WQ0023633_Application_20240226

DotuSign Envelgw ID: DOI0T572,AA52444o-A1E5-Fb21F62001ES
ROY COOPER
nor
ELIZABETH S, BISER
sravmry
R1CHARD E. ROGERS, JR.
Dprsrer
NORTH CAROLINA
F�►drvnn+s�tal Quetlry
February 15, 2024
.1OHN R. GARRtSON AND ANDREA B. GARR]SON
1550 STONEY CREEK CHURCH ROAD
BuRuNGTDN, NoRTN CAROLINA 27217
Dear Mr. and Mrs. Garrison:
Subject: Permit No. WQ0023633
Permit Renewal Notification
1550 Stoney Creek Church Rd.
Single -Family Residence
Wastewater Irrigation System
Alamance County
Division of Water Resources' records indicate that Permit No. WQ0023633, issued May 24, 2018,
expired .iuly 31, 2023. As the Penn ittee, you are responsible for renewing and maintaining this permit.
Pursuant to administrative code ISA NCAC 02T .0109, permit renewal requests shall be submitted at least
180 days prior to permit expiration.
Please complete and submit the attached Single -Family Residence Wastewater Irrigation System
Renewal application (Form: SFRWWMS-R 02-21). This form has been prefilled for your convenience.
Please complete any portions that are not Milled out and double-check all information For accuracy.
Within 30 calendar days of receiv i no this notification submit the com Meted forms to:
Email:
Non -Disc e.Re its nedenn ov
Mail:
Attn: Alys Hannum
OR Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Once the application is received, Winston-Salem Regional Office staff will conduct a site visit and
inspect the non -discharge system. Upon completion of the site visit and application review, a renewed non -
discharge permit shall be issued for a length of up to eight years. Failure to provide these forms prior to
the permit expiration date may result in a Notice of Violation for operating the subject facilities without
a valid permit, which is a violation of G.S. 143-215.1, and may subject the Per►nittee to appropriate
enforcement actionspursuant to G.S. 143-215.64-6C
ff you have any questions, please contact me at [phone] or [e-mail].
Sincerely, E
�*rr.
Ee
IW.wna....
?QC6AAMF7
Alys Hannum, Environmental Specialist
Division of Water Resources
cc: f.aserfiche File (Electronic Copy)
�� Korth Carollru D"M0mml of EnAronmeMAI Quality I Dlvtdun or Warr itaeaurm
x0-'rDE512 North SMbbW7 Street 1 1617 Md Service Center I Rml WK Non CarollrA 27699-M?
919107.90D0

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources
I'SA NCAC 02T .0600 — SINGLE-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM — RENEWAL
FORM: SFRWWIS-R 02-21
Pursuant to I SA tjCAC 0 T .0 1070J. if the application does not Include all requlred Informalion and the necessary supporting
documentation, the application shall he returned. The application and attachments shall be prepared In accordance with L
N(7:jg 02T _,a14d, 1SA NCA_ 02T ,0�, and Division Policies. For more Information, visit the Water Quality Permitting
Section's Non -Discharge Branch w„lbsite. The Applicant shall submit an electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) file to hitps:Iledoes deg nc.eov/Forms/NonDischarre-Branch-Submittal_
Eorm-Vert, or emalled to 'o-Dlschar He orls Co_uncdcnr.rzov If less than 20 megabytes (MS).
SECTION I1- FACILITY INFORMATION
1. Physical address: 1550 Stoney Creek Church Rd. County: Alamance
City: Burlington
1. Billing address: 1550 Stoney Creek Church Rd.
City: Burlington
State: NC Zip: 27217-
^--+ --
III — B1LI.ING INF RMA'
2. Verify the Applicant does not have any overdue annual fens:
State: NC Zip: 27217-
bttps:/Idm.ac.gev/ahm divisions/water-resources/water-resources- rmitslwq-eIMMents
Puranant to 15A N C 02 .0 c , permits for renewing facilities shall not he granted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: SFKWWiS-R 02-2I Page l of 4

:opERATiON AND.
County- Alamance
Permit No.: WQ4023633
Permittee: John R. Garrison and Andrea S. Garrison (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 clears 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) -
S. 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.
4. 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.
IIWe understand the above requirements and agree to these terms as part of the issued permit.
Signature: J P . Crain, &M Date: 0 - 4 - ;10 1-
Signamm: _ ��_ I.� -- Date: O -ZA A4_)rA
Signature: Date:
Sire: Date:
All deeded Property owners shall -sign this U eration and Maintenance Agreement
FORM: SFRWWiS-R 02-21 Page 2 of 4

ATTACHMSN7A,— SITE iHAP "
Was the facility originally permitted or had a major modification issued after September 1, 20067
❑ Yes— Pursuant to 1,5A NCAC 021' .Q I05(d), submit a site map pursuant to the requirements in d . These
requirements are;
❑ A scales! 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 NCAQ 02L.O. 107 and 1108, and l5A NCAC 02T .0601.
❑ Setbacks as required by l5A 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.
I'ACHIVCENTB-.SIGNATURE UTHORTT
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 lever pursuant to 15A NCAC 02T .0106{cauthorizing the signature authority to sign.
T. ATTACHMENT C — FLOW REDUCTION,
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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 .01 14 .
® 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 NCAQ 02T .01 16 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 afliliag, nos
® 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)
❑ Yea — Submit documentation that the compliance schedules have been met.
M No — Skip Attachment F.
FORM_ SFRWWIS-R 02-21 Page 3 of 4

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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.
7�iinvolved,
ATTACHMENT H — SETSACIC
permit include setback waivers?
nt to 15A NCAC 02T .0606(c), provide setbacks waivers that have been written, notarized, signed by all parties
recorded with the county Register of Deeds. Waivers involving the compliance boundary shall be in accordance
with 15A NCAC 02L .0107.
D9 No — Skip Attachment H.
Jokn FR_ Ga-rr'son r And rec. 13- (=,o�tsrison _ 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 bl, 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 I SA 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 § I43-215,6g, 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 S10,000 as well as civil penalties up to $25,000 per violation,
Signatum: J dil ._ 9z jc&..4�_� ,.a„— _ Q �l , d. (�' �L Date: ? +
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA -
Email:
Non-Discharee.Reports(a',nedenr.eov
Laserfche Upload:
lit s:lledocs.de .nc. ovlFormsfNonUischar e-Branch-
Submittal-Form-V er2
FORM: SFRWW]S-R 02-21 Page 4 of 4