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'�➢ A PIAT CF'fHE PRGPi3i'f'� OR SI'�.E PW�i WST HE � YiRfEI THIS APPl.LCA7'tON:
% P�OPEit7Y L�NE9 AND COR�S !/UST � Cl.EARLY DiARl4�. .
➢.7�IE L�OPC9� LOCA110N OF ALL 9TRUG'�1JRE8 At18T HE �t'Al� OR AACa�. • .
9 THE 5RE �AUBT BE RL�ADILY A�18LE FOR AAl EYALUAT�N BY T�iE HEALTH DH�l1�� �TAFF.
I• here� m�aa �on fin the Person Caurrty H�tth Dep�tr�nt ibr a s�e e�ua�On ibr the o�-eii8 ��s �sP�1
sY�m �Or the abave�de�bed properly. 1 agree tha�t the conbents af this aQp�tion ac�e� true and re{or�nt the r�wm
�itl� tin b+e pisc�d an th� prapert�/. 1 unde�and � ihe s�e is aitesed ar th� � u� d�anges, ihe p�mni shalt
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WELL PERMIT
PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT
Tax Map #: � 1 Parcel #��� Township ` f'1�1
T � � _ ._
Applicant:
Subdivision:
C�-5
T�e of Water Su��ly:
Requirements•
Site Approved by �
Grouting App oved bp �
Well Log • /L
Well T �
Air Vent
Hose Bib
Concrete Slab 9 i
�
1—
IndiPidual Community Public
Well Driller. �j/.9-r✓�a Wb'ELL ��2i /��✓�
Well Approved By: Date:
'�See Attached Site Sketch**
Wells must be 10 feet from property lines. \
Wells must be 100 feet from septic spstems. �j(�C,�U(�,; �(2(�-F(.�..,�,� 1
U
Wells must be at least 25 feet from anp building foundati . �
Other conditions:
c5
PCI-ID, rev. 04/07/Ol
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Owner: �
Location: <
Subdivision•
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�'cll Log
Tax Map�� p��el # _,��
_S�� „ „ qr r ' ; -� .
, ' r "L LOt # �_
Distance From nearest Property Line (Minimum 0 fee �onstruction
Distance from Se p t i c S y s tezn ( Minimum 60 feet) `
Total De th• `�
Water Beari�g Z� De �eld: �_ GpM Static Water Level: �� g
P -�— ft ft �.,�_ i't _________ �
Casing:
Depth: From
�_ to✓ y� $. Diameter: � in
Type: Galvanized Steel __ �
Weight: � Z-����5: � Height above Ground:
Drive Shoe: ,/ YeS No �y problems encountered whilc settin � C�,�is'In 7in
Tf `�es" give reason: b g. _Yes ��o
Grout:
Neat: � Sand/Cement ' � Concretc --
Annular Space Width Gravel/Cement
._�_ inchcs Watcr in Atuiular Space Yes No "
Method of Grout: Pumped Pressure �
Materials Used: —�°�ed DePth ___��__ to ��_ Ft.
No. Bags Portland cement ___ Weight of 1 Ba * n� po��5
If mixture (sand gravcl cuttings) - Ratio a—to �-'-7�--'
ID platesY '�yeS No
— 4 x 4 slab � No
Drillin� Lo�
I hereby certify that the above information is correct and tilat this well was constructed in accordance with re
set forth by the Person County Health Department. gulations
Signaturc of Contractor -
. ID # a :� r I)atc %- /,%—_
PC�iI� rev O1/16/OZ
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� STATE OF NORTH CAROLINA
DEPAR.TMENT OF ENVIRONMENT AND NATUR.AL RESOURCES
• DNISION OF WATER QUALITY
CERTIFICATE OF COVERAGE
GENERAL PERMIT NO. NCG551076
TO DISCHARGE DOMESTIC WASTEWATERS FROM SINGLE FAMILY RESIDENCES AND OTHER
DISCHARGES WITH SIMILAR CHARACTERISTICS 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,
William G. Oakley
is hereby authorized to construct and operate a wastewater treatmen[ facility that consists of a septic tank,
distribution box, primary sandfilters in pazallel, secondary sandfilter, chlorinator, chlorine contact chamber, rip rap
aeration and associated appurtenances with the discharge of treated wastewater from a facility located at the
William G. Oakley Residence
Lot # 13, Roy Carver Subdivision
north of Ceffo
Person County
to receiving waters designated as Hyco Lake/Hyco River 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 hereof.
This certificate of coverage shall become effective December 22, 2000
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 22, 2000
�R�'�����-�S.GNEF: =��
d'�! �.lA�� �.1���_'_:=.
Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission
�,State of North Carolina
• Department of Environment,
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
December 22, 2000
Mr. William G. Oakley
1224 Morton-Pulliam Road
Roxboro, NC 27573
1 • •
— �
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: General Pernut NCG550000
Cert. of Coverage NCG551076
Authorization to Construct
William G. Oakley Residence, Lot
#13, Roy Carver Subdivision
Person County
Dear Mr. Oakley:
In accordance with your application for an NPDES discharge permit received August 8, 2000 by
the Division, we are herewith forwarding the subject Certi�cate of Coverage under the state-NPDES
general permit for William G. Oakley. Authorization is hereby granted for the construction of a 360
GPD wastewater treatment system consisting of a 1000 gallon septic tank, distribution box with
adjustable caps, two 180 square foot (6'X30') primary sandfilters in parallel, with a loading rate of not
more than 1.15 GPD/ square foot for each primary sandfilter, 180 square foot (6'X30') secondary
sandfilter with a loading rate of not more than 2.30 GPD/square foot, chlorinator, chlorine contact
chamber and cascade aeration with a discharge of treated wastewater into Hyco LakeByco River
classifed WS-V & B waters in the Roanoke River Basin. Stone and fine gravel used in sandfilters must
be washed clean before installation to prevent clogging of the filter. All elbow piping must be of the
long sweeping type. 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.
If any parts, measurement frequencies or sampling requirements contained in this general permit
are unacceptable to you, you have the right to submit an individual permit application and letter
requesting coverage under an individual permit. Unless such demand is made, this decision shall be
final and binding. Please take notice this permit is not transferable. Part II, E.4. addresses the
requirements to be followed in case of change of ownership or control of this discharge.
The Authorization to Construct is issued in accordance with Part III, Paragraph 2 of NPDES
Permit No. NCG550000, and shall be subject to revocation unless the wastewater treatment facilities are
constructed in accordance with the conditions and limitations specified in Permit No. NCG550000.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone 919-733-5083 FAX 919-733-9919
an Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer pape
�Permit No. NCG551076
William G. Oakley Residence, Lot # 13
December 22, 2000
In the event that the facilities fail to perform satisfactorily, including the creation of nuisance
conditions, the Permittee shall take immediate corrective action, including those as may be required by
this Division, such as the construction of additional or replacement wastewater treatment or disposal
facilities.
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 inspection 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, a 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. Mail the Certification to the Stormwater and General Permits Unit, 1617 iVlail Service
Center, Raleigh, NC 27699-1617.
A copy of the approved plans and specifications shall be maintained on file by the �ernuttee for
the life of the facility.
The sand media of the sandfilters must comply with the Division's sand speciiications. The
engineer's certification will be evidence that this certification has been met.
A leakage test shall be performed on the septic tank and dosing tank to insure that any
exfiltration 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
condition.
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 issuance of this permit does not preclude the Permittee from complying with any and all
statutes, rules, regulations, or ordinances which may be required by the Division of Water Quality or
permits required by the Division of Land Resources, the Coastal Area Management Act or any Federal
or Local other governmental permit that may be required.
0
0
cPermit No. NCG551076
. • William G. Oakley Residence, Lot # 13
' , December 22, 2000
0
If you have any questions or need additional information, please contact Mack Wiggins,
telephone number 919/733-5083.
cc: Central Files
Raleigh Regional Office, Water Quality
Roosevelt Childress, EPA
Point Source Compliance Enforcement Unit
Person County Health Department
�
Sincerely,
�t�� `�t���. �tGN� �>'r"
�taf!+�.�A1� �. t�!l.iS
Kerr T. Stevens.