shall perform inspections and maintenance to ensure proper operation of the wastewater
treatment and irrigation facilities. [15A NCAC 02T .0608(f)]
2. The Permittee shall inspect the wastewater treatment and irrigation facilities to prevent malfunctions,
facility deterioration, and operator errors that may result in discharges of wastes to the environment,
threats to human health, or public nuisances. The Permittee shall maintain an inspection log that
includes the date and time of inspection, observations made, and maintenance, repairs, or corrective
actions taken. The Permittee shall maintain this inspection log for a period of five years from the date
of the inspection, and this log shall be made available to the Division upon request. [15A NCAC 02T
.0608(e), 02T .0608(f)]
Division authorized representatives may, upon presentation of credentials, enter and inspect any
property, premises, or place related to the wastewater treatment and irrigation facilities permitted herein
at any reasonable time for determining compliance with this permit. Division authorized
representatives may inspect or copy records maintained under the terms and conditions of this permit,
and may collect groundwater, surface water, or leachate samples. [G.S. 143-215.3(a)(2)]
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)]
WQ0042360 Version 1.0 Shell Version 200201 Page 6 of 8

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]
9. Unless the Division Director grants a variance, expansion of the facilities permitted herein shall not
occur if any of the following apply:
a. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has been convicted of
environmental crimes under G.S. 143-215.6B, or under Federal law that would otherwise be
prosecuted under G.S. 143-215.6B, and all appeals of this conviction have been abandoned or
exhausted.
b. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has previously abandoned
a wastewater treatment facility without properly closing the facility.
c. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid a civil
penalty, and all appeals of this penalty have been abandoned or exhausted.
d. The Permittee or any parent, subsidiary, or other affiliate of the Permittee is currently not compliant
with any compliance schedule in a permit, settlement agreement, or order.
e. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid an annual
fee.
[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)]
Permit issued this the 18"' day of June 2021
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
.7L4;�a�-a
S. Daniel Smith, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0042360
WQ0042360 Version 1.0 Shell Version 200201 Page 7 of 8

Permit No. WQ0042360 Single -Family Residence Wastewater Irrigation System
Peggy Douglas Waterman June 18, 2021
Parcel No. 1270001504 SFR Brunswick 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:
Professional Engineer's Name
Firm Name
Firm No.
Address
City
State
Zip Code
Telephone
Email
Seal, Signature, and Date
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
WQ0042360 Version 1.0 Shell Version 200201 Page 8 of 8

LI - . I.-
& WT_'_
Division of Water Resources
Permit No. WQ00
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM
OPERATION AND MAINTENANCE AGREEMENT
FORM: SFRWWIS-O&M 09-18
County: Brunswick
Permittee: PfxV Waterman _. (i.e., all deeded property owners)
The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system as
follows:
1. Inspect the septic tank annually, and pump out solids as needed.
2. Inspect and clean the septic tank effluent filter annually. (if applicable)
3. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets (e.g., calcium hypochlorite) as needed.
Swimming pool grade chlorine tablets are not acceptable. (if applicable)
4. Inspect the ultraviolet disinfection unit weekly. Clean or replace the lamps and quartz sleeves as needed. (if
applicable)
5. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all pump/storage tanks
when pumping the septic tank solids out.
6. Inspect the spray irrigation system monthly to verify: proper operation of the spray heads; that there are no leaks;
that vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not ponding in or running
off the designated irrigation area; and that there are no objectionable odors. (ifapplicable)
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 Change 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.
We understandthe above requir ments a e to these terms as part of the issued permit.
7
Signature: Date; y
Signature: Date:
Signature:
Signature:
Date:
Date:
All deeded property owners shall sign this Operation and Maintenance Aereement
FORM: SFRWWIS-O&M 09-18 Page i of 1

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