WQ0022805_Other Correspondence_20190503

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
ANDREW J. PRUSIK
705 HOMESTAED PARK DRIVE
APEX, NORTH CAROUNA 27502
Dear Permittees:
NORTH CAROLINA
Environmental Quality
May 3, 2019
Subject: Permit No. WQ0022805
Permit Renewal Notification
215 Constitution Ct. SFR
Single -Family Residence
Wastewater Irrigation System
Chatham County
Division of Water Resources' records indicate that your permit (Permit No. WQ0022805), which
was issued October 31, 2014, expires September 30, 2019. To date, the Division has not received a renewal
application. It is a condition of your permit and required by administrative code 15A NCAC 02T .0109 to
request renewal of your permit at least 180 days prior to its expiration.
As the Permittee, you are responsible for renewing and maintaining this permit. Accordingly,
please complete and submit the attached Single -Family Residence Wastewater Irrigation System Renewal
application (Form: SFRWWIS-R 09-18), and the Single -Family Residence Wastewater Irrigation System
Operation and Maintenance Agreement (Form: SFRWWIS-O&M 09-18). These forms have been prefilled
for your convenience.
Once the application is received, staff from the Raleigh Regional Office will conduct a site visit
and inspect your treatment and disposal system. Upon completion of the site visit and review of your
application, a new non -discharge permit will be issued in your name for a length of up to eight years.
Please complete and submit the attached forms within 30 days of receivine this notification.
Failure to provide these forms prior to the permit expiration date shall result in a Notice of Violation
for operating the subject facilities without a valid permit, which is a violation of G.S. 143-215.1, and
may subject you to appropriate enforcement actions in accordance with G.S. 143-215.6A-6C. Civil
penalties of up to $25,000 per day per violation may be assessed for failure to secure a valid permit.
If you need additional information concerning this letter, please contact me at [phone] or
nathaniel.thornbur I&ncderin ov.
Sincerely,
Nathaniel D. Thornburg, Branch Chi f
Division of Water Resources
cc: Laserfiche File (Electronic Copy)
SharePoint Archive (Electronic Copy)
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
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919.707.9000

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM RENEWAL
Division of Water Resources FORM: SFRWWIS-R 09-18
This form is for renewal without modification for single-family residence wastewater irrigation system permits.
For more information, visit the Water Quality Permitting Section's Non -Discharge Branch.
PERMIT INFORMATION:
1. Permit No.: WQ0022805
2. Permittee: Andrew J. Prusik (i.e., deeded property owners)
3. Signature authority's name: Andrew J. Prusik (i.e., deeded property owner or legal representative) [15A NCAC 02T .0106(b)]
4. Physical address of residence with treatment/irrigation system: 215 Constituation Ct.
City: Apex State: NC Zip: 27523- County: Chatham
5. Permittee's mailing address (if different from above): 705 Homestead Park Dr.
City: A ibex State: NC Zip: 27502-
6. Permittee's contact information:
Primary Contact: Phone number: (_} _- Primary email address:
Secondary Contact: Phone number: () _- Secondary email address:
7. Has the treatment/irrigation system been installed? ® Yes or ❑ No
Applicant's Certification per 15A NCAC 02T .0106(b):
I, attest that this renewal application has been reviewed by me, and is
accurate and complete to the best of my knowledge. I understand that any unauthorized discharge of wastewater from this non -discharge
system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal
prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated. I also
understand that if all required parts of this application are not completed, this application may be returned to me as incomplete. I further
certify that the Applicant or any parent, subsidiary, or other affiliate of the Applicant has not been convicted of an environmental crime,
has not abandoned a wastewater facility without proper closure, does not have an outstanding civil penalty where all appeals have been
exhausted or abandoned, are compliant with any active compliance schedule, and does not have any overdue annual fees.
Signature:
Date:
THE COMPLETED APPLICATION SHALL BE SUBMITTED TO:
By U.S. Postal Service: By Courier: By Email:
Non -Discharge Branch Non -Discharge Branch — Archdale 640D Non-Dischar e.Re orts ncdenr. ov
1617 Mail Service Center 512 N. Salisbury St.
Raleigh, NC 27699-1617 Raleigh, NC 27604
TELEPHONE NUMBER: [phone]
FORM: SFRWWIS-R 09-18 Page 1 of 1

State of North Carolina
nWR Department of Environmental Quality
Division of Water Resources
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM
Division of Water Resources OPERATION AND MAINTENANCE AGREEMENT
FORM: SFRWWIS-O&M 09-18
Permit No. WQ0022805
Permittee: Andrew J. Prusik (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 Change 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.
We understand the above requirements and agree to these terms as part of the issued permit.
Signature:
Signature:
Signature:
Signature:
Date:
Date:
Date:
Date:
All deeded ProVeM owners shall sign this O eration and Maintenance Agreement
FORM: SFRWWIS-O&M 09-18 Page 1 of 1