WQ0020817_Application_20221011

DWR
Division of Water Resources
State of North, Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0600 - SINGLE-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM - RENEWAL
�FORM: SFRWWIS-R 02-21
Pursuant to ISANCAC 02T.0107(b), if the aP
: plication does not include all required information and the necessary supporting
documentation, the application shall he returned. The application and attachments shall be prepared in accordance with I,SA
NC,_A(, P2T 0100, 15.E NCAC 02,T,&600, and Division Polit,jes. For more information,, visit the Water Quality Permitting
Section's Non -Discharge Branch, Website. The Applkant shall submit an, electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) file to httUs://edoes.deg,nc&o TorenIfNonDischa,rff_ik-Branch-Suhm ittal-
Forrn-Ver2, or emaited to Non if less than 20 megabytes (MR).
SECTION 1, -APPLI CANT INFORMATION
I., Applicanc ' "-�Co I
I Perniit'No.: WQOO L�
1 Signature authority: l FTitle:
4 Mailing address:
State-
5, Contact persom Email
Primary phone number- Secondary phone numbet Selact
—3 C
6. Secondary Contact person, Email: °�x C( D - c_N
Primary phone number flICI )q 111 6 c, -o,,S elect Secondary phone numher: Select
__ ...................................... .....
SECTION II - FACILITY INFORMATION
7,)
1. Physical address:Q 0 4 County:
citY _\ ) I , State: NC zip.
SECTION I'll - BILLING INFORKATION
. ............... ................... . ............ . .. ........ .
1, Billing address
City: (' 0 State: � r—, zi,p"
2, 'V er ify the App I icant do,es n�ot have any o Yet. due annual Fees;
. L I � LwA:, ;TAXM e n
uenpulugmi _t,-;
Pursuant to 15A NCAC 02'T.0120(c , permits, for renewing facilities shall riot he granted, if the Applicant or any affifiation haws
an unpaid annual, fc,
FORM, SFRWW15-K 02-2 1, Page 1 of 4

SECTION IV — OPERATION AND MAINTENANCE AGREEMENT
Permit No.;! WQOO
P,ermittee,. (ix,, all deeded property owners)
County,
The PermittQe agrees to operate and maintain the single-family residence wastewater treatment and irrigation systern as
follows,
I. Inspect the septic tank annually, and pump out solids as needed,
2. Insp,"t and clean the septic tank of filter annually, (if rap plicabILO)
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 disinfectionunit weekly, Clean, or replace the lamps and quartz sleeves as needed. (if
qpphcable)
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 veri�; pTOpCr operation of the spray heads; that there are no leaks,;
that vegetative growth does not obstruct the spray heads-1 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 rnonthl, toverify: proper operation ofthe drip, lines, that there are no leaks; dial;y I
vegetative growth does, not obstruct the drip emitters; that the irrigated wastewater is, not ponding in orrunning off
the dcsignated irrigation area;, and that there are no objectionable odors. ffapplicable)
8 Maintain, a set of Division -approved engineering plans and specifications,
9Pay the required annual let.
10, Request renewal of this perm it on Division -approved fonns no later than 180 days prior to expiration,
11, Sign and, provide a han �C jjAny� of Ownership application. to any future owner of the single -tea it residence wastewater
treatment and irrigation system for their completion and subinilssion to the: Division of Water Resources.
I/We understand the above requirements and agree to these terms as part, of the issued pem it,
Signattjre;
Signature: Date;
Signaturc: Date- _
Signaturc� Date�
All dccdcd properly owners shall sign this Operation and Maintenance Agreement
rnVIKA. C'MYS1111fle V Al q I pa'".1, nrA

ATTACHMENT A - SITE MAP
...... . ...... .
Was the facility, originally permitted, or had a major modification issued after September 1, 2006?
tj Yes -- Pursuant to 15�,A _N(ACO2 LI 0 : submit a site map pursuant to the requirements inI 5A NCAC 02T.9§2AU 1-1 1 I'll 1_ , , "rhese
requircmentsare.
rl Ascaled map of tile site with, topographic contour intmals notexceeding 10feetor 25 percent ofto-W site reliefand showing
all facility -related structures and fences within the wastewater treatment, storage, and irrigation, areas.
Lj Soil mapping, units shown on all Irrigation sites,
[I The location of all wcll,s (including usage and, construction details if available), streams ('ephemeral, intermittent, and
perennial), springs, lakes, ponds, avid other surface drainage features,witbin 500, feet of all wastewater treatment, storage,
andirrigation sites.
0l Delineation of thec-ompliance and review boundaries; per BA NCA.0 227I 21L7 and , 0, _108, and, I SA N
0 Setbacks as required by l5A'NCAC OIT.0606.
[I Site property boundaries within. 500 feet of all wastewater treatment, storage, and irrigation sites.
CI All habitable residences or places of public assembly within 500 feet of all treatmem, storage, and irrigation Sites,,
El No - Skip, Attachment A.
ATTACHMENT 8 - SIGNAIVRE AUTHORIFTY DELEGATION
Does the signature authority in Section 1, Item 3 meet the requirements purstlant to I M, NCAC 02T,O I 0,6Lb
r-j"Yes- Skip Attachment B.
[:] No - Submit a dALeg_atjaLi letter pursuant to 15 A CAS" 02YO_LQ§W authorising the signature authority to sign
ATTACH MENT C - FLOW RE, DUCTION
Does the existing perm, it i nel ude an approved flow reduction'?
Yes - Submit a copy of the flow reduction approval letter, as well as the measurcd monthly average aniount 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 Permitteeshall ptovide a reevaluation of the reduced flow value pursuant to the requirements in I 5�A
N, AQ 92T 4 1140.
No - Sk,ip, Attachment C
ATTACHMENT D -EASEMENT, ENCROACHMENT, A,ND LEASE AGREEMENTS
Does the Pennittee own all of the land associated with the wastewater collection, treatment, conveyance, and, irrigation systern?
13"Yes - Skip Attachment Di,
No - Pursuant to jjAlit; AQ_QZjL&j_jfijc), provide a copy of at] easements, lease agreements, and, encroachment agreements,
allowing the Perm,ittee to operateand maintain the wastewater collection, treatment, conveyance, and irrigation system on,
property not owned by the Pen-nittee.
Are be Perntiftec's affiliations of.record. correct? (,"heck affiliations.
',Yes - Skip, Auachnient E.
Cj No .- Provide the corrected affiliations and their contact Inflarmation,
ATTACHMENT F - COMPLIANCE SCHEDULES
Does the existing permit include any Compliance Schedules? ( ' See Section I of the most recently issued permit)
El 'Yes -, Submit documentation that the compliance schedu[es have been met.
Flo - Skip Attach nlent, F,
FOPLM: SFRW WIS-F, 02-2 1, Page 3 of 4

Does the Permittee have any ex,isting, civil penaftics or outstanding violations?
Yes, (civil peftalties) - Submit payment for the civil penalty, or proof of rernission request.
Yes (violations), -- Submit a copy of your response to the Noticeof V'ioiation.
,No - Skip Attachment G,
ATTACHMENT H - SETBACK WAIVERS
Does the existing pennit include: setback, waivers?
E] 'YCS - Pursuant to 1.5—ANCAC Q2jTL.MQ setbacks waivers, that have been written, notarised, signed by all parties
provide
nnvolved, and recorded with the county Regiiter of Deeds. Waivers involving thecompliance boundary shall be in accordance
with l SALNQ _j;j, _0,107, A.Q
No Skip Atlachment'11.
APPLICANT'S, CERTWICATION
. . ..................attest that this application
(Signature authority's narne as noted in Section 1, Item 3)
has been reviewed by me and is accurate and complete to the best of my knowledgc, I anderstand that if all required parts of this
application package are not completed,, and that if all required, supporting information and anachrnents are not included, this
application package will, be returned as incomplete, I further certify pursuant to 1,5A WAC 02T 1.0129(jb)l 'that the applicant, or any
parent, subsidiary, or other of of the applicant has: not been i�,onvicted of environmental crimes under'; not previously abandoned
a wastewater treatment facility witbout properly closing the facility; not paid a civil penalty; not been compliant with any comphance
schedule in a permit, Wtlemcnt agreement, or order,, not paid an annual fee.
Note: The Applicant's Ctrti ;cation ,shall be signed PUMIR'lut to 15A NCAC 0,2T,,.O I (Lfflb.). An ahernate person, may be delegated a,s
-1-11.11-1111.1111 ... . . ........
the signing, official if a letter is provided pursuant to 1.16111 r N . . . . . . . . . "' 92T .0 106(c),. Pursuant to § .5.6A and y
person who knowingly makes any false. statement, TePMSC7111,01ion, or, certification in any application package shall be g0ty of as Gass
2 misderneatior, which may include fine not to exceed $ 10,000 as well as civil penalties up to $25,000, per violation,.
Signature: e--; zr-g, Date
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email:
Non -Lisa h ag Ego, Re pQrts,(Rncd0reov
Laserfiche Upload:
https:�/e,daes.deg.nt,.ggv/,Forms/NonDischarge-l_$raggh-
Subrnittal-Forain -Ver2

Perm 11, WQ0020817 Effectilve, 041116 Expiration; 03[31121 Owner-, DonnaFl-laddock
SOC: Eflective, Expiration: Facility: 604 Perfect, Momeni, Dr. SFR
Co,unty: Chatham 604 Perfect Moment Dr
Region- Raleigh Durham NC V713
Contact Person: Donne F Haddock Title. Phone -
Directions to Facitity:
1-40, Exit 278. INC 55 S, 4A mil, Rt on O'KeIlly Chapel Rd, 2 miles, Rt on Royal Sunset Dr. (locked gate), 0,2 mi, Firstleft on Perfect
Moment Or,, 0.2 mi, House on left -
System ClassVications,
Primary ORQ Certificallon-, Phon&a
S"andary ORC(s):
On -Site RepresentatIve(s):
Related Permills:
inspection Date, 091,1002,022 En" Time 0930AM Exit Time, 10:30AM
Primary Inspector. James WeOcott Phone: 9,19-79,14247
Socondary Inspector($):
reason for linispection: Routine Inspection Type, Complianoo, Evaivalion
Flermitinspection TVIpe: Si nglle-F amity, ResIlidencle, Wastewater I mgation
Facility Status* a Compliant Not Compfiani
Question Areas;
Mlsoellaneous Questions Permit Status SeplicTank
Pomp Tank Drip or Irrigation General
(See allachment summary)

pgjrMjtj WQOn2O,8l7 Owner - Facility: Donro F Had dock
inspea(lonDaW OOMW2022Inspechan Tyke, , Camp] lance Evaluafion Reason for Vlsft. Routine
lInspection Summary
,Advantex AX-20 system was serviced at the time, of unspectjon and, all rnparlmenls, media.spray patterns, and UV
d1senfecton unit were inspected for proper operation, Thie drip field, was fenced andl ofearly definiated.Urip systerr Hnes
repaired inzona(s) #1 (4), #2 (37),#3 ('10), Previous maintenance reports ware avaiflable at the time of inspection and the
current inspection report was sent to th a ofte and upload ed to file.

Permit. W0,0020817 Owner - Faciffty., Da,nna F Hladdock
Inspection Dato, 09/06022 Inspection Type , Compliance Evalluafion Reason for VNItT Routine
Permit Status Yes No NA NE
Is the current resident in the home the Permillee? W 13 0 0
# If nQt, does the, resident irent from the Permidele? Como
Change of Ownership form needed? (Mail the form with the inspection letter) 13 0 M 1:1
# fs there an Inspection and maintenance -agreement with a contractor? 0 13 El El
U YES, who is the contractor (include contact info),?
AQ'WA, Inc,
2604 Willis Court
Mson, NC 27896
252-243-7693,
s Itis Tip—k Y-'Q$ No M Me,
` The septic tainkand filikeirs should be checkad annually and puimped1cle,ained as needed.
Is aII wastewater from the home connected to the sveptio tank? M El F1 n
# IDoes the permitte0resident know where the selpfictank is located? 01 0 El El
Has the septic tank been pumped in the last 5 years? a El 110
If YES, describ a if known and, proof' Onckide date pumped),,,
Contract staft provided documentation at time of inspection.
# Does the se pfic tank have, an E FF LUENT F LTE R or SANITARY T? a 1:11:10
"'FUER, when, was the filter cleaned and my who? At 1he time of
in$ paOion, by the
AQWA staff.
Comment:
PuMja,Ta.n Yes No NA iME
"" All' pump and alarm sytems shall be inspeded manthly. (Non-Umcharge)
Is tho p4imp working?
Is the aud 1 We and visual high, water alarm operafion al?
# Does the permi1tee know how to check the pump & high water aiarrn?
4 LastfunctJoinal tesV 9)M2022
Comment:
Drig or trrlga!Lon
ng t!o INA NE
"' Irrigation sysetm shaft be inspected imonthly to ensure system is free of leaks, and eqWpment Is operating
as, designed, ",
# Type of srystern (URP or IRRIGATION)':
D6p
A tf IRRIGATION, number of sprinkler, heads -
Are buffers 'and setbacks adequate?
Is the site free of pending arid runoff?
EMM,

perml#, W0002,08,17 Owner , Fadlilty Donna F Haddock
InspeCtion Date, 09M612022 Inspectilonlype Compllance EvalualjOn Roason for VWC RoOnO
Doos the ap,plicalon eqWpMent appear to be workinQ properly?
Is there l a cm inimurn two wire fence Surrounding the enure irrigation, area? C) 0 El
Comment'.
—G&neral
# Are the treatment units, looked andlor secured?
# Has resWervt had any sewage probleMs?
if YES, explain:
No concerns noted.
Does the system match the permit descrlpfi00
ff NO, explain -
Is the syslern, compfiant?
Is the systern falling? (V yes, take pictures if poS5 bile)
i,f system is faiiing, describe any exposures to peeplelajnmacs iDr environmental risks.
No concerns noted.

ROY COOPER
cowror
ELIZABETH S, BISER
Socreary
RJC HARD E. ROB ERS, JR.
Dirtelor
Donna F Haddock
604, Perfect Moment Dr.
Durham, N'C 27713,
NORTH CAROUNA
EnvirenmeaW Quality
Subject' Compliance Evaluation inspection
Single Family Wastewater Treatment System
Non -Discharge, Permit *WQ0020817
Facility� 60,4 Perfect Moment Dr., SFR
Durham Co,unty
Dear Ms. Haddock,
On September , 2,022, Jim'Westco,tt from the Raleigh Regional Office visited yaur single-
family residence (SFR) wastewater treatment and irrigation, system to evaluate coinpliaa(e
with the Non -Discharge Permit, WQ,00.20817, The cooperation. of the contract staff of AQWA
services was greatly appreciated.
You are permitted' to, operate a SFR wastewater treatment and irrigation facility consistiiag
of a, 1500 gallon baffledseptic tank with effluent filterl two Advantex AX,-20 Treatment
units VeriComm control, panels, a 7 gallon per minute (GP'M) ultraviolet (LTV), diainfection
unit a 2500 gallon storage, tank.; a 2500 gallon, dosing tank with a 20 GPM pump and
audiolvisual high water alarms; an integrated rain sensor;, a 0.37 acre drip irrigation area
with apprommately 5,418.1inear feet (LF)'; of drip line containing 2,709 emitters,and all
assmiated piping, valves, control and appurtances, to serve the single-family residence at
604 Perfect Moment Drive, Durham, NC 27713, with no discharge of wastes, to surface
waters,
Non -Discharge Permit #WQ002081? authorizesthe continued, discharge of up to 600
Fallons per day �GPD), The aullhorized irrigat �on is in aicmrdance with the effluent limits
2nd monitoring requirements eMaW shed within the N oni-Discharge Permit.. The items
belaw list the canditionsobserved.
At the time of inspection, thefacility was secured, clean and organized. The drip, irrigation
field was properly secured with wire fiencing and the vegetative cover well maintained.

During the inspection, the following was ow:-
1.
2. Treatment sySteM operation� The wastewater treatment system shall'be effectively
mg,intained andalways operated so there is no discharge to surface watersl norany
contravention of groundwa, , te!r'c)r,�su,rface-wa,terstaC=pO0OntsaPdintWJty
of the system are serviced under contract, %4th A OWA wrvims every six,mortha Two
previous wrVice d=monts were provided to the j"4�edcr at the time of Inspection,
&t,offlng the =npments and frequency d1maintenanm The CV-SNO'generator is, cyded
for 30, m1nuteso week each M oncifay morning
a) The ultraviolet disinfection unit shall, be checked weekly.They lamp6s) and quaftz
sleeve(s) shall be cleaned or rephaced as needed to ensure proper disil-IfOCti'Dn.
(f5AMCA CO2T.06,05(M The UV$leeves were dearoved and the UV output at the
control panel was in acw#able range of voltage at the time ofinspedlen.
b) The Storage, pump, and alarms system shall, be inspected monthly.
(15A N CAC 02, T. 0 10ft)(PI The StMa9e C"Partr"74 redrCula"O" and transfer
pumps were witneswd qwating as d�qd gnedat, the time Of insPedicn-
c), The irrigatiGn system shall be inspected monthly to make certain of the, proper
operation of the drip lines, that the system is free of leaks, that the vegetative
growth allows a proper drip pattern, that the soil is as&imilatia, g the disposed
treatedwastewater with no sUrface runnff, and that no objectionable, odors are being
goner,ated,fl5ANCACO2T010e(b)(I)I The drip irrigation, s�*em O(ZOOOS 1, 2 and 3
Ware InWededand' oboerved to ha va, small leaks which wgre natedand repaired by
the =trac( Staff on site and a, final r6pOrf was submitted to the InWedar the ned
Morning by the,A QW4 Contrail StOff.
d) Pumping the septic tank: You are required to inspect the septic tank at least
f naniceis
an, ually to determine i solids must be removed or if other maintA)
nacessary. Septic tanks should, bepumped out every five years or when the solids
level is, found to'be more than 1/3 of the liquid depth in the septiv, tank Compartment,
whinhever, is greater. A contractsrvice company periodically evaluates the status of
the accUnIulated solids, level. At the time atinspection &W2022, the cmtrOct $taff
pry dWa dowrne"t Showing the, ssmi-annual to ton records Indudingthe
buildup of metOHOI in the system. The sdids Wel was approKimately 8+LYMOterl0l
in the primary wdling tank.