WQ0006897_Renewal Application_20221205

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0006897
Applicant/Permittee Daniel R. Bass
Applicant/Permittee Address 4121 Murphy School Rd Durham, NC 27705
Is the owner in BIMS? Yes No Is the facility in BIMS?
Owner Type
Facility Name
County
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
Individual
4121 Murphy School Rd. SFR
Orange
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
llr�ore
Fee Amount $0
Complete App Date 12/05/2022
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* Daniel Bass
Email Address*
bass 1 [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*
919-740-3018
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
Permit Type: *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: *
WQ0006897
Has Current Existing permit number
Applicant/Permittee*
Daniel R. Bass
Applicant/Permittee Address*
4121 Murphy School Rd Durham, NC 27705
Facility Name*
4121 Murphy School Rd. SFR
Please provide comments/notes on your current submittal below.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
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.)
Permit info.pdf 189.79KB
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
10ffI&W

Submission Date 12/4/2022

Department of Environmental Quality
Division of Water Resources
Dfvlslon of WAteF Rsources
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 .01009 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 https://edocs.deg.nc.2ov/Forms/NonDischar2e-Branch-
Submittal-Form-Vert, or emailed to Non-Discharge.Reportskncdenr.gov if less than 20 megabytes (MB).
SECTION I — APPLIC
1.
Applicant: Daniel Bass
2.
Permit No.: WQ0006897
3.
Signature authority: Daniel Bass
Title:Owner
4.
Mailing address: 4121 Murphy School rd
City: Durham
State: NC Zip: - 27705
5.
Contact person: Daniel Bass
Email: [e-mail]
Primary phone number: ( 919) 740- 3018
Secondary phone number: ( ) -
6.
Secondary Contact person: Leah Bass
Email: [e-mail]
Primary phone number: ( 919) 475- 6636
Secondary phone number: ( ) -
SECTION IF — FACILITY INFORMATION
1. Physical address: 4121 Murphy School rd County: Orange
City: Durham State: NC Zip: - 27705
III — BILLING INFORMATION
Billing address: 4121 Murphy School rd
City: Durham
Verify the Applicant does not have any overdue annual fees:
State: NC Zip: - 27705
hgps://deg.nc. gov/about/divisions/water-resources/water-resources-permits/wq-oUments
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-R 02-21 Page 1 of 4

SECTION IV — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQ0006897 County: Orange
Permittee: Daniel Bass (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. (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: _ _ Date: 12/3/2022
Signature:
Signature:
Signature:
Date:
Date:
Date:
All deeded property owners shall sign this Operation and Maintenance Agreement
FORM: SFRWWIS-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 15A NCAC 02T .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, intermittent, 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 NCAC 02L .0107 and .0108, and 15A NCAC 02T .0601.
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 I, 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.
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%
of the approved flow reduction value, the Permittee shall provide a reevaluation of the reduced flow value pursuant to
the requirements in 15ANCAC 02T .0114(f).
No — 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?
Yes — Skip Attachment D.
No — Pursuant to 15A NCAC 02T .0116(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.
Yes — Skip Attachment E.
No — Provide the corrected affiliations and their contact information.
ATTACHMENT F —
Does the existing permit include any Compliance Schedules? (See Section I of the most recently issued permit)
Yes — Submit documentation that the compliance schedules have been met.
No — Skip Attachment F.
FORM: SFRWWIS-R 02-21 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.
No — Skip Attachment G.
ATTACHMENT H — SETBACK WAIVERS
Does the existing permit include setback waivers?
Yes — 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 15A NCAC 02L .0107.
No — Skip Attachment H.
I,
APPLICANT'S CERTIFICATION
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: Date:
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email:
Laserfiche Upload:
Non-Discharge.Reportskncdenr.gov https://edocs.deg.nc.2ov/Forms/NonDischar2e-Branch-
Submittal-Form-Vert
FORM: SFRWWIS-R 02-21 Page 4 of 4