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RBPR-05-2016-23932.TIF
StiY'A THIS IS NOT A PERMIT Case # RBPR-05-2016-23932 �� '�� ��� CATAWBA COUNTY HEALTH DEPARTMENT CI �o. CI 7.c- (-) ( !'� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES I i Igg2 sM Residential Building Plan Review -Building New 0 G r ri2rAA -V rakiirt IMPROVEMENT ci -A 1 • Owner .....)JONATHON PEYATT, 713 4TH AVE NE, HICKORY NC 28601 C:828-676-9171 NAME TO APPEAR ON PERMIT Jonathon Peyatt SITE ADDRESS: 3288 TATTERSTONE LN, MAIDEN NC 28650 PIN # 367804800214 NAME of SUBDIVISION: CRYSTAL FOREST PHASE 2 Lot# 3 Section/Block PROPERTY SIZE: Square Feet Acres 1.01 DIRECTIONS: 16S 1 to Rant Drum Rd/right Tatterstone/lot on left PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 1 story dwelling (no garge & no basement) No home currently on property. Existing system. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 26 x 54 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: E9 chapp lication 05/24/2016 08:42 Page I of 4 i . V 1 *-- I' - -1',9'.\:“ ri '.'*;---, ,,,,, My' :: ,,,. ,0' ,-7 '- -a., -10,8-,-,1:- 4,■rt: , , ' •- - Th 7' tr. - -t' THISIS:NOTA PERMIT Case# RBPR-05-20 I 6-23932 •L'5":eitj 1., ajr,•;1. , 'd ' CATAWBA COUNTY:HEA UiTi DEPARTMENT D•Tht.- VA.‘ 0 re:. 7P'irrl'.. .7stat.-..riP .,,,,,a-,... - -, , - PLAN IZEV I I-LW APPLICATION FOR EN V I RON N'I EN1A L S F RV I Clr.,S I .."C 'lit - • • . Iiesidential.Building Plan Review - Building New . ei ' 13 a IMPROVEMENT _ , ..._____ D .... J. • ' • , ,-. Owner ' • • • - • JONATHON PEYAT-r 71341.1AVE NE, HICKORY NC 28601 C:828-676-9171• . ., NAME TO APPEAR ON PERMIT , - . . Jonathon Peyati SITc ADDRESS: :3288 7ATTERSIONELN, MAIDEN NC 28650:: PIN # 367604800214 Li**. *,\MEnt41111)1ViSiON:•,* sh ' CRYSTAL FOREST PHASE 2 4 Lot 4 3 Section/Block kl, PROPERT'VS14:* Square Feet • Acres 1 01, - --- 4„. -IC..'`,,:..,-;),5:7-' •.; __......,-e„.,......--" I. • .4 "11-6iriEcTioNs: -.- 16S/toRant Drum Rd/right Taiterstone/lot on left •-;•,47 PRIMARY.CONTACT: Owner SEWER TYPE: Septic Tank GALLOWS PER DAY:. ' 360 WATER SUPPLY: Private Well , • DESCRIBE WC/RK: 1 story dwelling (no garge & no basement) SITE INFORMATION I ... Do any.boftheJollowing apply to the property for which this application is applied? . !if the.aris4,1er t6'any of the questions below is YES then supporting documentation is required: Does thinite contain any jurisdictional wetlands? J No ., Does this site contain any existing wastewater systems? • Yes , *r•*,iS'a['IV of the wastewater going to be generated on the site other than domestic sewage? No IS the site subject to approval by any other public agency? Yes .*,..N•e,there any easements or right-of-Ways on this'Property? - No ARP1:16ATION FOR New Structure • f': tzt,',"),L,..11- _. . .; ,• STRUCTURE;TYPE: PRIMARY RESIDENCE .1:: . ,;..„,;IF:494.ifir, TypEi...Sin.gle Family Residence OTHER DESCiiIPTION: : is f=.:15.,p0gri171. NibE.-..". . E x ts T)N o s r R y C T 1.1 R E S ' 1 - ON:S11*(IF ANY) - : DIM'EXISTING:StRUCTURE: , 1 1 . ' NUMBER OF EXISTING BEDROOMS #OF OCCUPANTS: 4...—..... PROPOSED CONSTRUCTION „. , . -rsiov,stRucTuRE cm:: 26x54 #.110FrAwBEDFoontis:: 3 }BASEMENT?* '' No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes , --:. --;•; ,• Desired•systeM•types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: , . ' OTHER: INNOVATIVE: ' ANY . . Other described. , . . . . . Improvement Permits issued as atesult of this information are valid for 5 years or may be non under certain specified conditions.An , Authorization to Construct issued byithisiePartment is valid for(5)five years from the date issued and is not transferable;Improvement Permits and Well • , i1Permits are tranSieliabie.•Pernnitsimayie revoked if the information on this application site plans'or intended use changes for the proposed facility.. I ha&e.tebdthis'application and certify Oatithe•information provided herein is bue,complete and correct Authorized county and state officials are granted •I right of anti-lie*Solidual necessary inspections to determine compliance with applicable laws and rules. nderstand that I am solely responsible for the proper idaaitifiaabonragCliabelingtaf all properly lines and corners and making the site accessibl o the a omelet,site evaluation can be performed. • , litne:- :i..-} --‘7-3.77-4: -1 Signature ol'Applicant or Agent , ' -a-•-• . Alf Environmehial Health Specialist will contact you within 5 \ rking di jo pi tcatton date. If you need further information or assistance ple:iSe call 828 66-7291 AREA1 .....n.n.,..-...........n....;........,,...m,........,....4.........‘,................................ . . . ., 1,s,_ellifti■Z,Ation 05123t2016 16444 Page I of 4 I -:r.-- -v- AT- Ir i:ns-15NC11APLR iT ,,HTt-Tv_.. ,,,,. -F CA'PAWBA COUNTY FWALTH DEPARTMENT page I ` °Application fi r`C nvirootntntal Services Improvement Permit Anthu??eation to Construct❑ Septic Repair❑ Septic btalfunction-❑ Septic.Expansion,.❑ Ness; Well Penuii❑ ReplaCemmii Well ❑ \Veil,Abandonment❑ .WelI;Repo ir 0 Exist ing System I ins pee Ihitt (Pre-Appi-oval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ -� % AcRS , en � Subdivision Property Address ..?oZSn. Lo t ____._._.__-_._Acres_ Section/Bloc WPhm sc t —rn (i c @ ht KvingI2rectionstciPropcny_ $��__ t 1 �kU�!' j - R LV ' (4'e '.: NAME TO APPEAR ON P3 RMI C? :IL Owner _ \ppticant kCoutractor Applicant Contact;Inform/a(tiio-n gyp / Ikao1C- q„, .C-i'C +! c_- �' UbO L lddresc cy.1-147 t <� N �tClccFy /?� ? Sa L i / ', Cell Phone ,j2.�D -�76. - ?/71 PltotSe 6 ' `a'17} ',,t?caner`Coot'utlafot ntation` Name _ Address Phone ` _ Ceh Phone Contractor Contitet information .j Name: AddrLcc ' Phone' ' 1 Cell Plume WHO WILL BE'IurPRIMAR.1'CON'IACP gO'viaer ❑ Ap( licant ❑ Contractor , Description of Existing Structures on Site ,; e2n/G -- *+ Structure I)irncnsums it of Occupants __. ,il.of I3edrorans -"- [3'ascment ❑,Yes ❑ No Basement Fixtures 0 Yes 0 No ..The Appltcant5hull notify the local health department upon stibnuttal of this application if tiny of the following apply to the propert} ut guest ion. .If(heanswcrtoallyqugst ion is yes'.applicant'must .hitchsupporting documentation. O Yes - 0 No 'Does the site contain anyjuris<hcttonal t'etlands” fiCytis ,..0 No Does the site contain any exist ng i itstetsaler systems? o:Yes .110 No Is any Wastewater going to be generated on the site other than domestic sewage? 10,Ycs '0 No Is the site subject to approval by sn'y other public'<igeney? 0 Yes 0 No _ Are there tiny easements or right of ceays on this Property? Describe I t xisring`wnter supph in use` KIndiv ulu.d Welt L} Community Well [J Semi Puhlic Wcl1 ❑ Counts/Citst'I ownship Waiter Line Is a public water supply available? ** ❑ Yes ❑ No If annlvinia for in TutproVeentcni Pu air or'Autliotit ttion to Construct, Please.Indicate Desired System'Typc(s): . -.' (systeins can be ranked in order of your preference) € Any , :r< D''Acixpted ,.'0 Alternative 0 Conventional ❑ innovative ❑ Other ,_____ } `{K at 1 t- p r r { ,. S' "1 r sir !4' i !4 i a sFt 0: tr. I 'PHI NOT API Rill h '',t CAT CATAW}3A GOUN f rlrfrlL7 i DP 'AR'ft17:1'sIV3' i G_tNt"r =""` , 4... Page 2 I\pplictitlenforEnsironiucnttatSer ices I .a,. cgs, Ptoposed Facility,Type Er Poffiii:im.Rtsitlenee, New lie.idcnec ❑ t\Idi on to RccIdtItLc if of Nett' Bedrooms ' •' project Deseetption- N 1 i! of Occup ens 2 A i?v, '$_./r cL (Cr£c=rl -Structure Dimensions_ . '. BaSeincnt ❑ Yes No iiasemuu Fixtures 0 Yes N'o �� (_} Acc'ccsnrt Strticture(s) t)csulht -.. - ---- �'- h of lled-frooms '"f if apphc thlc Structure Dimensions � _ __ !l.of Occupants Accessory Dwelling ❑ \es ❑ No ( -'Plumbingt0 Ycs 0 Na Pescribc Plumbing ❑-Multi I nails ReSnit uce if l traits - '-,'+Bedrooms per [Sort*r --- Total n Bedrooms `j' • Structure Dimensions __ _ _ Food Sen tee Spec dv Type II Sc its Floor Space -Entire ood Seric acility S • `t „- #: f"nmplot ctS per Shift ciofShifts t Dining Area }Sq. Ft,) l ` U I3u,imtss S}meei,itt Ihpeofi.Liusm><ss. , �.- Retail floor Space____ ' h of IliMpl a)ees per Shift • 4 at*Shifs Other E mcilth-'I vpt Spccifv ' -----" ..I1 Church ikor Seius Kitchen ❑ Yes :❑ No If Daycare Specify Occupancy ■ Application'IOC lV'dl Coma ruction/A bit into nmetit/Repiir Pins oeyd Well b,s'ac Individual Shell ❑ Sine-.,Public Well ❑ Community \\ill i ❑ �,_ ' Du [❑ Unknown I Alandonmt.nt 1'yllc -C)riiicd ❑ Liotcel ❑ S 1. ,Well epa Deeigmt,$ted ❑ Yes No.- ' Describe' t.. _.. --`• l�elhRepnn Rec}uc x _ , Flow,Commercial '1 .Additional information ttion m is be required to determine 1 . dnsign,ROtr from'cct'tztin.facihtits. l'.his value will be determined dm'tot consultation tt tthon-sdc stuff'. *Affy room ti:t spill be intended for sleupi ng at the time of construct ion or for future consideration should be noted is a bedroonm and counted,on all applieations.'1'he-number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issimanee. This may prevent the need for septic system site increase in the future. t IIstruetu e is plumbed but-no betlr toins,calculated design (lbw is required.. i' ., It-No ittvell permit must�he issued with the Authorization to Construes SYS I`i,bi'REDIsSIGN'ANDIOR RI I RIP Wit) INCUR AN ADDITIONAL. CIIARC F. (S1'sI FEE SCHEDULE) • ioplotanent permits issued as a result of this information are valid for 5 tears or nary be non-expiring under certain specified this department is evoked if the inlbnnmiiononctins application. . site plans unintended use Change for the proposed facility. ., I hate read this applicat ioit and certify that the in tormntioin provided herein is true,complete and coil vet. Authorized to nay and state officials are granted right of entry to con duct-necisary inspections to dctennineecompliance with applicable Imvs a n d rules. I understand that I ani solely responsible fur the proper iclenu Beat ion and labeling of all property lines and corners and making the site ,ticcessible so that a dimnplcte_site es-ablation can be performed ,- a Signature otO sncr or Agent TC.:_— 3Q �___ )'r rated Name of Ownertor Agcn ,c) - y'� J ,. ,t', CATAWBA Geospatial Permit Center Information Services '1" * ••.0116S5..! 't \ '; e..■• -( 4 2..* N',. \ 4 ch �:rw ^,, k•\ X t. h DVVMH-0- (33J Y h Y a \� X2696 p 22A6 . . \ ,- ,/X ,, 1 ' ; 13.72 - 27•194 ` l:A f / K is , "i, . h ,.�' : �! h t r, X •�� 1 'L .�/ t.;.::i v 7'/X x )A.,/\,,,.„ .Q i d x i / �� ",' 7 381' ti� y \ .., � ` \� At 111938 , t1 � � / G/ X 1 in=80ft 5 Parcel: 367804800214, 3288 TATTERSTONE LN MAIDEN, 28650 Owners: PEYATT AMANDA, PEYATT JONATHON OwnerrAddress: 713 4TH AVE NE `Values - Building(s): $0, Land: $12,900, Total: $12,900 I I This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts I to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends I . the independent verification of any data contained on this map/report product by the user.The County of Catawba.its employees,agents,and , . personnel disclaim,and shall not be held liable for any and all.damages,loss or liability,whether direct,indirect or consequential which arises or may arise.from.thismap/report product or the use thereof by any person or entity. - . Copyright 2014 Catawba County NC 05/23/2016 Catawba County Environmental Health • ....\\4-....'...'"%%1141 26 576, �� 17.18 • 2 . a\05 13 0 tr in 121.94 0 ) . . o,\\*--1 87.93 :�a Parcel: 367804800214, 3288 TATTERSTONE LN 1 in=50ft MAIDEN, 28650 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba, its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 05/23/2016 Parcel Report Page 1 of l Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 367804800214 Owner: PEYATT AMANDA Parcel Address: 3288 TATTERSTONE LN Owner2: PEYATT JONATHON City: MAIDEN, 28650 Address: 713 4TH AVE NE LRK(REID): 200084 Address2: null Deed Book/Page: 3119/0449 City: HICKORY Subdivision: CRYSTAL FOREST PHASE 2 State/Zip: NC 28601-5101 Lots/Block: 3/ null Last Sale: School Information: Plat Book/Page: 33/135 School District: COUNTY Legal: LOT 3 CRYSTAL FOREST PL 33-135 Elementary School: BALLS CREEK Calculated Acreage: 1.010 Middle School: MILL CREEK Tax Map: 006AK 02003 High School: BANDYS Township: CALDWELL School Map State Road #: 2741 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-40 Building(s) Value: $0 Zoning2: null Land Value: $12,900 Zoning3: null Assessed Total Value: $12,900 Zoning Overlay: DWMH-O,WP-O Year Built/Remodeled: null/null Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel It: 3710367800J Building Details 2010 Census Block: 2025 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P1 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. e -\ `% -rt d cz{y-\ goo EN /Oct http://gis.catawbacountync.gov/nomap/parcel_report.php?key=367804800214&typ=P 5/23/2016 OPERATIONS PERMIT FOR TYPE IV WASTEWATER SYSTEM PERMIT NUMBER 8157 In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended, and other applicable Laws and Rules PERMISSION IS HEREBY GRANTED TO Billy Gene Alexander, Jr. CATAWBA COUNTY FOR THE operation of a wastewater collection, treatment, and disposal system to serve tax map # 6AK-2-3 pursuant to 15 A NCAC 18A 1900 et seq and in conformity with the application, improvement permit, and other supporting data subsequently filed and approved by the Catawba County Health Department and conSic?ered a part of this permit. -Facilities to be served (Address and specific type of facility) Billy Gene Alexander, Jr. -Hh ' ' 3288 atterstone Lane Maiden, N.C... 28650, Type 4A The approved wastewater collection, treatment and disposal system consists of (1) 1000 gal . septic tank (2) 1000 gal . pump tank (Hydramatic SHEF 33A1 S/N 51874-004-7) (3) Pressurized Panels (2ft . head at end of trench) (4) 3 trenches (50ft. x 2ft . ) The Owner shall be subject to all applicable provisions of Article 11 of Chapter 130A of the General Statutes and 15A NCAC i8A 1900 et seq The Owner is especially referred to Rules 1935 (29, 31) , 1937 (d, e) , 1938 (g) , 1945 (a,b) , 1950 (a through i) , 1961 (a through d) , 1965, 1967 and 1968 The Owner shall also be subject to the following specified conditions and limitations as they apply r I GENERAL CONDITIONS 1 This permit is effective only with respect to the number and type of proposed facilities and volume and nature of wastes specified 2 In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the Owner/Operator shall take immediate corrective actions to correct the problem, including actions as may be required by the Catawba County Health Dept , such as the construction of or replacement of wastewater treatment or disposal facilities, upon receipt of a repair permit 3 The septage generated from this system shall be disposed of in accordance with Article 9 of Chapter 130A of the General Statutes and 15A NCAC 13B 0100 et seq and in a manner approved by the North Carolina Division Of Solid Waste Management 4 The issuance of this permit shall not relieve the Owner of the responsibility for damages to surface or groundwaters resulting from the operation of this system Neither does the issuance of this permit exempt the Owner from complying with any and all statutes, rules, regulations, or ordinances which may be imposed by other government agencies (local, state, and federal) which have jurisdiction 5 This permit may become suspended or revoked if the soils fail to adequately absorb and treat the wastes or if the facilities are not maintained and operated as designed The system must be operated and maintained in a manner which will not create a public health hazard or nuisance by surfacing of effluent or discharge directly into ground water or surface water any time during the operation of the system 6 Adequate measures shall be taken to divert stormwater from the disposal field area and to prevent wastewater runoff 7 Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited 8 Prior to the transfer of this land to a new owner, a notice shall be given to the new owner that gives full details about the system and the materials applied or incorporated at this site At the time of the sale of the property a new Operations Permit will have to be issued Operations permits are nontransferable. 9 The designated repair area shall be reserved for the installation of additional nitrification fields and is not to be covered with structures or impervious materials 3' 10 No addition, expansion, alte'r'ation or other repairs shall be made to the wastewater system without first obtaining an improvement permit from the Catawba County Health Dept in accordance with GS 130A-336 11 Failure to abide by the conditions and limitations contained in this permit may subject the Owner to an enforcement action in accordance with North Carolina General Statute 130A-18 , 130A-22C, 130A-23 , and/or 130A-25 12 In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the Owner/Operator shall contact the Catawba County Environmental Health Section of the Health Dept within 48 hrs of discovering this failure or problem 13 A suitable cover, preferably fescue, shall be maintained over the drainfields Grassed areas shall be kept mowed and the clippings and other debris removed as needed to prevent thatch build-up No traffic (including parking of RV's, boats, trailers as well as other vehicles) or other equipment shall be allowed on the drainfields with the exception of mowing equipment 14 . Non-biodegradable products (plastics, metals, etc ) chemicals (disinfectants, drain cleaners, acids, alkalies, pesticides, petroleum products, etc ) or grease shall not be discharged into the septic system 15 The owner shall keep the plumbing system in the facility in good repair and eliminate leaks, drips, or excess flows as they are found Use of ultra low fixtures and conservative water use practices are recommened II OPERATION AND MAINTENANCE REQUIREMENTS The Owner shall maintain a contract with a subsurface sewage system operator who is currently certified by the Water Pollution Control System Operators Certification Commission to maintain this system Verification of any changes to the contract currently on file shall be submitted in writing to the Catawba County Health Dept This system is required to be inspected by the certified operator at a minimum frequency of two times per year or as otherwise specified by the Catawba County Health Dept The distribution device should be inspected during each maintenance visit for proper operation If needed the pressure should be inspected and set properly at each maintenance visit Low pressure lateral lines shall be purged of solids at least 4 e once a year using potable water directly or added into the dosing tank If the operator and the health dept determine purging is needed more or less frequently, then a new schedule shall be implemented Pressure on the distribution lines shall be checked and adjusted in accordance to design pressures after each purging and at least semi-annually Pump drawdown level (between the on-float and the off-float) , approximate dosing volume, and pump delivery rate shall be measured after each purging and at least semi-annually The owner and operator shall be responsible for assuring any broken pipe, lateral end caps or cleanouts are repaired within 48 hrs of becoming aware of such a problem The condition of all pipework shall be evaluated during each inspection Surface and subsurface water shall be diverted away from the tanks and drainfield Outlets on diversion ditches and tile drainage tubes shall be kept open and free flowing The septic tank shall be inspected at least annually for leakage, blockage of influent/effluent lines, structural integrity, condition of baffle and tee, condition of risers if present, scum and solids level, and effluent clarity Solids shall be removed from the entire tank before the solids depth exceeds 1/3 of the liquid depth in the inlet compartment, and is otherwise determined to be needed by the operator or the Health Dept The dosing tank shall be inspected semi-annually for leakage, structural integrity, condition of risers, solids level and effluent clarity Solids shall be removed from the dosing tank when solids are removed from the septic tank or when the solid level is up to the pump or siphon intake level Solids accumulating on the pump or siphon and floats shall be removed by hosing Pumps and electrical controls shall be inspected at least semi-annually for pump presence and proper automatic functioning The floats / pipe / control valves / union / anti-siphon hole are in proper working condition The control panel / electrical connections are properly maintained and operational The highwater alarm is present and operating properly Siphons, when present, shall be inspected at least semi- annually to verify proper automatic functioning, and the highwater alarm is present and properly operating • Ivan ' - ' ***Op Permit and/cr Cert Op Required VtMust be completed prior to final) N o J 8 1 5 CA'TAVVBA COUNTYALTH DE'ARTMVMENI (704) Lot Eval ✓Improve Permit impair Permit Cert of Comp Permit er Permit Owner/Agent tS/L-L ii/6 /7GE}C�}/1/.Dcc. f2. Phone . : 442.3—/6 f/ Address ... 41.3/6-1.-_ ,a -}T Q„Sm�/(T- L/(/ Subdivision C,eyS'j_/-c 6d-2%2CS'7' '. -/ — /, Section/Block/Phase Lot#ij..' Lot �''ze in ' ections _ Q t •� 4:"Zir #,- . t . . Balk i Jt�- - A _J a n/ - 0. , - s . ra • Facility House obile Homet./$usiness Other Tax Map # 4/lA(-- ,2-3 Multi-family Other Zoning Approval # -a s03/..CS Bedrooms N3 Seats Employees Application Rate GPD Flow Hot Tub or Spa yes :o Special Fixtures 100% Repair ArealgrAr no REPAIR NOTICE: Basement yes/ Basement Plumbing ye. / o . REPAIRS MUST BE W IN 30 DAYS OR Water Supply Private t„,..* Vublic DAYS FROM DATE OF PERMIT Type of System Trench Bed Pump Pump/Panel c:/Panel LPP Other Tank Size: Septic Tank /00o Pump Tank /02)d , Nitrification Field: Total Square Feet 3400 Depth of Stone. Bed Size Trench Width Total Length of All Trenches /.$"J Number of Trenches v7 // Individual Trench Length.co/Sa/S / Feet on/Center Qr Maximum Trench Depth .�f/ Distance of Nearest Well SV !.4. Lot EvaluatQ€c /wpprove � o (Void After 24 months) ************************************ .. .. YTi***** Topo 8%-? % Slop-- e lot Evaluation Site - System Design thiiii Texture G4,/9-yor i DO NOT . i. INSTALL • Structure 13Coc.e y WHEN WET t Clay Min / ,'/ TQ Q C LIME Soil Wetness " i �4 �L y .-- 1 Soil Depth I ® -fire 1t 5 cok e Wa f l5 Restric Hoz at 1 �l // Available space yes no, 4't<< ��4 '' do .4(� ( Overall Class S PS U n ItP'1 ` Comments I CSC D Po33IQCc s1,.QC1 (Cct i°4sa *S cc l-4---rri9GH r '1 -. 7 FiCl. /lc en a �� - 3 Ter'w Nf5 X 3 X co/Qraii-croR--, I . 72n..cErz c -G (.. 4C/=o2t 1//'c/Sr' L./ - —�I9NcL ' c D, • -F/ot Septic Tank Contractors ( ( � E G -76-uRC.ye-s MUST contact the 1 i _ Sanitarian BEFORE l— -/ — ._ _ — Cr' Gabe v«I(«s changing permit _ ¢�1'^ /%#tt. 7 ' W ' **NO GUARANTEE OR WARRANTY IS IM' AD OR GIV -"ilY _ _ _ _ _141 _ - PERMIT* . Permit Date ... '"5- (Improvement Permit void after 60 months) Owner/Agen _a O.f1�T1a/T'\, Sanitarian Installed By wpm . ,, y ._ . Date C;-5--9 Sanitarian L (Not- 'any changes/information in rector by sketch on ' ck) *******IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PR ERTY, THERE IS AN ADDITIONAL $25 CHARGE White-Office. Blue-Building Inspection Completion Yellow-Owner/Agent Green-Building Inspection IP tl 4CMA 4 X 11 W EwTHEo-pgeoF t CON"r Q„oL .Zori W/ L%GN-r A.4D/o2 3ELL RISER tS SEALED AT TA.1K SE.Pw1L PITS LI e.e.ut-T$ Ant 4-r E%LT -PO/.1-7-3 Fog - Fog ALAQM -pump 'Cm{ SUPPLY LOyE A1-ID WIgwC1 NO E.LECTFz,1CwL. 1 i''• . • . ,-• 7UUCT•o.+5 !Ai ?uMp'TR0.IK GRADE •• i • • 6"A3ovE G-RFite y..e a L Cew..A EL/enc.t. QAg Loy I .4 • 2. TvL •• •c . •• . 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CO.1TQ13u 7 AT TDA., U L LISTED /9j • • _ / _ . $TA■ O 13,0e B•Co^aeeis CEMEVTE 'uTO -s ocrCS '-'1a s l 8" COVC.3tL • rr. r ,c,J i I t S/40 CM 3 >} 3 j *> r, a". • N Z £ 7s s o3 r <, ' 3 ¢ t • ° P -45- 1a £ m Z °o ai 1' 4 b a @ CaJ n. 5 .4.e..... 355 u°.i Dy z to - -� 11 r X T— a` c f n o S n as �� m N i m z' a io es ia4 Q 1 P ' �. 1 , c 1 1 o T 4.51. j I v I% ( I /r ` la��' r rfmb.__ro H / �� / / i ��` , ;?� \\ \ \-..:_•:...Lc I a o � r c N 7 r I j C# o \` \ r 1 -`tS,' N E ocof o m Z° z m(�U 9 3 ° x 0. { Z n I co T i 7 Q ..1 O N _ \ r- \ - r c 5 3 '< ."I \ - F n i w -O s- \ c -a r ° L P h P ., 1 r N • ~ 0 3 j L D m=^ i � I f at:--- ---; t \ N ,c,--,.. . ` 6 a m a. 1f \ \ m i m c m c tz \ t � — 1 �^1 ' pi,* a3 r.-..." a v "e •'C _j N G N y J v It . _ i C 0 O C O SI o,3-' . t— N- n ° n N o S.In rr' I S u P ° P ft t tu e r /Cedu c e,- To _ c„, - u no CNN\N-- 13 "16111(- --/-0 / V rya 1� /9 .:,,,,:,. p YAiu2 -.) ., S educe/. 4..o - /3 v PUc y ^fir ep I ere 4e ., 02 p v c s4PP 'y L;Ne Aug 02 16 10:31a Lake Norman Sewer 7044835933 p.2 LAKE NORMAN ;;.! E }a v n115. ,.--7.v4:g4311111?2153215g1116871110 • Contract for Inspections of On-Site Wastewater Systems (Type IV & V) This Contract is entered into this 1st day of August by and between Lake Norman Sewer and Septic Services, LLC, a full service provider and a forth Carolina company of Lincoln County, North Carolina (hereinafter the "ORC" or Operator in Responsible Charge) and John Peyatt (hereinafter "The Owner"). Preamble The ORC is contracting with The Owner to provide inspection services as described on Attachment A for the fees or charges also shown in Attachment A. The Owner owns or controls the property upon which a ground absorption sewage treatment system ("System") is installed, such System being designated as a type II, Ill, IV or V system under the Rules for Sanitary Sewage Collection. Treatment and Disposal found at 15A NC Admin. Code 18A.1900 et seq.; and 15A NC Admin. Code 18A.1961 requires that a condition of the Operation Permit for Type 3V &V systems be that a properly executed inspection contract between the System Owner and a management entity shall be in effect for as long as the System is in use.The ORC is a management entity which employs certified operators of a type authorized by 15A NC Admin. Code 18a.1961 to manage and inspect type II, Ill, IV and V systems. In consideration of the premises and of the mutual covenants and promises contained in the Agreement, it is hereby agreed by and between the Owner and the ORC as stipulated below. Conditions of the Contract A. The ORC, in consideration of the payment by the Owner as set out in the schedule of services and charges in Attachment A, incorporated herein, agrees: 1. To provide the services set out in Attachment A according to the minimum schedule of inspections/services required by regulations for the lots or parcels set out in Attachment B. 2. To report results of the inspections to the local environmental regulatory agency having jurisdiction as required by applicable laws or regulations, 3. If inspections indicate the need for system repairs: a. to notify the local environmental regulatory agency within 48 hours. b. to give notice to the Owner of needed repairs and if the necessary repairs are outside the scope of the routine maintenance described in the Maintenance Agreement,then the Owner may request the ORC to provide an estimate. At the authorization of the Owner the ORC will perform the necessary repairs at the ORC's then-prevailing charges for services and materials. 4. If the ORC's services are terminated, the ORC will notify the local environmental regulatory agency within 48 hours. B. The Owner, in consideration of the services performed, agrees: 1. To pay the ORC for its services according to the schedule of charges as set out in the Maintenance Agreement. Aug 02 16 10:31a Lake Norman Sewer 7044835933 p.3 2. Within 30 days of receipt of notice of repairs under A (3) above,the Owner(s) must provide proof that repairs have been performed by a licensed or qualified entity and the system is functioning properly or request and authorize the ORC to complete the needed repairs. 3. To notify the ORC promptly of any emergency or malfunction known to it which may violate environmental, health or other laws and regulations and to authorize immediate repair as necessary to restore the system to proper function and operation. 4. To use reasonable efforts to provide and to maintain at all times, such access to the system as is reasonably necessary for the ORC to comply with its obligations under this Agreement. Terms of the Agreement 1. This Agreement shall be effective for one year from the date of this contract. This contract will have to be renewed each year. 2. The real property to be serviced under this contract is listed on the Maintenance Agreement. 3. This Agreement automatically terminates if the Operation Permit for the system is revoked and all appeals of the revocation are exhausted or time for making an appeal has passed. 4. The parties may terminate at the end of the then current term by consent of each party or by not less than 60 days written notice to other party prior to the end of the then current contract year, and not less than 30 days written notice to the local environmental regulatory agency. 5. This Agreement may be terminated for cause for breach which remains unremedied after 15 days written notice to the defaulting party. Limited Warranty THE ORC'S SOLE DUTIES AND RESPONSIBILITIES UNDER THIS AGREEMENT IS TO PROVDE INSPECTION AND ROUTINE MAINTENANCE ONLY AS SPECIFIED IN THIS AGREEMETN. INSPECTIONS WILL COMPLY WITH APPLICABLE CODES, LAWS AND REGULATIONS IN FORCE AT THE TIME OF THE INPSECTION AND REPORT. WORK AND MATERIALS USED IN REPAIRS ARE WARRANTED ONLY TO BE OF GOOD WORKMANSHIP, FREE OF DEFECTS AND CONFORM TO THE SYSTEMS SPECIFICATIONS AND EQUAL TO THE ORIGINAL PARTS AND EQUIPMENT.THE OWNER'S SOLE REMEDY UNDER THIS EXPRESS WARRANTY IS REAIR OR REPLACEMENT AND CONSEQUENTIAL DAMAGE OR DAMAGES FOR DELAY ARE LIMITED TO THE TOTAL SUMS PAID THE ORC UNDER THIS AGREEMETN FOR THE PARTICULAR LOT OR PARCEL FOR THE THEN CURRENT YEAR. ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING MERCHANTABILITY OR FITNESS FOR PARTICULAR PURPOSE, ARE EXPRESSLY AND SPECIFICALLY EXCLUDED. REPAIRS, REPLACEMENTS, ADDITIONS AND CHANGES BY OTHERS TO THE SYTSMS COVERED BY THIS AGREEMETN WITHOUT PRIOR NOTICE TO THE ORC OR ACCEPTANCE OF THE WORK BY THE ORC DURING THE TERM OF THIS AGREEMETN VOIDS ANY WARRANTY GRANTED HER1N AS TO THE ORC. Miscellaneous 1. Transfer of rights, responsibilities and duties under this Agreement by any party shall be valid only on written notice and consent signed by all parties,which consent shall not be unreasonably or arbitrarily withheld. 2. The ORC may perform its duties and responsibilities by subcontract but the CRC will remain directly liable and responsible to the Owner under the terms of this Agreement. 3. Waiver of default or a breach of the Agreement by any party shall not operate nor be construed as a waiver of further or subsequent defaults or breach of this Agreement. Failure to take action in any default or breach does not bear action on such default at any time subsequent to such breach or default. 4. This Agreement constitutes the entire agreement of the parties, incorporating and superseding all prior representations and negotiations and may not be changed or amended except in writing signed by the Aug 02 16 10:31a Lake Norman Sewer 7044835933 p.4 waiver of further or subsequent defaults or breach of this Agreement. Failure to take action in any frn default or breach does not bear action on such default at any time subsequent to such breach or l',t default. 4. This Agreement constitutes the entire agreement of the parties, incorporating and superseding all prior representations and negotiations and may not be changed or amended except in writing signed by the d k " , a ncr I^. Y-,::•.,1-7,-,‘.;.--,-,,--..,,,,:-0,-;.:'; t MP,7A': t '"° `s,.? _"`" ?t, :'�A x �,,.r .1 ',,,�-�'.: 1 M ,,.,.2;'��Od.,... m.. .� _-..,.� ,s--.,.,d . t .¢s.'�..,. .,r..,..._«.. ,. ,.�.;i.. �,l,.. 'k... ,. .:v�.�...w 1% �,�.j�_ �_<-nn3 2.. ._,�, �.,.,u.. .1. _, a.. x _- ,a.>. < .�s:II,«u..�.,/; M parties.The Agreement shall be interpreted under North Carolina law. Any part of the Agreement declared void, illegal or unenforceable will not affect other provisions of the Agreement. 5. Disputes arising under this Agreement shall be determined by any method of alternative dispute resolution the parties choose, including but not limited to, mediation or arbitration, under the Uniform Arbitration Act of North Carolina or its equivalent, or such means or methods as the parties agree to in ',,t: writing. i 6. Notices are deemed delivered if delivered in person; by certified or registered mail; by courier; or i delivery service, if properly receipted, charges and postage prepaid, as follows: Owner: JOHN PEYATT 3288 TATTERSON LANE MAIDEN, NC 28650 ', Lake Norman Sewer and Septic Services, LLC 3405 Denver Drive Denver, NC 28037 0, sA Environmental Regulatory Agency: M CATAWBA COUNTY ENVIORMENTAL HEALTH DEPARTMENT 100 SOUTHWEST BLVD P. tm NEWTON, NC 28658 4 A party may change its address by giving notice in the manner provided above. Each party has executed this Agreement with full power,authority and legal right to enter into;to bind itself 1' to the rights, duties and responsibilities under this Agreeme , which is binding on the parties, their 100 Southwest Blvd, Newton, NC 28658successors and assigns irs and perso al presentatives, on -e date first above written. % 1 ATTEST: OWNER: 1 ii ii ♦9► : li l' :ii1;i 1,, r to 7 L ki ake Norman Sewer and Septic ServicesL r;').' .--- '''Irj. ATTEST: By: -!!17:::2 ;!:2 LLL... Title: ner :°�-' License number: s`* Aug 02 16 10:32a Lake Norman Sewer 7044835933 p.5 LAKE NORMAN F...;�� • Subsurface Wastewater Maintenance Agreement Low Pressure Pipe On-Site Sewage Disposal System with Biofilter Pretreatment The following items and conditions for the monitoring and inspection of the conventional system located at 3288 Tatterson Lane Maiden, NC 28650 are in compliance with the North Carolina Rules for Sewage Treatment and Disposal. Lake Norman Sewer and Septic Services, LLC will provide the services of a Certified Subsurface Operator and will provide the required inspections and maintenance/monitoring services for a period of one year from the date of this agreement. The cost for one year is $300.00 payable at the time this contract is signed. Twice-yearly site visits shall include the following: 1. Septic tank shall be inspected for influent/effluent line blockage, watertightness,structural integrity and level of solids accumulation. 2. Pump tanks shall be inspected for structural integrity, water tightness and solids accumulation. 3. Pumps, control floats and alarm system shall be checked for proper operation. 4. Control panel and other electrical components shall be inspected to field-verify proper operation including timer settings. 5. Lateral field area shall be inspected for seepage, saturation, settled ground surface, broken pipes or other components, maintenance of appropriate vegetation, protection from traffic and diversion of surface water. 6. All laterals shall be flushed of solids accumulation using pump pressure or other means, as needed. 7. Pressure head in each subfield shall be set according to the design specifications. Dosing rate (gallons per minute) shall be measured and recorded for the entire system after each subfield has been flushed and head has been set. Dosing volume (drawdown) shall be set according to design specifications or adjusted as determined by the certified operator. 8. Biofilter shall be checked for structural integrity,water tightness, proper air circulation around module lids and maintenance of media. 9. Sample chamber effluent shall be visually checked_ 10. Samples shall be collected and analyzed according to permit requirements. Lake Norman Sewer and Septic Services, LLC,a full service provider, may subcontract with such manufacturers, suppliers and other subcontractors as it deems desirable to perform any of Lake Norman Sewer and Septic Services, LLC's duties under the Agreement. Lake Norman Sewer and Septic Services, LLC shall remain responsible for the performance of all work performed by subcontractors. There shall be additional charges for any of the following, whether performed during a regularly scheduled visit or during additional visits requested by John Peyatt. • Repair or replacement of broken pipes or fillings. • Repairs to pump, controls or other components. • Removal of obstructions in sewer pipes, supply lines or manifolds. • Laboratory analysis of effluent samples as required by Health Department. • Other special requests by John Peyatt. Aug 02 16 10:32a Lake Norman Sewer 7044835933 p.6 ® LAKE 6 RM AN kF:rt t7te+n no y iP John Peyatt 3288 Tatterstone Lane Maiden, NC 28650 The customer hasn't built the home yet, but as soon as home is completed the homeowner will contact our office. Then the customer will receive the Bi-annual Type IV inspection by our company Lake Norman Sewer & Septic. If you have any questions please contact our office. Thank you ! /-� /. y , I. David Currier The Owner of: Lake Norman Sewer & Septic 3405 Denver Drive Denver,NC 28037 (704)-483-5 U5 Phone (704)-483-5933 Fax 3405 Denver Drive, Denver, NC 28037 Office: 704-483-5125 Fax: 704-483-5933 info @LakeNormanSeptic.com www.LakeNormanSeptic.corn