WQ0015760_Application_20241010

State of North Carolina
Department of Environmental Quality
Division of Water Resources
"plAslon of Water Resources
15A NCAC 02T .0600 — SINGLE-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM — RENEWAL
FORM: SFRWWIS-R 02-21
Pursuant to 15A NCAC 02T .01071 b F, 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) file to httus://edocs.deu.ne.gov/Forms/NonDischarge-Branch-Submittal-
Form-Vert, or emailed to Non-Discharae.Renorts(a-:.ncdenr.gov if less than 20 megabytes (MB).
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12.
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15.
SECTION I - APPLICANT INFORMATION
Applicant: Marva Bynum Life Estate
Permit No.: WQ0015760
Signature authority: Marva Bynum
Mailing address: 185 Walter Lambert Rd.
City: Goldston
Contact person: Marva Bynum
Primary phone number: ( ) - (home/work/cell)
6. Secondary Contact person:
Primary phone number: ( ) - (home/work/cell)
Title: Beneficiary
State: NC Zip: 27252-
Email:
Secondary phone number: ( )
Email:
- (work/cell/etc)
Secondary phone number: ( ) -
SECTION II — FACILITY INFORMATION
1. Physical address: 185 Walter Lambert Rd. County: Chatham
City: Goldston State: NC
Zip: 27252-
(work/cell/etc)
I
SECTION III — BILLING INFORMATION
1. Billing address: 185 Walter Lambert Rd.
City: Goldston State: NC Zip: 27252- 1
2. Verify the Applicant does not have any overdue annual fees: 1
httvs://deci.nc. aov/about/divisions/water-resources/water-resources-:lermits/wn-en avm ents
Pursuant to 15A NCAC 02T .0120(c)> permits for renewing facilities shall not be granted if the Applicant or any affiliation �as
an unpaid annual fee.
FORM: SFRWWIS-R 02-21 Page 1 of

SECTION IV — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQ0015760
Permittee: Marva Bynum Life Estate (i.e., all deeded property owners)
County: Chatham
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 Chante 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: ILA JU- 61 '9 Date: `
Signature: Date:
Signature: Date:
i-
Signature: Date:
All deeded prop ert. owners shall si,n 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+ &, 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 - SIGNATUREAUTHORITYDELEGATION
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 dele,ation letter pursuant to 15A NCAC 02T .0106(c! 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 .0114: fi.
❑ 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 .0116L 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.
❑ No - Skip Attachment F.
Page 3 of 4
FORM: SFRWWIS-R 02-21

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 .06061 ci, 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
I, —_M-LU1 Arft] ! attest that this application
(Sign)ure 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 .0120fb1, 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 .0106fc). Pursuant to § 143-215.6A and § 143-215.613, 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: 1 zrrr
Date: 1(i g o -�. 1
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email:
Non-Dischane.Reports( ncdenr.eov
Laserfiche Upload:
htts) s://edocs.deu .nc.eov/Forms/NonDischarne-Branch-
Submittal-Form-Ver2
FORM: SFRWWIS-R 02-21 Page 4 of 4

Docusign Envelope ID: 8472863D-BFA2-405D-B4F9-62DDF9BECBFO
ROY COOPER
Govvrnor
MARY PENNY KELLEY
SetrW-Y
RICHARD E. ROGERS. JR.
Dlnrew
NORTH CAROLINA
Envi►'anttttntat Quality
September 25, 2024
CERTIFIED MAIL NO. 70181830 0001 8029 3214
RETURN RECEIPT REQUESTED
MARVA BYNUM LIFE ESTATE
185 WALTER LAMBERT ROAD
GOLDSTON, NORTH CAROLINA 27252
Subject: Notice of Violation & Intent to Enforce
NOV-2024-RV-0009
Permit No. WQ0015760
185 Walter Lambert Rd. SFR
Single -Family Residence
Wastewater Irrigation System
Chatham County
Dear Ms. Bynum:
Division of Water Resources records indicate that Permit No. WQ0015760, issued July 31, 2018,
expired June 30, 2023. As the Permittee, you are responsible for renewing and maintaining this permit.
Pursuant to administrative code 15A NCAC 02T .0109, and G.S. 143-215.1(d)(1), the Permittee shall
submit a permit renewal request at least 180 days prior to permit expiration.
Please complete and submit the attached Single -Family Residence Wastewater Irrigation System
Renewal application (Form: SFRWWIS-R 02-21). This form has been prefilled for your convenience.
Please complete any blank portions and double-check all information for accuracy. Within 30
calendar days of receiving this notification, submit the comaleted forms to:
Email:
Non-Discharae.Renorts(d) deci.nc.2ov
Mail:
Attn: Alys Hannum
OR Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Once the Division receives a renewal application, Raleigh Regional Office staff may conduct a site
visit and inspect the non -discharge system. Upon completion of the site visit and review of the application,
the Division will issue a renewed non -discharge permit for a length of up to eight years.
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919.707.90()0

Docusign Envelope ID: 8472863D-BFA2-405D-B4F9-62DDF9BECBFO
Marva Bynum Life Estate
Notice of Violation
Page 2 of 2
Failure to submit a renewal application within 30 calendar days of this notice shall result in a
civilpenalty assessment for operating the subject facilities without a validpermit, which is a violation of
G.S. 143-215.1 and may subject you to appropriate enforcement actions pursuant to G.S. 143-215.6A,
6B• and 6C The Division may assess civil penalties of up to $25,000 per day per violation for failure to
secure a valid permit.
If you have any questions, please contact Alys Hanum, of my staff, at [phone] or
alvs.hannum(a,,deci.nc. izov.
Sincerely,
DoeuSigned by:
D1843082886C483...
Nathaniel D. Thornburg, Branch Chief
Division of Water Resources
Enclosure: SFRWWIS-R 02-21
cc: Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Laserfiche File (Electronic Copy)
�DKQ North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center 1 Raleigh, North Carolina 27699-1617
l r 919.707.9000