WQ0010882_Application_20240701

ROY COOPER
! _
Governer
ELIZABETH S. BISER
.
Secrerur�
Q py94ysi
RICHARD E. ROGERS, JR,
NORTH CAROLINA
Diret For
Env(ronrmentaf Qualo
June 27, 2024
KEvIN W. AND DARLENE 5MIT[I
483 BLACK WILLOW DR.
APEX, NC 27523-6088
Subject: Permit No. WQ0410882
Permit Renewal Notification
483 Black Willow Dr. SFR
Single -Family Residence
Wastewater Irrigation Syster
Chatham County
Dear Mr. and Mrs. Smith:
Division of Water Resources' records indicate that Permit No. WQ0010882, issued April 19, gal
expired May 31, 2023. As the Permittee, you are responsible for renewing and maintaining this perm
Pursuant to administrative code 15A NCAC 02T .0109, permit renewal requests shall be submitted at IeE
180 days prior to permit expiration.
Please complete and submit the attached Single -Family Residence Wastewater Irrigation Syste
Renewal application (Form: SFRW WIS-R 02-21). This form has been prefilled for your convenient
Please complete any portions that are not filled out and double-check all information for accurac
Within 30 calendar days of receiving this notification, submit the comnleted forms to:
Emai l:
Non -Di scharLe. Renorts(aincdenr.gov
Mail:
Attn: Alys Hannum
OR Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Once the application is received, Raleigh Regional Office staff will conduct a site visit and inspe
the non -discharge system. Upon completion of the site visit and application review, a renewed no
discharge permit shall be issued for a length of up to eight years. Failure to provide these forms prior
lire permit expiration date may result in a Notice of Violation for operating the subject fucililies witho
a valid permit, which is a violation of G.S. 143-215.1, and may subject the Permittee to appropria
enforcement actions pursuant to G.S. 143-215.6A-6C
if you have any questions, please contact me at [phone] or [e-mail].
Sincerely, OocuSlgned by:
W....,....w
4C72170C5AAC01.
Alys Hannwn, Environmental Specialist
Division of Water Resources
Enclosure: SFRWWIS-R 02-21
cc: Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Laserfiche File (Electronic Copy)
,.e� n r nsR Nart h Carolina department of Environmental Quality i Division of Water Resources

Department of Environmenin
Division of Water R
Division of Water Resources
15A NCAC 02T .0600 -- SINGLE-FAMILY RE
WASTEWATER IRRIGATION SYSTEM — R
FORM: SFRWW
Pursuant to 15A NCAC 02T .0107tb1, if the application does not include all required information and the necessary
documentation, the application shall be returned. The application and attachments shall be prepared in a__ It...,.:.,
NCAC Pq] .0100, 15A NC.AC 02T .0600, and Division Policies. For more information, visit the Water Quality
Section's Non -Discharge Branch website. The Applicant shall submit an electronic copy of the application and al
uploaded as a single Portable Document Format (PDF) file to httP�:lle4tips.4Vp"nc•aoyf oTW1nDiscbar�e-Brangpj
Forrn-1'er2, or emailed to 'Non-Discharee.gp�rts�'ncde{lx.go� if less than 20 megabytes (.NIB).
SECTION I — APPLICANT INFORMATION
1. Applicant: Kevin W. and Darlene Smith
2. PermitNo..
3. Signature authority: Kevin W. and Darlene Smith Title: Owners
4. Mailing address: 483 Black Willow Dr.
City: Apex State -.NC Zip: 27523-6088
5. Contact person: Kevin W. Smith Email: e
Primary phone number: [phone] Select Secondary phone number: �) -
6. Secondary Contact person: Darlene Smith Email:
Primary phone number: [phone] Select Secondary phone number:
SECTION II — FACILITY INFORMATION
1. Physical address: 483 Black Willow Dr. County: Chatham
City: Apex State: NC Zip: 27523
SECTION III — BILLING INFORMATION
1. Billing address: 483 Black Willow Dr.
City: Apex State: NC Zip: 27523-6088
2. Verify the Applicant does not have any overdue annual Fees:
$ s:llde .tic. ov/aboutidivisions/water-resources/water-resources-pcnnits/wa'enayi nents
Pursuant to J 5A N(<'AC 02T .0120(c), permits for renewing facilities shall not be.granted if the Applicant or any affil
an unpaid annual fee.

SECTION IV — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQD010882
County: t
Permittee: Kevin W. and Darlene Smith (i.e., all deeded property owners)
The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation s_
follows:
I . Inspect the septic tank annually, and pump out solids as needed.
2. Inspect and clean the septic tank effluent filter annually. (f applicable)
3. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets (e.g., calcium hypochlorite) as
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 ne+
applicable)
5. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all pumplstora
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 r
that vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not ponding in or
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 le
vegetative growth does not obstruct the drip emitters; that the irrigated wastewater is not ponding in or rur
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 Chanve of Ownership application to any future owner of the single-family residence wa
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: - _ ~ Date-
Signature -
Signature:
Signature:
Date:
Date:
Date:
All deeded oronerty owners Shall sign this Operation and Maintenance Agreement

ATTACHMENT A — SITE MAP
Was the facility originally permitted or had a major modification issued after September 1, 20067
❑ Yes — Pursuant to 15A NCAC 02T .0 t0ldh submit a site map pursuant to the requirements in 15A NCAC 02T .06041
requirements are:
❑ A scaled map of the site with topographic contour intervals not exceeding 10 feet or 25 percent of total site relief an
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, interm
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treammnr
and irrigation sites.
❑ Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108, and 15A NCAC 027
❑ Setbacks as required by 154 NCAC 02T .0600.
❑ 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 1, Item 3 meet the requirements pursuant to 15A NCAC 02T .0106fb]?
❑ Yes — Skip Attachment B.
❑ No — Submit a delegation letter pursuant to 15A NCAC 02T .0106f cl 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 waste■
contributed per unit for the 12 months prior to permit renewal. If any of these monthly averages are within 20% of the
flow reduction value, the Permittee shall provide a reevaluation of the reduced flow value pursuant to the requireme:
Nj�R9S 021'.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 sy
❑ Yes — Skip Attachment D.
❑ No — Pursuant to 15A NCAC 02T .011 blcl, provide a copy of all easements, lease agreements, and encroachment a
allowing the Permittee to operate and maintain the wastewater collection, treatment, conveyance, and irrigation
property not owned by the Permittee.
ATTACHMENT E —AFFILIATIONS
Are the Penn ittee'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 1 of the most recently issued permit}
❑ Yes — Submit documentation that the compliance schedules have been met.
❑ No — Skip Attachment F.

A'1"t'ACHMENT G—CIVIL PENALTIES AND OUTSTANDING VIOLATIONS
Does the Perrnittee 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 b
involved, and recorded with the county Register of Deeds. Waivers involving the compliance boundary shall be in
with 15A NCAC 02L .0107.
❑ No — Skip Attachment H.
APPLICANT'S CERTIFICATION
I, attest that this
(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 1
application package are not completed, and that if all required supporting information and attachments are not in,
application package will be returned as incomplete. I f irther certify pursuant to 15A NCAC 02-I- .0120jb1, that the appli
parent, subsidiary, or other affiliate of the applicant has; not been convicted of environmental crimes under; not previously
a wastewater treatment facility without properly closing the facility; not paid a civil penalty, not been compliant with any
schedule in a permit, settlement agreement, or order; not paid an annual fee.
Nate: The Applicant's Certification shall be signed pursuant to 15A NCAC 02T .0106(b). An alternate person may be c
the signing official if a letter is provided pursuant to 15A NCAC 02T .0106f 0. Pursuant to § 143-215.6A and § 143-:
person who knowingly makes any false statement, representation, or certification in any application package shall be guilt
2 misdemeanor, which m7y—Ll
ude a faro exceed $10,000 as well as civil penalties up to $25,000 per violation.
' 11 / �`� rrz `
Signature;~ �— _ Date: f
r
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF F
Email: Laserfiche Upload:
Nan-Discharge.Reuortsr ncdenr.gov htti)s:lledoes.den.nc.gov/Forms/NonDischarge_1
Submittal -Form -Vert

Dow Sign Envelope ID: FS851754-E1BD-4422-8A33-30DOCEE732F9
ROY COOPER
Gorrnor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS. JR.
Dtrectar
Kevin W. and Darlene Smith
483 Black Willow Drive
Apex, NC 27523
Subject:
Compliance Evaluation Inspection
Permit # WQ0010882
Facility: 483 Black Willow Drive
Chatham County
Mr. Smith,
'40RTH C.AROLINA
Environmental Quality
May 3, 2024
On May 3, 2024, Jim Westcott from the Raleigh Regional Office visited your Single-family
residence wastewater treatment and spray irrigation system to evaluate compliance with the
subject permit. The assistance of Mr. Smith during the inspection was appreciated.
The facility is permitted for the operation 480 gallon per day (GPD) wastewater treatment and
irrigation facility consisting of a 1,000 gallon baffled septic tank with an effluent filter; a 1,000
gallon sand filter pump tank with 1/3 horsepower (hp) pump; dual 72 square foot (ft2) cohered
surface sand filters with free access covers; a tablet chlorinator; a 3,000-gallon storage/pump
tank with a 1.5 hp submersible irrigatio pump; a 0.25-acre spray irrigation area and all
associated piping, valves, controls, and a purtenances with no discharge of wastes to surface
waters.
The permit, which was issued May 19, 2017, is effective through March 30, 2022. Division
records indicate the required annual fee for the period _ending October 31, 2024, due November
3, 2023, has been paid.
Findings during the inspection were as follows;
I. Treatment system Operation: The wastewater treatment system shall be effectively
maintained and always operated so there is no discharge to surface waters, nor any
contravention of groundwater or surface water standards. The treatment system
components are to be Inspected weekly and monthly by the permittee.
At the time of inspection, the permittee was on -site and provided a comprehensive tour
of the facility. The system components were tested and evaluated at the time of
Inspection.
North Carolina Department of Envh)CIm mennd Quality I Division of Water Resources
�� Raleigh RegiorW Office I 390O Barrett Dave I Raleigkt North Carolina 27609
e,-f �0'0 D E-��,,,�"� 419.791.42tltl

S. Pumping the septic tank: You are required to inspect the septic tank annually to
determine if solids must be removed or if other maintenance is necessary. Septic tanks
should be pumped out every five years or when the solids level is found to be more than 1 / 3 o
the liquid depth in the septic tank compartment, whichever is greater. A pumping company cE
check the status periodically and determine when pumping is required. The non -discharge
permit requires the permittee to retain records associated with residuals disposal for a period
of S years. The permittee provided a receipt from Septic Blue Services dated 2/28/2023
of the residuals removed from the system. The effluent filter is cleaned by the permitta
each month.
3. Disinfection- The system uses a tablet chlorination disinfection unit for disinfection of
wastewater. The chlorination tablet disinfection system provides effective disinfection and
reduces harmful bacteria from entering the environment. The chlorine tablet disinfection
system should be checked weekly to ensure proper disinfection of the wastewater prior to spra
irrigation. The tablet chlorinator was located at the time of inspection. The tablet feede
had the correct tablets in the chlorinator and adequate supply on site. The control
function box with visual/audible alarm was located.
4. Proper Operation and Maintenance: The system shall be inspected monthly to make
certain of the proper operation of the spray and irrigation system and that the sol is
assimilating the disposed treated wastewater with no surface runoff, and that no objectionable
odors are being generated. Any visible signs of a malfunctioning system shall be documented,
and steps taken to correct the problem. At the time of inspection, the spray irrigation
system was evaluated for operation. The spray field vegetative cover was in good
condition, there was no evidence of surface runoff or pondtng. The perimeter fencing
was secured.
Please continue to periodically inspect and evaluate the wastewater spray irrigation system
components are properly maintained and operating as designed. Maintain all associated
operational records onsite for a period of five nears as required by the subject permit.
If you have questions or comments about this inspection or the requirem is to take correctiv.
action (if applicable), then please contact Jim Westcott at iames.westcot cdenr.aov or 919-
791-4247.
Sincerely,
Dwuslytrod by:
872OCBCi39EE4M...
Michael Hall, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Cc: Laserfiche
North Carolinaaztment of Enrisanmental Quality 1 Division of Water Itesaurccs
45::LD_EQ 511 North 5alishwy Street 1 1611 Mail Service Center i Raleigh, Nortb Carolina 27699-1611
919.707.9NO