Cicy: ------Invoice Mailing Company: ------State: ----- Zip: --- Invoice Mailing Address: ------Telephone:

Home , Ar (Unix)

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 I. PERMITTEE/OPERATOR INFORMATION

Pennittee (Legal Name): Heath and Mia Stanley Operator Type: Permittee Mailing Address: 154:2. S. A;~ fl.~~~ fbv- D State D Partnership Pennittee City: H.t."(effev: H-e. . 0 Federal D Corporation* Pennittee State: ~ Zip: ~J-70 l ~ole Proprietorship/Private Pennittee Telephone Number: .lf?~ ~ ~ - ~..;l *State of Incorporation: ____ Permittee Fax Number: The legal name of the Permittee must be ------~------identical to the name listed with the Pennittee E-mail Address: h.s~(e'"-(~ttY'l2esf..ct>A.I\ 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 elltv//e . Ale 7c2 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 (IfApplicable): --'AR:=O=O'------ NPDES General Pennit Number (IfApplicable): _;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. Yoo must submit a new disclosure statement even ifyou 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.

ERTIFICATION OF OPERATOR (Initial) "I certifY that. if this facility is a corporation, it is registered with the Secretary of the State of Arkansas." I (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 ofmy knowledge and belie~ true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility offine 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 Title: homeowner Cognizant Official Signature: ------ Cognizant Official Email:

X. PERMIT REQUIREMENT VERIFICATION Please check the following to verity completion of permit requirements. 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: Wentz, Nathan Sent: Wednesday, October 22, 2014 1:53 PM To: Solaimanian, Jamal Cc: Bailey, John; Clem, Sarah Subject: ARG55

Jamal,

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.

Tate

O, ol M&D .>~ k

.M no....; worrJ ~~ iL C.. vd c-.\;-.~ C. I rl\(?e- J- 1 w- r:p

}c (A)c..I'I'J t:-) t.· AnA. ..12 fr!CM ~ h f ; /1J ( e ~ ." I Grn. J .> · fufvl:'t V'o ..?)L 1L~ ~(1- i+ i.S J ("~ .:...~ rr, ,... en ) c-f; (IV\_ I..) e. 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: Hand Deliver to: ADEQ ADEQ DISCLOSURE STATEMENT DISCLOSURE STATEMENT [List Propel' Division(s)] [List Proper Division (s)] 5301 Northshore Drive 5301 Northshore Drive North Little Rock, AR 72118-5317 North Little Rock, AR 72118-5317

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

TITLE: ______NAME~------

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 zoltl

OFFICIAL SEAL SARAH CROVVDER NOTARY PUBliC • ARKANSAS WASHINGTON COUNTY COMMISSION No. 12389937 COMMISSION I!XP. 08/12/2022

MY COMMISSION EXPIRES: q/1 z/1-02z Rivercrest Rd - Google Maps Page 1 ot 1

Rtverc.rest Rd. Fayetteville. AR €xploreth1s area Tr-affic 81cyehng Terram

-"" ·~ -

~ ~ '

..... - CI2014Gaoglo 500ft https://www.google.com/maps/place!Rivercrest+Rd/@36.098088,-94.0559609,16z/data=!... 6/10/2014 Arkansas Department ofHealth 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 Corbitt Environmental Consulting Address PO Box 937 City, State, Zip Lowell, AR 72745 Email [email protected] Phone 479--466~6183

Customer: Heath and Mia Stanley

Name Heath and Mia Stanley Address 1592 S. River Meadows Dr. City, State, Zip Fayetteville, AR 72701 Email [email protected] Phone 479-586-8042

System Location:

Physical Address 2413 Autumn View City, State, Zip 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 Property Information Name: STANLEY, HEATH & MIA Physical Address: 2413 N AUTUMN VIEW DR

Mailing Address: 1592 S RIVER MEADOWS DR Subdivision: AUTUMN VIEW S/D FAYETTEVILLE, AR 72701 Block I Lot: 009 Type: (RV} - Res. Vacant S-T-R: 34-17-29 Tax Dist: (010)- FAYETTEVILLE SCH, RURAL Size {in Acres): MiUage Rate: 51.65

Extended Legal:

Market and Assessed Values:

Estimated Full Assessed Taxable Market Value: (20% Market Value): Value: Land: $222,750 $44,550 $44,550 Building: $0 $0 $0 Total: $222,750 $44,550 $44,550

Homestead Credit; $0.00 Note: Tax amounts are estimates only. Contact the county/parish tax collector for exact amounts.

Land:

Land Use Size Units 12.57 AC M/L 1.000 House Lot

Not a Legal Document. Subject to terms and conditions. www.actDataScoutcom Page 1 Parcet 094-00009-000 Washington County Report ID: 94819 Prev. Parcel: 001-15833-000 As of: 7/17/2014

Deed Transfers:

Date Book Page Deed Type Stamps Est. Sale Grantee Code Type 5/24/2013 2013 17462 Warr. Deed 429.00 $130,000 STANLEY, HEATH & MIA Unval. Land Only 3/28/2005 2005 12884 Warr. Deed 627.00 $190,000 GRAY, JESSE & KRISTIN Valid Land Only 5/18/2004 2004 19486 Warr. Deed RIVER MOUNTAIN, LLC

Map:

Not a Legal Document. Subject to terms and conditions. www.actDataScoutcom Page2 Arkansas Department of Health <>:~ Environmental Health Protection Individual Onsite Wastewater System Permit Application Fee SchedtR for Structures ..J Structures 1600 sq It ar lesS $30.00 D PennitType 181 New Installation Slructures more than 1500 sq ft and up to 2000 sq ft $45.00 0 D Alteration I Repair Slructures more than 2000 aq It and up to 3000 sq n $90.00 0 DR EnvlronmentaiiD # Structures more than 3000 sq ft and up to 4000 sq ll $120.00 0 Structures more than 4000 sq It $160,00 ~ Alteration and Repair $30.00 0 Part 1 Application Treatment Type {check one) DisPosal Method (check one) 0 STD =standard Seplc Tank ~ ATU = Aerabic Trealment Plant g STD-Standard Absotplkln Field ~ LPD-' LOW PAisStn Di81ributton 0 ISF = lntelmlllent Sand Filter 0 RSf = Re-drculalng Sand Filter l'i!l SUR,. SUrface Discharge 0 HLD • Holding Tank 0 PMF = Proprielary Media Filter 0 RGF = Ra-drculallng Gtavl!l Filter 0 CPF,. Capping FBI 0 SRL • Serial OIQibulon 0 OTH ::other (Oesalbe} 0 HLD =Holding Tank 0 OTH :z Other 0 DRP • Drip Irrigation 1. OWnel's/Appllcant's Name 2. Phone Number Healh and Mia Stanley c/o GB Group Construction 1-479-283-1763 3. Mailing Address 4. County PO Box 7134 Springdale, AR 72766 Washilgton 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 7. Approval Dale 8, Date Recorded 9. Lot Number Autumn VIew NA NA 9 10. Lot Dinensions 11. Total Area (Acres) 12. # Bedrooms #f- People 13. Daily Flow (GPO) see attached survey 12.68 5 500 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 NA Inches SecondarY Area NA b. Size of Dose Tank NA gal g. Trench Spacing NA 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 Pennit Application IReceipt 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 1no 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 1no 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 IUcense 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

' essume 2-4" 1nvert c:::::l

ELECTAICAI..JUNCTlONBOX ( . ,, WITHiNDJCATO.RS N>KJ 1· : ., .. ALARMCONTACTS

,, ·'·· .. I.:.:;-:{;:,:;.._';·:>.

...... HANDLE ···RI:uovAi: FOR ,.~

i' i !

.~~Fl'CW,l EFFWENT

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 @ 2012Aero-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 HOW THE lF SERIES TABLET FEEDERS WORK

Bio-Dynamic LF Series tablet feeders are complete dry Bio-Dynamic LF Series tablet feeders are flow rated chemical dosing systems for water, wastewater, stormwater proportional chemical dosing units. Flow to be treated enters and process water treatment. They are designed to provide the tablet feeders through the integral inlet hub. The liquid · automatic control over the chemical application rate and then proceeds to the flow deck where the chemical tablets maximize installation flexibility. The LF Series tablet feeders are contained in one to four chemical feed tubes. The number consists of five separate models to accommodate flows of chemical feed tubes varies by model. The flow deck has ranging from less than 100 GPO through 400,000 GPO and three different levels (tiers) which accommodate varying chemical dosage ranging from hydraulic loads and properly 1 to 50 mg/L, depending upon BIO-DYNAMIC8 DRY CHEMICAL FEEDER channel liquid to the chemical the general component tablets. Active chemicals are configuration, daily flow rate and released into the flow stream as the type of chemical tablets ~FE;:;;;ED::-TU=BE"----~ FEED TIJBE the liquid erodes the tablets. applied. All models of LF Series CAP uFT HANDLE When the incoming flow rate tablet feeders are manufactured increases, the liquid level in the from durable PVC and can be tablet feeder rises. The increase STACKED VERTICALLY solvent welded to Schedule 40 ~LOCKING (AT LEAST 20 TABlETS in liquid level causes the flow to REQUIRED FOR FULL PVC piping. When properly CHARGE) contact more tablets, thereby installed, Bio-Dynamic tablet providing the additional chemical feeders will provide long term, CLEARCHECK EauAllv sPACED release required for consistent FEEDTIJBE unattended operation and FLowWJNOOws treatment. As the flow precise chemical application decreases, it contacts fewer UPPER throughout their rated flow ~~c:.~~~U: FLOW TIER tablets, reducing the chemical ranges. Please familiarize dosage. After contact with the yourself with the contents of this chemical tablets, properly OPTIONAL INTERMEDIATE manual before proceeding with INLET BAFFLE FLOW TIER treated liquid exits the tablet installation and operation. feeder through the outlet hub.

FEED TUBE INERT SYSTEM APPLICATION LOCATING RIBS DRAINAGE TIER SYSTEM PERFORMANCE

Bio-Dynamic LF Series tablet 4" SCHEDULE 40 4" SCHEDULE 40 Bio-Dynamic LF Series tablet PVC INLET HUB PVC OUTLET HUB feeders are designed to feed feeders are listed as a chlorine 2 5/s" diameter chemical tablets dispenser for secondary effluent SLOTTED SELF DRAINING from residential wastewater in gravity flow applications. MOUNTING FEET FLOW DECK These tablet feeders are not to treatment systems under NSF/ be used for pressurized ANSI Standard 46. Certification applications and must have a requires the use of Norweco gravity outflow. Common TABLET FEEDER MODEL LF 1000 Blue Crystal or Bio-Sanitizer applications for the LF Series disinfecting tablets and a tablet feeders are treating flows from septic tanks; aerobic chlorine contact tank of at least 11 112 gallons. Contact tank treatment units; sand filters; rock reed filters; curtain drains; retention time must comply with the controlling regulatory constructed wetlands; marine sanitation devices (MSD); jurisdiction. USEPA guidelines state "On the average, individual, community and municipal drinking water systems; satisfactory disinfection of secondary wastewater effluent process water systems; reservoirs; water towers; cooling can be obtained when the chlorine residual is 0.5 ppm after towers and irrigation systems. All LF Series tablet feeders 15 minutes contact." Significantly greater contact time can can be installed in-line at or below grade. decrease disinfection efficiency and allow bacteria regrowth. 1.10&70' ,. - ; I

i i

.·· / / .. / / .. ------./. ' ' .i i

,/ I

I ! / f I

/ !I j ... ,:.·OtY

~- ~7 --/ --s:~ -- :::::.:;.~- -- ' ,-- _J ---- .,..,_~- --a~ ----···-.... - \

Drive>

Pr-oposed Five Bedr-ooM HoMe

AE>roiech ATSOO

of'

895'

JnstQ-IIE't" to dig dowt"1 bct\oy-,

>------153''---=~~------315,'------ DI£ ncurgE> point 227'

Slope> 14%. bE>Iow d\scnc.rg

Facility Name S-tan l&t/1 ~2-esrc)r/h ·.~P --· v Permit Number ARG5SO L-,. AFIN NO."' ; z- o·z:Z1?;

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 Number/Place in red folder with Sect. N/A appropriate route sheet and filing !I-f~ folders (1-day) Completeness and Technical Engineer Review/Enter permit information into I(]- I tJ -If Database (3-days) -:J+ AA (Max of 5 AFIN request (1-day) business days) sfY~· t-6 \ \~ Enter AFIN and other information into PDS and NPDES database prior to -

REMARKS:

Revised I/5/20 II