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HomeMy WebLinkAboutLSSP-11-2022-184410.tif . hr i I�5 c - 0-5 /� y� ROY COOPER•Governor ( 'J 1912- o ff-Zu 2l `5 177 ;.,'y NC DEPARTMENT OF KODY H. KINSLEY•Secretary_ HEALTH AND HELEN WOLSTENHOLME• Interim Deputy Secretaryfor Health ,�r ;. 2gr HUMAN SERVICES ^ ••^- 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: /(` 7 7-1- by /11 Dote Initials PART 1:Notice of Intent to Construct(NOI)-Please check all that apply v ❑� 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.): Century Complete Mailing address: 9325 Center Lake Dr., Suite 160 City: Charlotte State: NC Zip: 28216 Telephone number: 833-791-0192 E-mail Address: Glenn.Bird@centurycommunities.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): Lot 125—Mill Stone,4874 Stone Drive Conover(Parcel: 3744-1722-4386) County Name: Catawba 6. Type of facility: 0 Place of residence No. Bedrooms: 3 No.Occupants:6 ❑ 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: L' �r— ) 1 —Z 022 r ol11 f o 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 pretreated PPBPS system located behind the proposed house site. System Type V(a). 9. Design wastewater flow: 360 gpd Design wastewater strength: Q 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: It 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(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 1 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.19,3 .ti ities determined to be engineering as determined by the North Carolina Board of Examiners for n ' and rveyors. 1 1-05-22 Signature of tic orr s tentist Date OI rcfself-submittal of N01: 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 OHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April2022 Page 2 of 6 I i COVID-19 Permit Option Common Form LHD Reference: LsJf— II l' 2 2—j o 1 f L1(d 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.C.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: Lo-ff` l I-?UL Z`l/&"I ! ('Q 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 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 deportment 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,LISPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date EY-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 LSS and the Owner on (-( Z via Dote 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 Date DHHS/EH5/OSWP-LSS C-19 COMMON FORM Updated April 2022 Page 4 of 6 • • DTP.- II-2°22 -I i/11 H COVID-19 Permit Option Common Form LHD Reference: o Re-submittal of NOI with missing items included This Section is for use by owner to submit Items noted as missing during LHD Compkteness Review above. Resubmittals must be accompanied by a cover letter from the LSS. LHD USE ONLY: This NOI resubmittal received: by Dote Initials Rem 8 from initial NOI Resubmittal description Attestation by LSS pursuant to S.L.2020-97,Section 3.29 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 Local'Health Department use after submittal of hems 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 Dote Email,FAX USPS,Hand-delivered A complete copy of this form with tracking information was sent to the State: via Date Email,FAX,USPS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date DHHS/ENS/OSWP—LSS C-19 COMMON FORM Updated April2022 Page 5 of 6 Lot 125-Millstone State of NC LSS Permit Option COVID-19 4874 Stone Drive LHD Reference: ff - It-Zai2 - I d 1/D Conover, NC 28613 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: 12-—(��`2 7- by /c-I �Date Initials Date of Post-construction Conference: rr'"�r The following items are included in this submittal for an Authorization to Operate under an LSS COVID-19 permit: 1. Signed and sealed copy of the LSS's report that includes: a. Signed and sealed evaluation of soil conditions and site features ®Yes ❑No b. Drawings,specifications, plans X❑Yes ❑No c. Reports on special inspections and final inspection ®Yes ❑ No d. Management Program manual ❑X Yes ❑ No e. On-site Wastewater Contractor's signed statement ®Yes ❑ No 2. Fee (as applicable) ❑Yes El No 3. Notarized letter documenting Owner's acceptance of the system from the LSS ©Yes ❑ No 4. On-site Wastewater Contractor name: Sid Gaskins License number: 1077 Mailing address: 4744 Celia Creek Road City: Lenoir State: NC Zip: 28645 Telephone number: 828-244-9765 E-mail Address: sid@watermanagementnc.net S. 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. X❑Yes ❑ No Attestation by the Owner for Authorization to Operate 1 Century Complete hereby attest that all items indicated above have been provided to the Print name of Owner Catawba County LHD and the system shall meet applicable federal,State,and local laws, regulations, rules and ordinances. Glenn Bird(Dec 1.3,2022 15:20 EDT) Dec 13, 2022 Signature of Owner Date This section for LHD Use Only. LHD Review of required information for the ATO ❑ INCOMPLETE Based upon review of information submitted by the Owner in the Section above,the following items are missing from the information required for an Authorization to Operate for an LSS COVID-19 permit: Copies of this signed form were sent to the LSS and the Owner on via . Date Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ['COMPLETE Based upon review of information submitted by the Owner in the Section above,this Authorization to Operate is hereby issued in accordance with G.S. 130A-336.2(m). A copy of this complete NitAoticti oitca,OI/ATO with tracking information was sent to the State on I).JIb1z i.a rear Oat Email,FAX,USPS,Hand-delivered 1 2- Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Dote 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/OSWPB-LSS COVID-19 COMMON FORM Effective September 8,2020 Page 6 of 6 LSS COVID-19 Permit Option Tracking information The LHD completes this form for each NOI/ATO submitted to their offices. The LHD updates this information and re- sends it throughout the process as appropriate. The Department will use this data to answer any questions on the implementation of the LSS COVID-19 permitting process. Tracking information for LSS COVID-19 permits (Required) County Cake(w a LHD Reference Number Lss P-o_ �aa-184 10 Permitting backlog as of date of NOI submittal(#days) 35 da`� Number of days to process the NOI(#days) 5 dal; Number of days to process re-submitted NOI(#days or 111I ` "NA") N Facility type ? eec`eoM Nye, Domestic,High Strength or IPWW Qbr j L Design Daily Flow 3b0 Residential or Commercial g.estdtr -ct I System type(per Rule.1961) q Date of Post-construction conference Nit Date Authorization to Operate issued )}t 15,2z Fee charged for LSS COVID-19 Nie3 ci o_oa Is fee sufficient to cover LHD costs? Date LHD notified of LSS COVID-19 malfunction Date LHD notified of Owner complaint DHHS/EHS/OSWP-COVID-19 Appendix A Updated February 2022 Page 4 of 4 Century Complete 9325 Center Lake Dr., Suite 160 Charlotte, NC 28216 Subject: Septic System Installation Lot 125—Millstone 4874 Stone Drive Conover, NC 28613 The septic system installed on the above-referenced property was specified by Larry Thompson, LSS,and installed by Sid Gaskins. Century complete does hereby accept the septic system installation for Lot 125 - Millstone. 12-13-22 R Century Complet Date NORTH CAROLINA NOTARY ACKNOWLEDGMENT THE STATE OF NORTH CAROLINA COUNTY OF U.-Is-oil I, C7)Let 11.4 n 1.61.,(4 , Notary Public,do hereby certify that `I7sd 1 yac"5 (name of individual(s)whose acknowledgment is being taken) personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and official seal this t3 day of�_ a v 2027— / 7„..e. frt 1 Notary Public Signature Print (: Ld44 a ' S11 My commission expires: 'osZ 2-T 1 2t7Z—I Official Seal) GLENN R BIRD ( I NOTARY PUBLIC 1 Union County North Carolina My Gonwni<.4t�n Expires August 23,2027 • December 14, 2022 RE: Septic System Installation Lot 125 — Millstone 4874 Stone Drive Conover, NC 28613 The purpose of this letter is to confirm that the septic system installation for Lot 125 — Millstone has been installed in general accordance with the proposal submitted to your office by Larry Thompson, LSS. Sincerely, Sdney L.Gaski Jr.(Dec 14. 04:45 EST) 9 Sid Gaskins Water Management of North Carolina, LLC A CC)REP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDM/YV) 8/14/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT RIC,a Bankers Insurance Company PPHONE Betsy Darst FAX 128 NC-65 (Ale.No.Exti: 336-280-0316 (NC.Nol:800-899-0146 Reidsville NC 27320 novRESS: bdarst@bankersinsurance.net INSURER(S)AFFORDING COVERAGE NAIC$ Liinse#:6387078 INSURER A: Frankenmuth Mutual Insurance Company 13986 INSURED WATEMAN•01 INSURER B: Water Management of North Carolina, LLC 4744 Celia Creek Rd INSURER C: Lenoir NC 28645-6706 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:880362191 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 LTR TYPE OF INSURANCE SD SW D POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS {M MI D DlYYI'Y1 I M M!D D/YYYY) A X COMMERCIAL GENERAL LIABILITY 6657470 2/26/2022 2/26/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X I OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $10,000 PERSONAL d ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ A AUTOMOBILE LIABILITY 6657469 2/26/2022 2/26/2023 (EOMacciden1SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Par person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED x NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ A UMBRELLA LIAR OCCUR 6657470 2/26/2022 2/26/2023 EACH OCCURRENCE _ $5,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $5.000,000 DED I X I RETENTION$to nnn $ A WORKERS COMPENSATION 6657468 2/26/2022 2/26/2023 X I STATUTE I I OERH AND EMPLOYERS'LIABILITY YIN -- ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Leased/Rented Equipment 6657470 2/26/2022 2/26/2023 Max Per Item(ACV) $100,000 Deductible $500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The Workers Compensation policy Contains an Owner/Member exclusion for Sidney Gaskins. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Thompson Environmental Consulting ACCORDANCE WITH THE POLICY PROVISIONS. P.O- Box 541 Midland NC 28107 AUTHORIZED REPRESENTATIVE USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THOMPSON ENVIRONMENTAL CONSULTING , INC . W-1 TL R ♦ WASTE IV-•1 TIs R • WETLANDS December 14, 2022 RE: Septic System Installation Lot 125— Millstone 4874 Stone Drive Conover, NC 28613 The purpose of this letter is to confirm that the septic system installation Lot 125 - Millstone was installed in general accordance with the proposal submitted to your office. This system has been inspected for the LSS COVID-19 permit closeout process. Sincerely, 4 Larry B.Thompson,Jr. PO BOX 541 • MIDLAND, NC • 28107 PIIUNIt: 704-301-4881 • PMAIL: LARRY(a3T1-IOMPSONP.NV,COM WEB: 1WW1W.THOMPSONENV,COM Residential Subsurface Wastewater Treatment and Disposal System COVID-19 Proposal for Lot 125 — Millstone 4874 Stone Drive Conover, NC 28613 Tax Parcel # 3744-1722-4386 November 4, 2022 Prepared for: tttl Sou sci� Gti �.IHoMA Sri so Glenn Bird ' - - • , as Century Complete g'tzi!= s0 :A' '�� •• • 9325 Center Lake Dr., Suite 160 � ' '' Charlotte, NC 28216 1-833-791-0192 ' Aberti Prepared by: Larry Thompson, REHS, LSSwit Thompson Environmental Consulting, Inc. .......• grv„ PO Box 541 Midland, NC 28107-0541 ` • Hunter Phone: 704-301-4881 _ ;: 1001$E I a Larry@thompsonenv.comz. • r . I I- Lot 125-Millstone Details Century Complete has contracted with Thompson Environmental Consulting, Inc. (TEC) to prepare a revised septic proposal for a 3-bedroom single family residence located on Lot 125 -Millstone,4874 Stone Drive, Conover,North Carolina. Based upon an investigation performed by TEC,it was determined that a sufficient amount of"Suitable"Group IV soils are available for the installation of an Alternating Dual Field Pre-Treated Prefabricated Permeable Block Panel System for a 3-bedroom residence. The property will be served by a municipal water supply. The enclosed Licensed Soil Scientist Evaluation is being submitted pursuant to and meets the requirements of SL 2020-97 Section 3.19. Century Complete would like to request that Catawba County Environmental Health(CCEH) issue the appropriate permits for a subsurface wastewater treatment and disposal system based upon the enclosed LSS COVED-19 permit option. Location From Conover, take 1st Avenue north. Take a left onto County Home Road for 2.2 miles, then a right onto Lee Cline Road for 2.5 miles. Left onto Houston Mill Road for 0.4 miles, left onto Sone Drive. Lot will be on left in approximately 0.3 mile. 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 1, 2017. Innovative Wastewater System Approval No: IWWS-2015-03-R 1; E-2 Treat Model 600 Pretreatment Systems, June 29, January 6, 2017. 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 NC Authorized Onsite Wastewater Evaluator No. 10016E SC Certified Professional Soil Classifier No. 1 l 1 NC Subsurface Septic System Operator No. 22199 NC Grade IV Wastewater System Installer No. 1762 NC Certified Wastewater System Inspector No. 17621 2 Lot 125-Millstone Plans and Specifications A. Septic Tank 1. The septic tank shall be State approved (Section .1953 of 15A NCAC 18A), watertight, structurally sound,and 1,000 gallons in capacity. 2. The septic tank shall be fitted with an approved effluent filter. 3. It is the responsibility of the septic contractor to thoroughly inspect the septic tank prior to accepting delivery to assure that the tanks have had time to properly cure and are free of cracks or other structural deficiencies. B. Recirculating Tank 1. The recirculating tank shall be State approved(Section .1953 of 15A NCAC 18A), watertight, structurally sound, and a minimum of 1,250 gallons in capacity. 2. The recirculation tank/chamber will contain the recirculating splitter valve, or an external splitter box may be used. The recirculation tank/chamber shall have an inlet sanitary tee. The sanitary tee shall be visible and reachable from the riser opening to serve as the influent sampling point. 3. A drain back configuration without a pump check valve is required for the force main supplying the media pod. 4. Recirculation pump shall be either Sta-Rite Model number STEP 20 or manufacturer approved equal. C. Treatment Unit 1. The E-Z Treat media pod is constructed of a polymer suitable for use in contact with wastewater. The Model 600 pod is approximately 7 ft 4 inches x 4 ft with a surface area approximately of 30 square feet and is 42 inches in depth. The pod is fitted with a weatherproof cover properly secured. The pod is designed and constructed to create channels down the sidewalls to facilitate air flow.The sidewall channels provide airspace to the bottom of the pod. The bottom of the vessel is designed to provide total drainage of the treated effluent back to the recirculation tank/chamber. 2. As the effluent enters the recirculation tank/chamber, this tank/chamber acts to further separate the septic tank effluent. The effluent entering the recirculation tank/chamber is charged by the recirculation pump to the media pod(s).The effluent is sprayed over the media mattress(es) using a spray manifold of evenly spaced wide-angle spray nozzles. The nozzles are manufactured with a free passage of 0.0625 inches in diameter. The system is set to recirculate effluent through the media pod on an average of 4 to 6 times prior to discharge. 3. The effluent is sprayed on mattress(es)measuring a total area of 30 square feet.The mattress(es) are fabricated from a non-biodegradable, chemically resistant, loose weave polypropylene material. The openings in the weave allows for effluent and air flow while containing the media. The media inside the mattress(es)are made of a styrene material.The specific gravity of this material meets the following criteria: 3 Lot 125-Millstone light enough to prevent compaction which results in a loss of effective surface area and provides a reduction in channeling across the media (short-circuiting). 4. Effluent passes through the media and enters a schedule 40 pipe located at the bottom of the pod. The effluent than gravity feeds back to the recirculation tank/chamber and the process is repeated. 5. The effluent bypass valve or splitter box is piped to intercept filtered wastewater and deliver it to the recirculation tank/chamber or the dosing tank/chamber, based on liquid volumes. 6. The Control Panel for the E-Z Treat System will consist of: recirculation pump on/off timer,discharge pump alarm,and high/low water alarm. Control panels shall meet the requirements of .1952 and shall be approved in writing by E-Z Treat Company for use in their systems. 7. Separate control and alarm circuits will be provided. 8. The UV disinfection system shall be rated for the appropriate discharge rate from the E-Z Treat pod. The UV disinfection system will be one of the following: a. E- Z Set UV-I000S (single bulb); b. E-Z Set UV-1000 (dual alternating bulbs); or c. Other UV systems specifically approved by the Department and E-Z Treat Company. 9. All access riser hatches shall be secured by approved tamper-resistant hardware approved by the manufacturer or by other means approved by the manufacturer as equal. Riser construction, attachment to tanks and security systems shall be pre- approved by the Department and E-Z Treat Company in accordance with the E-Z Treat specific approvals for the septic tanks and pump tanks, as applicable. D. 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. 3. The supply lines shall be constructed of SCH. 40 PVC. E. Distribution Method 1. This is a dual alternating drainfield. Effluent will be directed from the recirculating tank to a flow diversion valve that will be rotated between two distribution boxes. 2. Each subfield will be fed a distribution box. Distribution box shall be water tested at the time of the final inspection. F. Drainfield Installation 1. The proposed drainfield location has been marked on-site utilizing metal stemmed flags. The property owner/builder should mark this area and isolate it as much as possible from construction traffic. 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 the drainfield area is dry enough to begin construction, the environmental health 4 Lot 125-Millstone specialist for this area should be contacted for permission to proceed with the installation. 3. The specified system is an alternating dual field prefabricated permeable block panel system —specifically the 16-inch panel system manufactured by T&J Panel Wastewater Treatment System, Patent No, 4013559; telephone: 1-800-222-2577. 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. There are two subfields for this system. Each subfield will be fed by a distribution box fed by a flow diversion valve. Each subfield consists of two (2) lateral trenches,each being 3-feet wide by 75 feet long—center fed. 5. Each subfield will have 150 linear feet of drainlinc for a total of 300 linear feet of drainline. 6. It is essential that the lateral trenches be constructed on contour with the land, with each trench 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. 7. The maximum trench depth for this system shall be 21 inches. Each trench shall be placed on a minimum of 8-foot on centers. 8. Once trenches are dug, the side walls shall be raked, and a light dusting of lime applied. 9. Backfill the trench with 6 inches of sand and level to grade. Once leveled, place 1 x 6-inch boards on top of the sand the entire length of each trench. Once the grade boards have been set, the panels may be set into the trench. The panels should be placed 6 inches apart. 10. 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. I I. 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. 12. Once the panels for each trench have been installed and the top of the panels closed, the trench is ready to be backfilled to the top with the sand used in the trench bottom. At this point, the trenches should be left open for the final inspection by the county environmental health specialist. E. 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). 5 Lot 125-Millstone G. Final Landscaping 1. As previously stated, the final soil cover over the drainfield shall be a minimum of 6 inches deep. Additional soil cover will be required for this system. 2. The drainfield shall be shaped to shed rainwater and be free from low spots. 3. The drainfield area 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. H. Utility Conflicts 1. The builder and property owner must take special care in planning for water,power, gas, telephone, and cable lines. These utilities shall be kept clear of all parts 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. If there are any questions regarding preferred routes, contact system designer as soon as possible. 2. Lawn irrigation should not be placed over the drainfield area. Maintenance I. In General 1. The system classification will be the same as a Type Va and will require ongoing maintenance in accordance with Table V(a) of Rule .1961(b). Management and inspection shall be in accordance with Rules .1961 and .1970. 2. System type is alternating dual drainfields controlled by a flow diversion valve. The flow diversion valve should be rotated at each 6-month inspection. 3. All E-Z Treat Pretreatment systems require an operation and maintenance agreement between the system owner and E-Z Treat Company, Inc., its authorized representative, or with an operator authorized in writing by E-Z Treat Company as per Rule.1970.The system shall be inspected according to Rule.1961 by a certified subsurface operator authorized in writing by E-Z Treat Company according. The ORC shall be either an employee of E-Z Treat Company or authorized in writing by E-Z Treat Company to operate and maintain the system.The operator authorized in writing by E-Z Treat Company must have proper equipment and training to access and program the control panels on site. 4. E-Z Treat Pretreatment systems shall be operated and maintained according to the latest version of E-Z Treat Company's O&M manual. 5. At each E-Z Treat Pretreatment system inspection the ORC authorized in writing by E-Z Treat Company shall, at a minimum, observe, monitor, and record the following: a. Wastewater level in all the tanks. b. Sludge, scum, and grease levels in all the tanks. c. Clogging of effluent filter. d. Watertightness of tanks, risers, and pipe penetrations at the tanks. 6 Lot 125-Millstone e. Operation of pumps, floats, valves, electrical controls, and alarms. f. Any structural damage, accessibility issues, adequate ventilation, excess odors, ponding of effluent, insect infestations, vegetative growth over the drainfield, or surfacing of effluent on the drainfield area. g. Sample of E-Z Treat Pretreatment system effluent collected from the sampling point to check for effluent clarity and odor and a sample of influent, as required. h. Current operational set up for TS-II nitrogen removal enhancement(percent returned to septic tank),and recommendation for modifications(if needed). i. System operating conditions, from the review stored data for indication of 7-day and 30-day flows and flow variances or other abnormal conditions. 6. The ORC authorized in writing by E-Z Treat Company shall also conduct other additional observations, measurements, monitoring, and maintenances activities as specified in the Operation Permit and as recommended by the manufacturer. J. Sampling and Testing 1. All sampling shall be done in accordance with Rule .1970(n)(3) and (5). E-Z Treat systems shall be sampled annually (semi-annually for systems with a design flow of 1,501 to 3,000 gpd). 2. TS-II systems influent shall be analyzed for TKN. 3. Effluent for all systems shall be tested.for effluent CBOD5 and NH4-N. Systems specified to meet the TS-II standard shall also have the effluent analyzed for TN (TKN and NO3-N). Systems designed to meet the TS-lI standard with design flows of 1,501 gpd to 3,000 gpd shall have the effluent analyzed for fecal coliforms. 4. Additional sampling of effluent or influent may be determined to be necessary by the ORC authorized in writing by E-Z Treat Company during a system inspection to assist with troubleshooting or to verify system performance. 5. Effluent samples shall be taken from the final recirculating tank or a sampling port located downstream from the final treatment process. 6. Influent samples shall be taken from a sampling port located between the septic tank and recirculation tank/chamber. 7. Adjustments in the monitoring schedule and number of parameters sampled may be proposed by E-Z Treat Company and approved by the Department pursuant to Rule .1970(n)(3)(B) or(C). K. Notification and Performance of Maintenance and Repairs 1. The ORC authorized in writing by E-Z Treat Company shall alert E-Z Treat Company,the LHD,and the system owner within 48 hours of needed maintenance or repair activities including but not limited to landscaping, tank sealing, tank pumping, pipe or control system repairs, media replacement, and/or adjustments to any other system component. 2. System troubleshooting and needed maintenance shall be provided to maintain the pump delivery rate and average pump run time within 25%of initial measurements 7 Lot 125-Millstone conducted during system startup. The ORC authorized in writing by E-Z Treat Company shall notify the system owner, E-Z Treat Company, and the LHD whenever the pump delivery rate efficiency or average pump ran times are not within 25%of initial measurements conducted prior to system start-up. 3. The septic tank will be pumped as needed upon recommendation of the ORC authorized in writing by E-Z Treat Company and in accordance with the E-Z Treat Pretreatment system operation and maintenance instructions. However, at a minimum, the septic tank will be pumped whenever the solids level exceeds 25% of the tank's total liquid working capacity or the scum layer is more than four inches thick. 4. The tanks shall be pumped by a properly permitted septage management firm,and the septage handled in accordance with I5A NCAC 13B .0800. 5. The E-Z Treat Pretreatment systems require an operation and maintenance agreement between the system owner and E-Z Treat Company,Inc., its authorized representative, or with an operator authorized in writing by E-Z Treat Company as per Rule .1970. The system shall be inspected according to Rule .1961 by a certified subsurface operator authorized in writing by E-Z Treat Company according.The ORC authorized in writing shall be either an employee of E-Z Treat Company or authorized in writing by E-Z Treat Company to operate and maintain the system. The operator authorized in writing by E-Z Treat Company must have proper equipment and training to access and program the control panels on site. L. Reporting 1. The ORC authorized in writing by E-Z Treat Company shall provide a completed written report to the system owner, E-Z Treat Company, and the LHI] within 30 days of each inspection. At a minimum this report shall specify: a. The date and time of inspection, b. System operating conditions according to Section VII.D, VII.E, and VII.F. c. Results from any laboratory analysis of any influent and effluent samples, d. Maintenance activities performed since the last inspection report, e. An assessment of overall system performance, f. A list of any improvements or maintenance needed, g. A determination of whether the system is malfunctioning,and the specific nature of the malfunction, h. Any changes made in system settings, based on recommendations of the manufacturer, and i.A summary report of data retrieved from the control panel verifying actual daily, 7-day, and 30-day flows, flow variances, and other operating conditions. 8 Lot 125-Millstone Design Specifics Daily Design Flow: 360 GPD—3 bedroom house Septic Tank Size: 1,000 gallons(minimum) Recirculation Tank Size: 1,250 gallons(minimum) Treatment Unit: E-2 Treat Model 600 Effluent Loading Rate: Design=0.3 gpd/ft2 Drain Field Type: Alternating Dual PPBPS Distribution Method: Flow Diversion Valve and Distribution Boxes(2) Number of Drainlines: 4 Drainlines: (4)3-ft Wide x 75-ft Long Drainlines to be Center-Fed Total Trench Length: 300 Linear Feet Subfield Size: 150 Linear Feet Total Number of Panels: 64(See Attached PPBPS Sheet) Maximum Trench Depth: 21 Inches Final Cover Requirement: 6 Inches(minimum) 9 PPBPS Design Worksheet File#: Tax#: 3744-1722-4386 System Requirements Address: 4874 Stone Drive Design Flow 360 gpd Conover,NC 28613 LTAR 0.300 gpd/ft.^2 Consultant: Larry Thompson Linear footage 400 ft.(conventional) Phone:704-301-4881 Linear footage 300 ft.(PPBPS-Alternating Dual Drainfields) Reviewed By: Design Layout Date: Laterals Length(ft) #Panels Line#1 37.5 8 Line#2 37.5 8 Line#3 37.5 8 Line#4 37.5 8 Line#5 37.5 8 Line#6 37.5 8 Line#7 37.5 8 Line#8 37.5 8 Totals 300 64 Absorption Area Length(ft) Width(ft) Area(ft^2) 300 2 600 Trench Spacing is 8-ft OC T 8 J Panels Linear Feet #Panels 50 11 60 14 70 16 80 18 90 21 100 23 / . 4f/ /. _------/ ljr' l'T I7 nor 11 P LEG- ,� /� PJp f:., NO EY 1 / ��� . to A LL4 / • .• ____ •�Qf*AY 001 //// le/ dA" �/ l for cc, , *-;;,,...:,,..„, ,, "'� 1,1156 . _, --__ 4. • J:.r PIN i3744 r., j s. • a': rim. oti i ti y / 6-/\______„\7/../40 row \0101/4 oy• / 131.,\A / /r\,\- r"I5 r e1122.43)v: r ` J d 1 N. , ' r , !, BERK,tt.; J ' � A \ ,•________ • N, \ B3 a ' iii----- -4(7:1 /r '06 BS tIP rA "3 •M dit ipir.:7'7 '. a • LEGEND V01011 1°1 c i d- lead, 0000/ , - LIDAR Generated 1-ft Contour Lines Stream ..?'' ..... gil 1• 25-ft Stream Buffer arp " ' Water Line 48s. dR1�WE F Septic Tank and Recirculating Tank PG rsa /iI i LE EZ Treat Pod Supply Line oti° t• , . 4 Y. E DRIVE • Flow Diversion Valve iTANCa ND•+TANG% F/OT12$..K.Of StbNESU••MSION- frvE J POO BOOK S6. 'AGE 136 ••; 2 = P. El r. v,641 4 FEU ,III ® Distribution Boxes >x� n . R ••T •MA • ,' , cONovER. 28613/ NAY , .•.': • •:' a1 ',. . r y CATAWBACOUNTY. •.• CA OUNA solo::z' :ions nli • ' 0.• -• •' C •• °RD Y• • PER F vaEp•sr5, OR: �I • ,9 CENTURY COMy1UNITIE5 Date; Proposed Septic Layout Figure Thompson (�, November 2022 EnwronmenUf'� Prepared For: Lot 125-Millstone Scale: milmgwltlng 4874 Stone Drive a 's : a Century Complete Conover, NC 28613 TEC Job#: Catawba County 72-19 I -- • SFCIIOW WM • • EUtvmltt DIIiI t �.C11o ....Ir SEC IION'C' •• .n*.? " --I _I ,! - ,_222.-.t. MfY y4,.........4, - __..-. -.-. .. -.ir; .1 PLAN lir •=•,,.--..-x. 1 --- SEC igN'A' Dale: E-Z Treat Pretreatment Detail November 2022 Figure Thompson Prepared For: Lot 125- Millstone Environments p scale: Consulting 4874 Stone6 '�' 2' '�� Century Complete Conover, NC 28 28b13 Not to Scale TEC Job 44: Catawba County 22-19 fi _ 1)—Zc72Z — J Yfylo �,,,,STA7f�,, ROY COOPER•Governor !, 1 P� O K—7-d 2] '''S'/ ?7 v ,.. 09 �", / 4 'y�, NC DEPARTMENT OF KODY H. KINSLEY•Secretary e� .; ' i HEALTH AND �_` HUMAN SERVICES HELEN WOLSTENHOLME•Interim Deputy Secretary for Health ., w^•,. MARK T.BENTON•Assistant Secretary for Public Health « , E 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: // 7 "21-- by /`t Date Initials PART 1:Notice of Intent to Construct(NOI)-Please check all that apply ❑� Single System or El Multiple Systems AND ❑■ New ❑Expansion ❑Relocation of all or part of the Existing System ❑Relocation of Repair Area El Repair—LHD Permit Number ❑Repair—EOP/LSS COVID 19/AOWE Permit Number 1. Facility Owner's name:(Owner,Company Name,Utility,Partnership, Individual,etc.): Century Complete Mailing address: 9325 Center Lake Dr., Suite 160 City: Charlotte State: NC Zip: 28216 Telephone number: 833-791-0192 E-mail Address: Glenn.Bird@centurycommunities.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: ❑I LSS ❑ LG 5. Property location(physical address,tax parcel identification number or subdivision lot,block number of the property to be permitted): Lot 125—Mill Stone,4874 Stone Drive Conover(Parcel: 3744-1722-4386) County Name: Catawba 6. Type of facility: ❑■ Place of residence No. Bedrooms: 3 No.Occupants:6 ❑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: LLW ) 1 —2 6'22 ") L/L(J0 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 pretreated PPBPS system located behind the proposed house site. System Type V(a). 9. Design wastewater flow: 360 gpd Design wastewater strength: ❑Q 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 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(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 EYes ❑■ 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 l 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.193_ -ti'ities determined to be engineering as determined by the North Carolina Board of Examiners for n ' and rveyors. 11-05-22 Signoturs of Lic oir lentist Date Otivefself-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 Dote DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 2 of 6 COVID-19 Permit Option Common Form LHD Reference: L'}'F` — I( "Id Z L-) 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[Si.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—155 C-19 COMMON FORM Updated April 2022 Page 3 of 6 COVID-19 Permit Option Common Form LHD Reference: L JJ f, ` 11-20 Z 2-r & I ( (e 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 deportment 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 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 LSS 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,LISPS,hand-delivered ` d ). 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 April2022 Page 4 of 6 COVID-19 Permit Option Common Form LHD Reference: (- I 22 /YIN/0 Re-submittal of NOI with missing Items included This Section is for use by owner to submit items noted as missing during!HD 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#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 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 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 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 April2022 Page 5 of 6 COVID-19 Permit Option Common Form LHD Reference: J.t /- r Z d2-Z- D%'( /D 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 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 ISS'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 I, 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 Date Email,FAX,LISPS,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 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 LHD 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.I30A-339. DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April2022 Page 6 of 6 DATE(MMIDD/YYYY) ACC RD CERTIFICATE OF LIABILITY INSURANCE 9/7/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: David Vaughan Higginbotham Insurance Agency, Inc. PHONE l FAX - 500 W. 13th Street -(AIC.No.Ext): 9187797880 LAIC,Not:817-882-9284 Fort Worth TX 76102 ADD iESS: dlvjr@higginbotham.net INSURER(S)AFFORDING COVERAGE NAIC License#:2081754 INSURER A:Mid-Continent Casualty Company 23418 INSURED THOMENV-01 INSURER B:Hartford Underwriters Insurance Company 30104 Thompson Environmental Consulting, Inc. PO Box 541 INSURER C: _ Midland NC 28107-0541 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1600075032 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 ADDL SUBR POLICY EFF POLICY EXP W D/ LIMITS LTR JNSD VD POLICY NUMBER (MM/DYYYYI (MMJDD/YYYYI A X COMMERCIAL GENERAL LIABILITY 04-GL-001086672 9/25/2022 9/25/2023 EACH OCCURRENCE $1,000,000 DAMAGE TRENTE CLAIMS-MADE I J OCCUR PREMISES(Ea occurrence) $100,000 X Professional MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY PRO- JECTI ]LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ B :WORKERS COMPENSATION 38WECNW6175 10/17/2021 10/17/2022 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 • DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE 544.q41 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Residential Subsurface Wastewater Treatment and Disposal System COVID-19 Proposal for Lot 125 — Millstone 4874 Stone Drive Conover, NC 28613 Tax Parcel # 3744-1722-4386 November 4, 2022 Prepared for: to sort$ciF Glenn Bird r.` Century Complete ' '" 9325 Center Lake Dr., Suite 160 y����"� � "= �•, Charlotte, NC 28216 1287 1-833-791-0192 cl`'n cs4 Prepared by: Larry Thompson, REHS, LSS ��wA jl-' Thompson Environmental Consulting, Inc. ........ Er v: PO Box 541 + tniotban•' Midland, NC 28107-0541 Number AI Phone: 704-301-4881 =_ es. 1 0016 E r larry@thompsonenv.com _ , ' •; • ••F`AC �10 U ,. r I 1 Lot 125-Millstone Details Century Complete has contracted with Thompson Environmental Consulting, Inc. (TEC) to prepare a revised septic proposal for a 3-bedroom single family residence located on Lot 125 - Millstone, 4874 Stone Drive, Conover, North Carolina. Based upon an investigation performed by TEC, it was determined that a sufficient amount of"Suitable"Group IV soils are available for the installation of an Alternating Dual Field Pre-Treated Prefabricated Permeable Block Panel System for a 3-bedroom residence. The property will be served by a municipal water supply. The enclosed Licensed Soil Scientist Evaluation is being submitted pursuant to and meets the requirements of SL 2020-97 Section 3.19. Century Complete would like to request that Catawba County Environmental Health (CCEH) issue the appropriate permits for a subsurface wastewater treatment and disposal system based upon the enclosed LSS COVID-19 permit option. Location From Conover, take 1st Avenue north. Take a left onto County Home Road for 2.2 miles, then a right onto Lee Cline Road for 2.5 miles. Left onto Houston Mill Road for 0.4 miles, left onto Sone Drive. Lot will be on left in approximately 0.3 mile. 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 1, 2017. Innovative Wastewater System Approval No: IWWS 2015-03-R1; E-Z Treat Model 600 Pretreatment Systems, June 29, January 6, 2017. 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 NC Authorized Onsite Wastewater Evaluator No. 10016E SC Certified Professional Soil Classifier No. 111 NC Subsurface Septic System Operator No. 22199 NC Grade IV Wastewater System Installer No. 1762 NC Certified Wastewater System Inspector No. 17621 2 Lot 125-Millstone Plans and Specifications A. Septic Tank 1. The septic tank shall be State approved (Section .1953 of 15A NCAC 18A), watertight, structurally sound, and 1,000 gallons in capacity. 2. The septic tank shall be fitted with an approved effluent filter. 3. It is the responsibility of the septic contractor to thoroughly inspect the septic tank prior to accepting delivery to assure that the tanks have had time to properly cure and are free of cracks or other structural deficiencies. B. Recirculating Tank 1. The recirculating tank shall be State approved(Section .1953 of 15A NCAC 18A), watertight, structurally sound, and a minimum of 1,250 gallons in capacity. 2. The recirculation tank/chamber will contain the recirculating splitter valve, or an external splitter box may be used. The recirculation tank/chamber shall have an inlet sanitary tee. The sanitary tee shall be visible and reachable from the riser opening to serve as the influent sampling point. 3. A drain back configuration without a pump check valve is required for the force main supplying the media pod. 4. Recirculation pump shall be either Sta-Rite Model number STEP 20 or manufacturer approved equal. C. Treatment Unit 1. The E-Z Treat media pod is constructed of a polymer suitable for use in contact with wastewater. The Model 600 pod is approximately 7 ft 4 inches x 4 ft with a surface area approximately of 30 square feet and is 42 inches in depth. The pod is fitted with a weatherproof cover properly secured. The pod is designed and constructed to create channels down the sidewalls to facilitate air flow.The sidewall channels provide airspace to the bottom of the pod. The bottom of the vessel is designed to provide total drainage of the treated effluent back to the recirculation tank/chamber. 2. As the effluent enters the recirculation tank/chamber, this tank/chamber acts to further separate the septic tank effluent. The effluent entering the recirculation tank/chamber is charged by the recirculation pump to the media pod(s). The effluent is sprayed over the media mattress(es) using a spray manifold of evenly spaced wide-angle spray nozzles. The nozzles are manufactured with a free passage of 0.0625 inches in diameter. The system is set to recirculate effluent through the media pod on an average of 4 to 6 times prior to discharge. 3. The effluent is sprayed on mattress(es)measuring a total area of 30 square feet. The mattress(es) are fabricated from a non-biodegradable, chemically resistant, loose weave polypropylene material. The openings in the weave allows for effluent and air flow while containing the media. The media inside the mattress(es) are made of a styrene material. The specific gravity of this material meets the following criteria: 3 Lot 125-Millstone light enough to prevent compaction which results in a loss of effective surface area and provides a reduction in channeling across the media(short-circuiting). 4. Effluent passes through the media and enters a schedule 40 pipe located at the bottom of the pod. The effluent than gravity feeds back to the recirculation tank/chamber and the process is repeated. 5. The effluent bypass valve or splitter box is piped to intercept filtered wastewater and deliver it to the recirculation tank/chamber or the dosing tank/chamber, based on liquid volumes. 6. The Control Panel for the E-Z Treat System will consist of: recirculation pump on/off timer,discharge pump alarm,and high/low water alarm.Control panels shall meet the requirements of .1952 and shall be approved in writing by E-Z Treat Company for use in their systems. 7. Separate control and alarm circuits will be provided. 8. The UV disinfection system shall be rated for the appropriate discharge rate from the E-Z Treat pod. The UV disinfection system will be one of the following: a. E- Z Set UV-1000S (single bulb); b. E-Z Set UV-1000 (dual alternating bulbs); or c. Other UV systems specifically approved by the Department and E-Z Treat Company. 9. All access riser hatches shall be secured by approved tamper-resistant hardware approved by the manufacturer or by other means approved by the manufacturer as equal. Riser construction, attachment to tanks and security systems shall be pre- approved by the Department and E-Z Treat Company in accordance with the E-Z Treat specific approvals for the septic tanks and pump tanks, as applicable. D. 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. 3. The supply lines shall be constructed of SCH. 40 PVC. E. Distribution Method 1. This is a dual alternating drainfield. Effluent will be directed from the recirculating tank to a flow diversion valve that will be rotated between two distribution boxes. 2. Each subfield will be fed a distribution box. Distribution box shall be water tested at the time of the final inspection. F. Drainfield Installation 1. The proposed drainfield location has been marked on-site utilizing metal stemmed flags. The property owner/builder should mark this area and isolate it as much as possible from construction traffic. 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 the drainfield area is dry enough to begin construction, the environmental health 4 Lot 125-Millstone specialist for this area should be contacted for permission to proceed with the installation. 3. The specified system is an alternating dual field prefabricated permeable block panel system —specifically the 16-inch panel system manufactured by T&J Panel Wastewater Treatment System, Patent No. 4013559; telephone: 1-800-222-2577. 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. There are two subfields for this system. Each subfield will be fed by a distribution box fed by a flow diversion valve. Each subfield consists of two (2) lateral trenches,each being 3-feet wide by 75 feet long—center fed. 5. Each subfield will have 150 linear feet of drainline for a total of 300 linear feet of drainline. 6. It is essential that the lateral trenches be constructed on contour with the land,with each trench 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. 7. The maximum trench depth for this system shall be 21 inches. Each trench shall be placed on a minimum of 8-foot on centers. 8. Once trenches are dug, the side walls shall be raked, and a light dusting of lime applied. 9. Backfill the trench with 6 inches of sand and level to grade. Once leveled, place 1 x 6-inch boards on top of the sand the entire length of each trench. Once the grade boards have been set, the panels may be set into the trench. The panels should be placed 6 inches apart. 10. 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. 1 I. 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. 12. Once the panels for each trench have been installed and the top of the panels closed, the trench is ready to be backfilled to the top with the sand used in the trench bottom. At this point, the trenches should be left open for the final inspection by the county environmental health specialist. E. 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). 5 Lot 125-Millstone G. Final Landscaping 1. As previously stated, the final soil cover over the drainfield shall be a minimum of 6 inches deep. Additional soil cover will be required for this system. 2. The drainfield shall be shaped to shed rainwater and be free from low spots. 3. The drainfield area 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. H. Utility Conflicts 1. The builder and property owner must take special care in planning for water,power, gas, telephone, and cable lines. These utilities shall be kept clear of all parts 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. If there are any questions regarding preferred routes, contact system designer as soon as possible. 2. Lawn irrigation should not be placed over the drainfield area. Maintenance I. In General 1. The system classification will be the same as a Type Va and will require ongoing maintenance in accordance with Table V(a) of Rule .1961(b). Management and inspection shall be in accordance with Rules .1961 and .1970. 2. System type is alternating dual drainfields controlled by a flow diversion valve. The flow diversion valve should be rotated at each 6-month inspection. 3. All E-Z Treat Pretreatment systems require an operation and maintenance agreement between the system owner and E-Z Treat Company, Inc., its authorized representative, or with an operator authorized in writing by E-Z Treat Company as per Rule.1970.The system shall be inspected according to Rule.1961 by a certified subsurface operator authorized in writing by E-Z Treat Company according. The ORC shall be either an employee of E-Z Treat Company or authorized in writing by E-Z Treat Company to operate and maintain the system.The operator authorized in writing by E-Z Treat Company must have proper equipment and training to access and program the control panels on site. 4. E-Z Treat Pretreatment systems shall be operated and maintained according to the latest version of E-Z Treat Company's O&M manual. 5. At each E-Z Treat Pretreatment system inspection the ORC authorized in writing by E-Z Treat Company shall, at a minimum, observe, monitor, and record the following: a. Wastewater level in all the tanks. b. Sludge, scum, and grease levels in all the tanks. c. Clogging of effluent filter. d. Watertightness of tanks,risers, and pipe penetrations at the tanks. 6 Lot 125-Millstone e. Operation of pumps, floats, valves, electrical controls, and alarms. f. Any structural damage, accessibility issues, adequate ventilation, excess odors, ponding of effluent, insect infestations, vegetative growth over the drainfield, or surfacing of effluent on the drainfield area. g. Sample of E-Z Treat Pretreatment system effluent collected from the sampling point to check for effluent clarity and odor and a sample of influent, as required. h. Current operational set up for TS-Il nitrogen removal enhancement(percent returned to septic tank), and recommendation for modifications (if needed). i. System operating conditions, from the review stored data for indication of 7-day and 30-day flows and flow variances or other abnormal conditions. 6. The ORC authorized in writing by E-Z Treat Company shall also conduct other additional observations, measurements,monitoring, and maintenances activities as specified in the Operation Permit and as recommended by the manufacturer. J. Sampling and Testing 1. All sampling shall be done in accordance with Rule .1970(n)(3) and(5). E-Z Treat systems shall be sampled annually (semi-annually for systems with a design flow of 1,501 to 3,000 gpd). 2. TS-II systems influent shall be analyzed for TKN. 3. Effluent for all systems shall be tested for effluent CBOD5 and NH4-N. Systems specified to meet the TS-II standard shall also have the effluent analyzed for TN (TKN and NO3-N). Systems designed to meet the TS-II standard with design flows of 1,501 gpd to 3,000 gpd shall have the effluent analyzed for fecal coliforms. 4. Additional sampling of effluent or influent may be determined to be necessary by the ORC authorized in writing by E-Z Treat Company during a system inspection to assist with troubleshooting or to verify system performance. 5. Effluent samples shall be taken from the final recirculating tank or a sampling port located downstream from the final treatment process. 6. Influent samples shall be taken from a sampling port located between the septic tank and recirculation tank/chamber. 7. Adjustments in the monitoring schedule and number of parameters sampled may be proposed by E-Z Treat Company and approved by the Department pursuant to Rule .1970(n)(3)(B) or(C). K. Notification and Performance of Maintenance and Repairs 1. The ORC authorized in writing by E-Z Treat Company shall alert E-Z Treat Company,the LHD,and the system owner within 48 hours of needed maintenance or repair activities including but not limited to landscaping, tank sealing, tank pumping, pipe or control system repairs, media replacement, and/or adjustments to any other system component. 2. System troubleshooting and needed maintenance shall be provided to maintain the pump delivery rate and average pump run time within 25%of initial measurements 7 Lot 125-Millstone conducted during system startup. The ORC authorized in writing by E-Z Treat Company shall notify the system owner, E-Z Treat Company, and the LHD whenever the pump delivery rate efficiency or average pump ran times are not within 25%of initial measurements conducted prior to system start-up. 3. The septic tank will be pumped as needed upon recommendation of the ORC authorized in writing by E-Z Treat Company and in accordance with the E-Z Treat Pretreatment system operation and maintenance instructions. However, at a minimum, the septic tank will be pumped whenever the solids level exceeds 25% of the tank's total liquid working capacity or the scum layer is more than four inches thick. 4. The tanks shall be pumped by a properly permitted septage management firm, and the septage handled in accordance with 15A NCAC 13B .0800. 5. The E-Z Treat Pretreatment systems require an operation and maintenance agreement between the system owner and E-Z Treat Company,Inc., its authorized representative, or with an operator authorized in writing by E-Z Treat Company as per Rule .1970. The system shall be inspected according to Rule .1961 by a certified subsurface operator authorized in writing by E-Z Treat Company according.The ORC authorized in writing shall be either an employee of E-Z Treat Company or authorized in writing by E-Z Treat Company to operate and maintain the system. The operator authorized in writing by E-Z Treat Company must have proper equipment and training to access and program the control panels on site. L. Reporting 1. The ORC authorized in writing by E-Z Treat Company shall provide a completed written report to the system owner, E-Z Treat Company, and the LHD within 30 days of each inspection. At a minimum this report shall specify: a. The date and time of inspection, b. System operating conditions according to Section VII.D, VII.E, and VII.F. c.Results from any laboratory analysis of any influent and effluent samples, d. Maintenance activities performed since the last inspection report, e. An assessment of overall system performance, f. A list of any improvements or maintenance needed, g. A determination of whether the system is malfunctioning,and the specific nature of the malfunction, h. Any changes made in system settings, based on recommendations of the manufacturer, and i.A summary report of data retrieved from the control panel verifying actual daily, 7-day, and 30-day flows, flow variances, and other operating conditions. 8 Lot 125-Millstone Design Specifics Daily Design Flow: 360 GPD—3 bedroom house Septic Tank Size: 1,000 gallons(minimum) Recirculation Tank Size: 1,250 gallons(minimum) Treatment Unit: E-Z Treat Model 600 Effluent Loading Rate: Design=0.3 gpd/ft2 Drain Field Type: Alternating Dual PPBPS Distribution Method: Flow Diversion Valve and Distribution Boxes(2) Number of Drainlines: 4 Drainlines: (4)3-ft Wide x 75-ft Long Drainlines to be Center-Fed Total Trench Length: 300 Linear Feet Subfield Size: I50 Linear Feet Total Number of Panels: 64(See Attached PPBPS Sheet) Maximum Trench Depth: 21 Inches Final Cover Requirement: 6 Inches(minimum) 9 PPBPS Design Worksheet File#: Tax#:3744-1722-4386 System Requirements Address:4874 Stone Drive Design Flow 360 gpd Conover,NC 28613 LTAR 0.300 gpd/ft."2 Consultant:Larry Thompson Linear footage 400 ft.(conventional) Phone:704-301-4881 Linear footage 300 ft.(PPBPS-Alternating Dual Drainfields) Reviewed By: Design Layout Date: Laterals Length(ft) #Panels Line#1 37.5 8 Line#2 37.5 8 Line#3 37.5 8 Line#4 37.5 8 Line#5 37.5 8 Line#6 37.5 8 Line#7 37.5 8 Line#8 37.5 8 Totals 300 64 Absorption Arca Length(ft) Width(ft) Area(ft^2) 300 2 600 Trench Spacing is 8-ft OC T&J Panels Linear Feet #Panels 50 11 60 14 70 16 80 18 90 21 100 23 / } - ul,�ERT /// �4 I//; ONT YARD SETBACK P. ;IBC+QK /" �TINETYPE LEGEt4D �ti �� , ...- ..- .t ES NOT,11.1 :, " e 'si.... OAO R MT 9f AY �� N /:. �pe. 5• / TBA K UN$ / e / tc)178 J0 Y " K / ' PB 56 Po 1 is ! RMER / HATCH LEGEND / PN B3744i32. .. / :p 7 E -1. A // iZ: ( rep, le _, / Yf=YARD' ' k 0 ,/-4( •• r" _ `I. -.rONC• .;'. ck..tilli• . ,,,,,.. .,, .0' •'',,;:: „ // ..,,,---1.-er- ' - v- / /' •/// 4 44- . li -•.., . , - ./..y., 9,„ _z ._ • ____---- __.---i„- • 44.00001111111r,—`�' / PIN r 44M2 6 //,,:i Bl,%It, . 41, /-/ // 1 /I/ 1. T 125 4/7 N. --- ,/ ' I / • III Pi & B4.. �`� / of __ I / // i) iii 11:17. \.) ( / ><- ____ ----- ) r4a °‘ 'V / � — / / A , %0• // // i 1 / 7� f,i• . / RBF \14 LEGEND ----- LIDAR Generated 1-ft Contour Lines / / 7-- CV( ! Stream 7 . / ir P1 25-ft Stream Buffer 7._ o ( ,, A M o Water Line �. 4rT5•PUBt,, 1V� Ric / - PG,136- ' CALE 7-- ,--,-:---N,_. I )i (l Septic Tank and Recirculating Tank =) // /Pod , / j f ' ' l ' ( -J i Supply Line / / f ' f P 1 !//" _� st8i4'6r OGE DRIVE • Flow Diversion Valve ANC .PO ND (ANC OT 1 Et(.06NE3u6pPASION•PiiASEtivE PL T BOOK 5E.`,PPAGE 136 20 P 144 . I SQUARE ® Distribution Boxes '>1i REPORT A MA1y iE t T ' / ���SQ CEO '� C�ONOVER.Pk 28813 , eIAY , CKS-AND/OR kESf11 E� CAtAwBA COUNTY,NORTH CA`ROtmiA �• PPBPS Drainlines Mi' E SFARCIC6E P MED. % f H.ZARD ZO I�0NE)tj PER FIB( PRE•PA4l D FOR• / • Soil Boring Locations �`i 1 ! ; C NTURY COMMUNITIES Date: Proposed Septic Layout November 2022 Figure Thompson Lot 125- Millstone Environrnenta Prepared For: Scale: Consulting 4874 Stone 6 o 15 30 ft 11111111111110181.1111111111 Century Complete Conover, NCC 28 28613 TEC Job#: Catawba County 22-19 SEC nom'e ULTPAVkJLET 0t9NFECTIOh UM' SECTION'C' , PLAN SECTION'A maw— E-Z Treat Pretreatment Detail Date: Figure Thompson November 2022 Enwromnenta5* Prepared For: Lot 125 - Millstone Scale: Consulting 4874 Stone Drive 11 �In■ Century Complete Conover, NC 28613 Not to Scale 2 TEC Job if: Catawba County 22-19 r DEPARTMENT OF HEALTH AND HUMAN SERVICES Shrd I of 2 Th -DIVISION OF PUBLIC HEALTH.ENVIRONMENTAL HEALTH SECTION t ''PROPERTY ID#: q(1 Z�43bb ON-SITE WATER PROTECTION BRANCH COUNTY:('ata4... a SOHJSITE EVALUATION for ON-SITE WASTEWATER SYSTEM ' ', (Complete all fields in Roll) OWNER: K*TNNE 4 4bleAlr A LA,tSOkt APPLICATION DATE ' ADDRESS: DATE EVALUATED:(a,Z•3-21 PROPOSED FACILITY: Q. i c&t'LNy+ PROPOSED DESIGN FLOW(.1949): 3 b6 PROPERTY SIZE: •11,.5—/4G •.- LOCATION OF SITE: 'WI 4 Oa r t pr<,f..i ( Qvc., t1 G PROPERTY RECORDED: WATER SUPPLY: 0 Private I§Public ❑Well 0 Spring Cl Other EVALUATION METHOD: it Au er Boring D Pit ❑Cut TYPE OF WASTEWATER: 'Sewage 07 Industrial Process ❑Mixed ' r P R SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS t 1940 B LANDSCAPE HORIZON - , POSITION/ I)EP7fi 1142 PROFILE • SLOPE X OM) .1941 .1941 SOIL •1043 .1956 .1944 CLASS STRUCTURE! CONSISTENCE/ AVETWE S/ SOIL SATE ' RESTA &LTAR TEXTURE MWERALOGY COLOR DEPTH 0 HORIZ CLASS 0 — l 5 ent-ka 54R/146 t,S Ira-3� s 55/SP 5 3 _ — P S 1 36•3 }Lt3� i sY/Se l o ,3 0 -5 c * 05/r'/arc 2 �.s Zb - LA s /G/ I $5/SP/56 PS q— D,3 (a I t 3 us/ 1 A? L"L) I 0 - k c att-ede/SAS P71s/' 1?ii•J L.< < 1a-32- AtiCiii ss/s'Is — Ps 4 /t 1 32 - Lint SOY ,'cl-/fa 3s/sf/St I-lo k DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.19445): SITE CLASSIFICATION(.1948k knit, SiiW Available Space(_1945) QS fs ,//�� /� EVALUATED I3Y: I i ) �OOb sou System Type(a) I't cce P n G>.901' T� f��lu�P OTHER(S)PRESENT: L. Thompson ':_�,� � Site LIAR 01 3 D v. I� `ki -.> Updated February 2014 �, `�� r SOIL/SITE EVALUATION Sheet 2_ of 2- (Continuation Sheet-Complete all field in fill) PROPERTY ID#: 31 V 122.•q_314, DATE OF EVALUATION: Q ,2q - 21 COUNTY: ch TA wr3/4 ■ f . . P I R SOIL MORPHOLOGY OTHER 0 F (1941) PROFILE FACTORS 1 .1940 E LANDSCAPE HORIZ .1942 POSITION/ ON .1941 .1941 SOIL .1943 .1956 .1944 PROFILE # SLOPE V. DEPTH STRUCTURE/ CONSISTENCE/ WETNESS/ SOII SAPRO RESTR CLASS TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ &LTAR (IN.) o- z+ , rlsqVOL A1.5( tiP, Ale . L,5 2I - 2. ssv/c/ Ps ss se, s & 'i'� PS 31 11 g ( 5t/( c1 0 ` 2, _ 32 D, 3 I fit 0- I sc 1.--3/ � s�K f (Ut-Q, . O�Sj ;��P J Au( 16 -. , -Cell le 1�.0 s) SI/ )e 0� / COMMENTS: Robert Phelps From: Larry Thompson <larry@thompsonenv.com> Sent: Wednesday, November 9, 2022 6:00 PM To: Mckinney, Alan H; Robert Phelps Subject: Re: [External] FW: Mill Stone - Lot 125 Revision This is an external email. Please be cautious before clicking any links or attachments. If you have questions about this email, please send them to suspiciousemailncatawbacountvnc.gov And the discussion that took place in AOWE training related to PPBPS pointed out that the system is written into the rules. As such, it is technically not a "reduction". There is a prescriptive guide for sizing in the rules. Larry Thompson, PWS, LSS Thompson Environmental Consulting, Inc. www.thompsonenv.com 704-301-4881 cell On 11/9/2022 5:47:25 PM, Mckinney, Alan H <alan.mckinney@dhhs.nc.gov> wrote: Robbie, While our jurisdiction doesn't allow a denial of this submittal, it does not comply with Rule .1970 which prevents a reduction beyond 25% as proposed. While this is addressed in 18e, it is not in effect. Alan Alan McKinney Regional Soil Scientist Division of Public Health, Onsite Water Protection Branch N.C. Department of Health and Human Services 828-764-5076 office/mobile alan.mckinney@dhhs.nc.gov http://ehs.ncpublichealth.com/oswp/ PO Box 1972, Boone, NC 28607 1642 Mail Service Center Raleigh, NC 27699-1642 Find a vaccine location, get questions answered and more at YourSpotYourShot.nc.gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. Twitter YouTube Unauthorized disclosure of juvenile, health, legally privileged, or otherwise confidential information, including confidential information relating to an ongoing State procurement effort, is prohibited by law. If you have received this e-mail in error, please notify the sender immediately and delete all records of this e-mail. From: Robert Phelps <RPhelps@CatawbaCountyNC.gov> Sent: Wednesday, November 9, 2022, 8:42 AM To: Mckinney, Alan H <alan.mckinney@dhhs.nc.gov> Subject: [External] FW: Mill Stone - Lot 125 Revision CAUTION: External email. Do not click links or open attachments unless you verify.Send all suspicious email as an attachment to Report Spam. Call me when you have a chance to look at this Robbie Phelps, REHS Environmental Health Supervisor, OSWP Division 25 Government Drive, Newton, NC 28658 (828)320-3077 cell https://www.catawbacountync.gov/county-services/environmental-health/ f Catawba county Confidentiality Statement:The information contained in electronic transmissions is confidential and may be subject to protection under the law,including the Health Insurance Portability and Accountability Act(HIPAA).An electronic transmission is intended for the sole use of the individual or entity to whom it is addressed.If you are not the intended recipient,you are hereby notified that any use,distribution or copying of the message is strictly prohibited.If you received a message in error,please contact the sender immediately by replying to the e-mail and delete the material from any computer. From: Larry Thompson [mailto:larry@thompsonenv.com] Sent:Saturday, November 5, 2022 1:28 PM To: Robert Phelps <RPhelps@CatawbaCountyNC.gov> Cc: Sid Gaskins<sid@watermanagementnc.net>; Ryan C Jackson <ryanc.jackson@centurycommunities.com> Subject: Mill Stone - Lot 125 Revision This is an external email. Please be cautious before clicking any links or attachments. If you have questions about this email, please send them to suspiciousemailccatawbacountync.gov Hi Robbie, I have been working with Sid Gaskins on a septic option for Lot 125 - Mill Stone and have attached a revised LSS COVID-19 permit package to this email for consideration. The originally permitted system was negatively impacted due to grading. This proposal may conflict with the onsite branch policy and their view on "double dipping"with reductions and setbacks. The Rules do not appear to support that policy, which has been covered in recent AOWE training and addressed in 18E, hence the proposal before you. Please let us know if this needs to go through the front office and what fees may be required to repermit this lot. Thank you! Larry Larry Thompson, PWS, LSS Thompson Environmental Consulting, Inc. www.thompsonenv.com 704-301-4881 cell 2