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HomeMy WebLinkAboutEHPR-05-2022-41196.tif $ • THIS IS NOT A PERMIT Case# EHPR-05-2022-4 1 1 96 CATAWBA COUNTY HEALTH DEPARTMENT �v (*) PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \8 4 S'" Envir onmental Health Plan Review- Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant JOHN DAVID DELLINGER,4804 BUFFALO SHOALS RD,MAIDEN NC 28650 NAME TO APPEAR ON PERMIT John David Dellinger SITE ADDRESS: 4804 BUFFALO SHOALS RD,MAIDEN NC 28650 PIN# 365604743823 NAME of SUBDIVISION: Lot# _ Section/Block PROPERTY SIZE: Square Feet 82,328.40 Acres 1.89 DIRECTIONS: S NC 16 Hwy,right Buffalo Shoals Rd,cross E Maiden Rd,on left approx 1/4 mile PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: drainfield surfacing, tank has well lid which is broken over access hole was noted during septic inspection 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF residence EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 29 x 56 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: eharph,a0,1 05/27/2022 I5:43 Page 1 of 6 I. CATAWBA COUNTY Case# EHPR-05-2022-4 1 1 96 .t. Public Health Department Subdivision Qint 'd Environmental Health Division P]N# 365604743823 / PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /w NAME ON PERMIT: (JOHN DAVID DELLINGER),4804 BUFFALO SHOALS RI),MAIDEN NC 28650 (John David Dellinger) Site Address: 4804 BUFFALO SHOALS RD,MAIDEN NC 28650 Property Size: Square Feet 82,328.40 Acres 1.89 Directions: S NC 16 Hwy,right Buffalo Shoals Rd,cross E Maiden Rd,on left approx 1/4 mile Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or legal agent of the owner. Date: Signature of Applicant or Agent If you need further information or assistance please call 828-465-8270 AREA1 4t.4#ti#tti*t#k.t*s*i**#+#*+ik....##i##i******i*****..... ..........***** **...►*ti*#*..... 4......... FEENAME DATE FEE AMOUNT Authorization to Construct(Repair) Fee 05/27/2022 $300.00 TOTAL FEES S300.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) el,applinirn a 05/27/2022 I 5:43 Page 2 of 6 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction ❑Existing Facility ❑ Improvement Permit ❑ Authorization to Construct ❑New Septic Septic Repair/Malfunction El Septic Relocation ❑ Septic Expansion ❑ Existing System Inspection or Reconnection _❑New Well �p ❑ Replacement Well ❑ Well. bandonrnen ❑ Well Repair Proper Address —i+a � kc *I aI5 vtn Mck ( J€Y C Z?p5O Acres Subdivision NU Lot# Driving Directions to Property Describe work Applicant Name SG},„,l1 o3 _Del(,s,nvf Applicant Address t./ [=lii,50.4o S hc&A s ckO O NL. J Sc,iO phone $,)$ -3 i0•)(Act Tit ail � Nb`: � n Owner Name • 1 ��>7 • i)t° t 1 4(15e ~ Owner Address G- red Phone 3,),B - 310 -)02t Email de Contractor Name Contractor Address Phone Email ------___� Name to Appear on Permit? Er-Owner ❑ Applicant El Contiactor Who will be the Primary Contact? ✓L'Owner ❑ Applicant El Contractor Proposed New Construction - Residential Primary Residence ❑ NO1 Residence ❑ Addition to Residence #of New Bedrooms*t #of Occupants Project Description Structure Dimensions. also specify dimensions of decks& porches Basement ❑ Yes ❑ No Basement Plumbing ❑ Yes El No Accessory Dwelling #of New Bedrooms *t #of Occupants -- Structure Dimensions Basement ❑ Yes ❑ No Basement Plumbing (=I Yes El Nu Accessory StructUre(s) Describe Structure(s)Dimensions Plumbing ❑ Yes ❑ No Describe Plumbing Needed Multi-Family Residence x of Apartments #Bedrooms per Apartment*t Total# Bedrooms in Structure*t #of Occupants Structure Dimensions Basement ❑ Yes ❑ No Basement Plumbing El Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type El Individual Well El Semi-Public Well ❑Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unkno«n Well Repair Requested 0 Yes ❑ No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑ Yes ❑ No catawbacountync.gov Environmental Health (utuwcu I`ounty buweionicrit (enter 25 Government Drive I PO Box 389 Newton NC 28658 1828.465.8210 MAKING, li ING. BETTER. • Existing Structures on Site Describe l�Cjr00t^1 ha.. aft) taln5 Structure Dimensions #of Bedrooms* 3 #of Occupants Basement 0 Yes a< Basement Plumbing 0 Yes (De Existing Water Supply _ _ __ Individual Well ❑Shared Well—Number of Connections ❑Community Well 0 County/City/Township Water Line Is a public water supply available? ** 0 Yes 5 o Commercial 0 Proposed New Construction ❑ Existing/Change of Use 0 Repair Food Service Specify Type _ #Seats Dining Area(Sq. Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑ Yes 0 No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes ❑ No Residential Kitchen ❑ Yes ❑ No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts Other Information Calculated Design Flow,Commercial t (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. if to answer to any question is"yes",applicant must attach supporting documentation. ❑Yes Does the site contain any jurisdictional wetlands? ❑Yespp�o Does the site contain any existing wastewater systems? ❑Yes Q Rio Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes � Io Is the site subject to approval by any other public agency? IN❑Yes o Arc there any easements or right of ways on this property? Describe If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. ** If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTY AND/OILSYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soil/site evaluations require digging,augering,and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to: underground power,cable,telephone,gas, water lines,and irrigation systems./sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. Completed applications are valid for a period of 2 years. Improvement Permits are valid:with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct,issued for septic repair is valid for 60 months(5 years). Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or legal agent of the owner. Signature of Owner or Legal Agent 4 Ali �— Date 5 f q -aag Printed Name of Owner or Legal Agent Y\(A e - V e - - T e T - - - ' 1 11 it PI e 6i ` _ii— 41 eilli 51 1.1 1 2 ' • 04. ... ,71 ?.- n 1 S3 li 1 1 11 il Lii 1 i 1 i 8 K A ll 1; II il 11 I 1 1 11 Igi2N L g 11 1 ' 4 - III ' 1 PP �7 ~Mi gi !b c c ���� ass '1.fr S - r,0 , ti N i b o F h H'3aOd a , 3Sr;OH 1 I Z -` , 173M �47 a �� C.) In A 4 r CV• `� k, C w M/b •_`. 0) s o -....L, •�:b3�c4b.y �3,Ab � !, tL 8 -_``i 3 ro,l� / 'c/Q O M�`• • `K/N �� of N b _. iii il QW S7V N 8n os�0?bd a f ' `M/b N IIl2 g1 iiiii . 1. fli 61 9 I 1 k li3,,saiw 111. �111:111, �I � 1 III1. IH iItili 4 1_ ,.:1 1 . L , A . I , = ..). . I� O Chi a v� c) co . fe, (IIII) IQ go) --.0 i � a � g o ca 1— � wz o J 0) m II U ON u`ai 44 ,,...,04 x. 8.6) c 1 (2 v-\ PM W It C CV • z t�t Cr 7 0 `J EE %. ( I 4 c\)\ c_, W,=. —6 y I— 0 c0... '''--a N fiti (-7) c ,...... Si To ca, ) IF H N El.'m a o )zQ in On-site Wastewater Pre-inspection Contract Client Name: � i� ll --- 0 L.\ I! nC e-r Client Address: Client Phone: (� n Property Address: 4 0 0 Li (? u. f CJ0 Skcds �! 'L t 'CSC` Q V I V C. �f GJ 0 Client is: ❑ Owner of Record ❑ Realtor ❑ Lender�uyer❑ Seller ❑Other(Describe) Certified Inspector Name: Joseph Allen Snyder__ Company Name: _A&R Septic Service LLC Company Address:_2529 Shelton Ave_ Hudson NC 28638 Inspector Certification Number: _5825I _ Inspector Phone: _828-499-0921__ _ Certification Expires: December 31,20 c� The on-site wastewater system inspection,hereinafter referred to as Inspection,shall be performed in accordance with 21 NCAC 39.1004,21 NCAC 39.1005 and 21 NCAC 39.1006. General Statutes,Rules and Minimum Inspection Requirements,can be viewed at w•ww.ncowcicb.info Services provided shall include: [Nnspection meeting minimum requirements ❑ Pumping of Tank ❑Other(Describe) Cost of Services to be provided: $ -3 SO O-a-_ t d t JCL S Inspector is not required to report on: 1) Life expectancy of any component or system 2) The causes of the need for a repair 3) The methods,materials and costs of corrections 4) The suitability of the property for any specialized use 5) The market value of the property or its marketability 6) The advisability or inadvisability of purchase of the property 7) Normal wear and tear to the system Inspector is not required to: 1) Identify property lines 2)Offer warranties or guarantees of any kind 3)Calculate the strength,adequacy,or efficiency of any system or component 4) Operate any system or component that does not respond to normal operating controls C) Move excessive vegetation,structures,personal items, panels,furniture, equipment,snow, ice,or debris that obstruct access to or visibility of the system and any related components 6) Determine the presence or absence of any suspected adverse environmental condition or hazardous substance,including toxins, carcinogens, noise,and contaminants in the building or in soil, water, and air 7) Determine the effectiveness of any system installed to control or remove suspected hazardous substances 8) Predict future condition, including failure of components 9) Project operating costs of components 10) Evaluate acoustical characteristics of any system or component On-site Wastewater Inspection ❑ Pre-Inspection Contract,signed by Client is attached to Inspection Property Address 1 O I Lc. 1(0.1 0 kOCLI 1_t Street City St Zip Client Name: CjLs.r1 �k-1 3 Y1;'L.t� Current owner of Record Date of Inspection: LtJ a Advertised number of bedrooms as stated in MLS or as stated in attached sworn statement by owner or owner's representative Gallons per day for designed system size or number of bedrooms as stated in available local health department information Rinspection shall include any part of the system located more than 5 feet from the primary structure that is a part of the operations permit (aCopy of Operations permit from County Environmental Health Attached perations permit not available ❑System requires a certified subsurface water pollution control system operator pursuant to G.S.90A-44 Current Operator's Name Most recent performance,operation and maintenance reports are❑attached not available Type of water supply RVell ❑ Public Water ❑ Community Water ❑Spring Location of Septic Tank and septic tank details: ,Q..() ft from house or structure /Cs ft from well if applicable Ce- it."-sel ft from water line if applicable and readily visible it-A. ft. from property line if said property lines are known / distance from finished grade to top of tank or access riser A.)d Access riser(s) Dyes Dino Describe - Tank lids intact❑yes arm Tank has baffle wall Dyes Ono Describe condition of baffle wall: ✓ Inflow to tank is noted as sufficient _ Inflow to tank is noted as insufficient or blocked • Water level in tank is relative to tank outlet ✓ Outlet T is present❑yes❑ no Describe condition of Outlet T: Np Outlet has filter Dyes [lino Describe condition of filter: _ ✓ Effluent leaves the outlet E y s Ono Roots present in tank Dyes ❑no Describe extent of roots: /1,0 Evidence of tank leakage Describe: - NO Evidence of non-permitted connections.such as downspouts or sump pumps _Connection present from house to tank t Connection present from tank to next component 050 Percentage of solids in tank Unable to locate tank.System inspection cannot be completed until tank is located Date tank was last pumped ❑unknowns ' t5 Client requesting this inspection has been advised that for a complete inspection to be performed the tank needs to be pumped. Client has declined to have the tank pumped at inspection and hereby acknowledges they have so declined. Client Signature Date 11) Inspect equipment or accessories that are not listed as components to be inspected 12) Conduct dosing volume calculations 13) Evaluate soil conditions beyond saturation or ponding 14) Evaluate for the presence or condition of buried fuel storage tanks 15) Evaluate the system for proper sizing,design,or use of proper materials 16) Perform a hydraulic load test on the system Inspector is required to: 1) Uncover tank lids and distribution devices so as to gain access unless blocked as described om 21 MCAC 39.1004(b)(5). The distribution box may remain covered if the Inspector has an alternate method of observing its condition. 2) Probe system components where deterioration is suspected 3) Report the methods used to inspect the on-site wastewater system 4) Open readily accessible and readily openable components 5) Report signs of abnormal or harmful water entry into or out of the system or components As required by 21 NCAC 39 .1002 (1) this contract must he provided by Inspector and signed by client or client's representative prior to Inspection being performed. Signature below acknowledges receipt of copy of this contract and acceptance of Inspection as stated above: Signature of Client or Client's Representative Date c e �-- c- c3/4.0-, O'2f(c:, -11�a Sn f D Note: 21 NCAC 39 .1002 (2) Requires written permission from owner or owner's representative to perform the inspection must be acquired prior to the inspection. Does system have pump tank? ❑ yes(complete blanks below) Eno ft from house or structure ft from well or spring if applicable ft from water line if applicable ft. from property line if property lines are known ft from septic tank Distance from finished grade to top of tank or access riser Access risers in place Eyes Eno Describe type of access risers: Describe condition of tank lids Ls ation of control panel: _ Cs dition of control panel: Audible and visible alarms fas applicable)work Pump turns on and effluent is delivered to next component Unable to operate pump due to lack of electricity at site at time of inspection Dispersal field: Type of system: 'Conventional ❑ Accepted ❑ Innovative 0 Experimental ❑Controlled Demonstration 0 Pretreatment; Type of Pr treatment Brief Description of System Type F P - tic c,-ue_A /V ft. from property line if property lin s`jre known ____ ft from septic/pump tank —#of lines Gam: 'c0 length of lines -X tl Evidence of past or current surfacing at time of inspection Briefly describe: !1 o Evidence of traffic over the dispersal field n--'a Vegetation,grading and drainage noted that may affect the condition of the system or system components ✓ Effluent is reaching the dispersal field 0 Conditions present that prevented or hindered the inspection [tom}:Adverse conditions present that require repair or subsequent observation or warrants further evaluation by the local health department. Description of adverse condition: _$y Q.- yt,., I. 5 ,b-c I.t„J Consequences of the adverse condition: Client should contact Ca f A L &. County Environmental Health and/orl a certified on-site wastewater contractor Other pertinent facts noted during inspection Or'(,, ri ( : e_ I Ct , 5`(,._..set.$ C Ltrt-at .r15. t al' /u L. A r- erica n ca 0 i- y et r d 6.,.. .2 C) r ,6 c/o t._; fu r n C�r t t,.+a i r, Cf!r i v e.4_ J k.,4.� N-COe_I ( 1 s_.—=fS k4'.._Cr am Cir[<< el c `I -* 'T�ci Pt k ha W�l 1 I ti L b y oL e-•^ d ir.�t�.,c. �S �� kF� aLc€ss !-,(,)le- , Inspector Name:Joseph Allen Snyder Certification # 58251 Address 2529 Shelton Ave Hudson NC 28638 Phone 828-499-0921 No representation,warranties or opinions are hereby given,written or expressed otherwise,as to the future performance of onsite wastewater system described herein. This onsite wastewater system inspection is a presentation of system facts in place on date of inspection. Inspector Signature: C 6.1. e-t-�...�-xyd4-1 Date 1 a 7 a i " IiiilLitilT11111 "111 11'4'111 . 1:001 I 1111111 19 ! { II 1.1litil ' IC '/ critvIc iii il i:i j �` 1114 1,r., any ;_ l il BUFF it ill LO lipitilliiiiiriocZ-- _66 A pUB HOA tt I LIC RD s { •` R/W • �y0p �l 30 07 03� ��w` i iir .`• _ �.�• \ RA, qr R �r 4gRKER �`•----...... 4 a• �J ,\, c.. ht. rn ..,6-g, ',-. CT Ai 1 A VC WOE _._ ti Z u7 1 HOUSE i. o: PORCH � y w I .n a X1O CONc. S c,; . - N ti . co s 1 337359 w 1111 343 47. I - ilitlki 1111 N liii O 1 ,,,,, _.... 1 ,.... _. -7- 7 • -"v"- ---H ik.,4,0 9 ; 91 inl il pi g gc • • . 8 1 V is t 0. lipi 1- 8 i ,1 sl 1 1 11° 1 PI 1 a eg> ,,. tf . i la a I NO 9 0 Ii 'II i.! . t • Catawba County Environmental Health •4793 f cif:, ti ti 0 0 .4804 L_____/--J 721-4EN1?13 O N/J it co ~---,i 0 4, 0Q v J m a ,0 r7 ti� �J •4840 rs,,, 1 Parcel: 365604743823, 4804 BUFFALO SHOALS 1 in=80ft RD 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. Coovriaht 2021 Catawba County NC Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 365604743823 Owner: BEAL BRETT K Parcel Address: 4804 BUFFALO SHOALS RD Owner2: City: MAIDEN, 28650 Address: 4804 BUFFALO SHOALS RD LRK(REID): 11256 Address2: Deed Book/Page: 3443/0386 City: MAIDEN Subdivision: State/Zip: NC 28650-9542 Lots/Block: / Last Sale: $75,000 on 2004-08-16 School Information: School District: COUNTY Plat Book/Page: Elementary School: TUTTLE Legal: Middle School: MAIDEN Calculated Acreage: 1.890 High School: MAIDEN Tax Map: 011 K 03002 Township: CALDWELL School Map State Road #: 1003 TaxNalue 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: $130,500 Zoning2: Land Value: $20,000 Zoning3: Assessed Total Value: $150,500 Zoning Overlay: Year Built/Remodeled: 1945/2018 Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710365600J If available, Building Permits for this parcel. Septic 2010 Census Block: 4014 links are not permits. 2010 Census Tract: 011602 Septic Final Permits prior to 08/2018, contact Agricultural District: PROXIMITY Environmental Health. Building Details WaterShed: V l f 1Lt and Voter Precinct: P9/VotingMap P 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. ©2022, Catawba County Government, North Carolina.All rights reserved. K?*\ ;Aion. • CATAWBA COUNTY t100A SOUTI IWF,ST BEND NEWTON,NORTH CAROLINA 28658 RECEIPT .) ® PIIONE:828.465.8399 Friday,May 27,2022 I842 5M www.catawbacountync.gov PAYOR: Dellinger,John David PAYMENTS TRANSACTION NUMBER: TRC-406 1 5457-27-05-2022 PAYMENT DATE: 05/27/2022 PAYMENT TYPE: Credit Card 290443329 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 05-22-407065 t 10-580200-663000 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS: $300.00 EHPR-05-2022-4 1 196 CASE TYPE: Environmental I Iealth Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 4804 BUFFALO SHOALS RD,MAIDEN NC 28650 Applicant JOHN DAVID DELLINGER,4804 BUFFALO SHOALS RD,MAIDEN NC 28650 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 05/27/2022 15:42 Page 1 of 1 3891 0656 FILED ELECTRONICALLY CATAWBA COUNTY NC DONNA HICKS SPENCER FILED Aug 26, 2024 AT 01:43:00 PM BOOK 03891 START PAGE 0656 END PAGE 0661 INSTRUMENT # 15200 EXCISE TAX $0.00 ML Prepared by: Duke Energy'Carolinas,'LLC Site Address:48U4 Buffalo Shoals Road Return to: Duke Energy Carolinas,LLC Maiden,NC 28650 Attn:Susan Cannella Parcel#365604743823 North Carolina Distribution Encroachment Agreement for Nitrification Field Encroachments State of North Carolina County of Catawba THIS NORTH CAROLINA DISTRIBUTION iON ENCROACHMENT AGREEMENT FOR'NITRIFICATION rd FIELD ENCROACHMENTS(this"Agreement")is made and entered into this 2..3. day of„l ,i� 2Q ' ,by and between DUKE ENERGY CAROLINAS,LLC,a North Carolina limited liability company("Duke Energy")and JOII.N DAVID DELLINGER and wife.SARAH JAMES DELLINGER("Grantee"). • Grantee is the owner of a 1.96 acre parcel ofland situated in CaldwellTownship,Catawba County,North Carolina, and being the land described in a deed from John David Dellinger to Sarah James Dellinger recorded in Deed Book 3744,Page 1643,County Register of Deeds(the"Property"); • Duke Energy has previously acquired a thirty(30) foot wide easement area over the Property on which easement area Duke Energy maintains and operates electrical facilities(the"Easement Area");and • Grantee desires to use a portion of the Easement Area for the construction,installation,operation,and maintenance of a nitrification field(the"Encroachment"), NOW,THEREFORE,in consideration of the premises and of the mutual covenants herein contained,Duke Energy, insofar as-Duke Energy's-rights are concerned,hereby authorizes Grantee,their heirs-,successors,and assigns,ingress and egress to construct, install, operate,monitor, repair, and maintain the Encroachment within the Easement Area upon the following terms and conditions: 1. Grantee shall construct, install,operate and maintain the Encroachment as shown on a map, dated 6/4/2024, and entitled "A SEPTIC ENCROACHMENT MAP FOR JOI-IN DAVID DELLINGER AND SARAH JAMES DELLINGER", which is attached hereto as Exhibit A and incorporated herein by reference(the"Map"). Other Far Grantee's Internal Use: Work Order#:53586870 1 of 5 i submitted electronically by "Duke Energy" in compliance with North Carolina statutes governing recordable documents and the terms of the submitter agreement with the Catawba county Register of Deeds. 3891 0657 than removing the Encroachment,Grantee shall not alter or add to the Encroachment in any way without receiving prior written consent from Duke Energy.Should Grantee perform any work in the Easement Area without the prior written consent of Duke Energy,should it fail to perform the work in a manner consistent with the specifications approved by Duke Energy,or should the Encroachment threaten any Duke Energy facility,then Grantee shall be liable to Duke.Energy for any costs Duke Energy incurs while remedying actual or potential threats to Duke Energy's facilities arising from such work. 2. This Agreement shall automatically terminate upon complete removal of the Encroachment by Grantee.Should the encroachment no longer be required for the facility it is designed to serve,this Agreement shall be terminable by Duke Energy upon ninety(90)days written notice of Duke Energy's desire to terminate. 3. Duke Energy shall have the right to install at any time additional structures for the support of its present or future electric lines within the Easement Area. Duke Energy agrees to locate these additional structures, if reasonably possible,so as not to obstruct use of the Encroachment and in compliance with 15A NCAC 18A.1950. 4. Grantee may plant low-growing shrubbery on and around the Encroachment provided that Duke Energy shall have necessary access to its structures for maintenance purposes.Any trees or shrubs in the Easement Area shall not he permitted to reach a height of more than twelve(12)feet.If any such trees or shrubs do reach a height of more than twelve (12) feet,then Duke Energy shall have the right to remove them without removing the stumps if removal could damage system. 5. Grantee shall not place,or cause to be placed,a septic tank or any related device,constructed of any material type, in Duke Energy's Easement Area other than inert piping for septic draining purposes. 6. Grantee shall,upon request of Duke Energyand at no cost to Duke Energ y,eq erect barriers around the Encroachment area or existing facilities owned or operated by Duke Energy.Barriers shall be of an acceptable size and construction to Duke Energy. Once installed to Duke Energy's specifications, Grantee shall not be liable for the costs of relocating or replacing any barrier that is later determined by Duke Energy to hinder its access to the facilities or Easement Area. 7. Grantee shall not utilize any equipment within Duke Energy's Easement Area in such a manner that any portion of said equipment would come any closer than fifteen (15') feet from any conductors of its electric lines. Grantee's operation of equipment and use of materials within Duke Energy's Easement Area shall adhere to applicable federal, state,and local laws,rules and regulations,including the guidelines set forth by the National Electrical Safety Code (NESC), the OSHA Standard for equipment minimum safe working distances, and the North Carolina Overhead High-Voltage Line Safety Act(OHVSA). 8. Grantee shall be liable for, and shall indemnify, protect, and save harmless Duke Energy from any taxes or assessments which may be levied for or as a result of the Encroachment. 9. Duke Energy shall not be liable for any damage to the Encroachment resulting from Duke Energy or its contractors in the construction, reconstruction, replacement, maintenance, or removal of Duke Energy's present or future facilities. 10. Grantee shall not do any digging,guiding, or filling nearer than five(5')feet to any of Duke Energy structures or anchors and any slopes within the Easement Area shall be no greater than a one to four ratio. 11. Grantee shall not do any filling or piling of earth on Duke Energy's Easement Area unless shown on the Map and approved by Duke Energy. The surface of the Easement Area shall be properly graded, raked,and seeded after construction of the Encroachments is complete. For Grantee's Internal Use: Work Order#:53586870 2 of 5 i r , 3891 0658 12. Duke Energy may have facilities(e.g.counterpoise wires)buried in the vicinity of the Encroachment.Grantee shall exercise diligence to avoid damaging any underground facilities, will notify Duke Energy immediately if any damage does occur,and reimburse Duke Energy for the costs of any repairs made necessary by such damage. 13. The Encroachment is subject to the paramount right of Duke Energy at all times to make use of Duke Energy's entire Easement Area for the construction,maintenance,reconstruction,and operation of electric lines.In the future, Duke Energy may require, within the N.C.G.S. 13OA statute and the 15A NCAC .1900 rules, the relocation or modification of the Encroachment, and Grantee shall comply with the demand at no cost to Duke Energy within ninety(90)days after receipt of the written demand. 14. This Agreement is effective only insofar as the easement rights of Duke Energy in the Easement Area are concerned; and Grantee shall obtain from others such permission and permits as may be necessary from third parties. 15. Grantee assumes all risks incident to the Encroachment and does hereby release and shall indemnify,defend,and save harmless Duke Energy, its officers, directors, employees, contractors, and agents from and against claims, xlamages,.demands,legal or administrative actions(formal or informal),expenses(including reasonable.attorney'.s.: fees and court costs),and liability(whether or not such liability has been judicially determined)for loss ofor damage to property of Grantee, Duke Energy or others, (including environmental damages and hazardous or toxic waste cleanup) and injuries to or death of all persons, howsoever resulting, by reason of Grantee's use of the Encroachment. 16. The recitals set forth at the opening of this Agreement are-incorporated.herein as if fully restated in this Section 16. •17. Should Grantee desire or be required to contact Duke Energy for any reason related to this Agreement it shall contact Duke.Energy's customer service center and request to speak to the land services group. 18. This Agreement shall be governed by the laws of the state of North Carolina without regard to the conflicts of law provisions therein. The parties agree that the proper venue for any dispute related to this agreement are the courts • located in county in which the Property is located,and the parties hereby submit to the jurisdiction thereof. 19. This Agreement contains the complete understanding of the parties and-shall supersede any prior and contemporaneous communications,agreements,and assurances related to the subject matter of this Agreement.Any modification of this Agreement must be agreed to in writing and signed by the parties.The parties agree that the Easement shall remain in full force and effect. The only modifications to the terms thereof, caused.by the Agreement,shall be those which are expressly stated.in this Agreement. 20. The failureof Duke Energy in any one or more instances to•insist upon compliance with any provision or covenant herein or to exercise any right or privilege herein shall not constitute or be construed as a waiver of such or any similar provision or covenant. 21. This Agreement shall be recorded at Grantee's sole expense. !Remainder of Page Left Intentionally Blank! For Grantee's Internal Use: Work Order#:53586870 3 of 5 • 3891 0659 IN WITNESS WHEREOF,Duke Energy and Grantee have caused this Agreement to be signed under seal in their names,as of the date first above written. DUKE ENERGY CAROLINAS,LLC (SEAL) a North Carolina limited liability company By: ' / rsEAL� Name:J.Ryan Houck Title:Manager,Land Services STATE OF NORTH CAROLINA COUNTY OF MECKLENBURG The foregoing document was acknowledged before me this I(.Q4 day of 2024, by J_Ryan Houck,as Manager,Land Services of DUKE ENERGY CAROLINAS,LLC,a North Carolina limited liability company,who is personally known to me or who has produced as identification. ial signature of Notary Public SUSAN F.CANNELuA Suss Cannella NOTARY PUBLIC - Notary Public printed or signed name Mocldenburg County North Carolina,/3�u /3/�27 My Commission Fires My Commission expires: For Grantee's Internal Use: Work Order#:53586870 4 of 5 3891 0660 IN WITNESS WHEREOF, Grantor has signed this Easement under seal effective this 23"'tday of .4u A sr f,2n 2 . y �Lr' (SEAL) V'JOHN DAVID DEaLINGE 2,/5' (s.„,,, �ARAH J 111411-S DELLINGER � STATE OF 46r7 [ a).ro2.i,�. COUNTY OF �n. `f..t)3 r / 1, kit 1�• S ite.4 A r 1! , a Notary Public of s. County, State of !ri'rt ,certify that JOHN DAVID DELLINGER and SARAH JAMES DELLINGER,personally appeared before me this day and acknowledged the due execution of the foregoing EASEMENT. Witness my hand and notarial seal,this 23 day of €4,.4 r4„tf ,202 . N ry Public: / Commission expires: t` 'r :✓✓ire r�"_ R.SHERRILL!ff S Notary Pubiie Catawba Cows, S SMy Comm Nor1b Carolina S f..�r�l✓ssion Expires .r For Grantee's internal Use: Work Order#:53586870 5 of 5 or 3891 0661 c .„„,..‘,,,,,,,, gl]rr-i- xpq!.....,..:04,. I. . g§ II I, ! +211,Itto,..,0;.,........005qa8g:,143 - 9 P.• ' , B.i.a o„ON..t.e . mao sI1 ! �I"IiI911Ii 51 a m, > yi i s py Ill 1 $ / 3aQ s. E #4acoaRE y g fir' R/W__ -5 g.g 3 \' r_, iv p 3g- -, D(/K, 30. G :•. ..: :;. `— RCp_ , \_�Ap SHOAL g. s i ! UBLrc R%D w g . .... 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