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HomeMy WebLinkAboutRBPR-05-2022-41180.TIF $A �G THIS IS NOT A PERMIT Case# RBPR-05-2022-4 1 1 80 fi CATAWBA COUNTY HEALTH DEPARTMENT iili `) PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /g 2 sM Residential BuildingPlan Review- BuildingNew LICENSED SOIL SCIENTIST Applicant CAROLINE EDWARDS,991 DUNCAN RD,RUTHERFORDTON NC 28139 B:8282890122 CJEDWARDS234@GMAIL.COM Owner AVIAN WOODS LLC,5835 WALNUT GROVE I,N,HICKORY NC 28602 Paid By EAST ASHLEY INVESTMENT (COLE GAITHER),, CAGAITHER@COMCAST.NET NAME TO APPEAR ON PERMIT AVIAN WOODS LLC SITE ADDRESS: , PIN# 372011667084 NAME of SUBDIVISION: Avian Woods IV Lot# 6 Section/Block PROPERTY SIZE: Square Feet Acres 1.50 DIRECTIONS: Startown Rd right Milton St property on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: COVID-19 Submittal for new 4 bedroom 60 x 40 home no basement 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? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60 x 40 #OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: chapplication 06/01/2022 10:28 Page 1 of3 CA'1'AWRA(:OUN'I'Y Caset! RBPR-OS-2022 41180 C Public HealthDepartmentSubdivision Avian Woods IV Environmental health Division PIN# 372011667084 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 w NAME ON PERMIT: (AVIAN WOODS LLC),5835 WALNUT•GROVE LN,HICKORY NC 28602 (AVIAN WOODS LLC) Site Address: , Property Size: Square Feet Acres 1.50 Directions: Startown Rd right Milton St property on right 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 4k#iR#....##t#44.....t##4*#..... ....#*#*4k..... .....#*4**i##4#t##■##M#####k#..........tY*t*W#.......... FEENAME DATE FEE AMOUNT LSSP 05/26/2022 $135.00 TOTAL FEES S135.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) elapplicaii n 06/01/2022 10:28 Page 2 of3 • ( I RECEIVED M";Y 2 6 2022 IIss c ca t aw b a county Environmental Health public health ` l Application for Environmental Health Services 1166 t$S p e, h L THIS IS NOT A PERMIT ------._..--------._.. A pile tion is for: [rNew Construction ❑Existing Facility aft iirovement Permit authorization to Construct Q'&ew Septic ❑ Septic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion 0 Existing System Inspection or Reconnection ❑New Well El Replac menu Well ❑Well Abandonment ❑Well Repair Property Address (J l�(A ire `� 1?.h7Lt t{ Lot# Acres Y: SubdivisionVt2�� Driving i treed]ns o Property Describe work 0 .. t� 0 c 111. )Q -S1-- IMIMIIiIIMMIINIM Applicant Name __:_ .WIIPILIIIMISTIliml Applicant Address 1�� r Phone "}- ' 7'h •C` • _ Cell Phone Owner Name : V\ V•..) .. - _ Owner Address ; 3 '1/4•1\3 r. % ‘ ' I_ +. r at(0)e-7 Phone c.A; s :v S' r• . ,c 0, Cell Phone — Contractor Name License# Contractor Address Phone Cell Phone _ Name to Appear on Permit? t owner 0 Applicant El Contractor Who will be the Primary Contact? ❑Owner ErAilplicant ❑ Contractor Proposed New Construction-Residential Primary Residence New Residence ❑ t,jrdditiun to R�sidcncc Aof New Bedrooms*I' 14 #of Occupants A- Project Description E"pU /r--O-,'IN-Nr. LlrA , StnrctureDimensions,also specify dimensions of decks&porch \ (- C.') g 1--�• V 1 `Q'\t —� Basement ❑Yes }gyp(No Basement Plumbing ❑Yes No CLNJ\ .1---_ Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions Basement ❑Yes ❑No Basement Plumbing El Yes ❑ No Accessory Structure(s)Describe Stnucture(s)Dimensions Plumbing 0 Yes ❑No Describe Plumbing Needed Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions Basement El Yes ❑ No Basement Plumbing El Yes El No Well Construction/Abandonment/Repair Proposed Well Type [Individual Well El Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ I Inknown Well Repair Requested El Yes 0 No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?El Yes ❑No catawbacountyne.gov Environmental Health Catawba County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. Existing Structures on Site Describe Structure Dimensions #of Bedrooms* #of Occupants Basement ❑Yes ❑ No Basement Plumbing ❑ Yes ❑ No Existing Water Supply ❑ Individual Well ❑ Shared Well-Number of Connections ❑ Community Well ❑County/City/Township Water Line Is a public water supply available?** ❑ Yes ❑ No Commercial 0 Proposed New Construction ❑ Existing/Change of Use ❑Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑Yes ❑ No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes ❑No Residential Kitchen 0 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. Ife answer to any question is"yes",applicant must attach supporting documentation. ❑Yes QiIQo Does the site contain any jurisdictional wetlands? 0 Yes ���jjj to Does the site contain any existing wastewater systems? ❑Yes ® • Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes ra o Is the site subject to approval by any other public agency? ❑ Yes No Are 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) COAccepted 0 Alternative 0 Conventional 0 Innovative L ther LSS �l.�d t -1 ❑ 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/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) 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. 1 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 C Date � ~�r� �l•;.� } Printed Name of Owner or Legal Agent CO-C.)\.\P-i/._ 6��,E srnrea ROY COOPER•Governor NC DEPARTMENT OF KODY H.KINSLEY• Secretary o HEALTH AND 1 ti"r° r HUMAN SERVICES HELEN WOLSTENHOLME•Interim Deputy Secretary for Health MARK T.BENTON•Assistant Secretary for Public Health Division of Public Health COMMON FORM FOR LICENSED SOIL SCIENTIST COVID-19 PERMIT OPTION FOR NON-ENGINEERED SYSTEMS See Instructions for Use in Appendix A Except for"Date received",this Section to be completed by the LSS in accordance with S.L.2020-97,Section 3.19 and G.S. 1304-336.2 LHD USE ONLY: Initial submittal of this NOI received: by Date lnitrais PART 1:Notice of Intent to Construct(N01)-Please check all that apply ® Single System or ❑ Multiple Systems AND ®New ❑ Expansion ❑ Relocation of all or part of the Existing System ❑ Relocation of Repair Area ❑ Repair—LHD Permit Number ❑ Repair—EOP/LSS COVID 19/AOWE Permit Number 1. Facility Owner's name:(Owner,Company Name,Utility, Partnership, Individual, etc.): Avian Woods LLC c/o Cole Gaither Mailing address: 5835 Walnut Grove Ln City: Hickory State: NC Zip: 28602 Telephone number: 843-530-8901 E-mail Address: cagaither@me.com 2. Licensed Soil Scientist(LSS)name: Caroline Edwards LSS License number 1220 Mailing address: 991 Duncan Road City: Rutherfordton State: NC Zip:28139 Telephone number: 828-289-0122 E-mail Address: cjedwards234@gmail.com 3. Licensed Geologist(LG)(if applicable) name: NA License Number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 4. 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: LSS ❑ LG 5. Property location(physical address,tax parcel identification number or subdivision lot, block number of the property to be permitted): 0 Harper Lee Dr. Newton Lot 6 of 372011667084 County Name: Catawba 6. Type of facility: ® Place of residence No. Bedrooms: 4 No.Occupants:2 ❑ Place of business Basis for flow calculation: ❑ Place of public assembly Basis for flow calculation: NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION 5605 Six Forks Road,Raleigh,NC 27609 MAILING ADDRESS:1642 Mail Service Center, Raleigh,NC 27699-1642 www.ncdhhs.gov • TEL:919-707-5874 • FAx 919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER COVID-19 Permit Option Common Form LHD Reference: 7. Factors that would affect the wastewater load: NONE 8. Type and located of proposed wastewater system: Illg Front Yard of home 9. Design wastewater flow: 480 gpd Design wastewater strength: ®domestic ❑high strength ❑industrial process(For industrial process wastewater,a Professional Engineer licensed in accordance with G.S.89C shall design the on-site wastewater system.) 10. A plat as defined in G.S.130A-334(7a)is attached: ❑Yes ®No A site plan as defined in G.S. 130A-334(13a)is attached: ®Yes ❑ No 11. 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 1SA NCAC 18A.1950: ®Yes ❑ No This is a saprolite system. ❑Yes ®No 12. 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 13. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG Is attached ❑Yes ®NA 14. Proposed landscape,site,drainage,or soil modifications are attached: ❑Yes ®NA Attestation by LSS pursuant to S.L.2020-97,Section 3.19 and G.S.130A-336.2 Caroline J. Edwards hereby attest that the information required to be included with Licensed Soil Scientist(Print Nome) 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,and that the proposed system does not require a Professional Engineer,licensed in accordance with G.S.89C,and in accordance with 15A NCAC 18A.1938 and activities determined to be engineering as determined by the North Carolina Board of Examiners for Engineers and Surveyors. Signa ure of Licensed Soil ' ti Dote Owner self-submittal of NOI: I, hereby submit this NOI prepared by Print Nome of Owner Print Name of Licensed PE pursuant to G.S.130A-336.1. Signature of Owner Date DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 2 of 6 COVID-19 Permit Option Common Form LHD Reference: 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 LSS COVID-19 Permit Option(S.L.2020- 97,Section 3.19(d)and G.S. 130A-336.2(f)] 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 below,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. DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 3 of 6 COVID-19 Permit Option Common Form 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 the notice of intent to construct required pursuant to subsection(b)of this section is complete within five business days after receiving 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 local health department shall notify the owner and list the information needed to complete the notice. The owner may then submit additional information to the local health department to cure the deficiencies in the initial notice.The local health deportment shall make a final determination as to whether the notice of intent to construct is complete within five business days after the department receives the additional information.If the local health department falls to act within any time period set out in this subsection,the owner may treat the failure to act as a determination of completeness. The owner shall be able to apply for the building permit for the project upon the decision of completeness of the notice of intent by the local health department or If the local health department fails to act within the five business day time period." The review for completeness of this Notice of Intent was conducted in accordance with G.S.130A-336.2(c). This NOI is determined to be: ❑ INCOMPLETE(If box is checked,Information in this section is required.) Based upon review of information submitted in Part 1,the following items are missing: Copies of this form listing missing items were sent to the LSS 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 Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date ❑ COMPLETE(If box is checked,information in this section is required.) Based upon review of information submitted in Part 1 of this form,this NOI is deemed COMPLETE. Copies of this signed form were sent to the L55 and the owner on via 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 Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 4 of 6 COVID-19 Permit Option Common Form LHD Reference: Re-submittal of NOI with missing items Included This Section is for use by owner to submit items noted as missing during LHD Completeness Review above Resubmlttols must be accompanied by a cover letter from the LSS LHD USE ONLY: This NOI resubmittal received: by Dote Initials Item#from Initial NOI Resubmittal description Attestation by LSS pursuant to S.L.2020-97,Section 3.19 I, hereby attest that the information required to be included with Licensed Soil Scientist(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. Signature of Licensed Soil Scientist Dote The section below is for Local Health Department 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- 336.2(c). This NOI Is determined to be: ❑ INCOMPLETE Based upon review of information submitted 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 LSS 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 Dote ❑ COMPLETE Based upon review of information submitted 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 LSS 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 Date Email,FAX,LISPS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 5 of 6 COVID-19 Permit Option Common Form LHD Reference: PART 3: Authorization to Operate(ATO) Except for dote received,the Section below is to be completed by the Owner. LHD USE ONLY: Initial submittal of request for ATO received: by Date 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 the information in G.S.130A-336.2(k) ❑Yes ❑No 2. Operation and management program ❑Yes ❑No 3. Fee (as applicable) ❑Yes ❑No 4. Notarized letter documenting Owner's acceptance of the system from the LSS ❑Yes ❑No 5. On-site Wastewater Contractor name: License number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 6. Proof of Errors and Omissions or other appropriate liability insurance for the On-site Wastewater Contractor is attached and Includes the name of the insurer,name of the insured,and the effective dates of coverage. ❑yes ❑ No Attestation by the Owner for Authorization to Operate hereby attest that all items indicated above have been provided to the Print name of Owner County LHD and the system shall meet applicable federal,State,and local laws, regulations,rules,and ordinances. Signature of Owner Dare This section for LHD Use Only. LHD Review of required information for the ATO ❑ INCOMPLETE Based upon review of Information submitted 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 Dote Email,FAX,LISPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Dote ❑ COMPLETE Based upon review of information submitted 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 sent to the State on via Date Email,FAX,LISPS,Hand-delivered Print name of authorized Agent of the!HD Signature of authorized Agent of the LHD Date ISSUANCE OF CERTIFICATE OF OCCUPANCY: Once the LHD 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.130A-339. DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 6 of 6 ACo CERTIFICATE OF LIABILITY INSURANCE °ATE'"M,°°"Y"' 03/06/2022 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(les) 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 NAME: Hiscox Inc. N� FAX NE Ext�.. (888)202-3007 1(A/C,Not ---- 520 Madison Avenue E-MAIL 32nd Floor ADDRESS: contact@hiscox.com New York,New York 10022 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Hiscox Insurance Company Inc 10200 INSURED INSURER B: Earthwise Designs 991 Duncan Rd INSURERC: Rutherfordton,NC 28139 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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. IL R TYPE OF INSURANCE INSD AODCSUBR WVD POLICY NUMBER POLICY EFF II POLICY EXP LIMITS (MMlDDIYYYYLI(MM(DDfYYYY! COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S _ CLAIMS-MADE OCCUR DAMAGE 0(RENTED -- PREMISES occurrence) $ MED EXP(My one person) $ PERSONAL&ADV INJURY GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG S _OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea acddentl I ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED ' SCHEDULED BODILY INJURY(Per accident) S AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) _ I , $ UMBRELLA UAB — OCCUR � EACH OCCURRENCE $ __ EXCESS LIAR CLAIMS-MADE AGGREGATE 1 DED RETENTION$ $ I WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY y1 N STATUTE ER ANYPRCPRIE TOR/PARTNER'EXECUTIVE N/A EL.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under — —� DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S A Professional Liability P100.217.339.8 04/20/2022 04/20/2023 Each Claim:$2,000.000 Aggregate.$2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE . y ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Earthwise Designs Soils & Land Evaluation 8/6/2021 Site and Soils Report with System Design Four-Bedroom SFH Wastewater System Lot 6, Avian Woods Phase IV Parcel ID of Subdivision Tract: 3720-1166-7084 Newton, NC Catawba County Prepared for: Avian Woods LLC This report is submitted under the rule: LSS COVID-19 PERMIT pursuant to S.L. 2020-97, Section 3.19 and C.S. 130A-336.2 PART 1: Submittal of Notice of Intent to Construct(NOI) Earthwise Designs has performed a soils and site evaluation of the lot referenced above. We have found an area Provisionally Suitable for the following initial system: 4-bedroom III g. gravelless trench, Accepted system with 25%reduction. Repair is pumped to the same system type.Neither is a saprolite system. A new well will be dug. Details are discussed below and in attached documents. System Specifications Initial: III g. gravelless trench,Accepted system with 25%reduction. Use a d-box with an at- grade access riser feeding three 100' lines. See site plan. • Soils: Group III—Clay Loam • LTAR: 0.4(See detailed soil descriptions.) • Line length required=300' o Three 100'lines. • Trench width 36" • Trench bottom: 26"on downhill side of trench. • Septic tank: 1000 gallons Repair: III b.g. gravelless trench, Accepted system with 25%reduction. Pumped to d-box. • Soils: Group III—Clay Loam • LTAR: 0.4(See detailed soil descriptions.) • Line length required=300' o Three 100' lines. • Trench width 36" 2 • Trench bottom: 26"on downhill side of trench. Other site-specific requirements and notes: 1. Floor elevation must be raised above the septic tank corner of the envelope for a gravity system. 2. Heavy machinery over the drainfield area must be avoided after installation.No structures or roads can be placed there. 3. We recommend the at-grade distribution box be inspected every 1-2 years by a private inspector. 4. The owner must ensure that the field is installed as described above; will be maintained to reduce erosion, shed water,retain a vegetative cover and not be disturbed. 5. Earthwise Designs makes no guarantees regarding installation, maintenance and operations. System design may not be accurate if improper site alterations occur prior to permitting and installation. Thank you and please contact me for further information, if needed. Caroline J. Edwards NC Licensed Soil Scientist#1220 lea s°u sets SC Professional Soil Classifier#117NC Land Application of Bio-Solids #10006173 Attachments: Soils sheet °'`Nroen+c Site Plan EARTHWISE DESIGNS 991 Duncan Rd Rutherfordton, NC 28139 Ciedwards234(Wamaiicorn 828)289-0122 cell 1 .4 1 z e - I 4 v \\C , k Cv SSG y E,... UA V —W 1-41 � N, b 611 f >f H ij z 's}z cii-o> '�4 � b R % {m Nam! _ Ni U I N ry ,,x { y t m g m m'� � fiN4 _ i gg O a� _ 0 o L 6 < in Q (` ea Qa y �� "" { f O.r N NI TL l— �-1 . Etra v0 ON �`� y o e E o r o 741 Z ® V ^I y I cE(t 6 I\) 1\ -..... , 1 a gl T I4 �j V I ,ig U �v w cv a .� W � h• l w �, p, w E - -: .,,, , .,j -v a 1 6.2 : 1;. N..V! G 1•L V G i C V] L. 4" I 1 f u [i.> O G (Y=J m o J S Vy \A a w0 +7P!_ IRQ w 41 c Earthwise Designs Lot 6,Avian Woods Phase IV Soils&Land Evaluation Newton, Catawba Co.,NC Parcel ID: 3720-1166-7084 August, 2021 See written report for system details. Legend& Notes for attached Site Plan • Circled dots 9-10=pit numbers and locations. • Layout performed as indicated on 9'centers. o B=Blue flagging stakes;0=orange;Y=yellow. o Double stakes mark the end of lines. • R=repair. • House envelope corners marked by surveyors with wooden stakes and blue flagging. Additional locations from fixed points: PC 1-PC4=property corners marked by pins and wooden stakes. Pit 9:20'from PC3;108'from PC4 Pit 10: 102' from PC I; 120'from PC2 tip SA �+�fi ti� �� "4i18E4 Ufa' QQf a�� �'�Yy 3< 1 U, v 7.69O1-1'cS ` O n R a ,a P,., g ate:/ ti , [ice kSI' 1} . JJi e o b j. 1 01 p 1 U . \7,--,-;- iz .r w - d u zt in H Q • l.< W d 0 "'X. . 1.:!°111111111111 -411111111111* / I- . CO °tea N //P z-""*$ f/I'+z. Airily! btu lir° -1°- • T $ . A,.., ____ ,. ._,__ ..., . . ..... __________„ o:+eti 1 (1 B s 9! I@ p mails 9 ! 1� i $ �: i �^" 11 a ! AI Y k i .CO3 , 1aat .n 1 ; �Xafi !a o 3; gi a 1 ! -• ajiii/a ! I: all*MAI ens & tt it a $ a Ell s1# s'. a ! g6 pp a i 4 x 1 S at a I e S Q! 7 t S it t z t ! a 1 !l p� • 9. ,aIrl� iIIf g a$11II ! $ € p;;i i ili`;i �agF:1 I {e1 tPiA i 4 I ; 5 E ida:ibs�2!!iiila .I t 1 iG 111 !,11 ! S g. Iiii l �. t ° t ! E 4 d ![! � � �_---_- MILTUN STRF E!6h f " i =' "----—:1 .,,,:: � �_•F`p• ROW ( RI j :a�i! ,�t i aii./ IV .. ' H dA ! a 1 :. ,1 \ \ / ai ik i O 71 \\ g/ , . ..A 1, 1 4 11 ! y A + r'1 e.r. ia Oe ; J 1 IY fly e 1 E Q$ 1 • N !2 1F P ..._- ------1 • 1 I ---, 11 ` � --nr asr— t+ 1 1�' ?1l yE Y Tp+1 8 1 'x' fib 1 u 4 I O o 1 y 8" t ��' s}` _ +4 1 1 SF " ©� ---ai sr /////// �� 46(kNo 4 p6p �, 3 r i I�Q `� 4 +1 1 iiti gt u ck 00 ' ' lij } ) Y P G r) 1 1 y L lit C! Ks ,t i A 9g i @5 / ,1 .4 sit Om O� ' 14'=,fdi A�!!i $ Kia /, I/ ea l /\ o o % `.--- 2`j r c�i I` i�1i it t €f; y11ar � � II��II�� ` y Iaelpygx w s V i�1�1 tI 8 Ilhl % :11: a ci i / Iffillifin igx a lb P i- 7—____� FaaaaoaceeEec;E idi i Catawba County Environmental Health 00 I MILTON ST 26s.4a 6A • 46.7 i2413 `O v.. tt L....1, Q 82 t V .13 05 1. 250 • 1998A EH-1M 1 .70 r 257 • • (A ;,. 28 346 48 . 'il[ 182• 0 . . 67 •: •1280 •1048 1•4..93 109t• —L 15 9 c ••1275 252:. 407 1kt lJ •1.062 '• 'I 192. 112• ., I a 1] 85 0 21#1.36 2• N is 951 154 z 7 1 7 00 4' t. 11 160•• . 80 303.17 .• I —1 2, •r , i� 14 ..•7 132%1 ,,, •1092 t :: 16 t �3 2a L.,,23, f? 246.• ( j Q10 147•. 92 r` : .49 \ - . 5 2• .1 • • 184 I,,� po •1192 ,.. c 250 •1148 �� 7 Parcel: 372011667084, NEWTON, 28658 1in=200ft This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2021 Catawba County NC 05/31/2022 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372011667084 Owner: AVIAN WOODS LLC Parcel Address: Owner2: City: NEWTON, 28658 Address: 5835 WALNUT GROVE LN LRK(REID): 38887 Address2: Deed Book/Page: 3498/0844 City: HICKORY Subdivision: State/Zip: NC 28602-8817 Lots/Block: / School Information: Last Sale: School District: COUNTY Plat Book/Page: 43/73 Elementary School: STARTOWN Legal: PLAT 43-73 Middle School: MAIDEN Calculated Acreage: 10.990 Tax Map: 075N 01041 High School: MAIDEN Township: NEWTON State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-20 Building(s) Value: $0 Zoning2: Land Value: $329,100 Zoning3: Assessed Total Value: $329,100 Zoning Overlay: Year Built/Remodeled: / Small Area: STARTOWN 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 #: 3710372000J If available, Building Permits for this parcel. Septic 2010 Census Block: 2002 links are not permits. 2010 Census Tract: 011701 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: Voter Precinct: P34 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. 4'A • CATAWBA COUNTY '}+ 100A SOUTHWEST BLVD + NEWTON,NORTH CAROLINA 28658 RECEIPT API 7 PHONE:828.465.8399 Wednesday,June 1, 2022 1 g 4 2 sM www.catawbacountync.gov PAYOR: East Ashley Investment East Ashley Investment(Gaither,Cole) PAYMENTS TRANSACTION NUMBER: TRC-40881148-01-06-2022 PAYMENT DATE: 06/01/2022 PAYMENT TYPE: Credit Card 290661038 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 06-22-407161 110-580200-663000 LSSP S135.00 TOTAL PAYMENTS: S 135.00 RBPR-05-2022-41180 CASE TYPE: Residential Building Plan Review WORK CLASS: Building New SITE ADDRESS: Applicant CAROLINE EDWARDS,991 DUNCAN RD,RUTHERFORDTON NC 28139 B:8282890122 CJEDWARDS234@GMAIL.COM Owner AVIAN WOODS LLC,5835 WALNUT GROVE LN,HICKORY NC 28602 Paid By EAST ASHLEY INVESTMENT,, CAGAITHER@COMCAST.NET **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 06/01/2022 10:28 Page I of I