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Dan Laughhunn
205 Nottingham Drive
Chapel Hill, NC 27517
Dear Mr. Laughhunn:
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NCDENR
erso� � � ���
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Michael F. Easley
Governor
William G. Ross, Jr., Secretary
North Carolina Deparhnent of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
November 15, 2004
Subject: General Permit No. NCG550000
Certificate of Co� erage I�ICG551270
Dan Laughhunn Property
Person County
General Permit Coverage. In accordance with your application for discharge, the Division is forwarding herewith
the subject Certificate of Coverage to discharge under the subject state-NPDES general permit. This permit is
issued pursuant to the requirements of North Carolina General Statue 143-215 .1 and the Memorandum of
Agreement between North Cazolina and the US Environmental Protecrion agency dated May 9, 1994 (or as
subsequently amended).
The following inforn�ation is included with your permit package:
■ A copy of the Certificate of Coverage for your treatment facility
� A copy of General Wastewater Discharge Pemut NCG550000
� A copy of a Technical Bulletin for General Wastewater Discharge Pennit NCG550000
■ Engineer's Certification to be completed and retumed.
If any parts, measurement frequencies or sampling requirements contained in this general pernrit are unacceptable to
you, you have the right to request an individual permit by submitting an individual permit application. Unless such
demand is made, the certificate of coverage shall be final and binding.
Please take notice that this Certificate of Coverage is not transferable except a8er notice to the Division of Water
Quality. The Division of Water Quality may require modification or revocation and reissuance of the certificate of
coverage. This permit does not affect the legal requirements to obtain other pem�its which may be required by the
Division of Water Quality or permits required by the Division of Land Resources, Coastal Area Management Act or
any other Federal or Local governmental permit that may be required.
Authorization to Construct Permit. In accordance with your application for discharge, the Division is also
authorizing the construction of a wastewater treatment system consisting of a 1500 gallon septic tank, pump tank (5
day storage), two recirculating sand filters, 4 to 1 ratio box, chlorinator, chlorine contact tank and rip rap aeration
with a discharge of �eated wastewater into an unnamed tributary to New Hope Creek, class�ed C-NSW waters in
the Cape Fear River Basin. All elbow piping must be of the long sweeping type. All cleanouts are to be housed in
meter boxes below the surface. This system must be at least 10 feet from the dwelling and property lines and at least
100 feet from water supply wells on and off the site. The system must also be constructed and located above a 100
year flood.
N. C. Division of Water Quality 1 NPDES Unit Phone: (919) 733-5083
1617 Mail Service Center, Raleigh, NC 27699-1617 fax: (919) 733-0719
Intemet: h2o.enr.state.nc.us DENR Cusiomer Service Center.l B00 623-7748
This Authorization to Construct pemut is issued in accordance with Part III, Paragraph 2 of NPDES Permit No.
NCG550000, and shall be subject to revocation unless the wastewater treahnent faciliries are constructed in
accordance with the conditions and limitations specified in Permit No. NCG550000. In the event that the faciliries
fail to perform satisfactorily, including the creation of nuisance conditions, the Pernrittee shall take imrnediate
corrective action, including those as may be required by tlus Division, such as the constcuction of additional or
replacement wastewater treahnent or disposal facilities. Failure to abide by the requirements contained in this
Authorization to Construct may subject the Permittee to an enforcement action by the Division of Water Quality in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
The Raleigh Regional Office, telephone number 919/571-4700, shall be notified at least forty-eight (48) hours in
advance of operation of the installed facilities so that an in-place inspecrion can be made. Such notification to the
regional supervisor shall be made during the normal office hours from 8:00 a.m until 5:00 p.m. on Monday through
Friday, excluding State Holidays.
Upon completion of construction and prior to operation of this permitted facility, an Engineer's Certification must
be received certifying that the permitted facility has been installed in accordance with the NPDES Permit, the
Certificate of Coverage, this Authorization to Construct and the approved plans and specifications. A leakage test
shall be performed on the septic tank and dosing tank to insure that any e�ltration occurs at a rate which does not
exceed twenty (20) gallons per twenty-four (24) hour per 1,000 gallons of tank capacity. The Engineer's
Certification will serve as proof of compliance with this condi6on. Mail the completed Engineer's Certification to
the NPDES Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617.
A copy of the approved plans and spec�cations shall be maintained on file by the Pemuttee for the life of the
facility.
NPDES Permit Contact. If you have any quesrions conceming the requirements of this permit, please contact
Sergei Chernikov at telephone number 919/733-5083, extension 594.
cc: Central Files
NPDES General Pernut Files
Raleigh Regional O�ce, Water Quality
Person County Health Department
Sincerely,
�w� ����
�-Alan W. Klimek, P.E.
This Authorization to Construct perrnit is issued in accordance with Pars III, Paragraph 2 of i�IPDES Pernvt No_
NCG550000, and shalI be subject to revocatian unless the �vasteH�ater treatment fa:ilities are constructed in
accordance with the conditions and limitations speci6ed in Permit No. NCG550000. In the event that the facilities
fail to perform satisfactoriIy, including the creation of nuisance conditions, the Permittee shall take immediate
correcfive action, including those as may be required by this Division, such as the constrvcrion of addicional or
replacement wastewater treatment or disposal facilities. Failure to abide by the requuements contained in this
Authorization to Construct may subject the Pernuttee to an enforcement aciion by the Division of Water Quality in
accordance with North Carolina General Statute 143-215.6A to 143-2] 5.6C.
The Raleigh Regional Office, telephone number 919/573-4700, shall be notified at ]east forty-eight (48) haurs in
advance of operation of the installed facilities so that an in-place inspecrion can be made. Such notificarion to the
regional supervisor sha11 be made during the nonnal office hours from 8:40 a.m. untit 5:00 p.m on Monday through
Friday, excluding State Holidays.
Upon completion of construction and prior to operation of 2his permitted faciGry, an Engineer's Certification must
be received cectifying that the permitted facility has been instalIed in accordance with the NPDES Perniic, the
Certificate of Coverage, this Authorizatian to Construct and the approved plans and specifications. A lea}age test
shall be performed on the septic tank and dosu►g tanlc to insure that any e�ltradon occurs at a rate which does not
exceed twenty (20) gallons per twenty-four (24) hour per 1,000 gallons of tank capacity. The Engineer's
Certification will serve as praof of compliance with this condition. Mail the compieted Engineer's Certification to
the NPDES Unit, 1617 Maii 5arvice Center, Raleigh, NC 27b99-1617.
A copy of the approved plans and specifications shall be maintained on file by the Permittee for the life of the
facility.
NPDES Permit Contact. If you have any questions concerning the requirements of this pemui, please contact
Sergei Cheruikov at telephone number 919J733-5083, extension 594.
cc: Central Files
NPDES General Permit Files
Raleigh Regional Office, Water Quality
Person County Health Department
Sincetely,
n•
�,�� ��C��.
��
� Alan W. Klimek, P_E.
/
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATUR.AL RESOURCES
DNISION OF WATER QUALITY
CERTIFICATE OF COVERAGE NCG551270
GENERAL PERMIT NO. NCG550000
TO DI5CHARGE DOMESTIC WASTEWATERS FROM SINGLE FAMILY RESIDENCES AND OTHER DISCHARGES
. WITH SIMILAR CHAIZ�ICTERISTICS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and regulations
promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution
Control Act, as amended,
Dan Laughhunn
is hereby authorized to construct and operate a wastewater treatment facility consisting of a septic tank, pump tank, two
recirculating sand filters in parallel, 4:1 ratio box, chlorinator, chlorine contact tank, rip rap aerarion, and associated
appurtenances, and with the discharge of treated wastewater from a facility located at the
Dan Laughhunn Property
515 Oak Pointe Drive
Semora
Person County
to receiving waters designated as Hyco Lake in the Roanoke River Basin in accordance with the effluent limitations,
monitoring requirements, and other conditions set forth in Parts I, II, III and IV of General Permit NCG550000 as attached.
This certificate of coverage shall become effective November 15, 2004
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day November 15, 2004
�•
� �----
� Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
NCG551270
En�ineer's Certification
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the following domestic wastewater treatment system project:
Project Name Location
For the permittee hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the approved plans and specifications.
Signature
Registration No.
Date
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Oi�ions to the property (indud'mg med names and numbers �s
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4) P�ropoa�d Us� and Struc�u� D�s�om answ�er eech of the fdlwving questi«+s:
ay �� _, Exis6ng ..,Zc, Type oi' S#rudw+a: �v�� v�r�: 3�, �th: �,`,•
b) i�umber Of Bedroort�a: ,�, Numb� of occupar�ts a peopie b be serve� 1D_ .
c) HSsement Yes___, No ,� Wi� 1t�e be plumbing in the baaemeat?,Lf A
: d} �a Disposal: Yes � No -_
S} W�r 9uPP�y �tP� P�.,� �� � a eo�. Public^, Catnmw�ty'_, Sprie9 _.
Are any �o on adjointng p�vpectY? Yes No �C tf yes, piease i�iic�De appnoodmate la�iai on the
'sib� pbart.
�) � Y�' ProP��h► �� prevlousty tde�ltsa Jurbdf�tlot�al r�ratl�s? Y� No %�
m �e�� NO'1'� THE FOLO'WING: �
� ➢ A PL.A7 OF TF� PROPERTY OR SiTE PLAN MUST BE 9UBMIT'TED MRl�i 7H{S APPlaCAi70N.
➢ PROPEliiY LII�IE9 ANa CORN�.4 MUST 8E CLEARLY MARi�D. •,
➢ 7't� PROPOSED LOC�ATION O� ALL STRUCTUli�9 MUS7 BE ST1�f�D OR FIAGGED.
' ➢ TH� Sti� iWS7 8E READLL.Y ACCESSIBLE FOR AN EYA1.lJATIQN BY THE HEIILTN DEPARfME�fi'
' 3T/1F'�. _
I heretiy�make �n to the Person Couniy Health Departrnent for a s�e evaluatlan ior the an-site s�wege disPo�i
sya�tem ior the abave-descdbed property. l agree that the � a# t�is applicatloa �e trua and repr�sent the maximum
i�it(ea bo be pieced on the property. 1 pnderst�nd if the aite is aiter�ed a the ft�ded usa c�anges, the Pamit shell
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WELL PERMIT
PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOIUT
Tax Map ., q-oa3
Applicant: ��
Pazcel # c�Qs� Township: (�, o,,,,,`
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at� a� . �,�
�ype of Water Snpply: r/Individual r Community Public
Ytequirements:
Site Approved By: (�, �� a -� Liner:
Crrouting Approved By: JS � �Installed by:
Well Log: ..�..5 Depth set: ^
Pump Tag: � Grouted:
Well Tag: � Date:
Air Vent: �
Hose Bib: � Water Sample:
Casing Height: �
Concrete Slab: � �
Well Driller• 1 �
Well Approved by: �
****See Attached 5ite Sketch****
Wells must be 10 feet from property lines.
Wells muat be 100 feet from septic systems.
Wells must be at least 25 feet from any building foundation.
Other conditions ��cZ,,� �'j, �j ��
Date:,
PCFID rev Ol/27/04
�
Name _
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h4•w�.,r, Ta� Map #A � Pa�ce1 # �
�+� � Se�tion/Lot# �
� � �a�-�ss
Au�.orized �9tate Agent . �-'' � Date
'• System compartesr.�r re�tia�eserat up�'
beginning the installatiora to ,
(,�� � ,�
e�c;s�.� u�,�
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a
the systes�a pri�a� to
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D��{t�e D,r,illlecl�
Groat Log
Owner: � Lb u h�u nr Tax 14IapA n�� Parcel # Q$ �
TAcahOn. a a�n}G Subc��V�sion � eX��) �
3ubdivision:_� Ir�r,;��,e i.cit#��,
• W�ll Coustru�ction
17istancc From nearest Property Line (Minimum 10 feet) 1� ��^/' �
l�is�nce from Scpdc System {Minimurn 60 feet) o• � �
Tot�l Aepth: 3�0o ft Yield: � s GPM � Static Water Leve1: �a � ft �'� S� � n
Watcr Be�,ring Zones: Depth 1�o ft 17� ii y o S ft ft
7��u1 $9a� �g�l
Casiwg: �
Depth: rrom .�0 to 6 3 ft. Diameter: 6%,�_ in
Typc: Galvanized Stee1 i/'
Weight: Ttuckness: .�� Height above Crroimd: 1 Z in ,
Drivc Shoe: ✓ Yes No Any problems encountered �vhile settyr►g casiag? �Xes ✓No
If "yes" givc reason: No n�.,.,�� �__
Grout:
NeaL• SandlCezneni
Annnlar Space Width �
Iv�ethod of Grrou� Pumped _
� Concrete GravellCement
_ inch�:s Watcr in Asu�uj�r Space � Xcs ' No
_ Pressuro Pou�red ✓ t?epth -�-_ to �i 0 Ft_
MatcriaLs Uscd:
No. Bags �ortl�nci oement Weight of 1 Bag �"L Paunds
Tf mixturc (sand, gravcl, cuttings) — Ratio to
]A plates: ✓ Yes _ No 4 a 4 slab �ts _ No .
�,iner: T ..
Depth: Aate Ittstalled; Grout Installcd by:
Drilling Lag Lucakion Drawing
From To Form:ttion ox��or
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v' Sn o e I� �,
' 0 G�: per ��- Su b �
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I hereby eertify that the above inforrn�lion is correet azid that this well was eonstrncted in accordance with rcgvlations si;t fotth
by tht Persoa County Health Dcpartmcnt. �
S�gna#urc of Contrstetor � 7��^^�� 1D # 3��� Datc �'�!� O,�
" (�o�n e o w� cr I�io„'g �'ump YnstAllmCat
1'� � p
pump Jtistallatian Con�'acWr: State Registration Number:
Pump Dc.pth: ft Static Water I.evel: __.__-- �
P�p Make & Model; Pump Size and Ratin�: hp gprn
I hereby eertify thai this pump was installed and the we1l head compteted according W the Persott Caunty Well ltuics in c(l'ect
on this date and that a copy of this record has been provided to the well owner.
Pum� Installer Signakry re Aate:
PCHD rev 01/27J04
Z00'd d9Z�Z0 S0/GZ/60 SGZ6 86S 9^cE �uI 6uitti.lQ ttaM aiiau..teg
A lication Date: � -,6 � 7
Amount Paid: �
Recsi t #• ��
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APPLICATION FOR SERVICES
Tax Map #: I-+a.3 �S S
Parcel #:
IF THE INFORMATION IN THE APPLICATION FOR AN IMPROVEMENT PERMIT IS INCORRECT, FALSIFIED,
CHAiVGED OR THE SITE IS ALTERED, THEN THE IMPROVEMENT PERMIT AND AUTHORIZATION TO
CONSTRUCT SHALL BECOME INVALID. , -
�1) Permit requested by: (Owne agen ospective owner): J�-{ �Q�' -�s�9�/ %c�j A�u�lc%PS� �"��
Home Phone: S�G - 8 88 S Address: f� a I a 5
BusinessPhone: So�}-o2.i5 [� ���� Rox6oP.�; �1G a?s�3
2) Name and address of current owner. flm LAu H�u��
U 5 0�/r/ m �R
chapel �l ,NG �2?S17
3) Property Description: Lot size: �•35 A�- Township: �N��,q�,om Subdivision: ��.-�o�N�"
Directions to the property (Including road names and numbers): SI �() A k oi�1-� F
FXIST��6 Norhe. - S`i'RAlah+ I�J OAk Ao�N�s mn�N RoAo -
�2���t, 4- �.nr�Se i� � L2F�- - A SO�P�' fiRIVC.
Lot # �
- F, ouse-
4) P'roposed Use and Structure Description: answer eaph o+the fo{owi�g q�u ��►R�m Width: �$� De th: z2 �
a) Proposed �, Existing y�,, Type of Structure: Add�t�or� o ex�� �N _ p
b) Number of Bedrooms: Number of occupants or people% be served:
c) Basement: Yes . No X. Will there be plumbing in the basement? x
d) �arbage Disposal: Yes J No �,
5) Water Supply Type: Private �(new _ or existing�J, Public� Community_, Spring _
Are any welis on adjoining property? Yes_ No _ If yes, please indicate approximate location on the
�site plan. � _
'6) Does your property contain previously identified jurisdlctional wetlands? Yes_ No�
�
PLEASE NOTE THE FOLLOWING:
➢ A PLAT OF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED WITH THIS APPLICATION. .
➢ PROPERTY L1NES AND CORNERS MUST BE CLEARLY MARKED. �,
➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAICED OR FLAGGED.
➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMENT
STAFF: �
I hereby make application to the Person County Heaith Department for a site evaluation for the on-site sewage disposal
system for the above-described property. I agree that the contents of this applicatio,n are true and represent the maximum
facilities to be placed on the p�operty. I understand if the site is aitered or the intended use changes, the permit shali
� /`� �
Date
PCND, rev. 06127102
�
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I��.�.��-„��„�, ���.11 7HI�.�.g��.
�uilc�ing Addations/ l�obile �ome iteplac��ents
Tax Map #: ��
Approval Requested for.
APPlicant �
Address:
Phone #'s:
Parcel#• �0�
�� obile Home Replacement
✓ Buildi.ng Addition '
Permit Located: �'Yes No Sa`�`fi �f�r
Installation Date: Design'flow:. $!� (gpd)
Cusent Contract with Certified erator on $le (if required):
Water Supply: �� Well Public or Community �
Wastewater system shows no visual evidence of failure on: (date)
�� (Applicant's signature if site visit is not required)
Comments-
� Additio eplacea��nt Approved
Environm tal Health Specialist �
e
� �-�.2��7
Date
���� 1 ( ��
...... . `' � .f
� �1.� � �J � � 1L
lE_!��ra�v-�i �x�cr� u•n.:rarn�;: �rn iL�a ll IH[ «;:,r.a. �l �t:�n
Date: G / �o l /�
Tax Map: _� Parcel: ��
Name: /���.�ff-.�/'T �G
Address: �s p� p,,��� -��.
�F��. NC�
Re: Bacteriological Test Results
Dear ���C,y�.�— •
Your well water was sampled on �/ �/�, and tested by the Person County Health Department for
biological contaminants (total coliform and fecal coliform bacteria).
The results of your water sample are noted below:
� No coliform bacteria were detected in the sample. Your well water is safe for normal use.
_ Total coliform bacteria were detected in the sample.
_ Fecal coliform bacteria were detected in the sample.
Total coliform bacteria are naturally found in the soil. Fecal coliform bacteria are associated with animal
and/or human waste. The presence of either total or fecal coliform bacteria in well water may indicate that
a new or repaired well was not properly disinfected prior to use, or that contaminated groundwater may be
entering the well. lf coliform bacteria are present in your water sample, the water may not be safe for
use. Young children, the elderly, and individuals with compromised immune systems are especially
vzrinerable and their physicians should be notified of the test results.
A well that tests positive for total or fecal coliform bacteria should be properlv disinfected and retested
prior to resuming normal use. The well may be disinfected using the enclosed disinfection procedure. A
well contractor or plumber can assist you if needed. Once the chlorinated water has been thoroughly
tlushed out of the system, please contact the Health Department (597-1790) to request a re-sample.
For additional information, please feel free to contact Environmental Health at 336-597-1790. Our office
hours are 8:30 to 5:00, Monday through Friday.
Sincerely,
��
�C� �%�
Environmental Health Specialist
Person County Health Department
Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573, Phone: 336-597-1790, Fax: 336-597-7808
(revised 07/29/13)
PERSON COUNTY HEALTH DEPARTMENT
355A SOUTH MADISON BLVD
ROXBORO, NORTH CAROLINA 27573
BACTERIOLIOGICAL WATER SAMPLE ANALYSIS
Name of Owner or Tenant c� �►�c��,C-��_�
Address ��l S d.� � -j�-n ��� County �r��►'�
Collected By -1-��
Date Collected ����v Time Collected �7 � ��_
Source: ell o Spring ❑ Other
� / L� t-i-���`- � ; �..� 1L
Location: �Fiouse Tap ❑ Well Tap ❑ Other
❑ No Charge t�c:harge
..............................................................................�
******************�******************************************�**************
Total Coliform
Fecal/E. Coli
Results
Present
0
❑
;j� � �
, •
-.. -.
i?'�� ,--� . � ��
.. -.. -. �
Report Called
Called To
o YES ❑ NO
Absent