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HomeMy WebLinkAboutLSSP-11-2022-184987.tif Lot 2-Lakeside Lane State of NC LSS Permit Option COVID-19 LHD Reference: PART 3: Authorization to Operate (ATO) Except for date received,the Section below is to be completed by the Owner. LHD USE ONLY: Initial submittal of request for ATO received: _ by Date Initials Date of Post-construction Conference: The following items are included in this submittal for an Authorization to Operate under an LSS COVID-19 permit: 1. Signed and sealed copy of the LSS's report that includes: a. Signed and sealed evaluation of soil conditions and site features ❑X Yes ❑ No b. Drawings,specifications,plans X❑Yes ❑ No c. Reports on special inspections and final inspection ©Yes ❑No d. Management Program manual ®Yes ❑ No e. On-site Wastewater Contractor's signed statement ❑X Yes ❑ No 2. Fee (as applicable) ®Yes ❑ No 3. Notarized letter documenting Owner's acceptance of the system from the LSS ©Yes ❑ No 4. On-site Wastewater Contractor name: Dewey Grant License number: 2607 Mailing address: 214 S. Main Street City: Maiden State: NC Zip: 28650 Telephone number: 828-291-0569 E-mail Address: dewey@maidengrading.com 5. 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 Four Corners of Charlotte LLC 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. ramon gonzate2 iNov 16,2023 22:23 EST) 11-16-23 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 NOI/ATO with tracking information was sent to the State on via Date Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date 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 November 16, 2023 Subject: Septic System Installations Lakeside Lane—Lots 1, 2, and 3 Keisler Dairy Road Conover, NC 28163 The septic systems installed on the above-referenced properties were specified by Larry Thompson, LSS, and installed by Dewey Grant. Mr. Thompson has shared the closeout packages and maintenance plans with us. We do hereby accept the septic system installations for Lots 1, 2, and 3— Lakeside Lane. Sincerely, 10- ramon gonzalez(Nov 16,2023 22:23 EST) Four Corner of Charlotte LLC November 16, 2023 RE: Septic System Installations Lakeside Lane— Lots 1, 2, and 3 Keisler Dairy Road Conover, NC 28163 The purpose of this letter is to confirm that the septic system installations for the above referenced properties were installed in general accordance with the proposals submitted to your office by Larry Thompson, LSS. Sincerely, De I_Grant(Nov 16,2023 21:57 EST) Dewey Grant Maiden Grading and Septic Tank ' ® DATE(MM/DD/YYYY) ACCPR o CERTIFICATE OF LIABILITY INSURANCE 07/07/2023 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 Lisa NAME: Y L nch Davis Mauney Insurance Agency. Inc PHONE N FxtJ: (8288)428-8231 (mac,No): (828)428-8237 1205 E Main Street E-MAIL Idavis maune insurance.com ADDREss: @ Y INSURER(S)AFFORDING COVERAGE NAIC# Maiden _ _ NC 28650 INSURER A: Erie Insurance Exchange 26271 INSURED INSURER B: Maiden Grading and Septic Tank INSURER C: — 214 S Main Ave INSURER D: INSURER E: Maiden NC 28650 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WV!) POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 1000000 MED EXP(Any one person) $ 5000 A Q30-0621570 06/06/2023 06/06/2024 PERSONAL&ADV INJURY $ 1000000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2000000 OTHER: $ AUTOMOBILE LIABILITY COMBIacciden0NED SINGLE LIMIT $ 1,000,000 (Ea ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED AUTOS ONLY AUTOS Q06-0530679 06/05/2023 06/05/2024 BODILY INJURY(Per accident) $ _ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ $1,000,000 A OFFICER/MEMBER EXCLUDED? Y N/A Q91-5900316 07/09/2023 07/09/2024 (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 I LOCATIONS(VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thompson Enviromental Consulting, Inc ACCORDANCE WITH THE POLICY PROVISIONS. Post Office Box 541 AUTHORIZED REPRESENTATIVE I Midland NC 28107 Fax: Email:larry@thompsonenv.com @ 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 . VA TER • I7AS' TEWA7' ER • WETLANDS November 16, 2023 RE: Septic System Installations Lakeside Lane—Lots 1, 2, and 3 Keisler Dairy Road Conover, NC 28163 The purpose of this letter is to confirm that the septic systems for the above referenced properties were installed in general accordance with the permit package submitted to your office. The systems has been inspected for the LSS COVID-19 permit closeout process. Sincerely, Larry B.Thompson,Jr. PO BOX 541 • MIDLAND, NC • 28107 PHONE: 704-301-4881 • EMAIL: L.ARRY@TI-IOMPSONENV.COM WEB: WWW.THOMPSONENV.COM Residential Subsurface Wastewater Treatment and Disposal System LSS COVID-19 Proposal for Lot 2 - Lakeside Lane Keisler Dairy Road Conover, NC 28613 Tax Parcel #375114348027 November 15, 2022 Prepared for: Four Corners of Charlotte LLC 1612 Seattle Slew Court Waxhaw, NC 28173 704-713-2602 Prepared by: Michael G. Wood, LSS Thompson Environmental Consulting, Inc. SOIL Sc,FPO Box 541 (<00 °�1''* ` n Midland, NC 28107-0541 Irwin 1 Phone: 704-301-4881 larry@thompsonenv.com � 1219 Lot 2—Lakeside Lane Details Century Complete has contracted with Thompson Environmental Consulting, Inc. (TEC) to prepare LSS COVID-19 septic proposal for the 3-bedroom single family residence on Lot 2 - Lakeside Lane, Leeland Terrace, Keisler Dairy Road, Conover,North Carolina. Based upon a soils investigation performed by TEC, it has been determined that a sufficient amount of "Suitable" Group IV soils is available for the installation of gravity-fed Accepted System with a 25% reduction for both the initial and repair systems at a 0.30 GPD/ft. sq. long term acceptance rate (LTAR). The property is 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. The owner would like to request that the county issue the appropriate permits for a subsurface wastewater treatment and disposal system based upon the enclosed LSS COVID-19 permit option. Location From Newton, head north on Main Street, right on E 20`h street. In 2.0 miles, right on Emmanuel Church Road, left onto Keisler Dairy Road, intersection with Lakeside Lane will be in 0.4 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, December 6, 2018. Accepted Wastewater System No. AWWS-2005-02-R6; North Carolina Department of Environment and Natural Resources, Division of Environmental Health, On-Site Wastewater Section, August 21, 2015. Primary Investigator's Credentials NC Licensed Soil Scientist No. 1219 NC Authorized Onsite Wastewater Evaluator No. 10025E SC Professional Soil Classifier No. 114 VA Professional Soil Scientist No. 415 2 Lot 2—Lakeside Lane 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 will be fitted with an approved effluent filter and riser for easy access and periodic maintenance. 3. It is the responsibility of the septic contractor to thoroughly inspect the septic tank prior to accepting delivery to assure that the tank has had time to properly cure and is free of cracks or other structural deficiencies. B. Pipes and Fitting 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 line from the pump tank to Line 1 shall be 3-inch Schedule 40 PVC (approximate length of supply line is 45 feet). C. Distribution Method—Serial Distribution 1. The system will be gravity fed to Serial Distribution. D. Drainfield Installation 1. The drainfield has been previously laid out 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. 3. The specified system is the shallow placed innovative wastewater system Infiltrator Quick4 Chamber System. 4. The drainfield consists of three (3) lateral trenches 3-foot wide and 95, 95, and 110- feet long. 5. The trench depth for this system shall be 25-inches on the low side of trench. 6. The laterals are to be installed on contour with the land, keeping the individual trench bottoms level from beginning to end. 7. The trenches should be left open for the final inspection. 8. Each trench shall be placed on a minimum of 9-foot on centers. Lot 2 Lakeside Lane Initial and Repair Septic Systems Field Line# Color Initial/Repair Field Length System Length Setup#1 Relative Elevation 1 B Initial 95 95 7.6 100 2 W Initial 95 95 8.35 99.25 3 P initial 140 110 - 9.2 98.4 4 B Repair 120 105 9.55 98.05 5 W Repair 107 105 9.85 97.75 6 P Repair 90 90 10.25 ; 97.35 3 Lot 2—Lakeside Lane E. Final Landscaping 1. Final cover over the drainfield shall be at least 6-inches deep. Additional soil cover may be required to achieve the 6-inch requirement. 2. The drainfield shall be shaped to shed rainwater and be free from low spots. 3. The entire area of the drainfield 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. F. Utility/Drive Conflicts 1. The builder and property owner must take special care in planning for utilities(water, power, gas, telephone, cable lines, etc.). All utilities shall be kept clear of the septic system and its proposed repair area. Improper planning for underground utilities can negatively impact the installation and, in some cases, cause irreparable damage and permit revocation. If there are any questions regarding preferred routes, contact the County as soon as possible. 2. Water lines must be kept at least ten (10) feet from any portion of the septic system. 3. Irrigation systems should not be placed in the drain field area. Maintenance G. In General The designed system does not require ongoing maintenance via a person certified (Certified Subsurface System Operator)by the North Carolina Department of Environment and Natural Resources to operate subsurface wastewater systems (Section .1961 Maintenance of Sewage Systems). However,the following maintenance should be considered by the owner. 1. The homeowner must maintain the drainfield area through periodic mowing. The drainfield must not be allowed to become overgrown. 2. The septic tank should be pumped every 4 years or when the solids within the septic tank reach an elevation that is equivalent to 25% of the volume of the tank. In some situations, the tanks may need to be pumped more frequently. If you are using a garbage disposal, it is recommended that the septic and pump tanks be cleaned out annually. 3. When it becomes necessary to clean the effluent filters,the filters should be removed, and the accumulated debris washed back into the septic or pump tank—not onto the lawn. 4. Any damp areas, leakages or malfunctions in the drainfield should be addressed immediately. 5. Divert gutter downspouts and surface water runoff away from the drainfield and septic and pump tanks. 4 Lot 2—Lakeside Lane Initial System Design Specifics Daily Design Flow: 360 GPD—3 bedroom house Effluent Loading Rate: 0.300 GPD per sq.ft. Drainfield Type: Accepted (25 %Reduction) Maximum Trench Depth: 25 Inches on low-side Supply Size: 3 Inch Supply Line Length: Approximately 45 feet Number of Drainlines: 3 **Drain Lines: 3' Wide x 95',95',and 110' Long **Drainline Spacing: 9 Foot on Centers Total Trench Length: 300 Linear Feet Distribution Method: Serial ** See drainfield layout for site locations and more details. Repair System Design Specifics Effluent Loading Rate: 0.30 GPD per sq. ft. Drainfield Type: Accepted(25% Reduction) Maximum Trench Depth: 25 Inches on low-side Supply Size: 3 Inch Supply Line Length: TBD Number of Drainlines: 3 **Drain Lines: 3' Wide x 105, 105,and 90' Long **Drainline Spacing: 9 Foot on Centers Total Trench Length: 300 Linear Feet Distribution Method: Serial 5 OT N/F FOUR CORNERSL TF3 CHARLOTTE,LLC I i A PB 85-21 I SO4 so, v ' 0THONF A S i s.y. I :4; }lrt �GAS OF yj �RRFPLA 1 0' f 43.33'' -1 ram" --- --,..-.. )2421....r...„.. I propos_. ii _`__ I Z driveway— \� I �/ SO 2,R, •4 6- 04' W 5 proposed 8 ! /@ p b house 1 1 l !n vI tr l i Tax Parce1375114441082 Y •1 N/F HILDA T.DEAL I m lot I ;a DB 3285 PG 830 i 26,682 sq.H. I CONNECT TO DRA N LINE 1 1 a 0.61 acres L _ —-_ _ FOR SERIAL DIST IBUTION 10 s.y. DRAIN LINE SEGMENETS UNE LENGTH RELATIVE FUG SYSTEM 1000 GAL. 199.58' # IFTI ELEVATION IFTI COLOR I i 1 95 100.00 PINK INITIAL SEPTIC TANK 3"SCH.40 PVC z 95 99.25 WHITE INITIAL 3 140 98.40 BLUE INITIAL f LOT 1 PB85-21 4 120 98.05 PINK REPAIR j N!F FOUR CORNERS OF CHARLOTTE,LLC 5 107 97.75 WHITE REPAIR {{{��� 6 90 97.35 BLUE REPAIR I Ij LEGEND710 I` mpwn 2044 LAKESIDE LANE nts CONOVER,NC INITIAL DRAIN LINE PROPERTY CORNER 0 EnvironmeSUMSSL 2020-97 REPAIR DRAIN LINE ==== PROPERTY LINE --- - SEPTIC TANK 0 UTILITY POLE 'k I" = 30' SUPPLY LINE ---•--- POWER LINE — — Thompson Environmental Consulting,Inc. 30' 0' 30' 60' 90' PO Box 541 i■i••• �'1."1"1"'Nom. SOIL BORING i BUILDING SETBACKS Midland, NC 28107 GRAPHIC SCALE s I nompeon Environmental Cananking,Inc. ,sse,er /€A PO Box 541 PROPERTY ID 37s11`L I/ a Midland,NC 28107 coUrrlY: 6'43,, SOIUSITE EVALUATION for ON-SITE WASTEWATER SYSTEM OWNER: ADDRESS: DATE EVALUATED: Z•28 2 2- PROPOSED FACT T1 Y: k e s. PROPOSED DESIGN PLOW(.1949) ,93U q p d PROPERTY SIZE: /.fel •c LOCATION OF SITE: k.G.,s I lt d - C e N•v J PROPERTY RECORDED: WATER SUPPLY: 0 Private 0 Public 0 Well 0 Spring 0 Other EVALUATION MET IJOD: fa" Boring 0 Pit 0 Cut TYPE OF WASTEWATER: &YSCMragc 0 Industrial Proem 0 Mitrd P R SOIL MORPHOLOGY OTHER F (ism PROFILE FACTORS t .t948 ' E LANDSCAPE PROFILE E ._.Id-. 19Q[11 J!O I SUSIE% (E0 .1943 190 Ste. .1l43 -i .1lN CLASS STaucruRYJ cane rance/ amass/ soli. 3APRO meta !LTAR TIC MINERALOGY come Dor1E CLASS SIX. 6 - / I v 171,44P/Nrvp • 1r(7 ' Al h) 1 e %iJ cils"/s„a t ' PS 1it° ' . 0.3 , r: . , 3-, l b -D. , r I 1- ii-fgs/.NPAt P u5 a. 41.1 GI, /c/- ,k Ps - , - 2 H0 �,�l !� Ft Aix( L,px .1 , 0.3 - 11. 1'Ib . Cy ,I Ps - u • Lim r,'/a/g,i(AP . Ps, • q 'ti`° -t-lb /, /ri/rP/. . L-Iv Plc 0.3 R8.Arg SYSID4 OTHER FACTORS(.19+br Mly rd 0.,. TOM �1 DIi7CRIPflON IIAMLBYSiEM _ SITE(;LASS1F11CAT10N(•.1�948): 1 T H O,yA • Available Space(.1945) P s P s EVALUATED BY: I"IA t/ �i (-C 'I t. T. ti py,10, Accepted Accepted °maR(S)PRESE? T. / > s �) 0.3 0.3__ . ` 1 .g� p e 4tr4.• Site LTAR — ---. :J XWMENTS: jA c e DQIH 09;c01:1/ SOIL/SITE EVALUATION, Ant Z el'— (Continuat on Sheet-Complete aufaaai,fury 3�S/� Y PROPERTY m a1 '13 kaa 9- ,fJ DATE OF EVALUATION: Z-Zb ' Vt 't. tr 0-, d _ COUNTY: G'(L-+ Loc, A O SOIL MORPHOLOGY OTHER F 1 .1910 (1941) PROFILE FACTORS L E LANDSCAPSf Holm .1542 .11141 .L941 SO4L ,1943 .1936 .1914 PROFILE ON Y ill.OPE% an01cfHz/ CORMISTIIRM WETNESS/ eon, 8AP10 mane CLAD MIR OM) TEDIRI 11l1»t E ALOGY COLOR Dirm CLASS ROIZ &LTA, L lb -3 r i !-- • ` -l� SOAf CV /(f fop r 4 ` Ps t 3 "I t / 1IS°�r.9 • ,� � a1 il:0 1 „Q.3,gA t -' { 4, 1\0 0 ')b (r i, /� /g4 yt ) ',. . f, MM -- A!) 3 3 g f . ,�c s , JFjv o • tz5 -- to 4i,k lam{/ !Vt.( /re hero t ' ��k ' tit G it At //2/semo . . 75 ( - j 1'x L ��/fit,w P�� �i I 1/17 ) -A 61,Ki L. /do APAveP illi Li/ i PS i' 'w, i M; 70MMENTS: . e. - .Z,� . :at -, tluick4M STANDARD CHAMBER 52" Quick4 Standard Chamber — 48" - (EFFECTIVE LENGTH) n '7l • 6 ra b ' IF —th—ii la— ii. la [ � �= MallE •off ;2:117�a�7�m�i�n�1. �.,�1®*�� _= I=emsc �����_ _ ir ..e® =� _� I ,.._ ,, 34" SIDE VIEW SECTION VIEW MultiPort End Cap - b____i_____i, .11 • .i 1 12" 1/0111111!1k, ; � t�/ r`j• - iA f a fi�M�0 _ �_ I ��: _• 34" SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications Size (WXLxH) _ ___ 34"x52"x12" Size (Wx1.xH) 34"x16"x12" ' Effective Length 48" Invert Height 8" or 1.25" Invert Height 8" • INFILTRATOR SYSTEMS.INC.STANDARD LIMITED WARRANTY (a)The structural integrity of ouch chamber,and plate,wedge end other accessory manufactured by Infiltrator I antis'),when Installed and operated Ina leachfield of an onsite septic system in accordance with Infiltrator's Instructions,is warranted to the original purchaser("Holder'')against defective AMIIIIIIIIITHWEIHNIIIII materials and workmanship for one year horn the date that the septic permit Is issued for the septic system containing the Units;prodded,however. that if a septic permit is not required by appiceble law,the warranty period wit begin upon the data that Installation of the septic system commences. Toa s exercise its warranty defect. rights.Helder must notifylyr lacemer to nits tor at its Corporate Headquarters in OldSaybrook.theConoecticut eel within fifteen(15) I N FI LTRATO R days of the allegeU detect.Infiltrator wit supply replacement finite for Units determined by Inhlhator to be covered by this Limited Warranty Infitrator's liability specifically excludes the cost of removal and/or Installation of the Units. !� V TYE LIMITE WARRANTY M AS IN SUBPARAGRAPH OF N ARE EXCLUSIVE.SS ARE NORT OTHER WARRANTIES WITH RESPECT SYCTE M S I N C TO THE UNITS.INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. (c)This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other then Infiltrator. The Limited Warranty does not extend to incidental.consequential,special or indirect damages.Infiltrator shall not be liable for penalties or liquidated damages,including loss of Environmental Onsite Wastewater Solutions`"' production and profits,labor and materials,overhead costs,or other losses or expenses incurred by the Holder or any third party. Specifically excluded horn Limited Warranty coverage are damage to the Units due to ordinary wear and tear,alteration.accident,misuse,abuse or neglect of the Units:the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation Instruction;failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth in the Installation instructions:the placement of Improper materials into the system conteiring the Units;failure of the Units or the septic system due to Improper citing or Improper sizing.excessive water usage,improper grease disposal.or improper operation;or Old Saybrook, CT 06475 any other event not caused by Infiltrator.This Limited Warranty shall be void it the Holder falls to comply with an of the terms set forth In this Umrted Warranty, 860-577-7000• FAX 860--577-7001 Further.it no event shell Infiltrator be responsible for any loss or damage to the Holder,the Urds.or any third party resulting from installation or ship, 800-221-4436 went,or from any product liability claims of Helder or any third party For this Limited Warranty to apply.the Units must be installed In accordance with all she conditions required by state and lace!codes;all other applicable laws:end Infiltrators Instaltallah Instructions (d)No representative of Infiltrator has the authority to change or extend This Limited Warranty. No warranty applies to any party other than the origi- nal Holder. The above represents the Standard Untied Warranty offered by Infiltrator. A limited number of states and counties have different warranty require- ments. Any purchaser of Units should contact Infltrato's Corporate Headquarters In Old Saybrook,Connecticut.prior to such purchase.to obtain a copy of the applicable warranty,and should carefully read that warranty prior to-he purchase of Units. U.S.Patents:4.759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5.716,163;5,588,778;5,839,844 Canadian Patents:1,329,959;2,004,564 Other patents pending. Ili v« Infiltrator,Equalizer and SideWinder are registered trademarks of Infiltrator Systems Inc.Infiltrator Is a registered trademark In France.Infiltrator Systems Inc. is a registered trademark in Mexico.Contour,Contour Swivel Connection,MicroLeaching,PolyTutf,SnepLock,ChamberSpacer,PosiLock,OuickCut,QuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc.®2003 Infiltrator Systems Inc.Printed In U.S.A. 0011203HP-0 ) U 11 LI • 1...Ak ci (At Lir, 0 novfe- , qp -II-30) -i-1 ,)-7 L6-I 4 1-SC f -II - 6D) - 1 2 q cig7 STATE `a"` �.V ROY COOPER •Governor 44 �1: NC DEPARTMENT OF §�rA �. KODY H. KINSLEY •Secretary `;v,'� : ' j HEALTH AND% HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health „ftr .:0. MARK T.BENTON•Assistant Secretary for Public Health Division of Public Health COMMON FORM FOR LICENSED SOIL SCIENTIST COVID-19 PERMIT OPTION FOR NON-ENGINEERED SYSTEMS See Instructions for Use in Appendix A Except for"Date received",this Section to be completed by the LSS in accordance with S.L.2020-97,Section 3.19 and G.S. 130A-336.2 LHD USE ONLY: Initial submittal of this NOI received: 11 l 1 7 22 by Arilr thre bubo's PART 1: Notice of Intent to Construct(NOI)-Please check all that apply • Single System or ❑ Multiple Systems AND • New ❑ Expansion ❑ Relocation of all or part of the Existing System ❑ Relocation of Repair Area ❑ Repair—LHD Permit Number ❑ Repair—EOP/LSS COVID 19/AOWE Permit Number 1. Facility Owner's name:(Owner, Company Name, Utility, Partnership, Individual, etc.): Four Corners of Charlotte LLC Mailing address: 1612 Seattle Slew Court City: Waxhaw State: NC Zip: 28173 Telephone number: 704-713-2602 E-mail Address: romelle03@yahoo.com 2. Licensed Soil Scientist(LSS)name: Larry Thompson, LSS LSS License number: 1287 Mailing address: PO Box 541 City: Midland State: NC Zip: 28107 Telephone number: 704-301-4881 E-mail Address: larry@thompsonenv.com 3. Licensed Geologist(LG)(if applicable) name: N/A License Number: Mailing address: City: _ State: Zip: Telephone number: E-mail Address: 4. Proof of Errors and Omissions or other appropriate liability insurance for the following persons is attached that includes the name of the insurer, name of the insured and the effective dates of coverage: ❑� LSS ❑ LG 5. Property location(physical address,tax parcel identification number or subdivision lot,block number of the property to be permitted): Lot 2 -Lakeside Lane, Conover, NC 28613 (PO Parcel: 375114348027) 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 Mnu ING ADDRESS:1642 Mail Service Center,Raleigh,NC 27699-1642 www.ncdhhs.gov • TEL:919-707-5874 • FAx:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER COVID-19 Permit Option Common Form LHD Reference: LSS?-11 -) ) - 1q9 61 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 accepted system located behind the proposed house site. System Type III(g). 9. Design wastewater flow: 360 gpd Design wastewater strength: ❑■ domestic ❑ high strength ❑ industrial process(For industrial process wastewater,a Professional Engineer licensed in accordance with G.S.89C shall design the on-site wastewater system.) 10. A plat as defined in G.S. 130A-334(7a)is attached: ■❑Yes ❑ No A site plan as defined in G.S. 130A-334(13a)is attached: ❑■ Yes ❑ No 11. Location of proposed or existing wells(drinking water, irrigation,geothermal, groundwater monitoring, sampling,etc.)and any potable and non-potable water conveyance lines is indicated on attached plans and complies with 15A NCAC 18A.1950: ❑■ Yes ❑ No This is a saprolite system. ❑Yes ❑■ No 12. Evaluation(s) of soil conditions and site features in accordance with G.S. 130A-335(a1)signed and sealed by a LSS is attached: ❑■ Yes ❑ No 13. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LC 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 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 1SA.19, :ti"ities determined to be engineering as determined by the North Carolina Board of Examiners fork and rveyors. 11-15-22 Signature of Lic diir t ntist Date On."cr self-submittal of NO1: I, hereby submit this NOI prepared by Print Name of Owner Print Name of Licensed PE pursuant to G.S. 130A-336.1. Signature of Owner Date DHHS/EHS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 2 of 6 COVID-19 Permit Option Common Form LHD Reference: LSS i \\-) ) - NOTES: LIABILITY: The Department, the Department's authorized agents, or local health departments shall have no liability far wastewater systems designed, constructed, and installed pursuant to an LSS COVID-19 Permit Option[S.L.2020- 97,Section 3.19(d)and G.S. 130A-336.2(f)J 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/ENS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 3 of 6 • COVID-19 Permit Option Common Form LHD Reference:�5g l 1.--)(N.0.)- R19 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 o 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 Dote via with directions to re-submit missing items using Page 5 of this form. Email,FAX,USPS,hand-delivered Print Nome of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date g 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 ,Il IZ 1- 1- via {�{�L�t • Date Email,FAX,USPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via Date Email,FAX,USPS,hand-delivered \ (\kA.9.j) 7.1 • Print Nkn f Authorized Agent of the LHD Sign tur of Authorized Agentrof the LHD Da e DHHS/EHS/OSWP-L55 C-19 COMMON FORM Updated April 2022 Page 4 of 6 COVID-19 Permit Option Common Form LHD Reference: 1 ,e - 1 V I Id Re-submittal of NOI with missing items included This Section is for use by owner to submit items noted as missing during LHD Completeness Review above. Resubmittals must be accompanied by a cover letter from the LSS. LHD USE ONLY: This NOI resubmittal received: by Doty imhnis 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 Date The section below is for Local Health Deportment use after submittal of items noted as missing above. LHD Follow-up Completeness Review of Notice of Intent to Construct This follow-up review for completeness of this Notice and Intent was conducted in accordance with G.S. 130A- 336.2(c). This NOI is determined to be: ❑ INCOMPLETE Based upon review of information submitted in the RESUBMITTAL above,this Notice of Intent remains INCOMPETE because the following items from Part 1 of this form remain missing: Copies of this signed form were sent to the LSS and the Owner on via Date Email,FAX,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 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 L55 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,LISPS,hand-delivered Print name of authorized Agent of the IHD Signature of authorized Agent of the LHD Date OHHS/EHS/OSWP-LSS C-19 COMMON FORM Updated April 2022 Page 5 of 6 • COVID-19 Permit Option Common Form LHD Reference: LS,9? POZ- \ UI PART 3: Authorization to Operate(ATO) Except for date received,the Section below is to be completed by the Owner. LHD USE ONLY: Initial submittal of request for ATO received: by Dote Initials Date of Post-construction Conference: The following items are included in this submittal for an Authorization to Operate under an LSS COVID-19 permit: 1. Signed and sealed copy of the LSS's report that includes the information in G.S. 130A-336.2(k) ❑Yes ❑ No 2. Operation and management program ❑Yes ❑ No 3. Fee (as applicable) ❑Yes ❑ No 4. Notarized letter documenting Owner's acceptance of the system from the LSS ❑Yes ❑ No S. On-site Wastewater Contractor name: License number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 6. Proof of Errors and Omissions or other appropriate liability insurance for the On-site Wastewater Contractor is attached and includes the name of the insurer, name of the insured,and the effective dates of coverage. ❑Yes ❑ No Attestation by the Owner for Authorization to Operate hereby attest that all items indicated above have been provided to the Print name of Owner County LHD and the system shall meet applicable federal,State,and local laws, regulations,rules,and ordinances. Signature of Owner Date This section for LHO 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,USPS,Hand delivered Print name of authorized Agent of the LHO 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 LHO Signature of authorized Agent of the LHO Dote ISSUANCE OF CERTIFICATE OF OCCUPANCY: Once the LHD determines completeness based upon the A70 submission,the owner may apply to the local permitting agency for permanent electrical service to a residence,place of business or place of public assembly pursuant to G.S.130A-339. DHHS/EHS/OSWP-LSS C-19 COMMON FORM Updated April 2022 Page 6 of 6 AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. 1 , 2' and 3 PHASE PARCEL ID: 375114348027 STREET ADDRESS: Lakeside Lane Conover, NC 28613 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. flc;eSignature: Owner Signature: r anion gonzalez(Nov 15,2022 19:56 EST) Date: Nov 15,2022 Date: l ® DATE(MM/DD/YYYYI AccoRD 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 - FAX 500 W. 13th Street usic,No,ExU;_9187797880__ (A/C.No):817-882-9284 Fort Worth TX 76102 n DRESS: dlvjr(dhigginbotham.net INSURER(S)AFFORDING COVERAGE NAJC C 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 INSURER D: 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. INSRLT TYPE OF INSURANCE INSD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MNUDD/YYYY] (MMIDDlYYYY] A X COMMERCIAL GENERAL LIABILITY 04-GL-001086672 9/25/2022 9/25/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR I PREMISES(EaENTED occurrence) S 100,000 X Professional MED EXP(Any one person) $Excluded PERSONAL b ADV INJURY $1,000,000 GEN.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY JEC07 LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ 1Ea[(cadent) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERSCOMPENSATION 38WECNW6175 10/17/2021 10/17/2022 X ER P 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNERJEXECUTIVE N 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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 1St,Additional Remarks Schedule,may be attached II more apace 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Residential Subsurface Wastewater Treatment and Disposal System LSS COVID-19 Proposal for Lot 2 - Lakeside Lane Keisler Dairy Road Conover, NC 28613 Tax Parcel #375114348027 November 15, 2022 Prepared for: Four Corners of Charlotte LLC 1612 Seattle Slew Court Waxhaw, NC 28173 704-713-2602 Prepared by: Michael G. Wood, LSS Thompson Environmental Consulting, Inc. tas'D s°4 /F,,, PO Box 541 Midland, NC 28107-0541 ' ;Alie ` Phone: 704-301-4881 r""f - larry@thompsonenv.com 424. 1219 • Lot 2-Lakeside Lane Details Century Complete has contracted with Thompson Environmental Consulting, Inc. (TEC)to prepare LSS COVID-19 septic proposal for the 3-bedroom single family residence on Lot 2 - Lakeside Lane, Leeland Terrace, Keisler Dairy Road, Conover,North Carolina. Based upon a soils investigation performed by TEC, it has been determined that a sufficient amount of "Suitable" Group IV soils is available for the installation of gravity-fed Accepted System with a 25% reduction for both the initial and repair systems at a 0.30 GPD/ft. sq. long term acceptance rate (LTAR). The property is 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. The owner would like to request that the county issue the appropriate permits for a subsurface wastewater treatment and disposal system based upon the enclosed LSS COVID-19 permit option. Location From Newton, head north on Main Street, right on E 20`h street. In 2.0 miles, right on Emmanuel Church Road, left onto Keisler Dairy Road, intersection with Lakeside Lane will be in 0.4 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, December 6, 2018. Accepted Wastewater System No. AWWS-2005-02-R6; North Carolina Department of Environment and Natural Resources, Division of Environmental Health, On-Site Wastewater Section, August 21, 20 15. Primary Investigator's Credentials NC Licensed Soil Scientist No. 1219 NC Authorized Onsite Wastewater Evaluator No. 10025E SC Professional Soil Classifier No. 114 VA Professional Soil Scientist No. 415 2 • Lot 2—Lakeside Lane 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 will be fitted with an approved effluent filter and riser for easy access and periodic maintenance. 3. It is the responsibility of the septic contractor to thoroughly inspect the septic tank prior to accepting delivery to assure that the tank has had time to properly cure and is free of cracks or other structural deficiencies. B. Pipes and Fittings 1. All discharge piping, connectors and supply lines should be made of SCH 40 PVC. 2. All joints must be properly "welded" utilizing the appropriate PVC cement for each application. 3. The supply line from the pump tank to Line I shall be 3-inch Schedule 40 PVC (approximate length of supply line is 45 feet). C. Distribution Method- Serial Distribution 1. The system will be gravity fed to Serial Distribution. D. Drainfield Installation 1. The drainfield has been previously laid out 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. 3. The specified system is the shallow placed innovative wastewater system Infiltrator Quick4 Chamber System. 4. The drainfield consists of three (3) lateral trenches 3-foot wide and 95, 95, and 110- feet long. 5. The trench depth for this system shall be 25-inches on the low side of trench. 6. The laterals are to be installed on contour with the land, keeping the individual trench bottoms level from beginning to end. 7. The trenches should be left open for the final inspection. 8. Each trench shall be placed on a minimum of 9-foot on centers. Lot 2 Lakeside Lane Initial and Repair Septic Systems Field Une# Color Initial/Re it Field Len h System Length Setup#1 Relative Elevation 1 B Initial 95 95 7.6 100 2 W Initial 95 95 8.35 99.25 3 P Initial 140 110 9.2 98.4 4 B Repair 120 105 9.55 98.05 5 W Repair 107 105 9.85 97.75 6 P Repair 90 90 10.25 97.35 • Lot 2—Lakeside Lane E. Final Landscaping 1. Final cover over the drainfield shall be at least 6-inches deep. Additional soil cover may be required to achieve the 6-inch requirement. 2. The drainfield shall be shaped to shed rainwater and be free from low spots. 3. The entire area of the drainfield 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. F. Utility/Drive Conflicts 1. The builder and property owner must take special care in planning for utilities(water, power, gas, telephone, cable lines, etc.). All utilities shall be kept clear of the septic system and its proposed repair area. Improper planning for underground utilities can negatively impact the installation and, in some cases, cause irreparable damage and permit revocation. If there are any questions regarding preferred routes, contact the County as soon as possible. 2. Water lines must be kept at least ten (10) feet from any portion of the septic system. 3. Irrigation systems should not be placed in the drain field area. Maintenance G. In General The designed system does not require ongoing maintenance via a person certified (Certified Subsurface System Operator)by the North Carolina Department of Environment and Natural Resources to operate subsurface wastewater systems(Section .1961 Maintenance of Sewage Systems). However, the following maintenance should be considered by the owner. 1. The homeowner must maintain the drainfield area through periodic mowing. The drainfield must not be allowed to become overgrown. 2. The septic tank should be pumped every 4 years or when the solids within the septic tank reach an elevation that is equivalent to 25%of the volume of the tank. In some situations, the tanks may need to be pumped more frequently. If you are using a garbage disposal, it is recommended that the septic and pump tanks be cleaned out annually. 3. When it becomes necessary to clean the effluent filters,the filters should be removed, and the accumulated debris washed back into the septic or pump tank—not onto the lawn. 4. Any damp areas, leakages or malfunctions in the drainfield should be addressed immediately. 5. Divert gutter downspouts and surface water runoff away from the drainfield and septic and pump tanks. 4 Lot 2 -Lakeside Lane Initial System Design Specifics Daily Design Flow: 360 GPD—3 bedroom house Effluent Loading Rate: 0.300 GPD per sq. ft. Drainfield Type: Accepted (25 % Reduction) Maximum Trench Depth: 25 Inches on low-side Supply Size: 3 Inch Supply Line Length: Approximately 45 feet Number of Drainlines: 3 **Drain Lines: 3' Wide x 95',95',and 110' Long **Drainline Spacing: 9 Foot on Centers Total Trench Length: 300 Linear Feet Distribution Method: Serial ** See drainfield layout for site locations and more details. Repair System Design Specifics Effluent Loading Rate: 0.30 GPD per sq, ft. Drainfield Type: Accepted(25% Reduction) Maximum Trench Depth: 25 Inches on low-side Supply Size: 3 Inch Supply Line Length: TBD Number of Drainlines: 3 **Drain Lines: 3' Wide x 105, 105, and 90' Long **Drainline Spacing: 9 Foot on Centers Total Trench Length: 300 Linear Feet Distribution Method: Serial 5 O cn ,01y,JR. . 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VS taN i nompron Environmental Cwsdtlng,Inc. ake, !ier d PO Box 541 PROPERTY ID r: 33J1`i3 yga Midland,NC 28107 - COUNTY_ Ca `''ft' SOIIJJSIITTE EVALUATION fin ON-SITE WASTEWATER SYSTEM OWNER: 2 28 2 ADDRESS: DATE EVALUATED: Z. PROPOSED FACILITY: Res. PROPOSED DHSKIN PLOW(.1949)r .5 b U q p d PROPERTY SIZE: /.irl .c, LOCATION OF SITE' YL r,',s i-1 R. «I - (Oslo v PROPERTY RECORDED: WATER SUPPLY: 0 Private ISI Public 0 Well 0 Spring ❑Otha' EVALUATION METHOD: HAT,Boring 0 Pit 0 Cut TYPE OF WASTEWATER: EY/Sewrage 0 Industrial• Process 0 hard IT ,MORPHOLOGY cn7am P (JWI) PROP1L R MOORS t Ma K UNMAN 1a_UN - - MONT E yeomen it SOPS IC Irk) ,Sp ,yam p� -*943 Atli .!!M C[A65 a rRUCTUUJ O virtiT ILmsl so1L SPP* MTh s LTAR TEXIMAZ INIUMALt00ff COLOR Dig CLAD- mow 6 - y., I v hi,.1p1N,,,,,5 tic? j A3 55) , ex ri/sr/sPIS„.0 PS 0.3 1 NS i° OP L.y a� 4,ki Gk 1 /ss f , i' PS AO ,,l P' F�/c. kr�. 1 �U �to" 0.3 1. �glu x • PS 3 °fib (.9 0 C' TEDIMit 110 L • 0.3 111111111111111 I/ 0 _ /rv14 PS 4 �,`° j, , t? Syr 0, r' /t'lrP�s ao `VI �� i- 0.3 L\` 1 pVAM t n$ThM OTHER FACTORS(.19467 r T - DESCRIPTION ErIE CLASSIFICATION(.1948): ./V' Z H O_ SC/ PS PS Available `� �. '°s Available Space Accepted EVALUATED BY: �' Accepted p oTHERolPRFs1�`rz': g, , Sysbnu Type(°) ... � i is M I�F 0.3 0. �, � , Site LTAR 1MENT! " DQTH C SOIIJSITE EVALUATION shot Z cf Z (Co,Jhzsntion Ater-Comp/tie'Allied in MI) PROPERTY ID#: 3.7C/1'13 `fed.)?- t /) DATE OF EVALUATION: Z-Z.9 Vt'1 L It t COUNTY: G' - r 1 o SOIL MORPHOLOGY OTHER Ir i (1941) PROFILE FACTORS , .1940 g• LANDBCAlZ HoRIZ .L$41 TOBTICKI .1941 .bit SOIL 1943 .1556 l .1944 PYO>of.Z ON it &OM I STPOCflV CWRN7S 4t L WILTIM R1 sou,, RAMO RIMCLAM Dann Mt) I = O E ]I 11411AALOUT COLOR g CLAM HORN &LIAR 1/7 6 -3 I' l� !Y ,VS/N/i/r[,io . V. ,-13 f cv V . Ale 1, �. 71. P S ,‹ "siA 0 13 "ti _ 01\ ( i. (.0 /CP/see •s•-, 'I ° ‘ --:' ' Cr.3 --"'"' ~/ t (N01ArOM1 ,t) a-kii ul c).- tc;b3 hakleo .,_ 'IA :k.. - (� AO \121 149 (I' fi AS. /P `� ? 0. . r . y i l • 4 6 -3 f V 7/2/rs 'PivosP, 1. 5 5— r° :IN—, C L/ %r'/tr /sP/seR) a 0 0.3 ..- NA i 0 a 0 7) 77 C?1'lL frI 1 P i F,a �f7 ) -A . 4),. G(f Pis./ AP Aram _A4b 9'6tI 43 iig C //ri /r/rw zi( 0 3 la 1 I I) 1, ` • Quick4 rm STANDARD CHAMBER 52" Quick4 Standard Chamber - - -48" (EFFECTIVE LENGTH) a 12" I8, III 11 11 II 1111 1 1 34" SIDE VIEW SECTION VIEW MultiPort End Cap - IP0 /r1 r1 16• Ifl « I I ' 411bit ILJ r I 41)� _ ��i 34" 1 SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications Size (W x L x H) 34"x52"x12" Size (WxLxII) 34"x16"x12" Effective Length 48" Invert Height 8'or 1.25" Invert Height 8" INFILTRATOR SYSTEMS.INC.STANDARD LIMITED WARRANTY tt4 The structural ntegcy CO each&ember end plate.wedge and.her accessory netrutecntred by Wanner f"Units].when nstaled e•l operas.t •'.a let do0*i u'an aete Septic system et;t'(xfrlerce with Initrair'v nslnxtians,is wentried to the ogha purchaser(-holdall against delectrv, metenals end wGWnere p for from year horn the dale the Ire spec perm is sent 10 Ili spec system b.: ring the Units.prowled lewerer :Ian I'a septic{mist a int waked by amicable We.the wrlrty period MI teeth 1{xxh the Mete rha el the septic system Commences days :it it the rs and defect. cots.tickler must relay lacont 1110 4 a roe Memnon In byHlelat s to Ole 0000 dc.thrs Wined within laean 1151 I N F I LT RATS R o days o'tha Austad detect.lntleae ra soppy rePteoairatt Units 1Q leas dotrnr,odl by hMreta be coined W sits lhrted Warranty let0ao's lebrty spea0c0y excludes the owl of',giant ertdbr haykpn la eta Ihle A Re THE LIINTED WARRANTY ANo ROAEDIFS ti SUITIPARM3RAPH NI ARE EXCLL/SM1E THERE ARE NO OTHER WARRANTIES WITH RESPECT SYSTEMS INC -o THEseis.INCLUDING NO IIAPLIEO wAPPANTES cF MERCHANTABILITY OR riTNESS 10ft A PARTICut AR PURPOSE rc)Tfis United Warranty shell be MO l eery pat or the chiller eyMMf Ii mah/eekred by aryl re title anti Wimp. The tinted Warranty does ��� not extern to incidental. special.consegalspecialp®or Indirect derns .MIMI.shell not be home tortx0Wtxs or humbledUanstps.hdudng loss of Environmental Ones Wastewater ISoluiy1VnD pOdx lion end profits.labor and rnalerlab.overhead mem p ettw lour er apneas monad l W!he moll,or My Ilird pety Specific* eulul.d atm[kilted Werety Cwaege are therm".to the Unlit Aar 10 many weft end rem.attention..".cirkr,l.IIK;nle abuse or neglect at ate Units:the this being setseded to whole',attic or other rzmAYae whet ere I101 pommies.]oteel try ler.ocoiolrrl estrtr_IrU0.fain W mµ t04n the 6 Business Park Road • P.O. Box 768 trwwrsrn grand covers sot tom n the Irstalatien instructions:the pioentad of Metopes mammals into Soo system co nlase1g Ile Untie:tonne of dhe chits a the moan cystan due to io q,er siting<r.honor NTng,alceaaw war MVO,iroxax.grime 111SM00.fir inproper operation;. Old Saybrook,CT 06475 any d Gent not caused by Irekraa T Meanly This United ra ly erdl be wed If the Hydro Ie1B to u.rply Ms,ai a du tans am IWm In this limited 860-577-7000•FAX 860-577-7001 Further.in no event ghee Infitrala be reepor.6M to Nov bee or ocanoe to the Holder.Ile Leine.o ary third perry'mulling from nsteleson or ship- 800-221-4436 MG err kern airy product lab0ty cans of Holder or any thin IV Ulu e;Llniml Warranty to apply.the Unite meal be Installed acco lance nl, with are site cnhdtions racked try state and local codas.al cot..alapheable laws.eel UN1o,Arx'n installation iretructmorta (ell No representative of Marmot'has MO eumairy to change or extend this Limited Wntranly No wnr.Ity aloes in any pnry Ottom then toe oriO- na Holder The shove represents the Standard tinned Wmanty offered by nlerates Mintier.]tinter of states end counties have different w.tanry require mares. Arty purchaser CO Unite s otki contact nnelrelor's C.rporele Heedqualera lit CM So04.o0 k,Coeteolx:ut,lrx.to stx'It fxlnttaa0,to chef,e copy of the applicable warany.and should carefully read that warranty prior to the sundress of Unite. U.S.Patents:4.759,661:5,017.041:5,156.488:5.336.017:5.401.116:5.401.459:5.511.903:5,716,163:5.588.778:5.839.844 Canadian Patents:1,329,959;2,004,564 Other patents pending. t es to Infiltrator.Equalizer and SldeWirrtlex are registered trademarks of Infiltrator Systems Inc.Infiltrator is a registered trademark in France.Infiltrator Systems Inc. is a registered trademark in Mexico.Contour,Contour Swivel Connection,Micro(oaching,Pd m yTuff.SrtgpLock,CheberSpacer,Postocx,CLIIckCut.Cockney efCVC100 PAPS; and Oteck4 are trademarks of Infiltrator Systems Inc.C 2033 Infiltrator Systems Inc.Patted In U.S.A. Q01 1203HP-0