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A23 209SERVICES, April 17, 2013 Lorna Withrow NCDHHS-DPH-OSWP 1642 Mail Service Center Raleigh, NC 27699-1642 i��'�9l��.� APi� 2 5 2013 D��S OPd-STi� a`�ASTE6YATE� RE: Review of Proposed Subsurface Drip Wastewater Disposal System Clearwater Subdivsion - Lot 12, Margosian Property Semora, North Carolina Project No. 2013-11 Dear Ms. Withrow, On Apri19, 2013, Soil Services, PLLC received your comments on the wastewater system designed to serve Lot 12 in the Clearwater Subdivision. Soil Services has reviewed your comments and made the appropriate revisions and responses. The responses are as follows: General 1. "Project Description" (p.l of 3) revised with correct language. 2. Language revised on p. 2 of 11 in "Equipment Specifications". 3. Side fed detail removed from p. 8 of I 1 in "Equipment Specifications". 4. Language revised in item 11 of "Design Specifications". Specifications and Calculations 5. Doses were changed to whole numbers based on the recommended doses from American Manufacturing and the design daily flow. Revisions were made to item 25 of the "Design Specifications" as well as the Calculation Summary and TDH Calculations. 6. Language added to item 36 of "Design Specifications". Phone: (919) 745-1928 www.SoilServices.org Fax: (919) 554-1869 7. Zones are dosed alternately as indicated on p. 1 of 3 of "Calculation Summary". Language was also added to item 26 of the "Design Specifications". � 8. Buoyancy calculations were added to the "Design Calculations". 9. Language added to item 3 of "Design Specifications" 10. Language added to item 4 of "Design Specifications" 11. Buoyancy calculations were added to the "Design Calculations". 12. Trench details were added to p. 8-10 of "Equipment Specifications". 13. Valves shown on p. 10 of "Equipment Specifications". 14. Cleanouts and elevations aze shown on p. 9-10 of "Equipment Specifications" and language was added to items 35 & 41 of "Design Specifications". 15. Language added to items 6, 8, 9 of "Design Specifications" and labels were revised on p. 3 of "Equipment Specifications". 16. Language was added to item 10 of "Design Specifications". 17. Language added to item 24 of "Design Specifications" as well as p. 3 of "Equipment Specifications". If you have any questions or additional comments, please contact Sarah eeler by phone at 919-896-1607 or email at sarahwheeler@live.com or John R.�-in ��p�� jackharman53@gmail.com. �t� � �.• .��1 ,, �, Sincerely, S ah eeler, LSS Soil Services, PLLC cc: Kevin Neal - OSWP Regional Soil Scientist Adam Sarver - Person County EHS 981U J�• %��ti�NGINE ��`�:T ��4 �y h......... �r g., N � �.. •., R. HP ��. �� ,,,, ,..... 1 John R. ��arman, PE Environmental Engineer SOIL SERVICES, PLLC PO BOX 91 I I 5. RALEIGH, NC a 27675 Single Family Residence Subsurface Drip Irrigation System �� r;, �� £1;; M � ; �� o► �,� ��°; ��; �i �e� � � �_3 � �� "�`' � `r; � � � �°�' �l.� o i :� '� � � � � � �;s -� � � �, � �� -- � � � c� m ��`�N�� v ��a��o�'�FE�� y Sr :=jl� � 'i�i ' 'a� SLA1ue�ii �y: . 9 ; 9810 : ':�,�O��yNG.N��`'. e' 3' R. H �!s �� a�s��n � John R. Harman, PE Clearwater Lot 12 PIN: 9080-01-06-5900 Person County, NC Project No. 1146-1 March 27, 2013 Revised April 17, 2013 Designed By: Sarah I. Wheeler, LSS Pho�e: (919) 745-1928 wvwv.SoilServices.org Fax: (919) 251-9053 Project Description Background A five-bedroom house is proposed for construction on the Margosian Property, a 6 acre tract in the Clearwater Subdivision in Person County, North Carolina. The site contains soils suitable for a subsurface drip irrigation system (see attached soil report). The system consists of a septic tank, pump tank, recirculation tank, two Advantex AX-20 pretreatment units, Perc-Rite drip irrigation system, Perc-Rite (15 gaVmin) pressure compensating drip irrigation tubing and necessary appurtenances. � Based on the recommendations of Sarah Wheeler, LSS of Soil Services, PLLC (Soil Services), a subsurFace drip irrigation system has been designed to treat site wastewater. The estimated daily flow for the proposed five-bedroom house is 600 gal/day (120ga1/day/bedroom). The proposed wastewater disposal system shall be designed in accordance with 15A NCAC 18A .1900 rules and shalt meet the requirements of Innovative Wastewater . System Approval No: IVWVS 93-1-R6B and Approved IVWVS 2004-3�/2¢ �.��3 s��•� Septic Tank, AdvanTex� Recirculation Tank, and Pump Tank Effluent will flow by gravity through 4-inch Schedule 40 PVC into the septic tank. The tank shall be provided by Premium Tanks and Stone (ST-460) or engineer approved equivalent. The septic tank will provide anaerobic treatment and solid removal for the wastewater disposal system. The septic tank shall shall be a minimum of 1,500 gal liquid capacity. This tank will contain an Orenco Residential Biotube� effluent �Iter to prevent any solids from entering the recirculation tank. The effluent will flow by gravity into the recirculation tank. . The 1,500 gallon recirculation tank retains the septic tank effluent and the recirculated AdvanTex� effluent for the pretreatment process. The tank shall be provided by Premium Tanks and Stone (ST-252) or engineer approved equivalent. An effluent splitter valve is located in the recirculation tank, which allows the effluent to circulate from the tank to the fin►o AX20 AdvanTex� units and back to the tank. Effluent will continue to circulate until effluent from the septic tank enters the recirculation tank. When the splitter valve is closed, it will allow the pretreated effluent to enter the pump tank. As the pretreated effluent flows from the pretreatment unit into the pump tank, it passes through the UV disinfection unit. The pretreated effluent will be temporarily stored in the 1,500 pump tank. The pump tank shall be provided by Premium Tanks and Stone (PT- 252) or engineer approved equivalent. Clearwater Lot 12 Project No. 1146-1 Soil Services, PLLC Page 1 of 3 The pump will dose the disposal field once every 3.52 hours during average flow (6.8 times a day) and once every 2.12 hours during peak flow (11.3 times a day). As the effluent is pumped to the dispersal field, it passes through the headworks unit. AdvanTex� AX20 Pretreatment Units The two AdvanTex� pretreatment units are recirculating media filters. The units will provide biological treatment and removal of suspended solids in addition to the treatment provided by the septic tank. The AX20 unit consists of the unit housing, vertical geotextile sheets, low pressure pipe distribution, and an underdrain. Filtrate from the AdvanTex� flows by gravity into either the re-circulation tank or the ultraviolet (UV) disinfection system dependent upon the re-circulating tank level. Perc-Rite Drip Irrigation System The drip irrigation system is controlled by the headworks unit, which is the "brain" of the system. The headworks unit contains solenoid/zone valves, flow meter, disk filter, dosing pump, and control panel. The headworks unit monitors flow rates and regulates outflow and inflow. The control panel houses the system controls that determine when the pump doses the dispersal field. The panel controls dosing and flushing and monitors dose cycles, dose duration, power failure, high level alarm events, and peak timer events. The disk filter provides further filtration to insure the drip emitters do not become clogged. The filter contains a stack of grooved discs. Incoming effluent is forced through a labyrinthine passageway on its way through the filter element. The solenoid valves open for dosing and/or for each zone dependant upon the dosing/flush schedule. Perc-Rite Pressure Compensating Drip Irrigation Lines The drip irrigation lines receive pretreated effluent from the pump tank through the hydraulic unit. The lines are'h - inch diameter hollow tube lined with pressure compensating emitters spaced on 2-foot intervals. The emitters allow a flow of 0.61 gallons per hour. The lines are installed on contour with a 2-foot horizontal spacing (minimum) at 6 inches below the ground surface. The lines make a continuous loop back to the septic tank to allow flushing. Clearwater Lot 12 Project No. 1146-1 Soil Services, PLLC Page 2 of 3 e, Pat McCrory Governor North Carolina Department of Health and Human Services Division of Public Health May 2, 2013 Adam Sarver Person County Environmental Health 325 South Morgan St, Ste C Roxboro NC 27573 Subject: Approval of Revised Plans and Specifications Proposed Subsurface Drip Wastewater Disposal System Clearwater S/D - Lot 12, Margosian Property, Semora, North Carolina ` �� Project Number: 2013-11 Dear Mr. Sarver: Aldona Z. Wos, M.D. Ambassador (Ret.) Secretary DHHS Laura Gerald, M.D., M.P.H. State Health Director On Apri125, 2013 we received from you, three copies of a revised submittal package compiled by Sarah Wheeler, LSS (Soil Services, PLLC) for a proposed wastewater system with subsurface drip disposal. The proposed wastewater system is to serve a five-bedroom house to be constructed at Clearwater Subdivision - Lot 12, located in Semora, North Carolina near Hyco Lake. We have reviewed revised engineering plans and specifications for the proposed subsurface wastewater system and it appears that all of our previous technical comments have been adequately addressed. One "pen change" was made with the consent of Ms. Wheeler (given in an April 30, 2013 phone conversation). The "pen change" to correct "IWWS 2004-3-4R" to read "IWWS 2204-3-R4" is located in th�e last sentence of the "Background" section on page 1 of 3 of the "Project Description". Enclosed you should find one copy of the plans and specifications, stamped "Approved by the On-Site Wastewater Section, Division of Environmental Health, Department of Environment and Natural Resources." The Improvement Permit and Authorization to Construct to be issued for this new system must include the approved plans, specifications, System Operation and Maintenance Plan, legal documents and any other conditions deemed appropriate by the health department. The approved plans and specifications are for the following facilities and system components: F�cilities: Five (5) bedroom house Svstem: one 1,505-gallon septic tank; two AdvanTex� AX20 units; one 1,578-gallon recirculation tank; one single-bulb UV disinfection unit; one 1,578-gallon pump tank; drip headworks and hydraulic control unit; two subsurface drip dispersal zones (Zone 1— 8071inear feet, Zone 2— 8201inear feet); LTAR = 0.19 gallons per day/square feet www.ncdhhs.gov • www.publichealth.nc.�ov • http://ehs.ncpublichealth.com/oswp/ Te1888-251-5543 • Fax 919-845-3973 ��Location: 5605 Six Forks Road • Raleigh, NC 27609 � ,� Mailing Address: 1642 Mail Service Center • Raleigh, NC 27699-1642 �9`:• An Equal Opportunity / Affirmative Action Employer �bi H�iri� Clearwater S/D — Lot 12 1NIay 2, 2013 Page 2 of 5 Desi ng Fiow: 600 gallons per day �stem classification: Va, requiring semi-annual inspection by the ORC with semi-annual inspection reports submitted to the local health department and at least yearly inspection by your department. It is critical that the Health Department require a preconstruction meeting be held prior to system installation. Representatives of the Health Department, the owner, the installer and the engineer certifying the installation :� must attend this meeting. During this meeting, the sequencing of project construction, inspection, and testing activities must be discussed and clearly understood by all parties. Holding such a preconstruction meeting must be listed as a condition in the Authorization to Construct, with attendance required by all key parties �ni-ior to the onset of the system installation. As you are aware, there are a number of times during the installation of this system when direct supervision by the health department must be provided to insure that this system is installed properly. For this project, make certain that: (1) Facilities served remain as specified, with no new sources of wastewater to be added to the system. Water consen�ing measures are to be practiced, including low-flow fixtures (toilets which use no more than 1.6 gallons per flush, urinals which use no more than 1.0 gallons per flush, spigots which use no , more than 1.0 gallons per minute. No garbage grinders are permitted to be connected to the sanitary sewage system. HVAC and refrigeration/freezer unit condensate lines are not plumbed to the subsurface wastewater system. (2) Tanka�e, General: All tanks shall be installed in strict accordance with the approved plans and � .n ' specifications including use of properly constructed state-approved tanks, and paying strict attention to 4 specified invert elevations, water-tightness provisions including specified pipe penetrations, additional � waterproofing, and drainage provisions to divert surface water from the tanks and their access openings. Ensure that access openings and risers are provided as shown and determined to be fully accessible and :i� functional from the ground surface without requiring entrance into any basins. Ensure that all tanks are determined to be fully watertight and infiltration-resistant per the water-tightness tests specified. Do not accept any tanks that have had holes cast into them below the working liquid level, whether patched or not. Manhole rings or hatches are to be bolted and sealed onto their risers as shown to be provided. Wash-down water supplies in tankage vicinity must be provided. (3) Tanks and access openin�s, risers/manholes, outlet tees and effluent filters shall be installed in strict accordance with approved plans and specifications, as well as being in accordance with manufacturer's specifications. Fiiter must be readily accessible from the tops of.the tarik without i-equiring entrance into the tank (access handle should extend to within 12-inches of riser top. (4) All access riser hatches shall be secured by tamper-resistant stainless steel bolts, and inaccessible with � flathead screwdrivers, Phillips screwdrivers, or standard wrenches. Special provisions must be adhered `'��*` `' to for traffic-rated manhole lids to be installed in a manner that does not transmit a traffic load onto the tanks or risers. '��5) AdvanTex Units are installed per the plans and specifications. The units shall be specifically designed to meet NC design requirements, as follows: (i) Septic tanks shall be approved by the state and Orenco Systems�, Inc. specifically for the use with AdvanTex systems. As part of this approval, the septic tanks will have a state approved, appropriately sized Orenco Systems effluent filter on the outlet end of the second septic tank in series (ii) Recirculation tank will contain the recirculating splitter valve and the Biotube screened pump vault. The recirculation tanks shall be approved by the state and Orenco Systems�, Inc. �C earwa�ter S/D — Lot 12 ay 2, 2013 Page 3 of 5 (iii) A drainback configuration without a pump check valve is required for the feed lines. (iv) A single-tube UV unit will be provided on the subsurface drip system headworks feed line and will provide sufficient disinfection to attain the treatment goal. (6) Supply and return lines to tanks must be located and installed in strict accordance with manufacturers' specifications. (7) Pump tanks must include all specified pumps and components, with all hardware of stainless steel or comparable corrosion resistance material. Ensure that all appurtenances, (e.g., floats and float support mechanisms, valves, etc.) are provided as shown and specifed, including the use of corrosion-resistant stainless steel and PVGSchedule 40 and/or ductile iron pipe where indicated. Level control floats must be readily accessible from above grade and installed at specified activation elevations. Control panel is �: to be installed directly adjacent to the tank in NEMA 4X enclosure with wires conveyed from pumps �' and controls directly to the panel through conduit installed in the riser. Wire conduits must be watertight and gastight, yet still enable floats or pumps to be changed without requiring entrance into the tanks. The anti-siphon with check valve should be installed as shown on the plans. (8) Pump deliverv rates must all be measured (for each pump) and determined to be comparable to design specifications. (9) Final dosin� tank must include all specified pumps and components, with all hardware for float supports, access hatches and pump removal chains of stainless steel. Ensure that all appurtenances, (e.g., floats and float support mechanisms, valves, etc.) are provided as shown and specified. Level control floats must be readily accessible from above grade and installed at specified activation elevations. Control panel is to be installed at specified location adjacent to lift station in NEMA 4X enclosure with wires conveyed from pumps and controls through wire conduit installed in the riser. , Wire conduit(s) must be watertight and gastight, yet still enable floats or pumps to be changed without requiring entrance into the tanks. Dosing system appurtenances must be manually checked and controls must be tested for proper automatic operation. The high water alarm should also be tested and ensured to be properly functioning. (10) Site preparation procedures shall be conducted in a manner that results in negligible damage to the dispersal field areas. The Applicant's soil scientist should also be asked to make a field review of site preparation steps, due to their critical nature. (11) Subsurface drip svstem dispersal fields are properly installed in strict accordance with approved plans, manufactures specifications, and American Manufacturing Company, Inc. subsurface drip system __ _ innovative wastewater system approval IWWS-93-1-R6B including strict adherence to provisions to keep any debris out of the drip pipe network during system installation. Fields must include supply manifolds, field solenoid valves, manifold-to-lateral connections, manifold cleanouts with pressure monitoring nipples, pressure relieve valves and air release valves. Also ensure that: (i) approved site preparation procedures are used, including the specified method for removal of surface vegetation (site preparation approved by engineer and health department prior to backfill being placed on site); (ii) final drainfield layout and associated surface/subsurface diversions are located as shown, and approved prior to trench/drain installation by the engineer, soil scientist and health department maintaining required setback distances; and (iii) system details are installed as shown including (a) supply and return manifolds of specified sizes and locations, (b) trench width, depth, drip tubing placement, (c) cleanouts and shrader valves are provided on both ends of each supply and return manifold, Clearwater S/D — Lot 12 1VIay 2, 2013 Page 4 of 5 (d) manifold to lateral connectors (including top-feed distribution system), (e) solenoids in the zone control boxes adjacent to the headworks assemblies, and (� shut-off valves and air release valves at the beginning and air release valves and check valves at distal ends of the manifolds in each field zone. (12) Please note that among other requirements of the system approvals, the drip systems must be installed by a contractor authorized in writing by the manufacturer and must be approved by the manufacturer's representative. (13) Drip controls/dosing s s�em are installed in accordance with approved plans and manufacturer's specifcations, including all specified components within protective building, with dosing system and flushing system and demonstrated to be properly operational prior to system startup. Controls are to °i include auto-dialer alarm hook-ups and provisions for operator interface to the PLC indicator and . adjustment registers. (14) Su�plv lines and return lines are provided in strict accordance with approved plans and specifications, including pipe sizes, materials, freeze-protection provisions, installation depths, and specified leak-proof interconnections with drip laterals. Ensure that the hydrostatic pressure tests for water-tightness are executed in accordance with specifications in approved plans. (15) Fields must be finally landscaped to shed surface water. Ensure that measures for establishing an adequate vegetative cover are implemented, i.e., that fields are covered, seeded and landscaped as necessary to stabilize the ground surface and facilitate the establishment of a suitable vegetative cover. (16) Start-up provisions are completed including flushing of supply lines, testing of system performance, as well as and start-up per manufacturers specifications. Dosing system testing and adjustments must be completed including required measurements of AdvanTex� pretreatment units and American Perc-Rite subsurface drip system irrigation and flushing rates and network pressures during irrigation and flushing at both ends of the supply and return manifolds in each drip zone. (17) Prior to system start-up, a joint inspection must be held with the installer, equipment vendors, engineer, - operator and health department, to assure all parties have full knowledge of the capabilities and design/operational requirements for the systems to assure optimal system performance. The AdvanTex pretreatment units and American Perc-Rite subsurface drip system manufacturer's representative must concur in writing with the installation of their respective system components prior to Operation Permit Issuance. �18) Repair area: The repair area identified for this project and access thereto must be maintained and kept available for future repair. No construction on or utilization of this area is permitted. (19) Operation and Maintenance (O&M): All AdvanTex� Treatment Systems shall be maintained according to the latest revision of the AdvanTex� Operation and Maintenance Manual as published by Orenco Systems�, Inc. and also the Innovative Wastewater System IWWS 2004-3-R4 approval. All American Manufacturing Company, Inc. subsurface drip systems shall be maintained according to the latest revision of the American Manufacturing Company, Inc. Maintenance and Operation Guidelines as published by American Manufacturing Company, Inc. and also the Innovative Wastewater , System IWWS-93-1-R6B approval. A certified subsurface system operator (who must be authorized by Orenco Systems�, Inc. to operate the system) shall be contracted to operate the subsurface system. The operator shall inspect the system and report findings to the health department semi-annually. The health department shall review/inspect system operation annually. O&M procedures listed in the operation permit shall include that during Clearwater S/D — Lot 12 'May 2, 2013 Page 5 of 5 each operator visit, flow at the facility must be monitored and recorded, and the pump elapsed time and cycle counter readings shall be recorded at all pump tanks. (20) As-builtplans/ Record drawin�s with Professional Engineer certification are completed after the installation is complete. Copies of the as-built plans/record drawings are to be forwarded to our office � for review and for the archives no later than ninety (90) days after the final inspection has been conducted of the installation and approval given by the Person County Health Department. Note that a registered professional engineer must certify that the system has been installed in accordance with the approved plans and specifications. This certification is based upon periodic observations of construction and a final inspection for design compliance by the certifying engineer ar his representative. The operation permit is to be issued after the construction is completed, final inspections are approved, gzoundwater monitoring wells are installed and recordation paperwork transmitted, and the operator contract is provided. If you or the applicant'c consultant has any questions concerning these comments, please feel free to- contact me by phone at (919) 707-5879, by fax at (919) 845-3973, or by e-mail at Lorna.Withrow@dhhs.nc.gov. Sincerely, �,�� Lo a Withrow, PE On-Site Water Protection cc: Kevin Neal, LSS - OSWP Regional Soil Scientist Sarah Wheeler, LSS — Soil Services, PLLC John R. Harman, PE �; Apptication Datc: "T14'z- l �o timount Paid: Receipt #: �..r�".�`)�� `� � ....l.�a�c'c,��,,,,.- �`s' • ��.�.�.,.,�,. �i�,';ta��an•+�sxanat-und.�a� ��-��c��a�d�� ..�--- Ne i� � Go�+/'!� (^' �^Q�� .—� G.+c. �! �-c.�tc Q�r � f � /�o r� -- C'7�(��n-cN�( N�N- �-x �i �N4 I P A lication for Services Scrvices Re uested mproveme •'(Site F;valuation) i Construction Authorir.ation � 5200.00 $3UOA( if> 600 e d I�ee is de endent on the t e of svstem ermitted Mobile Homc r accment or t3uilding Additinn ! Permit Iicvision �150.00 if sitc visic re uired $7SA0 Wcli Pcrmit (Ne�+/Keplacement/Repair) �' Reps�ir of Existing Septic System �?OU.QOi52Q0.00/�75.00 Application: No Charge! CA $150.U0 or $300.00 1) Applic:�nt Information: Name: �a 2E4Ci M A�.Et �S t� Address: 327o Ntos� (2-�aG� C� 2,rLC�c 4�t �•�r c 2? t� t 3 2) Name and address of current owner (if different than applicant): Name: Address: ___ ___ I'hane (home): (�;��urt;/cel l): �% t k— 9�-1 —�q 9 Phone: 3) Property Description: Lot Size: Subdivision: CL��w�K�-' Lot #: �2 Address andlar directians to Property: ❑ yes Q-fio Does the site contain any jurisdictional wetlands" O yes j�d'fio Does the site contain any existing wastewater sy�stems? ❑ yes �0"nu Is any wasteH�ater going to be benerated on the site other than domestic sewage'? ❑ yes ,0"no ls the site subject to approval by any odier public agency? � yes �' no Are there any easements or right of ways on this property? (if `��es' is checked, please provide supporting documentation) 4�),�Y 'oposed Use and Type of Structure: �Residential ew Single Family Residence Maximum number of bedrooms: � / Occupaats: _ ❑ Fxpansion of I:xisting System If expansion: Current number of bedrooms: ❑ Kepair to Malfunctioning System Will there be a hasement? ❑ yes ❑ no With plumbing fixtures? ❑ yes ❑ no ❑Non-Residential 'I'ype of business: Maximum numberof'employees: Total Square footage of Building: Maximum number of seats: 5) Water Supply:,eJ New well � Existing Wetl ❑ Community Well ❑ Public Water � Spring Are there any existing wells, springs, or existing waterlines on this property? � yes H'no Please note any kno�vn ground water restrictions or sources of contamination: 6) If �ppl}�ing for'Authorization to Construct', please indicate preferred system ty�e(s): 0 Conventional ❑ Accepted ❑ Innovative O Altemative ❑ Other �_.___.___.,_,__,..,...,___, ❑ Any 1 cerlifY d7al the infc�rrnulion provided uboi�e is con�plete Q/1CI CU)'YC'Cl. I QISO IOJ[IL'i:stund that if !{IL' 1Y1,077)lLlll017 jJYOVlCJL'CI IJ i�urcczu-cr1e, th�> site is ,si�hsequenlly niterecf, or lhe intefrded use chnnges, nll permit.r und approvals shall be invulid � ��i Zof�o ._._..._......._ .._v .�__.. ._.. _.___........ �' __f _ ___ .... ..... ...... Sig . e(Ow •r Le�al Representative*) lla e� * Supporting doc ientation required. • Permits are v11id tor either 60 months or are non-ex�iring when accompanied by an ap�roved plat. • A compteted `Lot Preparatron' form must accompany any application requiring a site evalufition. c, ��c � � s�.Ge.: 1 "- �.�� a �---, . � .�.fl.�r�� . ...... .� � �., . . . . . . . +C C� �1��''� l ' � ''� �. $�.vo.. - ' xs.�"-s�$ • H�..o.laE7ts. . �/�u � � r � N 8�l a n' Z� P�caet #� �� . s ' t''. � r� � � ►�c_ - - . . � As�a�� . z� . ��_��.� a��r�.%�,�m�m�a�.�z.�b �� . .. . _____...______._ ___ __._ ...�.. :.,__ _ _... . � .� � ��,.�- .�'"" / �...._.. ..�. ---. 4--.- .�"'' ' . _.�' ' � � f� � � � � / ,� .. ''�, ! � ' _ , Person County Health Department VULUNTAKY RELINQUISHMENT UF ADMINISTRATIVE APPF.AL RIGHTS Date prepared: � / ? � � � _ Owncr{s): �-c''{-�� '�' �� i �'M�-4 or�/� Maitin�Address: 32'2� MoSS� �2 �t�Ge" C� (2- Az-ez 4 N- �� G 2-� b r 3 Pmperty (ocation/site legal description: LbT' 12 -- � �-'%A-✓t � n�t�t- '�''v F LoP�c ['�•.i�— Original Improvement Permit (IP) #t Date issued: Uriginal Authorization to Construct (AC) # Date issued: �� G�� Q,,.�.�� , voluntarily relinquish my rights to pursue a%rmal appeal through the North —�ij u name Carolina Office of Administrative Hearings pursuant to NC General Statute 130A-24 and 150B-23 and all other applicable provisions of Chapter 150B for the above referenced permit(s) (which includes ihe IPs and ACs) in order for the authorized agent/local health department to issue the applicable permit (ncw IP and/or CA) for the site. I understand by completing this form that the permit(s) for a �� SQ.Qroo � ��'T1L � t'�G� will bc revoked immediately by the authorized agendlocal health department. I understand that the local heatth department's revocation ofa permit can be appealed to the North Carolina Office of Administrative Hearings within 30 days of the revocation pursua�it to the North Carolina Administrati�e Procedure Act. 1 understand that in order for the local health department to issue another IP and AC that the current IP and AC must be revoked. I understand that the local health department's revocation of an IP or CA is not effective until 30 days from the revocation or, if the revocation is appealed, at the time that the Office of Administrative Hearings issues a final decision. I understand that by signing this fonn and relinquishing my right to appeal the permit revocation at the Office of Administrative Hearings that the local health department's permit revocation wilt become effective immediately. 1 understand and agree that the revocation of a permit that takes effect immediately is in my best interest. I understand that by signing this form that 1 agree that t do not want to appeal the permit revocation. I understand that I am not required to relinquish my appeal rights but that this is an option avaitable to me so t do not have to wait 30 days for the revocation of the perniit to take effect. Si >nature of Aro e� Owner: (�"' b �� Date sibned: ��Z� �� __ Person County Lnvironmental Health, 325 S. Morgan St., Suitc C, Roxboro, N(' 27573 Phone: 33G-597-] 790 ��. sf �� { � � �� e�ra�n��.aa,*-TM„ ¢��rn��.Il �'��.��:a Applicant: Permit Valid for: Five Y Type of Facility: S � Number of Bedrooms � Proposed Wastewater S s Proposed Repair: `� Permit �S-�e Authorized State Agent: (X) Owner or Legal Re e W, �,J Q �� r� Tax Map: 4� Parcel: �� Subdivision �r��f �' Phase/Section/Lot # � Improvement Permit , Non-expiring iC ��/ �g�New �C Addition _ Water Supply: we�( ��/ E�ploye�s / Seats: ` o'ected D ily Flow: t'�O gallons/day �v /C Crri lrr� o f��X Type: j�� f r�: Q �L, Type: O,M�..�-Q G�C/SrcL,S �'�'aS. R'�9� ��'iltir�r� D?4ug. Date: 5 —' S � ' Date: The issuance of this permit by the Health Uepartment does not guarantee the issuance of other reyuired permits. It is the responsibility of the applicant/properiy owner to insure that all Person County Planning and Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the PTorth Carolina °Laws an�l Rules %r Sewa�e Treatment and Disnosal Svstems'(15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic system will continue to function satisfactorily in the future, or that the water suppiy witl remain potable. _ Authorization to Construct Wastewater System See site plan and additi nal atta ments (�. �`' ."A�� Prog sed Wastewater System:��G��a% � G�i n (*)Type � Design Fiow �d� galJday New� Repair _ Expansion _ Soil LTAR: , j gal./day/ft2 Type of Facility: J��es', �,t/ Basement: � Yes _ No .� "��e- (*) System Types Illb, IIlSg, Iv, and V, require periodic system inspections by the Person County Health Department. Wastewater System Requirements e � � ,^ � ��5 � �� ,� �C��c, Tank Size: Septic Tar�k �5�� gai. "' Pump Tank �S� gai. .�ea3e=n�p gal. Drainfield: Total Area 3 �.s�sq. ft. Total Length � ft. Ma�c. Trench Depth � in. Trench Width � ft. Min.Soil Cover� in. Min.Trench Separation 2 ft. / Serial Distribution . / Pressure Manifold �� La �� ✓�,b.`,� �a;,� � 4 O� �'i� c�� Q'� � 9'�� a11�iu�k � Distribution: Distribution Box S Authorized State Agent: C w Issue Date: ! 5— 3 i—! f� � Permit Expiration Date: ' S-3 t— Z( The system permittec� is: Conventional /Accepted / Alternative / Innovative �. I accept the conditions and specifications of this permit. (X) Owner or Legal Representative: Date: Person County Environmental Health, 325 S. Morgan St, Suite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5/12) S&B CL.EARWATER LLC N ` DB 800/244 ` �°iKe" � � ��\ �� PB 15/632 `� M�"� N g�� PIN 908001072219 �`��\ , � 2� 33„ W �o ��2'29„ W � . �� S 8� • 05• � 1 , . � �� 244.85 ��0.9� N 6 0 � � � , � �� W \ � � � � 8S S 4� >> �pe � S 84 33 1 � P •2� � G� s�q cp, 352.80' z � '9�`S', �r PROP. o ,. � HOUSE �L 1 i (� ('�' s ,^ i �� '`, 1 V LJ�i , v J � "1 > > . -� � /� X .r PROP. � � �, -y � rv d` ^ �� 58.7' WELL O . � � � c0 � ��j' �� ,�, � N � '� � �s PROP. oD�"��D� � � �' � �' 166.1' GARAGE � �'`�� .16 ACRES �,� � �,; z� �� ;,� � 1 � -� -� �. � -� -� , �.. � ; , � :- � .- ,,o � � . , �� DRAINFIELD AREA Za`�R , h`�` pc� � J.�� 12,454 SQ. Ff. ,�, ,�oj ��. � J � Oa c9 � � C.Q t'� , �W '70. r- `"� ; - �� 15' WASTEWATER PUMP LINE � � \�� '37 �� ' , � / � c — �� cP� � EASEMENT � � � %" 2� �\ . `� _ � 1 ` 12 / _ , � ��` O �-= �= LINE r' � `� l� -'"f �� E � �� LINE LENG � � 'QGy �� ,-' N g�-`41'58 � ` ;%" ;: , � L1 ��•p S ' �v 183.19 �� L2 � / ;' ; : U��ti� ��\ L3 � �9 ��9� � ; ; � v'e- pl , �i�, � � � ' �` " � '�,� �° r � � �� I ,� � � L4 � \�� \ ts ,�s�O% ' ; � �� jU.�- �I.d �tv�►�t S��CC�2, Gr�I��r PUry� � L5 i � , �. , , o _ A �cS�' p ��` %� ;� �y � �� b� v��d� �o �-e-�— � �►'°9e L6 � �lS PLAT lS OF THE FOLLOWING TYPE: �/G9 � � � L7 4 TH/S SURVEY IS OF AN EXlST1NG �� \`\ ;t �_ �UM�i'�� 1'�� SQ(�C 't''°��' L8 4 AND A�VD COES NOT CREATE A NEIh' � ,p \� �; W � La+� S� SYS�'�''` �� L9 7 1SANG �TREET. � � , � � � L10 � �� S ; ; � S,� e��e� � � P _ ` --AND-- �\ 6`5 4 �� t' � � � �� .e�� L12 1 O ` ,,, � CERTIFY THAT THIS ?LAT WAS DRAWN �� 2 � 28 � i;i� o , `-= � c��gT1�T��Y �13 s �OM AN AC�IAL SURV�Y MADE UN�ER '`3S 3 �� I; d- � �„�a,;s��.�.n� �t�a.u�na. S�RlPTI4N RECORDED /N BOOK 817, \� � 2' � ; ;� . E BL�UNDARiES �NOT SURVEYED tiRE � � ~ � � � SITE PLAN � IWIJ FRO�i�I /NFORMAT/ON FOUIJD 1N \�\ ','z Name Y � �a✓� Tax Map# `� � Parce�t� 2�__ ' TNE RAF10 OF PRECISION AS CALCULA7E0 - � Subdi isi qt, ,� Section/Lots� A T l" J A S P R E P A R E D I N A C C O R D A N C E W l T H � 6NiTNESS MY OR/6/Nfi(. SIGNAT!lRF� \�� \� \�� Authorized Stat Agent Date i $EQL, Tl•(i$ . `10 �6 ��\ll l l l l(//r ` \. � System components represent approzimale contours only. The conrractor mustJlag the system prior !0 6eginnirg the �\� /+�� /� � ' \ installation to insure that proper grade is maintained. \\`��'`N �iQ/ ��/��i � Note: An Accepted system may be used in place oja conventional system without permit auchorization or modificalion. ; �' j �y � : � '`�[%'9 : � - . . �� Sf �'��.�� `--_-.' ' �� 7�:an.�n� � �n.n�n.�an.�<aL.II 1LHL �.$►.Il �I�n WELL PERMIT (New�,Repair� Tax Map: �� Parce • �� Subdivision: �Q,41�1 a � Lot: 12 Applicant's Name: l,n^e.s� Q �'l�-9os %a� Mailing Address: Phone Numbers: Location of � �t ,��i'vt��Lj �CC. --� Permit Conditions: I) See attached site plan for proposed well location. 2) All applicable State and County regulations governing construction and setbacks apply. 3) Permits expire S years from the date of issue. Other Conditions/Comments: Permit issued by: Date: S`�31—�W' CERTIFICATE OF COMPLETION New Well Inspection: EHS/Date Location: Grouting: Well Log: Well Tag: Pump Tag: Air Vent: Hose Bib: Casing Height: Concrete Slab: Well Driller• Pump Installer: Well Approved by: Date Sample Collected: Person County Environmental Health 325 S. Morgan St., Suite C� Roxboro, NC 27573 Liner Inspection: EHS/Date Installer: Depth: Grout: Well Abandonment: EHS/Date Completed: Method/Material(s): _ License #: License#: Date: Date Results Mailed: Phone: 336-597-1790 Fax: 336-597-7808 8/1/08 j $f '"�, ,..... t �� ° ;,;:. t � � ,s �y ,.�»..— ,,, ` .-. � ..�;.�.�— �L/ � � � � 1.l ��n.�a�^ �n��n��n��.� � c� �.� ��n Gregg Margosian Clearwater Lot 12 Tax Map A23 Parcel# 209 PERMIT CONDITIONS Information for the Installer: nsuring a healthy environment 1. System shall be installed per approved engineered plans. 2. Contractor must by certified by the drip and pretreatment manufacturer in order to install system. Contractor must also be a state certified Level IV installer. 3. Contractor shall have a set of approved engineered plans on the job site throughout the installation. 4. Pre-Installation meeting mandatory (Design engineer or rep. must be present). 5. Contractor must re-flag drip lines on contour after clearing and have layout approved by health dept. 6. When clearing drainfield area disturb soil as little as possible (see drip manufacturers site preparation instructions) 7. No site work should be done under wet conditions. 8. All tanks must be installed on a six inch gravel bed and be accessible from grade. Any inner-tank metal must be stainless steel. 9. Drainfield must be landscaped to shed surface water and seeded/strawed before Operation Permit will be released. 10. Contractor, design engineer/certified designer, drip manufacturer rep., and certified operator must be present at system start-up. 11. Before Operation Permit can be released a registered professional engineer or certified designer, drip manufacturer rep., and ORC must certify in writing that the system was installed in accordance with the approved plans and specifications. Also, the engineer/designer must submit an `As-Built' drawing. phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573 � � °.� x� ' ,' �b�M,>,.� Y � ,_ � � � '� ' %.,� � � � � � � ��n��n.n�a�n�n��.� �c��.�� Gregg Margosian Clearwater Lot 12 Tax Map A23 Parcel# 209 PERMIT CONDITIONS Information for the Owner: nsuring a healthy environment 1. Before the Operation Pertnit(OP) can be released a copy of the signed certified operator (ORC) maintenance contract must be submitted to the health dept. (a contract for operation and maintenance with an American/Orenco certified ORC shall remain in effect for as long as the system is to remain in use). The Operator shall collect wastewater samples and inspect the system and report findings to the health dept. semi-annually. The health dept. shall review/inspect system operation annually. 2. Also, before the (OP) can be released the health dept. shall have written confirmation from the ORC, drip rep., and design engineer that the system was installed correctly. The engineer must also submit an `As-Built' drawing to the health dept. 3. Grass must be established over the drainfield area and cut when needed. 4. Caution must be used concerning volume of water entering the system and what is put down the drain (ex. Grease, personal hygiene products, cigarette butts, etc.). No garbage disposals or HVAC condensate lines shall be plumbed into this system and low-flow water fixtures must be installed in the house. phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573