I.

ARKANSAS DEPARTMENT OF ENVID.ONMENTAL QUAUTY NOTICE OF INTENT

INDIVIDUAL TREATMENT FACIUTIES NPDES GENERAL PERMIT ARGSSOOOO

• Application Type: New 0 Renewal D (Permit# ARGSS. ___ --J

PERMITTEE/OPERATOR INFORMATION

Pennittee (Legal Name): Heath and Mia Stanley

Permittee Mailing Address: 154:2. S. A;~ fl.~~~ fbv-Pennittee City: H.t."(effev: H-e. .

Pennittee State: ~ Zip: ~J-70 l Pennittee Telephone Number: .lf?~ ~ ~ -~..;l

Permittee Fax Number: ------------~------------

Pennittee E-mail Address: h.s~(e'"-(~ttY'l2esf..ct>A.I\

Operator Type:

D State D Partnership

0 Federal D Corporation*

~ole Proprietorship/Private

*State of Incorporation: ___ _ The legal name of the Permittee must be identical to the name listed with the Arkansas Secretary of State.

n. INVOICE MAH.ING INFORMATION {Home owners are exempt.)

Invoice Contact Person: ------------------------- Cicy: ----------------Invoice Mailing Company: ----------------- State: ----- Zip: ---

Invoice Mailing Address: ----------------------- Telephone: --------------------

Ill. FACILITY INFORMATION

Facility Name: Stanley residence Facility Contact Person: -~--C_a..-t: __ /t __ 5_'f_'a_,_:_t....,-c.>"fY?' ____ _

Facility Address: 2413 Autumn View Telephone Number: _if.:... . .:...1..:..9_-...;5 __ J'...;(;_--.::.tf_::::c.._·· JL.:=:z=-. __

Facility County: _W.:.:.=as=hi=ngt=o.;;.;n;...._______ Facility City, State & Zip: Fa tt ellt v//e . Ale 7 c2 7 0/ I I

Facilicy Latitude: 36 Deg 5 Min 36 Sec Facility Longitude: 94 Deg 3 Min 57 Sec Accuracy: Method: ---- Datum: ___ Scale: ___ Description: ___ _

IV. DISCHARGE INFORMATION

Outfall Number: Flow: 500 gpd (Gallons per Day) Stream Segment: 31 Hydrologic Basin Code: .....;.;11;.;:1.;;.01;;.:0~3 __________ _ Outfall Latitude: 36 Deg S Min 36Sec Outfall Longitude: 94Deg 3 Min 57 Sec Accuracy: Method: _____ Datum: Scale: Description: ____ _

Type of Treatment: _;Aero:=..:::ctec=h::..:A.:::T=-5:::.:0::..:0'----------------------------------------------Receiving Stream: _Wh..:..:...::::::.ite=-Ri::.::·:..:..ve=r ______________________________________ _

V. FACILITY PERMIT INFORMATION

NPDES Individual Pennit Number (If Applicable): --'AR:=O=O'--------------------­NPDES General Pennit Number (If Applicable): _;AR:=G=--------------------­

State Construction Pennit Number: ------------------------NPDES General Construction Stonnwater Pennit Number (If Applicable): -=-=ARR==lS'--------------------

WATER DIVISION 5301 NORTHSHORE DRlVE/ NORTH LITTLE ROCK, ARKANSAS 72118

PHONE 501-682-0623/FAXSOI-682-0880 www.adeq.state.ar.us

-5-

VI. OTHER INFORMATION:

Operator Name: Rebecca Corbitt

Operator License Number: _.::.;10:.;:5:..=6.::.5 ___________ ___;L:=.t:.;:·ce~n=s:.;;.e...;:C~las=s:...;:II=----------

Consultant Contact Name: ...:R.!:.:e=.:b:.:e:.;;.cal=..;C::;.:o=r.::.:bitt=-----------------------

Consu:~:m:~ ~::l:~ ~=:f®cox.n~~ty: Lowell State: AR Zip: 72758

Consultant Phone Num6er: 479-466-6183 Consultant Fax Numbe....::.::r:::..:_'-_-_-=_-=_-=_ _______ _

Has this treatment system bell approved by AHD? Yes D No D Disclosure Statements:

Arkansas Code Annotated Secqon 8-1-106 requires that all applicants for the issuance or transfer of any pennit. license, certification or operational authority issued by the Arkansas Department of Environmental Quality (ADEQ) file a disclosure statement with their applications! The filing of a disclosure statement is mandatory. No application can be considered complete without one. Y oo must submit a new disclosure statement even if you have one on file with the Department. The form may be obtained from ADEQ web site at: htto:l/www.adeg.state.ar.us/disclosure stmtpdf.

IERTIFICATION OF OPERATOR (Initial) "I certifY that. if this facility is a corporation, it is registered with the Secretary of the State of Arkansas." (Initial) "I certifY that the cognizant official designated in this Application is qualified to act as a duly authorized

representative under the provisions of 40 CFR 122.22(b). If no cognizant official has been designated, I ,,/L2 understand that the Department will accept reports signed only by the Applicant." ~(Initial) "I certify under penalty of law that this document and aU attachments were prepared under my direction or

supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons directly responsible for gathering the information, the infonnation submitted is, to the best of my knowledge and belie~ true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations."

Responsible Official Printed Name: H~~th~~ Title: homeowner

Responsible Official Signature: __ Date: _.....,71-f-'/J-L/=--Y/'-'"(_4 _______ _ i L /) r' f 1

Responsible Official Email: h.SJRJI\).e'"(~ .CL>W\

Cognizant Official Printed Name: Heath and Mia Stanley

Cognizant Official Signature: ---------­

Cognizant Official Email:

X. PERMIT REQUIREMENT VERIFICATION

Please check the following to verity completion of permit requirements.

Title: homeowner

Yes No * II No is answered for any of the questions, then a pcnuit can not be issued!

Submittal of Complete NOI? D D Submittal ofR.!equired Permit Fee? D D Check Number:

Submittal of AHD Form BHP-19? 0 0 Submittal of Site Map? 0 0 Submittal ofDisclosure Statement? D D

WATER DIVISION 5301 NORTHSHORB DRIVE I NORTH LITTLE ROCK, ARKANSAS 72118

PHONE 50lp682p0623/ FAX 501-682-0880 www.adeq.state.ar. us

-6-

Bailey, John

From: Sent: To: Cc: Subject:

Jamal,

Wentz, Nathan Wednesday, October 22, 2014 1:53 PM Solaimanian, Jamal Bailey, John; Clem, Sarah ARG55

Sarah said that you asked for an email that outlined Planning's request for additional monitoring of mineral, particularly sulfates, and nutrient constituents for the individual treatment application near Fayetteville. Per section 5.5 of ARG550000 (Justification of Permit Limits and Conditions), the Department may determine that additional parameters may be required to comply with water quality standards. Reach -023 (HUC 1101001} is currently listed in Category 5 for sulfate; however, there is no empirical evidence of the efficacy of individual domestic treatment systems to remove or reduce mineral constituents. Regarding monitoring of total phosphorus and total nitrogen, Planning received data from the City of Fayetteville as part of a Use Attainability Analysis that indicates organic loading within the reach is affecting aquatic life; however not to the point of impairment. Again, Planning is unable to procure empirical data that documents the nutrient concentration within the effluent of these units.

Planning has further reservations regarding this and future units within segment -023 and segment -022 due to the current Category 5 listing for pathogens in upper portion of Beaver Lake (segment -021}. Section 1.2.2.3 (ARG550000-Exclusions) notes that, "Discharges to waterbodies listed on the most current 303 (d) list as impaired by pathogens, nutrients, or low dissolved oxygen," will not be covered by a General Permit and applicants should apply for an individual NPDES permit. While this is not a direct discharger to an impaired waterbody; there is a cumulative impact from multiple sources, including individual domestic treatments systems.

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Instructions for the Completion of this Document:

A. Individuals, firms or other legal entities with no changes to an ADEQ Disclosure Statement, complete items 1 through 5 and 18.

B. Individuals who never submitted an ADEQ Disclosure Statement, complete items 1 through 4, 6, 7, and 16 through 18.

C. Firms or other legal entities who never submitted an ADEQ Disclosure Statement, complete 1 through 4, and 6 through 18.

Mail to: ADEQ DISCLOSURE STATEMENT [List Propel' Division(s)] 5301 Northshore Drive North Little Rock, AR 72118-5317

I. APPUCANT:(F.UName} f-(~ + )v{;a.,. ~{e'-(

Hand Deliver to: ADEQ DISCLOSURE STATEMENT [List Proper Division (s)] 5301 Northshore Drive North Little Rock, AR 72118-5317

2. MAILING ADDRESS (Number and Street, P.O.Box Or Rural Route) : IS4~ S. 02..~ ~ev-- Meo.dt>~ bv. 3. CITY,STATE,ANDZIPCODE:

1-u'-fe l.fa.;; ( (e_ ~ ?J.Ibf . I

4. (ch&ek all tllllt apply.)

tplindivld••l 0 Corporate or Oilier Entity

~Permit D LlceiiSC 0 Certi6eatlon D Operational Authority

~ew AppUeation 0 Modffieotlo• 0 Renewnl Applieofion (1£ no changes from previous disclosure statement, complete 011mber 5 a11d 18.)

0Air @Wakr D HIZardous Wnstc D Regulated Stor2gc Tanlt 0Mtnlng D Solid Waste

0 Environmcotal Prcsernfion and Technical Service

s. IW:Iaratiu II[ till Cbnagcs: The 'riolntioa history, experience and credentials, ia¥Oivemeat in current or pending ePvironmentallows•ils, civil and criminal, have not cl~aaced since the last Dlsclesure Statemeot I filed with ADEQ oa

Signot.re oflndlvidual or Authorized Rcprescatatlve of Firm or Legal Entity (Also complete 1#18.)

6. Describe the experience and uedentials orthe Applicant, including the rea:lpt ohny past or present penni($, licenses, a:rtit"~eations or operational authorization relaling to elll'ironmental regulation. (Attach additional pages, if necessary.)

7. List and explain aU c:ivil or criminallcplactions by government agcndes involving environmental protcctiu t.ws or regulations agaill.lit the Applicant* ia t•e t.st ten (10) years induding:

1. Admiaistratift euron:ement actions resulting in the illlpositfon of sanctions; l. Permit or license revocations or dcalals Issued by nay state or federal authority; 3. Actions lllat have resulted In a finding or a settlement or a Yloladon; and 4. Peudillg actions.

(Attach ndditional pages, if necessary.)

" Firms or other lcpl eatlt!es shall also lncladc this lnfol'lllntioa for nil persoiiS and legal entities idenlir~~:d in sections 1-16 of this Disclosure Statement

8. List all ofi"JCers or the Applieaat. (Add additional pages, il accessory.)

NAME: tJ !l , TITLE:

STREET:

CITY,STATE,ZIP:

NAME: Alff TITLE:

STREET:

CITY, STATE, ZIP:

NAME: /l!f! TITLE:

STREET·

CITY,STATE,ZIP:

9. List all dlrettors oftlae ~At. (Add additional pages, if ne«SSary.)

NAME: TITLE:

STREET·

CITY, STATE, ZIP:

NAME: Jl/4 TITLE:

STREET:

CITY, STATE, ZIP:

NAME: /1111 TITLE:

STREET:

CITY,STATE,ZIP:

10. List all partners or dae AtfA (Add additional pages, If necessal)'.)

NAME: TITLE:

STREET:

CITY, STATE, ZIP:

NAME: 11/!l TITLE:

srREET·

CITY,STATE,ZIP:

NAME: AlA TITLE·

STREET·

CITY, STATE, ZIP·

1 L List all persons employed 1/.i;App&cant io a supervisory capacity or with authority over operations or the fadUty subject to this applicatioa.

NAME: A TITLE:

STREET: /

CITY, STATE, ZIP:

NAME: A/A_ TITLE:

STREET: CITY, STATE, ZIP:

NAME: A/71 TITLE:

STREET•

CITY, STATE, ZIP:

12. List all persons or A1 Aties, who own or control more Otaa five percent (5%) of the AppHcant's debt or eqalty.

NAME: TITLE: , ' STRBET:

CITY, STATE, ZIP:

NAME: TITLE:

STREET:

CITY, STATE, ZIP:

NAME: TITLE:

STREET:

CITY, STATE, Zll':

13. List nil legal entitiea,~ iif tltc Applienut holds a clebt or equity interest or more than five percent (5%).

NAME: TITLE: , STREET:

CITY, STATE, ZIP:

NAME: 'l'lTLE: STREET: CITY, STATE, ZIP:

NAME: TITLE:

STREET: CITY, STATE, ZIP:

14. List IUIY parent compall)' of the Applicant. Describe the pt~rellt company's ongoing organiutional relntlonsbip 1Yifh Che Applicant.

NAME=--~,M~'A_,_·· · ____ _ STREET: _____________________ ___

CITY, STATE, ZIP:-------------

Organiz:~tional Relationship:

IS. List any snbsidinr:r or the Appliennt. Describe tbe subsidiary's ongoing orgaalzalional relatioh!lllip with the Applicant.

NAME: __ --'-A/"'--'-tl-'--------STREET: ---------------CITY, STATE, ZIP: ____________ _

Organizational Relatloh!lhip:

16. List any penDD who is not now ill complinacc or has a history or noncompliance witb the environmental laws or regulations of this stale or any oll1er jurisdietioa aad wbo through relationship by blood or marriage or through any other rclallonslllp could be rca.so~tably expected to significantly iaftucace the AppHeaat in a manaer whleb could adversely all'ect tile environment.

NAM& ____________________ __ TrrLE: ____________________________ __

STREET:--------------------------------------------------------------------------------------CITY,STATE,ZW: ______________________________________________________________________________ __

NAME~----------------------TITLE: ____________________________ _

STREET:-------------------------------------------------------------------------------CIT~STAT~ZW: __________________________________________________________________________ __

17. List all Federal environmental ageac:ies and any other environmental agencies outside flais slate that lmve or have bAd regulatory respoasibillty over the Applicant.

fJt7WL

18. VERIFICATION AND ACKNOWLEDGEMENT

The Applicant agrees to provide any other information the director of the Arkansas Department of Environmental Quality may require at any time to comply with the provisions of the Disclosure Law and any regulations promulgated thereto. The Applicant further agrees to provide the Arkansas Department of Environmental Quality with any changes, modifications, deletions, additions or amendments to any part of this Disclosure Statement as they occur by filing an amended Disclosure Statement.

DELffiERATE FALSIFICATION OR OMISSION OF RELEVANT INFORMATION FROM DISCLOSURE STATEMENTS SHALL BE GROUNDS FOR CIVIL OR CRIMINAL ENFORCEMENT ACTION OR ADMINISTRATIVE DENIAL OF A PERMIT, LICENSE, CERTIFICATION OR OPERATIONAL AUTHORIZATION.

State of

County of tJog~~ -bV\ I, ~~< ~lAJ fl:( , swear and affirm that the information contained in this Disclosure Statement is true and correct to the best of my knowledge, information and belief.

APPLICANT

~GNATURE: __ -4~~~~~~~~~~~~---------------------------------

COMPANY TITLE:

DATE:

SUJISCRIBED AND SWORN TO BEFORE ME THIS 1 s- DAY OF JW '4 OFFICIAL SEAL

SARAH CROVVDER NOTARY PUBliC • ARKANSAS

WASHINGTON COUNTY COMMISSION No. 12389937

COMMISSION I!XP. 08/12/2022

MY COMMISSION EXPIRES:

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Arkansas Department of Health 4815 West Markham, Slot 46

Little Rock, Arkansas 72205-3867

MEMORANDUM OF AGREEMENT

SUBJECT: ONSJTE WASTEWATER SYSTEM APPLICATION

This is an agreement that the onsite wastewater system installed on this property has been permitted under authority of Act 402 of 1977 and by the Arkansas Department of Health with the understanding that the following provisions are met:

1. Onsite Wastewater Systems requiring a Monitoring Contract with a Certified Monitoring Personnel are Holding Tanks, Experimental Systems (i.e. Reduced Absorption Areas, *ABGs), and Drip Dispersal Systems. *Aerobic Biological Generators- Commercial applications only, residential applications must follow manufacturers' service contract requirements.

2. The property owner assumes all responsibility for the proper operation of the onsite wastewater system.

3. The property owner must maintain a monitoring contract with a licensed Certified Monitoring Personnel for the life of the system and retain Onsite Wastewater System Assessments (EHP-71 ), on file, for at least five (5) years.

4. The Arkansas Department of Health has no responsibility in the operation and maintenance of such systems.

5. That the Arkansas Department of Health may monitor the system as to its operation capabilities.

6. That the Arkansas Department of Health is granted permission to make such inspections as deemed necessary.

7. Subsurface systems with flows ~3000 gpd and all surface discharging systems require the owner to file an additional permit application with the Arkansas Department of Environmental Quality (ADEQ).

8. That, on the sale of the property, the owner of the property must disclose to the perspective buyer notice of this agreement and any permit requirements. The buyer is to sign memoranda, contracts or permit name change forms and submit these documents to the appropriate regulatory agen y.

SIGNED:..--.f1Hb1~~~~~;.;=.~----SIGNED: ____________ _ (Health Department)

DATE: __ J--->--ir=~-i..._.j_,__(5 ______ DATE:. ________ _

EHP-35 {R 1/13)

Corbitt Environmental Consulting PO Box937 Lowell, AR 72745 (479) 466-6183

Date: July 30, 2014

Maintenance Service Contract

Onslte Maintenance Provider/ Class II Wastewater Operator:

Name Address City, State, Zip Email Phone

Customer:

Name Address City, State, Zip Email Phone

System Location:

Physical Address City, State, Zip

Corbitt Environmental Consulting PO Box 937 Lowell, AR 72745 mwcorbjtt@cox.net 479--466~6183

Heath and Mia Stanley

Heath and Mia Stanley 1592 S. River Meadows Dr. Fayetteville, AR 72701 hstanley@arvest.com 479-586-8042

2413 Autumn View Fayetteville, AR 72701

1. Services to be provided:

1. BiMannual maintenance will be performed and copies of reports provided to all necessary parties. Copies of the monitoring reports shall be submitted to:

2. Homeowner 3. Department's Database, Little Rock 4. We will also retain a copy for our files

2. Terms of Agreement

This agreement shall be for the period of _24 __ months from the date of this agreement, unless otherwise terminated or canceled by either party as granted herein.

4. Charges

The ADEQ requires samples to be taken at the discharge point of the system twice yearly along with documentation of the samples and the results and quarterly monitoring of the system and components.

Corbitt Environmental Consulting will be responsible for any and all annual training requirements that the Arkansas Department of Environmental Quality has or the manufacturer deems necessary to maintain a Class II wastewater license. Any extra non-compliance testing and monitoring costs are not induded in this contract.

Corbitt Environmental Consulting will provide all of the above mentioned services for a fee of $600/year plus any required Jab fees or testing.

5. Tenninatlonjcancellation

This agreement may be tenninated at contracts end, or by notification of both parties.

Note: lhe ADEQ requires that you have samples taken routinely to utilize this type of system on your property and maintain a valid service contract. If you choose to terminate your contract with Corbitt Environmental Consulting, we encourage you to obtain a valid contract through another service provider as soon as possible, since we will be required to notify the ADEQ upon your contract termination/cancellation.

Onsite fll!aintenance provider

Company Corbitt Environmental Consulting

Name Rebecca Corbitt, Class ll Wastewater operator/Onsite Maintenance Provider

Signature

Date '7 [s1 J {t-f •

Propertyowner Hea:fk. .3\-a..cJec( Date --{s((ff

Parcel: 094·00009-000 Washington County Report ID: 94819

Prev. Parcel: 001-15833-000 As of: 7/17/2014

Property Owner

Name: STANLEY, HEATH & MIA

Property Information

Physical Address: 2413 N AUTUMN VIEW DR

Mailing Address: 1592 S RIVER MEADOWS DR FAYETTEVILLE, AR 72701

Type: (RV} - Res. Vacant

Tax Dist: (010)- FAYETTEVILLE SCH, RURAL

MiUage Rate: 51.65

Extended Legal:

Subdivision: AUTUMN VIEW S/D

Block I Lot: 009

S-T-R: 34-17-29

Size {in Acres):

Market and Assessed Values:

Land:

Building:

Total:

Homestead Credit; $0.00

Land:

Land Use

12.57 AC M/L

Estimated Market Value:

Full Assessed (20% Market Value):

$222,750

$0

$222,750

$44,550

$0

$44,550

Note: Tax amounts are estimates only. Contact the county/parish tax collector for exact amounts.

Size 1.000

Units

House Lot

Not a Legal Document. Subject to terms and conditions.

www.actDataScoutcom

Taxable Value:

$44,550

$0

$44,550

Page 1

Parcet 094-00009-000 Prev. Parcel: 001-15833-000 As of: 7/17/2014

Deed Transfers:

Date Book Page Deed Type

5/24/2013 2013 17462 Warr. Deed

3/28/2005 2005 12884 Warr. Deed

5/18/2004 2004 19486 Warr. Deed

Map:

Washington County Report

Stamps Est. Sale Grantee

429.00 $130,000 STANLEY, HEATH & MIA 627.00 $190,000 GRAY, JESSE & KRISTIN

RIVER MOUNTAIN, LLC

Not a Legal Document. Subject to terms and conditions.

www.actDataScoutcom

ID: 94819

Code Type

Unval. Land Only Valid Land Only

Page2

<>:~ Arkansas Department of Health Environmental Health Protection

Individual Onsite Wastewater System Permit Application

PennitType 181 New Installation

D Alteration I Repair

DR EnvlronmentaiiD #

Part 1 Application Treatment Type {check one) 0 STD =standard Seplc Tank ~ ATU = Aerabic Trealment Plant 0 ISF = lntelmlllent Sand Filter 0 RSf = Re-drculalng Sand Filter 0 PMF = Proprielary Media Filter 0 RGF = Ra-drculallng Gtavl!l Filter 0 OTH ::other (Oesalbe} 0 HLD =Holding Tank

1. OWnel's/Appllcant's Name Healh and Mia Stanley c/o GB Group Construction

Fee SchedtR for Structures

Structures 1600 sq It ar lesS $30.00 Slructures more than 1 500 sq ft and up to 2000 sq ft $45.00

Slructures more than 2000 aq It and up to 3000 sq n $90.00

Structures more than 3000 sq ft and up to 4000 sq ll $120.00

Structures more than 4000 sq It $160,00

Alteration and Repair $30.00

DisPosal Method (check one) g STD- Standard Absotplkln Field ~ LPD-' LOW PAisStn Di81ributton l'i!l SUR,. SUrface Discharge 0 HLD • Holding Tank 0 CPF,. Capping FBI 0 SRL • Serial OIQibulon 0 OTH :z Other 0 DRP • Drip Irrigation

2. Phone Number 1-479-283-1763

3. Mailing Address 4. County PO Box 7134 Springdale, AR 72766 Washilgton

..J

D 0 0 0 ~

0

5. Address of P~_;;ed System (If a 911 address ls not available, attach detailed directions or map) 911:2413 Autumn VlfNI Or, Fay, Hwy45 E, Ron Rivercrest Rd, R atT, go thru gated entrance and keep to the L until you reach the cui de sac

6. Subdivision Name Autumn VIew

7. Approval Dale NA

8, Date Recorded NA

10. Lot Dinensions see attached survey

11. Total Area (Acres) 12.68

12. # Bedrooms #f- People 5

14. Brief Legal Description of Property (Attach a separate sheet of paper, if necessary) Autumn View, Section 34, Township 17 North, Range 29 West

15. Water Supply (Specify supplier, if Pubic Water) 16. GPS Coordinates 36 36 094117 94 066647

17. Loading Rates laod/ft") 18. Svstam Soacifications

Primary Area NA a. Size of Septic Tank Aertotech gal f. Trench IJeDth

SecondarY Area NA b. Size of Dose Tank NA gal g. Trench Spacing

NA

NA

9. Lot Number 9

13. Daily Flow (GPO) 500

Inches

feet

Percolation Test Cmlnnnl c. Absorotion Area NA ft2 h. Trench Media (list Below) t.Trench Wldlh

Primary Area A~~g NA d. Number of F".eld Lines NA NA NA in

SecondarY_Area NA e. Length of Field Lines NA ft NA NA In

TO THE OWNER The pennit for construction may be deemed invalid by the local Environmental Health Specialist before the start of construction, if the site and/or son conditions have changed after approval of thls pennlt, or If the lnfonnallon within this pennlt Is Inaccurate or has been round to be misrepresented. Approval for operation does not constitute a guarantee that the system will function properly. The approval states that the system was designed and Installed according to the Alkansas Department of Health, Rules and Regulallons Pertaining to Onsle Wastewater Systems, unless there are exceptions or deviations noted In the comments. A Pennit for Construction Is valid for one (1) year from fhe date of approvaL The authorized agent must ravaldate a permit more than one (1) year old prior to the start of any constn.tdlon. 19. utilization Verilicalion

I hereby attest that item 12, the number of bedrooms (number of persons for commercial) and square footage of the structure that will utilize the designed individual onsite1~awater system in this perml application, Is accurate. I have reviewed the pennit application and

................ -· '~"Z:::::l': -"t'r.""" ....... ,.) ... _be ................ ..-. ! Owner/Applicant Signature ~~~~ ~~' ~J1..- Date 7/a'f U'-f 20. I certify that I have conducted the above tests and that tha.@ove listed infonnation is In accordance with the latest requirements of the

Arkansas Department of Health R~nt!. Regul&fions Pertaining to Onsife Wastewater Systems.

/1';!. L /( , { ~/z~~ Designated Representative Soil CertiTted ~ Yes 0 No Designated Representallve Signature TIUe

MarkW. Corbitt 07/01/14 479-466-6183 Print Name Data Phone Number

21. Approval of Health Authority The lnfOll'f'laUon and speciftcaUons In the applcatlon has been reviewed and found to meet the requirements of the Arkansas Department of Health Rules ~d~~tronye~ining To Onsite Wastewater Systems. A PERM~~F~R CONSTRUCTION ls hereb,Y Issued.

/tc.fv,.,£_;{1;~ 'fi'{' /&'U/!tt Environmental SDeclallst Sl!lnature EHS Number ' DaiJ

EHP-19 (R 8/13) Page 1

Individual Onsite Wastewater System Penn it Application I Receipt Number

Continue Part 1 22. SoN Criteria (Primary Anla) Indicate the depth to items a-f, if observed In the soli (designate In Inches)

a. Bedrock t b. BSWT I c.MSWT I d.LSWT I e. Adj. MSWT I f. Adj. LSWT I g. H.CJDepth I h. Loading Rate (gpd/ltj :>36" INA 10" 119" INA INA !Mod 1 no load

23. SoN Criteria (Secondary Area) Indicate the depth to items a-f, if observed in the soil (designate inches)

a. Bedrock I b. BSWT lc.Mswr I d.LSWT I e. Adj. MSWT I f. Adj. LSWT I g. H.C./Deplh I h. Loading Rate (gpdf1t1 NA INA NA 115" INA JNA j NA 1 no load

24. Seasonal Water Table (SWT) Classes Detail

Primary Area Ust Redoximorphic Features and/or Clay Content Restrictions

Brief NA In NA

Moderate 10" In NA

Long 19" in NA

Secondary Area Ust Redoximorphic Features and/or Clay Content Restrictions

Brief NA in NA

Moderate NA in NA

Long 19" in NA

Comments

Part2 Installation nspection Septic tank manufacturer Pump lnfonnation

Septic tank material Trench media and width

Dose tank manufacturer Depth of interceptor drain

Dose tank malarial Depth of seWed fill

Name of Installer I Ucense Number

Installation Inspected by c Environmental Heallh Specialist o Designated Representalive (check one or Installer signs System lns1allaUon Velfllcalon below)

Signature EHS I Llcansa Number Date System Installation Verification I have Installed this system as designed and in compliance with al Rules and Regulations Pertaining to Onsite Wastewater Systems.

Installer Signature License Number Dale

Part3 Pennit for Operation The information contained in Part 1 and 2 of this fotm has been reviewed and found to meet the requirements of the Arkansas Department of Health. THE PERMIT FOR OPERATION of this system is hereby issued.

Environmental Health Specialist Slanature EHS Number Dale

Comments

Site Revalidation conducted by c Environmental Health Specialist 1:1 Designated Representative (chedcone)

Skmature EHS I Ucense Number Dale

EHP-19 (R 8/1.3) Page 2 of2

rAero-Tech/CSI Control Panel

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ELECTAICAI..JUNCTlON BOX ( . ,, WITH iNDJCATO.RS N>KJ

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' TREATMENT I ·cHAM&ER ,

Trash Tank Pol;r Concrete or F1berglou SA-02 or SA-O"'i Tan • I to 2.5 t1mes des1gn ilow Aero- Tech Submer!iible

Aerat1on Pump

Aero-Tech 2900 Gar IN ·'H.Sb3 @ 2012 Aero-Tci:h June B. 2012

AT-150 Syste111 Section V1ew not to t~cale AT-l50-l --

weccJ® BID-DYNAMIC®

FOR MODELLF 1000, MODELLF 2000, MODELLF 3000

INSTALLATION AND OPERATION MANUAL INTRODUCTION

Bio-Dynamic LF Series tablet feeders are complete dry chemical dosing systems for water, wastewater, stormwater and process water treatment. They are designed to provide automatic control over the chemical application rate and maximize installation flexibility. The LF Series tablet feeders consists of five separate models to accommodate flows ranging from less than 100 GPO through 400,000 GPO and

HOW THE lF SERIES TABLET FEEDERS WORK

Bio-Dynamic LF Series tablet feeders are flow rated proportional chemical dosing units. Flow to be treated enters the tablet feeders through the integral inlet hub. The liquid · then proceeds to the flow deck where the chemical tablets are contained in one to four chemical feed tubes. The number of chemical feed tubes varies by model. The flow deck has three different levels (tiers) which accommodate varying

hydraulic loads and properly chemical dosage ranging from 1 to 50 mg/L, depending upon the general component configuration, daily flow rate and

BIO-DYNAMIC8 DRY CHEMICAL FEEDER channel liquid to the chemical tablets. Active chemicals are released into the flow stream as

the type of chemical tablets ~FE;:;;;ED::-TU=BE"----~­applied. All models of LF Series CAP

tablet feeders are manufactured from durable PVC and can be solvent welded to Schedule 40 ~LOCKING PVC piping. When properly installed, Bio-Dynamic tablet feeders will provide long term, CLEARCHECK

FEEDTIJBE unattended operation and precise chemical application throughout their rated flow ~~c:.~~~U: ranges. Please familiarize yourself with the contents of this

OPTIONAL manual before proceeding with INLET BAFFLE

installation and operation.

FEED TUBE

SYSTEM APPLICATION LOCATING RIBS

4" SCHEDULE 40 PVC INLET HUB

SLOTTED MOUNTING FEET

FEED TIJBE the liquid erodes the tablets. uFT HANDLE When the incoming flow rate

STACKED VERTICALLY (AT LEAST 20 TABlETS

REQUIRED FOR FULL CHARGE)

increases, the liquid level in the tablet feeder rises. The increase in liquid level causes the flow to contact more tablets, thereby providing the additional chemical

EauAll v sPACED release required for consistent FLowWJNOOws treatment. As the flow

UPPER FLOW TIER

INTERMEDIATE FLOW TIER

INERT

decreases, it contacts fewer tablets, reducing the chemical dosage. After contact with the chemical tablets, properly treated liquid exits the tablet feeder through the outlet hub.

DRAINAGE TIER SYSTEM PERFORMANCE

4" SCHEDULE 40 PVC OUTLET HUB

SELF DRAINING FLOW DECK

Bio-Dynamic LF Series tablet feeders are designed to feed 2 5/s" diameter chemical tablets in gravity flow applications. These tablet feeders are not to be used for pressurized applications and must have a gravity outflow. Common applications for the LF Series

TABLET FEEDER MODEL LF 1000

Bio-Dynamic LF Series tablet feeders are listed as a chlorine dispenser for secondary effluent from residential wastewater treatment systems under NSF/ ANSI Standard 46. Certification requires the use of Norweco Blue Crystal or Bio-Sanitizer disinfecting tablets and a

tablet feeders are treating flows from septic tanks; aerobic treatment units; sand filters; rock reed filters; curtain drains; constructed wetlands; marine sanitation devices (MSD); individual, community and municipal drinking water systems; process water systems; reservoirs; water towers; cooling towers and irrigation systems. All LF Series tablet feeders can be installed in-line at or below grade.

chlorine contact tank of at least 11 112 gallons. Contact tank retention time must comply with the controlling regulatory jurisdiction. USEPA guidelines state "On the average, satisfactory disinfection of secondary wastewater effluent can be obtained when the chlorine residual is 0.5 ppm after 15 minutes contact." Significantly greater contact time can decrease disinfection efficiency and allow bacteria regrowth.

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General Permit Route sheet

Facility Name S-tan l&t/1 ~2-esrc)r/h ·.~P --· v

AFIN NO."' ; z- o·z:Z1?; Permit Number ARG5SO L-,. Stream Segment: I '-JI( II Receiving Stream: Wh, re e, v~v-

Assigned k VI {_ I I ()I{){) {)I Activity Initials Date Complete/Entered

Application Logged/ Assign Tracking

Sect. Number/Place in red folder with !I-f~ N/A appropriate route sheet and filing folders (1-day) Completeness and Technical

-:J+ I(]- I tJ -If Engineer Review/Enter permit information into Database (3-days)

AA (Max of 5 AFIN request (1-day) sfY~· t-6 \ \~ business days)

Q0 Enter AFIN and other information into -<SY'? to\ \S PDS and NPDES database prior to

. requesting invoice (same day)

\Q\(1 Complete Invoice Request Form and V\~ submit Invoice Request (same day) Prepare Authorization letter and

<\Y7 lG\)0 attach appropriate permit, forms (1-day)

Engineer Review/organize folder for scanning (1- -::J+- t0-'2o-J'f day)

Engineer Review all the documents/permits/

8 , 0 -7.7 _I cf perform technical review for the Supervisor

proposed project. (1-day)

Assistant Review the documents and sign the

Chief authorization letter or the permit. (1-day) Enter Into PDS: Permit

At \~\o\\~ AA Status/Effective Date. Input effective date in access database. (1-day) Mail original to applicant. Scan complete folder and place in appropriate E-drive

~ II- 5 Sect. folders. Update Zylab. Be sure to include this permit in weekly report, due every Tuesday by 2:00P.M.

REMARKS:

Revised I/5/20 II