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HomeMy WebLinkAboutLSSP-03-2022-167735.TIF $C'esS Pc4 LSSP-03-2022-167735 • State of NC LSS Permit Option COVID-19 LHD Reference: �1 PART 3; Authorization to Operate(ATO) P a PR .f -3-X.)) -i/ 3 5 Except for date reodred,the Section below b to be completed by the Owner. - A MOUSE ONLY: Initial submittal of request for ATO received: 1 `11— % by Dote Initials Date of Post-construction Conference: // The following Items are included in this submittal for an Authorization to Operate under an LSS COVID-19 permit: 1. Signed and sealed copy of the LSS's report that includes: a. Signed and sealed evaluation of soil conditions and site features Pi Yes ❑ No b. Drawings, specifications, plans Q Yes ❑ No c. Reports on special inspections and final Inspection Yes ❑No d. Management Program manual Yes ❑No e. On-site Wastewater Contractor's signed statement Yes ❑No LiJ 2. Fee (as applicable) Yes ❑ No 3. Notarized letter documenting Owner's acceptance of the system from the LSS Q Yes ❑ No 4. On-site Wastewater Contractor name: Jarrid Lentz License number:2260i_ Mailing address:_461 Lentz Rd City:Statesville State: NC_ Zip:28625.__ Telephone number:980-82942T&—e-mail Address: offlce@lentzwastewater.corn 5. Proof of Errors and Omissions or other appropriate liability insurance for the On-site Wastewater Contractor is ached an ndudes the name of the insurer, name of the insured,and the effective dates of coverage. Yes Lj No Attestation by the Owner for Authorization to Operate TREGG MARKS hereby attest that all Items Indicated above have been provided to the Print name of Owner CATAWBA County LHD and the system shall meet applicable federal,State,and local laws, regulations,rules and ordinances. itC 7 frOt<C! Jan 12,2023 Signorure of Owner Dote This section for LHD Use Only. WO Review of required information for the ATO ❑ INCOMPLETE Based upon review of information submitted by the Owner in the Section above,the following items are missing from the information required for an Authorization to Operate for an LSS COVID-19 permit: Copies of this signed form were sent to the LSS and the Owner on via Dore Email,VAX,USPS,Hand-delivered Print name of authorized Agent of the UV Signature of oulhorued Agent of the LHD rt� Dote ET COMPLETE Based upon review of information submitted by the Owner In the Section above, this Authorization to Operate is hereby issued In accordance with G.S. 130A-336.2(m). A copy of this complete NOI/ATO with tracking information was ser?t to the State on 1-2?'23 via 1:Va%, Dote Enwri 1M.USPS,rrond-Otinered IL t„.t/Iiri - 'ct 2- i Print name of authorized Agent of the LHD Signotwt of authorized Agent of the LHD Dote ISSUANCE OF CERTIFICATE OF OCCUPANCY. Once the 1ND determines completeness based upon the ATO submission,the owner may apply to the local permitting agency for permanent electrical service to a residence,place of business or place of public assembly pursuant to G.S.110A-339 DHHS/EHS/OSWPB-LSS COVID-19 COMMON FORM Effective September 8,2020 Page 6 of 6 LSS COVID-19 Permit Option Tracking information The LHD completes this form for each NOI/ATO submitted to their offices. The LHD updates this information and re- sends it throughout the process as appropriate. The Department will use this data to answer any questions on the implementation of the LSS COVID-19 permitting process. Tracking information for LSS COVID-19 permits (Required) County Ca+awba LHD Reference Number LSS r- 0 3-2o.- f 6773 5 Permitting backlog as of date of NOI submittal(#days) 35 days Number of days to process the NOI(#days) 5j d op Number of days to process re-submitted NOI(#days or Facility type 1 Bec{rpo M Aivarimen4 i n 60.4c of Garage, Domestic,High Strength or IPWW Doan es+1 L t�JJ Design Daily Flow aTO led Residential or Commercial geSi°ten+ia I System type(per Rule.1961) in- Date of Post-construction conference NA 9 Date Authorization to Operate issued i- -23 Fee charged for LSS COVID-19 yes 4l CO,00 Is fee sufficient to cover LHD costs? - les Date LHD notified of LSS COVID-19 malfunction Date LHD notified of Owner complaint DHHS/EHS/OSWP—COVID-19 Appendix A Updated February 2022 Page 4 of 4 To: Catawba County Department of Public Health Re: Signed Statement of Verification of Installed Septic System at Address: $-5 0O E . ISo.mi s Kroh G ck},+.tz ba r n)c Z S6 09 My signature below hereby attests acceptance of this system from Caroline I. Edwards NC Licensed Soli Scientist#1220 EARTHWISE DESIGNS 991 Duncan Rd Ruthetfordton, NC 28139 I submit that this Authorization to Operate (ATO) is accurate and complete to the best of my knowledge and that the constructed system shall meet applicable federal, State, and local laws, regulations, and ordinances. Sign with NOTARY present, notarized below. Owner Signature: _ Date l- /3 - Z.3 North Carolina -- 44 .\ County I, Ag\e\Q t vd.1Y1 a Notary Public for Q. .\\ County, North Carolina, do �1 Hereby certithat_._._AN(2c&c NACLY s4.S personally appeared before me this day and acknowledged the due execution of the foregoing instrument. 2y� Witness my hand and official seal, this the J day of Y 2023. ``tttiiiiirri_ Notary public: , 5.•N. .OrA'•.,,.P My commission expires: t3 . �`l--al `4- A • p= V8LIC ' z' rF•. G : To: Catawba County Department of Public Health Re: Signed Statement of Verification of Installed Septic System Job site address: CO - )t,,D1/4..v- .1 C My signature below hereby attests that the installation went in as shown on the 'as- installed' Site Plan attached; and I submit that this Authorization to Operate (ATO) is accurate and complete to the best of my knowledge and that the constructed system shall meet applicable federal, State, and local laws, regulations, rules and ordinances. Installer Signature: 4tth(iehti Date Jan 13, 2023 Erie CERTIFICATE OF INSURANCE DATE ISSUED(MM/DD/YY1 • Insurance° >;"'��� -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Porn O`f,ce • 100 Erse Insurance Place • Ene,Pennsylvarea 16530 • 814.87C 200C Tdl tree 1.800.458.081' • =ex 814 870 3126 • w•.wv ereinsurance co-n NAME AND ADDRESS OF AGENCY SNIDER INSURANCE GROUPI_I.0 AGENT'S NO. • . CO‘,IV:hlflp. ,301$:l I, n{s :•GE 1438 WILKESBORO HWY JJ2072 . ►ems a:U1I ,1•Ridi;ia : N:s :11 = .711. 1 •bl'“ __ STATESVILLE,NC 28625 Co.:E ERIE INSU`•'nor 3'CHAN E 'ot•DPI •.le Erie indemni o. ttorn: -In-Fact in N1Y- - �i1II12+�I::21 *sill!0.1:1' s1�a]&i:. o.• e�a/3ei.i il' • I'i.ill•►•1'sl • I0•6'' NAME AND ADDRESS OF NAMED INSURED This certificate is issued for information purposes only and confers no rights on the certificate holder.It does not affirmatively or negatively amend,extend,or otherwise atter the terms,exciusioes Lentz Wastewater and conditions of insurance coverage contained in the policy(ies) Management Inc indicated below.The terms end conditions of the pollcy(ies)govern the insurance coverage as applied to any given situation,limits 463 f,entz Rd shown may have been reduced by claims paid.This certificate of Statesville,NC 28625 1596 Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer and the certificate holder. This is to certify-that policies,as indicated by the Policy Number below are in force for the Named Insured at the time that the Certificate is being issued. �LI�r�Ff ir�t ( 'III I �1"t (1 L e TYPE GF INSURANCE —_--POLICY Mit1aER ._➢Bl�LENT.I I:I 1 I�a11��•i UNITS F Q GENERAL UABfUTY EACH OCCURRENCE 1,000,000 COMMERCIAL GENERAL LIABILITY Q 31 1120611 7/11'.... 7r 1 I r_3 i E RITE DAMAGE(Airy One Ere; $ j ❑CLAIMS MADE ❑OCCLJ� MED EXP Om One Penal S 5.000 I PERSONAL&ADV.INJURY $ 1,000.000 ❑___ — GENERALAGGREGATE Is 2.000,000 GEN'L AGGREGATE UMRAPPLIES PER; PRODUCTS-COMP/OPAGG 2.000.000 ❑POut,Y ❑PROJECT CDLOC E O AUTOMOBILE LIABILITY T ❑ ovnaRED,wiraunr% Q07 0131769 7/I/22 7-1•23 BODILY INJURY S ❑OWNEDOBY INJURY ❑OWNEHIRED I MI ACC .$ PROPERTY DAMAGE S ❑NON-OWNED BODILY INJURY AND PERTY❑GARAGE PRO COMBINEDS I.0()0.000 0EXCESS LIABILITY EACH OCCURRENCE 1S ❑OCCURRENCE AGGREGATE S ❑RETENTION S I i3 G, WORKERS COMPENSATION& ___STA/U1a1 Y EMPLOYERSUABIUTY Q915101780 7;1/22 7/1/23 BODILY] ACCIDENT S 1,000,000 EACH ACCIDENT INJURY DISEASE S 1,000,000 POLICY LIMIT BY DISEASE S 1,000,000 EACH EMPLOYEE OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIV- ERED IN ACCORDANCE WITH THE POLICY PROVISIONS. IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). NAME AND ADDRESS OF CERTIFICATE HOLDER Earthwise Designs AUTHORIZED REPRESENTATIVE 991 Duncan Rd Ruthcrfordton,NC 28139 _ EIG6230 8/11 Page Iof1 1 .4‘ - -1.\(\e-vAlra.\6--6. 4 6 ..5 TADLxik • L I (1- (2_ A-1.,kz.,-0%-.6 Ito -- c . Lss? -3- 2 2 - 11..4.175 17. Earth wise Designs 1.86 ac. new lot E. Bandys Cross Rd. Soils& Land Evaluation Subdivision of 43 ac. Parcel 368902885479 February,2022 See legend and written report far details. ct „firIlD k)eti r19 if C-----CA : 230.11' A z PPP �� ' 144L Y 61 4r;b.-7 t'16..i. all - •-'' • ic'41 4 ... ..-.. . OM i IO C ii: Z„ V I. 1 / y-0 . ', '1 4.t '1T ok n I cO 1 I ;•a rer Brie r ie r le a '46. I 1 64' SHOP - to' . 1off I 56. 01 0' 1LI * HOUSE W " a n g U r �, r 54 g _ -- I .8 AC.± Ate`Absv 1 \\., 1 6' 1 �/� v, r, 1 IZS 1 t .i 1 —Iv" `�' I well i r r 1. 1.•4' C3 ----- -- - G '�+b��" lt On f��J�� it,..,;" _� .r —~ _� �' 2 f �YS cRQs•s VAIBUIC /`� l _ _F Bp'_ 4 all 6fl — -- - - - -- - Septic System State University Owner's Guide NCiWTIVE EXTENSION (mpawering Propi Providing Soluinns SoilFacts If you use a septic system, or if you are buying a home with a septic system, this owner's guide can help you be sure that your septic system is used and maintained properly. This folder also provides a place to record and keep important information, such as a copy of your permit, a sketch of your system, maintenance records, and other fact sheets. Know the Ins and Outs of Your System For this reason, state rules have specific maintenance requirements for a number of these more sophisticated What type of system do you have? technologies. Often, homeowners will be required by Many different kinds of septic systems are used in North state sewage rules to hire a state-certified operator to Carolina, but most of the nearly 2 million systems in regularly inspect and maintain the system. In addition, state use throughout the state are slight modifications of the rules also require the health department to inspect these conventional septic system. This system has a septic tank systems on a periodic basis. and a drainfield with gravel-filled trenches (usually two to six trenches). Since the mid-to late 1990s, the traditional Your local health department can tell you what type of gravel aggregate trenches used in the past have given way system you have and what the legal requirements are for to newer gravel-less trench designs. long-term maintenance. These gravel-less trench designs rely on alternative Do you know the location of your septic system and materials in place of the gravel.The most common gravel- repair area? less trenches now used include either long, narrow, tunnel- To properly maintain your septic system,you should shaped chambers in the trenches or gravel substitutes know the location of both the septic tank(and any other such as expanded polystyrene aggregate. pretreatment units) and the drainfield. Contact the local health department for a copy of your septic system Other alternative trench materials that are being used permit and soil evaluation sheet.These forms indicate the in some parts of the state include large diameter pipe, approximate locations of each of the system's components permeable concrete blocks, and even recycled rubber tires and the size of the septic tank. Keep these items in this chopped into chips or pieces of a specific size. Septic System Owner's Guide file folder. Cooperative Extension Service publication AG-439-13, The location of the septic tank and drainfield can usually Septic Systems and Their Maintenance, describes the be determined with a copy of the permit and with the conventional system, simple modifications of it, and help of a septic contractor, consultant, or the local health important maintenance needs. department. Other more sophisticated types of on-site systems used Most housing sites permitted since the early 1980s are for the last 20 to 25 years include systems with pumps, legally required to have a "repair area or replacement area" mechanical pretreatment units, or biofilters.These in which a second drainfield could be built if needed.This technologies are now being used in numerous new housing repair area was identified by the health department when developments or to replace or repair failing septic systems the site was permitted and should be shown on your septic at homes and businesses. Systems using these new system permit.The law also requires you to protect this technologies require a higher level of maintenance than the area from excavation; building a house addition, garage or more traditional conventional septic systems. outbuilding over it; swimming pool construction; and any soil disturbance activities. • How old is the system? Things You Need to Know About Your Septic System • Where are the tank and drainfield located (they may • What type of septic system do you have? not be at the same location or even on the same • Where is it located? lot)? • Where is the repair area located? • When was the tank last pumped? • Is the septic system working? • How frequently has it been pumped? • Has it been maintained in the past? • How often has the "effluent filter" in the septic tank been cleaned (these effluent filters are required on • What can you do on a day-to-day basis to keep systems installed since 1999). your system working properly? • Have there been signs of possible failure? • What maintenance is needed in the future? • Where is a copy of the permit and records showing how well (or poorly) the system has been Sketch your home, septic system (both the tank and maintained? drainfield), repair area, and other important features (such • Have there been additions made to the house that as your driveway) on the grid labeled Septic System would necessitate increasing the size of the system? Layout.When you have your septic tank pumped, measure and record the distance from the house to the • Has the system ever been repaired, and if so, when, access port on the tank. This will help you find it again. and by whom? You might also wish to mark your tank location and the drainfield boundaries in your yard. If a riser is not If the house has just been built, ask the septic system installed over the access port for your septic tank, you contractor to provide you an "as built" diagram that may want to have one installed. Be sure, though, that may show details not on the permit. If the house has the riser is secured with a lock or a heavy lid to prevent a system with a pump, ask the contractor and health children from opening it and endangering themselves department to provide details concerning the initial pump or others. Even properly operating septic tanks contain setup. poisonous gases and pollutants as well as bacteria and other germs that can cause serious diseases. NO ONE Proper care of your septic system requires day-to-day SHOULD EVER ENTER A SEPTIC TANK. management as well as periodic maintenance and repairs. Is your septic system working properly? Septic System Layout Unfortunately, if house fixtures drain well,few people investigate whether their septic system works. Many people don't realize that untreated sewage on top of the ground can be a health hazard. If your system shows signs of problems, contact your local health department immediately. State law requires that you get a permit from the health department before repairing a failing septic system. Be wary of any contractor who wants to attempt a repair without a permit. What maintenance has been done? Before planning a maintenance program, find out what maintenance has already been done. If you are buying an existing home, ask the seller a few important questions: Day-to-Day Management • Cut down and remove trees that like wet conditions.This includes willows, elms, Don't use too much water. sweetgums, and some maples. • The drainfield does not have unlimited capacity. • Landscape the yard to divert surface waters away • Typical daily water use is 50 gallons per person. from the tank and drainfield. • The soil drainfield usually has a maximum daily • Be sure that the water from the roof, gutters, and design capacity of 120 gallons per bedroom, even foundation drains does not flow over the system. for short periods of time. • If your system is at the base of a slope,then • Overloads can occur seasonally, daily, or on the consider installing a french drain to divert weekend. underground waters. • Repair dripping faucets and toilets. • Maintain drainage ditches, subsurface tiles, and • Water conservation will extend the life of your drainage outlets so that water can flow freely from system. them. Limit disposal to sewage. Septic tank: • Don't use your septic tank as a trash can for • Install risers over the tank if it is buried 6 inches or cigarette butts,tissues, sanitary napkins, cotton deeper. They provide easy access for measuring swabs, cat box litter, coffee grounds, or disposable and pumping solids as well as cleaning the effluent diapers. filter. • Restrict the use of your garbage disposal. These • Measure how quickly sludge and scum accumulate add quite a lot of extra solids. in the tank. Have your professional pumper record this information. • Don't pour grease or cooking oil down the drain. • Have solids pumped out of the tank as needed. • Don't poison your system with harmful chemicals, Most septic tanks have two compartments; get such as solvents, oils, paints, thinners, discarded both pumped. medications, disinfectants, pesticides, poisons, and other substances. • Cooperative Extension Service publication AG- 439-13, Septic Systems and Their Maintenance, • Save money. Commercial septic tank additives are contains more information on pumping frequency. usually not necessary. • Don't wait until your drainfield fails to have Protect the system from physical damage (site your tank pumped. By then, the drainfield may be ruined. With septic systems, an ounce of maintenance). prevention is worth a ton of cure! • Keep the soil over the drainfield covered with vegetation to prevent soil erosion. Regulations and precautions: • Don't drive vehicles over the system. • Hire a state-certified subsurface system • Avoid construction over the system and repair operator for any system with a pump. One will area. be required by law for low pressure pipe (LPP) Maintain the natural shape of the land immediately systems installed or repaired after July 1, 1992, • downslope of the system, and protect this area any subsurface drip irrigation systems, aerobic from excavation (cutting and filling), treatment units (ATUs), peat biofolters, sand biofilters, textile biofilters, and other complex • Don't cover the tank or drainfield with asphalt or systems. concrete. • A list of state-certified subsurface system operators can be obtained from the N.C. Water Dispose of all wastewater in an approved system. Pollution Control System Certification Commission • Don't put in a separate pipe to carry wash waters at(919) 707-9089. to a side ditch or the woods. This is illegal. • Be sure the pump and electrical components continue working properly between scheduled Periodic Maintenance and Repair maintenance visits. Home and yard (site maintenance): • Sewage contains germs that can cause diseases. • Protect and maintain the site of your septic tank Never enter a septic tank.Toxic and explosive and drainfield. gases in the tank present a hazard. Old tanks • Preventative Maintenance Record ▪ may collapse. Electrical controls Date I Work Done run Cost present a shock and spark hazard. Secure the septic tank lid so that children cannot open it. ■ Don't attempt to repair a failing system yourself. Get a repair permit and hire an experienced contractor. For more information about septic systems, contact your county Extension agent or local health Your Septic System Pumper department. Name Address Acknowledgements Phone This publication is a revision of an earlier version. Your Septic System Installer Nance Appreciation is extended to Tom Konsler Address (Orange County Health Department), Deanna Osmond, Mitch Woodward, Phone and Grace Lawrence(North Carolina Date System Installed Cooperative Extension)for peer review of the document and to Debra Ireland for graphic design, layout, and editing. Signs of Possible Septic System Problems • Sewage backing up into your toilets, tubs, or sinks. Authors: Michael T. Hoover • Slowly draining fixtures, particularly after it has rained. Extension Soil Science Specialist • The smell of raw sewage accompanied by soggy soil or sewage Department of Soil Science discharged over the ground or in nearby ditches or woods. North Carolina State University • Note: pump systems sewage may come to the ground surface when Edited by the pump is turned on and then disappear after the pump turns off. Jonathan Godfrey This is still a system failure and must be repaired. Director Onsite Wastewater Training Program • An alarm flashing (red light) or beeping in the house or in the yard Department of Soil Science indicating a pump is not working properly or that the water level in a North Carolina State University pump tank is too high and close to failure. Published by: • An increase in infections or illnesses associated with swimming in North Carolina Cooperative Extension lakes or rivers next to the system. Service NC STATE UNIVERSITY College of Agriculture and Life Sciences 5,000 copies of this publication were printed at a cost of$2,265 or$0.45 per copy. Distributed in furtherance of the acts of Congress of May 8 and June 30,1914.North Carolina State University and North Carolina A&T State University commit themselves to positive action to secure equal opportunity regardless of race,color,creed,national origin,religion,sex,age,veteran status,or disability.In addition,the two Universities welcome all persons without regard to sexual orientation.North Carolina State University,North Carolina A&T State University,U.S.Department of Agriculture,and local governments cooperating. 5/2016-5M—DI (Revised) AG-439-22 content.ces.ncsu.edu/septic-system-owners-guide ©2016 North Carolina State University