WQ0037501_Application_20231208

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Doman of ► ater Resources
1;A NCAC 02T .06W - SINGLE-FAMILY' RESIDENCE
WASTE ATER IRRIGAT10% SYSTEM — RENEWAL
FORM: SF'RWW%;-R 02-21
Pursuant to U NC.AC 02T .01U" b . if the appllrntion dues nut include ail required informutNin and Ike nec"+,an ruplx►rting
documentation. the application shall he rtturned- The application and attachments %hall hr prrparrd in accordance w Ith 14
V U 1121 .1)1011. 15A 1(-A( c121 .c1WAI, and Do i+rein 11,rlit: ,r%. For mnr+e information, ►isil the Water Qua liq Permitting
Section's Soo -Discharge Branch *eh+itc. The Applicant shall submit an electronic cop} of the appliCalwn and Attachments
uploaded as a tingle Portable Ikwurn enI Format (PDF) file to hiIjp%, cdiwA.Jcg.nc.yox F(-rm%. ti(in lrna; h,iry-s-U-rxmch- yuhmititil I
Fcrrm-r'rrR. yr eniaiied to ti�sr - l��char r.}te i"�rt. u ncdctrr. us iF lrs, than ?11 mr�xh}tcs (!NBj.
_ _ftUNI—E11•i4CAftff ily1F[)itMATIO-S
I, Applicant: Barbara S. Hunter and Frank W. Rtidthold
2. Permit No, %'(AX) t7501
3. Signatutt: authority. Barbara S. I luntcr and Frank A Rkvkhold
0. Mauling address: 360 Carolina Crossings Dri}e
City- Apex
5. Contact per+cm. Barham S. Hunter
Prirnxry phcxte number. (919) 649-31 a5 Coll
6. Secondary Contact person Frank W. Rockhold
Pnmary phone number. [phone] CeII
1. Physical a360 Carolma Crossings Dr
Ciry: Apex
1. Billing mkln aa.: 3W Carolina Crossings Dr.
City: Apex
Title: Trusmea
State: NC lip: 27523-
Emai l: barharahuntcr.nc,u gmail.cotn
Secctindnn phone number. ( ) -
Email • frank.rockholcW-gmail.ccirn
Sewndar} phone number- ( ] -
C ount) : Chatham
State: NC
Starr: SIC
Lip: 27523-
Lip: 27523-
Sckdt
Select
1 Verifr the Applicant dogs not have any overdue annual his:
;lttcn_ .iRy tic,► shy'di�i�4wattr-r�►utc�cs:wutrr rcurt.r��ti crznrcy u��t�a►mcntr
Pursuant to I `A SCAC 021,0121Acl. permit3 for rctvnbing facilities shall nut he granted if the Applic.attt or any affiliation has
an unpaid annual fee.
FORM. SFRH'%'ZS-R 02-21 Page 1 of

SF.C'TION IV —OPERATION AND MAINTENANCE AGREEMENT
Pcrmit No.: WQ0037501 County: Chatham
Permittee: Barbara S, Hunter and r rank 14 . Rockhold (i.e.. all deeded property oµ ners l
nc Penninee agrees to operate and maintain the Single-fam11% residence waste►satrr treatinent and irrigation system as
follows:
1 _ Inspcct the septic tank annually. and pump out solids as needed.
2. Inspect and clean the Septic tank cfliucnt F Iter annual IN . ( ii-applicable)
3. Inspect the tablet chlorinator ►+eekF -. Add wastcwater grace chktirine tablets (e.g.. calcium hypochloritef as needed.
Swimming pooi grade chlorine tablets arc not acceptable. (it applicable)
4. Inspect the ultraviolet disinfection unit %ee►l► Clean or replace the lamps and quam slexves as rk-cded. (if
�ta�ficuhla )
). Inspect all storage tanks, pumps, and alarms. monthh. Rcmovr the Floating scum la} er in all pump storage tanks
►hen pumping the septic tank uilids out.
ti. Inspect the spray irrigation system monthly to � rrify: proper operation of the spray heads. that there are no leaks.
that �,cgetattve gro►►th does not obstruct the spray heads: that the irrigated wastc%ater is not poriding in or running
off the designated irrigation area: and that there are no objectionable MIMS. (J upplicahlr)
T, 1ngvct the drip irrigation system monthly to ►crify proper operation of the drip lines: that there arc no leaks: that
►egctativc gro"th does not obstruct the drip emitters: that the irrigated wastcAatcr Ls rk-n pond ing to or running off
the desipriatrd irrigation area: and that dwrr air rto objectionable txk►rs. (►j uWicahl4 )
S. Maintain a set of I]ivi:sion-apprrn-cd engineering plans and specifications.
9. Pay the required annual fee
10. kequest renewed of this permit on Div ision-appru►ed forms no later than 180 days prior to cxpiralion
11. Sign and provide a 0bathe ,11 1.. hk nt r`h ip a►ppI ic:,t i,1„ to any future owner of the single -fain i1v residence waste" atcr
treatment and irrigation system for their completion and suhmissity to the Di►isitwi of Water Rrsuurces.
Puke understand the abo%e requirements and agree to these terms as part of the issued permit.
Signwtum:L� �F �y r G [ l)atc: ��'-_ /7'z _
r = -
� J f1
Signaturv: Date: 1 Z--17 �L
Signature:
Signature:
i]ate
Date.
All deeded prow rt► urt ners +hill sign this Ontestian and Nfaintenance Agi remertt
FORM: SFR WWIS-R 02-21 Page 2 of 4

Was the facility originally permitted or had a rriqur modification issued after 5cptember 1. 2006:'
XYes - Pursuant to 15A r ]S %uhr"a a site map pursuant to the rcyuirernents in l;A NCAC 02T .0604(d). These
rxqutremcros are:
❑ A scaled map of the site w ith tupogmphic contow i.ntcn•als not exceeding 10 fret or 3 c percent of total site relief and shooing
all faciiih-related str'twrures aM fences within the wastewater treattnenl. storage, and irrigation arras.
❑ Soil mapping units shown on all irrigation sites.
* The location of all welic (including toagr and construction dc^Wh if availablei streams (ephemcral, intermittent. and
perrrtnial), springs, lakes, ponds. and other surface dratnagc fewures within 500 foot of all wastewater treatment_ storage,
and irrigatw"i %ite+.
❑ DelineNion of the compliance and review boundarm per i S 7 and 11109. and 15A NCAC 021 .GWI
❑ Setbacks as required by 15.A 1�C AC' 02 i_oq0.
❑ Site propert} boundaries within SM feet of all wastewater treatment, stoma, and irrigation spies
❑ All hahitahlf residences or places of public assrmbl► within 5W feet of;ll UteattnVnt. stowage. and irrigation sites.
❑ No "skip Attachment A.
ATFACHMEN'T B - SIGNATURE AUTHORITY DELEGATION
I}urs the spgnaturc authuritti in tirtitum 1. Item I inert the requirements pursuant to . {.A NK'AC 02T -!'Fly]?
61 Yes - Ship Attachment It.
❑ No - SuNnit a t�t��Fri ILttrr pursuant to I5A NCAC 42T .gjNW autho razing t1w "signature authority to sign.
Does the existing permit include an approved flow reduction"
❑ Yes - Submit a copy of rice flow redlvcttun apprtmal lerter, as wet as the messurrd motuhly mersge amount of wastewater flow
con tnbut ed per unit for the t. month~ prK-ir to perynit renewa]. If any of these month a►-erages are within ?0°0 o#'thr approved
floor redua ion value, the Perm ince shalt provide a reevaluation of the reduced flow value pursuant to the requirements in A
K-AC�U�i A[ 144t
No - Skip Atoachmorrtt C .
ATrACHMANT D- EASEMENT, ENCROACHMENT, AND LEASE AGREEMENTS
[foes the Permince own all of the laird assocuded wrth the waxlcw Ater col loci ion. treatment, con vc. ancc, and irrip Kin system'
Is Yes - Skip Attachment D.
❑ No - Pursuant to I {A St At' U_' i U I I t.(c 1, prv► idc a cup~ o}f all easements. lca%c agreements. and encroachment uMvinrnts
allowing the Permitte*e to operate and maintain the wastewater collection, treatment, coanvc%ancc, and 'irrigation system on
property " ou-nod try the Pcmnittee.
ATTACHMENT E - AFFILIATIONS
Art the Permitter's atfihatwns of re wrd ccvrcct? Check affiliations
JO Yes - Skip AttKhmrni L.
❑ to - Provide the c(wrrect d of alWions and their contact infonn..-.
ATTACHMENT F - COMPLIANCE SCHEDULES
Does the existing permit include any L'oxnplianct: Schedules? (S" Swiom I of the must recently issued permit)
❑ Yes - Submit documeawwri that the ctxnphancc schedules have been met
No - Skip Attachment F
FOiLM- SFRW'WIS-R 02-21 Page 3 of 4

TTACHNILI T-6 - CUM FlNtILT" AMP QluMA DM W01ATIONS
lkxs the Pemiltee have any existing civil penalties or outataading viciWtiar>x''
❑ Yes (civil penalties) Submit paytnrnt for the civil penalty, of proof of remission rcqucst.
❑ Yes (violations) - Submit a copy of out re%ptmse to the Natke of Violation
® Net Skip Anschmcnt G.
ATTACHMENT H-SETBACK WAIVERS
Does the existing pertain include sciback waivers? I
❑ Yes - Pursuant to I iA NC:AC U?T .060(►to, provide utbwks wai►vn thail We been written. notaneed, signed by all partics
involved. and recorded with ttte county Register of i]eeds. Waivers involving the cornpltance boundary shall be in accordance
with 15A SL AC 0-1l, .0107
No - Skip Atwhrnent H
APPLICANT'S CERTIFICATION 7
aticst that this applicnicin
(Sigmiury awfkara%'s nainc .cti nutLt in Section 1. item 31
has been reviewed by me and is accurate and complete to the best of my kmm ledge. I understand that if all required pans of this
aMticatton package are not completed- and that if all required supfkwting intannation and attachments arc not included. this
applicatttm package will be returned as inctwnplete. 1 further certify puirsuant to 1 SA N AC 021 M12U(b . that the applicanL urany
patent, subsidiary. tar other atrliale of the applicant has: not been oonvicted of environmerttal crimes under, not previously abandoned
a wastewater treatment facility without property closing the facility; not paid a civil penalty. not been curripliam with any awnpliance
schedule in a permit, settlement agreement. aar order. not paid an annual fro.
Neft the Applicant's Certification shrill it signed pu mumtt to I SA K& Ii2'I , I�t+r. An alternatx pit um may be diekgiued as
the signing clUcial if a letter is providod pursuant to 14A NC'AC 02 T .01(Wct. Purmiant to § 143,-2 1 �.riA and j 143•215.66. =y
person who knowingly make► any falae Uakaytil, reprewirmion, ar certification in any application package shall be guilty of a Class
2 misdiernexnar. whio may, ioc4u& l'e to exceed S I RON as HrII as civil peaahics up to 52 5.0(it) per violation.
/ j f
5iLettaturc Fate:
THE COMPI.F.TF.D APPLIC'ATIGN AND ATTACHMENTS SHALL BE SUBMIITE1) AS A SIN(; LE PDF FILE VIA:
La"..
N -lit keiporuwa acdcnr. o%
Lawrfiche Upkiad:
ltnt„- rLbPt%-Jcrt.n%-g�,% 1-urm4. Ni+nUtschmEyv-F3rdach-
•uhniirlsl-FunnAer:
FOR SFRWWIS. R 02-21 Pegc 4 u1';