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HomeMy WebLinkAboutWQ0016381_Final Permit_20171116Water Resources ENVIRONMENTAL QUALITY November 16, 2017 JOHN U. AND ANN A. NEwMAN — TRUSTEES THE JOHN U. NEwMAN, III TRUST AND THE ANN A. NEwMAN TRUST 5594 NEw WINDSOR TRAIL BuRLINGTON, NORTH CAROLINA 27217 Dear Mr. and Mrs. Newman: ROY COOPER Governor MICHAEL S. REGAN Secretary LINDA CULPEPPER Interim Director Subject: Permit No. W00016381 Joyful Way Ln. Lot #4 SFR Single -Family Residence Wastewater Irrigation System Alamance County In accordance with your permit renewal request received September 25, 2017, we are forwarding herewith Permit No. WQ0016381 dated November 16, 2017, to The John U. Newman, III Trust and The Ann A. Newman Trust for the construction and operation of the subject single-family residence wastewater treatment and irrigation facilities. Please note that this renewed permit shall become effective on January 1, 2018 (i.e., the day after the expiration date of the existing permit). This permit shall be effective from January 1, 2018 until December 31, 2022, shall void Permit No. WQ0016381 issued January 14, 2009 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 condition has been removed since the last permit issuance dated January 14, 2009: ➢ Condition I.1 Lh —This setback has been removed. Please note the following permit conditions are new since the last permit issuance dated January 14, 2009: ➢ Condition II.4. — This condition includes information about the wastewater irrigation field. -_' Nothmg Compares 7- 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. John U. Newman, III and Mrs. Ann A. Newman November 16, 2017 Page 2 of 2 ➢ Condition IL7. — This condition establishes the compliance boundary at the property boundary in accordance with 15A NCAC 02L .0107(i). ➢ Condition II.8. — This condition establishes the review boundary midway between the compliance boundary and the disposal area in accordance with 15A NCAC 02L .0108. ➢ Condition II.9. — This condition requires the Permittee to apply for a permit modification to establish a new compliance boundary if any sale or transfer of property affects the existing compliance boundary. ➢ Condition IV.2.c. — This condition requires the Permittee to notify the Division any time self - monitoring indicates 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 are properly closed or permitted under another permit. ➢ Condition VI.8. — This condition notifies the Permittee that this permit is subject to revocation or unilateral modification upon 60 day notice from the Division Director, in whole or part for the requirements listed in 15A NCAC 02T .0110. ➢ Condition VI.9. — This condition notifies the Permittee that unless the Division Director grants a variance, expansion of the permitted facilities contained herein shall not be granted if the Permittee: has been convicted of an environmental crime; has previously abandoned a wastewater treatment facility; has not paid a civil penalty; is non -compliant with a permit schedule; or has not paid an annual fee. 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 Sonia Gregory at (919) 807-6319 or sonia.grregoryna tide ingov. Sincerely, �inada Culpepper, Interim Director Division of Water Resources cc: Alamance County Health Department (Electronic Copy) Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy) Digital Permit Archive (Electronic Copy) Central Files NORTH CAROLINA I. 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 The John U. Newman, III Trust and The Ann A. Newman Trust Alantance County FOR THE construction and operation of a 480 gallon per day (GPD) single-family residence wastewater treatment and irrigation facility consisting of: a 1,200 gallon baffled septic tank with an effluent filter; a 420 square foot (ftz) gravity dosed subsurface sand filter; a tablet chlorinator; a baffled 60 gallon chlorine contact chamber; two interconnected 2,000 gallon storage/pump tanks with a 15.2 gallon per minute (GPM) pump, audio/visual high water alarms, and an automatic rain shut-off device; a 0.38 acre spray irrigation area with five full -circle, overlapping 65 foot diameter, 3.04 GPM sprinkler heads set 60 feet apart on center; and all associated piping, valves, controls, and appurtenances to serve the single-family residence at Joyful Way Ln. Lot #4, Burlington, NC 27217 with no discharge of wastes to surface waters, pursuant to the application received September 25, 2017, 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 January 1, 2018 until December 31, 2022, shall void Permit No. WQ0016381 issued January 14, 2009 and shall be subject to the following specified conditions and limitations: SCHEDULES 1. Upon completion of construction and prior to operation of this permitted facility, a certification (attached) shall be submitted from a licensed North Carolina Professional Engineer certifying that the permitted facility has been installed in accordance with this permit, Division approved plans and specifications, and other supporting documentation, including the location of all monitoring wells as applicable. If this project is to be completed in phases and partially certified, the Permittee shall retain Division of Water Resources, Water Quality Permitting Section, NC 27699-1617. [15A NCAC 02T .0116] 1p eted. Mail the Certification to the 1617 Mail Service Center, Raleigh, W00016381 Version 4.0 Shell Version 171103 Page 1 of 8 2. Prior to beginning construction activities, the Winston-Salem Regional Office, telephone number (336) 776-9800, shall be notified to schedule a follow-up site evaluation. Notification to the regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding State Holidays. [15A NCAC 02T .0108 (b)(2)] 3. The Winston-Salem Regional Office, telephone number (336) 776-9800, shall be notified at least 48 hours in advance (excluding weekends and holidays) of operation of the installed facilities such that an in -place inspection can be made. Notification to the regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding State Holidays. [15A NCAC 02T .0108 (b)(2)] 4. 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 .0105(d) requires an updated site map to be submitted with the permit renewal application. [15A NCAC 02T .0105, 02T .0109, 02T .0115(c)] 5. 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] H. 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 1— APPLICATION LIMITATIONS Field Parameter Hourly Rate Yearly Max Units 1 01284—Non-Discharge Application Rate 0.09 1 18.2 inches [I5A 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 The John U. Newman, III 1 Trust and The Ann A. Alamance 36.23440 -79.41560 0.38 WbD-Wilkes Newman Trust soils, 10 to 15% [G.S. 143-215.11 W00016381 Version 4.0 Shell Version 171103 Page 2 of 8 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 IHA. and 111.5. of this permit. [15A NCAC 02T .0605(o)] 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 .0106. [15A NCAC 02L .0107(i)] 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)] 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 iu. Any well with exception of monitoring wells: 100 iv. Any property line: 150' v. Public right of way: 50 i The subject irrigation site is located within the required 150 foot setback to the property line for Parcel No. 8970748546. In the event that Parcel Nos. 8970744769 and 8970748546 come under separate ownership, then reciprocating setback waivers allowing irrigation with the 150 foot setback shall be recorded in the Alamance County Register of Deeds. [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: ii. Any property line: [15A NCAC 02H .02190)] 100 50 WO0016381 Version 4.0 Shell Version 171103 Page 3 of 8 M. 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 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 H.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 Joyful Way Ln. Lot #4, Burlington, NC 27217 shall be irrigated on the sites listed in Condition II.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)] 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. Any excavation into bedrock shall be lined with a 10 millimeter (mm) synthetic liner. [15A NCAC 02T .0605(d)] W00016381 Version 4.0 Shell Version 171103 Page 4 of 8 13. 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 ultraviolet disinfection unit shall be checked weekly. The lamp(s) and quartz sleeve(s) shall be cleaned or replaced as needed to ensure proper disinfection. [15A NCAC 02T .0605(I)] 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)(l)] 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 Winston-Salem Regional Office, telephone number (336) 776-9800, 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. 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. Pending 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 (800) 662-7956, (800) 858-0368, or (919) 733-3300. 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(l)] WQ0016381 Version 4.0 Shell Version 171103 Page 5 of 8 V. 1. 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(b)] 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] 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)] 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 .0104] 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)] WQ0016381 Version 4.0 Shell Version 171103 Page 6 of 8 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 .0110. [ 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). [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 16' day of November 2017 NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION mda Culpepper, Interim Director % I v Division of Water Resources v By Authority of the Environmental Management Commission Permit Number WQ0016381 WQ0016381 Version 4.0 Shell Version 171103 Page 7 of 8 Permit No. W00016381 Single -Family Residence Wastewater Irrigation System The John U. Newman, III Trust and The Ann A. Newman Trust November 16, 2017 Joyful Way Ln. Lot #4 SFR Alamance County ENGINEERING CERTIFICATION ❑ Partial ❑ Final In accordance with 15A NCAC 02T .0116, I, as a duly registered Professional Engineer in the State of North Carolina, having the Permittee's authorization to ❑ periodically ❑ weekly ❑ fully observe the construction of the permitted facility, hereby state to the best of my abilities that due care and diligence was used in the observation of the construction, such that the facility was built within substantial compliance and intent of this permit, the Division approved plans and specifications, and other supporting documentation. ❑ Any variation to this permit, the Division approved plans and specifications, and other supporting documentation has been documented in the attached as -built drawings, and shall serve as the Permittee's minor modification request to amend the permit accordingly. Provide a brief narrative description of any variations: I Professional Engineer's Name i Engineering Firm i r Mailing Address i 1 i City State ( Zip i Telephone E-mail NC PE Seal, Signature & Date THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS: NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF WATER RESOURCES WATER QUALITY PERMITTING SECTION NON -DISCHARGE PERMITTING UNIT By U.S. Postal Service: By Courier/Special Delivery: 1617 MAIL SERVICE CENTER 512 N. SALISBURY ST. RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604 W00016381 Version 4.0 Shell Version 171103 Page 8 of 8 WWTF Spray j) Field R-1 State of North Carolina Department of Environmental Quality WR Division of Water Resources 15A NCAC 02T .0600 — SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEMS DOPERATION AND MAINTENANCE AGREEMENT Divlslon of Water Resources FORM: SFRW WIS O&M 06-16 Permit No. W00016381 County: Alamance Property owners) as appearing on the recorded deed: John U. Newman, III Trust and Ann A Newman Trust Mailing address: 5594 New Windsor Trl., Burlington NC 27217 Facility address: Lot #4 Joyful Way Ln., Burlington NC 27217 Irrigation Method: ® SPRAY ❑ DRIP We agree to operate and maintain the single-family residence wastewater treatment and irrigation system as follows once constructed: 1. The Pennittee is responsible for the operation and maintenance of the entire wastewater treatment and irrigation system including, but not limited to, the following items: a. The septic tank shall be checked annually and pumped out as needed. b. The septic tank effluent filter shall be checked and cleaned annually. c. Accessible sand filter surfaces shall be raked and leveled every six months and any vegetative growth shall be removed manually. d. ® The 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 shall be checked weekly. The lamp(s) and quartz sleeve(s) shall be cleaned or replaced as needed to ensure proper disinfection. e. All pump and alarm systems shall be inspected monthly. f. The irrigation system shall be inspected monthly to ensure that the system is free of leaks, that all irrigation equipment is operating as designed, that vegetative growth does not interfere with the system inspection or operation, that the soil is assimilating the disposed 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 Permittee's failure to properly operate this system is subject to a penalty up to $25,000 per day. 4. Failure to meet the permit conditions or violation of the State's surface water or groundwater regulations may void the permit. All owners appearing on the legally recordedyronerty deed shall sign this Operation & Maintenance Agreement We understand the above requirements and agree to these terms as part of the issued permit. Owner Signature:Date: Owner Signature: Date: 9.1s.1� FORM: SFRWWIS O&M 06-16 Page 1 of 2