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Home My WebLink AboutWQ0000100_Application_20231204Division 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 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) rile to httpsWedocs.de4.nc.gov/Forms/NonDischarl;LBranch-Submittal- Form-Vert, or emailed to Non-Discharge.Reports(wncdenr.gov if less than 20 megabytes (MB). SECTION I — APPLICANT INFORMATION -71 1. Applicant: Bruce W. Knott and Lisa O. Knott 2. Permit No.: WQ0000100 3. Signature authority: Bruce W. Knott and Lisa O. Knott Title. Owners 4. Mailing address: 7802 Grandale Dr. City: Durham State: NC Zip: 27713- 5. Contact person: Bruce W. Knott Primary phone number: (919) 544-3444 Office Email: bknott@pinpointprop.com Secondary phone number: (919) 544-0141 Home 6. Secondary Contact person: Lisa O. Knott Primary phone number: (919) 544-0141 Home Email: Secondary phone number: { } - Select Physical address: 7802 Grandale Dr. City. Durham SECTION II — FACILITY INFORMATION County: Chatham State: NC Zip: 27713- I SECTION IH — BILLING INFORMATION 1. Billing address: 7802 Grandale Dr. City: Durham 2. Verify the Applicant does not have any overdue annual fees: State: NC Zip: 27713- https:lldeg. nc. gov/ab outldi v i sions/water-resources/water-resources-perm itslwg-epay m e nts 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: SFRW W1S-R 02-21 Page 1 of 4 SECTION IV — OPERATION AND MAINTENANCE AGREEMENT Permit No.: WQ0000100 County: Chatham Permittee: Bruce W. Knott and Lisa O. Knott (i.e., all deeded property owners) The Perm ittee agrees to operate and maintain the single-farn i ly 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. (ifapplicable) 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. 5. 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. (f 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. [IWe understand the above re irements and agree to these terms as part of the issued permit. Signature: ,` Date: 1141203 Signature: ' L Date: -11 1 � r, � a �3 S ignature: Signature: Date: Date: _ All deeded property owners shall -sign this Operation and Maintenance Agreement FORM: SFRWWIS-R 02-21 Page 2 of 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 .01 & 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)? 9 Yes — Skip Attachment B. ❑ No — Submit a delegation letter pursuant to 15A NCAC 02T .0106[c 1 authorizing the signature authority to sign. ATTACHMENT 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 15A NCAC 02T .Ol l4(fl. 9 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? 191 Yes — Skip Attachment D. PJ ❑ 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—COMPLIANCE SCHEDULES 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. �f No — Skip Attachment F. FORM: SFRWWIS-R 02-21 Page 3 of 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? 14 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. APPLICANT'S CERTIFICATION 6rv1, Ce- �j' 'W ry t� attest that this application (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 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 A 106ic). 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 misdemean Mich may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation. Signature: Date: L1412011 THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA: Email- Non -Discharge. ReUrts(a-) ncden r.gov Laserfiche Upload: h t t ns://ed ocs.deg. ne. gov/Forms/N on D isc h a ree-Branch - Submittal -Form -Vert FORM: SFRWWIS-R02-21 Page of BK 2012 PG 0322 State of North Carolina Department of Environmental Quality Division of Water Resources FILED CHATHAM COUNTY NC LUNDAY A. RIGGSBEE REGISTER OF DEEDS FILED Oct 09, 2018 AT 10:59:39 am BOOK 02012 START PAGE 0322 END PAGE 0323 INSTRUMENT # 10347 EXCISE TAX (None) NON -DISCHARGE WASTWATER SYSTEM WAIVER AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY 15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a) 1, Robert R. and Ramona H. Oakley , certify that I am a deeded owner of the property located at: Address: 7800 Grandale Drive Parcel No.: 0020004 City: Durham State: NC Zip Code: 27713 County: Chatham Furthermore, I certify that I am authorized to make decisions regarding this property, and that I do hereby agree that the setback distances cited below be granted to the Applicant/Perrnittee listed on the following page. ❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above, I consent to a reduced setback from feet to feet, thereby allowing the application of wastewater effluent as near as feet from my property line. ❑X I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above, I consent to a reduced setback from 400 feet to _ feet, thereby allowing the application of wastewater effluent as near as'j, feet from my residence. ❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above, I consent to a reduced setback from feet to feet, thereby allowing the construction of wastewater treatment and storage units as near as _ feet from my property line. ❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above, I consent to a reduced setback from feet to feet, thereby allowing the construction of wastewater treatment and storage units as near as feet from my residence. Signature: FORM: NC 1�'WvrV% T40 ;I GMT Or ►r 64-1 Nc :)? ,? 13 Date: 5 06* U1 g Page 1 of 2 BK 2012 PG 0323 Applicant/Permittee: Bruce W. and Lisa O. Knott Address: 7802 Grandale Drive City: Durham Parcel No.: 0065756 State: NC Zip Code: 27713 County: Chatham NORTH CAROLINA, IAIO'k e. COUNTY I, n��1 , &.6eiCa.'cro Notary Public for County, North Carolina, 1Zobe�- �:. Oakl� do hereby certify that �Ra fr} �1��,eui personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and official seal, this the 5•Nr\ day of 6e*g1bex' I 2p R SEAL EEANNE P. FAORICATME Signature of Notary Public D ary Public, North Carolina1Wake County MP commission expires /%/&V. 6f o oe2 y Commission Expires November 04, 2019 Once notarized, this form shall be recorded at the Register of Deeds in the county or counties in which the described properties are located. A copy of the recorded waiver shall be sent to the following address: Division of Water Resources Water Quality Permitting Section 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDWSW 03-17 Page 2 of 2 BK 2012 PG 0324 9hl:4Ili CHATHAM COUNTY NC LUNDAYA. RIGGSBEE REGISTER OF DEEDS FILED Oct 09, 2018 AT 10:59:44 am BOOK 02012 START PAGE 0324 END PAGE 0325 INSTRUMENT # 10348 EXCISE TAX (None) State of North Carolina Department of Environmental Quality Division of Water Resources NON -DISCHARGE WASTWATER SYSTEM WAIVER AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY 15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a) I, Ann S. Williams , certify that I am a deeded owner of the property located at: Address: 7801 Grandale Drive Parcel No.: 0020005 City Durham State: NC Zip Code: 27713 County: Chatham Furthermore, I certify that I am authorized to make decisions regarding this property, and that I do hereby agree that the setback distances cited below be granted to the Applicant/Permittee listed on the following page. ❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above, I consent to a reduced setback from feet to feet, thereby allowing the application of wastewater effluent as near as feet from my property line. X1 I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above, I consent to a reduced setback from 400 feet to _(,od feet, thereby allowing the application of wastewater effluent as near as _(AO feet from my residence. ❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above, I consent to a reduced setback from feet to feet, thereby allowing the construction of wastewater treatment and storage units as near as _ feet from my property line. ❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above, I consent to a reduced setback from feet to feet, thereby allowing the construction of wastewater treatment and storage units as near as feet from my residence. Signature: )A Date: j,6 FORM: NDWSW 03-17 r ( Page I of 2 (41c Da-1-6Ml Nc a��i3 BK 2012 PG 0325 Applicant/Permittee: Bruce W. and Lisa O. Knott Address: 7802 Grandale Drive City: Durham Parcel No.: 0065756 State: NC Zip Code: 27713 County: Chatham NORTH CAROLINA, W I&e _ COUNTY I, jej-Lmer _i . V"' r► a;6_Ma Notary Public for W 0-Xe. County, North Carolina, do hereby certify that Am S . 61MOOM.-I_ personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and official seal, this the 544\ day of Oe;}Og,(- , 20&. SEAL DEANNE P. FASRICATORE Notary Public, North Carolina Wake County My Commission Expires November 04, 2019 Signature of Notary Public My commission expires �1/dticnc a.ir 4, -Roil Once notarized, this form shall be recorded at the Register of Deeds in the county or counties in which the described properties are located. A copy of the recorded waiver shall be sent to the following address: Division of Water Resources Water Quality Permitting Section 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDWSW 03-17 Page 2 of 2