WQ0002342_Return_20220404

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
CHARLES W. AND NANCY F. DUNIIAM
1018 MOUNTAINSIDE LANE
BURLINGTON, NORTH CAROLINA 27217
Dear Mr. and Mrs. Dunham:
NORTH CAROLINA
Environmental Quality
April 4, 2022
Subject: Application No. WQ0002342
Permit Application Return
1018 Mountainside Ln. SFR
Single -Family Residence
Wastewater Irrigation System
Alamance County
This letter is in reference to your permit change of ownership request received April 4, 2022.
During the pre -review process, it was noted that the following items were missing from the
submitted application package:
1. The submitted application is for a Change of Ownership at 1018 Mountainside Ln., Burlington,
NC 27217. Review of the provided deed and the Alamance County Register of Deeds indicates
that this property has not changed ownership.
If the Dunham's are instead intending to renew Permit No. WQ0002342, then please complete
the renewal application that may be downloaded at: https:Hdeq.nc.gov/water-resources/non-
discharge/sfrwwis-r-02-21 /download.
Please note that renewal application is not due until September 1, 2022.
2. If the property is in fact changing ownership, please provide a Change of Ownership
application from the new/proposed property owners. The change of ownership application may
be downloaded at: https:Hdeg.nc.gov/water-resources/non-discharge/sfrwwls-co-03-
21/download.
Accordingly, your permit change of ownership request is being returned as incomplete pursuant to
15A NCAC 02T .0107(b).
The success of the Water Quality Permitting Section's Non -Discharge Branch process depends
upon the receipt of complete and accurate applications and supporting documentation. Please amend the
application package to include the previously noted omitted items and resubmit with the appropriate permit
processing fee.
D � North Carolina Department of Environmental Quality i Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
NOR�HCAROLINA
,.,roMMm 0­; /I 919,707,9000

Please be advised that construction and/or operation of the subject facilities without a valid
permit is a violation of G.S. 143-215.1, and may subject you to appropriate enforcement actions
pursuant to G.S. 143-215.6A., 6B., and 6C. Civil penalties of up to $25,000 per day per violation may
be assessed for failure to secure a valid permit.
If you need additional information concerning this letter, please contact me at [phone] or
nathaniel.thornburgkncdenr. gov.
Sincerely,
Nathaniel D. Thornburg, Branch Chi f
Division of Water Resources
Enclosure
cc: Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Laserfiche File (Electronic Copy)

DWR
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 httns://edocs.de(l.nc.eov/Forms/NonDischaree-Branch-Submittal-
Form-Vert, or emailed to Non-Discharee.Renorts(a)ncdenr.gov if less than 20 megabytes (MB).
SECTION I - APPLICANT INFORMATION
1.
;�
Applicant: ' �! `i2 CG S (,� 'J tIAJ �,q/1'I
C ►� C� (f /���?%
2.
Permit No.: WQ00 d o2 3l
3.
Signature authority:
Title:
4.
Mailing address: (U /9
City: ­6 VI? 11 N(>7_0W
State: Aj Zip: - � 7
5.
Contact person: C H4e? l,6z5 W OvAIPAM
Primary phone number: (33/4)j- %qSelect
Email: �—
Secondary phone number: (33`)6�,� 36ySelect
6.
Secondary Contact person: A% NC` (!' 0'11`1*4I
Primary phone number: (336)q z i-J�fg9Select
Email: P-7N6 tF 7-
Secondary phone number: (336)�750(3 elect
SECTION II - FACILITY INFORMATION
1. Physical address: 4�91� 4W County:
City: 3 U2 G Al6 M y State: NC Zip: ,27 2- 0
SECTION III - BILLING INFORMATION
1. Billing address: /O/gi fnO4,417IW5 ti>l L-W
City: 3f//2tI/y67y"y State: /VC Zip:
SECTION 1V - DEED INFORMATION
Has a deed been executed and recorded in the County Register of Deeds pursuant to 15A NCAC 02T .0604(e)(1)?
N Yes - Complete Items 1 through 4 below.
❑ No - See Attachment B on Page 3.
1. Parcel No.: 156 / / G
2. Date of Purchase: '_3-'� - j 19 G
3. Deed Book: .S / O
4. Deed Page Nos.: /1L_
FORM: SFRWWIS-CO 03-21 Pagel of3

SECTION V — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQ00
Permittee: (i.e., all deeded property owners)
County:
The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system as
follows:
1. Inspect the septic tank annually, and pump out solids as needed.
2. Inspect and clean the septic tank effluent filter annually. (if applicable)
3. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets (e.g., calcium hypochlorite) as needed.
Swimming pool grade chlorine tablets are not acceptable. (if applicable)
4. Inspect the ultraviolet disinfection unit weekly. Clean or replace the lamps and quartz sleeves as needed. (if
applicable)
5. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all pump/storage tanks
when pumping the septic tank solids out.
6. Inspect the spray irrigation system monthly to verify: proper operation of the spray heads; that there are no leaks;
that vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not ponding in or running
off the designated irrigation area; and that there are no objectionable odors. (if applicable)
7. Inspect the drip irrigation system monthly to verify: proper operation of the drip lines; that there are no leaks; that
vegetative growth does not obstruct the drip emitters; that the irrigated wastewater is not ponding in or running off
the designated irrigation area; and that there are no objectionable odors. (if applicable)
8. Maintain a set of Division -approved engineering plans and specifications.
9. Pay the required annual fee.
10. Request renewal of this permit on Division -approved forms no later than 180 days prior to expiration.
11. Sign and provide a 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
Signature:
Signature:
Signature:
Signature:
agree to these terms as part of the issued permit.
Date:
Date:
Date:
Date:
All deeded property owners shall sign this Operation and Maintenance Agreement
FORM: SFRW WIS-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 .0106(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
I, 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 § 143-215.613, 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: Date:
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email:
Non-Discharge.Reports(a,ncdenr.gov
Laserfiche Upload:
https://edoes.deci.nc.2ov/Fo rm s/NonDischaree-Branch-
Submittal-Form-Vert
FORM: SFRWWIS-CO 03-21 Page 3 of 3

PREPARED BY FORREST C. HALL, ATTOP.NEY, 205 N. Main Street, Graham, N.C. 27253
(A;!D��DRESS OF GRANTEES: 302 W. Lee Street, Mebane, N. C. 27302 BOOK HOPPE %4
V'h *l� Red, y made this 4th day of MarCh :'r 1986, _ by
wAISACE L. GIIJJAMand wife, MEDRA R. GILLIAM,
hereinafter called Grantors, to
—_� CHARLFG WESLEY DUNE l and wife, NANCY F. DUNIiAM,
hereinafter called Grantees.
The designations Grantors and Grantees as used herein shall include singular, plural, masculine, feminine, or neuter as required by the contox.
W ITNESSETH: That the Grantors, in consideration of t10.00 and other valuable consideration to them paid by the Grantees, the receipt
of which is acknowledged, have bargained and sold, and by these presents do bargain, sell and convey to the Grantees their heirs, successors, and
assigns, all of the following described real property:
A certain tract or parcel of land in Faucette Township, Alamance County, North Carolina,
adjoining a 60 ft. wide private Rd., William E. Covington, Frances B. Gillam and others and
being more particularly described as follows:
BEGINNING at an iron stake in the center line of a 60 ft. wide private road in the line of
David Ragan and a corner with Frances B. Gillam; thence with the center line of said Road,
S. 84 deg. 26' E. 587 ft. to an iron stake and corner with William E. Covington; thence with
the line of said Covington, in a lake, S. 12 deg. 54' E. 476.65 ft'. to a point; thence con-
tinuing with said Covington, in a lake, S. 40 deg. 181 E. 514.30 ft. to a point and corner
with said Covington and Wallace L. Gillam in the line of the Blanchard Estate- thence with
the line of Blanchard Estate, N. 87 deg. 28' 30" W. 636.44 ft. to a rock in ae line of
Frances B. Gillam; thence..with the line of said Gillam, the following courses and distances:
N. 23 deg. 03' W. 527.98 £t. to a rock; thence N. 24 deg: 39' W. 199.40 ft. to a rock and
thence; N. 23 deg. 39' W. 238.40 ft. to the point of BEGINNING and CONTAINING 10.30 ACRES,
more or less.
The above description and determination of area were taken from a survey and draw" made by
William L. Bolden, Registered Surveyor, dated October 13, 1977, and a copy of same is attached
hereto and incorporated herein by reference.
J
This conveyance is subject to all matters and things shoed on attached survey, recorded
easements and rights of way and the right of way for private road over a portion of premises
as shown on attached survey and this conveyance also includes an easement for access to the
above described property to S. R. #1609 over private road as shown on survey which said
easement shall be appurtenant to the property herein conveyed.
1
The above property was conveyed to the Grantors by See Book No. page
TO HAVE AND TO HOLD said real property, with all privileges, and appurtenances thereunto belonging, to the said Grantees, their
heirs, successors. and assigns forever.
The Grantors covenant that they are seized of said real property in fee, and have the right to convey the same in fee simple; that the same
is free from all encumbrances (with any exceptions above stated); and that they will warrant and defend the title to same against the claims of all
persons whomsoever.
IN WITNESS WHEREOF, the Grantors have hereunto set their hands and seals, or if corporate, have caused this Deed to be signed in '
their respective corporate names by their duly authorised officers and their seals to be hereunto affixed by authority of their Boards of Directors,
the day and year first above written.
(SEAL)
STATE OF L' Real Estate _ _ �t �e-
=_ N� LINA '. L Excise Tax = /y
<o PRo -..:,A //'.LeGt.Q-• P f/.G.-sti✓w ISEALj''
MAR-416 16. U O
o P.B. 10705 ~
STATE OF NORTH AkROLINA, COU T OF ALAMAN '
1. a Notary Public of said County, do hereby certify
that WAIS,ACE L. GILL IAM and wife, SEDRA R. GILLS s
personally
��JJappeared before me this day and acknow dged the due execution of the foregoing deed. Witness my hands and official seat,
this �a�day of March - 19 86. My Commission Expires: /O�/9/A �/ - . - r t �(� )
© Notary Public
...••...
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V$L�G.��r
N o:
STATE OF NORTH CAROLINA. COUNTY
BOOKF LED
/OPAGE —
HAR 4 fj 44 PH tB
MARIAN Ii. PITTI?AN
REGISTER :IF DEEDS
ALAMAHCE COUNTY, H.C.
The foregoing certificate(s) of -- ' L-
a Notary (or Notaries) Public of the govern men 1 units designated is (ai J certified t ba correct.
Filed for registration on the _day of Marckl ]9 86 et
d I recorded In
the fi of the Register of Deeds of this County in Book of Deeds No 15�10
hi!-trJ • e"QnC.� _ _ Register of Deeds
M..
F,

BOOK $10 FACE 565
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