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HomeMy WebLinkAboutEOP-04-2023-194364.tif sz�aFq EOP-04-2023-194364 ROY COOPER•Governor NC DEPARTMENT OF KODY H. KINSLEY•Secretary g HEALTH AND HELEN WOLSTENHOLME• Interim Deputy Secretary for Health "` IA HUMAN SERVICES 4,,,,; 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: I-7-4^ 2 3 by re Dote Initlals PART 1: Notice of Intent to Construct(NOI)-Please check all that apply ®Single System or ❑Multiple Systems ❑New I 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: 28656 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 Teiephone 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 C]LSS ❑ LG Q On-site Wastewater Contractor NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Raleigh,NC 27609 MAILING ADDRESS:1642 Mail Service Center,Raleigh,NC 27699-1642 www.ncdhhs.gov • TEL:919-707-5874 • FAX:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER EOP-04-2023-194364 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: 5 bedrooms =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: ®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 I No 14. Evaluation(s) of soil conditions and site features In accordance with G.S. 130A-335(al)signed and sealed by a LSS Is attached: ®Yes ❑ No 15. Evaluation of geologic and hydrogeologlc 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 Nome) 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)• ,„,,,�.�1/4 C�`„Pb-i. Sign ure of Licensed r es 1 nal Engineer s Z; $ ate ¢SEAL¢= "�3 14265 /� DNHS/EHS/OSWP—EOP COMMON FORM Updated February 2022 Page 2 of 6 EOP-04-2023-194364 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, E re elk Pt ill./ _ hereby designate Michel Lash, PE. Print Nome of Owner t Print Name of Registered Professional Engineer as my legal re esentative for pur ose of this Notice of Intent pursuant to G,S.130Ar-336.1, eel 10' g/,S 2--Q f �Z Signature of Owner Date Owner 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 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)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 WO 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. DNNS/EH5/OS WP—EOP COMMON FORM Updated April 2022 Page 3 of 6 EOP-04-2023-194364 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 in tent 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 • 12 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 t 6 L7 via 11 r'ti I 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 6-) LL dial 'El& Pr Print Name of Authorized Agent of the LHD Signature of Authorized Agent of the LHD Date DHHS/ENS/OSWP—FOP COMMON FORM Updated February 2022 Page 4 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 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 el ash, P.E. I ' *If.-11 NASD ,I . I 11 'Am;/ SITE\ I ~ Ao r�l hh i. IDORSETT CR. a RIVER BEND R0. S- O' C) c) z 2q rn SPRINGS RD. 1 ce • 5 I VICINITY SKETCH N.T.S. I I ( f q(.111 ( I (,_( -r• ` '' 1 11 7 ( (1 I I I I ! ► IIII 1 1 1Kl ��,-0.I ' 1 I k ,� 1• KU1 , , I I 11 ,fig '\ 1 ti l I 11 \ --' # 4 I t \ I ` Nth,\ \ \ IX ��, ��`*\` `�,`��F';:3I', I i \ \ \ --'-',,;y-f4tilj— )*'\ \ \� \ \\1 ,`,` \ ``0\` '� \ \ \\\ ) \ \;I:A. \ \\\ . ..•,,.. \ \.\' : 46ED 416 .,:ki,„\\, 1 I ` 1 . ,` I JEREMY PETTY WASTEWATER FACILITY Wastewater Facilities for: IJEREMY PETTY Jeremy Petty 6639 Dorsett Circle Catawba County Conover,NC. 28613 Tax Parcel ID.-374501498690 I (828) 320-1477 Jeremy@prin11mage.com Scale. 1`=200' Date: 3-03-2023 I I ILash Engineering, Inc. Civil/Consulting/Wastewater/Planning II 104 Cindy Carr Drive Matthews,NC 28105 Phone: 704-847-3031 mikelrLashEngineering.com I Lash Engineering, Inc. I Petty 5-bedroom Wastewater Facility Septic Tank-Aerobic Unit-Chamber Wastewater System Submittal 3-23-23 1 Table of Contents I EOP Submittal 1. Title Sheet 2. Table of Contents I3. Engineers Option Permit - Common Form 4. Survey 5. GIS Owners Information I 6. Engineers Project Summary 7. Earthwise Designs Soils Reports Lash Engineering— Omissions & Errors I 8. Lash Engineering— Omissions & Errors 9. Earthwise Designs— Omissions & Errors 10.Installer General Liability (Installer) I 11. Owner Wastewater Operation & Maintenance Manual I I I I I FOX SURVEYING COMPANY. P.G. .M«N,�,..w... � �' .PeT1TYIW I�r�[ia 1 is TO ND.HI&HHAY 16 SOUTH I PD.BOX 69l LnKe cN+Kr ` P*191 -0I44-6640 TAYLOP5VILLE,H.G.28661 019"1GE b]b-09S-I40Z PAX,D2D-685-1411 �,�L'�� �p�1s-� T 1er1m�T 41 I'' • �2-0 E-MAIL.Womb!oKwrveyk4pp.can %" �!4 7T7-�]I P.2C I T!17!72•6 TCTT2]7A• BUSINESS LICENSE lG-1402 'a:sv\/ / y 'S y.I � LAWS NIGKORY N a. OM L YAUy0 6 fi /V *. Ilk I ' \A 1 II ICI, p,, _.. • • • ^6` f • ' .7. \,_...1 L.,,, lq\, •+woad / - - '\N.\ / I � LAR! XILKORY • }} 1 / lV•v I 1 1 / 11 1 k OMIT LIM iJ 1Y%11-40 1• 11 1 I / IMMO ao..,T..wYM-0 .40 1 a'.-..7 swcww... um,.1.LAIL IS OMMIN. � nwa2 1 MT,1-44 9 a.i�Lr- I �x;�airr�a,...,.��.. 1 w r v w w OrG LGATION MAP n. SCALE) 1 sl� anew ,,rram� : L.w �•a..a.C�'""�••"'" �/r$ B Parcel Report http://gis.catawhacountyne.gov/nomap/parcel_report.php?key 37450 I 4... 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 Legal: LOT 9 PLAT 16-98 Middle School: RIVER BEND Calculated Acreage: 2.380 High School: BUNKER HILL I Tax Map: 0300 24009 School Map Township: CLINES IState Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY ICounty Fire District: OXFORD Zoning1: 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 IParcel 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 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:704-847-3 03 1 ' mikel�a�LashEngineerina.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. r I The major system components (Pre-treat unit, chambers, etc.) have been reviewed and approved ' 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. Engineering, Inc. if have anyquestions or concerns at Please contact Lash you 704-847-3031. I I I 1 1 I I r I • Earthwise r 'use Designs g 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 1 SA .1971 ENGINEERED OPTION PERMIT PART I: 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 2018-1 14 Section l 1.(c), regardtoresidential structure the Project: This report is in a current uc eat address ' 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 Mg (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: LIAR of 0.5 gal/sq.ft./day:Illg Chambers. ' • Depth for Trench Bottom: 22 inches due to slope 10-12%. I I I • 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, IIIg. • Repair field: Aerobic Pretreatment, Pump system; LTAR of 0.5 gal/sq.ft./day. • Depth for Trench Bottom: 20 inches due to slope 6%. 1 1 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. Edward 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 Rr Rtrt`rPrkvj ,r NC 28139 citvadal$2,3441cimarlGc!r) '_8+2&i-O%22cell I I REVISED 3/20/23 Initial System: Pretreated I Supplemental Site Map: to IIIg 3 lines@68' or equivalent. D = D box; Initial Septic System Layout ST= septic tank I 6639 Dorsett Ln See eng. plan for details. ISoil PIT 1; Soils Boring locations 2- 5 I I Graphic Scale I I 50ft. I Lake Hickory 3 Bedrm. House I Initial Field 2 Building Envelope I 68' 1168 1 • I ��. 50' DST I 18' Setbac I to Lake /VA .� 3 oa F.' e�Hickory 0 . 1 35' min. ..`-b 2 bedroo cture; 'i 1 Pretreatment to Illg y I Earthwise Designs .__ Soils & Land Evaluation 828)289-0122 I 1 Site Map: ' 5 Bedrooms Repair system: Repair Septic Pretreatment and Pump to N System Layout lug 3 lines@68' 6639 Dorsett Ln or equivalent ' 1 Soils Boring locations 1- 5 1 ' For Initial Field See Attached Site Map ' Repair:3'x67' ' Neighbor's Well 1 ' Driveway 1 1 1 3/20/23 Earthwise Designs <ln�;rrl r ter, Soils & Land Evalc�at�o�r 828)289-0122 1 I ewe I - r 1-1I---r-- - j • I Iv I 1 t I I I �UI NN `5 i i ; ; x . ..,,,.„.,;.„., ,, ,, 0, i r L Iki y j L t: ?jV I I } ') y ae i,CCy r',I . i p.. 1+n I H bL • Y Q ` yr� 1 i te, ,, ..-r_.7.-- c; Bi;o•it -;8i :21Ii :,6' , , I tlj' ✓ 7r s 14 -,,{ 'l I 1 � 1 1 ti 1�l J l i1. 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V) f ; O ! v , !, �a V i V] Ic I r ' \ I I I 1 q fJ 1 if: �• II t3i �i}N L J ! 1 3 O ! 1 I $ ' I Z I • N I tw UI E. tiIv� -vi1 �--ll 1. 1 r_ 1 I iUj i` E I �'` rnl�'� y I/ It' Y. °° y a ! ._ I I. I 0 r4. C �. 1. I — rJ — 1 • o -J ` _, I I Cu • ir-4 I �C�Im DATE(MNVDDIYYYY) C CERTIFICATE OF LIABILITY INSURANCE DATE ' 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: I Insurance Management Consultants,Inc. IT No,Exti; (704)799-1600 ADDRESS: 1 aAc,No): P.O.Box 2490 (©imcipls.com ADDRESS: cert INSURER'S]AFFORDING COVERAGE NAIC a I Davidson NC 28036 INSURER A RLI Insurance Company 13056 INSURED INSURER B: Lash Engineering.Inc. INSURER C: 325 Matthews Mint Hill Road INSURER 0: ' 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 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 INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS ' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE R.) PREMISES(EaEoccurrence) $ MED EXP(Any one person) $ I —GEN'LAGGREGATE UMITAPPLIES PERK PERSONALEADV INJURY $GENERAL AGGREGATE 5 1 POLICY n JE a n 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 $ J AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ I DED RETENTION $ $ WORKERS COMPENSATION SPR TATUTE OTH- ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE n N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatary M 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 S1.000,000 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 ./ J I - ©1988-2015 ACORD CORPORATION. All rights reserved. I ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD co DATEIMMIDOrYYYYI ACTOR!) CERTIFICATE OF LIABILITY INSURANCE 03/06;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: ' Hiscox Inc. PHONE _ FAX -- ---- (A/C.No.Ext1• (888)202-3007 INC,No): 32n Madison Avenue EMAIL Contact hiscox.com 32nd Floor ADDRESS:. � New York,New York 10022 INSURER(8)AFFORDING COVERAGE NAIC# INSURER : Hiscox Insurance Company Inc 10200 INSURED INSURER 8: Earthwise Designs INSURER C: 991 Duncan Rd Rutherfordton.NC 28139 INSURERD: 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 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 INSR TYPE OF -F6DL SUBR POLICY EFF POUCY EXP LIMITS LTR INSR WVD POLICY NUMBER ,(MMJDDIYYYY) IMM/DD/YYYYI ' 1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE �$ CLAIMS-MADE OCCUR PREMISES(EaDAMAGE TOEoccurrence) $ MED EXP(Any one person) $ I PERSONAL 3ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER JECT GENERAL AGGREGATE $ POLICY PRO- n 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 AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED O I AUTOS (Par accident) - S UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ �I EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DEC RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ERH ANYPROPRIETOR,PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED', N/A I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes.describe under DESCRIPTION OF OPERATIONS below r E.L.DISEASE-POLICY LIMIT $ A Professional Liability P100.217.339.8 04/20/2022 04/20/2023 Each claim 52.000.000 I Aggregate $2,000.000 DESCRIPTION OF OPERATIONS)LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule.may be attached If more space Is requlredl I CERTIFICATE 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 I ..f ©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 I 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(les)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 U the 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 ANO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. x TYPE OF!NSURANCE ,JIDDL1SVER7Min. POLICY NUMBER PCUCY IYPAW❑CYL LIMITSlSO - : Y) I r COMMERCIAL GENERAL LIABILITY GL 0471229 11/10/2022 11/10/2023 GENERAL AGGREGATE — $1,000,000 OCCURRENCE PRODUCTS-COMPJOPS 000,000 AGGREGATE $1, GEN'L AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $1,000,000 I EACH OCCURRENCE $1,000 000 $100, DAMAGE?ORENTEOauu0, 0 PREMISES[Ea OeereI MED EXP(Any one person) $5,000 ID EACH OCCURRENCE $ BUSINESSOWNERS AGGREGATE $ SI AUTOMOBILE LIABILITY CO ch occcidD nIN) GLE LIMIT $ ❑ SCHEDULED AUTOS BODILY INJURY(Per person) $I — ❑ HIRED AUTOS BODILY INJURY(Per,xitlenI) $ El NON OWNED AUTOS (Per a £ $ — ❑ GARAGE LIABILITY ❑ (Other) I ❑ EXCESS LIABILITY— _ EACH OCCURRENCE $ OCCURRENCE AGGREGATE $ •E WORKERSCOIUIPENSATION N/A I WCSTAMORYI.MTS AND EMPLOYERS'LIABILITY POLICY APPLIES TO THE WORKERS WC 0247457 11/04/2022 11/04/2023 E.L.EACH ACCIDENT $100,000 E.L.DISEASE-EA EMPLOYEE $100,000 ; COMPENSATION LAW IN THE STATE OF NC E.L.DISEASE-POLICY LIMIT $500,000 1 ❑ OTHER: I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES: I CANCELLATION 1 i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED I 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 I 2111. 1 WASTEWATER FACILITY 6• � Maintenance Plan and Schedule 51162241 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. S.-Mirlchi(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.-Sol]mcdfai(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 Page 1 of 4 I I 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.-,Few (if used)The fence is to protect the Wastewater Facility against outside 1 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. ' f When to o Examples 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 ' Ponding has occurred. one-time fertilizer application. Uncover the tubing. Inspect for damage. Call the Operator if repair required. I Lash Engineering, Inc. Page 2 of 4 I 1 Area of Inspection: Potential problems: How to remediate the problem: Ponding has occurred. Check for ground subsidence. ' Call Operator if repair required. Erosion is occurring. Re-grade the swale if necessary and provide erosion control ' devices such as reinforced turf matting or rip/rap to avoid future problems with erosion. All diversion ditches should be ' free flowing,vegetated,mowed and maintained. The Pretreatment Area Flow is near pretreatment area Re-grade if necessary to route ' 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 ' depth greater than three inches. all flow away from the pretreatment area. Re-stabilize the area after grading. ' Erosion has occurred. Provide additional erosion protection such as reinforced turf matting or riprap if needed to prevent future erosion ' problems. Weeds are present. Remove the weeds. The Disposal Area Plants Best professional practices Prune according to best ' 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, ' disease,etc.Remedy the problem and replace plants. Provide a one-time fertilizer ' application to establish the ground cover if a soil test indicates it is necessary. Grass/Weeds are high. Grass should be mowed to an ' optimum height for the grass species. Care should be taken not to disturb drip tubing(it's ' 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). ' 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 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 ' inches. Soils and/or mulch are clogged Determine the extent of the with sediment. clogging-remove and replace 1 Lash Engineering, Inc. Page 3 of 4 1 I I _lrea 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. I Use triple shredded hard wood mulch at a maximum depth of three inches.Search for the I 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. I I I I I I I I I I I I Lash Engineering, Inc. 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