SDTF6304_APPLICATION_INITIAL_2023

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
Operator and Fa(
1. Applicant
Address
Phone
2. Contact person for site operation (if different from applicant):
Title or position Phone l d r t 7 Z
Address
3. Landowner
Address
4. Site Location:
Directions to site:
5
C1
n G 'a t
State Road Number
Is the location on a permitted Septage Land Application Site? NO
If yes, give the site permit number here:
Indicate whether project is: new X renewal modification
For a permit renewal or modification, indicate the existing permit number
permit expiration date
and the
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. !f Limited Liability
Company owns the land, use a limited liability company landowner authorization form.Q4VIIJ
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). A"J
9. Vicinity map (county road map showing site location). Aqr1,c,1gc1
10. Land application site or wastewater treatment plant to be used after treatment or storage:
(over)

11. Facility Information; the following information shall be included with the application Torm.
1. Facility to be used for. Storage Treatment
2. Types of septage to be stored or treated:
Domestic Septage Grease Trap Pumpings
Portable Toilet Waste mmerciaWndustrial Septage a z3
7 3. Types of treatment to be provided: pH Adjustrnient [lime stabilization] r,
fir ' x /G� Screening Other (attach explanation if other)
r rn / v `
4. A description of the proposed detention or treatment facility including the size, type, and number, of,� ZS �
structures to be used and how thor structures will be constructed or installed u additional
paper h expl�, necessary): t! i ti G
LZ
is
5. An explanation of Prow septage will be discharged into and removed from lie fa iiity (use
additional paper to explain, if necessary}: < r (rn�cs
i
6. An explanation of how any leaks or spills at the facility will be cleaned and ho odors willbe
ni'dled (use additional paper_to explain, if necessary): �� r�� �� e XW. .
/e,,L— ks
ill. Certification iI'S
I hereby certify that '04
1, The information provided on this application is true, complete, and correct to the best o my
knowledge, and
2. 1 have read and understand the H.C. Septage Management Rules.
3. 1 am aware of the potential consequences, including penalties and permit revocation, for
failing to follow all applicable rules and the conditions of a Septage Detention or Treatment
Facility permit.
� � �'; � �" /", (— 2
SignaturO (Signature ofcompanyoffrJerrequko Date '
Print name Tilde
Mote: This appBclbm will not be accepted for review until all parts of the application are eompiete.
S:Soiil _Wwooel--ialispt VormslSDTF-AppikaWn & AuthoriraWMSD7F Permit Application -Jan 2016-docx
Pau rm-n-i_%

Landowner's Authorization 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, &44 �me of site owner) hereby certify that I am the owner of
C� 7* Z
S° ° y acres of land located '�5� _ ►�nr1 �� 1 _ ���G and
identified by ®' 3S-3 (book and page of recorded deed or tax map parcel) and
that I agree to allow — L f e- T j��ns (SDTF permit applicant) to use
said land for a septage detention or treatment facility for a period of as meq ,7 5 &,galength
of time), beginning A i - I'. o?Oo?3 (give date) and that I have read the North Carolina
Septage Management Rules *. I further understand that no septage may be stored or treated on the land
until the Division of Waste Management has issued a permit for a detention or treatment facility. The above
described property is owned solely by me or jointly with &$ 4 i4,; -r- fn J- v
(names of all co -owners. or state nonel.
Sinnature of landowner Date
Sworn to and subscribed before me this 1�04 day of , 20 a 3
MY
(Notary
My Commission expires: I- 1- o?Oay
* 15A N.C. Admin. Code 13B Section .0800
(OFFICIAL SEAL)
[fLINDA M SWEAT
lic, North Carolina
ore County
mission Expires
ary01, 2024
Rev. 01-07-16

•"°f'r°
County of Moore
Trade Permit
CODE ENFORCEMENT DIVISION
� 7Ai M
Permit Number 70492
P.O. Box 905
ofMa`r�°
Carthage, NC 28327
Date 03J0312023
Permit Type COMMERCIAL ZONING PERMIT
PROPERTYDs-
•
20081036
DALRYMPLE RD CAMERON
NAME: ATKINS, ARTHUR BALL III NAME:
ADDRESS: 788 ATKINS RD ADDRESS:
NAME: ATKINS, ARTHUR BALL III LICENSE NUMBER:
ADDRESS: 788 ATKINS RD
LICENSE EXP. DATE:
PHONE:
COMMERCIAL ZONING PERMIT ZONING PERMIT CAMPGROUND PARID 20081036 APP SLAKE ATKINS 910-690-7972
50.400
IVERMIT DETAIL4� PERMIT fTEMS QUAMT1
ANY PERMIT ISSUED EXPIRES SIX (6) MONTHS AFTER ISSUANCE IF NO INSPECTIONS HAVE BEEN MADE. ANY
PERMIT ISSUED SHALL EXPIRE TWELVE (12) MONTHS AFTER ISSUANCE IF THE WORK IS DISCONTINUED.
License Number
Date
03/0312023
Signature of approving official
Signature on file
Signature of owner/contractor
Total Fees - $150.00

CHAPTER 8. SPECIFIC USE STANDARDS
residential building code situated on the farm occupied by the owner, lessee, or operator of the farm and
other buildings or structures sheltering or supporting the farm use and operation.
4. SUPPLEMENTAL REQUIREMENTS
Certain building code and environmental health requirements such as subdivision (see Chapter 18), flood
damage prevention (see Chapter 16), and watershed protection standards (see Chapter 15) still apply to
bona fide farms but zoning permits are not required.
A. DEFINITION
An establishment for the manufacture, blending, brewing, fermentation, processing, and packaging of beer
or wine that may or may not be in association with an existing vineyard or hops and grain farm located on
the same property.
B. STANDARDS
1. Retail sales, banquet hall, tasting facility, and restaurant may be permitted as an accessory use with all
applicable Alcohol Beverage Control Commission (ABC) commission permits.
2. All buildings, outdoor seating, entertainment, and parking areas shall be 50 feet from any residentially
zoned property line.
3. Such uses shall provide at least one off-street parking space for every two people at full capacity.
A. DEFINITION
Land used by a nonprofit organization that consists of one or more buildings, located on a minimum 20 acres
of land that provides accommodations for more than nine individuals and where the activities of those
individuals predominantly occur in supervised groups for recreational, religious, and/or educational
purposes, including but not limited to retreat events and summer camps for children, groups or families.
Accessory uses may include, but are not limited to, tents or cabins, staff housing, worship areas, dining areas,
horse stables, ball fields, amphitheaters, retreat center, or swimming pools.
B. PARKING
Such uses shall provide at least one off-street parking space for each employee and one parking space for
every five beds.
C. UTILITIES
All water and sewage facilities shall be designed and installed according to the standards of the Moore County
Department of Public Works, Department of Environmental Health, and NC Department of Environmental
Quality.
D. PROHIBITED ACTIVITIES
No one shall remain at the campground for more than 30 continuous days within a 60-day period with the
exception of staff.
SECTION'•
A. DEFINITION
A lot in single ownership that has been developed or is intended to be developed for occupancy by tents,
cabins, and all types of recreational vehicles, including tent trailers, for transient dwelling purposes.
B. LOT LAYOUT
A campground shall be configured in accordance with the table below:
Moore County UDO I Page 91 1 Last Updated: 4.18.23

CHAPTER 8. SPECIFIC USE STANDARDS
SECTION: CAMPGROUND
CAMPGROUND CONFIGURATION
FEATURE
Minimum Property Size
REQUIREMENT
20 acres
Maximum Density
24 cam sites per acre
Peripheral Buffer including Street Rights -of -Way
Type 3 Screening
(see Section 7.11)
Minimum Campsite Size
1,000 square feet
Minimum Space Width
20 feet
Minimum Setback of Buildings from Any Property Line
50 feet
Minimum Common Open Space or Recreation Area
10% of gross site
C. EXISTING CAMPGROUND
All new campgrounds and all expansions to existing campgrounds shall meet all standards set forth in this
Ordinance.
D. SITE PLAN
1. The site plan shall be prepared by a North Carolina licensed engineer, architect, or surveyor, which depicts
the proposed general design and arrangement of uses and buildings.
2. In addition to the site plan requirements in Chapter 4 the following shall be included on the site plan:
i. Lighting;
ii. Streets;
ill. Peripheral buffer;
Iv. Campsite spaces; and
v.. Phase lines.
E. OFF-STREET PARKING
1. Each tent campsite shall have two off-street parking spaces.
2. The minimum parking space dimensions shall be 9 feet by 18 feet.
3. Each recreational vehicle space shall have off-street parking for one recreational vehicle and parking space
at least one automobile in a tandem configuration.
F. LIGHTING
1. Interior lighting is required in any building open at night.
2. Lighting shall be provided for all recreation areas, bathrooms, and dumping areas, and parking areas
(other than at each campsite), shall be lit at night, either with a light mounted on the building or as a pole
light.
G. UTILITIES
1. Drinking water and sanitary (bathrooms and showers) facilities shall be available within twelve hundred
(1,200) feet.
2. For recreational vehicle campgrounds, a minimum of one central sewage dumping station shall be
provided for removing and disposing of waste from waste holding tanks.
3. Sanitary facilities and dumping stations shall be separated from any campsite by a minimum of 50 feet.
4. All water and sewage facilities shall be designed and installed according to the standards of the Moore
County Department of Public Works, Department of Environmental Health, and NC Department of
Environmental Quality.
5. No provision of utilities or "hookups" shall be constructed on tent -only campsites.
H. STREETS
1. No space shall have direct access to a public street.
Moore County UDO I Page 92 j Last Updated: 4.18.23

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180 Perry Road
SANDERSSouthern Pines, NC 28387
NC License No P-2463
E N G I N E E R I N G www sandersengineers corn
SITE
Antique Town Campground
COUNTY VICINITY MAP
Moore County, Cameron NC
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DATE
1"= 24,000 Feet

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180 Perry Road Antique Town Campground
Southern Pones, NC 28387 VICINITY MAP
NC License No P-2463
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LEE COUNTY
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October 12, 2023
�7=ESANDERS
N G I N E E R I N G
Blake Atkins
1385 Atkins Road
Cameron, NC 28326
Re: Septage ❑etention and Treatment Facility (SDTF) Permit application
Blake Atkins at Antique Town Campground
Dalrymple Road (SR 1823)
Moore County, NC
Dear Mr. Atkins,
❑n ❑ctober 11, 2023, an initial site visit was made to the above referenced location to perform a leak test of the
installed concrete septage detention tank. At that time, the tank was filled with water and the water level was
noted. On October 12, 2023 another site visit was made 24 hours after the initial visit and the water level was
noted again. The water level did not change.
I certify that this concrete septage detention tank was water tested for leaks for a period of 24 hours and has
passed inspection.
Respectfully, = FESS�o'. /9
SEAL _
36249
16.
'NG[1�E Co
M. Shane Sanders, PE, PL5
Owner
Sanders Engineering, PLLC • 180 Perry Road . Southern Pines, NC 28387 e P: [phone] • License# P-2463
w w w s a n d e r s e n g i n e e r s. c o rn
Page T of 1

APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE MANAGEMENT FACILIT'r
(N0N-PUMPER - $200 FEE PER FACILITY)
DMSION OF WASTE MANAGEMENT - SOLID WASTE SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NC 27699.1646
(1.) Facility name: trc//t
Street address of office
Mailing address (If differenfj _ 1 1J, _ 1.
County rvl oo >rc �� Me 0i?- e
(2.) Facility owner's
Mailing address
name_ t j.� .T A%;,mr &/f.+sf��
}
Phonef 41®:� r :- 7 Email:�,`� `tfe® Coma
(3.) Facility operator's name Facility operator's title
Mailing address !
Phone( '!U 490 --IZY 72 ' I
(4.) Type(s) of sep m (check all that apply)
Domestic ,- = Portable Toilet Waste _ _ Grease (restaurant)
Treatment Plant _ Industrial/Commercial
(5) Facility Types: Check all that are applicable and provide the permit numbers.
a) Septage land application site
b) boat pump out storage
,,jSeptage storage tanks
d) Septage treatment r
e) Grease treatment
(6) Name and Permit Number of a8 permitted Se
(1) � pe ptage Management Firms using facility:
0 ► O
(2) _ --"" — N N
(3) - - lf�'
us
(Use additional sheets ff necessary) Doss
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
andIM are inal Ities knowingly making a false statement, repr sen `on, or certification.
�� 3
Signature* a -- -
Print Now
Signature of company official required. ritiie
S:Sdid Waste/CWseptagefformy2018Firm Application/Non-Pumper-2018