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A41 8e�� `� �� . �� .�a-�-n-� ,.-,�„ ��.�.�.IL ]F—ZL �.�.]1�Ila T�x IVI.�� / P�, ceI � i S�u�t� clfi vus,i.o i, FI,i�:�s�e.S�ction.`Lot # ' � . . � � L LI��. � C_, •� — , � .�.. ' �i �� `( � �� ` �� ,�R Pesmit Valad for � ff+'ive Ye: Type of Facility: �uv'�� # of Occupants �_ # of : Proposed'9Vastewater System: Proposed Repair: � P t Conditions: �,.d -- c n: Cr o�d Iffi�iOY�ffi�$ ��Y'iYllt '�o E�irat� � -e.-, �Kc.C/ �SC�tva �New �Add.iti n. W tes� Supp � � Daily Flow �� g.p.d.��c_qli� � � Type: � Type: � .l �� GIr,Lp� 3C� /�QrS � . . . � Owner or Legal Representative e� • Date• � _• Authurized State Agent: � ,vl/�� Da#e: ' . 'r� ''�' The issuance of this permit by the Health Department in does not guarantee the issuance of other pennits. It is the respons��ity of the appjicant/Property owner to in sure that all Peison County Planning and Zoning and Building Inspections requirements are met. This Improvement �er�it is subject ta revocation if the site plan, plat or the intended use ciianges. The Improvement Permit is not affecte�l by a c.hange. in ownerslup of the property. This permit.was issned ia compliance with the provisions of the North Carolina `Laws and ^-des for SewaQe Treubnent and Dfsnosal Svstems' (15A NCAC 18A .1900). Neither Person�Co�mty nor the Environmental �ealth ecialist warrants that tbe septic tank system w�11 continue to fnnc�on satisfactonly in the futnre or that the water suppiy w�l remain potable. � _ An#ho�aa��n to� Const�ct �aste�ater Systeffi (Iteqnired for Bwlding Permit) � * See site plan and addi#onal attachments { �� ). ��L .� � � ��Z� � �� Propos Wastewater System: �Clitii.d �jn2V�.-h� —Ri � '1'ype � � Wastewater Flow � �2 .p.d. New � R air Exp �on �j SQiI Lq'AYt- ,�a g.p.dJ ft 2 C-��a l�'� No ��' � T3�pe of Facilifiy: ��tu c.� '�rP� �� /v�SC�c.�, Basement Yes yC _. — �� . Wastewater System Reqnirements Size: Septic Tan)k: o��al Pnmp Ta,nk: ��al Grease Trap: 1�� gat field• Total Area: l�'�� sq ft Total I,�nngth J�� ft MaadYnnm'Trea�ch IDeptli �`� i�, 'I'rencli Width � ft Mini�auu� Boil Cover• � an Distr�ution: _ Distribution Box Serial Distrlbution sPecifications: Y re —�-*�scl�f ��`?�-� Authaaized State �lgen� I' Permit Exp' on Date: � The type of system permitted is k Conventional the pezmit Owner/Leg�1 k8eprr.�entaiav • Minimum Trench Separation:��, ft � Pressure Manifold . .. �'��,�f- t� Date: � � CO'd �% Innovative Alternative. I accept the spe�ifications of Date: PCHD7/30/2002 INFORMATION FOR THE OWNER - A copy of the O.R.C. contract must be provided to the health department before \ operation permit (O.P.) will be issued. - Owner, O.R.C., and installer must be present at initial start up inspection. - The owner in conjunction with the O.R.C. must adhere to the enclosed operation and maintenance (O.+ M.) requirements. !� , � ,;/ _ _ _ __ _ � a �� ., � � ��-.�'" nsuring a healthy environment . ,y..... � '� � ��.� -_.__... , . �.__.,__ - _--- --_.._ . ... ._. .___.. - —_ . .,_ ��a��.��.� ��.��. G,� a� K (�e�� ( �-1-t�ea � a�(tr � � � ( 2'' swpP�Y �i ��e 1��''�t9 yx �� o� �5�� `�Q'. �5�� I � a � C�`0 �c��u�4;�nu�, o� s-fas�e ls� , a� .4.. �91uM,�urh ��",�-� . ` `�a�a��'� QCC�SS O�Oor V'� � � �l a�q 61e� - ---..�.� � _ r.:�� =��■ . �� ,, , , .:• ' ' ��Lt WQ-iQr Cc�Qr�1 ,� 1 '� .�(oct{- ��MQ � � ov��;d�e e�ab � �, ., , 0 . i� . Ig � v �� l --, � 6 �a�K ., • � , , . w A � . ' � ^ � � ' • t w i � I w i a,� i l l� v��a� ►�t5� � `�-�-�``� �� ra.�-ec� • �� _�Mfr -��ab�� `p� t�� pu^►� ot� i�u k�a,t'� �%urh p ot'� phone 336.597.1790 fax 336.597.7808 20-B Court Street, Roxboro, NC 27573 � Operation, Maintenance and Monitoring Requirements a. System management entity shall be comparable to a Type V system in Rule .1961(b), Table V(b). Inspection/maintenance and reporting frequency requirements shall be as(unless more frequent visits are required based on the pretreatment or effluent distribution system and specified in the Operation Permit): Equalized Flow <1500 gpd 1500 — 3000 gpd 3000 —10000 gpd > 10000 gpd ORC Insp. Interval 2/year 4/year 12/year 1/week LHD Insp.Interval 1/year llyear 1/year 1/year If telemetry is provided and the ORC response time is 2 hours or less per the maintenance contract, the inspection frequency may be reduced as follows (unless more frequent visits are required based on the pretreahnent or effluent distribution system and specified in the Operation Permit): Equalized Flow <1500 gpd 1500 — 3000 gpd 3000 —10000 gpd > 10000 gpd ORC Insp. Interval 1/year 2/year 6/year 1/14 days LHD Insp. Interval 1/year 1/year 1/year 1/year b., The Operator in Responsible Cfiarge (ORC) shall provide monitoring reports to ' th� local health.department within 30 days of each required inspection. The ORC shall maintaii� a log of all malfunction incidences/notificarions, observations, maintenance activities, and meter readings of pump run events, pump run times, override events, and liigh-level alarm events at each visit. Minimum maintenance during each required inspection shall include visual observation of the drainfield, checking/cleaning filter screen(s), measuring delivery rate, and recording flow meter reading, pump run times, cycle counts, high-level events, and water meter readings where applicable. At least once per year, orifice control devices shall be flushed, pressure head measurements made, and solids accumulation in the tanks shall be measured and recorded. Necessary adjustments to timer settings shall be pre-approvecl by the local health department, and adjustment times noted in the monitoring log and reports. c. The ORC shall also conduct other additional observations, measurements, monitoring, and maintenance activities as specified in the Operation Permit.and as recommended by the timer control panel manufacturer. � State of North Carolina Department of Environment and Natural Resources Division of Environmental Health Michael F. Easley, Governor William G. Ross, Secretary Terry L. Pierce, Director Andy Adams, Chief December 1, 2005 Mr. Joe Zimmerman SJE-Rhombus 22650 County Highway 6 Detroit Lakes, MN 56501 1•• .—�.•�..•- � CDE R NORTH CAROUNA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Subject: Approval of SJE-Rhombus Flow Equalization Panels - Simplez and Duplex Dear Mr. Zimmerman: On December 1, 2005, we completed inspection and testing for the duplex control panel and found that it meets the requirements of Innovative Approval #IWWS 2004-01. Therefore, we approve the following models of SJE-Rhombus flow equalization control panel: IFS Q Q Q 1 or 9 , 1, or 2�� l0E 15 A 18A (Simplex) IFS Q Q 0 1 or 9 , 1, or 2�� l0E 15 A 18A (Duplex) 1 or 9 - Choose for starting device (1 = 120/208/240 VAC, 9= 120 VAC) , l, or 2 - Choose for pump full load amps (0 = 0-7 FLA, 1= 7-15 FLA, 2= 15-20 FLA) Please be aware that these panels are subject to periodic inspections, and should units be found to be in noncompliance with the submission or Innovative Approval, then the approval may be suspended or revoked. Please feel free to contact me if you have any questions pertaining to this approval. Sincerely, Tricia Angoli On-Site Wastewater Engineering cc: Tommy Carr, Harry Warren, LLC ON-SITE WASTEWATER SECTION 1642 Mail Service Center, Raleigh, North Carolina 27699-1642 Telephone: 919-715-3272 Fax: 919-715-3227 E-mail: trish.angoli@ncmail.net f� Take-Up ADJ:Expansion Clamp Boot R�� . ! `• � 1 ' 'ti 7 ti vN � i � r �� 1 ; r � �� i _ ` .� f - f1 :, . .� When the contractor sets the manhole in position to grade, ditch personnel need only insert pipe through Press-Boot and tighten the Take-Up Clamp to compress the Boot against the outside wall of pipe entering manhole. Press-Boot offers the unique advantages of the ADJ:Expansion Ring. This patented design provides unmatched flexibility in sealing a wide variation of hole sizes. The ADJ:Expansion Rng is precision-molded of a material with corrosion � resistance superior to competitive metallic expansion rings. The ADJ:Expansion Ring instalis quickly and easily, and requires only minimal training of installers. If necessary, the ADJ:Expansion Ring is easily removed and re-installed. �► � •- ;" ; , t � NI"•t' .� Press-Boot FEATURING �THE ADJUSTABLE ADJ:EXPANSION RING Each PRESS-BOOT connector consists of three components, a BOOT, an ADJ:EXPANSION RING, and a TAKE-UP CLAMP. Press-Boot connectors enable the manhole manufacturer and installation contractor to provide a flexible, watertight connection where pipe enters the manhole. The ADJ:Expansion Ring is mechanically expanded to compress the Boot against the receptacle hole surface in the manhole wall. After adequate compression of the Boot is achieved, the seif-locking design of the ADJ:Expansion Ring interlocks to insure against loss of compression. This secures Press-Boot in the manhole wall, ready to accept the desired size and type of plpe. Once Press-Boot is instalied, there is no need to retighten the ADJ:Expansion Ring before, during, oi after shipmenf fo the job site. �� . ., INFORMATION FOR TIiE INSTALLER: - The permit should be read very carefully prior to bidding. The following are details that must be considered along with other considerations. - Tanks shall be approved by DEHNR, and certification supplied by the manufacturer. - Tanks shall be water tested prior to installation. - The installer shall be responsible to the owner for placement of the tanks and to insure that final grades are returned to the original natural grade, with exception of added structural features. - The supply trench shall be compacted to eliminate cavities left during initial fill placement. - Installation of the system shall be during dry conditions in order to protect the soil structure. - All fittings shall be pressure rated fittings. - All joints shall be cleaned with PVC pipe cleaner and a heavy bodied glue applied to weld all joints. - Where required by the county health department, post installation inspections by the designer must be scheduled 5 wee�'days in advance. - Trenches shall be carefully excavated so the bottom is within 2" from the highest to the lowest points of elevation within the trench. If the bottom elevation needs adjusting after it has been trenched, it will be done by removing high points rather than filling low points. It is extremely important to insure that trenches are not over excavated during initial trenching. All fine grading within the trench will be hand done with a shovel. No loose material will be left in the trench. - All pipe openings in the tanks shall be properly grouted. This also applies to the � joints around the riser. � - All tanks shall be properly back filled and compacted to prevent slump at a later date. � � � - Earth dams, constructed of relatively impervious material, shall be installed at the beginning and end of each lateral. - No heavy equipment shall be used on the field during or after installation. The use of a small loader (i.e. Bobcat) or a trencher (i.e. Ditch Witch 2300/2310) may be used for installation. - - Elevations at pin flag locations should be checked by the installer prior to beginning trenches. . � - Pump tank riser should be 6" above grade; control panel should be 3' above ___ __ _ �r'ade. _ __ __ __ � ____ __ �� __ _____ ---_ ___ __.___ _ __ l� INFORMATION FOR INSTALLER (CONTINUED) - Drainfield must be seeded and strawed after installation - Pump tank must have inlet and outlet boots installed (press-type) - All tanks must be set on a 6" gravel bed. - Control panel must be a state approved flow equalization box (SJE-Rhombus approval enclosed) - PRE-CONSTRUCTION MEETING MANDATORY! �2 �� _ - __ _� _ __ _ _ _ _.� __ _. ��. _ � _ �: . _ � .l_/ � ` L � ��. ~ ��-r� � nsuring a hea � ��f� �� _ _-_.._ _ �__�..�...�� 1rn.�n��n��n�c��n��,� �c��,��. � t�Q l�`z.eo� �-ld�,/ �QZ ��. � �ld � � Q � ak� �1f "t-{,�r�, i -, 5�� .. . J i �� I�S�c� ( �Q�s,1 C / environment 1�� 1 � �3 —� �� -.�� W al. �4�1 ;' �,'7�a(, � �� q�s•� phone 336.597.1790 fax 336.597.7808 20-6 Court Street, Roxboro, NC 27573 � _ _ .._ �� _ _ . . __ .. � .. __ . 4.�,..�_e e� � � � �� . �• �,� r . �� • �� ;� � �� n��n�cc�n��.� ��,��n. C�tctrc� /�� ,y��lr� �C S�J°' �/�i� = l�pv ��'� ��- se4� t �( 2�{aY5 f W K ��o � ��w,� t!/jQ �Ll ec.✓'Pr S��'1 O�� 'r i C� ��O S�C��S � � ` C� �-� C �C�.- s • '� � � �,��pt-� x l�� cia� S Q We�� `�Y S��-� � �� = 2 soo �4 l. �f = I��Q� �-�o� � j. l`7 x'l��o - �Q �• s' _ -f-- �� v - � . 2Y 3d. s �q � .��—� �. - .—___�� _ nsurin� a healthy environment 3 o�a��-.,1WlC . � ��Y� __.. ,�--- yZ � 5�� .�q�� (�r� � �l�� -�iv �1 �r'►'Fsc C� oa l s � + C c � urc�� 4 Z� �� e�Ca l;Z.e.�.� ��c��.�/ �r.�� ra = J odc� � �(. �/�t � K� C�{��'�` �-� � r�r s-2 ��r s -%�� C �rG�r'S "�� C��cS. phone 336.597.1790 fax 336.597.7808 20-B Court Street, Roxboro, NC 27573 � �-��-g __ � _ _ _ _____ _ __ , }:.�., � � 1 � . `,..�, � �' � nsuring a healthy environment _ , ___.a.:__ .-� .� � �.��,� .<«-- _ _.. _ _ —=-- LL , __._. _.__----- —._.. _ �n��71��7rn]rnn.c�]rn��,� �«��.��n �Q; �,.��c�1 �Q2 ��d � . 3� C-r,q t� - 1�� _ �� ? ��, v.� �,',�.e � u� S��t�� =" iIS�+ ��'+�- �' �� Qi•fj�• = t��i'C� q(. � � � -�-�r�� c�� (� ��ec� �-�� j�,r � l G� �F��Q(. va�� = �35� �a(. ,� �; �, Wa�e� ��a.,r� � '3 � C�o�a� �� - — l � � 5a�- 5 /�i;�, �� v�(. ��f 7 t � . �s = 2 Y � t. �as,� 9 Q� phone 336.597.1 �' fax 336.597 20-B Court Street, Roxboro, N� rvcr�v� �� `�. � IPI�I�..�� -��-�� /1,,n�. 1E:�-a-n.�� ^ ��.]L 1HI�.�.11�El�. Owner: ` �C� / `l� Tax Map: Parcel #: Date:2 ! 4 � / I:,�� •. • � i � ��'ii ' " � . . � � � i �� %��Illl 'L� / � �� -/ -____-_- �. __-__--- �� __-_--�- � � �� =� � � � � �� ft of line x 65 gal. er 100 ft =� �,�.� =100 =� gal 7% x gal = gal per dose �� gal per minute (gpm) = A+'lo�v lSate � � � � lFriction �ead �G Loss: �. 3 ft per 100 ft of supply line x n'l �v ft of supply. line � 100 = 7 ft ft a 1.2 =�_ ft of friction head �. Manifold Size: ��" ]Force Main Size: � " PVC �otai Dynamic �ea ^'.� ft of Elevadon head +_�ft of Pressure head + s ft of Friction Head = �'�TDH Pump Requireauent: �� GPM @� ft of Hea Drawdown: �gal per dose : 21 ga.l per inch = inch drawdovcm per dose c Gemeral ID� Infor�nat�on , �� :.. ... �.�, �� - !��rs . . ,. ,. �i► �i► i► t� � . ��1 ,.�,.- 9ma� I � 4 � -' � — � �. � : I �: ■�c�»�omoo :::::.::::.:::::::..::::::�::::: ............................_..... � .,: sr� t � Ta�, Na Taps aff one side v'/s for taUAin� bo#h : Z 3" 6n � 4i}+ � 11 � �� . . . J , � �'i0'iY EI Tflp 5'�Z¢ ii�LtYCI'i[il FiOW i'i�� !.4" Sclied 3Q �.S � !�," Sched30 i•1 , s, •' Sched 80 1� 1 ;6 " Sched ?0 1? � � , , . � . . �� '� ,�-- ; �rw1 r"' =� � � � ` � A d s�� "'`Y' �'�C'_ �1�, � IL'IL�IL IC' QD Ir3171'I�ILc� IL�.'��1.� � (� �. �l ��LlL I. PERFORMANCE STANDARDS 1. The Permittee is subject to all provisions of Article 11 of Chapter 130A of the General Statutes and 15A NCAC 18A .1900 et. seq. 2. The Permittee shall keep the plumbing in the facility in good repair and eliminate leaks, drips, or excess flows as they occur. Use of low flow fixtures and water consezvation is a condition of this permit, and must be continued for the life of this system. 3. The issuance of this pernut shall not relieve the Pernuttee of the responsibility for damages to surface or groundwaters resulting from the operation of this facility. 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 government agencies or commissions which have jurisdiction. 5. The wastewater treatment and disposal facilities shall be effectively m�intained and operated at all times so that there is no discharge to the ground surface or to suriace waters. , In the event that the facilities fail to perform satisfactorily, including the crearion of nuisance conditions or failure of the subsurface disposal area to adequately assimilate t�e_ wastewater, the Permittee shall take immediate corrective actions including those actions�.that may,�e required by the Local Health Departinent, such as the constntction of additionali or replacement wastewater ireatment and disposal facilities, upon receipt of a repair pemut. 6. Diyersion or bypassing of the untreated wastewater from the treatment facilities is prohibited. 7. Residnals generated from these treatment facilities must be treated and disposed in accordance with the 40 CFR 503 and in a manner approved by the Division of Solid Waste. II. OPERATION AND MAINTENANCE REQUIREMENTS 1. The faciliries shall be effectively maintained and operated as a subsurface disposal system to prevent the discharge of any wastewater to the ground surface or surface waters resulting from the operation of this facility. 2. This system is classified as a Type Vb subsurface disposal system. The Permittee shall employ a certified wastewater treatment plant operator to be in responsible charge (ORC) of the wastewater treatment facilities. The operator must hold a Subsurface Operator certificate. The ORC of the facility must visit the facility at least monthly, and must properly manage and document operation and maintenance of the facility and must comply with all other conditions of 15A NCAC 8A .0202. Semi-annual operator reports must be submitted to the local health deparhnent each year. phone 336.597.1790 fax 336.597.7808 20-B Court Sireet, Roxboro, NC 27573 �� 3. An ORC shall be required for the duration of this permit. The Permittee shall submit a copy of the executed contract or notification of employment with the designated ORC prior to the date of Operation Permit issuance. Notification of any changes to this contract or a change in the system ORC shall be submitted in writing to the Local Health Department at least 30 days in advance of the change. . 4. The daily application rate shall not exceed the long term acceptance rate of O��'"gallons per day per square foot of drainfield trench area . 5. A suitable, year-round vegetative cover shall be maintained on the disposal areas., Clippings and other landscape debris shall be removed from the disposal area as needed to prevent thatch buildup. No traffic or other equipment shall be allowed on the disposal fields, with the exception of mowing equipment, without the permission of the operator and the Person County Health Department. The application of chemicals to the distribution fields is prohibited. 6. No surface water shall pond over or around the nitrification fields. III. MOIVITORING AND REPORTING REQUIItEMENTS a 1. Any monitoring (including groundwater, surface water, soil analyses) deemed necessary by the Local Health Department to ensure surface and , ground water protection will be established and an acceptable sampling reporting schedule shall be followed. 2. An on-site record shall be maintained of all residuals removed from this facility. This record shall include the name of the hauler, permit authorizing the disposal� or a letter from a municipality agreeing to accept the residuals, date�the residuals were removed, and volume of � residuals removed. • 3. A maintenance log shall be maintained at this facility including but not limited to the following items: _ . a. Visual observations of the plant and plant site. � b. Record of preventative and repair maintenance completed. ' c. Dates, times, and duration of site visits. 4. Noncompliance Notification: The Permittee shall report of telephone to the Local Health Department, telephone number 336-597-1790, 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 occurrence at the wastewater treatment facility which results in the treatment of _ significant amounts of wastes which are abnormal in quantity or characteristic, such as the dumping of oil or other engine fluids; , the known passage of a slug of hazardous substance through the facility; or any other unusual circumstances. b. Any process unit failure, due to known or unknown reasons, that render the facility incapable of adequate wastewater treatment such as mechanical or electrical failures of pumps, etc.. c. Any time that self-monitoring infortnation indicates that the facility has gone out of compliance with its permit limitations. Persons reporting such occurrences by telephone shall also file a written report in letter form within five (5) days following first lrnowledge of the occurrence. This report must outline the actions taken or proposed to be taken to ensure that the problem does not recur. When repairs are needed in accordance with-NCGS 130A-334(9)(a) and 15A NCAC 18A .1961(c), the permittee must obtain a repair permit from the Local Health Department prior to making the � repair. � �' I IV. GROUNDWATER REQUIltEMENTS 1. Any groundwater quality monitoring as deemed necessary by the State of North Carolina, Department of Environment and Natural Resources or the Person County Health Department shall be provided. Any groundwater samples required shall be analyzed by a state certified lab. 2. The COMPLIANCE BOiJNDARY for the disposal system is specified by regulations in 15A NCAC 2L, Groundwater Glassifications and Standards. The Compliance Boundary for disposal systems constructed after December 31, 1983, is established at the property boundary. An exceedance of Groundwater Quality Standards at or beyond the Compliance Boundary is subject to immediate remediation action in addition to the penalty provisions applicable under General Statute 143-215.6A(a)(1). 3. In accordance with 15A NCAC 2L, a REVIEW BOiJNDARY is established around the disposal system midway between the Compliance Boundary and the perimeter of the waste disposal area. Any exceedance of standards at the Review Boundary shall require remediation action on the part of the Permittee. V. INSPECTIONS 1. The Pernuttee or his designee shall inspect the wastewater treatment and disposal facilities to prevent malfunctions and deterioration, operator errors and discharges �which may cause or lead to the release of wastes to the environment, a threat to human health, or a nuisance. The Permittee shall keep an inspection log or summary including at least the date and time of inspection, observations made, and any maintenance, repairs, or corrective actions taken by the Permittee. This log of inspections shall be maintained by the Permittee foi. a period of three years from the date of the inspecrion and shall be made available upon request to the Local Health Departrnent or State or other permitting authority. 2. Adequate inspection, maintenance, and cleaning shall be provided by the Permittee to ensure proper operation of the subject facilities. 3. Any duly authorized officer, employee, or representative of the Local Health Department or DENR may, upon presentation of credentials, enter and inspect any property, premises or place on or related to the disposal site or facility at any reasonable time for the purpose of determining compliance with this permit; may inspect or copy any records that must be maintained under the terms and conditions of this permit, and may obtain samples of groundwater, surface water, or influent wastewater or effluent wastewater. VI. GENERAL CONDITIONS 1. This permit shall become voidable unless the facilities are constructed in accordance with the conditions of this pernut, the approved plans and specifications, and other supporting data. 2. 'This permit is effective only with respect to the nature and volume of wastes described in the application and other supporting data. 3. An Administering, Inspection and Compliance fee may be established by the Local Board of Health or DENR. 4. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee to an enforcement action by the Local Health Department or DENR. �,�- 5. Prior to a transfer of this land to a new owner, a notice shall be given to the new owner that , provides full details of the materials applied or incorporated at this site. . �� . 6. It shall be the responsibility of the Permittee to notify, any subsequent owners of the requirements contained within this permit, including the requirement to contract with or employ a management entity. 7. The repair areas as designated herein, with setbacks, shall be maintained in an undisturbed state. 9. The issuance of this pernut does not preclude the Permittee from complying with any and all statutes, rules, regulations, or ordinances which may be imposed by other government agencies (local, state, and federal) which have jurisdiction. 10. The Permittee for the life of the project must retain a set of approved plans and specifications for the subject project. j 11. , � :j � I . .. . ._. ...._..._..T...___......__......._...� _.__ _ ................__.._ . The Permittee, at least six (6) months prior to the expiration of this permit, shall request its extension. Upon receipt of the request, the Local Health Departrnent will review the adequacy of the facilities 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. __ .. _._. .__ .. _... - -.--;, � Y ' � . '� . � . � I� �LES E3. CRISP . 133, P. 466 � � 16a'a3 1 ° 5� ` �8" �6 23, : � . � , / io - �-" o � N ^ s4, EXISTING GRAVEI_ DRIVES 8 PARKING CHARLES B. CRISP D.B, 133, P. 466 �� . �' j�'F �\� EXISI�ING F'rI `�1 �1 � ' � PAVEU B�I�� Iiy�� `' � f)RIVES 8 Iiy�, Q � l� �\ � PARKING � � � J 9.20' 42'32" � w , ,,; � o, ` � � � � N F e (O � O ` Z • `nys'o -o �� o N �- 34� � � � , . a � .�— — — - o � J . � o��-�- , � � ` • •, � � eksr N � , � - I � '�� 'e�0 \ \ .\ � � ''� � EXISTING � � ` '` \ �. � YARD & � . � 1 \\ (_r� \ �\ WALK AREAS E PAVED G � � � DRIVES 8 .�� w � � PARKING \ � I °' ^ � \ � � / �- `� . � � � � � �� ° � � � �� I PLAY f o � � \ �� GROUND � Z \ � �O \ •.\ �� / AREA ' � \ i �� '� EXISTING � / � \ YARD 8 .• I � \ WALK AREAS � / : � \� � � � • / � I \ \ \ � ._ , �- _J � �` [%l.�i��i�vv \ ClX1J1 l�V�i \ / -_----�_ PAVED� PAVED v � � DRIVES \�DRIVES 8 � EXISTING PARKING � \ �PARKING RA.VEL � � �.. G \ \ \ DRIVES & � PARKING \ \ � �-� � . � \ \ j . \. � � ` � � � • � ` I �� - ! � � � j � .\ �, \ \ . ' � . \ \ \ \ \ �� ' S. � \ � � �XI ING � \ ! - � 6�16 AC.�=�-'� ! fF�ARCEL rn � � �, , ! 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G�rwwey. s�,+tira e,a t�e , sre.t. �� C.o�e1 ' : �NC1iCilU �►ii!f. ��p��T[tlM:� � _..,.. _ . a`�r 4sus� Fl�s #Cil�t rJ4�isr.M_�....r�..y ...r�ir ��} r_�on : t�o�: �I�!' M � i�/q► .... _.... .........._�..... a�wM� raiY. w n • ( f_MdCiTV�lF �'"�'�°� ixtinde-1�rc�stud� raurae� CiPS Tc�r��aDh►� m�tP id,oe,arkrr a/ tivf/ :�wqr Ia yl�swar e+A s Lk'i'C.T%/o� �pr erwd c�t vnlw! ro rAo r4wwr �/'�/ r►u� 'L'PS.I �s. � A K��LxTi T�r AYl�e d M� w�f► i!� w�q M'10�'�!f Ci�llfa 8�l �6Hl. :�i, n�ar�:m• ..a. wa+M: awwle�s 1b. +.sa arw � aatr. i P.�CIt.17Y t!3 At if yy eJ n •.,rsx�. Gr� FA�'JLCi'1 ��,�GiJ6L.iGl7+_..ICQ.�.s�:.:�t9:�... ST' 'i'TxC`�R.idSS.��.,,f3��.,[„i�%�/��_d� ..... _...__ , - _,.,...� .._r....._..___. �.��_._._ �:,� a r�,�,: ` a� C� 4r. cn�rr�►cY r�r,asc�. u owxs�: :..,� ._...,�??��:��..__...� . ....... ..� _. ;;' �T A1WKF35..�5 4�.�f� ��._........ ..._.. h��.�'!.'�:�.�....._r� .. ��.s�.�____ l. �ir Yr t p•�ta iN1l --•ZIR ��OCC �-��_� .�.��...�..a� _ ��s. red.. hlo.nrr r�..rs,.: f. '�Y�7.6 AtT'Ablld: � 'r� �=.1s�.�_.. n. a�e. ��R S. U1MMLtt�et (8tlo.. Mtsaw'itc� tarrtl• �,�V ei l�Icaaara� pamt i� ,�„_� .�.-„� irr�c! s.+ni�c: � ��. s CawwtD�rp+t+vrt�«e�: b. Csua� Rewav� c.rr�sh a;amc�r _L.� _ � ( �`_� . �� .�.. Q..._ '� _. _ _... �" �. oaa.i+��sr�no�: S'az C�c.�x-��e. (M�ount ot63•.a.'J'w cais�an r.yroch►ae++e e�udl s. �u►u�+c ��nwuwi.: � C�we� �,,,,,,,,,r,� ib W�....,,.......�.. �• � �it• ,�.,�„��,,,,, le. Trvr. �," Rtwu_. w,cu .__._. �+�. F""T�""� l:cnnrx_,r,,,�,�tr, W ass� p � S�s � TYpt �t _�. �.. ;�u� %�.ZC.L �►n�orm+�c�R�„!Z-'�:5.. M J.,�.�l�J. ►. h 1►aT 01�' CMt1.�CF�' UY� MA��y'I[pAl • d?....�� Gs"�..Lc4lt4-..��',l� p� '�. �Mii.�.:K�Oi�A�1'i: if'RM� a dh1�i19f1 Mt�1Ek d"� 13fi 4�a±) uR Ibr L�Mcit wt �a# (Ce:+� alnrat� w4! dc'ptR. �e�tl+ and Q'laax+lir a�[ u�tat � if aer) titn�t+mr.�; ia �As.sil. p�wi i�rvst. i�orosla� af ca�i� ysstcu�:;uni. trd �r� ati.� ty� er'l5�t �nr�rWi we. fA. pA71C ENi1�.f�.I►sMi�iJW��... 0,�� r�..�,......_.. i OO 1tYCfJtTdY S�tar tKtt wi4.. w�s.►1*�'Lt)xfD t+:.►CCt,�tGsnGr 1S MAC'lC, W'j.il CGR!#TR.t,KTH)�I i7AuK'A,�L1;. A`rG 7�A'C A Ci:M't +fap iti MA�t 8�?tf�R�vl6�SD TCl ft+'E Wfii.Cl1�:'1vk�� L � Ia-r1"G' %' i�w Ovs6�t.stxvr�l!at'7'K�R ' u�►�. .�._._..�_ fErJ�1 C! ATZ M�R�1. G�N�'Ni� A�1+INDONING iNl ti176.l.Y. YA75 n weq evrNr a�w1 M a� i�6riM1 Wti � sirr�irn�s l�,t;!�w ,r,eea.e+ w�. �* ��s Nc�ttc.oir►, �iJ ��,►AliKi �AAwi�fiblV:hi� .....�LL ...... . �vir�N � c+�7 !w t� �ww� esd tAs �t4sisal I� t►� �liMs �f M�esr CjAt+elk'y w1t►fa kQ 1bn 6atr� c;�t'. ;4 a:•�. Tase►rw�thrt+ rl+rra�t 1 t17 i�Mall �stvJe� GraMt - IRe1�i�L, NIC 27N*•!it 1, 1Yaw N�, (fI9}?33.7A1:� ess fii Itc. :. • �G ri. Y z � U F- � W � � Q U W � d R O T � INLET 4soo us c�.LLor�s H2D TR.AFFIC �tATE� P�i 1P TANK YY �, — t67' 155' S� 97' S1' .. .. . _ .. . - -�: :'"', ''•%:i 'r .; :':''' _;�' �'' _ , 107' TU 807'fOM .•' pF b• tNLE7 �. lOb' �'` F[] BdTTO�i � OF 6' iNLET ' r �' :j .�. ti. SN[1AF PRECAST SEPTIC INC. 4130 WEST US HWY E,4 LEXINLTON, NC 27293 ?HOt� C336) 787-5826 FAX (336) 787-2925 _ Sfi�AF-450D N20 TF2AFFIC RATED P7-499 H2� TRAFFIC RATED _ LENGTH Tq WIDTH RATIO-2 TO 1 ' iYP� 0� INLET ��UT�ET-4' T� 6` PIPE TYPE 13F INLET & qUTLE7-PRESS SEAI. GASKET OR �Qt1AL LIQUID CAPACITY-�500 US GA�.L�NS � AGc�ss NAND�E-#4 REBAR I7R EGKJAI U� �' TAtvK HE[GHT-115' � ETS 6 fLE7S BCJTTOM D� TANiC TO CEN?ER QF INLEi-109' fDOTTOM OF TANK TU CENTER � f�l1TlET-t08' C�ICRE7E PSI-500� . 7� APPROVAL � 66' StiOAF-4300 7�PT-499 . �UTL.ET � 7• / �; -- ,� .� 41' �4'X 2 !; VENT ;:� '�� 'r �, ' ,� 119` 23' ' ,; 103 i ..� y� i � � :r 41' :� � d4' x 2 . � � •a ,, Q . .r�si: •• •!.J�� j. •• i•• ' �� %.�..`. ,n. •�, _?� •'+; .� �•� ';: ��: '� � 1 f •w', � I03' T� BLiTiE3hl' OF 6' QUTLEi . 104' TCI BOTT�M �F 4' OI�TLET _ __ 7� d . ��µ. �� ..� �� _ _ �� ._ �' � cC��.T�T�� • �� ( ��o � � �� . r��r�� -��..�.�� .��. � � o . o 0 0 Applicant: /v`T � 2�n - t�� , . . . Locafion: � ; �, ,►� � � I - � . . .erati�n erm it � t� e��.�,��, � � . System .Type (in Accordance Wifih Table Va): � THIS SYSTE3Vt HAS BEEA! INSTALLE� IN COMPLIAiVCE WITH APPLICABLE . NORTH G'�ROLI�lA GENEF.�►L STlkTUTES, �RU�ES FOR SEWAGE TREATMEi�T AND DtSPOSAL, • AND • ALL CONDITiONS OF ' THE lMPROVEMEAIT PERMIT l�ND COiVSTRUCTION AllTH (ZATION. - � . � � !o : �g � . uihorized St�te Agent � Date . installed. By: J• (�l�T~� pv� Date: �'f'�'�� % . . . �' . . ��1� ��y . �P��S c� � . f r n�s � . 'c7 1 � ' n7� � 'f�oM ��'��YQ�✓� �l -� � �,�`�lc �°� -� �� Gt,,,,,�Yi � r L"�}`�r-�' l��'�� . O° �? � � �~, � �� N � 5 . J��-, E-e ir��^ . - U� � Z�i .� � � � ' `'r 4.�' °�* � � .� � °� � ^� N � . ` � ; ; s � .:� ' ►� q�r � i�E`� N �� p� fj ��Z`� Sc�" gd �qr' S � s �c�' <<��5 � G p�ct�S W� sf r� t�F� J PCHD, rev. 07/2Q/01 � �� -nc �°�� '�v� ��t��..9sz �'�� - i� Tax Ma� #� Parc�! #_____�_ Sysiem Type (Tab�e Va} OvsmerlAppiicant � � Subdivision Address/Location SeclPhase Lot # � � �e��ic. T'�nk Inita�l ai� otra ��iion n� � In��a a� � State �lD/date -30 -v 5 (� � � � ✓ Trenct� il1lidth� 3 � ft. 5 � ,,� , Ca aci , l,00,� a ai. ' � Trench De th 2 in. Tee and Filter � � �✓� Trench Len SS'� ft. � Baffle . ' � Trench G�ade � � � Sealant � Trench S ac9n � �..� � Riser ifi a iicable �� Rock De ih and Qual" �✓ • ��''ank Outlet Sea! �� Dams/Ste down� etc. �-- F Permanent Marker Pressure Laterals � �� . Purnp Tank • � Hofe S acing . �`�^ �+.,+., e r. �., � ryr c./� o e IZB --"� Riser Water Tight � � � Purn Checic ValvelGate � au�ible � Rate m ., . A proved Pump Mode! Blocic Under Pum � Pum Removal �Ro e/C . � Dis�ibution:Sys� � Serial Distribution Pressure an o �ow P.ressure Pi e A r. Pi e l�iateriai and Pi e. Sleeve � � � � Turn- slP.rvtectors . �- Re uired� Sefbac� From� Wells � 'S � From Prooertv lines � � � �Surfaee Waters Pubiic Waier Su 1 Vertical Cuts >2 ft Water Lines � , �Ea$ements/Righf of W� . Oth�a� � Easements Recorded . ,_ Cc�amen#� � � 1_ , � . . 5 r�R S�. � � `��' . � ( 0-� (P • S t Oc��? � �� s�--� ��z . pchd rev. 3/13/0� � `_ � IY. C. DepaRment of Environment and Natural Resources Division of Environmental Health INSPECTION OI+ ENGINEERED SUB�7RTACE WASTEWATER SYSTEM ��s'� Health Department �� Location / G� Owner/Agent �� Operator , ,r Name 1. ESTABLISHMENT: 'fype, size, and sewage flow in accordance with permit? ...................... 2. COLLECTI01v SYSTEM: No evidence of leaks into or out from sewer lines/manholes? ............... Free of blockages/solids buildup in lines or manholes? ........................ 3. TANKAGE (Grease Traps/Lifi Stations/Septic/Dosing Tanks): Tank risers accessible and surface water diverted? ............................. .. 7'anks and access manholes swcturally sound, watertight? .................. Sanitary tee(s) in good working condition? ........................................... Tanks pumped, cleaned oui as needed? ................................................. 4. RAW SEWAGE LIFT STA7'ION (if present): Required pumps present, operating, and cycling properly? ................... High-water alarm present and operating properly? ................................ Floats/pipe/valves/disconnects in good working condition? ................. Control panel enclosure/cornponents in good condition? ...................... 5. EFFLUENT DOSING SYSTEM: L-ffluent appears ciear, free of excess solids? ......................................... PUMP SYSTEMS: Required pumps present, operating, and cycling properly? ................... High-water alarm present and operating properly? ................................ Floats/pipe/valves/disconnects in good working condition? ................. Control panel enclosurelcomponents in good condition? ...................... Elapsed time readings: SIPHON SYSTEMS: No evidence of overflow or siphon leakage? .......................:................. Siphon(s) appear to be workina/alternating properly? ........................... Bells and vents free of debris and in good condition? ........................... 6. GROUND ABSORPTION FIELDS: No evidence of effluent surfacing/reaching surface waters? .................. Minimal ponding in subsurface trenches? ............................................. Surface water being effectively diverted away? ..................................... Diversions/ditches/swales/tile drains properly maintained? .................. Line cover/vegetation adequate/maintained as needed? ........................ Protected from traffic, destructive uses? ................................................ Distribution devices in good condition, working properly? .................. Repair area properly reserved, maintained? ........................................... LOW-PRESSURE PIPE DRAIN FIELDS: Tumupslcleanouts/valves intact and accessible? ................................... effluent standing in lower laterals? ......... ................................ Laterals free o ex ' out as needed? ........................... Pressure head i perly adjusted? ....................................................... OVERALL CONDITION AND OPERATION OF SYSTEM: Im rovemcnt /vn of Establishment � 1 ■ ■ % ■ II ■ � ■ (/ ■ � ■ G ■ I ■ Vi ■ �/ ■ U ■ w ■ % ■ I/ ■ I�I ■ ■ �I � ■ N ■ ■ G � ■ /. ■ � ■ II ■ i1 ■ � i I/. ■ ■ ■ SUMMARY OF INIPROVEMEnTS NEEDED: REMARKS Permit/Project No. � Design Flow Phon�� —�; Phon`� - ��id P Repair �Vithi�� (Days) �i� _ � �s � �s GL = l/yo DATE: �,�,,� d � �1�� SIGNED: DENR 3',0? (Rz��sed J:98) / /� / /y OmSite Wastewarcr Section (Review 1:;98) / n^, /�.-.'� U� ui � — over — Division of Environmental Health AGENT �� sf �� . �_. . �� ,� ��.��.� ��.��.� WELL PERNIIT PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Taac Map �� Parcel #�_ Township: Applicant: �k. �,�-. �V12�,�u�� C�.�-. Subdivision: Lot # Location: Is'7 � �Fo 4-�.� h,�.,��e —� �- � �'Qo,_f (� � � c�..,,.� �.. (_�- Type of Water Supply: ✓ Individual _ Community Requirements: Z Site Approved By: ✓ C� i7, ry -o� � a�. Grouting Approved By: CS �r.-l�/-o� ��' Well Log: � v1��'� Pump Tag: Well Tag: Air Vent: Hose Bib: Casing Height: Concrete Slab: Well Driller: }��,,;�� (,JtC.Cr ��1C�.�4 Well Approved by: ****See Attached Site Sketch**** Public Liner: Installed by: Depth set: _ Grouted• _ Date: Water Sample: Wells must be 10 feet from property lines. � Wells must be 100 feet from septic systems� Wells must be at least 25 feet from any building foundation. Other conditions: Date: PCHD rev O1/27/04 �...�_ � '� ,1", �� ]��a. V ~ / �^ � ' � •W � I�azvaa-��a�aaoaa i�-3laa,e�.Il�3-a D��lI�� LD " / � � Cfi)I11�)�itl�� ri'�ItTll' I . / // L � d' ;lt� �1 i:l�t. (j � � Well Log � IM�, Z.►v�n IMP-�hc�%� C'��,�.,s.� Tax �.1�Iap �{,1 Parcel #$_ �ocarion: _� s� 5-��.._ 1-��i,�� 1-P �.�1 S�) r� r� G a.� �GN G�� h,r i,. ., :� (l\ ubdivision: Llot # � Well Constrnction ��ce From neare.st Property Line (Miaimum 10 fcet) _ I a Distance from Segtic System_ (Minimum 60 fees) I UQ" Total Depth: t Ca5 ft Yield: o2U �M Static Watcr LeveI: $ Water Bearing Zones: Depth � 10�toZ0 � s fi ft C�a�ing: C� 3 L�epth: From 't" ( to C¢ � ft. Diameter: �t �`� � Type: Gatvanized Steel 'Weigh�.Ul, 3 t� Thiclaiess: . O1 s�� Heigh# above Cxround � a2 ia Thive Shoe: �Yes No Any proble�ms eac;ountered while set�in g c;asin g? Yes ✓No If "yes" giva reasan: Grout: � �i�, � �ixt�- C�'4f NCat: V Sa.ndlCememt Concrete GraveUCement Annular Space Width inches Water in Annular Space Yes X No Method of Grout: Pumped Pressure Poured Depth _� to�3 _ F� ?4luterixla LTscd: No. Bags Portland cemeat Weight of 1 Bag �� Pounds If mixt�ue (s�ad, gravel, cuttiags) — Ratio to ID plates: �� Yes ____ No 4 x 4 slab � Yrs ____ No Drilling Log Lors►tion Drstwing From To Farmatioa Q �2Q,rt t � � p [ (� lC ' 1 t � G t�ari.�,�. �l q �...0 L C� �- }------ I hereby certify that the above information is correcL and that this weil was constructed in accordance writh re8ulations s�t forth by +he Pnson County Health t3epar#men� �n ��l�.� � �].2it .ht� ID # ��% a D ate f a - / � ' l�� Si ature af Cuntractor PCHD rev O1116,'Ou N. C. Depanment of Environment and Natural Resources Division of Environmentaf Health INSPECTION OI' �l�'GIi�'EERED SUBSURFACE WASTEWATER SYSTEM l' C''i':-I On Health Department ,' � Locat�on � - Owne / � nt 1 Operatcr Remarks "fype of Estab]ishment l. ESTABLISHMENT: Type, size, and sewage flow in accordance �vith permit? ...................... 2. COLLECTION SYSTE141: No evidence of feaks into or out from sewer lines/manho(es? ............... Free of blockages/solids buildup in lines or manholes? ........................ 3. TANKAGE (Grease Traps/Lift Stations/Septic/Dosing Tanks): Tank risers accessibte and surface water diverted? ................................ Tanks and access manholes structura(ly sound, watertight7 .................. Sanitary tee(s) in �ood working condition? ........................................... Tanks pumped, cleaned out as needed? ..................... ............................ 4. RAW SEWAGE LIFT STATION (if present): Required pumps present, operaYing, and cycling properly? ................... High-water alarm present and operating properly? ................................ FioatsJpipe/valves/disconnects in good working condition? ................. Control panel enclosure/cotnponents in good condition? ...................... 5. EFFLUENT DOSItv'G SYS'iEM: Effluent appears ciear, rree of excess solids? ......................................... PUMP S;'S7EMS: Req�ired pumps present, operating, and cycling properly? ................... High-water alarm present and operating properly? ................................ Floats/pipe/valves/disconnects in good working condition? ................. Control panel enclosure/components in good condition? ...................... Elapsed time readings: SIPHON SYSTEMS: No evidence of overflow or siphon leakage? ......................................... Siph�n(s) appear to be workin�/altemating praperly? ........................... Belis and vents free of debris and in aood condition? ........................... 6. GROUND ABSORPTION FIELDS: No evidence of effluent surfacing/reaching surface waters? .................. Minimal ponding in subsurface trenches? ............................................. Surface water being effectively diverted away? ..................................... Diversians/ditchesiswales/tile drains properly maintained? .................. Line cover/vegetation adequate/maintained as needed? ........................ Protected from traffic, destructive uses? ................................................ Distribution devices in good condition, working properly? .................. Repair area properly reserved, maintained? ........................................... LOW-PRESSURE PIPE DRAIN FIELDS: Tumups/cleanouts/valves intact and accessibie? ................................... No effluent standing in lower laterals? .................................................. Laterals free of excess solids, cleaned out as needed? ........................... Pressure head is properly adjusted? ....................................................... % ,',- "i AGdress YCS �0 ❑ ,- � i � ■ r/ ■ rI ■ � ■ /I ■ V ■ // ■ // ■ %� ■ % ■ ri ■ II ■ ■ G I � r ■ � ■ ■ / ■ ■ ■ ■ ■ OVERALL CONDITION AND OPERATION OF SYSTENt: L� ��I ; q�e �(� �' C - �9L—�t �c�f SUNINIARY OF INIPROVEMEnTS NEEDED: Impravement REMARKS PermiUProject No. Design Flow / Phone �, Phone Repair �Vithin (Day�s) DA'TE: /��,��. �, �O/7SIGNED: � ' �� AGEI�T � oc�a _'o: i�e;��ed �;vy, Div�sien uf Env�ronmental Health C`.r-Sife',Vasiewa�erSrcven(Hev,e.i- 1=:9F? — OVZC —