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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 b�crr`e in„aiia. . _p-� Z or Legai Reo�ve � ' p • - p�D, � 10t171D1 . � � � J ���.sf ��I�.���T , �----= -�-� � � ���� �aadn3r��aaxa.�aa��.� ��a�.m,.��E�n. 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 ��` 7� �� ���� �� �' � �C� ZC7":1�`�C`' �y�- � �.�i �r-mtm �rn�icn.-n_ �cr �L-n. sG-..:n. JL �j�c..n�,G-��T. Owner: � Location: < Subdivision• � �ouc� a� � _ 0 3 �l°�UW�(!� lN�llA�" _ L U�-.-, � �n� / �r. ��. n` D�O Dr��0�;1 _ �_ /� � � + �'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 / VICIN:TY MAP � F, O � O C c� 2 �_�� j v � � � i, •:i � �c{!_ =:Jtk ' ' '.<:_ $^� '� • Ic:�. F.lh: :�,,..:_�. r- � MA'.,cvF'I:R' ?:::.' r._r55 f';NE� -_ �v' '��E'. .:r:�.�.• ?.�7 ,ni' c?F 4EG:RCr"t'� "' � �:\��•I'.'.r�. WWLETT—JENNINGS dc IISSOCNTFS. P.�l --�- " ' c-E `•'' c'�'E„ ' ' '_ •ra' 'E_ ' ' _ ' _ o' .c�__= ; ` _'_ I 0 \ 15 t06.or �ae J J � °� o �\ . � C `\ ART OF l07 1! y OY S. CARYER• � , J \ �,\ � 1 . � o �o �`\ . ��Rt .,\\ ' �l . � � `'� ' � v � � K \ � \ \ \ \ F � \ ``� \ � \ � \ \ \ \ � � a \� ` + \ ` � \ � � ' •�' \\ \ �. " \ \ \ \ , � \ `� � � � � J CONTROL �� -- � ,\ - � �ORNER _ J --- r �� � IF � 120' CONTOUR � '' �'�., x ' ' . ���� � ' J1 �� ,,11� 2 V .�'.�- �t �1 � 1 . 13 ��� � '� CRES .p 1`� �y �, �, l c� �or » � C � �Rbr . c�rtvER• . �o m ov �` P.B. . P. 15 0 ` � , r �' � �� � o � � 0 O �� 1 � ,\ . ,�, V \� � � ` a� , � N'4'n w�F:-Li4/ DryjGh CGIMTT +.� fGPrGCI�+G C!F•I�I:�TE G� _�_^_�'�!=y �.� ?'r.�:s4. N:iI.Rr p�g!iC fr !NE G:+ERNYEtiT�L W1? GE`IGM �" )� [ER';�IE:. 'C BE [DkRECi. Tn75 Y:�' ��S pRESE^+?E: /.'.F R�::.TR��j'r: �YG RECORDEG IN TY.IS OFFjCF �T i.�T [�BI�ET -_C�.T P�GE?Y :r THIS '__ 7�r pF '__ =1—_ t'9_YL �' S?r_'r.$_ L'CLGCR _p Y. . .� _ 4.. a �..d.� -�- ---::c.w�. �'��_______'________���� .'���_'�'� F_G.5'�y .f _____ �.zo� coNra,�rt � li � SJ � o, e J° �e � ' ��9.�,�� 57+. g9 1 P�F7 Of �OT 12 'R01 S. CARVER• CAROL:fM PoI'E2 a «cM couv�r r,rco u� � i v.r !� LL � L i. S�rQQ� i I e,e arear r r„� - a n. . COtTIFI'-ATE OF QCEVt(ON ' I t�El 1F.REBY CERTI�Y iW1T I �Y I�E �REI T{E ' ObERfS) Of T�E PNOGEFiI' S/M�N A!D DESCRIBED � /ERfOM. MIM r�5 CCNYf7FL TO YF <US) BT OEFD . RECWtOFD IM 80dI �__. I�GE�__. �u0 T1ut SAID vaoPERT� qMlIFlES AS �N ExCEPTI^+. •; TNE vRortsta.s or nc acrtson cou+rr sueoirt.^:oH RE'•ULATIONS U1DER SECTION +e-�. � ,__' _ O�rf� �'�'_'"" C�.E ' GVNER �____,__ 'J�Tf �/M1sa .AA_� 6 - �:�ti c,•e �i�:�wthc .Mo zai - ' A7�INISTRATOR . . P£NSON COlNT1', N.G. � _ ♦ t. _KdL£�'N!4E?L_. certrtn r�• r�ts \ ��,... ,,, P_�i ��5 pp�w� �/Z',(R Y1' SWERYjS1fM FPGY \ IF '�[pr? '• iw �CiL•�l SUnE* rWE WGEN rr S;iERv152Gy • . ��pP�,�..37 �!/,�,'c, 17EE0 DESCRIPTfOh R£CWeDEO IN Btpf �"" � � Fi� 1. ►�6E _= E.•:.)/071ER1: :1uT iME BCVCFGIES MGT SURYE�'ED �aE C:EUKY iWIGTEC �5 �M�IM '�� se�i �i • ntpl IKGRr�r70Y FOu10 IN BCCK '� o�,E ; �� ( • ' • T1ui !NE R�ifO Of ARECISION �5 :��- ,� �a�s �Pi :tL�TED IS 1:_Q.p�p� _: bu� TNIS P:�' US ��iGSC..\t f ►AE�MED IN �[CORC�NCE �1TN 6.5. ��-7: �5 �ti4f�l;t�.' • � 751�A�rtoa Mr6rn uDcSE�L iN75 _! �L�r ........... 7►__,�tf_». �.t.. 19_fG.. M;.Ntn ^.AAC_;M PEk50h :GWT� � '" iiJ. �' �NJ9.f.LT_'_-_. CER•3�T Tw' "w:5 51M+E+ �w11�7ES �5 �N EICEF•JOK t� T�[ iF�/;S:�NS G� TI( oER50N COLMiT SUBO!/1S7GN REGJi��1C'�= JI�YiE5 SECTIUN i6-t 1�_i__l. �7TNE55 Y1 �u4L �v: :E�i T.tIS _1L �.r oe "'",Nf'�'• �9_4Q_. ",-'��-`-- n -- I:! ' �["tV.'`L=F L --"--'---"- REii-i�4[� . . :JRiE"'vR �' s.��,E.�. �=-��--�-�----- =-``-^,,-�-_: ' �G:S:R��IGN Mw6Ep "_'__'i'�1l7"""'_' �::F :�RGLI�:A V[ie:h GCUN�f , � v7i�Rr PVB_'C ct �ME :[ A'r �`n _" �°:IK_S1IJ. :rq.�r. .�y• �.�ks._�yyl..!, ' ',,ti�0+,\ iAf p�'.,I � or15TEkE� i��_ S:Rv[r9R. oEFS.n+__! •- �:�R�J BEipRE YE'yIS :A/ �v[ ALFM�_!�F: : � +! 'f AE FtE_U7:'� c r� r:�REGt:�G :�_'4:rEti7 �iOTA(? ' f:'1ESS YT w�v� �\ 'JFr7:I�L SE�.. '"'3" � �� • ' ,F "YK"". '3_96_. ^ � •�l� �JB•/�'�, ,. .a� aue�:c %i71!'.����U�2i�lf , ,. ;• _. n...`� • ..�YIS::Cti' _ :4E: ._K=�D:�f___'____._" � . ........ ......... ...�,..._ . .-....-.-� ......_ ____�'_.....�.� .. . ��w����iri�b��l��ir � — .. . . � . � . . . . . . . . � � � � . � . . . . .. . T � 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.