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HomeMy WebLinkAboutLSSP-11-2022-184975.tif Lot 1 - 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 ❑X 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 gonialez(Nov 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/ENS/OSWPB—LSS COVID-19 COMMON FORM Effective September 8,2020 Page 6 of 6 November 16, 2023 Subject: Septic System Instal►ations 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, rainon 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, Deg I_Grant(Nov 16,2023 21:57 EST') Dewey Grant Maiden Grading and Septic Tank DATE(MM!DDYYY) ACCPRD M 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 Lynch Davis NAME: Y MauneyInsurance Agency, Inc PHONE (828 428-8231 FAX 828 428-8237 _(91C,1�Io;_Ext1: � fAIC,Nol: ( ) 1205 E Main Street ADDRESS: Idavis@mauneyinsurance.com INSURER(S)AFFORDING COVERAGE NAIC tf Maiden NC 28650 INSURER A: Erie Insurance Exchange 26271 INSURED INSURER B: Maiden Grading and Septic Tank INSURERC: 214 S Main Ave INSURER D: INSURER E: Maiden NC 28650 INSURERF: 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 LTRINS° WVD POLICY NUMBER IMMIDDIYYYYI (MMIDDIYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 DAMAGE TO D 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 LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY E OCT J LOC PRODUCTS-COMP/OP AGG $ 2000000 � OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 {Ea accident) ANY AUTO BODILY INJURY(Per person) $ A AWNED SCHEDULED AUTOSQ06-0530679 06/05/2023 06/05/2024 BODILY INJURY(Per accident) $ HIRED ONLY AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY A ANY OFFICER/MEMBEREXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE YYN NIA 091-5900316 07/09/2023 07/09/2024 E.L.EACH ACCIDENT $ $1,000,000 (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 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 1 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 . WATER • WASTEWATER • 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: LARRY@TIIOMPSONENV:COM WEB: WW\C 1IIOMPSONENV.COM Residential Subsurface Wastewater Treatment and Disposal System LSS COVID-19 Proposal for Lot 1 - Lakeside Lane Keisler Dairy Road Conover, NC 28163 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 0 SOIL s Thompson Environmental Consulting, Inc. G� #�G. $ti,�� PO Box 541 a Midland, NC 28107-0541vtzit„ey. Phone: 704-301-4881 Larry@thompsonenv.comu�,, ' Lot 1—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 to be located on Lot I - 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 20th 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 1—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 the distribution box (D-Box) shall be 3-inch Schedule 40 PVC (approximate length of supply line is 20 feet). C. Distribution Method—D-Box 1. The system will be gravity fed into a D-box. 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 four(4) lateral trenches 3-foot wide and 75-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. Initial 1 Lakeside Repair ln �Feld Line Systems Initial/Repair Field Length System Length Aetup#1 Relative Elevation__ 1 Blue initial 85 _ 75 4.8 100.0 2 Pink initial 85 75 _ 5.45 99.4• _ 3 White initial 85 75 6.3 98.5 4 Blue initial 85 75 7.25 97.6 5 Pink Repair 85 85 7.85 97.0 6 White Repair 92 90 8.7 96.1 7 Blue Repair 125 125 9 95.8 Line 1 4.8 100 3 Lot 1—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 1—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 20 feet Number of Drainlines: 4 **Drain Lines: 3' Wide x 75' Long **Drainline Spacing: 9 Foot on Centers Total Trench Length: 300 Linear Feet Distribution Method: D-box ** 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 85, 90,and 125' Long **Drainline Spacing: 9 Foot on Centers Total Trench Length: 300 Linear Feet Distribution Method: Serial 5 LOT I 9S01( N/F FOUR CORNERS OF CH JG;g?NpMo ARLOTTE,LLC P685-21 _". sp .� BASISREP.PLAT Lii 46.51" I ----C� o ".oa -'- 1 propose. 375114441082 "�� - j in I drtvewa N/F HILDA T.DEAL = I DB 3285 -830 w e a proposed g (/ `� house y O yy, DRAIN UNE SEGMENETS C I ' /O LINE LENGTH' RELATIVE FUG l # Mr ELEVATION IPTI COLOR SYSTEM .a,s / 1 75 100.00 BLUE INITIAL 2 t7 • •�9 I 2 75 99.41 WHITE INITIAL, 3 75 98.54 PINK INITIAL • f 4 7597.61BLVEINITIALl_ I 5 B597.01WHITEREPAIR------.__.,_,._�.__ d 92 96.46 PINK REPAIRpt - P _—7 125 95.86 BLUE REPAIR 1000 GAL. 199.95' SEPTIC TANK "" "` 3"SCH.40 PVC KEISLER DAIREY ROAD 60'Public Right-Of-Way LEGEND INITIAL DRAIN LINE _-- - PROPERTY CORNER 0 Th9mp�fl 2062 LAKESIDE LANE REPAIR DRAIN LINE ==_= PROPERTY LINE EflV�f6flttl&flt CSL ON2020-'97C SEPTIC TANK 0 UTILITY POLE r, SUPPLY LINE ------- POWER LINE - , I" = 30' DISTRIBUTION BOX ❑ BUILDING SETBACKS ThPOompsonBox541 ■ • Environmental Consulting,Inc. 30' • 0' 30'6' 90' ■ • • � 501E BORING • Midland, NC 28107 GRAPHIC SCALE L 1 nompson Environmental nrtal Crag Inc. meg/of a PO Box 541 PROPERTY ID t 37S/!Ll3`lg41a Midland,NC 28107 • COUNTY: ca)LL,k SOUJSITE EVALUATION for ON-,SITE WASTEWATER SYSTEM OWNER: Z 28 1 L ADDRESS: DATE EVALUATh1R PROPOSED FACILITY: Res. PROPOSED DRI(Pi PLOW(.1949) Lib U g p d PROPERTY SIZE: 'G LOCATION OF SITE: {4 L,•...i� R .) " to N N.v ur PROPERTY RECORDED:_- WATER SUPPLY: 0 Private ®Public 0 Well 0 Spring 0 Other EVALUATION METHOD: VAT(Boring 0 Pit 0 Cut TYPE OF WASTEWATER: 61/Sewage 01n�trial 0 Mixed P so SOIL MORPHOLOGY OTHER F (.ONI) PROFILE FACTORS t JON • E LA1 *ft NI pkt%u1 » >eoiioeu ..1110 i SU % �0 ,11A .11i/ 8�1 .11 .1!!sf .!!N CLASS �� t Wt71Z�S SOIL MPRO X; !LTAR IDArosz DilfALOGY Coma WIN CLASS • 1 ' Q l 5/ I v e-/,4,s/P4),45 I ; , . ; PS 1 '\a 3 .y,. 0.3 �,� L( • rJ b -a r r!j t- H'ANs/,- NO •nip fr/�skr . t. D `•v t 0.3 • •{ 2 -�fl ,l x I x .. .�_ • 'L c. r- F (4, NP t� 1- t! •kr_ � .40414.- L 1.- j ilf•fLI0 I PS 3 , 7 0.3 I/ _ r. r'/ APAl( • 4 rok° i, 'tb �1 GIf'/rP/r,c, L-co, , 0.3 SWAM e� OTHER FAc cas(.1946r i 0s Toµ 1• .. ; _- vocRirooN mrnA[VMS SITE CLASS��CATION(.1948): Ala- Se/ PS PS f �•THo4+.0 Available space C 194� 1 L�.- EVALUATED BY: v li � �'r' ti`r0 ��" ! ,,444; y Accepted Accepted orlilaR(s)PRss�rr: �_ � Sal l�M,;;�� :,� Sloe LTAA 0.3 0. -; ttL {„ Ck‘AtOrzit4cPeol SOIL/SITE EVALUATION Shed Z V Z (Co zinuar o„Mieet-Complele all field In fill) 3�C/1 y 3 Y�oa PROPERTY ID#: DATE OF EVALUATION: Z-Z$Vt iL .Lr • COUNTY: G.L, t 4 P o SOIL MORPHOLOGY OTHER P (.1941) PROFILE FACTORS � .1940 E LANDSCAPE ` Homy '1942 POSITION/ ASO .11941 SOIL as43 .195k .1944 PROFILE A SLOPE% WPM COIISTINCE/ WETNESS/ Ball. $A ID II�H MASS P 'lissom MINERALOGY COLOR imam CLASS HO= A LTAR V> 6 -3 T 1. ,-,/Ns1~'1rtmo ")-13 5VAl CV /� ,kp . l �' �rx� ,P. ,Zci; PS Lk 0 $ ' (A.1 T r V 15-401 ,4i4vp ` `4; x• t 19 —0/ 41� CA, ,�;/.0 /s0/S�� - �� �- 11 1ti-44 i)bl~ f., it //s /.9'j o `ik ) ; • -", 4— ,0.3 D -/5 ,_� satf J I___ /r7cs A'�V� C li ,-t/sr /S�/cCt0 .........r........6.4 Pt 1 l U `it �/ it/ss /S°/f-OP , L " . :� ,+;�. . : 2� • • KL a , R A. 75 -77 r 1( L fr/ /PA(xP LS ) -t 1 60\ 1;-L-' IduAPAf 1. . to 0 !-h 0.3• 1 1 i r,•, y 4 ,A ;OBIS: • • '' , . . . . .• . . 0uthk4M STANDARD CHAMBER 52" • Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) \.1 f a Li Ie 1.f® ®E-®1511 � m � aka 34" SIDE VIEW SECTION VIEW Muto t End iP r Cap —Ilk ': inliftWOI _16" • 12° \\� Al(.....,71ti ill (r.... , ::, ...„...m.....„ ...... __„ ,,_ _ 34" — SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications MnitiPort End Cap Nominal Specifications Size(Wx.LxH) 34"x52"x12" Size (WxLxH) 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 each chamber,and plate,wedge and other accessory manufactured by Infiltrator('Units"),when Installed end operated • in a Ieechfield of an onsite septic system in accordance with infltrator's instructrons.is warranted to the original purchaser Chidden against defective Allaffifflift14171ZIROSIMIIMMICIMEIll materials and workmanship for one year from the date that the septic permit is Issued fa the septic system containing tha Units;provided,however, • that If a septic permit is not required by applicable law,the warranty period w t begin upon the date that installation of the septic system commences. To a exercise its warranty clef rights,Holder mist notify Infiltrator In i f at it Corporatedetenn Head by lnlltrterse:nn It Old covered orb,ConnecticutLimited rta fifteen(t 5) I N FI LTRATO.R o days of the alleged defect Infiltrator wtl supply replacement Wits for Units determhhed by Infiltrator to be covered by this Limited Warranty ' Infleator's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE UMfTED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SY�T�M S I N C TO THE UNRS,INCLUDING NO IMPUED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. to This Limited Warranty shell be void If any part of the chamber system Is manufactured by anyone other than Infiltrator.The United Warranty does not extend to incidental,consequential,special or indirect damages.Infiltrator shall not be liable la.penalties or liquidated damages,Including loss at Environmental Onsite Wastewater Solutions" • production and profits.labor end materiels.overhead costs,or other losses or expenses Incurred by the Hoder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear.alteration.accident.misuse.abuse or neglect of the Units;the halts being subjected to vehicle traffic or other conditions which are not permitted by the installation Instructions;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 materiels Into the system containing the Units;failure of the Units or the septic system due to improper siting or improper sizing,excessive water usage.improper grease disposal,or improper operation;or Old Saybrook, CT 06475 any Warranty.event not caused by Infiltrator.This Limited Warranty shall be void if the Helder fails to comply with al of the terms set forth in this Limited 860-577-7000• FAX 860-577-7001 Further in no event shall infiltrator be responsible for any loss or damage to the Holder,the Units,or any third party resultkhg from installation or ship- 800-22 1-r1436 ment.or from any product liability claims of Holder or any third party. For this Limited Warranty to apply the Units must be instated in accordance `f with all site conditions required by state and local codes;ell other applicable laws;end Infiltrator's Installation Instructions ()No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the aigi- ' nal Helder. The above represents the Standard Limited Warranty offered by Infiltrator A limited number of states and counties have different warranty require- 1 /rents.Any purchaser of Units should contact Infiltrator's Corporate Headquarters In Old Saybrook,Connecticul,prior to such purchase,to drain e copy or the applicable warranty.and should carefully read that warranty prior to the 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 SS Canadian Patents:1,329,959;2,004,564 Other patents pending. s * 111• 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,PolyTuff,SnapLock,ChamberSpacer,PosiLock,OulckCut,QUIckPlay RECYCLED PAPER and Quick4 are trademarks o1 Infiltrator Systems Inc.0 2003 Infiltrator Systems Inc.Printed.In U.S.A. 0011203HP-0 OL) L ke d Com1H . C- i1 - y•R),( Lk-1 i \ LISP-l 1 - )a» - 115 STAiEa� ROY COOPER •Governor t + 41's NC DEPARTMENT OF KODY H. KINSLEY•Secretary '�I` _'•'' HEALTH AND HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health MARK T. BENTON•Assistant Secretary for Public Health Division of Public Health COMMON FORM FOR LICENSED SOIL SCIENTIST COVID-19 PERMIT OPTION FOR NON-ENGINEERED SYSTEMS See Instructions for Use in Appendix A Except for"Date received",this Section to be completed by the L55 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: III f]jzZ by A re m[iols 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: Q LSS ❑ LG 5. Property location (physical address,tax parcel identification number or subdivision lot, block number of the property to be permitted): Lot 1 - 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 MAILING ADDRESS 1642 Mail Service Center.Raleigh,NC 27699-1642 www.ncdhhs.gov • TEL:919-7D7-5874 • FAx:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER COVID-19 Permit Option Common Form LHD Reference: IJS�_ k\- -o)) iU'1 177 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: 36° 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: UI 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-33S(a1)signed and sealed by a LSS is attached: ❑■ Yes ❑ No 13. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG is attached ❑Yes UI NA 14. Proposed landscape,site,drainage, or soil modifications are attached: ❑Yes 0 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 1SA NCAC 18A.19, -ti ities determined to be engineering as determined by the North Carolina Board of Examiners for n and rveyors. 11-15-22 Signature of Lic —if S ientist Date Owt±ei`self-submittal of NO!: 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: isS1 - II -20 22- jq75 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 fS.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. DHFIS/EHS/OSWP—LSS C-19 COMMON FORM Updated April 2022 Page 3 of 6 COVID-19 Permit Option Common Form LHD Reference: LSP 11-DOD). IS.LI 775 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 deportment 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 deportment shall notify the owner and list the information needed to complete the notice. The owner may then submit additional information to the local health department to cure the deficiencies in the initial notice. The local health deportment shall make a final determination as to whether the notice of intent to construct is complete within five business days after the department receives the additional information.If the local health department 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 1.55 and the Owner on Dote 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 X 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 11 I$(Livia tiW1a] t . 11 Date Email,FAX,LISPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via . Dote Email,FAX,USPS,hand-delivered ik IA' i'V (ii)NA-‘A ej ifs-\ 4/4 • t Prin( me of Authorized Agent of the LHD Sign t e of Authorized Agent of the!HD Da DHHS/EHS/OSWP-LSS C-19 COMMON FORM Updated April 2022 Page 4 of 6 COVID-19 Permit Option Common Form LHD Reference: LSSr - 1-2b27- 07 Ct--75 Re-submittal of NOI with missing items included This Section is for use by owner to submit items noted as missing during LHO Completeness Review above. Resubmittols must be accompanied by a cover letter from the LSS. LHD USE ONLY: This NOI resubmittal received: by _ Pate IMiais Item#from initial NOI Resubmittal description Attestation by LSS pursuant to S.C.2020-97,Section 3.19 hereby attest that the information required to be included with Licensed Soil Scientist(Print Nome) this Notice of Intent to Construct is accurate and complete to the best of my knowledge and that the proposed system shall meet applicable federal,State, and local laws,regulations,rules,and ordinances. 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,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 LSS and the Owner on via Dote Email,FAX,LISPS,Hand-delivered A complete copy of this form with tracking information was sent to the State: via Date Email,FAX,LISPS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date DHNS/EHS/OSWP-LSS C-19 COMMON FORM Updated April 2022 Page 5 of 6 COVID-19 Permit Option Common Form LHD Reference: L 1 I I I q ` 5 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 the information in G.S. 130A-336.2(k) ❑Yes ❑ No 2. Operation and management program ❑Yes ❑ No 3. Fee (as applicable) ❑Yes ❑ No 4. Notarized letter documenting Owner's acceptance of the system from the LSS ❑Yes ❑ No 5. On-site Wastewater Contractor name: License number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 6. Proof of Errors and Omissions or other appropriate liability insurance for the On-site Wastewater Contractor is attached and includes the name of the insurer, name of the insured, and the effective dates of coverage. ❑Yes ❑ No Attestation by the Owner for Authorization to Operate hereby attest that all items indicated above have been provided to the Print name of Owner County LHD and the system shall meet applicable federal,State,and local laws, regulations, rules,and ordinances. Signature of Owner Date This section for LHO Use Only. LHO 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 LHD Signature of authorized Agent of the LHD Dote ❑ COMPLETE Based upon review of information submitted in the Section above,this Authorization to Operate is hereby issued in accordance with G.S. 130A-336.2(m). A copy of this complete NOI/ATO with tracking information was sent to the State on via Dote Email,FAX,USPS,Hond-delivered 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/OSWP—LS5 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. Ow r Signature: Owner Signature: i,ininn gonzalez(Nov 15,2022 19:56 EST) Date: Nov 15, 2022 Date: • ACa CERTIFICATE OF LIABILITY INSURANCE DATE(MM1D0/YYYY) 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 (IC.Ne Ex* 9187797880 (A/c,Nol:817-882-9284 Fort Worth TX 76102 ADDRESS: dlyjr@higginbotham.net INSURER(5)AFFOROING 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. PC 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. INBR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXPD/ LIMITS LTR INSD WVD POLICY NUMBER (MMIDDJYYYYI (MM!DYYYYi A X COMMERCIAL GENERAL UABILITY 04-GL-001086672 0/25/2022 9/25/2023 EACH OCCURRENCE $1,000,000 D GE TO RENTED CLAIMS-MADE X OCCUR PREMISES SES(Ea occurrence) $100,000 X Professional MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $3,000,000 X POLICY JECT [ J LOG 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 accdent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY ^� AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTIONS S B WORKERS COMPENSATION 38WECNW6175 10/17/2021 10/17/2022 X AND EMPLOYERS'LIABILITY Y f N STATUTE ERA ANYPROPRIETOR/PARTNER/EXECUTIVE N f A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? 1 . (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 ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED PRESENTATIVE ©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 LSS COVID-19 Proposal for Lot 1 - Lakeside Lane Keisler Dairy Road Conover, NC 28163 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. AID u ��' PO Box 541 Midland, NC 28107-0541 f/ Phone: 704-301-4881 '` j Larry@thompsonenv.com 4i', ;H Lot I-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 to be located on Lot 1 - 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 (LIAR).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 20th 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, I SA 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 1—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 the distribution box (D-Box) shall be 3-inch Schedule 40 PVC (approximate length of supply line is 20 feet). C. Distribution Method— D-Box I. The system will be gravity fed into a D-box. 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 four(4) lateral trenches 3-foot wide and 75-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. Initial a Repair Systems-Lot 1 Lakeside Lane Field Une N Color Initial/Repair Field Length I System Length Setup#i i Relative Elevation 1 Blue Initial 85 75 4.8 100.0 2 Pink Initial 85 75 5.45 99.4 3 White Initial 85 75 6.3 98,5 4 Blue Initial 85 75 7.25 97.6 5 Pink Repair 85 85 7.85 97.0 6 White Repair 92 90 8.7 96.1 7 Blue Repair 125 125 9 95.8 Line 1 4.8 100 Lot I-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 I-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 20 feet Number of Drainlines: 4 **Drain Lines: 3' Wide x 75' Long **Drainline Spacing: 9 Foot on Centers Total Trench Length: 300 Linear Feet Distribution Method: D-box ** 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 85,90, and 125' Long **Drainline Spacing: 9 Foot on Centers Total Trench Length: 300 Linear Feet Distribution Method: Serial 5 o EEEgaaa N zzzz;2;�� iit 'r •`•i11�:�/v1" \\\\ g1JR E Om IW3 s lm s m ( J V� Q a _,�w 12 ��H >ZO 4pI20wd ❑�Otit r0 gPPIPPPP Wwz - r N Lu ZJ • rbM Nin wf N I� UEnnnnmP� N 1'. W` ,OO Z#�wYnn NNQ❑ COrt ,— DN S co ti — ,R0'b£I. o 131 ,� III III Q) II G III �� C4 111 U UCO W f III E®`0¢ u.rNIL � �111 L7T � � a cNz I— O ,� of JJJ a W ° X� OO c, co ^ 1 /// _fit o.m c za i /// uoo Qom,' 13 U �i/ W O=cr ; ate � g d¢ 1 FL a y Z Lar . CR'tiy til J Y 1 _ - f4s,Ob Q C7 1 w V O h (�D ' w U 1 j m co O � W 1 1 0 W W cLLS n d ,7— a rn I V J J Z d — 1, , O J E9"E£l d — -- � (_) oc ce Z -(BM-JO-145W oNnd.09 ----- — _ ce _ 3Ndl 301S3Nyl z o o __ w — w i I 1 Z Z x O J J CO Z Z Y W Z V i7 4 Z Z O Z G C a. -1r 'la CO~ W W n H O m Z OC to V) ❑ (A • i nompsen Environmental Cansalting,Inc. gem I of PO Box 541 PROPERTY m t: 370/431$a.3- Midland,NC 28107 • Co[1M1v. 6' "' SOILJSITE EVALUATION for ON-SiTE WASTEWATER SYSTEM OWNER: z 2a 1 z ADDRESS: DATE EVALUATED: ' PROPOSED FACILITY: Res. PROPOSED D FLOW(.1949) ibU q pd FROWN I•fel '(- LOCATION OF SITE: r,,,•,s LJ R /eN s v✓• PROPERTY RECORDED: WATER SUPPLY: ❑Private Ill Public 0 Well 0 Spring 0 Other EVALUATION METHOD: grAiser Boring 0 Pit ❑Cut TYPE OF WASTEWATER: D 9ewnge 0 IIBrlrW i rvccis 0 Mind NI 0 SOIL MORPHOLOGY OTHER y (.Tail) PROFILE!ACTORS r .aw L LANDSCAPE BM" _ - - ppaiE • > a. J!O t7.A I SAWS% fa.) lark SOIL .1943 _Ms MO SI BTRUCTINIs/ co1sISTENCl/ WETNESS/ sat, MPRO 1iCW1111 a LIAR ISM= DISSOtALOGY cOLGS DETHI , CLASS > >a r _ 5/ I v ir%/PIN,, f V-7 ' ,M*5 c►a i ci ;--,f ciIs,hr,.0 PS 1 0: 9 y 3rf, 0.3 ��f `d _a , r' L- Ty-Ads ivoo =2 -'k o khk/ i. r-�/rI krx� +o x - kiii 0.3 s‘- L r 1 ,+r A+P Ga _Cs } - _ i L c rt rf - Si, : "� D • y 14111 . PS 3 ��� �o Q F:/ �• s :. 110 0.3 1 ` - r- %/r`'(1jp up J �' V 1( ti 1A Fr/a 4*i ,, , . L PS 4 `D (�-Ll l? )'j 0 L'10 0.3 4\ i me„µ[MM.' nsAet sty oTTi R FACTORS(.1946) 1 ,D 7, ��~�`•.' DESCRIPTION SITE Q.ASS FICATION(•194S): f — PS PSjr 7�6.'zI1aMA • Available Sty I.1945) EVALUATED BY: 146' / `Q',1,0,, 0 0 . �' sy��u ) Accepted Accepted =ER(s)PRE9DIT: � / i, ,1'�/Irv?,e lV'i,.L? a 0 3 0 - `; MAIO .►r7 /r?�i - Site LTAR � tWt,.'+ ,t:Ay RIH cr, SOILBITE EVALUATION s+l..r Z 4- (ContLRw ton Sheet-Complete o11JPrid In full) 3��Ir 3 Y�'o a PROPERTY ID 11 DATE OF EVALUATION: Z-Zg • Vt 't 15��/ COUNTY: 4ft`4' CU, P R O SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS L .1940 E LANDSCAPE , BORIL .041 ROIIn'iont am .1941 SOIL J .199f .1944 P11OW1LH ✓ R.OM% O sneurnotsr COMISTiMCV ICETNIt>�r ,, NAM nssri ci.a TIMM SONICRALOGY COLOR erg CLASS watt a LTA' — r r „y 6 -3 5i FL—, .=�%,s�^"ri(tp -13 S4( cv ,=,/,, Abirt� ;. q=r PS ' Flo , •ti _ C-I t (/ ,; /.U /.°/%e ,.- :l , _ 4 y • 1.3 tk (A) \ (� 110 1�-" 1j ` Ci t As- isPAcaP 9% ) ' . y 0.3 a -3 Ar) L...- r i;/ s A9A' L/5 J to cL /cr /se Ago 7' 1 b-'Il G II/sr he/kr,� :� 7.--4. . P I` 0l o cif ) f:i. t - r 1 t_ /rip&iiv P>✓N 49 I,i, ) .. G(.-- Frio //P Ari I ,%it( 9•`l I 44/ /sf /rr/ram p Ps •5 ��i 0.3 a • i • TA . 'l' ' ti_•r • 01ck41741 STANDARD CHAMBER 52„ Ouick4 Standard Chamber — -- 48" (EFFECTIVE LENGTH) 12" 11111111111l11111, 34• SIDE VIEW SECTION VIEW MultiPort End Cap IL1IflIir -*, 16. \ftimoni 4114...1101111 34• SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications _ MultiPort End Cap Nominal Specifications Size(WxLxH) 34"x52"x12" Size (WxLxH) 34'x16"x12" Effective Length 48" Invert Height 8"or 1.25" Invert Height 8" INFILTRATOR SYSTEMS.INC.STANDARD LIMITED WARRANTY to The structural ntegity o each chanter,nod ewe wedge and whet accessory mar ufeclured by Infiltrator 1 Timms).when rivaled and operated r.o kecigekd um an mete septic system In accordance with nAwa'or's nelesbaw.a wenenled to the towel rA.dares f ftic7re'I agars;Oelectrue nnlones and worlarwrnlvp for one year from the dew that an septic permit to issued for the spec system motoring le Jrrls provided.Inv ex r, 'hat r e aq>Is pent*a not reytante by eppio1]le law the wenwey prod will bay,lean Ire dale set rvohga•n of 11.swirls system cortnma%ee To exercise Its warranty Holds co fi n on onna at Corporate Headquarters t Old obi Connecticut fifteen rwn 1151 digs of the aesel detect bnfloerrwsttAly notify Urns kr Uiss dearmind by Infiltrator to be covered by S lowed Womanly IrdlhalayNmedrcally excludes the cost or rorrroval uncles'ngelatlnothe Units I N FI LTRAT�R 0 Ile)THE LIMITED WARRANTY AND RrMF.DlES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE API'NO OTHER WARRANTIES WITH RESPECT SYSTEMS INC TO THE UNITS,lNC1LIOING NO IMPLIED WARRANTIES OF k61CHANTA61U1Y OR RTNEss FOR A PAFITICL1LAR PURPOSE. IU This Omitted Warmly anal be vmd 11 any pert of the chamber system le rrenulectued by anyone dlxe ern rlarela The Limited Warranty does not extend to w9dental cwneeluenslel,specie)or Minot damp .IrAaator elW not be fable or peneltiee or kpldeted damages.inducing loss o' Environmental On&te Wastewater Sok111013 ` production cod croft.,tabor ail materiels,weaved sate.or der Imes of avenue Incurred try Its Holder Or any Wed parry Specifically excluded morn Larded Wenerly corerege are damage to the LAga due to Miran,wear and leer.eaauaat sOalwnt.meta..slams a neglect or the Llnita.the Units berg clubfooted to vehicle traffic ardor condolers which we red pinged by the Welber,'reductions:farm to maintain the 6 Business Park Road •P.O. Box 768 nesmum ground coves set tar In he keelelen Mwvctitot dal plc man or,reaper mwerlW into the system cwntarnno the tins(Are of the Lone or the septic Elysian flue lw improper Wang or►ma,crer amng...cerm water mega.improve awe teslxea or romper upends,.ds,. Old Saybrook, CT 06475 any other event not caused by nrawar.Thee tinged~wily she be old 1 the Haider rests to comply salt el or lie terns set north in this Limited War08y 860.577-7000• FAX 860-577-7001 Furher.n no event shell relator be responsible for wry foss or damage to the Holder the Units.or any third party resulting floor oetalwfpn or shoe mere a d Worn Orly product liability art.of Holder a s y the petty Fa this L need Warranty to apply.the Us me rn et be tal 801)-ed n accordance 22 w vl.] 22 �4436 weh el see codrkr.5 morsel by stale and Iota codes:al other.ppeceble'ewe:and netrekis atelaeetkn Yetnallote Id)No mprevinraww of Infiltrate lies the alhanty to themg,or exla,d rem I coved Warranty No waranty Woes to any paty other than lie,orig. nal Hwldpr The aloha represents tie Standard I cored Warranty omwed by neenaa A tooted number sO slams One counties hex.niiaant warranty maims marts Any cachesar or Plots should contact lnamatore Corporate Headquarters in Old Saybrook.Comnctcte,prior to such purchase.to dime,a copy o the amicable warranty and should carefully read that warring poor to the purchase or'Jets 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 If Canadvnn Patents'1,329,959:2.004,564 Other patents Perking. +*� Infiltrator.Equable,and SkleWirlder are registered trademarks of Infiltrator Systems Inc.Infiltrator is a registered trademark an France.Inlltrata Systems inc. is a registered trademark inMexico.Contour,Contour Swivel Connection.Mimi rvr.Mng.PohyTull.SnepLock,Char11berSpacer,PoeaLock.OuickCtrl.QuickPlay RECYCLED PAPER and 0UCk4 are trademarks of Infiltrator Systems Inc.0 2003 Infiltrator Systems Inc.Printed in U.S.A. COT 1203HP-0