SDTF6305_APPLICATION_INITIAL_2024

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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 Facility Informatioi
1. ApplicantIc
Address
Contact person for site operation (if different from applicant):
Title or position Phone k
Address
3. Landowner
Address
4. Site Location: County Arbrt, State Road Number
Directions to site:
6.
Is the location on a permitted Septage Land Application Site? D
If yes, give the site permit number here:
Indicate whether project is: new V 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. 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, I 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:
(over) 10414 A�r Rd. Avrlem A C, ( -6ce a4u,6 i)

H. Facility Information: the following information shall be included with the application form.
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 _ Commercial/industrial Septage
3. Types of treatment to be provided: pH Adjustment (lime stabilization)
Screening Other ✓ (attach explan tion if other)
C066h�1
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):
GIO�1Q� tisSL_ r T {
5. An explanation of how septage will be discharged into and removed from the cility (usg� r
additional paper to explain, if necessary): —:n `t � 4" IAC C d i kSv-e- [11r'►^.--
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):
III. 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. 1 have read and understand the N.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
cility permit.
Ic4 2 , .2_ —
Signature (Signature of company kial required) Date
_. AAAA C
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 & Authorization\SDTF Permit Application -Jan 2016.docx
Rev 01-07-16

Addendum to "Application for a Permit to Operate a Septage
Detention or Treatment Facility"
Question II.4.
One 1,000-gallon concrete tank will be buried to be used as a RV Dump
Station.
correcf
Question II. 5.
Wastewater from the RV is discharged into the 1,000-gallon tank through a
drain port. The wastewater will be removed from the 1,000-gallon tank by a
permitted Septage Management Firm. Donathan Pumping Service, Permit
# NCS-00264, will be under contract to pump the tank.
(7off-« /
Question II. 6.
Any spills or leaks will be contained and cleaned up. Any liquid waste will
be disposed of into the 1,000-gallon tank. Any solid waste will be bagged
and disposed of at a lined permitted landfill. Hydrated lime will be used to
treat the spill area.
e'Or/-eG/-
Signature

The tank will be a 1000 gallon concrete one piece tank with cast in plastic risers, child safety pans,
stainless steel lid screws supplied by Garner Septic. Moore County requires an on site dumping station
to obtain a permit for a campground. The campground is permitted by the local health dept for full
hookup on all sites, yet zoning still requires the addition of a holding tank to be used as a dump station.
There is no requirement for the owner to allow anyone to use the station, but even so it must exist on
the property.
Donathan Pumping Service (NCS 00264) will be under contract to empty and transport waste from the
tank to the Moore County Waste Water Treatment Plant 1094 Addor Rd, Aberdeen NC. A high water
outdoor alarm will be installed to monitor the tank as well.
I understand my engineer must confirm the tank is leak free prior to being put into operation. The tank
is also leak tested my Moore Co. Environmental Health on the manufacture's yard prior to delivery.

County of Moore
• ,� �, Planning and Inspections
s=, n
Inspections/Permitting:
[phone]
Planning. [phone]
Fax: [phone]
To: Aaron Hudson, Building Inspector
From: Ruth Pedersen, Senior Planner
Date: September 20, 2023
Re: Plan Review —New Campground— ParID 00003222 (1741 Stanton Hill Rd)
Approved for Permit X Revisions Required
The submitted site plan and related documentation has been reviewed by the Moore County
Planning Department for compliance with the Moore County Unified Development Ordinance.
Following notes to be added to the "Permit Expiration Statement" for the Applicant to sign:
Zoning/Setback Requirements
✓_ Approved Use: Campground (Phase 1)
Zoning District: This property falls within the RA zoning district.
Specific Use Standards - Section 8.23 Campground
The submitted site plan and application meets the requirements of Section 8.23 of
the Moore County Unified Development Ordinance.
A separate permit submittal will be required for the development of "Phase 2"
shown on the site plan.
A Zoninz Decision Sign IS required.
The applicant shall post a sign containing the words "Zoning Decision" in letters at
least 6 inches high, including contact information of the Administrator, on the site in
a prominent location including street frontage, and provide evidence to the
Administrator within 10 days of the permit issuance for new non- residential
buildings or changes of use, for a minimum of 10 days to notify the neighbors, or the
Zoning Permit shall be null and void.
** Issuance of a zoning permit shall in no case be construed as waiving any provisions of
the UDO, approved plans, specific use standards, and the intended use of such building
and land do, in all respects, conform to the provisions of the UDO.**

ENVIRONMENTAL ENGINEERING SERVICES
P.O. Box 426, Aberdeen, N.C.28315 Phone: [phone] FAX: [phone] Email: IarrygrRham54(7agmail.com
Mr. Don Gaddy
164 McDonald Road
Cameron, N.C. 28326
Sent via email to: r1011 a(Mrs e tic •enIu rllnk.►aet
February 14, 2024
Re: Engineer's inspection and certification letter for the new precast sewage dump tank to be used at Herd's
Creek Campground located at 1741 Stanton Hill Road, Cameron, NC.
Dear Mr. Gaddy.
On January 30, 2024, 1 visited the Garner Septic Tank Company tank yard at 121 Stanton Hill Road, Cameron
NC, to inspect a 1,000-gallon concrete precast septic tank which you had purchased. This was a top seam tank
and had the letters "DG" spray painted on the sides and ends of the tank designating it for Don Gaddy (see
photos attached to this letter). The embossed identification on the end of the tank was STS-1000 and PT-301.
According to my understanding this tank will be used at Herd's Creek Campground as a dump tank for the new
RV campground.
Garner Septic Tank employees reported that they filled the 1,000-gallon tank with water on or about January 24,
2024. The tank was originally filled to the outlet hole invert in the end of the tank, which is approximately 10
inches from the top inside of the tank lid. Upon my inspection, the water level inside the tank was within '/2 inch
of the outlet hole invert. Upon inspection, I did not see any evidence of leaking, wet spots, or seeping places on
the tank. Therefore, I would conclude the tank is water tight.
This letter shall certify that I have inspected the above referenced tank and found it to be water tight as per the
aforementioned circumstances. Information given to the engineer by others and used in this certification shall
be taken as truth if it cannot be verified otherwise.
The engineer takes no responsibility for changes made to the above tank before, during, or after construction
without his knowledge. Nor does the engineer take any responsibility for current or future human losses or
property damages which might occur due to poor workmanship, improper use of the tank, unknown conditions
above or below ground level, defective manufacturing, damage that takes place in component transport or
installation, "short-cuts" the manufacturer may have taken in component construction, or use of the component
beyond its intended purpose.
Please call me if I can be of further assistance.
LnVonment5l Engineering Services
++++++++++++++....+.-}-.....++++++++++++++++++++++++++++++++++
PROFESSIONAL ENGINEER'S C T l~O O E PROJECT
Professional Engineer's Signature: ,tilt alryyr�a
CA ,
�Ati�y�� rrh� �(j��}ii
N. C. Professional Registration Number. 11 2 .� •r. �F1SS"� •. >y �``
+ F e
Date of Certification: "
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PHOTOGRAPHIC RECORDS OF THE WATER TIGHTNESS TEST ON A 1,000 GALLON
PRECAST TANK FOR HERD'S CREEK CAMPGROUND — OWNER: DON GADDY
AM
Photo 1. This photo shows one end of the 1,000-gallon precast tank for Herd's Creek Campground. It is
full of water to the outlet hole invert seen on this end. This tank is slated for use as a dump tank. Photo
taken January 30, 2024.
1

Photo 2. This photo shows one end and the side of the 1,000-gallon precast concrete tank for Herd's
Creek Campground. It is full of water to the outlet hole invert seen on the other end of the tank_ This tank
is slated for use as a dump tank. Photo taken January 30, 2024.
2

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Moore County
January 23, 2024
1:4,800
0 0.04 0.08 0.16 mi
' Address
CANDOR
SOUTHERN PINES I! .. .I I I I I , I , I r
U Parcels
CARTHAGE
TAYLORTOWN 0 205 410 820 Feet
County Jurisdiction Layer
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MOORE COUNTY
Tuesday, January 23, 2024 by Moore County GIS Department
Ownership Data Location Data
Pin: 951800553005 City Code: N/A
Parcel Id: 00003222 Fire District: V
Owner Name:
GADDY, DONALD E
Tax Address:
164 MCDONALD RD
Class Code:
CAMERON, NC,28326
Deed/Bk Page:
2593 / 172
Land Use Type:
Trans Date:
6/30/2004
Zoning:
Sale Arl
$115,000.00
NBHD#:
Accessed Acres:
41.9600
Property Desc.:
Cal. Acreage: 42.7500
Assessment Summary/ Rates Per $100 Value
Values
Land Value: $269,040.00
Assessed Value: $312,550.00
Bldg Imp Value: $43,510.00
Parcel Map
it
FI
R01
RA
401
HERDS CREEK
Moore County GIS Disclaimer
All the information contained on this media is prepared for the inventory of real property found within Moore. All data is compiled from recorded deeds, plats, and
other public records and data. Users of this data are hereby notified that the aforementioned public primary information sources should be consulted for verification of
the information. information contained herein was created for the County's internal use. MOORE COUNTY, ITS OFFICIALS, AGENTS AND EMPLOYEES MAKE NO
WARRANTY AS TO THE CORRECTNESS OR ACCURACY OF THE INFORMATION SET FORTH ON THIS MEDIA WHETHER EXPRESS OR IMPLIED, IN FACT
OR IN LAW, INCLUDING WITHOUT LIMITATION THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR USE.Any resale of
this data is strictly prohibited in accordance with North Carolina General Statutes 132-10. Grid is based on North Carolina State Plane Coordinate System NAD83
(feet).

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APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE MANAGEMENT FACILITY
(NON -PUMPER - $200 FEE PER FACILITY)
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION
L SERVICE CENTER, "LEIGH, NC 27699-1646
(1.) Facility name:
Street address of office
A -A 3a4
Mailing address (if different)
County _ I na re.
(2.) Facility owner's name
Mailing address IG
Phone:Ql 2!j5-3 a IfA10793 7l tg—Email:_C ,l S�e�G �rt,nlr���ilnk.
(3.) Facility operator's name DW�4\1E onas\N Facility operator's title t% t
Mailing address _Cj�uie
Phone !R16 -743 77'71 CA EmaiL•_ta�p �;C p u n (i n
(4.) Type(s) of septage m}naged (check all that apply) '� I !
Domestic t/ 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
C1 c) Septage storage tanks
r d) Septage 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)
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 w - based upon incorrect or inadequate information that materially affected the decision to issue the permit
and th t re ate! nal ies for knowingly making a false statement, representation, or certification.
-4 a
Signature* Date
1A Ede cd
Print Name
*Signature of company official required.
6i,)nre-
Title
S:Solid Waste/CLA/septage/forms/2018 Firm Application/Non-Pumper-2018