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RBPR-04-2023-44005.tif
R61)Q-044)3-41toos- ,STATE (.'647 DOtSefi LnecAt ;l tiow ROY COOPER• Governor FfG .14 .'_,')k NC DEPARTMENT OF KODY H.KINSLEY•SecretaryHEALTH AND ' HUMAN SERVICES HELEN WOLSTENHOLME•Interim Deputy Secretary for Health �r . •„ . MARK T. BENTON •Assistant Secretary for Public Health Division of Public Health Petty 5 bedroom-Wastewater System COMMON FORM FOR ENGINEERED OPTION PERMIT See Instructions for Use in Appendix A Except for"Date received",this Section to be completed by the Professional Engineer licensed in accordance with G.S.89C LHD USE ONLY: Initial submittal of this NOI received: by Date Initials PART 1:Notice of Intent to Construct(NO1)-Please check all that apply n Single System or DD❑ Multiple Systems Existing system is being abandoned and a completely new systemfor new uses is being installed. Q 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.): Jeremy Petty Mailing address: PO Box 1170 City: Newton State: NC Zip: 28658 Telephone number: (828)320-1477 E-mail Address: Jeremy@printimage.com 2. Professional Engineer(PE)name: Michael Lash, PE. License number: NC.#14265 Mailing address: 1104 Cindy Carr Drive City: Matthews State: NC. Zip: 28105 Telephone number: (704) 847-3031 E-mail Address: mikel@lashengineering.com 3. Licensed Soil Scientist(LSS) name:Caroline J. Edwards License number: #1220 Mailing address: 991 Duncan Road City: Rutherford State: NC Zip:28139 Telephone number: (828) 289-0122 E-mail Address: CJEdwards234@gmail.com 4. Licensed Geologist(LG)(if applicable) name: N/A License number: Mailing address: City: State: Zip: Telephone number: E-mail Address: 5. On-Site Wastewater Contractor name:Cool Park Pumping-Kelly Isenhour License number: 10991 Mailing address: 1535 Victorian Hills Circle City: Conover State: NC. Zip: 28613 Telephone number: (828) 256-2926 E-mail Address: 4isenhour@gmail.com 6. 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: X❑ PE 0 LSS ❑ LG X❑ On-site Wastewater Contractor RECEIVED NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Raleigh, NC 27609 APR 1 0 2023 MAILING ADDRESS:1642 Mail Service Center, Raleigh, NC 27699-1642 www,ncdhhs.gov • TEL:919-707-5874 • FAX:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Environmental Health • Engineer Option Permit Common Form LHD Reference: 7. Property location (physical address,tax parcel identification number or subdivision lot, block number of the property to be permitted): 6639 Dorsett Lane Conover County Name: Catawba 8. Type of facility: ❑X Place of residence No. Bedrooms: 3 No.Occupants:6 ❑ Place of business Basis for flow calculation: 5bedrooms =600gpd ❑ Place of public assembly Basis for flow calculation: 9. Factors that would affect the wastewater load: Standard Residential Wastewater 10. Type and location of proposed wastewater system: Septic Tank to AquaSafe aerobic unit to Chamber disposal Type Vc. 11. Design wastewater flow: 600 gpd(For flow>3,000 gpd and industrial process,duplicate plans shall be sent to the State.) Design wastewater strength: ❑X domestic ❑high strength ❑ industrial process 12. A plat as defined in G.S. 130A-334(7a)is attached: X❑Yes ❑No 13. 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 X❑ No 14. 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 15. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG is attached ❑Yes X❑ NA 16. Proposed landscape,site, drainage,or soil modifications are attached: X❑Yes ❑ NA Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C Michael Lash, PE. hereby attest that the information required to be included with Registered Professional Engineer(Print Name) this Notice of Intent to Construct is accurate and complete to the best of my knowledge and that the proposed system shall applicable f I,State,and local laws,regulations,rules, and ordinances in accordance with G.S. 130A (6). j ,•►,,•I ••.., ��� `0 N` CAI '••. •, Sign ure of Licensed r. nal Engineer .Z Q v' mate f. SEALS-J=�3 14265 ,3 ciNCE?•••0/ DHHS/EHS/OSWP—EOP COMMON FORM Updated February 2022 Page 1 of 6 Engineer Option Permit Common Form LHD Reference: This section is for Owner use to either designate PE as their legal representative or to self-submit the NOI. Designation of Registered Professional Engineer as legal representative of Owner for this Notice of Intent: --Se,r"eru, i gL1 hereby designate Michel Lash. PE. Print Nam of Owner Print Name of Registered Professional Engineer as my legal re esentative for ose of this Notice of Intent pursuant to G.S. 130A-336.1. {ter pur /2-4 /ZZ— Signature of Owner Date Owner self-submittal of NM: hereby submit this NOI prepared by Print Name of Owner Print Nome of Licensed PE pursuant to G.S. 130A-336.1. Signature of Owner Dote 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 Engineer Option Permit[G.S. 130A- 336.1(f)] RIGHT OF ENTRY: The submittal of this Notice of Intent to Construct grants right of entry to the Local Health Department and the State to the referenced property. ISSUANCE OF BUILDING PERMIT: Once the LHO deems that the Notice of Intent to Construct is complete via signature in the section below, the owner may apply to the local permitting agency for a permit for electrical, plumbing,heating,air conditioning or other construction,location,or relocation activity under any provision of general or special law pursuant to G.S. 130A-338. DHHS/EHS/OSWP-EOP COMMON FORM Updated April 2022 Page 3 of 6 Engineer Option Permit Common Form LHD Reference: This section for Local Health Department use only. PART 2: LHD Completeness Review of the Notice of Intent to Construct "(c)Completeness Review for Notice of Intent to Construct.—The local health department shall determine whether a notice of intent to construct,as required pursuant subsection(b)of this section,is complete within 15 business days after the local health department receives 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 department shall notify the owner or the professional engineer of the components needed to complete the notice. The owner or professional engineer may submit additional information to the department to cure the deficiencies in the notice. The local health department shall make a final determination as to whether the notice of intent to construct is complete within 10 business days after the department receives the additional information from the owner or professional engineer. if the department fails to act within any time period set out in this subsection, the owner or professional engineer may treat the failure to act as a determination of completeness." The review for completeness of this Notice of Intent was conducted in accordance with G.S. 130A-336.1(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 design PE and the Owner on Dote via with directions to re-submit missing items using Page 5 of this form. Email,FAX,USPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date ❑ COMPLETE(If box is checked,information in this section is required.) Based upon review of information submitted in Part 1 of this form,this NOI is deemed COMPLETE. Copies of this signed form were sent to the design PE and the Owner on via Date Email,FAX,LISPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via Date Email,FAX,USPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date DHHS/EHS/DSWP—EOP COMMON FORM Updated February 2022 Page 4 of 6 Engineer Option Permit Common Form LHD Reference:_ Re-submittal of NOI with missing items included This Section is for use by the owner or PE to submit items noted as missing during LHD Completeness Review above. Resubmittals must be accompanied by a cover letter from the PE. LHD USE ONLY: This NOI resubmittal received: by Date Initials Item#from initial NOI Resubmittal description Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C I, hereby attest that the information re-submitted for this Notice of Licensed Professional Engineer(Print Name) 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 in accordance with G.S. 130A-336- .1(e)(6). Signature of Licensed Professional Engineer Date 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- 336.1(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 design PE 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 PE and the Owner on via Date Email,FAX,USPS,Hand-delivered A complete copy of this form with tracking information was sent to the State: via Date Email,FAX,USPS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date DHHS/EHS/OSWP—EOP COMMON FORM Updated February 1021 Page 5 of 6 Engineer Option Permit Common Form LHD Reference: PART 3: Authorization to Operate(ATO) Except for date received,the Section below is to be completed by the Owner or the PE. 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 EOP: 1. Signed and sealed copy of the Engineer's report that includes the information in G.S. 130A-336.1(k)(1)and 15A NCAC 18A.1971(f) ❑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 PE ❑Yes ❑ No 5. Owner meets requirements of ownership or control of the system per 15A NCAC 18A.1938(j) ❑Yes ❑ No 6. Easement, right of way,or encroachment agreement required per 15A NCAC 18A.1938(j) ❑Yes ❑ No 7. Multi-party agreements required,as applicable, pursuant to 15A NCAC 18A. .1937(h) ❑Yes ❑ No If yes,agreements filed in County Register of Deeds in Deed Book Page Attestation by the Owner or the PE for Authorization to Operate I, hereby attest that all items indicated above have been provided to the Print name of Owner or Professional Engineer County LHD and the system shall meet applicable federal,State,and local laws, regulations, rules and ordinances in accordance with G.S. 130A-336-.1(e)(6). Signature of Owner or Professional Engineer Date This section for LHD Use Only. LHD Review of required information for the ATO ❑ INCOMPLETE Based upon review of information submitted in the Section above,the following items are missing from the information required for an Authorization to Operate for an EOP: • Copies of this signed form were sent to the design PE and the Owner on via Date Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ❑ COMPLETE Based upon review of information submitted in the Section above,this Authorization to Operate is hereby issued in accordance with G.S. 130A-336.1(m). A copy of this complete NOl/ATO with tracking information was sent to the State on via . Dote Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ISSUANCE OF CERTIFICATE OF OCCUPANCY: Once the 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—EOP COMMON FORM Updated February 2022 Page 6 of 6 TRANSMITTAL Date: April 5, 2023 LASH ENGINEERING Attention of: Meghan McBride Consulting Engineers Civil,Planning,Wastewater 1104 Cindy Carr Dr. Company: Matthews,NC 28105 p y Phone: 704-847-3031 Catawba County Environmental Health From: Michael Lash, PE Project: Petty 5-bdrm Wastewater EOP Special Instructions: Please find attached are a set of the sealed plans with the completed EOP Common Form attached with the submittal package (bound copy) enclosed for the EOP-NOI. Copies of the EOP form, insurance certificates, Soils Report and the Operation & Maintenance Reports are all in the submittal bound package (See the Table of Contents). Please ca 847-3031, if you have any questions or need additional information. Tha Mi ael ash, P.E. I II*) I.q( 1'7 11171.4 / . --- -- *Ili 11 tb %dlii4: I SITE c, / o r+r K!i i f (h l Ih DORSEIT CR. > RIVER BEND RD. I z �o c, IOf A SPRINGS RD. 4�. S I VICINITY SKETCH N.T.S. I ( (I( / / ( ' ( -( 7. ( ( ( I ,II /( I I 1 3�BEi'O' 1 , 1 I I I I I I 1 t I HOSEI 1 I III \ ` 'i , \ I \ \ \--,..:;Y e FC r) 3.. \ \ \ R\ \ \ \ \\\\�\' ;1.t`` \ 1 ii� \\ \\\ \ \ \` \ \\\\\\\\\\ 1� 4,. u \ \\ \ \ \ se AWT \ \\\ •�',;* OgMB 10MYp \ \ \ \ \ \ \• I ... \ .',..: ; 1 I JEREMY PETTY WASTEWATER FACILITY Wastewater Facilities for: I JeremyJEREMYPe 6639 DorsettPETTY Circle Catawba County Conover,NC. 28613 Tax Parcel ID.-374501498690 I (828)320-1477 Jeremyeprintlmage.com Scale:1'=200' Date 3-03-2023 1 1 1 Lash Engineering, Inc. Civil/Consulting/Wastewater/Planning ' 1104 Cindy Carr Drive Matthews,NC 28105 Phone:704-847-3031 ' mikel)LashEngineering.com Lash Engineering, Inc. ' Petty 5-bedroom Wastewater Facility Septic Tank-Aerobic Unit-Chamber Wastewater System Submittal 3-23-23 1 Table of Contents ' EOP Submittal 1. Title Sheet 2. Table of Contents ' 3. Engineers Option Permit - Common Form 4. Survey 5. GIS Owners Information ' 6. Engineers Project Summary 7. Earthwise Designs Soils Reports Lash Engineering— Omissions & Errors t 8. Lash Engineering— Omissions & Errors 9. Earthwise Designs — Omissions & Errors 10.Installer General Liability (Installer) ' 11. Owner Wastewater Operation & Maintenance Manual 1 1 1 1 I cur I s STA7F> ,.•;''''',• tioo ROY COOPER •Governor 7r ��' NC DEPARTMENT OF KODY H. KINSLEY•Secretary I ;�- - i HEALTH AND HELEN WOLSTENHOLME• Interim Deputy Secretary for Health _� HUMAN SERVICES I a • MARK T.BENTON •Assistant Secretary for Public Health Division of Public Health Petty 5 bedroom-Wastewater System I COMMON FORM FOR ENGINEERED OPTION PERMIT See Instructions for Use in Appendix A IExcept for"Date received",this Section to be completed by the Professional Engineer licensed in accordance with G.S.89C LHD USE ONLY: Initial submittal of this NOI received: by IDate Initials PART 1:Notice of Intent to Construct(NOI)-Please check all that apply Il Single System or D❑ Multiple Systems Existing system is being abandoned and a completely new system for new uses is being installed. ❑x New ❑ Expansion ❑ Relocation of all or part of the Existing System ❑ Relocation of Repair Area I ❑ Repair—LHD Permit Number ❑ Repair—EOP/LSSCOVID 19/AOWE Permit Number 1. Facility Owner's name: (Owner,Company Name, Utility, Partnership, Individual,etc.): IJeremy Petty Mailing address: PO Box 1170 City: Newton State: NC Zip: 28658 I Telephone number: (828)320-1477 E-mail Address: Jeremy@printimage.com 2. Professional Engineer(PE)name: Michael Lash, PE. License number: NC.#14265 I Mailing address: 1104 Cindy Carr Drive City: Matthews State: NC. Zip: 28105 Telephone number: (704)847-3031 E-mail Address: mike)@lashengineering.com 3. Licensed Soil Scientist(LSS) name:Caroline J. Edwards License number: #1220 IMailing address: 991 Duncan Road City: Rutherford State: NC Zip: 28139 Telephone number: (828)289-0122 E-mail Address: CJEdwards234@gmail.com I4. Licensed Geologist(LG) (if applicable)name: N/A License number: Mailing address: City: State: Zip: I Telephone number: E-mail Address: 5, On-Site Wastewater Contractor name:Cool Park Pumping Kelly Isenhour License number: 10991 III Mailingaddress: 1535 Victorian Hills Circle City: NC. Zip: 28613 Telephone number: (828)256 2926 E-mail Address State:4isenhour@gmail.com 6. Proof of Errors and Omissions or other appropriate liability insurance for the following persons is attached Ithat includes the name of the insurer,name of the insured and the effective dates of coverage: X❑ PE X❑ LSS ❑ LG X❑ On-site Wastewater Contractor I NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH I LOCATION:5605 Six Forks Road, Raleigh, NC 27609 MAILING ADDREss:1642 Mail Service Center,Raleigh,NC 27699-1642 www.ncdhhs.gov • TEL:919-707-5874 • FAX:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER 1 I Engineer Option Permit Common Form LHD Reference: I 7. Property location (physical address,tax parcel identification number or subdivision lot,block number of the Iproperty to be permitted): 6639 Dorsett Lane Conover County Name: Catawba 8. Type of facility: ❑X Place of residence No. Bedrooms: 3 No.Occupants:6 I ❑ Place of business Basis for flow calculation: 5 bedrooms =600gpd ❑ Place of public assembly Basis for flow calculation: I9. Factors that would affect the wastewater load: Standard Residential Wastewater I 10, Type and location of proposed wastewater system: Septic Tank to AquaSafe aerobic unit to Chamber disposal Type Vc. 11. Design wastewater flow: 600 gpd(For flow>3,000 gpd and industrial process,duplicate plans shall be sent to the State.) IDesign wastewater strength: ❑X domestic ❑ high strength ❑ industrial process 12. A plat as defined in G.S. 130A-334(7a)is attached: Q Yes ❑ No 111 13. 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 I complies with 15A NCAC 18A.1950: ®Yes ❑ No This is a saprolite system. ❑Yes X❑ No 14. Evaluation(s)of soil conditions and site features in accordance with G.S. 130A-335(a1)signed and sealed by a ILSS is attached: ®Yes ❑ No 15. Evaluation of geologic and hydrogeologic conditions signed and sealed by a LG is attached ❑Yes X❑ NA I16. Proposed landscape,site, drainage,or soil modifications are attached: X❑Yes ❑ NA Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C ' I Michael Lash, PE. hereby attest that the information required to be included with Registered Professional Engineer(Print Name) I this Notice of Intent to Construct is accurate and complete to the best of my knowledge and that the proposed system shall applicable f ,opal,State,and local laws, regulations,rules,and ordinances in accordance with G.S. 130A 33 (6) •�...............�� CA 1 ' �-� ©: ot~ssip .. ' Sign ure of Licensed r es ' nal Engineer ,.; Q 1'y'• v mate :::SEAL = =�3 14265 il I DHHS/EHS/OSWP—EOP COMMON FORM Updated February 2022 Page 2 of 6 Engineer Option Permit Common Form LHD Reference: This section is for Owner use to either designate PE as their legal representative or to self-submit the NOI. Designation of Registered Professional Engineer as legal representative of Owner for this Notice of Intent: I, ' Tc t .i'./ prilt, hereby designate Michel Lash, PE. Print Name of Owner I Print Name of Registered Professional Engineer as my legal re sentative for pur ose of this Notice of Intent pursuant to G.S. 130A-336.1. rte g12-i/Z.2_ Signature of Owner Date Owner self-submittal of NOI: I, hereby submit this NOI prepared by Print Name of Owner Print Name of Licensed PE pursuant to G.S. 130A-336.1. Signature of Owner Dote • 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 Engineer Option Permit(G.S. 130A- 336.1(f)] • RIGHT OF ENTRY: The submittal of this Notice of Intent to Construct grants right of entry to the Local Health Department and the State to the referenced property. ISSUANCE OF BUILDING PERMIT: Once the LHD deems that the Notice of Intent to Construct is complete via signature in the section below, the owner may apply to the local permitting agency for a permit for electrical, plumbing,heating,air conditioning or other construction,location,or relocation activity under any provision of general or special law pursuant to G.S. 130A-338. i 1 11 DHHS/EHS/OSWP—COP COMMON FORM Updated April 2022 Page 3 of 6 I Engineer Option Permit Common Form LHD Reference: This section for Local Health Department use only. ' PART 2: LHD Completeness Review of the Notice of Intent to Construct "(c)Completeness Review for Notice of intent to Construct.—The local health department shall determine whether a notice of intent to construct,as required pursuant subsection(b)of this section,is complete within 15 business days after the local health department receives 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 department shall notify the owner or the professional engineer of the components needed to complete the notice. The owner or professional engineer may submit additional information to the deportment to cure the deficiencies in the notice. The local health department shall make a final determination as to whether the notice of intent to construct is complete within 10 business days after the department receives the additional information from the owner or professional engineer. If the department fails to act within any time period set out in this subsection, the owner or professional engineer may treat the failure to act as a determination of completeness." ' The review for completeness of this Notice of Intent was conducted in accordance with G.S. 130A-336.1(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 design PE and the Owner on Date ' via with directions to re submit missing items using Page 5 of this form. Email,FAX,USPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date ' ❑ COMPLETE (If box is checked, information in this section is required.) Based upon review of information submitted in Part 1 of this form,this NOI is deemed COMPLETE. Copies of this signed form were sent to the design PE and the Owner on via Date Email,FAX,USPS,hand-delivered A copy of this NOI and tracking information was sent to the State on via Date Email,FAX,USPS,hand-delivered Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date 1 I r DHHS/EHS/OSWP—EOP COMMON FORM Updated February 2022 Page 4 of 6 I Engineer Option Permit Common Form LHD Reference: ' Re-submittal of NOI with missing items included This Section Is for use by the owner or PE to submit items noted as missing during LHD Completeness Review above. Resubmittals must be accompanied by a cover letter from the PE. LHD USE ONLY: This NOI resubmittal received: by Date Initials Item#from initial NO1 Resubmittal description ' Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C I, hereby attest that the information re-submitted for this Notice of Licensed Professional Engineer(Print Name) 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 in accordance with G.S. 130A-336- .1(e)(6). i Signature of Licensed Professional Engineer Date 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- 336.1(c). This NOI is determined to be: D 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 design PE and the Owner on via Date Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ' ❑ COMPLETE Based upon review of information submitted in the RESUBMITTAL above in addition to information provided in Part 1 of this form,this NOI is deemed complete. Copies of this signed form were sent to the PE and the Owner on via Date Email,FAX,USPS,Hand-delivered A complete copy of this form with tracking information was sent to the State: via Date Email,FAX,USPS,hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date DHHS/EHS/OSWP—EOP COMMON FORM Updated February 2022 Page 5 of 6 I Engineer Option Permit Common Form LHD Reference: IPART 3: Authorization to Operate(ATO) I Except for date received,the Section below Is to be completed by the Owner or the PE. LHD USE ONLY: Initial submittal of request for ATO received: by I Date Initials Date of Post-construction Conference: The following items are included in this submittal for an Authorization to Operate under an EOP: Signed and sealed copy of the Engineer's report that includes the information inI i. G.S. 130A-336.1(k)(1)and 15A NCAC 18A.1971(f) El Yes El No 2. Operation and management program ❑Yes ❑ No 3. Fee (as applicable) ❑Yes ❑ No I 4. Notarized letter documenting Owner's acceptance of the system from the PE ❑Yes Li No 5. Owner meets requirements of ownership or control of the system per 15A NCAC 18A.1938(j) ❑Yes ❑ No I 6. Easement, right of way,or encroachment agreement required per 15A NCAC 18A.1938(j) ❑Yes ❑ No 7. Multi-party agreements required, as applicable, pursuant to 1SA NCAC 18A. .1937(h) ❑Yes ❑ No If yes,agreements filed in_ County Register of Deeds in Deed Book Page IAttestation by the Owner or the PE for Authorization to Operate I, hereby attest that all items indicated above have been provided to the I Print name of Owner or Professional Engineer County LHD and the system shall meet applicable federal,State, and local laws, regulations, rules and ordinances in accordance with G.S. 130A-336-.1(e)(6). ISignature of Owner or Professional Engineer Date I This section for LHD Use Only. ❑ INCOMPLETE I 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 EOP: • I Copies of this signed form were sent to the design PE and the Owner on via Date Email,FAX,USPS,Hand-delivered IPrint name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date ❑ COMPLETE Based upon review of information submitted in the Section above,this Authorization to Operate is hereby issued Iin accordance with G.S. 130A-336.1(m). A copy of this complete NOI/ATO with tracking information was sent to the State on via . IDate Email,FAX,USPS,Hand-delivered Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date IISSUANCE 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. I II DHHS/EH5/OSWP—EOP COMMON FORM Updated February 2022 Page 6 of 6 IBOREN,No FOX SURVEYING COMPANY, P.C. - - `.eno • .PETTY 770 N.G.HIGHWAY 16 SOUTH "�•p'°'c am CLINES raTASEIA I k.I"13-15-]]I ioi I 40 P .BOX 637 LAKE HICKORY Tw""� _ I TAYLORSVILLE,N.G.28681 PIN 7T16-0149-0690 OFFICE.828-695-1902 FAX.828-685-1912 �% -a�r� T LOT v ��_D B-MAIL,wFox•foxFlarveymgsom %'°� IM-]]I I'•20, IV 'I 9°C27221A' BUSINESS LICENSE KG-14402 "'0'Oa as°'� / I a 210 /TF Q2QQ��1 "ea.rm l4 iro '°a Zo LANe HICKORY xme' Y� / • LDean 1 F /_ PLAT.1I-04 if ilk ir 1,10 f 1 � \\. y 2.sos ACRES I 1 11 T_ ` �� \ 0 I 4 / � . 11*1 di 1 be o xai Oa>/ / $S 4 / /P F / / ' /9 / / LAK■ HICKORY / / xmr w• a I [Ara re.. /IP/ 3„,„,:....„, ,,:,...„..„..,„..,.. .7sF.1r w-gr,;,,: ,.: i\ / 1 aaRE e T v4e AT.b.F PL 1 \irr mom 4 �1 I - ' PALPILAA0 MKS-4O "mow♦ .war • R� a . I LEAOr B.LAK •p r MAR PPM y.•.a,�wP Hl09 PAMPA.2 1i rrew� m PLAT.444 g WO _ _ _ LOT IT $ aZ.oen ws.ra im• I I 0' IV 20' wu "0' LOCATION HAP NO SCALE) 20' SITE SPECIAL NOTES I •ra a�m r w •MA raw, f ' ••MM..OP WNW LIMO NW TERM MOP MEM OP ORM OPPAPOR IOW nem Ma MO PLOS.ROMP.PROOKTP•mere..ew w WOO ow..r.waaerr. iw. I more swarm.,r n rm.m,+,e (0, r•oeuc.,rL wo•unerw ewe Parcel Report http://gis.catawbacountync.gov/nomap/parcel_report.php?key=37450I4... 1 IParcel Report - Catawba County NC Parcel Information: Owner Information: I Parcel ID: 374501498690 Owner: PETTY JEREMY LANCE Parcel Address: 6639 DORSETT LN Owner2: SPENCER SHERRI DENEAL City: CONOVER, 28613 Address: PO BOX 1149 I LRK(REID): 26494 Address2: Deed Book/Page: 3511/1628 City: NEWTON Subdivision: CRESCENT LAND AND TIMBER State/Zip: NC 28658-1149 I COMPA Lots/Block: 9/ School Information: School District: COUNTY Last Sale: $260,000 on 2002-06-12 I Plat Book/Page: 16/98 Elementary School: OXFORD Middle School: RIVER BEND Legal: LOT 9 PLAT 16-98 Calculated Acreage: 2.380 High School: BUNKER HILL I Tax Map: 0300 24009 School Map Township: CLINES I State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY ICounty Fire District: OXFORD Zoningl: R-40 Building(s)Value: $32,900 Zoning2: I Land Value: $196,900 Zoning3: Assessed Total Value: $229,800 Zoning Overlay: CRC-O,FPM-O Year Built/Remodeled: / Small Area: ST STEPHENS/OXFORD I Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers I Miscellaneous: Firm Panel Date: 2007-12-18 Building Permit Address Search for this parcel. Firm Panel#: 3710374500K If available, Building Permits for this parcel. Septic 2010 Census Block: 1006 I links are not permits. 2010 Census Tract: 010201 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. I Building Details WaterShed: Voter Precinct: P33/Voting Map I Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report IThis map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for I any and all damages,loss or liability,whether direct;indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2021, Catawba County Government, North Carolina.All rights reserved. I I 1 of 1 4/12/2021,3:15 PM 1 Lash Engineering, Inc. Civil/Consulting/Wastewater/Planning ' 1104 Cindy Carr Drive Matthews,NC 28105 Phone:704-847-3031 I mikek LashEngineering.com Lash Engineering, Inc. Project Summary for: ' Petty 5-bedroom Wastewater Facility 6639 Dorsett Lane ' Catawba County, NC. ' The proposed wastewater facilities are shown in the plan. A Sub-Surface Standard Chamber Wastewater Disposal system is proposed because of some good soils found on the site. The ' Soils investigation was conducted by Caroline Edwards,LSS. Their report is included in this submittal. The primary soil disposal area has an associated treatment level of NSF 40 with an LTAR of 0.5. The repair area has an associated treatment level of NSF 40 with an LTAR of ' 0.40. The Septic tank collects effluent from the house and shed,this then flows to the pre-treat tank that flows over into a common chamber drain field through a Distribution Box(D-Box) with Speed Levelers. The system will be gravity through-out the PreTreat to the distribution box to feed the 3 runs of chambers. The proposed PreTreat units are made of fiberglass at the factory, assembled at the factory and ' shipped to the site ready to be installed. Floatation of the tanks is a factor as the units are being installed well above the lake but could have saturated soils in the lower parts of the tanks. Once the treated effluent has been processed,the effluent is discharged by gravity to the chamber ' disposal field. The system utilizes a Control Panel for the PreTreat unit. The panel is housed within a NEMA 4X enclosure that is set up for the internal monitoring of the system. ' Site Specific Information The design flow as reflected on the site plan for the homes is based on 120 gpd per bedroom. 1 ' home at 5-bdrms. 5 bdrms @ 120 gpd = 600 gpd design flow. Based on an in-field soils analysis performed by Caroline Edwards, LSS, the design LTAR is 0.5, and utilizing the 25% reduction from the chambers, installing at 9'o.c. (because of the topography) with a saturation trench width ' of 3', requires a need for 200' of chambers. Based on the site's topography, available space, required setbacks, and system performance, the system is designed with 3 equal length lines with an average of approximately 68' each. The first two lines are 68' the third line consist of two joined segments that total 68'. The chamber lines are fed from a distribution box. 1 (Pre-treatreviewed and a roved The major system components unit, chambers, etc.) have beenpp for this application by the State of North Carolina, and many systems of this type have already been installed and certified. The system shall be installed by a certified contractor, and the entire system shall be certified as complete and operational by Lash Engineering, Inc. The septic, ' pump, and chamber system must be inspected once a year to check for leaks, make sure the control panel and the alarms are working, run the system through a manual cycle, and verify valves and filters are working properly. The chamber disposal field should be checked ' thoroughly for leaks, ponding, or erosion, which could indicate a problem with the disposal system. The Engineer has provided the Owner a Check Sheet for evaluating the system on a monthly basis. Any issues should be brought to the attention of the Operator. ' Certification & Final: Lash Engineering, Inc., in conjunction with Tim Barbee (operator), and the installer will provide ' a final certification packet including a letter stating that the system was installed properly, and that all connections and programming have been checked. If significant changes have occurred during the construction process, then a final "As-Built" drawing showing those changes made due to site-specific conditions will be supplied to the Owner along with the Certification. Please contact Lash Engineering,Inc. ifyou have anyquestions or concerns at e e g g, 704-847-3031. 1 1 1 I • Earthwise Designs Soils& Land Evaluation 3/20/2023 Revision Revision: ' Site and Soil Evaluation and System Design Five Bedroom Wastewater System ' 6639 Dorsett Lane, Conover NC Parcel #374501498690 Catawba County Applicant: Jeremy Petty This report is submitted under the rule: ' 15A NCAC 18A .1971 ENGINEERED OPTION PERMIT PART 1: Submittal of Notice of Intent to Construct(NOI) ' Earthwise Designs has performed a Soils and Site Evaluation on the lot referenced above. We have found the area Provisionally Suitable for initial and repair systems. ' Details are discussed below and in the attached documents. This area had previously been approved for this system type under SL 2018-114 Section 11.(c). ' re Project: This report is in and to a current residential structure at the address P regard ' above. It will be removed and the two new structures requires a new septic system, initial and repair; and will utilize an Aerobic Pretreatment system. ' Soils and Site Evaluation: Soil Boring 1: Soil depth 34"; Usable saprolite to 45"; Provisionally Suitable. ' Sheets 1 and 2 attached, 5 borings; Site Classification is Suitable. See attached two soils sheets. ' Fixed Points are measured to the SW house corner as shown. Initial and Repair Systems will be Aerobic Pretreatment to IIIg. The D box has 3 active outlets leading to 3 IIIg (Infiltrator) lines that total 68' each. ' The uppermost/first line is 68'; as is the second line also 68'. The third line is 50' with a hump-over to a line of 18'. • Gravity flow from Dbox: LTAR of 0.5 gal/sq.ft./day:IIIg Chambers. ' • Depth for Trench Bottom: 22 inches due to slope 10-12%. 1 I 1 ' • Drain lines (Initial and Repair) can be installed where shown in the attached sketch; the Initial field has been laid out. The Repair area will be uphill of the structures and will be pumped, to a D box, then gravity flow by 3 outlets to 3 lines of 68' each, IMIg. • Repair field: Aerobic Pretreatment, Pump system; ' LTAR of 0.5 gallsq.ft./day. • Depth for Trench Bottom: 20 inches due to slope 6%. t Other site-specific requirements: 1. The owner must insure that the field will be maintained to reduce erosion, shed water, maintain a vegetative cover and not be disturbed; and that the System and ' Drain Field will be operated properly with standard maintenance according to manufacturers' components' guidelines. 2. Earthwise Designs makes no guarantees regarding installation, maintenance and operations. System design recommendations may not be accurate if site ' alterations occur prior to permitting and installation. ' Please contact me for further information if needed. Sincerely, - ' Caroline J. Edwards.' NC Licensed Soil Scientist#1220 ' SC Professional Soil Classifier#117 NC Land Application of Bio-Solids#10006173 Attachments: Site Map -2 p. Soils Field Sheets — 2 p. EARTHWISE DESIGNS 991 Duncan Rd Ri.irfirtfordrun NC 28139 Cre 1wards2340)cJir I c m e,289--C 12 �&I I I REVISED 3/20/23 Initial System: Pretreated I Supplemental Site Map: to IIIg 3 lines@68' or Initial Septic System Layout equivalent. D = D box; p y y ST= septic tank I 6639 Dorsett Ln See eng. plan for details. ISoil PIT 1; Soils Boring locations 2- 5 I IGraphic Scale I I 50ft. I I i Lake Hickory 3 Bedrm. House I Initial Field 2 Building Envelope 68' il— 1 % t 1 �'' 50, 1 \ DST I 18' Setbac to a 3 Lakeig4* ---.. c oa 55 Hickory A°�e ��. I 35' min. Lco 2 bedroo • cture; �(;) IPretreatment to IIIg -y I IEarth wise Designs Soils & Land Evaluation 828)289-0122 I Site Map: ' 5 Bedrooms Repair system: Repair Septic Pretreatment and Pump to N System Layout IIIg 3lines@68' 6639 Dorsett Ln or equivalent ' O 1 Soils Boring locations 1- 5 1 ' For Initial Field See Attached Site Map Repair:3'x67' to Neighbor's Well caq To 1 1 ' Driveway 1 1 Earthwise Designs 3/20/23 Soils & Land Evaluation r Ir )28 rl 828)289-0122 1 I ;? F F- 1r -I I I i 1 II. i *.' i 4;y 14\ .. Ia 1 t 1 -,,. I 1 1` v /(}�� I Z I i v �`� �p5 �r .-p 1 C� 1 ,d`i I I I "" .A Y I + �', iiii "�� �iI ic ^ 3 w 1 I ` a ► •�;147 ` y �.am . /�' �y , .!.. r4 ,i F..., et. ii.......7 X-'1•_..0 .� �+ Et O 3,. I^Z t :14I 3t. I I .ty IN`� I � I ( to n a E. U I /�, O x�+,L 4 f. ` 04 y } I 1 y Ami u Iv ' yl +°.ai I I ( I I,A, ,.. 0 . El o u ----r- il •--1 ' ,, , , _i____ , -. yr f l I ( I I I '` ' �+i-- �- O I ci + f 1` I I / { vlI Ip 1 C '1- I _L_ T �i oi-1,,i,n tIta y 4.-> ;14 w I t I I ! 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I t ,..... ', , \---). 1 II I =ao 3.. at , —•- - tt , 0 _ 41 X \. oL c J I 0 11 70- 1. . . . • -- _ - c., a c''\___1\I a- ________,. 1 - • • I Aco CERTIFICATE OF LIABILITY INSURANCE L.i DATE)MWDD/YYYY) 08/09/2022 I 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. I 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 Janice Adams NAME: Insurance Management Consultants,Inc. PHONE (704)799-1600 g ((,A�!C No,Ext); (A/C,No): P.O.Box 2490 E-mAIL cert@imcipls.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Davidson NC 28036 INSURER : RLI Insurance Company 13056 I INSURED INSURER B: Lash Engineering,Inc. INSURER C: 325 Matthews Mint Hill Road INSURER D: I Suite 201 INSURER E: Matthews NC 28105 INSURER F: COVERAGES CERTIFICATE NUMBER: 2022-2024 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 IINDICATED. 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 SUER POLICY NUMBER POLICY EFF POLICY EXP OMITS LTR INSR WVD (MMIDD/YYYY) (MM/DD/YYYY) I COMMERCIAL GENERAL UABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREM SES Ea occurrence) $ MED EXP(Any one person) $ I PERSONAL&ADVINJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JDECO-T LOC PRODUCTS-COMP/OP AGG $ OTHER: $ I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED - NON-OWNED PROPERTY DAMAGE $ IAUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ I DED RETENTION$ $ WORKERS COMPENSATIONPER AND EMPLOYERS'LIABILITY Y/N STATUTE OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE N!A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability A RDP0047800 08/04/2022 08/04/2024 Per Claim $1,000,000 I Aggregate $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I ICERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN FOR INSURANCE PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i I 9-#V• ©1988-2015 ACORD CORPORATION. All rights reserved. IACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I ------"" ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDlYYYY) ACORD 03/D6/2022 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC TE 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. I 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: I Hiscox Inc. PHONE FAX (A/C.No.Ext►: (888)202-3007 (A/C,No): 520 Madison Avenue EMAIL contact@hiscox.com 32nd Floor ADDRESS: New York,New York 10022 INSURER(S)AFFORDING COVERAGE NAIC fl INSURER A: Hiscox Insurance Company Inc 10200 IINSURED INSURER B: Earthwise Designs INSURER C: 991 Duncan Rd Rutherfordton,NC 28139 INSURER D: I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IINDICATED. 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 ADDL SUBR POLICY EFF POUCY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD(YYYY) (MM/DDIYYYYL LIMITS I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCURDAMAGE TO PREMISES(EaENTED occurrence) $ MED EXP(Any one person) $ I PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY accident)DAMAGEI $ HIRED AUTOS ^ AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ST STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability P100.217.339.8 04/20/2022 04/20/2023 Each Claim:$2,000,000 I Aggregate:$2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) I ICERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE If ®1988-2015 ACORD CORPORATION. All rights reserved. IACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD INORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. I CERTIFICATE OF LIABILITY INSURANCE 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 U 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 pollcy(Ies)must 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 Ithe certificate holder in lieu of such endorsement(s). INSURED COOL PARK PUMPING INC CERTIFICATE LASH ENGINEERING NAME AND 1535 VICTORIAN HILLS CIR HOLDER 1104 CINDY CARR DR I ADDRESS CONOVER NC 28613 MATTHEWS NC 28105 ICOVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I 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. X TYPE OF INSURANCE ,,JNSD N/O, POLICY NUMBER (�ICY Y) (�D LIMITS Y) I 1E1 COMMERCIAL GENERAL LIABILITY GL 0471229 11/10/2022 11/10/2023 GENERAL AGGREGATE $1,000,000 -OCCURRENCE PRODUCTS $1,000,000 GEN'L AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $1,000,000 I EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100 000 PREMISES(Ea Occurrence! MED EXP(Any one person) $5,000 ID EACH OCCURRENCE $ BUSINESSOWNERS AGGREGATE $ OMAUTOMOBILE LIABILITY (Each I �SINGLE LIMIT $ ❑ BODILY INJURY(Per parson) $ I El SCHEDULED AUTOS HIREDAUTOS BODILYINJURY(Peraccident) $ NON-OWNED AUTOS ((PROerecc�nOMMGE $ ❑ GARAGE LIABILITY ❑ (Other) EACH OCCURRENCE $ I ❑ EXCESS LIABILITY- OCCURRENCE AGGREGATE $ WC STATUTORY LMTS ' GI WORKERSOYERSNSATION NIAI WC 0247457 11/04/2022 11/04/2023100,000 AND EMPLOYERS'LIABILITY E.L.E.L,EACH ACCIDENT E.L.DISEASE-EA EMPLOYEE $100,000 POLICY APPLIES TO THE WORKERS COMPENSATION LAW IN THE STATE OF NC E.L.DISEASE-POLICY LIMIT $500,000 I OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES: 1 ICANCELLATION , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPRESENTATIVE BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE ZAC SMITH IDELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 03/07/2023 COI 0910 I 1 ■ I WASTEWATER FACILITY , •— Maintenance Plan and Schedule �mie,LASH for Owner U ENGINEERING Wastewater Facility Maintenance Plan - Subsurface Drip Common Maintenance Issues Wastewater Disposal Facilities require plant,soil,and sometimes mulch maintenance to ensure optimal infiltration,storage,and pollutant removal capabilities.Disposal System maintenance requirements are typical landscape care procedures and include: 1. Watering:Watering should not be required after establishment(about 2 to 3 years). However,watering may be required during prolonged dry periods after plants are ' established. 2.Erosion Control: Inspect tubing areas for leaks,ponding,or surface overflow areas ' periodically.Replace soil,plant material,and/or mulch in areas where erosion has occurred. Erosion problems should only occur during extreme weather events. If sediment is deposited in the Disposal area,immediately determine the source,remove excess deposits,and correct the problem. 3.Plant Material: Occasional pruning and/or removal of dead plant material may be necessary. Replace any dead plants or dead areas immediately upon discovery. If specific ' plants consistently have a high mortality rate,alternate similar approved species may be used.Periodic weeding is necessary until groundcover plants are established.Weeding should become less frequent as the design density is accomplished. Plants (grass)should be ' mowed at a height consistent for good growth of cover. The tubing is buried 6"deep. 4.Nutrients and Pesticides: The soils are existing and have not been augmented. Nutrient and pesticide inputs should NOT be required and will degrade the pollutant processing ' capability,as well as contribute to additional pollutant loading to receiving soils or waters. By design,Disposal facilities are typically specified in areas where phosphorous and nitrogen levels are often elevated. Therefore,these should not be limiting nutrients with regard to plant health.If in question,have the soil analyzed for fertility. 6.-Mulch+(if used) Replace mulch annually in Disposal facilities where required and where heavy metal deposition is likely(e.g.,drainage areas that include commercial/industrial uses,parking lots,or roads). In residential or other settings where metal deposition is not a concern,replace or add mulch as needed to maintain a 2 to 4 inch depth at least once every two years. 6.-Soil-mediaF(if used) Soil mixes for Disposal facilities are designed to maintain long-term fertility and pollutant processing capability.Estimates from metal attenuation research ' indicate that metal accumulation should not present a toxicity concern for at least 20 years (USEPA 2000).Further,replacing mulch where heavy metal deposition likely occurs provides an additional factor of safety for prolonged Disposal performance. If in question, have soil analyzed for fertility and pollutant levels. When the filtering capacity diminishes ' substantially (e.g.,when water ponds on the surface for more than 12 hours),remedial actions must be taken.One common problem occurs when the drip tubing becomes t Page 1 of 4 r I clogged. Flushing through the drip tubing is an everyday occurrence and is built into the automatic process of the system. There are 2 filters that are automatically cleaned by the system so clogging should not occur. If the water continues to pond for more than 12 hours,then remove the top few inches of material and inspect the tubing and area for damage. If excessive ponding still occurs,more extensive investigation is required. b-Feueingf (if used)The fence is to protect the Wastewater Facility against outside intrusion. It should be capable of being locked. Public access should never be allowed ' so the locking mechanism should be kept operable. Should the fence become damaged, it is the Owners responsibility to have it fixed or repaired in a timely manner. Once the fence has been repaired and the disposal area secured,the site should be investigated to ensure that the area is complete. For most settings,the fence should be capable of restricting access from rabbits,dogs,opossum,etc. that could cause burrowing and digging issues. t f o Examples When to Perform Maintenance P ' • Fill disposal area shows signs of erosion or excess sediment deposition. • Anywhere that ponding has occurred. • Surface of ground anywhere around the facility is damp on a dry day. • Plants are in need of water or need to be replaced. Important inspection and maintenance procedures: ' -Immediately after the Disposal Area is established,the plants should be watered twice weekly if needed until the plants become established (commonly six weeks). ' —Snow,mulch or any other material should NEVER be piled on the surface of the Disposal Area. —Heavy equipment should NEVER be driven over the Disposal. ' —Special care should be taken to prevent sediment from entering the Disposal Area. After the Disposal Area is established,inspection is required once a month and within 24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal County).Records of inspection and maintenance will be kept in a known set location and will be available upon request. Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately. ' Inspection and Maintenance Provisions for Wastewater Facility Area of Inspection: Potential problems: How to remediate the problem: The entire Wastewater Facility Trash/debris is present. Remove the trash/debris. Areas of bare soil and/or erosive Re-grade the soil if necessary to ' ditches have formed. remove the ditch,and then plant a ground cover and water until it is established. Provide lime and a one-time fertilizer application. Ponding has occurred. Uncover the tubing. Inspect for damage. Call the Operator if repair required. Lash Engineering, Inc. Page 2 of 4 r I I Area of Inspection: Potential problems: How to remediate the problem: Ponding has occurred. Check for ground subsidence.I Call Operator if repair required. Erosion is occurring. Re-grade the swale if necessary and provide erosion control I devices such as reinforced turf matting or rip/rap to avoid future problems with erosion. All diversion ditches should be I free flowing,vegetated,mowed and maintained. The Pretreatment Area Flow is near pretreatment area Re-grade if necessary to route I and/or gullies have formed. all flow away from the pretreatment area. Re-stabilize the area after grading. Sediment has accumulated to a Re-grade if necessary to route I depth greater than three inches. all flow away from the pretreatment area. Re-stabilize the area after grading. I Erosion has occurred. Provide additional erosion protection such as reinforced turf matting or riprap if needed to prevent future erosion Iproblems. Weeds are present. Remove the weeds. The Disposal Area Plants Best professional practices Prune according to best I show that pruning is needed to professional practices. maintain optimal plant health. Plants are dead,diseased or Determine the source of the dying. problem:soils,hydrology, I disease,etc.Remedy the problem and replace plants. Provide a one-time fertilizer I application to establish the ground cover if a soil test indicates it is necessary. Grass/Weeds are high. Grass should be mowed to an I optimum height for the grass species. Care should be taken not to disturb drip tubing(it's I staked to the ground) Tree stakes/wires are present Remove tree stake/wires six months after planting. (which can kill the tree if not removed). I The Disposal Area:soils and Mulch is typically not used with Spot mulch if there are only mulch subsurface drip tubing, random void areas.Replace however if the design whole mulch layer if necessary. constituted using the mulch as Remove the remaining mulch I a cover then: and replace with triple Mulch is breaking down or has shredded hard wood mulch at a floated away. maximum depth of three I inches. Soils and/or mulch are clogged Determine the extent of the with sediment. clogging-remove and replace I Lash Engineering, Inc. Page 3 of 4 I 1 Area of Inspection: Potential problems: How to remediate the problem: ' either just the top layers or the entire media as needed. Dispose of the spoil in an appropriate off-site location. ' Use triple shredded hard wood mulch at a maximum depth of three inches.Search for the source of the sediment and ' remedy the problem if possible. An annual soil test shows that Dolomitic lime shall be applied pH has dropped or heavy as recommended per the soil ' metals have accumulated in the test and toxic soils shall be soil media. removed,disposed of properly and replaced with new planting media. 1 1 1 Lash Engineering, Inc. Page 4 of 4 1 in t ISM '1 - ,�_i$ Ih! hI dtdli i o 1 I i�! k. \ m�W 11- ii a II I 1 C8 i � A 'al ;ibtJ il ! . 4m ggEll' : .L'h • I RV. 1Ia ': , E 1 ., lilqig1 :4.14:...- - .. ;014111!!!! a \ E II P16011, H i I . §Li I- COZ I % c 16u Bg I _ B §v I } E cc I * cc ll 1 kl 11111144"‘ LLII rz ® Z ;di � f 5diL11iiI d a., a s b in 01 N I N QRRA AQ� R^PtI1RR % 8Ht ! h (il + �1iiisjFy p NI .11iJ i'I 1ii!,1,, �__1 n iihil+it�rtg1l1iirli r I IF si, It „ 9'! ,� : '1 / • "i''' d'ir i'_:, iiii -"'i.1mM-. x y_ I , tp lax 1 f .9s II! INA 4:1 100 Io 1 I } � 3V ft r ' ' d ii i6 R SS y31 hi{ +yy i U •,). g i Q Q is I aa,1 ti 00 iJ:Lt ai I G - g, ��p _ g g dt IN tP6 I 1 \i i 0 I� R 1� § Q I 1 gi I 1 • zLI3 Jt I ' z 1 ''''''":"::"'' Milli idri If / li' r4 hi/ 1 1 r • d S O II ——...7.7.,1_. \ . 0„. ...\\ 4 el § � a1bt e ayp 2qgqg ' � Al17, 9!5 ` _ `. 1gl1,,,,,,- -- N T•1 — .od<e x-".I — �y_t'aN I 1Sh Li ... Curg N .'911,1 � Jhill! 9 j�� a10 p iii ar C 8 $ II ffl ., CI ail 3 Q ��_ a ;;�� ��13 w o illy Yam' I 1 /111 1 V A C CATAWBA COUNTY ,� I OOA SOUTHWEST BLVD Ely NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE.828.465.8399 Monday,April 10,2023 18 42 sM www.catawbacountync.gov PAYOR: Petty,Jeremy PAYMENTS TRANSACTION NUMBER: TRC-61587991-10-04-2023 PAYMENT DATE: 04/10/2023 PAYMENT TYPE: Credit Card 303566995 .-.. INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 04-23-421034 110-580200-663000 EOP/AOWE S135.00 TOTAL PAYMENTS: $135.00 RBPR-04-2023-44005 W...�.._..._...,.._..._..._._.V...._.....,.....-..W..Y....._...a � CASE TYPE: Residential Building Plan Review WORK CLASS: Building New SITE ADDRESS: 6647 DORSETT LN,CONOVER NC 28613 Applicant LASH ENGINEERING,1104 CINDY CARR DR,MATTHEWS NC 28105 C:704847303I MIKEL@LASHENGINEERING.COM Owner JEREMY PETTY,PO BOX 1170,NEWTON NC 28658-1149 JEREMY@PRINTIMAGE.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 04/10/2023 16:39 Page 1 of 1