WQ0014598_Application_20220705

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Division of Water Resources
State of North Carolina
Department of Environmental Quafity
Division of Water Resources
15A NCAC 02T.0600 — SINGLE-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM — RENEWAL
FORM: SFRWWIS-R 02-21
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 web.siltc. The Applicant shall submit an electronic copy of the application
and attachments uploaded as a single Portable Document Format (PDF) file to htVs-/f&_q.,Ac. jov/FRrms/NonDischA!:gc-
Bra nch-Su bm ittal- Form -Ve r2, or emailed to Non-Discharge.Reports nancdenr.g-qy if less than 20 megabytes (MB).
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Applicant: Richard V. Stockmans & Kathleen C. Wallace
1
Permit No.: WQO014598
3.
Signature authority: Richard Stockmans
Title: Mr.
4.
Mailing address: 522 McGhee Road
City: Chapel Hill
State: NC Zip: 27517-8740
5.
Contact person: Richard Stockmans
Email: [e-mail]
Primary phone number: (919) 607-178 Cell
Secondary phone number: ( - Select
6.
Secondary Contact person.- Kathleen Wallace
Email: [e-mail]
Primary phone number: (919) 225-522 Cell
. . . .......... . ....
Secondary phone number: Select
1. Physical address. 522 McGhee Road County: Chatham
City: Chapel Hill State- NC Zip: 27517-8740
1. Billing address: 522 McGhee Road
City: Chapel Hill State: NC Zip: 27517-8740
2. Verify the Applicant does not have any overdue annual fees:
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Pursuant to 15A NCAC 02T .0 12 gj, permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: SFRWWIS-R 02-21 Page 1 of 4

Perin it No.: WQOO 145 98 County: Chatham
Permittee. Richard V. Stockmans & Kathleen C. Wallace (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. (ifopplicable),
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. (ifopplicable)
7. Inspect the drip irrigation system monthly to verify: proper operation of the drip lines; that there are no leaks; that
vegetativegrowth 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,, (ifopplicable)
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_.UpLication 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/W'e understand the above
Signature:
Signature:
Signature:
Signature:
and agree to these terms as part of the issued permit.
Date. J
Date:
Date:
Aland Maintenance Agreement
FORM: SFRWWIS-R 02-21 Page 2 of 4

Was the facility originally permitted or had a major modification issued after September 1, 200�6?
Ej Yes — Pursuant to 15A NCAC 02T .010 , submit a site map pursuant to the requirements in l5A NCAC 021' .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 fenbes within the wastewater treatment, storage, and irrigation areas.
Cl Soil mapping units shown on all irrigation sites.
* The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage,
and irrigation sites.
0I Delineation, of the compliance and review boundaries per 15A NCAC 021, O 107 and .0 108, and 15A NCAC 02T .O0 1.
0 Setbacks as required by 15A NCAC 02T.0606.
El Site property boundaries within 500 feet of all wastewater treatment, storage, and irrigation sites,.
[11 All habitable residences or places of public assembly within 500 feet of all treatment, storage, and irrigation sites.
No — Skip Attachment A.
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Does the signature authority in Section 1, Item 3 meet the requirements, pursuant to 15A N CAC 921 .0106Lb
Yes — Skip Attachment B,
No — Submit a delegaCtQtLIctter pursuant to 15A NCAC 02T&L1 Q6 L) authorizing the signature authority to sign.
Does the existing permit include an approved flow reduction?
El 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% 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 0114
0 No — Skip Attachment C.
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and irrigation system?
0 Yes — Skip Attachment D.
.0 T 1
El No — Pursuant to 15A NCAC 026 , provide a copy of all easements, lease agreements, and encroachment agreements
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allowing the Per�mittee to operate and maintain the wastewater collection, treatment, conveyance, and irrigation system on
property not owned by the Permittee.
Are the Perm ittee's affiliations of record correct? Check affi I ial ions.
Yes — Skip Attachment P.
F1 No — Provide the corrected affiliations and their contact information.
LIANf
AtTA61MENT F — Cp XSC
Does the existing permit include any Compliance Schedules? (See Section I of the most recently issued permit)
E3 Yes— Submit documentation that the compliance schedules have been met.
0 No — Skip Attachment P.
FORM: SFRWWIS-R 02-21 Page 3 of 4

Does the Permittee have any existing civil penalties or outstanding violations?
EJ Yes (civil penalties) — Submit payment for the civil penalty, or proof of remission request,
El Yes (violations) — Submit a copy of your response to, the Notice of Violation.
0 No — Skip Attachment G.
Does the existing permit include setback waivers?
Yes — Pursuant to l 5 A N CAC 02'r mo 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 15A N CAC 02 L .0107..
No — Skip Attachment H.
/ I
t Vo Cy Ce —__,,._.—attest that this appl
(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 .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 property 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 15 A NCAC 02T .O I 06(b . An alternate person may be delegated
as the signing official if a letter is provided pursuant to 15A NQAC 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 misdemganofq wl�jch may include a fine not to exceed $1 0,000 as well as civil penalties up to $25,000 per violation.
MOOED
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THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Ernail: Laserfiche Upload:
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Submittal-Form-Ver2
FORM: SFRWWIS-R 02-21 Page 4 of 4