Loading...
HomeMy WebLinkAboutRBPR-06-2022-41426.TIF • THIS IS NOTA PERMIT Case# RBPR-06-2022-41426 CArAW13A COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1alt ski Residential Building Plan Review- Building New LICENSED SOIL SCIENTIST Applicant FOUR CORNERS OF CHARLOTTE LLC, 1612 SEATTLE SLEW CT,WAXI IAW NC 28173 C:704-713-2602 ROMELLE03@YAHOO.COM Paid By FOUR CORNERS OF CHARLOTTE INC (ROMIL CAlIUDGAR), 1612 SEATTLE SLEW CT,WAXHAW NC 28173 NAME TO APPEAR ON PERMIT Four Corners of Charlotte LLC SITE ADDRESS: 2650 CHARLESTON CT,CLAREMONT NC 28610 PIN# 375207683425 NAME of SUBDIVISION: OLDE SAVANNAH Lot# 42 Section/Block PROPERTY SIZE: Square Feet Acres 0.82 DIRECTIONS: Rock Barn Rd,right on Savannah Ln right Charleston Ct at end on right in cul-de-sac PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water DESCRIBE WORK: COVID 19 Submittal New 4 bedroom SFR 45 x 47 with 10x10 rear deck 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: 8 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 45 x 47, 10x10 rear deck 0 OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: PPBPS Bed ehappliculuni 06/21/2022 14.13 Page I of 3 .t. CATAWBA COUNTY Case# RBPR-06-2022-41426 (.i.lik Public Health Department Subdivision OLDE SAVANNAH vit ., .., Environmental Health Division PIN# 375207683425 ....... :roPO Box 389,100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: FOUR CORNERS OF CI IARLOTTE LLC ( ), 1612 SEATTLE SLEW CT,WAXIIAW NC 28173 Four Corners of Charlotte LLC Site Address: 2650 CHARLESTON CT,CLAREMONT NC 28610 Property Size: Square Feet Acres 0.82 Directions: Rock Barn Rd,right on Savannah Ln right Charleston Ct at end on right in cul-de-sac 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 properly 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 AREA2 FEENAME DATE FEE AMOUNT LSSP 06/20/2022 $135.00 TOTAL FEES $135.00 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) charpli ati,,n 06/212022 14:13 Page?of3 i • • RECEIVED catawba county JUN 1 7 2022 public health Environmental Health Application for Environmental Health Services (/�LID(P $12 THIS IS NOT A PERMIT I : C ! _ A !nation is for: ®New Construction ❑Existing Facility Improvement Permit — Authorization to Construct ❑New Septic ❑Septic Repair/Malfunction 0 Septic Relocation 0 Septic Expansion ❑Existing System Inspection or Reconnection ❑New Well ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair Property Address 2650 Charleson Court, Claremont, NC 28610 Acres 0.826 Subdivision Olde Savannah Place Lot 42 Driving Directions to Property From Newton, take NC-16 N. to Rock Barn Road, NE. Turn right onto Rock Barn Road, NE, right onto Savannah Lane, and right onto Charleston Court. Lot is located on the ri ht. Describe work Constructing new 4-bedroom single family residence eov ID i &NOW Applicant Name Four Corners of Charlotte, Inc. f Applicant Address 1612 Seattle Slew Court, Waxhaw, NC 28173 r D r,(i t 1e, 03 Q ye oo t Phone Cell Phone 704-713-2602 Owner Name Same as above Owner Address Phone Cell Phone Contractor Name License# Contractor Address Phone Cell Phone Name to Appear on Permit? ®Owner ❑Applicant ❑Contractor Who will be the Primary Contact? ®Owner ❑Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ® New Residence ❑ Addition to Residence #of New Bedrooms*t 4 #of Occupants 8 Project Description Constructing new single family residence. _ Structure Dimensions,also specify dimensions of decks&porches 45-ft x 47-ft with 10-ft x 10-ft rear deck Basement ❑Yes ® No Basement Plumbing ❑Yes $ No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions Basement ❑Yes ❑No Basement Plumbing ❑Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes ❑No Describe Plumbing Needed Multi-Family Residence #of Apartments #Bedrooms per Apnrtmcnt*t Total#Bedrooms in Structure*t #of Occupants_ Structure Dimensions Basement ❑Yes ❑ No Basement Plumbing ❑Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑Semi-Public Well ❑Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑Yes ❑ No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑Yes ❑No catawbacountyne.gov Environmental Health (atowba (ounty Government [enter 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 n Individual Well ❑ Shared Well—Number of Connections ❑Community Well F ) County/City/Township Water Line is a public water supply available?** ® Yes ❑ No Commercial ❑ 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 Shills Commercial Kitchen ❑Yes ❑ No Residential Kitchen 0 Yes ❑No Daycare#of Children #of Employees per Shill #of Shills Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shill #of Shills 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 the answer to any question is"yes",applicant must attach supporting documentation. ❑ Yes CS No Does the site contain any jurisdictional wetlands'? ❑Yes (9 No Does the site contain any existing wastewater systems? ❑Yes ®No Is any wastewater going to be generated on the site other than domestic sewage? Yes IF Is the site subject to approval by any other public agency? a Yes (V No 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 ❑Conventional ❑ Innovative Id Other PPBPS Bed 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 tune 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. 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 pro rty or legal agent of the owner. Signature of Owner or Legal Agent ramon gonzalez(Jun 16,2022 12:46 EDT) Date Jun 16, 2022 Printed Name of Owner or Legal Agent ramon gonzalez sung ROY COOPER •Governor : E �s NC DEPARTMENT OF e KODY H.KINSLEY•Secretary its) -�g HEALTH AND HELEN WOLSTENHOLME•Interim Deputy Secretary for Health �r / , _ HUMAN SERVICES %L„0,. 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. 130A-336.2 LHD USE ONLY: Initial submittal of this NOI received: by Date Initials PART 1:Notice of Intent to Construct(NOI)-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.): Four Corners of Charlotte, LLC Mailing address: 1612 Seattle Slew Court City: Waxhaw State: NC Zip: 28173 Telephone number: 704-713-2602 E-mail Address: romelle03@yahoo.com 2. Licensed Soil Scientist(LSS) name: Larry Thompson, LSS LSS License number: 1287 Mailing address:PO Box 541 City: Midland State: NC Zip: 28107 Telephone number: 704-301-4881 E-mail Address: larry@thompsonenv.com 3. Licensed Geologist(LG) (if applicable) name: N/A 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): 2650 Charleston Court, Claremont, NC 28610 (Lot 42- Old Savannah PI.) County Name: Catawba 6. Type of facility: ❑■ Place of residence No. Bedrooms: 4 No.Occupants:8 ❑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 MAR ING 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: Design is for domestic strength wastewater only. 8. Type and located of proposed wastewater system: Gravity flow PPBPS bed located to the left of the proposed house site. System type IIIe_ 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: Q 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 15A 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(a1)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 El 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 Larry Thompson, LSS 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,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.19, ti ities determined to be engineering as determined by the North Carolina Board of Examiners for n art rveyors_ 06-20-22 Signature of Lk 7 S f ntist Date l /fr / Ohbaifself-submittal of NOI: I, hereby submit this NOI prepared by Print Name of Owner Print Name of Licensed PE pursuant to G.S. 130A-336,1. Signature of Owner Date DHHS/ENS/OSWP—155 C-19 COMMON FORM Updated April2022 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(fM] 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. 1304-338. DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April2022 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 deportment determines that the notice of intent to construct is incomplete, the local health deportment 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 department 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 fails 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 LS5 and the Owner on Dote 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!HD Signature of Authorized Agent of the LHD Dote ❑ 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,LISPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via Date Email,FAX,LISPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Dote 01-INS/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. Resubmittals must be accompanied by a cover letter from the LSS. LHD USE ONLY: This NOI resubmittal received: by Date Initials Item tt from initial NOI Resubmittal description Attestation by LSS pursuant to S.L.2020-97,Section 3.19 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 Date The section below is for Load 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- 336.2(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 Date ❑ 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,USPS,Hand-delivered A complete copy of this form with tracking information was sent to the State: via Dote Emit,FAX,U5P5,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date DHNS/ENS/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 date received,the Section below is to be completed by the Owner. LHD USE ONLY: Initial submittal of request for ATO received: by Dote Initials Date of Post-construction Conference: The following items are included in this submittal for an Authorization to Operate under an LSS COVID-19 permit: 1. Signed and sealed copy of the LSS's report that includes 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 E 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 Dote 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 Dale Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LFIO Date ❑ 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 Dote Email,FAX,USPS,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 LHO 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. OHHS/EHS/OSWP—LSS C-I9 COMMON FORM Updated April 2022 Page 6 of 6 �� THOMP-0 OP ID:D2 Ate"_UROr CERTIFICATE OF LIABILITY INSURANCE DATE(2812021 J ��" asr8zozl 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 poiicy(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 918-779-7880 Farm. David Vaughan Vaughan Insurance Group, LLC PHONE 918-779-7880 I FAX 918-779-7885 IC PO Box 52534 [A�,No,(� Extl: (Mc,No): Tulsa, OK 74152-0534 A4DqRESS;dIvjrahigg)nbotham.net David Vaughan INSURER(S)AFFORDING COVERAGE NAIC i INSURERA:Mid Continent Casualty Company 23418 INSURED Thompson Environmental INSURERB:Hartford Underwriters Ins Co 30104 Consulting, Inc. INSURER c: PO Box 541 Midland, NC 28107-0541 INSURER 0: 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. INSR TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR ,INSD,WVD, ,(MMIODIYWYI_(MMIDDrYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 04-GL-001067648 09/25/2021 09/25/2022 DAMAGE To RENTED 1 D0,000 PREMI. SJEa occurrence) $ _ MED EXP(AN one person) $ EXCLUDED A X Professional Llab 04-GL-001067648 09/25/2021 09/25/2022 PERSONAL s ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 X POLICY T&T LOC PRODUCTS•COMP/OP AGG $ 3,000,000 OTHER $ AUTOMOBILE LIABILITY CEMoBwderill LE LIMIT $ ANY AUTO BODILY INJURY jPer person) $ — OWNED --SCHEDULED _ AUTOSA�{{��EE�p ONLY _AUUTµOSSyy��p BODILY INJURY jPer accident) $ _�AI.JTOS ONLY _ AUTOS OrIY PROPERTYn?)AMAGE $ $ UMBRELLA LIAR ^J OCCUR EACH OCCURRENCE •$ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ B•AND EMPLOYERS LLIIABILITY Y r N ATION X STATUTE ERA ANY PROPRIETORIPARTNERIEXECUTIVE 38WECNW6175 10/17/2021 10/17l2022 E.L.EACHACCIDENT $ 1,000,000 QFFICERRAEvIBEREXCLUDr_09 N NIA 1,000,000 ( ride ry in MO E.L.DISEASE•EA EMPLOYEEI_$ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION FORIN-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Informational Purposes ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Residential Subsurface Wastewater Treatment and Disposal System .1948(d) LSS COVID-19 Permit Option for Lot 42 — Olde Savannah Place 2650 Charleston Court Claremont, NC 28610 Catawba County Parcel: 375207683425 June 16, 2022 Prepared for: �� it, $cif mac, 4 0Hootix, 0 r Four Corners of Charlotte, LLC ��' 1.K.9 ° - 1612 Seattle Slew Court '� •� • Waxhaw NC 28173 if i' '' �3 ,,,j 704-713-2602 . 128701, ck -i Prepared by: ,,,0 1a1wnu.,,,,` Larry Thompson, REHS, LSS ,�•�'�� . 0,1'�•,,� Thompson Environmental Consulting, Inc. 0'.• ti��sTERF'•-• s•. 1. PO Box 541 ' Midland, NC 28107-0541 i r- f SEAL Phone: 704-301-4881 s 1��$ : larry@thompsonenv.com %,y AZ KO:4PS ,,,,,lJllllllllt" 2650 Charleston Court Details Four Corners of Charlotte, I.LC has contracted with Thompson Environmental Consulting, Inc. (TEC) to prepare a septic proposal for a 4-bedroom single family residence to be located at 2650 Charleston Court, Claremont, North Carolina. Based upon a deep pit saprolite investigation performed by TEC, it was determined that a sufficient amount of "Suitable" Group 11 saprolite is available for the installation of a Gravity-Fed Prefabricated Permeable Block Panel Bed System (PPBPS) for a 4- bedroom residence at a 0.4 Long Term Acceptance Rate (LTAR) based on I5A NCAC 18A .1956 MODIFICATIONS TO SEPTIC TANK SYSTEMS. The enclosed Licensed Soil Scientist Evaluation is being submitted pursuant to and meets the requirements of SL 2020-97 Section 3.19. The basis for the .1948(d) proposal can be found in 15A NCAC 18A .1956 MODIFICATIONS TO SEPTIC TANK SYSTEMS which states, in part: Other saprolite systems may be approved on a site-specific basis in accordance with Rule.1948(d) or.1970 of this Section. The saprolite was evaluated in deep pits and meets the criteria set forth in .1956(a) with a specified LTAR within the approved range found in .1956(b). One benefit of utilizing a PPBPS bed for this project is that the system will utilize 50% more backfill sand than the equivalent PPBPS trench layout, adding even more treatment and storage capacity. Location From Newton, take NC 16 N., turn right onto Rock Barn Road, NE, turn right onto Savannah Lane, and right onto Charleston Court. Lot is located on the right. References Laws and Rules for Sewage Treatment and Disposal Systems, 15A NCAC 18A, Section .1900, Department of Environment and Natural Resources, Division of Environmental Health, On-Site Wastewater Section, April 2017. Onsite Wastewater Treatment and Disposal Systems; EPA 625/R-00/008 Design Manual, February 2002. Design, Installation and Maintenance of the T& J Panel Wastewater Treatment System; Sixth Edition, published by T& J Panel. Primary Investigator's Credentials NC Registered Sanitarian No. 1208 NC Licensed Soil Scientist No. 1287 Professional Wetland Scientist No. 1346 NC Subsurface Septic System Operator No. 22199 2 2650 Charleston Court NC Grade IV Wastewater System Installer No. 1762 NC Certified Wastewater System Inspector No. 17621 Plans and Specifications A. Septic Tank 1. The septic tank shall be State approved (Section .1953 of 15A NCAC I8A), watertight, structurally sound, and 1,000 gallons in capacity. 2. The septic tank will be fitted with an approved effluent filter and riser for easy access and periodic maintenance. 3. It is the responsibility of the septic contractor to thoroughly inspect the septic tank prior to accepting delivery to assure that the tank has had time to properly cure and is free of cracks or other structural deficiencies. B. Pipes and Fittings 1. All discharge piping,connectors and supply lines should be made of SCH 40 PVC. 2. All joints must be properly"welded"utilizing the appropriate PVC cement for each application. C. Distribution Method 1. Drainlines within the bed will be fed by a distribution box. 2. Distribution box shall be water tested for equal flow at the time of the final inspection. D. Backfill 1. Backfill sand shall be clean, washed, medium sand that is naturally occurring and falls within the gradation of ASTM C-33 specification (used in the ready mix industry and is readily available). E. Drainfield Installation 1. The drainfield location has been marked on-site utilizing metal stemmed flags. Once this area has been approved by the county,the property owner/builder should mark this area and isolate it as much as possible from construction traffic. Prior to the system installation, the septic contractor shall contact the LSS for a preconstruction conference at which time the drainfield area will be re-verified. 2. Under no circumstances shall any construction take place within the drainfield area while the soil is in a wet condition. If the installer has doubts as to whether or not the drain field area is dry enough to begin construction,the LSS for this area should be contacted for permission to proceed with the installation. 3. The specified system is a horizontally installed pre-fabricated permeable block panel bed system — specifically the panel system manufactured by T&J Panel Wastewater Treatment System, Patent No. 4013559; telephone: 1-800-222-2577. 3 2650 Charleston Court The installer must follow the manufacturer's guidelines for installing the T&J Panel System and should request an installation manual from the manufacturer prior to beginning construction. 4. The initial bed is 24 feet wide x 38 feet long bed with eight(8)35 foot long PPBPS drainlines placed 3 feet on centers (outer PPBPS lines will be 1.5 feet off bed sidewalls). Total trench length is 280 linear feet. 5. It is essential that the bed be constructed on contour with the land, with the trench bottom being excavated level from beginning to end. The use of a tripod mounted engineer's level is essential to assure that each trench is constructed as level as possible. 6. The bed depth for this system shall be 48 inches(high-side). Each PPBPS drainline shall be placed on 3 foot centers and 1.5 feet off each side wall. 7. Once bed has been dug, the side walls shall be raked, and a light dusting of lime applied. 8. Backfill the trench with 6 inches of sand and level to grade. Once leveled, place l x 4 or 6 inch boards on top of the sand the entire length of each drainline. Once the grade boards have been set, the panels may be set into the bed. The panels should be placed 6 inches apart (end-to-end). 9. Once the panels have been set, line the top portion of each chamber with the T&J supplied sand alternative product (SAP—geotextile fabric). GE Foam Sealer or tar seal rope should be placed in the bottom of the U outs to form seals around the pipe as shown in earlier drawings. 10. Tar seal rope, or approved foam, should be placed in the "U" outs of each end of the panel to form seals. Once the tar rope is in place, the Schedule 40 PVC connectors can be added, and the seal completed by the addition of more tar rope on the top and sides of the pipe. Now that the connection and seals are complete,a block cap is placed on each end of the panel so that all openings are covered. 11. Once the panels for each trench have been installed and the top of the panels closed, the bed is ready to be backfilled to the top with the same sand material used in the first lift on the bed bottom. At this point, the bed should be left open for the final inspection by the I,SS. F. Final Landscaping 1. The bed backfill shall be shaped to shed rainwater and be free from low spots. 2. The entire area of the bed should be planted with grass as soon as possible to prevent erosion. The soil should be properly tilled, limed (if necessary)and fertilized prior to planting. After applying grass seed, the area should be heavily mulched with straw or other suitable material. G. Utility Conflicts 1. The builder and property owner must take special care in planning for utilities (water, power, gas, telephone, cable lines, etc.). All utilities shall be kept clear of the septic system and its proposed repair area. Improper planning for underground utilities can negatively impact the installation and, in some cases,cause irreparable damage and permit revocation. 4 2650 Charleston Court 2. Water lines must be kept at least ten(10)feet from any portion of the septic system. 3. Irrigation systems should not be placed in the drain field area. Maintenance H. Required Maintenance 1. The septic should be pumped/cleaned out when the solids within the tank reach an elevation that is equivalent to 25% of the volume of the tank. In some situations, the tanks may need to be pumped more frequently; for example, if you are using a garbage disposal, it is recommended that the septic and pump tanks be cleaned out annually (TEC recommends that a garbage disposal not be used with this system). At a minimum, the septic tank should be cleaned out every 3-5 years. A reputable septic contractor or certified septic inspector can help you establish a pumping frequency after you have been in the home for a few years. 2. The effluent filter should be inspected once per year. When it becomes necessary to clean the effluent filter,the filter should be removed,and the accumulated debris washed back into the septic tank— not onto the lawn. 3. The drain field area should be maintained to prevent overgrowth of vegetation. Any damp areas, leakages or malfunctions should be addressed immediately. 4. Divert surface water runoff away from the septic tank and drainfield area. Design Specifics Daily Design Flow: 480 GPD—4 bedroom house Septic Tank Size: 1,000 Gallons (2 compartments) Effluent Loading Rate: 0.4 GPD per sq. ft. Bed Dimensions: 24' Wide x 38' Long Bed Depth: 48 Inches Deep(high-side) Distribution Method: Distribution Box Number and Size of Drainlines: (8)35 Feet Long Drainline Spacing: 3 Foot on Centers Distance of Closest Drainline to Bed Sidewall: 1.5 Feet Total Length of PPBPS Drainline: 280 Linear Feet Total Number of Panels: 64 5 2650 Charleston Court Repair Option System Type: Non-Treated Drip Dispersal System LTAR: 0.125 Required Square Footage: 3,840 Square Feet Available Square Footage: 4,800 Square Feet 6 �/ 7�w NOTES: Co r •LEGEND �a.1. APPARENT SOURCE OF TITLE: LOT 42.RECORDED IN PLAT BOOK 37 PAGE 205. (CATAWBA COUNTY REGISTER 0 /4 MBAR(FOUND) Cr PrP OF DEEDS)PARCEL I13/3752-0766-3425(2650 CHARLESTON COURT) 0 CONCRETE MON POUND 4J� v O 2 AREA CALCULATED BY COORDINATE GEOMETRY METHOD. SPY IRON PIN FOUND clod.6ARH RD• TOTAL LOT AREA 36,993 NIN/0.6 war.. PROPERTY ZINC - - LINES NOT SURVEYED 3. SUBJECT TO R-20 ZONNG REGULATIONS. ----- SETRACI3 4. MINIMUM SETBACK JS' —MN— RIGHT OF WAY TIn CA MINIMUM SIDE YARD 12' N MNUM REAR YARD 25' 5.THIS PARCEL MAY RE SUBJECT TO EASEMENTS AND/OR R/W5 ( PI EITHER RECORDED OR IMPLIED. A COMPLETE AHD FULL TITLE SEARCH WAS NOT PERFORMED FOR THIS SURVEY. �Aw` 6.NO PORTION OF THIS PARCEL LIES WHIN A COMMUNITY OR FERIA FLD00 ' V YAT ZONE PER FIRM#371O375200.I DATED SEPTEMBER 5.2007. VICINITY MAP Omn cKq ••••SUPERINTENOANT TO VERIFY ALL DIMENSIONS CURVE TABLE / CURVE LENGTH RADIUS DELTA TANGENT CHORD BEARING v PRIOR TO CONSTRUCTION•••• Cl 155.80' 572.80' 15'34'14" 76.33' 155.21' 543'34'53"W Cl 70.47 50.00' 80'4202- 42.46' 64.75' 510'02'32"W / LINE TABLE • / LINE BEARING DISTANCE IRS#4'#r/ LI N35'1758'E 41.76' pP0 40/' \\r •, R \ H _Q�\G y7. FOUR CORNERS OF 0 CO CHARLOTTE LL5 4- s.)' q DB 3729 PG.185 ;+��O op / \ S� PB.37 07 205 mo 6 Q \ 9. PCS 37524786-3435 qG'` ZONE R.20 s \ 75.929 SO.593 FT. pr� \ `a7. A- e°a Ni''• �'> by \°r 'cS r5tia cr le,i, \ 6,421 7'S0' M \\ IRE 1"PIPE IPF#4 3 Gr IRE SQUARE / ORNAMENTAL a �O �‘ , TREES 2 er4r017 '9h•E9r. 4,,,, CITY OF 45, AT /°Oros 'TPE► CLAREMONT ti DR1yEW^E GOJ�' I UTILITY EASEMENT �/ Op1 �,,I.1 4 \ FOUR CORNERS OF `�1 49,67 �eJO',PC21 \ CHARLOTTE.LLC (� Q 31 / \ OB.3729 G 1B5 PB.37 PG 205 ` 2 ` r\ PION 3752-010&3425 s\ ZONE R-20 IRE#4 35,993 SO.FT. a2B• �'b ' 0.828 AC. 02 si7. \ Ih r \ , °� R so \ r A •�a, ,40 ` A6 7� NY \\ N/F \ / n° AIANG CIIUN ZHENG 6 TCAIMY L PARRIS+j, \/ 5 TING LIU \\\ RACHEL PARRIS I7B.3469 PG.7464 DEL 2064 PG.466 PB.37 PG 205 PB.37 PG 205 P106 3752-0798 4340 PID*3752-076B-2274 RF TREE LINE ZONE R-20 5 ZONE R-3D GRAPHIC SCALE \ \ 50 0 25 50 ` _ � II \ ( IN FEET ) 1 Inch — 50 ft. \ DATE REVISION \ 4/28/22 REVISED PLAN TO THE WILLOW ` PLOT PLAN: 2650 CHARLESTON COURT CLAREMONT TOWNSHIP,CATAWBA COUNTY,NC THIS IS AN EXISTING PARCEL OF LAND WITHIN A MU/ACIPAUTY DATE: MARCH 2B, 2022 THAT REGULATES PARCELS OF LAND. SCALE 1•=50' I CERTIFY THAT TARS MAP DRAWN UNDER MY SUPERVISION FROM AN ACTUAL SURVEY MADE UNDER MY SUPERVISION (DESCRIPTION RECORDED IN PROJECT#1091-0002 DEED BOOK 1395 PAGE 25): THAT THE BOUNDARIES NOT SURVEYED ARE INDICATED AS DRAWN FROM INFORMATION IN PLAT BOOK 9995, PAGE 4180; PROPERTY OWNER: THAT NE RATIO OF PRECISION OR POSITIONAL ACCURACY IS 1:10,000:AND FOUR CORNERS OF CHARLOTTE THAT THIS MAP MEETS THE REQUIREMENTS OF THE STANDARDS OF PRACTICE FOR LAND SURVEYING IN NORTH CAROUNA(21 NCAC 56.1600). 1612 SEATTLE SLEW CT. THIS 28TH DAY OF APRIL. 2022. WAXHAW,NC 28173 PRELIMINARY_ SURVEY PROVIDEDBY, JULIA A. MCDONALD RFCISTRATION / I 3617 (ri-IDE *�-4; 3556-A CENTRE CIRCLE FORT MILL. SC 29715 844-865-5263 C-4291 Ai.7EID2SIUS7-°.•-6•-.°--''115D55-,E•-e-3-114 L.41,T.A'.'v•,s'4*,)'T<A'7'4sN' 1t290iG9<4I21PE 35SNA'4'rT C 16H545O_.7l 2R5.1D 4Bi 3fEr'A3oR4m'S 5O:.T G i• //4,,r,,..../;/ ,rIp-V /- /.//t,• .;;/..0-„//../,/,.,/,,--,,,-/--• pi .r; O F / ° 1 0 W ; / / " 0-: - /S // / /-d OUR C017:7 0C / i . :- / e37 F52- , • cp.). cg.' NV.1/1" \.>.\ ..r. 0. P90 - SB-4 ..#57f,..T E:. SB-6 , - IP2 // ' ' C),,,,i# -;.1 - • ' . /+, I* ,,,,,„..--. ....•: sc rf ,,07,,,e„,,_,..,„,;• 1..: •c v V. / 9?yiiiiiif , ,•••(<,:'-: LI - . . ''''.,,,- j N. •, _ ,.... .. . ,•4 waA4 4-.'t'','' i'---f/ F /41 1"1 111I,f tlr4'114i1/,,/i,1.A'.411O,'104„01 / ig , 0 ' / r.•.... ,, `-v\tv,\o.:,.,S>i,1/4 . . 1 ---._-,--- .._41.-•1C- .---- .- •:o'' ' - PiilYPIA7 '/*in ' • s'SC*GlittS''' ----' I/ . ''. -.. ,.,' , NT ,,, • , ---.. 'fit : De- .7.-1 PC) 18( iiiiiiiip Iiii, - i y--,d7c-i? , , • -6 ,..._ ________. . . • PB.37 PG 255 if if,piA1,I ,.. \ S Ilk' RF - • N. i \ . // pat 37,527o7138-442 yltilivi l'i - i,... ---- .°- A.''''\* i • ''N. / "..,''...-: lfriii,ipi jilt SNIP ) -' -•--'* *I. ., VA ,., 7 441 . - ir4 P6 Of .71/ / .., - ,---- / ......./ , 411P4 . // A? Ill' f ‘L I r4 ws — / ,./..' / , . ' . or if e/ - ,, „co?, LEGEND PARRIS& 7 PO' -- LIDAR Generated 1-ft Contour Lines .." Tomliry L i ... i RACHEL PARRIS .7 . _ = •--- DB 2094 PG.480 ,I House Box i i / PB.37PG 205 7 ,.- 7 RF I Septic Tank— / • ) 111. PIO*3752-0768-2274 - ( 7 . - en E22 123 PPBPS Bed Area , z • Soil Boring Locations Pit Locations 7 , ....__ , / ) , h I • I Date: Thompson Prepared For: Proposed Septic Layout June 2022 Figure invironsnnesnutItlnliN 2650 Charleston Court 0 ft C4 Four Corners of Claremont, NC 28610 Scale: 20 40 1 Charlotte,LLC Catawba County TEC Job#: 22-173 , — . Thompson Environmental Consulting, Inc. Parcels: 375207683425, 375207684535, and 375207685671 Sheet 1 of 2 PO Box 541 PROPERTY ID#: Midland,NC 28107 COUNTY: Catawba SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM OWNER: Four Corners of Charlotte, LLC ADDRESS: 1612 Seattle Slew Court,Waxhaw, NC 28173 DATE EVALUATED: 05-06-22 PROPOSED FACILITY: Res. PROPOSED DESIGN FLOW(.1949): 480 gpd PROPERTY SIZE: varies LOCATION OF SITE: 2650, 2658. and 2670 Charleston Court. Claremont. NC 28610 PROPERTY RECORDED: WATER SUPPLY: ❑Private Ig Public ❑ Well ❑Spring ❑Other Lots 42,43, and 44 Olde Savannah Place EVALUATION METHOD: Auger Boring [ Pit ❑ Cut TYPE OF WASTEWATER: ISewage ❑ Industrial Process ❑Mixed r r . r P o SOIL MORPHOLOGY OTHER F (1941) PROFILE FACTORS 1 .1940 L LANDSCAPE HORIZON E POSITION/ DEPTH 1942 PROFILE # SLOPE% (IN.) .1941 .1941 ' SOIL. .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE! WETNESS/ SOIL SAPRO RESTR &LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ 0-8 FILL LS 8-84 M/SL FR/NS/NP/NEXP II I 1% SL PS 0.4 sap 0-12 FILL 12-84 M/SL FR/NS/NP/NEXP LS II PS 1% SL 0.4 sap 0-84 M/L FR/NS/NP/NEXP LS II PS 1% SL 0.4 sap 0-20 SBK/C FI/S/P/SEXP 20-84 M/SL FR/NS/NP/NEXP II PS LS 1% SL 0.4 sap DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): 7:p SOIL sc,->. \\ ANailable Space(.1945) PS PS SITE CLASSIFICATION(.1948): _Provisional) i,t It -. 1HO4q tar EVALUATED BY: Mac Haut, LSS leff System Type(s) PPBPS Drip OTHERS)PRESENT:LThompson, t ` `1 rt - Site LTAR 0.4 0.125 - ' � -`\ , - COMMENTS: - • ,. • ••. S Updated February 2014 -'• SOIL/SITE EVALUATION Sheet 2 of 2_ (Continuation Sheet-Complete all field infra!) PROPERTY ID#: DATE OF EVALUATION: 05-06-22 COUNTY: Catawba ■ . . . P R 0 SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS I .1940 E LANDSCAPE HORIZ .1942 POSITION/ ON .1941 .1941 SOIL .1943 .1956 .1944 PROFILE # SLOPE% DEPTH STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR CLASS TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ &LTAR (IN.) 0-24 SBK/C FI/S/P/SEXP 24-84 M/SL FR/NS/NP/NEXP II PS 5 LS 24" SL 0.4 sap 0-20 SBK/C FIIS/P/SEXP 20-84 M/SL FR/NS/NP/NEXP LS II PS 6 1% 20 SL 0.4 sap 0-8 FILL 8-84 M/SL FR/NS/NP/NEXP LS II PS 7 1% SL 0.4 sap 0-84 M/SL FR/NS/NP/NEXP II PS LS 8 1% SL 0.4 sap 0-8 FILL 8-84 M/SL FR/NS/N P/N EXP LS II PS 9 1% SL 0.4 sap COM\1I I�: Updated February 2014 LEGEND --- ------ ---use the following standard abbreviations SOIL CONVENTIONAL LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957 LTAR* CONSISTENCE STRUCTURE CC(Concave Slope) 1 S(Sand) 1.2-0.8 0.6-0.4 SEXP(Slightly Expansive) G(Single Grain) CV(Convex Slope) LS(Loamy Sand) EXP(Expansive) M(Massive) D(Drainage Way) CR(Crumb) DS(Debris Slump) ll SI.(Sandy Loam) 0.8-0.6 0.4-0.3 GR(Granular) FP(Flood Plain) L(Loam) SBK(Subangular Blocky) FS(Foot Slope) ABK(Angular Blocky) H(Head Slope) III Si(Silt) 0.6-0.3 0.3-0.15 PL(Platy) L(Linear Slope) SiCI.(Silty Clay Loam) PR(Prismatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SCL(Sandy Clay Loam) MOIST WET S(Shoulder Slope) SiL(Silt Loam) T(Terrace) VFR(Very Friable) NS(Non-sticky) IV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Friable) SS(Slightly Sticky) SIC(Silty Clay) Ft(Firm) S(Sticky) C(Clay) VFI(Very Firm v.Very Sticky) VS(Very Sticky) 0(Organic) None None EFI(Extremely Firm) NP(Non-plastic) SP(Slightly Plastic) *Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality. P(Plastic) NOTES VP(Very Plastic) HORIZON DEPTH In inches below natural soil surface DEPTH OF FILL. In inches from land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAPROIJTE St suitable)or U(unsuitable) SOH,WEINES'S Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less-record Munsell color chip designation CIASSH'7C'ATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable) Evaluation of saprolite shall be by pits. Long-term Acceptance Rate(LTAR):galidaylft1 Showprofile locations and other site features(dimensions,reference or benchmark,and North,. , 1 SEEFIGURE1I - - Updated February 2014 Thompson Environmental Consulting, Inc. Parcels: 375207683425, 375207684535, and 375207685671 Sheet 1 of 2 PO Box 541 PROPERTY ID 4: Midland,NC 28107 COUNTY: Catawba SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM OWNER: Four Corners of Charlotte, LLC ADDRESS: 1612 Seattle Slew Court, Waxhaw, NC 28173 DATE EVALUATED: 02-08-22 PROPOSED FACILITY: Res. PROPOSED DESIGN FLOW(.1949): 480 gpd PROPERTY SIZE: varies LOCATION OF SITE: 2650, 2658,and 2670 Charleston Court. Claremont, NC 28610 PROPERTY RECORDED: WATER SUPPLY: ❑Private IX Public ❑ Well ❑Spring ❑Other Lots 42,43, and 44 Olde Savannah Place EVALUATION METHOD: IX Aup�er Boring ❑ Pit ❑Cut TYPE OF WASTEWATER: [XSewage U Industrial Process ❑Mixed • • • P R 0 SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS 1 .1940 I 1•: LANDSCAPE HORIZON POSITION/ DEPTH 1942 PROFILE # SLOPE% (IN.) .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR &LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ 0-20 SBK/C FI/S/P/SEXP I 20-43 M/SL FR/NSINP/NEXP II PS Ls 1% 20" SL 0.125 drip Need PS Pit 0.4 sap 0-43 M/SL FR/NS/NP/NEXP II 7 LS SL PS 1°,10 Need 0.4 sap Pit 0-23 SBK/C FI/S/P/SEXP -, LS PS 23`- 23" 23"AR 0.15 0-20 SBK/C FI/SIP/SEXP 20-48 M/SL FR/NS/NP/NEXP II PS LS SL 0.125 d 1% — 20" drip Need 0.4 sap Pit DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): _ED Mk Se. SITE CLASSIFICATION(.1948): Provisional! ; jut) �t Available Space(.1945) PS PS VA EVALUATED BY: Mac Haupt, LSS -- y• it ,4 ,y System Type(s) PPBPS Drip t, l p OTHER(S)PRESENT:LThompso , � �Or -1 rL, y 10;n 4. _ 'K,..14,xr it • Site LTAR 0.4 0.125 i ,, ti\_-.< COMMENTS: ' _ Updated February 2014 f' {` . Lam` • I SOIL/SITE EVALUATION Sheet 2 of 2 (Continuation Sheet-Complete all field in full) PROPERTY ID#: DATE OF EVALUATION: 02-08-22 COUNTY: Catawba • • • • • P SOIL MORPHOLOGY OTHER 0 (.1941) PROFILE FACTORS .1940 LANDSCAPE IIORIZ .1942 POSITION! ON .1941 .1941 SOIL .1943 .1956 .1944 PROFII.I'. M SLOPE% DEPTH STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SA PRO RESTR CLASS (IN.) TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ &LTAR 0-40 SBK/C FUS/P/SEXP 5 LS PS 23% 40 0.3 0-42 M/SL FR/NSINP/NEXP • I I LS SL PS '� 1% Need 0.4 sap Pit 0-30 SBK/CL FI/SS/SP/SEXP I I LS SL PS 7 23% 30" Need 0.3 Pit 0-40 M/SL FR/NS/NP/NEXP II PS LS SL g 1�'r 0.4 Need Pit 0-40 M/SL FR/NS/NP/NEXP LS 11 PS 9 1% SL 0.4 Need Pit COMMENTS: Updated February 2014 LEGEND use the following standard abbreviations SOIL. CONVENTIONAL LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957 LTAR* CONSISTENCE STRUCTURE CC(Concave Slope) 1 S(Sand) 1.2.0.8 0.6-0.4 SEXP(Slightly Expansive) G(Single Grain) CV(Convex Slope) LS(Loamy Sand) EXP(Expansive) M(Massive) D(Drainage Way) CR(Crumb) DS(Debris Slump) 11 SL(Sandy Loam) 0.8-0.6 0.4-0.3 GR(Granular) FP(Flood Plain) L(Loam) SBK(Subangular Blocky) FS(Foot Slope) ABK(Angular Blocky) H(Head Slope) Ill Si(Silt) 0.6-0.3 0.3-0.15 PL(Platy) L(Linear Slope) SiCL(Silty Clay Loam) PR(Prismatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SCL(Sandy Clay Loam) MOIST WET S(Shoulder Slope) SiL(Silt Loam) T(Terrace) VFR(Very Friable) NS(Non-sticky) IV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Friable) SS(Slightly Sticky) SiC(Silty Clay) FI(Firm) S(Sticky) C(Clay) VFI(Very Firm v Very Sticky) VS(Very Sticky) 0(Organic) None None EFI(Extremely Firm) NP(Non-plastic) SP(Slightly Plastic) *Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality. P(Plastic) NOTES VP(Very Flame) HORIZONDEPIH In inches below natural soil surface DEPTH OF FILL In inches from land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAPROIJTE S(suitable)or U(unsuitable) SOIL WETNESS Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less-record Munsell color chip designation ('LASSII-!CATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable) Evaluation of saprolite shall be by pits. Long-term Acceptance Rate(LTAR):gal/day/tV Show profile locations and other site features(dimensions,reference or benchmark,and North). r b 1 ' ' i ' -inii__. , . , , . , , ..._ _ . , . , i SEE FIGURE 1 -� i i l Updated February 2014 AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. 42, 43, & 44 PHASE PARCEL ID: 375207683425.375207684535 and 375207685671 STREET ADDRESS: 2650, 2658, and 2670 Charleston Court (Olde Savannah Place) Claremont, NC 28610 Please print: Property Owner: Four Corners of Charlotte, LLC Property Owner: The undersigned, registered property owners of the above noted property, do hereby authorize Larry Thompson, LSS of Thompson Environmental Consulting, Inc. (Contractor/Agent) (Name of consulting firm) to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this permit or certification and any and all standard and special conditions attached. Property Owner's Address (if different than property above): 1612 Seattle Slew Court, Waxhaw, NC 28173 Telephone: 704-713-2602 We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. The NC LSS evaluation attached to this application is to be used to produce design and construction features for permitting in accordance with Session Law 2018-114 Section 11. (c). Ow Si np re: Owner Signature: ramon gonzalez(Jun 16,2022 12:46 EDT) Date: Jun 16, 2022 Date: Catawba County Environmental Health 14, Y, 75.01 A III 11' 7A� 84.63 5 Air •3901 ��O j�. 161. 155.74 Spel-" •2658 o\ p� 24.11 Dik- GC I.,- v�4 Ix •2650 di" ' 70.7 43 7 I. --,. log 153y •389 6'0 Np,20, 77.51 ■ 'LS JIII /I\ .( 2 ! 0,1 `SS F------\ ....."--........" Parcel: 375207683425, 2650 CHARLESTON CT 1 in=60ft CLAREMONT, 28610 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 06/17/2022 I Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375207683425 Owner: FOUR CORNERS OF CHARLOTTE LLC Parcel Address: 2650 CHARLESTON CT Owner2: City: CLAREMONT, 28610 Address: 1612 SEATTLE SLEW CT LRK(REID): 300241 Address2: Deed Book/Page: 3729/0185 City: WAXHAW Subdivision: OLDE SAVANNAH State/Zip: NC 28173-6642 Lots/Block: 42/ School Information: Last Sale: $27,500 on 2003-12-30 School District: COUNTY Plat Book/Page: 37/205 Elementary School: CLAREMONT Legal: LOT 42 42 PL37-205 OLDE SAVANNAH PL Middle School: RIVER BEND 37 205 High School: BUNKER HILL Calculated Acreage: .820 Tax Map: School Map Township: CLINES State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: CLAREMONT Zoning District: CLAREMONT County Fire District: All in City Zoning1: R-1 Building(s) Value: $0 Zoning2: Land Value: $32,400 Zoning3: Assessed Total Value: $32,400 Zoning Overlay: Year Built/Remodeled: / Small Area: ST STEPHENS/OXFORD 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 #: 3710375200J If available, Building Permits for this parcel. Septic 2010 Census Block: 3012 links are not permits. 2010 Census Tract: 010102 Septic Final Permits prior to 08/2018, contact Agricultural District: PROXIMITY Environmental Health_ Building Details LsJ ) VG sJhe- WaterShed: WS-IV Protected Area Voter Precinct: P6/Voting Map L/-a R L1 °g Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report 3; This map/report product was prepared from the Catawba County,NC Geospabal 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. 1?'41111111‘.. � CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 Tuesday,June 21, 2022 Ig , sM www.catawbacountync.gov PAYOR: Four Corners of Charlotte Inc Four Corners of Charlotte Inc(Cahudgar,Romil) PAYMENTS TRANSACTION NUMBER: TRC-42058350-21-06-2022 PAYMENT DATE: 06/21/2022 PAYMENT TYPE: Credit Card 291482252 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 06-22-408190 110-580200-663000 LSSP S135.00 TOTAL PAYMENTS: $135.00 RBPR-06-2022-41426 CASE TYPE: Residential Building Plan Review WORK CLASS: Building New SITE ADDRESS: 2650 CHARLESTON CT,CLAREMONT NC 28610 Applicant FOUR CORNERS OF CHARLOTTE LLC, 1612 SEATTLE SLEW CT,WAXHAW NC 28173 C:704-713-2602 ROMELLE03@YAHOO.COM YAHOO.COM Paid By FOUR CORNERS OF CHARLOTTE INC, 1612 SEATTLE SLEW CT,WAXHAW NC 28173 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 06/21/2022 14:11 Page 1 of