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HomeMy WebLinkAboutIMPV-11-2022-184719.tif CCfA\VBA COUNTY • . Public Health Department Subdivision SOUTHBRIDGE �ifn. Environmental health Division PINt: 376404736279 1 :,if PO Box 389.25 Government Drive.Newton.NC 28h58 LOfa 21 &22 Site Address: 4919 GATEWAY DR, CLAREMONT NC 28610 Name on Permit: 'FOUR CORNERS OF CHARLOTTE LLC Property Size: Acres 1.6 Directions: N NC 16 right Riverbend Rd, right Bolick Rd, right Gateway Dr lots on left Owner/Authorized Representative Acknowledgement of Permit Receipt )(Rix, I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. RAC As the property owner or authorized representative. I have received the above referenced permit(s)as requested in the application for service RBPR-06-2022-41267. by the following method(s): Received in Person Facsimile"Transmittal (Return form with signature required) 4 Electronic Image Transmittal/E-mail (Return receipt required) `f RAC As the property owner or authorized representative I have reviewed and understand the specific conditions +} of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(I5A NCAC I8A.19(10), and/or Well Construction Standards(15A NCAC 2C .0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date: 12/06/2022 Owner/Authorized Representative Signature Xk..K,:L'_4t1+e• Date 1/10/2023 Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name n/'perso);sending permit) et Signature Qt. .. . ... Date/lime j fAl Method: Fax /Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService 1d met ie03C l41100. euvl 14' a,,,.,,,„, i2 na 2u22 i t ni. County: Catawba IMPROVEMENT PERMIT FOR G.S. 130A-335(a2)/SL2022-11 PIN/Lot Identifier: 376404736279 Issued To: Four Corners of Charlotte LLC Property Location: 4919 Gateway Drive, Claremont, NC 28610 Subdivision: Southbridge Lot#: 21 & 22 Block: Section: LSS Report Provided: Yes El No 0 If yes,name and license number of LSS: Larry Thompson, NCLSS No. 1287 New❑✓ Repair❑ Expansion ❑ System Relocation ❑ Proposed Structure: Single Family Residence Proposed Wastewater System Type: Accepted (Initial) Accepted (Repair) Fill System:❑Yes ❑✓ No If yes,specify:0 New 0 Existing (when adding more than 6 inches of fill to system area please provide a fill plan) Proposed Design Daily Flow: 360 GPD Proposed LTAR(Initial): 0•3 Proposed LTAR(Repair): 0.3 Design Wastewater Strength:Eldomestic 0 high strength ❑industrial process Number of bedrooms: 3 Number of Occupants: 6 Other: Pump Required: 0 Yes ❑No ❑May be required based upon final location and elevations of facilities Artificial Drainage Required: ❑Yes QNo If yes,please specify details: Type of Water Supply:❑Private well 0 Public well ❑✓ Municipal Supply 0 Spring El Other: Drainfield location meets requirements of Rule.1945: Yes ElNo❑ Drainfield location meets requirements of Rule.1950: Yes El No❑ Permit valid for:❑✓ Five years(site plan submitted pursuant to GS 130A-334(13a)) 0 No expiration[plat submitted pursuant to GS 130A-334(7a)] Permit conditions: Licensed Soil Scientist Print Name: Larry Tho , LS Licensed Soil Scientist Signature: Date: 11/4/22 The L55 evaluatiTf Trig "bmltted pursuant to and meets the requirements of G.S.130A-335(a2). *See attached site sketch* The LSS/LG evaluation(s) attached to this application is to be used to issue an Improvement Permit in accordance with G.S. 130A-335(a2)and (a3). county: Catawba This Section for Local Health Department Use Only Initial submittal received: 11/4/22 by RP Date Initials Permit Number: I MPV-11-2022-184719 G.S. 130A-335(a4)states the following: 'If a local health department fails to act on an application for an improvement permit submitted pursuant to subsection (a3)of the section within 10 business days of receipt of a complete application, the local health department shall issue the improvement permit.' In accordance with G.S. 130A-335(a3)the improvement permit application is: ❑ Incomplete(If box is checked, information in this section is required.) The following items are missing: Copies of this were sent to the LSS and the Owner on Date State Authorized Agent: Date: ❑ Denied(See attached report.) Copies of this were sent to the LSS and the Owner on Date State Authorized Agent: Date: © Complete //// State Authorized Agent: 'G' Date of Issuance: 11/17/22 This Improvement Permit is issued pursuant to G.S. 130A-335(a2),(a3),and (a4)using the signed and sealed LSS/LG evaluation(s) attached here. The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This site is subject to revocation if the site plan,plat,or the intended use changes,or if information submitted in the application was falsified, inaccurate or misleading. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit. The location and identification of all property lines,easements,water lines,and other appropriate utilities shall be the responsibility of the owner. The Department,the Department's authorized agents,and the local health departments shall be discharged and released from any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to evaluations,submittals,or actions from a licensed soil scientist or licensed geologist pursuant to GS 130A-335(a2). Improvement Permit Expiration Date: 11/17/27 *See attached site sketch* AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. PHASE PARCEL ID: 376404736279 STREET ADDRESS: 4919 Gateway Drive 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 LSS/LG evaluation(s) attached to this application is to be used to issue an Improvement Permit in accordance with G.S. 130A-335(a2) and (a3). The plans or evaluations attached to this application are to be used to issue a Construction Authorization in accordance with G.S. 130A-335(a2), (a5) and (a6). Own ature: Owner Signature: rarnon gonzalez (Nov 16,2022 16:21 EST) Date: Nov 16,2022 Date: CIO U m m d C r -J O a > z a� r/`„�,l -J f L ODD C O N C N I.i. LL 6 L U L N O Tr W N C li U a Z U ~ 0 03 co CD l/'RJ d a 0 0 V Nfl @ C? N 14�' C U c Na)v a; O ❑ g' C w a o� 1 m J sL L d 096'66l MrEL,9„COS a. a r-, --1 I - II g ,D co co rn $ 1 fi a P I t- 1 co a u) 6 r$n D g7 N 0 M Z N 0) } it) to aw ; el � 4 r W0 ea co CI ti55 aO IE �� i 1..Q \\\\\\t\ ef6co u \\ s\\\ WlZ : \\\\\\\\\\\ a - 9yh (0 a fir co o aG c C O !O -p o,,, I 1, 73c 71 0 d ,E6'LlL 3„LEPEON a o m, Lu v) a, r = v ° n o `O 4 eil o rn aa , 3RnMi�aQ.a4L1Ml3lQ1ndblO5b ryo e a c ° vami ► m Agent Authorization Form Final Audit Report 2022-11-16 Created: 2022-11-16 By: Larry Thompson(tarry@thompsonenv.com) Status: Signed Transaction ID: CBJCHBCAABAArGsuTTQ-YBJa9VJb16GrTxXZGb8Tx9FL "Agent Authorization Form" History ,t Document created by Larry Thompson (larry@thompsonenv.com) 2022-11-16-9:00:17 PM GMT-IP address:108.70.197.25 ,., Document emailed to ramon gonzalez(romelle03@yahoo.com) for signature 2022-11-16-9:00:43 PM GMT 5 Email viewed by ramon gonzalez(romelle03@yahoo.com) 2022-11-16-9:18:53 PM GMT-IP address:69.147.93.12 60 Document e-signed by ramon gonzalez(romelle03@yahoo.com) Signature Date:2022-11-16-9:21:32 PM GMT-Time Source:server-IP address:107.77.236.225 0 Agreement completed. 2022-11-16-9:21:32 PM GMT Rwmpfon I d�a� Fm.0i ultmg ~jug L S Thompson Environmental Consulking,Inc. `r l .�6 / 3 PO Box 541 PROPERTY ID t ff13 496 kr,t y Midland,NC 28107 cowry: c+ 'i-, SOIIJSTPE EVALUATION for ON-SITE WASTEWATER SYSTEM OWNER: Four Corners of Charlotte, LLC ADDRESS: DATE EVALUATED: 2 -5`2 L PROPOSE)FACILITY: Res. PROPOSED DESIGN FLOW(.1949): 360 PROPERTY SIZE: .2 /.2 in., /66 LOCATION OF SITE: G G ..Un S)f. ) Cie r c IMin.►-L PROPERTY RECORDED: WATER SUPPLY: 0 Private� ®Public 0 0 Well ❑Spring ❑Other EVALUATION METHOD: LK�Anier Hosing 0 Pit 0 Cut • TYPE OF WASTEWATER: giewage 0 Industrial Process 0 Mixed P o SOIL MORPHOLOGY OTHER F (JWI) PROFILE FACTORS L .1lM E LAiODSCAPE HOWSON Dim l OF .IlsZ PROS= i SLOl�E'K MO CLASS.1lq San. -19L3 aSSs .1l14 CLASB Sr uc111Rf! cortsisrorcti wrrnass! SOIL SAFRO awn •LTAR I om=RE MINERALOGY COLOR DOTS CLASS HOR 0 -"q cr V FR/NS/NP/NEXP 3d r j ^f4,. . t'/ (4 -"( ok./a. Fl/S/P/SEXP ~ T S'1' f to .t- PS 1 . lr 0.3 �lD �` . .-A . .- C�t N.l i 4 C, b'3 5,f L— FR/NS/NP/NEXP� ,. 19 pits 'k ! S 3� �" L'/ 1 —40 41— �:i FI/S/P/SEXP ~ t5�c3 - Ir � f .( PS 2 �sl� - b `iv S- 0.3 ,P 0" 3 010 ii-k)-\e\t1) - L nc 0 s peo.0.44 4 i4 I V DSSCRIPT7OPI IMMAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): � F SITE CLASSIFICATION(.1948): Provisionally' _ Available Space(.1945) PS PS �`Ci- .- • EVALUATED BY: ''t+G ^i System Type(s) Accepted Accdpted O�R(S)pRES�. L.Thomps j4,1 ' , `;'..r ',r .' She LTAR 0.3 0.3 low F '�� i - X �� LJ-J Ii �.AI/ •• SOIL SITE EVALUATION 4eY'�3�.a i. shed Z er 3 (Coldin�tion Sbevet-Co,p1ete cuf field in.full) PROPERTY ID#: 3X`t?Yg3(' S DATE OF EVALUATION: 2-t -2 L j� r t COUNTY: C1�'s'" G0&bTy r' ) Clc.run,,-r • • r • P R O SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS 1 .1940 - L LANDSCAPE HORIZ .1943 e lOBtl'I@i/ .1941 .1941 SOIL 4543 .I956 .1944 PROFILE A SLOPE% °N muumuu/ CONSZTEvCE/ WETNERW SOH, RAPRO Rlld1R CLASS DEPTH TEXTURE MINERALOGY COLOR DEPTh CLASS HOB &LTAR M1 /'1? L,S) ► D �� 1C.4 p lo oar, ,r _ r ka5 � 5r ( (� FR/NS/NP/NEXP 3 C.,- t(d_c-�- o AA r r 5 �L(L L ( FI/S/P/SEXP �' evier-f)'( � y i' JJ • Li L , '=46r ''' F l L FR/NS/NP/NEXP hi Mr/ e! L.c 3 6k/ • e., FI/SIP/SEXP / / •( ram,-° PS a+� it i 3� �b�/ G(. FI/SS/SP/SEXP Li - L I' 0.3 1 I 7./-m, 41 f (,..(� FI/SS/SP/SEXP / '3 -3 �`� FRINSINP/NE)CP l .-� 49 (— FI/SS/SP/SEXP ' `b D(O ��31) 4/\ C. FI/S/P/SEXP LIDr 11 f 0.3 oit,,,,_,�,1)...,40 J 0 t.„ FUSS/SP/SEXP i f— Pm 9 6 3 L 5r-) L. FR/NS/NP/NEXP / GL FUSS/SP/SEXP 0 5j��3 FI/S/P/SEXP 't 3 PS TI / � � 0.3 , • COS: SOIL/SITE EVALUATION Shen?of 3 (Continuation Shert-Complete oilfield WO) ?X#Olt 334.47/1 PROPERTY ID#: S74 eY AA,3'j DATE OF EVALUATION: 2 t GI-L IOt, L fe<< M COUNTY: C �-- . ; , r R O SOIL MORPHOLOGY OTHER F (.1941} PROFILE FACTORS � .1940 E LANDSCAPE noRiz .1942 POSITION/ ON 1901 .1941 SOIL ,lse J95 .1944 PROFILE A SLOPE% STRUCTURE/ COK_STINCE/ memo, SAII%O REM R CLASS arm ON.) 1WURE MINERALOGY COLOR 8 CLASS HOME &LTAR J) D -3 5 r I [/ FR/NSINP/NEXP l I 3-1/ 4 ( et.. FUSS/SP/SEXP oretwy ' PS lb 74v ?�1- FI/S/P/SEXP " f i 0.3 5141. Os CC/ FI/SS/SP/SEXP G ~ G 4V L 1 .1 1 i ._ COMMe1TS: