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HomeMy WebLinkAboutEOP-04-2022-169958.tif 22 B act S -N�c �r � � -� ��2z-�taG 3'f 56 e .y ..STnyr •,Q oP— a'1_ 2022 - 16�� j:. DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH ROY COOPER MANDY COHEN,MD, MPH GOVERNOR SECRETARY DANIEL STALEY DIRECTOR COMMON FORM FOR ENGINEERED OPTION PERMIT See Instructions for Use in Appendix A Except for"Date received",this Section to be completed by the Professional Engineer licensed in accordance with G.S.89C�l LHD USE ONLY: Initial submittal of this NOI received: —'I` Z' by I~ Dote Initials PART 1:Notice of Intent to Construct(NOI) ® New ❑ Expansion ❑ Repair—LHD Permit Number ❑ Repair—EOP Permit Number 1, Facility Owner's name:(Owner, Company Name, Utility, Partnership, Individual,etc.): Ashley Beach Mailing address: 5610 Beach Street _ City: Hickory State: NC Zip: 28602 Telephone number: 828-329-0658(Mike Taylor) E-mail Address: mikephncggmail.com (Mike Taylor) 2. Professional Engineer(PE)name: Robert Paul Patterson License number: NC 023131 Mailing address: P.O.Box 6114 City: Hendersonville State: NC Zip: 28793 Telephone number: 828-692-6629 or 828-699-3362 E-mail Address: pattpatt555@bellsouth.net 3. Licensed Soil Scientist(LSS)name: Steve Melin License number: 1254 Mailing address: 15 Lone Coyote Ridge City: Fletcher State: NC Zip: 28732 Telephone number: 828-551-9903 E-mail Address: sjmelin@gmail.com 4. Licensed Geologist(LG)(if applicable) name: N/A License Number: Mailing address: City: State: Zip: Telephone number: E-mail Address: S. On-site Wastewater Contractor name: Zachary Anthony License number: 7275 Mailing address: 3943 Zero Mull Road City: Morganton State: NC Zip: 28655-8304 Telephone number: (828)439-3252 E-mail Address: 6. Proof of Errors and Omissions or other appropriate liability insurance for the following persons is attached that includes the name of the insurer,name of the insured and the effective dates of coverage: ® PE ® LSS ❑ LG ®On-site Wastewater Contractor WWW.NCDIIILS.GOV TEL.919-707-5874•Fax 919-845-3972 LOCATION:5605 SIX FORKS RD•RALEIGH,NC 27609 MAILING ADDRESS: 1642 MAIL SERVICE CENTER•RALEIGH,NC 27699-1642 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER State of NC EOP LHD Reference: f-Ut_ ° Z2 7. Property location (physical address,tax parcel identification number or subdivision lot,block number of the property to be permitted): 5622 Beach St.,Hickory,NC 28602(Pin#2791-1046-2250)P.B. 83 @ Page 99 County Name: Catawba 8. Type of facility: ® Place of residence No. Bedrooms: 3 No.Occupants: 6 Max. ❑ Place of business Basis for flow calculation: ❑Place of public assembly Basis for flow calculation: 9. Factors that would affect the wastewater load: N/A 10. Type, location, and classification(per Rule.1961)of wastewater system: 300 Feet of Low-profile Gravity System @Depth = 14"(low side);LTAR=0.40 {Please See Attached Soils Report} 11. Design wastewater flow: 360 gpd (For flow>3,000 gpd and Industrial process,duplicate plans shall be sent to the State.) Design wastewater strength: ►1 domestic ❑high strength ❑industrial process 12. A plat as defined in G.5. 130A 334(7a)is attached: ®Yes ❑ No 13. Owner meets requirements of ownership or control of the system per 15A NCAC 18A.1938(j): ®Yes ❑No 14. Easement,right of way or encroachment agreement required per 15A NCAC 18A.1938(j): ❑Yes ®No If yes, documentation filed in County Register of Deeds in Deed book Page 15. Multi-party agreements required, as applicable,pursuant to 15A NCAC 18A.1937(h): ❑Yes ®No If yes,agreements filed in County Register of Deeds in Deed book Page 16. Location of proposed or existing wells(drinking water,irrigation,geothermal,groundwater monitoring, sampling,etc.)and any potable and non-potable water conveyance lines is indicated on attached plans and complies with 15A NCAC 18A.1950: /�1 Yes ❑ No (Proposed Individual Well) This is a saprolite system. ❑Yes ►n No 17. Evaluation(s)of soil conditions and site features in accordance with G.S. 130A-335(al)signed and sealed by a LSS is attached: ®Yes ❑No 18. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG is attached ❑Yes ®NA 19. Proposed landscape, site,drainage,or soil modifications are attached: ❑Yes ® NA Attestation by Professional Engineer licensed in North Carolina pursuant to G.S. 89C I, Robert Paul Patterson hereby attest that the information required to be included with Registered Professional Engineer(Print Name) this Notice of Intent to Construct is accurate and complete to the best of my knowledge and that the proposed system shall meet applicable federal,State, and local laws,regulations, rules and ordinances in accordance with G.S. 130A- - 1(e)(6). r,�ct.�N�ZH CAR,"u6ul1,q " 6:1440e IC; (04 March 30,2021 ram. QP ta O~4 ar• Signature of Licensed Professional Engineer Date 14 SEAN' % or2t31 o i1{ ),4.4GINE: .41' ,q;/ MI Page 2 of 6 DHHS/EHS/O5WP8—COMMON FORM Effective June 1,2018 State of NC EOP LHD Reference: f� `� — U a 21J —1 ti J+ Sg This section is for Owner use to either designate PE as their legal representative or to self-submit the N01. Designation of Registered Professional Engineer as legal representative of Owner for this Notice of Intent: I, Ashley Beach hereby designate Robert Paul Patterson,PE Print Nome of Owner Print Name of Registered Professional Engineer as my le I representativ for purposes of this Notice of Intent pursuant to .S. 130A•336.1. � 3D n tort of Owner D to Owner self-submittal of NO!: , hereby submit this NOI prepared by Print Nornc of Owner Print Name of Licensed PE pursuant to G.S. 130A-336.1. Signature of Owner Date NOTES: LIABILITY: The Department, the Department's authorized agents or local health departments shall have no liability for wastewater systems designed,constructed and installed pursuant to an Engineered Option Permit.[(NC General Statute 130A-336.1(f)J RIGHT OF ENTRY: The submittal of this Notice of Intent to Construct grants right of entry to the Local Health Department and the State to the referenced property. ISSUANCE OF BUILDING PERMIT: Once the LHD deems that the Notice of Intent to Construct is complete via signature in the section above,the owner may apply to the local permitting agency for a permit for electrical, plumbing, heating,air conditioning or other construction, location or relocation activity under any provision of general or special law pursuant to G.S. 130A-338. Page 3 of 6 DH115/EH5/05 WP8—COMMON FORM Effective June 1,2018 kap_ cy-2022-j6is g State of NC'EOP LHD Reference: This section for Local Health Department use only. PART 2: LHD Completeness Review of the Notice of Intent to Construct "(c)Completeness Review for Notice of Intent to Construct.—The local health department shall determine whether a notice of intent to construct,as required pursuant subsection(b)of this section,is complete within 15 business days after the local health department receives the notice of intent to construct. A determination of completeness means that the notice of intent to construct includes all of the required components. if the local health department determines that the notice of intent to construct is incomplete,the department shall notify the owner or the professional engineer of the components needed to complete the notice. The owner or professional engineer may submit additional information to the department to cure the deficiencies in the notice. The local health department shall make a final determination as to whether the notice of intent to construct is complete within 10 business days after the department receives the additional information from the owner or professional engineer. If the department fails to act within any time period set out in this subsection,the owner or professional engineer may treat the failure to act as a determination of completeness." The review for completeness of this Notice of Intent was conducted in accordance with G.S. 130A-336.1(c). This NOI is determined to be: ❑ INCOMPLETE(If box is checked, Information in this section is required.) Based upon review of information submitted by the PE in Part 1,the following items are missing: Copies of this form listing missing items were sent to the design PE and the Owner on Date via with directions to re-submit missing items using Page 5 of this form. Email,FAX,USPS,hand-delivered Print Nome of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date U COMPLETE(If box is checked,information in this section is required.) Based upon review of information submitted by the PE in Part 1 of this form,this NOI is deemed COMPLETE. Copies of this signed form were sent to the design PE and the Owner on -2 I_Z via FA R/ Date Email,FAX,USPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via Date Email,FAX,USPS,hand-delivered c `,Le(0 r Apal Print Name of Authorized Agent if the LHD Signature of Authorized Agent of the LHD Date Page 4 of 6 DH1-15/EHS/OSWPB—COMMON FORM Effective June 1,2018 State of NC SOP LHD Reference: Re-submittal of NOI with missing items included This Section is for use by PE to submit items noted as missing during LHD Completeness Review above. Resubmittals must be accompanied by a cover letter from the PE. LHD USE ONLY: This NOI resubmittal received: by Dote initials Item#from initial NOI Resubmittal description Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C I, hereby attest that the information re-submitted for this Notice of Licensed Professional Engineer(Print Name) Intent to Construct is accurate and complete to the best of my knowledge and that the proposed system shall meet applicable federal, State, and local laws, regulations, rules and ordinances in accordance with G.S. 130A-336- .1(e)(6). Signature of Licensed Professional Engineer Dote The section below Is for Local Health Deportment use after submittal of items noted as missing above. LHD Follow-up Completeness Review of Notice of intent to Construct This follow-up review for completeness of this Notice and Intent was conducted in accordance with G.S. 130A- 336,1(c). This NOI is determined to be: ❑ INCOMPLETE Based upon review of information submitted by the PE in the RESUBMITTAL above,this Notice of Intent remains INCOMPETE because the following items from Part 1 of this form remain missing: • Copies of this signed form were sent to the design PE and the Owner on via Date Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ❑ COMPLETE Based upon review of information submitted by the PE in the RESUBMITTAL above in addition to information provided in Part 1 of this form,this NOI is deemed complete. Copies of this signed form were sent to the PE and the Owner on via Date Email,FAX,LISPS,Hand-delivered A complete copy of this form with tracking information was sent to the State: via Dote Email,FAX,USPS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date Page 5 of 6 DHHS/ENS/OSWPB—COMMON FORM Effective June 1,2018 State of NC EOP LHD Reference: EOP-04-2022-169958 PART 3: Authorization to Operate(ATO) Except for date received,the Section below is to be completed by the Owner or by the PE designated to act as their legal representative for the EOP. LHD USE ONLY: Initial submittal of request for ATO received: q-I-2'— by ge Date Initials Date of Post-construction Conference: Wa I Ys4 The following items are included in this submittal for an Authorization to Operate under an EOP: 1. Signed and sealed copy of the Engineer's report that includes: a. Signed and sealed evaluation of soil conditions and site features (Previously Submitted) ®Yes ❑No b. Drawings,specifications,plans (Previously Submitted) ®Yes [IINo c. Reports on special inspections and final inspection ®Yes ❑ No d. Management Program manual XIYes ❑ No e. On-site Wastewater Contractor's signed statement Z Yes E No f. Signed and sealed statement pursuant to 15A NCAC 18A.1938(h) ®Yes ❑ No 2. Fee (as applicable) ®Yes ❑ No 3. Notarized letter documenting Owner's acceptance of the system from the PE ®Yes ❑ No Attestation by the Owner or the PE for Authorization to Operate I, Robert Paul Patterson hereby attest that all items indicated above have been provided to the Print name of Owner or Professional Engineer Catawba County LHD and the system shall meet applicable federal,State,and local laws,`O:tt t t t 1 t Illy'' regulations,rules and ordinances in accordance with G.S. 130A-336-.1(e)(6). �� 'C�CARD, �,A. � .•FESSIO'• ClOW".rGla 4GZ41 August 30,2022 ti . Ni`•9 Signature of Owner or Professional Engineer Date = 7v • • Ste' • x— = 0 ; 023L31 • O= This section for LHD Use Only. i Cr •••t� 4 . $ � � •hOINE;• 4V . LHD Review of required information for the ATO �i T •••••• '. .� ❑ INCOMPLETE ,��ii pf i It l`‘ SN��` Based upon review of information submitted by the Owner or PE in the Section above,the following items are missing from the information required for an Authorization to Operate for an EOP: Copies of this signed form were sent to the design PE and the Owner on via . Date Email,FAX,LISPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date dCOMPLETE Based upon review of information submitted by the Owner or PE in the Section above,this Authorization to Operate is hereby issued in accordance with G.S. 130A-336.1(m). A copy of this complete NOI/ATO with tracking information was sent to the State on I2 /LZ. tout;I I . M.',Pitic--- to Email,FAX,LISPS Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ISSUANCE OF CERTIFICATE OF OCCUPANCY. Once the LHD determines completeness based upon the PE 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. 130A-339. Page 6 of 6 DHHS/EHS/OSWPB—COMMON FORM Effective June 1,2018 EOP 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 draft required legislative reports on implementation of the EOP. Tracking information for Engineered Option Permits (Required) County _ LHD Reference Number Ea-o -nu-I vtebq Permitting backlog as of date of NOI submittal(#days) 140 ao.s Number of days to process the NOI(#days) 15 dols Number of days to process re-submitted NOI(#days or "NA") NA Facility type sin Ate flhi ty at/Jair15 Domestic,High Strength or IPWW �r e 4, Design Daily Flow 360 Residential or Commercial Fideh#iii,1 System type(per Rule.1961) Tag 100 p(6.'e 61.c. ,r Date of Post-construction conferences yea Date Authorization to Operate issued Cl II 12y Fee charged for EOP 1 � p J Is fee sufficient to cover LHD costs? les Date LHD notified of EOP malfunction Date LHD notified of Owner complaint DHHS/EHS/OSWP—EOP Appendix A Updated February 2022Page 4 of 4 August 29, 2022 Catawba County Environmental Health Attn.: Mr. Robbie Phelps, EH Supervisor—On-site Wastewater Program 100A Southwest Boulevard Newton, NC 28658 Mr. Phelps, An EOP was obtained from the C to ba County Environmental Health for a proposed 3- bedroom septic system at'5 x B6ach Street, Hickory, NC 28602. The septic system as set forth in the EOP Documents was installed by Zachary Anthony (#7275) and inspected by Paul Patterson, PE, on May 11, 2022. I hereby accept the engineered septic system as installed by Mr. Anthony as being completed in accordance with specifications set forth in the EOP documents. Sincerely, r ley each State of North Carolina County of Pu 4<€- r�AA I, 1.) • a Notary for E, U & County, North Carolina, J do hereby certify that Ashley Beach personally appeared before me this day and acknowledge the due execution of the foregoing instrument. Witnessed my hand and official seal, this the l 5! day of SC pheym r , 2022. 00111111/g,``z viz- A 1. 60roi Li) . )17k.:(),--ft,t,t.ii- .... ... ,TA,c4. . My Commission Expires: •�-rl ;Z&- ��� '� t18L\O �� ; n # X043?)(02.� PATTERSON & PATTERSON PAUL PATTERSON WILLIAM PATTERSON Professional Engineer/Land Surveyor Professional Land Surveyor,Ret. P.O.BOX 6114,HENDERSONVILLE,NC 28793-6114 TEL.& FAX:(828)692-6629 CELL: (828)699-3362 pattpatt555@bellsouth.net www.pattpatt-esp.com NC Firm: F-0734 Memorandum To: Robbie Phelps, REHS @ Catawba County Environmental Health Date: August 29, 2022 From: Paul Patterson, PE Re: 5622 Beach Street, Hickory, NC 28602 (Beach) Mr. Phelps, The onsite sewage disposal system for the EOP at 5622 Beach Street has been installed and inspected on May 11, 2022. The system was walked through with the contractor, his crew and myself on the date noted above. The field lines and septic tank were installed and approved with notice to cover system. All components of the system were installed in basic compliance with the drawings prepared by Steve Melin, LSS. An as-built drawing has been attached herewith for your files. As part of a maintenance plan, it is recommended that the home owner have the septic tank pumped every three to five years, or as needed. Lastly, a visual inspection of the septic system should be made monthly or bi-monthly. No vehicular traffic shall be made over the newly installed septic system. With the items noted above, it is my professional opinion that the onsite sewage disposal system has been completed in substantial compliance with the EOP documents and plans, as well as G.S 130A-336-.1(e)(6). As such, the system should be approved for use by your office with an Authorization to Operate being provided in accordance with G.S. 130A-336.1(m). Should you have any questions and/or comments, please feel free to call. Thanks in advance for your assistance in completing this matter. `,�� \'‘`.,0 C AR 01//,� Sincerely, �.1. �0•p• ssto,t�..I ••q SEAL 1 . C;20,(1. = 7c1 •o� ; 023ul : °_ Paul Patterson, PE/PLS �`e,p�;Note `� cc: File for 22-03-39-ENG (5622 Beach Street - Beach) }1/ ,Pq'U '``` ENGINEERING-SURVEYING-PLANNING Alternative Septic Services, LLC 15 Lone Coyote Ridge; Fletcher, NC 28732 FinaiI: sjmelin@gmail.com Cell: (828)551-9903 August 29, 2022 Mr. Robbie Phelps, REHS Environmental Health Supervisor On-site Wastewater Program Catawba County 100A Southwest Boulevard Newton, NC 28658 Re: 5622 Beach Street —(Soil Scientist) Septic Installation Verification; Engineered Option Permit(PIN# 2791-1046-2250) Dear Mr. Phelps, This letter is intended to satisfy the requirement that the system at 5622 Beach Street was designed and installed according to recommendations in the Soils Report. I hereby certify that the system was installed consistent with the Soils Report. This included installing a 1,000 gallon septic tank that feeds 300 linear feet of Low-profile Infiltrator material for the 3-bedroom residence. Please note that the 0.40 LTAR and 14" trench depth (low side of trench) were utilized as specified in the Soils Report. [ greatly appreciate your time. Please feel free to contact me if additional information is required. Kind Regards, ,711A-7 01126Y 6- Steven J. Melin, LSS Project Manager—Environmental Services 'I>lr1,CV °1 Alternative Septic Services, LLC Cc: Paul Patterson, P.E. • AR D CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDO/YYYY) 07/20/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT Holly Parrish NAME: Correll Insurance Group-Rock Hill PHONE (803)324-2984 FAX (A/C,No,Ertl: IA1C,No): 319 Oakland Ave E-MAIL h arrish correllinsurance.com ADDRESS: p INSURER(SI AFFORDING COVERAGE NAIC s Rock Hill SC 29730 INSURER A: Pennsylvania National Mutual Casualty Ins Co 14990 INSURED INSURER B: Accident Fund Alternative Septic Services LLC INSURER C: National Fire&Marine Insurance Company 168 Highway 274 Suite 155 INSURER D: INSURER E: Clover SC 29710 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 Master(4) REVISION NUMBER: THIS IS TO CERTIFY THAT THE POI ICIES OE INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI-IE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER (MM!DDTYYYY) (MMIDD/YYYY) LIMITS X'COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED CLAIMS-MADE I OCCUR PREM SESO(Ea occu encel $ 100,000 r MED EXP(Any one person' $ 5,000 A GL9 0727799 03/09/2022 03/09/2023 PERSONAL dADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2.000,000 X POLICY 0JEC7 ri LOC PRODUCTS•COMP/OP AGG $ 2.000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED AU90757292 07/24/2022 07/24/2023 BODILY INJURY(Per accident) $ AUTOS ONLY ALTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) X 19 Underinsured motorist $ 1,000,000 UMBRELLA LIAB HOCC ""'a'V"'"'• 1000,000 X OCCUR EACH OCCURRENCE $ , A EXCESS LIAB CLAIMS-MADE UL9 0727799 03/09/2022 03/09/2023 AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION VI PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA AFWCP10001972601 04/04/2022 04/04/2023 E.L.EACH ACCIDENT $ 1,000,000 OFFICERMIEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below F,I DISFASF-POI.ICY LIMIT $ Each Occurrence $1,000,000 Professional Liability C F85108221AEM 07/09/2022 07/09/2023 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space Is required) Brett Schaefer-Professional Engineer;Steven Melin-Licecnsed Soil Scientist;Brian Grissom-On-Site Waterwater Contractor;Matthew Velkovich- Professional Engineer CERTIFICATE HOLDER CANCELLATION Paul Patterson,PG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN P.O.Box 6114 ACCORDANCE WITH THE POLICY PROVISIONS. Hendersonville,NC 28793 AUTHORIZED REPRESENTATIVE pattpatt555(4 hclIsouth.net 6ott.r;1� 4 1 c©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ATO Z Operations, LLC 3943 Zero Mull Road Morganton, NC 28655-8304 (828) 439-3252 May 11, 2022 Catawba County Environmental Health 100A Southwest Boulevard Newton, NC 28658 To whom it may concern: The septic system has been installed for Ashley Beach at 5622 Beach Street, Hickory, NC 28602. All work is in compliance with plans and details as provided by Steve Melin, Soil Scientist, and Paul Patterson, Professional Engineer. All installations were inspected by Paul Patterson, PE, on May 11 , 2022, with the system being ready to use. Sincerely, Vic(( AI (t/G4/7 Zachary Anthony Certified Septic Installer (#7275) NCS213uvd 1 l ai( ILl Yd -WOE J ?I AcC3 O I- tVnn' v E m y DL 9 L �.r`. cV CV tV OL n �} V Qa:401..„111111!!!g~ Mn0 aN1]g8 W 0 � �!m- lq M;111 I _ Der �. 0 CO m/yJ�V N,pc �Qj - t O,a V U .''iolk °R O W.,,,� Q p z 1J� fO `-� ; — �f ti. 111/11111ti " Ra I .ynp a v_ OII o 4 � C�� LL p'J �1 V '^ � tO iZ3p `^ NJ JO - �dqh luau » Q_H-- r Q r Mi . ;p War 1 F-': if. ! • 6 J- LL i 31 6 0 S I-- g big _ • 9 dJ ,9 n1 N t\I0 u6 tas -3t12 0 2 $ o w 4* a E 6 -IL::.g 1 --\' 1 Leg L. 50)1 Zj °I c K 5 P �R ai fc`Ap r�N@ 4e-e 112q) U (pg. 2314 1 URaa co> z ybn I Nl— ZIO LL li PATTERSON & PATTERSON PAUL PATTERSON WILLIAM PATTERSON Professional Engineer/Land Surveyor Professional Land Surveyor,Ret. P.O.BOX 6114,HENDERSONVILLE,NC 28793-6114 TEL. &FAX:(828)692-6629 CELL:(828)699-3362 pattpatt555@bellsouth.net www.pattpatt-esp.com NC Finn:F-0734 Memorandum To: Robbie Phelps, REHS Cal CCDPH Environmental Division Date: August 29, 2022 From: Paul Patterson, PE Re: 5622 Beach Street(Ashley Beach) Mr. Phelps, In accordance with Session Law 2021-117, House Bill 366, I hereby request that the Post-Construction Conference for the above noted site be waived as previously required under G.S 130A-336-.1(j). Further,the owner has also signed and dated this letter to attest to their approval of this waiver. All other requirements as set forth in G.S 130A-336-.1(e)(6) shall be met prior to obtaining the Authorization to Operate (ATO). Should you have any questions and/or comments, please feel free to call. Thanks in advance for your assistance in completing this matter. Sincerely, S. CAR 0,QA,t, (Pcal -�. - • SEAL . 7.a ; 023131 °= Paul Patterson, PE/PLS .t ,•,/„fA U L l gC, Owner's Authorization to waive Post-Construction Conference: Print Owner's Name(s): Ashley Beach ey B ENGINEERING-SURVEYING-PLANNING Understandingand Protecti Y n our Se tic S stem g p Y If you currently discharge wastewater to a septic system, if you are looking to How They Work: purchase a place of residence,public assembly,or business,or to move to a place SEPTIC TANKS & Sewer Gas Vent that is served by a septic system,this guidance document should be helpful. LEACH FIELDS : Contact your local health department for additional assistance and information. ` • Know Your Septic System L Not all septic systems are the same.It is important to know about your - septic system,such as the components that make up the system and their location on the property,the system functioning and maintenance history, After the . ,i-sh • as well as what to do and what not to do.Traditional conventional septic systems have a septic tank and a drainfield with gravel-filled trenches or a gravel bed.Newer septic systems may have polypropylene or polyethylene "chambers"or polystyrene aggregate in place of the gravel. Some systems use advanced technologies that require a higher level of maintenance than traditional conventional septic systems,and state rules have specific maintenance requirements for these systems. Sometimes owners will be required by state rules to hire a state-certified operator to regularly inspect and maintain the system. In addition, state rules require the local health department to inspect these systems on a periodic basis. Some properties are legally required to have a "repair area or replacement area"in which a second drainfield could be installed if needed.This repair area should have been identified typically by the health department when the site was permitted and should be shown on your septic system permit ("Improvement Permit").State rules also require you to protect this area from any soil disturbance activities such as excavation; building a house addition,garage, or other structure; swimming pool construction and installation; and grading. If you are not sure what type of wastewater system you have, contact the local health department to request a copy of the septic system permit and soil evaluation sheet for your property. These forms should indicate the approved design daily flow, type of system, size of each of the system components (septic tank,any other tanks or pretreatment units, the drainfield,and the repair area), and approximate locations of those components.Also, ask the previous owner or the seller for information about the system (e.g., installations, repairs, maintenance). Ask Questions "Keep this information "Let your for future reference Health Ensure you have answers to the following questions: to help you Department • What type of septic system do you have? • How old is the system (i.e.,when were the system properly maintain know the components installed)? your septic system" problem" • Where are all the system components located, including the drainfield and repair area?(Note:They may not be at the same location or even on the same lot.) Signs of Possible Septic System Failure • How many gallons a day(e.g., number of bedrooms, occupants,seats in the restaurant) is the septic • Sewage backing up into your toilets, tubs,or sinks. system designed to treat and dispose of? • Sewage backing up in the septic and/or pump tank • What is the volumetric (liquid) capacity of each tank • Slowly draining plumbing fixtures, particularly during in the septic system? and after it has rained. • Which drainfield option or product was used for • The smell of raw sewage accompanied by soggy soil your system? or sewage discharged over the ground or in nearby • Is the septic system working properly? ditches or woods. • Does the system require a certified operator? • Sewage comes to the ground surface when the pump • What are the legal requirements for turns on and then disappears after the pump turns off. long-term maintenance? • An alarm flashing (red light) and/or blaring horn • Has the septic system been maintained in the past? coming from the pump control panel. Understanding and Protecting Your Septic System DOsandDON'Ts DO DON'T • Do learn the location of the septic tank, drainfield and • Don't ignore problems with your septic system hoping repair area. Keep a sketch of the system location and they will just go away. layout with your maintenance record for service visits. • Don't enter the septic tank. • Do keep your septic tank cover accessible for • Don't wait until the tank overflows, the drainfield fails, inspections and pumping. or the system backs up to have the tank pumped. • Do keep suitable vegetation growing over the drainfield • Don't expand the size of the place of residence,business,or and repair area to stabilize the soil and prevent erosion. public assembly without obtaining prior written approval to • Do have a maintenance plan for your system. adjust the size of the septic system accordingly. • Do have your septic system inspected in accordance • Don't make or allow repairs to your septic system with state regulations. without obtaining required permits from the local • Do make sure you have an effluent filter installed on your health department. septic tank to prevent solids from reaching the drainfield • Don't direct downspouts,water softeners, sump and to increase the life of your system. pumps, water features, swimming pool, hot tubs, HVAC • Do have solids pumped out of the septic tank by a condensate drains or similar discharges into the septic State-permitted pumper every 3 to 5 years (typical system or toward the drainfield. primary residence)or as required per the permit. Do • Don't install sprinkler systems or wells in the septic make sure both compartments of the septic tank are system and repair areas. pumped out. If the septic system includes a pump tank • Don't perform construction of any type over the septic have it pumped out too. system and repair areas (e.g., decks, patios, sheds). • Do periodically check to ensure the septic system, • Don't cover the septic tank, d-box.or drainfield with pumps and electrical components,continue working structures(e.g., planters,firepits, grills) or hardened properly between scheduled maintenance visits. surfaces (e.g.,asphalt, concrete, stone, brick). • Do call the local health department or an onsite • Don't drive or park vehicles over the septic system. wastewater contractor certified by the North Carolina Onsite Wastewater Contractor Inspector Certification • Don't put cigarette butts,paper towels,disposable wipes, Board(NCOWCICB)whenever you experience problems sanitary napkins/tampons,condoms,cotton swabs,kitty with your system,or if there are any signs of system failure. litter, coffee grounds,disposable diapers,plastics or other • Do keep a detailed record of installations, repairs, and non-biodegradables into the septic system. tank pump outs. • Don't pour grease or cooking oil down the drain or foul up the septic system with harmful chemicals(e.g., • Do hire a state-certified subsurface system operator solvents, paint, medications,disinfectants, pesticides) when required by the septic system permit. and other hazardous substances. • Don't install garbage grinders at sinks. State-Certified Septic System Installers and Inspectors Contact the North Carolina Onsite Wastewater Contractor Inspector Certification Board (NCOWCICB) Phone: (336)202-3126 • Website: https://ncowcicb.info State-Certified Subsurface System Operators Contact the North Carolina Water Pollution Control System Certification Commission(WPCSOCC) Phone: (919)707-9089 • Website: https://deq.nc.gov/about/divisions/water-resources/operator-certification NC Department of Health and Human Services • Division of Public Health • On-Site Water Protection • httP5.://ighs.nCPLItlichealth.com/oswp • NCDHHS is an equal opportunity employer and provider. • 9/2020