SDTF9503_APPLICATION_20211129

Engineering I Planning I Environmental
Blue Ridge RV Park-Firm and Facility Permitting
11-10-2021
Mr. Cobb,
The attached application and check are for the completion of Non-pumper Firm & SDTF
Permitting. This is a new SDTF that is in progress, currently. Troy Harrison has made a
preliminary site visit an~ is agreeable to the chosen tank location. Connie Wylie has been
mailed the facility application and supporting documents. The client's goal is to install the tank
for use next season 2022. If you have any questions, please contact Me at (828) 8S5-4327 or
email [e-mail].
Thanks,
Max G. Prestwood Ill, P.E.
1520 Meadowview Drfve m
Wilkesboro NC 28697 V
[e-mail] _.a 336.844.4088 t
www.brec.biz U-"-
APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE DETENTION OR.
TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management -Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
I. Operator and Facility Information
1. Applicant BLUE RIDGE RV PARK
Address 3490 NC HWY 194 N, BOONE, NC 28607
Phone [phone]
·uv 2 9 2□2
t
2. Contact person for site operation (if different from applicant): __________ _
Title or position OWNER/OPERATOR Phone ----------
Address
3. Landowner WILLIAM & RONDA KULCZIK
Address 3490 Ne HWY 194 N, sooNE, Ne 28601
4. Site Location: County WATAUGA State Road Number _N_c_-1_94 ___ _
Directions to Site: From intersection of E King St. and NC-194 in Boone, continue on NC-194 N for 3.4
miles. Site is on the right.
5. Is the location on a permitted Septage Land Application Site? _N_o ___ _
If yes, give the site permit number here: __________ _
6. Indicate whether project is: new __y__ renewal ___ modification
For a permit renewal or modification, indicate the existing permit number ______ and the
permit expiration date ______ _
7. Attach written, notarized landowner authorization to operate a septage storage or treatment facility
form signed by the landowner (if the permit applicant does not solely own the property}. If a
corporation owns the land use a corporate landowner authorization form. If Limited Liability
Company owns the land, use a limited liability company landowner authorization form.
8. Aerial photograph scale 1 inch= 400 feet with site property lines accurately located on the photograph
must be enclosed (if 1 inch= 400 feet is not available, 1 inch = 660 feet may be substituted).
9. Vicinity map (county road map showing site location).
10. Land application site or wastewater treatment plant to be used after treatment or storage:
Wastewater treatment
(over)
II. Facility Information: the following infonnation shall be included with the application form.
1. Facility to be used for: Storage -✓~----Treatment -----
2. Types of septage to be stored or treated: RV/CAMPER sEPTAGE
Domestic Septage ✓ Grease Trap Pumpings __ _
Portable Toilet Waste ___ Commercial/Industrial Septage __
3. Types of treatment to be provided: pH Adjustment (lime stabilization) _N_tA __ _
Screening ___ Other ___ (attach explanation if other)
4. A description of the proposed detention or treatment facility including the size, type, and number of
structures to be used and how those structures will be constructed or installed (use additional
paper to explain, if necessary): A single water tight 3000 gal. H-20 traffic rated concrete tank is to be burried
for use as a below grade septage detention facility.
5. An explanation of how septage will be discharged into and removed from the facility (use
additional paper to explain, if necessary): camper septage will be dischaged directly into tank by
typicaly gravity methods. Washdown area to be provided. The septage will be removed by a pump truck
and hauled to approved treament facility, by an approved pumper.
6. An explanation of how any leaks or spills at the facility will be cleaned and how odors will be
controlled (use additional paper to explain, if necessary): Concrete washdown area to be installed
around tank inlet. Leak/spills can be washed into the tank. Odors to be minimized by extending recieving
pipes within 18" of bottom tank.
Ill. Certification
I hereby certify that:
1. The information provided on this application is true, complete, and correct to the best of my
knowledge, and
2. I have read and understand the N.C. Septage Management Rules.
3. I am aware of the potential consequences, including penalties and pennit revocation, for
failing to follow all applicable rules and the conditions of a Septage Detention or Treatment
Facility permit.
tJ;)l 1f?J? ~ -JrZ /dd f{-'l_']--21
Signature (Signature of company official required) Date
WILLIAM J, KULCZIK RONDA M, KULCZIK OWNER/CO-OWNER
Print name Title
Note: This application will not be accepted for review until all parts of the application are complete.
S:Solid _ Waste\cla\septage\forms\SDTF-Application & Aulhorization\SDTF Permit Application.Jan 2016.docx
Rev 01-07-16
..
APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE MANAGEMENT FACILITY
(NON-PUMPER-$200 FEE PER FACILITY)
DMSION OF WASTE MANAGEMENT· SOLID WASTE SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646
(1.) Facility name: BLUE RIDGE RV PARK
Street address of office 3490 NC HWY 194 N, BOONE, NC 28607
Mailing address (if different} ____________________ _
County WATAUGA
(2.) Facility owner's name_W_IL_L_IA_M_K_U_L_C_Z_IK _________________ _
Mailing address 3490 NC HWY 194 N, BOONE, NC 28607
Phone: [phone] Ema~: [e-mail]
(3.) Facility operator's name WILLIAM KULCZIK Facility operator's fitle _O_W_N_E_R ___ _
Mailing address 3490 NC HWY 194 N, BOONE, NC 28607
Phone [phone] Email: [e-mail]
(4.) Type(s) of septage managed (check all that apply)
Domestic ✓ Portable To~etWaste ______ Grease {restaurant) __ _
Treatment Plant _______ Industrial/Commercial _____ _
(5) Facility Types: Check all that are applicable and provide the permit nOmbers.
a) Septage land application site _________________ _
b) Boatpump-outstorage -,-------------------
c) Septage storage tanks _✓ __ T_B_D _______________ _
d) Sep1age treatment
e) Grease treatment
(6) Name and Permit Number of all permitted Septage Management Firms using facility:
(1)
(2)
(3)
(Use additional sheets if necessary)
•NOTE: TRIPLET PUMPING WILL LIKELY BE THE FIRM USED TO HAUL OFF SEPTAGE FROM THE SITE.
Certification Statement
I certify that the information and representations in this application for a permit are true, complete, and accurate to the
best of my knowledge and belief. I am aware that a permit may be suspended or revoked upon a finding that its
issuance was based upon incorrect or inadequate information that materially affected the decision to issue the permit
an~t there are crir.!2nal1ies for kl1owingly making a false stateJ¥i!l, re_piesentalion, or certification. _A+ l. :C ,.._ ,,. ".,,
~~~ ~
WILLIAM J, KULCZIK OWNER
Print Name Title
"'Signature of company official required.
S:Solid_ Waste/CLA/septagelforms/2018 Firm Application/Non-Pumper-2018
Excise Tax -$1,352.00-
FILEO -J. Shook Resistor of Deeds. Wataug& Co, NC
F .. AMl: $26.00 r«: Excise TU: $1,3S2.GB
Bk 1840 Pg 253 (2)
Rocorct-d : 12/3112¢115 at 10:49;58 AM
l)oc Ho! 64'1581 Klnd: OEE0
\II \II\Ul\11\\\\\l\\1\\I~ \\\ II\
&,3581
Recording Time, Book and Page
Prepared by: Miller & Johnson, PLLC. P.O. Box 49, Boone, NC, 28607
Return 10: Grantee by mail
STATE OF NORTH CAROLINA
COUNTY OF\VATAUGA
GENERAL WARRANTY
This General Warranty made this 29th day of December, 2015, by and between
DEBORAH E. GREENE, single
3900 NC H,vy 194 N, Boone, NC 28607
(hereinafter called "Granters")
and
✓ William J. Kulc-.tyk and wife, Rhonda M. Kulczyk
P.o, (3::i~ 52 II
6 "•~ fl<--Z,$c,o'1
(hereinafter caried "Grantees")
WITNESSETH:
Granter, for and in consideration of the Ten Dollars and other good and valuable consideration to it in
hand paid by Grantee, the receipt of which is hereby acknowledged, has transferred, given, granted, bargained ,
sold and conveyed and by these presc11ts does give, grant, bargain, sell, convey and confirm unto Grantee, its
successors and assigns, in fee simple all that certain lot, parcel or tract of land situated in Meat Camp Township,
Watauga County, North Carolina, and more particularly described as follows:
BEING all of Tract 2, contain ing 90.13 acres, as shown on that survey entitled "Boundary Sun•ey for
William J. Kulczyk and wife, Rhonda M. Kulczyk," dated November 25, 2015, by Hencle Matheson, PLC,
and filed in Plat Book g5 , Page 1.QL, \Vatauga County Registry, to whitb plat reference is hereby made
for a more complete description of said property.
The property being conveyed is NOT a primary residence of the Granter.
BK 1840 PG 254 DOC# 643581
This deed was prepared without the benefit of a current title examination. The property hereinabove described
was acquired by Grantor by instrument recorded in Record Book 1524, Page 211 , Watauga County, North
Carolina Public Registry.
TO HA VE AND TO HOLD the aforesaid lot, parcel or tract of land and all privileges and appurtenances
thereunto belonging. or in any wise appertaining, unto Grantee, its successors and assigns in fee simple forever.
Grantor covenants with Grantee that Grantor is seized of the premises in fee simple and has the right to
convey the same in fee simple; that title is marketable and free and clear of all encumbrances, other than those
exceptions set forth below; and that it will warrant and defend the title to the same against the lawful claims of all
persons whomsoever except for the exceptions hereinafter stated.
Ti.tie to the property hereinabovc described is subject to the following exceptions:
I. Utility, rights of way, and other easements of public record.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal , or if corporate, has caused this
instrument to be signed in its corporate name by its duly authorized officers and its seal to be hereunto affixed by
authority of its Board of Directors, the day and year first above written .
.i.l.tkt1 A e, {}~ (Seal)
DEBORAH E. GREEN"E, single
STA TE OF NORTH CAROLINA
COUNTY
OF WATAUGA
I, a Notary Public of said County and State. do hereby certify that the following person personally
appeared before me this day and acknowledged the exec u1ion of the foregoing instrument:
DEBORAH E. GREENE
WITNESS my hand and oflicial seal this the 3J_ day of_~=::....,...,...-·
NOTARIAL SEAL:
Bk 1840 Pg 254
October 11, 2021
William Kulczyk
Ronda Kulczyk
PO Box 3211
Boone, NC 28607
WATAUGA COUNTY Department of
Planning & Inspections
f 26 Poplar Grove Connector Suite 201 • Boone, North Carolina 28607 [phone]
TTY l-800-735-2962
Voice J-800-735-8262
or 711
FAX [phone]
RE: Zoning Verification Letter
PIN# 2912-93-7453-000
This correspondence is to confirm that the property referenced above is located in an unzoned, unincorporated
area of Watauga County.
Let me know if additional information is needed.
BlueRidge
ENERGY
October 19, 2021
William J. Kulczyk
Rhonda M. Kulczyk
PO Box 3211
Boone, NC 28607
Re: Septic Encroachment
Dear Mr. and Mrs. Kulczyk,
1216 BLOWING ROCK BLVD NE
PO BOX 112 • LENOIR. NC 28645
P 828-758·:!383
F 828-758-2699
Recently, Max Prestwood, Project Engineer with BREC, contacted Blue Ridge regarding the placement of
a septic detention tank for you proposed campground located on Hwy 194 and recorded in Plat Book 28,
Page 219 Watauga County Registry. Per Max Prestwood, this will be a 3000-gallon H20 Traffic rated
tank. Based on the drawing provided by Blue Ridge Environmental Consultants, Blue Ridge Electric will
agree to the location of the tank within the right of way of our Boone-Todd Transmission line and
distribution line. In the event the tank would ever need to be replaced, proper clearances must be
maintained at all times and the use of a crane would be prohibited.
If you should have any further questions, please feel free to give me a call.
,:inc~~ Q , ~t
Jana C. Wike
Larilf Rights Specialist
Blue Ridge EMC
[phone]
[phone] cell
Enclosures
Bl RIDGE: E.l TRIC ME:M R 1-< P
CALDWELL DISTRICT OFFICE WATAUGA DISTRICT OFFICE
N R ES
ASHE DISTRICT OFFICE ALLEGHANY DISTRICT OFFICE

April 21, 2022

Engineers Certification For: Blue Ridge RV Park
3490 NC HWY 194 N, Boone, NC 28607

To whom it may concern,
This letter is to acknowledge and certify the septage detention tank at 3490 NC
HWY 194 N, Boone, NC 28607 was installed with acceptable conformity to approved
plans, specifications, and approved modifications. Periodic observations were made
during installation and a detailed inspection report was completed. This system was
completed in compliance with the North Carolina Septage Management Rules. For
questions or concerns regarding this please feel free to contact me.

Sincerely,

Max G. Prestwood III P.E.
Project Engineer / BREC, PA.

1520 Meadowview Drive to\
Wilkesboro NC 28697 V
Engineering I Planning I Environmental
[e-mail] 0
www.brec.biz 0 336.844.4088 \_.

Engineers Report For: Blue Ridge RV Park
3490 NC HWY 194 N, Boone, NC 28607

Multiple visits were made to the site during construction. On 11-04-2021 and 5-18-2021
for location evaluation, on 3-24-2022 for tank installation and on 4-21-2022 for final
inspection. Some pictures from the tank installation are attached. The Tank installed
was a Shoaf Precast 3160, H-20, STB-550. The tank, risers, and lids were all installed
that day. The tank was vacuum tested by Shoaf Precast, and their certification is
included along with the tank specification. On 4-21-2022 Troy Harrison with DEQ –
Solid Waste Section met on site. Troy recorded the GPS location and verified all
setbacks were met. Tank had been backfilled and graded to direct runoff away from the
tank’s location. All work had been completed with acceptable conformity to the plans,
specifications, and NC Septage Management Rules.

Installation Pictures Below

3-25-2022
SHOAF PRECAST SEPTIC TANK, INC.
4130 West U.S. Hwy. 64
Lexington, NC 27295
Telephone: [phone]
FAX No. [phone]
Email Address: [e-mail]
TO WHOM IT MAY CONCERN:
This letter is to certify that the following tanks were vacuum tested to 5'' hg
and held for five minutes with no leakage.
Contractor Will Kulczyk
Invoice# 42486
Job Info: Blue Ridge RV Park
Tank Size
3,160 gal
Notes:
Phillip S
Vice
Sho
Description
H20 Traffic Rated Septic Tank
NC Approval #
STB-550
Date: ---------
Qty
1
----------167' -----------. I ----------155• --------
.. ,."?;,··;•4·_ ....... ~ .~: .... ,t:i,:· t> .. :,~·-·.:•; .. ·.\·>·~-.. :.··_ .• ,· .. ::a.:."~•-··=~·-~::. .
NT .... . s·
78'66' 24' e···
INLET
4' DR 6'
.-.. INLETS 8.
;-· OUTLET
..._~~--~~~-~-~~....!--r,......,~~--~~..,...,....\\· BOOTS ON : .: ... ~ .. :._ . .:-:•~· .. ~• .. ·.-!.-~·,.:.·1._. :8;.--:.;.:.:-.:•-:··~:.:}:~(· :..:-:.•:•· .. _.~•!:··:. ENDS ONLY
ND BOOTS ON
SIDE INLETS,
USE CONCRETE
KNOCKOUTS
••N□TE-T□P VIE'w MEASUREMENTS ARE TD
'wIDEST DIMENSIONS
-----------167' ----------s·
------97• ------
SHOAF PRECAST SEPTIC INC,
4130 \JEST US H'wY 64 MODEL: MS 3160 mo S TB
LEXINGTON, NC 27295 mo TRAFFIC RATED
PHONE [phone] Gallon Sepie Tank
FAX [phone]
'w'w'w .SH□AFPRECAST.C□M
SH□AF-3160 H20 TRAFFIC RATED
STB-550 TRAFFIC RATED
LIQUID CAPACITY-3160 GALL□NS/AIRSPACE-9'
TANK HEIGHT-96'
BOTTOM OF TANK TD CENTER OF INLET-86'
BOTTOM OF TANK TD CENTER OF □UTLET-83'
LENGTH TD 'wIDTH RATI□-2 TD 1
SIZE OF INLET 8. □UTLET-4' DR 6' PIPE
TYPE OF INLET 8. □UTLET-P□LYL□CK DR EQUAL (MEETS ASTM C-923>
CONCRETE PSI-5000J TANK 'wEIGHT-40,000 LBS,
ACCESS TOP 'wITH RISER PLUS RINGS AND COVERS (NOT INCLUDED)
REINFORCING PER ENGINEERING DRA'wING
SCALE -N,T,S,
MANHOLE RINGS 8.
COVERS AND RISERS
AS REQUIRED~
f-.'.'1 :~-.: ~---,....,..,,.......,_ .. _. ·\~-~•,..,.....,..,....~
STATE
APPROVAL #
SH□AF-3160
STB-550
7•
l I HNOTE-TEE
NOT SUPPLIED
f':--~ : ..... :. ::
..----+-oi-.
84'
TD BOTTOM
OF 4' INLET
83'
TD BOTTOM ..
OF 6' INLET _-..
:'·
... •· SIDE VIE'w
FL□'w
THROUGH
3• 73•
.•.. . . :-~-.... ~ .... :_---:• ._--:/,-~,,..., ...... _:----.-~ .--~, ...... :~--::-.-~.~~--=-~ .. • ... :--,._-.. ~•'"':..:.,...:. ~~4----.~-: ,...·:~·-='_:~:: ... "; ·::···:: .• ~t~, ~·•: _ .. ;~·~.; ~-: --+---I
80' TD BOTTOM OF 6' OUTLET
81' TD BOTTOM OF 4' OUTLET
96' 82' q O 0
\_ 1114'
FL□'w
THROUGH
:. ; END VIE'w
0
.. , ..
, ..
11' BUTYL
RUBBER MASTIC
SEALANT
CONTINUOUS IN
JOINT
Received on 11/29/2021w 2J2.~ 290.M 2801'2 0 N 22'01 Hi W "' or•• u c $ M".29 E Notes l M>-t,. l.r ,.,<711,.. re vc r;;,;; per Q't:<,-= ,~.;~: .... ~ff,-r'Q, 2 /11, <ltH:6',,,_..,.,s/Joo,t al~ I.£',,: ""9,.?N J ~ Ol'N ./JIIOS c;'fN77pv/rto' b/ e;~a fl'll()mtllif All c/,s/a,a!.9 artt l!orlJ'Ol1tol. _,. In~ Slot~ ,qOlt" CoordN1ohr ~ ~ .,,th Stoll(:' t:PS' ~t,o,,s IMd' p,oe,,nrW ,,.,h, /JOtlS bJ1 oe~f aF M~ tJPt/S lnhm.bltDn ,S d .a?.Jm. MY/M-<t,:,f /hf,un• NAP 4J P<JI/.J ~ 2dltlt:7tXJtJ fM -/oc/<Y ,s a9SIM?$ll Robert L. ~l'U/\e .,,_,.,~_.;,.,..,.s,,, ~= ~',~ l \ J .75 : ..... I '.s4,tw.,-,.._,.,.... ... ~:~ ; lf,.} ! le.M f ~-!: ! ~;: : Hs~+.;;-cc~;i-,-H---,ffl,QO f ~~~=tt~~t~~::~~::::'.=~~~.:..~~ r f-",~+..;>~="r.~;;..+---,•~··~•';..i : ~~~===~-~ .. ~-"~ I .Tel\" Grune, Jr. I ;ti(,.,,,,~ I Jott~'.!; Jr. ·,,"'-t~ ', ~o!~~;!a_,w!!' ,..,..,,,,,,,,......,.J# f ~borall,E, Gr / 1/1## ., Awu' .. ,w-........, ......,_,,. .,_fllOtc: ,' 1, Willian, Gr-\ t::Zli~ \_ .... , • .,.. ..... ~4,m, '\, \ ~. ---L-._.,-,(J , .... ,,..,,.1-I • 1 \ -~~ co,-,t,r;y ""( vs«/ Tract l 83.40 Ac John Grune. Jr. ..,.,,......, ....... p,i --4 ow--. ~------, a o -Tract 3 32.83 Ac. •f I :ll..._ _ __...._ _ _,__..c_ ____ __.~ '~ I if. \l t ' I ~ ' I ! I I i I \ \ I I ' J : \ ' I I ' ' w: ,• r,:--r,' I , I I I I ,' I ,fl Tract 2 90.13 Ac. c:::? -----· ,., I :;DJ I ·---._,/ OI /-, l DJ! 3 ! Waterston£ ,_,.,.._.,/H,_..h.1 Castle Estates -,,._,~_,H.._...$#° 4 Oovndory Svr.-ey M'ode For U11Hom J. £"ulc.zyk And/If/& Rho/Joo 41. £"ulc.zyk QO(J/ or Records /.5.?4 ol Po9e .?II Iola/_,,,...,, lllis Vo,o .?t76.J5 ;lcres 206.35 ACRES Tola! ' / ' i I I / ....... "4'"Nw-,.,._~.,.,.,;\ \ Meal Camp Township Watauga Counly, North Carolina November 25, 2015 ... "2!5 ~ uu (1) ::-.. --~I·~::•~ "',, ,v-,i; "Ji-,t,,,,111~ u. \ Sylvia Sue. G. Picard 11 I , ... .,.,_,,.,_.-n-,~..W ! Glorra Jena G. Dickens \ I .,,._.,,__..A#~,..,.SM \ ' I Scele 1"' • o· 300' 300' 600' 'JO()" --------Copyrighted '1DICU: ~ 1,1,'lliESON, PLS L-2561 NC. L-1397 rn, 7883 RO~INClR ROAD, SUGAR GROVE, '40RTH C~ROIJNA, 18679, Ptt 8?8•297-~lll!, © __ ...,..,_ ~/, r,,, M, 130>5 {>d,,,,r.9 fi'(!f ,N'(;t /~/
Received by email on 02/03/2022 crcNotes 1 North is re!OhYe ta Ptat 800k 25 al Pogll!' 101 2. Tha detid refen:nce. is BOOk of R«aros 1840, Paqe 253 J_ Tha ore.a was compolcd by c.oo,d,nota qaomelry An ctls\oncits ore hor-1tonlol. , Morium.-.lalion dosct1pt\on I• o• notitd on our 201 S ..SIJt'IM,Y J I I I I I I I I I I I Rock Cruk Events , LLC _ _, __ ,.,,,,..._ MIJ/Jt:»i~ Ill~ ti~ A Boundary Survey For William J. Kulczyk And Wife Ronda M. Kulczyk Book of Records 1840 at Page 253 Total Area This Map 14.746 Acres HQrdin Joseph RoyQII, ill .dibAtfd ........ /JIMqf,...., 4111 \ Recording Dal.a ,,uo .., J ..,_~ ..... , .... , ~ 111.6\1111 ... c.. Mi r-•• u,• Meal Camp Township Watauga County, North Carolina August 6, 2020 St,Ale 1-* 100' 0' too• 200 300 --------HCNCI.E. J. ~AlliESON, PLS L-2561 NC. L·IJ97 TN, 7883 RO\ONCER ROAD, SUGAR CR0\/1;, NORTH CAAOUNA, 28679, PH 828-297·!it86 ~m,~ nie, Na 20.a:;u -m? r.i, M, M-OOJ-2
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PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPEEEEEEEEEEEEEEENC HWY 194100'50'118.56'WELLGARAGE-BARNRESIDENCE12345678910111213141516171819FUTURE
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