WQ0016232_Final Permit_20170125

Water Resources
ENVIRONMENTAL QUALITY
January 25, 2017
G. RONALD & AMANDA L. SPiNKs
3 819 OLD US 1
MONCURE, NORTH CAROLINA 27559
Dear Mr. and Mrs. Spinks:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
Subject: Permit No. WQ0016232
3819 Old US 1 SFR
Single -Family Residence
Wastewater Irrigation System
Chatham County
In accordance with your permit renewal request received September 21, 2016, and subsequent
additional information received January 18, 2017, we are forwarding herewith Permit No. WQ0016232
dated January 25, 2017, to G. Ronald and Amanda L. Spinks for the continued operation of the subject
single-family residence wastewater treatment and irrigation facilities. Please note that this renewed permit
shall become effective on April 1, 2017 (i.e., the day after the expiration date of the existing permit).
This permit shall be effective from April 1, 2017 until March 31, 2022, shall void Permit No.
WQ0016232 issued April 15, 2008, and shall be subject to the conditions and limitations as specified
therein. An extension shall be requested at least six months prior to the expiration of this permit.
Upon receipt of the request, the Commission will review the adequacy of the facility described therein and,
if warranted, will extend the permit for such period of time and under such conditions and limitations as it
may deem appropriate.
Please pay particular attention to the operation and maintenance requirements listed in Section III
for they may differ from the previous permit issuance. Failure to establish an adequate system for collecting
and maintaining the required operational information shall result in future compliance problems. Also note
that Condition VI.6. requires the Permittee to retain a set of Division approved plans and specifications for
the life of the facilities permitted herein.
Please note the following permit conditions have been removed since the last permit issuance
dated April 15,2008:
➢ Old Condition 1.3. — This condition has been removed because the sand filter has been
constructed.
➢ Old Condition I.6.e. —This setback was inadvertently added during a previous permit issuance.
Please note the following permit conditions are new since the last permit issuance dated April
15,2008:
➢ Condition II.4. — This condition lists the fields where the subject facility has been approved to
land apply wastewater effluent.
<7-- Nothing Compares-.
State of North Carolina i Environmental Quality i Water Resources i Water Quality Permitting i Non -Discharge Permitting
1617 Mail Service Center i Raleigh, North Carolina 27699-1617
919-807-6332

Mr. G. Ronald Spinks and Mrs. Amanda L. Spinks
January 25, 2017
Page 2 of 2
➢ Condition 11.6. - This condition requires that the irrigation system shall be connected to a rain
or moisture sensor, which shall indicate when effluent application is not appropriate in
accordance with Conditions 111.4. and 11L5.
➢ Condition 11.7. — This condition explains that the compliance boundary is established at the
property boundary. Any exceedance of standards at the compliance boundary shall require
action in accordance with 15A NCAC 02L .0106.
➢ Condition II.8. — This condition requires that the review boundary be established midway
between the compliance boundary and the effluent disposal area.
➢ Condition 11.9. - This condition requires that the Permittee apply for a permit modification to
establish a new compliance boundary prior to any sale or transfer of property affecting a
compliance boundary.
Condition W.2.c. — This condition requires the Permittee to notify the Division any time self-
monitoring indicated the facility has gone out of compliance with its permit limitations.
➢ Condition IV.2.d. — This condition requires the Permittee to notify the Division any time there
is ponding in or runoff from the irrigation sites.
➢ Condition VI.7. - This condition requires the Permittee to maintain this permit until all
permitted facilities herein are properly closed or permitted under another permit issued by the
appropriate permitting authority.
➢ Condition VIX — This condition explains that this permit is subject to revocation or unilateral
modification upon 60 days' notice from the Division Director, in whole or part for the
requirements listed in 15A NCAC 02T .0110.
➢ Condition VL9. — This condition notes that unless the Division Director grants a variance,
expansion of the permitted facilities contained herein shall not be granted if the Permittee
exemplifies any of the criteria in 15A NCAC 02T .0120(b).
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this permit, please contact Alice M. Wessner at (919)
807-6425 or alice.wessner(cci)ncdenr.gov.
Sincerely,
JS. Jay Zimmerman, P.G., Director
Division of Water Resources
cc: Chatham County Health Department, Anne Lowry, REHS, Environmental Health Director,
anne.lowrygehathamnc.org (Electronic Copy)
Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules and Regulations
PERMISSION IS HEREBY GRANTED TO
G. Ronald and Amanda L. Spinks
Chatham County
FOR THE
continued operation of a 600 gallon per day (GPD) single-family residence wastewater treatment and
irrigation facility consisting of:
a 1,250 gallon baffled septic tank; a 216 square -foot (ftp) pressure -dosed surface sand filter; a 1,200 gallon
sand filter pump tank with a 12 gallon per minute (GPM) pump; a tablet chlorinator; a 3,000 gallon chlorine
contact/storage/pump tank with a 11A GPM pump, and audible/visual high-water alarms; a 0.41 acre spray
irrigation area with six full -circle, overlapping, 72 -foot -diameter, 1.9 -GPM sprinkler heads, a precipitation
sensor, and a soil moisture sensor; and all associated piping, valves, controls, and appurtenances
to serve the single-family residence at 3819 Old US 1, Moncure, NC 27559, with no discharge of wastes to
surface waters, pursuant to the application received September 21, 2016, and subsequent additional
information received by the Division of Water Resources, and in conformity with the project plans,
specifications, and other supporting data subsequently filed and approved by the Department of
Environmental Quality and considered a part of this permit.
This permit shall be effective from April 1, 2017 until March 31, 2022, shall void Permit No. WQ0016232
issued April 15, 2008, and shall be subject to the following specified conditions and limitations:
I. SCHEDULES
No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T.0 105(d) requires an updated site map to be submitted with the permit renewal application.
[15A NCAC 02T.0105, 02T.0109, 02T .0115(c)]
2. If a public or community sewage system is or becomes available, the subject single-family residence
wastewater treatment and irrigation facilities shall be closed and all wastewater shall be discharged into
the public or community sewage system within 180 days of its availability. Prior to the initiation of
these connection activities, appropriate Division approval shall be received. [ 15A NCAC 02T .0607]
WQ0016232 Version 4.0 Shell Version 151201 Page 1 of 6

II. PERFORMANCE STANDARDS
The subject non -discharge facilities shall be effectively maintained and operated at all times so there is
no discharge to surface waters, nor any contravention of groundwater or surface water standards. In
the event the facilities fail to perform satisfactorily, including the creation of nuisance conditions due
to improper operation and maintenance, or failure of the irrigation areas to adequately assimilate the
effluent, the Permittee shall take immediate corrective actions including Division required actions, such
as the construction of additional or replacement wastewater treatment or disposal facilities. [15A
NCAC 02T .0108(b)(1)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this facility. [15A NCAC 02B .0200, 02L .0100]
3. Application rates, whether hydraulic, nutrient or other pollutant, shall not exceed those specified in the
following table:
TABLE I — APPLICATION LIMITATIONS
Field
Parameter
Hourly Rate
Yearly Max
Units
1
01284— Non -Discharge Application Rate
0.4
25.0
inches
[15A NCAC 02T .06050)]
4. The subject facility has been approved to land apply wastewater effluent on the following fields:
TABLE 2 — IRRIGATION AREA INFORMATION
Field
Owner
County
Latitude
Longitude
Net
Dominant
Acreage
Soil Series
CrC —
1
G. Ronald & Amanda L.
Chatham
35.623650°
-79.036720°
0.41
Creedmoor-Green
Sinks
Spinks
complex, 6
'
to 10% slo es
[G.S. 143-215.1]
5. The Operation and Maintenance Agreement (attached) between the Permittee and the Division of Water
Resources is incorporated herein by reference and shall be a condition of this permit. Noncompliance
with the terms of the Operation and Maintenance Agreement shall subject the Permittee to all sanctions
provided by North Carolina General Statutes § 143-215.6A to § 143-215.6C for violation of or failure
to act in accordance with the terms and conditions of this permit. [15A NCAC 02T .0115 (2)]
6. The irrigation system shall be connected to a rain or moisture sensor, which shall indicate when effluent
application is not appropriate in accordance with Conditions II1.4. and IIL5 . of this permit. [ 15A NCAC
02T .0605(0)]
7. The compliance boundary is established at the property boundary. Any exceedance of standards at the
compliance boundary shall require action in accordance with 15A NCAC 02L.0 106, [ 15A NCAC 02L
.0107(1)]
8. The review boundary is established midway between the compliance boundary and the effluent disposal
area. Any exceedance of groundwater standards at the review boundary shall require action in
accordance with 15A NCAC 02L .0106. [15A NCAC 02L .0108]
9. The Permittee shall apply for a permit modification to establish a new compliance boundary prior to
any sale or transfer of property affecting a compliance boundary. [ 15A NCAC 02L .0107(c)]
WQ0016232 Version 4.0 Shell Version 151201 Page 2 of 6

10. The facilities permitted herein shall be constructed according to the following setbacks:
a. The setbacks for irrigation sites permitted under 15A NCAC 02H .0200 shall be as follows (all
distances in feet):
i. Any habitable residence or place of public assembly under separate ownership: 400
ii. Surface waters: 100
iii. Any well with exception of monitoring wells: 100
iv. Any property line: 150,
v. Public right of way: 50
1 Per a setback waiver recorded in the Chatham County Register of Deeds, setbacks from the
wetted area to any property line has been reduced for the following:
[15A NCAC 02H.02190)]
b. The setbacks for storage and treatment units permitted under 15A NCAC 02H .0200 shall be as
follows (all distances in feet):
i. Any well with exception of monitoring wells: 100
ii. Any property line: 50
[15A NCAC 02H.02190)]
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities shall be properly maintained and operated at all times. The facilities shall be effectively
maintained and operated as a non -discharge system to prevent the discharge of any wastewater resulting
from the operation of this facility. The Permittee shall maintain an Operation and Maintenance Plan
pursuant to 15A NCAC 02T .0604(f). [ 15A NCAC 02T .0604(f)]
2. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the subject non -discharge facilities, in accordance with 15A NCAC 08G .0200 the
Permittee shall designate and employ a certified operator in responsible charge (ORC) and one or more
certified operator(s) as back-up ORC(s). The ORC or their back-up shall visit the facilities in
accordance with 15A NCAC 08G .0200, and shall comply with all other conditions specified in the
previously cited rules. [15A NCAC 02T .0117]
3. A suitable year round vegetative cover (or leaf litter in wooded areas) shall be maintained at all times,
such that crop health is optimized, allows for even distribution of effluent and allows inspection of the
irrigation system. [ 15A NCAC 02T .0108(b)(1)]
4. Adequate measures shall be taken to prevent effluent ponding in or runoff from the irrigation sites listed
in Condition II.4. [15A NCAC 02T .0605(o)]
5. Irrigation shall not be performed during inclement weather or when the ground is in a condition that
will cause ponding or runoff. [15A NCAC 02T .0605(o)]
6. Only effluent from the single-family residence at 3819 Old US 1, Moncure, NC 27559 shall be irrigated
on the sites listed in Condition 1:1.4. [G.S. 143-215.1]
7. No automobiles or machinery shall be allowed on the irrigation sites except during equipment
installation or while maintenance is being performed. [15A NCAC 02T .0108(b)(1)]
WQ0016232 Version 4.0 Shell Version 151201 Page 3 of 6
PIN
Parcel No.
Deed Book / Page
Setback
Easement
9688-92-1474
66670
1902/0286
137 feet
13 feet
[15A NCAC 02H.02190)]
b. The setbacks for storage and treatment units permitted under 15A NCAC 02H .0200 shall be as
follows (all distances in feet):
i. Any well with exception of monitoring wells: 100
ii. Any property line: 50
[15A NCAC 02H.02190)]
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities shall be properly maintained and operated at all times. The facilities shall be effectively
maintained and operated as a non -discharge system to prevent the discharge of any wastewater resulting
from the operation of this facility. The Permittee shall maintain an Operation and Maintenance Plan
pursuant to 15A NCAC 02T .0604(f). [ 15A NCAC 02T .0604(f)]
2. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the subject non -discharge facilities, in accordance with 15A NCAC 08G .0200 the
Permittee shall designate and employ a certified operator in responsible charge (ORC) and one or more
certified operator(s) as back-up ORC(s). The ORC or their back-up shall visit the facilities in
accordance with 15A NCAC 08G .0200, and shall comply with all other conditions specified in the
previously cited rules. [15A NCAC 02T .0117]
3. A suitable year round vegetative cover (or leaf litter in wooded areas) shall be maintained at all times,
such that crop health is optimized, allows for even distribution of effluent and allows inspection of the
irrigation system. [ 15A NCAC 02T .0108(b)(1)]
4. Adequate measures shall be taken to prevent effluent ponding in or runoff from the irrigation sites listed
in Condition II.4. [15A NCAC 02T .0605(o)]
5. Irrigation shall not be performed during inclement weather or when the ground is in a condition that
will cause ponding or runoff. [15A NCAC 02T .0605(o)]
6. Only effluent from the single-family residence at 3819 Old US 1, Moncure, NC 27559 shall be irrigated
on the sites listed in Condition 1:1.4. [G.S. 143-215.1]
7. No automobiles or machinery shall be allowed on the irrigation sites except during equipment
installation or while maintenance is being performed. [15A NCAC 02T .0108(b)(1)]
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8. Public access to the irrigation sites and wastewater treatment facilities shall be prohibited. Fencing
shall be provided to prevent access to the irrigation site (minimum 2 -strand wire) and treatment units
shall be secured with locks on all tank accesses and control panels. [15A NCAC 02T .0605(i)]
9. The residuals generated from the wastewater treatment facilities shall be disposed or utilized in
accordance with 15A NCAC 02T .1100. [15A NCAC 02T .1100].
10. Diversion or bypassing of untreated or partially treated wastewater from the treatment facilities is
prohibited. [15A NCAC 02T .0605(f)]
11. Pump/dosing tanks shall have audible and visual alarms external to any structure. [15A NCAC 02T
.0605(n)]
12. The Permittee is responsible for the operation and maintenance of the entire treatment and disposal
system including, but not limited to, the following items:
a. The septic tank shall be checked annually and pumped out as needed. The septic tank effluent filter
shall be checked and cleaned at the same frequency as the septic tank. [15A NCAC 18A .1900,
02T .0605]
b. The tablet chlorinator shall be checked weekly. Wastewater grade chlorine tablets (calcium
hypochlorite) shall be added as needed to provide proper chlorination. Pool chlorine tablets shall
not be used. [ 15A NCAC 02T .0605(1)]
c. The storage, pump, and alarm systems shall be inspected monthly. The scum layer in the pump
tanks shall be removed at the same interval as the septic tank is cleaned out. [15A NCAC 02T
.0108(b)(1)]
d. The system shall be inspected monthly to make certain of the proper operation of the spray heads,
that the system is free of leaks, that the vegetative growth allows a proper spray pattern, that the
soil is assimilating the disposed treated wastewater with no surface runoff, and that no objectionable
odors are being generated. [15A NCAC 02T .0108(b)(1)]
WQ0016232 Version 4.0 Shell Version 151201 Page 4 of 6

IV. MONITORING AND REPORTING REQUIREMENTS
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water analyses)
necessary to ensure groundwater and surface water protection shall be established, and an acceptable
sampling reporting schedule shall be followed. [15A NCAC 02T .0108(c)]
2. Noncompliance Notification:
The Permittee shall report by telephone to the Raleigh Regional Office, telephone number (919) 791-
4200, as soon as possible, but in no case more than 24 hours, or on the next working day following the
occurrence or first knowledge of the occurrence of any of the following.-
a.
ollowing:a. Any process unit failure (e.g., mechanical, electrical, etc.), due to known or unknown reasons,
rendering the facility incapable of adequate wastewater treatment.
b. Any facility failure resulting in a by-pass directly to receiving surface waters.
c. Any time self-monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Ponding in or runoff from the irrigation sites.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
betaken to ensure the problem does not recur. [ 15A NCAC 02T .0105(1)]
V. INSPECTIONS
The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
wastewater treatment and irrigation facilities. [15A NCAC 02T .0108(b)]
2. The Permittee or their designee shall inspect the wastewater treatment and irrigation facilities to prevent
malfunctions, facility deterioration and operator errors resulting in discharges, which may cause the
release of wastes to the environment, a threat to human health or a public nuisance. The Permittee shall
maintain an inspection log that includes, at a minimum, the date and time of inspection, observations
made, and any maintenance, repairs, or corrective actions taken. The Permittee shall maintain this
inspection log for a period of five years from the date of the inspection, and this log shall be made
available to the Division upon request. [15A NCAC 02T .0108(6)]
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the wastewater treatment and irrigation facilities
permitted herein at any reasonable time for the purpose of determining compliance with this permit;
may inspect or copy any records required to be maintained under the terms and conditions of this permit,
and may collect groundwater, surface water or leachate samples. [G.S. 143-215.3(a)(2)]
VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to an
enforcement action by the Division in accordance with North Carolina General Statutes 143-215.6A to
143-215.6C. [G.S. 143-215.6A to 143-215.6C]
2. This permit shall become voidable if the permitted facilities are not constructed in accordance with the
conditions of this permit, the Division approved plans and specifications, and other supporting
documentation. [15A NCAC 02T .0110]
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3. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, Division approved plans and specifications, and other supporting documentation. No
variances to applicable rules governing the construction or operation of the permitted facilities are
granted, unless specifically requested and approved in this permit pursuant to 15A NCAC 02T .0105(n).
[G. S. 14.-215.1]
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules in
15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4 and
under General Permit NCGO10000; any requirements pertaining to wetlands under 15A NCAC 02B
.0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of Chapter 143 of the
General Statutes. [15A NCAC 02T .0105(c)(6)]
5. In the event the permitted facilities change ownership or the Permittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate property ownership documentation and other supporting
documentation as necessary. The Permittee of record shall remain fully responsible for maintaining
and operating the facilities permitted herein until a permit is issued to the new owner. [15A NCAC
02T.01041
6. The Permittee shall retain a set of Division approved plans and specifications for the life of the facilities
permitted herein. [15A NCAC 02T .0108(b)(1)]
7. The Permittee shall maintain this permit until all permitted facilities herein are properly closed or
permitted under another permit issued by the appropriate permitting authority. [ 15A NCAC 02T
.01050)]
8. This permit is subject to revocation or unilateral modification upon 60 days notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T.01 10. [ 15A NCAC 02T .0110]
9. Unless the Division Director grants a variance, expansion of the permitted facilities contained herein
shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC 02T .0120(b). f 15A
NCAC 02T.0120]
10. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to pay
the annual fee accordingly shall be cause for the Division to revoke this permit. [15A NCAC 02T
.0105(e)(3)]
Permit issued this the 25`x' day of January 2017
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
?S. Jay Zimmerman, P. G., Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0016232
WQ0016232 Version 4.0 Shell Version 151201 Page 6 of 6

a
State of North Carattrur
lkpnrtment of Rurlrunnienl and Natural tteanurreI
VIrl+tlon of Water RrRovrce"r
Dw. R 15A NCACO2'1',0600--SIiV(.i,F,YA11lt.Y ItILSIDIMIC WANTHWA-1'1111t IKRIGA'rION lit/SUPM,I
OPFkATION AND MAI1VTYNANCP. Af:uf'FUP-Vi
t)tvlslon of Water Ite:sourcrs VoRMt %FR W WtS 0&.04 Ott -l.!
)'tont No. —L��(,
iamperty owlterW as aPMAIIS 00 die I'mouled tired; �!+tc�r.cic, 1. �: ►Y. ►. 5 �1{. '� �J a� h< ick ? n ' � r
tailing addt v.0
14
Facility addremi- '; 4L., -1C . _ —� - -. —
Irrigation Mother), E Si'RAY ❑ DRIP
I t We a9m to operate and maintain the single-family residence wastewater treAtrnent find irrigation system as follow":
I. The Permittee is rr:-Wruiblc fur tic opcmiion and maintenance of the entire wash
sy-ctem including. but not limited to, the following items:
a. Thr i;cpttc tank %hall be checked annually and pumped out m needed. DEC 2016
b. Thc septic tarok effluent filter shall be checked and cleaned annually. Non-Dscha rge
Rarmid'ing Un
c. Accewsrhle %and filter surfaces shall be raked and leveled every six months and any vegetative growth shall be
remosrd manually.
d G3'& tablet chlorinator shall be checked weekly. Wastewater grade tablets (calcium hypochlorite) shall be
added as needed to provide proper chlorination (pool chlorine tablets shall not be used), OR
❑ The ultraviolet disinfection unit sludl be clhccked s,.cckly The lamps) and quartz slceve(s) shall be
cleaned or mplamd as nccdod to ensure proper disinfection.
r- All pump and alarm systems shall be inspected rrumthly.
f Thc 'irrigation system shall be inspected monrhly to ensure that the system is free of leaks, that all in ig ttion
equipment is operating as designed. that vegetative growth does not interfere with the system inspection or
open ion, that the axil is assimilating tic disposal treated wastewater with no visible runoff or ponding, and
that no objectionable odors are being generated.
2, Failure to pay the annual fee shall be cause for the Division to revoke the permit pursuant to 15A NCAC 02T
.0105(e)(3).
3. The Pcrnrimm's failure to properly operate this system is subject to a penalty up to $25,000 per day.
Q. f=ailure to meet the permit conditions or violation of the Slate's surface water or groundwater regulations may void
the permit,
All owners ap2gElng 2n the leully rccoL&d ItroycrtyI l n h 1Q1I-fi Maln(tannift Agreement
I / We understand the above requirements and agree to these terms ug pari of the imucd permit.
Owner Signature: __ Date:
Owner Signature: _ pate:
EOMI; SFRWWIS O&M 08-13
Page 1 of 1

BK 1902 PG 0286
RFeelVS pINcDE
�qN �D R
Non, 18 Z01T
P�"m�ti g � 9Q
n�
FILED
CHATHAM COUNTY NC
LUNDAYA. RIGGSSEE
REGISTER OF DEEDS
FILED Jan 17, 2017
AT 04:19:30 pm
BOOK 01902
START PAGE
0286
END PAGE
0288
INSTRUMENT #
00533
EXCISE TAX
(None)
State of North Carolina
Department of Environment and Natural Resources
Division ofWaterResources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORMMAY#,F PHOTOCOPIED FOR USERS ANORKWAL)
The Division of Water Resources wl* not consider this form complete unless all instructions aretpllowed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For more information or for an electronic version ofVwa fare; vLWIl ow web ark at
httn�7varral.nedenr 4rghveb/w /gapsllau/epplications,
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non -Discharge Permitting Unit appliostiprrbsnn.1
✓ Any changes to this form will result in the application package being returned.
✓ Any other setbacks required by 15A NCAC Subchapter 02T other than time referenced belfw, c waiyod
through execution of this form. o
✓ A copy of the completed and appropriately executed farm must be provided to the property oviter.
AGREEMENT TO WAIVE SETBACKS AS RFQUIRED BY
15A NCAC 02T .0SWa), .0506(b), .0606(ah .0706(9) and .1006(a)
The undersigned property owner(s) hereby permits:
Applicanfsname• Ror%9i 6 4-. 4m&n� —S0LniK5
�Complete mailing address of applicant: 300 R O Let�-
City: monc,vrC, ._ State: ^ NL Zip_ 0753'9
Telephone number: iq 6T- oISS Facsimile number:
,Hereinafter referred to as the Permittee, to (check all that apply):
1� tion -Discharge disposal of wastewater effluent within 137 feet of the property line,
❑ Non -Discharge disposal of wastewater effluent within feet of the identified residence,
❑ Construct treatment and storage units within feet of the property line,
❑ Construct treatment and storage units within feet of the identified residence.
FORM. NOWSW 11-13 Page I of2

BK 1902 PG 0287
The waived setbacks apply as shown on the attached mapandlocated at the following:
Location addressofproperty: Cka Qw� Co. Ybt-G,-A 66670
City:tr t G
' YY1 onvState- N Zip:
U/
7
3 I certify that I am a deeded property owner of above -referenced property and am aathodwd to make decisions
regarding this property on behalf of other deeded property owners. Furthermore, I certify that I have read and
understand this Agreement and do hereby grant permission to the Permittee to dispose of wastewater effluent or
construct wastewater treatment oohs as specified herein. I further amee_ the upon the Division of Water Resources's
Of Deeds and =3d* 29 Pomtittee and Division -of grater Resources Mth,dacumenta&n of„ur} h
Propertyowner(s) name(s): _1 /r6 ,4S
Signature:Date
Signature: Dam_
NORTH CAROLINA, ��^
COUNTY.
I, Vt5 0
a Notary Public for County, Worth Carolina,
do hereby certify that Tin p
10M4,4 i _- personally appeared before me this day and
aelmowledged the due execution,of the foregoing inshumnt.
��ttttrrrhq
w`tjtA��jircial
seal this the _ day of . ,YMQ - t/� 1--•,
�A
4cawmkaon
riCO,,,0,
-Vws
FORM: NIDwsW 11,.13 Page 2 of 2

BK 1902 PG 0288
LOT 2
10.
RECORDED IN PLAT BOOK 99, PAGE 0459
ADDRESS 3819 01D US I
U
MONCURE, NC 27559
N102921i
I inch = 200 F IL
SITE DATA
_NOTES:
N97'eT1Yw
+. AIL INSTANCES ARE HDAI10NFu GROUND
OWNER: GRAOY RONALD JR. SPINNS
2. ALL ORIERIONSMEIN lAS SURVEY FEET
S AMANDA LEMONS SPINXS
3' AREA COMPUTEUSNO COORDWATENETIOO FROM MEASMEOFELOOIA
3519 OLD1151
l aAMBF13fMW0S E NGORIONORTH NA063I20111. TIESREW SLOCNIZED
UTkWL Rcu-Y"KINEMVITN: ong GtO PU51130NW0 SYSTFJI(OPSI SOLUTIONS
MONCURE, NC 27559
REFERENCING THE COIRNUOUSLY OPERATING RETERCM•E STATION (CB" AERV'ORK
lS
SASE STATION NCRO, RALE GH. NC
PARCE L ID' 00762113
5.THIS SURVEY IS NOT POR RECOROAT"
le
6 TINS SURVEY WAS PRFDMFO WNHOUT THE IIEAEHT OFA TIRE REPOATAIOMAY BE
PIN'_ 9858 00 91 19116
SURACTTO ANY I01ATT9IS TFIAT A I'M TRE SPMETI VMM C=OSE
7. THE TOP OF CREEK EMII( WAS MEASURED SEGIA9e10 AT THE MM LANVAIAPLTNIT
OFR 10: 1187504
WN
Of THE ROOTED HERBACEOUS VECFFATION ME
822'p%'SFE
t NONE OF THE SPRAY FIPW RABB ENUT3011CH WTO THE 136 STREW BUTTER
REFERENCE', PB 99. PG 0453
DB 814, PO 0495
u
YOWNSHIP, CAPE FEAR
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RATE MAP
PANEL 371DXWWJ, EFFECTNE FEBRUARY 2,2007,
TOP 11F
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N'F NOWORFOO66Y
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PO PAGE
At. ACREACE
SF. SO FEET
EP MISTING IRON PIPE
IPS molhl m SFT
EA E7 STFq
TR COMPUIEOPONT
EMAO "ISTNG MAONETIO NAIL
I certify this plat was drawn of field
GRAPHIC SCALE
survey pu retard dM
MANmI�
SEPTIC SYSTEM
( TN ee>r y
AS-I;UtLT SURVEY
I inch = 200 F IL
�J
A PORTION OF THIS PROPERTY l� (IS). Cl US NOT)
alOHN A. EDWARDS & COMPANY
NC License F-0289
LOCATED WITHIN A FEMA SPECIAL FLOOD HAZARD AREA AND
LOCATED IN ZONE "AE" PEA FEMA FLOOD INSURANCE
RATE MAP
PANEL 371DXWWJ, EFFECTNE FEBRUARY 2,2007,
FA mATf1A2EMEHT
D54e5 vDaM
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MAIYI GMII
LEGEND
RAY R1GHf OF NAY
N'F NOWORFOO66Y
IW BoaxO L4AP3
OBOEm BODIL
PO PAGE
At. ACREACE
SF. SO FEET
EP MISTING IRON PIPE
IPS molhl m SFT
EA E7 STFq
TR COMPUIEOPONT
EMAO "ISTNG MAONETIO NAIL
I certify this plat was drawn of field
SURVEY FOR:
survey pu retard dM
GRADY RONALD JR. SPINKS
buildings lie wholly D
encroachments axis{
& AMANDA LEMONS SPINI(S
isnot Fur reoordatiol sa DrMDNCURE
This plat isnm/B nD�dm p b���
CHATHAM COUNTY NORTH CAROLINA
112W
alOHN A. EDWARDS & COMPANY
NC License F-0289
1 °01
-2
333 Wade Ave., Ralelgh, NC 27885
Phone [phone]