HomeMy WebLinkAboutWQ0030257_Final Permit_20150223A74
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
February 23, 2015
ROBERT T. & MELROSE W. FISHER
50004 BROGDEN
CHAPEL HILL, NORTH CAROLINA 27517
Dear Mr. and Mrs. Fisher:
Donald R. van der Vaart
Secretary
Subject: Permit No. WQ0030257
Cub Creek Estates Lot #20 SFR
Single -Family Residence
Wastewater Irrigation System
Chatham County
In accordance with your permit renewal request received January 27, 2015, we are forwarding
herewith Permit No. WQ0030257 dated February 23, 2015, to Robert T. & Melrose W. Fisher 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 October 1, 2015 (i.e. the day
after the expiration date of the existing permit).
This permit shall be effective from October 1, 2015 until September 30, 2020, shall void Permit
No. WQ0030257 issued January 17, 2007, 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 January 17, 2007:
➢ Old Conditions 1.5., 1.6. and 1.8. — These conditions have been removed because they are
included in the approved plans and specifications, and are therefore inherently covered under
Condition VI.6.
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: 919-807-64641 Internet: http7/1porla1.ncdenr.om1weblwg
An Equal Opportunity 1 AifirmaGve Aolion Employer — Made in part with recycled paper
Mr. Robert H. & Mrs. Melrose W. Fisher
February 23, 2015
Page 2 of 2
Please note the following permit conditions are new since the last permit issuance dated
January 17, 2007:
➢ Condition II.4. — This condition includes information about the wastewater irrigation field.
➢ Condition II.7. — This condition establishes the compliance boundary at the property
boundary in accordance with 15A NCAC 02L .0107(i).
Y 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.
iP Condition 11.9. — 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 VI.7. — This condition requires the Permittee to maintain this permit until all
permitted facilities are properly closed or permitted under another permit.
➢ Condition VIX — This condition notifies the Permittee 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 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 Nathaniel Thornburg at
(919) 807-6453 or nathaniel.thombura@ncdenr.gov.
Sincerely,
. Jay 2mmerman, Acting Director
Division of Water Resources
cc: Chatham County Health Department (Electronic Copy)
Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Central Files
Digital Permit Archive (Electronic Copy)
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
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
Robert T. & Melrose W. Fisher
Chatham 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; a 420 square foot (A) subsurface sand filter; a chlorine disinfection
unit; a 5,000 gallon storage/pump tank with a 40 gallon per minute (GPM) pump, audible/visual high-
water alarms and a rain sensor; a 0.41 acre drip irrigation area with approximately 2,000 emitters; and all
associated piping, valves, controls and appurtenances
to serve the single-family residence at Cub Creek Estates Lot #20, Eagle Dr., Chapel Hill, NC 27517,
with no discharge of wastes to surface waters, pursuant to the application received January 27, 2015, and
in conformity with the project plans, specifications, and other supporting data subsequently filed and
approved by the Department of Environment and Natural Resources and considered a part of this permit.
This permit shall be effective from October 1, 2015 until September 30, 2020, shall void Permit No.
WQ0030257 issued January 17, 2007, and shall be subject to the following specified conditions and
limitations:
I. SCHEDULES
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 the responsibility to track further construction approved under the same permit, and shall
provide a final certificate of completion once the entire project has been completed. Mail the
Certification to the Division of Water Resources, Water Quality Permitting Section, 1636 Mail
Service Center, Raleigh, NC 27699-1636. [15A NCAC 02T .0116]
1 The Raleigh Regional Office, telephone number (919) 791-4200, 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)]
WQ0030257 Version 2.0 Shell Version 150101 Page 1 of 7
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)]
4. 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
.06071
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]
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
1 01284—Non-nischargeApplication Rate
0.201
15.6
inches
[I 5A 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
Acreaoe
Soil Series
1
Robert T. & Melrose W. Fisher
Chatham
35.945006'
-79.0156000
0.41
Creedmoor
[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 I11.4. and IR.S. of this permit-
[ISANCAC 02T .0605(o)]
WQ0030257 Version 2.0 Shell Version 150101 Page 2 of 7
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 A108]
9. The Permittee shall apply for a permit modification to establish a new compliance boundary prior to
any sale or transfer of properly 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: 100
ii. Surface waters: 50
iii. Any well with exception of monitoring wells: 100
iv. Any property line: 50
v. Public right of way: 50
[15A NCAC 02H .0219(k)]
b. The setbacks for storage and treatment units permitted under 15A NCAC 0214 .0200 shall be as
follows (all distances in feet):
i. Any well with exception of monitoring wells: 100
ii. Any property line: 50
[15ANCAC 02H .0219(k)]
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 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(h)(1)]
4. Adequate measures shall be taken to prevent effluent ponding in or runoff from the irrigation sites
listed in Condition IIA. [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)]
WQ0030257 Version 2.0 Shell Version 150101 Page 3 of 7
6. Only effluent from the single-family residence at Cub Creek Estates Lot 920, Chapel Hill, NC 27517
shall be irrigated on the sites listed in Condition II.4. [G.S. 143-215.1]
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. [I5A NCAC 02T .0605(i)]
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. [I5A NCAC 02T .0605(#)]
11. Pump/dosing tanks shall have audible and visual alarms external to any structure. [I5A NCAC 02T
.0605(n)]
12. Any excavation into bedrock shall be lined with a 10 millimeter (mm) synthetic liner. [15A NCAC
02T .0605(d)]
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 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(I)]
c. The storage, pump, and alarm systems shall be inspected monthly. The scum layer 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 drip lines,
that the system is free of leaks, that the vegetative growth allows a proper drip 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(bxl)]
WQ0030257 Version 2.0 Shell Version 150101 Page 4 of 7
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. 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 (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(I)]
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(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]
WQ0030257 Version 2.0 Shell Version 150101 Page 5 of 7
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.-215.11
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 NCG010000; 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
.0105U)1
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 because for the Division to revoke this permit. [ 15A NCAC 02T
.0105(e)(3)1
Permit issued this the 23'a day of February 2015
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
r
. Jay ZjAmerman, Acting Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0030257
WQ0030257 Version 2.0 Shell Version 150101 Page 6 of 7
Permit No. WQ0030257 Single -Family Residence Wastewater Irrigation System
Robert T. & Melrose W. Fisher February 23, 2015
Cub Creek Estates Lot #20 SFR Chatham 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:
Professional Engineer's Name
Engineering Firm
Mailing Address
City State Zip
Telephone E-mail
NC PE
nature & Date
THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING
INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PEPJATI7 'ING UNIT
ByU.S. Postal Service:
1636 MAIL SERVICE CENTER
By Courier/Special Delivery:
512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1636 RALEIGH, NORTH CAROLINA 27604
WQ0030257 Version 2.0 Shell Version 150101
Page 7 of 7
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Figure 2 — Directional Map
WQ0030257
Eagle Dr., Chapel Hill, NC 27517
Robert T. & Melrose W. Fisher
Latitude: 35.844698'
Cub Creek Estates Lot #20 SFR
Longitude: -79.015105'
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State of North Carolina
Department of Environment apd Natural Resources
Division of Water Ressources
ISA NCAC 02T.0600 -SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEMS
OPERATION AND MAINTENANCE ACRIE;EMENT
Dlvislon of Water Resources FORM: SFRWWtS O& 108-]3
Permit No.
County: CL'4 q,6 0-
Property owner(s) as appearing on the recorded deed: �t J'k':' ct,%>J rk e j re se
M ai I ing add ress: �� �' I�: c c� car' ��= . C1��c, �F ( {-{-� 1 l rU c. Z � ?
Facility address: rya t- 2L) ee k = 5 i C, +e 5
Irrigation Method: ❑ SPRAY �DR1P Feel e
I I We agree to operate and maintain the single-family residence wastewater treatment and irrigation system as follows:
The Pennittee is responsible for the operation and maintenance of the entire wastewater treatment and irritation
system including, but not limited to, the follow. ing items: RECEIVEDIDENRINVI, R
a. The septic tank shall be checked annually and pumped out as needed.
' N 2 7 2015
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 vegeta iv
removed manually.
d. YThe 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 risible rt-notf 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 pen -nit 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 recorded rroperty 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: T `(C) CT-� Date: 'd '.
Owner Signature:
Date:
FORM: SFRWWIS O&M 08-13 Page i of I